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CLIENT COMMUNICATION | TELEHEALTH | PARASITES APRIL 2022
trends.aaha.org
An Eco-Friendly Ending
Aquamation Gaining Popularity as Alternative to Cremation 24
AAHA 2022 Pain
Management Guidelines
for Dogs and Cats
Executive Summary of the Latest
Guidance from AAHA 35
Get Smart
Keeping Up Innovating to Meet
the Challenges of Pet
with the Bugs Parasites
by Maureen Blaney Flietner
Parasites aren’t the most pleasant
part of veterinary practice work. Not
only must veterinary teams identify
and treat for parasites and educate
clients, they must also stay vigilant
to protect themselves from zoonotic
diseases. To make matters more
concerning, parasites are spreading,
migrating, and showing resistance to
certain treatments.
Intestinal parasites continue to be on
the rise in the United States, according
to Craig Prior, BVSc, CVJ, a board
member and past president of the
Companion Animal Parasite Council
(CAPC). “Every year on CAPC maps,
we see more parasites showing up
in areas they shouldn’t,” Prior said.
“A lot of this is because parasites are
dynamic, ever changing, and on the
move. We’re also seeing parasite rates
go up.”
Prior noted a 2019 study by
Jason Drake, DVM, DACVM, that
revealed increasing prevalence for
roundworms and hookworms, and, for
the first time, apparent seasonality to
canine whipworms.
“We’re also seeing resistant
hookworms. It started in the greyhound
population in Florida and now has
“Every year on CAPC maps, we see more moved to the general dog population,”
parasites showing up in areas they shouldn’t.” said Prior. “The conversation changes
—CRAIG PRIOR, BVSC, CVJ, VETERINARY CONSULTANT
when you have resistant hookworms
because we don’t need to be helping
to further that resistance. We as
veterinarians should be practicing
preventative medicine, preventing
Hookworm photo courtesy of Antech APRIL 2022 55
disease in not just animals but Molecular Diagnostics The testing platform identifies
in humans.” In January, Antech Diagnostics zoonotic and anthelmintic
launched a molecular testing platform drug-resistant parasites that
Ticks also are on the move. for parasites called KeyScreen GI have evolved to become a more
Parasite PCR. serious concern, a hallmark being
The Asian longhorned tick was multidrug-resistant hookworms, he
reported for the first time in the United PCR (polymerase explained. It also is the most sensitive
States in 2017 in New Jersey. Able to chain reaction) test for parasites in veterinary
reproduce without mating, it spread offers the most medicine, differentiating round- and
rapidly. According to the Centers for sophisticated tapeworms and identifying important
Disease Control and Prevention (CDC), diagnostic modality parasites such as Toxoplasma,
the tick is now found in 17 states from M. Leutenegger, for the COVID virus. whipworms, protozoa, and coccidia.
DMV, BSc,
Arkansas to New York, and discovered PhD, FVH Antech’s molecular
on pets, livestock, and wildlife. testing modality for Leutenegger said Antech is investing
parasites is essentially the same, heavily in molecular technologies,
The lone star tick also continues offering the most sensitive test for which are key for fast and affordable
to expand its range and numbers, parasites, explained Christian M. parasite screening in wellness exams.
according to the CDC. It is now found Leutenegger, DMV, BSc, PhD, FVH, He expected that the most important
as far north as Maine and as far west director of molecular diagnostics at cost and efficiency benefits for
as central Texas and Oklahoma. It can Antech Diagnostics. veterinary practices would be:
transmit several bacteria and other • Rapid access to highly actionable
disease-causing agents that can “Molecular testing is fundamentally information that will allow practices
cause, for examples, cytauxzoonosis different and more sensitive than any to provide effective treatment from
in cats and ehrlichiosis in dogs. other kind of diagnostic testing. It the first visit instead of having the
can detect a much broader range of pet return months later because
What can be done? Trends reached parasites from one small sample. Our they “still aren’t 100%.”
out to several sources who shared test currently detects 20 parasites. • The ability of veterinarians
how they are innovating to meet It accomplishes this by reading the to practice pharmaceutical
the challenges. genetic material, or the DNA/RNA, of stewardship because there is
a parasite,” said Leutenegger. no risk of overtreatment if they
“Molecular testing is fundamentally
different and more sensitive than any
other kind of diagnostic testing.”
—CHRISTIAN M. LEUTENEGGER, DMV., BSC, PHD, FVH,
ANTECH DIAGNOSTICS
Ancylostoma Trichuris
56 TRENDS MAGAZINE Christian M. Leutenegger, DMV, B.Sc., Ph.D., FVH, photo courtesy of Antech Diagnostics
Parasite Challenges Get Smart
know exactly what’s there and used one anthelmintic, determined egg shedding, it needs to be
how to treat it. lack of efficacy, and then used a monitored and rechecked, she said.
• Saving time and resources as the combination of different anthelmintic Veterinarians also need to learn
molecular test requires a very classes with appropriate follow-up whether their clients are buying
small sample—0.15 grams—which testing,” explained Antoinette Marsh, dewormers off the internet and
can be stored for 10 days after JD, MS, PhD, associate professor of whether they are being sourced from
collection. Practice staff can parasitology at Ohio State University. reputable outlets.
submit the sample without any She also chairs the American
special preparation and send Association of Veterinary Parasitologists Marsh said she sees more challenges
it refrigerated to the Antech Hookworm Task Force. ahead. Appropriate health and
laboratory. diagnostic screening need to be done
“Just because a dog for dogs involved in cross-country or
“Veterinary practices are having is infected with international trips or rehomed after
to serve more patients with fewer hookworms doesn’t natural catastrophes since some
resources so the time and resource mean it is drug places have parasites other areas
benefits of the more sensitive test resistant. It really do not. In addition, climate change
can’t be understated,” he explained. Antoinette means the owner is allowing endo- and ectoparasites
Marsh, JD,
MS, PhD and veterinarian to become established in new areas,
Leutenegger said this innovation need to work she noted, pointing out that Ohio now
will provide a broader database of together to identify if it could has nine fewer frost days.
the prevalence and spectrum of potentially be drug resistance or
gastrointestinal parasites in pets, a something else because there are Artificial Intelligence
level of differentiation that current effective treatments for GI parasites, Zoetis’ Vetscan Imagyst uses the
diagnostic modalities do not have. including hookworms,” she noted. deep learning of artificial intelligence
as its innovation to meet parasite
Other than for COVID PCR testing, “We are seeing treatment successes challenges. The first-of-its-kind
molecular testing for parasites isn’t at Ohio State by following dogs technology allows for quick
widely used in human medicine, that are initially hookworm fecal identification of specific parasite eggs
explained Leutenegger. And while positive. We document treatment in fecal samples, thus saving time and
there are more and more PCR tests, success through subsequent fecal effort for technicians.
turnaround time is often weeks. examinations. Dogs are treated and
then, 12 to 14 days later, we get a “One of the things
“You could argue that veterinary follow-up fecal. If it cleared, we have we have learned
medicine is once again ahead of success. If it did not, then we check from COVID is that
human medicine.” what dewormer was used and if we time is everything
need to provide additional treatment.” for technicians and
A Hierarchy of Protocols Richard E. veterinarians. And
Goldstein, DVM,
At Ohio State University, a study of “There’s a hierarchy of protocols we now there is such a
DACVIM (SAIM),
drug-resistant hookworms is innovating are currently using,” said Marsh, “such DECVIM-CA shortage of
by bringing information learned from as if we need to use a combination technicians,” said
other areas to companion animals. therapy of three different classes Richard E. Goldstein, DVM, DACVIM
of dewormers or an alternative (SAIM), DECVIM-CA, vice president
“Resistant nematodes are not new. It’s treatment. Pablo Jimenez Castro, and chief medical officer at Zoetis
not something that sporadically just DVM, associate chair of the task Global Diagnostics, Medical Affairs.
happened in dogs. We have seen it force, provided laboratory-based “This deep learning algorithm gives
coming through our understanding of studies to support this approach.” us real-time results and saves an
the treatment of livestock and horse estimated 15 minutes for a technician
parasites. Livestock practitioners If a dog is positive for hookworm on every sample.”
Antoinette Marsh, JD, MS, PhD, photo courtesy of Antoinette Marsh. Richard E. Goldstein, DVM, DACVIM (SAIM), DECVIM-CA photo courtesy of Zoetis Global Diagnostics APRIL 2022 57
Trichuris Parasite Double Cystisospora Parasite Toxocara Parasite
With AAHA recommending frequent “What we’ve one is going to scan a QR code,”
testing for parasites, it’s a lot for learned from explained Mather. “Well, we have
veterinarians to accomplish, said TickSpotters, our all learned how to scan a QR code
Goldstein. The Vetscan Imagyst nationwide because we were buying takeout
can do the fecal at the level of a crowd-sourced tick food or looking at drink menus. It
parasitologist within 10 minutes at Thomas N. survey, is that while seems like the timing is right.”
Mather, PhD
the veterinary hospital. It uses a most people learn
contained sample, with one gram put about ticks and A typical tick warning sign may
in a tube for two minutes and one tick-bite prevention using just-in- include such unactionable items as
drop put on a slide into the device. case approaches such as lectures, wear light-colored clothing.
brochures, and media reports when
“Five to seven minutes later, the they actually have a tick encounter, it “Then the person looks down at his
results are in, and you can talk to can be difficult to accurately recall that blue jeans and says ‘Aw, crap. I’m
the owner in real time. If the pet is information,” explained Thomas N. sunk.’ Or the sign advises to apply
negative, that’s great. If it has giardia, Mather, PhD, professor and director of repellants, but no one has brought
hookworms, roundworms, and such, the Center for Vector-Borne Diseases, any along. These are not in-the-
you can take care of that at the time, University of Rhode Island. moment actions one can take,”
helping with compliance issues and said Mather.
giving you back tech time.” He said TickSpotters is a good
example because there is never On the other hand, a QR code
The algorithm lives in the cloud, going to be someone more interested on a sign can link a person to
not on the device itself. Upgraded in potentially taking action than the the BeReadyForTicks landing
periodically and taught by person who has just taken a tick off page containing prioritized,
board-certified parasitologists, their pet or child. With TickSpotters, a regionalized information.
the algorithm reviews thousands person who encounters a tick, snaps
of identified images to learn to a photo, and submits it then receives Another just-in-time innovation the
differentiate. It can identify 99% the identification and best next team is working on is customizable
of the parasites seen in the US, actions to take. dog ID tag blanks already etched
said Goldstein. on the back with a high-resolution
The first venture launched this BeReadyForTicks QR code. It links
Just-in-Time Learning spring is a tick warning sign with a owners with best next actions for their
Flipping tick-bite prevention twist—a QR code, a bar code that most likely scenario—just finding a
education from a just-in-case can be scanned by a smartphone tick on their pet.
approach to a just-in-time approach is for information.
the inspiration behind innovative tick The QR on the tag will guide the
efforts this spring. “Before the pandemic, I would have owner to confirming the tick’s
said that this is stupid because no identification but also link the pet’s
58 TRENDS MAGAZINE Parasite photos courtesy of Zoetis’ VETSCAN . Thomas Mather, PhD photo courtesy of University of Rhode Island.
tick protection with a message for the
owner. “You protect me once a month.
Now, protect yourself by spraying
your shoes with permethrin once
a month.”
Paraprobiotics
Safety concerns prompted studies
into a new avenue of attack against
gastrointestinal nematodes that affect
humans and animals—paraprobiotics.
Cry5B IBaCC offers
a potentially new
product to address
the growing threat Shridula Hegde, first year veterinary student (left); Antoinette Marsh, associate professor
of gastrointestinal (center); and Cristina Iazbik, blood bank staff; who are part of an OSU CVM team investigating
drug-resistant canine hookworms, along with Caroline, a recently retired racing greyhound,
Raffi V. worms in animal who is being evaluated for parasite shedding.
Aroian, PhD
and human health.
The engineered
bacterium that safely treats Unlike drugs, Cry5B IBaCC works shelf and it rapidly loses its vitality.
hookworms in animal models now just by a different mechanism and If you give a paraprobiotic, it’s
needs veterinary and human health has been shown to attack a wide already dead. It can’t lose its vitality.
pharmaceutical development partners variety of gastrointestinal worms, It’s a much more stable product on
to push it forward, according to Raffi said Ostroff. He explained that the the shelf.”
V. Aroian, PhD, professor of molecular benefits are provided as a result of
medicine at University of worm-selective interactions between Another reason for choosing this
Massachusetts Chan Medical School. the paraprobiotics, the crystal protein avenue is because of environmental
payload, and nematode parasite contamination issues, he noted.
Aroian, who developed this gastrointestinal system. “Because the bacterium is dead, it
technology with his colleague and can’t replicate in the environment
partner Professor Gary Ostroff, PhD, “While a probiotic is a live so you’re not contaminating the
explained that this paraprobiotic is microorganism that confers a environment with live bacteria. You
not a small-molecule or chemical health benefit when you take it, a minimize concerns about an avenue
anthelmintic but a crystal protein from paraprobiotic is a dead microorganism of resistance developing, which is
Bacillus thuringiensis, a natural soil that confers a health benefit when always an issue with deworming drugs
bacteria family. Proteins like it from taken,” said Aroian. “Even though because they’re excreted into the
this bacterium have been used for probiotics are considered safe, within feces. There’s always a chance with a
more than 60 years in environmental any given population there’s always a drug in the environment at suboptimal
applications against insects. population of humans or animals that concentrations that it helps to develop
will adversely react to a live bacterium. resistant parasites.”
Studies of the bacterium show it is Even for the safest probiotics, that’s
nontoxic, effective, stable at room true. So a paraprobiotic, a dead
temperature, and easily delivered, probiotic, removes that concern.
and it can be mass produced by a
scalable process that can be made “When you kill bacteria, you also
inexpensively anywhere in the world, greatly reduce any concerns about Maureen Blaney Flietner is
an award-winning freelance
he noted. a shelf life. You put a probiotic on a writer living in Wisconsin.
Raffi V. Aroian, PhD photo courtesy of University of Massachusetts Chan Medical School. APRIL 2022 59
Healthy pets. Happy pet parents. High-performance practice.
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