BABEZIOZA IZAZOV ZA VETERINARA KLINIČARA. Dragan Petrović dr.vet.med. Veterinarska ambulanta Nera, Zagreb
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1 BABEZIOZA IZAZOV ZA VETERINARA KLINIČARA Dragan Petrović dr.vet.med. Veterinarska ambulanta Nera, Zagreb
2 Primarni prijenosnik bolesti krpelj Rhipicephalus sanguineus
3 Uzročnik babezioze Babesia canis B. canis canis B. canis vogeli B. canis rossi 4-5 µm Babesia gibsoni 3 µm
4 Prvi simptomi bolesti Anamneza: pretežno leži, apatičan, ne jede, ima tamnu mokraću. Prije par dana smo mu skinuli nasisanog krpelja Inkubacija : 7-28 dana
5 Dijagnostika babezioze U ambulanti Mikroskopski u razmazu periferne krvi Sumnja na temelju kliničkih, hematoloških i biokemijskih pretraga Anemija, trombocitopenija, splenomegalija,hemoglobinurija U specijaliziranim laboratorijima PCR Serološki indirektna imunofluorescencija
6 Oblici bolesti Nekomplicirana babezioza Komplicirana babezioza Povišena temperatura Gubitak apetita Blijedilo sluznica Depresija Poboljšanje zdravstvenog stanja unutar sati nakon terapije imidocarbom (Imizolom) Zatajenje bubrega Cerebralna babezioza Perakutna babezioza Koagulopatija Žutica i oštećenje jetre Autoimuna hemolitička anemija Akutni respiratorni distres sindrom Oštećenje miokarda Pankreatitis Šok SINDROM VIŠESTRUKOG ZATAJIVANJA ORGANA
7 Klinički znakovi bolesti Sindrom sustavnog upalnog odgovora upalni odgovor cijelog tijela ("sustava") bez dokazanog izvora infekcije protozoalna sepsa sindrom višestrukog zatajivanja organa 4 KRITERIJA Temperatrura >39,7 ili < 37,8 C Bilo > 160 Razvit će se kod 2/3 obolljelih pasa Disanje > Leukociti <4 x 10 ili >12 x 10 uz 10% nesegm. neutrofila Prema OKANO i sur. (2002).
8 Sindrom sustavnog upalnog odgovora uzorak od 332 psa 68% pasa razvilo je SSUO 70% 60% 67% 50% 40% 30% 20% 10% 0% 29% 4% KRITERIJA Temperatura Bilo Disanje Leukociti MATIJATKO, V., I. KIŠ, M. TORTI, M. BRKLJAČIĆ, R. BARIĆ RAFAJ, Z. ŽVORC, V. MRLJAK: Systemic inflfl ammatory response syndrome and multiple organ dysfunction syndrome in canine babesiosis. Vet. arhiv 80, , 2010.
9 Sindrom višestrukog zatajivanja organa prisutnost poremećene funkcije organskih sustava, u pacijenata sa sepsom u kojih se funkcija ne oporavlja bez intervencije. Bubrežna disfunkcija Kreatitnin >180 μmol/l norm. Disfunkcija jetre: enzimi ( μmol/l), ALT >176 U/L norm. ( 88 U/L) AP > 360 U/L norm. do (156 U/L), Respiratorna disfunkcija nalaz plućnog edema, otežano disanje, pjenušavo krvavi iscjedak iz nosa Mišićna disfunkcija CPK > 600 U/L - norm. ( 88 U/L) Disfunkcija centralnog živčanog sustava (modificirana Glasgowska skala kome < 9) (WEISER, 1992).
10 Sindrom višestrukog zatajivanja organa 90% 80% 70% 60% 50% 40% 90% 30% 20% 10% 10% 0% Broj pacijenata SVZO negativan SVZO pozitivan Kriterij PREŽIVJELI UGINULI SVZO pozitivan 33 % 67 % SVZO negativan 95 % 5 % MATIJATKO, V., I. KIŠ, M. TORTI, M. BRKLJAČIĆ, R. BARIĆ RAFAJ, Z. ŽVORC, V. MRLJAK: Systemic inflfl ammatory response syndrome and multiple organ dysfunction syndrome in canine babesiosis. Vet. arhiv 80, , 2010.
11 Sindrom višestrukog zatajivanja organa Mortalitet % 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 100% 90% 55% Disfunkcija organa MATIJATKO, V., I. KIŠ, M. TORTI, M. BRKLJAČIĆ, R. BARIĆ RAFAJ, Z. ŽVORC, V. MRLJAK: Systemic inflfl ammatory response syndrome and multiple organ dysfunction syndrome in canine babesiosis. Vet. arhiv 80, , 2010.
12 100% 90% 91% 80% 70% 60% 50% 40% 30% 61% 57% 48% BUBREZI JETRA MIŠIĆJE PLUĆA CNS 20% 10% 9% 0% bubrezi jetra mišićje pluća cns Organi zahvaćeni tijekom akutne babezioze MATIJATKO, V., I. KIŠ, M. TORTI, M. BRKLJAČIĆ, R. BARIĆ RAFAJ, Z. ŽVORC, V. MRLJAK: Systemic inflfl ammatory response syndrome and multiple organ dysfunction syndrome in canine babesiosis. Vet. arhiv 80, , 2010.
13 Primjer cerebralne babezioze
14 Etiološka Terapija Babesia spp. Lijek Doza Primjena Trajanje Imidocarb dipropionate (Imizol ) B. canis Diminazene aceturate (Berenil ) Simptomatska Trypan blue (Trypan blue ) Infuzije: koliodi, kristaloidi Transfuzije Terapija kisikom ATB, vitamini 7 mg/kg IM/SC jednokratno (ponoviti za 14 dana) 3.5 mg/kg IM jednokratno 10 mg/kg IV jednokratno
15 Često: Autoimuna hemolitička anemija Kod pasa koji su više puta preboljeli babeziozu Non-regenerativna anemija Žutica Terapija: kortizoni, imunosupresivi
16 Često: Zatajivanje bubrega Kod akutne babezioze Oligurija, anurija Pogoršanje općeg stanja, povraćanje, zadah po urinu Terapija: poticanje rada bubrega Po oporavku specifična dijeta
17 Često: Zatajivanje jetre Kod akutne babezioze Pogoršanje općeg stanja, žutica Terapija: poticanje rada jetre Po oporavku specifična dijeta
18 Vakcinacija Profilaksa Pirodog, Biokema SA, Merial, inaktivirani antigeni B. canis 2 doze s razmakom 2-4 tj, 1-2 x godišnje Solidan imunitet postiže se 1 mjesec nakon 2. vakcinacije Potpunu zaštitu nije moguće postići, smanjuje se učestalost i težina simptoma Suzbijanje krpelja Na životinji Primjenom preparata akaricida, insekticida i repelenata Djelatna tvar Repelent Oblik Djelovanje Imidakloprid+permetrin (Advantix) Fipronil (Frontline, Fypryst) DA Spot on 4 tj NE Spot on/spray Spot on 4 tj Permetrin (Exspot) DA Spot on 4 tj Pyriprole(Prac-tick) NE Spot on 4 tj
19 U okolini Košnjom livada, uređivanjem vrtova, krčenje šikara Ostale mjere Izbjegavati boravak i šetnje na jako infestiranim mjestima u kritično doba godine Svakodnevno pregledavati krzno životinje Prikvačenog krpelja skinuti bez odgađanja
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