2010 ACVIM small animal consensus statement on leptospirosis: diagnosis, epidemiology, treatment, and prevention

This report offers a consensus opinion on the diagnosis, epidemiology, treatment, and prevention of leptospirosis in dogs, an important zoonosis. Clinical signs of leptospirosis in dogs relate to development of renal disease, hepatic disease, uveitis, and pulmonary hemorrhage. Disease may follow periods of high rainfall, and can occur in dogs roaming in proximity to water sources, farm animals, or wildlife, or dogs residing in suburban environments. Diagnosis is based on acute and convalescent phase antibody titers by the microscopic agglutination test (MAT), with or without use of polymerase chain reaction assays. There is considerable interlaboratory variation in MAT results, and the MAT does not accurately predict the infecting serogroup. The recommended treatment for optimal clearance of the organism from renal tubules is doxycycline, 5 mg/kg p.o. q12h, for 14 days. Annual vaccination can prevent leptospirosis caused by serovars included in the vaccine and is recommended for dogs at risk of infection.     

An old disease with a new face: canine leptospirosis does not lose its relevance

The clinical features of the disease are presented based on retrospective analysis of the records of eleven dogs diagnosed with leptospirosis using clinical signs and results of the microagglutination test (MAT) between 1991 and 1996. Additionally, Leptospira titres were determined in 30 healthy dogs and 20 hospitalised dogs without clinical or laboratory evidence of leptospirosis. A positive titre for L. grippotyphosa, L. pomona, L. bratislava, L. australis, L. icterohaemorrhagiae and/or L. canicola was found in 16 normal dogs and only one hospitalised patient. Eight of these dogs had titres of > or = 1:800. Only one of them had been vaccinated shortly before sampling. These results suggest that many dogs from the surroundings of Bern, Switzerland have contact with various Leptospira interrogans serovars. In ten healthy dogs, the Leptospira titre was determined before and four weeks after vaccination with leptospiral antigen. Only two of the dogs showed a serologically measurable response to the antigen contained in the vaccine. In dogs MAT titers presumably do not reliably reflect the immune status against leptospiral infections.     

Serological findings in cases of acute leptospirosis in the dog

Fourteen dogs which had died from acute leptospirosis, three dogs which survived an acute attack of leptospirosis and seven healthy dogs living in close contact with the animals which died were examined for the presence of lepto-spiral antibodies by the microscopic agglutination test. Twelve dogs had titres of 1:3200 or greater. The predominant titre was directed against serovar bratislava in seven cases, serovar grippothyphosa in two cases and both these serovars in two cases. In one case the predominant titre was directed against serovars bratislava, grippothyphosa, copenhageni (serogroup icterohaemorrhagiae) and pomona. The present study and other recent reports suggest that the epidemiology of canine leptospirosis is changing with the emergence of serovars differing from those typically infecting dogs, namely canicola and icterohaemorrhagiae.     

Influence of infecting serogroup on clinical features of leptospirosis in dogs

The purpose of this study was to review recent cases of leptospirosis seen at referral centers in New York State and to identify differences in clinical or clinicopathologic aspects of the disease among different suspected infecting serogroups. Medical records at the Cornell University Hospital for Animals and the Animal Medical Center in New York City were reviewed to identify dogs diagnosed with leptospirosis from September 1996 to August 2002. Records of 55 dogs met the inclusion criteria for the study. The suspected infecting serogroups included 21 occurrences of Grippotyphosa, 12 of Pomona, 6 of Autumnalis, 5 of Bratislava, 2 of Hardjo, and 1 of Canicola. Five dogs had equal titers to serogroups Grippotyphosa and Pomona, and 3 had equal titers to 2 other serogroups. Common clinical signs included lethargy, anorexia, and vomiting. Common clinicopathologic findings included anemia, thrombocytopenia, azotemia, hyperphosphatemia, high liver enzyme activity, and hyperbilirubinemia. Forty-three of 55 dogs were discharged from the hospital. Serogroup-specific analysis indicated that dogs with suspected serogroup Pomona infection were more likely to suffer from vomiting (P = .01), thrombocytopenia (P = .009), severe azotemia (P = .04), and hyperphosphatemia (P = .006) than dogs with other serogroups and were less likely to be discharged alive from the hospital (P = .03). This study suggests that only minor clinically relevant differences exist among serogroups. Leptospira serogroup Pomona caused more severe renal disease and was associated with a worse outcome compared with disease caused by other serogroups.     

Use of machine-learning algorithms to aid in the early detection of leptospirosis in dogs

Leptospirosis is a life-threatening, zoonotic disease with various clinical presentations, including renal injury, hepatic injury, pancreatitis, and pulmonary hemorrhage. With prompt recognition of the disease and treatment, 90% of infected dogs have a positive outcome. Therefore, rapid, early diagnosis of leptospirosis is crucial. Testing for Leptospira-specific serum antibodies using the microscopic agglutination test (MAT) lacks sensitivity early in the disease process, and diagnosis can take >2 wk because of the need to demonstrate a rise in titer. We applied machine-learning algorithms to clinical variables from the first day of hospitalization to create machine-learning prediction models (MLMs). The models incorporated patient signalment, clinicopathologic data (CBC, serum chemistry profile, and urinalysis = blood work [BW] model), with or without a MAT titer obtained at patient intake (=BW + MAT model). The models were trained with data from 91 dogs with confirmed leptospirosis and 322 dogs without leptospirosis. Once trained, the models were tested with a cohort of dogs not included in the model training (9 leptospirosis-positive and 44 leptospirosis-negative dogs), and performance was assessed. Both models predicted leptospirosis in the test set with 100% sensitivity (95% CI: 70.1–100%). Specificity was 90.9% (95% CI: 78.8–96.4%) and 93.2% (95% CI: 81.8–97.7%) for the BW and BW + MAT models, respectively. Our MLMs outperformed traditional acute serologic screening and can provide accurate early screening for the probable diagnosis of leptospirosis in dogs.     

Evaluation of environmental risk factors for leptospirosis in dogs: 36 cases (1997-2002)

OBJECTIVE: To identify environmental risk factors for leptospirosis. DESIGN: Retrospective study. ANIMALS: 36 dogs with leptospirosis and 138 dogs seronegative for leptospirosis as determined by microscopic agglutination test for antibodies against Leptospira spp. PROCEDURES: Medical records of dogs evaluated for leptospirosis from 1997 though 2002 were identified. Owner address was used to geocode locations of dogs, and location-specific environmental risk factor data were obtained by use of a geographic information system. Risk of leptospirosis was estimated by odds ratios, controlling for potential confounding by dog age, sex, and breed. RESULTS: Leptospirosis in 19 of the 30 dogs in which an infecting Leptospira serovar could be identified was associated with Leptospira kirschneri serovar grippotyphosa infection. Dogs in which a diagnosis of leptospirosis was made, and dogs with leptospirosis caused by L kirschneri serovar grippotyphosa, were more likely to have addresses located in areas classified as rural in 1990 but urban in 2000. By use of information on recent urbanization and a logistic regression model, the status of 81.6% and 89.8% of dogs with leptospirosis and leptospirosis caused by serovar grippotyphosa, respectively, were correctly classified. Other environmental variables (proximity to streams, recreational areas, farmland, wetlands, areas subject to flooding, and areas with poor drainage; annual rainfall; and county cattle or pig population) did not significantly improve accuracy of classification. CONCLUSIONS AND CLINICAL RELEVANCE: Dogs in periurban areas are at greater risk of leptospirosis. Vaccination of dogs in these areas to protect against leptospirosis should be considered.     

Clinical application of a polymerase chain reaction assay for diagnosis of leptospirosis in dogs

OBJECTIVE: To evaluate the use of a polymerase chain reaction (PCR) assay on urine samples for diagnosis of leptospirosis in dogs. DESIGN: Prospective case study. ANIMALS: 132 dogs with clinical signs suggestive of leptospirosis and 13 healthy dogs. PROCEDURE: PCR testing was performed on urine samples to detect leptospiral DNA; results were compared with results of conventional criteria for the diagnosis of leptospirosis. RESULTS: Leptospirosis was diagnosed in 8 dogs via established criteria; all these dogs had positive results of PCR assay, including 1 dog with positive results before seroconversion developed. A positive PCR assay result was also obtained in 16 dogs that did not have a confirmed diagnosis of leptospirosis. In the 8 dogs that had a confirmed diagnosis of leptospirosis, serovars pomona (n = 3 dogs), grippotyphosa (2), canicola (2), and bratislava (1) were identified serologically. The remaining 121 dogs all had a diagnosis other than leptospirosis or were healthy. For PCR testing on urine, sensitivity was 100%, specificity was 88.3%, positive predictive value was 33%, and negative predictive value was 100%. CONCLUSIONS AND CLINICAL RELEVANCE: Positive PCR test results prior to seroconversion may have value in establishing an early diagnosis. Positive results in dogs that had signs consistent with leptospirosis despite failing to meet established criteria for leptospirosis raise questions regarding the sensitivity of serologic testing in diagnosis of leptospirosis. Serovars pomona, grippotyphosa, and canicola were most common.     

Is the microagglutination test (MAT) good for predicting the infecting serogroup for leptospirosis in Brazil?

Leptospirosis is a zoonotic infection caused by pathogenic members of the genus Leptospira spp. Knowledge of the prevalent serovars and their maintenance hosts is essential to understand the disease. The aim of this study was to evaluate the ability of serology by the microscopic agglutination test (MAT) to predict the serogroups compared with results of identification of leptospires in São Paulo, Brazil. MAT correctly assigned the serogroup of the infecting isolate in 49/52 cases (94.23%). The serogroup Icterohaemorrhagiae was the predominant serogroup (88.46%). This study showed the usefulness of the MAT to correctly identify the infecting serogroup with a good overall agreement between the serologically-identified infecting serogroup and by identification of the isolate and can be used in epidemiological surveys in São Paulo. However, it should be complemented by the identification of Leptospira isolates.     

Serovar-specific prevalence and risk factors for leptospirosis among dogs: 90 cases (1997-2002)

OBJECTIVE: To estimate serovar-specific prevalence of leptospirosis by use of veterinary teaching hospital and laboratory submission data; describe annual and seasonal patterns of leptospirosis; and identify risk factors for age, sex, and breed. DESIGN: Retrospective study. ANIMALS: 90 dogs with leptospirosis. PROCEDURES: Hospital records of dogs examined at Purdue University Veterinary Teaching Hospital with a diagnosis of leptospirosis and laboratory records of dogs from which sera were tested for antibodies against Leptospira spp at Purdue University Animal Disease Diagnostic Laboratory from 1997 through 2002 were reviewed. The likely infecting Leptospira serovar was identified. Seasonal and annual prevalences were calculated by use of hospital population at risk (hospital cases) or serologic testing submissions (diagnostic laboratory cases). Age-, sex-, and breed-specific risk factors for hospital cases were estimated by odds ratios. RESULTS: Of the 39 hospitalized dogs identified, 34 had been serologically tested, and 22 of those were infected with Leptospira kirschneri serovar grippotyphosa. Of the 51 diagnostic laboratory cases, 59% had a reciprocal titer > or = 800 against serovar grippotyphosa. Diagnostic laboratory cases were more common in summer, whereas hospital cases of leptospirosis were more common in fall. Male dogs were at significantly greater risk of leptospirosis than female dogs; and dogs 4 to 6.9 years old were at significantly greater risk than dogs < 1 year old. CONCLUSIONS AND CLINICAL RELEVANCE: L kirschneri serovar grippotyphosa infection was associated with most cases of leptospirosis in dogs. Use of an effective vaccine that includes this serovar is advisable for dogs at risk of leptospirosis.     

Immunity to leptospirosis: bacterins in dogs and hamsters.

Resistance to clinical and renal leptospirosis in dogs vaccinated with a bacterin containing Leptospira interrogans serotype canicola and Leptospira interrogans serotype icterohaemorrhagiae was demonstrated. The relationship between resistance induced in vaccinated dogs and that induced in vaccinated hamsters was also demonstrated, using criteria of leptospiremia, renal infection, leptospiruria, and clinical signs of disease in dogs and death in hamsters.     

Seroepidemiology of leptospirosis, toxoplasmosis, and leishmaniosis among dogs in Ankara, Turkey

Seroprevalence of five different Leptospira interrogans serovars, Toxoplasma gondii and Leishmania infantum in stray dogs in Ankara was investigated. A total of 116 dog sera collected from apparently healthy stray dogs were tested for L. interrogans serovars by microscopic agglutination test (MAT), for T. gondii antibodies by Sabin-Feldman dye test (SFDT), and for L. infantum antibodies by indirect fluorescence antibody test (IFAT). Of the 116 dogs, 51 (43.96%) were seropositive for leptospirosis, 72 (62.06%) for T. gondii and 3 (2.58%) for L. infantum. No statistically significant difference was observed between male and female dogs in the seroprevalences of toxoplasmosis and leptospirosis (P>0.05), but statistically significant difference was observed among different age groups in the seroprevalences of toxoplasmosis and leptospirosis (P<0.05). Although the seroprevalence of L. infantum was low, asymptomatic animals should be considered as a reservoir for the spread of the disease.     

Serological survey of leptospiral infection in kennelled dogs in Italy

Two hundred and forty-five dogs were examined serologically for the presence of antibodies against different serovars of Leptospira interrogans. The dogs belonged to five different groups: group 1 was composed of clinically healthy pet dogs referred for a regular veterinary check-up visit or for vaccination; group 2 was composed of stray dogs; and groups 3, 4 and 5 were composed of dogs maintained in three different kennels which had varying standards of hygiene. Seventy-two out of the 245 dogs examined were seropositive for leptospirosis. In group 1, there were 3-4 per cent seropositive dogs; in group 2, 30.3 per cent; in group 3, 13.8 per cent; in group 4, 38.6 per cent; and in group 5, 49.2 per cent. This study demonstrates that leptospiral infection is common in dogs housed in kennels, despite most of them being vaccinated, and that crowding of animals into unsanitary quarters is associated with a high prevalence of infection. The most common infecting serovars found were bratislava and grippotyphosa, confirming recent observations that demonstrate a significant change in the epidemiology of canine leptospirosis.     

Kidney Injury Molecule-1 in the detection of early kidney injury in dogs with leptospirosis

Renal damage, a common feature in canine leptospirosis, ranges from a subclinical affection to kidney dysfunction and death. Chances of recovery can be improved by early intervention. However, traditional biomarkers (serum urea and creatinine) have limited relevance for precocity. Kidney Injury Molecule-1 (KIM-1) is a transmembrane protein upregulated in early stages of tubular injury. This study evaluated the use of urinary KIM-1 to detect early renal injury in naturally occurring canine leptospirosis. This exploratory research included 30 dogs divided into two groups: (1) dogs with leptospirosis (n = 25) and (2) healthy dogs (n = 5). Leptospira sp. infection was diagnosed through urine PCR and/or direct bacteriologic culture and/or serology (single MAT titters ≥800). Additionally, stage of infection was further characterized in acute and subacute phases based on the onset of clinical symptoms from 3 to 7 days. Urinary KIM-1 (uKIM-1) concentrations were measured in both groups with a commercial canine ELISA kit.uKIM-1 levels were statistically different (P < 0.01) between the studied groups, especially in non-azotemic dogs (P = 0.0042). The biomarker showed 88 % sensibility to diagnosis of kidney injury at> 1.49 ng/mL cut-off. Urine KIM-1 was negatively correlated with urine specific gravity (USG) but accompanied histopathological evidence of renal degeneration, necrosis and regeneration processes, extending information on kidney health. Measurement of KIM-1 in the urine of canine patients was able to detect naturally occurring acute and subacute leptospirosis accompanied by tubular injury in early non-azotemic infections.     

Post-mortem diagnosis of leptospirosis in two dogs

Leptospirosis was diagnosed post-mortem in a 2-year-old male Dogo Argentino and a 7-week-old male Foxhound puppy. The two cases were unrelated. Clinical symptoms were mainly confined to the gastro-intestinal tract. Pathological lesions were suggestive of acute leptospirosis. Leptospires infection was confirmed by serological (indirect IgM/Ig6 ELISA and MAT) and immunohistochemical techniques.     

A systematic review of leptospirosis on dogs,pigs, and horses in Latin America

Leptospirosis is a worldwide zoonosis which can affect many species. Control programs need accurate diagnosis to be successful, and currently, diagnosis relies on serology. It presents three main issues: the sampling, the antigen panel, and the cutoff point. Herein, we propose a systematic review on leptospirosis among dogs, pigs, and horses in Latin America in order to improve the understanding of the seroepidemiology of leptospirosis in these species in the region as well as the temporal development of the research on this topic and, consequently, improve the chances of success on control programs. Internet databases were consulted over 2015. Inclusion criteria included serosurvey using MAT; a relevant number of animals; the presence in the antigen panel of at least one representative of serogroups Icterohaemorrhagiae and Canicola for dogs, Icterohaemorrhagiae, Australis, and Pomona for pigs, and Icterohaemorrhagiae and Australis for horses; and a cutoff point of ≥100. Overall, 240 papers were studied, of which 87 referred to dogs, 66 to pigs, 39 to horses, and 48 to more than one of the studied species. In relation to those that met all the inclusion criteria, it was 45 (66.2%) in dogs, 23 (41.8%) in pigs, and 23 (63.9%) in horses. Leptospirosis is widespread in Latin America. Predominant serogroups are Canicola to dogs and Icterohaemorrhagiae to pigs and horses. Therefore, research on animal leptospirosis should be encouraged in Latin America, in order to reach a greater standardization in studies and then achieve better results on control programs.     

Duration of immunity in dogs vaccinated against leptospirosis with a bivalent inactivated vaccine

Duration of immunity in dogs induced with current commercial inactivated leptospirosis vaccines and evaluated against experimental infection, to date, has hardly been documented. The purpose of the present work was to assess the duration of immunity in dogs that is attainable with a commercial inactivated bivalent leptospirosis vaccine. For this purpose, young dogs were vaccinated twice followed by challenge with either Leptospira interrogans serovar canicola or L. interrogans serovar icterohaemorrhagiae 5 weeks, 27 weeks or 56 weeks after the second vaccination. For assessment of the duration of immunity, titres of agglutinating serum antibodies were measured before and after challenge, and the effects of challenge on a variety of parameters were determined including reisolation of challenge organisms from blood, urine and kidney. Both challenge strains induced a generalised infection in control dogs, the canicola strain being most virulent. From the results with different parameters it appeared that the two vaccinations induced a high rate of protection from generalised infection with canicola and icterohaemorrhagiae at 5, 27 and 56 weeks after the second vaccination. In addition, after 56 weeks, still a high level of immunity against renal infection with sv. canicola and, as a consequence, urinary shedding of sv. canicola bacteria, was demonstrated. It was, therefore, concluded that with this vaccine, using this vaccination schedule, a duration of immunity of 1 year can be attained against infection with both serovars.     

Clustering of reported cases of leptospirosis among dogs in the United States and Canada

A retrospective study was conducted to determine whether cases of leptospirosis diagnosed among dogs in the United States and Canada were clustered in time, space, or time-and-space. The study population was estimated--based on first examination of each dog--to consist of 1,035,366 dogs examined at 22 veterinary teaching hospitals between 1983 and 1998. The veterinary medicine database was searched for records of dogs in which a diagnosis of leptospirosis was made during the study period. The scan statistic (Poisson model) was used to examine for clustering of cases, using recorded date of diagnosis and the location of the veterinary teaching hospital at which the diagnosis was made. Three-hundred and forty dogs diagnosed with leptospirosis were identified. Cases were clustered in the period of 1992-1998. A cluster of dogs diagnosed at three veterinary teaching hospitals located in the midwest of the United States was identified. The composition of this spatial cluster was influenced by the age and gender distribution of the population at-risk. A cluster of cases involving 143 dogs diagnosed with leptospirosis between 9 April 1993 and 14 December 1998 at six veterinary teaching hospitals located in the midwest of the United States was identified. This time-space cluster was not influenced by the age, gender or breed distribution of the population of dogs presented at veterinary teaching hospitals during the study period. Leptospirosis was clustered during the 1990s in the midwest of the United States. Dog risk factors (age, gender, breed) do not explain the clustering that was observed. Leptospira serovar or environmental factors might be responsible for the clustering of canine leptospirosis in the United States and Canada.     

Canine leptospirosis infections - clinical signs and outcome with different suspected Leptospira serogroups (42 cases)

OBJECTIVES: The aim of the study was to investigate the presence of serum antibodies to different Leptospira serogroups in dogs with a clinical diagnosis of leptospirosis in southern Germany and to compare seroreactivity to different serogroups with history, clinical signs, laboratory findings and survival rate. METHODS: In this study, the data of 42 dogs with the diagnosis of leptospirosis were evaluated retrospectively. Dogs were presented to the Small Animal Medicine Teaching Hospital (Medizinische Kleintierklinik) of the Ludwig Maximilians University Munich, Germany, between 1990 to 2003. RESULTS: Reactivity to the serogroup grippotyphosa (13/42) was most frequently present, followed by reactivity to the serogroup saxkoebing (10/42). There was no difference in the clinical picture and the laboratory changes between dogs whose sera were reactive to different serogroups. CLINICAL SIGNIFICANCE: Most of the dogs with leptospirosis in southern Germany had sera reacting to serogroups other than icterohaemorrhagiae and canicola, which are contained in the vaccine. Thus, currently available vaccines in Europe do not protect against the most common Leptospira organisms associated with clinical disease.     

Diagnostic accuracy of an in-house ELISA using the intermediate species Leptospira fainei as antigen for diagnosis of acute leptospirosis in dogs

Diagnosis of animal leptospirosis is still challenging. The microscopic agglutination test, is the current method for diagnosing leptospirosis. However, this technique requires specific equipment, highly trained staff and the maintenance of live cultures of several reference strains of Leptospira for use as antigens. Recently, an ELISA (enzyme-linked immunosorbent assay) employing a Leptospira fainei serovar Hurstbridge based antigen for the early diagnostic of human leptospirosis was developed. In this study we estimate the diagnostic sensitivity and specificity of this test in identifying acute canine leptospirosis. A total of 271 serum samples divided into five panels and tested by MAT as a reference test, were used to evaluate the ELISA. Comparing acutely and non-acutely infected dogs, ELISA-Hb showed 95.6% sensitivity and 93% specificity. L. fainei-based ELISA is adequate for diagnosing acute canine leptospirosis, with high sensitivity and specificity and presenting practical advantages when compared to current techniques.     

Canine leptospirosis—Do we have a problem?

Acute canine leptospirosis is well known to vet surgeons. To protect dogs against this lethal disease, vaccination is widely used. However, chronic forms of leptospirosis have been noticed even in vaccinated animals, generally induced by bacteria from serogroups other than Icterohaemorrhagiae and Canicola such as Sejroë, Australis or Grippotyphosa. In a survey on 98 ill cats, 48% were positive in microagglutination test (MAT) to Leptospira spp., showing that this infection is also frequent in the feline species.