A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: 15 Aug 2009
Source: VINNews.com [edited]
Dogs with very severe signs including hemorrhagic diarrhea
A single clinic on Florida's west coast has seen 6 cases in the past month
of hemorrhagic diarrhea and vomiting accompanied by high fevers in dogs,
predominantly from a poor section of Sarasota County, veterinarians from
the clinic said this week [10-14 Aug 2009].
Dr Steve Koch, owner of Tuttle Animal Medical Clinic, and his associate, Dr
Eva Ojolick-Ryan, told VIN News Service that 5 of the 6 dogs died within 24
hours of being at the hospital. Most had been sick for only one or 2 days
before being seen. The cause of the outbreak is unknown.
Apart from the fact that all but 2 of the dogs had lived in a low-income
area, Koch said they had little in common. "They varied anywhere from
(about) age 8 months to 6 years," he recounted. "Some had had every vaccine
out there, including 4-way lepto; some had had no vaccines at all. One of
the dogs, (the owner) had only owned it for a day, so he had no history."
Of the 6 dogs, 4 were pit bulls, Ojolick-Ryan said. The others were a
greyhound and an American Eskimo. Koch said one animal from outside the
area was a well-cared-for pit bull that was up-to-date on his vaccinations.
It had moved from Daytona Beach and was in Sarasota only 4 days when it
Koch said the sick dogs had extremely high temperatures, in the
neighborhood of 107 degrees Fahrenheit [42 degrees Celsius], and very
bloody diarrhea and vomitus: "I mean, it's pure blood," he said.
The dogs had low white blood cell counts, soaring serum creatinine values,
and acute renal failure and destruction, Ojolick-Ryan said. "Urine also
turned from yellow at onset to brown near death," she said. [Brown urine
may be an indication of myoglobinuria or hematuria that is not frank blood.
- Mod.TG] Most of the dogs' owners were of limited means and unable to pay
for diagnostic lab work, the veterinarians said. Koch said his clinic
picked up the bill for tests for parvovirus and leptospirosis on some of
the patients. The results were negative.
"The clinic has picked up the cost of a lot of the blood work and treating,
too, to try and save these dogs," Ojolick-Ryan said. "So diagnostics have
been limited, as well as post studies."
The veterinarians discussed whether rawhide chews might be a factor, but
case notes provided by Ojolick-Ryan show that only 3 of the 6 dogs were
given rawhide treats. "We were grasping at straws," Koch said.
The cases began showing up on 22 Jun 2009 -- 2 of them back-to-back that
day. The most recent patient came to the clinic on 28 Jul 2009.
In trying to solve the mystery, the clinic contacted a variety of experts,
among them Dr Cynda Crawford, an immunology and infectious diseases expert
at the University of Florida College of Veterinary Medicine. Crawford
agreed to look into the matter, and Ojolick-Ryan sent her some data.
However, Crawford told VIN News Service by e-mail last Wednesday [12 Aug
2009] that she had nothing to report. "There is very little case material
to work with, so am struggling with meaningful diagnostic approaches," she
wrote. "...Everything is basically speculation at this point."
Dr Bill Jeter, a veterinarian and bureau chief of contagious and infectious
diseases in Florida's Division of Animal Industry, said his department is
monitoring the situation. He noted that there was some discussion among his
colleagues that the outbreak could be caused by infections of a virulent
strain of _Escherichia coli_. In humans, exposure to _E. coli_ 0517:H7 can
lead to hemolytic-uremic syndrome (HUS), the onset of which may include
bloody vomiting and diarrhea. HUS occurs when toxins produced by _E. coli_
destroy red blood cells. Among people infected by _E. coli_, HUS is seen
mostly in children, the elderly and adults with weak immune systems. It is
rare in dogs, but not unheard of.
Ojolick-Ryan, continuing to work on the cases while on vacation in Canada,
said by email on Friday [14 Aug 2009] that she's following up on the HUS
angle by sending fecal samples to Dr Alice Agasan, chief of the bureau of
diagnostic laboratories in the state Department of Agriculture. She said
she is also sending tissue samples to Crawford. "I only have samples from
one case so far," Ojolick-Ryan said. "If -- heaven forbid -- we get another
case, more samples will be taken."
Jeter said that if the diagnosis turns out to be HUS, it would be odd to
see an outbreak confined to one clinic. "I haven't heard of anybody else
reporting it," he said. "I'm sure if it was (being found elsewhere), we'd
be hearing about it."
Ojolick-Ryan said she heard of one other case, in south Charlotte County,
involving a Greyhound with similar signs. But she was unable to confirm
whether the case could be considered part of the same outbreak.
Marilyn Knapp Litt
[While this "outbreak" seems rather limited in area as well as cases, it
could be the so-called "tip of the iceberg". There may be other clinics in
the area that have had similar cases and have not reported it, or may not
have connected the dots that there is more than one case, especially if it
is a multiple doctor hospital.I sure hope these vets compared the foods these dogs were consuming. One would think this would be the first question they'd ask.