Babesiosis treatment

RE: Babesiosis treatment

Iva Mayer — Fri, 08 Apr 2016 10:11:38 GMT

Hi Mariette,

I don't think that we ever saw relapse of babesiosis in dog with IMHA but we definitely never use steroids if parasitaemia is still present...so basically we treat babesia with Imizol 6.6mg/kg and after 48 hours it should not be any more babesias in RBC-s...then if the dog has signs of IMHA we start treatment with normal full protocol for IMHA meaning corticosteroids and azathioprine with all of support therapy

RE: Babesiosis treatment

mariette asselbergs — Tue, 05 Apr 2016 22:46:18 GMT

Thanks for your thorough posting Iva.

I was intrigued by your last remark. What do you do if IMHA follows Babesiosis? When do you decide you can treat with a full on dose of corticosteroids without the risk of getiting a fierce relapse of Babesia?

Mariette

RE: Babesiosis treatment

Iva Mayer — Tue, 05 Apr 2016 12:47:10 GMT

Hi guys,

as an assistant professor in Internal medicine in Croatia I ‘m seeing more then 100 cases of babesiosis per year so I thought that I might help you with few tips about it.

1. Babesiosis in S. Africa is totally different disease than babesiosis caused by B. canis canis that is presented in Europe.

2. The is hallmark of babesiosis caused by B. canis canis is systemic inflamantory response (SIRS) so basically babesiosis is parasitic sepsis and should be treated like sepsis , meaning not only with antiparasitic …you should provide all of the standard supportive treatment and monitoring even in “uncomplicated” cases.

3. The first sign of babesiosis is not an anemia.. it is marked thrombocytopenia, anemia is often not present or it is really mild during first 24-48 hours of disease.

4. We have lots of combined babesia + erlichia or babesia+ anaplasma infections so if your patient is not recovering well enough or it is still anemic and thrombocytopenic a week after Imizol treatment you should consider testing for other tick-born diseases

5. Please don’t give any steroids when treating babesiosis, it will cause sever parasitaemia

6. You can expect that about 30% of your babesia patients will be complicated and about 20 % of those will develop MODS no matter what

7. It has been proved that single dose 6.6mg/kg of Imizol is the most effective treatment, lower doses can be used but there is a big chance that you will have to repeat the application which you can do 3 days after the first application but in that case you will already have severely sick patient with all chances to develop at least renal failure

8. Repeat blood samples at least 3th and 7^th day after treatment even if dog is doing perfect..IMHA is a common complication in canine babesiosis ( especially in Rottweilers, Shepard dogs, and all “polar breeds”)

I hope I managed to help you bit….

Greetings from Zagreb

Iva

RE: Babesiosis treatment

mariette asselbergs — Wed, 30 Mar 2016 18:42:11 GMT

A few "tuppences" here:

Babesiosis in S Africa is quite different from the one in France, It is a different Babesia (actually various ones), it is most of the time concurrent and complicated by Ehrlichia, and then also most dogs are from a population which has been in contact with Babesia for many generations. Not only natural selection influence, but also the contact with ticks and babesia as young puppies which gives much less serious disease and helps to build "premunity" (the immunity maintained by continuous presence or reinfection with the organism.

There also seems (and has been documented) to be a definite breed difference in vulnerability for serious disease. Shepherd type dogs seem to be more susceptible.

Then, it maybe easy to get imidocarp (which really is the best and easiest treatment here in the UK), but this is not the case if you don't have it on the shelf and it is Friday night A&E. These cases need very urgent treatment. If you can find the drug and treat, they will be a lot better the next day, if you don't treat they may be dead or have such kidney damage from haemogloburia that they are beyond treatment. I have had a desperate owner phoning all the vet schools and referral centres and not finding the drug. As a last resort they could just take the ferry to France and have the dog treated there, all vets over there have it on the shelf.

One last thing: Be VERY sure to distinguish properly between Babesiosis and IMHA, because preds in a Babesiosis case will cause massive parasitaemia. We used it to produce babesia vaccine (which was basically blood full of parasites stored in liquid nitrogen).

Mariette

RE: Babesiosis treatment

Madhu Vet — Tue, 29 Mar 2016 11:47:45 GMT

I always go with imidocarb and doxycycline,check for platelet count if they are low prednisolone should be on ..

RE: Babesiosis treatment

Luca Poddighe — Mon, 21 Mar 2016 18:25:32 GMT

I used to see a fair deal of tick borne diseases back in Sardinia, mostly ehrlichia and rickettsia. If you get used to see them and you are aware of their presence they're not that hard to treat. The summary, posted earlier on, is very good!

RE: Babesiosis treatment

Kate Richardson — Sat, 19 Mar 2016 13:33:52 GMT

Thankyou Stephen and Alet, really excellent summary on clinical signs, treatment and prognosis.

RE: Babesiosis treatment

Charlie Lyon — Sat, 19 Mar 2016 11:09:18 GMT

Thanks for your help all, feel much better informed and less confused now. Found that article just by plugging the title into google.

RE: Babesiosis treatment

Stephen Courtney — Sat, 19 Mar 2016 10:13:30 GMT

Back in the days of quarantine in the UK I looked after a Jack russell from south Africa which became unwell, and one of the tests I asked for was a Travel Screen PCR that included Babesiosis. He was positive, but he was not suffering an illness relating to Babesia - simply had been exposed before, and the organism was still present at some level, but not causing any issues.

Alet has given a good summary - bear in mind Babesiosis in South Africa tends to be more virulent than the European flavour so we are a little luckier here.

RE: Babesiosis treatment

Alet Engelbrecht — Sat, 19 Mar 2016 06:26:30 GMT

If caught early (boodsmear), most cases of babesiosis are simple uncomplicated diseases with good prognosis. If not treated, it can be life threatening (B. canis rossi). So I would weigh this against any pre-existing renal/hepatic issues and treat regardless.

In South Africa, we use Diminizene at 3.5mg/kg as our first line treatment and 90% of cases are managed as outpatients. The area I practice, we often see concurrent Ehrlichia canis infections, so we use doxycycline at 10mg/kg for 21 days for that, not to potentially clear/treat babesiosis. I have not seen chronic babesiosis. I have seen possible relapses or reinfections. Imidocarb can be used at 6.6mg/kg and if necessary (for relapse/reinfection) can be repeated in 14 days apparently. Diminizene apparently only in 21 days.

On the other hand, Ehrlichiosis is often chronic, the parasite can hide away virtually anywhere (including the brain) and PCR may stay positive for ever.

There is a good article (and although quite old by now, still relevant) by Remo Lobetti, a South African internal medicine specialist, about the complications and management of the disease. I could not find the exact article, but he gave a lecture on it at WSAVA and it can be found on IVIS.org. Not sure if I can attach a pdf file.

UPDATE ON THE COMPLICATIONS AND MANAGEMENT OF CANINE BABESIOSIS - Remo Lobetti

Good luck, we are always grateful when the 'unwell/not eating' on the cons queue turns out to be a babesiosis - nice little recipe: Bloodsmear, Haematocrit + TSP, In saline agglutination test. This was our outpatient database. Coombs if concerned about concurrent IMHA. Treat with single dose of Diminizene at 1ml/20kg. Treat pyrexia (often 40C+) with nsaids or corticosteroids (if concerned about IMHA we start early). Inpatient and drip/blood transfusion if clinically necessary (we catch them early as we make a lot of bloodsmears in endemic areas). If not, outpatient with recheck in 24-48 hours. Repeat haematocrit and ISA.

Jaundice and heamoglobinuria are often features of the disease and do not necessarily mean ongoing liver and renal issues.

RE: Babesiosis treatment

Charlie Lyon — Fri, 18 Mar 2016 23:15:54 GMT

Ok - its a long time since studied it so revision required. What about if renal\hepatic issues are already present?

RE: Babesiosis treatment

Stephen Courtney — Fri, 18 Mar 2016 22:45:10 GMT

Nothing can completely get rid of of the parasite- once it's on board it can hide away for years. chronic babesiosis cases are not uncommon in endemic areas and are much trickier to diagnose - they kind of mimic things like ehrlichiosis, lyme disease etc. chronic disease usually relates to natural / partial immunity where the dogs carry the organism but don't suffer much, and that is unlikley to be seen in the UK for a while anyway. I doubt this problem will become a massive one in the UK - the climate just doesn't suit the vectors that well, but this may change.

You get the acute infection under control, the dog gets better, the immune system learns to suppress the parasite, and the dog will stay better until either it is re infected or perhaps suffers a relapse eg due to some other illness. Watch out for concommitant tick borne diseases as these are common in endemic areas.

RE: Babesiosis treatment

Charlie Lyon — Fri, 18 Mar 2016 22:40:02 GMT

Apparently imidocarb is a drug that can incompletely clear the parasite in some babesia sp and lead to relapse? Or is that not an issue with most cases?

RE: Babesiosis treatment

Stephen Courtney — Fri, 18 Mar 2016 22:34:32 GMT

See the thread on tick control - i put some info on there.

Phenamidine is i think a historical drug that is no longer available. It had a fair amount of potentially nasty side effects. Diminazene aceturate ( Berenil) is still in use in Southern Africa. Cheap and effective, relatively safe, and totally unavailable in the UK. Trypan blue is another historical anti piroplasm type drug that has been superceded by proper drugs a long time ago. No idea where you might get it from

There is absolutely no reason not to use imidocarb/ imizol . If I didn't have any I would use doxycicline before antirobe - - until recently hadn't heard of using antirobe for this, but can't see how it could be better than doxy.

Imidocarb is licensed in the UK for treating Babesiosis in cattle, and is relatively easy to get hold of.