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    Klinische, labordiagnostische, radiologische Befunde und Verlauf bei 99 Hunden mit Leptospirose 2006 - 2013 (2015)

    Art
    Hochschulschrift
    Autor
    Knöpfler, Stefanie Valentina (WE 20)
    Quelle
    Berlin: Mensch und Buch Verlag, 2015 — VIII, 191 Seiten
    ISBN: 978-3-86387-627-2
    Verweise
    URL (Volltext): http://www.diss.fu-berlin.de/diss/receive/FUDISS_thesis_000000100127
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    Abstract / Zusammenfassung

    Leptospirosis is a zoonotic bacterial disease with a worldwide distribution, which is caused by spirochetes of the pathogenic genus Leptospira. It is a „re-emerging disease“ in humans and dogs. The aims of this study were 1) to evaluate distribution of Leptospira serogroups in dogs with leptospirosis from North East Germany (2006-2013) and to link specific serogroups with particular clinical manifestations, 2) to analyse epidemiological data and to define risk factors for leptospirosis in dogs, 3) to describe clinical, laboratory and radiological features and outcome in dogs with leptospirosis and 4) to examine negative prognostic factors (clinical signs, laboratory and radiological findings) in dogs with leptospirosis. 1) 526 dogs suspicious for leptospirosis were presented at the small animal clinic between April 2006 and March 2013. The dogs were tested for leptospirosis and 99 dogs met the inclusion criteria. Diagnoses were based on microscopic agglutination testing (MAT; n=55), blood/urine polymerase chain reaction (PCR; n=22), MAT and PCR-results (n=15) and histopathology (Levaditi staining; n=7). Grippotyphosa (65%), Australis (61%) and Pomona (60%) were the most common serogroups with the highest MAT titers. Serogroup distribution in dogs with leptospirosis from North East Germany changed only slightly in the last seven years. Serogroup-specific evaluation revealed a possible link between thrombocytopenia and Pomona infection and radiological pulmonary changes and Australis/Grippotyphosa infection. 2) Most of the dogs in this study were presented from August to October, in warm, moist weather conditions. Affected dogs often drank from ponds (67%), lived in rural or suburban regions (62%) and had regularly contact to standing water, lakes or streams (62%). Contact with rodents and wild boars or their urine were also often described (46%). 80% of the dogs with leptospirosis were regularly vaccinated.
    3) At initial presentation, the most common clinical findings were lethargy (96%), anorexia (88%), vomitus (85%), a painful abdomen (39%), diarrhea (38%), oliguria (27%), tachypnea (26%), delayed capillary refill time (18%), pale mucous membranes (17%), fever (15%), hypothermia (15%) and icteric mucous membranes (10%). Abnormal findings of the CBC on admission included anemia (63%), thrombocytopenia (62%) and leukocytosis (57%). Biochemistry abnormalities included increased urea (84%) and creatinine concentrations (82%), elevated liver enzyme activities (80%), hyperbilirubinemia (70%), hyperphosphatemia (67%), hyponatremia (63%) and hypoalbuminemia (55%). In the course of disease leukocytosis (87%), anemia (85%) and thrombocytopenia (75%) were the most common findings of the CBC. Biochemistry abnormalities included increased creatinine (95%) and urea concentrations (93%), elevated liver enzyme activities (93%), hyperbilirubinemia (87%), hyponatremia (81%), hypoalbuminemia (80%) and hyperphosphatemia (75%). Urinalysis often revealed glucosuria (77%) and an elevated urine-protein/creatinine-ratio (U-P/U-C; 75%). Radiological pulmonary changes were detected in 57% of the dogs during the progression of disease. Based on clinical, laboratory and radiological changes in the majority of patients renal (95%) and/or hepatic (93%) disease was detected. A pulmonary form of leptospirosis was present in 57% of the dogs. In the course of disease, 99% of the dogs had a multi-organ involvement. Kidneys/liver/lungs, kidneys/liver, kidneys/lungs or liver/lungs were affected in 49,5%, 41,4%, 5,1% or 3% of the dogs, respectively. One dog (1%) had only liver insufficiency. 67 dogs survived. 32 dogs died or had to be euthanized, 24 of them (75%) due to “leptospiral pulmonary hemorrhage syndrome” (LPHS). In conclusion, lung involvement represented a severe complication causing increased mortality. 4) Severe dyspnea (odds ratio {OR}=16; p-value<0.001), high-grade increased bilirubin (OR=6; p=0.001) and creatinine values (OR=5; p=0.001) as well as radiological pulmonary changes grade 3 (generalized severe reticulonodular interstitial pattern with patchy alveolar consolidations) (OR=19; p<0.001) were associated with an increased risk of mortality. In multiple linear regression, dogs with renal, hepatic and pulmonary involvement had the highest risk of letality (p<0.001). Furthermore, severely increased creatinine concentrations in combination with severe thrombocytopenia (OR=4; p=0.006) or high-grade elevated liver enzyme activities (OR=4; p=0.004) were significantly associated with letality in dogs with leptospirosis.