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Paper text:
to potentially carry zoonotic diseases , fleas cause skin irritations due to their bites , including in some animals an allergic dermatitis ( the so - called flea allergic dermatitis or fad ) [ 6 , 7 ] . fad is the most common allergic skin disease of dogs and cats , although its frequency varies according to geographical location .
the past twenty years have brought important advances in flea biology as well as better insecticides .
nevertheless , flea control in general , and more specifically in cats with fad , remains a real challenge for veterinarians and owners .
the goal is to minimize flea bites , that is , to minimize the amount of saliva injected by fleas in order to be under the allergic threshold .
a chewable tablet is indicated for the treatment and prevention of flea infestations caused by ctenocephalides felis ; it was first introduced for dogs to the usa market in 2007 after approval by the food and drug administration .
the european commission granted a marketing authorisation valid throughout the european union in 2011 after approval by the european medicines agency .
subsequently , it was approved for cats in usa , canada , and japan in 2012 and in the european union in 2013 .
its excellent efficacy against fleas and its rapid killing effect that are observed in dogs [ 912 ] are also reported in cats [ 13 , 14 ] .
we had the opportunity to observe a colony of fifteen cats , housed strictly indoors and naturally infested with fleas ; it included cats with clinical signs of fad .
we aimed to describe the distribution of fleas in a strictly indoor cat colony composed of fad cats and non - fad cats .
we also aimed to evaluate the efficacy of spinosad used alone , both on the adult flea population and on the skin lesions .
within a laboratory colony of fifteen strictly indoor , adult domestic shorthair cats , receiving no ectoparasiticide , four of them presented with excessive licking and alopecia , which had progressed over the past month .
advice was sought from the dermatology clinics of the small animal hospital of the toulouse veterinary school . clinical examination , test procedures ,
treatment , and followup of the cats were done after obtaining a written consent from the people responsible of the cat colony .
coat brushing had allowed demonstration of flea infestation ( adult fleas and/or flea dirt ) .
tape impressions from the skin surface had not shown evidence of secondary bacterial or yeast infections .
domestic shorthair cats ( 7 females spayed and 8 males neutered ) between 4.7 and 6.7 years of age and weighing from 3 to 4.7  kg were housed in a stone - floored four - room space , measuring 23  m and having an additional surface of 8  m of cat tree furniture .
temperature was maintained at 19  2c and air was renewed 20 times per hour .
cats were vaccinated against feline panleukopenia virus , feline herpesvirus 1 ( fhv-1 ) , and feline calicivirus ( fcv ) and had no medical history .
each animal was submitted to a full clinical examination on days 0 , 15 , 30 , 45 , 60 , and 90 .
skin lesions were scored according to the scoring feline allergic dermatitis lesion severity scale ( scorfad ) .
scorfad reduction was calculated at each time point t using the arithmetic mean of scorfad according to the following formula : scorfad  reduction  ( % ) = 100  ( meanday  0  meant)/meanday  0 .
cats were combed for 10 minutes prior to the treatment ( days 0 , 30 , and 60 ) and additionally on days 15 , 45 , and 90 .
one person handled and restrained gently the cat ; the second combed the cat , quantified the fleas recovered from each comb , and recorded the data . during combing , an extra - fine flea comb ( 11.4 teeth / cm , http://www.easypets.fr )
the method of combing included several strokes of the comb in each area of the animal , each time moving in the same direction , following the pattern of the hair coat .
movement from one part of the cat 's fur to the next was via strokes overlapping each other , so that no area of fur was missed .
after completion of the combing procedure for all body areas , the whole procedure was repeated so that all areas were combed twice .
efficacy was calculated at each time point t using the arithmetic mean numbers of fleas according to the following formula : efficacy  ( % ) = 100  ( meanday  0  meant)/meanday  0 .
all cats received flavored spinosad tablets ( comfortis , eli lilly and company ltd . ,
basingstoke , uk ) at a dosage of 5075  mg / kg on days 0 , 30 , and 60 .
the tablet was first offered to the cat ; in case of nonimmediate voluntary reception , the tablet was given with a pilling device .
the environment was routinely cleaned , but no insecticide or insect growth regulator was applied .
on day 0 , prior to the initial treatment , a total of 60 fleas were collected ( mean : 4  4 , min : 0 , max : 12 ) .
two cats had self - induced alopecia , mainly on the dorsolumbar and dorsal tail regions .
two cats suffered from miliary dermatitis , principally of the dorsum and self - induced alopecia .
the four cats with fad had a scorfad of 6 , 8 , 12 , and 13 and harbored 0 , 2 , 1 , and 0 fleas , respectively .
additionally , very mild lesions were observed on five other cats ( scorfad of 1 or 2 ) ( figure 1 ) .
non - fad cats harbored a total of 57 fleas ( mean : 5.2  4.1 , min : 0 , max : 12 ) .
tablets were taken immediately and voluntarily by 8 , 11 , and 12 cats on days 0 , 30 , and 60 , respectively .
no adverse event was recorded . from d15 to d90 , no fleas could be collected ( 100% efficacy ) .
scorfad was reduced by 40% , 71% , 80% , 89% , and 98% on days 15 , 30 , 45 , 60 , and 90 , respectively ( figure 1 ) .
flea infestation in strictly indoor animals , particularly cats , is frequently overlooked , possibly denied . in a study conducted in 2007 in uk ,
48% of the owners whose pets had signs of an active flea infestation were unaware that their pet had fleas .
cat owners may think that because they have an indoor - only cat , it is impossible for their pet to get fleas .
initially one or two fleas may be introduced from a pant leg , sock , or shoe after the owner had been gardening , walking , and so forth . in multipet households , a dog might be infested during walks .
then , ideal conditions for the life cycle of the cat flea ( relative humidity of 70% and a temperature of between 20 and 30c ) are provided by a modern home environment .
furthermore , cats have such a nomadic sleeping behavior that bed underneath , sills , boxes , suitcases , planter boxes , and tops of furniture are but a few of the places that cats curl up and nap .
most of the time , the infestation level will remain relatively low   due to the feline grooming behavior , making flea identification difficult , especially if there is a flea infestation denial .
this was the case in the present situation with an average of 4 fleas per cat and caregivers who were convinced that flea infestation was not possible .
cats can be secretive and may not be observed grooming or traumatising themselves , increasing owner 's disbelief . in the present study
, non - fad animals harbored 5.2 fleas in average whereas fad cats had only 0.75 fleas .
cats with fad show commonly a very low level of infestation and sometimes do not have fleas at the time of the examination .
these cats remove more fleas by grooming than do nonflea allergic cats since their level of pruritus is much higher .
this confirms that fad should not be ruled out based on the absence of fleas in a cat with skin lesions .
this clinical situation confirms the excellent efficacy and tolerance and the good palatability of spinosad tablets in cats [ 13 , 14 ] . in the present study ,
vomiting had been reported in 14% of the cats recruited in a large field trial .
excessive grooming , which is very common in cats with fad , particularly in cases of self - induced alopecia , might reduce the amount of insecticide present on the skin thereby reducing or delaying its efficacy .
moreover , cutaneous inflammation and secondary cornification disorders ( scaling ) could impair the diffusion of topical products .
consequently , systemic products can be considered as the type of product of choice because the active ingredient is at a sufficient concentration despite overgrooming or a lesional skin .
spinosad acts very rapidly [ 11 , 14 ] , which is adequate in fad animals : a fast - acting product decreases the total duration of the meals , thereby reducing the amount of saliva injected and consequently minimizing the allergenic stimulus .
the spontaneous acceptability was much higher than the data provided in the field study , where 11% of the tablets were taken spontaneously .
the cats included in the present study were particularly easy to medicate ; this could explain the high level of spontaneous acceptability .
clinical improvement took longer than ectoparasiticidal efficacy . even after fleas have disappeared , skin inflammation persists , particularly when there are secondary infections or chronic pruritus .
part of the inflammation is self - induced , notably in cats with their tongues barbed .
furthermore , even if cats are no longer pruritic , hair regrowth takes time . in the current case
, the two cats with miliary dermatitis lesions improved much more rapidly than the cats with self - induced alopecia .
we elected not to use symptomatic relief as there was no secondary pyoderma and discomfort was considered as mild to moderate .
fad should not be ruled out before at least a two - month period of intense flea treatment , particularly in cats presenting with self - induced alopecia . in households with several animals , it is essential to treat all animals , since the clinical unaffected animals ensure the environmental contamination with eggs . within the colony of fifteen cats ,
95% of fleas were collected from the non - fad cats , who harbored in average 5 fleas whereas the fad cats had less than 1 flea per cat in average .
cat flea egg production usually peaks during the night , coinciding with normal sleep periods for indoor pet dogs and cats . as a consequence
, there is a higher density of immature stages in animal resting places , including bedrooms .
we elected not to use any insecticide or insect growth regulator in the environment as the level of infestation was mild and external sources which could bring fleas were absent .
it is usual to recommend flea control in indoor and outdoor environments in addition to treatments on pets [ 7 , 8 ] to eliminate immature stages .
however , modern products , with more rapid - killing effect and more persistent activity , applied on the pet only , may be sufficient to control flea infestation provided that all the animals are treated at the correct dosage and correct intervals .
this is likely to be successful in a restricted environment ( only - indoor pet ) whereas indoor / outdoor pets are at higher risks of exposure to flea life stages present in the environment . in conclusion , this clinical situation illustrated the fact that flea treatment should not be neglected in indoor animals .
cats with fad were much less severely infested than cats without skin lesions ; consequently , even in the absence of fleas fad can not be ruled out .
this clinical situation also confirmed that spinosad given orally at a dose of 5075  mg / kg was very well tolerated , easily accepted , and 100% effective against fleas in naturally infested adult cats .
the aims of the study were ( i ) to describe adult fleas distribution in a strictly indoor cat colony composed of cats with flea allergy dermatitis ( fad ) and non - fad cats and ( ii ) to evaluate the efficacy of spinosad used alone . 
 skin lesions were scored according to the scoring feline allergic dermatitis lesion severity scale ( scorfad ) on days 0 , 15 , 30 , 45 , 60 , and 90 . 
 cats were combed prior to the treatment ( days 0 , 30 , and 60 ) and on days 15 , 45 , and 90 ; collected fleas were replaced on the animals . 
 all cats received flavored spinosad tablets ( comfortis ) at a dosage of 5075  mg / kg on days 0 , 30 , and 60 . 
 cats were fed immediately afterwards . on day 0 , a total of 60 fleas were collected ( mean : 4  4 ) . cats with fad had a scorfad of 6 , 8 , 12 , and 13 and harbored 0 , 2 , 1 , and 0 fleas , respectively . 
 tablets were taken voluntarily by 8 , 11 , and 12 cats on days 0 , 30 , and 60 , respectively . 
 no adverse event was recorded . from day 15 to day 90 , no fleas could be collected . 
 scorfad was reduced by 40% , 71% , 80% , 89% , and 98% on days 15 , 30 , 45 , 60 , and 90 , respectively .