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Monheim/Belgrade, September 14, 2018 – At the 6th European Dirofilaria and Angiostrongylosis Days meeting, parasitological and clinical thought leaders addressed growing concerns around Angiostrongylus vasorum and the risk of fatality as a result of parasite-associated illness such as bleeding disorders.
About 100 experts in the field of parasitology and clinicans responsible for diagnosing and treating cases on a daily basis attended the meeting, which was held in Belgrade, Serbia, on July 5 to July 7.
It has been suggested that recent increases in reported occurrences of A. vasorum were due to a rise in practitioner awareness and the availability of new diagnostic tests. Professor Eric Morgan, Queen’s University in Belfast, addressed this, presenting data from separate fox surveys in the UK, and dog surveys in Germany. They all showed a significant increase in prevalence, from 12 positive cases in the years 2002-2006 to 426 cases from 2012-2016 (1). This was further supported by data from Switzerland which found there had been a significant increase in the prevalence of A. vasorum in fox populations since 2003. (2) In North-Eastern Switzerland for example zero-prevalence increased from under 2% in the eighties to over 60% in the current decade.
“Angiostrongylus vasorum is most definitely spreading across Europe, but many factors will determine what happens next. Definitive and intermediate host distribution, as well as climate, are contributing factors, which are unfortunately all trending in favour of the parasite. It is likely that we will continue to see an increase in distribution and prevalence; distribution in established areas is also anticipated to become less patchy,” said Professor Morgan.
The meeting provided attending practitioners with valuable hands-on experience of the latest diagnostic tests available for A. vasorum. This included a live demonstration of a Baermann test, as well as a discussion on performing and interpreting radiographs and ultrasound.
The need for better diagnostic tools and treatments for bleeding disorders, a major cause of death in A. vasorum infected dogs, was also a main point of interest, sparking lively discussions among participants. Discussions focused on exciting new research findings published in the Journal of Veterinary Internal Medicine (JVIM).
The study, presented by Professor Manuela Schnyder, University of Zurich, explored the pathomechanisms, diagnosis and treatment of angiostrongylosis associated bleeding in dogs. Professor Schnyder commented:
“While bleeding diathesis is a potentially lethal manifestation, observed in up to one-third of clinical cases of angiostrongylosis, the exact pathomechanisms involved are still unclear. Recent studies have suggested hyperfibrinolysis and hypofibrinogenemia as important factors in angiostrongylosis associated bleeding in dogs, which can be identified through rotational thromboelastometry (ROTEM) testing. The study also suggested that treatment with tranexamic acid, an antifibrinolytic drug used in human medicine, and plasma transfusions, provided a successful resolution. (3)’’
This could be an important procedure for veterinary practitioners, as the care of animals with A. vasorum-related bleeding disorders is currently a significant challenge. The study therefore identifies a potentially practicable treatment option for these animals, although further clinical trials are needed.
Despite these breakthroughs, emphasis must continue to be on routine preventative treatment to protect dogs at risk, as foxes remain a major reservoir of A. vasorum that cannot be treated or controlled. The Congress provided several clear outcomes the veterinary practitioners can apply to prevent A. vasorum spread and reduce the number of fatal cases. These included:
• Be vigilant clinically and routinely use available diagnostic tests
• Support efforts to enhance practice-based surveillance
• Educate pet owners about the parasite and their role in reducing risk
• Consider routine preventive treatment, for dogs more susceptible to eating lungworm hosts in endemic regions
To find out more about the ESDA meeting and how you can improve management of angiostrongylosis in practice, you can visit the following websites to view educational tutorials:
1) Barutzki D, Dyachenko V, Schaper R., Lungworms in Germany 2002 - 2016: Is there an increase in occurrence and geographical spread?
2) Gillis-Germitsch N., Schnyder M., The spread of Angiostrongylus vasorum in the Swiss fox population in the last 30 years.
3) Sigrist, N.E., Hofer-Inteeworn, N., Jud Schefer, R., Kuemmerle-Fraune, C., Schnyder, M., Kutter, A.P.N., 2017, Hyperfibrinolysis and hypofibrinogenemia diagnosed with rotational thromboelastometry in dogs naturally infected with Angiostrongylus vasorum. Journal of veterinary internal medicine, doi: 10.1111/jvim.14723
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