Cardiopulmonary dirofilariasis is a cosmopolitan disease caused by Dirofilaria immitis , which affects mainly canids and felids. Moreover, it causes zoonotic infections, producing pulmonary dirofilariasis in humans. Heartworm disease is a vector-borne transmitted disease, thus transmission depends on the presence of competent mosquito species, which is directly related to favorable climate conditions for its development and survival. Cardiopulmonary dirofilariasis is mainly located in countries with temperate and tropical climates.
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Cardiopulmonary dirofilariasis is a cosmopolitan disease caused by Dirofilaria immitis , which affects mainly canids and felids. Moreover, it causes zoonotic infections, producing pulmonary dirofilariasis in humans. Heartworm disease is a vector-borne transmitted disease, thus transmission depends on the presence of competent mosquito species, which is directly related to favorable climate conditions for its development and survival.
Cardiopulmonary dirofilariasis is mainly located in countries with temperate and tropical climates. Europe is one of the continents where animal dirofilariasis has been studied more extensively. In this article we review the current prevalence of canine and feline cardiopulmonary dirofilariasis in the European continent, the transmission vectors, the current changes in the distribution and the possible causes, though the analysis of the epidemiological studies carried out until and between and Several factors can exert an influence on the spreading of the disease, such as movement of infected animals, the introduction of new species of mosquitoes able to act as vectors, the climate change caused by the global warming, and development of human activity in new areas.
Veterinary controls to prevent the spreading of this disease, programs of control of vectors, and adequate protocols of prevention of dirofilariasis in the susceptible species should be carried out. Dirofilaria immitis is a parasitic nematode responsible of canine and feline cardiopulmonary dirofilariasis in both domestic and wild hosts, and the causal agent of human pulmonary dirofilariasis.
Different species of culicid mosquitoes Culex spp. When taking a blood meal from a microfilaremic host, the mosquitoes become infected and the microfilariae develop to the third-stage larvae L3 in the malpighian tubules of the mosquitoes Cancrini and Kramer, , which are deposited on the host while the mosquito is taking a blood meal, becoming sexually mature within a few months in the main pulmonary arteries and right ventricle. Heartworm infection is a severe and life-threatening disease.
Initially the pulmonary vasculature is affected, and the lung itself and, finally, the right chambers of the heart Furlanello et al. Feline infection is diagnosed with increasing frequency in areas where the disease is endemic in canines. However, the development of the parasite in cats takes longer compared to dogs and most infections are amicrofilaraemic. Additionally, many cats tolerate the infection without any noticeable clinical signs or with signs manifested only transiently and sometimes sudden death may arise without warning Genchi et al.
The presence of D. The transmission of infectious diseases is influenced by many factors, including climatic and ecological elements. It is widely anticipated that climate change will impact the spread of vector-borne diseases in Europe, since arthropod vectors are especially sensitive to climatic factors. Weather influences the development and maintenance of the vectors, but climate change is one of many factors that influence vector habitat.
Several studies have described the effects of the climate change in the spreading of other vector-borne diseases in Europe Semenza and Menne, ; Genchi et al. The aim of the present work is to review the current epidemiological situation of the cardiopulmonary dirofilariasis in dogs the main host and cats in Europe, its vectors and evaluate the possible causes of the changes in the distribution of the disease by conducting a retrospective analysis of the epidemiological situation.
Until , cardiopulmonary dirofilariasis was mainly found in the southern European countries, such as Spain, Portugal, Italy, and France. Comparison of geographical distribution in Europe of heartworm disease observed in dogs between and Endemic areas Red. Sporadic cases reported Pink. A study of defined as infected by D. In the s and s, D. Similarly, in Piedmont, an extensive survey carried out in the s reported a spread of D. The disease was also present northwards into the provinces of Friuli-Venezia-Giulia Pietrobelli et al.
Heartworm disease has also been reported in central areas of the country, which showed lower infection rates for D. Epidemiological data on the occurrence of dirofilariasis by D.
In Sardinia a prevalence of 4. The infection by D. Cases of foxes infected by D. In Spain, D. In the rest of the Iberian Peninsula, the higher prevalences were associated with irrigated areas.
In the central areas of Iberian Peninsula low prevalences of canine dirofilariasis were reported. In Madrid, several studies stood the canine prevalence between 1. In the northeast of Spain, the highest prevalences were found in Zaragoza In Catalonia the global prevalence remained low 2. Besides, the prevalences in this area raised noticeably in the irrigated areas, such as River Ebro Delta Canary Islands, sited in front of the north-western African coast, were considered an endemic area of the disease.
On the island of Gran Canaria, serial epidemiological studies carried out in different years allowed monitoring the evolution of the canine dirofilariasis. These studies showed an increase in the prevalence from This is the highest prevalence reported in Spain so far Montoya et al. The island of Tenerife, on the other hand, showed a drop of prevalence from Infections by D.
Finally, in the northern areas of the Iberian Peninsula no cases of canine dirofilariasis were reported Guerrero et al. In Portugal, the only study published showed that canine heartworm infection was prevalent in several southern regions of Portugal, including Ribatejo In France, D. The overall prevalences of canine dirofilariasis reported in France were 0. Doby et al. Guerrero et al. In cats, microfilariae of D. The cat also showed radiographic evidence of D. In Greece a study carried out between and showed microfilariae of D.
In general, in Greece during the 90s decade the incidence of the disease increased rapidly and at the end of the millenium was considered endemic in the central and northern parts of the country Polizopoulou et al. In a study carried out in in the Attiki region south of Greece low canine D. Until only a few studies regarding the distribution and prevalence of animal dirofilariasis are published.
In Switzerland, border country with Italy and France, Arnold et al. In the south of Switzerland, between and , the reported prevalences ranged from 0. Deplazes et al. In the same region, in the prevalence raised considerably, reporting In Germany, between and a total of 80 dogs were diagnosed, of which 45 were amicrofilaremic Zahller et al.
In the Netherlands, seven cases of infected dogs were recollected between and , the same amount of cases of canine dirofilariasis reported in the previous years Meyer et al. In the only study published in Macedonia, the prevalence reported was 0. In Rumania, at least four dogs were diagnosed between and Genchi et al.
In the former Yugoslavia, in Croatia between and several cases of canine dirofilariasis were reported but no considered autochthonous Brglez and Senk, ; Genchi et al. In Serbia the first report data from by Dimitrijevic In Slovenia and Bulgaria, the reported prevalence of D. In Albania, a study carried out between and with samples from the coastal western area showed infection in In the former USSR Russia there are only 3—4 reports of isolated incidents of infection in dogs from the Republics of Azerbaijan and Turkmenistan, situated in the center of the country, in Ussuri Region in the Far East and in Abkhazia Artamonova et al.
In Italy, D. While the last studies report the lower prevalences published in the endemic area of northern Italy 6. Nowadays, heartworm disease infection has become endemic in these areas Piergilli-Fioretti et al. In Tuscany a prevalence of canine dirofilariasis of Furthermore, D. In a recent study carried out in and , in the Abruzzo region of central Italy prevalences of 2.
In a recent survey dogs from four different areas of southern Italy were sampled Apulia and Calabria regions , and prevalences between 0. In the central area of Italy a prevalence of In Tuscany too, epidemiologic studies observe the presence of adults of D.
For the first time, has been described the first diagnosis of mature heartworm infection and presence of microfilariae in an exotic felid Panthera pardus pardus in north-eastern Italy Mazzariol et al. Furthermore, a case of D. In a study carried out in Salamanca between and , a prevalence of Besides, for the first time significant D.
On the island of Gran Canaria, the prevalence of canine dirofilariasis has been gradually dropping, from On the island of Tenerife, the prevalence remains constant ranging from Regarding feline dirofilariasis, on the island of Gran Canaria two seroepidemiologic studies show an increase of the prevalence from In , the first diagnosis of D. Besides, exists a report of D. Finally, a study carried out in Eurasian otter Lutra lutra , 48 Eurasian otters from different regions of the Iberian Peninsula were examined, finding D.
In Portugal, in the overall canine prevalence in the north and north center of Portugal is 2. In cats, a study carried out in the north and north-center of Portugal reports a D.
In France, in , a canine prevalence of 0. Simultaneously, a study was done over dogs with clinical signs compatible with D. In this group, D. Of these, most of them are from the South of France, where local prevalences are The authors of the study suggested that an expansion of the Southern endemic areas of D.
Human and Animal Dirofilariasis: the Emergence of a Zoonotic Mosaic
Human pulmonary dirofilariasis: a review. The authors presented a detailed summary of the geographical distribution, clinical and pathological aspects of human pulmonary dirofilariasis. Although benign, this zoonosis, of which Dirofilaria immitis is the major etiological agent, represents a medical problem since it produces symptoms which may be confused with neoplasia and thus may subject patients to unnecessary thoracic surgery. Of cases cited in the literature, only 17 were reported in Brazil, despite the existence of highly favorable conditions for the transmission of this infection in man. Thus it may well be that this parasitic infection remains underdiagnosed.
U.S. Food and Drug Administration
The genus Dirofilaria includes vector-borne filarial nematodes, which are usually associated with carnivore hosts. Some Dirofilaria spp. Rare human infections with other species such as D. Recently, a D. Human dirofilariasis is generally divided into pulmonary dirofilariasis D. During a blood meal, an infected mosquito introduces third-stage filarial larvae of Dirofilaria immitis into the skin of the definitive host, where they penetrate into the bite wound.