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Babesiosis
Basics
OVERVIEW
RBC destruction and anemia caused by Babesia spp. of intracellular protozoa
B. cani—a large (4–7 mm-long), pear-shaped parasite of canine RBCs; in the U.S., strains generally cause mild or inapparent disease in adults (unless immunosuppressed), but severe disease in pups; South African strains cause severe disease and death in some adult dogs.
B. gibsoni—a small (2.5 mm), ring-shaped organism that causes severe disease in most infected adult dogs; rare in the U.S. but common in Africa and Asia; organisms can be difficult to see in stained blood films.
B. felis—a very small (1 mm), ring-shaped organism that occurs in cats in Africa and southern Asia; of similar size and morphology to Cytauxzoon felis, which occurs in cats in the U.S.
SIGNALMENT
Dogs in many countries, including the U.S.
Cats in Africa and southern Asia
SIGNS
Signs and laboratory findings similar in cats and dogs
Vary with age of the animal and the species and strain of Babesia
Course of disease may be acute and fulminating, subclinical, or chronic
Dogs—lethargy, anorexia, pale mucous membranes, fever, emesis, amber to brown urine, splenomegaly, icterus, weight loss, tachycardia, and tachypnea
Cats—lethargy, anorexia, rough hair coat, pale mucous membranes, tachycardia, tachypnea, and occasionally icterus (fever not reported)
CAUSES & RISK FACTORS
Caused by B. canis and B. gibsoni in dogs and B. felis in cats; additional Babesia spp. in African wild cats may be transmitted to domestic cats.
Can be transmitted by ticks and blood transfusions
Risk of disease increased by splenectomy and immunosuppression
Diagnosis
DIFFERENTIAL DIAGNOSIS
Other causes of hemolytic anemia, including autoimmune hemolytic anemia, hemobartonellosis, cytauxzoonosis (cats only), Heinz body hemolytic anemia, microangiopathic hemolytic anemia, pyruvate kinase deficiency, and phosphofructokinase deficiency (dogs only)
Difficult to differentiate from autoimmune hemolytic anemia if parasites are not recognized in blood; both may be Coombs' test positive
New methylene blue stains used to identify Heinz bodies
Enzyme assays or specialized DNA tests used to identify pyruvate kinase or phosphofructokinase deficiencies
C. felis infection differentiated from B. felis infection by schizonts in tissues of cats with cytauxzoonosis, which are not seen in cats with babesiosis
CBC/BIOCHEMISTRY/URINALYSIS
Anemia with evidence of a regenerative response (reticulocytosis) unless a precipitous decrease in PCV occurs early in the course of disease
A peracute form of disease, resulting in DIC and death before anemia is severe, has been reported in dogs in South Africa.
Differential leukocyte counts variable and provide little diagnostic assistance; mild lymphocytosis may occur in dogs.
Mild to severe thrombocytopenia often present
Bilirubinemia and anemic hypoxia demonstrated in biochemical profiles of some animals
Bilirubinuria in many dogs; prominent hemoglobinuria rarely recognized in dogs in the U.S.
OTHER LABORATORY TESTS
Definitive diagnosis made by identification of protozoal organisms in stained blood films
IFA—tests for B. canis and B. gibsoni demonstrate antibodies in serum directed against these organisms, but some cross-reactivity occurs between Babesia spp.; high titers suggest current infection; tests may be negative in acutely infected animals, especially pups.
Direct Coombs' test positive in some animals
Prolonged coagulation times (i.e., APTT, PT, ACT) and positive fibrin degradation product test in some animals with severe DIC
Metabolic acidosis in some severely affected animals secondary to tissue hypoxia and shock
Treatment
None required in adult animals with mild anemia and clinical signs, although these animals can be reservoirs of infection for other animals
Life-threatening anemia—IV blood transfusions necessary
Shock—use IV fluids with added bicarbonate.
DRUGS
Dogs—diminazene aceturate (3.5 mg/kg SC or IM, single injection) or imidocarb dipropionate (5 mg/kg SC, single injection) or phenamidine (15 mg/kg SC on 2 consecutive days) may be efficacious in treating babesiosis; these drugs are not approved for use in the U.S.; thus an ECINAD exemption from the FDA is required before drugs can be obtained from suppliers.
Cats—primaquine phosphate (1 mg/kg IM, single injection); not approved for use in cats in the U.S.
CONTRAINDICTIONS/POSSIBLE INTERACTIONS
Antibabesial drugs potentially dangerous and can cause neuromuscular signs and liver or kidney injury
Follow-Up
Animals may relapse after completion of treatment; more likely to occur in dogs with B. gibsoni infection than in those with B. canis infection
Many treated and untreated animals remain carriers of disease.
Organisms not usually seen in blood films of recovered carrier animals
Copyright 2000 by Lippincott Williams & Wilkins
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