Angiostrongylus vasorum (Baillet, 1866) infestation in a greyhound kennels

Hemostatic Dysfunction in Dogs Naturally Infected with Angiostrongylus vasorum—A Narrative Review

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.

Serological and faecal detection of Angiostrongylus vasorum in dogs from Austria

Canine angiostrongylosis is a potentially lethal parasitic disease that can manifest itself with a broad spectrum of clinical signs, including respiratory distress, neurological and bleeding disorders, or non-specific signs. The occurrence of Angiostrongylus vasorum is widely reported in Europe, but very little is known about its presence in Austria. In this first large-scale survey, 1279 sera were collected from Austrian dogs and tested by an ELISA for the detection of circulating antigen of A. vasorum (sensitivity: 95.7%, specificity 94.0%) and by a separate ELISA detecting specific antibodies (sensitivity 81.0%, specificity 98.8%). Furthermore, 1040 faecal samples were tested for the presence of lungworm first stage larvae (L1). One dog (0.1%, 95% confidence intervals [CI]: 0.0-0.4%) was positive in both ELISAs, while 1.2% (n = 15, CI: 0.7-1.9%) of the tested dogs were antigen-positive and 1.5% (n = 19, CI: 0.9-2.3%) were positive for specific antibodies. Overall, 13 dogs (1.3%; CI: 0.7-2.1%) were positive for A. vasorum L1 while 31 dogs were positive for Crenosoma vulpis L1 (3.0%; CI: 2.0-4.2%). One dog shed L1 from both A. vasorum and C. vulpis (0.1%, CI: 0.0-0.5%). Dogs positive for A. vasorum originated from northeast, southeast and south Austria (antigen and/or antibody detection), but also from north, west and southwest Austria (antibody detection) and from northeast and west Austria (L1 detection). One of 88 blood samples (1.1%, CI: 0.0-6.2%) submitted from the eastern part of Austria was positive by a rapid assay for A. vasorum antigen detection (Angio Detect™). Crenosoma vulpis positive samples originated from northwest, north, northeast, south and west Austria. These results confirm the very sporadic occurrence of A. vasorum in the investigated areas of the country. However, due to the substantial infectious pressure from the surrounding countries and the free circulation of dogs and foxes acting as wildlife reservoirs and due to clinical relevance for infected dogs, it is crucial to maintain disease awareness also in areas where the parasite has not yet been detected.

A grid-cell based fecal sampling scheme reveals: land-use and altitude affect prevalence rates of Angiostrongylus vasorum and other parasites of red foxes (Vulpes vulpes)

In view of the role of foxes as a reservoir for Angiostrongylus vasorum, a nematode of the heart and lungs of dogs and foxes, its occurrence across Switzerland was investigated in foxes applying a standardized sampling scheme for fox fecal samples. In 72 study areas, which consisted of three 1-km² grid cells, a total of 1481 samples were collected by walking transects following linear features in the terrain, and analyzed by a flotation-sieving method. The overall prevalence rate of A. vasorum in fecal samples was 8.8% (95% confidence interval, CI 7.4-10.3%), being significantly higher in the Swiss Plateau (11.4%, CI. 9.4-13.8%) compared with other bioregions, and more prevalent in areas with less than 50% of cultivated land (p = 0.043). Prevalence rates increased with decreasing altitudes being significantly higher below 400 m above sea level (20.6%, 95% CI 15.2-26.9%), while all samples collected above 900 m asl were negative. Eggs of Toxocara sp. (12.1%), Taeniidae (10.5%), Capillaria spp. (8.3%), Trichuris vulpis (5.5%), hookworms (5.3%), Toxascaris leonina (1.3%) and Strongyloides sp. (0.4%) were furthermore identified. Taeniid eggs were positively and Capillaria spp. negatively associated with the amount of cultivated land. The prevalence rates based on our fecal analyses were generally lower compared with previous studies from Switzerland which were based on fox necropsies. However, the grid cell-based sampling scheme with replicable transects for fox feces collection proved to be a suitable, non-invasive method for parasitic large-scale surveys providing information on the relative infectious pressure for the local dog population.

Faecal detection of the lungworms Crenosoma vulpis and Angiostrongylus vasorum and serological detection of A. vasorum in dogs from the Czech Republic

Dogs are definitive hosts for the lungworms Crenosoma vulpis and Angiostrongylus vasorum. Intermediate hosts are gasteropoda (Mollusca). In the past, lungworms in dogs were rarely identified in the Czech Republic and in neighbouring countries. A total of 253 dogs were sampled for faecal analysis performed by the Baermann method for isolation of first stage larvae (L1) of lungworms. A total of 193 serum samples were collected and analysed by ELISA for the detection of a circulating antigen and specific antibodies against A. vasorum. All dog owners were asked to fill out a questionnaire. Nine dogs (4.7%, 95% Confidence Interval, CI: 2.2–8.7%) were positive for the A. vasorum circulating antigen, seven dogs (3.6%, CI: 1.5–7.3%) had specific antibodies against A. vasorum; of these, three animals (1.6%, CI: 0.3–4.5%) were positive for both ELISAs. Most of them were under the age of three years. Only three of 13 seropositive dogs were not healthy, namely, in one dog vomitus was observed and two dogs were pyretic. Faecal samples of 5 dogs were positive for C. vulpis L1 (2.0%, CI: 0.6–4.6%). Angiostrongylus vasorum L1 were found in the faecal sample of one dog (0.4%, CI: 0.01–2.2%). This study illustrates the wide-spread occurrence of lungworms in the Czech Republic. Disease awareness of lungworms among animal owners and veterinarians should be implemented.

Geographical distribution of Angiostrongylus vasorum in foxes (Vulpes vulpes) in the Republic of Ireland

The reported incidence of the metastrongylid nematode Angiostrongylus vasorum, that infects dogs and other canids, is increasing worldwide outside recognized endemic foci. This apparent expansion of the parasite's range is causing concern to veterinary clinicians as the disease caused in dogs can be life threatening and its treatment is not straightforward. The red fox is thought to be a reservoir host for dogs. To investigate the spatial distribution of infection in foxes in Ireland, the hearts and lungs of 542 foxes from all over Ireland were examined. The incidence of infection was found to be 39·9% [95% confidence interval (CI) 35·7-44·1] with positive samples occurring in each of the country's 26 counties. This report confirms that the parasite is endemic in Ireland and the overall prevalence is the second highest in Europe. This is the first survey of A. vasorum infection in Irish foxes and highlights the potential exposure of the Irish dog population to high risk of cross-infection. Additionally, Crenosoma vulpis was found in seven of the foxes, a parasite not previously reported in the Irish fox.

Combined Serological Detection of Circulating Angiostrongylus vasorum Antigen and Parasite-specific Antibodies in Dogs from Hungary

The occurrence of the nematode Angiostrongylus vasorum, also known as the French heartworm, is increasingly being reported from various European countries. The adults of this parasite species live in the pulmonary arteries and right cardiac ventricle of wild canids and domestic dogs. Larval stages and eggs in the lungs induce inflammatory verminous pneumonia, causing severe respiratory disease in dogs. Furthermore, haematological and neurological signs and even death may occur. In Hungary, A. vasorum has been identified in red foxes, golden jackals and in two dogs and some slugs. In this first large-scale survey, 1247 sera from pet dogs were collected and tested by an ELISA for the detection of circulating antigen of A. vasorum and by a separate ELISA to detect specific antibodies against the parasite. A total of 1.36% (n = 17, 95 % confidence intervals, CI: 0.80 - 2.17 %) of the animals were positive in both ELISAs, while 1.76 % (n = 22, CI: 1.11 - 2.66 %) of the tested dogs were antigen-positive only and 2.73 % (n = 34, CI: 1.90 - 3.79 %) were positive for specific antibodies only. Regions with antigen- and antibody-positive animals overlapped and were distributed over nearly the whole sampled areas of the country. A considerable number of cases was observed in Budapest and also in the southern part of the country bordering Croatia, while in the most eastern part bordering Ukraine no positive samples were detected. These results confirm the endemic occurrence of A. vasorum in dogs originating from different parts of Hungary and the significant advantages of A. vasorum serology in epidemiological studies.

Canine angiostrongylosis: recent advances in diagnosis, prevention, and treatment

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.

Analysis of Circulating Haemocytes from Biomphalaria glabrata following Angiostrongylus vasorum Infection Using Flow Cytometry

Angiostrongylus vasorum is an emerging parasite of dogs and related to carnivores that have an indirect life cycle, with a wide range of terrestrial and aquatic gastropods as the obligatory intermediate host. Unfortunately, the relationship between A. vasorum and their snail hosts remains poorly understood. Circulating haemocytes are the main line of cellular defence involved in the destruction of helminths in snails. Aiming to further characterize the haemocyte subsets in Biomphalaria snails, we have performed a flow cytometric analysis of whole haemolymph cellular components using a multiparametric dual colour labelling procedure. Our findings demonstrated that B. glabrata infected with A. vasorum have two major circulating haemocyte subsets, referred to as small and large haemocytes. Differences in the cell proportion occurred over time. The development of better invertebrate infection control strategies would certainly result in the better control of human diseases caused by other species of the genus Angiostrongylus. Such knowledge will assist in the establishment of novel control strategies aimed at parasites that use molluscs as intermediate hosts and clarify new aspects of the parasite-host relationship regarding cell recognition and activation mechanisms, which are also found in the innate response of vertebrates.

Geographical, clinical, clinicopathological and radiographic features of canine angiostrongylosis in Irish dogs: a retrospective study

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.

Imaging diagnosis: CT findings in a dog with intracranial hemorrhage secondary to angiostrongylosis

A seven-month-old Cocker Spaniel had a cough, acute lethargy, decreased responsiveness, and episodes of hyperexcitability. There were bilateral generalized increased lung sounds, bilateral episcleral hemorrhage, and systemic hypertension. Prolonged buccal mucosal bleeding time and elevated D-dimer concentrations were detected. Radiographically, there was a generalized moderate unstructured interstitial pattern. In thoracic CT images, there was a diffuse moderate hyperattenuating appearance of the bronchial walls and interstitium and diffuse areas of moderate bronchiectasis. The brain CT images were characterized by marked hyperattenuating well-defined masses. In addition, there were smaller hyperattenuating and hypoattenuating masses scattered throughout the cerebral and cerebellar parenchyma. A zinc sulphate flotation test confirmed large numbers of Angiostrongylus vasorum L1 larvae. Despite therapy the dog continued to deteriorate and underwent euthanasia. Postmortem examination confirmed the presence of multiple intracranial and extracranial hemorrhages. Angiostrongylosis should be considered as one of the differential diagnoses in dogs presenting with neurologic signs consistent with acute intracranial haemorrhage.

Effect of temperature on activity of third-stage larvae of Angiostrongylus vasorum

To evaluate the effect of temperature on the activity and mortality of the L3 of Angiostrongylus vasorum, 1,500 L3 were isolated from experimentally infected snails and distributed into five equal groups. Three groups were incubated at 37°C, 27°C, and 5°C. The remaining two groups were incubated at 27°C and 5°C for 10 days, at which time the temperature for the 27°C group was reduced to 5°C and the 5°C group increased to 27°C. Larva activity was observed daily and inactive larvae were removed. At 37°C, larvae survived up to 8 days. At 27°C, larvae were active until day 6. When subjected to a reduction in temperature from 27°C to 5°C beginning on day 10, the number of active larvae increased until day 13. Only on day 17 did the number of active larvae decline to zero. At 5°C, larvae remained active until day 15, surviving to 24 days. When temperature was increased from 5°C to 27°C beginning on day 10, larvae were found active until day 12 and maintained an intermediate level of activity to day 21. Survival of larvae was greater at lower temperatures, while high temperatures were associated with higher mortality.

Angiostrongylus vasorum: Experimental Infection and Larval Development in Omalonyx matheroni

The susceptibility and suitability of Omalonyx matheroni as an intermediate host of Angiostrongylus vasorum and the characteristics of larval recovery and development were investigated. Mollusks were infected, and from the 3rd to the 25th day after infection, larvae were recovered from groups of 50 individuals. The first observation of L2 was on the 5th day, and the first observation of L3 was on the 10th day. From the 22nd day on, all larvae were at the L3 stadium. Larval recovery varied from 78.2% to 95.2%. We found larval development to be faster in O. matheroni than in Biomphalaria glabrata. Our findings indicate that this mollusk is highly susceptible to A. vasorum. Infective L3 were orally inoculated into a dog, and the prepatent period was 39 days. This is the first study to focus on O. matheroni as an intermediate host of A. vasorum.

Clinical, laboratory and pathological findings in dogs experimentally infected with Angiostrongylus vasorum

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.

Immune-mediated thrombocytopenia associated with angiostrongylus vasorum infection in a Jack Russell terrier

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.

Larvicidal effect of imidacloprid/moxidectin spot-on solution in dogs experimentally inoculated with Angiostrongylus vasorum

A controlled, randomized, blinded dose confirmation study was conducted to evaluate the larvicidal efficacy and safety of imidacloprid 10 mg/kg/moxidectin 2.5 mg/kg body weight spot-on solution in dogs experimentally inoculated with 200 infective third stage larvae (L3) of Angiostrongylus vasorum. Twenty-four adult dogs were randomly allocated to three study groups of 8 dogs each. Animals in group 1 were treated 4 days post-inoculation (dpi), those in group 2 at 32 dpi, and the dogs in group 3 were left untreated. All dogs were euthanized and necropsied 56-59 dpi. In order to determine the worm burdens in the arterial lung vessels a method of reverse lung perfusion with phosphate buffered solution after inhibition of coagulation with heparin was applied. In the control group, excretion of first stage larvae (L1) of A. vasorum started 47-55 dpi and all dogs excreted L1 at least on one sample day before euthanasia (0.1-32.5 larvae per gram of faeces). A mean of 99 (SD 42.8) adult parasites were recovered in the post-mortem examinations in these eight control dogs. In contrast, no L1 at all were found in the faeces of dogs of groups 1 and 2, nor were any adult parasites detected at necropsy. Respiratory symptoms were observed in dogs of groups 2 and 3. Pathological findings in the lungs correlated with the treatment groups: in the animals of group 1, no or minimal lesions were found, while in all those of group 2 dispersed patterns of pale pink, slightly raised and consolidated foci were present in all lung lobes. In contrast, the lungs of the dogs from group 3 were severely affected: large confluent areas were hardened, raised and discoloured, with frequent haemorrhagic patches. Pneumonia, thrombi and parasites were histologically confirmed. The lung lymph nodes were regularly enlarged. Hence, imidacloprid/moxidectin spot-on effectively eliminated fourth stage larvae (L4) and immature adult A. vasorum in experimentally infected dogs and prevented patent infections. The earlier an infected dog was treated, the less severe were the pathological lesions observed in the lungs.

Autochthonous Angiostrongylus vasorum infection in dogs in The Netherlands

Until recently, autochthonous infections with Angiostrongylus vasorum were not thought to occur in The Netherlands. However, in 2007 four dogs were diagnosed with angiostrongylosis. Three of them had never left the country. Subsequently, faecal samples from 485 dogs living in the same region where the positive dogs had been diagnosed in 2007 were collected through veterinarians, hunting associations and kennels between January and April 2008. A. vasorum larvae were found in faecal samples of four dogs. Three of those had never been outside the country. Though only few samples were found positive, A. vasorum is now considered autochthonous in The Netherlands.

Pathological findings in dogs naturally infected with Angiostrongylus vasorum in Newfoundland and Labrador, Canada

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.

Feline aelurostrongylosis and canine angiostrongylosis: a challenging diagnosis for two emerging verminous pneumonia infections

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.

Canine pulmonary angiostrongylosis: an update

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.

Serologic detection of Angiostrongylus vasorum infection in dogs

Angiostrongylus vasorum, French Heartworm, is a metastrongylid nematode infecting the pulmonary arteries and right heart of wild and domestic canids in various regions of the world. Infection in dogs can result in fatal cardiopulmonary disease. A single endemic focus of A. vasorum in North America occurs in the southeastern portion of Newfoundland, Canada. Dogs are currently diagnosed by detection of first-stage larvae shed in feces using the Baermann technique or fecal flotation. However, these procedures may lack sensitivity due to intermittent fecal larval shedding. The potential for using detection of circulating worm antigen for diagnosis was investigated by developing a sandwich-ELISA using rabbit anti-whole adult worm antiserum. This test detected circulating antigen in sera from 22/24 Baermann positive dogs naturally infected with A. vasorum. Negative results (0/52) were obtained from sera collected from Baermann negative dogs from outside of the endemic region, and from sera (0/30) from dogs from non-endemic regions that were infected with Crenosoma vulpis, the fox lung worm. Receiver operating curve analysis gave a specificity of 100% and a sensitivity of 92% for the sandwich-ELISA at an optical density cut-off of 0.19. Subsequently, 239 dogs from Newfoundland displaying clinical signs of cardiopulmonary disease, were examined using both the Baermann fecal examination and the sandwich-ELISA. Larvae were detected in 10% (24/239) of these dogs by fecal examination, whereas the sandwich-ELISA detected circulating antigen of A. vasorum in serum from 18.8% (45/239) of the dogs. This suggests that fecal diagnostics may have missed approximately half of the A. vasorum infected dogs, and that the sandwich-ELISA may be a useful tool in the diagnosis of this parasite.

Larval output of infected and re-infected dogs with Angiostrongylus vasorum (Baillet, 1866) Kamensky, 1905

Canine angiostrongylosis is a nematode infection in domestic dogs and wild canids. A natural infection in a domestic dog frequently leads to pneumonia, loss of physical performance, coughing, anemia, cardiac insufficiency, pulmonary fibrosis and death. The main diagnostic method is based on the finding of Angiostrongylus vasorum first-stage larvae (L1) in infected dog feces. With this objective, 11 experimentally exposed to 100 third-stage larvae (L3) per kilogram of body weight (mean = 885.45 L3/animal; S.E. = 77.7). The animals were monitored for 300 days post-single-infection (PI) and the quantity of L1 output measured. Our results showed an irregular excretion of L1 and a variation in the pre-patent period (33-76 days) and the number of L1 excreted by individual animals (1-1261 L1/g). After 300 days PI, five dogs were exposed a second time and monitored for 300 days post-re-infection (PRI) (=600 days PI). The quantity of L1 output demonstrated that double exposed dogs also presented an irregular excretion of L1 but a smaller variation in the number of L1 excreted by individual animals (4-550 L1/g).

Intracranial haemorrhage associated with Angiostrongylus vasorum infection in three dogs

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.

Angiostrongylus vasorum infection in 23 dogs (1999-2002)

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.

Ectopic location of adult worms and first-stage larvae of Angiostrongylus vasorum in an infected dog

A mongrel dog with angiostrongylosis died suddenly and was submitted to necropsy. Post-mortem findings showed adult worms in ectopic locations. This is the first report of Angiostrongylus vasorum adult worms being found within the pericardial sac and in the lumen of the bladder of an infected dog. A total of 587 A. vasorum first-stage larvae were recovered from different organs and tissues after concentration using Baermann apparatus.

Radiographic findings in 16 dogs infected with Angiostrongylus vasorum

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.

Reversible pulmonary hypertension presenting simultaneously with an atrial septal defect and angiostrongylosis in a dog

A one-year-old female neutered beagle was presented with marked abdominal effusion. Echocardiography showed marked dilatation of the right cardiac chambers, an atrial septal defect and severe tricuspid insufficiency. Systolic pulmonary arterial pressure (sPAP), evaluated by continuous wave Doppler echocardiography, was very high (80 mmHg), with a right to left interatrial shunt. The radiographic images were compatible with widespread pneumonitis. Numerous larvae of Angiostrongylus vasorum were visible on direct faecal examination. The animal was given fenbendazole for 15 days, combined with diuretics, an antibiotic and a vasodilator. Two weeks later, the dog showed a marked improvement. The treatment, except the anthelmintic, was continued for seven weeks and then stopped. At that stage, Doppler echocardiography revealed that the sPAP had returned to normal (20 mmHg) and the interatrial shunt had reversed (left to right). Eighteen months later, clinical and Doppler echocardiographic examinations were normal.

Clinical signs, diagnosis and treatment of three dogs with angiostrongylosis in Ireland

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.

Angiostrongylus vasorumandCrenosoma vulpisin red foxes (Vulpes vulpes) in Newfoundland, Canada

Angiostrongylus vasorum and Crenosoma vulpis infect the pulmonary arteries and airways, respectively, of red foxes (Vulpes vulpes). Both are widespread in Europe, but within North America, A. vasorum occurs only on the island of Newfoundland. During 2000–2002, 366 red fox carcasses were examined from six regions of Newfoundland for the purpose of determining the distribution of both parasites, effects on the condition of their host, and whether infection with one affects that of the other. Crenosoma vulpis occurred island-wide with a prevalence of 87% and mean (±SE) intensity of 230 ± 20.8. Young-of-the-year red foxes had more C. vulpis (260 ± 39.4) than yearlings (91 ± 31.2) or adults (78 ± 41.1) (χ2= 25.72, df = 2, p < 0.001), and numbers of adult worm were weakly related to fecal output of first-stage larvae (r2= 0.20, p < 0.001) but not to host sex or body-fat index. Angiostrongylus vasorum occurred only in southeast Newfoundland where prevalence was 56% and mean intensity was 72 ± 7.6. Its distribution may be limited by cold, as it was absent from areas with mean winter temperatures below –4 °C. Intensity of adult A. vasorum was not related to host age, sex, larval output, or measures of body condition. Although referred to as a heartworm, 88% of adult worms were actually found in the pulmonary arteries rather than in the right ventricle. Furthermore, there was no apparent association between infections with the two parasites (Gc[1]= 0.10) even though 40% of red foxes had dual infections.

Hematological and coagulation profiles in dogs experimentally infected with Angiostrongylus vasorum (Baillet, 1866)

Hematological and coagulation profiles were studied in crossbred dogs experimentally infected with Angiostrongylus vasorum. Two groups of five dogs were experimentally inoculated with 50 and 100 third stage infective larvae (L(3)) of A. vasorum per kilogram of body weight. A third group of five uninfected animals was used as control. One sample of 10 ml of blood was collected from each animal on the 10, 20, 30, and 45 days after inoculation (dai) and at 30-day intervals thereafter for the remainder of the 210-day experimental period. The blood sample was used for the complete hemogram and platelet count, as well as measurements of prothrombin time, partial thromboplastin time and factors V and VIII. Anemia was observed in infected dogs, 6 weeks after the infection. The eosinophils presented peaks in four periods after infection. Thrombocytopenia became accentuated on the 72 dai. Decreased prothrombin time activity and increased partial thromboplastin time were observed at the 6 and 9 weeks after infection and decreased of factors VIII and V activities occurred from 4 to 6 weeks after infection. It may be conclude that infection by A. vasorum in dogs may cause a discrete anemia during the acute phase which is probably regenerative. In addition, important hemostatic alterations due to the infection suggest a chronic intravascular consumption coagulopathy.

Immune-mediated thrombocytopenia associated with Angiostrongylus vasorum infection in a dog

A three-year-old weimaraner was presented with lethargy, anorexia, neck pain and a soft fluctuant swelling in the thoracic inlet. A cough had been noted previously. Clinical examination revealed tachycardia, tachypnoea, pallor and a large subcutaneous swelling, with bruising, suggestive of a haematoma in the thoracic inlet. Thoracic radiographs revealed a cranial mediastinal mass which had the ultrasonographic appearance of fluid, and there was also a marked generalised interstitial lung pattern. Routine haematology revealed severe anaemia and thrombocytopenia, although coagulation tests were within normal limits. A diagnosis of immune-mediated thrombocytopenia was however made on the basis of a positive antiplatelet antibody test and a rapid response to prednisolone therapy. Furthermore, a tentative diagnosis of Angiostrongylus vasorum infection was suggested on the basis of clinical and radiographic findings, although no lungworm larvae were identified on faecal analysis. Despite initiating treatment with fenbendazole, the dog died suddenly. Postmortem examination revealed myocarditis, thrombosing arteritis, pneumonia and chronic membranoproliferative glomerulonephritis associated with A vasorum infection.

Hypovolaemic shock after anthelmintic treatment of canine angiostrongylosis

Canine angiostrongylosis was diagnosed in a whippet with typical signs of respiratory and circulatory distress. Subclinical Angiostrongylus vasorum infections were also demonstrated in two other whippets belonging to the same owner. All three dogs were given standard anthelmintic levamisole treatment combined with corticosteroids. Two days after initiation of treatment, one of the subclinically infected dogs developed severe hypovolaemic shock that required intravenous fluid therapy and corticosteroids to save its life. The shock is believed to have been caused by an anaphylactic reaction triggered by the rapid release of a large amount of worm antigen in the blood due to the rapid death of adult worms by levamisole. Thus, dog owners should be instructed to monitor dogs undergoing levamisole treatment against A vasorum. Alternatives to levamisole treatment of canine angiostrongylosis should be considered.

Rupture of femoral artery in a dog infected with Angiostrongylus vasorum

A crossbred bitch, infected with Angiostrongylus vasorum, died on the 46th day post infection. Post mortem findings showed that the rupture of the femoral artery was the cause of death. A. vasorum was present in the femoral artery.

Role of chronic disseminated intravascular coagulation in a case of canine angiostrongylosis

A dog whose major clinical signs suggested a coagulopathy, is described. The dog had a history of bleeding episodes and had a severe regenerative anaemia. By using specific factor assays, the coagulopathy was found to be due to a consumptive intravascular process that resembled chronic disseminated intravascular coagulation. Subsequent investigations identified Angiostrongylus vasorum as the cause.

The fox (Vulpes vulpes) as a reservoir for canine angiostrongylosis in Denmark. Field survey and experimental infections

Until recently, Angiostrongylus vasorum was not considered to be an endogenous Danish parasite, since demonstration of this worm had been confined to necropsy findings in 2 dogs, both of which had visited France. During the last 2 years, however, clinical cases have been diagnosed among a considerable number of Danish dogs, none of which had ever been outside Denmark. All these cases have occurred north of Copenhagen, where an endemic focus seems to exist. In this field survey A. vasorum was found for the first time in wild Danish red foxes. Furthermore, experimental infections showed that the parasite can be transferred between foxes and dogs. Consequently, the wild fox population must be considered a potential reservoir for transfer of A. vasorum to domestic dogs.