Silva Kleverton Ribeiro da, Mendonça Vitor Rosa Ramos de, Silva Kellen Matuzzy, Nascimento Leopoldo Fabrício Marçal do, Mendes-Sousa Antonio Ferreira, Pinho Flaviane Alves de, Barral-Netto Manoel, Barral Aldina Maria Prado, Cruz Maria do Socorro Pires E
Fundação Oswaldo Cruz-Fiocruz, Centro de Pesquisas Gonçalo Moniz, Salvador, BA, Brasil.
Universidade Federal do Piauí, Departamento de Morfofisiologia Veterinária, Teresina, PI, Brasil.
Mem Inst Oswaldo Cruz. 2017 Jan 1;112(1):53-63. doi: 10.1590/0074-02760160305.
Canine visceral leishmaniasis (CVL) diagnosis is still a challenge in endemic areas with limited diagnostic resources. This study proposes a score with the potential to distinguish positive CVL cases from negative ones. We studied 265 dogs that tested positive for CVL on ELISA and parasitological tests. A score ranging between 0 and 19 was recorded on the basis of clinical signs. Dogs with CVL had an overall higher positivity of the majority of clinical signs than did dogs without CVL or with ehrlichiosis. Clinical signs such as enlarged lymph nodes (83.93%), muzzle/ear lesions (55.36%), nutritional status (51.79%), bristle condition (57.14%), pale mucosal colour (48.21%), onychogryphosis (58.93%), skin lesion (39.28%), bleeding (12.50%), muzzle depigmentation (41.07%), alopecia (39.29%), blepharitis (21.43%), and keratoconjunctivitis (42.86%) were more frequent in dogs with CVL than in dogs with ehrlichiosis or without CVL. Moreover, the clinical score increased according to the positivity of all diagnostic tests (ELISA, p < 0.001; parasite culture, p = 0.0021; and smear, p = 0.0003). Onychogryphosis (long nails) [odds ratio (OR): 3.529; 95% confidence interval (CI): 1.832-6.796; p < 0.001], muzzle depigmentation (OR: 4.651; 95% CI: 2.218-9.750; p < 0.001), and keratoconjunctivitis (OR: 5.400; 95% CI: 2.549-11.441; p < 0.001) were highly associated with CVL. Interestingly, a score cut-off value ≥ 6 had an area under the curve of 0.717 (p < 0.0001), sensitivity of 60.71%, and specificity of 73.64% for CVL diagnosis. The clinical sign-based score for CVL diagnosis suggested herein can help veterinarians reliably identify dogs with CVL in endemic areas with limited diagnostic resources.
在诊断资源有限的流行地区，犬内脏利什曼病（CVL）的诊断仍然是一项挑战。本研究提出了一种评分方法，有可能区分CVL阳性病例和阴性病例。我们研究了265只在ELISA和寄生虫学检测中CVL呈阳性的犬。根据临床症状记录了0至19分的评分。与没有CVL或患有埃立克体病的犬相比，患有CVL的犬大多数临床症状的总体阳性率更高。CVL犬出现淋巴结肿大（83.93%）、口鼻/耳部病变（55.36%）、营养状况（51.79%）、鬃毛状况（57.14%）、黏膜颜色苍白（48.21%）、爪甲异常（58.93%）、皮肤病变（39.28%）、出血（12.50%）、口鼻色素脱失（41.07%）、脱毛（39.29%）、睑缘炎（21.43%）和角膜结膜炎（42.86%）等临床症状的频率高于患有埃立克体病或没有CVL的犬。此外，根据所有诊断检测（ELISA，p < 0.001；寄生虫培养，p = 0.0021；涂片，p = 0.0003）的阳性率，临床评分增加。爪甲异常（长指甲）[比值比（OR）：3.529；95%置信区间（CI）：1.832 - 6.796；p < 0.001]、口鼻色素脱失（OR：4.651；95% CI：2.218 - 9.750；p < 0.001）和角膜结膜炎（OR：5.400；95% CI：2.549 - 11.441；p < 0.001）与CVL高度相关。有趣的是，评分临界值≥6时，曲线下面积为0.717（p < 0.0001），对CVL诊断 的敏感性为60.71%，特异性为73.64%。本文提出的基于临床症状的CVL诊断评分可以帮助兽医在诊断资源有限的流行地区可靠地识别患有CVL的犬。
