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PEER REVIEWED 80 FOCUS ON LEPTOSPIROSIS Prognosis With early and aggressive treatment that includes attentive monitoring, prognosis for recovery is excellent. Urine output should be monitored; development of oliguric renal failure significantly worsens the prognosis and prompts escalation of therapy. 8 Resolution of azotemia occurs within 10 to 14 days, however, damaged renal tissue may continue to regenerate for more than than 4 weeks after treatment. Some dogs may suffer from permenent renal damage. 1,6 Hyperbilirubinemia, if present, may be slower to resolve. Prevention Vaccination In the United States, vaccines for prevention of leptospirosis contain the serovars Icterohaemorrhagiae and Canicola and may include Grippotyphosa and Pomona. Vaccines effectively prevent disease after challenge with serovars included in the vaccine, and disease is rare in dogs vaccinated with the four-serovar vaccine; however, cross-protection of vaccines against other pathogenic serovars requires further investigation. 1,3,6 Vaccines have been shown to provide immunity from serovar-specific challenge for 1 year, but longer duration of immunity has not been demonstrated. While previously associated with a type I hypersensitivity reaction, the vaccine is no longer considered more reactive than other vaccines. 6 Vaccination is recommended annually in "at-risk" dogs. 9 At-risk dogs include those with exposure to wildlife reservoirs and/or contaminated water sources. 1 Exposure Avoidance Additional disease prevention includes avoidance of environmental water sources and contact with wildlife. Wildlife reservoirs of leptospirosis, such as rats and raccoons, are present in urban and suburban environments. As evidenced by this case, even small-breed dogs traditionally thought to have a low risk of exposure can contract the disease. Public Heath Similar to dogs, humans can become infected with leptospires from contaminated water sources or contact with reservoir hosts. Reports of transmission of disease from incidental hosts to other animals (eg, dogs to humans) are rare; however, in-hospital precautions should be taken to minimize the risk of zoonotic transmission ( BOX 1 ). 6 All dogs presenting with acute renal failure should be handled as having leptospirosis until proven otherwise. At home, owners should avoid contact with their dog's urine, wearing gloves to clean up spilled urine until antimicrobial therapy is complete. 1 References 1. Sykes JE, Hartmann K, Lunn KF, et al. 2010 ACVIM small animal consensus statement on leptospirosis: diagnosis, epidemiology, treatment, and prevention. J Vet Intern Med 2011;25(1):1-13. 2. Lunn KF. Leptospirosis. In: Bonagura JD, Twedt DC, eds. Kirk's Current Veterinary Therapy XV. St. Louis, MO: Elsevier; 2014:1286-1289. 3. Green CE, Sykes JE, Moore GE, et al. Leptospirosis. In: Green CE, ed. Infectious Diseases of the Dog and Ca t. 4 th ed. St. L ouis, MO: Elsevier; 2012:431-447. 4. Goldstein RE, Lin RC, Langston CE, et al. Influence of infecting serogroup on clinical features of leptospirosis in dogs. J Vet Intern Med 2006;20:489-494. 5. Harkin KR, Hays MP. Variable-number tandem-repeat analysis of leptospiral DNA isolated from canine urine samples molecularly confirmed to contain pathogenic leptospires. J AVMA 2016;249(4):399-405. 6. Sykes JE. Leptospirosis. In: Sykes JE, ed. Canine and Feline Infectious Diseases. St. Louis, MO: Elsevier; 2014:474-485. 7. van de Maele I, Claus A, Haesebrouck F, et al. Leptospirosis in dogs: a review with emphasis on clinical aspects. Vet Rec 2008;163(14):409-413. 8. Ross L. Acute kidney injury in dogs and cats. Vet Clin North Am Small Anim Pract 2011;41(1):1-14. 9. Klaasen HL, Molkenboer MJ, Vrijenhoek MP, et al. Duration of immunity in dogs vaccinated against leptospirosis with a bivalent inactivated vaccine. Vet Microbiol 2003;95(1-2):121-132. BOX 1 Precautions for Leptospirosis Patients Place a warning sign on cage designating animal as leptospirosis patient (suspected or diagnosed) Avoid patient contact with pregnant or immunocompromised humans House patient away from high-traffic areas Minimize patient movement around hospital Disinfect urine spills promptly Wash hands before and after handling patient Wear personal protective equipment, including gloves, disposable gown, protective eyewear, and facemask when handling patient Place an indwelling urinary catheter, if necessary, to monitor urine output or control incontinence Walk uncatheterized dogs outside frequently to urinate in a restricted area that is easily decontaminated