Webinar Club - Leishmaniasis
The first webinar of the Webinar Club was presented by Dr. Ângelo Pitães DVM MSc MRCVS PgCert SAM on the 26th August 2025.
You can also watch this webinar on Youtube.
Summary
Here's what was discussed during this webinar:
Core disease facts
Causative Agent: Primarily Leishmania infantum in Europe, a protozoal flagellate.
Transmission: Spread by the sandfly (Phlebotomus), not mosquitoes.
Incubation Period: Can be extremely long, lasting from seven years or more.
Alternative Transmission: Emerging evidence for vertical (mother to offspring), venereal, and blood-to-blood transmission (e.g., dog bites).
Clinical presentation
Dermatological: Exfoliative alopecia, periocular alopecia ("spectacles"), non-healing ulcers (especially on the pinna), and onychogryphosis (abnormally long nails).
Ocular: Uveitis and keratoconjunctivitis are very common.
Systemic: Weight loss, lethargy, intermittent fever, epistaxis (nosebleeds), and generalised lymphadenomegaly.
Other Findings: Non-regenerative anemia, hyperproteinemia, and potential kidney disease (azotemia/proteinuria).
Diagnostic approach
Serology: Qualitative "quick tests" followed by Quantitative Serology (IFAT or ELISA) to determine antibody titers.
Cytology: High success rate finding amastigotes in lymph nodes, spleen, skin lesions, or bone marrow.
PCR: More sensitive than cytology, but blood and urine are unreliable samples; lymph nodes or skin lesions are preferred.
Treatment and staging
Stage the disease (Stages 1–4) to determine the prognosis and treatment.
Stage 1 (Mild): Close monitoring or immunomodulators (Domperidone).
Stage 2 (Moderate): Combination therapy using Allopurinol (leishmanistatic) plus a leishmanicidal like Meglumine antimoniate (injections) or Miltefosine (oral).
Stage 3 & 4 (Severe): Same as Stage 2 but requires intensive management of kidney disease following IRIS guidelines.
Side Effects: Allopurinol can cause xanthine crystals in urine; low-purine diets are recommended.
Monitoring and prevention
Monitoring: First check at 15 days to assess drug tolerance, then every 3–4 months for biochemistry and urinalysis. Titers should only be re-checked every 6 months.
Prevention: A multi-modal approach is best:
Repellents: Collars and spot-ons to prevent sandfly bites.
Vaccination: (e.g., LetiFend or CaniLeish) should only be given to negative dogs to reduce the risk of clinical disease.
Practical tips
Initial Check (15 Days): Always perform a follow-up 15 days after starting leishmanicidal treatment (injections or Miltefosine) to assess drug tolerance, liver enzymes, and kidney function.
Managing Injections: Meglumine antimoniate injections can be quite large and painful for the dog; it is often easier to divide the daily amount into two separate doses.
Allopurinol and Urinary Health:
Diet: Dogs on Allopurinol should be placed on a low-purine diet to prevent the formation of xanthine crystals.
Monitoring: Check a urine sample every three months; if you see crystals (which can look like sand in the sample), you may need to adjust the diet or consider alternative medications.
Timing of Titer Re-checks: Do not re-check antibody titers sooner than every six months; they do not change quickly enough to provide useful clinical data before that window.
Protein Electrophoresis: Use this test instead of frequent titers to get a clearer idea of whether the disease is actually improving or progressing during the monitoring phase.
Pain Management Caution: If a leishmania patient requires pain relief, try to avoid non-steroidal anti-inflammatories (NSAIDs) due to existing kidney risks; safer alternatives like paracetamol are preferred.
Vaccination Protocol: Always test the dog first. If a dog is already positive for leishmaniasis, there is no clinical benefit to vaccinating them.
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