Dirofilaria immitis, heartworm

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cellular organisms - Eukaryota - Fungi/Metazoa group - Metazoa - Eumetazoa - Bilateria - Pseudocoelomata - Nematoda - Chromadorea - Spirurida - Filarioidea - Onchocercidae - Dirofilaria - Dirofilaria immitis

Brief facts

• Dirofilaria immitis is a filarial parasitic nematode that infects primarily dogs and other canid species. It usually resides in the pulmonary, femoral, and hepatic arteries, as well as other blood vessels including veins and right atrium of live dogs. Heartworms cause serious vascular damages and can be fatal, especially in working dogs with high level of physical activity.
• The common name heartworm is originated from the fact that the worms are frequently found in the heart. However, it is considered to be a postmortem artifact. Heartworm is a vascular pathogen rather than an intracardiac one.
• The vectors of Dirofilaria immitis larvae are many mosquito species. The following is an incomplete list of mosquito species that were shown to be capable of supporting larval development of Dirofilaria immitis to the 3rd (infective) larval stage: Culex pipiens (often infects cats), Anopheles maculipennis, Coquillettidia richiardii, Aedes triseriatus, Ochlerotatus notoscriptus (prevalent in Australia), Aedes albopictus, Aedes aegypti, Culex quinquefasciatus, Aedes taeniorhynchus, Aedes scapularis, Aedes trivittatus.
• Dirofilaria immitis is capable of infecting wide variety of mammals (cats, dogs, rodents, horses, humans), as well as birds (there is a documented case of the parasite infecting the Humboldt penguin). Human pulmonary dirofilariasis, while being a benign and relatively rare zoonosis, represents itself as a medical problem, because it being manifested as a "coin lesion" similar to pulmonary neoplasia (tumor) that warrants unnecessary invasive diagnostics and even surgery.
• Frequency of infection in organisms other than dogs often depends on regionally prevalent competent mosquito species and their preferences to different hosts. Also, normal development of heartworms in hosts other than dogs is usually inhibited; they mature longer and live shorter. In cats, dying parasites might cause acute inflammation that can be lethal.
• Dirofilaria immitis, like some other filarial parasites, carry endosymbiotic Wolbachia bacteria whose metabolites contact with the host's organism and can play a significant role in the survival, adaptation, and reproduction of the pathogen, as well as in the host's immune response and overall pathogenesis. Specifically, two main mechanisms of Wolbachia interfacing with the host were identified: (1) a release of Wolbachia upon death of the parasites regardless of their developmental stage of the parasite, and (2) continuous release of Wolbachia products (metabolites, excreted proteins, etc.) by heartworm females during their production of microfilariae (L1 larvae of the worm, see below). Discovery of Wolbachia changed traditional view on duality of filaria-host interactions. It presented an additional challenge for researchers to understand and conquer filarial parasites.
• According to 2001 year survey the following states had greatest numbers of dignosed human dirofilariasis: Texas (23), Florida (16), Louisiana (10), and South Carolina (8).

 

Protect yourself from mosquitos - vectors of numerous diseases and parasites including the heartworms.

Detailed information on three species of mosquito at MetaPathogen.

 

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Developmental stages

• microfilariae L1, first stage larvae that circulate in the bloodstream; the microfilariae can live for years in the bloodstream of canid species
  • microfilariae
    in blood stream mature heartworms release live larvae into the host's bloodstream; larvae are accumulating and can reach thousands organisms per mililiter of blood
  • microfilariae
    in mosquito during bloodmeal, the mosquito ingests some microfilariae that start their development into infective heartworm larvae during which they molt twice (L1 to L2 to L3); the process is temperature dependent; when temperature is low, the larvae are not able to reach the infective stage by trhe time mosquito's finishes its blood feeding
• infective larvae
  in mosquito the microfilariae develop into the infective larval stage (L3) inside mosquito's gut; in 10-14 days after that they move to mosquito's mouthparts; they break out of the mosquito mouthparts during the bloodmeal, and have to find their way through the hole in the skin after the mosquito finished feeding; as many as 45% of the infective larvae are being lost on the surface of the skin and fail to enter the organism
• larvae in the host description of the migration of the parasite in the host slightly varies in reviewed sources
  • L3 larvae the larvae settle at the place of the infection; in 1-12 days they molt and transform into L4
  • L4 larvae the larvae migrate with blood and many of them settle in submuscular membranes all over the body as intermediate sites of development; between 85 and 120 days of infection L4 larvae move from the intermediate sites by entering the blood vessels and migrating to places where they ultimately lodge; if L4 larva enters an artery, it will likely to develop in the branch of the arterial tree, including pulmonary arteries; if L4 larva enters in a vein, it will likely arrive in the lungs
  • L5 larvae L5 is a juvenile worm - the last larval stage before mature adult
• mature adult mature female heartworm can measure 31 cm in length; overall, in the dog, it take a little over six months for the infective larvae to mature into adult worms that can live for five to seven years in the dog; in cats, it takes about eight months to mature into adult worms that live from two to three years

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Types of infection

Symptoms

• Initial infection, asymptomatic and usually undetected, takes place between L3 and adult stages of the parasite, before microfilariae are released into the bloodstream of the canine host and the parasites at different stages of development start dying because of the host's defense reaction or other reasons.
• Chronic asymptomatic infection is the most wide-spread type of the infection. The animal hosts (dogs and cats) do not exhibit clear signs of vascular and cardiac distress especially when the parasite burden as well as physical activity are low.
• Chronic symptomatic infection usually occurs when the parasite's burden is high and vascular deterioration and local inflammation events take place because of the parasite's activities: feeding, reproducing, leaking toxins and antigens, etc. This period can last as long as 5-7 years. Coughing, anemia, weakness, and lethargy are common.
• Acute infection can occur as a result of (1) ectopic (not typical) migration of the worms in an atypical host (e.g. cats) or after strenuous physical activity, (2) massive death and disintegration of the parasites, or (3) extremely high parasite burden. Heart and kidney failure, seizures, blindness, and ultimately death can occur.

Presence of microfilariae

• Chronic microfilaraemic infection is characterized by presense and gradual accumulation of microfilariae (L1 stage larvae) in the host's bloodstream. This type of infection occurs in canine species infected by both genders of the parasites (males and females).
• Transient microfilaraemic infection is characterized by brief occurence and subsequent clearance of the microfilariae in the bloodstream of an atypical host such as cats.
• Amicrofilaraemic infection is characterized by absense of the microfilariae in the bloodstream of an atypical host such as human. Amicrofilaraemic infection also occurs when the host was infected by one gender (male or female) of the parasite.

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References

PubMed articles

• Hoch H, Strickland K. Canine and feline dirofilariasis: life cycle, pathophysiology, and diagnosis. Compend Contin Educ Vet. 2008 Mar;30(3):133-40; quiz 141. PMID: 18409140
• Cancrini G et al. Natural vectors of dirofilariasis in rural and urban areas of the Tuscan region, central Italy. J Med Entomol. 2006 May PMID: 16739418
• Sano Y. et al. The first record of Dirofilaria immitis infection in a Humboldt penguin, Spheniscus humboldti. J Parasitol. 2005 Oct;91(5):1235-7. PMID: 16419779
• Debboun M et al. Relative abundance of tree hole-breeding mosquitoes in Boone County, Missouri, USA, with emphasis on the vector potential of Aedes triseriatus for canine heartworm, Dirofilaria immitis (Spirurida: Filariidae). J Am Mosq Control Assoc. 2005 Sep PMID: 16252517
• Kozek WJ. What is new in the Wolbachia/Dirofilaria interaction? Vet Parasitol. 2005 Oct 24 PMID: 16198819
• Theis JH. Public health aspects of dirofilariasis in the United States. Vet Parasitol. 2005 Oct 24;133(2-3):157-80. PMID: 16039780
• Foley DH, Russell RC, Bryan JH. Population structure of the peridomestic mosquito Ochlerotatus notoscriptus in Australia. Med Vet Entomol. 2004 Jun PMID: 15189244
• Grieve RB, Lok JB, Glickman LT. Epidemiology of canine heartworm infection. Epidemiol Rev. 1983;5:220-46. PMID: 6139288

Websites

• American Heartworm Society Information
• Plymouth County Mosquito Control Project: Dog hearworm

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