Dr. Jane Sykes joins us as we dive into the 2023 ACVIM Consensus Statement on leptospirosis. In this episode, Dr. Andy Roark is joined by Dr. Jane Sykes, a renowned small animal internist at UC Davis College of Veterinary Medicine and editor of Greene’s Infectious Diseases of the Dog and Cat. Dr. Sykes emphasizes the growing importance of leptospirosis vaccination for all dogs, including those in urban areas. Dr. Sykes provides insights into recent advances in leptospirosis diagnostics, prevention, and the disease’s zoonotic potential, explaining how the updated consensus reflects new knowledge and data on this pathogen. She highlights critical details, such as new safety guidelines for veterinary staff when handling suspect cases and ways to improve accuracy in diagnosing leptospirosis. Dr. Sykes also shares her personal experiences with leptospirosis, underlining the importance of awareness, timely diagnosis, and vaccination for better patient and staff safety. This episode is packed with valuable information for veterinary professionals who want to keep their practices informed and up to date on infectious disease protocols.
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LINKS
Updated ACVIM Consensus Statement on Leptospirosis in Dogs: https://onlinelibrary.wiley.com/doi/10.1111/jvim.16903
CDC Leptospirosis in Animals: https://www.cdc.gov/leptospirosis/pets/index.html
Uncharted’s Practice Owner Summit: https://unchartedvet.com/practice-owner-summit-2024/
Dr. Know-It-All Card Game: https://drandyroark.com/in-the-know/
Dr. Andy Roark Charming the Angry Client Team Training Course: https://drandyroark.com/charming-the-angry-client/
Dr. Andy Roark Swag: drandyroark.com/shop
All Links: linktr.ee/DrAndyRoark
ABOUT OUR GUEST
Dr. Jane Sykes is a powerhouse in veterinary medicine and infectious disease research! A professor at UC Davis with board certification in Small Animal Internal Medicine, she holds degrees in veterinary science, a PhD, an MBA, and a public health certification. Renowned for her work on infectious diseases in pets, Dr. Sykes has published extensively and earned numerous awards for her research on zoonotic diseases. Her passion for teaching and her impressive expertise make her a top voice in veterinary health and public safety—so prepare to be inspired and informed as we dive into her world!
EPISODE TRANSCRIPT
Dr. Andy Roark: Welcome everybody to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I got a super important one for you today. I am here with Dr. Jane Sykes and we are talking about the 2023 updated ACVIM consensus statement on lepto sclerosis in dogs. Guys, this rattled cages at my vet clinic.
The recommendation outta this consensus statement is that. All dogs should be recommended for leptospirosis. That means an initial vaccine, a booster, and an annual vaccine thereafter. And the recommendation here is that all boarding facilities and dog daycares should also be requiring leptospirosis vaccines in dogs.
We talk about why that is. We talk about what the differences, what the changes were for the 2010 consensus statement to the 2023. it’s a fascinating conversation. Dr. Sykes is amazing. Anyway this is big. It’s changed the way we’re doing stuff at our vet practice. it’s big for staff awareness and keeping our team safe.
I hope you’re gonna love this episode Let’s get into it
Kelsey Beth Carpenter: (singing) This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to the Cone of Shame with Dr. Andy Roark.
Dr. Andy Roark: Welcome to the podcast. Dr. Jane Sykes, thank you so much for being here.
Dr. Jane Sykes: Thank you for having me. I’m excited to be
Dr. Andy Roark: here.
It is, it is an absolute pleasure and honor to have you on the podcast. You are amazing. you are on the faculty at UC Davis College of Veterinary Medicine. You are a small animal internist. You have an MBA. You have a Master’s of Public Health. You are the editor of the 5th edition of Greens Infectious Diseases of Dogs and Cats. You are the chair of the 2020 Consensus Statement on Leptospirosis from ACVIM and the updated statement, which is what blew my doors off. And was the reason I reached out and was like, Hey, would you be willing to come and talk to me?
You have an incredible resume. You have done really incredible things in your career. And you’re doing work that really matters and that’s really important. And so I was not kidding when I said, the 2023 updated ACVIM consensus statement on leptospirosis in dogs came out last year.
This has been a very popular piece. I saw, I think it was the most downloaded piece from ACVIM last year. And I, it was handed out at our vet practice because of some of the recommendations that were in it and specifically in the updated consistent consensus statement, the word that was sort of put forward was the recommendation of all dogs, small dogs, all dogs.
urban dogs being vaccinated for leptospirosis. It was recommended that all boarding and daycare facilities also require this vaccine. And that’s a massive shift from what a lot of vets have been saying. It’s a shift from what I’ve been saying. It is It also has ramifications for staff awareness and staff safety because you talk a bit more about the zoonotic potential of leptospirosis.
So let me just sort of stop here can you unpack that for me? Is that, is an accurate representation of what’s being recommended in the, in the consensus statement?
Dr. Jane Sykes: Yeah, I think you know, there’s been a lot of change since the original 2010 ACVIM consensus statement was published, and we tried to reflect that in this updated version of the consensus statement, it’s been a long time and we have new diagnostic tests. We have new understanding of the epidemiology of the disease.
We have new vaccines as well. And so, you know, we really wanted those things to be reflected in the statement. And we also really understand that we have a better understanding of how pathogenic lepidospires are transmitted in terms of environmental sources of the organism as well as animal to animal transmission.
So I do want to just, before I start talking about the consensus statement, a few acknowledgements and disclosures. First of all, I’m supported by a number of industry groups in terms of my research and speaking, including industry groups that make vaccines for lepto. But I’ve really been quite passionate about leptospirosis throughout my career.
I’ve seen. I’ve seen it in all places that I’ve worked and I’ve seen dogs dying from it. So I, you know, I believe when I’m recommending vaccination for leptospirosis, it’s because I truly believe in it. And my own dog is vaccinated for leptospirosis. So there’s that. And then I also want to say that I’m really speaking as the chair of the consensus statement.
It’s my opinions that I’m giving here, but there were several other panel members that were part of the consensus statement. And the way that we have done these consensus statements lately is to do what’s called the modified Delphi method. And so when we proposed the new updated consensus statement to the ACVIM Board of Regents, we then had a core panel and we identified a number of expert reviewers.
So the total number of people that were voting on statements in the consensus statement was 12. And so then we presented the consensus statement recommendations at the 2023 ACVIM forum last year. And then after we had presented the statement, we then posted, the document on the ACVIM listserv for comments.
And really, we had really positive feedback about. The recommendations that were made. It was pretty quick for it to go through to publication in the Journal of Veterinary Internal Medicine. And it, you will see if you do look at the document that for every statement there’s a level of agreement, which is the number of people that were in favor of the statement.
Sometimes voters didn’t vote if they didn’t feel like they, knew enough about the topic to vote. So there was some abstentions for some of the statements, but you can see that, for most of the statements, almost all panel members agreed with them.
Dr. Andy Roark: I’ll put a link to the statement in the show notes so people can see it. Was there something that in particular that came up that made you say, we need to revisit the 2010 statement? Was there anything that sort of drove that decision to go back? I know that there’s a threshold where you must have said, my position on this has changed or the information has reached a new level and it’s worth revisiting.
But was, what, was there a moment that you said, yeah, we need to go back and look at this again?
Dr. Jane Sykes: I think we’d always wanted to do it. And I think we’d always received questions from people about when it was going to be updated given the new knowledge on the disease. And I think it was, really about a group of people that felt like it was the right time to do it based on everything that we knew about LEPTO and and a little bit was the right time as far as ACVIM was concerned in terms of their production of new consensus statements.
Dr. Andy Roark: Have you gotten any pushback on the new statement? Have there been people who said, Oh that’s Bobbycock. I don’t know. Whatever. Has anyone just said, that’s not that. Surely not that. This is over the top.
Dr. Jane Sykes: I’ve been involved in a lot of consensus statements over the years, including some really tough ones, like the antimicrobial is great antimicrobial guidelines, which were internet international guidelines and where you really don’t have a lot of evidence sometimes to make statements.
But the great thing about consensus statements that I’ve learned is that when you get feedback that, there’s not enough evidence to support that or what you’re saying, we don’t agree, is it usually stimulates people to go out and do research and then you get more information and you can do these revised statements and so that’s, that, that has been one thing that’s made me quite optimistic now about developing new consensus statements and guidelines documents, but I would have to say that this leptospirosis one was a relatively easy one in terms of all of the ones I’ve been involved with in terms of acceptance.
And there has been some questions surrounding the use of bleach in hospital environments given its corrosive nature and also concerns about people handling bleach. Bleach. So there was one recommendation in the statement about with there was a large volume of urine diluting it. If you had a bag full of urine diluting it one to one with bleach as being maybe the best way to inactivate leptospires in that situation.
But and concerns about the use of bleach in general. And so I think that’s really been the main one that’s come up. And I think any disinfectant is going to be active against leptospires. They are really fussy friable organisms in the environment. You know, I think if you used other hospital based disinfectant or accelerated hydrogen peroxide, that would just be fine.
Dr. Andy Roark: When. When we talk about, vaccination and, and a rise in prevalence in the condition, do you think that we’re missing these cases when they come into the clinic? Do you think that it’s common for vets to see leptospirosis dogs and not recognize what they are?
Dr. Jane Sykes: I think my feeling talking to veterinarians over the course of my career about, about lepto in big audiences and in small audiences is that we both see under diagnosis of leptospirosis and over diagnosis of leptospirosis. And certainly I’ve presented cases in front of veterinarians and they’ve come up to me and said, Oh my gosh, I am sure I saw a dog with leptospirosis recently based on that.
It was very, very similar to what you described and leptospirosis is really quite a pattern recognition disease, right? In fact, Adolf Weil, it’s kind of an interesting historical story because I love history of infectious diseases, but Adolf Weil who the, who discovered leptospirosis in people in the late 1800s, he recognized these people who had leptospirosis.
Really similar clinical signs. And he thought that there was something infectious that was causing their jaundiced. And that’s how leptospirosis in people got the name Weil’s disease. So he was actually practicing patent recognition back then. And now we have, you know, recently been developing things like machine learning algorithms.
Krystle Reagan, who’s on faculty here at UC Davis and was my infectious disease fellow, has been training a machine learning algorithm to recognize leptospirosis in dogs that can help us pick up these cases because they do often have this pattern of clinical laboratory abnormalities. it is under recognized in some practices, but in other situations, it’s overdiagnosed to, and that kind of reflects some of the challenges surrounding diagnostic testing for the disease.
One of the really cool things that I’m very proud of about the consensus statement is that it includes a case definition for leptospirosis, and believe it or not, this is the very first case definition for any companion animal infectious disease that’s ever been developed formally.
There is a table in the consensus statement that can guide veterinarians with the diagnosis by stating, you know, the findings that are needed to diagnose leptospirosis. And so we have, clinical criteria and we have laboratory criteria and the clinical criteria require that the dog has to have onset of systemic illness within the last two weeks.
So it’s not a chronic grumbling disease that we’re talking about. We get lots of questions about dogs with chronic PU/PDing lepto really, we think that leptospirosis in dogs is characterized by an acute onset of illness in the last two weeks. And we have supportive biochemical and CBC findings as well as imaging findings and then these specific laboratory diagnostic test findings to support the diagnosis.
Dr. Andy Roark: For those who don’t know a lot about leptospirosis, what are the waving flags that should get their attentions when cases come into their practice? So, if you’re a, you know, if you’re a, veterinary assistant or something and you come in and, you’re setting up a room, you’re taking a history, you know, things like that, what are the, what are the flags that our staff should be looking for?
It’s always, I always, I want to keep them safe and the easiest way for me to keep people safe is for them to be looking out for themselves at least partially. And so, what should they look for?
Dr. Jane Sykes: Yeah, so I think, first of all, if a dog has a history of being properly vaccinated with a 4-serovar vaccine for a lepto, it’s really unlikely that a dog will have leptospirosis. So leptospirosis should be suspected in dogs that have not been properly vaccinated for a lepto really have very few cases where breakthroughs have occurred in vaccinated dogs.
And so, you know, acute onset of clinical signs that usually nonspecific, right? Not eating, vomiting, diarrhea P U. P. D. Oftentimes early on in the course of illness. And one of the challenging things is in the first day or so of illness Those animals can have blood work. That looks pretty normal.
They might have a fever, but pretty normal blood work. And we do say in the consensus statement that whenever you see an animal that’s unvaccinated for lepto and has this sort of acute onset of a febrile illness, And really any dog can get lepto too. So it can be a small breed dog, a large breed dog, an indoor dog and outdoor dog.
So the history may not always help you there. But if, if ever you see that it’s the recommendation is because lepto can progress to acute kidney injury pretty quickly within 24 to 48 hours. And those dogs can then. Maybe even need dialysis to save their lives. We recommend that clients be told that if their dog is not better in 24 hours, they should return for re examination.
And so having that high index of suspicion for the disease is really important. We even go so far as to, to recommend considering giving a short course of antimicrobials in those dogs because it could potentially protect them from developing A. K. I. And there is stewardship issues with that one.
But if you’re in a region where leptospirosis occurs, there’s maybe history that’s suggestive, lack of vaccination history. Then you might even want to think about giving a short course of doxycycline or amoxicillin.
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Dr. Andy Roark: Can you talk a little bit about the difficulty in diagnosing leptospirosis? I know that there’s, as you said, it can be challenging to get a formal diagnosis. Walk me through the process there. Have there been updates or changes in the recommended approach to diagnosing the condition?
Dr. Jane Sykes: Yeah. So we have both nonspecific diagnostic tests, right? So we, certainly as a pattern recognition disease, you could have supportive findings on blood work. So especially that combination of azotemia and a cholestatic liver enzyme increase. So it’s usually not liver failure that these dogs develop.
It’s a cholestatic liver injury. So if you saw really, really high ALT, for example, and evidence of hepatic failure, that would not be likely to be a lepto case. A lot of dogs with lepto are thrombocytopenic. A lot of them have glucose urea. They can be red flags in conjunction with the presence of azotemia.
So that’s, oftentimes we’re diagnosing it based on clinical suspicion, and we do recommend that if you suspect lepto that all dogs get thoracic radiographs because many dogs have evidence of this condition known as leptospiral pulmonary hemorrhage syndrome, which can be just a mild interstitial pattern initially on radiographs, but then can progress to more severe pulmonary infiltrates that are alveolar due to hemorrhage.
And so identifying those changes early can help increase the suspicion for a lepto and it also can make you more cautious with your fluid therapy. So there’s the combination of those findings, but then we have specific diagnostic tests for a lepto and the gold standard diagnostic tests that you may have heard of is a serial logic test called the microscopic agglutination test or the MAT test.
And this is when. Let’s say you went out and got leptospirosis tonight, right? So if you decided to go out and get lepto tonight you might go and eat a rat kidney because that’s a really good source of organisms. And so I’m just going to put you in the position of someone or a dog that develops leptospirosis.
And so let’s say you ate rodent tissue and then a week from today you got sick and you went to your doctor and you said, Oh, I got leptospirosis. I think I have leptospirosis because I ate this rodent kidney tissue, then they would take your blood and they would submit it for a leptospira PCR, but they would also submit it for this serologic test, the MAT test.
And so what this test is doing is looking for antibodies to different serovars. And at the CDC, their panels include 23 different serovars. So the point of doing that to the point of including all of those serovars is to try to maximize the chance of detecting an antibody response to a pathogenic cerebrum.
And so they’re going to do serial twofold dilutions of your serum, and they’re going to react them with each of those live leptospiral cerebrums, and they’re looking under a darkfield microscope for the title that causes 50 percent of the organisms to agglutinate. And that’s the title that’s reported out to the clinician.
So you may be familiar with the veterinary panels, which includes six or seven different serovars typically, and sometimes you see multiple positive titers to different serovars, and that’s because of cross reactivity among those serovars. The problem is that when dogs first come in sick with leptospirosis, this is an antibody test and lepto is an acute disease.
So oftentimes dogs do not have positive titers in that very early phase of illness. In fact, they can be completely negative and we expect that. And if you have a dog that’s been sick for two days and has high titers. They might be left over from previous exposure or from vaccination because most dogs that get exposed to lepto actually don’t get sick and then one to two weeks later is when you want to take your convalescent sample.
So your doctor would tell you to come back in one to two weeks and they would again repeat the test and you should see zero conversion over that time period. And so you’ll notice that I said that at the CDC, they use more than 20 different serovars, whereas veterinary panels often include six or seven different serovars and can understand that might be the case because it’s such a laborious test to actually perform, right?
It’s just, you can imagine trying to do that, and that’s why they tend to batch it. And it’s only done once a week. And so that’s one of the other problems with these diagnostic tests is that we often have to wait a long time to get those test results back. And the other thing I’ll say about that is because this is not a serovar test.
Right? It’s just a diagnostic test for leptospirosis. You can keep on adding more and more serovars and see higher and higher titers to other serovars that you add in. It’s really just trying to increase the chance of detecting a positive reaction. So there’s been lots of people looking at alternatives to the MAT test because it is so cumbersome to perform and we have to wait for those results.
And they’re often negative early on in the course of illness. And so now we have these point of care tests. And that was another reason for for, doing the updated consensus statement, because these point of care tests. are increasingly being used in practice environments. And so these point of care tests are also antibody tests.
They’re not organism detection tests. They’re just detecting antibodies. But we have two different platforms. We have the SNAP lepto test from IDEXX and we have the witness lepto from Zoetis. Now the witness lepto is an IgM based test, so it’s more likely to detect recent infection than the snap lepto, which is an IgM IgG based test.
But these tests still have limitations in that they can be negative early on in the course of illness. And they can be positive from previous exposure. That’s just a lot less likely to occur with the witness test than with the snap lepto. And so the studies that have been published now are showing that when the witness test is positive in association with clinical science it is really likely to truly be leptospirosis.
But we had a case recently come in this year that we did was sick just early on in the course of illness. We did the witness test. Witness test. It was negative, and I recommended to the resident that they did another witness test in 5 to 7 days. And so they repeated the point of care test, and it went from negative to positive.
So that’s, you know, one way that these tests can be used rapidly to detect zero conversion.
Dr. Andy Roark: That’s amazing. Given the zoonotic potential of this condition, Jane, if you owned a vet hospital, are there certain guidelines that you would put into place? What are the, what are the sort of the safety standards that that you would say, I want my staff to know these things just to keep everyone safe, knowing the prevalence of the condition?
Dr. Jane Sykes: Yeah. And so this, there’s actually been some interesting comments about zoonotic transmission in the updated consensus statement that I think are worth spending some time on. Because actually, you know, if anything, we’ve backed off on handling precautions a little bit. And we know that with lepto, we have reservoir hosts that are chronically infected with lepto and shed organisms typically in the absence of clinical signs.
And then we have incidental hosts like sick people. Dogs and humans with leptospirosis. And we know that actually incidental hosts, they have a lot of inflammation to the spirochete. And so they actually don’t shed very many organisms. Oftentimes it’s a lot about the inflammatory response, whereas it’s these reservoir hosts
that shed lots of organisms and are a much more important source of infection. So you’re actually more likely to get leptospirosis from handling a reservoir host, like large animal species that’s chronically shedding lepto, like horse or cattle, than you are even maybe working with a sick dog that truly has leptospirosis.
So we still, we’re not discounting the zoonotic disease potential there, but there’s been a few other studies looking at outbreaks of lepto in dogs and lepto in dogs and really there’s not a lot of evidence that transmission from sick dogs with lepto occurs. There was one particular study
regarding outbreak of leptospirosis that was occurring in the Phoenix area again, underscoring the fact like you’ve got an arid area and leptospirosis is still occurring. In fact, large numbers of cases in that region. So in this particular outbreak, the CDC got involved and they went and studied the outbreak and people who are in contact with the infected dog.
So they looked at nine dog owners and 109 animal caregivers and many of these people, especially the veterinary technicians were saying that they when any PPE they were splashed in the face with urine or had extensive blood contact when they were working with dogs that had to leptospirosis. And so they were looking to see if anybody got sick after those experiences, and they found seven people who got flu like illness afterwards, and they tested them for antibodies to lepto, and they were all zero negative. So the thought was, is that they actually had probably some other cause of their flu like signs. And so they concluded that the title of the paper is, despite high risk exposures, no evidence of zoonotic transmission during a canine outbreak of leptospirosis. And there’s been other studies looking at veterinarians who are in contact with dogs in lepto one in Italy, for example, that showed that really there wasn’t much evidence of zero conversion among those people.
So now instead of requiring, you know, handling precautions for all of those AKI dogs that we see, you know, we see a lot of dogs with renal disease, but only a small percentage of them actually have lepto, but we still end up handling a lot of animals as if they’re lepto precautions, but to reduce the impact of that and also environmental waste associated with those types of precautions.
Now, if you have a lepto suspect, we recommend using those precautions for 48 hours only. And after 48 hours of suitable antibiotic therapy, even either doxycycline or penicillin, that you can then lift those precautions. So these long hospitalizations with precautions no longer recommended.
Dr. Andy Roark: That’s reassuring. I, I appreciate it. It’s funny looking at the, you start to look at the symptoms that we might be looking for and I say, well, you know, when we have a vomiting diarrhea dog come in, should we be gloving up and treating this as a potential, you know, zoonotic condition?
And that’s very reassuring. That helps a lot. Dr. Jane Sykes. Thank you so much for being here. Thanks for talking about this with me. I really appreciate it I’ll put a link to the consensus statement in the show notes Where can people find you online? Do you have resources that you really recommend for people who are interested in this?
Dr. Jane Sykes: the nice thing is, is the JVIM consensus statements are all open access. So you can download them free and get all the information in the consensus statement. Also I think the other resources are the CDC websites on leptospirosis and their healthy pets, healthy people resources.
There’s information on leptospirosis there for animal owners that might be asking questions about it. Or if you do see a case and you want to give owners resources, I would refer them to the CDC resources.
Dr. Andy Roark: That’s absolutely wonderful. Thanks so much for being here. Gang, thanks for tuning in everybody. Take care of yourselves. We’ll see you later
And that’s what I got for you guys.
I hope you enjoyed it. I hope you got a lot out of it I hope it sparked some kind of some discussion at your practice. Are you seeing leptospirosis dogs? I hate the idea that I might be seeing them and not recognizing them I also hate the idea that there’s a vaccine that can keep these dogs safe and I maybe we haven’t been recommending it as much as we should. Anyway, all you can do is learn and take in the new data that’s out there and keep adjusting what you do to get better that’s my takeaway from this This is a somehow I’m just really interested in and I think that we have the potential to do a lot of good here. Alright, guys, onward and upward take care of yourselves. I’ll talk to you later on.
