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

Current knowledge on leptospirosis in cats: A systematic review with metanalysis on direct detection, serological response, and clinical data

Leptospirosis is a neglected bacterial zoonosis that affects a wide range of mammals, with important implications from a One Health perspective. Over the past years feline leptospirosis has gained increased attention in the scientific community. Here we describe a systematic review with meta-analysis that followed the PRISMA guidelines, with an additional PROSPERO registration. The study provides global seropositivity, urinary shedding rates, global serogroup distribution, descriptive data of leptospires that had been isolated from cats and clinical and laboratory features presented by symptomatic cats with acute disease. The search was carried out in six different databases, with the identification of 79 reports describing leptospiral infection in cats. The pooled frequency of seroreactive cats was 11% (95% CI: 9%-13%), with Javanica and Pomona as the most frequent serogroups found. Frequency for urinary shedding was 8% (95% CI: 5%-10%), with L. interrogans identified in most samples. A total of 16 isolates were isolated from cats, with Bataviae as the most frequent serogroup. Twenty symptomatic cats with confirmed leptospiral infection were identified. Anorexia, lethargy, polydipsia, and bleeding disorders were the clinical signs most frequently reported. The results suggest that cats from some locations are exposed to leptospires and may act as urinary shedders of this pathogen, thus indicating a possible role of this species in disease transmission. Clinical data indicates that acute infection is mostly atypical when compared to dogs, and due to difficulties to define an archetypal clinical presentation in cats, feline leptospirosis is likely to be underdiagnosed disease in this species.

THREE CASES OF CLINICAL LEPTOSPIROSIS IN PATAGONIAN MARAS (DOLICHOTIS PATAGONUM)

Rodents are typically viewed as asymptomatic reservoirs for leptospirosis infection, as clinical disease in rodents is rarely described. This report includes three separate cases of leptospirosis in Patagonian maras (Dolichotis patagonum) over a 3-yr period in multiple locations within a single zoo. All three cases presented with varying clinical signs including lethargy, conjunctival hyperemia, hyperbilirubinemia, and presumed renal azotemia. Infection with Leptospira spp. was diagnosed antemortem by PCR on whole blood (n = 1, Case 1) or urine (n = 2, Cases 2 and 3). Leptospira antibody titers measured by serum microagglutination testing (n = 3) were elevated or increased in all three animals over a 1-3-wk period for Leptospira serovars Bratislava and Hardjo (Case 1) and Grippotyphosa (Case 2 and 3). Two of the three animals responded to treatment with penicillin and doxycycline and supportive care, whereas one animal did not respond to treatment. Postmortem findings in this individual included conjunctivitis, chemosis, dehydration, icterus, tricavitary serosanguinous effusions, necrotizing hepatitis, diffuse pulmonary congestion, and edema. Immunohistochemical examination identified scattered Leptospira organisms within hepatocytes and renal tubular epithelial cells. A wild raccoon (Procyon lotor) at the institution tested positive by PCR on kidney tissue for the same Leptospira spp. serovar and was the suspected source of infection. This case series highlights the clinical importance of leptospirosis as a differential for Patagonian maras presenting with lethargy, ocular signs, acute hepatic disease, and azotemia.

A Clinical Study on Urinary Clusterin and Cystatin B in Dogs with Spontaneous Acute Kidney Injury

Novel biomarkers are needed in diagnosing reliably acute kidney injury (AKI) in dogs and in predicting morbidity and mortality after AKI. Our hypothesis was that two novel tubular biomarkers, urinary clusterin (uClust) and cystatin B (uCysB), are elevated in dogs with AKI of different etiologies. In a prospective, longitudinal observational study, we collected serum and urine samples from 18 dogs with AKI of different severity and of various etiology and from 10 healthy control dogs. Urinary clusterin and uCysB were compared at inclusion between dogs with AKI and healthy controls and remeasured one and three months later. Dogs with AKI had higher initial levels of uClust (median 3593 ng/mL; interquartile range [IQR]; 1489-10,483) and uCysB (554 ng/mL; 29-821) compared to healthy dogs (70 ng/mL; 70-70 and 15 ng/mL; 15-15; p < 0.001, respectively). Initial uCysB were higher in dogs that died during the one-month follow-up period (n = 10) (731 ng/mL; 517-940), compared to survivors (n = 8) (25 ng/mL; 15-417 (p = 0.009). Based on these results, uClust and especially uCysB are promising biomarkers of AKI. Further, they might reflect the severity of tubular injury, which is known to be central to the pathology of AKI.

Infection and re-infection of Leptospira spp. in stray dogs and cats from Bogota, Colombia

Background and Aim

Leptospirosis is a re-emerging zoonosis that is under-reported in tropical countries, and canines can be a potential reservoir of the disease. The objective of this study was to diagnose Leptospira spp. that is actively infected and re-infected in stray dogs and cats from Bogota, D.C., Colombia.

Materials and Methods

A sample of 200 animals, including dogs and cats from the animal protection programs of Bogota, Colombia, were used in this study. Blood was collected from these animals for serum and DNA analysis. Conventional polymerase chain reaction (PCR) was performed using the 16s rRNA primer set, and higher-quality amplification products were sequenced by Sanger. For serodiagnosis, a group of PCR-positive samples was tested using the microagglutination test (MAT).

Results

The overall PCR positivity of stray dogs and cats was 56%, 52.9%, and 65.3% in dogs and cats, respectively. The MAT seropositivity was 77.3%, and only dogs showed titers higher than 1:400. Canicola, Icterohaemorrhagiae, Pomona, Hardjo Prajitno, and Canicola and Hardjo prajitno were the serogroups associated with dogs and cats, respectively. Phylogenetic analysis revealed that the strains belonging to Leptospira interrogans serovars related to isolated samples of American, European, and Asian bats (Myotis myotis), dogs, and bovines of American origin.

Conclusion

These results showed that stray dogs and cats were previously exposed to different serovars of Leptospira spp. and re-infected with other serovars that actively participated in the transmission cycle. These findings highlight the importance of actively diagnosing infectious animals to design effective intervention strategies.

Acute kidney injury and liver disease in an American bulldog with suspected leptospirosis

A 6-year-old spayed female American bulldog was brought to a veterinary clinic with a 3-day history of vomiting, lethargy, anorexia, icterus, hemorrhagic diarrhea, and oliguria. The dog's clinical signs, complete blood (cell) count, serum biochemistry, urinalysis, and diagnostic imaging were indicative of acute kidney injury and acute hepatopathy consistent with leptospirosis. Treatment for leptospirosis was initiated but, due to the dog's lack of response and progression of clinical signs, euthanasia was ultimately elected after 3 d of hospitalization. The dog tested negative for Leptospira spp. on ELISA; urine, blood, and tissue PCRs; and immunohistochemistry. This case demonstrates that confirmation of leptospirosis can be challenging, even in an animal with the expected clinical presentation. Therefore, limitations of the diagnostic tests available, as well as the possibility of other, less likely differential diagnoses such as toxicosis, must be considered.

Serological evidence of exposure of healthy dogs to Leptospira in Sydney, New South Wales, Australia

In 2017, highly fatal canine leptospirosis emerged in Sydney, Australia. Based on results of microscopic agglutination testing (MAT), serovar Copenhageni appeared to be the most common causative serovar. Prior to this, no clinical cases had been reported since 1976. In a serosurvey of healthy dogs in Australian shelters in 2004, 2.4% of 431 New South Wales dogs had serological evidence of exposure to Copenhageni, the most prevalent serovar. The aim of this study was to estimate the current prevalence of Leptospira exposure and associated serovars in healthy Sydney dogs, previously unvaccinated against Leptospira. Serum samples from 411 healthy dogs in leptospirosis hotspots and neighbouring suburbs were collected before vaccination. MAT for 23 serovars was performed at the WHO Leptospirosis Reference Laboratory in Queensland, Australia. The overall seroprevalence was 4.1% (17/411) with low titres (1/50-1/200) detected. Eleven dogs were from known leptospirosis hotspots. Eight dogs were known to hunt rodents. One dog had been in contact with a leptospirosis positive dog 1 year prior. Serovar Topaz was the most prevalent serovar (n = 5) followed by serovars Australis (n = 4), Copenhageni (n = 4), Djasiman (n = 2), Cynopteri (n = 1), Javanica (n = 1), Medanensis (n = 1), and Pomona (n = 1). In conclusion, serological evidence of exposure of dogs in Sydney to Leptospira is low, but apparently has increased since 2004. Positive titres to serovars not previously reported to cause disease in dogs could be due to low virulence of those serovars or cross-reactivity with other serovars.

[Overview on utility of in-house tests for detection of systemic infectious diseases in dogs]

For detection of infectious diseases, several point-of-care (POC) tests are on the market in addition to methods performed in commercial laboratories. These POC tests are based on enzyme-linked immunosorbent assay (ELISA) or other immunochromatographic technologies and present results within few minutes in veterinary practice. This article gives an overview of the utility of numerous POC tests of different manufacturers for detection of parvovirus antigen in feces, Dirofilaria (D.) immitis antigen in blood as well as antibodies against Borrelia (B.) burgdorferi, Anaplasma (A.) spp., Ehrlichia (E.) spp., Leptospira (L.) spp. and Leishmania (L.) infantum in blood (single or in different combinations). Sensitivity and specificity of these tests are important for their usefulness in veterinary practice. Furthermore, presence of antibodies or detection of antigen has to correlate with the presence of clinical signs. POC tests for detection of canine parvovirus antigen have a very high specificity, the sensitivity of all evaluated POC tests, however, is very low. POC tests for detection of D. immitis antigen have a very high sensitivity and specificity. As they detect antigen from the uterus of female adult parasites, test results are negative when only very few female or only male adults are present. POC tests for detection of antibodies against B. burgdorferi only indicate contact with Borrelia spp. and do not prove clinical Lyme disease, as the infection only extremely rarely causes clinical signs. POC tests for detection of antibodies against A. phagocytophilum are also not suitable for diagnosis of clinical anaplasmosis. Infections with A. phagocytophilum only lead to clinical disease in very rare cases and in these, clinical signs occur before the development of antibodies. POC tests for detection of antibodies against E. canis have a very high sensitivity as well as specificity. POC tests for detection of antibodies against L. infantum and Leptospira species (spp.) show a very high specificity and a high sensitivity. However, Leptospira spp. antibody-positive results may occur following vaccination, as the POC tests cannot distinguish between field and vaccination strains.

Investigation of anti-Leptospira spp. antibodies and leptospiruria in cats attended to a veterinary teaching hospital in southern Brazil

Leptospirosis is a bacterial zoonosis that affects both humans and animals worldwide. Currently, it is known that cats may be susceptible to infection. This study aims to investigate the presence of anti-Leptospira spp. antibodies and leptospiruria in cats, using Microscopic Agglutination Test (MAT) and Real-time Polymerase Chain Reaction (PCR) techniques, respectively. A total of 76 cats, undergoing comprehensive anamnesis, general physical examination, and complementary exams were included in the investigation. Among the 76 cats tested, 9.2% (7/76) exhibited the presence of anti-Leptospira spp. antibodies, while Leptospira spp. DNA was detected in at 1.3% (1/76) of the evaluated urine samples. No significant associations were observed between the serological and molecular diagnostic results and the assessed variables, including clinical data and laboratory results of cats testing positive. This study provides insight into the occurrence of Leptospira spp. infection and leptospiruria in cats treated at a veterinary teaching hospital in southern Brazil.

Retrospective evaluation of 22 dogs with leptospirosis treated with extracorporeal renal replacement therapies (2018-2021)

BACKGROUND

Outcomes of dogs with acute kidney injury secondary to leptospirosis (AKI-L) treated using renal replacement therapies (RRT) are poorly characterized.

HYPOTHESIS/OBJECTIVES

Describe survival to discharge, short (≤30 days) and long-term (≥6 months) outcomes of AKI-L dogs receiving RRT and determine if there is a significant difference in maximum blood urea nitrogen (maxBUN), maximum creatinine (maxCr), maximum bilirubin (maxBili) and the number of body systems affected between survivors and non-survivors.

ANIMALS

Twenty-two client-owned dogs with AKI-L receiving RRT.

METHODS

Retrospective medical record review of dogs with AKI-L that received RRT between 2018 and 2021.

RESULTS

Sixteen of 22 (73%) dogs survived to discharge. Of the survivors, 13 (81%) were alive >30 days from discharge and 12 (75%) were alive at 6 months from discharge. Factors significantly higher in non-survivors included number of body systems affected (survivors: 1 (19%), 2 (50%), 3 (25%) and 4 (6%) vs non-survivors: 3 (33.3%), and 4 (66.7%); P = .01) and median maxBili (survivors: 1.9 mg/dL; range, 0.1-41.6 vs non-survivors: 21.0 mg/dL; range, 12.3-38.9; P = .02). There was no significant difference in median maxBUN (survivors: 153.0 mg/dL; range, 67-257 vs non-survivors: 185.5 mg/dL; range, 102-218; P = .44) and median maxCr (survivors: 9.8 mg/dL; range, 6.2-15.9 vs non-survivors: 9.8 mg/dL; range, 8.4-13.5; P = .69) between survivors and non-survivors.

CONCLUSIONS AND CLINICAL IMPORTANCE

Regardless of azotemia severity, dogs with AKI-L receiving RRT have a good survival rate to discharge. The number of body systems affected and hyperbilirubinemia might be associated with worse outcomes.

Identification of the most effective serovars to be included in the MAT antigen panel to optimize the serodiagnosis of Leptospira infection in Northern Italy

The microscopic agglutination test (MAT) assay is adopted as a world-wide reference test for the serodiagnosis of leptospirosis in humans and animals. One of the main limitations of MAT is the lack of sensitivity and serodiagnostic antigens should be periodically updated with locally circulating serovars in order to optimise its performance. The aim of this study was to determine the need to implement the antigen panel currently adopted in Northern Italy for the diagnosis of Leptospira infection in dogs. For this purpose, a group of 288 dogs with and without clinical signs potentially consistent with Leptospira infection or found to have an increased C-reactive protein (CRP) serum concentration, sampled in 2013-2016 in Northern Italy, were tested by MAT comparing the results obtained with a nine antigens panel (Australis-Bratislava, Ballum-Ballum, Canicola-Canicola, Grippotyphosa-Grippotyphosa, Icterohaemorrhagiae-Copenhageni, Icterohaemorrhagiae-Icterohaemorrhagiae, Sejroe-Hardjo, Pomona-Pomona and Tarassovi-Tarassovi serovars) routinely adopted and a panel expanded to 27 antigens. In general, the antigen panel currently adopted in Northern Italy for the routine MAT assay resulted adequate for the diagnosis of Leptospira infection in dogs. The main exception concerns the Sejroe serogroup, with the Saxkoebing and Sejroe serovars that were more effective than Hardjo for diagnosis in dogs and whose inclusion in the antigen panel is recommended. Among other antigens evaluated in this study, Cynopteri serovar was detected with high frequency but its pathogenic role in dogs and as public health threat deserve further investigation.

Nephrology in Veterinary Medicine

Veterinary nephrology is a specialized field of veterinary medicine providing a high level of care for animals with all types of kidney disease. Veterinarians complete extensive training to become board-certified in veterinary nephrology-urology. Companion animal nephrology is the most advanced field; however, all species are afflicted by a variety of renal disorders. Most naturally occurring animal kidney diseases have similar disorders found in people; where veterinary research is lacking, clinical management is often modified from standard of care in people. Veterinarians have become adept at scaling down procedures to safely perform them on dogs and cats weighing only a few kilograms. Advanced diagnostics (renal biopsy, cystoscopy, fluoroscopic studies, etc. ) and therapeutics (renal replacement therapy, interventional endourology, etc. ) are commonly performed within the practice of veterinary nephrology-urology. Collaboration between veterinary and human nephrologists may advance both disciplines and improve care for people and animals alike.

Updated ACVIM consensus statement on leptospirosis in dogs

Since publication of the last consensus statement on leptospirosis in dogs, there has been revision of leptospiral taxonomy and advancements in typing methods, widespread use of new diagnostic tests and vaccines, and improved understanding of the epidemiology and pathophysiology of the disease. Leptospirosis continues to be prevalent in dogs, including in small breed dogs from urban areas, puppies as young as 11 weeks of age, geriatric dogs, dogs in rural areas, and dogs that have been inadequately vaccinated for leptospirosis (including dogs vaccinated with 2-serovar Leptospira vaccines in some regions). In 2021, the American College of Veterinary Internal Medicine (ACVIM) Board of Regents voted to approve the topic for a revised Consensus Statement. After identification of core panelists, a multidisciplinary group of 6 experts from the fields of veterinary medicine, human medicine, and public health was assembled to vote on the recommendations using the Delphi method. A draft was presented at the 2023 ACVIM Forum, and a written draft posted on the ACVIM website for comment by the membership before submission to the editors of the Journal of Veterinary Internal Medicine. This revised document provides guidance for veterinary practitioners on disease in dogs as well as cats. The level of agreement among the 12 voting members (including core panelists) is provided in association with each recommendation. A denominator lower than 12 reflects abstention of ≥1 panelists either because they considered the recommendation to be outside their scope of expertise or because there was a perceived conflict of interest.

TaqMan real-time PCR for detection of pathogenic Leptospira spp. in canine clinical samples

Introduction

Canine leptospirosis has always been a differential diagnosis in dogs presenting with clinical signs and blood profiles associated with kidney and/or liver disease. The conventional polymerase chain reaction (PCR) provides diagnoses, but real-time PCR-based tests provide earlier confirmation and determine the severity of infection, especially in the acute stage, allowing early detection for immediate treatment decisions. To our knowledge, real-time PCR has not been routinely adopted for clinical investigation in Malaysia. This study evaluated TaqMan real-time PCR (qPCR) assays diagnosing leptospirosis and compared their applicability to clinical samples from dogs with kidney and/or liver disease against a conventional PCR reference.

Material and Methods

The qPCR assays were validated using existing leptospiral isolates. Whole blood and urine samples were analysed using a conventional PCR, LipL32(1) and LipL32(2) qPCRs and a microscopic agglutination test. The sensitivity and specificity of the qPCRs were determined.

Results

The LipL32(1) qPCR assay had more diagnostic value than the LipL32(2) qPCR assay. Further evaluation of this assay revealed that it could detect as low as five DNA copies per reaction with high specificity for the tested leptospiral strains. No cross-amplification was observed with other organisms. Analysing the clinical samples, the LipL32(1) qPCR assay had 100.0% sensitivity and >75.0% specificity.

Conclusion

The LipL32(1) qPCR assay is sensitive, specific and has the potential to be applied in future studies.

Time for change? A systematic review with meta-analysis of leptospires infecting dogs to assess vaccine compatibility in Brazil

Dogs are thought to be highly exposed to environmental pathogenic leptospires, possibly acting as potential sources of infection for zoonotic transmission. Vaccination stands as the cornerstone strategy to prevent disease and urinary shedding in dogs, yet the success of vaccination is highly dependent on the correspondence of leptospires circulating locally with those used in vaccine compositions. To provide evidence for vaccine compatibility, and to assess whether there are regional differences on serogroup distribution, we conducted a systematic review with meta-analysis on serological data, characterization of leptospiral isolates and risk factors for seropositivity in dogs from Brazil. Studies reporting canine leptospirosis within the Brazilian territory were eligible for inclusion, and methodology was validated by PROSPERO under registration CRD42020204187. Six electronic databases were searched, and data regarding population, methods, and outcomes were extracted. Sixty-one studies were included to access serogroup distribution and risk factors, with a pooled positivity rate of 19.7% in dog population. Serological evidence indicates that Canicola, Icterohaemorrhagiae and Autumnalis are the most frequently found serogroups. Twenty-eight records were included to access leptospiral strains isolated in Brazil, with n = 56 strains characterized as serogroups Canicola, n = 37 as Icterohaemorrhagiae, n = 2 as Pomona, and n = 1 strain as Australis and Sejroe each. Risk factor analysis revealed that stray dogs, puppies or elderly dogs, male dogs and dogs kept by tutors with poor social and economic conditions are at high risk for infection. The present study revealed overall good compatibility of leptospiral strains circulating locally with those used in vaccines against canine leptospirosis in Brazil. The circulation of serovars Pomona and Grippotyphosa has not been consistently demonstrated, and the inclusion of these serovars in local vaccines cannot be supported by our results. The results also provided serological evidence for the circulation of Serogroup Autumnalis among the studied populations.

Evaluation of Leptospira infection and exposure in free-roaming cat populations in northern California and southern Texas

OBJECTIVES

Leptospirosis is a re-emergent zoonotic bacterial disease associated with renal and hepatic injury. In free-roaming cats in some regions, a high prevalence of Leptospira antibodies has been identified, and pathogenic leptospires have been detected in renal tissue, indicating that they may play a role in Leptospira epidemiology. The objective of this study was to determine the prevalence of Leptospira seroreactivity and urinary shedding of Leptospira DNA in free-roaming cats from northern California and southern Texas. A secondary objective was to compare the results of a point-of-care (POC) assay, designed to detect Leptospira antibodies, with the results of the microscopic agglutination test (MAT) when applied to serum samples from feral cats.

METHODS

Specimens were obtained from free-roaming cats from northern California (n = 52; 2020) and southern Texas (n = 75; 2017). Leptospira quantitative PCR was performed on blood and urine specimens from Californian cats. Serum samples from Californian and Texan cats were subjected to MAT to categorize them as Leptospira antibody-positive or antibody-negative. The performance of the POC assay was assessed using the MAT as the gold standard.

RESULTS

Leptospira DNA was not detected in the blood or urine of any cats tested. The results of the MAT were positive in 17.3% (n = 9) of Californian cats and 10.7% (n = 8) of Texan cats (P = 0.3). The median MAT titer was 1:100 (range 1:100-1:200) in Californian cats and 1:200 (range 1:100-1:800) in Texan cats. The POC assay was negative in all specimens.

CONCLUSIONS AND RELEVANCE

Free-roaming cats in California and Texas are exposed to Leptospira species and may have the potential to act as sentinel hosts. No cats had evidence of current infection, as determined using PCR on blood and urine specimens. The POC test did not reliably detect anti-Leptospira antibodies in these cats. The role of cats in the maintenance or shedding of pathogenic leptospires requires further investigation.

Microscopic detection of Leptospira bacterial organisms in urine sediment from a young dog with leptospirosis and a review of the pathobiology and diagnosis of canine leptospirosis

Samples collected from an 11-month-old Dachshund-mix dog with a history of acute azotemia, fever, and enlarged and irregular kidneys were received at the Colorado State Veterinary Diagnostic Laboratory (CSU VDL). The submitting veterinarians were concerned about lymphoma versus acute nephritis/pyelonephritis. The CSU clinical pathology laboratory received urine for urinalysis and kidney aspirates for cytologic evaluation. Urine had also been submitted for aerobic culture and Leptospirosis PCR, and serum was submitted for Lepto-5 microscopic agglutination testing (MAT). Upon examination of a wet mount of the urine sediment, technical staff noted "vibrating" clumps of granular-appearing material throughout the slide, which prompted the preparation of a stained sediment slide for pathologist review. Very small, faintly staining organisms were observed, and an attempt was made to picture-match these with published reports of Leptospira in dog urine, but none could be found. In addition, some references claimed that Leptospira organisms are not seen in urine with light microscopy. The suspicion that these organisms were Leptospira sp. was supported by the MAT results and later confirmed by PCR. The organisms subsequently exhibited strong positive immunolabeling for the Leptospira antigen. This case report provides a searchable record of Leptospira organisms visualized by routine light microscopy in dog urine during natural infection and a review of canine leptospirosis pathobiology and diagnosis.

Feline Susceptibility to Leptospirosis and Presence of Immunosuppressive Co-Morbidities: First European Report of L. interrogans Serogroup Australis Sequence Type 24 in a Cat and Survey of Leptospira Exposure in Outdoor Cats

Leptospirosis is one of the most widespread zoonotic diseases and can infect both humans and animals worldwide. The role of the cat as a susceptible host and potential environmental reservoir of Leptospira is still not well understood, due to the lack of obvious clinical signs associated with Leptospira spp. infection in this species. This study aims to describe the first European detection of Leptospira interrogans serogroup Australis ST 24 in a young outdoor cat with a severe comorbidity (feline panleukopenia virus). In addition, the results of a preliminary study conducted in 2014-2016 are presented (RC IZSVE 16/12), which reports an investigation of Leptospira exposure of outdoor cats in Northeast Italy by means of serological investigation and molecular evaluation of urine. The animals included in the survey are part of samples collected during active and passive surveillance (diagnostic samples). The study reported a seroprevalence of 10.5% among outdoor cats and the serogroups identified were Grippotyphosa, Icterohaemorrhagiae, Bratislava, Canicola and Ballum. Symptomatic cats reported high MAT titres (ranging from 1:800 to 1:1600) towards antigens belonging to the serovars Grippotyphosa (1:800), Bratislava (1:1600), Icterohaemorrhagiae (1:200) and Copenhageni (1:200-1:800). In one subject, urine tested positive for Leptospira PCR. Cats with high antibody titres for Leptospira and/or positivity on molecular test suffered from immunosuppressive comorbidities (feline immunodeficiency virus and feline leukaemia virus; feline herpesvirus and lymphoma; hyperthyroidism). The overall prevalence of serum antibodies against Leptospira found in free-ranging cats (10.53%, 95% CI: 4.35-16.70%) and the identification of L. interrogans ST 24 in a young cat with immunosuppressive disease (feline panleukopenia virus) suggest the possibility of natural resistance to clinical leptospirosis in healthy cats. In a One Health perspective, further studies are needed to better define the pathogenesis of leptospirosis in cats and their epidemiological role as environmental sentinels or possible carriers of pathogenic Leptospira.

Leptospira borgpetersenii Leucine-Rich Repeat Proteins Provide Strong Protective Efficacy as Novel Leptospiral Vaccine Candidates

Leucine-rich repeat (LRR) proteins are advocated for being assessed in vaccine development. Leptospiral LRR proteins were identified recently in silico from the genome of Leptospira borgpetersenii serogroup Sejroe, the seroprevalence of leptospiral infections of cattle in Thailand. Two LRR recombinant proteins, rKU_Sej_LRR_2012M (2012) and rhKU_Sej_LRR_2271 (2271), containing predicted immunogenic epitopes, were investigated for their cross-protective efficacies in an acute leptospirosis model with heterologous Leptospira serovar Pomona, though, strains from serogroup Sejroe are host-adapted to bovine, leading to chronic disease. Since serovar Pomona is frequently reported as seropositive in cattle, buffaloes, pigs, and dogs in Thailand and causes acute and severe leptospirosis in cattle by incidental infection, the serogroup Sejroe LRR proteins were evaluated for their cross-protective immunity. The protective efficacies were 37.5%, 50.0%, and 75.0% based on the survival rate for the control, 2012, and 2271 groups, respectively. Sera from 2012-immunized hamsters showed weak bactericidal action compared to sera from 2271-immunized hamsters (p < 0.05). Therefore, bacterial tissue clearances, inflammatory responses, and humoral and cell-mediated immune (HMI and CMI) responses were evaluated only in 2271-immunized hamsters challenged with virulent L. interrogans serovar Pomona. The 2271 protein induced prompt humoral immune responses (p < 0.05) and leptospiral tissue clearance, reducing tissue inflammation in immunized hamsters. In addition, protein 2271 and its immunogenic peptides stimulated splenocyte lymphoproliferation and stimulated both HMI and CMI responses by activating Th1 and Th2 cytokine gene expression in vaccinated hamsters. Our data suggest that the immunogenic potential renders rhKU_Sej_LRR_2271 protein a promising candidate for the development of a novel cross-protective vaccine against animal leptospirosis.

Outcome of Acquired Fanconi Syndrome Associated with Ingestion of Jerky Treats in 30 Dogs

Acquired canine proximal renal tubulopathy (Fanconi syndrome) related to excessive ingestion of jerky treats has been recognized since 2007. This study aimed to improve knowledge about the syndrome’s characteristics, especially long-term outcome. By reaching out to veterinarians and dog owners, dogs suspected of jerky induced Fanconi syndrome were identified. The dog’s medical records were reviewed, and owners interviewed. Data was analyzed using linear mixed models (p < 0.05 was considered statistically significant) and descriptive statistics are reported. Thirty dogs, median body weight 6.8 (range 1.2−59) kg and age 6.5 (0.5−14) years, were enrolled as suspected cases based on history of jerkey ingestion and confirmed normoglycemic/hypoglycemic glycosuria. Clinical signs included polydipsia (23/30), polyuria (21/30), lethargy (19/30), weight loss (15/30), hyporexia (11/30), vomiting (7/30), diarrhea (7/30) and no clinical signs (2/30). Para-clinical findings included azotemia (6/28), hypophosphatemia (9/25), metabolic acidosis (3/8), hypokalemia (6/20), proteinuria (13/26), aminoaciduria (4/4), hematuria (22/29) and ketonuria (7/27). Clinical signs resolved in 22/28 within 11 (0.3−52) weeks and glycosuria resolved in 28/30 within 6.5 (1−31) weeks. There were no associations between serum creatinine and urea and the amount/duration of jerky ingestion. Serum symmetric dimethylarginine concentrations were only available for a few dogs, therefore no conclusion was achieved on a possible association with duration of jerky ingestion. Apart from a larger percentage of dogs achieving complete recovery, the current findings are in agreement with previous reports.

Potential Drivers for the Re-Emergence of Canine Leptospirosis in the United States and Canada

Canine leptospirosis is an important zoonotic disease in many countries. This review examines potential drivers for increased diagnoses of canine leptospirosis in the United States and Canada, using the epidemiologic triad of agent-environment-host as a template. Leptospira spp. are classified into more than 250 serovars, but in many laboratories only 6 are routinely tested for in serologic agglutination tests of canine sera. Leptospiral infections in dogs may potentially go undetected with unemployed or currently employed diagnostic methods. Disease transmission from infected reservoir hosts usually occurs via urine-contaminated environmental sources such as water. Direct contact between infected and susceptible individuals, environmental factors such as climate changes in temperature and/or rainfall, and increasing number and urbanization of reservoir hosts may greatly increase dog exposure risks. A dog's lifestyle may influence exposure risk to leptospirosis, but vaccination based on proper identification of circulating serogroups dramatically reduces post-exposure infections. Regrettably, resistance to vaccination by veterinarians and dog owners leaves a large number of dogs at risk for this zoonotic disease.

Clinical characteristics and prognosis of patient with leptospirosis: A multicenter retrospective analysis in south of China

Purpose

Leptospirosis is a zoonotic disease caused by pathogenic spirochetes of the genus Leptospira. However, there is currently no consensual definition or diagnostic criteria for severe and different forms of leptospirosis. Therefore, more insight on clinical manifestations, risk factors, and outcomes of leptospirosis is warranted. The identification of leptospirosis with distinct clinical manifestations and prognosis in our population.

Methods

Multiple correspondence analysis and hierarchical classification on principal components were presented to identify different clinical types of leptospirosis. The outcomes were clinical phenotypes, laboratory and imaging findings, and prognosis.

Results

The 95 enrolled patients had median values of 54.0 years (39.0-65.0) for age, 9.0 (7.0-14.0) for total hospital stay lengths, of whom 86.3% was male and 40.0% was transferred to ICU. Three clinical types were distinguished: mild leptospirosis (n=43, 45.3%) with less organ dysfunction and shorter hospital stays; respiratory leptospirosis (n=28, 29.5%) with hemoptysis, and respiratory and circulatory failure; and hepato-renal leptospirosis (n=24, 25.3%) with worst liver and kidney dysfunction. Total hospital mortality was 15.8% and was associated with dyspnea and high levels of neutrophil counts.

Conclusions

The identification of leptospirosis with distinct clinical manifestations and prognosis in our population may assist clinicians to distinguish leptospirosis-like disease. Moreover, dyspnea and neutrophil count were found to be independent risk factors for severe leptospirosis progression.

Health Screening of American Beavers (Castor canadensis) in Utah, USA

American beavers (Castor canadensis), trapped between 2017 and 2020 for the purpose of translocation, underwent hematologic, serologic, and fecal examinations. Eight of 73 beavers were seropositive for Leptospira spp. and 1/49 seropositive for Toxoplasma gondii. Two of 40 beavers tested positive for Giardia spp., and 22/44 beavers had strongyle-type ova in the feces; one was positive for coccidia. Hematologic variables were largely within published reference ranges for captive beavers. Within the specific ecosystems sampled, the disease prevalence in beavers appeared low; however, prophylactic deworming is recommended prior to translocation. Further, appropriate personal protective equipment should be used when handling beavers, to prevent zoonotic infection with Giardia spp.

Treatment of Bovine Leptospirosis with Enrofloxacin HCl 2H2O (Enro-C): A Clinical Trial

Pharmacokinetics/pharmacodynamics ratios of enrofloxacin HCl-2H2O (enro-C) in cows to treat bovine leptospirosis prompted this clinical trial in the highlands (HL) and the tropics (TL) in Mexico. In the HL, 111 Holstein-Friesian cows were included and 38 F1 Zebu–Holstein/Friesians in the TL. Affected cows were randomly divided into two treatment groups, both in the HL and TL. PCR and MAT tests were performed before and after treatment. Treatments in both groups were administered for 5 d with either IM injections of enro-C or streptomycin/penicillin-G. Reproductive performance data were gathered for 90 d. The cows treated with enro-C became PCR negative: 87.5% and 78.94% on day 5, 92.85% and 94.73% on day 28 (in the HL and TL, respectively). For streptomycin/penicillin-G, the same values were 65.45% and 70.90% on day 5, and 73.68% twice on day 28 in the HL and TL, respectively. In both groups and geographical settings, the MAT titers dropped on day 28 but remained above reference values usually considered negative. The gestation rates were: 86.53% and 79.06% and 88.88% and 87.5% for the HL and TL, either with enro-C or streptomycin/penicillin-G, respectively. This is the first report of successful treatment with a fluoroquinolone derivative in treating bovine leptospirosis with a high bacteriological cure rate.

Emerging canine leptospirosis in Sydney and the role of population demographics

An outbreak of canine leptospirosis commenced in Sydney, Australia in 2017. The aim of this retrospective study was to determine if clusters of leptospirosis occurred during this outbreak, and if these were associated with host factors, to assist investigation of the drivers of emerging leptospirosis at this location. Within the City of Sydney local government area, 13 cases were reported during the outbreak. Administrative data on the canine population were collected and mapped. Clusters of leptospirosis cases were detected using a retrospective space-time analysis and a discrete Poisson probability statistical model. Sydney dog population registration [55.6%, 95% confidence interval (CI) 51.8-58.1%] was lower than the Australian national average (80%). The distribution of dog types, based on the United Kennel Club standards, was significantly (p < .0001) different to that of the national profile: there was a distinct preference in Sydney for companion dogs. The age distribution of dogs in Sydney did not reflect a typical right-skewed curve; instead, a relatively uniform distribution was observed between the age group of 1 to 8 years. A primary disease cluster (radius 1.1 km) in the eastern area of the Sydney City Council was identified (4 cases observed between 24 May and 9 August 2019 vs. 0.10 cases expected), p = .0450. When adjusted for the age, breed type and sex distribution of the population, similar clusters were identified; in the case of age-adjustment, the spatiotemporal cluster identified was larger and of longer duration (seven cases observed between 28 June and 11 November 2019 versus 0.34 cases expected), p = .0025. The presence of clusters of canine leptospirosis in the City of Sydney during this outbreak, which persisted after adjustment for demographics (age, sex, breed type), suggest that environmental factors - rather than host or pathogen factors - might be responsible for the emergence of leptospirosis. Environmental factors that potentially might be linked to this outbreak of canine leptospirosis and the clusters observed require investigation.

Leptospirosis with multiple organ dysfunction in a mongoose-scat-detection dog infected with Leptospira interrogans serogroup Hebdomadis, Okinawa, Japan

A 2-year-old male mongoose-scat-detection dog was diagnosed with leptospirosis by urine PCR. The patient developed acute renal failure, hepatic dysfunction, and disseminated intravascular coagulation. Treatment with antibiotics was administered, including ampicillin and doxycycline, and supportive care management was provided. Seroconversion against serogroup Hebdomadis was observed on day 8. The leptospiral gene flaB was detected only in urine collected on day 1, from which Leptospira interrogans ST329 was identified by multilocus sequence typing using seven housekeeping genes. L. interrogans serogroup Hebdomadis ST329 has been isolated from mongooses and humans in Okinawa, Japan. This patient received early treatment with antibiotics, which may have contributed to the early recovery of renal function and removal of L. interrogans from kidney tissue.

A global one health perspective on leptospirosis in humans and animals

Leptospirosis is a quintessential one health disease of humans and animals caused by pathogenic spirochetes of the genus Leptospira. Intra- and interspecies transmission is dependent on 1) reservoir host animals in which organisms replicate and are shed in urine over long periods of time, 2) the persistence of spirochetes in the environment, and 3) subsequent human-animal-environmental interactions. The combination of increased flooding events due to climate change, changes in human-animal-environmental interactions as a result of the pandemic that favor a rise in the incidence of leptospirosis, and under-recognition of leptospirosis because of nonspecific clinical signs and severe signs that resemble COVID-19 represents a "perfect storm" for resurgence of leptospirosis in people and domestic animals. Although often considered a disease that occurs in warm, humid climates with high annual rainfall, pathogenic Leptospira spp have recently been associated with disease in animals and humans that reside in semiarid regions like the southwestern US and have impacted humans that have a wide spectrum of socioeconomic backgrounds. Therefore, it is critical that physicians, veterinarians, and public health experts maintain a high index of suspicion for the disease regardless of geographic and socioeconomic circumstances and work together to understand outbreaks and implement appropriate control measures. Over the last decade, major strides have been made in our understanding of the disease because of improvements in diagnostic tests, molecular epidemiologic tools, educational efforts on preventive measures, and vaccines. These novel approaches are highlighted in the companion Currents in One Health by Sykes et al, AJVR, September 2022.

Canine leptospirosis in Canada, test-positive proportion and risk factors (2009 to 2018): A cross-sectional study

Over the past decade, there has been an apparent increased frequency and widened distribution of canine leptospirosis in Canada, however, this has been minimally investigated. Availability and clinical uptake of Leptospira polymerase chain reaction (PCR)-based testing of dogs in Canada may provide important insight into the epidemiology of this canine and zoonotic infectious disease. Study objectives were to evaluate clinical canine Leptospira PCR test results from a large commercial laboratory to determine temporal and spatial distribution in Canada and identify dog, geographic and temporal risk factors for test-positive dogs. This cross-sectional study analyzed data obtained from IDEXX Laboratories, Inc. on 10,437 canine Leptospira PCR tests (blood and/or urine) submitted by Canada-based veterinarians (July 2009 to May 2018). Multivariable logistic regression was used to identify risk factors for test-positive dogs. Test-positive proportion varied widely annually (4.8–14.0%) and by location. Provinces with the highest test-positive proportion over the study period were Nova Scotia (18.5%) and Ontario (9.6%), with the prairie provinces (Manitoba and Alberta combined) having the lowest proportion (1.0%); the northern territories could not be evaluated due to limited testing. In the final model, dog age, sex, breed, month, and year test performed, and location (urban/rural, province) of the practice submitting the sample were significant predictors of a positive Leptospira PCR test. Dogs less than one year of age (OR = 2.1; 95% CI: 1.6–2.9), male sex (OR = 1.3; 1.1–1.5), toy breed (OR = 3.3; 2.5–4.4), and samples submitted from an urban practice (OR = 1.3; 1.0–1.8) had the greatest odds of a positive Leptospira PCR test as compared to referent groups. Significant two-way interactions between province-month and year-month highlight the complex spatial and temporal influences on leptospirosis occurrence in this region. Our work suggests a high incidence of canine leptospirosis regionally within Canada. Identifiable dog and location factors may assist in future targeted prevention efforts.

The efficacy and tolerability of antibiotics in scrub typhus: An updated network meta-analysis of randomized controlled trials

INTRODUCTION

Inadequate treatment of scrub typhus results in severe complications such as septic shock and is also associated with a high median mortality rate of 6%. However, there has been no conclusive evidence about the superiority of different antibiotics in managing scrub typhus in terms of efficacy and tolerability.

METHODS

The current network meta-analysis (NMA) was conducted using the frequentist method. The included participants were pediatric and adult patients infected with scrub typhus. The primary outcome was the cure rate in the patients included. The subgroup analysis was done according to pediatric or adult patients.

RESULTS

Overall, 14 randomized controlled trials (RCTs) with 1264 participants were included in this study. The NMA revealed that all the investigated antibiotics were associated with cure rates similar to those of doxycycline. The chloramphenicol and minocycline were ranked to be associated with the highest cure rate in the pediatric subgroup and adult subgroup, respectively. Second-generation quinolones, including ofloxacin and ciprofloxacin and chloramphenicol were associated with significantly lower adverse event rates than doxycycline.

CONCLUSION

The current update NMA provides evidence for the efficacy of chloramphenicol and minocycline in scrub typhus management. However, future large-scale RCTs with longer follow-up times are warranted.

TRIAL REGISTRATION

PROSPERO CRD42020222410. The current study was approved by the Institutional Review Board of the Tri-Service General Hospital, National Defense Medical Center (TSGHIRB No. B-109-29).

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

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

Long-term outcome of dogs recovering from acute kidney injury: 132 cases

Background

Information regarding long‐term outcome of dogs recovering from acute kidney injury (AKI) is limited.

Objectives

Determine the long‐term outcome of dogs recovering from AKI and identify predictors for serum creatinine concentration (sCr) normalization and long‐term outcome.

Animals

One hundred thirty‐two dogs with AKI that survived ≥30 days postdischarge.

Methods

Retrospective study. Search of medical records of dogs diagnosed with AKI that survived to discharge. Follow‐up data were retrieved from medical records and by telephone interviews with the owners or primary care veterinarians or both.

Results

Estimated median survival time (MST) was 1322 days (95% confidence interval [CI], 1147‐1626), and 76% of the dogs were alive at last contact. Normalization of sCr was documented in 55% of the dogs at discharge and in additional 20% during the follow‐up period. The proportion of dogs with sCr normalization decreased with increase in AKI grade (P = .02). Long‐term survival was not associated with sCr normalization (P = .63). Etiology was associated with the long‐term outcome (P = .004).

Conclusion and Clinical Importance

Long‐term survival of dogs with AKI is longer than previously described. Normalization of sCr in 99 dogs (75%) occurred, either at discharge or within the follow‐up period. Normalization of sCr was not associated with long‐term survival. Estimated MST of dogs with sCr normalization was not different compared with dogs that developed azotemic chronic kidney disease (CKD), presumably because of slow CKD progression rate. Etiology is an important factor determining sCr normalization and long‐term survival, emphasizing the importance of the reversibility of renal injury rather than its severity.

The Evaluation of the Diagnostic Value of a PCR Assay When Compared to a Serologic Micro-Agglutination Test for Canine Leptospirosis

Objective

To evaluate PCR assay sensitivity and specificity compared to that of microscopic agglutination test (MAT) for diagnosis of canine leptospirosis. Electronic records search was performed to identify dogs with results for both PCR and MAT testing for leptospirosis.

Methods

All dogs were clinically ill. Diagnosis of leptospirosis was defined as an unvaccinated dog with a positive MAT titer of ≥1:800 or a vaccinated dog or dog with an unknown vaccination status with a positive MAT titer of ≥1:1,600. Diagnosis of leptospirosis was excluded based on MAT titer <1:800 on both the initial and convalescent samples or an initial MAT titer <1:800 and an alternative definitive diagnosis.

Results

Forty-nine samples (urine, n = 39; blood, n = 10) were evaluated. Leptospirosis was diagnosed in 17 dogs and excluded in 26 dogs. Urine PCR assay demonstrated sensitivity of 69.2%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 86.6%. Blood PCR assay demonstrated sensitivity of 25%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 25%. Overall PCR sensitivity was 52.4%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 73.7%.

Conclusions

PCR assay performed on urine or blood has high specificity and positive predictive value when compared to MAT for diagnosis of clinical canine leptospirosis. Sensitivity and negative predictive value are moderate to low, so PCR testing should be performed in conjunction with paired MAT testing for canine leptospirosis. Prior antibiotic therapy does not preclude the use of the PCR test.

Compatibility Between A Rabies Vaccine and Two Canine Combined Vaccines Against Canine Distemper, Adenovirosis, Parvovirosis, Parainfluenza Virus Disease and Leptospirosis, With or without Canine Coronavirus

In many countries, vaccination programs still require dogs to be vaccinated against rabies in addition to Canine distemper virus (CDV), adenovirus (CAV), parvovirus (CPV), parainfluenza virus (CPiV), Leptospira (L) or Canine coronavirus (CCV= Cv). Few vaccines containing all these antigens are commercially available and, unless compatibility between the vaccines was demonstrated, concurrent administration of a DAPPi-L(Cv) vaccine and a vaccine against rabies should not be recommended. This may be of concern for practitioners who wish to vaccinate dogs with all components on the same day. This study aimed at evaluating immunological compatibility between a monovalent rabies vaccine (Rabisin™) and two large combination vaccines against CDV, CAV, CPV, CPiV with 2 leptospira components +Cv (Recombitek® C6/Cv) or with 4 Leptospira components (Recombitek® C8), when injected concomitantly at two separate injection sites.

Fourteen days after administration of the rabies vaccine, with or without concomitant administration of combo vaccines, all dogs had seroconverted against rabies and maintained protective titers over the duration of the study. In addition, 100% of the puppies vaccinated with one or the other combo vaccines seroconverted against CDV, CAV, CPV, CPiV (CCV) and Leptospira, whatever the vaccination group. Lack of immunological interference between Rabisin™ and all components of the Recombitek® C6/Cv or Recombitek® C8 Combo vaccines was demonstrated by non-inferiority analysis, except for CDV in the Recombitek®C8+ Rabisin™ group. Based on these results, a concomitant administration of Rabisin™ with Recombitek® C6/Cv or Recombitek® C8 can be recommended in daily practice, which can be essential for facilitating vaccination compliance.

Isolation of Leptospira interrogans Serovar Canicola in a Vaccinated Dog without Clinical Symptoms

More than one million cases of leptospirosis occur across the globe annually, resulting in about 59,000 deaths. Dogs are one of the most important reservoirs of Leptospira species and play an important role in transmitting the pathogen to humans. Many of these infections are controlled by routine vaccination that has reduced the possible reintroduction of leptospiral serovars into the human population. However, it is still not clear how a vaccinated dog can become infected with one or more Leptospira serovars contained in the vaccine formulation and thus against which it should be immunized. Here, we present the case of an asymptomatic dog who developed leptospiral infection despite being vaccinated. This unusual case emphasizes the substantial impact of immunization on mitigating the acute signs of the disease, even while providing limited protection against infection. Further studies will be required to better understand the role of dogs in the environmental circulation of leptospiral serovars in Sardinia. Asymptomatic leptospiral infection in vaccinated dogs should be considered to allow for better diagnosis and management of the infection. This will be essential for preventing Leptospira outbreaks in the future.

Outbreak of Leptospira borgpetersenii Serogroup Sejroe Infection in Kennel: The Role of Dogs as Sentinel in Specific Environments

Kennels may represent high-risk environments for the diffusion of Leptospira infection in dogs and consequently a threat to public health. This study describes an outbreak of Leptospira infection in a kennel in Italy in 2020, both with clinically ill and asymptomatic dogs. Fifty-nine dogs, including three ill dogs, were tested for Leptospira spp. infection by the microscopic agglutination test (MAT) and real-time qPCR. Multi-locus sequence typing (MLST) analysis was used to genotype the identified leptospires. Thirty of the fifty-nine (50.9%) dogs had MAT titer and/or molecular positivity indicative of Leptospira infection. Twenty-two of the fifty-nine (37.3%) dogs exhibited seropositivity against at least one serovar belonging to the Sejroe serogroup, and MLST analysis identified L. borgpetersenii serogroup Sejroe (Leptospira ST155) as responsible for the outbreak. Up to now, Sejroe serogroup infection was sporadically reported in dogs. The extension of the MAT antigen panel to several serovars belonging to the serogroup Sejroe could be useful in the diagnosis of canine leptospirosis. Dogs may serve as sentinel of leptospires in specific environments, and surveillance of Leptospira infection in kennels is strongly recommended even when the correct vaccine prophylaxis is administered, because the vaccines currently available are not able to protect from all of the serogroups.

Role of Diagnostics in Epidemiology, Management, Surveillance, and Control of Leptospirosis

A One Health approach to the epidemiology, management, surveillance, and control of leptospirosis relies on accessible and accurate diagnostics that can be applied to humans and companion animals and livestock. Diagnosis should be multifaceted and take into account exposure risk, clinical presentation, and multiple direct and/or indirect diagnostic approaches. Methods of direct detection of Leptospira spp. include culture, histopathology and immunostaining of tissues or clinical specimens, and nucleic acid amplification tests (NAATs). Indirect serologic methods to detect leptospiral antibodies include the microscopic agglutination test (MAT), the enzyme-linked immunosorbent assay (ELISA), and lateral flow methods. Rapid diagnostics that can be applied at the point-of-care; NAAT and lateral flow serologic tests are essential for management of acute infection and control of outbreaks. Culture is essential to an understanding of regional knowledge of circulating strains, and we discuss recent improvements in methods for cultivation, genomic sequencing, and serotyping. We review the limitations of NAATs, MAT, and other diagnostic approaches in the context of our expanding understanding of the diversity of pathogenic Leptospira spp. Novel approaches are needed, such as loop mediated isothermal amplification (LAMP) and clustered regularly interspaced short palindromic repeats (CRISPR)-based approaches to leptospiral nucleic acid detection.

Clinical disease and treatment of Leptospira kirschneri sv Grippotyphosa in a Sumatran tiger (Panthera tigris sumatrae)

CASE DESCRIPTION

A 12-year-old sexually intact male zoo-managed Sumatran tiger (Panthera tigris sumatrae) was evaluated for a 3-day history of vomiting, hyporexia, and lethargy. Radiographs were supportive of gastrointestinal obstruction, and an exploratory laparotomy was performed.

CLINICAL FINDINGS

Diffuse tan foci were present on the liver parenchyma, and the tiger became icteric throughout the procedure. Hepatic histopathology and immunohistochemistry resulted in a diagnosis of leptospirosis. Serum microagglutination testing for Leptospira spp antibody titers were positive for L kirschneri serovar Grippotyphosa, rising from 1:400 to 1:3,200 in 2 days.

TREATMENT AND OUTCOME

The tiger was treated with antimicrobials, ursodiol, and mirtazapine, and increased biosecurity measures were instituted. Free-ranging wildlife on grounds were trapped, euthanized, and submitted for necropsy to screen for disease vectors. The tiger's urine was intermittently opportunistically collected from the enclosure and remained PCR assay negative for Leptospira spp until being positive once again on day 595. Although the tiger was without clinical signs at that time, antimicrobial therapy and increased biosecurity protocols were instituted a second time until urinary Leptospira shedding was confirmed to have stopped. By 1,071 days after initial presentation, the tiger remained nonclinical, with no additional urinary shedding episodes.

CLINICAL RELEVANCE

While domestic and nondomestic free-ranging felids have been reported as subclinical Leptospira spp carriers, this report indicates the clinical importance of leptospirosis when a tiger presents with generalized gastrointestinal signs and icterus. Due to the zoonotic potential, biosecurity measures are necessary. This patient had a clinically successful outcome with antimicrobial therapy and supportive care.

Integrated Lateral Flow Electrochemical Strip for Leptospirosis Diagnosis

LipL32 is an outer membrane protein present only on pathogenic Leptospira species, which is the causative agent of leptospirosis. Leptospirosis symptoms are often misdiagnosed with other febrile illnesses as the clinical manifestations are non-specific. Therefore, an accurate diagnostic tool for leptospirosis is indeed critical for proper and prompt treatment. Typical diagnosis via serological assays is generally performed to assess the antibodies produced against Leptospira. However, their delayed antibody response and complicated procedure undoubtedly limit the practical utilization especially in a primary care setting. Here, we demonstrate for the first time an early-stage detection of LipL32 by an integrated lateral-flow immunoassay with an electrochemical readout (eLFIA). A ferrocene trace tag was monitored via differential pulse voltammetry operated on a smartphone-based device, thus allowing for on-field testing. A superior performance in terms of the lowest detectable limit of detection of 8.53 pg/mL and broad linear dynamic range (5 orders of magnitude) among other sensors available thus far was established. Additionally, the developed test strip provided a straightforward yet sensitive approach for diagnosis of leptospirosis using the collected human sera from patients, in which the results were comparable to the real-time polymerase chain reaction technique.

Emerging leptospirosis in urban Sydney dogs: a case series (2017-2020)

Canine leptospirosis has not been reported in the Sydney dog population since 1976. However, between 2017 and 2020, leptospirosis was confirmed in 17 dogs, five of which were known to hunt rodents. Dogs infected between 2017 and 2019 lived within a 3 km radius in the Inner City of Sydney (n = 11). In 2020, cases emerged across a broader area of Sydney; Inner City (n = 1), Inner West (n = 3), Lower North Shore (n = 1) and Upper North Shore (n = 1). The disease was characterised by severe hepatorenal involvement resulting in an unusually high case fatality rate (88%). In conjunction with supportive clinical signs, diagnosis was confirmed by real‐time PCR on whole blood (n = 1), kidney (n = 1), urine (n = 4), whole blood and urine (n = 9) or by seroconversion (n = 3). Antibody titres determined by Microscopic Agglutination Test (MAT) to Leptospira serovars were measured in 12 dogs: seven were positive for serovar Copenhageni, one was positive for serovar Hardjo, three were negative for all serovars, likely due to insufficient time for seroconversion before death and one had a low positive titre (1/50) for serovars Australis and Robinsoni. This sudden emergence of a highly fatal disease in pet dogs in Sydney has led to the introduction of Leptospira vaccination protocols for dogs living in inner Sydney using a monovalent vaccine containing serovar Copenhageni. The success of this vaccination program will require ongoing research to understand the emergence of leptospirosis in this region and the serovars involved.

Next Generation Sequencing for Diagnosis of Leptospirosis Combined With Multiple Organ Failure: A Case Report and Literature Review

Introduction

Leptospirosis poses a major threat to human life. The disease spectrum ranges from a nearly undetectable presentation to severe multi-organ dysfunction and death. Leptospirosis is difficult to diagnose by traditional antibody and culture tests. We here present a case of multiple organ failure associated with leptospirosis.

Material and Methods

A 64-year-old woman presented with fatigue and arthralgia, which developed rapidly into multiple organ injuries, and she eventually died of cerebral hemorrhage. Serum antibody test and cultures of blood, sputum, urine, and feces samples were all negative. The patient was diagnosed with leptospirosis by the next-generation sequencing (NGS).

Conclusion

We conclude that leptospirosis is a neglected zoonosis caused by pathogenic Leptospira species. New techniques such as NGS are highlighted for early diagnosis. Surveillance for pathogens during diagnosis can provide guidance for clinical treatment and improves prognosis.

Variability in non-core vaccination rates of dogs and cats in veterinary clinics across the United States

Vaccination guidelines for dogs and cats indicate that core vaccines (for dogs, rabies, distemper, adenovirus, parvovirus; for cats, feline parvovirus, herpes virus-1, calicivirus) are essential to maintain health, and that non-core vaccines be administered according to a clinician's assessment of a pet's risk of exposure and susceptibility to infection. A reliance on individual risk assessment introduces the potential for between-practice inconsistencies in non-core vaccine recommendations. A study was initiated to determine non-core vaccination rates of dogs (Leptospira, Borrelia burgdorferi, Bordetella bronchiseptica, canine influenza virus) and cats (feline leukemia virus) in patients current for core vaccines in veterinary practices across the United States. Transactional data for 5,531,866 dogs (1,670 practices) and 1,914,373 cats (1,661 practices) were retrieved from practice management systems for the period November 1, 2016 through January 1, 2020, deidentified and normalized. Non-core vaccination status was evaluated in 2,798,875 dogs and 788,772 cats that were core-vaccine current. Nationally, median clinic vaccination rates for dogs were highest for leptospirosis (70.5%) and B. bronchiseptica (68.7%), and much lower for canine influenza (4.8%). In Lyme-endemic states, the median clinic borreliosis vaccination rate was 51.8%. Feline leukemia median clinic vaccination rates were low for adult cats (34.6%) and for kittens and 1-year old cats (36.8%). Individual clinic vaccination rates ranged from 0 to 100% for leptospirosis, B. bronchiseptica and feline leukemia, 0-96% for canine influenza, and 0-94% for borreliosis. Wide variation in non-core vaccination rates between clinics in similar geographies indicates that factors other than disease risk are driving the use of non-core vaccines in pet dogs and cats, highlighting a need for veterinary practices to address gaps in patient protection. Failure to implement effective non-core vaccination strategies leaves susceptible dogs and cats unprotected against vaccine-preventable diseases.

Canine Leptospirosis Outbreak in Japan

Canine leptospirosis was suspected in 11 dogs in Osaka Prefecture, Japan and 9 dogs died within a month, from October 12 to November 10, 2017. Eight of the dogs had been taken on walks along the same riverbed and 4 dogs lived in the same town. Logistic regression analysis between a comparative group and the incident cases group showed that the odds of leptospirosis infection was 13.3 times higher (p = 0.044) in the dogs taken on walks along the riverbed than in the dogs not being walked along the riverbed. It is suggesting that these walks had been a risk factor. Microscopic agglutination tests showed that antibody titers against Leptospira interrogans serovar Australis were 1:2,560 and 1:10,240 in 2 dogs. Therefore, L. interrogans serovar Australis was suspected to be the causative agent, for which no canine vaccine is available in Japan. These results suggested that L. interrogans serovar Australis can cause local outbreaks. The development of a canine vaccine against various serotypes might help reduce local infections. Leptospirosis is an important infectious disease of dogs and it is also a zoonotic disease.

First Isolation and Molecular Typing of Pathogenic and Intermediate Leptospira Species from Urine of Symptomatic Dogs

Aim of this study was to evaluate, the presence and diversity of Leptospira spp. in blood and urine samples collected from 175 owned-dogs from Sardinia, Italy. After determination of leptospiral infection by microscopic agglutination test (MAT), urine from MAT-positive dogs were examined by real-time polymerase chain reaction (lipL32 rt-PCR) and then isolated by culture. In order to characterize obtained serovars, positive cultures were then subjected to 16S rRNA and secY sequencing, phylogenetic analysis and Multilocus Sequence Typing (MLST). Results showed that seven dogs (4%; 95% CI: 0-55) had Leptospira DNAs in their urine and five strains were isolated from urine cultures. The three different sequence types (ST17, ST198 and ST24) belonging to Leptospira interrogans genomospecies identified by MLST analyses in this study, confirmed that the leptospiral infection was widespread in Sardinian dogs. We also reported the first characterization of a new Leptospira spp. isolated from urine of one dog living in the study area. Whole genome sequencing and phylogenetic analysis, confirmed that this genospecies was closely related to Leptospira hovindhougenii, an intermediate Leptospira spp. with unknown pathogenicity previously isolated from a rat in Denmark. Further studies are required to clarify whether healthy dogs that shed leptospires in their urine could represent a zoonotic risk for humans in this region.

Risk and Predictive Factors of Leptospirosis in Dogs Diagnosed with Kidney and/or Liver Disease in Selangor, Malaysia

Simple Summary

Canine leptospirosis is commonly associated with kidney and/or liver disease. The current study identified the potential risk and predictive factors of dogs diagnosed with kidney and/or liver disease due to leptospirosis. A total of 124 client-owned dogs were recruited and the samples collected were directly tested using polymerase chain reaction (PCR) and subsequently inoculated for bacterial isolation. Statistical analyses were descriptively analyzed, and risk analyses were performed using Pearson chi-square tests and logistic regression. The different breeds of dog with history of exposure to rats and those managed outdoors had a greater risk of leptospirosis (p < 0.05). The significant predictors for the dogs’ positivity were presence of rats and acute clinical illness (p < 0.05). Administration of antibiotics and detection of clinical illness at an early stage of the disease improved the survivability of the dogs (p < 0.05).

Abstract

Canine leptospirosis is commonly associated with kidney and/or liver disease. It has been widely reported and causes public health concerns due to its zoonotic potential and its re-emergence, resulting from close contact between humans and dogs. The current study identified potential risk and predictive factors for dogs diagnosed with kidney and/or liver disease due to leptospirosis. A total of 124 client-owned dogs were recruited, and information such as signalment, medical history, management, and clinical findings were documented. Samples collected from the recruited dogs were directly tested using polymerase chain reaction (PCR) and subsequently inoculated for bacterial isolation. Statistical analyses were descriptively analyzed, and risk analyses were performed using Pearson chi-square tests and logistic regression. A total of 53 dogs (42.7%) were positive for leptospiral infection based on PCR, and 10 leptospiral isolates were successfully recovered from eight dogs. The mortality rate of infected dogs was 34.0% (18/53). Medium and large dog breeds, with a history of exposure to rats, and managed outdoors had a greater risk for leptospirosis (p < 0.05). The significant predictors for the dogs’ positivity were the presence of rats and acute clinical illness (p < 0.05). Administration of antibiotics and the detection of clinical illness at an early stage of the disease improved the survivability of the dogs (p < 0.05). Identifying the profile of dogs that are at risk to leptospirosis could be useful in the design of diagnostic and treatment strategies, as well as to increase awareness for prevention of the disease.

Evaluation by polymerase chain reaction assay of persistent shedding of pathogenic leptospires in the urine of dogs with leptospirosis

BACKGROUND

Persistent leptospiruria in naturally infected dogs occurs despite appropriate antibiotic treatment.

HYPOTHESIS/OBJECTIVES

To determine the frequency of persistent leptospiruria in naturally infected dogs and the association of persistent leptospiruria with different antibiotic treatments.

ANIMALS

Thirty-two dogs of varying age and breed diagnosed with leptospirosis via urine polymerase chain reaction assay (PCR).

METHODS

A prospective observational study of dogs diagnosed with leptospirosis was undertaken to determine the frequency of persistent leptospiruria as determined by PCR. Clinical presentation of leptospirosis, antibiotic treatment, serum creatinine concentration, and outcome were recorded.

RESULTS

Fifteen of 32 dogs had a negative urine PCR on the first submission in the study, 5 of 15 received only an aminopenicillin. The remaining 17 dogs had a negative urine PCR on the second (n = 6 dogs), third (n = 5), fourth (n = 5), and eighth (n = 1) submissions. Acute kidney injury was reported in 32/32 dogs. Two of 32 dogs developed chronic kidney disease.

CONCLUSIONS AND CLINICAL IMPORTANCE

Persistent leptospiruria is common despite treatment with antibiotics frequently recommended for treatment. Follow-up urine PCR to confirm clearance of the organism is recommended in all dogs. In dogs with persistent leptospiruria, chronic kidney disease can develop after acute kidney injury.

Emergency vaccine immunization protects hamsters against acute leptospirosis

Leptospirosis, caused by pathogenic Leptospira, is a global critical zoonotic disease in terms of mortality and morbidity. Vaccines are often used to prevent leptospirosis. However, few studies have reported the therapeutic effect of a vaccine against Leptospira infection. This study demonstrates the efficacy of the emergency vaccine immunization against acute leptospirosis in hamsters. Treatment with a whole-cell vaccine (Leptospira interrogans serovar Lai) at 24 h post-infection improved the survival rate of hamsters with lower leptospiral burden and minor pathological damage to organs. The vaccine also protected against multiple Leptospira serotypes acute infection. However, the protective effect of the vaccines was lost when beginning treatment at 36 h or 48 h post-infection. These results indicated that vaccines could treat acute leptospirosis in hamsters, but only if immunization is within 24 h after infection.

Successful management of suspected acorn (Quercus petraea) toxicity in a dog

A 7-year-old neutered male Labrador retriever dog was referred to a tertiary care veterinary hospital because of gastrointestinal signs and icterus. The dog developed a hepatopathy and acute kidney injury after ingesting acorns (Quercus petraea) 4 days prior to referral. The dog required hospitalization in an intensive care unit but made a full clinical recovery and was discharged after 6 days. This report documents that dogs can be affected by this toxicity and highlights the need for veterinarians to consider acorns as a potential cause of acute hepatotoxicity and renal injury. To the authors' knowledge, this is the first reported case of acorn toxicity in a dog.

Incidence and demographic risk factors for leptospirosis in dogs in the UK

OBJECTIVES

To estimate the annual incidence risk of leptospirosis diagnosis in practice-attending dogs in the UK during 2016 and identify risk factors for diagnosis.

METHODS

Incidence of leptospirosis diagnosis in dogs during 2016 was estimated from dogs in primary-care practices from the VetCompass Programme (n = 905,543). A case-control study of laboratory cases (n = 362) versus VetCompass controls explored factors (age, sex, neutering, breed, Kennel Club group, urban-rural location, indices of deprivation) associated with leptospirosis diagnosis through multivariable logistic regression.

RESULTS

Annual incidence risk of leptospirosis in the VetCompass population was 0.8 cases per 100,000 dogs (0.0008%, 95% CI 9.1 × 10^-8 -5.2 × 10^-5 ). Adult dogs, especially 1- < 5 years olds (odds ratio [OR] = 0.38, 95% CI 0.27-0.54), and dogs attending urban clinics (OR = 0.26, 95% CI 0.19-0.35) had reduced odds of leptospirosis versus dogs < 1 year old and rural dogs, respectively. Dogs attending clinics in less deprived areas had increased odds of diagnosis (OR = 3.63, 95% CI 2.28-5.78) compared to crossbreds, Cocker Spaniels (OR = 4.25, 95% CI 2.65-6.84), Collies (OR = 3.53, 95% CI 2.22-5.62) and Lurchers (OR = 3.49, 95% CI 1.50-8.11) had increased odds of diagnosis.

DISCUSSION

Leptospirosis is rarely diagnosed in clinical practice, suggesting that many true cases may be missed. Demographic risk factors identified here may inform the index of suspicion and encourage increased use of confirmatory diagnostic testing.

Multidisciplinary approach in the diagnosis of acute leptospirosis in dogs naturally infected by Leptospira interrogans serogroup Icterohaemorrhagiae: A prospective study

Leptospirosis, a zoonotic disease with worldwide distribution, is caused by spirochetes of the genus Leptospira. In dogs, this disease is frequently misdiagnosed. Few studies have attempted to associate the detection of Leptospira spp. infection with clinicopathological and renal histopathological findings using a multidisciplinary approach. The present study isolated and characterized Leptospira spp. obtained from naturally infected dogs and described relevant clinical and histopathological findings. Blood and urine were collected from 57 dogs with clinical symptomatology suggestive of leptospirosis; 38 cases were confirmed by PCR in urine or by culture or microscopic agglutination testing (titers ≥800). A total of 12 strains of pathogenic Leptospira were isolated from the studied dogs (seven in blood, four in urine and one in both blood and urine samples). All isolates were characterized as Leptospira interrogans serogroup Icterohaemorrhagiae. Of the confirmed cases, almost one-third of the animals had been vaccinated. Our analysis of laboratory testing revealed that azotemia and proteinuria were statistically significant predictors of infection. The main histopathological findings seen in kidney tissues were necrosis, degeneration, tubular regeneration, mononuclear inflammatory infiltrate and congestion. A multidisciplinary approach involving clinicopathological and histopathological characterization of renal involvement can aid in the identification of acute leptospirosis infection.