DIAGNOSTIC UPDATE IDEXX Canine and Feline Diarrhea RealPCR Panels from IDEXX Reference Laboratories

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DIAGNOSTIC UPDATE
IDEXX Reference Laboratories • January 2009
IDEXX Canine and Feline Diarrhea RealPCR™ Panels
from IDEXX Reference Laboratories
Background
Diarrhea is a common problem in companion animals.
Identifying infectious causes of diarrhea is an important
component of the diagnostic workup, but it is often
overlooked. Performing fecal ova and parasite screens and
supplementary Giardia testing is fairly routine, but rarely are
additional diagnostic tests performed to identify infectious
causes of diarrhea. This may in part be because traditional
methods for identifying gastrointestinal infections have been
expensive, of low diagnostic sensitivity and slow to yield
results. It is common for dogs and cats to be treated with
broad spectrum anthelmintic and antibiotic therapies. If
diarrhea persists, infectious causes are considered unlikely
and dietary trials and symptomatic treatment is often
pursued. If this approach is unsuccessful, intestinal biopsies
may be obtained in some cases in an attempt to yield a
definitive diagnosis that may lend itself to specific treatment.
Treatment failure with persistent or recurrent diarrhea, lack of
a definitive diagnosis and expense of ineffective medications
can lead to client dissatisfaction and noncompliance as well
as jeopardize the pet’s health.
IDEXX Diarrhea RealPCR Panels
The IDEXX diarrhea RealPCR panels allow you to screen
for multiple infectious causes of diarrhea from a single fecal
sample. These panels offer a comprehensive tool to identify
common intestinal pathogens to help you more quickly
and accurately identify the infectious agents that may be
contributing to diarrhea in your patients.
The panels are specifically designed for dogs and cats, and
they detect the most likely infectious causes of diarrhea
in each species. These diarrhea panels can be used to
complement your routine fecal tests (e.g., fecal ova and
parasite screen and SNAP® Giardia Test in dogs and cats
with diarrhea). The diarrhea panels are not intended to be
used as a screening tool in healthy pets except in a sheltertype environment for surveillance.
Toxoplasma gondii, Salmonella spp., Clostridium perfringens
enterotoxin A gene, feline coronavirus (FeCoV) and feline
panleukopenia virus.
Interpreting Results
Results of IDEXX diarrhea RealPCR panels should be
interpreted in light of patient signalment, history, clinical
presentation, vaccination history and other laboratory data.
For example, a positive parvovirus PCR test result in a
3-month-old puppy with acute onset of vomiting, bloody
diarrhea and leukopenia is very diagnostic for parvovirus
enteritis. However, a positive coronavirus PCR test result in
a 5-year-old well-vaccinated dog with chronic intermittent
diarrhea, a good appetite and otherwise clinically healthy
is likely an incidental finding, and further diagnostics to
determine the etiology of the diarrhea should be considered.
This dog, however, may be chronically shedding coronavirus
and may be a source of infection for other dogs.
The chart on the following page contains a list of the
fecal pathogens in the IDEXX Canine and Feline Diarrhea
RealPCR Panels and summarizes the following for each
pathogen: the common clinical signs, the prevalence
reported in the literature, the prevalence from diarrhea
RealPCR panels submitted over a 5-month period, the
clinical significance including zoonotic potential, additional
diagnostic tests that should be considered when this
organism is identified and treatment recommendations.
It is interesting to point out that the prevalence data from
the literature for most organisms is similar to the IDEXX
RealPCR prevalence data. Differences may stem from the
animal populations studied and the diagnostic tests used to
detect the pathogen in these studies.
When to Use IDEXX Diarrhea RealPCR Panels
1.To identify the pathogen(s) that may be causing or
contributing to diarrhea in dogs and cats
The canine diarrhea panel includes RealPCR tests for
Giardia spp., Cryptosporidium spp., Salmonella spp.,
Clostridium perfringens enterotoxin A gene, canine enteric
coronavirus, canine parvovirus 2 and canine distemper virus.
2.To support timely diagnosis and initiation of appropriate
therapy
The feline diarrhea panel includes RealPCR tests for
Tritrichomonas foetus, Giardia spp., Cryptosporidium spp.,
4.To identify and minimize human exposure to zoonotic
pathogens
3.As a surveillance tool for dog or cat populations
(e.g., shelters, breeding facilities)
IDEXX Diarrhea RealPCR Panels for Dogs and Cats
Organism
Clostridium
perfringens
Enterotoxin A Gene
Salmonella spp.
Gram-negative bacteria
Cryptosporidium
spp.
Giardia spp.
Tritrichomonas
foetus
Protozoon
Coccidia
Protozoon
Gram-positive bacteria
Species Affected
Dog, Cat
Dog, Cat
Dog, Cat
Dog, Cat
Cat
Clinical Signs
•Acute/chronic/
intermittent smalland/or large-bowel
diarrhea
•Fever/sepsis
Acute/chronic/intermittent
small- and/or large-bowel
diarrhea
Acute/chronic/intermittent
small- and/or large-bowel
diarrhea
Chronic or recurrent
large- bowel diarrhea
•Overall 8% in dogs9
•Canine nosocomial
diarrhea1
•Anorexia, diarrhea
(may or may not be
hemorrhagic), vomiting,
weight loss
•Hemorrhagic diarrhea
(e.g., HGE) in dogs
Prevalence
(in literature)
•7%–14% in
nondiarrheic dogs1,2
•0%–1.9% in
nondiarrheic animals3,4
•7.3% in kittens5
•4.7% in shelter cats
•36%–50% in puppies
•31% in purebred cattery
cats10
•41% in diarrheic dogs1,2
•0%–1.4% in diarrheic
animals3,4
•3%–10% PCR
prevalence in dogs7,8
•Up to 100% in dogs in
shelters and kennels9
•14.4% of cats with
diarrhea in UK11
6
9
•Overall 4% in cats9
•9.8% in shelter cats6
•31% in purebred cattery
cats10
IDEXX RealPCR
Prevalenceb
•39% in dogs
•0.1% in dogs
•6% in dogs
•8.3% in dogs
•37.8% in cats
•0.4% in cats
•5.4% in cats
•5.1% in cats
Clinical
Significance
•Detection is likely
significantc
•Detection is likely
significantc
•Detection is significantd
•Detection is significantd
•Detection is significantd
•Zoonotic potential
•Zoonotic potential
•No zoonotic potential
•No zoonotic potential
•Zoonotic potential
Additional
Diagnostics
Recommended
Strengthen significance of
a positive C. perfringens
enterotoxin A gene
PCR test result by
C. perfringens enterotoxin
by ELISA2,f
Culture and sensitivity
Treatment
•Ampicillin/amoxicillin
•Controversial
•Fenbendazole
Ronidazole12
•Metronidazole
•Only if systemic illness
•Treatment often
ineffective
•Tylosin
•Resistance to
tetracyclines
•High-fiber diet
aVaccination
•Based on sensitivity
sting
•Azithromycin
•Fluoroquinolones,
chloramphenicol,
trimethoprim-sulfa and
amoxicillin
•Paromycin
(caution: nephrotoxicity)
•Tylosin
•Febantel-praziquantelpyrantel (Drontal® Plus)
•Metronidazole
(less effective)
with a modified live vaccine may result in positive results for up to a few weeks post vaccination.
RealPCR prevalence data from a total number of 918 samples for dogs and 944 samples for cats collected over a 5-month time frame.
cDetection is likely significant: The organism may be the cause of the clinical signs, contributing to the clinical signs or may indicate carrier state.
dDetection is significant: The organism is likely the cause of the gastrointestinal signs.
eDetection may not be significant: The organism is not likely the cause of the gastrointestinal signs.
f Test code 4030, best performed on a fresh sample.
bIDEXX
9.2% in cats
Toxoplasma gondii
Coccidia
Canine Enteric
Coronavirusa
Feline Coronavirus
(FeCoV)a
Canine
Parvovirus 2a
RNA virus
RNA virus
DNA virus
Feline
Panleukopenia
Virusa
Canine Distemper
Virusa
RNA virus
DNA virus
Cat
Dog
Cat
Dog
Cat
•Usually asymptomatic
•Clinical signs
typically mild without
coinfection
•Coronaviral enteritis
•Acute diarrhea,
sometimes preceded
by vomiting
•Feline infectious peritonitis
(FIP): fever, weight loss,
inappetance
•Acute anorexia,
diarrhea (may or may
not be hemorrhagic),
vomiting, dehydration
•Acute anorexia,
•Mild
vomiting, dehydration –Respiratory: coughing,
with or without diarrhea
oculonasal discharge
•Fever/sepsis
•Systemic: fever
•Self-limiting
small-bowel diarrhea
possible
–Transient, mild diarrhea,
vomiting
•Fever/sepsis
–Respiratory: coughing,
oculonasal discharge
•Presence or absence of –Noneffusive: granulomatous
fever
gastroenteritis possible
with constipation, chronic
diarrhea, vomiting; uveitis;
neurologic signs, etc.
–Gastrointestinal:
anorexia, vomiting,
diarrhea
–Neurological: seizures,
myoclonus, ataxia
–Effusive: pleural effusion/
ascites
0.9% of feline fecal
samples13
•15%–26% family pets14 •Up to 80% of cats from
catteries, shelters, large
•59.3% in nondiarrheic
multicat households16
shelter dogs15
Dog
•No published data
19.2% in cats with
diarrhea at the Clinic of
•High in young or
unvaccinated dogs with Small Animal Medicine,
Ludwig-Maximilians
appropriate clinical
University, Munich,
signs
Germany18
•No published data
•Likely high in young or
unvaccinated dogs with
appropriate systemic
clinical signs including
gastrointestinal signs
•73.3% in diarrheic
shelter dogs15
•Approximately 25% of cats
from households with
1–2 cats and urban/
suburban feral cats16
0.5% in cats
10.6% in dogs
60.2% in cats
3.5% in dogs
3.2% in cats
1.2% in dogs
•Detection may not be
significante
•Detection may not be
significante
•Detection may not be
significante
•Detection is
significantd
•Detection is
significantd
•Detection is
significantd
•Zoonotic risk high for
pregnant women
•No zoonotic potential
•Likely not cause of diarrhea
•No zoonotic potential
•No zoonotic potential
•No zoonotic potential
CBC: leukopenia
common
CBC: leukopenia
common
•CBC: lymphopenia
common
•May indicate chronic carrier
•Zoonotic risk for
immunocompromised
individuals
•No zoonotic potential
IgG and IgM ELISA if
extraintestinal signs
present
•To detect chronic shedders,
perform FeCoV PCR test on
feces weekly for
4 consecutive weeks17
•Chest radiographs if
respiratory signs
•If FIP suspected, a positive,
FeCoV PCR test result on
ascites or pleural fluid,
whole blood or tissues
supports diagnosis
•Clindamycin
(preferred)
•Pyrimethaminesulfonamide
combination
•Supportive
•Identify and treat
secondary or
concurrent infections
•Rarely indicated for
gastrointestinal signs
•No effective treatment for
FIP; supportive care
•Supportive
•Supportive
•Supportive
•Treat secondary
infections
•Treat secondary
infections
•Anticonvulsants if
seizuring
•Treat secondary
infections
References
Ordering Information
test code
test name, contents and specimen requirements
2625
Canine Diarrhea RealPCR™ Panel
Giardia spp., Cryptosporidium spp., Salmonella spp.,
Clostridium perfringens enterotoxin A gene,
canine enteric coronavirus, canine parvovirus 2 and
canine distemper virus RealPCR tests
5 g of fresh fecal material; 1 g minimum
2627
Feline Diarrhea RealPCR™ Panel­—Comprehensive
Tritrichomonas foetus, Giardia spp., Cryptosporidium
spp., Toxoplasma gondii, Salmonella spp., Clostridium
perfringens enterotoxin A gene, feline coronavirus
(FeCoV) and feline panleukopenia virus RealPCR tests
5 g of fresh fecal material; 1 g minimum
Specimen requirements: 5 g fecal material (1 mg minimum)
in a sterile container, keep refrigerated
Limitations: A PCR test may not detect silent carriers,
especially if they are not actively shedding the infectious
agent. In addition, a negative PCR test result may be caused
by treatment, occurrence of new strain variations (especially
parvovirus) or number of organisms below limit of detection.
Contacting IDEXX
Laboratory Customer Support
If you have any questions regarding test codes, turnaround
times or pricing, please contact our Laboratory Customer
Support Team at 1-888-433-9987, option 3, option 5.
Expert Feedback When You Need It
Our team of internal medicine specialists is always available
for complimentary consultation. Please call 1-888-433-9987,
option 4, option 2, if you have questions.
Turnaround time
The IDEXX nationwide network of reference laboratories
provides daily courier service or IDEXX-Direct® service
to pick up your samples and forward them to our IDEXX
Molecular Diagnostics Laboratory in California. IDEXX
RealPCR tests are run daily, Monday–Friday. Samples
received on Saturday or Sunday are processed on Monday.
You can expect results within 1–3 working days, depending
on shipping time.
1.Kruth SA, Prescott JF, Welch MK, Brodsky MH. Nosocomial diarrhea
associated with enterotoxigenic Clostridium perfringens infection in dogs.
JAVMA. 1989;195(3):331–334.
2.Marks SL, Kather EJ, Kass PH, Melli AC. Genotypic and phenotypic
characterization of Clostridium perfringens and Clostridium difficile in
diarrheic and healthy dogs. J Vet Intern Med. 2002;16:533–540.
3.Cave NJ, Marks SL, Kass PH, Melli AC, Brophy MA. Evaluation
of a routine diagnostic fecal panel for dogs with diarrhea. JAVMA.
2002;221(1):52–59.
4.Hill SL, Cheney JM, Taton-Allen GF, Reif JS, Bruns C, Lappin MR.
Prevalence of enteric zoonotic organisms in cats. JAVMA.
2000;216:687– 692.
5.Shukla R, Giraldo P, Kraliz A, Finnigan M, Sanchez AL. Cryptosporidium
spp. and other zoonotic enteric parasites in a sample of domestic dogs
and cats in the Niagara region of Ontario. Can Vet J. 2006;47:1179 –1184.
6.Mekaru SR, Marks SL, Felley AJ, Chouicha N, Kass PH. Comparison
of direct immunofluorescence, immunoassays, and fecal flotation for
detection of Cryptosporidium spp. and Giardia spp. in naturally exposed
cats in 4 northern California animal shelters. J Vet Intern Med. 2007;21(5):
959–965.
7.Giangaspero A, Iorio R, Paoletti B, Traversa D, Capelli G. Molecular
evidence for Cryptosporidium infection in dogs in Central Italy. Parasitol
Res. 2006;99(3):297–299.
8.Abe N, Sawano Y, Yamada K, Kimata I, Iseki M. Cryptosporidium infection
in dogs in Osaka, Japan. Vet Parasitol. 2002;108(3):185–193.
9.Kirkpatrick CE. Enteric protozoal infections, in Greene CE (ed):
Infectious diseases of the dog and cat. Philadelphia, Pa: WB Saunders;
1990:804–814.
10.Gookin JL, Stebbins ME, Hunt E, et al. Prevalence of and risk factors for
feline Tritrichomonas and Giardia. J Clin Microbiol. 2004;2707–2710.
11.Gunn-Moore DA, McCann TM, Reed N, Simpson KE, Tennant B.
Prevalence of Tritrichomonas foetus infection in cats with diarrhœa in the
UK. J Feline Med Surg. 2007;9(3):214–8.
12.Gookin JL, Copple CN, Papich MG, Poore MF, Stauffer SH, Birkenheuer
AJ, Twedt DC, Levy MG. Efficacy of ronidazole for treatment of feline
Tritrichomonas foetus infection. J Vet Intern Med. 2006;20:536–543.
13.Dabritz HA, Miller MA, Atwill ER, Gardner IA, Leutenegger CM, Melli
AC, Conrad PA. Detection of Toxoplasma gondii-like oocysts in cat
feces and estimates of the environmental oocyst burden. JAVMA.
2007;231(11):1676–1684.
14.Mochizuki M, Hashimoto M, Ishida T. Recent epidemiological status of
canine viral enteric infections and Giardia infection in Japan. Jap J Vet Sci.
2001;63:573–575.
15.Sokolow SH, Rand C, Marks SL, Drazenovich NL, Kather EJ, Foley JE.
Epidemiologic evaluation of diarrhea in dogs in an animal shelter. AJVR.
2005;66:1018–1024.
16.Pedersen NC. An overview of feline enteric coronavirus and infectious
peritonitis virus infections. Feline Practice. 1995; 23(3):7–20.
17.Lutz H. Biology of feline coronavirus and its control. Proceedings from:
28th World Congress of the World Small Animal Veterinary Association;
October 24–27, 2003; Bangkok, Thailand.
18.Neuerer FF, Horlacher K, Truyen U, Hartmann K. Comparison of different
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© 2009 IDEXX Laboratories, Inc. All rights reserved. • 09-69110-03
All ®/ TM marks are owned by IDEXX Laboratories, Inc. or its affiliates in the United States and/or other countries.

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