General Considerations and Recommendations

Diagnosis

• Cats should be tested for endoparasites regularly (two times a year) to monitor the efficacy of control regimes and owner compliance.
• Standard or modified faecal flotation using a specific gravity (SG) of between 1.18-1.20 is recommended for the diagnosis of most, but not all internal parasites of cats. In some cases, more sensitive diagnostic methods may be appropriate for specific parasites and these are indicated in the guidelines
• Diagnosis of endoparasite infections in cats may be complicated by the intermittent shedding of diagnostic parasitic stages in the faeces, even in symptomatic cases. Testing samples, taken over three consecutive days, may increase the probability of finding diagnostic parasitic stages in the faeces.
• Clinical signs of endoparasite infections in cats may occur prior to shedding of parasite stages in the faeces. Thus, history and clinical signs should guide treatment decisions.
• In some cases, ancillary tests (e.g. blood counts, urinalysis, x-ray, and echocardiography) should be conducted to better guide treatment and management of the feline patient.

Treatment

• The availability of drugs for treating endoparasite infections in cats may vary from country to country. TroCCAP recommends the use of approved drugs.
• Veterinary practitioners should apply a high level of caution when recommending off-label (=extra-label) use of drugs/protocols and closely monitor the cat for any unexpected adverse events. The responsibility for any adverse event related to the off-label use of drugs/protocols lies with the prescribing veterinary practitioner.
• All cats residing in the same household should be treated for intestinal parasites at the same time.
• Care should be taken to minimize the risk of endoparasite transmission and morbidity, especially in kittens, by improving nutrition, environmental hygiene, and by avoiding overcrowding and other stressors.
• Supportive care (e.g. fluid therapy, blood transfusion, iron supplementation and high protein diet) should be provided as indicated.

Prevention and control

• Considering trans-mammary transmission and the pre-patent period of Toxocara cati, kittens need to be treated for ascarids at 3 weeks of age and fortnightly thereafter until 10 weeks of age. However, in scenarios where queens and their kittens are kept outdoors in potentially contaminated environments, kittens should be treated against hookworms starting at 2 weeks of age and then every 2 weeks until they are at least 10 weeks old. Nursing queens should be treated simultaneously with their litters.
• Cats should be dewormed regularly (cats living in catteries, free roaming, outdoor cats are at a higher risk and should be dewormed monthly).
• Monthly heartworm prophylaxis is recommended in areas where canine infection is endemic.
• Cat faeces should be removed and disposed daily.
• The litter box should be cleaned daily and if bleach is used, it must be thoroughly rinsed to avoid exposing cats to of the toxic effects of bleach.
• Disinfection of gravel, loam surfaces or lawns with sodium borate (5 kg/m2) will kill larvae but could also destroy vegetation.
• Do not feed raw meat or allow cats to hunt, as many animals (e.g., snails, slugs, birds, rodents and other micromammals) can act as intermediate or paratenic hosts for some endoparasites.
• If fleas are present, cats should be treated for Dipylidium caninum.
• Blood donor cats should be screened by PCR and serological tests to rule out the presence/exposure to pathogens that can potentially be transmitted via blood transfusion (e.g., Bartonella henselae, Mycoplasma haemofelis, Feline Immunodeficiency Virus, Feline Leukaemia Virus, FeLV, and where appropriate other infections including Leishmania spp. and Babesia spp.). Further information on blood transfusions in dogs and cats can be accessed at
  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4913655/pdf/JVIM-30-015.pdf

Public health considerations

• Some endoparasites of cats are zoonotic (definition: within these guidelines, parasites for which at least one report of human infection has been published). These parasites and vector-borne agents may affect people, especially children and immunocompromised individuals. Thus, their control is also important from a public health perspective.
• Veterinary practitioners and public health authorities should educate cat owners regarding the potential risks of improper parasite control in cats.
• Veterinary practitioners should also advocate good hygienic practices (e.g. hand washing, wearing footwear while outdoors, and daily removal of cat faeces) for cat owners to avoid the risks of zoonotic parasite transmission.