Feline heartworm disease: A'Rubik's-cube-like' diagnostic and therapeutic challenge
Abstract
Feline heartworm disease presents a unique diagnostic, therapeutic, and preventive challenge for veterinarians. Due to the elusive clinical nature and peculiar physiopathology of heartworm infection in cats, a multistep diagnostic process is mandatory. Clinical signs may be absent or atypical. At the present time there is no single ante mortem diagnostic test that can reach a high level of sensitivity for feline heartworm infection. The most efficient approach for the diagnosis of feline heartworm disease is based upon a synergic association of several tests: thoracic radiography and serum antibody tests for rising index of suspicion, and echocardiography and serum antigen tests for confirming the infection. Other tests should be considered of secondary importance, even if they can help to support the diagnosis. Treatment of feline heartworm disease is typically based on clinical signs, as adulticidal therapy is associated with a high rate of complications and cats frequently self-cure. Chemoprophylaxis, knowledge of the biology of the parasite, and a high index of suspicion seem to be the most important tools for combating feline heartworm disease.
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Many heartworm-infected cats are misdiagnosed with asthma or allergic bronchitis.
“It is estimated that many heartworm-infected cats are misdiagnosed with asthma or allergic bronchitis (4, 5).”
From Seroprevalence of Feline Heartworm in Spain: Completing the Epidemiological Puzzle of a Neglected Disease in the Cat (2022) · cites this paper as [5]
Continued exposure, even with preventive therapy, could result in a positive heartworm test.
“continued exposure, even with preventive therapy, could result in a positive test (5, 29).”
From Seroprevalence of Feline Heartworm in Spain: Completing the Epidemiological Puzzle of a Neglected Disease in the Cat (2022) · cites this paper as [5]
Microscopic detection of microfilariae and ELISA to detect circulating antigens have low sensitivity in cats.
“Microscopic detection of microfilariae and ELISA to detect circulating antigens have low sensitivity in cats [1].”
From First Autochthonous Infection of a Cat with Dirofilaria immitis in Austria (2021) · cites this paper as [1]
To diagnose FHWD, a multimodal approach is necessary, combining thoracic radiographs, serum antibody tests, echocardiography and serum antigen tests; necropsy is the gold standard for detecting adult worms.
“To diagnose FHWD, a multimodal approach is necessary. A combination of diagnostic tools like thoracic radiographs, serum antibody tests, echocardiography and serum antigen tests are recommended. Necropsy is the gold standard for detecting adult worms [1,10,11].”
From First Autochthonous Infection of a Cat with Dirofilaria immitis in Austria (2021) · cites this paper as [1]
Usually, the worm burden is low and infections with only male or female adults reduce the sensitivity of the antigenic reaction.
“Usually, the worm burden is low and infections with only male or female adults reduce the sensitivity of the antigenic reaction.”
From First Autochthonous Infection of a Cat with Dirofilaria immitis in Austria (2021) · cites this paper as [1]
Right atrial and right ventricular enlargement appear quite rarely in cats and are commonly observed in dogs.
“These findings seem to appear quite rarely in cats and are commonly observed in dogs [1].”
From First Autochthonous Infection of a Cat with Dirofilaria immitis in Austria (2021) · cites this paper as [1]
In a study, cats experimentally infected with 100 L3 larvae developed three to ten adult heartworms in 75% of the study population.
“As part of a study, cats were experimentally infected with 100 L3 larvae, three to ten adult heartworms developed in 75% of the cats in this study population [1].”
From First Autochthonous Infection of a Cat with Dirofilaria immitis in Austria (2021) · cites this paper as [1]
A negative antigenic test cannot be the basis for ruling out an infection with D. immitis.
“A negative antigenic test cannot be the basis for ruling out an infection with D. immitis.”
From First Autochthonous Infection of a Cat with Dirofilaria immitis in Austria (2021) · cites this paper as [1]
Melarsomine is not safe in cats and can trigger pulmonary thromboembolism and anaphylactic reactions as a result of parasite death.
“Melarsomine, which is used as adulticidal therapy in dogs is not safe in cats and can trigger pulmonary thromboembolism and anaphylactic reactions as result of parasite death.”
From First Autochthonous Infection of a Cat with Dirofilaria immitis in Austria (2021) · cites this paper as [1]
Acute death of cats can occur when even only one worm is present.
“Acute death of cats can occur when even only one worm is present [1,10].”
From First Autochthonous Infection of a Cat with Dirofilaria immitis in Austria (2021) · cites this paper as [1]
In cats, the benefit of doxycycline pre-treatment has not yet been evaluated.
“In cats, this benefit has not yet been evaluated.”
From First Autochthonous Infection of a Cat with Dirofilaria immitis in Austria (2021) · cites this paper as [1]
Antibody tests detect antibodies produced by the host in response to infection, can remain positive for a long time after the death of the parasite, and do not differentiate a current from a past infection.
“On the other hand, antibody tests detect antibodies produced by the host in response to infection, which therefore can remain positive for a long time after the death of the parasite and do not differentiate a current or a past infection [24, 26].”
From Prevalence of heartworm in dogs and cats of Madrid, Spain (2017) · cites this paper as [26]
Detection of antigen cannot confirm the presence of immature stages of the parasite.
“Detection of antigen cannot confirm the presence of immature stages of the parasite.”
From First Autochthonous Infection of a Cat with Dirofilaria immitis in Austria (2021) · cites this paper as [1]
Melarsomine is toxic to cats at doses as low as 3.5 mg/kg.
“Melarsomine is toxic to cats at doses as low as 3.5 mg/kg [1,10,15].”
From First Autochthonous Infection of a Cat with Dirofilaria immitis in Austria (2021) · cites this paper as [1]
D. immitis and D. repens have moderate host specificity and are able to infect a wide range of vertebrates, including cats and humans.
“Nevertheless, these filarioids have moderate host specificity and are able to infect a wide range of vertebrates, also including cats and humans”
From Dirofilaria spp. and Angiostrongylus vasorum: current risk of spreading in Central and Northern Europe. (2021) · cites this paper as [17]
Laboratory diagnosis may reveal eosinophilia on complete blood count and on bronchoalveolar lavage cytology.
“Laboratory diagnosis may reveal eosinophilia on complete blood count and on bronchoalveolar lavage cytology.”
From Dirofilarioses in cats: European guidelines from the ABCD on prevention and management (2020) · cites this paper as [39]
In contrast with dogs, both microscopic detection of microfilariae and ELISA or immunochromatographic (IC)-based tests that detect circulating antigens of adult D immitis females have low sensitivity in cats.
“In contrast with dogs, both microscopic detection of microfilariae and ELISA or immunochromatographic (IC)-based tests that detect circulating antigens of adult D immitis females have low sensitivity in cats.”
From Dirofilarioses in cats: European guidelines from the ABCD on prevention and management (2020) · cites this paper as [39]
Characteristic radiographic abnormalities include a vascular pattern and patchy infiltrates around the caudal lobar arteries or a diffuse bronchointerstitial pattern.
“Characteristic abnormalities include a vascular pattern (enlargement, loss of tapering, tortuosity and truncation of the right or both caudal pulmonary arteries on ventrodorsal radiographs) and patchy infiltrates around the caudal lobar arteries resulting from plasma leakage and perivascular inflammation (often peripheral in caudal lobes) (Figure 8) or a diffuse bronchointerstitial pattern.”
From Dirofilarioses in cats: European guidelines from the ABCD on prevention and management (2020) · cites this paper as [39]
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- Authors
- Venco, L., Marchesotti, F., & Manzocchi, S.
- Corresponding author
- Venco, L.
- Venue
- Journal of Veterinary Cardiology
- Publisher
- Elsevier BV
- Published
- 2015-12
- Volume
- 17
- Pages
- S190-S201
- ISSN
- 1760-2734 (ISSN-L)
- OpenAlex
- W2250787604
- Semantic Scholar
- 46953fda11fa1432ac6a0ca8f65b4d8e5f081528
- Cited by
- 71
- References
- 46
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 3 · 2023: 7 · 2022: 18 · 2021: 9 · 2020: 6 · 2019: 5 · 2018: 4 · 2017: 6 · 2016: 2
- FWCI
- 0.60
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Veterinary Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Parasitic Diseases Research and Treatment
- Health Sciences › Veterinary › Small Animals › Helminth infection and control
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Research on Leishmaniasis Studies
- Keywords
- feline heartworm disease, Dirofilaria immitis, diagnostic testing, antibody detection, echocardiography, thoracic radiography, chemoprophylaxis, self-cure
- MeSH terms
- Animals, Cat Diseases, Cats, Dirofilariasis, Filaricides
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