Diagnosis of Aelurostrongylus abstrusus verminous pneumonia via sonography-guided fine-needle pulmonary parenchymal aspiration in a cat

Abstract

Case summary A 9-year-old, male neutered, indoor–outdoor domestic shorthair cat from the northern Alabama countryside presented for a 3 week history of coughing, lethargy and an episode of self-resolving dyspnea that occurred 1 week prior to presentation. Three-view thoracic radiographs revealed a moderate-to-severe, diffuse, mixed bronchial to structured interstitial (miliary-to-nodular) pulmonary pattern in all lung lobes with peribronchial cuffing and multifocal areas of mild patchy alveolar opacity. Ultrasound-guided evaluation and fine-needle aspiration of the caudodorsal lung parenchyma was performed with sedation. Cytology revealed many widely scattered Aelurostrongylus abstrusus larvae and ova. Upon the confirmed diagnosis of A abstrusus verminous pneumonia, treatment with fenbendazole and selamectin resulted in complete resolution of clinical signs within 6 weeks of the initial diagnosis.Relevance and novel information We report herein the first documented case in the Americas of A abstrusus verminous pneumonia diagnosed via cytologic evaluation of an in vivo, percutaneous ultrasound-guided fine-needle aspirate of affected lung. Additionally, to our knowledge, we offer the first account of the sonographic (pulmonary) features of the disease.

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“…tracheal swabs or wash, BAL, pleural effusions and expectorated material, may be microscopically examined for the presence of A. abstrusus L1s. Recently, cytological evaluation of fine needle aspirate of sonographically affected lung has been reported in a domestic shorthair cat from Alabama, USA [ 76 ]. However, these methods have inherent limitations in terms of risks for the animal’s health while obtaining the material, requirement of general anesthesia combined with low sensitivity in the absence of significant pulmonary tissue involvement [ 43 , 77 ].…”

“…UK) for treating A. abstrusus infection and has been shown to be efficacious when administered orally at 50 mg/kg body weight (BW) for three consecutive days with an efficacy greater than 99 % for larval count reductions [ 56 , 91 , 92 , 94 ]. Fenbendazole was also successfully used to eliminate A. abstrusus in a domestic shorthair cat when administered at 50 mg/kg PO q24h for 14 days as evidenced by improvement in blood parameters, enhanced clinical recovery and absence of A. abstrusus larvae by Baermann fecal examination 2 weeks after treatment [ 76 ].…”

“…Hence, in severe clinical cases supportive treatment is needed, for instance in cases complicated with secondary bacterial infection and inflammatory reactions, broad-spectrum antibiotics should be administered together with anti-inflammatory doses of corticosteroids (e.g. prednisolone 0.5 mg/kg PO q24h for 10 days) [ 76 , 101 ]. Antibiotics should be selected on the basis of culture and sensitivity, with doxycycline being a good choice where concurrent Bordetella bronchiseptica or Mycoplasma spp.…”

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“…The financial cost of bronchoscopy could also limit its use as a first choice diagnostic procedure. Cytological diagnosis of A. vasorum with fine‐needle aspiration of the lung under only brief sedation has been reported in occasional case reports in dogs and in one cat with Aelurostrongylus abstrusus infection . However, the sensitivity of this test has not been investigated in clinical series, especially in comparison with qPCR on BAL material; in addition, absence of peripheral pulmonary lesions on radiographs and potential coagulopathies can preclude the realization of this procedure.…”

“…Cytological diagnosis of A. vasorum with fine-needle aspiration of the lung under only brief sedation has been reported in occasional case reports in dogs 26,27 and in one cat with Aelurostrongylus abstrusus infection. 28 However, the sensitivity of this test has not been investigated in clinical series, especially in comparison with qPCR on BAL material; in addition, absence of peripheral pulmonary lesions on radiographs and potential coagulopathies 29 can preclude the realization of this procedure. Bronchoalveolar lavage analysis has the advantage to provide additional diagnostic information such as the presence of bacterial coinfection that requires specific therapeutic management or monitoring.…”