Feline Leishmania infection in a canine leishmaniasis endemic region, Portugal

Alternative hosts of Leishmania infantum: a neglected parasite in Europe

Multi-host pathogens that infect various animal species and humans are considered of great importance for public and animal health. Leishmania spp. parasites are a characteristic example of such pathogens. Although leishmaniosis in humans is endemic for about 100 countries around the world it is classified as a neglected tropical disease. There are three main forms of leishmaniosis in humans: cutaneous (CL), visceral (VL) and mucocutaneous leishmaniosis (MCL). Each year, about 30,000 new cases of VL and more than 1 million new cases of CL are recorded. In Europe L. infantum is the dominant species with dogs being reservoir hosts. Apart from dogs, infection has been recorded in various animals, which suggests that other species could play a role in the maintenance of the parasite in nature. Herein we provide an in-depth review of the literature with respect to studies that deal with Leishmania infantum infections in domestic and wild animal species in Europe. Given the fact that domesticated and wild animals could contribute to the incidences of leishmaniosis in humans, the aim of this paper is to provide a comprehensive review which could potentially be used for the development of measures when it comes to the control of the Leishmania infantum parasite.

FeliLeish: An Update on Feline Leishmaniosis and Factors Associated with Infection in Different Feline Populations from Italy

Feline leishmaniosis is a worldwide infection caused by the parasite of the genus Leishmania transmitted by sandflies. Based on the complexity of epidemiology and diagnosis of this infection, the role of cats in the epidemiology and clinical impact of disease is still under debate. By using serological and molecular methods, this study aimed to update the epidemiology of the infection in different feline populations from various areas of Italy and to study factors associated with the infection. Of 1490 cats tested, 124 (8.3%, 95% CI 6.9-9.9) were infected, 96 had only specific L. infantum IgG, 18 were only positive for parasite DNA and 10 were both IFAT and qPCR positive. Risk factors for infection were sampling in the winter season (OR = 3.2, 95% CI 2.2-4.8), originating from the Sicily region (OR = 2.0, 95% CI 1.3-3.0), male gender (OR = 1.8, 95% CI 1.1-3.2), outdoor lifestyle (OR = 2.3, 95% CI 0.9-5.6) and seropositivity for FIV antibodies (OR = 2.2, 95% CI 1.2-4.2), while sampling in the spring (OR = 0.5, 95% CI 0.3-0.7) and summer (OR = 0.3, 95% CI 0.1-0.7), and originating from the Lazio region (OR = 0.1, 95% CI 0.05-0.4) were protective factors for infection. In endemic areas, Leishmania infection should be investigated by using both serological and molecular methods and cats should be protected from sandfly bites, particularly if they are FIV infected.

Leishmaniosis in Greece: The Veterinary Perspective

Leishmaniosis caused by the protozoon Leishmania infantum that is transmitted through the bites of infected phlebotomine sandflies is of major veterinary concern in Greece. The country is endemic with particularly favourable environmental conditions for the spread of this infection. Moreover, Greece remains a popular touristic destination, and the continuous travel of pets raises concern regarding the possible dissemination of infection from endemic to non-endemic areas. Dogs are the main reservoir host, although other animal species, including humans, may also be infected. Canine leishmaniosis manifests as a visceral disease that can result in death if left untreated. Serological and molecular epizootiological studies have confirmed circulation of the parasite in Greek canine and feline populations as well as in other mammals. As a result, constant surveillance and identification of high-risk localities are necessary to establish chemoprophylactic protocols for travelling animals to safeguard animal and public health.

Exposure to and infection by Leishmania infantum among domestic dogs in an area of the Cerrado biome, Maranhão, Brazil

Visceral Leishmaniasis is a serious public health problem and dogs are considered to be the main source of infection in urban areas. In Brazil, this disease is present in all regions, but with high concentration of cases in the Northeast, and the state of Maranhão is considered to be an endemic region. The aim of this study was to conduct an epidemiological, spatial, molecular and serological survey on Leishmania infantum among domestic dogs in the municipality of Belágua, Maranhão. Blood samples were collected from dogs and questionnaires were applied to their owners to obtain epidemiological data and risk factors relating to this zoonosis in the region. The coordinates of the dogs' homes were obtained to produce a disease risk map. Serological diagnoses were made using the indirect immunofluorescence reaction (IFAT) and the dual-path platform chromatographic immunoassay test (DPP®) (Bio-Manguinhos/FIOCRUZ, Brazil). A molecular investigation was undertaken using the polymerase chain reaction (PCR). Georeferencing was performed using the global positioning system (GPS) and cases of canine visceral leishmaniasis in the municipality were spatially represented and analyzed using QGIS version 3.16.6 (QGIS Development Team, 2021). A total of 205 blood samples were collected, of which 122 (59.51%) were seroreactive for L. infantum through IFAT, while the DPP test showed 84 reactive samples (40.97%). IFAT and DPP detected 16 positive animals simultaneously. One sample that was seroreactive through IFAT was also positive through PCR. In the clinical evaluation, it was observed that among the seropositive dogs, 112 (91.80%) were symptomatic and 10 (8.20%) were asymptomatic. In the spatial analysis, the Kernel density estimator enabled determination of the place at greatest risk of occurrence of the disease. The areas with the highest concentrations of cases were in districts with large quantities of precarious housing and lack of basic sanitation. This was the first report on the occurrence of L. infantum among dogs in the municipality of Belágua. The results show that canine visceral leishmaniasis is well dispersed in this municipality, thus putting at risk the human population.

Clinical, diagnostic and epidemiological implications of Hepatozoon spp., Babesia spp. and Leishmania infantum infection in cats and dogs in a Mediterranean periurban setting

Hepatozoon spp., Babesia spp. and Leishmania infantum are common parasites of dogs in Mediterranean countries and are less frequent in cats, particularly Babesia spp. and L. infantum. Moreover, there is limited information on coinfections between these parasites and on L. infantum's distribution in blood, skin and lymphoid tissue in cats. We used PCR and DNA sequencing to investigate the prevalence of these parasites and the aetiology of Hepatozoon spp. and Babesia spp., in blood, skin, spleen and lymph node samples from up to 212 stray cats and 82 abandoned dogs in southeast Spain. All except 2 dogs were healthy; instead, 112 cats had clinical signs. The estimated PCR prevalences (95% confidence interval) were 25% (19-31%) Hepatozoon felis in cats, 13% (6-21%) Hepatozoon canis in dogs, 1% (0-4%) Babesia vogeli in dogs, 0% Babesia spp. in cats and 21% (15-26%) and 44% (33-55%) L. infantum in cats and dogs, respectively, and infections were not associated with each other. Leishmania infantum prevalence in lymphoid tissue was significantly higher in dogs than in cats (p < 0.001), and dogs had higher parasite loads than cats (p = 0.012). Moreover, L. infantum prevalence was significantly higher in the skin and lymphoid tissue compared to blood in infected, asymptomatic animals but it was similar in cats with clinical signs, which also had higher parasite loads compared to infected, asymptomatic cats (p < 0.05). The study highlights significant differences between sympatric dogs and cats with respect to the parasite infections investigated, as well as the need to examine both lymphoid tissue and skin samples to maximise the sensitivity of L. infantum infection diagnosis.

Leishmania infantum Specific Humoral and Cellular Immune Responses in Cats and Dogs: A Comparative Cross-Sectional Study

Dogs are the main reservoir of Leishmania infantum and display different immunological patterns correlating with the progression of infection to disease. Data about feline L. infantum adaptive immune response are scant. This study aimed to compare the prevalence and immune response in cats and dogs from the same endemic area of canine leishmaniosis. Stray cats (109) and rescued dogs (59) from Córdoba (Spain) were enrolled. Data about their exposure to L. infantum were analyzed by detection of parasite DNA, measurements of Leishmania-specific interferon-γ (whole blood assay in 57 cats and 29 dogs), and antibodies (enzyme-linked immunosorbent assay and immunofluorescence antibody test). An overall L. infantum prevalence of 30.5% in dogs and 30% in cats were found according to serology and PCR tests. Prevalence was 44.8% in dogs and 35.1% in cats tested also for interferon-γ production. Dogs showed higher anti-L. infantum antibody levels compared to cats. More than one-third of cats had contact with or were infected by L. infantum and they may contribute to the endemicity of leishmaniosis in the investigated region. The immunopathogenesis of feline L. infantum infection has similarities with dogs but cats show a lower level of adaptive immune response compared to dogs.

Leishmania V. braziliensis infection in asymptomatic domestic animals within an endemic region in the Northeast of Brazil

Background:

American cutaneous leishmaniasis is a commonly neglected, vector-borne tropical parasitic disease that is a major public health concern in Brazil. Leishmania (Viannia) braziliensis is the main species associated with the disease. Accurate diagnosis is based on epidemiological surveillance, clinical assessment, and laboratory testing. Leishmania (V.) braziliensis has been detected in several wild and synanthropic mammals. Their epidemiological role has not been entirely elucidated. This study aimed to assess potential L. braziliensis infections in asymptomatic domestic animals, by molecular and serological testing in endemic areas, in the metropolitan region of Recife.

Methods:

Blood samples and conjunctival fluids were collected from 232 animals (canids, felids, equines, and caprines) for the detection of L. braziliensis using molecular tests (conventional and real-time polymerase chain reaction [PCR and qPCR]). For immunological detection, blood samples from 115 dogs were assessed using enzyme-linked immunosorbent assay.

Results:

Real-time quantitative PCR showed positive results for blood and conjunctival samples in all investigated species. The results of the blood and conjunctival samples were 68.2% and 26.9% in Canis familiaris, 100% and 41.7% in Felis catus, 77.3% and 30.8% in Equus caballus/Equus asinus, and 50% and 33.3% in Capra hircus samples, respectively.

Conclusions:

Results from this study adds valuable information to our understanding of the role of asymptomatic domestic animals, L. braziliensis life cycle, and American cutaneous leishmaniasis in Northeast Brazil.

Clinical Case of Feline Leishmaniosis: Therapeutic Approach and Long-Term Follow-Up

Simple Summary

In the present report, clinical, diagnostic, and therapeutical findings observed in a case of feline leishmaniosis (FeL) along with its long-term follow-up data are reported with the aim to provide more evidence-based data on the treatment of this important zoonotic vector-borne disease of cats. The present study represents one of the few reports of FeL with a 28-month follow-up period. This case underlines the effectiveness of allopurinol and highlights how the interruption of treatment frequently leads to relapse, impairing the animal’s health condition and prognosis.

Abstract

The response to allopurinol treatment and survival time of a case of feline leishmaniosis in a FIV co-infected cat is herein reported. In May 2019, a 13-year-old neutered European Shorthair male was referred due to weight loss and exfoliative dermatitis. Lymphadenomegaly and splenomegaly were detected upon clinical inspection, while the presence of several Leishmania infantum amastigotes were detected on splenic and lymphonodal fine needle aspiration (FNA). Allopurinol (10 mg/kg PO q 12 h) was administered. After two months, the cat’s clinical symptoms disappeared, and the owners decided to interrupt the therapy. In February, two reddish nodular fleshy neoformations appeared in both eyes, and amastigotes of Leishmania were detected by cytology on conjunctival swabs. Allopurinol treatment was re-started at the same rate; the ocular lesions regressed in two weeks, and the owner again decided to interrupt the therapy. In July, the patient had a new relapse, but the owner, tired of continuous relapses, refused further treatment of the disease. The cat’s health condition continued to worsen: in October 2021, the ocular lesions appeared again, and in November the patient died. This case underlines the effectiveness of allopurinol and highlights how interruption of treatment frequently leads to relapse, impairing the animal’s health condition and prognosis.

Review and statistical analysis of clinical management of feline leishmaniosis caused by Leishmania infantum

Background

There is limited information about feline leishmaniosis (FeL) management in clinical practice. Leishmania infantum is the species of Leishmania most frequently reported in both dogs and cats in countries of the Mediterranean region (henceforth ‘Mediterranean countries’), Central and South America, and Iran. This study was conducted to provide veterinary clinicians with an updated overview of evidence-based information on leishmaniosis in cats.

Methods

A review was performed using PubMed, Science Direct, Google Scholar and Web of Science. Case reports of FeL caused by L. infantum were sought for the period 1912 to 1 June 2021.

Results

Sixty-three case reports are included in this review. Fifty-nine out of the 63 cats were from Europe, mostly from Mediterranean countries (88.9%). Most of them were domestic short-haired cats (90%) with a mean age of 7.9 years, and had access to the outdoors (77.3%). Sixty-six percent of the cats had comorbidities, of which feline immunodeficiency virus infection was the most frequent (37.7%). Dermatological lesions (69.8%) was the most frequent clinical sign, and hyperproteinemia (46.3%) the most frequent clinicopathological abnormality. Serology was the most performed diagnostic method (76.2%) and was positive for 93.7% of cats. Medical treatment was applied in 71.4% of cats, and allopurinol was the most used drug (74.4%). Survival time was greater for treated cats (520 days; 71.4% of cats) than non-treated cats (210 days; 25.4%).

Conclusions

The majority of the cats had comorbidities, of which feline immunodeficiency virus was the most frequent. Dermatological lesions were frequently reported, and systemic clinical signs and clinicopathological abnormalities were also common. Serology may be useful for the diagnosis of FeL in clinical practice, and a positive titer of ≥ 1/40 may be a useful cut-off for sick cats. The reported treatments and dosages varied, but there was a good clinical response and longer survival in most of the cats treated with allopurinol monotherapy.

Graphical abstract

Feline Leishmaniosis in Northwestern Italy: Current Status and Zoonotic Implications

Leishmaniasis remains one of the major neglected tropical diseases. The epidemiological profile of the disease comprises a wide range of hosts, including dogs and cats. Despite several studies about feline Leishmaniosis, the role of cats in disease epidemiology and its clinical impact is still debated. The present study raises awareness about the impact of leishmaniasis in cats from an endemic region in of Northwestern Italy (Liguria). A total number of 250 serum and 282 blood samples were collected from cats, then assessed for Leishmania infantum (L. infantum) serologically using western blot (WB) and molecularly using polymerase chain reaction (PCR). We also tested the association of Leishmania infection with some infectious agents like haemotropic Mycoplasma, Feline immunodeficiency virus (FIV) and Feline leukemia virus (FeLV) together with the hematobiochemical status of the examined animals. Interestingly, all tested animals were asymptomatic and out of 250 examined serum samples, 33 (13.20%) samples (confidence interval (CI) 95% 9.56-17.96%) were positive at WB for L. infantum, whereas of the 282 blood samples, 80 (28.36%) returned a positive PCR (CI 95% 23.43-33.89%). Furthermore, there was a statistical association between PCR positivity for L. infantum and some hematological parameters besides FIV infection as well as a direct significant correlation between Mycoplasma infection and WB positivity. Taken together, the present findings report high prevalence of L. infantum among cats, which reinforces the significance of such positive asymptomatic animals and confirms the very low humoral response in this species. In addition, the laboratory values provide evidence that infection by the parasite is linked to alteration of some hematological parameters and is correlated to some infectious agents. These data are of interest and suggest future research for accurate diagnosis of such zoonosis.

Feline Leishmaniosis: An Emerging Public Health Problem

Leishmaniosis is the third most important vector-borne disease in humans, preceded by malaria and lymphatic filariasis, and it is considered endemic in tropical and subtropical areas, where higher temperatures favor development of its vector, sandflies. This zoonotic disease is caused by infection of protozoa Leishmania spp. and the most serious mucocutaneous and visceral form is produced by Leishmania infantum, which predominates in the Mediterranean region. The usual hosts for this parasite are dogs and humans, but an increment in cases of L. infantum infection has been observed in cats in the last years. This increase could be due to the use of sandflies repellents in dogs, obligating the parasite to looking for other hosts. The role of cats in the epidemiology of this disease is unknown, although increase of prevalence of feline leishmaniosis has been observed in endemic areas in the last years. Diagnostic techniques and treatments in cats are not standardized, which makes it difficult to establish prevalence and epidemiology of feline leishmaniosis. Furthermore, the clinical signs and immune response against Leishmania in cats are different to those in dogs, with an observed increment of drug resistance. It is necessary to increase our knowledge about L. infantum infection in cats, including clinical signs, transmission, treatments, and the role of cats in the increasing of zoonoses. Finally, new alternative treatments are required for controlling the spread of this disease in all species of mammals.

Serum amyloid A levels and alpha 2 and gamma globulins on serum protein electrophoresis in cats exposed to and infected with Leishmania infantum

Background

Dogs are the main reservoir hosts of Leishmania infantum; nevertheless, recent investigations indicate a likely role for cats in the epidemiology of Leishmania infection. Feline leishmaniosis (FeL) remains poorly characterised, partly due to the lack of suitable diagnostic tools. This study aimed to compare serum amyloid A (SAA) levels and serum protein electrophoresis (SPE) profiles (specifically, alpha 2 and gamma globulins) in cats naturally exposed to or infected by L. infantum from southern Italy versus those of healthy controls and versus cats with neoplastic or inflammatory conditions from non-endemic areas.

Methods

Serum or plasma samples from four cohorts of cats were analysed for SAA levels and by SPE: (i) G1: healthy controls from Leishmania-non-endemic regions of Switzerland; (ii) G2: cats pre-diagnosed with neoplastic or inflammatory conditions available from the University of Cambridge sample archive; (iii) G3: L. infantum-seropositive, quantitative (q)PCR-negative cats from southern Italy; (iv) G4: L. infantum-seropositive and qPCR-positive cats from southern Italy. SAA data were assessed for normality and homoscedasticity using the Shapiro–Wilk and Levene’s tests, respectively; the Kruskall–Wallis test, followed by Dunn’s test with Bonferroni correction were subsequently used to compare SAA serum levels between groups. A weighted generalised linear model with a binomial distribution was used to assess statistically significant differences in the numbers of animals displaying elevated gamma globulins and increased alpha 2 globulins between groups.

Results

Overall, 68 samples were analysed (G1: n = 16, G2: n = 20, G3: n = 20, G4: n = 12). Cats suffering from neoplastic and inflammatory conditions (G2 ) showed significantly higher SAA levels than healthy controls (G1) (median values [interquartile range]: G1: 0.00 [0.00–0.00] mg/l versus G2: 0.85 [0.00–49.55] mg/l). G2, G3 and G4 cats showed higher percentages of individuals with increased alpha 2 globulins (percentages ± standard error: G1 = 20.0% ± 10.3, G2 = 80.0% ± 8.9, G3 = 70.0% ± 10.2, G4 = 75.0% ± 12.5) and gamma globulins (G1 = 0.0% ± 0, G2 = 65.0% ± 10.7, G3 = 50.0% ± 11.2, G4 = 58.3% ± 14.2) than healthy control cats (G1). For all three markers, no significant difference between cats within G2, G3 and G4 was recorded.

Conclusions

This study indicates that the proportions of animals with elevated levels of alpha 2 and gamma globulins are significantly higher in cats exposed to and infected with L. infantum. Levels of SAA and alpha 2 and gamma globulins may not be used to differentiate between L. infantum infection or exposure, and neoplastic and/or inflammatory conditions.

Graphic Abstract

Skin Lesions in Feline Leishmaniosis: A Systematic Review

Feline leishmaniosis (FeL) is increasingly reported throughout the world and skin lesions predominate in the clinical picture. There are, however, few evidence-based data on cutaneous feline leishmaniosis and directions are strongly needed for a better management of the disease. In this study, we systematically reviewed what is currently known about the clinical dermatological presentation of FeL through analysis of the literature and, further, by adding unpublished cases managed by Italian veterinary dermatologists. Sixty-six feline cases of cutaneous leishmaniosis published in 33 articles between 1990 and 2020 met the inclusion criteria and were analyzed. Six unpublished cases of cutaneous FeL managed by Italian dermatologists were also reviewed. The majority of cases were reported from South America, followed by Europe and North America. Nodules were the most frequently reported clinical signs and the presence of Leishmania in lesioned skin was assessed mainly by cytology. A total of six Leishmania species have been identified as being responsible for skin lesions. Coinfections by FIV or FeLV were reported in 12.1% and 9.1% of the cases, respectively. Clinical data including treatment have been analyzed and discussed to provide directives for proper management of the disease for which cats may also serve as domestic reservoirs for human infections.

Seroprevalence and molecular detection of Leishmania spp. in cats of West Aegean Region, Turkey

Zoonotic visceral leishmaniasis is caused by protozoa of the genus Leishmania. Although dogs are considered to be primary reservoir hosts of Leishmania spp., several mammals, such as foxes, jackals and small rodents may also be hosts of different Leishmania spp. Previously, cats were considered as asymptomatic hosts of the parasite without acting as a reservoir. In recent years, there has been an increasing number of leishmaniasis cases in cats, especially in regions where the infection endemically occurs. This data indicate that cats are more likely to be one of the main reservoirs of Leishmania spp. rather than being a non-reservoir host. The aim of this study is to determine the prevalence of Leishmania spp. by molecular and serological techniques among owned and stray cats in four different cities located in western part of Turkey. A total of 386 blood and 301 serum samples were collected from cats in Western Turkey where leishmaniasis is endemic. Feline serum samples were tested by IFAT to detect IgG antibodies against Leishmania spp. antigens. Blood samples collected from 386 cats were examined by PCR for the presence of Leishmania spp. According to PCR results using RV1/RV2 primers, nine (2.3%) out of 386 samples were positive for Leishmania spp. Further PCR analysis using MC1/MC2 primers showed that one cat in Izmir was found to be infected with L. infantum/donovani complex. Sequence analysis revealed the presence of L. infantum, L. major and L. tropica among sampled cats in western part of Turkey. On the other hand, IFAT results indicated that an overall of 47 out of 301 (15.6%) cats that examined by PCR were found to have anti-Leishmania antibodies. Also, six of the seropositive cats were owned animals. The present study demonstrated that both owned and stray cats can be infected with Leishmania spp. and might be potential reservoirs for other animals and humans. Therefore, all communities living in or nearby endemic regions should be made aware of the role of cats as potential reservoirs of infection. In endemic regions, all animals should be protected against infection with insecticides and monitored routinely to control the spread of zoonotic visceral leishmaniasis.

New Epidemiological Aspects of Animal Leishmaniosis in Europe: The Role of Vertebrate Hosts Other Than Dogs

Infection with Leishmania parasites can lead to severe disease in humans and dogs, which act as a reservoir in zoonotic transmission. An increasing number of reports suggest that leishmaniosis is not restricted to dogs, but also affects many other mammalian and avian species. Consequently, this expands the potential reservoir and is of great public and veterinary health concern. The present study reviews, based on a comprehensive search of scientific literature published from 1 January 2001 to 31 December 2020, the currently available information on animal leishmaniosis in vertebrates in Europe, other than dogs and humans. This review provides an exhaustive list of mammals and birds in which infections with or exposure to Leishmania parasites have been detected in European countries. Most cases are reported from the Mediterranean region. Domestic animals, in particular cats, pose a concern because of close contact with humans. The wildlife reservoir is less likely to contribute to zoonotic transmission, with the exception of hares. This potentially large reservoir needs to be taken into account when developing control measures for zoonotic leishmaniosis. From a veterinary point of view, it is important that veterinarians are better aware of leishmaniosis and trained in its management.

Retrospective evaluation of vector-borne pathogens in cats living in Germany (2012-2020)

Background

Blood-feeding arthropods can transmit parasitic, bacterial, or viral pathogens to domestic animals and wildlife. Vector-borne infections are gaining significance because of increasing travel and import of pets from abroad as well as the changing climate in Europe. The main objective of this study was to assess the percentage of cats with positive test results for selected vector-borne pathogens in Germany and explore any possible association of such results with time spent abroad.

Methods

This retrospective study included test results from cats included in the “Feline Travel Profile” established by the LABOKLIN laboratory at the request of veterinarians in Germany between April 2012 and March 2020. This diagnostic panel includes the direct detection of Hepatozoon spp. and Dirofilaria spp. via PCR as well as indirect detection assays (IFAT) for Ehrlichia spp. and Leishmania spp. The panel was expanded to include an IFAT for Rickettsia spp. from July 2015 onwards.

Results

A total of 624 cats were tested using the “Feline Travel Profile.” Serum for indirect detection assays was available for all 624 cats; EDTA samples for direct detection methods were available from 618 cats. Positive test results were as follows: Ehrlichia spp. IFAT 73 out of 624 (12%), Leishmania spp. IFAT 22 out of 624 (4%), Hepatozoon spp. PCR 53 out of 618 (9%), Dirofilaria spp. PCR 1 out of 618 cats (0.2%), and Rickettsia spp. IFAT 52 out of 467 cats (11%) tested from July 2015 onwards. Three cats had positive test results for more than one pathogen before 2015. After testing for Rickettsia spp. was included in 2015, 19 cats had positive test results for more than one pathogen (Rickettsia spp. were involved in 14 out of these 19 cats).

Conclusions

At least one pathogen could be detected in 175 out of 624 cats (28%) via indirect and/or direct detection methods. Four percent had positive test results for more than one pathogen. These data emphasize the importance of considering the above-mentioned vector-borne infections as potential differential diagnoses in clinically symptomatic cats.

Leishmania infection in cats and feline leishmaniosis: An updated review with a proposal of a diagnosis algorithm and prevention guidelines

Leishmaniosis is a vector-borne disease caused by protozoans of the genus Leishmania, which are transmitted to vertebrates, including cats, through the bites of female phlebotomine sand flies. An increasing number of epidemiological and experimental studies concerning Leishmania infection in cats, as well as case reports of clinical leishmaniosis in these felids, have been published in recent years. In the present study, a comprehensive review was made by sourcing the National Library of Medicine resources to provide updated data on epidemiology, immunopathogenesis, diagnosis, treatment, and prevention of feline leishmaniosis. Cats were found infected with Leishmania parasites worldwide, and feline leishmaniosis appears as an emergent disease mostly reported in countries surrounding the Mediterranean Sea and in Brazil. Cats with impaired immunocompetence seem to have a higher risk to develop clinical disease. The main clinical and clinicopathological findings are dermatological lesions and hypergammaglobulinemia, respectively. Diagnosis of feline leishmaniosis remains a challenge for veterinarians, in part due to the lack of diagnosis support systems. For this reason, a diagnostic algorithm for clinical decision support is herein proposed. No evidence-based treatment protocols are currently available, and these remain empirically based. Control measures are limited and scarce. Thus, a set of prevention guidelines are herein suggested.

Leishmania infantum Seroprevalence in Cats From Touristic Areas of Italy and Greece

Leishmaniosis by Leishmania infantum is a major zoonotic Vector-Borne Disease (VBD) in terms of geographic distribution, pathogenicity and zoonotic potential. While dogs are the main reservoir of L. infantum, the infection in cats is poorly understood although increasingly reported from enzootic and non-enzootic areas. The Mediterranean basin is a key area for leishmaniosis and includes touristic spots that require continuous surveillance for VBDs in consideration of the growing tendency of tourists to travel with their pets. This study evaluated L. infantum seroprevalence in cats living in selected touristic localities of Italy and Greece. A total of 269 cat serum samples from three Sites i.e., 76, 40, and 153 from Adriatic Coast of Abruzzo, Italy (Site A), Giglio Island, Tuscany, Italy (Site B), and Mykonos Island, Greece (Site C), respectively, were included in the survey. Sera samples were subjected to an indirect immunofluorescence antibody assay for the detection of anti-L. infantum specific IgG. Associations between possible risk factors and seropositivity to L. infantum were statistically evaluated. Antibodies against L. infantum were detected in eight out of 269 (3.0%) cats tested i.e., 4/76 (5.3%), 1/40 (2.5%), and 3/153 (2.0%), from sites A, B, and C, respectively. A statistical association between anti-L. infantum antibodies and cohabitation with dogs was shown. This study indicates that feline populations living in the examined Italian and Greek touristic areas are exposed to L. infantum and that they may contribute to the circulation of L. infantum, enhancing the risk of infection for dogs and humans.

Detecting antibodies to Leishmania infantum in horses from areas with different epizooticity levels of canine leishmaniosis and a retrospective revision of Italian data

Background

Leishmania infantum is a vector-borne pathogen endemic in countries in the Mediterranean basin, including Italy. Dogs act as the primary reservoir for this parasite, but other animal species may also be infected. Low-to-moderate seroprevalence levels of infection have been reported in apparent healthy equine populations in southern Europe, reinforcing the importance of exploring those species, including horses, that act as a food source for vectors and may thus participate in the epizoological scenario of canine leishmaniosis (CanL) and zoonotic visceral leishmaniosis (ZVL). Since little is known regarding the exposure to L. infantum in horses in Italy, we assessed the seroprevalence in healthy equine populations from different CanL endemic areas.

Methods

The survey was conducted on 660 apparently healthy horses distributed throughout central and northern regions of Italy between 2016 and 2019. Blood samples were collected and the presence of anti-Leishmania antibodies (IgG) was investigated by the immunofluorescence antibody test. Information on the location and altitude of the stables, along with the horses’ breed, age, sex, and reproductive status was obtained by filling in a questionnaire. This was then used for statistical analysis by generalized linear models to explore risk factors associated with seroreactivity to L. infantum.

Results

An average seroprevalence of 13.9% was detected for L. infantum in the equine populations investigated, with statistically significant associations between seroprevalence, geographical variables (northern vs central Italy, origin and altitude) and individual factors (i.e. age and breed morphotype).

Conclusions

Our results highlight that horses are frequently exposed to L. infantum. Further prevalence surveys in horses, also using direct methods (e.g. PCR), are warranted to clarify the role of these hosts in the epidemiology of Leishmania in Italy.

Feline leishmaniosis: diagnosis, treatment and outcome in 16 cats

OBJECTIVES

Leishmaniosis is a vector-borne disease and in European countries is caused by Leishmania infantum. Cats are considered secondary reservoirs of the infection in endemic areas. The objective of this retrospective study is to describe the clinical findings, diagnosis, treatment and outcome of feline leishmaniosis (FeL) in 16 cats in Spain.

METHODS

Medical records of cats diagnosed with leishmaniosis were retrospectively reviewed for cases that met the following inclusion criteria: identification of Leishmania organisms and/or DNA on cytological and/or histological specimens and/or a high anti-Leishmania antibody titre, compatible clinical findings and pathological abnormalities.

RESULTS

Sixteen cats met the inclusion criteria, all of which were living in areas endemic for canine leishmaniosis. Systemic signs were present in 11 cases (68.8%). The most common clinical signs on presentation included cutaneous lesions in 12 cats (75%), ocular disease in six cats (37.5%) and anorexia in six cats (37.5%). A polyclonal gammopathy was noted in 12 cats (85.7%). Non-regenerative anaemia and renal abnormalities were present in six (37.5%) and five patients (31.3%), respectively. In nine cats (56.3%), immunosuppressive conditions/comorbidities were identified. The diagnosis was made in eight of the cats (50%) by cytology, but a combination of diagnostic tests was needed for definitive diagnosis in the remaining patients. Twelve cats (75%) were treated specifically for leishmaniosis. Five of the 12 cats (41.7%) did not improve with treatment. The median survival time in the group of patients treated specifically for leishmaniosis was 17 months. Median survival of patients treated with concomitant diseases was 13 months vs 41 months in those without, although this was not statistically significant (P = 0.557).

CONCLUSIONS AND RELEVANCE

Presentation of FeL appears to be similar to canine leishmaniosis but with some specific features: ulcerative and nodular skin lesions are the predominant cutaneous signs; cats with immunosuppressive conditions or coexisting diseases were more commonly present than typically seen in dogs (mainly feline immunodeficiency virus). A combination of diagnostic tests may be needed for definitive diagnosis.

Serological, molecular and clinicopathological findings associated with Leishmania infantum infection in cats in Northern Italy

OBJECTIVES

The aims of this study were to investigate the prevalence of Leishmania species infection in cats in Northern Italy and to evaluate the associations between infection and signalment and clinicopathological data.

METHODS

The study was carried out in a veterinary university hospital from June to November 2017. Blood, urine, conjunctival swabs and hair were collected from all randomly selected cats. Leishmania species infection was evaluated using the indirect fluorescent antibody test (IFAT), setting a cut-off value of 1:80, and using real-time PCR on blood, conjunctival and hair samples. A complete blood count, serum chemistry profile, serum electrophoresis and urinalysis were also carried out. The cats were grouped on the basis of the results of the diagnostic criteria adopted in positive, negative and unconfirmed Leishmania cases. Non-parametric variables and continuous data were compared among the study groups using the χ2 test and the Mann-Whitney U-test, respectively.

RESULTS

One hundred and fifty-two cats were included. Nineteen of the 152 (12.5%) cats were positive (18/152 [11.8%] showed an IFAT titre of ⩾1:80 and 1/152 [0.7%] was real-time PCR-positive from a hair sample); 106/152 (69.7%) cats were negative; and 27/152 (17.8%) cats were unconfirmed for Leishmania species. Total proteins, beta2-globulin and gamma-globulin were significantly increased in the positive Leishmania group compared with the negative group.

CONCLUSIONS AND RELEVANCE

The results of the present study demonstrated the spread of Leishmania infantum infection in cats in Northern Italy. Hyperproteinaemia and hypergammaglobulinaemia appeared to be significant clinicopathological abnormalities in this population of cats with L infantum infection.

Serological study of feline leishmaniasis and molecular detection of Leishmania infantum and Leishmania braziliensis in cats (Felis catus)

Blood samples and swabs from ocular conjunctiva and mouth were obtained from 64 cats. Of 64 serum samples, 19 were positive for Leishmania antibodies by ELISA (29.80%). Eight cats were positive by PCR (12.5%) in swab samples from mouth and/or ocular mucosa. Poor kappa agreement between serological and molecular results (k = 0.16) was obtained. From five positive PCR samples one was L. braziliensis and four were L. infantum. Phylogenetic analysis performed with the five isolates of Leishmania, showed that samples of L. infantum isolated from the cats were phylogenetically close to those isolated from domestic dogs in Brazil, while the L. braziliensis is very similar to the one described in humans in Venezuela. The study demonstrated that, despite high seropositivity for Leishmania in cats living in the study region, poor agreement between serological and molecular results indicate that positive serology is not indicative of Leishmania infection in cats. Parasite DNA can be detected in ocular conjunctiva and oral swabs from cats, indicating that such samples could be used for diagnosis. Results of phylogenetic analyzes show that L. infantum circulating in Brazil is capable of infecting different hosts, demonstrating the parasite's ability to overcome the interspecies barrier.

A molecular survey of vector-borne pathogens and haemoplasmas in owned cats across Italy

BACKGROUND

Feline vector-borne pathogens (FeVBPs) have been increasingly investigated for their impact on cat health and their zoonotic potential. The aim of the present study was to assess the prevalence of FeVBPs and haemoplasmas in cats across Italy and to identify potential risk factors linked to their occurrence.

METHODS

Blood samples from 958 owned cats living in the North (n = 556), Centre (n = 173) and South (n = 229) of Italy were tested for Babesia spp., Hepatozoon spp., Ehrlichia spp., Anaplasma spp. and filarioids by conventional PCR (cPCR) and for haemoplasmas and Bartonella spp. by SYBR green real-time PCR. Cats included in the study represent a sub-sample from a larger number of animals enrolled in a previous study, which were selected based on the geographical origin. Data on cats' positivity for Leishmania infantum, feline leukaemia virus (FeLV) and for feline immunodeficiency virus (FIV), available from the previous study, were included and examined. Potential risk factors for pathogen infection were assessed in relationship to categorical variables including sex, geographical origin, breed, neutering status and age of cats.

RESULTS

Out of the 958 cats, 194 (20.2%) were positive for at least one of the tested pathogens, 89 (16%) from the North, 32 (18.5%) from the Centre and 73 (31.9%) from the South of Italy. A high prevalence of FeVBPs was detected in male cats (n = 125, 27.8%), living in the southern part of the country (n = 73, 31.9%), younger than 18 months of age (n = 24, 22.4%) and not neutered (n = 39; 27.5%). In particular, 24 cats (2.5%) tested PCR-positive for Bartonella spp., of which 1.6% for B. henselae and 0.9% for B. clarridgeiae. A total of 111 cats scored PCR-positive for haemoplasmas (11.6%), specifically "Candidatus Mycoplasma haemominutum" (n = 95, 9.9%), M. haemofelis (n = 14, 1.5%) and "Candidatus Mycoplasma turicensis" (n = 2, 0.2%). Moreover, 39, 31 and 8 cats were positive for FeLV (4.1%), L. infantum (3.2%) and FIV (0.8%), respectively. Co-infections were registered for 19 (9.8%) cats.

CONCLUSIONS

These results confirm the occurrence of haemoplasmas and FeVBPs throughout Italy. Preventive measures to protect both animal and human health should be carried out also for owned cats, even if no health status of animals has been assessed in this study.

Leishmania infection in cats and dogs housed together in an animal shelter reveals a higher parasite load in infected dogs despite a greater seroprevalence among cats

Background

An outbreak of leishmaniosis was studied in cats and dogs housed together with no separation in an animal shelter in Israel.

Methods

The study included recording of clinical signs, serology for Leishmania infection by ELISA, PCR of blood for Leishmania DNA by ITS1 HRM and kDNA PCR, parasite quantification, and trapping of sand flies around the shelter.

Results

Thirty-seven % (22/60) of the dogs and 75% (50/67) of the cats were seropositive to L. infantum with a significantly higher seropositivity rate in the cat population (χ² = 42.160, P < 0.0001). Twenty-five percent (15/60) of the dogs were positive for Leishmania by blood PCR, 12% by the Leishmania ITS1 HRM PCR and 22% by kDNA PCR. Of the cats, 16% (11/67) were positive by kDNA PCR and none by ITS1 HRM PCR. All the PCR-positive animals were infected by L. infantum verified by DNA sequencing and there was no significant difference between the PCR-positivity in the dog and cat populations. Altogether, 43% (26/60) of the dogs and 79% (53/67) of the cats were positive by serology or PCR for L. infantum. The average Leishmania parasite load in the blood of PCR-positive dogs (42,967 parasites/ml) was significantly higher than in PCR-positive cats (1259 parasites/ml) (t₍₁₂₎ = 2.33, P = 0.037). Dogs that were positive by the Leishmania ITS1 HRM PCR and kDNA PCR had significantly higher parasite loads than dogs positive only by the kDNA PCR (t₍₁₁₎ = − 3.186580, P < 0.009). No significant effect was found for FIV seropositivity on Leishmania infection in the cats (χ² = 0.506, P = 0.777). A higher percentage of Leishmania-positive dogs showed clinical signs compatible with leishmaniosis compared to Leishmania-positive cats (100 vs 52.8%, χ² =15.242, P < 0.0001). Phlebotomus perfiliewi, a proven vector of L. infantum, comprised 92% of trapped sand flies.

Conclusions

Comparisons of populations of cats and dogs exposed to sand flies and L. infantum under the same conditions indicated that although a high rate of exposure was detected in cats as manifested by a significantly greater degree of seropositivity, dogs had significantly higher blood parasite loads, and were likely to be more infectious to sand flies than cats.

Validation of a new immunofluorescence antibody test for the detection of Leishmania infantum infection in cats

The prevalence data of Leishmania infantum infection in cats are characterized by a large variability mainly attributed to the differences in diagnostic techniques. In the absence of consensus about the method of choice for diagnosing feline leishmaniosis, the performance of a new immunofluorescence antibody test (IFAT) was herein analytically described by the comparison with IFAT commonly used for the diagnosis of canine leishmaniosis (i.e., IFAT-OIE) and a laboratory enzyme-linked immunosorbent assay (ELISA). Sera of cats living in visceral leishmaniosis-endemic (n = 105) and visceral leishmaniosis-non-endemic (n = 50) areas were tested by the above methodologies and real-time PCR (qPCR). The most frequent result was represented by triple negativity to the three tests (IFAT-OIE, ELISA, and qPCR) in 42.9% and 80% cats from endemic and non-endemic areas, respectively. Bayes latent class analysis gave an output probability of 34.1% (posterior standard deviation, psd = 5.4%) of true L. infantum cases (TCL) which represent the true estimated prevalence of infection. The sensitivity of each variable contributing to define the TCL was 24% (psd = 6.3%) for qPCR, 78.8% (psd = 8.7%) for ELISA and 91.8% (psd = 5.2%) for IFAT-OIE. The probability to be a TCL was 94.5% for the sample from an endemic area. The cross-validation of the new IFAT by a logistic model correctly identified as positive 80.7% of subjects defined as TCL and negative 89.9% as not TCL, respectively, by the Bayesian model. The study results estimate a good accuracy of the IFAT in predicting cats exposed to L. infantum. Therefore, this procedure may be beneficial for screening cat populations for a better understanding of the epidemiology of feline leishmaniosis.

Diagnosis and epidemiology of Leishmania infantum in domestic cats in an endemic area of the Amazon region, Brazil

Visceral leishmaniasis is a zoonotic disease caused by Leishmania infantum for which dogs are the main reservoir. In South America, presence of this disease is expanding along with increasing dispersion of its principal vector, the sand-fly Lutzomyia longipalpis. Feline leishmaniasis is an emerging disease in domestic cats, but epidemiological studies in endemic areas of the Amazon region of Brazil are scarce and the role of cats as reservoirs of L. infantum has been debated. The aim of this study was to investigate L. infantum infection in cats living in the Amazon biome region, using serological and molecular methods. A total of 105 cats were subjected to clinical examination and blood samples were taken for immunofluorescent-antibody (IFAT) serological evaluation, to determine anti-Leishmania antibody titers. Conventional PCR and Sanger's sequencing targeting L. infantum chitinase and Leishmania species ribosomal internal transcribed spacer (ITS-1) encoding genes were performed on conjunctival swabs from these cats. Seropositivity was detected in 32 animals (30.48%), thus confirming that contact between these cats and the parasite was occurring. PCR followed by amplicon sequencing showed that three samples (2.86%) were positive for a chitinase gene and six (5.71%) were positive for the ITS-1 gene. Parasite-positive diagnoses presented a statistically significant association with free access to the streets (p = 0.0111), cohabitation with dogs affected previously by VL (p = 0.0006) and absence of backyard cleaning and garbage collection (p = 0.00003). These results emphasize that cats should be included in epidemiological surveys of leishmaniasis, especially in endemic areas, if not as the reservoir host (unproven), at least as a "sentinel host" that is useful for revealing situations of endemic circulation of L. infantum. Moreover, in these areas, feline leishmaniasis needs to be considered in the differential diagnosis among domestic cats presenting alopecia, rarefied hair, lacerations and ulcerative dermatitis.

A nationwide survey of Leishmania infantum infection in cats and associated risk factors in Italy

Though scantly investigated, Leishmania infantum infection and clinical cases of leishmaniasis in cats have been recently reported in several countries of the Mediterranean basin, with large variability in prevalence data. A major limitation in the comparability of the data available is attributed to the differences in diagnostic techniques employed and cat populations sampled. The aim of this study was to assess the prevalence of L. infantum infection in owned cats across Italy by serological and molecular tests and the identification of potential risk factors. Blood samples from 2,659 cats from northern (n = 1,543), central (n = 471) and southern (n = 645) Italy were tested for antibodies against L. infantum, by an immunofluorescence antibody test and for the parasites’ DNA, by real-time PCR. Samples were additionally screened for feline leukemia virus (FeLV) and feline immunodeficiency virus (FIV) proviral DNAs. An overall cumulative L. infantum prevalence of 3.9% was recorded by serology (3.3%) and/or qPCR (0.8%), with a higher rate (10.5%) in southern Italy. The risk of L. infantum infection in cats was significantly associated to the geographical areas (South vs North and Centre; p<0.0001), age class (from 19 months to 6 years old vs ≤18 months old, p = 0.0003), neutering status (not neutered vs neutered, p = 0.0028) and FIV infection (p = 0.0051).Though the role of cats in the epidemiology of L. infantum is still debated, our findings indicate that cats are exposed to and/or infected by this protozoan, mainly in endemic regions of Italy. Hence, a standardization of procedures for a prompt diagnosis of L. infantum infection in cats and for screening cat population is crucial for a better understanding of the epidemiology of feline leishmaniasis, and of the potential role of cats in the transmission cycle of zoonotic visceral leishmaniasis.

Zoonotic visceral leishmaniasis is a potentially fatal parasitic disease, which is caused by Leishmania infantum. Its distribution is associated with the occurrence of the sand fly vectors and reservoir hosts. Since L. infantum infection can occur in cats with clinical or subclinical outcomes, the role of cats in the epidemiology of zoonotic visceral leishmaniasis needs to be thoroughly assessed. This study aimed to evaluate the prevalence and associated risk factors for infection with L. infantum in a large subset of cats across Italy, a known endemic area with records of human cases of visceral leishmaniasis. Serum and blood samples from 2,659 cats from northern (n = 1,543), central (n = 471) and southern (n = 645) Italy were tested for antibodies against L. infantum and parasites’ DNA, respectively. A cumulative L. infantum prevalence of 3.9% was recorded by serology (3.3%) and/or real-time PCR (0.8%). The risk of L. infantum infection in cats was associated to the geographical areas, age class, neutering status and feline immunodeficiency virus infection. These findings reveal that cats are exposed to and/or infected by this protozoan across the country, warranting further investigation to assess their role in the epidemiology of zoonotic visceral leishmaniasis to refine surveillance and prevention strategies against this veterinary and medically important ailment.

Serological and Molecular Findings of Leishmania Infection in Healthy Donkeys (Equus asinus) from a Canine Leishmaniosis Endemic Focus in Tuscany, Italy: A Preliminary Report

Leishmania parasites are considered to be emergent zoonotic pathogens, which is a new concept regarding their epidemiology and the identification of novel animal hosts. The present study is the first in Italy to evaluate anti Leishmania seroprevalence, and the first in Europe to detect parasite DNA in donkeys' blood. The study was performed on jennies living in a Leishmania infantum endemic area of Central Italy. One hundred and ten blood samples were obtained from 67 healthy lactating Amiatina jennies that were semi-extensively reared in Tuscany. When possible, more than one sample was subsequently obtained from the same subject. All samples were processed by immunofluorescence antibody test (IFAT) and by polymerase chain reaction (PCR). For the results, 11 out of 30 animals (36.7%) showed positive scores under IFAT. In addition, 22 out of the other 37 jennies had positive scores, also. The animals showed titers ranging from 40 to 320. Furthermore, 2 subjects that were submitted for 2 and 3 blood samplings, both had more than one positive score. Moreover, 2 seropositive animals were positive for Leishmania DNA. Donkeys are considered to be a preferred source for a sandfly blood meal, even if clinical leishmaniosis has never been reported in Europe for this animal species. In the view of these facts, our preliminary findings would suggest the role of donkey as a potential reservoir for this protozoan agent. Additional studies would be welcome to elucidate the role of the donkey in Leishmania epidemiology of CanL endemic areas and to confirm the preliminary findings and the hypothesis proposed here.

Is the cat an important reservoir host for visceral leishmaniasis? A systematic review with meta-analysis

In recent years feline leishmanial infections (FLI) have been studied more than ever before in various parts of the world. However, evidence-based knowledge on FLI has remained unavailable. The main objectives of this study were to investigate the status of felines infected by Leishmania spp. worldwide. Data were extracted from 10 available databases over the period of 1982 to 2017. Overall, 78 articles fulfilled the inclusion criteria and were used for data extraction in this systematic review. The overall FLI prevalence by both serological and molecular methods was estimated at 10% (95% CI: 8%-14%). In Italy, both the seroprevalence (24 %) and PCR prevalence (21 %) were found to be higher than in other countries. The most common diagnostic test used was the indirect fluorescent antibody test (38.5%). Studies on mixed-breed felines were more common than those on other breeds, while the most common parasite species was L. infantum (63%). Our findings suggest that cats act as primary and/or secondary reservoir hosts in the transmission of the Leishmania spp. to humans and also to dogs, by sandflies, at least in endemic foci. Moreover, available data confirm the enzootic stability situation of FLI in several countries including some in Europe.

Immunohistochemical characterization of cutaneous leishmaniasis in cats from Central-west Brazil

Feline leishmaniasis (FeL) is an emerging infectious disease of cats caused by Leishmania infantum with global distribution. This study investigated the cause of chronic progressive cutaneous lesions in two cats from Central-west Brazil by using cytological, histopathologic, and immunohistochemical (IHC) analyses. Clinically, both cats had ulcerative cutaneous lesions at the nasal planum and ear resulting in a tentative diagnosis of squamous cell carcinoma (SCC). Moreover, both cats had varying degrees of onychogryphosis. However, cytology revealed chronic inflammatory reactions associated with intralesional amastigotes; histopathology confirmed chronic ulcerative dermatitis associated with intralesional and intracytoplasmic parasitic organisms consistent with amastigotes of Leishmania spp. within histiocytes. The IHC assay demonstrated that the intralesional parasitic structures identified by cytology and histopathology were immunoreactive to antigens of Leishmania spp., confirming the participation of this infectious disease agent in the development of the cutaneous lesions of these cats. The observation of onychogryphosis must be highlighted, since this lesion is frequently observed in dogs with visceral leishmaniasis but is underreported in FeL. Collectively, the pathologic and IHC findings of the chronic cutaneous disease confirmed active infections due to Leishmania spp. in these cats. Additionally, FeL with associated lesions to the ear and nasal planum must be considered as differential diagnosis for SCC in cats.

Antibody response to Phlebotomus perniciosus saliva in cats naturally exposed to phlebotomine sand flies is positively associated with Leishmania infection

Background

Zoonotic leishmaniosis, caused by the protozoan Leishmania infantum, is a public and animal health problem in Asia, Central and South America, the Middle East and the Mediterranean Basin. Several phlebotomine sand fly species from the subgenus Larroussius are vectors of L. infantum. Data from dogs living in endemic areas of leishmaniosis advocate the use of antibody response to phlebotomine sand fly saliva as an epidemiological biomarker for monitoring vector exposure. The aim of this study was to analyse the exposure of cats to phlebotomine sand flies using detection of IgG antibodies to Phlebotomus perniciosus saliva. The association between phlebotomine sand fly exposure and the presence of Leishmania infection was also investigated.

Results

IgG antibodies to P. perniciosus saliva were detected in 167 (47.7%) out of 350 cats; higher antibody levels were present in sera collected during the period of phlebotomine sand fly seasonal activity (OR = 19.44, 95% CI: 9.84–38.41). Cats of 12–35 months had higher antibody levels than younger ones (OR = 3.56, 95% CI: 1.39–9.16); this difference was also significant with older cats (for 36–95 months-old, OR = 9.43, 95% CI: 3.62–24.48; for older than 95 months, OR = 9.68, 95% CI: 3.92–23.91). Leishmania spp. DNA was detected in the blood of 24 (6.9%) cats, while antibodies to L. infantum were detected in three (0.9%). Only one cat was positive to Leishmania by both techniques. Cats presenting IgG antibodies to P. perniciosus had a significantly higher risk of being positive for Leishmania infection.

Conclusions

To our knowledge, this is the first study demonstrating anti-sand fly saliva antibodies in cats. The evaluation of the contact of this animal species with the vector is important to the development of prophylactic measures directed to cats, with the aim of reducing the prevalence of infection in an endemic area. Therefore, studies evaluating whether the use of imidacloprid/flumethrin collars reduces the frequency of P. perniciosus bites in cats are needed. It is also important to evaluate if there is a correlation between the number of phlebotomine sand fly bites and IgG antibody levels.

Serological and molecular detection of Leishmania infantum in cats of Northern Sardinia, Italy

Leishmania infections are endemic in dogs in central and southern regions of Italy while feline leishmaniosis has only been sporadically described in these areas and few studies have been reported on serological and molecular investigation of infections in domestic cats. The purpose of this study is to assess the presence of Leishmania infantum infection in cats from Sardinia, a typical endemic area of leishmaniasis in Italy. Ninety cats attended at the Veterinary Teaching Hospital of the University of Sassari, Italy, were tested for L. infantum using the indirect immunofluorescent antibody (IFA) test and PCR. Serological (10%) and molecular (5.5%) detection in this population was low, with antibody titres ranging from 1/40 to 1/80. Only one cat was simultaneously positive by IFAT and PCR. This study shows the presence of L. infantum infection in cats living in Sardinia, with a prevalence that falls within the ranges described in other endemic areas and confirms the need of further research to better characterize the epidemiologic role of cats in the transmission of this infection.

Infection by Mycoplasma spp., feline immunodeficiency virus and feline leukemia virus in cats from an area endemic for visceral leishmaniasis

Background

Visceral leishmaniasis (VL) has been increasingly recognized in cats living in areas endemic for the disease. Co-infection with Leishmania infantum and other infectious agents is well established in dogs. However, for cats, data on co-infections with L. infantum and other infectious agents are still sparse. The aim of this study was to identify the prevalence of vector-borne pathogens, Mycoplasma spp., feline immunodeficiency virus (FIV) and feline leukaemia virus (FeLV) in cats from an area endemic for VL in southeastern Brazil.

Results

Of the 90 cats, eight (8.9%) were infected with Mycoplasma spp., five (5.5%) were FIV- positive and one (1.1%) was FeLV-positive. Co-infection with L. infantum and at least one other infectious agent was found in 9/50 (18.0%; CI: 8.6–31.4%) cats. In Group 1 (cats infected naturally by L. infantum), 4/50 (8.0%) cats were positive for FIV, 4/50 (8%) for Mycoplasma spp. and 1/50 (2.0%) was co-infected with FeLV and Mycoplasma spp. In Group 2 (cats non-infected with L. infantum), 2/40 (5.0%) cats were infected with Mycoplasma spp. and 1/40 (2.5%) was co-infected with FIV and Mycoplasma spp. All cats were negative for Ehrlichia spp., Babesia spp. and Anaplasma platys.

Conclusion

A low prevalence of co-infection in Leishmania-infected and non-infected cats was found. Co-infections with Leishmania and vector-borne diseases in cats are not common in this area endemic for VL in Brazil.

Feline leishmaniosis: Is the cat a small dog?

Leishmania infantum is a vector-borne zoonotic disease transmitted by phlebotomine sand flies and dogs are considered the main reservoir of the parasite. Feline leishmaniosis (FeL) caused by L. infantum is an emergent feline disease more and more frequently reported in endemic areas. This review summarizes current knowledge focusing similarities and differences with canine leishmaniosis (CanL). Cats are infected by the same Leishmania species than dogs but prevalence of the infection is lower and cases of disease are less frequently reported. Scarce information is available on adaptive immune response of cats naturally exposed to L. infantum infection and mechanisms responsible for susceptibility or resistance of feline hosts. However, about half of clinical cases of FeL are reported in cats with possible impaired immunocompetence. Coinfections or comorbidities are frequently detected in sick cats and they can contribute to a misrepresentation of clinical FeL albeit lesions associated with the presence of the parasite have been detected in skin, lymph nodes, spleen, bone marrow, liver, oral mucosa, stomach, large bowel, kidney, nasal exudate, lung, eye. As for dogs, skin or mucocutaneous lesions are the most common reason for veterinary consultation and finding on physical examination in cats with leishmaniosis.

Molecular investigations of Leishmania DNA and anti- Leishmania antibody detection are largely used with the same methodologies for both CanL and FeL, however few information is available about their diagnostic performance in feline hosts. Treatment of cats with clinical FeL is still empirically based and off label by using the most common drugs prescribed to dogs. Life expectancy of cats with clinical FeL is usually good unless concurrent conditions or complications occur and prognosis does not seem significantly influenced by therapy or retroviral coinfection.

According to current knowledge, cats can play a role as additional reservoir host of L. infantum and, in a « One Health » perspective, preventative measures should be taken.

In conclusion, albeit feline infection and the associated cat disease caused by L. infantum is increasingly reported in endemic areas and have many similarities with CanL, consolidated evidence-based knowledge is not available and we cannot exclude that important differences between dogs and cats exist about transmission, immunopathogenesis and best practice for management and prevention.

Survey of feline visceral leishmaniasis in Azarshahr area, north west of Iran, 2013

Leishmania infantum is a causative agent of visceral leishmaniasis or kala-azar, which is endemic in some part of Iran. Azarshahr city located in East Azerbaijan province, North West of Iran, which is endemic for visceral leishmaniasis. This study aimed to investigate the possible reservoir role of cats for visceral leishmaniasis in the Azarshahr area. Totally 65 cats have been trapped alive from villages of Azarshahr county and their serum samples subjected to direct agglutination test (DAT) for L. infantum antibodies. Giemsa stained impression smears have been prepared for parasitological examination of spleen and liver tissue. Also liver and spleen samples of the cats have been cultured in Novy-MacNeal-Nicolle (NNN) medium and also used for PCR. None from 65 samples was positive in NNN culture, PCR and microscopic examination. Fifteen (23.07 %) out of 65 serum samples showed Leishmania specific antibody agglutination at 1:320 dilution or above, but all considered as negative because none of them confirmed by Giemsa stained smears, PCR and NNN culture. According to the findings of the present study, cats are not a reservoir for visceral leishmaniasis in the Azarshahr area.

What do we know about feline leishmaniosis?

According to the World Health Organization (WHO), endemic areas of leishmaniosis have spread and the number of reported cases has increased. Europe is one of the continents with greatest risk of the re-emergence of this zoonosis. The significance of the cat as a reservoir of Leishmania species and not simply an accidental host seems to be gaining ground, mainly because: (i) cats can present increased seropositivity between serological analyses, but the pattern of seropositivity is not consistent between cats; (ii) cats can be infected for some months and thus are available for sandflies; and (iii) cats transmit the Leishmania species agent in a competent form. Furthermore, cats have behavioural characteristics that contribute to infection by Leishmania infantum and, as such, feline leishmaniosis (FeL) has been reported worldwide. When clinical signs of FeL are present, they are non-specific and frequently occur in other feline diseases. If they go undiagnosed, they can contribute to an underestimation of the actual occurrence of the disease in cats. The low seroprevalence titres, along with the commonly asymptomatic infection in cats, can further contribute to the underestimation of FeL occurrence. This work aims to raise awareness about FeL among veterinarians by providing a review of the current status of FeL infection caused by L infantum worldwide, the major clinicopathological features of infection, along with recent developments on FeL diagnosis, treatment and prevention.

Seroprevalence of Leishmania infection and molecular detection of Leishmania tropica and Leishmania infantum in stray cats of İzmir, Turkey

Leishmaniasis caused by more than 20 species of genus Leishmania is transmitted by the bite of infected phlebotomine sand flies. The studies on Leishmania infection in cats is very few in Turkey and therefore we aimed to screen stray cats living in city of İzmir located in western Turkey using nested PCR targeting kinetoplast DNA and serological techniques (ELISA and IFA). Leishmania DNA positive samples were also studied by ITS1 real time PCR. Whole blood and serum samples were obtained from stray cats (n: 1101) living in different counties of İzmir. In serological assays, a serum sample was considered positive in 1:40 dilution in IFA and for ELISA a serum sample was accepted positive when the absorbance value (AV) exceeded the mean AV + Standard Deviation (SD) of the negative control serum samples. According to the results, the seropositivity rates were 10.8% (119/1101) and 15.2% (167/1101) by in house ELISA and IFA, respectively. Among serology coherent samples, the seropositivity rate was 11.1% (116/1047) as detected by both assays after discordant samples (n: 54) were discarded. Of the 1101 stray cats, six (0.54%) were positive by nested PCR while only one of these six samples was positive by ITS1 real time PCR. During PCR, three controls designated as Leishmania infantum, Leishmania tropica, and Leishmania major were used for species identification. According to nested PCR results, L. tropica was identified in two cats (no.76 and 95). In another cat (no. 269), there were two bands in which one of them was well-matched with L. infantum and the other band had ∼850 bp size which does not match with any controls. Remaining three cats (no. 86, 514, and 622) also had the ∼850 bp atypical band size. ITS1 real time PCR detected L. tropica in only one cat (no. 622) which showed an atypical band size in nested PCR. These results indicated that three cats with only one atypical band (no. 86, 514, and 622) and the cat with mixed infection (no. 269) were infected with L. tropica. Altogether, L. tropica was detected in all six DNA positive cats and L. infantum was detected in one cat with mixed infection. In conclusion, although the reservoir role of cats in nature is still unclear the high seroprevalence rate against Leishmania parasites and detecting parasite DNA in stray cats in İzmir indicates that the stray cats are frequently bitten by infected sand flies. Further research activities are required to reveal the frequency of leishmaniasis in cats in different regions of Turkey where Leishmania species are endemic.

Feline leishmaniosis in Portugal: 3 cases (year 2014)

Leishmaniosis caused by Leishmania infantum is a zoonotic disease endemic in many countries of America, Asia and Europe, including Portugal. Dogs are the major reservoir of L. infantum, but domestic cats may also be infected. Three clinical cases of feline leishmaniosis are described, with ocular clinical signs as the only manifestation of the disease. A case had bilateral anterior uveitis and a granulomatous conjunctivitis, another one presented keratitis and the third case had a nodular blepharitis. All the affected cats had high serum titres of antibodies to L. infantum, while polymerase chain reaction results were positive in two of the cats. Although all cats in the present study improved after treatment with meglumine antimoniate and/or allopurinol, one of them died 6months later apparently due to a systemic L. infantum infection. The prevalence of disease may be underestimated in cats, because leishmaniosis is often not considered in the differential diagnosis of feline diseases. Feline leishmaniosis should be suspected in cats with ocular clinical signs and in those living in or traveling to areas where the zoonosis is endemic.

Successful treatment of feline leishmaniosis using a combination of allopurinol and N-methyl-glucamine antimoniate

CASE SUMMARY

This work describes the diagnosis and successful treatment of a 2-year-old domestic cat infected with Leishmania species and presenting fever, and ulcerative and nodular skin lesions after being treated for pyodermatitis for 1 year without clinical improvement. After anamnesis the cat was submitted to a complete clinical examination. Blood was collected for determination of haematological and biochemical parameters, detection of feline leukaemia virus (FeLV), feline immunodeficiency virus (FIV), feline coronavirus (FCoV) and Leishmania amastigotes. Fine-needle aspiration puncture from the skin nodules was also performed. After definitive diagnosis the animal was treated and followed up over a 2 year period. The animal tested negative for FIV-specific antibodies, FeLV antigen and feline coronavirus RNA. Leishmania amastigotes in the skin nodules were confirmed by cytology and molecular diagnosis. Treatment was initiated with allopurinol, resulting in a slight clinical improvement. Thus, N-methyl-glucamine antimoniate was added and administered for 30 days, with complete closure of the ulcerative lesions in the hindlimbs requiring a surgical approach. Close monitoring of the patient in the following 24 months indicated that combined therapy was safe and clinical cure was achieved without further relapses or side effects.

RELEVANCE AND NOVEL INFORMATION

Considering the increasing number of feline leishmaniosis cases and the inconsistent results of most therapeutic protocols described in the literature, the use of new approaches, especially in refractory cases, is essential. Although the use of allopurinol and N-methyl-glucamine antimoniate is off-label in cats, in this case the combination treatment was followed by an extensive analytical monitoring, supporting their safety and effectiveness.

HisAK70: progress towards a vaccine against different forms of leishmaniosis

BACKGROUND

Leishmania major and Leishmania infantum are among the main species that are responsible for cutaneous leishmaniosis (CL) and visceral leishmaniosis (VL), respectively. The leishmanioses represent the second-largest parasitic killer in the world after malaria. Recently, we succeeded in generating a plasmid DNA (pCMV-HISA70m2A) and demonstrated that immunized mice were protected against L. major challenge. The efficacy of the DNA-vaccine was further enhanced by the inclusion of KMP-11 antigen into the antibiotic-free plasmid pVAX1-asd.

METHODS

Here, we describe the use of a HisAK70 DNA-vaccine encoding seven Leishmania genes (H2A, H2B, H3, H4, A2, KMP11 and HSP70) for vaccination of mice to assess the induction of a resistant phenotype against VL and CL.

RESULTS

HisAK70 was successful in vaccinated mice, resulting in a high amount of efficient sterile hepatic granulomas associated with a hepatic parasite burden fully resolved in the VL model; and resulting in 100% inhibition of parasite visceralization in the CL model.

CONCLUSIONS

The results suggest that immunization with the HisAK70 DNA-vaccine may provide a rapid, suitable, and efficient vaccination strategy to confer cross-protective immunity against VL and CL.

Antibodies to Leishmania spp. in domestic felines

Abstract Leishmaniasis is a vector-borne zoonotic disease caused by protozoa in the genus Leishmania, typical of rural and peri-urban environments. The causative agent of American visceral leishmaniasis is Leishmania (Leishmania) infantum chagasi and the main insect vector in Brazil is Lutzomyia longipalpis. Dogs (Canis familiaris) are important in the transmission of the disease, as a reservoir closely related to humans and an infection source for phlebotomine vectors. Since 1990, an increasing number of feline leishmaniasis cases have been reported, suggesting that domestic cats (Felis catus) might be involved in the epidemiology of the disease. The present study analyzed the prevalence of anti-Leishmania spp. antibodies in naturally infected domestic cats from various neighborhoods in the municipality of Belém, Pará, Brazil, using the indirect immunofluorescence assay (IFA) and the direct agglutination test (DAT). Among the 443 samples tested, 18 (4.06%) presented positive reactions in the IFA. The observed titers were 40 IU in 4.97% of the samples and 80 IU in 0.90%. In the DAT test, positive results were found in 25 (5.64%) of the samples. The observed titers were also 40 IU (4.97%) and 80 IU (0.68%). The agreement rate between the two tests was considered low (Kappa coefficient = 0.10).

Parasite control practices and public perception of parasitic diseases: A survey of dog and cat owners

Drugs used in the control of internal and external parasites in companion animals play a crucial role in Animal and Public Health. To ensure continuing protection, these drugs should be administered regularly and in intervals, as suggested by the manufacturers. To assess parasite control practices and other related factors, including the degree of public awareness on the topic, 312 dog and cat owners were surveyed while attending the Small Animal Hospital, Faculty of Veterinary Medicine, Lisbon University. Results showed that 89.7% of the dogs were currently being treated with endoparasitic drugs. Of these, 74.3% were dewormed every four months or longer and merely 11.8% with the recommended treatment regimen (minimum quarterly). In cats, 63.6% were being treated with endoparasitic drugs and 85.7% of these were irregularly dewormed every four months or longer and merely 5.5% with the recommended treatment regimen (minimum quarterly). Combinations of praziquantel, pyrantel embonate and febantel were the most commonly used drugs in dogs, whereas macrocyclic lactones were more frequently used in cats. Regarding external parasitic control, 92.2% of the dogs were being treated, 50.5% of these at monthly intervals (all-year round or seasonally). The most common ectoparasitic drug formulation used on dogs was the spot-on imidacloprid+permethrin (89%). Only 28.4% of the dogs were uninterruptedly protected throughout the year from the main canine vector borne diseases transmitted by fleas, ticks, sandflies and mosquitoes. Merely 63.6% of the cats were being controlled with ectoparasitic drugs, most at infrequent drug intervals and imidacloprid was the most frequently used drug on cats (44.4%). Additionally, 85% of the respondents had never heard of the word "zoonosis" and 37% of them did not collect their dog's faeces in all public places. Scabies, toxoplasmosis and leishmaniasis were the most frequent parasitic diseases identified by the public in this survey. Although the majority of pet owners give antiparasitic drugs, our results show that most of them do not follow the manufacturers recommendations, deworming at irregular and consequently ineffective intervals. Therefore, it is of utmost importance for the veterinarians to educate pet owners regarding parasite cycles, methods of prevention and transmission mechanisms, as well as to follow the drug recommendations, in order, respectively, to increase their awareness and thereby improve the effectiveness of the available control measures.

Survey of Wild and Domestic Mammals for Infection with Leishmania infantum following an Outbreak of Desert Zoonotic Visceral Leishmaniasis in Jiashi, People's Republic of China

In 2008 and 2009, an outbreak of desert-subtype zoonotic visceral leishmaniasis occurred in Jiashi county, Xinjiang, China. So far, no animal reservoir has been identified for this type of visceral leishmaniasis. Therefore, we surveyed the most common mammals (wild and domestic) for Leishmania infections during the outbreak in 2008 and 2009 in order to identify the source of the visceral leishmaniasis in this region. Spleen, liver, bone marrow and blood samples collected from 86 wood mice (Apodemus sylvaticus), 61midday jirds (Meriones meridianus) and 27 Yarkand hares (Lepus yarkandensis) were tested for the presence of Leishmania by microscopy, culture and PCR. All of the animals were found to be negative for Leishmania infections; On the other hand, Leishmania DNA was detected in blood samples collected from livestock reared in the outbreak area: 30.36% (17/56) of sheep, 21.57% (11/51) of goats, 17.78% (8/45) of cattle, and 21.62 (8/37) of donkeys were positive for Leishmania DNA by PCR. The amplified kDNA sequences from the livestock samples matched Leishmania DNA sequences isolated from patients with visceral leishmaniasis in the study area. We suggest that these domestic mammals are a possible reservoir host for Leishmania infantum in the outbreak area.

First case of feline leishmaniosis caused by Leishmania infantum genotype E in a cat with a concurrent nasal squamous cell carcinoma

Case summary

This is the first clinical report of feline viscerocutaneous leishmaniosis caused by Leishmania infantum genotype E associated with an invasive squamous cell carcinoma (SCC) in a domestic cat from Portugal. Initially, the cat presented a single cutaneous lesion in the right nostril. A fine-needle aspiration was performed and Leishmania amastigotes were observed without the presence of cells compatible with neoplasia. Systemic treatment with allopurinol was started. One year later, the cat presented a crateriform non-encapsulated and badly delineated mass in the nasal planum, with naso-oral fistulation and nasal destruction. Histologically, the skin mass consisted on an ulcerative plaque-like lesion with a nasal SCC. Leishmania infantum MON-1 parasites were detected by histopathology, culture and PCR of the skin mass, submandibular and popliteal lymph nodes, liver and spleen. Restriction enzyme analysis revealed genotype E, previously identified in humans and dogs living in the same region.

Relevance and novel information

This is, to the best of our knowledge, the first clinical report of feline viscerocutaneous leishmaniosis caused by L infantum genotype E. The detection and isolation of parasites from a cat that are genetically identical to the ones obtained from humans and dogs with visceral leishmaniosis highlights the need to clarify whether cats play a role in the epidemiology of this parasitic zoonosis. From a clinical point of view, this case reinforces the importance of including leishmaniosis in the differential diagnoses of feline pathology, especially in cats with cutaneous lesions.

Leishmaniases diagnosis: an update on the use of immunological and molecular tools

Leishmaniases are caused by obligate intracellular protozoan parasites of the genus Leishmania. They cause a spectrum of diseases, most notably visceral (VL), cutaneous (CL), and mucosal (ML) leishmaniasis, which affect millions of people around the world, each year. Despite scientific advances, leishmaniases cases are expanding, constituting an important public health problem. Immunological and molecular diagnostic tools have been increasingly applied for the early detection of these parasitic infections, since the existence of limitations in clinical and parasitological examinations may provide false results, thus interfering in epidemiological research and diseases control. Although there is a great diversity of available immunological assays, important common deficiencies persist, which explains the current exploration of the molecular biology in research fields, especially the Polymerase Chain Reaction (PCR) and its variants, such as real-time quantitative PCR. However, in the last years, significant results have also been reached inside of immunological context (especially by Flow Cytometry), for humans and dogs, demonstrated by research works of the New and Old worlds. In spite of their potential to clarify and minimize the present global situation of the diseases, the implementation of molecular or immunological innovative reference assays for VL and CL at health services is still a challenge due to several reasons, including lack of standardization among laboratories and structural concerns. In this article we bring classical and current information about technological advances for the immunological and molecular leishmaniases diagnosis, their features, and applications.