Visceral leishmaniasis is an infectious disease of chronic, emerging and zoonotic nature that presents various degrees of severity. In Brazil, this illness is caused by Leishmania infantum (Leishmania chagasi), which is transmitted by the bite of the sand fly Lutzomyia longipalpis, and dogs are its main reservoir. Given the increasing spread of this disease across Brazil, the aim of this study was to report on six cases of canine visceral leishmaniasis, diagnosed in June 2013, in the city of Pedregulho, State of São Paulo, considered to be a non-endemic area and free of phlebotomine sand flies. The diagnosis was based on clinical signs of the patients and additional tests (serological and parasitological). It was concluded that the diagnosis of leishmaniasis is complex because the clinical signs are similar to other systemic diseases, thus justifying the importance of parasitological test of bone marrow, considered "gold standard", in the confirmation of the disease. In addition, the area was not, until now, considered risk place, despite notification.
Visceral leishmaniasis is an infectious disease of chronic, emerging and zoonotic nature that presents various degrees of severity. In Brazil, this illness is caused by Leishmania infantum (Leishmania chagasi), which is transmitted by the bite of the sand fly Lutzomyia longipalpis, and dogs are its main reservoir. Given the increasing spread of this disease across Brazil, the aim of this study was to report on six cases of canine visceral leishmaniasis, diagnosed in June 2013, in the city of Pedregulho, State of São Paulo, considered to be a non-endemic area and free of phlebotomine sand flies. The diagnosis was based on clinical signs of the patients and additional tests (serological and parasitological). It was concluded that the diagnosis of leishmaniasis is complex because the clinical signs are similar to other systemic diseases, thus justifying the importance of parasitological test of bone marrow, considered "gold standard", in the confirmation of the disease. In addition, the area was not, until now, considered risk place, despite notification.
As neoplasias mamarias espontâneas sao as mais comuns na cadela, apresentando alta heterogeneidade biologica e histomorfologica. Cerca de 50% destes tumores sao malignos, possuindo um alto potencial metastatico para linfonodos ou outros orgaos, como o pulmao. Diversos protocolos quimioterapicos adjuvantes sao propostos em literatura (1). O objetivo do presente trabalho, e relatar o uso da quimioterapia metronomica como opcao de tratamento adjuvante em um caso de carcinoma mamario anaplasico metastatico. Foi atendida em uma clinica veterinaria, uma cadela, nao castrada, sem raca definida, de 14 anos de idade, com historico de neoplasia mamaria ha tres anos, apresentando crescimento acelerado nos ultimos quatro meses, seguido por ulceracao. No exame fisico foi constatada uma massa em M2 direita de aproximadamente 20 cm e aumento de linfonodo inguinal ipsilateral. Foram realizados exames laboratoriais rotineiros como hemograma completo, dosagens de alanina-amino-transferase (ALT), fosfatase alcalina, ureia e creatinina sericas, ultrassom abdominal, exame radiografico de torax em tres projecoes e ecodopplercardiograma. Nao foram observadas alteracoes nos exames hematologicos e nem alteracoes compativeis com metastase nos exames de imagem, sendo apenas constatada a presenca de espondilose deformante. A paciente foi encaminhada para cirurgia de mastectomia unilateral total direita e castracao. O laudo histopatologico evidenciou a presenca de carcinoma mamario anaplasico de alto grau com metastase em linfonodo inguinal. Diante do diagnostico histopatologico, foi sugerido terapia quimioterapica adjuvante. O protocolo inicial estabelecido foi de doxorrubicina 30mg/m²/IV com intervalos de 21 dias, sendo que apos a terceira aplicacao, a paciente apresentou episodios emeticos frequentes, prostracao e leucopenia, os sinais foram tratados com antiemeticos e Leucogen®. Apos a quinta aplicacao de doxorrubicina, a paciente apresentou novo quadro de prostracao, seguido por emese e leucopenia severa. A paciente ficou internada por tres dias para tratamento suporte. Diante da maior severidade dos efeitos adversos optou-se por suspender o tratamento quimioterapico adjuvante convencional apos a quinta aplicacao de doxorrubicina. Trinta dias depois, a paciente retornou para o primeiro segmento e foi observada a presenca de uma massa circular de aproximadamente 2,5 cm de diâmetro em torax, sugestiva de metastase pulmonar. Portanto, a terapia metronomica com ciclofosfamida 12,5 mg/m²/VO/Sid foi instituida. Retornos mensais foram realizados para avaliacao da paciente e realizacao de exames hematologicos e sericos. A paciente recebeu a terapia metronomica por seis meses, durante o qual, o exame radiografico de torax em tres projecoes era repetido a cada dois meses, sendo que a massa nao apresentou aumento de tamanho. Durante o tratamento a paciente apresentou otite bacteriana que foi tratada sem intercorrencias. Apos os seis meses de tratamento, a paciente apresentou paralisia de membros posteriores, porem o proprietario nao aceitou realizar exames complementares como mielografia e tomografia computadorizada para diagnostico da lesao medular. Diante do quadro nao responsivo ao tratamento clinico, foi realizada a eutanasia. O proprietario nao permitiu a realizacao de necropsia. Neste caso, foi possivel observar um bom controle no crescimento de metastase pulmonar devido a um carcinoma anaplasico mamario com o uso de terapia metronomica com ciclofosfamida 12,5 mg/m²/VO/Sid, sem presenca de efeitos adversos comuns a terapia adjuvante convencional. Referencias: (1) CASSALI et al., 2014. Consensus for the diagnosis, prognosis and treatment of canine mammary tumors. Aluna de mestrado em Ciencia Animal, UNIFRAN. Autor para correspondencia, juliana_santillil@hotmail.com Medicos veterinarios autonomos. Residente do Hospital Veterinario UNIFRAN. Docente do programa de mestrado da UNIFRAN
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