Frequently Asked Questions

How do I diagnose/manage leishmaniosis in canine patients imported from abroad?

Quantitative serology is a sensitive and specific test for infection. Measuring quantitative serology over time can give an early warning of clinical leishmaniosis if antibody levels are climbing. PCR is also a useful test but carries a low sensitivity if blood is used. PCR and histopathology of clinically affected skin and lymph nodes is useful to confirm infection as the cause of the clinical presentation.

What parasites should I recommend testing for, to clients who have rescued a dog from abroad?

Due to the ongoing risk that imported parasites represent to individual pets, owners, the wider public and UK biosecurity as a whole, ESCCAP UK & Ireland recommend four key steps (the ‘four pillars’) when dealing with all imported or travelled pets arriving in the UK:

  1. Check for ticks and subsequent identification of any found - Identification of ticks allows the introduction and distribution of exotic tick species to be monitored in the UK but also indicates which tick-borne diseases the imported pet may have potentially been exposed to.
  2. Treat dogs again with praziquantel within 30 days of return to the UK and treat for ticks if treatment is not already in place - This will ensure that Echinococcus multilocularis is eliminated from imported pets, whenever the timing of their compulsory treatment or if there is doubt about it having been administered correctly/at all. Tick treatment will increase the likelihood of attached ticks being killed if they are missed on examination. Ticks are easily missed in large or long coated breeds and in cats and dogs that are reluctant to be examined.
  3. Recognise clinical signs relevant to diseases in the countries visited or country of origin -While it is not possible to be familiar with every exotic parasite a thorough and comprehensive clinical exam of imported pets will identify adverse clinical signs and these can then be compared to parasitic diseases in the countries that the pet has visited.
  4. Screening for Leishmania spp. and Brucella canis and exotic tick-borne diseases in imported dogs – Both Leishmania infantum, Brucella and tick-borne diseases can have long incubation periods and carrier states. Infection can also be lifelong and in some cases can carry a poor prognosis. Screening for these parasites will lead to early diagnosis, preparing the owner for what could be a lifetime of potential treatment, any associated zoonotic risk and limiting wider spread through effective tick control.  Testing dogs from France, Eastern and Southern Europe for heartworm antigen is also useful as infection may have long term health consequences and complicates the routine use of macrocyclic lactones in these patients.

How do I know if lungworm (Angiostrongylus vasorum) is present/a problem in my area?

Angiostrongylus vasorum is now endemic in foxes across the UK but with a patchy distribution. It should be considered as a differential for coagulopathies, respiratory signs, neurological disorders and heart disease in any part of the country. Testing cases with relevant signs and sharing case information remains the best way to assess geographic risk and fluid rates of exposure in local areas.  A point-of-care blood test which detects circulating A.vasorum antigen in the blood (Angiodetect®) allows for a more rapid diagnosis in a clinical setting and also allows many dogs with clinical signs compatible with A.vasorum infection to be tested relatively economically and rapidly. This in turn allows a picture within practices to be built up as to whether A.vasorum is a present in the local area. This picture needs to constantly updated however as the regional prevalence of A.vasorum can change rapidly. Case maps with collated national reported data are also available such as the one from Elanco

Why is flea control failing/is it due to drug resistance?

The most important aspect of flea control is to ensure adult fleas are killed on the pet before they can initiate egg production. Treatment of the environment with insect growth regulators, environmental insecticides, hot washing of bedding and daily vacuuming is also important to reduce environmental larvae and eggs. Reducing pupal numbers in the environment is difficult however, making effective, rapid killing of adults essential. For effective flea control to occur, choice of adulticide, how to effectively treat the environment and management of client expectation all need to be considered.
Failure to consider any of these factors will increase the time required for flea control to be achieved or lead to complete flea control breakdown. Even when all these measures are employed, however flea control may still fail. This can happen for a number of reasons and all of them need to be considered if flea control is to be reestablished.

  • Flea resistance to insecticide - Despite numerous large scale studies into the efficacy of flea treatments, no published evidence of flea resistance to products containing fipronil or imidacloprid in the field has emerged. Even where resistance genes are known to exist in laboratory strains of fleas, fipronil, selamectin and spinosad have all been shown to be highly efficacious at 3 weeks post application. The presence of resistance genes in a flea population may lead to a need for increased treatment frequency but this would appear to be comparatively rare compared with other reasons for the reproductive breakpoint being reached. Therefore, although the possibility of drug resistance as a cause of flea control breakdown should not be ignored, it should only be considered as a possibility once other more common causes have been eliminated.  
  • Insufficient frequency of application – Many pet owners live busy life style and it can be easy for flea treatment doses to be missed or not applied on time.
  • Not all pets in the house being treated – Cat fleas are highly adaptable and capable of infesting and reproducing on a variety of mammals as well as cats, including dogs, rabbits and ferrets. Clients may not realise that rabbits and ferrets may be infested with cat fleas and it is important therefore to ensure all pets in the house have been treated with an appropriate product. Clients may also not mention stray or owned cats that visit the house from elsewhere.
  • Infestations being cuased by types of flea other than cat fleas -  It is important to identify what type of flea is causing and infestation if control is being lost. The cat flea is the most common flea found on domestic cats and dogs but other fleas may be the cause of the infestation. Pulex irritans, the “human flea” is primarily a flea of wildlife but may also infest cats, dogs and people. Due to the predominance of the cat flea, climatic and wildlife distribution changes, it is now uncommon in Northern Europe. Its presence in a household however, means that medical advice must be sought by pet owners as treatment of the owner as well as pets in the household will be required. Spilopsyllus cuniculi, the “rabbit flea” are smaller than other fleas infesting household pets with adult females typically only reaching 1mm long and adult males being smaller. They characteristically congregate around the ear pinna and fleas found predominantly in this location should raise suspicion of S.cuniculi infestation. Reproduction in the flea is controlled by rabbit hormones to ensure that flea mating and egg production occurs in the presence of young rabbits. S.cuniculi therefore will not establish household infestations but cats and dogs can become incidentally infested when hunting rabbits or when investigating warren entrances. prevent repeated infestation. It may appear in these circumstances that household flea control is failing when it is outdoor repeated exposure that is taking place. Bird fleas will vacate nests if they are not reused and seek out new hosts. If nests are situated close to chicken coups or domestic pigeon housing these may be infested. Houses may also be invaded if nests are adjoining buildings and owners and pets subsequently bitten. In this situation, control will centre on treatment of the environment and eradication of the unused nest if it is in the rafters, eves or attic space of the building.
  • Poor compliance – If clients are having difficulty administering a product or are not shown how to administer a new product effectively then correct dosage and frequency of drug treatment may not occur. If finances are an issue, then owners may compromise on dosing frequency recommendations beyond license claim statements and/or veterinary advice. Discussing client treatment preferences and demonstrating to clients how to administer products will help to improve compliance. It must also be explained to clients that it will take at least 3 months to eliminate an existing flea infestation or they may become disillusioned very quickly and resistance blamed.

At what interval should I treat pregnant bitches/queens and puppies/kittens for worms?

Puppies and kittens provide the largest source of environmental contamination with Toxocara eggs with zoonotic potential. Treatment of puppies should start at two weeks of age, repeated at 2 weekly intervals until 2 weeks post weaning and then monthly until 6 months old. This is to eliminate T.canis egg shedding from trans-placental and trans-mammary infection and significant populations establishing in the intestine. Kittens should be treated in the same way but the first treatment can be given at 3 weeks old as there is no trans-placental transmission. Bitches and Queens should be treated at the same time as puppies and kittens to kill worms arising from autoinfection during this period and prevent egg shedding. Many products are now licensed for use during lactation and pregnancy so the routine worm treatment of bitches and queens can continue from pregnancy. Fenbendazole is the only licensed drug to reduce transplacental and transmammary infection, treating daily form from day 40 of pregnancy until 2 days post partum but even this will not completely eliminate infection of the puppies and kittens and they should still be treated. 

How do I diagnose heartworm in dogs and what are the best protocols for treatment?

Antigen Serology is considered the gold standard test for heartworm in the living canine patient. It is highly specific and in canine patients, also highly sensitive. Sensitivity increases as adult female worm burden increases with the test detecting antigens in uterine secretions. Sensitivity will therefore potentially be lower in cases with low adult worm burdens. If clinical signs combined with a history of foreign travel make heartworm infection a likely differential and antigen serology is negative then Knott’s concentration blood test for circulating microfilariae can be carried out. Numbers of microfilariae may also be low or absent if there are few or no adult female heartworm adults present. Ultrasonography can also be useful in identifying adult worms but the pulmonary artery must be thoroughly investigated.

Treatment of infections with adult worms requires surgical removal or medical treatment with an adulticide.  Intravascular snares and forceps are often used in endemic countries to remove large numbers of worms in the least invasive manner.  These techniques require experience and specialised equipment however, and as a result, most UK cases will be treated medically.


Treatment protocols in dogs vary and fall into one of two strategies.  Use of an adulticide (melarsomine) or macrocyclic lactones without an adulticide ("slow kill" methods)  An example of a typical adulticide treatment program is:

  • Day 1 - Doxycycline 10 mg/kg sid orally for 30 days
  • Heartworm preventive (macrocyclic lactone on day 0 and 30)
  • Day 30 - Melarsomine dihydrochloride 2.5 mg/kg i.m.
  • Day 60 and 61 - Melarsomine dihydrochloride 2.5 mg/kg i.m.

The patient should then be tested for microfilariae 30 days post treatment and antigen serology tested 6 months post treatment.  The use of doxycycline is to kill Wolbachia baterial infection residing within the heartworms.  The worms and bateria have an obligatory symbiotic relationship and treatment of the Wolbachia with doxycycline renders the worms more susceptible to treatment (Kramer et al, 2011). There is growing evidence to suggest waiting a month after doxycycline treatment before adulticide is beneficial in eliminating adult worms.  If this is to be incorporated into a treatment protocol then adulticides would be administered at days 60, 90 and 91.

Prednisone has some benefit in reducing the risk of thromboembolic complications if given alongside adulticide treatment where worm burdens are high (Dzimianski et al 2010).  If high worm burdens are suspected, then oral prednisolone can be used from the initiation of adulticide treatment at 0.5 mg/kg twice a day for 1 week and 0.5 mg/kg once daily for the second week, followed by 0.5 mg/kg every other day for 2 weeks.  These doses are also useful in managing bronchitic signs.  There is no evidence that aspirin has any protective effect against thromboembolism in heartworm cases during treatment.

The three most significant prognostic factors following adulticide treatment are the severity of existing pulmonary vascular disease, the number of worms present and level of exercise.  Of these three, exercise is thought to be the most significant.  Exercise should therefore be restricted during treatment, starting from day 0 to at least one month after the last adulticide injection.  The highest risk period of complications from pulmonary thromboembolism is 7-10 days after adulticide treatment but can occur up to 4 weeks after adulticide treatment is completed.

An alternative which avoids the use of melarsomine are "slow kill" regimes.  This should not be a first choice treatment in endemic countries as it has been linked to the development of resistance (Bowman et al, 2012).  It is a viable alternative to adulticide protocols though if melarsomine is unavailable or unaffordable.  Doxycycline is still used for the first 30 days alongside a monthly macrocyclic lactone (typically moxidectin).  Monthly macrocyclic lactones are given until two consecutive negative antigen tests are achieved.  This is typically after at least 6 months but can take longer than a year.  Exercise restriction is still essential until infection is eliminated.  

Who can I send ticks to for identification?

Identification and recording of ant ticks removed ticks is important to map their distribution, monitor potential introduction of exotic ticks to the UK, and know which pathogens pets may have been exposed to. Ticks can be sent to the Public Health England Tick Surveillance Scheme for identification. Ticks should be placed in a container with a secure lid and sent in an envelope marked “biological sample” and sent to.

Tick surveillance scheme
Public Health England
Porton Down

Tick surveillance forms and further information can be obtained from

What is the incidence of Lyme disease in the UK and what is the risk of dog/cat exposure?

Lyme disease incidence in the UK human population is increasing year on year with cases rising from 1.64 cases population in 2010 to 2.70 cases per 100,000 in 2017. There is no incidence data for cats and dogs, but we know that they are exposed to ticks infected with Borrelia spp capable of causing Lyme disease. Borrelia spp have been found in 1.8% and 2.37% of ticks attached to cats and dogs respectively. Increased green space, Forestation, wildlife corridors, deer numbers and outdoor recreational activity all increase the risk of tick exposure.  Tick activity has also increased with peak activity now lasting from early spring to late Autumn with the potential to come into contact with ticks at any time of year. The overall risk of exposure of cats and dogs to infected ticks is therefore increasing.