Babesia, a reminder

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jtalt7
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Babesia, a reminder

Postby jtalt7 » Sat Jan 22, 2011 11:28 pm

So Red's Tig has reminded me to make this post as I have been wanting to for a long time. Something that has been really overlooked in our community when it comes to the health of our dogs is Babesia. When you are dealing with rescue dogs, dogs of unknown history or dogs from the south, you really really should be testing your dogs for Babesia.

As you see with Tig you never know when this disease will come out of hiding and strike down your dog and it can be with fatal consequences. The greyhound community has been dealing with it for a couple years now and it really is something that we need to be addressing as well, because it is alive and well in our dogs.

Because it is something that is passed by dog bites/fights it obviously is something that is of concern for our dogs. It is also something that can be passed in utero to puppies.

I have been battling treating a few dogs now over the past year and I wish I had been more aware of this disease before, as I could have missed something before in dogs that just 'werent right'.

Just so you know that any dog can have it...............when I sent out all my blood for my MO500 dogs almost 2 yrs ago I also sent out blood on all my own dogs and current fosters. Guess what? Two or my OWN dogs and one of my previous fosters came up positive. I had NO IDEA.

So something to think about.............lets learn from these dogs and learn from Tig.

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Re: Babesia, a reminder

Postby HappyPuppy » Sun Jan 23, 2011 8:59 am

WITHOUT permission from turtle, I am recopying the med description link (cuz I wanted to reread it after this post) - hope it's OK: http://www.johnkoerner.org/SportingDogB ... iapbb.html

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Re: Babesia, a reminder

Postby HappyPuppy » Sun Jan 23, 2011 9:00 am

Well that didn't work - (why to the urls get truncated upon repost?!?)
http://www.johnkoerner.org/SportingDogB ... iapbb.html

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Re: Babesia, a reminder

Postby turtle » Sun Jan 23, 2011 10:58 am

HappyPuppy wrote:Well that didn't work - (why to the urls get truncated upon repost?!?)
http://www.johnkoerner.org/SportingDogB ... iapbb.html


Yes there is a lot of good info on that page, no problem to re-post it!
We should all be aware of babesia and the threat it poses to our dogs.

The leading expert in studying Babesia is Dr. Adam Birkenheuer at the University of North Carolina. I did a search on google with his name and Babesia and there are quite a few links with more such as --

http://www.cvm.ncsu.edu/vth/ticklab.html

http://www.cvm.ncsu.edu/vth/ticklab.html#babesia

There is a link to a Word Document about diagnosis and treatment in the above page.

http://www.cvbd.org/3054.0.html?&tx_ttnews[tt_news]=1552&tx_ttnews[backPid]=3053&cHash=b1e8ec16b6988c83a9993222bcf27bd0

Has anyone looked on Greyhound forums for more info? I know Babesia is rampant in racing greyhounds and also in American foxhounds so maybe owners of those breeds would have more info.

It is a horrible illness and I hope more folks will be aware of it and keep an eye on their dog's heatlh...
.

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Re: Babesia, a reminder

Postby Otis » Sun Jan 23, 2011 11:01 am

If you catch it early in your dogs, are there things you can do to treat it even though it isn't causing symptoms? On average how much does it cost to test for it?

Ashes came from the South, and because of Mica's build and a few other hints I don't think her life was headed for great intentions. I'd like to get them tested.

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Re: Babesia, a reminder

Postby turtle » Sun Jan 23, 2011 11:03 am

Well... my last link on the post above did not copy correctly. I guess one could copy & paste it but here is the article from it, it was written in Aug 2010 so it is quite current info --


Unknown Babesia spp. pathogen discovered in immunocompromised dogs

RALEIGH/USA, (BIERMANN) - American researchers found a large unknown Babesia species in a dog with lymphoma. In a retrospective case review, they discovered that multiple dogs seemed to have been affected by the same species.,
08.02.10

Dr. Adam J. Birkenheuer from the University of Pennsylvania School of Veterinary Medicine and his associates detected a large unnamed Babesia species in a dog suffering from lymphoma. Since it was unknown whether this was an underrecognized pathogen, he and his team performed a retrospective case review. For their review, they collected data by contacting attending clinicians and sighting medical records. The 18S rRNA genes of Babesia sp. were amplified and sequenced in a diagnostic laboratory. Birkenheuer identified seven immunocompromised dogs from which the specific Babesia was determined with the help of 18S rRNA gene sequencing.

His team looked at the treatment protocol of the affected dogs. Six of the seven dogs had been splenectomized, the remaining dog received oncolytic drugs. Nearly all dogs (6/7) were lethargic and anorexic. About half of the dogs suffered from fever (4) and pigmenturia (3). Laboratory findings demonstrated mild anemia in all dogs and severe thrombocytopenia in six. PCR assays used to detect Babesia sensu stricto species were all positive, however the PCR assays for Babesia canis and Babesia gibsoni were negative in all dogs. Furthermore, cross-reactive antibodies against other Babesia spp. were not always detectable, the authors find. Five dogs received treatment with imidocarb dipropionate and one dog received atovaquone/azithromycin, with some favorable response. The remaining dog was left untreated, and remained a clinically stable carrier.

The authors therefore conclude that dogs with pigmenturia, anemia and thrombocytopenia should be tested for Babesia sp. by PCR as serology could not sufficiently demonstrate a reliable diagnosis of this Babesia sp. Asplenia, chemotherapy, or both might pose a risk for persistent infection, illness or both, Birkenheuer and his team wrote.

http://www.cvbd.org/3054.0.html?&tx_ttnews[tt_news]=1552&tx_ttnews[backPid]=3053&cHash=b1e8ec16b6988c83a9993222bcf27bd0
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Re: Babesia, a reminder

Postby Otis » Sun Jan 23, 2011 11:11 am

It sounds like from what I read (and unfortunately I'm not good at technical jargon) that it is hard to get an accurate test for it?

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Re: Babesia, a reminder

Postby jtalt7 » Sun Jan 23, 2011 12:16 pm

This is my experience with Babesia...............

I took a bunch of MO500 dogs. The majority of those we took we co infected with BCanis and Bgibsoni. When the dogs were originally impounded they were all PCR tested for BGibsoni only. When we pulled the dogs we were going to take we sent all of our blood to Protatek labs in AZ for IFA testing to get titers as we already knew they were infected. At that time none of our dogs were symptomatic. Protatek labs is the lab that the majority of your Grey rescues use for the Babesia testing. Dr Holland who is their pathologist is FABULOUS. She is very easy to talk to and will consult with anyone.

Once we got titers from everyone we decided treatment plans from there. I decided to go ahead and treat for Bcanis first and do the Imizol treatments. A week after the last shot I started the Atovoquane/Zithromycin 10 day course for the BGibsoni. All of our dogs that we pulled were in fact co infected. To this day none of our dogs have been symptomatic. I can tell you that there were some of our dogs that treatment was not yet recommended because titers were not high, and symptoms were not there. My own dogs included. With that said, titers are needed to be checked on a yearly basis to monitor possible flare ups. If a dog gets sick, testing needs to be done. I monitor cbc/pvc regularly to make sure everything is ok.

I will tell you after retesting one of our dogs a yr out of treatment we are not sure if treatment has been successful in touching the infection.

I personally recommend sending out for titers to see possible infection if asymptomatic and I personally recommend Protatek and absolutely do not like idexx for Babesia. But this is based of my experience dealing with Babesia

Costs...........it can be expensive if you dont have a vet that will work with you. Since Imizol is a drug essentially only used for Babesia and sometimes ECanis the vet is probably going to make you buy it by the bottle.

If I didnt work at my clinic the Imizol would have cost me $150 for the bottle and probably at least $500 for administration, bloodwork and fluids.

The Atovoaquane and Zithromycin for 10 days would be around $400 per 50lb dog if I remember correctly. It has been a year since I treated everyone.

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Re: Babesia, a reminder

Postby turtle » Sun Jan 23, 2011 2:08 pm

Thanks for posting your experiences. The more we can learn about this, the better we can fight it....

Here is another article --

http://www.vin.com/proceedings/Proceedi ... &O=Generic

Introduction

Canine babesiosis was first described in South Africa in the late 1800's and was originally presumed to be a "biliary form" of canine distemper. Most researchers assume that this was actually a case of babesiosis caused by Babesia canis rossi. The first report of canine babesiosis in the United States was made in 1934 and is presumed to have been caused by Babesia canis vogeli. The first report a small Babesia infection in a dog was in 1968. The first case of endemic babesiosis caused by a small piroplasm was in 1979. Since the early 1990's the number of cases of babesiosis in the US and around the world has increased dramatically. Classical babesiosis is characterized by fever, hemolytic anemia and splenomegaly. Over the past twenty years there has been a dramatic increase in the number of as cases reported as well as the geographic distribution of canine babesiosis around the world.

Emerging Infections or Emerging Information

The number of publications on PubMed that include the term Babesia has increased steadily and the total number of publications has nearly doubled in the past ten years. The number of piroplasms known to infect dogs has increased from just 4 in 1989 t oat least 10 genetically distinct piroplasms at the time of this writing. While some of these reports have documented the true emergence of an infectious agent such as the spread of Babesia gibsoni across North America, South America and Europe, other reports are more likely to have simply shed light on an a genotype of Babesia that has been present for years.

The most important reason for the "sudden" appearance of so many "new" species of piroplasms is the advent of the polymerase chain reaction and improvements in DNA sequencing technology that have made it widely available and affordable. Prior to PCR and DNA sequencing, species determinations were made almost exclusively based on parasite morphology and presumed host and vector specificity. We now clearly know that these characteristics alone are not sufficient to definitively identify a piroplasm to the species level.

Small Piroplasms of Dogs

Babesia gibsoni

First described in 1910 in Asia, Babesia gibsoni was believed to be the only small piroplasm of dogs for nearly a century. The first molecularly confirmed cases of B. gibsoni in North American dogs were reported in 1999. Since that time, B. gibsoni has been recognized in dogs throughout the United States. Similarly, this infection has been identified in Australia, Europe, South America and South Africa all of which were believed to be free of this parasite. Babesia gibsoni is now the most commonly identified cause of canine babesiosis in the US. This parasite has emerged and spread rapidly throughout the world in the absence of known competent tick vectors in many regions. Dog to dog transmission rather than tick-transmission is believed to be the primary route of infection outside of Asia. Epidemiological evidence suggests that dog to dog transmission via bite wounds is a common route of infection. Additionally this parasite can be spread via transplacental transmission. Breeds associated with dog-fighting, American Pit Bull Terriers and the Tosa Inu, are the most common breeds in which B. gibsoni is identified. They are not believed to have any increased genetic susceptibility to infection. They are believed to have increased infection rates due to increased chance of being used in illegal dog-fighting as well as through transplacental transmission.

Babesia conradae

Babesia conradae was first described in 1991 from dogs in Southern California. Due to the lack of complete genetic database at the time, this parasite was believed to be B. gibsoni. Babesia conradae appears to be geographically limited to Southern California and very little is known about the life-cycle or risk factors for this infection.

Babesia microti-like Parasite (AKA Theileria annae, Babesia annae)

A Babesia microti-like parasite was first described in 1999 in a German dog that had traveled to Northwest Spain. Since that time several large case series have described babesiosis associated with this parasite. To date, these cases have been limited to dogs in NW Spain or dogs that have traveled to that region. A large proportion of dogs infected with the B. microti-like parasite have suffered from renal failure (presumably due to advanced glomerulonephritis). A closely related parasite has been identified in the blood of North American foxes.

Theileria Species

Several molecular surveys have identified Theileria sp. DNA in the blood of dogs. Theileria equi DNA has been amplified by PCR from the blood of European dogs. More recently a large molecular survey of dogs from South Africa identified a genetically unique Theileria sp. in nearly 40% of the dogs from one region. Clinical data from these dogs is sparse so few conclusions can be drawn regarding the clinical significance of Theileria infections in dogs.

Large Piroplasms of Dogs

Babesia canis vogeli

Babesia canis vogeli or Babesia vogeli has a nearly worldwide distribution as its primary vector is the brown dog tick Rhipicephalus sanguineus. Babesia canis vogeli has long been considered to be a puny pathogen only affecting puppies and splenectomized dogs. With increased vigilance and testing B. c. vogeli is being recognized more frequently causing clinical illness in adult dogs.

Babesia canis canis

Babesia canis canis has long been recognized as the most common cause of canine babesiosis in Europe. More recently this genotype has been identified in both North and South America. It is generally considered a moderately pathogenic parasite. A vaccine against Babesia canis canis reduces morbidity and mortality, but does not induce protective immunity is available in Europe. This vaccine does not confer cross-protection against other species of Babesia.

Babesia canis rossi

Babesia canis rossi or Babesia rossi is a highly virulent parasite that is endemic to Africa and has not yet been described in other parts of the world. Dogs with B. c. rossi typically present with either "uncomplicated" babesiosis characterized by anemia, fever and splenomegaly or "complicated" babesiosis which can include organ failure in one or more systems including: CNS signs, renal failure, hepatic failure, myocardial dysfunction, ARDs and pancreatitis.

Other Large Piroplasms

Recently two "new" Babesia spp. have been identified in dogs. One species has been identified in North America and appears to be a cause of thrombocytopenia and mild anemia in dogs that have been splenectomized or are undergoing chemotherapy. The second species has been described in a dog from the United Kingdom that had no history of travel. Rangelia vitali is an apicomplexan parasite that is believed to occasionally infect erythrocytes and appear morphologically similar to Babesia spp. has received renewed attention from Brazilian veterinary researchers. Rangelia primarily infects endothelial cells and causes hemorrhagic disease.

Clinical Disease

Hemolytic anemia and its accompanying signs are what most practitioners associate with canine babesiosis. While these remain common and important signs of canine babesiosis, we are recognizing an ever widening spectrum of signs associated with canine piroplasmosis.

The first form of "atypical" babesiosis that we need to be on the alert for is "typical" babesiosis caused by an "atypical" species. Unfortunately the available tests for babesiosis are far from perfect. Serological assays can have both false positive and false negative results due to differences in parasite strains, laboratory technique and variations in immune responses by individual animals. Molecular tests such as PCR can result in false positive tests due to laboratory error. Additionally PCR tests may actually be too specific. For example an assay that is designed to detect Babesia gibsoni may fail to detect every other piroplasm and result in a "false negative" result if the dog is infected with B. canis. Broad-range assays designed to screen for all piroplasms with follow-up species specific assays or DNA sequencing can minimize these types of errors. As it is very easy to import dogs into the US it is crucial that diagnostic assays are able to detect all species.

Another common form of "atypical" babesiosis is Babesia infection in a non-anemic or mildly anemic dog. A close scrutiny of the literature reveals that although many dogs with Babesia infections are anemia, many only have mild anemia (i.e., PCV of 30-35%) or have packed cell volumes well into the normal range. Many of these dogs have a moderate to severe thrombocytopenia as their sole hematologic abnormality. In most large studies, thrombocytopenia is the most common hematological abnormality associated with canine Babesia infection. The practitioner that only tests for Babesia when anemia is present will miss some cases.

Lastly we are recognized Babesia infections in dogs where neither anemia or thrombocytopenia appear to be the most prominent clinicopathological abnormality. Some cases of babesiosis have presented solely for evaluation of hyperglobulinemia. These have been polyclonal in nature and resolved with anti-protozoal therapy. Additionally protein losing nephropathies have been identified in dogs with Babesia infections caused by species other than the B. microti-like parasite from Spain.

Treatment

Note: Since the incidence of canine babesiosis is increasing in the US, specific anti-Babesial treatment is appropriate and indicated in dogs highly suspected of having babesiosis even without a definitive diagnosis. However since all treatments are not effective against all piroplasms and cost may vary considerably it is preferable to correctly identify which genotype is present in stable patients.

Antibiotics

Antibiotics are not the treatment of choice, but are reasonable to consider while waiting for specific anti-protozoal therapy. Doxycycline will reduce clinical signs and is associated with decreased morbidity and mortality. The dose is 10mg/kg/day. Administered IV or PO once or twice daily. I prefer once daily dosing unless the patient is vomiting after the medications. Clindamycin has been used to treat babesiosis. The dose in a recent study was 25mg/kg PO BID for 14 days, and was associated with a reduction of clinical, hematological and biochemical abnormalities. Some recent work has shown that a combination of doxycycline (5mg/kg PO BID), clindamycin (25mg/kg PO BID) and metronidazole (15mg/kg PO BID) may be effective in clearing B. gibsoni infections however the duration of therapy is not well defined with some dogs receiving treatment for several months. Administration of antibiotics alone without specific testing has resulted in a number of dogs being tentatively diagnosed with ehrlichiosis based on a partial or complete recovery. Cost: $10-50

Imidocarb Dipropionate

Imidocarb dipropionate (Imizol®, Schering-Plough) is the only FDA approved drug for the treatment of canine babesiosis. Dose 6.6mg/kg IM once. Repeat dose in 2 weeks. I will usually re-dose in one week if the dog is not responding well. Likely to cure B. canis vogeli. Good to reduce morbidity, mortality and parasitemia in B. gibsoni (Asian genotype), but is not curative. Side-effects include pain at injection site and cholinergic effects (SLUD). Pre-treatment with atropine reduces cholinergic effects. Cost: $50-100

Atovaquone and Azithromycin

An atovaquone and azithromycin drug combination is the only treatment shown to reduce B. gibsoni parasitemia below the limit of detection by a sensitive PCR test. Was effective in 83% of treated dogs in a controlled trial. Atovaquone is an anti-protozoal drug believed to inhibit the action of cytochrome B. It is available in two formulations in the US, Mepron® (GlaxoSmithKline) and Malarone® (GlaxoSmithKline). Mepron is a single drug formulation and is available in a liquid suspension. Malarone is a multi-drug combination containing atovaquone and proguanil hydrochloride. In our experience Mepron is more expensive, but is very well tolerated, while Malarone has been associated with severe GI side-effects in some cases. The atovaquone dose is 13.5mg/kg PO TID administered with a fatty meal for 10 consecutive days in combination with azithromycin. The azithromycin dose is 10mg/kg PO Q24 for 10 consecutive days. We have not used this combination to treat B. canis or B. gibsoni (USA/California genotype). Cost: $300-900

Diminazene Aceturate

Not FDA approved. Dose 3-7mg/kg IM once. Diminazene is likely to be curative for B. canis. It does not cure B. gibsoni (Asian genotype), but reduces morbidity, mortality and parasitemia. Anecdotal evidence suggests that B. gibsoni infected dogs recover more quickly than those treated with Imidocarb. Side-effects are similar to Imidocarb. Mortality has been noted at doses greater than 10mg/kg. Cost: ?

Supportive Care

Intravenous fluids are indicated for hypovolemic patients. Whole-blood or Packed RBC transfusions (from screened donors of course) for dogs that are clinical for their anemia. We have also used a hemoglobin based oxygen carrying solution in some dogs with babesiosis.

Immune-Suppressive Drugs

The use of immune-suppressive drugs for the immune-mediated components of the disease (anemia and thrombocytopenia) is controversial. If a dog is stable (i.e., eating and drinking and does not require ICU), regardless of PCV, I will treat with anti-protozoal drugs alone. I have treated dogs with PCV's as low as 8% with imidocarb alone and they have done very well. If a dog is crashing despite anti-protozoal therapy, I will treat like an IMHA case with 2mg/kg/day of prednisone. I will taper the prednisone faster in these cases than I do with idiopathic IMHA cases. Cases that have been treated with long-term immune-suppressive drugs prior to specific anti-protozoal treatment tend to have a poor response to treatment.

References

1. Birkenheuer AJ, et al. Vet Parasitol. 2004 Oct 5;124(3-4):151-60.

2. Holm LP, et al. Vet Rec. 2006 Aug 5;159(6):179-80.

3. Matjila PT et al. Vet Parasitol. 2008 Oct 20;157(1-2):34-40.

4. Garcia AT. Vet Parasitol. 2006 May 31;138(1-2):97-102.

5. Kjemtrup AM, Conrad PA. Vet Parasitol. 2006 May 31;138(1-2):112-7.


Speaker Information
(click the speaker's name to view other papers and abstracts submitted by this speaker)

Adam J. Birkenheuer, DVM, PhD, DACVIM
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Re: Babesia, a reminder

Postby Red » Thu Jan 27, 2011 3:13 am

Thank you Jtalt, for posting this. All my dogs had blood drawn this morning, to send out here:
http://www.cvm.ncsu.edu/vth/ticklab.html

I could not possibly deal with this devastating disease again so my guys will get treatment if they need to. All the blood work Tigger went through was not enough so I am trying to do right by those who are left.

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Re: Babesia, a reminder

Postby jtalt7 » Thu Jan 27, 2011 9:54 am

Urgh, I have still thought about this daily Red.......I know not nearly to the extent as you but it just weighs on my heart. I have posted about your story in all the circles I am in so that the story hits home and people listen to me about testing their dogs for Babesia.

I probably was one of those people who believed none of my dogs had this disease but I tested them anyways because I got a great group deal when I sent off all my bust dogs.....

If nothing else, I hope the awareness of this disease is something we can gain from Tigger's death.

You all are still on my mind..............I hope you get negative results on the rest of your bunch, if not you have the knowledge and tools and time now to battle this disease.

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Re: Babesia, a reminder

Postby heartbullies » Thu Jan 27, 2011 10:19 am

Now there is a CA Bay Area dog afflicted with this illness! viewtopic.php?f=7&t=141278&start=15

Not from the south. :(

We had a HW positive local dog recently, too.
I'll be getting B tested ASAP. This is scary.

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Re: Babesia, a reminder

Postby WackyJacki » Thu Jan 27, 2011 10:44 am

From some of the articles I read it seems as though pit bulls, along with Greyhounds, are especially susceptible to this...? Why is that? (excuse my complete ignorance on the subject!)

I'm in the midwest, so it doesn't look like it's a big concern here. However, in some of the wooded areas we walk the dogs in during the warmer months there are ticks, and I want to make sure I am well informed on all of this. :/

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Re: Babesia, a reminder

Postby AllisonPitbullLvr » Thu Jan 27, 2011 1:14 pm

Thankfully, babesia is not much of a concern here either. But last year when some of Buddy's bloodwork was wonky, and a lymph node was enlarged, the pathologist wanted us to run tests to rule it out.

Buddy is from a humane society so her past is sketchy at best. Thankfully, she was negative.

What a great thread guys.

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Re: Babesia, a reminder

Postby turtle » Thu Jan 27, 2011 2:49 pm

Here is the web site for the Protatek Labs in AZ that Jtalt7 said she used for testing her dogs --

http://www.protatek.com/

They have some interesting articles, here is one on Babesia in Greyhounds which has a list of the symptoms at the top --

http://www.protatek.com/reflab/greyhnd.html

And an article about Babesia in pit bulls --

http://www.protatek.com/PDF/babesiaPitBulls-Cook.pdf

Scary stuff... many of us with rescue dogs do not know where they came from nor much about their history. This insidious disease is hard to detect and it sounds like even the tests do not give completely reliable results.

We should all be aware of this serious heath threat and learn about it. If your dog shows anemia, and is lethargic with pale gums, it would be a good idea to test for Babesia.

Mods, could this thread be made a Sticky? It is an important health concern. The loss of Red's beautiful Tigger to this awful parasite is heartbreaking.
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