Parasitol ResDOI 10.1007/s00436-007-0713-6
Crenosoma vulpis in dog: first case report in Italyand use of the FLOTAC technique for copromicroscopicdiagnosis
L. Rinaldi & G. Calabria & S. Carbone & A. Carrella &G. Cringoli
Received: 12 June 2007 / Accepted: 1 August 2007
Abstract Crenosoma vulpis is a metastrongylid nematode
In conclusion, the discovery of C. vulpis for the first time in
that infects the bronchi, bronchioles, and trachea of wild
a dog in Italy indicates that the fox lungworm should be
and domestic canids and various other carnivores. It is
considered in the differential diagnosis of respiratory
endemic in the red fox population in the north-eastern parts
disease in dogs; in addition, the findings of the comparison
of North America and in Europe, including Italy. Dogs are
study showed that the FLOTAC technique may improve the
susceptible to infection with clinical signs consisting
ability to accurately diagnose canine lungworm infections.
primarily in a chronic cough. The present paper reports—to the authors’ knowledge—the first case of spontaneousC. vulpis infection in a dog in Italy. In addition, it also
reports, for the first time, the use of the FLOTAC techniquefor C. vulpis diagnosis in canine fecal samples, with results
Crenosoma vulpis Dujardin 1945, the fox lungworm, is a
compared to the following four standard copromicroscopic
metastrongylid nematode that infects the bronchi, bron-
techniques: the Baermann technique, the McMaster tech-
chioles, and trachea of wild and domestic canids and
nique, the simple flotation technique, and the Wisconsin
various other carnivores (Bihr and Conboy ). It is
technique. The results showed that the FLOTAC technique
endemic in red fox (Vulpes vulpes) populations in the north-
produced mean larvae per gram of feces greater than that
eastern parts of North America and in Europe (Sreter et al.
produced by the other more widely used diagnostic tools.
; Nevarez et al. ; Saaed et al. ), including
After the treatment of the C. vulpis infected dog with a
Italy (Iori et al. ; Manfredi et al. ). Since the first
single oral dose of 0.5mg/kg milbemycin oxime, the
report in a domestic dog in the UK (Cobb and Fisher
clinical signs resolved and the shedding of larvae ceased.
very few cases in dogs in Europe have been reported inliterature, e.g., in Ireland (Reilly et al. ), Switzerland(Unterer et al. and Germany (Barutzki and Schaper
Dipartimento di Patologia e Sanità Animale,
Infection in dogs appears to be non-lethal with clinical
Università degli Studi di Napoli “Federico II”–CREMOPAR
signs consisting mainly of chronic cough; diagnosis is
based on detecting first-stage larvae in fecal samples using
the Baermann technique or fecal flotation techniques (Bihr
Dipartimento di Patologia e Sanità Animale,
Via della Veterinaria, 1. 80137 Naples, Italy
the first case of spontaneous C. vulpis infection in a dog in
Italy. In addition, it also reports, for the first time, the use ofthe FLOTAC technique (Cringoli ) for C. vulpis
diagnosis in canine fecal samples, with results compared
G. Calabria : A. CarrellaMarigliano, Naples, Italy
to other four standard copromicroscopic techniques.
A 2-year-old male English Setter from the Campania regionof southern Italy was presented to the referring clinician witha productive cough, a dribbled saliva, and dyspnea. Onauscultation, the dog had increased lung sounds over theentire lung fields. Bronchoscopic examination revealed ahyperemic trachea and a mucopurulent exudate affecting thelower bronchi. Nematode parasites were visible grossly, andthe examination of fluid collected by bronchoalveolar lavagerevealed the presence of adults of C. vulpis, easily identifiedby microscopic examination, as the presence of theirdistinctive horizontal cuticolar ridges at their anterior ends(Fig. Craig and Anderson Georgi and Georgi ).
Fig. 2 C. vulpis first stage larvae at 400× magnification. The larvae
Fecal examination by the FLOTAC technique (Cringoli
have a straight, pointed tail and their length ranges from 246 and308 μm (Wetzel )
; see next section) revealed the presence of C. vulpislarvae (95 larvae per gram of feces, LPG; Fig. and thepresence of eggs of Toxocara canis (4,428 eggs per gram of
2. The FLOTAC technique (Cringoli ), a new
feces, EPG), Ancylostoma caninum (26 EPG), and Trichuris
multivalent copromicroscopic technique in both human
The dog was treated with a single oral dose of 0.5mg/kg
3. The McMaster technique (MAFF ), the most
milbemycin oxime (Interceptor®, Novartis Animal Health),
universally used technique for estimating the number
of helminth eggs/larvae in animal feces (Cringoli et al.
Comparison of copromicroscopic techniques
4. The simple flotation technique (MAFF utilized
as copromicroscopic technique at most veterinary
For the study on the copromicroscopic diagnosis of C.
vulpis, the following five techniques were compared:
1. The Baermann technique, considered as choice tech-
nique for the lungworm diagnosis in canids (Bihr and
A 1-day fecal sample (≈130g) was collected from the
C. vulpis infected dog and accurately homogenized. First,ten replicates of 10g-based Baermann technique (technique1) were performed and analyzed 24h later. Second, theremaining 30g were suspended in tap water (dilution ratio =1:10). The suspension was then poured through a wiremesh screen having an aperture of 350μm and, afterdiscarding debris and homogenizing, was divided into 40aliquots of 6ml to have ten replicates of each of the fourflotation-based methods (techniques 2, 3, 4, and 5). Alltubes were centrifuged for 2min at 1,500rpm, and thesupernatant was poured off and discarded (MAFF leaving only a pellet in the tube, thus containing 1/6 ofgram of feces. Each tube was then randomly assigned to atechnique. A zinc sulfate solution (specific gravity = 1.200)was used for techniques 2, 3, 4, and 5. This solution waschosen from a battery of 14 solutions with specific gravityranging between 1.200 and 1.450 (Cringoli et al. after a pre-testing study performed on the canine fecal
Fig. 1 Anterior end of an adult of C. vulpis at 400× magnification. Note the presence of the distinctive horizontal cuticolar ridges
sample containing C. vulpis larvae (data not shown).
When the FLOTAC or the McMaster technique was used
FLOTAC technique was significantly higher (P < 0.05) than
(techniques 2 and 3), the tube was filled with the solution to
that obtained by all the other four techniques. Statistical
the previous 6-ml level and slowly agitated. The resulting
differences were observed neither between the mean LPG
agitated suspension was then taken up by a pipette to load
produced by the Baermann technique and the flotation
the two chambers of either the McMaster slide (Weber
technique (P = 0.793) nor between the mean LPG produced
Scientific International, England, volume = 1.0ml) or one
by the McMaster technique and the Wisconsin technique
chamber of the FLOTAC® apparatus (volume = 5ml).
When the simple flotation or the Wisconsin technique
was used (techniques 4 and 5), the tube was filled with thesolution to 15ml, covered with a coverslip, and left for
15min (technique 4) or centrifuged at 1,500rpm for 10min(technique 5).
European literature reports of C. vulpis in dogs are quitescant. Spontaneous infections have been recently reported in
dogs from UK (Cobb and Fisher Ireland (Reilly et al. and Switzerland (Unterer et al. ); in addition,
Data were double-entered and cross-checked, and statistical
data from 8,438 dogs from Germany revealed a C. vulpis
analyses were performed using version 13 of the SPSS
prevalence of 0.9% (Barutzki and Schaper The
software for Windows (SPSS; Chicago, USA). Mean,
present paper reports, according to the author’s knowledge,
standard error (SE) and 25th, 50th, and 75th percentiles of
the first case report of C. vulpis infection in Italy, a country
LPG values were calculated for the five different tech-
where this lungworm has been already reported in red foxes
niques. The statistical differences between the mean LPG
(Iori et al. Manfredi et al. The infected dog had
were analysed using analysis of variance (ANOVA; GLM
a typical respiratory disease caused by metastrongylidae. The
for repeated measures) in conjunction with the Bonferroni
treatment with milbemycin oxime showed full efficacy
against C. vulpis—as previously reported by Conboy)—as well as against T. canis and T. vulpis. Besidesmylbemicyn oxime, an anthelmintic currently approved for
use in dogs, although there is no label claim for C. vulpis,other successful treatment options against the fox lungworm
After treatment, the C. vulpis infected dog made a rapid
in dogs include febandazole, febantel, levamisole, diethyl-
recovery, with resolution of all clinical symptoms within
carbamazine, and ivermectin (Bihr and Conboy ).
14days; in addition, shedding of larvae in feces ceased as
The findings of the present paper also provide important
revealed by the copromicroscopic examination performed
new information on the performance of available methods
with the FLOTAC technique, performed at follow-up
for the in vivo diagnosis of C. vulpis infection in domestic
examination 2weeks after treatment. Further, no more eggs
dogs, an infection that might be more widespread than the
of T. canis and T. vulpis were found in the dog’s feces.
literature reports suggest (Reilly et al. ). In fact, larvae
Table summarizes C. vulpis LPG values (mean, SE, and
are not generally detected using the standard fecal flotation
percentiles) according to the copromicroscopic technique
techniques utilized at most veterinary clinics; thus, a huge
used and the multiplication factors utilized for each technique
number of C. vulpis infected dogs could be misdiagnosed
to obtain LPG values. The mean LPG revealed by the
as having allergic respiratory disease (Bihr and Conboy
Table 1 LPG values (mean, standard error, and percentiles) of Crenosoma vulpis detected by the five copromicroscopic techniques
*Significant differences for different letters (P<0.05).
). In addition, also the Baermann technique, consid-
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CASO CLÍNICO 2 PFJ , 50 anos, casada, professora de Educação Física QP - Efeitos colaterais de tratamento para menopausa HDA – Paciente antiga em que havia detectado hipotireoidismo há 5 anos atrás (TSH 9,8) desde então usando LT4 que foi aumentado progressivamente chegando a 88 mcg ao dia. Ausente há 3 anos. Ultima menstruação há 18 meses com calores, perda de disposição física na
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