Table 2:

Clinical staging of canine leishmaniosis based on serological status, clinical signs and laboratory findings, and types of therapy and prognosis for each clinical stage (based on Solano-Gallego and others 2017)

Clinical stageSerology*Clinical signsLaboratory findingsTherapyPrognosis
Stage I
Mild disease
Negative to low positiveDogs with clinical signs such as solitary lymphadenomegaly or papular dermatitisUsually no clinicopathological abnormalitiesScientific neglect or monitoring of disease progressionGood
Stage II
Moderate disease
Low to high positiveDogs that, apart from the signs listed in Stage I, may present with diffuse or symmetrical cutaneous lesions such as exfoliative dermatitis/onychogryphosis, ulcerations, generalised lymphadenomegaly, loss of appetite, weight lossMild non-regenerative anaemia, hypergammaglobulinaemia, hypoalbuminaemia, serum hyperviscosity syndrome
Substage:
• Normal renal profile: creatinine <124 μmol/l; non-proteinuric UPC <0.5
• Creatinine <124 μmol/l; UPC = 0.5 to 1
Allopurinol + meglumine antimoniate or miltefosineGood to guarded
Stage III
Severe disease
Medium to high positiveDogs that, apart from the signs listed in Stage I and II, may present signs originating from immune complex lesions (eg, uveitis and glomerulonephritis)Clinicopathological abnormalities listed in Stage II
CKD IRIS Stage I with UPC = 1 to 5 or Stage II (creatinine 124 to 180 μmol/l)
Allopurinol + meglumine antimoniate or miltefosine
Follow IRIS guidelines for CKD
Guarded to poor
Stage IV
Very severe disease
Medium to high positiveDogs with clinical signs listed in Stage III. Pulmonary thromboembolism, or nephritic syndrome and end-stage renal diseaseClinicopathological abnormalities listed in Stage II
CKD IRIS Stage III (creatinine 181 to 440 μmol/l) and Stage IV (creatinine >440 μmol/l) or nephritic syndrome: marked proteinuria UPC >5
Specific treatment should be tailored to the individual
Follow IRIS guidelines for CKD
Poor
  • *Dogs with negative to medium positive antibody levels should be confirmed as infected with other diagnostic techniques such as cytology, histology/immunohistochemistry and PCR.

  • Dogs in Stage I (mild disease) are likely to require less prolonged treatment with one or two combined drugs (allopurinol, domperidone, meglumine antimoniate or miltefosine) or alternatively monitoring with no treatment. There is limited information on dogs in this stage and, therefore, treatment options remain to be defined

  • CKD Chronic kidney disease, IRIS International Renal Interest Society, UPC Urine protein:creatinine ratio