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

Occurrence of Eucoleus aerophilus in wild and domestic animals: a systematic review and meta-analysis

BACKGROUND

Eucoleus aerophilus (syn. Capillaria aerophila) is a nematode with a worldwide geographical distribution. It causes a disease called lung capillariosis by affecting the respiratory tract of wild and domestic animals, and has also occasionally been described in humans. Despite steady increases in knowledge of the morphology of this neglected parasite, many aspects are still poorly understood. Epidemiological data regarding, for example, geographic distribution, range of hosts, clinical relevance and the actual zoonotic potential of this nematode are scarce and incomplete.

METHODS

This article is a systematic review based on the screening of three databases (PubMed, Web of Science and Science Direct) to identify eligible studies published from 1973 to the end of 2022.

RESULTS

From a total of 606 studies describing the occurrence of E. aerophilus, 141 articles from 38 countries worldwide were included in this meta-analysis, all of which presented results obtained mainly with flotation and necropsy. Due to the occurrence of E. aerophilus in many different species and different matrices (lungs and faeces), we decided to conduct the meta-analysis separately for each species with a given matrix. This systematic review confirmed the status of the Red fox as the main reservoir and main transmitter of E. aerophilus (average prevalence of 43% in faeces and 49% in lungs) and provided evidence of a higher prevalence of E. aerophilus in wild animals in comparison to domestic animals, such as dogs (3% in faeces) and cats (2% in faeces and 8% in lungs). Previous studies have investigated many host-related factors (age, sex, environmental/living conditions) in relation to the prevalence of E. aerophilus, but they show wide variations and no simple relationship has been demonstrates. Furthermore, mixed infections with other pulmonary nematodes, such as Crenosoma vulpis and/or Angiostrongylus vasorum, are reported very frequently, which greatly complicates the diagnosis.

CONCLUSIONS

This systematic review focused on identifying data gaps and promoting future research directions in this area. To the best of our knowledge, this is the first systematic review that evaluates and summarizes existing knowledge on the occurrence and prevalence of E. aerophilus in wild and domestic animals originating from different geographical locations worldwide.

Multicenter randomized, and blinded European field study evaluating the efficacy and safety of Felpreva®, a novel spot-on formulation containing tigolaner, emodepside and praziquantel, in treating cats with mixed infection with intestinal nematodes, cestodes and/or lungworms

This paper describes a multicentric field study which has evaluated the safety and efficacy of a novel spot on formulation containing emodepside 2.04% w/v, praziquantel 8.14% w/v and tigolaner 9.79% w/v (Felpreva®, Vetoquinol) when administered at the intended commercial dose of 0.15 ml/kg body weight to privately owned cats infected with major intestinal nematodes (Toxocara cati, Toxascaris leonina, Ancylostoma tubaeforme, Uncinaria stenocephala) and/or cestodes (Dipylidium caninum, Taenia taeniaeformis) and/or lungworms (Aelurostrongylus abstrusus, Troglostrongylus brevior). A total of 219 cats from 26 veterinary clinics located in Albania, Greece, Hungary, Italy and Portugal were included in the study. Feces from the cats were examined on a single occasion between Study Day −7 and Day 0 (baseline) and post-treatment (i) twice between Day 7 and Day 14 (± 2) (for intestinal helminths) or (ii) twice between Day 21 (± 2) and Day 28 (± 2) (for lungworms). Cats were allocated into two groups at a ratio of 2:1 (Felpreva®: Profender®, i.e. a commercial control product containing emodepside and praziquantel). Cats infected with intestinal helminths were treated once on Day 0 (i) with Felpreva® (Group 1) or (ii) with Profender® (Group 2). Animals infected with lungworms received a second treatment with Profender® on Day 14 (± 2) regardless of group allocation. Faecal egg or larval count reduction for Felpreva® was 97.47% for intestinal nematodes and 96.80% for lungworms. No cats infected with cestodes at baseline resulted positive after treatment with Felpreva®. However, the low number of cats (n = 10) did not allow for a statistical analysis to be performed. Non-inferiority of Felpreva® compared to Profender® was statistically demonstrated for all target intestinal and respiratory parasites. No adverse events nor application site reactions were observed. These results show that the new topical combination product Felpreva® is highly safe and efficacious in treating infections caused by major species of feline intestinal nematodes, cestodes and lungworms under field conditions.

•

Felpreva®, containing tigolaner, emodepside and praziquantel, is a spot-on formulation.

•

This study confirmed the safety and high efficacy of Felpreva®, Vetoquinol, against feline helminths.

•

Faecal egg count (FEC) reduction for intestinal nematodes was 97.47%.

•

Faecal larval count (FLC) reduction for lungworms was 96.80%.

•

All cats infected with tapeworms at baseline were negative after treatment with Felpreva®.

Cat Respiratory Nematodes: Current Knowledge, Novel Data and Warranted Studies on Clinical Features, Treatment and Control

The nematodes Aelurostrongylus abstrusus, Troglostrongylus brevior and Capillaria aerophila are the most important parasites inhabiting the airways of cats. They are receiving growing attention from academia, pharmaceutical companies and veterinarians, and are now considered a primary cause of respiratory diseases in feline clinical practice and parasitology. In the past few years, several studies have been conducted in both natural and experimental settings to increase knowledge, provide new insights and fill gaps on respiratory parasitoses of cats. Awareness and knowledge of clinical scenarios towards appropriate and timely diagnosis and prompt and efficacious treatment options have become a priority to investigate. At the same time, chemopreventative approaches have been evaluated to assess the geographical spreading of these parasites and the rise in the number of clinical cases in cat populations of different countries. Given the intense accumulation of novel data, this review presents and discusses the state of the art and the latest updates on the clinical features, treatment, and control of major respiratory parasitoses of cats. Moreover, food for thought is also provided with the aim of spurring on new studies in the near future.

Transmammary transmission of Troglostrongylus brevior feline lungworm: a lesson from our gardens

•

Transmammary transmission of Troglostrongylus brevior in domestic cats is suggested.

•

Snails, rats and lizards play a role in the epidemiology of this feline lungworm.

•

Observational parasitology is important in studying events that may occur in small ecological niches around us.

Feline lungworms such as Aerulostrongylus abstrusus and Troglostrongylus brevior are snail-borne pathogens causing respiratory disease in domestic cats. Paratenic hosts such as rodents and reptiles have also been implicated in the epidemiology of these parasites. Although A. abstrusus has been recognized for a long time as the most prevalent lungworm among cats worldwide, T. brevior is of major concern in kittens. Bearing in mind that disease due to T. brevior occurs mainly in pediatric patients younger than 6 months of age, the diagnosis of this parasite in two kittens presenting severe respiratory disease from the garden of one of the authors inspired us to investigate the potential routes of transmission for T. brevior in domestic cats. Of the three queens (A, B and C) that delivered kittens (n = 8), only cat A was positive for T. brevior, presenting her two kittens severe respiratory clinical signs, which lead to the exitus in one of them, 18 days of age. In addition, three kittens, the offspring of queen B, turned to be positive at the coprological examination after suckling from queen A, whereas those from queen C (that suckled only on their own mother) remained negative. A series of coprological, histological and molecular tests were conducted to confirm the presence of T. brevior in the patients as well as in the other cats cohabiting the same garden. Adult nematodes were retrieved from the trachea and bronchi of the dead kitten (kitten 1A), and larvae at the histology of the lung and liver parenchyma associated with bronco pneumonitis and lymphocytic pericholangitis, respectively. Cornu aspersum (n = 60), Eobania vermiculata (n = 30) snails (intermediate hosts) as well as lizards and rats (potential paratenic hosts) were collected from the same garden and processed through tissue digestion and molecular detection. Troglostrongylus brevior larvae were recovered through tissue digestion from two C. aspersum (3.33 %) and it was confirmed by PCR-sequencing approach, which also detected T. brevior DNA in the liver and lungs of one rat and in the coelomatic cavity of one gecko lizard. During the COVID-19 lockdown, when scientists spent more time at home, we grasp the opportunity to decipher T. brevior biology and ecology starting in a small ecological niche, such as the garden of our house. Data herein presented led us to suggest: i) the transmammary transmission of T. brevior in domestic cats; ii) the role of intermediate and paratenic hosts (including reptiles) in the epidemiology of the infection which they transmit; as well as iii) the importance of observational parasitology in studying any event that certainly occurs in small ecological niches, as it could be in our home gardens.

Occurrence of canine and feline extra-intestinal nematodes in key endemic regions of Italy

Extra-intestinal nematodes of companion animals are of growing concern in veterinary medicine for their pathogenic potential and the current expansion throughout Europe. The present study has evaluated the occurrence of major canine and feline extra-intestinal nematodes in regions of Italy having epidemiological relevance. Associations of various recorded parameters related to the examined animals have been statistically evaluated, along with a comparative analysis with the most recent epidemiological data. Overall, 1055 dogs and 1000 cats were tested. Among extra-intestinal nematodes Angiostrongylus vasorum was the most common in dogs followed by Capillaria aerophila and Dirofilaria spp.; Aelurostrongylus abstrusus was the most recorded parasite in cats, followed by C. aerophila and Troglostrongylus brevior. The statistical analysis revealed that outdoor access is associated with A. vasorum, A. abstrusus and T. brevior infections, that were also more prevalent in animals with cardio-respiratory signs. Moreover, cats aged less than 12 months had more chances to be infected by lungworms. The data herein presented confirm the occurrence and the possible risk of expansion of different extra-intestinal parasitoses of dogs and cats in Italy, underlining the importance of a constant epidemiologic vigilance and of appropriate control methods.

Pilot study evaluating the efficacy of a topical formulation containing emodepside and praziquantel in the treatment of natural feline troglostrongylosis

Background

Troglostrongylus brevior, a lungworm usually affecting wild felids, has been recently recorded in a number of cases in domestic cats, mainly in Mediterranean areas. Although feline troglostrongylosis is a severe and life-threatening disease, especially in young cats, treatment options are very limited. The present study evaluated the efficacy and safety of a spot-on formulation containing emodepside 2.1% and praziquantel 8.6% (Profender^®, Bayer), which is licensed for treatment of the more common cat lungworm Aelurostrongylus abstrusus, for the treatment of natural troglostrongylosis.

Methods

Sixteen cats enrolled in the study were 1:1 allocated to two groups, i.e. Group T, treated with Profender^® spot-on on days 0 and 14 (± 2) at the recommended clinical dose, and Group C which remained untreated. After study completion, the control cats received two rescue treatments with Profender^® on days 28 (± 2) and 42 (± 2). The primary efficacy criterion was the absence of T. brevior L1 following treatment. Other efficacy parameters were the quantitative comparison of L1 presence before (baseline) and after treatment in both groups, and the comparison of clinical signs pre- and post-treatment.

Results

In terms of stopping larval shedding, Profender^® showed an efficacy of 97% and 97.5% (arithmetic and geometric means, respectively) for group T, 97.1% and 98.5% for group C after one administration, and 100% for both groups after two doses. Overall, 12 cats showed clinical signs related to T. brevior. Specifically, 9 were clinically affected before treatment while clinical signs appeared after the first treatment in 3 cats. At the end of the study, all symptomatic cats fully recovered with the exception of 3 cats that showed clinical signs similar to those observed at the pre-treatment examination at the end of the study.

Conclusions

This study shows that Profender^® is effective against T. brevior.

Clinical Case of Respiratory Eucoleosis in a Dog from Bosnia and Herzegovina

AIMS

This case report describes a clinical case of patent and natural infection with trichuroid Eucoleus aerophilus in a 5-month-old, mixed-breed female dog in Bosnia and Herzegovina.

METHODS

A detailed history was taken from the owner. Physical exam and thoracic radiography were performed. Faecal sample was processed by the passive flotation tube test with saturated zinc sulphate solution. After the final diagnosis, a dose of 0.4 mg /kg ivermectin was applied subcutaneously to the diseased dog.

RESULTS

The history revealed intermittent, non-productive cough after physical exercise. During the physical exam, mild signs of general distress, moderate cachexia with bad body condition, increased heart and respiratory rates, mild dyspnoea and increased bronchovesicular respirations were observed. Thoracic radiography showed mixed bronchial-alveolar lung pattern compatible with chronic bronchopneumonia. Trichuroid eggs of Eucoleus aerophilus were detected in faecal samples from the affected dog. Ivermectin administration at a dose of 0.4 mg/kg was sufficient to eliminate parasitic infection with Eucoleus aerophilus.

CONCLUSION

This is the first report of respiratory eucoleosis in a dog from Bosnia and Herzegovina.

Feline Troglostrongylosis: Current Epizootiology, Clinical Features, and Therapeutic Options

Parasitic bronchopneumonia plays an important role in feline respiratory medicine, thus it is receiving growing attention by researchers and practitioners. In recent years, Troglostrongylus brevior, a lungworm usually infecting wild felids, has been recognized as an agent of the lower respiratory tract in domestic cats. In particular, as a likely consequence of a spill-over from wild reservoirs (e.g., the European wildcat), T. brevior infection is increasingly reported in cats from Mediterranean and Balkan countries. This parasitic nematode has an indirect life cycle, and its biology overlaps that of the better known "cat lungworm" Aelurostrongylus abstrusus. In fact, cases of co-infections caused by both lungworms are not infrequent in domestic cats. Knowledge on clinical features of troglostrongylosis is still incomplete. Available data indicates that clinical signs and radiographic evidence are severe especially in kittens and young cats, are non-specific and often overlap with those of other feline respiratory diseases, such as feline bronchial disease/asthma, or infectious pneumonia. These characteristics make a definitive diagnosis of troglostrongylosis challenging, this disease requires a timely ancillary therapy and an appropriate anthelminthic treatment. As feline troglostrongylosis is an emerging parasitic disease of domestic cats, it should be included in differential diagnosis for lower respiratory tract disease in cats from regions where this parasite is present but also where it is unexpected. This article reviews current knowledge on the pathogenic role of T. brevior in domestic cats and resulting respiratory illness, with a special focus on clinical aspects, diagnosis, and management of the disease.

Troglostrongylus brevior: a feline lungworm of paediatric concern

The immature immune system of cats in their paediatric age (i.e., first six months of life) favours the establishment of infectious respiratory tract diseases mainly caused by well recognized viruses and bacteria species. Conversely, lungworm infections are less investigated during respiratory disorders in kittens. In the last decade, Troglostrongylus brevior has been found affecting the respiratory tract of cats, along with the better-known Aelurostrongylus abstrusus. Given the scant data available on the epidemiology of feline troglostrongylosis, faecal samples from 575 domestic animals living in three Italian municipalities (i.e., Bari, Messina and Siena) were screened for lungworm infection by Baermann and molecular tecniques. Animals were grouped according to their age as ≤6 months (i.e., paediatric patients), 6-24 months, or >24 months. Paediatric cats were further sub-divided in infant (2-6 weeks), weanling (6-12 weeks) and juvenile (3-6 months). Of the 575 animals tested, 241 (42.0%) were younger than 6 months, 188 (33%) were 6-24-month-old and 146 (25%) were older than 24 months. Lungworm infection was diagnosed in 84 (14.6%) of the examined cats. Of the 49 (20.3%) paediatric animals positive for lungworms, T. brevior was the nematode species most frequently diagnosed (n = 44; 89.8%), followed by A. abstrusus (n = 2; 4.1%), and three cats (6.1%) were co-infected by both species. The diagnosis of T. brevior infection was significantly associated with animals aging ≤6 months (18.2%; P < 0.01) than elder cats. Indeed, the prevalence of infection by T. brevior decreased in animals aging 6-24 months (3.2%) being not detected in cats older than two years. Results of this study indicate that paediatric cats are at higher risk of T. brevior infection compared to adults (P < 0.01).

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.

The 3Rs Concept: Time to Change How We Evaluate the Efficacy of Anthelmintics in Companion Animals

Experimental infections are required by current guidelines for investigating the efficacy of anthelmintics in dogs and cats. Recently, alternatives to experimental infections and the sacrificing of research dogs and cats have been evaluated, and novel conceptual investigations and methods of examination have been explored. Several of these approaches could potentially be used in efficacy studies for anthelmintics in dogs and cats. Here, we provide food for thought towards using new tools for evaluating the efficacy of anthelmintics in companion animals, for promoting the value of field trials, and for updating the existing guidelines for the efficacy testing of anthelmintics in dogs and cats.

Single and mixed feline lungworm infections: clinical, radiographic and therapeutic features of 26 cases (2013-2015)

Objectives The aim of this study was to retrospectively describe clinical, radiographic and therapeutic features of feline lungworm infection. Methods Medical records of cats with lungworm diagnosis, thoracic radiography and without concurrent diseases between 2013 and 2015 were reviewed. Collection of data included physical examination, haematology, serum biochemistry, therapy with a variety of anthelmintics and outcomes. Results Thirty-seven records were recovered and 26 were included in the study. Single infections by Aelurostrongylus abstrusus (n = 15), Troglostrongylus brevior (n = 3) and Capillaria aerophila (n = 1) and coinfections by T brevior/ A abstrusus (n = 6) and T brevior/ C aerophila (n = 1) were diagnosed. The most common respiratory signs were coughing (n = 12), increased vesicular sounds (n = 10), dyspnoea (n = 9), such as laboured breathing, orthopnoea or open-mouth breathing, and tachypnoea (n = 6). Two cats were subclinically infected. The most common laboratory abnormality was anaemia (n = 7). Radiographic patterns recorded were interstitial (n = 24), bronchial (n = 21), alveolar (n = 10) and vascular (n = 2). Twenty-five cats had a complete recovery within 2-6 weeks of therapy. One kitten died 7 days after the diagnosis. Conclusions and relevance Lungworms should always be included in the differential diagnosis in cats living in endemic areas and presenting with respiratory signs and radiographic abnormalities. A copromicroscopic examination should be considered as the first diagnostic step for all cats at risk of lungworm infections. In most cases, timely therapy with a variety of anthelmintics guarantees recovery.

Mitochondrial haplotypes of Aelurostrongylus abstrusus and Troglostrongylus brevior (Nematoda, Metastrongyloidea) from domestic and wild felids

The lungworm Aelurostrongylus abstrusus is the most important respiratory parasite of domestic cats. Pulmonary aelurostrongylosis has been reported in wild felids, though unequivocally evidence of wildlife infection by A. abstrusus is scant. Recently, Troglostrongylus brevior, a lungworm usually infecting wild felids, has been described in domestic cats from Mediterranean areas. The present work evaluates the sequence variation of an informative region within the gene encoding the mitochondrial cytochrome c oxidase subunit 1 of A. abstrusus and T. brevior, in order to provide novel information on the genetic make-up of these lungworms. Parasitic stages of A. abstrusus and T. brevior were collected from domestic and wild hosts (i.e., domestic cat, European wildcat, caracal, serval, and lion) from Italy, Greece, and South Africa. Five (HI-HV) and four (HI-HIV) haplotypes were recorded for A. abstrusus and T. brevior, respectively, mostly shared between domestic and wild felids in different geographical areas. The phylogenetic analysis showed that all haplotypes of A. abstrusus and T. brevior clustered as monophyletic groups with a strong nodal support, indicating that all haplotypes identified were distinct from each other. All sequence types represent two distinct species, A. abstrusus and T. brevior, and these genetic convergences are also detected within and among populations of these nematodes, irrespective of their hosts and geographical origin. The occurrence of A. abstrusus and T. brevior haplotypes in different hosts from the same regions and between different countries indicates that the same lungworm populations circulate in domestic and wild hosts under the same routes of transmission.

OCCURRENCE OF LUNGWORMS IN EUROPEAN WILDCATS (FELIS SILVESTRIS SILVESTRIS) OF CENTRAL ITALY

The increasing focus on infections in domestic cats ( Felis catus ) has raised questions about lungworm distribution in wild hosts. To enhance knowledge of the occurrence of lungworms in enzootic regions of central Italy, we examined the carcasses of 16 European wildcats ( Felis silvestris silvestris). Adult nematodes, feces, respiratory flushings, and pulmonary tissues were collected at necropsy and then microscopically and genetically analyzed. Fourteen wildcats had single or mixed lungworm species. Aelurostrongylus abstrusus was the most common parasite retrieved, followed by Troglostrongylus brevior. In addition, three specimens of Angiostrongylus chabaudi were found in the pulmonary arteries of one wildcat. Histologically, the most common lesions were a mild-to-severe chronic catarrhal bronchitis and a chronic interstitial pneumonia with smooth muscle hypertrophy, associated with T. brevior and A. abstrusus , respectively. These results demonstrate that the European wildcats may harbor several species of lungworms that may impair their health and welfare. Also, F. s. silvestris is a potential reservoir for respiratory nematodes in domestic cats.

Efficacy of Emodepside/Praziquantel Spot-on (Profender®) against adult Aelurostrongylus abstrusus Nematodes in Experimentally Infected Cats

The adulticidal efficacy of a topical combination of emodepside 2.1 % (w/v) plus praziquantel 8.6 % (w/v) (Profender® spot-on for cats, Bayer) against adult Aelurostrongylus abstrusus nematodes was evaluated in two randomised, placebo-controlled laboratory efficacy studies. Each study involved 16 cats experimentally inoculated with L3 (800 and 600 each in studies no. 1 and 2, respectively) and randomised into two study groups of 8 cats each after onset of patency. While cats in the treatment group in study no. 1 received a single spot-on application at the minimum therapeutic dose (3 mg/kg emodepside and 12 mg/kg praziquantel), cats in study no. 2 were treated twice with an interval of 14 days. The faecal output of first stage larvae was monitored throughout the study. Necropsy was conducted 4 or 5 weeks after the (first) treatment and the worm counts were used for efficacy calculations. The control groups showed a geometric mean of the total worm count (live and dead worms) of 28.8 (study no. 1) and 17.6 (study no. 2), respectively. All control animals were infected. While the single treatment in study no. 1 resulted in a reduction of the total worm burden by 73.0 % (p = 0.0070), the treatment protocol in study no. 2 was 99.2 % effective (p = 0.0035). Based on live worm counts, the efficacy in study no. 2 was 100 % (p = 0.0030). It is concluded that two applications of Profender® spot-on given two weeks apart represent a safe and highly efficacious treatment regime against feline aelurostrongylosis.

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.

Lungworm Eucoleus aerophilus (Capillaria aerophila) infection in a feline immunodeficiency virus-positive cat in France

CASE SUMMARY

A 2-year-old domestic shorthair female outdoor cat living in France was diagnosed with a lungworm infection due to Eucoleus aerophilus. The history and clinical signs, in association with bronchoscopic examination, suggested chronic upper respiratory disease. Cytological examination of bronchoalveolar lavage fluid (BALF) was consistent with suppurative bronchitis. Direct microscopic examination of BALF enabled the identification of E aerophilus ova.

RELEVANCE AND NOVEL INFORMATION

The cat was positive for feline immunodeficiency virus and had been treated with steroids for a suspected allergic bronchitis, suggesting that immunodeficiency was probably a facilitating factor for E aerophilus infection, as described in previous cases. This case report emphasises the importance of considering eucoleosis (capillariosis) in the differential diagnosis of respiratory disease in cats. To our knowledge, this is the first clinical case of E aerophilus infection described in a domestic cat in France.

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.

First evidence of the European wildcat (Felis silvestris silvestris) as definitive host of Angiostrongylus chabaudi

Angiostrongylus chabaudi (Strongylida, Angiostrongylidae) is a parasitic nematode described for the first time last century from the pulmonary arteries of six European wildcats (Felis silvestris silvestris) in central Italy. Since then, this parasite remained practically unknown until recently, when immature A. chabaudi have been reported from one wildcat in Germany and two domestic cats (Felis silvestris catus) in Italy. The present report describes the first record of A. chabaudi in Greece and, most importantly, the first known case of patent infection by A. chabaudi. The necropsy of a road-killed F. s. silvestris found near the lake Kerkini, in the municipality of Serres (Macedonia, Greece), revealed the presence of nematodes of both sexes in the right ventricle and the pulmonary artery of the heart. All parasites were mature adults and numerous eggs were present in the uteruses of females. The morphological characteristics of the parasites were consistent with those of A. chabaudi. Moreover, Angiostrongylus-like first stage larvae (L1) were present in the faeces of the animal that was negative for any other cardio-pulmonary parasite. Genetic examination of adult parasites and L1 confirmed the morphological identification as A. chabaudi. Histopathological examination of the lungs showed severe, multifocal to coalescing, chronic, interstitial granulomatous pneumonia due to the presence of adult parasites, larvae and eggs. These findings demonstrate for the first unequivocal time that this nematode reproduces in the European wildcat which should be ultimately considered a definitive host of A. chabaudi. Finally, the L1 of A. chabaudi are described here for the first time, opening new prospects for further studies on this neglected parasite.

Occurrence of Aelurostrongylus abstrusus and Troglostrongylus brevior in domestic cats in Greece

Background

Despite the evidence that Mediterranean Europe offers suitable conditions for the biology of felid respiratory metastrongyloids, no updated data on the presence of felid lungworms are available for Greece. Although the cat lungworm Aelurostrongylus abstrusus is considered as enzootic in domestic cats (Felis silvestris catus) living in some areas of continental Greece, conversely, Troglostrongylus brevior, has only been reported in the island of Crete. The present study aimed to evaluate the occurrence of Aelurostrongylus abstrusus and Troglostrongylus brevior in domestic cats from four different Greek locations including islands where European wildcats (Felis silvestris silvestris), believed to be the natural reservoir of T. brevior, are considered absent.

Methods

Faeces were collected from 125 stray cats in the city of Athens, and in Crete, Mykonos and Skopelos Islands, and examined by copromicroscopic techniques for the presence of lungworm larvae. When present, larvae were morphologically and molecularly identified.

Results

The occurrence of A. abstrusus and T. brevior was confirmed in 10 (8 %) and 7 (5.6 %) of the samples, respectively. In particular, T. brevior was detected in domestic cats in the city of Athens, and in Mykonos and Skopelos Islands, where wildcats are not present.

Conclusions

This information illustrates that T. brevior may infect domestic cats regardless of the presence of the natural host. Considering the relevant clinical impact of this nematode especially in young animals, it is advisable to include troglostrongylosis in the differential diagnosis of cat respiratory diseases also where this parasite is unexpected.

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.

Respiratory nematodes in cat populations of Italy

The occurrence of common respiratory parasites of domestic cats (the metastrongyloid "cat lungworm" Aelurostrongylus abstrusus and the trichuroid Capillaria aerophila) and of neglected respiratory nematodes of felids (Troglostrongylus brevior, Angiostrongylus chabaudi and Oslerus rostratus) was here evaluated in two and three geographical sites of Northern and Central Italy, respectively. In 2014-2015, individual fecal samples of 868 domestic cats were examined microscopically and genetically, and epidemiological data related to parasitic infections were evaluated as possible risk factors by binary logistic regression models. The most common parasite was A. abstrusus in both mono- and poli-specific infections, followed by T. brevior and C. aerophila, while cats scored negative for other parasites. Cats positive for A. abstrusus (1.9-17 % infection rate) and C. aerophila (0.9-4.8 % infection rate) were found in all examined sites, while cats scored positive for T. brevior (1-14.3 % infection rate) in four sites. Also, T. brevior was here found for the first time in a domestic cat from a mountainous area of Northern Italy. The occurrence of lungworms was statistically related to the presence of respiratory signs and more significant in cats with mixed infection by other lungworms and/or intestinal parasites. Cats living in site C of Central Italy resulted statistically more at risk of infection for lungworms than cats living in the other study sites, while animals ageing less than 1 year were at more risk for troglostrongylosis. Finally, the presence of lungworms was more significant in cats with mixed infection by other lungworms and/or intestinal parasites. These results are discussed under epidemiological and clinical points of views.

Metastrongyloid infection by Aelurostrongylus abstrusus, Troglostrongylus brevior and Angiostrongylus chabaudi in a domestic cat

The "cat lungworm", Aelurostrongylus abstrusus, affects cats worldwide. Recently, other cardio-pulmonary parasites, e.g. Troglostrongylus brevior and Angiostrongylus chabaudi, have been isolated from cats either for the first time or a long time after they were first described. This paper describes the first known mixed infection by A. abstrusus, T. brevior and A. chabaudi in a domestic cat. Biological and epidemiological implications of old and "new" metastrongyloid-caused infections in cats are discussed.

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.

First report of Troglostrongylus brevior in a kitten in Greece

The first case of a natural infestation with Troglostrongylus brevior in a kitten in Greece is described here. A ∼40-day-old stray cat was referred to a private veterinary clinic with signs of respiratory distress. First stage larvae of a metastrongyloid nematode were observed in the wet mount faecal preparation. Despite an anthelmintic treatment, the respiratory signs worsened and the kitten died 2 days later. The larvae in the faeces were identified morphologically and genetically as T. brevior. The present evidence suggests a vertical or direct infestation of the kitten and a severe pathogenic role of T. brevior in young cats. This report expands the recent published cases of troglostrongylosis in domestic cats to a wider geographical distribution and opens new questions on the apparent spreading of T. brevior from wild to domestic hosts.