Prevention, Diagnosis, and Management of Infection in Cats

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Prevention, Diagnosis, and Management of Infection in Cats Current Feline Guidelines for the Prevention, Diagnosis, and Management of Heartworm (Dirofilaria immitis) Infection in Cats Thank You to Our Generous Sponsors: Printed with an Education Grant from IDEXX Laboratories. Photomicrographs courtesy of Bayer HealthCare. © 2014 American Heartworm Society | PO Box 8266 | Wilmington, DE 19803-8266 | E-mail: [email protected] Current Feline Guidelines for the Prevention, Diagnosis, and Management of Heartworm (Dirofilaria immitis) Infection in Cats (revised October 2014) CONTENTS Click on the links below to navigate to each section. Preamble .................................................................................................................................................................. 2 EPIDEMIOLOGY ....................................................................................................................................................... 2 Figure 1. Urban heat island profile. BIOLOGY OF FELINE HEARTWORM INFECTION .................................................................................................. 3 Figure 2. The heartworm life cycle. PATHOPHYSIOLOGY OF FELINE HEARTWORM DISEASE .......................................................................................................................................... 4 Figure 3. Microscopic lesions of HARD in the small pulmonary arterioles. Figure 4. Microscopic lesions of HARD in the alveoli. PHYSICAL DIAGNOSIS ............................................................................................................................................ 5 Clinical Signs and Findings DIAGNOSTIC TESTING ........................................................................................................................................... 5 Microfilariae Serology Thoracic Radiography Echocardiography Necropsy Confirmation Figure 5. Summary of feline heartworm diagnostics. Table1. Interpretation of heartworm diagnostic procedures and tests in cats. TREATMENT ............................................................................................................................................................. 8 Medical Options Surgical Options Additional Considerations for Adulticide Therapy Wolbachia Surveillance of Infected Cats PREVENTION ......................................................................................................................................................... 11 Drugs Serologic Testing 2014 Feline Heartworm Guidelines 1 Prepared and approved by the Executive Board of support the transmission of heartworms for brief the American Heartworm Society periods. Thus, the introduction of microfilaremic dogs or wild canids could set up a nidus of infection (Officers: Dr. Stephen Jones, President; Dr. Wallace for local transmission of heartworm in this state. Graham, Past President; Dr. Cristiano von Simson, Such relocation of microfilaremic dogs and Vice President; Dr. Robert Stannard, Secretary- expansion of the territories of microfilaremic wild Treasurer; Dr. Doug Carithers, Editor; Dr. Patricia canids in other areas of the United States continue Payne, Dr. Chris Rehm, Dr. Charles Thomas Nelson, to be important factors contributing to further Dr. Martha Smith-Blackmore, Dr. Elizabeth Clyde dissemination of the parasite, as the ubiquitous and, Dr. Bianca Zaffarano Board Members; presence of one or more species of vector-competent Dr. Matthew Miller, Symposium Chair; Dr. Clarke mosquitoes makes transmission possible wherever Atkins, Symposium Co-Chair; Dr. John McCall, a reservoir of infection and favorable climatic Co-Editor; Dr. Mike Loenser and Dr. Tony Rumschlag, conditions co-exist. Change in any of these factors Ex Officio Members. can have a significant effect on the transmission Preamble potential in a specific geographic location. These recommendations supersede the previous Environmental changes, both natural climatic edition of these guidelines and are based on the change and those created by humans, and animal latest information presented at the 2013 Triennial movement have increased heartworm infection Symposium of the American Heartworm Society and potential. Commercial and residential real estate recently completed studies. The recommendations development of non-endemic areas and areas of for the prevention, diagnosis, and management low incidence has led to the resultant spread and of heartworm infection in dogs are contained in a increased prevalence of heartworms by altering companion document (http://heartwormsociety.org/ drainage of undeveloped land and by providing veterinary-resources/canine-guidelines.html). water sources in new urban home sites. In the western United States, irrigation and planting of EPIDEMIOLOGY trees has expanded the habitat for Aedes sierrensis (western knot hole mosquito), the primary vector Heartworm infection has been diagnosed around for transmission of heartworms in those states. the globe, including all 50 of the United States. In Aedes albopictus (Asian tiger mosquito), which the United States, its territories and protectorates, was introduced into the Port of Houston in 1985, heartworm is considered at least regionally endemic has now spread northward, approaching Canada, in each of the contiguous 48 states, Hawaii, Puerto and isolated populations have been identified in Rico, U.S. Virgin Islands, and Guam. Heartworm areas in the western states. This urban-dwelling transmission has not been documented in Alaska; mosquito is able to reproduce in small containers however, there are regions in central Alaska that such as flowerpots. Urban sprawl has led to the have mosquito vectors and climate conditions to Figure 1. Sketch of an urban heat island profile. From http://eetd.lbl.gov/eatIsland/HighTemps/ 2 American Heartworm Society formation of “heat islands,” as buildings and parking reflect a shorter transmission season than actually lots retain heat during the day (Figure 1), creating exists. microenvironments with potential to support the development of heartworm larvae in mosquito Once a reservoir of microfilaremic domestic and wild vectors during colder months, thereby lengthening canids is established beyond the reach of veterinary the transmission season. care, the ubiquitous presence of one or more species of vector competent mosquitoes makes transmission As vectors expand their territory, the number possible and eradication becomes improbable. of animals infected will continue to increase. A BIOLOGY OF FELINE HEARTWORM INFECTION pivotal prerequisite for heartworm transmission is a climate that provides adequate temperature and Significant differences exist between feline humidity to support a viable mosquito population, heartworm disease and its classical canine and also sustain sufficient heat to allow maturation counterpart and these are consistent with of ingested microfilariae into the infective, third- characteristics of partially adapted host–parasite stage larvae (L3) within this intermediate host. It relationships. Although cats are susceptible hosts, has been shown that maturation of larvae, within they are more resistant to infection with adult three mosquito species, ceases at temperatures Dirofilaria immitis than are dogs. When dogs not below 57ºF (14ºC). Heartworm transmission does previously exposed to heartworms are injected with decrease in winter months but the presence of 100 L3 larvae, an average of 60 adult worms develop microenvironments in urban areas suggests that in almost 100% of the dogs; in cats, however, 3 to 10 the risk of heartworm transmission never reaches adult worms develop in approximately 75% of the zero. Furthermore, some species of mosquitoes cats. These L3 larvae molt to L4 and juvenile worm overwinter as adults. While heartworm larval (immature adult) with some loss along the way but development in these mosquitoes may cease in cool there is a very high mortality rate of the juvenile temperatures, development quickly resumes with worms as they reach the lungs 3 to 4 months after subsequent warming. infection. Most heartworm infections in cats are comparatively light and consist of less than six The length of the heartworm transmission season adult worms. Although much heavier infections in the temperate latitudes is critically dependent occur occasionally, usually only one or two worms on the accumulation of sufficient heat to incubate are present, and approximately one third of these larvae to the infective stage in the mosquito. The consist of worms of the same sex. Nevertheless, peak months for heartworm transmission in the because of their relatively small body size, cats with Northern Hemisphere are typically July and August. only a few worms are still considered to be heavily Models predict that heartworm transmission in the infected in terms of parasite biomass. Some clinical continental United States is limited to 6 months or surveys and data from experimentally infected less above the 37th parallel at approximately the cats have documented a slight preponderance of Virginia–North Carolina state line. While model- infection in male cats, but it has not been determined based predictions of transmission using climatic conclusively that male cats are at greater risk. No data are academically appealing, they typically fail sex predilection for anti–D immitis host antibody to consider several potentially important factors, seropositivity has been proven within populations such as influence of microclimate, unique biological of naturally exposed cats, nor has
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