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Canine leptospirosis: An emerging disease? (Proceedings)
Leptospirosis is caused by infection with serovars of Leptospira interrogans sensu lato.
Leptospirosis is caused by infection with serovars of Leptospira interrogans sensu lato. Organisms are transmitted by direct contact with infected urine, bite wounds or ingestion of infected tissues, or indirectly, through contact with infected water, soil, food or bedding. Survival of leptospires is promoted by stagnant warm water, a neutral or slightly alkaline pH, and temperatures between 0 and 25 degrees celsius. In California, the incidence of leptospirosis is highest in the late fall and winter.
There are over 150 antigenically-distinct pathogenic serovars, which are grouped into serogroups. Serovars known to affect dogs include Canicola, Icterohemorrhagiae, Grippotyphosa, Pomona, Ballum, Bratislava, Autumnalis, Bataviae, Australis, and Hardjo. Each serovar is adapted to a one or more mammalian host species (maintenance hosts). Other hosts act as incidental hosts. Disease in incidental hosts tends to be more severe and the duration of shedding is generally shorter. Maintenance hosts include dogs (Canicola); rats (Icterohemorrhagiae); raccoons, skunks, voles and opossums (Grippotyphosa); cattle and pigs (Pomona); pigs (Bratislava); cattle (Hardjo); and mice (Ballum). The prevalence of infection with a serovar in dogs depends on the degree of contact between the dog population and the maintenance host for that serovar.
The most common species thought to infect dogs before the introduction of the Leptospira vaccines were Icterohemorrhagiae and Canicola. Vaccines containing only serovars Icterohemorrhagiae and Canicola do not protect against other serovars. Since introduction of the bivalent bacterins containing these serovars, there have been decreasing reports of disease due to Canicola and Icterohemorrhagiae, and increasing reports of disease caused by serovars Pomona, Grippotyphosa and Bratislava. Vaccine pressure, and increasing contact between dogs and skunks, raccoons and opossums, have been suggested as reasons for this change.
Pathogenic leptospires penetrate abraded skin or mucus membranes and multiply in the bloodstream and tissues, causing hepatic and/or renal failure and vasculitis. A number of studies have suggested an association between clinical manifestations and the infecting serovar, although this is not clear cut. It seems likely that infections with serogroup Pomona are associated with more severe renal failure. Clinical manifestations may also depend on age, outbreak, and geographical location.
Most infections are subclinical. Younger, large breed, outdoor adult dogs are commonly affected. Younger animals tend to be more severely affected. Males may be predisposed.
Lethargy, anorexia, vomiting, pyrexia, dehydration, abdominal pain and increased thirst are common signs of acute leptospirosis. Reluctance to move, icterus, and petechial and ecchymotic hemorrhages may be noted.
Leukocytosis, thrombocytopenia, azotemia, hypoalbuminemia and elevated liver enzymes are common. Urinalysis may reveal isosthenuria, proteinuria, glucosuria and casts. Thoracic radiography may reveal a focal or diffuse interstitial to bronchointerstitial pattern; alveolar patterns may represent pulmonary hemorrhage. Hepatomegaly, splenomegaly, renomegaly and/or peritoneal effusion may be evident from abdominal radiography. Hyperechoic renal cortices and mild renal pelvis dilation are occasionally seen with abdominal ultrasound.
Diagnosis is generally based on serology using the microscopic agglutination test. Respective titers are provided for each of several different serovars, and the results are serogroup specific. The organism with the highest titer is identified as the infecting one; lower titers represent cross reactions between serogroups. Titers are usually negative in the first week of illness, and demonstration of a fourfold rise in titer is required over a 1-4 week interval. Antibiotic therapy early in disease may blunt the rise in titer. Postvaccinal titers against Icterohemorrhagiae, Canicola, Grippotyphosa and Pomona occasionally rise as high as 1:3200 for a few months after vaccination, and these can interfere with interpretation. It is important to note that results can vary between laboratories. Use of a laboratory with a high level of quality control is recommended.
Darkfield microscopy of the urine is not recommended as sole test for diagnosis because of the large number of false positives and false negatives. Silver staining and fluorescent antibody or immunoperoxidase staining of tissue specimens can also yield false negatives, and does not help identify the infecting serovar. Culture is difficult because of the fastidious growth requirements of leptospires. Cultures must be incubated for several weeks. Multiple sampling may be required due to intermittent shedding. PCR assays are becoming more widely available, and have potential to be rapid, sensitive and specific, but will not provide information about the infecting serovar.
Specific treatment involves initial use of parenteral penicillin derivatives for leptospiremia. In our hospital, we generally use ampicillin (20 mg/kg IV q8h, adjusting dose down if severe azotemia is present) for 14 days. It is recommended that treatment then be changed to doxycycline (5 mg/kg q12h) for 2 weeks, in order to eliminate the carrier phase. Supportive and symptomatic therapy is also indicated for acute renal failure, vasculitis, and DIC (eg. IV fluids, H2 blockers, antihypertensives, gastric protectants, antiemetics, phosphate binders, plasma, whole blood and nutritional support). The use of hemodialysis can improve survival in dogs with severe renal failure, and early referral of these cases is recommended if client finances allow. Approximately 50% of our cases are dialyzed. Euthanasia or death due to leptospirosis is recorded in 18% of our cases.
Vaccines are now available for serovars Canicola, Icterohemorrhagiae, Pomona and Grippotyphosa. The efficacy of these vaccines and duration of immunity in the field is not well understood. Leptospira bacterins have been associated with occasional acute, severe allergic reactions. Because of these reactions, unclear efficacy, and their short duration of immunity, vaccination against pathogenic leptospires is only recommended for dogs living in endemic areas that are likely to be exposed. Minimizing access to rodents, farm animals and other wild animals also should help to prevent infection.
Public Health Risk
Leptospirosis remains an important zoonosis, and with increasing reports of canine disease caused by other serovars, the risk of human infection with these serovars may also be increasing. Human leptospirosis is typically a 'flu-like illness', but in some cases may be associated with vomiting, diarrhea, shock, jaundice, renal failure, pneumonia, meningitis, or abortion. Any animal with acute hepatic and/or renal failure should be treated as a suspect. Warnings should be placed on cages, gloves should be worn while handling these dogs and iodine-based disinfectants should be used to clean areas soiled with urine. Owners should be warned that without specific treatment, leptospires may be shed in the urine for months despite clinical recovery.