Lyme Disease Diagnosis Treatment and Prevention in Canines Caitlin Cotter DVM DHMH PHASE Intern 2016 Johns Hopkins School of Public Health Katherine Feldman DVM Center for Zoonotic and Vectorborne Diseases ID: 680525
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A Survey of Maryland Veterinarians: Lyme Disease Diagnosis, Treatment, and Prevention in Canines
Caitlin Cotter, DVMDHMH PHASE Intern, 2016Johns Hopkins School of Public HealthKatherine Feldman, DVMCenter for Zoonotic and Vector-borne DiseasesMD Department of Health and Mental Hygiene
Photo credit: CT Veterinary Diagnostic LaboratorySlide2
Lyme Disease in MD Canines
BackgroundClinical Signs & DiagnosticsACVIM Consensus StatementStudy: Survey of Maryland VeterinariansAnalysisResults
ConclusionsSlide3
BackgroundLyme disease
Spirochete bacteriaBorrelia burgdorferiIxodes ticksWhite-footed mouseHumans, Canines
Photo credit:
Warde
Medical Laboratory, Cary InstituteSlide4
Clinical Signs/SymptomsHumans
Dogs
Photo credits:
borreliaburgdorferi.com, Merck Veterinary Manual
70-80% erythema
migrans
“
bullseye
” target rash
Flu-like symptoms
Arthritis,
carditis
, neurological disease
No rash
Polayrthropathy
Fever
Anorexia
Lyme
nephropathySlide5
DiagnosticsHumans
Signs & SymptomsTick exposure historyEIA / Western BlotOther serology, lymphocyte assays, joint fluid tests not recommended
Dogs
SNAP point-of-care ELISAs
Quantitative C6 antibody assayUrinalysis
Urine protein-creatinine ratio
Photo credits: University of Michigan Medical School,
www.lymeinfo.caSlide6
ACVIM Consensus StatementScreening for Lyme disease in canines
Benefits: early detection of Lyme nephropathy, seroprevalence trackingRisks: overdiagnosis, overtreatment; poor prediction of clinical disease; antimicrobial resistance (AMR)Treatment of asymptomatic positive dogsUnknown: is treatment of seropositive, health dogs beneficial?
Case-by-case decisions: consider dog breed (shelties, retrievers), AMRVaccinationNot recommended for seropositive dogs
Seropositivity indicates tick exposure.Check for tick-borne co-infections, evaluation for proteinuriaTick controlSlide7
Survey of Maryland Veterinarians
ScreeningHow often do you screen dogs for Lyme disease?Why do you *Screen annually? *Not recommend annual screening?TreatmentHow do you manage asymptomatic, Lyme SNAP-test positive dogs?VaccinationIs Lyme vaccination mandatory, based on risk, or not performed?Follow-Up TestingWhich follow-up tests do you recommend?
Is follow-up urinalysis repeated annually? Slide8
AnalysisDescriptive analysis
Veterinary practice characteristics and location in MDVeterinarian preferencesDiagnosis and prevention of Lyme diseaseVeterinarian beliefsTreating SNAP- test positive dogsPerception of Lyme disease riskAssociations between survey variablesSlide9
Practice Location
No.
%
Maryland county (n=191)
Anne Arundel
29
15.8%
Montgomery
29
15.8%
Baltimore City
18
9.8%
Other counties
115
58.6%Slide10
Practice Characteristics
Number of vets in practice (n=180)
1 to 3
76
3.8%
4 or more
104
57.8%
Practice type
(n=183)
Exclusively small animal
165
90.2%
Mixed animal
11
6.0%
No
.
%
Photo Credits: Woodlake Animal Hospital, Redmond Vet ClinicSlide11
Veterinarian Perception of Canine LD Risk
Perception
of risk
for canine LD (n=191)
High Risk
114
59.7%
Moderate Risk
71
37.2%
Low Risk
2
1.0%
Not At Risk
0
0.0%
Other
4
2.1%
No.
%Slide12
Use of LD Screening Tests
Screening with which Lyme disease test (n=148)
Idexx
SNAP 4Dx
117
79.1%
Idexx
SNAP 3Dx
12
8.1%
Antech
Accuplex
panel
17
11.5%
PCR
0
0%
Other
2
1.4%
No.
%
Photo credits:
Idexx
,
AntechSlide13
Frequency of LD Screening
Frequency of LD Screening (n=145)
Annually
145
76.3%
Only with clinical signs
23
12.1%
No screening recommended
3
1.6%
Other
19
10.0%
No
.
%Slide14
Reasons for Annual Screening
Reason
for annual LD screening
(n=155)
(multiple answer selections possible)
Endemicity of disease
127
81.9%
Tracking
seroprevalence
46
29.7%
Informing dog owners
72
46.5%
Annual heartworm testing, with LD test included
60
38.7%
Other
4
2.6%
No.
%
Photo credit:
CDCSlide15
Reasons for Not Recommending Annual Screening
Reason to not recommend annual LD screening
(n=35)
(multiple selections possible)
Test does not diagnose or predict disease
17
48.6%
Overdiagnosis/ overtreatment
14
40.0%
Expense of treatment
3
8.6%
Antimocrobial
resistance
6
17.1%
Unnecessary owner distress
6
17.1%
Other
10
28.6%
No.
%
Photo credit:
www.iran-daily.comSlide16
Follow-Up Diagnostic Testing
If perform follow-up tests, which tests recommended (n=59)
(multiple answer selections possible)
Quantitative Lyme C6
42
71.2%
Urinalysis
38
64.4%
Urine
Protein:Creatinine
Ratio
17
28.8%
Serum Chemistry/CBC
20
33.9%
Other
4
6.8%
Is urinalysis follow-up repeated annually? (n=60)
Yes
32
53.3%
No
18
30.0%
We do not perform UA
for dogs screening positive
10
16.7%
No.
%Slide17
Management of Asymptomatic, SNAP-test Positive Dogs
Treatment
of asymptomatic dog screening positive
(n=149)
Treat all positive dogs with antibiotics
11
7.4%
Treat the first time screening positive, then based on clinical signs
55
36.9%
Perform follow-up testing
59
39.6%
No treatment or follow-up without clinical signs
9
6.0%
Other
15
10.1%
No.
%Slide18
Lyme Vaccination
Do you use a Lyme vaccine (n=187)
Mandatory, core vaccine
60
32.1%
Vaccinate if high risk
88
47.1%
No Lyme vaccination
4
2.1%
Other
35
18.7%
No.
%
Lyme vaccine brand used (n=182)
(multiple selections possible)
LymeVax
,
Zoetis
39
21.4%
Recombitek
Lyme,
Merial
87
47.8%
Duramune
Lyme combo,
BI
43
23.6%
Other
25
13.7%Slide19
Associations
Treating
asymptomatic positive dogs
with antibiotics
Annual Screening
YesNoChi-squared
p-value
Yes
68
78
0.067
No
3
0
Photo credit:
www.crossingthinice.comSlide20
Conclusions
ACVIM recommends weighing benefits and risks of Lyme disease screening 76.3% of veterinarians screen annuallyACVIM recommends case-by-case decisions: treatment of asymptomatic positive dogs7.4% veterinarians treat all asymptomatic positives36.9% of
veterinarians treat all dogs at first seropositivityACVIM does not
recommend vaccinating seropositive dogsMajority (79.2%) of Maryland veterinarians recommend Lyme as core vaccine or recommend if patient at high risk96.9% feel patients are at high riskHow many are seropositive at time of vaccination?Slide21
ACVIM does recommendFor asymptomatic dogs screening positive:Check for tick-borne co-infections,
Evaluate for proteinuriaTick control
Photo credit: Loomis Urinalysis TestingSlide22
Next StepsMore research is necessary Is treatment of asymptomatic positive dogs beneficial?
Are SNAP diagnostic tests beneficial? Updated Consensus StatementACVIMScreening, treatment: seropositive caninesDetailed algorithmCurrently known risks and benefits of treatmentVarious screening and disease stagesSlide23
Thank You!DHMH State Public Health Veterinarian:
Dr. Katherine FeldmanCZVBD / DHMH Team: Kim MitchellS.B. WeeHeather
RutzMary ArmoltRichard Brooks
Michael KingAndrea Palmer
David BlytheLucy WilsonShaylee Mehta