Disseminated angiostrongylosis with involvement of the central nervous system as a cause of sudden death in a dog in Germany

BACKGROUND: The metastrongyloid nematode Angiostrongylus vasorum, known as "French Heartworm", is an emerging concern in canine health in Europe. Foxes are considered the main reservoir hosts, and affected carnivores predominantly show cardiovascular and respiratory signs. However, a disseminated course of infection can have diverse and severe consequences, including fatal outcomes. CASE PRESENTATION: A six-year-old male Labrador Retriever was presented to the clinic with progressive episodes of stupor lasting a few seconds and dyspnea. Radiographic examination revealed multifocal pulmonary consolidation. In addition, a prolonged blood clotting time was detected. The dog died of acute cardiovascular failure. Histological examination revealed a multifocal, moderate granulomatous pneumonia with numerous intralesional nematode first stage larvae and eggs and interstitial fibrosis in the lungs as well as nematode larvae in the kidneys, brain, spinal cord and myocardium. In addition to morphology, the identity of the nematode larvae as A. vasorum was confirmed by PCR. CONCLUSIONS: Several case reports and studies show that the endemic regions of A. vasorum are expanding, and consequently the number of affected countries is increasing. Angiostrongylosis, particularly the disseminated form, remains an underestimated cause of death in dogs and should be taken into consideration in dogs with an unknown cause of disease, especially when cardiovascular or respiratory symptoms and/or neurological signs are present.