You May Like: Dogs And Cats Rule Doylestown. Dealing with a sick cat can be scary. FIP is caused by a. How to Entertain Your Indoor Cat. Sometimes, a biopsy of the infected tissue inside the abdominal cavity may be performed. Feline coronavirus is very common and usually doesnt cause any serious issues, aside from mild diarrhea. Offer FIP-positive cats their favorite food or treats to encourage them to eat. However, as stated above, those that do develop the disease almost invariably die. Unfortunately, the disease will eventually result in death in almost every case. Some cats also have a mixture of the 'wet' and 'dry' forms of the disease. Here is a very good link on FIP that I want you to have. Although the SARS virus that affects humans is a type of coronavirus, there is absolutely no evidence that this virus can be transmitted between humans and domestic cats. Further tests on fluid can be performed to look for the virus (PCR for example). You may have heard about FIP in the past year as it is caused by a coronavirus, specifically, a feline coronavirus known as FCoV, however, its important to understand that it isnt the same virus as SARS-CoV-2 (COVID-19) which affects people. The fluid accumulates because infection with FIPV causes damage to and inflammation of blood vessels (called vasculitis) which results in fluid leaking from the blood into the abdomen or chest. This is why a series of tests will be used including blood work to identify any abnormalities or x-rays to look for fluid build-up in the body. The major indication for using such a vaccine would be in breeding households, especially with a history of FIP, but by the time a kitten can be vaccinated (at 16 weeks) they would almost invariably have already been exposed to FCoV infection and so the vaccine probably has little or no value. There's a virus in cats called Feline Coronavirus (FCoV). The most common laboratory abnormality in cats with FIP is an increase in total serum protein concentration caused by increased globulins, mainly -globulins, which occurs in >70% of cats with FIP. The main symptoms include: involuntary muscle movement, foaming at the mouth, and aggressiveness. (Easy & Complete). Kitten With FIP (Feline Infectious Peritonitis) showing Neurologic Signs. Is FIP in cats a death sentence? A mutated feline coronavirus can trigger feline infectious peritonitis, so before we get to the specifics of the FIP disease in cats, lets look at what the feline coronavirus is and how your pet might get it. FIP occurs commonly in catteries (pedigreed cats), shelters, kitten foster/rescue facilities and dense free-roaming colonies. However, it is likely that the breeding household does have endemic FCoV infection and this is dealt with under the section What should be done in breeding households with endemic FIP?. Feline infectious peritonitis (FIP) is a viral disease caused by a feline coronavirus that affects wild and domestic cats. Several recommendations can be made to reduce this risk: Where possible have the diagnosis confirmed , as many other diseases can look like FIP. In most cats, infection causes no signs or just mild diarrhoea that resolves without treatment. In wet FIP, the fluid that accumulates typically has a very high protein content and is often a clear-yellowish colour. . 4. Other tests that may be helpful include analysis of the blood proteins for the presence of specific markers. At the moment, the best thing pet owners can do is discuss all the available options (which can include supportive treatments where appropriate) with their vet and be emotionally prepared for the situation in which euthanasia is the most humane step to take. A biopsy of the liver (usually performed when the ultrasound is done) is needle to verify the diagnosis. It attacks the cat's immune system which can result in the development of cancer, anaemia and damage to the immune system. Free Shipping on All US Orders! Yet other cats may be infected, manage to eliminate the virus yet get recurrent infections. These attempts, however, may be painful and will result in only small amounts of urine being produced. What is FIP Disease in Cats? Typically, infected cats have vague signs at first, such as lethargy, loss of appetite and weight loss. Feline Infectious peritonitis (FIP) is one of the most devastating diseases of cats. It is still unknown which exact genes The dry or non-effusive form occurs in approximately 25% of the cats with FIP. Cats with FIP can develop a range of symptoms, including poor appetite, lethargy, weight loss, fluid build-up in the abdomen or chest, enlarged lymph nodes, difficulty breathing, eye abnormalities, difficulty walking, behavioral changes, and seizures. Feline coronavirus is very common and usually doesn't cause any serious issues, aside from mild diarrhea. FIP is also more common in cats kept in groups or colonies as this is an environment where FCoV infections are spread easily. If FIP is suspected, your veterinarian may take an X-ray or ultrasound of your cat. If you own multiple cats, keep a maximum of three cats in each room to prevent overcrowded living conditions. Stress may be a factor, as cats diagnosed with FIP often come from multi-cat households (more than 5 cats), animal shelters, or breeding catteries. Fluid may also build up in the chest, making it hard for the cat to breathe. This type of coronavirus is different from the coronavirus that causes COVID-19 in people. Although FIP is not a particularly common disease, it is important because once a cat develops the disease, the outcome is almost invariably fatal. Click here to schedule a video consult to speak to one of our vets. WebMD does not provide medical advice, diagnosis or treatment. Consider referral to a Veterinary Internal Medicine Specialist (known as Diplomates of the American or European College of Veterinary Internal Medicine) who are experts in the current diagnosis options and new treatment possibilities for FIP. Feline infectious peritonitis is a viral disease caused by a feline coronavirus that affects wild and domestic cats. A new clinical trial has resulted in a critical veterinary breakthrough cats with feline infectious peritonitis in remission following treatment with a novel antiviral drug. A vaccine is available for FIP but has not been shown to prevent the disease, therefore it is not currently recommended. However, it can easily transmit from feline to feline and its usually passed in cat faeces. Feline infectious peritonitis is caused by a mutated coronavirus, and targets kittens and young cats under 2 years of age. In cats that develop FIP disease, the first signs of illness may be very vague. The most common fatal feline diseases include: -Feline infectious enteritis (also known as panleukopenia or feline parvovirus) -Feline leukemia virus -Feline immunodeficiency virus -Feline infectious peritonitis . The FIP 7b Elisa is a test that still is up there as far as how accurate it is. There are lots of decisions to make before allowing a cat to own you! So, for example, if youre moving house, make sure you dont acquire another cat at the same time. These drugs are not yet approved by the Food and Drug Administration (FDA), and their long-term effectiveness is still unknown.. This can lead to very diverse and often complex clinical signs including neurological disease, ocular disease, liver disease, kidney disease and intestinal disease. Feline infectious peritonitis (FIP) is a fatal viral disease caused by a strain of virus called feline coronavirus (FCoV). The Cat Gallery has partnered with International Cat Care to host the charitys online shop and manage the distribution of shop bought goods to customers. ), Typical changes are seen on routine blood tests these may include, Lymphopenia (low numbers of lymphocytes, a type of white blood cell), Neutrophilia (increased numbers of neutrophils, a type of white blood cell), Elevated globulin concentrations (one of the major groups of proteins in the blood), Elevated bilirubin (and jaundice or yellowing of the gums and eyes), Further analysis of proteins in the blood (e.g. can actually be quite common, and it's currently the leading infectious cause of death in cats Many of these abnormalities may also not be present in the early stages of the disease but may become evident as the disease progresses. Your Vet may become suspicious of FIP if a pet shows elevated white blood cells, increase globulin concentrations (protein in the blood), elevated liver enzymes and jaundice (a yellow discolouration to the skin). HCM is often a progressive disease . Other cats may be infected, develop strong immunity, and be protected from future infections. In some countries, a commercially available vaccine is available to protect against FCoV. Owners of FIP-positive cats often make the difficult decision to euthanize or put their beloved kitten or cat to sleep to prevent prolonging their suffering and pain. Since many different organs can be involved with the dry form, the symptoms we see with this form of FIP can mimic other common diseases of cats, like hyperthyroidism , liver disease , sugar diabetes and kidney disease. It turns out COVID-19 may have hijacked the cure for FIP and that's why you haven't heard about it. (Although humans may be able to pass COVID-19 to cats in rare cases,. It is estimated that 25-40% of household cats are positive for FCoV (however this is closer to 80% in colonies). Feline Coronoavirus (FCoV) is a common viral infection in cats that most often causes mild gastrointestinal clinical signs. There is evidence that genetics can also play a role in susceptibility to disease, although this is complex. There are a few other tests that may help support a FIP diagnosis. The virus will spread through a cat's body causing systemic inflammation. You can also download the FirstVet app from the Apple App Store and Google Play Stores. FCoV can remain inactive in a cat for months, even years before they develop signs of FIP. Below is a list of the best Diseases that mimic fip in cats public topics compiled and compiled by our team 1 Feline Infectious Peritonitis (FIP) Corona Virus 2 FIP (Feline Infectious Peritonitis) - Mentor Animal Hospital 3 PNEUMONIA IN CATS - Feline 4 Feline infectious peritonitis (FIP) - Cat Friendly Homes In this form or stage of disease there is accumulation of fluid within the abdominal cavity (resulting in abdominal distension) and/or the chest cavity (resulting in breathing difficulties). Infected cats can have symptoms of only one form or a combination of both.. If there is a build-up of fluid in your cats abdomen or chest, your veterinarian may collect a sample of the fluid for testing. Feline infectious peritonitis (FIP) is a progressive systemic disease with a wide spectrum of clinical signs and high mortality (Hartmann 2005).It is caused by a mutation in the feline enteric coronavirus, a common pathogen of cats that may cause no clinical signs or transient diarrhea (Pedersen, 1995, McReynolds and Macy, 1997, Hartmann, 2005).The mutated FIP virus disseminates via the . They provide cat owners, veterinary professionals and those who live and work with cats the resources, support, and advice they need to better care for cats. A crowded environment may also contribute to stress, which can be a factor in disease development as it compromises the cats immune response. The dry form of FIP causes infection and inflammatory lesions around the blood vessels in a cats body. Feline Coronavirus is a very common virus in cats and most cats will have very mild symptoms which completely resolve on their own. In both cases, once the symptoms appear they will progress rapidly in a matter of days or weeks. Keep reading to learn more about FIP and how you can protect your cat. Once a cat has FIP in either form, the symptoms tend to get worse with time. While vitamin B12 deficiency is most commonly associated with intestinal disease and long-term diarrhea, vitamin B12 is essential for so many processes within a cat's body. As time goes by, infected cats may have more FIP symptoms that depend on the form of FIP. These are referred to as feline enteric coronavirus (FeCV). If your cat is FIP-positive and stops eating, begins panting or open-mouth breathing, or shows signs of breathing difficulty contact the nearest vet for immediate care. 101. On the other hand, 1 cat originally thought to have FIP was later reclassified to a viral infection of a less specific nature (9). It occurs due to a mutation of one particular strand of the felinecoronavirus (FCoV), of which there are many strands that many cats are exposedto throughout their lifetimes and especially as young kittens. Several factors cause the virus to change, which leads to the serious FIP infection we see in some cats. An affected cat may have a painful abdomen, lose interest in food, and become more and more depressed. Evidence has shown that genetics can make some cats more susceptible to FIP. After a period of several days or weeks (or sometimes even many months) other signs usually develop. This might also happen in the chest cavity causing breathing problems. To prevent infection, the following is recommended: Keep litter boxes away from food and water dishes. Other tests that can also sometimes be helpful include: Looking for the presence of antibodies against the virus in a blood sample (coronavirus serology) is of very limited value antibodies against FCoV develop when a cat meets coronavirus this does not mean they have or will get FIP. diseases that mimic fip in cats. Many of its symptoms could also be symptoms of other issues, and there is no single blood test available to confirm FIP. Unfortunately, FIP is a fatal disease in many cases, but there are treatment options that will alleviate some of the symptoms to help make your cat more comfortable. Share this post. This fatal viral disease previously had no effective treatment or cure. Diseases that can mimic IHL in cats include FIP, cholangiohepatitis, and liver cancer. After a period of several days to a few weeks other symptoms typically begin to occur. At this stage, most cats will develop the wet or effusive form of FIP, which refers to the accumulation of fluid in body cavities fluid may accumulate in the abdomen, leading to a swollen abdomen, or in the chest cavity, resulting in difficulty with breathing. In the UK, this can be seen with mycobacterial disease, toxoplasmosis, cryptococcosis and feline infectious peritonitis (FIP) 10,11. The virus can involve the liver, kidneys, lungs, brain, spinal cord, and eyes. FIP is also more common in cats kept in groups or colonies (especially breeding households) as this is an environment where FCoV infections are spread easily. A study in 2011 found that the average survival time after diagnosing FIP with effusions was only three weeks. The feline enteric coronavirus is a contagious virus but most cats that get infected just get temporary flu-like symptoms (fever, diarrhea, malaise). Reducing risk in multi-cat and breeding households, Willows Veterinary Centre and Referral Service. However, other diseases can also cause a similar fluid accumulation. FIP is much more prevalent in multi-cat households, shelters, and breeding colonies. Recent research by Professor Niels Pedersen of University of California, Davis, has shown that some newer anti-viral drugs such as GC-376and GS-441524, used in humans against some emerging viruses, may be effective. However, because of the relatively large numbers and turnover of cats in a rescue shelter, this is a situation where there is a higher than normal risk of FCoV infection being spread and of FIP developing. calcitriol. Keep litter boxes away from food and water dishes. FIP can be challenging to diagnose because blood tests cannot determine whether the FCoV is the one causing severe, often fatal, symptoms or the form that causes none of these symptoms. Try to minimize stressful situations, keep them indoors, warm and comfortable, with their litter box, fresh water, and food nearby. There is no justification for routine serotesting of cats in a rescue centre, and euthanasia should never be performed simply on the basis of a high antibody titre. Vets caution owners to wait about a month after a FIP-positive cat dies before bringing a new cat into the house, which decreases the chance of exposure to the FCoV. Supportive care such as intravenous fluids and pain relief, can relieve signs for a short time and drugs such as interferon (a drug which stimulated the immune system) has been trailed with mixed results. Where a definitive diagnosis is needed then a tissue biopsy will probably be required. All rights reserved. Thus, a wide range of signs may be observed including neurological disease (e.g., a wobbly and unsteady gait or fits), bleeding in the eyes and other vague signs of disease that may occur with lesions in the liver, kidneys or other internal organs. When this begins, the virus is spread around the body, and if not met by an appropriate immune response, FIP will develop. Feline infectious peritonitis (FIP) is a complex and inevitably fatal disease whose mode of transmission and infection is still not entirely understood. Your purchase directly supports the leading global cat welfare charity, International Cat Care. Classically, FIP has been divided into wet (effusive) and dry forms, but actually cats are likely to have both at different times, or a mixture of both presentations. What is FIP and how does infection with FCoV? Touring the world with friends one mile and pub at a time; best perks for running killer dbd. Advice and articles tailored to your pet's needs. What is FIP (feline infectious peritonitis) in cats? Early signs are generally vague but can include fluctuating fever, lethargy and reduced appetite. Scientists dont know yet what is causing these mutations, but a weak immune system, stress and even age (with younger cats being more susceptible to FIP virus) have been proposed as possible explanations. Because there is still so much we dont understand about FIP and because coronavirus is easily transmitted to many cats worldwide, its unlikely that we can prevent FIP. Also Check: Cat Insurance Pre Existing Conditions. Its important to note that this is different from the coronavirus that infects people and leads to COVID-19. Certain cat breeds may be more likely to develop FIP including Abyssinian, Bengal, Birman, Himalayan, Ragdoll, and Devon Rex. Why does feline coronavirus cause feline infectious peritonitis? Author Summary Coronaviruses are important pathogens in humans and animals. Walter M Chesnut. The main indication for use of this vaccine would be in high risk cats (breeding households or colonies), however cannot be given in cats under 16 weeks of age, by which point the cats would have most likely already have been exposed to FCoV. FIP can present in different ways but affected cats can have an effusion (fluid) in their chest or abdomen. Coronavirus infection is extremely widespread in cats, especially where large numbers of cats are kept together. Many cats that develop FIP are now in single cat homes, despite coming from multi-cat environments. The first signs are vague and common to so many other conditions. Feline infectious peritonitis ( FIP) is the name given to a common and aberrant immune response to infection with feline coronavirus (FCoV). The risk of FIP in a boarding cattery should be very low assuming that good standards are maintained. Although these tests can help support a veterinarians diagnosis, none of them is 100% accurate. FCoV can remain inactive in a cat for months, even years before they develop signs of FIP. Protecting Your Cat from Feline Distemper. Polymerase chain reaction technology can be used to test for the virus in the tissue or body fluid. The most common symptom is fluid in the belly, which distends the tummy. Cats develop increased fluid in the abdomen area which often mimics a pot-bellied appearance. FIP is difficult to diagnose. Image: deyangeorgiev / Shutterstock. While a FIP vaccine is available, it has not been proven effective and is not recommended by the American Association of Feline Practitioners Feline Vaccine Advisory Panel. About 5 to 10 per cent of cats with FCoV eventually progress into clinical FIP. As FIP is difficult to diagnose, your vet may recommend a biopsy be taken to distinguish FIP from a treatable disease. Stress may be a factor, as cats diagnosed with FIP often come from multi-cat households , animal shelters, or breeding catteries. Without a vaccine, currently there is no known way to prevent the feline coronavirus from triggering the FIP disease. The letters 'FIP' stand for feline infectious peritonitis. There are 2 forms of FIP that veterinarians describe as wet and dry. FIP can be a challenging disease to diagnose, in part based on the non-specific clinical signs and in part due to the lack of a simple diagnostic test. Efforts at vaccination and treatment have been unproductive. Read Also: Cheapest Place To Buy Cat Litter. Most cats exposed to feline coronavirus, even to the potentially FIP-inducing strains, are able to develop an immune response that protects them, therefore only a small proportion of infected cats actually develop clinical disease. If FIP is confirmed it should be recognised that this may be a one-off case or a very intermittent problem. Unfortunately, FIP in cats cant be easily recognised through symptoms alone. Always have 1 more litter box than the number of cats in the home. Know FIP is fatal, but could this be something else? . Initial experience has been positive with response rates of around 80% and therefore we have reason to be optimistic. It is considered nearly 100% fatal. However, this vaccine (while showing some efficacy) can only be given to kittens over 16 weeks of age. Once a reasonably reliable presumptive diagnosis has been made, euthanasia is often the most appropriate course of action. Around 80% of cases diagnosed are in cats less than 2 years old, and many cases are seen in kittens around 4-12 months old. The Cat-Lovers Guide to Litter Box Bliss, Toys, Games, and Puzzles! Coronavirus infection is extremely common in cats, especially in high population areas. If your cat shows any of the signs listed above, you should contact your pDVM (primary veterinarian) right away. In this case of FIP in cats there will be minimal fluid accumulation and the symptoms will be vague and not specific to only one illness: weight loss, vomiting or lethargy. In some cases, cats will also have excessive thirst and urination, vomiting, weight loss, and jaundice. More than anything else, breed and age will determ Fleas are one of the most common parasites that we see in our pets. Researchers from Kansas State University and the University of California, Davis, published their study results in the Journal of Feline Medicine and Surgery. Do not immediately rehome any cats that were in direct contact with the affected individual. Do you have a copy of his blood work ? Feline Infectious Peritonitis (FIP) is a fatal condition in cats where the causative virus (a coronavirus) which is harmlessly present in most cats, mutates and becomes harmful. Thus, some tests that give normal results may have to be repeated later. The feline infectious peritonitis virus (FIPV), in contrast, is not infectious via the fecal-oral route, but arises by mutation from the avirulent FECV within a small percentage of infected cats and then causes the fatal disease feline infectious peritonitis (FIP) [4-6]. Litter boxes should be kept clean and located away from food and water dishes. Inflammation might also develop and affect various organs such as eyes, kidneys, lungs or skin. In the final stages of FIP, cats struggle to breathe and eat, often resulting in euthanasia. FIP is also caused by a coronavirusnot the same one that causes COVID-19, but one that specializes in infecting cats. There may be episodes of pyrexia (fever). Males are more commonly infected than females, and purebred cats are at an increased risk, especially the Asian . Ways to look for the presence of the virus include immunocytochemistry and immunohistochemistry (staining the virus so it can be detected) and PCR (testing for the viruses genetic material). Feline Infectious Peritonitis (FIP) | Cat doctor Feline Infectious Peritonitis (FIP) FIP is a disease caused by Feline Coronavirus. cat to have most likely identified diseases that could mimic FIP. 17. But after a few days, other signs start to appear which are more worrying and give the disease the two forms its known for: wet and dry FIP. So, even if the cat becomes infected with the FIP virus, it does not necessarily follow that they will suffer from the FIP disease. Hypertrophic cardiomyopathy (HCM) is the most common heart disease of cats, whether they are random bred or pedigreed. This form often causes the development of chronic inflammatory lesions around the blood vessels and in other organs known as pyogranulomatous inflammation. It is considered one of the least understood of all cat diseases. FIP is almost always a fatal diagnosis with few very cats living several months under supportive care. A vaccine is available for FIP but has not been shown to prevent the disease, therefore it is not currently recommended. The clinical trial at the University of . If some cats have to be group-housed, keep them in small groups and do not mix cats > from different groups. Neurological Disorders Hyperesthesia Syndrome Squamous Cell Cancer: Dangerous A generally healthy and typically agile cat suddenly seems to be having trouble getting up on all four legs and maintaining its balance. Symptoms worsen over days, weeks, sometimes even months. This research is the first attempt to use modern antiviral strategies to cure a fatal, systemic viral disease of any veterinary species, said Dr. Pedersen. 12. In cases of dry FIP, the disease mainly manifests as areas of inflammation within various tissues of the body. Unfortunately, there is no cure for FIP, and cats showing symptoms listed above often get sicker over days, weeks, sometimes even months and die from the virus. They may have lethargy and weight loss, wobbliness, and breathing problems. Good practice to minimise risk would include: avoiding large groups of cats or having multiple litters in one go, keeping small isolated groups separate, having numerous, easy to clean litter trays Keep litter boxes away from food or water bowls, avoiding stress and maintaining good hygiene. Its a fast-acting, serious, often fatal infection with no known cure at this time. FIP may be considered more likely when: None of these blood changes are specific for FIP, occurring with other diseases too, but if multiple changes are seen in combination with appropriate signs, a diagnosis of FIP becomes more likely. Difficulty breathing with increased respiratory effort and panting, or open-mouth breathing happens when there is fluid in the chest area. Feline infectious peritonitis is infectious, caused by a coronavirus, but the FIP-causing form of the virus appears not be too highly contagious. There were two groups of cats in the study. Sometimes, only ocular symptoms will occur. This is a feline coronavirus that is very common and only causes mild symptoms, but in a few cases, it mutates into the feline infectious peritonitis virus, triggering FIP, a serious disease that is deadly for most cats. Vets caution owners to wait about a month after a FIP-positive cat dies before bringing a new cat into the house, which decreases the chance of exposure to the FCoV. The virus will then be called feline infectious peritonitis virus. Cats can develop FIP at any age, but it is usually diagnosed in cats between 6 months and 2 years of age. It is caused by the feline infectious peritonitis virus (FIPV), which is believed to be a mutated form of the feline coronavirus (FCoV). Total protein in cats with FIP can reach very high concentrations of 12 g/dL. FIP is caused by infection with a virus known as feline coronavirus. It is a complex disease to diagnose and in the last few years, significant developments have occurred in the treatment of this previously fatal condition. The risk of FIP can be minimised by obtaining your pet from a source with relatively few cats. Feline Infectious Peritonitis (FIP) aymen_bet / Flickr / CC BY 2.0 FIP is a strange disease in that it is a mutated form of a very common infection in cats caused by Feline Coronavirus. By clicking Subscribe, I agree to the WebMD, Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats, Smoking Pot Every Day Linked to Heart Risks, Artificial Sweetener Linked to Heart Risks, FDA Authorizes First At-Home Test for COVID and Flu, New Book: Take Control of Your Heart Disease Risk, MINOCA: The Heart Attack You Didnt See Coming, Health News and Information, Delivered to Your Inbox. While FIP can present in ways that mimic other feline conditions, these signs can serve as a red flag to investigate further: This type of coronavirus is different from the coronavirus that causes COVID-19 in people. Your veterinarian is more likely to assume FIP is present if your cat: Has an unusually high number of white blood cells, Has elevated concentrations of protein in the blood. Often, blood will be present in the urine. Looking for fluid is an important part of investigating a cat for FIP so xrays, and particularly ultrasound, can be very helpful and again may need to repeated later as the disease progresses. When a cat gets FIP, it is progressive and almost always fatal.. Around 80% of cases diagnosed are in cats less than 2 years old, and many cases are seen in kittens around 4-12 months old. FIP can occur in any cat of any age however it is most common in young cats, with 80% of cases occurring in cats less than two years of age. Read Also: What Kind Of Cat Does Justin Bieber Have. OK, so what causes it? Feline infectious peritonitis (FIP) is a viral-induced, immune-mediated disease of cats caused by virulent biotypes of feline coronaviruses (FCoV), known as the feline infectious peritonitis virus (FIPV). Peritonitis, or inflammation of the abdominal cavity, is only one feature of this systemic disease, which can cause ocular inflammation, neurological signs, liver problems, and fluid around the lungs.
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