So good evening everybody, and thank you very much for joining us for tonight's webinar that has been presented by Ian Wright. Ian is a practising veterinary surgeon and co-owner of the Mount Veterinary practise in Fleetwood. He has a master's degree in veterinary Parasitology and European Scientific Council of And director for the ECCAP in Europe.

Ian is regularly published in peer reviewed journals and an editorial board member for the Companion Animal and Vet CPD journals. He continues to carry out research and practise, including work on intestinal nematodes and ticks. So tonight, Ian is going to be discussing exotic worms and what's new with them.

So over to you, Ian. Thank you very much. And, well, who doesn't love an exotic worm, a livening up your week, but, increasingly, I tell you what's new is that more and more of them are coming into our practise, week in, week out.

So, you know, thank you all for, for joining us tonight, because I think this is an increasingly relevant topic. And well just incredible, really, that, you know, we're seeing things that even a few years ago would have been inconceivable that we would have seen them in first opinion practise in the UK and yet here we are seeing very strange things, like this little guy, this little guy is lingua Sara. I've put him on the front because he's not a worm.

He's called a, a tongue worm. I'm going to talk about him briefly. He's not, he's not really a worm.

He's a nasal pentastomid, but just a, a great example of the very, very strange things that we see coming into practise at the moment, week in and week out. So, if we think about exotic worms, they, they, they're true worms, and then there are the worm-like. So the, the worm-like is, is very much linguaging the errata, called a worm, not a worm at all.

But the actual true worms, true exotic worms that we see, are roundworms. They're, they're vector transmitted roundworms. So diro.

Species, so heartworm, diophylaria rheumatus, but also skin worm, diophylaria repens, both transmitted by mosquitoes, and Falasia caloppia that we're starting to see in imported and travelled dogs in the UK, which is an eye worm transmitted by fruit flies. So, you know, real bit of the exotica there. The worm that we haven't seen yet in the UK but is easily of the greatest concern in terms of pet importation and pet travel is Echinococcus multilocularis, which is a tapeworm.

And I'm going to spend a bit of time talking about Echinococcus and just talking about it in relation to the pet travel scheme because it is, you know, in terms of biosecurity, individual owner, and public health, far and away the most important worm that I'm going to talk about, possibly the most important worm in companion animal medicine as a whole. The reason it's so important is that it is a very, very significant stenosis. So, you know, not a sort of cause of acute illness, or sudden death, but very chronic, very prolonged illness, so, you know, tremendous morbidity and reduction in, in life expectancy as a result of infection.

So, you know, very, very serious. But also, dogs that carry it remain subclinical. They don't show any external signs.

And if they did bring it in and it was introduced, it's maintained, by a sylvatic life cycle. So from that point of view, it's very, very difficult, very, very different to its friend Ikaya. Granulosis, sort of closely related cousin, which is maintained by a domestic cycle of dogs and ruminants.

This is a wildlife cycle. So it tends to be maintained by rodent intermediate hosts, most commonly a microtine voles, but other rodents can get involved as well. And then foxes acting as the primary definitive host with the tiny tapeworm inside.

And if you go to mainland Europe, you'll find all sorts of other canned hosts like raccoon dogs, golden jackals, but it is the fox even in mainland Europe, that remains the primary reservoir. So just to remind you about the life cycle, if we take the fox at the top, that's got a tiny little tapeworm inside, just a few millimetres long, so it's gonna pass microscopic eggs, so, you know, no visible segment. Nothing that you'll be able to see with the naked eye, but immediately infected eggs that are passed in the faeces.

So, not like toxicara, let's say, that takes time to mature, these eggs are immediately ready to go. And they're going to contaminate the environment through faecal contamination, so they might get on to wild berries, they might get on to edible vegetation, fruit and vegetables. They might be eaten by paritic hosts like little invertebrates, little beetles.

Any of these things might be eaten by the poor microtine vole that then acts as an intermediate host. So the parasite will spread in the vole and then the vole will be eaten, circle of life complete. The fox is going to eat it and you're going to end up with a little tiny tapeworm back inside the fox.

What brings the parasite into close proximity with people and the way that people get infected is mostly dogs. So in endemic countries, people do get infected by eating wild berry picking, . Eating straight from their allotments without thoroughly washing fruit and veg or cooking it.

But the main route of infection comes from dogs, and this is because dogs eat voles, they get infected and pass the eggs. You know, most of us, I suspect, won't go out and cuddle a fox and get in around a fox's bottom and get it exposed that way, but we will cuddle our dog and we'll. Groom our dog, have a very close relationship with our dog, and as a result, we can get infected much more easily.

And what happens as a result of that infection is very, very nasty. So, if we take echinococcus granulosis, that develops individual cysts, and you might get infected with multiple cysts, but as long as they don't rupture, they're going to remain as individual cysts. In contrast, Echinococcus multilocularis will spread and bud, both locally in the organ it starts in, which is most commonly the liver, but also the other organs like the lungs, the central nervous system, so, you know, potential for for very, very nasty disease and for it to spread very much like, a malignancy, like a malignant neoplasia.

Most people that are infected will develop liver failure, as this tends to be the primary site of the cysts. Now, I mean, it has to be said that treatments have improved enormously over the years. So, you know, if you went and caught this decades ago, then you would be in real trouble.

You might not survive more than 10 years. I mean, now, you know, there have been good anelmintic, combinations developed. There's a lot of success with surgery in mainland Europe.

There's a lot of surgeons in, in Germany and Austria, very proud photo collections of, of the liver lobes that they've. Taken off, but even with these advances in medicine, you are going to be very, very ill, potentially from infection, and it is going to shorten your life expectancy as a whole. So very, very much well worth avoiding.

And the worry is, it's spread. After very successful, rabies control in mainland Europe, one of the great health success stories in the 1980s. Fox populations came back, you know, I mean, we were very lucky, you know, it's a very good thing that we've, by and large, got rid of fox rabies from central, western, northern, southern Europe, but the fox populations have done incredibly well, felt much better as a result, and Echinococcus multilocularis has spread and spread a long way quite quickly.

This is the, the purple areas where it was in, where it had been recorded in 2014. And I mean, since then there has been a degree of further spread, crucially, it spread westwards, so now definitely present in central and northern France, probably further west than that. We don't know exactly where.

But it has also, spread into Denmark. Denmark has lost its, Echinococcus multilocularis free status, and also patchy endemic folkline now in Sweden that has lost its status as well. So there's a big worry, both in terms of there now being lots of countries that we, import dogs from and that dogs travel to.

That, you know, are now very endemic for infection, but also countries bordering, free states, free countries like Norway and Finland, with, you know, very long land borders, so very easy to take. For wildlife to cross and for infection to spread that way. So, you know, we should essentially, almost any country, that dogs are visiting, we should have some sort of protection in place for them, just in case.

And what is the risk to the UK? Well, the worry is that we have very, very large numbers of reservoir hosts. So if dogs come in and they're subclinical, then we're going to find that there are lots of wildlife reservoirs that are.

To pick that infection up. So migraine hope, migraine voles are the most common rodent in the UK and we have lots and lots and lots of them. So they're there to potentially act as an intermediate reservoir host.

And we've had for decades, because we haven't had rabies, I had fox rabies for a very, very long time, we have huge numbers of foxes and have had for decades in, in the UK. So, you know, we've got a large. Infinity post reservoir, we've got a large intermediate host reservoir.

So any dogs come in that are infected, deposit eggs in the environment, it's very, very likely that we would get endemic status very, very quickly. And the problem is if we compare that on the human side, you're looking at an average, and it is very much only an average of 10 to 15 years before we would see the first untraveled human clinical cases after it became endemic, and that's because of the very long incubation period of the disease in people. And sometimes.

It is a little bit shorter than that, but it can be much longer. It can be 25, 30 years. So, you know, you're looking at this big lag.

By the time we realised those human cases were there, it would be far, far too late to do anything about it. The parasite would already be endemic in the UK. And there's been very good statistic modelling done by Torgeson and Craig back in 2009, it's published in the Vet Record, .

Demonstrated if that compulsory tapeworm treatment on the pet travel scheme wasn't in place, and tapeworm treatment before entry to the UK, you could pretty much guarantee that infected dogs would arrive and that if they did arrive, an endemic status for the UK would establish. So that compulsory tapeworm treatment has remained vitally important to keep us free. I mean, as far as we know, up until today, it has kept us free, and we still don't have any chinococcus multilocularis in the country.

Having said that though, since 2012, the treatment window has relaxed. So instead of it being 1 to 2 days that people have to have their dogs treated before entry to the UK, it is now a 5 day window. So, you know, you've got a much larger window, much bigger opportunity for dogs to get infected, and Praicon has a very short half life.

You know, possibly as low as 1.5 hours, certainly no longer than 5. So it's eliminated from the body very, very quickly.

And I mean, if, if dogs are travelling for less than 5 days, they can have their compulsory treatment in the UK before they leave, which kind of demonstrates that there is very much an opportunity for infection there while they're abroad before they came back. So what are our options for prevention? Well, certainly screening has been discussed, you know, rather than just sort of treating everything, could we screen dogs that are coming into the UK to see if they're infected?

So that's been discussed as an option. Alongside whatever we do with dogs, we need to be careful for intermediate hosts that are infected being imported into the country, released into the wild, and then potentially they've being predated on by foxes and a sylvatic cycle being set up, . But the, the mainstay of treatment so far and likely to be in the future are preventative treatments, so the compulsory treatment before dogs come in, but also additional risk-based treatments, which I'll discuss in addition to that.

If we briefly consider screening for achinococcus multiocularis. Well, even if we'd have had this, discussion sort of 6 months ago, I would have said, that diagnosis was very, very difficult. And that is because the only option then, certainly the only commercial option was, faecal flotation.

A faecal flotation for tapeworm eggs it carries a very, very poor sensitivity. They just don't float very well. So, I mean, if you get a teen egg, you don't know which teen you've got, whether it's a true teenia or whether it's an egg, .

From Echinococcus granulosis or multilocularis, but to get a tapewormme at all, you have to be quite lucky, given how poorly they float. So that was never really a screening option. What has recently come to the fore, though, is copper antigen testing.

And there are a couple of companies, at least that I know, are working on this. Hariba, that have in-house PCR machines, they have echinococcus as an option to run on those machines. Now, it can't distinguish between granulosis and multilocularis, but I think, you know, if you had a dog, any dog that was positive for Echinococcus, then you'd want to go on and treat it.

But in terms of sort of, specific screening for dogs coming in, it, it does have that drawback, but still, you know, it's certainly useful. IEX as well in the states where chinococcus is just starting to sort of rear its head and establish, They've also developed a copper antigen test for Echinococcus, but again, it doesn't differentiate between the two, so presumably at some stage that will become available in the UK as well. And the thing is, screening is a useful thing to do.

I don't think that it can be a substitute for preventative treatments. And the reason for this is if you get a positive dog, you know, say if you test a dog on arrival and it's positive, well you can treat it and then you're probably going to minimise the risk for UK biosecurity, which is good. But that individual that owns that dog, anyone else that's been in touch with it, may have already been exposed to infectious eggs with really quite significant zoonotic risks.

So, I think that, you know, it's a very good adjunct, it's something to use alongside preventative treatments, but it is not a substitute for preventative treatment on its own. We mustn't forget the Trojan beaver. I can't take credit for the Trojan beaver, but it, it sums it up nicely in that, you know, there's been a lot of focus rightly on the worry of Trojan dogs bringing infectious pathogens into the UK if they're imported.

But we did take our eye off the ball a little bit with beavers that rightly or wrongly, not an area of my expertise, are being, reintroduced to the UK in certain areas in the wild for, ecological benefits, because they're cuddling, I guess. But you know, like them or hate them, they're being rein. Into the UK when they were first introduced, they were, some of them were from Echinococcus multilocularis endemic countries.

So perhaps wasn't a surprise when one of them was found to be infected with Echinococcus. And if it had been eaten by a fox, that may well have been it for our endemic status. So we do have to be cautious about.

Other routes of introduction of Echinococcus multi ocularis. I mean, it is found periodically in zoo and wildlife park animals as long as foxes don't end up eating them, which I'm sure is the aim of most wildlife parks and zoos, then, you know, that isn't a tremendous UK biosecurity risk. But animals that are going to be reintroduced to the wild potentially are.

But as vets and veterinary professionals, our focus should very much be on this preventative treatment, which is absolutely essential, is the mainstay of keeping people and the UK safe. And that, preventative treatment consists of rasiuanttal. Prasicuanttal is still the great nuclear weapon that just wipes out tapeworms.

It comes as a short half-life, so it comes, it wipes them out, and it goes, exquisitely, sensitive. It kind of got us multilocularis to the drug. So we've been lucky in that we've had such a potent drug to keep it out of, of the UK.

As I've said, it's dogs that are important because they're bridging hosts. They are what bring it into very close proximity with people, and of course, you know, could potentially bring it into the UK. We do get asked about cats because cats don't have to have a compulsory treatment on the scheme, and there is some logic to that.

Cats don't carry as many tapeworms if they get infected. They don't tend to be ascus. They don't produce as many eggs, and it is much more difficult to get cats infected in the first place, so.

I don't think they represent a tremendous UK biosecurity risk, but if you have cats that are travelling with their owners for a long time, or, you know, they, they, sort of, you know, spending a long time abroad or frequent holidays, then, you know, there is that potential risk that eventually they're going to get infected and then be a risk to their owner. So for that reason, I'm intrigued. But you know, they're nowhere near as significant a UK biosecurity risk as infected dogs would be.

Pre-patent period of the parasite is 30 days. So the focus, you know, has been rightly on treating dogs before they come back in, or when they arrive back in the UK, the UK biosecurity, but if they're out for their own. As with more than, for more than a month, then potentially they could get infected, produce eggs after a month, and then their individual owners, individual people would be at considerable risk.

So for that reason, every month, they should be treated with Prazuil every 30 days while they're abroad. There is also this window of opportunity with the 5 day 5 day window for reinfection. So for that reason, a repeat treatment is recommended by SAP UK and Ireland after dogs, within 30 days after dogs come into the.

And this will ensure that if they have been infected in that window, that the tapeworms killed before it can produce eggs in the UK. So a very good, second sort of backup method of ensuring, infected dogs don't start producing eggs in this country. Moving on now to diophylariaimitous to heartworm, this is a worm very much that we just weren't seeing in the UK a few years ago.

Certainly even with the pet travel scheme, not in significant numbers, most dogs, and cats travelling on holiday would have a preventative treatment, very few of them will get infected and come back. What has changed is the increasing numbers of dogs that have been rescued and brought in from endemic countries. Many of them previously street dogs or welfare dogs, haven't had adequate prophylaxis and protection, therefore much more likely to be positive when they come into the UK.

And this is a very clinically significant worm, for cats and dogs, but particularly for dogs, because of the numbers of heartworms they can get and then the potential heart disease that can develop, arterial obstruction, and from embolism, you know, I mean, these worms are 10 centimetres long, having them in your pulmonary artery and heart is not going to be good for you. Cats do also get infected, but they're not as competent hosts. They tend to have much lower numbers of worms.

They can have, acute complications from that. They can get respiratory signs from migrating larvae. So cats can be affected, so it's very, very important that they have adequate protection while they're abroad, but it is dogs, that, you know, really, really do suffer from the parasites.

We mustn't forget that ferrets also get infected, so they need protection while they're going abroad. But, having said that, they tolerate the parasite, remarkably well, as ferrets do so many parasites, so, you know, again, not as severely clinically affected as dogs. All of these pets need protection if they're abroad.

It is a myth that the mosquito vector isn't present in the UK. The mosquito vectors that can transmit heartworm are present all over Europe, including the UK. It doesn't live for long enough for heartworm to complete its life cycle here.

So as a result, You know, there isn't a huge risk, certainly at the moment of heartworm establishing in the UK. I mean, give it another 5 or 10 years, currently with sort of climate trends, and in the south of England, you may be looking at that as a possibility. But at the moment, it's crucial to diagnose and pick up infected dogs that are coming into the country, not because of UK biosecurity, but so you can plan and manage and treat those infected dogs, because it is very, very likely that they're going to have health problems at some point down the line if they haven't already, due to their infection.

So how do you go about diagnosis? Well, certainly, I mean, whether you're diagnosing a suspected case or whether it's routine screening, either looking for microfilaria or, doing antigen serology is gonna be the way to go. And you can do a direct smear and have a look.

In fact, in terms of imported dog, exotic parasites and cats, imported parasites in general always recommend a blood smear because you can pick up all sorts of things if you're lucky. In the case of heartworm, you would have to be very lucky to detect it on a direct smear, you know, you'd have to really sort of hit the jackpot there. You need some sort of concentration method, and the modified knots test is actually a very, very good one.

I mean you can spin it down in-house and look in buffy coats, sometimes you'll see larvae. You won't know whether they're heartworm or ripens, but you'll know that they're microfilaria there. But it, certainly, I certainly, I think Langford and NWL labs now do modified knots because of the numbers of cases that have come in.

They've dusted off their modified knots test. So if you send blood samples to them, they can look for microfilaria, and this It is useful because it tells you the microfilarial load, tells you, you know, how many circulating larvae are there and whether they're likely to cause a problem during treatment. So it is in itself, it's a very, very useful test.

What's probably most useful as an initial screen though, is antigen serology, and there are lots of patient side tests now that you can use for antigen serology. So what it's doing is it's picking up the the antigen in the worms uterine secretions. So it will only pick up infections if female worms are present, which is a problem in cats, relatively insensitive.

Test in cats where perhaps you've only got one or two worms present, but in dogs, it is extremely useful and it's a very, very specific test. And if you've got any reasonable worm burden, certainly a worm burden that's likely to cause a problem, it's pretty sensitive as well. Patient side tests are relatively cheap.

They need a small amount of blood to, to run, and you know, There's a whole range available. I put up this one, the 4DX test, only because if you are looking to screen for a range of pathogens, there's a number of ways you can do that in the imported pets. But this one say, will cover, a lia anaplasma, as well as heartworms.

So you've got the opportunity to sort of bunch a few of those, a few of those tests together. The question is, having got a positive dog, then what do you do with it? And sometimes there is a bit of a dilemma as to whether you should treat a heartworm positive dog.

And you know, the, the first question that you need to ask is, well, is it really positive or negative? Because there are, increasingly, I'm finding dogs that are coming in that are heartworm positive allegedly, and the person who's adopted the dog from the charity will be clutching a bit of paper. You know, you know, very rarely, sometimes, but very rarely, the original test results, and sometimes not clear which test has been carried out.

And I've been alluded to at least one, where the owner had been told it had a borderline positive results. And, you know, if you're doing antigen serology, or you're doing microfilaria testing, it's positive or negative, there is no borderline. So that really has to have been an antibody serology, which has some use in cats, if you're considering larvae migration, or, you know, just the possibility that they might have been exposed to.

But isn't so useful in dogs that almost certainly, you know, will have been exposed, to infected mosquitoes at some point, because they're living in a positive country. So, you really need to know whether it's positive or negative, and my advice would be, if you're not sure, just do it again. You know, patient side test, it's cheap, it's cheerful, get it done, get a positive or a negative result.

It's then very important to know how large and how old that infection is. So if you've got very large numbers of worms, and you've got a clinically stable patient, then it's probably going to be better to treat and try and eliminate those worms in a relatively controlled fashion than let them die of old age, which might be potentially en masse. Having said that, if you've got a very light infestation, this dog's clinically normal and it's been in the country for 56 years.

Those worms, if you're very, very lucky, might, might pass of old age, without incident. I mean, I would only ever consider that. If you're looking at a very, very low burden, because any significant burden, and if you're unlucky, even a small burden could cause very significant problems.

But you know, it's certainly, considering the size and the age of that infection is very, very important. You've got to consider where the clinical signs are present. If heart disease is developing and the patient will tolerate treatments, then you've really got to get started as soon as possible.

You know, if you are going to treat at all. If you've got advancing clinical heart disease, or if you've got co-infections like Alicia, hepazoin, particularly chronic olichiosis, or say, le meiosis that's developing, and all of these things are compounding factors, which means that treatment may not go very well. .

In that situation, I think, you know, you really have to consider whether it is in the dog's best interest to treat. But, you know, if you've got a reasonable worm burden, a healthy dog, early signs of heart disease, then, you know, treatment is a very, very reasonable option, but the owner has to understand that there is going to be a risk of death, unfortunately, and I mean, the charity where they've got the dog from may well not have prepared them for this. But you know, any treatment protocol carries a risk of thromboembolism or anaphylaxis, and particularly to sudden death from thromboembolism.

And that certainly could happen. If you don't treat, you could get obstruction, anaphylaxis, or thromboembolism from dying or migrating worms. So whichever route you take, unfortunately, there is going to be a risk to the pets.

If you are going to treat, then what you do is you start off with doxycycline. I should say there are all sorts of protocols available. This is just one example, but they all have certain key things in common.

And the American Heartworm Society for evolving and up to-date protocols, very good source of information, very good website. Broadly speaking, what you're gonna do is you're gonna soften up the worm, so you're gonna hit it with some doxycycline, which is going to kill the Wolbachia that it has a symbiotic relationship with inside its body. That's going to soften it up for for treatments.

You're then going to hit it with macrocyclic lactones, to sort of again soften it up further, prepare it for adulticide treatment. And then after 1 month and then again with two further treatments after 2 months, you're going to hit it with a dultaide. The one that's most commonly used now is melarinine, which is miticide.

And that is, you know, effectively what the treatment involves. And then you're looking for microfilaria after treatment and antigen serology after treatment to demonstrate that infection's been. Eliminated.

Now, that all sounds fairly straightforward. The, the biggest risk with any treatment protocol is the risk of thromboembolism and death as a result. And of all the things you can do to try and mitigate that, strict rest is absolutely essential.

So if you have a dog where that Just isn't going to be possible. If you've got owners who aren't prepared to strictly rest the pet, cage rest it, if it's a bouncy dog, for what is going to be a long period of time. If that dog doesn't rest, there is a very significant chance it's going to die.

So owners have to be prepared for that. They really have to be on board to rest the dog from the start, otherwise things just are not going to work out well. Preds are quite useful as an anti-inflammatory and the American Heartworm Society supports their use both to limit the risk of anaphylaxis if you've got large numbers of circulating microfilaria, but also there's some evidence now that they do reduce the risk of thromboembolism as well.

But you know, again, they're an adjunct to treat. They are no substitute for strict rest on their own. A lot of people over the years have suggested aspirin.

There's no evidence that that makes any difference in terms of mitigating, from Wmul is risk. There's been a lot of debates and a lot of people ask about the slow kill, and whether that is an alternative to, using an adultticide. It's become very popular in the states.

If you go online and look up heartworm treatments, you're gonna find, somebody promoting slow kill and it being just as good, as using an adulty side. This is, you know, absolutely not true, and I mean if you go on to the American Heart Society website, you know, they will treat the slow kill method as something akin to Satan. Now, partially, that is because there's some evidence to suggest that slow kill sort of methods in.

In the states have promoted resistance there, and that is a problem. Resistance is developing in the Mississippi River basin, it's spreading and it's a big concern in, in the US. So for that reason, you know, if you're in an endemic country, I absolutely would say the slow kill, just, you know, don't, don't do it.

In the UK, I think there are situations where it's going to be a valid alternative, but only if adultticides are not available, and sometimes they're not. They have to be imported from other countries and sometimes supply just isn't there. You just can't get your hands on them.

They are also very expensive, and that shouldn't be a barrier to using them, if at all possible, but there are some clients for which they are just going to be out of reach. So in those situations, you might consider using this type of approach. .

The approach is just to use the doxycycline to start off with, just as you would, if you were going to use an adultticide, but then you just carry on with a monthly macrocyclic lactone until you get negative tests and the parasite has been eliminated. The myths that surround it are that somehow this is just as good a treatment as using an adultticide. Now, I mean, eventually you will probably get there, you'll soften up the worms and they'll die, but getting there, it can take 6, 12 months, sometimes longer in the literature to eliminate.

That adult infection, and that is a tremendously long time during which the pet has to be rested for that whole time. And if you've got high microfilarial loads, you're gonna have an ongoing risk of anaphylaxis as well, which, you know, if you have got high loads, it's going to be a pretty bumpy ride. .

If you do go on Mr. Google and look at sort of, you know, people who promote slow kill, some of them will say, oh well, there's less risk of thromboembolism, you know, slow kill is good. There's absolutely no evidence that there's less risk of thromboembolism.

Dogs on slow kill regimes have and do die from thromboembolism complications, so strict rest is just as important. And if you're even going to consider this technique, then I would establish a microfilarial load first because if you have got very high microfilarial burdens, as I say, it is gonna be a bumpy, bumpy ride. In terms of control, you know, if you, for pet travel, it's very, very straightforward.

You want to use a licenced macrocyclic lactone the whole time, every month while you're out there, and you want to carry it on for at least a month after you get back. In terms of imported cats and dogs, we want to be very, very vigilant for signs of cardiopulmonary disease in cats and dogs that are coming in, but I would recommend screening all imported dogs that come in, and certainly with antigen serology. And, I mean, if, if your client can afford it, I would do a modified not test to assess microfilarial load as well.

But what I would absolutely stress again is don't trust the imported history unless you have in your hands those original test results. I wouldn't trust a negative or positive results without testing again. Diophylaia ripens is the less pathogenic cousin of diophylaria rheumatus, and it's less pathogenic because the adult worms live in the skin and not in the heart.

So they might live in distinct nodules or they might live diffusely through the skin. They can be found less commonly on the surface of the eye or established with nodules that are discharging onto the eye. And then again, you've got microfilaria that are circulating in the blood or the lymphatics.

Nowhere near as pathogenic as heartworm. It's mostly infection in dogs, occasionally you see it in cats, but the worry is that it's zoonotic, and zoonotic through, mosquitoes feeding on people in endemic countries. And unlike, diophylaritti, it would be more than capable of establishing in the UK.

It can play its lifestyle. Much more quickly in mosquitoes that are living for the sort of length of time they are in the UK, so temperature would just not be a barrier. So if you've got undetected dogs being imported into the UK, being fed on by mosquitoes, or if clinical cases are missed, then that is going to be a real problem.

And subsequent human cases, lesions like this, are likely to occur. So it's very, very important that we pick up and deal with cases that are coming into the UK and that is tricky because you often haven't got a lot to go on. I mean, dogs may come infected, you may find them with dermatitis, you may find them with worms on the conjunctiva or sometimes coming out of the nasal passages.

You may find distinct nodules that you can remove and send for histology, but often they are completely, subclinical, and there, you know, there, there is in that situation, very little that you can do to detect them. The image there is the worm, that crawled out of a pre-scrotal incision, and that dog had been in the country with no other clinical signs for five weeks before that happened, had been imported from Corfu, so. If you're, again, if the new owner can afford it, I would go for the modified knots test because that will detect circulating microphylaria to diophylaria res, as well as diophylaria remittances.

So in that respect, you know, it's not guaranteed to pick up infections, but it is more likely to pick up infections that mosquitoes in the UK could then take advantage of. . The other option is to use treatments.

Now, if you've got a clinical case and the owner can't afford any testing, even if you've got a subclinical dog that's come in, the owner doesn't want to pay for a NOS test, and you've done, antigen serology testing for diophylaria rheumatti and it's negative, then I think treatment is very, very justified and in confirmed clinical cases or in imported dogs, moxidine in medical operate spot on, sort of is, is, is licenced for treatments. And I mean, I would keep that, I would keep that up for at least sort of 2 or 3 months, just to ensure that infection is cleared, but that is very much there as an option. So that's sort of your options in in terms of case cases coming in, you can do your knots, or you can do your preventative treatments.

If dogs are coming, travelling abroad, then, you know, I think it's worth considering, preventative routine treatment for them while they're abroad, and cats as well. So if they're going to, a heartworm endemic country, then they're going to be on a macrocipient lateone, which in all probability is going to do the job for repos as well. But if they are travelling, to countries which are endemic for reasons and not endemic for, then I think there is an argument, for using, a licenced product in those pets to prevent exposure to this parasite.

And as I say, moxidectinidocloripodon is licenced for this purpose. If we look at the distribution map, we can see why diophylaria repens is such a concern. So the hashed areas, diophylaria reens, the solid areas are diophylaria immaus, which is present in Portugal since this, this map was done.

But you can see how much further north, how much more widespread diectical area regions is because of its temperature requirements. And, you know, this is a, is a really big concern, so could establish in the UK very, very easily. It should be said as well that diophylaria imetus has spread to countries where you might not expect it.

So it is now positive. Heartworm is now prevalent and endemic in Romania, in Bulgaria, and a lot of Eastern Europe, it's becoming more prevalent. So it's in Serbia, for instance, it's overtaken diophylaria rens as the most common filaroid.

There, which is a, is a big sea change. You know, it's a big sort of shift in distribution. So, it can also, spread, seasonally up in some central France.

So we just need to be very, very aware on the border of this solid area that cats and dogs might still be, and ferrets. Let's not forget the ferrets might also be exposed to infection. Is gonna briefly talk about Falazia caloppia, the eye worm, because there have been cases, seen in the UK, in travelled and imported dogs.

There were 3 cases written up in the vet record a couple of years ago. It's called the Oriental eye worm because traditionally it's found in Asia. It's really considered to be a far eastern worm, certainly not a sort of central southern European worm, but that is where it has moved and it's following its fruit fly host.

So these 4. Species feed on fruit and tree sap and all sorts of innocent things, but also eye secretions, so they can move the worm from one host to another. And that host in terms of pets is most commonly dogs, although again, occasionally cats do get infected, but crucially, again, it's a zoonotic, a parasites.

So what happens is that this fruit fly is moved. Rapidly across southern Western Europe, and, you know, established in lots of new countries. We've got travel cases in Spain, Italy, Switzerland, France, so, you know, fruit flies have moved there, and then the eye worm has followed, and wherever the eye worms followed, then there have been human cases afterwards.

So there is a significant zoonotic risk there. And yet pet movement is largely driving, the spread of parasites, although there are sort of wildlife movements involved as well, but it is very much climate and changed to a favourable climate that is driving the spread of the fruit fly. And we can see this is sort of climate modelling.

So the black rings, so the spots you can see where there have been recorded cases, already, but the bands that you can see are the likelihood of it establishing in the future with, red, you know, being an almost certainty, and then coming down from there. And what we can see is that there have been These fruit flies already been found in the south of the UK, but more worrying, we can see a big chunk of the UK is just ripe for fruit fly invasion, and we can just expect it to establish and spread. So if we have undetected Falasia dogs coming into the country, they are going to be a potential reservoir of infection for these fruit flies.

It's not hard to imagine how this could very easily become an endemic parasite in the UK. So it's very important to catch these cases, both to prevent that happening, but also, it's not very nice for the dog, I, I would imagine. I mean, almost all of these cases have associated conjunctivitis.

If the parasite's there for any length of time, you're gonna start to get more serious changes like keratitis and corneal ulceration. And what you're looking for is the larvae and the adult worms presence on the surface of the conjunctiva. They like going behind the third eyelids, you know, like sort of tucking themselves away.

So you may see them in the conscious dog and Jujunctivitis, that should be the big sort of alarm bell that's going off. To get a really good look though and identify these worms, you might have to give the patient a light sedation, so you can really get behind that third eyelid and encourage the worms to come out to play. Treating them is very, very straightforward.

It just physically remove the worms, flush the eye out, and in combination with that, there are now licenced treatments available. So single dose of moxidectin, immioclopra is spot on. Or, milbamycin oxin, praicontal tablets, two treatments, 7 days apart, so treatment, 7-day break, treat again, in combination with this physical removal of works is very, very effective.

And finally, I'd like to talk about lingu tuba serrata. I mentioned it because like I say, it is called a tongue worm. Many people assume that it is a worm, actually more closely related to a crustacean, about 2 to 3 centimetres long and lives in the nasal cavity or at the back of a nasopharynx, upper airways, .

The main worry with it is zoonotic risks. So this isn't a pet travel risk parasite. Dogs, it's mostly dogs again, that get infected, tend to get infected through eating raw offal from ruminants or rabbits.

Occasionally, sort of muscles of ruminants as well, eating the nymphs that then develop into adult, worms. So unless you're going to let your dog feast on some raw sort of livestock, you know, they're probably not going to get the infection while they're on holiday. However, dogs that live in endemic countries live in close proximity, you know, in Eastern Europe and the Middle East, you know, live with the ruminants that they're looking after people and their dogs live in close proximity with herds and flocks and tend to eat the raw viscera associated with.

So as a result, the dogs can get infected and humans in endemic countries get infected with the adult worms in the same way. Now, that isn't gonna be a zoonotic risk for people, in the UK unless they're having, you know, the holiday of a lifetime, beasting on that raw viscera abroad. The worry is that we can also act as an intermediate host.

So if you have infected dogs come into the UK, they're shedding eggs in the faeces and more in the nasal secretions, then new owners can get infected through a bit of lovely facial snuggling, which people love to do, and before you know it, you've got your own cyst in your liver or in your muscles or, you know, perhaps a little. Shrimp-like organism wandering around in the anterior chamber of your eyes. So the risk is low, but if people are living with infected dogs for any length of time, it's a problem.

So we just need to be vigilant for signs of sneezing, occasionally epistaxis, nasal discharge, choking, gagging type signs, in infected dogs. Most commonly though, people realise that dogs are infected when they sneeze these wonderful organisms out on the carpets. So the one on the left is a carpet in Bradford that ended up with a lovely lingua, the errata residing on it, the one on the right, they called.

On some tissue paper or, or kitchen towel by the look of it, and that was down in the southeast. So they're they're turning up very regularly turning up in Eastern European, and even Middle Eastern dogs. Recently heard of a dog from Turkey, that was infected.

Overall, SAP UK and Ireland are promoting the four pillars. So for imported dogs, we want a very systematic approach which exotic worms are a part. So we want to check the ticks on arrival, get those identified.

We want to give them this additional prazoquanal treatment, and we also want to treat them for ticks if they haven't been on arrival. We want to recognise any relevant clinical signs, that might be relevant to pathogens, from the country they've come from, and we won't be familiar with all of those, but if we can pick up those relevant clinical signs, we can then marry them to parasites from the countries that they've lived in or visited. But also this routine screening, testing for leishmania, heartworm, ideally for diophylaria res as well, and exotic tick-borne pathogens is vital, and not only in some cases for UK biosecurity, but for the long term health and management of these new pets.

And don't forget SCAP, which is a wonderful, wonderful, depository, or repository of information. And it's completely independent, we've got lots of information actually on the website, distribution maps. We have a pet importation sheet for people who might be considering importing a pet from abroad, it's things to consider.

We have a pet travel sheet that you can down. We have the guidelines, but also, if you have any queries at all, please remember, that you know, you can just pop an email into us, and we will do our very best, to answer it. And, thank you very much.

Thank you for listening. Thank you very much, Ian, for that. Oh my gosh, that really informative talk, and I'm just trying to imagine the owners when their dogs have actually sneezed them worms out onto their house that onto their carpet.

Oh my God. It gets them on the big red phone. Pretty fast.

I can imagine. And, I'm sure everyone else, who's been listening has hopefully got some, information that they can actually take back to practise. So for when they are having to deal with any, patients that have been travelling around, and it just look like that, that SCAT website looks absolutely fantastic.

I'm, I'm sure I'm gonna go and have a little nosy on there myself. So does anyone have any questions, if you'd just like to add them into the question and answer box, and then I can put them over to Ian. I do have one already, and this is from another Ian, and he is saying that he's seen quite a number of dogs that have been imported from Eastern Europe, which were heartworm positive.

They have found that, for, forgive probably the pronunciation of this word, and they found that melas. Yeah, that's that's the one that one exact one was unavailable and they were difficult. Can you source it in the UK or do you need to get a special import licence?

Unfortunately you do need an import licence, and that's the really easy bit. So, you know, there's absolutely, you know, the VMD a very straightforward system for getting the import licence. It it's just availability abroad and .

You know, there are a number of websites, if you go online, that supply it, but just like us getting drugs in the UK, they are dependent on their own suppliers, you know, in the manufacture of the drug. So in that situation, it is a judgement call whether you go ahead with a slow kill type. Strategy or not.

You know, it's not wrong to go ahead and I mean, indeed, if the patient is starting to deteriorate with heart signs, you might have no choice, but it's just that strict rest for very long periods of time, that can be, can be difficult in, in some patients. OK, thank you very much. So, I, I think that was the only question, that we've had put over for us this evening.

So thank you very, very much for such a wonderful talk. I feel like I'm off to Google images of one. Thank you very.

Thank you very much, Peter, in the background at Webinarett. Thank you, everyone, for joining us. And again, thank you very much, Ian, for this absolutely wonderful talk.

And, yeah, everyone, I hope you have a really good evening. Thank you. Bye-bye.

Thank you.