Diagnosis and Treatment
Clinical Cases - Zeke
The following case is taken from actual medical records. Names, photographs and minor details have been changed to maintain client/patient confidentiality.
CASE 3: Zeke, a neutered 6-year-old male Boston terrier
Zeke had been a happy, playful dog until shortly before presenting with a
fever (104.4°F), progressive anorexia with vomiting, polyuria and polydipsia and
discolored urine. He had been previously well-vaccinated including leptospiral
vaccines containing L. canicola and L. icterohaemorrhagiae.
Blood tests indicated elevated BUN and creatinine, and neutrophilia with a left shift. Pyuria, proteinuria, hematuria and bacteruria with isosthenuria also were confirmed by urinalysis. The veterinarian considered a urinary tract infection or renal disease as differential diagnoses.
Zeke was hospitalized and treated with I/V fluids and enrofloxacin. His fever resolved, however, bloody diarrhea developed, his BUN continued to climb and urine output decreased. Zeke was transferred to a referral institution and received aggressive therapy. Despite therapy, Zeke developed aspiration pneumonia and was euthanized.
Serology testing indicated titers for L. grippotyphosa of =1:3200, L. pomona 1:1600, L. bratislava =1:3200, L. canicola and
L. icterohaemorrhagiae < 1:100. Thus, L. grippotyphosa was likely the infecting serovar.
Case Note: Zeke presented with clinical signs highly suggestive of kidney disease rather than cystitis (which normally does not result in elevated BUN and creatinine). Leptospirosis should be very high on a list of differential diagnoses for all cases of acute renal failure. Amoxicillin, ampicillin and doxycycline are the antibiotics of choice for treating leptospirosis whereas fluoroquinolones (a reasonable choice for cystitis) generally are not recommended. This case also demonstrates leptospirosis can and does occur in small breed dogs. Any dog with even limited exposure to wildlife is at risk of developing leptospirosis.