Leishmaniose canina: casos clínicos do Hospital Clínico Veterinário Complutense (Madrid)
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2017-09-27
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Leishmania infantum é o agente etiológico da leishmaniose canina (LCan) na Europa, sendo a doença endémica em toda a bacia do Mediterrâneo. Nestas regiões endémicas, a seroprevalência da infeção pode atingir valores superiores a 30%. Recentemente, a distribuição da leishmaniose aumentou e novos focos foram detetados em regiões previamente livres da doença. As alterações climáticas, o aumento das deslocações de animais infetados entre diferentes regiões do mundo e a ampliação das zonas de dispersão do parasita são as potenciais causas deste fenómeno.
O ciclo de vida do parasita envolve um vetor e um hospedeiro vertebrado. Insetos do género Phlebotomus são responsáveis pela transmissão das promastigotas metacíclicas através de picadas no cão, sendo estas respetivamente as formas infetantes e o hospedeiro vertebrado do parasita. O cão é considerado o maior reservatório do parasita para o ser humano e para outros mamíferos, e em Portugal apenas as espécies Phlebotomus-ariasi e Phlebotomus-perniciosus são vetores confirmados de L. infantum. O principal modo de transmissão de leishmania envolve a picada por parte dos flebótomos, outros modos de transmissão incluem a transfusões sanguíneas com origem em cães infetados, transmissão transplacentária e transmissão venérea.
As manifestações clínicas de LCan são amplas e variadas devido aos vários mecanismos fisiopatológicos desencadeados pelo protozoário. Por sua vez, estes promovem diferentes respostas imunitárias no hospedeiro e afetam múltiplos órgãos com diferentes graus de gravidade. O tratamento adequado e atempado exige, antes de tudo, um diagnóstico correto e precoce da doença, envolvendo um exame clínico minucioso, a realização de exames complementares e a determinação do estado sanitário e imunitário do animal. Por outro lado, a prevenção exige uma abordagem combinada, focada tanto no animal como no ambiente onde o vetor é abundante. Nas últimas décadas têm sido realizados esforços notáveis no desenvolvimento de estratégias de controlo da doença, sendo a vacinação e o uso repelentes à base de piretróides sintéticos as promessas de prevenção e controlo da doença.
Este estudo consiste na descrição de quatro casos clínicos que foram observados no Hospital Clínico Veterinário Complutense durante o período de estágio curricular (Setembro a Novembro, 2016). Foi possível observar sinais clínicos como linfodenomegalia, lesões cutâneas, lesões oculares, onicogrifose e perda de peso. Os
protocolos terapêuticos usados foram combinações de antimoniato de meglumina, alopurinol, miltefosina e marbofloxacina. Após tratamento foi feita uma monitorização regular.
Leishmania infantum is the etiologic agent of canine leishmaniosis (CanL) in Europe, the disease being endemic throughout the Mediterranean basin. In these endemic regions, the seroprevalence of the infection may reach values higher than 30%. Recently, the distribution of leishmaniosis has increased and new outbreaks have been detected in previously free regions of the disease. Climate change, increased movements of infected animals between different regions of the world and the expansion of parasite dispersal areas are potential causes of this phenomenon. The life cycle of the parasite involves a vector and a vertebrate host. Insects of the genus Phlebotomus are responsible for the transmission of metacyclic promastigotes through bites in the dog, these being respectively the infecting forms and the vertebrate host of the parasite. The dog is considered the largest reservoir of the parasite for humans and other mammals, and in Portugal only the species Phlebotomus-ariasi and Phlebotomus-perniciosus are confirmed vectors of L. infantum. Leishmania main mode of transmission involves sand flies, other modes of transmission include blood transfusions from infected dogs, transplacental transmission and venereal transmission. The clinical manifestations of LCan are broad and varied due to the numerous pathophysiological mechanisms triggered by the protozoan. In turn, they promote different immune responses in the host and affect multiple organs with different degrees of severity. Appropriate and timely treatment requires, first and foremost, a correct and early diagnosis of the disease, involving careful clinical examination, complementary examinations and determination of the animal's health and immune status. On the other hand, prevention requires a combined approach, focused on both the animal and the environment where the vector is abundant. Significant efforts have been made in the last decades to develop disease control strategies, with synthetic pyrethroids-based vaccination and repellent promising to prevent and control the disease. This study consisted in a description of four clinical cases of dogs that were observed at the Hospital Clínico Veterinário Complutense during the curricular practice period (from September till November, 2016). It was possible to observe clinical signs as lymphadenopathy, skin lesions, ocular lesions, onychogryphosis and weight loss. The therapeutic protocols used were the combination of meglumine antimoniate, allopurinol, miltefosin and marbofoxacin. After treatment regular monitoring was required.
Leishmania infantum is the etiologic agent of canine leishmaniosis (CanL) in Europe, the disease being endemic throughout the Mediterranean basin. In these endemic regions, the seroprevalence of the infection may reach values higher than 30%. Recently, the distribution of leishmaniosis has increased and new outbreaks have been detected in previously free regions of the disease. Climate change, increased movements of infected animals between different regions of the world and the expansion of parasite dispersal areas are potential causes of this phenomenon. The life cycle of the parasite involves a vector and a vertebrate host. Insects of the genus Phlebotomus are responsible for the transmission of metacyclic promastigotes through bites in the dog, these being respectively the infecting forms and the vertebrate host of the parasite. The dog is considered the largest reservoir of the parasite for humans and other mammals, and in Portugal only the species Phlebotomus-ariasi and Phlebotomus-perniciosus are confirmed vectors of L. infantum. Leishmania main mode of transmission involves sand flies, other modes of transmission include blood transfusions from infected dogs, transplacental transmission and venereal transmission. The clinical manifestations of LCan are broad and varied due to the numerous pathophysiological mechanisms triggered by the protozoan. In turn, they promote different immune responses in the host and affect multiple organs with different degrees of severity. Appropriate and timely treatment requires, first and foremost, a correct and early diagnosis of the disease, involving careful clinical examination, complementary examinations and determination of the animal's health and immune status. On the other hand, prevention requires a combined approach, focused on both the animal and the environment where the vector is abundant. Significant efforts have been made in the last decades to develop disease control strategies, with synthetic pyrethroids-based vaccination and repellent promising to prevent and control the disease. This study consisted in a description of four clinical cases of dogs that were observed at the Hospital Clínico Veterinário Complutense during the curricular practice period (from September till November, 2016). It was possible to observe clinical signs as lymphadenopathy, skin lesions, ocular lesions, onychogryphosis and weight loss. The therapeutic protocols used were the combination of meglumine antimoniate, allopurinol, miltefosin and marbofoxacin. After treatment regular monitoring was required.
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Dissertação de Mestrado Integrado em Medicina Veterinária
Palavras-chave
Cão , Leishmaniose , Leishmania infantum , Diagnóstico , Prevenção e controle , Terapêutica