Ivermectin-Intoxikation bei drei Hunden mit und ohne MDR1-Gen- Defekt durch ein für Pferde zugelassenes orales Antiparasitikum

 

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Zusammenfassung:

Gegenstand und Ziel: Es werden Symptomatik und Verlauf einer Ivermectin-Vergiftung bei Hunden beschrieben, die durch die Aufnahme von Pferde-Wurmpaste (Ivomec P^®, Deutschland bzw. Eqvalan^®, Schweiz) verursacht wurde. Material und Methode: Dokumentation von drei Fällen. Ergebnisse: Zwei Hunde besaßen ein intaktes MDR1-Gen, während ein Hund von dem MDR1-Gen-Defekt betroffen war. Dementsprechend entwickelte sich eine unterschiedliche Symptomatik. Das klinische Leitsymptom bei den Hunden mit intaktem MDR1-Gen war eine symmetrische Mydriasis verbunden mit einer Visuseinschränkung bzw. vorübergehendem Visusverlust. Daneben wurden unkontrollierte Muskelzuckungen im Kopfbereich beobachtet. Eine ähnliche Symptomatik würde man bei einer oralen Einzeldosis von etwa 2,5–5 mg Ivermectin/kg Körpergewicht erwarten. Ein homozygot von dem MDR1-Gen-Defekt betroffener Collie (Fall 3) zeigte eine wesentlich gravierendere Symptomatik: Mydriasis, Apathie, Tremor und Hypersalivation, Koma mit krampfartigen Phasen begleitet von Schreien. Ein derartiger Verlauf wäre bei einem Hund mit homozygotem MDR1-Defekt nach einer oralen Einzeldosis von etwa 150–300 µg/kg KM zu erwarten. Schlussfolgerung: Für Hunde mit intaktem MDR1-Gen verlaufen derartige Intoxikationen vergleichsweise harmlos und sind von kurzer Dauer, während Hunde mit homozygotem MDR1-Gen-Defekt bereits bei der Aufnahme geringer Mengen Ivermectin-Wurmpaste für Pferde in den letalen Dosisbereich (≥ 0,2 mg/kg KM) kommen. Klinische Relevanz: Vergiftungen mit Ivermectin-Pferdepaste beim Hund kommen gelegentlich vor und müssen bei auffälliger Mydriasis mit oder ohne Visuseinschränkung differenzialdiagnostisch in Betracht gezogen werden.

Summary:

Objective: We report on symptoms and course of ivermectin toxicosis in dogs that had taken up ivermectin vermicide paste licensed for use in horses (Ivomec P^® and Eqvalan^® in Germany and Switzerland, respectively). Material and methods: Documentation of three such cases. Results: Two dogs had an intact MDR1 gene and one dog a homozygous MDR1 gene mutation. Different symptoms developed accordingly. The dogs with intact MDR1 gene showed mainly bilateral mydriasis, visual deficits, as well as uncontrolled facial muscular contractions. In these cases, ivermectin intake was estimated to be 2.5–5 mg/kg body weight. One collie dog which was affected by the homozygous MDR1 gene mutation, showed more severe symptoms including apathy, tremor, hypersalivation, and coma with phases of spasm and screaming. In this case, ivermectin intake was estimated to be 150–300 µg/kg body weight. Conclusion: Dogs with an intact MDR1 gene usually display harmless symptoms, which subside after two or three days. In contrast, dogs with homozygous MDR1 gene mutation may suffer from a lethal dose of ≥ 0.2 mg/kg with the uptake of even small amounts of ivermectin worm-paste for horses. Clinical relevance: Ivermectin toxicosis in dogs occasionally occurs after oral uptake of horse vermicide paste and must be considered as differential diagnosis in cases of mydriasis and/or visual deficits of unclear etiology.

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