Leishmania

Re: Leishmania

Charlotte Marshall — Wed, 22 Jan 2014 23:56:05 GMT

we have had a couple of cases over the years which have been stable just with allopurinol and if cost is an issue I would say it is certainly worth a try.

Re: Leishmania

Sarah Wheadon — Wed, 22 Jan 2014 22:58:14 GMT

Treated one of these, Great Dane. Owner and I looked at meg lumina but she opted against on grounds of pain of injections, side effects and cost and used allopurinol (which is cheap as chips) alone. Clinical signs resolved well and we stopped treatment after about 6 months. She died of something completely different 18 months later.

Re: Leishmania

David Mills — Wed, 22 Jan 2014 21:42:48 GMT

Thanks all, esp Mr Bell - fantastically helpful answer.

Rock and hard place - charity client, nasty dog that is almost unexaminable. Looks like oral or bust really.

Thanks again,

Re: Leishmania

Rory Bell — Wed, 22 Jan 2014 11:57:37 GMT

Hi David

Meglumine antimonate (75-100mg/kg SID s/c for 4 weeks with the option to extend therapy for 2-3 weeks further depending on the extent to which clinical signs resolve) combined with allopurinol(10mg/kg BID PO for 6-12 months depending on clinical response) offers approximately equal efficacy to miltefosine (2mg/kg SID PO for 4 weeks) combined with allopurinol as above.

Drawbacks of meglumine include cellulitis / sterile abscesses at site of injection, potential nephrotoxicity and the potential for other idiosyncratic reactions. Given that leishmaniosis can cause proteinuria and renal damage (both of which, along with overall severity of clinical signs) are negative prognostic indicators, its wise to screen and re-evaluate patients for evidence of azotemia prior to and during the course of meglumine treatment.

30-40% of dogs on miltefosine will have GI upsets, the other disadvantage of miltefosine is its expense relative to meglumine but it is easier to administer and (possibly) less likely to result in adverse reactions, particularly if the dog is azotaemic.

Allopurinol can cause xanthine crystaluria, xanthine urolithiasis has also been reported following chronic use.

Treatment is unlikely to result is clinical cure, therapeutic targets are therefore primarily resolution of clinical signs. Declining antibody titres and a decline in DNA copies using quantitative PCR (although I don't think the latter test is routinely available in the UK) can also serve as objective markers of response. If using PCR, then conjunctival swabs (based on recent work from Israel), or material from spleen, lymph node, bone marrow or skin lesions is more rewarding then blood or urine.

Some dogs can be weaned off all treatment once their clinical signs resolve, some require ongoing (permanent) allopurinol treatment. Generally, its the dogs with severe proteinuria, severe clinical signs and azotaemia that respond poorly.

Dogs that are weaned off treatment can still have relapses of clinical signs. If relapses are mild in terms of clinical severity, then they might be controllable on allopurinol alone. You do need committed owners to treat this disease successfully.

Hope this helps. All of the above based on 'extensive' experience of treating a handful of dogs but more importantly, lots of conversations with Spanish, Italian and Portugese colleagues over the years on this subject.

cheers

Re: Leishmania

Anthony Dennison — Wed, 22 Jan 2014 08:48:09 GMT

[quote user="Anne Seawright"] Christine Prost isn't at Bristol anymore either! The dermatologist are Natalie Barnard and Paul Coward.[/quote]

Wow, she didn't last long then! Good to see Natalie's back

Re: Leishmania

Anne Seawright — Tue, 21 Jan 2014 16:49:01 GMT

[quote user="Anthony Dennison"]

[quote user="Christina Smith"]

Susan Shaw at Bristol University is worth talking to. I don't think you can expect to cure just control. What test proved to be positive ? Does it have lymphadenopathy or systemic signs? I believe most dogs from certain areas of Spain will be positive on serology.

[/quote]

Sue isn't at Bristol any more, it's a woman called Christine Prost

[/quote] Christine Prost isn't at Bristol anymore either! The dermatologist are Natalie Barnard and Paul Coward.

Re: Leishmania

Anthony Dennison — Tue, 21 Jan 2014 10:21:47 GMT

[quote user="Christina Smith"]

[/quote]

Sue isn't at Bristol any more, it's a woman called Christine Prost

Re: Leishmania

Francisco Gomez — Mon, 20 Jan 2014 21:12:03 GMT

Would be using daily allopurinol long term as far as i remember. We used to have a protocol of iv meglumine injections (i think it was about 10 in a couple of weeks, but id have to have a look, until getting in remission), then invariably the symptoms would come back again, sometimes in a couple of months, sometimes in a couple of years. Now it is proven that subcut inj are equally effective (tho painful) than iv ones...

Re: Leishmania

Andrew Kent — Mon, 20 Jan 2014 20:33:05 GMT

We tend to use miltefosine rather than meglumine as is oral and apparently equally efficacious. The manufacturer (I think Novartis) keep a stock in the uk so also easily accessible with relevant certificates.

Re: Leishmania

John Flynn — Mon, 20 Jan 2014 19:55:43 GMT

Only the one in a similar situation to yourself.

Owner was Spanish and I emailed their previous vet in spain as I figured they'd be pretty familiar with the day-to-day treatment of these. Was giant breed and stopped collecting (paying for) their allopurinol after a couple of months and seemed to get on all right with no treatment in medium term anyway...

Theres a review in JAVMA, Vol 236, No. 11, June 1, 2010 if you can get it.that discusses treatments based on clinical stage of disease.

I don't think zoonotic risk if no competent vectors.

Re: Leishmania

Christina Smith — Mon, 20 Jan 2014 19:50:09 GMT