Review and statistical analysis of clinical management of feline leishmaniosis caused by Leishmania infantum

Abstract

Background: There is limited information about feline leishmaniosis (FeL) management in clinical practice. Leishmania infantum is the species of Leishmania most frequently reported in both dogs and cats in countries of the Mediterranean region (henceforth 'Mediterranean countries'), Central and South America, and Iran. This study was conducted to provide veterinary clinicians with an updated overview of evidence-based information on leishmaniosis in cats.

Methods: A review was performed using PubMed, Science Direct, Google Scholar and Web of Science. Case reports of FeL caused by L. infantum were sought for the period 1912 to 1 June 2021.

Results: Sixty-three case reports are included in this review. Fifty-nine out of the 63 cats were from Europe, mostly from Mediterranean countries (88.9%). Most of them were domestic short-haired cats (90%) with a mean age of 7.9 years, and had access to the outdoors (77.3%). Sixty-six percent of the cats had comorbidities, of which feline immunodeficiency virus infection was the most frequent (37.7%). Dermatological lesions (69.8%) was the most frequent clinical sign, and hyperproteinemia (46.3%) the most frequent clinicopathological abnormality. Serology was the most performed diagnostic method (76.2%) and was positive for 93.7% of cats. Medical treatment was applied in 71.4% of cats, and allopurinol was the most used drug (74.4%). Survival time was greater for treated cats (520 days; 71.4% of cats) than non-treated cats (210 days; 25.4%).

Conclusions: The majority of the cats had comorbidities, of which feline immunodeficiency virus was the most frequent. Dermatological lesions were frequently reported, and systemic clinical signs and clinicopathological abnormalities were also common. Serology may be useful for the diagnosis of FeL in clinical practice, and a positive titer of ≥ 1/40 may be a useful cut-off for sick cats. The reported treatments and dosages varied, but there was a good clinical response and longer survival in most of the cats treated with allopurinol monotherapy.

Keywords: Allopurinol; Cats; Leishmaniasis; Practitioners; Serology.

Fig. 1

Flow chart showing the search and selection process for the inclusion of articles in this study

Fig. 2

Kaplan–Meier survival curves of cats treated with allopurinol, allopurinol plus meglumine antimoniate, allopurinol plus miltefosine, meglumine antimoniate, other, or no treatment. Median survival time of the treated cats was as follows: allopurinol (28/63; 619 days); allopurinol plus meglumine antimoniate (8/63; 614 days); allopurinol plus miltefosine (1/63; 45 days); meglumine antimoniate (5/63; 1372 days); other such as fluconazole, metronidazole, spiramycin or lomidine (3/63; 660 days); no treatment (10/63; 411 days)