Alabama Rot (CRGV)

Alabama Rot (AKA Cutaneous and Renal Glomerular Vasculopathy (CRGV))

Alabama Rot, apart from one potential greyhound, was first discovered in the UK in 2012.  Prior to this a similar disease by the same name was present in Greyhounds in the USA throughout the 1980s and ‘90s and affected a Great Dane in Germany in 2002.

 

Though Alabama Rot in the UK is very similar to the disorder affecting Greyhounds in the US, it isn’t the same disorder.  The disease in the UK is known by a number of names; Alabama Rot, Alabama Rot-like Syndrome and finally Cutaneous and Renal Glomerular Vasculopathy (CRGV); the latter being the more medical term and describes what happens to the body.

 

Alabama Rot is a very rare but devastating disease but appears just to affect dogs and currently just appears to affect the UK (plus one confirmed case in Ireland).  The reason this disease appeared only during 2012 and its cause are still very much unknown.  There is a chance of cases occurred before 2012 but were missed or misdiagnosed as Acute Kidney Injury (AKI) which is one of the disorders that Alabama Rot causes.

 

Cases first appeared in/ around the New Forest, Hampshire.  Since then there have been cases across the whole of England and Wales with a small number of cases having been diagnosed in Scotland, Northern Ireland and Ireland.  The fact that it has spread across to Ireland and NI is particularly worrying due to the natural barrier of the sea which usually stops the spread of disease.  At the time of writing, throughout the UK and Ireland there have been 152 confirmed cases of CRGV.

 

Historically, CRGV has appeared to be seasonal with most cases being between November and May but some cases have occurred outside of this time.

Currently, even with effective treatment, the mortality rate in most cases (once the kidneys are affected) is 80% meaning if 10 dogs were to become infected by the disease between 8 would die.

Possible Causes

The seasonality of the disease has led to some researchers wonder if it is related to bacteria in the mud, with muddy areas being more abundant between November and May.  A fish vet called Fiona Macdonald did come across a bacteria, Aeromonas hydrophila, which lives in water and mud and causes skin ulcerations followed by AKI in fish. The link between this and CGRV has not been confirmed at the time of writing.

The Signs of CRGV

  • Skin ulceration/ wound
    • Usually on the lower leg but may be around the belly or on the muzzle. Some may also be on the tongue.  Some may also be between the toes.
    • These are usually surrounded by a reddened area of skin.
    • If a dog is licking or paying a lot of attention to parts of their body check tha area for a wound
    • Limping; if the sore is on the leg the pain from the skin pulling against the wound when walking can cause a limp
  • Drinking a lot
  • Urinating less than normal
  • Lethargy
  • Vomiting
  • Not eating
  • Collapse
  • Dehydration
  • Jaundice

 

The signs other than the wound are mostly due to the dog having problems with their kidneys known as an Acute Kidney Injury (AKI).

 

It is ultimately the AKI and associated damage rather than the skin wound that may kill the dogs.

 

Dogs with Alabama Rot tend to develop AKI about 4 days after the skin wound(s) but this is not always the case.  Sometimes the skin wound is the only sign whereas other times they just develop the AKI without any wounds.  Also, sometimes the AKI can start before the skin wounds or quite some time after.

 

This unpredictability, and the fact that the skin wounds look like normal wounds, can make it difficult to diagnose in the early stages and therefore treatment may be delayed.

What Does Alabama Rot Do to the Body?

In the UK, Alabama Rot’s medical name is Cutaneous and Renal Glomerular Vasulopathy.

Cutaneous means the skin.

Renal = Kidney.

Glomerular is the main part of the kidney that it affects; the part that filters the blood.

Vasculopathy= A disorder which affects the blood supply.

This means that it’s a disorder affecting the blood supply to parts of the kidney and skin.

 

It causes small blood clots within the blood vessels of the skin and kidneys.  This stops that area of skin/ kidneys getting the oxygen and nutrients it needs (as well as getting rid of any waste products it has) causing the area to die.

Some red blood cells squeeze past the clots but due to the tiny space, they are often damaged.  This damage may be seen in a blood sample and it can cause anaemia.

The large number of clots throughout the body use up quite a lot of platelets which may show up in the blood sample as there are fewer left in the blood than there should be.

 

The anaemia can also affect organ function across the body, however, most issues are due to the kidney damage.

 

The skin wounds may also become infected too causing further problems.

 

Diagnosis

A complete diagnosis is made by looking at samples of the skin and kidneys for the typical damage for this.  Sampling the kidneys is only usually done after a dog has died by post-mortem examination.

 

In alive dogs, the diagnosis is made by the symptoms and the presence of typical skin wounds/ ulcerations.  Skin lesions are usually on the lower leg or foot but can be under the belly or muzzle and in some cases they are also on the tongue too.

 

Kidney disease is diagnosed by blood and/ or urine samples.  If your dog is suspected of having Alabama Rot, even if well, your vet will usually want to take blood samples.  The blood samples are usually repeated after a few days to see if the markers for kidney damage increase.  If they increase above a certain amount, even if your dog seems well, they likely have AKI and need to be treated.

 

Blood samples may look at the number of platelets and white blood cells (and their types) in the blood. The type of white blood cells can point to the presence of an infection, and sometimes the type of infection (ie if it’s due to bacteria or parasites).

Any abnormalities in the shape of the red blood cells can happen with CRGV due to them squeezing past the blood clots.

Vets also look at the level of something called Bilirubin in the blood.  This can be raised due to damage to the red blood cells or with liver damage.  Dogs with high bilirubin levels are often jaundiced; their skin, gums, and the whites of their eyes look yellow.  This is seen in up to half the dogs with CRGV.

 

Finally, vets look for evidence of other infections which could cause these symptoms eg; Leptospirosis or poisons.

 

Treatment of Alabama Rot

The main treatments revolve around the AKI.

The wounds are treated with thorough cleaning and antibiotics.  They may be covered with a dressing and the dog may have a buster collar on to stop them licking the wounds.

 

They will be put on a drip to help flush out any toxins within the kidneys and help with their dehydration.

Dogs may have a catheter placed into their bladder for vets to measure the amount of urine they pass.  This helps them evaluate the effectiveness of the treatment.

Dogs are usually given anti-sickness medication.  If they are eating they may be fed on a prescription diet to help their kidneys.  Some dogs are fed using a feeding tube into their stomach.

 

Giving them plasma via a blood transfusion replaces the platelets used up during clotting but this may not help to a huge degree.

 

Finally, a new treatment that has been trialled at the Royal Veterinary College called Plasmapheresis.  Here the plasma (the liquid part of the blood) is filtered to remove antibodies.  These are parts of the body’s immune system but sometimes cause harm and thereby removing them, or an excess of them, can help the dog.  In the trial, two out of six severely affected dogs survived which is a significant improvement on the usual odds.  This trial is still very early on so its overall success is still unknown.

 

Prevention

There is no known, reliable prevention for Alabama Rot.

As the cause of this disease is unknown a vaccine cannot be produced.  Also, people cannot be advised on specific protocols to follow.

This disease is more common during muddier times of the year and potentially in dogs walked in specific areas.  Some recommend washing the dogs legs and paws after coming home from a walk.  This usually won’t harm your dog and may actually increase the chances of you finding new wounds on them.  It is important to remember, more often than not new wounds are not caused by Alabama Rot.

 

Once a cause is found likely more information will come out regarding preventative measure to help you protect your dog from this devastating disease.

Rabbit Haemorrhagic Disease 2 (RHD2)

Introduction to Rabbit Haemorrhagic Disease

Rabbit Haemorrhagic Disease Type 1 (RHD1) is a disease affecting rabbits first which was discovered in 1984 in China and causes sudden death in rabbits (Oryctolagus cuniculus).  RHD1 spread quickly but overtime was controlled by a combination of improved hygiene and a vaccination program, one which is still available today.

Fast forward until 2010, a new version of Rabbit Haemorrhagic Disease, this time Type 2 (AKA RHD2), appeared. By 2014 RHD2 had spread to the UK and from there it spread as far away as Canada and Australia.

Rabbit Haemorrhagic Disease Type 2

RHD2 affects European rabbits of all ages and, unlike type 1, also affects hares.  In 2015 it also started to really cause problems among shows, breeding colonies and in rescue centres where it spread quickly between animals sharing a small space and where rabbits were coming and going. The presence of it in shows also accelerated it’s spread across the UK.

Unlike RHD1, Type 2 can affect many species of rabbit/ hare

Rabbit Haemorrhagic Disease Type 1 tends to cause sudden death with nothing much else seen otherwise.  RHD2, however, only causes sudden death in a minority of cases, in fact only killing approximately 20% of affected rabbits (though it can kill as few as 5% up to as many as 70% dependent on the area and the timing). Instead, RHD2 often leads to a longer period of illness followed by a recovery.

Between a rabbit catching RHD2 and showing signs of illness there, is approximately 3-9days, known as the incubation period.  During this period, the rabbit can pass it to other rabbits without you even knowing they had it.  Therefore, RHD2 is often spread before you have the chance to improve or alter your cleaning practices and therefore you need to be prepared. It is important you improve your methods and act as if your animal may have it right now; clean their cages to the best of your ability all the time and, perhaps the best prevention, keep rabbits vaccinated against RHD2 to protect them from catching it.

The signs of RHD2

The virus can cause your rabbit to become ill in three different forms;

Percute type
  • This looks similar to RHVD1 in terms of it just leads to sudden death
Acute Type
  • Fatal in a lot of cases, often within the space of 36htrs.
  • Signs of it are
    • collapsing,
    • large amount of bleeding; blood in their urine, any discharge from their body, bleeding gums and nosebleeds.
    • Some show signs of brain and nerve problems
    • collapse,
    • seizuring,
    • poor balance,
    • falling over, or,
    • walking like they are drunk (Ataxia).
    • crying out a lot.
Subacute/ Chronic Form
  • This sometimes causes rabbis to die but often not for over a week and is due to liver failure, the main organ affected by RHD.
  • During this time they have
    • severe jaundice (meaning their skin and the white of their eyes, along with other places, looks yellow),
    • they refuse to eat
    • very quiet
    • lethargic.

Treatment

Firstly if you suspect one of your rabbits has RHD2 it is important for you to contact your vet straight away.

When rabbits have Subacute/ Chronic RHD2 they often stop eating and drinking. To prevent rabbits becoming dehydrated, make them feel better and increase their odds of survival you should make sure they’re kept warm (be careful using heat pads or hot water bottles; these can burn their sensitive skin. Only use heat pads if they are no warmer than around 40C and they are able to move away from them on their own). If they are very unwell or not drinking your vet may want to put them on a drip until they are drinking and eating enough.

How it’s Spread

RHD2 is highly contagious meaning it can spread from one rabbit to another very easily.

However, it’s not just rabbits you have to make sure don’t pass it on, if any of the virus gets on the bowls, cages, your shoes etc, anything another rabbit may come into contact with it can be passed along.

The main things the virus is passed on in is the tears, saliva and nasal discharge but it also stays in and on any of the rabbit’s bodies who died from it.

Indoor rabbits may be affected by RHD2 too. Image; Twitter @SarahTait123

To make it worse and even less predictable, if a fly has been near an infected rabbit they can pass it to another rabbit they spend time near/ bite.

Finally, RHD2 is spread in the rabbits urine and faeces throughout the whole time they are infected until around one-two days after the infection has resolved.  The risk is if one cage is stacked on top of another then it could be spread easily if they are not completely waterproof and any urine seaps from one cage into another, infecting the second group of rabbits.

It is unknown how long the virus survives to reinfect other rabbits when it’s in the environment.  One thing to watch out for is later infections if a previous rabbit had one such as a rabbit catching it from bits of virus left in its cage.

Therefore, if you are keeping rabbits near/ in an area where a rabbit has been previously infected with RHD2 it is important you keep up with high levels of hygiene, vaccinate all of the rabbits and be vigilant for signs of infection.

If your rabbits have previously had it or you own a breeding colony/ similar leaving rabbits your rabbits are at high risk of getting it.

Preventing the Spread of RHD2

If you have several rabbits and one has come down with RHD2 you should isolate the affected one and look after that one totally separately. Your hands should be thoroughly cleaned and/ or alcohol rub used to clean your hands and you should wear different clothes when looking after/ interacting with your healthy rabbits to try and prevent its spread.

RHD2 is a very difficult virus to kill and prevent its spread so often doing this isn’t 100% effective especially with rabbits spreading the disease before they show any signs of illness.

One any affected rabbits have been separated from the healthy ones it is important you get the healthy rabbits vaccinated against RHVD2.  A vaccine for type 1 has been shown to now really help against type 2 (though in some cases may offer a small amount of protection). Your rabbits will then need to get boosters at least every year, ideally every six months if your rabbits are at a higher risk of catching it such as you show or breed them or you’ve owned affected rabbits near where your current rabbits are housed.

Really young rabbits are at risk of RHD2 and, in high risk areas, vaccinating them at four weeks old should be considered

With the disease spreading very easily and being difficult not only to save rabbits but to prevent others from becoming infected, rabbit shows are now cancelled in an affected area. You should not take a rabbit to a show if you suspect they are infected or if you have another rabbit who has it or recently did.

To prevent RHD2 from spreading you should use plenty of good quality disinfectants when cleaning their cage and anything they come into contact with. Sadly, the RHD2 virus is difficult to kill so not all disinfectants are effective.  The use of alcohol skin rubs rather than a disinfectant called Chlorhexidine (either within a rub or as a soap with water) is more effective.  Other than that, when cleaning their cages diluted household bleach may be one of the most reliable things. If you use bleach make sure the cage is thoroughly rinsed out afterwards to prevent it burning your rabbits skin or the inside their mouth if they gnaw on a treated area.

 

Vaccination

For rabbits at high risk, it is worthwhile considering vaccinating kits from four weeks old.  Prior to this age if their mother has either had RHV2 or has been exposed to it the kits will get immunity from their mother’s milk, however, this immunity wears off at four weeks.

At four weeks old these rabbits no longer are protected by their mother and are very susceptible to it due to their underdeveloped immune system. If they’re not vaccinated at four weeks and are exposed to RHD2 they will likely get it.  Current vaccines have a licence to be used from 10weeks of age but are believed to be safe to use from four weeks of age.  However, if given the vaccine at four weeks old, young rabbits will need a second vaccination when they are ten weeks old as it hasn’t been shown to last longer than this 8n such young rabbits.

It is still important they have vaccines against myxomatosis which, itself, is often lethal

Vaccinations, once given at ten weeks of age or older last for a year in mild-moderate risk areas.  However, if your rabbits are at high risk of an infection it is recommended they have a booster every six months.

RHD2 vaccines are on top of Myxo-RHD1 vaccinations which are the normal vaccines given annually in the UK against myxomatosis and RHD1.  This vaccine is very important for rabbits to still get as RHD2 vaccines do not work against myxomatosis or RHD1 and vice versa. Myxomatosis in its own right is a very common and often fatal disease which can be easily prevented by annual boosters s9 these should be unavoided as other methods o& prevention are less effective.

Currently, there is no evidence of whether the Myxo-RHD and the RHD2 vaccines interfere with each other if given at the same time and, therefore, it is recommended that at least two weeks is given between a vet giving your rabbit each of these vaccines. Though, it doesn’t matter if the vaccines are separated by a longer period of time, or which is given first.

The new vaccine in the UK by Filavacs however, does cover both types of RHVD. However, it must be remembered that this vaccination still doesn’t cover myxomatosis at all so getting that vaccine too is still highly recommended.

In Summary

There are two types of Rabbit Haemorrhagic Disease; type one tends to cause sudden death. Type two however can cause a more long-lasting disease.

Both types can be prevented by vaccination and Filavacs does a vaccine protecting against both but rabbits should also be vaccinated against Myxomatosis in a separate vaccine.

Rabbits at high risk should be vaccinated from very young (4weeks of age) and maybe twice a year as well as thorough cleaning and prevention strategies.  Shows should be avoided in high risk areas too.

If you believe your rabbit may have RHD then contact your vet immediately.

 

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