The prevalence of Dirofilaria immitis in dogs in Sydney

Multiple diagnostic tests demonstrate an increased risk of canine heartworm disease in northern Queensland, Australia

Background

Canine heartworm (Dirofilaria immitis) is a life-threatening infection of dogs with a global distribution. Information on the prevalence of D. immitis and associated risk factors for canine heartworm antigen positivity—and thus disease—in Australia is scarce or outdated. The current reference method for D. immitis diagnosis in dogs is via the detection of heartworm antigen in blood using commercially available microwell-based enzyme-linked immunosorbent assays (ELISAs). Heat treatment of canine plasma prior to testing has been suggested to increase test sensitivity. The aim of the current study was to estimate the prevalence of D. immitis in dogs confined to shelters in Queensland, Australia. The impact of heat treatment on antigen test results was also assessed.

Methods

Blood samples (n = 166) were collected directly from dogs in seven shelters across Queensland (latitudinal span of approx. 1700 km) into EDTA blood collection tubes. A commercially available ELISA (DiroCHEK®) was used to detect canine heartworm antigen in untreated and heat-treated plasma. Whole blood was concurrently tested for the presence of microfilariae and D. immitis DNA using a modified Knott’s test and real-time PCR, respectively. Risk factors (age, gender, source, location) associated with the odds of positivity for canine heartworm were assessed using binary logistic regression models.

Results

A total of 16 dogs (9.6%; 95% confidence interval [CI]: 5.9–15.2%) were positive for canine heartworm based on combined test results. Heat treatment did not impact on the positivity of D. immitis antigen within samples (Cohen’s kappa = 0.98), but the optical density was significantly increased in paired plasma samples for D. immitis antigen-positive samples (Wilcoxon matched-pairs signed rank test, two-tailed P < 0.01). Location of the dog in a shelter in northern Queensland was the only risk factor significantly associated with the odds of a dog being more likely to be D. immitis antigen positive (odds ratio: 4.39; 95% CI: 1.26–13.51). All samples positive for the modified Knott’s test were also positive for D. immitis DNA by PCR.

Conclusions

This study demonstrated the presence of heartworm-positive dogs in shelters in Queensland, with positive animals significantly more likely to occur in northern Queensland than southern Queensland. Sustained testing for the presence of D. immitis microfilariae and antigen remain important diagnostic tools in areas with known and re-emerging canine heartworm activity.

Graphical Abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s13071-021-04896-y.

Suspect 'baggage canine heartworm' case: canine heartworm disease in a dog from Sydney, New South Wales

Locally acquired canine heartworm (Dirofilaria immitis) infection in the temperate southern climate zones of Australia is currently rare. We report a case of locally acquired canine heartworm from Sydney, New South Wales in a 12-year-old Fox Terrier × Jack Russell female that presented with coughing and breathing difficulties. Absence of heartworm prevention and no travel outside Sydney was noted. Blood sample was D. immitis positive using antigen test, but negative on Modified Knott's testing. PCR confirmed the presence of D. immitis DNA in circulating blood. Echocardiographic examination revealed multiple parallel echogenic lines separated by a hypoechoic region ('tram-tracks') in the right pulmonary artery. The patient was treated and clinical condition gradually improved over the following 12 months. Antigen test remained positive for D. immitis at ~7 months and became negative at ~15 months after the start of the treatment. The most plausible scenario is importation of infected mosquito(s) in the luggage arriving from Queensland, Australia, common holiday destination for many Sydney-siders. We consider this a case of 'baggage canine heartworm'. Canine heartworm in dogs who did not travel should be considered in the differential diagnosis and D. immitis antigen test coupled with Modified Knott's test or PCR must be considered.

The global status of Dirofilaria immitis in dogs: a systematic review and meta-analysis based on published articles

Dirofilaria immitis is a parasitic filarial nematode responsible for heartworm disease in domestic as well as wild canines and felines and pulmonary or cutaneous infections in humans. This systematic review and meta-analysis aimed to evaluate the status of D. immitis in dogs based on available literature. Four English language databases (ISI Web of Science, Scopus, PubMed and Science Direct) containing data on D. immitis prevalence in dogs were thoroughly searched resulting in the inclusion of 193 studies. The findings revealed that the pooled and weighted prevalence of D. immitis infection in dog population based on published papers throughout the world was 10.91% (95% CI=10.18-11.65). In addition, subgroup analysis based on meta-regression revealed that a significant difference between the pooled and weighted prevalence of D. immitis in dogs and country (β =0.14, P=0.049). Given the relatively high prevalence of D. immitis infection in dogs and its adverse effects, it is suggested that to perform more research on the prevention and control of dirofilariasis infection in dogs worldwide.

Pig-hunting dogs are an at-risk population for canine heartworm (Dirofilaria immitis) infection in eastern Australia

BACKGROUND

Canine heartworm disease, caused by Dirofilaria immitis, has global veterinary importance. In Australia, the prevalence of canine heartworm infection decreased markedly following the introduction of over-the-counter macrocyclic lactones. We aimed to estimate the prevalence of canine heartworm infection in at-risk populations of dogs in eastern Australia and analyse published prevalence data from Australia.

METHODS

In total, 566 dogs from eastern Australia were tested for the presence of D. immitis antigen. Four cohorts were studied: pig-hunting dogs from Queensland (Cohort 1, n = 104), dogs from remote New South Wales (NSW) (Cohort 2, n = 332), urban pets from rural NSW (Cohort 3, n = 45) and ex-racing Greyhounds from Sydney, NSW (Cohort 4, n = 85). Serum samples were screened for D. immitis antigen using a reference laboratory microwell-based assay (DiroChek^®) or a point-of-care immunochromatography test kit (Anigen Rapid^®). Risk factors associated with the odds of D. immitis antigen seropositivity were identified using binary logistic regression models. Seropositive blood samples were tested for the presence and quantity of D. immitis DNA using a species specific real-time (q)PCR assay. A metanalysis of the Australian canine heartworm literature was conducted.

RESULTS

The prevalence of dirofilariasis in pig-hunting dogs from Queensland (Cohort 1) was 12.5% (95% CI: 6.5-18.9%), with a subpopulation of dogs from Central Queensland having a prevalence of 21% (95% CI: 12.3-33.4%). Age was significantly associated with D. immitis antigen seropositivity (increased risk with increased age). The odds of being > 5 years versus ≤ 5 years was 3.7-times (95% CI: 1.1-12.5) greater in antigen positive versus antigen negative dogs. No D. immitis antigen positive dogs were detected in dogs from NSW (Cohorts 2-4). The Australian canine heartworm disease literature includes 98 peer-reviewed publications (1901-2019) with 30 studies reporting on D. immitis prevalence in dogs. Throughout the publication peak period (1980s), the primary antemortem diagnostic test was detection of microfilariae.

CONCLUSIONS

Canine heartworm infection in dogs used for pig hunting is a previously unexplored topic in Australia. Pig-hunting dogs are infected with canine heartworm in Queensland, Australia, placing pet dogs and cats at increased risk of infection.

Is canine heartworm (Dirofilaria immitis) endemic to South Australia?

BACKGROUND

Canine heartworm (Dirofilaria immitis) was reported as endemic to South Australia over 25 years ago, but the current status of canine heartworm infection in South Australia is unknown.

METHODS

We surveyed South Australian veterinary practices to collect evidence about canine heartworm cases, prevention, screening and treatment practices.

RESULTS

In total, 141 veterinary practices operating in South Australia (92.3% response rate) completed a 12-question telephone survey. Five confirmed cases of heartworm and one suspected false-positive case were reported from separate practices over the 2016-17 financial year. All confirmed cases had recently relocated to South Australia from interstate. Incidence of canine heartworm was estimated at 0.00% (95% confidence interval (CI): 0.00-0.0006) and prevalence at 0.002% (95%CI: 0.00-0.004) using conservative estimates of the South Australian dog population. Attitudes and protocols regarding heartworm differed significantly between metropolitan and rural veterinary practices. All metropolitan practices recommend systematic medicated prevention against heartworm, while some rural practices (20.7%) recommend prevention only when travelling interstate (P < 0.001).

CONCLUSION

Although there is a minor source of heartworm from introduction of infected dogs into South Australia, there is no evidence that the infection is transmitted to other dogs within the state. Therefore, it is unlikely that heartworm is currently endemic to South Australia as reported in the past. This new evidence provides a strong case to refine current prevention practices to reflect the current negligible risk of heartworm infection within South Australia.

Prime detection of Dirofilaria immitis: understanding the influence of blocked antigen on heartworm test performance

Detection of circulating antigen of Dirofilaria immitis has been a mainstay of identifying heartworm infection in clinical practice for the past three decades. Several validated commercial antigen tests have very good sensitivity, specificity, and positive predictive values, especially when used in patients for which heartworm infection is likely. In some dogs and cats infected with heartworm, antigen may not be available for detection although present in the patient sample; heat pretreatment of these samples reveals the antigen, changing the false negative to positive. This phenomenon was documented in the literature in the 1980s but subsequently overlooked by the heartworm research community for many years. In this review, we provide a summary of the current understanding of the role of heat reversal in diagnosing heartworm infection. This additional diagnostic step is most important for patients in which heartworm infection is likely, such as dogs or cats in an endemic area with an inconsistent history of heartworm preventive use, or dogs with a prior diagnosis of heartworm infection that were recently treated. To illustrate the concept, we share a summary of results from canine samples tested at the state veterinary diagnostic laboratory in Oklahoma, USA in 2017 by modified Knott test and by commercial antigen test before and after heat treatment of samples; in this sample set, heat treatment changed all D. immitis microfilaria-positive but antigen-negative samples to antigen-positive. Pet dogs with a history of consistent preventive use are unlikely to become positive with heat pretreatment; for that reason, routine pretreatment of all samples tested in a veterinary practice is not recommended. We also review known causes of false negative and false positive results on heartworm antigen tests that, although uncommon, can complicate accurate diagnosis in individual patients. Together, this review provides a primer to aid understanding of strategies that can enhance accurate diagnosis of heartworm infection in veterinary practice and clinical research.

Mosquito-borne heartworm Dirofilaria immitis in dogs from Australia

Background

Heartworm (Dirofilaria immitis) in dogs is considered endemic in Australia, but the clinical heartworm disease caused by the heartworm is rare and prevalence is low. The mainstream prevention of the heartworm is based on macrocyclic lactone (ML) administration. The aim of this study was to confirm endemism of the heartworm under current Australian conditions using a cohort of recent microfilaria-positive dogs which were on variable heartworm prevention.

Methods

A hotspot of canine heartworm antigen-positive and microfilaria-positive dogs has been detected recently in Queensland, Australia. Blood samples from 39 dogs from Queensland and two dogs from New South Wales were investigated for canine filarioids. Rapid antigen diagnostic tests capable of detection of D. immitis and real-time PCR for quantification and differentiation between D. immitis from Acanthocheilonema reconditum with quantification of microfilariae in canine blood samples, together with D. immitis specific real-time PCR assay, were applied to microfilaria-positive dogs. The P-glycoprotein genotype was determined to test whether Australian-sourced heartworm shared the same genetic markers as those suspected of ML-resistance in North America.

Results

Only D. immitis was detected in the samples from Queensland and New South Wales, Australia. Using high resolution melt real-time PCR and D. immitis specific real-time PCR, the calculated microfilaria concentration ranged from 1 to 44,957 microfilariae/ml and from 7 to 60,526 microfilariae/ml, respectively. DNA sequencing of the PCR products confirmed D. immitis. Fifteen of the examined dogs were on putative, rigorous ML prevention. For the remaining dogs, compliance with heartworm prevention was unknown or reported as inconsistent. Wild-type genotype AA-GG of the P-glycoprotein locus of D. immitis sequence has been obtained for three blood samples. Due to the incomplete history, any suggestion of a loss of efficacy of MLs must be treated as ‘remotely possible’. In the immediate future, records of preventative administration and annual antigen testing would be required to determine any problems with the efficacy of preventatives.

Conclusions

The prevalence of canine heartworm in Australia remains poorly understood. It is generally assumed to be low by veterinary practitioners. The localised increase in the study area confirms endemism of canine heartworm and a requirement for ongoing vigilance through annual heartworm testing to better understand the changing distribution of canine heartworm, client compliance, as well as to detect any change in ML-susceptibility.

Electronic supplementary material

The online version of this article (doi:10.1186/s13071-016-1821-x) contains supplementary material, which is available to authorized users.

Human and animal dirofilariasis: the emergence of a zoonotic mosaic

Dirofilariasis represents a zoonotic mosaic, which includes two main filarial species (Dirofilaria immitis and D. repens) that have adapted to canine, feline, and human hosts with distinct biological and clinical implications. At the same time, both D. immitis and D. repens are themselves hosts to symbiotic bacteria of the genus Wolbachia, the study of which has resulted in a profound shift in the understanding of filarial biology, the mechanisms of the pathologies that they produce in their hosts, and issues related to dirofilariasis treatment. Moreover, because dirofilariasis is a vector-borne transmitted disease, their distribution and infection rates have undergone significant modifications influenced by global climate change. Despite advances in our knowledge of D. immitis and D. repens and the pathologies that they inflict on different hosts, there are still many unknown aspects of dirofilariasis. This review is focused on human and animal dirofilariasis, including the basic morphology, biology, protein composition, and metabolism of Dirofilaria species; the climate and human behavioral factors that influence distribution dynamics; the disease pathology; the host-parasite relationship; the mechanisms involved in parasite survival; the immune response and pathogenesis; and the clinical management of human and animal infections.

Heartworm disease in animals and humans

Heartworm disease due to Dirofilaria immitis continues to cause severe disease and even death in dogs and other animals in many parts of the world, even though safe, highly effective and convenient preventatives have been available for the past two decades. Moreover, the parasite and vector mosquitoes continue to spread into areas where they have not been reported previously. Heartworm societies have been established in the USA and Japan and the First European Dirofilaria Days (FEDD) Conference was held in Zagreb, Croatia, in February of 2007. These organizations promote awareness, encourage research and provide updated guidelines for the diagnosis, treatment and prevention of heartworm disease. The chapter begins with a review of the biology and life cycle of the parasite. It continues with the prevalence and distribution of the disease in domestic and wild animals, with emphasis on more recent data on the spreading of the disease and the use of molecular biology techniques in vector studies. The section on pathogenesis and immunology also includes a discussion of the current knowledge of the potential role of the Wolbachia endosymbiont in inflammatory and immune responses to D. immitis infection, diagnostic use of specific immune responses to the bacteria, immunomodulatory activity and antibiotic treatment of infected animals. Canine, feline and ferret heartworm disease are updated with regard to the clinical presentation, diagnosis, prevention, therapy and management of the disease, with special emphasis on the recently described Heartworm Associated Respiratory Disease (HARD) Syndrome in cats. The section devoted to heartworm infection in humans also includes notes on other epizootic filariae, particularly D. repens in humans in Europe. The chapter concludes with a discussion on emerging strategies in heartworm treatment and control, highlighting the potential role of tetracycline antibiotics in adulticidal therapy.

Spatial and temporal transmission risk of Dirofilaria immitis in Argentina

The aim of this work was to assess spatial and seasonal Dirofilaria immitis transmission risk throughout Argentina with models based on the temperature threshold below which filarial development will not proceed in the mosquito (i.e. 14 degrees C), the occurrence and the number of potential vector mosquito species, and the Heartworm Development Units derived from the degree-days concept. The four models showed a similar increasing southwest-northeast tendency and correlated significantly with canine prevalences used as external validation data. About one-third of Argentina would be suitable for heartworm transmission and the highest risk areas include the north-eastern provinces. According to our models, heartworm transmission is markedly seasonal with peaks in January and February; no region would support transmission throughout the year. To improve the present models, it is necessary to know which mosquito species are competent rather than potential vectors in the country. We believe the present study provides the first risk assessment maps for D. immitis transmission in the Southern Hemisphere and provides a useful guide for heartworm prevention during the transmission periods in different regions of Argentina.

Snake envenomation in dogs in New South Wales

OBJECTIVE

To obtain baseline data on the prevalence of elapid snake envenomation in dogs presented to veterinary practices in New South Wales and to assess attitudes of veterinarians to this clinical entity.

PROCEDURE

A mailed questionnaire, sent to all veterinary clinics within New South Wales, was utilised to collect epidemiological information regarding elapid snake envenomation in dogs.

RESULTS

A response rate of 68% was obtained and a yearly prevalence of snake envenomation in dogs across New South Wales veterinary clinics was estimated as 0.31%. The most common species reported to be responsible for envenomation within NSW was the Red Bellied Black snake (Pseudechis porphyriacus) followed by the Brown snake (Pseudonaja textilis) and then Tiger snake (Notechis scutatus). The reported envenomation syndromes caused by these common snake species were perceived to be similar for Brown and Tiger snakes but differed for Red Bellied Black snakes. Diagnosis of snake envenomation was based predominantly on the recognition of clinical signs. Specific diagnostic tests, such as venom detection kits, were used infrequently. The most common treatment was reported to be a combination of intravenous fluid therapy and antivenom, and monitoring of response to this treatment was usually through assessment of clinical signs. Survival after antivenom administration was reported to be highest for Red Bellied Black snake species. Survival was perceived to be associated with time between envenomation and presentation to the veterinary clinic and with antivenom administration.

CONCLUSIONS

Current attitudes and perceptions of veterinarians have been defined. Diagnosis of species-specific snake envenomation is shown to be made on the basis of clinical signs which are, however, reported as similar for each species. Clearer definition of these envenomation syndromes and identification of accessible diagnostic testing procedures are needed.

Prevalence of canine dirofilariosis in the City of Buenos Aires and its outskirts (Argentina)

During the past 10 years, the prevalence of canine dirofilariosis in the City of Buenos Aires and its outskirts, particularly in the northern and southern areas, has increased significantly. In the present work, studies were carried out in dogs living in the city and in its northern, western and southern outskirts from 1997 to 2001. For this purpose, 782 blood samples were collected and analyzed to determine circulating antigen, processed with the Witness Merial antigen test. The samples resulted in negative tests for subjects who lived in the city; however, 17.7 and 23.5% of the tests were positive from the northern and southern outskirts, respectively. When analyzed by sex, positive results were distributed as follows: 62.5% males and 37.5% females (P<0.05). No significant statistical difference was found on comparing purebred and cross-breds (P<0.05). It is interesting to point out the geographical distribution of the disease, which confirms that ecological factors such as water currents, abundant vegetation and the existence of mosquitoes all year round, are important for the biological cycle of Dirofilaria immitis.

Seroepidemiologic survey of Dirofilaria immitis infection among domestic dogs in Taipei City and mountain aboriginal districts in Taiwan (1998-1999)

To estimate the seroprevalence of Dirofilaria immitis infection in domestic dogs in Taiwan, we utilized a commercial ELISA kit (Snap, IDEXX, USA) for detecting circulating antigens released by adult female worms. Serum specimens of 664 domestic dogs sampled from Taipei City in northern Taiwan and 14 mountain aboriginal districts in eastern Taiwan were screened for D. immitis antigens. Multivariate-adjusted odds ratios (ORs) with their 95% confidence intervals (CIs) were estimated by multiple logistic regression analysis. A total of 89 subjects were antigen-positive, giving a seroprevalence of 13.4%, of which the seroprevalence in Taipei City and mountain aboriginal districts were 13.8 and 12.1%, respectively. The mean overall seropositive rates were 6.3% in 1-3-year-old age group, 14.1% in 3-6-year-old age group and 23.7% in the > or =6-year-old age group. The older the age, the higher the seroprevalence (OR=4.6, 95% CI=2.4-9.0 for the > or =6-year-old age group versus 1-3-year-old age group, P<0.001) for all the dogs in the present study. Moreover, seroprevalence was not different between female and male dogs in either Taipei City or mountain aboriginal districts (P>0.05). Also, no significant difference in seroprevalence among dogs between the two geographical areas was found (P>0.05). In the logistic regression analysis, the seroprevalence of D. immitis remained significantly increased with age after multivariate adjustment in the present study. To our knowledge, this is the first report on the status of D. immitis infection in domestic dogs in Taipei City and mountain aboriginal districts in Taiwan to date.

Canine heartworm (Dirofilaria immitis) detected in red foxes (Vulpes vulpes) in urban Melbourne

Canine heartworm (Dirofilaria immitis) was detected by antigen ELISA in 8 (6.4%) of 125 red foxes (Vulpes vulpes) captured in the Melbourne (Australia) metropolitan area. Circulating microfilariae were also detected by whole blood filtration in six of these foxes. Cursory sampling of mosquitos at two of the sites where positive foxes were captured revealed the existence of two known mosquito vectors of Dirofilaria. The existence of widespread fox populations in Melbourne, together with known mosquito vectors may offer the potential for a sylvatic cycle of canine heartworm within the urban area.