Reliability of different sets of criteria in diagnosing canine atopic dermatitis applied to a population of 250 dogs seen in a veterinary teaching hospital.

BACKGROUND: Different sets of criteria are available in veterinary dermatology for the diagnosis of canine atopic dermatitis (cAD); there are limited data to assess their reliability. HYPOTHESIS/OBJECTIVES: The aim of this study was to assess the discriminative and predictive ability of four sets in diagnosing cAD in a population of dogs with different skin diseases. ANIMALS: Two hundred and fifty dogs examined in the dermatology unit of a veterinary teaching hospital. METHODS AND MATERIALS: Dogs were diagnosed with cAD, flea infestation (FI), flea bite hypersensitivity (FBH), sarcoptic mange (SM) and other skin diseases (OD). FI, FBH and SM were pooled in one group of dermatoses mimicking cAD (MD). All nonatopic dogs were grouped as a "global population" (GP). Four criteria sets were applied to all dogs. For each set of criteria, sensitivity, specificity, positive and negative predictive values (PPV, NPV), likelihood ratios (LR) and diagnostic odds ratio (DOR) were calculated. RESULTS: When applied to the GP, sensitivities ranged from 54 to 83%, specificities from 68 to 75% and PPVs from 35 to 43%. NPVs ranged from 87 to 94%. LRs and DORs were poor. When applied to MD, sensitivities remained unchanged, specificities and PPV were mildly higher, whereas NPVs were mildly lower and LRs and DORs were comparable. CONCLUSIONS AND CLINICAL IMPORTANCE: This study showed that each set of criteria had a low diagnostic reliability when used alone. The use of more discriminant criteria integrated into a thorough clinical approach excluding MDs should be considered.

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Detection of Bartonella spp. in fleas by MALDI-TOF MS.

BACKGROUND: Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS) has recently emerged in the field of entomology as a promising method for the identification of arthropods and the detection of associated pathogens. METHODOLOGY/PRINCIPAL FINDINGS: An experimental model of Ctenocephalides felis (cat fleas) infected with Bartonella quintana and Bartonella henselae was developed to evaluate the efficacy of MALDI-TOF MS in distinguishing infected from uninfected fleas, and its ability to distinguish fleas infected with Bartonella quintana from fleas infected with Bartonella henselae. For B. quintana, two groups of fleas received three successive blood meals, infected or not. A total of 140 fleas (100 exposed fleas and 40 control fleas) were engorged on human blood, infected or uninfected with B. quintana. Regarding the second pathogen, two groups of fleas (200 exposed fleas and 40 control fleas) were fed in the same manner with human blood, infected or not with Bartonella henselae. Fleas were dissected longitudinally; one-half was used for assessment of B. quintana and B. henselae infectious status by real-time PCR, and the second half was subjected to MALDI-TOF MS analysis. Comparison of MS spectra from infected fleas and uninfected fleas revealed distinct MS profiles. Blind queries against our MALDI-TOF MS arthropod database, upgraded with reference spectra from B. quintana and B. henselae infected fleas but also non-infected fleas, provided the correct classification for 100% of the different categories of specimens tested on the first model of flea infection with Bartonella quintana. As for Bartonella henselae, 81% of exposed qPCR-positive fleas, 96% of exposed qPCR-negative fleas and 100% of control fleas were correctly identified on the second model of flea infection. MALDI-TOF MS successfully differentiated Bartonella spp.-infected and uninfected fleas and was also able to correctly differentiate fleas infected with Bartonella quintana and fleas infected with Bartonella henselae. MALDI-TOF MS correctly identified flea species as well as their infectious status, consistent with the results of real-time PCR. CONCLUSIONS/SIGNIFICANCE: MALDI-TOF is a promising tool for identification of the infection status of fleas infected with Bartonella spp., which allows new possibilities for fast and accurate diagnosis in medical entomology and vector surveillance.

What's eating you? sticktight flea revisited.

The sticktight flea (Echidnophaga gallinacea) earns its name by embedding its head in the host's skin. It has been found in many species of birds and mammals, including humans. The sticktight flea is found worldwide in the tropics, subtropics, and temperate zones, and it is the only representative of this genus found in the United States. Bites from fleas cause irritation and itching for hosts including humans, typically resulting in clusters of firm, pruritic, erythematous papules. Treatment can be tricky, as the fleas can be difficult to remove, and any flea-infested environments should be properly treated to prevent further bites.

Efficacy of fluralaner flavored chews (Bravecto) administered to dogs against the adult cat flea, Ctenocephalides felis felis and egg production.

BACKGROUND: Fluralaner is a potent insecticide and acaricide with rapid and persistent efficacy. This study measured the efficacy of fluralaner flavored chews (Bravecto®, Merck Animal Health) administered to dogs against adult Ctenocephalides felis felis and egg production. METHODS: Twelve purpose-bred dogs were randomly allocated to two groups of six dogs each. Dogs in treatment group 1 were administered a single fluralaner flavored chew to achieve a minimum dose of at least 25 mg/kg while treatment group 2 served as untreated controls. On Days -2, 28, 56, 84, 91, 98, 105, 112, and 120 post-treatment, each dog was infested with approximately 200 unfed cat fleas, C. felis felis (KS1 strain). Forty-eight hours after treatment and 48 h after each infestation, eggs were collected over a 3-h period, counted and viability determined. Dogs were combed to remove any remaining fleas. RESULTS: Treatment of dogs with oral fluralaner provided a 100% reduction in flea counts 48 h after treatment and within 48 h of every post-treatment infestation through Day122. Egg production from fluralaner treated dogs was reduced by 99.9% (two eggs from one dog) within 48 h after treatment and not a single egg (100% efficacy) was thereafter collected from treated dogs. Adult flea counts and egg production from the fluralaner-treated dogs were significantly lower than for non-treated controls at all post-treatment evaluations (P < 0.001). The two eggs collected from the single treated dog 48 h after treatment did not produce any adult fleas. As no additional eggs were collected from treated dogs, no viability assessment was performed. CONCLUSIONS: A single oral dose of fluralaner flavored chews provided 100% efficacy against repeated flea infestations on dogs for 4 months. Fluralaner reduced egg production of activity reproducing female fleas by 99.9% and then killed every single female flea before any eggs could be produced following each subsequent re-infestation for the entire 122-day evaluation period.

Hepatozoonosis in cats: ABCD guidelines on prevention and management.

OVERVIEW: Hepatozoonosis of domestic cats has been reported in several countries, mainly as a subclinical infection. DISEASE AGENT: Infection has been described mostly in areas where canine infection is present and, in recent years, Hepatozoon felis has been identified as a distinct species by molecular techniques. The vector for feline hepatozoonosis remains unknown and the pathogenesis has not been elucidated. INFECTION IN CATS: Feline hepatozoonosis is mainly a subclinical infection and few cases have been reported with clinical signs. The diagnosis of hepatozoonosis in cats can be made by observation of parasite gamonts in blood smears, parasite meronts in muscles by histopathology, and detection of parasite DNA in blood and tissue by PCR. DISEASE MANAGEMENT: The treatment of choice is not known, but single cases have been treated with doxycycline or oxytetracycline and primaquine. Although the mode of transmission and the type of vector is not known, preventive treatment against blood-sucking vectors (fleas and ticks) is advised.

Comparison of two techniques for the detection of flea faeces in canine and feline coat brushings.

Flea infestation is diagnosed after the detection of either adult parasites or flea faeces in the fur. The latter is generally tested with the wet blotting paper technique (WBPT). However, microscopical examination (MT) of the coat brushing material is sometimes suggested as an alternative. This study aimed to compare the efficiency of the two techniques. In dogs, the entire body was hand-brushed and cats were combed. One half of the collected material was mounted in liquid paraffin on a glass slide and examined microscopically at low magnification. The second half was placed on a blotting paper and sterile water was added. After drying, reddish aureoles were counted. 255 animals (158 dogs and 97 cats) were included. 119 (47%) and 94 (37%) samples were revealed to be positive with WBPT and MT, respectively. 13 cases (5%) were positive with MT only and 38 cases (15%) were positive with WBPT only. 81 cases (32%) were positive and 123 (48%) were negative with both techniques. More positive cases were detected by WBPT than MT (P < 0.001). Amongst the 51 samples which were found positive with a sole technique, infestation was considered low in 43 cases and WBPT detected significantly more positive samples (31) than MT (12), P < 0.01.

In the clinic. Common cutaneous parasites.

This issue provides a clinical overview of Common Cutaneous Parasites focusing on prevention, diagnosis, treatment, practice improvement, and patient information. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including ACP Smart Medicine and MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic from these primary sources in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of science writers and physician writers. Editorial consultants from ACP Smart Medicine and MKSAP provide expert review of the content. Readers who are interested in these primary resources for more detail can consult http://smartmedicine.acponline.org, http://mksap.acponline.org, and other resources referenced in each issue of In the Clinic.

Arthropod bites.

The phylum Arthropoda includes arachnids and insects. Although their bites typically cause only local reactions, some species are venomous or transmit disease. The two medically important spiders in the United States are widow spiders (Latrodectus), the bite of which causes intense muscle spasms, and the brown recluse (Loxosceles), which may cause skin necrosis. Widow bites usually respond to narcotics, benzodiazepines, or, when necessary, antivenom. Most recluse bites resolve uneventfully without aggressive therapy and require only wound care and minor debridement. Tick bites can transmit diseases only after prolonged attachment to the host. Treatment of clothing with permethrin and proper tick removal greatly reduce the risk of infection. Ticks of medical importance in the United States include the black-legged tick, the Lone Star tick, and the American dog tick. The prophylactic use of a single dose of doxycycline for Lyme disease may be justified in high-risk areas of the country when an attached, engorged black-legged tick is removed. Bites from fleas, bedbugs, biting flies, and mosquitoes present as nonspecific pruritic pink papules, but the history and location of the bite can assist with diagnosis. Flea bites are usually on ankles, whereas mosquito bites are on exposed skin, and chigger bites tend to be along the sock and belt lines. Antihistamines are usually the only treatment required for insect bites; however, severe mosquito reactions (skeeter syndrome) may require prednisone. Applying insect repellent containing diethyltoluamide (DEET) 10% to 35% or picaridin 20% is the best method for preventing bites.

Cat flea infestation in a hospital: a case report.

Cat flea bite in humans results in extremely pruritic skin lesions. It has been reported to occur among those living in domiciliary accommodation. However, nosocomial infestation with cat flea has not been reported. We hereby report a case of nosocomial infestation of cat flea in a hospital facility. Identification of the parasite, its appropriate eradication, and adequate medical management of the patients resulted in a satisfactory outcome.

Cat Flea Infestation in a Hospital: A Case Report

Cat flea bite in humans results in extremely pruritic skin lesions. It has been reported to occur among those living in domiciliary accommodation. However, nosocomial infestation with cat flea has not been reported. We hereby report a case of nosocomial infestation of cat flea in a hospital facility. Identification of the parasite, its appropriate eradication, and adequate medical management of the patients resulted in a satisfactory outcome.

Infestation with the cat flea, Ctenocephalides felis felis (Siphonaptera: Pulicidae) among students in Kuala Lumpur, Malaysia.

This paper reports six male undergraduate students living at a local university hostel who were infested with cat fleas (Siphonaptera: Pulicidae: Ctenocephalides felis felis) in February 2009. All of them suffered from maculopapular rashes and severe pruritus after the bites. Investigation revealed the presence of a stray cat in the hostel building; five of the students had a history of contact with the cat. Six cat fleas were collected at the hostel and identified as C. felis felis. Most of the students were not aware of this infestation and did not seek medical treatment.