UPDATES IN DEMODICOSIS. Dr. Amelia G. White, DVM, MS, DACVD (Dermatology)

UPDATES IN DEMODICOSIS Dr. Amelia G. White, DVM, MS, DACVD (Dermatology)

Case 1 Gizmo 12 yo MC Beagle

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?

Diagnostics

Case 1 Gizmo 12 yo MC Beagle Ovum Larva Nymph Adult

Diff quik stain 100X Malassezia Cocci

Demodex canis Normal fauna Hair follicle epithelium Sebaceous glands Life Cycle 3-5 weeks www.vetstream.com

Demodicosis Pathogenesis Transmission Population control normal functioning immune system Loss of population control alteration of immune function Stimulus proliferation of mites folliculitis/furunculosis alopecia www.dogtime.com

Demodicosis Get back with your partner/group List 5 predisposing factors for the development of demodicosis.

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

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

Deep Pyoderma

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)

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

Case 1 Gizmo 12 yo MC Beagle

Case 1 follow-up

Case 2 Toby 12 yo MC Maltese

Diagnostic Techniques Deep Skin Scrape

Diagnostic Techniques - Trichography

Diagnostic Techniques Tape Cytology + Squeeze

Diagnostic Techniques Histopathology

Diagnostic Techniques Fecal Flotation

Diagnostic Techniques - PCR de Rojas et al, 2012

Case 2 Toby 12 yo MC Maltese

NexGard v. Bravecto v. Simparica v. Credelio Systemic (oral [or topical]) MOA: GABA and glutamate inhibitor Extra-label uses? mites! Cost: (6 months) $71 119 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

Case 2 Toby 12 yo MC Maltese 4 months after Simparica 0 mites

Case 3 Griffin 5 yo MC German Wirehaired Pointer

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?

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 12-24 hrs Benadryl at home rdvm Cytopoint Continued to worsen euthanasia and dog was cremated w/o necropsy

Feline Generalized Demodicosis (Matricoti et al., 2017)

Silver fox

Chickens

Wildlife/Exotics

Pigs

Humans??

Thanks! Questions??