Clinical and Hematological Outcomes of Miltefosine-Allopurinol Treatment in Dogs with Leishmaniasis in Albania

Abstract

Canine leishmaniasis (CanL) is a zoonotic disease caused by Leishmania infantum, with conventional treatment relying on parenteral antimonials that carry significant nephrotoxic risks, necessitating safer and more practical therapeutic alternatives. This study evaluates the clinical efficacy, tolerability, and hematological/biochemical parameters changes associated with the oral combination of Miltefosine and Allopurinol in naturally infected dogs, with clinical and laboratory parameters monitored at weeks 3, 6, and 9 post-treatment initiation. The combination therapy demonstrated clinical efficacy comparable to standard protocols, with rapid resolution of anemia observed in 83.3% (5/6) of dogs by week 3, indicating effective parasiticidal action and restoration of erythropoiesis. However, markers of chronic inflammation, including leukocytosis, hyperproteinemia, and hyperglobulinemia, showed a persistent or increasing trend over the study period, suggesting that while parasite load is reduced, the secondary immune-mediated inflammatory response may require extended monitoring. Notably, despite the recognized renal safety profile of miltefosine compared to antimonials, elevations in renal markers and liver enzymes persisted 100% of the affected subset (2/2) at all checkpoints, underscoring the necessity of rigorous biochemical surveillance even with this oral protocol. The treatment was well-tolerated, with only mild and transient gastrointestinal side effects reported. In conclusion, the Miltefosine-Allopurinol combination constitutes an effective, safe, and owner-friendly oral alternative for CanL, particularly advantageous for dogs with pre-existing renal disease or when injectable therapies are impractical, though the persistence of inflammatory and biochemical abnormalities mandates long-term clinical and laboratory monitoring to optimize patient outcomes and mitigate the risks of relapse or progressive organ dysfunction.