[Show abstract][Hide abstract] ABSTRACT: Infection of cats with Dirofilaria immitis causes seroconversion on antibody tests and pulmonary pathology, often without subsequent development of adult heartworms. Consistent administration of topical 10% imidacloprid-1% moxidectin has been shown to result in sustained plasma levels of moxidectin in cats after three to five treatments, a pharmacokinetic behavior known as "steady state".
To evaluate the ability of moxidectin at "steady state" to protect cats from subsequent infection with D. immitis, cats (n = 10) were treated with the labeled dose of topical 10% imidacloprid-1% moxidectin for four monthly treatments. Each cat was inoculated with 25 third-stage larvae of D. immitis 7, 14, 21, and 28 days after the last treatment; non-treated cats (n = 9) were inoculated on the same days, serving as infection controls. Blood samples were collected from each cat from 1 month prior to treatment until 7 months after the final inoculation and tested for antibody to, and antigen and microfilaria of, D. immitis.
Measurement of serum levels of moxidectin confirmed steady state in treated cats. Cats treated with topical 10% imidacloprid-1% moxidectin prior to trickle inoculation of D. immitis L3 larvae throughout the 28 day post-treatment period remained negative on antibody and antigen tests throughout the study and did not develop gross or histologic lesions characteristic of heartworm infection. A majority of non-treated cats tested antibody positive by 3-4 months post infection (6/9) and, after heat treatment, tested antigen positive by 6-7 months post-infection (5/9). Histologic lesions characteristic of D. immitis infection, including intimal and medial thickening of the pulmonary artery, were present in every cat with D. immitis antibodies (6/6), although adult D. immitis were confirmed in only 5/6 antibody-positive cats at necropsy. Microfilariae were not detected at any time.
Taken together, these data indicate that prior treatment with 10% imidacloprid-1% moxidectin protected cats from subsequent infection with D. immitis for 28 days, preventing both formation of a detectable antibody response and development of pulmonary lesions by either immature stages of D. immitis or young adult heartworms.
Full-text · Article · Dec 2015 · Parasites & Vectors
[Show abstract][Hide abstract] ABSTRACT: Amblyomma maculatum (the Gulf Coast tick), an aggressive, human-biting, Nearctic and Neotropical tick, is the principal vector of Rickettsia parkeri in the United States. This pathogenic spotted fever group Rickettsia species has been identified in 8-52% of questing adult Gulf Coast ticks in the southeastern United States. To our knowledge, R. parkeri has not been reported previously from adult specimens of A. maculatum collected in Kansas or Oklahoma. A total of 216 adult A. maculatum ticks were collected from 18 counties in Kansas and Oklahoma during 2011-2014 and evaluated by molecular methods for evidence of infection with R. parkeri. No infections with this agent were identified; however, 47% of 94 ticks collected from Kansas and 73% of 122 ticks from Oklahoma were infected with "Candidatus Rickettsia andeanae" a spotted fever group Rickettsia species of undetermined pathogenicity. These preliminary data suggest that "Ca. R. andeanae" is well-adapted to survival in populations of A. maculatum in Kansas and Oklahoma, and that its ubiquity in Gulf Coast ticks in these states may effectively exclude R. parkeri from their shared arthropod host, which could diminish markedly or preclude entirely the occurrence of R. parkeri rickettsiosis in this region of the United States.
Published by Elsevier GmbH.
No preview · Article · Mar 2015 · Ticks and Tick-borne Diseases
[Show abstract][Hide abstract] ABSTRACT: Background
Dogs with chronic inflammation, including those with heartworm being managed with macrocyclic lactones and doxycycline (slow kill, SK), may develop immune complexes that block detection of Dirofilaria immitis antigen on commercial tests.Methods
To determine if SK could result in development of false-negative antigen tests, we collected serum samples from dogs that had been diagnosed with heartworm by antigen detection, with or without confirmation by detection of D. immitis microfilariae, placed on monthly macrocyclic lactones and doxycycline, and that later tested negative on an antigen test, and then tested them for antigen of D. immitis before and after treatment to disrupt immune complexes.ResultsSerum samples from a total of 15 dogs managed with SK were negative for antigen prior to heating on commercial assay (DiroCHEK®, Zoetis) by colorimetric detection and spectrophotometry, but after heat treatment, 8/15 (53.3%) samples converted to positive. Review of the medical records of each dog indicated that, after the heartworm diagnosis, only 7/15 (46.7%) dogs appeared to receive preventive monthly as prescribed, including 3 dogs that had detectable antigen after heating the sample and 4 dogs that did not have detectable antigen after heating. Whole blood was available from 9 dogs; microfilariae of D. immitis were detected in 1 sample.Conclusions
These data suggest that immune complex formation in dogs infected with heartworm and managed with SK can induce false negative antigen test results, misleading veterinarians and owners about the efficacy of this approach. Moreover, compliance with preventive administration appears poor, even after a heartworm diagnosis. The presence of persistent microfilaremia in at least one dog has implications for resistance selection.
Full-text · Article · Feb 2015 · Parasites & Vectors
[Show abstract][Hide abstract] ABSTRACT: Canine serum samples may contain factors which prevent detection of antigen of D. immitis on commercial assays, precluding accurate diagnosis. To determine the degree to which the presence of blocking antibodies or other inhibitors of antigen detection may interfere with our ability to detect circulating antigen in canine samples, archived plasma and serum samples (n = 165) collected from dogs in animal shelters were tested for D. immitis antigen before and after heat treatment. Negative samples were also evaluated for their ability to block detection of D. immitis antigen in a sample from a positive dog. All 165 samples were negative prior to heating, but 11/154 (7.1%) became positive after heat treatment, a conversion that was documented and quantified on spectrophotometric plate assays, and 7/165 (4.2%) samples decreased detection of antigen when mixed with a known positive sample, suggesting some blocking ability was present. An additional 103 plasma and serum samples which tested positive prior to heating also were evaluated; the optical density (OD) of 14/101 (13.9%) increased by ≥ 50%, and one sample by as much as 15-fold, after heat treatment. Our results suggest that canine serum and plasma samples from dogs in the southeastern United States can contain inhibitors of D. immitis antigen detection, and that prevalence estimates of heartworm infection based on these assays would benefit from heat treatment of samples prior to testing.
Full-text · Article · Nov 2014 · Veterinary Parasitology
[Show abstract][Hide abstract] ABSTRACT: Abstract To determine the prevalence of Borrelia burgdorferi and Anaplasma phagocytophilum in a newly established population of Ixodes scapularis in the mountainous region of southwestern Virginia, questing adult ticks were collected and the identity and infection status of each tick was confirmed by PCR and sequencing. A total of 364 adult ticks were tested from three field sites. B. burgdorferi sensu stricto was identified in a total of 32/101 (32%) ticks from site A, 49/154 (32%) ticks from site B, and 36/101 (36%) ticks from site C, for a total prevalence rate of 33% (117/356). In addition, A. phagocytophilum was detected in 3/364 (0.8%) ticks, one from site A and two from site B. The prevalence of both pathogens in ticks at these sites is similar to that reported from established endemic areas. These data document the presence of I. scapularis and the agent of Lyme disease in a newly established area of the Appalachian region, providing further evidence of range expansion of both the tick and public and veterinary health risk it creates.
No preview · Article · Nov 2014 · Vector borne and zoonotic diseases (Larchmont, N.Y.)
[Show abstract][Hide abstract] ABSTRACT: Dogs exposed to ticks in the southern US may become infected with multiple species of Ehrlichia. To better define infection risk, blood samples collected from 10 dogs infested with ticks via a natural infestation model were evaluated by blood smear examination, PCR, patient-side ELISAs (SNAP® 4Dx® and SNAP® 4Dx® Plus), IFA, and peptide based ELISA for evidence of infection with Ehrlichiacanis, E. chaffeensis, and/or E. ewingii. Although morulae were rarely identified in blood smears, every dog (10/10) became infected with Ehrlichia spp. as evidenced by nested PCR detection of E. chaffeensis (7/10) and E. ewingii DNA (10/10); real-time PCR detection of E. chaffeensis (0/10) and E. ewingii (9/10); seroconversion on two different patient-side ELISAs (4/10 or 10/10); seroconversion on IFA to E. canis (10/10, maximum inverse titer = 128-4,096, GMTMAX = 548.7) and E. chaffeensis (10/10, maximum inverse titer = 1,024-32,768, GMTMAX= 4,096); and seroconversion on peptide specific ELISA to E. chaffeensis VLPT (7/10) and E. ewingii p28 (9/10). Rickettsemia with E. chaffeensis and E. ewingii, as determined by nested PCR, persisted in dogs for an average of 3.2 or 30.5 days, respectively. Ehrlichia canis was not detected in any dog by any method, and no dogs developed signs of clinical disease. Our data suggest that in areas where ticks are common, dogs are at high risk of infection with Ehrlichia spp., particularly E. ewingii and E. chaffeensis, and can serve as a sentinel for monitoring for the presence of these zoonotic pathogens
No preview · Article · Oct 2014 · Veterinary Microbiology
[Show abstract][Hide abstract] ABSTRACT: The Companion Animal Parasite Council hosted a meeting to identify quantifiable factors that can influence the prevalence of tick-borne disease agents among dogs in North America. This report summarizes the approach used and the factors identified for further analysis with mathematical models of canine exposure to tick-borne pathogens.
[Show abstract][Hide abstract] ABSTRACT: We designed a study to assess veterinarians' competency regarding parasitological procedures, skills, and areas of knowledge currently used in small-animal practice. The outcome will help us refine our curriculum on the basis of the parasitological working knowledge and skill sets that small-animal practitioners are using today. A questionnaire was developed and sent to small-animal practitioners. Their responses provided general information on practice characteristics, parasitological procedures used, and client education. Parasitological procedures included those to diagnose helminths, protozoa, and ectoparasites. We focused on three questions: "Do you perform or request this procedure?" "Where is this procedure performed?" and "What is your frequency?" The respondents were 478 small-animal practitioners. We performed descriptive analyses of practice characteristics along with bivariate and multivariate analyses. These analyses revealed the clinical competence of parasitological diagnoses performed or requested by small-animal practitioners. Results showed that more involved or time-consuming methods such as fecal flotation using centrifugation and the Baermann test are more often sent to a diagnostic laboratory and are requested more often by veterinarians in larger practices (i.e., those that employ more veterinarians). The outcomes also suggest that the main diagnostician may not fully understand the tests available at the diagnostic laboratory, which has an impact on decision making for management, treatment, and prevention of parasites and ultimately client education. In addition, small-animal practitioners who have been in practice longer and practices that employ five veterinarians or fewer (i.e., smaller practices) offer more client education.
No preview · Article · Aug 2014 · Journal of Veterinary Medical Education
[Show abstract][Hide abstract] ABSTRACT: Abstract Tick infestations and infection with tick-borne agents are commonly recognized in horses in North America, but equine infection with true Ehrlichia spp. has not been described. To determine the degree to which horses in the south-central United States are naturally exposed to and infected with tick-borne disease agents, serum samples were collected at random (n=240) or from horses with active tick infestations (n=73) and tested by immunofluorescence antibody assay (IFA) and/or enzyme-linked immunosorbent assay (ELISA) for evidence of antibodies reactive to Ehrlichia spp., Anaplasma spp., and Borrelia burgdorferi. Positive samples were further evaluated by species-specific serology for antibodies reactive to E. canis and E. chaffeensis, and whole blood samples were tested by PCR for evidence of infection with E. canis, E. chaffeensis, E. ewingii, and an E. ruminantium-like organism referred to as the Panola Mountain Ehrlichia. Antibodies reactive to Ehrlichia spp. were identified in 8.75% (21/240) of the randomly acquired samples and 24.7% (18/73) of the serum samples from tick-infested horses, but species-specific ELISA and PCR failed to confirm exposure to or infection with any known Ehrlichia spp. Antibodies to Anaplasma spp. (5/313; 1.6%) and B. burgdorferi (3/313; 1.0%) were uncommon. These data suggest that horses in the south-central United States are likely exposed to a novel Ehrlichia sp. Further research is needed to identify the etiologic agent responsible for the serologic activity seen and to determine the clinical significance, if any, of this finding.
No preview · Article · Aug 2014 · Vector borne and zoonotic diseases (Larchmont, N.Y.)
[Show abstract][Hide abstract] ABSTRACT: Objective-To evaluate the performance of an in-clinic ELISA designed for detection of heartworm antigen and antibodies against 5 tick-borne pathogens. Design-Validation study. Sample-1,601 serum or matched serum, plasma, and blood samples from dogs. Procedures-Samples were tested for Dirofilaria immitis (heartworm) antigen and antibodies against Anaplasma phagocytophilum, Anaplasma platys, Borrelia burgdorferi, Ehrlichia canis, and Ehrlichia ewingii by means of an in-clinic ELISA. Evaluation of assay sensitivity and specificity, agreement of results among sample types, and cross-reactivity of E canis antigens in the assay with anti-Ehrlichia chaffeensis antibodies in stored samples from experimentally infected dogs were performed at a reference laboratory. Field tests of the in-clinic ELISA were performed at 6 veterinary facilities. Results were compared with confirmatory test results. Results-Sensitivity and specificity of the in-clinic ELISA were > 89% for detection of antibodies against A phagocytophilum (93.2% and 99.2%, respectively), A platys (89.2% and 99.2%, respectively), B burgdorferi (96.7% and 98.8%, respectively), E canis (97.8% and 92.3%, respectively), and E ewingii (96.5% and 93.9%, respectively). Sensitivity of the assay for detection of D immitis was 98.9%, with 99.3% specificity. The in-clinic ELISA identified exposure to > 1 vector-borne pathogen in 354 of 1,195 samples. Cross-reactivity of E canis antigens with anti-E chaffeensis antibodies was confirmed. Results of field evaluations confirmed that the in-clinic ELISA could be reliably used under typical clinical conditions to identify dogs exposed to the pathogens of interest. Conclusions and Clinical Relevance-The in-clinic ELISA provided a comprehensive in-house serologic screening test for all vector-borne pathogens evaluated.
No preview · Article · Jul 2014 · Journal of the American Veterinary Medical Association
[Show abstract][Hide abstract] ABSTRACT: Diagnosis of Dirofilaria immitis infection in dogs is largely dependent on detection of antigen in canine serum, plasma, or whole blood, but antigen may be bound in immune complexes and thus not detected. To develop a model for antigen blocking, we mixed serum from a microfilaremic, antigen-positive dog with that of a hypergammaglobulinemic dog not currently infected with D. immitis and converted the positive sample to antigen-negative; detection of antigen was restored when the mixed sample was heat-treated, presumably due to disruption of antigen/antibody complexes. A blood sample was also evaluated from a dog that was microfilaremic and for which microfilariae were identified as D. immitis by morphologic examination. Antigen of D. immitis was not detected in this sample prior to heating but the sample was strongly positive after heat treatment of whole blood. Taken together, our results indicate that blood samples from some dogs may contain factors that inhibit detection of antigen of D. immitis, and that heat treatment of these samples prior to testing could improve the sensitivity of these assays in some patients.
Full-text · Article · Jun 2014 · Veterinary Parasitology
[Show abstract][Hide abstract] ABSTRACT: Background
The geographic distribution of canine infection with vector-borne disease agents in the United States appears to be expanding.
To provide an updated assessment of geographic trends in canine infection with Dirofilaria immitis, Borrelia burgdorferi, Ehrlichia spp., and Anaplasma spp., we evaluated results from an average of 3,588,477 dogs tested annually by veterinarians throughout the United States from 2010 – 2012.
As in an earlier summary report, the percent positive test results varied by agent and region, with antigen of D. immitis and antibody to Ehrlichia spp. most commonly identified in the Southeast (2.9% and 3.2%, respectively) and antibody to both B. burgdorferi and Anaplasma spp. most commonly identified in the Northeast (13.3% and 7.1%, respectively) and upper Midwest (4.4% and 3.9%, respectively). Percent positive test results for D. immitis antigen were lower in every region considered, including in the Southeast, than previously reported. Percent positive test results for antibodies to B. burgdorferi and Ehrlichia spp. were higher nationally than previously reported, and, for antibodies to Anaplasma spp., were higher in the Northeast but lower in the Midwest and West, than in the initial report. Annual reports of human cases of Lyme disease, ehrlichiosis, and anaplasmosis were associated with percent positive canine test results by state for each respective tick-borne disease agent (R2 = 0.701, 0.457, and 0.314, respectively). Within endemic areas, percent positive test results for all three tick-borne agents demonstrated evidence of geographic expansion.
Continued national monitoring of canine test results for vector-borne zoonotic agents is an important tool for accurately mapping the geographic distribution of these agents, and greatly aids our understanding of the veterinary and public health threats they pose.
Full-text · Article · May 2014 · Parasites & Vectors
[Show abstract][Hide abstract] ABSTRACT: Ticks, sera and ethylenediaminetetraacetic acid (EDTA) blood were collected from dogs evaluated at the Amakom Veterinary Clinic in Kumasi, Ghana. Sera were evaluated for Dirofilaria immitis antigen and antibodies against Borrelia burgdorferi, Anaplasma phagocytophilum and Ehrlichia canis. Conventional polymerase chain reaction assays designed to amplify the deoxyribonucleic acid (DNA) ofEhrlichia spp. or Anaplasma spp. or Neorickettsia spp. or Wolbachia spp., Babesia spp., Rickettsia spp., Hepatozoon spp., Bartonella spp. and the haemoplasmas were performed on DNA extracted from EDTA blood and all positive amplicons were sequenced. This small survey shows that the following vector-borne pathogens are present in urban Ghanian dogs: Ehrlichia canis, Hepatozoon canis,Dirofilaria immitis and Anaplasma platys. Bartonella henselae was isolated from ticks but not from the dogs.
[Show abstract][Hide abstract] ABSTRACT: Diagnosis of Dirofilaria immitis infection in cats is complicated by the difficulty associated with reliable detection of antigen in feline blood and serum samples.
To determine if antigen-antibody complex formation may interfere with detection of antigen in feline samples, we evaluated the performance of four different commercially available heartworm tests using serum samples from six cats experimentally infected with D. immitis and confirmed to harbor a low number of adult worms (mean = 2.0). Sera collected 168 (n = 6), 196 (n = 6), and 224 (n = 6) days post infection were tested both directly and following heat treatment.
Antigen was detected in serum samples from 0 or 1 of 6 infected cats using the assays according to manufacturer's directions, but after heat treatment of serum samples, as many as 5 of 6 cats had detectable antigen 6-8 months post infection. Antibodies to D. immitis were detected in all six infected cats by commercial in-clinic assay and at a reference laboratory.
These results indicate that heat treatment of samples prior to testing can improve the sensitivity of antigen assays in feline patients, supporting more accurate diagnosis of this infection in cats. Surveys conducted by antigen testing without prior heat treatment of samples likely underestimate the true prevalence of infection in cats.
Full-text · Article · Jan 2014 · Parasites & Vectors
[Show abstract][Hide abstract] ABSTRACT: Abstract To determine the risk of canine infection with spotted fever group (SFG) Rickettsia spp. following natural tick exposure, 10 dogs determined to be free of evidence of exposure to or infection with tick-borne disease agents were exposed to ticks via weekly walks in a wooded area in north-central Oklahoma. After each walk, dogs were examined and the number and species of ticks present were recorded. The dogs were then returned to outdoor kennels to allow the infestations and subsequent transmission of any pathogens to proceed. Serum samples and whole blood were collected from each dog twice weekly for 121 days and evaluated via indirect fluorescence antibody (IFA) for antibodies reactive to Rickettsia rickettsii, R. montanensis, and "R. amblyommii," and by PCR for evidence of Rickettsia spp. Dogs became infested with a total of 57-108 ticks over the entire 8-week infestation period (weekly average tick infestation=12.0±4.1). The great majority of the ticks present were Amblyomma americanum (90.5%), with a small number of Dermacentor variabilis and A. maculatum also identified. All (10/10) dogs seroconverted to R. rickettsii, R. montanensis, and "R. amblyommii," with mean maximum inverse titers of 1176, 1448, and 6654, respectively, for all dogs in the study. Maximum inverse titers to "R. amblyommii" ranged from 4096 to 16,384 and were higher in 9/10 dogs than maximum inverse titers to R. rickettsii or R. montanensis. Sequence-confirmed SFG Rickettsia spp. (R. montanensis and "R. amblyommii") were occasionally, but not consistently, identified from whole blood by PCR. Taken together, our data suggest that, in areas where A. americanum is common, antibodies reactive to R. rickettsii in dogs may be due instead to infection with "R. amblyommii" or other, closely related SFG Rickettsia spp.
No preview · Article · Dec 2013 · Vector borne and zoonotic diseases (Larchmont, N.Y.)
[Show abstract][Hide abstract] ABSTRACT: Ticks are common on horses, but there is a dearth of contemporary data on infestation prevalence, predominant species, and tick-borne disease agents important in this host. To determine the species of ticks most common on horses and the prevalence of equine exposure to and infection with tick-borne disease agents, ticks and blood samples were collected from 73 horses during May, June, and July of 2010. Adult ticks were identified to species, and antibodies to Ehrlichia spp., Anaplasma spp., and Borrelia burgdorferi were identified using indirect fluorescence antibody assay, a commercial point-of-care enzyme-linked immunosorbent assay, or both. In total, 1,721 ticks were recovered at the majority (85%) of equid examinations. Amblyomma americanum (L.) was the most common tick collected (1,598 out of 1,721; 92.9%) followed by Dermacentor variabilis (Say, 1821) (85 out of 1,721; 4.9%) and Amblyomma maculatum Koch, 1844 (36 out of 1,721; 2.1%); single specimens of Ixodes scapularis Say, 1821 and Dermacentor albipictus (Packard, 1869) were also identified. Antibodies reactive to Ehrlichia spp. were found in 18 out of 73 (24.7%) of horses tested, and were more commonly identified in horses with moderate or high tick infestations than those with low tick infestations (P < 0.001). These data support A. americanum as the most common tick species infesting horses in central Oklahoma from May through July and suggest horses are also commonly exposed to an Ehrlichia sp.
Full-text · Article · Nov 2013 · Journal of Medical Entomology
[Show abstract][Hide abstract] ABSTRACT: Patch burning (PB) uses frequent, spatially discrete fires throughout a pasture to create variation in the composition and structure of the plant community. The complex vegetation changes incurred from this type of burning regimen in addition to the focal grazing of cattle induced by PB should reduce tick populations by creating less favorable microhabitats. To determine if a reduction in tick populations occurred on PB pastures, three PB-treated pastures and three control pastures were used. PB pastures were divided into six subplots with one burned rotationally each spring and summer. Control pastures and each PB subplot had a burn interval of 3 yr. Pastures were dragged with 1-m2 flannel cloth panels to estimate tick abundance for 4 yr. (2006, 2007, 2009, and 2010). Infestation levels with ticks (i.e., tick burden) and weight for five calves and three cows per pasture were recorded once a month from April to October in 2009, 2010, and 2011. Differences in tick abundance between PB pastures and control pastures were not significant except in 2006 when fewer adult ticks were detected in PB pastures. A total of 13 609 ticks were observed on cattle. Animals on PB pastures had 4 028 (29.6%) ticks whereas 9 581 (70.4%) ticks were on cattle from control pastures. Tick burden was significantly reduced on animals in PB pastures compared to animals in control pastures in 4 out of 6 mo. Significant differences in average daily weight gain of calves in PB and control pastures were not detected. Although differences were not detected in questing tick abundance on pastures, significant reductions of tick burden on cattle in PB-treated pastures indicates that PB can be used to help control ticks in pastures.
[Show abstract][Hide abstract] ABSTRACT: In February 2012, 12 farmed mule deer (Odocoileus hemionus) were moved from a facility in southwestern Oklahoma to a facility in southeastern Oklahoma that housed 100 farmed white-tailed deer (Odocoileus virginianus). Between the third and fifth weeks, 9 of the 12 mule deer had died, 4 of which were submitted for necropsy. The deer were heavily infested with Amblyomma americanum (lone star ticks). Hematologic data from 1 deer revealed severe anemia, leukocytosis, and intraerythrocytic hemoparasites consistent with Theileria spp. Microscopically, the liver, lymph nodes, and spleen contained multifocally distributed, enlarged monocytic cells whose cytoplasm was replaced by developing meronts in various stages of merogony. It appears that, upon arrival, the Theileria cervi-naïve mule deer became infested with large numbers of Theileria-infected lone star ticks leading to massive exposure of the mule deer to sporozoites of the protozoan, resulting in an acute hemolytic crisis and fatalities. The merogonic stages of T. cervi are also described. The lack of earlier reports of merogony may be due to the fact that only a single, short-lived, merogonic cycle follows exposure to sporozoites and thus merogonic stages are demonstrable for only a short period. Polymerase chain reaction testing of paraffin-embedded tissue yielded a 507-bp amplicon sequence that was 100% identical with the sequence of T. cervi previously reported from white-tailed deer in Oklahoma and from elk in Wisconsin and Indiana.
No preview · Article · Sep 2013 · Journal of veterinary diagnostic investigation: official publication of the American Association of Veterinary Laboratory Diagnosticians, Inc