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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