Cocker Spaniel Alice was referred to Ian Battersby, Veterinary Internal Medicine Specialist at Davies with a two-week history of tachypnea and intermittent coughing when exercising.

X-rays taken by Alice’s referring practice, Valley Veterinary Surgery in Stevenage, showed a marked infiltrate in the lung parenchyma that called for further investigation.

Given how much of her lung was affected, Alice was surprisingly bright and alert on arrival. Follow-up chest radiographs showed that the infiltrate had progressed, with a severe alveolar-interstitial pattern concentrated in the peripheral lung fields. Inflammatory disease such as eosinophilic bronchopneumopathy was still on the differential list, but the team chose to screen for parasitic disease first, before performing an airway wash. Her clotting times were normal, while a blood antigen test for Angiostrongylus came back positive. Alice was started on Advocate (imidacloprid and moxidectin) and kept in hospital for 48 hours of monitoring, receiving a low dose of dexamethasone to limit the inflammation expected as a heavy worm burden dies off. A ten-day course of fenbendazole was started at the same time; because it is not licensed for Angiostrongylus, it was given with the owner’s consent. Two days later Alice was breathing comfortably and well enough to go home, and her local practice, Valley Veterinary Surgery in Stevenage, will now oversee her long-term parasite prevention plan to make sure she is not reinfected.

Ian Battersby explained that Angiostrongylus infection can cause respiratory signs, as it did for Alice, but that some patients first show signs of a clotting disorder instead, so the parasite belongs on the differential list for any dog with uncontrolled bleeding. Left undiagnosed, the infection can be fatal, yet with prompt treatment dogs like Alice can make a full recovery. He stressed that prevention is better than cure: the best protection is for owners to follow a suitable worming plan agreed with their own vet.