[Leish-l] Fwd: Leishmaniasis - UK: (England) dogs, 1st local cases

Sat May 4 17:28:50 -03 2019

Dear all,

I would suggest that the owners of the sick dogs should be carefully
investigated for past or present infection with L. infantum since humans
are also infective to sandflies that eventually would have been carried on
(included in vases with plants). Additionally, L. infantum has been
identified and isolated from the respiratory tract and from the blood of
asymptomatic humans.

Cheers,

Carlos.

Em sex, 3 de mai de 2019 às 16:35, Leishmania News <leishnews at gmail.com>
escreveu:

> LEISHMANIASIS - UK: (ENGLAND) DOGS, 1ST LOCAL CASES
> ***************************************************
> A ProMED-mail post
> <http://www.promedmail.org>
> ProMED-mail is a program of the
> International Society for Infectious Diseases
> <http://www.isid.org>
>
> [1]
> Date: Thu 4 Apr 2019
> Source: EurekAlert [edited]
> <https://www.eurekalert.org/pub_releases/2019-04/b-fru040319.php>
>
>
> Veterinary professionals have sounded the alarm in this week's Vet
> Record after treating the 1st UK case of a dog with the potentially
> fatal infection leishmaniosis that is thought to have been passed on
> by another dog, rather than by travel to an area where the infection
> is endemic.
>
> Canine leishmaniosis is caused by the parasite _Leishmania infantum_,
> carried by the female sand fly and transmitted in its bite. It is
> zoonotic, so can be passed on to people.
>
> Dogs have been known to pick up the infection after being bitten or
> wounded by another infected dog. But up to now, this has not been
> reported in the UK, where cases to date have been associated with
> blood transfusion, breeding programmes, or overseas travel.
>
> But a 3-year-old neutered male shih tzu cross, which had been with its
> owner since a puppy and had none of the known risk factors for
> infection, was nevertheless diagnosed with leishmaniosis in
> Hertfordshire.
>
> Dog-to-dog transmission is the most likely explanation, suggest the
> authors, because another dog in the household that had been imported
> from Spain had to be put down 6 months earlier after developing severe
> leishmaniosis.
>
> "To the authors' knowledge, this is the 1st reported case of
> leishmaniosis in the UK in a dog without a history of travel to an
> endemic area," they write, adding that extra vigilance is now needed
> to guard against the spread of the infection.
>
> "In an era of increased foreign travel of dogs and increased
> importation of dogs to the UK, it is likely that the number of dogs
> seropositive for _L. infantum_ will continue to increase," they warn.
>
> "Leishmania-infected dogs may present an infection risk to other dogs,
> even in the absence of natural vectors, as direct transmission between
> dogs is possible," they add.
>
> A 2nd case of canine leishmaniosis in a dog with no obvious risk
> factors has now also come to light in a different part of the UK [see
> comment].
>
> In a recently published letter in Vet Record, vets describe the case
> of a 3-year-old fully vaccinated male neutered English pointer that
> was eventually diagnosed with leishmaniosis.
>
> The dog had never travelled outside of the UK, or beyond the borders
> of Essex, where it lived. But its owners had lived in Spain and
> travelled to the Jalon Valley (between Alicante and Valencia) without
> their pet in the summer of 2018.
>
> Unlike the 1st case, this dog was not living, or in regular contact
> with another infected dog, and it may be that infected sand flies were
> inadvertently brought back in the owners' transport, luggage, or
> clothing, suggest the authors.
>
> "However, the increased importation of infected dogs into the UK also
> makes incidental socialising with infected dogs increasingly likely,"
> they point out.
>
> The case also "serves as a reminder that we should not be complacent
> about the risk of _L. infantum_ establishing in the UK, even in the
> current absence of the sand fly vector," they warn.
>
> Junior Vice President of the British Veterinary Association (BVA),
> Daniella Dos Santos, comments: "The increase in cases of non-endemic
> diseases such as leishmaniasis is extremely concerning, with more than
> a quarter of vets surveyed by BVA last year [2018] mentioning seeing
> cases of this rare disease in practice.
>
> "Leishmaniasis is mainly associated with pets who have recently
> travelled outside of the UK or 'trojan' rescue dogs from abroad with
> unknown health histories, which is why we have called on the
> government to strengthen existing pet travel legislation and its
> enforcement for the sake of animal and human health in the UK."
>
> She advises pet owners planning on overseas travel with their dog to
> seek advice from a vet before travel, while those who already own an
> imported rescue dog should contact their local vet for advice on
> testing and treatment for any underlying conditions.
>
> "Anyone looking to get a dog should consider adopting from a UK
> rehoming charity or welfare organisation instead of rescuing from
> abroad," she recommends, "as the unintended consequences from trojan
> dogs can be severe for the health and welfare of UK's pets and, in
> some cases, humans too."
>
> --
> Communicated by:
> ProMED-mail
> <promed at promedmail.org>
>
> [The new article, to which the above report refers, is McKenna M,
> Attipa C, Tasker S, Augusto M. Leishmaniosis in a dog with no travel
> history outside of the UK. Vet Record 2019;184:441
> <https://veterinaryrecord.bmj.com/content/184/14/441>.
>
> This is the 2nd Vet Record publication during 2019 dealing with canine
> leishmaniasis in the UK. The previous one was a letter, published on
> 23 Mar in volume 184, issue 12 (Wright I, Baker S. Leishmaniosis in a
> dog with no history of travel outside the UK. Vet Record
> 2019;184:387-8
> <https://veterinaryrecord.bmj.com/content/vetrec/184/12/387.3.full.pdf>).
> The affected dog had, similarly, never travelled outside of the UK, or
> outside of the county of Essex. However, the owners previously lived
> in Spain and travelled to the Jalon Valley without the patient in the
> summer of 2018. Unlike the case addressed in the above media report,
> this dog was not living with, or in regular contact with, another
> infected dog. This makes the odds of direct contact with another
> infected dog much lower and more likely that infection is in some way
> related to the owners' foreign travel.
>
> The grave concern raised in the UK following the 2 canine _Leishmania_
> publications led the Vet Record to publish a research comment. Its
> full text is included in item [2]. - Mod.AS]
>
> ******
> [2]
> Date: Thu 4 Apr 2019
> Source: Veterinary Record [edited, references omitted]
> <https://veterinaryrecord.bmj.com/content/vetrec/184/14/438.full.pdf>
>
>
> Citation: Duthie MS, Petersen C. Could canine visceral leishmaniosis
> take hold in the UK? Vet Record 2019;184:438-40
> <http://dx.doi.org/10.1136/vr.l985>.
>
> Canine visceral leishmaniosis (CVL) is a life-threatening outcome of
> infection with _Leishmania infantum_, a protozoan parasite that is
> found throughout the Mediterranean basin, the Middle East, Latin
> America and some parts of Asia. Reviews of veterinary records have
> indicated a CVL prevalence of between 0.007% and 0.04% in the UK. The
> majority of cases have been reported in southern England, with all
> affected dogs having spent at least several months in endemic
> countries such as Spain.
>
> _Leishmania_ is typically transmitted during the blood meal of
> infected sand flies. However, sand flies are not found in the UK. In
> the absence of sand flies, alternative routes of transmission such as
> vertical, venereal and receipt of infected blood transfusions have
> been demonstrated.
>
> Additionally, it has been speculated that direct dog-to-dog
> transmission through bites or wounds was the likely mode of
> transmission in isolated CVL cases in Finland, Germany and New
> Caledonia in the southwest Pacific.
>
> In an article summarised on page 441 of this issue of Vet Record,
> McKenna and colleagues document what they believe to be the 1st
> reported case of CVL in a dog without a history of foreign travel.
> Although the possibility of direct transmission of leishmaniosis
> between dogs in the UK has been suggested, it has not been
> conclusively shown. McKenna and colleagues concluded that
> veterinarians in the UK should include CVL as a differential diagnosis
> when appropriate clinical findings are present. However, the clinical
> signs of CVL are quite general, so symptomology is not particularly
> useful for detecting and differentiating _Leishmania_ from other
> aetiologies. Even in endemic countries, discriminating the early
> clinical signs of CVL can be difficult.
>
> A unique aspect that probably aided the diagnosis of the case
> described by McKenna and colleagues was prior knowledge of the
> likelihood of disease; another dog in the same household had been
> diagnosed with CVL 6 months before the clinical presentation of this
> particular dog. Therefore, both the owners and the veterinarians had
> an uncharacteristically heightened awareness of CVL as a possible
> diagnosis.
>
> This particular case presented for investigation after a 3-week period
> of weight loss, intermittent vomiting, moderate pancytopenia and
> diarrhoea with haematochezia. Although not reported in this case,
> epistaxis is another common clinical sign that is observed in 10% to
> 25% of cases. The potential for exposure to infected blood or body
> fluids increases as CVL advances, and this could very well have been
> the mode of transmission from the index case to this particular dog.
> This situation may also present a risk to owners and handlers, as _L.
> infantum_ can cause disease in people.
>
> Although the dog in the case described by McKenna and colleagues had
> never been used for breeding, there would have been a risk of
> transmission through sexual contact if it had. Transmission can also
> occur transplacentally between a dam and her pups. This route is
> believed to be the dominant source of infection within several
> pedigree breeds, with genetic analyses indicating that _L. infantum_
> could well have been introduced into the US foxhound population by
> breeding from dogs that originated from France. Any breed of dog
> originating from _Leishmania_-endemic areas could harbour the
> parasite, with breeds such as briards, Neapolitan mastiffs, cane
> corsos and Italian spinones indicated as at risk.
>
> Introduction of infection through breeding could potentially lead to
> sustained vertical transmission of the parasite for generations.
> Another possible route of transmission is via infected blood. Canine
> blood transfusions are on the rise, and over 10 000 dogs in the UK are
> now registered as blood donors. To qualify as donors, dogs need to
> meet certain criteria such as being in general good health and having
> a normal temperature, heart rate and respiration. Among other
> requirements, owners must also confirm that the dog has not been
> abroad. However, because of prohibitive costs, formal testing is not
> conducted for bloodborne diseases that are not prevalent in the UK.
>
> The dog in the case described by McKenna and colleagues never received
> a blood transfusion, but it could well have qualified as a donor
> during the time in which it was subclinically infected (which was a
> period of at least 5 months). Dogs can maintain subclinical _L.
> infantum_ infection for years before progression to CVL. Therefore, it
> may be prudent to expand donor exclusion criteria to include
> significant contact with dogs that have spent time in
> _Leishmania_-endemic regions.
>
> Treatment with a 28-day course of 2 mg/kg miltefosine once a day
> orally and 10 mg/kg allopurinol twice a day orally, and thereafter
> continuation with allopurinol alone, resolved the clinical signs and
> improved the body condition score in the case described by McKenna and
> colleagues. Alleviation of clinical signs and a decreased parasite
> load are considered indicators of treatment success in CVL patients,
> although complete parasitological clearance is often not achieved.
> Further control could be provided by vaccination, which has been shown
> to prevent progression in non-endemic areas and would be recommended
> for any dog travelling to an endemic area.
>
> Given what we know regarding possible transmission routes, reasonable
> steps to prevent _L. infantum_ from becoming established in the UK
> would include screening of dogs that are imported from
> _Leishmania_-endemic regions, implementing similar screening among the
> contact population of any dogs presenting with CVL, regular follow-up
> to ensure conversion does not occur (an important consideration given
> the chronic nature of the infection and often delayed disease
> presentation), exclusion of subclinically infected dogs from blood
> donation, vaccination and use of topical insecticides for dogs
> travelling to endemic areas.
>
> --
> Communicated by:
> ProMED-mail
> <promed at promedmail.org>
>
> [Leishmaniosis is an OIE-listed zoonotic disease, warranting
> reporting. For the relevant chapter 3.1.11 of the Terrestrial Manual
> 2018 (version adopted May 2014), please go to
> <
>
> http://www.oie.int/fileadmin/Home/eng/Health_standards/tahm/3.01.11_LEISHMANIOSIS.pdf
> >.
> - Mod.AS
>
> HealthMap/ProMED-mail map:
> England, United Kingdom: <http://healthmap.org/promed/p/279>]
>
> [See Also:
> 2018
> ----
> Leishmaniasis, visceral - Israel: (HZ) feline, canine
> http://promedmail.org/post/20181215.6209970
> Leishmaniasis - Brazil: (AL) canine, human
> http://promedmail.org/post/20180905.6009156
> 2016
> ----
> Leishmaniasis, canine - France
> http://promedmail.org/post/20160220.4033101
> Leishmaniasis - Uruguay: (SA) canine, alert
> http://promedmail.org/post/20160122.3952222
> 2015
> ----
> Leishmaniasis - Argentina (05): (ER) canine
> http://promedmail.org/post/20151008.3701288
> Leishmaniasis - Colombia: (HU) canine
> http://promedmail.org/post/20150918.3653741
> Leishmaniasis - Uruguay: (SA) canine, OIE
> http://promedmail.org/post/20150305.3208769
> 2013
> ----
> Leishmaniasis - Syria (04): comment on canine reservoir
> http://promedmail.org/post/20130420.1660409
> 2012
> ----
> Leishmaniasis, canine - Brazil: (MG)
> http://promedmail.org/post/20121111.1404680
> Leishmaniasis, human, canine - Spain (02): background
> http://promedmail.org/post/20120329.1084736
> Leishmaniasis, human, canine - Spain: (MD)
> http://promedmail.org/post/20120328.1083656
> Leishmaniasis, canine - Uruguay (02): prevention & control
> http://promedmail.org/post/20120126.1022719
> Leishmaniasis, canine - Singapore ex Spain: OIE
> http://promedmail.org/post/20120125.1022003
> Leishmaniasis, canine - Uruguay: (Montevideo) OIE
> http://promedmail.org/post/20120120.1016268
> 2011
> ----
> Leishmaniasis, canine - Argentina (04): (CN)
> http://promedmail.org/post/20111202.3502
> Leishmaniasis, canine - Argentina (03): (CN)
> http://promedmail.org/post/20110925.2916
> Leishmaniasis, canine - Argentina (02): (CN)
> http://promedmail.org/post/20110625.1943
> Leishmaniasis, canine - Argentina: (CN)
> http://promedmail.org/post/20110323.0908
> 2010
> ----
> Leishmaniasis, human, canine - Paraguay
> http://promedmail.org/post/20100813.2784
> Leishmaniasis, canine - Argentina: (CN)
> http://promedmail.org/post/20100211.0483
> 2009
> ----
> Leishmaniasis, canine - Argentina: (SF)
> http://promedmail.org/post/20091107.3859
> Leishmaniasis, visceral - Brazil: (MT), human, canine
> http://promedmail.org/post/20090123.0290
> 2008
> ----
> Leishmaniasis, visceral - Brazil (03): (DF), human, canine
> http://promedmail.org/post/20081130.3766]
> .................................................sb/arn/rd/mpp
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President
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