Prospective study on the incidence and progression of clinical signs in naïve dogs naturally infected by Leishmania infantum

The incidence of clinical and clinicopathological signs associated with the progression of infection was evaluated prospectively in 329 naïve young dogs exposed to Leishmania infantum transmission and examined periodically during 22 months (M). The dogs were part of Leishmania vaccine investigations performed under natural conditions. Vaccinated groups were considered in the evaluation when the vaccine resulted non-protective and the appearance and progression of signs did not differ statistically from controls at each time point, otherwise only control groups were included. 115 beagles were part of 3 studies (A to C) performed in the same kennel; 214 owned dogs (29 breeds, 2.3% beagles) were included in a study (D) performed in 45 endemic sites. At M22 the prevalence of any Leishmania infection stage classified as subpatent, active asymptomatic, or symptomatic was 59.8% in studies A-C and 29.2% in study D. Despite different breed composition and infection incidence, the relative proportion of active infections and the progression and type of clinical and clinicopathological signs have been similar in both study sets. All asymptomatic active infections recorded have invariably progressed to full-blown disease, resulting in 56 sick dogs at M22. In these dogs, lymph nodes enlargement and weight loss--recorded from M12--were the most common signs. Cutaneous signs were seen late (M18) and less frequently. Ocular signs appeared even later, being sporadically recorded at M22. Most clinicopathological alterations became evident from M12, although a few cases of thrombocytopenia or mild non-regenerative anemia were already observed at M6. Albumin/globulin inversions were recorded from M12 and urea/creatinine increase appeared mostly from M18. Altogether our findings indicate that any susceptible young dogs naturally infected by L. infantum present a common pattern of progression of signs during 2 years post infection, providing clues for medical and epidemiological applied aspects.

Fatigue and its relationships with cognitive functioning and depression in paediatric multiple sclerosis

BACKGROUND

There is limited information on fatigue and its clinical and psychosocial correlates in children and adolescents with multiple sclerosis (MS).

OBJECTIVE

To assess the relationships between fatigue, cognitive functioning and depression in paediatric MS.

METHODS

The study cohort consisted of patients with MS recruited for an Italian collaborative study on cognitive and psychosocial functioning in paediatric MS. The present assessment included evaluation of fatigue on the Pediatric Quality of Life Inventory-Multidimensional Fatigue Scale, cognitive functioning on an extensive neuropsychological battery and depression on the Children's Depression Inventory (CDI). A psychiatric interview through the Kiddie-SADS-Present and Lifetime Version was also administered.

RESULTS

In total, 57 patients with relapsing-remitting MS were compared with 70 healthy controls. Percentages of fatigued patients ranged from 9% to 14% according to self-reports, and from 23% to 39% according to parent reports. Fatigue was significantly related with higher scores on the CDI (p < 0.03). Higher levels of self-reported cognitive fatigue were associated with impaired performance on a problem-solving test, whereas higher levels of parent-reported cognitive fatigue were associated with impairment on tests of verbal learning, processing speed, complex attention and verbal comprehension.

CONCLUSIONS

Our data show that fatigue can affect a sizeable proportion of paediatric MS patients, and confirm the association between fatigue and depressive symptoms in MS. They also highlight the difficulties of fatigue assessment in the paediatric population and provide a few clues to further research in the field.

Tick-transmitted diseases in dogs: clinicopathological findings

In this article we describe the main clinicopathological findings of some tick-transmitted diseases observed in Italy, due to Ehrlichia canis and Babesia canis, and most rarely Anaplasma phagocytophilum and Anaplasma platys. Canine monocytic ehrlichiosis (CME) is a multisystemic disorder that is characterized by various clinical signs. Acutely-infected dogs show various clinical and haematological abnormalities including fever, lymphadenopathy, anorexia, lethargy, depression and thrombocytopenia. Many dogs with CME evolve in to an asymptomatic or chronically symptomatic carrier states. In Italy there are very few cases of Canine Granulocytic Ehrlichiosis (CGE) and all are attributed to A. phagocytophilum. The early manifestations of CGE are usually mild and consist in acute onset of fever and depression with or without thrombocytopenia. Lameness due to polyarthritys is also possible. Other clinical manifestations most rarely described are very similar to those reported in chronic form of E. canis infections. There are very few studies about clinicopathological findings of canine babesiosis in Italy. In our country this infection is caused by Babesia canis (large form of parasite) subspecies B. canis canis and B. canis vogeli. These two subspecies are morphologically indistinguishable. Clinical signs reflect the intravascular and extravascular haemolysis due to the life cycle of the parasite. The most common haematological abnormalities found in canine babesiosis are anaemia and thrombocytopenia. It is important to point out that co-infection between two or more agents is possible. In this case it is very difficult to attribute the clinical signs and haematological and/or biochemical abnormalities to a single specific agent.