A. Pagano

FOGLIA MANZILLO, VALENTINA

L. Gradoni

OLIVA, GAETANO

PACIELLO, ORLANDO

T. Di Muccio

English

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The Veterinary Record, February 12, 2005 213muscular system, central nervous system, endocrine glands(Cortese and others 1999) or gonads, with or without func-tional damage. Oral and lingual localisations are rarelydescribed in dogs (Lamothe and Poujade 2002). This shortcommunication describes the oral lesions in a dog with leish-maniosis.A four-year-old female dobermann was diagnosed as suffering from leishmaniosis in February 2002. Clinical andhaematological examinations showed lymphadenomegaly,weight loss, moderate anaemia and thrombocytopenia. Theindirect immunofluorescent antibody test (IFAT) for L infan-tum and Ehrlichia canis was positive for both infections ata titre of 1:1280 and 1:1600, respectively. Serum proteinelectrophoresis showed elevated total proteins (10·8 g/dl),with hypoalbuminaemia, hyperglobulinaemia and a lowalbumin:globulin ratio (0·32). Bone marrow aspirate smearsrevealed numerous Leishmania species amastigotes. The dogwas treated with a combination of meglumine antimoniate(Glucantim; Aventis) (50 mg/kg subcutaneously twice a day)and allopurinol (Zyloric; GlaxoSmithKline) (10 mg/kgorally twice a day) for 60 days, and doxycycline (Vibravet;Pfizer) (10 mg/kg orally) for 30 days. At the end ofthe treatment the animal showed full remission of clinicalsigns and a reduction of the antileishmanial IFAT titre(1:640).Six months later, in October 2002, the dog was referredbecause of ocular disease, weight loss and hypersalivation.Clinical examination showed a severe uveitis with hyphemaon the left eye and a nodular lesion on the right eyelid.Examination of the oral cavity revealed the presence of mul-tiple red, lentil-like lesions on the tongue surface (Fig 1). Thehaematological parameters and IFAT titre were unchangedfrom the previous examination, and urinalysis revealed theslight proteinuria. Biopsy of lingual and eyelid lesions wasperformed by fine-needle aspiration and a brushing tech-nique. In both lesions, cytological examination demonstratedthe presence of numerous non-degenerated neutrophils,macrophages with foamy cytoplasm, epithelial cells,lymphocytes and a few multinucleated giant cells (Fig 2).Bacteria were not seen. Numerous Leishmania speciesamastigotes were seen in macrophage cytoplasm or extracel-lularly (Fig 3), and a culture from the left prescapular lymphnode aspirate was positive for Leishmania species.A specific therapy for uveitis, consisting of subconjuncti-val injections of triamcinolone (Uvitriam; Centralvet) weeklyfor two doses and orally administered prednisone (DeltaShort CommunicationsVeterinary Record (2005)156, 213-215V. Foglia Manzillo, DVM,PhD,A. Pagano, DVM,G. Oliva, DVM,Dipartimento di ScienzeCliniche Veterinarie,O. Paciello, DVM, PhD,Dipartimento di Patologiae Sanità Animale, Facoltàdi Medicina Veterinaria,Università degli Studi diNapoli Federico II, Via F.Delpino 1, 80137 Napoli,ItalyT. Di Muccio, BSc,L. Gradoni, BSc, PhD,Istituto Superiore diSanità, Viale Regina Elena299, 00166 Rome, ItalyFIG 1: Numerous red, lentil-like lesions on the tongue surface(arrows) are evidentPapular-like glossitis ina dog with leishmaniosisV. Foglia Manzillo, A. Pagano,O. Paciello, T. Di Muccio, L. Gradoni,G. OlivaCANINE leishmaniosis is a severe systemic disease caused bythe kinetoplastid protozoan Leishmania infantum, an ob-ligatory intracellular parasite of mammalian macrophagestransmitted by the bite of haematophagous phlebotominesandflies. Domestic dogs represent the main reservoir hostsfor zoonotic human visceral leishmaniosis in both the Oldand New Worlds. Canine leishmaniosis is characterised bychronic viscerocutaneous signs, such as lymphadenopathy,skin lesions (furfuraceous dermatopathy, ulcers and nodularlesions), splenomegaly, onychogryphosis, and renal and ocu-lar damage due to immunocomplex deposition (Ciaramellaand others 1997). Atypically the parasites are found in the214 The Veterinary Record, February 12, 2005Cortene; Lepetit) (1 mg/kg) was started. Four days after glu-cocorticoid therapy, both eyelid and lingual lesions disap-peared (Fig 4). A new antimonial therapy was started at thesame dosages as before. Two weeks after beginning treatment,the dog’s clinical condition worsened and it developed vom-iting, weight loss and polyuria/polydipsia. Laboratory find-ings showed moderate normocytic, normochromic,hyporegenerative anaemia and severe increases of blood ureanitrogen (176 mg/dl) and creatinine (3·35 mg/dl). Cytologicalexamination of a bone marrow aspirate showed erythroidhypoplasia (myeloid:erythroid ratio 3·86) and the presence ofnumerous Leishmania species amastigotes. Six months laterthe dog died.Oral Leishmania-positive granulomatous lesions, particu-larly on the tongue, are unusual in dogs. To the authors’knowledge, only one case has been described in the veterinaryliterature (Lamothe and Poujade 2002); concerning nodularulcerated lesions in a dog. It was suggested that the lesionswere a probable consequence of systemic dissemination ofparasites. In human beings, oral lesions caused by L infantumare frequently seen in severely immunosuppressed patients,such as individuals coinfected with HIV or graft recipients(Aliaga and others 2003). Borzoni and others (1991)described a 60-year-old immunocompetent patient affectedby leishmaniasis who showed a single lingual nodule and sev-eral palatine nodular lesions. The patient was not affected byother diseases. The absence of clinical, parasitological andimmunological signs of generalised leishmaniasis led to theconclusion that the lesions originated at the site of parasiteentrance, probably after the patient had crushed an infectedsandfly.In the present case the macroscopic aspect of the lingualand eyelid lesions, and some peculiar microscopic featurescommon to both (the presence of numerous neutrophilgranulocytes and a high parasite load), suggest that thelesions could have been of recent origin. The time ofappearance (early October) is also coincident with theperiod of highest rate of natural L infantum infections ofsandflies in southern Italy. As with the case in a humanbeing described by Borzoni and others (1991), the linguallesions could represent entrance sites of parasites afteringestion or crushing of infected sandflies. A clinical featureof the oral lesions described in human beings is their per-sistence (as long as one year before the correct diagnosis ofleishmaniasis), the specific drugs (pentavalent antimonyand amphotericin B) and the long duration of therapy (40to 60 days) required for clinical improvement. On the con-trary, in this case the clinical remission of lesions was fast(three to four days) and associated only with glucocorticoidadministration.It was therefore believed that the clinical signs observed inthis dog could have originated from distinct events: uveitisand renal damage resulting from the previous chronic infec-tion and localised mucosal lesions from a new infection. There-infection of dogs that had had previous contact withLeishmania species is assumed to be possible, as shown byexperimental work (Santos Gomes and others 2003).However, dogs that have developed an asymptomatic ‘resis-tant’ condition following first infection do not develop signsof disease at re-infection. In the dog in the case described here,the new entrance of parasites could have been favoured by theanergic clinical response as demonstrated by the progressiveevolution of the disease and the poor response to treatment.However, the possibility that the lingual lesions resulted fromthe reactivation and dissemination of previous infection can-not be excluded.In conclusion, it is suggested that the unusual glossitisdescribed in this case was not a mucocutaneous form of leish-maniosis, never before described in dogs, or a disseminationfrom a visceral form, but a localised mucosal leishmaniosisresulting from a new infection.Short CommunicationsFIG 2: Non-degenerated neutrophils (black arrows),macrophages containing Leishmania species amastigotes(arrowhead) and some lymphocytes (red arrow) in biopsymaterial from the lingual lesions. May-Grünwald-GiemsaQuick. x 100FIG 3: Macrophagescontaining numerousLeishmania speciesamastigotes (arrows) inbiopsy material fromthe lingual lesions.Kinetoplasts(arrowhead) ofparasites are evident.May-Grünwald-GiemsaQuick. x 1000FIG 4: Total clinicalresolution of the tonguelesions after treatmentwith a combination of meglumineantimoniate, allopurinoland doxycylineThe Veterinary Record, February 12, 2005 215(c) British Veterinary Association. All rights reservedReferencesALIAGA, L., COBO, F., MEDIAVILLA, J. D., BRAVO, J., OSUNA, A., AMADOR,J. M., MARTIN-SANCHEZ, J., CORSERO, E. & NAVARRO, J. M. (2003)Localized mucosal leishmaniasis due to Leishmania infantum: clinical andmicrobiologic findings in 31 patients. Medicine 82, 147-158BORZONI, F., GRADONI, L., GRAMICCIA, M., MACCIONI, A., VALDES, E.& LODDO, S. (1991) A case of lingual and palatine localization of a viscerotropic Leishmania infantum zymodeme in Sardinia, Italy. TropicalMedicine and Parasitology 42, 193-194CIARAMELLA, P., OLIVA, G., DE LUNA, R., GRADONI, L., AMBROSIO, R.,CORTESE, L., SCALONE, A. & PERSECHINO, A. (1997) A retrospective clinical study of canine leishmaniasis in 150 dogs naturally infected byLeishmania infantum. Veterinary Record 141, 539-543CORTESE, L., OLIVA, G., RESTUCCI, B., CIARAMELLA, P. & PERSECHINO,A. (1999) Primary hypothroidism associated with leishmaniasis in a dog.Journal of the American Animal Hospital Association 35, 487-492LAMOTHE, J. & POUJADE, A. (2002) Ulcerative glossitis in a dog with leish-maniasis. Veterinary Record 151, 182-183SANTOS GOMES, G. M., CAPELA, M. G., RAMADA, J. & CAMPINO, L.(2003) Experimental canine leishmaniasis: evolution of infection followingre-challenge with Leishmania infantum. Acta Tropica 87, 235-244Short Communications

Papular-like glossitis in a dog with leishmaniosis

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Papular-like glossitis in a dog with leishmaniosis

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