The Veterinary Journal 2003, 165, 175–177
doi:10.1016/S1090-0233(02)00243-5
Short Communication
Dermatitis Associated With Dirofilaria repens Microfilariae
in a Dog from Rome
WALTER TARELLO
C.P. 1644, 06129 Perugia, Italy
KEYWORDS: Subcutaneous dirofilariasis; dog; zoonosis; Dirofilaria (Nochtiella) repens; microfilariae.
Subcutaneous dirofilariasis due to Dirofilaria (Noch-
tiella) repens is a helminthic zoonosis, widely distrib-
uted in Europe, Asia, and Africa and nowadays
reported with increased frequency in both humans
(Pampiglione & Rivasi, 2000) and dogs (Tarello,
1999). The higher prevalences are found in dogs
from Sri Lanka (30–60%) (Dissanaike et al., 1997)
and from Italy (20.5–39%) (Rossi et al., 1996, Mar-
concini et al., 1996). Intermediate hosts are Anoph-
eles, Aedes, and Culex spp. and the definitive hosts are
dogs, cats, foxes, and other wild carnivores (Mar-
concini et al., 1996). Man is an accidental host of the
nematode and Italy is apparently the most affected
country in the world (Pampiglione & Rivasi, 2000).
The distribution of human cases follows the distri-
bution of microfilaraemia observed in dogs and cats
(Pampiglione et al., 1995; Tarello, 2000a–c).
A four-year old male Pyrenean Mountain dog,
with a four-month history of pruritic dermatitis,
which had relapsed after previous treatments with
antibiotics and corticosteroids, was presented in late
August 2000. The dog was born and lived in Rome
and had never travelled abroad or to other parts of
Italy, including Perugia. At first clinical inspection,
skin lesions were observed on all parts of the body:
multifocal alopecia (Fig. 1), erythema on head (Fig.
2), neck and hind limbs, hypercheratosis on lumbo-
sacral region, papulae on abdomen and hind limbs,
chronic otitis, and generalized pyoderma intertrigo.
Collateral signs were poor appetite, lethargy, weight
Correspondence to: Walter Tarello DVM, C.P. 1644, 06129
Perugia, Italy; E-mail: tarello@iol.it
1090-0233/03/$ - see front matter Ó 2003 Elsevier Science Ltd. All rights reserved.
loss, pruritus, and conjunctivitis. A concentration
test for the search of microfilariae (Difil-test) per-
formed on 2 mL of whole blood revealed the pres-
ence of 29 Dirofilaria (Nochtiella) repens microfilariae
at microscopic observation (Fig. 3). A heartworm
antigen test (Wittness Dirofilaria, Merial) proved
negative. Microfilariae from other species (Dirofi-
laria immitis, Acanthocheilonema reconditum) were not
detected. A Wright-stained fresh blood smear
showed the concurrent presence of small Babesia-
like organisms in the blood.
Diagnosis of subcutaneous dirofilariasis was based
upon the skin lesions, which were unresponsive to
previous treatments, the finding of D. repens micro-
filariae and a negative test for circulating D. immitis
antigens (Tarello, 1999). Recent reports indicate
that subcutaneous dirofilariasis may be an oppor-
tunistic illness (Tarello, 2000a–c, 2002) and that
infections with Babesia and/or Ehrlichia spp. induce
immunosuppression and favour secondary oppor-
tunistic infections (Kordick et al., 1999).
Consequently, therapy with imidocarb dipropio-
nate (Carbesia, Mallinckrodt Veterinary, 1 mL/
17 kg, s.c., once a week for four weeks) was admin-
istered and led to resolution of systemic clinical
signs, including poor appetite, lethargy, and
conjunctivitis (Zahler et al., 2000; Tarello, 2001b).
A significant improvement in cutaneous lesions,
including pyoderma and otitis was also observed.
The macrofilaricide treatment (melarsomine,
Immiticide; Rhone-Merieux, 2.5 mg/kg, twice at an
interval of 24 h) was begun 2–3 days after complet-
ing the therapy for babesiosis and produced a
176 THE VETERINARY JOURNAL, 165, 2

significant improvement of the cutaneous lesions

Fig. 1. Multifocal alopecia and erythema in the reported
case.
Fig. 2. Head lesions caused by pruritus and local
scratching.
Fig. 3. Dirofilaria repens microfilaria in the blood of the
reported case (10, Difil-test, Leitz Biomed).
and disappearance of pruritus. The microfilaricide
treatment (ivermectin, Ivomec; 50 lm/25 kg, 1 mL/
25 kg, s.c.) was carried out 10 days after the macro-
filaricide treatment. Clinical re-examination and a
second Difil test, carried out one month later,
showed that the cutaneous lesions had resolved and
Dirofilaria repens microfilariae were no longer found
in the blood. A 12-month course of preventive
treatment with oral ivermectin (Cardotek, MSD,
1 cmp/month) was subsequently initiated. A clinical
and haematological check in August 2001 con-
firmed complete lasting remission of dermatological
symptoms and the absence of microfilariae.
Although the parasitosis may be asymptomatic
(Pampiglione & Rivasi, 2000), dogs infested with
D. repens show seasonal and temperature-dependent
variations in the number of circulating microfilariae
with the higher number of larvae observed in Au-
gust–September (Cancrini et al., 1975), in associa-
tion with clinical signs, caused by mechanical, toxic,
and immuno-mediated actions of the parasite
(Mantovani, 1965). Adult nematodes were not
found nor searched for in the present study.
Nonetheless, the detection of microfilariae in the
blood provides significant diagnostic support for the
presence of adults in Dirofilaria spp. infections
(BSAVAÕs Scientific Committee, 1998).
Previous reports (Tarello, 1999) have indicated
co-infection with other pathogens in dogs with D.
repens. Concurrent findings of babesiosis (100%) and
canine granulocytic ehrlichiosis (60%) were the
more frequent associations recently reported in 22
dogs from Central Italy (Tarello, 2002). Naturally
occurring Babesia spp. infections produce nonspe-
cific symptoms such as those reported here, includ-
ing poor appetite, lethargy, and conjunctivitis
(Zahler et al., 2000; Tarello, 2001b). Our case from
Rome showed disappearance of these signs after
specific treatment with imidocarb dipropionate,
suggesting co-infection with a Babesia sp. The finding
of D. repens microfilariae was in agreement with the
observation that suitable vectors exist in the Rome
province (Pampiglione et al., 1995) and moreover a
man living in the same area and diagnosed with
subcutaneous dirofilariasis in Hungary (Elek et al.,
2000) had had the nematode surgically removed
from his lowed eyelid. Canine (Tarello, 2000c) and
human (Pampiglione et al., 1994; Degardin & Si-
monart, 1996) cases of dirofilariasis have previously
been reported in other countries.
The case presented here is, to this authorÕs
knowledge, the first description of subcutaneous
 DIROFILARIA REPENS IN THE DOG
dirofilariasis in a dog resident in Rome. Although it
was examined in Spina (Perugia province), about
150 km from Rome, the case provides a reminder
that, as a consequence of the increased number of
traveling pets, it is necessary to be aware of the geo-
graphical distribution of infectious agents, particu-
larly those causing zoonosis. Furthermore, strict
quarantine regulations seldom prevent propagation
of Dirofilaria repens, because the infestion becomes
patent only after 6–10 months or more, and the
adult parasite can live 2–4 years in the subcutaneous
tissues of dogs (Pampiglione et al., 1995). Suitable
climate and vectors can therefore, facilitate the
diffusion of this filarial nematode, as recently
described for Dirofilaria immitis (Rossi et al., 1996;
Tarello, 2001a).
The routine use of concentration tests (Knott,
Difil) may be an important diagnostic tool. Differ-
entiation between D. immitis, D. repens, and Acan-
thocheilonema reconditum is mainly based upon the
morphology of the microfilariae. The average width
of D. repens microfilariae is 7.1–8.3 lm, whereas D.
immitis is 5.4–6.2 lm, and A. reconditum is less than
5 lm wide (Schrey, 1996). The measurement of
length is less reliable as a differential criterion. The
microfilariae observed in the present study had the
typical wide and squat aspect of D. repens larvae (Fig.
3). In the filtration test, the tails of A. reconditum are
hook-shaped (Tarello, 2001a) and usually thin, like
those of D. immitis, however, the caudal end of D.
repens microfilariae is much wider (Fig. 3).
In conclusion, D. repens is not as harmless as
currently considered, and apparently is present in
the canine population in Rome.
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(Accepted for publication 26 June 2002)