Babesia Or Cll?

[kudzu]

Luke is our senior Grey, 11 yo. Has had persistent lymphocytosis since I adopted him last year at age 10. He appears perfectly healthy except for the elevated lymphocytes. Repeated CBC & blood chem seems to confirm this. Tick panel was run last year with Ehrlichia & RMSF negative but low positive Lyme. For several reasons we chose to do a 4 week round of doxy. No changes in Luke's appearance, behavior or lymphocytes were observed.

 

Recent blood work shows all on CBC & blood chem remain fine except abs. lymphocytes are now up to 17000+. However, we also checked for babesia, sample sent to Protatek, that showed positive with titers at 1:320. In addition he came up positive for toxoplasmosis but that is apparently a low positive indicating exposure but not active disease.

 

Now the question is does he have chronic lymphocytic leukemia? Whether he does or not, should we treat with Imizol for the babesia? If we do a PCR test & it comes back negative does that really mean he does not have babesiosis? Could the babesia be contributing to the lymphocytosis? Dr. Couto has already replied to me twice. He has been so responsive & caring. They can do a test at OSU to help us get a better idea about possible CLL. He thinks it a good possibility in Luke's case based on what I reported to him. My vet is thinking along those lines also & I have feared this since last year. Dr. Couto also recommended PCR before considering Imizol treatment but after everything I've read I am not certain a negative PCR is really conclusive. Though a positive PCR certainly would help the decision.

 

Does anyone know of a lab that can do the flow cytometry immunophenotyping? Dr. Couto said OSU does it but they do not take outside samples. He may be able to work something out & I would certainly appreciate that but hate to impose on him.

 

Any ideas or comments on all of this? All thoughs/help will be greatly appreciated.

 

Laura

[Burpdog]

I'd post to the tick list and ask this question

 

http://saluqi.home.netcom.com/ticklinks.htm

 

Personally, I'd most likely treat with Imizol.

[Guest mandm]

Last time I got a +babesia titer, I skipped the PCR & went immediately to Imizol treatment. My reasoning was that a +PCR would confirm that the dog needed treatment and a -PCR would only confirm, in my mind, that I needed to do another PCR to really be certain. PCR turnaround time is not quick -- 2-4 weeks. I lost a greyhound waiting for PCR results and that has made me much less conservative when it comes to treating suspected TBD.

 

My youngish greyhound was treated with Imizol last year. He had minimal side effects and very quick positive response to the Imizol. The injections were very painful though. I understand why you are hesitant.

[kudzu]

I'd post to the tick list and ask this question

 

http://saluqi.home.netcom.com/ticklinks.htm

 

Personally, I'd most likely treat with Imizol.

 

Thanks for the suggestion. They are a helpful list & I did post to them a couple days ago. Their responses are why I am leaning to treating. However, Dr. Couto isn't the only one to lean more to following up with PCR tests. If my guy was younger it would be an easier decision. And I do want to know where we stand on possible CLL. Thought I would check here to see what others thought about the situation. Just want to cover all my bases, if that is possible. We are blessed to have a chance to do all this while he still seems well. I think if he was acting ill or even just ADR there may be more of a consensus opinion. Still, do I want to wait to see if he gets ill from babesia? What is more likely to get him, babesia, CLL or plain ol' old age? Where is my crystal ball when I need it?!

[Batmom]

For my own dogs:

 

I prefer the PCR tests as IMHO they are much more meaningful than the titers. A negative PCR is a pretty good indication that the dog doesn't have the disease. Not 100% but awfully close. A titer at this or that number means the dog was exposed, with no certainty as to whether the dog has the disease or not. We tend to take a high titer as meaning the dog has active disease, but a dog can be treated -- or be exposed and never have the disease -- and still retain a high titer for years ......

 

I personally don't like Imizol and would not use it without a positive PCR.

[Burpdog]

Well, I am going to disagree (what is new). Too many dogs have died or almost died waiting. Babesia is not something to mess around with. Even though Tootsie had an undesirable effect from the second shot, her blood work shows it was the right thing to do. Her platelets last month remained over 200,000 after the low of 132,000 in September. Of all the people that I have talked with who do many Imizol injections, none have had an adverse reaction like Toots (figures, doesn't it?)

 

What are your dogs platelets, HCT & RBC and have you plotted the blood work ups?

[Batmom]

Too many dogs have died or almost died waiting.

 

If the dog was in a precarious condition and I could identify nothing else, I'd certainly treat. I'm not sure I understand why people wouldn't in that case! But, you wouldn't know what to treat for unless you'd done a titer, and if you took the time to do a titer, you could've done a PCR in pretty much the same timeframe.

 

But, again JMO for my personal dogs, I'd hope to never be in that situation. I personally am not a fan of titers -- I'd go for PCR testing. You could also send for the titer panel and include enough blood to start a PCR on any suspicious titer. NCSU does that, and the lab fee itself isn't terribly expensive. They also have a stat service that gets the basic PCR done in 5 days. For me, those extras would be worth paying for under some circumstances.

Edited February 28, 2008 by Batmom

[kudzu]

What are your dogs platelets, HCT & RBC and have you plotted the blood work ups?

 

Platelets are reportedly fine but since they were clumped we do not have accurate auto platelet count. RBC & HCT are normal but on the low end. All his bloodwork is in a spreadsheet which includes a column to show the change since the last tests.

Edited February 29, 2008 by kudzu