Page 51 – Second Chance AIHA Dogs

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Keymaster

Clara,
If I saw the CBC and chem screens I could tell you for sure exactly what transpired. But yes, the immune system can be triggered by the tick disease and attack its own red blood cells. IMHA. Some of the tick diseases are a common trigger. As I said, Lyme is not one of those but never-the-less has its own serious implications.

The first experience some veterinarians had with the tick disease Ehrlichiosis were with military German Shepherds returning from Viet Nam with a disease they called canine hemorrhagic fever. These dogs were very sick. They had serious autoimmune hemolytic anemia combined with thrombocytopenia, a severe shortage of platelets. This is the most dangerous condition. A dog that does not have enough platelets cannot control internal bleeding via clotting. This is extremely serious and can lead to a condition called DIC disseminated intravascular coagulation. Without intervention a dog can succumb to this condition.

A tick disease can even trigger the immune system to begin attacking the precursor cells in the bone marrow so that the dog stops making red blood cells or platelets or even white blood cells. This is a particularly difficult condition to treat.

So at some point Hector’s immune system was challenged by the Babesiosis and reacted by attempting to destroy the tick disease by destroying the red blood cells. IMHA. The question is were there co-infections with other tick diseases? Did they test for them?

It’s important to think of AIHA and IMHA as complex conditions that can have more than one trigger. For instance a pure bred dog from a good line that has no health issues and is exposed to Babesiosis may be able to throw it off with mild symptoms. An older dog that has been ill for a while and is stressed from constant pain will likely not be successful in fighting it off.

All kinds of things impact how our dog’s immune system functions. The big ticket items for dogs are inherited genetics, general health, age, diet, stress, hormones (sex), viruses, bacteria, thyroid health and vaccinations. Dogs can also be affected by things like bee stings, snake or spider bites. They can also eat inappropriate things that can lead to hemolytic anemia or cause serious allergic reactions. Exposure to several of these at one time can set off an autoimmune attack, not only on RBC but on tissues and organs. We can probably never know all the triggers that led our dog to develop IMHA.

Certain things that might challenge the immune system at this point in Hector may weaken it and that might lead to a relapse of Babesiosis. Sometimes with these dogs you just have to take more care with them.

In humans it is well known that older folks who have a major accident like a fall or other health issue tend to develop painful shingles. The immune system that was protecting them all their life from their childhood chicken pox virus (living in the roots of the spinal cord nerves) let down it’s guard and shingles erupted.
my best
patrice

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Patrice

Keymaster

Clara,
Yes of course I understand your confusion. Please read the articles I am linking to.

There is definitely a relationship to the Babesia gibsoni entering the red blood cells and the reaction by the immune system to attack its own red blood cells. This is autoimmune hemolytic anemia, “intolerance of self.” Nearly every dog with Babesia gibsoni goes through an acute stage of some level of hemolytic anemia. The spleen is also active in this immune process, targeting RBC that contain this tick disease and destroying them in an attempt to get to the tick disease. That is why I say the spleen is the organ of control for Babesia.

This is referred to as IMHA, immune mediated hemolytic anemia. Different than Primary hemolytic anemia, This Secondary hemolytic anemia is caused by some condition. This can be variable but in Hector’s case it is directly related to the infection with Babesia gibsoni. Treating the tick disease is the appropriate way to stop the hemolytic anemia. If the IMHA is severe and there is a very low PCV, then the dog may also need treatment with transfusions and even the application of prednisone and cyclosporine in an attempt to halt the active immune mediated hemolysis.

The real goal, however, is to eradicate the disease. But to save a dog’s life, this other approach may also be taken. If the dog goes into a carrier state, does this mean they are essentially clear of the disease and will not be affected by it anymore? I don’t know that for sure. Dr. Holland would know more about that. But it is clear that Hector’s immune system stepped up and actually did fight the disease in the spleen. Otherwise he may not have survived the original acute stage of the disease.

Anemia really is only a sign, not a disease. The cause of the anemia must be identified and treated if possible. Tick disease is an insidious direct cause of autoimmune hemolytic anemia. The goal of this disease (any tick disease) is to find a place in the body to reproduce and the RBC is the perfect location.

Lyme Disease is also a tick borne disease, but it tends to seek out body tissues rather than RBC and it causes orthopedic disease, neurological symptoms, nephritis of the kidneys etc.

Each tick disease has a different set of symptoms and in fact many dogs can be co-infected with several diseases at once. This can lead to great difficulty in diagnosis and treatment. What if a dog is infected not only with Babesia but also with Ehrlichia? The only effective treatment for Ehrlichia is doxycycline, which doesn’t do much to clear Babesia and vice versa for the treatments used with Babesia.

The diagnostics for these diseases are well known, the treatments are less standard. There is a disagreement among experts whether the high dose, long treatment doxycycline protocol that many, including Tick-L, recommend is actually necessary and effective. However, on Tick-L the saying goes, “treat hard and long to avoid tickling the disease.” Get it the first time to avoid relapses. Dogs that relapse have a harder time and do very poorly.

So having a known carrier state with Babesia gibsoni does lead one to believe that there could be a relapse. I am no expert in this that is why I hope you are able to get more information from vets who are experts. I want to know what they say.

We have discussed this hundreds of times on Tick-L over the years and Gil’s information on the link I sent you is the highlight of those conversations. What we have all agreed over time is that there is just not enough research on dogs and tick disease. Period. And the sad thing for me about this is that many dog owners are not even aware of the dangers of tick disease. I stay active in the canine tick disease world just so I can specifically catch those dogs that are experiencing IMHA. I know how serious it is and I know most of the diagnostic test results that point to this. I know what the treatments are.

The tough part in the end is convincing owners to test their dogs and getting past vets that don’t think tick disease is an issue. You are one of the lucky ones who not only tested for it, your vet actually treated it properly.

does this help? do you have more questions?
my best
patrice

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Patrice

Keymaster

Clara,

Thank you for finding the lab results. There is an important distinction between the two species: Babesia gibsoni and Babesia Canis. First is the difference in size when viewed under a microscope, thus Babesia canis is referred to as “large” Babesia whereas Babesia gibsoni is referred to as “small” Babesia. The difference appears to be related to where the strains originated from(and thus the difference in the virility of the strain.) So how this disease plays out in dogs is different depending on the strain.

I know I already posted the link to an article that discusses this, but I want to pull out some important information to read about this strain for everyone else so they can follow along.

Note that while you are located in Minnesota, the following information about the location of Babesia gibsoni puts you right next door to Wisconsin, where this strain has been reported since 1999. Ticks don’t necessarily honor state lines, and with warmer weather worldwide, it is pretty likely that ticks have migrated across state lines since 1999 so that they carry Babesia gibsoni in your state as well. In addition you will note that these cases have appeared in American Pit Bull and American Staffordshire terriers.

http://veterinarynews.dvm360.com/canine-babesiosis-continues-create-challenges-practitioners

“In 1999, Babesia gibsoni infection was reported in nine dogs from North Carolina. Since that time, infections have been reported in dogs from Oklahoma, Alabama, Georgia, Indiana, Missouri, Wisconsin, Michigan and Florida. Almost all of the reported cases have occurred in American Pit Bull terriers or American Staffordshire terriers.”

“This small Babesia organism appears to be identical to the original pathogen from Okinawa, Japan, that is endemic in Northern Africa, the Middle East and Southern Asia. The parasite appears to be a rapidly emerging pathogen in the United States that is currently endemic in the Pit Bull population in diverse areas of the country east of the Mississippi River.”

“Researchers at Oklahoma State University experimentally infected dogs with blood from two naturally infected Pit Bulls from Oklahoma. One of the source dogs had been treated twice with imidocarb but still had detectable organisms in the blood. Parasitemia was detected in all dogs within one to five weeks after inoculation and peaked at four to six weeks before declining. The degree of parasitemia was 1.9-6 percent, except in the splenectomized dog which reached 16.4 percent before euthanasia. All dogs developed regenerative anemia and marked thrombocytopenia within one to three weeks post innoculation. Clinical signs included lethargy, fever and pallor, but were mild or inapparent in some dogs. Parasitemia persisted for three to four weeks and then became undetectable as the dogs apparently entered a carrier state.”

“Initial reports of the Babesia gibsoni organism isolated from dogs in the Midwest and Southeast United States seem to indicate that it is not as pathogenic as the California isolate. Although acute infection is associated with severe anemia and thrombocytopenia, many dogs survive the acute phase and become chronic carriers. A recent study reported that 55 percent of American Pit Bull dogs tested in Alabama were subclinically infected. Dogs with subclinical infections had lower hematocrits and platelet counts and increased mean platelet volume compared to dogs that were negative. The tendency to relapse or exhibit signs of vasculitis, protein-losing nephropathy or hepatic failure that is seen in dogs infected with the California isolate has not been reported in dogs chronically infected with the Southeast/Midwest United States isolate.”

So there you have it. There is a chronic carrier state and most likely Hector is one of these dogs. What to do? Well, your best resource is Dr. Holland. This is all she does every day, all year round. If she knows a successful treatment protocol she will tell you. You may find other owners on the internet that have found a successful treatment protocol. Many vets apply clinical experience to treating dogs with intractable conditions.

As you have read above, those dogs that were used in research and infected with this, and had their spleens removed, were far less able to clear the Babesia gibsoni. If you can determine if the spleen is otherwise healthy besides being enlarged, it may be in your best interest to leave it be. This is a decision that you and your vet need to make together, my opinion matters little in this.

I think you have done a fabulous job at maintaining him in a stable state. You are welcome to stay here on this forum for friendship and support!

my best, patrice

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Patrice

Keymaster

It is a big complex to describe, and I am a bit tired at this point, but the lowish PCV most likely has two connections.

One is that Babesiosis is a disease of red blood cells. It is possible that this disease, as like many other tick diseases, does not restrict infection to just the RBC in circulation. All body tissues are fair game after all this time. Thus, the reason they say that dogs can be carriers. You will see this mentioned specifically with Pit Bulls. So the bone marrow, which is considered an organ, is susceptible to infection as well.

In addition there is a condition called Anemia of Chronic Disease. Trying to shorten this for easy understanding, the body when confronted with invaders like bacteria, viruses or even parasites may attempt to alter the environment in the body to make it less hospitable to these invaders. What research is beginning to reveal is that the body most likely modifies and moderates the amount of iron available to the body in order to restrict it to bacteria etc that also need iron for survival. So the thought goes, reduce iron and the bacteria etc fail to thrive.

However this also shorts the bone marrow from receiving the proper amount of iron to make new red blood cells. So you may find a moderate chronic anemia as a symptom of chronic disease. A PCV of 34% is fine. Chance, once his spleen was removed never topped over about 36-38%. That is acceptable.

I think in addition to Dr. Dodds, who will provide you with more information on the blood aspects of this condition, you probably should become familiar with Dr. Holland at Protatek Labs, she is the Dr. Dodds of the tick world and has been known to take phone calls from owners who have questions about testing and treatments.
https://sites.google.com/site/tickbornediseaseindogs/testlaboratories

Here is a part of that page I posted the link to that discusses Dr. Holland’s opinion of how to view titers and continued testing.
“Continuing, low positive titer for B. canis

EG was actively involved in greyhound adoption for many years. Many of the dogs her group placed were positive for B. canis and of the 600 they titered, more dogs than not had titers as low as 1:80, possibly indicating exposure only. E tells me the ideal thing to do with low positive dogs showing no symptoms is to run a number of PCRs to see if any of the blood serum samples has the B. canis organism in it. Otherwise, continue doing regular bloodwork and the occasional titer to see if there are any changes.

In 1996, E spoke with Dr. Cynthia Holland of ProtaTek about one of her own greyhounds, Molly, who was asymptomatic but continued to have a low titer for B. canis. She asked Dr. Holland the question she had heard from many others: What do I do now?” Read the answer here:
https://sites.google.com/site/tickbornediseaseindogs/b-canis-what-now

By the way it is important to know whether Hector was infected with Babesia canis or Babesia gibsoni, Do you know what your test results showed?

my best
patrice

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Patrice

Keymaster

Clara,
I am really really sorry to read this. You have had quite a time with Hector. I do have some good information for you to research. You should be commended for all you have done up to this point. You must love Hector very much.

What is important to understand is the the spleen in considered to be the organ that is most active in fighting Babeseosis. Without a spleen, humans and dogs alike are virtually defenseless against this tick disease. So in fact, a relatively healthy human or dog exposed to this should, by all accounts, be able to fend off the disease and recover. The US recommends that humans that have had a splenectomy do not travel abroad for this reason so it stands to reason that dogs should not either. My dog Chance had a splenectomy and my vet warned me of this danger of his inability to fight this tick disease.

What can alter this ability to fight it off? Well, other illness can reduce the ability to muster the immune system properly to fight, say perhaps co-infection with another tick disease at the same time. The fact that his spleen was enlarged is a good clue that it has been working hard to fight this for a very long time. And subsequently, his marrow is having a hard time making blood right now too. This is a very specific cause for this non-regenerative anemia.

The attending vet may feel like they are tasked to fight two things, the autoimmune anemia and/or the tick disease and it is hard to figure out what to do in this case. It is definitely not straightforward. But the reality is if a dog is not making blood there is only so long that you can allow this to continue. And if they decide to forgo the immunosuppressive treatments in order to allow the immune system to fight the tick disease, there is a risk of death from anemia before you have successfully completed the treatment for the tick disease. So it may be appropriate for an expert to treat for both conditions simultaneously.

Your vet has missed one particularly highly recommended treatment for Babeseosis, Imidocarb Dipropionate (Imizol). In fact, I would, if this were me, try this next. It is quite expensive and requires two shots to be effective.
http://www.merck-animal-health-usa.com/products/130_163327/productdetails_130_163631.aspx

But first I want you to read one website page very very carefully and follow all the links provided on this page carefully. Gil Ash developed this website over many years while on a tick disease email list called Tick-L. I have also been on this list a long time. It is moderated by a scientist and there is a vet who helps from time to time with discussions. Gil started collecting this information we talked about and gathered from many sources. She is a consummate researcher and her information is the best on tick disease.
https://sites.google.com/site/tickbornediseaseindogs/babesiosis

The most important information for you on this page may be that a dog with Babesiosis can remain sub-clinically infected and may have relapses.

Whether or not to remove the spleen is extremely complicated. It is not healthy to have a diseased and necrotic spleen, but is it still protecting Hector to a certain extent from the Babesiosis? I think in this case you need an expert opinion from a veterinarian hematologist. I recommend you request a consultation with Dr. Jean Dodds of Hempet.org. Her on-line consultation form is easy to use and the cost in inexpensive. She will review all your paperwork, your detailed history and will give you an expert opinion on the continued treatment.
https://labordatenbank.com/cake/hemopet/onlineorders/hemopet_add

Getting Hector to better health is the critical matter. The healthier he is the better he is able to fight this disease, as he may be a carrier for life. His life should be one of low stress and generally reduced exposure to disease. Dr. Dodds can discuss this with you.

If you have questions, please ask away.
my best
patrice

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