Leptospirosis and immune-mediated hemolytic anemia: A lethal association

Document Type: Clinical Report

Authors

San Marco Veterinary Clinic and Laboratory, Veggiano, Italy

Abstract

Immune-mediated hemolytic anemia (IMHA) is a common cause of anemia in dogs. The immune aggression towards erythrocytes can be triggered by many pathological conditions such as infection, inflammatory disease or neoplasia. Upon ruling out any eliciting conditions, a diagnosis of the primary immune-mediated disease can be made. In this particular case of severe anemia (tested positive for circulating antibodies against red blood cells with flow cytometry), vector-borne diseases (which are a common cause of immunopathology in Mediterranean countries) were excluded, leptospirosis was not. This resulted in an unsuccessful immunosuppressive therapy with prednisone, two whole blood transfusions and ultimately death of the patient. Leptospirosis (confirmed positive in two tests, micro-agglutination test for antibodies and PCR for microbial DNA in urine), can mimic a primary IMHA and must be considered in its differential list of causes. A liver involvement, that included elevated serum activity of liver enzymes and increased serum bile acid was observed at the admission and suggested an etiopathogenesis other than a primary IMHA.

Keywords

Main Subjects

 

  1. Murphy K. Leptospirosis in dogs and cats: New challenges from an old bacteria. In Pract 2018; 40:
    218-229.
  2. Schuller S, Francey T, Hartmann K et al. European consensus statement on leptospirosis in dogs and cats. J Small Anim Pract 2015; 56(3): 159-179.
  3. Marinho M, Cardoso T. Pathogenesis of leptospirosis: Important issues. J Med Microbiol Diagn 2015; e127. doi: 10.4172/2161-0703.1000e127.
  4. Chirathaworn C, Kongpan S. Immune responses to Leptospira infection: Roles as biomarkers for disease severity. Braz J Infect Dis2014; 18(1):77-81.
  5. Goldstein RE. Canine leptospirosis. Vet Clin North Am Small Anim Pract 2010; 40(6): 1091-1101.
  6. Natale A, Lucchese L, Boniotti A et al. Trying to better understand the epidemiology of leptospirosis in dogs: strain genotyping. In proceedings: The Prato conference on the pathogenesis of bacterial infections of animals, Monash University,Prato, Italy 2016; 11-14.
  7. Klaasen E, Adler B. Recent advances in canine leptospirosis: Focus on vaccine development. Vet Med (Auckl) 2015; 6: 245-260.
  8. Bovens C, Fews D, Cogan TA. Leptospirosis and immune-mediated hemolytic anemia in a dog. Vet Rec Case Reports 2014; 2 (1): e000065. doi: 10.1136/vetreccr-2014-000065.
  9. Gershwin LJ. Current and newly emerging autoimmune diseases. Vet Clin North Am Small Anim Pract2018; 48(2): 323-338.
  10. Piek CJ. Canine idiopathic immune-mediated hemolytic anemia: A review with recommendations for future research. Vet Quart 2011; 31(3): 129-141.
  11. Swann J, Skelly B. Canine autoimmune hemolytic anemia: Management challenges. Vet Med (Auckl) 2016; 7: 101-112.
  12. McCallum KE, Constantino-Casas F, Cullen JM, et al. Hepatic leptospiral infections in dogs without obvious
    renal involvement. J Vet Intern Med 2018; 33(1): 141-150.
  13. Chapman SE, Hostutler RA. A laboratory diagnostic approach to hepatobiliary disease in small animals. Clin Lab Med 2015; 43(6): 1209-1225.
  14. Wardrop KJ. Coombs’ testing and its diagnostic significance in dogs and cats. Vet Clin North Am Small Anim Pract 2012; 42(1): 43-51.
  15. Day MJ. The immunopathology of canine vector-borne diseases. Parasit Vectors 2011; 4: 48, doi:10.1186/ 1756-3305-4-48.