Lungworm disease in cats: ABCD guidelines on prevention and management

Comparative analysis of diagnostic methods and risk factors for Aelurostrongylus abstrusus infection in brazilian cats

This study aimed to prospectively evaluate the risk factors of infection by Aelurostrongylus abstrusus in Brazilian cats with cough and/or radiographic changes, using as diagnostic tools the Baermann method (BM), polymerase chain reaction (PCR) of feces, bronchoalveolar lavage fluid (BALF), and cytology. Forty-three cats that were presented with cough or lung radiographic abnormalities compatible with bronchoalveolar disease were included in the study. After clinical evaluation, feces samples were collected to investigate lungworm parasitism through BM and PCR. BALF was performed to provide samples for cytology, bacteriology, and fungal culture. Stool PCR was considered the gold standard for diagnosis tests, and the other methods were evaluated by their agreement. PCR presented 74% (32/43) of positivity for A. abstrusus, while in the BM, 41% (18/43) were positive. BM showed sensitivity of 56.25% and specificity of 100% when compared with PCR. No larva was found in the cytological evaluation of 21 BALF samples. Lungworm is an important cause of bronchopulmonary disease in domestic cats in Brazil and should be included as a differential diagnosis when a cat is presented with cough or radiographic abnormalities. BM is a sensitive, non-invasive, and cheap technique to diagnose the disease, but it is not as sensitive as PCR.

Metastrongyloid Infection with Aelurostrongylus abstrusus, Troglostrongylus brevior, Oslerus rostratus and Angiostrongylus chabaudi in Feral Cats from the Canary Islands (Spain)

Lungworms are a major cause of feline respiratory disease, frequently underdiagnosed due to its presentation of symptoms being similar to that of other feline respiratory pathologies. Epidemiological data about these nematodes are scarce in the Canary Islands (Spain). Given the veterinary importance of these parasites, the aim of the present study was to improve the current epidemiological knowledge of the lungworm species that could be affecting feral cats in this archipelago. A total of 29 feral cats from La Gomera were analyzed. The respiratory tract of each animal was inspected and the nematodes obtained were identified by morphological keys and molecular techniques. Metastrongylids were detected to be widely distributed throughout the island with a prevalence of 55.2% (16/29). The species Aelurostrongylus abstrusus, Troglostrongylus brevior, Oslerus rostratus and Angiostrongylus chabaudi were identified. Also, coinfections with A. chabaudi and O. rostratus were detected in two animals. The present study shows a high diversity of lungworms in feral cats in La Gomera, with the first report of A. chabaudi and T. brevior for the Canary Archipelago and the first citation of A. chabaudi in cats for Spain. The wide distribution and high prevalence found in this study indicate a high risk of exposure to pulmonary infections in cats.

Case Report: Notoedric Mange and Aelurostrongylidosis in Two Domestic Cats From Rural Environment in Romania

This article describes two cases of notoedric mange concurrent with aelurostrongylidosis in two domestic-owned cats from a rural environment in Romania. Two European shorthair cats originating from the same litter were referred to our clinic, at 2 months apart, with a history of skin lesions, pruritus, weight loss, and respiratory signs. Cats lived mainly outdoor together with the queen and a third littermate. The latter two expressed the same clinical signs and had died before the presentation of the first cat. None of the four cats was vaccinated, dewormed, or treated for external parasites. Coat brushing, skin scrapings, skin cytology, earwax direct microscopic examination, and coproparasitological techniques (flotation and Baermann methods) were used as laboratory procedures. A blood sample was also collected for hematology, blood biochemistry, and feline immunodeficiency virus/feline leukemia virus (FIV/FeLV) test. Notoedres cati mites in high numbers were identified by all complementary tests, alongside fleas and Aelurostrongylus abstrusus first-stage larvae. The blood analysis revealed neutrophilia, and the FIV/FeLV fast test was negative. The cats were successfully treated off-label with selamectin spot-on formulation (Stronghold^®, Zoetis) three times at 1- or 4-week intervals. Furthermore, they were treated with amoxicillin trihydrate/clavulanic acid, housed indoor, and fed with a commercial diet. Before presentation to the clinic, the female cat was unsuccessfully treated with a combination of fipronil, S-methoprene, eprinomectin, and praziquantel. During this period, the female cat remained outdoor and fed with home wastes. The cats become negative for A. abstrusus L1 larvae after 2–4 months of treatment. The owners developed pruritic skin lesions 1 month after introducing the first cat in the house. In conclusion, notoedric mange and aelurostrongylidosis can be treated successfully with selamectin as a spot-on formulation and the treatment must be continued until no parasite will be detected through specific techniques. The success of treatment depends on improving the quality of animal life (nutrition and hygiene) and treatment of secondary complications.

Efficacy of a spot-on combination containing 10% w/v imidacloprid and 1% w/v moxidectin for the treatment of troglostrongylosis in experimentally infected cats

Background

Parasitic bronchopneumonia in domestic cats in Europe, which can manifest with moderate to severe clinical signs, is frequently caused by Troglostrongylus brevior. Data on epizootiological and clinical relevance of cat troglostrongylosis have been published in the last decade but treatment options are still limited. Promising effectiveness data have been generated from clinical cases and field trials for a spot-on formulation containing 1% w/v moxidectin and 10% w/v imidacloprid (Advocate^®, Elanco Animal Health). Therefore, two studies have been conducted to confirm under experimental conditions the efficacy of moxidectin 1% contained in Advocate^® for the treatment of cat troglostrongylosis.

Methods

Sixteen and 20 cats experimentally infected with T. brevior were included in two separate studies, i.e., Study 1 and 2, respectively. Cats were infected with T. brevior third-stage larvae via gastric tube. In both studies cats were randomized to untreated (control, Group 1) and treatment (Group 2) groups. In Study 1 and Study 2, the two groups comprised eight and 10 cats each. Treated cats received Advocate^® spot-on twice at a 4-week interval. The primary efficacy criterion was the number of viable adult T. brevior counted at necropsy. Throughout the trial, the fecal shedding of first-stage larvae (L1) was assessed in treated and untreated control cats.

Results

The experimental model was successful in both studies, as all cats started shedding T. brevior L1 within 25 days post-infection. At necropsy, T. brevior adults were found in 4/8 and 4/10 cats of the control groups in Study 1 and 2, respectively, while none of the treated cats harbored adult worms. The necropsy worm counts in controls did not meet relevant guideline requirements for adequacy of infection, with fewer than six infected cats in the control groups, thus limiting conclusions on treatment efficacy. The fact that 6/8 and 8/10 control cats in Study 1 and 2, respectively, shed L1 up to necropsy while larval shedding ceased in all treated animals after the first treatment provides supporting evidence on the level of efficacy. No remarkable adverse events were recorded in the two studies.

Conclusion

These results indicate that Advocate^® spot-on is a safe and effective option for treating cats infected by T. brevior.

Graphical Abstract

Drug-Induced Liver Injury in a Patient with Nonsmall Cell Lung Cancer after the Self-Administration of Fenbendazole Based on Social Media Information

Fenbendazole is a benzimidazole anthelmintic agent, with a broad antiparasitic range in animals such as dogs and pigs. The agent is also reported to exert antitumor effects and inhibit microtubule-associated tubulin polymerization, but its safety and tolerability profile in humans remains unclear. An 80-year-old female patient with advanced nonsmall cell lung cancer (NSCLC) was started on pembrolizumab monotherapy. The patient experienced severe liver injury 9 months later. An interview with her and her family revealed that she had been taking fenbendazole for a month, solely based on social media reports suggesting its effectiveness against cancer. After discontinuation of the self-administration of fenbendazole, the patient's liver dysfunction spontaneously resolved. The antitumor inhibitory effects of fenbendazole have been reported; however, she did not experience tumor shrinkage. This is the first case report of a patient with advanced NSCLC who self-administered the anthelmintic, fenbendazole. Twitter and Facebook are online social media platforms which have been constructively used to exchange information among cancer patients. However, sources of medical information on these platforms are often unproven, and it is difficult for nonmedical professionals to accurately select and filter complex medical information. Physicians should enquire patients about self-administration of orally ingested products, including dietary supplements, herbs, or bioactive compounds, in cases of unexpected adverse reactions.

Efficacy of Bravecto® Plus spot-on solution for cats (280 mg/ml fluralaner and 14 mg/ml moxidectin) for the prevention of aelurostrongylosis in experimentally infected cats

Background

The feline lungworm Aelurostrongylus abstrusus affects the lower respiratory tract in cats worldwide. As infections may lead to chronic respiratory changes or even death, preventive treatment in cats with outdoor access is warranted.

Methods

The preventive efficacy of a spot-on solution (Bravecto® Plus spot-on solution for cats, MSD) against cat aelurostrongylosis was evaluated using three different preventive treatment regimes in a negative controlled, randomized and partially blinded laboratory efficacy study with 31 purposed-bred cats. The minimum recommended dose of 2.0 mg moxidectin + 40 mg fluralaner/kg bodyweight was applied once 12 (Group [G]1), 8 (G2) or 4 (G3) weeks before experimental infection with 300 third-stage larvae (L3) of A. abstrusus. Another group served as untreated control (G4). Individual faecal samples were analysed as of day 30 post infection (pi) to monitor larvae excretion. Necropsy was performed at days 47–50 pi. The lungs were examined macroscopically for pathological findings and (pre-)adult worms were counted to assess preventive efficacy.

Results

Beginning at day 32–40 pi, all cats of the control group were constantly shedding larvae of A. abstrusus, whereas only one animal of G1 excreted larvae at several consecutive days. In addition, two cats of G1 and G3 and three of G2 were positive on a single occasion. The geometric mean (GM) of the maximum number of excreted larvae was 7574.29 in the control group compared to 1.10 (G1), 1.19 (G2) and 0.53 (G3), resulting in a GM reduction of > 99.9% in all treatment groups. All lungs of the control animals showed severe or very severe alterations at necropsy, while in 94.44% of the treated cats lung pathology was rated as absent or mild. The GM number of (pre-)adult A. abstrusus retrieved from the lungs was 26.57 in the control group, 0.09 in G1 and 0.00 in G2 and G3. Thus, GM worm count reduction was 99.66% in G1 and 100% in G2 and G3.

Conclusions

A single application of Bravecto® Plus spot-on solution at a dose of 2.0 mg moxidectin + 40 mg fluralaner/kg bodyweight reliably prevents cat aelurostrongylosis for at least 12 weeks.

Clinical Case of Life-threatening Co-infection Due to Dirofilaria Immitis and Aelurostrongylus Abstrusus in a Cat: First Report of Feline Heartworm Disease in Bulgaria

The present report describes the first clinically manifested and serologically proven case of Dirofilaria immitis infection in a cat in Bulgaria. A 10-year-old intact male cat was referred to the Small Animal Clinic, Trakia University with a history of anorexia, weight loss, intermittent coughing and itching skin lesions on the head and neck. Physical examination revealed abnormal heart sounds and respiration, cyanosis of the mucous membranes, and generalized enlargement of the lymph nodes. Mild infestation with hard ticks and fleas was also detected during the initial skin inspection. In addition, adult Otodectes cynotis mites were observed in the skin lesions. The fecal sample was positive for larvae of Aelurostrongylus abstrusus and eggs of Toxocara cati. Blood serology revealed antigens of D. immitis as well as antibodies against both feline immunodeficiency virus and D. immitis. Thoracic radiographic findings included a pronounced generalized reticular interstitial pattern; alveolar and bronchial shades with multiple nodular thickenings throughout the lungs. Electrocardiography demonstrated a sinus tachycardia, a peaked P-wave (P-pulmonale) and an abnormally low ST-segment. The clinical signs disappeared after treatment with selamectin, doxycycline and corticosteroids. Despite the improvement in general health condition, the cat suddenly died several months later.

Dirofilarioses in cats: European guidelines from the ABCD on prevention and management

OVERVIEW

Dirofilaria immitis and Dirofilaria repens are the most important filarial worms, causing heartworm disease and subcutaneous dirofilariosis, respectively. D repens is currently considered an emerging zoonotic agent in Europe.

LIFE CYCLE AND INFECTION

Filarial worms infect mainly dogs, but also cats, ferrets, wild carnivores and humans. The life cycle involves an intermediate mosquito host. Compared with dogs, cats are imperfect hosts for dirofilarial worms. After inoculation, only a low number of L3 larvae develop to the adult stage in a small percentage of cats. Heartworm disease in cats may be associated with severe pulmonary thromboembolism and an eosinophilic inflammatory response in the lungs, potentially leading to sudden death. Otherwise self-cure occurs in most cases after 18-48 months. Subcutaneous dirofilariosis may present as subcutaneous nodules or dermatitis.

DIAGNOSIS AND TREATMENT

Diagnosis in cats is more difficult compared with dogs and needs a multistep approach (antigen and antibody tests, as well as diagnostic imaging). Cats with acute heartworm disease require stabilisation within an intensive care unit. Cats with respiratory signs or suggestive radiographic changes should receive prednisolone and follow-up with a similar multistep approach. Adulticidal therapy is not safe in cats.

PREVENTION

In endemic areas cats should receive year-round chemoprophylaxis from 2 months of age.

Troglostrongylus brevior is the dominant lungworm infecting feral cats in Jerusalem

Feline lungworms infect the respiratory tract of wild and domestic cats, causing infection often associated with clinical disease. Until recently, Aelurostrongylus abstrusus has been considered the most relevant species of lungworm, while Troglostrongylus brevior was considered of less significance. Fecal samples of feral cats from Jerusalem, Israel, collected over a year, were examined for first stage lungworm larvae (L1) using the Baermann method. Positive samples were morphologically identified, and their species identity was molecularly confirmed. Forty of 400 (10.0%) cats were lungworm-positive, of which 38/40 (95.0%) shed Troglostrongylus brevior and 6/40 (15.0%) shed Aelurostrongylus abstrusus. Four cats (10.0%) had mixed infections with both lungworm species. L1 shedding was associated with clinical respiratory signs in 11 (19.0%) T. brevior shedding cats of a total of 58 cats manifesting respiratory signs, while 23/342 (6.7%) cats without respiratory signs were L1-positive (p = 0.006). Non-respiratory clinical signs were also found to be more prevalent in L1 shedders (p = 0.012). A young kitten ≤ 4 weeks of age shed T. brevior L1 larvae. DNA sequences of both lungworm species using the ribosomal internal transcribed spacer 2 (ITS2) locus were > 99% similar to other sequences deposited in GenBank, suggesting that T. brevior and A. abstrusus ITS2 sequences are both highly conserved. In conclusion, L1 shedding in feral cats from Jerusalem were mostly caused by T. brevior with only a small proportion involving A. abstrusus, different from many studies from other geographical regions.

Efficacy of imidacloprid 10%/moxidectin 1% spot-on formulation (Advocate®) in the prevention and treatment of feline aelurostrongylosis

Background

In three randomized, controlled laboratory efficacy studies, the efficacy in the prevention of patent infections of a topical combination of imidacloprid 10%/moxidectin 1% (Advocate® spot-on formulation for cats, Bayer Animal Health GmbH) against larval stages and immature adults of Aelurostrongylus abstrusus, as well as the treatment efficacy of a single or three monthly treatments against adult A. abstrusus, were evaluated.

Methods

Cats were experimentally inoculated with 300–800 third-stage larvae (L3). Each group comprised 8 animals and the treatment dose was 10 mg/kg bodyweight (bw) imidacloprid and 1 mg/kg bw moxidectin in each study. Prevention of the establishment of patent infections was evaluated by two treatments at a monthly interval at three different time points before and after challenge infection. Curative efficacy was tested by one or three treatments after the onset of patency. Worm counts at necropsy were used for efficacy calculations.

Results

In Study 1, the control group had a geometric mean (GM) of 28.8 adult nematodes and the single treatment group had a GM of 3.4 (efficacy 88.3%). In Study 2, the control group had a GM of 14.3, the prevention group had a GM of 0 (efficacy 100%), while the treatment group had a GM of 0.1 (efficacy 99.4%). In Study 3, the GM worm burden in the control group was 32.6 compared to 0 in all three prevention groups (efficacy 100% for all of those groups).

Conclusions

The monthly administration of Advocate® reliably eliminated early larval stages and thereby prevented lung damage from and patent infections with A. abstrusus in cats. Regarding treatment, a single application of Advocate® reduced the worm burden, but it did not sufficiently clear the infection. In contrast, three monthly treatments were safe and highly efficacious against A. abstrusus.

Molecular Survey of Metastrongyloid Lungworms in Domestic Cats (Felis silvestris catus) from Romania: A Retrospective Study (2008-2011)

Background: Lungworms are recognized as important agents in the pathology of the respiratory system in domestic cats. While Aelurostrongylus abstrusus is worldwide known and studied, Troglostrongylus brevior has gained the attention of the scientific community only in the last decade. The pathogenicity of this species seems to be higher than A. abstrusus, causing more severe clinical presentations and being potentially fatal, especially in young animals. Methods: In this study, 371 DNA isolates of faecal samples were tested by multiplex polymerase chain reaction for the presence of A. abstrusus, T. brevior, and Angiostrongylus chabaudi. Results: The results showed that 30.2% and 6.7% of the investigated domestic cats were positive for A. abstrusus and T. brevior respectively, stressing out the importance of these parasites as agents of respiratory conditions in domestic cats from Romania. None of the samples were positive for A. chabaudi. The age, the outdoor access, and the lack of deworming were identified as significant risk factors for infection with A. abstrusus. Conclusions: This paper represents the first report of T. brevior in domestic cats from Romania. Moreover, it presents the most northern localization in Europe of T. brevior.

Survey of lungworm infection of domestic cats in Hungary

From 61 settlements of 12 Hungarian counties, 303 domestic cats were included in this survey. Between autumn 2016 and spring 2018, fresh faecal samples were randomly collected and examined by flotation and by the Baermann-Wetzel method for the presence of lungworm infection. No eggs of Eucoleus aerophilus were detected. Morphological identification of first instar larvae (L1) was also carried out. In the faeces of 60 cats (19.8%) from 17 settlements and Budapest, L1 of Aelurostrongylus abstrusus were found. More than half of the cats were from the western part of the country. The average number of larvae per gram of faeces was 190.2 ± 304.88. These results are in line with the former findings on the prevalence of aelurostrongylosis of domestic cats in Hungary. In addition, Oslerus rostratus was also found for the first time in the faecal samples of three cats from the eastern part of the country, infected also with Ae. abstrusus. The average age (2.51 ± 1.26 years) of infected cats indicates that lungworm infection is more common among younger cats. No relationship was found between the lung-worm infection and the sex of cats. Non-neutered cats had a significantly higher proportion of lungworm infections. Two-thirds of the infected cats were apparently healthy, and only 19 individuals showed clinical signs of respiratory disorders.

First molecular identification of Aelurostrongylus abstrusus in a cat presenting severe respiratory disease from Israel

Feline lung worm infection is increasingly reported in recent years, and recognized as a cause for respiratory disease in cats. Aelurostrongylus abstrusus is regarded as the most prevalent cause of such cases. Infective L3 larvae carried in gastropods and paratenic hosts infect felines, developing to adult worms that reside in the lungs' parenchyma and may cause verminous pneumonia. The L1 larvae hatch from eggs deposited in the lung, and are released to the environment by either feces or sputum. While the majority of epidemiological information regarding A. abstrusus originates in European countries, recent studies have shown that it is also found around the Mediterranean basin, as far east as Turkey and Cyprus. A local domestic cat from Israel showing signs of respiratory illness was diagnosed with aelurostrongylosis, confirmed by both morphological and molecular tools. Presence in Israel of this nematode was previously reported in 1949, with no further mentions since. ITS-2 sequence of the isolated larvae was highly similar to that of A. abstrusus from domestic cats from Italy. These findings show that distribution of A. abstrusus stretch to the eastern shores of the Mediterranean, and that this nematode should be considered as a cause for respiratory disease in cats in Israel and the surrounding countries.

Shedding of feline lungworm larvae and their infectivity to snail intermediate hosts after anthelmintic treatment

Aelurostrongylus abstrusus and Troglostrongylus brevior are snail-transmitted helminths causing respiratory diseases in infected cats. The shedding of feline lungworm L1s and their infectivity to the snail intermediate host, after administration of anthelminthic products to cats, are poorly documented. To assess the efficacy of 8.3% fipronil, 10% (S)-methoprene, 0.4% eprinomectin and 8.3% praziquantel (i.e. eprinomectin formulation) and 10% imidacloprid/1% moxidectin (i.e. moxidectin formulation) against these nematodes and to determine the number of days post-treatment until viable L1s are released in the faeces, 384 animals were screened by faecal examination. Of the 54 positive animals (i.e., 14.1%; 7.3% A. abstrusus, 6.2% T. brevior and 0.5% coinfected), 36 were randomly allocated to four groups. Groups A and B were composed of cats positive for T. brevior and treated with the eprinomectin and with the moxidectin formulations, respectively, whereas cats in groups C and D were positive to A. abstrusus and treated with the eprinomectin and the moxidectin formulations, respectively. Prior to and every day after treatment, faecal samples were analysed by the Baermann technique and the number of larvae per gram of faeces determined, and again four weeks after treatment, to assess the efficacy of a single administration of the products. In addition, to evaluate the pre- and post-treatment infectivity of L1s to snail intermediate hosts, one/two snails per cat were infected with 100 L1s collected from the faeces of enrolled animals and then digested 28 days p.i. Based on L1s faecal counts, the efficacy of the eprinomectin and the moxidectin formulations at 28 days was 100% for both A. abstrusus and T. brevior, with a mean number of days of 7.9 ± 1.2 in group A, 7.8 ± 1.9 in B, 6.9 ± 1.6 in C and 8.9 ± 2.0 in D to become negative. Following the artificial digestion, active L3s of T. brevior and A. abstrusus were found in 160 (87.4%) experimentally infected snails. The results of this study demonstrate that a single administration of the two formulations is effective in the treatment of A. abstrusus and T. brevior infections and that during the post-treatment period live L1s are shed for up to 8.9 ± 2.0 days. L1s of both lungworm species released in the faeces after drug administration are still able to reach the infective larval stage in the infected snails. Hence, preventative measures after the treatment of infected animals should include keeping cats indoors and disposal of their faeces for approximately 10 days to avoid environmental contamination and infection of gastropod intermediate hosts.

Developing practical recommendations for preventative healthcare consultations involving dogs and cats using a Delphi technique

Preventive healthcare is the focus of a large proportion of UK small animal veterinary consultations. The evidence base for how to optimise these consultations is limited. Therefore, evidence-based practical recommendations are needed for veterinary surgeons conducting these consultations. The aim of this study was to use an evidence-based methodology to develop the first consensus recommendations to improve dog and cat preventative healthcare consultations (PHCs).

Evidence from multiple sources was systematically examined to generate a list of 18 recommendations. Veterinary surgeons and pet owners with extensive experience of PHCs were recruited to an anonymous panel to obtain consensus on whether these recommendations would improve PHCs. A Delphi technique was followed during three rounds of online questionnaire, with consensus set at 80 per cent agreement or disagreement with each recommendation. Thirteen of the original 18 recommendations reached consensus (>80per cent agreement), while the five remaining recommendations did not reach consensus.

Globally, these are the first evidence-based recommendations developed specifically in relation to small animal general practice PHCs, generated via a Delphi panel including both veterinary surgeons and pet owners. Future work is needed to understand how these recommendations can be implemented in a range of veterinary practice settings.

Prevalence of feline lungworm Aelurostrongylus abstrusus in England

Infection of cats with lungworm Aelurostrongylus abstrusus has recently been documented in the UK. Here, we aimed to study the prevalence of A. abstrusus in fecal samples from cats across England. A total of 950 fecal samples were collected from cats together with information on their age, breed, gender, geographic region, lifestyle, and treatment history. A total of 17 (1.7%) cats were positive for A. abstrusus based on species-specific morphological features of the larvae isolated by Baermann's technique. There was no statistically significant difference in the proportion of positive samples between females (506; 53.2%) and males (444; 46.7%). Multiple regression analysis showed that prevalence of feline lungworm was significantly different across geographic regions: in comparison with East Midlands, some regions had shown significantly increased odds of A. abstrusus-positive samples (South East [odds ratio [OR] = 7.68; 95% confidence interval [CI] = 1.70 to 32.76; p = .01]; West Midlands [OR = 6.20; 95% CI = 1.21 to 26.84; p = .02]), while other regions had also increased odds although not statistically significant (Greater London [OR = 9.63; 95% CI = 0.43 to 84.05; p = .07]; North West [OR = 4.25; 95% CI = 0.59 to 20.89; p = .09]; South West [OR = 2.48; 95% CI = 0.12 to 17.64; p = .43]; and North East [OR = 1.88; 95% CI = 0.10 to 12.24; p = .57]). Keeping cats inside was protective against the risk of infection compared with those having outdoor access (OR = 0.09; 95% CI = 0.01 to 0.48; p = .02). On the other hand, age, breed, gender and deworming history did not have any significant effect on the likelihood of infection. Our data indicate that A. abstrusus is a parasite of potential significance in cats, in particular those from certain geographic regions in England. To reduce the spread of this parasite, an integrated feline lungworm control program needs to be implemented.

Feline Troglostrongylosis: Current Epizootiology, Clinical Features, and Therapeutic Options

Parasitic bronchopneumonia plays an important role in feline respiratory medicine, thus it is receiving growing attention by researchers and practitioners. In recent years, Troglostrongylus brevior, a lungworm usually infecting wild felids, has been recognized as an agent of the lower respiratory tract in domestic cats. In particular, as a likely consequence of a spill-over from wild reservoirs (e.g., the European wildcat), T. brevior infection is increasingly reported in cats from Mediterranean and Balkan countries. This parasitic nematode has an indirect life cycle, and its biology overlaps that of the better known "cat lungworm" Aelurostrongylus abstrusus. In fact, cases of co-infections caused by both lungworms are not infrequent in domestic cats. Knowledge on clinical features of troglostrongylosis is still incomplete. Available data indicates that clinical signs and radiographic evidence are severe especially in kittens and young cats, are non-specific and often overlap with those of other feline respiratory diseases, such as feline bronchial disease/asthma, or infectious pneumonia. These characteristics make a definitive diagnosis of troglostrongylosis challenging, this disease requires a timely ancillary therapy and an appropriate anthelminthic treatment. As feline troglostrongylosis is an emerging parasitic disease of domestic cats, it should be included in differential diagnosis for lower respiratory tract disease in cats from regions where this parasite is present but also where it is unexpected. This article reviews current knowledge on the pathogenic role of T. brevior in domestic cats and resulting respiratory illness, with a special focus on clinical aspects, diagnosis, and management of the disease.

Troglostrongylus brevior: a feline lungworm of paediatric concern

The immature immune system of cats in their paediatric age (i.e., first six months of life) favours the establishment of infectious respiratory tract diseases mainly caused by well recognized viruses and bacteria species. Conversely, lungworm infections are less investigated during respiratory disorders in kittens. In the last decade, Troglostrongylus brevior has been found affecting the respiratory tract of cats, along with the better-known Aelurostrongylus abstrusus. Given the scant data available on the epidemiology of feline troglostrongylosis, faecal samples from 575 domestic animals living in three Italian municipalities (i.e., Bari, Messina and Siena) were screened for lungworm infection by Baermann and molecular tecniques. Animals were grouped according to their age as ≤6 months (i.e., paediatric patients), 6-24 months, or >24 months. Paediatric cats were further sub-divided in infant (2-6 weeks), weanling (6-12 weeks) and juvenile (3-6 months). Of the 575 animals tested, 241 (42.0%) were younger than 6 months, 188 (33%) were 6-24-month-old and 146 (25%) were older than 24 months. Lungworm infection was diagnosed in 84 (14.6%) of the examined cats. Of the 49 (20.3%) paediatric animals positive for lungworms, T. brevior was the nematode species most frequently diagnosed (n = 44; 89.8%), followed by A. abstrusus (n = 2; 4.1%), and three cats (6.1%) were co-infected by both species. The diagnosis of T. brevior infection was significantly associated with animals aging ≤6 months (18.2%; P < 0.01) than elder cats. Indeed, the prevalence of infection by T. brevior decreased in animals aging 6-24 months (3.2%) being not detected in cats older than two years. Results of this study indicate that paediatric cats are at higher risk of T. brevior infection compared to adults (P < 0.01).

Fatal aelurostrongylosis in a kitten in Serbia

This paper describes a case of aelurostrongylosis in a four-month old female domestic cat (Felis catus) from South Banat, Serbia. The kitten that had died suddenly without signs of illness was autopsied in the Veterinary Specialised Institute "Pančevo". The macroscopic finding was typical of granulomatous pneumonia and subsequently, histopathology revealed verminous pneumonia. Based on the parasite morphology, it was confirmed that the lung lesions were caused by Aelurostrongylus abstrusus. The present finding contributes to the knowledge of the prevalence of this underestimated parasite in the Balkan Peninsula.

Case report: Severe and progressive bronchopneumonia by Aelurostrongylus abstrusus in an adopted stray cat from Portugal

The cat lungworm Aelurostrongylus abstrusus is the most common respiratory parasite of cats. This nematode has a worldwide distribution and is considered an emerging pathogen. Respiratory signs overlap with those of other pathologies, and some agents which co-exist in the same animal may concur in the clinical scenario. Nonetheless, feline verminous bronchopneumonia is underestimated by practitioners and is not commonly included in differential diagnosis in routine practice. The present report describes the clinical presentation of a 6-month old stray cat from central Portugal, which developed respiratory distress. A clinical improvement of lower respiratory signs was achieved after a course of doxycycline and prednisolone course. However, a relapse with a progressive decline in the respiratory functions occurred two weeks later. A further investigation led to the identification of an A. abstrusus infection that was treated with fenbendazole. Ten days after the treatment the cat became negative for A. abstrusus and further analyses performed in the followings 2 months showed improvement of the animal's pulmonary condition and negative results at the faecal examinations. These findings indicate that veterinarians should include aelurostrongylosis in the differential diagnosis of feline respiratory distress even in non-endemic regions and should perform appropriate diagnostics procedures in the presence of compatible signs.

Respiratory distress associated with lungworm infection in a kitten

CASE SUMMARY

A 5-month-old feral kitten developed worsening respiratory signs, including tachypnea, coughing and wheezing after standard anthelmintic treatment with fenbendazole at a local shelter. The kitten was referred to the University of California, Davis, William R Pritchard Veterinary Medicine Teaching Hospital for further evaluation. Thoracic radiographs revealed a severe diffuse bronchointerstitial pattern with bronchial cuffing, ill-defined nodules and lymphadenomegaly. Differentials included infectious etiologies such as toxoplasmosis, feline infectious peritonitis and cryptococcosis. Parasitic infection was considered less likely, owing to previous anthelmintic treatment. Bronchoalveolar lavage revealed marked neutrophilic and eosinophilic inflammation, and parasitic larvae were observed in a swab of trachea mucus. PCR confirmed the larvae as Aelurostrongylus abstrusus. The kitten recovered with two more rounds of anthelmintic treatment.

RELEVANCE AND NOVEL INFORMATION

Parasitic pneumonia should be considered as a cause of respiratory distress in kittens and cats. Lungworm infections have been more commonly reported in free-roaming young and adult cats, but cannot be excluded as a differential diagnosis in cats from varied environments and in kittens. Kittens appear to be especially sensitive to lungworm infections, manifested by the development of more severe clinical signs; thus lungworm infection should always be considered when presented with a kitten in respiratory distress. In the absence of cytologic confirmation of infection via bronchoalveolar lavage or oropharyngeal swab, PCR provides a valuable means for identification of lungworms, such as A abstrusus and Troglostrongylus brevior.

Updates on feline aelurostrongylosis and research priorities for the next decade

Feline aelurostrongylosis, caused by the metastrongyloid nematode Aelurostrongylus abstrusus, is an important gastropod-borne parasitic lung disease in cats. Infection with A. abstrusus is widespread globally, but the increasing awareness of this parasite and the advent of more sensitive diagnostics have contributed to the apparent increase in its prevalence and geographic expansion. Clinical features may range in severity from subclinical to life-threatening respiratory disease. Parasitological standard techniques, such as visualization of the nematode first larval stage in faecal and respiratory (bronchial mucus or pleural fluid) samples, remain the mainstays of diagnosis. However, diagnosis is evolving with recent advances in serological and molecular testing, which can improve the time to initiation of effective anthelmintic therapy. Despite numerous anthelmintics that are now available as treatment options, the role of host immunity and lifestyle factors in selecting cats that may benefit from more targeted anthelmintic prophylaxis or treatment practice remains unclear and is likely to guide therapeutic choices as newer data become available. This review summarizes the biology, epidemiology, pathophysiology, diagnosis and treatment options currently available for feline aelurostrongylosis.

Aelurostrongylus abstrusus in wild felids of South Africa

The increasing interest on respiratory nematodes of domestic cats (Felis silvestris catus) has recently stimulated several studies on their epidemiology and geographic distribution. At the same time, there are still important gaps in our knowledge of the infections caused by respiratory nematodes in wild felids. The present study investigated the occurrence of pulmonary parasites in wild hosts housed in sanctuaries and protected areas of South Africa. Faecal samples collected from seven species of wild felids living in three study sites were copromicroscopically and genetically examined. Of twenty-one samples six, i.e. three from caracals (Caracal caracal), two from lions (Panthera leo) and one from a serval (Leptailurus serval), scored positive for the metastrongyloid Aelurostrongylus abstrusus at copromicroscopic and/or molecular tests. No other lungworms were recorded. The occurrence of the cosmopolitan cat lungworm A. abstrusus in wild hosts has been so far questioned. Importantly, the present findings represent an unequivocal evidence of the capability of A. abstrusus to infect some species of wild felids. Further studies are warranted to understand the epidemiological patterns of lungworms in wild and domestic felids, and to better investigate the impact of these parasitoses on health and welfare of wild animals.