Elsevier: Ct: Clinical Veterinary Advisor, 3rd Edition Babesiosis

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Clinical Veterinary Advisor

Dogs and Cats, 3rd Edition

Etienne Ct, DVM, DACVIM

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Babesiosis
Basic Information

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Definition

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Canine babesiosis is a tick-borne disease caused by a hemoprotozoan parasite that infects red blood cells of dogs, causing
hemolytic anemia and thrombocytopenia. Two primary species have been identified: Babesia canis (large Babesia) and Babesia
gibsoni (small Babesia).

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Synonyms
Babesiosis: piroplasmosis
Babesia annae: B. microtilike parasite
Babesia gibsoni: B. gibsoni (Asian genotype)
Babesia conradae: may be referred to as B. gibsoni (U.S. genotype)

Epidemiology
Species, Age, Sex

Dogs of any age and either sex

Genetics and Breed Predisposition

American pit bull terriers (APBT) and Tosa Inus at risk for B. gibsoni
Greyhounds at risk for B. canis vogeli
Risk Factors

Dog fights (particularly bites by an APBT)

Tick infestation
Blood transfusion
Shared needles or surgical instruments
Vertical transmission in affected breeds
Contagion and Zoonosis
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Elsevier: Ct: Clinical Veterinary Advisor, 3rd Edition Babesiosis

Transmission is through blood contamination or arthropod infestation (Rhipicephalus, Haemaphysalis, or Dermacentor spp.).
Canine babesiosis is not a documented zoonotic disease; B. microti is a small Babesia infecting human red blood cells.
Canine species of Babesia causing infections in humans have not been well documented.
Geography and Seasonality

Since babesiosis can be either acute or chronic, it can be diagnosed at any time of year.
Small babesias:
B. gibsoni was once limited to Asia but now has a worldwide distribution.
B. annae: Spain
B. conradae: southern California
Large babesias:
B. canis vogeli: worldwide
B. canis canis: Europe
B. canis rossi: southern Africa

One of the novel large Babesia sp. has been diagnosed in the United States and the other in the United Kingdom.
Associated Disorders

Some patients with babesiosis have been concurrently diagnosed with other tick-borne diseases.
The novel large Babesia sp. identified in United States has been primarily diagnosed in dogs that have previously undergone
splenectomy or are undergoing chemotherapy.

Clinical Presentation
Disease Forms/Subtypes

Babesiosis can cause severe, life-threatening disease in some dogs; others show few or no outward clinical signs. B. annae is
commonly associated with azotemia and proteinuria.
History, Chief Complaint

Owners may observe weakness, lethargy, anorexia, pallor, icterus, or discolored urine (bilirubinuria or hemoglobinuria). Other
historic findings may include tick exposure, recent blood transfusion, or recent dog fight (especially with an APBT).
Physical Exam Findings

Pallor and splenomegaly, +/ lymphadenopathy, fever, or icterus

Etiology and Pathophysiology

Sporozoites in tick salivary glands transmitted to dog during feeding (requires 2-3 days)
Sporozoites enter red blood cells (RBCs), where they become merozoites and undergo asexual reproduction.
Intravascular and extravascular hemolysis occurs.
Secondary immune-mediated destruction of RBCs and platelets may occur.
Azotemia and proteinuria are presumed to be secondary to glomerulonephritis and are most commonly seen with B. annae
infections, but are recognized with increasing frequency in association with other Babesia spp.

Diagnosis
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Elsevier: Ct: Clinical Veterinary Advisor, 3rd Edition Babesiosis

Diagnostic Overview
Most dogs with babesiosis have one or more of the following abnormalities: thrombocytopenia, anemia, hyperglobulinemia,
and/or splenomegaly. PCR assays have become the primary means of accurately diagnosing Babesia infections; however,
serologic testing can help make a presumptive diagnosis of babesiosis in cases with low numbers of circulating parasites.

Differential Diagnosis
Immune-mediated hemolytic anemia
Immune-mediated thrombocytopenia
Zinc toxicosis
Splenic torsion
Ehrlichiosis
Leptospirosis
Heartworm disease with caval syndrome
Neoplasia: lymphoma or hemangiosarcoma

Initial Database
One or more of the following may be identified in dogs with babesiosis:
Regenerative anemia: It is important to note that not all dogs with Babesia infections have anemia.
Thrombocytopenia: This is the most common hematologic abnormality in dogs with babesiosis; platelet counts can be as
low as < 5000 platelets/mcL.
Blood smear: identification of Babesia organisms (recall that an erythrocyte is 8 microns in diameter)
Small babesiosis: 1-3 micron signet ring forms.
Large babesiosis: 3-6 micron single or paired tear drop forms, but other more ameboid forms can predominate.
Serum bilirubin: may be increased
Hyperglobulinemia: a polyclonal gammopathy is frequently detected
Urinalysis: +/ bilirubinuria, hemoglobinuria or proteinuria
Coombs' test: positive in up to 85% of cases

Advanced or Confirmatory Testing

PCR test: only way to determine species or subspecies. More sensitive than blood smear
False-positive, false-negative results recognized
Tests vary between laboratories.
Not always able to detect all species (check with laboratory about sensitivity and specificity)
IFA test > 1 : 64 is considered positive.
Cannot differentiate species
False-negative results can occur with acute or peracute disease or severe immunosuppression.

Treatment
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Treatment Overview
It may not be possible to completely eradicate the parasite in all cases, but clinical signs usually improve with supportive care
and antiparasitic therapy. The treatment of choice is dependent on which Babesia species is identified. Currently, most data
are available for treatment of B. canis and B. gibsoni.

Acute General Treatment

Supportive treatment may require blood transfusion (see p. 1233) or hemoglobin polymer (e.g., Oxyglobin) for animals that
are anemic.
IV fluids may be required in animals that are febrile and dehydrated.
Imidocarb diproprionate (6.6 mg/kg IM once, repeat in 7-14 days). Pretreatment with atropine (0.04 mg/kg IM or SQ 30
minutes before imidocarb injection) may reduce cholinergic side effects. This drug appears to reduce morbidity and
mortality for nearly all Babesia spp. but is not effective for the clearance of B. gibsoni. It is the treatment of choice for B.
canis vogeli.
Atovaquone (13.5 mg/kg PO q 8h with fatty meal for 10 days) plus azithromycin (10 mg/kg PO q 24h for 10 days) is the
treatment of choice for B. gibsoni. Results in elimination or reduction of the parasite below the limit of detection of PCR
testing in 82% of cases. Resistance to atovaquone has been identified.
Clindamycin (25 mg/kg PO q 12h for 14 days) has been associated with clinical improvement but not clearance of B.
gibsoni.
A combination of clindamycin (25 mg/kg PO q 12h), metronidazole (15 mg/kg PO q 12h), and doxycycline (5 mg/kg PO q
12h) has been associated with elimination or reduction of the parasite below the limit of detection of PCR testing. A welldefined treatment course has not been established, with treatment times ranging from 24 to 92 days.
Concurrent immune suppression should be avoided whenever possible, as it may reduce the ability to clear the infection
with antiprotozoal drugs.

Chronic Treatment
Vector control: topical acaricide and/or flea/tick collar
Dogs with positive Babesia titers or PCR should not be used as blood donors.

Possible Complications
Prolonged immunosuppressive therapy before specific antibabesial treatment can worsen outcome and should not be used in
sick, hospitalized dogs.

Recommended Monitoring
Monitor hematocrit and platelet count daily until improvement is seen and then every 1-3 weeks until anemia and
thrombocytopenia resolve.
PCR should be negative 60 and 90 days post treatment if the parasite has been successfully eradicated.

Prognosis & Outcome

Good prognosis with early diagnosis and treatment
Animals may remain subclinically infected for life.
Severely anemic animals may die without supportive care such as blood transfusions or hemoglobin-based oxygen-carrying
solutions.

Pearls & Considerations

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Comments
New Babesia species are being identified through molecular techniques.

Prevention
Effective tick control, particularly topical acaricides, is likely to reduce the risk of infection.
Screening blood donors for Babesia infections will reduce the chances of iatrogenic infections.

Technician Tips
The characteristic features of Babesia make them identifiable on a blood smear with little practice.

Client Education
In endemic areas, use both a topical acaricide and a repellent tick collar. Avoid blood transmission (shared needles,
vaccines, etc.).
Babesia spp. can be transmitted vertically and should be considered in puppies with weakness and pallor.

Suggested Reading
Birkenheuer AJ, et al: Double-blind placebo controlled trial evaluating the efficacy of an atovaquone azithromycin
combination therapy for chronic Babesia gibsoni infections. J Vet Intern Med 18494498, 2004.

Author:
Adam J. Birkenheuer, DVM, PhD, DACVIM

Editor:
Joseph Taboada, DVM, DACVIM

Ct: Clinical Veterinary Advisor: Dogs and Cats, 3rd Edition

Copyright 2015 by Mosby, Elsevier
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