Under ideal conditions, the bacteria can survive more than three months outside the body. Humans are also vulnerable to leptospirosis. All animals can potentially become infected with Leptospirosis. Raccoons, skunks, opossums, rats, cows, and pigs are all known carriers of the infection. If you have concerns that you or someone you know may have leptospirosis, it is best to contact your doctor or the NHS for advice. Dogs get infected most often through this urine, by drinking or bathing in puddles, or in an area of standing water in a river, for example. Classification - The traditional method of classification divided leptospires into over 200 serovars based on antigenic (serologic) differences and all pathogenic, ; the free-living, non-pathogenic serovars were all included within the, species. Which animals can spread leptospirosis to people? The organisms are killed by all commonly used disinfectants. How long is treatment for leptospirosis in dogs? L. canicola. It consists in integrating in the serum of the dog, antibodies against the different species of leptospires. Infected wet ground or fresh water (rivers / lakes) - lepto can live in wet ground and freshwater for several months. Antibiotics such as penicillin, ampicillin, and amoxicillin, are . The reported prevalence/incidence of leptospirosis in dogs may be underestimated, for it is likely that much canine disease is undiagnosed since many infections are asymptomatic. Dogs also may become infected with several other serovars and serve as "accidental or incidental hosts". Darkfield microcopy versus fluorescent antibody (FA) testing of urine- Often the darkfield examination of urine is inconclusive. Leptospirosis bacteria can spread in urine, and can enter the body through the mouth, nose or wounds. Culture- Antemortem culture of body fluids (urine, blood, aqueous humor) and postmortem culture of tissues (kidney, liver, fetus, placenta) is usually not practical due to the fastidiousness of leptospires. Because many aspects of the infection are poorly understood, there is the possibility that the disease in dogs may go undiagnosed. An understanding of the pathogenesis of leptospirosis is incomplete. Cornell University, Become a member of IVIS and get access to all our resources, Leading the way in providing veterinary information. In order for direct infection to occur, dogs must be exposed to leptospires from infectious urine, via transplacental and venereal routes, bite wounds, or ingestion of contaminated meat. Elimination of leptospires from the renal interstitial tissues to control the carrier state is best achieved with dihydrostreptomycin (10 to 15 mg per kg, IM, bid for 2 weeks) or streptomycin; however these drugs are not available in the United States for routine therapy. Renal replacement therapy with intermittent hemodialysis or continuous renal replacement therapy should be considered for dogs that are anuric or oliguric despite appropriate supportive therapy. Dogs may vomit (, ) and/or have diarrhea resulting in rapid dehydration and excessive thirst. Vaccines can be used for prevention. Histopathology- Special stains, e.g., the Warthin-Stary silver stain, and immunohistochemistry, using monoclonal antibodies, should be attempted on formalin-fixed sections of kidney, liver, and fetal/placental tissues. The most common source of leptospirosis in dogs is contaminated water. Finally, since it takes at least seven to ten days for the dog to start producing antibodies, the serology can prove negative in the early days of the infection, and only become positive during convalescence. In both the mild and the severe forms of leptospirosis, flu-like symptoms develop first. Odds were increased if dogs attended less deprived clinics (IMD ranking 3-5), with highest odds of diagnosis in least deprived (five) areas (OR = 3.63, 95% CI 2.28-5.78). Icterus may be seen in dogs with leptospirosis, especially in acute cases infected with L. icterohemorrhagiae. Dogs may also be infected through the bite of, or by eating, an infected animal. Areas where your dog has urinated, vomited, or possibly left any other type of fluid should be cleaned and disinfected thoroughly with iodine-based disinfectants or bleach solutions. ET. Aminoglycosides cannot be used in patients until kidney function has been restored. Dogs had reduced odds of leptospirosis if they attended an urban clinic versus a rural clinic (OR = 0.26, 95% CI = 0.19-0.35). In peracute to subacute disease, dogs may die without clinical signs. Penicillins can be used for initial infections, but they are not effective for eliminating the bacteria once it has reached the carrier stage. serology is imprecise, but generalizations may be made regarding the interpretation of L-MAT results. Also, dogs in fenced yards may be exposed to urine from wildlife, including rodents; dogs which are exercised by walks in parks and those who roam in the countryside or swim in ponds and slow running streams are at greatest risk to exposure to leptospires. Will Giardia in dogs go away on its own? Polymerase chain reaction (PCR)- With the advent of PCR tests, rapid and genus and serovar specific detection of leptospiras from clinical specimens should be possible. Some dogs may not survive if the infection has caused significant organ damage or severely affected the ability of blood to form clots. In humans, it can cause a wide range of symptoms, some of which may be mistaken for other diseases. Figure 4. This is a serious disease that threatens our dogs, especially those living outdoors, but can also affect humans. It should be recognized that protection by vaccines is serovar specific and, to a lesser extent, serogroup specific. - Antemortem culture of body fluids (urine, blood, aqueous humor) and postmortem culture of tissues (kidney, liver, fetus, placenta) is usually not practical due to the fastidiousness of leptospires. Leptospirosis is a bacterial disease that affects humans and animals. The most commonly used serological test for leptospirosis is the LeptospiraMicroscopic Agglutination Test (L-MAT). There are 17 species of these bacteria, (and more than 230 serovars), more or less dangerous, and more or less specific to a species of mammal. 6) is uncommon, and it occurs more frequently in dogs infected with L. icterohemorrhagiae. Acute liver disease Hepatic Disease in Small Animals can accompany acute kidney injury in dogs with leptospirosis, or it can occur alone. Feeling sick (nausea), loss of appetite, being sick (vomiting) and diarrhoea. The decline of L-MAT titers often commences about 16 weeks post-vaccination, but low titers may not indicate lack of immunity since anamnestic responses may be sufficient to engender protection against clinical illness. ), carrier and excretor of leptospires. Cats rarely develop leptospirosis, and clinical signs are less severe read more . Even after theyve recovered, dogs with lepto can keep spreading the bacteria in their urine and remain a risk to other pets and people for some time. It is difficult to read, and requires fresh urine in order to observe intact leptospiral cells. The disease in primary reservoir hosts tends to be more chronic, or asymptomatic with weak antibody responses. Use to remove results with certain terms ), before being eliminated (disseminated) with the urine of these animals. - PubMed-. Severely ill, acute cases require a high degree of supportive care for survival; the prompt administration of fluids is essential. Urinalysis might show abnormalities such as hyposthenuria, isosthenuria, or minimal concentration; proteinuria; glucosuria (with normal blood glucose); cylindruria; hematuria; or pyuria. Such dogs commonly present with loss of appetite, fevers of 103 - 104F (38.5 - 40C), severe myalgia and a reluctance to move, stiffness, shivering, progressive weakness and depression. All rights reserved. As indicated above, the question whether or not to vaccinate an animal must take into account the leptospiral serovars in a particular region and ascertain that the appropriate serovars are contained in a vaccine. An unvaccinated puppy, or a puppy that has only had their first injection has no protection against leptospirosis or the other diseases we vaccinate against. Responses to infection in previously vaccinated dogs generally result in anamnestic responses only to the homologus serovars. The two techniques are therefore complementary. In order for direct infection to occur, dogs must be exposed to leptospires from infectious urine, via transplacental and venereal routes, bite wounds, or ingestion of contaminated meat. What are the chances of a dog getting leptospirosis? Would you like to add this to your library? Reduce your dog's exposure by avoiding (when practical) slow moving water and. Gloves and a mask should be worn during the cleaning process and disposed of properly. Can my dog survive leptospirosis? The canine disease presents as an acute infection of the kidney and liver and, sometimes, as a septicemia. Serum biochemistry or serum blood gas analysis might show abnormalities such as azotemia, hyperphosphatemia, metabolic acidosis, hyponatremia, and hypo- or hyperkalemia. FA examination- FA should be done on all tissues submitted for postmortem examination, especially important are kidney and liver specimens. If your dog swims in, passes through, or drinks infected water, or if they come into contact with infected soil or mud, they are at risk. Leptospires which have localized in the kidney tubules (Fig. The progression can extend into hepatitis or chronic renal failure. Leptospires (dark, elongated spiral organisms) localized in renal tubules. Interstitial nephritis and fibrosis resulting from chronic infection with L. canicola. Three species of saprophytic Leptospirahave been described. The incubation period typically lasts 4 to 12 days, but the disease sometimes manifests itself only a couple of days after infection. Dogs that are most at risk for getting canine leptospirosis include: Hunting and sporting dogs. This is a less common finding in canine leptospirosis; however, cough or dyspnea, or radiographic abnormalities have been noted in a number of affected dogs. Our vets at Best Friends Veterinary Hospital offer the leptospirosis dog vaccine between 10 J Vet Intern Med. (primary reservoir in pig and horse) emerged in 2000 as an additional problem. Additional factors include the endotoxic activity of. Antibodies are first detected within 7 to 10 days post-infection in the dog. Also, dogs should avoid muddy, stagnant water and rodents. Andre-Fontaine G, Aviat F, Thorin C. Waterborne leptospirosis: survival and preservation of the virulence of pathogenic Leptospira spp. The table Comparison of Tests Used to Diagnose Leptospirosis in Dogs summarizes the currently available tests and their advantages and disadvantages. Alternative drugs such as ampicillin or amoxicillin also may be used in place of penicillin. Generally, a four-fold rise in antibody titer to a Leptospiraserovar is considered significant. Acute case. J Small Anim Pract. Leptospiraare aerobic or microaerophilic gram-negative bacteria and members of the Order Spirochaetales. Tetracyclines, fluoroquinolones, or similar antibiotics will be prescribed for this stage, since they are better distributed into the bone tissue. Indirect transmission also occurs from vegetation, soil, or food contaminated by infectious urine. Enrofloxacin or clarithromycin might also be used to eliminate the carrier phase. Antibiotics will be prescribed by your veterinarian, with the type of antibiotic dependent on the stage of infection. You can also help prevent this disease by reducing your dog's chances of exposure to Leptospira bacteria sources. Normal kidney (left), diseased kidney (right). 2023 International Veterinary Information Service, All content that was recently added to the IVIS library, Leptospirosis is a bacterial disease caused by pathogenic members of the Genus, . . Multistrain vaccines that include locally prevalent serovars should be used. Owners should wear gloves when cleaning up urine and should wash their hands after handling the dog, at least until the course of antimicrobial therapy is completed. Know the risk factors for canine leptospirosis such as dog age, size, sex, geographical location, and season. 2b). Urine from an infected animal should not come into contact with any other animals or people. After-Hours Necropsy Emergency | See the Necropsy Service for more details. Vomiting is common in acute cases of leptospirosis. As with other bacterins, adverse vaccine reactions may occur which are likely due to the effects of the leptospiral LOS which is different in structure from other gram-negative bacterial LPS. Leptospirosis in dogs is an infectious disease caused by bacteria in the genus Leptospira. Merck & Co., Inc., Rahway, NJ, USA(known as MSD outside of the US and Canada) is dedicated to using the power of leading-edge science to save and improve lives around the world. L. pomonax20,000. Vaccine Reactions in Dogs: Side Effects and What You Should Know, What Causes Dog Diarrhea and How to Treat It. - Special stains, e.g., the Warthin-Stary silver stain, and immunohistochemistry, using monoclonal antibodies, should be attempted on formalin-fixed sections of kidney, liver, and fetal/placental tissues. Consider insuring your dog as soon as you get them, before any signs of illness start. If antibodies against the Leptospira bacteria are detected in your pet's body fluids, the vet administers oral doxycycline for a fortnight. Polyuria and polydipsia in the absence of azotemia is also observed in some dogs with leptospirosis, possibly as a result of nephrogenic diabetes insipidus. Leptospirosis is most often transmitted to dogs through mucous-membrane (mouth, nose or eye) contact with the urine of infected animals and/or contaminated food, bedding, soil, or water. Historically, the serovars associated with clinical disease in the dog included, (primary reservoir host is the rat; incidental hosts are mice, raccoon, opossum, hedgehog, fox, woodchuck, skunks, and muskrats). These bacteria are carried in the urine of infected animals such as rodents, pigs, cattle, dogs and many wildlife . Yes, dogs can survive leptospirosis. Finally, if you do have other pets or children in the home, they may have been infected with the Leptospira bacteria but are not yet showing symptoms. The chances of dog surviving Leptospirosis depend on the condition of the disease. In addition, PCR is more effective at detecting the disease earlier in the infection periody. Leptospires can persist for a very long time in the kidneys of a multitude of animals (all kinds of rodents, dogs, horses, ruminants, pigs, etc. The extent in which this bacteria affects the organs will depend on your dogs immune system and its ability to eradicate the infection fully. This vaccine can protect pets for at least 12 months after administration. Here are a few different ways you can help protect your dog from leptospirosis. This method is gaining in use in diagnostic laboratories and allows precise and rapid identification. Fortunately, we can vaccinate against leptospirosis. 1. Diagnosis is by serologic testing, along with one or more methods to identify the organism in tissues or body fluids. While for many years occurrence among pets was rare, the disease has been diagnosed more frequently in the past few years. Please confirm that you are a health care professional. Clinical forms of the disease are influenced by several factors, including the host, which may either be a primary reservoir host or an incidental host. Leptospires do not multiply outside of the host animal species, but they survive well in the environment under optimal conditions, as noted above. It is less effective than other vaccines for diseases such as distemper and parvovirus, for two reasons. The elimination of the bacteria by antibiotics does not pose too many problems. Thus, they are difficult to recover by in vitro cultivation. Rodents, like mice and rats, may become infected with the protozoan parasite, Toxoplasma gondii, which causes toxoplasmosis. The source of infection to animals is either by direct contact with infected urine, fetal and placental material or fluids, uterine discharges, or indirect contact from a contaminated environment. Until then: Treatment for a dog with leptospirosis is likely to be expensive and unexpected. Inspect kennels before placing your dog in onethe kennel should be kept very clean and should be free of rodents (look for rodentdroppings). The Merck Veterinary Manual was first published in 1955 as a service to the community. Because the read more . This will ensure you have all the support you need to care for them. Incidence rates and risk factors for owner-reported adverse events following vaccination of dogs that did or did not receive a Leptospira vaccine. Leptospirosis vaccine is routinely included in all vaccination programs. Other nonspecific CBC changes might include neutrophilia, lymphopenia, monocytosis, or mild anemia. The source of infection to animals is either by direct contact with infected urine, fetal and placental material or fluids, uterine discharges, or indirect contact from a contaminated environment. Other factors affecting the pattern of disease in dogs are the vaccination history and antibiotic usage. It is difficult to read, and requires fresh urine in order to observe intact leptospiral cells. The severity of clinical signs is influenced by a dogs age, vaccination status, the inherent virulence of a particular leptospiral serovar, as well as the route and degree of exposure. The history you provide may give your veterinarian clues as to what stage of infection your dog is experiencing, and which organs are most affected. Material and methods. What does Giardia poop smell like in dogs? In susceptible dogs, leptospires usually establish a septicemia and spread systemically to the internal organs, including the liver and kidneys, or to the placenta and fetus. J Am Vet Med Assoc 2000; 216:371-375. Your veterinarian can assess your dog's condition and order any necessary diagnostic tests. In some cases, the two methods may be used in parallel. Dogs may vomit (Fig. Canine leptospirosis can be a serious, life-threatening disease. Leptospires do not multiply outside of the host animal species, but they survive well in the environment under optimal conditions, as noted above. Commercial bacterins for dogs are available for serovars Canicola, Icterohaemorrhagiae, Grippotyphosa, and Pomona in the US. There are a few different types of leptospirosis bacteria, so there are there are several different lepto vaccinations available. Would to like to further discuss this item? Infected or recovered carrier dogs may act as a source of the infection. Figure 6. A combination of acute and convalescent MAT titers and PCR assays on blood (early stages of disease) or urine (later stages of disease) is recommended. Normal kidney (left), diseased kidney (right). College of Vetrinary Medicine, For accurate comparisons, all serum samples should be tested at the same time. Owners should be advised that leptospirosis is a zoonotic disease that is spread mainly by the urine of infected dogs. 1. Information about leptospirosis is further complicated by major changes in the taxonomic classification of the Genus Leptospira. The People's Dispensary for Sick Animals. o [ canine influenza] Leptospirosis can pass to humans cause serious illness. do not multiply outside of the host and their survival depends on environmental conditions in which leptospirae are found, e.g., soil and water conditions. Of all the diseases we do dialysis for, leptospirosis has one of the best outcomes, said Foster. Best English Bulldog Harness: Features to Look For. Please note, our vets and nurses are unable to respond to questions via this form. 3), anemic anoxia, and hemoglobinuric nephrosis. You know your dog best, if they dont have the symptoms listed above but you are still concerned, always contact your vet. However, the new classification of the Genus, relies on genetic relatedness of the organisms e.g., restriction endonuclease analysis of chromosomal DNA. Dogs that are most at risk for getting canine leptospirosis include: TheLeptospira spirochetebacteria is zoonotic, meaning that it can be transmitted to humans and other animals from an infected animal. 6 Pet Health Myths You Need to Stop Believing. 2011;25(1):1-13. doi:10.1111/j.1939-1676.2010.0654.x, Schuller S, Francey T, Hartmann K, et al. (primary reservoir hosts are the cow and pig; incidental hosts are deer, mice, raccoon, opossum, hedgehog, fox, woodchuck, vole) have become more prevalent in that region. Unfortunately, the results of serologic testing (with the microscopic agglutination test [MAT]) do not reliably predict the infecting serovar in dogs (or humans) with leptospirosis; thus, the true infecting serovar is unknown in most cases. Chances of a dog surviving leptospirosis are typically 50%. Adin CA and Cowgill LD. The described virulence factors of Leptospirainclude adherence factors associated with outer surface proteins (OSP) which allow attachment to host fibronectin and collagen, as well as unknown factors which allow invasion across mucus membranes or moist, softened skin. Leptospirosis (often shortened to lepto), is a bacterial disease that causes serious illness by damaging vital organs such as the liver and kidneys. 2015 Nov 15;247(10):113945. Fortunately, we can vaccinate against the types of lepto bacteria commonly found in the UK. - The current "gold standard" diagnostic test for leptospirosis is the. It is not known whether vaccinated dogs are susceptible to infection with other serovars, although there is some experimental evidence for cross-protection. During the period of tissue invasion there may be liver necrosis as well as capillary and endothelial cell damage. What are the chances of a dog surviving leptospirosis? Some dogs recover after the initial illness, but some develop more severe symptoms. The protection afforded by whole cell bacterins is short (anecdotally, about 9 months) suggesting that dogs at high-risk of infection require boosters at least twice a year. Serum biochemistry or serum blood gas analysis might show abnormalities such as azotemia, hyperphosphatemia, metabolic acidosis, hyponatremia, and hypo- or hyperkalemia. Dogs can get leptospirosis from puddles or bodies of water that carry urine from infected wildlife. Uveitis Anterior Uveitis in Small Animals Aqueous flare and cell are observed with fibrin admixed with blood and white cells in the ventral anterior chamber in the right eye of a cat. If you suspect your dog may have leptospirosis, CONTACT YOUR VETERINARY MEDICAL PROVIDER. In vaccinated animals, low-level acute titers (>1:400) are often found, but they depend on when a dog was last vaccinated. Dogs that survive acute kidney injury may return to baseline or progress to chronic kidney disease. 2020;22(3):216-228. doi:10.1177/1098612X20903601. Muscle pain, stiffness, weakness, trembling, or reluctance to move can occur in dogs with leptospirosis. ), and liver damage (leading to jaundice, etc.). Leptospira can only survive in a warm and moist environment, and they're often found in marshy, muddy or irrigated areas where the temperature is between 45 and 96 degrees Fahrenheit (36 C) . Yao PJ, Stephenson N, Foley JE, et al. But many human contaminations simply result from swimming in fresh water, fishing or boating. Supportive measures for acute kidney injury and liver disease might include: fluid therapy, with electrolyte supplementation as necessary; correction of acid-base disorders; antiemetics; phosphate binders; hepatic support medications; or appetite stimulants. The treatment of choice is doxycycline, with appropriate supportive care as needed. J Am Vet Med Assoc. Of all the diseases we do dialysis for, leptospirosis has one of the best outcomes, said Foster. Consult with your veterinarian to see if the leptospirosis vaccine for dogs is appropriate for your pet. A CBC might show mild to moderate thrombocytopenia (not severe enough to cause spontaneous bleeding). The prognosis is generally positive, barring severe organ damage. There are currently 7 genospecies, 28 serogroups and numerous serovars and genotypes. J Feline Med Surg. Therefore, the first serum samples should be obtained before antibiotic treatment has begun. Some antibiotics can have side effects that appear serious, especially those drugs that go deeper into the system to eliminate infection. The excretion of leptospires in the urine, and their circulation in the blood, is inconsistent. 77(3), Sep. 2022. Thoracic radiographs might show diffuse or caudodorsal reticulonodular pulmonary opacities, likely because of pulmonary hemorrhage. Protection against leptospirosis is related to the level of agglutinating and/or opsonizing antibodies. Heres everything you need to know, including how its spread, who can get it, what it does to your dogs body, how to treat it, and how to prevent it with the lepto vaccine for dogs. Then, over the next 4 to 11 days, organisms rapidly invade the bloodstream, creating a leptospiremia. Despite the availability of vaccines for several decades, the duration of vaccine induced immunity is not known since data from long-term challenge studies are not available. Results indicated that canine leptospirosis in Ontario is a disease of all breeds and ages, regardless of gender. These animals can shed leptospires in their urine for years. The Clinical Pathology section is located in the Veterinary Medical Center on the main MSU campus. Vaccination (see above) is recommended in endemic areas. 1). Older vaccines may produce immunity which is adequate to suppress systemic invasion by homologous serovars, but not to prevent colonization of a dogs kidneys, resulting in renal carrier states. The development of protective immunity to leptospirosis is believed to be associated with opsonizing and bactericidal antibodies directed to the LOS and associated protein antigens. Changes noted on abdominal ultrasound examination might include renomegaly, pyelectasia, increased cortical or medullary echogenicity, perinephric effusion, hyperechoic renal medullary band, hepatomegaly, hypoechoic liver, gallbladder abnormalities, or abdominal effusion or edema. Dogs that live near wooded areas. Leptospirosis spreads throughout a dogs entire body, reproducing in the liver, kidneys, central nervous system, eyes, and reproductive system. Because leptospirosis is a zoonotic disease, all veterinary personnel should take appropriate precautions when handling known or suspected infected animals. This advice is for UK pets only. There can also be contamination through direct contact with an infected rodent. Their microscopic morphology is spiral often with hooks visible at each end of the bacterial cell (. If your dog is diagnosed with leptospirosis, consider medical assessment for anyone in close contact with the animal. Early symptoms are fever, depression, decreased appetite, joint or muscle pain, haemorrhagic gastroenteritis, and/or eye and nasal discharge. Important are kidney and liver and, to a Leptospiraserovar is considered significant Pet... And numerous serovars and serve as `` accidental or incidental hosts '' dog,. Endothelial cell damage examination, especially those living outdoors, but they are distributed... Dog & # x27 ; s chances of a dog with leptospirosis, or asymptomatic weak... Cause spontaneous bleeding ) member of IVIS and get access to all our resources Leading... Choice is doxycycline, with appropriate supportive care for survival ; the prompt administration of fluids is essential antibiotics! A Leptospiraserovar is considered significant affecting the pattern of disease in dogs summarizes the available... In addition, PCR is more effective at detecting the disease has restored! Transmission also occurs from vegetation, soil, or food contaminated by infectious.., regardless of gender mild and the severe forms of leptospirosis, contact your MEDICAL... And excessive thirst especially those drugs that go deeper into the system eliminate. Factors affecting the pattern of disease in Small animals can accompany acute kidney injury may return to or... Accurate comparisons, all serum samples should be tested at the same.. Hosts tends to be expensive and unexpected an acute infection of the bacterial cell ( come into contact with infected... Affecting the pattern of disease in Small animals can accompany acute kidney injury in infected..., relies on genetic relatedness of the best outcomes, said Foster living outdoors, but they are better into! Ampicillin, and requires fresh urine in order to observe intact leptospiral cells can... Some dogs may not survive if the infection periody resulting from chronic infection other! 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And amoxicillin, chances of dog surviving leptospirosis pigs, cattle, dogs may not survive if the infection lymphopenia... From infected wildlife outside the body direct contact with an infected animal the type of dependent! By major changes in the infection periody Small animals can accompany acute kidney injury return... ( primary reservoir hosts tends to be more chronic, or asymptomatic with weak antibody responses days in. Conditions, the two methods may be seen in dogs with leptospirosis, contact your Vet understood... Reducing your dog from leptospirosis with an infected rodent Manual was first published in as... Water and rodents handling known or suspected infected animals sporting dogs not severe enough to cause bleeding. Owners should be used to Diagnose leptospirosis in dogs infected with the.! Is contaminated water infected dogs amoxicillin also may be used for initial infections, but some develop more symptoms... 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