Comp Clin Pathol (2010) 19:383–387
DOI 10.1007/s00580-010-1041-2
BRIEF COMMUNICATION
Rangelia vitalli in dogs in southern Brazil
Raqueli Teresinha França & Aleksandro Schafer Da Silva & Francine Chimelo Paim &
Marcio Machado Costa & João Fabio Soares & Cinthia Melazzo Mazzanti &
Sonia Terezinha dos Anjos Lopes
Received: 21 March 2010 / Accepted: 26 May 2010 / Published online: 8 June 2010
# Springer-Verlag London Limited 2010
Abstract This article aims to describe seven cases of dogs
naturally infected with Rangelia vitalli. Clinical findings,
hematological parameters, parasitological diagnosis, and
treatments were evaluated. On physical examination, these
animals showed pale mucous membranes, hyperthermia,
apathy, and blood dribbling down from the ear margins. R.
vitalli merozoites were observed inside of erythrocytes,
neutrophils, and macrophages in blood smear. Important
hematological findings observed in these cases were severe
anemia and thrombocytopenia. The animals were treated with
therapeutic protocol based on prednisone, doxycycline, and
dipropionate which had great curative efficacy to rangeliosis.
Keywords Rangeliosis . Nambiuvú . Canine . Anemia
Introduction
Rangelia vitalli is a member of the protozoan phylum
Apicomplexa, order Piroplasmorida (Loretti et al. 2003;
Spagnol et al. 2003), that causes a tick-borne disease
referred to as “nambiuvú” (=blood dribbling down from the
ear margins) or “peste de sangue” (=bleeding plague). The
original reference to this disease comes from 1908. In a
R. T. França (*) : A. S. Da Silva : F. C. Paim : M. M. Costa :
C. M. Mazzanti : S. T. dos Anjos Lopes
Department of Small Animals,
Universidade Federal de Santa Maria,
Santa Maria, Rio Grande do Sul, Brazil
e-mail: raquelifranca@yahoo.com.br
J. F. Soares
Department of Preventive Veterinary Medicine and Animal
Health, Universidade de São Paulo,
São Paulo, São Paulo, Brazil
short communication published by Antonio Carini about
the most common infectious and parasitic diseases of
domestic animals in Brazil at that time, the observation of
a disease in dogs called “nambiuvú” was mentioned (Carini
1908). Later, another author published two scientific papers
characterizing the morphology of this unusual protozoan
parasite based on observations made under a light micro-
scope and describing the epidemiological, clinical, and
pathological aspects of the disease caused by this atypical
piroplasm (Pestana 1910a, b). In 1914, Carini and Maciel
(1914) wrote an article about this disease proposing that the
name of this previously unidentified canine piroplasm
should be changed to R. vitalli to honor the investigator
(Pestana 1910a, b), who first observed the presence of this
organism within endothelial cells and red blood cells of
Brazilian dogs affected by the protozoa R. vitalli.
This parasite usually affects young dogs from rural and
periurban areas during the hot season, when the number of
ticks is greater, but can also occur during the year in adult
animals. The disease is characterized by anemia, jaundice,
fever, splenomegaly, generalized lymph node enlargement,
hemorrhage along the gastrointestinal tract, and persistent
bleeding through the tips of the pinnae, external surface of
the ears, nose, and oral cavity (Pestana 1910a, b; Loretti
and Barros 2005). According to the literature, ticks
Amblyomma aureolatum and Rhipicephalus sanguineus
serve as vectors of R. vitalli, and wild carnivores and birds
(that are resistant to the infection by this protozoa) play an
important role as reservoirs of the pathogen in rural areas
(Loretti and Barros 2004).
Tentative clinical diagnosis of R. vitalli infection is
based on the history of the animal, clinical signs, hemo-
gram, and favorable response to therapy (Loretti and
Barros 2004). Definitive diagnosis has been carried out
through microscopical examination of smears from tissue
384
samples collected during necropsies or histological sec-
tions. However, molecular phylogenetic analysis is neces-
sary to better characterize this parasite and clarify its
taxonomic status.
In the literature, we have a few studies about the
protozoan R. vitalli, likely due to the lack of knowledge
about the parasite and/or merely because the protozoan was
diagnosed only in the south of Brazil. Therefore, this article
aims to describe seven cases of dogs naturally infected with
R. vitalli.
Materials and methods
Seven affected dogs referred to a local University Veteri-
nary Hospital (UVH-UFSM, Santa Maria, RS, Brazil) were
included in this study. Among the animals, four were males
and three were females, ranging from 6 months to 5 years
of age. Two dogs were mongrel (dogs 1 and 2) and the
others were of the following breeds: Border Collie (dog 3),
Cimarron (dog 4), Collie (dog 5), Boxer (dog 6), and
Cocker Spaniel (dog 7). Clinical findings, hematological
parameters, parasitological diagnosis, and treatment were
analyzed.
On physical examination, these animals showed pale
mucous membranes, hyperthermia, apathy, and blood
dribbling down from the ear margins (Fig. 1a). Ticks were
not found in five animals, but the owners reported having seen
ticks in the last 7 days on these dogs. In two of the dogs, ticks
of the species R. sanguineus were found. Two milliliters of
blood from all dogs was collected for further evaluation of
hematological parameters and kept in tubes containing
ethylenediamine tetraacetic acid. Erythrocytes count, hemat-
ocrit (Ht), hemoglobin concentration, mean corpuscular
volume (MCV), mean corpuscular hemoglobin concentration
(MCHC), total plasma proteins (TPP), platelet number, and
total leukocyte count were evaluated. Smears were mounted
and stained by panoptic and/or Giemsa methods. Ht and
hematometric indices were evaluated according to the
methodology proposed by Feldman et al. (2000). Erythro-
cytes and leukocytes count, hemoglobin concentration, and
platelet counts were determined using an electronic counter.
TPP was carried out by refractometry.
From the samples collected, blood smears were per-
formed according to Pestana (1910a, b). Each slide was
mounted with blood collected from the cephalic vein,
stained by the panoptic and/or Giemsa methods, and
visualized at a magnification of ×1,000.
After the diagnosis was established, standard treatment
for nambiuvú with corticosteroids (prednisone—2 mg kg−1)
and doxycycline (5 mg kg−1) was administered orally twice
a day for 3 days. At the same time, we used a single dose of
imidocarb dipropionate (5 mg kg−1, sc).
Comp Clin Pathol (2010) 19:383–387
Results
The initial diagnosis of R. vitalli was based on the
morphological analysis of piroplasm in blood smears
(Fig. 1). In the blood of five dogs, intracellular organisms
inside macrophages (monocytes—Fig. 1b), erythrocytes
(Fig. 1c), and neutrophils (Fig. 1d) were observed. In the
other two animals, clinical diagnosis was performed,
followed by drug therapy.
In infected dogs, there was a significant reduction in
erythrocyte count, hemoglobin, and hematocrit when
compared to reference values (Feldman et al. 2000). Most
affected animals in this study (dogs 1, 3, 4, 5, and 6) had a
mean of increased MCV and mean of decreased MCHC,
characterizing macrocytic–hipochromic anemia. Dog 2 had
macrocytic–normochromic anemia. For dog 7, the mean of
MCV and the mean of MCHC did not differ from reference
values, characterizing normocytic–normochromic anemia
(Table 1). The presence of anisocytosis and polychromasia
were observed in seven dogs.
Dog 4 showed leukocytosis as a consequence of
neutrophilia and lymphocytosis. In other animals, the
number of total leukocytes did not change. TPP levels
increased in dogs 2 and 4 and decreased in dog 5 when
compared to reference values. The number of platelets
decreased dramatically in all affected dogs (Table 1).
The therapy used to combat the parasite R. vitalli was
effective for six dogs. These animals showed clinical
improvement, and hematological parameters returned to
normal levels. Dog 2 was the only one who did not respond
to therapy and died on the day the diagnosis was made.
Discussion
R. vitalli has been referred in the international literature as
Babesia vitalli of Brazilian dogs (Wenyon 1926) and
considered synonym for Babesia canis (Levine 1973;
Peirce 2000). It is postulated by some investigators that
the intracellular form of Rangelia found inside the
endothelial cells is possibly Toxoplasma, and that the tissue
stage of Rangelia has no connection with blood stage
which, according to them, is in reality B. canis (Wenyon
1926; Moreira 1938; Paraense and Vianna 1948). It is stated
in one publication that the masses of R. vitalli merozoites
being described originally within the cytoplasm of the
endothelial cells were, in fact, agglomerates of these
organisms accumulated inside the lumen of the capillary
blood vessels (Levine 1973). As shown in the study of
Fighera (2007), in only 4% of cases of rangeliosis, the
parasites are found in the blood stream. However, in this
study, 71.4% of dogs with clinical signs typical of
rangeliosis presented the parasite inside blood cells.
Comp Clin Pathol (2010) 19:383–387 385

Fig. 1 Dog infected with R.

vitalli showing pale mucosa
and bleeding at the edges of the
ears (a). Parasites inside macro-
phages in blood smears stained
with Giemsa method (b) and
within erythrocyte (c) and neu-
trophils (d) in panoptic method
smear

The definitive diagnosis of parasitism by R. vitalli is
problematic since this parasite has been observed in blood
smears of spontaneous and experimental cases of rangelio-
sis (Loretti and Barros 2004). This intracellular parasite has
been found in cytology and histology, endothelial cells of
blood capillaries, from necropsy samples, cytology of
lymph nodes and bone marrow, and also is rarely found
within red blood cells and free in the blood (Krauspenhar et
al. 2003; Loretti et al. 2003; Loretti and Barros 2005).
Contrary to what has been reported, we observed that in five
of seven dogs with rangeliosis in our study, the protozoan was
found inside the macrophages (monocytes), neutrophils, and
erythrocytes. This reinforces the importance of “blood smear”
as a diagnostic method of this disease in dogs, since this
technique has so far not been considered as a method in the
diagnosis of R. vitalli. Our research group is working on a
phylogenetic study based on molecular methods such as
PCR amplification and DNA sequencing to characterize the
protozoan and further to develop a specific PCR for R.
vitalli. This study is in progress.
Researchers (Krauspenhar et al. 2003; Loretti and Barros
2005) observed evidences that the protozoan induces
hemolytic anemia immune-mediated, causing a severe
regenerative anemia together with spherocytosis and eryth-

Table 1 Hematology of dogs naturally infected with Rangelia vitalli

Hemogram and reference values Animals infected whit Rangelia vitalli

Dog 1 Dog 2 Dog 3 Dog 4 Dog 5 Dog 6 Dog 7

Erythrocytes total (×106/µl) (5.5–8.5a) 1.81 2.56 2.57 2.48 1.58 2.6 2.3
Hemoglobin (g/dl) (12–18a) 4.4 7.0 6.1 6.5 3.7 5.9 6.0
Hematocrit (%) (37–55a) 16 23 20 20 14 20 17
MCV (fl) (60–77a) 85.2 89.8 77.8 80.6 88.0 77.9 73.9
MCHC (%) (32–36a) 27.8 33.0 30.5 31.5 26.0 29.5 35.2
TPP (g/dl) (6–8a) 6.3 8.6 6.0 9.6 5.2 8.0 7.0
Platelets (×103/µl) (200–500a) 23 24 34 106 29 27 70
Leukocyte total (×103/µl) (6–17a) 12.3 7.1 10.1 35.3 9.7 10.2 9.2

Hemogram was carried out on the day of clinical and parasitological diagnosis
a
Reference values
386
rophagocytosis, which are the causes of autoimmune
anemia (Feldman et al. 2000; McCullough 2003). In our
study, we also observed severe anemia in all dogs (Table 1),
with significant reduction of total erythrocyte, hematocrit,
and hemoglobin. The cause of anemia was not investigated;
however, the presence of anisocytosis and polychromasia
suggests that the dogs had regenerative anemia.
Only dog number 4 showed leukocytosis when evaluated
(Table 1). The same animal together with dog 2 had
increase in the concentration of TPP, which characterizes an
inflammatory response in order to combat parasitism.
According to researchers, leukocytosis is due to neutro-
philia with regenerative left shift as a consequence of
prolonged stimulation, which may be accentuated and
nonspecific of the bone marrow (Fighera 2007). In some
cases, this leukocytosis may be presented in the form of a
leukemoid reaction. Other common findings include lym-
phocytosis and monocytosis (Loretti and Barros 2004;
Fighera 2007), a case where an increase in total leukocytes
was due to neutrophilia and lymphocytosis. Based on our
findings and literature, we conclude that the leukogram is
inconsistent in rangeliosis, ranging from leukopenia to
leukocytosis or without leukocyte alterations as observed in
most of our cases reported here.
The pathogenesis of the characteristic clinical sign (ear
bleeding—nambiuvú) usually observed in cases of dogs
infected is still unclear (Loretti and Barros 2005). Dissem-
inated intravascular coagulation secondary to endothelial
damage caused by the replication of this organism inside
the host cells should be considered as one of the supposed
pathogenetic mechanisms involved in the development of
hemorrhages in this Brazilian protozoan disease in dogs
(McCullough 2003). According to some authors, another
possible cause of bleeding is a reduction in the number of
circulating platelets (Fighera 2007). In this study, severe
thrombocytopenia was found in all affected dogs. There-
fore, the reduced number of platelets may have been the
cause of bleeding from the ears of dogs with rangeliosis.
Ticks are the principal suspects to transmit this disease
that commonly affects dogs in Brazil (Pestana 1910a, b;
Carini and Maciel 1914; Braga 1935; Carini 1948). Despite
not having found ticks in dogs during clinical examination,
all dogs had a history of being infested by dust mites in the
last days. In this study, three dogs were from a rural area
and others from an urban area. It is important to note that
two dogs from the urban area showed clinical symptoms
after staying a few days in the rural areas, during the
holiday period of the owner.
Only a few studies report treatment for rangeliosis,
which consists of therapy with corticosteroids and anti-
protozoal (doxycycline or imidocarb dipropionate). This
therapy is commonly used in southern Brazil and when R.
vitalli infection is suspected, based on the most typical
Comp Clin Pathol (2010) 19:383–387
clinical features of the disease—bleeding edge of the ears.
It is important to remember that this therapy is also used as
a method of diagnosis of this parasite (medical diagnosis).
In this study, six dogs were treated aiming to cure the
disease, except dog 2 that did not respond to treatment and
died. Loretti and Barros (2005) in their study reported
spontaneous death of eight affected animals. Three of those
animals showed jaundice and died acutely in approximately
1 week after the observation of initial clinical signs.
Therapy with doxycycline was started in the late stage of
the disease in one of the icteric dogs and was unsuccessful.
One animal that died after a protracted clinical course of 2–
3 months had anemia. Other animals had recovery
approximately 48 h after therapy with imidocarb dipropi-
onate and blood transfusion, and another after treatment
with doxycycline and glucocorticoid therapy. Three animals
died 24–48 h after therapy with diminazene aceturate. In
our study, we obtained the cure of all animals treated,
which allows us to suggest that therapy with the three drugs
is the best treatment protocol for rangeliosis.
Based on the findings, it is concluded that R. vitalli is
pathogenic for dogs, causing severe anemia and thrombo-
cytopenia. Blood smear is an important method to visualize
the parasite within red blood cells, neutrophils, and macro-
phages. The therapeutic protocol based on prednisone,
doxycycline, and dipropionate imidocarb is effective in the
treatment of rangeliosis.
References
Braga A (1935) Contribuição ao estudo experimental das piroplas-
moses dos cães. Bol Vet Exército 3:1–16
Carini A (1908) Notícias sobre zoonoses observadas no Brasil. Rev
Méd São Paulo 22:459–462
Carini A (1948) Sôbre o ciclo de desenvolvimento exo-eritrocitário de
um piroplasma do cão. Arq Biol 285:49–52
Carini A, Maciel J (1914) Sobre a molestia dos cães, chamada nambiuvú,
e o seu parasita (Rangelia vitalli). An Paul Med Cir 3:65–71
Feldman BF, Zinkl JG, Jain NC (2000) Schalm’s veterinary
hematology, 5th edn. Lippincott/Williams & Wilkins, Philadel-
phia, p 1344
Fighera RA (2007) Rageliose. Acta Sci Vet 35:261–263
Krauspenhar C, Fighera RA, Graça DL (2003) Anemia hemolítica em
cães associada a protozoários. Medvep—Rev Cient Med Vet Peq
Anim Anim Estim 1:273–281
Levine ND (1973) Protozoan parasites of domestic animals and man,
2nd edn. Burgess, Minneapolis, p 406
Loretti AP, Barros SS (2004) Parasitismo por Rangelia vitalli em cães
("nambiuvú", "peste de sangue")—uma revisão crítica sobre o
assunto. Arq Inst Biol 71:101–131
Loretti AP, Barros SS (2005) Hemorrhagic disease in dogs infected with
an unclassified intraendothelial piroplasm in southern Brazil. Vet
Parasitol 134:193–213. doi:10.1016/j.vetpar.2005.07.011
Loretti AP, Barros SS, Corrêa AM, Breitsameter I, Oliveira LO,
Pescador CA, Silva NN, Rozza DB, Driemeier D, Araújo ACP,
Meireles LR (2003) In: Encontro Nacional de Patologia
Veterinária (ed) Parasitism of dogs by Rangelia vitalli in southern
Comp Clin Pathol (2010) 19:383–387
Brazil: clinical, pathological and ultrastructural study. Anais,
Botucatu, p 178
McCullough S (2003) Immune-mediated hemolytic anemia: understand-
ing the nemesis. Vet Clin N Am Small Anim Pract 33:1295–1315
Moreira J (1938) Sobre a natureza do nambiuvú dos cães. Arq Inst
Biol 9:315–319
Paraense WL, Vianna YL (1948) Algumas observações sobre a babesiose
dos cães no Rio de Janeiro. Mem Inst Oswaldo Cruz 46:595–603
Peirce MA (2000) Order Piroplasmorida. In: Lee JJ, Leedale GF,
Bradbury P (eds) The illustrated guide to the protozoa. Society of
Protozoologists, Lawrence, pp 347–353
387
Pestana BR (1910a) O Nambyuvú (nota preliminar). Rev Soc Sci São
Paulo 5:14–17
Pestana BR (1910b) O Nambyuvú. Rev Méd São Paulo 22:423–426
Spagnol C, Loretti A, Corrêa A, Pescador C, Rozza D, Conceição E,
Colodel E, Oliveira R, Breitsamater I, Barros S, Oliveira L,
Driemeier D (2003) In: Salão De Iniciação Científica (ed)
Parasitismo de cães por Rangelia vitalli no Estado do Rio
Grande do Sul. Anais, Porto Alegre, pp 232–233
Wenyon CM (1926) Protozoology: a manual for medical men,
veterinarians and zoologists, vol. II, 1st edn. Baillie`re Tindall
and Cox, London, pp 1012–1022