Geographical Distribution, Clinical Presentation, Treatment and Prevention of Canine Leishmaniosis in Portugal: a 2007 Field Survey
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RPCV (2010) 109 (573-576) 21-29 REVISTA PORTUGUESA DE CIÊNCIAS VETERINÁRIAS Geographical distribution, clinical presentation, treatment and prevention of canine leishmaniosis in Portugal: a 2007 field survey Resultados de um inquérito realizado em 2007 sobre a distribuição geográfica, apresentação clínica, tratamento e prevenção da leishmaniose canina em Portugal Ana M. Oliveira1*, Suraya Diaz2, Cristina Santos2, Patrick Bourdeau3, Isabel Pereira da Fonseca2 1Faculdade de Medicina Veterinária, Universidade Lusófona de Humanidades e Tecnologias, Campo Grande 376, 1749-024 Lisboa, Portugal 2CIISA, Faculdade de Medicina Veterinária, Pólo Universitário Alto da Ajuda, 1300-477 Lisboa, Portugal 3Ecole Vétérinaire de Nantes, Atlanpole, La Chantrerie, BP 40706, Nantes, France Resumo: A leishmaniose canina, doença endémica em Portugal, clinical presentation, diagnosis, treatment and prevention é causada por Leishmania infantum, sendo transmitida por offered by the Portuguese clinicians throughout the country. Phlebotomus perniciosus e P. ariasi. Através de um inquérito Material and methods: 790 written questionnaires were sent, nacional, realizado em 2007, os autores pretenderam caracteri- one per clinic, to all licensed small animal clinics in Portugal. zar o panorama da doença, determinando as áreas geográficas From those 17.8% (141) clinicians answered the questionnaire. recententemente afectadas, e descrevendo a apresentação 93% of the clinicians had consulting patients with leishmanio- clínica, diagnóstico, tratamento e prevenção referidos pelos sis. The districts reported to be affected were Beja, Bragança, clínicos do País. Foram enviados 790 questionários, um para Castelo Branco, Coimbra, Évora, Faro, Guarda, Leiria, Lisboa, cada uma das clínicas de pequenos animais registadas em Madeira, Portalegre, Porto, Santarém, Setúbal, Viana do Portugal. Obtiveram-se 17,8% (141) de respostas, tendo 93% Castelo, Vila Real and Viseu. Several newly affected areas were dos veterinários referido casos de leishmaniose. A doença foi reported in these districts. The most common clinical signs mencionada nos distritos de Beja, Bragança, Castelo Branco, recognized were weight loss/muscle wasting, alopecia and lym- Coimbra, Évora, Faro, Guarda, Leiria, Lisboa, Madeira, phadenopathy. For the diagnosis indirect immunofluorescence Portalegre, Porto, Santarém, Setúbal, Viana do Castelo, Vila was commonly used and the first treatment option was allopuri- Real e Viseu. Nestes distritos foram referidas novas áreas onde nol which was very frequently associated with the meglumine recentemente surgiu leishmaniose canina. Os sinais clínicos antiamoniate. Leishmaniosis is still endemic in the same areas mais apontados foram perda de peso/atrofia muscular, alopécia as before and according to our data, it is likely that new areas e linfadenopatia. No diagnóstico, a técnica de imunofluores- are affected which would mean that the disease is spreading in cência indirecta foi comummente referida. A primeira opção Portugal. The clinical signs in the canine population are similar no tratamento foi alopurinol, frequentemente associado a to the typical leishmaniosis presentation and, in general, the antimoniato de meglumina. Em Portugal, a leishmaniose canina diagnostic tests, treatment protocols and prevention measures continua a ser endémica em áreas anteriormente conhecidas e offered by the veterinary clinicians are according to the scien- de acordo com os resultados agora obtidos, verificaram-se tific evidence available at the time of the survey. novas áreas afectadas devido à dispersão do parasita. Os sinais clínicos referidos são comuns na apresentação típica da leishmaniose e em geral, os testes de diagnóstico, os protocolos de tratamento e as medidas de prevenção preconizados pelos Introduction clínicos veterinários, estiveram de acordo com os conhecimentos científicos disponíveis à data do inquérito. Leishmaniosis are parasitic diseases caused by pro- Summary: Canine leishmaniosis (formerly leishmaniasis) is an tozoans of the genus Leishmania typically transmitted endemic disease in Portugal, caused by Leishmania infantum by phlebotomine insects (Thomaz-Soccol et al., and transmitted by Phlebotomus perniciosus and P. ariasi. We 1993). Depending on the Leishmania species they may performed a field survey with the following purposes: first, we infect humans and other animals (Maia et al., 2008; aimed to determine the geographical areas affected by Sastre et al., 2008), especially dog, that constitute the leishmaniosis including spreading of the parasite to areas not main reservoir for visceral zoonotic leishmaniosis due previously affected; second, we aimed to characterize the to L. infantum. Leishmaniosis is a common canine disease in the Mediterranean Basin, Latin America and an emergent disease in North America (Duprey *Correspondência: [email protected] et al., 2006). Human visceral leishmaniosis can be 21 Oliveira AM et al. RPCV (2010) 109 (573-576) 21-29 acquired through anthroponotic natural and artificial location and the number of patients consulted per cycles as well as through zoonotic cycle were the dog year; b) assessment of the origin and number of cases plays the main role (Marques et al., 2007). Due to the diagnosed with leishmaniosis; c) clinical presentation zoonotic nature of the disease infected dogs represent of the disease; d) diagnostic methods; e) treatment a problem for both veterinary and public health. protocols; f) prognosis; g) prevention; and h) zoonotic It has been estimated that at least 2.5 million dogs aspects. We also enclosed a prepaid envelope to be are infected in southwestern Europe alone (Moreno used to return the questionnaire. The deadline for and Alvar, 2002). In Portugal, leishmaniosis is caused reception of replies was October 2007. by several zymodemes of Leishmania infantum being MON-1 the most prevalent both in dogs and human beings (Baptista-Fernandes et al., 2007). The parasite Results is transmitted by females of Phlebotomus, especially of the species P. perniciosus and P. ariasi in Portugal A total of 141 (17.8%) answered questionnaires (Campino et al., 2006). The disease is endemic in were returned by mail. The results are presented in 3 several areas of the country such as Alto-Douro parts that cover different topics. (Abranches et al., 1992; Cardoso et al., 2004), Lisbon (Cortes et al., 2007), Setúbal (Abranches et al., 1984), Part 1: Distribution of leishmaniosis in Portugal Loulé (Campino et al., 1995) and Évora. In the first part of the questionnaire, we aimed to Canine leishmaniosis is a chronic systemic disease characterize the veterinary practices according to characterized by a variety of clinical signs such as skin location and the number of patients consulted. Results lesions, lymphadenopathy, weight loss, anorexia, show that most of the practices consulted 1000-2500 ocular lesions, epistaxis, renal failure and diarrhea dogs per year (Chart 1), with most of them consulting (Baneth et al., 2008). The pathogeny of the disease is fewer then 10 dogs per day (Chart 2). dependent on several factors such as the breed Clinicians were asked to give an average of the total (Solano-Gallego et al., 2000), virulence of the strain number of leishmaniosis cases per year in the last 2 (Baptista-Fernandes et al., 2007), and immune years. The total number includes new cases and ongoing response of the host against the parasite (Cabral et al., cases. The results revealed that 27% of the practices 1998). It is currently accepted that a specific were consulting between 1-5 leishmaniosis cases per anti-Leishmania cellular immune response is protec- year, 21% of the practices consulting 20-50 cases and tive and a humoral immune response is associated 19% practices consulting 10-20 cases (Chart 3). with development and severity of clinical disease Clinicians were also asked if in their opinion the (Cabral et al., 1998; Solano-Gallego et al., 2000). number of new and ongoing cases had "decreased", Several treatments can be used to clinically improve "increased", or "stabilized" in the last 5 years. Most of the patient but parasitological cure is rarely achieved the clinicians agreed that the number of new cases and (Noli and Auxilia, 2005). The aim of this survey was to characterize the Chart 1 - Number of dogs consulted at least once a year (total current status of leishmaniosis in Portugal. First, we of 137 answers) aimed to determine the geographical areas affected by leishmaniosis including spreading of the parasite to areas not previously affected. Progression to new areas is an important issue in any endemic disease. Second, we aimed to characterize the standard of care in diagnosis, treatment and prevention offered by the clinicians in the clinics throughout the country. The study had a similar design to a survey done in other European countries in order to obtain comparable results (Bourdeau et al., 2004). Chart 2 - Number of dogs consulted per day (total of 141 answers) Material and methods Seven hundred and ninety written questionnaires composed of 65 questions were sent to all licensed small animal clinics in Portugal including Madeira and Azores islands in June 2007. One questionnaire was sent per practice to avoid duplication of the data. The questionnaire covered the following topics: a) characterization of the veterinary clinic according to 22 Oliveira AM et al. RPCV (2010) 109 (573-576) 21-29 Chart 3 - Number of leishmaniosis cases per year (total of 140 ongoing cases had increased (Table 4).