Great. Thank you, Bruce. Welcome everyone, to this Thursday evening, webinar on imported infections.
It can happen to you. In fact, it just did. Today at Glasgow, an 8 year old female neutered dog imported from Romania two years ago was presented to our ophthalmologist with retinal detachment in one eye and a vitriol mass, longer history of 7 months of colitis, hypoglobu anaemia, hyperalbinemia.
the ophthalmologist ran a, 4DX plus and gets a positive on Aleia canni and Darala imatus. And I don't think either of those are being associated with the eye signs, and we are worried about other diseases such as prototheosis that may be causing this. It is happening to all of us.
I hear stories like this every day of the week, So, I think it, it's useful to start with an idea, of the scale, of the, of the issue. So, just to give us a brief idea, how many dogs do you think were imported last year into the UK under the pet scheme? Right, the poll is active guys, you know how it works.
Simply click on the answer that you believe is the correct one. It is completely anonymous so don't get splinters by sitting on the fence. Let's get some voting going.
Right, let's end that poll quickly and can you see those results again? I, I can, I can. So 27% said 100,000, 20% said 200,000, and, 13% said, 500,000, half a million, dogs.
Let's see, let's see. Let's, let's, let's go see. Let's go back to that presentation.
So a bit, a bit of history really, first of all, that, until, 2000, really, almost hardly any dogs came into the UK because they, they had to be quarantined for six months. I mean, it, it was, a rare thing to do. But in February 2000, the pet scheme was launched, which allowed entry without quarantine.
That entry was restricted to certain countries, and there were certain vaccinations and testing, were made compulsory. At the time, I was sitting on BSAVA council. I remember we, we campaigned very, very hard, to, to get some sort of monitoring.
None of us were keen on this, relaxation of quarantine, because we thought that it might increase, importation of pets. But, we couldn't dissuade the ministry from not doing it, so we at least said, well, at least let's monitor. And so was born the so-called Daktari scheme.
Which was a voluntary monitoring scheme for imported diseases. 2004, pet passports were introduced and significantly in 2012, testing for rabies virus antibodies, was abandoned, on the grounds that, it was not, a, a, a good use of owners' resources, basically, or time because there were so few animals that were not responding. Show you the effect of that.
In 2000, about 12,000 dogs were imported into the UK, ie before pet scheme, really got started. By 2008, that number had ridden, risen to 93,000 dogs coming in. That climbed very steadily up to 2012, to 154,000.
But then we abandoned testing. And 2015. 164,000 dogs came in under the pet scheme.
Including 65,000 dogs that had never actually left the country from over 128 different countries. So the ones who put 200,000 were the closest. Well done you.
But clearly, the trend is, is ever upwards. And I think what's really worrying is the number coming in for commercial purposes. The pet scheme is now being used to import dogs as young as 8 weeks old, from Romania and other parts of Europe, which didn't traditionally supply us with, with dogs.
Traditionally, they came from Ireland. But now it's moved into Eastern Europe, and this year Romania overtook Ireland as the number one destination for puppies bred outside of the UK coming in. And it's a, it's a complete abuse of the pet scheme, of course.
It was never set up for that. It was never designed for that, but this is what, what we're faced with now. Of course, any presentation like this would not, not be without a mention of our favourite topic of the moment.
And that, of course, is, is Brexit and the effect that this will have on the EU pet travel scheme and the new pet passport. When I started doing this, writing this presentation, I thought I might be writing about a deal. But as you know, at the moment, we have no deal, so I really can't tell you what's going to happen.
Come March the twenty-ninth. Our, our best advice at the moment is that we're going to have to revert to a rabies testing system. It's costing a lot of owners a lot of money to get their dogs vaccinated and get them tested if they want to take them abroad, but I don't see any alternative at the moment in the absence of a, a, a deal.
the, hope is that if we get a deal, that the EU pet travel scheme. Will be included in that and that we were able to carry, carry on, but, . We, we don't know that yet at this time.
And I guess we know we won't for another, few days yet. The Daktari scheme was interesting in, in that it was a voluntary scheme, but vets did embrace with it. And what it showed almost immediately within 6 years or so of it starting was that although the Prime The primary worry was about rabies, of course.
The, the pet scheme was allowing into the country significant numbers of dogs with Leishmania and Babezia, and in, in, in addition, a few cases of Alia were, were coming in. And that was, quite a, quite a, a difference for the UK veterinary population, but the numbers were still relatively small, in this state. After these figures were published, DEFRA shut down the Daktari scheme.
That's what you do if you, you don't like the results, because, it, it was obvious that the PET scheme was allowing stuff in. I should note the graph on the map on the right there. These cases were not confined to a narrow band of, of the home counties and the south coast.
People were travelling with their pets from as far north as, as, as Aberdeen and Wick, and we've certainly seen a number of cases of, of these diseases at Glasgow vet school. So we clearly have a national problem with this. So what are the main imported diseases?
Well, rabies, obviously, and I, and I think it would be remiss not to talk about rabies at this stage. We need to just remind ourselves about that. But the main ones are Leishmania, Elia, Babezia, but there's a huge variety of others coming in as well now, and perhaps just mention those briefly at the end.
But I'll focus mainly on those four diseases. But before we go anywhere, I think it's worthwhile just reminding ourselves about rabies, said to be the world's worst way of dying. If you haven't seen it, and I think every vet should see this.
I would advise you to go and see this video on YouTube, which was made in the 1950s by some Americans working in Iran. Looking at humans with, with rabies, but it's a truly terrifying film, not for the faint hearted, but I think we should say, we should remind ourselves of just how bad a disease it is. And of course rabies has a worldwide prevalence.
Only a few island nations are exempt, and a few countries where geography prevents sufficient large numbers of large mammals being around. So, so that's why I explained Norway and Sweden not not getting it. I've never quite understood how Greece manages to avoid rabies.
I think that's an interesting one. What rabies is, is a series of viruses that are closely related, and they host adapted to a certain extent on different continents. So in Western Europe, we talk about fox rabies, in, in Middle East and Africa, it's street rabies.
So in, in, in the street dog population in South America, the vampire bat, and, bats also in, North America, but also the raccoon. And these are, these. Host adaptations are not complete.
They can all pass the virus from the host adapt to host a raccoon to raccoon to raccoon to raccoon, and sometimes they will get over them, and we know that they've been exposed at low levels to rabies because they're antibody positive. The problem is when one of those hosts then bites or somehow or other infects another host, is that they can jump species. The virus dose needed is much greater, but if he gets into one of those other hosts, then nearly always the infection will progress to a fatal conclusion.
Rabies is spread by biting, replication of the bite wound takes several weeks to months before the virus will then penetrate the nerve by the ACH receptor. It specifically binds to the ACH receptor, enters the nerve, travels along the nerve, gets into the spinal cord, makes a beeline up into the brain where it replicates, and then It spreads through all the rest of the nerves of the body, causing the signs that it does. But one nerve is really particular, that's the cranial nerve because it gets into the salivary gland, and there the virus replicates again, and that's why the saliva becomes infectious.
So the signs of rabies have been characterised into furious and paralytic forms, and, and it's not a terribly good distinction. And I, and I think it's actually quite a dangerous distinction because I think a lot of people, when they think of rabies, think of this picture of this rabid dog. Got attacking everything very dangerous, but in fact, paralytic forms are out there quite commonly, and ultimately both forms will progress to paralysis.
And so eventually both end up in the paralytic, state, and, and, and it's, and it's easy to, to, to mistake them for something else. Most dogs will despise some sorts of behavioural change. Excitability, abnormal sexual behaviour, vocalisation is quite common, attacking and eating inanimate objects, and they will mostly display some sort of cranial nerve signs with dysphonia, dysphagia, dropped jaw, resulting in drilling the saliva.
The one thing that we know is fairly rare in rabies is any evidence of seizures. And, and so, that, that's not something you, you would look out for. And paralysis, paralysis starting in the bitten limb, progressing to other limbs, and finally, the pharyngeal and respiratory muscles, which is what kills the animal.
From start of the signs to death is about 7 to 10 days. So it's, it's a, it's a relatively rapidly progressive disease. If the owners come in with a two-month history of problems, it ain't rabies.
But we need to be aware of, of that, That rapid progression as an important part of the, the differential diagnosis. Trouble in the UK, of course, is that no one will see rabies on a regular basis. And so what we tend to do is see, think, think of things like brain tumours or hepatic encephalopathy.
Many features of that, in that, some of the systemic disorders like anaemia, which might cause Pika. There are other causes of viral and pro. So will encephalitis apart from rabies, and of course, we have GME as well.
So many of those behavioural changes that we saw, particularly in the later stages, can look like, like rabies. The dysphonia, dysphagia drooling of saliva could be reminiscent of myasthenia gravis, trigemalitis, tetanus, tetanus can look like rabies, in a picture. And, other brain, related, lesions there.
And of course, GI disease and, and the esophageal foreign bodies, and some of these dogs with rabies will eat strange things and end up with esophageal foreign bodies, and it's easy. To, to, to see how that's confused. I was always reminded of this by, by my lecturer in virology, a chap who'd actually, done his early career in Africa.
And he tells, told the story of the dog that came in with the ball stuck in its throat. And everyone reached in, pulled it out, but actually the dog had rabies, and, so that, that was, quite a nasty surprise, from that point of view. I have obtained a video from a colleague in the United States of America, which shows a, a, a, a rabid dog.
The dog was euthanized shortly after this and rabies was discovered. But I think it's, it's worthwhile, looking at, looking at this video to, to see the sort of presentation that you might get. With in in the late stage of rabies.
This is not a furious, furious dog at all. This is not fitting the sort of type of, mental image that many people have about, about rabies, and we can see why the, this, this, A vet here is examining this dog because they're worried about what it might be, about what's going on, but rabies is not on their minds, because if it was, they wouldn't be handling it with their hands. So You can, you can see the dog is very disorientated, loss of facial sensation there.
There's cranial nerve deficits. Mm. This is the loss of the oculocephalic reflex.
So when you do this to a dog's head, the dog's eyes should track, as it, as it moves around. There should be, horizontal movement in the eyes, and you can see there, there is no horizontal movement. And we try to walk and and he's now Absolutely attaic and uncoordinated.
So we'll just start, stop, stop that there at the moment, but I think that video is quite important because it shows you how easy it is, and this is a situation where they have rabies in the United States. They're, you know, they're looking for it and even experienced practitioners can mistake it for something else. So It's important to be aware of that.
I don't have any videos of rabies in cats. There's a YouTube video reference there. If you, you want to have a look.
The ferrous form is, is said to be more prominent. difficulty, of course, is that, some cats can look, really, Cross anyway, at times. How will rabies get into the UK?
The most likely route is someone smuggling it. When I was a young man, you never saw a dog on a cross-channel ferry. And if anyone did bring a dog on a cross-channel ferry, it would be likely that other passengers would say something and notice it and do something.
Now it's very common to see dogs on cross-channel ferries, so you can just bring a dog into the UK and it's unlikely that anyone will challenge you. . The most person most likely to identify that this dog has rabies, therefore, is now very definitely the local veterinary surgeon who will be presented with a dog, and, and it may be a dog that the owners have brought home, in completely good faith.
they may not have, thought anything of it, and, they, they, they, they've got a dog with problems. And you don't have to go very far to find cases of this happening. In France, they've had multiple cases of cases being imported into.
their, country, from, North Africa, particularly, Morocco being a particular source for, for the French, and many of these, these dogs have bitten their, their vet or their owners, and have subsequently turned out to have rabies. This is just a selection of the cases that have come into France, and that makes some worrying reading too. So if you do suspect rabies, and by suspect I mean it crosses your brain.
If you have the R word in your brain, you suspect it, you mustn't go on beyond that. The only two things that you need to do legally are #1, keep the animal in a cage. and #2, contact.
I legally, it's either the local divisional veterinary office or the police. My strong advice to you is not to contact the police, because it is likely that they will not know what to do and they will not handle it terribly well. The local divisional veterinary office, on the other hand, having been through this myself several times, are absolute stars.
They're calm. They have a clear way of doing it. They don't send in large helicopters and so forth.
They don't close your veterinary facility down. They have a checklist. They work through it with you, firstly, over the phone, and if they're happy over the phone, then, then they, they can say, no, it's not rabies, carry on.
Sometimes they will actually have to come out depending on the the checklist, and they will look at the animal. Do not euthanize the animal. I can't emphasise that too much.
You might very well likely be wrong, A and B, if you're not, then the disease progression is a very important part of the diagnosis. I also have to say working in my job, do not refer the animal. It, it sounds obvious, but, that is not an appropriate referral.
. What'll happen if you do have a case of rabies, is that the animal will be observed, and, if it deteriorates rapidly and in the, the, the expected, rate of clinical sequences, then on welfare grounds, ultimately it will be euthanized. And at that point, a, a postmortem will be done and what they'll be looking for are these *** bodies in the brain. I suspect one of the times that you will think about rabies is when a dog that's been imported has bitten somebody in the practise.
And it's important to realise that first aid is absolutely crucial in making sure that the individual who's been bitten is not suffering, going to suffer from rabies, is, is to clean the wound immediately, using a very strong soap solution. Surgical spirit, which is the 45% ethanol, or Quaternary ammonia compound, and that's that's things like parvoci and so forth. I have to say of those three options, I'd rather go for the 20% soap solution in the wound rather than a 45% ethanol.
I could imagine that the 45% ethanol would sting quite a bit. If there are deep puncture wounds from a dog bite, then take a 20 mL syringe full of your wash solution, put it in the hole, and press down on the plunger. Don't use needles, just use the nozzle of the syringe.
It creates enough force to dislodge most particles out without driving particles deeper into the tissue. And of course, obviously, seek medical help. Immediate vaccination is usually effective in almost all cases where this has been done.
But if it turns out this is a rabid dog and there is a serious thing, then they can also give you local or systemic immunoglobulins as well. We like to think in the UK that we are free of rabies, but when we tried to convince the EU that we were free of rabies, the EU asked us to look at our bats. And so, a few years after the, the, the pet scheme came out about 2003, the, sorry, it was a bit more but it was in the 90s actually.
In the 90s, they, they started looking at bats for bat lyssavirus. And in 1996, the first virus. A positive.
So this was a a virus, a bat that had not just antibodies, but actual rabies virus, i.e., it had rabies was identified in Sussex, and DA's explanation from this that it was obviously blown over from France because all bad things come from France.
6 years later, a second positive bat was found in Lancashire, and one has to say that that is quite some wind to blow over a bat to Lancashire from France. And very shortly after that, a bat worker in Scotland, developed a bat lesser virus infection. They never found the positive bat, bat, but, ever since that time, all bat workers have been vaccinated against bat lesser virus.
Since that time, at least 5 more positive bats have been found, and some species of bat in the UK have a 5% 0 conversion rate, so there is quite a bit. So does this mean batless the virus in the UK mean that rabies is in the UK? And, and the answer is that, well, it's clearly circulating in the population, and clearly many of these animals are, are, are seeing the infection but recovering from it, fine.
It can cause disease in humans. 2 to 3 people die each year from bat lyssavirus in the United States. It's very rare, but it does happen.
But the disease it causes is definitely rabies. So the answer is yes, we already have rabies in the UK. But I would emphasise again, not all rabies viruses are equal.
If we get street rabies or sylvatic rabies into our dog or fox population, we have an enormous problem on our hands. A bat lyssavirus, is very, very, very unlikely to transmit to a human, and as you know, there have been no cases reported in dogs in the UK spontaneously developing rabies. But we should be aware of the risk for, for, from bats.
This is from 2008, when a, injured bat that had been handled by, wait for it, 6 bat workers. It apparently took 6 bat workers to get this one bat to a vet. These bat workers had been, previously vaccinated, as recommended, but the veterinary surgeon and her staff were totally unaware of the potential rabies risk from the bats.
And despite having the same needle sticker that had neither sought nor received post-exposure prophylaxis, i.e., vaccination at that time, it was only when the postmortem came out that they discovered what had happened.
That veterinary surgeon was incredibly lucky. It is really, really important that we are aware of the fact that injured bats presented to our clinic, may have batlessa virus. It's very rare, but it is there.
So with that, little, coverage of, of rabies, in the UK, let's go and look at the, the things that we, see more commonly, and, the, the existence of, leishmaniosis. Now, I'm not sure we've got this as a poll question, have we? No, sorry, we don't.
OK, I, I forgot to highlight that. Don't worry, let's not worry about. I, I know that most, most vets have seen cases of leishmaniasis.
We've seen, leishmaniasis, mostly imported dogs. But, we know that in, England now there have been documented cases. Of dogs developing leishmaniasis, despite the fact that they've not been abroad.
These are often thought to be dogs that have contracted it from another dog that has been abroad, so it's been dog to dog transmission, but there have been even one case where that, that could, that the infecting dog could not be found. It is very, very common in all those parts of the world which the UK population likes to take their dog on holiday. It's a disease that has a long incubation period that can be measured in months to years.
Recently at Glasgow, we diagnosed leishmanialysis in a dog that had been in the UK for 7 years. It had been obtained as a puppy from Portugal, but it, and it was brought in as, as a young adult dog, but 7 years later before it started about leishmaniasis, it can take a very long time. It can look like many other diseases.
It can be difficult to treat, and it is potentially a zoonosis, particularly to immunosuppressed individuals, although it's quite hard to get le analysis from a dog, it's certainly not impossible. It's transmitted by sandflies, which are most, common in woodlands, sandy woodlands, and beaches. The vector is not present in the UK at the moment, but direct transmission dog to dog and dog to human is possible.
Dogs that have been born in Portugal and Spain and southern, France and Italy and so forth, have antibodies from their mothers. And so when they're bitten by their first sandfly, they already are partly protected. And so they're able to mount an early response and contain the disease, and many dogs, therefore, in these countries are live with the parasite or have are completely immune to it, and they, and they restrict the disease.
If we take our dogs from the UK over overseas, we are taking a completely naive, immunologically naive dog into potentially areas such as woodlands and beaches. Where there is a very high exposure risk. And so I make a distinction here in leishmananalysis between dogs that were born and, and raised in countries, where leishmaniasis is, is common, and, .
Those that go abroad, and get a, a large dose. The, the clinical signs, are of a chronic waxing waning disease, and it, it causes weight loss, fever, lymphadenopathy, palms. Brains.
It's particularly characterised by dermatological signs, and, and, and I just draw your attention to this, the, the, the nodular lesions that you can see on the tongue here. the, these are, are quite pathogonnemonic for, le meiosis. And I signs are common, lamenesses, and, er anemias.
And these are the sort of pictures where we, we, we see of dogs with panophthalmmitis, with this silvery sheen here, this, this photograph from Susan Shaw, a very famous photograph, and, panophthalmmitis here. And these are what we see in dogs that have been to, abroad for their holidays and, and come, come back. Dogs that are born and brought up there can be really mild.
These, these are all, cases of leishmaniasis, but you can see the dermatological changes are really quite slight. These dogs are living with the parasite, quite nicely. Another couple of dogs, they look like they might be leishmaniasis.
In fact, they're not. The, the, the, the dog above is a dog with pemphigus foliacious, and the dog below has a epitheliotrophic lymphoma. So it can look like other diseases.
The systemic change. Can look like a lymphoma, other tumours like plasma cell myelomas, they can look like a systemic locuthematosis, that lots of things can look like Leishmania. So it's certainly not, an easy disease necessarily to, to diagnose.
Loy findings are, are quite characteristic, a high level of globulins. They can be monoclonal, which gives a, a, a problem with, plasma cell myeloma. The, hyperaleinemia, the, hypoglobu anaemia, put it all together, that all looks very inflammatory.
So you can certainly diagnose the inflammatory aspect of, of this, but identifying what's going on, it can be difficult. In the anaemic animals, you might be tempted to do an in saline or glutination test that can be positive. Coombs tests can be positive, so these dogs can look like an IMHA.
On the urinalysis, they can have severe proteinuria, so you can think about glomerulonephritis. There are lots of things to look at. And the problem is these sorts of pictures of, of, of, a master goats in a, a macrophage there, you will not see that on a blood smear.
You have to look at the lymph node smears or bone marrow aspirates to find them. You have to go to where the white cells are there in number. And they're not that common.
So, you, you, you go, you hopefully would see them, after 5 or 10 minutes of looking around the bone marrow aspirate, but you won't necessarily see them absolutely straight away, particularly in dogs that are only mildly affected. Serology is not very useful in dogs that have been exposed at an early stage in their life. So dogs that have been born and brought up in Europe will expect to find a high level of seropositivity anyway, so it's really not very good.
If dog has been, to Europe on holiday and comes back with clinical signs and is serology positive, that's a little more convincing, in, in, in, in my view. Ideally, one would do PCR and the Aris Lab at Bristol University offers a very good service for this. But again, you, you can't just do PCR on blood.
They may get false negatives. You need to go to those lymph node aspirants. So if you do an aspirate and then you squirt it into a, an EDTA tube filled with a little bit of sterile saline, so that you get the cells into that li, that, that saline to keep them in.
In good condition and send them to the lab like that, making clear that how you've prepared the, the, the, the specimen. Sending in blood samples has a lower success rate, and in particular, it's very important to remember, we need the cells alive, so it has to be an EDA blood sample. I know the ARs lab would want me to say there's no point sending serum.
It sounds obvious, but every week they get cases of people who've sent. Serum samples in, for, the diagnosis of, leishmania on PCR and that does not work. Oh, just to say the other thing is that if you do send things for PCR, please do go for the panel.
There's no point in just, doing all this effort for Leishmania. There's enough coinfection out there with Alikia and Babezia that you really do need, the panel. If you diagnose leishmaniosis, then, you want to go to a, treatment.
I think, in, in, in mainland Europe, it's very common to just give, allopurinol. it's a cheap option. And it's one that, the charities that, deliberately import these dogs into the UK, they will often give these leishmaniasis, affected dogs, to their new owners with a supply of allopurinol.
It really does not get rid of the disease. The failure rate of this treatment is pretty high. If you want to get rid of leishmania, then you really need to use something like the pentaval and animinals.
So melamine animinate, is, is, gun, is, is probably the best and most widely available. These, have to be given as, subcutaneous injections. They have to be given every day.
They're painful to the dog and they cause quite a lot of local reactions. This treatment should not be given by owners because they will not complete the 4 weeks. It simply is too painful for the dog and the owner-dog bond is too badly damaged.
The most common advice is that they should be brought in and the dog should be taken away from the owner for that injection to be done. But it is the only good way of getting rid of leishmanialysis. If you just treat them with allopurinol, eventually you will get the, the, leishmania becoming resistant, and, then you'll be in a pickle.
New, new one on the scene if, if Fish Moses doesn't, if the, antenna mills don't take your fancy or the owner's fancy. Then the other option is to import mil to fossin. It's, it's expensive, but, it, it has perhaps less immediate and dramatic side effects, for the dog.
And, although many of them will develop diarrhoea, they do live with the diarrhoea as long as the owner is prepared to live with, live with the diarrhoea, then, this is, this is another alternative. But I'm afraid again, it has to be imported. And this is something that, obviously with Brexit looming, we, we're quite worried about.
Clearly advising your owners on, prevention is important. Don't take your dog into woodland, particularly at dawn and dusk. Don't take it for that last, romantic walk along the beach, at dawn and dusk.
the, make sure they're wearing good insect repellents, to keep these sandflies away. Avoiding the disease is better than treating it. For dogs that are, routinely, going to, to, these climates, then it may be worthwhile considering the Leishmaniasis vaccine, which, which has been available now for, for some time.
Again, I think this now has to be imported into the UK. This is a significant public health, issue in some parts of the world. And, so this vaccine is proving very effective in places like Brazil and so forth, but it is useful, in Europe as well.
It does not reduce the number of, parasites per dog that much, and it certainly does not provide the kind of protection. That, you would expect out of, a viral vaccine like Parvovirus. But it does reduce the number of dogs that get infected, and, that reduces the differences between about 80%.
Infection in a high, high, challenge situation compared to 30% in the vaccinated dogs when measured over a year. But that, you know, it's not a good, good figure. And up to half of those dogs did show signs of infection at one time or another.
So it really is not a vaccine that you can rely on. Absolutely. It just reduces the chance.
Alongside leishman analysis, the, the, the other disease that's been reported quite frequently now is alechiosis and and Alichia taxonomy is, is a difficult one. Some of these leias have now been renamed plasmas, so you will see, Aleia phagocytophilia is now plasma phagocytoya. And we, we, have different ticks and different distributions of different populations of Eleus.
There's a lot we still don't, don't know about this. The brown dog tick, Grifficephalus, is the major vector of Elekia canus and that fortunately is not present in large numbers in, in the UK. What we do have, of course, are the exo exoes ticks, and these do carry Alekophagocytoya quite readily.
And we know that large parts of Sweden and Norway have considerable amounts of elephagous cytophilia. So there's no reason why places like Scotland and so forth, shouldn't either, and we suspect they probably do. The signs of elechiosis, well, the, the monocy soleia canis is, is one of petiation and, and epitaxis, whereas the granulocytic aus leop phagocytofia or Anaplasma hagocytoya tends to present more like lameness and joint swelling.
It's more of an immune-mediated polyarthritis type of presentation, although they may develop anemias and so forth. These are, these are those, those lithium moulla in cells, but I think I should point out these, these are career best photographs from individuals who very kindly lent me them. The chance of actually seeing a limoulla are really quite few and far between in most infected dogs.
So to make the diagnosis, is, is quite tricky. There is one other presentation of aliy that you should be aware, and that is the chronic pancytopenia form, which can look like a, a, a, a, a form of leukaemia in that they, they have a non-regenerative anaemia, thrombocytopenia. And leu leukopenia.
And you might on that basis start thinking there's serious bone marrow disease. There is, but, but it can be caused by, by a lia. And that can take 2 to 4 to 6 years to manifest itself after initial infection.
So the diagnosis direct observation is improved if we look at buffy coat smears or lymph node aspirates, but occasionally we'll see it on, on direct haematology. Serology is useful, an evidence of exposure, at least in the past, and of course, PCR. So PCR from the lymph node, from the, bone marrow aspirates, from buffy coat smears are better than PCRs from haematology.
and then we can get down to the level of speciation once we've done the generic PCRs. And again, Acuras, offer this, offer this service. The treatment is fairly straightforward, tetracyclines, and, with a little bit of prednisolone if we need it, because of the polyarthritis.
Babesiosis is a more acute disease. we see it, in Europe with, babesia canis. There are different strains of babesia canis and they have different pathogenicities.
Before this, webinar starting. I was talking to Bruce, who, of course, is from South Africa. They see a particularly virulent form of Babesiosis, in South Africa.
When we get Bbe here in the UK, it is not that, severe. It is not that, rapid, and, the diagnosis, can, can therefore, take a little more time. Depending on, which Bbezia will depend on which tick vector, whether it's democephalo or cephalus.
And as we know, we've, we've had several cases in imported dogs and most recently in Essex, we actually had a, a, a few dogs that have been come down with it, having never travelled abroad. That presumes that the local tick population, therefore, has at least temporarily been infected with the Babezia species. Concurrent infection with a lia is very common in these cases.
It tends to be an acute disease, so it's not something that we see chronically, and, what we see is a hemolytic anaemia, which, in, you know, South African dogs can take hours to kill the dogs, in, in the European dogs, it, it takes, a little longer, a few days to, to get to, to fulminant. forms, and some dogs may even survive it, without, without treatment, but most of them will need some treatment. They, they can become jaundiced, and progress, of course, to, to DIC and death.
Unlike Alichia, these are big organisms, and they're really quite obvious in the red blood cells. It does not require a lot of looking at red blood cells to realise that there's something rather odd about them. The best chance of finding them is an erythrocytes just below that buffy coat, and taking ear prick samples from peripheral veins rather than taking a jugular sample, do an ear prick, and, and smear, smear it direct onto, onto the slide.
These tests, these, dogs may autoglutinate. So, you know, if you've got a hemolytic anaemia, autoglutinates, it would be so easy to think that this dog has autoimmune hemolytic anaemia, which just goes to show the real importance of, first of all, asking about travel history in any dog with autoimmune hemolytic anaemia, and secondly, always, always, always looking at a blood smear and not just relying on a machine count. Serology, of course, if it's positive, it would be very indicative in a dog that is on holiday, come back from holiday.
But in a travel dog, a dog that, sorry, in a dog that was born abroad, it may have been exposed to Birbeia early on. So in those cases, definitely PCR is the only way to make the diagnosis of an active infection. Here are more examples of other Birbezias, the so.
Called signet ring formation, these little, exclusion monies, these pear shaped and coding into two so-called teardrops, two teardrops here as well, in, in this other one here, very, easy to see these, and really all it takes is somebody looking down the microscope and making a, an open mind about what, this dog, might have. How do we treat, blood transfusions, and sadly, oxyglobin no longer available, but, but was a, a, a godsend when, when it was available. But now it would have to be, just, blood transfusions.
And, and one would suggest that probably this is a situation where pack reds, red blood cells would provide immediate relief. But if you have a more serious case where the dog may be going into DIC, then having whole blood, so you get fresh clotting factors and antithrombin II levels makes sense, as well. If you haven't got fresh blood, then a com combination of fresh frozen plasma and packed red blood cells, would be ideal.
The specific treatment is a miocarb, it's a painful injection to give, it's hepatotoxic, and you need to, to, to get it, from, an importer. Prednisolone is useful, low doses for short periods, and, treat for alicur anyway using, a doxycycline, even if you've not made the diagnosis, it's so easy to treat that, not to do so would, would be a mistake. So today, we've run through, 4 diseases.
We've run through rabies, we've run through leishmania, we've run through Alekia, we've run through Babezia. and the key to all of those 4 is to ask the question every time of owners. Has this dog been abroad?
Is it sharing a house with a dog that has been abroad? We need to know the travel history now for virtually every case that we come into contact with because it can look like so many other things, but particularly, we need to ask in cases with, immune-mediated diseases, anemias, and any sort of neurological signs, we need to ask the question about, travel. And I would also add any glomer nephritis is to that as well.
Of course, this is just tip of the iceberg. There's a whole load out there and cyostoma is more common abroad. It does occur very occasionally in the UK on scenario, again, very common in the UK, fungal disease, so cryptococcosis and things like that, prototheosis.
These are, these are all coming in in these imported dogs as well. Just to give you an example, recently, we Published a case of canine brucellosis in Glasgow. The dog would come in from Romania, again, came into the ophthalmologist.
He seems to, to be a bit of a magnet for these dogs, with UVI test. And it was only when we, we started to realise what was going on, we actually realised this was an entire male dog, and his testicles, were slightly larger, slightly harder than normal. Sadly, these dogs do not respond to treatment, they are potentially zoonotic, and so that dog was euthanized.
There's lots of them out there. We just need to ask the history, we need to find out what's going on, and, to, to make sure that, owners are aware of the risks they're taking when they take their dogs, abroad. No supporter of Brexit, but it may be one thing that we can reduce, if we have Brexit.
This talk would not have been possible without the cooperation and, support of a number of colleagues who I've worked with around the world, from South Africa to Spain to, USA. I'm indebted to the people listed on this slide, for their, pictures that they provided me, and the, the helpful advice, for, for, some of the cases that I've had to manage, at Glasgow. And with that I will be happy to take any questions.
Yeah, and that was absolutely fascinating, a complete whistle stop tour. And I think a take home message here is prevention is better than cure. Absolutely, absolutely.
And I think that prevention also includes just being forewarned and forearmed, when people decide to take their dogs abroad. Yeah, or when they decide to try and rescue dogs from abroad is another one. Well, yes, indeed, we, we, we, we're actually aware of a number of dogs that are a number of charities that are deliberately bringing dogs into the UK with these diseases, which is, which is just unbelievable, unbelievable that, they're doing it, but they, and they tell these owners, they're saving these dogs' lives and they put such a guilt trip on them.
That, and they tell them that the UK vets, you know, they got it all wrong. It's not a bad disease and you can treat it, it's not a problem. And, and, you know, of course, they, they don't tell them about the costs of treating it.
They don't tell them about a hassle. They don't tell about pain, and, and these poor people come back. Yep, unfortunately I have met a few of those who have been caught in that, that situation.
Greg has got a good question here. He says if a dog already has Lamania, is it worth vaccinating it? No.
I am not aware of any data that that is, suggested that that would help, . It might, and potentially it might even make it worse, of course. I mean, I'm stand to be corrected if, if someone has, has had different experience or knowledge on this, but, the, the amount of antibodies in a leishmania infected dog is absolutely huge.
I mean, I mean, you know, serology for leishmania is so easy. You know, it, it, they, they can tight to these antibodies down to 1 in 10,000, 1 in 20,000, that problem. So, really, no, the answer to that.
Yeah, it's it's always hard when you, when you're not sort of living and working with the disease. As you mentioned, you and I were chatting before we went live about Babezia. And you know, when you see it every day, it, it's kind of easier to deal with because it becomes run of the mill.
And Leishmania is one of those diseases I think where because we don't see a lot of it, it becomes a lot more difficult and you get all these weird stories coming through and if you phone somebody we had a dog brought into us and, the lady said, oh, the vet in, in, I can't even remember where he was, speaks very good English and he said you can phone him and he'll tell you how to treat the dog. Yeah, yeah. Oh, absolutely, yes.
I mean, I mean, if you want help, you know, just, just ask your Spanish vets and, and they, they know all about leishmania. I mean, of course, the problem is that in Spain, because they've got so much lemania, they don't really trust or recognise perhaps other diseases like idiopathic immed polyarthritis. That we might or type 3, immunity polyarthritis.
So GI associated polyarthritis that, that we would associate in, in this, in this country. and, and, and so it depends on, it's so much depends on your local disease population about what you're good at and what you're not good at. I, I'm just looking at the questions actually.
Greg's also asked a question about the dose of clindamycin, in Leishmania. . The, the, I put up leishmania and clindamycin simply because people have tried it.
It didn't work very well. So I don't use clindamycin. I'm just popping that, that, that, in case anyone thought that I was recommending it, I'm not recommending it.
I just know there are various, other treatments for leishmania that have been suggested, but the ones I've just told you about, the only ones that are working consistently well. And I think this is also the problem is that because they're not diseases that we deal with on a regular basis in the UK you get all these weird stories popping up and people, oh, this vet said I must do that from Spain and from Portugal and wherever else and you know it it's it's often not taken in the context. Yes.
Yeah yeah yeah yeah. Yeah. OK.
I, Ian Taylor also makes a, a, a, a very good point. By far and away, the most common imported disease that I see in dogs is distemper. Yes, absolutely.
I, I mean, you, you know, they, they still get distemper and pavo and all the rest, in, in Italy and Spain and Portugal, and absolutely, you will, you will see cases of, of, of these things, but I, I. You know, I don't regard distemper as an imported disease. We know from serology that distemper is alive and well in the UK.
We know if we do surveys of the fox population, of which we've got millions around Glasgow vet schools, and we do lots of postmortems on foxes. We know they get distemper, we know they get power. We know they get infectious cancer and hepatitis.
And if anyone ever want needs an argument for why you carry on vaccinating, just read the papers about that. That you, you know, you, if you have foxes anywhere near you, you absolutely need to be vaccinating your dogs. Yeah, and it, it's, it's once you've seen it, it's a horrible, horrible disease.
I, I did smile at Ian's comment that came through saying that he mentions it because it looks like rabies and sometimes it does. Yeah, it does. I mean, the, the, the difference I think with, with, with distemper, you know, not huge.
I mean, Intel's got more experience than I have on this. But I would argue that the rate of progression of rabies and the severity is the rate of progression is greater. In rabies than it is in distemper.
And often starts the dogs as well. Yeah. Sally's got a good point.
She says, what precautions should we take when handling imported leasero clinical sign free dogs? It was a mouthful. Right, so these are dogs that, that have been known, known to be exposed to leishmania, but have no clinical signs.
The answer is actually no precautions. There there's no reason to, I mean, if you, if you have a dog in France walk up to you in southern France or Spain or Portugal, well, you might be, be worried about other diseases, you wouldn't worry about, about particularly handling it. You, you.
No more so than any other, you know, if it licks, if dogs lift your hands, you should wash them. You know, it's, it, you shouldn't let them lick open wounds and, and, and things like that. yeah, that would be the limit of it in a dog that is clinic.
Sign free. So this is an asymptomatic dog because, to be honest, it may not have Leishmania. It may have got rid of the leishmania.
And, even if it has got leash mania, it is pretty much hidden away. Clinical signs and parasite burden are linked in Leishmania, so that if you see a dog with clinical signs of leishmania, then you have to be a little more careful, especially with the discharges from the skin and from the wounds and from the saliva and so so forth. Then I think You have to be a bit more careful.
Make sure you wear gloves when you're handling the dog, particularly as a vet, handling the lesions and so forth. You should be aware of that and you should make sure the owners are aware, that, that, that, that, that, to, to keep their hands away from that and to make sure that they wash, wash their hands thoroughly. it's in, you know, obviously, there's a risk, risk benefit, risk hazard analysis here.
It is low risk. Leishmania is low risk. But the hazard is substantial.
And if you do get leash mania, you've got a problem. and, so, if you are immunosuppressed, if you have, HIV, if you're, pregnant, whatever, you really don't want to get anywhere near this. Yeah.
What about the, the philosophy which is quite common. I know there's some of the animals that I've been treating with leishmania. The, the owners belong to a I don't know, Facebook group or whatever else group.
And then they come in and they go, oh, the latest trend now in Europe is that we must do monthly serology. And if the titers are climbing, then we've got to increase the dose of allopurinol and and come in with all their weird cocktails. Do you think that is something that is worth tracking?
Well, I, I think it's, you know, there's a, there's a, there's a canine Leishmaniasis, working group consisting of, of the top vets in Italy, Spain, working together, and they produce recommendations, and that's not one of their recommendations, I should say. And that's, yeah, yeah, and, and that, and that's my answer. You know, people who deal with this disease on a daily basis do not recommend this.
You know, the, the, the evidence base is poor. And what it shows is that people who are, they're, they're stuck with these dogs. They're, they're, they're suffering.
They will grasp at anything, to try to, to help their dogs, even though there's no evidence base, for, for that. Rising titters, to, to determine allopurinol dose, I think cis me as a particularly bad idea because actually what you'd be probably doing at that point is, is dealing with a, an allopurinol resistant strain. So it's likely that, that, you'd have to be increasing the allopurinol absolutely hugely, and, to, to, to, to deal with this.
And, and I don't think that's, A sensible, way about it. I think that, that if you've got rising tights and potentially progressing clinical signs, I think you need to go and get some, treatment like the allopurinols like the miltosans and so forth. Yeah, your special import certificate and I, we have unfortunately run out of time.
It's a fascinating topic and we could speak about it for hours and hours. But, we'd just like to thank you for your time again tonight. I know you are not new to the webinar vet and, we certainly hope we will have you back again in future.
But thank you very much.