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LeVine DN, Kidd L, Garden OA, Brooks MB, Goggs R, Kohn B, Mackin AJ, Eldermire ERB, Chang Y, Allen J, Christopherson PW, Glanemann B, Maruyama H, Naskou MC, Nielsen LN, Shropshire S, Viall AK, Birkenheuer AJ, Forman MA, Hanzlicek AS, Langner KF, Lashnits E, Lunn KF, Makielski KM, Roura X, Spada E. ACVIM consensus statement on the diagnosis of immune thrombocytopenia in dogs and cats. J Vet Intern Med 2024; 38:1958-1981. [PMID: 38752421 PMCID: PMC11256148 DOI: 10.1111/jvim.16996] [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: 12/20/2023] [Accepted: 01/16/2024] [Indexed: 07/19/2024] Open
Abstract
Immune thrombocytopenia (ITP) is the most common acquired primary hemostatic disorder in dogs. Immune thrombocytopenia less commonly affects cats but is an important cause of mortality and treatment-associated morbidity in both species. Immune thrombocytopenia remains a diagnosis of exclusion for which diagnostic guidelines are lacking. Primary, or non-associative, ITP refers to autoimmune platelet destruction. Secondary, or associative, ITP arises in response to an underlying disease trigger. However, evidence for which comorbidities serve as ITP triggers has not been systematically evaluated. To identify key diagnostic steps for ITP and important comorbidities associated with secondary ITP, we developed 12 Population Evaluation/Exposure Comparison Outcome (PECO) format questions. These questions were addressed by evidence evaluators utilizing a literature pool of 287 articles identified by the panelists using a structured search strategy. Evidence evaluators, using panel-designed templates and data extraction tools, summarized evidence and created guideline recommendations that then were integrated by diagnosis and comorbidity domain chairs. The revised PECO responses underwent a Delphi survey process to reach consensus on final guidelines. A combination of panel expertise and PECO responses were employed to develop algorithms for diagnosis of ITP in dogs and cats, which also underwent 4 iterations of Delphi review. Comorbidity evidence evaluators employed an integrated measure of evidence (IME) tool to determine evidence quality for each comorbidity; IME values combined with evidence summaries for each comorbidity were integrated to develop ITP screening recommendations, which also were subjected to Delphi review. Commentary was solicited from multiple relevant professional organizations before finalizing the consensus. The final consensus statement provides clinical guidelines for the diagnosis of, and underlying disease screening for, ITP in dogs and cats. The systematic consensus process identified numerous knowledge gaps that should guide future studies. This statement is a companion manuscript to the ACVIM Consensus Statement on the Treatment of Immune Thrombocytopenia.
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Affiliation(s)
- Dana N. LeVine
- Department of Clinical Sciences, College of Veterinary MedicineAuburn UniversityAuburnAlabamaUSA
| | - Linda Kidd
- Western University of Health Sciences College of Veterinary MedicinePomonaCaliforniaUSA
- Zoetis Animal Health DiagnosticsParsippanyNew JerseyUSA
| | - Oliver A. Garden
- School of Veterinary MedicineLouisiana State UniversityBaton RougeLouisianaUSA
| | - Marjory B. Brooks
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary MedicineCornell UniversityIthacaNew YorkUSA
| | - Robert Goggs
- Department of Clinical Sciences, College of Veterinary MedicineCornell UniversityIthacaNew YorkUSA
| | - Barbara Kohn
- Clinic for Small Animals, Faculty of Veterinary Medicine, Freie Universität BerlinBerlinGermany
| | - Andrew J. Mackin
- College of Veterinary MedicineMississippi State UniversityStarkvilleMississippiUSA
| | - Erin R. B. Eldermire
- Flower‐Sprecher Veterinary Library, College of Veterinary MedicineCornell UniversityIthacaNew YorkUSA
| | - Yu‐Mei Chang
- Department of Comparative Biomedical SciencesRoyal Veterinary CollegeLondonUK
| | - Julie Allen
- Veterinary Information NetworkDavisCaliforniaUSA
| | | | - Barbara Glanemann
- Department of Clinical Science and Services, Royal Veterinary CollegeUniversity of LondonLondonUK
| | - Haruhiko Maruyama
- Department of Veterinary Medicine, College of Bioresource SciencesNihon UniversityChiyoda CityJapan
| | - Maria C. Naskou
- Department of Pathobiology, College of Veterinary MedicineAuburn UniversityAuburnAlabamaUSA
| | - Lise N. Nielsen
- Department of Veterinary Clinical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Sarah Shropshire
- College of Veterinary Medicine and Biomedical SciencesColorado State UniversityFort CollinsColoradoUSA
| | - Austin K. Viall
- Department of Pathology, Microbiology, and ImmunologySchool of Veterinary Medicine, University of California, DavisDavisCaliforniaUSA
| | - Adam J. Birkenheuer
- College of Veterinary MedicineNorth Carolina State UniversityRaleighNorth CarolinaUSA
| | | | | | | | - Erin Lashnits
- School of Veterinary MedicineUniversity of WisconsinMadisonWisconsinUSA
| | | | - Kelly M. Makielski
- College of Veterinary MedicineUniversity of MinnesotaSt PaulMinnesotaUSA
| | - Xavier Roura
- Hospital Clinic Veterinari, Universitat Autonoma de BarcelonaBellaterraSpain
| | - Eva Spada
- Veterinary Transfusion Research Laboratory (REVLab), Department of Veterinary Medicine and Animal SciencesUniversity of MilanLodiItaly
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De Cerqueira MAF, Pinheiro AMR, Costa DL, Costa CHN. Association between clinical outcomes, peripheral blood and cytomorphologic features of bone marrow in visceral leishmaniasis. Hematol Transfus Cell Ther 2024:S2531-1379(23)02601-9. [PMID: 38272737 DOI: 10.1016/j.htct.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/07/2023] [Accepted: 10/21/2023] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION An intracellular parasite of mononuclear phagocytes, mainly distributed in the bone marrow and the spleen, causes visceral leishmaniasis. Complete blood count (CBC) reveals the poorly understood pathogenesis of anemia, leukopenia and thrombocytopenia. Our study aimed to compare the CBC with bone marrow cytomorphological features and their association with clinical outcomes to clarify this relevant issue. METHODS The CBC and bone marrow of 118 patients were described by two hematologists and compared to check their association with each other and mortality. RESULTS Peripheral cytopenias were common findings, particularly anemia, as seen in almost all patients. No relationship was found between values of hemoglobin, neutrophils and platelet count with fatal outcomes. The bone marrow was normocellular in 61.9% of the cases. Dysplasia figures were frequent and 49.1% of the samples had dysgranulopoiesis. Additionally, erythroid hyperplasia was found in 72% of the patients with severe anemia. Patients with reduced bone marrow cellularity, erythroid hypercellularity and dyserythropoiesis seem to have a riskier disease. CONCLUSION The study results suggest that the bone marrow of patients with visceral leishmaniasis manifests a reactional pattern to the inflammatory event, thereby modulating cytokines and other colony growth factors. This compensatory response may be dysplastic and ineffective and generate peripheral cytopenias of varying intensity. Further studies are needed to clarify the signaling pathways involved, which may be used as therapeutic tools in the future.
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Affiliation(s)
| | | | - Dorcas Lamounier Costa
- Instituto de Doenças Tropicais Nathan Portella (IDTNP), Teresina, Brazil; Universidade Federal do Piauí (UFPI). Teresina, PI, Brazil
| | - Carlos Henrique Nery Costa
- Instituto de Doenças Tropicais Nathan Portella (IDTNP), Teresina, Brazil; Universidade Federal do Piauí (UFPI). Teresina, PI, Brazil
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Canine Leishmaniasis in an Endemic Area for Human Leishmaniasis in Nicaragua. J Trop Med 2022; 2022:5774296. [PMID: 36072825 PMCID: PMC9444458 DOI: 10.1155/2022/5774296] [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: 04/29/2022] [Revised: 07/20/2022] [Accepted: 08/17/2022] [Indexed: 12/02/2022] Open
Abstract
In this study, the frequency of canines infected with Leishmania spp. in an area endemic to leishmaniasis in humans was determined. A descriptive pilot study was conducted between the months of October and December 2020 on dogs from Rota, a community in the municipality of León, which included 45 specimens from the peridomestic area. Different variables from each specimen were monitored, such as age, sex, breed, body condition, and clinical characteristics, as well as information on the owners and cases of human leishmaniasis presented in less than 5 years. Blood samples were collected from the cephalic vein and peripheral blood was separated. A complete blood count (CBC) was performed using venous blood samples with ethylene diamine tetraacetic acid (EDTA), as well as a conventional PCR was applied for the detection of Leishmania spp. Amastigotes were found in 22% of venous or peripheral blood samples, whereas a high prevalence of 28.89% (95% CI: 14.53–43.24) was found by PCR. Only 1/12 of positive dogs in PCR presented dry exfoliative dermatitis, therefore, there was no significant difference (p ≥ 0.05), the age and sex of the dogs were also not factors associated with infection (p ≥ 0.05). This study reports for the first time the molecular detection of Leishmania in dogs in an endemic area of leishmaniasis in humans in Nicaragua. The high frequency of dogs infected with Leishmania suggests that they play an important role in the transmission cycle of human leishmaniasis.
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Forrester S, Goundry A, Dias BT, Leal-Calvo T, Moraes MO, Kaye PM, Mottram JC, Lima APCA. Tissue Specific Dual RNA-Seq Defines Host-Parasite Interplay in Murine Visceral Leishmaniasis Caused by Leishmania donovani and Leishmania infantum. Microbiol Spectr 2022; 10:e0067922. [PMID: 35384718 PMCID: PMC9045295 DOI: 10.1128/spectrum.00679-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 03/10/2022] [Indexed: 01/22/2023] Open
Abstract
Visceral leishmaniasis is associated with hepato-splenomegaly and altered immune and hematological parameters in both preclinical animal models and humans. We studied mouse experimental visceral leishmaniasis caused by Leishmania infantum and Leishmania donovani in BALB/c mice using dual RNA-seq to investigate the transcriptional response of host and parasite in liver and spleen. We identified only 4 species-specific parasite expressed genes (SSPEGs; log2FC >1, FDR <0.05) in the infected spleen, and none in the infected liver. For the host transcriptome, we found 789 differentially expressed genes (DEGs; log2FC >1, FDR <0.05) in the spleen that were common to both infections, with IFNγ signaling and complement and coagulation cascade pathways highly enriched, and an additional 286 and 186 DEGs that were selective to L. donovani and L. infantum infection, respectively. Among those, there were network interactions between genes of amino acid metabolism and PPAR signaling in L. donovani infection and increased IL1β and positive regulation of fatty acid transport in L. infantum infection, although no pathway enrichment was observed. In the liver, there were 1,939 DEGs in mice infected with either L. infantum or L. donovani in comparison to uninfected mice, and the most enriched pathways were IFNγ signaling, neutrophil mediated immunity, complement and coagulation, cytokine-chemokine responses, and hemostasis. Additionally, 221 DEGs were selective in L. donovani and 429 DEGs in L. infantum infections. These data show that the host response for these two visceral leishmaniasis infection models is broadly similar, and ∼10% of host DEGs vary in infections with either parasite species. IMPORTANCE Visceral leishmaniasis (VL) is caused by two species of Leishmania parasites, L. donovani in the Old World and L. infantum in the New World and countries bordering the Mediterranean. Although cardinal features such as hepato-splenomegaly and alterations in blood and immune function are evident, clinical presentation may vary by geography, with for example severe bleeding often associated with VL in Brazil. Although animal models of both L. donovani and L. infantum have been widely used to study disease pathogenesis, a direct side-by-side comparison of how these parasites species impact the infected host and/or how they might respond to the stresses of mammalian infection has not been previously reported. Identifying common and distinct pathways to pathogenesis will be important to ensure that new therapeutic or prophylactic approaches will be applicable across all forms of VL.
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Affiliation(s)
- Sarah Forrester
- York Biomedical Research Institute, Department of Biology, University of York, York, England, United Kingdom
| | - Amy Goundry
- York Biomedical Research Institute, Department of Biology, University of York, York, England, United Kingdom
- Instituto de Biofisica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Bruna Torres Dias
- Instituto de Biofisica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Paul M. Kaye
- York Biomedical Research Institute, Hull York Medical School, University of York, York, England, United Kingdom
| | - Jeremy C. Mottram
- York Biomedical Research Institute, Department of Biology, University of York, York, England, United Kingdom
| | - Ana Paula C. A. Lima
- Instituto de Biofisica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Rani GF, Ashwin H, Brown N, Hitchcock IS, Kaye PM. Hematological consequences of malaria in mice previously treated for visceral leishmaniasis. Wellcome Open Res 2021; 6:83. [PMID: 34286101 PMCID: PMC8276186 DOI: 10.12688/wellcomeopenres.16629.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Polyparasitism is commonplace in countries where endemicity for multiple parasites exists, and studies in animal models of coinfection have made significant inroads into understanding the impact of often competing demands on the immune system. However, few studies have addressed how previous exposure to and treatment for one infection impacts a subsequent heterologous infection. Methods: We used a C57BL/6 mouse model of drug-treated Leishmania donovani infection followed by experimental Plasmodium chabaudi AS malaria, focusing on hematological dysfunction as a common attribute of both infections. We measured parasite burden, blood parameters associated with anemia and thrombocytopenia, and serum thrombopoietin. In addition, we quantified macrophage iNOS expression through immunohistological analysis of the liver and spleen. Results: We found that the thrombocytopenia and anemia that accompanies primary L. donovani infection was rapidly reversed following single dose AmBisome® treatment, along with multiple other markers associated with immune activation (including restoration of tissue microarchitecture and reduced macrophage iNOS expression). Compared to naive mice, mice cured of previous L. donovani infection showed comparable albeit delayed clinical responses (including peak parasitemia and anemia) to P. chabaudi AS infection. Thrombocytopenia was also evident in these sequentially infected mice, consistent with a decrease in circulating levels of thrombopoietin. Architectural changes to the spleen were also comparable in sequentially infected mice compared to those with Plasmodium infection alone. Conclusions: Our data suggest that in this sequential infection model, previously-treated L. donovani infection has limited impact on the subsequent development of Plasmodium infection, but this issue deserves further attention in models of more severe disease or through longitudinal population studies in humans.
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Affiliation(s)
- Gulab Fatima Rani
- Hull York Medical School, University of York, UK, York, N. Yorks, Yo10 5DD, UK
| | - Helen Ashwin
- Hull York Medical School, University of York, UK, York, N. Yorks, Yo10 5DD, UK
| | - Najmeeyah Brown
- Hull York Medical School, University of York, UK, York, N. Yorks, Yo10 5DD, UK
| | - Ian S. Hitchcock
- Department of Biology, University of York, UK, York, N. Yorks, Yo10 5DD, UK
| | - Paul M. Kaye
- Hull York Medical School, University of York, UK, York, N. Yorks, Yo10 5DD, UK
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Rani GF, Ashwin H, Brown N, Hitchcock IS, Kaye PM. Hematological consequences of malaria infection in mice previously treated for visceral leishmaniasis. Wellcome Open Res 2021; 6:83. [PMID: 34286101 PMCID: PMC8276186 DOI: 10.12688/wellcomeopenres.16629.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 05/07/2024] Open
Abstract
Background: Polyparasitism is commonplace in countries where endemicity for multiple parasites exists, and studies in animal models of coinfection have made significant inroads into understanding the impact of often competing demands on the immune system. However, few studies have addressed how previous exposure to and treatment for one infection impacts a subsequent heterologous infection. Methods: We used a C57BL/6 mouse model of drug-treated Leishmania donovani infection followed by experimental Plasmodium chabaudi AS malaria, focusing on hematological dysfunction as a common attribute of both infections. We measured parasite burden, blood parameters associated with anemia and thrombocytopenia, and serum thrombopoietin. In addition, we quantified macrophage iNOS expression through immunohistological analysis of the liver and spleen. Results: We found that the thrombocytopenia and anemia that accompanies primary L. donovani infection was rapidly reversed following single dose AmBisome® treatment, along with multiple other markers associated with immune activation (including restoration of tissue microarchitecture and reduced macrophage iNOS expression). Compared to naive mice, mice cured of previous VL showed comparable albeit delayed clinical responses (including peak parasitemia and anemia) to P. chabaudi AS infection. Thrombocytopenia was also evident in these sequentially infected mice, consistent with a decrease in circulating levels of thrombopoietin. Architectural changes to the spleen were also comparable in sequentially infected mice compared to those with malaria alone. Conclusions: Our data suggest that in this sequential infection model, previously-treated VL has limited impact on the subsequent development of malaria, but this issue deserves further attention in models of more severe disease or through longitudinal population studies in humans.
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Affiliation(s)
- Gulab Fatima Rani
- Hull York Medical School, University of York, UK, York, N. Yorks, Yo10 5DD, UK
| | - Helen Ashwin
- Hull York Medical School, University of York, UK, York, N. Yorks, Yo10 5DD, UK
| | - Najmeeyah Brown
- Hull York Medical School, University of York, UK, York, N. Yorks, Yo10 5DD, UK
| | - Ian S. Hitchcock
- Department of Biology, University of York, UK, York, N. Yorks, Yo10 5DD, UK
| | - Paul M. Kaye
- Hull York Medical School, University of York, UK, York, N. Yorks, Yo10 5DD, UK
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