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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
  1. *Dogs with negative to medium positive antibody levels should be confirmed as infected by other diagnostic techniques such as cytology, histology, immunohistochemistry or PCR. High levels of antibodies, defined as a 3-4 fold elevation above the cut off level of a well established reference laboratory, are conclusive of a diagnosis of CanL. **Dogs in stage I (mild disease) are likely to require less prolonged treatment with one or two combined drugs or alternatively monitoring with no treatment. However, there is limited information on dogs in this stage and, therefore, treatment options remain to be defined.