Tick Fever Protocol

Presentation: O calls to say P “is not himself”/has a rash/sore eyes/lethargic/inappetant/stiff when

walking/bleeding from the nose/blood in the poo/ataxic. Symptoms can vary and are often vague

Hx: Not UTD tick prevention/has a lot of ticks. Symptoms chronic vs acute. Chronic presents waxing and waning
inappetance and lethargy, uveitis, poor coat, stiff gait. Acute shows sudden symptoms

CE: Variable – sometimes pyrexic, mm pale/white, tachycardia, tachypnoeic, weight loss, poor BCS, uveitis,
petechiae, splenomegaly – sometimes none of the above!!

Diagnosis: Minimum database to include E.canis snap test, CBC, biochem, urinalysis, smear.

E.canis in house test: Antibody test. Beware false negatives!

CBC: Parameters that indicate TF – anaemia, thrombocytopaenia, nutropaenia, lymphocytosis

Biochemistry: Parameters that indicate TF – hyperglobulinaema. Also need to assess BUN + Creat as chronic
Ehrlichiosis can lead to glomerulonephritis + CRF.

Urinalysis: Checking for proteinuria + S.G as a measure of renal function – again glomerulonephritis + CRF

Smear: To assess morphology of cells + if correlates with CBC. Also checking for evidence of inclusion bodies.
Babesia (often paired) in RBC + morula in WBC (rare, usually only in acute)

PCR + Genotyping also available

Treatment + follow up care:

Diagnosis of TF is a big picture approach. Complex dz that should not be ruled in/out on the basis of a single
diagnostic. Also complicated by the fact that patient may have TF AND another disease!

>90% of infections are mixed (ehrlichia + babesia), therefore we use a blanket approach and treat for both.

Doxycycline 10mg/kg po SID x 28d. Must be given with food. If vomiting is a problem can divide dose 5mg/kg BID,
add cimetidine 10mg/kg po BID or try Vibravet paste. Occasionally if P not eating/vomiting can use Engemycin
injection (not ideal)

Imizol 6.6mg/kg SQ, repeat 14 days later. WARNING! This injection stings. WARN owner and muzzle all dogs.

Occasionally encounter non-responsive Babesia:

Atovaquone 13.5mg/kg TID

Azithromycin 10mg/kg SID. Both given for 10 days with a fatty meal (neither are kept in stock but can be ordered if
O is happy with cost)

OR

Berenil 3-5mg/kg injection, risk of cerebral necrosis and death!! O must sign consent form.
Stable P needs to RV at day 7, 14 +28

Day 7, check if P responding clinically + CBC to check parameters improving

Day 14, repeat Imizol injection and CBC

Day 28, repeat CBC + smear to ensure infection cleared. Can extend doxy for 2 more weeks if concerned about CBC
parameters

The case with moderate/severe anaemia

HCT 10-15%, transfusion area. Recommend O begin looking for donor dog

HCT 5-10%, stress to O importance of finding a donor. P may die without

HCT <5%, P will die without transfusion

PLT <50, risk of haemorrhage. Recommend transfusion

These patients should be hospitalized, IVFT and have CBC repeated within 48hrs

Tansfusion protocol:

Donor dog: >25kg, 2 – 7 years old, fully vaccinated, >3months since last donation

Donor dog: perform CBC, E.canis, HWT, smear

Sedate donor dog and place on table in lateral recumbency.

Clip and prep jugular surgically.

Inject lidocaine SQ over venipuncture site.

Raise vein + insert needle. Collect blood by gravity and agitate bag until full. Clamp and tie off giving sets. (closed
system) Usually collect 330ml. Reverse + ensure recovery ok.

Insert blood transfusion giving set. FWB must be used within 4 hrs of collection

Prepare recipient dog. Place fresh iv catheter. Chlorpheniramine 5mg/dog IM. P should be receiving iv fluids
simultaneously

Begin to transfuse recipient at a slow rate (0.25-1 mL/kg/hr) for 20 mins. If no reaction noted can increase to 3-
6ml/kg/hr. PATIENT MUST BE MONITORED CONSTANTLY. This includes TPR as well as observation. Any adverse
signs to be reported to vet on duty immediately.

Take home: Prevention better than cure. All P entering ADI must be current on tick prevention.
Billing a blood transfusion:

The following is an example of how to bill for a blood transfusion. This case is missing HWT. Normally we would
advise clients that it is ~$600 (estimate) and then prepare the correct invoice after completing the procedure.