Use of preventive measures and serological screening tools for Leishmania infantum infection in dogs from Europe

Comparison of four commercial serological tests for the detection of Leishmania infantum antibodies in dogs

Early detection and treatment of cases of Leishmania infantum infection are critical in controlling the spread of the disease in dogs. Several serological methods are available to support the diagnosis of canine leishmaniosis. The immunofluorescence antibody test (IFAT) and enzyme-linked immunosorbent assay (ELISA) are the main tests used by clinicians. High antibody levels are associated with severe parasitism and disease and are diagnostic of clinical leishmaniosis. Conversely, the presence of low antibody levels is not necessarily indicative of disease and may be more difficult to detect by serological tests. The aim of this study was to evaluate and compare the diagnostic performance of four commercially available serological tests, including ELISAs (CIVTEST® CANIS LEISHMANIA short and standard protocols), LEISHMANIA-ELISA DOG®, ELISA/S7® and MegaFLUO®LEISH IFAT, for the detection of specific antibodies against L. infantum antigens in dogs in different states of infection. Canine sera samples from seropositive sick infected dogs (n = 75), seropositive apparently healthy dogs (n = 48), and seronegative apparently healthy dogs from a high endemic area (Cadiz, n = 40) and seronegative apparently healthy dogs from very low endemic area of L. infantum infection (Asturias, n = 40) were classified based on the results of an in-house UAB ELISA as a reference test. The positive percent of agreement (PPA) and negative percent of agreement (NPA) observed for each test were as follows: CIVTEST® standard (93.4 %, 100 %) on 202 samples tested, CIVTEST® short (84.4 %, 100 %) on 202 samples tested, LEISHMANIA-ELISA DOG® (81.8 %, 72.2 %) on 138 samples tested, ELISA/S7® (34.8 %, 45 %) on 195 samples tested and MegaFLUO®LEISH IFAT (100 %, 100 %) on 203 samples tested, respectively. The accuracy was as follows: CIVTEST® standard (0.96), CIVTEST® short (0.91), LEISHMANIA-ELISA DOG® (0.77), ELISA/S7® (0.39), and MegaFLUO®LEISH IFAT (1). The Cohen´s Kappa index (K) from best to worst was: MegaFLUO®LEISH IFAT (K = 1), CIVTEST® standard (K = 0.92), CIVTEST® short (K=0.81), LEISHMANIA-ELISA DOG® (K =0.54), and ELISA/S7® (K=-0.19). Finally, the area under the receiver operating characteristic curve (AUC-ROC), in the ELISAs test, ordered from the maximum to the minimum value was: CIVTEST® short (1), CIVTEST® standard (0.99), LEISHMANIA-ELISA DOG® (0.87), and S7® (0.37). In conclusion, this study demonstrated that the diagnostic performance of the commercially available ELISA tests against L. infantum antigen can vary widely. Moreover, it highlights the fact that CIVTEST® CANIS LEISHMANIA is a reliable test to support the diagnosis of canine leishmaniosis in clinical settings.

Twenty-year evolution of Leishmania infantum infection in dogs in Valdeorras (Galicia, Northwestern Spain): implication of climatic factors and preventive measures

BACKGROUND

Abiotic factors play a significant role in the evolution of Leishmania infantum infection due to its vectorial nature. This study aims to assess the evolution in the detection of new L. infantum infection cases in Valdeorras (Ourense, Northwestern Spain) over a 20-year period and how different climatic variables and preventive measures may have affected it.

METHODS

Indirect immunofluorescence antibody tests (IFAT) were performed on serum samples collected from dogs attending the 'Servicios Veterinarios de Sil' veterinary clinic (Valdeorras, Northwestern Spain) between May 2003 and April 2023 to detect L. infantum exposure. The percentage of new cases of L. infantum infection was calculated from May of one year to April of the following year. Climatic conditions in the region, global sales of ectoparasiticides and the number of vaccines against L. infantum delivered in the veterinary clinic from 2003 to 2022 were recorded. Statistical analyses were conducted to determine the associations between these factors and the percentage of new cases of L. infantum infection.

RESULTS

A total of 2909 dogs were assessed, and 3785 IFAT tests were performed between May 2003 and April 2023. The mean percentage of new seropositive cases over the 20-year period studied was 21.65 ± 10.8%, with a decline from the beginning to the end of the period studied. The percentage was significantly higher between May 2003 and April 2008 compared with the other periods (May 2008 to April 2013, May 2013 to April 2018 and May 2018 to April 2023). There was a positive correlation between the percentage of new cases of L. infantum infection and the maximum relative humidity in winter. Conversely, there was a negative correlation between the percentage of new cases and sales of ectoparasiticides and vaccination against L. infantum.

CONCLUSIONS

This study is one of the longest evaluations of the evolution of L. infantum infection in a fixed location and its association with external factors including climatic conditions and preventive measures. The results confirm that Valdeorras is a high-risk area for L. infantum infection. The use of ectoparasiticides and vaccines against L. infantum has been shown to play a significant role in preventing L. infantum infection, highlighting the crucial role of veterinarians in the fight against this disease.

A 10-Year Retrospective Study on Pediatric Visceral Leishmaniasis in a European Endemic Area: Diagnostic and Short-Course Therapeutic Strategies

BACKGROUND

Visceral leishmaniasis (VL) is a potentially fatal disease, with an increasing occurrence in northern Italy, affecting children and both immunocompetent and immunocompromised adults.

METHODS

This retrospective study conducted at the St. Orsola University Hospital of Bologna, Italy, evaluates the characteristics of 16 children (with a median age of 14.3 months) who were hospitalized between 2013 and 2022 for VL.

RESULTS

Seventy-five percent of patients presented with a triad of fever, cytopenia, and splenomegaly. An abdominal ultrasound examination revealed splenomegaly and hypoechoic spleen abnormalities in 93.8% and 73.3% of cases, respectively. Five VL cases were complicated by secondary hemophagocytic lymphohistiocytosis. Eleven patients were treated with a single 10 mg/kg dose of Liposomal Amphotericin B (L-AmB), while five received two doses (total of 20 mg/kg); one of the former groups experienced a recurrence. The fever generally decreased 48 h after the first L-AmB dose, and hemoglobin levels normalized within a month. The splenomegaly resolved in approximately 4.5 months.

CONCLUSIONS

Pediatricians should consider VL in children with fever of an unknown origin, anemia, cytopenia, and splenomegaly. In our experience, abdominal ultrasounds and molecular tests on peripheral blood contributed to diagnosis without the need for bone marrow aspiration. The short-course therapy with two 10 mg/kg doses of L-AmB is safe and effective.

Knock, knock, knocking on Europes door: Threat of leishmaniasis in Europe with a focus on Turkey

Leishmaniasis epidemiology is currently undergoing substantial transformations in both Turkey and Europe, signifying potential implications for public health. This review analyzes the evolving patterns within Turkey and their potential ramifications for Europe. Within Turkey, the dynamics of leishmaniasis are undergoing noteworthy alterations, manifesting in a rise in cutaneous leishmaniasis (CL) cases and the emergence of Leishmania major and Leishmania donovani. These transformations are predominantly driven by factors such as the distribution of vectors, human activities, climate fluctuations, and migration. Across Europe, particularly in countries within the Mediterranean basin, leishmaniasis is endemic, primarily attributed to Leishmania infantum. Recent evidence suggests a resurgence of the disease even in previously non-endemic areas, propelled by climate change, urbanization, and migration. The changing landscape of leishmaniasis in Turkey carries direct implications for Europe. The presence and distribution of Leishmania tropica, L. major, and L. donovani raise concerns regarding cross-border transmission. Turkey's strategic position along migration routes further compounds the risk, alongside the facilitative effects of climate change and host mobility. Embracing a One Health approach with public awareness campaigns should be a priority. To ensure the protection of public health in Europe, it is imperative to adopt a proactive approach by establishing robust surveillance mechanisms, implementing preventive measures, and cultivating collaboration with Turkey. The invaluable experience, strategic geographical location, and well-established infrastructure of Turkey make this collaboration crucial in effectively addressing the evolving dynamics of leishmaniasis and its potential impacts on Europe.

Transmission-Blocking Vaccines for Canine Visceral Leishmaniasis: New Progress and Yet New Challenges

Dogs with visceral leishmaniasis play a key role in the transmission cycle of Leishmania infantum to humans in the urban environment. There is a consensus regarding the importance of developing a vaccine to control this disease. Despite many efforts to develop a protective vaccine against CVL, the ones currently available, Leish-tec® and LetiFend®, have limited effectiveness. This is due, in part, to the complexity of the immune response of the naturally infected dogs against the parasite and the complexity of the parasite transmission cycle. Thus, strategies, such as the development of a transmission-blocking vaccines (TBVs) already being applied to other vector-borne diseases like malaria and dengue, would be an attractive alternative to control leishmaniasis. TBVs induce the production of antibodies in the vertebrate host, which can inhibit parasite development in the vector and/or interfere with aspects of vector biology, leading to an interruption of parasite transmission. To date, there are few TBV studies for CVL and other leishmaniasis forms. However, the few studies that exist show promising results, thus justifying the further development of this approach.

Serological survey of Leishmania infantum in apparently healthy dogs in different areas of Spain

BACKGROUND

Canine leishmaniosis caused by Leishmania infantum is an endemic disease in Spain. The dog is considered the main reservoir, and the detection of specific serum antibodies against L. infantum antigen is the most used technique for diagnosing this infection. The LEISCAN LEISHMANIA ELISA test is a commercialized enzyme-linked immunosorbent assay for the detection and measurement of canine anti-Leishmania serum antibodies.

OBJECTIVES

The aim of this study was to assess seroprevalence results of apparently healthy dogs in different areas of Spain using LEISCAN.

METHODS

Collection of sera from 5451 apparently healthy dogs was performed between 2020 and 2021 in different areas of Spain. Dogs were of adult age (≥12 months), were not previously diagnosed with clinical leishmaniosis or vaccinated against Leishmania and did not present clinical signs compatible with L. infantum infection. LEISCAN was performed following the manufacturer's protocol.

RESULTS

The overall seroprevalence was 5.5%. The highest seroprevalences were found in the Southeast of Spain: Comunidad Valenciana (14%) and Región de Murcia (14%), whereas the lowest seroprevalences were found in Northern Spain: Galicia (1%), Navarra (2%) and Castilla y León (2%) (p-value <0.001).

CONCLUSIONS

In conclusion, the seroprevalence for L. infantum in apparently healthy dogs in Spain varied from almost no infection to being over 10%.

Signalment, Immunological and Parasitological Status and Clinicopathological Findings of Leishmania-Seropositive Apparently Healthy Dogs

Canine leishmaniosis caused by Leishmania infantum is a disease with a wide range of clinical manifestations. Epidemiological serosurveys performed in Europe often lack a thorough assessment of clinical health status of studied dogs. The aim of this study was to evaluate signalment, immunological and parasitological status and clinicopathological findings of L. infantum-seropositive apparently healthy dogs (n = 212) living in endemic areas. Routine laboratory tests, endpoint in-house ELISA to quantify the anti-Leishmania antibodies, blood Leishmania qPCR and IFN-γ ELISA were performed. All dogs enrolled were L. infantum-seropositive and were classified as healthy (n = 105) or sick (n = 107) according to LeishVet guidelines. The sick group presented a higher proportion of medium to high antibody levels and positive qPCR and lower IFN-γ concentration compared to the healthy group. Sick dogs were mostly classified in LeishVet stage IIa. Biochemical alterations (98%) were the most common clinicopathological findings, with fewer urinary tract (46%) and hematological (40%) alterations. Apparently healthy L. infantum-seropositive dogs can be classified between truly healthy dogs and sick dogs with clinicopathological findings. Sick dogs presented medium to high seropositivity and parasitemia and low IFN-γ concentrations, and their most common clinicopathological abnormalities were serum protein alterations followed by proteinuria and lymphopenia.

Seroprevalence of canine leishmaniosis in asymptomatic dogs in Kosovo

Canine leishmaniosis (CanL) is a neglected zoonotic disease caused by Leishmania spp. Leishmania infantum is the species responsible for the zoonotic form of the disease where dogs are reservoir hosts. This study aimed to determine the seroprevalence of CanL in asymptomatic dogs in Kosovo. Blood samples were collected from 285 dogs in all seven regions in Kosovo (35-50 samples per region) from summer 2021 to spring 2022. Sera were tested using enzyme-linked immunosorbent assay (ELISA), and the presence of anti-Leishmania IgG was confirmed by an indirect fluorescent antibody test (IFAT). The true overall seroprevalence of CanL of asymptomatic dogs in Kosovo with ELISA was 4.21% (95% CI: 2.42-7.21) while with IFAT was 3.51% (95% CI: 1.92-6.34). The highest rates were found in the Prishtina region to be 8.0% (4/50) by ELISA and 6.0% (3/50) by IFAT, and in the Mitrovica region, the prevalence was 0% (0/40). There were no significant differences among the different regions, gender, age, health status, and breed. These findings highlight the presence of CanL in most regions of Kosovo and underline the veterinary relevance of clinically asymptomatic dogs infected with Leishmania.

Establishment of an indicator framework for the transmission risk of the mountain-type zoonotic visceral leishmaniasis based on the Delphi-entropy weight method

BACKGROUND

Visceral leishmaniasis (VL) is one of the most important neglected tropical diseases. Although VL was controlled in several regions of China during the last century, the mountain-type zoonotic visceral leishmaniasis (MT-ZVL) has reemerged in the hilly areas of China in recent decades. The purpose of this study was to construct an indicator framework for assessing the risk of the MT-ZVL in China, and to provide guidance for preventing disease.

METHODS

Based on a literature review and expert interview, a 3-level indicator framework was initially established in November 2021, and 28 experts were selected to perform two rounds of consultation using the Delphi method. The comprehensive weight of the tertiary indicators was determined by the Delphi and the entropy weight methods.

RESULTS

Two rounds of Delphi consultation were conducted. Four primary indicators, 11 secondary indicators, and 35 tertiary indicators were identified. The Delphi-entropy weight method was performed to calculate the comprehensive weight of the tertiary indicators. The normalized weights of the primary indicators were 0.268, 0.261, 0.242, and 0.229, respectively, for biological factors, interventions, environmental factors, and social factors. The normalized weights of the top four secondary indicators were 0.122, 0.120, 0.098, and 0.096, respectively, for climatic features, geographical features, sandflies, and dogs. Among the tertiary indicators, the top four normalized comprehensive weights were the population density of sandflies (0.076), topography (0.057), the population density of dogs, including tethering (0.056), and use of bed nets or other protective measures (0.056).

CONCLUSIONS

An indicator framework of transmission risk assessment for MT-ZVL was established using the Delphi-entropy weight method. The framework provides a practical tool to evaluate transmission risk in endemic areas.

Seroprevalence and Risk Factors Associated with Leishmania Infection in Dogs from Portugal

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.

Canine Leishmaniasis: Update on Epidemiology, Diagnosis, Treatment, and Prevention

Dog are the main reservoir of Leishmania infantum, causing canine leishmaniasis, an incurable multisystemic disease that leads to death in symptomatic dogs, when not treated. This parasite causes visceral, cutaneous, and mucosal leishmaniasis in people in the Mediterranean Basin, North Africa, South America, and West Asia. This disease is mostly unknown by veterinarians outside the endemic areas, but the disease is expanding in the Northern Hemisphere due to travel and climate change. New methodologies to study the epidemiology of the disease have found new hosts of leishmaniasis and drawn a completely new picture of the parasite biological cycle. Canine leishmaniasis diagnosis has evolved over the years through the analysis of new samples using novel molecular techniques. Given the neglected nature of leishmaniasis, progress in drug discovery is slow, and the few drugs that reach clinical stages in humans are unlikely to be commercialised for dogs, but several approaches have been developed to support chemotherapy. New-generation vaccines developed during the last decade are now widely used, along with novel prevention strategies. The implications of the epidemiology, diagnosis, treatment, and prevention of canine leishmaniasis are fundamental to public health.