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LeVine DN, Kidd L, Garden OA, Brooks MB, Goggs R, Kohn B, Mackin AJ, Eldermire ERB, Chang Y, Allen J, Christopherson PW, Glanemann B, Maruyama H, Naskou MC, Nielsen LN, Shropshire S, Viall AK, Birkenheuer AJ, Forman MA, Hanzlicek AS, Langner KF, Lashnits E, Lunn KF, Makielski KM, Roura X, Spada E. ACVIM consensus statement on the diagnosis of immune thrombocytopenia in dogs and cats. J Vet Intern Med 2024; 38:1958-1981. [PMID: 38752421 PMCID: PMC11256148 DOI: 10.1111/jvim.16996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/16/2024] [Indexed: 07/19/2024] Open
Abstract
Immune thrombocytopenia (ITP) is the most common acquired primary hemostatic disorder in dogs. Immune thrombocytopenia less commonly affects cats but is an important cause of mortality and treatment-associated morbidity in both species. Immune thrombocytopenia remains a diagnosis of exclusion for which diagnostic guidelines are lacking. Primary, or non-associative, ITP refers to autoimmune platelet destruction. Secondary, or associative, ITP arises in response to an underlying disease trigger. However, evidence for which comorbidities serve as ITP triggers has not been systematically evaluated. To identify key diagnostic steps for ITP and important comorbidities associated with secondary ITP, we developed 12 Population Evaluation/Exposure Comparison Outcome (PECO) format questions. These questions were addressed by evidence evaluators utilizing a literature pool of 287 articles identified by the panelists using a structured search strategy. Evidence evaluators, using panel-designed templates and data extraction tools, summarized evidence and created guideline recommendations that then were integrated by diagnosis and comorbidity domain chairs. The revised PECO responses underwent a Delphi survey process to reach consensus on final guidelines. A combination of panel expertise and PECO responses were employed to develop algorithms for diagnosis of ITP in dogs and cats, which also underwent 4 iterations of Delphi review. Comorbidity evidence evaluators employed an integrated measure of evidence (IME) tool to determine evidence quality for each comorbidity; IME values combined with evidence summaries for each comorbidity were integrated to develop ITP screening recommendations, which also were subjected to Delphi review. Commentary was solicited from multiple relevant professional organizations before finalizing the consensus. The final consensus statement provides clinical guidelines for the diagnosis of, and underlying disease screening for, ITP in dogs and cats. The systematic consensus process identified numerous knowledge gaps that should guide future studies. This statement is a companion manuscript to the ACVIM Consensus Statement on the Treatment of Immune Thrombocytopenia.
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Affiliation(s)
- Dana N. LeVine
- Department of Clinical Sciences, College of Veterinary MedicineAuburn UniversityAuburnAlabamaUSA
| | - Linda Kidd
- Western University of Health Sciences College of Veterinary MedicinePomonaCaliforniaUSA
- Zoetis Animal Health DiagnosticsParsippanyNew JerseyUSA
| | - Oliver A. Garden
- School of Veterinary MedicineLouisiana State UniversityBaton RougeLouisianaUSA
| | - Marjory B. Brooks
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary MedicineCornell UniversityIthacaNew YorkUSA
| | - Robert Goggs
- Department of Clinical Sciences, College of Veterinary MedicineCornell UniversityIthacaNew YorkUSA
| | - Barbara Kohn
- Clinic for Small Animals, Faculty of Veterinary Medicine, Freie Universität BerlinBerlinGermany
| | - Andrew J. Mackin
- College of Veterinary MedicineMississippi State UniversityStarkvilleMississippiUSA
| | - Erin R. B. Eldermire
- Flower‐Sprecher Veterinary Library, College of Veterinary MedicineCornell UniversityIthacaNew YorkUSA
| | - Yu‐Mei Chang
- Department of Comparative Biomedical SciencesRoyal Veterinary CollegeLondonUK
| | - Julie Allen
- Veterinary Information NetworkDavisCaliforniaUSA
| | | | - Barbara Glanemann
- Department of Clinical Science and Services, Royal Veterinary CollegeUniversity of LondonLondonUK
| | - Haruhiko Maruyama
- Department of Veterinary Medicine, College of Bioresource SciencesNihon UniversityChiyoda CityJapan
| | - Maria C. Naskou
- Department of Pathobiology, College of Veterinary MedicineAuburn UniversityAuburnAlabamaUSA
| | - Lise N. Nielsen
- Department of Veterinary Clinical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Sarah Shropshire
- College of Veterinary Medicine and Biomedical SciencesColorado State UniversityFort CollinsColoradoUSA
| | - Austin K. Viall
- Department of Pathology, Microbiology, and ImmunologySchool of Veterinary Medicine, University of California, DavisDavisCaliforniaUSA
| | - Adam J. Birkenheuer
- College of Veterinary MedicineNorth Carolina State UniversityRaleighNorth CarolinaUSA
| | | | | | | | - Erin Lashnits
- School of Veterinary MedicineUniversity of WisconsinMadisonWisconsinUSA
| | | | - Kelly M. Makielski
- College of Veterinary MedicineUniversity of MinnesotaSt PaulMinnesotaUSA
| | - Xavier Roura
- Hospital Clinic Veterinari, Universitat Autonoma de BarcelonaBellaterraSpain
| | - Eva Spada
- Veterinary Transfusion Research Laboratory (REVLab), Department of Veterinary Medicine and Animal SciencesUniversity of MilanLodiItaly
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Thomsen AS, Petersen MP, Willesen JL, Bach MBT, Kieler IN, Kristensen AT, Koch J, Nielsen LN. Clinical bleeding diathesis, laboratory haemostatic aberrations and survival in dogs infected with Angiostrongylus vasorum: 180 cases (2005-2019). J Small Anim Pract 2024; 65:234-242. [PMID: 38332620 DOI: 10.1111/jsap.13701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 10/25/2023] [Accepted: 12/06/2023] [Indexed: 02/10/2024]
Abstract
OBJECTIVES Bleeding diathesis is a complication in dogs infected with Angiostrongylus vasorum. This retrospective study investigated clinical and laboratory haemostatic differences in A. vasorum-positive dogs with and without signs of bleeding and impact of bleeding on survival. MATERIALS AND METHODS Demographics, type of clinical bleeding, haematocrit and a range of haemostatic tests, including thromboelastography and derived velocity curves were retrospectively registered from A. vasorum-positive dogs. All parameters were compared between dogs with and without signs of bleeding using univariable analyses. Binomial and multinomial regression models were applied to examine specific indicators in the bleeding dogs. P-values were false discovery rate adjusted, and adjusted P<0.05 was considered significant. RESULTS One hundred and eighty dogs entered the study, including 65 dogs (36.1%) presenting with bleeding diathesis. Different types of cutaneous and mucosal bleeding were the most common clinical findings. Twenty dogs presented with neurological signs associated with intracranial and intra-spinal bleeding. One hundred and thirty-seven dogs had haematological and/or haemostatic laboratory analyses performed. Haematocrit, platelet count, thromboelastographic angle, maximum amplitude, global clot strength, maximum rate of thrombin generation and total thrombin generation were decreased, while prothrombin time was prolonged in bleeding dogs. Survival rate of bleeding dogs was lower at hospital discharge (76.9%) and 1 month after diagnosis (66.0%) than in dogs without signs of bleeding (94.8% and 90.1% at discharge and at 1 month, respectively). CLINICAL SIGNIFICANCE Several haemostatic aberrations were detected in A. vasorum-positive dogs with bleeding diathesis. Bleeding was identified as an important negative prognostic indicator in A. vasorum-positive dogs.
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Affiliation(s)
- A S Thomsen
- Dyrlaegehuset Gentofte, Brogaardsvej 10, 2820, Gentofte, Denmark
| | - M P Petersen
- Vejen Dyrehospital, Oestergade 12, 6600, Vejen, Denmark
| | - J L Willesen
- Department of Veterinary Clinical Sciences, University of Copenhagen, Dyrlaegevej 16, Copenhagen, Denmark
| | - M B T Bach
- Department of Veterinary Clinical Sciences, University of Copenhagen, Dyrlaegevej 16, Copenhagen, Denmark
| | - I N Kieler
- Department of Veterinary Clinical Sciences, University of Copenhagen, Dyrlaegevej 16, Copenhagen, Denmark
| | - A T Kristensen
- Department of Veterinary Clinical Sciences, University of Copenhagen, Dyrlaegevej 16, Copenhagen, Denmark
| | - J Koch
- Department of Veterinary Clinical Sciences, University of Copenhagen, Dyrlaegevej 16, Copenhagen, Denmark
| | - L N Nielsen
- Department of Veterinary Clinical Sciences, University of Copenhagen, Dyrlaegevej 16, Copenhagen, Denmark
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Jackson D, Di Bella A. Concurrent hypoadrenocorticism, immune‐mediated thrombocytopenia and immune‐mediated haemolytic anaemia in a Jack Russell Terrier dog. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- David Jackson
- Southern Counties Veterinary Specialists Ringwood UK
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Hemostatic Dysfunction in Dogs Naturally Infected with Angiostrongylus vasorum—A Narrative Review. Pathogens 2022; 11:pathogens11020249. [PMID: 35215192 PMCID: PMC8878016 DOI: 10.3390/pathogens11020249] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/05/2022] [Accepted: 02/11/2022] [Indexed: 01/27/2023] Open
Abstract
This narrative review aims to describe Angiostrongylus vasorum-induced hemostatic dysfunction of dogs with emphasis on clinical and laboratory findings as well as potential therapeutic strategies for the bleeding patient. Canine angiostrongylosis (CA) is a disease with potentially high morbidity and mortality in endemic areas and with fatal outcome often associated with either severe respiratory compromise, pulmonary hypertension and right-sided heart failure, or hemostatic dysfunction with severe bleeding. The most common signs of hemorrhage are hematomas, petecchiation, ecchymoses, oral mucosal membrane bleeding and scleral bleeding, while intracranial and pulmonary hemorrhage are among the most severe. The pathophysiological mechanisms underlying hemostatic dysfunction in these patients are presently researched. While the larval effect on platelets remains unknown, the parasite appears to induce dysregulation of hemostatic proteins, with studies suggesting a mixture of pro-coagulant protein consumption and hyperfibrinolysis. Importantly, not all dogs display the same hemostatic abnormalities. Consequently, characterizing the hemostatic state of the individual patient is necessary, but has proven difficult with traditional coagulation tests. Global viscoelastic testing shows promise, but has limited availability in general practice. Treatment of A. vasorum-infected dogs with hemostatic dysfunction relies on anthelmintic treatment as well as therapy directed at the individual dog’s specific hemostatic alterations.
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Gratwick Z, Frean J, Plessis D, Hewetson M, Schwan V. A case of verminous mastitis in a mare. EQUINE VET EDUC 2021. [DOI: 10.1111/eve.13363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Z. Gratwick
- Department of Companion Animal Clinical Studies University of Pretoria OnderstepoortSouth Africa
| | - J. Frean
- National Institute for Communicable Diseases (Division of the National Health Laboratory Service) University of the Witwatersrand Johannesburg South Africa
| | - D. Plessis
- National Institute for Communicable Diseases (Division of the National Health Laboratory Service) University of the Witwatersrand Johannesburg South Africa
| | - M. Hewetson
- Department of Clinical Science and Services The Royal Veterinary College Hertfordshire UK
| | - V. Schwan
- Department of Tropical Diseases University of Pretoria Onderstepoort South Africa
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Genome sequence of the cardiopulmonary canid nematode Angiostrongylus vasorum reveals species-specific genes with potential involvement in coagulopathy. Genomics 2021; 113:2695-2701. [PMID: 34118383 DOI: 10.1016/j.ygeno.2021.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 05/21/2021] [Accepted: 06/07/2021] [Indexed: 11/22/2022]
Abstract
Angiostrongylus vasorum is an emerging parasitic nematode of canids and causes respiratory distress, bleeding, and other signs in dogs. Despite its clinical importance, the molecular toolbox allowing the study of the parasite is incomplete. To address this gap, we have sequenced its nuclear genome using Oxford nanopore sequencing, polished with Illumina reads. The size of the final genome is 280 Mb comprising 468 contigs, with an N50 value of 1.68 Mb and a BUSCO score of 93.5%. Ninety-three percent of 13,766 predicted genes were assigned to putative functions. Three folate carriers were found exclusively in A. vasorum, with potential involvement in host coagulopathy. A screen for previously identified vaccine candidates, the aminopeptidase H11 and the somatic protein rHc23, revealed homologs in A. vasorum. The genome sequence will provide a foundation for the development of new tools against canine angiostrongylosis, supporting the identification of potential drug and vaccine targets.
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Peak K, Walker D, Agthe P. Dorsal mediastinal haemorrhage in dogs: four cases (2010-2018). J Small Anim Pract 2021; 63:62-71. [PMID: 33739465 DOI: 10.1111/jsap.13323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/16/2021] [Accepted: 02/19/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This retrospective case series describes the clinical presentation and CT findings of dogs with presumed mediastinal haemorrhage with no apparent identifiable underlying cause. MATERIALS AND METHODS Medical records were searched for dogs with presumed or suspected mediastinal haemorrhage of non-thymic origin. For all dogs, data on signalment, history, physical examination, treatment and outcome were collected by reviewing the medical records. Follow-up information was collected by telephone interviews with the owners and/or their primary-care veterinarians. RESULTS Four dogs were included. All survived to discharge with apparent resolution of the mediastinal haemorrhage (based on repeat imaging and/or clinical signs) with supportive treatment alone. Follow-up information was available from 2 months to 5 years following discharge, and none of the patients showed a recurrence of clinical signs during this period. CLINICAL SIGNIFICANCE This case series highlights that presumed haemorrhage into the mediastinum can occur in dogs without an obviously identifiable cause and, whilst rare, should be considered as a cause of dorsal mediastinal masses and may be successfully managed with supportive care alone.
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Affiliation(s)
- K Peak
- Anderson Moores Veterinary Specialists, Internal Medicine, Winchester, SO21 1LL, UK
| | - D Walker
- Anderson Moores Veterinary Specialists, Internal Medicine, Winchester, SO21 1LL, UK
| | - P Agthe
- Anderson Moores Veterinary Specialists, Diagnostic Imaging, Winchester, SO21 1LL, UK
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Tritten L, Gillis-Germitsch N, Kockmann T, Schnyder M. Quantitative proteomics analysis of Angiostrongylus vasorum-induced alterations in dog serum sheds light on the pathogenesis of canine angiostrongylosis. Sci Rep 2021; 11:283. [PMID: 33431914 PMCID: PMC7801463 DOI: 10.1038/s41598-020-79459-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 12/09/2020] [Indexed: 12/22/2022] Open
Abstract
Blood contains hundreds of proteins, reflecting ongoing cellular processes and immune reactions. Infections with the blood-dwelling cardiopulmonary nematode Angiostrongylus vasorum in dogs manifest with a broad spectrum of clinical signs including respiratory distress, bleeding diathesis and neurological signs, and are associated with a perturbed blood protein profile in dogs. However, current knowledge does not completely explain the observed pathologies induced by A. vasorum infections, including bleeding disorders. Using sera from experimentally infected dogs, dog serum proteome was analysed by quantitative mass spectrometry methods over several time points before and after inoculation. Following computational analysis, we identified 139 up- and downregulated proteins after infection (log2 ratio cut-off ≥ 1.0; q-value ≤ 0.05). Among upregulated proteins were chitinase 3-like 1 and pulmonary surfactant-associated protein B (log2 fold-changes ≥ 5). Pathway enrichment revealed the complement (especially the lectin pathway) and coagulation cascades as significantly affected upon analysis of downregulated proteins. Among them were mannan-binding lectin serine peptidases, ficolin, and coagulation factor XIII-B. These results bring new elements towards understanding the underlying pathomechanisms of bleeding diatheses observed in some A. vasorum-infected dogs.
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Affiliation(s)
- Lucienne Tritten
- Institute of Parasitology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.
| | - Nina Gillis-Germitsch
- Institute of Parasitology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Tobias Kockmann
- Functional Genomics Center Zurich, ETH/UZH Zurich, Zurich, Switzerland
| | - Manuela Schnyder
- Institute of Parasitology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.
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Cortese L, Christopherson PW, Pelagalli A. Platelet Function and Therapeutic Applications in Dogs: Current Status and Future Prospects. Animals (Basel) 2020; 10:E201. [PMID: 31991713 PMCID: PMC7071006 DOI: 10.3390/ani10020201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 11/16/2022] Open
Abstract
Significant progress has been made in the functional characterization of canine platelets in the last two decades. The role of canine platelets in hemostasis includes their adhesion to the subendothelium, activation, and aggregation, leading to primary clot formation at the site of injury. Studies on canine platelet function and advancements in laboratory testing have improved the diagnosis and understanding of platelet-related disorders as well as the knowledge of the mechanisms behind these diseases. This review focuses on the most recent discoveries in canine platelet structure, function, and disorders; and discusses the efficacy of various tests in the diagnosis of platelet-related disorders. With the relatively recent discovery of angiogenetic and reparative effects of growth factors found in platelets, this review also summarizes the use of canine platelet-rich plasma (PRP) alone or in association with stem cells in regenerative therapy. The characterization of proteomic and lipidomic profiles and development of platelet gene therapy in veterinary species are areas of future study with potential for major therapeutic benefits.
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Affiliation(s)
- Laura Cortese
- Department of Veterinary Medicine and Animal Productions, Division of Internal Medicine, University of Naples Federico II, Via Delpino, 1, 80137 Naples, Italy;
| | - Pete W. Christopherson
- Department of Pathobiology, Auburn University College of Veterinary Medicine, Auburn University, Auburn, AL 36849, USA;
| | - Alessandra Pelagalli
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy
- Institute of Biostructures and Bioimaging (IBB), National Research Council (CNR), 80131 Naples, Italy
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Birkbeck R, Humm K, Cortellini S. A review of hyperfibrinolysis in cats and dogs. J Small Anim Pract 2019; 60:641-655. [PMID: 31608455 DOI: 10.1111/jsap.13068] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 08/21/2019] [Accepted: 08/21/2019] [Indexed: 12/14/2022]
Abstract
The fibrinolytic system is activated concurrently with coagulation; it regulates haemostasis and prevents thrombosis by restricting clot formation to the area of vascular injury and dismantling the clot as healing occurs. Dysregulation of the fibrinolytic system, which results in hyperfibrinolysis, may manifest as clinically important haemorrhage. Hyperfibrinolysis occurs in cats and dogs secondary to a variety of congenital and acquired disorders. Acquired disorders associated with hyperfibrinolysis, such as trauma, cavitary effusions, liver disease and Angiostrongylus vasorum infection, are commonly encountered in primary care practice. In addition, delayed haemorrhage reported in greyhounds following trauma and routine surgical procedures has been attributed to a hyperfibrinolytic disorder, although this has yet to be characterised. The diagnosis of hyperfibrinolysis is challenging and, until recently, has relied on techniques that are not readily available outside referral hospitals. With the recent development of point-of-care viscoelastic techniques, assessment of fibrinolysis is now possible in referral practice. This will provide the opportunity to target haemorrhage due to hyperfibrinolysis with antifibrinolytic drugs and thereby reduce associated morbidity and mortality. The fibrinolytic system and the conditions associated with increased fibrinolytic activity in cats and dogs are the focus of this review article. In addition, laboratory and point-of-care techniques for assessing hyperfibrinolysis and antifibrinolytic treatment for patients with haemorrhage are reviewed.
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Affiliation(s)
- R Birkbeck
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, Hertfordshire, AL9 7TA, UK
| | - K Humm
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, Hertfordshire, AL9 7TA, UK
| | - S Cortellini
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, Hertfordshire, AL9 7TA, UK
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Cummings FO, Rizzo SA. Treatment of presumptive primary immune-mediated thrombocytopenia with mycophenolate mofetil versus cyclosporine in dogs. J Small Anim Pract 2017; 58:96-102. [DOI: 10.1111/jsap.12621] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 07/10/2016] [Accepted: 07/11/2016] [Indexed: 11/28/2022]
Affiliation(s)
- F. O. Cummings
- Practice Limited to Internal Medicine; Louisville Kentucky 40223 USA
| | - S. A. Rizzo
- Practice Limited to Internal Medicine; Louisville Kentucky 40223 USA
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12
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Hausmann L, Pack A, Hausmann S, Neiger R. [Acquired von-Willebrand factor and factor-VIII deficiencies caused by angiostrongylosis in a dog]. TIERAERZTLICHE PRAXIS AUSGABE KLEINTIERE HEIMTIERE 2016; 44:189-93. [PMID: 27189252 DOI: 10.15654/tpk-150743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 01/07/2016] [Indexed: 11/13/2022]
Abstract
An 8-year-old male Australian Shepherd was presented with bleeding from the lip and hemoabdomen. Hematology demonstrated marked thrombocytopenia and anemia. Abdominal ultrasound followed by laparotomy did not detect the cause of bleeding. Plasma transfusion resulted in temporary stabilization. Severe von-Willebrand factor deficiency and factor-VIII deficiency were diagnosed. After subsequent bleeding episodes, infection with Angiostrongylus vasorum was found in both a fecal parasitological examination and by PCR from EDTA-blood. Following successful therapy with fenbendazole, von Willebrand factor and factor VIII were within the normal range. This is the second case report of an acquired von-Willebrand-factor deficiency associated with Angiostrongylus-vasorum infection in a dog, and the first case report with concurrent factor-VIII deficiency.
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Affiliation(s)
- Lisa Hausmann
- Lisa Hausmann, Klinik für Kleintiere, Innere Medizin, Justus-Liebig-Universität Gießen, Frankfurter Straße 126, 35392 Gießen, E-Mail:
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13
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Di Cesare A, Traversa D, Manzocchi S, Meloni S, Grillotti E, Auriemma E, Pampurini F, Garofani C, Ibba F, Venco L. Elusive Angiostrongylus vasorum infections. Parasit Vectors 2015; 8:438. [PMID: 26306788 PMCID: PMC4549937 DOI: 10.1186/s13071-015-1047-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 08/17/2015] [Indexed: 11/10/2022] Open
Abstract
Background The parasitic nematode Angiostrongylus vasorum causes severe clinical signs in dogs. The disease is often challenging because infected animals are often presented with clinical signs overlapping those of other diseases. Methods The present article describes six angiostrongylosis cases (Cases 1-6) that represent key examples of how canine angiostrongylosis may be extremely confounding. The six animals presented clinical signs compatible with canine angiostrongylosis but they were subjected to clinical examinations for other diseases (e.g. dirofilariosis or immune-mediated disorders) before achieving a correct diagnosis. Results In Case 1 clinical, radiographic and ultrasound examinations' results resembled a lung neoplasia. Case 2 was a dog with a mixed infection caused by A. vasorum and Dirofilaria immitis. Case 3 was a critically ill dog presented in emergency for an acute onset of dyspnoea caused by lungworm infection. The dog died a few hours after presentation despite support and etiologic therapy. Case 4 was a dog presented for chronic hemorrhages and ecchymoses caused by thrombocytopenia of unknown origin, thought to have an inherited, immune-mediated or infective cause. Case 5 was referred for neurological signs due to a suspected discospondylitis. Case 6 was erroneously diagnosed infected only with D. immitis although the dog was infected only with A. vasorum. A timely administration of an anthelmintic (mostly moxidectin) showed to be effective in treating the infection in those dogs (i.e. Cases 1,2, 4 and 5) that did not suffer with severe lung haemorrhages yet. Conclusions Dogs 1-5 were referred in two regions of Italy that are considered non-endemic for A. vasorum. These findings indicate that veterinarians should include angiostrongylosis in the differential diagnosis of cardio-respiratory distress also in non-endemic regions and should perform appropriate diagnostics in the presence of compatible signs even if the clinical picture is atypical.
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Affiliation(s)
- Angela Di Cesare
- Faculty of Veterinary Medicine, University of Teramo, 64100, Teramo, Italy.
| | - Donato Traversa
- Faculty of Veterinary Medicine, University of Teramo, 64100, Teramo, Italy.
| | - Simone Manzocchi
- Novara Day Lab - IDEXX Laboratories Italia, S.P. 9, 28060, Granozzo con Monticello, Italy.
| | - Silvana Meloni
- Faculty of Veterinary Medicine, University of Teramo, 64100, Teramo, Italy. .,Veterinary Hospital "Città di Pavia", Viale Cremona 179, 27100, Pavia, Italy. .,Veterinary Clinic "LidoVet", Via Poggio di Venaco 16, 00121, Ostia, Italy.
| | - Eleonora Grillotti
- Faculty of Veterinary Medicine, University of Teramo, 64100, Teramo, Italy. .,Veterinary Pratice "Centro Italia", Via Biancifiori 3, 02100, Rieti, Italy.
| | - Edoardo Auriemma
- Istituto Veterinario di Novara, S.P. 9, 28060, Granozzo con Monticello, Italy.
| | | | - Cecilia Garofani
- Veterinary Pratice "Centro Italia", Via Biancifiori 3, 02100, Rieti, Italy.
| | - Fabrizio Ibba
- Veterinary Pratice "Poggio dei Pini" Strada 40, 09012, Capoterra, Cagliari, Italy.
| | - Luigi Venco
- Veterinary Hospital "Città di Pavia", Viale Cremona 179, 27100, Pavia, Italy.
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Swann JW, Priestnall SL, Dawson C, Chang YM, Garden OA. Histologic and clinical features of primary and secondary vasculitis. J Vet Diagn Invest 2015; 27:489-96. [DOI: 10.1177/1040638715587934] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Inflammation of the blood vessel wall has been reported infrequently in dogs, and it may occur without apparent cause (primary vasculitis) or as a pathologic reaction to a range of initiating insults (secondary vasculitis). The aims of our study were to report histologic, clinical, and survival data from a large series of cases with primary and secondary vasculitis, and to compare the clinical parameters and outcome data between groups. Clinical data was collected retrospectively from the medical records of 42 client-owned dogs with a histologic diagnosis of primary or secondary vasculitis, and follow-up information was obtained. Cases were grouped according to clinical and histologic descriptors, and biochemical, hematologic, and survival data was compared between groups. Several forms of primary vasculitis were observed, and vascular inflammation was observed in conjunction with numerous other diseases. Female dogs were more likely to develop primary vasculitis, and serum globulin concentration was greater in dogs with primary vasculitis compared to those with underlying disease. All dogs with primary vasculitis of the central nervous system died or were euthanized shortly after presentation, but other forms of primary vasculitis could be managed effectively. In conclusion, presentation of clinical cases in this series was variable, and there did not appear to be well-defined vasculitic syndromes as described in people.
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Affiliation(s)
- James W. Swann
- Royal Veterinary College, University of London, Hatfield, Hertfordshire, UK
| | | | - Charlotte Dawson
- Royal Veterinary College, University of London, Hatfield, Hertfordshire, UK
| | - Yu-Mei Chang
- Royal Veterinary College, University of London, Hatfield, Hertfordshire, UK
| | - Oliver A. Garden
- Royal Veterinary College, University of London, Hatfield, Hertfordshire, UK
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Adamantos S, Waters S, Boag A. Coagulation status in dogs with naturally occurring Angiostrongylus vasorum infection. J Small Anim Pract 2015; 56:485-90. [PMID: 26032443 DOI: 10.1111/jsap.12370] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 04/01/2015] [Accepted: 04/07/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Angiostrongylus vasorum infection is associated with bleeding tendencies in approximately one-third of clinical cases. The cause of the coagulopathy is poorly understood but may be related to disseminated intravascular coagulation. Thromboelastography is a global evaluation of coagulation and has not been described in a cohort of dogs with this disease. MATERIALS AND METHODS Thromboelastography in association with other measures of coagulation including prothrombin and activated partial thromboplastin times, antithrombin percentage activity and D-dimer and von Willebrand factor concentrations was evaluated in a group of 30 dogs with A. varosum infection. RESULTS A total of 18 dogs had signs of bleeding on physical examination. Thromboelastography was consistent with hypocoagulation in 17 of these dogs. There was no association between any of the other measures and hypocoagulation on thromboelastography. Abnormal coagulation times were not significantly associated with bleeding. Only fibrinogen concentration was significantly lower in dogs that were bleeding compared with those that were not (P = 0 · 026). D-dimer concentrations were increased in 22/25 cases in the study; however, other coagulation parameters were more variable. CLINICAL SIGNIFICANCE Although the changes identified in this study were not consistent, there is activation of coagulation within this population, possibly consistent with an intravascular disseminated coagulopathy.
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Affiliation(s)
- S Adamantos
- Langford Veterinary Services, University of Bristol, Langford House, BS40 5DU
| | - S Waters
- Royal Veterinary College, Hawkshead Lane, North Mymms, AL9 7TA
| | - A Boag
- Vets Now, Penguin House, Castle Riggs, Dunfermline, Fife, KY11 8SG
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16
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Borgeat K, Sudunagunta S, Kaye B, Stern J, Luis Fuentes V, Connolly DJ. Retrospective evaluation of moderate-to-severe pulmonary hypertension in dogs naturally infected with Angiostrongylus vasorum. J Small Anim Pract 2014; 56:196-202. [PMID: 25483150 DOI: 10.1111/jsap.12309] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 10/08/2014] [Accepted: 11/05/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The outcome in dogs with pulmonary hypertension associated with natural Angiostrongylus vasorum infection is unclear. This study aimed to report long-term outcome of dogs with A. vasorum and pulmonary hypertension, and to evaluate factors associated with pulmonary hypertension development. It was hypothesised that dogs with pulmonary hypertension had a shorter survival time than dogs without pulmonary hypertension. METHODS Retrospective review of clinical records of dogs diagnosed with A. vasorum. Dogs were classified as having or not having pulmonary hypertension based on clinical signs and imaging findings. Signalment, signs and outcome were recorded. DNA obtained from banked samples was genotyped for the PDE5a:E90K polymorphism, a possible factor in development of pulmonary hypertension. RESULTS The proportion of dogs with moderate-to-severe pulmonary hypertension and A. vasorum infection in the study population was 14 · 6%. No difference in the population characteristics or PDE5a genotype was detected between dogs with and without pulmonary hypertension. Dogs with pulmonary hypertension had a significantly shorter survival time (P = 0 · 006) and a greater risk of death within 6 months of diagnosis (odds ratio 12 · 5, 95% confidence interval 2 · 1 to 74 · 9; P = 0 · 0053). CLINICAL SIGNIFICANCE A. vasorum-associated pulmonary hypertension is an important problem in naturally infected dogs and has a negative effect upon survival.
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Affiliation(s)
- K Borgeat
- Clinical Science and Services, Royal Veterinary College, Hatfield, AL9 7TA; Highcroft Veterinary Referrals, Bristol, BS14 9BE
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Di Cesare A, Traversa D. Canine angiostrongylosis: recent advances in diagnosis, prevention, and treatment. VETERINARY MEDICINE-RESEARCH AND REPORTS 2014; 5:181-192. [PMID: 32670858 PMCID: PMC7337173 DOI: 10.2147/vmrr.s53641] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 04/23/2014] [Indexed: 11/23/2022]
Abstract
Angiostrongylus vasorum is a parasitic nematode affecting the heart and pulmonary arteries of wild (eg, foxes) and domestic canids. The parasite has an indirect life cycle in which slugs and snails act as intermediate hosts. In the last few years the parasite has spread outside the traditional endemic foci, and there is a rise of documented cases of canine angiostrongylosis across Europe. Angiostrongylus vasorum causes cardiopulmonary disorders and coagulopathies, along with different nonspecific clinical signs. Fatal infections are frequently reported. Given the severity of the infection and the recent geographic spreading of the parasite, this article reviews and discusses the current knowledge of A. vasorum, with a special focus on recent insights on diagnosis, prevention, and treatment of dog angiostrongylosis.
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Affiliation(s)
- Angela Di Cesare
- Faculty of Veterinary Medicine, University of Teramo, Teramo, Italy
| | - Donato Traversa
- Faculty of Veterinary Medicine, University of Teramo, Teramo, Italy
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18
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Elsheikha HM, Holmes SA, Wright I, Morgan ER, Lacher DW. Recent advances in the epidemiology, clinical and diagnostic features, and control of canine cardio-pulmonary angiostrongylosis. Vet Res 2014; 45:92. [PMID: 25283220 PMCID: PMC4189173 DOI: 10.1186/s13567-014-0092-9] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 08/21/2014] [Indexed: 11/25/2022] Open
Abstract
The aim of this review is to provide a comprehensive update on the biology, epidemiology, clinical features, diagnosis, treatment, and prevention of canine cardio-pulmonary angiostrongylosis. This cardiopulmonary disease is caused by infection by the metastrongyloid nematode Angiostrongylus vasorum. The parasite has an indirect life cycle that involves at least two different hosts, gastropod molluscs (intermediate host) and canids (definitive host). A. vasorum represents a common and serious problem for dogs in areas of endemicity, and because of the expansion of its geographical boundaries to many areas where it was absent or uncommon; its global burden is escalating. A. vasorum infection in dogs can result in serious disorders with potentially fatal consequences. Diagnosis in the live patient depends on faecal analysis, PCR or blood testing for parasite antigens or anti-parasite antibodies. Identification of parasites in fluids and tissues is rarely possible except post mortem, while diagnostic imaging and clinical examinations do not lead to a definitive diagnosis. Treatment normally requires the administration of anthelmintic drugs, and sometimes supportive therapy for complications resulting from infection.
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Lowrie M, De Risio L, Dennis R, Llabrés-Díaz F, Garosi L. CONCURRENT MEDICAL CONDITIONS AND LONG-TERM OUTCOME IN DOGS WITH NONTRAUMATIC INTRACRANIAL HEMORRHAGE. Vet Radiol Ultrasound 2012; 53:381-8. [DOI: 10.1111/j.1740-8261.2012.01934.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 02/07/2012] [Indexed: 11/29/2022] Open
Affiliation(s)
- Mark Lowrie
- From the Davies Veterinary Specialists; Manor Farm Business Park; Higham Gobion; Hitchin; SG5 3HR; England
| | - Luisa De Risio
- Animal Health Trust; Centre for Small Animal Studies; Newmarket; Suffolk; CB8 7UU,; England
| | - Ruth Dennis
- Animal Health Trust; Centre for Small Animal Studies; Newmarket; Suffolk; CB8 7UU,; England
| | - Francisco Llabrés-Díaz
- From the Davies Veterinary Specialists; Manor Farm Business Park; Higham Gobion; Hitchin; SG5 3HR; England
| | - Laurent Garosi
- From the Davies Veterinary Specialists; Manor Farm Business Park; Higham Gobion; Hitchin; SG5 3HR; England
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20
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Gallagher B, Brennan SF, Zarelli M, Mooney CT. Geographical, clinical, clinicopathological and radiographic features of canine angiostrongylosis in Irish dogs: a retrospective study. Ir Vet J 2012; 65:5. [PMID: 22433388 PMCID: PMC3349590 DOI: 10.1186/2046-0481-65-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 03/20/2012] [Indexed: 12/03/2022] Open
Abstract
Background Angiostrongylus vasorum infection is associated with high morbidity and mortality in dogs. Although recognised in Ireland, there are no large series of cases reported. The aim of this retrospective study was to identify pertinent clinical and geographical features in Irish dogs. Results The case records of dogs presenting to the University College Dublin Veterinary Hospital (1999-2010) were reviewed. A contemporaneous review of external faecal parasitology and post mortem submissions was also performed. A positive diagnosis of angiostrogylosis was identified in 49 dogs including 24 clinical, 10 post mortem and 15 external faecal sample cases. The majority (n = 44 (90%)) resided on the East Coast. In the clinical cases, the median age was 20 months, 29% of cases were older than 2 years. Clinical features included cardiorespiratory (63%), coagulopathic (71%) and other (63%) signs. Cough (n = 10), dyspnoea (n = 5) and tachypnoea (n = 3) were the most common cardiorespiratory abnormalities. Of animals with evidence of coagulopathy, excessive haemorrhage from a wound (n = 5), airway haemorrhage (n = 9), epistaxis (n = 3), haematoma (n = 4), suspected haemarthrosis (n = 3), neurological signs (n = 2) and haematuria (n = 1) were found. Ten dogs were anaemic, of which two were severe (haematocrit ≤ 0.20 L/L). Ten animals had thrombocytopenia, with four severely affected (≤50 × 109/L). PT and APTT values were prolonged in 4 (24%) of 17 and a BMBT was prolonged in 5 (63%) of 8 cases. Vague signs of exercise intolerance (n = 6), lethargy (n = 6) and weakness (n = 2) were identified, with two (8%) animals having only these signs. In one animal the diagnosis appeared to be incidental. Thoracic radiographs (n = 19) identified abnormalities in 100% of cases. Four (17%) animals died before or within 24 hours of treatment and post mortem examinations confirmed angiostrongylosis. Fenbendazole was administered in 19 cases, 18 (95%) recovered. Two animals were euthanised, one which failed to respond to therapy and another in which an ante mortem diagnosis had not been made. Conclusions Angiostrongylosis is not uncommon in Ireland, is not confined to young dogs or the East Coast and can present with a wide variety of signs, particularly coagulopathic, respiratory or neurological signs.
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Gredal H, Willesen JL, Jensen HE, Nielsen OL, Kristensen AT, Koch J, Kirk RK, Pors SE, Skerritt GC, Berendt M. Acute neurological signs as the predominant clinical manifestation in four dogs with Angiostrongylus vasorum infections in Denmark. Acta Vet Scand 2011; 53:43. [PMID: 21711538 PMCID: PMC3141560 DOI: 10.1186/1751-0147-53-43] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 06/28/2011] [Indexed: 11/16/2022] Open
Abstract
Four dogs with acute neurological signs caused by haemorrhages in the central nervous system were diagnosed with Angiostrongylus vasorum infection as the underlying aetiology. Two dogs presented with brain lesions, one dog with spinal cord lesions and one with lesions in both the brain and spinal cord. Only one dog presented with concurrent signs of classical pulmonary angiostrongylosis (respiratory distress, cough), and only two dogs displayed overt clinical signs of haemorrhages. Results of coagulation assays were inconsistent. Neurological signs reflected the site of pathology and included seizures, various cranial nerve deficits, vestibular signs, proprioceptive deficits, ataxia and paraplegia. One dog died and three were euthanised due to lack of improvement despite medical treatment. This emphasises canine angiostrongylosis as a potential cause of fatal lesions of the central nervous system and the importance of including A. vasorum as a differential diagnosis in young dogs with acute neurological signs in Denmark.
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22
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Canine angiostrongylosis: The French heartworm: An emerging threat in North America. Vet Parasitol 2011; 176:382-9. [DOI: 10.1016/j.vetpar.2011.01.025] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Clinical, laboratory and pathological findings in dogs experimentally infected with Angiostrongylus vasorum. Parasitol Res 2010; 107:1471-80. [PMID: 20700604 DOI: 10.1007/s00436-010-2021-9] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Accepted: 07/27/2010] [Indexed: 10/19/2022]
Abstract
The aim of this comparative study was to investigate the development of clinical signs and accompanying haematological, coproscopic and pathological findings as a basis for the monitoring of health condition of Angiostrongylus vasorum infected dogs. Six beagles were orally inoculated with 50 (n=3) or 500 (n=3) A. vasorum third stage larvae (L3) obtained from experimentally infected Biomphalaria glabrata snails. Two dogs were treated with moxidectin/imidacloprid spot-on solution and two further dogs with an oral experimental compound 92 days post infection (dpi), and were necropsied 166 dpi. Two untreated control dogs were necropsied 97 dpi. Prepatency was 47-49 days. Dogs inoculated with 500 L3 exhibited earlier (from 42 dpi) and more severe respiratory signs. Clinical signs resolved 12 days after treatment and larval excretion stopped within 20 days in all four treated dogs. Upon necropsy, 10 and 170 adult worms were recovered from the untreated dogs inoculated with 50 and 500 L3, respectively. Adult worms were also found in two treated dogs, in the absence of L1 or eggs. Despite heavy A. vasorum infection load and severe pulmonary changes including vascular thrombosis, only mild haematological changes were observed. Eosinophilia was absent but the presence of plasma cells was observed. Neutrophilic leucocytes showed a transient increase but only after treatment. Signs for coagulopathies were slight; nevertheless coagulation parameters were inoculation dose dependent. Ten weeks after treatment pulmonary fibrosis was still present. Infections starting from 50 L3 of A. vasorum had a massive impact on lung tissues and therefore on the health of affected dogs, particularly after prepatency, although only mild haematological abnormalities were evident.
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24
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Jo'neill E, Acke E, Tobin E, McCarthy G. Immune-mediated thrombocytopenia associated with angiostrongylus vasorum infection in a Jack Russell terrier. Ir Vet J 2010; 63:434-40. [PMID: 21851748 PMCID: PMC3113836 DOI: 10.1186/2046-0481-63-7-434] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
A twenty-month-old Jack Russell terrier was presented with a four-day history of thrombocytopenia, echymotic inguinal haemorrhages, coughing and reduced exercise tolerance. Clinical examination revealed several petechial haemorrhages on the gingivae and small echymotic haemorrhages in the inguinal region, along with mild bilateral epistaxis. Haematology confirmed a platelet count of 1.0 × 10/L. Thoracic radiographs revealed a wide-spread mixed alveolar-interstitial lung pattern, apparent throughout the entire lungfield, but particularly marked within the left lung lobes. A presumptive diagnosis of immune-mediated thrombocytopenia was made and the dog was treated with vincristine and immunosuppressive doses of prednisolone. Initially anaemia developed following gastrointestinal haemorrhage; however, after symptomatic treatment the dog showed a marked clinical improvement. Evaluation for an underlying cause of the disease revealed Angiostrongylus vasorum L1 larvae on faecal analysis and treatment with fenbendazole was commenced. The dog made a full clinical recovery with all treatment was withdrawn within five weeks of diagnosis. This is the second report of immune-mediated thrombocytopenia associated with Angiostrongylus vasorum infection and it is the first to be successfully managed. The report highlights that Angiostrongylus vasorum should be considered in young dogs presented with thrombocytopenia.
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Affiliation(s)
- Emma Jo'neill
- School of Agriculture, Food Sciences and Veterinary Medicine, University College Dublin, Belfield, Dublin 4, Ireland.
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25
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Helm JR, Morgan ER, Jackson MW, Wotton P, Bell R. Canine angiostrongylosis: an emerging disease in Europe. J Vet Emerg Crit Care (San Antonio) 2010; 20:98-109. [DOI: 10.1111/j.1476-4431.2009.00494.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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26
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Helm J, Gilleard JS, Jackson M, Redman E, Bell R. A case of canine Angiostrongylus vasorum in Scotland confirmed by PCR and sequence analysis. J Small Anim Pract 2009; 50:255-9. [PMID: 19413751 DOI: 10.1111/j.1748-5827.2009.00741.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
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.
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Affiliation(s)
- J Helm
- Division of Companion Animal Sciences, Faculty of Veterinary Medicine, University of Glasgow, Glasgow
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Denk D, Matiasek K, Just FT, Hermanns W, Baiker K, Herbach N, Steinberg T, Fischer A. Disseminated angiostrongylosis with fatal cerebral haemorrhages in two dogs in Germany: a clinical case study. Vet Parasitol 2008; 160:100-8. [PMID: 19062192 DOI: 10.1016/j.vetpar.2008.10.077] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Revised: 09/08/2008] [Accepted: 10/15/2008] [Indexed: 10/21/2022]
Abstract
Canine angiostrongylosis is a nematode infection in domestic dogs and wild carnivores. Few single case reports describing the occurrence of this disease in Germany exist and until recently angiostrongylosis has not been considered endemic in this country. The present report focuses on clinical, pathological and parasitological findings in two cases of fatal disseminated canine angiostrongylosis associated with multifocal haemorrhages in the central nervous system. Both animals, which lived in Germany, presented with rapidly progressive neurological signs including depression, ataxia, unilateral central blindness and epileptic seizures. Blood work revealed grossly elevated D-dimers and mild thrombocytopenia. Both animals were subsequently euthanised due to progressive clinical aggravation. Necropsy showed cerebral and lung haemorrhages in both animals. Multiple sections of nematode larvae consistent with Angiostrongylus vasorum were identified on histopathological sections of the brain, heart, kidney and lung in both animals and a predominantly granulomatous inflammation with the occurrence of multinucleated giant cells was observed. Adult nematodes were found in the larger lung arteries of one dog and Angiostrongylus infection was subsequently confirmed by PCR-analysis and sequencing in both dogs. A. vasorum larvae were not detected by faecal Baermann examination performed in one of the dogs. It was concluded that canine angiostrongylosis should be considered as differential diagnosis in dogs in Germany, even if faecal examination is negative. There is currently still a lack of studies investigating the occurrence of angiostrongylosis in dogs and intermediate hosts in Germany which would be necessary to survey the endemic realities of this disease.
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Affiliation(s)
- D Denk
- Institute for Veterinary Pathology, Ludwig-Maximilians-University Munich, Veterinärstrasse 13, 80539 Munich, Germany.
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Bourque AC, Conboy G, Miller LM, Whitney H. Pathological findings in dogs naturally infected with Angiostrongylus vasorum in Newfoundland and Labrador, Canada. J Vet Diagn Invest 2008; 20:11-20. [PMID: 18182502 DOI: 10.1177/104063870802000103] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Fifty-six dogs from St. John's, Newfoundland, Canada, were evaluated for Angiostrongylus vasorum infection. Small numbers of nematodes were found within pulmonary arteries of 6 dogs. Larvae were identified in fecal samples in 2 of 6 dogs. All 6 dogs had multifocal granulomatous pneumonia and sometimes foci of chronic thrombosis, which varied from very mild to severe. One dog had extensive pulmonary lesions resulting in cor pulmonale. Right heart failure was characterized by right ventricular hypertrophy, hepatic congestion, ascites, and hydrothorax. Microscopically, in most cases, eggs, larvae, and sometimes intravascular adults, were present within lung tissue sections. Small foci of granulomatous inflammation with and without larvae were present in kidney and brain in 4 dogs. An additional dog, diagnosed antemortem with angiostrongylosis via fecal examination, was also examined. Pathological findings consisted of severe pyogranulomatous interstitial pneumonia with myriad eggs, larvae, and numerous intravascular pulmonary adult nematodes with extensive arterial thrombosis. Five hundred and seventy-two adult worms were removed from pulmonary arteries. Foci of granulomatous inflammation, often associated with larvae and/or eggs, were present in tracheobronchial lymph nodes, adrenal gland, brain, and kidneys. Severe seizuring noted antemortem was attributed to several large, discrete areas of acute hemorrhagic infarction within the cerebrum and cerebellum. Natural A. vasorum infection in domestic dogs in eastern Newfoundland causes lung pathology of variable severity, which in some cases, may progress to cor pulmonale and which may be associated with extrapulmonary lesions and clinical signs.
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Affiliation(s)
- Andrea C Bourque
- Department of Pathology and Microbiology, Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, Prince Edward Island, Canada C1A 4P3.
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Willesen J, Bjornvad C, Koch J. Acute haemoabdomen associated with Angiostrongylus vasorum infection in a dog: a case report. Ir Vet J 2008; 61:591-3. [PMID: 21851721 PMCID: PMC3113881 DOI: 10.1186/2046-0481-61-9-591] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
A one-year-old intact female, Danish shorthaired pointer was referred to the emergency service with a history of acute collapse and pale mucous membranes after a month of reduced activity but with no other clinical signs. An ultrasound examination of the abdomen indicated the presence of a large amount of free fluid with no obvious cause such as neoplasia or splenic rupture. Fluid analysis had the macroscopic appearance of blood with no signs of infection or neoplasia. Multiple Angiostrongylus vasorum L1 larvae were revealed on a direct rectal faecal smear. The dog was treated with fenbendazole 25 mg/kg orally once daily for 20 days and given supportive treatment. The dog was stabilised on this treatment. Haemoabdomen is a clinical sign where surgical intervention is often considered an integral part of the diagnostic investigation (i.e., laparotomy) or treatment. Failing to make the diagnosis of canine angiostrongylosis before performing surgery may have a serious adverse affect on the outcome. Consequently, in areas where A. vasorum is enzootic, a Baermann test and a direct faecal smear should be included in the initial diagnostic investigation of all dogs presenting with bleeding disorders of unknown origin.
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Affiliation(s)
- Jl Willesen
- Department of Small Animal Clinical Sciences, Faculty of Life Sciences, University of Copenhagen, Dyrlaegevej 16, 1870 Frederiksberg C, Denmark.
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Traversa D, Guglielmini C. Feline aelurostrongylosis and canine angiostrongylosis: a challenging diagnosis for two emerging verminous pneumonia infections. Vet Parasitol 2008; 157:163-74. [PMID: 18775603 DOI: 10.1016/j.vetpar.2008.07.020] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2008] [Revised: 06/26/2008] [Accepted: 07/15/2008] [Indexed: 11/16/2022]
Abstract
Aelurostrongylus abstrusus and Angiostrongylus vasorum (Nematoda, Metastrongyloidea) are causative agents of verminous feline and canine pneumonia. Both are presently emerging in several geographical areas and are of major clinical importance. Given the range of parasitic and non-parasitic pathogens which may cause cardio-respiratory distress in dogs and cats, the unequivocal specific diagnosis of both diseases is pivotal for unravelling their epidemiology and central to therapy and control. Several conventional clinico-pathologic, diagnostic imaging and parasitological approaches are currently used in practice, but all have major limitations in the specific diagnosis of these diseases. Serological methods have shown promise in the diagnosis of A. abstrusus and A. vasorum infections, but no clinically useful tests are currently available. Additionally, there have been major advances in the development of novel molecular diagnostic tools for feline aelurostrongylosis, but efforts to develop molecular diagnostic tests are still preliminary for angiostrongylosis. This article provides a review of A. abstrusus and A. vasorum infections in cats and dogs, focusing on the advantages and shortcomings of classical diagnostic methodologies and on present diagnostic advances as well as future perspectives instrumental to epidemiological and clinical studies.
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Affiliation(s)
- Donato Traversa
- Department of Comparative Biomedical Sciences, University of Teramo, Piazza Aldo Moro 45, Teramo 64100, Italy.
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Koch J, Willesen JL. Canine pulmonary angiostrongylosis: an update. Vet J 2008; 179:348-59. [PMID: 18180185 DOI: 10.1016/j.tvjl.2007.11.014] [Citation(s) in RCA: 155] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Revised: 11/06/2007] [Accepted: 11/11/2007] [Indexed: 11/16/2022]
Abstract
Canine pulmonary angiostrongylosis is an emerging snail-borne disease causing verminous pneumonia and coagulopathy in dogs. The parasite is found in Europe, North and South America and Africa, covering tropical, subtropical and temperate regions. Its distribution has been characterised by isolated endemic foci, with only sporadic occurrences outside these areas. In the last two decades, the literature has been dominated by several case reports and small case series describing sporadic disease in old or new endemic areas. Case reports and experimental studies with high doses of infective third stage larvae may not reflect what happens under field conditions. There is insufficient understanding of the spread of infection and the dynamic consequences of this parasite in the canine population. This review discusses the biology, epidemiology, clinical aspects and management of canine pulmonary angiostrongylosis.
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Affiliation(s)
- J Koch
- Department of Small Animal Clinical Sciences, Faculty of Life Sciences, University of Copenhagen, Frederiksberg C, Denmark.
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Mellor PJ, Mellanby RJ, Baines EA, Villiers EJ, Archer J, Herrtage ME. High serum troponin I concentration as a marker of severe myocardial damage in a case of suspected exertional heatstroke in a dog. J Vet Cardiol 2006; 8:55-62. [DOI: 10.1016/j.jvc.2005.07.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2005] [Revised: 07/25/2005] [Accepted: 07/28/2005] [Indexed: 10/24/2022]
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Garosi LS, Platt SR, McConnell JF, Wrayt JD, Smith KC. Intracranial haemorrhage associated with Angiostrongylus vasorum infection in three dogs. J Small Anim Pract 2005; 46:93-9. [PMID: 15736817 DOI: 10.1111/j.1748-5827.2005.tb00300.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This report describes three dogs with intracranial haemorrhage secondary to severe coagulation defects associated with Angiostrongylus vasorum infection. The initial case was diagnosed at necropsy, with two subsequent cases diagnosed antemortem and successfully treated. The dogs ranged in age from 14 months to four years and were presented for evaluation of a severe, subacute onset of suspected cerebral disease. Magnetic resonance imaging performed on all three dogs was suggestive of multiple areas of intraparenchymal brain haemorrhage. Coagulation assays showed a consumptive coagulopathy resembling chronic disseminated intravascular coagulation. Postmortem examination of the initial case confirmed the presence of multiple intracranial and extracranial haemorrhages. An unexpected finding was that of a marked multifocal nematode infection of the lungs with an associated vasculopathy. The parasites were confirmed to be A vasorum. In the two other dogs, faecal examination by Baermann technique confirmed A vasorum infection. Both dogs were treated with fenbendazole and one was additionally given a plasma transfusion. Repeated coagulation assays were normal within one week. Neurological examinations were normal for both dogs within six weeks. This case series indicates that A vasorum infection should be considered as a possible aetiology of intracranial haemorrhage in dogs.
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Affiliation(s)
- L S Garosi
- Centre for Small Animal Studies, The Animal Health Trust, Newmarket, Suffolk
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Whitley NT, Corzo-Menendez N, Carmichael NG, McGarry JW. Cerebral and conjunctival haemorrhages associated with von Willebrand factor deficiency and canine angiostrongylosis. J Small Anim Pract 2005; 46:75-8. [PMID: 15736813 DOI: 10.1111/j.1748-5827.2005.tb00296.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A case of angiostrongylosis is described in a 14-month-old golden retriever bitch. Conjunctival haemorrhage and neurological signs, referable to a space-occupying cerebral lesion, were associated with defective primary haemostasis caused by low levels of von Willebrand factor. Full clinical recovery followed treatment with desmopressin, fresh whole blood transfusion, fenbendazole and supportive care. The magnetic resonance image of the suspected organising haematoma is described. Similarities to the human condition, acquired von Willebrand syndrome, and a possible role for aberrant larval migration in haematoma formation are suggested.
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Affiliation(s)
- N T Whitley
- Davies Veterinary Specialists, Manor Farm Business Park, Higham Gobion, Hitchin, Hertfordshire
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Morgan ER, Shaw SE, Brennan SF, De Waal TD, Jones BR, Mulcahy G. Angiostrongylus vasorum: a real heartbreaker. Trends Parasitol 2005; 21:49-51. [DOI: 10.1016/j.pt.2004.11.006] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Angiostrongylosis was diagnosed in 23 dogs presenting to the Queen Mother Hospital for Animals between June 1999 and August 2002. The animals' clinical records were reviewed retrospectively and certain risk factors were compared with a control population of 3407 dogs. Twenty-two of the 23 dogs were from south-east England and dogs from Surrey (n=8) were significantly overrepresented. There were also significantly more Cavalier King Charles spaniels (n=5) and Staffordshire bull terriers (n=5) among the affected dogs than in the control group. The median age of affected dogs was 10 months (range five to 90 months). The most common presenting signs were cough (65 per cent), dyspnoea (43 per cent), haemorrhagic diathesis (35 per cent) and collapse (26 per cent). Four dogs were thrombocytopenic and eight had significant prolongations in prothrombin time and/or activated partial thromboplastin time. Thoracic radiographs were abnormal in 18 of 19 dogs. A variety of changes were observed, the most typical being a patchy alveolar-interstitial pattern affecting the dorsocaudal lung fields. Angiostrongylus vasorum larvae were found in seven of 10 bronchoalveolar lavage specimens and 19 of 19 faecal samples. Three dogs died shortly after admission to the hospital. The remainder were successfully treated with fenbendazole at a dose of 50 mg/kg for five to 21 days. A vasorum should now be considered endemic to south-east England.
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Affiliation(s)
- P S Chapman
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire AL9 7TA
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Boag AK, Lamb CR, Chapman PS, Boswood A. Radiographic findings in 16 dogs infected with Angiostrongylus vasorum. Vet Rec 2004; 154:426-30. [PMID: 15119894 DOI: 10.1136/vr.154.14.426] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Thoracic radiographs of 16 dogs infected naturally with Angiostrongylus vasorum showed signs of bronchial thickening, an interstitial pattern and a multifocal and/or peripheral alveolar pattern. In dogs treated with fenbendazole, follow-up radiographs showed that the alveolar pattern had resolved and a mild, hazy interstitial pattern had developed. In contrast with dogs with heartworm (Dirofilaria immitis), no pulmonary vascular lesions were identified.
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Affiliation(s)
- A K Boag
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hertfordshire AL97 7TA
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Brennan SF, McCarthy G, McAllister H, Bassett H, Jones BR. Clinical signs, diagnosis and treatment of three dogs with angiostrongylosis in Ireland. Ir Vet J 2004; 57:103-9. [PMID: 21851655 PMCID: PMC3113816 DOI: 10.1186/2046-0481-57-2-103] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Infection with Angiostrongylus vasorum was diagnosed at necropsy on a dog that died from acute pulmonary haemorrhage, and on recovery of L1 larvae by Baermann examination of faeces from two dogs, one of which had abdominal pain and retroperitoneal haemorrhage, while the other had right-sided heart failure due to cor pulmonale. The presenting signs included syncope (one dog), exercise intolerance (two dogs), cough (two dogs), abdominal pain (one dog) and depression (one dog). One-stage prothrombin time and activated partial thromboplastin time were prolonged in two dogs, buccal mucosal bleeding time was prolonged in one dog and globulin was elevated in all three dogs. Two dogs were treated with fenbendazole and recovered.
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Affiliation(s)
- Sheila F Brennan
- Departments of Small Animal Clinical Studies, Faculty of Veterinary Medicine, University College Dublin, Belfield, Dublin 4, Ireland.
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