Follow-up monitoring in a cat with leishmaniosis and co-infections with Hepatozoon felis and 'Candidatus Mycoplasma haemominutum'

Case summary: A 6-year-old, female neutered, domestic shorthair cat from Cyprus was presented with multiple ulcerated skin nodules. Cytology and histopathology of the lesions revealed granulomatous dermatitis with intracytoplasmic organisms, consistent with amastigotes of Leishmania species.

Biochemistry identified a mild hyperproteinaemia. Blood extraction and PCR detected Leishmania species, Hepatozoon species and “Candidatus Mycoplasma haemominutum” (CMhm) DNA. Subsequent sequencing identified Hepatozoon felis. Additionally, the rRNA internal transcribed spacer 1 (ITS1) locus of Leishmania infantum was partially sequenced and phylogeny showed it to cluster with species derived from dogs in Italy and Uzbekistan, and a human being in France.

Allopurinol treatment was administered for six months. Clinical signs resolved in the second month of treatment with no deterioration eight months post-treatment cessation.

Quantitative PCR and ELISA were used to monitor L infantum blood DNA and antibody levels. The cat had high L infantum DNA levels pre-treatment that gradually declined during treatment but increased eight months post-treatment cessation. Similarly, ELISA revealed high levels of antibodies pre-treatment which gradually declined during treatment and increased slightly eight months post-treatment cessation. The cat remained PCR positive for CMhm and Hepatozoon species throughout the study. There was no clinical evidence of relapse twenty-four months post-treatment.

Relevance and novel information: To our knowledge this is the first clinical report of a cat with leishmaniosis with H felis and CMhm co-infections. The high L infantum DNA levels post-treatment cessation might indicate that although the lesions had resolved, prolonged or an alternative treatment could have been considered.