Coccidia (Coccidiosis):
What is Coccidia?
Coccidia are single celled organisms that infect the intestine. They are microscopic parasites detectable on routine fecal tests in the same way that worms are but coccidia are not worms and they are not visible to the naked eye. Coccidia infection causes a watery diarrhea which is sometimes bloody and can even be a life-threatening problem to an especially young or small pet.
Where do Coccidia Come From?
Oocysts (pronounced o'o-sists), like those shown above, are passed in stool. In the outside world, the oocysts begin to mature or “sporulate.” After they have adequately matured, they become infective to any host (dog or cat) that accidentally swallows them.
To be more precise, coccidia come from fecal-contaminated ground. They are swallowed when a pet grooms/licks the dirt off itself. In some cases, sporulated oocysts are swallowed by mice and the host is infected when it eats the mouse. Coccidia infection is especially common in young animals housed in groups (in shelters, rescue areas, kennels, etc.) This is a common parasite and is not necessarily a sign of poor husbandry.
What Happens Inside the Host?
The sporulated oocyst breaks open and releases eight sporozoites. These sporozoites each finds an intestinal cell and begins to reproduce inside it. Ultimately, the cell is so full of what are called “merozoites” that it bursts releasing the merozoites which seek out their own intestinal cells and the process begins again. It is important to note how thousands of intestinal cells can become infected and destroyed as a result of accidentally swallowing a single oocyst.
As the intestinal cells are destroyed in larger and larger numbers, intestinal function is disrupted and a bloody, watery diarrhea results. The fluid loss can be dangerously dehydrating to a very young or small pet.
How Are Coccidia Detected?
A routine fecal test is a good idea for any new puppy or kitten whether there are signs of diarrhea or not as youngsters are commonly parasitized. This sort of test is also a good idea for any patient with diarrhea. The above illustration demonstrates coccidia oocysts seen under the microscope in a fecal sample. Coccidia are microscopic and a test such as this is necessary to rule them in. It should be noted that small numbers of coccidia can be hard to detect so just because a fecal sample tests negative, this does not mean that the pet is not infected. Sometimes several fecal tests are performed, especially in a young pet with a refractory diarrhea; parasites may not be evident until later in the course of the condition.
How is Coccidiosis Treated?
We do not have any medicine that will kill coccidia; only the patient’s immune system can do that. But we can give medicines called “coccidiostats” which can inhibit coccidial reproduction. Once the numbers stop expanding, it is easier for the patient’s immune system to “catch up” and wipe the infection out. This also means, though, that the time it takes to clear the infection depends on how many coccidia organisms there are to start with and how strong the patient’s immune system is. A typical treatment course lasts about a week or two but it is important to realize that the medication should be given until the diarrhea resolves plus an extra couple of days. Medication should be given for at least five days total. Sometimes courses as long as a month are needed.
The use of sulfa drugs in pregnancy can cause birth defects. Sulfa drug use can also lead to false positive test results for urine glucose.
Can People or Other Pets Become Infected?
While there are species of coccidia that can infect people (Toxoplasma and Cryptosporidium, for example), the Isospora species of dogs and cats are not infective to people. Other pets may become infected from exposure to infected fecal matter but it is important to note that this is usually an infection of the young (i.e. the immature immune system tends to let the coccidia infection reach large numbers where the mature immune system probably will not.) In most cases, the infected new puppy or kitten does not infect the resident adult animal.
Coccidia are a group of protozoan parasites that are extremely common and which infect a
wide number of animal species, including dogs, cats, horses, cattle, goats, sheep and chickens
--- and many other species of animals, as well. The groups of coccidians that infect pets
include Eimeria, Isospora, Hammondia, Toxoplasma and Neospora. Of these, the two that are
usually referred to as "coccidia" infections are Eimeria and Isospora infections and the rest are generally identified by name, as they are more complex parasites and cause specific disease problems. Eimeria species are more commonly involved in infections in cattle, sheep, horses, etc. and Isospora species are most commonly involved in infection in dogs and cats. So for the purpose of the rest of this note, the enteric (gastrointestinal) forms of Isospora are what will be covered.
The first thing that has to be considered is that coccidosis is very common. It is likely that 30 to 50% of puppies have coccidia in their stools at some time during their first few months of life. These may be coccidia from another species that the puppy or kitten has in the digestive tract due to ingestion of stool, such as rabbit feces, squirrel feces or cat feces (in the case of puppies). If this is the case it is unlikely that the puppy or kitten will actually have any clinical disease as a result of ingesting the coccidia. In other cases, a puppy or kitten becomes infected with coccidiosis, produces lots of oocysts of coccidia but never has clinical signs of disease such as diarrhea, loss of appetite, vomiting or failure to thrive. These pets may never show any clinical signs and without signs it is questionable whether they should be treated or not, although I think that almost all veterinary practitioners go ahead and treat for the infection. Isospora species can also be transmitted through ingestion of intermediate hosts, such as infected mice.
Isospora species that affect dogs include Isospora canis, I. ohioensis, I. neorivolta and I.
burrowsi. The species that affect cats include Isospora felis and Isospora rivolta. These
coccidia tend to be pretty species specific, so infection of a puppy or kitten is not thought to be a risk to humans and puppies are not a risk to cats or infected kittens a risk to dogs. It is very likely that if one puppy in a litter has coccidiosis that all puppies are affected. It is extremely difficult to prevent coccidia infections, especially in group situations, so puppies coming from a breeder with coccidia is not an indication of poor sanitation or poor health care practices. It is simply a very common problem.
Coccidia spread when oocysts are shed in the stool of infected pets and then the oocysts are
consumed later by another susceptible dog or cat. Since incredible numbers of oocysts are shed from infected pets, the environmental contamination with coccidia oocysts is severe. Puppies and kittens often show signs of illness, usually watery diarrhea, before there are oocysts in their stools, so it sometimes takes several fecal samples to know if a puppy or kitten is infected. In addition, lots of dogs, cats, puppies and kittens are infected and are shedding oocysts despite having no clinical signs of infection.
Coccidia are easy to find using standard fecal floatation methods for fecal exams and are often present in sufficient numbers to show up if a small amount of stool is smeared on a glass slide, mixed with a small amount of saline and examined.
When Isospora species cause disease the most common form is watery diarrhea that is very
profuse. Many kittens and puppies seem to just leak watery stools as if they have no control at
all over their bowel movements, while others have a more "normal" diarrhea. Without treatment, the diarrhea might last for several weeks. With treatment the diarrhea might last several weeks, too --- but it does seem to cut down some on the duration of the diarrhea to treat affected puppies and kittens. The most commonly used medications are sulfonamide antiseptics, such as sulfadimethoxine (Albon Rx, Bactrovet Rx) given at 55mg/kg of body weight initially and then 27.5mg/kg per day for 4 to 7 days. The medication should be given until two days after symptoms of illness have disappeared. Lots of vets substitute trimethoprim/sulfa combination medications (Ditrim Rx, Tribrissen Rx, Bactrim RX) for this sulfadimethoxine, using a dosage of 15mg/lb of the combined product and this seems to work, too. While it is probably impossible to kill all the coccidia in a puppy with clinical disease using medications, it may help reduce the numbers of organisms that littermates and housemates are subjected to and to shorten the duration of clinical signs.
In some cases it does seem like there is resistance to the sulfanomides. I am not sure if this is actually the case, since it is difficult to tell if the medication is working in the first place.
However, if this is suspected, alternative medications include ampolium (Corid Rx) and
furozolidin (Furoxone Rx).
General cleanliness does not ensure that infections will not occur, but removal of contaminated
stool reduces the potential for infection. The oocysts are supposed to be pretty resistant to most disinfectants and things like steam cleaning or flame guns may be necessary to actually kill the oocysts, which is impractical for most situations. Keeping access to mice down (especially for cats) is also a good idea.
So the direct answers to your questions are that most of the time all littermates are infected. It is not likely that other species will be affected. The organism is spread in the stool, so keeping non-infected pets away from the stool of infected pets is helpful but if they share a common environment it is highly likely that infection will occur. The infection may or may not cause clinical disease and treatment is generally considered to be necessary only for pets showing clinical signs.