Susan Little, DVM, PhD, Diplomate ACVM (Parasitology), and Lindsay Starkey, DVM
The cat flea, Ctenocephalides felis, readily feeds on cats, dogs, humans, and other animals, causing local pruritus, allergic reactions and, in severe infestations, anemia.1
Fleas are particularly troublesome because populations are quickly established in homes and kennels where constant sources of nutrition—pets—are readily available.
Eggs, larvae, or pupae comprise the majority of fleas in an infestation (Figure).2 Once immature stages are present, they may continue to emerge for weeks to months, despite control of adult fleas.2 Flea populations can persist indefinitely when untreated pets or other animals are present, creating a constant source of infestation to pets and humans.
Figure. Immature stages of fleas, including eggs (A), larvae (B), and pupae (C), can provide a continuous, long-term source of reinfestation for pets in the home.
Fleas are also a major source of disease. Pets infested with cat fleas have been associated with transmission of an increasing number of infections, including those that cause zoonotic disease.3 Infections may be transmitted by:
- Flea bites
- Flea frass (feces)
- Fleas ingested during grooming.
Infectious agents transmitted by cat fleas include:
- Bartonellosis (Bartonella henselae and other Bartonella species)
- Murine typhus and other rickettsial infections (Rickettsia typhi and R felis)
- Hemotropic mycoplasmosis (Mycoplasma haemofelis and Candidatus M haemominutum)
- Tapeworm (Dipylid ium caninum).
The most well-known form of bartonellosis in humans is Bartonella henselae infection (cat scratch disease). Infected individuals, usually children, develop fever and regional lymphadenopathy after a cat scratch or bite.
- The role of fleas in transmitting B henselae between cats is well established; transmission of other Bartonella species to cats, dogs, and wildlife hosts is also likely.4,5
- Fleas feeding on bacteremic animals shed the organisms in their feces; the bacteria-laden frass is transferred to claws and teeth during grooming, resulting in infection if a human is bitten or scratched.6
- Other disease manifestations have been associated with bartonellosis in recent years, including arthropathies, myalgia, and granulomatous hepatitis.7-9
While rickettsial infections are commonly considered tick borne, some pathogens are transmitted by fleas.
- Rickettsia typhi is responsible for cases of murine (flea-borne) typhus reported each year in humans from Texas, California, and Hawaii.10
- Infection involves opossum reservoir hosts and C felis infestations in pets.11,12
- Both flea bites and inhalation of flea frass are considered likely sources of human infection13; affected humans develop rash, fever, headache, and muscle pain.12
- Rickettsia felis is a more recently identified organism that has been found worldwide in C felis populations and it is associated with murine typhus-like illnesses in humans.14,15
- Mycoplasma haemofelis is another agent widely thought to be transmitted by cat fleas.16
- Infections can cause feline infectious anemia—characterized by severe anemia, anorexia, and lethargy.
- The disease is more common in immunosuppressed cats.17,18
- “Candidatus Mycoplasma haemominutum”, a related agent, appears less pathogenic.
- Anemia in cats with “Candidatus Mycoplasma haemominutum” is usually mild, if it occurs at all, even when co-infections are present.
- A number of cases have been reported in cats infected with feline leukemia virus (FeLV).18,19
Infection with feline hemoplasmas is more common in male cats and cats with concurrent feline immunodeficiency virus (FIV) or FeLV.20 Fleas collected from infected cats harbor the bacterium, but experimental transmission studies have not yet been successful, leading some to suspect that transmission may occur through another route, such as bite wounds from fighting.18,21,22
Dipylidium caninum Infection
Dipylidium caninum (tapeworm) is another common infection vectored by fleas. Dogs and cats are readily infected upon ingestion of fleas containing cysticercoids while grooming, with prevalence rates as high as 62% of dogs and 22% of cats.23
- While not considered pathogenic, D caninum infections are aesthetically unpleasant for the owner as proglottids are often found on the perianal region or in the home environment.
- Effective treatment of D caninum infection requires:
1. Cestode treatment
2. Diligent flea control.
Treatment of both fleas and cestodes prevents re-infection of pets and reappearance of proglottids.1
- Human infection with D caninum (due to ingestion of fleas containing cysticercoids) is commonly reported, most often in children, and may be confused with pinworms.24-26
FLEA CONTROL CHALLENGES
One reason flea infestations continue despite attempted control efforts is the presence of untreated pets in the home environment.
- Some clients treat a favorite indoor dog, but another dog that resides primarily outdoors or only visits occasionally remains untreated.
- Similarly, owners may treat their dogs but fail to implement flea control for their cats, especially those that only occasionally go outdoors.
- Pets of roommates, visiting family or friends, or those living in adjacent condominiums or apartments can continually expose treated pets to fleas.
Untreated pets seed the environment with eggs, creating a constant source of newly-emerged fleas that leads to failure of flea control.27
Wildlife, Strays, & Roaming Pets
Although many home owners are unaware of their presence, flea-infested wildlife, strays, and roaming pets contribute to flea burdens around homes.27,28 These flea-bearers include:
- Peridomestic wildlife, such as opossums, often take refuge in crawl spaces or beneath porches and decks.
- Raccoons or foxes investigate the trash on a nightly basis.
- Stray or feral cats hunt around the neighborhood.
- Neighbors’ unruly dogs visit other pet owners’ lawns.
Areas where many animal populations mingle—neighbors’ homes, dog parks, boarding kennels, and camp sites—provide an excellent opportunity for newly-emerged adult fleas to find food sources, such as pet dogs, and ultimately create an infestation in the home.
Simply put: fleas are ubiquitous. However, measures can be taken to protect pets from these voracious insects.
PERSISTENT FLEA CONTROL
The vast majority of a home’s fleas—eggs, larvae, and pupae—resides in carpets, pet beds, and furniture.2 Adult fleas on the pet account only for about 5% of the overall flea population.
Stages of Fleas
- Eggs and larvae are usually concentrated in areas where pets spend most of their time. While these stages can be killed, they may be difficult to reach as they are often buried in carpet, upholstered furniture, or cracks and crevices, such as grooves in a hardwood floor.
- Pupal stages are very difficult to destroy with insecticides and can last for months in the environment, waiting for an opportunity to start an infestation.29
- Newly emerged adult fleas feed on pets and produce more offspring, creating or maintaining an infestation, when flea control is not consistently applied every month.
Flea Control Products
A number of highly effective flea control products are available in the U.S.
- Adulticides are compounds that kill adult fleas on treated pets; some compounds also kill developing larvae within the egg. Adulticides include:
- Insect growth regulators and insect development inhibitors prevent normal development of eggs and larvae, killing developing stages.30 Examples include:
- Combining adulticides with compounds that kill developing flea stages is recommended to ensure environmental infestations do not become established.29
However, the most important component of any flea control strategy is consistent use of control products.
- In ideal conditions of warmth and humidity, a fairly moderate flea infestation that continues for days to weeks can lead to environmental contamination with eggs, resulting in emergence of hundreds of fleas each day.
- When conditions are less than ideal, such as clean, dry home environments, or in the winter months when air is drier and colder, most larvae are killed by desiccation and starvation; however, brief breaks in flea control still allow continued infestations.31
Many clients believe that flea control is not necessary during winter. It is true that all life stages of fleas are killed when temperatures fall below freezing (30.2°F or -1°C) for > 5 days.32
However, adult fleas within the hair coat or immature stages inside climate controlled homes or kennels may survive even when outdoor temperatures plummet. Newly developed adult C felis can survive indoors within the pupal case for 4 to 5 months, and delayed emergence of adult C felis has been suggested as an overwintering strategy.31,33
Mild winters often result in unexpected early flea infestations in pets that haven’t been consistently treated during what has been historically considered the “off-season.” Pets must be treated every month, all year long to keep flea populations in check.
Treating Pets & the Environment
Once a flea infestation has developed in a home, it often takes several weeks to months to eliminate. Owners should be aware that:
- A single treatment will not eliminate infestations in pets (and the home).
- While most fleas are seen on pets, pets host only a small fraction of the entire flea population.
- If significant numbers of developing stages are present, the infestation will take several weeks to months to eliminate.
Treatment for flea infestations often involves multiple steps:
- Treating the pet: In most cases, treating the pet with insecticides + compounds effective against immature stages of fleas is adequate to eliminate mild to moderate infestations as long as every pet is treated every month.
- Investigating flea sources: When infestations persist despite consistent use of effective compounds for at least 3 months, sources of flea introduction should be investigated, including:
- Untreated animals (domestic and wild)
- Pet access to contaminated areas, such as under decks or in bushes
- Highly contaminated home environment.
- Applying premise sprays: Severe flea infestations may take several months to eradicate. Application of premise sprays, either by a licensed pest control operator or the pet owner, will likely accelerate flea elimination. Treatment of premises should only be used in combination with consistent, routine treatment of all pets.
- Habitat management: These strategies can remove a significant number of developing stages of fleas:
- Washing rugs, beds, and blankets
- Thorough vacuuming of wood floors, carpets, and upholstered furniture, including under cushions
- Disposing of vacuum cleaner bags immediately with municipal waste outdoors.
HOW TO PREVENT FLEA INFESTATIONS
- Administer insecticides to all pets in the household, including:
- Both dogs and cats
- Indoor and outdoor pets
- Use compounds effective against immature stages of fleas:
- On all pets in the household
- In the environment
- Apply preventive products to pets:
- Year round
- Limit encounters, if possible, with potentially infested animals, such as:
- Pets of friends and neighbors
- Wildlife and feral animals
- Areas where pets congregate—dog parks, camp sites, boarding kennels, etc.
- Protect the home environment, both indoors and outdoors:
- Apply premise sprays:
- By licensed pest control operator or pet owner
- In combination with consistent, routine treatment of pets
- Wash pet bedding and accessories
- Thoroughly vacuum floors, carpets, and furniture; dispose of vacuum bags immediately outdoors
- Apply premise sprays:
Dogs and cats have ample opportunities to become infested with limitless supplies of fleas.
- When fleas feed on pets, they breed, contaminating the environment with eggs, which will establish a home infestation that can take several weeks to months to eliminate.
- Consistently treating all pets in the home with quality flea adulticides limits feeding of adult fleas, reducing their overall reproductive capacity; incorporating a product that prevents maturation of immature stages further hinders establishment of infestations.
- Flea control prevents transmission of diseases to pets and people.
Consistent use of products—in every pet, every month, all year long—kills adult fleas and limits development of immature fleas. This approach is a critical aspect of basic wellness care and responsible pet ownership. Every pet deserves to live flea-free.
- Bowman DD. Georgis’ Parasitology for Veterinarians, 9th ed. St. Louis: Saunders Elsevier, 2009, p 451.
- Rust MK, Dryden MW. The biology, ecology, and management of the cat flea. Annu Rev Entomol 1997; 42:451-473.
- McElroy KM, Blagburn BL, Breitschwerdt EB, et al. Flea-associated zoonotic diseases of cats in the USA: Bartonellosis, flea-borne rickettsioses, and plague. Trends Parasitol 2010; 26(4):197-204.
- Foil L, Andress E, Freeland RL, et al. Experimental infection of domestic cats with Bartonella henselae by inoculation of Ctenocephalides felis (Siphonaptera: Pulicidae) feces. J Med Entomol 1998; 35:625.
- Foley JE, Chomel B, Kikuchi Y, et al. Seroprevalence of Bartonella henselae in cattery cats: Association with cattery hygiene and flea infestation. Vet Q 1998; 20:1.
- Chomel BB, Kasten RW. Bartonellosis, an increasingly recognized zoonosis. J Appl Microbiol 2010; 109(3):743-750.
- Al-Matar MJ, Petty RE, Cabral DA, et al. Rheumatic manifestations of Bartonella infection in 2 children. J Rheumatol 2002; 29(1):184-186.
- Maggi RG, Mozayeni BR, Pultorak EL, et al. Bartonella spp. bacteremia and rheumatic symptoms in patients from Lyme disease-endemic region. Emerg Infect Dis 2012; 18(5):783-791.
- VanderHeyden TR, Yong SL, Breitschwerdt EB, et al. Granulomatous hepatitis due to Bartonella henselae infection in an immunocompetent patient. BMC Infect Dis 2012; 12:17.
- Liddell PW, Sparks MJ. Murine typhus: Endemic Rickettsia in southwest Texas. Clin Lab Sci 2012; 25(2):81-87.
- Williams SG, Sacci JB Jr, Schriefer ME, et al. Typhus and typhuslike rickettsiae associated with opossums and their fleas in Los Angeles County, California. J Clin Microbiol 1992; 30(7):1758-1762.
- Eisen RJ, Gage KL. Transmission of flea-borne zoonotic agents. Annu Rev Entomol 2012; 57:61-82.
- Traub R, Wisseman CL. The ecology of murine typhus—a critical review. Trop Dis Bull 1978; 75(4):237-317.
- Schriefer ME, Sacci JB Jr, Dumler JS, et al. Identification of a novel rickettsial infection in a patient diagnosed with murine typhus. J Clin Microbiol 1994; 32(4):949-954.
- Pérez-Osorio CE, Zavala-Velázquez JE, Arias León JJ, Zavala-Castro JE. Rickettsia felis as an emergent global threat for humans. Emerg Infect Dis 2008; 14(7):1019-1023.
- Woods JE, Wisnewski N, Lappin MR. Attempted transmission of Candidatus Mycoplasma haemominutum and Mycoplasma haemofelis by feeding cats infected Ctenocephalides felis. Am J Vet Res 2006; 67(3):494-497.
- Harrus S, Klement E, Aroch I, et al. Retrospective study of 46 cases of feline haemobartonellosis in Israel and their relationships with FeLV and FIV infections. Vet Rec 2002; 151(3):82-85.
- Sykes JE. Feline hemotropic mycoplasmas. Vet Clin North Am Small Anim Pract 2010; 40(6):1157-1170.
- George JW, Rideout BA, Griffey SM, Pedersen NC. Effect of preexisting FeLV infection or FeLV and feline immunodeficiency virus coinfection on pathogenicity of the small variant of Haemobartonella felis in cats. Am J Vet Res 2002; 63(8):1172-1178.
- Sykes JE, Terry JC, Lindsay LL, Owens SD. Prevalences of various hemoplasma species among cats in the United States with possible hemoplasmosis. JAVMA 2008; 232(3):372-379.
- Woods JE, Brewer MM, Hawley JR, et al. Evaluation of experimental transmission of Candidatus Mycoplasma haemominutum and Mycoplasma haemofelis by Ctenocephalides felis to cats. Am J Vet Res 2005; 66(6):1008-1012.
- Lappin MR, Griffin B, Brunt J, et al. Prevalence of Bartonella species, haemoplasma species, Ehrlichia species, Anaplasma phagocytophilum, and Neorickettsia risticii DNA in the blood of cats and their fleas in the United States. J Feline Med Surg 2006; 8(2):85-90.
- Conboy G. Cestodes of dogs and cats in North America. Vet Clin North Am Small Anim Pract 2009; 39(6):1075-1090.
- Samkari A, Kiska DL, Riddell SW, et al. Dipylidium caninum mimicking recurrent Enterobius vermicularis (pinworm) infection. Clin Pediatr (Phila) 2008; 47(4):397-399.
- Cabello RR, Ruiz AC, Feregrino RR, et al. Dipylidium caninum infection. BMJ Case Rep 2011; Nov 15.
- Szwaja B, Romanski L, Zabczyk M. A case of Dipylidium caninum infection in a child from the southeastern Poland. Wiad Parazytol 2011; 57(3):175-178.
- Dryden MW, Broce AB, Cawthra J, Gnad D. Urban wildlife as reservoirs of cat fleas, Ctenocephalides felis. AAVP Conf Proc 2005; p 65.
- Dryden MW. Understanding persistent and recurrent flea problems. NAVC Proc 1998; 12:559-560.
- Dryden MW, Payne P, Zurek L. Fleas infesting our pets and homes. Kansas State University Agricultural Experiment Station and Cooperative Extension Service; Sept 2003.
- Inglis S, Haussler D, White K, Allen K (eds): Compendium of Veterinary Products. Shawnee, KS: Bayer Corporation, 2012, bayerdvm.com/Resources/cvp_main.cfm.
- Dryden MW, Ryan WG, Bell M, et al. Assessment of owner-administered monthly treatments with oral spinosad or topical spot-on fipronil/(S)-methoprene in controlling fleas and associated pruritus in dogs. Vet Parasitol 2012; in press.
- Silverman J, Rust MK. Some abiotic factors affecting the survival of the cat flea, Ctenocephalides felis (Siphonaptera: Pulicidae). Environ Entomol 1983; 12:490-495.
- Silverman J, Rust MK. Extended longevity of the pre-emerged adult cat flea (Siphonaptera: Pulicidae) and factors stimulating emergence from the pupal cocoon. Ann Entomol Soc Am 1985; 78:763-768.
Susan Little, DVM, PhD, Diplomate ACVM (Parasitology), is the Director of the National Center for Veterinary Parasitology at Oklahoma State University’s Center for Veterinary Health Sciences, where she serves as Regents Professor and the Krull-Ewing Chair in Veterinary Parasitology. Her research focuses on zoonotic parasites and tick-borne diseases. She has been recognized for teaching excellence through the Pfizer (Norden) Distinguished Teaching Award (1999 and 2010) and the national Student AVMA Excellence in Teaching Award (1998 and 2005), and for her outstanding research through the Pfizer Award for Research Excellence (2012). Dr. Little received her DVM from Virginia Tech.
Lindsay Starkey, DVM, currently serves as the Bayer Resident in Veterinary Parasitology through the National Center for Veterinary Parasitology at Oklahoma State University. In 2012, Dr. Starkey received the AAVP/CAPC Graduate Student Award in Zoonotic Disease from the American Association of Veterinary Parasitologists, for her dissertational research, which focuses on ticks and tick-borne diseases. She received her DVM from Oklahoma State University.