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April is Heartworm Awareness Month, and I think it&#;s a good time to talk about ivermectin. As you may recall, ivermectin was all over the news during the height of the pandemic as an unproven treatment for COVID-19. Most people had never heard of this drug, however many dog owners have ivermectin in their kitchen cabinet in the form of heartworm preventative.
In , the Nobel Prize in Physiology or Medicine was awarded to William C. Campbell and Satoshi Omura for their discovery of a novel therapy against infections caused by roundworm parasites. The diseases caused by these parasites affect some of the world&#;s poorest populations, causing Elephantiasis and River Blindness. The discovery resulted in avermectin, the protype drug of this class of anti-parasite medications from which ivermectin is derived.
Dogs become infected with heartworms when a mosquito carrying juvenile heartworms injects the developing worms into a dog. The juvenile heartworms migrate to the blood vessels of the lungs and mature into spaghetti-like worms. The term &#;heart&#;worms is a misnomer. Dirofilaria immitis, the scientific name for heartworm, lodge in the blood vessels of the lungs. In severe cases, they spill over into the heart, giving them a descriptive, but incorrect name. The juvenile heartworms are very susceptible to ivermectin, which is why veterinarians prescribe a monthly regimen. Ivermectin, selamectin, milbemycin oxime and moxidectin are all members of the avermectin class of drugs. If your dog receives monthly heartworm preventative, he receives one of these medications.
Ivermectin and the other closely related drugs have broad activity against a variety of parasitic worms, including hookworms, whipworms and roundworms, which infect the intestines of dogs and cats. The human worms causing Night Blindness and Elephantiasis are also roundworms. If you read the label of your pet&#;s monthly heartworm medication, it may say the medication is effective against other worms like tapeworms. Tapeworms are flat, not round, and are not killed by ivermectin. Instead, they are targeted by other medication that is included in your dog&#;s heartworm preventative.
Even though fleas and ticks are not spaghetti-like worms, some drugs in the ivermectin family will kill fleas, ticks and ear mites. If the heartworm medication is not effective against fleas and ticks, it will be combined with flea and tick preventative to create a single once-a-month parasite medication that prevents against both internal and external parasites.
The Companion Animal Parasite Council and the American Heartworm Society recommend year-round heartworm preventative and flea and tick prevention. Talk to your veterinarian about what medication is right for your pet.
Fleas can infest pets and home environments. Flea bites can cause skin irritation and may, in rare cases, transfer infections to humans. Pet owners spend more than $15 billion (US) annually to protect their pets from fleas. Read more to learn about the causes of flea bites, signs & symptoms, risk factors, prevention, and treatment options.
What Are Flea Bites?
Flea bites cause lesions on the skin. These insects may bite numerous times while exploring the skin surface, resulting in clusters of bites on the skin. The flea bite appears as a raised, reddened region on the skin approximately 5 to 30 minutes after the bite. Flea bites harden 12 to 24 hours after a bite and can persist for a week or more [1].
Most fleas do not come into contact with humans or pets and have little or no medical relevance.
Fleas can cause harm to humans and pets include the human flea (Pulex irritans), cat flea (Ctenocephalides felis felis), dog flea (Ctenocephalides canis), oriental rat flea (Xenopsylla cheopis), northern rat flea (Nosopsyllus fasciatus), sticktight flea (Echidnophaga gallinacea), and sand flea or jigger (Tunga penetrans) [1].
Flea Life Cycle
The flea life cycle includes: egg &#; larva &#; pupa &#; adult [1].
In general, female fleas require a blood meal from a host (human or pet) to complete ovary development. Fleas bite hosts as a part of their life cycle. After an adult flea has taken a blood meal from a host, the flea will mate. Females then lay eggs on a host or the surrounding area [1].
Eggs take 1 to 10 days to hatch, depending on humidity and temperature [1].
Larvae have biting mouthparts but lack eyes and legs. They often live deep in carpet or bedding of homes with flea infestations [1].
Pupae live in cocoons that have an oval shape and white coloration. Pupae can remain dormant for several weeks and up to a year until a host arrives [1].
Adults emerge from cocoons and immediately seek a blood meal. Certain features of the host attract adult flea to host. Examples include body heat, exhaled carbon dioxide, movement, and scent [1, 2].
Fleas usually reach their peak potential to attack humans and pets in late summer (August through September). Temperature and humidity during late summer allow flea populations to increase in comparison to other times of the year [3].
Symptoms & Causes
Flea bites present as [4]:
Fleas can bite and infest any body part they come in contact with. Fleas feed on the blood vessels of humans and animals, which allows for easy entry of pathogens. Hence, flea bites may give rise to symptoms of the disease as well [5].
Flea infestations of pets and homes may cause flea bites. Fleas usually extend 2 to 10 mm in length and can jump up to 150 times their body length. Their hind legs (largely composed of the protein resilin) allow fleas this jumping ability [1].
Research indicates that cat fleas infest pets and homes most frequently. In Columbia, cat fleas made up 94.2% of fleas taken from cats and dogs. Cat fleas usually cause health problems in both pets and humans, unlike some other flea species [6, 7].
Risk Factors
The majority of flea species infest rodents. If rodents have nests in a home, pets can pick up fleas if they come into contact with rodents or their nests. It is important to limit or eliminate rodent infestations in homes with pets [1].
Temperature and humidity are crucial determinants of flea development. Warmer temperatures lead to the expansion of flea populations in the northern hemisphere [1].
Human encroachment on wild habitat may also increase the number of illness-causing flea bites. In fact, the re-emergence of diseases from fleas may become an epidemic due to human encroachment and climate change [1].
Evidence for this comes from the discovery of:
Potential Complications in Humans
Flea bites in humans usually resolve by themselves and rarely cause complications. That said, if you notice any signs of infection &#; such as severe rash, swelling, or white pocket &#; make sure to see your doctor.
Infections
Tungiasis comes from the bite of a sand flea or jigger. A female penetrates the skin, which becomes irritated and painful within 24 hours. Scratching of the irritated area spreads eggs and may lead to bacterial infection [1].
Scientists first detected flea-borne spotted fever in cat fleas. Many other species of fleas have also been shown to transmit the disease. Although rare, the disease occurs worldwide [1].
The main symptoms include rash, headache, and fever. Symptoms may also include black crusted skin lesions, vomiting, and diarrhea [1].
Murine typhus gets transferred from a rodent to a flea, often oriental rat fleas. The fleas can then pass the disease to humans through bites [1].
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Symptoms of the disease include high fever and nausea, which constitute symptoms of many other illnesses. Thus, a laboratory must confirm the presence of the disease [1].
The cat flea may transmit Bartonella henselae through scratches or bites. The disease is present worldwide [1].
Symptoms include a small, raised and reddened area that develops after one week. Enlarged lymph nodes appear at 2 to 3 weeks. Enlarged lymph nodes may persist for up to 3 months [1].
Most cases resolve without treatment after 2 to 4 months. Twenty-five percent of patients with heart valve complications die from the disease [1].
Cat fleas and human fleas transmit Bartonella Quintana to humans through bites. A recent re-emergence of the disease has occurred in Europe and the USA, especially among homeless people. No deaths have been reported so far [1].
Some people infected with the disease show no symptoms. Others with this illness have a fever with a headache and pain in bones of the legs that lasts for short time periods. Others with these disease show symptoms that persist for long periods of time and do not stop [1].
Skin Conditions
Papular urticaria entails increased sensitivity of flea-bitten regions. The increased sensitivity is similar to an allergic response. This disease does not show at first bite but occurs after repeated flea bites [8].
Identifying which insect may cause papular urticaria remains difficult. Researchers have suspected that fleas and/or mosquitos cause the disease [8].
Most often, bites from cat fleas cause flea allergic dermatitis. When fleas pierce the skin with highly specialized mouthparts, some people have allergic reactions to flea saliva. This leads to dermatitis [3].
Symptoms of flea allergic dermatitis include severe itching and swelling in the region of the bite. Usually, symptoms only last a few days. In extreme cases, itching and swelling can last up to 2 years. Secondary infections may also follow due to excessive itching [3].
Common Complications in Pets
Flea allergic dermatitis consists of severe itching, swelling, and hair loss in flea-bitten regions of pets. Flea allergic dermatitis usually arises from cat flea bites. This condition is common in cats and dogs. For example, a survey of 163 cats and dogs found that 58.3% of cats and dogs exposed to fleas showed signs of flea allergic dermatitis [9, 7].
Cat fleas can get infected with tapeworm. When a dog or cat eats an infected flea, they get tapeworm. Although rare, pets may transmit tapeworm to humans. Infection rarely causes disease in dogs and cats. Animals with tapeworm should get treated to prevent the risk of human infection [10, 11, 12].
Prevention of Flea Bites
Flea control often prevents discomfort and spread of disease from flea bites. Strategies in flea control include:
Successful Flea Control Agents
Before applying any flea treatment to your pet, make sure to consult your vet first. One substance may be safe in one species but dangerous in another, and adequate doses may vary.
Examples of possibly useful insecticides include:
Insecticide Resistance
Often, treatment failure gets mistaken for insecticide resistance. Treatment failure comes from not following treatment directions. Examples include not treating all pets in a household, not treating during winter, and improper application of a product to pets [6].
Resistance occurs when fleas become less sensitive to insecticides. Cross-resistance can happen when resistance to one insecticide gives resistance to another insecticide. Recent reports show that cat fleas and human fleas have resistance for carbamates, organophosphates, pyrethroids, and pyrethrins [6].
There is less flea resistance to organochlorines, imidacloprid, lufenuron, and fipronil. Some studies suggest resistance to fipronil. Usually, cat fleas get tested with these products for studies. Different degrees of resistance may exist in other species [6, 21, 7].
Safety Issues
Permethrin-based spot-on flea treatments for dogs can have harmful effects in cats. Pet owners should not use permethrin-based flea treatments for cats [22].
Treatment of dogs (Scottish terriers) with spot-on flea control showed no increase in cancer (transitional cell carcinoma). The spot-on flea controls tested contained imidacloprid or fipronil [23].
Flea control collars do not have toxic effects on dogs. Dogs can eliminate chemicals from flea control collars quickly [24].
Treatments for Flea Bites
For humans, washing the area with soap and water will reduce the spread of infection. Application of an ice pack to a bitten region for 10 minutes reduces swelling from a flea bite. A bitten individual should avoid scratching the irritated area to avoid a risk of infection [25].
Topical anti-itching creams and lotions may also be used [4].
Complication Treatment for Humans
If you notice any signs of infection or other complications &#; such as severe rash, swelling, or white pocket &#; make sure to see your doctor. Do not apply any treatment on your own.
Topical ivermectin or metrifonate were effective at eliminating fleas on the seventh day of application in infected humans. These drugs do not kill the fleas in the early stages of skin penetration [1].
Other agents kill skin-embedded fleas after early phases of penetration. These agents include:
Treatment for Pets
Before applying any flea treatment to your pet, make sure to consult your vet first. One substance may be safe in one species but dangerous in another, and adequate doses may vary.
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