Loobani AcademyAbstract
Canine babesiosis is a kind of blood protozoa disease which transmitted by ticks. It is caused by a group of intraerythrocytic (piroplasm), hemo-protozoan organisms of the Apicomplexa phylum.Babesia spp. are classified into large and small forms. Dogs and cats may be infected with either form, although infection in cats is rarer than in dogs.Babesia spp. are the second most common hematologic parasite of mammals worldwide.Symptoms such as depression, shortness of breath, fever, loss of appetite, anemia, brown or red urine, yellow staining of skin and mucous membrane, and diseases of the central system can be actively treated. The cure rate of insecticidal treatment is high, but the dogs may become a pathogen carrier with their hole life.
key word:Immune-mediated hemolytic anemia(IMHA), Fever, Canine babesiosis infection.
Base information
Name: DA BAI
Breed: Samoyeh skewer
Sex: Male(No castrated)
Age: 8 months old
Body weight: 23.9kg
History: None
Main problem: Da Bai was found loss of appetite, keep diarrhea and was fever half a month ago, and there was no recovery.During the time.Owners had take him to animal hospital to give symptomatic treatment without any diagnosis, but didn’t work. The vaccinate history is complete. No deworming in this year.
Physical examination
Clinical examination showed emaciation（body condition scoring is 2/5）, depression, pale mucosa and sensitive palpation of abdomen.Also can find tick infection on the surface.Heart rate is 80 bpm,there was no obvious abnormalities in cardiopulmonary sound.Respiratory is normal.According to the symptom such as pale mucosa,it may infer it had a anemia situation in his body. So I decide to do some laboratory examination to have a initial diagnosis.
Laboratory exmination
1.Table1 Complete Blood Count（CBC）
Project | Unit | Result | Reference Range |
RBC(Red blood count） | 109/ L
| 3.6 | 5.65~8.87 |
HCT | 109/ L | 23 | 37.3~61.7 |
HGB | 109/ L | 8.6 | 13.1~20.5 |
MCV | fL | 67.3 | 61.6~73.5 |
MCH | pg | 23.9 | 21.2~25.9 |
MCHC | g/L | 35.5 | 32~37.9 |
RDW | % | 13.6% | 13.6~21.7 |
RETIC | 109/ L | 44.9 | 10~110 |
WBC(White blood count) | 109/ L | 7.51 | 5.05~16.76 |
NEU | 109/ L
| 5.56 | 2.95~11.64 |
LYM | % | 0.65 | 1.05~5.1 |
MONO | % | 1.29 | 0.16~1.12 |
EOS | % | 0.01 | 0.06~1.23 |
BASO | % | 0.0 | 0~0.1 |
PLT | 109/ L | 45 | 148~484 |
MPV | fL | 0 | 8.7~13.2 |
PDW | % | 14.2 | 9.1~19.4 |
PCT | % | 0 | 0.14~0.46 |
2. Vcheck V200 for dog CRP test
Table 2.the result of the CRP testing
Project | Result | Reference Range |
CRP | 63 mg/L | ≤20 |
3. Idexx Catalyst biochemistry CHEM10
Table 3. the result of idexx CHEM10
Project | Unit | Result | Reference Range |
GLU(Glucose) | mmol/L | 4.98 | 4.11~7.95 |
CREA（Creatinine） | mg/dL | 92 | 44~159 |
UREA | mg/dL | 11.0 | 2.5~9.6 |
BUN/CREA |
| 30 |
|
TP(Total protein) | g/L | 55 | 52~82 |
ALB(ALBUMIN) | g/L | 15 | 23~40 |
GLOB(Globulin) | g/L | 40 | 25~45 |
ALB/GLOB |
| 0.4 |
|
ALT(Alanine transaminase) | U/L | 316 | 10~125 |
ALKP(Alkaline phosphatase) | U/L | 193 | 23~212 |
4. IEDXX cPL test
Project | Result |
CPL | Positive（+） |
2.5 Microscopic examination of blood smear
Picture 1 The result of the blood smear
2.6 Universal Real-time PCR Kit for Nucleic Acid Extraction of Babesia Cayudi BAB (Probe Method)
Project | Result |
babesiosis | Positive (+) |
The analysis of the diagnostic
The differential diagnosis of this disease are anemia of chronic disease,caval syndrome,certain neoplasia such as lymphosarcoma,hemangiosarcoma，and ehrlichiosis.Zinc toxicosis，splenic torsion,leptosirosis are also the differential diagnosis,but they are rare. We know thae this cases symptom include fever, diarrhea about half a time, Although the owner went to the take a medication, but there were no obvious improvement.The dog had a history of diarrhea and fever, and had used anti-inflammatory drugs and “Huoxiang Zhengqi Shui” in other hospitals, so the possibility of poisoning could not be ruled out.Most part of disease is limit,which means the patient which is diarrhea can recovery or medication by themself for few days.On the contrary，the spirit of Da Bai worse and worse，So in this case,we might do more examination to find what the really reason of this symptoms.Through simple interrogation and basic inspection, found that the affected puppies mucosa pale, weakened slightly skin elasticity, abdominal palpation sensitive, with a tick infection.we get 3 important information.1）No deworming but always walk dog around the park.2）anemia by checking the pale mucosa.3）Fever.
After a series of laboratory tests, it was found that CRP of the dog was increased that mens there were inflammation in his body; HCT, HGB and the number of red blood cells decreased sharply in the routine blood examination; ALT indexes were all increased by multiples and albumin decreased in the blood biochemical examination.
The result of the Complete Blood Count is RBC infer there is a moderate regenerative anemia.Leukocytosis,neutrophilia is nonspecific and thrombocytopenia.Results of biochemistry are normal except UREA（high may association with Azotemia ,or dehydration consistent with clinical examination），ALB（low may association with inadequate nutrient intake，consistent with loss of appetite，infer the hypoproteinemia）and ALT (high may association with the cellular damage).The most important finding is the morphology of parasite under the microscope.CPL test was positive too.In general combining all this result，we have a preliminary judgment for blood parasite infection.The define what blood parasite is，we should perfoem PCR test,and the result of this case is positve,Babesia infection.
The diagnosis was babesia infection, pancreatitis, and the possibility of cholestasis was not ruled out.
Treatment
- Atovaquone3mg/kg tid
- Azithromycin 10mg/kg sid
- Fluid transport therapy by LRS
- Liver protecting treatment
- Giving iron-nutrition supplement
Before therapy: According to the statistics of clinical cases in our hospital, the time of recurrence of most cases is generally 1-4 months after recovery, so communicate well with the master in advance. On the one hand, the master is easy to cooperate with treatment when the recurrence occurs, on the other hand, the master will pay attention to observe during this period, and the abnormality can be found earlier when the recurrence occurs, and receive treatment earlier. The high recurrence rate of puppies may be related to the incomplete development of their immune system. In addition, the author found that if the activity of the affected dogs can be well controlled after recovery, and the stress can be reduced, the recurrence rate can be reduced to a certain extent. The recurrence rate is the highest within 4 months after recovery, and the recurrence rate is rare after six months to one year.
The choice of treatment: Atovaquone (13.3-13.4 mg/kg PO q 8 hrs given with a fatty meal), in combination with azithromycin (10 mg/kg PO q 24 hrs for 10 days) can eliminate both acute and subclinical B. gibsoni infections in some dogs.Parasitemia may only be eliminated temporarily.Atovaquone resistance may become a concern over time.Treatment of B. conradae is similar to B. gibsoni but a 10-day course must be given to fully eliminate the parasite.Blood transfusions may be necessary for severe hemolytic anemia. Glucocorticoid use is controversial because it may worsen parasitemia. Evaluate and correct dehydration and acidosis. Start specific therapy for any concurrent diseases (e.g. ehrlichiosis, leishmaniasis, hepatozoonosis).6,31-33,36 See the appropriate Canine Associate chapters for treatment of serious complications, such as acute renal failure, DIC, pancreatitis, etc.
After therapy：The animal’s condition improved slightly and the spirit got better.We were happy to see his visible mucous membrane was light pink.After a week of therapy,there were no vomiting, willing to eat chicken, canned and dog food. After two weeks of treatment, he was reexamined in the hospital. PCR was negative for babesia, and blood routine showed that the number of red blood cells was within the normal range.
Prognosis
Prognosis depends on the infecting strain and the patient’s immune capabilities.1,6 Splenectomized individuals usually have a worse prognosis.Due to dehydration, moderate anemia, angular, shortness of breathing,loss of appetite, diarrhea, preliminary diagnosis Canine Babesiosis infection, anemia, pancreatitis, the injury of liver and kidney are possible. To treat the primary cause ，we should kill the worm and take a symptomatic treatment (blood nutrition supplement (giving iron preparation)as well as liver protective medicine, glucose, lactic acid liquid.Giving antibiotics to prevent potential infection is vital.Monitoring the blood once or twice per day to avoid the anemia become worse.If the Hct get down under 15%,and the weakness improves, i will consider to give a blood transfusion treatment to maintain blood volume for life.And we should have the communication with pet owner with this dangerous situation. After the the treatment of the symptomatic treatment and the administration of babesiosis drugs.
Summary
Babesiosis is reported in worldwide mainly found in United States,Australia, and Asia for thousands of years.Only puppies and immunosuppressed adult dogs will develop the disease, while most dogs infected with Babesia gibri will show severe clinical symptoms. Both canine babesia and gibberella babesia have been reported in the south of China. A study in the United States showed that dogs infected with Babesia Canis may only carry the disease and do not show obvious symptoms.Most people have never heard of canine Babesia infection although they have caused red blood cell destruction.The babesia is spread by ticks(only limited to specific tick species we will tall later) and is particular significane to racing greyhounds,American pit bull terrier,Sataffordshire terrier,and American bull.Humans may be infected by babesia as well.There are over 120 species of babesia but only a few are found in the United States and transmissible to dogs. We know that the transmission can occur through a tick bite.In addition to tick bite transmission, babesia can also be transmitted through blood transfusion, bite by carrying dogs, and transplacental infection is also a suspected transmission route. The cured dogs will become pathogen carriers, and it has even been reported that they will develop certain immunity, but there is a risk of immune-mediated complications, and the low immunity will recur in a certain stage, so they cannot be used as blood supply dogs or exported to non-epidemic foci.If the dog are infected,incubation occurs over 7-21days. The pathogenic species in transmission are Lxodes，Rhipicephalus，Dermacentor，Haemaphysilis and Hyalomma spp.Rhipicephalus sanguineus is the most common vector we can find in the USA.
Intraerythrocytic babesiae are ingested from the blood of an infected host by a vector, usually a tick of the family of the Ixodidae.The infected red blood cells are often digested and destroyed within the tick midgut.The small proportion that survive transform into gametocytes, followed by zygote fusion. They then invade the midgut epithelium. Zygotes undergo meiosis, transform into motile ookinetes, and cross the hemocele of the vector. Babesiae go through asexual reproduction, which results in sporokinetes that spread to all organ systems within the vector and remain there for life. Interestingly, ticks infected with Babesia spp. tend to have diminished maturation, although some Rhipicephalus spp. are developing a tolerance to the protozoa.Reproduction and multiplication of Babesia spp. within blood result in clinical signs of disease.12 These signs are primarily related to hemolytic anemia and thrombocytopenia.6 Pathogenicity varies depending on the strain.1,6 Infection may be more severe, and may be clinical in previously splenectomized or asplenic patients.
Some infections in dog are usually sub-clinical. When the clinical disease occurs, it often takes two forms,hemolytic anemia (most common) and multi-organ dysfunction (rare). The most severe clinical form is often caused by the B.canis rossi.Occasionally, disseminated intravascular coagulopathy (DIC) can occur from hemolytic and vascular injury followed by destruction of platelets and consumption of coagulation factors,it is a very dangerous in dog when DIC happens.
About human Babesiosis
At last, I will introduce the huaman babusiosis infection to you. The species of Babesia which infected animals should not pose any problems to people with those are in normal immune systems. People with compromised immune-systems or people who have had their spleens removed may have some concerns,which exist the risk of infection. In the U.S., babesiosis usually occurs on the East Coast and along the Great Lakes and stems from tick bites. Most symptoms are mild or easily treated but a five percent mortality rate has been reported. The usual organism is Babesia microti.
