Prevalence and risk factors of hypoglycemia in virulent canine babesiosis

Combined Untargeted and Targeted Metabolomics Approaches Reveal Urinary Changes of Amino Acids and Energy Metabolism in Canine Babesiosis With Different Levels of Kidney Function

Canine babesiosis is a tick-borne disease with a worldwide distribution, caused by the haemoprotozoan parasites of the genus Babesia. One of the most prevalent complication is acute kidney injury, and an early diagnosis of altered kidney function remains a challenge for veterinary practice. The aim of this study was to assess the urine metabolic profile from dogs with babesiosis and different degree of kidney function using untargeted and targeted MS-based metabolomics approaches. In this study, 22 dogs naturally infected with Babesia canis and 12 healthy dogs were included. Untargeted metabolomics approach identified 601 features with a differential abundance between the healthy group and groups of dogs with babesiosis and different level of kidney function, with 27 of them identified as a match to known standards; while targeted approach identified 17 metabolites with significantly different concentrations between the groups. A pattern of significantly altered metabolites referring to the inflammatory host response, oxidative stress, and energy metabolism modulation in babesiosis was presented. Our findings have demonstrated that kidney dysfunction accompanying canine babesiosis was associated with changes in amino acid metabolism, energy metabolism, fatty acid metabolism, and biochemical pathways such as urea cycle and ammonia detoxication. These findings will enable the inclusion of urinary markers for the detection and monitoring of renal damage in babesiosis, as well as in other similar diseases.

Experimental Babesia rossi infection induces hemolytic, metabolic, and viral response pathways in the canine host

Background

Babesia rossi is a leading cause of morbidity and mortality among the canine population of sub-Saharan Africa, but pathogenesis remains poorly understood. Previous studies of B. rossi infection were derived from clinical cases, in which neither the onset of infection nor the infectious inoculum was known. Here, we performed controlled B. rossi inoculations in canines and evaluated disease progression through clinical tests and whole blood transcriptomic profiling.

Results

Two subjects were administered a low inoculum (10⁴ parasites) while three received a high (10⁸ parasites). Subjects were monitored for 8 consecutive days; anti-parasite treatment with diminazene aceturate was administered on day 4. Blood was drawn prior to inoculation as well as every experimental day for assessment of clinical parameters and transcriptomic profiles. The model recapitulated natural disease manifestations including anemia, acidosis, inflammation and behavioral changes. Rate of disease onset and clinical severity were proportional to the inoculum. To analyze the temporal dynamics of the transcriptomic host response, we sequenced mRNA extracted from whole blood drawn on days 0, 1, 3, 4, 6, and 8. Differential gene expression, hierarchical clustering, and pathway enrichment analyses identified genes and pathways involved in response to hemolysis, metabolic changes, and several arms of the immune response including innate immunity, adaptive immunity, and response to viral infection.

Conclusions

This work comprehensively characterizes the clinical and transcriptomic progression of B. rossi infection in canines, thus establishing a large mammalian model of severe hemoprotozoal disease to facilitate the study of host-parasite biology and in which to test novel anti-disease therapeutics. The knowledge gained from the study of B. rossi in canines will not only improve our understanding of this emerging infectious disease threat in domestic dogs, but also provide insight into the pathobiology of human diseases caused by Babesia and Plasmodium species.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12864-021-07889-4.

Prevalence of canine babesiosis and their risk factors among asymptomatic dogs in the federal capital territory, Abuja, Nigeria

Babesia sp. are intracellular parasitic organisms that affects mainly the red blood cells of most mammals, causing the disease known as babesiosis, and transmitted by ticks. Babesisosis is potentially fatal and a major disease of dogs in Nigeria. Therefore, active and routine surveillance is recommended. In this study, the infection was investigated among apparently healthy domestic dogs in six Area Councils of the Federal Capital Territory (FCT), Abuja, Nigeria with the aim of determining the prevalence of the infection and the associated risk factors. Blood samples were collected from dogs (n = 480) at randomly selected households, from September 2015 to August 2016. Data regarding sampling location, sex, age, breed, use, presence or absence of ticks were recorded. Blood smears were prepared, stained with Geimsa stain, and examined under light microscope for Babesia sp. The results showed an overall prevalence of 10.8% Babesia canis infection. The prevalence among dogs examined in the six Area Councils were 6.3%, 12.5%, 10.0%, 12.5%, 11.3%, and 12.5 % for Abaji, AMAC, Bwari, Gwagwalada, Kuje and Kwali Area Council, respectively. The prevalence was highest (12.5%) among dogs from Kwali, AMAC and Gwagwalada, and lowest 5 (6.3%) among dogs from Abaji. Of the infected dogs, 13.7% were females and 8.3%, males. Dogs between 12 < 36 months old had the highest (17.0%) prevalence of infection while those of >60 months of age had the lowest (4.5%). Based on breed, the infection was more prevalent among exotic dogs (12.9%) than cross breeds (9.4%). While none of pet dogs were positive for Babesia canis, prevalence of 11.1% and 11.3% were recorded for guard and hunting dogs, respectively. Tick infestation was recorded for 254 dogs of which 17.3% had Babesia canis while only 3.5% of 226 non-infested dogs were Babesia positive. Babesia infection during the rainy season was 14.6% while 3.5% of dogs were positive during dry season. The data on monthly prevalence showed that August and September had the highest (13.5%) prevalence while January and February had the lowest (2.0%). We conclude that the canine babesiosis in the FCT was significantly dependent on age, use of dogs, tick infestation, and season. Therefore, priorities should be given to these factors while instituting control measures against the infection.

Vitamin D status in dogs with babesiosis

Canine babesiosis is a virulent infection of dogs in South Africa caused principally by Babesia rossi. Hypovitaminosis D has been reported in a wide range of infectious diseases in humans and dogs, and low vitamin D status has been associated with poor clinical outcomes. However, the relationship between vitamin D status and canine babesiosis has not been investigated. The objective of this study was to examine the relationship between the presence and severity of B. rossi infection and vitamin D status of infected dogs. Owners with dogs with a confirmed diagnosis of B. rossi infection and of healthy control dogs were invited to enrol onto the study. Vitamin D status was assessed by measurement of serum concentrations of the major circulating vitamin D metabolite, 25-hydroxyvitamin D (25[OH]D). Dogs with babesiosis (n = 34) had significantly lower mean serum 25(OH)D concentrations than healthy dogs (n = 24) (37.76 ± 21.25 vs. 74.2 ± 20.28 nmol/L). The effect of babesiosis on serum 25(OH)D concentrations was still significant after adjusting for any effect of age, body weight and sex. There was a negative relationship between serum 25(OH)D concentrations and disease severity in dogs with babesiosis. Serum concentrations of creatinine and alanine aminotransferase and time to last meal were not associated with serum 25(OH)D concentrations in dogs with babesiosis. In conclusion, dogs with Babesia rossi infections had lower serum 25(OH)D concentrations than healthy dogs. The inverse correlation between 25(OH)D concentrations and the clinical severity score indicate that hypovitaminosis D might be a helpful additional indicator of disease severity.

Pathophysiology and aetiology of hypoglycaemic crises

Hypoglycaemia is a common, life-threatening complication that occurs as a component of a wide variety of disease processes. Despite its frequent occurrence, information concerning the aetiology, characteristics and outcomes of hypoglycaemic crises in veterinary medicine is limited. This review summarises the current understanding of the pathophysiology of hypoglycaemia, the body's counter-regulatory response, underlying aetiologies, diagnosis and treatment. Disease mechanisms are discussed and published evidence in veterinary literature regarding prognostic indicators, prevalence, diagnosis and treatment is examined for hypoglycaemia-related disease processes including insulinoma, glucose-lowering toxins and medications.

MCP-1, KC-like and IL-8 as critical mediators of pathogenesis caused by Babesia canis

Canine babesiosis caused by the intraerythrocytic protozoan parasite Babesia canis is a tick-borne disease characterized by a host response that involves both cellular and humoral immunity. This study focuses on the secretion of cytokines Granulocyte-Macrophage Colony-Stimulating Factor (GM-CSF), Keratinocyte Chemotactic-like (KC-like), Interleukins (IL)-2, IL-7, IL-8, IL-10, IL-15, IL-18 and Monocyte Chemotactic Protein-1 (MCP-1) in babesiosis caused by Babesia canis upon treatment with Imizol®. We assessed time dependent changes in cytokine levels and tested whether these changes correlate with pathogenesis of the disease. Sixteen healthy dogs and 31 dogs infected with Babesia canis, of which 18 showed complications, were treated with Imizol®. One dog died during the study (3.2%). Longitudinal study was perfomed by monitoring dogs at the first day of presentation (day 1) and 6 days later (day 7). Our results show that higher MCP-1 levels on day 1 are positively associated with the occurrence of complications, (complicated vs. uncomplicated; p = 0.00016). A similar pattern was observed for KC-like on day 1 (p = 0.0326) and day 7 (p = 0.044). Moreover, babesiosis caused by B. canis produced a steady increase in IL-8 levels with a moderate to strong negative correlation with erythrocyte counts and hematocrit in uncomplicated diseased dogs only (Spearman's rank correlation coefficient rs = -0.582 and rs = -0.598 respectively). Like for MCP-1, KC-like levels also differed in complicated and uncomplicated diseased dogs on day 1 (p = 0.03236) and day 7 (p = 0.044). Furthermore, KC-like levels were strongly correlated with IL-8 levels (rs = 0.663-0.7) and non-segmented neutrophil counts (rs = 0.572-0.732) in both diseased groups. Analysis of ROC suggests the use of serum levels of MCP-1 and IL-7 as predictors of the occurrence of complications with an AUC of 0.906 and 0.896 respectively and linear combinations of MCP-1, KC-Like, IL-7 and GM-CSF with values up to AUC = 0.983. Cytokine cluster analysis presented in this study can contribute to a better understanding of the pathogenesis of babesiosis and serve as a prognostic tool for the early detection of cases with highest likelihood of developing complications. Overall, our studies show that infection by B. canis elicits a cytokine pattern that is distinct from that observed with B. rossi, and that some of the inflammatory mediators can be useful to predict complications. Our results also suggest targets for the development of novel therapeutic strategies in babesiosis caused by B. canis.

A review of canine babesiosis: the European perspective

Canine babesiosis is a significant tick-borne disease caused by various species of the protozoan genus Babesia. Although it occurs worldwide, data relating to European infections have now been collected for many years. These data have boosted the publication record and increased our working knowledge of these protozoan parasites. Both the large and small forms of Babesia species (B. canis, B. vogeli, B. gibsoni, and B. microti-like isolates also referred to as "B. vulpes" and "Theileria annae") infect dogs in Europe, and their geographical distribution, transmission, clinical signs, treatment, and prognosis vary widely for each species. The goal of this review is to provide veterinary practitioners with practical guidelines for the diagnosis, treatment and prevention of babesiosis in European dogs. Our hope is that these guidelines will answer the most frequently asked questions posed by veterinary practitioners.

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.

Serum canine pancreatic-specific lipase concentrations in dogs with naturally occurring Babesia rossi infection

Babesia rossi is the cause of a highly virulent multisystemic disease with a variable outcome, which is a reliable model of systemic inflammatory response syndrome (SIRS). The objective of this study was to determine the concentration of canine pancreatic-specific lipase (cPL) in a population of dogs with naturally acquired B. rossi infection. In addition, the associations between serum cPL and death and SIRS status were examined. An observational study recruited 87 dogs diagnosed with B. rossi infection and serum cPL concentrations were measured daily until discharge or death. The median concentration of serum cPL was 124.0 µg/L (interquartile range: 51.0 µg/L - 475.5 µg/L) on admission (n = 87) and 145.5 µg/L (62.3 µg/L - 434.0 µg/L) on day two of hospitalisation (n = 40). Twenty-four dogs (28%) had a serum cPL concentration within the diagnostic range for pancreatitis (> 400 µg/L) at admission with 13 dogs (32.5%) presenting as such on the second day of hospitalisation. The median concentration of serum cPL in dogs with SIRS was 158 µg/L (interquartile range: 52.5 µg/L - 571.5 µg/L; n = 53), which was significantly higher than in those without SIRS (75 µg/L; 50.3 µg/L - 131.8 µg/L; n = 32) (P = 0.018). This study demonstrated that an unexpectedly high number of dogs diagnosed with naturally acquired canine babesiosis had a serum cPL concentration within the diagnostic range for acute pancreatitis and a significantly higher serum cPL concentration was found in dogs that were classified as having SIRS.

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.

Clinical and laboratory findings of Babesia infection in dogs

Canine babesiosis is a worldwide tick borne disease. Dogs with fever, in appetence and enlarged lymph nodes were screened for the presence of haemoprotozoan parasites during the one year period of study at T.V.C.C., C.V.Sc., Proddatur. Based on the stained peripheral blood smears examination, six dogs were found to be affected with babesiosis. Clinical examination of the dogs revealed ticks over the body, congested conjunctival mucus membranes, dullness, fever, tachycardia, tachypnoea in all the dogs. Some of the dogs had icterus, lymphadenopathy, haemoglobinuria. Laboratory examination of the clinical samples revealed reduction in haemoglobin concentration, erythrocyte count, platelet count, serum total protein, serum albumin and glucose levels. Increased serum SGPT, creatinine, BUN levels were recorded. Dogs were treated with inj. Diminazene aceturate (Berenil RTU) @ 5 mg/kg body weight, single dose along with supportive and symptomatic therapy in individual cases.

Why is Southern African canine babesiosis so virulent? An evolutionary perspective

Canine babesiosis is a common, highly virulent disease in Southern Africa with even pups and juveniles being severely affected. This contrasts with bovine babesiosis, for example, where host, parasite and vector co-evolved and young animals develop immunity after infection without showing clinical signs. Babesia rossi, the main causative organism of canine babesiosis in sub-Saharan Africa, was first described from a side-striped jackal (Canis adustus) in Kenya. Although data are meagre, there is evidence that indigenous African canids, such as jackals and wild dogs (Lycaon pictus), can harbour the parasite without showing untoward effects. Dogs are not indigenous to Africa. The vast majority of dogs presented at veterinary facilities in South Africa represent recently introduced European, Asian or American breeds. The contention is that B. rossi is a new challenge to which these dogs have not adapted. With intensive treatment of clinical cases, natural selection is effectively negated and the status quo will probably be maintained indefinitely. It is postulated that Babesia vogeli, which frequently results in unapparent infections or mild manifestations in dogs, represents or is closely related to the ancestral form of the canine parasite, possibly originating from wolves (Canis lupus).

Glucose, lactate, and pyruvate concentrations in dogs with babesiosis

OBJECTIVE

To document changes in glucose, lactate, and pyruvate concentrations in dogs with severe or complicated babesiosis; assess relationships among glucose, lactate, and pyruvate concentrations in those dogs; and compare clinical and laboratory variables in dogs with and without hypoglycemia and hyperlactatemia.

ANIMALS

20 dogs with naturally developing severe or complicated babesiosis.

PROCEDURE

Samples and measurements were obtained before treatment was initiated. Babesiosis was diagnosed by examination of blood smears. Arterial blood pressure measurement, parasite quantification, CBC count, serum biochemical analysis, urinalysis, venous blood gas analysis, and acid-base determination were performed. Glucose, lactate, and pyruvate concentrations were measured in samples of venous blood.

RESULTS

We detected a significant negative correlation between glucose and lactate concentrations. Glucose, lactate, and pyruvate concentrations all differed significantly between dogs that died and those that survived. Three of 5 dogs that died had concurrent hypoglycemia, hyperlactatemia, and hyperpyruvatemia. Hypoglycemic dogs differed significantly from normoglycemic dogs with regard to lactate, urea, and bicarbonate concentrations; lactate-to-pyruvate ratio; percentage parasitemia; and PCO2. Dogs with hyperlactatemia differed significantly from normolactatemic dogs with regard to clinical collapse; alanine transaminase activity; concentrations of bilirubin, urea, creatinine, and bicarbonate; percentage parasitemia; and PCO2.

CONCLUSIONS AND CLINICAL RELEVANCE

Abnormal carbohydrate metabolism is commonly evident in dogs with severe or complicated babesiosis and is often associated with changes in other clinical and laboratory variables. Significant differences were found between survivors and nonsurvivors. Hypoglycemia should be assessed and aggressively treated in dogs with babesiosis. Lactate concentration can be used as an indicator of disease severity.