Publicação
Clinical management of canine leishmaniosis in Portugal : the veterinary community perspective
| Resumo: | Canine leishmaniosis (CanL) is an endemic disease in more than 70 countries, including Portugal. Scientific research has allowed developments concerning the management of the disease, including the publication of international guidelines, such as those published by the LeishVet group. However, this management has shown to be variable among countries and there is scarce information concerning the treatment of the associated renal disease, which is often present in more advanced stages and is the main cause of death due to CanL. This study aimed to investigate the current paradigm of the clinical management of CanL in Portugal, including the treatment of renal disease in these patients. An online questionnaire was developed, including 24 to 64 questions, depending on the answering pathway of each respondent. The content was divided in three parts: general characteristics, medical approach (diagnosis, treatment and prevention) in face of different hypothetical scenarios of CanL and other questions. This last part focused on the knowledge regarding the existing guidelines, the diagnostic tools routinely applied and the use of immunosuppressants for treatment of glomerulonephritis secondary to CanL. After internal validation, the questionnaire was uploaded using an electronic platform and diffused online, over 2 months, via Portuguese social network veterinary groups. The survey included 86 answers and revealed that most measures applied by the enquired veterinary clinicians are in accordance with the international recommendations. Furthermore, the treatment with miltefosine and allopurinol was prioritized to that of meglumine antimoniate (MA) with allopurinol (selected by 48.8% and 23.3%, respectively) in stage IV of CanL, probably due to the nephrotoxicity associated with MA, according to some studies. Furthermore, euthanasia was only considered for the stage IV scenario. The preferred protocol for treatment of proteinuria in dogs with leishmaniosis consisted in the use of angiotensin converting enzyme inhibitors (ACEI). The use of immunosuppressants was considered by 44.2% of the veterinary surgeons, showing an evident preference for prednisolone (94.7%) and, in a much lesser proportion, for mycophenolate mofetil (5.3%). These findings contributed to emphasise the lack of evidence regarding the use of specific immunosuppressive drugs for the treatment of immune-mediated glomerular disease, especially when associated with an infectious cause, and the preference given to miltefosine rather than MA in the most advanced stage of disease. |
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| Autores principais: | Monteiro, Marta Nunes Eusébio Meneses |
| Assunto: | Canine leishmaniosis renal disease questionnaire clinical approach Leishmaniose canina doença renal questionário abordagem clínica |
| Ano: | 2021 |
| País: | Portugal |
| Tipo de documento: | dissertação de mestrado |
| Tipo de acesso: | acesso aberto |
| Instituição associada: | Universidade de Lisboa |
| Idioma: | inglês |
| Origem: | Repositório da Universidade de Lisboa |
| Resumo: | Canine leishmaniosis (CanL) is an endemic disease in more than 70 countries, including Portugal. Scientific research has allowed developments concerning the management of the disease, including the publication of international guidelines, such as those published by the LeishVet group. However, this management has shown to be variable among countries and there is scarce information concerning the treatment of the associated renal disease, which is often present in more advanced stages and is the main cause of death due to CanL. This study aimed to investigate the current paradigm of the clinical management of CanL in Portugal, including the treatment of renal disease in these patients. An online questionnaire was developed, including 24 to 64 questions, depending on the answering pathway of each respondent. The content was divided in three parts: general characteristics, medical approach (diagnosis, treatment and prevention) in face of different hypothetical scenarios of CanL and other questions. This last part focused on the knowledge regarding the existing guidelines, the diagnostic tools routinely applied and the use of immunosuppressants for treatment of glomerulonephritis secondary to CanL. After internal validation, the questionnaire was uploaded using an electronic platform and diffused online, over 2 months, via Portuguese social network veterinary groups. The survey included 86 answers and revealed that most measures applied by the enquired veterinary clinicians are in accordance with the international recommendations. Furthermore, the treatment with miltefosine and allopurinol was prioritized to that of meglumine antimoniate (MA) with allopurinol (selected by 48.8% and 23.3%, respectively) in stage IV of CanL, probably due to the nephrotoxicity associated with MA, according to some studies. Furthermore, euthanasia was only considered for the stage IV scenario. The preferred protocol for treatment of proteinuria in dogs with leishmaniosis consisted in the use of angiotensin converting enzyme inhibitors (ACEI). The use of immunosuppressants was considered by 44.2% of the veterinary surgeons, showing an evident preference for prednisolone (94.7%) and, in a much lesser proportion, for mycophenolate mofetil (5.3%). These findings contributed to emphasise the lack of evidence regarding the use of specific immunosuppressive drugs for the treatment of immune-mediated glomerular disease, especially when associated with an infectious cause, and the preference given to miltefosine rather than MA in the most advanced stage of disease. |
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