Pan was glowing in the dark. He was so jaundiced, it looked like someone had scrubbed him with iodine and forgotten to wash it off. His eyes, face, and ears were yellow.
“He was one of the most yellow dogs I’ve seen with leptospirosis in a long time,” said Dr. JD Foster, staff veterinarian and head of Ryan Hospital’s hemodialysis service.
Leptospirosis is a bacterial disease that affects animals and people. Standard treatment includes the administration of antibiotics, such as amoxicillin or doxycycline, and supportive care for kidney failure, liver failure, and respiratory complications. It is very common in dogs, but rarely seen in cats. If untreated, leptospirosis is fatal.
Dogs typically come into contact with the Leptospira bacteria in infected water or soil, or from coming into contact with urine from an infected animal, wild or domestic. Leptospira cannot replicate outside of the body, but can remain viable in soil for weeks to months.
While thought to be a concern only for “country dogs” exposed to lakes and streams, leptospirosis is increasingly common for “city dogs,” too. Pan, for instance, is a two-and-a-half-year-old Pit Bull Terrier who lives in the Bronx. He killed a rat prior to getting sick in October.
Pan and Merle
Pan exhibited the common symptoms associated with leptospirosis—lethargy, lack of appetite, muscle trembling, and vomiting. At his local veterinarian’s office, radiographs revealed a possible foreign body in the stomach. A surgical exploration was planned, but pre-operative bloodwork showed elevated liver and kidney levels, another symptom of leptospirosis. Pan was transferred to the ASPCA for overnight treatment. Those monitoring the young dog noted that he showed no urine output.
The next morning, Pan was transferred to the Animal Medical Center (AMC) in Manhattan. In addition to elevated liver values and worsening kidney values, Pan had elevated white blood cells, low platelets, and was anemic. Pan’s yellow hue was caused by his severe liver damage. He also showed signs of vasculitis, which occurs when fluid and hemorrhage accumulate in the lungs, making it difficult to breathe. Pan was then referred to Penn Vet for dialysis.
Penn Vet’s Ryan Hospital is the only veterinary hospital in the Philadelphia area offering hemodialysis, and one of only three established hemodialysis centers along the East Coast. Foster revitalized the service three years ago; it celebrated its 300th treatment last month.
Dialysis allows for metabolites, electrolytes, excess fluid, and toxins that are elevated in the blood stream to be removed. Treatments are performed during acute renal failure to allow patients to feel better and to support kidney function while antibiotics are at work.
“Of all the diseases we do dialysis for, leptospirosis has one of the best outcomes,” said Foster. “Dogs that are really sick can turn around and have a remarkable recovery.”
According to Foster, the survival rate for dogs that are treated for the disease is approximately 90%.
Pan's kidney and liver values steadily improved while his urine output slowly increased to a more normal level. However, he still had not completely recovered, and would require additional care at home. He would also need frequent re-checks and monitoring over the next few months to determine his long-term kidney function.
“We are extremely grateful,” said Pan’s owner, Luca Iorga. “We know Pan would have died without the expertise of the wonderful team at Penn Vet.”
While Pan required four dialysis treatments, Merle only needed two.
A two-and-a-half-year-old mixed breed dog, Merle also encountered a rat. A week later, he seemed lethargic and did not want to eat his dinner. His symptoms persisted, so his owners brought him to their primary care veterinarian, where initial blood work revealed elevated liver values. Leptospirosis was suspected, tests were submitted, and Merle started a doxycycline regimen.
The following day, Merle remained inappetent and was admitted to AMC. Blood work showed both elevated liver and kidney values, in addition to a low platelet count. Merle's urine output was below normal and his kidney values continued to increase, so he was referred to Penn Vet for continued monitoring and dialysis.
“I'll never forget the feeling of despair when we learned that Merle had gone into kidney failure and would need dialysis,” said Merle’s owner, Elizabeth Gawlik. “That’s when it really hit me that we could lose Merle, a dog we adopted less than a year prior. I was devastated, but I knew there was nothing I wouldn't do to give him a chance.”
One of the most dramatic signs of leptospirosis, associated with acute kidney injury, is decreased urine production, even up to the point where dogs stop making urine.
“Merle and Pan both exhibited this, but at different times during their sickness,” explained Foster. “Those patients can be challenging to manage without dialysis because they retain all of the fluids administered to them.”
Dialysis supports animals and allows time for antibiotics to begin working. Many animals with severe disease may not survive this waiting period without dialysis, according to Foster. Once the antibiotics kick in, many of these dogs go from producing no urine at all to urinating so much that they have to stay in the hospital for another few days so they can be monitored for dehydration.
After his second dialysis treatment, Merle started producing liters of urine. Intravenous fluids were administered at a high rate to support his output until his kidneys could restore normal balance.
A few days later, Merle’s kidney values stabilized within a normal limit and he was well enough to go back to New York City. He did, however, need a few days at AMC to allow his kidneys to fully recover. Today, Merle is back to his high-energy self and eating as much as possible.
“The best moment was coming to pick him up for the trip back to New York,” Gawlik recalled. “After days of seeing him so weak, I was amazed to see him come running into the waiting room. He was definitely ready to go home!”
A Family Affair
Carolyn Habbersett and Jeff Davis of Media, PA, share a family of Old English Sheepdogs. Davis owned Daisy, a sheepdog who gave birth to a litter of nine puppies in 2006. From her litter, Davis kept Spot, Ogee, and Blue. Habbersett owns Bumble and Sweetie.
Habbersett and Davis are friends and neighbors, so the dogs get together often. Habbersett lives on a five-acre wooded property visited by wild and domestic animals. In November 2013, five of the six dogs tested positive for leptospirosis.
“All of these dogs were exposed in the same backyard. It’s eye-opening in terms of how devastating this disease can be,” said Foster.
Spot, normally an active dog, was the first to visit Penn Vet. He was lethargic and hadn’t eaten for two days. His local vet ran a blood test that revealed a lethally high creatinine level. Davis decided to take the dog to Penn Vet immediately. Spot was placed on a ventilator upon arrival at Ryan Hospital.
Leptospirosis was suspected and Spot was started on antibiotics. Fearing the other dogs might be infected, Davis and Habbersett brought the rest of them in for testing that day.
“After three days of aggressive treatment in the ICU, Spot was lying in the operating room with machines keeping him alive,” said Habbersett. “It was time to let go. It was traumatic, but the vets and vet techs showed such empathy and respect. We will be forever grateful.”
Ogee was the next most-affected dog in the family. He had high levels of nitrogen in his blood and indications of serious kidney damage. Blue was also hospitalized, though she only stayed three days after responding well to treatment.
Ogee had a much harder time, but eventually pulled through, thanks in part to Davis’ meticulous following of medical and dietary instructions. The leptospirosis took a serious toll on Ogee’s kidneys. Today he has Stage 3 chronic kidney disease and will be on medications and a special low-protein diet for the rest of his life.
Sweetie and Bumble fared much better, responding well to antibiotics with no complications. Daisy was the only dog to test negative for leptospirosis. Sadly, she succumbed to cancer last summer at age thirteen.
“Penn Vet’s level of expertise is so reassuring to pet owners,” said Habbersett. “We are fortunate to live relatively close. I understand why people travel here from far and wide.”
The Importance of Vaccination
It is generally believed that the leptospirosis vaccine helps prevent severe disease. The vaccination does not, however, entirely prevent infection. Kidney and liver disease is generally seen much less often in patients that have been vaccinated.
“Most of the dogs we’ve treated have not been vaccinated,” said Foster. “We highly recommend the vaccine. Leptospirosis is a prevalent disease; Penn Vet has seen 21 cases in the last six months alone.”
It is recommended that the vaccine be repeated once a year. It is best to have it administered in early summer so that the peak efficacy of the vaccine will occur in late summer/early fall, when the disease is most prevalent. However, due to shifting weather patterns and a lack of a consistently cold winter, that timeframe may be widening, starting as early as April and lasting into late November.
There are several versions of the vaccine due to different serovars, or strains, in the environment. These serovars are “cousins” of the Leptospira family – different enough that, if you prevent against one, it does not mean you’re preventing against another. Quadrivalent vaccines have been developed to cover four serovars. These are recommended for the best protection.
Unfortunately, a leptospirosis infection does not provide dogs with lifelong immunity, like chicken pox in humans. It is recommended that dogs get vaccinated after a complete recovery from leptospirosis.
“We had never heard of leptospirosis prior to Merle’s diagnosis,” said Gawlik. “Merle is scheduled to be vaccinated now that he’s healthy again, and I have been encouraging others to get their dogs vaccinated, too.”
Habbersett has maintained that the four sheepdogs will visit Penn Vet for their full leptospirosis boosters for the rest of their lives, as prescribed.
“One of the many things that impressed me about Penn Vet is how thorough and patient the doctors and technicians are when explaining complex medical conditions and procedures,” said Habbersett. “They also followed up with discharge papers and remained accessible for questions.”
“The whole Penn Vet team was amazing, from the receptionists to the emergency vets,” said Gawlik. “I want to give a special thank you to Dr. Shannon Palermo and Merle's nurse Jen, who cared for him and stayed with him during the long hours of dialysis.”
Visit the AVMA’s website for resources on leptospirosis.