Thelazia callipaeda (Spirurida: Thelaziidae): first report in Greece and a case of canine infection

Thelazia callipaeda as a potential new threat to european wildcats: insights from an eco-epidemiological study

Global warming and displacement of vectors and wild and domestic hosts by humans greatly change host-parasite interactions and parasite transmission rates. Thelazia callipaeda Railliet and Henry, 1910 (Spirurida: Thelaziidae) is a zoonotic parasite rapidly colonizing Europe from its Asian native range. This nematode is vectored by Phortica flies and may cause ocular disorders, such as keratitis and corneal ulcers, in wild mammals, dogs, cats and humans. With the aim of detecting possible threats for the European wildcat (Felis silvestris) in one of its last Mediterranean strongholds, we initiated in 2017 a long-term monitoring program in Sierra Arana (southeastern Spain), which includes exploring its epidemiological and spatial relationships with domestic cats (Felis catus). During routine medical check-ups, we detected ocular nematodes in 3 of 17 (17.6%) wildcats and 1 of 23 (4.3%) domestic cats tested, confirmed to be T. callipaeda by microscopic and molecular analyses. This nematode species was first detected in the study area in 2021. To our knowledge, this is the first case of infection in wildcats in Spain. Through telemetry, we detected little spatial overlap between the home ranges of wildcats and domestic cats, which seems to be sufficient to facilitate the inter-specific transmission of T. callipaeda. Our findings suggest that this pathogen could be a new threat to the wildcat, a locally endangered wild felid. Further eco-epidemiological monitoring and sanitary control of domestic cats will be strongly needed, especially given the ongoing global warming scenario.

Feline thelaziosis (Thelazia callipaeda) in Spain: state-of-the-art and first prophylactic trial in cats

OBJECTIVES

Thelaziosis caused by the nematode Thelazia callipaeda (Spirurida, Thelaziidae) affects the eyes of domestic and wild carnivores, lagomorphs and even humans. The role of cats in spreading thelaziosis remains unclear. The present study assesses the current status of feline T callipaeda infection in Spain and presents the results of the first prophylactic trial conducted in this species.

METHODS

We retrospectively analysed the occurrence of feline thelaziosis (study 1), examined its prevalence based on cross-sectional sampling of endemic areas (study 2), and assessed the therapeutic/prophylactic benefits of a spot-on (moxidectin) and therapeutic efficacy of an eye drop (ivermectin) formulation (study 3).

RESULTS

In study 1, 69 Thelazia-infected cats were examined. Autochthonous cases were detected in 18/26 municipalities surveyed in Spain, which corresponds to 88.4% (n = 61/69) of the total number of cases. In study 2, 74 cats (20 from La Vera region and 54 from Orense province) were examined from 2011 to 2013. Ten of these cats (13.5%) were infected with T callipaeda. The infection prevalence was 40% (n = 8/20) in La Vera and 3.7% (n = 2/54) in Orense. The therapeutic efficacy of ivermectin was assessed over a summer (2011) in 12 cats, while that of moxidectin was examined over a 17-month period in seven cats. Four of these seven cats were subsequently included in an all-year-round prophylaxis trial. Treatment efficacy ranged from 91.7% (ivermectin) on day 28 after treatment to 100% (moxidectin) on day 14. Moxidectin prevented reinfections in cats.

CONCLUSIONS AND RELEVANCE

Our data confirm the endemic status of T callipaeda infection in Spain, revealing its high prevalence in cats living in known endemic areas. Moxidectin was effective in treating and preventing infection. We strongly recommend the inclusion of thelaziosis in the differential diagnosis of pets and humans presenting with ocular manifestations, along with adequate preventive measures.

Update on the treatment and prevention of ocular thelaziosis (Thelazia callipaeda) in naturally infected dogs from Spain

This study examines the therapeutic and year-round prophylactic efficacy of different formulations used in dogs in three Spanish areas where canine thelaziosis is endemic. The study was conducted as a Good Clinical Practice, multicentre, randomised field study in privately owned outdoor dogs naturally infected with Thelazia callipaeda. The active pharmaceutical ingredients tested were: an oral formulation of milbemycin oxime 12.5 mg combined with praziquantel 125 mg (A), a subcutaneous sustained-release formulation of moxidectin 10 g (B), a moxidectin 2.5% weight/volume (w/v) spot-on formulation combined with imidacloprid 10% w/v (C), and an eye drop formulation (6 µg) of ivermectin 10 mg/ml diluted 10% in propylene glycol (D). Infected dogs were randomly allocated to treatment Groups A, B, C and D. Dogs testing negative for T. callipaeda inspection in two visits (Day 7/Day 14 and D30) were enrolled in the prophylaxis trial and reallocated to the corresponding study group (A, B, C or D). Treatment efficacy ranged from 70.4% recorded in Group A 1 week after treatment, to 100% recorded in Group C on Day 30 and in Group B on Day 60. Treatment was more efficacious in Group D (85.7% 1 week after treatment) than A, but was never 100% efficacious as in Groups B and C. Year-round prophylactic efficacy was 83.3% in Group A, 100% in Group B, 93.5% in Group C and 87.5% in Group D. In conclusion, products containing moxidectin were highly efficacious both in treating and preventing canine thelaziosis. Milbemycin also emerged as a good option. However, the off-label use of topical or subcutaneous ivermectin should be avoided due to possible adverse reactions such as pruritus, irritation or redness. In endemic areas, monthly prophylaxis to limit the spread of T. callipaeda to new areas across Europe and reduce zoonotic risks is essential.

Systematic review on infection and disease caused by Thelazia callipaeda in Europe: 2001-2020

Cases of thelaziosis by Thelazia callipaeda have been increasing considerably in Europe throughout the 21st century, with recent emphasis on Eastern Europe. A systematic review was conducted using defined search terms across three major databases and, additionally, with the examination of the references of the 56 articles selected. Available information about epidemiological and clinical features of all cases of thelaziosis by T. callipaeda in companion animals, wildlife and humans was extracted, evaluated and subjected to qualitative and quantitative analysis. In all cross-sectional studies about dogs, cats and red foxes, males were more frequently infected than females (dogs: p = 0.0365; cats: p = 0.0164; red foxes: p = 0.0082). Adult dogs seem to be more prone to infection (p < 0.0001), as well as large-sized dogs (p < 0.0001), and companion animals that live exclusively outdoors (p < 0.0001). Dogs and red foxes involved in these cross-sectional studies harboured significantly more female than male nematodes (p < 0.0001). Thelaziosis by T. callipaeda is far from controlled in Europe. Only through updated epidemiological data, knowledge improvement and awareness can correct diagnosis and appropriate treatment and prevention be ensured to tackle this zoonosis.

Canine thelaziosis in the Czech Republic: the northernmost autochthonous occurrence of the eye nematode Thelazia callipaeda Railliet et Henry, 1910 in Europe

The eye nematode Thelazia callipaeda Railliet et Henry, 1910 (Spirurida: Thelaziidae) is a vector-borne zoonotic nematode infecting a range of wild and domestic carnivores as well as humans. It is considered to be a causative agent of emerging and neglected disease and currently invades central part of Europe. Nematodes were collected from the eye of a dog living in Prague, which never travelled outside the Czech Republic. The nematodes were identified based on their morphology and partial sequence of the cox1 gene as T. callipaeda haplotype 1. This finding represents the northernmost record of autochthonous canine thelaziosis in Europe. The insufficient control of imported animals as well as free movement of dogs and wild carnivores within Europe probably facilitates spreading of T. callipaeda throughout the continent. To better understand the spreading of T. callipaeda and to prevent its zoonotic transmissions, information about the risk of this infection in newly invaded countries should be disseminated not only among veterinarians and physicians, but also within the community of pet owners and hunters.

First report of canine ocular thelaziosis in the Republic of Moldova

Background

Countries of eastern Europe are considered, due to several risk factors, more vulnerable to infections with newly (re)emerging pathogens. During the last decade, in several European countries, reports of autochthonous cases of ocular thelaziosis due to Thelazia callipaeda have been published, posing a great concern from both veterinary and public health perspective. However, in the Republic of Moldova only limited epidemiological data are available regarding zoonotic vector-borne pathogens and, until now, no data exist on the zoonotic nematode T. callipaeda.

Methods

In September 2018, an 11-year-old dog, mixed-breed, intact male was referred to a private veterinary clinic from Chișinău, Republic of Moldova, with a history of 2 weeks of an ocular condition affecting the right eye. The ophthalmological exam revealed the presence of nematode parasites in the conjunctival sac and under the third eyelid. The collected parasites were identified by morphological techniques and molecular analysis.

Results

A total of 7 nematodes were collected, and 5 females and 2 males of T. callipaeda were identified morphologically. The BLAST analysis confirmed the low genetic variability of this parasite in Europe. The travel history of the patient allowed us to confirm the autochthonous character of the case.

Conclusions

To the best of our knowledge, this is the first report of thelaziosis in dogs from the Republic of Moldova, which confirms the spreading trend of T. callipaeda and the existence of an autochthonous transmission cycle of this zoonotic parasite in the country.

Vector-borne nematode diseases in pets and humans in the Mediterranean Basin: An update

Vector-borne diseases (VBDs) are among the leading causes of morbidity and mortality in humans and animals. The scale of VBDs is increasing worldwide, including in the Mediterranean Basin, a region exposed to climate changes. Indeed, weather conditions may influence the abundance and distribution of vectors. The vector-borne nematode diseases of dogs and cats, such as dirofilariosis, onchocercosis, thelaziosis, Cercopithifilaria, and Acanthocheilonema infections, are some of these vectorized diseases, several of which are zoonoses. They are all caused by parasitic nematodes transmitted by arthropods, including mosquitoes (Dirofilaria spp.), black flies (Onchocerca lupi), drosophilids (Thelazia callipaeda), ticks (Acanthocheilonema dracunculoides and Cercopithifilaria bainae), and fleas and lice (Acanthocheilonema reconditum). The control and prevention of these infections and diseases require a multidisciplinary approach based on strengthening collaboration between the different actors in the fields of health, research, sociology, economics, governments and citizens, to improve human, animal, and ecosystem health. This is the concept of "one health." The review aimed to provide a general update on the spatial and temporal distribution of vector-borne nematodes diseases affecting companion animals and humans, as well as the vectors involved in the Mediterranean area. Simultaneously, certain epidemiological parameters, diagnosis, treatment, and control of these diseases based on the "one health" concept will also be discussed.

Thelaziosis due to Thelazia callipaeda in Europe in the 21st century-A review

Thelazia callipaeda was first described at the beginning of the 20th century in Asia, but this eyeworm is now frequently reported in Europe in the 21st century. To date, thelaziosis has been described in the following European countries (in order of appearance): Italy, France, Germany, Switzerland, Spain, Portugal, Belgium, Bosnia and Herzegovina, Croatia, Serbia, Romania, Greece, Bulgaria, Hungary, Slovakia, the United Kingdom, Turkey and Austria. The infected vertebrate host species include domestic carnivores (dogs and cats), wild carnivores (red foxes, wolves, beech martens, wildcats and golden jackals), lagomorphs (brown hares and wild European rabbits) and humans. In Europe, 11 cases of human thelaziosis have been reported, the majority of which are autochthonous. However, some of them have been imported, a fact which highlights the importance of surveillance policies to restrict cross-border spread of the parasite. The objectives of this article are to review key aspects of the epidemiology of T. callipaeda, summarise animal and human cases in Europe and emphasise the importance of education and awareness among veterinarians, physicians (particularly ophthalmologists) and animal, in order to owners to tackle this zoonosis.

The first autochthonous case of feline ocular thelaziosis in Austria

Over the last 30 years, Thelazia callipaeda (Spirurida: Thelaziidae) has increasingly been reported as an agent of ocular infections in animals and humans throughout Europe. Following the cases of canine ocular thelaziosis recently recorded in Austria for the first time, in the present paper, we describe the first case of T. callipaeda infection in an Austrian cat with no history of traveling abroad. This finding further supports the occurrence of the parasite’s autochthonous transmission cycle in the country. The cat showed serous ocular discharge, conjunctival hyperemia, and mild conjunctival edema in the right eye. Mechanical removal of the parasite from the cat’s eye, in combination with milbemycin oxime/praziquantel oral treatment and topical use of tobramycin/dexamethasone eye drops led to complete resolution of the clinical signs within 2 weeks. Results presented in the current study are of great importance for the local veterinarians who seemed largely unaware of this zoonotic parasite. Therefore, increased awareness of medical and veterinary communities is imperative for preventing further infections in both animals and humans.

A historical review on vector distribution and epidemiology of human and animal leishmanioses in Eastern Europe

Many canine diseases, infectious or parasitic, have been newly reported as autochthonous in the last few years in Eastern Europe. This is notably evident for vector-borne diseases. The mechanisms behind the particular epidemiological pattern of infectious and parasitic diseases of pets in Eastern Europe are complex. Most countries from Eastern Europe are regarded as non-endemic for leishmaniosis, with sporadic cases only in both humans and dogs. However, recently, new imported or autochthonous cases are reported every year. The aim of the current review is to synoptically review and critically analyse the epidemiological situation of leishmaniosis and the distribution of the sand fly vectors in Eastern Europe, namely in Romania, Hungary, Czech Republic, Slovakia, Bulgaria, Poland, Moldova, Ukraine, and Belarus.

Prevention of canine ocular thelaziosis (Thelazia callipaeda) with a combination of milbemycin oxime and afoxolaner (Nexgard Spectra®) in endemic areas in France and Spain

In the past decade, canine thelaziosis due to Thelazia callipaeda has been diagnosed in an increasing number of European countries, with endemic areas being identified. A multi-center field trial was conducted in endemic areas in France and Spain to evaluate the efficacy of monthly administrations of the oral milbemycin oxime/afoxolaner combination (NexGard Spectra^®) for the prevention of T. callipaeda infection in at-risk dogs. A total of 79 dogs negative for T. callipaeda and with a clinical history of eyeworm infection in the past two years completed the study. Dogs were randomly allocated either to a negative control group (42 dogs) or to the NexGard Spectra^® treated group (37 dogs). All dogs were followed up for a 6-month period and assessed monthly for the presence of nematodes on the eyes and for the signs of ocular thelaziosis (e.g., conjunctivitis, keratitis, and ocular discharge). When the presence of nematodes was confirmed, the conjunctival fornix was flushed with a saline solution for parasite recovery and counting, and the dogs were treated appropriately. Recovered parasites were stored in 70% alcohol for subsequent morphological identification. During the course of the study, 57.1% (24/42) of the control dogs were diagnosed positive for Thelazia infection, which illustrates a high incidence rate of parasite infection. Conversely, no eyeworm was recovered from any of the 37 dogs that received NexGard Spectra^®. All parasites sampled were confirmed to be T. callipaeda. This clinical field study demonstrated that monthly administrations of NexGard Spectra^® provided 100% preventive efficacy against canine thelaziosis.

Detection of Thelazia callipaeda in Phortica variegata and spread of canine thelaziosis to new areas in Spain

Background

The fruit fly Phortica variegata (Drosophilidae: Steganinae) feeds on the ocular secretions of animals and humans, and has been described as an intermediate host of the eye worm Thelazia callipaeda (Spirurida: Thelaziidae) in Italy. Despite the increased detection of T. callipaeda in many European countries, information about its vector role in natural conditions is still limited. In the Iberian Peninsula, thelaziosis caused by T. callipaeda has been reported in dogs, cats, red foxes, wild rabbits and humans.

Methods

In the last seven years, we have detected increased numbers of cases of canine thelaziosis at three locations in mainland Spain: Site 1, La Vera region (Cáceres Province, central-western Spain; 51 cases); Site 2, El Escorial municipality (Madrid Community, central Spain; 23 cases); and Site 3, Miraflores de la Sierra municipality (Madrid Community, central Spain; 41 cases). Site 1 is considered endemic for T. callipaeda while the other two sites have been recently recognised as risk zones for T. callipaeda infection.

Results

From June 2016 to September 2017, 2162 flies were collected and morphologically identified as Phortica spp. (Site 1, n = 395; Site 2, n = 1544; and Site 3, n = 223). Upon dissection, third-stage T. callipaeda larvae were found in two out of 155 flies examined from Site 1, and both these larvae tested molecularly positive for the eye worm. Of the 395 flies collected from Site 1, 371 were molecularly processed for arthropod species identification and T. callipaeda detection. All 371 flies were identified as P. variegata and 28 (7.5%; 95% CI: 4.8–10%) tested positive for T. callipaeda DNA haplotype 1.

Conclusions

Our findings indicate that T. callipaeda circulates among dogs and P. variegata in Spain, where zoonotic cases have been also reported. The co-existence of canine thelaziosis and Phortica spp. in geographical areas previously considered free of the eye worm indicates a risk of infection for both animals and humans living in this region.

The eyeworm Thelazia callipaeda in Portugal: Current status of infection in pets and wild mammals and case report in a beech marten (Martes foina)

Ocular thelaziosis is caused by nematodes of the genus Thelazia (Spirurida, Thelaziidae), which inhabit the surface of the eyes and associated tissues. Thelazia callipaeda affects a range of mammal species, including humans, and in the last two decades has been reported in multiple European countries, being classified as an emergent vector-borne pathogen. In Portugal T. callipaeda is endemic in north-eastern areas, where it has been reported in domestic dogs, cats, red foxes (Vulpes vulpes) and wild European rabbits (Oryctolagus cuniculus). We report, for the first time, T. callipaeda in a beech marten (Martes foina) from Portugal and highlight the presence of haplotype 1 as the only one found in Europe, irrespective of the host species and geographical area of provenience.

Spreading of Thelazia callipaeda in Greece

Thelazia callipaeda (Spirurida, Thelaziidae), the so-called oriental eyeworm, has been increasingly reported as an agent of infection in animals and humans from many European countries. Clinical signs range from subclinical to moderate or severe ocular disorders (e.g., epiphora, photophobia, conjunctivitis, keratitis, ulcers). The disease has been also diagnosed in animals from countries of the Balkan area (e.g., Croatia, Bosnia and Herzegovina and Serbia), but only a single case of canine thelaziosis, presumably autochthonous, was reported in Northern Greece. In this study, we provide robust information of the occurrence of thelaziosis in Greece by reporting autochthonous cases of thelaziosis in dogs (n = 46), cats (n = 3) and in one rabbit (Oryctolagus cuniculus) living in Northern and Central regions of Greece. The occurrence of a single haplotype of the cytochrome oxidase subunit 1 gene confirms that the same zoonotic haplotype of the parasite circulating in Europe is also spreading in Greece. The increased awareness of this parasitosis is crucial to limit the risk of further infections in both humans and animals in European countries.

Thelazia callipaeda in wild carnivores from Romania: new host and geographical records

Background

Thelazia callipaeda is a vector-borne zoonotic nematode parasitizing the conjunctival sac of domestic and wild carnivores, rabbits and humans, with a vast distribution in Asia and the former Soviet Union. In Europe, the nematode has an emerging trend, being reported in Italy, France, Switzerland, Germany, Spain, Portugal, Bosnia and Herzegovina, Croatia, Romania, Greece and Serbia, with human cases known in Italy, France, Spain, Serbia and Croatia. In Romania, the infection was so far reported only in dogs, whereas there are no reports in wildlife despite the large numbers of wild carnivores in the country. The aim of this study was to evaluate the role of wild carnivores in the natural cycle of T. callipaeda in Romania.

Methods

Between 2014 and 2016, 89 wild carnivores (64 golden jackals, Canis aureus, 13 grey wolves, Canis lupus, nine wildcats, Felis silvestris and three Eurasian lynxes, Lynx lynx) have been examined. During the necropsy, both eyes of all the examined animals have been thoroughly inspected for the presence of parasites. If present, all nematodes were collected in absolute ethanol (for molecular analysis of the partial cox1 gene) or in 4 % formalin (for morphological identification).

Results

In total, three animals were found to be infected with T. callipaeda: a grey wolf, a golden jackal and a wildcat. The BLAST analysis of all the sequences showed a 100 % similarity to T. callipaeda haplotype h1. To the best of our knowledge, this study represents the first report of T. callipaeda in golden jackals, and the first study on T. callipaeda in wildlife from Romania.

Conclusion

Our data broaden the host spectrum and geographical distribution of T. callipaeda, highlighting the role of wild carnivores as natural reservoirs for the infection and confirming the ongoing expanding trend of this zoonotic nematode in Europe.

The Increase of Exotic Zoonotic Helminth Infections: The Impact of Urbanization, Climate Change and Globalization

Zoonotic parasitic diseases are increasingly impacting human populations due to the effects of globalization, urbanization and climate change. Here we review the recent literature on the most important helminth zoonoses, including reports of incidence and prevalence. We discuss those helminth diseases which are increasing in endemic areas and consider their geographical spread into new regions within the framework of globalization, urbanization and climate change to determine the effect these variables are having on disease incidence, transmission and the associated challenges presented for public health initiatives, including control and elimination.

First report of canine ocular thelaziosis in the Muntenia Region, Romania

Ocular thelaziosis by Thelazia callipaeda is a vector-borne disease that infects domestic and wild carnivores as well as humans. In this paper, we present two cases of ocular thelaziosis in dogs that had never traveled outside Romania. Both presented with moderate conjunctivitis and ocular discharge. In total, 41 adult nematodes were removed from the conjunctival sacs of both dogs; these were identified via morphology as T. callipaeda. To the best of our knowledge, this is the first report of canine ocular thelaziosis caused by T. callipaeda from the Muntenia Region of Romania.

New Cases of Thelazia callipaeda Haplotype 1 in Dogs Suggest a Wider Distribution in Romania

Thelazia callipaeda is an emerging vector-borne zoonotic helminth parasitizing the conjunctival sac of a broad spectrum of definitive hosts, such as dogs, cats, rabbits, wild carnivores, and humans. Its presence is associated with mild to severe ocular disease. Here, we report two new clinical cases in dogs originating from western and southern Romania, with no travel history. On clinical examination, the nematodes were retrieved from the conjunctival sac and identified using morphological keys and molecular tools. Twenty-two adult nematodes (8 males, 14 females) were collected and were identified as T. callipaeda by morphology. The molecular analysis revealed a 100% identity with haplotype h1 of T. callipaeda. This study describes the occurrence of new autochthonous cases of thelaziosis in Romania, reinforcing the spreading trend of this zoonotic eyeworm and highlighting the need for increased awareness among medical and veterinary practitioners. Moreover, we provide additional molecular evidence for the exclusive distribution of haplotype 1 of T. callipaeda in Europe.