Fluralaner as a novel treatment for sarcoptic mange in the bare-nosed wombat (Vombatus ursinus): safety, pharmacokinetics, efficacy and practicable use

Assessment of the in vitro acaricidal activity of Bravecto® (fluralaner) and a proposed orange oil-based formulation vehicle for the treatment of Sarcoptes scabiei

BACKGROUND

Sarcoptic mange is a serious animal welfare concern in bare-nosed wombats (Vombatus ursinus). Fluralaner (Bravecto®) is a novel acaricide that has recently been utilised for treating mange in wombats. The topical 'spot-on' formulation of fluralaner can limit treatment delivery options in situ, but dilution to a volume for 'pour-on' delivery is one practicable solution. This study investigated the in vitro acaricidal activity of Bravecto, a proposed essential oil-based diluent (Orange Power®), and two of its active constituents, limonene and citral, against Sarcoptes scabiei.

METHODS

Sarcoptes scabiei were sourced from experimentally infested pigs. In vitro assays were performed to determine the lethal concentration (LC50) and survival time of the mites when exposed to varying concentrations of the test solutions.

RESULTS

All compounds were highly effective at killing mites in vitro. The LC50 values of Bravecto, Orange Power, limonene and citral at 1 h were 14.61 mg/ml, 4.50%, 26.53% and 0.76%, respectively. The median survival times of mites exposed to undiluted Bravecto, Orange Power and their combination were 15, 5 and 10 min, respectively. A pilot survival assay of mites collected from a mange-affected wombat showed survival times of < 10 min when exposed to Bravecto and Orange Power and 20 min when exposed to moxidectin.

CONCLUSIONS

These results confirm the acaricidal properties of Bravecto, demonstrate acaricidal properties of Orange Power and support the potential suitability of Orange Power and its active constituents as a diluent for Bravecto. As well as killing mites via direct exposure, Orange Power could potentially enhance the topical delivery of Bravecto to wombats by increasing drug penetration in hyperkeratotic crusts. Further research evaluating the physiochemical properties and modes of action of Orange Power and its constituents as a formulation vehicle would be of value.

Crusted scabies in a rabbit model: a severe skin disease or more?

BACKGROUND

Around 200-300 million people are estimated to be affected by scabies annually worldwide. However, the mechanisms by which this disease may affect the general condition of the host are not entirely clear. The aim of the present study was to evaluate the systemic changes that may accompany crusted scabies in both treated and non-treated experimental animals.

METHODS

Male New Zealand rabbits were infected with Sarcoptes scabiei var. cuniculi and divided into the following three groups: control, ivermectin-treated, and fluralaner-treated. Several methods were used to evaluate the systemic changes, including histopathological examination of the liver, kidney, heart, and spleen, as well as the measurement of serum biochemical parameters and immunological parameters.

RESULTS

Several definite structural and functional changes at the systemic level were revealed, as evidenced by the observed histopathological changes in the tissue sections of internal organs and the highly significant increases in markers of systemic inflammation, serum procalcitonin, and oxidative stress markers. Abnormalities in the liver and renal function results, as well as in the serum lipid profile, were also noted. Additionally, a disorganized immune response was noted, evidenced by a mixed type 1 and type 2 helper T cell response. Although there was notable clinical and parasitological cure in the ivermectin-treated group, the histopathological, biochemical, and immunological markers indicated incomplete resolution. In contrast, the fluralaner-treated group exhibited a nearly complete resolution of changes in these parameters.

CONCLUSIONS

We conclude that crusted scabies is a systemic syndrome that can affect several organs besides the skin. Inflammation, oxidative stress, and possibly bacterial infections, are all implicated as underlying mechanisms of tissue damage due to the disease. We recommend that fluralaner, a promising scabicidal agent, should be studied for possible human use, and especially for control programs.

Evaluation of the scabicidal effect of a single dose of fluralaner in a rabbit model of crusted scabies

Recently, scabies was included in the WHO roadmap for neglected tropical diseases 2021-2030. Till now, ivermectin is the only available oral drug that is currently approved for treating crusted scabies in humans. Concerns regarding its efficacy and safety have prompted research efforts to find new alternatives. Our study aimed to evaluate the therapeutic effect of a single dose of fluralaner in cases of crusted scabies in comparison with that of repeated weekly high doses of ivermectin. For the in vitro study, twenty adult female mites were exposed to 50 μg/ml and 100 μg/ml ivermectin and fluralaner to evaluate their effects on mites' survival. For the in vivo study, thirty-five male crossbreed rabbits were divided into 4 groups: group I (non-infected, non-treated), group II (infected, non-treated), group III (infected and treated with ivermectin in a weekly oral dose of 0.4 mg/kg body weight/rabbit for 4 weeks, starting 8 weeks post-infection), and group IV (infected and treated with fluralaner given as a single oral dose of 25 mg/kg body weight/rabbit, starting 8 weeks post-infection). Clinical, parasitological, histopathological, and biochemical assessments were done. Clinical and parasitological assays were accomplished to all infected groups starting from day 0, then on days 2, 4, 6, 8, 10, 12, 14, 21, 28, 35, 42, 49 and 56 post-treatment, while histopathological and biochemical assessments were done at the end of the 8th week post-treatment (day 56). Our results showed that fluralaner exhibited a higher acaricidal effect on adult Sarcoptes scabiei var. cuniculi when compared with ivermectin applied in the same concentration (50 μg/ml or 100 μg/ml). Concerning the in vivo study, both clinical cure and parasitological cure were noted in both treated groups, evidenced by complete absence of all clinical signs of infestation and absence of mites in all skin scrapings. However, the ivermectin-treated group showed incomplete histopathological and biochemical resolution. Interestingly, both clinical cure and negative skin scrapings were noticed earlier in the fluralaner-treated group, with no apparent side effects. Also, no significant differences were noticed in the skin sections and serum biochemical parameters when compared with those of the negative control group. We concluded that fluralaner is a promising scabicidal agent that is recommended to be studied for possible human use, especially in control programs.

Pharmacokinetic and pharmacodynamic considerations for treating sarcoptic mange with cross-relevance to Australian wildlife

Sarcoptes scabiei is the microscopic burrowing mite responsible for sarcoptic mange, which is reported in approximately 150 mammalian species. In Australia, sarcoptic mange affects a number of native and introduced wildlife species, is particularly severe in bare-nosed wombats (Vombatus ursinus) and an emerging issue in koala and quenda. There are a variety of acaricides available for the treatment of sarcoptic mange which are generally effective in eliminating mites from humans and animals in captivity. In wild populations, effective treatment is challenging, and concerns exist regarding safety, efficacy and the potential emergence of acaricide resistance. There are risks where acaricides are used intensively or inadequately, which could adversely affect treatment success rates as well as animal welfare. While reviews on epidemiology, treatment strategies, and pathogenesis of sarcoptic mange in wildlife are available, there is currently no review evaluating the use of specific acaricides in the context of their pharmacokinetic and pharmacodynamic properties, and subsequent likelihood of emerging drug resistance, particularly for Australian wildlife. This review critically evaluates acaricides that have been utilised to treat sarcoptic mange in wildlife, including dosage forms and routes, pharmacokinetics, mode of action and efficacy. We also highlight the reports of resistance of S. scabiei to acaricides, including clinical and in vitro observations.

Pathophysiological and Pharmaceutical Considerations for Enhancing the Control of Sarcoptes scabiei in Wombats Through Improved Transdermal Drug Delivery

Sarcoptic scabiei is an invasive parasitic mite that negatively impacts wombats, causing sarcoptic mange disease, characterized by alopecia, intense pruritus, hyperkeratosis, and eventual mortality. Evidence suggests that wombats may be unable to recovery from infection without the assistance of treatments. Transdermal drug delivery is considered the most ideal route of administration for in situ treatment in free-ranging wombats, as it is non-invasive and avoids the need to capture affected individuals. Although there are effective antiparasitic drugs available, an essential challenge is adequate administration of drugs and sufficient drug retention and absorption when delivered. This review will describe the implications of sarcoptic mange on the physiology of wombats as well as discuss the most widely used antiparasitic drugs to treat S. scabiei (ivermectin, moxidectin, and fluralaner). The prospects for improved absorption of these drugs will be addressed in the context of pathophysiological and pharmaceutical considerations influencing transdermal drug delivery in wombats with sarcoptic mange.

A rapid evidence assessment of the potential risk to the environment presented by active ingredients in the UK's most commonly sold companion animal parasiticides

A number of parasiticides are commercially available as companion animal treatments to protect against parasite infestation and are sold in large volumes. These treatments are not intended to enter the wider environment but may be washed off or excreted by treated animals and have ecotoxic impacts. A systematic literature review was conducted to identify the existing evidence for the toxicity of the six most used parasiticides in the UK: imidacloprid, fipronil, fluralaner, afoxolaner, selamectin, and flumethrin. A total of 17,207 published articles were screened, with 690 included in the final evidence synthesis. All parasiticides displayed higher toxicity towards invertebrates than vertebrates, enabling their use as companion animal treatments. Extensive evidence exists of ecotoxicity for imidacloprid and fipronil, but this focuses on exposure via agricultural use and is not representative of environmental exposure that results from use in companion animal treatments, especially in urban greenspace. Little to no evidence exists for the ecotoxicity of the remaining parasiticides. Despite heavy usage, there is currently insufficient evidence to understand the environmental risk posed by these veterinary treatments and further studies are urgently needed to quantify the levels and characterise the routes of environmental exposure, as well as identifying any resulting environmental harm.

Zoonotic Episodes of Scabies: A Global Overview

Zoonotic scabies (ZS), also referred to as “pseudoscabies”, is considered a self-limiting disease with a short incubation period and transient clinical skin signs. It is commonly thought that Sarcoptes scabiei mites from animals are unable to successfully reproduce and persist on human skin; however, several ZS case reports have mentioned the persistence of symptoms and occasionally mites for weeks. The aim of this review was to collect and organize the sparse literature explicitly referring to S. scabiei zoonotic transmission, focusing on the source of the outbreak, the circumstances leading to the transmission of the parasite, the diagnosis including the identification of the Sarcoptes “strain” involved, and the applied treatments. A total of 46 articles, one conference abstract and a book were collected describing ZS cases associated with twenty animal hosts in five continents. Dogs were by far the most common source among pet owners, while diverse livestock and wildlife contributed to the caseload as an occupational disease. Genetic epidemiological studies of ZS outbreaks are still limited in number, but tools are available to fill this knowledge gap in the near future. Further research is also needed to understand the apparent heterogeneity in the morbidity, disease severity and timing of the response to treatment among people infected with different animal-derived strains.

Sarcoptic mange outbreak decimates South American wild camelid populations in San Guillermo National Park, Argentina

Sarcoptic mange epidemics can devastate wildlife populations. In 2014, mange was first detected in vicuñas (Vicugna vicugna) and guanacos (Lama guanicoe) in San Guillermo National Park (SGNP), Argentina. This study describes the temporal dynamics of the outbreak, its effects on the park's wild camelid populations between 2017-2019, and investigates the potential source of the epidemic. From May 2017 to June 2018, transect surveys indicated a sharp decrease in the density of living vicuñas and guanacos by 68% and 77%, respectively. By April 2019 no vicuñas or guanacos were recorded on transect surveys, suggesting their near-extinction in the park. Clinical signs consistent with mange (e.g., intense scratching, hyperkeratosis, alopecia) were observed in 24% of living vicuñas (n = 478) and 33% of living guanacos (n = 12) during surveys, as well as in 94% of vicuña carcasses (n = 124) and 85% of guanaco carcasses (n = 20) examined. Sarcoptes scabiei was identified as the causal agent by skin scrapings, and the cutaneous lesions were characterized by histopathology (n = 15). Genetic characterization revealed that mites recovered from seven vicuñas (n = 13) and three guanacos (n = 11) shared the same genotype, which is consistent with a single source and recent origin of the epidemic. Tracing the potential source, we identified a governmental livestock incentive program which introduced llamas (Lama glama) in areas adjacent to SGNP in 2009, some of which had alopecic scaling consistent with sarcoptic mange. Though at the time of our study no llamas with mange were available for confirmatory sampling, we hypothesize that the introduction of mange-infected llamas may have triggered the outbreak in wild camelids. This unprecedented event in SGNP had devastating effects on dominating herbivores with potentially profound cascading effects at the community and ecosystem levels.

Contrasting population manipulations reveal resource competition between two large marsupials: bare-nosed wombats and eastern grey kangaroos

Resource competition is an important interaction that can structure ecological communities, but is difficult to demonstrate in nature, and rarely demonstrated for large mammals including marsupials. We analysed 10 years of population survey data to investigate resource competition between bare-nosed wombats (Vombatus ursinus) and eastern grey kangaroos (Macropus giganteus) at two sites to assess whether resource competition is occurring. At one site, wombat abundance was reduced by increased mortality from mange disease, whereas at the other site, kangaroo abundance was reduced primarily by culling. We used the modified Lotka-Volterra competition (LVC) models to describe the mechanism of resource competition and fitted those models to the empirical data by maximum likelihood estimation. We found strong negative relationships between the abundance of wombats and kangaroos at each site, and resource competition was also mechanistically supported by the modified LVC models. The estimated competition coefficients indicate that bare-nosed wombats are a slightly superior competitor of eastern grey kangaroos than vice versa, and that intraspecific competition is almost twice as strong as interspecific competition. In addition, this study facilitated the calculation of the transmission rate associated with mange disease at one site (0.011), and the removal rate owing to culling, the introduction of a predator species, and drought at the other site (0.0006). Collectively, this research represents a rare empirical demonstration of resource competition between large mammals and contributes new insight into the ecology of two of Australia's largest grazing marsupials.