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Tapeworms. The most common species of tapeworms in dogs and cats in North America is Diplydium caninum. Infection with this
tapeworm is acquired by eating infected fleas. In populations with high flea burdens, nearly all animals may be infected with D. caninum.
Infected animals may intermittently shed egg-containing worm segments (called ?proglottids?) in their feces. The pre-patent period is usually
around 2-3 weeks. The second most common type of tapeworm in dogs and cats are various Taenia species. Dogs and cats may become
infected with these types of tapeworms by feeding on smaller mammals, such as mice or rabbits. There are also a few other kinds of
tapeworms that are much less common, such as Echinococcus, Diphyllobothrium and Spirometra. These tapeworms are generally limited
to certain regions of the country. For example, in Florida, Spirometra is the second most common tapeworm in cats.
Most tapeworm infections in dogs and cats are sub-clinical (i.e. they do not usually cause clinical signs, such as diarrhea). They do
sometimes cause peri-anal irritation, resulting in an animal scooting its rear end along the ground. Heavy infections can sometimes result in
abdominal pain, vomiting, weight loss, and possible intestinal blockage. However, several tapeworm species are zoonotic ? they can also
infect humans. Humans (most often children) can become infected with Diplydium caninum the same way dogs and cats do - by eating
infected fleas. As in dogs and cats, these infections are usually asymptomatic and not serious, and are usually only recognized when
proglottids are passed in the stool. However, the larval forms of Echinococcus tapeworms pose a serious zoonotic threat. While this type of
tapeworm is uncommon in most areas of the US, humans can become infected through contact with the feces of dogs harboring the
tapeworm.
Tapeworms are often diagnosed when proglottids are seen on the feces or near the anus of an animal. These proglottids resemble grains of
rice or cucumber seeds. For some tapeworm species, individual eggs rather than proglottids are shed, and these eggs may occasionally be
detected on fecal float exams. However, fecal flotation exams are generally unreliable for detection of tapeworm infections.
Praziquantel is the drug most commonly used to treat tapeworm infections in dogs and cats. Epsiprantel is also effective against most
tapeworms, and fenbendazole is effective against a few types of tapeworms. Eliminating and preventing fleas is also extremely important in
controlling Diplydium caninum infections.
Strongyloides stercoralis: Strongyloides stercoralis infection in dogs may be asymptomatic, or may cause bronchopneumonia or severe
diarrhea. S. stercoralis is potentially zoonotic, but transmission of S. stercoralis from dogs to humans is probably relatively rare. Nevertheless,
the potential human health hazard should always be taken into account, and infected dogs should be handled with caution. S. stercoralis is
diagnosed by observing larvae in fecal culture, and is typically treated with ivermectin.
Protozoans:
Coccidia (Isospora spp.) The national shelter canine parasite study showed that about 8% of shelter dogs less than 6 months old were
shedding coccidian oocysts. Coccidia are less common in dogs over 1 year of age, and very uncommon in dogs over 7 years old. The
prevalence of Coccidia is fairly consistent across various regions of the country. Drugs used to treat Coccidia include ponazuril (Marquis
Paste), toltrazuril, and sulfadimethoxine (Albon). In shelters in which Coccidia is a common problem, prophylactic treatment of all puppies and
kittens with ponazuril is recommended. See our Infectious Disease: Profiles of Common Shelter Diseases page for more information.
Giardia (multiple species). The prevalence of Giardia in shelter dogs and cats is probably underestimated. Giardia is potentially zoonotic, but
the risk of humans contracting Giardia infection from dogs and cats is low. Giardia cysts are difficult to detect on fecal floats. If fecal flotation is
relied upon, a zinc sulfate centrifugation method be used, and that at least three samples should be examined over a period of about a week.
Direct smears are about 50% sensitive for detecting Giardia in diarrheic fecal samples. In cats, Giardia may be mistaken for Tritrichomonas
on a fecal direct smear. The most sensitive method for diagnosis of Giardia in shelters is a SNAP ELISA test, but this test is not intended for
screening of asymptomatic dogs. Vaccination for Giardia is available, but not recommended for use in shelters. Giardia can be treated with
metronidazole, fenbendazole, or febantel (Drontal Plus) See our Infectious Disease: Profiles of Common shelter Diseases page for more
information.
Tritrichomonas foetus. This is a recently recognized intestinal protozoal pathogen in cats. Although its prevalence in shelters is unknown,
one study found that approximately 1/3 of cats at cat shows and breeding catteries were infected with Tritichomonas. Tritrichomonas infection
is most common in kittens and young adult cats and in crowded environments, so it may be an important problem in shelter cats. In addition, it
is not detected by standard diagnostic methods (e.g. fecal float) and does not respond to routinely used anti-parasite medications.
Tritrichomonas tends to cause chronic, mucoid diarrhea, with fecal incontinence and anal swelling, pain and redness. Tritrichomonas can be
detected by a direct fecal smear, although more sensitive diagnostic tests are available. Fecal protozoal culture using the ?InPouch? test is
most practical for shelters. Co-infection of cats with Tritrichomonas and Giardia is not uncommon, and the two parasites may be confused
when seen on a direct fecal smear. Cats thought to have Giardia but not improving with treatment may have Tritrichomonas. Ronidazole is
the only drug that has shown to be effective for treatment of Tritrichomonas. See our Infectious Disease: Profiles of Common shelter
Diseases page for more information.
Cryptosporidium (C. parvum, C. felis). The prevalence of Cryptosporidium in shelter dogs and cats in unknown. In studies that included
shelter cats and ferals, 4-7% of cats were shedding Cryptosporidium oocysts. Cryptosporidium can also infect guinea pigs, cattle, humans,
and other species. Infections in dogs and cats are usually mild, with only self-limiting diarrhea, but may cause more severe diarrhea in kittens
and puppies. Cryptosporidium presents a potential zoonotic risk, and the infective dose (number of oocysts needed to cause infection) is very
low, especially in immunocompromised people. However, most human infections are not obtained from animals, and the risk of infections
from pets is generally low. Oocysts are often shed only intermittently and in small numbers from infected animals, but prolonged shedding
from infected dogs and cats may occur. Oocysts are difficult to detect on fecal flotation exams because they are extremely small. Using
sucrose solution and repeating flotation exams may increase the chances of detecting Cryptosporidium. There are several other tests for
Cryptosporidium available; most require sending samples out to a diagnostic lab, and there is little consensus about which test is the most
accurate. Cryptosporidium does not respond to any anti-parasitic medications. Cryptosporidium oocysts are resistant to most disinfectants,
and can remain viable in the environment for months.
Toxoplasma. Exposure to this parasite is common in cats. Studies of antibody titers in cats suggest that nearly half of cats in the U.S. have
been exposed to Toxoplasma. Cats are the only ?definitive? host, meaning that they are the only animals that can shed infective forms of the
parasite (?oocysts?) in their feces. Although previous exposure is common, it is quite uncommon for cats to be actively shedding Toxoplasma
oocysts. In one study of 77 shelter cats, none were shedding Toxoplasma. Studies indicate that at any point in time, less than 1% of cats in
the U.S. have a patent intestinal infection and are shedding oocysts, but shedding is more likely in kittens and young cats. Cats typically
become infected through exposure to the feces of other cats, or by eating undercooked meat or rodents. Shortly after their first exposure to
Toxoplasma, cats usually shed oocysts for 1 to 3 weeks. This is typically followed by the development of significant immunity. Subsequent reinfections are uncommon, and generally do not result in shedding. Toxoplasma infections are usually sub-clinical in cats; diarrhea is not
generally seen. Occasionally, the parasite causes systemic inflammation, affecting the brain, eye and other tissues, but these manifestations
are not necessarily associated with active shedding of oocysts.
Serum antibodies titers can be measured to determine whether a cat has ever been exposed to toxoplasmosis, but this is of little practical
value. The vast majority of cats with positive antibody titers are not shedding oocysts. If present, oocysts can usually be detected on fecal
floatation, but it can be challenging to distinguish Toxoplasma oocysts from those of other protozoans. Toxoplasma oocysts are smaller than
those of Coccidia.
While cats are the only species that can shed Toxoplasma oocysts, many other species can be infected with Toxoplasma, including dogs,
pigs, sheep, goats, rodents and humans. Exposure to toxoplasmosis is common in humans, with 30-40% of people having positive antibody
titers. Toxoplasma infections can also be obtained through the ingestion of intermediate forms of the parasite in the tissues of other animals,
such as pigs or rodents. Most human Toxoplasma infections result from ingestion of undercooked meat, but humans may also become
infected by ingestion of oocysts from soil contaminated with cat feces, usually following gardening or ingestion of raw vegetables from such
soil, or through exposure to cat feces, usually when cleaning litter boxes. Toxoplasma infections in humans are usually asymptomatic, but can
be serious in immunosuppressed people and in pregnant women.
Shelters commonly contain a large, non-immune population of young cats with the potential to experience initial Toxoplasma infection and
shed the Toxoplasma oocysts in large quantities. This could increase the risk of spread by ingestion of oocysts. Therefore, screening cats
through fecal floatation is recommended, especially for cats less than 1 year old, and for cats being introduced into group housing. Cats found
to be actively shedding toxoplasma oocysts should not be made available for adoption. If possible, they should be isolated during the 3 week
potential shedding period, until oocysts are no longer detected on fecal floatation. Careful measures to prevent human exposure should also
be taken during this period.
After this period, and once oocysts are no longer detected on fecal floatation, the cat need not be considered a particular zoonotic risk.
Oocysts in fresh feces are not immediately infective; the oocysts require at least 24 hours after being passed to ?mature? to a form that can
cause infection in humans. Therefore, removal of feces from litterboxes at least once daily, followed by proper disposal of feces, will reduce
the risk of exposure. Use of disposable litterboxes can also be helpful.
Toxoplasma oocysts are resistant to most disinfectants. Cleaning with scalding hot water or steam is most effective for environments
contaminated by Toxoplasma oocysts, but obviously, must be done carefully to avoid burns.
Treatment of Toxoplasma infections should not be undertaken based solely on detection of Toxoplasma oocysts in the feces. Diarrhea in
kittens or cats is much more likely to be due to other parasites or to other non-parasitic causes. Most cats who are shedding Toxoplasma
oocysts do not experience clinical signs from this infection and do not require treatment.
Shelters may want to consider offering antibody testing for female employees of child-bearing age at the start of employment. Employees
testing negative should be warned of the risk of contracting toxoplasmosis during pregnancy. Pregnant women should not handle cat litter,
particularly if the woman does not already have antibody titers to Toxoplasma.
Education of adopters about Toxoplasma is important. Since most human infections with Toxoplasma are not transmitted by direct contact
with cats or cat feces, the best prevention for the general public is to cook meat properly, wash vegetables thoroughly or peel before eating,
and wear gloves when gardening. To prevent Toxoplasma infection in their cats, adopters should prevent hunting activity by cats (e.g. keep
cats indoors) and avoid feeding raw or undercooked meat or viscera to cats (e.g. feed cats only commercially prepared diets.) Because
oocysts require at least 24 hours to become infective, remove fecal material from litter boxes daily, especially when introducing a new cat to a
household with other cats.
Adopters of cats in which Toxoplasma shedding has been documented need not be overly concerned about zoonotic risk, as long as the cat
has been isolated through the potential shedding period and cessation of shedding has been confirmed by serial negative fecal floatation
exams. As stated above, after the initial infection has ceased, cats are unlikely to become re-infected and shed oocysts again in the future.
Thus, cats that have a previous history of shedding Toxoplasma oocysts and/or have positive antibody titers could actually be considered
lower risk than cats that have never been exposed to the organism.
For more information, visit the following links:
Centers for Disease Control (CDC) Fact Sheet on Toxoplasmosis
Companion Animal Parasite Council (CAPC) & then search for Toxoplasma gondii
Diagnosis of Intestinal parasites
Protocols should be based on known prevelance of parasites for the region. The Companion Animal Parasite Council is one resource for such
information, as are local practitioners, veterinary schools, diagnostic laboratories and the scientific literature. Diagnostic testing for parasites
may provide additional information specific to the shelter either to refine general treatment protocols or direct the response to an increase in
symptomatic animals. Additionally, diagnostic tests are sometimes indicated to direct treatment in an individual.
Tests to identify and diagnose intestinal parasites differ in their accuracy. There are two main aspects of a test's ?accuracy:? sensitivity and
specificity. Sensitivity is the likelihood that the test will correctly identify infected animals (i.e. a very sensitive test has few false negatives, it
doesn't "miss" very many infections). Specificity is the likelihood that the test will correctly identify animals that are NOT infected (i.e. a very
specific test has few false positives, it is unlikely to identify an animal as infected if it?s not).
Note that several of the available tests are prone to false positives or false negatives. In addition, due to the parasites life cycle (e.g.
intermittent shedding or a long prepatent period) the test may be negative even in an infected animal. Finally, many internal parasites can be
found in clinically normal animals. Simply identifying a parasite does not mean it is the cause of the animal's symptoms, nor does it
necessarily require treatment. In some cases, it is more appropriate to simply treat likely infections based on the animal's history, signalment
(species, age, etc.), symptoms, and known risks in the population. Additional testing is indicated in severely ill animals, those that fail to
respond to empirical treatment, or in the event of an outbreak.
Fecal flotation (fecal float). In this procedure, feces are suspended in a solution with a specific density, so that parasite eggs and cysts will
float, while other fecal debris will sink. This method can be used to detect roundworm, hookworm, and tapeworm eggs, and Coccidia and
Toxoplasma oocysts. A fecal float is relatively insensitive for detecting Giardia cysts and tapeworm eggs, and cannot be used to detect
Tritrichomonas.
There are many different types of fecal flotation methods, and they can be categorized in two main ways: by the type of solution that is used
(Fecasol, sucrose, zinc sulfate), and by the type of force that is used to separate the floating eggs & cysts from the sinking debris (standing /
gravitational vs. centrifugation techniques).
Solution type. Solutions that may be used include sucrose (sugar), sodium nitrate (Fecasol) and zinc sulfate. Zinc sulfate is generally
preferred for the detection of most common parasite eggs and oocysts, because it is less likely to cause distortion of cysts. However, sucrose
solution is better for detection of certain parasites, such as Cyrptosporidium oocysts. The recommended concentration and specific gravity
and concentration for the solutions depend on which solution is used (for zinc sulfate, 33%, specific gravity 1.18 to 1.20; for sucrose, specific
gravity 1.25 to 1.33)
Gravitational/standing vs. centrifugation techniques. The commonly used Fecalyzer system is probably the most familiar standing fecal
float technique. While standing methods are easier and quicker, and do not require a centrifuge, centrifugation techniques are more sensitive
for detection of certain parasites, particularly Giardia cysts. Giardia will very likely be missed if only a standing technique is
used.Centrifugation may also improve detection of whipworm eggs. A centrifuge with free-swinging buckets is recommended.
Instructions for performing a fecal flotation with centrifugation:
Suspend 2-5 grams of feces in 5-10ml of flotation solution. This can be done by mixing in a paper cup using a tongue depressor.
Strain the suspension by pouring it through gauze. Discard the solids that were strained out.
Pour the strained liquid into a centrifuge tube (15-20ml size).
Add more flotation solution to completely fill the tube and create a positive or reverse meniscus at the top.
Place a coverslip on top of the tube and place the tube in the centrifuge (This step will only work when using a centrifuge with freeswinging buckets. This step must be modified for fixed-angle centrifuges ? see below).
Centrifuge the tube for 10 minutes at 600 rpm.
Nutter FB, Dubey JP, Levine JF, et al. Seroprevalences of antibodies against Bartonella henselae and Toxoplasma gondii and fecal shedding
of Cryptosporidium spp, Giardia spp, and Toxocara cati in feral and pet domestic cats. Journal of the American Veterinary Medical
Association 2004;225:1394-1398.
Spain CV, Scarlett JM, Wade SE, et al. Prevalence of enteric zoonotic agents in cats less than 1 year old in central New York state. Journal
of Veterinary Internal Medicine 2001;15:33-38.
Hill SL, Cheney JM, Taton-Allen GF, et al. Prevalence of enteric zoonotic organisms in cats. Journal of the American Veterinary Medical
Association 2000;216:687-692.
Sokolow SH, Rand C, Marks SL, et al. Epidemiologic evaluation of diarrhea in dogs in an animal shelter. American Journal of Veterinary
Research 2005;66:1018-1024.
Georgi JR, Sprinkle CL. A case of human strongyloidosis apparently contracted from asymptomatic colony dogs. American Journal of
Tropical Hygiene 1974;23:899-901.
Bowman DD, Lynn RC, Eberhard ML, et al. Georgi's Parasitology for Veterinarians. 8th ed. St. Louis, Missouri: Saunders, 2003.
Bowman DD, Fogarty EA, Barr SC. Parasitology: Diagnosis and Treatment of Common Parasites in Dogs and Cats. Jackson, WY:
Teton NewMedia, 2005.
Guptill LF. Selected zoonoses of dogs. North American Veterinary Conference 2007;606-608.
Marks SL. Demystifying infectious diarrhea: An update on the diagnosis, management and prevention of common causes of parasitic and
bacterial causes of diarrhea. Shelter Medicine Symposium: Building Community Health 2006.
Guptill LF. Selected zoonoses of cats. North American Veterinary Conference 2007;609-611.
Marks SL, Hanson TE, Melli AC. Comparison of direct immunofluorescence, modified acid-fast staining, and enzyme immunoassay
techniques for detection of Cryptosporidium spp. in naturally exposed kittens. Journal of the American Veterinary Medical Association
2004;225:1549-1553.
Scorza AV, Radecki SV, Lappin MR. Efficacy of a combination of febantel, pyrantel, and praziquantel for the treatment of kittens
experimentally infected with Giardia species. Journal of Feline Medicine & Surgery 2006;8:7-13.
Payne PA, Ridley RK, Dryden MW, et al. Efficacy of a combination febantel-praziquantelpyrantel product, with or without vaccination with a
commercial Giardia vaccine, for treatment of dogs with naturally occurring giardiasis. Journal of the American Veterinary Medical
Association 2002;220:330-333.
Barr SC, Bowman DD, Frongillo MF, et al. Efficacy of a drug combination of praziquantel, pyrantel pamoate, and febantel against giardiasis in
dogs. American Journal of Veterinary Research 1998;59:1134-1136.
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Source: http://www.sheltermedicine.com/shelter-health-portal/information-sheets/internal-parasite-control-guidelines
2010 UC-Davis Koret Shelter Medicine Program