Impact in the United States
M. cerebralis was first recorded in North America in 1956 in Pennsylvania, having been introduced via infected trout imported from Europe, and has spread steadily south and westwards. Until the 1990s, whirling disease was considered a manageable problem affecting rainbow trout in hatcheries. However, it has recently become established in natural waters of the Rocky Mountain states (Colorado, Wyoming, Utah, Montana, Idaho, New Mexico), where it is causing heavy mortalities in several sportfishing rivers. Some streams in the western United States have lost 90% of their trout. In addition, whirling disease threatens recreational fishing, which is important for the tourism industry, a key component of the economies of some U.S. western states. For example, "the Montana Whirling Disease Task Force estimated trout fishing generated US $300,000,000 in recreational expenditures in Montana alone". Making matters worse, some of the fish species that M. cerebralis infects (bull trout, cutthroat trout, and steelhead) are already threatened or endangered, and the parasite could worsen their already precarious situations. For reasons that are poorly understood, but probably have to do with environmental conditions, the impact on infected fish has been greatest in Colorado and Montana, and least in California, Michigan, and New York. Impact in Canada
Whirling disease was first detected in fish in Johnson Lake in Banff National Park in May, 2016. CFIA Labs confirmed in August and Parks Canada announced the outbreak August 23, 2016. Although it was first discovered in Banff, it is not necessarily where the disease originated and spread.
Verteporfin (trade name Visudyne), a benzoporphyrin derivative, is a medication used as a photosensitizer for photodynamic therapy to eliminate the abnormal blood vessels in the eye associated with conditions such as the wet form of macular degeneration. Verteporfin accumulates in these abnormal blood vessels and, when stimulated by nonthermal red light with a wavelength of 689 nm in the presence of oxygen, produces highly reactive short-lived singlet oxygen and other reactive oxygen radicals, resulting in local damage to the endothelium and blockage of the vessels.Verteporfin is also used off-label for the treatment of central serous retinopathy. Administration
Verteporfin is usually injected intravenously into the largest arm vein. It is injected at a dose of 6 mg/m2 and light-activated. It is usually is given 15 minutes before laser treatment. This dose can be repeated 4 times per year. Contraindications
Porphyria. Side effects
Most common side effects are blurred vision, headache, and local effects at the injection site. Also, photosensitivity; it is strictly advised to avoid exposure to sunlight and unscreened lighting until 48 hours after verteporfin administration.Dogs and rats have been treated with inactivated daily doses 32–70 times higher than the dose advised for humans. The 4 weeks of treatment resulted in mild extravascular hemolysis and hematopoiesis in the animals. Interactions
Verteporfin is known to interact with the herbal remedy feverfew (Tanacetum parthenium), the latter of which seems to act as an antagonist to verteporfin for unknown reasons.