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EV ACVD Study > Demodex Consensus Statement > Flashcards

Demodex Consensus Statement Flashcards

1
Q

Most likely cause of generalized demodicosis in young dogs

A

Temporary immune alteration

Usually CELL-MEDIATED deficiency

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2
Q

Most likely cause of generalized demodicosis in older dogs

A

Immunosuppressive conditions, treatments

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3
Q

Which demodex species can infect healthy cats

A

Demodex gatoi

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4
Q

T or F: a single gene mutation is responsible for juvenile generalized demodicosis

A

False. It is genetic, but likely multiple genes

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5
Q

Which is longer: Demodex canis or Demodex injai

A

Injai is longer!

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6
Q

Which is longer: Demodex cati or Demodex gatoi

A

Cati. Demodex gatoi is short

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7
Q

Which breeds are predisposed to Demodex injai

A

Terriers. Excessively greasy

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8
Q

Clinical sign of Demodex gatoi

A

Truncal pruritus

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9
Q

Best diagnostic for demodex

A

Deep skin scrape

But can do trichograms, tape strips, examine exudate too!

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10
Q

T or F: if you find a single mite on a deep skin scrape, that is confirmatory of clinically relevant demodicosis

A

False. But more than 1 does confirm clinical relevance

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11
Q

T or F: A dam or sire may be breed again if one of their puppies has generalized demodicosis

A

False. Dogs with generalized demodicosis and their parents should not be bred.

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12
Q

Monitoring protocol for a dog with generalized demodicosis

A

Skin scraping q1month until 2 negative scrapings

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13
Q

How long should treatment continue for demodicosis

A

At least 4 weeks past 2nd negative monthly skin scrape

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14
Q

Topical treatment protocol for dogs with demodicosis

A

Amitraz 0.025-0,05% weekly.

Clip long haired animals

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15
Q

Oral ivermectin, moxidectin, milbemyxin oxime protocol for demodicosis in dogs

A

Ivermectin 0.3-0.6mg/kg PO q24h

Moxidectin 0.3-0.5 mg/kg PO q24h

**START AT LOWER DOSE AND TAPER UP- in case sensitivity to macrocyclic lactones (toxicity)

Milbemycin oxime 1-2 mg/kg PO q24h

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16
Q

SC doramectin protocol for demodicosis in dogs

A

0.6 mg/kg SC q1w

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17
Q

T or F: Topical moxidectin/imidacloprid should be considered for mild-moderate cases of
canine demodicosis

A

True

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18
Q

Topical treatments for cats with demodicosis

A

2% Lime sulfur dip weekly

Amitraz bath 0.0125% weekly

OR

Weekly moxidectin/imidacloprid spot on

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19
Q

T or F: demodex is a commensal of many mammals

A

True.

Transmitted from dam to puppies within first days of life

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20
Q

What type of immunity is deficient in dogs with juvenile demodicosis?

A

Cell mediated!
*Low CD4 T cells
*Low TNFa (proinflam)
*Increased IL-2, IL-5, IL-6, IL18, IL-10, TGF-b (immunosuppressive)

Normal humoral response

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21
Q

Are MHC class II molecules upregulated or downregulated on keratinocytes of dogs with demodex

A

Upregulated

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22
Q

Which TLR is increased in dogs with demodicosis

A

TLR2– recognizes chitin

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23
Q

T or F: Most dogs with juvenile generalized demodicosis have recurrence once it is treated

A

FALSE. Recurrence is very uncommon

Likely a TEMPORARY immune aberration to allow mites to overpopulate

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24
Q

Diseases/drugs in adult dogs that predispose them demodicosis

A

*Leishmaniosis
*HAC
*Hypothyroidism
*Neoplasia
*Babesiosis
*Ehrlichiosis
*Glucocorticoids
*Chemotherapy

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25
Q

Diseases in adults cats that predispose them to demodicosis

A

*FIV
*Xanthoma
*Diabetes mellitus

Localized form with BISC

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26
Q

Breeds predisposed to generalized demodicosis

A

*American Staffordshire terrier
*Staffordshire bull terrier
*Chinese Shar Pei
*French bulldog

27
Q

Breeds predisposed to juvenile onset demodicosis

A

*English bull dog
*Pit bull
*Sealyham terrier

28
Q

Which DLA haplotypes (encode for MHC) are associated with generalized demodicosis in mastiffs and boxers?

A

FH2002
FH2975
FH2054

29
Q

Is Demodex cornei it’s own species?

A

No. It is a short version of D canis (or dying ones!)

30
Q

Are D injai females or males longer?

A

Males are longer than females

31
Q

T or F: there is a third, unnamed species of demodex mites in cats (other than D gatoi, D felis)

A

True.

It has a longer gnathosoma and short opisthosoma than D cati.

32
Q

Where in the USA is Demodex gatoi common

A

Southeast USA

Very regional

33
Q

T or F: Short D canis (aka Demodex cornei) is more pruritic than D canis

A

True

Also, pruritic if 2’ bacterial infection

34
Q

Clinical lesions of Demodex injai

A

Marked greasiness of dorsal trunk

35
Q

Where in the skin does Demodex gatoi live

A

Stratum corneum (like sarcoptes)

NOT hair follicle

36
Q

How to perform a trichogram for demodex

A

Pluck hairs from 1 cm^2 (50-100 hairs) in direction of growth. Put on mineral oil w/cover slip.

37
Q

In intact female dogs, what can trigger recurrences of demodicosis

A

Estrus

38
Q

T or F: systemic antibiotics should only be used for SEVERE bacterial pyoderma 2’ to demodicosis

A

True! Topical benzoyl peroxide shampoo was enough to clear mild/moderate cases, as long as ivermectin was administered for demodex

39
Q

MOA of amitraz leave-on rinse

A

Monoamine oxidase inhibitor
Alpha 2-adrenergic agonist
Inhibits prostaglandin synthesis

40
Q

AE of topical metaflumizone+ amitraz; topical fipronil + amitraz spot on products

A

Pemphigus foliaceus-like drug eruption

41
Q

How to perform amitraz leave-on rinse

A

-Clip hair short
-Apply with sponge; allow to dry without rinsing
-Do not get wet BETWEEN weekly baths, so amitraz stays on the skin
-Do not ingest

42
Q

AEs of Amitraz

A

*Depression, sleepiness
*Ataxia
*Pruritus, urticaria, edema
*Skin irritation
*Polydipsia, polyphagia
*Hypotension, bradycardia, hyperglucemia
*Vomiting, diarrhea

43
Q

Reversal to amitraz toxicity

A

Yohimbine, atipamezole

44
Q

Which humans need to avoid contact with amitraz

A

Diabetic humans

45
Q

Which dogs are predisposed to amitraz toxicity

A

Small breeds: Pomeranians, Chihuahuas

CHIHUAHUAS ARE ON THE LABEL

46
Q

Which medications should be avoided with amitraz

A

Other sedating agents (bc Amitraz is alpha-2 agonist)

Synergistic toxicity

47
Q

What percent of dogs with amitraz monotherapy for their demodicosis do not achieve cytologic cure

A

20% – combo with other meds

48
Q

T or F: Ivermectin is labeled for treatment of demodicosis in dogs but not cats

A

False. Only approved treatment for demodicosis in dogs is Amitraz

49
Q

What is the most effective route to administer ivermectin (for tx demodex)

A

PO daily

> > > SC q1w, pour on 3x/w

50
Q

AEs of ivermectin

A

Neurotoxicity!!

Early:
Mydriasis, temporary blindness
Lethargy
Vomiting
Ataxia, tremors

Late: Seizures, coma, respiratory failure, death

51
Q

What is the first clinical sign of ivermectin toxicity

A

Mydriasis

Mydriasis is also the last sign to resolve of ivermectin toxicity

52
Q

What is the antidote for ivermectin toxicity

A

None

Charcoal, IV lipids
(Flumazenil in rats, Physostigmine helps CNS short term but AEs)

53
Q

Which breeds are sensitive to ivermectin? Mutation?

A

Collies
Australian shepherd dogs
Shetland sheepdogs
English sheepdogs

ABCB1 gene (formerly mdr1); autosomal recessive–> nonfunctional P-glucoprotein = ATP-dependent transmembrane transporter protein, esp at the blood-brain barrier. Cannot transport drugs OUT of the CNS

54
Q

What medications should be avoided with ivermectin

A

Other substrates of P-glycoprotein efflux transporter

ALSO Spinosad products —> inhibitor of P-gp!

55
Q
A
56
Q

Which medication is safer than ivermectin in ABCA1 dogs (though still titrate dose up!

A

Moxidectin

57
Q

What is the best tolerated method of moxidectin/imidacloprid administration

A

Topical q1w

58
Q

Isoxazoline MOA

A

Bind to ligand-gated chloride channels (GABA receptors). Block Cl ions across cell membrane of pre and postsynaptic cleft.
=
Prolonged hyperexcitation –> death

59
Q

How is fluralaner excreted

A

Unchanged in feces by hepatic elimination

60
Q

How is afloxolaner excreted

A

Biliary excretion of unchanged afoxolaner

Biliary and renal clearance of afoxalaner metabolites

61
Q

At what age can afoxolaner, surolaner be administered to puppies?

A

8 weeks

62
Q

T or F: inactivated Parapox virus suis subcutaneously with amitraz leave on may be benefitical. Immunostimulant

A

True

63
Q

Which oral isoxazoline has been successful in treating a CAT with demodicosis

A

Fluralaner

EV ACVD Study (52 decks)

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