The mixed acid-base disturbances of severe canine babesiosis

Thirty-four dogs suffering from severe babesiosis caused by Babesia canis rossi were included in this study to evaluate acid-base imbalances with the quantitative clinical approach proposed by Stewart. All but 3 dogs were severely anemic (hematocrit <12%). Arterial pH varied from severe acidemia to alkalemia. Most animals (31 of 34; 91%) had inappropriate hypocapnia with the partial pressure of CO2 < 10 mm Hg in 12 of 34 dogs (35%). All dogs had a negative base excess (BE; mean of - 16.5 mEq/L) and it was below the lower normal limit in 25. Hypoxemia was present in 3 dogs. Most dogs (28 of 34; 82%) were hyperlactatemic. Seventy percent of dogs (23 of 33) were hypoalbuminemic. Anion gap (AG) was widely distributed, being high in 15, low in 12, and normal in 6 of the 33 dogs. The strong ion difference (SID; difference between the sodium and chloride concentrations) was low in 20 of 33 dogs, chiefly because of hyperchloremia. Dilutional acidosis was present in 23 of 34 dogs. Hypoalbuminemic alkalosis was present in all dogs. Increase in unmeasured strong anions resulted in a negative BE in all dogs. Concurrent metabolic acidosis and respiratory alkalosis was identified in 31 of 34 dogs. A high AG metabolic acidosis was present in 15 of 33 dogs. The lack of an AG increase in the remaining dogs was attributed to concurrent hypoalbuminemia, which is common in this disease. Significant contributors to BE were the SID, free water abnormalities, and AG (all with P < .01). Mixed metabolic and respiratory acid-base imbalances are common in severe canine babesiosis, and resemble imbalances described in canine endotoxemia and human malaria.     

Cardiac troponins in canine babesiosis

This study compared the sensitivity of ECG and cardiac troponins to predict cardiac histopathological changes, clinical severity, and survival in canine babesiosis. One control group (n = 9) and 4 groups of dogs with mild uncomplicated babesiosis (n = 8), severe uncomplicated babesiosis (n = 9), complicated babesiosis (n = 8), and babesiosis and concurrent immune-mediated hemolytic anemia (IMHA) (n = 9) were studied. A 1-minute lead II ECG was recorded, and cardiac troponin I (cTnI) and T (cTnT) concentrations in plasma were measured. cTnI concentrations were significantly higher in the complicated (mean, 9.9; SE, +/-5.76) and concurrent IMHA (mean, 6.53; SE, +/-4.32) groups and in the 3 dogs that died of the disease (mean, 22.17; SE, +/-12.85) than in the control dogs (concentration below detection limit of test, -0.3 ng/mL). The 3 nonsurvivors had the most severe cardiac histopathological changes, but no arrhythmia and minimal other ECG changes. Dogs with babesiosis developed a variety of ECG abnormalities, but the abnormalities were not associated with disease severity, outcome, or plasma cardiac troponin concentrations. The exception was the presence of ventricular premature complexes (VPCs), which were associated with high cardiac troponin concentrations. This study showed an association between cTnI concentration and histological changes, clinical severity, and survival and no correlation between ECG abnormalities and histological changes or biochemical evidence of myocardial damage as reflected by cTnI concentrations. From this study, it was concluded that the analysis of plasma cTnI is a feasible and sensitive test and is superior to cTnT in diagnosing cardiac involvement in dogs with babesiosis.     

Cardiac involvement in canine babesiosis

Cardiac dysfunction in canine babesiosis has traditionally been regarded as a rare complication, with the majority of lesions reported as incidental findings at post-mortem examination. Recent studies have, however, demonstrated cardiac lesions in canine babesiosis. Cardiac troponins, especially troponin I, are sensitive markers of myocardial injury in canine babesiosis, and the magnitude of elevation of plasma troponin I concentrations appears to be proportional to the severity of the disease. ECG changes in babesiosis are similar to the pattern described for myocarditis and myocardial ischaemia and together with histopathological findings indicate that the heart suffers from the same pathological processes described in other organs in canine babesiosis, namely inflammation and hypoxia. The clinical application of the ECG appears to be limited and thus cardiovascular assessment should be based on functional monitoring rather than an ECG tracing. On cardiac histopathology from dogs that succumbed to babesiosis, haemorrhage, necrosis, inflammation and fibrin microthrombi in the myocardium were documented, all of which would have resulted in ECG changes and elevations in cardiac troponin. Myocardial damage causes left ventricular failure, which will result in hypotension and an expansion of the plasma volume due to homeostatic mechanisms.     

Autochthonous canine babesiosis in The Netherlands

Outbreaks of autochthonous babesiosis, caused by Babesia canis, occurred in The Netherlands in the spring and autumn of 2004 affecting 23 dogs. Nineteen animals recovered after treatment, whereas four dogs died. Adult Dermacentor reticulatus ticks collected from these dogs indicate that canine babesiosis could become endemic in The Netherlands.     

Nitric oxide metabolites in naturally occurring canine babesiosis.

Babesiosis, caused by the virulent haemoprotozoan parasite Babesia canis rossi, is an important disease of dogs in South Africa. The nitric oxide metabolites, nitrate and nitrite (collectively termed reactive nitrogen intermediates or RNIs) were measured in admission sera from dogs in a babesiosis-endemic area. Five groups were prospectively studied: mild uncomplicated (n=9), severe uncomplicated (severe anaemia) (n=10) and complicated babesiosis (n=11); and two groups of healthy aparasitaemic dogs: endemic controls from the study area (n=10) and experimental dogs kept in tick-free conditions (n=10). Four measures of RNI production were studied: (i) serum RNI; (ii) serum RNI/creatinine ratio; (iii) fractional clearance of RNI (FC(RNI)); (iv) fractional excretion of RNI (FE(RNI)). Marked elevations of serum RNI occurred in only two dogs, both in the severe uncomplicated group. The highest concentration (log value 5.29 micromol/l) was in a dog that died, but concentrations in the other four dogs that died were unremarkable (0, 0.34, 1.66 and 2.64 micromol/l). Age, appetite and free serum haemoglobin were significant covariates for measures of RNI production. There were no significant differences among the babesiosis groups for serum RNI. Adjustment for creatinine had minor effects on the results. All babesiosis groups had significantly higher serum RNI and RNI/creatinine than the tick-free control group, but did not differ from the endemic controls except for the severe uncomplicated group, which had higher RNI/creatinine. The complicated group had significantly lower FC(RNI) and FE(RNI) than all other groups, except for the tick-free control group, which had similar FE(RNI). The results indicate that, in an endemic area, measures of RNI production are unlikely to be useful indicators of severity or outcome in canine babesiosis.     

Clinical management of canine babesiosis

Objective – To review and summarize current information regarding epidemiology, pathogenesis, and pathophysiology leading to the various clinical syndromes associated with canine babesiosis. Diagnosis, treatment, preventative strategies, and zoonotic implications are discussed.
Etiology – Babesiosis is caused by hemoprotozoa of the genus Babesia . Numerous species of Babesia exist worldwide. An increased incidence of babesiosis is described, especially in North America. The babesial organism spends the majority of its life cycle within the erythrocyte of the definitive host, resulting in hemolysis, with or without systemic complications.
Diagnosis – Definitive diagnosis depends on direct visualization of the organism on blood smear or polymerase chain reaction. A positive serologic antibody test indicates exposure with or without active infection.
Therapy – Antiprotozoal drugs, antimicrobials, and supportive care are the mainstays of babesiosis therapy.
Prognosis – Prognosis depends on the severity of disease, which in turn depends on both organism and host factors. Clinical syndromes associated with a poorer prognosis include red biliary syndrome, acute renal failure, acute respiratory distress syndrome, neurologic dysfunction, acute pancreatitis, cardiac dysfunction, and hypoglycemia.     

Electrocardiographic changes and cardiac pathology in canine babesiosis

The main purpose of this study was to describe electrocardiographic (ECG) changes in canine babesiosis, and to relate these to clinical severity, outcome and cardiac pathology.Four groups of dogs with babesiosis were studied: mild to moderate anemia, severe anemia, concurrent autoagglutination and concurrent complications. Lead II ECG was recorded at admission for 1 minute in all dogs (121). A six lead ECG was recorded in 88 dogs. Full necropsy was performed on 16 dogs (5 died on arrival, 11 had ECG recording).The following ECG changes were recorded in relatively high prevalence: sinoatrial blocks or sinus arrest (7%), ventricular premature complexes (7%), low R-amplitude (23%), prominent Q (13%), axis deviations (40%), prolonged QRS (32%), ST depression and coving (28%), large T (42%), and notched R (28%). Differences between groups were minor. There was a significantly higher prevalence of sinus bradycardia and irregular rhythm in the non-survivors. Gross pathological changes were pericardial effusion and hemorrhages. Histological changes were hemorrhages, necrosis, inflammation and fibrin microthrombi. The only correlation between pathology and ECG was low R-amplitude and pericardial effusion.The ECG changes were similar to the pattern described for myocarditis and myocardial ischemia, and together with the histopathological findings indicated that the heart suffers from the same pathological processes described in other organs in canine babesiosis, namely inflammation and hypoxia. As the clinical application of the ECG changes found in this study was limited, cardiovascular assessment should be based on functional monitoring rather than ECG.     

Thrombocytopaenia in canine babesiosis and its clinical usefulness

Canine babesiosis is a common cause of thrombocytopaenia but there are few formal studies that have investigated this haematological finding in dogs. Thrombocyte counts from full blood counts were retrospectively analysed for the years 1996-2002. Thrombocyte counts and mean platelet volumes of dogs with babesiosis were compared with those of dogs, seen over the same period of time, that did not have babesiosis. There were 1162 cases in the Babesiosis group and 10 808 in the Non-babesiosis group. A frequency distribution of the thrombocyte counts showed a trimodal distribution in the Non-babesiosis group compared to a bimodal distribution in the Babesiosis group, with a strong positive skewness. The modes for the frequency distributions were 10, 40, 300 and 10, 35 x 10(9)/l thrombocytes, respectively. The median thrombocyte count in the Babesiosis group was 14 x 10(9)/l and 282 x 10(9)/l in the Non-babesiosis group. There was a statistically significant difference in the median thrombocyte count between the Babesiosis group and the Non-babesiosis group. In the Babesiosis group, 99% of the thrombocyte counts were below the lower reference range value (250 x 10(9)/l) and 62% of thrombocyte counts were below 25 x 10(9)/l. The mean platelet volume (11.1 fl) for the Babesiosis group was greater than the reference range (6-10 fl) and significantly larger than in the Non-babesiosis group (median 9.7 fl). Thrombocyte counts greater than 110 and 250 x 10(9)/l had a predictive value that the dog was not suffering from babesiosis of 99.3% and 99.8%, respectively. There was a statistically significant difference between the thrombocyte counts of dogs with babesiosis when grouped by parasitaemia scores. The mechanisms of the thrombocytopaenia are not fully understood, and multiple mechanisms, including concomitant thrombocytopaenia-inducing diseases such as ehrlichiosis, probably result in this haematological finding. Babesiosis in the South African canine population is associated with thrombocytopaenia in nearly all patients and is severe in the majority of them. In the absence of thrombocytopaenia, babesiosis is an unlikely diagnosis.     

Survey of canine babesiosis in South Africa

A questionnaire, designed to obtain qualitative information on a number of variables concerning canine babesiosis (biliary fever) in South Africa, was sent to 510 veterinary practices in late 1993. Of the 157 practices that responded, all were presented with cases of babesiosis and most were situated in Gauteng, the Western Cape and KwaZulu-Natal. Apart from the Western Cape, a winter-rainfall region, the prevalence of babesiosis cases in dogs was highest in summer. Most of the respondent practices treated between 1,000 and 5,000 sick dogs that included 100 to 500 babesiosis cases each year. Respondents identified cerebral babesiosis, enterorrhagia, 'red' or haemoconcentrated babesiosis, acute renal failure and pulmonary babesiosis or 'shock lung', amongst others, as the most prevalent forms of complicated ('atypical') babesiosis. Diminazene, imidocarb and trypan blue were the most popular antibabesials. Trypan blue was most often used in shocked patients, whereas diminazene and imidocarb were preferred when there was a high parasitaemia in the absence of shock. At least 19 antibabesial treatment regimens were used in practices. These comprised the use of single doses of antibabesial drugs; split doses with repeat injections, and combined drug variations, some of which are undesirable due to possible sterilisation of Babesia infection or potential toxicity. Side-effects were most commonly associated with imidocarb use. Ninety-six percent of respondents used supportive treatment (e.g. corticosteroids, vitamins and 'liver support') in all cases of babesiosis. The use of blood transfusion as supportive treatment varied according to practice and severity of the case. Most practices never cross-matched blood to be transfused, and transfusion reactions were rare. Diminazene was most frequently incriminated in cases where drug 'resistance' or relapses occurred. Cerebral and 'red' cases resulted in high mortality. Treatment of babesiosis costs the dog-owning public in South Africa more than R20 million each year. Information on the distribution and possible complicating role of Ehrlichia canis was obtained. Development of a vaccine was the first research priority identified.     

An unusual form of canine babesiosis

An Akita Inu, living in Belgium, was presented with unusual clinical manifestations of acute babesiosis that included neurological signs and pancytopenia. Diagnosis was made by identifying Babesia canis in the blood smear. Neurological signs resolved after treatment with imidocarb diproprionate. Normalization of hematological abnormalities was gradual over 5 months.     

南京地区犬巴贝斯虫病的诊断与治疗

4年来,笔者在宠物门诊工作过程中,通过对161例犬巴贝斯虫病的诊治与跟踪调查(治愈148只,死亡13只,治愈率达91.93%),总结出发病规律和治疗方案,发现本地区犬巴贝斯虫病主要是由吉氏巴贝斯虫和犬贝斯虫感染所致。其中由吉氏贝斯虫感染的病例为106例,由犬巴贝斯虫感染的病例为55例,未发现韦巴贝斯虫感染的病例。针对犬巴贝斯虫病的发病特点,提出了预防新措施。     

Alteration of haemostatic parameters in uncomplicated canine babesiosis

Babesiosis is a tick-borne zoonotic disease caused by haemoprotozoan parasites. The aim of this study were to assess markers of coagulation pathways in 25 dogs with naturally occurring babesiosis caused by B. canis, compared to 10 healthy controls. Protein C (PC) and antithrombin III (AT III) activity were assessed using a chromogenic substrate test, while levels of thrombin-antithrombin (TAT) complexes, activated protein C (APC) and endothelial protein C receptor were assessed using canine-specific ELISA. AT III activity was decreased as a result of a negative acute phase response, degradation by elastase, reduced availability of glycosaminoglycans, and, most importantly, consumption as a consequence of thrombin formation. Procoagulant state and haemostatic shift towards thrombin formation are also demonstrated by elevated TAT levels. Regarding PC pathway only significant difference was found for APC. Taken together, haemostatic alterations in uncomplicated babesiosis represent a procoagulant state that is mostly reversed during treatment.     

Rhabdomyolysis as a complication of canine babesiosis

Rhabdomyolysis was diagnosed in two dogs with babesiosis. The first animal presented with muscle pain and caramel-coloured urine, and had markedly elevated serum myoglobin and muscle enzymes. Acute renal failure complicated the clinical picture. The second dog exhibited muscle pain and tremors, together with neurological signs and pulmonary oedema, and died soon after admission. Muscle necrosis and haemorrhage were found at necropsy. In human malaria, a disease clinically similar to canine babesiosis, rhabdomyolysis is unusual, but clinically silent muscle damage appears to be common. Likewise, biochemical evidence of muscle damage is readily found in experimental bovine babesiosis. Muscle enzymes were mildly elevated in three dogs with severe babesiosis and pigmenturia but there was no obvious muscle damage, indicating that this might also apply to canine babesiosis. The pathogenesis of infection-associated rhabdomyolysis and acute renal failure remains unclear, but inflammatory cytokines and nitric oxide could play an important role.     

Seroepidemiology of canine babesiosis and ehrlichiosis in a hospital population

Canine ehrlichiosis and babesiosis have a worldwide distribution with geographic variation in prevalence and main clinical manifestations. We prospectively determined seroprevalence of canine babesiosis and ehrlichiosis, and risk factors for seropositivity. Three hundred and eighty-one dogs were randomly selected to represent the canine population at a Veterinary Teaching Hospital in south Brazil (latitude 23° S). Dogs were tested with a point-of-care ELISA for Ehrlichia canis antibodies and IFA to confirm previous exposure to Babesia vogeli. Multiple logistic regression analysis was then used to estimate adjusted odds ratio (OR) and their 95% confidence intervals. One hundred and thirty-six (36%) dogs were seropositive for B. vogeli antibodies, whereas 87 (23%) dogs were seropositive to E. canis antibodies. Fifty-four (14%) dogs seroreacted to both agents. Adult dogs previously infested with ticks were more likely to seroreact to B. vogeli or E. canis. Superficial bleeding (OR = 12.4) was more common in dogs exposed to B. vogeli, whereas neurological signs (OR = 7.7) were more common in dogs seropositive to E. canis. Neurological signs (OR = 12.0) and lameness (OR = 12.8) were more prevalent in dogs that seroreacted to both organisms. Owners of dogs with ticks were more likely to have been exposed to ticks themselves (OR = 3.2). Canine babesiosis and ehrlichiosis appear to be highly prevalent in this hospital population. Clinical signs differed from the most common signs in other regions with bleeding occurring more in dogs seropositive to babesiosis, but not ehrlichiosis; neurologic signs in dogs with E. canis antibodies; and lameness in dogs that seroreacted to both organisms.     

Prevalence and risk factors of hypoglycemia in virulent canine babesiosis

Hypoglycemia is a common complication of virulent canine babesiosis. A study was conducted to determine the prevalence of and potential risk factors for hypoglycemia in canine babesiosis from Babesia canis rossi. Plasma glucose concentration was measured at presentation in 250 dogs with babesiosis, of which 111 were admitted to hospital. The prevalence of hypoglycemia (<60 mg/dL) was 9% (23/250). Twenty-two hypoglycemic dogs required admission, making the prevalence of hypoglycemia in admitted dogs 19.8%. Sixteen dogs had severe hypoglycemia (<40 mg/dL), of which 5 had glucose < 18 mg/dL. Hyperglycemia (>100 mg/dL) was present in 38 dogs, of which 21 were admitted. Risk factors for hypoglycemia identified by univariate analysis were collapsed state (P < .00001), severe anemia (P = .0002), icterus (P = .003), age < 6 months (P = .02), and vomiting (P = .03). After logistic regression analysis, collapsed state (odds ratio [OR] = 18; 95% CI, 1.9-171; P = .01) and young age (OR = 2.8; 95% CI, 0.8-9.7; P = .1) remained significantly associated with hypoglycemia. Toy breeds and pregnant bitches were not at higher risk for hypoglycemia than other dogs. Blood glucose concentration should ideally be measured in all dogs requiring inpatient treatment for babesiosis but is mandatory in collapsed dogs; puppies; and dogs with severe anemia, vomiting, or icterus. Many dogs have probably been misdiagnosed with cerebral babesiosis in the past, and hypoglycemia should be suspected in any dog with coma or other neurological signs.     

Autochthonous cases of canine babesiosis in the canton Solothurn

Starting in November 2003 a series of five clinical cases of canine babesiosis was registered in the region of Oberg?sgen (canton Solothurn). All presented dogs showed increased body temperature, thrombocytopenia and hemoglobinuria, and none of the dogs had been abroad or visited endemic regions in the southern or western part of Switzerland so far. Babesia canis was detected in the blood smears of all five patients, but only three had detectable specific antibodies against this parasite. However, seroconversion was found in a second sample collected from the negative dogs at a later timepoint, confirming the diagnosis of canine babesiosis. The blood samples of two parasitized dogs were used for DNA-isolation and were tested with a Babesia-specific PCR, detecting the 18S rRNA-gene. Sequencing of the amplified products revealed a 100% identity with the sub-species B. canis canis. The ticks Rhipicephalus sanguineus and Dermacentor marginatus are potential vectors for B. canis. In the area where the infection with B. canis was suspected a total of 152 ticks was collected and characterized; one was a female R. sanguineus.Although babesia could not be detected in the latter tick and the final prooffor the complete life cycle is still lacking, it is very probable that B. canis has become autochthonous in the canton Solothurn.