Oh, thank you all for joining me. Er today we're going to be contemplating er parasites that may have become an issue because they're emerging, or ones that we're concerned about arriving or that may arrive in the future. So er what stemmed this webinar is that I did a webinar about a decade ago, which wasn't just focused on this topic.
But you know, as part of that, I speculated, you know, as, as someone fictionally famous once said, you know, it's a capital mistake to speculate without data, but a little speculation about what might turn up. Over the next 1010 years, and you know what the major concerns might be. So we thought it might be interesting, just to look at some of the, parasites of current concern, but also which ones we weren't expecting and which ones actually turned up.
So, I think it is fair to say it was true 10 years ago, it's certainly true now that parasites are a moving target. So we're seeing increasing distribution of parasites, so parasites coming into new countries, new geographic areas, and we're seeing, increased numbers of vectors. So those vectors er may be spreading from one region to another, they may be increasing in density, you know, potentially moving continents, say via bird migration or, you know, sort of over vast distances.
Er and where new vectors turn up, there's the potential for them to transmit new parasites. But all of this is being driven by opportunity, so opportunity that's being created by lovely increased green space, it's wonderful that we have more green space er and forests, er but those are potentials, habitats for vectors. Intermediate and transport hosts for parasites.
We're seeing, those transport and intermediate hosts move around, so, you know, things like rodents, deer, migratory birds, and their patterns are changing, because of changes in climate, and changes in climate, and new habitats being created in combination. Means that, you know, you can get quite rapid spread of, of wildlife, which can be a very good thing, but also, you know, great news, for parasites and their vectors. Another major driver that we're seeing is increased pet travel.
So, you know, er recreational er travel for pets, but also just permanent relocation through rescue of pets or purchase of them from abroad and then bringing them back to completely new places. And they might bring wondrously exotic parasites or ticks er with them. So the effect of regional relocation of dogs is a major one.
It was a major 110 years ago. There'd already been changes to the pet travel scheme, you know, it's being relaxed, and everyone was concerned then, about the. Increased numbers of dogs that might be moving, primarily dogs, as a result, and the parasites that they might bring.
And I think it's fair to say that from the parasite point of view, those concerns were warranted. Absolutely. So, new dogs moving into areas, or you know to a lesser extent, cats, ferrets, can bring, .
Parasites into existing vector populations, so examples being Diroylaria repens or tick-borne encephalitis virus, came, you know, have might come into the UK and infect, vectors that we already have. So, mosquitoes that are already here, Isos ticks that are already here. So, you know, you're not necessarily importing the vector, just the parasite.
They might bring in, parasites with their vectors, so they might bring riphocephalus ticks, attached to them, chocker full of tick-borne pathogens that they might transmit, arrive as a whole package, and then, as we'll, briefly discuss later, those riphocephalus ticks might infest your house, if, if you're, if you're unlucky. You might get introduction of parasites into completely new vector populations. So an example there being Phylaia callipeda, the eyeworm, follows Fortica fruit flies around, and Fortica fruit flies are rapidly expanding their distribution because of climate.
Wherever they arrive, seems like it's only a matter of time before an infected dog will arrive with Faria and infect that new vector population. And then finally, dogs moving around might move, Leishmania into countries, like the UK that don't have the sandflies that transmit it, and yet there's probably not a vet now in the country at some point that hasn't. Seen or known someone who's seen a Leishmania case, and that's not because we have the vector, it's just because we're getting some non-vectorial transmission and large numbers of infected dogs coming into the UK.
Climate is also a big effect, so global warming is a big concern for a, for a huge number of reasons, but it is the fuel for fire for parasite and vector spread. So if a parasite or a vector moves into a new area, it's like the spark, it's like the ignition, but if the climate is warmer, if it's more humid, er that ignition is, is likely to take off in that fuel. So if it's warmer and it's more humid, we might get increased vector.
A survival time. If a vector survives for longer, it's got more chance to persist and establish in new areas. We might get increased vector activity time, so ticks, for instance, ICides ticks in the UK are more active, for longer parts of the year because it's warmer and it's more humid.
And we might get establishment of completely new vectors, so we might get, things like Fordeca fruit flies arriving, you know, landing, and that suddenly they love the new climate, they love the warmth, they love the humidity, and they decide that they're going to stay. So There are, if, if I got to pick every parasite er that I consider to be emerging er and talk about them all in this webinar, er we'd be here forever. So you know, this is a, to a certain extent a a selection of what I would consider to be significantly emerging parasites of interest, er either in Europe with the threat of them coming into the UK or they're already here.
And the worry is that they're going to spread, that we're going to get increased exposure. So examples would be Echinococcus granulosis tapeworm, which is already here, or Echinococcus multilocularis, which is a closely related tapeworm that we're trying to keep out of the UK at the moment. There's a wide range of tick-borne pathogens and exotic ticks that we're going to talk about.
There's the old favourite, Leishmania in Phantom. A range of fly-borne nematodes, oh, I'll jump forward, let's move back, a whole range of fly-borne nematodes, like heartworms, skin worms, eye worms, and then, the nasal pentastamid that I don't think any of us saw coming 10 years ago, Linguula serrata, which I'm gonna talk about briefly. Let's start with Echinococcus granulosis.
I've been talking a little bit about this recently, because it is, it is currently, I would say, a parasite of major concern, because of its zoonotic risk. This was on our radar 10 years ago. It was in the UK 10 years ago and we were worried because of its long incubation period in humans, as there would be a long time lag before you realise that it was spreading and lack of surveillance that this would be an increased problem going forwards.
One of the reasons that we're worried about it is that what the the major reason that we're worried about it is its zoonotic potential. So it can cause something called hidatid disease, cystic echinococcosis in, in people. It's a very tiny tapeworm, just a few millimetres long.
It's non-pathogenic in canids, and it has a domestic life cycle. So it's domestic dogs, traditionally been farm dogs, hunting dogs, but certainly potentially any, any domestic dog, could get the tapeworm and then pass immediately infective microscopic eggs, in the faeces. If those eggs get onto pasture or into livestock food bins, then to a lesser extent cows for for human zoonotic risk, but mostly sheep, er if they consume those eggs will develop these big hide added cysts in their body.
And they will be largely untroubled by those, er but then if their offal is subsequently eaten by dogs, then the life cycle is complete. Now that can lead to some awful condemnation for farmers and economic losses as a result and we should be mindful of that. But the biggest worry is if humans accidentally consume er those microscopic eggs.
We can gethydatid cysts, and they can be severely pathogenic, developing in a range of organs, the liver, the lungs, sometimes pathogenic fractures to bones, heart or brain, so potentially very serious. And as such, it's one of the World Health Organisation's top neglected zoonosis, and that hasn't really changed over the past decade. It's a real challenge, a real cause of human morbidity, in highly intensive livestock areas of the world.
So in answer to the question, is, is Echinococcus granulosis endemic in the UK? I mean the answer is absolutely, er and we've known it has been for for some time. We know that there's a focus that it that is endemic in Wales, so listeners from Powys will probably be very familiar with this parasite er and adjoining Welsh counties.
We know it's in the Western Isles of Scotland, but what is less certain is whether it's in other parts of the UK. Perceived wisdom is that it's absent in Ireland and, you know, as far as we know it still is. There's not tremendously intense surveillance there and there have been human cases in, the island of Ireland, but, you know, there's no concrete evidence that it's present.
We'll, we'll, we'll leave it at that. But certainly there is strong evidence to say that it is in other parts of Britain. So through faecal testing of hunt and farm dogs, and through abattoir trace back studies, we we know that there are cases that have originated sort of dog and livestock cases.
Have originated in other parts of the country than Wales and the Western Isles of Scotland. And one of the real difficulties we've got, one of the major concerns is that we don't know where exactly to advise people and to concentrate control efforts. And that's compounded by the fact that it would be at least 7 to 10 years before any current increase in incidence of human exposure was seen.
Now, it is true that we would see it a little bit sooner in young children, it develops a little bit quicker in young children and also in the lungs. And, the London School of Hygiene and Tropical Medicine, down in London, they, they presented at BSAVA this year, . And shows some human cases would suggest that the incidence, in, in people in the UK is increasing at the moment, and that, that is a concern because, you know, some of these are on travel cases, it looks like cases may be ticking up, due to increased exposure and, and lack of awareness.
So, you know, so we have this time lag that we have to consider. And that, time lag, has been seen in other, European countries. So in Eastern Europe, it was largely neglected for a long time and then saw big spikes in cases, and we absolutely, don't want the same thing to happen here in the UK if we can avoid it.
So, a question that we're, we're asked at ESCAP and that I'm asked sometimes is, well, you know, is there a big risk to the wider public given that, you know, this tends to be something that happens around foxhound packs and farms. There's still a lot of active foxhound packs still registered in the UK and they get around, er they cover, you know, a lot of ground across the land, I mean so do farm dogs potentially, so you know they could contaminate fruit, vegetables, you know, sort of areas where people may come into contact with the eggs. There's certainly occupational risk.
A study that was done about 10 years ago showed that 30 31% of kennel hands were completely unaware that they might be at risk from hiatid disease. So education there is really important. Unprocessed, raw food, so raw food that hasn't been adequately pre-frozen, is a growing trend in the UK, and that, you know, potentially is gonna widen the reach.
I mean, some of these cysts are gonna be missed at meat inspection, and that's not a big problem if you're gonna cook your meat, but if you're gonna eat it raw, then, you know, you've got that potential, in dogs for onward transmission. And this is reflected in the fact that in the UK there are people with no association with livestock or the hunt industry that are still being infected, so it is a wider public health problem. So we really need to focus on future risks and prevention of of this parasite.
And we very difficult to gauge how big that future risk will be. We've got a parasite with a long incubation period, we're seeing a lot of changing land use, we're seeing increased feeding of raw diets, and we don't know exactly where the parasite is. So that does make things unpredictable, but the fact that we're seeing an uptick in human cases is a concern and one that I think we should take seriously.
Surveillance is really important, so it's really useful to include tapeworm testing as part of routine faecal testing, but the fact that these zoonotic eggs are passed immediately infective in the faeces means that testing isn't a substitute for targeted treatment. So treating high risk pets with prasequonal to try and avoid people being exposed at all. So, you know, as I often say for for tapeworm control, your sort of chihuahua that's on a cooked diet being carried around in a handbag doesn't really need tapeworm prevention.
But high risk dogs, you know, dogs that are sort of indulging in high risk activities absolutely do. So, we can reduce transmission in a number of ways, not just treatment, we can adequately pre-freeze raw diets to kill the cysts. We can try and prevent access to fallen livestock on pasture, keep dogs on leads to prevent access to food bins, and of course responsible disposal of dog faeces, so anti-dog fouling campaigns play a big part in this.
But this targeted strategic treatment with prasequantal on a monthly basis, I mean, pre-patent period of the parasite is 6 weeks, you could treat every 6 weeks, doesn't really fit in with sort of other sort of parasite treatment regimes. So we tend to say monthly. So monthly treatment with Prasequantal is on the basis of lifestyle and geography risk.
So those geographic risks are at the moment known foci, F Echinococcus granulosis, so, the Welsh areas that we know are endemic and the Western Isles of Scotland. Outside of those areas, it's really a lifestyle risk. So those dogs that have access to pasture and fallen livestock, those with unmonitored off-lead activity, those that are on, on.
Processed raw diets, and those that are passing teenier, so big tapeworm segments, other tapeworm species, similar risk factors means that they may have been exposed, to Echinococcus granulosis as well. The tapeworm though, that we're all worried about 10 years ago, coming into the UK we're all worried about 20 years ago coming into the UK is Echinococcus multilocularis. So this is like the evil cousin of Echinococcus granulosis, it makes it look like a cuddly teddy bear.
And it really is a severe new zoonosis. It, it's more severe because of its potential, to spread in the body. So for cysts to spread, like a cancer, they, they metastasize to different organs, so they tend to start and spread in the liver, but they can move to the lungs, and to other organs, making it very difficult to treat.
As a result, you get severe morbidity in many cases, and reduction in life expectancy. Unlike Echinococcus granulosis, it's a sylvadic life cycle, so it's the wildlife that carry it. You tend to have, rodents, so cute little snuffly creatures like microtine voles, as the intermediate.
Hot being eaten by wild canids, mostly in Europe, the red fox, but also, wolves, raccoon dogs, golden jackals, none of those of which we have in the UK. Unlike Echinococcus granulosis, we don't think that multilocularis is endemic in the UK and we do have official free status. So the technical and legal and official answer to that question is no.
It has spread very rapidly through Europe as foxes have done very well in Europe. It's really a, a fox success story on the back of good rabies control, but where we have healthy rampant foxes, we have the spread of Echinococcus multilocularis. At the moment, the, the compulsory tapeworm treatment 1 to 5 days before entry into the UK does appear to have been effective in keeping it out.
But, you know, it has to be said that that free status is on the basis of fairly minimal fox surveillance, you know, checking. Dead foxes or those, those that have been called for surveillance, relatively small numbers. So we're not certain that it's, that it's not here, and again, we're looking at a long incubation period before we would see human cases.
So 10 to 15 years before human clinical cases would appear, possibly longer. And it's because of these very long time lags, it's very difficult to ascertain if human cases are required abroad or whether they're required here. So if I developed, alve alveolar echinococcosis, so, you know, disease from this parasite tomorrow.
I could have caught it any time in the last 10 to 15 years. It's very difficult to say with certainty that you haven't been abroad, to endemic countries in that time. But if we assume, and you know, certainly grounds to be very hopeful that Echinococcus multilocularis isn't currently endemic in the UK, what are its risks of future establishment?
Well, they are high, and one of the reasons that we're so worried about it is that they've been high for a very long time. So I mean we have large numbers of reservoir hosts. We have a sea of cute cuddly micro time voles that like this one that I saw in a walking holiday up in Scotland.
We have a lot of foxes, loads of foxes. So you know, if positive dogs were introduced and they shed eggs, I mean we have lots of, reservoir hosts to, to pick those eggs up, get eaten by lots of foxes, and for it to spread very quickly. And because we wouldn't know it had arrived, for years, there would really then be no hope of controlling it.
We've also got the risk of introduction through intermediate hosts, so we have had positive beavers, in the, in the UK, that were introduced and then rapidly gathered back up again. Occasionally it's seen in zoo animals. So, you know, we need to be very cautious with those, and screen those appropriately.
But mostly it is the threat of dog arrival. So there was a study done in 2009 that showed for every 10,000 dogs, this was modelling, but showed that for 10,000 dogs travelling on just a short visit to an endemic country, the probability of at least one returning with Echinococcus multilocularis was approximately 98%. So, you know, without sort of adequate preventative treatment in place before dogs come into the UK, it is almost certain to establish, sooner or later.
And even with the compulsory treatment, there is this 5 day window. So prasequonal isn't long acting. So the fact that we have a 5 day window does allow an opportunity for reinfection to occur before entry into the UK.
So we need to be aware of that as well. So preventative measures hang on prasequantal, prasequonal use strategically, and prasequanttal is a nuclear weapon against Echinococcus of both types. So, you know, the absolute linchpin of keeping us free has been the compulsory treatment 1 to 5 days before UK entry.
But because of this treatment window, SSCAP, also advises an additional treatment within 30 days after arrival in the UK. While pets are travelling abroad, monthly treatment is important, to stop egg shedding, for any dogs, with off-lead access, and this is because, you know, they would be treated hopefully before they came back into the UK, but because of immediate risk to people who are in contact with them. And it's sensible if you can to stop, your dog eating all those lovely micro time voles, while they're on holiday.
And also screening of these wildlife intermediate hosts that are being imported is very important as well, if there's the remote possibility they're gonna get eaten, by our foxes. So Something that's been on our mind for a long time as well, certainly over the past decade, has been the risk of emerging a new tick-borne pathogens. So the ones that we already have in the UK that we're worried or have had in the UK that we're worried about spreading or emerging are Babezia canis, and that is carried by Dermacenta species, Dermacenta reticulatus in the UK.
An Ioes species, transmitting Lyme, and tick-borne encephalitis. So Iodes ticks, just to remind you, are the boring ones, so the inornate, undecorated, not very exciting looking, that probably most of us remove on a, you know, weekly, daily, probably in some parts of the country at certain times of year basis. But they are important vectors.
Lyme disease remains, a massive concern for many people in the UK, many of which suffer from Lyme disease, but also for their pets. And tick-borne encephalitis is, is a new player in town. It is very important to remember, when we're checking, pets for ticks that female Ixides ticks, can be quite large when they're engorged, quite an obvious target, but nymphs are tiny, just, a few millimetres long and much easier to miss.
And this is just to remind you for size comparison, so you get a big chunky juicy Iides female tick there, you're probably gonna spot, if you're having a careful check of, of the coat of dogs, but that nymph that's compared to a 5p piece, you know, just demonstrates just how small they are. So, there's actually been over the past 10 years, a fair amount of work done on where ICos is in the UK. So there was the Big Tick project, that was done, published, I'm casting my mind back now, I think it was published in 2015, I think.
But around that time, showed that ICos is present right across the UK, but we have this sort of focal distribution, with high prevalence areas. And this has been supported by work by the tick surveillance scheme, which excellent scheme, which is, government run. And data from Sasned as well has shown this sort of very focal area around, rural livestock, deer areas, but there's potentially nowhere in the UK where you might not come across Nixoes tick.
An increase. Rural areas, in sort of urban places, so things like parks, gardens, wildlife corridors, means that, you know, there's increasing, areas probably close to your home where you might come into contact with an icos tick or your pet mite. Predominating species, on dogs, Ixodes risus, which is, is the most common type of Ixodes in the UK, also very common on livestock.
Ixos hexagonous, which is, a tick of perhaps more, smaller creatures, predominates, in cats, in, in urban areas, significantly less common, in dogs. Lyme disease is, is a big worry, so this is caused by Borrelia bergdorfri, so by spirochete bacteria, and a lot of the risk, a lot of the worry centres around its zoonotic risk. And a lot of the worry that people have isn't around their getting it from their pets, but it is important to say that if their pets are infected, they don't represent a direct transmission risk, to owners.
So it is very important to reassure them in that respect. Having reassured them, you can, you know, gently worry them by telling them that, you know, if their dog's infected, then that they are good sentinels er to suggest that you might have been exposed as well, skipping through the same vegetation, being exposed to the same ticks, so. You know, it's absolutely fine if you if you have a positive dog just to say to owners that, you know, if they have any relevant clinical signs, it's important to mention er that they might have been exposed to their GP.
We are, you know, we think seeing an increase, well we are seeing an increased incidence of human disease is just unknown, a big unknown factor as to whether er we're seeing the same in cats and dogs. Pathology, clinical signs in dogs are hugely variable, so a lot of dogs, particularly in Europe and the UK because of the strains of Borrelia that we have, that are exposed to Borrelia through infected ticks, will be absolutely fine and exhibit no clinical signs. If they do, they tend to be immune mediated, so, .
You know, they can be polyarthritis, joint disease, you can get generalised signs like fever, lethargy, raised lymph nodes. We don't tend to see, it can cause renal disease and a range of renal disease. We don't tend to see the severe Lyme nephritis which is seen in the US.
I mean that, that is a rare phenomenon in Europe. Similarly, cardiac disease is rare in, cats and dogs, but it is recognised, so you know, there have been cardiac cases written up. What is far less certain is whether, Erythema migraines, so the classic bull's eye rash, which is used for diagnostic purposes in people, is, is a reliable indicator in cats and dogs.
It's certainly not a consistent finding and the difficulty is that other bite reaction. Reactions like these ones that are horse fly bite reactions can do a very good impression of erythema migraines. So finding similar lesions on your pet actually tells you very little about whether they've been exposed to ticks or to Lyme.
Lyme disease in cats is hotly contested er by experts, vets, er all sorts of other groups. I mean they certainly get infected, they can get infected with Borrelia, but there, there hasn't been good correlation found between infection and clinical signs in the field. And part of the difficulty is that if cats get a generalised lymphadenopathy, fever, lethargy, immune mediated disease, they might be carrying all sorts of other organisms like anaplasma, Bartonnella, that will have similar similar clinical presentations.
It can be difficult to pick it apart. And currently, the American College of Veterinary Internal Medicine, I don't believe this has changed, in a relatively recent consensus statement stated, that Borreliosis, to their satisfaction, had never been definitively confirmed in a cat. I mean, infected cats in experimental conditions do appear to be more resistant to clinical signs, although they get the same histopathological changes.
And it may be that Lyme contributes, to medical sort of, clinical presentations in cats as part of a combination of multiple infections. It's epidemiologically very difficult to pick apart. So Is Lyme disease on the rise in the UK because there's a lot of concern er that it is and a lot of concern about whether pets might be being exposed and whether people might be being exposed.
Well, there definitely is a rising incidence in the human population, so, and this is slightly historical data, but this trend has been broadly upward since since. There was a very good paper done looking at GP records that suggests that the actual true number of clinical cases, that are diagnosed may be 3 times higher than this, because it's not notifiable. A lot of GPs, you know, do a very good job of, of recognising it and treating it, but don't necessarily report it.
There's been no large scale prevalence or disease incidence studies, done in the past 25 years in cats and dogs, so we don't know really to what extent or in what sort of numbers they've been developing disease or even being exposed to infection. So we, we badly need more studies done in the UK to know what sort of effects exposure is having, on cats and dogs. Tick-borne encephalitis virus, I didn't see coming, this wasn't on my radar, I think everybody's focus 10 years ago in terms of new tick-borne pathogens turning up was with Rhiphocephalus, riphocephalus, and the potential for household infestation, which I'll come to in a moment.
So this was a bit of a curveball, but it was a concern. It's been a concern because it was spreading across Europe, lots of Isodes ticks, for it to infect, and it's been moved around by transport hosts, by bird migration, pushing it into these new, populations and enjoying its time there. It's a concern because it's caused, unsurprisingly, of tick-borne encephalitis, it's a neurological disease.
Again, zoonotic, but again, no direct risk from dogs. It's very serious, human, zoonosis, although cases in endemic countries are uncommon. But it does depend how endemic your country is.
So in Eastern Europe exposure can, can be quite high, especially among certain demographics. It's pushed west and north across Europe. We need to keep risk in perspective, particularly as unfortunately it's now arrived in the UK focally.
I mean. Cases, I, I mean you've got one case per 10,000 human months of woodland activity, so a lot of time spent in the woods. So if you're just on holiday visiting an endemic country, you probably don't need to worry too much as long as you take sense.
Precautions. Once it becomes endemic, and particularly if it starts to become highly endemic, you're spending a lot of time in, in outdoor locations where there might be ticks, that the need to take precautions becomes that much higher. Now dogs are affected less frequently than humans, but sadly they do have a higher fatality rate in clinical cases, and it should certainly be on your differential list er for meningoencephalitis and similar sort of neurological presentations.
So, it starts off febrile and then develops into this syndrome with a variety of neurological signs, many different types of neurological signs, but what really classifies it is that they're often progressive and disease is often fatal. So it should be on your differential list, diagnosis is tricky at the moment in the UK and we're largely relying on serology, . But to be honest, treatment is supportive anyway, so it, it's good to know, particularly epidemiologically, but also in terms of knowing what you're treating, it's good to have a diagnosis, but we're looking at, intravenous fluids, pain relief, either treatment for the neurological signs, to try and manage rather than treat the underlying cause.
So sadly now, tick-borne encephalitis virus is endemic in the UK er this is one pathogen that I don't think we can blame on imported dogs. I mean it's not impossible that they brought it, but it's much more likely given the way it's spread across the rest of Europe that it was migratory birds that brought us this gift with infected Iodes ticks attached to them. And then, you know, it's established in our own populations, .
There have been, so I mean there's there's very good evidence to show that it is endemic in the UK now. I mean there's been free untraveled human cases, but also serological evidence looking at deer. So deer aren't infected with the virus, but they produce antibodies against it.
So they're very, very good sentinels, and this was used by tick surveillance scheme and researchers to show that they've been exposed in the New Forest and the Thetford Forest, and that was actually confirmed in a ticker from the Thetford Forest. But these untraveled cases have cropped up now in other parts of the country, I believe one of them was in Yorkshire, so it is likely present in Isodes ticks in other parts of the country and having arrived, it is likely to spread, to be moved around by transport hosts like birds and deer, . And you know, we are seeing increased cases of of Flavivirus, so potentially tick-borne encephalitis virus or possibly Lauping ill.
It's not possible serologically to tell the two apart. But you know, tick-borne viruses are causing increasing numbers of neurological cases in dogs in the UK. So it's another very, very good reason to have good tick protection in place.
Babeia Canis caused a real stir, a phone ringing off the hook, 10 years ago, because it arrived in Harlow in Essex, established in a group of dermacentre ticks there, and, unfortunately dogs died as a result of exposure. So Babezia canis is a serious pathogen, transmitted by dermacenter ticks. Aren't dermacenter tics beautiful compared to Ixos ticks?
Decorated, festoons, it's like to compare to a, a well crafted Cornish pasty around the outside. They've really made an effort, they look great, but unfortunately do also transmit a severe pathogen. Babesia canis can cause, IMHA and IMT, so clotting problems, low platelets, low red blood cells, your classic, coffee grounds, urine.
So it should be considered as a differential essentially for any dog, that has IMHA, but especially those in parts of the country, where Dermacenta reticulatis is endemic, and there's a few pockets, around the UK which I'll show you, in a mo on a map. In terms of ongoing endemicity, there's just always the possibility of Babezia canis establishing temporarily or longer term while we have dogs coming in and out of the country er that may have it and while we have the vector here. So just always a potential for it to establish, so you know, we want to be aware of that possibility.
So this just shows that showed the map, it's these little, little folka that we have knocking around the country. And although it's moved fractionally in a recent study in the southeast of England, it's really moved very little in in decades. So although we've got global warming, we've got Isodes ticks running around, we've got the bees here canis.
And Dermacenta reticulatis have expanded their range in Europe for whatever reason, they, they seem quite happy in their little foci in the UK. So we, so we shouldn't be complacent about that, they could move in the future, but it does mean that, you know, we can be hyper-aware in those endemic foci. So Babesia canis in the UK it was, it was a big news story.
So there were 4 cases confirmed in untraveled dogs in Harlow in Essex, 2015, 2016, almost 10 years to the, to the month, that it all kicked off. Dermasentotics were recovered from infected dogs, and they were, confirmed by PCR to be both Dermacenta reticularis and also to be infected, with Babezia canis. Tick survey was then carried out in the area and it's a brilliant piece of work.
It's effectively triangulated where all four of these dogs have visited, been walking, and ticks, on that land, dermascent ticks were found to be positive for Babezia canis by PCR. So genuinely endemic foci. There were then sporadic cases in untraveled dogs in Romford, nearby in 2016 and Ware in the, in an adjoining county in 2017, a positive tick turned up in one of the Welsh foci, but no Babezia cases in in dogs in that area.
And I'm happy to say that a recent survey showed no evidence of infection persisting in Harlow, which is something that we were worried about, very worried about, . So you know, so it appears to have just sort of fizzled out, died out in Harlow, although the ticks are still there, but in that same survey, a positive tick was found in the southwest of England, so it does just show that it's just always a risk, always a possibility, that you know it may reestablish and that we might see cases again. Rhiphocephalus sanguineus is an exotic tick, it's, it's quite nicely decorated as well, it's got some eyes and festoon decorations.
And it is a vector of a wide range of pathogens that can infect dogs, with potentially serious pathogenic consequences, but also they transmit Rickettsia. So Rickettsia canori is Mediterranean spotted fever. It was the main reason and the main focus of concern 10 years ago really, about the, compulsory tick treatment being dropped.
You know, we were worried about the potential for establishment in people's homes, transmission of Mediterranean spotted fever. So it's, it's zoonotic aspects which, remain a significant concern, and it, I mean, it doesn't really at the moment want to establish outdoors in the UK. It's just too cold and chilly and miserable.
It's a, it's a Mediterranean and Eastern European tick. But it is spreading in Europe, it's adaptive, but it's crafty trick is that it can survive like fleas, in people's centrally heated homes. You can do this because its life cycle can be completed quickly, much faster er than ICsos or Dermacentre, and crucially, all life stages can feed on a variety of hosts.
So, you know, it can feed on your dog, your cat, on you, and the central heating allows it to persist over the winter and then it can just keep on going. And it's this significant zoonotic risk transmission once it's established cos it can feed, on a variety of, of hosts in the home may already be carrying, Rickettsia that could be transmitted to you. And this has just been a reality over the past decade.
There have been reports of household infestations, some of them, have been written up, some of them are anecdotal, but essentially if you miss these ticks on your dog after you've rescued it or you've been on a lovely holiday, then, you know, you could potentially look forward to, to a household infestation. So, there is an increasing risk. I mean this is, this has been a long term concern, there absolutely is an increasing risk of tick exposure and exotic tick establishment in the UK.
So more chance of meeting the ticks that we've already got and more chance of new exotic ticks establishing. So this is partly due, to increased seasonal fluctuations, so either because we've got a lovely milder, humid, warmer climate, it means that Isos ticks, our, our primary tick, can just be active for longer. So traditionally, we used to have two nice peaks in spring and autumn where it would be more active, but now we have massive peak that starts in early spring and finishes in late autumn.
And we can be exposed to Ios ticks at any time of year. And this is all climate driven. We've got a lot more, lot more habitat for these ticks, so we've got increased forestation and we've got wildlife corridors, which makes it easier for, for wildlife with these ticks to move from one area to another.
It's become increasingly favourable climate because it's getting warmer, for exotic ticks to survive. So hyalomma ticks, which transmit a range of pathogens, managed to overwinter in Sweden, even though. So it's, you know, prefers life in the Med.
I mean it didn't persist in Sweden, but it did mean that, you know, it could, it could transmit and survive over winter. And that is just a demonstration of how much warmer it's getting. And of course we're going out to meet these ticks, so there's increased outdoor human and pet activity in the great wild, wonderful UK outdoors, which is is is a fantastic thing, but it is going to mean more tick exposure.
And we're seeing what's described as the crossroads effect. So my colleague Susan Little er described in the US huge swathes of territory full of Iodes ticks, chocker full of lime, irrelevant because no one ever goes into those areas to visit them. Until you decide to build some lovely holiday homes in that area where they live, or you decide to chop some of that forest down and turn it into camping, er or you encourage holidays to go and hike there, and then suddenly all of these infected ticks come into play.
So some of it is climate, some of it is habitat change, and some of it is changes in lifestyle. So I think, you know, we can all agree that we want tick-borne disease prevention. And that's going to involve using preventative products on dogs and cats that are living a high risk lifestyle, outdoors, in the undergrowth, living the dream, and where.
Appropriate using repellents on ourselves, and also for humans and for pets, prompt checking and removal of ticks and just physical avoidance of ticks by staying on paths, you know, wherever possible. So we live in a wondrous age where there is a a wide range of preventative treatments, so spot on preparations, collars, tablets. So, you know, we can take owner compliance into account, we can see what they're gonna find easiest to use, what's most appropriate to their lifestyle, and as I've said, that is very important for high risk pets and a lot of these products often kill fleas, have a licence for fleas as well.
If we want to significantly reduce transmission, we want to pick a product that's going to rapidly kill or repel and kill, but we need to remember that no product is 100% effective. So it is very important to check for ticks after outdoor activity, how to remove any that we find. Always good to remind clients how to remove ticks, so to remind them to check, after outdoor activity, to use either fine point tweezers or a tick hook, not to start using our fingernails to try.
Take them out or blunt tweezers, because we're going to crush that tick and we're going to stress it, and then it's going to increase its chances of regurgitation or salivary ejection. It's actually going to increase the risk of, of pathogen transmission. So we just want to follow the instructions on our appropriate tick removal device and just take the tick off.
It will stress it, it'll increase the risk of disease transmission if we cover it in petroleum jelly, if we burn it, if we set it on fire, don't do any of those things, just remove it with your dedicated tick removal device. So as well as the ticks and the tapeworms, there are a range of exotic filaroid worms er that we need to worry about. And and probably the most common of those that we're seeing in imported and travelled dogs is Dirophylaria imatus heartworm.
So this is transmitted by mosquitoes, it's a clinically significant, really quite significant cause of cardiopulmonary disease in dogs, and cats, and ferrets as well, . And I mean there are mosquito vectors present right across Europe, including the UK that could transmit it as we have dogs continue to be introduced that are infected all of the time. The only thing that is keeping it out is temperature.
So at the moment it's not warm enough for it to establish er and for transmission to establish. Certainly not year on year. I mean it is getting warmer, and the possibility of non-travel cases appearing is starting to grow, but so far that hasn't happened.
And yes, I mean, a decade ago, I was worried about temperatures possibly hitting a point where that might happen in a decade, and it still hasn't happened yet. Temperatures are still getting warmer, so certainly need to be vigilant for that possibility. But control at the moment is really centred on trying to keep dogs safe and cats and ferrets while they're abroad, by using licenced prophylactic treatments monthly when they're visiting endemic countries, but also for rapid .
Identification to start treatment for prognosis, you know, rapid identification of cases is really important. So, you know, we want to clinically exam cats and dogs entering the country just to be aware of signs of cardiopulmonary disease. But we want to screen dogs that are coming in 100%, in case they are carrying worms.
So antigen blood test is an excellent, screen, and also the modified Knotts test to look for microfilaria in the blood. And crucially, I would say, you know, don't trust import history unless you can get the original test results. If somebody says, well, we've already tested that dog, unless you can get those test results or unless it's from a, a charity or an organised group, that you really trust, if in doubt, redo the test.
Diopylaria repens is closely related, er and we're seeing cases crop up in imported dogs that are coming into the UK from abroad. Unlike Diopylaria immaus, adult worms, Diopylaria repens, er tend to live in skin or skin nodules, so nowhere near as pathogenic, often subclinical. In dogs and cats.
The microfilaria are still knocking around in blood or in the lymphs, so they can still be detected by knots. Adult worms sometimes turn up in the eye. There was a case of that that was written up, or testing my memory now, but maybe about 67 years ago, in the UK.
So we need to be aware of it as a possibility in ocular disease as well in, in cats and dogs. But again we're, we're worried about its zoonotic potential. So we're worried, about, it establishing in UK mosquito populations and then people getting infected when they're exposed to those mosquitoes.
Again, mosquito vectors are present right across the UK, with potential, for establishment because temperature isn't a barrier for diophylaria res. And there's already been all. Of them travelled so far, but there's been a number of cases already recorded in the UK, and without some preventative measures, it does feel inevitable that it's going to establish in our own mosquitoes.
Control of diroylaria repens therefore isn't so much. I mean, it's useful to treat dogs that are affected clinically, naturally, to a lesser extent cats, but it's really just to stop it establishing in the UK, that we want to have control measures in place. So generally all round, it's good to have preventative measures in travelling pets, so to consider a licenced macrocyclic lactone monthly while they're abroad, even if they're in a country that isn't endemic for heartworm, they may be in a country that's endemic for dirophylaria repens cos its distribution is much wider.
Again, we want to be vigilant for clinical exam, for relevant clinical signs in dogs or cats entering the country, so, you know, dermatitis, swellings, nodules, ocular signs, . But I would, you know, do a modified knots, or, you know, if you've got a heartworm negative result, just use a preventative treatment, in dogs particularly that have, been imported, that have been rescued from abroad. Leishmania in Phantom is a big one.
So, you know, it was really starting to take off a decade ago. We were starting to see more cases in the UK and, you know, with the increased importation of dogs, you were starting to think, yeah, this is something that we're going to see a lot. And over the past decade, we've seen it a lot, absolutely.
And the reason that's a concern is largely for the individual dogs, that carry it. I mean, it's a cause of chronic morbidity, shortened life expectancy in dogs, and I should say cats as well, can be infected, but it's mostly dogs that we see it in in the UK just because of the sheer number that, that are imported. And sometimes Leishmania is imported accidentally, but sometimes, people will just take them on, knowing that they're infected and just deciding that they're going to manage them, as best they can.
It's sandfly transmitted because the distribution of sandflies means that it's currently endemic in southern and eastern Europe, although like so many other parasites, its range is spreading. So it's largely limited by the sandfly vector, and we don't have the sandfly vector in the UK, but it can be transmitted for a variety of other routes such as venereal, congenital, blood transfusion, possibly dog bites. Possibly direct contact as well if you've got open sores, and there have been an increasing number of cases of untraveled er dogs er that have leechmaniosis.
Its pathology and clinical signs are associated with immune mediated disease, so, can be cutaneous or visceral in nature, and that can lead to a whole range of either quite severe skin signs or quite mild, like alopecia in, in this dog. You can get epistaxis in around 12% of dogs with leash maniosis, and without, IMT, why, if the mechanism's known, it's, it's not known to me, but, epistaxis is, is a regular finding. But so is thrombocytopenia as well, you can see polyarthritis, ocular lesions, but it's really the effect of immune complexes on the kidney and the development of glomellaronephritis, which shortens dogs' lives, and tends to create problems over time.
And sometimes get neurological signs associated with granulomas as well. The big question is whether we should consider leishmania to be endemic in the UK currently and what its risks are of establishment in the future. And there certainly have been cases in untraveled UK dogs, so, you know, depending on your definition of endemicity, er not all dogs that have leash mania in the UK have travelled.
So the question is, you know, how have they gone? It. Well, at the moment, we don't have the sandfly vector.
Now, again, give it another decade, you know, the, the sandfly vector is continuing to spread. It's not impossible that it could arrive here one day. A lot of the untraveled cases that we see in the UK are due to, vertical or venereal transmission, so there's a clear mechanism there, and that can allow breeding foci to develop.
So that is, an endemic foci effectively without the vector. It can happen accidentally through blood transfusion. Like I say, there are these question marks over dog bites and direct contact, and there was a case in the UK, a couple of years ago, where direct contact with sores appeared to be the route of transmission, of a dog without leishmania obtaining it from one in the same household that did.
Fleas have been speculated to be a vector, absolutely no evidence for that. But Clicoides midges have acted as mechanical vectors for other trippanosomes like T.vivax.
So, you know, it's not impossible, and something that we should be aware of, that the pathogen could jump vectors. It could decide that it's not going to wait for the sunfly, that it's gonna use disturbed feeders like horse flies or biting midges instead, so. You know, it's, it's likely that, you know, a lot of the transmission in the UK will continue to be non-vectorial, we need to be aware of that, but also of the possibility of it jumping vectors.
So in terms of controlling it, fly repellency, licenced fly repellents in dogs travelling abroad is absolutely essential if they're going to visit an endemic country. And the vaccines are a really good idea if they're available. So there is a new one at the moment that's been launched in Europe, but there's no vaccine currently commercially available in the UK but if one does become available, then, you know, it's also a good idea.
It's really important to screen dogs that are entering the country, that have lived in endemic areas because of the risk of them carrying it, and, you know, both for managing them as individual cases, but also incur in but also to limit, the risk of ongoing transmission. It's really important to know whether dogs are positive or not. So that screening is really important and also really important to screen dogs before blood transfusion as well.
We want to prevent breeding of positive dogs, and that's, that's, that's really important. And we just want to have care around other dogs. So if we have a positive dog, we want to manage those open sores, we want to try and ensure that the positive dog doesn't try and eat the negative dog, you know, just sensible precautions that we can take.
Belaiacalipeda is er the oriental eyeworm, what a great name, what a great parasite. It affects a wide range of mammals, er including people, so it's, it's zoonotic as well. And in people and animals, it can cause, you know, very mild signs, just conjunctivitis, but if inflammation starts to escalate, irritation starts to escalate, it can lead to much more serious, eye conditions, like keraitis, ulcers, ultimately blindness, if, if it was just ignored.
It's transmitted by Fortica fruit flies, that feed on eye secretions and then move the parasite around, and that's, larvae and adult worms are present in the conjunctival sac. So, If we have dogs coming into the country er that have ocular signs, it's really important to thoroughly examine that eye under sedation if necessary, to see if the worms are present. Then if they are, timely flushing out, treatment with a licenced product is going to be great, it's gonna be beneficial for the pet, but also just limit the risk of that onward transmission.
Now we, again, we've had cases in the UK all with travel history, no untravel cases yet, but climate modelling suggests that we are gonna get more and more of the Fortica fruit fly in wider, wider. Distribution in the UK and that is just going to increase the risk of endemic establishment as time goes on. So it is really important to catch these cases early so we can treat them effectively and stop that onward transmission.
This was a a modelling map that was done just to look at what the effect on climate is likely to be with fruit flies as time goes on, and bottom line is fruit flies are loving it, living the dream, moving across Europe, largely unhindered. And we mustn't forget the complete curveball, Linguaula serrata was a. You know, it's a parasite that was, you know, relegated to like half a page in most textbooks, you know, a curiosity that we were just, we were never going to see in the UK, were we?
But yes, we were, is the answer. We started to see, cases regularly turn up from the Middle East, and Eastern Europe where it's endemic. Again, in travel dogs, largely dogs that have lived in endemic countries.
They're pentastomids, so their, their common name is tongue worms because of their shape. But they're not actually worms, they're more closely related to shrimps. They're 22 to 3 centimetres long, live in your nasal cavities or your upper airway.
Most dogs and occasionally cats that get infected tolerate infection very well, but we do need to just be aware of rhinitis and upper airway signs in, in imported dogs. All of the UK cases so far have been imported, with one exception. So there has been one on travel case, and it was on a diet, that was being imported from abroad, so it is possible it may have obtained it through that route.
There have been, sporadic cases found in wildlife over the years in the UK, so it's not impossible that there could be endemic foci here. The main reason that we, we're worried about it is once again that humans can act as definitive or intermediate hosts. So, dogs catch it from eating raw offal and like living the dream.
We can do the same and then get some spectacular allergic reactions as a result if we're having that wild foreign holiday. But mostly in the UK we would act as an intermediate host, so if we do some facial snuggling with infected dogs, we get eggs onto our hands and accidentally consume them, we might get cysts in our body. So again, you know, vigilance for positive dogs is important so they can be treated promptly, but also to keep owners safe, to reduce the risk of onward transmission.
So just a brief reminder, SSCAP UK and Ireland has the four pillars that we recommend for imported dogs. So it's really important to check for ticks, and subsequent identification. Really important to treat with Prasequantal and for ticks on arrival in the UK and to treat with the Prasequantal within 30 days.
This is an additional treatment because of that 1 to 5 day window. It's important to have a really thorough clinical check, to look for relevant clinical signs and to do screening tests for leishmania, heartworm, Brucella canis, and exotic er tick-borne pathogens. Also should plug that the APHA has, a, surveillance, scheme going with SSCAP UK and Ireland.
So if, you have a worm that you discover grossly, so an eye worm that you think might be phasia or Diroylaria repens or a skin worm, or you think you might have Linguula serrata cos it's been sneezed up on some. One's carpet, please, please send them to the APHA and you know, they'll then be able to identify them, but also it will contribute to surveillance data in the UK. So resist the temptation to put it on your shelf, don't throw it away, please don't throw it away.
Send it to the APHA it's free service, and you know, that, that will be really useful. But we're using specific tests otherwise to look for pathogens that we, we can't just identify by sight. So, screening tests would be, for leishmania using quantitative serology or PCR, for heartworm, we'd be using antigen blood testing or nuts test, for Alicia canis nanoplasma, serology or PCR hepatozoo in canis, really useful to test for, by blood smear or PCR.
Babezia, if we're screening, an ear prick is really useful in clinical cases, and just blood smear to look for the lovely, p pyroplasms, but you know, if we're screening, PCR really useful tool. Brucella canis, we'd be doing serology and also useful to do faecal screening for intestinal worms. If cost is an issue, the ones in bold are the ones that I would really focus on.
If we can test for them all as part of packages, either travel packages at external labs, or sort of in-house PCR I mean, you know, it'd be really good if we could be testing imported dogs for, for all of these. It's important to remember, due to detection time lag. That we need to retest for Bruceella after 3 months, Dirofilarimatus after 6 to 9 months, and Fellemania after 6 months.
I mean if we've got subclinical dogs and cost is a real issue, we could just wait 6 months and just test for them all. I mean, I, I would be shocked by, by, some of my SSCAP colleagues for suggesting that, but sometimes cost is, is a factor, and these tests do cost a lot of money. But if we can do both tests, that is always best and you know, if, if we can, you know, we can always, you know, do the, the second round of testing for convenience at the same time, maybe after, after 6 months.
So thank you very much and please remember that the ESCAP UK and Ireland website and the European SSCAP website is, is a wondrous source of information on all of these wondrous parasites. Er so thank you very much, thank you for listening.