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Babesiosis — Clinical Guidelines

Overview

Babesiosis is a tick-borne disease caused by protozoan parasites of the genus Babesia, primarily affecting dogs and humans. In dogs, Babesia canis is a common causative agent leading to severe hemolytic anemia and systemic complications 1 7.

Diagnosis

Clinical Signs: Hemolytic anemia, thrombocytopenia, fever, and nonspecific symptoms like respiratory distress 2.

Laboratory Tests:

- Hematology: Low platelet count, increased mean platelet volume, elevated percentage of large unstained cells 1. - Peripheral Smear: Identification of intraerythrocytic parasites or inclusion bodies 2. - PCR/Blood Smear: Confirmatory tests for Babesia DNA or direct visualization 1.

Biomarkers: Elevated levels of LTB4 and PGE2 in serum may indicate active disease 4.

Management

First-Line Treatments:

- Clindamycin: Often used in combination with [quinidine/quinine] 2.

Adjunctive Treatments:

- Red Cell Exchange Transfusion: For severe anemia 2. - Supportive Care: Fluid resuscitation, monitoring for organ dysfunction 2 5.

Special Populations

Elderly: Susceptibility to severe complications including refractory shock and multiorgan failure 2.

Comorbidities: Presence of SIRS and MODS significantly impacts outcomes, with central nervous system and renal involvement correlating with higher mortality 5.

Key Recommendations

Utilize hematological parameters such as platelet count and large unstained cells for early screening of Babesia canis infection (Evidence: Moderate 1).

Initiate treatment with clindamycin, often combined with quinidine or quinine, for confirmed cases (Evidence: Expert opinion 2).

Monitor for and aggressively manage multiorgan dysfunction, particularly central nervous system and renal involvement, to improve outcomes (Evidence: Moderate 5).

References

1 Pijnacker T, Bartels R, van Leeuwen M, Teske E. Identification of parameters and formulation of a statistical and machine learning model to identify Babesia canis infections in dogs using available ADVIA hematology analyzer data. Parasites & vectors 2022. link 2 Ripoll JG, Rizvi MS, King RL, Daniels CE. Severe . BMJ case reports 2018. link 3 Kuleš J, de Torre-Minguela C, Barić Rafaj R, Gotić J, Nižić P, Ceron JJ et al.. Plasma biomarkers of SIRS and MODS associated with canine babesiosis. Research in veterinary science 2016. link 4 Mrljak V, Kučer N, Kuleš J, Tvarijonaviciute A, Brkljačić M, Crnogaj M et al.. Serum concentrations of eicosanoids and lipids in dogs naturally infected with Babesia canis. Veterinary parasitology 2014. link 5 Welzl C, Leisewitz AL, Jacobson LS, Vaughan-Scott T, Myburgh E. Systemic inflammatory response syndrome and multiple-organ damage/dysfunction in complicated canine babesiosis. Journal of the South African Veterinary Association 2001. link 6 Passos LM, Bell-Sakyi L, Brown CG. Immunochemical characterization of in vitro culture-derived antigens of Babesia bovis and Babesia bigemina. Veterinary parasitology 1998. link00095-8) 7 Jacobson LS, Clark IA. The pathophysiology of canine babesiosis: new approaches to an old puzzle. Journal of the South African Veterinary Association 1994. link 8 Goodger BV, Commins MA, Waltisbuhl DJ, Wright IG, Rode-Bramanis K. Babesia bovis: immunity induced by vaccination with a lipid enriched fraction. International journal for parasitology 1990. link90129-b) 9 Moreau Y, Vidor E, Bissuel G, Dubreuil N. Vaccination against canine babesiosis: an overview of field observations. Transactions of the Royal Society of Tropical Medicine and Hygiene 1989. link90611-1) 10 Snary D, Smith MA. An antigenic determinant common to both mouse red blood cells and several membrane proteins of the parasitic protozoa Babesia rodhaini. Molecular and biochemical parasitology 1986. link90147-7)

Babesiosis