terapia della leishmaniosi canina...terapia della leishmaniosi canina: il vecchio e il nuovo a...
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Terapia della leishmaniosi canina:
il vecchio e il nuovo a confronto
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Index
Treatment of canine leishmaniosis
www.gruppoleishmania.org
l When do we need to treat?
Stage A/B vs. Stage C/D
l Suitable treatment
l Immunotherapy
Treatment
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Prevalence of infection: >60%
Prevalence of disease: 10%
www.gruppoleishmania.org
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www.gruppoleishmania.org
No treatment!
2016 Jan 6; 10(1): e0004341
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www.gruppoleishmania.org
Treatment!
2013 Oct; 198 (1): 43-47
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STADIO DEFINIZIONEDELPAZIENTE
PROGNOSI
A Esposto Favorevole
B Infe8o Favorevole
C Malato Favorevole
D Malatoconquadroclinicograve
Riservata
E (Ea)Refra8ario(Eb)Recidivo
Riservata-Infausta
l When do we need to treat?
Stage A/B vs. Stage C/D
l Suitable treatment
l Immunotherapy
Treatment
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meglubine antimoniate 40-50 mg/kg/12h/1 month
+ allopurinol
10 mg/kg/12h-24h/12 months
miltefosine 2 mg/kg/PO/28 days
+ allopurinol
10 mg/kg/12h-24h/12 months
allopurinol
10 mg/kg/12h-24h/12 months
Treatment of leishmaniosis
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J Am Anim Hosp Assoc 2013; 49:231–236.
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Santos MF et al. 2018
l Good response to treatment (high %)
l Good response to treatment but with allopurinol for years (moderate %)
l Good response but only to leishmanicide treatment (low %)
l No response to the treatment (very low %)
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l When do we need to treat?
Stage A/B vs. Stage C/D
l Suitable treatment
l Immunotherapy
Treatment
DISEASE AS CONSEQUENCE OF
INFECTION
DISEASE AS CONSEQUENCE OF
INFECTION
+ INADEQUATE
IMMUNE-RESPONSE
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Infection and clinical signs are intrinsically related to the interaction between Leishmania, Phlebotomus and dog host immune system
Infection Immune-response
INOCULATION OF THE PROMASTIGOTES IN THE
SKIN OF DOGS Subclinical infection Effective immune-response
Systemic disease Non effective immune-response Complete elimination
of infection
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Th3
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GENETIC FACTORS
NON GENETIC FACTORS
Th1 / Th2 IMMUNE-RESPONSE
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GENETIC FACTORS
INMUNE RESPONSE
Th1 / Th2
2012; 7(4): e35349
NO GENETIC FACTORS
INMUNE RESPONSE
Th1 / Th2
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Immunotherapy
monoclonal antibody specific lymphocytes
NK cells cytokines vaccines
anti-Leishmania treatment TLRs
nucleotides antioxidants domperidone
Immunotherapy
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www.gruppoleishmania.org
Treatment!
l Good response to treatment (high %)
l Good response to treatment but with allopurinol for years (moderate %)
l Good response but only to leishmanicide treatment (low %)
l No response to the treatment (very low %) Immunotherapy!
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Infection Immune-response
INOCULATION OF THE PROMASTIGOTES IN THE
SKIN OF DOGS Subclinical infection Effective immune-response
Systemic disease Non effective immune-response Complete elimination
of infection
DOMPERIDONE 0.5 mg / kg / SID / PO / 30 days
every 4 months
Immunotherapy
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Immunotherapy
Immunotherapy
“After the
treatment of the
disease”
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www.gruppoleishmania.org
No treatment!
Infection Immune-response
INOCULATION OF THE PROMASTIGOTES IN THE
SKIN OF DOGS Subclinical infection Effective immune-response
Systemic disease Non effective immune-response Complete elimination
of infection
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DOMPERIDONE 0.5 mg / kg / SID / PO / 30 days
every 4 months
Immunotherapy
Immunotherapy
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“HEALTHY
but
INFECTED”
Immunotherapy
l When do we need to treat?
Stage A/B vs. Stage C/D
l Suitable treatment
l Immunotherapy
Conclusions
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Grazie xavier.roura@uab.cat
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