Mucocutaneous Leishmania tropica infection in a dog from a human cutaneous leishmaniasis focus
© Baneth et al.; licensee BioMed Central Ltd. 2014
Received: 31 December 2013
Accepted: 19 January 2014
Published: 24 March 2014
Leishmania tropica is a causative agent of cutaneous leishmanaisis in the Middle East, North Africa and parts of southeastern Europe. Although transmission of L. tropica has been reported as anthroponotic, in Israel it was found to have a zoonotic pattern.
A one year old male Pekingese dog from Maale Adumim, a focus of L. tropica human cutaneous leishmaniasis near Jerusalem, was presented by its owner with a large proliferative red mucocutaneous lesion on the lip between the mouth and nose. Physical examination and a biochemistry panel were normal and a complete blood count showed mild leukocytosis with lymphocytosis and eosinophilia. A biopsy of the lesion was suggestive of the presence of Leishmania organisms. Serology for Leishmania sp. by ELISA was positive and an aspirate from the lesion showed a large number of Leishmania amastigotes. ITS1-HRM-PCR of the lesion was positive and sequencing indicated that infection was caused by L. tropica, which was also cultured from the lesion. Blood PCR was negative. The dog responded well to allopurinol treatment and its lesion shrunk considerably within one month of therapy and healed after two months.
Only a few cases of dog infection with L. tropica have been described to date. They were reported from Morocco and Iran and involved infection of visceral organs. This is the first report of focal mucocutaneous L. tropica infection in a dog and its response to anti-leishmanial treatment. Domestic and wild canines should be evaluated for being possible animal reservoirs for human L. tropica infection in endemic areas or merely accidental hosts.
Ma’ale Adumim, the city where the dog described here lives, is a major emerging focus of human cutaneous leishmaniasis where 54 and 73 L. tropica human cases were recorded during 2004 and 2005, respectively. These numbers reflect a sharp increase in the annual incidence from 2 cases per 100,000 residents from 1999 until 2003 to 214 per 100,000 residents in 2004 .
Leishmania tropica is an important causative agent of cutaneous leishmaniasis in the Old World including the Middle East, North Africa, Central Asia and some parts of southern Europe. It has also been described as a rare cause of human visceral leishmaniasis . Although cutaneous leishmaniasis caused by L. tropica is usually considered an anthroponotic infection transmitted between people directly by phlebotomine sand flies without the involvement of an animal reservoir , in Israel, Jordan and the Palestinian Authority it is a zoonosis with the rock hyrax (Procavia capensis) as a main reservoir host [9, 10]. Golden jackals (Canis aureus) and red foxes (Vulpes vulpes) have also been found to be infected with L. tropica in Israel and assumed to have a role in transmission of the infection between distant locations, but clinical signs of infection in these wild canids have not been detected .
In the domestic dog, L. tropica infection has been described in only a few cases reported from Morocco and Iran where infection was mostly described to involve visceral organs [12–16]. While some surveys described the detection of parasite infection from dog organs by culture or PCR without much detail on the manifestations of disease [14, 16], reports from Morocco described two dogs infected with L. tropica with clinical manifestations similar to those found in canine L. infantum infection including generalized lymphadenomegaly, onychogryphosis, alopecia, keratoconjunctivitis, and also glomerulonephritis in one case [12, 13]. A report from northwestern Iran also described L. tropica in a dog with cutaneous and visceral involvement comparable to canine L. infantum infection . However, an earlier report from Morocco described seven dogs infected with L. tropica that had only dermal manifestations consisting of small facial papules without lymphadenomegaly or splenomegaly . In addition, a five month old pup with multiple lesions adjacent to the eyes, lips and jaw described as mucocutaneous, as well as generalized lymphadenomegaly and visceral infection of the spleen and liver, was reported from central Iran .
The dog described in the current report was admitted with a distinctive presentation of a single large proliferative mucocutaneous lesion that contained a large amount of L. tropica amastigotes, which is different from the typical dermal manifestations of canine L. infantum infection and also from the descriptions of visceralizing L. tropica in dogs. The dog did not present with any manifestations of involvement of internal organs or hematological and serum biochemical abnormalities common in visceral infection such as anemia, hyperglobulinemia, or hypoalbuminemia, and there was no indication that infection had progressed beyond the skin as the blood PCR was negative, although such progression cannot be ruled out. The lymphocytosis and eosinophilia found by CBC are not common findings in canine leishmaniasis and could be explained by some unique inflammatory response with an eosinohilic and lymphocytic component. The seropositivity to L. infantum antigen was also reported in other cases of canine L. tropica infection [12, 13] and is not surprising as there is a strong serological cross-reactivity between different Leishmania species. None of the dogs described with L. tropica infection previously have been treated with anti-leishmanial drugs. The excellent initial response to allopurinol treatment and the healing of the dog’s lesion indicate that allopurinol used as the major drug against canine L. infantum infection, is also effective against canine L. tropica infections.
This is the first report of focal mucocutaneous L. tropica infection in a dog and its response to anti-leishmanial treatment. Domestic and wild canine infection with L. tropica may be more prevalent in areas of endemic human L. tropica cutaneous leishmaniasis than currently recognized, and canines should be evaluated as possible additional reservoirs for human infection.
This study was supported by the Deutsche Forschungsgemeinschaft (DFG) as part of a German-Israeli-Palestinian cooperative project on the Emergence of Cutaneous Leishmaniasis in the Middle East: ‘An investigation of Leishmania tropica in the Palestinian Authority and Israel’ (SCHO 448/8-1). Publication of the CVBD9 thematic series has been sponsored by Bayer HealthCare - Animal Health division.
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