Canine leishmaniosis in a low-but-non-zero risk setting: A practice-oriented review from Hungary.

Abstract

Canine leishmaniosis (CanL) caused by Leishmania infantum is traditionally endemic in the Mediterranean basin; however, imported infections and sporadic autochthonous cases are increasingly often reported in Central Europe. Recent field surveys and curated vector-distribution datasets indicate that several phlebotomine sand fly species occur in the Carpathian Basin and climate-based suitability models suggest that ecologically favourable microhabitats may be present beyond the historical endemic zone. In this narrative, practice-oriented review, we synthesise literature published between 2004 and 2026, including European entomological studies, VectorNet outputs and current clinical guidelines, to frame CanL risk in Hungary as low but non-zero. Available evidence confirms the presence of multiple Phlebotomus species in Hungary, whereas detection of Leishmania in sand flies remains rare and sustained local transmission has not been demonstrated. Within this epidemiological context, we propose a risk-stratified diagnostic approach that integrates travel or import history, pre-test probability and staged use of quantitative serology, PCR, cytology/histology and clinicopathology. Stage-adapted treatment, preventive measures for travelling and imported dogs and blood donor screening are discussed with emphasis on avoiding misclassification and overtreatment in low-prevalence settings. Finally, we outline how veterinary practices can contribute sentinel data and risk communication within a One Health framework.