Concurrent Leptospira borgpetersenii serogroup ballum and ehrlichia canis infection in a dog in Israel: A case report

An 11-month-old, intact female Great Dane dog was presented with complaints of vomiting, diarrhea, thrombocytopenia and severe azotemia. The dog has resided in a rural environment. Due to acute kidney injury the dog was hospitalized and treated with intravenous fluids, antibiotics (cefazolin and doxycyline), anti-emetics and diuretics. Serum antibody titer and PCR for E. canis were positive. Serum microscopic agglutination test antibodies titers for Leptospira interrogans sensu lato serogroups canicola and ballum were 1:50 and 1:100, respectively at day one. A second sample at day 7 yielded a titer of 1:800 for Leptospira interrogans sensu lato serogroup ballum with no cross-reactivity with other serogroups. The dog's clinical signs, the thrombocytopenia and serum chemistry abnormalities all improved over seven days of hospitalization, and it was then discharged. This is the first record in the veterinary literature of L. borgpetersenii serogroup ballum infection in a dog in Israel and the first record of concurrent canine monocytic ehrlichiosis and leptospirosis in a dog. This dog was likely infected with leptospirosis through drinking stagnant water in a garden pool although it had been fully vaccinated with a commercially available bivalent vaccine, containing bacterins of L. interrogans serovars icterohaemorrhagiae and canicola. Leptospirosis should be included in the differential diagnosis of acute azotemia, and its diagnosis can be complicated by concurrent infections, such as in this case. Due the zoonotic potential of leptospirosis, dogs should be kept under hygienic conditions, because the commercially available vaccines do not provide cross protection against most leptospiral serogroups.