Distribution and characterization of Heterobilharzia americana in dogs in Texas.

Heterobilharzia americana is a trematode parasite (family Schistosomatidae) that infects a wide range of wild mammalian hosts. Canine cases have been reported in the Gulf coast and south Atlantic states, Kansas, and Oklahoma. A total of 238 canine H. americana cases in Texas were retrospectively collected for a period of approximately 22 years from case records at the Texas Veterinary Medical Diagnostic Laboratory and the Veterinary Medical Teaching Hospital pathology service, diagnostic parasitology service, and Gastrointestinal Laboratory at Texas A&M University College of Veterinary Medicine. Of these cases, 26 patients had 1-2 repeat positive tests for a total of 268 positive tests (26 biopsies, 39 necropsies, 160 fecal examinations, and 43 PCR). Multiple dogs were infected in 12 households. Cases were distributed primarily in the eastern region of Texas in 42 of 254 counties. Cases were seen as far west as Kerr county and in counties bordering Oklahoma, Louisiana, Mexico, and the Gulf of Mexico. The median dog age was 5.6 years (2.7 months to 17.2 years) and the median weight was 20.5 kg (1-61.6 kg). All American Kennel Club (AKC) breed groups were represented (n=186): crossbred (20%), herding (17.8%), sporting (16.1%), toy (10.8%), hounds (10.8%), working (10.1%), terrier (8.5%), non-sporting (4.9%), and miscellaneous (1%). No seasonal pattern of diagnosis was apparent. Clinical signs reported (n=90) were diarrhea (67%), weight loss (38%), anorexia/hyporexia (27%), vomiting (22%), hematochezia (20%), lethargy (17%), polyuria/polydipsia (6%), and collapse (3%). In 39 necropsy cases, trematode eggs were identified by histopathology in the small intestine (84%), liver (84%), large intestine (39%), pancreas (35%), lung (9%), lymph node (8%), spleen (4%), and stomach (3%). Adult parasites were identified histologically in four cases. Granulomatous inflammation associated with the eggs was the most commonly reported histopathologic change. Other changes reported were fibrosis, pigment in macrophages, and organ mineralization. Glomerulonephritis was identified in four cases. Of 20 necropsy cases where death was attributable to H. americana infection, only one case was diagnosed ante mortem. Eleven of these dogs were examined by a veterinarian but H. americana was included as a differential diagnosis in only two cases. Reported differential diagnoses included ethylene glycol toxicity, cholecalciferol toxicity, lymphoma, and pancreatitis. These data indicate that this parasite is more widely distributed and more common than is generally recognized. Increased awareness may aid in more diagnoses and timely therapy.