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.     

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.     

Prevalence of heartworm infection in healthy cats in the lower peninsula of Michigan

OBJECTIVE: To determine prevalence of heartworm infection among healthy, client-owned cats in the lower peninsula of Michigan. DESIGN: Cross-sectional prevalence study. ANIMALS: 1,348 healthy cats examined at private veterinary practices throughout the lower peninsula of Michigan. PROCEDURE: Sera were tested by use of an ELISA-based antigen test kit to determine infection and 2 commercially available antibody detection kits to determine exposure. A questionnaire was used to collect data to assess risk factors associated with infection. RESULTS: 25 cats had positive results for heartworm antigen, yielding an observed prevalence of 1.9%. Neither antibody test was reliable or provided reproducible results, and neither yielded positive results for more than 20% of the antigen-positive heartworm-infected cats. Multivariate regression indicated that cats from southeastern Michigan and cats > or = 2 years old had a higher risk of infection. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that most (80%) heartworm-infected cats in the lower peninsula of Michigan were from the southeastern part of the state, a pattern that closely paralleled the prevalence of heartworm infection in dogs. Therefore, knowledge of the regional prevalence of heartworm infection in dogs may be useful in assessing the risk of infection in cats. Results also suggested that currently available in-clinic heartworm antibody detection kits have limited utility in the diagnosis of heartworm infection in cats.     

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.     

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.     

Dirofilaria immitis in cats from inner Sydney

Two hundred feral cats from the inner suburbs of Sydney were examined post mortem for adult Dirofilaria immitis and circulating microfilariae, and 101 of these cats were tested for heartworm antigens by an ELISA. Only 2 cats (1%) had adult heartworms, the blood sample from another cat contained a single microfilaria. The blood of a further three cats contained small amounts of D immitis antigen. Although D immitis occurs in cats in Sydney, the prevalence is not high enough to warrant prophylactic treatment.     

Pulmonary arterial disease in cats seropositive for Dirofilaria immitis but lacking adult heartworms in the heart and lungs

OBJECTIVE: To determine the prevalence and severity of pulmonary arterial lesions in cats seropositive for heartworms (Dirofilaria immitis) but lacking adult heartworms in the heart and lungs during necropsy. ANIMALS: 630 adult cats from an animal control shelter in Florida. PROCEDURE: Cats were tested for adult heartworms in the heart and pulmonary arteries and antibody against heartworms in the serum. Histologic examination was conducted on the right caudal lung lobe of 24 heartworm- and antibody-positive cats; 24 heartworm-negative and antibody-positive cats; and 24 heartworm-, antibody-, and antigen-negative cats. Wall areas of 10 small to medium-sized pulmonary arteries of each cat were measured and expressed as a proportion of total cross-sectional area. RESULTS: Heartworm infection or seropositive status was significantly and strongly associated with seventy of medial hypertrophy of pulmonary arterial walls. Heartworm- and antibody-positive cats and heartworm-negative and antibody-positive cats had a significant increase in wall thickness, compared with wall thickness for heartworm- and antibody-negative cats. Heartworm- and antibody-positive cats had the most severe hypertrophy. The proportion with occlusive medial hypertrophy was significantly higher in heartworm- and antibody-positive cats (19/24 [79%]) and heartworm-negative and antibody-positive cats (12/24 [50%]), compared with heartworm- and antibody-negative cats (3/24 [13%]). CONCLUSIONS AND CLINICAL RELEVANCE: Cats with serologic evidence of exposure to heartworms, including those without adult heartworms in the lungs and heart, have a greater prevalence of pulmonary arterial lesions than heartworm-negative cats without serologic evidence of exposure. Additional studies are needed to define the pathogenesis, specificity, and clinical importance of these lesions.     

Serologic prevalence of Dirofilaria immitis,Ehrlichia canis,and Borrelia burgdorferi infections in Brazil

Dogs infected with Dirofilaria immitis, Ehrlichia canis, or Borrelia burgdorferi may show nonspecific clinical signs or may be asymptomatic. In Brazil, E. canis and D. immitis infections are frequently diagnosed based on the presence of classical signs; however, serologic tests are seldom performed to confirm the presence of infection. To estimate the seroprevalence of these three canine diseases in Brazil, 2,553 dogs presented at veterinary practices for various tests, routine treatments, or examinations were evaluated by an in-office commercial ELISA test kit (SNAP 3Dx, IDEXX Laboratories). Each dog was examined by the veterinarian, and a whole-blood sample was collected and immediately tested for the simultaneous detection of B. burgdorferi and E. canis antibodies and D. immitis antigen. D. immitis infection was detected in 51 dogs (2.0%) and E. canis antibodies were present in 505 dogs 19.8%). Only one dog tested positive for B. burgdorferi antibodies.     

Comparative study of diagnostic testing for feline leukemia virus infection.

Results of commercially available diagnostic test kits and commercial laboratory test results were compared for ability to detect FeLV antigen. Results of the immunofluorescent antibody (IFA) test were compared with test kit ELISA results and with results of a system in which samples were applied to an absorbent material, dried, sent to a laboratory, eluted, and assayed by a plate ELISA. Test kits were generally highly sensitive and specific, compared with the IFA test performed at a commercial laboratory. Feline heterophile antibody, specific for mouse immunoglobulin, was detected in approximately 0.14 to 0.57% of the cat population. Test kits B, E, and D contain reagents that correct for antimouse antibodies. During 1989 and 1990, 2,229 feline serum samples were tested for FeLV antigen (gsa p27); positive ELISA results were obtained for 204 (9%) of the samples. Results for 32 (1.4%) samples were interpreted as equivocal (color development slightly exceeded that of the negative control, but was much less than that of the positive control). Collectively, the data indicate that when testing serum or saliva, a negative test result may be a good predictor that a cat is not infected. In populations of cats in which FeLV prevalence is low, a positive test result may not be reliable and thus, a confirmatory test should be performed.     

Evaluation of feline leukemia virus diagnostic tests available for in-office use by veterinarians.

Blood samples from cats were tested for FeLV group-specific antigen by use of an indirect immunofluorescent antibody (IFA) test, ELISA, or both. Several ELISA kits were evaluated as they would be used in a veterinary clinic, and some ELISA kits were compared with an IFA test for agreement of results. Good agreement of results was evident among the commercially available ELISA kits; results for most blood samples were clearly negative or decidely positive. Occasionally, test results were equivocal and retesting was necessary to obtain clear interpretation. Negative results are highly reliable, which makes ELISA valuable screening tests for FeLV in healthy cats. Results of tests on blood from healthy cats in Alabama indicated positivity rate of 4.0% in 1978 with an IFA test and 4.8% with ELISA in 1988 through 1989. Infection rate in sick cats ranged from 11.6 to 35.8%. The frequency of positive test results for FeLV in cats tested at Auburn University decreased from a 5-year average of 27.7% during 1980 through 1984 to a 5-year average of 14.9% during 1986 through 1990; the rate in 1990 was 11.6%.     

Feline heartworm infection: serological survey of asymptomatic cats living in northern Italy.

Heartworm infection is now recognized as a potential cause of serious disease in cats. Epidemiological studies indicate that in locations where the infection is endemic in the dog, cats are at risk. The aim of this work was to carry out a serological survey for the presence of anti-Dirofilaria immitis antibodies in privately owned, predominantly asymptomatic cats living in different areas of northern Italy in order to determine the distribution of the parasite and the risk of infection in this species. Serum samples from 1045 cats were evaluated using a commercial antibody (Ab) detection kit (Heska Solo Step Filariosi Felina, Heska Corporation) and results were analyzed together with information obtained by questionnaire. Results showed that 16% of all tested cats were positive for anti-D. immitis antibodies, with values ranging from 9 to 27%, depending on location. Male cats and outdoor cats appeared to be at greater risk, with a significantly higher number of positive antibody tests. The results of this study suggest that the risk of exposure with D. immitis in cats is high in northern Italy and suggest that the use of preventive drugs would be advisable in this area endemic for canine heartworm disease.     

Effect of vaccination against feline immunodeficiency virus on results of serologic testing in cats

OBJECTIVE: To determine the effect of vaccination against FIV on results of serologic assays for FIV infection. DESIGN: Prospective clinical trial. ANIMALS: 26 specific-pathogen-free cats, 102 laboratory-reared cats (42 unvaccinated and uninfected, 41 vaccinated and uninfected, and 19 infected with FIV), and 22 client-owned cats infected with FIV. PROCEDURE: To determine the onset and duration of anti-FIV antibody production in cats following vaccination with a whole-virus vaccine, serum was obtained from the 26 specific-pathogen-free cats prior to vaccination and weekly for 10 weeks, then monthly for 52 weeks, after vaccination; serum was tested for anti-FIV antibodies with lateral flow and microwell plate ELISAs. To determine the diagnostic performance of serologic assays for FIV infection, plasma from uninfected, unvaccinated cats; uninfected, vaccinated cats; and FIV-infected cats was tested for FIV antibodies with the 2 ELISAs, a western blot assay, and an immunofluorescence antibody assay and for FIV antigen with an ELISA. RESULTS: Anti-FIV antibodies were detected in all 26 vaccinated cats 1 year after vaccination. Sensitivity of the antibody assays for FIV infection was high (98% to 100%). Specificity was high in unvaccinated cats (90% to 100%) but poor in vaccinated cats (0% to 54%). None of the vaccinated or infected cats had detectable FIV antigen in plasma. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that vaccination against FIV causes false-positive results for at least 1 year with currently available serologic assays for FIV infection. Negative FIV antibody assay results are highly reliable for detection of uninfected cats, but positive results should be interpreted with caution.     

Quantitative analysis of microfilarial periodicity of Dirofilaria immitis in cats

Microfilarial periodicity of Dirofilaria immitis in the venous blood of infected cats was analyzed by a trigonometric model. Cats were infected by subcutaneous transplantation with 120-day-old juvenile D. immitis. Microfilariae in the blood were first observed 98 days after transplantation. Blood was collected at 4h intervals for a 24h period, and examinations were repeated five times in two cats. The calculated periodicity index was 75.1 and 50.3 in these two cats. The estimated hour of peak microfilarial density ranged from 1.00 to 2.84h. Thus, the periodicity of microfilariae of D. immitis in the blood of cats was characterized as nocturnally sub-periodic.     

Prevalence of Dirofilaria immitis and gastrointestinal helminths in cats euthanized at animal control agencies in northwest Georgia

Cats euthanized at six northwest Georgia animal control agencies were examined for adult Dirofilaria immitis in heart and lung tissue and presence of gastrointestinal helminth ova by fecal flotation. D. immitis were found in 4 of 184 cats (2.1%). The prevalence of feline dirofilariasis in northwest Georgia was lower than that found in other studies conducted in the southeastern United States, but closer to the prevalences occurring in areas of similar topography. Heartworm antigen and antibody tests performed on batched serum samples resulted in low sensitivity and high specificity. Gastrointestinal helminth ova were found in 39.6% of the fecal samples examined and 6.1% of the samples contained two or more species.     

Physiological and haematological findings and clinical observations in a model of acute systemic anaphylaxis in Dirofilaria immitis-sensitised cats

OBJECTIVE: This study aims to understand the pathophysiology of anaphylaxis in Dirofilaria immitis-sensitised cats by analysing objective physiological and haematological measurements after challenge. DESIGN: Nineteen healthy D immitis-naive cats were sensitised using weekly injections of aluminium hydroxide-adjuvanted D immitis antigen, administered subcutaneously over 6 weeks. After sensitisation, cats (n = 16) were anaesthetised and challenged with intravenous D immitis antigen. A control group (n = 3) was sham-challenged using intravenous sterile 0.9% saline. Systolic blood pressure (measured non-invasively/indirectly), respiratory rate, degree of dyspnoea, blood O2 saturation, expired CO2, and heart rate and were measured immediately before and at 10 to 15 min intervals after challenge until terminal apnoea occurred or euthanasia at 140 mins post-challenge. Blood was collected for complete blood count immediately before and at 10, 20 and 35 mins after challenge. Clinical observations were recorded as they occurred. RESULTS: Antigen-challenged cats were divided into two groups: acute (apnoea occurred within 25 mins of challenge) and subacute (breathing at 25 mins after challenge). In both groups, the degree of dyspnoea increased and blood O2 saturation and blood pressure decreased. Respiratory rate increased in the subacute group. Expired CO2 decreased in both Ag-challenged and control groups. Haematocrit increased in the subacute group. Neutrophil count decreased in the acute group and platelet count decreased in the subacute group. Eosinophil count decreased in the subacute and control groups. Sustained dyspnoea and gastrointestinal signs were the most common clinical manifestations of anaphylaxis in the antigen-challenged cats. CONCLUSIONS: Intravenous challenge with D immitis antigen in sensitised cats results in dyspnoea, hypoxaemia and systemic hypotension accompanied by haemoconcentration.     

Evaluation of a single injection of a sustained-release formulation of moxidectin for prevention of experimental heartworm infection after 12 months in dogs

OBJECTIVE: To evaluate the efficacy of a single injection of a sustained-release formulation of moxidectin in preventing heartworm (Dirofilaria immitis) infection for 12 months in dogs. ANIMALS: 14 healthy dogs. PROCEDURE: Group A (nontreated control dogs; n = 6) received sterile vehicle administered SC, and group B (treated dogs; n = 6) received a sustained-release formulation of moxidectin administered SC. All dogs were housed in a heartworm-endemic area for 11.5 months, and heartworm antigen and modified Knott tests were performed monthly. All dogs (including 2 additional control dogs [group C]) were then inoculated with infective-stage larvae (L3) of D. immitis, and 4.5 months later, all dogs were euthanatized and post-mortem examinations were performed. Adult D. immitis were counted and measured, and their age was estimated. RESULTS: All dogs in groups A and C were infected with young (4- to 4.5-month old) adult male and female D. immitis. No dogs in group B were infected with heartworms. CONCLUSIONS AND. CLINICAL RELEVANCE: The age of heartworms recovered suggests that infection was the result of experimental inoculation and not natural exposure to mosquitoes during the 11.5-month period the dogs resided in a heartworm-endemic area. A single SC injection of a sustained-release formulation of moxidectin was effective in providing protection against heartworm infection after 12 months in dogs. This formulation is a convenient method of heartworm prophylaxis that could eliminate the problem of poor owner compliance.     

Serological survey of Toxoplasma gondii, Dirofilaria immitis, Feline Immunodeficiency Virus (FIV) and Feline Leukemia Virus (FeLV) infections in pet cats in Bangkok and vicinities, Thailand

The seroprevalence of Toxoplasma gondii, Dirofilaria immitis (heartworm), feline immunodeficiency virus (FIV) and feline leukemia virus (FeLV) infections was examined using serum or plasma samples from 746 pet cats collected between May and July 2009 from clinics and hospitals located in and around Bangkok, Thailand. The samples were tested for heartworm, FIV, and FeLV using a commercial ELISA. Of the 746 samples, 4.6% (34/746) were positive for heartworm antigen, 24.5% (183/746) had circulating FeLV antigen, and 20.1% (150/746) had antibodies against FIV. In addition, the first 348 submitted samples were tested for T. gondii antibodies using a modified agglutination test (MAT, cut off 1:25); 10.1% (35/348) were seropositive. Of the 348 cats sampled for all four pathogens, 11, 10, and 1 were positive for T. gondii antibodies and FIV antibodies, FeLV antigen, or D. immitis antigen, respectively. Of the 35 T. gondii-seropositive cats, 42.9% (15/35) were co-infected with at least one of the other three pathogens. The presence of antibodies to FIV was significantly associated with both age and gender, while FeLV antigen presence was only associated with age. In the case of FIV, males were twice as likely to be infected as females, and cats over 10 years of age were 13.5 times more likely to be infected than cats less than 1 year of age. FeLV antigen was more common in younger cats, with cats over 10 years of age being 10 times less likely to be FeLV positive than cats under 1 year of age. This is the first survey for these four pathogens affecting feline health in Thailand.     

Seroprevalence of canine dirofilariosis in South Korea

Eight-hundred and forty eight dogs (480 females and 368 males) not on chemoprophylaxis were examined for Dirofilaria immitis infection from 2001 to 2002. Three-hundred and thirty nine (40.0%) of 848 samples tested with antigen detecting ELISA kits showed positive reaction for D. immitis antigen. More male (43.5%) than female (37.3%) dogs were affected in this study, although there was no significant difference between both groups. Chi2 analysis showed that female and male dogs of shoreline areas had higher significant prevalence than other areas (P<0.001), respectively. The mean overall positive rates of heartworm infection were 10.4% in dogs <2-year-old group, 46.5% in 2-4-year-old group, 48.4% in 4-6-year-old group and 50.3% in >6-year-old group. The older the age, the higher the prevalence of D. immitis infection in this study. Chi2 analysis revealed a significant higher prevalence in 4-6-year-old group (100%) of shoreline areas and in 2-4-old-year group (51.2%) of urban areas (Chungnam province), respectively (P<0.001), and also revealed that the over 6-year-old group (50.3%) in mean overall prevalence had the significant higher prevalence than other age group (P<0.001). In climate comparison, our data showed that shoreline areas (69.5%) had the significant higher prevalence than urban areas and mountain areas (P<0.001). This survey confirms that the prevalence of canine heartworm infection increases, and also that the prevalence in shoreline areas is higher than in other areas in South Korea.     

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.