{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T14:45:43Z","timestamp":1785422743830,"version":"3.56.0"},"reference-count":61,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T00:00:00Z","timestamp":1778544000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"IDEXX Laboratories Inc., Westbrook, ME, USA"},{"id":[{"id":"https:\/\/ror.org\/04172zb59","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Canine leishmaniosis can cause a variety of signs. The detailed assessment of disease severity lacks a standardized, validated scoring system. This prospective study aimed to develop and validate an objective scoring system (\u201cTotal Leishmania Score\u201d, TLS) combining clinical and laboratory parameters for monitoring dogs with Leishmania (L.) infantum\u00a0infection. Fifty-one L. infantum-infected dogs were examined every 3 months over 1 year. Evaluations included physical examination, complete blood count, serum biochemistry, urinalysis including protein-to-creatinine ratio, and a L. infantum antibody Enzyme-Linked Immunosorbent Assay (ELISA). At each visit, 2 veterinarians applied the TLS, comprising 10 clinical and 8 laboratory parameters graded on a four-point severity scale (0\u20133) and weighted according to their estimated prognostic relevance values. Interobserver agreement was assessed using intraclass correlation coefficients (ICCs) and Bland\u2013Altman analysis. Longitudinal changes were analyzed using robust linear mixed-effects models. In total, 488 scores were evaluated. Interobserver reliability was excellent (ICC: 0.998; CI95%: 0.997\u20130.998; p &lt; 0.001) with no relevant systematic bias. Reliability remained excellent at all time points (ICC: 0.996\u20130.999). The TLS increased significantly before and during relapse (p &lt; 0.001) and decreased significantly within 3 months after leishmanicidal treatment (p &lt; 0.001). The TLS demonstrated excellent reliability and responsiveness, supporting its use for the longitudinal monitoring of dogs with leishmaniosis.<\/jats:p>","DOI":"10.3390\/pathogens15050517","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T15:17:23Z","timestamp":1779203843000},"page":"517","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and Validation of a New Scoring System (Total Leishmania Score) for Dogs with Leishmania infantum Infection Including Clinical and Laboratory Parameters"],"prefix":"10.3390","volume":"15","author":[{"given":"Julia C.","family":"Voelk","sequence":"first","affiliation":[{"name":"LMU Small Animal Clinic, Centre for Clinical Veterinary Medicine, Ludwig Maximilian University of Munich (LMU Munich), 80539 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie","family":"Kaempfle","sequence":"additional","affiliation":[{"name":"LMU Small Animal Clinic, Centre for Clinical Veterinary Medicine, Ludwig Maximilian University of Munich (LMU Munich), 80539 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7508-5411","authenticated-orcid":false,"given":"Roswitha","family":"Dorsch","sequence":"additional","affiliation":[{"name":"LMU Small Animal Clinic, Centre for Clinical Veterinary Medicine, Ludwig Maximilian University of Munich (LMU Munich), 80539 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vera","family":"Geisen","sequence":"additional","affiliation":[{"name":"LMU Small Animal Clinic, Centre for Clinical Veterinary Medicine, Ludwig Maximilian University of Munich (LMU Munich), 80539 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralf S.","family":"Mueller","sequence":"additional","affiliation":[{"name":"LMU Small Animal Clinic, Centre for Clinical Veterinary Medicine, Ludwig Maximilian University of Munich (LMU Munich), 80539 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanne K.","family":"Lauer","sequence":"additional","affiliation":[{"name":"LMU Small Animal Clinic, Centre for Clinical Veterinary Medicine, Ludwig Maximilian University of Munich (LMU Munich), 80539 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6928-4089","authenticated-orcid":false,"given":"Yury","family":"Zablotski","sequence":"additional","affiliation":[{"name":"LMU Small Animal Clinic, Centre for Clinical Veterinary Medicine, Ludwig Maximilian University of Munich (LMU Munich), 80539 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5256-863X","authenticated-orcid":false,"given":"Katrin","family":"Hartmann","sequence":"additional","affiliation":[{"name":"LMU Small Animal Clinic, Centre for Clinical Veterinary Medicine, Ludwig Maximilian University of Munich (LMU Munich), 80539 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mich\u00e8le","family":"Bergmann","sequence":"additional","affiliation":[{"name":"LMU Small Animal Clinic, Centre for Clinical Veterinary Medicine, Ludwig Maximilian University of Munich (LMU Munich), 80539 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.vetpar.2015.05.003","article-title":"Spread of Leishmania infantum in Europe with dog travelling","volume":"213","author":"Maia","year":"2015","journal-title":"Vet. Parasitol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"100971","DOI":"10.1016\/j.lanepe.2024.100971","article-title":"A climatic suitability indicator to support Leishmania infantum surveillance in Europe: A modelling study","volume":"43","author":"Carvalho","year":"2024","journal-title":"Lancet Reg. Health Eur."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1186\/1756-3305-4-86","article-title":"LeishVet guidelines for the practical management of canine leishmaniosis","volume":"4","author":"Miro","year":"2011","journal-title":"Parasites Vectors"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1184","DOI":"10.2460\/javma.236.11.1184","article-title":"Guidelines for diagnosis and clinical classification of leishmaniasis in dogs","volume":"236","author":"Paltrinieri","year":"2010","journal-title":"J. Am. Vet. Med. Assoc."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Garcia-Castro, A., Egui, A., Thomas, M.C., and Lopez, M.C. (2022). Humoral and Cellular Immune Response in Asymptomatic Dogs with Visceral Leishmaniasis: A Review. Vaccines, 10.","DOI":"10.3390\/vaccines10060947"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1136\/vr.141.21.539","article-title":"A retrospective clinical study of canine leishmaniasis in 150 dogs naturally infected by Leishmania infantum","volume":"141","author":"Ciaramella","year":"1997","journal-title":"Vet. Rec."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1136\/vr.100637","article-title":"Prognostic analytes in dogs with Leishmania infantum infection living in a non-endemic area","volume":"171","author":"Geisweid","year":"2012","journal-title":"Vet. Rec."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.tvjl.2013.04.001","article-title":"Prognosis and monitoring of leishmaniasis in dogs: A working group report","volume":"198","author":"Roura","year":"2013","journal-title":"Vet. J."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Foglia Manzillo, V., Di Muccio, T., Cappiello, S., Scalone, A., Paparcone, R., Fiorentino, E., Gizzarelli, M., Gramiccia, M., Gradoni, L., and Oliva, G. (2013). Prospective study on the incidence and progression of clinical signs in naive dogs naturally infected by Leishmania infantum. PLoS Negl. Trop. Dis., 7.","DOI":"10.1371\/journal.pntd.0002225"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1016\/0035-9203(88)90510-X","article-title":"Studies on canine leishmaniasis control. 1. Evolution of infection of different clinical forms of canine leishmaniasis following antimonial treatment","volume":"82","author":"Mancianti","year":"1988","journal-title":"Trans. R. Soc. Trop. Med. Hyg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1318","DOI":"10.1128\/JCM.44.4.1318-1322.2006","article-title":"Incidence and time course of Leishmania infantum infections examined by parasitological, serologic, and nested-PCR techniques in a cohort of naive dogs exposed to three consecutive transmission seasons","volume":"44","author":"Oliva","year":"2006","journal-title":"J. Clin. Microbiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"412808","DOI":"10.1155\/2014\/412808","article-title":"Relationship between Leishmania IFAT Titer and Clinicopathological Manifestations (Clinical Score) in Dogs","volume":"2014","author":"Proverbio","year":"2014","journal-title":"BioMed Res. Int."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1590\/0074-02760160305","article-title":"Scoring clinical signs can help diagnose canine visceral leishmaniasis in a highly endemic area in Brazil","volume":"112","author":"Silva","year":"2017","journal-title":"Mem. Inst. Oswaldo Cruz."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1016\/j.tvjl.2009.09.011","article-title":"Clinical and laboratory monitoring of dogs naturally infected by Leishmania infantum","volume":"186","author":"Paradies","year":"2010","journal-title":"Vet. J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1111\/j.1365-3164.2009.00824.x","article-title":"Multicentric, controlled clinical study to evaluate effectiveness and safety of miltefosine and allopurinol for canine leishmaniosis","volume":"20","author":"Miro","year":"2009","journal-title":"Vet. Dermatol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.rvsc.2008.12.009","article-title":"Evidence for a relationship between Leishmania load and clinical manifestations","volume":"87","author":"Manna","year":"2009","journal-title":"Res. Vet. Sci."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.rvsc.2017.10.011","article-title":"Clinicopathological findings in sick dogs naturally infected with Leishmania infantum: Comparison of five different clinical classification systems","volume":"117","author":"Ordeix","year":"2018","journal-title":"Res. Vet. Sci."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1016\/j.jclinepi.2010.02.006","article-title":"The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes","volume":"63","author":"Mokkink","year":"2010","journal-title":"J. Clin. Epidemiol."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Pereira, M.A., Santos, R., Oliveira, R., Costa, L., Prata, A., Goncalves, V., Roquette, M., Vala, H., and Santos-Gomes, G. (2020). Prognostic Factors and Life Expectancy in Canine Leishmaniosis. Vet. Sci., 7.","DOI":"10.3390\/vetsci7030128"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1186\/s13071-023-05777-2","article-title":"Survival time and prognostic factors in canine leishmaniosis in a non-endemic country treated with a two-phase protocol including initial allopurinol monotherapy","volume":"16","author":"Rappoldt","year":"2023","journal-title":"Parasites Vectors"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Plant, J.D., Gortel, K., Kovalik, M., Polissar, N.L., and Neradilek, M.B. (2012). Development and validation of the Canine Atopic Dermatitis Lesion Index, a scale for the rapid scoring of lesion severity in canine atopic dermatitis. Vet. Dermatol., 23.","DOI":"10.1111\/j.1365-3164.2012.01113.x"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1111\/j.1748-5827.2011.01079.x","article-title":"WSAVA Nutritional Assessment Guidelines","volume":"52","author":"Members","year":"2011","journal-title":"J. Small Anim. Pract."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1136\/vr.153.21.648","article-title":"Clinical and radiographic study of bone and joint lesions in 26 dogs with leishmaniasis","volume":"153","author":"Agut","year":"2003","journal-title":"Vet. Rec."},{"key":"ref_24","unstructured":"International renal Interest Society (IRIS) (2023). Guidelines for Staging Chronic Kidney Disease (CKD), International Renal Interest Society (IRIS)."},{"key":"ref_25","unstructured":"Willard, M.D., and Tvedten, H. (2004). Immunologic and plasma protein disorders. Small Animal Clinical Diagnosis by Laboratory Methods, Saunders. [4th ed.]."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1016\/j.pt.2008.04.001","article-title":"Canine leishmaniosis\u2014New concepts and insights on an expanding zoonosis: Part one","volume":"24","author":"Baneth","year":"2008","journal-title":"Trends Parasitol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1186\/s13071-025-07042-0","article-title":"Unveiling prognostic indicators in canine leishmaniosis: Two decades of evidence","volume":"18","author":"Sarquis","year":"2025","journal-title":"Parasites Vectors"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Maia, C., Conceicao, C., Pereira, A., Rocha, R., Ortuno, M., Munoz, C., Jumakanova, Z., Perez-Cutillas, P., Ozbel, Y., and Toz, S. (2023). The estimated distribution of autochthonous leishmaniasis by Leishmania infantum in Europe in 2005\u20132020. PLoS Negl. Trop. Dis., 17.","DOI":"10.1371\/journal.pntd.0011497"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1186\/1756-3305-7-110","article-title":"Management of canine leishmaniosis in endemic SW European regions: A questionnaire-based multinational survey","volume":"7","author":"Bourdeau","year":"2014","journal-title":"Parasites Vectors"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Kaempfle, M., Hartmann, K., and Bergmann, M. (2025). Treatment of Leishmania infantum Infections in Dogs. Microorganisms, 13.","DOI":"10.3390\/microorganisms13051018"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/jsap.13249","article-title":"Canine leishmaniosis and kidney disease: Q&A for an overall management in clinical practice","volume":"62","author":"Roura","year":"2021","journal-title":"J. Small Anim. Pract."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1111\/jsap.12484","article-title":"Adverse urinary effects of allopurinol in dogs with leishmaniasis","volume":"57","author":"Torres","year":"2016","journal-title":"J. Small Anim. Pract."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1186\/s13071-025-06731-0","article-title":"Characterisation and evaluation of predisposing factors for the development of xanthinuria in dogs with leishmaniosis under allopurinol therapy","volume":"18","author":"Oliveira","year":"2025","journal-title":"Parasites Vectors"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Kaempfle, M., Dorsch, R., Zablotski, Y., Hartmann, K., and Bergmann, M. (2025). Importance of Different Parameters for Monitoring Dogs with Leishmania infantum Infections in a Non-Endemic Country. Pathogens, 14.","DOI":"10.3390\/pathogens14121282"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"159","DOI":"10.2307\/2529310","article-title":"The measurement of observer agreement for categorical data","volume":"33","author":"Landis","year":"1977","journal-title":"Biometrics"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.jcm.2016.02.012","article-title":"A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research","volume":"15","author":"Koo","year":"2016","journal-title":"J. Chiropr. Med."},{"key":"ref_37","first-page":"1","article-title":"Directions for the diagnosis, clinical staging, treatment and prevention of canine leishmaniosis","volume":"165","author":"Koutinas","year":"2009","journal-title":"Vet. Parasitol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1186\/s13071-024-06423-1","article-title":"Relapses in canine leishmaniosis: Risk factors identified through mixed-effects logistic regression","volume":"17","author":"Sarquis","year":"2024","journal-title":"Parasites Vectors"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"S72","DOI":"10.1097\/ACM.0b013e318183e1ac","article-title":"A comparison of alternative item weighting strategies on the data gathering component of a clinical skills performance assessment","volume":"83","author":"Kahraman","year":"2008","journal-title":"Acad. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"595","DOI":"10.2460\/ajvr.80.6.595","article-title":"Evaluation of the use of muscle condition score and ultrasonographic measurements for assessment of muscle mass in dogs","volume":"80","author":"Freeman","year":"2019","journal-title":"Am. J. Vet. Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"254","DOI":"10.2460\/ajvr.81.3.254","article-title":"Usefulness of muscle condition score and ultrasonographic measurements for assessment of muscle mass in cats with cachexia and sarcopenia","volume":"81","author":"Freeman","year":"2020","journal-title":"Am. J. Vet. Res."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Cugmas, B., and Olivry, T. (2021). Evaluation of skin erythema severity by dermatoscopy in dogs with atopic dermatitis. Vet. Dermatol., 32.","DOI":"10.1111\/vde.12932"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1111\/vde.12802","article-title":"Antibody levels to Malassezia pachydermatis and Staphylococcus pseudintermedius in atopic dogs and their relationship with lesion scores","volume":"31","author":"Khantavee","year":"2020","journal-title":"Vet. Dermatol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1136\/jclinpath-2017-204760","article-title":"Can reference images improve interobserver agreement in reporting liver fibrosis?","volume":"71","author":"German","year":"2018","journal-title":"J. Clin. Pathol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1111\/jvim.15458","article-title":"Why measuring outcomes is important in health care","volume":"33","author":"Pantaleon","year":"2019","journal-title":"J. Vet. Intern. Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"376","DOI":"10.5326\/15473317-35-5-376","article-title":"Clinical considerations on canine visceral leishmaniasis in Greece: A retrospective study of 158 cases (1989\u20131996)","volume":"35","author":"Koutinas","year":"1999","journal-title":"J. Am. Anim. Hosp. Assoc."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1111\/j.1748-5827.2007.00441.x","article-title":"A retrospective study of 61 cases of spontaneous canine epistaxis (1998 to 2001)","volume":"49","author":"Mylonakis","year":"2008","journal-title":"J. Small Anim. Pract."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1177\/0300985814521248","article-title":"Pathologic mechanisms underlying the clinical findings in canine leishmaniasis due to Leishmania infantum\/chagasi","volume":"51","author":"Koutinas","year":"2014","journal-title":"Vet. Pathol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1111\/vde.70006","article-title":"World Association for Veterinary Dermatology Consensus Statement for Diagnosis, and Evidence-Based Clinical Practice Guidelines for Treatment and Prevention of Canine Leishmaniosis","volume":"36","author":"Saridomichelakis","year":"2025","journal-title":"Vet. Dermatol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1136\/vr.146.24.698","article-title":"Masticatory and skeletal muscle myositis in canine leishmaniasis (Leishmania infantum)","volume":"146","author":"Vamvakidis","year":"2000","journal-title":"Vet. Rec."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1002\/hed.23578","article-title":"Lymphadenopathy: Defining a palpable lymph node","volume":"37","author":"Xu","year":"2015","journal-title":"Head Neck"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.1159\/000516505","article-title":"Accuracy and Reproducibility of Endoscopic Ultrasound B-Mode Features for Observer-Based Lymph Nodal Malignancy Prediction","volume":"100","author":"Verhoeven","year":"2021","journal-title":"Respiration"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1111\/j.1740-8261.2008.00366.x","article-title":"Relation between age, body weight, and medial retropharyngeal lymph node size in apparently healthy dogs","volume":"49","author":"Burns","year":"2008","journal-title":"Vet. Radiol. Ultrasound"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.actatropica.2004.04.007","article-title":"Canine visceral leishmaniasis: A histopathological study of lymph nodes","volume":"92","author":"Lima","year":"2004","journal-title":"Acta Trop."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1935","DOI":"10.2460\/javma.1991.198.11.1935","article-title":"Xanthine-containing urinary calculi in dogs given allopurinol","volume":"198","author":"Ling","year":"1991","journal-title":"J. Am. Vet. Med. Assoc."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"S128","DOI":"10.1017\/S0007114511001875","article-title":"Effect of dietary water intake on urinary output, specific gravity and relative supersaturation for calcium oxalate and struvite in the cat","volume":"106","author":"Buckley","year":"2011","journal-title":"Br. J. Nutr."},{"key":"ref_57","first-page":"1","article-title":"Total Proteins, \u03b2- and \u03b3-globulins as efficacy therapy response indicators in dogs infected with Leishmania infantum\u2014A Review","volume":"1","author":"Carreira","year":"2017","journal-title":"J. Vet. Healthc."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"e13021","DOI":"10.1111\/pim.13021","article-title":"Understanding hypergammaglobulinemia in experimental or natural visceral leishmaniasis","volume":"46","author":"Hiramoto","year":"2024","journal-title":"Parasite Immunol."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Silva-O\u2019Hare, J., de Oliveira, I.S., Klevorn, T., Almeida, V.A., Oliveira, G.G., Atta, A.M., de Freitas, L.A., and Dos-Santos, W.L. (2016). Disruption of Splenic Lymphoid Tissue and Plasmacytosis in Canine Visceral Leishmaniasis: Changes in Homing and Survival of Plasma Cells. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0156733"},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Ceron, J.J., Pardo-Marin, L., Caldin, M., Furlanello, T., Solano-Gallego, L., Tecles, F., Bernal, L., Baneth, G., and Martinez-Subiela, S. (2018). Use of acute phase proteins for the clinical assessment and management of canine leishmaniosis: General recommendations. BMC Vet. Res., 14.","DOI":"10.1186\/s12917-018-1524-y"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1016\/j.jclinepi.2011.10.019","article-title":"A confidence interval approach to sample size estimation for interobserver agreement studies with multiple raters and outcomes","volume":"65","author":"Rotondi","year":"2012","journal-title":"J. Clin. Epidemiol."}],"container-title":["Pathogens"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-0817\/15\/5\/517\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T15:29:18Z","timestamp":1779204558000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-0817\/15\/5\/517"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,12]]},"references-count":61,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["pathogens15050517"],"URL":"https:\/\/doi.org\/10.3390\/pathogens15050517","relation":{},"ISSN":["2076-0817"],"issn-type":[{"value":"2076-0817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,12]]}}}