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.