The prevalence of antibodies to Dirofilaria immitis in Aboriginal and Caucasian Australians

More bark than bite: Comparative studies are needed to determine the importance of canine zoonoses in Aboriginal communities. A critical review of published research

The objective of this review was to identify and critique over forty years of peer-reviewed literature concerned with the transmission of canine zoonoses to Aboriginal people and determine the zoonotic organisms documented in dogs in Australian Aboriginal communities. A systematic literature search of public health, medical and veterinary databases identified 19 articles suitable for critical appraisal. Thirteen articles documented the occurrence of recognized zoonotic organisms in dogs in Aboriginal communities, including Toxocara canis, Dirofilaria immitis, Streptococcus dysgalactiae, Rickettsia felis, Sarcoptes scabiei and Giardia. Currently, there is definitive evidence indicating that dogs act as a reservoir for human scabies in Aboriginal communities. However, there is a need for large-scale, high-quality, comparative studies of dogs and humans from the same household to assess the occurrence and importance of transmission of S. scabiei and other diseases between dogs and humans. These studies should use current genetic and molecular techniques along with traditional techniques to identify and type organisms in order to better understand their epidemiology. This review has revealed that there is a lack of high-quality comparative studies to determine whether dogs are contributing to human disease by transmitting zoonoses. Our recommendations differ significantly from current public health policy and may have substantial implications for human and dog health.

Dingoes (Canis dingo Meyer, 1793) continue to be an important reservoir host of Dirofilaria immitis in low density housing areas in Australia

Heartworm (Dirofilaria immitis) is a parasitic nematode responsible for canine and feline cardiopulmonary dirofilariasis and human zoonotic filariosis in both tropical and temperate regions throughout the world. Importantly, this study in the Wet Tropics of Far North Queensland found D. immitis remains at high prevalence (72.7%) in wild dingoes in low density housing areas in Australia. This prevalence is equivalent to the highest levels seen in wild dogs in Australia and represents an ongoing risk to domestic dogs, cats and humans. In contrast, in higher density residential areas prevalence was significantly lower (16.7%, p=0.001). It is possible that chemotherapeutic heartworm (HW) prevention in domestic dogs in these higher density housing areas is helping to control infection in the resident dingo population. Five dingoes killed in council control operations around Atherton, a non-endemic HW region in the Wet Tropics, were all negative for HW likely due to the colder climate of the region restricting transmission of the disease. This survey highlights the importance of dingoes as reservoir hosts of HW disease and that the subsequent risk of infection to companion animals and humans depends on local factors such as housing density, possibly linked to chemotherapeutic HW control in domestic dogs and climate. Our findings show that veterinary clinicians need to ensure that pet owners are aware of HW disease and do not become complacent about HW chemoprohylaxis in areas which support dingo populations.

Public health aspects of dirofilariasis in the United States

Coin lesions in the human lung present significant differential diagnostic problems to the physician. There are at least 20 known causes of such lesions, including neoplastic lesions, infectious diseases, and granulomas. The human medical literature contains many misconceptions about the life cycle of Dirofilaria immitis, including the method of entry of the infective-stage larvae and the development of the young adult worm. These misconceptions have obscured the recognition of the clinical presentation of pulmonary dirofilariasis and the potential for D. immitis to lodge in many other areas of the human body besides the lung. Exposure to infective larvae of D. immitis is more common in humans than is currently recognized. Reported cases in humans reflect the prevalence in the canine population in areas of the United States. The veterinary literature provides compelling evidence that D. immitis is a vascular parasite, not an intracardiac one. Its presence in the right ventricle is a post-mortem artifact, because it has never been shown to be there by echocardiography or angiography in a living dog, even though these techniques have demonstrated adult D. immitis in the pulmonary, femoral, and hepatic arteries; posterior vena cava; and right atrium of live dogs. Physicians have taken the name "heartworm" literally, believing that the worm lives in the heart and only after it dies does it embolize to the pulmonary artery. However, the coin lesion is spherical in shape, not pyramidal, as embolic infarcts to the lung in humans are known to be. The coin lesion is an end-stage result of the parasite's death in the vascular bed of the lungs and the stimulation of a pneumonitis followed by granuloma formation. This pneumonitis phase of human pulmonary dirofilariasis is often not recognized by the radiologist because of the way pneumonitis is diagnosed and treated and because the developing nodule is obscured by the lung inflammation. Serologic methods for use in humans are needed for clinical evaluations of patients with pneumonitis living in highly enzootic D. immitis regions. As well, epidemiological surveys are needed to determine the real extent of this zoonotic infection.

Human dirofilariasis with reactive arthritis--case report and review of the literature

A 43-year-old German man suffered from an insect bite, which was followed by a severe local inflammation and lymphadenitis. A year later, he developed dry cough, chest pain, and an oligoarthritis of the ankle and knee joints. While other causes of the symptoms could be excluded, serologic findings suggested a dirofilarial infection with reactive arthritis due to the parasite. The observation points out, that in cases of unclassifiable mono- or oligoarthritis, reactive arthritis due to parasites should be considered in the spectrum of differential diagnoses. The disease is rare at present, but its frequency might be underestimated because of the diagnostic difficulties. Dirofilarial infection should be borne in mind after a stay abroad. The present case, however, shows, that the disease also occurs in patients who had not travelled to regions of risk in recent years.

A survey of heartworm in dogs in Australia

A survey conducted throughout Australia indicated that Dirofilaria immitis was far more widespread than previously described. It was prevalent throughout Queensland and New South Wales, including the western regions and was increasing in incidence. Confusion exists as to which diagnostic tests to use and the methods of treatment are extremely variable.

Immunodiagnosis of parasitic zoonoses: comparative efficacy of three immunofluorescence tests using antigens purified by affinity chromatography

Three immunofluorescent antibody assays were developed during this study: the direct (DFAT) and indirect (IFAT) fluorescent antibody tests using frozen worm sections, and the cyanogen bromide indirect fluorescent antibody test (CNBr-IFAT) using helminth antigens purified by affinity chromatography bound on to commercially prepared CNBr-Sepharose 4B beads. Purified antigens used in the CNBr-IFAT gave greater specificity and sensitivity than either the DFAT or IFAT. Dirofilaria immitis, Toxocara canis, Angiostrongylus cantonensis and Ascaris lumbricoides infections were studied in natural and zoonotic hosts and in rabbits immunized with antigens prepared from these parasites. In addition, a serological survey of Aboriginal Australians from Queensland was made.