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EPISCLERAL ONCHOCERCIASIS IN 19 DOGS
JM DREYFUS DVMRR DUBIELZIG DVM, DIPL. ACVP
COMPARATIVE OCULAR PATHOLOGY LAB OF WISCONSINUNIVERSITY OF WISCONSIN, SCHOOL OF VETERINARY MEDICINE
PURPOSE: RETROSPECTIVE STUDY OF 19 DOGS
To describe diagnostic histologicappearance
To describe regional and breed distribution
To characterize clinical signs and response to therapy
Provide a forum to share clinical experiences
METHODSDatabase search of 26,861 clinical submissions
Identification of 19 cases with definitive or likely onchocerciasis
Review of histologic slides
Review of submission records
Survey of submitting ophthalmologists: 15/19 returned either records and/or completed surveys
Contact with referring veterinarians when possible
CLINICAL PRESENTATIONChronic inflammatory lesions unresponsive to antibiotics and steroid therapy
Symptoms of 3 weeks to 1 year, average 4 months
17/19 cases: single or multiple masses in the conjunctiva, limbal or retrobulbar episclera
ALL clinical photos, courtesy of Dr. Anastasia Komnenou. School of Veterinary Medicine, Aristotle University of Thessaloniki,Greece
CLINICAL PRESENTATION
Non-specific symptoms: painful swollen eye, corneal edema, keratitis, chemosis, conjunctival swelling with mucus discharge.
+/- Parasites seen clinically:
Vermiform, stringy tissue
Parasites seen at surgery and submitted in biopsy jar.
Parasite in conjunctivalnecrosis.
HISTOLOGIC FEATURES
6 globes, 12 tissue nodules, 1 worm
Nodular tissue sections from 2 mm to 2 cm
HISTOLOGIC FEATURES
14 cases, with definitive Onchocerca spdiagnosis
Morphologic features: low, rounded, circumferential external ridges and internal striae.
Thelazia sp do not have external ridges
PRESUMPTIVE DIAGNOSES 5 CASES
Eosinophilic Granulomatousinflammation in perioculartissues Geographic location Clinician interpretation
Quiet globe beyond nodules
Greater inflammatory response to dead worms
Spendore-Hoeppli
PATENT INFECTIONS
7 of 19 contain gravid adult femalesL3 infective stage
Live microfilaria in paired uteri
SUBCLINICAL CASESEnucleation for other reasons
Parasites found incidentally
Minimal inflammation
Other subclinical cases in endemic regions?
THE LIFE OF THE DOGS
Signalment12 males and 7 femalesAverage 5 years (range, 1-11)8 OS, 5OD, 4OU, 2 unknown
Heartworm Prophylaxis?13 responses1 dog on therapy
Hobbies:Contact with other animals: ostriches, goats, horses, deer, cows, other dogsBeen to several rodeos
Herding dogs: 9/19Outdoor lifestyle?
Ivermectinavoidance?
RECENT PHENOMENON
Cases diagnosed by year18/19 after 2004
TIGHT GEOGRAPHIC DISTRIBUTION
Previous reports
Diagnosed by other labs
COPLOW cases
GREEK DIAGNOSIS AND TREATMENT
Diagnosis: acute and chronic formsClinical signs
• Microfilaria in skin • Circulating eosinophilia (40%)
Day 1:Surgical excision of cysts/nodulesOral prednisone Systemic doxycycline*
Days 9 and 10:Melarsomine, adulticideIntense pruritus and conjunctivalswelling
Day 30Ivermectin, microfilaricide
Day 1
Day 15
Day 30
RESPONSE TO THERAPY in US:
Treatment details from 12/19
Variations on Greek protocol
2 dogs with repeat excisions
No news is good news?
Don’t return to ophthalmologist
No reports of pruritus and edema
Shock-like symptoms following melarsomine treatment
SPECIATION IN US DOGS UNCLEARPARASITOLOGY MORE ADVANCED IN EUROPE
2000: Eberhart ML. Experimental infection of common domestic Onchocerca sp.
15 month follow-upMonthly ocular and skin snip examsFull post-mortem examNo clinical signs, microfilaria or adults found
Onchocerca lupi : proposed species name in Europe
Doxycycline kills wolbachia, a rickettsial endosymbiont of Onchocerca
Doxycycline and ivermectin may act synergistically to kill adult Dirofilaria immitis
NEXT STEPS TO STUDY SPECIATION AND LIFE CYCLE
Presence of microfilaria in skin?
Bank tissues for molecular work
Skin snip procedure: 1mm circular skin snips from canthus, ears, umbilicus Float in saline, watch for microfilaria Save microfilaria, skin, and or nodules in 30-50% alcohol for up to 1 year
ACKNOWLEDGEMENTSCOPLOW Lab: Dick Dubielzig, Kate Lieber, Scott Earnest, Leandro Teixeira, Mitzi Zarfoss
Anastasia Komnenou. Clinic of Surgery, Veterinary Teaching Hospital, School of Veterinary Medicine, Aristotle University ofThessaloniki, Greece
Contributing clinicians: Jeanette da Silva Curiel, Lisa Felchle, Robert Gwin, Nicole MacLaren, Brian Marchione, Kristiane Schmidt, Bruce Silverman ,Barbara Steele, Jennifer Urbanz, Dean Vestre
Mark Eberhard, CDC
John McCall, Professor Emeritus, University of Georgia
QUESTIONS?COMMENTS?
DOXYCYCLINE THERAPYMcCall JW, Genchi C, Kramer L, Guerrero J, Dzimianski MT, Supakorndej P, Mansour AM, McCall SD, Supakorndej N, Grandi G, Carson B. Heartworm and Wolbachia: therapeutic implications. Vet Parasitol. 2008 Dec 10;158(3):204-14.
Experimental heartworm infections treated with combinations of ivermectin, doxycycline, and melarsomine.
93% reduction of adult worm burden with all three. 78% reduction with Ivermectin and Doxycycline alone.
o Enucleation: 6
o Surgical debridement: 12
o Ivermectin, oral, injectible or both: 6
o Melarsomine (Immiticide®) IM x 2, 1 month after dx: 5
o Doxycycline: 2
o Pyrantel Pamoate (presumably w/ Ivermectin in HeartGuard+): 2
o Steroids: 4 prednisone, 1 intralesional Depo-Medrol
o Cryoablation: 2
AVAILABLE TREATMENT DETAILS IN COPLOW DOGS (12/19)
2000: Eberhard ML, Ortega Y, Dial S, Schiller CA, Sears AW, Greiner E. Ocular Onchocercainfections in two dogs in western United States. Vet Parasitology. 2000Jul 4;90(4):333-8.
Transmission of infectious stage of Onchocercavolvulus (human origin), Onchocerca linealis (cattle origin), Onchocerca cervicalis (horse origin).
REFERENCES
McCall JW, Genchi C, Kramer L, Guerrero J, Dzimianski MT, Supakorndej P, Mansour AM, McCall SD, Supakorndej N, Grandi G, Carson B. Heartworm and Wolbachia: therapeutic implications. Vet Parasitol. 2008 Dec 10;158(3):204-14.Sréter T, Széll Z. Onchocercosis: a newly recognized disease in dogs. VetParasitol. 2008 Jan 25;151(1):1-13. Sréter-Lancz Z, Széll Z, Sréter T. Molecular genetic comparison of Onchocerca sp. infecting dogs in Europe with other spirurid nematodes including Onchocercalienalis. Vet Parasitol. 2007 Sep 30;148(3-4):365-70. Gionfriddo JR, Mangan B, Wilkerson G, Powell CC, Friedman D, Ehrhart EJ. A challengin case: A dog with Ocular masses. Veterinary Medicine. 2005 Aug: 570-576.Hermosilla C, Hetzel U, Bausch M, Grübl J, Bauer C. First autochthonous caseof canine ocular onchocercosis in Germany. Vet Rec. 2005 Apr 2;156(14):450-2.Zarfoss MK, Dubielzig RR, Eberhard ML, Schmidt KS. Canine ocularonchocerciasis in the United States: two new cases and a review of theliterature. Vet Ophthalmol. 2005 Jan-Feb;8(1):51-7. Komnenou A. "Canine Ocular Onchocercosis." The World Small Animal Conference , Rhodos Greece, October 2004.Komnenou A, Egyed Z, Sréter T, Eberhard ML. Canine onchocercosis in Greece:report of further 20 cases and molecular characterization of the parasite and itsWolbachia endosymbiont. Vet Parasitol. 2003 Dec 1;118(1-2):151-5. Egyed Z, Sréter T, Széll Z, Nyiro G, Márialigeti K, Varga I. Molecularphylogenetic analysis of Onchocerca lupi and its Wolbachia endosymbiont. VetParasitol. 2002 Sep 10;108(2):153-61. Sréter T, Széll Z, Egyed Z, Varga I. Ocular onchocercosis in dogs: a review.Vet Rec. 2002 Aug 10;151(6):176-80.Sréter T, Széll Z, Egyed Z, Varga I. Subconjunctival zoonotic onchocerciasisin man: aberrant infection with Onchocerca lupi? Ann Trop Med Parasitol. 2002Jul;96(5):497-502. Review. Komnenou A, Eberhard ML, Kaldrymidou E, Tsalie E, Dessiris A. Subconjunctival filariasis due to Onchocerca sp. in dogs: report of 23 cases in Greece. VetOphthalmol. 2002 Jun;5(2):119-26. Egyed Z, Sréter T, Z. Széll, G. Nyir , M. Dobos-Kovács, K. Márialigeti, I. Varga. Electron microscopic and molecular identification of Wolbachiaendosymbionts from Onchocerca lupi: implications for therapy. Veterinary Parasitology, Volume 106, Issue 1, 30 May 2002, Pages 75-82Egyed Z, Sréter T, Széll Z, Beszteri B, Oravecz O, Márialigeti K, Varga I.Morphologic and genetic characterization of Onchocerca lupi infecting dogs. VetParasitol. 2001 Dec 28;102(4):309-19. Széll Z, Sréter T, Erdélyi I, Varga I. Ocular onchocercosis in dogs: aberrantinfection in an accidental host or lupi onchocercosis? Vet Parasitol. 2001 Nov5;101(2):115-25. Széll Z, Erdélyi I, Sréter T, Albert M, Varga I. Canine ocular onchocercosis in Hungary. Vet Parasitol. 2001 Jun 12;97(3):243-9. Eberhard ML, Ortega Y, Dial S, Schiller CA, Sears AW, Greiner E. OcularOnchocerca infections in two dogs in western United States. Vet Parasitol. 2000Jul 4;90(4):333-8. Hall LR, Pearlman E. Pathogenesis of Onchocercal Keratitis (River Blindness). Clinical Microbiology Reviews, July 1999, p. 445-453.Gardiner CH, Dick EJ Jr, Meininger AC, Lozano-Alarcón F, Jackson P.Onchocerciasis in two dogs. J Am Vet Med Assoc. 1993 Sep 15;203(6):828-30. Orihel TC, Ash LR, Holshuh HJ, Santenelli S. Onchocerciasis in a California dog. Am J Trop Med Hyg. 1991 May;44(5):513-7.
TIGHT GEOGRAPHIC DISTRIBUTION
COPLOW Cases
SURVEY QUESTIONS:
Duration of symptoms before and after diagnosisAny adverse reactions to therapy?Heartworm prophylaxis?Any other clinical signs of onchocerciasis?Lifestyle: outdoor, indoor/outdoor, indoor, hunting, swimming, hiking, etc…