{"id":1296,"date":"2013-05-01T16:01:38","date_gmt":"2013-05-01T16:01:38","guid":{"rendered":"http:\/\/phosdev.com\/todaysveterinarypractice\/?p=1296"},"modified":"2022-02-17T19:13:19","modified_gmt":"2022-02-17T19:13:19","slug":"heartworm-hotline-question-answer-heartworm-screening-for-cats","status":"publish","type":"post","link":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/parasitology\/heartworm-hotline-question-answer-heartworm-screening-for-cats\/","title":{"rendered":"Question &amp; Answer: Heartworm Screening for Cats"},"content":{"rendered":"<p class=\"p1\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2016\/09\/T1305C03.pdf\"><img decoding=\"async\" class=\"alignnone size-full wp-image-9886\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2011\/07\/pdf_button.png\" alt=\"pdf_button\" width=\"110\" height=\"27\" \/><\/a><\/p>\n<hr \/>\n<p class=\"p1\"><span class=\"s1\"><em>Clarke Atkins, DVM, Diplomate ACVIM (Internal Medicine &amp; Cardiology)<\/em><\/span><\/p>\n<p class=\"p1\">Two questions regarding feline heartworm prevention are addressed in this issue&#8217;s column: Is it necessary to test cats for heartworms prior to starting preventive therapy? And, is yearly testing necessary in cats receiving heartworm preventive?<\/p>\n<hr \/>\n<div class=\"orange-box\">\n<p class=\"p1\"><span class=\"s1\">The <strong>Heartworm Hotline<\/strong> column is cosponsored by <strong><em>Today&#8217;s Veterinary Practice<\/em> <\/strong>and <strong>The American Heartworm Society<\/strong> (heartwormsociety.org). This series presents questions and answers on topics related to heartworm infection, prevention, diagnostics, and\/or treatment.<\/span><\/p>\n<\/div>\n<h2 class=\"p3\"><span class=\"s1\"><b>QUESTION<\/b><\/span><\/h2>\n<p class=\"p1\"><span class=\"s1\">My practice is in an area of moderate to high heartworm prevalence. We make a dedicated effort to ensure that all clients&#8217; dogs are receiving heartworm preventive and, based on the American Heartworm Society guidelines (<b>heartwormsociety.org<\/b>; Veterinary Resources), I am now promoting feline heartworm prevention.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">A long-time client and I discussed heartworm prevention for her 4 indoor\/outdoor, adopted cats that are routinely vaccinated, but do not receive heartworm preventive. After explaining that cats can become infected with heartworms and there is no definitive therapy, she decided to pursue heartworm prevention. However, when faced with the fees for initial heartworm tests, preventive medication, and follow-up tests, the owner changed her mind, stating that her decision was economically based.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">This experience raised the following questions in my mind regarding feline heartworm.<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><b><\/b><span class=\"s1\"><b>Is it absolutely necessary to test cats for heartworms prior to starting preventive therapy? <\/b><\/span><\/li>\n<li class=\"li1\"><b><\/b><span class=\"s1\"><b>Is yearly testing advisable\/necessary in cats receiving heartworm preventive?<\/b><\/span><\/li>\n<\/ul>\n<h2 class=\"p4\"><span class=\"s1\"><b>ANSWER<\/b><\/span><\/h2>\n<p class=\"p1\"><span class=\"s1\">This is an excellent and somewhat difficult question, particularly when product labels on heartworm (HW) preventive products advise or sanction &#8220;testing&#8221; prior to administering the product.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Medically speaking, I personally believe that neither testing prior to initiation of preventive therapy (<i>pretesting<\/i>) nor yearly testing are necessary or even advisable in a case such as yours\u2014in which the client declined preventive therapy due to the costs of initial and follow-up testing.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">However, this does not mean that pretesting in cats is without value\u2014 it is <b>never incorrect<\/b> to test cats for HW antigen, microfilariae, or antibodies as long as the owner:<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">Understands the cost:benefit ratio and limitations of testing with current technology<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Is involved in the decision to test or not to test.<\/span><\/li>\n<\/ul>\n<h2 class=\"p4\"><span class=\"s2\"><b>HEARTWORM ANTIBODY TESTING<br \/>\n<\/b><\/span><\/h2>\n<h3 class=\"p4\"><span class=\"s1\"><b>Arguments <i>For<\/i> Testing Prior to Preventive Therapy<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">The HW antibody test reacts to the protein(s) associated with the L4 larval stage.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">A <b>positive antibody test<\/b> indicates the:<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">Cat has certainly been exposed to HWs<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Possibility (approximately 10%\u201320%) that the cat may have a mature heartworm infection (HWI)<\/span><span class=\"s3\"><sup>1<\/sup><\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Patient is at risk for HW-associated respiratory disease (HARD),<\/span><span class=\"s3\"><sup>2<\/sup><\/span><span class=\"s1\"> which is related to <i>immune-mediated<\/i> or <i>treatment-related<\/i> death of immature adult worms, and mature <i>Dirofilaria immitis<\/i> infection.<\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\">The owner can be offered the opportunity to pursue diagnosis of heartworm disease (HWD)\/HWI, including an antigen test, complete blood count, thoracic radiographs, and echocardiogram. In addition, the owner can be advised that the cat could eventually develop severe, even fatal, cardiorespiratory disease.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">A <b>negative antibody test<\/b> indicates that:<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">It is unlikely the cat is infected with HWs<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">The cat is likely at less risk for HWI than a cat that tests positive. A negative test should not, however, be used to determine whether cats are free from risk for HWI.<\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\">The conclusion that a cat is not at risk for HWI is based on many factors (besides a negative antibody test), including whether dogs in the community are on HW preventive, if populations of coyotes are present, and the cat&#8217;s indoor\/outdoor lifestyle.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\"><b>In conclusion, an antibody-positive cat should, indeed, be on preventive due to the:<\/b><\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">Fact that cat has been exposed to HWs<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Possibility cat is infected with HWs<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Risk that cat may develop mature HWI and\/or HARD <\/span><\/li>\n<\/ul>\n<h3 class=\"p4\"><span class=\"s1\"><b>Arguments <i>Against<\/i> Testing Prior to Preventive Therapy<\/b><\/span><\/h3>\n<ul class=\"ul1\">\n<li class=\"li1\"><b><\/b><span class=\"s1\"><b>Regardless of the test result\u2014positive or negative\u2014HW prevention is indicated. <\/b><\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">The cost of the testing and associated office visits may very well deter the client from initiating preventive, particularly in the instance of a multicat household.<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">A negative test may be <i>misinterpreted<\/i> as an indication that no HW prophylaxis is needed. However, as mentioned earlier, a negative antibody test does not mean there is no risk for future HWI. <\/span><\/li>\n<li class=\"li1\"><b><\/b><span class=\"s1\"><b>There is virtually no risk of an adverse reaction in cats with a mature HWI placed on a macrocyclic lactone preventive.<\/b> This is because cats are rarely infected with microfilariae and, if microfilariae are present, their number is small. If, despite this, there is concern about an adverse reaction, a microfilaria test (direct smear, modified Knott test, or millipore filter test) can be performed.<\/span><\/li>\n<\/ul>\n<p><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Screen-Shot-2015-06-04-at-3.19.58-PM.png\"><img fetchpriority=\"high\" decoding=\"async\" class=\"alignnone wp-image-4307 size-medium\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/05\/Screen-Shot-2015-06-04-at-3.19.58-PM-e1456775610208-300x290.png\" alt=\"Screen Shot 2015-06-04 at 3.19.58 PM\" width=\"300\" height=\"290\" \/><\/a><\/p>\n<h3 class=\"p4\"><span class=\"s1\"><b>Annual Testing for Cats on Preventive Therapy<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">An HW antibody test becomes positive early in HW development, reacting to antigens of the early larval (L3 and\/or L4) stages. This is also the point at which macrocyclic lactones exert their effect in aborting developing\/maturing HWI. Therefore, in exposed cats on HW preventive, antibody tests are expected to remain positive for &gt; 6 months.<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">A <b>positive antigen test<\/b> means that a cat has been exposed to HWs and that prevention should be continued.<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">A <b>negative antibody test<\/b> neither indicates that a cat is no longer at risk for HWI nor that HW preventive should be terminated.<\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\"><b>Therefore, annual antibody testing for cats on HW preventive is not advised.<\/b><\/span><\/p>\n<h2 class=\"p3\"><span class=\"s1\"><b>HEARTWORM ANTIGEN &amp; MICROFILARIA TESTING<\/b><\/span><\/h2>\n<p class=\"p1\"><span class=\"s1\"><b>There are virtually no arguments for use of antigen or microfilaria testing as screening tools (pretesting or yearly) in cats<\/b>, unless run as a supplement to the antibody test. Some owners, after discussion of cost:benefit ratio, may prefer to have the tests run in tandem for peace of mind.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\"><b>Antigen tests<\/b> react to proteins produced by mature female <i>D immitis<\/i> worms. Due the typically low worm burden in cats, the sensitivity of this test in cats is low (50%\u201370%).<\/span><span class=\"s3\"><sup>3<\/sup><\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">A positive antigen test indicates a mature HWI and the presence of at least 1 mature female worm.<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Due to the test&#8217;s low sensitivity, it is not considered useful as a routine screening test in asymptomatic cats.<\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\"><b>Microfilaria testing<\/b> also has low sensitivity (&lt; 15%).<\/span><span class=\"s3\"><sup>4<\/sup><\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">Microfilaria testing is very specific; a positive test indicates the presence of at least 1 mature female <i>and<\/i> 1 mature male worm. <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">This testing should be reserved for cats in which HWI is suspected.<\/span><\/li>\n<\/ul>\n<h2><span class=\"s1\"><b>HEARTWORM TESTING FOR CATS WITH CLINICAL SIGNS<\/b><\/span><\/h2>\n<p class=\"p1\"><span class=\"s1\">It is important to emphasize the context of the previous discussion\u2014screening asymptomatic cats. However, HW testing, particularly the antibody test, is underutilized in cats with coughing, wheezing and, in some instances, dyspnea. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">HW antibody testing is important in coughing cats because the radiographic appearance of HWD in cats is often minimal, or worse, mimics feline bronchial disease (&#8220;asthma&#8221;), resulting in misdiagnosis.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\"><b>Therefore, any cat with appropriate clinical signs\u2014cough, wheeze, dyspnea\u2014should have antibody testing performed to rule out HWD or HARD. <\/b><\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">A negative antibody tests means that neither HWD or HARD is likely and that bronchial disease is the most probable diagnosis.<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">A positive antibody test should be followed by (or accompany) an antigen test; a positive result indicates mature HWI.<\/span><\/li>\n<\/ul>\n<div class=\"orange-box\">\n<h2><span class=\"s1\"><b>COMPARISON OF HEARTWORM TESTING IN DOGS &amp; CATS<\/b><\/span><\/h2>\n<p><span class=\"s1\">Annual antigen testing is appropriate in dogs but not cats due to the relative sensitivity and specificity of methodologies used and difference in HW prevalence between species.<\/span><\/p>\n<ul>\n<li><span class=\"s1\">The antigen test is used for screening in dogs; currently there is no canine antibody test.<\/span><\/li>\n<li><span class=\"s1\">The antigen test is much more sensitive in dogs than cats (but very specific in both species), providing fewer false-negative results. <\/span><\/li>\n<li><span class=\"s1\">In the U.S., risk for HWI is much greater in dogs (approximately 10-fold) than cats. <\/span><\/li>\n<li><span class=\"s1\">The incidence of false-positive results increases as prevalence decreases:<\/span><span class=\"s3\"><sup>5-7<\/sup><\/span><span class=\"s1\"> A positive antigen test in an asymptomatic cat has a substantially greater chance of being false-positive than a positive antigen test in an asymptomatic dog because there is a lower incidence of feline HW than canine HW.<\/span><span class=\"s3\"><sup>8<\/sup><\/span><\/li>\n<\/ul>\n<\/div>\n<p>HARD = heartworm-associated respiratory disease; HW = heartworm; HWD = heartworm disease; HWI = heartworm infection<\/p>\n<blockquote><p><strong>This article is the last in the first installment of the Heartworm Hotline column.<\/strong> We want to extend our sincerest thanks to Dr. Atkins for sharing his amazing knowledge on this topic with us and to the American Heartworm Society for working with us to bring this knowledge to our readers. We look forward to the return of Heartworm Hotline in future issues. Read all the articles published in the column at todaysveterinarypractice.com (search <i>Heartworm Hotline<\/i>).<\/p><\/blockquote>\n<div class=\"orange-box\">\n<h2><span class=\"s1\"><b>MANUFACTURER-ADVOCATED TESTING<\/b><\/span><\/h2>\n<p><span class=\"s1\">All makers of feline HW preventives, to varying degrees, advocate testing cats prior to initiating use of their products. However, no particular type of testing is recommended and testing recommendations are softening with the passage of time. Following are each manufacturers&#8217; specific recommendations from their product handouts:<\/span><\/p>\n<ul>\n<li><b><\/b><span class=\"s5\"><b>Advantage Multi for Cats:<\/b><\/span><span class=\"s1\"> <i>At the discretion of the veterinarian, cats older than 6 months of age may be tested to determine the presence of existing heartworm infections before beginning treatment with Advantage Multi for Cats. <\/i><\/span><\/li>\n<li><b><\/b><span class=\"s5\"><b>Heartgard for Cats:<\/b><\/span><span class=\"s1\"> <i>It is recommended that cats should be tested for existing heartworm infection prior to starting treatment with Heartgard for Cats. Cats already infected with adult heartworms can be given Heartgard for Cats monthly to prevent further infection.<\/i><\/span><\/li>\n<li><b><\/b><span class=\"s5\"><b>Revolution:<\/b><\/span><span class=\"s1\"> <i>At the discretion of the veterinarian, cats &gt; 6 months of age may be tested to determine the presence of existing heartworm infections before beginning treatment with Revolution.<\/i><\/span><\/li>\n<\/ul>\n<\/div>\n<h3 class=\"p5\"><span class=\"s1\"><b>References<\/b><\/span><\/h3>\n<ol>\n<li class=\"p5\"><span class=\"s1\">Miller MW, Atkins CE, Stemme K, et al. Prevalence of exposure to <em>Dirofilaria immitis<\/em> in cats in multiple areas of the United States. In Seward RL (ed): Recent Advances in Heartworm Disease. <i>Proc Annu Heartworm Symp<\/i> 1998; pp 161-166.<\/span><\/li>\n<li class=\"p5\"><span class=\"s1\">Dillon AR, Blagburn BL, Tilson DM, et al. Immature heartworm infection produces pulmonary parenchymal airway and vascular disease in cats. <i>Annu Heartworm Symp Proc<\/i> 2007.<\/span><\/li>\n<li class=\"p5\"><span class=\"s1\">Atkins CE, Ryan WG. CVT update: Diagnosis and prevention of heartworm disease in cats. <i>Kirk&#8217;s Current Veterinary Therapy: Small Animal Practice<\/i>, 13th ed. Philadelphia: WB Saunders, 2000, p 782.<\/span><\/li>\n<li class=\"p5\"><span class=\"s1\">Atkins CE, DeFrancesco TC, Coats JR, et al. Heartworm infection in cats: 50 cases (1985\u20131997). <i>JAVMA<\/i> 2000; 217(3):355-358.<\/span><\/li>\n<li class=\"p5\"><span class=\"s1\">Bayes T, Price R. An essay towards solving a problem in the doctrine of chance. <i>Philosophical Transactions of the Royal Society of London<\/i> 1763; 53:370-418. <\/span><\/li>\n<li class=\"p5\"><span class=\"s1\">Courtney CH, Zeng Q. Comparison of heartworm antigen test kit performance in dogs having low heartworm burdens. <i>Vet Parasitol<\/i> 2001; 96(4):317-322.<\/span><\/li>\n<li class=\"p5\"><span class=\"s1\">Atkins CE. Comparison of results of three commercial heartworm antigen test kits in dogs with low heartworm burdens. <i>JAVMA<\/i> 2003; 222(9):1221-1223.<\/span><\/li>\n<li class=\"p5\"><span class=\"s1\">Bowman BB, Atkins CE. Heartworm biology, treatment, and control. <i>Vet Clin North Am Small Anim Pract<\/i> 2009; 39(6):1127-1158.<\/span><\/li>\n<\/ol>\n<p class=\"p5\"><span class=\"author-bio\"><strong><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2016\/01\/Author_C-Atkins.jpg\"><img decoding=\"async\" class=\"alignleft size-full wp-image-7809\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2016\/01\/Author_C-Atkins.jpg\" alt=\"Author_C-Atkins\" width=\"100\" height=\"129\" \/><\/a>Clarke Atkins<\/strong>, DVM, Diplomate ACVIM (Internal Medicine &amp; Cardiology), is the Jane Lewis Seaks Distinguished Professor of Companion Animal Medicine at North Carolina State University. He is also a member of the <em>Today&#8217;s Veterinary Practice<\/em> Editorial Peer Review Board and American Heartworm Society&#8217;s Executive Board. Dr. Atkins received the 2004 Norden Award for excellence in teaching. His research involves canine and feline heartworm disease and pharmacologic therapies for cardiac disease. Dr. Atkins received his DVM from University of California\u2013Davis and completed his internship at Angell Memorial Animal Hospital in Boston, Massachusetts.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Clarke Atkins, DVM, Diplomate ACVIM (Internal Medicine &amp; Cardiology) Two questions regarding feline heartworm prevention are addressed in this issue&#8217;s column: Is it necessary to test cats for heartworms prior to starting preventive therapy?<\/p>\n","protected":false},"author":1,"featured_media":2747,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"iawp_total_views":388,"footnotes":""},"categories":[374],"tags":[],"class_list":["post-1296","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-may-june-2013","column-parasitology","clinical_topics-parasitology"],"acf":{"hide_sidebar":false,"hide_sidebar_ad":false,"hide_all_ads":false},"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v24.7 (Yoast SEO v27.3) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Question &amp; 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