Table 4 Clinical staging of canine leishmaniosis based on serological status, clinical signs, laboratory findings, and type of therapy and prognosis for each stage [27]
From: LeishVet guidelines for the practical management of canine leishmaniosis
Clinical stages | Serology * | Clinical signs | Laboratory findings | Therapy | Prognosis |
|---|---|---|---|---|---|
Stage I Mild disease | Negative to low positive antibody levels | Dogs with mild clinical signs such as peripheral lymphadenomegaly, or papular dermatitis | Usually no clinicopathological abnormalities observed Normal renal profile: creatinine < 1.4 mg/dl; non-proteinuric: UPC < 0.5 | Scientific neglect/allopurinol or meglumine antimoniate or miltefosine/allopurinol + meglumine antimoniate or allopurinol + miltefosine** | Good |
Stage II Moderate disease | Low to high positive antibody levels | Dogs, which apart from the signs listed in stage I, may present: diffuse or symmetrical cutaneous lesions such as exfoliative dermatitis/onychogryphosis, ulcerations (planum nasale, footpads, bony prominences, mucocutaneous junctions), anorexia, weight loss, fever, and epistaxis | Clinicopathological abnormalities such as mild non-regenerative anemia, hyperglobulinemia, hypoalbuminemia, serum hyperviscosity syndrome Substages a) Normal renal profile: creatinine < 1.4 mg/dl; non-proteinuric: UPC < 0.5 b) Creatinine <1.4 mg/dl; UPC = 0.5-1 | Allopurinol + meglumine antimoniate or allopurinol+ miltefosine | Good to guarded |
Stage III Severe disease | Medium to high positive antibody levels | Dogs, which apart from the signs listed in stages I and II, may present signs originating from immune-complex lesions: vasculitis, arthritis, uveitis and glomerulonephritis. | Clinicopathological abnormalities listed in stage II Chronic kidney disease (CKD) IRIS stage I with UPC > 1 or stage II (creatinine 1.4-2 mg/dl) [79] | Allopurinol + meglumine antimoniate or allopurinol + miltefosine Follow IRIS guidelines for CKD [80] | Guarded to poor |
Stage IV Very severe disease | Medium to high positive antibody levels | Dogs with clinical signs listed in stage III. Pulmonary thromboembolism, or nephrotic syndrome and end stage renal disease | Clinicopathological abnormalities listed in stage II CKD IRIS stage III (creatinine 2-5 mg/dl) and stage IV (creatinine > 5 mg/dl) [79] Nephrotic syndrome: marked proteinuria UPC > 5 | Allopurinol (alone) Follow IRIS guidelines for CKD [80] | Poor |