Transcript Clinical Disease

It’s the only way to screen
dogs quickly and easily for
Lyme, Ehrlichia canis and
Heartworm in your clinic!
Why test, you ask?
Don’t have ticks or tickborne diseases in your
area? Think again!
Incidence is Growing
Experts agree that tick-borne diseases
are being uncovered everywhere and
prevalence is on the increase.
FACTS:
• Ticks are second only
to mosquitoes in disease
transmission
• Ticks can carry more
than one disease
• Dogs can be infected with
more than one disease
Believe it!
Tick-borne disease
is in your area.
“Maps circulated by vaccine manufacturers ten years
ago attributed Lyme disease to the northeastern and
upper Midwestern states. Today, the disease almost
covers the entire contiguous United States.”
Richard B. Ford, DVM, PhD, ACVIM
U.S. Canine Positive Lyme Results
Reported positives from over 3,000 veterinary clinics over one year via
phone surveys and IDEXX reference laboratories’ results.
What do you think
are the two most
common canine
infectious diseases in
the United States?
How common is
E. canis, really?
“Canine ehrlichiosis is the second most common
infectious disease in the United States, with the
most prevalent being canine parvovirus disease.”
Hoskins JD. Seroprevalence of Ehrlichia Dogs.
Veterinary Forum, October 2000.
U.S. Canine E. canis Exposure
Reported positives from over 5,000 veterinary clinics over two years via
phone surveys and IDEXX reference laboratories’ results.
Isn’t Heartworm Disease
now under control?
A recent study
demonstrated that, despite
tremendous awareness of
heartworm disease, the
infection rate remains
unchanged over the past
10 years.*
An estimated 240,000
dogs were diagnosed
with heartworm disease
last year.*
Approximately one-half
of U.S. dog-owning
households are not using
heartworm preventatives.*
*DVM Newsmagazine, July 2002.
Testing for
Heartworm only
is not enough!
Introducing a new
concept in screening:
“The Parasitic
Disease Screen”
Test for Lyme, E. canis
and Heartworm Disease.
Why screen for
these diseases?
Why not just test
dogs you suspect
are infected?
If you’re not testing,
you won’t find it!
Screening is essential. You
already screen for heartworm
disease on a regular basis, why
not maximize your evaluation?
Screen for Lyme and Ehrlichia too.
Be your own epidemiologist!
Know the threat of these diseases
in your patient population.
Early detection allows for
early intervention.
FACTS:
• The #1 clinical sign of these
diseases can be no sign at all.
• Symptoms are vague and
can be misdiagnosed…
Lyme
Disease
Progression
Tick bite to transmission of Borrelia burgdorferi
organism is 24-48 hours. Lyme disease transmission is a
high concern in both spring and fall. In spring, deer ticks
must feed in order to progress from a larvae to a nymph
- and then again - in order to mature into an adult tick.
Clinical Disease - 3 Phases:
Acute
Subclinical
Chronic
Signs
Lab Finding
Duration
Fever,
lethargy, joint
swelling,
arthritis,
shifting leg
lameness
+/- Positive serology
Bloodwork —
unremarkable
Urinalysis —
proteinuria, cells,
7 - 21 days
Signs
Lab Finding
Duration
No symptoms
+ Positive serology
Bloodwork —
unremarkable
1 - 3 years
Signs
Lab Finding
Duration
Shifting leg
lameness,
arthritis,
neurological
signs, renal
failure, cardiac
arrhythmia,
myocarditis
+ Positive
serology
Organ systemspecific
Could be
fatal
casts
Canine
Ehrlichiosis
Disease
Progression
Tick bite to transmission of Ehrlichia canis is 24-48 hours with
incubation period of 1-3 weeks. Vaccines are not available for
E. canis and exposure to E. canis does not provide immunity
from future infection. Re-infection will occur.
Clinical Disease - 3 Phases:
Acute
Signs
Lab Finding
Duration
Fever, anorexia,
lymphadenomegaly, mild
weight loss, edema, and
ocular and nasal
discharge
+/- Positive serology
Thrombocytopenia
Variable leukocyte
counts
7 - 21 days
Lab Finding
Duration
No symptoms
+/- Positive serology
Thrombocytopenia
Variable leukocyte
counts Anemia
40 to 120
days (may
last several
years)
Signs
Lab Finding
Duration
Anemia, depression,
peripheral edema,
chronic weight loss,
bleeding tendencies,
abdominal
tenderness, anterior
uveitis, retinal
hemorrhages,
seizures, arthritis
+/- Positive serology
Thrombocytopenia
Variable leukocyte
counts
Neutropenia due to
secondary bacterial
infections
Pancytopenia
Hyperglobulinemia
Lymphocytosis (often
mimicking lymphocytic
leukemia)
Subclinical Signs
Chronic
Could be
fatal
Can a dog be
infected with
Lyme disease,
E. canis and
Heartworm
all at once?
What’s the defense
against these
deadly diseases?
Early Detection
Prevention
Client Education
The Parasitic Disease Screen
The Canine SNAP® 3DxTM Test is the fastest, easiest
and most accurate way to screen dogs simultaneously
for Lyme, E. canis, and heartworm disease:
• 3 diagnostics
• Differentiation between vaccinated and naturally infected animals
• Experts agree to routinely test for E. canis, Lyme and Heartworm
All dogs
should have an
annual Parasitic
Disease Screen.
Why?
TRUTH IS:
• Lyme vaccinations are not 100% effective.
• Dogs cannot clear Lyme infections on
their own.
• Tick preventatives are not 100% effective.
• Ticks in the nymph stage are hard to see.
• The most common sign of these diseases are
no signs at all.
• Heartworm, Lyme and E. canis can have
devastating clinical outcomes.
Don’t wait
for the
disease
to test.
• SICK DOG TESTING
Awaiting clinical disease and
sending off for confirming diagnosis?
• TIME
Is the lag time to results excessive?
• ACCURACY
Do you understand the limitations of
traditional testing methods?
• SUBJECTIVITY
Do results depend on who is reading
the tests?
Awaiting clinical disease
and then testing?
With SNAP® 3DxTM you’ll
have the results in 8 minutes,
allowing you to keep the dog
in clinic and treat immediately
if necessary.
Know for sure.
Know right now.
What are the drawbacks
with the way you may
be testing now?
Sample #
Disadvantages of current assays:
IFA
Specificity is poor, resulting in
questionable results.
Disadvantages
• Sick Dog Testing
• Time
• Accuracy
• Subjectivity
Laboratory A Titer
Laboratory B Titer
4453
1:1600
1:320
8946
1:1600
1:1280
1:100
2212
1:1600
1:640
1:400
1:2560
1:400
0367
Dr. Johnny Hoskins, 2000
>
=
1:3200
Laboratory C Titer
>
=
1:3200
Know for sure.
Know right now.
What are the drawbacks
with the way you may
be testing now?
Dog A
Dog B
Disadvantages of current assays:
Western Blot
Used to distinguish between vaccinated
dog and infected dog BUT is highly
subjective, costly and takes 3-7 days
to run.
Disadvantages
•Sick Dog Testing
•Time
•Accuracy
•Subjectivity
Vaccines generate numerous bands on the Western
Blot, obscuring the ability to interpret the bands
needed to determine exposure/infected status.
Why should you
use SNAP® 3DxTM
as an annual
screening tool?
The test is sensitive, quick and easy.
Here are some factors to consider…
• Early detection means intervention can begin earlier.
• Currently available Lyme vaccines don’t interfere with
the Lyme test results of SNAP® 3DxTM by screening.
• One blood sample yields three test results
- quickly, accurately and economically.
• By screening for Lyme disease and E. canis at the
same time that you test for Heartworm Disease, you will
increase the value of the annual visit for your clients.
Benefits
of testing
in-house with
SNAP® 3DxTM
• Early detection allows for
early intervention.
• The test allows you to begin
follow-up diagnostics immediately.
• Clients are willing to pay
more for immediate results.
• Your clients want to know
which means better client
satisfaction.
• You can use the time while the test
is running to offer other
products/services - 8 minute
consult.
• You don’t have to call clients
with results or spend time filing
results from lab, which saves
you time and money!
How does
SNAP® 3DxTM work?
Only the SNAP® test offers gold-standard
ELISA technology in an in-clinic format.
Easy to interpret and more sensitive due to
its unique wash step and signal amplifier
The Lyme
Diagnostic
The Technology Lyme Disease
C6 identifies infection
C6 wanes post-treatment
C6 doesn’t cross-react with
currently available vaccines
SNAP® 3DxTM makes all the difference because
the revolutionary C6 ELISA technology is unique.
With all of the advantages of C6 diagnostic technology,
you can identify Lyme infection in clinically and subclinically infected dogs by using the SNAP® 3DxTM test.
Recommended
protocol for
Lyme disease
The SNAP® 3DxTM peptide distinguishes between patients that are
infected from those that are only vaccinated. Whole cell antibody titers
determined by IFA do NOT distinguish between patients that have been
infected, treated or vaccinated. Western blot results are inherently
subjective and cannot reliably distinguish infection from exposure.
Lyme Disease Result
Positive Result
Negative Result
Without
Clinical Signs
With
Clinical Signs
Without
Clinical Signs
With
Clinical Signs
• Patient has
been infected
with
B. burgdorferi*
• Consider
empiric
treatment with
doxycycline or
an alternative
antimicrobial
• Monitor patient
for
development of
clinical signs
• Review tick
control protocol
• Patient has
been infected
with
B. burgdorferi*
• Treatment with
doxycycline
(or an
alternative
antimicrobial is
indicated)
• Monitor clinical
response to
treatment
• Review tick
control protocol
• Patient is
not
infected
• Treatment
is not
indicated
• Lyme
infection
is unlikely;
pursue an
alternative
diagnosis
• Retest with
SNAP®
3DxTM test
after one
month. Dog
may not
have
developed
a detectable
serum titer
* Philipp M., et al. Antibody response to IR6, a conserved immunodominant region of
the VIsE lipoprotein, wanes rapidly after antibiotic treatment of Borrelia burgdorferi
infection in experimental animals and in humans. J. Infect. Dis. 2001;184(7);870-878.
Developed by:
Steven Levy, VMD
Roberta Relford, DVM, MS, PhD, DACVIM, DACVP
Terri Wheeler, DVM
E. canis
Diagnostic
The Technology E. canis
SNAP® 3DxTM uses a highly
accurate peptide-based
screen, for early detection.
• 98.2% specificity for
E. canis exposure
• Early detection is critical
- prognosis is good for
early-stage infection
• Allows for prevention and
proactive monitoring, not
reactive treatment
Recommended
protocol for
Ehrlichiosis
(E. canis)
E. canis Result
Positive Result
Clinical signs†
and laboratory
data** support
ehrlichiosis
Clinical signs†
and laboratory
data** DO NOT
support
ehrlichiosis
Treat & Monitor
Options
• Tetracycline
• Doxycycline
• Imidocarb
• Monitor CBC
for correction
of the
hematologic
abnormalities
(3-6 months)
• Review tick
control
protocol
Suspect subclinical
phase infection.
Monitor CBC every
3-6 months for
consistent
hematologic
changes.
• Educate clients
on risk versus
benefits of
treatment
• PCR
• Recheck normal
bloodwork in 3-6
months
• Review tick
control protocol
Negative Result
Clinical signs†
and laboratory
data** support
ehrlichiosis
Clinical signs†
and laboratory
data** DO NOT
support
ehrlichiosis
Options
No Action
• Serum titer
by
IFA*
• PCR
• Treat
• Closely
Monitor
†
Clinical Signs: Lameness, bleeding (usually petechial and ecchymotic hemorrhages),
lethargy, weight loss, lymphadenomegaly, splenomegaly, anorexia, anterior uveitis,
retinal disease, and/or occasionally neurological signs due to meningitis. ** Laboratory
Data: Anemia, leukopenia, thrombocytopenia, pancytopenia and/or hyperglobulinemia. *
IFA results vary from lab to lab.
Developed by:
Edward Breitschwerdt, DVM, ACVIM, Dean Cornwell, DVM
Dean Basel, DVM, MS, DACVP
Roberta Relford, DVM, MS, PhD, DACVIM, DACVP
Don’t let your
guard down
Now that we have covered the
facts, here is how SNAP® 3DxTM
can protect your clients’ pets
and benefit your business…
Educate your clients
on the importance
of a Parasitic
Disease Screen
“Early detection is the best medicine.”
Educational pieces are available to help
you educate pet owners about the dangers
of Ehrlichiosis, Lyme and Heartworm Disease.
Client Educational Pieces
How can the
SNAP® 3DxTM test
help build your
practice?
Diagnose, Prevent and Treat
Use the SNAP® 3DxTM test to increase the value of
annual testing for your patients and your clinic!
Due to the increased prevalence and awareness
of tick-borne diseases, your clients will
understand the importance and value of
screening and preventatives - not just for
Heartworm - but for tick-borne diseases as well.
By screening three deadly diseases in one blood
sample, your clinic can offer an annual Parasitic
Disease Screen to clients - in just 8 minutes!
What are you
waiting for?
With over 6,000 clinics offering the SNAP® 3DxTM test
to their customers, and over 3 million tests used,
there’s never been a better time to increase the
value of an annual visit.
Better medicine. Better business.
“The test [SNAP® 3DxTM] has definitely increased
revenues in my practice, but more importantly,
we have more satisfied clients, because we can
identify disease states earlier.”
Dr. Fred Metzger, DVM, ABVP
Metzger Animal Hospital, State College, PA