2. Nicole K. Little, DVM

3.  4.5yr old MN Labradoodle  Moved from KY to Key West on 2/7/10  History of chronic v/d since 2/14/10  Referred to VSSF on 3/19/10  Poor hair coat and generalized muscle wasting

4.  Blood work: leukocytosis, thrombocytopenia, elevated liver enzymes, azotemia  Idexx cPL: normal  UA: glucosuria, proteinuria, isosthenuria  Urine culture: no growth  ACTH stim: wnl  Thoracic radiographs: hypoperfusion  Abdominal ultrasound: normal study  Lepto titers: 1:400 L. icterohaemorrhagia, L. grippotyphosa, L. autumnalis

5.  Hospitalized from 3/19 – 3/26  Intravenous fluids  Urinary collection system  Nasogastric tube  Ampicillin IV  Pepcid  Mirtazipine  Sent home with Amoxicillin and Doxycycline

6.  Etiology  Epidemiology  Pathogenesis  Clinical Signs  Diagnosis  Treatment  Prevention  Zoonosis

7.  Species: Leptospira interrogans sensu lato  Over 200 antigenically distinct serovars  Thin, flexible, motile, filamentous spirochete bacteria  Worldwide distribution in many mammalian hosts  Cats less susceptible

8.  Transmission  Direct and Indirect  Insects?  Environment = stagnant or slow moving warm water  Routes of infection  Penetrate mucous membranes and abraded skin  Can invade intact skin with prolonged contact

10.  Canicola, bratislava and grippotyphosa  Replicates and persists in renal tubular epithelial cells  Acute impairment of renal function  Role of leptospiral lipopolysaccharides, unsaturated fatty acids and endotoxins

11.  Icterohaemorrhagiae and pomona  Profound dysfunction may occur  Degree of icterus usually corresponds to the severity of hepatic necrosis  Chronic active hepatitis

12.  Lungs  Edema and hemorrhage  Nervous system  Meningitis  Eyes  Uveitis  Reproduction  Abortion and infertility

13.  Signalment  Young animals  Large breed, outdoor dogs  Clinical Signs  Fever  Vomiting  Dehydration  Reluctance to move  Petechia or ecchymosis  Icterus, ascites, HE  Oliguria or anuria  Cough or dyspnea

15.  CBC = leukocytosis, thrombocytopenia  Chemistry  Electrolyte abnormalities  Azotemia  Increased liver enzymes  Increased amylase and lipase  UA = glucosuria, proteinuria, bilirubinuria, isosthenuria  Urinary sediment = WBC, RBC, granular casts

16.  Microscopic Agglutination Test (MAT)  Standard  Detects antibodies  Requires darkfield microscopy  ELISA  IgG or IgM antibodies

17.  Isolation  Darkfield microscopy  Fluorescent antibody  PCR  Thoracic radiographs  Abdominal ultrasound

18.  Kidneys  Acute: enlarged, pale yellow-gray, subcapsular hemorrhage  Less acute: focal white spotting in renal cortex  Chronic: scarred and shrunken  Liver  Enlarged and friable, yellow-brown  Petechiae and ecchymoses  Lungs  Edematous and congested with spotty, diffuse infiltrates

19.  Microscopic Agglutination Test  Vax > 3 months prior  4-fold rise in paired titers at 3 week interval or titer ≥ 1:800  Compatible clinical findings  Microscopy  Compatible gross and microscopic lesions  Silver or immunostaining of tissues  Organism Identification  Darkfield microscopy of urine  Immunostaining of urine sediment  Positive PCR  Culture

20.  Leptospiremia  Penicillin G (25,000-40,000 U/kg IM, SQ, IV BID)  Ampicillin (22mg/kg PO, SQ, IV TID-QID)  Azotemia  Amoxicillin (22mg/kg PO BID-TID)  Carrier state  Doxycycline (2.5-5mg/kg PO BID x 2wks)  Aminoglycosides  Macrolides

21.  Diuresis  Osmotic diuretics +/- furosemide  Jugular catheter  Urinary catheter  Nutrition  Hemodialysis  Transfusions

22.  Kennel sanitation  Rodent control  Strict isolation of infected animals  Disinfectants

23.  Current vaccine includes canicola, icterohemorrhagiae, grippotyphosa, pomona  Older bacterins = allergenic  New Fort Dodge vaccine  Vaccination program  2-3 injections 2-3 weeks apart, then bi-annual to annual boosters

24.  Occupational and Recreational exposure  If your dog has Leptospirosis:  Avoid high-risk contact  Wear protective clothing  Wash your hands after handling your pet  Use diluted bleach or antibacterial cleaning agents  Symptoms in humans:  Usually flu-like  Weil syndrome (Highly symptomatic – possible death)

25.  Infectious Diseases of the Dog and Cat, 3 rd edition. Greene. Saunders, 2006. 402-417.  Stokes, JE et al. Prevalence of serum antibodies against six Leptospira serovars in healthy dogs. JAVMA, Vol 230 (11), 2007 (1657-1664).  Greene, Sessions, McLaughlin. Canine Leptospirosis: Epidemiology, Pathogenesis, and Diagnosis. Compendium, Vol 26 (8), 2004  Greene, Sessions, McLaughlin. Canine Leptospirosis: Treatment, Prevention and Zoonosis. Compendium, Vol 26 (9), 2004  Guerra, MA. Leptospirosis. JAVMA, Vol 234 (4). 2009 (472-478)