Synovial fluid and radiographic evaluation of joints from dogs with visceral leishmaniasis

Polyarthritis has been associated with canine visceral leishmaniasis (CanVL), and co-infection with Ehrlichia canis is common and may alter clinical manifestations.

A total of 89 dogs presenting CanVL were subdivided into two groups: (1) G1, consisting of 46 dogs seronegative to Ehrlichia spp., and (ii) G2, consisting of 43 dogs seropositive to Ehrlichia spp. Eight joints (carpal, tarsal, stifles and elbows) from each dog were evaluated by radiography and synovial fluid (SF) cytologic analysis.

Overall, 74 of the 89 (83.1%) dogs presented joint abnormalities suggestive of osteoarthritis by radiography (G1: 40/46 [86.9%]; G2: 34/43 [79.0%]), with no statistically significant between-group difference. All dogs with abnormal joint X-ray images presented radiographic lesions bilaterally, independent of the characteristics of the lesion. Soft tissue swelling around the joint and joint space narrowing were more commonly observed in G1 than in G2 dogs. There was no significant between-group difference in terms of other radiographic abnormalities suggestive of osteoarthritis (evident trabecular pattern, subchondral bone sclerosis, osteolysis, osteolytic-proliferative lesions or bone proliferation). SF from 174/315 (55.2%) and 152/307 (49.5%) joints from G1 and G2 dogs, respectively, presented an inflammatory infiltrate, but there was no significant association between the presence of inflammatory infiltrate and group. There was also no statistical difference between groups in either of the evaluated joints in terms of the percentage of neutrophils or mononuclear cells. Leishmania spp. amastigotes were found in 69/315 (21.9%) joints from G1 dogs and in 100/307 (32.5%) joints from G2 dogs (Fisher's exact test, P = 0.002, odds ratio = 0.5, 95% confidence interval = 0.4-0.8). The neutrophilic infiltrate was significantly higher in joints with amastigote forms in both G1 (Mann-Whitney U-test, U₍₁₈₎ = 817, Z = -3.76, P = 0.0001) and G2 dogs (Mann-Whitney U-test, U₍₁₈₎ = 6543, Z = - 5.06, P < 0.0001).

A high prevalence of arthritis in dogs with CanVL was found, and all dogs presented involvement in multiple joints. Although no difference was observed between groups in terms of the number of dogs with polyarthritis and the presence of an inflammatory infiltrate in SF, Leishmania spp. amastigotes were found more frequently in joints from G2 dogs. Further studies evaluating SF in dogs co-infected with L. infantum and E. canis should be performed to evaluate this finding.