1. Veterinary Specialists Of South Florida Presents

2. Sara D. Hartzell, DVM, VETERINARY SPECIALISTS OF SOUTH FLORIDA

3. * 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

4. * 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

5. * Initial Diagnostics * Fecal Exam: NPS * PCV/TS: 27%, 6.5 * PT/APTT: WNL * HWT/Tick 4DX: Negative

6. * Rule Outs * Infectious (ricketssial, lepto, other), immune- mediated disease, neoplasia.

7. * 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

8. * 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.

9. * 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

12. * 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

13. * 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.

16. * Pathogenesis * 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

17. * Pathogenesis Cont. * Inadequate Tissue oxygenation * Acidosis * Shock * Death * Or: * Microvascular Stasis * Microangiopathic hemolysis * DIC * Death

18. * 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

19. * 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.

20. * Clinical Laboratory Findings * CBC: Anemia and Thrombocytopenia * Autoagglutination * Chemistry: Usually normal * Arterial Blood Gas: Metabolic acidosis * Microscopic Identification * Serologic Testing * Nucleic Acid Detection

21. * 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

22. * 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

23. * 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

24. * Prognosis * 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

25. * Vector Control * Inspect daily for ticks * Frontline, Advantix * Vaccine * Available in Europe * Efficacy 70%-100% * Does not prevent infection

26. * Public Health and Zoonosis * 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

27. * 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 1 st imidocarb injection * 3/19/11 was 2 nd imidocarb injection

28. * References * 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. 3 rd ed. Saunders Elsevier. St. Louis, MO: 2006. * Irwin, Peter J. Canine Babesiosis: From Molecular Taxonomy to Control. Parasites and Vectors. March 26 th, 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: 265- 270. * 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.

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