Question:Meningeal Worm Treatment

I am a veterinarian. I have a few questions about a 3 yr., intact male alpaca that I saw today. He presented with a history of trouble rising in the hindlimbs which just became evident to the owner yesterday. Upon exam, he is weak, ataxic and knuckling in both hindlimbs but still able to rise without assistance. No signs of blindness, circling, head pressing. Appetite is fine, Temp - 100 F. Ht and lungs - WNL. They live in an area where there are deer and a pond etc. I am thinking P. tenius or possibly WNV? I realize there are other DDX to consider - vertebral body abscess, neoplasia etc.I treated him with 100 mg of Flunixin Meglumine IM and 40 mg of Ivomec 1% SQ this afternoon.

My questions are:

1) Is it better to treat with Fenbendazole at 50 mg/kg
PO SID for 5 days rather then Ivomec 1% injectable at a high dose for 3-5 consecutive days?

2) What form of Fenbendazole is best to use (i.e. approx. 50 g of paste or 50 ml of the suspension)?   This owner has been feeding a "small amount" of the granules daily for years.

3)  Do you recommend having camelids on Omeprazole if they are receiving Flunixin Meglumine.  Are they very prone to getting ulcers? 4) Are you seeing a significant number of camelids with WNV? Any other suggestions would be appreciated!  Thanks in advance!


Sounds most consistent with Meningeal worm. WNV usually shows cranial signs quickly.

Here is Buckeye Blast protocol for M. worm:
fenbendazole 50 mg/kg, po, daily for 5 days
flunixin meglumine 1 mg/kg BID for 3 days, then sid for 3 days
Omeprazole 2 to 4 mg/kg po daily for 7 to 10 days
Bo-Se 1 mg based on selenium per 25 kg (e.g. 1 cc per 50 lbs) as a single injection
Vitamin A/D/E 1000 to 2000 units based on Vitamin D fraction as a single injection
Vitamin E powder daily in feed at 1000 units per day
Physical therapy as needed

CSF is best to fine tune DDX, but it is fine to do the "BB" in mean time.

David E Anderson,  DVM, MS, DACVS