Summary of ACVIM Consensus Update: Lyme borreliosis in dogs and cats

The American College of Veterinary Internal Medicine (ACVIM) recently released an updated consensus statement on Lyme borreliosis in dogs and cats. The original consensus statement was released in 2006. This new document shares updated information on diagnosis, treatment and prevention of Lyme disease in dogs and cats, and highlights key gaps in knowledge. 

 

The Consensus Statement is structured by topic and question. For any recommendation, a scale of the level of supporting evidence-based medicine is provided, as well as the number of panelists that agree with that recommendation. 

 

Here are the areas where there is strong consensus and represent current best practices for Lyme borreliosis:

  • Screening all dogs in endemic or emerging areas of North America with an approved qualitative serological test. This practice allows appropriate follow-up to be conducted on any seropositive dog (regardless if asymptomatic) including assessment for proteinuria and potentially other baseline testing like CBC and biochemistry to evaluate for other health risks associated with tick exposure. Additionally, dogs act as good sentinels to indicate higher risk of tick-borne pathogen exposure to other species (humans included). If tick prevention is routinely used, monitoring seroprevalence is also an effective way to determine if current tick prophylaxis protocols are sufficient. More studies are required to determine the performance of, and overall need for, similar testing in cats.

  • Monitoring all B. burgdorferi positive dogs for proteinuria two to three times per year. This is recommended even if the dog is asymptomatic or has already received antibiotic treatment. 

  • Treating all clinically ill dogs. The preferred choice is doxycycline at 10 mg/kg/day for 4 weeks. For patients which doxycycline is not appropriate, other antibiotic treatments guidelines are provided. Management recommendations for immune-complex glomerulonephritis are also outlined. 

  • Using regular tick control with a product that repels or rapidly kills ticks during feeding. 

 

The panel remained divided on several issues. These are areas of ongoing research and hopefully as we continue to learn more about Lyme disease in our companion animals, we can have more guidance on how to approach these issues in clinical practice.

  • Treating dogs that are seropositive for B. burgdorferi, but otherwise healthy (no proteinuria). The benefits of treating all seropositive dogs include treatment of potential subclinical joint inflammation, treatment of possible co-infections and potential prevention of future disease. However, the list of drawbacks is quite long, including overuse of antibiotics, risk of adverse reactions to treatment and high owner cost (among others).  More than half (4/6) of the panelists do not recommend treating asymptomatic dogs.

  • Applying quantitative serological tests (e.g., QuantC6) to assess health status and treatment choice. There is no evidence that the higher titre values relate to clinical disease. Only 1 panelist would use quantitative test results to guide treatment choice

  • Vaccinating dogs using current Lyme vaccines. Half of the panelists support regular vaccination in endemic areas. The other half of the panel, who do not support routine vaccination for Lyme disease, state that the efficacy of vaccination and duration of immunity is variable, among other reasons. 

  • Using antibiotics for 1 month versus 3-6 months in suspect Lyme nephritis. There is so much that we still do not know about Lyme nephritis, and it is very difficult to study.

 

Any small animal practitioner will find great value in this document. Most of the questions we regularly receive about Lyme borreliosis are discussed, including the ones for which we do not yet have good answers.  There are many helpful tables summarizing available antibody tests, treatment guidelines for Lyme arthritis and nephritis, and an overview of tick preventatives and Lyme vaccines available on the market. 

PETS AND TICKS!

In 2016, Dr. Scott Weese of the Ontario Veterinary College launched the Pet Tick Tracker to help monitor changes in tick populations. Through this online tool, pet owners could submit reports of tick findings - and the response was overwhelming! He's now teamed up with Drs. Katie Clow and Michelle Evason to create Pets and Ticks - a comprehensive website that brings the Pet Tick Tracker together with up-to-date, evidence-based information on ticks in Canada.  

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