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. 2025 Jan 29;124(2):14.
doi: 10.1007/s00436-025-08458-4.

Co-infections of rickettsiales in clinically healthy, Leishmania infantum seropositive and seronegative dogs: a systematic literature review and new findings from Southern Italy

Oana Gusatoaia  1 , Livia Perles  1 , Maria Alfonsa Cavalera  1 , Annamaria Uva  1 , Floriana Gernone  1 , Domenico Otranto  1   2 , Andrea Zatelli  3
Affiliations

Co-infections of rickettsiales in clinically healthy, Leishmania infantum seropositive and seronegative dogs: a systematic literature review and new findings from Southern Italy

Oana Gusatoaia et al. Parasitol Res. .

Abstract

Canine leishmaniosis (CanL), caused by Leishmania infantum, is a widespread vector-borne disease. In Italy, an endemic region for CanL, overlapping transmission of L. infantum and tick-borne pathogens (TBPs) like Anaplasma phagocytophilum and Ehrlichia canis is increasingly reported. Dogs with clinical leishmaniosis often show higher co-infection rates and pronounced clinicopathological abnormalities. This study presents a systematic literature review and new findings from southern Italy, focusing on co-infections with E. canis and A. phagocytophilum in clinically healthy L. infantum seropositive and seronegative dogs. The systematic review identified two eligible studies. The first reported 34/488 (7%) dogs L. infantum seropositive, with 11.8% also seropositive for A. phagocytophilum. Among 454 seronegative dogs, 3% were seropositive for A. phagocytophilum and 2.4% for E. canis. The second study identified 154/1260 (12.2%) dogs L. infantum seropositive, with co-infection rates of 0.6% and 1.9% for A. phagocytophilum and E. canis, respectively. Among 1106 seronegative dogs, 1.3% were seropositive for A. phagocytophilum and 2.3% for E. canis. In the retrospective study from southern Italy, 90/154 (58.4%) dogs were L. infantum seropositive, with co-infection rates of 4.4% for A. phagocytophilum and 2.2% for A. phagocytophilum and E. canis. Among 64 seronegative dogs, 1.6% showed similar co-infections. This is the first systematic review in Italy, documenting low and comparable co-infection rates with A. phagocytophilum and E. canis in clinically healthy dogs, regardless of L. infantum serostatus. These findings suggest that co-infections may occur independently, offering insights into vector-borne disease dynamics in endemic areas.

Keywords: Anaplasma phagocytophilum; Ehrlichia canis; Leishmania infantum; Canine vector-borne disease; Co-infection; Serology.

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Conflict of interest statement

Declarations. Ethics approval: Not applicable. Clinical trial number: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA 2020 flowchart illustrating the study selection process
Fig. 2
Fig. 2
Positive (“ + “) and negative (“ – “) serologic results for Ehrlichia canis and/or Anaplasma phagocytophilum in Leishmania infantum serpopositive and seronegative dogs from the cohort studied
See this image and copyright information in PMC

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