At my wit's end- spirometra "fish tapeworm"

Hello! I am here, kind of desperate for help for my latest addition to my cat family. Our vet is out of ideas and has exhausted all resources in resolving this, so I was hoping to find someone who has had a similar experience with this spirometra worm/parasite.

My little girl was living in my yard when I first moved here in April. She was so very skinny and skittish, would run away as soon as I stepped outside. I started leaving food out, and gradually she became velcro to my leg We brought her inside in August, isolated her, brought her to the vet for a physical, fecal, fiv/felv test, and a treatment of Profender for fleas and parasites(hooks).. In August she was 5.5 pounds and the vet guessed about a year old. After a week or so, she was using the litterbox fine, eating like a horse, and do she was dubbed Betty White, and she met my other two cats Sota and Bea Arthur. They get along so well, there was never even a hiss- just went straight to constant snuggling <3

Flash forward a couple of weeks (mid september) and that's when the problems started. I was sitting down watching TV and in runs Betty, with (I kid you not) a cluster of 6 or so long flat white worms that were a good ten inches long trailing behind her, coming out of her butt. It was.. gross. The worst/somewhat funny part was that my other cat Bea was chasing her, wanting to play with this new string toy her sister had >< I had literally no idea what to do, I have vet tech experience and have never seen this. I caught her and put her in the spare room, tried to clean her up, put gloves on and gently tried to get what I could to come out, and used scissors for the rest. In the process of catching and cleaning her, I noticed there was diarrhea all over the house- I'm talking the stuff of nightmares.. everywhere, with sections of worms. There were many string cheese and pasta jokes the next day.

SO off to the vet, they assumed normal tapeworms and retreated with another dose of Profender.. Things calmed down for a few weeks and then, round two This time I caught the attention of the head vet, I brought another sample in and he sent it out for identification..  It took a month  to get an answer(late october), meanwhile she was off and on diarrhea, sometimes in the box, sometimes not. Finally we heard back. It turns out this is not your typical common tapeworm(from fleas), this is spirometra, a fish tapeworm, not very common in cats at all, and there are NO approved treatments for them in the US... The best plan he could come up with was a very high dose of injectable droncit/praziquantel, two days in a row.

We did that. Things calmed down. A few weeks later, guess what... Diarrhea except this time no sign of worms. yay? Back to the vet with fecals, and he put her on amoxi for spirochete bacteria(November). Things calmed down.. A month later- December.. yep. The vet gave me metronidozole, and this latest fecal showed more spirometra eggs again, even though I hadn't seen any worms. The vet reached out again to his network and has yet to come up with anything. No one in the community has a clue on how to really treat this, and he just suggested trying another round of injections, that maybe the infestation was so bad that she needs more high-dose droncit.

So the other day I saw her string cheese friends were back full force. I called the vet and he still has not heard from his peers, the university, multiple parasitologists, no one. So today(Jan 12th) we went for a second round of injections and I am crossing my fingers.

The good news is she went from 5.5lbs to 11.5lbs and is now a fat mama. The bad news is she barely trusts me now after medication after medication(she will snuggle once in a while, and run away the rest), still has intermittent diarrhea, and will not use the litterbox- only sometimes(the good news from that is I have all tile floors). This post ended up being super long..

But basically August to January and we still have not gotten this spirometra parasite under control, and I'm desperate for help or info. Google does not give me much hope. Once she is healthy I -hope- she will go back to using the litterbox full time, and if not that'll be another discussion- the poor thing is traumatized.

Please help! Any insight would be appreciated

There is an old thread about it: 

http://www.thecatsite.com/t/314506/my-cat-has-spirometra 

The original poster @Rosa Bood  was online not too long ago so she might be able to give you an update or tell you what worked for her. 

I really don't have any personal experience or advice to help out. The whole thing sounds like a bad situation and I am sending good vibes for a good outcome. 

This says that treatment requires an elevated dose of praziquantel, or another drug they recommend. With all de-wormers, you have to treat again in 3 weeks because new eggs hatch in that time. To be safe I'd probably do 3 or 4 treatments each 3 or 4 weeks apart.

http://www.aavp.org/wiki/cestodes/pseudophyllidea/spirometra/spirometra-mansonoides/

And this is what the Merck manual says, though they don't mention treating again in 3 weeks:

"Infections with Spirometra sp in dogs and cats can be treated with praziquantel at 7.5 mg/kg, PO, for 2 consecutive days. Spirometra sp infections in cats can also be treated with a single dose of praziquantel at 30 mg/kg, SC, IM, or PO. Mebendazole at 11 mg/kg, PO, has also been successful. All these treatments are extra-label."

Thank you. I pm'd the op of that thread, hopefully she can give me an update on what happened with her situation.

Thanks willowy, we did do one treatment of a high dose of injectable praziquantal/droncit, on two consecutive days. The vet and every resource states one treatment is sufficient and there was no need to retreat, but since that didn't work, we went back today for the first of two more injections. I will ask him tomorrow if it would be wise to treat again in a month even without symptoms.

wow, what a mess!  Yes, I think I agree that multiple rounds of that dewormer may be the answer.  It's true that there may be varying stages of developing eggs/larvae to deal with.  If a redose is done too soon, it does not catch the larvae and if done too late they reproduce and the cycle repeats itself.  I would ask for 3-4 rounds of this dewormer.  My foster's vet told me once that the only thing a dewormer kills are the worms.

If your vet refuses to re-treat in a month. . .well, there is a way for you to do it yourself. You can buy praziquantel online without a prescription, the product is called "fish tapes" made by Thomas Labs. It's just regular praziquantel, sold for aquarium fish, which is why they can get away with selling it without a prescription.

I don't normally think treating your pet without the vet's approval is a good idea, but I do know some vets get nervous about using drugs off-label. So if you have to, it's an option. Hopefully your vet will be on board though.

It is important to retreat after initial treatment, even if they seem to be gone. Treatments for worms work on different life stages of the worm. So with only on treatment you could be missing a bunch of the parasites that are not at that vulnerable life stage. That is why it is so important to repeat treatments. Hopefully your vet can understand that.

What was the precise identification? 

No offense but it might be time to consider a new vet.  If it is spirometra that's actually fairly common in animals (rare in humans), easily treated, and has a well established protocol.  It's also very quick/easy to identify and should not take a month.  There's only one other tape worm it can be easily confused with and there's a simple test to distinguish between the two.  If your vet did it themselves it's an hour at most, sending it out to a lab maybe 48 hours.

Jmjimmy, no offense taken. I don't know specifically which, all I know is spirometra. She was treated for two months with profender, and then two days of a 10x dose of droncit/praziquantal injection, and now we are doing another two days of the same high dose praziquantal. What is this common easy treatment protocol? Everything I've read online has stated it's not easily treated, and the only suggested treatment I can find is the high dose injection which is off label, not guaranteed. Thanks for your help!

tiggereye said:

Jmjimmy, no offense taken. I don't know specifically which, all I know is spirometra. She was treated for two months with profender, and then two days of a 10x dose of droncit/praziquantal injection, and now we are doing another two days of the same high dose praziquantal. What is this common easy treatment protocol? Everything I've read online has stated it's not easily treated, and the only suggested treatment I can find is the high dose injection which is off label, not guaranteed. Thanks for your help!

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https://www.capcvet.org/capc-recommendations/diphyllobothriidean-tapeworm

diphyllobrothriidean is the family Spirometra belongs to.  Without knowing the specific type it's hard to research properly, however, the established treatment protocol is 25-35mg/kg of praziquantel.  Typically 30mg/kg for 1 day is the first attempt, if that fails, 25-35mg/kg per day for 2 days.  For an 11.5lb cat that's 12-14 x 23mg Droncit pills given over 2 days.  It sounds like your vet is close to that with a 115mg/day dose but that's actually low for treatment of Spirometra - the high end dose for your cat's current weight would be 182mg/day.

Edit: I'm also confused as to why injectable Droncit?  The oral is more effective since they resides in the small intestine - also less harmful to the cat since it won't absorb as much as subcutaneous injections.  Try to find out from your doctor the specific type of Spirometra - other types are responsive to other types of medications

Off-label doesn't mean it might not work. It means that the US regulating bodies haven't approved it for use in cats, that's all. This parasite may be more common in other countries and have a treatment protocol familiar to vets in those places. There's no reason the proper dosage of praziquantel would be ineffective.

Yes, I know what off-label means. I was referencing research that states the treatment has not always proven effective. I am on my phone atm so am not able to provide links.

JMJimmy said:

https://www.capcvet.org/capc-recommendations/diphyllobothriidean-tapeworm

diphyllobrothriidean is the family Spirometra belongs to.  Without knowing the specific type it's hard to research properly, however, the established treatment protocol is 25-35mg/kg of praziquantel.  Typically 30mg/kg for 1 day is the first attempt, if that fails, 25-35mg/kg per day for 2 days.  For an 11.5lb cat that's 12-14 x 23mg Droncit pills given over 2 days.  It sounds like your vet is close to that with a 115mg/day dose but that's actually low for treatment of Spirometra - the high end dose for your cat's current weight would be 182mg/day.

Edit: I'm also confused as to why injectable Droncit?  The oral is more effective since they resides in the small intestine - also less harmful to the cat since it won't absorb as much as subcutaneous injections.  Try to find out from your doctor the specific type of Spirometra - other types are responsive to other types of medications

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We went with injectable because she is stressed easily and not a good patient, or easy to catch once she knows the goal. She can be sweet(towards me only), but any attempt at restraining or pilling her throws her into fight or flight mode.. that many droncit pills would not be doable, even scruffed and burrito'd in a towel.

I will ask tomorrow for the dose, and the species of spirometra. Thank you.

tiggereye said:

We went with injectable because she is stressed easily and not a good patient, or easy to catch once she knows the goal. She can be sweet(towards me only), but any attempt at restraining or pilling her throws her into fight or flight mode.. that many droncit pills would not be doable, even scruffed and burrito'd in a towel.

I will ask tomorrow for the dose, and the species of spirometra. Thank you.

Click to expand...

No problem.  It may even be worth it to take her to the vet for those two days, have them give the pills.  Sub-q is usually only indicated if the worms have moved out of the intestinal tract (rare unless there are intestinal ulcers, anal fissures, or other open wounds they can get into).  The danger is that not enough toxicity builds up in the tract to actually be lethal to the worms, the more they're subjected to non-lethal levels the more they can tolerate resulting in a vicious cycle and more dangerous medications for your cat.

So we went today for the second injection. She received 160mg yesterday and the same today, which is just over the recommended 30mg/kg. The lab report did not specify which species of spirometra it is, and all have the same treatment of high-dose praziquantal.

The vet will retreat her in a month but he is concerned of the safety of such a high dose injection so many times (She received two of the same injections on 11/4, 11/5, and then two more yesterday and today). Also, if I'm interpreting life cycle information correctly, the spirometra needs an intermediary host to complete its life cycle and reinfect, such as a fish, frog, or lizard(This is not the flea tapeworm). It cannot be passed to other cats or humans without an intermediary host, and it can't recycle on its own. We are assuming she was so infested that the first treatment did not kill all the worms and they repopulated. Hopefully this second treatment will work. I'll do another fecal in a few weeks and we'll go from there, I guess.

Good to hear the dose is higher than you thought!  Hopefully it works - keep us updated

Sounds like you are getting some great advice from a group of very knowledgeable people maybe 

@catwoman707  can chime in too

I understand the hesitance in re-treating her, however I strongly urge she is followed up in 2 weeks rather than 4. 

I'm afraid otherwise this will just go on and on, they must be completely gone, overkill? Perhaps but who's to say......

It's the same with ordinary roundworms. They are treated, then usually a follow up treatment in 2 weeks.

However, when a kitten gets to the point of vomiting worms, there is a full blown invasion and it takes repeated treatments every 2 weeks for sometimes months to get the kitty cleaned completely. Def not the standard but what is necessary for a complete recovery of them.

There is also the factor of the worms becoming resistant to the praz too, if the doses are not enough to wipe out that current load and are repeated doses.

For repeated dosing of praz it's the amt that will be fully effective vs too much at one time, it does not stay in their system long so there is no build up.

Here is an excellent and very informative link to read the max doses, and possible dangers.

http://parasitipedia.net/index.php?option=com_content&view=article&id=2695&Itemid=3023

I agree - the eggs hatch after 10 days so 4 weeks is likely to be 2 generations in