Abstract
Simple SummaryCanine Leishmaniosis is a chronic and potentially fatal disease, caused by Leishmania infantum, a zoonotic microorganism. In economically disadvantaged regions, costs associated with long-term patient monitoring may determine that some owners decline veterinary follow-up of their dogs, with potentially severe implications for animal welfare and public health. This online, questionnaire-based survey aimed to assess how Portuguese veterinary practitioners perform long-term patient management and recognize relapses. More than half of the respondents stated that most dog owners declare having financial restraints, which condition the use of diagnostic tests during long-term follow-up. Allopurinol ad aeternum or until disease remission and domperidone were the most prescribed treatment, and relapses were detected by the reappearance or worsening of clinical signs by most veterinary practitioners. The rate of relapse detection was higher in the most economically favored regions, probably because of a lesser constraint on the use of the appropriate diagnostic tests. This study confirms that owner financial restraints negatively influence veterinary follow-up and relapse recognition, potentially compromising clinical decision making and favoring the maintenance of Leishmania infantum infection endemic status in Portugal.Canine Leishmaniosis (CanL) is a chronic and potentially fatal disease. In economically disadvantaged regions, costs associated with long-term patient monitoring may determine that some owners decline veterinary follow-up of their dogs. This online, questionnaire-based survey aimed to assess how Portuguese veterinary practitioners perform long-term patient monitoring and recognize relapses. More than 50% of respondents reported that 50–100% of dog owners declared financial restraints. Hence, in these circumstances, most veterinary practitioners only performed clinical examination and serology. However, when owners did not declare financial restriction, other tests were additionally performed, such as renal and hepatic profiles, hemogram, serum protein electrophoresis and urine protein creatinine ratio. The mean number of exams performed when owners presented financial restraints was significantly lower than the number of exams performed without economic limitations. Most veterinary practitioners prescribed allopurinol ad aeternum or until disease remission and domperidone. CanL relapses were recognized by more than half of respondents “Always”, through the reappearance or worsening of clinical signs, whereas about a quarter detected an increase in anti-Leishmania antibody levels and identified abnormalities in the serum protein electrophoresis profile. The relapse rate was higher in the Lisbon Metropolitan Area and north, the most economically favored regions of Portugal. This study confirms that owner financial restraints negatively influence veterinary follow-up and relapse recognition, ultimately compromising clinical decision making and favoring the maintenance of Leishmania infantum infection endemicity.
Highlights
Canine leishmaniosis (CanL) is a zoonosis, mainly caused by the parasite Leishmania infantum, which is transmitted by blood-sucking insects
Veterinary practitioners were asked to consider dogs suspected of having Canine Leishmaniosis (CanL), those presenting clinical signs and/or clinicopathological abnormalities compatible with CanL, and CanL diagnoses in those dogs with compatible clinical signs and/or clinicopathological abnormalities in which the infection was confirmed by serological tests, Polymerase Chain Reaction (PCR) or direct diagnoses
One hundred and fifty-five replies were obtained from veterinary practitioners working in the 18 geographical districts of mainland Portugal, grouped in five Nomenclature of Territorial Units for Statistics (NUTS) II regions (Figure 1a)
Summary
Canine leishmaniosis (CanL) is a zoonosis, mainly caused by the parasite Leishmania infantum, which is transmitted by blood-sucking insects. CanL is endemic in more than 70 countries in South and Central America, the Mediterranean region, Africa, and Asia [1,2]. The overall seroprevalence of L. infantum infection in mainland Portugal is 6.31%, ranging from 0.88% to 16.16% [3], varying from one area to another, depending on specific demographic and environmental factors that condition the habitat of the vector [1,4]. CanL is a chronic and potentially fatal disease. Common clinical signs include dermatological lesions, weight loss, lymphadenopathy, osteoarticular pathology, muscle atrophy, ocular lesions, and splenomegaly, among others. The most frequent clinicopathological abnormalities include anemia, thrombocytopenia, monocytosis, hyperproteinemia, and elevated blood urea and creatinine levels. Chronic kidney disease (CKD) is a common consequence of CanL progression and the main cause of death or euthanasia of affected dogs [5–7]
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