Leishmaniasis: All You Should Know – Part IV

Introduction to the Series

Important Note: I’ve done my best to keep this post informative and accurate. Be aware that I am neither a doctor, a veterinarian, nor a biologist, and that my knowledge of biology and medicine is limited to what I learnt in high school and what I may have picked up along the way since then. Before trying anything on your dog or if in doubt, check with your vet. If you spot any mistakes, please let me know by leaving a comment or contacting me through any social networks.

If you’ve been following the blog for a while, you may know that one of my dogs, Syd, was diagnosed with Leishmaniasis (or Leishmaniosis) at four years of age. Although she survived the disease, it certainly made the remainder of her life much more complicated.

Since there have been several advances on the topic since then, I decided to do some research and write  comprehensively about it. I considered writing just one post, but it would be very long, and I think it’s better to digest the information in stages. These are the points that I will be covering (the list will be expanded as posts are published):

Feel free to jump to the post or section that interests you the most.

My dog has been infected with leishmaniasis! What now?

The good news: first of all, don’t stress out. If your dog is suffering from a mild form of the disease (the earlier it is detected, the better) and does not have renal insufficiency, studies say there is an 80% chance that your dog will still live 4 years later (Petersen and Barr 2009).

The not-so-good news: a dog infected with leishmaniasis will keep the disease for life. Relapses happen, so it’s important to keep regular appointments with your vet (Petersen and Barr 2009).

In my personal opinion, chances may be higher if you take proper care of your dog. Regular check-ups with your vet and administering the medication are a must. When Syd was diagnosed with leishmaniasis, I started telling people what had happened to her. To my surprise, at least two people knew of other dogs who had been diagnosed and all had survived. Syd herself lived until 10 years of age, and we had to put her down due to cancer, not leishmaniasis.

Syd in 2009, 10 years ago. She was 7 years old at the time.

Treatment

Traditional Treatment

Treatment of leishmaniasis consists of the following. In a first stage, when the disease is more active, treatment combines pentavalent antimony (Glucantime) and allopurinol for 30 days. In a second stage, when the infection goes into remission, only allopurinol is administered.

Be aware, though, that pentavalent antimony (Glucantime) is not licensed for treatment in the US. However, allopurinol on its own has also been shown to be effective (Petersen and Barr 2009).

An alternative treatment is using miltefosine (Milteforan) combined with allopurinol. Again, when the disease goes into remission, the dog only has to take allopurinol.

The main differences between the two treatments are:

  • Pentavalent antimony is administered via an intramuscular injection, whereas miltefosine is administered orally.
  • Long-term, pentavalent antimony seems to have a higher clinical efficacy as fewer dogs relapsed, according to the study by Manna et al (2015).

However, note that both treatments proved to be effective, and allopurinol is key to keep the disease in check (Manna et al. 2015).

Even if your dog is diagnosed with Leishmaniasis, your dog may keep you company until old age if he is taken proper care of.

New treatments

Some veterinarians have also used as a second-line treatment a combination of domperidone (Motilium) and allopurinol. Domperidone is also used to prevent the disease, as it can help reduce the clinical signs and antibody titres, especially in mild cases (Lladró et al. 2017).

The Sad Reality

As I have explained previously, leishmaniasis is a disease which is very difficult to keep under control. It can be transmitted from animals to people, through the bite of the sandfly. To try to keep it under control, some countries – such as Brazil – have adopted euthanizing policies: the authorities must be informed when dogs are found to be seropositive, and they are euthanized (Otranto and Dantas-Torres 2013).

However, this policy is turning out to be ineffective. There are many other mammals which can be carriers of leishmaniasis, so just trying to keep the infected dog population under control simply isn’t enough (Ribeiro et al. 2018; Otranto and Dantas-Torres 2013).

Let’s hope, then, that these policies will soon be rejected, since they are perceived by many people as unethical and, as we have seen, they have not resulted in the expected outcomes.

Puppy Nix.

References

Lladró, S., A. Picado, C. Ballart, M. Portús, and M. Gállego. 2017. “Management, Prevention and Treatment of Canine Leishmaniosis in North-Eastern Spain: An Online Questionnaire-Based Survey in the Province of Girona with Special Emphasis on New Preventive Methods (CaniLeish Vaccine and Domperidone).” Veterinary Record 180 (2): 47–47. https://doi.org/10.1136/vr.103653.

Manna, Laura, Raffaele Corso, Giorgio Galiero, Anna Cerrone, Paolo Muzj, and Angelo Elio Gravino. 2015. “Long-Term Follow-up of Dogs with Leishmaniosis Treated with Meglumine Antimoniate plus Allopurinol versus Miltefosine plus Allopurinol.” Parasites & Vectors 8 (1). https://doi.org/10.1186/s13071-015-0896-0.

Otranto, Domenico, and Filipe Dantas-Torres. 2013. “The Prevention of Canine Leishmaniasis and Its Impact on Public Health.” Trends in Parasitology 29 (7): 339–45. https://doi.org/10.1016/j.pt.2013.05.003.
Petersen, Christine A., and Stephen C. Barr. 2009. “Canine Leishmaniasis in North America: Emerging or Newly Recognized?” Veterinary Clinics of North America: Small Animal Practice 39 (6): 1065–74. https://doi.org/10.1016/j.cvsm.2009.06.008.

Ribeiro, Raul Rio, Marilene Suzan Marques Michalick, Manoel Eduardo da Silva, Cristiano Cheim Peixoto dos Santos, Frédéric Jean Georges Frézard, and Sydnei Magno da Silva. 2018. “Canine Leishmaniasis: An Overview of the Current Status and Strategies for Control.” BioMed Research International 2018: 1–12. https://doi.org/10.1155/2018/3296893.

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