I remember it clearly: I was standing in the exam room at my vet’s office. Across the table stood my vet, and between us sat Mick, the cat who had deviled us for the past six months. She was now just a shell of her former Psycho Demon Cat self – and I had just learned she’d lost even more weight in the past week, taking her to a scant 4.8lbs. We’d tried everything. She’d been seen by top internalists at Oklahoma State University. She’d been scoped, prodded, stuck, injected, treated, tested. And nothing was working. I could feel her spine and ribs through her short fur. I looked down at her and realized this was probably the end of the line, and even opened my mouth to ask the vet if that was the case – at the same moment he said, “I want to try one more thing.”
A week later, in my kitchen, I got the phone call. “I have good news and bad news,” the vet said, and I could hear the excitement in his voice. “The good news is, it’s histoplasmosis. The bad news is, it’s histoplasmosis.”
“There is no bad news,” I said.
My vet said he’d already ordered the antifungal drugs, and within 48 hours of being on them, Mick was eating normally and acting more like her Psycho Demon Cat self.
Anyone who owns animals – dogs, cats, snakes (blech!), whatever – knows the utter frustration and fear that comes with knowing your pet isn’t well – but you have NO idea why. You take them to the vet, who will examine them and do diagnostics – blood work, temperature check, etc. Sometimes you get an idea of what’s wrong right away. Sometimes past issues get in the way (one time, my cat Rascal wasn’t feeling well, and given his history of bladder issues, that’s what the vet jumped to – until I went to pick up Rascal and discovered he had a huge abscess on his chest). And sometimes, the vet just doesn’t know.
And sometimes, you get lucky. Because you’ve seen the symptoms before.
That’s was the case a few months ago when one of my barn cats, Nigel, started to drop weight inexplicably. Because it was getting colder, I let him come inside. I also took him to the vet immediately. He had no underlying issues, no real medical past, so we assumed perhaps it was worms (though he’d been wormed just a few months earlier) and he came home. But he kept losing weight. And then he got picky about his food, only licking the gravy from his canned and refusing most things.
And suddenly, I knew what it was. Because I’d seen this before with Mick.
Histoplasmosis is a fungal infection, carried by birds. If a cat ingests it or breathes in the spores, they can’t shed it – it takes root in the body, settling in various areas, including the kidneys, bone marrow, and lungs. There’s some debate about where it’s endemic – it’s actually endemic in the Ohio Valley region – but having had two cats with it, I can tell you that it IS in Kansas, and elsewhere through the Midwest. If there are birds, histoplasmosis is a possibility.
Every cat presents slightly differently, but for me, the major symptoms were:
Weight loss – It’s an insidious weight loss – not sudden, but slow enough that you look at your cat one day and think “Wow, when did you get so skinny?” Because they start to become anorexic (technical term for ‘not eating’) they lose more and more weight. It took Mick about six months to go from a health 10lbs to about 4.8lbs; it took Nigel about three months.
Picky about food – for both Mick and Nigel, the tell-tale sign was this one, and it’s very specific. The cat loses interest in ALL food, but will lick gravy from canned food. You may go through 20 types of canned food to find something they’ll eat once or twice, then abandon. My vet has seen 11 or 12 histo cats in the past ten years, and all of them had this symptom. They eat barely enough to stay alive, and sometimes, not even that much.
Weird blood work results – Mick’s histo settled in her bone marrow and kidneys .Every time we did blood work, the results led us down a different path. Once, her potassium levels were wonky. Another time, it was something else. Every few weeks, it was always something else. With Nigel, we never saw that, but I think that’s because we figured out right away what it was we were dealing with. We didn’t run blood work on him like we had to with Mick while we were trying to diagnose her.
Respiratory issues – with Nigel, the histo settled into his lungs and sinus cavities. He sounded like he had pneumonia, and it affected his sense of smell as well.
Depression – cats with histo feel like hell, all the time. They’re not interested in doing anything. In fact, even when we had Nigel on medicine and I was syringe-feeding him, there were days when I thought we would lose him just to his depression.
I was lucky with both of my cats. I was blessed with a vet who was committed to finding out what was wrong with Mick – she was his first case of histoplasmosis, and it took us about 6 months to diagnose it, from her first symptom of weight loss to the final diagnosis. There’s only one lab in the country that tests for it. Without my vet, I would have lost Mick – and without Mick, I couldn’t have diagnosed Nigel.
It was clear immediately, once I saw Nigel licking gravy and not eating, what we were dealing with, and I instantly called my vet to schedule the histo test. The results came back as I was battling COVID-19. But unlike Mick, Nigel didn’t respond to the usual medication. It made him extremely ill – he became anorexic (more than usual, and I didn’t think that was possible), more depressed, and nauseated. It took a while to figure out that we needed to switch him over to an inject-able antifungal instead. By that time, he was being syringe-fed (a wonderful product from Canada called Critical Care Carnivore saved his life) and weighed just 5.8lbs. There were definitely days when I wondered what I was doing, and it was always in the back of my mind that just because you diagnose something doesn’t mean you can cure it.
Today, almost four months after his first symptoms, Nigel is clear of histoplasmosis. He’s back up to 7.5lbs. He still won’t eat canned food – I think it made him nauseous when he was already ill, and he associates it with that – but he does have a specific dry food he loves. He probably will never again be an outside cat (he won’t drink anything but water from my Brita pitcher now), but he’s happy and healthy, and that’s what matters.
I wanted to share this story because I know there must be dozens – maybe hundreds – of cat owners out there who are struggling, or have struggled, with these symptoms and had no way to know what was causing them. Taken apart, they’re so indistinct that they could indicate almost anything – we tested Mick for FIV, FeLV, even scoped her for ulcers and GI issues and tested her for lymphoma. And unless your vet is familiar with histoplasmosis, they probably won’t even think to test for it. It’s not recognized as endemic in most of the Midwest, after all. Your vet might even point that out. Insist on the test anyway. As I said, only one lab in the country does the test. But a positive result is a POSITIVE result – there are no false positives with this test. And once you know, you can start the treatment. If your cat has a bad reaction to the antifungal, like Nigel did, insist on switching to the injections. They have to be given in subQ fluids – Nigel was on a three-day-a-week schedule – but it’s worth it.
Here’s some good resources and references on histoplasmosis:
https://vcahospitals.com/know-your-pet/histoplasmosis-in-cats
https://news.okstate.edu/articles/communications/2019/recognizing_histoplasmosis_in_pet_dogs_and_cats.html – this is a 2019 article from Oklahoma State University. Good to see them recognizing it as endemic now!
https://www.dvm360.com/view/canine-and-feline-histoplasmosis-review-widespread-fungus – a bit older, but still good information.
Postscript: I have had so many reactions to this post, but I do need to add a postscript, and a warning.
We lost Nigel last fall to kidney failure. As with Mick, the histo had settled into his kidneys, though we didn’t catch it at the time because we were more focused on his lungs. It’s really important to run those blood panels, and if the kidney levels are even a little indicative of kidney disease, to put them on a kidney diet immediately, and check again in a few months to see if they are improving. Mick had a full recovery; she has been in remission for years with no issues. Nigel was not that lucky, and as cats are wont to do, he showed no real symptoms of kidney failure until he was already at Stage 4, with no chance of recovery. I was heartbroken to have brought him through one life-threatening disease, only to lose him to another in just a few short months. Please run the blood panels.
KS Writer & Teacher 
Thanks for sharing your story, and telling it so well. I’m glad your cats have made comebacks. We learned about histoplasmosis this past year quite by accident as you did. The only reason we got lucky with a reasonably quick diagnosis is that our girl developed a lump on her spine, and our vet had the presence of mind to get some fluid on a slide and send it to the lab. The vet had never seen it before – we’re in PA where it just doesn’t happen. Our girl has been on Itrafungol 8 months and just had a clean urine test a month ago, so we have stopped it, but will be re-checking at 3 and 6 months to be sure it’s gone.
So where did she get it? She’s an indoor cat with access to a fenced in patio (without much in the way of birds, nor bats). My guess: Remember back when terrariums were cool? My mom had one in a huge glass bottle (the size of your average lunchroom water bottle). When the plants eventually croaked, she stuck it in the basement, probably figuring that someday she’d re-use that bottle. It sat there with the cork in it for literally decades. At some point my husband, who didn’t know what it was, opened the bottle and shook out some of the soil to see what it was. He cleaned it up, but I think the spores came from there. It also makes sense because the cat got sick not long after, AND where my husband did the investigation was literally right next to an old chair in the basement the cat loved to sleep on. My assumption is that the soil came from some place where histoplasmosis was a thing, whether in the states or imported. Anyway, now that she is feeling better, our little darling keeps meowing at the basement door, asking to go down again. Ugh, no way to explain this, but she won’t be in the basement again, promise.
Thanks for sharing your story! Histo is just so insidious – it pops up in the most random places. Mick was the first animal in Kansas diagnosed with it, and about four months after her diagnosis, the first person in Kansas was diagnosed with it, and then my vet had another cat come in who tested positive. I’m glad your kitty is doing well on the Intrafungol! Mick responded to it well, but that’s what made Nigel ill.
Hi any chance you could reach out to me?
I lost my cat two months ago to histo. Now my other cat is very sick with it. He’s on an antifungal but his lungs are working so hard. Just wondering what your experiences were regarding the months of recovery.
Thanks
Katie
Hi – I’m so sorry for you and your kitties! I’m happy to answer some questions.
I’m no expert, but it sounds like the histo has settled into his lungs – that’s what happened to Nigel, though maybe not as bad as your kitty. You may want to talk to your vet about anything they can do – steroids would be a bad idea, I think, but perhaps even just letting him be in an oxygen-rich area for several hours a day could help? Or perhaps they could board him for a few days and put him in a crate with oxygen, until the anti fungal has a chance to really kick in? How long has he been on the meds?
In terms of recovery – it differs with every cat, unfortunately. Mick took about three months, IIRC; Nigel was about that, too, but with the anti fungal, you should see improvement within a week or two, even if the cat is still positive. That’s my experience, anyway, but i do know that not all cats respond to the treatment, either. My vet had a histo cat right after Mick tested clean – in fact, I gave them the rest of my second bottle of meds – but they had caught it too late.
I don’t know if that helped at all or not, but feel free to reach out with any more questions. Hugs and jingles (well wishes) for you and your kitty.
Also, I’m sorry I didn’t see your other messages! I don’t know why my email didn’t notify me about them.
Hello,
Reading your post gave me such a sense of relief actually – that someone else understands the hell that my cat has been going through, and me respectively too, since I have been DYING to figure out what was wrong with him. My cat has been declining for about a year … weight loss, not wanting to eat as much, diarreah, trouble walking, and his symptoms as of late have moved to his eyes followed by loud breathing/sneezing. After going to several vets, I went to mission veterinary hospital in Shawnee mission, Kansas. They did X-rays, ultrasounds , nothing came up, UNTIL they performed a urine test, which came back positive for histoplasmosis. I will admit, I was extremely relieved and hopeful, to finally have an answer for all the the problems that my cat was having and every vet could not find an answer for, I finally knew I was not crazy for knowing something was wrong with my cat. I prayed and prayed and finally , the vet had given me an answer. The vet has prescribed fluconazole pills for treatment to be given to him twice a day, she chose this particular medication because it supposedly is a better treatment for ocular penetration (since the infection has moved to his eyes). He is currently on day three of his medication, and I am so desperately needing words of encouragement and hope and he starts his several month long journey of his histoplasmosis treatment. I have 5 other cats besides him, and none of them have had any health issues or have contracted histoplasmosis . My only thought of how he could have gotten it is maybe from my screened in porch, I live on the top level of a condo where many birds frequent , and there is a potted plant out there that I have since disposed of, but it is behind the screen so I have no idea how my cat could have gotten to it unless he could have inhaled the fungus through the air outside. I have a few questions for you- what advice can you give me in my current situation? In your cats case, did they have any difficulty walking or any troubles with lameness or their limbs at all? Also – my cat is still breathing and wheezing, even being on day 3 of the fluconazole. How long did it take for your cats breathing to to not be so loud ? Anything you can tell me that can help me in the process of my cats healing would be incredible . I feel so alone in this and I am just desperate for him to get better so he can finally live the happy, healthy life he deserves. Thank you.
First, hugs to you! I know what you’re going through.
Second – it’s so hard to tell when a cat will start to get better. Day 3 is, I can tell you, way too soon to see any results from the medicine. This process takes WEEKS – in fact, it can be up to two months of medication before they are clear of it. If he’s still wheezing, it has probably settled in his sinuses and lungs, which will probably take at least a couple of weeks to start clearing out (I’m not a vet, so I’m guessing here, based on my experiences!)
My cats did not have any trouble with walking, or lameness. That is a very odd symptom. How old is your cat? Is it possible he might have arthritis, separate from the histo? But, as we know that histo can get into literally any part of the cat, I wonder if it might have inflamed his joints, sort of like rheumatoid arthritis? Or perhaps the histo is affecting his sense of balance?
I hope your kitty makes a full recovery! You can always reach out to me – it may take me some time to respond, as I don’t always check this site and don’t always get notifications that someone has left a comment, but I will respond. 🙂