by Elmar M. Breuer, Dr. med. vet., practical TA / FTA f. pathology
Leishmaniasis is an important zoonosis caused by protozoa of the genus Leishmania. The pathogen is transmitted from animal to animal through bites of the female mosquito of Phlebotomus perniciosus and P. ariasi, which preferably bites dogs. Other parasites such as fleas or ticks that have previously bitten dogs or hosts with leishmaniasis can also transmit leishmaniasis.
Leishmania is originally a subtropical parasite – however, due to global climate change and the global warming, leishmaniasis is now also widespread in the Mediterranean, around the Swiss lakes and in many rural areas in the southern and central part of the Iberian Peninsula.
In nature, wild rodents serve as hosts of the parasite and are a source of sporadic transmissions. Hosts often do not show any noticeable symptoms, which helps the self-preservation of parasite and host.
The risk of being bitten by the tiny sand flies and becoming ill is particularly high in spring and in the warmer seasons and usually takes place around sunrise and sunset.
An effective prevention against leishmania consists is giving dogs medicinal or scent repellants of natural plant such as citronella and / or Cistus spp (Rockrose) to prevent mosquitoes from biting sensitive areas such as the head, mucous membranes, neck or areas not covered by fur.
The sand flies have quite a limited flight radius. During their lifetime, they do not fly further than 200 meters from where the larvae are deposited, and in flight, they hardly reach a height of more than five meters. They develop their larvae in riverside areas and mud substrates, e.g. in puddles of tree nurseries and agricultural areas, which results in urban and rural areas with a high occurrence of leishmaniasis.
There are two clinical manifestations of leishmaniasis:
a) cutaneous form (on the skin)
b) visceral form; this latter is the more serious form.
A couple of breeds are infected more frequently, among them Boxer, Golden Retriever and, especially, Huskies. The disease occurs less frequently in the Galgo and Podenco breeds.
Skin leishmaniasis is usually not so noticeable in dogs at first, but can infect internal organs such as kidneys and liver if not treated in time. The cutaneous form usually only progresses slowly after the bite and in many cases without any symptoms. The clinical symptomatology is very variable. Ultimately, it can be fatal to the dog through organ failure.
Indications for skin leishmaniasis are:
– Skin changes without itching in the form of hyperkeratoses and irregular, whitish scales, alopecia, depigmentation, ulceration, cracks in the skin and (oozing) bleeding, especially at the edges of the ears
– Places of skin changes: joints, limbs and hyperkeratotic pads, edges of the ears, nose, nasal mirror, around both eyes (typical glasses formation)
– Brittle and unusually long, partly hollow claws. When the disease progresses, the following symptoms may occur
– reduced exercise capacity
– weight loss
– swollen lymph nodes, often on the dog’s hind limbs
– Movement disorders
Visceral form with measurable kidney or liver insufficiency, nosebleeds, indigestion, tummy tuck, weight loss, loss of appetite, apathy and moderate, undulating fever
Diagnosis, standard treatment and further individual treatment:
- Direct diagnosis via identification of pathogens by means of PCR from puncture material (bone marrow, lymph nodes) or from skin biopsies or imprints of skin lesions.
• Indirect diagnosis through antibody detection using ELISA (90% sensitivity) or IFAT (50-70% sensitivity); Antibodies can be verified only 2-3 weeks after infection.
- Assumption: The dog is infected but clinically healthy. The dog shows no symptoms on clinical examination and there are no clinical pathological findings in routine laboratory examinations (complete blood count, biochemical profile and urine examination); however, an infection was detected.
- Such dogs must be monitored every 3 to 6 months
- Assumption:The dog is infected and shows clear clinical and / or clinicopathological findings.
- Recording of the current medication in the dog: preparation and dosage:
• Antibody titer height:
• Results of protein electrophoresis
• Albumin / globulin quotient
• Creatinine value:
• proteinuria? UPC value
LupArte 2.0: THERAPY PROTOCOL
The dosage and protocol for Leishmania may vary depending on the Leishmania titers and the clinical condition of the dog.
There are two protocols for LupArte 2.0, one with added iron and one without iron.
To date, there is no treatment that guarantees a complete cure for leishmaniasis. The standard treatment with Allopurinol / Glucantime is – for good reasons – designed to be permanent. It usually alleviates the animal’s clinical symptoms significantly (at least temporarily) and reduces organ complications. Often, however, effectiveness is being reduced with time and some dogs develop a severe intolerance. Furthermore, the titer can sometimes not be controlled / reduced.
Parasites are camouflage experts and when they feel threatened (e.g. by treatment), they acquire persistent forms that cannot be noticed by the immune system. Therefore, depending on the titer, usually lifelong clinical treatment is required.
LupArte 2.0 (Plant leafs and an extract of Artemisia annua 30: 1 in an optimized blend) has been used for more than a decade with successful results e.g. in Spain and has also been monitored by veterinarians with laboratory diagnostics: The symptoms can be reduced; the titer sinks. There are ongoing systematic investigations.
Depending on the cultivation method, climate and soil, Artemisia annua plants differ in their composition. In addition, different modes of processing and medication administration have a strong effect on the active ingredient content.
After more than a decade of experience with the effects of Artemisia annua in dogs, we know that this plant contains an effective set of active ingredients. The scope of this plant is still relatively unknown and its effect has not yet been adequately researched, but there are some positive changes.
LupArte 2.0 is a carefully selected and prepared mixture of high-quality Annua Artemisia plants of various origins. Various spectroscopic analyses have been performed to improve this product and to achieve an optimum combination of artemisinin, casticin, chrysosplenol-D and eupatorin in addition to all the other largely unknown ingredients of this herb.
LupArte 2.0 protocol without addition of iron:
Dogs with high titers and / or severe symptoms: approx. 75 mg / kg / day of LupArte 2.0, divided into 3, or better 4 doses / day, for 12 weeks without interruption, always approx. 30-60 minutes before feeding in cheese / rice balls.
This is also the ideal time to check the Leishmania titer for the first time. From the 12th week the dose is usually reduced to continue therapy with approx. 50mg / kg / day which is also given in 3 to 4 doses, for a further 12 weeks without interruption.
Lifelong treatment is recommended, as the parasite cannot be completely eliminated: It uses an effective immunological camouflage and may multiply without being noticed by the immune system. Therefore, treatment should only be experimentally discontinued after 6 months, when the disease appears to be controlled.
Continuous situational therapy:
Dogs with low titers and controlled symptoms can be treated with a maintenance dose of approx. 50 mg / kg / day from the 12th week, ideally without interruption, or on an experimental basis with a duration of 5-7 days with a 2-day interruption.
If the symptoms return due to decreasing effectiveness or discontinuation of LupArte 2.0, it is advisable to start again with the initial therapy of approx. 75 mg / kg / day, and the symptoms usually decrease again. If not, watch out for possible visceral symptoms.
LupArte 2.0 protocol with iron addition: (under veterinary supervision)
The effects of the treatment with LupArte 2.0 can be improved through an additional oral application of iron or, even better, iron injections (frequency to be adjusted accordingly).
This supports what is known as ferroptosis, which means that the complex Artemisia annua effect is optimized by the presence of increased free iron. This treatment is only recommended under strict veterinary supervision, a regular titer analysis and a correction of the weekly iron doses if required. The aim is to maintain permanently high, but safe iron levels in the blood. The normal iron range is 140-170 µg / dl.
The target iron range is 250 + – 30 µg / dl during the entire treatment.
Start: After the initial control of the serum iron in the first three days before starting treatment with LupArte 2.0, iron should be orally given, e.g. in the form of Ferrosanol® capsules (100 mg / capsule) or Ferrosanol® drops (30 mg / ml). Initial dose: 100 mg / 30 kg weight. Cheaper and more effective are intramuscular or subcutaneous injections, e.g. of Ursoferran® / Myofer® (100mg iron / ml). Initial dose: 100 mg / 10 kg weight once or twice a week.
From the third day of administering iron, a continuous treatment with LupArte 2.0 is to be started. Dose: 50 mg x kilo / day divided into 3 doses, about one hour before meals. The drug should preferably be administered with cheese / rice balls instead of meat!
The iron doses are to be continued depending on the situation, and the doses and frequency are to be readjusted during the first 12 weeks of treatment with LupArte 2.0 to guarantee a high level of 250± 30 µg / dl. The ideal time to measure the Leishmania titer is after approx. 12 weeks. Lifelong treatment with LupArte 2.0 may be required. After the first 12 weeks and after the veterinarian’s analyzes, you can stop giving iron, at least for some time, and give LupArte 2.0 in a basic dosage of 50mg / kg / day according to the iron-free treatment protocol. As discussed, attempting a (temporary) discontinuation of treatment can be considered, even if this involves risks. In general, increased iron serum levels have a synergistic effect on Artemisia annua.