Milbemycin Oxime and Angiostrongylus

RE: Milbemycin Oxime and Angiostrongylus

Thomas Johnson — Mon, 21 Oct 2019 08:37:40 GMT

[quote user="David Mills"]

The in field sensitivity may not be that high where there is co infection with other parasites, low 80s here. IDEXX fund a lot of studies.

https://www.ncbi.nlm.nih.gov/m/pubmed/24548539/?i=13&from=Angiostrongylus%20idexx

[/quote]

That's the same study I listed 3rd in my last post.

RE: Milbemycin Oxime and Angiostrongylus

janine redman — Sun, 20 Oct 2019 19:45:27 GMT

We have diagnosed a few over the last 10 years , the tow definite diagnosis were 1) a female cocker spaniel was coughing. 2) a young golden retriever which had neurological tremors and TDDS suggested it as a diagnosis on blood work and CSF tap. Later confirmed.

RE: Milbemycin Oxime and Angiostrongylus

David Mills — Sun, 20 Oct 2019 12:39:14 GMT

The in field sensitivity may not be that high where there is co infection with other parasites, low 80s here. IDEXX fund a lot of studies.

https://www.ncbi.nlm.nih.gov/m/pubmed/24548539/?i=13&from=Angiostrongylus%20idexx

RE: Milbemycin Oxime and Angiostrongylus

Neil Wheadon — Sun, 20 Oct 2019 12:20:28 GMT

[quote user="Thomas Johnson"]The dog we diagnosed this week wasn't coughing, and neither was the last one I saw.[/quote]

Willows referral have excellent fact sheets and several referral centres report spinal issues with it

https://www.willows.uk.net/general-practice-service/pet-health-information/lungworm-is-your-dog-at-risk

Salient quote from this link;

The presence of lungworm can lead to poor blood clotting, which means that these unfortunate dogs sometimes present with bleeding problems. Neurological (nervous) signs such as seizures (fits) and back pain can also be seen. If left untreated these problems can be life threatening.

Neil

RE: Milbemycin Oxime and Angiostrongylus

Thomas Johnson — Sun, 20 Oct 2019 09:18:03 GMT

[quote user="janine redman"]How specific is the snap test and is it for angiostrongylus rather than crenosoma ? [/quote]

It is only for angiostrongylus. Idexx quote that compared to a Baermann test it has a relative sensitivity of 98.1% and a relative specificity of 99.4%:

https://idexxcom-live-b02da1e51e754c9cb292133b-9c56c33.aldryn-media.com/filer_public/eb/66/eb667f93-1736-4a0a-ab5d-9d6064a582c8/09-71997-01-a-vasorum-wp-h.pdf

Another similar study gives a sensitivity of 97.1% and a specificity of 98.9%:

https://www.sciencedirect.com/science/article/pii/S2405939016300910

Though this study gives a sensitivity of 86.4% and a specificity of 100%:

https://www.ncbi.nlm.nih.gov/pubmed/24548539

[quote user="Christina Smith"]Coughing is the key to lungworm surely.[/quote]

The dog we diagnosed this week wasn't coughing, and neither was the last one I saw.

[quote user="Kate Richardson"]out of the dog loop clinically now, but can you be certain that lungworm is the sole cause of all those symptoms?[/quote]

I wasn't certain at the beginning, but the dog is significantly improved after 2 days of Fenbendazole, and there are reports of dogs with lungworm having spinal bleeds.

RE: Milbemycin Oxime and Angiostrongylus

Christina Smith — Sun, 20 Oct 2019 00:37:53 GMT

Coughing is the key to lungworm surely.Age immunity is likely too. Sudden deaths are idiosyncratic. It was present in the uk 40 years ago accordng to my 1982 parasitoloy notes. Cornwall and Wales.

RE: Milbemycin Oxime and Angiostrongylus

janine redman — Sat, 19 Oct 2019 18:28:14 GMT

How specific is the snap test and is it for angiostrongylus rather than crenosoma ?

RE: Milbemycin Oxime and Angiostrongylus

Thomas Johnson — Sat, 19 Oct 2019 11:43:07 GMT

[quote user="Bob Russell"]A positive test such as this would justify treatment in my mind whether it is involved in the symptoms or not. However what fenbendazole protocol should we use? 3 days, 7 days, 21 days (used by one of our referral centres)?[/quote]

We're treating with fenbendazole at 50mg/kg once daily for ten days, which is what it says in the BSAVA formulary. In the past I have given it for 7 days and that has worked well.

RE: Milbemycin Oxime and Angiostrongylus

Bob Russell — Sat, 19 Oct 2019 10:45:30 GMT

A positive test such as this would justify treatment in my mind whether it is involved in the symptoms or not. However what fenbendazole protocol should we use? 3 days, 7 days, 21 days (used by one of our referral centres)?

Advertising has created fear in clients without quantifying the level of risk. I consider reps have been guilty if instilling a similar level of fear in practices as part of their marketing.

It is a risk to patients, it is not a massive risk but this can be reduced with preventative treatment after sympathetic and realistic discussion. Crossing a busy road is far more dangerous in my opinion and we do that all the time.

I choose to use monthly milbemycin in my dogs but more to reduce the toxacara risk for the toddler that interferes with our sleep pattern!!

RE: Milbemycin Oxime and Angiostrongylus

Kate Richardson — Sat, 19 Oct 2019 08:56:51 GMT

[quote user="Thomas Johnson"]

[quote user="Bob Russell"]Lungworm is a triumph of marketing with an occasional tragedy! There have been cases around here but the pockets of infection seem to be very distinct. You either see none or regularly as far as I can see.[/quote]

I'm not sure about this, the consequences of a lungworm infection can be so serious that we should be recommending prophylaxis if we have it in our area. We diagnosed one this morning, dog presented with severe neck pain, screaming in pain when touched, it also had bright red conjunctiva and haemorrhagic diarrhoea:

[/quote]out of the dog loop clinically now, but can you be certain that lungworm is the sole cause of all those symptoms?

RE: Milbemycin Oxime and Angiostrongylus

Bob Russell — Thu, 17 Oct 2019 11:52:45 GMT

I did not suggest that lungworm is not a dangerous parasite nor that prophylaxis is unnecessary.

We recommend Nexgard Spectra monthly as it targets the common local parasites (fleas & ticks) as well as providing the 'socially responsible' roundworm treatment. At the same time it reduces further the already low risk of lungworm as cases locally are very few and far between.

There do seem to be a few hotspots but none appear to be within our catchment area.

RE: Milbemycin Oxime and Angiostrongylus

Thomas Johnson — Thu, 17 Oct 2019 11:16:55 GMT

RE: Milbemycin Oxime and Angiostrongylus

Mark Hedberg — Wed, 16 Oct 2019 09:09:19 GMT

It's a species that really knows how to pull the wool over your eyes!!!

RE: Milbemycin Oxime and Angiostrongylus

vetbl.locum — Tue, 15 Oct 2019 17:52:24 GMT

Just shows perverse nature of sheep :

Drugs given to cure , they still die

Giving pentobarbitone to kill , they survive !!!

RE: Milbemycin Oxime and Angiostrongylus

Bob Russell — Tue, 15 Oct 2019 14:44:52 GMT

Which goes to confirm my view that no medicine is 100%!!

Some may be 99.999%

RE: Milbemycin Oxime and Angiostrongylus

David Mills — Mon, 14 Oct 2019 22:13:24 GMT

[quote user="Michael Woodhouse"]

[quote user="David Mills"]Apart from sheep. [/quote]

I've successfully killed every sheep I've intended to with pentobarb..........

My preference remains a firearm, but I must have injected 100+.............

[/quote]

Used to think it was an urban/rural myth about the difficulty of killing sheep with pento.

But then I was called out to two farms within a month where a sheep had been determined dead after pento 24h earlier to see them wandering around the barn. Compare this to bloody calves when trying to anaesthetise them...

RE: Milbemycin Oxime and Angiostrongylus

Michael Woodhouse — Mon, 14 Oct 2019 21:49:37 GMT

[quote user="David Mills"]Apart from sheep. [/quote]

I've successfully killed every sheep I've intended to with pentobarb..........

My preference remains a firearm, but I must have injected 100+.............

RE: Milbemycin Oxime and Angiostrongylus

David Mills — Mon, 14 Oct 2019 21:45:36 GMT

[quote user="Michael Woodhouse"]

[quote user="Bob Russell"] I have never seen a drug that works 100% of the time![/quote]

Pentobarbitone can't be far off - as long as you get enough in the right place..................

[/quote]

Apart from sheep.

RE: Milbemycin Oxime and Angiostrongylus

Michael Woodhouse — Sun, 13 Oct 2019 23:51:03 GMT

[quote user="Bob Russell"] I have never seen a drug that works 100% of the time![/quote]

Pentobarbitone can't be far off - as long as you get enough in the right place..................

RE: Milbemycin Oxime and Angiostrongylus

Christina Smith — Fri, 11 Oct 2019 22:14:03 GMT

Thanks for replies re rocks. I don't think we have limestone in Scotland. The paper I read had 6.7% in snails [Glasgow]. The famous bleeding case was a weimeraner - untravelled from Glasgow. And yet dog faecal samples 0% positive [60 coughing/suspected cases]. Assuming 60 % regular prophlylatic worming not all veterinary sourced then that is surely remarkable. 2009 vet recoord

RE: Milbemycin Oxime and Angiostrongylus

Rob Loxley — Thu, 10 Oct 2019 13:29:37 GMT

We haven't found any cases - despite snap tests, BAL or faecal testing appropriate cases; nor other local vets I have asked. If you look at the map the prevalence is supposedly significant in our area, but then our postcode area includes a number of referral hospitals that will be seeing cases from a wider area - I wonder how this affects things?

[quote user="Bob Russell"]Lungworm is a triumph of marketing with an occasional tragedy[/quote]

brings to mind Blackadder

Doctor: You know the leech comes to us on the highest authority?
Edmund: Yes. I know that. Dr. Hoffmann of Stuttgart, isn't it?
Doctor: That's right, the great Hoffmann.
Edmund: Owner of the largest leech farm of Europe.

RE: Milbemycin Oxime and Angiostrongylus

David Mills — Thu, 10 Oct 2019 08:51:32 GMT

There was a theory that those regions with a considerable limestone geology fail to support with the slug and snails (there are about 30 different vector species) or the larvae required for infection. It's not been studied AFAIK. But it would explain the large swathes of the North West who never seem to see a case (I didn't in the Lakes).

There are also seasonal variations. It's been postulated that a large fox population is also required for transmission.

RE: Milbemycin Oxime and Angiostrongylus

Lucy Fleming — Wed, 09 Oct 2019 15:09:52 GMT

[quote user="Christina Smith"]What is the theory on rocks[/quote]

Different rocks/ soils mean different conditions (moisture, plants) mean different slug/snail species - and some are more or less likely to carry angiostrongylus? (I'm just guessing, I actually have no idea)

RE: Milbemycin Oxime and Angiostrongylus

Christina Smith — Tue, 08 Oct 2019 23:42:49 GMT

Awareness started with a case in Glasgow, a dog that had never travelled. What is the theory on rocks ? if the slugs/snails are positive then surely the larvae are picked up from grass or eating the vector.

RE: Milbemycin Oxime and Angiostrongylus

KathW — Tue, 08 Oct 2019 21:43:39 GMT

[quote user="Anthony Dennison"]

[quote user="Christina Smith"]

[quote user="David Mills"]rock, [/quote] condescending as usual

[/quote][quote user="Gillian Mostyn"]I'm in Lancashire and am yet to diagnose one, so I'm just curious.[/quote]

I'm in Lancashire too. We've looked for it but never found it in the 7 years I've worked here.

[/quote]

I‘m in Lancashire too and I (or colleagues) have seen a couple of confirmed cases in the last 8 years. Have looked for it in other cases ( with a lower index of suspicion but felt it worth try to rule it out) and not found it with in house faecal smears or angio detect test. It’s my understanding that neither of those tests have high sensitivity so we could have had false negative of course.