Today's Veterinary Business

OCT 2018

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Leptospirosis: 5 things you probably didn't learn in vet school Leptospirosis is a bacterial disease of dogs, humans and many other mammals caused by a family of organisms mostly belonging to Leptospira interrogans. These are corkscrew-like Gram-negative bacteria that are capa- ble of penetrating intact mucous membranes and thus gaining access to the animal bloodstream without the need for a cut or a bite. Leptospira organ- isms can survive outside the mammalian host in fresh or brackish water but do not replicate there. They require a mammalian carrier host for replication, typically in the renal tubules. They are then excreted in the urine and if that urine is then mixed with fresh water in a puddle, stream or pond a new ani- mal can be infected by drinking or splashing that water into its eye. 1 Many of these carrier hosts are rodents. Each serovar (or type of Lep- tospira organism) is adapted to one or more mammals as the definitive host, meaning these mammals can remain infected with the organism for their entire lives without getting obviously sick, thus allowing the bacteria to replicate and be excreted intermittently throughout their lives. 2 The requirement for a mammalian definitive host for replication and spread of the bacteria indicates that this is a zoonotic disease. In fact, leptospirosis is a tremendously important zoonotic disease around the world in terms of the numbers of human infections and even deaths. 3 Over the past 10 years or so we have learned so much about this disease in dogs — and in fact we have learned that there are many differences between the disease we are seeing today and what we were all taught in veterinary school even a few years ago. Here are some major examples of the things we now know versus what was taught years ago: 1. Signalment – This used to be considered a rare lifestyle disease, a disease of large-breed hunting dogs in rural communities. NOT TRUE! Leptospirosis today is common to every breed, every size and everywhere. It has even become predominantly a small-dog disease in inner cities, suburban and rural communities. 4,5 2. Presenting complaint – We were taught this is a disease of kidney failure and/or liver failure. 10 NOT TRUE. The most common present- ing complaint of dogs with leptospirosis today are lethargy and inappetence or ADR and then GI signs or vomiting and abdominal pain. Only a small minority of cases very late in the disease process actually present in kidney or liver failure. 6,7 3. Testing – We were taught that microscopic agglutination test (MAT) was the best way to diagnose leptospirosis, even though it is expen- sive, has a slow turn around and often requires an initial and then convalescent test for multiple serovars. NOT TRUE. The best way to diagnose this disease today is rapid non-serovar-specific serology and, if needed, real-time PCR (see diagram) for the recommended diagnostic algorithm using Zoetis WITNESS™ Lepto test, the test that is most likely to pick up early infection in your practice. 8,9 4. Treatment – We were taught that a combination of antibiotics is necessary to treat this disease. NOT TRUE. Doxycycline is the drug of choice and every dog with leptospirosis should receive at least two weeks of doxycycline at 10mg/kg. If they are too sick to handle dox- ycycline initially, then an injectable penicillin or cephalosporin with or without a fluoroquinolone can be used until they are well enough for doxycycline. 6 5. Vaccination – We were taught that the vaccines were ineffective and reactive and could be worse than the disease itself and therefore should only be used in high-risk large-breed dogs. NOT TRUE. Van- guard® L4 and other lepto vaccines on the market are very effective, clean, safe vaccines and can and should be used in any dog in your practice. This should be a core part of every vaccine protocol in the vast majority of North America. 10,6 So, in summary what do we know today? This is very common disease everywhere in North America and every dog is at risk. It is no longer a lifestyle disease! Typical presentation is non-specific and gastrointestinal clinical signs. We finally have an accurate, rapid and inexpensive way to di- agnose leptospirosis early and in every dog. Therefore, every dog should be vaccinated for this potentially life-threatening yet preventable disease. 1. Adler, B., & Moctezuma, A. (2010). Leptospira and leptospirosis. Veterinary Microbiology, 140, 287-296. 2. Green, C.E., et al. 'Leptopirosis.' Infectious Diseases of the Dog and Cat. Ed. C.E. Greene:Elsevier, 2012.431-447. 3. Bharti, A.R., et al (2003). Leptospirosis: a zoonotic disease of global importance. The Lancet, 3, 757-771. 4. Lee, H.S., Guptill, L., Johnson, A.J., & Morre, G.E ((2014). Signalment changes in canine leptospirosis between 1970- 2009. J Vet Intern, 28, 294-299. 5. White, A.M., et al (2017). Hotspots of canine leptospirosis in the United States of America. The Veterinary Journal, 222,29-35. 6. Sykes, J.E., et al (2011) 2010 ACVIM small animal consensus statement on leptospirosis diagnosis, epidemiology, treatment and prevention. J Vet Intern Med, 25, 1-13. 7. Tangeman, L.E., & Littman, M.P. (2013). Clinicopathologic and atypical features of naturally occurring leptospirosis in dogs: 51 cases (2000-2010). JAVMA, 243 (9), 1316-1322. 8. Lizer, J et al (2017) Evaluation of 3 serological tests for early detection of Leptospira-specific antibodies in experimentally infected dogs. J Vet Intern Med. DOI:10.1111/jvim.14865. 9. Lizer, J.,et al (2017) Evaluation of rapid IgM detection test for diagnosis of acute leptospirosis in dogs. Vet Record. DOI:10.1136/vr.104134. 10. Moore, G.E., et al (2005). Adverse events diagnosed within three days of vaccine administration in dogs. JAVMA, 227 (1), 1102-1108. Suspected leptospirosis 1 History, physical examination, clinical signs, CBC, chemistry panel, urinalysis Negative Recent onset of clinical signs Extended duration of clinical signs Consider PCR or treat and retest with WITNESS Lepto in 7-10 days Leptospirosis unlikely Positive Leptospirosis likely Treat Leptospirosis diagnosed Treat Leptospirosis possible Consider treatment or MAT Negative Positive Leptospira Real-Time PCR Recently Vaccinated Unvaccinated ©2018 Zoetis Services LLC. All rights reserved. WIT-00350 1. Skyes JE, Hartmann K, Lunn KF, et al. 2010 ACVIM Small Animal Consensus Statement on Leptospirosis: Diagnosis, Epidemiology, Treatment, and Prevention. J Vet Intern Med 2011;25:1-13. 11 October/November 2018 • TODAYSVETERINARYBUSINESS.COM Sponsored Content from Zoetis

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