Leptospirosis in Dogs: What's Bloodwork Got to Do with It?
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Title: Leptospirosis in Dogs: What's Bloodwork Got to Do with It? Presented by: Ciera Earl, LVT, VTS (Emergency) Description: Leptospirosis is a common zoonotic disease that can cause serious illness in dogs, other wild animals, and people. Throughout this lecture, we will look at common lab work and provide a better understanding of the values, their meaning, and how it all ties together in diagnosing Leptospirosis. We will also discuss the signs and symptoms, transmission, prevalence, and treatment.
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Leptospirosis in Dogs: What's Bloodwork Got to Do with It?
- 1. WHAT'S BLOOD GOT TO DO WITH IT? LEPTOSPIROSIS Ciera Earl, LVT, VTS (ECC) Critical Care Upstate Veterinary Specialties
- 2. WWW.UVSONLINE.COM Overview & understanding of Leptospirosis Infection How understanding bloodwork results can provide clues What is a “Lepto Suspect” & what precautions should we take LEARNING OBJECTIVES 9/26/2023 LEPTOSPIROSIS, WHATS BLOODWORK GOT TO DO WITH IT?
- 3. WWW.UVSONLINE.COM What is Leptospirosis How is It Spread Clinical Signs Testing and Diagnosing Treatment and Survival Rates Blood work and what to watch What makes a patient a Lepto suspect Safe Handling and Best Practices OUTLINE 9/26/2023 LEPTOSPIROSIS, WHATS BLOODWORK GOT TO DO WITH IT?
- 4. WWW.UVSONLINE.COM LEPTOSPIROSIS – WHAT IS IT? 9/26/2023 • Leptospirosis is a bacterial infection, caused from a bacteria called Leptospira • Leptospira bacteria organisms are thinly coiled spirochetes that are helical or spiral shaped • There are multiple strains of this bacteria called serovars • A serovar is a subtype of a bacteria, usually characterized by the antigens on the cell's surface • There are over 200 recognized serovars, many of which can infect dogs What other diseases are caused by Spirochetes? Syphilis & Lyme Disease LEPTOSPIROSIS, WHATS BLOODWORK GOT TO DO WITH IT?
- 5. WWW.UVSONLINE.COM A zoonotic disease that can affect multiple species of animals including humans Up to 150 different types of mammals Prevalent in other common wild animals such as skunks, racoons, opossums, rats & deer Leptospirosis bacteria can live in the soil and in water It survives best in water that is stagnant or slow moving, especially after heavy rains in a warm environment Once the puddle or stream dries up, the bacteria can survive in the soil for many months. LEPTOSPIROSIS – WHAT IS IT? 9/26/2023 Fun Fact: Leptospirosis is one of the top zoonotic disease causes of illness worldwide LEPTOSPIROSIS, WHATS BLOODWORK GOT TO DO WITH IT?
- 6. WWW.UVSONLINE.COM Spread through the urine of an infected animal Drinking from streams, puddles, rivers or lakes, usually on property that also has a high population of wildlife Mucus membranes or any cut, scrape or wound contacting infected urine, urine contaminated soil, food or bedding A bite from an infected animal Eating infected tissues or carcasses Passed through the placenta from the mother to the puppies HOW IS LEPTOSPIROSIS SPREAD 9/26/2023 LEPTOSPIROSIS, WHATS BLOODWORK GOT TO DO WITH IT?
- 7. WWW.UVSONLINE.COM All dogs are at risk for Lepto regardless of environment, lifestyle and geographical location CDC reports 100-150 cases/yr in the US NYS Dept of Health Reports 1-3 cases/yr It is a notifiable disease in humans but not in domesticated pets Some researchers believe up to 8% of dogs are actively shedding but are asymptomatic Prevalence of Lepto has increased in recent years Many of the cases of Lepto originate in the NYC area because of the rat population PREVALENCE OF LEPTOSPIROSIS 9/26/2023 What is the percentage of dogs in the US that are vaccinated for Leptospirosis? 70% LEPTOSPIROSIS, WHATS BLOODWORK GOT TO DO WITH IT?
- 8. WWW.UVSONLINE.COM Cats Can Get Lepto Too Very little research available to show the clinical presentation Potential correlation between chronic kidney disease and lepto especially in outdoor cats Cats don’t usually show any symptoms Symptoms are nonspecific They are susceptible to the infection and can develop antibodies Cats are Reservoir Hosts Cats will carry the infection and shed the bacteria without becoming ill Infection in cats is usually due to eating infected rodents Outdoor cats have a higher risk of becoming infected WHAT ABOUT CATS? 9/26/2023 Fun Fact : There are currently no Leptospirosis vaccinations for cats LEPTOSPIROSIS, WHATS BLOODWORK GOT TO DO WITH IT?
- 9. WWW.UVSONLINE.COM Incubation period is 7 to 14 days Organism can enter the blood stream and cause inflammation to blood vessels Can cause injury to different organ systems (polysystemic) such as kidneys, liver, lungs, and vasculature Favors the kidney and liver Severity of signs is variable CLINICAL SIGNS 9/26/2023 LEPTOSPIROSIS, WHATS BLOODWORK GOT TO DO WITH IT?
- 10. WWW.UVSONLINE.COM First Phase The non-specific phase of illness Not eating Fever Vomiting and/or diarrhea PU/PD CLINICAL SIGNS 9/26/2023 Foreign Body? Gastroenteritis? Pancreatitis? Toxin? LEPTOSPIROSIS, WHATS BLOODWORK GOT TO DO WITH IT?
- 11. WWW.UVSONLINE.COM 7 Days Post Exposure Fever Abnormal bleeding Bruising Tissue edema 14 Days Post Exposure Kidney and Liver malfunction Pain & inflammation in kidneys and liver Pulmonary Hemorrhage Syndrome Bleeding disorders CLINICAL SIGNS 9/26/2023 LEPTOSPIROSIS, WHATS BLOODWORK GOT TO DO WITH IT?
- 12. WWW.UVSONLINE.COM 2nd Phase - Clinical Manifestations CLINICAL SIGNS 9/26/2023 Clinical Manifestations Acute Kidney Injury Hepatopathy Pancreatitis Myocarditis LPHS Coagulopathy Vasculitis Uveitis LEPTOSPIROSIS, WHATS BLOODWORK GOT TO DO WITH IT?
- 13. WWW.UVSONLINE.COM TESTING & DIAGNOSTICS 9/26/2023 Slide presented at ACVIM forum June 15, 2023 Consensus Statement: Leptospirosis: Diagnosis, Epidemiology, Treatment, and Prevention. Jane Sykes, Larry Cowgill, Thierry Francey, George Moore, Simone Schuller and Robyn Stoddard LEPTOSPIROSIS, WHATS BLOODWORK GOT TO DO WITH IT?
- 14. WWW.UVSONLINE.COM Minimum database blood work CBC, Serum Chemistry, Electrolytes & Urinalysis Serial Bloodwork checks while in hospital Renal function, electrolytes, acid-base status, PCV and TP should be checked daily CBC every 48 hours LEPTOSPIROSIS TESTING & DIAGNOSTICS 9/26/2023 LEPTOSPIROSIS, WHATS BLOODWORK GOT TO DO WITH IT?
- 15. WWW.UVSONLINE.COM Radiographs Thoracic radiographs are recommended in all dogs suspected to have Lepto Even in the absence of respiratory signs If you can catch radiographic changes of LPHS early, it can help in diagnosing Lepto and aid in treatment LEPTOSPIROSIS TESTING & DIAGNOSTICS 9/26/2023 LEPTOSPIROSIS, WHATS BLOODWORK GOT TO DO WITH IT?
- 16. WWW.UVSONLINE.COM Ultrasound changes seen in Lepto cases Renomegaly Hepatomegaly Thickening of gall bladder wall Peritoneal Effusion Enlargement of the pancreas LEPTOSPIROSIS TESTING AND DIAGNOSTICS 9/26/2023 LEPTOSPIROSIS, WHATS BLOODWORK GOT TO DO WITH IT?
- 17. WWW.UVSONLINE.COM LEPTOSPIROSIS TESTING & DIAGNOSTICS 9/26/2023 Leptospirosis: New Tests Improve Diagnostic Capabilities. DVM 360. 2017;2. Accessed August 7, 2023. https://www.dvm360.com/view/leptospirosis-new-tests-improve- diagnostic-capabilities LEPTOSPIROSIS, WHATS BLOODWORK GOT TO DO WITH IT?
- 18. WWW.UVSONLINE.COM 3 tests to detect Leptospirosis 1. PCR Testing (molecular) 2. Microscopic Agglutination Test (serology) 3. In House Screening Test (Elisa) LEPTOSPIROSIS TESTING & DIAGNOSTICS 9/26/2023 LEPTOSPIROSIS, WHATS BLOODWORK GOT TO DO WITH IT?
- 19. WWW.UVSONLINE.COM PCR Testing Detects the Leptospira DNA Test both blood and urine Best to test 10 days after infection Pros: past vaccinations won’t affect results Cons: antibiotic exposure will alter results – may get false negatives LEPTOSPIROSIS TESTING & DIAGNOSTICS 9/26/2023 LEPTOSPIROSIS, WHATS BLOODWORK GOT TO DO WITH IT?
- 20. WWW.UVSONLINE.COM 9/26/2023 Jane E. Sykes, BVSc (Hons), PhD, MBA, GCPH, DACVIM (SAIM) LEPTOSPIROSIS, WHATS BLOODWORK GOT TO DO WITH IT?
- 21. WWW.UVSONLINE.COM Microscopic Agglutination Test (MAT) Most common test used & test of choice Detects specific serovars and measures antibody levels A MAT titer of 1:800 or higher is considered positive Pros: most accurate and inexpensive Cons: slower test and sometimes may require follow up testing LEPTOSPIROSIS TESTING & DIAGNOSTICS 9/26/2023 Leptospira Microagglutination Testing. Cornell University College of Veterinary Medicine. Published February 26, 2019. Accessed August 7, 2023. https://www.vet.cornell.edu/animal-health-diagnostic-center/testing/protocols/leptospira- microagglutination LEPTOSPIROSIS, WHATS BLOODWORK GOT TO DO WITH IT?
- 22. WWW.UVSONLINE.COM 9/26/2023 Table provided by IDEXX reference Lab LEPTOSPIROSIS, WHATS BLOODWORK GOT TO DO WITH IT?
- 23. WWW.UVSONLINE.COM ELISA point of care test Detects the lipoprotein antibodies found in pathogenic species of Leptospira Provides a positive or negative antibody result Pros: quick results and small sample size Cons: you won’t get a numerical titer and will often get false positives “ A negative result with any point-of-care antibody detection assay does not rule out leptospirosis, and should be followed with a second antibody test 7 to 14 days later, to document seroconversion” Jane E. Sykes, BVSc (Hons), PhD, MBA, GCPH, DACVIM (SAIM) LEPTOSPIROSIS TESTING & DIAGNOSTICS 9/26/2023 LEPTOSPIROSIS, WHATS BLOODWORK GOT TO DO WITH IT?
- 24. WWW.UVSONLINE.COM 9/26/2023 Table provided by IDEXX reference Lab LEPTOSPIROSIS, WHATS BLOODWORK GOT TO DO WITH IT?
- 25. WWW.UVSONLINE.COM TREATMENT & SURVIVAL RATES 9/26/2023 There are two strategies to Leptospirosis treatment • Specific Antimicrobial Therapy • Care of the individual organ system LEPTOSPIROSIS, WHATS BLOODWORK GOT TO DO WITH IT?
- 26. WWW.UVSONLINE.COM TREATMENT & SURVIVAL RATES 9/26/2023 Antibiotic Therapy IV Fluid Therapy Supportive Care Nutritional Support Treatment LEPTOSPIROSIS, WHATS BLOODWORK GOT TO DO WITH IT?
- 27. WWW.UVSONLINE.COM Antibiotic Therapy IV Penicillin derivatives are the recommended antibiotics • Ampicillin 20–30 mg/kg IV q6–8h • Ampicillin/Sulbactam (Unasyn) 10-20 mg/kg IV q 8 h • Penicillin G 25,000–40,000 U/kg IV q6–8h • Doxycycline 5 mg/kg PO q12h or 10 mg/kg PO q24h TREATMENT & SURVIVAL RATES 9/26/2023 LEPTOSPIROSIS, WHATS BLOODWORK GOT TO DO WITH IT?
- 28. WWW.UVSONLINE.COM IV Fluid Therapy Maintaining hydration due to anorexia and ongoing losses Correcting electrolyte imbalances TREATMENT & SURVIVAL RATES 9/26/2023 LEPTOSPIROSIS, WHATS BLOODWORK GOT TO DO WITH IT?
- 29. WWW.UVSONLINE.COM Supportive Care Anti-emetics for GI upset Anti-hypertensives Pain Control FFP Hemodialysis TREATMENT & SURVIVAL RATES 9/26/2023 LEPTOSPIROSIS, WHATS BLOODWORK GOT TO DO WITH IT?
- 30. WWW.UVSONLINE.COM Nutritional Support Nutritional support needs to happen early, and you need to be proactive Consider a feeding tube – NG tube is ideal Parenteral Nutrition should be normal to high in proteins Kidney diets are not recommended while in hospital TREATMENT & SURVIVAL RATES 9/26/2023 LEPTOSPIROSIS, WHATS BLOODWORK GOT TO DO WITH IT?
- 31. WWW.UVSONLINE.COM Survival Rates With early treatment 80-90% survival rates are reported Recovery will depend on extent of organ damage Prognosis with mild to moderate azotemia was good Lung involvement and/or DIC have poor survival rates TREATMENT & SURVIVAL RATES 9/26/2023 LEPTOSPIROSIS, WHATS BLOODWORK GOT TO DO WITH IT?
- 32. WWW.UVSONLINE.COM 1. Monitoring Blood Work Shows Us the BIG picture 2. We can learn so much about our patient by checking blood work early and often 3. Guide Treatment Expectations 4. Prognostic Indicators 5. Veterinary Staff & Owner Safety BLOOD WORK – WHY DO WE CARE 9/26/2023 LEPTOSPIROSIS, WHATS BLOODWORK GOT TO DO WITH IT?
- 33. WWW.UVSONLINE.COM 9/26/2023 Slide presented at ACVIM forum June 15, 2023 Consensus Statement: Leptospirosis: Diagnosis, Epidemiology, Treatment, and Prevention. Jane Sykes, Larry Cowgill, Thierry Francey, George Moore, Simone Schuller and Robyn Stoddard LEPTOSPIROSIS, WHATS BLOODWORK GOT TO DO WITH IT?
- 34. WWW.UVSONLINE.COM 9/26/2023 1. Garcia ED. Leptospirosis. Today’s Veterinary Practice. Published January 16, 2018. https://todaysveterinarypractice.com/infectious-disease/focus-on-leptospirosis/ LEPTOSPIROSIS, WHATS BLOODWORK GOT TO DO WITH IT?
- 35. WWW.UVSONLINE.COM Having suspicion of Lepto can help reduce the risk of transmission to veterinary workers Any dog that has elevated kidney values or acute kidney injury that otherwise can’t be explained If regional incidence is high and history supports Lepto LEPTO SUSPECTS 9/26/2023 LEPTOSPIROSIS, WHATS BLOODWORK GOT TO DO WITH IT?
- 36. WWW.UVSONLINE.COM Patients do not need to be kept in isolation but should: Housed in a low-traffic area Movement around the hospital should be avoided Mark the patient’s cage indicating he is a lepto suspect Place a tape boarder in front of the patients cage to limit foot traffic by other staff SAFE HANDLING & BEST PRACTICES 9/26/2023 LEPTOSPIROSIS, WHATS BLOODWORK GOT TO DO WITH IT?
- 37. WWW.UVSONLINE.COM Urine Containment Walked in an area that can be contained from other pets and easily disinfected Limit the distance the pet must walk to get to an elimination area. If they urinate then the area should be cleaned immediately If the pet has urine on it, make sure to bathe/clean it as soon as possible SAFE HANDLING & BEST PRACTICES 9/26/2023 LEPTOSPIROSIS, WHATS BLOODWORK GOT TO DO WITH IT?
- 38. WWW.UVSONLINE.COM PPE Considerations Infection can enter through cuts or cracks in the skin or through mucus membranes of the eyes, nose or mouth Gloves, disposable gown, facemask Wash your hands every time after handling the pet SAFE HANDLING & BEST PRACTICES 9/26/2023 LEPTOSPIROSIS, WHATS BLOODWORK GOT TO DO WITH IT?
- 39. WWW.UVSONLINE.COM Cleaning & Laundry Considerations RESCUE recommends using a 1:16 dilution and using a 5-minute contact time Diluted Bleach – 1:32 concentration Laundry: bedding from Lepto patients should be washed with bleach, if can’t be washed right away, then put into a labeled bag so whoever is washing can wear proper PPE SAFE HANDLING & BEST PRACTICES 9/26/2023 LEPTOSPIROSIS, WHATS BLOODWORK GOT TO DO WITH IT?
- 40. WWW.UVSONLINE.COM 9/26/2023 LEPTOSPIROSIS, WHATS BLOODWORK GOT TO DO WITH IT?
Editor's Notes
- Leptospira organisms can live in the soil for 3 to 6 months.
- The bacterium that causes Leptospirosis is spread through the urine of an infected animal Spread through direct or indirect contact. direct contact (from a rat bite or from eating a rat) and indirect contact (drinking urine-contaminated water or licking contaminated soil).
- Lepto varies by region and season Prevalence of Lepto may have gone up because we are diagnosing it more. Lepto is seasonally influenced and climate change is expected to increase the prevalence. Because we are seeing warmer temperatures and more rain we will see higher rates of Lepto. Weather changes, population growth and increased canine exposure. Many cases of increased exposure is due to the increased rat population – rats are asymptomatic carriers – spirochetes live in the distal renal tubules but do not cause failure – they shed the bacteria in their urine and dogs and other animals can get lepto from biting or killing rats Up to 50-60% of rats carry lepto
- If cats do show symptoms it will usually be related to symptoms associated with kidney disease such as fever, vomiting, loss of appetite and increased thirst. A reservoir host is a host that harbors the pathogen and serves as a source of the infective agent that it transmits to a potential host. There is no vaccine available for cats
- There is a huge variance in the organ systems that Lepto can affect, usually will hit the kidney's first AKI was reported in 90% of reported cases with Lepto Liver disease occurs in 10-20% of cases (usually along with AKI) Leptospira bacteria attaches to the blood cells that line the blood vessels, which can make it difficult for the blood to clot Once the bacteria enters the blood stream it can spread to the organs such as kidney’s liver and lungs Some dogs can shed the bacteria and never really get sick while others get mild symptoms and recover quickly and some end up with organ failure and die Generally younger animals are more seriously affected than older animals.
- This is when you start thinking about Lepto – especially if they don’t respond to treatment within the first 24 hours.
- 87-100% of infected dogs will have some degree of azotemia, which means renal parameters will be elevated on routine blood testing. With pulmonary hemorrhage syndrome you will see rapid breathing and pulmonary hemorrhage organism gets into the lungs where the Leptospira toxins produce what is termed “Leptospira Pulmonary Hemorrhage Syndrome." The lung bleeding that results is associated with a 70% mortality rate and bodes especially poorly. Bleeding disorders can lead to blood tinged vomit, urine in the urine or stool, nosebleeds
- Some manifestations are directly due to the illness while others are due to the severe inflammation There are increasing case reports that pancreatitis is a more common manifestation of lepto than we once thought.
- This is a new case definition that was presented this year at the ACVIM Forum back in June. It was created together with the CDC based on information on the case definition created in human medicine
- Major manifestation that we fear the most. The alveoli become flooded with blood According to the 2023 ACVIM consensus on Lepto – all patients that are lepto suspects should ideally be getting thoracic radiographs. We are increasingly recognizing in many areas. It may be possible to recognize this type of alveolar pattern even before they start showing clinical signs. If you have an x ray like this in a dog that is already a lepto suspect, it can bump up the suspicion and move lepto higher on the differential list.
- A study was published in 2017 by the American College of Radiography looking at the ultrasonographic findings in 35 dogs with confirmed Lepto. One consistent abnormality that was seen in all dogs was renal abnormalities, most commonly being increased cortical echogenicity. 60% of cases had renomegaly. Hepatic changes were identified in 83% of the cases. Gallbladder abnormalities were found in 60 % of the dogs. The other most frequently observed changes were peritoneal effusions, intestinal wall thickening and lymphadenopathy.
- Lepto should not be ruled out based on a single negative test. Tests should be done in an interval of 7 to 14 days to demonstrate seroconversion.
- Make sure you are obtaining samples prior to the administration of antibiotics You should be testing both blood and urine because the organism is in the blood in the first week and start being shed in urine so you aren’t sure where they are in that phase
- Nucleic acid antigen detection tests, such as conventional polymerase chain reaction (PCR) and real‐time PCR, identify the bacterium or its DNA directly in blood or urine. There can be intermittent shedding so negative results don’t rule out the disease. Non clinical healthy dogs can shed Leptospira DNA in their urine so be cautious if you get a positive result with just urine.
- The Microscopic Agglutination Test (MAT) is widely used as the gold standard for diagnosis of leptospirosis. In this method, diluted patient serum is mixed with serotype-determined Leptospires, and the presence or absence of aggregation is determined under a dark-field microscope to calculate the antibody titer. Very high antibody titers (≥1600) are suggestive of recent infection, but paired serum titers produce more reliable prognostic information. A 4-fold rise in titer, or a seroconversion to ≥1600 is an indication of a current leptospirosis infection. Highest antibody level is the one that is causing the disease – very high tiers > 1:1600 are suggestive of recent infection - If the dog has previously been vaccinated you should retest in 2 to 4 weeks to see if the tier went up. If the titer value goes up and shows a four fold increase in antibody production then consider it positive Lepto should not
- A negative test does not rule out a Lepto infection and should be followed up with a MAT test 7 to 14 days later
- We primarily use Unasyn ampicillin/sulbactam – this is a broad spectrum antibiotic thought to treat more bacteria than just ampicillin alone. Many dogs are vomiting and not eating when you begin treatment. Best to start with IV drug therapy and then switch to oral doxy once the dog is eating and not vomiting.
- IV fluid therapies need to be individualized based on the patient. Some patients may be anurinc and some are extremely polyuric and require fluid rates as high as 20 ml/kg/hr. It is important to measure ins and outs in these patients and to watch for changes in body weight.
- Degree of supportive care depends on the severity of the infection Try and take a proactive approach to decrease the risk of any fatal complications Hypertension seen with renal disease is common – treatment is usually started if the systolic BP is over 180 Dogs with liver and clotting problems may require FFP to replenish clotting factors. In severe cases dialysis may be needed or indicated if the kidney’s have completely shut down and aren’t doing the job of filtering the blood. Can improve prognosis for cases with severe azotemia. Indications for dialysis may be failure to respond to conservative therapy, persistent hyperkalemia and acidosis. Another indication is overhydration with oliguria – producing very little urine despite IV fluid therapy.
- Some of these dogs won’t eat for days Make sure you are paying attention to and calculating the RER of your patient and they are getting daily calories needed. May need to trickle feed
- The surviving dogs may return to completely normal renal function or may have chronic renal failure. * Of the surviving dogs about 30% end up with long term chronic kidney disease.
- Compilation of 20 studies over the last 20 years CBC in red, Chem in blue, urinalysis in yellow and coag in green This shows that there is no single pattern of the disease seen on blood work and there is a wide range of manifestations. Main point is that these signs are possible but not always present
- Lepto is expected to be inactivated by any hospital grade disinfection product that claims to kill gram negative bacteria. Any bleach product or accelerated hydrogen peroxide solution