UPDATES IN DEMODICOSIS. Dr. Amelia G. White, DVM, MS, DACVD (Dermatology)
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1 UPDATES IN DEMODICOSIS Dr. Amelia G. White, DVM, MS, DACVD (Dermatology)
2 Case 1 Gizmo 12 yo MC Beagle
3 Case 1 Gizmo 12 yo MC Beagle
4 Case 1 Gizmo 12 yo MC Beagle
5 Case 1 Gizmo 12 yo MC Beagle
6 Case 1 Gizmo 12 yo MC Beagle
7 Case 1 Gizmo 12 yo MC Beagle Pretend this isn t a talk about Demodex. Find a partner or small group and discuss the following 2 questions for the next few minutes: 1) What are your top five differentials for this dog? 2) Considering your top differentials, what are the top three diagnostics you plan to perform?
8 Diagnostics
9 Case 1 Gizmo 12 yo MC Beagle Ovum Larva Nymph Adult
10 Diff quik stain 100X Malassezia Cocci
11 Demodex canis Normal fauna Hair follicle epithelium Sebaceous glands Life Cycle 3-5 weeks
12 Demodicosis Pathogenesis Transmission Population control normal functioning immune system Loss of population control alteration of immune function Stimulus proliferation of mites folliculitis/furunculosis alopecia
13 Demodicosis Get back with your partner/group List 5 predisposing factors for the development of demodicosis.
14 Demodicosis Juvenileonset Adultonset Localized Generalized <5 focal sites 5 focal sites < 18 months of age >4 years of age Self-limiting 2 paws Large surface areas
15 Case 1 Gizmo 12 yo MC Beagle Adult-onset, generalized demodicosis What s wrong with this dog? Advanced diagnostics: bloodwork, abdominal US, tissue culture and histopathology
16
17
18 Deep Pyoderma
19
20 Traditional Treatment Options Amitraz (Mitaban ) Topical High-Dose Macrocyclic Lactones Systemic (Oral) MOA: MAO inhibitor, 2 agonist MOA: GABA inhibitor Approved for Demodex in USA Cheap Neurotoxic sedation, vomiting, diarrhea, salivation, hyperglycemia, ataxia, bradycardia, hypothermia, seizure Extra-label use Expensive Fairly safe (neurotoxicity is possible)
21 Case 1 Gizmo 12 yo MC Beagle Milbemycin daily: 1.5 mg/kg/d Topical antiseptics 2% benozyl peroxide shampoo 2x/week 4% chlorhexidine spray twice daily Systemic antibiotic Cephalexin 30 mg/kg every 12 hours x 8 weeks Rechecks q 3 weeks
22 Case 1 Gizmo 12 yo MC Beagle
23 Case 1 Gizmo 12 yo MC Beagle
24 Case 1 Gizmo 12 yo MC Beagle
25 Case 1 Gizmo 12 yo MC Beagle
26 Case 1 follow-up
27 Case 2 Toby 12 yo MC Maltese
28 Case 2 Toby 12 yo MC Maltese
29 Case 2 Toby 12 yo MC Maltese
30 Case 2 Toby 12 yo MC Maltese
31 Diagnostic Techniques Deep Skin Scrape
32 Diagnostic Techniques Deep Skin Scrape
33 Diagnostic Techniques - Trichography
34 Diagnostic Techniques - Trichography
35 Diagnostic Techniques Tape Cytology + Squeeze
36 Diagnostic Techniques Histopathology
37 Diagnostic Techniques Fecal Flotation
38 Diagnostic Techniques - PCR de Rojas et al, 2012
39 Case 2 Toby 12 yo MC Maltese
40 NexGard v. Bravecto v. Simparica v. Credelio Systemic (oral [or topical]) MOA: GABA and glutamate inhibitor Extra-label uses? mites! Cost: (6 months) $ Today s Veterinary Business, 9/2018 Safety: Neurotoxicity possible FDA statement Differences 1 month v. 12 weeks? 8 weeks v. 6 months? Which ticks and for how long? 4, 4* (2*), 5, 4
41 Case 2 Toby 12 yo MC Maltese 4 months after Simparica 0 mites
42 Case 3 Griffin 5 yo MC German Wirehaired Pointer
43 Case 3 Griffin 5 yo MC German Wirehaired Pointer
44 Case 3 Griffin 5 yo MC German Wirehaired Pointer
45 Case 3 Griffin 5 yo MC German Wirehaired Pointer
46 Case 3 Griffin 5 yo MC German Wirehaired Pointer What do we do with these super aggressive patients? How can we diagnose them with minimal restraint and no sedatives? Was this always Demodex? What s wrong with this dog if so?
47 Case 3 Griffin 5 yo MC German Wirehaired Pointer Case outcome Sedated: CBC, Chemistry, UA, U cult, histopathology, fungal culture, aerobic culture, mycobacterial culture, HWT Inflammatory leukogram, nonregenerative anemia Staphylococcus sp. + Demodex No other organisms Bravecto applied topically in hospital Severe pruritus and facial swelling within hrs Benadryl at home rdvm Cytopoint Continued to worsen euthanasia and dog was cremated w/o necropsy
48 Feline Generalized Demodicosis (Matricoti et al., 2017)
49 Silver fox
50 Chickens
51 Wildlife/Exotics
52 Pigs
53 Humans??
54 Thanks! Questions??
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