Detection of Leishmania spp. Infection by Immunohistochemistry in Archived Biopsy Samples from Dogs with Colitis in an Area Endemic for Leishmaniosis

Atypical Lesions in Canine Leishmaniosis: Description of New Cases

Simple Summary

Canine leishmaniosis is a zoonotic disease caused mainly by the protozoan Leishmania infantum that is endemic in the Mediterranean basin. The clinical signs and pathological characteristics have been extensively described; however, atypical lesions leading to clinical and pathological misdiagnosis have been sporadically reported. This study presents three cases of dogs experimentally infected with Leishmania infantum that showed gross lesions considered atypical of canine leishmaniosis and not previously reported. Macroscopic lesions were observed in the liver, spleen, and peritoneal cavity that corresponded to tan to whitish nodular lesions in all organs and multifocal irregular and linear whitish lesions in one of the livers that mimicked tumors. Microscopically, a marked granulomatous inflammation with a relative scarcity of parasites was observed in all the organs. In conclusion, microscopic and parasitological studies should be performed on atypical lesions observed in Leishmania-infected and non-infected dogs, especially in endemic regions. In addition, due to its zoonotic importance, leishmaniosis should be considered when atypical nodular lesions are observed in dogs from non-endemic regions with a history of travel to endemic regions.

Abstract

Pathological characteristics are well described in canine leishmaniosis (CanL). However, atypical lesions that can be confused with other pathologies or trigger unusual clinical signs are sporadically reported. Atypical lesions were observed during routine postmortem examination in three Leishmania-infected dogs and samples were taken for histopathological and immunohistochemical studies. Clinical signs, biochemical parameters, level of antibodies, and parasite detection by PCR were also evaluated. Atypical lesions were found in the peritoneal cavity, liver, and spleen. Splenomegalia and hepatomegalia were observed in all dogs. In addition, multifocal dark to white nodules of variable size were observed in the peritoneal cavity, liver, and spleen of one dog and in the spleen of the other two dogs. One dog presented diffuse irregular whitish lines with a threadlike appearance and another an intense fibrotic depression in the intermediate lobe. Microscopically, an intense granulomatous inflammation with abundant macrophages, a variable number of lymphocytes, and a low to moderate number of parasites was observed. This study represents the first description of granulomatous peritonitis associated with Leishmania in dogs. It also shows atypical macroscopic expression of hepatitis in CanL. In the absence of an adequate clinical history and laboratory analyses, certain lesions observed in CanL could admit alternative diagnoses.

Ménétrier-like disease in a Pointer with concurrent granulomatous gastritis, helicobacteriosis and leishmaniosis: a case report

Background

Ménétrier-like disease is a rare hypertrophic canine gastropathy, reported in only seven dogs. Clinical signs are vomiting, anorexia and weight loss. Macroscopically, giant cerebriform gastric mucosal folds are typically seen in the corpus and fundus of the stomach. Histopathologically, fundic mucous cell hyperplasia and loss of parietal and chief cells are typical.

Case presentation

A nine-year-old spayed female Pointer had a history of intermittent vomiting, marked weight loss and hypoalbuminaemia. A gastroduodenoscopy was performed three times within three months with macroscopic changes remaining the same. The gastric mucosa of the corpus, fundus and proximal antrum was markedly irregular, with cerebriform mucosal folds. In the first gastric biopsies, histopathology revealed a moderate granulomatous gastritis, with a severe manifestation of Helicobacter-like organisms. Treatment for Helicobacter spp. decreased the vomiting slightly. The dog was diagnosed with concurrent leishmaniosis; the conventional anti-Leishmania treatment decreased the vomiting moderately, the hypoalbuminaemia resolved and the dog gained weight back to a normal body condition. Granulomatous gastritis was not present in the gastric biopsies after these treatments. The dog increased vomiting when palliative treatment (maropitant citrate, ondansetron and esomeprazole) was discontinued, and thus, full-thickness biopsies of the stomach were taken and Ménétrier-like disease was diagnosed. The affected area was too large to be surgically removed; thus, palliative treatment was reinstated. The dog remained clinically well 39 months after the first clinical presentation.

Conclusions

This is the first report of Ménétrier-like disease in a dog with a simultaneous manifestation of granulomatous gastritis, helicobacteriosis and leishmaniosis. The clinical signs decreased after treatment of helicobacteriosis and leishmaniosis, but vomiting remained probably as a sign of Ménétrier-like disease. Treatment options for dogs are surgical removal of the abnormal area or palliative treatment. In humans, promising results for a cure have been shown with cetuximab treatment, a human monoclonal antibody, but no canine antibody is commercially available yet. The dog here was doing well 39 months after first presentation, which is the longest reported survival time for Ménétrier-like disease with only palliative treatment in dogs. Full-thickness biopsies are preferred in macroscopic hypertrophic lesions of the stomach for better assessment of Ménétrier-like disease.