Transcript Canine Babesiosis

Veterinary Specialists Of
South Florida Presents
*
Sara D. Hartzell, DVM,
VETERINARY SPECIALISTS OF SOUTH FLORIDA
* Signalment: 6 year old, MN, CKCS
* History: Presented to VSSF Emergency Service
on 3/2/11 with a history of lethargy, anorexia,
and orange urine of 48 hours duration.
* PPHx: Umbilical Hernia, Colitis, Skin Allergies,
and Kennel Cough (1-2 years old)
* No travel or tick history
* Physical Exam:
* Unremarkable except for a temperature of 104.2
* Initial Diagnostics
* CBC: Pancytopenia (WBC: 4.8, HCT: 26.4%, PLT: 41)
* CHEM: increased liver enzymes and T. Bili
* UA: USG: >1.060, proteinuria
* Blood Smear: Spherocytes, decreased platelets
* Slide Agglutination: Negative
* Whole Body Radiographs: Normal
* Initial Diagnostics
* Fecal Exam: NPS
* PCV/TS: 27%, 6.5
* PT/APTT: WNL
* HWT/Tick 4DX: Negative
* Rule Outs
* Infectious (ricketssial, lepto, other), immunemediated disease, neoplasia.
*
* Lepto Titers: Negative
* Tick PCR: Babesia canis positive
* Abdominal Ultrasound: Moderate Splenomegaly
* Reticulocyte Count: 46,529
* Blood Smear Evaluation: Consistent with
pancytopenia
* Coomb’s Test: Negative
*
* Also known as piroplasmosis
* World wide tick borne disease
* Hemoprotozoan parasite
* Primarily causes RBC destruction
* Severity of illness ranges from mild to fatal
* Hemolytic anemia is the hallmark of infection
* Complications involving multiple organs may
develop.
*
* Dogs:
* Babesia canis:
* Large piriform-shaped organism that exists singly or
paired within RBCs.
* Wide Geographic Range
* Babesia canis vogeli
* Babesia canis canis
* Babeisa canis rossi
* Babesia gibsoni
* Small pleomorphic organism that exists singly within
RBCs
*
* Babesia canis vogeli
* United States
* Most common along the gulf coast and in the
southern, central, and southwestern states.
* Prevalence: 3.8% to 59%
* Transmitted by Rhipicephalus sanguineus
* Greyhounds
*
* Babesia gibsoni
* Infections occur worldwide
* Originated in Asia, and has been transported
worldwide
* United States: Eastern and Midwestern regions
* Transmitted by: Rhipicephalus sanguineous and
Dermacentor variabilis
* American Stafforshire Terriers and Pit Bull Terriers
* Or dogs that have been in fights with one of these two
breeds.
*
* Infected RBCs display parasite antigen on cell
membranes which leads to antibody
production.
* Intravascular and extravasular hemolysis
* Progressive anemia
* Endogenous Pyrogens
* Fever
* Hemoglobinemia, hemoglobinuria, bilirubinuria,
and icterus
*Pathogenesis
* Inadequate Tissue oxygenation
* Acidosis
* Shock
* Death
* Or:
* Microvascular Stasis
* Microangiopathic hemolysis
* DIC
* Death
*Pathogenesis Cont.
* General Features
* Hyperacute: Rare
* Hypothermia, shock, Coma, DIC, Metabolic acidosis,
Death
* Acute: Most common
* Hemolytic Anemia, Icterus, Splenomegaly,
lymphadenopthay, Vomiting
* Chronic
* Intermittent pyrexia, Partial anorexia, loss of body
condition, lymphadenopathy
*
* Uncomplicated Babesiosis
* Clinical signs related to acute hemolysis
* Complicated Babesiosis
* ARF, Cerebral Babesiosis, Coagulopathy, Icterus
and hepatopathy, IMHA, ARDS,
Hemoconcentration, Hypotension, Cardiac
changes, Acute pancreatitis, Acid-base
disturbances.
*
* Clinical Laboratory Findings
* CBC: Anemia and Thrombocytopenia
* Autoagglutination
* Chemistry: Usually normal
* Arterial Blood Gas: Metabolic acidosis
* Microscopic Identification
* Serologic Testing
* Nucleic Acid Detection
*
* Indirect Florescent Antibody
* Most specific and most commonly used test for
detection of babesial antibody
* B. canis titers ≥1:80
* B. gibsoni titers ≥1:320
* Young dogs and dogs early on in the disease
process may be negative so you need
convalescent titers
* ELISA: more sensitive but less specific than FA
test
*
* Genetic methods of detection are the most
sensitive and specific means of detecting
infection.
* PCR
* Identify the species by comparing the small
subunit (SSU) rRNA gene sequences found with
known sequences of B. canis and B. gibosoni
*
* Babesia canis
* Imidocarb Dipropionate (Imizol)
* Dose: 5-6.6 mg/kg, IM
* Repeat in 14 days
* Babesia gibsoni
* Azithromycin (Zithromax)
* Dose: 10 mg/kg, PO SID X 10 days
* Atovaquone (Mepron)
* Dose: 13.3 mg/kg, PO TID X 10 days
*
* Prognosis depends on the severity of the
disease.
* Poor prognosis associated with Red biliary
syndrome, ARF, ARDS, Neurological dysfunction,
acute pancreatitis, cardiac dysfunction, and
hypoglycemia
*Prognosis
* Vector Control
* Inspect daily for ticks
* Frontline, Advantix
* Vaccine
* Available in Europe
* Efficacy 70%-100%
* Does not prevent infection
*
* Human babesiosis is a significant and emerging
disease in the US.
* Ixodes and Dermacentor families of ticks are
suspected
* No human specific species of babesia.
* Humans are an accidental host.
* Treatment
* Clindamycin and quinine
* Atovaquone and azythromycin
*Public Health and
Zoonosis
* Ollie was discharged from the hospital 2 days
after admission (3/4/11) on doxycycline,
prednisone, and denamarin.
* Called owner late afternoon on 3/4/11 to let
owner know results of Tick PCR and that Ollie
needed to come in the next day for imidocarb
* 3/5/11 was 1st imidocarb injection
* 3/19/11 was 2nd imidocarb injection
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Ayoob, Ashley L. et.al. “Clinical Management of Canine Babesiosis.” Journal of
Veterinary Emergency and Critical Care. 2010 (1) 20, pp 77-89.
Green, Craig E. Infectious Diseases of the Dog and Cat. 3rd ed. Saunders
Elsevier. St. Louis, MO: 2006.
Irwin, Peter J. Canine Babesiosis: From Molecular Taxonomy to Control.
Parasites and Vectors. March 26th, 2009.
Irwin, Peter J. “Canine Babesiosis.” Veterinary Clinics of North America: Small
Animal Practice. Volume 40, November 2010.
Keller, Ninette et. Al. “Prevalence and Risk Factors of Hypoglycemia in Virulent
Canine Babesiosis.” Journal of Veterinary Internal Medicine. 2004; 18: 265270.
Sikorski, L.E. et. Al. “Babesiosis Caused by a Large Babesia Species in 7
Immunocompromised Dogs. Journal of Veterinary Internal Medicine. 2010; 24:
127-131.
Wulansari, Retno, et. Al. “Clindamycin in the Treatment of Babesia gibsoni
Infections in Dogs. Journal of the American Animal Hospital Association. 2003;
39: 558-562.
*References
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