Doxycycline-Chloroquine combination for the treatment of canine monocytic ehrlichiosis
Aysul, NuranUral, KeremCetinkaya, HandanKuskucu, MertToros, GöktugEren, HasanDurum, Ceren
Background: Ehrlichiosis in dogs is a vector borne disease caused by Ehrlichia canis, from the Anaplasmataceae family, capable of causing multisystemic disorders. Following an incubation period of 8-20 days, acute, subclinical and chronic forms of the disease may develop and affected dogs frequently showed hemorrhage, lymphadenopahty, splenomegaly, hepatomegaly, along with cardiac/renal disorders and myelosupression. Most of the untreated dogs spontaneously recover form the acute phase and enters the subclinical phase, in which some of them may develop chronic phase characterized by bone marrow aplasia. Ehrlichial organisms are commonly susceptible to tetracycline derivatives, and doxycycline is probably most commonly used for treatment of the infection. Doxycycline may be quite effective for clearing parasitemia in acute E. canis infection. Clinical recovery may be observed within 2-3 days, besides treatment should be continued for 3 weeks, as some cases may remain carriers even if short treatment protocole is administered. Most dogs infected with CME usually recover from the acute and subclinical phases when treated with doxycycline or other tetracyclines. Some dogs enter the chronic phase of the disease for which the prognosis is grave. The purpose of the present study was to report the presence of E. canis infection in dogs in Aydin, with a special reference to the efficacy of combined doxycycline and chloroquine therapy. Materials, Methods & Results: A propective study was carried out on dogs referred and 12 dogs were diagnosed as canine monocytic ehrlichiosis within traditional buffy coat smear within giemsa staining, Snap 4dx test and nested PCR applications. Data on rectal temperature, clinical haematology and serum biochemistry (involving vbALT, AST and BUN) were registered before and after treatment in both groups. A total of 6 dogs with a diagnosis of CME were enrolled in each group. Group CD (n = 6) received doxycycline (10 mg/kg perorally twice a day for 2 weeks) and chloroquine (2.5 mg/kg perorally twice a day for 2 weeks) and group D received solely doxycycline (10 mg/kg perorally twice a day for 2 weeks). The clinical haematology and biochemistry results of canine ehrlichiosis before (day 0) and after treatment (day 30) for both gorups were compared. Among relevant parameters of aforementioned groups, no statistically significant differences were detected (P > 0.05). Following treatment in both groups the clinical signs were dinished, body temperature of the dogs returned to physiological levels in both groups. Lymphadenopathy was regressed in 1 week, and 1 month later the clinical examination was repeated in which all dogs in combined treated group showed complete clinical recovery, whereas lymphadenopathy was stil evident in some of the dogs in chloroquine group. Discussion: Doxycycline has still been the first line-drug option for the treatment of acute canine monocytic ehrlichiosis, however for the subclinical and chronic phases of the diseases its effectiveness is controversial. Further research are warranted to investigate any adjuvant or combined therapy may be an alternatives. In this clinical trial combined doxycycline and chloroquine therapy were used for dogs with active Ehrlichia canis infection (PCR + and E. canis seroactive). Although there were no statistically significant hematological and serum biochemical differences among dogs treated with doxycycline and chloroquine in contrast to dogs treated alone with doxycycline, clinical recovery was impressive in dogs with combined treatment. These observations demonstrate that chloroquine may have helped hastening the relevant clinical signs of canine monocytic ehrlichiosis and clinical improvement.
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