The use of milbemycin oxime in a prophylactic anthelmintic programme to protect puppies, raised in an endemic area, against infection with Spirocerca lupi

Esophageal spirocercosis with pulmonary egg deposition and secondary hypertrophic osteopathy in a dog from Costa Rica

Spirocerca lupi is the etiologic agent of spirocercosis in canids from the tropical and subtropical regions of the world. A 1-year-old dog was presented with weight loss and diarrhea. Upon examination, thickened limbs, a mass in the lung's right middle lobe and an esophageal mass were found. The pulmonary mass aspirate revealed S. lupi eggs surrounded by a purulent infiltrate. Limb bone biopsies showed irregular mineralization and cartilaginous metaplasia. Treatment with doramectin resolved the initial clinical signs. However, regurgitation was reported 5 months later. Therefore, the dog received additional doramectin and later vomited a worm morphologically consistent with a S. lupi adult. Herein we report the esophageal migration of S. lupi with egg deposition to the lung parenchyma, accompanied by secondary hypertrophic osteopathy. This report highlights the presence of S. lupi in Costa Rica and the importance of including this parasite as a differential diagnosis when compatible signs are identified.

Insights on Spirocerca lupi, the Carcinogenic Dog Nematode

Spirocerca lupi is a nematode transmitted by dung beetles that infects domestic and wild canids in tropical and subtropical regions and is associated with neoplasia. It produces a distinctive pathology with the formation of esophageal nodules classified as inflammatory, preneoplastic, or neoplastic with metastasis to distant organs. Aberrant central nervous system migration of this nematode is also responsible for severe neurological manifestations. Reports of spirocercosis have increased over the last two decades showing spread of this canine helminth in five continents. S. lupi from different geographical locations is genetically distinct with two genotypes, genotype I from Africa, Asia, and Australia, and genotype II from Europe, and recently separated from Spirocerca vulpis, a new species described in red foxes from Europe.

Acute mesenteric ischemia-like syndrome associated with suspected Spirocerca lupi aberrant migration in dogs

OBJECTIVE

To describe acute mesenteric infarction due to suspected Spirocerca lupi aberrant migration in 5 dogs.

CASE SERIES SUMMARY

All dogs were large breed, none of which exhibited typical clinical signs associated with spirocercosis. All dogs were eventually diagnosed with septic peritonitis. On exploratory laparotomy, thickening of the jejunal arteries, surrounding mesojejunum, and segmental necrosis were identified. Similar thickening and hematoma formation were found in other regions of the mesentery. In 4 of the cases, the necrotic segment was located in the distal jejunum. Histology revealed thrombotic mesenteric vessels with intralesional S. lupi nematode larvae. Resection and anastomosis of the necrosed section was performed and all but 1 dog survived and were discharged within 1-6 days.

NEW OR UNIQUE INFORMATION PROVIDED

Spirocerca lupi is a potential cause of mesenteric infarction in endemic areas when no other obvious etiology is identified.

Evaluation of the efficacy of monthly oral administration of afoxolaner plus milbemycin oxime (NexGard Spectra(®), Merial) in the prevention of adult Spirocerca lupi establishment in experimentally infected dogs

The nematode Spirocerca lupi (Rudolphi, 1809) is widely distributed but mostly occurs sporadically with stable populations only in certain geographic areas. This helminth mainly infects dogs and wild canids. Primary pathology relates to migration of third stage larvae (L3) damaging the thoracic aorta and establishment of adults in nodules in the oesophagus. The objective of the present study was to evaluate the efficacy of milbemycin oxime in combination with afoxolaner (NexGard Spectra(®), Merial), administered monthly, in preventing establishment of adult worms after experimental infection. Two groups consisting of eight animals each were experimentally infected with 15 L3 on Days -28, -14 and -2, respectively (45 L3 per animal in total). Group 1 dogs served as untreated (negative) control, whereas animals in group 2 were treated with NexGard Spectra(®) at a minimum dose of 0.5mg/kg milbemycin oxime on Day 0 and from then onwards every 28 days up to Day 140 (six treatment occasions). Endoscopy was performed on Day 112 and for some animals also Day 140. Necropsy for worm recovery and nodule/lesion scoring was performed on Day 168. All eight animals in the control group (group 1) presented with 1-3 nodules and worm counts ranging from 9 to 41. Six animals in the NexGard Spectra(®) group presented with 1-4 nodules and worm counts ranging from 1 to 5. Significantly (p<0.05) fewer worms were collected from treated animals in the treated group (geometric mean 1.7) versus the negative control group (geometric mean 22.0) with 92.3% efficacy calculated. There was no significant (p>0.05) difference between groups with reference to number of nodules in the oesophagus. However, nodules in the control group were significantly (p<0.05) larger than those in the treated group. Number and size of lesions in the dorsal aorta did not differ statistically between groups 1 and 2. Because NexGard Spectra(®) was administered 28 days after onset of inoculation, migrating and developing L3 caused damage to the aorta wall of animals in the treated group. Milbemycin oxime (administered as NexGard Spectra(®)) demonstrated effectiveness in reducing infection with adult Spirocerca lupi worms in the oesophagus.

Spirocercosis in dogs in Israel: A retrospective case-control study (2004-2009)

This case-control retrospective study (years 2004-2009) investigated the epidemiological, clinical, and diagnostic test findings of dogs with esophageal spirocercosis (ES) presented to the Hebrew University Veterinary Teaching Hospital (HUVTH) and coproscopy-positive dogs at the Kimron Veterinary Institute (KVI), Israel. It included 133 dogs with ES and 133 negative controls diagnosed at the hospital, and 343 dogs diagnosed at the KVI. The average incidence of ES at the HUVTH was 22.5/year, and the percentage of spirocercosis cases was stable at both institutions (HUVTH, 0.67-1.23%; KVI, 5-8%). Dogs aged > 5 years old had 100-fold likelihood to be infected compared to dogs aged ≤ 1 year of age (P < 0.001). Mean body weight (P = 0.0004), proportion of Retrievers (P = 0.002) and sporting breed dogs (P = 0.006) were higher, while proportion of toy breeds (P = 0.004) was lower in the ES group compared to the control group. The proportion of cases from Greater Tel-Aviv decreased (P = 0.002), while that of those from Judea and Jerusalem increased (P = 0.01) compared to the 1990 s. Spirocercosis occurred in 22 dogs despite past prophylactic avermectin treatment. Vomiting and regurgitation were the most common clinical signs of ES. Coproscopy was S. lupi-positive in 33/60 dogs (55.0%). The median number of esophageal nodules was two (range 1-8), with a median diameter of 3.5 cm (range 1.0-11.0). Malignant esophageal lesion transformation was confirmed in 29 dogs (22%). Despite preventive attempts, spirocercosis has spread in Israel over time, compared to previous findings, raising questions about the efficacy of the currently accepted prophylactic protocol is incompletely effective.

Follow-up survey of the prevalence, diagnosis, clinical manifestations and treatment of Spirocerca lupi in South Africa

Spirocercosis is an important disease in South Africa. The object of this study was to determine if there had been a change in the prevalence, clinical manifestations and treatment of Spirocerca lupi over a 14-year period. A questionnaire was sent to 577 veterinary practices throughout South Africa in 2012. Of responders, 76% indicated that S. lupi occurred in their area, whilst 24% indicated that it did not; 84% considered S. lupi not to be a new phenomenon, whereas 16% considered it to be new. Monthly or seasonal distribution of the disease was not reported, and 76% of responders reported it to occur in no specific breed of dog, whereas 24% reported a breed risk, most considering large breeds to be at greater risk. No specific age or sex was identified as at higher risk. Common owner complaints were vomiting, weight loss, cough, or regurgitation. Reported clinical findings tended to mirror the clinical signs reported by owners. Most common diagnostic methods used were radiology, endoscopy, faecal flotation, and post mortem examination. Forty-four percent did not report seeing asymptomatic cases, 40% reported asymptomatic cases and 16% did not know. Associated complications were reported by 85% of responders, and included oesophageal neoplasia, hypertrophic osteopathy and acute haemothorax. Four different drugs were used as therapy: doramectin, ivermectin, milbemycin and Advocate®, with 9% of the responders using a combination of these four; 85% considered treatment to be effective and 15% ineffective. Treatment was considered more effective if the disease was diagnosed early and there were no complications. Two important conclusions were that more cases are being seen and that efficacy of therapy has increased, with a decrease in the mortality rate.

Spirocerca lupi-associated vertebral changes: a radiologic-pathologic study

Spirocerca lupi causes a caudal esophageal mass in dogs which may be accompanied by aortic changes and caudal thoracic spondylitis. Previous literature hypothesized that the spondylitis was caused by either aberrant larval migration or was secondary to the inflammation caused by the aortic migration. The current study aimed to evaluate these hypotheses. Ten dogs of various breeds and ages with radiographic evidence of spondylitis, which were necropsied, had the affected vertebrae removed and prepared for light and transmission electron microscopy examination. Transverse and sagittal sections of the ventral vertebrae were taken from 27 spondylitis and 8 spondylosis deformans lesions as well as from 8 normal vertebrae. Early spondylitis changes were characterized by periosteal woven new bone covered by hyperplastic periosteum with some involvement of the ventral longitudinal ligament. More mature lesions were characterized by nodules of denser trabecular bone and cartilage, also covered by hyperplastic periosteum and involved the ventral longitudinal ligament. It was difficult to distinguish the spondylitis and spondylosis deformans new bone. Inflammation was seen in five spondylitis cases (edema, lymphocytes, plasma cells, eosinophils and fibrin fibers). Spirocerca eggs were seen in one histologic section. This study shows that inflammation is mild and inconsistent in spirocercosis-induced spondylitis and that aberrant migration of the larvae or adults did not appear to be a predominant cause. Inflammatory mediators or osteoproliferative growth factors, which may be related to the primary esophageal lesion or to the worm itself, could be involved. This requires further investigation.