68 



THE HEMOFLAGELLATES 



There may be anemia due to blockage of 

 the reticulo-endothelial system. 



In dogs and also in the Brazilian bush- 

 dog, L. duiiova)ii may cause either vis- 

 ceral or cutaneous lesions, but the latter 

 are much more common. The disease is 

 usually chronic with low mortality, altho 

 an acute, highly fatal type is known. 

 There may be emaciation and anemia. 

 There is an abundant scurfy desquamation 

 of the skin, and in some dogs more or 

 less numerous cutaneous ulcers. In 

 Chinese kala-azar, cutaneous lesions occur 

 especially around the nose and ears. The 

 hair is shed on parts of the body, particu- 

 larly the head. The parasites occur in the 

 macrophages in the subcutaneous tissues 

 or in nodular lesions in the skin. They 

 have also been recovered from healthy 

 appearing skin. The visceral type of the 

 disease is similar to that in man. 



Diagnosis : The only sure diagnostic 

 method is the demonstration of the para- 

 sites themselves, altho serologic and 

 other tests have also been used and are of 

 suggestive value. Smears made from 

 biopsy samples of spleen pulp, liver pulp, 

 superficial lymph nodes, bone marrow or 

 thick blood smears can be stained with 

 Giemsa's stain and examined microscopi- 

 cally. In visceral leishmaniosis, the 

 spleen is most often positive, but a certain 

 amount of danger is associated with punc- 

 turing a soft, engorged, enlarged spleen. 

 Thick blood smears are more often posi- 

 tive in man than in dogs. 



Examination of bone marrow obtained 

 by sternal puncture is becoming increas- 

 ingly popular. In the cutaneous form of 

 the disease, scrapings should be made 

 for staining from the lesions or from the 

 dermis with as little bleeding as possible. 

 This is probably the method of choice for 

 dogs, since the cutaneous disease is more 

 common than the visceral form in them. 

 L. donovaiii can often be found in appar- 

 ently normal skin in dogs and also, in the 

 Sudanese and Middle Asiatic forms of the 

 disease, in man (Manson-Bahr, 1959). 

 Examination of the superficial lymph 

 nodes is also valuable. 



Leishmania can be cultivated readily 

 in NNN medium or a similar medium. The 

 medium is inoculated with spleen, lymph 

 node or liver juice, bone marrow, blood, 

 or excised dermis and incubated for a week 

 to a month at 22 to 24"^ C. Leptomonad 

 forms are present in culture. Leishmania 

 can also be grown in chicken embryos 

 (Trincao, 1948) and in tissue culture 

 (Hawking, 1948); see Pipkin (1960) for a 

 review of this subject. 



Animal inoculation can also be prac- 

 ticed, but is not usually done because it 

 takes several months. The golden hamster 

 is the most susceptible laboratory animal. 



The complement fixation test has been 

 used with some success, particularly in 

 man. It is often positive before the para- 

 sites themselves can be found. 



The formol gel test (Napier's aldehyde 

 test) is positive in more advanced cases. 

 It is carried out by adding a drop of com- 

 mercial formalin to 1 ml of serum. In a 

 positive reaction the serum turns into a 

 milky white gel; a clear gel is not positive. 

 Organic antimony compounds, resorcinol, 

 and many other compounds will also pro- 

 duce this reaction. It is due to an increase 

 in euglobulin and decrease in albumin in 

 the serum. It also occurs in diseases 

 other than kala-azar. 



Treatment: Leishmanial infections 

 can be treated successfully with various 

 organic antimony compounds. The cheap- 

 est is tartar emetic, which is administered 

 intravenously. In man, at least 25 or 30 

 doses totaling at least 2. 5 g must be ad- 

 ministered daily or on alternate days. 

 Pentavalent antimony compounds are more 

 expensive, but they are less toxic, act 

 more quickly, and most of them can be in- 

 jected intramuscularly as well as intra- 

 venously. Even so, 10 or 12 doses total- 

 ing 2. 7 to 4. g are needed. Among these 

 compounds are neostibosan, neostam, 

 solustibosan and urea stibamine. The 

 aromatic diamidines, pentamidine and stil- 

 bamidine, have been used in treating hu- 

 man leishmaniosis, but they are appar- 

 ently not very effective in dogs. Goodwin 



