Hospitals & Asylums
New investigational animal drugs for the amelioration of the
WNS and EHM epidemics HA-25-5-11
By Anthony J. Sanders
Notice of claimed investigational exemption for new animal drug
Part I Lamisil AT spray for the treatment of white-nose syndrome in hibernating bats?
Part II Valacyclovir for the treatment of equine herpesvirus myeloencephalophy?
Conflict of Interest with the Deepwater Horizon Overpayment
2011 is global veterinary crisis. First, red wing blackbirds (grackles) fell out of the sky on New Year's Eve in Arkansas, Louisiana and Kentucky,
it appears that the birds died of blunt force trauma - possibly from being hit by a truck. Blackbirds are certainly behaving strangely; three separate
blackbirds swooped low and brushed passed me, as I was walking in the park yesterday. Within days of the grackle die off, thousands of fish
washed up dead in an Arkansas river. Then it was two million fish in the Chesapeake Bay, 150 tons of red tilapia in Vietnam, 40,000 crabs in Britain
and other places across the world. In the past eight months, the USGS has logged 95 mass wildlife die-offs in North America. The list includes 900
some turkey vultures that seemed to drown and starve in the Florida Keys, 4,300 ducks killed by parasites in Minnesota, 1,500 salamanders done in
by a virus in Idaho, 2,000 bats that died of rabies in Texas, and the still mysterious death of 2,750 sea birds in California. On average, 163 such
events are reported to the federal government each year, according to USGS records. Unusual or not the news reports of deadly epidemics of animal
diseases demand a cure. Two ongoing outbreaks in particular could be treated if information regarding effective pharmaceuticals were disseminated.
First, in May 2011 the U.S. Fish and Wildlife Service (FWS) released a National Plan for Assisting States, Federal Agencies, and Tribes in Managing
White-Nose Syndrome (WNS) in Bats caused by the fungus Geomycetes destructans that has taken the lives of over a million hibernating bats in
affected caves. Second, an outbreak of potentially fatal equine herpesvirus myeloencephalophy (EHM) caused by equine herpesvirus-1 (EHV-1) began
at a horse show in Ogden, Utah, April 29-May 8, with at least 33 horses sick around the country. New animal drugs for investigational use for the
treatment of animal epidemics of known etiology are (1) Lamasil AT (micanozole nitrate), or safer and more effective antifungal spray, to sterilize bat
caves in danger of WNS and/or bat weight specific doses of oral Ketoconazole (Nizoral) 200 mg tablets, around 1/100 of 1 mg and (2) Valacyclovir
(Valtrex) 30-40 mg/kg twice to three times daily for 7 days to treat EHM. Sponsors of investigations, are directed to submit in triplicate a “Notice of
Claimed Investigational Exemption for a New Animal Drug” to the U.S. Food and Drug Administration (FDA) under 21CFR§511.1(b)(4).
Part I Lamisil AT spray for the treatment of White-nose syndrome in hibernating bats?
Little brown bats with white-nose syndrome, New York
Credit:
Nancy
Heaslip, New York Department of Environmental
Conservation
White-nose syndrome was first
observed in four caves centered roughly 30 km west of Albany, New York, in the
winter of 2006/2007. Subsequently, over
a million hibernating bats have died.
Overall colony losses at the most closely monitored sites have reached
95 percent within 2 to 3 years of initial detection. As of April 2011, WNS has
been detected in 6 of the 9 species of hibernating bats that occur in the
affected region (Connecticut, Delaware, Indiana, Kentucky, Maryland,
Massachusetts, New Hampshire, New Jersey, New York, North Carolina, Ohio,
Pennsylvania, Tennessee, Vermont, Virginia, West Virginia, and the Canadian
provinces: New Brunswick, Nova Scotia, Ontario, and Quebec). Species known to
be susceptible to WNS thus far are the little brown bat (Myotis lucifugus), Indiana bat (M. sodalis),
northern long-eared bat (M. septentrionalis), eastern small-footed bat (M. leibii),
tricolored bat (Perimyotis subflavus),
and big brown bat (Eptesicus fuscus).
Three additional bat species were found in 2010 that tested positive for the
presence of Geomyces destructans,
the fungus associated with WNS, but not with the pathological invasion of the
skin that is characteristic of the disease. These bats, the gray bat (M. grisescens),
the cave myotis (M.
velifer), and the southeastern myotis (M. austroriparius), were found in Missouri, Oklahoma, and
Virginia, respectively, and their discovery could portend the spread of WNS
into new regions of the southeastern and western U.S., and beyond, in the near
future. White-nose syndrome was named
for the visible presence of a white fungus around the muzzles, ears, and wing
membranes of affected bats. Scientists recently identified a previously unknown
species of cold-loving fungus (G. destructans) as a consistent pathogen causing skin
infection in bats at affected sites. This fungus thrives in low temperatures
(5-14º C; 40-55º F) and high levels of humidity (>90 %), conditions
characteristic of many bat hibernacula. Pathologic findings thus far indicate
that such fungal infections can be detected as early as October, and it is
hypothesized that bats affected by WNS arouse from hibernation more frequently,
and/or for longer periods than normal, and are prematurely expending the fat
reserves they rely on for winter survival.
List of compounds from Spectrum Plus Compound Library found highly effective at growth
inhibition of Geomyces destructans
at 6°C and 15°C
# |
Compounds |
Abbreviation |
Chemical Description |
Mode of action |
1 |
Econazole nitrate |
ECO |
Imidazole class |
Inhibition of 14
<alpha>-sterol demethylase and the subsequent
blockage of ergosterol biosynthesis; antifungal
drug for Athlete's foot, ringworm, etc. |
2 |
Sulconazole nitrate |
SCO |
Imidazole class |
Inhibition of 14 <alpha>-sterol
demethylase and the subsequent blockage of ergosterol biosynthesis; antifungal drug for treatment of
Athlete's foot, ringworm, etc. |
3 |
Phenylmercuric acetate |
PMA |
Organomercury compound |
Fungicide |
4 |
Chloroacetoxyquinoline |
CAQ |
Hydroxyquinoline derivative |
Antibacterial, antifungal |
5 |
Fluorouracil |
5-FU |
Pyrimidine analog (heterocyclic
aromatic compound) |
Noncompetitive inhibition of thymidylate synthase; synthesis of aberrant mRNA and the
subsequent inhibition of protein synthesis; cancer drug |
6 |
Pyrithione Zinc |
ZnP |
Coordination complex of Zinc |
Antifungal & antibacterial
agent |
7 |
Ciclopirox olamine |
CPX |
Synthetic compound
(6-cyclohexyl-1-hydroxy-4-methylpyridin-2(1H)-one) |
Topical antifungal for superficial
mycoses |
8 |
Digitonin |
DIG |
Glycoside (from Digitalis purpurea) |
Detergent, Biomembrane
disruptor |
9 |
Chloroxine |
CHL |
Halogenated hydroxyquinoline |
Antibacterial, Antifungal |
10 |
Benzalkonium chloride |
BZCL |
Quaternary ammonium group |
Antiseptic, biocide, surfactant, |
Source: Chaturvedi
S. et al. Antifungal Testing and High-Throughput Screening of Compound Library
against Geomyces destructans,
the Etiologic Agent of Geomycosis (WNS) in Bats. PLoS One. 2011
The U.S. Fish and Wildlife Service
(FWS) has
temporarily blocked public access to many caves and mines as a preventative
measure aimed at stopping further spread of the disease by humans and created a White Nose Syndrome (WNS) website to coordinate the
federal response to the epidemic under the National Environmental Policy Act,
the Endangered Species Act, and the Federal Cave Resources Protection Act. The National Environmental Policy Act of 1969
declares a national policy which encourages productive and enjoyable harmony
between man and environment; promotes efforts which prevent or eliminate damage
to the environment and biosphere and stimulate the health and welfare of man,
and enriches the understanding of the ecological systems and natural resources
important to the Nation under 42USC(55)§4321
The Endangered Species Act of 1973 provides
for interagency cooperation in consultation with the Secretary of the Interior
regarding agency actions not likely to jeopardize the
continued existence of any endangered species or threatened species or result
in the destruction or adverse modification of habitat of such species which is
determined by the Secretary, to be critical under 16USC(35)§1536. The
Federal Cave Resources Protection Act of 1988 prohibits
anyone who without authorization disturbs, defaces, mars, alters, removes or
harms any significant cave or alters the free movement of any animal or plant
life into or out of any significant cave located on Federal lands under 16USC(63)§4306. The Secretary of Interior must approve human
intervention with antifungal sprays in bat caves before it is tried in
federally protected caves by the FWS WNS clinical researchers. Information on the whereabouts of caves is
kept confidential under 16USC(63)§4304 without the management of the Secretaries
under 16USC§4303. In the meanwhile the Fish and Wildlife
Service (FWS) can disinfect the bat caves in as few months as Lester M.
Crawford D.V.M. Ph.D. was Commissioner of the FDA, 7/18/2005 -9/23/05, before
being sentenced to three years’ probation and $90,000 fines on 2/28/07 for
lying about stocks that might pose a conflict of interest with the FDA and
finally get some antibiotics for their eternal Director Sam
Hamilton, who died of a heart attack in February 2010 as well as Allegra for
the FWS National Forensic Laboratory permanently quarantined under flu sign,
and Allegra-D for the allergy sufferers in the field.
Part II Valacyclovir for the
treatment of Equine herpesvirus myeloencephalophy?
Interstate equine herpesvirus myeloencephalophy outbreak as of May 21, 2011
Source: Horsetalk. Seven horses dead from EHV-1, 33 confirmed
cases. May 21, 2011
The recent outbreak of neurologic disease equine herpesvirus myeloencephalophy (EHM), caused by equine herpesvirus-1 (EHV-1), appears related to initial cases at a horse show in Ogden, Utah, April 29-May 8. As of May 22 there have been 33 confirmed cases, of which seven have died or been euthanized, 32 were at the event in Ogden EHM causes the death of 10-15% of afflicted horses. Equine herpesvirus-1 (rhinopneumonitis) also causes upper respiratory infections in horses and abortions in pregnant mares. The neurologic disease (EHM) affects the horse's brain and spinal cord and can result in paralysis and death. Clinical signs include incoordination (ataxia) that can progress to the inability to stand, lower leg swelling, the inability to urinate or pass manure, urine dribble, and reduced tail tone. The EHM virus is the most infrequent and potentially devastating form of EHV-1 infections and is difficult to treat once neurologic symptoms are observed. EHV vaccines are not effective against the neurological form of the disease. EHV is extremely contagious, and many horses may become latently infected-infecting other horses but may never display symptoms themselves. The EHV-1 virus is transmitted through both direct and indirect contact with infected horses, primarily through nasal secretions and can spread via water buckets, feed tubs, tack, grooming equipment, and even the hands and feet of people caring for affected animals. Follow proper biosecurity measures around the farm to ensure the best protection against an outbreak. Isolate all infected horses, and limit movement of horses on and off the premises. New arrivals should be isolated for three weeks. Grooms should work with isolated animals last. Make sure horse professionals wear clean clothes and park their vehicles away from the horses. Minimum isolation precautions include the prevention of fomite transmission through ‘nose to nose’ contact or the indirect transmission of infective nasal secretions by mechanical transmission through stable employees or horse owners. All horse vans and trailers should be thoroughly cleaned and disinfected after use. The Horse Protection Act of 1970 provides each horse owner, exhibitor, trainer, or other person having custody of, or responsibility for, any horse at any horse show, horse exhibition, or horse sale or auction, shall allow any Animal and Plant Inspection Service (APHIS) representative to reasonably inspect, detain and treat such horse Equus caballus under 9CFRI§11.4.
Algorithm to establish a rapid ante-mortem laboratory diagnosis of EHV-1 infection in a horse with neurological deficits
Source:
Pusterla, N. et al.,
Equine herpesvirus-1 myeloencephalopathy: A review of
recent developments, The Veterinary Journal. August 8,.
2008.
The
incubation period of EHV-1 infections is typically one to two days, with
clinical signs and fever then occurring over the following 10 days. The
neurologic form of the disease typically occurs eight to 12 days after the
primary infection. Horses can shed the virus for up to 21 days after they stop
showing clinical signs. Disinfect all areas where the disease might have
spread, including halters, lip chains, and feed buckets. Please report any cases or suspect cases to
your state/provincial animal health department as soon as possible. The multifocal
distribution of lesions caused by neurotropic EHV-1 strains results in
considerable variability in clinical presentation and a number of conditions
should be included in the differential diagnosis. These include equine protozoal myeloencephalitis,
cervical stenotic myelopathy, cervical vertebral
instability (‘wobbler’ syndrome), cervical vertebral fracture or other central
nervous system (CNS) trauma, neuritis of the cauda equina, fibrocartilaginous
infarction, aberrant parasite migration, degenerative myelopathy, togaviral encephalitis (flaviviruses,
alphaviruses, West Nile Virus), rabies, botulism, CNS
abscessation and a variety of plant and chemical
intoxications. The sudden onset of
neurological signs, including ataxia, paresis and urinary incontinence, the
involvement of multiple horses and a recent history of fever, abortion, or
respiratory disease in an affected horse population are sufficient to make a
tentative diagnosis of EHM. Pyrexia
(fever) has consistently been reported as the major clinical sign before the
onset of neurological disease but is frequently not present by the time
neurologic deficits become apparent. A
diagnosis can be supported by ruling out other conditions, demonstrating xanthochromia and an elevated cerebrospinal fluid (CSF)
protein concentration, in identifying or isolating EHV-1 from the respiratory
tract, buffy coat or CSF and in demonstrating a 4-fold increase in antibodies
using serum neutralizing (SN), complement fixation (CF), or ELISA tests
performed on acute and convalescent serum from affected or in-contact horses
7–21 days apart. Virus isolation is
considered the ‘gold standard’ test for a laboratory diagnosis of EHV-1
infection and should be attempted, especially during epidemics of EHM, using
real-time PCR (RT-PCR). Results of virus
isolation may, however, be negative because the peak of virus shedding has
usually passed by the time neurological signs appear. Interpretation of serology is complicated by
the fact that the SN, CF and ELISA tests in use at most diagnostic laboratories
do not distinguish between antibodies to EHV-1 and -4. A specific ELISA based
on the C-terminal portion of glycoprotein G of both viruses has been developed
and should prove valuable in the investigation and management of disease
outbreaks (Pusterla et al ’08).
Drugs
Commonly Used in the Treatment of equine herpesvirus-1 myeloencephalopathy
Drug |
Dosage |
Regiment, route and duration of treatment |
Anti-inflammatories |
|
|
Flunixin meglumine |
1.1 mg/kg |
Twice daily, PO, IM or IV for 3-5
days |
Dexamethasone |
0.05-0.25 mg/kg |
Daily, IM or IV, for 3 days |
Prednisolone acetate |
1-2 mg/kg |
Daily PO for 3 days |
Free-radical scavenger |
|
|
Dimethyl sulfoxide
(DMSO) |
0.5-1 mg/kg |
Daily, IV or PO for 3 days |
Antimicrobials |
|
|
Trimethoprim-sulfamethxazole |
30 mg/kg |
Twice daily PO for 5-7 days |
Ceftiofur |
2.2 mg/kg |
Once to twice daily, IM or IV for
5-7 days |
Antiherpetics |
|
|
Acyclovir |
10-20 mg/kg |
Three to five times daily for 7
days |
Valacyclovir |
30-40 mg/kg |
Twice to three times daily for 7
days |
Source:
Pusterla, N. et al.,
Equine herpesvirus-1 myeloencephalopathy: A review of
recent developments, The Veterinary Journal. August 8, 2008
The treatment of EHM is challenging and
the outcome is directly related to the severity of the neurological deficits in
the affected horse. Rest and relaxation
in isolation are the basic treatment for EHM.
There are 17 vaccines containing an EHV-1 antigen marketed in North
America or Europe however compelling evidence for their efficacy in preventing
EHM is lacking and no vaccine is currently licensed to offers protection
against the development of EHM. The Army 183 strain of EHV-1 has been shown to
carry the D752 polymerase gene mutation associated with an increased risk of
inducing neurological disease. The EHV-1
vaccines currently marketed in North America include two single-component
inactivated vaccines, namely Pneumabort K-1B (Fort
Dodge) and Prodigy (Intervet), that are licensed for
the prevention of abortion in pregnant mares, several multi-component
inactivated vaccines (Prestige, Intervet; Calvenza, Boehringer Ingelheim; Innovator, Fort Dodge) and one MLV vaccine (Rhinomune, Pfizer) for the prevention of respiratory
disease induced by EHV-1 and -4. The
significant reduction in viral shedding observed in vaccinated horses provides
reasonable justification for booster vaccination of non-exposed horses at risk
for infection in order to reduce viral shedding in the event of exposure to
EHV-1.Acyclovir, a synthetic purine nucleoside analog with inhibitory activity
against several human herpesviruses, has recently
been used in the treatment and prevention of EHV-1 infection. The efficacy of
acyclovir has been demonstrated in vitro with inhibitory concentrations of
0.3–7.0 lg/mL effective against neurotropic and
non-neurotropic EHV-1 isolates. Another
nucleoside analog, valacyclovir, used to treat Herpes
Simples I in humans, may be even more effective in both the treatment of
EHV-1-affected horses and in the prophylaxis and containment of EHV-1
outbreaks. Because of the high risk of
developing cystitis and other secondary bacterial infections, it is advisable
to administer broad-spectrum antimicrobials such as potentiated sulfonamides or
ceftiofur, particularly when accompanying
corticosteroid treatment. Experimental
studies are needed to define the appropriate doses of valacyclovir
and acyclovir in horses and to document their efficacy in the treatment of
EHM. Valacyclovir
(Valtrex) twice to three times daily is probably the
most effective treatment for EHV-1(Pusterla et al
’08).
Conflict of Interest with the Deepwater
Horizon Overpayment
Oiled gannet being cleaned with
Dawn Hospitals &
Asylums would like to declare only the federal half of a heartfelt conflict of
interest with the Fish and Wildlife Service (FWS) pre-dating the Deepwater
Horizon Overpayment, that has been implicated by the Secretary of Interior as a
possible human cause of the multi-vortex tornadoes that took at least 123
lives, sent 750 to the hospital and will cost insurers $1-3 billion, in Joplin,
Missouri, on May 22, the deadliest tornado since 1925. The April storms caused $3.7 billion to
$5.5 billion in insurance industry losses.
Flooding is likely to cost insurance another $5 billion. In national disasters such as these, federal
disaster assistance is expected to match private insurance by paying all
hospital bills of uninsured people, unemployment insurance and low interest
reconstruction loans, as well as ensure there is an effectively public employment
response to the national disaster. The federal government is however morally
bankrupt. In Flood and Tornado
Insurance from the Deepwater Horizon Overpayment it was found that the FWS has declared
Gulf seafood safe to eat and this means that the +/-$40 billion BP settlement,
above the $20 billion requested by the author, who was wronfully evicted and
robbed $300 rent the day the Response Solution was filed, is an overpayment,
and should be diverted to disaster relief for flood and tornado victims under 33USC(40)§2718.
Funds allocated to Department of the Interior
for Gulf cleanup, that are now unecessary, can be transferred to the adoption
of an antifungal regime for the treatment of WNS hibernating bats and other
worthy projects. The Department of the
Interior has bathed every waterfowl in the Gulf with Dawn, now it is time for
the FWS to disinfect every bat cave with Lamisil AT. In the future the Departrment of the Interior
might be able to defray the federal costs of domestic natural disasters with
fines of the liable industries, reasonable enough to not cause consumer prices
to rise, yet industrially responsible, and repeal Bush’s armed hideout in the
wilderness at 16USC(1)(I)§1a-7b
after (a)(3). The savings make one
speculate that the Federal Emergency Management Agency (FEMA) might prefer to be overseen by the
Department of Interior, leaving only an international office with U.S.
Customs. As a disclaimer to any
political motive that might impinge upon the neutrality of medicine, this article
has been written exclusively with the intention to expand access to unapproved
therapies whereas the probable risk from the investigational drug is not
greater than the probable risk from WNS and EHM under 21USC(9)(V)(E)§360bbb(b)(1).
Bibliography
Antifungal Dog, Cat & Pet
Health Products at Discount Prices. 2002-2011 DRUGINFO@fda.hhs.gov, ocod@fda.hhs.gov
Birds and Fish Dying Around the World. EU Times. First posting January
6, 2011
Chaturvedi S. et al.
Antifungal Testing and High-Throughput Screening of Compound Library against Geomyces destructans,
the
Etiologic
Agent of Geomycosis (WNS) in Bats. PLoS One. March 2, 2011; 6(3)
vishnu@wadsworth.org
Pusterla, N. et al.,
Equine herpesvirus-1 myeloencephalopathy: A review of
recent developments, The Veterinary Journal. August 8, 2008. npusterla@ucdavis.edu
Sanders,
Marcel DVM. Telephone onsultation
regarding the use of antifungals and acyclovir. Hospitals
& Asylums. May 25, 2011
Credit: IBR Photo
Sanders, Tony J. Best
Medicine Monographs. Hospitals & Asylums. HA-14-2-11
Sanders, Tony J. Flood and Tornado Insurance from the Deepwater
Horizon Overpayment. Hospitals & Asylums HA-16-5-11
Sanders, Tony J. Ruling Regarding the
Threatened Endangered Species Act. Hospitals & Asylums HA-8-10-05
United
States Fish and Wildlife Service. A National Plan for Assisting States, Federal Agencies, and Tribes in
Managing White-Nose Syndrome in Bats. May
2011, Jeremy_Coleman@fws.gov
Veterinarian Advice
Encouraged in Wake of EHV-1 Outbreak. The Horse. Article # 18272. May 22, 2011
White-Nose Syndrome (WNS) Threatens the Survival of
Hibernating Bats in North America. United States Geological Survey. cryanp@usgs.gov, AskFORT@usgs.gov
Hibernating
species |
Long-distance
Migrants/Non-hibernating species |
1 Myotis auriculus
Mexican long-eared bat 2 Myotis austroriparius
Southeastern bat 3 Myotis californicus
California bat 4 Myotis ciliolabrum
Western small-footed myotis 5 Myotis evotis
Western long-eared bat 6 Myotis grisescens
Gray bat 7 Myotis keenii
Keen's bat 8 Myotis leibii
Eastern small-footed bat 9 Myotis lucifugus
Little brown bat 10 Myotis occultus
Occult bat 11 Myotis septentrionalis
Northern long-eared bat 12 Myotis sodalis
Indiana bat 13 Myotis thysanodes
Fringed bat 14 Myotis velifer
Cave bat 15 Myotis volans
Long-legged bat 16 Myotis yumanensis
Yuma bat 17 Nycticeius humeralis
Evening bat 18 Parastrellus hesperus
Canyon bat 19 Perimyotis subflavus
Tricolored bat 20 Corynorhinus townsendii
Townsend's big-eared bat 21 Corynorhinus rafinesquii
Rafinesque's big-eared bat 22 Eptesicus fuscus
Big brown bat 23 Antrozous pallidus
Pallid bat 24 Euderma maculatum
Spotted bat 25 Idionycteris phyllotis
Allen's big-eared bat |
1 Mormoops megalophylla
Ghost-faced bat 2 Choeronycteris mexicana
Mexican long-tongued bat 3 Leptonycteris nivalis
Greater long-nosed bat 4 Leptonycteris yerbabuenae
Lesser long-nosed bat 5 Macrotus californicus
California leaf-nosed bat 6 Lasionycteris noctivagans
Silver-haired bat 7 Lasiurus blossevillii
Western red bat 8 Lasiurus borealis Eastern red bat 9 Lasiurus cinereus
Hoary bat 10 Lasiurus ega
Southern yellow bat 11 Lasiurus intermedius
Northern yellow bat 12 Lasiurus seminolus
Seminole bat 13 Lasiurus xanthinus
Western yellow bat 14 Eumops floridanus
Florida bonneted bat 15 Eumops perotis
Greater mastiff bat 16 Eumops underwoodi
Underwood's mastiff bat 17 Molossus molossus
Pallas' mastiff bat 18 Nyctinomops femorosaccus
Pocketed free-tailed bat 19 Nyctinomops macrotis
Big free-tailed bat 20 Tadarida brasiliensis
Brazilian free-tailed bat |