So, our fourth speaker for the day is going to be speaking on Angie Strongylus for sore. Still a parasite on the move, which I think is an excellent question. And we've got a fantastic speaker in Manuela Schneider to try and answer that for us.

Manuela is, a group leader in veterinary parasitology, at the Institute of Parasitology and the medical faculty at the University of Zurich. Graduated, in veterinary medicine at the same university in 1999 and then performed a doctoral thesis at the University of Bern. From 2001 to 2003, she worked as a veterinarian in both companion animal and farm animal practise, and then employed as an assistant and senior assistant at the Institute of Parasitology in Zurich.

During this time, she obtained her board certification, for the E VPC, and the Swiss specialist title for parasitology laboratory medicine. She's a member of several professional organisations, and is treasurer and committee member for the Swiss Society for Tropical Medicine and Parasitology and also a presidential member of the European Scientific Council from companion Animal parasites. Esca, in the Swiss section, and she'd been elected president from 2012, So a really, really phenomenal CV there, continues to do, fantastic output of research focusing on cardiopulmonary nematodes of dogs and cats.

So the perfect person to speak to us on this subject. So over to you, Manuela. Thank you.

Ian, for presenting me, for this last session of today about, the topic of my heart, the French heartworm. Thank you very much for having me talking about this really fascinating parasite. And, I I we'll test you and see if we will be able to answer to this question.

Still a parasite on the move. Of course. There is some other as you said, relevant aspects that have been also partially mentioned this morning by Eric that are directly correlated to this topic.

Parasite on the move and also about very much about disease awareness and the clinical relevance. Just before I'm really starting, I'm obliged to inform that they are really part of these presentations that are protected that are, protected by a copyright, especially some of these images so I'm really asking not to further distribute them. After also this presentation, except for your personal use.

So coming. So, as I said, the, parasite of my heart, it's of course not a human parasite. It's not a zoonotic parasite, but, it's a parasite of our dogs and canines.

As you can see, foxes play a role in this parasite. The adults are here in this arterial pulmonaries on the left side. Very beautiful worms.

The female, with the red intestine, the white uterus, It's it's really a wonderful parasite. But we also have to be aware, of course, of the issues. And these are of course, due to these various stages that are floating around, in the circulating in the body of the dog, after ingestion of the intermediate hosts which are our gastropods nails and slacks, most probably the ones that are more coprophilia that like dog faeces.

And we know that, of course, we call it the French Heartworm. But as you can see once, the infectious stages are further developing into L four, L five. And after mating of these adult parasites in the arteria.

What we have to consider are the L ones that are produced in huge masses into the alveoli, the lung alveoli, where they they are switching then, to the, respiratory airways, going up to the pharynx, swallowed down again into the gastrointestinal tract. And, of course, L one excreted in the faeces, which are also, diagnostically relevant. We call it the French Heartworm.

Very much. Also to differentiate from Diop images that has also been mentioned this morning and the French. Why French?

It has been truly discovered already in 1853. It seems maybe even a bit earlier, but for sure, in France and for sure, in the vet school in Toulouse, where this first dog was showing apathy, some further non specific signs also bleeding. This dog died because of bleeding, and the words were still described as Zoars not only defined as something because it was really unknown again.

If you don't know that it's existing, how you can, how can you name it? So these findings came very much around Toulouse in southern France, a bit close to the Spanish border. But at this stage, and also some experiments later on, they were not really clearly indicating the life cycle.

And it's only then, and there's also a reason more to to say why it is a French heartworm. It was, Professor von in Paris that finally, with some experiments, collaborating with the people, in in southern France, then was able to do these experiments that confirm that in non endemic areas you can induce this infection this deadly infection, in dogs when you feed them when infected snails. Interestingly.

And this is a pretty, strange. Also for for people. When I talk to them from France.

There there has been not much more later on from France, of course, some descriptions from these people that were in these areas that that were knowing about the disease. But mostly we saw them, more, cases in these other countries that you see here also very early. A first spot of cases in Switzerland, close to Zurich in Ireland, in the UK, especially in Cornwall and South Wales, and also, pretty early.

Also in the nineties, spread pretty spread north of Copenhagen in Denmark. And it's it's this, researcher Bolt that wrote of this first reviews where he said that strong it was zum was present in endemic fori. And around this there were only sporadic occurrences.

And of course, it's always difficult. Also, when we think of the presentation of this morning, and the definition of a about local occurrence of a parasite, it's not always easy with dogs because they may move from one place to another, to say where exactly the infection occurred. And maybe the infection occurred on several places and so on.

These details, of course, in natural infected dogs don't know. But, if we have accumulation of cases like in these countries already some decades ago, we consider this as an endemic area, but have them to rely more specifically on the suitability of the area for, for instance, intermediate hosts. And obviously it seems that UK is a very good area.

This was the first collection around the year 2000 from UK that I would like to use as an example, where, as I said, we have in southern England and Wales. This first description of 23 cases that were, clinically affected of dogs and, through serological studies. Approximately 10 years later, we could get the serum samples from more than 4000 dogs in from different areas of, UK.

And you see, more or less, we have, more, intense situations still going on in these areas, but also some other directions again, considering that these dogs, the details of their movement, are not known. But, there is a third way of investigation of of the occurrence of the parasite. And this was also the more recent study where it was about a questionnaire performed by the colleagues in UK, where they were asking the different practitioners in the country if they saw 15 or more cases in a year, and more or less, it again shows that there are still these areas where we regularly keep finding cases that most probably are the areas with highest risk of infection.

With an strong los vor here now, in the UK. Again, referring to the first presentation of Eric Morgan this morning, where he very early also asked himself 10 years ago can a worm change its spots? And it was a editorial about thinking why the parasite is not everywhere.

We have a lot of rain everywhere. He was staying in UK. No cold winters.

Normally, slugs are abundant everywhere. There is also a presence of wild cans in rural and urban areas. So there must be really some other reasons why we have these endemic spots.

And this most probably related to this complex interactions that he partially mentioned this morning between factors involved in local transmission but on the other side and now referring more to the drug travelling, mentioned very much by Ian, as a consequence of spread due to dogs that were travelling or coming from new areas that also supports the colonisation of new areas with the parasites. So at the end, I can anticipate already we don't know exactly what will happen in the future, because the spots may Q full fusion together. And then at this stage, UK, for instance, would be considered as high risk all over the country.

But we don't know exactly when this may happen. We can rely on models and again models. Can be useful, but we have to consider all the factors that we cannot really measure in in anticipation or will these patches this endemic foresight persist over time and especially then in these areas, the the practitioners have to keep aware, are ongoing, and yeah, at the end.

Right now, this answer is partially answered from this morning and partially not, I would like to to move on to what we Maybe we can learn from other countries as a comparison. And this, was a review already from 1972. Where you see that were cases already in Asia Single cases in Australia, Africa and South America, which is is not really the topic of today.

But, there are, for me as an example close to mainland Europe, the cases of of Germany and Switzerland, where you can see also around the sixties, first cases have been illustrated, most probably related to imported animals. And then what happened afterwards? This was in the sixties.

So for Germany again, we had the opportunity to, do a large epidemiological study based on Doc era and the the The Star is indicating where this very first case has been discovered. And around there, you see there with red spots are animals that were serologically positive for antigen and antibodies. I come to this later, but also, in some other areas around there, we found cases three spots, very close to Switzerland, by the way.

And the next, information at a large scale that we have from a country. Is this study relying on more than 12,000 docs and on the middle in the middle you see the prevalence for Strongylus vor room and on the left side for Chryo zoa BP. And the areas are more or less dark in the same intensity, Let's say, indicating that these two parasites are present more or less, at the same geographic areas.

But I would like to to just shortly go into the meaning of the presence of krinos a BP. This is a long worm with the same intermediate hosts. Let's say, for Angus, like Angus stronger.

We also have snails and slugs. But it's more a respiratory parasite. The adult stages are living in a trachea and for this or the bronchi, and for this reason, coughing, bronchial pattern of the diagnostic imaging and ain ofilia are the most common signs that are described in dogs infected with Creno Zuma BPI Where it becomes interesting is when these 12,000 dogs were analysed over decades and you can see in red on the left side, down left side.

Angio strongly seems to increase over time while with cleos bulp the situation is not fully clear. And on the other side in this other study, also from Germany, we see, of analysis of more than 50 65,000 dogs that, there are, prevalences that more or less are at the same level. But if we see over the years, there is a clear dominance of Angus strong that it seems to chasing away creno zoa over the years becoming more and more dominant year by year.

And this, I think, is really interesting and shows the success of establishment and further spread more or less after the year 2000 in Germany. I can illustrate this also with our, data from Switzerland, where around the year 2000 we had some more cases in dogs and two foxes that were described not really immediately close to these first cases from the sixties. But if we analyse further on, Serologically more than 6000 dogs.

We see that the parasite is present more or less in different parts of the country, Not there Where its grades around Alps. It's a bit too high up for the parasite for, establishment in snails. It seems so in this case, we see that the presence, it seems unstoppable, widely present in the country.

And now I would like to extend a bit Why, serological studies. It's helpful, of course, to, have this, performed because it's allowing mass screening. And this is mainly based on these two tests that we developed at the institute where we can detect the circulating antigens, but also antibodies illustrating exposition to the parasite and advantages.

And it has been shown also just previously in the first presentation, we can, use these two tests, especially in areas where we don't know much about the present. If we combine these two tests, we have a high positive predictive value. If the if the sample is positive for both samples and especially the antigen detection has been, first developed in collaboration with the commercial company to develop this fast test, this rapid essay, which is of course, helping very much in cases where you suspect clinically affected animals where we are not at the sensitivity level, like with the in house Eliza.

But as I said, for clinically affected animals, this test is very highly vulnerable. Again with serology, we thought, what about foxes? What about the wildlife reservoir?

And here, thanks to, collaboration with Denmark, we had the, the availability of fox era that were experimentally infected. And we could confirm that for antigen detection, at least we have a high sensitivity and the high specificity for detection of antigen in Fox era. And interestingly, we could confirm this with necropsy data from foxes around Zurich.

One must say that it needs a bit of experience to do a correct dissection of foxes to really find the worms. We also had to learn this, on the other side. If we do serology, we come now very, very much close to the necropsy data.

And this is what I would like to say. If, a study initiates us, with foxes, it needs a skilled person to find the worms. But on the other side, serologist and other at the end.

What we saw here, if you look at the data from 2012 to 2017 where we did dissecting foxes in the same areas we saw year by year, a steady increase. And it's impressive because right now we have a pre prevalence in foxes that is above 90%. So again, showing the success of this disease.

And of course, in this case, we have, a possibility to investigate the role of foxes and this, We, also understood much better when we, for instance, saw that the serological detection was not working Well, it works very well with dogs, but not in foxes. And the theory was that foxes don't develop immunity, meaning that this may have a role also for foxes as a reservoir. And being, Fox is not able to develop this immunity.

The experimental data also show that they will not stop larvae excretion. Over time they go, don't get immune, they will continue to excrete larvae. They will continuously infect, the the and contaminate the environment with first larvae stages and what we also learned from our foxes that they are having harbouring high numbers partially of parasites.

And And we were able to compare this with studies also from London and saw that that they may have a single fox may have up to 16 haplotypes of strong los vor showing really the role of foxes. Also, for genetic diversity of this parasite. When we use the sa that we had from past research on on a Hino coccus multilocularis Foetus de Plata sa, we we saw that, around until the year 2000.

The prevalence in foxes was pretty low. And this was really, really impressive because when we had the control zero after the year 2000, you see, it was really increasing impressively 62% in 2017 and partially we could correlate this and explain this with data from the fox population. Where, after this successful RAB elimination, we see a real increase over number of foxes.

These are only the hunted foxes, of course, not showing the true number of foxes. But based on the fact on on this serology data, based on the fact that they are not getting immune. Foxes are for us.

A model for illustrating, the their role as reservoir for Angus Truss, Baz orum and, based on that, I have here collected some data on on Fox. Studies. You see, the higher the prevalence, the older also the data in general.

Because, it it seems that of course, it could be that over time also repeating this study, at a later stage, it could be the same that these prevalences may increase, and we will see in the future what will happen if this data may increase. Also, in other countries, illustrating also their the role of foxes, the really fundamental role being foxes everywhere. And this we translated a bit from the fox tapeworm studies where we have different factors influencing this interaction between, the nature between Wild Reservoir between intermediate hosts between, the activities of humans, and here we I rely a bit also to what U has been telling about, especially close to urban periphery and, agriculture areas.

There is these recreation areas where we expect most contact most interaction between fox areas and, dog human areas that have walks with dogs in these areas. I think we can say that there is, the really the successful transfer from foxes to dogs. Also for Angus Truss Bazo.

I have here some maps that I put together over the years. And, you see here some countries, have a little spot because there was some descriptions. Some countries have a larger spot due to some studies.

Where, also, for instance, it very much depends on what kind of population you analyse. You see again, the example from Germany. If you analyse asymptomatic dogs, of course, the prevalence is lower.

If you ex, investigate symptomatic dogs automatically, the prevalence will be higher. But, if we follow this up with Fox studies again, it confirms that the prevalence in foxes is very much higher. Foxes are not treated obviously, and, they contribute to further expansion.

And in addition, we have other wild animals which are not as much present as foxes but also contributing to, the presence of the disease. For instance, wolfers and badgers have been described, but, at the end, if we follow this up in the latest years. You see, I tried to collect all the studies.

From the past years. It it's not exhaustive, but, very much all these stars in red shows the present on the occurrence of Angus strong vor in docs and complimented with, a lot of data also on foxes, in green stars. And at the end, we have also wolf Golden Jackals Mostel, its, which contribute very much golden jackals.

Is the chapter aside already in the sixties in France. It was shown that it's as good host as foxes and, of course, coming also from Eastern Europe. There are, quite some golden jackals that are very much suitable as hosts, like foxes are.

So in summary, we can say that the French heartworm became international. And, this map again is based on on studies, from Eric, already from 2009, where, he tried to investigate, based on climate information and, the current at that stage distribution of, strong to anticipate a bit. Where could the French also established outside of Europe or where it was already?

And, you see, there are quite some areas mostly coastal areas. And if we look now, in the European situation, I think more or less this is overlapping with the maps that I showed before on the other side. When we look at, these other count other continents that that are, North and South America the situation is very much interesting In, North America, we have, this, work of Gary Convoy that has been studying on the parasite very early on, also already in Canada.

But in particularly in, the, Atlantic area, Newfoundland and Labrador Islands, where the parasite is a talk to us since very long also in the wild animal reservoir. And nevertheless, he anticipated it could be one day that this parasite is spreading in North America. And this was in 2011.

So right now we know. OK, in 2014, there was a description in West Virginia in boxes, but, it was not, clearly confirmed, very much so. It it was calm after that, but very, very recently, we have these two mentioning of, Angus Strongylus in, black bear and coyote in wild animals.

But also in the first dog that seems that was not being travelling outside of the US. And now coming back to the map with the stars in North America, this is more or less overlapping with the anticipated suitable areas for North America. Now for South America, it's again also interesting from another point of view.

And there there is this review, from Penagos Tavares, which, shows the presence of angio, of course, also auro strong this year. But the circles indicate Strongylus, where we see in different South American countries. But what we also have to consider is that there appears to be a larger, different population of can it and most elite populations that may contribute to the establishment of an strong in South America is very, pretty exotic and not very much similar to foxes can its overall.

And on the other side, there must be some differences. And, what I would like to say about the South American isolates this could be a different lineage, and this has been shown in the past. They look very much similar genetically and of course, morphologically.

But they may represent a slightly different lineages. Nevertheless, we see this parasite has a broad spectrum of definitive hosts, and another one that we realised also is, this zata Surina, which are living, here in Zurich. Normally, of course, they are more, well, in the Kalahari Desert.

So normally this hosts would not be suitable, but, because they were living in Zurich in an ender endemic area in a, enclosure where obviously it looks like they had contact with infected snails. We could confirm that these animals became patent, seven out of 17 were paid, and and, the one of these animals even died because of Angus strong. So, it was very interesting to, discover that even an animal that normally lives in the desert is suitable to become, a natural, but obviously well adapted host to an strong Mazor.

Now, sometimes people confuse an Strongylus and auro strong, at least, the students. But, one day we had to interact about, with pathology about the cat that had been euthanized because it was not well at all. And, in addition to, glome paia.

The lung was, showing this granulomas, which were close to vessels. And also there was adult sections of nematodes in the Arteria. Of course, I was thinking first of angiolo kaudi, which is a parasite of cats or palates, similar to Strongylus.

But our results were positive for angio Strongylus vor in a cat. And this is in brackets showing that in a highly endemic area, even cats can become infected, but they will not become patent. This is something that we did not observe in this case and which also other researchers previously showed that if you infect cats, OK, you can get infections, but they will not be competent.

You will not be able to diagnose them through larval excretion, which may be a problem. So if we would like to summarise, why this impressive spread, probably throughout Europe, we can say that most probably foxes play a very crucial role as reservoir hosts correlated with an increase of this wild reservoir population. Compared to other wild animal reservoirs, they may, also get infected.

But probably from the epidemiological point of view, they are less relevant for sure. In areas where this overlap with dog populations and fox populations is there that we will have a number of cases popping up in dogs. And in addition, dogs may contribute to further spread not on a local, spread, but because of strong movements, global movements of all our companion animals, especially dogs.

But what we also have to say And, also, Eric Morgan was telling this this morning, if you don't think of the parasite, you will not diagnose it. So in new areas, the disease awareness is probably not there at the beginning. And there we will miss, these cases unless, we increase the disease awareness.

And of course, this is coupled with diagnostic tools. Once we start to diagnose these animals that are affected, we will also find the cases before they die before they are dissected. Where normally, yeah, through histology or identification of worms, you have also confirmation.

So all these things are correlated together and, lead us to the fact that we need first of all, increased disease awareness. And then maybe in areas where we don't know yet about the present, we may diagnose them. And these cases these cases about the year 2000 are clearly illustrating this, for Switzerland, you see, out of these 10 cases, seven died.

And this is because the diagnosis happened pretty late and it was nothing more to do or the animals was very, very sick. So it was decided to euthanize them. And and this is unfortunately happening, in early phases, in new discovered areas, what also this table illustrates is that we have a dominance of blue with blue.

I coloured the respiratory signs and, we have also green and red with green. I mark the neurological signs and in red to the were showing bleeding. And now I would like because I'm so lucky to talk only of one parasite a bit more.

Go too deep about our latest research results. So here I try to summarise different, reviews of cases that have been done in Italy, in Denmark, in UK and also our very last current data. This is but the idea to show what do we have, to think Why, when do we have to think of when we have, clinical signs, potential clinical signs of strongylosis And and here in blue, we see throughout, we have respiratory signs that are dominating coughing dyspnea tachypnea These are the signs that are mostly dominating and present in almost not all but almost every dog on the second place.

Like now, in our most current studies, with 46% we see unspecific signs, which makes it pretty difficult. We have lethargy, weakness, Even gastrointestinal signs are pretty frequent, like in the very first dog in Toulouse that was diagnosed also with gas intestinal signs. So this is an option that may, that we all have to consider before also we consider bleeding.

Bleeding, of course, is a very relevant clinical sign. This, bleeding may be unstoppable or very hard to stop. So dogs with bleeding, immediately we have to think of canine Angus strongylosis.

Neurological signs are less frequent. I will come to that right now because already Chapman in UK summarised this for these three different, groups, symptom complexes that may appear. And in addition, as I advanced, we have to consider that there are unspecific signs and asymptomatic talks.

And overall, I like this expression from our colleagues from Denmark that said strong vor is a great imitator. So this is why clinical diagnosis is challenging, especially in in new areas where the parasite was not present anymore. Yet it can be misinterpreted or misdiagnosed because very often at the beginning, the dogs are subclinical, or or chronic, where you cannot observe immediately what has been different.

Nevertheless, some cases are really acute, and life threatening. And this is where, I I would, make an accent that, this parasite is also different to diagnose because it's so different showing up as a clinical picture. And first of all, of course, the respiratory signs where we see this, strong, radiographic changes in areas where the people, the the clinicians, and the radiologists see these cases regularly, they may be able to say, yes, this is a case of strong varum, but of course, still, it's it's not a part of pneumonic finding in such advanced cases.

This This may be pretty clear. Maybe, also what I would like to show this was all data from experimental infections. These images now are from 13 weeks post inoculation to nine weeks after until metic treatment.

And this was successful until metic treatment. But still what I would like to post and is still we see all these, interstitial pattern. The tissue is not like it should be.

And these nine weeks after treatment, so still, this, lung tissue has not the function of a healthy animal. So if I, can summarise this from before treatment where we have these strong patterns in diagnostic imaging, complemented with a very strong histological picture, I think here it's even very hard to see that this histology, section shows the lung because we have plenty of inflammatory tissues and of course, of larvae. If we check this, overall, we know that it's not only an alveolar or intestinal pattern, we have very much also sometimes bronchial patterns, vascular patterns.

This all is possible and makes it a bit difficult to diagnose from diagnostic imaging And what we also learned that this diagnostic imaging not necessarily is directly correlated with the severity of the disease. And there may be a marked discrepancy between the radiographic changes and the disease severity. Now, if we compare after treatment here, we see a pretty nice lung after treatment.

But if we look at histology, not, really lung tissue like it should be. We have a lot of interstitial. Tissue.

That is not functional, like normal tissue. So this is what we have to consider when it comes to to the function of the treatment. When it comes to prevention, how can we prevent these changes in the lungs of the dogs?

Back to this overview. I can, complete with the bleeding part and the neurological signs together because they are very much correlated. We have here some nice pictures from, also the colleague in Denmark, Jacob Wizen, that, participated in this study That is also very recent, where they described from where these dogs could show bleeding.

So maybe you really don't think, when there is a melena or ocular haemorrhage? If it's out of the mouth or whatever, all this is possible, bleeding may occur, wherever it's possible. Of course, it's not nice if you have, planned the surgery.

And then the dog is starting to bleed. So this is an issue. And also, when it comes to neurological signs, very often, this is correlated to the bleeding in 17 out of 20 dogs.

With neurological signs. They were also bleeding. And this has been shown in several other studies.

indicating that these two things are very much correlated. We have, studied also, and compared dogs that were bleeding versus non bleeding dogs through rotational thrombo astory. And in these two groups, some were showing coughing, some not.

This was not significantly different. Also, the neurological signs were not different, but some dogs were showing hypofibrinogenemia Some dogs were showing hyperfibrinolysis, and this was definitively more frequent in the bleeding dogs. Why?

This happens. This is, now something I could talk about for hours. But, very shortly.

We have been investigating this because some dogs were bleeding and some not. And this is very much, the call partially due to the parasite, that is, excreting modulators of hot coagulation. And all these coagulation pathways are pretty complicated.

And Angus strong seems to interact with direct errors in different sections of this complex coagulation system and may induce bleeding in some dogs. And in some dogs not, of course, this is a a more complicated situation when it comes to the treatment. But before we treat, we have to diagnose the, the parasite.

And the first of all, I still would like to say how fond I am of the Berman funnel because it's still a very cheap and easy method. Of course, it takes some time before you can, get the larvae. But at the end, normally, what we mostly have to differentiate are these two parasite that I mentioned creno, zoa, vulpis and Angus strong vor.

And if you look at these two tails, I think it's pretty easy. You can and should be normally be able to differentiate them. By that chance, you may have a contemporaneous infection with the two, but at least we in our area we don't see creno zoa VP so much anymore.

And we almost never see these other more exotic, first stage larvae so that I will not spend my time on these. So what it when it comes to the Vermont fun matter, there are some little points that we have to consider. If a dog is positive.

Is it really positive? Mm, not always, because sometimes we observe coprophagia, especially in group holdings. If a dog is negative, of course, not necessarily the dog is really negative because the faeces might not be fresh then.

Larva migration is not possible. Also, in dogs with low worm burdens or that have been partially dewormed, we may not find the larvae, and this decreases the sensitivity of the method. Sensitivity also, over time, if we should.

If we would examine daily fresh faeces, the sensitivity is high. However, very often the recommendation is to collect the samples over three days. So is it good or not to collect the samples over three days?

We wanted to know this and did this study, in our institute by, examining fresh fess daily or kept it over several days and you see day by day the number of larvae that can be detected detected diminishes down with the reduction rate to 93% after four days of of pieces of the age of the faeces. So rather than collecting and pulling the samples over several days, I would say that it's better to consider to use several droppings and then also consider that the larvae are excreted, also after antic treatment. Even if it's successful, wait at least three weeks because we can find larvae so long in the faeces.

Alternatively, we have some, more diagnostic tools. And these are, with, blood serum or blood or with faeces or, with the swab material that we compared for detection of DNA and, making the long story short. When we when we consider the first in experimental settings the first positive dogs after inoculation.

This may reflect the sensitivity. And, you see, we can detect the first positive dogs antibodies 3 to 6 weeks after infection, very little earlier than with berman. But when it comes to the DNA detection in blood faeces or swab samples, first of all, they are not necessarily earlier.

But especially they are not consistent because sometimes DNA is there, and sometimes DNA is not there. So still, I think the values for the Burman are very good and also for antigen and antibody detection. An alternative, also, that I would only shortly mention is this case of Aramis.

Aramis was the first treated against Kenneth Cough and came, of course, with classical respiratory signs at this for a second consultation and by chance, in addition to this, diagnostic imaging. The dog had also bronchial Alvera lava a BAL, And, in addition to this, inflammatory cells, larvae were identified. And with this larvae, we did PC R Because when we do PC R when we do BAL the larvae are very often damaged, and we cannot identify them by morphological features.

So, this colleague in in Belgium, she also collaborated with us and we saw that, very often, the tests are not consistently positive In special cases, we may also do a PC R on a BAL and identify the infection. This is maybe a bit invasive. But as I said, if you, cannot identify the larvae clearly you will do a PC R and the PC R is what we do also, for instance, in histological sections.

And in this case, of course, it's an invasive method. But if bronchoscopy is done for other reasons, we may also do, PC R. With such material, many roads lead to Rome.

In the case of angio strong diagnostics, we can have this, larval migration absolutely simple and great. Also with the possibility still to identify also Reno zoa Also some in some urgent cases, we can, recommend to use a faecal smear or do the Berman funnel collection after two hours just because maybe it's urgent to have a diagnosis. Very rapid is also the antigen detection by rapid essay.

And then you have other means and other tools for difficult cases for tricky cases where you are not sure or you have the suspect and nothing else works. Now when you have the diagnosis, this is only possible if you have started to do it. And it's important also because in view of the fact that the earlier the treatment, the better it is for the dog, because the longer the infection is ongoing, you remember these damages in the lung tissue.

Also, the bleeding, signs will develop rather over time in chronic cases. So use these diagnostic tools is fundamental to identify the positive cases. And when it comes to treatment, of course we need antic treatment, and this will be also the slide, the following slide, what I may recommend, but, as a supportive treatment, we also have to consider the severity of the cases.

Maybe they need fluid therapy cortico oxygen symptomatic medications as necessary. And especially also in dogs with bleeding. Fresh frozen plasma sometimes needs to be necessary to substitute all this coagulation factor that are lost with the bleeding also internally.

And there is the possibility also to use tranexamic acid, which is used in human medicine, especially in sepsis and surgery related bleeding. Because this helps also, to, the formation of plasmin bringing back the coagulate the coagulation status as it should be. Here I have, summarised the, different, possibilities on how, dogs can be treated when diagnosis is there, but also in a prophylactic way.

And that is the dominance of macrocyclic lactone because they are currently what, is most suitable to you to treat and to, prevent S strongylosis. That is also the protocol for F be. That's all still on a high level dose and also for a long time.

So for some, cases, this may be used, for instance, if you have a kennel with 20 dos and probably this is a bit too expensive, and this prognosis is theoretically depending very much on the severity. Of course. The still.

Now the disease can be fatal up to 25% especially if the dog shows coagulopathy neurological signs and so on. And in these two studies, from Denmark and from Zurich, we see that the survival rate, depending on bleeding or not bleeding, may be similar, meaning, for instance, from from Denmark. Also, this very recent data.

If the dog was showing bleeding at hospital discharge, 77% of the dogs survive so, meaning that the others do not survive. If these dogs are not bleeding, 95% will survive and even one month after diagnosis. These percentages are lower, so it's an important and relevant disease.

But it can be, a very good prognosis if the dogs only show coughing if the it's it at an early stage where the dogs still do not show specific signs or, non specific signs or they are still asymptomatic. And when the alterations in in diagnostic imaging are not there at all, most probably, also, the prognosis is good for survival. I conclude here with saying we have a situation where we think that the spread of Angus Strongs at this stage seems unstoppable.

Of course, related. Also to the talk of Eric this morning. There are some places where the infectious pressure also will be high.

Also may be related to the wild reservoir, to the weather situation to the special local situation. And, on the other side, we have still probably areas where the nematodes, the cardiopulmonary nematodes in general are underestimated. And this is very much related to this tricky diagnostic.

Based on clinical signs. It can be asymptomatic and multifaceted. So it's a diagnostic challenge, and nevertheless, it's important because it can be potentially fatal.

We have diagnostic tools, we have prophylactic and therapeutic tools. So some have advantages. Have good advantages, and some have disadvantages.

We have to consider all these, But first of all, I think it's important, to think of the parasite. It's a beautiful but dangerous parasite in animals that, of course, have direct or indirect access to intermediate hosts. Whatever dog is free roaming, I call especially the Hoover dogs that may eat everything at very high risk of infection.

If dogs are not regularly irregularly treated, with antics, then, also every dog may be infected in endemic areas and especially we don't have to think, only in of Angus tongue when the shock shows respiratory signs, but also when the dog is coming from high endemic areas with this, I would like to thank for, having listened to my presentation. And, of course, I am available for questions. Well, thank you for that.

Wonderful, presentation. I don't know if everyone can hear me. My screen's frozen.

Oh, yeah, yeah, we're good. I think we're in the game, so yeah. No, thank you for that.

I, too think it's a beautiful worm. And and I love a Berman's as well. I think I'm we're partially part of a niche group that still love a Berman's.

I've got some questions. So I think we'll take those before we move on to the panel discussion. The first one, which I think you covered a little bit.

But it says, What about molecular tests such as Q PC R with a rapid turnaround time for screening for lung worms, as well as to be able to differentiate between true parasites of dogs and coprophagia? Yes, it's it's, absolutely justified. Question.

The fact that the molecular tools are more and more in use. Worldwide. In some places, I heard even in the clinics, done, in a veterinary practise.

For what we see from our data is that it very much depends on the starting material. Of course, you can do, PC R with with the faeces, which I think is the most common, but also on tracheal swabs and blood. If you are able to limit the inherent negative effects of inhibition in faeces, probably faeces is the most suitable material.

And if you have a panel that is also detecting, other parasites, you will be able to differentiate strong from others. But in case of Coro, probably this will not be possible to be differentiated, because at the end, it's the same DNA. Yep.

No, absolutely. The next question is, what kind of disease does it cause in foxes? It's nice that somebody's thinking about the poor foxes.

Yes. Of course, this question is is important. We we, We were checking for descriptions of living dogs that were showing clinical disease.

In the experimental ones, there were no clinical signs but in experimental ones, we also have to consider that they were not moving. They didn't have to run whatever and in in some, in one description from Canada, they were showing, clinical signs of of being not so fit. The point is that very often they die because of other reasons, at least what we see here in Switzerland.

Most of the foxes probably don't get older than two or three years old, but the lungs are very strongly affected. And there are differences between dogs and foxes that we saw with serum proteomics that we saw now in doing in culture tissue. So there are differences.

But to see sick foxes in the nature due to clinical strongylosis is almost impossible. I I Let's say it's very hard. Yeah, yeah, and like you say, natural selection, probably at work, even if they're just a little bit affected.

Let's have a look at the next one. Could you make a comment about the treatment of Angios strongylosis with fmb azole or imidacloprid stroke moxidectin spot on when treating a dynek or bleeding sick dog? Would you treat with Feb zole for three weeks or, Aidy moyet in every two weeks.

Thank you. This is a very good question through which, I also had several discussions with with Swiss veterinarians. Very, very, very good colleagues of mine, which also swear that it's better to treat fenbendazole because they think it's acting slower and because it's given over three weeks and therefore the worms die slower and a bit like the idea of theophila.

The point is, we don't have studies on that. The point is that also advocate as amoxin will act slowly on the worms. The point is, we really do not have studies and most probably dogs that are dyno or very, very sick, they might die indifferently of the protocol you use.

So I cannot tell you and be Aso is better in this case it because there is no study on that. And my personal opinion would be that that this is equivalent because it's very much depending on the severity of the case of the doc. But there are other opinions because of personal experiences.

Yeah, absolutely. And I. I have exactly the same experience.

I know lots of clinicians that, you know, swear that fenda zole is the way to go. But to my knowledge, yes, I agree. There's there's absolutely no evidence to support that.

Excellent presentation. Have there been Oh, I like this question. Have there been any human cases reported?

Are French human beings at risk from the French lung worm from eating the LISC cargo? No. Human infections are not described.

It's considered not to be a zoonotic worm. But we heard this morning of angulos cantonensis so I would stop to eat snails because of that. But not because of Azor, but yeah, French.

Yeah. Anyway, cook them. Well, that that's the answer.

That's also a good part. I take my snails well done. Definitely.

Thank you for your informative presentation today. I had a dog with creno of VPs. So this is right on time.

I wanted to ask if there was any way to figure out whether the larvae come from an animal or from Coprophagia. Yes. The only thing is to repeat the C, testing because, based on the fact that there is some time needed to for the passage in a true infection to swallow, to put this up and swallow down.

It will take some time. Let's say 4 to 5 days and then repeat. But in this time, of course, prevent coprophagia.

And and But if if the dog is known to eat, a lot of faeces from other animals, especially foxes or dogs. It could be, and And if you want to test this again But, this is the way to go. Probably, also, if if you find huge numbers of creno zom apis larvae, it's also an indication that it's a proper infection and not cedent.

Yeah, but no, no, it's a very good question. We have similar issues with hookworm being misidentified and Isospora being misidentified. Just because yeah, dogs love eating faeces.

Yeah. OK, I was just having a quick skip down to a little bit over time. Well, this is interesting.

Although the same could be asked of the UK. Really? What happened in 2000 that precipitated the spread you described in Germany?

Yeah, in Germany and in Switzerland, we really have around the year 2000. This increase that we saw in foxes and consequently also in dogs and the at least for Switzerland. We we have had really experienced an increase of the fox population.

And this is the most the closest reason we may have for debt. And then right now, I have no other additional explanation. Yeah, yeah.

No, no, that could be OK, I think, last one. Is there any point in trying to prevent dogs from eating mollusks? Say EG muzzling.

And they all say thank you for a great practical talk. No idea. Not am I.

I would say, You know, unless you have to muzzle your dog for legal reasons, then hard, isn't it? Yeah. OK, well, thank you again.

It's been fantastic.