Must-Know Parasites That Could Harm Your Pets!

Are your pets at risk for dangerous parasites like Giardia or Coccidia? In this episode, Dr. Sugerman and Dr. Z dive deep into the world of microscopic parasites, revealing how these hidden threats can impact your pet's health. Learn how to identify the symptoms, prevent infections, and understand the life cycle of these common pet parasites. Don't miss this essential guide to keeping your furry friends safe! 

What You’ll Learn:

• How to identify common pet parasites like Giardia and Coccidia

• The life cycle and transmission of microscopic parasites

• Symptoms of parasite infections in dogs and cats

• Effective treatment options for Giardia, Coccidia, and salmon poisoning

• How to prevent parasite infections in your pets

• The impact of parasites on your pet's health and well-being

• Differences between parasites affecting cats, dogs, and other animals

• When to seek veterinary care for parasite-related issues

Ideas Worth Sharing:

• "Giardia and Coccidia are single-celled protozoan organisms that infect the intestines. They're not worms, and you need a microscope to see them." – Dr. Z

• "Diagnosing these parasites can be tricky because symptoms like diarrhea can be caused by many different issues, so a detailed history and fecal tests are crucial." – Dr. Sugerman

Resources From This Episode:

Center for Disease Control and Prevention

Companion Animal Parasite Council

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Read The Transcript:

[00:00:00] Dr. Sugerman: Hi everybody. Welcome back to another episode of Vetsplanation. I am your host, Dr. Sugerman, and I have Dr. Z with me here again today. Thank you so much for coming in. You are definitely my go-to GP person.

[00:00:11] Dr. Z: Happy to be that person.

[00:00:12] Dr. Sugerman: Yes, always excited to have you on because I learn new things all the time.

[00:00:16] Dr. Z: Good, good.

[00:00:17] Dr. Sugerman: So today we're going to be talking about some parasites. Which is interesting because we talked a lot about worms before and this is a different type of parasites we're going to be talking about this time, right?

[00:00:28] Dr. Z: Yeah, I decided to separate these ones from the worms because they're different. The main thing is they're microscopic, right?

They're not worms that you can actually see. These ones you need a microscope to see at any stage of their life, and they also cause diarrhea and GI stuff, but they work in different ways, and so I just wanted to separate them.

[00:00:49] Dr. Sugerman: Yeah, yeah, absolutely. Let's get into it. Let's start talking about Giardia.

So what is Giardia?

[00:00:54] Dr. Z: Yes, we'll start with Giardia. The actual name in Latin is Giardia duodenalis. It was also once called intestinalis or lamblia. Now, they're all just synonyms for the same kind of creature. But there are different strains of the Giardia and they're called assemblages, which I think is fun.

And they're lettered from A through H. So you have A, B, C, D, E, F, G, H. So people mostly get the A and the B kind and then dogs get the C and the D. And cats get F most of the time. And then cattle, they can get A, like people, but also E.

Anyway, it goes on and on. And sometimes dogs and cats can get the people ones too, the A and B. But interestingly, the little bit of literature that's out there about that, the rule of thought seems to be that we actually give that to our pets rather than the other way around for those particular assemblages.

And again, they're not worms. These are single celled protozoan organisms that infect the intestines. That's what they are.

[00:02:01] Dr. Sugerman: Yeah, which makes it really hard to be able to know that they're in there and that's what's causing them, right?

[00:02:05] Dr. Z: Yes, yeah. And the next one I'll talk about, coccidia, is also a very interesting single celled parasite.

And the little bit of digging I did into the history about it, it took people 60, 100 years to figure out what these creatures are actually doing in their different life cycle stages and everything they're so tiny, like, how do you even figure out what they're doing?

[00:02:26] Dr. Sugerman: Exactly. Like you said, they're microscopic, so it's so hard to know.

[00:02:29] Dr. Z: Yeah, pretty interesting stuff.

[00:02:31] Dr. Sugerman: So how do our pets get Giardia?

[00:02:33] Dr. Z: It's what we call a fecal oral transmission for most, most of these intestinal parasites. So that means you either directly eat poop or you indirectly eat or consume something that was contaminated with poop.

So for people, drinking contaminated water is a big way they get Giardia. And dogs and cats they groom themselves, they lick poop off themselves, they run through poop and then they lick their paws. There's toys that get poop on them and they'll chew on that, so there's, there's indirect ways of getting it to you, but basically you have to get it in your mouth.

[00:03:06] Dr. Sugerman: Okay. So what is the life cycle of Giardia then? You said that it's really hard to study these things, so what have they figured out?

[00:03:13] Dr. Z: Yeah, it seems to be, for Giardia anyway, that they have two life forms, or they exist in two different forms. So pretty simple actually. The first form is called a trophozoite.

So trophozoite is the modal form of the Giardia. So it looks like, if you look at it in the microscope, it's pear shaped, or like teardrop shaped. And it's got two nuclei, in it, and they look like eyes. And then there's another part in the middle that kind of looks like a smiley face mouth.

[00:03:42] Dr. Sugerman: I know, they're really... They're actually cute.

[00:03:44] Dr. Z: They are cute. And at the tip of the teardrop is a thread, or a flagella, and they, they wag that back and forth, and that's how they swim, and how they move. And these do not survive long outside. Like when they're in that modal form, they are actually rarely passed out in the poop.

Sometimes you'll see them, but most of the time they're not. And they're not infective at that stage. If you were to eat a trophozoite, you would be fine.

[00:04:08] Dr. Sugerman: Yeah.

[00:04:09] Dr. Z: It doesn't do anything. Yeah. But the other form is called a cyst. And so Giardia cysts are basically when two of those trophozoites come together and we'll, we'll go into it a little bit.

But they create like a cyst around themselves and then that becomes very resistant to the environment. And they can persist for months outside.

[00:04:27] Dr. Sugerman: In pretty crazy weather too, right?

[00:04:30] Dr. Z: I think so, although I honestly didn't look up the details.

[00:04:33] Dr. Sugerman: If I remember correctly, I think like they could survive pretty intense weather.

[00:04:36] Dr. Z: So you mean freezing?

[00:04:38] Dr. Sugerman: Yeah, like I think if I remember correctly, I think like freezing and heat, like they could still withstand both of those things.

[00:04:44] Dr. Z: I think they are susceptible to heat though, and drying. Yeah.

[00:04:47] Dr. Sugerman: Yeah. Drying, yeah, that's a good point.

[00:04:49] Dr. Z: Yeah, it has to be wet, I think. And maybe they can survive cold, but I know they don't like heat. They can be deactivated in the heat.

[00:04:55] Dr. Sugerman: Yeah.

[00:04:56] Dr. Z: But anyway, they're pretty resistant. They can last for months and months. And that's the infective stage. So if, if you were to consume a Giardia cyst, then you would get Giardia.

So once a cyst is eaten, like to go through the life cycle now a little bit it bursts open inside the, stomach and small intestine. And then those little trophozoites that are in there are freed, and they start swimming and doing their thing. And they can swim around in the intestines but they have these, also these like sucking discs.

Pretty disgusting, and they stick onto the intestine and they start feeding.

[00:05:28] Dr. Sugerman: Yeah.

[00:05:29] Dr. Z: And then they get bigger, and they start to reproduce themselves. They don't reproduce sexually, they reproduce asexually. Do you remember binary fission?

[00:05:39] Dr. Sugerman: Yes, yes.

[00:05:41] Dr. Z: So that's like how yeast, for example, also reproduces.

They just get bigger until they have enough to make two of themselves, and then they split down the middle.

[00:05:49] Dr. Sugerman: They just kind of bud off.

[00:05:51] Dr. Z: Bud off. Yep, and basically are clones of each other.

[00:05:54] Dr. Sugerman: Yeah.

[00:05:55] Dr. Z: There's no mixing of DNA or anything, they just reproduce themselves with asexual means.

And so they make more trophozoites, and there are more of them swimming around. And they keep moving on down the intestines, and as they get closer to the colon, they hook up together again and form a cyst. And then the cyst is passed out in the feces, and that's how you start the life cycle again.

[00:06:17] Dr. Sugerman: Some other animal eats it. You go through the same thing.

[00:06:19] Dr. Z: And they burst open into new trophozoites. So it's pretty simple, really.

[00:06:23] Dr. Sugerman: Yeah.

[00:06:23] Dr. Z: But when they're sucking on the intestines and reproducing like that, that's where the damage to the intestines happens, and then you get all the symptoms from Giardia. Sometimes.

[00:06:33] Dr. Sugerman: Are they sucking a lot of the nutrients, like the worms, where we were talking about?

[00:06:37] Dr. Z: I think a little bit, but not as much as worms. I think it's more just like disruption of the normal gut that causes all the symptoms in these cases, yeah.

[00:06:45] Dr. Sugerman: Got it.

[00:06:46] Dr. Z: I just wanted to point out that unlike worms, Giardia, or some worms I should say, they don't do any migrating.

Like they don't go inside the cells at all, they just stay on the outside. And that's also, coccidia is different, they do go inside the cells, but Giardia does not, so it's pretty simple and I'd say of all the parasites out there.

This one isn't one of the worst ones.

So what are the symptoms there? Number one is diarrhea, of course And it can be any kind of diarrhea. It can be acute. It can be chronic. It can be small intestine, which is like large volumes of diarrhea versus large intestines, which is like straining little bits of mucousy diarrhea.

Sometimes blood in there, but not really with Giardia, not so much as some of the other parasites. Usually you see like a pale mucous stool, and your belly hurts, and you're tired. And then, if it gets really bad, or especially in a young animal, they can get all the problems that you see with diarrhea, like dehydration. You can get weight loss, and poor body condition, and that kind of thing. So it can be pretty severe in some cases.

And so those trophozoites that are sucking on the intestinal cells, they cause a dysfunction of the intestine because of that. So all the normal gut things like absorbing food and, digesting food just stops working well and the intestinal cells start secreting extra fluid to try and get rid of the parasite.

And so then you get this horrible diarrhea and sometimes the trophozoites come out in the feces, but usually it's the cysts that do. But it can take a while for them to show up and start coming out. So sometimes all the diarrhea symptoms happen well before they start shedding any cysts.

So there can be some false negatives, especially early on in an infection.

[00:08:32] Dr. Sugerman: And there are intermittent shedders too, right? So sometimes we see them in the feces, sometimes we don't.

[00:08:36] Dr. Z: Correct, yeah. And the trophozoites especially are hit and miss. If you're lucky, you'll see one. But most of the time it's the cysts that are coming out and then even then it's like intermittent and sometimes not for a week or two past when they were infected.

Can be a little tricky to diagnose. And it's unclear why there's such a range in the virulence, like some, many animals and people too are just asymptomatic. Like you have Giardia and nothing happens. Other ones get very, very sick, and then there's like anybody in between. So a little bit of diarrhea, chronic, intermittent, so it's a wide range.

Our best guesses are, number one patient immunity. Especially the younger animals tend to have more immature immune systems. They have a harder time getting rid of them. Immunocompromised people would have a harder time with Giardia probably and those would be the ones more likely to get diarrhea from the parasite, yeah.

There's also all those different assemblages and some probably are more pathogenic than others. And some maybe, there's some guesses that some might produce a toxin. Maybe that's partly also causing some diarrhea. And I think just the disruption in the normal gut flora can always contribute to diarrhea too.

Some animals have better gut flora than others. And so that might make it harder to get through a giardia infection. What else?

[00:09:57] Dr. Sugerman: Allergies too, right? Like allergies.

[00:09:58] Dr. Z: Yeah, yeah. If they have an underlying disease or another parasite. A lot of puppies have roundworms and giardia.

[00:10:05] Dr. Sugerman: Right. Exactly.

[00:10:05] Dr. Z: And that's gonna double mess up their intestines. So yeah, all of those additional diseases.

And then as far as the environment goes, like it's always worse when there's overcrowding of puppies and kittens. Catteries. Puppy mills. Especially if it's not very sanitary. There's a lot of poop everywhere.

They're not cleaning it up very well. They're more likely to eat more cysts and get more and more likely to get diarrhea for all those reasons. There was also a study showing in cats that were housed separately and had giardia, they were less likely to shed cysts than cats that were in multiple cat households because stress probably plays a role as well as far as whether you're gonna start shedding those cysts.

[00:10:46] Dr. Sugerman: Yeah, that's a really good point.

[00:10:48] Dr. Z: Yeah, cats get stressed very easily even when you don't realize it.

[00:10:51] Dr. Sugerman: Yes.

[00:10:52] Dr. Z: And if they have stress, then they're more likely to get Giardia or have trouble clearing it. Start shedding it more and all of that.

[00:11:00] Dr. Sugerman: With all of that, like you mentioned how sometimes they're intermittent shedders, they don't always show up in the beginning.

So how do we diagnose them with Giardia then?

[00:11:07] Dr. Z: It is tricky. So fecal tests are our biggest way. For the floats, remember we talked about fecal floats for all the worms and the zinc centrifugation is like harder to see some of the worm eggs, but it's actually better for Giardia than the sugar flotation, which is better for most of the worms. But there's something about the sugar that can distort the Giardia cysts and make them harder to see. So actually the zinc float is better for looking for Giardia specifically.

There's also, you can just do a fresh poop direct look. And that's where you're more likely to see the trophozoites. All the centrifugation and the floats are gonna probably make those trophozoites go away. You're less likely to see them on a float, but on a direct smear, just a drop of liquid diarrhea and a drop of saline and look and see.

You might see some swimming trophozoites on the ER maybe. And then you can pretty much assume that's the cause of the diarrhea if you see those. Because I think you can get false negatives. They might still be there, but if you see one, you know for sure that that pet has Giardia.

[00:12:07] Dr. Sugerman: Yeah.

[00:12:08] Dr. Z: And there's antigen tests. Just like when you send out poops, you can look for PCR tests on Giardia. There is a snap test for Eliza in house too. I don't think we have it, but..

[00:12:19] Dr. Sugerman: We don't have it.

[00:12:20] Dr. Z: There was a couple of hospitals I worked at that used to. And so you could know right away, it's a more sensitive test for looking at the DNA of the trophozoites. So you're more likely to find it with those tests.

[00:12:32] Dr. Sugerman: I think that's what the lab uses too, isn't it?

[00:12:34] Dr. Z: Maybe.

[00:12:34] Dr. Sugerman: I don't remember if they use that or a PCR.

[00:12:36] Dr. Z: I think maybe the diarrhea panels that you send out are like the PCRs. But yeah, you're right the fecal with Giardia is probably just the ELISA snap test. Yeah. Yeah.

[00:12:45] Dr. Sugerman: Okay. Yeah, but definitely can be a little more sensitive than when we do them.

[00:12:49] Dr. Z: Absolutely. Yeah, and you're so pressed for time. It's hard to do a proper float and everything too so I'd say just send it out. And if you suspect I don't think there's anything wrong with just treating either.

[00:12:59] Dr. Sugerman: Exactly.

[00:12:59] Dr. Z: Yeah.

[00:13:00] Dr. Sugerman: And then we mentioned how dogs get certain types of Giardia, cats get certain types of Giardia. Do we have other pets that can get Giardia as well?

[00:13:07] Dr. Z: Oh yeah. There's a lot of, a wide variety of mammals that can get Giardia. I have a list.

[00:13:14] Dr. Sugerman: Yes!

[00:13:14] Dr. Z: Besides humans, there's other primates like apes and monkeys can get it.

Dogs, cats, of course, farm animals are a big one. Cattle, sheep, goats, horses, and pigs. And they've found Giardia in beavers and coyotes.

[00:13:28] Dr. Sugerman: In beavers? Oh, that's cool.

[00:13:30] Dr. Z: And rodents, apparently. And raccoons have been. There's probably more, but that was the little list that I found.

[00:13:37] Dr. Sugerman: Yes, yes.

[00:13:38] Dr. Z: There's Giardias everywhere.

[00:13:39] Dr. Sugerman: Exactly.

[00:13:39] Dr. Z: It can get into lots of different animals.

[00:13:42] Dr. Sugerman: I'm sure that's also one way it can just potentiate in our dogs and cats, too, when they're eating all those other feces from the racoons...

[00:13:49] Dr. Z: Although there's the assemblages, right? I think there is probably some crossover though, like more so in Giardia than Coccidia, which we'll go into.

But yeah, in general they have their own species, or yeah, species specific Giardia strains that tend to be the problem for them.

[00:14:05] Dr. Sugerman: Got it.

[00:14:05] Dr. Z: Yeah.

[00:14:06] Dr. Sugerman: And we talked about humans have A and B, but can they get it from their pets?

[00:14:11] Dr. Z: Yeah, so very unlikely. Usually people get the A and B, cats again get the F one, and then dogs get C and D.

But there is some reports of people getting one or the other. And, I guess the possibility is there. Although..

[00:14:29] Dr. Sugerman: Immunocompromised people probably.

[00:14:30] Dr. Z: Yeah, yeah. So even though it's unlikely, it's common sense in this case. Use good hygiene. Boil water if you're camping, or you, wash your hands after picking up your dog's poop.

Hopefully you're doing that anyway.

[00:14:43] Dr. Sugerman: Hopefully. Yes.

[00:14:44] Dr. Z: Yeah, and then you're less likely to do it. Don't go drinking puddles and stuff. Outside in your backyard.

[00:14:50] Dr. Sugerman: I haven't planned to do that yet, but, you know. So then, after we figured out that they do have Giardia, how do we treat it then?

[00:14:58] Dr. Z: Yeah, let's talk about treatment, but first let's talk about when should we treat. Because there's a whole bunch of patients that are asymptomatic. You might be running a routine fecal and, oh, surprise, they come up with Giardia. But it's like a..

[00:15:10] Dr. Sugerman: They have no diarrhea.

[00:15:11] Dr. Z: Yeah, six year old, healthy dog, no diarrhea, normal stools.

And you're like, oh, wow, you have Giardia cysts in your poop, so that's a surprise. There might be in that case where I might just watch and not treat. The goal of treatment, the primary goal anyway, is to stop diarrhea, like you want to get rid of the symptoms. And then clearing the parasite is a secondary goal in general.

So healthy animals can shed it, but there's not a lot of evidence that this will predispose others to the disease and to getting diarrhea. So it may not be a pathogenic strain. Maybe it's an assemblage that's not, a problem for that dog. And then you're treating them with these antibiotics and meds for no reason.

So..

[00:15:51] Dr. Sugerman: Which can disrupt their regular gut flora, right?

[00:15:53] Dr. Z: Exactly. Yeah, especially metronidazole.

[00:15:55] Dr. Sugerman: Yeah.

[00:15:56] Dr. Z: You want to be diligent with when you decide to treat this, and really it's if they have diarrhea. Although, if it's a young puppy, or a young kitten, and it's positive and their poops are normal, I still might treat that one.

[00:16:09] Dr. Sugerman: Okay.

[00:16:09] Dr. Z: Because I'm worried that they're so young that eventually it might become a problem for them, even if it hasn't yet. So that's like an exception. Another exception would be like an immunocompromised household person. Then you would worry there's a small chance that they might pick up this Giardia and maybe trying to clear it might be a good goal, actually.

[00:16:27] Dr. Sugerman: Yeah.

[00:16:28] Dr. Z: But generally you just treat when they have diarrhea and when they're really young. And so the two meds we have to treat are Fenbendazole, it's a big one. That's, I mentioned it last time when we talked about the worms. It's a very good dewormer. It deworms many different types of worms and it's effective for the most part against Giardia as well.

And then the other one is Metronidazole, which is actually an antibiotic. But it has activity against Giardia. And it's anti inflammatory in the gut. It really helps when you have diarrhea happening. It gets that to turn around and they feel better pretty quickly on that one.

With monitoring you usually I say repeat a fecal a month after you treat or In some of the reading I was doing, say, check two days after treatment stops, but I don't think we ever check that soon.

[00:17:13] Dr. Sugerman: Yeah, no, I was like, I think I always tell people a week, but..

[00:17:16] Dr. Z: Yeah, anywhere in between. A couple days, a week, a month.

Maybe recheck the poo, just to see how we're doing. Because a lot of the time it takes time for these to get better too. And if you check too early, it's probably still going to be positive. So you want to give the body a little bit of time to try and clear the parasite after you help out with these medications.

But if it's still positive, you could then consider trying if you did Fenbendazole, try Metronidazole next, or maybe do a combination. And if you really are trying to clear the parasite for an immunocompromised whatever. There are some other tricks I have up my sleeve, like you can definitely add probiotics.

Sometimes that makes a huge difference. Sometimes it doesn't, but I feel like some people just then keep their pets on it and they seem to have better poops. So great. If it's that easy.

[00:18:01] Dr. Sugerman: Yeah.

[00:18:01] Dr. Z: Probiotics. They're great. I also really like fiber diets for this kind of thing.

Cause I almost feel like it's like a brush for the intestine that kind of scrapes the little Giardia trophozoites off and just so psyllium husk powder is really what's in these high fiber prescription foods that we have so you don't have to necessarily buy the prescription food. You can just buy psyllium husk powder.

[00:18:23] Dr. Sugerman: Yeah.

[00:18:24] Dr. Z: It's over the counter.

You can buy it online or yeah, bulk food section of a store. And just put a little bit on top of their food every day and it really creates like a bulkier smoother poop that doesn't stick to anything. It just comes out really nice. And I think with the fiber and time and probiotics and these meds, usually you will get through the Giardia with maybe a couple of treatments, but usually you will eventually get rid of it.

[00:18:51] Dr. Sugerman: Nice. Yeah, I think that it's important that sometimes it's a couple of treatments. A lot of people think it's one treatment. We're done.

[00:18:57] Dr. Z: If you're lucky, it can be, but a lot of times it's still there, for a few times. And it can be very frustrating. I've had some owners just be like, really upset. What, what am I doing wrong?

And also, part of it is reinfection, right? The cysts are still out there, and even though we're treating, they just pick up another one.

[00:19:15] Dr. Sugerman: They're eating poop again, they're licking their paws after pooping, right?

[00:19:19] Dr. Z: So we actually recommend quite a bit of besides picking up the poop a lot, washing your hands a lot. Bathe the pets a lot.

Especially on the last day of treatment, but you could even do it every other day if you really wanted to be, get into it, and just make sure you're washing all the poop off of their fur, because there could be cysts in that that they're then licking off later. Doing a lot of bathing can make a big difference too.

And then of course, prevent them from drinking puddles and if it's real rainy, which it is here most the year, try to do your best to avoid them playing around in the puddles and drinking all that water.

[00:19:51] Dr. Sugerman: Yeah, I remember it used to be a really big thing to make sure you gave them a bath right after they were done with their treatments.

Because otherwise they'd just like turn around and lick their butt.

[00:19:59] Dr. Z: Yep.

[00:19:59] Dr. Sugerman: Reinfect themselves.

[00:20:00] Dr. Z: Yes, absolutely. So all the bathing can help with that. But not necessarily after the treatment, maybe during the treatment too.

A couple times.

[00:20:08] Dr. Sugerman: It definitely makes a lot of sense to do it during the treatment.

[00:20:10] Dr. Z: Yeah, yeah. I usually, when I write the script for a Panacur or whatever, I usually say bathe patient on the last day of treatment.

[00:20:16] Dr. Sugerman: Yeah.

[00:20:16] Dr. Z: Either way.

[00:20:17] Dr. Sugerman: Yeah, good to know. Do you mean Fenbendazole? Yeah, Fenbendazole.

[00:20:21] Dr. Z: Panacur, yeah. Panacur is Fenbendazole, sorry. Yeah. But those cysts in the environment, I did have a note here, they are susceptible to common disinfectants, such as Lysol. I think I remember reading the chlorine ones not as much, but like the quaternary ammonia compounds are great for killing Giardia. And then high temperatures, so sunny, dry spots Giardia can't last there. But it's rainy here a lot, and it's cold a lot.

[00:20:46] Dr. Sugerman: Not sunny a lot, yeah.

[00:20:47] Dr. Z: So those, just like Parvo, I think, right? Parvo's similar. They like the, they last forever in the, the shady, cold and wet places.

[00:20:56] Dr. Sugerman: Yep, exactly. Was there anything else you wanted to add about giardia before we move on?

[00:21:02] Dr. Z: I think we did everything that I wanted to talk about.

[00:21:05] Dr. Sugerman: Perfect. Alright, so let's talk about Coccidia.

So what is Coccidia?

[00:21:10] Dr. Z: Coccidia, the actual Latin name is Cystospora. Which previously was Isospora, but now it's cystoisospora. Anyway, we broadly just call it coccidia. And dogs get the Cystospora canis, and cats get Cystospora felis. Easy enough.

It's just another protozoan parasite, single celled organism. Don't confuse it with coccidioides, which is a fungus. That's completely different. I remember struggling with that in vet school, but coccidioides causes coccidioide mycosis. Say that five times faster. That's like a completely different like fungal infection and it has nothing to do with this organism that is a parasite in the gut.

Yeah, so we're just talking about coccidia.

[00:21:56] Dr. Sugerman: Okay, just a parasite.

[00:21:58] Dr. Z: Yep.

[00:21:58] Dr. Sugerman: Okay.

[00:21:58] Dr. Z: Not the fungus.

[00:21:59] Dr. Sugerman: Are there different types of coccidia?

[00:22:01] Dr. Z: Yeah, there's like an overwhelming amount of types and kinds and it's a very complex categorization. Some are If you go back to like nomenclature and the kingdoms and the phylums and everything like protozoans is a huge phylum of animals.

Yeah, so the big other one that we think of sometimes is eimeria. That's another type of coccidia that's in birds mainly, like poultry. And then it gets into sheep and cattle and goats and farm animals as well. Those tend to just, never cause a problem in dogs or cats though, but we do see them sometimes positive for eimeria on fecals. And those are typically farm dogs that are going around eating cow poop and stuff.

But luckily, they're just passing through, they don't cause any problems at all. It's just oh gee whiz, they have some eimeria, you probably have that problem in your chickens that are on the farm.

[00:22:55] Dr. Sugerman: You may need to treat your other animals.

[00:22:59] Dr. Z: And for this, let's just talk about the two coccidia types that we see in dogs and cats.

Okay.

[00:23:07] Dr. Sugerman: So what exactly are those two types?

[00:23:10] Dr. Z: Okay we talked about the canis and the felis, and they do the same thing in both cats and dogs, so let's talk about their life cycle.

[00:23:16] Dr. Sugerman: Okay, perfect.

[00:23:17] Dr. Z: It's again a fecal oral transmission, just like with Giardia. Direct or indirect. But this one can also get into slugs and snails that are going around the poop area.

[00:23:29] Dr. Sugerman: Yeah.

[00:23:30] Dr. Z: They could also get indirect infection from eating a slug or a snail, apparently. But..

[00:23:34] Dr. Sugerman: I did not know that.

[00:23:35] Dr. Z: Yeah, I was surprised to read about that. In the poop, though, there are these non infective non sporulated oocysts that are immediately pooped out. If you were to eat, again, fresh poop, usually that's okay, you're not going to get coccidia.

Just like roundworms and hookworms and whipworms, remember, they have to sit outside for a bit, and then sporulate and mature, and then they become infective after some time. If the conditions are ideal, like for coccidia specifically, they can mature in 16 hours if it's a warm day. Like between, there was studies, 68 degrees and 104 degrees.

If you're below 68, they have a harder time maturing. So colder months, you don't see it as much. And if it's super hot outside, then they can't seem to mature either. But usually it's within a week or so that those non infective cysts that have been pooped out will then become infective.

So they sporulate inside the little egg, and these are ingested and those are infective. They do a crazy thing once they're ingested. They get inside the intestinal cells first, which is different than Giardia, Giardia just stay on the outside. But these guys actually go inside the enterocyte or the intestinal cell.

And then they do all kinds of unbelievable things. And I think this is where I was reading that people have figured out over time all these different forms of coccidia because they, they go crazy. They, they do both asexual and sexual reproduction, but the asexual part is they, they turn into what's called schizonts.

And then those get bigger, and that's like a binary fission, right? They're just asexually producing schizonts. But then those get really big and invade more cells. And then they start doing sexual reproduction, where they form these male and female gametes, they're called. And then those kind of burst out of cells and find each other and mate.

So it's just crazy. And then sometime during all of this, they also form a third kind of thing called a zoite. And these are like the latent forms, kind of like what roundworms do when they're just hanging out in the female dog's liver for years and years, and then when she gets pregnant, they re-emerge.

So the coccidia does this as well, and these can hang out in all kinds of spots, like they can go to the lymph nodes, the liver, the spleen, or they can get into transport hosts and form these zoites, like in mice and rats and other vertebrates, apparently. Anyway, so that's just how I think they persist in the world, is they find these secret hiding places.

But eventually they'll emerge from that for one reason or another, and then they go back to the schizonts and the gametes and they just, you know, reproduce and then eventually they hatch or lay non sporulated oocysts. So eggs again, that like, where we started. And those get pooped out. So then the whole cycle starts again.

So but again, the fresh poop is not infectious. They have to sit outside for a bit before they sporulate and then they become infectious, so.. It's kind of crazy.

[00:26:46] Dr. Sugerman: It's crazy that they have all three types of ways that they exist in the body.

[00:26:50] Dr. Z: Yes. It's quite a remarkable organism, actually. Yeah.

Pretty impressive.

[00:26:55] Dr. Sugerman: Yes. I'm surprised I don't see so much more of it.

[00:26:57] Dr. Z: Yeah, and you can imagine when they're doing all of this reproducing and busting out of cells, that they're damaging those intestinal cells like crazy.

[00:27:06] Dr. Sugerman: Exactly.

[00:27:06] Dr. Z: And then that's where we get all the symptoms of the disease.

[00:27:10] Dr. Sugerman: Yeah, so what are these symptoms that we would see?

[00:27:12] Dr. Z: Yeah. That brings me right into it. Diarrhea number one is a big one with this. And this is a nastier diarrhea than Giardia in general. It's more mucousy. It's more bloody. Like all that disruption of those cells leads to bleeding into the intestines. This in the young animals can cause anemia, not because they're sucking blood out of them like hookworms.

But just because they're destroying their intestines.

[00:27:37] Dr. Sugerman: Cells, right?

[00:27:38] Dr. Z: Yeah. Yeah.

[00:27:38] Dr. Sugerman: They burst open.

[00:27:39] Dr. Z: Yeah, not the same as parvo, but it reminds me of parvo in that like you're just losing so much normal intestinal cells that it's causing that to happen.

[00:27:47] Dr. Sugerman: Right.

[00:27:48] Dr. Z: The same kind of symptoms, depression, dehydration, lethargy, belly hurts you can become pale and of course you don't want to eat and you can lose weight and become anemic.

Dehydration and death can even occur in the little guys. Yeah, so little puppies that have a severe infection can be serious.

[00:28:06] Dr. Sugerman: Yeah.

[00:28:07] Dr. Z: But given all that there still are some animals that have asymptomatic shedding It seems to be less likely than Giardia though. These ones tend to be a little more symptomatic in general.

[00:28:18] Dr. Sugerman: Well, can pets give coccidia to each other?

[00:28:22] Dr. Z: Yeah. Between cats and cats, yes, and between dogs and dogs, yes.

But they are actually very species specific, even more so than Giardia. Like a cat can't give its coccidia to a dog, or vice versa. Like it has to be the dog one or the cat one.

[00:28:36] Dr. Sugerman: Got it. And then, can humans get coccidia from their pets?

[00:28:42] Dr. Z: So that's also super rare, for the same reasons. There are some human strains of coccidia, though, that I did look up.

It's on the CDC website. I've never really heard about it. They seem to be more in the tropics or the subtropics of the world. There's a particular one named Isospora belli. Belly, maybe?

I know. B E L L I.

There was a article about this guy that kind of had chronic diarrhea for 20 years. Poor guy.

And they finally did like additional testing and they found like a lesion in his small intestine and they biopsied it. And there was schizonts and gametes, and all of the like, they identified Isospora belli in him. And then they treated him and he fully recovered and didn't have diarrhea anymore.

[00:29:30] Dr. Sugerman: Oh my god, that poor guy, he could have had that done 20 years before.

[00:29:33] Dr. Z: That's the saddest article, but I was at the end, it was a happy ending.

[00:29:36] Dr. Sugerman: That's good, yeah. It's still a long time.

[00:29:39] Dr. Z: I know. Poor guy. So if you have chronic diarrhea, maybe, maybe just run a fecal, tell your doctor, can I..

[00:29:46] Dr. Sugerman: Run a fecal, right? Exactly.

[00:29:48] Dr. Z: Might be coccidia.

[00:29:49] Dr. Sugerman: Yes. Yes. I know I, I had listened to a podcast. I don't know, a couple weeks ago, they were talking about that, that somebody who, they do a lot of people who, who go overseas for military and stuff, that she's running fecals on all of them.

[00:30:03] Dr. Z: That's a great idea.

[00:30:04] Dr. Sugerman: Yeah. She was saying that a good majority of people test positive for something.

[00:30:08] Dr. Z: Do they really? That's fascinating.

Yeah. See, we're just not looking, I think.

[00:30:12] Dr. Sugerman: Exactly.

[00:30:12] Dr. Z: There might be all kinds of things. What's going on in there?

[00:30:17] Dr. Sugerman: So now once we've diagnosed them with with coccidia, which I'm assuming is just our fecal again.

[00:30:22] Dr. Z: Yeah.

[00:30:22] Dr. Sugerman: Correct?

[00:30:23] Dr. Z: Oh, similar, yeah. I didn't even go into it for this.

Again, you're just running fecals. This one on the floats really easily. The coccidia eggs are very distinct.

[00:30:33] Dr. Sugerman: Look like an egg. Yeah. If you were to open it, crack an egg.

[00:30:36] Dr. Z: I guess so, yeah. Because they have I don't know. It's like an oval, but wider, much wider in the middle, almost pointy at the ends.

[00:30:42] Dr. Sugerman: Yeah.

[00:30:42] Dr. Z: And then a tiny little nucleus in the middle. Like the yolk.

[00:30:45] Dr. Sugerman: Yep, exactly. I was thinking about cracking an egg and that's what it looks like.

[00:30:48] Dr. Z: Sure. I never thought of it that way, but that's great.

[00:30:51] Dr. Sugerman: So how is it treated then once we've diagnosed it?

[00:30:54] Dr. Z: This one's pretty easy to treat. For the most part, you just do a sulfonamide antibiotic.

The most commonly used one for us is called Albon, or sulfadimethoxine is the name of the drug. There's also trimethoprim-sulfo which can work on it. Maybe in resistant cases we can try that one. And there's other ones out there. And there's also triazines which are I think a type of dewormer.

Ponazuril is the one that's often used in like poultry, I think. It's pretty safe and I know that I've seen that on, you, you probably don't see a lot of new puppies, but I, I do. And like it on the records that the owner brings me, like you can see the breeder gave Ponazuril.

[00:31:32] Dr. Sugerman: Yeah.

[00:31:33] Dr. Z: You know, early on.

It's not a drug I ever really prescribed, but I remember I looked at it and I'm like, what is this? Ponazuril. And I'm like, Oh, it gets coccidia. So we don't reach for it very often, but it works for coccidia too. So those are the two big ones. These are considered coccidio stat medications. So they stop that reproduction and, skizonts and gametes from happening, but they don't actually kill the coccidia.

So it's basically just slowing them down. It's really up to the animal's immune system to get rid of them finally. So we're just helping them while they get them out. And then sometimes, like what you've probably seen, the really sick puppies and stuff, they might need supportive treatments, absolutely. IV fluids even, I don't know if you've ever actually given a blood transfusion to one, but I was reading that somebody had.

[00:32:21] Dr. Sugerman: Not yet, but yeah.

[00:32:22] Dr. Z: Okay.

[00:32:23] Dr. Sugerman: There could have been some kitten ones that we potentially could have had. Those are, we always see fleas on them and we just assume that's what it is.

[00:32:29] Dr. Z: Yeah.

[00:32:30] Dr. Sugerman: But definitely

[00:32:31] Dr. Z: Many parasites can steal blood, I think.

[00:32:34] Dr. Sugerman: Yes.

[00:32:34] Dr. Z: So occasionally a blood transfusion might be needed.

It was also interesting to read. I never thought of this, but you can bathe them with an antibacterial shampoo. That kind of tends to kill the cysts and the eggs. Maybe I'll be adding that into my young puppies that have nasty diarrhea.

[00:32:50] Dr. Sugerman: And I'm assuming you still talk about doing my probiotics.

[00:32:54] Dr. Z: Oh yeah. Same thing. So fiber supplements. So psyllium husk powder is great. And then probiotics. And then a note I wrote here is time. Like sometimes they just need a few months to get over it with these supportive treatments. Maybe don't check those fecals again too quickly if they're doing all right.

Just maybe a month or two later, check again.

[00:33:13] Dr. Sugerman: Yeah, they're not having diarrhea at that point. Maybe check later.

[00:33:15] Dr. Z: Yeah. Yeah. Because chances are it's probably still going to be positive for a bit while they're working on it.

[00:33:20] Dr. Sugerman: Yeah.

[00:33:21] Dr. Z: Give them some time.

[00:33:22] Dr. Sugerman: Very hard to get rid of sometimes.

[00:33:23] Dr. Z: Yeah.

All these parasites are, seems like. And again, it's hard to know if it's because they didn't get rid of it versus did they just reinfect themselves? I think that's half, or more than half the battle most of the time. You just gotta wait for them to grow up a little bit. Seems like the older patients don't tend to get trouble with coccidia as much as the puppies and kittens.

[00:33:43] Dr. Sugerman: I know there were a couple other things you wanted to talk about before we get into my favorite one.

[00:33:49] Dr. Z: Oh, yes. As I was doing research for this, I was like, oh yeah, there's a couple more that I totally forgot to talk about. But they're, they're rare. So the two I'm thinking of is tritrichomonas in cats and then cryptosporidium which is, can be in many animals, but those are like rarer forms of Giardia and coccidia.

They're a similar parasites. We just don't see them nearly as often. And you usually need to have more extensive testing to diagnose them. You have to do a special fecal for cats to find them or, or just a diarrhea panel. That tests for a bunch of different things with PCR testing until you can figure it out.

So tritrichomonas, I'll start with them. They, they're like a fancy Giardia. They have three or sometimes up to five flagella. And so they're, swimming around a little bit better. Somebody described their swimming as like the jitterbug dance. And also, you can distinguish them from Giardia trophozoites because they have Instead of just a smooth outside surface, they have a little cilia that kind of wave, too, on their outsides.

They're just like fancy Giardia. People don't get them. It's just a cat problem. It can cause really chronic and recurring diarrhea in some cats. I've only diagnosed it a couple times. One was a Abyssinian cat, came from a cattery and just always having diarrhea bouts of it.

He would be fine for a while and then he'd have diarrhea again. So we finally ran a diarrhea panel and lo and behold, it came up positive for tritrichomonas. The treatment for that is called ronidazole, which is like a fancy metronidazole. But it's got more potential side effects. It can be toxic, and there's a very narrow dose range.

You have to be really careful with it. So it's not one that we usually just prescribe all the time like we do for metronidazole.

[00:35:33] Dr. Sugerman: Right.

[00:35:34] Dr. Z: I did treat that one cat with it, and his diarrhea got better, but then we, the owner insisted we check again, and it was still positive. And then he didn't tolerate a second round of treatment for whatever reason.

I can't, I think vomiting or something. And so we just stopped, but his, his poops have been fine, so we're just kind of not, not worrying about it.

[00:35:51] Dr. Sugerman: Out of sight, out of mind.

[00:35:52] Dr. Z: Yeah, so that's tritrichomonas. It's out there. It's less common, but if you have a chronic diarrhea cat, we could test for that.

Cryptosporidium, that one people can get it from farm animals. It seems to be, it's a, it's a coccidia like organism. It causes terrible diarrhea, just terrible. Luckily, though, there's a nice treatment for it. It's called azithromycin. It's a good old antibiotic. It tends to take care of it for us.

And it's generally self limiting. You can get over it on your own, even.

[00:36:20] Dr. Sugerman: Is that the one that causes really bloody diarrhea?

[00:36:22] Dr. Z: Ooh, I'd have to look it up. I don't remember. I think it's just watery, large amounts.

[00:36:26] Dr. Sugerman: Yeah. Okay. Gross. Okay.

[00:36:31] Dr. Z: Yeah. So moving on though.

[00:36:34] Dr. Sugerman: Yes, moving on to my favorite one. So I love salmon poisoning.

Please talk to me about.

[00:36:39] Dr. Z: I have to ask why do you love it so much? It's so funny.

[00:36:41] Dr. Sugerman: Because it's not a thing in Southern California, where I was from. And then when I came here. And we never even really learned about it in vet school in Southern California. And I came here and I was like, oh, what is the, what are the things, what are the ticks and stuff I need to know about here when I first came here?

And it was like, nothing. Okay, what type of snakes do I need to learn about? It was like, nothing. Okay. And then it was like, was there anything that I need to know about the Pacific Northwest? And this came up and I was like, this life cycle. It's crazy. It's a crazy life cycle.

I don't even understand how we could have so many dogs that have same poisoning with this crazy life cycle that you're going to talk to us about.

[00:37:14] Dr. Z: Yes, it is quite remarkable and we'll go into it, but I do have to say there's so many parasites that have similar crazy life cycles.

[00:37:21] Dr. Sugerman: True. This is true.

[00:37:22] Dr. Z: This one is amazing, but like heartworms are pretty crazy too.

[00:37:25] Dr. Sugerman: Yeah, heartworms are really crazy. Exactly.

[00:37:27] Dr. Z: Anyway. Let me start from the beginning. Salmon poisoning in dogs is just in dogs. Cats don't have it. It has been seen in coyotes, wolves, foxes, other canids. It was interesting, I was reading they found it in some black bears too.

And then I was like worried, I'm like, can grizzlies get it? Because they eat salmon all the time. And I didn't do a deep dive into that, but it seemed like it's possible. So it made me sad for the grizzlies. Because they don't ever cook their fish.

[00:37:52] Dr. Sugerman: Exactly. Exactly. They have found it, I think, in a wolf and stuff as well.

[00:37:56] Dr. Z: Yeah. Wolves and coyotes and foxes.

[00:37:58] Dr. Sugerman: Yeah.

[00:37:59] Dr. Z: It is, there's two organisms we need to learn about to understand salmon poisoning. There's a fluke, and it's called Nanophyetus salmincola. And, it's a trematode. It's like a flatworm fluke. And it exists here in the Northwest from Northern California up through Washington.

It's also been found in parts of the B.C. coast, so north of us. Interestingly though, it's been reported in Brazil, which is..

[00:38:25] Dr. Sugerman: Oh, that's weird.

[00:38:26] Dr. Z: That's not west, that's east coast, ocean, I don't know. It's much further south than us, but apparently there's, it's over there too, a little bit.

[00:38:33] Dr. Sugerman: Weird.

[00:38:34] Dr. Z: Yeah.

But inside this fluke, there is a bacteria. That's the fun part. And just like the heartworms. Remember when we talked about heartworms, they, they harbor a bacteria called wolbachia.

And they have an endosymbiotic relationship. They help each other out. They live happily together. It's the same with this fluke and this bacteria.

The bacteria is called Neorickettsia helminthoeca. I practiced and I still messed it up.

[00:39:00] Dr. Sugerman: I, I can never say it correctly, so you're good.

[00:39:02] Dr. Z: Neorickettsia helminthoeca. Yeah, and, interestingly, when I was reading about this, they have just discovered another type of Rickettsial bacteria in these flukes. It's got a completely different name.

This one is Stellanchasmus falcatus.

[00:39:18] Dr. Sugerman: Oh.

[00:39:19] Dr. Z: Different letters, everything. But, there's a report here in Washington, there was three dogs that seemed to die from salmon poisoning disease. And then they tested them afterwards and there was zero Neorickettsia helminthoeca in them.

Like when they PCR tested their blood and everything. But they did find this Stellanchasmus falcatus, which is also spread by the same flukes. So it turns out there might be a second organism that they previously thought wasn't as severe, but this may also cause horrible poisoning as well.

[00:39:51] Dr. Sugerman: Interesting.

[00:39:52] Dr. Z: Yeah I thought it was interesting.

[00:39:53] Dr. Sugerman: Yeah.

[00:39:54] Dr. Z: Either way, there's a bacteria in these flukes that causes all the problems.

[00:39:58] Dr. Sugerman: So how does this bacteria get into our fluke then?

[00:40:02] Dr. Z: Let's talk about the life cycle. The best part. So the fluke carries this bacteria its whole life from the egg to the adult stages.

Through, we'll go into the details, but they need two different intermediate hosts to complete their life cycle, which is the fun part. So they have to go through a snail and a fish, as the intermediate host. So let's start with the eggs, right? We got fluke eggs in the dog's poop. The dog has got Salmon Poisoning Disease, got the fluke, the fluke is making babies, and it's pooping them out.

So those eggs are in the environment, and then they hatch into Myracidia, which I will call the babies. Yep. Fluke babies. And these, in the poop, eventually a snail comes along and eats the miracidia. And inside the snail, they then mature into like a larval stage called a cercaria, and I'll call these the tweens because they're a little bit bigger than babies.

But these are interesting. They can swim at this stage. They're actually like a tiny worm and they can then exit the snail and swim around in the water that they're in. And then a fish comes along and they'll swim into the fish. Also, a fish could simply eat one of those snails.

There are some fish that might eat a snail, and get them that way. But most likely, they're swimming and burrowing into the fish. I want to make a note that they really love salmon the best. That's their favorite intermediate host, but they'll get into other fish too.

And there's even..

[00:41:32] Dr. Sugerman: Any freshwater fish.

[00:41:33] Dr. Z: Yeah. And even salamanders. They've been fine to get into salamanders too. And even if a dog is unfortunate enough at this point to go swimming where these tween flukes are, they could burrow into a dog at that point as well. Which I thought was pretty interesting. Just bypass eating the fish part.

But that's I think pretty unusual. Most of the time the dog has to eat the fish.

[00:41:55] Dr. Sugerman: Yeah.

[00:41:56] Dr. Z: But inside the fish once the tweens get in there, they have another stage and they turn from the cercaria to a metacercaria. It's a little bit bigger. So I'll call them the teenagers. The teenager flukes are then inside the fish and then they just have a party.

They go everywhere inside the fish. They really like to get into the kidneys, but they also go everywhere and including into the mucus of a fish's skin. So like between the scales they have a mucus and there'll be lots of little metacercaria that's in there. And so I will say at this point, this is where the dog eats the fish, right?

All they have to do is lick the fish. Yeah. A part of the fish, a dead fish on the beach, they just lick it even. And then the owner pulls them away. That lick could have been infectious because those little metacercaria could have been on the scales. And they got into the dog's mouth as soon as they just barely touched it with their tongue.

I will also say this is only for raw fish or partially cooked fish. Like smoking won't kill the metacercaria. So if you give your dog some smoked salmon, you're risking giving them salmon poisoning.

[00:43:03] Dr. Sugerman: And this is like fresh caught fish. Not, we're not talking about grocery store fish.

[00:43:08] Dr. Z: Hopefully not.

Yeah. I never really thought about it. I wouldn't give them fresh grocery store fish that raw either. I just wouldn't do it.

[00:43:15] Dr. Sugerman: Nor would I, but I believe what I, what I remember from before is that they had not found it come from the grocery store because they deep freeze them for so long. But after that, they're usually okay.

But the, but they had to be a deep, deep freezer, not like a regular freezer that we use.

[00:43:30] Dr. Z: Yeah. Some of the grocery store fish is fresh, like not previously frozen.

[00:43:34] Dr. Sugerman: Yeah, that's true.

[00:43:35] Dr. Z: That would be dangerous. So I would just avoid all raw fish for a dog.

[00:43:39] Dr. Sugerman: Yeah.

[00:43:40] Dr. Z: Just in case.

But my big, I always remember learning being surprised when it was that smoking didn't kill them.

Like you'd think that's cooked, but it's not.

[00:43:48] Dr. Sugerman: It's not, it doesn't get hot enough when you're smoking.

[00:43:50] Dr. Z: Yeah. Yeah, so it has to be fully cooked and then it'll deactivate or kill them. They're just a metacercaria and the dog can eat cooked fish. Just no raw, no smoked. I would be cautious with grocery store.

[00:44:02] Dr. Sugerman: Yeah, fresh water or fresh fish.

[00:44:03] Dr. Z: Yeah, fresh water fish for sure. Yeah. After five to six days, those metacercaria then mature into the adult flukes inside the dog, and then those attach onto their intestine, start to feed like many other intestinal parasites. And then they start damaging the intestine by just sucking physically on them.

But this is where the magic happens with their bacteria that they've been carrying the whole time, your good old Let me say it right, Neorickettsia helminthoeca. Yeah. Or, Stellanchasmus falcatus. So one of those will get then, basically injected into the dog from the bite of the fluke inside their belly, or inside their intestines I should say.

And then about five to seven days later, the bacteria then get into the blood and go all over their body. They, they don't discriminate. They let's list it, the spleen, the lymph nodes, the tonsils, the thymus, the liver, the lungs, the brain.

Goes everywhere. Along where the flukes are feeding, it causes like a granulomatous inflammation in the stomach and then the bacteria can get into the lungs and they can get granulomatous lesions there too and have trouble breathing.

Granulomatous just means like chronic inflammation causes like a hard abscess like to form that's hard to get rid of. And so all kinds of horrible symptoms obviously come from that. But to finish the life cycle, so those adult flukes then, happily eating and wreaking havoc, they mate and lay eggs, and then the dog poops those out, and it all starts over again.

Yeah.

[00:45:39] Dr. Sugerman: So crazy.

[00:45:40] Dr. Z: It is crazy. It's quite the journey.

[00:45:42] Dr. Sugerman: Yes, exactly. Yeah. Those little bacteria and those little flukes.

[00:45:46] Dr. Z: Yeah. I feel like the bacteria are just along for the ride, and it's the flukes that are like doing the craziness.

[00:45:51] Dr. Sugerman: Doing the things. Yeah, exactly. Yeah. So then we've talked about it goes into so many parts of the body.

So what are the symptoms usually that we see?

[00:45:59] Dr. Z: Yeah, let's go through it. So the big one is fever. Like many infectious diseases, they get a nasty fever, but in this one, it's interesting after that initial fever, they can then get hypothermic and they get really cold. I think that's when they're really sick, but.

It's a history, so if they don't have a fever when you see them, then it's still, yeah, they might still have salmon poisoning if you look harder for things. Vomiting and diarrhea, for sure, it's causing all kinds of problems in the gut. This usually progresses to a bloody diarrhea and vomiting.

They can have fresh blood vomit from these guys. Their lymph nodes also get big. The body tries to, react to the bacteria, the rickettsial organisms and you can actually find them in the big lymph nodes. Usually within five days of infection they have big lymph nodes that you can see.

[00:46:49] Dr. Sugerman: Yeah.

[00:46:50] Dr. Z: It can cause fast breathing if they're getting in the lungs. And then of course lethargy, weakness, weight loss, and eventually death. This does kill dogs for the most part.

[00:47:00] Dr. Sugerman: Absolutely.

[00:47:00] Dr. Z: Within six to ten days, that's pretty quickly that they'll die. And usually from like low blood pressure and heart arrhythmias that kind of ensue.

[00:47:08] Dr. Sugerman: Severe dehydration.

[00:47:09] Dr. Z: Yep.

[00:47:10] Dr. Sugerman: Yeah.

[00:47:11] Dr. Z: If it's not treated, it's a bad, bad disease.

[00:47:14] Dr. Sugerman: So I'll tell you my very first one that I saw. There was no fever, the lymph nodes were not enlarged, the lymph nodes you could feel at least.

[00:47:22] Dr. Z: Okay.

[00:47:23] Dr. Sugerman: No vomiting, no diarrhea.

[00:47:24] Dr. Z: Wait, you could feel them but you didn't think they were big?

[00:47:26] Dr. Sugerman: They weren't big.

[00:47:27] Dr. Z: Yeah.

[00:47:27] Dr. Sugerman: Yeah. Okay. My very first one, like I said, no vomiting, no diarrhea, had none of the classic symptoms.

[00:47:32] Dr. Z: How did you even think to test for it?

[00:47:34] Dr. Sugerman: So I had ultrasound of the dog.

[00:47:36] Dr. Z: Okay.

[00:47:36] Dr. Sugerman: And I saw that it said, It's mesenteric, so it's lymph nodes inside the abdomen, were large.

And I was like, oh, that's really interesting.

And then we did blood work on the dog, which I think we're going to talk about next is like how do you diagnose it, right? And I did blood work on the dog, and then that led me to ask the pet parent. Was there any exposure to any sort of river, stream, anything? And it had been.

[00:47:57] Dr. Z: Aha. See? It's like a puzzle every time we're trying to figure things out.

Why a dog is sick.

[00:48:04] Dr. Sugerman: Yes, exactly. Yeah. So how.. Yeah, exactly. So can other pets and humans get it from like the pet that is sick?

[00:48:11] Dr. Z: Let's see. No, so most of the time the dog has to eat the fish, the fluke, the teenager flukes in it to become infected.

I guess if you were to theoreticize, if you took blood from an infected dog and then transfused it into a healthy dog, you would probably give them the neorickettsial bacteria. But no, generally the dog has to just eat the fish. Humans, I was looking, though, can get mild GI signs from eating the fluke teenagers.

But it's nothing like the poison that happens to dogs. So it was just a transient. You might not even put it together that it was the fish that.. The sushi that you ate the other day.

[00:48:50] Dr. Sugerman: Exactly. And cats, we said, don't get it. Nobody knows why.

[00:48:54] Dr. Z: They seem to be perfectly fine. They can eat as many flukes as they like and do well.

[00:48:58] Dr. Sugerman: Yeah. That's so weird. All right. So how do we diagnose it then?

[00:49:02] Dr. Z: Actually, like you were talking about, history is a big part of it, so you might not think to ask every vomiting and diarrhea dog owner if..

[00:49:08] Dr. Sugerman: Oh I do.

[00:49:09] Dr. Z: Okay, great, but yeah, it should be part of the questioning, have they had any raw fish, or have they, have you been to the beach, and, or to a river, and were they playing around with, or do you, there's a lot of people that fish salmon around here, and they sometimes will throw...

[00:49:23] Dr. Sugerman: Throw it anywhere.

[00:49:23] Dr. Z: things to the dog, yeah, or..

Yeah.

[00:49:26] Dr. Sugerman: They clean it and then they, or I put it in a bag outside or..

[00:49:29] Dr. Z: Yeah. And the dog gets into the trash later.

[00:49:31] Dr. Sugerman: Yeah. I had apparently a bird dropped one into somebody's backyard once.

[00:49:35] Dr. Z: Bummer. The dog's like thanking his lucky stars.

[00:49:40] Dr. Sugerman: It's like a fish dropped from the sky. Unfortunately, that made him really sick.

[00:49:44] Dr. Z: It was delicious.

[00:49:45] Dr. Sugerman: Yeah.

[00:49:45] Dr. Z: But, anyway. Yeah, so history is a big one because there's so many other things that can cause vomiting and diarrhea and all of it. You can check a fecal and look for the fluke eggs. They're very visible, just like any other parasite.

[00:49:58] Dr. Sugerman: They're huge.

[00:49:58] Dr. Z: Yeah, they're big, they have it's called an operculum.

It's a distinct characteristic on them. And, they can be missed though. Sometimes the flukes are intermittently shedding those eggs and then, actually this is one where it's more likely to be seen on the sediment than on the float. So again, it's kind of like there could be false negatives going on.

[00:50:17] Dr. Sugerman: So maybe we do a direct fecal on it, where you just put the fecal..

[00:50:21] Dr. Z: You can.

Yeah.

Although I think spinning it and then looking at the bottom rather than the top might, might. But who, again, who has time for that? We usually send out our fecals. And then we're not getting results for at least a day or two.

It's, yeah, it's not a 100 percent way to diagnose the problem. If you have big lymph nodes, you can always do a cytology on those. It's never a bad idea anyway when you have big lymph nodes. And you can actually, if you stain it, you can see the what are they called? The rickettsial bodies of the bacteria are visible in the macrophages and the histiocytes.

Like they're purple, staining, very obvious inclusions. But I don't know how often we do that.

[00:50:59] Dr. Sugerman: Never.

[00:51:00] Dr. Z: Yeah. There is a PCR blood test that you can send out looking for Neorickettsia, but it takes one to four days for that to come around to. A lot of the times you're just presuming it's a possibility even when all of these are negative or you don't have time to get results.

And he's got the symptoms and there's a history of eating fresh fish, maybe, then I would just go ahead and treat. And while you're waiting, if you want to know what the answer is..

[00:51:24] Dr. Sugerman: Yeah. And then blood work?

[00:51:27] Dr. Z: Yeah. So you can run your chemistries and CBC a lot of these guys will have low platelets, like secondary to an autoimmune response.

And it's almost like in, in, ITP. But usually they're not as low. So ITP is immune mediated thrombocytopenia, which is a whole nother talk. That one, we may or may not know the cause, but platelets are needed to clot our blood. And so if we don't have enough of them, we can just randomly bleed and hemorrhage anywhere.

And usually if they have low platelets from some like neorickettsial infection like this, it's not super severe, but getting there, like maybe 50,000. Normally, it's over 150,000. When we have the actual autoimmune ITP, it's usually like zero or 1,000.

[00:52:13] Dr. Sugerman: Is there a platelet in your body?

[00:52:14] Dr. Z: Yeah.

[00:52:14] Dr. Sugerman: Yeah.

[00:52:15] Dr. Z: Yeah much more serious, I think. Do you see other things also like when you run chemistries, like that one dog you were talking about, is there anything?

[00:52:21] Dr. Sugerman: Yeah, sometimes we'll have like elevated liver values, but I think that's just because of the granulomas that are being made in those areas.

But..

[00:52:27] Dr. Z: Yeah, non specific, right?

[00:52:29] Dr. Sugerman: Yeah, exactly. It's, it's pretty.. Like the very most common thing is going to be those low platelets. And I'd say 90,000 tends to be like the magic number that I see two thirds of them at.

[00:52:39] Dr. Z: Okay.

[00:52:39] Dr. Sugerman: So 90,000 for the platelets rather than over 150,000, versus, like you said, almost zero for ITP dogs.

[00:52:46] Dr. Z: Those ones are really bad. Yeah.

[00:52:48] Dr. Sugerman: Yeah. But I have definitely seen them at 20,000 still and been like, is this ITP? Is this?

[00:52:53] Dr. Z: Yeah, that's like in the middle.

[00:52:54] Dr. Sugerman: Yep. Exactly. Yeah. But it's pretty, yeah, usually the, the platelets are the most significant thing.

[00:52:59] Dr. Z: So that dog you saw with big mesentery lymph nodes, no fever, but what were his platelets at?

[00:53:04] Dr. Sugerman: So he was at 90,000.

[00:53:05] Dr. Z: Ah, okay.

[00:53:06] Dr. Sugerman: He was at that weird and I was like, is this normal? So usually what we do, we see low platelets, we do what's called a blood smear. So we put the blood on there, smear it, and then we're counting to see how many platelets there are to make sure it's not because it was just a bad blood draw.

Because sometimes if they are very slow with their blood draw, those platelets get used up.

[00:53:23] Dr. Z: Yeah. Or they clump.

[00:53:24] Dr. Sugerman: Yeah.

[00:53:24] Dr. Z: And then the count goes down artificially.

[00:53:27] Dr. Sugerman: Yeah. Yeah. So if it's in that 90,000, you're like do we just have some blood clumps or is this truly that we have a low platelet count?

[00:53:33] Dr. Z: Yeah. I'll often just check a fresh sample again too, just to double check if I get a low count.

[00:53:39] Dr. Sugerman: Yeah. And sometimes they're just so sick that they will still be such a slow blood draw, because they're so dehydrated at that point. Yeah. So we're like checking to make sure that there's no blood clots.

And then usually it'll be roughly around 90,000. So that was what that one was, that first one.

[00:53:52] Dr. Z: Yeah, that's good. I'm glad that raised the red flag for you.

[00:53:54] Dr. Sugerman: Exactly, yeah. And I was like, this is just weird. I just have this, just lethargic, mesenteric lymph nodes enlarged.

[00:54:00] Dr. Z: Yeah.

[00:54:01] Dr. Sugerman: Platelet count.

[00:54:01] Dr. Z: And there you go.

[00:54:02] Dr. Sugerman: I was like, I've read about this.

[00:54:04] Dr. Z: Good, good. Yeah. So I guess they don't always show all of the symptoms. Like that's sometimes they don't all read the book, but it's this case with many diseases. But..

[00:54:13] Dr. Sugerman: Yeah.

[00:54:13] Dr. Z: Usually they have one or two of the things happening. So yeah.

[00:54:16] Dr. Sugerman: That's, and that's our most typical things I usually see is large lymph nodes, fevers, diarrhea.

And I'd also say that orange diarrhea is another weird one that we see a lot.

[00:54:25] Dr. Z: Is that because the salmon is orange?

[00:54:27] Dr. Sugerman: I'm assuming so, right? I don't, but this is days, like a week after. I don't know, but for some reason if I see orange dairy, I'm like, we need to test that.

[00:54:34] Dr. Z: Oh, okay. Sure, why not?

[00:54:36] Dr. Sugerman: Weird. I don't know why. Yeah.

[00:54:39] Dr. Z: Yeah, it's like a lot of things like, oh, that's parvo diarrhea, I know that smell. There was a lab tech that said if it's a lymph node aspirate and you squirt it out on the side and it's foamy, it's probably lymphoma.

[00:54:51] Dr. Sugerman: Oh.

[00:54:52] Dr. Z: I'm like, oh, I don't know if I believe that until I actually look at the cells, but..

[00:54:55] Dr. Sugerman: Yeah, exactly.

Yeah, but it's still like a red flag. You're like, oh, I should go looking for those things. Yeah, exactly. So then after we've diagnosed it with them, how do we treat it?

[00:55:05] Dr. Z: Good. So thankfully this is a very treatable disease. Hooray for antibiotics again, our saviors just like a lot of the rickettsial tick borne diseases the doxycycline, tetracyclines are the treatment of choice for this bacteria.

If they're super sick and in the hospital vomiting, it's hard to give them doxycycline pills when they're puking them up. So it comes in an injectable form, an oxytetracycline. Do we, we have that?

[00:55:31] Dr. Sugerman: We use it quite often.

[00:55:32] Dr. Z: Good. And then we have. I was reading that doxycycline comes in an IV form as well.

[00:55:38] Dr. Sugerman: It does.

Yeah. It's just not as stable and a lot more expensive. So oxytetracycline does have a couple more side effects that can occur from it, but it's a lot easier to get.

[00:55:47] Dr. Z: Okay. And cheaper too. So I would definitely just, go ahead and give it. Yep. Once they're eating again, you can switch over to the doxycycline and usually you probably have to give a couple of weeks course or something of it.

And then you probably should think about deworming for the flukes to just get the rest of the flukes out of there. So we stop having transmission of this bacteria. So praziquantel, if you remember when we talked about tapeworms, that's the wonderful tapeworm dewormer also gets flukes. You have to give it at a pretty high dose.

So I always have to like double check it because it seems like a lot of praziquantel.

[00:56:18] Dr. Sugerman: Exactly.

[00:56:18] Dr. Z: And you have to give it for three to five days in a row, which is also different, but that will clear the flukes. And then supportive care, just like all the others, IV fluids, anti nausea meds if they're really bad.

Sometimes you can't catch it early enough. If they're to the point where they're hypothermic and they got bloody, vomiting and diarrhea and they're just flat out, you might not be able to save them. But hopefully you catch it before then.

[00:56:43] Dr. Sugerman: Yeah. So far with ours, we've been able to treat like 99 percent of them.

[00:56:47] Dr. Z: Yeah, yeah. It's usually very treatable. Once you figure it out, you can usually turn them right around.

[00:56:52] Dr. Sugerman: I do wonder if that, if the praziquantel works with the other type of rickettsia that you were talking about. The one that they found in those deceased dogs.

[00:57:03] Dr. Z: Probably. Again, the praziquantel is getting the fluke, not the bacteria.

Yes. It'll probably work for both. But yeah, it's the doxycycline that's getting your bacteria. Yeah. I know. It's confusing.

[00:57:15] Dr. Sugerman: I know. I always get it mixed up. But yeah.

[00:57:17] Dr. Z: Me too.

[00:57:17] Dr. Sugerman: I wonder if the doxycycline kills those other

[00:57:20] Dr. Z: I would hope so.

[00:57:21] Dr. Sugerman: I would hope so, yeah.

[00:57:22] Dr. Z: In that one report of the three dogs I don't know why they died.

Because it said they suspected they had salmon poisoning, but they still died. I don't know if they tried to treat them and it didn't work or something.

That would be horrible. I hope it's not, I hope it is susceptible to doxycycline. I'd have to look further, honestly. But anyway you can also monitor the CBCs and make sure those platelets are coming back.

If they're not or they're going down, you might want to do a little pred, right? And get a little, calm down their immune system a little bit because you need your platelets. But generally the prognosis is good. They most, most of the time recover fully just after you start the antibiotic. So, you just gotta treat it early and think about asking those fish questions.

[00:58:01] Dr. Sugerman: Yes. That's such an important thing here.

[00:58:03] Dr. Z: Yeah, absolutely.

[00:58:04] Dr. Sugerman: Cool. Was there anything else you wanted to add then about anything else?

[00:58:07] Dr. Z: I think, oh sources. Let's see. Similar to the worms, I actually used VIN a lot, Veterinary Information Network. It's just for veterinarians to use but they have an amazing almost an encyclopedia.

I really just looked at all of that for these parasites. And at the end of those, they have a huge list of references with different articles.

There was three specific articles that went over that new bacteria that I thought was interesting.

So those are in there. Always looking at the Companion Animal Parasite Council website. It's great. They have, again, an alphabetical list of, you go to C and then you can find coccidia and you can read all about coccidia in pets. And then the CDC, the Center for Disease Control in people has all kinds of information on the human end as far as getting these parasites goes.

Good old Wikipedia. Some really good information there sometimes just for general questions. And then I used Plumb's veterinary handbook a lot. Drug handbook. It goes over the different dewormers and medications. I'm always looking at that. All the time.

[00:59:13] Dr. Sugerman: Yep. Same here. Yep. Alright. Cool.

[00:59:17] Dr. Z: That's all I had.

[00:59:17] Dr. Sugerman: Perfect. Thank you so much for sharing all of this with us.

[00:59:20] Dr. Z: You're welcome.

[00:59:20] Dr. Sugerman: You know, I think we've rounded out all of our, our parasites internally at this point.

[00:59:25] Dr. Z: Yeah. I was thinking there's other causes of diarrhea, like all kinds of bacterial infections that we didn't go over.

Maybe we can go into those eventually or, or the autoimmune diseases. I really like managing those. They're sad diseases, but I try hard to get those dogs to come back.

[00:59:42] Dr. Sugerman: Absolutely. I, I, I like diagnosing them and I like handing them to you to manage.

[00:59:47] Dr. Z: Yeah, so maybe we can tackle those eventually.

[00:59:49] Dr. Sugerman: Yeah, for sure. Yeah, absolutely. Perfect. All right. Thank you again, Dr. Z.

[00:59:53] Dr. Z: You're welcome.

[00:59:53] Dr. Sugerman: We super appreciate it. To everybody else, I just wanted to give you like a forewarning. So I talked to Dr. Z about this, but I've had a bunch of stuff that happened at my house, including a flood. So I've had to like cut back on the podcast a bit.

We'll be a little bit more intermittent than I wished until I have everything figured out.

[01:00:09] Dr. Z: Yeah. Sorry, good luck with everything.

[01:00:11] Dr. Sugerman: Yeah, thanks. Alright everybody, make sure to keep your pets happy, healthy, and safe. Thanks guys.