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Dermatological features of canine leishmaniasis
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Both cutaneous and visceral forms of leishmaniasis can occur in regions of the world where the insect vector is endemic; this paper reviews the dermatological forms of the disease, with a focus on clinical signs and potential treatment options.
Laura Ordeix
DVM, MSc, Dip. ECVD
Dr. Ordeix is associate professor and head of the dermatology division at the Universitat Autònoma de Barcelona. Boardcertified since 2002, she has authored many articles and book chapters on various aspects of dermatology. Her current research focuses on canine leishmaniasis.
![Ordeix L.](/sites/default/files/images/media/image/35.jpg)
Xavier Roura
DVM, PhD, Dip. ECVIM-CA
Dr. Roura received his DVM from UAB in 1989 then pursued an internship at the same establishment. He has worked as a clinical instructor at UAB since 1992 but has also been visiting veterinarian at various US establishments over the years. He has a major interest in vectorborne diseases in dogs and cats, and was awarded his PhD for work on canine leishmaniasis.
![Roura X.](/sites/default/files/images/media/image/36.jpg)
Key Points
- Leishmaniasis is a chronic disease with a long incubation period – clinical signs may develop months or years after the initial infection.
- Despite recent advances in knowledge, the diagnosis, treatment and control of leishmaniasis remains challenging.
- More than 80% of dogs with leishmaniasis disease develop dermatological signs, but there is a wide variety in the type of skin lesions seen.
- A structured clinical approach is necessary for any dog with suspected leishmaniasis, and accurate diagnosis, adequate treatment and frequent follow-ups are vital.
Introduction
Leishmaniasis is a frequent and important infectious disease of dogs living in or coming from endemic areas. The causative agent is a single-celled parasite of the Leishmania genus, L. infantum, which is transmitted by phlebotomine sand flies in the Mediterranean area, although vertical transmissions of the parasite from pregnant bitches to their offspring and directly through blood transfusions have also been documented ( 1 ) ( 3 ). Within endemic areas transmission of Leishmania occurs focally, so broad variations in the prevalence of infection may be seen in contiguous territories, depending mainly on the relative vector densities ( 1 ) ( 2 ) ( 3 ). This paper provides essential general information for a clinician faced with a case of canine leishmaniasis, with specific focus on managing the different dermatological pictures seen with the disease.
Infection and disease
Canine leishmaniasis is a classic example of an illness where the clinical signs can vary widely, from asymptomatic to severe clinical disease; this variation is intrinsically related to the interaction between the parasite, the arthropod vector and the canine immune system ( 1 ) ( 3 ).
In canine leishmaniasis the immune response from T-helper CD4+ lymphocytes plays a pivotal role in tipping the balance from infection to disease. If the response is dominated by an exaggerated humoral (Th2) reaction, together with no or minimal cell-mediated (Th1) response, dogs generally develop a chronic, progressive disease, although it usually takes several weeks or months before signs become apparent following infection. By contrast, if the immune response is characterized by little or no Th2 reaction and a robust Th1-specific response against Leishmania, affected dogs are usually clinically healthy or have a mild, self-limiting form of the disease.
The spectrum of clinical presentation can vary widely, from infection with no obvious clinical findings but detectable laboratory abnormalities, to overt infection characterized by moderate or severe clinical signs (and laboratory abnormalities) that may require hospitalization. Additionally, both clinical and laboratory findings can be identical to many other infectious, immune-mediated, endocrine or neoplastic diseases. The most common clinical signs of canine leishmaniasis are enlargement of the lymph nodes and skin lesions. However, a broad and heterogeneous spectrum of signs may be detected on physical examination, including pale mucous membranes, weight loss or cachexia, polyuria/polydipsia, epistaxis, onychogryphosis, ocular lesions, lameness, lethargy, and fever. Significant laboratory findings can include thrombocytopenia, mild to moderate non-regenerative anemia, hyperproteinemia with hyperglobulinemia and hypoalbuminemia, and proteinuria.
Atypical forms of the disease have also been described, with gastrointestinal, neurological, musculoskeletal, cardiopulmonary, lower urinary tract or genital tract signs ( 1 ) ( 3 ). [...]
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