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Feline Helminths Article Recommendations from the Companion Animal Parasite Council Susan E

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Feline Helminths Article Recommendations from the Companion Animal Parasite Council Susan E PEER REVIEWED PARASITE PROTOCOLS Feline PARASITE PROTOCOLS FOR YOUR PRACTICE Friendly FELINE HELMINTHS Article Recommendations from the Companion Animal Parasite Council Susan E. Little, DVM, PhD, Diplomate ACVM (Parasitology) Oklahoma State University Rick Marrinson, DVM Longwood Veterinary Clinic Longwood, Florida 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. elminth infection in cats is remarkably common. Ascarids. Cats acquire infection with ascarids by in- Recent surveys have documented helminths in more gestion of larvated eggs from the environment or in- Hthan 2/3 of adult cats examined in animal shelters in gestion of rodents or birds that have ingested eggs. In some areas.1 The most common nematode of cats, Toxocara some surveys, T cati eggs are identified by fecal flota- cati, also has zoonotic potential, making control particu- tion in as many as 35% of cats, and necropsy surveys larly important. place the prevalence even higher.4,5 The high prevalence of infection is often surprising to Kittens infected with T cati may have a pot-bellied ap- both veterinarians and parasitologists, in part because fecal pearance and general ill thrift; adult cats also common- flotation may fail to reveal the presence of helminths. An ly harbor infection. Migration of adult T cati into the absence of helminth eggs on fecal flotation is especially stomach irritates the mucosa, resulting in vomiting, and true for tapeworms; a recent study showed that, in 87% of T cati are commonly found in feline vomitus. The other cats with tapeworms confirmed in the small intestine, eggs feline ascarid, T leonina, is less common than T cati were not detected on fecal flotation.1 and not thought to be associated with clinical disease.3 Dirofilaria immitis (heartworm) also infects and causes Hookworms. The hookworm, A tubaeforme, is found disease in cats, although diagnostic test results can be dif- in the small intestine of cats and has been associated ficult to interpret.2 with anemia and weight loss; Ancylostoma braziliense Broad-spectrum anthelmintic products are widely avail- also occurs but is much less common in the United able to protect and treat cats, but their use and acceptance States. remain limited. To protect feline health and limit environ- Cats become infected with hookworms upon inges- mental contamination with zoonotic parasites, CAPC rec- tion of larvae or ingestion of rodent paratenic hosts; un- ommends use of year-round parasite control products in like with dogs and Ancylostoma caninum, transmam- cats throughout all areas of the United States.3 mary transmission with A tubaeforme is not known to occur.3 FELINE GASTROINTESTINAL HELMINTHS Nematodes Diagnosis. Infection with ascarids and hookworms The most common gastrointestinal nematodes among con- can often be diagnosed by fecal flotation. To ensure tinental North American cats are ascarids (T cati and Tox- adequate sensitivity to allow detection, CAPC recom- ascaris leonina) and hookworms (Ancylostoma tubae- mends that fecal flotation be performed by centrifuga- forme). Other nematodes occasionally seen include Phy- tion, using an adequate sample size. However, eggs can- saloptera species, Strongyloides species, and Ollulanus not be detected if only a single sex of worm is present tricuspis. or the nematodes are immature and, thus, prepatent. tvpjournal.com September/October 2014 Today’s Veterinary Practice 39 | PARASITE PROTOCOLS Eggs of T cati are spher- ranted. Praziquantel and epsiprantel are label-approved ical and surrounded by as effective against T taeniaeformis and D caninum, and a thick, roughly pitted can be used off-label for treatment of intestinal Mesoces- shell (Figure 1), while toides species. eggs of A tubaeforme Effective treatment of Spirometra species is more dif- are oval and smooth ficult, requiring administration of an elevated, off-label shelled and contain a de- dose of praziquantel (25 mg/kg PO Q 24 H) for 2 con- veloping embryo (Figure 2). secutive days.7 Figure 1. Egg of Toxocara The prepatent period for T cati; note the pitted shell cati is 4 to 5 weeks, while Trematodes and dark appearance. that of A tubaeforme is 2 to Gastrointestinal trematode infection in cats is rare com- 3 weeks. pared with nematode and cestode infection. However, Treatment. Both asca- occasional infections with Alaria species or Nanophyetus rids and hookworms salmincola are seen in certain geographic areas. are readily treated with Life Cycle & Transmission. Alaria species infections several different an- are acquired when cats prey on intermediate or paratenic thelmintics, including hosts, such as frogs and snakes, that harbor the metacer- pyrantel, emodepside, cariae. Migration of immature Alaria species through the milbemycin, moxidec- lungs can lead to pulmonary damage, with focal areas of tin, and selamectin; the hemorrhage evident.3 topical formulation of some Feline infection with N salmincola occurs when cats in- Figure 2. Thin-shelled of these compounds facili- gest metacercariae in salmonid fish. Although trematodes oval egg of Ancylostoma tates administration to cats.3 tubaeforme. develop in the small intestine, classic “salmon poisoning” disease due to Neorickettsia helminthoeca infection has Cestodes not been described in cats.3 Historically, adult tapeworms in the intestinal tract have Diagnosis. Diagnosis of infec- not been thought to cause significant clinical disease in tion with Alaria species, N cats. However: • Intestinal impactions with Taenia taeniaeformis neces- salmincola, and other trematodes usually re- sitating surgical removal have been reported6 • Spirometra species, a common cestode of cats in some quires concentrating coastal and swampy areas, can cause diarrhea, vomit- eggs by sedimentation, ing, and weight loss.7 because the eggs do Feline intestinal infections with Mesocestoides species not readily float in the are usually asymptomatic, but organisms in extraintesti- specific gravity of many nal stages (tetrathyridia) that multiply asexually in the ab- flotation solutions. dominal cavity can cause severe clinical sequelae, includ- Identity of trematode eggs Figure 3. Large eggs of ing death, in some cats. can usually be confirmed by the presence and shape of the Alaria species recovered Life Cycle & Transmission. All of these cestodes have an operculum, general egg mor- from infected cat. indirect life cycle, requiring 1 or more intermediate hosts: phology, and size. For exam- • T taeniaeformis and Dipylidium caninum use rodents ple, eggs of Alaria species are approximately 120 microns and fleas, respectively. × 70 microns, are operculate, and contain an undifferen- • Spirometra species require a copepod first intermedi- tiated embryo when shed (Figure 3). ate host and then use many different vertebrates as second intermediate hosts. Treatment. Although no products are label-approved for • The life cycle of Mesocestoides species has not yet been trematode treatment in cats, praziquantel is expected to 3 determined, but ingestion of vertebrate intermediate be effective. hosts containing tetrathyridia is considered the most likely route of intestinal infection.8 FELINE EXTRAINTESTINAL HELMINTHS Nematodes Diagnosis. Diagnosis of cestode infection is challeng- The 2 most common extraintestinal nematodes infecting ing. Fecal flotation is recommended, and, when identi- cats in North America are heartworms (D immitis) and fied, eggs definitively confirm the presence of tapeworms. feline lungworms (Aelurostrongylus abstrusus).3 Both However, in most cats with cestodes, eggs from the small parasites can cause respiratory disease in cats due to pul- 1 intestine are not recovered on fecal flotation, but owner monary damage. reports of proglottids are helpful in reaching a diagnosis. The death of developing D immitis may lead to pulmo- Treatment. In cats that commonly ingest prey species, in- nary, bronchial, and alveolar disease in cats collectively fections are likely, and presumptive treatment may be war- referred to as heartworm-associated respiratory disease; 40 Today’s Veterinary Practice September/October 2014 tvpjournal.com PARASITE PROTOCOLS | HS INT adult heartworms in the pulmonary artery are associated care, such as corticosteroids, oxygen therapy, or broncho- ELM H with sudden death. dilators. Preventive use is also recommended to limit ad- E 9 Life Cycle & Transmission. D immitis is transmitted by ditional infections. IN There are no label-approved treatments for A abstrusus EL mosquitoes, and dogs are considered the main reservoir F host. Microfilariae rarely persist in cats long enough for infection, but efficacy has been documented with topical 10,11 them to serve as a source of infection to mosquitoes.9 moxidectin and topical emodepside. Snails and slugs are required intermediate hosts for A ab- strusus, but infections are most common in cats allowed to Cestodes prey on rodent, avian, or lizard paratenic hosts. Mesocestoides species may establish both intestinal infec- tions (described earlier) and, rarely, extraintestinal infec- Clinical Signs. Vomiting is often present in cats infected tions in cats. with D immitis, while some cats infected with A abstrusus develop chronic cough, dyspnea, and anorexia. Clinical Signs & Transmission. Cats
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