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Iranian Journal of Veterinary Science and Technology

Vol. 3, No. 1, 2011, 49-56 IJVST

Dirofilaria immitis infection in a Dachshund dog:


Diagnosis and Treatment

Mohammad Hossein Razi Jalali1*, Bahman Mosallanejad2, Reza Avizeh2


1
Departments of Pathobiology, Faculty of Veterinary Medicine, Shahid Chamran University of Ahvaz, Ahvaz, Iran
2
Department of Clinical Sciences, Faculty of Veterinary Medicine, Shahid Chamran University of Ahvaz, Ahvaz, Iran

Received: July 10, 2011 Accepted: October 11, 2011

Abstract
Dirofilaria immitis is a filariid worm which typically lives as adult in the right ventricle of
the heart and the pulmonary arteries of the dog, causing the canine heartworm disease.
Therapy of canine dirofilariosis due to Dirofilaria immitis is indicated for dogs suffering
from clinical signs of the disease (such as chronic cough). The present paper describes
diagnostic and treatment features of a D. immitis affected dog in Ahvaz district, Southwest of
Iran. The dog had coughing, tachypnea, labored breathing, panting, hind limb edema,
weakness, and exercise intolerance, at the time of referral. Auscultation revealed grade III/VI
systolic murmur over the left apex of the heart. Giemsa stained blood smears containing
microfilaria was morphologically identified as D. immitis. CBC revealed an inflammatory
leukogram and mild anemia. Combined therapy with ivermectin (440 μg/kg as single dose),
levamisol (10 mg/kg q 24 h for 10 days) and aspirin (10 mg/kg q 12 h for 10 days), during 2
stages, was effective. The number of microfilaria dropped from 1250±50/ml blood pre-
treatment to 150±10/ml (following the first treatment stage, after 10 days) and reached 0 a day
after the second treatment. The animal remained negative regarding D. immitis microfilaremia
during a follow-up period of 180 days. This record confirms the efficacy of ivermectin with
levamisol and aspirin in the treatment of adult heartworm infection in a dog.

Keywords: Dirofilaria immitis, Dog, Ivermectin, Levamisol, Aspirin

*Corresponding author: Mohammad Hossein Razi Jalali


Email: mhjalali243@yahoo.com

Iranian Journal of Veterinary Science and Technology, Vol. 3, No. 1


50 Razi Jalali M. H., et al.

Introduction glucocorticosteroid (prednisolone 2 mg/kg


s.i.d. for four or five days) given at
Heartworm disease is caused by Dirofilaria diminishing rate can control pulmonary
immitis, a parasitic worm that lives as adult in inflammation and thromboembolism. Diuretics
the right side of the dog's heart and large blood (furosemide 1 mg/kg b.i.d.) are useful to
vessels leading to the lungs. Heartworms can reduce fluid effusions caused by right
cause serious cardiopulmonary disease in their congestive heart failure. Digoxin may be
hosts. Canine heartworm has become administered only to control atrial fibrillation.
widespread in many parts of the world, and its The organical arsenical melarsomine
range continues to expand. Wildlife reservoirs dihydocloride is the only available compound
play a role in perpetuation and transmission of to be used in the adulticide heartworm therapy
this parasite to dogs (Greene, 2006, Lee et al., in dogs. Two intramuscular injections of 2.5
2010). Although adult Dirofilaria immitis mg/kg 24 h apart is the standard regimen
affects dogs, cats, foxes and other wild (Greene, 2006). In fact, one administration of
mammal, larvae have been reported melarsomine at dose of 2.5 mg/kg kills about
sporadically in humans from various parts of 90% of male worms and 10% of female worms
the world. Most infected dogs do not show any resulting therefore in 50% reduction of the
symptoms of the disease for a long time, worm burden (Di Sacco and Vezzoni, 1992,
months or years (Dillon et al., 1995). Signs of Vezzoni et al., 1992). It is now known that
the disease develop gradually and may begin macrocyclic lactones have evidence of
with a chronic cough. Sudden death rarely resistance in D. immitis (Bourguinat et al.,
occurs and usually it happens following 2011). Spontaneous pneumothorax has been
respiratory distress (Venco, 2004). Cases of reported in a dog secondary to D. immitis
ocular dirofilariosis due to D. immitis have infection (Oliveira et al., 2010). Experimental
been previously recorded in Australia, the studies have shown ivermectin to have partial
United States and Europe (Dantas-Torres et adulticidal properties when used continuously
al., 2009). Diagnosis of heartworm infection for at least 16 months at preventative doses (6-
can be made in dogs by blood test detecting 12 mcg/kg/month) and 100% adulticidal
circulating microfilaria or adult antigens but efficacy if administered continuously for over
further diagnostic procedures are usually 30 months (McCall et al., 2001, Venco et al.,
required to determine the severity of disease 2004). To the authors’ knowledge, a few
and the best treatment (Knight, 1995). Tests published reports have described treatment and
designed to detect heartworm adult antigens clinical management of canine D. immitis
based on ELISA or colloidal gold staining infection. This paper describes diagnostic and
techniques are considered highly specific and treatment features of a naturally infection of D.
cross reactivity with other dog's parasites (i.e. immitis, in Ahvaz district, Southwest of Iran.
D. repens, Dipetalonema sp.) does not occur
(Greene, 2006, Schnyder et al., 2011). It has
been said that the treatment of heartworm Case history
infection is difficult. Symptomatic therapy A 7.5-year-old female spayed Dachshund
includes drugs and measures that can improve was referred to the Veterinary Hospital in
cardiopulmonary circulation and lung Ahvaz, Southwest of Iran. On physical
inflation. Restriction of exercise and, in examination, the dog showed coughing,
selected cases, cage rest seems to be the most tachypnea, labored breathing, panting, hind
important measure to improve limb edema, weakness, and exercise
cardiopulmonary circulation and to reduce intolerance. Respiratory rate was increased of
pulmonary hypertension (Dillon et al., 1995). 46 breaths/min and a normal heart rate of 108
Anti-inflammatory doses of beats/min. Auscultation revealed grade III/VI

Iranian Journal of Veterinary Science and Technology, Vol. 3, No. 1


Dirofilaria immitis infection in a Dachshund dog 51

systolic murmur over the left apex of the heart. Results


Blood sample was examined after Microscopical examination of the blood
concentration (Knott test) for the presence of smear revealed microfilaremia with a filarial
microfilaria. A microfilarial count was species. Giemsa stained blood smears was
performed from venous blood in EDTA for morphologically identified as D. immitis. A
five times. The blood was mixed in the tube modified Knott’s test was used for detection of
for 5 min by placing on a tube roller, in order microfilaria (Fig. 1). Serology for D. immitis
to allow equal dispersion of the microfilaria. antigen (Anigen Rapid D. immitis Ag Test Kit)
Thin blood smears were made from 3 μl of showed positive reaction (Fig. 2). The number
blood measured by a micropippete. Smears of microfilaria dropped from 1250±50/ml
were stained with Giemsa. The serum sample blood pre-treatment to 150±10/ml (following
was separated in vacuum blood tubes by the first treatment, after 10 days) and reached
centrifugation at 1000 rpm for 5 min. Serum 0, one day after the second treatment. A
was examined with a commercial Rapid D. modified Knott’s test was negative 24 h post
immitis Ag Test kit (Cat No: RB21-03) by the second treatment when the dog was
Immunochromatography assay (ICA) discharged from hospital. No microfilaria was
(Manufactured by Anigen, Animal genetics, found in blood. The dog remained negative for
Inc., Korea). This kit is a chromatographic D. immitis microfilaremia during a follow-up
immunoassay for the qualitative detection of period of 180 days. Prothrombin time and an
D. immitis antigen in whole blood, plasma or activated partial thromboplastin time were
serum. Sensitivity and specificity of these kits within reference range. Six months after the
were 95.8 and 99.7%, respectively (according initial treatment, the dog was admitted again.
to the manufacturer’s instructions). Treatment A repeated microfilaria count and modified
of the edema was initiated with 2 mg/kg of Knott’s test were negative. Thoracic
furosemide and 1 mg/kg of prednisone once a radiograph was normal. There was no
day. Ultrasonographic examination of the heart evidence of D. immitis worms in related
and abdomen and an electrocardiogram (ECG) organs. No abnormalities were detected on
were performed. Combined therapy with complete blood count, serum biochemistry
ivermectin (440 microgram/kg as single dose), panel, thoracic radiographs, abdominal
levamisol (10 mg/kg q 24 h for 10 days) and ultrasound and electrocardiogram (Fig. 3).
aspirin (10 mg/kg q 12 h for 10 days) were
performed in the Dachshund dog. Prothrombin
time (PT) and an activated partial
thromboplastin time (APTT) were evaluated
for a possible coagulopathy.
The Anigen Rapid D. immitis Ag test kits
were used in the present study. Interpretation
of test results is at 5-10 min. If a color band
appears in the left section of the result
window, it means that the test is working
properly. This is the control band. If another
colored band is appeared in the right section of
the result window, it would be the test band.
The presence of two colored bands (T and C)
indicates a positive result within the result
window (according to the manufacturer’s
Figure1: Microfilaria of Dirofilaria immitis by Knott test
instructions).

Iranian Journal of Veterinary Science and Technology, Vol. 3, No. 1


52 Razi Jalali M. H., et al.

cardiopulmonary compromise and the severity


of heartworm disease. The affected dog was
more out door, and was thereby exposed to
infectious agents. Therapy of canine
dirofilariosis is important in order to decrease
the risk of infection of other dogs and humans.
Anaphylactoid reaction has been reported in a
heartworm-infected dog undergoing lung
lobectomy (Carter et al., 2011). Previous
reports of treatment and clinical management
Figure2: Heartworm kit (positive immunochromatography of D. immitis infections are few. It was
assay) suggested that doxycycline could impaire D.
immitis transmission due to the reduction of
microfilaria and also endosymbiotic bacteria in
the larvae turning them incapable of
completing development once they infect a
new host (Rossi et al., 2010). Treatment with
ivermectin (6 μg/kg PO weekly) combined
Figure3: Electrocardiogram of the affected dog heart
with doxycycline (10 mg/kg/day orally from
Weeks 0-6, 10-12, 16-18, 22-26 and 28-34)
Discussion resulted in a significantly faster decrease of
The present record confirmed the efficacy circulating microfilaria and higher adulticidal
of ivermectin with levamisol and aspirin in the activity compared with either ivermectin or
treatment of adult heartworm infection in a doxycycline alone (Bazzocchi et al., 2008).
dog. It may be supposed that adult D. immitis The covered-rod silicone implant containing
was killed based because no further 7.3 mg of ivermectin was 100% effective in
microfilaria were seen up to 6 months after the preventing experimental infection with D.
end of the treatment. Disease severity is immitis larvae and had been resulted in
classified on the basis of clinical signs, history, negative results for heartworm antigen
findings at physical examination, results of (Cunningham et al., 2006). Oral
laboratory tests, and evaluation of radiographs. diethylcarbamazine at 5.5 mg/kg daily for 1
Four classes of heartworm disease have been month was used in Nigeria (Kamalu, 1991).
established: subclinical or mildly clinical Melarsomine (2.5 mg/kg) followed later by
disease (class 1); moderate disease (class 2); ivermectin (50 μg/kg) were used for treatment
severe disease (class 3); and caval syndrome, a of a dog in Italy (Tarello, 2002). An
very severe form of the disease (class 4). The ivermectin/pyrantel chewable formulation was
treatment protocol in this study followed the found to be beneficial in the prevention of D.
producer’s recommendations for therapy of repens infection (Pollono et al., 1998). Otranto
moderate (class 2) heartworm disease. It is et al., (2010) demonstrated that imidaclopride
difficult to define the clinical signs that should 10% and permethrin 50% preventive treatment
be attributed to D. immitis in this dog. against arthropods protects autochthonous and
Coughing, dyspnea and limb edema found naive beagle dogs against canine vector-borne
before the anti-filarial treatment recurred pathogens. It was suggested that a combination
several weeks after treatment. The of doxycycline (10 mg/kg/sid for 30 days) and
restlessness, respiratory distress and other ivermectin-pyrantel (6g/kg of ivermectin
clinical signs were not observed in our case. +5mg/kg of pyrantel every 15 days for 180
Thoracic radiography and electrocardiogram days) was adulticide in dogs with D. immitis.
were done to characterize the degree of Of 7 dogs that were positive for visualization

Iranian Journal of Veterinary Science and Technology, Vol. 3, No. 1


Dirofilaria immitis infection in a Dachshund dog 53

of parasites at echocardiography, 6 (85.7%) shown to be effective in clearing of D. immitis


became negative by day 300. Treatment was infection in dogs.
well-tolerated by all dogs (Grandi et al., 2010).
Microfilaricidal effects of plant extracts (the Acknowledgement
aqueous extracts of Zingiber officinale) We would like to mention the greatly
against Dirofilaria immitis has been suggested appreciation to Research Council of Shahid
also (Merawin et al., 2010). Imidacloprid plus Chamran University of Ahvaz for the financial
moxidectin topical solution were effective for support.
the prevention of heartworm disease in dogs
(Arther et al., 2005). References
In the present case, therapy of ivermectin
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moxidectin topical solution for the
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Iranian Journal of Veterinary Science and Technology, Vol. 3, No. 1


‫‪Iranian Journal of Veterinary Science and Technology‬‬
‫‪Vol. 3, No. 1, 2011, 49-56‬‬ ‫‪IJVST‬‬

‫ﻋﻔﻮﻧﺖ ﻧﺎﺷﻲ از دﻳﺮوﻓﻴﻼرﻳﺎ اﻳﻤﻴﺘﻴﺲ در ﻳﻚ ﻗﻼده ﺳﮓ داﺷﻬﻮﻧﺪ‪:‬‬

‫ﺗﺸﺨﻴﺺ و درﻣﺎن‬

‫‪2‬‬
‫ﻣﺤﻤﺪ ﺣﺴﻴﻦ راﺿﻲ ﺟﻼﻟﻲ‪ ،*1‬ﺑﻬﻤﻦ ﻣﺼﻠﻲ ﻧﮋاد‪ ،2‬رﺿﺎ آوﻳﺰه‬

‫‪ 1‬ﮔﺮوه ﭘﺎﺗﻮﺑﻴﻮﻟﻮژي‪ ،‬داﻧﺸﻜﺪه داﻣﭙﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه ﺷﻬﻴﺪ ﭼﻤﺮان اﻫﻮاز‪ ،‬اﻫﻮاز‪ ،‬اﻳﺮان‬
‫‪ 2‬ﮔﺮوه ﻋﻠﻮم درﻣﺎﻧﮕﺎﻫﻲ‪ ،‬داﻧﺸﻜﺪه داﻣﭙﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه ﺷﻬﻴﺪ ﭼﻤﺮان اﻫﻮاز‪ ،‬اﻫﻮاز‪ ،‬اﻳﺮان‬

‫ﭘﺬﻳﺮش ﻧﻬﺎﻳﻲ‪90/7/19 :‬‬ ‫درﻳﺎﻓﺖ ﻣﻘﺎﻟﻪ‪90/4/19:‬‬

‫ﭼﻜﻴﺪه‬
‫دﻳﺮوﻓﻴﻼرﻳﺎ اﻳﻤﻴﺘﻴﺲ ﻳﻚ ﻣﻴﻜﺮوﻓﻴﻠﺮ اﺳﺖ ﻛﻪ ﻓﺮم ﺑﺎﻟﻎ آن ﺑﻪ ﻃﻮر ﻣﻌﻤﻮل در ﺑﻄﻦ راﺳﺖ ﻗﻠﺐ و ﺳﺮﺧﺮگ ﻫﺎي ﺗﻨﻔﺴﻲ ﺳﮓ ﻫـﺎ زﻧـﺪﮔﻲ‬
‫ﻣﻲ ﻛﻨﺪ و ﻣﻲ ﺗﻮاﻧﺪ ﻣﻮﺟﺐ ﺑﻴﻤﺎري ﻗﻠﺒﻲ در ﺳﮓ ﻫﺎ ﮔﺮدد‪ .‬درﻣﺎن دﻳﺮوﻓﻴﻼرﻳﻮز ﺳﮓ ﺳﺎﻧﺎن ﻧﺎﺷﻲ از دﻳﺮوﻓﻴﻼرﻳﺎ اﻳﻤﻴﺘﻴﺲ ﺑـﺮاي ﺳـﮓ ﻫـﺎﻳﻲ‬
‫ﻛﻪ از ﻋﻼﺋﻢ ﺑﺎﻟﻴﻨﻲ اﻳﻦ ﺑﻴﻤﺎري رﻧﺞ ﻣﻲ ﺑﺮﻧﺪ )ﻧﻈﻴﺮ ﺳﺮﻓﻪ ﻣﺰﻣﻦ( ﺗﻮﺻﻴﻪ ﻣﻲ ﺷﻮد‪ .‬در اﻳﻦ ﻣﻘﺎﻟﻪ‪ ،‬ﻳﺎﻓﺘﻪ ﻫﺎي ﺗﺸﺨﻴﺼﻲ و درﻣﺎﻧﻲ در ﻳﻚ ﻗـﻼده‬
‫ﺳﮓ ﻣﺒﺘﻼ ﺑﻪ ﻋﻔﻮﻧﺖ ﻧﺎﺷﻲ از دﻳﺮوﻓﻴﻼرﻳﺎ اﻳﻤﻴﺘﻴﺲ‪ ،‬در ﻣﻨﻄﻘﻪ اﻫﻮاز‪ ،‬واﻗﻊ در ﺟﻨﻮب ﻏﺮب اﻳﺮان ﺗﻮﺻﻴﻒ ﻣﻲ ﺷﻮد‪ .‬ﺳـﮓ دﭼـﺎر ﺳـﺮﻓﻪ‪ ،‬ﺗـﺎﻛﻲ‬
‫ﭘﻨﻪ‪ ،‬ﺗﻨﻔﺲ ﺻﺪادار‪ ،‬ﻟﻪ ﻟﻪ زدن‪ ،‬ادم اﻧﺪام ﺧﻠﻔﻲ‪ ،‬ﺿﻌﻒ و ﻋﺪم ﺗﺤﻤﻞ ﺗﻤﺮﻳﻦ‪ ،‬ﺑﻪ ﻫﻨﮕﺎم ﻣﺮاﺟﻌﻪ ﺑﻮد‪ .‬ﺳﻤﻊ ﻗﻠﺐ ﻳﻚ ﻣﺮﻣﺮ ﺳﻴﺴﺘﻮﻟﻴﻚ درﺟﻪ ‪3/6‬‬
‫را در ﺳﻤﺖ ﭼﭗ ﻧﻮك ﻗﻠﺐ ﻧﺸﺎن داد‪ .‬ﮔﺴﺘﺮش ﻫﺎي ﺧﻮﻧﻲ ﺣﺎوي ﻣﻴﻜﺮوﻓﻴﻠﺮ رﻧﮓ آﻣﻴﺰي ﺷﺪه ﺑﺎ ﮔﻴﻤـﺴﺎ‪ ،‬از ﻧﻈـﺮ ﻣﻮرﻓﻮﻟـﻮژﻳﻜﻲ دﻳﺮوﻓﻴﻼرﻳـﺎ‬
‫اﻳﻤﻴﺘﻴﺲ ﺗـﺸﺨﻴﺺ داده ﺷـﺪﻧﺪ‪ .‬در ‪ ،CBC‬ﻟﻜـﻮﮔﺮام آﻣﺎﺳـﻲ و آﻧﻤـﻲ ﺧﻔﻴـﻒ آﺷـﻜﺎر ﺷـﺪ‪ .‬درﻣـﺎن ﺗﺮﻛﻴﺒـﻲ ﺑـﺎ داروﻫـﺎي آﻳـﻮرﻣﻜﺘﻴﻦ )‪440‬‬
‫ﻣﻴﻜﺮوﮔﺮم‪/‬ﻛﻴﻠﻮﮔﺮم و ﺑﻪ ﺻﻮرت ﺗﻚ دوز(‪ ،‬ﻟﻮاﻣﻴﺰول )‪ 10‬ﻣﻴﻠﻲ ﮔﺮم‪/‬ﻛﻴﻠﻮﮔﺮم‪ ،‬روزاﻧﻪ و ﺑﻪ ﻣﺪت ‪ 10‬روز( و آﺳﭙﻴﺮﻳﻦ )‪ 10‬ﻣﻴﻠﻲ ﮔـﺮم‪/‬ﻛﻴﻠـﻮﮔﺮم‪،‬‬
‫ﻫﺮ ‪ 12‬ﺳﺎﻋﺖ و ﺑﻪ ﻣﺪت ‪ 10‬روز( ‪ ،‬در ﻃﻲ ‪ 2‬ﻣﺮﺣﻠﻪ‪ ،‬در ﺑﺮ ﻃﺮف ﺷﺪن ﻋﻔﻮﻧﺖ در ﻳﻚ ﻗﻼده ﺳﮓ داﺷﻬﻮﻧﺪ‪ ،‬ﻣﻮﺛﺮ ﺑﻮدﻧﺪ‪ .‬ﺗﻌﺪاد ﻣﻴﻜﺮوﻓﻴﻠﺮﻫﺎي‬
‫ﺧﻮن از ‪) 1250±50‬ﻗﺒﻞ از درﻣﺎن( ﺑﻪ ‪150±10‬رﺳﻴﺪه ﺑﻮد )ﻣﺘﻌﺎﻗﺐ اوﻟﻴﻦ ﻣﺮﺣﻠﻪ درﻣﺎﻧﻲ‪ ،‬ﺑﻌـﺪ از ‪ 10‬روز( و ﻳـﻚ روز ﺑﻌـﺪ از دوﻣـﻴﻦ ﻣﺮﺣﻠـﻪ‬
‫درﻣﺎﻧﻲ‪ ،‬ﺑﻪ ﺻﻔﺮ رﺳﻴﺪ‪ .‬ﺣﻴﻮان از ﻧﻈﺮ ﻣﻴﻜﺮوﻓﻴﻠﺮ دﻳﺮوﻓﻴﻼرﻳﺎ اﻳﻤﻴﺘﻴﺲ‪ ،‬در ﻃﻲ ﻳﻚ دوره ‪ 180‬روزه ﻣﻨﻔﻲ ﺑﻮد‪ .‬اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﻛـﺎراﻳﻲ آﻳـﻮرﻣﻜﺘﻴﻦ‬
‫ﻫﻤﺮاه ﺑﺎ ﻟﻮاﻣﻴﺰول و آﺳﭙﻴﺮﻳﻦ را در درﻣﺎن ﻋﻔﻮﻧﺖ ﻧﺎﺷﻲ از ﻛﺮم ﺑﺎﻟﻎ در ﺳﮓ ﺗﺎﻳﻴﺪ ﻣﻲ ﻛﻨﺪ‪.‬‬

‫واژﮔﺎن ﻛﻠﻴﺪي‪ :‬دﻳﺮوﻓﻴﻼرﻳﺎ اﻳﻤﻴﺘﻴﺲ‪ ،‬ﺳﮓ‪ ،‬آﻳﻮرﻣﻜﺘﻴﻦ‪ ،‬ﻟﻮاﻣﻴﺰول‪ ،‬آﺳﭙﻴﺮﻳﻦ‬

‫‪Iranian Journal of Veterinary Science and Technology, Vol. 3, No. 1‬‬

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