Prevalence of Dirofilaria immitis infection among shelter cats

OBJECTIVE: To determine prevalence of Dirofilaria immitis infection among shelter cats. DESIGN: Cross-sectional study. ANIMALS: 239 cats euthanatized at an animal shelter in southeastern Michigan. PROCEDURE: A gross necropsy focusing on the thoracic cavity, heart, lungs, and pulmonary vessels was performed within 5 hours after cats were euthanatized. Blood was collected directly from the heart of cats found to be infected and tested, using a filter test for microfilariae. Serum was tested for D immitis antigens by use of 2 antigen detection kits and for D immitis-specific antibodies by use of 2 antibody detection kits. RESULTS: Cats ranged from approximately 4 months to 15 years old. Adult D immitis were found in 6 (2.5%) cats. Blood could not be recovered from 1 of the cats with heartworm infection. For the 5 other cats, results of the filter test were negative, and results of both antigen and both antibody tests were positive. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that cats living in an urban area in the northern part of the United States have a low prevalence of adult D immitis infection. However, this is likely to be an underestimate of the true prevalence of infection, because no attempts were made to identify cats infected with larval or juvenile stages of D immitis.     

Epidemiological aspects of filariosis in dogs on the coast of Paraná state, Brazil: with emphasis on Dirofilaria immitis

The present study determined the prevalence and geographical distribution of Dirofilaria immitis and other filariae, from dogs in littoral areas of Paraná state, in Brazil. This survey spanned eight months, between 1998 and 1999, and was also designed to compare the efficacy of different tests for diagnosis of heartworm infection in that area. Blood samples were collected from 256 native-owned dogs distributed along the Paraná coastal area. Five diagnostic procedures were used: direct smear examination, the Knott's modified test, filtration assay, and two heartworm antigen detection kits. A follow-up imaging exam was performed to support the heartworm diagnosis. The imaging diagnosis included radiographic and ultrasonographic exams of six dogs that had positive results for the heartworm antigen detection kits, but showed different microfilarial burdens. The presence and severity of radiographic and ultrasonographic signs were compared with the results obtained in microfilariae detection and antigen tests. Diagnostic parasitology results indicated that 31.25% of the dogs were microfilaremic. Three different microfilariae were recovered: D. immitis, Dipetalonema reconditum, and the third (mf3) was not identified. D. reconditum was the species with the highest prevalence: 22.6%. In general, D. immitis prevalence was 5.47% (28.57% occult infections), but it varied along the coast and the range was from 0 to 20%. No correlation could be established between the overall scores for microfilarial counts (small or large numbers) and the severity of radiographic results or the likelihood of detecting filariae in the pulmonary artery using echocardiography. The finding of a different type of microfilaria (mf) suggested the existence of a third species in Paraná state, whose prevalence was 4.68%. These results show that to obtain a reliable diagnosis of heartworm infection, antigen detection kits are indicated. Knott's test or filtration should be performed to confirm microfilaremia and not for diagnosis of heartworm infection. Imaging tests support parasitology exams and add more about severity of infection. The northern areas, specially Guaraque?aba and Ilha das Pe?as, presented the highest number of heartworm-infected dogs.     

Prevalence of naturally occurring Dirofilaria immitis infection among nondomestic cats housed in an area in which heartworms are endemic

OBJECTIVE: To determine prevalences of heartworm exposure (ie, positive heartworm antibody test results) and heartworm infection (ie, positive heartworm antigen test results or identification of mature heartworms at necropsy) among nondomestic cats housed in an area in rural North Carolina where Dirofilaria immitis is known to be endemic and among nondomestic cats housed in areas with a low prevalence of dirofilariasis or in an area considered to be free from heartworms. DESIGN: Cross-sectional prevalence survey. ANIMALS: 97 nondomestic cats in North Carolina (study population) and 29 nondomestic cats in Colorado; Queensland, Australia; or Auckland, New Zealand (control population). PROCEDURE: Results of serologic tests and postmortem examinations were reviewed. RESULTS: Results of heartworm antibody tests were positive for 57 of 75 (76%) study cats and 1 of 29 (3%) control cats. Male study cats had a significantly higher risk of heartworm exposure than did female study cats (relative risk, 1.3). Results of heartworm antigen tests were negative for all 47 study cats and 16 control cats that were tested. Postmortem examinations were performed on 21 study cats, and 1 (5%) was found to be infected with heartworms. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that nondomestic cats housed outdoors in the southeastern United States are at risk for heartworm exposure and infection, with male cats having a greater risk of exposure than female cats.     

Prevalence and risk factors for heartworm infection in cats from northern Florida

Necropsies were performed on 630 adult cats in northern Florida to determine the prevalence and risk factors for heartworm infection in cats of this region. Heartworms were identified in 4.9% of cats, and serological evidence of heartworm exposure was present in 17% of cats. Not all cats from which heartworms were recovered were seropositive for heartworm antigen or antibody. There was no association between heartworm infection and co-infection with feline leukemia virus (FeLV) or feline immunodeficiency virus (FIV). Male cats were at higher risk of infection with heartworm, FeLV, or FIV than were females. Because even a single heartworm can cause clinical disease or death in cats, the authors conclude that cats in this region should receive heartworm prophylaxis to prevent heartworm infection.     

Incidence of positive heartworm antibody and antigen tests at IDEXX Laboratories: trends and potential impact on feline heartworm awareness and prevention

Data from the IDEXX Laboratories Reference Laboratory Network were retrospectively examined for feline heartworm testing trends in testing frequency, geographic bias, and prevalence for the years 2000--2006. Examination of the data supports the commonly held view that veterinarians do not embrace heartworm disease testing or prevention in cats to the same degree they do in dogs. Despite significant awareness and adoption of heartworm testing and prevention in dogs, we hypothesized that heartworm testing rates are lower for cats than for dogs despite a significant prevalence of feline infection. This is important because a perceived low rate of infection in cats is likely to manifest in a low adoption of testing and prevention. In reality, the overall feline heartworm antigen-positive rate is significant--on average 0.9% over the period studied--and in some regions was estimated to be as high as 4.6%. This compares with an average canine heartworm prevalence rate of 1.2%, a feline leukemia virus prevalence of 1.9%, and a feline immunodeficiency prevalence of 1.0%. Based on the low rate of testing and these prevalence rates, practitioners are routinely missing cases of adult feline heartworm infections and the recently defined heartworm-associated respiratory disease (H.A.R.D). Increased antigen testing would result in detection of a significant number of positive cases. In addition, this population of infected cats would represent the "tip of the iceberg" relative to the greater number of cats that have early infection or are at risk for infection.     

Myocardial fluid balance in dogs with naturally acquired heartworm infection

OBJECTIVE: To determine the effect of naturally acquired heartworm (Dirofilaria immitis) infection on myocardial fluid balance as indicated by myocardial water content and the dynamics of transepicardial fluid flow. ANIMALS: 7 dogs infected with adult heartworms and 8 dogs free of heartworm infection. PROCEDURES: Infected dogs had heartworms in the right ventricle, pulmonary artery, or both but no evidence of cardiovascular disease on physical examination. A hemispheric capsule was attached to the epicardial surface of all dogs for determination of transepicardial fluid dynamics and permeability of the epicardium to water and protein. Myocardial water content and hydroxyproline content were assessed at necropsy. RESULTS: Myocardial water content was significantly lower in heartworm-infected dogs. No differences in myocardial hydroxyproline content, transepicardial fluid flow, or epicardial water or protein permeability were detected. Conclusions and CLINICAL RELEVANCE: Heartworm infection significantly altered myocardial fluid balance in dogs, possibly because of a change in the myocardial interstitial pressure-volume relationship. These changes may be associated with increased vulnerability to cardiovascular stressors in heartworm-infected dogs.     

Comparison of results of three commercial heartworm antigen test kits in dogs with low heartworm burdens

OBJECTIVE: To compare results of 3 commercial heartworm antigen test kits performed on serum samples from dogs infected with low numbers of adult female heartworms. DESIGN: Blinded laboratory evaluation. Sample Population-Serum samples from dogs (n = 208) proven at necropsy to be infected with 1 to 4 adult female heartworms and from dogs (32) without heartworms. PROCEDURE: Samples were sequentially tested with each test kit, following the manufacturers' instructions, by licensed veterinary technicians in private practice who were not aware of infection status of the dogs. The order of test kit evaluations was randomly chosen. For each test kit, sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were evaluated. RESULTS: All tests yielded some false-negative results, and there were significant differences among tests in regard to ability to detect low heartworm burdens. Sensitivity of the test kits ranged from 78 to 84%. For all test kits, sensitivity increased as number of female heartworms increased. All 3 test kits had high specificity (97%). CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that sensitivity of the 3 commercially available heartworm antigen test kits ranged from 78 to 84% when used to test serum samples from dogs with low heartworm burdens, and that sensitivity varied among test kits. For all 3 test kits, specificity was 97%. All 3 test kits yielded false-positive and false-negative results for some dogs with low heartworm burdens.     

Use of echocardiography for the diagnosis of heartworm disease in cats: 43 cases (1985-1997)

OBJECTIVE: To determine the usefulness of echocardiography in the diagnosis of heartworm disease in cats and to compare this modality with other tests. DESIGN: Retrospective study. ANIMALS: 43 cats with heartworm infection that had echocardiographic examinations at 2 veterinary teaching hospitals between 1985 and 1997. Twenty-two of these 43 cats also underwent radiography of the thorax and heartworm antibody and heartworm antigen testing. PROCEDURE: Cats were determined to be infected with Dirofilaria immitis infection on the basis of 1 or more of the following findings: positive modified Knott or antigen test result, echocardiographic evidence of heartworm disease, or confirmation of the disease on postmortem examination. The percentage of echocardiographs in which heartworms were evident was compared with the percentage of radiographs in which pulmonary artery enlargement was evident and results of antigen or antibody tests in cats in which all tests were performed. RESULTS: Overall, heartworms were detectable by use of echocardiography in 17 of 43 cats, most often in the pulmonary arteries. In the 22 cats in which all tests were performed, antibody test results were positive in 18, antigen test results were positive in 12, and pulmonary artery enlargement was evident radiographically and heartworms were identifiable echocardiographically in 14. Heartworm infection was diagnosed exclusively by use of echocardiography in 5 cats in which the antigen test result was negative. CONCLUSIONS AND CLINICAL RELEVANCE: Although echocardiography was less sensitive than antigen testing, it was a useful adjunctive test in cats that had negative antigen test results in which there was a suspicion of heartworm disease. The pulmonary arteries should be evaluated carefully to increase the likelihood of detection of heartworms echocardiographically.     

Diagnosis of Aelurostrongylus abstrusus and Dirofilaria immitis infections in cats from a human shelter

During a 6-month period, 108 sexually mature stray cats were euthanatized at a humane shelter in Alabama. Aelurostrongylus abstrusus was identified in 20 of the cats (18.5%) by Baermann fecal examination, necropsy, or histologic examination. The Baermann fecal examination was a more sensitive test for aelurostrongylosis than was necropsy or histologic examination. Thoracic radiography was useful in identifying infected cats, but was a less sensitive and more nonspecific method of detection than was the fecal examination. Changes in CBC and serum protein concentrations were not helpful identifying cats with aelurostrongylosis. Six of 17 (35%) heartworm-free, lungworm-infected cats had antibodies to Dirofilaria immitis, as determined by an ELISA method, but none had circulating D immitis antigen, as determined by an ELISA method. Three (2.8%) cats had D immitis. Two of the heartworm-infected cats had no detectable antemortem radiographic or clinicopathologic evidence of the infection. Results of ELISA were positive for antibodies to adult heartworms in 2 cats and for circulating heartworm antigen in 2 cats. One cat that had only one heartworm had no detectable circulating heartworm antigen.     

Prevalence of serum antibodies against six Leptospira serovars in healthy dogs

OBJECTIVE: To determine the prevalence of antibodies against 6 Leptospira serovars and determine risk factors associated with positive Leptospira titers in healthy client-owned dogs in Michigan. DESIGN: Cross-sectional study. ANIMALS: 1,241 healthy dogs at least 4 months of age. PROCEDURES: Dogs were examined by veterinarians at private practices. Vaccinated and unvaccinated dogs were enrolled in the study, which occurred prior to the availability of a 4-serovar (Canicola, Grippotyphosa, Icterohaemorrhagiae, and Pomona) Leptospira vaccine. Sera were tested by use of the microscopic agglutination test to determine antibody titers against Leptospira serovars Bratislava, Canicola, Grippotyphosa, Hardjo, Icterohaemorrhagiae, and Pomona. A questionnaire was used to collect demographic information about each dog to identify risk factors associated with seropositive status. RESULTS: 309 of 1,241 (24.9%) dogs had antibody titers against at least 1 of the 6 Leptospira serovars, which suggested exposure to Leptospira spp. Prevalence of antibodies was highest to serovar Grippotyphosa, followed by Bratislava, Canicola, Icterohaemorrhagiae, and Pomona. Age, travel outside Michigan, exercise outside fenced yards, and exposure to livestock and wildlife were significant risk factors for positive titers. CONCLUSIONS AND CLINICAL RELEVANCE: Among healthy dogs from the lower peninsula of Michigan, > 20% have antibodies against leptospiral serovars historically considered uncommon but more recently incriminated as causing clinical canine leptospirosis. Wildlife and livestock may be of increasing importance as reservoirs for canine leptospirosis as urbanization continues to occur. Expanded vaccination strategies may partially mitigate these trends.     

Clinical evolution and radiographic findings of feline heartworm infection in asymptomatic cats

Clinical manifestations of heartworm disease in cats are variable; most cats seem to tolerate the infection well for extended periods. Heartworm-infected cats may undergo spontaneous self-cure due to the natural death of parasites without any symptomatology, or they may suddenly show dramatic and acute symptoms. Sudden death in apparently healthy cats is not a rare event. Thoracic radiographs are important tool for the diagnosis of cardiopulmonary disease. However, thoracic abnormalities are often absent or transient and highly variable in heartworm-infected cats. Findings, such as enlargement of the peripheral branches of the pulmonary arteries, with a varying degree of pulmonary parenchymal disease and hyperinflation, are the most typical features consistent with infection. A field study was performed for cats referred to the Veterinary Hospital Città di Pavia from January 1998 to December 2001 for routine health examinations and procedures to evaluate the clinical evolution and radiographic findings of feline heartworm infection. Thirty-four asymptomatic cats diagnosed with feline heartworm infection by antibody and antigen tests together with an echocardiogram that allowed worm visualization were included in the follow-up study. Cats were routinely examined every 3 months from the time of heartworm diagnosis until the outcome (self-cure or death). Self-cure was defined as no positive serology for heartworm antigens and no visualization of worms by echocardiography. A final examination for antibodies was carried after 12 months as a final confirmation of self-cure. Twenty-eight cats (82.4%) self-cured; including 21 that showed no clinical signs of infection throughout the study. Six cats died. The most common clinical features observed were acute respiratory symptoms and sudden death. Infection lasted over 3 years in the majority of the cats enrolled in the study. Thoracic radiograph appearance was variable, and the most commonly observed findings were focal and diffuse pulmonary parenchymal abnormalities.     

Diagnostic, treatment, and prevention protocols for feline heartworm infection in animal sheltering agencies

Cats are at risk for heartworm infection (Dirofilaria immitis) wherever the disease is endemic in dogs. Diagnosis is more difficult in cats, and little information is available regarding effective palliative and curative treatments for infected cats. In contrast to the challenges of diagnosis and treatment, chemoprophylaxis is highly effective, and current guidelines call for preventive medications to be administered to all cats in endemic areas. The purpose of this study was to survey feline heartworm management protocols used by 400 animal shelters and foster programs in the endemic states of Alabama, Florida, Georgia, and Mississippi. Only 23% of shelters performed feline heartworm testing. The most common reasons for not testing were expense (36%), lack of treatment options for infected cats (18%), and because the agency considers heartworm infections in cats to be less important than in dogs (12%). Most agencies (69%) did not provide preventive medication to cats. Reasons included because testing was not performed (36%), expense (35%), and the perception that local heartworm risk was low (10%). When preventive was provided, feline-labeled broad-spectrum products were used more commonly (81%) than livestock products (14%). The survey also indicated that many policy decisions were based on inaccurate knowledge of feline heartworm prevalence and pathogenesis. Issues of cost, feasibility, and education prevent most Southeastern sheltering agencies from adequately protecting cats against heartworm disease. Practical guidelines tailored to the needs of these agencies should be developed. Subsidized testing and preventive products may facilitate implementation of feline heartworm management protocols in sheltering agencies.     

Dirofilaria immitis infection in dogs: cardiopulmonary biomarker levels

Cardiopulmonary biomarkers are biological parameters that can be objectively measured and quantified as indicators of pathogenic processes (heartworm disease) or as indicators of response to therapeutic intervention. To determine levels of cardiopulmonary biomarkers in canine dirofilariasis, measurements of cardiac troponin T, cardiac troponin I, myoglobin, and D-dimer concentrations were performed for dogs with and without evidence of adult heartworm infection. The results showed that levels of cardiac troponin T were undetectable in all dogs studied while levels of cardiac troponin I were higher in dogs infected with Dirofilaria immitis. In healthy dogs, levels of myoglobin and D-dimer were below detection limits of the instrument and were significantly higher in heartworm-infected dogs, notably in microfilaremic dogs. The results suggest the possibility of using troponin I and myoglobin as markers for cardiac damage and the D-dimer as a supportive tool for a diagnosis of pulmonary thromboembolism in dogs with cardiopulmonary dirofilariasis.     

Performance of serologic tests used to detect heartworm infection in cats

OBJECTIVE: To compare heartworm serum antibody (Ab) and antigen (Ag) test results, using commercial laboratories and in-house heartworm test kits, with necropsy findings in a population of shelter cats. DESIGN: Prospective study. ANIMALS: 330 cats at an animal shelter. PROCEDURE: Between March and June 1998, 30 ml of blood was collected from the cranial and caudal venae cavae of 330 cats that were euthanatized at a local animal shelter. Results of heartworm Ab and Ag serologic tests for heartworm infection were compared with necropsy findings in this population of cats, using commercial laboratories and in-house test kits to measure serum Ab and Ag concentrations. RESULTS: On necropsy, adult Dirofilaria immitis were found in 19 of 330 (5.8%) cats. Combining results from serum Ab and Ag tests achieved higher sensitivities than using serum Ab and Ag test results alone (i.e., maximum sensitivities of 100% vs 89.5%, respectively, whereas use of serum Ag and Ab test results alone achieved higher specificities compared with the use of a combination of serum Ab and Ag results (i.e., maximum specificities of 99.4% vs 92.9%, respectively). CONCLUSIONS AND CLINICAL RELEVANCE: On the basis of our findings, if a cat has clinical signs that suggest heartworm disease despite a negative heartworm serum Ab test result, an alternative heartworm Ab test, a heartworm Ag test, thoracic radiography, or two-dimensional echocardiography should be performed.     

Feline heartworm disease: a clinical review

Feline heartworm disease is caused by the filarial nematode Dirofilaria immitis, and is transmitted by mosquitoes in heartworm-endemic areas worldwide. While dogs are the definitive hosts for this parasite, cats can also be infected, and the overall prevalence in cats is between 5% and 10% of that in dogs in any given area. The spectrum of feline presentations varies from asymptomatic infections to chronic respiratory signs, sometimes accompanied by chronic vomiting to acute death with no premonitory signs. Ante-mortem diagnosis can be challenging and relies on a combination of tests, including antigen and antibody serology, thoracic radiography and echocardiography. As treatment with heartworm adulticidal drugs can be life-threatening and heartworm infection in cats is often self-limiting, infected cats are frequently managed with supportive treatment (corticosteroids, bronchodilators, and anti-emetics). Surgical removal of filariae using extraction devices may be considered in some acute cases where immediate curative treatment is necessary, but filarial breakage during the procedure may result in an acute fatal shock-like reaction. Necropsy findings are mainly pulmonary and include muscular hypertrophy of the pulmonary arteries and arterioles on histopathology. A number of safe and effective macrocytic lactone drugs are available for prophylaxis in cats. These drugs can kill a range of larval and adult life-cycle stage heartworms, which may be advantageous in cases of owner compliance failure or when heartworm infection status is undetermined at the time prophylaxis is commenced. An index of suspicion for feline heartworm disease is warranted in unprotected cats with respiratory signs, and perhaps chronic vomiting, in areas where canine heartworm disease is endemic. Many cats, once diagnosed and with appropriate supportive care and monitoring, will resolve their infection and be free of clinical signs.     

Can heartworm prevalence in dogs be used as provisional data for assessing the prevalence of the infection in cats?

Cats are considered a susceptible host for Dirofilaria immitis; however, increased host resistance is reflected by relatively low adult worm burdens in natural and experimental infections; the prolonged prepatent period (8 months); the low level and short duration of microfilaremia; and the short life span of adult worms (2-3 years). From April to September 2006, 212 cats and 608 dogs, all exposed for at least one transmission season, were screened for D. immitis infection in a multi-center study in the Po River Valley in northern Italy. Cats were initially evaluated by antibody testing; positive subjects were followed up by antigen testing and echocardiography (and necropsy if death occurred). The prevalence in dogs was 29% by a modified Knott test and antigen testing compared with a prevalence of 4.7% in cats by an antibody test; six of these infections (2.8%) were confirmed by the follow-up evaluations. This field study demonstrated that the prevalence of heartworm infection in cats in this area is within the expected limits of 9-18% of the prevalence in dogs. Antibody testing likely underestimates the real prevalence of D. immitis infection in cats. These results also emphasize the importance of preventive treatment in cats.     

Dirofilaria immitis: worm burden and pulmonary artery proliferation in dogs from Michigan (United States)

Despite the ability to prevent heartworm disease, infection with Dirofilaria immitis continues to be a major problem for domestic dogs. To determine worm burden in heartworm-positive dogs from three county animal shelters in the state of Michigan in the United States and to assess the relationship between gross intimal proliferation and worm burden, necropsy was done on 176 heartworm-positive dogs. Adult heartworms were found in the heart and pulmonary artery of 170 of the 176 (96.6%) dogs examined. Mean worm burden was 14 +/- 13 (range 0-85). Fifty-nine percent of dogs had < or =10 heartworms. In contrast, 52% of dogs in a published report from the southern US (Florida) had worm burdens >10 [C.H. Courtney, Q.Y. Zeng, The structure of heartworm populations in dogs and cats in Florida, in: Proceedings of the American Heartworm Symposium, 1989]. These data suggest that mean worm burden in northern areas may be < or = that in warmer areas. Also, since diagnostic tests are less sensitive with lower worm burdens, diagnosis of heartworm infection in Michigan and other surrounding more northern states may be a greater challenge than in areas with higher worm burdens.     

Comparison of serological tests for the detection of natural heartworm infection in cats

Serological tests were performed on 380 cats with necropsy-confirmed heartworm disease to compare the performance of currently available commercial laboratory and point-of-care heart-worm serological tests in a heartworm-endemic area. Overall, antigen tests detected 79.3% to 86.2% of heartworm infections and were highly specific. Most cats with false-negative antigen tests had a single male worm. Antibody tests detected 62.1% to 72.4% of heartworm infections and had a wider range of false-positive results (1.4% to 19.1%) than antigen tests (0.3% to 2.0%). Serological tests for feline heartworm infection varied in diagnostic performance. Combining results from antigen and antibody tests achieved greater sensitivity than using either test alone.     

Canine heartworm testing in Canada: are we being effective?

Mass testing of dogs in Canada for the presence of Dirofilaria immitis has been ongoing since 1977. Since that time, there have also been changes in the diagnostic tests available to detect the presence of heartworm and changes in the therapy for heartworm, which necessitate a reevaluation of heartworm screening as currently practiced in Canada. The principles of evidence-based medicine were used to determine the prevalence of heartworm infection in various dog populations, and the effectiveness of screening these populations. The annual surveys of heartworm testing have shown that Canada is a low prevalence area (0.16%), with most of the test-positive dogs located in southern Ontario (0.19%), southern Manitoba (0.18%), southern Quebec (0.09%), and the southern Okanagan Valley (0.04%). Foci of higher prevalence are found within these 4 main geographic areas. Furthermore, the prevalence of heartworm infection is higher in the population of dogs not on preventative medication (0.62%), when compared to the population of dogs on preventative medication (0.04%). The evidence indicates that a heartworm diagnostic test applied to an asymptomatic dog on preventative medication contributes little information regarding the heartworm infection status of that dog. However, testing of a dog characterized as being high risk will provide clinically useful information. Recommendations regarding the testing of dogs for heartworm in Canada are derived on the basis of available evidence.     

Renal effects of Dirofilaria immitis in experimentally and naturally infected cats

Canine heartworm infection has been associated with glomerular disease and proteinuria. We hypothesized that proteinuria, likely due to glomerular damage, would also be found in cats experimentally and naturally infected with Dirofilaria immitis. Two populations of cats were evaluated, including 80 that were each experimentally infected with 60 infective heartworm larvae as part of a drug safety study, and 31 that were naturally infected with D. immitis. Each had a control population with which to be compared. In the experimentally infected group, we evaluated urine from 64 cats. Ten of these cats were shown to have microalbuminuria 8 months post infection. No cat refractory to infection with larvae and no cats from the control group demonstrated microalbuminuria. All 10 microalbuminuric cats were shown to have significant proteinuria, as measured by the urine protein:creatinine ratio. There was a subtle, but significant, association between worm burden and proteinuria, and although the presence of adult heartworms was required for the development of proteinuria, both microfilaremic and amicrofilaremic cats were affected. Neither the presence of circulating heartworm antibodies and antigen nor the presence of antigenuria predicted the development of proteinuria. Both heavily infected cats (5-25 adult heartworms) and cats with worm burdens compatible with natural infections (1-4 adult heartworms) developed proteinuria, and the relative numbers of cats so affected were similar between heavily and more lightly infected cats. Naturally infected cats, for which only dipstick protein determinations were available, were shown to have a significantly greater incidence of proteinuria (90% vs 35%) than did those in an age- and gender-matched control population. Additionally, the proteinuria in heartworm-infected cats was 3- to 5-fold greater in severity. We conclude that cats infected with mature adult heartworms are at risk for developing proteinuria and that this is recognized relatively soon after infection. While heavier infections may predispose cats to developing proteinuria, this complication is seen in naturally infected cats and experimental cats with worm burdens similar to those seen in natural infections (i.e., "clinically appropriate" worm burdens). The clinical relevance of heartworm-associated proteinuria is yet to be determined.