Dog w/Lethargy, Weight Loss? Vomiting, Diarrhea? (Posted for KS Vets)
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Thread: Dog w/Lethargy, Weight Loss? Vomiting, Diarrhea? (Posted for KS Vets)

  1. #1
    Bob Pr. is offline Senior Member
    Join Date
    Feb 2009
    Lawrence (ex-Topeka), KS

    DefaultDog w/Lethargy, Weight Loss? Vomiting, Diarrhea? (Posted for KS Vets)

    (This thread is posted as a service to the Kansas Veterinary Medical Association so the link can be published & available to all Kansas vets)

    Dog w/ Lethargy, weight loss? Vomiting, diarrhea?

    In early May of this year, my 8 year old Labrador Retriever ("Puff") was--somewhat by chance--found to be infested by a parasitic trematode which, until recently, had not been found in Kansas.

    During surgery at KSU's CVM-TH to remove her spleen (because of a lump detected on it), a mass was also noticed in the wall of her small intestine (jejunum). This section was also removed and her intestine resectioned. Both the spleen and intestinal section were sent to histopathology.

    The report came back with (thankfully) no sign of the dreaded hemangiosarcoma in her spleen but a number of eggs of Heterobilharzia americana (H.A.) were seen in the removed section of her intestinal wall. It was this that probably caused her continued vomiting, diarrhea and refusal to eat--her initial symptoms that led to our going to KSU and, when there, the subsequent X-rays and ultrasound trying to find the cause, which led to the chain of events that identified a lump on her spleen (and its high risk of usually fatal hemangiosarcoma that prompted her splenectomy), the resectioning of her small intestine and, finally, the ultimate identification of her infestation with H.A.

    H.A. infestations have been typical in Louisiana and the mudflats of the Mississippi River and also in the Gulf states. But recently cases have been reported in Kansas, Indiana, Tennessee, Georgia, North & South Carolina, and northern Texas.

    H.A. is a parasitic trematode (AKA fluke, blood fluke) which has an intermediate life stage in snails and a definitive life stage in dogs (plus other members of the dog family, raccoons, bobcats, rabbits, and nutria). It's found in the mud of streams, ponds and marshes. When it contacts a suitable definitive host, it penetrates the skin and usually migrates to the liver and then to the intestinal wall where it lays eggs; the H.A. eggs are then broadcast in the fecies. (Click on the references below for a fuller description of the life cycle of H.A.)

    My Lab and I walk every morning in a large nature preserve just east of the Topeka VA Hospital and Felker sports complex. Its fields and woods have abundant wild life (deer, foxes, raccoons, rabbits, etc.) and many ponds and sloughs that invite dogs to wade or plunge in. This almost certainly is where my dog received her H.A. infestation. Since this preserve's web of trails also attract many dog owners and their dogs taking similar walks, there will be a number of other dogs in this Kansas region infested with H.A.--and no doubt broadcasting H.A. to other areas they visit.

    H.A. is impossible to detect unless it's specifically tested for because H.A. eggs do not float (as do the eggs of most other similar flukes and worms) so the sediment of fecal material in solution must be microscopically examined to detect their presence (unless identified by histopathology or the PCR test). Because of this and because H.A. has not been seen in Kansas until very recently, and because its presenting symptoms are not definitive and mimic many other disorders, most dogs with this infestation can easily be misdiagnosed.

    Symptoms (in addition to the lethargy, weight loss, vomiting & diarrhea in the title) may also include drinking lots of water and lots of peeing. The diarrhea may contain blood and any stools may be covered with mucus. These symptoms can suggest many diseases or causes (e.g., diabetes, eating contaminated food, renal or adrenal problems, etc.). [See the PCR reference below for more clinical signs.]

    A recent JAVMA article reported less than 2 tenths of 1 percent of dogs are diagnosed with H.A. and, in another recent JAVMA article, many subjects included in that study were identified by necropsy because infestation with the H.A. trematode had not been identified while those dogs were alive.

    Typical symptoms of H.A. infestation (with % of cases in which it's shown) are:
    lethargy (91%),
    weight loss (77%),
    anorexia (59%),
    diarrhea (55%, often with blood traces),
    vomiting (% not given),
    hypercalcemia (% not given)
    polydypsia/polyuria (% not given)
    hematochezia (% not given)

    My Lab has finished a 10 day course of Fenbendazole (FBZ) in an effort to kill any lingering H.A. eggs or trematodes in her system. None were found in the sedimentation test at KSU-CVM-TH of her fecal sample 14 days later but a portion of that sample was sent to the lab at Texas A&M for the more sensitive PCR test (see reference below). Had those results also been negative, we'd rely on semi-annual fecal sedimentation retesting. However, her PCR results, unfortunately, came back positive (despite the negative findings from KSU's sedimentation test) so Puff was started on another 10 day course of FBZ.

    1st: June 19, 2010
    -- Her second course of FBZ had to be discontinued after 6 days due to several days of vomiting, runny stools, and anorexia. "Puff" today started a diet of cooked white rice and chicken to settle her stomach and encourage eating. She's also taking generic Pepcid (10 mg) 2X/day. She'll return to the KSU-CVM-TH on Monday morning.
    /// 2nd: Jun 21, '10 -- For now the treatment is to restore her normal eating and elimination patterns with the help of an I/D diet. Then we'll decide on what to do next.
    ///3rd: Jul 20, '10 -- After Puff's normal eating was restored, she completed her 3rd round of FBZ for 10 days. 30 days after completing it, a fecal sample from her will be taken to KSU-CVM-TH (around Aug. 16th); they will send this to the Texas A&M lab for the more powerful PCR test. The results should be back about 10 days later (around Aug. 26th).
    ///4th: Aug 26th -- An e-mail informed me this morning that Puff's PCR test was negative for H.A.
    Suggestion for Giving FBZ Medicine
    We found the best way to give the powder was to mix about 3 TBS (about golf ball size) of raw hamburger into 1/2 cup of water, stir until shreds are completely separated, then microwave until cooked. When this "hamburger soup" cools, the FBZ powder can be mixed in and a dog will eagerly eat all of it.
    On our every morning walks in the nature preserve, my Lab's now on leash whenever we're near ponds, sloughs, or marshes; also, I now carry a water bottle and folding bowl with which to slake her thirst, reducing her temptation to find water elsewhere.


    There have been two JAVMA articles early in 2010 on H.A. in dogs; here are some other articles & links:

    PCR - Heterobilharzia americana

    Heterobilharzia americana infection in a dog. [J Am Vet Med Assoc. 2002] - PubMed result

    Heterobilharzia americana

    Heterobilharzia: Liver & Intestinal Parasite of Dogs

    Last edited by Bob Pr.; 08-30-2010 at 02:25 PM. Reason: add further info
    Puff [YF, AKC field line (from competing HT/FT breeder) 62 lbs, dob: 8-'01]

    Bess [BF, AKC bench line (from competing show breeder) 55 lbs., 1967-1981] "Poor Bess, the Wonder Dog":

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  3. #2
    Bob Pr. is offline Senior Member
    Join Date
    Feb 2009
    Lawrence (ex-Topeka), KS


    As soon as my Lab was diagnosed with H.A., I sent out information similar to the above post to all the people who attended our weekly LabFests in Topeka. I just received the following post from a person who used to attend those with 2 Labs. It sounds suspiciously like his Lab died of undiagnosed H.A. infection.

    Hi Bob, I haven’t talk to you in quite a while. This e-mail was painful, as we lost Jake about a month ago. The symptoms sound very similar. He was very lethargic, and wouldn’t eat, he had a temperature, and the blood test came back that he was anemic. Our vet said the symptoms look like it could be a blood disease he got from a tick bite, or it could be cancer. We had him on massive doses of anti-biotic, and then some steroids. We were buying liver and fish just for Jake to build up the blood count, but he was not interested in eating. He reminded me of when my dad was dying of Pancreatic cancer, it was almost like “leave me alone to die in peace”. I came home about a week after we started all this medicine, and found him laying in the back yard under his favorite shade tree, and it looks like he had just exploded inside, and everything bleed out thru the rectum. Two days before we took him in the first time, he was chewing up the deck, and eating bark and wood off of our woodpile. He knew something was in his gut, and was trying to scrape it out.

    I am going to forward this to my vet, maybe it will help the next time. I wonder if there is a pill they can take to prevent this, like heartworm pills. Sid was in the same mud puddles as Jake, but so far he shows no sign of problems. -- Larry

    (FWIW -- There is no pill so far. -- Bob Pr.)

    Last edited by Bob Pr.; 06-02-2010 at 12:58 PM.
    Puff [YF, AKC field line (from competing HT/FT breeder) 62 lbs, dob: 8-'01]

    Bess [BF, AKC bench line (from competing show breeder) 55 lbs., 1967-1981] "Poor Bess, the Wonder Dog":

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