Leishmaniosis* - The Skin Vet

Leishmania Amastigotes, pouring out of a ruptured Macrophage, in-house Lymph Node Aspirate Cytology

Leishmania Granulomas: Inner Ear Flap before & after only 4 weeks of treatment, immediate Diagnostic Aspirate Cytology; 7.5 month old Hungarian Vizsla (Leishmania infantum)

I am receiving increasing numbers of e-consultations and referrals for cutaneous Leishmaniosis cases. This is due to the ever increasing number of dogs travelling to and from the Mediterranean basin on holiday, as well as stray dogs being rescued by individuals independently or through animal welfare organisations, for re-homing in the UK.

2015 Leishvet Guidelines for the Practical Management of Canine & Feline Leishmaniosis. Solano-Galego L., Miro G., Koutinas A., Cardoso L., Pennisi M. G., Ferrer L., Bourdeau P., Oliva G. and Baneth G. http://www.leishvet.org/fact-sheet/

Leishmaniosis Fact Sheet (BSAVA)

In August 2009, The BSAVA Companion magazine published an article entitled ‘Keeping Britain Safe’ about the further relaxation in health checks and disease control measures in the Pets Travel Scheme and the already increasing prevalence of imported exotic diseases in travelled dogs. I was asked contribute to this article with comments and photographs on a recent fatal case of Leishmaniosis. Frustratingly the most important point I was hoping to make in the article was misquoted – a corrigendum (apology) was finally made in the November issue: ‘whilst the majority of cases present within the first 18 months, the incubation period in canine Leishmaniosis may be very prolonged and clinical signs have been reported to first occur up to 7 years after infection”. The original article had stated the incubation period was “up to a year”.

In 2016, the Journal of Small Animal Practice published a paper by Silvestrini P et al (2016) Clinical Leishmaniosis in Dogs living in the UK. JSAP 57(9) p453-8. Only 38 cases were described, from between 2005 and 2014, because the authors only looked at the records of 7 referral centres despite the title of the paper. Diagnoses made by peripatetic dermatologists, such a myself, as well as general practitioners, were not included. Interestingly, despite being referenced in this paper, a dermatologist-authored paper described 258 cases in the UK (only between 2005 and 2007). Shaw, S et al (2009) Canine Leishmaniosis in the UK: a zoonotic disease waiting for a vector. Vet Parasitol 163(4) p281-5. Being such a recent paper, I am concerned that after a brief search for prevalence data the authorities, and other interested parties, might feel that the condition is ‘rare’ in the UK, as was concluded by Silvestrini et al.

Of further concern, in 21st January 2019, the Vet Record journal published a confirmed case report describing so-called horizontal transmission of Leishmaniosis from an infected dog to a un-travelled companion dog in the UK. This is termed autocthonus transmission and can be likened to a human contracting malaria within the UK, after being in close contact with an infected human, but without being bitten by an Anopheles mosquito (which are not resident in the UK). McKenna, M et al (2019) Leishmaniosis in a dog with no travel history outside of the UK Veterinary Record 184, 441.

In March 2019, I took part in a round-table discussion with other colleagues, facilitated by UK Vet (Companion Animal) Journal & MSD Animal Health on pet travel and exotic (imported) diseases. I presented on the dermatological aspects of Leishmaniosis.

Once a definitive diagnosis of Leishmaniosis has been made, a UK Vet legally has to apply to the Veterinary Medicines Directorate (VMD, DEFRA) for a Special Import Certificate (SIC) before being allowed to purchase & import one of only two leishmaniocidal medications. I proposed to the aforementioned round-table delegates that the sum of the two totals of annual SICs would provide us with a close, though minimal, approximation for the rising number of diagnosed cases of this exotic disease in the UK. Soon after, the VMD released the telling data, which I have charted, below recently including the 2019 & 2020 totals. This was made possible due to the Freedom of Information Act 2000 and he UK Government’s Transparency Agency. As you can see there is a rapid increase in the number of annual cases – 243 times as many cases in 2022 as in 2006 (despite the SARS-CoV-2 Pandemic), a total of 4,715 in the last full 10 years (2013-2022) or 545 cases versus the 38 described in Silvestrini’s UK 2005-2014 prevalence paper (minus the 2015 figure).

20230101 Graph of SICs for Tx Leishmaniosis (VMD)

These figures do not include the fatal cases that were not diagnosed, the cases that were euthanased upon diagnosis, the cases that were only treated palliatively and the cases for which medication was acquired without SIC application.

*formerly Leishmaniasis

We consulted Charlie Walker, The Skin Vet, with our 2yr old Greek rescue dog, Leo, who had been suffering with a progressive skin condition which had not responded to the usual treatments. At our first consultation Charlie suggested a possible diagnosis of Leishmaniasis, a potentially fatal parasitic condition common in Mediterranean Europe, but not seen in British-born dogs and therefore not commonly seen by British vets. Clinical tests quickly confirmed the diagnosis and Charlie recommended a treatment which was known to be effective, but not licensed for use in Britain. He quickly organised for a special licence which would allow us to obtain and use this medication, which he also sourced for us. Charlie even managed to find a way to help us recoup some of the cost of medication after treatment.

Client: Mrs Lucy Caynes, Crossbreed ‘Leo’
Six months after rescuing ‘Luna’ from Serbia, she started to show skin irritation. Fast forward two years later and many, many, many different treatments from various vets I was at my wits end. ‘Luna’ was getting progressively worse with scratching, her fur falling out and I could see she was uncomfortable. She was very bad tempered with other dogs (which, incidentally, I did not relate to her skin condition – I thought it was linked to her being a nervous rescue dog). One week after ‘Luna’s appointment the improvement in her is unbelievable. She has never had such a full, glossy coat & the best bit is that, now she is no longer uncomfortable, her behaviour has improved. I am aware that she may have a flare up, but the fact that she has improved by 100% rather than progressively getting worse is amazing. I highly recommend Charlie Walker. He explains all the procedures and tests precisely & his interest in the skin condition is heart-warming as I know he is taking ‘Luna’s symptoms seriously. My only regret is that I only found out about him recently. Thank you, Charlie for all your help.

Client: Mrs Sue Crabtree, terrier crossbreed ‘Luna’
20210520 Having adopted our wonderful former street dog, Livi, from the Greek island of Zakynthos - who had been tested and cleared of leishmaniasis - our vet referred us to Charlie (The Skin Vet) when we noticed patches of dry skin & hair loss appearing on her face & legs which the vet could not explain or treat. Charlie explained that leishmaniasis can remain dormant in dogs for years & set about attempting to obtain a diagnosis - which proved tricky as 'Livi's condition was in such early stages. He was ultimately proved right & subsequently oversaw 'Livi's treatment, recovery & ongoing health & wellbeing through medication, diet & regular testing. We are very grateful to Charlie for his knowledge of & expertise in this relatively little-known (in the UK) condition, and for always being so helpful & approachable.

Client: Miss Heather Stanley, Crossbreed 'Livi'