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PPCO Twist System PEER REVIEWED PARASITE PROTOCOLS PARASITE PROTOCOLS FOR YOUR PRACTICE CANINE PROTOZOA Recommendations from the Companion Animal Parasite Council Susan E. Little, DVM, PhD, Diplomate ACVM, and Emilio DeBess, DVM, MPVM The mission of the Companion Animal Parasite Council (CAPC) is to foster animal and human health, while preserving the human–animal bond, through recommendations for the diagnosis, treatment, prevention, and control of parasitic infections. For more information, including detailed parasite control recommendations, please visit capcvet.org. rotozoan parasites, including vector-borne Vectors & Transmission. Many different tick species infections and intestinal protozoa, are respon- transmit Babesia species when feeding on dogs; the sible for a number of different diseases in dogs most common U.S. species include: P(Table, page 44). Although many infections are • B vogeli (formerly, B canis vogeli), transmitted by acquired by direct ingestion of infective stages, others Rhipicephalus sanguineus ticks may be transmitted by arthropods. These parasites are • B gibsoni; transmission with this species has been distributed worldwide or regionally. Accurate, prompt associated with dog fighting. diagnosis and appropriate, specific treatment are critical Transmission of any Babesia species can to managing and preventing protozoan parasitic dis- occur following blood transfusion.1 eases in dogs. Diagnosis. Dogs with babesiosis present with fever, anorexia, de- VECTOR-BORNE INFECTIONS pression, and often, hemolytic ane- Babesia Species mia.1 Diagnosis is achieved by ex- Distribution. Worldwide, dogs may become infected amining stained blood smears for with Babesia canis, B vogeli, B rossi, B gibsoni, B con- characteristic piroplasms in erythro- radae, and other small and large Babesia species, some cytes (Figure 1). that have yet to be named.1,2 Treatment. Preferred treatment op- Figure 1. Piroplasms of a tions include:3 large Babesia species in • canine erythrocytes About This Series Imidocarb diproprionate for large Babesia species (B canis, B vogeli, B rossi) One of CAPC’s principal achievements has • Atovaquone/azithromycin for small Babesia species been creating recommendations that support (B gibsoni, B conradae). practitioners in their efforts to protect pets and people from parasites. These recommendations Prevention. Infection prevention requires careful at- are based on peer-reviewed, published research tention to tick control and avoidance of fighting among findings and the collective parasitologic and dogs. clinical expertise of the CAPC board. In this series, CAPC board members will: Hepatozoon Species r Review the diagnosis, treatment, and control of Distribution. Hepatozoon americanum has only been common parasites of dogs and cats described in the U.S., while H canis is found worldwide.4 r Suggest strategies for implementing specific Vectors & Transmission. H canis and H america- CAPC recommendations in practice. num are transmitted to dogs by ingestion of the vec- The full recommendations are available at tor—ticks—rather than their bite. H americanum can capcvet.org. also be transmitted by ingestion of paratenic vertebrate hosts. September/October 2013 Today’s Veterinary Practice 43 | PARASITE PROTOCOLS Diagnosis. H americanum infection presents as se- and long-term therapy consisting of ponazuril or trim- vere, febrile disease, with lethargy, myalgia, and mus- ethoprim/sulfamethoxazole combined with clindamycin cle wasting commonly reported. It also infects skeletal and azithromycin, followed by long-term decoquinate and cardiac muscle, and induces pyogranu- therapy and pain management with nonsteroidal anti- lomatous myositis. Chronically infect- inflammatory drugs.5 ed dogs often develop periosteal Prevention. Tick control helps prevent infection by proliferative lesions on their long limiting the number of ticks ingested. Prevention of bones and bloodwork reveals H americanum also requires limiting consumption of profound neutrophilia. Clinical paratenic hosts, especially rabbits and rodents.6 disease with H canis is relative- ly mild by comparison.5 Leishmania Species Diagnosis of both Hepatozoon Distribution. Althought fairly uncommon in North Amer- species can be made by:5 ica, dogs are infected with Leishmania species through- • Identifying gamonts in leukocytes out much of the world. Infection has been diagnosed in on stained blood smears; gamonts Figure 2. Gamont of dogs imported from endemic areas, such as the Mediter- Hepatozoon americanum are rare in H americanum infection ranean basin and Central and South America. in canine leukocyte but much more common in H canis infection (Figure 2). Vectors & Transmission. In many areas of the world, • Polymerase chain reaction (PCR) of whole blood phlebotomine sandflies that have fed on an infected ver- • Histologic examination of muscle biopsy (more sensi- tebrate transmit Leishmania species to dogs. In the U.S., tive in detecting H americanum infection than PCR). transmission by sandflies has not been epidemiologically demonstrated, but canine infections are recognized, par- Treatment. H canis infection is treated with imidocarb ticularly in foxhound kennels, and are presumably ac- diproprionate. H americanum requires more aggressive quired by direct transmission between dogs.7 TABLE. U.S. Canine Protozoa: Routes of Acquisition, Diagnostic Strategies, & Preferred Treatments TRANSMISSION DIAGNOSIS PREFERRED TREATMENT CANINE VECTOR-BORNE PROTOZOA Babesia Tick bite Blood smear Large Babesia species: species Blood transfusion PCR of whole blood Imidocarb diproprionate Dog fighting (B gibsoni) Serology Small Babesia species: Atovaquone/azithromycin combination therapy Hepatozoon Ingestion of ticks (H canis, H Blood smear H canis: Imidocarb diproprionate species americanum) PCR of whole blood H americanum: Ponazuril or Ingestion of vertebrate Histologic examination trimethoprim sulfa combined paratenic host (H of muscle biopsy (H with clindamycin and americanum) americanum) azithromycin, followed by long- term decoquinate Leishmania Sandfly bite Impression smear of lesion Pentavalent antimonials species Direct dog-to-dog PCR Allopurinol transmission Serology Trypanosoma Stercorarian from kissing bug Blood smear Benzinidazole (not available in cruzi Ingestion of infected bugs PCR the U.S.) Serology CANINE VECTOR-BORNE PROTOZOA Cystoisospora Ingestion of oocysts Fecal flotation Sulfadimethoxine species Ponazuril Cryptosporidi- Ingestion of oocysts Fecal flotation Paromomycin um species Fecal IFA Azithromycin Giardia species Ingestion of cysts Fecal flotation Fenbendazole Fecal IFA Febantel Fecal ELISA Additional treatment options and dosages for the medications listed in this table are available at capcvet.org (select CAPC Recommendations). 44 Today’s Veterinary Practice September/October 2013 PARASITE PROTOCOLS | Diagnosis. Infected dogs may Prevention. Preventing infection requires limiting ac- remain asymptomatic or can cess to kissing bugs by sealing kennels and keeping develop severe, chronic dogs inside. Limiting predation is also recommended disease, involving mus- because, although unproven, ingestion of infected reser- cle wasting, ocular signs, voir hosts is a suspected route of transmission.12 renal disease, and alope- Zoonosis. T cruzi is zoonotic and, in endemic areas, 8 cia and other skin lesions. people are readily infected from a feeding bug vector’s Diagnosis is made by serol- feces. In the U.S., most human infections are associated ogy or identification of amasti- with blood transfusion or travel to endemic areas.11 Figure 3. Amastigotes of gotes in impression smears from Leishmania species from affected tissues (Figure 3); PCR INTESTINAL PROTOZOA ruptured macrophages assays are also available. Cystoisospora Species on impression smear Treatment. Canine leishmani- Distribution. Coccidia is a common finding in dogs, asis is difficult to treat, although pentavalent antimoni- with some studies suggesting approximately 1% to 5% of als and allopurinol can be used. dogs may be infected worldwide. Prevention. In endemic areas, protecting dogs from Vectors & Transmission. Canine infection with Cys- sandflies by routine application of repellent insecticides toisospora species (Isospora species) commonly occurs decreases transmission of Leishmania species9; isola- upon ingestion of:13,14 tion of infected dogs is recommended to prevent direct • Sporulated oocysts from an environment contami- transmission. nated with feces • Zoonosis. Dogs are a major reservoir host for leishmani- Transport hosts. osis—a zoonotic disease. Euthanasia of infected dogs has Diagnosis. Many infected been recommended to limit transmission to humans and dogs remain asymptom- other dogs, particularly in regions where vector-borne atic, developing immuni- Leishmania transmission is not yet endemic. ty to limit infection and protect them from future Canine Protozoa: Recommendations from the Companion Animal Parasite Council Trypanosoma cruzi infections; however, diar- Distribution. Trypanosoma cruzi is the agent of Ameri- rhea, weight loss, dehydra- can trypanosomiasis or Chagas disease. Autochthonous tion, and even death can occur Figure 5. Oocysts of cases are occasionally reported from dogs in the south- in severe infections, particularly Cystoisospora canis on ern U.S., where natural maintenance cycles exist, and those in young animals.15 Infec- fecal float are common in parts of South and Central America and tions are diagnosed by fecal flota- Mexico.10,11 tion, which
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