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Heartworm Disease

Heartworm Disease

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HEARTWORM DISEASEIN CANINE AND FELINE
Introduction
a serious and potentially fatal condition caused by parasitic worms
Causative agent:
 Dirofilaria immitis
Heartworms are classified as nematodes (roundworms)and
are filarids, a small to a very large thread-like white-to-cream colored worm, one of many species of roundworms.
it is almost worldwide and often common in humid areasthat support mosquitoes that spread from host to hostthrough the bites of mosquitoes.
living in the arteries of the lungs and occasionally in theright side (ventrivle) of the heart
Hosts
dogs, cats and other species of mammals, includingwolves, foxes, ferrets, sea lions and (in rare instances)humans.
Dogs and cats of any age or breed are susceptible toinfection.
it can infect man causing pulmonary infarction withgranuloma formation
World distribution of dog heartworm
 Dirofilaria immitis described by Joseph Leidy in 1856 in Philadelphia
Mosquito Vectors
Many mosquitoes worldwide have been identified ascapable of sustaining the development of dog heartworm
have been identified as natural hosts of 
 D.
Examples are
 Aedes aegypti, Ae. albopictus, Ae.canadensis
,
 Ae. cantator, Ae. excrucians, Ae. sollicitans, Ae. sticticus, Ae. stimulans, Ae. taeniorhynchus, Ae.vexans, Anopheles bradleyi
,
 A. punctipennis, An. quadrimaculatus
,
Culex nigripalpus
,
Cx.quinquefasciatus
,
Cx. salinarius and Psorophora ferox
 
Morphology of D. immitis
Body: unsegmented--the bilateral symmetry
covered by a typical cuticle which is formed by ahypodermis.
 pseudocoelomatic body cavity
contains a complete digestive tract, the anus subterminallysituated.
respiratory and circulatory systems are lacking.
movements by contractions of the typically longitudinallyoriented muscle cells with the fluid of the pseudocoel andthe pressure of the cuticle working together as ahydrostatic skeleton.
 Dirofilaria immitis
- microfilaria
 Note the tapered anterior end. In most specimens you will seea straight body and straight or slightly curved) tail.The width is > 6 um.
Male
12-16 cm long
Slender, white color 
Spirally coiled hind end
Referred to as “pigtail”
Female
25-30 cm long
Ovoviviparous (lay microfilaria)
Shows genital organs
 
Life cycle pattern of D. Immitis
The mosquito ingests microfilariae after a blood mealfrom a infected dog.
The microfilariae develop into L2 in the malpighiantubes.
Then L3 develop and enter the body cavity, thehemoceol. Development from the microfilariae to the L3takes 15-16 days.
The L3 escape in a pool of hemolymph as themosquito inserts its labium into the definitive host, whichis usually a dog.
If its stylets are withdrawn, the L3 enter through the puncture wound made by the mosquito.
The L3 will then molt into the L4 in the definitivehost 0-14 days after infection.
The L4 migrate to sub muscular membranes andsubcutaneous tissue and remain dormant.
They molt into the L5 and migrate through venulewalls and end up in the pulmonary arterioles and rightheart of the definitive host.
The L5 will mature into adults that will furthemigrate to the right ventricle or pulmonary artery 85-120days after infection.
The adult will reach maturity in a further 2-month period and shed microfilariae in the blood to begin thecycle all over again.
The adults can remain in the heart or artery for up to7 years. Microfilariae can remain in the circulation of themosquito for up to 2 years.
Pathogenesis
Dogs with low numbers of adult worms may beasymptomatic and also produce false negatives..
no indication of heartworm infection during the 6-month-
Rarely, migrating heartworm larvae get "lost" andend up in unusual sites such as the eye, brain, or an arteryin the leg,
But normally, until the larvae mature and congregateinside the heart, they produce no symptoms or signs of illness.
 blindness,
seizures
lameness.
Early signs
cough, especially on exercise and early exhaustion uponexercise.
severe weight loss,
fainting,
coughing up blood
weakness
dypsnea are clinical signs
Severe cases
circulatory distress , progressive endarteritis
cardiac dysfunction
 pulmonary hypotension
ascites and edema of legs
hepatic vein lesions
compensatory hypertrophy of right ventricle
chronic passive congestion (liver enlargement – edema)
deep, dry cough
haemoptysis
congestive heart failure
severe shock-like symptoms
Various pathologic changes
 pulmonary embolism,
endocarditis of heart valves,
glomerulonephritis due to immune complexes,
 pulmonary endoarteritis and
eosinophilia even to pneumonia.
x-ray
main pulmonary artery – dilated
Diagnosis
Here are the methods can be used for the diagnosis foMicrofilarial detection.
a.
Direct blood smear  b.Serological test
IFA for microfilarial antibody
ELISA for adult antibody
Adult antigen detection by colloid goldc.Radiography. X-rays are used to evaluatethe amount of lung damage caused by the presence of heartworms.d.Electrocardiograme.Echocardiogramf.Tracheal cytology
Treatment
Heart, liver, kidney,a nd lungs should be assessed first
melarsomine dihydrochloride, is marketed under the brand name Immiticide - It has a greater efficiency andfewer side effects
arsenical thiacetarsamide or thiacertarsamide sodium, soldas Caparsolate - safer alternative for dogs with late-stage
 
infections. (IV dose 0.1 ml/.45 kg 2x a day for 2-3 days).It is a potential nephrotoxin and hepatotoxin
Melasoprol 100mg/kg adulticide
restricted exercise for several weeks
surgical removal of the adult heartworms (ventricular  puncture or arteriotomy main trunk of pulmonaryartery)
microfilariacide dithiazanine iodide 2mg/ .45 kg in persistent cases and dose is increased by 5mg/.45kg (notuse if having hepatoportal diseases)
Levamisole 10mg/kg for 15-20 days
Ivermectin: (Heart Guard, Iverhart, Stromectol,Mectizan)--Macrocyclic lactone derivative of avermectin(22, 23-dihydro-avermectin). Adult Dose: 150-200mcg/kg administered orally.
Control/ Prevention
Animals should be indoors at evening and night
Long term monthly administration of ivermectin yearound at three times the dose
Avermectin b1a 0.2 mg/kg/day
Melarsoprol 100 mg/kg/day
Prophylactic medicine – thiacetarsamide (every 6 months)
Milbemycin and DEC (5.5 mg/kg daily for 2 months)
moxidectin (ProHeart) administered as pills or chewabletablets.
Mebendazole 80mg/kg daily for 30 days
Selamectin (Revolution), is a topical preventive that islikewise administered monthly and alsocontrols fleas,ticks, and mites.
Mosquito control depends upon
 public health
(PH)measures per district and per season. PH protects the public by indoor & outdoor spraying, and by mosquitolarva control
Public Health Significance
Infection results from mosquito bites.
The worms lodge in the pulmonary artery causingvascular occlusion, coagulation, necrosis and fibrosis.
Symptoms include chest pain, coughing and in somecases hemoptysis.
In some patients radiographs have disclosed anasymptomatic, fibrotic nodule 1-3 cm in diameter.
The parasite is usually found in the lung (pulmonarydirofilariasis), and less often in the heart.
Although the worm forms a "coin lesion" in the lung,which may be confused with other diseases on x-rays,such as carcinoma
During the last 30 years about 100 cases of human pulmonary dirofilariasis have been reported from Florida.
FELINE HEARTWORM
Cats are susceptible yet are poorer hosts than dogs.
Etiology
Heartworm disease caused by
 Dirofilaria immitis
is asignificant disease of cats.
It is found worldwide where the canine disease occurs.
Prevalence rates in cats are estimated to be about 10 % of that of local dogs.
The average worm burden is 1-5.
The mean age of affected cats is 3-6 years.
Clinical Features
Clinical signs are absent to severe.
A small worm burden can cause chronic vomiting,coughing,
dyspnea,
lethargy
acute collapse
respiratory failure and
weight loss.
The infection is sometimes confused with bronchialasthma.
Six to 10 worms may cause right side heart failure.
When the disease is acute there may be convulsions,diarrhea, tachycardia and collapse.
 As less than 20% of infected cats have mfs in the blood,
Diagnosis
X-rays,
echocardiograhy
or serologic tests (ELISA)
Treatment.
 
The use of an adultacide such as thiacetarsamide IV may be accompanied by pulmonary thromboembolism and amortality of 20-30 %.
Various drugs are used for supportive therapy including prednisone or prednisolone to reduce inflamation,
theophyline for bronchial dilation and inflamationreduction and lifesaving supplemental oxygen.
Control.
 
Cats are usually tested for antigens before beginning prophylactic medication which involves monthlyadministration of ivermectin in tablet form to cats 6weeks or older,
or selamectin (Revolution) applied topically.
These and several other drugs kill the larvas of 
 D.immitis.
 Different species of Dirofilaria:
 D. repens
Railliet & Henry[1911]Subcut tissues of dogs
 D.Corynods
Linstow[1899]Monkey
 D. Conjuctivae
Addario[1885]Human

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