Treating Ringworm in Shelter Settings The Fungus Among Us

Treating Ringworm in Shelter
The Fungus Among Us
Who we are
Michael Keiley
Dr. Pamela Wilmot DVM
Noble Family Animal Care and Adoption Center
MSPCA at Nevins Farm
400 Broadway
Methuen, MA
A bit about our shelter
• 19,000 sq. ft building built opened November 7th, 2004
• Open admission shelter taking in about 6,000 animals a year
• About 2300 cats a year
• Between 40-50% of cats are “stray”
• 87.6% adoption rate for cats
• 1 full time veterinarian, 1 full time tech and 1 part time tech
What we will be talking about today
• The goals of this presentation
• Not to try to convince everyone to treat
• Challenge euthanasia protocols
• The concerns and risks of treating ringworm
• The realities of treatment
• Cases we have treated
• How to treat ringworm
• Other tips we have learned
• Can you treat ringworm?
Concerns about ringworm
What makes us fear ringworm?
• Staff can catch it
• There will be an outbreak throughout the shelter
• The public will get it
• You’ll have to shut down your shelter/intake
• You have to treat your whole population preemptively
The reality of the risk…
Athlete’s face
The Realities of the risk
• Ringworm comes in and out of your shelter without you ever knowing
• The most likely time for ringworm to spread is before you even know
you have it
• Not all staff or animals will catch it even with direct exposure
The realities of treatment
• You DO NOT have to treat your whole population as a precaution
• You DO NOT have to shut down your shelter/intake
• It IS labor intensive
• It IS unpleasant for the staff
• You DO have to commit the space to quarantine the animals
Cases we have
treated…”the big one”
First big case – May 2008
45 exotic cats and two
boring old DSH cats
Devon Rex, Ragdoll,
Siamese, Sphynx, Himalayan
30 adults and 17 kittens
ranging from 2 weeks-4mos
Ringworm, URI, Ear mites,
conjunctivitis, giardia
Challenges with
Shelter was full
Not equipped to quarantine 47 cats
Animals had to be housed in groups for space
Treating multiple medical issues on intake
Animals were surrendered, but multiple
owners involved which made an unclear
High profile case
High interest in adoption
“The big one”
All cats were started on Lime Sulfur dips
immediately after cultures were taken
23 cats tested negative on the first culture 24
cats tested positive
After initial clearing it took 10 months to
clear the last cat
Extremely laborious
“The big one”
• The 24 positive cats started treatment 5/9/08
• 5 cleared on 7/10/08(3 cultures)
• 1 cleared on 7/14/08(3 cultures)
• 5 cleared on 8/7/08(3 cultures)
• 3 cleared on 8/30/08 (4 cultures)
• 3 cleared on 11/4/08(4 cultures)
• 2 cleared on 3/9/09 (6 cultures)
Additional cases - Milly and Kittens
Milly and kittens – December 2010
• Mother cat and 7 kittens (5-6 weeks old)
• Lesions on feet and face (initially looked like hair loss from messy
eating of canned food)
• Treatment started 12/9/10
• Treatment ended 1/20/11
• Total treatment days: 42 days
Challenges with
Shelter was full
Isolation spaces unavailable
Makeshift isolation space had to be created
Animals had to be housed in groups
Kittens were nuts!!
Group of four, eight week old kittens
• Started treatment on 9/30/11
• Treatment ended 12/1/11
• Total treatment days:62 days
Challenges for treatment
• Quarantine space available, but could not separate
• Initial diagnosis determined while in foster care
• Foster home initially tried to treat but later needed to be absorbed
into shelter
• Maintaining socialization, enrichment in isolated space
• Single 8 week old kitten
• Started treatment: 7/7/2011
• Treatment ended: 9/26/11
• Total treatment days:81 days
• Why wasn’t this one easy!!??
• Tested positive on 3 consecutive cultures
Other tips we have learned
• Be sure everyone has bought in to the plan
• Be fair – share treatments
• Stay the course – do not stop treating until you get 2 negative
• Its ok to throw it away
• Don’t forget the enrichment
Can you treat ringworm?
• You never know until you try
• Best if you are a shelter vs. a foster home
• Best if you have a committed quarantine space
Ringworm Considerations
• Mandatory factors when considering to treat:
Need to work closely with a veterinarian
Look at cost and capability of shelter
Fungal culture in-house or lab
Quarantine ability
Personnel ability (and time for daily/ weekly care)
Ability to care for a potentially long-term zoonotic animal.
May get URI during the treatment period.
Ringworm Considerations
• Can be treated successfully in the shelter with proper
quarantining, disinfecting, and treatment procedures
• Zoonotic. Animal must be isolated, and must wear protective
clothing at all times.
• Foster. Consider person’s immunity, family, lifestyle, living
arrangement. Will need to consider the foster person’s house
contaminated and remove them from the foster pool.
Ringworm –
Microsporum Canis
Occurs in all mammals
Incubation period 1-3 weeks
Fungus grows in the hair follicles and hair shafts
Outside of shelter, can be self-limiting
Susceptible in young, immunosuppressed, debilitated, or
previously unexposed animals
• Presentation of hair loss highly variable
• Some environments can’t be decontaminated
Ringworm - Diagnosis
• Work closely with a veterinarian for diagnosis and treatment
• Woods lamp – let warm up for a few minutes. Bright green apple glow
(not all cases)
• Glows on entire hair shaft and base
• Don’t confuse with yellow glow
from surface debris
• If not sure, always quarantine
and culture
Ringworm - Diagnosis
• Direct exam (if experienced): spores on hair,
mineral oil or KOH prep
• Fungal culture: in-house or Lab
- In-house 7-10 days in 80 degree temp.
- Lab may wait up to 25-30 days to post final results
• Culture at 4 weeks and once/week until negative culture.
• If multiple cats per cage, need 2 consecutive negative cultures
from each cat.
Ringworm - Diagnosis
• For localized lesion, use sterile hemostat to pluck hairs and
press into medium
• For generalized, use “toothbrush” method – use individually
packaged toothbrush or packaged dry surgical scrub brush
• Brush cat all over 30-50
strokes (head, back, legs,
tail), combing lesions
Ringworm - Diagnosis
• Gently press into medium in several locations
• Do not press so hard into medium as to crack the gel =>
• The growth in the cracks
makes transfer to a slide difficult.
• 7-10 days at 78-80 degrees
2-3 weeks at room temperature
• Red color change with white
cottony flat growth.
• Spore ID: magic tape, clear double sided.
Press onto fungus, then onto drop of stain
Lactophenol blue or Dipquick (stain #3)
purple stain on slide.
Spore Identification
Microsporum Canis
• Scan slide at 10X. Use 40X for closer evaluation
• Cigar shaped colonies
with more than 6 cells
• Spines along wall
Spore Identification –
• Aspergillus
Starburst on a stick
• Penicillium
Brush like appearance
Spore Identification –
• Alternaria
• Fungal hyphae
not present yet)
Ringworm - treatment
• Always must wear protective gloves and clothing!!
• Change clothes
• Throw away items in cage or soak in bleach, minimum
contact time 10 minutes
• Clean and remove hair from environment daily
• Cats may get URI during the treatment period
Ringworm - Cleaning
• When animal is present, bleach 1:32 dilution. Contact time 15
• When cage empty, bleach 1:10 dilution. Contact time 10
• Trifectant, Nolvasan, Virkon-S have not been shown to be
effective for ringworm
• Dishes & other washable items can be run through the
dishwasher provided water temp reaches at least 110 F.
Ringworm – Treatment
• For solitary lesion not on face, if oral is not tolerated, or oral
treatment not ideal (FELV/FIV, other immunosuppressed
animal, geriatric animals)
• Options: Spot-on lime sulfur dip. Topical wipes: Chloraseb
(miconazole), Mal-a-ket (ketoconazole), Malaseb (miconazole)
• OTC Topical antifungal ointment (2% ideal)
Ringworm – Treatment
• Multiple lesions, and /or on the face making local
treatment difficult
• Oral itraconazole
• Lime sulfur dip twice weekly – treats spores on hair.
Follow diluting instructions on bottle. Use e-collar
for 1-2 hours to prevent licking/ ingestion of dip from
Ringworm – Treatment
• Itraconazole 10mg/kg PO SID for 30 + days until a negative
Order 100mg/ml or 50mg/ml from a reputable
compounding pharmacy.
Wedgewood Pharmacy/ NJ: Itraconazole 100mg/ml
$38 for 15 mls. Good for 60 days from date of compounding
• Sporonox 10mg/ml: $250 for 150 ml bottle
• Side effects: not eating, vomiting, lethargy, hepatotoxic –
jaundice. Discontinue immediately. Can try again after a
few days if eating & active at 5mg/kg PO BID. If still not
tolerated, don’t use oral.
Ringworm – Treatment
• Fluconazole – works well
• Griseofulvin, Ketoconazole – No, too frequent side effects
• Chlorhexidine, iodine, Program (leufenuron) are not effective
for ringworm
Ringworm – solitary lesion
• Woods lamp
Portable jor-vet Woods light j-132 $60-70
Plug in 115V model UVL-21
-Mineralogical Research Co.
• Culture plates
Vetlab Supply Inc.
About $33 for 10.
**Has microscopic interpretation chart available
Hardy Diagnositics
Derm-Duet II biplate About $25.50 for 10.
• Stain, microscope.
• Lab - Idexx cost fungal culture $60 each
Helpful Resources
• Muller and Kirk’s Small Animal Dermatology, 7th ed.
Descriptions and photos for fungal identification
• Great series of articles on pathogenesis, testing, and
Symposium on Feline Dermatophytosis
Vet Med. October 2003; 98(10): 844.
Karen A. Moriello.
Ringworm Look Alike
• Not ringworm. This dog had
hypothyroidism. Skin biopsy
helped with diagnosis.
• Skin lesions cleared up with
• Not ringworm. Fur loss on back.
Possibly due to another rabbit,
fur shedding, or overgrooming
Ringworm Look Alike
• This dog had demodex mites.
Lesions cleared up with treatment.
• Not ringworm.
Eosinophilic Granuloma Complex.
Biopsy helped with diagnosis.
Ringworm – your shelter
• Any suspicious hair loss – must quarantine
• Have plenty of disposable exam gloves
available in all sizes. Some types extend up
Ringworm – troubleshooting
• Network with other shelters to troubleshoot
• Maybe another facility has quarantine
capability (Need to discuss with Dept of Ag
before transporting)
Ringworm – your shelter
• If you can’t treat for ringworm, try to get a
positive diagnosis
• Other types of hair loss in kittens might
include fleas, a/d or food stuck to fur then
rubbed off, unsanitary conditions, kittens
nursing on each other, wounds, matts