Babesiosis, also called red water or cattle tick fever, is a tick-borne disease caused by Babesia spp, which  infects red blood cells. B. bovis and B. bigemina are  the two forms of babesiosis in cattle. The disease is  transmitted exclusively by ticks, which acquire Babesia infections from infected animals and then pass it to other healthy animals at a subsequent blood meal. The infections in ticks can be passed onto the next generation through the eggs. This disease can occur almost everywhere around the world. It is a major threat to cattle development in many tropical and sub-tropical countries, especially when exotic breeds are used. Nevertheless, controlling the disease is possible, but requires high standards of management and veterinary supervision. The control processes usually involve a combination of treatment, vaccination and tick control. CAUSES: More than 100 species of Babesia exist, but only a small number of species are known to be responsible for the majority of symptomatic disease. The causative agent of Babesiosis varies according to geographic region. In animals, Babesia canis rossi, Babesia bigemina, and Babesia bovis cause particularly severe forms of the disease that include a severe haemolytic anemia, with positive erythrocyte-in-saline-agglutination test indicating an immune mediated component to the haemolysis. Common sequelae include haemoglobinuria "red-water", disseminated intravascular coagulation (DIC) and "cerebral Babesiosis" caused by sledging of erythrocytes in cerebral capillaries. CLINICAL SIGNS: Fever is the first clinical sign one to three weeks after an infective tick bite. Following the bite, the parasites invade red blood cell where they multiply and invade more red blood cells. The destruction of increasing number of red blood cells causes the affected animals become anemic shocked and also releases large quantities of red blood cell pigment (hemoglobin) into the circulation. The sick animals are usually depressed, lose appetite, and their eyes and gums are pale from anemia and yellow (jaundiced) due to bile pigments in their circulation. Red colored urine can usually be observed in these animals. Pregnant animals often abort. In severe B. bovis infection cases, signs like nervous signs, in coordination, paralysis and coma are presented which often lead to death. Babesia infections can range from in apparent to acute severe diseases. In severe cases, animals often die within one or two days of the appearance of clinical signs. However, in less severe cases, animals can have a fever for about a week and sick for about three weeks. After that, they can have slow recovery, but will remain infected carriers for the rest of their lives. EPIDEMIOLOGY: Babesiosis is a vector-borne illness usually transmitted by ticks. (Babesia microti uses the same tick vector, Ixodes scapularis, as Lyme disease does, and frequently occurs in conjunction with it.) In babesia-endemic areas, the organism can also be transmitted by blood transfusion. In Pakistan mostly cross bred and exotic breeds are effected by this disease. Babesiosis causes a disease very similar to Malaria. In mild cases, people may experience mild fevers and anemia. In more severe cases, fevers go up to 105F / 40C with shaking chills, and anemia (hemolytic anemia) can become severe. Organ failure may follow including adult respiratory distress syndrome. Infection with Babesia parasites can be asymptomatic or cause a mild non-specific illness, and therefore many cases go unnoticed. It may also cause severe disease. While most severe cases occur in the very young, very old, or persons with underlying medical conditions (such as immunodeficiency) and those without a spleen, they can occur in normal individuals. Indeed, both the incidence or all cases of Babesiosis and severe cases are increasing rapidly. Some cases are identified when patients with another tick-borne illness are screened for Babesiosis. Little is known about the occurrence of Babesia species in malaria-endemic areas, where Babesia can easily be misdiagnosed as Plasmodium. DIAGNOSIS: In Animals Babesiosis is suspected by observation of clinical signs (haemoglobinuria and anemia) in animals in endemic areas. Diagnosis is confirmed by observation of merozoites on thin film blood smear examined at maximum magnification under oil using Romonovski stains (methylene blue and eosin). This is a routine part of the veterinary examination of dogs and ruminants in regions where babesiosis is endemic. Babesia canis and Babesia bigemina are "large babesias" that form paired merozoites in the erythrocytes , commonly described as resembling "two pears hanging together", rather than the "Maltese Cross" of the "small babesias". Their merozoites are approximately twice the size of small babesias. Cerebral babesiosis is suspected in-vivo when neurological signs (often severe) are seen in cattle that are positive for Babesia bovis on blood smear. Outspoken red discoloration of the grey matter on post-mortem further strengthens suspicion of cerebral babesiosis. Diagnosis is confirmed post-mortem by observation of Babesia infected erythrocytes sludge in the cerebral cortical capillaries in a brain smear. DIFFERENTIAL DIAGNOSIS: Bacillary haemoglobinuria Theleriosis Post Parturient haemoglobinuria Pre Parturient haemoglobinuria TREATMENT: Veterinary treatment of Babesiosis does not normally use antibiotics. In animals Diminazene (Berenil), Imidocarb or Trypan blue would be the drugs of choice for treatment of Babesia canis rossi (Dogs in Africa), Babesia bovis, and Babesia bigemina. There is a vaccine that is effective against Babesia canis canis (dogs in the mediterranean region) but this is ineffective against Babesia canis rossi. Babesia imitans casuses a mild form of the disease that frequently resolves without treatment (dogs in South East Asia). CONTROL MEASURES: In endemic areas, many indigenous cattle are naturally infected with babesiosis in calf hood, and are immuned as a result. This situation is called blue endemic stability. Generally, no control measures are required in these areas. Occasionally, immuned animals may develop clinical babesiosis under stress, malnutrition, other diseases or overwork, and these should be treated as they arise. However, in some endemic areas, indigenous cattle may not have been naturally infected and immuned early in life due to the inactivity of the Boophilus vectors, e.g. prolonged dry seasons, droughts, etc. Outbreaks of babesiosis can sometimes happen to indigenous cattle. This situation is called endemic instability. In these areas, young cattle should be vaccinated to protect them until they are naturally immuned. Exotic cattle are very susceptible to babesiosis. If they are introduced into endemic areas, they must be vaccinated on arrival to avoid heavy losses. Strict tick control programme aimed at the one-host Boophilus ticks is another option. However, because the difficulties in practice to ensure that the protected cattle are not exposed to infected ticks, the disease control is often more efficient to combine tick control with vaccination.