March 25, 2022

#65: Ehrlichia canis update

#65: Ehrlichia canis update
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Season 1

It’s happened: In late January 2022, an astute veterinarian in Mount Isa diagnosed the first locally acquired case of the tick-borne disease, ehrlichiosis, in a Queensland dog. As predicted the disease is making its way south, and we want to make sure that you, like our Mt Isa vet, are able to spot and treat ehrlichiosis when it comes knocking on your door. Which, in all likelihood - it will, regardless of where you are in the country. 

This episode is a composite of two episodes that we released over the past two years on the Vet Vault Clinical podcast. Part one was released in 2021 soon after the disease first made its appearance in Western Australia in 2020. We speak to Dr Paolo Pazzi - a medicine specialist from South Africa where ehrlichiosis is an endemic disease and is commonly seen in practice. This episode covers the clinical aspects of the disease and aims to ensure that you don’t miss these cases and to give you a guide on how to manage them. 

In part two we speak to Dr Katy Davis, who works in Karratha in Western Australia where the outbreak started, and Professor Peter Irwin, THE guru in all things vector-borne disease. They give us an update on the situation in Australia, and the message is clear: it’s here, it’s serious, and it’s not quite the same disease in Australia as it is in countries where the disease is endemic. We talk about what you can expect, what to do and how to test when you see your first case, and we clarify some of the confusion around disease prevention. See it as a ‘how-to’ guide for Australian vets.

Thank you to Elanco Australia for supplying us with the expertise to help us clarify preventatives. Check out their tick preventative products, including the tick repellents Seresto and Advantix, as well as a new monthly chewable isoxazoline, Credelio, that will sort out you patients against tick paralysis, but as you'll hear, NOT ehrlichiosis.  

 

Who to contact if you have a suspected case of ehrlichiosis: 

Emergency Animal Disease Hotline: 1800 675 888.

Western Australia

Northern Territory

Queensland

NSW

Victoria

South Australia

 

Go to thevetvault.com for show notes and to check out our guests’ favourite books, podcasts and everything else we talk about in the show.

If you want to lift your clinical game, go to vvn.supercast.com for a free 2-week trial of our short and sharp high-value clinical podcasts.

We love to hear from you. If you have a question for us or you’d like to give us some feedback please get in touch via email at thevetvaultpodcast@gmail.com, or just catch up with us on Instagram.

And if you like what you hear then please share the love by clicking on the share button wherever you’re listening and sending a link to someone who you know will enjoy listening.

 

 

Some of them are presenting with the initial acute infection swollen lymph nodes pale gums with our Jake of food just that General kind of ill Thrift but we are actually getting a lot of dogs who are going from the acute through the subclinical and then sadly presenting in the in the chronic phase which is only taking, you know, realistically within kind of six weeks.
We've seen these dogs presenting in The Chronic phase which is really challenging.I need Burton's dress.I'm Gerardo Pope and this is the vid felt It's happened in late January, 20, 22 and astute veterinarian in Mount Isa Queensland.
Diagnosed the first locally acquired taste of the tick-borne disease aleosis in a Queensland dog.As predicted the disease is making its way down south and we want to make sure that you like our Mount eyes of, it are able to spot and treat the Lew Harris's when it comes knocking on your door.
And if you from the seven states of Australia and you thinking thank goodness, I don't have to deal with this horrible disease so I don't need to listen to this think again as you'll hear in this episode while it's highly unlikely that a look here is his will become endemic south of around Brisbane on the east coast and Geraldton in the west.
It is very likely that cases will pop up anywhere and everywhere due to travel from time to time.So it's worth being aware of at least what to look out for and what to recommend.In terms of protecting dogs, in 2021, we released two episodes.The vet V clinical podcasts about Ella Harris.
After the disease made its appearance in Western Australia, early in 2020 with the bacteria, very quickly deciding that it will also see you in the NT.In the first episode, we spoke to dr.Barlow, Patsy a medicine specialist from South Africa, where alejos is an endemic disease and is commonly seen in practice this episode is all about the clinical aspects of the disease.
Pathogenesis clinical signs, testing a treatment basically getting ready as a clinician to make sure that you don't Don't miss these cases.When they first start appearing in your hospital and to give you a guide on how to manage them from someone who's been treating, these cases at a high level all of his career.
After we released this episode though, we had some feedback from vets working in the midst of the Australian outbreak and it wasn't good.The message was clear.It's here, it's serious.And it's not quite the same disease in Australia as it is in countries where it's been present for a long time.
So we made a follow-up episode in late, 20, 21.With dr.Katie Davis who works in karratha and Western Australia where the outbreak sort of started.And with Professor Peter Owen, the guru in all things vector-borne diseases in Australia and possibly the world in part 2.
We discuss what the situation looks like here in Australia.What we can expect what to do, and how to taste when you see your first case.And we clarify, some of the confusion around disease prevention, we've rolled both these episodes into an edited sort of a how-to guide for Australian rates.
Listen apt right at the end for a state-by-state resource guide on who to contact if you have a case and way to send samples, we've also put links to these in the episode description and in the show notes, of course, I've also done a little addendum on prevention products as I had some questions of my own for my bit about what the best products are to use.
Also a quick thank you to a sponsor, we mentioning a lot of products in this discussion.So I contacted the guys, at a Lancome, Australia to see if they'd like to support the pod.Cast financially seeing as the rest o colors, which is now, one of their products keeps getting mention and they kindly said, yes.
So officially thank you, elanco Australia for supporting the vet with.I will take a moment to plug a flea and tick products of this.That I didn't know existed, until recently, the dealio, which contains aloe to Lana, which can hear by the learner is one of the Isaac's has olins, like effects Alana Flora lonicera Lana.
All the ones that are really good for tick paralysis, prevention, Trudy, Leo.Monthly chewable tablet with fantastic advocacy against ticks, including paralysis and brown, dog ticks.But as you'll hear from this discussion, along with all of the other drugs in this group, it will not be sufficient to protect against the harrises.
Let's jump in and find out more with dr.Pile out, but see follow, can I quickly just ask you the first thing that confuses me.Everybody calls it a bacteria.I thought it was something else.Is it look here bacteria or what?What kind of parasite is it?
It is actually a bacteria and and it's a special kind of bacteria because it's not your typical bacteria.Just gets into the bloodstream and gets taken away by neutrophils and that sort of thing, it goes and lives inside the monocyte.So one of the white blood cells and goes and lives inside their and essentially by doing that, and going living inside the monocytes protects itself from the rest of the immune system.
So it's a clever little bacteria that has learned to escape and evade the immune system.And that's part of the reason why you get different phases.Of Elisha follow in South Africa.What's the tick that spreads the, the bacteria live here.It's the brown dog ticks or the roof we syphilis, and good news.
Is that the same one you have this same idea?Same one here.So, yes, in terms of where it is probably going to go that tick.So if you Google the cattle tick line in Australia, that's sort of a line that cuts Northern coastal region of Australia, all the way down, pretty much already out of Brisbane all along the coast.
And as far as We know the dog tick for syphilis sanguinis, follows a roughly that line, maybe a little bit further south so it's unlikely that it will become completely endemic in the southern half of the country up there.It looks like it will probably become endemic.It's a, they haven't declared it as such.
But it's they seeing lots of cases.So, it's there, it's coming.It's there, and it's coming, just add has no chance of tackling this and getting rid of it.Now, it's not a definite no and nobody saying it is endemic but the As they sing, it is a hard one to get rid of.
I don't know follows you can if you can talk to that what why is it hard to get rid of?I mean once it's there it is extremely hard to get rid of because I can harm level Harbor in the tick for overwinter basically.So you think you got rid of it but also if it bites a dog is in the chronic phase has it can pick up the parasites or at least the bacteria again and then start spreading it all over again.
And the problem is you do have carrier status as in dogs, so they go into a subclinical face.As we're not showing any clinical signs at all, but they could possibly still transmit to a dog.So you think you got rid of it and then a year or two later pops up again.Yeah, what's the impact of this disease in South Africa?
That's very difficult to assist.I mean, you'd have to take it on a case-by-case basis.We do see a fair amount or Olivia, probably sure.I don't think a prevalence study has been done, but you're looking at about two to five percent.Dogs in our Hospital anyway, that do present with it and the effects on the dog.
Some of them are subclinical and they come can completely clear the infection on their own, but a number of dogs will be very critical for it.Very sick and they do require treatment.So it does have an impact on both dog and owner.So I very vague memories of it, as I left South Africa, long ago and you practice the more probably 23 years.
All I remember about earlier here is anything that comes in sick or has a fever gets a blood smear and we're looking forward for the busy houses.The video is easy to diagnose on a blood smear.Where is a live here?Not you could sometimes see it sitting in the morning sides.But if you saw me there and the dog had an unexplained fevers, this is obviously not a high-level practice, but we basically just put them on Doxie because it in case.
Okay, so Enlighten us, I'm sure that's not the way, it should be dealt with all.First of all.What do they present as follow?Really.Refresh my memory and tell everybody if we you've never seen it before.I've got a dog.Come through the door.What should I be looking out for?
That's going to make me think.Oh, shit, I should be testing for it, true.So sometimes it's extremely very good, dog.Just presents with lethargy anorexia and just not itself, but I'll most of the time I probably say, 90% of the cases we've got Something that that's giving you a hint, that there's a possible, a liquor going on.
The most common hints are going to be that the lymph nodes or enlarged.So you got peripherals lymphadenopathy and it's not, it's not lymphoma size.But, I mean, you're looking at about one and a half times a 2 times normal.So you need to feel, there's no studs.And they can be subtle but they often are quite a large.
And when you do an abdominal palpation, a lot of time, there's a splenomegaly as well because the parasite goes and lives in the white cells, it still causes an immune reaction.That's why you're getting lodging or of those lymph nodes.I don't know if you guys do blood smears, we routinely, because as you say, it's everything that comes in into left for gets a blood smear and because of the babesia, but if you do a complete blood count, if you're not doing blood smears thrombocytopenia in the acute stages is typical, so you can see here and it's, and it's sitting, it's not going to be the thrombus.
It typically is not to thrombocytopenia of immune-mediated thrombocytopenia, so it's not sitting below.It's 30, it's usually sitting in the range of between about 50 to 150.So that's a good clue as well, that there's something going on.If a dog presents to me with petechiae and ecchymosis and a bleeding nose.
So, if there's epistaxis, you know, I need to rule out a liquor because surprisingly every Stacks is quite a common presentation because of the thrombocytopenia and a few other things going on as well.Yeah, but it because like the vast majority of the times we would see a plate, the count of 50, To 150 would actually be artifact from clumping and the Machine kind of reading.
It's a part of that for me clinically I would do a blood screen.Check to see if those clumping, right?And so then if you see no clumping and then you have a low platelet count, then that's when you get bit more concerned.Yes, exactly.Definitely.And then, as you say, you can look in the monocytes in the acute stages, it's quite nice to pick it up.
You have to be okay, we have a Visa, but if there's something else going on with you, Dog, and your Mana sorts of factors were tossing, red blood cells.For any reason, it can be difficult to differentiate.And the actual bacteria itself is quite small, but they're often in a circular shape and there's little almost looks like granules with in that circular shape within the monocyte itself, but it's very poorly.
Sensitive e, even in the acute stages of the disease, you probably looking at about 10:00 10% to 15% two dogs that are going to have that on a peripheral blood smear.It definitely doesn't rule it out.So are we for testing at the moment?How do ya Emmett?So, you need to have obviously the clinical suspicion, so your thrombocytopenia your enlarged, lymph nodes.
Sometimes there's a mild anemia as well.I don't know if you guys have serology at this point.So usually our first step is going to be immunofluorescence antibody.So serology, IGG and IGM, my emergency, if it's positive.
So of course, the IGM tells you that it's an acute.Conviction.And that's going to go up after about.Yeah, depends on the dog, but about five to seven days after it gets infected.So you can send away for an IGM.And if that comes back positive, you have a cute early here.
Okay?I'm staying away from IGG as well.So that's the one that stays up for months to years.After you have an immune reaction.The problem with that one being positive, is that some dogs that are exposed to live here, they are going to rid themselves of the actual bacteria.So they don't necessarily I continue to have the disease, you have to be careful of the positive IG.
It may just mean that they've been exposed to the liquor before.Okay.Yeah, so that's what that that for me.Is this generally the starting point and it depends on my index of Suspicion and whether those come back as positive or negative.Because if it is the very early stage, you may not have antibody production just yet and then it is a good idea to run a PCR as well.
Okay?To look for the actual DNA of the bacteria.So the problem with that Course, is you need to have circulating parts of a liquor or D or helical DNA in your sample for it to be positive, right?It's not going to be positive if there's no DNA in your sample.
So you collecting a random blood sample for from this, dog, probably two moles three moles and you sending that off and hoping it's positive.So you can get false negatives with the PCR.Oh and I thought to be just like super sensitive.Like so sensitive.Like most engine gesture fix up.
This tiny little mountain.You're not too sure if it's clinically relevant.No, no.So you can't get false negatives and and that's the problem with the test the PCR.If it comes back as positive, you know that's that's perfect because then nothing else is going to do that.But if it's negative it also doesn't rule out completely.
But usually these dogs that you are suspicious they are going to have.I mean the easiest and cheapest for us anyway is to do an immunoglobulin.It's just if it comes back positive and your dogs clinical signs foot, you're going to treat for it, okay?And that's the at that you IGM, we're looking at yet If it's the acute phase.
Now, do you got to be careful?Because it's, sometimes very difficult to differentiate acute from chronic, okay?It's that even The Chronic ones can sometimes have enlarged.Lymph nodes and an enlarged spleen.
And if I'm going to test for liquor, I'm going to do both.I'm going to do IGM and IGG and then related back to my clinical findings and my hematology results and and why is it important to differentiate acute from?Chronic like you treat them differently, this is what is it, what does it mean for us in practice?
So that's a good question.You don't, you don't necessarily treat them differently but the chronic ones tend to have more problems.And what I mean by that is they can live in the subclinical phase, four months, two years and they have absolutely no science but what they're doing and you don't realize it until the whole Baron.
All the bone marrow is destroyed is that they're destroying the bone marrow and then if it is chronic, and you have pants are to piñas.We're talking Reds are white, so, and and platelets.If you have that your prognosis becomes poorer for Recovery, depending on how low your white cell count is, or how low your red cell count is okay.
So that even if you eliminated with like the treatment doctors, talk to somebody in the damage, there is chronic and it's irreversible or something.Exactly.So if and now the prognostic indicators are a persistent, anemia of lesson, 14, and a persistent.
Neutropenia So, Lucas odd, and specifically, neutrophils of less than 1.If you have that on your initial blood work and you diagnose Olivia, the chances of recovery are quite small.You know that power is unlikely to bounce back and you need to treat them the usual course of Doxycycline and then you need to give support to frequent because as you can imagine, if the white cell count is less than 1 and your dogs, very prone to opportunistic infections and that's amazing.
Wow, so this is what they call it like my oh, the thesis or something I kind of Other words, the scarring of the bone marrow or something Yo, Mi appliances or myelofibrosis depending which one you have there.So so how does it work?Was if they sit in the - sighs, how does it start destroying the entire bone marrow?
What's the better Genesis in there?We don't actually know, there's been very little research into, exactly how it how it destroys the bone marrow.So with acute, phase is thought to be an immune component with and that's why you get the thrombocytopenia because it's Ali partly destroying the platelets.
Through an immune process, okay?In terms of how exactly it destroys the precursors or fix the precursors, it's not clear.We don't have a clear answer on that.So treatment-wise.Are we a treatment or we are we missing anything anymore?Like are they sneaky ones that we're going to miss clinical presentations, things like that?
That we that we brushing over.The other thing that might point you in the direction over there, here is hyper Global anemia friend and you got to be careful of those because the differentials are, of course, things like lymphoma and multiple myeloma and they can be surprisingly High.
These hyperchloremia sometimes sitting in 65 70 zones.That's quite high for globulin.So that's just something else you might pick up on your biochemistry that will point you in the direction of the lake here.It's always a treatment.I think so, can we, can we talk to you?
Hey, this thing is a freaking pain in the ass.It's like that is because you get such a mixture of of presentations, I mean, and, and everywhere you read.It says it's difficult to differentiate a cute from chronic and it is important because it has an effect in your bone marrow, but you get such very presentations, everything from just depression to do, the extreme of having absolutely no white cells left and it can be such a confused sometimes, do I really have a?
Do I not have?It and it's like Hubert said in the beginning, you know, sometimes in private practice in South Africa, if you just mildly suspicious, you're going to treat because because we see it so often.Mmm, so treatment.Why do we do?So we've got our results back.Do we differentiate our treatment?
If we suspect it's chronic or acute?Or is it just the same way we do?We're all at the same treatment know, so it's the same.So it's doxycycline 10 milligrams per kilogram once a day for 28 days, stock standards.That's what acute or chronic gets.
So there's variation you can give the doxycycline had five milligrams per kilogram twice a day because some dogs may not tolerate to doxycycline so well but it's still 28 days.It's been a lot of articles on how long you should be treating for.
And one of the concerns is that even after a doxycycline treatment of 28 days, even if the owners very good about it and gives everything that the parasites, or at least their bacteria can can persist East.And what's amazing about this bacteria is that usually you see a clinical response to the dog does clinically much better after about 2 to 4 days dramatically better, okay.
But the hematology legs.So if you had a thrombocytopenia and that sort of thing you probably going to see any what you do.See Improvement about seven to fourteen days later but that is a stock standard treatment, the concern.Like I mentioned is, is that sometimes it comes back and this is even if the dog hasn't been exposed to ticks over owners, very good with Tick Control, They do get relapse or sometimes the, exact prevalence of relapse isn't clear, but you should be retesting your hematology in about four to eight weeks after your doctor stocking course is finished, okay?
To see if there's any signs of your thrombocytopenia or you can also, by the way, I forgot to mention, you can also get a monocytosis with this whole disease as part of your CBC results.Okay.So if any of that comes back then then you need to be worried that that you may have recurrence of the Alicia and are we monitoring our hematology during the 28 days like a frequently, would you be getting it back in and checking blood on it?
Yeah.So there is some recommendations, it has to be what you come to with, I don't stick quite with recommendations to be honest.I think it's a little bit of a waste.What I tend to do is about seven days after I've started treatments, I get them back and make sure 7 to 10 days.
Make sure that the CBC And the platelets are at least looking a bit better and it's on the road to recovery and the dogs doing better and the lymph nodes or smaller and all that sort of thing.And then the next time point that you should be doing a CBC is at the end of treatment and really you should have normalization of your cell Lines by then, you know, and then after that you should see them again in 48 Greeks, repeat the CBC and see what's going on then.
And I we re checking any of the serology or the PCR at any stage or to check whether it's plated or not, that's a great question because serologies not good to use because unfortunately, it will be positive because the dog has been exposed to it, so it can be positive for months to years, especially the IGG afterwards.
She actually used for monitoring but you can use the PCR for monitoring.So we have seen a number of relapse has and then we send off the PCR and sometimes it comes back as positive and sometimes it comes back as - and that's pretty much for.
The reason I mentioned earlier you may just not have the action America in your sample and you just got lucky, okay?But if all the clinical signs were exactly the same as the first time, even if your pc r is negative, then I'm going to treat anyway.Okay.The dog was Old and deok seon the sons came back, even if he shows - going to treat, so in an Ideal World, you going to check your PCR again at four to eight weeks to make sure that it's gone that there's no more circulating Nikki.
Oh, that's often expensive.It is expensive to run a PCR and it's often not practical.So we base.A lot of a dicey on our decisions.Basically, on a CBC, okay?Because there's a lot of controversy as to whether you should be treating an asymptomatic dog that has a positive PCR for Alicia or not because if a dog comes back positive for PCR and it's cbc's, completely know, when the dogs completely normal, will it not rid itself of that infection is the real Student reinfection or was the relapse?
Because we haven't quite eliminated and it's coming back.Most of the time it's because it's, you have any limited properly, and it's coming back, okay?And do they get them basket?Some degree of immunity?That, would you get if it's headed once, can it get reinfected?
Because you have these lingering antibodies, there's a desert land, any protection or not really, no antibodies.Don't because it goes into the monocytes.Okay, if the bacteria, get some honesty.I can dance, but he's pretty much don't work.So they know ongoing community and they can get if they get.
I mean, if your own is look bad and and doesn't treat for ticks and re-infections definite sacrifice was the first time because we talked about relapse has and so forth.Is there a way of being sure that a dog is clear?
If it's moving out of a ticket zone, is there any way of telling, who may have future relapse?Has sure.So there's Best you can do.So, is to treat the dog for 28 days, that's your best option, wait for weeks, and then in a perfect Ideal World to try to make 100% sure is you should get blood, you should get splenic aspirants and you should get bone marrow, aspirates and send those for PCR.
Well because it loves in the spleen and it lives in the bone marrow.So the only way to make sure your dog is one well and even then you may miss it.But the chances are small that you'll miss it, if you take samples from all three of those, Those sources.So blood spleen, and bone marrow.
So, it's a quite a invasive process to be 100% sure he's gonna castrate.You don't need to take a chunk of screen, but, but still it at requires, some multiple aspirants Paulo or just, I mean, you need to get enough to run a PCR.
So it's really not a lot.I think it's 100 microliters for Run a PCR.So you just need enough of that zone for you, okay.So it's not this, it's not cytology.Look at it, look at PCR.So you're sticking it on This Plane by ultrasound and you suck some blood and get some blood out.
You like done, kick at the kneeler out.Exactly.Yeah.He's a snap test available because apparently there's one available in the US.So the one that I think Andrews talking about is a vet for DX test which also test for the more endemic things in the u.s. we do have an Alicia SNAP test here, which is just a basic, that's not an addict stairs, but it's a simple kind of almost like overlooking chest.
That's not a snap test, and I don't know the sensitivity and specificity you have to pick up antigen and I think a fair amount.So If it's positive again, it's useful.If it's if it's - I'm not convinced that rules that out I guess because we don't use them routinely here.
Okay, the vet for DX test in the states, is very sensitive and specific.But it's a little bit of a waste because it tastes for the other three diseases as well.So it's like 97% sense to have a 98% specific.So it's a very good test to run, but on these little ones or Felicia taste, we don't know the sensitivity to be honest.
So just so That, you know, that one can be very good and we don't know the other one.So other other treatments.As soon as you said an immune component to wiping out the bone marrow are we giving them immunosuppressive?So is there anything else we give or is it just their have you doxy good luck.
So have you Doxie have a nice day.So pretty goodness goodness.Alone has has not been shown to improve outcome at all.It doesn't improve the right the bone marrow responds.It doesn't improve how quickly they can make irresponsible So the only time we do is when we think we have Olivia and it's the cause of an INTP.
So in other words, an immune mediated thrombocytopenia, so if your white cell count is sitting less than 30, it just becomes less likely that that's caused by Alicia.And if it sits down if ten or seven your if your platelet count, keep sitting that low then you probably have an immune mediated thrombocytopenia so you can read to you a liquor.
And we do think that we see a lot of autoimmune diseases, secondary to Alexia.So that's something else to keep in mind as a sequela of Alicia itself, you can get an auto immune component, including I'm a chain, including I MTP.So I would never use, I would never use prednisolone in a dog that has a place account of 70, because it's not.
I am GP, but only if it's sitting really learn.I think it's a cause of the IMT piece.Hmm, I'm surprised that they actually had clinical signs of primary key mistake does things with with, you know, platelet counts of, I don't know.Dies or something like that.
I don't know.Clinically I'd be, I just don't really ever see that.But I like the kind of for you saying, in a way that it's like generally forget that low, then there probably is some kind of immune mediated component.But if it's not that load then maybe it's just the fact that it's just the infection itself.So if you're exactly does it I was thinking the same thing about the numbers that sound that low just not getting nosebleeds.
It does it affect the functionality of the the remaining players like are they listening?Yeah, that's authorities.That it's either the parasite itself, which seems less likely.But the more likely contributor is the is the globulins that of that, why aren't you platelet surfaces and then affect their function.
So, that's one of the biggest contributors to dogs actually showing petechiae and ecchymosis, and all that sort of thing.Damn, who brought this freaking thing for the country.That's been one of the question about vitamin B12, you know, they said to come vitamins come up with a lot.But is there any proven benefit with using vitamin B12 as part of your management?
For this disease.No, not to my knowledge.No, literally nothing else, no curve?Well, tumeric.So you know, so the only times you got to think of adjunctive treatments is when they are in those, chronic pancytopenia phase and then it's supportive care.
And there's a little bit of controversy about if neutrophil count is less and less than 1000.So less than one.Do you do you start antibiotics?Do you not know?So my thought process is if the Dog is eating and normal and not febrile.
Then if you starting antibiotics in that stage, all you're doing is breathing for his assistance, in your dog, because only bacteria that is that are going to survive all the ones that are resistant.So in my opinion and again, there's controversy, you should wait until the dogs febrile so that whatever first line ends goats you do use is likely to be more effective because the majority of infections they do pick up are opportunistic.
You know they're not necessarily severe pathogens, that's a really good thing you covered there because you know, we get You know, neutropenic or leukopenia, patients part of chemotherapy and then everyone's kind of like threshold full for How brave they are and holding off anybody different.
So sometimes we start when it's less than 1, because it just sounds really bad.But I like what you said there, that kind of really resonates with me.It's very controversial though, and some oncologist will start at less than 1 or 1.5, but for me it just doesn't make sense.
You breeding for resistance, basically?Okay, that was the clinical part stick around for dr.Katie Davis, and Professor Peter, Owens discussion on what things look like for us and our Immunology.
Even logically naive patients down under a quick.Reminder about our clinical series of podcasts.If you enjoy staying up-to-date by listening and learning, while you're on the go like this, and you'll love our clinical podcasts three short episodes per week in small is medicine, surgery.
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Yeah, absolutely.We're seeing it every day.Every day, it's coming in.So, unfortunately, initially when it started, we were seeing a lot of the dogs coming from the communities outside of karratha.They were coming in and testing positive, but now we're getting positives, well and truly in the middle of the town's.
So these are, but well cared for pets that are coming down at the liquor.They do well, cared for dogs who sleep in pajamas on couches, you name it as effective, tick, prevention, as what a lot of people were doing here.So I monthly oral preventative.
And unfortunately, yeah, we're still getting positive tests.Okay, so we'll come back to that.I want to ask Peter to give us a rundown of the actual transmission, and all of that.So we can understand how to do have effective prevention.What are you seeing Katy?Why do they coming in as a, you just seeing fever dogs coming in?
Are they coming in bleeding?What's the sort of clinical picture that you mostly see?I put it into groups.We definitely still because we work a lot with a rescue organization.Safe, we get a lot of dogs again, out through communities Etc.They're coming in and we test every dog that goes through that organization.
So we are seeing a lot of positives that would probably otherwise not be picked up, okay?But then our second group is the dogs who you wouldn't suspect the dogs from you know in town.Well cared for that side of things.Some of them are presenting with the initial acute infection swollen lymph nodes pale gums.
Skyfire, Jake of food just that General kind of a thrift but we are actually getting a lot of dogs who are going from the acute through the subclinical and then sadly presenting in The Chronic phase which is only taking, you know, realistically within kind of six weeks.We've seen these dogs presenting in The Chronic phase, which is really challenging reminders.
Again, Peter The Chronic phase.What do they look like?So The Chronic phase, dogs are usually emaciated and the Very Thin they not eating it.Ben of a sort of progressive decline.I guess they'll often be febrile and they'll also tend to bleed because the classical understanding of this disease is that the chronic phase is the sort of bone marrow, failure phase.
So, those dogs are very liable to sepsis and it's the fever, they become anemic, they thrombocytopenic Omar has failed and so they bleed as well.So you can get that sort of combination of signs and it's interesting.What Katie says, about this really rapid progression from from what might be, you know, acute disease to chronic disease.
And that's something that practitioners are reporting all around Australia during this outbreak.And that's different to the, if you like conventional wisdom, or if you look at, if you read a textbook, people talk about that, chronic phase being months to years later, even.
But I think that We have a unique situation here in some respects.The canine population is naive.So, none of these dogs have ever seen liquor, of course, plus we have very heavy tickbird and particularly in the communities that Katie was referring to.
So it's a combination of high dose of a liquor, a naive population.And we're seeing this rapid transition of disease in the chronology.Now, the one of the biggest feedback I got from that.So when we asked dr.Barlow, why do we do for, what do they do for prevention?
What's an effective way to prevent?And he was pretty casual about it.He said, pretty much anything that's going to kill it.Take it's going to prevent it and had quite a few people including Katie saying, not the case for us.You have to be more astute than that before we get into actual products and protocols talk to us about the transmission Peter.
How long does it take from B to infected in that?What's the pacifist behind it?Okay, so any stage of the tick can pick it up.So, lava, nymph, adult.And you remember that ticks only feed once.So, they will then have to mold into the next stage before they can transmit it.
Okay?An interesting, actually, the females can't do that.So that the next stage, after a female eggs and larvae, and this is not a trans overly transmitted disease, so lovey.Lovey can't transmit it unlike but be easier.For example, but Lobby will transmit.
But bz osis, because they're trans.Oh, very early transmitted.That's not the case.Us for a liquor.So nymphs and adults will transmit.Yep.To the dog.Okay.Okay.And so the thing about this, that is so critical from a treatment or preventative perspective is that there's now plenty of research to show that a liquor canis is transmitted within three hours.
Well, in three hours of lighting, you know, almost instant it's not quite as Instinct as a mosquito transmission or Same flight transmission, but it's within three hours of the tick beginning to attach and that's absolutely critical in understanding how to prevent a liquor in any given dog, because although the group of drugs that we use most commonly these days, I Sox's olins, they're an excellent group of drugs, but they rely on the tick, having attached and being biting and been feeding for some time to work.
Yeah, they've been very, very effective, for example, along the Eastern Seaboard and Australia, Venting tick paralysis.Yeah, that's that's been amazing.But with this disease is transmitted so quickly, you need a drug that kills the tics or repels them, okay?
Before they even attached.Okay, so what are we looking at Katie?What are you guys?What are you suggesting to your clients?Then why do you find is working.So we aware typically suggesting agile approach.So something like a monthly or a 3 monthly preventative.
So Next Guard, productos him Perico, whichever the owner is more But wait, but then also I second line or I guess it's a first line of defense, like Peter said something to actually repel.The tips are so Resto collar where we can or something topical that cab antiques or ticks phrase out in the communities as well to try and prevent the actual Tech biting.
Okay?So let's go through the repellents.What are they and feel free to say brand names?This, I want to make this practical.What are the effective repellent?Okay, so there are two drugs that are available.For preventing tick bites and tick attachment or Permethrin and flew, mathurin and these are available in, its Katie was saying, I colors and a spot on.
So the surest, oh, collars contain a flume Efrain, which is an Icarus.I did prevents the text from attaching abiding in the first place and kills them as well.And then also Advantix, which is the Permethrin based product, which does a similar thing.
The important things about both of these drugs is that they have been Shown through experimental study to prevent dogs.Getting a liquor canis.So, you know it's all very well know that they kill and prevent ticks, but the studies have been done to show that they prevent this disease.
So, for individual dogs, this is the best way to protect them.The, our socks as islands that Katie mentioned are very effective.Well, they're very effective at killing ticks and once they've been attached, and they're very effective at reducing burdens in community.To, and we've had a lot of reports about Out when they used a lot that the tick burden overall, the sort of community or the environmental take burden Falls considerably.
But unfortunately, those drugs will not prevent any given.Dog.Getting a lucky osis and that's a message that has to be gone across.Okay?That's vital because we missed out on that one.And the last episode Katie.Anything else there on that front?Yeah, and I think exactly what paid this that I guess here the practicality and like like I was saying if we could get us arrested Cola on every dog.
And we would when it comes down to the actual practical earlier, that's where we really, really struggling, okay.And now, in terms of distribution in Australia specifically, so it's the brown dog ticks?Yep.Round again, don't take their ethically have.
Can it go based on climate and distribution of the tick half-assed South?Should we be expecting it?Okay.Well, the the brown dog ticks or enzootic range, that means it's the range where it's naturally found, if you like all comfortable being found, Is old, throughout the tropics, so north of the Tropic of Capricorn, but because Australia's because of Australia's geography and climate, the, the tech has been found well, established, well into Southern parts, of the Northern Territory and Northern parts of South Australia.
So, there's a sort of dip there in the middle of Australia and then it extends down east sea.Each Seaboard quite a long way.So down to Geraldton and even John Calipari on the west coast and down the east coast.
Probably even as far as Brisbane and on into Northern New South Wales.Okay.And that's where the climate is suitable for the tick to even Thrive, but, but what's important about this stick is it's referred to as being as an endo philic Tech, which means it's adapted to domestic or household living its evolved with domestic dogs for a very long time.
Okay.And so, it actually has the unique ability to be able to survive in.Houses in places far from its endemic range and this has been particularly well described in.Europe tickets, come up from the Mediterranean and has established in northern Europe.
You know, we think of Germany, the Netherlands, even in Scandinavia and the UK, where it cannot very tropical at me.Not very tropical, you're absolutely right.Centrally heated houses, and that it can survive and if it's a female, you know, gravid female for example she'll lay her eggs.
They won't desiccate if it's warm enough and not too dry.They want to skate they'll hatch and those tips Will Survive.So you get these clusters of ticks surviving quite well in those locations now you know Melbourne Sydney will be very long time before such places have left behind dog.
Taxi.That's going to have some pretty serious climate change for that to happen.But but I think it's worth reiterating that the stick can survive well beyond its range.And and of course, traveling pets and traveling ticks other problem.Yeah.Yeah.So we all have to kind of keep it in the back of your head.
You live in Melbourne and I'm going to be seeing regular cases, but it you might see the are traveling dog.Bring it in, but all the way up to resident.You say Brisbane, we could expect that.It might become a more regular.So and then diagnosing it, we talked about a PCR when we talk to dr.
Paula.What's the, the current standard Katie?What are you guys using and Peter over here if you think you've got one where we sending it to?Is it still funded by the When just basically, what's the current situation was tasting for it?Yes, at the moment, we were waiting to see after the state election over here whether it change from exotic to endemic but currently it's still considered exotic and notifiable disease.
So every dog suspected, every test, every dog tested goes through the DPI Labs, so essentially, I don't that comes in.If we've got suspicious, if we've got high suspicion, we are running a 4dx in in clinic to test for heartworm or anaplasma.
And coincidentally, if it comes up for a liquor as well, we're obviously aware of it there.And then the thing with the 40 x and Peter will be able to correct me on this but I believe the 40 x is missing some of the particular Australian streams where you can get a negative in the 40 x and then you send it away for PCR and it does come back positive.
But we do have the ability to obviously then pick up our babesia and anaplasma as well, which we are seeing a combination of.So basically every dog will get a blood smear where we have a look, For the morrow, a we do a CBC prior to any dog undergoing surgery in our Clinic because of the high chance of thrombocytopenia.
And we are picking up a lot of dogs who are coming in just for their routine.Space routine Dental is ETC.Every dog now gets the CBC prior so that we can have a look.Obviously if we see a monocytosis and a thrombocytopenia where there and having a chat to the owners doing a 40 x or sending the blood straight to DPI to have a PCR, analyzer test.
Well yeah, that sounds like my days in South Africa, you didn't touch.Anything with a blade but at least looking at a blood smear.Yeah, yeah, yeah.Anything to add with the Diagnostics, a pewter that no just to reiterate what Katie said that?The seems to be a sensitivity issue with the snap 40, executed by decks and so PCR is the gold standard I guess at least for acute infections.
One of the problems we're going to have as Veterinary practitioners in Australia with this disease is that once they get into a more chronic phase and I'd be interested to hear what Katie is.With with cases of mind being more chronic, but it is known that the PCR becomes less sensitive because the DNA of the, the bacterium, is not in the blood all the time in more chronic cases.
And, you know, people have done studies to show, which tissue type is more sensitive or better to use for a diagnosis of the liquor.And that's included lymph nodes and I get a lymph node, a spurt is easy enough but spleen or bone marrow, you know, not really feasible.So that's something to bear in mind that the sensitivity View the PCR decreases with time but then this feeds into the success of treatment to actually determine if a patient is cured is extraordinarily difficult.
In fact, I'd even say it's really impossible unless I unless you're doing serology and Teeters like immunofluorescent, anybody teaches in you actually get a teacher and you follow that dog over weeks months or years and you can show the teacher comes to 0 again, this is Impractical.
Yep.It's Difficult to know if you successfully treated.The patient on the, have a quick question for Peter on that one in terms of acute infections.What is the current timeline in terms of somebody sees a tick on their dog?How early would a PCR test, be able to pick up?
Is it basically, in that first week after the, after the bacterium has been transferred?Yeah.Well, I think it's less than than that.There are studies that have tested.Exactly.This.I think it's two to four days.Okay.Yeah.Yeah.We talked.We talked earlier about the bacterium being transmitted within three hours but of course then takes a while for bacteria.
Yeah.Multiply and get into the bloodstream.My recollection is two to four days.It's certainly much less than a week.Yes a way we stick at it from a practical side, if somebody brings up and they say I've seen a dog, I'd take on my dog, I want to get it tested.We go at one week.Post that incident.
Just for kind of a practical buffer.Would you change that and decrease it down?Or do you think that's okay.I think it's And then you doing a PCR for that in that instance, Katie.Yep, a PC Elsa every because again it's still a notifiable disease.Every animal with suspicion or and that is included in terms of location, it gets a PCR test, I guess go back to what Peter was talking about.
I think this was I what I would like to chat to Peter about it as well, because we are seeing such a speed between the acute subclinical and then chronic phases so far, I haven't any dog.That's kind of in that chronic phase that I've sent away a blood test for peace.ER and Eliza the blood tests have supported our suspicions.
So I haven't come across one as of yet where I'm convinced that the dog is, in fact a where they live here and I'm not seeing it on a blood results.Oh I don't know if it's whether we're seeing it at that speed across the acute subclinical.Chronic so far store you know, in a year or so once we've had a few more whether we're going to start running into that problem of where we actually should be aspirating and testing.
Yeah, that's right.It's really interesting.Again we're using the sort Conventional wisdom, aren't we?We using the literature here that talks about this problem, but then the literature has been published overseas has a different epidemiological or different chronology of the disease.
At least, we have here.What we were talking about earlier.So, I think you're right at the moment, you do PCR in the blood, in all these cases might be fine, but it as we get further down the track and I'm sure in South Africa with endemic stability of this disease, that's an issue for them as well.
Yeah, so practically speaking, what are the guidelines at the moment?Katie for dogs moving out of that area to see a rescue dog, which is quite do you have guidelines, how do you decide okay, you're okay to move to Melbourne from karratha.
Yeah, yes, I will.This has caused a massive headache for me.All this year are currently wa only has a dog movement guideline and a strict hard border technically out of the Kimberley.So, from the kimberley's down, then dogs have to have proof that they are. - and they have to have proof of tick, prevention to move South.
However, in saying that, like I said, going back, we work very closely with safe, which is a rescue organization and work very close with them to, basically come up with a guideline to ensure that we're not sending high risk, dogs down, south ovaries, Etc, through the adoption progress.So, process, so what we do now is every animal that comes or every dog that comes through, they get the initial PCR test if they're positive, they get the four weeks doxy.
And then they have a follow-up PCR test, two weeks after finishing the dogs.E, as per the D guideline and then another six weeks after that second test as per the DPI guidelines.And then we actually are applying for a movement of dogs for any of these adopted animals so that the DPI can trace their movements.
If they head south, they have to show that they have appropriate tick, prevention, two weeks, prior to moving south.And we also have implemented a waiver of sorts of.It's basically a nice little poster and it's something we could probably share for other clinics work.Rescue organizations.
Nice little poster that basically says, hey, I'm a dog that's been adopted from Annie canis area.Please be aware that if I have been positive and I have tested negative, this may still be, you know, it may still come back in the future, just in layman's terms for owners, please look out for these signs and present to your vet clinic, and make sure that your vet knows that I came from.
Annie came as positive area, so we're trying to put in as many safety buffers as possible for owners for dogs for vets working down south because, obviously, they're not seeing it to the extent that we are, Seeing it, but it is a very it's a pretty tedious, tedious process, comments, Peter.
That's very responsible, that's good.But it sounds like you'll get the old one, the, through the net, the test test - potentially, it could live happily somewhere and then flare up.Again, that's true.In addition to all the others that don't get tested responsibly.
Yeah, because, you know, the that's the other thing that's whole movement of dogs across the north is enormous movement of dog.Between communities but also in traveling people, Katie with any things that when you started looking at this that particularly challenged you, well it's anything that we haven't covered yet.
You listen to the previous episode as well, stuff that you had to phone Peter about ization.I'm stuck with this.Give me a hand that you think would be useful for listeners to know.Yeah, I think I think it's starting to slow down now, but I think the scariest thing at the first was the fact that our dogs were dying and for all reports, When you read the literature and people's experiences in South Africa, southeast Asia, South America, their dogs weren't dying.
It was just a case of every dog, has it.Give it some, give it some ducks and they're fine.But we were, we were seeing deaths every day.I'm still seeing dogs.I had one just a couple days ago, died.Just why do we ask is that despite treatment?That's these dogs presenting in The Chronic form but it's only been a week since they've been bitten and we are getting a lot of dogs presenting The Chronic form and unfortunately the bone Mary damage and they Then Facebook spontaneous bleeding and trying to turn them around is yet, we are still definitely, always in dogs, own dogs, and also Community dog.
So, I think that was the big thing and I think at first, a lot of people kind of brushed aside saying, oh, you know, it's fine, dog survived with this.But that's not what we were seeing on the ground.And I think it's taken a little while for people to sit up and listen to what was happening here.And now, in Australia, and seeing it as a little bit of a different response, here, we do see it in combination with anaplasma and babesia quite often.
So, We do get secondary complications from that side of things.I know I've sent Peter a couple of cases where the dogs are too far gone and the secondary immune-mediated diseases associated with it as well.The other really interesting thing that came about it that I have spoke to Peter about was the opportunity.
We had to follow pregnant bitches and see whether it when they were positive, see whether their pups were - which has been awesome just from kind of gaining error in data.And we've had both instances where a pregnant, bitch has been Positive Charlie.Yeah, her puppies have tested negative and vice versa where we've had a negative bitch and the puppies have actually tested positive just from obviously been exposed to an infected tick.
So we're seeing that side of things up here too and so so the pups not positive from it's not transferred by Mom's blood, it's like, just kidding but no.Yeah that's right for whatever reason that the bacterium wasn't transmitted to the pups across the placenta which is strange Isn't it because any other bees?
But these you can be for example.So I guess keeper.Keep a lookout Katie because you may yet find some.Yeah.So we're testing like again with the community dogs in the safe Dogz.We get a lot of opportunities, so every Beach that comes through pregnant and then the puppies and we're following it and so far no data is going against what the current understanding is, I guess the only thing that we have to be very aware of our peers, blood donors, obviously the potential to transmit via blood donor.
So all of our blood donors are now Going to be screened for a leap year as well.And again, screaming with the PCR.Yeah, you would.It's going to say you're not just doing.Absolutely, I'm just a 48, the 4dx.We only really use in.If you want an answer there and then in the clinic as much as possible, every dog still gets blood sent to the DPI so we never realized so Leona for DX.
Okay cool.Is there anything else that we missing Katie that you think people need to know about?I think just the awareness again like Peters mentioned the ability for these texts to live outside.Then known happy environment with the on say I know in wa with David.We seen Travelers everybody from down south is swarming up north.
A lot of these people are very much of the mindset, you know, my dog doesn't get tix ever.And that's great from, you know, a Suburban backyard in Perth, but when they are moving North.So I think it's very important for vets to be aware of it.And to really be pushing, especially in wa Northern Territory.
Queensland, obviously dancer, Northern New, South Wales, just that awareness that if people are traveling that, if they're not protecting, protects obviously, the east coast is a little bit safer because you guys, Check for paralysis.Take that over here.No nobody a lot of people going to Nile but trying to get that through to them now that you know the it is the brown dog.
Take if you dogs are dog, there is every chance that it's going to get a check and with a transfer of potential years lowers three hours, it's just not worth the risk.Okay, a quick update on what to do if you have a suspected case of a look here.
As of March 20 22 the disease remains a nationally notifiable disease.This means that testing to confirm a diagnosis is still free regardless of where you are in the country.If you have a suspected case you can contact the emergency animal disease.Watch hotline on 1-800-695-1418 the presence of econ has infection in any dog in Queensland.
You must report it to Your security Queensland on 13, 25 23 and in wa you can contact DP'd.Vit, D p.I r d.Links are all in episode-description, including links to the appropriate labs, to get it tested in each of the states.
Now, a few more things around prevention.I spoke to one of the weights at alenko and did a bit of Googling on my own to get some clarity on a few things around preventative that I wasn't quite clear on.So here's what I've got for you.So we said that because of the rapid speed of transmission of a living carnist, will need to use a tick repellent to stop The Tick's biting.
We mentioned the rest of colors and kill tick, Scholars, and Advantix spot on as our tick repellents here, in Australia.Only series though, and Advantix have been shown to block transmission of lacan has and dogs.But only surest oh has an approved label claim in Australia.
So recommending, anything else would be off label including Advantix and kill ticks Advantix contains Permethrin.So obviously take A with Kitty, and it should be applied monthly to repeal and kill brown, dog ticks, so Resto and kill ticks, both contained, flu mithran.
As an economist, I'd kill ticks, is the cheaper older generation collar and releases flow method and within a powder that spreads over the surface of the dog's coat while the new technology and sarastro allows the flu methadone to penetrate into the lipid layer of the skin and coat and be continuously topped up as needed from the reservoir in the collar, this allows for a consistent dose of glutamate Written on the dog that protects it from washing off, if the pet swims.
So definitely more ideal for your Beach or RiverDogs.So, Resto repels and kills ticks, and reduces the risk of transmission of tick-borne diseases to dogs for four months.Now, my big question was, if I live in the tick paralysis area, which I do.And one day soon, I might have to start worrying about aleosis, which I probably will.
Can I just use the rest o instead of my current tick prevention?So, here's what I'm told.Yes.There is though, is highly effective at repelling and killing paralysis ticks on its own.But the guys at elanco told me that considering the fact that a single tick, surviving long enough to cause tick paralysis is so catastrophic that an ideal strategy to reduce the chance of tick paralysis even further would be to use the repellency of this race, their color as the first line of defense and a systemically acting as officers Oli in as a second line preventative or an insurance policy.
We've all seen those cases where the pages on the right to control but then still come.As in, especially towards the end of the protective period with clinical tick paralysis.The thinking, is that having sir Esther on board as a tick?Repellent that sustains its killed speed in addition to your systemic acaricide at you will greatly minimize the risk of both a little kosis and tick paralysis and that that should be our gold standard recommendation.
I asked her my favorite question, but what do you do for your pets?And the answer was both.So there you have it.I hope we don't see a little Oasis in the outcome. all your clinic for a very long time yet, but if you do at least, we ready, Hi, I'm Hubert.
This is Gerardo.And you are listening to the vet pump clinical podcast.