犬猫的蠕形螨病的诊断和治疗-2020版指南（摘要报告）

王帆

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

Background –Demodicosis is a common disease in small animal veterinary practice worldwide with a variety of diagnostic and therapeutic options.

Objectives –To provide consensus recommendations on the diagnosis, prevention and treatment of demodicosis in dogs and cats.  

Methods and materials –The authors served as a Guideline Panel (GP) and reviewed the literature available before December 2018. The GP prepared a detailed literature review and made recommendations on selected topics. A draft of the document was presented at the North American Veterinary Dermatology Forum in Maui, HI, USA (May 2018) and at the European Veterinary Dermatology Congress in Dubrovnik, Croatia (September 2018) and was made available via the World Wide Web to the member organizations of the World Association for Veterinary Dermatology for a period of three months. Comments were solicited and responses were incorporated into the final document.

Conclusions –In young dogs with generalized demodicosis, genetic and immunological factors seem to play a role in the pathogenesis and affected dogs should not be bred. In old dogs and cats, underlying immunosuppressive conditions contributing to demodicosis should be explored. Deep skin scrapings are the diagnostic gold standard for demodicosis, but trichograms and tape squeeze preparations may also be useful under certain circumstances. Amitraz, macrocyclic lactones and more recently isoxazolines have all demonstrated good efficacy in the treatment of canine demodicosis. Therapeutic selection should be guided by local drug legislation, drug availability and. Evidence for successful treatment of feline demodicosis is strongest for lime sulfur dips and amitraz baths.

背景–蠕形螨病是全世界小动物兽医临床中的常见疾病，具有多种诊断和治疗选择。

目标–为犬猫的蠕形螨病的诊断、预防和治疗提供共识指南。

方法和材料-作者担任指导小组（GP）并审查了2018年12月之前的可用文献。指导小组编写了详细的文献综述，并对选定的主题提出了建议。该文件的草案已在美国夏威夷州毛伊岛的北美兽医皮肤病学论坛上（2018年5月）和在克罗地亚杜布罗夫尼克的欧洲兽医皮肤病学大会上（2018年9月）进行了介绍，并已通过万维网提供给世界兽医学会会员组织，为期三个月。征求意见，并将建议纳入最终文献。

结论–在幼犬全身性蠕形螨病中，遗传和免疫因素在发病机理中是起了作用，因此患犬不应该繁育。在成年犬和猫中，应调查导致蠕形螨病的潜在免疫抑制疾病。皮肤深刮是蠕形螨病的诊断金标准，但在某些情况下，毛发检查和胶带粘贴法也可能有用。双甲脒、大环内酯和最新的异恶唑啉在犬的蠕形螨病的治疗中均显示出良好的疗效。治疗方法的选择应以当地药物法规，药物供应情况和具体病例参数为指导。石硫合剂浸泡和双甲脒药浴是成功治疗猫蠕形螨病的最有效证据。

Summary of statements

报告摘要

Consensus Statement 1 In young dogs with generalized demodicosis a temporary immune alteration most likely plays an important role in the pathogenesis. In older dogs, the disease may be associated with an immunosuppressive condition or treatment. However, other hitherto unknown factors also may play a role. In cats, demodicosis is usually associated with other diseases, with the exception of the contagious Demodex gatoi that can also affect otherwise healthy cats.

共识声明1：在幼犬全身性蠕形螨病患犬中，暂时的免疫改变很可能在发病机理中起重要作用。在成年犬中，该疾病可能与免疫抑制疾病或治疗有关。但是，迄今为止其他未知的因素也可能起作用。在猫中，蠕形螨病通常与其他疾病有关，除了具有传染性的蠕形螨病以外，也会影响其他健康猫。

Consensus Statement 2 In young dogs, demodicosis has a genetic basis and most likely multiple genes are involved

共识声明2：在幼犬中，蠕形螨病具有遗传基础，有可能涉及多个基因。

Consensus Statement 3 In dogs, two Demodex species occur, the shorter D. canis and the longer D. injai. In cats, the shorter D. gatoi has a more regional occurrence and different clinical signs than the classical D. cati.

共识声明3：在犬中有两种蠕形螨，犬蠕形螨较短，隐在蠕形螨较长。 在猫中，与传统的猫蠕形螨相比，较短的戈托伊蠕形螨更有区域性且临床症状不同。

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 injai 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。在更严重的患犬中，可能会出现结痂伴有继发性细菌感染和全身症状。犬蠕形螨引起的犬蠕形螨病也可能有瘙痒，尤其是在存在继发感染的情况下。隐在蠕形螨感染多见于㹴犬品种中，并且还会非常油腻。在猫中，猫蠕形螨表现出相似的临床症状，而相比之下，感染了具有传染性的戈托伊蠕形螨经常导致剧烈的瘙痒。

Consensus Statement 5 Deep skin scrapings (currently the diagnostic method of choice), trichograms, tape strips and examinations of exudate may be useful in identifying Demodex mites. More than one mite on any given test is an indication of clinically relevant demodicosis.

共识声明5：皮肤深刮（目前为诊断的首选方法）、毛发检查、胶带粘贴和渗出液检查能帮助找到蠕形螨。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。

Consensus Statement 6 Dogs with generalized demodicosis and their parents should not be bred.

共识声明6：全身性蠕形螨病患犬及其父母不应进行繁育。

Consensus Statement 7 Treatment for generalized demodicosis should be monitored clinically and microscopically every month until the second negative skin scraping. Miticidal therapy should be continued four weeks beyond the second set of negative monthly scrapings to decrease the risk of a disease recurrence.

共识声明7：治疗全身性蠕形螨病，应每月进行临床症状和显微镜检查，直到第二次皮肤刮片为阴性。在第二次皮肤刮片为阴性后，应继续进行杀螨治疗四周，以降低疾病复发的风险。

Consensus Statement 8 In dogs with demodicosis, systemic antibiotics will typically not be needed and topical antibacterial therapy combined with good miticidal agents will be sufficient unless severe bacterial infection is present.

共识声明8：蠕形螨病患犬，通常不需要全身性抗生素治疗，除非存在严重的细菌感染，否则外用抗菌治疗与良好的杀螨剂相结合就足够。

Consensus Statement 9 Weekly amitraz rinses at 0.025–0.05% are effective for canine demodicosis; long-haired animals should be clipped.

共识声明9：每周0.025-0.05％的双甲脒浸泡对犬蠕形螨病有效。长毛动物应剪毛。

Consensus Statement 10 Oral ivermectin at 0.3–0.6 mg/kg daily, moxidectin at 0.3–0.5 mg/kg daily, milbemycin oxime at 1.0–2.0 mg/kg daily and doramectin injected subcutaneously every week at 0.6 mg/kg are effective therapies for canine demodicosis, but an initial gradual dose increase is recommended for systemic moxidectin and ivermectin to identify dogs sensitive to toxicosis induced by those macrocyclic lactones. Topical moxidectin/imidacloprid should be considered for mild-moderate cases of canine demodicosis.

共识声明10：口服伊维菌素每日0.3–0.6 mg / kg，莫昔克丁每日0.3–0.5 mg / kg，米尔贝肟每日1.0–2.0 mg / kg和多拉菌素每周皮下注射0.6 mg / kg是犬蠕形螨病的有效疗法，但是对于全身性使用莫昔克丁和伊维菌素，建议初始剂量逐步增加，以确定患犬是否对大环内酯类敏感中毒。轻度-中度犬蠕形螨病应考虑外用莫昔克丁/吡虫啉。

Consensus Statement 11 A number of studies have evaluated the efficacy of isoxazolines for canine demodicosis in pet dogs. The published data are very encouraging and make this drug class an excellent treatment option for dogs with demodicosis.

共识声明11：大量研究评估了异恶唑啉类对犬蠕形螨病的功效。公开的数据非常令人鼓舞，并使该类药物成为蠕形螨病患犬的绝佳治疗选择。

Consensus Statement 12 Demodicosis in cats may be treated with weekly lime sulfur dips at a concentration of 2% or amitraz baths at a concentration of 0.0125%. An easier alternative may be weekly administration of a spot-on containing moxidectin/imidacloprid.

共识声明12：猫的蠕形螨病可以每周用浓度为2％的石硫合剂浸泡或浓度为0.0125％的双甲脒溶液药浴。更简单的替代方法是每周一次外用含莫昔克丁/吡虫啉的滴剂。