Hemostatic abnormalities in uncomplicated babesiosis (Babesia rossi) in dogs

The Diverse Pathogenicity of Various Babesia Parasite Species That Infect Dogs

Babesia species infect a very wide range of mammal hosts across the globe, and zoonotic infections are of growing concern. Several species of the Babesia genus infect dogs, and some of these cause significant morbidity and mortality. The Apicomplexan parasite resides within the red cell and infections result in direct damage to the host through intra- and extravascular hemolysis. An exuberant inflammatory response by the host to some species of Babesia parasites also results in significant collateral damage to the host. Canine infections have been the subject of many studies as the well-being of these companion animals is increasingly threatened by the spread of tick vectors and an increasingly mobile dog population. There are currently no widely available and effective vaccines, and effective treatment can be challenging. Understanding disease pathogenesis underlies the development of new treatments. The varying pathogenicity of the various Babesia parasite species that infect dogs offers an opportunity to explore the molecular basis for the wide range of diseases caused by infection with this parasite genus. In this review, we focus on what has been reported about the clinical presentation of Babesia-infected dogs in an attempt to compare the severity of disease caused by different Babesia species.

Serum proteome profiling of naturally acquired Babesia rossi infection in dogs

Babesiosis is a disease of significant medically and veterinary importance with worldwide distribution. It is caused by intra-erythrocyte protozoal parasites, with Babesia rossi causing the most severe clinical signs of all the large Babesia parasites infecting dogs. The disease can be clinically classified into uncomplicated and complicated forms with a wide range of clinical presentations from a mild, subclinical illness to complicated forms and death. The aim of this study was to assess serum proteomic profiles from dogs with babesiosis and healthy dogs using a label-based proteomics approach. Altogether 32 dogs naturally infected with B. rossi (subdivided into 18 uncomplicated cases and 14 complicated cases of babesiosis) and 20 healthy dogs were included. There were 78 proteins with significantly different abundances between the three groups of dogs. Elucidation of proteins and pathways involved in canine babesiosis caused by B. rossi have revealed key differences associated with haemostasis, innate immune system, lipid metabolism and inflammation. Shotgun proteomic profiling allowed identification of potential serum biomarkers for differentiation of disease severity in canine babesiosis caused by B. rossi. These findings may be applicable to the study of host-parasite interactions and the development of novel therapeutic targets.

Evaluation of cardiovascular biomarkers and histopathological alterations in cattle naturally infected by Babesia bigemina

Hemolytic anemia and secondary hypoxia are characteristics of naturally occurring Babesia bigemina infection in cattle. The anemic phase comes with cardiovascular insufficiency due to hypoxia-induced system dysfunction; but to date there is no description of cardiac damage in the infected animals. Therefore, this study was undertaken to investigate hematological parameters, biomarkers of cardiac function and D-dimer in 13 cattle infected with B. bigemina which were unresponsive to standard treatment. The animals were necropsied and the cardiac tissue was examined for histopathologic alterations. A significant parasitemia burden-dependent increase in the cardiac biomarkers and D-dimer level were recorded in the infected cattle compared to the control animals. Thrombocytes count was also significantly lower in the infected animals than the control. Both macroscopic and microscopic hemorrhage, mononuclear infiltrates, and myocardial necrosis were the evident histopathologic findings. These findings suggest that B. bigemina infection can potentially induce cardiac dysfunction in cattle. Furthermore, mechanistic studies should be conducted to understand the mechanisms beyond cardiac complications.

A clinical and pathological description of 320 cases of naturally acquired Babesia rossi infection in dogs

Babesia rossi causes the most severe clinical disease in dogs of all the babesia parasites. We included 320 naturally-infected dogs that presented for care at the Onderstepoort Veterinary Academic Hospital between 2006 and 2016. All dogs had mono-infections confirmed by multiplex PCR. The data allowed more accurate clinical classification of the disease and identified parameters that were associated with disease severity and death. Odds ratios for dying were significant (P < 0.05) for increased band neutrophil count, collapse at presentation; presence of cerebral signs; hypoglycaemia; hyperlactatemia; high urea, high creatinine; hyperbilirubinaemia; hypercortisolaemia; and hypothyroxinaemia. Joint component analysis confirmed that the variables with significant odds ratios grouped together with death. Yet, multivariate logistic regression was unable to identify a group of significant independent predictors of death. Receiver Operator Characteristic curves indicated that low total thyroid hormone, high bilirubin, high serum urea and high cortisol concentrations were the variables with the highest sensitivity and specificity for death. These data provide both the clinician and researcher with a set of easily-measured laboratory and clinical assessments to classify cases into those that are uncomplicated and those that are complicated. The disease is complex and multisystemic and probably involves mechanisms more proximal in the pathogenesis than those that have been evaluated.

Thromboelastographic platelet mapping in dogs with complicated Babesia rossi infection

BACKGROUND

Dogs with Babesia rossi infection display a normocoagulable thromboelastogram, despite being markedly thrombocytopenic, which is purportedly due to large-scale platelet activation. Thromboelastographic platelet mapping (TEG-PM) evaluates individual contributions of thrombin, fibrinogen, and platelets to clot formation, and may elucidate some of the pathomechanisms of thrombocytopenia-associated hemostatic alterations.

OBJECTIVE

This study investigated potential differences in TEG-PM variables in dogs with complicated B rossi infection compared with healthy controls, and whether these variables correlated with platelet activation indices.

METHODS

The maximum amplitude (MA) following thrombin generation (MA_Thrombin ) was determined using kaolin-activated TEG. The TEG-PM variables included MA following the addition of platelet agonists arachidonic acid (MA_AA ) and adenosine diphosphate (MA_ADP ), and MA due to fibrin alone (MA_Fibrin ). In addition, platelet indices and fibrinogen concentrations were determined.

RESULTS

Thirteen dogs with complicated B rossi infection and five healthy controls were included. The median MA_Fibrin and fibrinogen concentrations were significantly higher (P < 0.01 for both) and median platelet count was significantly lower (P < 0.01) in the babesiosis group vs the control group. No significant differences were found for MA_Thrombin and MA_AA/ADP . maximum amplitude due to fibrin alone was positively correlated with fibrinogen concentration (r = 0.735), mean platelet volume (r = 0.517), and mean platelet mass (r = 0.498), and negatively correlated with hematocrit (r = -0.685), platelet count (r = -0.476), and plateletcrit (r = -0.479) (P < 0.05 for all).

CONCLUSIONS

This study suggests that the presence of hyperfibrinogenemia offsets the severe thrombocytopenia associated with B rossi to result in normal thromboelastograms and lack of overt clinical bleeding.

LC-MS/MS analysis of the dog serum phosphoproteome reveals novel and conserved phosphorylation sites: Phosphoprotein patterns in babesiosis caused by Babesia canis, a case study

Phosphorylation is the most commonly studied protein post-translational modification (PTM) in biological systems due to its importance in controlling cell division, survival, growth, etc. Despite the thorough research in phosphoproteomics of cells and tissues there is little information on circulating phosphoproteins. We compared serum from 10 healthy dogs and 10 dogs affected by B. canis-caused babesiosis with no organ dysfunctions by employing gel-free LC-MS/MS analysis of individual samples and tandem mass tag (TMT) label-based quantitative analyses of pools, both supported by phosphopeptide enrichment. Results showed a moderate number of phosphorylated proteins (50-55), with 89 phosphorylation sites not previously published for dogs although a number of them matched phosphorylation sites found in mammalian orthologs. Three phosphopeptides showed significant variation in babesiosis-affected dog sera compared to controls: Serum amyloid A (SAA) phosphorylated at serine 101 (up-regulation), kininogen 1 phosphorylated at threonine 326, and fibrinogen α phosphorylated at both threonine 20 and serine 22 (down-regulation). 71.9% of the detected phosphorylated sites were phosphoserine, 16.8% phosphothreonine and only 11.2% phosphotyrosine residues. TMT label-based quantitative analysis showed α-2-HS-glycoprotein / Fetuin A to be the most abundant phosphoprotein (50-70% of all phosphoproteins) followed by kininogen-1 (10-20%). The alterations of phosphorylated proteins observed in canine babesiosis caused by Babesia canis suggest new insights into the largely neglected role of extracellular protein phosphorylation in health and disease, encouraging urgent further research on this area. To the best of our knowledge the present study represents the first attempt to characterize canine serum phosphoproteome.

Prevalence of canine Babesia and Ehrlichia co-infection and the predictive value of haematology

Canine babesiosis and ehrlichiosis are important tick-borne infections in South Africa. Many South African general veterinary practitioners perceive co-infection with Ehrlichia spp. as a common occurrence in dogs with babesiosis. Studies about the prevalence of co-infection in South African dogs are lacking. This retrospective study aimed to determine the prevalence of Ehrlichia co-infection in dogs with babesiosis. Additionally, the predicative value of specific haematological variables for co-infection was evaluated. The study population consisted of 205 dogs diagnosed with canine babesiosis presented to the Onderstepoort Veterinary Academic Hospital (OVAH) in 2006 and between 2011 and 2013. The Babesia-infected dogs were grouped based on presence or absence of an Ehrlichia spp. co-infection. Ehrlichia spp. co-infection was confirmed using polymerase chain reaction. Positive and negative predictive values (PPVs and NPVs) of leukopenia or thrombocytopenia for co-infection were also calculated. The prevalence of Babesia spp. and Ehrlichia spp. co-infection in this cohort of dogs was 2%. In the babesiosis dogs, the PPV of leukopenia for co-infection with Ehrlichia spp. was 1.3%, and the NPV 97.4%. Similarly, the PPV and NPVs of thrombocytopenia for co-infection were 2.1% and 100%, respectively. Co-infection with Ehrlichia spp. was a rare occurrence in dogs with babesiosis presented to the OVAH. Normal leukocyte or platelet counts confidently ruled out the presence of concurrent ehrlichiosis in this cohort of dogs. However, the diagnosis of Ehrlichia co-infection based on the presence of thrombocytopenia or leukopenia would have been associated with false positive results in more than 97.4% of cases.

Canine Babesiosis: Where Do We Stand?

Canine babesiosis is a tick-borne disease caused by protozoal haemoparasites of different Babesia species. Babesiosis is one of the most important globally extended and quickly spreading tick-borne infections of dogs. This comprehensive review gives an in-depth overview of Babesia species currently identified in dogs together with relevant vector tick species and their geographical distribution, life cycle and transmission of parasite. The main mechanisms in the pathogenesis of babesiosis are described and elucidated by recent literature overview. As Babesia infection causes a disease with very variable clinical manifestations, special attention is given to clinical signs, laboratory features and clinicopathological findings. The diagnosis of canine babesiosis by microscopy, serological and molecular methods is reviewed, together with recent advances in mass spectrometry based assays. Accurate detection and species recognition are important for the selection of the appropriate therapy, monitoring and prediction of the outcome of the disease. Finally, guidelines for the treatment and prevention of canine babesiosis are given.

Prognostic Markers in Acute Babesia canis Infections

Background

Canine babesiosis, caused by Babesia canis, is a prevalent and clinically relevant disease in Europe. Severe acute babesiosis is characterized by a high mortality but prognosis is not always correlated with clinical signs nor with the level of parasitemia.

Objective

This study evaluated prognostic markers associated with poor outcomes in acute Babesia canis infections.

Animals and Methods

We compared the results of routine laboratory profiles, hand‐held lactate and glucose analyzer, and the acute phase response in 2 groups of naturally infected dogs (7 survivors and 8 nonsurvivors). Samples were collected at the time of first admission and before any treatment. Subsequently, the course of prognostic markers was followed in 3 dogs experimentally inoculated with B. canis.

Results

Nonsurvivors showed significantly higher concentrations of lactate, triglycerides and phosphate and lower hematocrit, leukocyte counts, total serum protein concentrations, and thrombocyte counts when compared to survivors. All nonsurvivors (8/8) had hyperlactatemia, whereas most survivors (6/7) had values within the reference range. All survivors had leucocyte counts within the reference range, unlike the nonsurvivors, which showed leukopenia. During the course of acute babesiosis, the variables serum lactate, triglyceride, and phosphate concentrations, and thrombocyte count only exceeded a prognostic threshold during acute crisis.

Conclusions and clinical importance

Poor outcome in acute B. canis infection is indicated by changes in the laboratory profile. Intensive care should be considered for dogs presenting with moderate anemia, severe thrombocytopenia, mild to moderate leukopenia, hyperlactatemia, moderately increased serum phosphate, and triglyceride concentrations, and moderately decreased total serum protein concentrations.

Canine babesiosis: a perspective on clinical complications, biomarkers, and treatment

Canine babesiosis is a common tick transmitted disease of dogs worldwide. A number of Babesia sp. can infect dogs and the spectrum is increasing as molecular methods are developed to differentiate organisms. Clinical signs are generally attributed to hemolysis caused by the organisms in the erythrocytes but in some animals with some Babesia spp. there can be an immune mediated component to the anemia and/or a severe inflammatory reaction associated. This complicated form of canine babesiosis is associated with high morbidity and mortality. A variety of clinical markers has been investigated to enable clinicians to provide more accurate prognoses and adapt their treatments which vary according to the infecting species. In this review, we discuss the taxonomy, clinical signs, diagnostic imaging, clinical biomarkers, treatment, and prophylaxis of one of the most common and important diseases of dogs worldwide.