The toxic effect of intravenous application of the trypanocide isometamidium (Samorin)

The health of working dogs in conservation in Africa

Introduction

Dogs are increasingly being employed for conservation purposes worldwide. In Africa, they work in challenging environments with unique health risks which have not been investigated until now.

Methods

To understand the health challenges faced by the dogs, semi-structured interviews were conducted with participants from 14 organisations that used working dogs in their conservation programmes. The data was qualitatively analysed by thematic analysis.

Results

Five themes were generated. Three affective themes influenced how participants responded to the challenges associated with having a successful conservation dog programme. A strong handler-dog attachment, proficient handler training, and the acknowledgement of the challenging environment were pivotal to maintaining dog health. Two themes related to the difficulties in managing these programmes and how veterinary support interacts with the management choices being made.

Discussion

To have healthy conservation dogs, current and future programmes should focus on fostering the handler-dog relationship and provide continuous handler training. The management of conservation dogs' health should adopt an evidence-based approach. Future research should focus on areas where the evidence base is lacking, particularly in the areas of prevention and treatment of African canine trypanosomiasis. Programmes should develop a good working relationship with a veterinarian that has access to evidence-based veterinary medical information.

Safety and efficacy of three trypanocides in confirmed field cases of trypanosomiasis in working equines in The Gambia: a prospective, randomised, non-inferiority trial

Background

Globally, working equines have a continued and growing socioeconomic role in supporting the livelihoods of between 300–600 million people in low income countries which is rarely recognised at a national or international level. Infectious diseases have significant impact on welfare and productivity in this population and equine trypanosomiasis is a priority disease due to its severity and prevalence. Strategies are required to improve the prevention, diagnosis, management and treatment of trypanosomiasis in equines and more data are required on the efficacy and safety of current trypanocidal drugs.

Methods

A prospective randomised, open-label non-inferiority trial was performed in The Gambia on horses and donkeys that fulfilled 2/5 clinical inclusion criteria (anaemia, poor body condition, pyrexia, history of abortion, oedema). Following randomised trypanocidal treatment (diminazene diaceturate, melarsomine dihydrochloride or isometamidium chloride), animals were observed for immediate adverse drug reactions and follow-up assessment was performed at 1 and 2 weeks. Blood samples underwent PCR analysis with specific Trypanosoma sp. primers. Treatment efficacy was assessed by measuring changes in clinical parameters, clinicopathological results and PCR-status post-treatment after evaluating for bias. Using PCR status as the outcome variable, non-inferiority of isometamidium treatment was determined if the upper bound limit of a 2-sided 95% CI was less than 10%.

Results

There was a significant beneficial effect upon the Trypanosoma sp. PCR positive population following trypanocidal treatment for all groups. The findings of clinical evaluation and PCR status supported a superior treatment effect for isometamidium. Melarsomine dihydrochloride efficacy was inferior to isometamidium. There were immediate, self-limiting side effects to isometamidium in donkeys (26%). Diminazene had the longest duration of action as judged by PCR status.

Conclusions

The data support the continued use of isometamidium following careful dose titration in donkeys and diminazene for trypanosomiasis in equines using the doses and routes of administration reported.

Equine trypanosomiasis is endemic in many areas of the world with high morbidity and mortality in affected populations. Trypanocides form an essential part of current treatment strategies but evidence regarding efficacy in equines is scarce. In order to inform disease management, the efficacy of three trypanocidal drugs was assessed in horses and donkeys that fulfilled 2/5 clinical inclusion criteria for trypanosomiasis in The Gambia. Selected equines received randomised treatment with either isometamidium, diminazene or melarsomine dihydrochloride and were observed for adverse drug reactions. Follow-up was performed at 1 and 2 weeks. Blood collected at each timepoint was analysed for Trypanosoma spp. using a PCR approach. Within the selected population 66% were PCR positive pre-treatment for Trypanosoma spp.. Trypanosome positive individuals responded favourably to each treatment, but clinical evaluation and PCR status post-treatment supported a superior effect for isometamidium. Melarsomine dihydrochloride had inferior efficacy to isometamidium. Immediate adverse side effects were only documented following isometamidium administration in donkeys (26%) and these were self-limiting. Diminazene had the longest duration of action as judged by PCR status. The data support the continued use of isometamidium and diminazene but not melarsomine dihydrochloride for trypanosomiasis in equines at the doses and routes of administration reported.

Concentrations of isometamidium chloride (Samorin) in sera of Zebu cattle which showed evidence of hepatotoxicity following frequent trypanocidal treatments

The concentrations of isometamidium circulating in poorly nourished Zebu cattle which showed morbidity, mortality, and biochemical and histopathological evidence of hepatotoxicity, following frequent treatments with isometamidium chloride and diminazene aceturate were investigated using the isometamidium-ELISA. As few as two isometamidium treatments one month apart were associated with significant weight loss, and cattle treated with diminazene aceturate after three or four isometamidium treatments suffered a 50% mortality. Although there were no obvious, marked elevations in isometamidium concentration which might have allowed the use of the ELISA as a predictor of a potential toxicity problem, concentrations did increase significantly with the number of monthly treatments administered, suggesting drug accumulation, and the increases were significantly higher in cattle to which diminazene had also been administered. In cattle treated with both trypanocides, weight loss and serum glutamate dehydrogenase levels were correlated with isometamidium concentrations. These observations, together with the histopathological findings, support the hypothesis that the morbidity and mortality observed were related to the repeated treatment with isometamidium in conjunction with diminazene aceturate, and that the pathogenesis involved a component of hepatic damage. It is therefore recommended that cattle, particularly those under nutritional stress, are not subjected to repeated treatments with isometamidium at intervals as short as one month, and particularly not with concurrent administration of diminazene.

Development of multiple drug resistance of Trypanosoma congolense in Zebu cattle under high natural tsetse fly challenge in the pastoral zone of Samorogouan, Burkina Faso

Preliminary data from an ongoing epidemiological survey in the pastoral zone of Samorogouan (Kénédougou) indicate the occurrence of multiple-drug-resistant Trypanosoma congolense. Despite frequent trypanocidal drug treatments with diminazene aceturate (Berenil, Hoechst) at 7 mg/kg body weight (bw) at intervals of 2 to 4 weeks, no significant drop in the prevalence of African animal trypanosomosis (AAT) was observed. To examine a suspected drug resistance, 20 Zebu cattle, naturally infected with T. congolense and/or T. vivax, were transferred in December 1989 from Samorogouan into a fly-proof stable. Diminazene aceturate at 7 mg/kg bw cured infections of T. vivax, but was ineffective against T. congolense. Likewise, treatments with homidium bromide (Ethidium, FBC) at 1 mg/kg bw and isometamidium chloride (Trypamidium, Rhône Mérieux) at 1 mg/kg bw, respectively, proved to be ineffective. Corresponding chemotherapeutic trials in previously unexposed Zebu bulls and Sahelian goats infected with one primary T. congolense isolate from Samorogouan demonstrated a high level of resistance to diminazene aceturate (7 mg/kg bw in cattle and 17.5 mg/kg bw in goats), isometamidium chloride (1 and 2 mg/kg bw i.v. in goats) and quinapyramine sulphate (Trypacide'S', Rhône Mérieux) at 5 mg/kg bw in goats. The appearance of a multiple-drug-resistant strain of T. congolense emphasizes the urgent need for new chemical substances as trypanocidal drugs and the increasing importance of efficient vector control.

Therapeutic activity of isometamidium chloride in Boran cattle against a tsetse-transmitted clone of Trypanosoma congolense with a low level of drug resistance

Experiments were conducted with a clone of Trypanosoma congolense, IL 3580, which exhibited a low level of resistance to isometamidium chloride. Five cattle were treated intramuscularly with isometamidium chloride at a dose rate of 0.5 mg kg-1 body weight (BW) and challenged 28 days later with 5 Glossina morsitans centralis infected with T. congolense IL 3580. All 5 cattle and 15 untreated steers challenged on the same day became parasitaemic by day 15 post-infection. Thus, at a dose of 0.5 mg kg-1 BW, the prophylactic action of isometamidium chloride did not extend to 28 days following treatment. Subsequently, the 20 steers were divided into 4 groups of 5 animals each and treated with isometamidium chloride at one of the following dose rates; 0.5 or 1.0 mg kg-1 BW intramuscularly and 0.5 or 1.0 mg kg-1 BW intravenously (Groups A, B, C and D, respectively). Group A consisted of the 5 animals that had previously been treated with isometamidium chloride. Animals relapsed in all groups except those in Group B, treated intramuscularly with isometamidium chloride at a dose of 1.0 mg kg-1 BW. Four of the 5 animals in Group A, treated intramuscularly with isometamidium chloride at a dose of 0.5 mg kg-1 BW relapsed following a mean interval of 16 days post-treatment. Similarly, infections in all animals in Groups C and D, given intravenous injections of isometamidium chloride at a dose of 0.5 and 1.0 mg kg-1 BW, respectively, were not eliminated as a result of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Therapeutic and prophylactic activity of isometamidium chloride against a tsetse-transmitted drug-resistant clone of Trypanosoma congolense in Boran cattle

An investigation was conducted on the therapeutic and prophylactic activity of isometamidium chloride (SamorinR) in Boran (Bos indicus) cattle against a Trypanosoma congolense clone, IL 3270. This clone was derived, without drug selection, from a stock originally isolated in Burkina Faso and has previously been shown to be resistant to isometamidium in both cattle and mice using an infection and treatment regimen. A group of 5 cattle were treated intramuscularly with 1.0 mg kg-1 isometamidium chloride and 28 days later challenged with Glossina morsitans centralis infected with T. congolense IL 3270. All 5 cattle and 17 untreated cattle challenged on the same day became parasitaemic by day 16 post challenge, indicating that prophylaxis did not extend to 28 days post treatment. The cattle were then treated with isometamidium chloride at one of the following doses and by different routes of administration; 1.0 or 2.0 mg kg-1 intramuscularly, 0.25, 0.5, 0.75 or 1.0 mg kg-1 intravenously. Infections relapsed in all cattle at an interval of 12-21 days following treatment, with the exception of those treated with 2.0 mg kg-1 intramuscularly in which the development of relapse infections was delayed. Similar studies were also conducted with a highly sensitive clone of T. congolense, IL 1180. Infections in cattle with this clone were eliminated by intravenous treatment with 0.25 mg kg-1 isometamidium chloride or intramuscular treatment with 0.5 mg kg-1 isometamidium chloride. Thus, although intravenous administration of isometamidium eliminated a fully sensitive infection, treatment by this route appeared not to enhance the therapeutic efficacy of the drug in the treatment of a T. congolense clone which expresses a high level of resistance.

Isometamidium in pigs: disposition kinetics, tissue residues and adverse reactions

The disposition and adverse effects of the anti-trypanosomal drug isometamidium in pigs were evaluated. Following intramuscular administration of the drug at doses of 0.5, 15 and 35 mg kg-1, the drug was rapidly absorbed within 15 to 30 minutes to reach maximum plasma concentrations of 12 to 477 (n = 6), 302 to 655 (n = 4) and 1620 (n = 1) ng ml-1, respectively. No drug was detectable in plasma (less than 5 ng ml-1) 24 hours after drug administration at the three doses used. The half-lives of disappearance of the drug from plasma during the terminal phase were 7.12 h for the pigs given a dose of 15 mg kg-1, and 7.20 h for the pig which received a dose of 35 mg kg-1. At all the intramuscular injection sites, high drug concentrations were found six weeks after administration. The most dramatic adverse reactions observed were: one death after intramuscular administration at a dose of 35 mg kg-1 to two animals, and two deaths after intravenous administration at a dose of 2 mg kg-1 to two animals. For all these cases, the immediate cause of death was acute cardiovascular collapse. Biochemical analyses and gross and histological examinations showed that the animals that tolerated the high doses of 15 and 35 mg kg-1 given intramuscularly had extensive and severe tissue damage at the injection sites. Significant increases in plasma gamma-glutamyltransferase and alanine aminotransferase following drug administration suggested a degree of hepatobiliary damage.

Isometamidium in goats: disposition kinetics, mammary excretion and tissue residues

The pharmacokinetics of the antitrypanosomal drug isometamidium were studied in lactating goats after intravenous and intramuscular administration at a dose of 0.5 mg/kg body weight, in a crossover design at an interval of 6 weeks. Following intravenous administration, the half-life of the disappearance of the drug from plasma during the terminal phase was 3.2 h, and the mean residence time was 2.4 h. The apparent volume of distribution averaged 1.52 l/kg, and the mean total body clearance was 0.308 l/kg/h. After intramuscular administration, the absolute bioavailability was low, averaging 27%. This was consistent with a low mean maximum concentration of 24 ng/ml which occurred after 6 h. No drug was detectable (less than 10 ng/ml) in milk samples collected over a period of 14 days following drug administration by either the intravenous or intramuscular route. In tissues analysed when the goats were killed 6 weeks after administration of the second dose, no drug was detectable (less than 0.4 micrograms/g wet tissue) in the liver, kidney and muscle. However, at the injection site, drug concentrations varied from less than 0.4 to 18.8 micrograms/g wet tissue.

Notes on the routine intravenous use of isometamidium in the control of bovine trypanosomiasis on the Kenya coast

Various chemotherapeutic regimes were used to control trypanosomiasis in 3,000 Boran cattle on an estate on the Kenya coast. Recently the therapeutic use of isometamidium by the intravenous route was adopted to treat individual trypanosome-infected cattle. This was in order to overcome tissue reactions encountered after intramuscular injection and also to control a "thin cow" syndrome attributed to chronic trypanosomiasis. Toxic side effects were eliminated by careful attention to the intravenous technique which was safely used in calves, pregnant cattle and bulls. Weekly blood sampling and treatments of infected individuals resulted in a reduction of cases from 2,187 to 208 out of 46,495 and 46,329 samples examined in 1985 and 1986 respectively. The standard of management was very high and although this routine successfully controlled bovine trypanosomiasis on this estate its application elsewhere is likely to be limited.

A survey of some drugs commonly used in the camel

Specific recommendations for drug dosages for the camel are rare and doses for this species are usually extrapolated from those recommended for other species. The pharmacology and toxicity of drugs likely to be used in the camel needs to be further studied to ensure the efficacy and safety of these drugs in this species. Most of the reported work is on the chemotherapeutic efficacy of a few drugs long in use in other species against trypanosomiasis, mange and gastrointestinal nematodes. Areas of study most deficient are pharmacodynamics, pharmacokinetics and drug metabolism. The anatomical, physiological and biochemical peculiarities of the camel warrant more pharmacological and toxicological studies in this species. This article surveys the literature on the pharmacology, toxicity and therapeutic uses of some antiparasitic and antibacterial drugs and central nervous system depressants commonly used in the camel. It appears that camels are more susceptible to the toxic action of some trypanocidal drugs than other species. In certain cases they may metabolize some drugs differently. In general, the camel appears to be a good subject for analgesics and anaesthetics.