A Survey of Maryland Veterinarians:
Lyme Disease Diagnosis, Treatment, and
Prevention in Canines
Caitlin Cotter, DVM
DHMH PHASE Intern, 2016
Johns Hopkins School of Public Health
Katherine Feldman, DVM
Center for Zoonotic and Vector-borne Diseases
MD Department of Health and Mental Hygiene
Photo credit: CT Veterinary Diagnostic Laboratory
Lyme Disease in MD Canines
 Background
 Clinical Signs & Diagnostics
 ACVIM Consensus Statement
 Study: Survey of Maryland Veterinarians
 Analysis
 Results
 Conclusions
Background
• Lyme disease
• Spirochete bacteria
• Borrelia burgdorferi
• Ixodes ticks
• White-footed mouse
• Humans, Canines
Photo credit: Warde Medical Laboratory, Cary Institute
Clinical Signs/Symptoms
Humans
• 70-80% erythema migrans
“bullseye” target rash
• Flu-like symptoms
• Arthritis, carditis, neurological
disease
Photo credits: borreliaburgdorferi.com, Merck Veterinary Manual
Dogs
• No rash
• Polayrthropathy
• Fever
• Anorexia
• Lyme nephropathy
Diagnostics
Humans
Dogs
• Signs & Symptoms
• SNAP
• Tick exposure history
• EIA / Western Blot
point-of-care
ELISAs
• Quantitative C6 antibody assay
• Other serology, lymphocyte
assays, joint fluid tests not
• Urinalysis
recommended
• Urine protein-creatinine ratio
Photo credits: University of Michigan Medical School, www.lymeinfo.ca
ACVIM Consensus Statement
• Screening for Lyme disease in canines
• Benefits: early detection of Lyme nephropathy, seroprevalence tracking
• Risks: overdiagnosis, overtreatment; poor prediction of clinical disease;
antimicrobial resistance (AMR)
• Treatment of asymptomatic positive dogs
• Unknown: is treatment of seropositive, health dogs beneficial?
• Case-by-case decisions: consider dog breed (shelties, retrievers), AMR
• Vaccination
• Not recommended for seropositive dogs
• Seropositivity indicates tick exposure.
• Check for tick-borne co-infections, evaluation for proteinuria
• Tick control
Survey of Maryland
Veterinarians
• Screening
• How often do you screen dogs for Lyme disease?
• Why do you *Screen annually? *Not recommend annual screening?
• Treatment
• How do you manage asymptomatic, Lyme SNAP-test positive dogs?
• Vaccination
• Is Lyme vaccination mandatory, based on risk, or not performed?
• Follow-Up Testing
• Which follow-up tests do you recommend?
• Is follow-up urinalysis repeated annually?
Analysis
• Descriptive analysis
• Veterinary practice characteristics and location in MD
• Veterinarian preferences
• Diagnosis and prevention of Lyme disease
• Veterinarian beliefs
• Treating SNAP- test positive dogs
• Perception of Lyme disease risk
• Associations between survey variables
Practice Location
Anne Arundel
Maryland county
Montgomery
(n=191)
Baltimore City
Other counties
No.
29
29
18
115
%
15.8%
15.8%
9.8%
58.6%
Practice
Characteristics
Number of vets in
practice (n=180)
Practice type
(n=183)
No.
%
1 to 3
76
3.8%
4 or more
104
57.8%
165
90.2%
11
6.0%
Exclusively small
animal
Mixed animal
Photo Credits: Woodlake Animal Hospital, Redmond Vet Clinic
Veterinarian Perception of
Canine LD Risk
High Risk
Perception of
risk for canine Moderate Risk
Low Risk
LD (n=191)
Not At Risk
Other
No.
114
71
2
0
4
%
59.7%
37.2%
1.0%
0.0%
2.1%
Use of LD Screening Tests
Screening with
which Lyme
disease test
(n=148)
Photo credits: Idexx, Antech
Idexx SNAP 4Dx
No.
117
%
79.1%
Idexx SNAP 3Dx
12
8.1%
Antech Accuplex panel
17
11.5%
PCR
Other
0
2
0%
1.4%
Frequency of LD Screening
Frequency of
LD Screening
(n=145)
Annually
Only with clinical signs
No screening recommended
Other
No.
145
23
3
19
%
76.3%
12.1%
1.6%
10.0%
Reasons for Annual Screening
%
81.9%
Reason for annual
LD screening
(n=155)
Endemicity of disease
No.
127
Tracking seroprevalence
46
29.7%
Informing dog owners
72
46.5%
(multiple answer
selections possible)
Annual heartworm testing,
with LD test included
Other
60
38.7%
4
2.6%
Photo credit: CDC
Reasons for Not Recommending
Annual Screening
No.
Reason to not recommend
annual LD screening
(n=35)
(multiple selections
possible)
Test does not
diagnose or predict
disease
Overdiagnosis/
overtreatment
Expense of treatment
Antimocrobial
resistance
Unnecessary owner
distress
Other
Photo credit: www.iran-daily.com
17
%
48.6%
14
40.0%
3
8.6%
6
17.1%
6
17.1%
10
28.6%
Follow-Up Diagnostic Testing
If perform follow-up tests, which Quantitative Lyme C6
tests recommended (n=59)
Urinalysis
(multiple answer selections
possible)
Is urinalysis follow-up repeated
annually? (n=60)
No.
%
42 71.2%
38 64.4%
Urine Protein:Creatinine
Ratio
Serum Chemistry/CBC
Other
17 28.8%
Yes
No
32 53.3%
18 30.0%
We do not perform UA for
dogs screening positive
10 16.7%
20 33.9%
4 6.8%
Management of Asymptomatic,
SNAP-test Positive Dogs
Treatment of
asymptomatic
dog screening
positive (n=149)
No.
%
Treat all positive dogs with
antibiotics
Treat the first time screening
positive, then based on
clinical signs
Perform follow-up testing
11
7.4%
55
36.9%
59
39.6%
No treatment or follow-up
without clinical signs
Other
9
6.0%
15
10.1%
Lyme Vaccination
Do you use a
Lyme vaccine
(n=187)
Mandatory, core vaccine
Vaccinate if high risk
No Lyme vaccination
Other
Lyme vaccine
LymeVax, Zoetis
brand used
Recombitek Lyme, Merial
(n=182)
Duramune Lyme combo,
(multiple selections
BI
possible)
Other
%
No.
60
88
4
35
32.1%
47.1%
2.1%
18.7%
39
87
43
21.4%
47.8%
23.6%
25
13.7%
Associations
Treating asymptomatic positive dogs with
antibiotics
Annual
Screening
Photo credit: www.crossingthinice.com
Yes
No
Chi-squared
p-value
Yes
68
78
0.067
No
3
0
Conclusions
• ACVIM recommends weighing benefits and risks of Lyme
disease screening
• 76.3% of veterinarians screen annually
• ACVIM recommends case-by-case decisions: treatment of
asymptomatic positive dogs
• 7.4% veterinarians treat all asymptomatic positives
• 36.9% of veterinarians treat all dogs at first seropositivity
• ACVIM does not recommend vaccinating seropositive dogs
• Majority (79.2%) of Maryland veterinarians recommend Lyme as
core vaccine or recommend if patient at high risk
• 96.9% feel patients are at high risk
• How many are seropositive at time of vaccination?
ACVIM does recommend
• For asymptomatic dogs screening positive:
• Check for tick-borne co-infections,
• Evaluate for proteinuria
• Tick control
Photo credit: Loomis Urinalysis Testing
Next Steps
• More research is necessary
• Is treatment of asymptomatic positive dogs beneficial?
• Are SNAP diagnostic tests beneficial?
• Updated Consensus Statement
• ACVIM
• Screening, treatment: seropositive canines
• Detailed algorithm
• Currently known risks and benefits of treatment
• Various screening and disease stages
Thank You!
• DHMH State Public Health Veterinarian:
• Dr. Katherine Feldman
CZVBD / DHMH Team:
Kim Mitchell
S.B. Wee
Heather Rutz
Mary Armolt
Richard Brooks
Michael King
Andrea Palmer
David Blythe
Lucy Wilson
Shaylee Mehta