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标题: 犬猫的蠕形螨病的诊断和治疗-2020版指南（症状、诊断） [打印本页]
作者: 王帆 时间: 2022-6-29 08:50
标题: 犬猫的蠕形螨病的诊断和治疗-2020版指南（症状、诊断）
本帖最后由 王帆 于 2022-6-29 08:50 编辑
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Diagnosis and treatment of demodicosis in dogs and cats
犬猫的蠕形螨病的诊断和治疗
Clinical consensus guidelines of the World Association for Veterinary Dermatology
世界兽医协会皮肤病临床治疗指南
翻译：蔡欢 校对：王帆
4 Clinical signs in dogs
4犬的临床症状
In the dog, localized and generalized forms of demodicosis were differentiated on the basis that the vast majority of dogs with localized demodicosis went into spontaneous remission without treatment. However, the definition of localized demodicosis is subjective and thus different presentations are judged differently by different breeders and veterinarians. The reported lesion extent consistent with localized disease ranges from four lesions to 50% of the body surface. It is unknown whether the size of a lesion considered localized is influenced by the size of the dog or whether an area with inflammatory lesions such as papules, pustules, exudation, crusting and ulcers is comparable to an area characterized only by alopecia and comedones. This may make the differentiation of localized from generalized disease difficult in some individual cases.
在犬中，局灶性蠕形螨病和全身性蠕形螨病的形式有所不同，其依据是绝大多数局灶性蠕形螨病患犬未经治疗即可自愈。但是，局灶性蠕形螨病的定义是主观的，因此不同的繁育者和兽医对不同的表现形式有不同的判断。报告的病变程度与局部疾病一致，范围从4个病变到50％体表面积。尚不清除局部病变的大小是否受犬的大小影响，也不清楚炎性病变如丘疹、脓疱、渗出物、结痂和溃疡，是否与仅以脱毛和粉刺为特征的区域相类似。在某些病例中，这可能使区分局部疾病和全身性疾病变得困难。
Clinical signs develop after mite proliferation has occurred; they depend on the degree of mite proliferation. Initially, there may be a noninflammatory hypotrichosis/ alopecia and/or an inflammatory dermatitis with mild erythema, comedone formation, scaling and associated hypotrichosis/ alopecia (Figures 1 and 2). The lesions may be focal or multifocal to coalescing involving large areas of the body. Follicular plugging, dilation and hyperpigmentation of hair follicular ostia may be present and when seen are a clinical clue for the disease. Pedal demodicosis commonly causes quite marked hyperpigmentation (of both follicles and surrounding skin) and may present with significant interdigital inflammation, oedema and pain (Figure 3). In more inflammatory presentations, follicular-oriented papules may develop. Pruritus is generally not thought to be characteristic of milder presentations; however, it is more common if the short-bodied morphological variant of D. canis is present and/or if secondary bacterial infection develops. Follicular casts (scale adherent to the hair shafts) may be present.
蠕形螨增殖后就出现了临床症状，症状表现取决于螨虫增殖程度。最初，可能会出现非炎性少毛症/脱毛和/或炎性皮肤病，伴有轻度皮肤发红、粉刺形成、皮屑和相关的少毛症/脱毛（图1和2）。病变可能是局灶性或多灶性，可累及全身大面积。在看到毛囊口出现毛囊堵塞、扩张和色素沉着时，可能提示该疾病的临床表现。足部蠕形螨病通常会导致明显的色素沉着（毛囊和周围皮肤），并且可能会出现明显的趾间炎、水肿和疼痛（图3）。在更多的炎症表现中，可能会形成毛囊丘疹。症状较轻时通常不认为会有瘙痒特征。但是，如果存在犬蠕形螨的短体形态时和/或继发细菌感染时，则更常见瘙痒。可能会出现毛囊管型（附着在毛干上的皮屑）。
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Figure 1.Comedones in the perivulval area of a dog with demodicosis. [Colour figure can be viewed at wileyonlinelibrary.com]
图1.蠕形螨病患犬的阴门周周的粉刺。 [图片可在wileyonlinelibrary.com上查看]
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Figure 2.Erythematous and scaly pinna of a dog with demodicosis. [Colour figure can be viewed at wileyonlinelibrary.com]
图2蠕形螨病患犬的皮肤发红和耳廓皮屑。 [图片可在wileyonlinelibrary.com上查看]
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Figure 3.Pododemodicosis in a 1-year-old, male neutered pug with generalized demodicosis. [Colour figure can be viewed at wileyonline library.com]
图3 1岁的雄性已去势患有全身性蠕形螨病的巴哥犬的足部蠕形螨病。 [图片可以在wileyonline library.com上查看]
With more severe or advanced disease (Figures 4 and 5), secondary bacterial infection may lead to follicular pustules, furunculosis with scale, crust, exudation and ulceration with draining tracts. Severe, generalized pustular demodicosis may be painful and associated with hyperpigmentation, lymphadenopathy, lethargy and fever. In those severely affected dogs, septicaemia secondary to bacterial infection is possible and may even have a fatal outcome.
对于更严重或更晚期的疾病（图4和5），继发性细菌感染可能导致毛囊脓疱、疖病伴有皮屑、结痂、渗出液和带瘘道的溃疡。严重的全身性脓疱性蠕形螨病可能会疼痛，并伴有色素沉着、淋巴结肿大、嗜睡和发烧。在严重感染患犬中，可能会出现继发于细菌感染的败血症，甚至可能导致致命的后果。
Demodex injai has been reported in several dog breeds but seems over-represented in terrier breeds and their crosses. Whilst it may be associated with erythema, comedone formation, hyperpigmentation and alopecia, similar to D. canis, the most striking and consistent clinical feature is marked greasiness of the dorsal trunk.
隐在蠕形螨在几种犬种中都有报道，但在㹴犬品种及其杂交犬中似乎更多。虽然可能出现与犬蠕形螨有关的相似的皮肤发红、粉刺形成、色素沉着和脱毛表现，但最显着的临床特征是躯干背部明显的油腻感。
Environmental factors such as a high humidity and ambient temperature are anecdotally discussed as leading to more severe clinical signs in the dog, although no scientific studies have been conducted to confirm this statement.
环境因素，例如高湿度和环境温度传闻会导致犬的临床症状更为严重，但没有进行科学研究来证实这一说法。
5 Clinical signs in cats
5猫的临床症状
Demodex cati can cause localized or generalized disease and lesions include erythema, hypotrichosis/alopecia, scale and crusting (Figure 6). Pruritus is variable but may be intense in some individuals. Generalized disease commonly is associated with an underlying disease such as feline immunodeficiency virus, xanthoma or diabetes mellitus. In some cats, no other disease may be identified. Demodex mites also have been reported to proliferate within the scaly alopecic lesions of Bowenoid in situ carcinoma (BISC).
猫蠕形螨可引起局部或全身性疾病，病变包括皮肤发红、少毛症/脱毛、皮屑和结痂（图6）。瘙痒程度多样，但在某些病例中可能很严重。全身性疾病通常与潜在疾病相关，例如猫免疫缺陷病毒、黄瘤或糖尿病。在某些猫中，没有发现其他疾病。还据报道蠕形螨在鲍氏原位癌（BISC）的皮屑脱毛病变中有增殖。
Demodex gatoi is a contagious mite that inhabits the stratum corneum (like Sarcoptes) and the most common clinical feature is pruritus ranging from mild to very intense. Skin lesions aside from self-induced alopecia and scale (Figure 7) are secondary hyperpigmentation, superficial erosion and ulceration. The changes predominantly are truncal with the ventral abdomen having been reported as a site of predilection.
戈托依蠕形螨是一种传染性螨虫，它生活在皮肤角质层（如疥螨属），最常见的临床特征是瘙痒，程度从轻度至非常强烈。皮肤病变除自损性脱毛和皮屑外（图7），也有继发性色素沉着、表面糜烂和溃疡。该变化主要发现在躯干部，据报道腹部是易感部位。
Consensus Statement 4 Demodicosis in dogs is characterized by alopecia and comedones, follicular casts, papules and pustules. In more severely affected dogs crusting with secondary bacterial infections and systemic signs may develop. Dogs with demodicosis due to D. canis also can exhibit pruritus, especially when secondary infection is present. Demodex injae occurs more often in terrier breeds and additionally causes excessive greasiness. In cats, D. cati shows similar clinical signs, whereas by contrast infestations with the contagious D. gatoi often lead to truncal pruritus.
共识声明4：犬蠕形螨病的特征是脱毛和粉刺、毛囊管型、丘疹和脓疱。在严重感染患犬中，可能会出现结痂伴有继发性细菌感染和全身症状。感染犬蠕形螨的蠕形螨病患犬也可能出现瘙痒症，尤其是在存在继发感染的情况下。隐在蠕形螨在㹴犬中更常见，此外导致非常油腻。在猫中，猫蠕形螨表现出相似的临床症状，而相比之下，具有传染性的戈托伊蠕形螨的感染经常导致剧烈瘙痒。
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Figure 4. Pustular demodicosis on the ventrum of a dog with generalized demodicosis. [Colour figure can be viewed at wileyonlinelibra ry.com]
图4.一只全身性蠕形螨病患犬的腹侧脓疱性蠕形螨病。 [图片可以在wileyonlinelibra ry.com上查看]
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Figure 5. Severe facial demodicosis in a dog. [Colour figure can be viewed at wileyonlinelibrary.com]
图5.一只严重的面部蠕形螨病患犬。 [图片可在wileyonlinelibrary.com上查看]
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Figure 6. Demodicosis caused by Demodex cati in an 8-year-old female spayed domestic short-haired cat with lymphoma. [Colour figure can be viewed at wileyonlinelibrary.com]
图6.一只患有淋巴瘤的8岁雌性已绝育家猫，猫蠕形螨感染引起的蠕形螨病。[图片可在wileyonlinelibrary.com上查看]
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Figure 7. Alopecia due to Demodex gatoi in a DSH. [Colour figure can be viewed at wileyonlinelibrary.com]
图7. 一只DSH中由于戈托伊蠕形螨引起的脱毛。[图片可在wileyonlinelibrary.com上查看]
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Figure 8. Debris gathered with a deep skin scraping. [Colour figure can be viewed at wileyonlinelibrary.com]
图8.皮肤深刮获得的皮肤组织碎片。[图片可在wileyonlinelibrary.com上查看]
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Figure 9. Demodex canis mites in a skin scraping (×100). [Colour figure can be viewed at wileyonlinelibrary.com]
图9.皮肤刮片中的蠕形螨成虫（100倍放大）。[图片可在wileyonlinelibrary.com上查看]
6 Diagnosis
6诊断
6.1 Deep skin scrapings
6.1皮肤深刮
Deep skin scrapings are considered to be the diagnostic tool of choice in most patients with suspected demodicosis. Samples may be collected with curettes, spatulae, sharp or dull scalpel blades. Placing a drop of mineral oil on the sampling instrument or directly on the skin is helpful for better adherence of the sampled debris to the instrument. Multiple scrapings of approximately 1 cm 2 of affected skin should be performed in the direction of the hair growth and importantly the skin should be squeezed constantly or intermittently during scraping to extrude the mites from the depth of the follicles to the surface. Squeezing the skin has been shown to increase the number of mites found. Primary lesions such as follicular papules and pustules should be selected in order to obtain the best yield. If at early onset papules and pustules are not present, erythematous, alopecic areas should be chosen. Ulcerated areas are not suitable as it is less likely to find parasites in such areas. The skin is scraped until capillary bleeding occurs indicating sufficient depth of the scraping. The gathered debris should be of reddish to brownish colour, indicating sufficient material (Figure 8). If necessary in a long- or medium-haired dog, lightly clipping the area to be scraped (in the direction of hair growth) will minimize the loss of the scraped material into the surrounding hair. Debris then is transferred to a slide, mixed with mineral or paraffin oil and examined with a cover slip under the microscope at low magnification (overall ×40 or×100). Recognition of mites is easier with a lowered microscope condenser and decreased light to increase the contrast in the microscope field (Figure 9). Specimens should be evaluated immediately, as anecdotally mite deterioration may occur making accurate identification of numbers and stages more difficult with time.
皮肤深刮被认为是大多数疑似蠕形螨病患动物的诊断工具。可以用刮匙，刮铲，锋利或钝的手术刀刀片采集样品。将一滴矿物油放在采样器上或直接放在皮肤上，有助于更好地将采样的碎屑粘附到载玻片上。应在顺着毛发生长的方向上多次刮擦大约1 到2 cm 大小的患处皮肤，重要的是刮取过程中应不断或间断的挤压皮肤，以将螨虫从毛囊深处挤出到皮肤表面。已经表明，挤压皮肤会增加螨虫发现的数量。应选择原发性病变，例如毛囊脓疱和脓疱，以获得最佳样本。如果早期不出现丘疹和脓疱，应选择红斑，脱毛区域。溃疡区域不适合，因为在此类区域很少发现寄生虫。刮擦皮肤直至出现毛细血管出血，表明刮擦深度足够。聚集的碎片应为红至棕褐色，表明有足够的物质（图8）。如有必要，在长毛或中毛犬中，轻轻修剪要取样的区域（在毛发生长的方向上）的毛，可以将刮取后的样本因附着到周围毛发上的损失降至最低。然后将样本转移到载玻片上，与矿物油或石蜡油混合，盖上盖玻片并在显微镜下以低倍数（总体×40或×100）检查。降低显微镜的聚光镜和减少光线以增加显微镜视野的对比度，可以更轻松地识别蠕形螨（图9）。应立即评估样本，因为蠕形螨形态可能会发生改变，随着时间增加，准确鉴定数量和阶段会变得困难。
As Demodex mites are part of the normal microfauna, one mite identified on several deep skin scrapings could be a normal but uncommon finding. However, more than one mite is strongly suggestive of clinical demodicosis. If only one mite is found in a dog with compatible clinical signs, further skin scrapings should be performed to confirm the diagnosis. Different life stages (eggs, larvae, nymphs and adults) and their numbers should be recorded and compared from the same sites at each visit to objectively measure the treatment success.
由于蠕形螨是体表正常微动物的一部分，因此在数个深层皮肤碎屑上发现一个螨虫可能是正常但不常见的发现。然而，不止一个螨虫则强烈提示临床蠕形螨病。如果在具有相适应的临床特征的犬中仅发现一只螨虫，则应进行进一步皮肤刮片以确认诊断。每次复查时，应记录并比较来自同一部位的不同生命阶段（卵，幼虫，若虫和成虫）的蠕形螨及其数量，以客观地衡量治疗效果。
6.2 Trichograms
6.2毛发镜检
Trichograms have been reported as an alternative to deep skin scrapings and are particularly useful in areas that are difficult to scrape, such as periocular and interdigital areas. An area of 1 cm2 should be plucked with forceps in the direction of the hair growth and placed in a drop of mineral or paraffin oil on a slide. The use of a coverslip greatly facilitates thorough and rapid inspection of the specimen (Figure 10). To increase the chance of a positive trichogram, a large number of hairs (50–100) should be plucked, if possible. When performed properly, trichograms have a high diagnostic yield. However, negative trichograms should be followed by deep skin scrapings before ruling out demodicosis. Positive trichograms in healthy dogs are rare.
据报道，拔毛镜检可以替代皮肤深刮，并且在难以刮擦的区域（例如眼周和指间区域）特别有用。应使用镊子顺着毛发生长的方向拔除1平方厘米的区域，并将其放在载玻片上的一滴矿物或石蜡油中。盖玻片的使用极大地方便了样品的全面和快速检查（图10）。如果可能的话，为了增加出现病变毛发的机率，应拔除大量的毛发（50–100根）。如果操作得当，拔毛镜检的检出检出率很高。但是，在排除蠕形螨病之前，进行皮肤深刮同时应进行拔毛镜检。健康犬中的病变毛发很少见。
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Figure 10. Demodex canismites in a trichogram. [Colour figure can be viewed at wileyonlinelibrary.com]
图10.拔毛镜检中的蠕形蠕。 [图片可在wileyonlinelibrary.com上查看]
6.3 Tape strips (“Scotch tapeTM tests”)
6.3胶带（“ 胶带粘贴法”）
Tape strips also have been reported as an excellent diagnostic method for canine demodicosis. While squeezing the skin, the acetate tape is pressed onto the skin with the sticky surface down. Although this technique initially was reported to be more sensitive than deep skin scrapings, follow-up studies have shown contradicting results.
胶带粘贴法也已被报道为犬蠕形螨病的极佳诊断方法。挤压皮肤时，将醋酸纤维胶带以粘性表面朝下的方式压在皮肤上。尽管最初报道该技术比皮肤深刮更敏感，但后续研究显示出相反的结果。
6.4 Skin biopsy (histopathological investigation)
6.4皮肤活检（组织病理学检查）
In some rare cases, skin scrapings, trichograms and tape preparations may be negative and skin biopsies for histopathological investigation may be needed to detect the Demodex mites in the hair follicles or in foreign body granulomas observed as a consequence of furunculosis. This may be more likely in certain body locations such as the paws and certain breeds such as the shar-pei.
在某些罕见的情况下，皮肤刮片，拔毛镜检和胶带粘贴可能是阴性的，可能需要进行组织病理学检查的皮肤活组织检查，以检测毛囊中的蠕形螨或由于疔疮而观察到的异物性肉芽肿。这在某些身体部位（例如爪子）和某些品种（例如沙皮犬）中更容易发生
6.5 Other methods of mite detection
6.5其他的蠕形螨虫检测方法
Direct examination of the exudate from pustules or draining tracts may reveal mites in some cases. Specimens can be collected by squeezing the exudate onto a glass slide, and visualized by adding mineral oil and a coverslip. In one study, exudate was collected from dogs showing exudative lesions with the blunt side of a second scalpel blade after gently removing the crusts and squeezing the lesion. In this particular study, the exudate sampling was compared to deep skin scrapings and trichograms and was positive in all dogs sampled. However, this technique is only possible in dogs with more severe forms of demodicosis.
在某些情况下，直接检查脓疱或瘘道中的渗出物可能会发现螨虫。可以通过将渗出物挤压到载玻片上来收集样本，并通过添加矿物油和盖玻片进行显微镜观察。在一项研究中，从犬身上的病变处，轻轻去除结痂并挤压病灶，用手术刀刀片的钝边收集渗出性病变物。在这项特殊的研究中，将渗出物样本与皮肤深刮和拔毛镜检进行了比较，在所有采样中均为阳性。但是，这种技术仅在患有严重蠕形螨病的犬中才可行。
Cytological specimens stained with commercial Romanowsky stains, such as Diff Quik, also may reveal Demodex mites (more easily recognized with the condenser lowered for searching). Although this is not a very sensitive method for the diagnosis, it is not uncommon to find mites on the evaluation of cytological samples of dogs with exudative forms of demodicosis.
用商品罗曼诺夫斯基染色剂（例如Diff Quik）染色的细胞学标本也可能会检出蠕形螨（较低的聚光器下进行搜索更容易识别）。尽管这不是非常敏感的诊断方法，但在评估具有渗出性的蠕形螨病的犬的细胞学样本时发现螨虫并不少见。
Faecal flotation was evaluated for diagnosis of canine and feline demodicosis and was reported to yield less mites than skin scrapings and be frequently false-negative.
皮屑漂浮法可用于诊断犬猫蠕形螨病，据报道其螨虫检出率少于皮肤碎屑，并且经常为假阴性
Consensus Statement 5
共识声明5
Deep skin scrapings (currently the diagnostic method of choice), trichograms, tape strips and examinations of exudate may be useful in identifyingDemodexmites. More than one mite on any given test is an indication of clinically relevant demodicosis
皮肤深刮（目前为诊断的首选方法），拔毛镜检，胶带粘贴和渗出液检查可能对识别蠕形螨种类很有帮助。在任何给定的检查方法中，发现超过一个螨虫是临床确定感染蠕形螨病的指征。
6.6 Diagnosing bacterial infections
6.6诊断细菌感染
Frequently, generalized demodicosis is associated with secondary bacterial infections. Particularly in severe cases involving furunculosis, a bacterial septicaemia is possible. When clinical signs of possible bacterial infection such as pustules or draining tracts are present, an impression smear should be obtained, stained and evaluated for an increased number and/or intracellular location of bacterial organisms. Most commonly,Staphylococcus pseudintermediuswill be present, but in some patients, particularly those with furunculosis, Gram-negative rods such asEscherichia coliorPseudomonas aeruginosamay dominate. For these cases, a culture and susceptibility testing is indicated.
通常，全身性蠕形螨病与继发性细菌感染有关。特别是在严重的疖结病例中，细菌败血症是可能的。当可能存在细菌感染（例如脓疱或瘘道）的临床特征时，应制作压印涂片，进行染色并评估细菌生物的数量和/或细胞内感染。最常见的是会出现假性葡萄球菌，但在某些患者中，特别是在患有疖结病的患者中，革兰氏阴性菌如大肠杆菌或铜绿假单胞菌可能占主导。对于这些情况，需要进行菌种鉴定和药敏试验。
6.7 Breeding considerations
6.7育种注意事项
Canine generalized demodicosis is a relatively frequent and often very severe parasitic skin disease. As many as 0.58% of the dogs in the USA suffer from the generalized form of the disease. Multiple risk factors are involved in the development of canine demodicosis and one of the most important recognized risk factors is breed predisposition. Juvenile demodicosis is more common in purebred dogs of particular breeds. Selective breeding in order to obtain a certain set of desired characteristics in a particular breed can lead to a reduction of genetic variation within a breed. This may facilitate the clinical expression of recessive genes and in turn can result in a greater susceptibility to certain diseases.
犬全身性蠕形螨病是一种相对常见且通常非常严重的寄生虫性皮肤病。在美国，多达0.58％的犬普遍患有这种疾病。犬蠕形螨病的发展涉及多种危险因素，最重要的公认危险因素之一是品种易感性。在特定品种的纯种犬中，幼年病害更为普遍。为了在特定品种中获得所需的特定特征而进行的选择性育种可以导致品种内遗传变异的减少。这可以促进隐性基因的临床表达，进而可以导致对某些疾病的更高的易感性。
Knowledge about breed predispositions for certain diseases such as demodicosis is useful not only while creating a list of differential diagnoses and when advising clients which breed to purchase, but also when advising breeders. Implementing appropriate prophylactic strategies can markedly reduce the prevalence of generalized juvenile demodicosis in the dog. Excluding bitches from breeding that have given birth to puppies with demodicosis will lead to a prominent decrease of puppies affected with demodicosis. As early as 1981, the American Academy of Veterinary Dermatology adopted a resolution recommending “neutering all dogs who have had generalized demodicosis so that the incidence of the disease is decreased and not perpetuated”. We recommend that affected dogs or their parents should not be used for breeding. One report recommended that the need to use acaricidal therapy was a determining factor for the exclusion of dogs from breeding, given the advent of isoxazolines used for ectoparasite control, this recommendation is difficult to maintain. It is the consensus of the authors to recommend that dogs with generalized demodicosis and their parents not be bred until further studies are evaluated regarding the impact of isoxazolines.
有关某些疾病（如蠕形螨病）的品种易感性的知识，不仅在创建差异诊断列表以及在为要购买品种犬的客户提供建议，而且为育种者提供的信息都非常有用。实施适当的预防策略可以显着降低犬中全身性幼年犬蠕形螨病的患病率。将繁殖出患有蠕形螨病幼犬的母犬排除在繁殖之外将导致患蠕形螨病的幼犬显著减少。早在1981年，美国兽医皮肤病学会就通过了一项决议，建议“对所有患有全身性蠕形螨病的犬进行绝育，以减少这种疾病的发生率并使其淘汰”。我们建议不要将受感染的犬或其父母用于繁殖。一份报告建议使用杀螨剂治疗是将犬排除在繁殖之外的决定因素，考虑到用于体外寄生虫控制的异恶唑啉的问世，这一建议难以维持。作者们一致建议，在没有对异噁唑啉的影响进行进一步研究评估之前，不要饲养患有全身性蠕形螨病的犬及其父母。
Consensus Statement 6
共识声明6
Dogs with generalized demodicosis and their parents should not be bred.
患有全身性蠕形螨病的犬及其父母不宜饲养。
作者: 曾医生 时间: 2022-11-24 07:16
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