Red de Revistas Científicas de América Latina, el Caribe, España y Portugal
Sistema de Información Científica
Moreira Borges, Olivia Maria; Pereira de Souza, Almir; de Souza Mendes, Rodrigo; Nunes de Araújo, Kamila;
Mendes Torres, Leonardo; Fernandes Pereira Dantas, Alinne Kattia
Clinical Effectiveness of Autohemotherapy as an Adjunct Treatment of Canine Parvovirus
Acta Scientiae Veterinariae, vol. 42, núm. 1, enero, 2014, pp. 1-7
Universidade Federal do Rio Grande do Sul
Porto Alegre, Brasil
Available in: http://www.redalyc.org/articulo.oa?id=289029240062
Acta Scientiae Veterinariae,
ISSN (Printed Version): 1678-0345
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Acta Scientiae Veterinariae, 2014. 42: 1224.
RESEARCH ARTICLE
ISSN 1679-9216
Pub. 1224
Clinical Effectiveness of Autohemotherapy
as an Adjunct Treatment of Canine Parvovirus
Olivia Maria Moreira Borges1, Almir Pereira de Souza2, Rodrigo de Souza Mendes1,
Kamila Nunes de Araújo3, Leonardo Mendes Torres3 & Alinne Kattia Fernandes Pereira Dantas3
ABSTRACT
Background: Canine parvovirus is highlighted among the gastroenteric diseases that are common medical occurrences
in small animals due to its clinical evolution. Although the treatment is often successful, the success rate has remained
unchanged over the years, reflecting a clear need for searching more efficient protocols in order to reduce hospitalization, treatment cost and increase survival rates. Autohemotherapy efficacy has been demonstrated for several diseases and
identified as a stimulating tool and immune mediator. Thus, the objective of this research was to determine the clinical
effectiveness of autohemotherapy as an adjunct in the treatment of dogs suffering from parvovirus.
Materials, Methods & Results: Twenty dogs suffering from parvovirus, diagnosed via immunochromatography, were
distributed (n = 10) into two groups: autohemotherapy (GAHT) and control (GCO). Both groups were treated with the
appropriate support therapy for hemorrhagic gastroenteritis (GHE), while the dogs of the GAHT group were also treated
with the adjunct autohemotherapy (AHT). The AHT consisted of the administration of blood collected by jugular venipuncture, without anticoagulant, immediately injected in equal proportion in the semitendinosus and semimembranosus
muscle region. The blood volume injected was based on animal weight: up to 5 kg/2.5 mL; between 5-10 kg/5 mL; 10-15
kg/7.5 mL; above 15 kg/10 mL. The dogs of the control group were injected a NaCl 0.9% solution instead of blood. The
vital parameters, heart rate (HR), respiratory rate (RR), and rectal temperature (RT), as well as the clinical parameters,
mucous color, dehydration, level of consciousness, abdominal tenderness, anorexia, diarrhea and vomiting were evaluated
and recorded. The hematological and parasitological stool analyses were also performed. The parameters were measured
upon hospital admission; time zero (M0) and every 12 h during 48 h (M12, M24, M36 and M48). The vital parameters
were submitted to ANOVA or Friedman test. For the hematological variables and remission of clinical signs of paired
samples the t test or Wilcoxon test was performed. The comparison of averages/medians was performed by either the
t test or Mann-Whitney test. The level of significance used was 5% (P < 0.05). All clinical parameters that indicated remission of the disease were statistically significantly different in the GAHT dogs, which lead to early hospital discharge. The
GAHT animals exhibited more effective recovery signs, evidenced by the reduction of recovery time in half. The hospital
discharge record shows that one dog was discharged after 33 h and another two dogs, after 46 h.
Discussion: During the hospitalization, complete remission of clinical signs initially cited was observed, but this was
not homogeneous, as can be seen in GCO, in which three animals needed to be treated for a longer period. Two of them
presented endotoxemia and one died 72 h and 70 h after starting the treatment. The comparison shows that animals of
GAHT recovered more effectively, evidenced by the recovery time half as long as that needed for the dogs of the GCO.
Thus, the autohemotherapy proved to be clinically effective, and resulted in premature recovery of patients suffering from
parvovirus. Furthermore, no side effects or systemic organic impairment was observed in this treatment, revealing benefits
as an alternative therapy and adjunct to treatment of this disease.
Keywords: autohemotherapy, diarrhea, parvovirus, dog, early recovery.
Received: 5 July 2014
Accepted: 25 October 2014
Published: 12 November 2014
Post Graduate student in Medicine Veterinary, Universidade Federal de Campina Grande (UFCG), Patos, PB, Brazil. Post Graduate Program in Veterinary
Medicine, UFCG, Campus de Patos, PB. 3Centro Médico Veterinário Dr. Leonardo Torres, Patos, PB. CORRESPONDENCE: A.P. Souza [almir@cstr.
ufcg.edu.br - Tel.: +55 (83) 3423-9523]. UFCG, CSTR, Campus de Patos, Av. Universitária s/n, Bairro Sta. Cecília. CEP 58708-110 Patos, PB, Brazil.
1
2
1
O.M.M. Borges, A.P. Souza, R.S. Mendes, et al. 2014. Clinical Effectiveness of Autohemotherapy as an Adjunct Treatment
of Canine Parvovirus.
Acta Scientiae Veterinariae. 42: 1224.
enteritis (GHE), while the dogs of the GAHT group
were also treated with the adjunct autohemotherapy
(AHT).
The treatment which was adapted and consisted of Ringer’s Lactate Solution2 and/or 0.9% NaCl
solution3 for correction of dehydration; Cimetidine
hydrochloride4 5 mg/kg/SC/BID as H2 antagonist;
Citrate Maropitant5, 1 mg/kg/SC/SID, as centrally
acting antiemetic; Enrofloxacin 2.5%6, 5 mg/kg/SC/
BID as antibiotics; Dipyrone7, 25 mg/kg/IV/SID as
analgesic and antipyretic; and multivitamin8, 20 mL/
infusion [1].
INTRODUCTION
Gastroenteric diseases are common medical
occurrences in small animals, whose typical clinical
signs are vomiting and diarrhea [6]. Since 1970, viral
enteritis is considered one of the most common causes
of infectious diarrhea in dogs, thus becoming one of
the most common diseases of the species [14]. The
parvovirus stands out among the juvenile canine viruses, since it presents severe gastroenteric symptoms,
resulting in high rates of clinical complications and
mortality [7].
Although the appropriate treatment is often
successful, the success rate has remained unchanged
over the years, reflecting a clear need to investigate
more effective protocols in order to further reduce
morbidity rate, hospitalization time and treatment cost,
and to increase the survival rate, as well.
Autohemotherapy arises as one of several
therapeutic protocols adjuvants to treat this disease.
Although little studied, autohemotherapy has shown
clinical efficacy in the treatment of several diseases
[9,21,23,25], being pointed out as an immune mediator
and stimulatory tool [24], assisting in the potentialization of the organic defenses against the debilitating
infection. Thus, the aim of this study was to determine the clinical effectiveness of autohemotherapy as
an adjuvant in the treatment of dogs suffering from
parvovirus.
Description of the AHT technique
The AHT consisted of immediately injecting
the blood collected by jugular venipuncture with
sterile syringes without anticoagulant, respecting a
fractionation of equal amounts in the semitendinosus or
semimembranosus muscles of the right and left limbs
region, which were previously shaved and thoroughly
cleaned. The volume administered was based on animal
weight, determined in previous pilot studies: 2.5 mL
for animals up to 5 kg; 5 mL/between 5 and 10 kg; 7.5
mL/10-15 kg; and 10 mL/ above 15 kg. The dogs of the
control group (GCO) underwent the same procedure,
but the blood was replaced by NaCl 0.9%.
Evaluated clinical parameters
The vital parameters: heart rate (HR), respiratory rate (RR) and rectal temperature (RT), as well
as the clinical; color of mucous membranes, dehydration, level of consciousness, abdominal tenderness,
anorexia, diarrhea, and vomiting were evaluated and
recorded [19]. Parameters were measured at the time
of outpatient care (M0) and every 12 h, for a total of
two evaluation days (M12, M24, M36 and M48). The
patient was discharged after remission of the gastrointestinal symptoms.
MATERIALS AND METHODS
The experimental site and the animals
The study was conducted in the Small Animal
Clinical Sector of the Veterinary Hospital of the Federal
University of Campina Grande, Campus de Patos-PB
(HV/UFCG) and in the Veterinarian Medical Center
Dr. Leonardo Torres (CMVLT), Patos-PB.
A total of twenty dogs seen at the outpatient
care unit, regardless of age, sex or breed, with clinical
signs of hemorrhagic gastroenteritis caused by Parvovirus, confirmed by immunochromatography kits1
were used.
Statistical Analysis
Data normality was checked using the Shapiro-Wilk test. The clinical data obtained were subjected to
analysis of variance (ANOVA) or Friedman test. Wilcoxon test or t-test was used for remission of clinical
signs of paired samples. The comparison of averages/
medians between CGO and GAHT was performed
by the t-test or Mann-Whitney test as indicated. The
BioEstat 5.0 software was used, at significance level
of 5% (P < 0.05).
Experimental Design
The animals were randomly divided into two
groups (n = 10), the autohemotherapy (GAHT) group
and the control (GCO) group. After confirming the
involvement of parvovirus, both groups were treated
with the appropriate therapy for hemorrhagic gastro-
2
O.M.M. Borges, A.P. Souza, R.S. Mendes, et al. 2014. Clinical Effectiveness of Autohemotherapy as an Adjunct Treatment
of Canine Parvovirus.
Acta Scientiae Veterinariae. 42: 1224.
of them presented endotoxemia and one died after 72 h
and 70 h after initiating the treatment. In comparison,
the animals of the GAHT exhibited the most effective
clinical signs of recovery, evidenced by shortening by
half the time required for recovery compared to GCO.
The hospital discharge records show that from the
animals of the GAHT, one was discharged 33 h and
another two 46 h after admission.
In the GCO, three animals remained with
signs of vomiting and diarrhea beyond the specified
period of evaluation, thus requiring an additional
36 h ± 24 h of hospital treatment. Eight animals of
the GCO required a total of 72 h ± 12.8 h to recover
from the anorexia symptoms. These events were not
observed outside of the evaluation period for the dogs
of the GAHT.
With regard to treatment, six dogs from the
GCO were required to undergo complementary
therapy, which according to each clinical condition,
consisted of Tranexamic acid (30 mg/kg)9, methylprednisolone (1 mg/kg)10, Sucralfate (30 mg/kg)11,
Ampicillin (20 mg/kg)12, Ketoprofen (1 mg/kg)13, and
metronidazole (15 mg/kg)14. Only one dog from the
GAHT required complementary therapy, which consisted of adding Tranexamic acid (30 mg/kg) to the
protocol. All animals underwent endoparasites control
with Ivermectin 1% (0.2 mL/kg)15, and one animal from
each group was treated for Babesiosis with imidocarb
dipropionate (5 mg/kg)16.
RESULTS
Clinical evaluation
The dogs of the GCO and GAHT groups
displayed average age of 4.8 ± 2.6 months and 3.4 ±
1.07 months and average weight of 3.96 ± 1.90 and
5.6 ± 5.0 kg, respectively. Males prevailed in both
groups. Regarding the breeds, 50% of the dogs of the
GCO were mongrel (ND), 20% Poodle, 20% Pinscher
and 10% Cocker Spaniel while, in the GAHT, 60%
were mongrel (ND), 20% Poodle and 20% Pinscher.
Moreover, it was observed that of the dogs of the GCO
and GAHT groups, respectively, 30% and 40% had
incomplete immunization, and 70% and 60% were not
vaccinated at all. As for worming, 7/10 of the GCO and
10/10 GAHT were not wormed.
The main clinical symptoms reported for the
dogs of both groups were lethargy (20/20), anorexia
(20/20), persistent vomiting (19/20) and foul-smelling
diarrhea (20/20), varying in color from bloody (14/20)
to yellow with traces of blood (6/20).
As for the vital parameters, no statistical differences between the experimental groups studied (Table
1) were observed. Regarding the remission of clinical
signs, all parameters evaluated were significantly between the groups (Table 2). During the hospital stay,
there was complete remission of clinical signs initially
cited, but this was not homogeneous. Three dogs from
the GCO needed to be treated for a longer period. Two
Tabela 1. Mean/median and standard deviation/interquartile range, in hours, heart rate (HR), respiratory rate (RR) and rectal temperature (RT) of dogs
affected with the parvovirus, in the control group (GCO) and in the group submitted to autohemotherapy (GAHT) for the time intervals studied.
Variable
HR
RR
RT
Time (hours)
Group
M0
M12
M24
M36
M48
GAHT
154 ± 44aA
149 ± 47aA
121 ± 31aA
137 ± 35aA
127 ± 31aA
GCO
160 ± 61aA
137 ± 18AA
124 ± 30aA
120 ± 40aA
114 ± 54aa
GAHT
38 ± 22aA
48 ± 11aA
38 ± 10aA
40 ± 13 aA
38 ± 14 aA
GCO
34 ± 35aA
38 ± 58aA
30 ± 18aA
34 ± 33aA
36 ± 11aA
GAHT
38.4 ± 0.4aA
38.2 ± 0.4aA
38.1 ± 0.5aA 38.4 ± 0.3aA 38.4 ± 0.4aA
GCO
38.5 ± 0.8aA
38.5 ± 1.6aA
38.3 ± 0.3aA 38.7 ± 0.7aA 38.2 ± 0.9aA
Lowercase letters correspond to the rows while the uppercase letters correspond to the columns. *Feitosa [8].
3
Normal range
values*
60-160 bpm
18-36 mpm
37.5 to 39.5° C
O.M.M. Borges, A.P. Souza, R.S. Mendes, et al. 2014. Clinical Effectiveness of Autohemotherapy as an Adjunct Treatment
of Canine Parvovirus.
Acta Scientiae Veterinariae. 42: 1224.
Table 2. Mean/median and standard deviation/interquartile range, in hours, of remission of clinical signs of dogs affected with the parvovirus, in
the control group (GCO) and in the group submitted to autohemotherapy (GAHT).
Remission of clinical signs (hours)
Group
Symptom
P -value
GCO
GAHT
Apathy
54 ± 42a*
24 ± 12b*
0.0312
Anorexia
67 ± 15a**
36 ± 13b**
<0.0001
Vomiting
30 ± 51a*
12 ± 0b*
0.0336
Diarrhea
36 ± 21a*
12 ± 12b*
0.0412
Dehydration
24 ± 21a*
12 ± 0b*
0.0284
Pale mucous
54 ± 21a*
24 ± 12b*
0.0015
Abdominal sensitivity
54 ± 28a**
19b ± 20**
0.0059
Hospital discharge
70.8 ± 17.38a**
43.2 ± 10.11b**
0.0004
Deaths (n/%)
1/10%
0
0 Endotoxemia(n/%)
2/20%
0
0
Lowercase letters correspond to the rows while uppercase letters correspond to the columns; Means followed by different letters are statistically
different (P < 0.05) *Median; **Average.
protocol used, due to animal age [17]. It is suggested
that the AHT protocol can be considered safe according
to this research, since although younger and clinically
relatively weaker, no animal of the GAHT died or
presented symptoms of endotoxemia.
Additionally, the animals clinical debilitating
initial picture with varied stool colors, especially the numerically more parasitized GAHT dogs, clearly showed a
clinically more severe parasitic gastrointestinal infection.
It is more debilitating and more difficult to treat associated
infections [18,19]. Furthermore, as the CPV replicates
only in dividing cells, any agent (parasitic, bacterial or
viral) that causes destruction of the villi, stimulating mitosis in the intestinal tissue, can facilitate the reproduction
of CPV, and, as a result, cause a more severe disease [3].
The vomiting and bloody diarrhea reported are
closely associated with the erosive and inflammatory
processes of the stomach and intestinal mucosa [14,15],
where the vomiting originated in the secondary disturbances to the viral agent, resulting from the stimulation
of peripheral receptors located on the TGI, activating
the vomiting center located in the medulla [8], and the
diarrheal process by lesions in the germinal epithelium
of intestinal crypts [17]. These findings corroborate the
considerations presented in the literature, which emphasize that vomiting and diarrhea are the first to be observed,
causing the animals to become lethargic and depressed,
as well as anorexia as the disease progresses [6].
DISCUSSION
There is a growing demand for more accurate
and efficient therapeutic protocols to treat several
infectious diseases that affect dogs, especially those
with acute evolution, such as the parvovirus infection.
Factors related to antimicrobial resistance, contraindications regarding age, cost, benefit, have hampered the
use of many drugs, considerably decreasing treatment
options, and leading to research for new alternatives.
Thus, use of AHT in this study proved to be low-cost,
accessible and easy to administer by the Veterinarian.
Clinical evaluation
In general, a higher prevalence of the disease
was observed in young animals, with defined breed that
had not been wormed and vaccinated. These facts show
a greater exposure of these dogs to parvovirus infection,
and minor, but worrying nonetheless, parasitosis. The
low immunological capability, compromised or total
lack of vaccination and poor sanitary conditions are the
main factors that determine the appearance and installation of the disease [7,15]. From this study, it can be
inferred that age and health conditions associated with
deficient sanitation were major factors triggering and
intensifying the infectious process.
The severity of infections caused by canine
parvovirus (CPV), and consequently the time of remission of clinical signs vary independently of the
4
O.M.M. Borges, A.P. Souza, R.S. Mendes, et al. 2014. Clinical Effectiveness of Autohemotherapy as an Adjunct Treatment
of Canine Parvovirus.
Acta Scientiae Veterinariae. 42: 1224.
With regard to the time of clinical remission,
it is possible to correlate early improvement of vomiting and dehydration symptoms to both the effective
action of Maropitant citrate [5] and the remission of
inflammatory processes in the gastric mucosa promoted
by the adopted support treatment. It can be inferred
that such effects reduced energy consumption and
abdominal discomfort caused by muscle contractions
in the act of vomiting, as well as the hemodynamic
improvement and correction of fluid and electrolyte
imbalance promoted by dehydration [27].
Another important aspect to be highlighted
concerns the recovery from diarrheal symptoms,
which again was more effective in the GAHT. The
AHT promotes the increase of leucocytes in abdominal
organs [28]. It is, therefore, suggested that these cells
may be present in greater amounts in the gut of this
patients, providing a more intense and effective action,
with earlier recovery of the pathological process, aiding, besides the recovery of diarrheal symptoms, the
improvement in the general condition of the animal.
Thus, it is believed that the treatment adopted in GAHT
provided a dynamic retrieval of existing lesions in the
germinal epithelium of the intestinal crypts, which are
the cause of hemorrhagic diarrhea [14,17].
Finally, the remission of anorexia of the GAHT
took approximately 50% of the time of the GCO. The
anorexia remission is directly related to the recovery
of the inflammatory process in the gastrointestinal tract
(GIT). To this end, neuroendocrine mechanisms, such
as the release of cytokines in the inflammatory processes, may be valuable for anorexia [22], further stressing
that any disorder that reduces the brain stimulation,
such as apathy, can also reduce food consumption.
The endotoxemia and the deaths observed, as
well as complementary therapies added to the GCO
protocol adopted, suggest that the adopted antibiotic
therapy was not widely effective to treat the gastrointestinal symptoms and disease. This fact corroborates
the results previously described for the treatment of
dogs with parvovirus infection [11,20]. The absence
of such symptoms in the GAHT strongly suggests the
effectiveness of the autohemotherapy in controlling
the infection, contributing to survival rates and clinical progress.
CONCLUSION
These results show that the autohemotherapy is
clinically effective. They determine early recovery of
patients suffering from parvovirus, without side effects
or systemic organic impairment, revealing benefits as
adjuvant alternative therapy to treat parvovirus successfully.
SOURCES AND MANUFACTURERS
1
SensPERT P®, Vencofarma Ltda., Brazil, PR, Brazil.
2
Eurofarma Laboratories Ltd., SP, Brazil.
3
Eurofarma Laboratories Ltd., SP, Brazil.
4
Cimetidine Hydrochloride ®, Teuto Brasileiro S/A, GO, Brazil.
5
Cerenia®, Pfizer Ltda. - Division of Animal Health, SP, Brazil.
6
Enrofloxacin®, Vencofarma Ltd. of Brazil, PR, Brazil.
7
Dipyrone D-500®, Fort Dodge, SP, Brazil.
8
Hertavita®, Hertape Calier, SP, Brazil
9
Hemoblock®, Sigma Pharma Ltda, SP, Brazil.
Corti-dural®, König of Brazil Ltda, SP, Brazil.
10
Sucrafilm®, Sigma Pharma, SP, Brazil.
11
Ampicillin®, EMS S/A, SP, Brazil.
12
Ketoflex1%®, Vencofarma Ltd. of Brazil, PR, Brazil.
13
Flagyl®, Sanofi Aventis Pharmaceutical Ltd., SP, Brazil.
14
Baymec®, Bayer, SP, Brazil.
15
Diazen®, MG, Brazil.
16
Ethical approval. This study was approved by the Ethics and
Research Committee (COEP) of the Center for Health and Rural
Technology, Universidade Federal de Campina Grande, Patos,
PB, under protocol n° 28/2011.
Declaration of interest. The authors report no conflicts of
interest. The authors alone are responsible for the content and
writing of the paper.
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