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Home / Case studies / #10
Case study #10
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A-7-years old, male, mongrel arrived at your Emergency Veterinary Clinic. The animal showed several clinical signs such as skin lesions and epistaxis.
In the anamnesis, the owners commented that the skin lesions appeared about 15 days ago and that they had gone to the clinic due to nasal bleeding.
On clinical survey, the lesions are located on the face, symmetrically around the eyes and in the dorsal region of the nose. They are characterized by exfoliative dermatitis due to the presence of hyperkeratosis with flaking of white scales. A deterioration of the general condition of the animal is observed, showing significant weight loss (Image 1).
Image 1: Exfoliative dermatitis around the eyes and nasal plane.
(Source: Guadalupe Miró. Professor of the Dept. of Animal Health. Faculty of Veterinary Medicine. UCM).
Image 2: We can appreciate the prominent bone reliefs (ribs, spine cord and the sacrum) due to a marked lost weight. Despite, a generalized muscular atrophy are clearly visible. (Source: Guadalupe Miró. Professor of the Dept. of Animal Health. Faculty of Veterinary Medicine. UCM).
Skin scraping is normal. Blood tests showed moderate non-regenerative anemia, leukocytosis (neutrophilia), hyperproteinemia, renal azotemia, and proteinuria in the urinalysis.
The serological diagnosis is positive (1/160), and Image 3 shows one of the stages of the suspected microorganism.
The bone marrow aspirate shows hypercellularity with a marked deviation to the left (presence of numerous neutrophils – black arrow), as well as abundant plasma cells (*), some eosinophils, lymphocytes and macrophages (arrowhead), with massive presence of intracytoplasmic formations of the microorganism (red circles) causing the disease (Image 4).
Image 3: IFI technique. (Source: CNM Microbial Immunology Unit, Carlos III Health Institute)
Image 4: Bone marrow aspirate. Marked cytologic hypercellularity characterized by the presence of numerous neutrophils, some plasma cells, lymphocytes, eosinophils and macrophages. In this last cell type, there are numerous intracytoplasmic microorganisms. May-Grünwald-Giemsa. 100x
(Source: Spanish Group of Hematological Cytology atlas).
Secondary questions
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Main question
Symptomatology and laboratory results suggest a parasitic process.
What disease does the animal present?
- Ehrlichiosis (Ehrlichia canis)
- Leishmaniasis (Leishmania infantum)
- Amebiasis (Entamoeba histolytica)
Solution
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The pathogen identified was Leishmania infantum.
Leishmaniasis is a zoonotic disease transmitted by mosquitoes, mainly of the genus Phlebotomus.
This disease is associated with and limited by the geographical distribution of its phlebotomine vectors. In recent years, the number of regions becoming endemic to Leishmania has increased considerably, and the number of cases in animals and humans has also increased.
In Spain, in 2009-14, a zoonotic outbreak of Leishmaniasis occurred in the population of the northern area of Fuenlabrada (Madrid region), due to an overpopulation of hares and rabbits that favored the multiplication of sandflies and acted as a reservoir of the parasite. Parasitic forms of Leishmania infantum were found in 40 of 138 hares tested. In man, the clinical spectrum varies from asymptomatic infections to those with high mortality, with three classic forms described: visceral (VL), cutaneous (CL) and mucocutaneous (MCL).
Infection in the dog usually occurs with L. infantum, which cause chronic viscero-cutaneous disease in the host (canine Leishmaniosis, LCan).
Asymptomatic infection in the dog is widespread and contributes to maintaining the presence of the parasite in endemic areas in the long term. The clinical profile and evolution of Leishmaniosis is a consequence of complex interactions between the parasite and the host immune response. The evolution of the infection depends on the ability of host macrophages to effectively destroy the parasite.
Serology is the most indicated diagnostic method for canine Leishmaniasis, even during the early stages of the disease. In subclinical forms, seropositive cases are confirmed by PCR. Among the various serological techniques available, the indirect immunofluorescence test and the enzyme immunoassay are the most appropriate.
