Leishmaniasis or Sandfly

The name sand fly is really not the best name for this creature and it wrongly suggests to the layman that he or she may be at risk of leishmaniasis while on holiday on the beach. A distinction must therefore be made for the vectors of the leishmaniasis which are correctly termed phlebotomine sand flies. This sand fly can be found in Southern Europe, from the South of France, southwards covering Spain, Italy, Greece, Portugal and so on. In this region, the sand fly is active from March until and including October. In this period is active during dawn and dusk. It can be found in areas with water (lakes, ponds, beach) around, but also in areas where there is agriculture activity, as it thrives in organic matters, like compost heaps, and so on.

Therefore prevention for leishmaniasis is absolutely required, the best prevention is the combination of the scalibor collar together with pulvex spot on (administered every 28 days). Please keep your dog(s) indoors if at all possible during these times of the day! Should this be impossible, please use disinfectant to deter the sand fly around the area where your dog lives! Leishmaniasis can be transmitted from one dog to the other, ONLY by the sand fly, going from one dog to the other.

Leishmaniasis will progress slowly in the dog’s body and it may take up to seven years from infection to the point when the dog owner starts to notice Leishmaniasis symptoms in the dog. The symptoms are often vague and the vet might treat the dog for other more common diseases before realizing that the cause of the problems is Leishmaniasis. Or treat the animal for ehrlichiose (tick fever). There are also quite a lot of dogs that seem to be naturally resistant to the parasite – they are infected but they never develop any symptoms of Leishmaniasis. The parasite lies dormant in the bone marrow, and will stay there until the parasite dies, this can take up to seven years after the infection.

How do you find out if your dog has leishmaniasis or not? There are ample possibilities:

• Quick test, also known as snap test. The veterinary will take some blood which is tested immediately. The result is either positive or negative. When tested negative, the advise will be to keep testing every year and also to provide preventative protection, by f.e. scalibor collar, and pulvex spot on treatment every 4 weeks. When tested positive, the blood will have to be sent to a laboratory for further assessment/analyzing as to how badly the animal is affected.
• In Southern Portugal, the best time to test the blood for leishmaniasis is from February to April, or several months after the peak summer months. Note, a negative is not a definite negative. A negative means there are no signs of leishmaniasis at that time. To ensure a dog is entirely negative it must be tested on repeat occasions and be protected from sandfly during the interim periods.
• IFAT or ELISA Test, however cross reactivity between Leishmaniasis species and false negatives may occur.
• PCR – Polymer Chain Reaction: Detection of genus or species Leishmaniasis DNA in blood, lymph node and bone marrow aspirates is indicative of active infection. PCR on peripheral blood is less sensitive (60-70%) when compared to bone marrow. A PCR test on bone marrow is helpful when the leishmaniasis is chronic, but less accurate if it is acute.

When testing for leishmaniasis, please test the functions of the liver and kidney as well. If either or both of the organs are infected and/or affected, the treatment will be very difficult, as the medication used for the controlling the leishmaniasis can only be used when these organs are in order.

When a test result comes back as indefinite, it may indicate that the dog has ehrlichiose (sometimes as well as leishmaniasis). The problem with this is that the treatment for ehrlichiose is totally different to the treatment/controlling of Leishmaniasis. A dog with leishmaniasis should never be treated with antibiotics, only in emergency cases! The antibiotics can trigger the parasite, and activate it! Whilst the treatment for ehrlichiose requires treatment with antibiotics.

Treatment possibilities:

Allopurinol should be given (dosage is depending on the weight of the dog and the stage of the leishmaniasis) for at least 6 months. In many cases the allopurinol dosage is adjusted after 6 months, and can be given for as long as the dog lives. When additional treatment is required in the form of Glucantime or Milteforan, continue with the allopurinol!

Glucantime can only be given as injections, they should be given at 24 hours intervals, the best results are achieved when administered on exactly the same time every day for one month! Glucantime is injected under the skin, very slowly, and can be given by the owners. The veterinarian will happily explain how to do this properly. Glucantime does not kill the parasite but knocks it out and it should withdraw back in the bone marrow and sleep. Side effects: it could be a painful injection, because of the 28 days course.

Milteforan is fairly new on the market, and should be easier to administer than Glucantime, Milteforan is a liquid which should be given with food. However, common side effects: nausea, no appetite, and some dogs seem to deteriorate for a little while, before they seem to getting better.

Please note:

Glucantime, Allopurinol, Milteforan are all medications which are very very hard on the kidneys! In order to support the kidney, it is sometimes advised to give solidago on a daily basis. Solidago is a herbal support for the kidneys. Other possibilities include natural food supplements like sardines in oil. Sardines contain enormous natural amounts of Omega 3, 6, 9, these omega’s and fatty acids may boost a dog’s immune system and improve condition of their skin and fur. However, please consult your veterinarian as there is some disagreement about whether herbal supplements and fatty acids should be given to dogs without adequate testing of how such supplements interact in an animal.

Common symptoms of Leishmaniasis in dogs are:

• Skin problems: very often centralized around the muzzle, ears and eyes. The typical ring around their eyes, like glasses; lesions which will result in crusts on around their ears, very often bleeding.
• Nail problems: long and fast growing nails, very often incredibly hard, sometimes deformed
• Lesions: the pads on their feet can be affected with lesions, causing tremendous bleeding
• Other skin problems: loss of fur all over their body, usually starting with small patches of lesions.
• Weight loss: affected dogs will very likely lose their appetite. If Leishmaniasis is already in an advanced state, it will mean that the internal organs (kidneys, liver) are affected and failing. Chronic diarrhea is also very common.
• General: affected dogs may have swollen joints, and/or swelling of their legs, have fever, they may be less active and even very very calm.

Whilst leishmaniasis is not curable, it is controllable in many cases. Many dogs receiving treatment will live happily until they are old, just by being treated with allopurinol, receiving prevention in the form of a scalibor collar supplemented with pulvex spot on every 4 weeks and of course annually tested for leishmaniasis. Others will unfortunately die earlier. Please realize when leishmaniasis is untreated/uncontrolled, the dog dies a horrible and painful death.

Interesting and informative website for more information:
http://www.leishmaniasis.info/