ahallada
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Coccidiosis
Last updated on 4/21/2011.
Contributors:
Linda Shell, DVM, DACVIM (Neurology)
Synonyms:
Isospora
Intestinal coccidiosis
Isospora infection
Cystoisospora
Cystoisospora infection
Cystoisosporosis
Coccidia
Coccidia infection
Disease description:
Coccidiosis usually refers to gastrointestinal infections caused by Isospora species in dogs and cats. These protozoan parasites can be readily identified on fecal flotation with zinc sulfate. Diarrhea may or may not be present. Young or immunocompromised animals with diarrhea may require treatment. Isospora species tend to be host specific: the species that infect cats do not infect dogs and vice versa. In addition, there is no zoonotic threat to people.1-8
PATHOGENESIS
Dogs are the definitive hosts for I. canis, I. ohioensis, I. neorivolta, and I. burrowsi; cats are definitive hosts for I. felis and I. rivolta.
Infection is acquired by ingestion of sporulated oocysts in the environment or by ingestion of tissues of other infected vertebrate intermediate hosts. Infection may also occur if sporulated oocysts within paratenic hosts (flies, cockroaches, or dung beetles) are ingested.3
The enteroepithelial phase occurs in the small intestine of infected animals. In the presence of bile, the ingested oocysts release sporozoites which invade the crypt cells of the intestinal wall. Sporozoites undergo 2-4 generations of schizogony, asexual reproduction. The schizont releases merozoites that infect nearby cells. Gametogony (sexual reproduction) occurs producing microgamonts and macrogamonts. Fertilization takes place producing a zygote which becomes an oocyst that is released in the feces. Sporogony occurs in the external environment producing infective sporozoites in as little as 12 hours.3
Prepatent and patent periods vary slightly by species. In general, the prepatent period is 3-11 days.
Although the pathogenicity of Isospora is difficult to demonstrate experimentally, infections are often implicated in outbreaks of diarrhea in shelters and breeding facilities. Clinical signs may appear because more virulent strains may exist or because of a combination of stress, concurrent infections, and high dose loads.2
Microscopic lesions observed in some infected animals include villous atrophy, dilation of lacteals, and hyperplasia of lymph nodes in Peyer’s patches.3
PREVALENCE
Infection with Isospora spp. is common in puppies and kittens with and without diarrhea; prevalence estimates for the United States vary from 3% to >30%. 3
CLINICAL SIGNS AND DIAGNOSIS
Clinical disease is most common in young, debilitated, and immunocompromised animals. Clinically ill puppies and kittens can exhibit vomiting, abdominal discomfort, inappetance, and watery diarrhea that sometimes contains blood and blood. Depending on the age of the animal and the parasite burden, severe dehydration and death can occur.
Hemogram and serum chemistry results are either normal or non-specific. For example, anemia may develop from blood loss in puppies or kittens with heavy parasite loads. Decreases in total protein, albumin and globulin concentrations can occur concurrently with blood loss.
Fecal flotation with zinc sulfate is the recommended method of diagnosis. Isospora spp oocysts are large and often occur in large numbers. Because normal animals can pass Isospora spp oocysts, positive test results do not prove a disease association.3
Disease description in this species:
In one study of dogs experimentally infected with I. canis, the mean prepatent period was 9.8 days; the patent period was 8.9 days and all puppies developed diarrhea, suggesting the organism can be a primary pathogen.3 In another study, the prepatent period for I. ohioensis was 6 to 7 days and presence of diarrhea was variable.
Etiology:
Isospora burrowsi
Isospora canis
Isospora neorivolta
Isospora ohioensis
Isospora spp.
Age predilection:
Juvenile
Newborn
Diagnostic procedures: Diagnostic results:
Hemogram (complete blood count) ANEMIA
Urinalysis Urine specific gravity increased
Fecal flotation with zinc sulfate Isospora observed in feces
Biopsy and histopathology of small intestines Intestinal hemorrhage
Treatment/Management/Prevention:
SPECIFIC
1) Coccidiosis is generally self-limiting. Mild clinical signs in most healthy puppies and kittens will resolve without therapy. However, administration of treatment may speed resolution of clinical disease and may lessen environmental contamination and the potential for infecting other contact animals.
2) The only approved treatment for coccidiosis in the United States is sulfadimethoxine.
Sulfadimethoxine: 50 to 60 mg/kg daily for 5 to 20 days (dogs and cats).3
3) Other drugs have been used:
Trimethoprim-sulfonamide: 15-30 mg/kg trimethoprim q 12-24 hr x 5 days.
Amprolium: 300 to 400 mg total dose, PO, every 24 hours for 5 days. Amprolium (150 mg) can also be used in combination with sulfadimethoxine (25 mg/kg) PO, daily x 14 days.3
Ponazuril (Marquis paste, Bayer) This coccidiocidal drug can be administered off label. Different dose protocols have been published
20 mg/kg/day twice 1-7 days apart.3
50 mg/kg/day once3
Toltrazuril (Baycox, Bayer): Different doses have been published in North American Companion Animal Formulary, Eighth Edition 2008:
5-20 mg/kg PO once
7 mg/kg PO q 24 hr x 2 days
4) Other agents such as furazolidone, quinacrine, and metronidazole probably are of little clinical value.8
Preventive Measures:
1) Isospora spp oocysts are very resistant to environmental conditions and disinfectants. Frequent removal of feces (sporulation occurs within 12-36 hours so collect and dispose of feces daily) is helpful to prevent environmental contamination.2
2) Because cysts are resistant to all commonly used disinfectants, kittens and puppies should be housed in areas amenable to effective mechanical cleaning.
3) Steam cleaning can be used to destroy oocysts that contaminate surfaces.
4) In environments with heavy infections, treatment of all in-contact dogs, particularly puppies, should be considered.
5) Prophylactic treatment of positive dogs in shelter or kennel situations may be recommended to prevent environmental contamination. Ponazuril administered to all at-risk puppies on intake to shelters may aid in the control of coccidiosis.2,6
6) Isospora are species specific and not considered a zoonotic threat.
Special considerations:
Many species of coccidia infect the intestinal tract of cats and dogs. All species appear to be host-specific. Cats have species of Isospora, Besnoitia, Toxoplasma, Hammondia, and Sarcocystis. Dogs have species of Isospora, Hammondia, and Sarcocystis. Neither dogs nor cats have Eimeria. Eimeria oocysts are often found in cat and dog stools because the dog or cat ingested bird, rodent or rabbit droppings. Thus, the oocysts are merely "passing through". Eimeria oocysts will not be in the two-celled stage as is common for Isospora species and they often will have ornamentations, such as micropyle caps or dark thick walls, that are not found on Isospora oocysts. Because Eimeria do not infect cats or dogs, treatment is not necessary.
The oocysts of Cystoisospora (formerly known as Isospora) contain 2 sporocysts each containing 4 sporozoites. The oocysts of Eimeria contain 4 sporocysts each containing 2 sporozoites.
Cryptosporidium differs from Isospora in that Cryptosporidium organisms are extracytoplasmic and may produce autoinfection. A Cryptosporidium oocyst contains four sporozoites not within a sporocyst.
References:
1) Buehl IE, Prosl H, Mundt H-C, et al: Canine isosporosis - epidemiology of field and experimental infections . J Vet Med B Infect Dis Vet Public Health 2006 Vol 53 (10) pp. 482-7.
2) Hurley KF: Identification & Management of Diarrhea Outbreaks in Animal Shelters. Western Veterinary Conference 2007.
3) Lappin MR: Update on the Diagnosis and Management of Isospora spp Infections in Dogs and Cats. Top Companion Anim Med 2010 Vol 25 (3) pp. 133-5.
4) Wright I: Severe Anaemia Associated with Isosopora canis Infection. British Small Animal Veterinary Congress 2010.
5) Lloyd S: Activity of toltrazuril and diclazuril against Isospora species in kittens and puppies. Vet Rec 2001 Vol 148 (500-11).
6) Daugschies A, Mundt HC, Letkova V: Toltrazuril treatment of cystoisosporosis in dogs under experimental and field conditions. Parasitol Res 2000 Vol 86 (10) pp. 797-99.
7) Charles SD, Chopade HM, Ciszewski DK, et al: Safety of 5% Ponazuril (Toltrazuril sulfone) Oral Suspension and Efficacy against Naturally Acquired Cystoisospora ohioensislike Infection in Beagle Puppies. Parasitol Res 2007 Vol 101 (suppl 1) pp. 137-44.
8) Marks SL: Frustrating Kitten Diarrhea. Western Veterinary Conference 2009.
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