Treatment of Sarcoptic Mange in an American Black Bear ( Ursus americanus) with a Single Oral Dose of Fluralaner

Adaptive interventions for advancing in situ wildlife disease management

There is a critical need for advancements in disease management strategies for wildlife, but free-living animals pose numerous challenges that can hinder progress. Most disease management attempts involve fixed interventions accompanied by post hoc outcome assessments focused on success or failure. Though these approaches have led to valuable management advances, there are limitations to both the rate of advancement and amount of information that can be gained. As such, strategies that support more rapid progress are required. Sarcoptic mange, caused by epidermal infection with Sarcoptes scabiei mites, is a globally emerging and re-emerging panzootic that exemplifies this problem. The bare-nosed wombat (Vombatus ursinus), a marsupial endemic to southeastern Australia, is impacted by sarcoptic mange throughout its geographic range and enhanced disease management capabilities are needed to improve upon existing in situ methods. We sought to advance in situ wildlife disease management for sarcoptic mange in free-living bare-nosed wombats, implementing an adaptive approach using fluralaner (Bravecto, MSD Animal Health) and a structured process of learning and method-optimisation. By using surveillance of treated wombats to inform real-time management changes, we have demonstrated the efficacy of topically administered fluralaner at 45 and 85 mg/kg against sarcoptic mange. Importantly, we observed variation in the effects of 45 mg/kg doses, but through our adaptive approach found that 85 mg/kg doses consistently reduced mange severity. Through modifying our surveillance program, we also identified individual-level variation in wombat observability and used this to quantify the level of surveillance needed to assess long-term management success. Our adaptive intervention represents the first report of sarcoptic mange management with fluralaner in free-living wildlife and evaluation of its efficacy in situ. This study illustrates how adapting interventions in real time can advance wildlife disease management and may be applicable to accelerating in situ improvements for other host-pathogen systems.

A retrospective epidemiological study of sarcoptic mange in koalas (Phascolarctos cinereus) using wildlife carer admission records

Outbreaks of sarcoptic mange are sporadically reported in koala populations across Australia, but disease characteristics (e.g., distribution across the body) remain poorly understood. In an area of Northern Victoria regular cases coming into care suggest mange may have become enzootic, and here we characterise those koala mange admission records. In 18% (n = 10) of mange affected koala reports that had a recorded outcome (n = 55), the animals died before the carers could locate them, and of the remaining 45 koalas that were alive upon carer arrival, 80% (n = 36) had to be euthanised due to severe mange. The number of admissions varied among years (highest observed in 2019), and over 60% of affected koala admissions were male. Male admissions peaked in austral spring and again in late austral summer-autumn (mating and birthing seasons), with female admissions only exhibiting the latter peak (birthing season). Fissures of the epidermis of the front paws occurred in 100% of admitted koalas, with 70% also showing these signs elsewhere on ventral surfaces or limbs. Only male koalas had signs of mange on the chest and face, and only female koalas had signs of mange on their back. Collectively, this study suggests sarcoptic mange can be a severe disease in koalas, and that male koalas may play an important role in seasonal transmission dynamics. We discuss how these findings may help inform intervention strategies.

Demodicosis in a Free-Ranging Eurasian Brown Bear (Ursus arctos arctos) Cub in the Endangered Cantabrian Population, Spain

A free-living female Cantabrian brown bear (Ursus arctos arctos) cub severely affected by mange in Asturias (northern Spain) represented the first report of demodicosis for this species. After antimicrobial, antiparasitic, anti-inflammatory, and analgesic therapy it recovered and was released back into the wild to the eastern Cantabrian brown bear subpopulation.

Assessment of the in vitro acaricidal activity of Bravecto® (fluralaner) and a proposed orange oil-based formulation vehicle for the treatment of Sarcoptes scabiei

BACKGROUND

Sarcoptic mange is a serious animal welfare concern in bare-nosed wombats (Vombatus ursinus). Fluralaner (Bravecto®) is a novel acaricide that has recently been utilised for treating mange in wombats. The topical 'spot-on' formulation of fluralaner can limit treatment delivery options in situ, but dilution to a volume for 'pour-on' delivery is one practicable solution. This study investigated the in vitro acaricidal activity of Bravecto, a proposed essential oil-based diluent (Orange Power®), and two of its active constituents, limonene and citral, against Sarcoptes scabiei.

METHODS

Sarcoptes scabiei were sourced from experimentally infested pigs. In vitro assays were performed to determine the lethal concentration (LC50) and survival time of the mites when exposed to varying concentrations of the test solutions.

RESULTS

All compounds were highly effective at killing mites in vitro. The LC50 values of Bravecto, Orange Power, limonene and citral at 1 h were 14.61 mg/ml, 4.50%, 26.53% and 0.76%, respectively. The median survival times of mites exposed to undiluted Bravecto, Orange Power and their combination were 15, 5 and 10 min, respectively. A pilot survival assay of mites collected from a mange-affected wombat showed survival times of < 10 min when exposed to Bravecto and Orange Power and 20 min when exposed to moxidectin.

CONCLUSIONS

These results confirm the acaricidal properties of Bravecto, demonstrate acaricidal properties of Orange Power and support the potential suitability of Orange Power and its active constituents as a diluent for Bravecto. As well as killing mites via direct exposure, Orange Power could potentially enhance the topical delivery of Bravecto to wombats by increasing drug penetration in hyperkeratotic crusts. Further research evaluating the physiochemical properties and modes of action of Orange Power and its constituents as a formulation vehicle would be of value.

A Review of Circumpolar Arctic Marine Mammal Health-A Call to Action in a Time of Rapid Environmental Change

The impacts of climate change on the health of marine mammals are increasingly being recognised. Given the rapid rate of environmental change in the Arctic, the potential ramifications on the health of marine mammals in this region are a particular concern. There are eleven endemic Arctic marine mammal species (AMMs) comprising three cetaceans, seven pinnipeds, and the polar bear (Ursus maritimus). All of these species are dependent on sea ice for survival, particularly those requiring ice for breeding. As air and water temperatures increase, additional species previously non-resident in Arctic waters are extending their ranges northward, leading to greater species overlaps and a concomitant increased risk of disease transmission. In this study, we review the literature documenting disease presence in Arctic marine mammals to understand the current causes of morbidity and mortality in these species and forecast future disease issues. Our review highlights potential pathogen occurrence in a changing Arctic environment, discussing surveillance methods for 35 specific pathogens, identifying risk factors associated with these diseases, as well as making recommendations for future monitoring for emerging pathogens. Several of the pathogens discussed have the potential to cause unusual mortality events in AMMs. Brucella, morbillivirus, influenza A virus, and Toxoplasma gondii are all of concern, particularly with the relative naivety of the immune systems of endemic Arctic species. There is a clear need for increased surveillance to understand baseline disease levels and address the gravity of the predicted impacts of climate change on marine mammal species.

Pharmacokinetic and pharmacodynamic considerations for treating sarcoptic mange with cross-relevance to Australian wildlife

Sarcoptes scabiei is the microscopic burrowing mite responsible for sarcoptic mange, which is reported in approximately 150 mammalian species. In Australia, sarcoptic mange affects a number of native and introduced wildlife species, is particularly severe in bare-nosed wombats (Vombatus ursinus) and an emerging issue in koala and quenda. There are a variety of acaricides available for the treatment of sarcoptic mange which are generally effective in eliminating mites from humans and animals in captivity. In wild populations, effective treatment is challenging, and concerns exist regarding safety, efficacy and the potential emergence of acaricide resistance. There are risks where acaricides are used intensively or inadequately, which could adversely affect treatment success rates as well as animal welfare. While reviews on epidemiology, treatment strategies, and pathogenesis of sarcoptic mange in wildlife are available, there is currently no review evaluating the use of specific acaricides in the context of their pharmacokinetic and pharmacodynamic properties, and subsequent likelihood of emerging drug resistance, particularly for Australian wildlife. This review critically evaluates acaricides that have been utilised to treat sarcoptic mange in wildlife, including dosage forms and routes, pharmacokinetics, mode of action and efficacy. We also highlight the reports of resistance of S. scabiei to acaricides, including clinical and in vitro observations.

PHARMACOKINETICS OF A SINGLE DOSE OF FLURALANER ADMINISTERED ORALLY TO AMERICAN BLACK BEARS (URSUS AMERICANUS)

Sarcoptic mange continues to impact free-ranging mammal populations, including the American black bear (Ursus americanus). Administration of a single oral dose of fluralaner may be a viable treatment option for captive and free-ranging black bears affected by mange. This novel ectoparasitic in the isoxazoline class acts as an inhibitor of γ-aminobutyric acid (GABA)-gated chloride channels and l-glutamate-gated chloride channels (GluCls) and is commercially available in the United States as a flea and tick preventative medication for domestic dogs and cats. Pharmacokinetic parameters of fluralaner were evaluated in clinically healthy American black bear cubs (n = 10) administered a single oral dose of fluralaner at a targeted minimum dose of 25 mg/kg. Blood was collected at 24 hr and 7, 14, 21, 28, 35, 42, 49, 56, 63, and 70 days, and harvested plasma was analyzed for drug concentration using high-performance liquid chromatography. The average half-life (K_e t_1/2) was determined to be 4.9 days, which is shorter than that published in domestic dogs. It was estimated that the average drug withdrawal time is approximately 64-72 days in this species.

USE OF FLUMETHRIN-IMPREGNATED COLLARS TO MANAGE AN EPIDEMIC OF SARCOPTIC MANGE IN AN URBAN POPULATION OF ENDANGERED SAN JOAQUIN KIT FOXES (VULPES MACROTIS MUTICA)

Sarcoptic mange epidemics can have long-lasting impacts on susceptible wildlife populations, potentially contributing to local population declines and extirpation. Since 2013, there have been 460 reported cases of sarcoptic mange in an urban population of endangered San Joaquin kit foxes (Vulpes macrotis mutica) in Bakersfield, CA, with many of them resulting in fatality. As part of a multifaceted response to mitigate mange-caused mortalities and reduce this conservation threat, a 2-yr randomized field trial was conducted to assess the efficacy of long-acting flumethrin collars against sarcoptic mange in kit foxes. Thirty-five kit foxes living in a high-density population on a college campus were captured, examined, administered selamectin, and each fox randomly assigned to either receive a flumethrin collar placed within a VHF radio collar or a VHF radio collar without flumethrin. The survival and mange-infestation status of study animals was monitored via radio telemetry, remote cameras, and periodic recapture examinations and compared among treated and control kit foxes using a Cox proportional hazards model. The average time to onset of mange for treated kit foxes (176 days) was similar to controls (171 days) and treatment with flumethrin did not significantly reduce mange risk for all kit foxes. Kit foxes that had a mild mange infestation at the beginning of the study were four times more likely to develop mange again, regardless of flumethrin treatment, compared with kit foxes that had no signs at initial recruitment. This study demonstrates an approach to evaluating population-level protection and contributes to the limited literature on efficacy, safety, and practicality of acaricides in free-ranging wildlife.

A systematic review of moxidectin as a treatment for parasitic infections in mammalian species

Moxidectin (MOX) is a macrocyclic lactone approved worldwide for the treatment of both endo- and ecto-parasites in many mammalian species. The aim of this study was to assess the efficacy of MOX as a treatment against parasites in a range of mammalian species. An electronic literature search was performed for publications to the 1^st September 2020. A total of 205 papers were retrieved and screened against all required criteria; hence, 35 were papers were reviewed in this study. The level of evidence and methodological quality was analysed, where a total of 13 publications were categorised as a 'randomised control trial', seven were categorised as a 'non-randomised control trial' and 15 as an 'experimental control trial'. The overall methodological quality of the publications was considered low, low to moderate, moderate, moderate to high and high in ten, four, twelve, five and a further four, respectively. We assessed the treatment and possible toxicity of MOX in 13 mammalian species, six investigations reported adverse effects to MOX in a small percentage of individuals. The authors reported observed reactions that were typically mild symptoms that did not require additional therapies, and/or resolved themselves. Further studies are needed to assess the efficacy of MOX treatment in a larger number of species, particularly in wildlife.

Fluralaner as a novel treatment for sarcoptic mange in the bare-nosed wombat (Vombatus ursinus): safety, pharmacokinetics, efficacy and practicable use

Background

Sarcoptic mange causes significant animal welfare and occasional conservation concerns for bare-nosed wombats (Vombatus ursinus) throughout their range. To date, in situ chemotherapeutic interventions have involved macrocytic lactones, but their short duration of action and need for frequent re-administration has limited treatment success. Fluralaner (Bravecto®; MSD Animal Health), a novel isoxazoline class ectoparasiticide, has several advantageous properties that may overcome such limitations.

Methods

Fluralaner was administered topically at 25 mg/kg (n = 5) and 85 mg/kg (n = 2) to healthy captive bare-nosed wombats. Safety was assessed over 12 weeks by clinical observation and monitoring of haematological and biochemical parameters. Fluralaner plasma pharmacokinetics were quantified using ultra-performance liquid chromatography and tandem mass spectrometry. Efficacy was evaluated through clinical assessment of response to treatment, including mange and body condition scoring, for 15 weeks after topical administration of 25 mg/kg fluralaner to sarcoptic mange-affected wild bare-nosed wombats (n = 3). Duration of action was determined through analysis of pharmacokinetic parameters and visual inspection of study subjects for ticks during the monitoring period. Methods for diluting fluralaner to enable ‘pour-on’ application were compared, and an economic and treatment effort analysis of fluralaner relative to moxidectin was undertaken.

Results

No deleterious health impacts were detected following fluralaner administration. Fluralaner was absorbed and remained quantifiable in plasma throughout the monitoring period. For the 25 mg/kg and 85 mg/kg treatment groups, the respective means for maximum recorded plasma concentrations (C_max) were 6.2 and 16.4 ng/ml; for maximum recorded times to C_max, 3.0 and 37.5 days; and for plasma elimination half-lives, 40.1 and 166.5 days. Clinical resolution of sarcoptic mange was observed in all study animals within 3–4 weeks of treatment, and all wombats remained tick-free for 15 weeks. A suitable product for diluting fluralaner into a ‘pour-on’ was found. Treatment costs were competitive, and predicted treatment effort was substantially lower relative to moxidectin.

Conclusions

Fluralaner appears to be a safe and efficacious treatment for sarcoptic mange in the bare-nosed wombat, with a single dose lasting over 1–3 months. It has economic and treatment-effort-related advantages over moxidectin, the most commonly used alternative. We recommend a dose of 25 mg/kg fluralaner and, based on the conservative assumption that at least 50% of a dose makes dermal contact, Bravecto Spot-On for Large Dogs as the most appropriate formulation for adult bare-nosed wombats.

Graphical abstract

Comment on: "The treatment of sarcoptic mange in wildlife: a systematic review"

This letter comments on the article “The treatment of sarcoptic mange in wildlife: a systematic review” published in Parasites & Vectors 2019, 12:99, and discusses the limitations in the use of endectocides for scabies control in free-ranging wildlife. The ecological impact and drug resistance to ivermectin are also discussed. In our view, scabies control in free-ranging wildlife should be based preferably on population management measures, and whether to apply individual treatments to free-ranging populations should be considered very carefully and avoided where not absolutely warranted.

SEROLOGY AS A TOOL TO INVESTIGATE SARCOPTIC MANGE IN AMERICAN BLACK BEARS (URSUS AMERICANUS)

Black bears (Ursus americanus) have historically been considered an uncommon host for sarcoptic mange. However, over the last 25 yr, sarcoptic mange has been increasingly reported in black bears in the northeastern US. Syndromic monitoring is the most common surveillance approach for mange in bears, but tools to monitor exposure to Sarcoptes scabiei in bear populations have not been thoroughly evaluated under field conditions. In this study, we validated a commercially available enzyme-linked immunosorbent assay (ELISA), designed to detect antibodies against S. scabiei in dogs, for use in black bears with a sensitivity and specificity of 95.6% and 96.6%, respectively. To further examine the performance of this assay, serial serum samples from seven black bears with confirmed sarcoptic mange were collected posttreatment to determine the persistence of detectable antibody response with the ELISA. Antibodies in black bears waned to below the limit of detection between 4 and 14 wk, suggesting that serology studies might underestimate the number of exposed black bears after antibodies have waned. State-wide serosurveys in Pennsylvania from hunter-harvested black bears in 2017 and 2018 showed a significant difference in seroprevalence between regions with high occurrence of mange (mean seroprevalence 6.7%, range of 6.6-6.8%) and low occurrence of mange (no seropositive black bears were detected). Within Pennsylvania, these data indicate that the geographic distribution of exposure to S. scabiei, based on serologic testing, generally reflects the distribution of overt disease, as determined by syndromic surveillance. Collectively, these results indicate the evaluated ELISA is an effective tool for monitoring S. scabiei exposure in bear populations and provides the framework for additional studies regarding sarcoptic mange epidemiology in black bears.

A review of sarcoptic mange in North American wildlife

The "itch mite" or "mange mite", Sarcoptes scabiei, causes scabies in humans and sarcoptic mange in domestic and free-ranging animals. This mite has a wide host range due to its ability to adapt to new hosts and has been spread across the globe presumably through human expansion. While disease caused by S. scabiei has been very well-studied in humans and domestic animals, there are still numerous gaps in our understanding of this pathogen in free-ranging wildlife. The literature on sarcoptic mange in North American wildlife is particularly limited, which may be due to the relatively limited number of clinically-affected species and lack of severe population impacts seen in other continents. This review article provides a summary of the current knowledge of mange in wildlife, with a focus on the most common clinically-affected species in North America including red foxes (Vulpes vulpes), gray wolves (Canis lupus), coyotes (Canis latrans), and American black bears (Ursus americanus).

The treatment of sarcoptic mange in wildlife: a systematic review

BACKGROUND

Sarcoptic mange, caused by the Sarcoptes scabiei mite, is an infectious disease of wildlife, domestic animals and humans with international importance. Whilst a variety of treatment and control methods have been investigated in wildlife, the literature is fragmented and lacking consensus. The primary objectives of this review were to synthesise the diverse literature published on the treatment of sarcoptic mange in wildlife from around the world, and to identify the qualities of successful treatment strategies in both captive and free-roaming wildlife.

METHODS

A systematic search of the electronic databases CAB Direct, PubMed, Scopus, Web of Science, EMBASE and Discovery was undertaken. Data pertaining to study design, country, year, species, study size, mange severity, treatment protocol and outcomes were extracted from eligible studies and placed in a table. Following data extraction, a decision tree was used to identify studies suitable for further analysis based on the effectiveness of their treatment protocol, whether they were conducted on captive or non-captive wildlife, and the quality of their post-treatment monitoring period.

RESULTS

Twenty-eight studies met our initial inclusion criteria for data collection. Of these studies, 15 were selected for further analysis following application of the decision tree. This comprised of 9 studies on captive wildlife, 5 studies on free-living wildlife and 1 study involving both captive and free-living wildlife. Ivermectin delivered multiple times via subcutaneous injection at a dose between 200-400 µg/kg was found to be the most common and successfully used treatment, although long-term data on post-release survival and re-infection rates was elusive.

CONCLUSIONS

To our knowledge, this review is the first to demonstrate that multiple therapeutic protocols exist for the treatment of sarcoptic mange in wildlife. However, several contemporary treatment options are yet to be formally reported in wildlife, such as the use of isoxazoline chemicals as a one-off treatment. There is also a strong indication for more randomised controlled trials, as well as improved methods of post-treatment monitoring. Advancing this field of knowledge is expected to aid veterinarians, wildlife workers and policy makers with the design and implementation of effective treatment and management strategies for the conservation of wildlife affected by sarcoptic mange.