Tick bite fever...

[Mairi]

has anyone had the misfortune to experience anaplasmosis ? My BC of 10 months was bitten by a tick carrying the disease and has had a fever of between 39.4 to 41.5 for almost 3 weeks now. She was recovered in a clinic for the first six days and then sent home with the relative anti biotics. She now has polyarthritis and is very reluctant to move. Her appetite returns when her temp goes down slightly and she does drink. On the vets advice I gave her cortisone (subcutaneous) and had her on a Ringer solution drip (twice a day for 2 days) Im in daily contact with the vet who has told me that I will have to be patient and that it could take weeks before she's better. Im beginning to tear my hair out and cant bear to see her like this. Any input greatly welcomed.

 

[JoanneF]

Sorry no, but didn't want to read and run. @leashedForLife may be able to suggest something, she will see I have tagged her.

 

[Josie]

Sorry to hear this @Mairi it’s awful when our dogs are not well :-(

I hope she gets better soon

 

[Whippylove]

Sad to hear
I hope she recovers soon x

 

[Violet Turner]

Hi, this link may give you some insight into the condition - Anaplasmosis in Dogs

 

[leashedForLife]

QUOTE, Mairi:

has anyone had the misfortune to experience anaplasmosis ?
My 10-MO BC was bitten by a tick carrying the disease, & has had a fever of between 39.4 to 41.5 for almost 3 weeks now. She [was treated as a resident] in-clinic for the first six days, then sent home with [Rx] antibiotics.
She now has polyarthritis, & is very reluctant to move. Her appetite returns when her temp goes down slightly, and she does drink.
On the vet's advice, I gave her sub-Q cortisone &... a Ringer solution drip (twice a day, for 2 days). I'm in daily contact with the vet, who's told me that I will have to be patient - it could take weeks before she's better.
I'm beginning to tear my hair out, & can't bear to see her like this. Any input greatly welcomed.
____________________________
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oh, i'm so sorry to hear this! - poor dog, & poor U.
We don't have this particular Rickettsial bacteria disease in the USA, but we have other, similar tick-borne diseases - Erlichiosis being one, which is also tick-borne & like Anaplasmosis, can infect dogs, humans, & cats.


I looked up UK Anaplasmosis, & this is the current SOP:
____________________________________________
"Doxycycline (10 mg/kg SID PO) is the treatment of choice for A. phagocytophilum-associated disease. The optimum treatment duration is not known, but 2 weeks of doxycycline treatment is usually sufficient. Most dogs improve within 24 to 48 hours of starting treatment. Supportive care - e.g, IV-fluid therapy - may be required for some dogs. Repeat PCR testing can be performed following treatment, though it is not known if a negative (undetected) result should be expected in this situation."

source:
Anaplasma phagocytophilum | Langford Vets

U & Ur dog were very unlucky - per that link, A.p has been found in less than 1% of UK ticks... maybe U hit a local hotspot, with more infected ticks than usual, but it only takes 1 bite from an infected tick to pass the bacterium. The ONLY good news is that daily tick-checks can prevent infection, if U find & remove all the ticks - it takes 36 to 48-hrs for the pathogen to be passed, & if U get the tick off B4 that, the dog [or cat, or human] won't be infected.
But of course, U're already past that, with a confirmed case.
Also, up to 80% of dogs who test positive for A.phag show no symptoms... but Ur dog is in that 20% of symptomatic patients.

I'm WRONG -
Anaplasmosis was Dx'ed in 1996 in the USA, in dogs living in Minnesota & Wisconsin - so it's here, too, now, along with a related species, A. platys - in a severely-affected animal [including humans], the platys version causes
profound platelet loss, with visible bleeding & / or bruising, & can be cyclic, meaning chronic, with periods of flare-up & remission [for years? - for life? - doesn't specify].
QUOTE,
"Unlike A. phagocytophilum, which appears to be one-time temporary problem for the occasional patient, A. platys may cause cycles of low platelets after an initial acute flare-up. If your pet shows evidence of this type of disease, the platelets will be inspected because the organism is found in circulating platelets. Treatment is similar to that for
A. phagocytophilum."

source:
Canine Anaplasmosis

here's something on A. platys distribution in Europe -

"Anaplasma platys has been diagnosed in dogs, particularly from countries in the Mediterranean basin, including Italy [48], Spain [58], Portugal [59], France [60], Turkey [61], Greece [62], Croatia [63], and Romania [64]. Information is limited re prevalence of A. platys infections in dogs from Europe, based on molecular analysis (Table 3)."
Source -
Guideline for veterinary practitioners on canine ehrlichiosis and anaplasmosis in Europe

A photo from that link, showing "Microscopic image of a morula of Anaplasma platys in a platelet (x100)."

close-up:

QUOTE,
"The most-common clinical signs of A. phag are non-specific; they include lethargy, inappetence/ anorexia, & fever. Other findings are pale mucous membranes, a tense abdomen, & gastrointestinal signs (vomit /diarrhea). Lameness may result from secondary immune-mediated (neutrophilic) polyarthritis.
Mildly enlarged lymph nodes, tachypnea, & surface bleeding (petechiae, melena, epistaxis) may occur. Rare signs include collapse, mild cough, scleral injection, uveitis, limb edema, and polydipsia/ polyuria [145-151].
It is controversial whether central nervous system signs associate with this infection [152-154].
In a few cases, association was suggested between steroid-responsive meningitis/ arteritis and A. phag infection [155]. A. phag infection may trigger some immunopathies, such as immune-mediated thrombocytopenia/anemia. Splenomegaly diagnosed with radiography and ultrasonography is a very common finding [147].

Clinical signs of A. platys infection have been described, experimentally & in naturally-infected dogs, in Greece, Spain, Portugal, & Israel, including fever, lethargy, anorexia, weight loss, pale mucous membranes, petechiae, nasal discharge, & lymphadenomegaly. Single-case studies have described bilateral uveitis and epistaxis.
However, not all studies used PCR to exclude co-infections with other vector-transmitted diseases that produce the same clinical signs [54,62,63,66,146,156-158]."

co-infections:
"Coinfections tend to worsen some conditions & mask others, which could complicate diagnosis [131]. Most vector-borne diseases [cause] similar clinical signs & abnormal laboratory findings in dogs (e-g, epistaxis & uveitis can be due to either ehrlichiosis and/or leishmaniosis). This complicates diagnosis, & increases the list of differential diagnoses. In one study, coinfection... delayed clinical improvement per dogs with either CME or leishmaniosis alone [182]. In another, more clinical signs were noticed in dogs with dual infections... [thus], pathogens may have synergistic pathological effects (183).
Further, A. platys together with other infectious agents... may potentiate clinical disease & [resulting] laboratory abnormalities (54,66,90).
Therefore, when an infection of one specific species is diagnosed, a comprehensive work-up is necessary to rule out coinfections with other vector-borne pathogens (177)."

to be continued...

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[leashedForLife]

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continuing from LINK
Guideline for veterinary practitioners on canine ehrlichiosis and anaplasmosis in Europe

"Doxycycline (for 2 to 3 weeks) at the dosage described above for E. canis is apparently effective in treating A. phag infections."

INSERT:
5 mg/kg twice daily, or 10 mg/kg once daily for 4 weeks. This regime guarantees a complete response in the majority of cases [125,168,176]. Some experimentally-infected dogs remained infected & became subclinical carriers after shorter treatments, even at the recommended doses [125,166,170]. Therefore, the more prolonged treatment of 4 weeks is recommended. Although clinical improvement is achieved in most cases, it can be difficult to ensure... total elimination... The clinician should not target seronegativity, but rather, negative PCR results [6,142,166,168].

Doxycycline, unlike other tetracyclines, does not seem to cause enamel discoloration in puppy teeth. Moreover, ... vomiting can be eliminated by splitting the antibiotic dose into two half-doses every 12 h (q12h) or by administering the antibiotic after meals. When the dog has liver problems, Rx of doxycycline should be reconsidered. Liver function tests should be performed before & during treatment; if liver parameters increase, the treatment regime should be stopped [6,142,166,168].
However, several parameters remain to be established, including the most effective or optimal dose; the length of doxycycline treatment; and the value of adding other antibiotics [145,146,174,175,190]. Rifampin and levofloxacin have also shown in vitro effects against A. phag [190]. Chloramphenicol has been mentioned as an alternative for treating puppies [191].
END INSERT

continuing:
"When dogs with circulating Anaplasma organisms have moderate to severe clinical disease or do not rapidly respond to doxycycline therapy, they should probably be tested for other tick-borne diseases [146].

A. platys infections can be treated with tetracyclines (e-g, doxycycline 5-10 mg/kg q12-24h for 8 to 10 days). Alternatively, they can be treated with enrofloxacin at 5 mg/kg, q12h for 14-21 days [131,192].

Are there other supportive therapies... for ehrlichiosis and/or anaplasmosis?
In severe or chronic ehrlichiosis and/or anaplasmosis, other therapeutic agents or treatments may be needed, particularly for E. canis infections. For cases with hemorrhage or organic lesions, the dog may require admission to a hospital for a more intensive treatment. In general, according to the seriousness determined in the clinic, dogs may need blood transfusions when the packed cell volume (PCV) is very low; fluid therapy when dehydration or secondary kidney disease is present; or antipyretic & analgesic drugs [138,142,146].

In some cases of chronic ehrlichiosis, when aplasia of all cell lines occurs, other treatments have been used. For example, growth factors, like granulocyte colony stimulating factor or erythropoietin have been used; however, scientific evidence of effectiveness is scarce. One case of chronic ehrlichiosis was treated successfully with a combination of hematopoietic growth factors, low dose vincristine, doxycycline, & glucocorticoids [193]."

Is it necessary to use steroids for treating ehrlichiosis and/or anaplasmosis?
Treatment of ehrlichiosis or anaplasmosis should not be initiated with glucocorticoids combined with antibiotics. Steroids should only be considered when no satisfactory response is noticed, or when immune-mediated complications arise.
Ehrlichia and Anaplasma species may mediate an immune response, typically indicated by hemolytic anemia, thrombocytopenia, uveitis, glomerulonephritis, vasculitis, etc. In those cases, treatment with glucocorticoids (usually prednisone or prednisolone) may be indicated; doses of prednisone should range from 0.5 to 2 mg/kg/day, & treatment duration should vary per the type & seriousness of the immune-mediated condition [133, 147, 152, 194-196].
However, use of immunosuppressive glucocorticoids for treatment of secondary immune-mediated diseases must be considered very carefully. Of note, immunosuppressive doses of glucocorticoids or other drugs to subclinically infected dogs may result in the re-emergence of bacteremia, although the dog may not show clinical signs [6,129,142,174,175].

What is the expected clinical response post-Tx of ehrlichiosis and/or anaplasmosis?
Doxycycline is effective against ehrlichiosis and/or anaplasmosis in dogs [120,145,146]. When treated in the acute phase... they improve quickly, within 24-48 hrs, & prognosis is good when the whole course of therapy is administered [120,147,197].
However, prognosis of dogs with a chronic severe form of ehrlichiosis is grave [120,197]. Shipov & colleagues (2008) investigated prognostic indicators for mortality & survival [198]. They found that pronounced pancytopenia (white blood cell count, WBC < 4 × 103/μL; PCV < 25%; & platelet concentration [PLT] < 50 × 103/μL) was a risk factor for mortality.
[Also], severe leucopenia (WBC < 0.93 × 103/μL), severe anemia (PCV < 11.5%), prolonged activated partial thromboplastin time (APTT > 18.25 s), and hypokalemia (K < 3.65 mmol/L) could each predict mortality with a probability of 100%.
Conversely, a WBC > 5.18 × 103/μL, PLT > 89.5 × 103/μL, PCV > 33.5%, APTT < 14.5 s, or K > 4.75 mmol/L could each predict survival with a probability of 100%.

When the clinical response in... anaplasmosis is not rapid, or when clinical signs persist after treatment with doxycycline, the dog must be re-examined for other infectious diseases or diseases with similar clinical signs (neoplasia or immune-mediated diseases) [6,142,146]."
__________________________________________
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[leashedForLife]

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In conclusion, I would ask my vet for 2 tests:
- a re-test to try to determine the current level of A. phag infection;
- & I'd also ask my vet to specifically screen for other tick-borne diseases, as co-infection complicates treatment.

Plus, around 2 to 3-weeks after doxycycline stops, I'd also ask for a post-treatment PCR test.

QUOTE,
"There are two goals for performing PCR some weeks after the completion of treatment. One, minimize the probability of false-negative results, due to antibiotic effects on bacteremia. Two, minimize the chance of detecting DNA of dead pathogens that continue to circulate during treatment [6,132,142,174,175].

...PCR is useful for monitoring dogs post-Tx, as it can detect pathogen DNA, regardless of serologic antibody titers. However, PCR's effectiveness may be limited for detecting pathogens in subclinically infected dogs, because organisms may circulate intermittently. Therefore, PCR analysis should not be considered definitive, to conclusively exclude subclinical infection in dogs that remain seropositive post-Tx [6,142,145,146]."
_____________________________-


There's also this -
Rickettsiosis Information

...an article on rickettsiosis & polyarthritis.

I hunted, in every way I could think of, for specific Tx for tick-borne polyarthritis [Correction: polyarthritis 2ndary to tick-borne disease], but found no sources. Sorry.

HTH,
- terry

.

 

[Mairi]

.

In conclusion, I would ask my vet for 2 tests:
- a re-test to try to determine the current level of A. phag infection;
- & I'd also ask my vet to specifically screen for other tick-borne diseases, as co-infection complicates treatment.

Plus, around 2 to 3-weeks after doxycycline stops, I'd also ask for a post-treatment PCR test.

QUOTE,
"There are two goals for performing PCR some weeks after the completion of treatment. One, minimize the probability of false-negative results, due to antibiotic effects on bacteremia. Two, minimize the chance of detecting DNA of dead pathogens that continue to circulate during treatment [6,132,142,174,175].

...PCR is useful for monitoring dogs post-Tx, as it can detect pathogen DNA, regardless of serologic antibody titers. However, PCR's effectiveness may be limited for detecting pathogens in subclinically infected dogs, because organisms may circulate intermittently. Therefore, PCR analysis should not be considered definitive, to conclusively exclude subclinical infection in dogs that remain seropositive post-Tx [6,142,145,146]."
_____________________________-


There's also this -
Rickettsiosis Information

...an article on rickettsiosis & polyarthritis.

I hunted, in every way I could think of, for specific Tx for tick-borne polyarthritis [Correction: polyarthritis 2ndary to tick-borne disease], but found no sources. Sorry.

HTH,
- terry

.

Thankyou so much for taking your time to reply ! You obviously went to a lot of work in doing so It all makes for interesting reading and I will print it off and reread it again (and again) Will def ask my vet to retest. Did I mention that I live in Italy ? Many vets here are a case of hit and miss but this guy seems to have hit the bullseye. Her temp is still high but we are continuing with the battle and she certainly isn't giving up the fight. Once more, thankyou.

 

[leashedForLife]

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i forgot to mention, I'd also ask for a full blood-panel to look at PCV, hematocrit, kidney & liver enzymes, esp'ly liver, as doxycycline can cause problems when metabolized. If her liver is coping well, that's great! - but it's good to check.
If her PCV is really low, she'll need a screened transfusion of whole blood or blood-cell rich fraction.
The blood needs to be pre-screened to be sure we don't introduce a new source of infection - another rickettsial bacteria, hepatitis, etc.

Hope she's feeling much better, soon,
- terry

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[Mairi]

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i forgot to mention, I'd also ask for a full blood-panel to look at PCV, hematocrit, kidney & liver enzymes, esp'ly liver, as doxycycline can cause problems when metabolized. If her liver is coping well, that's great! - but it's good to check.
If her PCV is really low, she'll need a screened transfusion of whole blood or blood-cell rich fraction.
The blood needs to be pre-screened to be sure we don't introduce a new source of infection - another rickettsial bacteria, hepatitis, etc.

Hope she's feeling much better, soon,
- terry

.

it never rains but it pours ! her temp this morming at 8.30 was 40.4 and at 12.30 had gone down ever so slightly to 40.3. It usually goes down by at least 1 degree in the morning but not today. She ate her breakfast but couldn't be tempted at lunch time. Will def mention the above to my vet. Thankyou somuch for taking an interest

 

[Mairi]

Update on my collie. She is completely back to normal albiet very thin ! Six days ago we awoke to find her sitting up and wagging her tail and ready for her breakfast . It was wonderful to see the light back in her eye. It was as if someone had waved a magic wand and the magic was done. Her temp has now been completely normal ever since and her appetite is wolf like She has gone back to collecting stones and not coming back until she is ready when I take her down to the stream at the bottom of the field. I think I can forgive her anything (for the moment ) Thankyou to all of you for your interest and support. What a lovely buch of people you are ! XX

 

[JoanneF]

Great news, thank you for updating us. I am delighted to hear she is on the mend.

 

[Josie]

Great to hear @Mairi