Objectives Leishmaniosis is a vector-borne disease and in European countries is caused by Leishmania infantum. Cats are considered secondary reservoirs of the infection in endemic areas. The objective of this retrospective study is to describe the clinical findings, diagnosis, treatment and outcome of feline leishmaniosis (FeL) in 16 cats in Spain. Methods Medical records of cats diagnosed with leishmaniosis were retrospectively reviewed for cases that met the following inclusion criteria: identification of Leishmania organisms and/or DNA on cytological and/or histological specimens and/or a high anti- Leishmania antibody titre, compatible clinical findings and pathological abnormalities. Results Sixteen cats met the inclusion criteria, all of which were living in areas endemic for canine leishmaniosis. Systemic signs were present in 11 cases (68.8%). The most common clinical signs on presentation included cutaneous lesions in 12 cats (75%), ocular disease in six cats (37.5%) and anorexia in six cats (37.5%). A polyclonal gammopathy was noted in 12 cats (85.7%). Non-regenerative anaemia and renal abnormalities were present in six (37.5%) and five patients (31.3%), respectively. In nine cats (56.3%), immunosuppressive conditions/comorbidities were identified. The diagnosis was made in eight of the cats (50%) by cytology, but a combination of diagnostic tests was needed for definitive diagnosis in the remaining patients. Twelve cats (75%) were treated specifically for leishmaniosis. Five of the 12 cats (41.7%) did not improve with treatment. The median survival time in the group of patients treated specifically for leishmaniosis was 17 months. Median survival of patients treated with concomitant diseases was 13 months vs 41 months in those without, although this was not statistically significant ( P = 0.557). Conclusions and relevance Presentation of FeL appears to be similar to canine leishmaniosis but with some specific features: ulcerative and nodular skin lesions are the predominant cutaneous signs; cats with immunosuppressive conditions or co-existing diseases were more commonly present than typically seen in dogs (mainly feline immunodeficiency virus). A combination of diagnostic tests may be needed for definitive diagnosis.

We have studied the occurrence of dual diagnoses (psychoses as well as abuse of either amphetamine, cannabis or opiates) during a 15-year period, among patients treated at Huddinge Hospital, Stockholm, Sweden. The purpose of the study is to evaluate if the different drugs were coupled to different rates of psychiatric co-morbidity. During the period in question, 461, 425 and 371 different patients respectively had been admitted at least once due to dependency on amphetamine, cannabis and opiates. Approximately 30% of the patients with a pure abuse of amphetamine or cannabis and less than 6% of the opiate abusers had been diagnosed at least once with any of the psychoses studied. Comparing the frequency of psychoses among mixed and pure abusers of illegal drugs, with and without a concomitant abuse of alcohol, we found that the co-morbidity rate for mixed opiate abusers increased significantly from 7.2 to 20.2% when alcohol abuse was also present. For abusers of amphetamine and cannabis (both pure and mixed), no differences in co-morbidity rates were seen when an abuse of alcohol was added to that of the drugs. It is difficult to find an explanation for the significant difference between the co-morbidity of pure abuse of amphetamine or cannabis on the one hand and opiates on the other. In conclusion, our findings show that the distribution of psychotic illness is high among abusers of amphetamine and cannabis, in contrast to the generally lower co-morbidity among abusers of opiates. Although these findings are consistent with earlier studies that have shown a propensity for developing psychoses among abusers of amphetamine and cannabis, one should bear in mind that this study is based on inpatients, and is not necessarily representative for all abusers of the drugs in question.

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ResumenHemos estudiado la presencia de diagnósticos dobles (psicosis y además abuso de anfetamina, cannabis u opiáceos) durante un periodo de 15 años entre pacientes tratados en el Hospital Huddinge, Estocolmo, Suecia. El propósito del estudio es evaluar si las diferentes drogas se asociaban con tasas diferentes de comorbilidad psiquiátrica. Durante el periodo en cuestión, se había admitido al menos una vez a 461, 425 y 371 pacientes diferentes debido, respectivamente, a dependencia de anfetamina, cannabis y opiáceos. Aproximadamente 30% de los pacientes con un abuso puro de anfetamina o cannabis y menos de 6% de los pacientes con abuso de opiáceos habían tenido al menos una vez el diagnóstico de alguna de las psicosis estudiadas. Comparando la frecuencia de psicosis entre los pacientes con abuso mixto o puro de drogas ilegales, con abuso concomitante de alcohol y sin él, encontramos que la tasa de comorbilidad para los pacientes con abuso mixto de opiáceos aumentaba significativamente de 7,2 a 20,2% cuando estaba presente el abuso de alcohol. Para los pacientes con abuso de anfetamina y cannabis (tanto puro como mixto), no se vieron diferencias en la tasa de comorbilidad cuando se añadió abuso de alcohol al de drogas. Es difícil encontrar una explicación para la diferencia significativa entre la comorbilidad del abuso puro de anfetamina o cannabis, por una parte, y opiáceos, por otra. En conclusión, nuestros resultados muestran que la distribución de la enfermedad psicótica es alta entre los que abusan de anfetamina y cannabis, por contraste con la comorbilidad generalmente más baja entre los que abusan de opiáceos. Aunque estos resultados son consistentes con estudios anteriores que han mostrado una propensión para desarrollar psicosis entre los que abusan de anfetamina y cannabis, se debería tener presente que este estudio se basa en pacientes hospitalizados, y no es necesariamente representativo de todas las personas que abusan de las drogas en cuestión.