NOTOEDROSIS IN A HOUSEHOLD CAT-CASE REPORT

Th is paper describes a rare case of severe notoedrosis (notoedric mange) in a household cat from the suburban region of Banja Luka, Bosnia and Herzegovina. According to history, the male cat was in direct contact with stray kitten which had dermatological disorder. Th e examination of the skin revealed an intensely pruritic and hyperkeratotic dermatitis with typical scabby appearance. Deep scarifi cation samples were collected from the altered skin area and macerated in 10% KOH. Th e microscopic examination revealed mites from genus Notoedres, later identifi ed as Notoedres cati according to the morphological shape and size. Th e aff ected cat was treated with ivermectin 0.4 mg/kg, subcutaneously, two times with 7 day intervals. Th e fi rst follow-up physical examination was done aft er seven days. Th is control showed that pruritic changes began to disappear. Th is case report confi rms the presence of Notoedres cati in the cat population in Bosnia and Herzegovina.


INTRODUCTION
Notoedrosis or notoedric feline mange is a rare but potentially fatal disease of domestic and wild felids caused by obligate sarcoptic mite species Notoedres cati (Foley et al., 2016). Members of the genus Notoedres are related to the Sarcoptes genus, but they diff er with regard to some morphological characteristics such as shape or development of setae so that these traits were initially suffi cient to separate mites into individual genera (Foley et al., 2016). Notoedres cati is extremely contagious, and it spreads rapidly via direct contact among cats, other mammals (hedgehogs, guinea pigs, European rabbits) and humans (Foley et al., 2016;Klompen, 1992). Notoedric mange was documented in dogs (Leone, 2007) but there are scarce data explaining how dogs can serve as defi nitive hosts for Notoedres cati or if dogs can serve as a source of infection for cats in the transmission chain. It is accepted that Notoedres cati has a cosmopolitan worldwide distribution in felid population with several reported endemic foci in North and South America; however, epidemiological studies on mite distribution and mange prevalence are scarce (Foley et al., 2016). So far, a limited number of clinical case reports indicate that Notoedres cati is present and widespread in Europe (Foley et al., 2016). In the Balkans, Notoedres cati was reported in stray cats in Slovenia (Rataj et al., 2004), Bosnia and Herzegovina (Vuković, 1959), Greece (Lefk aditis et al., 2015) and rabbits in Serbia (Ilić et al., 2018). In today's small veterinary practices, clinical cases of notoedric mange can be rarely seen because the current use of 'new' antiparasitic drugs and indoor keeping of domestic cats reduced the prevalence of this skin disease.
Th is case report describes clinically manifested notoedrosis (notoedric feline mange) in a household domestic cat from the suburban region of Banja Luka, Bosnia and Herzegovina.
In mid-February 2019, a male, one-year castrated domestic shorthair cat was brought to the veterinary practice "BL vet" Banja Luka for a physical and dermatological examination due to intense and frequent itching. Th e cat lived in a house, but it used to go outdoors regularly and was oft en in direct contact with other stray cats in the area of Rakovačke bare (44.796082; 17.183279), Banja Luka. According to the owner, 14 days before he went on a business trip, he noticed that the cat was in direct contact (they oft en lay together outside) with the stray kitten with an advanced skin disorder. Aft erwards (approximately 5 -10 days) the cat began to scratch itself constantly around the head and ears until the fi rst lesions appeared. Th ere was no history of vaccination and deworming of the owned cat.
Th e physical examination revealed good body condition and mild lethargy with normal respiration, heart rate and body temperature. Visible gingival mucosa and conjunctiva were mildly anaemic. Th ere were indications of mild dehydration. Th e skin was dry and dull with the hair coat of poor quality. Alopecia and secondary scratches were present on the skin of the ears, head and face (Figure 1.). Due to intense pruritus, scales and crusts on the face, ear pine, head and front legs were observed. Pruritus was intense in the periocular area so that the eyes were sometimes closed during the episodes of scratching and consequent self/mutilation dermatitis. Th e reactive skin on the head was hyperkeratotic, hyperpigmented/grey of scabby appearance (Figure 2). Aft er clinical and dermatological examinations, clinical suspicion to notoedric mange was established. According to Hellmann et al. (2013), skin lesions were scored as 3 rd -grade ones -severe lesions aff ecting an area wider than the region of the head, severe alopecia, a thick/crusty and scabby appearance of the skin, intensive scratching, inducing to self-trauma injury.
Several deep skin scrapings from the altered skin area of ear pine and head were taken with a scalpel blade. Th e collected skin material was macerated in 10% KOH (potassium hydroxide) and observed under the microscope (4x, 10x, 20x, 40x) in the veterinary practice "BL vet". Th e microscopic examination revealed a high number of adults and eggs of small burrowing mites from the family Sarcoptidae. At higher magnifi cations, oval idiosoma with longer front legs, short pretarsi with long pedicel and terminal sucker (p), long bristle or terminal setae on the third and fourth leg were observed in female mites -Tse ( Figure 3). At the dorsal surface, the idiosoma had concentric, fi ngerprint-like striations (St), the anus surrounded by blunt spines (Sp) and dorsal setae (Se) (Figure 4). According to the morphological and morphometric examinations (Bowman, 2008;Klompen, 1992) the defi nitive diagnosis was Notoedres cati. Th e aff ected cat was treated with ivermectin 0.4 mg/kg, subcutaneously, in 7 days intervals. In addition, dexamethasone 0.2 mg/kg, intramuscularly, was administered. Th e fi rst follow-up physical examination was done aft er the fi rst seven days. Th e severe pruritus decreased and the skin lesions started to heal, and hence the treatment with ivermectin was repeated using the same dose to fi nishing the treatment protocol. No adverse eff ects of ivermectin were observed in this case. No further follow-up examinations of the cat were performed.

DISCUSSION
Th e occurrence of notoedrosis in household cats is extremely rare in Bosnia and Herzegovina, as evidenced by the fact that the last written evidence of its occurrence dates back to 1959 (Vuković, 1959). In this fi rst report, there was no precise information on the clinical impact of Notoedres cati to cats and other hosts; however, the author noticed only a low prevalence of mites in carnivores (Vuković, 1959). Th is report suggests that this mite species is still present in the population of domestic cats and that it can cause severe disease in cats -especially among stray animals without regular monitoring of health condition.
Given the data obtained from the anamnesis in this case, it can be assumed that the current mite infection in the cat was probably developed as a consequence of direct contact with a stray kitten. Th erefore, it is possible that the disease is present in a wider area of this part of the city. In order to confi rm the suspicion of potential spread of this parasite it is necessary to conduct an extensive epidemiological investigation not only in Banja Luka but in a wide area of the country.
Earlier surveys suggest that subclinical infection with Notoedres cati is possible, especially in stray cats (Rataj et al., 2004). Th e advanced infection found in our case is less common in the literature and the fact is that this condition, if left untreated, can cause serious health disorders and, in some cases, the death of diseased animals (Hellmann et al., 2013). Th e clinical manifestations of the disease described in the literature can be divided into several degrees in relation to the distribution of lesions (Hellmann et al., 2013). In the described case, the established degree of the lesion is described as extremely "diffi cult" and "advanced". Th ere are several strategies for feline scabies therapy that mainly depend on the availability of active antiparasitics and the severity of the disease. Th e systemic use of ivermectin administered in our case was oft en implemented in the treatment of feline mites (Sampaio et al., 2017). It should be noted that, in the meantime, new "spot-on" formulations of safer antiparasitics based on imidacloprid 10% / moxidectin 1% for cats have been developed that are more accessible on markets (Hellmann et al., 2013). Ivermectin is toxic to kittens (Kirkpatrick and Megella, 1987), which must be taken into account when selecting the therapy. Supportive therapy with corticosteroids and antibiotics is justifi ed in severe cases to reduce intense itching and prevent secondary pyoderma. Dexamethasone was applied in our case due to intense itching which could lead to self-mutilation.
Th is case represents a rare description of notoedrosis in a household cat, and confi rms the presence of this 'forgotten' parasite in the territory of Bosnia and Herzegovina. In daily clinical practice, deep skin scarifi cation samples should be taken from cats with manifest pruritus and tested for the presence of Notoedres cati.