Feline heartworm disease: A'Rubik's-cube-like' diagnostic and therapeutic challenge.

Feline heartworm disease presents a unique diagnostic, therapeutic, and preventive challenge for veterinarians. Due to the elusive clinical nature and peculiar physiopathology of heartworm infection in cats, a multistep diagnostic process is mandatory. Clinical signs may be absent or atypical. At the present time there is no single ante mortem diagnostic test that can reach a high level of sensitivity for feline heartworm infection. The most efficient approach for the diagnosis of feline heartworm disease is based upon a synergic association of several tests: thoracic radiography and serum antibody tests for rising index of suspicion, and echocardiography and serum antigen tests for confirming the infection. Other tests should be considered of secondary importance, even if they can help to support the diagnosis. Treatment of feline heartworm disease is typically based on clinical signs, as adulticidal therapy is associated with a high rate of complications and cats frequently self-cure. Chemoprophylaxis, knowledge of the biology of the parasite, and a high index of suspicion seem to be the most important tools for combating feline heartworm disease.