A Survey of Maryland Veterinarians Lyme Disease Diagnosis
- Slides: 23
A Survey of Maryland Veterinarians: Lyme Disease Diagnosis, Treatment, and Prevention in Canines Caitlin Cotter, DVM DHMH PHASE Intern, 2016 Johns Hopkins School of Public Health Katherine Feldman, DVM Center for Zoonotic and Vector-borne Diseases MD Department of Health and Mental Hygiene Photo credit: CT Veterinary Diagnostic Laboratory
Lyme Disease in MD Canines Ø Background Ø Clinical Signs & Diagnostics Ø ACVIM Consensus Statement Ø Study: Survey of Maryland Veterinarians Ø Analysis Ø Results Ø Conclusions
Background • Lyme disease • Spirochete bacteria • Borrelia burgdorferi • Ixodes ticks • White-footed mouse • Humans, Canines Photo credit: Warde Medical Laboratory, Cary Institute
Clinical Signs/Symptoms Humans • 70 -80% erythema migrans “bullseye” target rash • Flu-like symptoms • Arthritis, carditis, neurological disease Photo credits: borreliaburgdorferi. com, Merck Veterinary Manual Dogs • No rash • Polayrthropathy • Fever • Anorexia • Lyme nephropathy
Diagnostics Humans Dogs • Signs & Symptoms • SNAP • Tick exposure history • EIA / Western Blot point-of-care ELISAs • Quantitative C 6 antibody assay • Other serology, lymphocyte assays, joint fluid tests not • Urinalysis recommended • Urine protein-creatinine ratio Photo credits: University of Michigan Medical School, www. lymeinfo. ca
ACVIM Consensus Statement • Screening for Lyme disease in canines • Benefits: early detection of Lyme nephropathy, seroprevalence tracking • Risks: overdiagnosis, overtreatment; poor prediction of clinical disease; antimicrobial resistance (AMR) • Treatment of asymptomatic positive dogs • Unknown: is treatment of seropositive, health dogs beneficial? • Case-by-case decisions: consider dog breed (shelties, retrievers), AMR • Vaccination • Not recommended for seropositive dogs • Seropositivity indicates tick exposure. • Check for tick-borne co-infections, evaluation for proteinuria • Tick control
Survey of Maryland Veterinarians • Screening • How often do you screen dogs for Lyme disease? • Why do you *Screen annually? *Not recommend annual screening? • Treatment • How do you manage asymptomatic, Lyme SNAP-test positive dogs? • Vaccination • Is Lyme vaccination mandatory, based on risk, or not performed? • Follow-Up Testing • Which follow-up tests do you recommend? • Is follow-up urinalysis repeated annually?
Analysis • Descriptive analysis • Veterinary practice characteristics and location in MD • Veterinarian preferences • Diagnosis and prevention of Lyme disease • Veterinarian beliefs • Treating SNAP- test positive dogs • Perception of Lyme disease risk • Associations between survey variables
Practice Location Anne Arundel Maryland county Montgomery (n=191) Baltimore City Other counties No. 29 29 18 115 % 15. 8% 9. 8% 58. 6%
Practice Characteristics Number of vets in practice (n=180) Practice type (n=183) No. % 1 to 3 76 3. 8% 4 or more 104 57. 8% 165 90. 2% 11 6. 0% Exclusively small animal Mixed animal Photo Credits: Woodlake Animal Hospital, Redmond Vet Clinic
Veterinarian Perception of Canine LD Risk High Risk Perception of risk for canine Moderate Risk Low Risk LD (n=191) Not At Risk Other No. 114 71 2 0 4 % 59. 7% 37. 2% 1. 0% 0. 0% 2. 1%
Use of LD Screening Tests Idexx SNAP 4 Dx Screening with which Lyme Idexx SNAP 3 Dx disease test Antech Accuplex panel (n=148) PCR Other Photo credits: Idexx, Antech No. 117 % 79. 1% 12 8. 1% 17 11. 5% 0 2 0% 1. 4%
Frequency of LD Screening (n=145) Annually Only with clinical signs No screening recommended Other No. 145 23 3 19 % 76. 3% 12. 1% 1. 6% 10. 0%
Reasons for Annual Screening % Reason for annual LD screening (n=155) Endemicity of disease No. 127 Tracking seroprevalence 46 29. 7% Informing dog owners 72 46. 5% (multiple answer selections possible) Annual heartworm testing, with LD test included Other 60 38. 7% 4 2. 6% Photo credit: CDC 81. 9%
Reasons for Not Recommending Annual Screening No. Reason to not recommend Test does not annual LD screening diagnose or predict (n=35) disease Overdiagnosis/ overtreatment (multiple selections Expense of treatment possible) Antimocrobial resistance Unnecessary owner distress Other Photo credit: www. iran-daily. com 17 % 48. 6% 14 40. 0% 3 8. 6% 6 17. 1% 10 28. 6%
Follow-Up Diagnostic Testing If perform follow-up tests, which Quantitative Lyme C 6 tests recommended (n=59) Urinalysis (multiple answer selections possible) Urine Protein: Creatinine Ratio Serum Chemistry/CBC Other Is urinalysis follow-up repeated Yes No annually? (n=60) We do not perform UA for dogs screening positive No. % 42 71. 2% 38 64. 4% 17 28. 8% 20 33. 9% 4 6. 8% 32 53. 3% 18 30. 0% 10 16. 7%
Management of Asymptomatic, SNAP-test Positive Dogs Treatment of asymptomatic dog screening positive (n=149) No. % Treat all positive dogs with antibiotics Treat the first time screening positive, then based on clinical signs Perform follow-up testing 11 7. 4% 55 36. 9% 59 39. 6% No treatment or follow-up without clinical signs Other 9 6. 0% 15 10. 1%
Lyme Vaccination Do you use a Lyme vaccine (n=187) Lyme vaccine brand used (n=182) (multiple selections possible) Mandatory, core vaccine Vaccinate if high risk No Lyme vaccination Other Lyme. Vax, Zoetis Recombitek Lyme, Merial Duramune Lyme combo, BI Other % No. 60 88 4 35 32. 1% 47. 1% 2. 1% 18. 7% 39 87 43 21. 4% 47. 8% 23. 6% 25 13. 7%
Associations Treating asymptomatic positive dogs with antibiotics Annual Screening Photo credit: www. crossingthinice. com Yes No Chi-squared p-value Yes 68 78 0. 067 No 3 0
Conclusions • ACVIM recommends weighing benefits and risks of Lyme disease screening • 76. 3% of veterinarians screen annually • ACVIM recommends case-by-case decisions: treatment of asymptomatic positive dogs • 7. 4% veterinarians treat all asymptomatic positives • 36. 9% of veterinarians treat all dogs at first seropositivity • ACVIM does not recommend vaccinating seropositive dogs • Majority (79. 2%) of Maryland veterinarians recommend Lyme as core vaccine or recommend if patient at high risk • 96. 9% feel patients are at high risk • How many are seropositive at time of vaccination?
ACVIM does recommend • For asymptomatic dogs screening positive: • Check for tick-borne co-infections, • Evaluate for proteinuria • Tick control Photo credit: Loomis Urinalysis Testing
Next Steps • More research is necessary • Is treatment of asymptomatic positive dogs beneficial? • Are SNAP diagnostic tests beneficial? • Updated Consensus Statement • ACVIM • Screening, treatment: seropositive canines • Detailed algorithm • Currently known risks and benefits of treatment • Various screening and disease stages
Thank You! • DHMH State Public Health Veterinarian: • Dr. Katherine Feldman CZVBD / DHMH Team: Kim Mitchell S. B. Wee Heather Rutz Mary Armolt Richard Brooks Michael King Andrea Palmer David Blythe Lucy Wilson Shaylee Mehta
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