HEARTWORM DISEASE IN CANINE AND FELINE

Introduction a serious and potentially fatal condition caused by parasitic worms Causative agent: Dirofilaria immitis Heartworms are classified as nematodes (roundworms) and are filarids, a small to a very large thread-like white-tocream colored worm, one of many species of roundworms. it is almost worldwide and often common in humid areas that support mosquitoes that spread from host to host through the bites of mosquitoes. living in the arteries of the lungs and occasionally in the right side (ventrivle) of the heart

Morphology of D. immitis Body: unsegmented--the bilateral symmetry covered by a typical cuticle which is formed by a hypodermis. pseudocoelomatic body cavity contains a complete digestive tract, the anus subterminally situated. respiratory and circulatory systems are lacking. movements by contractions of the typically longitudinally oriented muscle cells with the fluid of the pseudocoel and the pressure of the cuticle working together as a hydrostatic skeleton. Dirofilaria immitis - microfilaria

Hosts dogs, cats and other species of mammals, including wolves, foxes, ferrets, sea lions and (in rare instances) humans. Dogs and cats of any age or breed are susceptible to infection. it can infect man causing pulmonary infarction with granuloma formation World distribution of dog heartworm

Note the tapered anterior end. In most specimens you will see a straight body and straight or slightly curved) tail. The width is > 6 um.

Dirofilaria immitis described by Joseph Leidy in 1856 in Philadelphia Mosquito Vectors Many mosquitoes worldwide have been identified as capable of sustaining the development of dog heartworm have been identified as natural hosts of D. Examples are Aedes aegypti, Ae. albopictus, Ae. canadensis, Ae. cantator, Ae. excrucians, Ae. sollicitans, Ae. sticticus, Ae. stimulans, Ae. taeniorhynchus, Ae. vexans, Anopheles bradleyi, A. punctipennis, An. quadrimaculatus, Culex nigripalpus, Cx. quinquefasciatus, Cx. salinarius and Psorophora ferox

Male 12-16 cm long Slender, white color Spirally coiled hind end Referred to as pigtail Female 25-30 cm long Ovoviviparous (lay microfilaria) Shows genital organs

Life cycle pattern of D. Immitis The mosquito ingests microfilariae after a blood meal from a infected dog. The microfilariae develop into L2 in the malpighian tubes. Then L3 develop and enter the body cavity, the hemoceol. Development from the microfilariae to the L3 takes 15-16 days. The L3 escape in a pool of hemolymph as the mosquito inserts its labium into the definitive host, which is usually a dog. If its stylets are withdrawn, the L3 enter through the puncture wound made by the mosquito. The L3 will then molt into the L4 in the definitive host 0-14 days after infection. The L4 migrate to sub muscular membranes and subcutaneous tissue and remain dormant. They molt into the L5 and migrate through venule walls and end up in the pulmonary arterioles and right heart of the definitive host. The L5 will mature into adults that will further migrate to the right ventricle or pulmonary artery 85-120 days after infection. The adult will reach maturity in a further 2-month period and shed microfilariae in the blood to begin the cycle all over again. The adults can remain in the heart or artery for up to 7 years. Microfilariae can remain in the circulation of the mosquito for up to 2 years.

seizures lameness.

Early signs cough, especially on exercise and early exhaustion upon exercise. severe weight loss, fainting, coughing up blood weakness dypsnea are clinical signs Severe cases circulatory distress , progressive endarteritis cardiac dysfunction pulmonary hypotension ascites and edema of legs hepatic vein lesions compensatory hypertrophy of right ventricle chronic passive congestion (liver enlargement edema) deep, dry cough haemoptysis congestive heart failure severe shock-like symptoms Various pathologic changes pulmonary embolism, endocarditis of heart valves, glomerulonephritis due to immune complexes, pulmonary endoarteritis and eosinophilia even to pneumonia. x-ray main pulmonary artery dilated Diagnosis Here are the methods can be used for the diagnosis for Microfilarial detection. a. Direct blood smear b. Serological test IFA for microfilarial antibody ELISA for adult antibody Adult antigen detection by colloid gold c. Radiography. X-rays are used to evaluate the amount of lung damage caused by the presence of heartworms. d. Electrocardiogram e. Echocardiogram f. Tracheal cytology Treatment Heart, liver, kidney,a nd lungs should be assessed first melarsomine dihydrochloride, is marketed under the brand name Immiticide - It has a greater efficiency and fewer side effects arsenical thiacetarsamide or thiacertarsamide sodium, sold as Caparsolate - safer alternative for dogs with late-stage

Pathogenesis Dogs with low numbers of adult worms may be asymptomatic and also produce false negatives.. no indication of heartworm infection during the 6month Rarely, migrating heartworm larvae get "lost" and end up in unusual sites such as the eye, brain, or an artery in the leg, But normally, until the larvae mature and congregate inside the heart, they produce no symptoms or signs of illness. blindness,

infections. (IV dose 0.1 ml/.45 kg 2x a day for 2-3 days). It is a potential nephrotoxin and hepatotoxin Melasoprol 100mg/kg adulticide restricted exercise for several weeks surgical removal of the adult heartworms (ventricular puncture or arteriotomy main trunk of pulmonary artery) microfilariacide dithiazanine iodide 2mg/ .45 kg in persistent cases and dose is increased by 5mg/.45kg (not use if having hepatoportal diseases) Levamisole 10mg/kg for 15-20 days Ivermectin: (Heart Guard, Iverhart, Stromectol, Mectizan)--Macrocyclic lactone derivative of avermectin (22, 23-dihydro-avermectin). Adult Dose: 150-200 mcg/kg administered orally.

Prevalence rates in cats are estimated to be about 10 % of that of local dogs. The average worm burden is 1-5. The mean age of affected cats is 3-6 years.

Control/ Prevention Animals should be indoors at evening and night Long term monthly administration of ivermectin year round at three times the dose Avermectin b1a 0.2 mg/kg/day Melarsoprol 100 mg/kg/day Prophylactic medicine thiacetarsamide (every 6 months) Milbemycin and DEC (5.5 mg/kg daily for 2 months) moxidectin (ProHeart) administered as pills or chewable tablets. Mebendazole 80mg/kg daily for 30 days Selamectin (Revolution), is a topical preventive that is likewise administered monthly and also controls fleas,ticks, and mites. Mosquito control depends upon public health (PH) measures per district and per season. PH protects the public by indoor & outdoor spraying, and by mosquito larva control Public Health Significance Infection results from mosquito bites. The worms lodge in the pulmonary artery causing vascular occlusion, coagulation, necrosis and fibrosis. Symptoms include chest pain, coughing and in some cases hemoptysis. In some patients radiographs have disclosed an asymptomatic, fibrotic nodule 1-3 cm in diameter. The parasite is usually found in the lung (pulmonary dirofilariasis), and less often in the heart. Although the worm forms a "coin lesion" in the lung, which may be confused with other diseases on x-rays, such as carcinoma During the last 30 years about 100 cases of human pulmonary dirofilariasis have been reported from Florida. FELINE HEARTWORM Cats are susceptible yet are poorer hosts than dogs.

Clinical Features Clinical signs are absent to severe. A small worm burden can cause chronic vomiting, coughing, dyspnea, lethargy acute collapse respiratory failure and weight loss. The infection is sometimes confused with bronchial asthma. Six to 10 worms may cause right side heart failure. When the disease is acute there may be convulsions, diarrhea, tachycardia and collapse. As less than 20% of infected cats have mfs in the blood, Diagnosis X-rays, echocardiograhy or serologic tests (ELISA) Treatment. The use of an adultacide such as thiacetarsamide IV may be accompanied by pulmonary thromboembolism and a mortality of 20-30 %. Various drugs are used for supportive therapy including prednisone or prednisolone to reduce inflamation, theophyline for bronchial dilation and inflamation reduction and lifesaving supplemental oxygen. Control. Cats are usually tested for antigens before beginning prophylactic medication which involves monthly administration of ivermectin in tablet form to cats 6 weeks or older, or selamectin (Revolution) applied topically. These and several other drugs kill the larvas of D. immitis.

Different species of Dirofilaria: D. repens D.Corynods D. Conjuctivae Railliet & HenrySubcut tissues of dogs [1911] Linstow[1899] Addario[1885] Monkey Human

Etiology Heartworm disease caused by Dirofilaria immitis is a significant disease of cats. It is found worldwide where the canine disease occurs.

D. romeri

Linstow[1605]

Subcut, IM CT, Pelvic region of wallabies & kangroo Subcut recoons

Sequels can be congestive cardiac failure and cardiac insufficiency. Signs may include anorexia, coughing and dyspnea.

D.Tenuis D.Urci

Chandler[1942]

Diagnosis. Demonstration of larvas in feces and saliva. Treatment and Control. Levamisole, fenbendazole and mebendazole have been effective. Many other deparasitizing drugs against nematodes work well.

Yamaguti [1941] Black bears

Dipetalonema recondita. The adult worms measure 13 mm (male) to over 25 mm (female). Fleas as Ctenocephalides felis and lice as Heterodoxus spiniger are the intermediate hosts. Life Cycle The flea ingests mfs when feeding on an infected dog. The mfs develops into infective larvas in 7-14 days. When the flea again feeds on a dog, the larvas are injected into the skin. The female worm lays mfs which find their way into the bloodstream. The prepatent period is about 60-65 days. As the host is asymptomatic, there is no real treatment! Dirofilaria repens It also lives in the skin of dogs and most rarely infects man. The female is about 12.0 x 0.5-1.0 cm. The vectors are mosquitoes. Angiostrongylus infection This parasite is the nematode Angiostrongylus vasorum, up to 2.5 cm long. With the exception of North and South America, it is found worldwide. Because of the infections frequency in France, it is called the "French heartworm." Dogs are the definitive host and adults are found in pulmonary vessels. Life Cycle. Eggs are laid in the pulmonary arteries and are trapped in capillaries where they hatch. The larvas emerge into alveoli and move up the trachea to the pharynx where they are swallowed and passed in the feces. Larvas enter snails or slugs and undergo 2 molts. Dogs become infected by ingesting infected snails, slugs or their hosts. The 3rd stage larvas migrate from the intestine into lymph nodes and to the pulmonary arteries. The prepatent period is 7 weeks and adults may live in the host for over 2 years.. Clinical Features Obstruction of pulmonary arteries by adult worms and obstruction of arterioles and capillaries by larvas lead to perivascular fibrosis and endocarditis of the tricuspid valve.