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.

The Carl Story; My Rescue Guinea Pig

Today I’m going to focus on Carl, my rescue guinea pig.  Carl is a black long and curly haired male guinea pig.  He’s nearly two years old and I’ve owned him for one and a half years.  I adopted him after he had several medical conditions, some due to neglect, which is the reason he is still currently housed alone; not ideal but I’ll explain later.

Carl; the Early Stages

Carl was first brought to me as a patient when I was working as a vet.  He was only eight weeks old and was in a pet shop at the time.  He was healthy apart from his right eye.  When I examined Carl his eye was very swollen and infected with shavings around it. I also couldn’t tell whether his eye was just infected or if it was no longer fully in the eye socket.  At the time I was seeing quite a few guinea pigs who had at least one eye socket that was shallow.  This defect increased the risk of their eyes no longer staying in the socket and becoming infected more often.  As many of these guinea pigs were bred at the same place I think it was probably a genetic problem amongst the group and one which affected Carl.

After I had examined Carl I spoke to the pet shop staff member that brought him to me.  Together we decided to see how he went on medications to start off with as we didn’t want to remove his eye unless we had to.  So, I prescribed him a course of antibiotics (Baytril) to treat the infection, non-steroidal anti-inflammatories (Metacam) to take down the swelling and lessen the pain, pain-killers (Buprenorphine) which were similar to Morphine as it was really sore and antibiotic eye drops.

I wanted to do everything I could to save his eye and quickly so hoped that would do it.  I could’ve tried surgery to check if his eye was in place or not and place it back in but I needed to get on top of the infection first.  Finally, I warned the staff member about the prospect of him losing his eye if the treatment regime didn’t help.

When I next saw Carl the swelling around his eye had improved as well as the infection.  However, it was clear his eye wasn’t fully in the socket and was very damaged.  The only option was for me to surgically remove Carl’s eye ASAP.

Guinea Pig in cage
Carl (Guinea Pig)
Carl’s First Surgery

I operated on Carl later that day, carefully dissecting around and removing his right eye.  Whilst doing this I checked for more infection but found none. His eye was removed successfully and he woke up with no problems.  Due to his eye having been infected he needed to stay on antibiotics and staff at the pet shop were instructed to keep his wound clean. Carl also had to stay on the anti-inflammatories and be regularly checked by a vet.  On top of this, I requested that he had puppy pads down in his cage rather than shavings.  All caged animals should have their bedding changed this way if they have any wounds; shavings cause problems if they stick in wounds.

Over the coming weeks, Carl wasn’t given his antibiotics regularly and his wound wasn’t cleaned.  His health was neglected.  As a result of this neglect, Carl’s wound became very infected and turned into an abscess.  After two weeks the infection was at it’s worst and sadly wound completely reopened.  Carl’s face really didn’t look good and there was a chance it would never heal.  I spoke to the pet shop staff about this neglect and found it was due to some of the staff being unaware of how to give him his treatments.  To reduce the risk of further problems, I spent time teaching the store staff members how to give him his treatments.  Also, I explained the how important it was for him to get his medications.  At that point, they seemed to understand what h needed and why.

Carl Faced Further Problems

Over the next few weeks, my veterinary colleagues kept seeing Carl.  His wound infection cleared and his face began to heal.  Carl faced more problems though.  He developed a ringworm; a fungal infection, which commonly occurs in stressed guinea pigs and can spread to people.  Carl also contracted an airway infection from some ill rabbits housed around him.  In a bid to tackle these infections Carl was started on different antibiotics (Septrin) and had an anti-fungal medicine (Itrafungol) every day for over two weeks for his ringworm.  This all cleared up.

Ten Weeks Had Passed

Ten weeks after I first removed his eye, I saw Carl again.  He was still living in the pet store as he’d not been healthy enough to be sold.  By this point, his ringworm and airway infections had resolved.  His face, however, had not fully healed.  There was no infection but a small hole was still present from and clear fluid leaked from it.  The hole didn’t look like it wasn’t going to heal on its own.

The only way to treat this was to put him under the knife once more.  This was risky surgery.  His skin was already thickened and scarred due to the infections.  There was a chance I wouldn’t be able to close the wound, in which case he would be left with a larger wound over his eye socket.  Even if I could stitch it back together there was a chance of the wound becoming infected or opening back up again.  However, if it wasn’t closed he’d have got infections under the skin on his face over time which would have been disastrous.

Guinea pig plastic surgery
Carl after his second surgery sporting his stitches and shaved face
Plastic Surgery!

Carl was brought for surgery again.  I carefully dissected the thickened and damaged skin around the hole in his face.  For it to heal I had to remove a small amount of skin all the way around the hole and look for any infection. There was none.  The surgical site was carefully and gently stitched before I sat with him whilst he awoke from the anaesthetic.

Adopting Carl

One week before Carl’s final surgery, I started to think about adopting him and discussed this with several other people.  I knew, however, that I was busy for the next week so couldn’t take him then.

When I performed Carl’s surgery I decided if he stayed where he was he was likely to be neglected once more.  His wound may have become infected again which would have been disastrous, damaging his face further.  I was also concerned that he may not have recovered fully from the anaesthetic before the pet shop staff went home.  This was all I needed to decide the best course of action was for me immediately adopt him.

Carl wasn’t currently up for adoption due to his poor health.  With me being his vet, however, the pet store made an exception, knowing I could care for him. They allowed me to adopt him straight away.  Having been very busy in the week between me thinking about adopting him and actually adopting him, I hadn’t bought him anything.  The solution; to buy everything he needed from the pet shop he was in.  For the rest of my working day he sat by my side whilst I did paperwork.   Finally, after eleven weeks of him being isolated in a cage behind the pet store and his needs neglected he was coming home.

Metacam is tasty!
Carl nibbling on the Metacam Syringe
At Home

As soon as I got home from work I set up Carl’s cage.

Over the next few days, I allowed him to settle.  Though, during this time, I still had to interact with him to give him his treatment.  By this point, he was only on Metacam and I also needed to had to clean his wound.

Over the next few days, he began to like me giving him his Metacam, grabbing the syringe off me, hoping to get seconds.  He also accepted me cleaning my face though he didn’t enjoy that as much!  Carl did, however, have a relapse; his airway infection returned.  I listened to his airways with my stethoscope at least daily. Carl also stayed on Metacam to reduce any swelling in his airways. Apart from his infection, Carl was otherwise well.  He was eating and active and I monitored him to check it hadn’t spread to his lungs.  I didn’t want him on antibiotics due to the amount he’d had in the past and me believing he could recover without them.  After a few days, he had improved.  Carl’s wound had healed nicely with no signs of infection in either his wound or his airways.

Nowadays

Carl is doing well now.  He’s become more confident; six months ago he wanted to be in his cage all the time.  Now when I leave the door open he runs excitedly around my lounge!  He eats well, loves his hay and eats a wide variety of food.  Carl loves eating.

Guinea pigs are sociable animals and they really need companionship.  Carl, unfortunately, is still a lone pig.  The only companionship, apart from me, is with a friend’s rabbit who occasionally comes to stay in its own cage.  Carl has also, unintentionally, been face to face with Darwin, my Leopard gecko.  I don’t know what they both made of each other.  I also talk to him a lot though but is that enough?

The reason for Carl being alone is, from 8weeks old he’s been isolated from other guinea pigs and he didn’t even acknowledge the rabbit for the first two week-long periods it spent here.    It was as if Carl didn’t even recognise that anything else existed.  I don’t know how he would react with another guinea pig.

Could Carl Make a Friend Ill?

Secondly, and the main reason, is his airway infection.  Every so often when he’s stressed his infection returns for a few days.  It is only mild when it does return but with no other mammals here and him being kept indoors it’s likely he has bacteria lying dormant in his airways.  Though the majority of the time these bacteria cause Carl no issues, he has passed his infection on to his rabbit friend twice.  Carl also only tends to become ill when the rabbit is here.  It is likely the presence of another animal is making him stressed and this stress is leading on to his infection.  Finally, as the rabbit catches Carl’s infection it tells me it can pass to other animals.

The worry is that if and when Carl gets a friend they may contract his infection especially when they first meet as they will both be stressed.  This infection, though mostly harmful to Carl may cause damage to another guinea pig.  However, Carl is more stable and healthier now than he used to be so I am considering getting him a friend.  I don’t know what colour, breed or sex his friend will be but I do know they will be another rescue guinea pig.

Guinea pig facial scar
Carls scar a couple of months post surgery
Consider Adopting

I couldn’t end this blog without linking a few places you can adopt guinea pigs from.  Firstly is a guinea pig rescue which is local to me, Cavy Corner.  Secondly, guinea pigs can be adopted nationwide from both the RSPCA or SSPCA (in Scotland) and Support Adoption for Pets.  There are also other guinea pig rescues around the UK so it may be worthwhile searching online.

If you want to discuss any of the issues raised in this blog or want to find out more about keeping Guinea Pigs feel free to Contact Me via email kim@animalwelfarematters.co.uk.  If you liked this blog or think others may do then please share it.  Finally, if you like my blogs you can subscribe by placing your email in the box in the sidebar.  If you subscribe you will recieve an email alert each time I post a new one.