Luís Cardoso

Directions for the diagnosis, clinical staging, treatment and prevention of canine leishmaniosis

Canine leishmaniosis (CanL) due to Leishmania infantum is a life threatening zoonotic disease with a wide distribution in four continents and importance also in non-endemic regions. The purpose of this report is to present a consensus of opinions on the diagnosis, treatment, prognosis and prevention of CanL in order to standardize the management of this infection. CanL is a disease in which infection does not equal clinical illness due to the high prevalence of subclinical infection among endemic canine populations. The most useful diagnostic approaches include serology by quantitative techniques and PCR. High antibody levels are associated with severe parasitism and disease and are diagnostic of clinical leishmaniosis. However, the presence of lower antibody levels is not necessarily indicative of disease and further work-up is necessary to confirm CanL by other diagnostic methods such as cytology, histopathology and PCR. We propose a system of four clinical stages, based on clinical signs, clinicopathological abnormalities and serological status. Suitable therapy and expected prognosis are presented for each of the stages. The combination of meglumine antimoniate and allopurinol constitutes the first line pharmaceutical protocol. However, although most dogs recover clinically after therapy, complete elimination of the parasite is usually not achieved and infected dogs may eventually relapse. Follow-up of treated dogs with blood counts, serum biochemistry, urinalysis, serology and PCR is essential for prevention of relapses. Protection against sand fly bites by topical insecticides is effective in reducing infection, and recent development of vaccines has indicated that prevention by vaccination is feasible.

LeishVet guidelines for the practical management of canine leishmaniosis.

The LeishVet group has formed recommendations designed primarily to help the veterinary clinician in the management of canine leishmaniosis. The complexity of this zoonotic infection and the wide range of its clinical manifestations, from inapparent infection to severe disease, make the management of canine leishmaniosis challenging. The recommendations were constructed by combining a comprehensive review of evidence-based studies, extensive clinical experience and critical consensus opinion discussions. The guidelines presented here in a short version with graphical topic displays suggest standardized and rational approaches to the diagnosis, treatment, follow-up, control and prevention of canine leishmaniosis. A staging system that divides the disease into four stages is aimed at assisting the clinician in determining the appropriate therapy, forecasting prognosis, and implementing follow-up steps required for the management of the leishmaniosis patient.

Prevalence of Dirofilaria immitis, Ehrlichia canis, Borrelia burgdorferi sensu lato, Anaplasma spp. and Leishmania infantum in apparently healthy and CVBD-suspect dogs in Portugal - a national serological study

BackgroundCanine vector-borne diseases (CVBDs) are caused by a wide range of pathogens transmitted to dogs by arthropods including ticks and insects. Many CVBD-agents are of zoonotic concern, with dogs potentially serving as reservoirs and sentinels for human infections. The present study aimed at assessing the seroprevalence of infection with or exposure to Dirofilaria immitis, Ehrlichia canis, Borrelia burgdorferi sensu lato, Anaplasma spp. and Leishmania infantum in dogs in Portugal.MethodsBased on 120 veterinary medical centres from all the regions of mainland and insular Portugal, 557 apparently healthy and 628 CVBD-suspect dogs were sampled. Serum, plasma or whole blood was tested for qualitative detection of D. immitis antigen and antibodies to E. canis, B. burgdorferi s. l., Anaplasma spp. and L. infantum with two commercial in-clinic enzyme-linked immunosorbent assay kits. Odds ratios (OR) were calculated by logistic regression analysis to identify independent risk factors of exposure to the vector-borne agents.ResultsTotal positivity levels to D. immitis, E. canis, B. burgdorferi, Anaplasma spp., L. infantum, one or more agents and mixed agents were 3.6%, 4.1%, 0.2%, 4.5%, 4.3%, 14.0% and 2.0% in the healthy group, and 8.9%, 16.4%, 0.5%, 9.2%, 25.2%, 46.3% and 11.6% in the clinically suspect group, respectively. Non-use of ectoparasiticides was a risk factor for positivity to one or more agents both in the apparently healthy (OR = 2.1) and CVBD-suspect (OR = 1.5) dogs. Seropositivity to L. infantum (OR = 7.6), E. canis (OR = 4.1) and D. immitis (OR = 2.4) were identified as risk factors for the presence of clinical signs compatible with CVBDs. Positivity to mixed agents was not found to be a risk factor for disease.ConclusionsDogs in Portugal are at risk of becoming infected with vector-borne pathogens, some of which are of zoonotic concern. CVBDs should be considered by practitioners and prophylactic measures must be put in place to protect dogs and limit the risk of transmission of vector-borne agents to humans. This study is expected to give veterinary and public health authorities an increased awareness about CVBDs in Portugal and to serve as a reference for future investigations and control actions.

Use of a leishmanin skin test in the detection of canine Leishmania-specific cellular immunity

The leishmanin skin test was used to detect Leishmania-specific cellular immunity in asymptomatic dogs from an endemic region of visceral leishmaniosis. The test was safe since no clinical signs of intolerance to leishmanin were detected during 1 month, in 14 dogs after inoculations of 3 x 10(8) promastigotes/ml. In another group of four dogs no cross reactivity was found after inoculations of a PPD which demonstrated the specificity of the test. In the same group of animals, repeatability was assessed by repeated inoculations of leishmanin at 1-5-month intervals and the threshold of sensitivity was the concentration of 3 x 10(6) promastigotes/ml. Secondly, we applied the test in a dog population that live in an endemic region of visceral leishmaniosis and found a significant increase in Leishmania-infected dogs after the application of this test in the field.

Risk factors for canine leishmaniasis in an endemic Mediterranean region.

Human visceral leishmaniasis is an emergent/re-emergent parasitic zoonotic disease in Europe caused by Leishmania infantum, with domestic dog as its main reservoir host. This study presents the results of a canine epidemiological survey in a mediterranean region where human and canine leishmaniasis (CanL) are endemic - Portugal. The main goal was to identify risk factors, which can be relevant for Leishmania infection control. The national survey was carried out in January 2009 with a screening of 3974 dogs from all 18 districts of mainland Portugal. Direct Agglutination Test was used for the detection of anti-Leishmania antibodies in canine blood. An overall CanL true prevalence of 6.31% was observed. Apparent prevalence at district level ranged from 0.88% to 16.16%, with the highest prevalence in the interior regions. Identified risk factors for positivity were: dogs of 2 years and older (adjusted odds ratio OR=5.39); spending exclusively/most of the time outdoors (OR=2.51); origin from the interior of Portugal in comparison to littoral/coast districts (OR=2.51); not having long fur (OR=2.03); and being pure exotic (OR=1.67). The results confirm the leishmaniasis endemicity in Portugal and the dynamic character of prevalence as new foci emerged and old foci lost their importance. The dogs age, fur size, district and living outdoors as opposed to indoors were more important than dog breeds and insecticide treatment in the transmission of Leishmania infection. The future of CanL prevention and control rely on an integrated approach involving veterinarians, dog owners and health authorities in order to reduce the canine infection risk and consequently, the human zoonotic visceral leishmaniasis.

Reclassification of Theileria annae as Babesia vulpes sp. nov.

BackgroundTheileria annae is a tick-transmitted small piroplasmid that infects dogs and foxes in North America and Europe. Due to disagreement on its placement in the Theileria or Babesia genera, several synonyms have been used for this parasite, including Babesia Spanish dog isolate, Babesia microti-like, Babesia (Theileria) annae, and Babesia cf. microti. Infections by this parasite cause anemia, thrombocytopenia, and azotemia in dogs but are mostly subclinical in red foxes (Vulpes vulpes). Furthermore, high infection rates have been detected among red fox populations in distant regions strongly suggesting that these canines act as the parasite’s natural host. This study aims to reassess and harmonize the phylogenetic placement and binomen of T. annae within the order Piroplasmida.MethodsFour molecular phylogenetic trees were constructed using a maximum likelihood algorithm based on DNA alignments of: (i) near-complete 18S rRNA gene sequences (n = 76 and n = 93), (ii) near-complete and incomplete 18S rRNA gene sequences (n = 92), and (iii) tubulin-beta gene sequences (n = 32) from B. microti and B. microti-related parasites including those detected in dogs and foxes.ResultsAll phylogenetic trees demonstrate that T. annae and its synonyms are not Theileria parasites but are most closely related with B. microti. The phylogenetic tree based on the 18S rRNA gene forms two separate branches with high bootstrap value, of which one branch corresponds to Babesia species infecting rodents, humans, and macaques, while the other corresponds to species exclusively infecting carnivores. Within the carnivore group, T. annae and its synonyms from distant regions segregate into a single clade with a highly significant bootstrap value corroborating their separate species identity.ConclusionPhylogenetic analysis clearly shows that T. annae and its synonyms do not pertain to Theileria and can be clearly defined as a separate species. Based on the facts that T. annae and its synonyms have not been shown to have a leukocyte stage, as expected in Theileria, do not infect humans and rodents as B. microti, and cluster phylogenetically as a separate species, this study proposes to name this parasite Babesia vulpes sp. nov., after its natural host, the red fox V. vulpes.

Serological survey of Toxoplasma gondii infection in domestic cats from northeastern Portugal

Cats are very important hosts in the epidemiological cycle of Toxoplasma gondii, a zoonotic protozoan parasite that can infect humans and many other animal species worldwide. We report a serological survey of antibodies to T. gondii in domestic cats from northeastern Portugal, by means of the modified agglutination test. Three cats had titres of 20 (3.9%), 18 had titres of 40 (23.7%) and 55 animals had titres of > or =800 (72.4%). Results of three seropositive kittens with less than 4 months were not considered for determining the seroprevalence of infection, which was found to be 35.8% (73/204). Differences in the seroprevalence levels were not statistically significant between males (35.6%) and females (36.0%) or pure non-European (26.7%) and European or mixed-breed cats (39.6%). Animals aged 36-71 months and 72-180 months had the highest seroprevalences of infection, i.e. 51.7% and 51.2%, respectively, which significantly differ from the values observed in cats with 2-11 months (14.6%) and 12-35 months (26.3%). Infection levels were also significantly different between cats that lived totally indoors (7.7%) and those that had access to outdoors (45.4%), as well as between cats living alone (13.8%) and those that had contact with other cats (39.4%). Seroprevalence values in cats fed only commercial canned or dried food (22.9%) and animals whose diet included raw or undercooked viscera and/or meat (53.5%) were also significantly different. Furthermore, considering only 108 cats, differences of seropositivity to T. gondii were significant between feline immunodeficiency virus infected and non-infected animals, but this was not observed for feline leukaemia virus. Age, habitat and diet were identified as risk factors for the feline T. gondii infection by logistic regression analysis. Some control measures are suggested based on these findings.

Feline vector-borne pathogens in the north and centre of Portugal

BackgroundIn recent years, several clinical cases and epidemiological studies of feline vector-borne diseases (FVBD) have been reported worldwide. Nonetheless, information on FVBD agents and their prevalence in Portugal is scarce.MethodsThree-hundred and twenty domestic cats presented to 30 veterinary medical centres in the north and centre regions of Portugal were randomly sampled. Blood was assayed by real-time polymerase chain reaction (PCR) for genera Anaplasma/Ehrlichia, genus Babesia, Hepatozoon canis, Hepatozoon felis, Leishmania infantum and the genus Rickettsia. Babesia-positive samples were further tested for Babesia canis and Babesia vogeli.ResultsEighty (25.0%) out of the 320 cats were positive to at least one vector-borne agent, including seven (2.2%) cats co-infected with two agents. Two cats (0.6%) were infected with Anaplasma/Ehrlichia spp., four (1.3%) with B. canis, 26 (8.1%) with B. vogeli, 50 (15.6%) with H. felis, one (0.3%) with L. infantum and four (1.3%) with Rickettsia spp. No cat tested positive for H. canis. One cat (0.3%) was co-infected with B. canis and B. vogeli, three (0.9%) with B. vogeli and H. felis, one (0.3%) with H. felis and L. infantum, and two (0.6%) with H. felis and Rickettsia spp.ConclusionsA considerable prevalence of infection with vector-borne pathogens among the domestic feline population of the north and centre of Portugal has been revealed by the present study. Additionally, this is the first detection of B. vogeli in cats from Europe and of H. felis in cats from Portugal.

Development of a fast agglutination screening test (FAST) for the detection of anti-Leishmania antibodies in dogs

A fast agglutination screening test (FAST) for the detection of anti-Leishmania antibodies in serum samples from dogs with visceral leishmaniosis was developed. The test is based on the direct agglutination test (DAT), but combines a higher parasite concentration with a smaller test volume. In contrast to the DAT, the FAST makes use of only one serum dilution and the results can be read within 3 h as opposed to 18-20 h for the DAT. The FAST was evaluated using serum samples of confirmed cases of the disease and healthy controls collected in the most important endemic regions of canine visceral leishmaniosis, import cases of canine leishmaniosis in a non-endemic country, from non-endemic healthy controls and from dogs with other diseases. The performance of the FAST was compared with standard DAT. In the present study, the FAST had a sensitivity of 93.6% and a specificity of 89.0%. The DAT had a sensitivity of 88.6% and a specificity of 96.7%. Furthermore, using a large panel of serum samples of previously examined DAT positive or negative dogs it was shown that degree of agreement between the two tests was high (95.7%; kappa value = 0.91). The FAST offers the advantages of the DAT based on freeze-dried antigen with respect to stability of the antigen, sensitivity and specificity. Moreover, the FAST allows the rapid screening of a large number of samples, which makes the test very useful for epidemiological screening of large populations of dogs.

Low seroprevalence of Leishmania infantum infection in cats from northern Portugal based on DAT and ELISA.

Cats have been considered playing a role in the epidemiology of leishmaniasis caused by Leishmania infantum, an endemic zoonosis in countries of the Mediterranean basin. The present study assessed the prevalence of antibodies to L. infantum in 316 domestic cats from northern Portugal, by means of the direct agglutination test (DAT) and an enzyme-linked immunosorbent assay (ELISA). Seroreactivity to DAT was found in six cats, and nine cats were positive in the ELISA, including the six DAT-positive animals. The overall seroprevalence of Leishmania infection was 2.8%, based on ELISA and DAT. A substantial agreement (99%; κ value=0.80) was found between DAT and ELISA results. The difference between seroprevalence values in females (0.7%) and males (4.7%) was statistically significant (p=0.045). The age of seropositive cats ranged from 31 to 84 months. Cats with 5-6 years (60-71 months) and 6-7 years (72-83 months) presented the highest level of seropositivity (15.4% and 33.3%, respectively). A significant difference was found comparing the seroprevalences in cats aged less than 24 months (0.0%) and in those with 24 months or more (7.3%) (p=0.022). Seroprevalences in cats living in a rural environment (10.5%) or in urban areas (0.0%) were also found to be significantly different (p<0.001). No significant differences were detected between serological status to Leishmania in pure non-European and European or mixed breeds (p=0.442), cats that lived totally indoors and those that had access to outdoors (p=0.412), cats seropositive and seronegative to Toxoplasma gondii (p=0.276), or apparently healthy animals and those with clinical illness (p=0.271). This study is the largest epidemiological investigation performed on feline Leishmania infection in Portugal. The seroprevalence of Leishmania infection was low in cats living in northern Portugal, a region where canine leishmaniasis is endemic. Nevertheless, Leishmania infection must not be underestimated and leishmaniasis may be included in the differential diagnosis of cutaneous or systemic clinical signs in cats.