Maxwell Elizabeth, Ryan Kirk, Reynolds Caryn, Pariaut Romain
Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA 70803, United States.
Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA 70803, United States.
Vet Parasitol. 2014 Nov 15;206(1-2):71-7. doi: 10.1016/j.vetpar.2014.05.033. Epub 2014 May 27.
Since 2008, the American Heartworm Society has recommended using a three-dose melarsomine protocol (a single intramuscular injection of melarsomine dihydrochloride at 2.5mg/kg, followed approximately 1 month later with two doses administered 24h apart) for all heartworm-positive dogs, with doxycycline given at 10mg/kg twice daily for 4 weeks prior to administration of melarsomine. To report the efficacy and side effects of this standard heartworm treatment protocol in 50 dogs presenting to our hospital from 2008 to 2011, information on the history, clinical, laboratory, and diagnostic imaging findings and treatment was obtained from medical records. When possible, additional follow-up information was obtained through telephone interviews with referring veterinarians and owners. Twenty-six dogs (52%) experienced minor complications, such as injection site reactions, gastrointestinal signs (vomiting, diarrhea, inappetance), and behavioral changes (lethargy, depression) during or after heartworm treatment. Twenty-seven dogs (54%) experienced respiratory signs (coughing, dyspnea) and heart failure attributed to progressive heartworm disease and worm death. Seven dogs (14%) died within the treatment period. Owners frequently reported behavioral changes, such as depression and lethargy, suspected to be secondary to pain. Fifty percent of owners surveyed indicated that, prior to the diagnosis, they either were not currently administering heartworm preventative, or they had recently adopted the dog from a shelter that did not administer preventatives. After treatment, 100% were administering heartworm preventatives to their pet. Eighteen dogs (36%) received a heartworm antigen test 6 months after adulticide therapy, 12 of which tested negative and six tested positive. Four of the dogs with a positive test at 6 months had negative tests 1 month later with no additional treatment. Adverse effects were common with the recommended protocol, but the majority of these were mild. Dogs in Class 1 (i.e., heartworm positive but otherwise largely lacking clinical evidence of disease) did not experience any major adverse effects or death.
自2008年以来，美国心丝虫协会建议对所有心丝虫检测呈阳性的犬采用三剂量美拉索明治疗方案（肌肉注射一次2.5mg/kg的盐酸美拉索明，大约1个月后再分两次给药，两次给药间隔24小时），在注射美拉索明前4周，给予强力霉素，剂量为10mg/kg，每日两次，持续4周。为了报告2008年至2011年期间到我院就诊的50只犬采用这种标准心丝虫治疗方案的疗效和副作用，我们从病历中获取了病史、临床、实验室及诊断性影像学检查结果和治疗信息。如有可能，还通过与转诊兽医和犬主的电话访谈获取了额外的随访信息。26只犬（52%）在心丝虫治疗期间或之后出现了轻微并发症，如注射部位反应、胃肠道症状（呕吐、腹泻、食欲不振）以及行为改变（嗜睡、抑郁）。27只犬（54%）出现了呼吸系统症状（咳嗽、呼吸困难）以及因进行性心丝虫病和虫体死亡导致的心力衰竭。7只犬（14%）在治疗期间死亡。犬主经常报告犬出现行为改变，如抑郁和嗜睡，怀疑这是由疼痛继发引起的。接受调查的犬主中有50%表示，在诊断之前，他们要么未给犬使用心丝虫预防药物，要么是最近从未使用预防药物的收容所领养了犬。治疗后，100%的犬主都给宠物使用了心丝虫预防药物。18只犬（36%）在成虫杀灭治疗6个月后接受了心丝虫抗原检测，其中12只检测结果为阴性，6只检测结果为阳性。6个月检测呈阳性的犬中有4只在1个月后检测结果转为阴性，且未接受额外治疗。推荐的治疗方案不良反应常见，但大多数不良反应较为轻微。1类犬（即心丝虫检测呈阳性，但在很大程度上缺乏其他疾病临床证据的犬）未出现任何严重不良反应或死亡情况。
