Autochthonous babesiosis in the United Kingdom

Cross-sectional study of approaches to diagnosis and management of dogs with immune-mediated haemolytic anaemia in primary care and referral veterinary practices in the United Kingdom

Objectives

To determine whether veterinarians in primary care practices (PCPs) and board-certified clinicians (BCCs) approach treatment of dogs with immune-mediated haemolytic anaemia (IMHA) similarly, and whether practitioners with more experience treat similarly to those with less experience. We hypothesised those in PCPs would show more variation in their approach to similar cases than BCCs.

Methods

A cross-sectional study was conducted by distributing a questionnaire to BCCs and veterinarians in PCPs. The questionnaire included direct questions and a number of clinical scenarios intended to capture approaches to common treatment problems.

Results

Questionnaire responses were received from 241 veterinarians, including 216 in PCPs and 25 BCCs. Veterinarians in both settings used similar tests for diagnosis of IMHA, but BCCs performed more tests to exclude underlying causes of ‘associative’ disease. All veterinarians reported use of similar initial dosages of glucocorticoids (median 2 mg/kg per day in both groups, p = 0.92) but those used by more experienced practitioners were higher than those with less experience. Most veterinarians made allowances for the weight of dogs, using lower prednisolone dosages in a clinical scenario involving a 40 kg dog compared to a 9 kg dog (p = 0.025 for PCP, p = 0.002 for BCC). BCCs reported greater use of combinations of immunosuppressive drugs (p<0.0001) and of antithrombotic drugs (p<0.0001); use of antithrombotic drugs was also less common among more experienced practitioners compared to less experienced.

Conclusions

Approaches to treatment of dogs with IMHA differ between BCCs and those in PCP. These differences may affect design and implementation of future research studies and clinical guidelines.

Pregnancy-associated immune-mediated hemolytic anemia in a dog

OBJECTIVE

To describe the clinical presentation, diagnostic investigations, and outcome of a dog with pregnancy-associated immune-mediated hemolytic anemia.

CASE SUMMARY

A 6-year-old, pregnant Bichon Frise was presented due to lethargy, inappetence, and progressive regenerative anemia with spherocytosis. The dog had been recently receiving ranitidine and amoxicillin/clavulanate. An in-house saline agglutination test identified marked agglutination and a urinalysis identified hemoglobinuria. Thoracic and abdominal imaging, as well as infectious diseases testing, was unremarkable. The bitch started whelping shortly following hospitalization, and the anemia progressively resolved without any other intervention. Ranitidine and amoxicillin/clavulanate were re-introduced within the following 2 months but the anemia did not reoccur. In light of these findings, a diagnosis of pregnancy-associated immune-mediated hemolytic anemia was made.

NEW OR UNIQUE INFORMATION PROVIDED

Pregnancy-associated immune-mediated hemolytic anemia should be considered in female dogs that develop severe hemolytic anemia during pregnancy and may resolve spontaneously following parturition.

A short-term and long-term relationship between occurrence of acute canine babesiosis and meteorological parameters in Belgrade, Serbia

Belgrade, the capital of the Republic of Serbia, is an endemic location for canine babesiosis caused by Babesia canis. This tick-borne disease occurs seasonally in regions with moderate continental climate. However, recent clinical data show that: 1) some cases of canine babesiosis have been recorded during the winter, and 2) canine babesiosis is spreading to the northern parts of Europe with a colder climate, which is a region previously free of this disease. Our study investigates the occurrence of canine babesiosis in different seasons over 2013-2016, and explores a short-term link between meteorological parameters and number of diagnosed cases of canine babesiosis in Belgrade. It also looks into possible long-term correlations that span one year before the onset of the disease. Based on 872 recorded cases over four years, our results show a bimodal seasonal distribution of canine babesiosis, with a pronounced peak in the spring, and a less conspicuous one in the autumn. Throughout the year, even over the coldest and warmest periods, there is a broad range of temperatures and relative humidities when the disease is recorded. Over one year prior to the spring and autumn onset of the disease, we found a noticeable impact of temperature and relative humidity, and to a lesser extent, of atmospheric pressure and cloud cover, on the number of diagnosed cases. These findings imply short-term and long-term relationships between occurrence of acute canine babesiosis and certain meteorological parameters, and they open further questions that need to be investigated in order to understand the epidemiology of this disease.

Research on Babesia: A bibliometric assessment of a neglected tick-borne parasite

Given the emergence and reemergence of tick-borne diseases, here we assessed the publishing patterns of research focused on Babesia. We also discuss the implications for the articles published in the last decade, and how more clinical and epidemiological information concerning Babesia is still required. The findings of this article would be useful to define research priorities about Babesia and diagnose the important of scientific production on this pathogen.

Babesiosis in Essex, UK: monitoring and learning lessons from a novel disease outbreak

Canine babesiosis is a parasitic disease caused by apicomplexan protozoa of the genus Babesia, with Babesia canis being a pathogenic and widespread species in mainland Europe. The United Kingdom has thought to have been free of endemic B. canis infection, despite its vector, Dermacentor reticulatus being present in endemic foci. The winter of 2015/2016 saw the establishment of the first recording of a known endemic foci of B. canis in the UK. Since this outbreak in Harlow and subsequent cases in Romford later in 2016, information has been gathered regarding the population of Dermacentor ticks in Harlow and awareness of the disease promoted among Veterinary professionals and pet owners. This letter describes what is known about the two clusters of cases seen in 2016 and the distribution of D. reticulatus in the UK. A further untraveled case in the UK in 2017 close proximity to the 2016 cases is also described, as well as the lessons this outbreak brings in terms of managing other vector-borne disease.

Emergence of Babesia canis in southern England

Background

The United Kingdom is considered free of autochthonous transmission of canine babesiosis although cases are reported in dogs associated with recent travel abroad. During the winter months of 2015/16, a cluster of cases of disease in dogs with signs suggestive of canine babesiosis were reported in Harlow, Essex.

Methods

Babesia species were detected in dog blood samples by Giemsa staining of blood smears and by pan-piroplasm PCRs. Babesia species were also detected in extracts of tick DNA using pan-piroplasm PCRs. DNA sequencing and phylogenetic analysis was used to confirm the species of Babesia present in dog blood and tick samples. Tick species were identified by PCR-sequencing based on amplification of the cytochrome c oxidase subunit one (cox1) gene. Dermacentor reticulatus ticks were sampled from field sites in England and Wales.

Results

Blood smear analysis on samples taken from some of the affected dogs confirmed the presence of a large Babesia species within erythrocytes. A tick recovered from one of these cases was identified as Dermacentor reticulatus, a species with a limited distribution in England and Wales, but a known vector of canine babesiosis in continental Europe. Babesia canis was subsequently identified in blood samples obtained from three clinical cases (all dogs) within the area and from ticks associated with these dogs. A field survey detected 17 adult D. reticulatus ticks from one area visited by the affected dogs. Fourteen of these ticks were shown to be positive for the B. canis parasite, implicating them as a potential source for babesiosis in Harlow. In order to assess whether the parasite is present in more than one tick population, D. reticulatus ticks from across England and Wales were screened for the presence of Babesia species. In addition to the Harlow site, a further five locations where D. reticulatus is present were screened for Babesia species. Babesia was not detected from most sites tested but one tick from a single location in Wales was positive for B. canis.

Conclusions

Infection with B. canis was confirmed in a number of dogs in Harlow, Essex, with no history of travel outside of the country. The same pathogen was identified in field-caught D. reticulatus ticks in the same area and is considered the likely source of infection. This highlights the need for vigilance by veterinary surgeons for future outbreaks of tick-borne disease in dogs.