Page 1005 - Clinical Small Animal Internal Medicine

100 Lyme Borreliosis 943

should be checked for proteinuria. Joint tap cytology 1–2 days. If unresponsive, consider other causes. The
VetBooks.ir shows a neutrophilic inflammatory response without prognosis for Lyme nephritis is guarded to poor if the
dog presents in renal failure, but may be better in earlier
bacteria, but morulae may be seen due to co‐infections.
stages. Monitoring abnormalities frequently with treat­
Lyme Nephritis ment adaptation is essential.

Abnormalities may include elevated blood pressure
measurement, proteinuria/cylindruria, ± glucosuria, ± Prevention
decreased concentrating ability, hypoalbuminemia,
hypercholesterolemia, azotemia, hyperphosphatemia, Tick control year round (ticks are active when tem­
anemia, thrombocytopenia, and abnormal (hypercoag­ perature is >40 °F or 4 °C) is most important, since
ulable) thromboelastography. Diagnostic work‐up ticks in Lyme‐endemic areas may transmit borreliosis
of PLN also includes screening for other infectious, as well as anaplasmosis, babesiosis, ehrlichiosis,
inflammatory, genetic, and neoplastic diseases that mycoplasmosis, and Rocky Mountain spotted fever,
cause proteinuria (e.g., serologic testing, urine culture, and possibly bartonellosis. Some of these are trans­
chest radiographs, abdominal ultrasonogram). Renal mitted within the first day of tick attachment so prod­
imaging is usually unremarkable. Renal biopsy by ucts which prevent tick attachment (e.g., permethrins
experienced personnel with thin section light micros­ or amitraz) or kill ticks fast after attachment (e.g.,
copy, special stains, immunofluorescence, immunohis­ isoxazolines) are preferred.
tochemistry, and transmission electron microscopy There are five Lyme vaccines available: three killed
shows immune‐complex glomerulonephritis (staining adjuvanted bivalent bacterins (LymeVax, Zoetis;
techniques for Lyme‐specific complexes are not vali­ Duramune Lyme, Elanco; Nobivac Lyme, Merck Animal
dated), and possible secondary tubular necrosis/regen­ Health) including ospA and ospC, a nonadjuvanted
eration and interstitial nephritis.
recombinant subunit ospA vaccine (Recombitek Lyme,
Merial), and a chimeric recombinant adjuvanted vac­
Therapy cine which includes ospA plus ospC from seven strains
(Vanguard crLyme, Zoetis). Even in endemic areas,
Lyme vaccination is controversial because:
Therapy for nonclinical nonproteinuric dogs is not war­
ranted. For Lyme arthritis signs, doxycycline (10–20 mg/ ● tick control is important to protect dogs from other
kg/day for 30 days) or minocycyline is recommended tick‐borne diseases in these areas
because of possible responsive co‐infections. Other ● most exposed dogs do not become ill or they respond
antispirochetal antibiotics include amoxicillin, erythro­ quickly to commonly used antibiotics
mycin, azithromycin, cefovecin, and ceftriaxone. Mana­ ● Lyme vaccines may interfere with some diagnostic
gement for Lyme nephritis includes longer antibiotic tests
regimes (perhaps until the Quant C 6 result has waned), a ● Lyme vaccines are costly, have inconsistent efficacy,
modified low‐protein diet, renin‐angiotenin‐aldosterone produce weaker/shorter duration of immunity
system inhibitors (e.g., angiotensin‐converting inhibitors that may require six­month boostering, and cause
and/or angiotensin receptor blockers), omega‐3 fatty more postvaccinal adverse events than other canine
acids, antithrombotics, antihypertensives, drugs for renal vaccines.
failure (e.g., antiulcer medications, phosphate binders), ● the most serious forms of Lyme disease have an immune‐
and possibly immunosuppressives if renal biopsy shows mediated pathogenesis, so theoretically it may not be a
glomerular immune‐complex deposition or, in rapidly good idea to introduce Lyme antigens to genetically
progressive cases, even without biopsy confirmation predisposed dogs, lest sensitization or aggravation
(compassionate care). The best protocol is unknown but of immune‐complex deposition in glomeruli or joints
may include single or combined mycophenolate, cyclo­ may occur.
phosphamide, steroids, chlorambucil, cyclosporin, and/
or azathioprine. These last possibilities may not appear temporally asso­
ciated with vaccination and are difficult to study without
an experimental model of Lyme nephritis. Most con­
Prognosis cerns are anecdotal and theoretical, and because owner
compliance to using adequate tick control may be prob­
The prognosis for Lyme arthritis is excellent as the lematic, many veterinarians recommend Lyme vaccina­
course is self‐limiting or responsive to antibiotics within tions in addition to tick control.