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Magalhães TR, Lourenço AL, Corbee RJ, Queiroga FL. Clinical management of feline chronic kidney disease in Portugal: a questionnaire-based study. J Feline Med Surg 2023; 25:1098612X231206125. [PMID: 37987623 PMCID: PMC10811999 DOI: 10.1177/1098612x231206125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
OBJECTIVES The aim of the study was to characterise the clinical management of feline chronic kidney disease (CKD) by veterinary practitioners in Portugal. METHODS A questionnaire-based study was designed to be completed by all veterinarians who had diagnosed and treated at least one case of feline CKD in the previous year. RESULTS A total of 409 veterinary practitioners responded to the questionnaire, with approximately half of them diagnosing 2-5 cases of feline CKD per month (n = 219, 53.5%). Although a high proportion of these reported using the guidelines published by the International Renal Interest Society (n = 379, 92.7%), only 19.1% (n = 78) systematically performed systolic blood pressure (SBP) measurements in all of their patients. A renal diet was advised by almost all respondents (n = 406, 99.3%), but 36.9% (n = 150) of them considered that it represented less than 75% of the daily food intake for most of their patients. This dietary intervention was often prescribed regardless of stage (n = 298, 73.4%) and without a proper gradual diet transition. Appetite stimulants were frequently prescribed (n = 366, 89.5%), as well as a calcium channel blocker (n = 171, 41.8%) and an angiotensin-converting enzyme inhibitor (n = 245, 59.9%) to control systemic hypertension and proteinuria, respectively. Prescription of a phosphate binder was also common (n = 311, 76.0%). Regarding monitoring, 70.9% (n = 290) recommended that stable patients be reassessed every 2-3 months or more frequently, but only 35.7% (n = 146) were able to comply with this periodicity due to owners' constraints. CONCLUSIONS AND RELEVANCE The findings showed that although most survey respondents are aware of international guidelines for the clinical management of cats with CKD, the SBP measurement still needs to be more systematic to allow proper substaging and detection of systemic hypertension. The monitoring frequency was lower than recommended. Furthermore, the introduction of a renal therapeutic diet should be refined to improve its acceptance rate.
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Affiliation(s)
- Tomás Rodrigues Magalhães
- Department of Veterinary Sciences, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
- Animal and Veterinary Research Centre (CECAV), University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
| | - Ana Luísa Lourenço
- Animal and Veterinary Research Centre (CECAV), University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
- Department of Animal Science, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
| | - Ronald Jan Corbee
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Felisbina Luísa Queiroga
- Department of Veterinary Sciences, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
- Animal and Veterinary Research Centre (CECAV), University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
- Centre for the Study of Animal Science, CECA-ICETA, University of Porto, Porto, Portugal
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Rocha R, Conceição C, Gonçalves L, Maia C. Knowledge, perceptions and practices of health students and professionals regarding leishmaniasis in Portugal: a cross-sectional study. Parasit Vectors 2023; 16:381. [PMID: 37880779 PMCID: PMC10598964 DOI: 10.1186/s13071-023-05982-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/24/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Control of leishmaniasis in the Mediterranean Basin relies on the active contributions from researchers in the fields of animal, human and environmental health. The application of knowledge, perceptions and practices (KPP) questionnaires to health students and professionals in Europe could be fundamental to identify and explore gaps in KPP, highlighting the diversity of conceptions related to this disease between students and professionals active in (One) Health. The objective of this study was to characterize and compare the current knowledge, perceptions and practices regarding leishmaniasis among subgroups of students and health professionals in Portugal through the application of an online questionnaire. METHODS A cross-sectional study targeted the population of health students and professionals in Portugal, including students in medicine, veterinary medicine and environmental health, physicians, veterinarians and environmental health technicians. Potential participants were approached by email via universities and professional societies and organizations and provided with the link to access the online questionnaire. Answers to the self-administered sociodemographic and KPP questionnaire were collected between July and December 2022. Individual KPP scores were calculated by summing grades defined for each question. Logistic regression models were used to search for potential associations, and the results were expressed at estimated crude and adjusted odds ratios with 95% confidence intervals. RESULTS In total, 486 participants were included in this study: 254 students and 232 professionals. Overall, 75% of the participants reported having heard of both human and animal leishmaniasis, and > 80% reported hearing about the disease during their course work (although this was significantly lower among those in the field of environmental health). Around 90% of participants identified the pathogenic agent as a parasite, and an arthropod bite was identified as the main route of transmission by > 95%. Animal leishmaniasis was considered to be diagnosed in Portugal by 87% of participants and human leishmaniasis by only 69%. The main barriers pointed out by professionals to the control of leishmaniasis were: lack of knowledge in the general population, failures in the early diagnosis and treatment of diseased animals, absence/inefficacy of vector control programs and lack of knowledge in human health professionals. Median knowledge and perception scores were higher among professionals in the animal health field and higher in professionals than in students. Median practice scores were not significantly different between groups and subgroups. The multivariate analysis revealed that a longer period of study (for students) and having seen cases of leishmaniasis (for physicians) were associated with above-mentioned median knowledge score. CONCLUSIONS Most health students and professionals are knowledgeable about the cause and transmission route of leishmaniasis. However, recognition of the disease as autochthonous in humans is less common, highlighting the importance of promoting an approach to this infection through a One-Health lens. A national structured plan to control leishmaniasis could overcome some of the barriers pointed out by professionals, namely by implementing systematic phlebotomine surveillance and integrated reporting of animal and human cases of disease.
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Affiliation(s)
- Rafael Rocha
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Lisbon, Portugal
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Institute of Hygiene and Tropical Medicine (IHMT), NOVA University Lisbon (UNL), Lisbon, Portugal
| | - Cláudia Conceição
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Lisbon, Portugal
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Institute of Hygiene and Tropical Medicine (IHMT), NOVA University Lisbon (UNL), Lisbon, Portugal
| | - Luzia Gonçalves
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Lisbon, Portugal
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Institute of Hygiene and Tropical Medicine (IHMT), NOVA University Lisbon (UNL), Lisbon, Portugal
- Centro de Estatística e Aplicações da Universidade de Lisboa (UL), Lisbon, Portugal
- Z-Stat4life, Lisbon, Portugal
| | - Carla Maia
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Lisbon, Portugal.
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Institute of Hygiene and Tropical Medicine (IHMT), NOVA University Lisbon (UNL), Lisbon, Portugal.
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Baxarias M, Donato G, Mateu C, Salichs M, Homedes J, Miró G, Pennisi MG, Solano-Gallego L. A blinded, randomized and controlled multicenter clinical trial to assess the efficacy and safety of Leisguard ® as an immunotherapeutic treatment for healthy Leishmania infantum-seropositive dogs. Parasit Vectors 2023; 16:344. [PMID: 37794502 PMCID: PMC10552330 DOI: 10.1186/s13071-023-05903-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 07/27/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Domperidone (Leisguard®) is an immunomodulatory drug used as a preventive measure in healthy dogs. However, no studies have been published in healthy Leishmania infantum-seropositive dogs. The aim of this study was to evaluate the clinical efficacy and safety of domperidone as immunotherapy in Leishmania-seropositive healthy dogs. METHODS Sixty-seven dogs were treated with domperidone at 0.5 mg/kg and 44 dogs received placebo, once daily for 4 consecutive weeks. Monthly treatments were repeated every 4 months until the end of the 1-year follow-up period. Veterinary examinations were performed on days 0, 30, 120, 150, 240, 270 and 360. Samples of blood and urine were collected on days 0, 120, 240 and 360 for routine laboratory tests and quantitative in-house ELISA for the detection of L. infantum-specific antibodies. Furthermore, Leishmania real-time PCR and IFN-γ ELISA were performed at day 0 and the end of the study. Dogs that developed disease were withdrawn from the study and classified as sick dogs. Adverse drug reactions were reported. RESULTS Thirty dogs developed disease during the follow-up period: 13/67 (19.4%) in the group treated with domperidone and 17/44 (38.6%) in the placebo-treated group (P = 0.03). Low-seropositive dogs treated with domperidone (4/40, 9.1%) were significantly less likely to develop disease compared to low-seropositive dogs treated with placebo (7/24, 29.2%; P = 0.04), while no differences were found between domperidone (9/23, 39.1%) and placebo (10/20, 50%) in medium- to high-seropositive dogs. At the end of the study, a higher proportion of Leishmania PCR-positive dogs was observed in the placebo-treated group (16/33, 48.5%) compared to the domperidone group (13/51, 25.5%; P = 0.04). Furthermore, low-seropositive dogs treated with domperidone with an increase of IFN-γ concentration presented a higher increase than those treated with placebo at the end of the study. Four dogs treated with domperidone presented self-limiting diarrhea. CONCLUSIONS Healthy dogs with low L. infantum antibody levels treated with domperidone were less likely to develop disease compared to placebo-treated dogs. Furthermore, domperidone presented a good safety profile.
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Affiliation(s)
- Marta Baxarias
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Giulia Donato
- Dipartimento di Scienze Veterinarie, Università di Messina - Polo Universitario Annunziata, Messina, Italy
| | | | | | | | - Guadalupe Miró
- Departamento de Sanidad Animal, Universidad Complutense de Madrid, Madrid, Spain
| | - Maria Grazia Pennisi
- Dipartimento di Scienze Veterinarie, Università di Messina - Polo Universitario Annunziata, Messina, Italy
| | - Laia Solano-Gallego
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Bellaterra, Spain.
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Molina CC, Dias MJ, Domingues TD, Englar RE, Leal RO. Clinical findings and prognostic factors for mortality in hospitalized dogs with leishmaniosis: aretrospective study. Comp Immunol Microbiol Infect Dis 2023; 101:102041. [PMID: 37634471 DOI: 10.1016/j.cimid.2023.102041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 08/29/2023]
Abstract
This retrospective study evaluated factors responsible for mortality of dogs hospitalized for Canine Leishmaniosis. Medical records of 31 dogs with leishmaniosis from a Portuguese Veterinary Teaching Hospital were examined between August 2018 and January 2022. Females (n = 18) and pure breed dogs (n = 27) were overrepresented, with higher frequency of Labrador Retriever (n = 4). Median age was 7 years (interquartile range=7). Most had historical findings of lethargy (n = 26) and the commonest clinicopathological abnormality was hypoalbuminemia (n = 26). Eleven dogs were classified as LeishVet stage II, 10 stage III and 10 stage IV. Fourteen dogs (45.2%) died or were euthanized, with azotemia, leukocytosis, stage IV, absence of diagnosis before hospitalization and lack of leishmaniosis specific treatment during hospitalization contributing to mortality. Absence of hypoalbuminemia and stages II/III increased survival. Mean hospitalization length prior to discharge was 5.41days ( ± 1.84) and diarrhea prolonged hospital stay.
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Affiliation(s)
- Carlota Carvalho Molina
- Hospital Escolar Veterinário, Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal.
| | - Maria Joana Dias
- Hospital Escolar Veterinário, Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal; Centre for Interdisciplinary Research in Animal Health (CIISA) , Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal; Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), Lisbon, Portugal.
| | | | - Ryane E Englar
- College of Veterinary Medicine, University of Arizona, Oro Valley, USA.
| | - Rodolfo Oliveira Leal
- Hospital Escolar Veterinário, Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal; Centre for Interdisciplinary Research in Animal Health (CIISA) , Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal; Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), Lisbon, Portugal.
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Almeida M, Maia C, Cristóvão JM, Morgado C, Barbosa I, Ibars RF, Campino L, Gonçalves L, Cortes S. Seroprevalence and Risk Factors Associated with Leishmania Infection in Dogs from Portugal. Microorganisms 2022; 10:2262. [PMID: 36422332 PMCID: PMC9695918 DOI: 10.3390/microorganisms10112262] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/12/2022] [Accepted: 11/13/2022] [Indexed: 07/30/2023] Open
Abstract
Canine leishmaniosis (CanL) caused by Leishmania infantum is an important zoonosis in southwestern European countries where this disease is endemic, and dogs, as domestic animals in close contact with humans, are the reservoir hosts for the parasite. In Portugal, CanL is of relevant veterinary concern. The previous national study revealed an overall seroprevalence of 6.3%. Since then, new prophylactic measures, such as vaccines, have been introduced in Europe. The aim of this study was to update seroprevalence for Leishmania infection and reassess risk factors in Portugal. A cross-sectional study was conducted from January-March 2021 with 1860 client-owned dogs from continental Portugal. A questionnaire and whole blood samples on filter paper were collected and a direct agglutination test was used to calculate anti-Leishmania antibody titres. True seroprevalence was 12.5% (95% CI 10.3-13.2%). Potential risk factors associated with L. infantum infection in dogs were age ≥ 2 years (aOR = 1.68, 95% CI 1.1-2.6) and residing in the interior regions of the country (aOR = 1.92, 95% CI 1.3-2.9) and non-use of repellents (aOR = 1.75, 95% CI 1.2-2.5). The key to controlling CanL and its impact on Public Health in endemic areas lies in continuous implementation of prophylactic measures, through the correct use of repellents/insecticides and vaccines and early detection and monitoring of infected dogs.
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Affiliation(s)
- Maria Almeida
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira, 100, 1349-008 Lisboa, Portugal
| | - Carla Maia
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira, 100, 1349-008 Lisboa, Portugal
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira, 100, 1349-008 Lisboa, Portugal
| | - José M. Cristóvão
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira, 100, 1349-008 Lisboa, Portugal
| | | | - Inês Barbosa
- MSD Animal Health Lda, 2770-192 Paço de Arcos, Portugal
| | | | - Lenea Campino
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira, 100, 1349-008 Lisboa, Portugal
| | - Luzia Gonçalves
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira, 100, 1349-008 Lisboa, Portugal
- Centro de Estatística e Aplicações da Universidade de Lisboa (CEAUL), Faculdade de Ciências, Universidade de Lisboa, 1749-016 Lisboa, Portugal
- z-Stat4life, Cowork do Palácio Baldaya, 1549-011 Lisboa, Portugal
| | - Sofia Cortes
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira, 100, 1349-008 Lisboa, Portugal
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira, 100, 1349-008 Lisboa, Portugal
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Monteiro M, Prata S, Cardoso L, Pereira da Fonseca I, Leal RO. Dogs with leishmaniosis: how are we managing proteinuria in daily practice? A Portuguese questionnaire-based study. Parasit Vectors 2022; 15:125. [PMID: 35410442 PMCID: PMC8996528 DOI: 10.1186/s13071-022-05222-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/24/2022] [Indexed: 12/03/2022] Open
Abstract
Background Proteinuria is a common finding in dogs with leishmaniosis. Although antileishmanial therapeutic protocols are widely implemented, little information is available on which treatments are most adequate for identifying proteinuria in patients with canine leishmaniosis (CanL), especially regarding the use of immunosuppressants. The aim of this study was to explore the current paradigm regarding the antiproteinuric approach adopted by veterinary practitioners in Portugal to treat dogs with CanL. Methods A questionnaire-based study was developed using Google Forms®. The questionnaire presented a number of different hypothetical scenarios of CanL, and the topics surveyed included the general features of the respondents and the protocols preferred by these respondents to manage proteinuria in the presented scenarios, including choice of therapeutic drugs, appropriate diet and use of immunosuppressants, in dogs with immune-mediated glomerulonephritis. The questionnaire was internally prevalidated and diffused online over a 2-month period through Portuguese veterinary social networking groups, and data were collected for descriptive analysis. Results A total of 86 veterinary practitioners responded to the survey. When exposed to theoretical scenarios of proteinuria in dogs with CanL at stages IIb, III and IV (LeishVet guidelines), 16.3%, 62.8% and 93.8% of the respondents, respectively, answered that they would treat it. The dog was started on a renal diet as therapy by 28.6%, 83.3% and 97.4% of respondents, respectively. Angiotensin-converting enzyme inhibitors (ACEI) were prescribed by 100%, 85.2% and 78.9% of respondents as first-choice drugs for CanL at stages IIb, III and IV, respectively, with ACEI used in monotherapy by 64.3%, 40.7% and 46.1%. In comparison, protocols using ACEI in combination with other compounds were chosen by 7.1%, 33.3% and 39.5% of respondents, and combination therapy which did not include ACEI was the choice of 0.0%, 12.9% and 14.5%. Regarding immunosuppressants, 44.2% of the respondents answered they would prescribe them, with 97.4% electing for prednisolone and 5.3% choosing mycophenolate mofetil. Conclusions Among the veterinary practitioners who responded, proteinuria treatment was considered since stage IIb CanL, although implementation of a therapeutic approach was more evident in advanced CanL stages. ACEI were the first-choice drugs, particularly for the treatment of stage IIb CanL; in advanced stages, a combination of antiproteinuric drugs was more often used. Immunosuppressant use was controversial, although when applied, prednisolone was the preferred choice. These findings reinforce the small body of evidence that supports the use of such drugs and the need to further explore their role in CanL. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s13071-022-05222-w.
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Affiliation(s)
- Marta Monteiro
- Hospital Escolar Veterinário, Faculdade de Medicina Veterinária, Universidade de Lisboa, Lisbon, Portugal.,Centro de Investigação Interdisciplinar em Sanidade Animal (CIISA), Faculdade de Medicina Veterinária, Universidade de Lisboa, Lisbon, Portugal.,Laboratório Associado Para Ciência Animal e Veterinária (AL4AnimalS), Lisbon, Portugal
| | - Sara Prata
- Hospital Escolar Veterinário, Faculdade de Medicina Veterinária, Universidade de Lisboa, Lisbon, Portugal
| | - Luís Cardoso
- Department of Veterinary Sciences, and Animal and Veterinary Research Centre (CECAV), University of Trás-os-Montes and Alto Douro (UTAD), Vila Real, Portugal.,Laboratório Associado Para Ciência Animal e Veterinária (AL4AnimalS), Lisbon, Portugal
| | - Isabel Pereira da Fonseca
- Hospital Escolar Veterinário, Faculdade de Medicina Veterinária, Universidade de Lisboa, Lisbon, Portugal.,Centro de Investigação Interdisciplinar em Sanidade Animal (CIISA), Faculdade de Medicina Veterinária, Universidade de Lisboa, Lisbon, Portugal.,Laboratório Associado Para Ciência Animal e Veterinária (AL4AnimalS), Lisbon, Portugal
| | - Rodolfo Oliveira Leal
- Hospital Escolar Veterinário, Faculdade de Medicina Veterinária, Universidade de Lisboa, Lisbon, Portugal. .,Centro de Investigação Interdisciplinar em Sanidade Animal (CIISA), Faculdade de Medicina Veterinária, Universidade de Lisboa, Lisbon, Portugal. .,Laboratório Associado Para Ciência Animal e Veterinária (AL4AnimalS), Lisbon, Portugal.
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Jesus L, Arenas C, Domínguez-Ruiz M, Silvestrini P, Englar RE, Roura X, Leal RO. Xanthinuria secondary to allopurinol treatment in dogs with leishmaniosis: Current perspectives of the Iberian veterinary community. Comp Immunol Microbiol Infect Dis 2022; 83:101783. [DOI: 10.1016/j.cimid.2022.101783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 11/15/2022]
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Pereira MA, Santos R, Nóbrega C, Mega C, Cruz R, Esteves F, Santos C, Coelho C, Mesquita JR, Vala H, Santos-Gomes G. A Questionnaire-Based Survey on the Long-Term Management of Canine Leishmaniosis by Veterinary Practitioners. Animals (Basel) 2022; 12:ani12060731. [PMID: 35327128 PMCID: PMC8944528 DOI: 10.3390/ani12060731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/04/2022] [Accepted: 03/11/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Canine Leishmaniosis is a chronic and potentially fatal disease, caused by Leishmania infantum, a zoonotic microorganism. In economically disadvantaged regions, costs associated with long-term patient monitoring may determine that some owners decline veterinary follow-up of their dogs, with potentially severe implications for animal welfare and public health. This online, questionnaire-based survey aimed to assess how Portuguese veterinary practitioners perform long-term patient management and recognize relapses. More than half of the respondents stated that most dog owners declare having financial restraints, which condition the use of diagnostic tests during long-term follow-up. Allopurinol ad aeternum or until disease remission and domperidone were the most prescribed treatment, and relapses were detected by the reappearance or worsening of clinical signs by most veterinary practitioners. The rate of relapse detection was higher in the most economically favored regions, probably because of a lesser constraint on the use of the appropriate diagnostic tests. This study confirms that owner financial restraints negatively influence veterinary follow-up and relapse recognition, potentially compromising clinical decision making and favoring the maintenance of Leishmania infantum infection endemic status in Portugal. Abstract Canine Leishmaniosis (CanL) is a chronic and potentially fatal disease. In economically disadvantaged regions, costs associated with long-term patient monitoring may determine that some owners decline veterinary follow-up of their dogs. This online, questionnaire-based survey aimed to assess how Portuguese veterinary practitioners perform long-term patient monitoring and recognize relapses. More than 50% of respondents reported that 50–100% of dog owners declared financial restraints. Hence, in these circumstances, most veterinary practitioners only performed clinical examination and serology. However, when owners did not declare financial restriction, other tests were additionally performed, such as renal and hepatic profiles, hemogram, serum protein electrophoresis and urine protein creatinine ratio. The mean number of exams performed when owners presented financial restraints was significantly lower than the number of exams performed without economic limitations. Most veterinary practitioners prescribed allopurinol ad aeternum or until disease remission and domperidone. CanL relapses were recognized by more than half of respondents “Always”, through the reappearance or worsening of clinical signs, whereas about a quarter detected an increase in anti-Leishmania antibody levels and identified abnormalities in the serum protein electrophoresis profile. The relapse rate was higher in the Lisbon Metropolitan Area and north, the most economically favored regions of Portugal. This study confirms that owner financial restraints negatively influence veterinary follow-up and relapse recognition, ultimately compromising clinical decision making and favoring the maintenance of Leishmania infantum infection endemicity.
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Affiliation(s)
- Maria A. Pereira
- Instituto Politécnico de Viseu, Escola Superior Agrária de Viseu, Campus Politécnico, 3504-510 Viseu, Portugal; (C.N.); (C.M.); (R.C.); (F.E.); (C.S.); (C.C.); (H.V.)
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, UNL, Rua da Junqueira 100, 1349-008 Lisboa, Portugal;
- CERNAS—Research Centre for Natural Resources, Environment and Society, ESAV, Instituto Politécnico de Viseu, 3500-606 Viseu, Portugal
- Correspondence: ; Tel.: +351-232-446-600
| | - Rute Santos
- Polytechnic Institute of Portalegre, 7300-110 Portalegre, Portugal;
- Research Centre for Endogenous Resource Valorization (VALORIZA), 7300-555 Portalegre, Portugal
| | - Carmen Nóbrega
- Instituto Politécnico de Viseu, Escola Superior Agrária de Viseu, Campus Politécnico, 3504-510 Viseu, Portugal; (C.N.); (C.M.); (R.C.); (F.E.); (C.S.); (C.C.); (H.V.)
- Centre for the Research and Technology of Agro-Environmental and Biological Sciences (CITAB), University of Trás-os-Montes e Alto Douro, 5001-801 Vila Real, Portugal
| | - Cristina Mega
- Instituto Politécnico de Viseu, Escola Superior Agrária de Viseu, Campus Politécnico, 3504-510 Viseu, Portugal; (C.N.); (C.M.); (R.C.); (F.E.); (C.S.); (C.C.); (H.V.)
- CERNAS—Research Centre for Natural Resources, Environment and Society, ESAV, Instituto Politécnico de Viseu, 3500-606 Viseu, Portugal
| | - Rita Cruz
- Instituto Politécnico de Viseu, Escola Superior Agrária de Viseu, Campus Politécnico, 3504-510 Viseu, Portugal; (C.N.); (C.M.); (R.C.); (F.E.); (C.S.); (C.C.); (H.V.)
- Epidemiology Research Unit (EPIUnit), Instituto de Saúde Pública da Universidade do Porto, 4050-091 Porto, Portugal;
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), 4050-600 Porto, Portugal
| | - Fernando Esteves
- Instituto Politécnico de Viseu, Escola Superior Agrária de Viseu, Campus Politécnico, 3504-510 Viseu, Portugal; (C.N.); (C.M.); (R.C.); (F.E.); (C.S.); (C.C.); (H.V.)
- CERNAS—Research Centre for Natural Resources, Environment and Society, ESAV, Instituto Politécnico de Viseu, 3500-606 Viseu, Portugal
| | - Carla Santos
- Instituto Politécnico de Viseu, Escola Superior Agrária de Viseu, Campus Politécnico, 3504-510 Viseu, Portugal; (C.N.); (C.M.); (R.C.); (F.E.); (C.S.); (C.C.); (H.V.)
| | - Catarina Coelho
- Instituto Politécnico de Viseu, Escola Superior Agrária de Viseu, Campus Politécnico, 3504-510 Viseu, Portugal; (C.N.); (C.M.); (R.C.); (F.E.); (C.S.); (C.C.); (H.V.)
- CERNAS—Research Centre for Natural Resources, Environment and Society, ESAV, Instituto Politécnico de Viseu, 3500-606 Viseu, Portugal
| | - João R. Mesquita
- Epidemiology Research Unit (EPIUnit), Instituto de Saúde Pública da Universidade do Porto, 4050-091 Porto, Portugal;
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), 4050-600 Porto, Portugal
- ICBAS—School of Medicine and Biomedical Sciences, Porto University, 4050-313 Porto, Portugal
| | - Helena Vala
- Instituto Politécnico de Viseu, Escola Superior Agrária de Viseu, Campus Politécnico, 3504-510 Viseu, Portugal; (C.N.); (C.M.); (R.C.); (F.E.); (C.S.); (C.C.); (H.V.)
- CERNAS—Research Centre for Natural Resources, Environment and Society, ESAV, Instituto Politécnico de Viseu, 3500-606 Viseu, Portugal
- Centre for the Research and Technology of Agro-Environmental and Biological Sciences (CITAB), University of Trás-os-Montes e Alto Douro, 5001-801 Vila Real, Portugal
| | - Gabriela Santos-Gomes
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, UNL, Rua da Junqueira 100, 1349-008 Lisboa, Portugal;
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Segarra S. Nutritional Modulation of the Immune Response Mediated by Nucleotides in Canine Leishmaniosis. Microorganisms 2021; 9:2601. [PMID: 34946204 PMCID: PMC8703464 DOI: 10.3390/microorganisms9122601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/09/2021] [Accepted: 12/14/2021] [Indexed: 12/24/2022] Open
Abstract
Leishmaniasis is an emerging, uncontrolled, and neglected zoonotic disease. Climate change is contributing to its ongoing global expansion. The dog is the main reservoir; hence the importance of implementing effective treatment, prevention, and control measures in this animal species to protect public health. However, although the standard treatment for canine leishmaniosis (CanL) is effective, it does not provide full parasitological clearance, and side effects and drug resistance have been described. The host's immune system plays a key role in the establishment and evolution of leishmaniasis. Dietary nucleotides modulate the immune response and, given their reported efficacy and safety in sick and clinically healthy Leishmania-infected dogs and because they represent a sustainable option with no associated side effects or resistance, they could be included within the prevention, treatment, and control strategies for leishmaniasis. This article briefly summarizes the scientific literature on CanL management, including unresolved issues, and reviews the scientific evidence on immunomodulatory effects of dietary nucleotides in different animal species. It also proposes a CanL management algorithm, including nucleotides. It is concluded that nutritional modulation of the immune response with nucleotides can contribute to better management of leishmaniasis following a One Health approach, especially in the COVID-19 era.
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Affiliation(s)
- Sergi Segarra
- R&D Bioiberica S.A.U., 08950 Esplugues de Llobregat, Spain
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