Leishmania infantum in a Central Italy dog shelter: Retrospective study of serologic reactivity during a 4-year period in a confined dog population subjected to preventive and therapeutic treatment

Leishmania infantum and Dirofilaria immitis infections in Italy, 2009-2019: changing distribution patterns

BACKGROUND

For long time, canine leishmaniosis (CanL) was considered endemic in the southern, central, and insular regions of Italy, whereas heartworm disease (HW) caused by Dirofilaria immitis was considered endemic in the northern region and in the swampy Po Valley. Following the reports of new foci of both diseases, in this study we update the distribution patterns and occurrence of new foci of CanL and HW discussing the main drivers for the changes in the epidemiology of these two important zoonotic canine vector-borne diseases.

METHODS

Based on the statistical analyses of serological assays (n = 90,633) on L. infantum exposure and D. immitis infection performed by two reference diagnostic centres in Italy over a ten-year period (2009-2019) irrespective of the anamnesis of dogs. The distribution patterns of both parasites are herein presented along with the occurrence of new foci.

RESULTS

Results highlighted the changing distribution patterns of L. infantum vs D. immitis infection in Italy. CanL is endemic in some areas of northern regions and HW has endemic foci in central and southern regions and islands. Significant differences in L. infantum exposure and HW infection prevalence among the study macroareas were detected. The overall results of the positive tested samples were 28.2% in southern Italy and islands, 29.6% in central Italy and 21.6% in northern Italy for L. infantum and 2.83% in northern Italy, 7.75% in central Italy and 4.97% in southern Italy and islands for HW. HW positivity significantly varied over years (χ2 = 108.401, df = 10, P < 0.0001), gradually increasing from 0.77% in 2009 to 8.47% in 2016-2017.

CONCLUSIONS

New potential epidemiological scenarios are discussed according to a range of factors (e.g. environmental modifications, occurrence of competent insect vectors, transportation of infected animals to non-endemic areas, chemoprophylaxis or vector preventative measures), which may affect the current distribution. Overall, the results advocate for epidemiological surveillance programmes, more focussed preventative and control measures even in areas where few or no cases of both diseases have been diagnosed.

Controlling phlebotomine sand flies to prevent canine Leishmania infantum infection: A case of knowing your enemy

Leishmaniosis caused by Leishmania infantum is a widespread zoonotic disease that can be transmitted to animals and humans by their vectors, blood-sucking phlebotomine sand flies. To prevent canine leishmaniosis across the whole Mediterranean region, vector control is essential. Because of phlebotomine breeding sites are diverse, environmental larval controls have limited practical value. Control methods of adults are being evaluated, such as selective baits based on sugar feeding of males and females or Attractive Toxic Sugar Baits (ATSB), and the indoor use of Long-Lasting-Insecticidal Nets (LLINs) treated with permethrin to prevent sand fly bites complementing the Indoor Residual Spraying (IRS) approach suggested by WHO. Although several strategies exist, the best control measure to prevent canine Leishmania infantum is to treat dogs using biocidal topical formulations based on legal insecticides (PTs18) or repellents (PTs19) (as collars, spot-ons and/or sprays) during the period when the vectors are active. This means we need to really know the biology and life cycle of the sand fly vector. According to available data, by mapping ambient temperatures we can already predict high risk areas where vector densities will be higher. In ongoing research, new candidates are emerging to fight against sand flies including natural plant extracts with low impacts on the environment and host animal. Other options in the future could be systemic insecticides to help reduce sand fly populations in high density areas. In parallel, health authorities and professionals involved in animal and public health (veterinarians, physicians, entomologists and epidemiologists) must work together in a One Health approach to minimize Leishmania infection. Veterinarians play a crucial role in liaising between key stake holders and dog owners to ensure the latter act responsibly in using repellents as a preventive measure against sand fly bites.

Five-month serological monitoring to assess the effectiveness of permethrin/fipronil (Frontline Tri-Act®) spot-on in reducing the transmission of Leishmania infantum in dogs

Canine vector-borne diseases are highly endemic in European countries of the Mediterranean basin. The use of repellent insecticides aids to reduce the risk of pathogen transmission. The primary objective of this 5-month serological field study conducted in a highly endemic area of canine leishmaniosis in Greece was to comparatively assess the effectiveness of a topical formulation of fipronil/permethrin (Frontline Tri-Act®/Frontect®) and of a deltamethrin collar (Scalibor®) for the prevention of Leishmania infantum transmission. Initially, 72 clinically healthy owned dogs were sampled for inclusion. Ten out of the 72 (13.8%) were seropositive according to the Snap Leish® ELISA test and removed. Ultimately, a total of 56 dogs were followed from May to October 2015 with monthly blood samples and serological tests based on Snap Leish® and Snap 4Dx® ELISA tests. Twenty-five dogs were treated with deltamethrin collar (Scalibor®) (Group 1) and 31 were treated monthly with the topical fipronil/permethrin formulation (Group 2). In group 1, three dogs out of 25 (12%) seroconverted for Leishmania whereas none of the dogs (0/31) seroconverted in group 2. In addition, this trial provided means to serological assess the transmission of other vector-borne pathogens. Regarding Anaplasma spp., one dog in each group was seropositive at the beginning of the study and no dogs became positive during the study. For Ehrlichia canis, 9/25 (36%) dogs in group 1 and 5/31 (16.1%) in group 2 were seropositive at inclusion time. Two out of 16 (11.8%) and 3/26 (11.5%) dogs became positive for E. canis after 3months in groups 1 and 2, respectively. No Borrelia burgdorferi sensu lato seropositive dog was found during the study. In regard to Dirofilaria immitis, 7/25 (28%) dogs and 12/31 (38.7%) were antigen-positive in groups 1 and 2, respectively, at inclusion. There was no significant difference between groups 1 and 2 in regard to new seroconversions during the trial. This study, conducted in a highly endemic area for vector-borne pathogen transmission, confirmed that the use of deltamethrin and permethrin is a suitable approach to reduce the risk of L. infantum infection by sandflies.

Leishmaniosis of companion animals in Europe: an update

Leishmaniosis caused by Leishmania infantum is a vector-borne zoonotic disease endemic in southern Europe, but which is spreading northwards. Millions of dogs, cats and other non-conventional companion animals susceptible to L. infantum, living in European households, may develop a severe disease and contribute to the spread of leishmaniosis because of travelling or re-homing. Dogs are the main reservoir but other new reservoirs have recently been incriminated. Sand flies remain the sole proven vector and non-vectorial transmission has been reported at individual level and in areas where the vector is absent. Clinical disease affects only a proportion of infected dogs and a complex genetic background of immune response is responsible for this susceptibility. There is a wide range of serological and parasitological diagnostic tools available whose cost-effective use depends on a reasoned approach. Clinical response to treatment of sick dogs is variable. Clinical cure is often obtained but clinical recurrence can occur and post-therapy follow up should be maintained life-long. In Europe, vaccination can be combined with individual protection with pyrethroids as part of an integrated approach to prevention. L. infantum is the only species isolated from cats in Europe and xenodiagnosis substantiated that infected cats are infectious for sand flies. Feline infection may be frequent in endemic areas, but prevalence is generally lower than in dogs. When cats are tested by both serological and molecular techniques discordant results are often observed. Feline cases have been reported from endemic areas in Italy, France, Spain and Portugal, but four cases were also diagnosed in Switzerland in cats that had travelled to or been imported from Spain. Half of the cases were diagnosed in cats with impaired immune responses. Clinical manifestations compatible with feline leishmaniosis include lymph node enlargement, skin and mucocutaneous lesions, ocular lesions, chronic gingivostomatitis, hypergammaglobulinemia, and normocytic normochromic anemia. Cats have been empirically treated with some drugs used in dogs. Due to polymorphic clinical picture and the insidious progressive course, leishmaniosis can persist for a long time before dogs or cats are brought to a veterinarian and so diagnosis can be delayed. Exotic or new Leishmania spp. have been reported in humans, animals and vectors in Europe. This changing situation requires attention in Europe for designing epidemiological studies and control measures.

Management of canine leishmaniosis in endemic SW European regions: a questionnaire-based multinational survey

Background

Canine leishmaniosis (CanL) caused by Leishmania infantum is a widespread endemic disease in SW Europe. This study was designed to determine how veterinarians clinically manage CanL in this region by analysing information collected in a questionnaire completed by local veterinarians working in clinics in France, Portugal, Greece, Spain, Italy and Slovenia.

Methods

Over the period 2004–2011, a questionnaire on CanL was sent to 12,546 small animal clinics located in the six countries surveyed. The questionnaire with 10 items comprising open and closed questions sought to obtain comparable data regarding the main clinical manifestations of CanL, the diagnostic methods used, the treatment regimens selected, recommended preventive measures and awareness of the important public health implications of CanL.

Results

The data collected reflect similarities in the clinical manifestations reported although there was some variation in the concurrent diseases described, and wide variation in the clinical management of CanL among the countries examined in terms of dosing regimens, therapeutic agents and the criteria used to diagnose CanL. Most veterinarians properly informed dog owners about the preventive measures available and about the zoonotic implications of CanL.

Conclusions

This survey describes the current situation in SW endemic countries in Europe regarding the clinical management of CanL. The data collected reveal a need to unify criteria from evidence-based medicine to determine and similarly apply the best diagnostic and treatment methods available for this disease in the different countries.

A surveillance program on canine leishmaniasis in the public kennels of Emilia-Romagna Region, Northern Italy

Since 2007, a canine leishmaniasis (CanL) surveillance program has been carried out in public kennels of the Emilia-Romagna region with the aim of providing health guarantees for dog adoptions. According to this program, monitoring activities were performed to verify the presence of sandflies and infected dogs, and a specific CanL risk class was assigned to each kennel, resulting in different control approaches (entomological and/or serological monitoring, clinical surveillance, therapeutic treatment of infected dogs, protections against vector bites). From 2007 to 2012, 20,931 dogs, 89.8% of which were identified by microchip and housed in 73 kennels, were examined using an indirect fluorescent antibody test. In all, 528 (2.8%) dogs tested positive, and 43.0% of these were asymptomatic. The authors used monitoring results, in particular serological tests performed on dogs at admittance to the kennel and annual controls of sentinel dogs, to estimate CanL risk in the whole region and to evaluate the efficacy of the preventive measures adopted. CanL seroprevalence in dogs tested at the admittance in kennels increased significantly from 2010 (1.0%; 29/2858) to 2012 (2.4%; 69/2841). In contrast, the number of seroconversions in sentinel dogs was stable in 2010 (1.2%; 11/896) and 2011 (1.6%; 13/825) and decreased in 2012 (0.9%; 8/850), suggesting the efficacy of the preventive measures applied.

A twenty-year follow-up of canine leishmaniosis in three military kennels in southeastern France

Background

Canine leishmaniosis (CanL) is enzootic in southeastern France, and military working dogs (MWD) posted in this area are highly exposed. To assess the efficiency of prevention, we performed a serological and clinical follow-up of 80 MWD in the Var and Corsica regions during the 20-year period from 1993 to 2012. The systematic and specific prevention of CanL using a deltamethrin-impregnated collar (DMC) was implemented in 2002.

Findings

Out of 80 dogs tested annually, the cumulative serological and clinical incidence was 42.5% (34/80) and 21.2% (17/80) respectively, during the first period, and these numbers decreased to 6.2% (5/80) and 2.5% (2/80) during the second period (p < 0.00001). Considering the incidence of serology since 2002, the CanL risk has been reduced by 85.2% and the level of protection of MWD reached 93.8%. Dogs without collars had a 10.4-fold greater chance of becoming infected than protected dogs. Although other ecological factors might have influenced the epidemiology of CanL, DMC usage was the main factor affecting dog exposure to CanL.

Conclusions

The prevention strategy based on DMC proved highly efficient in our population of MWD, as it effectively controlled the disease. This result is also of interest to public health, as dogs are reservoirs for Leishmania infantum.

Preventing zoonotic canine leishmaniasis in northeastern Brazil: pet attachment and adoption of community Leishmania prevention

Visceral leishmaniasis (VL), caused by Leishmania infantum chagasi (L.i. chagasi syn. infantum) in northeastern Brazil, was responsible for 51,000 new VL cases from 1980 to 2003. Household presence of L. infantum-infected dogs is a major risk factor for human infection. Despite culling of dogs based on seropositivity, canine L. infantum seroprevalence remains near 20%, suggesting that dog culling is ineffective for preventing VL spread. We administered a cross-sectional survey to 224 households within 300 m of the homes of VL human patients diagnosed within the last year. The goal was to develop a model for voluntary preventative use based on characteristics and motivations of dog owners. We identified that owner knowledge deficiencies regarding canine transmission of L. infantum associated with increased risk of dog infection (odds ratio [OR] = 3.681, confidence interval [CI] = 1.223, 11.08). Higher owner education was associated with decreased levels of dog seropositivity (OR = 0.40, CI = 0.20, 0.81). Pet attachment (P = 0.036) and perception of risk/disease knowledge (P = 0.040) were significantly associated with willingness to voluntarily purchase canine VL prevention. These results highlight the importance of owner attachment to their pet in implementing reservoir-targeted zoonotic VL prevention.

Questionnaire-based survey on the clinical management of canine leishmaniosis in the Madrid region (central Spain)

This paper describes a questionnaire designed to gain information on how veterinarians clinically manage canine leishmaniosis (CanL) in the Madrid region (central Spain). The present survey is one of the several similar questionnaire-based surveys conducted within the framework of the project EDEN (Emerging Diseases in a changing European eNvironment). The questionnaire sought to obtain data regarding the main clinical manifestations observed, the diagnostic methods used and the preventive measures recommended. Its Spanish version was sent by post to veterinary practitioners within the study area in two lots, one sent out in December 2006 and the other in March 2007. Only 174 of the 760 questionnaires sent were completed and returned (reply rate of 23%). Among the completed questionnaires, clinics differed widely in terms of features such as the habitats of the dogs (urban, peri-urban or rural) and patient volumes. Clinics attending dogs from peri-urban/rural habitats reported more suspected (p<0.001), confirmed (p=0.001) and newly diagnosed (p=0.001) cases/year than clinics providing service to a city clientele alone. According to the veterinary practitioners, skin lesions, lymphadenomegaly and weight loss were commonly observed, although these signs are not specific to CanL. Signs described to be of high diagnostic value were epistaxis and kidney disease. All the veterinarians polled reported that a suspicion of Leishmania infantum infection was confirmed by at least a serological method; the immunofluorescence antibody test (IFAT) being the technique most used. To prevent the disease, most vets recommended topical synthetic pyrethroids applied as impregnated collars or spot-ons. It is observed that despite considerable progress is being made in clinical management and controlling the disease, in Madrid Region its incidence continues to increase.

Methods of Control of the Leishmania infantum Dog Reservoir: State of the Art

Leishmania infantum is a protozoan parasite causing severe vector-borne visceral diseases both in humans and dogs. The latter are the most important natural reservoir and therefore should be the main target of control measures. The real efficacy of seropositive dogs culling as a direct control method is still debated, and the new sensitivity of large part of population considers ethically unacceptable this kind of approach. Treatment of infectious dogs with one of the available therapeutic protocols is recommendable as it allows to reduce parasite burdens and therefore the possibility of transmission of Leishmania infantum to vectors. Vaccination has been proven to be a very effective control tool, but the absence of a commonly recognized diagnostic method able to distinguish vaccinate from seropositive individuals is still an important limit. Concerning indirect control methods, a number of studies have demonstrated the efficacy of topical insecticides treatment (collars, spot-on, and sprays) in reducing incidence and prevalence of L. infantum. Also, the reduction of the odds of seroconversion in humans in endemic areas has been reported after the application of indirect control measures on dogs. The contemporary use of direct and indirect methods is even more effective in reducing seroprevalence in dogs.

Canine leishmaniasis surveillance in a northern Italy kennel

An epidemiological survey on canine leishmaniasis (CanL) was performed during a 3-year period (2007-2009) in a public kennel of the Bologna province. The presence of the disease was shown in the canine population for the first time in 2007 by indirect fluorescent antibody test (IFAT). The parasite circulation was confirmed also by direct diagnostic tools, as PCR, cytology and cultural method, performed on different bioptic materials. The parasite was isolated and identified as Leishmania infantum zymodeme MON 1. The serological monitoring was performed also in 2008 and 2009 on animals that previously showed negative or uncertain results. The incidence values calculated by significant seroconversions in IFAT titre ≥ 1/160, ranged between 4.9% and 6.6%, indicating a stable focus of leishmaniasis. The entomological survey, performed by sticky and CO(2)-baited traps in 2008, showed the presence of the vector Phlebotomus perfiliewi. This study allowed us to identify a stable focus of CanL in an area that was not considered eco-compatible with the presence of the vector and infection. Our results confirm the northward spread of CanL towards areas not previously affected by autochthonous foci.