Clinical Staging, Treatment and Prognosis
Table 3. Clinical staging in CanL
Staging is performed following canine patient diagnosis of L. infantum infection with clinical signs and/or clinicopathologic abnormalities to facilitate appropriate treatment and monitoring of the patient). Infected but clinically healthy dogs are not included in this staging (see below).
| CLINICAL SIGNS | LABORATORY FINDINGS* | QUANTITATIVE SEROLOGY** | SPECIFIC THERAPY | PROGNOSIS | |
| STAGE I Mild disease |
Mild clinical signs such as example papular dermatitis or localized lymphadenomegaly | No clinicopathological abnormalities observed. Normal renal profile: creatinine < 1.4 mg/dL, non-proteinuric: UPC< 0.5 |
Negative to low positive antibody levels. | Scientific neglected*** | Usually good |
| STAGE II Moderate disease |
Diffuse or symmetrical cutaneous and/or mucocutaneous lesions such as example exfoliative, ulcerative or nodular dermatitis, onychogryphosis, generalized lymphadenomegaly, loss of appetite and weight loss. | Clinicopathological abnormalities compatible with L. infantum infection such as example mild non-regenerative anemia, hypergammaglobulinemia and hypoalbuminemia. Substage a) Normal renal profile: Creatinine < 1.4 mg/dl; non-proteinuric: UPC < 0.5 b) Creatinine < 1.4 mg/dL; proteinuric (UPC= 0.5-1) |
Low to high positive antibody levels. | Meglumine antimoniate + allopurinol Miltefosine + allopurinol Substage b: Follow IRIS Guidelines (†) for CKD |
Good to guarded |
| STAGE III Severe disease |
Dogs, which apart from the signs listed in stages I and II, may present signs originating due to immune-complex deposition (e.g. glomerulonephritis, uveitis). | Clinicopathological abnormalities listed in Stage II. CKD IRIS stage 1 with proteinuria UPC > 1 or CKD IRIS stage 2 (creatinine 1.4-2.8 mg/dl) |
Usually high positive antibody levels. | Meglumine antimoniate + allopurinol Miltefosine + allopurinol Follow IRIS Guidelines (†) for CKD |
Guarded to poor |
| STAGE IV Very severe disease |
Dogs with clinical signs listed in Stage III. Pulmonary thromboembolism, or nephrotic syndrome and end stage renal disease. | Clinicopathological abnormalities listed in stages II and III. CKD IRIS stage 3 (creatinine 2.9-5 mg/dl) and CKD IRIS stage 4 (creatinine > 5 mg/dl) or nephrotic syndrome or marked proteinuria UPC > 5 |
Usually high positive antibody levels. | Specific treatment should be instituted individually. Follow IRIS Guidelines (†) for CKD |
Poor |
CKD: Chronic kidney disease – IRIS: International Renal Interest Society – UPC: Urinary protein:creatinine ratio
* Full CBC, biochemical profile with serum protein electrophoresis and urinalysis with UPC.
(†) IRIS recommendations must be strictly followed in stages III and IV (http://www.iris-kidney.com/)
** Infection should be confirmed via other diagnostic techniques such as cytology, histology/immunohistochemistry and PCR in dogs with negative to low positive antibody levels. High antibody levels, are conclusive of CanL.
*** Dogs in stage I (mild disease) are likely to require short treatment with one (meglumine antimoniate, miltefosine, allopurinol) or two conventional anti-Leishmania drugs (combination of meglumine antimoniate with allopurinol or miltefosine with allopurinol). Immune-potentiating treatments in conjunction with antileishmanial drugs or alone may be considered (domperidone, nucleotides plus AHCC). Alternatively, consider monitoring without treatment. There is limited evidence of treatment outcomes for dogs in this stage and, therefore, efficacy of these treatment options remains inconclusive.