**5. Treatment**

alarming 40–80% of all cases, for asymptomatic dogs are a major source of infection for sand

At first, kala-azar signals can be rather discrete and easily confused with other diseases. Animals may have discrete lesions on the edge of the ears and slight changes in blood profile

Clinical leishmaniasis may appear quickly after infection or within two years. Classic canine kala-azar is characterized by thickened skin, cutaneous lesions, intermittent fever, appearance shift and fur loss, periorbital alopecia, hepatosplenomegaly, akinesia, diarrhea, onychogryphosis (nail growth; **Figure 5**), and nosebleeding. Partial paralysis of hindquarters is often seen

The most common skin lesions in dogs with kala-azar are exfoliative dermatitis (generalized, regional, or localized); ulcerative dermatitis, onychogryphosis, and papular dermatitis.

Cutaneous ulcers are usually located on the ear margins and have been attributed to local trauma and/or vasculitis, pressure points (**Figure 6**), limbs, and mucocutaneous junctions. Focal or multifocal nodular forms have a high amastigote load and may indicate either

Ocular disease occurs in CVL, with anterior uveitis being the most common ocular manifestation, characterized by conjunctivitis, blepharitis, periocular alopecia, exophthalmia, keratitis,

The nosebleeding (epistaxis) occurs due to thrombocytopenia and is often confused with ehrlichiosis, a bacterial disease transmitted by ticks, which in many cases might associate with leishmaniasis. In endemic areas, it is advisable that any diagnosis of ehrlichia or anaplasma in

In general, dogs in endemic areas are poly-infected and malnourished, particularly stray dogs or those who frequently wander on the streets, leading to a plurality of overlapping clinical pictures. Among other conditions, furfuraceous flaking due to scabies, weight loss as

keratoconjunctivitis sicca, anterior uveitis, glaucoma, and retinal detachment [106].

inefficient or strong cellular immunity by the host [101, 103–105].

dogs must be accompanied by differential diagnosis of kala-azar.

flies, and owners naturally resist to elimination of their animals [102].

(mild anemia and/or thrombocytopenia).

32 Canine Medicine - Recent Topics and Advanced Research

in the final stage of the disease.

**Figure 5.** Onychogryphosis.

Treating seropositive dogs for canine visceral leishmaniasis (CVL) is a controversial practice in Brazil and, above all, not recommended by the World Health Organization, mainly because it does not lessen the importance of the dog as a reservoir, and utilizes drugs used in human treatment of visceral leishmaniasis (VL) [109]. Nevertheless, European countries legally established treatment since the twentieth century [110].

Frequent usage of these drugs in veterinary clinics may select resistant parasites due to variation in sensitivity of leishmania species, in addition to providing low parasiticide effect, thus interfering negatively in human treatment [111]. The lack of success for parasitological cure occurs mainly because it is an intracellular parasite and is located in less vascularized tissues where it can be difficult to obtain therapeutic doses, such as the vitreous body [112].

Many studies have been conducted in order to find an effective treatment for CVL, but drugs currently available are still inefficient, only allowing temporary remission of clinical signs. Besides, some have a high cost and produce toxic effects. Pentavalent antimonies (glucamine antimoniate—Glucantime® or sodium stibogluconate—Pentostam®) are widely used in CVL therapy protocols because they usually produce faster clinical remission but are often combined with allopurinol, since they do not prevent relapses [34]. A variety of drugs, such as amphotericin B, pentamidine isethionate, ketoconazole, fluconazole, miconazole, itraconazole, has been used either isolated or in combination and produced different results [111].
