Jenny Helm

Canine angiostrongylosis: an emerging disease in Europe

OBJECTIVE The aim of this article is to review Angiostrongylus vasorum infection in dogs, including the life cycle, signalment, clinical signs, diagnosis, and treatment. Apparent changes in the epidemiology of this unique parasite are considered, alongside information available regarding its recent geographic spread. ETIOLOGY A. vasorum is a metastrongyloid parasite capable of causing an array of clinical problems in dogs, including cardiorespiratory, coagulopathic, and neurologic signs. Currently, the parasite has a worldwide distribution; however, it usually arises in small pockets of enzootic foci. Recent reports suggest a changing distribution of this parasite, which has renewed interest in its epidemiology and in the risk of expansion to new areas including mainland North America. DIAGNOSIS A definitive diagnosis of angiostrongylosis is usually made using the modified Baermann technique either using feces or tracheobronchial secretions; however, this review also discusses novel methods such as serologic and molecular techniques. THERAPY Once a diagnosis of angiostrongylosis is made, prompt treatment should follow with anthelmintic drugs (such as moxidectin/imidacloprid, milbemycin oxime, or fenbendazole) and supportive care dependent upon the patients clinical signs. Currently, there is no proven prophylactic regime. PROGNOSIS The prognosis appears to be very dependent upon the severity of clinical signs at presentation. A. vasorum can be fatal and death may be sudden. However, if a prompt diagnosis is made and appropriate treatment is administered complete clinical resolution is possible.

A case of canine Angiostrongylus vasorum in Scotland confirmed by PCR and sequence analysis

This report describes the first recognised case of Angiostrongylus vasorum infection in a native Scottish dog and its diagnostic confirmation using polymerase chain reaction. The use of this technique to definitively diagnose canine angiostrongylosis confirms the presence of this epidemiologically significant case. The implications of the changing distribution of this parasite are discussed.

A comparison of factors that influence survival in dogs with adrenal-dependent hyperadrenocorticism treated with mitotane or trilostane

BACKGROUND Trilostane is a recognized treatment for canine pituitary-dependent hyperadrenocorticism (PDH); however, its efficacy in dogs with adrenal-dependent hyperadrenocorticism (ADH) is unknown. OBJECTIVES To examine factors that might influence survival in the medical management of ADH, with particular emphasis on treatment selection. ANIMALS Thirty-seven animals referred to 4 centers over a period of 12 years that had been diagnosed with ADH and treated with either trilostane (22/37), mitotane (13/37), or both (2/37). METHODS Retrospective analysis of clinical records. RESULTS There was no statistically significant difference between the survival times of 13 dogs treated only with mitotane when compared with 22 dogs treated only with trilostane. The median survival time for animals treated with trilostane was 353 days (95% confidence interval [CI] 95-528 days), whereas it was 102 days (95% CI 43-277 days) for mitotane. Metastatic disease was detected in 8 of 37 dogs. There was a significantly lower probability of survival for dogs with metastatic disease when compared with those without metastatic disease (P < .001). CONCLUSIONS AND CLINICAL IMPORTANCE The choice of medical treatment for ADH may not have a major effect on survival times. However, the presence of metastatic disease considerably decreases survival time regardless of the choice of medical treatment.

Epidemiological survey of Angiostrongylus vasorum in dogs and slugs around a new endemic focus in Scotland

The nematode parasite Angiostrongylus vasorum is an increasingly important cause of respiratory and other diseases in dogs. Geographical spread from previously limited endemic foci has occurred rapidly. This paper investigates parasite epidemiology around the location of the first reported case in Scotland in 2009: by detection of A vasorum-specific DNA in gastropod intermediate hosts, and in dogs circulating DNA and specific antibodies, and first stage larvae in faeces. Overall prevalence in gastropods was 6.7 per cent (16/240), with parasite DNA found in slugs in the Arion ater and Arion hortensis species aggregates and the snail Helix aspersa (syn. Cornu aspersum). Of 60 dogs presenting with clinical signs compatible with angiostrongylosis, none tested positive using PCR on peripheral blood or Baermann test on faeces, and none of 35 tested for circulating anti-A vasorum antibodies were positive. PCR prevalence in gastropods was highest (11 per cent) in the park frequented by the canine angiostrongylosis index case. Molecular survey for infection in gastropods is a potentially informative and efficient method for characterising the distribution of A vasorum and therefore local risk of canine infection. However, there appears to be a complex relationship between prevalence in gastropods and emergence of canine clinical disease, which requires further work to advance understanding of parasite transmission and geographical disease spread.

Veterinarians' attitudes to chronic pain in dogs.

Veterinary surgeons in the UK were invited to complete an internet survey concerning their attitudes to chronic pain in dogs. UK veterinary surgeons numbering 215 completed surveys in full along with 48 worldwide specialists in anaesthesia and 37 worldwide specialists in oncology. Osteoarthritis, dental and aural disease, vertebral and spinal cord conditions, neoplasia and skin conditions were considered important causes of chronic pain in dogs. UK practitioners used significantly fewer classes of analgesic drugs regularly than either category of specialist. The major barriers to adequate treatment of chronic pain were reported as difficulties with pain assessment, expense of drugs, and difficulties with owner compliance. Illustrations of six common neoplastic conditions were used and scored for pain according to prior experience by practitioners. All six conditions were consistently described as involving some degree of pain with primary bone tumour and oral tumour, causing severe pain and moderate to severe pain, respectively. Years since graduation and specialist status affected the pain scores attributed to the conditions. There was a significant correlation between the pain score attributed to the illustrated condition, and the tendency to administer analgesia.

Cavernous sinus syndrome secondary to intracranial lymphoma in a cat.

Cavernous sinus syndrome is characterised by internal and external ophthalmoplegia and sensory deficits over the head due to combined deficits of the three cranial nerves (CNs) responsible for the eye movements and pupil function (CN III, IV, VI) and at least one branch of the trigeminal nerve (CN V). It has rarely been described in cats and may occur secondarily to inflammatory, infectious or neoplastic lesions within the region of the cavernous sinus on the ventral aspect of the calvarium. This report describes the clinical and magnetic resonance imaging findings in a 14-year-old domestic shorthair cat with neurological deficits compatible with cavernous sinus syndrome caused by presumptive extranodal lymphoma. Treatment with chemotherapy resulted in clinical and imaging remission. Identification of the neurological deficits in cavernous sinus syndrome allows accurate neuroanatomical localisation in order to target diagnostic imaging studies.

Musculoskeletal neoplasia: an important differential for lumps or lameness in the cat.

Practical relevance Musculoskeletal neoplasia is an uncommon but Important differential diagnosis for cats presenting with lameness, pain or swellings associated with bones and/or soft tissues. The most common tumours of soft tissue origin are the sarcomas (in particular feline injection site sarcomas [FISSs]); the most common bone tumour of the cat is osteosarcoma (OSA). Clinical challenges FISSs present a clinical challenge in terms of their local invasiveness, difficulty in obtaining complete surgical excision and high risk of local recurrence. Axial and extraskeletal OSAs pose similar challenges, whereas appendicular OSA is usually easy to remove via limb amputation and can, therefore, carry a good prognosis in many cases. Patient group Cats of any age, gender or breed may be affected, although bone tumours predominantly affect middle- to old-aged cats. Global importance Vaccination of cats is of global importance in preventing feline diseases; hence, any possible significant consequences of vaccination such as neoplasia, even of a low incidence, are of huge concern to cat owners and veterinarians alike. Evidence base This review is based on current literature relating to pathogenesis, pathology, presentation, diagnosis, staging, treatment and prognosis. It aims to summarise feline musculoskeletal neoplasia for clinicians in general practice.

Canine and feline lungworm infections in the UK

Lungworm infections in dogs and cats have gained attention in practice in recent years, driven largely by the spread of Angiostrongylus vasorum outside historically recognised endemic foci and associated efforts to increase awareness and encourage treatment and prevention. While several species of lungworm are clinically relevant, A vasorum in particular is common and can be highly pathogenic in dogs in the UK. The tools available for the diagnosis and treatment of lungworm infections have advanced and informed clinicians are well equipped to deal with threats from this group of parasites. This article reviews the helminth parasites of the canine and feline respiratory systems, and summarises their life cycles, epidemiology, pathogenesis, diagnosis, treatment and prevention. It also discusses apparent changes in the epidemiological patterns of lungworm infections in both species and the implications for risk assessment and management.

Retrospective evaluation of the effect of trilostane on insulin requirement and fructosamine concentration in eight diabetic dogs with hyperadrenocorticism

OBJECTIVES To describe the effect of trilostane on insulin requirements and serum fructosamine in dogs with diabetes mellitus (DM) and hyperadrenocorticism (HAC). METHODS Observational retrospective study of eight dogs. RESULTS Median fructosamine concentration at presentation was 401 μmol/L (range 244 to 554 μmol/L). Median insulin dose at presentation was 1·1 IU/kg/dose (0·4 to 2·1 IU/kg/dose) administered twice daily in five animals and once in three. Four dogs had their insulin dose prospectively reduced at the start of trilostane therapy. The HAC was controlled within 28 days in seven dogs. The remaining case was controlled by 17 weeks. Two dogs died within 40 days of starting trilostane. The median fructosamine concentration was 438 μmol/L (range 325 to 600 μmol/L) after stabilisation of the HAC. One case had a consistent reduction in serum fructosamine concentration over the first four months. The median insulin dose after stabilisation of HAC was 1·5 IU/kg dose (range 0·25 to 3·0 IU/kg/dose). Insulin requirements were reduced in two cases after treatment with trilostane. Four dogs required increased insulin doses. CLINICAL SIGNIFICANCE Insulin requirements and fructosamine concentrations do not consistently reduce during trilostane treatment for HAC. Prospective studies are required to provide recommendations regarding reductions in insulin doses with trilostane treatment.

Use of accelerometry to investigate physical activity in dogs receiving chemotherapy

OBJECTIVES To perform a preliminary study to assess whether single-agent palliative or adjuvant chemotherapy has an impact on objectively measured physical activity in dogs. METHODS Fifteen dogs with neoplasia (treatment group) wore ActiGraph™ accelerometers for 5-day periods before, during and after receiving single-agent adjuvant or palliative chemotherapy. Mean 5-day total physical activity and time spent in three different intensities of activity (sedentary, light-moderate and vigorous) before, during and after receiving chemotherapy were compared to a group of 15 healthy dogs (control group). Results were also compared within the treatment group across time. RESULTS Prior to chemotherapy, treated dogs tended to be less active than control dogs. Treatment group dogs were slightly more active at restaging than they were prior to treatment but had similar activity levels to control dogs. Marked effects of chemotherapy on physical activity were not detected. Physical activity was slightly lower in treated dogs during chemotherapy when compared to control dogs but there was a slight increase in physical activity of treated dogs during chemotherapy when compared with pretreatment recordings. There was little change in the mean 5-day total physical activity between treated dogs during chemotherapy and at restaging but a mild decrease in time spent sedentary and increase in time spent in light-moderate activity at this comparison of time points. CLINICAL SIGNIFICANCE Single-agent adjuvant or palliative chemotherapy had minimal impact on physical activity levels in dogs with neoplasia.