Larval development of the feline lungworm Aelurostrongylus abstrusus in Helix aspersa

Efficacy of Bravecto® Plus spot-on solution for cats (280 mg/ml fluralaner and 14 mg/ml moxidectin) in the prevention of feline Aelurostrongylus abstrusus infection evaluated in a multi-diagnostic approach

BACKGROUND

Aelurostrongylus abstrusus is one of the most important respiratory nematodes of felines. Infections may lead to respiratory clinical signs with varying severity or even death, emphasizing the need for preventive treatment of cats with outdoor access to circumvent patent infections.

METHODS

Therefore, the preventive efficacy of a spot-on formulation of 280 mg/ml fluralaner and 14 mg/ml moxidectin (Bravecto® Plus spot-on solution for cats, MSD) against A. abstrusus was evaluated in a negative controlled, randomized and partially blinded efficacy study with 28 purpose-bred cats in a non-terminal design. In three different treatment regimes, the minimum recommended dose of 40 mg fluralaner and 2.0 mg moxidectin/kg bodyweight (BW) was administered once at 12, 8 or 4 weeks (study group G1, G2 and G3, respectively) prior to experimental infection with 300 third-stage A. abstrusus larvae, while G4 served as placebo-treated control.

RESULTS

From 30 to 46 days post infection (dpi; SD 114 to 130), faeces were sampled to monitor first-stage larvae (L1) excretion for efficacy determination. Secondary efficacy criteria, including respiratory parameters, serological antibody levels and computed tomography (CT) findings, were assessed once before enrolment (SD -7 to -1) and before infection (SD 75 to 83). After infection, CT evaluation was performed once at 47-50 dpi (SD 131 to 134), and respiratory parameters and antibody levels were regularly assessed twice or once a week, respectively (1 up to 78 dpi, SD 85 up to 162). All animals in the control group excreted L1 by 33-37 dpi and remained positive throughout the study period from 41 to 46 dpi (SD 125 to 130). In the treatment groups, only one animal each of G1 and G2 excreted L1 at two consecutive days, and four cats of G1, two of G2 and three of G3 were positive on single occasions. While the geometric mean (GM) of the maximum number of excreted L1 per 5 g of faeces was 7380.89 in the control group (G4), GMs were significantly lower in the treatment groups with 1.63 in G1, 1.37 in G2 and 0.79 in G3. Thus, based on GMs, the reduction in excreted L1 exceeded 99.9% in all three treatment groups. Based on CT severity scores, all lungs of the animals of the control group showed severe pulmonary changes post infection, whereas lungs of the cats of the treatment groups were either unaltered (4 animals), mildly (11 animals), or moderately altered (5 animals). Moreover, seroconversion was observed in all cats of the control group, but not in those of the treatment groups.

CONCLUSIONS

The combination of diagnostic methods used in this non-terminal study yielded coherent and reliable results. A single administration of Bravecto® Plus spot-on solution for cats was well tolerated and effective in the prevention of aelurostrongylosis for at least 12 weeks.

Reaction of Cornu aspersum Immune System against Different Aelurostrongylus abstrusus Developmental Stages

Cornu aspersum, the land snail, is recognized as a suitable intermediate host of Aelurostrongylus abstrusus; however, there is little information both on larval development as well as on the intermediate host’s immune system reaction to the parasite. The aim of the study was to assess the histological reaction of C. aspersum’s immune system against A. abstrusus. Sixty-five snails were provided by a snail farm. Five of them were digested to assess the absence of natural parasitic infections. The remaining sixty were divided into five groups. Three groups of snails were infected with A. abstrusus using by-contact or injection methods; one group was injected only with saline solution and one group was left untreated as the control. The snails of group A were sacrificed and digested on study days 2, 10, and 18; snails of the other groups were collected and examined for histopathological analysis on study days 2, 10, and 18. On study day 2, in the infected snails, several free L1s were observed along with the absence of immune system reactions. On day 10, the L2s elicited an intense reaction in the internal layer of the muscular foot. On day 18, all L3s partially encapsulated by the snail’s immune system were observed in the outermost part of the muscular foot, which is near and among the goblet cells. This last finding suggests that L3s could be shed with the snail’s mucus and spread in the environment, representing an alternative route of transmission for this feline lungworm.

The giant African snail Achatina (Lissachatina) fulica Bowdich, 1822 as an intermediate host of Aelurostrongylus abstrusus (Railliet, 1898) in the Rio de Janeiro state, Brazil

Aelurostrongylus abstrusus is a metastrongilid nematode that causes feline aelurostrongylosis. The adult life stage parasitizes the lungs of wild and domestic felids. Terrestrial mollusks act as its intermediate host, and birds, amphibians, and small mammals act as paratenic hosts. Aelurostrongylus abstrusus presents a worldwide distribution, and in Brazil it has been recorded in most states. The present study investigates the occurrence of Aelurostrongylus abstrusus in terrestrial mollusks from urban areas of two out of the six Mesoregions of Rio de Janeiro state: Metropolitana and Centro Fluminense (46 municipalities). Larvae were recovered from the tissue of the mollusks collected during the surveys and identified based on morphology and sequences of the Internal Transcribed Spacer 2 (ITS2). In all, 2791 mollusks, belonging to 14 different species, were collected. Larvae of A. abstrusus were recovered from two species: Achatina fulica in 22 out of 46 municipalities, and from the slug Latipes erinaceus in 1 out of 46 municipalities. Aelurostrongylus abstrusus was recorded in half (50%) of the municipalities of the Metropolitana Mesoregion and in 44% of those of the Centro Fluminense Mesoregion. Results indicate a strong association between A. abstrusus and A. fulica, since 99% of the mollusks infected with A. abstrusus were A. fulica. This study recorded A. abstrusus in the Centro Fluminense Mesoregion and naturally parasitizing L. erinaceus for the first time. Despite the high number of mollusks infected with A. abstrusus and their wide distribution in Rio de Janeiro State, there are still few reports of infection in Brazilian felids, probably given that this is an under-diagnosed parasitosis in this country. Further studies in other regions of the Rio de Janeiro State, and other Brazilian States, focusing on intermediate and definitive hosts, particularly in the urban environments where they coexist, are needed. These studies will enable further understanding of the epidemiology and prevention of aelurostrongylosis.

A Comparison of Copromicroscopic and Molecular Methods for the Diagnosis of Cat Aelurostrongylosis

Simple Summary

Feline aelurostrongylosis is a worldwide distributed parasitic disease of domestic cats caused by the nematode Aelurostrongylus abstrusus. Cats may have a subclinical infection with this parasite or may show signs that overlap with those of many other respiratory conditions of cats, either parasitic or not. The diagnosis of feline aelurostrongylosis currently relies on fecal examinations, though this approach has some limits that can be overcome by innovative molecular techniques. Therefore, the present study has investigated the diagnostic reliability of a PCR assay performed on different samples collected from cats from Italy and Greece. The results of the study confirmed that PCR is highly sensitive and specific for the diagnosis of A. abstrusus infections in domestic cats.

Abstract

The gold standard method for the diagnosis of cat aelurostrongylosis is the detection of Aelurostrongylus abstrusus first stage larvae with the Baermann’s examination. Nevertheless, molecular assays have shown higher diagnostic performances compared to copromicroscopy. This study evaluated the usefulness of an A. abstrusus species-specific PCR on different biological samples collected in clinical settings from 100 privately-owned cats in Italy (n. 60) and Greece (n. 40). A fecal sample was collected from each animal and a pharyngeal swab was also obtained for cats from Italy. All stool samples were subjected to flotation and Baermann’s test. The cats were categorized in three groups based on the results of copromicroscopy, i.e., Group A (n. 50 cats with A. abstrusus infection regardless of positivity for other helminths), Group B (n. 25 cats negative for A. abstrusus but positive for at least one of any other helminth), Group C (n. 25 cats negative for any helminth). DNA was extracted from individual aliquots of feces, flotation supernatant, Baermann’s sediment and the pharyngeal swab and then subjected to a PCR specific for A. abstrusus. At least one fecal aliquot or the pharyngeal swab scored positive by the A. abstrusus-specific PCR for 48/50 (96%) cats enrolled in Group A; in particular, 38/50 (76%), 35/50 (70%), 41/50 (82%) and 21/25 (84%) DNA extracts from feces, flotation supernatant, Baermann’s sediment and pharyngeal swabs were positive by PCR. These results confirm that molecular tools are highly sensitive and specific and indicate that pharyngeal swabs are the most suitable sample for molecular analysis in clinical settings.

Efficacy of a spot-on combination containing 10% w/v imidacloprid and 1% w/v moxidectin for the treatment of troglostrongylosis in experimentally infected cats

Background

Parasitic bronchopneumonia in domestic cats in Europe, which can manifest with moderate to severe clinical signs, is frequently caused by Troglostrongylus brevior. Data on epizootiological and clinical relevance of cat troglostrongylosis have been published in the last decade but treatment options are still limited. Promising effectiveness data have been generated from clinical cases and field trials for a spot-on formulation containing 1% w/v moxidectin and 10% w/v imidacloprid (Advocate^®, Elanco Animal Health). Therefore, two studies have been conducted to confirm under experimental conditions the efficacy of moxidectin 1% contained in Advocate^® for the treatment of cat troglostrongylosis.

Methods

Sixteen and 20 cats experimentally infected with T. brevior were included in two separate studies, i.e., Study 1 and 2, respectively. Cats were infected with T. brevior third-stage larvae via gastric tube. In both studies cats were randomized to untreated (control, Group 1) and treatment (Group 2) groups. In Study 1 and Study 2, the two groups comprised eight and 10 cats each. Treated cats received Advocate^® spot-on twice at a 4-week interval. The primary efficacy criterion was the number of viable adult T. brevior counted at necropsy. Throughout the trial, the fecal shedding of first-stage larvae (L1) was assessed in treated and untreated control cats.

Results

The experimental model was successful in both studies, as all cats started shedding T. brevior L1 within 25 days post-infection. At necropsy, T. brevior adults were found in 4/8 and 4/10 cats of the control groups in Study 1 and 2, respectively, while none of the treated cats harbored adult worms. The necropsy worm counts in controls did not meet relevant guideline requirements for adequacy of infection, with fewer than six infected cats in the control groups, thus limiting conclusions on treatment efficacy. The fact that 6/8 and 8/10 control cats in Study 1 and 2, respectively, shed L1 up to necropsy while larval shedding ceased in all treated animals after the first treatment provides supporting evidence on the level of efficacy. No remarkable adverse events were recorded in the two studies.

Conclusion

These results indicate that Advocate^® spot-on is a safe and effective option for treating cats infected by T. brevior.

Graphical Abstract

Dirofilaria spp. and Angiostrongylus vasorum: Current Risk of Spreading in Central and Northern Europe

In the past few decades, the relevance of Dirofilaria immitis and Dirofilaria repens, causing cardiopulmonary and subcutaneous dirofilariosis in dogs and cats, and of Angiostrongylus vasorum, causing canine angiostrongylosis, has steadily increased in Central and Northern Europe. In this review, a summary of published articles and additional reports dealing with imported or autochthonous cases of these parasites is provided for Central (Austria, Czechia, Germany, Hungary, Luxemburg, Poland, Slovakia, Slovenia, and Switzerland) and Northern (Denmark, Finland, Iceland, Norway, and Sweden) Europe. Research efforts focusing on Dirofilaria spp. and A. vasorum have varied by country, and cross-border studies are few. The housing conditions of dogs, pet movements, the spread of competent vectors, and climate change are important factors in the spread of these nematodes. Dogs kept outside overnight are a major factor for the establishment of Dirofilaria spp. However, the establishment of invasive, diurnal, synanthropic, competent mosquito vectors such as Aedes albopictus may also influence the establishment of Dirofilaria spp. The drivers of the spread of A. vasorum remain not fully understood, but it seems to be influenced by habitats shared with wild canids, dog relocation, and possibly climatic changes; its pattern of spreading appears to be similar in different countries. Both Dirofilaria spp. and A. vasorum merit further monitoring and research focus in Europe.

Morishitium polonicum as a Cause of Severe Respiratory Disease in Eurasian Blackbirds (Turdus merula) in Central Italy

Two Eurasian Blackbirds (Turdus merula) from central Italy were found with severe cyclocoelid trematodosis associated with airsacculitis. The birds were submitted with severe respiratory distress; one died shortly after hospitalization, while the second bird was euthanized. At necropsy, a massive presence of cyclocoelid flukes was observed in the coelomic cavity and air sacs of both birds. The air sacs were diffusely opaque, thickened, and covered by scant fibrinous exudate mixed with numerous parasites. Histologically, the air sacs showed diffuse and severe oedema with fibrinous exudate. Diffuse mononucleated and heterophilic infiltration mixed with multiple granulomas contained degenerated trematodes. Morishitium polonicum was identified using morphologic keys and molecular analysis of extracted DNA. Infections caused by M. polonicum are poorly documented in blackbirds and the findings in these birds support the pathogenic role of this trematode as a potential cause of death in blackbirds in Italy. Extended epidemiologic surveys are required to properly assess the potential importance of M. polonicum as a life-threatening pathogen in Blackbird populations.

The Influence of Temperature on the Larval Development of Aelurostrongylus abstrusus in the Land Snail Cornu aspersum

The metastrongyloid Aelurostrongylus abstrusus has an indirect lifecycle involving gastropod intermediate hosts. The widespread snail Cornu aspersum is an efficient intermediate host of A. abstrusus. As the temperature may influence the developmental rate of metastrongyloids from first (L1) to the third infective larval stage (L3) inside molluscs, this study evaluated the effect of two controlled temperatures on the development of A. abstrusus in C. aspersum. Overall, 300 snails were infected with 500 L1 of A. abstrusus and kept at ∼25 °C. Fifteen days post infection (D15), the overall developmental rate to L3 (0.8%) was assessed in a subset of 20 snails. The remaining gastropods were divided in 2 groups, i.e., 180 still kept at ∼25 °C (G1) and 100 hibernated at ∼4 °C (G2). On D30, the larval development was evaluated in 20 snails from each group, while another batch of 80 snails was selected random from G1 and hibernated at ∼4 °C (G3). The larval developmental rate was determined digesting 20 snails from each of the three groups on D45, D60, and D75. The higher mean developmental rate was registered in G1 (3.8%) compared to G2 (1.9%) and G3 (2.3%), indicating that the development to L3 of A. abstrusus in C. aspersum is positively influenced by the increase of temperature.

Do All Roads Lead to Rome? The Potential of Different Approaches to Diagnose Aelurostrongylus abstrusus Infection in Cats

An infection with the cat lungworm, Aelurostrongylus abstrusus, can be subclinical, but it can also cause severe respiratory clinical signs. Larvae excretion, antibody levels, clinical assessment findings of the respiratory system and diagnostic imaging findings were recorded and compared for six cats with experimental aelurostrongylosis. In five cats, patency started 33-47 days post infection (pi), but two cats excreted larvae only in long intervals and low numbers. Positive ELISA results were observed in four cats with patent aelurostrongylosis, starting between five days before and 85 days after onset of patency. One seropositive cat remained copromicroscopically negative. Mild respiratory signs were observed in all cats examined. A computed tomographic (CT) examination of the lungs displayed distinct alterations, even in absence of evident clinical signs or when larvae excretion was low or negative. The thoracic radiograph evaluation correlated with the CT results, but CT was more distinctive. After anthelmintic treatment in the 25th week post infection, pulmonary imaging findings improved back to normal within 6-24 weeks. This study shows that a multifaceted approach, including diagnostic imaging, can provide a clearer diagnosis and monitoring of disease progression. Furthermore, a CT examination provides an alternative to post mortem examination and worm counts in anthelmintic efficacy studies.

Efficacy of Bravecto® Plus spot-on solution for cats (280 mg/ml fluralaner and 14 mg/ml moxidectin) for the prevention of aelurostrongylosis in experimentally infected cats

Background

The feline lungworm Aelurostrongylus abstrusus affects the lower respiratory tract in cats worldwide. As infections may lead to chronic respiratory changes or even death, preventive treatment in cats with outdoor access is warranted.

Methods

The preventive efficacy of a spot-on solution (Bravecto® Plus spot-on solution for cats, MSD) against cat aelurostrongylosis was evaluated using three different preventive treatment regimes in a negative controlled, randomized and partially blinded laboratory efficacy study with 31 purposed-bred cats. The minimum recommended dose of 2.0 mg moxidectin + 40 mg fluralaner/kg bodyweight was applied once 12 (Group [G]1), 8 (G2) or 4 (G3) weeks before experimental infection with 300 third-stage larvae (L3) of A. abstrusus. Another group served as untreated control (G4). Individual faecal samples were analysed as of day 30 post infection (pi) to monitor larvae excretion. Necropsy was performed at days 47–50 pi. The lungs were examined macroscopically for pathological findings and (pre-)adult worms were counted to assess preventive efficacy.

Results

Beginning at day 32–40 pi, all cats of the control group were constantly shedding larvae of A. abstrusus, whereas only one animal of G1 excreted larvae at several consecutive days. In addition, two cats of G1 and G3 and three of G2 were positive on a single occasion. The geometric mean (GM) of the maximum number of excreted larvae was 7574.29 in the control group compared to 1.10 (G1), 1.19 (G2) and 0.53 (G3), resulting in a GM reduction of > 99.9% in all treatment groups. All lungs of the control animals showed severe or very severe alterations at necropsy, while in 94.44% of the treated cats lung pathology was rated as absent or mild. The GM number of (pre-)adult A. abstrusus retrieved from the lungs was 26.57 in the control group, 0.09 in G1 and 0.00 in G2 and G3. Thus, GM worm count reduction was 99.66% in G1 and 100% in G2 and G3.

Conclusions

A single application of Bravecto® Plus spot-on solution at a dose of 2.0 mg moxidectin + 40 mg fluralaner/kg bodyweight reliably prevents cat aelurostrongylosis for at least 12 weeks.

Felid Cardiopulmonary Nematodes: Dilemmas Solved and New Questions Posed

In the past decade cardiopulmonary nematodes affecting felids have become a core research topic in small animal parasitology. In the late 2000s, an increase in studies was followed by unexpected findings in the early 2010s, which have stimulated research teams to start investigating these intriguing parasites. Prolific scientific debate and exchanges have then fostered field and laboratory studies and epi-zootiological surveys. New data have improved basic and applied knowledge, solved dilemmas and posed new questions. This article discusses the past and present background to felid cardiopulmonary nematodes after the last few years of intense scientific research. New data which have demonstrated the key role of Aelurostrongylus abstrusus and Troglostrongylus brevior in causing respiratory infections in domestic cats, and on the nil to negligible current importance of other species, i.e., Troglostrongylus subcrenatus, Oslerus rostratus and Angiostrongylus chabaudi, are presented. Biological information and hypothesized alternative routes of infection are analysed and discussed. Novel identification and taxonomical data and issues are reported and commented upon. On the whole, recent biological, ecological and epi-zootiological information on felid meta-strongyloids is critically analysed, with the aim to answer outstanding questions, stimulate future studies, and underline new research perspectives.

Detection of Crenosoma spp., Angiostrongylus vasorum and Aelurostrongylus abstrusus in Gastropods in Eastern Austria

Canine and feline cardiorespiratory parasites are of utmost relevance in veterinary medicine. Key epizootiological information on major pet metastrongyloids, i.e., Angiostrongylus vasorum and Crenosoma vulpis infecting dogs, and Aelurostrongylus abstrusus and Troglostrongylus brevior infecting cats, is missing from Austria. This study investigated their occurrence in 1320 gastropods collected in the Austrian provinces of Styria, Burgenland, Lower Austria, and in metropolitan Vienna. Metastrongyloid larvae were microscopically detected in 25 samples, and sequence analysis confirmed the presence of metastrongyloids in nine samples, i.e., A. vasorum in one slug (Arion vulgaris) (0.07%), C. vulpis in five slugs (one Limax maximus and four A. vulgaris) (0.4%), A. abstrusus in two A. vulgaris (0.17%), and the hedgehog lungworm Crenosoma striatum was detected in one A. vulgaris. The present study confirms the enzooticity of major cardiorespiratory nematodes in Austria and that canine and feline populations are at risk of infection.

Troglostrongylus brevior is the dominant lungworm infecting feral cats in Jerusalem

Feline lungworms infect the respiratory tract of wild and domestic cats, causing infection often associated with clinical disease. Until recently, Aelurostrongylus abstrusus has been considered the most relevant species of lungworm, while Troglostrongylus brevior was considered of less significance. Fecal samples of feral cats from Jerusalem, Israel, collected over a year, were examined for first stage lungworm larvae (L1) using the Baermann method. Positive samples were morphologically identified, and their species identity was molecularly confirmed. Forty of 400 (10.0%) cats were lungworm-positive, of which 38/40 (95.0%) shed Troglostrongylus brevior and 6/40 (15.0%) shed Aelurostrongylus abstrusus. Four cats (10.0%) had mixed infections with both lungworm species. L1 shedding was associated with clinical respiratory signs in 11 (19.0%) T. brevior shedding cats of a total of 58 cats manifesting respiratory signs, while 23/342 (6.7%) cats without respiratory signs were L1-positive (p = 0.006). Non-respiratory clinical signs were also found to be more prevalent in L1 shedders (p = 0.012). A young kitten ≤ 4 weeks of age shed T. brevior L1 larvae. DNA sequences of both lungworm species using the ribosomal internal transcribed spacer 2 (ITS2) locus were > 99% similar to other sequences deposited in GenBank, suggesting that T. brevior and A. abstrusus ITS2 sequences are both highly conserved. In conclusion, L1 shedding in feral cats from Jerusalem were mostly caused by T. brevior with only a small proportion involving A. abstrusus, different from many studies from other geographical regions.

Intermediate gastropod hosts of major feline cardiopulmonary nematodes in an area of wildcat and domestic cat sympatry in Greece

Background

The metastrongyloid nematodes Aelurostrongylus abstrusus, Troglostrongylus brevior and Angiostrongylus chabaudi are cardiopulmonary parasites affecting domestic cats (Felis catus) and wildcats (Felis silvestris). Although knowledge on these nematodes has been improved in the past years, gaps in our knowledge of their distribution and role of gastropods as intermediate hosts in Europe still exist. This study reports on the presence of these nematodes and their intermediate hosts in an area in Greece where domestic cats and wildcats occur in sympatry.

Methods

Terrestrial gastropods were collected in the field and identified morphologically and by mitochondrial DNA-sequence analysis. Metastrongyloid larvae were detected by artificial digestion, morphologically identified to the species and stage level and their identity was molecularly confirmed.

Results

Aelurostrongylus abstrusus was found in the snails Massylaea vermiculata and Helix lucorum, T. brevior in the slug Tandonia sp., and A. chabaudi in the slug Limax sp. and the snails H. lucorum and M. vermiculata.

Conclusions

To the best of our knowledge this study provides the first reports of (i) terrestrial gastropods being naturally infected with A. chabaudi, (ii) T. brevior naturally infecting terrestrial gastropods in Europe, and (iii) A. abstrusus naturally infecting terrestrial gastropods in Greece. Furthermore, the present study describes for the first time developmental stages of A. chabaudi and T. brevior in naturally infected gastropods. The biological characteristics of various intermediate gastropod hosts that could influence the distribution and expansion of feline cardiopulmonary nematodes are discussed, along with epizootiological implications and perspectives.

The effect of the hibernation on the larval development of Troglostrongylus brevior in the land snail Cornu aspersum

Troglostrongylus brevior, a lungworm affecting wild felids, has been increasingly reported in domestic cats from Europe. Troglostrongylosis is a relevant disease that may result in a potentially life-threatening bronchopneumonia, especially in kittens. The life cycle of T. brevior is indirect with terrestrial gastropods acting as intermediate host. The widely distributed spread land snail Cornu aspersum (former Helix aspersa) is competent for T. brevior development and may transmit the nematode in natural conditions. The present study evaluated the larval development of T. brevior in C. aspersum at two different environmental temperature conditions, with a focus on the effect of hibernation. One hundred and seventy snails were infected with 500 first stage larvae (L1) of T. brevior and kept in vivaria at 25 ± 2 °C. Fifteen days post infection (p.i.), 20 specimens were digested to evaluate the overall larval developmental rate from L1 to L3 (2.5 % on days 15 p.i.) and then the snails were divided in two groups, i.e. G1 kept at 25 ± 2 °C and G2 that were hibernated at 4 ± 2 °C. The developmental rate of T. brevior was evaluated in these groups on 30 and 60 days p.i. by snail digestion at each time-point. An additional batch of 40 snails (G2-1) was hibernated on D15 and digested on D60. Larvae recovered were morphologically and morphometrically examined. The infective third larval stage (L3) was detected in the muscular foot of C. aspersum at different rates depending on the environmental temperature. In particular, T. brevior showed a higher developmental rate in hibernated snails (G2: 6.9 % and 14.1 % on days 30 and 60 p.i; G2-1: 4%; G2 + G2-1 overall mean percentage: 9%) compared to non-hibernated snails (G1: 4% and 5.2 % on days 30 and 60 p.i.), indicating that lower temperatures may positively influence the developmental in C. aspersum. These data are suggestive for a seasonal pattern of T. brevior infections under field conditions, with snails containing higher parasitic burdens after their natural hibernation occurring in winter. Studies on the larval development of T. brevior in other mollusc species in field surveys evaluating differences in developmental rates and transmission patterns in different seasons are warranted.

Is Angiostrongylosis a Realistic Threat for Domestic Cats?

Three species of Angiostrongylus have been found in felids thus far, i.e., Angiostrongylus chabaudi, Angiostrongylus felineus and Angiostrongylus vasorum. Angiostrongylus chabaudi lives in the right heart and pulmonary arteries of the definitive natural host, the European wildcat (Felis silvestris), and non-patent infections have been reported in domestic cats (Felis catus). Angiostrongylus felineus, described in the Puma yaguarondi (Herpailurus yagouaroundi), has never been reported in domestic felids, while recently a non-patent infection by A. vasorum was unequivocally described in a F. catus. Nonetheless, epizootiological and clinical relevance of angiostrongylosis in domestic cats are practically unknown. This study investigated whether cases of angiostrongylosis may be missed in cats living in areas enzootic for Angiostrongylus spp. and other metastrongyloids. Overall, 100 cats that were either positive (n.50) or negative (n.50) for metastrongyloid larvae at the Baermann's test, were examined for Angiostrongylus spp. with DNA-based methods and with the serological test Angio Detect™ for circulating antigen. The PCR analysis confirmed the copromicroscopy results, where 25 cats scored positive for Aelurostrongylus abstrusus, 16 for Troglostrongylus brevior and 9 for both, while no cats were positive for Angiostrongylus-like larvae, including A. chabaudi. None of the 100 sera samples scored positive at the Angio Detect™ test. These data suggest that currently feline angiostrongylosis is a minor parasitosis for domestic cats. Nevertheless, it cannot be excluded that the epizootiological drivers which have favored the spillover of A. vasorum and T. brevior from wildlife to dogs and cats, could promote the emergence of feline angiostrongylosis, with an unpredictable health impact.

Brachylaima spp. (Trematoda) parasitizing Cornu aspersum (Gastropoda) in France with potential risk of human consumption

The edible land snail Cornu aspersum, native to the Mediterranean coastlines of North Africa, is widely distributed on most continents and often invasive in areas where introduction is recent. This species could contribute to the geographic spread of parasites as demonstrated for Brachylaima spp. These cosmopolitan trematodes may represent a threat to human health, like in Australia where Brachylaima cribbi infects humans. In this study, we demonstrate for the first time the occurrence of Brachylaima spp. in two French populations of C. aspersum, Thorigné-Fouillard (Ille-et-Vilaine), and Arçais (Deux-Sèvres), with an overall prevalence of 10.4% (Thorigné-Fouillard) and 73.3% (Arçais), respectively and a metacercarial intensity on average three times higher in Thorigné-Fouillard (37) than in Arçais (11). Cornu aspersum may act as a first and second intermediate host, as demonstrated in Arçais. The morphometrics of metacercariae, particularly the great body length about 2 mm, discriminate our Brachylaima species from those already described in C. aspersum (B. cribbi in Australia, and B. aspersae, B. llobregatensis and B. mascomai in Europe). Molecular analysis, based on 28S and COI, suggests the occurrence of two species in our study, one of which is probably Brachylaima mesostoma, an intestinal parasite of passeriform birds described in Central Europe. We underline the need for further research to identify species of Brachylaima in France and measure the health hazard of consuming field-collected snails.

Effect of different temperatures on survival and development of Aelurostrongylus abstrusus (Railliet, 1898) larvae

Aim of the study was to get in-depth information on Aelurostrongylus abstrusus first-stage larvae (L1s) survival at different temperatures and to assess the capability of these larvae to develop into the third infective stage (L3s). Faeces of a naturally infected cat were split into two aliquots: the first was divided in subsamples assigned to four groups (F1-F4); from the second aliquot, L1s were extracted by Baermann technique, suspended in water and divided into four groups (W1-W4). Groups were stored at different temperatures (F1/W1 -20 ± 1°C; F2/W2 +4 ± 1°C; F3/W3 +14 ± 1°C; and F4/W4 +28 ± 1°C) and L1s vitality assessed every seven days. The capability of L1s stored in water to develop into L3s in snails was evaluated at the beginning and every 21 days. The L1s of W2 and F2 groups remained viable for a longer period (231 and 56 days, respectively) compared to those of other groups. The capability of L1s to moult into L3s in snails showed a decreasing trend; the group W2's L1s maintained the capability to moult into L3s for the longest time (day 189) compared to the other groups. The time of survival of A. abstrusus L1s is influenced by temperature. However, the species seems to be more resistant to temperature variations than other feline lungworms, and this may explain its wider distribution across Europe.

Distribution of the feline lungworm Aelurostrongylus abstrusus in the USA based on fecal testing

Objectives

The aim of this study was to compile commercial reference laboratory data over a 10-year period to determine the distribution of Aelurostrongylus abstrusus, commonly known as feline lungworm, within the USA based on widespread fecal testing in cats.

Methods

The results of 3,610,455 feline ova and parasite (O&P) zinc sulfate centrifugation fecal flotation tests performed at IDEXX Reference Laboratories in the USA from January 2008 to December 2017 were compiled and sorted for tests positive for A abstrusus larvae. The results of 3625 Baermann tests, currently considered the gold standard diagnostic for feline lungworm, were also retrieved from the same period.

Results

Of the tests performed, 4721 (0.13%) feline O&P zinc sulfate centrifugation fecal flotation tests and 75 (2.07%) of the Baermann tests conducted were positive for the presence of A abstrusus larvae. The O&P data revealed a significant association between infection status and sex, while male cats in both the O&P and Baermann data sets had a higher risk of A abstrusus infection than females. Significant variation in positive rates were observed by region and most positive cases were clustered in the Northeast, Midwest and West regions of the USA.

Conclusions and relevance

This study highlights the distribution of feline lungworm in the USA and the limitations of using current testing to diagnose this infection. The introduction of higher throughput, less labor-intensive diagnostic methods could help increase awareness of this parasite among veterinary professionals, achieve a greater understanding of epidemiological factors, and improve the care and treatment for clinically ill feline patients.

Survey of lungworm infection of domestic cats in Hungary

From 61 settlements of 12 Hungarian counties, 303 domestic cats were included in this survey. Between autumn 2016 and spring 2018, fresh faecal samples were randomly collected and examined by flotation and by the Baermann-Wetzel method for the presence of lungworm infection. No eggs of Eucoleus aerophilus were detected. Morphological identification of first instar larvae (L1) was also carried out. In the faeces of 60 cats (19.8%) from 17 settlements and Budapest, L1 of Aelurostrongylus abstrusus were found. More than half of the cats were from the western part of the country. The average number of larvae per gram of faeces was 190.2 ± 304.88. These results are in line with the former findings on the prevalence of aelurostrongylosis of domestic cats in Hungary. In addition, Oslerus rostratus was also found for the first time in the faecal samples of three cats from the eastern part of the country, infected also with Ae. abstrusus. The average age (2.51 ± 1.26 years) of infected cats indicates that lungworm infection is more common among younger cats. No relationship was found between the lung-worm infection and the sex of cats. Non-neutered cats had a significantly higher proportion of lungworm infections. Two-thirds of the infected cats were apparently healthy, and only 19 individuals showed clinical signs of respiratory disorders.

The invasive giant African snail Lissachatina fulica as natural intermediate host of Aelurostrongylus abstrusus, Angiostrongylus vasorum, Troglostrongylus brevior, and Crenosoma vulpis in Colombia

BACKGROUND

Several metastrongyloid lungworms are unreported pathogens in Colombia. Angiostrongylus vasorum and Crenosoma vulpis target the cardiopulmonary system of domestic and wild canids. Aelurostrongylus abstrusus and Troglostrongylus brevior infect felids and considering that six wild felid species exist in Colombia, knowledge of feline lungworm infections is important for their conservation. The zoonotic metastrongyloids Angiostrongylus costaricensis and Angiostrongylus cantonensis can cause severe gastrointestinal and neurological diseases. Angiostrongylus costaricensis has been reported in Colombia, while Ang. cantonensis is present in neighbouring countries. Research on the epidemiology of metastrongyloids in Colombia and South America more broadly requires evaluating the role that gastropods play as intermediate hosts in their life cycles. This study assessed the prevalence of metastrongyloid larvae in populations of the invasive giant African snail, Lissachatina fulica, in Colombia.

METHODOLOGY/PRINCIPAL FINDINGS

A total of 609 Lissachantina fulica were collected from 6 Colombian municipalities. The snails were then cryo-euthanized, artificially digested and the sediments examined microscopically for the presence of metastrongyloid larvae. Based on morphological characteristics 53.3% (56/107) of the snails from Puerto Leguízamo (Department of Putumayo) were infected with Ael. abstrusus larvae, 8.4% (9/107) with Ang. vasorum larvae, 6.5% (7/107) with T. brevior larvae and 5.6% (6/107) with C. vulpis larvae, being the region with highest prevalences of the four species. Snails from Andes (Department of Antioquia) and Tulúa (Department of Valle del Cauca) were positive for Ang. vasorum larvae with a prevalence of 4.6 (11/238) and 6.3% (4/64), respectively. Species identifications were confirmed by PCR and sequencing.

CONCLUSIONS/SIGNIFICANCE

This epidemiological survey reports for first time the presence of Ael. abstrusus, T. brevior, C. vulpis and Ang. vasorum in L. fulica in a number of regions of Colombia.

Feline gastrointestinal parasitism in Greece: emergent zoonotic species and associated risk factors

BACKGROUND

Feline gastrointestinal parasitism constitutes an issue of concern for veterinarians since parasites are widespread and affect animals' health and welfare. Furthermore, some of these pathogens have zoonotic potential. To provide detailed data on the current epizootiology of feline endoparasitism, a multicentric survey was conducted during 2016.

METHODS

Faeces from 1150 cats were collected from all regions of Greece and examined by sedimentation and flotation techniques. Possible risk factors including gender, age, ownership status, living conditions and co-infections with other parasites were assessed using binary regression models for each one of the most prevalent parasites.

RESULTS

The overall gastrointestinal parasite prevalence in cats was 50.7%. The study population consisted of cats of both sexes, different age groups, ownership status and living conditions. A total of 10 gastrointestinal parasitic species were detected and up to 5 different parasites were isolated in the same faecal sample. The most frequently identified parasites were Toxocara cati (n = 278; 24.2%), followed by Cystoisospora spp. (n = 189; 16.4%), Ancylostomatidae (n = 186; 16.2%), Aelurostrongylus abstrusus (n = 40; 3.5%), Giardia spp. (n = 26; 2.3%), Joyeuxiella pasqualei (n = 14; 1.2%), Capillaria aerophila (n = 8; 0.7%), Dipylidium caninum (n = 3; 0.2%), Toxascaris leonina (n = 2; 0.1%) and Troglostrongylus brevior (n = 2; 0.1%). The occurrence of co-infections was 11.6%. Concerning risk factors, the likelihood of T. cati infection was higher for female cats living outdoors and for cats being infected with Cystoisospora spp. In the same frame, young, stray, male and free of A. abstrusus cats were more likely to be infected with Cystoisospora spp. Correspondingly, stray, infected with Giardia spp. but free of Cystoisospora spp. cats were more likely to be infected with Ancylostomatidae. Regarding A. abstrusus infection, a higher probability was reported for cats living outdoors and for cats free of Cystoisospora spp., while Giardia spp. infections were more common in young and co-infected with Ancylostomatidae animals.

CONCLUSIONS

The prevalence of parasitized cats in Greece was high and thus consideration should be paid to control the risk factors, to implement targeted preventive antiparasitic treatments and educate cat owners on the value of prevention for the health and welfare of their cats.

Angiostrongylus vasorum and Aelurostrongylus abstrusus: Neglected and underestimated parasites in South America

The gastropod-borne nematodes Angiostrongylus vasorum and Aelurostrongylus abstrusus are global causes of cardio/pulmonary diseases in dogs and cats. In the last decade, the number of reports on canine and feline lungworms has increased in several areas of Europe and North America. The unspecific clinical signs and prolonged course of these diseases often renders diagnosis challenging. Both infections are considered as emerging and underestimated causes of disease in domestic pets. In South America, little information is available on these diseases, apart from occasional reports proving the principle presence of A. vasorum and A. abstrusus. Thus, the purpose of this review is to summarize reports on infections in both domestic and wildlife animals in South America and to increase the awareness on gastropod-borne metastrongyloid parasites, which also include important zoonotic species, such as A. cantonensis and A. costaricensis. This review highlights the usefulness of diagnostic tools, such as the Baermann funnel technique, serology and PCR, and proposes to include these routinely on cases with clinical suspicion for lungworm infections. Future national epidemiological surveys are recommended to be conducted to gain a deeper insight into the actual epidemiological situation of gastropod-borne parasitoses in South America.

Prevalence of Angiostrongylus vasorum, Aelurostrongylus abstrusus and Crenosoma vulpis larvae in native slug populations in Germany

Metastrongyloid parasites represent sparsely studied parasites of dogs and cats in Germany. Recent European surveys indicate that these parasites are spreading in Europe. Actual data on prevalence of Angiostrongylus vasorum in dogs and foxes reveal several endemic foci in Germany. However, actual data on the prevalence of A. vasorum and other metastrongyloid lungworm larvae in a wide range of slug and snail intermediate hosts, such as Arion lusitanicus, are missing for Germany. To fill this gap, we conducted an epidemiological survey on native German slugs in selected regions of Hesse and Rhineland-Palatinate. The focus was on slugs, because in study areas slugs appear to be more abundant than snails. Slugs were collected throughout different seasons of the year in areas that were previously proven to be hyperendemic for A. vasorum fox infections. Overall, a total of 2701 slugs were collected and examined for lungworm larvae via artificial digestion. The number of A. vasorum larvae per slug varied considerably (1-546 larvae per specimen). Some hotspot areas with high A. vasorum prevalence in slugs (up to 19.4%) were identified. The overall A. vasorum prevalence varied with season with largest number of slugs infected in summer (9.1%) and lowest number in winter (0.8%). The current study revealed a total A. vasorum prevalence of 4.7% in slugs based on microscopic analyses. Confirmation of lungworm species was made by specific duplex-real-time PCRs. Hence, these data demonstrate that final hosts are at a permanent risk for A. vasorum infections during all seasons when living in investigated areas. Besides A. vasorum, other lungworm larvae were also detected, such as Crenosoma vulpis (the fox lungworm, 2.3%) and Aelurostrongylus abstrusus (feline lungworm, 0.2%).

Larval development of Aelurostrongylus abstrusus in experimentally infected Rumina decollata snails

Aelurostrongylus abstrusus is a lungworm distributed worldwide that affects wild and domestic cats, causing bronchopneumonia of varying intensity. Snails serve as intermediate hosts. The aim of the present study was to assess the larval development of A. abstrusus in R. decollata snails and to investigate its potential as an intermediate host. For this purpose, first-stage larvae (L1) of A. abstrusus were obtained from the faeces of naturally infected cats. Doses of 500 L1/snail were given to 24 R. decollata snails, placed on the soil of the breeder chamber, and maintained under laboratory conditions. Three snails were killed at 8, 10, 12, 16, 22, 26, 45 and 55 days post-infection (dpi), and the muscular foot and visceral body were separately digested by an artificial digestion technique. The morphometric parameters of different larval stages were recorded. The mean number of larvae reaching the infective stage at the end of the study (L3) was 262 larvae/snail. The greatest development to L3 was recorded from days16 to 55 pi, during which the isolation was maximum. A. Abstrusus L3 were isolated from the viscera, but isolation from the snail foot was significantly higher. Our results showed for the first time the ability of A. Abstrusus larvae to develop in R. decollata, thus serving as a potential intermediate host.

Occurrence and zoonotic potential of endoparasites in cats of Cyprus and a new distribution area for Troglostrongylus brevior

The present study investigated for the first time the occurrence of pulmonary and intestinal parasites of cats in Cyprus. Cats from five districts of Cyprus (Lefkosia, Lemesos, Larnaka, Pafos and Ammochostos) were examined by classical parasitological methods and the identity of lungworm larvae, whenever present, was confirmed by PCR-coupled sequencing. A total of 185 cats, 48 living exclusively indoors and 137 with outdoor access, were included in the study. Parasites were found in 66 (35.7%) of the examined cats, i.e. Toxocara cati (12%), Cystoisospora rivolta (12%), Joyeuxiella/Diplopylidium spp. (7%), Giardia spp. (6.5%), Troglostrongylus brevior (5%), Cystoisospora felis (2.5%), Aelurostrongylus abstrusus (2%), Taenia spp. (0.5%) and Dipylidium caninum (0.5%). Mixed infections were recorded in 18 cats. Cats that lived exclusively indoors or had received an antiparasitic treatment in the last 6 months were less likely to be infected (p < 0.05). Moreover, cats younger than 1 year old were more likely to shed first-stage larvae of T. brevior (p = 0.04). The present study shows that cats in Cyprus are infected at a high percentage by a variety of parasites that potentially affect their health and also, in some cases (i.e. T. cati, D. caninum, Giardia spp.), may have an impact on human health. Moreover, it was revealed that T. brevior, a lungworm of emerging significance, is present on the island, rendering Cyprus the easternmost distribution border of this parasite in Europe to date.

Lungworms and gastrointestinal parasites of domestic cats: a European perspective

With the exception of Aelurostrongylus abstrusus, feline lungworms have been poorly studied. Information on their distribution is patchy and mostly limited to case reports. In this study, the occurrence of feline lungworms and co-infecting gastrointestinal parasites has been investigated in 12 European countries (i.e. Austria, Belgium, Bulgaria, France, Greece, Hungary, Italy, Portugal, Romania, Spain, Switzerland and the United Kingdom). An average of 10 domestic cats, with regular outdoor access, was sampled each month for 12months, and freshly passed faeces were collected. Stools were processed using a McMaster assay and a quantitative Baermann-Wetzel method. Animals positive for lungworms and/or gastrointestinal parasites were treated with a formulation containing fipronil, (S)-methoprene, eprinomectin, and praziquantel (Broadline®, Merial), and re-sampled 28days post-treatment. The association between lungworm infection and risk factors was analysed using statistical medians/means and the efficacy of the treatment against each lungworm species was assessed. Of 1990 cats sampled, 613 (30.8%) were positive for at least one parasite, while 210 (10.6%) were infected by lungworms. The prevalence of lungworm infection varied between the sampled sites, with the highest recorded in Bulgaria (35.8%) and the lowest in Switzerland (0.8%). None of the cats from Austria or the United Kingdom were infected by lungworms. Aelurostrongylus abstrusus was the species most frequently detected (78.1%), followed by Troglostrongylus brevior (19.5%), Eucoleus aerophilus (14.8%) and Oslerus rostratus (3.8%). The overall efficacy of the treatment was 99% for A. abstrusus and 100% for T. brevior, O. rostratus and E. aerophilus. Data presented provide a comprehensive account of the diagnosis, epidemiology and treatment of feline lungworms in Europe, as well as of the occurrence of co-infections by gastrointestinal parasites.

Natural infection of the feline lungworm Aelurostrongylus abstrusus in the invasive snail Achatina fulica from Argentina

The giant African snail Achatina fulica is an invasive mollusk native to Africa, the first record in Argentina was in Puerto Iguazú, in northeastern Argentina in 2010. Recently it was reported in Corrientes Province. This snail can act as an intermediate host of Metastrongyloidea nematodes of importance in public health as: Angiostrongylus cantonensis, Angiostrongylus costaricensis and Angiostrongylus vasorum. Taking into account the presence of A. fulica in Argentina, the objectives of this study is to assess the presence of Metastrongyloidea nematodes in this mollusk species in Puerto Iguazú, Misiones, close to the international border with Brazil and Paraguay. A total of 451 samples were collected from February 2014 to November 2015. The snails were processed using a digestion technique to recover the parasites. A total of 206 nematodes larvae were founded in the digestion solution of 10 hosts (P=2%; MA=0.5; MI=21). Third larval stage (L3) nematodes identified as Aelurostrongylus abstrusus were founded parasitizing the snails. No other larval stage was observed. This species has veterinary importance because it causes 'aelurostrongilosis', also known as feline strongyloidosis. This study constitutes the first record of a Metastrongyloidea nematode in A. fulica in Argentina and also highlights the susceptibility of this mollusk as intermediate host of other helminthes of health importance. The present study suggests that there is a need to establish an epidemiological monitoring system in order to prevent the possible installation of an infected mollusks focus.

Updates on feline aelurostrongylosis and research priorities for the next decade

Feline aelurostrongylosis, caused by the metastrongyloid nematode Aelurostrongylus abstrusus, is an important gastropod-borne parasitic lung disease in cats. Infection with A. abstrusus is widespread globally, but the increasing awareness of this parasite and the advent of more sensitive diagnostics have contributed to the apparent increase in its prevalence and geographic expansion. Clinical features may range in severity from subclinical to life-threatening respiratory disease. Parasitological standard techniques, such as visualization of the nematode first larval stage in faecal and respiratory (bronchial mucus or pleural fluid) samples, remain the mainstays of diagnosis. However, diagnosis is evolving with recent advances in serological and molecular testing, which can improve the time to initiation of effective anthelmintic therapy. Despite numerous anthelmintics that are now available as treatment options, the role of host immunity and lifestyle factors in selecting cats that may benefit from more targeted anthelmintic prophylaxis or treatment practice remains unclear and is likely to guide therapeutic choices as newer data become available. This review summarizes the biology, epidemiology, pathophysiology, diagnosis and treatment options currently available for feline aelurostrongylosis.

Evaluation of different methods for the experimental infection of the land snail Helix aspersa with Aelurostrongylus abstrusus lungworm

The laboratory maintenance of parasitic life cycles is crucial to support research in many fields of parasitology. The land snail Helix aspersa (syn. Cornu aspersum), an intermediate host of feline lungworms Aelurostrongylus abstrusus and Troglostrongylus brevior, is adopted to produce infective stages of those nematodes in laboratory condition. The aim of this study was to compare the most common methods of experimental infection of H. aspersa with first stage larvae (L1) of A. abstrusus (i.e., contact of the snail foot with the L1) with the injection of these larvae in the foot of the snail, instrumental to reduce the infection time and to maximize the output of third-stage larvae (L3). Three groups (i.e., A, B, C) of 15 H. aspersa snails were infected with L1 of A. abstrusus (n=250 for each snail), whereas a fourth group (group D) was not infected (control). Snails were individually placed for 48h on a microfilm containing L1 (group A), on a potato slice previously irrigated with a suspension of L1 (group B), or they were inoculated by injection of L1 in the posterior-ventral portion of the foot (group C). Eighteen days after the infection all snails were analyzed and tissues were digested to recover L3. No difference in mortality rate was recorded among snail groups and the mean number of retrieved L3 was significantly larger in group C (71.5±52.9) compared to group B (38.2±44.9; p=0.0161) and group A (19±23.3; p<0.0001). The injection of A. abstrusus L1 in the foot of H. aspersa proved to be a fast, easy to apply and effective method, resulting in the largest number of infective larvae retrieved.

Relation between Aelurostrongylus abstrusus larvae excretion, respiratory and radiographic signs in naturally infected cats

A study was carried out to assess the possible relation between the number of Aelurostrongylus abstrusus larvae per gram of feces (LPG) with respiratory signs and radiographic findings in naturally infected cats. Out of 196 owned cats, 52 (26.5%) were found infected with A. abstrusus. Positive cats were divided into 4 age groups (1, 2-6 months; 2, 7-11 months; 3, 1-5 years and, 4, >6 years). Thoracic radiographs in double orthogonal views were carried out and cats were ranked on the basis of the respiratory signs (0, no symptoms; 1, mild; 2, moderate and 3, severe symptoms) and radiographic changes. Data showed that increasing LPGs were associated with higher probability to develop more severe symptoms, although some asymptomatic cats had high number of LPGs. Radiographic score and LPGs decreased with increasing cat age. A. abstrusus should be included in the differential diagnosis of lung diseases also in cats with mild respiratory symptoms.

Diagnosis and management of lungworm infections in cats: Cornerstones, dilemmas and new avenues

PRACTICAL RELEVANCE

Respiratory parasites infecting domestic cats are attracting increased attention in feline clinical practice. In addition to the most commonly recognised 'cat lungworm' Aelurostrongylus abstrusus, Troglostrongylus brevior and Capillaria aerophila are now considered important pathogens of the respiratory tract of cats.

GLOBAL IMPORTANCE

These parasites are being increasingly diagnosed in several regions of the world and a continuous update on epidemiological changes and advances in diagnosis and control is of practical importance.

AIMS

This article reviews current knowledge of lungworms affecting cats, with a special focus on recent insights into diagnosis and management of the diseases they cause. The article also explores some potential new avenues for control of feline parasitic respiratory diseases, and highlights some key areas requiring further research.

Felid Lungworms and Heartworms in Italy: More Questions than Answers?

Nematodes infecting the cardiorespiratory system of cats have recently stimulated high scientific interest. Over the past few years, different aspects of these parasites have been clarified and various issues elucidated. This increased knowledge has improved awareness on this topic but, at the same time, some dilemmas have not been solved and new questions have been raised. In this review, we underline and discuss current knowledge of, and new doubts relating to, feline lungworms and heartworms, with the aim of stimulating new studies to fill gaps of basic (i.e., epidemiology and biology) and applied (i.e., clinical aspects) knowledge of the old and new parasites affecting the cardiorespiratory system of cats.

Lungworm disease in cats: ABCD guidelines on prevention and management

OVERVIEW

Cardiopulmonary nematodes are emerging parasites of cats in Europe. A number of helminth parasites may be involved. The most prevalent lungworm in domestic cats is Aelurostrongylus abstrusus. Oslerus rostratus and Troglostrongylus species are found mainly in wild cats. The trichurid Capillaria aerophila has a low host specificity and is not uncommon in cats. Additionally the lung flukes Paragonimus species are reported in many species outside of Europe, including cats.

CLINICAL SIGNS

Lungworm infections may be asymptomatic, or cause mild to severe respiratory signs, dependent on the worm species and burden; mixed infections are observed. Kittens can be vertically infected and may develop a more severe disease. Affected cats show a productive cough, mucopurulent nasal discharge, tachypnoea, dyspnoea and, in severe cases, respiratory failure and death.

MANAGEMENT

Early diagnosis and treatment greatly improves the prognosis. First-stage larvae can be easily detected in fresh faecal samples; the Baermann migration method is the enrichment technique of choice, but takes 24 h. Lungworm larvae can be found in tracheal swabs and bronchoalveolar lavage fluid, but with less sensitivity than in faeces. Molecular methods have been developed that exhibit high specificity and sensitivity, and allow diagnosis in the prepatent phase. Treatment options include fenbendazole paste, milbemycin oxime/praziquantel and various spot-on formulations. Severe cases should receive prompt medical care in an intensive care unit.

PREVENTION

Avoiding predation is at present the only preventive measure for pulmonary worms with indirect life cycles.

ZOONOTIC RISK

C aerophila has zoonotic potential, causing severe pulmonary disease in humans. Some Paragonimus species are also of zoonotic concern.

Release of lungworm larvae from snails in the environment: potential for alternative transmission pathways

Background

Gastropod-borne parasites may cause debilitating clinical conditions in animals and humans following the consumption of infected intermediate or paratenic hosts. However, the ingestion of fresh vegetables contaminated by snail mucus and/or water has also been proposed as a source of the infection for some zoonotic metastrongyloids (e.g., Angiostrongylus cantonensis). In the meantime, the feline lungworms Aelurostrongylus abstrusus and Troglostrongylus brevior are increasingly spreading among cat populations, along with their gastropod intermediate hosts. The aim of this study was to assess the potential of alternative transmission pathways for A. abstrusus and T. brevior L3 via the mucus of infected Helix aspersa snails and the water where gastropods died. In addition, the histological examination of snail specimens provided information on the larval localization and inflammatory reactions in the intermediate host.

Methodology/Principal Findings

Twenty-four specimens of H. aspersa received ~500 L1 of A. abstrusus and T. brevior, and were assigned to six study groups. Snails were subjected to different mechanical and chemical stimuli throughout 20 days in order to elicit the production of mucus. At the end of the study, gastropods were submerged in tap water and the sediment was observed for lungworm larvae for three consecutive days. Finally, snails were artificially digested and recovered larvae were counted and morphologically and molecularly identified. The anatomical localization of A. abstrusus and T. brevior larvae within snail tissues was investigated by histology. L3 were detected in the snail mucus (i.e., 37 A. abstrusus and 19 T. brevior) and in the sediment of submerged specimens (172 A. abstrusus and 39 T. brevior). Following the artificial digestion of H. aspersa snails, a mean number of 127.8 A. abstrusus and 60.3 T. brevior larvae were recovered. The number of snail sections positive for A. abstrusus was higher than those for T. brevior.

Conclusions

Results of this study indicate that A. abstrusus and T. brevior infective L3 are shed in the mucus of H. aspersa or in water where infected gastropods had died submerged. Both elimination pathways may represent alternative route(s) of environmental contamination and source of the infection for these nematodes under field conditions and may significantly affect the epidemiology of feline lungworms. Considering that snails may act as intermediate hosts for other metastrongyloid species, the environmental contamination by mucus-released larvae is discussed in a broader context.

Gastropod-borne parasites may cause debilitating clinical conditions in animals and humans. The infection occurs by consumption of intermediate hosts (i.e., snails). However, the ingestion of fresh vegetables contaminated by water and/or snail mucus has been proposed as a transmission source for some zoonotic metastrongyloids (e.g., Angiostrongylus cantonensis). Aelurostrongylus abstrusus and Troglostrongylus brevior cause severe clinical conditions in cats and their prevalence is increasing in feline populations. The epidemiology of feline lungworm infections is poorly understood and the role of gastropod molluscs, as vectors of the disease, is questioned. Since metastrongyloid nematodes may use other little-studied infection pathways, the presence of A. abstrusus and T. brevior larvae was herein assessed in the mucus of Helix aspersa snails and in the water where specimens died. The finding of A. abstrusus and T. brevior infective L3 in the mucus shed by H. aspersa or when infected gastropods die submerged in water indicates that alternative pathways for the transmission of feline lungworms may occur. Accordingly, these results should spur the interest of the scientific community towards the delineation of further infection routes for other metastrongyloids of major human concern, such as Angiostrongylus costaricensis and A. cantonenis.

Treatment of Troglostrongylus brevior (Metastrongyloidea, Crenosomatidae) in mixed lungworm infections using spot-on emodepside

Feline lungworms have long been known as pathogens of cats. However, an increased incidence of clinical cases in some areas has been the focus of a number of recent epidemiological and clinical studies. While Aelurostrongylus abstrusus causes respiratory signs in cats all over the world, Troglostrongylus brevior has recently been found in domestic cats from Spain and Italy (where it often causes severe clinical signs). Capillaria aerophila, a parasite that infects many wild carnivores, may cause respiratory distress in cats. A variety of treatment options are known for A abstrusus, while almost no information is available on the treatment of troglostrongylosis and capillariosis. This series describes two mixed infections in clinically affected kittens with T brevior, one with concurrent A abstrusus and the other with C aerophila. In both cases, the nematodes were identified and confirmed by copromicroscopic examination and specific DNA-based assays. Kittens showed respiratory signs that resolved after one or two administrations of a spot-on solution containing emodepside. Larval (T brevior and A abstrusus) and egg (C aerophila) shedding was also eliminated 2-4 weeks after treatment. New clinical insights into these parasitoses are discussed.

Canine angiostrongylosis: recent advances in diagnosis, prevention, and treatment

Angiostrongylus vasorum is a parasitic nematode affecting the heart and pulmonary arteries of wild (eg, foxes) and domestic canids. The parasite has an indirect life cycle in which slugs and snails act as intermediate hosts. In the last few years the parasite has spread outside the traditional endemic foci, and there is a rise of documented cases of canine angiostrongylosis across Europe. Angiostrongylus vasorum causes cardiopulmonary disorders and coagulopathies, along with different nonspecific clinical signs. Fatal infections are frequently reported. Given the severity of the infection and the recent geographic spreading of the parasite, this article reviews and discusses the current knowledge of A. vasorum, with a special focus on recent insights on diagnosis, prevention, and treatment of dog angiostrongylosis.

Cardio-Pulmonary Parasitic Nematodes Affecting Cats in Europe: Unraveling the Past, Depicting the Present, and Predicting the Future

Various cardio-pulmonary parasitic nematodes infecting cats have recently been fascinating and stimulating the attention of the Academia, pharmaceutical companies, and veterinary practitioners. This is the case of the metastrongyloids: Aelurostrongylus abstrusus and Troglostrongylus brevior, the trichuroid: Capillaria aerophila (syn. Eucoleus aerophilus), and the filarioid: Dirofilaria immitis. Apparently, these parasites have been emerging in several European countries, thus, gaining an important role in feline parasitology and clinical practice. Under a practical standpoint, a sound knowledge of the biological, epidemiological, and clinical impact of cardio-respiratory parasitoses affecting cats, in addition to a potential risk of introduction, establishment, and spreading of “new” parasites in Europe is mandatory in order to understand the present and future impact for feline medicine and to address new strategies of control and treatment. The purpose of the present article is to review the current knowledge of heartworm and lungworm infections in cats, discussing and comparing past and present issues, and predicting possible future scenarios.

The European wildcats (Felis silvestris silvestris) as reservoir hosts of Troglostrongylus brevior (Strongylida: Crenosomatidae) lungworms

The increasing reports of Troglostrongylus brevior lungworm in domestic cats from Italy and Spain raised questions on its factual distribution and on the role wildcats play as reservoirs of these parasites. Carcasses of 21 wildcats were collected in natural parks of southern Italy (i.e., Catania, Sicily n=5 and Matera, Basilicata n=16) and biometrically and genetically identified as Felis silvestris silvestris, but two as hybrids. Troglostrongylus brevior and Eucoleus aerophilus lungworms were found in 15 (71.4%) and 7 (33.3%) individuals, respectively, being five (23.8%) co-infected by the two species. Both lungworms showed an aggregated distribution in the host population, assessed by k-index (i.e., 0.69 for T. brevior and 0.42 for E. aerophilus). Although no statistical significant difference was recorded among age, gender and geographical location of wildcats, a larger rate of infection by T. brevior was assessed in yearlings (85.7%) than adults (64.3%). This is the first epidemiological study reporting T. brevior infection in the European wildcat and discusses the potential threat this may represent for the conservation of this endangered species of felids. In addition, given the large frequency of lungworm infection herein recorded, the role of wildcats as reservoir hosts of these parasites to domestic cats is discussed.

Lungworms of the genus Troglostrongylus (Strongylida: Crenosomatidae): neglected parasites for domestic cats

Feline lungworms belonging to the Troglostrongylus genus have been neglected for a long time. However, recent reports of Troglostrongylus brevior and Troglostrongylus subcrenatus in domestic cats have stimulated the interest of the scientific community on these lungworms. Troglostrongylus spp. have an indirect life cycle, which overlaps that of the better known Aelurostrongylus abstrusus. Nonetheless, adult worms of both genera have a distinct morphology and localization within the respiratory system of definitive hosts and, potentially, a different epidemiology and pathogenicity. As copromicroscopy has a low specificity for metastrongyloids due to the similarities of first-stage larvae, specific morphometrical keys and/or PCR diagnostic tools are advocated. Accordingly, more clinical studies and necropsy data are needed to elucidate the impact of Troglostrongylus spp. on the health of domestic cats. This article reviews current information on Troglostrongylus spp. as well as data on their occurrence in Europe and reports specific key morphological characters for the identification of adults and larvae, which is important to refine their diagnosis and for a better understanding of the feline lungworm infections.

Development of the feline lungworms Aelurostrongylus abstrusus and Troglostrongylus brevior in Helix aspersa snails

Aelurostrongylus abstrusus (Strongylida, Angiostrongylidae) and Troglostrongylus brevior (Strongylida, Crenosomatidae) are regarded as important lungworm species of domestic felids, with the latter considered an emerging threat in the Mediterranean region. The present study aimed to assess their concurrent development in the mollusc Helix aspersa (Pulmonata, Helicidae). Thirty snails were infested with 100 first-stage larvae (L1) of A. abstrusus and T. brevior, isolated from a naturally infested kitten. Larval development was checked by digesting five specimens at 2, 6 and 11 days post infestation. Larvae retrieved were morphologically described and their identification was confirmed by specific PCR and sequencing. All H. aspersa snails were positive for A. abstrusus and T. brevior, whose larval stages were simultaneously detected at each time point. In addition, snails were exposed to outdoor conditions and examined after overwintering, testing positive up to 120 days post infestation. Data herein presented suggest that A. abstrusus and T. brevior develop in H. aspersa snails and may eventually co-infest cats. Data on the morphology of both parasitic species in H. aspersa provide additional information on their development and identification, to better understand the population dynamics of these lungworms in receptive snails and paratenic hosts.

Mixed infection by Aelurostrongylus abstrusus and Troglostrongylus brevior in kittens from the same litter in Italy

Parasitic nematodes affecting the respiratory system of felids are spreading in endemic regions and emerging in previously free areas and/or hosts. This is particularly the case of the cat lungworm Aelurostrongylus abstrusus, which can cause respiratory signs in cats all over the world. Additionally, Troglostrongylus brevior has been recently found in domestic cats from Ibiza Island in Spain and Southern Italy. The present paper describes the first mixed infection by these lungworms in kittens belonging to the same litter. Two ∼10-11 weeks old kittens were found infected by A. abstrusus and T. brevior at a copromicroscopical examination. The identity of larvae shed by faeces were confirmed with an already validated PCR specific for A. abstrusus and a novel DNA-based assay specific for T. brevior. One kitten showed severe respiratory signs and died despite an anthelmintic treatment, while the other had a subclinical infection and recovered after a parasiticide administration with milbemycin oxime. New insights into epidemiology, biology, clinical aspects and control of these parasitoses are discussed.

Intermediate and paratenic hosts in the life cycle of Aelurostrongylus abstrusus in natural environment

The cat lungworm Aelurostrongylus abstrusus affects the domestic cats and other felids all over the world. Feline aelurostrongylosis is of importance in clinical feline medicine. Snails and slugs are the intermediate hosts, but the cat is probably infected by eating paratenic hosts, e.g., rodents, birds, amphibians and reptiles. Herein we present the first finding of A. abstrusus in a naturally infected invasive synantropic slugs Arion lusitanicus (intermediate host) and wild living rodents Apodemus agrarius (paratenic host). The results confirm the usefulness of molecular approaches for investigating the biology, ecology and epidemiology of A. abstrusus, the agent of feline aelurostrongylosis.

Feline lungworms: what a dilemma

Aelurostrongylus abstrusus is regarded as the major lungworm infecting Felis catus, although other, albeit poorly studied, nematodes have been described from the respiratory system of domestic cats. Recent records of these neglected parasites have renewed the attention of the scientific community, but their actual role in respiratory disease in cats is blurred. The epidemiology, pathogenic role, and diagnosis of Troglostrongylus spp., Oslerus rostratus, and Capillaria aerophila in domestic cats are far from being clarified. Indeed, recent studies have provided novel information but have also given rise to relevant doubts. We discuss here the state of current knowledge regarding felid lungworms together with the dilemmas recently roused in the scientific literature.