New clinico-pathological findings and prognostic factors of canine leishmaniasis in endemic and nonendemic areas

Canine Leishmaniasis (CanL) is due to Leishmania infantum (syn. Leishmania chagasi) and is endemic in Mediterranean countries, Portugal, Latin America and Southern Asia. In the last few decades, imported and even autochthonous cases have been recorded in traditionally non-endemic areas such as Central and Northen Europe and Northen America. This is possibly due to a wider spread of the vector and especially to a larger numbers of travelling dogs. Many studies about CanL have been published in the last years and have contributed in understanding different aspects of this disease, including the alternative ways of transmission and the pathologic mechanisms underlying the clinical findings. However, CanL still remains a very challenging disease to diagnose, treat and prevent. Moreover, it is still very difficult to predict the outcome given the low numbers of controlled studies evaluating markers of prognosis. So, the main aims of the present thesis were to investigate new clinico-pathological aspects of CanL and to possibly identify useful prognostic factors. The first study demonstrated that a significant proportion of dogs with leishmaniasis have increased serum cTnI concentration, suggesting that CanL can cause cardiac disease, mainly myoand endocarditis. In the second study, the iron status and its relationship with C-reactive protein (CRP) was for the first time investigated in CanL. The results indicated that dogs with leishmaniasis have decreased serum iron, total iron-binding capacity (TIBC), unsaturated iron-binding capacity (UBIC) and percentage of transferrin saturation and increased concentrations of ferritin. Increased CRP and decreased TIBC are also risk factors for moratility. Finally, since the disease is progressively changing its geographical distribution, the last investigation was conducted in the United Kingdom (UK), currently considered a non-endemic country. The majority of dogs that were diagnosed of leishmaniasis have been adopted from an endemic area (especially from the Mediterranean countries) respect a minority that have travelled to those regions. No autochthonous cases were recognised. Purebreed dogs and those that were classified in stage D according to the Canine Leishmaniasis Working Group guidelines were at higher risk of death. Differently to what has been reported in endemic countries, serology titre at diagnosis and IRIS staging for chronic kidney disease did not influence the outcome