New therapeutic protocol for canine babesiosis: a case report

doi:10.15406/jdvar.2016.03.00082

Journal of

eISSN: 2377-4312

Dairy, Veterinary & Animal Research

Case Report Volume 3 Issue 3

New therapeutic protocol for canine babesiosis: a case report

Nandini MK,¹ Poonam Vishwakarma,²

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Ansar Kamran C³

¹The Companion Animal Clinic, India
²Biosafety Support Unit, India
³Department of Teaching Veterinary Clinical Complex, Hasan Veterinary College, India

Correspondence: Poonam Vishwakarma, Scientist, Biosafety Support Unit, Regional Centre for Biotechnology, Government of India, New Delhi, India, Tel 011 2465 4007

Received: May 17, 2016 | Published: June 6, 2016

Citation: Nandini MK, Vishwakarma P, Kamran CA. New therapeutic protocol for canine babesiosis: a case report. J Dairy Vet Anim Res. 2016;3(3):112-113. DOI: 10.15406/jdvar.2016.03.00082

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Abstract

Canine babesiosis is typically characterized by hemolyticanemia, thrombocytopenia, fever, and splenomegaly. A male Labrador aged three years eight months was presented to the veterinary clinic with a history of brownish urination, anorexia and lethargy since one week. Clinical examination revealed high temperature (105.7⁰F), pale mucous membrane and splenomegaly. Haematology revealed anaemia and thrombocytopenia (Hb- 7.7g/dl; Platelet count- 86,000/µl). B. Gibsoni (+++) was evidenced in blood smear. Treatment was initiated with a combination therapy of Clindamycin @ 25mg/kg PO q 12h, Metronidazole @ 15mg/kg PO q 12h and Doxycycline @ 5mg/kg PO q 12h for 10days. There was no adverse reactions and the dog showed clinical and haematological improvement from 4^th day of treatment onwards and recovered uneventfully by the end of therapeutic protocol.

Keywords: B. gibsoni, canine, clindamycin, metronidazole, doxycycline, combination therapy, haematology, biochemistry

Abbreviations

Hb, haemoglobin; TLC, total leucocyte count: SGOT, serum glutamic oxaloacetic transaminase; SGPT, serum glutamic-pyruvic transaminase; ALP, alkaline phosphatase; @, at sign; SC, subcutaneous; IM, intramuscular

Introduction

Babesiosis is an important disease of domestic dogs and has been attributed to infection with either Babesia canis or B. Gibsoni, based on parasite size and the geographic location in which the infection was acquired. It is diagnostically important to determine the species that causes canine babesiosis, since the virulence, prognosis, and response to anti babesial drugs may be different for each organism.¹ Babesia gibsoni was first recognized in India in 1910.² There are at least three distinct isolates of B. Gibsoni that are morphologically identical: one from Asia, one from California, and a third from Europe. The Asian isolate is the original organism found in India and is considered Babesia gibsoni sensustricto.³

Case presentation

A male Labrador aged three years eight months was presented with a history of brownish urination, anorexia and lethargy since one week. Clinical examination revealed high temperature (105.70 F), pale mucous membrane and spleenomegaly. Blood was collected and subjected to routine hematology and biochemistry. Peripheral smear study revealed presence of B. gibsoni (+++) in the RBCs. Based on clinical signs, hematological and biochemical report case was suspected for Babesiosis and blood smear confirmed it as B. gibsoni infection.

The animal was treated with Clindamycin @ 25 mg/kg PO q 12h, Metronidazole @ 15 mg/kg PO q 12h and Doxycycline @ 5 mg/kg PO q 12h for 10 days and was advised for follow up after 3 days. On fourth day of treatment temperature was normal (101.80 F), parasitemia was reduced to less than 10%, there was clinical and hematological improvement. Owner was further advised to come after four days for blood test (Table 1).

Parameters	Day 1	Day 4	Day 7
Hb(g/dl)	7.7	8.5	10.1
Platelet count (lakhs/ µl)	0.86	0.88	1.2
TLC (10³/µl)	18.3	16.2	16.3
Neutrophils (%)	66	63	60
Eosinophils (%)	11	8	14
Lymphocytes (%)	22	29	25
Monocytes (%)	1	-	1
Creatinine (mg/dl)	0.9	-	1.3
SGOT (IU/L)	49	-	49
SGPT (IU/L)	23	-	45
ALP (IU/L)	120	-	352
Total bilirubin (mg/dl)	1.8	1.8	0.6
Direct bilirubin (mg/dl)	0.8	0.9	0.2
Total protein (g/dl)	6.6	-	7.0
Albumin (g/dl)	2.4	-	2.6
Globulin (g/dl)	4.2	-	4.4
Albumin : Globulin ratio	0.57:1	-	0.59:1

Table 1 Haematological and Biochemical findings in affected dog

Discussion

Conventional therapy for canine Babesiosis includes 2 doses of Inj. Imidocarbdipropionate @ 5mg/kg SC or IM 2weeks apart. It reduces morbidity and mortality but ineffective for clearance of B. Gibsoni. Other drug used to treat Babesiosis is single injection of Diminazeneaceturate @ 3.5mg/kg SC or IM, but this is potentially dangerous and shows a propensity to develop severe cerebral toxicity with classic cerebellar sulci haemorrhages. Moreover, B. Gibsoni are very difficult to clear with such conventional therapy and dogs usually become chronic carriers or present with recurrent episodes of acute babesiosis.⁴

The first treatment that has been shown to be effective against B. Gibsoni is a combination of atovaquone and azithromycin.⁵ Unfortunately Atovaquone is not available in India and it’s expensive for import. Moreover Possible Emergence of Drug-Resistant Variants of B. Gibsoni in clinical cases treated with Atovaquone and Azithromycin has also been reported.⁶

In the present case, combination of Clindamycin, Metronidazole and Doxycycline gradually reduced parasitemia levels and Clindamycin treatment reduced the clinical symptoms characteristic of Babesia infection, including anemia, anorexia, and listlessness also subsided. The effectiveness of clindamycin for treatment of B. Gibsoni infection has also been reported by several workers.^7,8 But it’s been suggested that clindamycin might not eliminate parasites rapidly from the peripheral blood but damages it which might stimulate humoral and cellular immunity against Babesia infection and results in improvement in clinical condition.⁹ So, a Combination therapy of clindamycin (CLDM), metronidazole (MNZ), and doxycycline (DOXY) as an efficacious alternative treatment strategy for B. Gibsoni infection with no adverse effects has been suggested.¹⁰

Thus, present clinical case concluded that a combination therapy of Clindamycin @ 25mg/kg, Metronidazole @ 15mg/kg and Doxycycline @ 5mg/kg for 10days is effective against B. Gibsoni with no adverse reactions and the dog showed uneventful recovery.