To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. ·...
Transcript of To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. ·...
![Page 1: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/1.jpg)
To Their Health: Treating Parvo, Panleukopenia and
Heartworm
Jennifer Wilcox, DVMErin Katribe, DVM, MS
![Page 2: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/2.jpg)
Outline
• Decision-making and general principles
• Parvovirus and panleukopenia
• Heartworm disease
![Page 3: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/3.jpg)
Should we treat?
• Live outcomes for treated animals
• Capacity for care for medical conditions
• Space limitations and length of stay
• Budget
• Staff to provide care
![Page 4: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/4.jpg)
Staff resources
• Staff veterinarian
• Contract veterinarian
• Outsourcing care to private practices
• Support staff– Technicians and assistants
– Trained foster caregivers
– Trained volunteers
![Page 5: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/5.jpg)
Disease prevention
• Cheaper than treatment!
• Intake
– Vaccination
– Recognize signs of contagious disease
• Sanitation and biosecurity
![Page 6: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/6.jpg)
Recent Intake/Healthy
Rabies Quarantine
URI Recovered
Sniffling
Outbreak Map in Dog Adoptions (old PACC): Adoption Floor 2016
Fomites (including US) spread disease.
![Page 7: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/7.jpg)
In what order shouldWe ALWAYS be
CLEANing?
Healthiest
SickestDistemper
Mild CIRDC
Biosecurity is CRITICAL when you start treating infectious disease.
Outbreak Map in Dog Isolation, 2016 (old PACC)
![Page 8: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/8.jpg)
Pick your favorite fomite
![Page 9: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/9.jpg)
Disease prevention
• Reduce overcrowding and stress
• Reduce length of stay
• Fast-tracking
• Reduce movement
• “All in, all out”
![Page 10: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/10.jpg)
Disease prevention
• Outbreak management– Isolate the infected
– Quarantine the exposed
– Transmission in shelter vs. prior to intake
– “Clean break”
– Ask for help!
• Prevention is also cheaper than an outbreak!
![Page 11: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/11.jpg)
Reducing costs
• Protocols for staff to increase efficiency
• Send to foster care, utilize volunteers
• Limit expensive diagnostics
• Alternatives for expensive drugs
![Page 12: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/12.jpg)
Treating parvo and panleuk in a shelter setting
![Page 13: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/13.jpg)
•Viral pathogen of canine intestinal tract: CPV-2 emerged in 1970s
•Transmitted by nose/mouth exposure to CPV+ feces
•Recognized by vomiting/diarrhea
Exposure/Infx
Day0 Day3 Day5
Replicates in blood Day 1-5
Day7 Day14
Shed in feces starting Day 4-5
Clinical signs Start Day 7-14
• DEATH by dehydration, sepsis, low blood glucose, heart damage (young pups).• Treatment is supportive care only: no antiviral therapy. Immunoglobulin tx: no benefit found.
Canine parvovirus (CPV) infection
![Page 14: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/14.jpg)
• Prevention by VACCINE. In shelter pups, start MIN 4 weeks age.- Need series as maternal antibodies wane- Consider vaccinating rejected pups/orphans earlier
• Diagnosed by ELISA SNAP test (IDEXX): Detects virus ANTIGEN.- Parvo vax contains antigen: possible False+ 5 days post vaccination
- IDEXX denies that vaccine can cause False+ on SNAP test
?
Canine parvovirus (CPV) infection (continued)
• Infx virus lasts in environment 5 mos to 1 year. UV kills.
• Disinfect with 1:32 bleach, 1:16 Rescue, “strong” Trifectant.
• Hand sanitizer? HELL, NO!
![Page 15: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/15.jpg)
• Viral PARVOVIRUS. Oldest known viral disease in cats: “feline distemper.”
• Transmitted by nose/mouth exposure to FPV+ feces; maybe aerosol. Like fomites.
• Clinical signs: acute death, fever, lethargy, vomiting, diarrhea.
• DEATH by dehydration/shock, sepsis, low blood glucose.• Treatment is supportive care. HIGH MORTALITY = 50%-80% WITH treatment, recent publication.
Feline panleukopenia virus (FPV) infection
Exposure/Infx
Day0 Day3 Day5
Replicates in blood Day2-7
Day7 Day14
Shed in feces, urine, saliva, vomitus starts Day2, then 3-6 weeks
Clinical signs Start Day 2-7 after exposure
![Page 16: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/16.jpg)
• Prevention by VACCINE. In shelter kittens, MIN 4 weeks age.- Need series as maternal antibodies wane- CAN’T vaccinate earlier due to risk of cerebellar disease (published)
and vaccine-induced dz (anecdotal)
• Diagnose by CANINE parvo ELISA SNAP test (IDEXX): Detects virus ANTIGEN.- Panleuk vax contains parvo antigen, possible False+ 14 days post vax
- Parvo tests 50%–80% accurate for panleuk
?
Feline panleuk (FPV) infection (continued)
• Infx virus lasts in environment 5 mos to 1 year. UV kills.
• Disinfect with 1:32 bleach, 1:16 Rescue, “strong” Trifectant.
• Hand sanitizer? HELL, NO!
![Page 17: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/17.jpg)
Canine parvovirus (CPV) infx: Can you recognize it?
Meatball Test
![Page 18: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/18.jpg)
Feline panleukopenia virus (FPV) infx: Can you recognize it?
Puppies puke, should kittens?
![Page 19: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/19.jpg)
What about symptomatic animals that SNAP neg?
Treat them like infx parvo/panleuk
In past 12 months: 14 pups
>20 kittens tested NEG for parvo on SNAP
![Page 20: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/20.jpg)
What about symptomatic animals with NEG SNAP tests?(continued)
![Page 21: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/21.jpg)
When is YOUR worst month for parvo?
![Page 22: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/22.jpg)
Parvo/panleuk: Treatment and costs
“Standard” treatment: BAR-QAR, good reserves, not bloody diarrheaProtocol = 3 day Colorado “outpatient” treatment
▪ Cefovecin (Convenia) 7mg/kg SQ once▪ Maropitant (Cerenia) 0.9mg/kg SQ SID x 3 days▪ Vitamin B12 SQ once▪ Syringe of Nutrical▪ SQ LRS 20ml/kg BID-TID x 3-5 days
Consumables cost for 15# = $38/pup for 3 days tx- Parvo SNAP $35 if singleton- Only test RUNT in litters to save $$
Consumables cost for 2# kitten = $12
![Page 23: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/23.jpg)
Parvo/panleuk treatment (continued)
“Aggressive” treatment:Bloody diarrhea, lethargic, poor BCS, severe dehydrationProtocol = 3 day outpatient treatments, PLUS:▪ IVC catheter▪ IV LRS ¼ shock bolus▪ IV Metronidazole 15mg/kg BID▪ IV 5% Dextrose/NaCl at 5ml/kg/hr
Cost for Ave 15# Pup = $10(Agg) + $38 (Standard) for 3 daysCost for 2# kitten = $10(Agg) + $12 (Standard) for 3 days
![Page 24: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/24.jpg)
Live outcomes: Parvo
Past 12 months: 298 parvo+ dogsEuth 15 at intake due to grave prognosis
Standard treatment (all) = 86%
Aggressive treatment survivorship = 70%-16% of pups need aggressive tx
![Page 25: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/25.jpg)
Always worry about your puppies, but DON’T ignore Vomit/Diarrhea in Adults too!
![Page 26: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/26.jpg)
Parvo ward is full, foster homes are full: Euthanize?
Harness the labor of the owner/finder!- Intake the pup(s)- Sign up the person as a foster caregiver- Teach them outpatient protocol and SEND HOME- They get preferred option to adopt after spay/neuter- 36 parvo pups “fostered” in 2018 (35 survived)
![Page 27: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/27.jpg)
Got firm poop at day #5 in pup parvo? SNAP, BATHE, S/N!
![Page 28: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/28.jpg)
Parvo: Our ONLY source of small-breed and PB puppies*
*Studies show purebred dogs more susceptible to CPV infx — in particular, Rottweiler, Doberman, Lab, staffie, husky
![Page 29: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/29.jpg)
https://youtu.be/ftRvH04zUPA
Panleuk infections in pregnant queens can result in abortion, nervous system defects, eye deformities in kittens.
Where do those adorable head-bobbing kittens come from?
![Page 30: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/30.jpg)
Panleuk: How to treat and costs
Best Friends:▪ Ampicillin 20mg/kg SQ BID▪ Metronidazole 10mg/kg PO BID▪ Cerenia 1mg/kg SID PRN▪ Probiotics▪ SQ LRS 20ml/kg BID-TID▪ If no vomit/diarrhea for 2 days, test runt
and bathe. Retest q3days until Neg▪ “Graduate” 1 week later, S/N 2 weeks
later, no cohousing for 6 weeks
Consumables = $10/2# kitten for 3 days tx- Parvo SNAP costs $35 if singleton
APA:▪ Ampicillin 10mg/kg PO BID▪ Baytril 4.4mg/kg diluted SQ SID▪ Cerenia 8mg/kg SID▪ SQ LRS 20ml/kg BID-TID▪ Force feed 1-3mls q1hr▪ If no vomit/diarrhea for 3 days, test runt
and bathe twice
Consumables = $15/2# kitten for 3 days tx- Parvo SNAP costs $35 if singleton
![Page 31: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/31.jpg)
Live outcomes: Panleuk
Best Friends: 64%
APA: 80%
PACC: Current outbreak, TBA!
![Page 32: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/32.jpg)
Can parvo and panleuk be comingled? Parvovirus = Parvovirus?
NO!▪ Recent studies in U.K. found 30% of healthy
shelter cats shed virulent canine parvovirus
▪ Rarely, virulent canine parvovirus strains cause clinical signs of panleukopenia in kittens
![Page 33: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/33.jpg)
Collateral damage from cohousing or merging litters?
Before you isolate for 2 weeks, Vaccicheck!
Positive predictive value = 94%
![Page 34: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/34.jpg)
Nervous about having contagious parvo EVERYWHERE?
Get creative, but SCARE your staff and volunteers for good compliance.
![Page 35: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/35.jpg)
Ounce of prevention?
5 off-site free clinics 2017-18, 1,100 animals received:– Vaccines and microchips– Deworm and flea, tick, mite tx– Spay/neuter vouchers
![Page 36: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/36.jpg)
Within the shelter: Only PUBLIC can cuddle puppies and kittens (without PPE)
![Page 37: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/37.jpg)
Questions?
![Page 38: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/38.jpg)
Heartworm Disease
![Page 39: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/39.jpg)
Incidence in the U.S.
![Page 40: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/40.jpg)
Prevalence in shelters
• 10 times the prevalence in owned dogs
• Reports of 10% to 50% in shelters
![Page 41: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/41.jpg)
Biology and life cycle
![Page 42: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/42.jpg)
Canine clinical signs• Cough
• Exercise intolerance
• Difficulty breathing
• Right-sided heart failure
• Caval syndrome
• Sudden, severe difficulty breathing
• Pigment in urine
• Pale gums
![Page 43: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/43.jpg)
Diagnostic screening
• ELISA testing– Detects female worms
– Antibody complexes can interfere
• Microfilaria testing – Send to lab
– Slide examination
• 6 months from infection to a positive test or microfilaria Acanthocheilonema reconditum (top)
Dirofilaria immitis (bottom)
![Page 44: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/44.jpg)
American Heartworm Society recommended treatment
• Prevention for 2 months
• Doxycycline for Wolbachia
• Melarsomine intramuscularly
– 3 injection protocol
• Steroids to reduce complications
• Activity restriction
![Page 45: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/45.jpg)
Susceptibility gap
![Page 46: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/46.jpg)
Two injection protocol
• Doxycycline, prevention• Two back-to-back melarsomine injections • Pros
– Shorter time for treatment– Expense
• Cons– Kills ~90% of worms– Cleared dogs of all worms only 50% of the time– More complications
![Page 47: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/47.jpg)
Slow-kill• Prevention and doxycycline only
• Pro: Less expense
• Cons– Takes months to years to clear worms
• Activity restriction
• Ongoing damage to heart and lungs
– Transmission during treatment
– Increased resistance to preventives?
– More complications
![Page 48: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/48.jpg)
Prevention
• Monthly oral and topical, every 6 month injectable options
• Oral ivermectin
• Lack of efficacy– Compliance
– Resistance
• AHS recommends year-round
![Page 49: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/49.jpg)
Feline heartworm disease
• Clinical signs– Cough, difficulty breathing (like asthma)– Weight loss– Vomiting– Collapse– Sudden death
• No melarsomine!• Don’t test in shelters
![Page 50: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/50.jpg)
Challenges and solutions for heartworm disease management
![Page 51: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/51.jpg)
Length of stay
• Extended LOS before, during, after treatment
• Activity restriction
• Behavioral decline and welfare
• Solutions– Foster
– Treatment AFTER adoption
– Transport prior to treatment
– 2 injection protocol
![Page 52: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/52.jpg)
Expense
Prevention
• Reduce transmission
• Commercial products
– Cost for large dog: $3-$5/month
• Solutions
– Shelter discount: $1.61/month
– Ivermectin• Toxicity risk
• “White feet, don’t treat”
![Page 53: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/53.jpg)
Expense
Treatment• 50-pound dog with AHS-
recommended protocol: ~$250• Required diagnostics?• Solutions
– Consider alternative treatment options• Based on individual animal risk
– Informed adoption with waiver– Skip diagnostics
![Page 54: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/54.jpg)
Informed adoption• Provide adopters with full disclosure
• Adoption waiver
• Heartworm Resource Task Force brochures
• Encourage them to consult with their vet
![Page 55: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/55.jpg)
“Adult heartworms are a grave risk to our canine patients. The longer they remain in an animal, the
greater the damage to the cardiopulmonary system and the greater the risk of illness and death. It is probable that treating in the absence of
diagnostics, while not ideal, is better than refusing to perform a needed treatment.”
– American Heartworm Society, 2018
![Page 56: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/56.jpg)
Treatment failure
• Wait six months (or more) to retest
• Shelters usually don’t recognize
• Reasons for failure:
– Retesting too soon
– Susceptibility gap
– Two injection or slow kill protocols
![Page 57: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/57.jpg)
Transport
• Not all states allow positive dogs
• AHS guidelines
![Page 58: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/58.jpg)
![Page 59: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/59.jpg)
Complications
• Reaction to treatment
– Monitor for the day
• Labored breathing
– Due to clots in the lungs or inflammation
– Rare with activity restriction
• Plan ahead
![Page 60: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/60.jpg)
Elective surgery?
Asymptomatic or mild disease: Proceed with surgery
Moderate or severe disease: Treat and recover prior to surgery
![Page 61: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/61.jpg)
What do real shelters do?
• Most give prevention
– Ivermectin use is common
• About half tested only some dogs
• 85% treated at least some dogs
– Treatment varied
![Page 62: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/62.jpg)
Summary
• Incidence is increasing
• Significant challenge for shelters
• Share resources and minimize spread with safe transport
• Focus on LIFESAVING!
![Page 63: To Their Health: Treating Parvo, Panleukopenia and Heartworm To their... · 2019. 8. 23. · “Standard” treatment: BAR-QAR, good reserves, not bloody diarrhea Protocol = 3 day](https://reader033.fdocuments.in/reader033/viewer/2022051822/5fec6f31f6d5e171695c34b6/html5/thumbnails/63.jpg)