Successful treatment of feline leishmaniosis using a combination of allopurinol and N-methyl-glucamine antimoniate

Abstract

Case summaryThis work describes the diagnosis and successful treatment of a 2-year-old domestic cat infected with Leishmania species and presenting fever, and ulcerative and nodular skin lesions after being treated for pyodermatitis for 1 year without clinical improvement. After anamnesis the cat was submitted to a complete clinical examination. Blood was collected for determination of haematological and biochemical parameters, detection of feline leukaemia virus (FeLV), feline immunodeficiency virus (FIV), feline coronavirus (FCoV) and Leishmania amastigotes. Fine-needle aspiration puncture from the skin nodules was also performed. After definitive diagnosis the animal was treated and followed up over a 2 year period. The animal tested negative for FIV-specific antibodies, FeLV antigen and feline coronavirus RNA. Leishmania amastigotes in the skin nodules were confirmed by cytology and molecular diagnosis. Treatment was initiated with allopurinol, resulting in a slight clinical improvement. Thus, N-methyl-glucamine antimoniate was added and administered for 30 days, with complete closure of the ulcerative lesions in the hindlimbs requiring a surgical approach. Close monitoring of the patient in the following 24 months indicated that combined therapy was safe and clinical cure was achieved without further relapses or side effects.Relevance and novel informationConsidering the increasing number of feline leishmaniosis cases and the inconsistent results of most therapeutic protocols described in the literature, the use of new approaches, especially in refractory cases, is essential. Although the use of allopurinol and N-methyl-glucamine antimoniate is off-label in cats, in this case the combination treatment was followed by an extensive analytical monitoring, supporting their safety and effectiveness.

Feline leishmaniosis: Is the cat a small dog?

“…Less frequent and less severe clinical presentations could currently be unreported and we are presumably underestimating the clinical relevance of FeL. As it is reported in CanL, skin or mucocutaneous lesions are the most common reason for veterinary consultation and finding on physical examination in cats with leishmaniosis (Bardagi et al, 2016;Basso et al, 2016;Brianti et al, 2015;Dedola et al, 2015;Maia et al, 2015;Pennisi et al, 2015aPennisi et al, , 2016Saridomichelakis and Koutinas, 2014). Moreover, diverse macroscopic skin lesions can occur in the same dogs or cats.…”

“…Conversely, immunosenescence and the progressive chronic course of disease may explain another peak of disease seen in dogs older that eight years (Abranches et al, 1991;Day, 2010). Age range of cats reported with FeL is wide (2-21 years), however they are mostly mature cats (7-10 years old) at diagnosis and very few have 2-3 years of age (Bardagi et al, 2016;Basso et al, 2016;Britti et al, 2005;Hervás et al, 1999;Navarro et al, 2010;Pennisi et al, 2015aPennisi et al, , 2016. Moreover, FeL was never reported in pedegree cats so that at present there are no data supporting a genetic susceptibility to the disease in some cats.…”

“…However, the review of 89 reported cases of FeL where cats were serologically tested for FIV and Feline Leukemia Virus (FeLV) provides a 30.3% prevalence of FIV coinfection in cats with FeL and only four cats with FeLV co-infection (three of them also FIV positive) were detected (Bardagi et al, 2016;Basso et al, 2016;Brianti et al, 2015;Britti et al, 2005;Caracappa et al, 2008;Coelho et al, 2010;Dalmau et al, 2008;Dedola et al, 2015;Fileccia, 2012;Grevot et al, 2005;Hervás et al, 1999;Ibba, 2009;Laruelle-Magalon and Toga, 1996;Leiva et al, 2005;Marcos et al, 2009;Migliazzo et al, 2015;Ozon et al, 1998;Pennisi et al, 2013;Pimenta et al, 2015;Pocholle et al, 2012;Poli et al, 2002;Richter et al, 2014;Rüfenacht et al, 2005;Sanches et al, 2011;Verneuil, 2013;Vides et al, 2011). Other FeL cases reported in FIV negative cats were diagnosed in animals affected by immune-mediated diseases (and treated with immunosuppressive drugs), neoplasia, or diabetes mellitus (Bardagi et al, 2016;Basso et al, 2016;Caracappa et al, 2008;Laruelle-Magalon and Toga, 1996;Leiva et al, 2005;Maia et al, 2015;Marcos et al, 2009;Maroli et al, 2007;Migliazzo et al, 2015;Rüfenacht et al, 2005) and impaired immuno-competence is overall suspected in about half clinical cases of FeL. In...…”

“…Currently, in areas endemic for L. infantum, FeL is less frequently reported than CanL. Case reports published in recent years provided information on the most common clinical signs and clinico-pathological abnormalities associated with FeL (Bardagi et al, 2016;Basso et al, 2016;Brianti et al, 2014;Dedola et al, 2015;Maia et al, 2015;Pennisi et al, 2015aPennisi et al, , 2016Pimenta et al, 2015). However, coinfections or comorbidities are frequently detected in these cats and they can contribute to a misrepresentation of clinical FeL albeit lesions associated with the presence of the parasite have been detected in skin, lymph nodes, spleen, bone marrow, liver, oral mucosa, stomach, large bowel, kidney, nasal exudate, lung, eye (Pennisi, 2015).…”

“…Feline leishmaniosis (FeL) 3 caused by Li appears as an emerging feline disease, in fact in the past two decades it was more and more frequently reported in endemic areas and sporadically seen also in nonendemic areas in rehomed cats (Rüfenacht et al, 2005;Richter et al, 2014;Pennisi et al, 2015a;Maia et al, 2015;Basso et al, 2016;Pimenta et al, 2015). However, the increased level of medical care given to cats contributed to the «emergence» of FeL as well as availability of more sensitive diagnostic tools and progress in understanding parasite-host-vector interactions (Cantacessi et al, 2015).…”