Dirofilarioses in cats: European guidelines from the ABCD on prevention and management

The Distribution, Diversity, and Control of Dirofilariosis in Brazil: A Comprehensive Review

Brazil's extensive coastline, tropical and subtropical climate, and well-preserved environment represent a conducive setting for dirofilariosis, a zoonotic mosquito-borne disease. Although this condition has long been recognised in the country, it has been relatively under-studied, and it is currently considered to be an emerging disease. Diagnosis, treatment, and control remain challenging due to the extensive gaps in knowledge. In order to help address this issue, this review aims to (i) summarise the available literature on the distribution of Dirofilaria spp. in Brazilian dogs over the last decade, (ii) review case reports of dirofilariosis in cats, wild animals, and humans over the last twenty years, and (iii) highlight the benefits of taking a One Health approach to managing this disease. While there have been several prevalence studies in dogs, disease distribution is poorly characterised in cats, and little is known about the occurrence of the parasite in wildlife. Human cases are sporadically reported, and no large-scale studies have been undertaken to date. Evidence indicates that Dirofilaria immitis is the main species circulating in Brazil, although Dirofilaria repens has also been detected. Molecular studies have also suggested the circulation of a highly virulent form of D. immitis, which may be genetically distinct from those of the Old World. A programme of epidemiological, ecological, genomic, and pathogenicity-based studies is required to quantify the impact of dirofilariosis in Brazil on both veterinary and public health and to inform others on its control.

Causes and consequences of feline haemothorax: A retrospective case series

BACKGROUND

The objective of this study was to describe the causes of haemothorax in cats, patient presentation and outcome.

METHODS

This was a retrospective study based in a university teaching hospital. The electronic case records of cats presenting with a haemothorax between January 2005 and January 2023 were searched. Cases were categorised into 'trauma', 'neoplasia', 'coagulopathy' or 'other'. Signalment, physical examination, clinical pathology findings, concurrent injuries and diagnostic imaging findings were recorded. The median hospitalisation time was calculated, and survival to discharge was noted.

RESULTS

Twenty-five cats were eligible for inclusion. Twenty cases of haemothorax were traumatic in origin, two were neoplastic, two were 'other' and one was coagulopathic. Increased respiratory rate (n = 22) and effort (n = 20) were common, and most patients were anaemic at presentation (n = 16). Common concurrent injuries included pulmonary contusions (n = 15) and pneumothorax (n = 11). The median hospitalisation time for the trauma cats was 5 days (range 1‒15). Overall, 83.3% of the cases survived to discharge.

LIMITATIONS

The limitations of this study are related to its retrospective nature and the relatively small number of cats in the study population.

CONCLUSION

Haemothorax requiring a thoracocentesis in cats is rare, with trauma being the most likely cause. These patients tend to have concurrent injuries and require ongoing hospitalisation. Owners can be advised that the short-term outcome is generally favourable.

First report on natural infection by Dirofilaria repens in a cat in Spain: case report and literature review of feline subcutaneous dirofilariosis in Europe

Dirofilaria repens is an endemic mosquito-borne pathogen widely spread throughout Europe and other non-Europen regions. Infection by D. repens has been reported in dogs, although little is known about the occurrence and epidemiological features of this nematode in cats. During the surgical procedure within the framework of a trap, neuter and release sterilization program, two female filarial nematodes with spontaneous movement were removed from the internal part of the spermatic cord from asymptomatic stray cat in Spain (Grao de Castellón, Castellon de la Plana, province of Spain). Moreover, the presence of microfilariae was detected by using three different methods, including direct blood smear technique, the microhematocrit tube test, and Knott´s modified test. PCR performed from the nematodes extracted from the spermatic cord and from microfilariae in EDTA-blood sample tested both positive for D. repens. To the authors' knowledge, this is the first report that demonstrates the presence of D. repens in cats in Spain. In this sense, a review of the current scientific status of feline subcutaneous dirofilariosis in Europe was also performed. Future investigations should analyze the epidemiological role of cats in D. repens infection including the prevalence of infection. Veterinarians working in endemic areas should be aware of this infection in cats and their susceptibility.

Molecular survey on vector-borne pathogens in clinically healthy stray cats in Zaragoza (Spain)

BACKGROUND

In Europe, feline vector-borne infections are gaining importance because of the changing climate, expanding habitats of potential vectors and expanding pathogen reservoirs. The main objective of this study was to assess the prevalence of vector-borne pathogens (VBPs) in stray cats in Zaragoza, Spain, and to investigate potential risk factors for infection, including feline leukaemia virus (FeLV) and feline immunodeficiency virus (FIV).

METHODS

Blood samples from stray cats presented to the veterinary faculty in Zaragoza between February 2020 and 2022 were tested by polymerase chain reaction (PCR) for the presence of Anaplasma phagocytophilum, Anaplasma platys, Bartonella henselae, Ehrlichia canis, Rickettsia spp., haemotropic Mycoplasma spp., Hepatozoon spp., Leishmania infantum, piroplasms and microfilariae at the LABOKLIN laboratory. The cats were also tested for FeLV and FIV by PCR.

RESULTS

Nearly half of the cats (158/332, 47.6%) were positive for at least one VBP. Hepatozoon spp. were detected in 25.6%, haemotropic Mycoplasma spp. in 22.9%, B. henselae in 9.3% and L. infantum in 2.1% of the cats. Male sex had a statistically significant association with test results for haemotropic Mycoplasma spp. (odds ratio 1.38 [1.21;1.57]); regionality with Hepatozoon spp., B. henseale and FIV; and seasonality with Hepatozoon spp., haemotropic Mycoplasma spp., L. infantum and FeLV (P ≤ 0.05 each). A strong positive correlation was reported for the amount of rainfall and the number of cats that tested positive for Hepatozoon spp. (ρ = 753, P = 0.05). None of the cats tested positive for A. phagocytophilum, A. platys, E. canis, Rickettsia spp., piroplasms, or microfilariae. Co-infections with multiple VBPs were detected in 56 out of 332 cats (16.9%). Thirty-one of the 332 cats included in the study (9.3%) tested positive for FeLV (6.9%) and for FIV (3.6%). In 20/31 cats (64.5%) that tested positive for FeLV/FIV, coinfections with VBP were detected (P = 0.048, OR 2.15 [0.99; 4.64]).

CONCLUSIONS

VBPs were frequently detected in stray cats in Zaragoza. In particular, regionality and seasonality had a statistically significant association with PCR results for most VBPs included in the study.

Diagnostic Accuracy of a Point-of-Care Immunoassay for Feline Immunodeficiency Virus Antibodies, Feline Leukemia Virus Antigen, and Dirofilaria immitis Antigen

Feline immunodeficiency virus (FIV) and feline leukemia virus (FeLV) are retroviral infections of cats worldwide whose clinical manifestations range from mild to severe disease. In both cases, infected cats can live a long life with proper care and should be managed to prevent infection of other cats. Dirofilaria immitis, the nematode that causes heartworm disease, can infect cats in any region where dogs are infected. Though cats are more resistant to infection, clinical diseases in the form of heartworm-associated respiratory disease can cause death. Screening for these infectious diseases enables veterinarians to manage their cases and prevent the spread to other cats. We describe the diagnostic accuracy of a point-of-care immunoassay for FIV, FeLV, and heartworm, compared to reference methods commonly available through reference laboratories to the practicing veterinarian. For FIV, we report 100% sensitivity (95% confidence limits (CL): 96.2-100%) and 97.8% specificity (95% CL: 95.4-99.4%). For FeLV, we report 100% sensitivity (95% CL: 97.7-100%) and 99.2% specificity (95% CL: 97.1-99.9%). And for heartworm, we report 90.2% sensitivity (95% CL: 76.9-97.3%) and 100% specificity (95% CL: 98.3-100%). Veterinarians may expect this performance relative to the reference methods they use for confirmatory serological testing.

First serological study of Dirofilaria immitis antibodies in household domestic ferrets (Mustela putorius furo) in southern Spain - Short communication

Dirofilaria immitis is an endemic mosquito-borne pathogen widely spread throughout Europe as well as North and South America. Infection by D. immitis has been reported in domestic ferrets, although little is known about the occurrence and the epidemiological features of this nematode in this species. The aim of the present retrospective study was to assess the prevalence of D. immitis antibodies using an in-house enzyme-linked immunosorbent assay specifically developed for use in ferrets. One hundred and eighty-six serum samples were obtained from the Province of Valencia (Spain), an area endemic for dirofilariosis. Of the 186 serum samples included in the study, 27 (14.51%) were classified as D. immitis seropositive and 159 samples as D. immitis seronegative. The results provide valuable information on the seroprevalence of D. immitis infection in domestic ferrets in an area endemic for this vector-borne pathogen. The presence of seropositive ferrets should be taken into account and preventive measures should be implemented, including the possibility of serological screening for the early detection of Dirofilaria antibodies as a serological marker of exposure. This is the first study that demonstrates the presence of D. immitis exposure in ferrets in Spain. Veterinarians working in endemic areas should be aware of this infection in ferrets and their susceptibility.

The Presence of Dirofilaria immitis in Domestic Dogs on San Cristobal Island, Galapagos

This study's concept was outlined around the principle of conservation medicine in a biodiversity hotspot from the Neotropical realm: the Galapagos Islands. The wildlife balance has been modified by multi-host parasites introduced with some domestic animals (dogs and cats). The endemic and endangered species, the Galapagos sea lion (GSL, Zalophus wollebaeki), has been exposed to pathogens of canine and feline origin that could become a significant conservation problem for this species. One of these potential cases is the filarial heartworm infection, Dirofilaria immitis, which has been reported on other pinnipeds, with fatalities and clinical symptoms. Therefore, this study evaluated the presence of the microfilaria of D. immitis in dogs from Puerto Baquerizo Moreno, San Cristobal Island, where the largest rookery of GSLs lives and where the proximity to domestic dogs is the most intimate compared to other rookeries of the archipelago. Between July and September 2021, 587 blood samples were collected from owned dogs of Puerto Baquerizo Moreno. Overall, 10 dogs (1.7%) were positive for the presence of the microfilaria of D. immitis with a confidence interval of 0.7%-2.8%. No other filarial species were identified. Significant differences in prevalence between different dog categories were observed only for the age (p = 0.001). This study represents the first report of D. immitis, the agent of canine heartworm disease, in dogs from San Cristobal Island. Hence, the presence of the microfilaria of D. immitis in the blood of dogs could increase the risk of infection to which the GSL is exposed in the region.

Ultrasonography of Parasitic Diseases in Domestic Animals: A Systematic Review

Simple Summary

The aim of this literature review was to summarize the current knowledge on the application of ultrasonography in diagnosis, staging and monitoring of helminthic diseases in domestic animals. We selected and analyzed 122 papers about the application of ultrasonography in parasitic disease in ruminants, equids, swine, and companion animals. Helminths can be recognized in ultrasound images by their morphology, size, and location. In some cases, the parasites are not directly seen by ultrasound, but the lesions caused by them can be easily visualized. Ultrasound imaging is taking on an increasingly important role in veterinary parasitology.

Abstract

The aim of this review was to summarize the current knowledge on the application of ultrasonography in diagnosis, staging and monitoring of helminthic diseases in domestic animals. Only peer reviewed papers written in English language were included in this systematic review. All papers concerning unicellular parasites, wild animals, non-domestic experimental animals, or ex vivo or in vitro applications of ultrasonography were excluded from the review. A total of 122 papers met the inclusion criteria. Among them 47% concerned nematodes, 37% cestodes, and 16% trematodes with the genus Dirofilaria, Echinococcus, and Fasciola the most represented, respectively. Helminths can be recognized in ultrasound images by their morphology, size, and location. In some cases, the parasite stages are not directly seen by ultrasound, but the lesions caused by them can be easily visualized. Ultrasound imaging is taking on an increasingly important role in the diagnosis, staging, monitoring, and control of parasitic diseases in veterinary medicine. However, it cannot replace the clinical approach and the diagnostic tests commonly used in veterinary parasitology.

Seroprevalence of Feline Heartworm in Spain: Completing the Epidemiological Puzzle of a Neglected Disease in the Cat

Feline heartworm is a vector-borne zoonotic disease caused by Dirofilaria immitis. It is a cosmopolitan disease that is continuously expanding. Spain is considered an endemic country; however, although there are many published studies in dogs, feline heartworm has been poorly studied in this country. Thus, the objective was to analyze the exposure to D. immitis throughout Spain to complete the epidemiological map in the feline species. For this, 6,588 feline serum samples were analyzed for the presence of D. immitis antigens and antibodies against D. immitis and Wolbachia. The results were analyzed according to sex, age, breed, habitat, origin (owned or shelter cats), presence of clinical signs, use of preventive, location and climatology. The results showed a prevalence of 0.5% and a seroprevalence of 9.4%. The highest antibody seroprevalences were reported in the Canary Islands and the Balearic Islands (19.2 and 16%, respectively), as well as in the autonomous communities located on the Mediterranean coast (9.2–11.2%). Seropositive cats were found in both indoor and outdoor cats, and from 6 months of age. Furthermore, only 5.8% of cats received regular prophylactic treatment. The results show that feline dirofilariasis is widely distributed throughout the national territory and corroborate that, where infected dogs are present, there are cats exposed to the parasite. It is necessary to implement efficient awareness and prophylaxis measures to control the incidence and expansion of feline heartworm in Spain.

Heartworm disease - Overview, intervention, and industry perspective

Dirofilaria immitis, also known as heartworm, is a major parasitic threat for dogs and cats around the world. Because of its impact on the health and welfare of companion animals, heartworm disease is of huge veterinary and economic importance especially in North America, Europe, Asia and Australia. Within the animal health market many different heartworm preventive products are available, all of which contain active components of the same drug class, the macrocyclic lactones. In addition to compliance issues, such as under-dosing or irregular treatment intervals, the occurrence of drug-resistant heartworms within the populations in the Mississippi River areas adds to the failure of preventive treatments. The objective of this review is to provide an overview of the disease, summarize the current disease control measures and highlight potential new avenues and best practices for treatment and prevention.

Dirofilarioses in two cats in southern Italy

Two cats infected by Dirofilaria immitis and Dirofilaria repens, respectively, were taken to two different private practitioners for a clinical examination. The analyses conducted on the first cat revealed a microfilaraemia due to D. repens of 66 mfs/mL by a modified Knott's test. No clinical signs of D. repens infection were observed in the cat. The animal was euthanised because of a lymphoma condition, and two adult females of D. repens were found in the subcutaneous tissue of the lumbar and left scapular regions at the post-mortem examination. The second cat showed severe abnormalities in the white blood cells, including eosinophil count. Microfilariae of D. immitis were detected in the blood smear, with an average length (n = 2) of 296.2 μm. These clinical cases represent the first reports of feline dirofilarioses in southern Italy and are indicative of a common occurrence of dirofilarial infection in the local canine population.

Updates on Laboratory Evaluation of Feline Cardiac Diseases

Laboratory tests can be altered in cardiovascular diseases and the investigation of specific tests or biomarkers may provide additional information about myocardial damage. Traditional laboratory tests, such as cell blood count, serum biochemistry, and coagulation, can be useful in investigating patients, but are not specific. However, markers like Troponin and Natriuretic Peptides may possibly furnish further data on myocardium damage and can be used in both studying and monitoring cats with cardiac disease. Moreover, the evaluation of the thyroid profile is very important as hyperthyroid cats concomitant cardiovascular diseases are very common and they can also be a direct consequence of endocrinopathy. The purpose of this manuscript is to provide the widest possible overview of what is present in the literature about the feline clinical pathology of heart diseases through a rational division of the main alterations of traditional tests and biomarkers.

Retrospective evaluation of vector-borne pathogens in cats living in Germany (2012-2020)

BACKGROUND

Blood-feeding arthropods can transmit parasitic, bacterial, or viral pathogens to domestic animals and wildlife. Vector-borne infections are gaining significance because of increasing travel and import of pets from abroad as well as the changing climate in Europe. The main objective of this study was to assess the percentage of cats with positive test results for selected vector-borne pathogens in Germany and explore any possible association of such results with time spent abroad.

METHODS

This retrospective study included test results from cats included in the "Feline Travel Profile" established by the LABOKLIN laboratory at the request of veterinarians in Germany between April 2012 and March 2020. This diagnostic panel includes the direct detection of Hepatozoon spp. and Dirofilaria spp. via PCR as well as indirect detection assays (IFAT) for Ehrlichia spp. and Leishmania spp. The panel was expanded to include an IFAT for Rickettsia spp. from July 2015 onwards.

RESULTS

A total of 624 cats were tested using the "Feline Travel Profile." Serum for indirect detection assays was available for all 624 cats; EDTA samples for direct detection methods were available from 618 cats. Positive test results were as follows: Ehrlichia spp. IFAT 73 out of 624 (12%), Leishmania spp. IFAT 22 out of 624 (4%), Hepatozoon spp. PCR 53 out of 618 (9%), Dirofilaria spp. PCR 1 out of 618 cats (0.2%), and Rickettsia spp. IFAT 52 out of 467 cats (11%) tested from July 2015 onwards. Three cats had positive test results for more than one pathogen before 2015. After testing for Rickettsia spp. was included in 2015, 19 cats had positive test results for more than one pathogen (Rickettsia spp. were involved in 14 out of these 19 cats).

CONCLUSIONS

At least one pathogen could be detected in 175 out of 624 cats (28%) via indirect and/or direct detection methods. Four percent had positive test results for more than one pathogen. These data emphasize the importance of considering the above-mentioned vector-borne infections as potential differential diagnoses in clinically symptomatic cats.

Clinical Case of Life-threatening Co-infection Due to Dirofilaria Immitis and Aelurostrongylus Abstrusus in a Cat: First Report of Feline Heartworm Disease in Bulgaria

The present report describes the first clinically manifested and serologically proven case of Dirofilaria immitis infection in a cat in Bulgaria. A 10-year-old intact male cat was referred to the Small Animal Clinic, Trakia University with a history of anorexia, weight loss, intermittent coughing and itching skin lesions on the head and neck. Physical examination revealed abnormal heart sounds and respiration, cyanosis of the mucous membranes, and generalized enlargement of the lymph nodes. Mild infestation with hard ticks and fleas was also detected during the initial skin inspection. In addition, adult Otodectes cynotis mites were observed in the skin lesions. The fecal sample was positive for larvae of Aelurostrongylus abstrusus and eggs of Toxocara cati. Blood serology revealed antigens of D. immitis as well as antibodies against both feline immunodeficiency virus and D. immitis. Thoracic radiographic findings included a pronounced generalized reticular interstitial pattern; alveolar and bronchial shades with multiple nodular thickenings throughout the lungs. Electrocardiography demonstrated a sinus tachycardia, a peaked P-wave (P-pulmonale) and an abnormally low ST-segment. The clinical signs disappeared after treatment with selamectin, doxycycline and corticosteroids. Despite the improvement in general health condition, the cat suddenly died several months later.

Prevalence of microfilariae, antigen and antibodies of feline dirofilariosis infection (Dirofilaria immitis) in the Zaragoza metropolitan area, Spain

Feline heartworm disease is a vector-borne parasitical disease caused by Dirofilaria immitis. Heartworm infection in dogs is prevalent in the Mediterranean countries. Information about the geographical distribution and epidemiological features of D. immitis infection in cats is scarce, particularly in urban stray cats that live within endemic regions for canine heartworm disease. The aim of the current study was to determine the seroprevalence of antigen and antibodies to D. immitis in feral cats in Zaragoza city, an endemic region of Spain. For this purpose, blood samples were examined for microfilariae using a direct blood smear technique and the modified Knott test. Two serological techniques for anti-D. immitis antibody detection (Solo Step® FH and in-house ELISA) and three different commercial antigen tests (DiroChek®, MegaELISA® DIRO Antigen and FASTest® HW) were performed. Blood samples from 250 stray cats were tested: 61 cats (24.40%) tested positive by the in-house ELISA, and 9 cats gave positive (3.6%) results with Solo Step® FH. The global seroprevalence of D. immitis in the feline population of the studied area of Zaragoza was 25.20% (63/250) including Solo Step® FH result and in-house ELISA. The blood exam for all samples was negative when evaluating for microfilariae and not a single cat was positive for antigen testing. This study demonstrates the presence of D. immitis infection in Zaragoza city. Veterinarians working in endemic areas should be aware of this infection in cats at risk and their susceptibility.

First report of Dirofilaria repens infection in a microfilaraemic cat from Romania

The present study describes the first report of Dirofilaria repens infection with the presence of both microfilariae and adult nematodes in a cat from Northeastern Romania. Briefly, a 5-year-old male mixed breed cat was presented to a veterinary clinic in Iasi (Romania), for neutering, in early February 2020. During the surgery, two whitish worms were removed from the internal part of the scrotum. Two adult nematodes, one female and one male, were identified, on the basis of morphological features, as D. repens with whitish, cylindrical bodies, measuring 12.5 cm and 6.5 cm in length, respectively. At histology, the female nematode showed two cavitated structures containing myriads of variably arranged microfilariae. The male had a transversal diameter of 350 μm, a 10 μm thick cuticle and a ridge-period of 10 Μm. multiplex PCR confirmed the diagnosis of D. repens from both nematodes. The Knott's test revealed the presence of microfilariae of D. repens. Routine biochemistry panel was within range with one exception, urea serum level slightly increased. The haematology results revealed an increased number of neutrophils, lymphocytes and eosinophils. The cat had an infection with Otodectes cynotis as well. The cat was discharged with the following therapy recommended: oral doxycycline (10 mg/kg) for 30 days and topical moxidectin, monthly doses. After six months, the Knott's test gave negative results. Further studies should include new insights of D. repens infection in cats concerning its epidemiology, diagnosis and control.