Use of miltefosine to treat canine visceral leishmaniasis caused by Leishmania infantum in Brazil

Abstract

BackgroundVisceral leishmaniasis (VL) is an infectious disease with a variety of clinical signs. The main form of parasite transmission to humans and other mammalian hosts is through the bite of infected arthropod females with Lutzomyia longipalpis serving as the main vector in the Americas. Dogs are the main urban domestic reservoirs of the parasite and the main source of vector infection due to their high prevalence in endemic areas and the large number of parasites in the skin of infected animals. Although miltefosine has been used in Europe since 2002 for treatment of VL infected dogs, in the Americas the treatment of dogs has not been recommended. Therefore, this study aimed to evaluate efficacy of miltefosine observing a reduction of clinical signs in infected dogs and the infectiveness to the vector by Leishmania (L.) infantum.MethodsTo our knowledge, this is the first controlled study using qPCR and xenodiagnosis to evaluate the efficacy of miltefosine (Milteforan®, Virbac) as a single treatment in Brazil. Thirty-five adult dogs with canine visceral leishmaniasis (CVL), confirmed by clinical and laboratory tests, were included in this study. They received miltefosine at a dose of 2 mg/kg every 24 h for 28 days. The dogs were observed over a three-month period, during which clinical evaluations based on a scoring system were conducted at pre-established times. Parasite load was assessed by cytology and real-time polymerase chain reaction (qPCR). Transmissibility to the vector was evaluated by xenodiagnosis.ResultsAt the end of the period, the following were observed: (i) the remission of clinical signs with a reduction in clinical scores for 94.2% of the animals; (ii) a statistically significant reduction (98.7%) in parasitic load by qPCR; and (iii) a reduction in infectivity to sand flies. After treatment, 74.2% of the animals remained or had become non-infectious.ConclusionsOur study indicates that the use of miltefosine administered orally for 4 weeks contributes to a clinical improvement and reduction in infectivity of dogs to L. infantum.

Trans-Atlantic Spillover: Deconstructing the Ecological Adaptation of Leishmania infantum in the Americas

“…This is of upmost relevance because miltefosine was recently approved in Brazil for treatment of canine visceral leishmanisis (CVL), and little information on the impact of the dog treatment on the epidemiology of AVL is available. Only one study [63], evaluating infected dogs from São Paulo, Brazil, is published. Authors described a remission of clinical signs, reduction in parasitic load by qPCR, and reduction in infectivity to sandflies.…”

A cross-sectional approach including dog owner characteristics as predictors of visceral leishmaniasis infection in dogs

“…Although these measures, directly or indirectly, reduce the risk of acquiring the infection or improve the prognosis for the development of symptomatic canine visceral leishmaniasis (CVL), further studies are needed to identify their possible impacts on human health. (9,10,11) For these reasons, it is important to study the factors that may be involved in the disease process, improving its understanding, which may contribute to better strategies for disease control.…”

Bibliometric Analysis of Chemotherapy of Canine Leishmaniasis (2000-2017)

“…MIL, the only oral drug for chemotherapy of leishmaniasis was approved for human (2000) and since 2005 for veterinary use in Europe. Oral administration and the good results reported [30][31][32] would suggest a higher presence in scienti c literature.…”