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Ehrlichiosis A Silent and Deadly Killer By Jan Hendricks, Border Terrier Breeder Bob Wilson, Border Terrier Owner |
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Ehrlichiosis A Silent and Deadly Killer By Jan Hendricks, Border Terrier Breeder Bob Wilson, Border Terrier Owner |
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First I want to thank Jan and Bob for giving me the opportunity to make some
remarks and to congratulate them for undertaking such heavy and well executed
responsibility to address this important issue. Their basic premise was to reach
the owner/breeder and also to establish dialogue with the veterinary clinicians
and scientists outside the vet's office. I think they have achieved both. The
owners and breeders will gather tremendous information from this article in a
language they will understand since there is a minimum of technical jargon to
cloud their reading enthusiasm. The veterinarian and scientist will get the
challenging message that the 21st century clients have modern tools to watch
everything we do and publish and they are looking for a practical product for
their pet.... at times regardless of how much it will cost. The clients are also
prepared to work with us to the extent possible and when they question our
training they are not vetbashing but trying to develop a dialogue.
The authors are right in indicating that diseases have no borders. Today the
definition of a tropical
disease could not have been more nebulous and blurred! That is why we have
task forces in USA and Europe to deal with "Emerging diseases" which show up
suddenly and unexpectedly. In some ways ehrlichiosis meets that definition.
This raises the issue of training in tropical
medicine. The authors' point is well taken that veterinary curricula are
facing the challenge to accommodate the problems of newly emerging diseases,
such as ehrlichiosis.
Extra attention needs to be paid to this segment if future veterinarians are
going to be prepared for diseases that just emerge here or encountered in
missions overseas. It is gratifying to know that there is a Society of Tropical
Veterinary Medicine and "Intervet" which expose our veterinary community to so-
called foreign diseases. The USDA at Plum Island along with the CDC are examples
of establishments that have enormous resources to educate all of us on these
issues.
Bob and Jan bring up the issue of the complexity of ehrlichiosis. In fact the
disease is more of a syndrome. Readers will appreciate this from articles such
as that written by David Huxsoll who has so neatly categorised the stages of the
disease. The spectrum of syndromes and disease entities imitated by ehrlichiosis
are incredible, emphasizing the need to carefully rule out ehrlichiosis for
common infectious diseases.
The warning signs may certainly be subtle. Can one rule out ehrlichiosis by
the IFA test and
should we treat all animals which are IFA positive? First, a positive IFA test
simply means "current or previous exposure" ........treatment or recovery does
not guarrantee a negative IFA.
Any patient positive in the IFA and presenting with signs consistent with
ehrlichiosis should definitely be treated. Indeed empirical treatment is
reasonable if in the clinician's assessment waiting for the IFA results could
endanger the patient. IFA could certainly be negative during the very early
phase of the disease even when severe signs are evident.
Therefore, in the writer's opinion a clinical assessment may supercede the
IFA status. A positive IFA test excludes a dog from being a blood donor and
membership of a breeding stock for the fear of transmitting the disease and
every effort should be made to research into methods of terminating the carrier
state.
Provided the treatment is prescribed and monitored by a veterinarian, it
seems less risky to treat IFA positive animals resident in a non-endemic area
than to risk a severe disease. In an endemic area, however,treatment on the
basis of the IFA test per se cannot be justified since the patient will again be
exposed and the synergistic advantage between antibodies and the cellular immune
system may be of value in fighting the new infection. In other words, in areas
where the diseases are common practically every dog has been exposed and
treatment can only be justified on the basis of the clinical disease.
The relatively low endemicity in many parts of North America means that
supervised treatment of early diagnosed( by IFA or PCR) cases is worthwhile to
prevent costly potential worsening of the patient's condition or even death, as
mentioned by Bob and Jan. They have shared with us their private experiences in
which intervention helped some cases and when the problem was recognized too
late the patient could not be saved. It must be emphasized, however that
empirical treatment with antibiotics must be carefully evaluated and monitored
to avoid abuse of these important compounds.
The other issue raised is "early diagnosis". The PCR test is showing promise
and perhaps in future it will be available routinely. Because the test is
DNA-based, it offers the most specific and sensitive detection method which
confirms that the patient is definitely infected and treatment would be
indicated without any doubt. Finally, we must join the authors in a crusade to
find alternative drugs to doxcyline and tetracyline in case we encounter
resistance to these drugs or we are treating mixed infections ( e.g.
ehrlichiosis and babesiosis). A case in point is ImizolŪ a well tested drug used
in may parts of the world but not legally available for dog treatment in USA.
(Since the article was written in 1996 , unfortunately, little has changed.
However, one important change is the fact that Imizol is now available and your
vet should be able to easily obtain it. This drug is given by injection in a
series, normally, of two shots two weeks apart. - Bob Wilson 1/14/2000).
Compassionate users of ImizolŪ have reported impressive results in cats and dogs
suffering from ehrlichiosis and we should continue research to facilitate
approval by the FDA. The ultimate goal should however be the development of a
vaccine for this disease complex and for that we need to work with the breeder,
the owner, industry and academia. This mission is noble according to the wishes
of friends such as Pajti, Jake, Bear, Saucy and many others born in the
Hendricks and Mair families.
For those searching for additional reading please search under the following
scientists: Ewing, S; Huxsoll, D; Breschwerdt, E; Dawson, J; Lewis, G E;
Holland, C J; Ristic, M R; Dutta; Rikihisa, Y; Madigan, J; Dumler; Bakken;
Nyindo; Roult; Long, M; Goetz; Palmer, G; Walker, D; and many other scientists.
Ibulaimu Kakoma,DVM PHD We also encourage you to reproduce the document should you wish to pass it on
to others. We only ask that it be the complete document so that nothing is taken
out of context and to give credit to those who labored so diligently in its
preparation.
While a lot of detail is contained in this document, it is thought and hoped
that it will be shared with the dog owners' veterinarian. Many vets are not
familiar with ehrlichiosis, do not appreciate the magnitude of the problem or
have treated it as something else failing to treat the underlying cause. This is
in no way meant to condemn the veterinary community. As you will see, they are
reacting to what they perceive as signs of diseases they are more familiar with,
which is a very logical approach but not one that will work with ehrlichiosis.
The nature of this disease is such that it mimics a great many other diseases,
and this tends to confuse and complicate treatment.
There are many forms of the disease attributed to the organizms in the genus
ehrlichia that are genetically related, including one of the species recently
found in humans which causes the disease HGE (Human Granulocytic Ehrlichiosis).
Another is E. equi species which causes illness in horses. This is a
different species than E. risticii which causes Potomac Horse Fever and
is also found in dogs. Other identified species are E. sennetsu, human
pathogen, E. ewingii and E. platys, both canine pathogens. The
species E. ewingii has been reported in dogs in Minnesota, and likely
occurs in other states as well.
The two keys to success are early recognition and treatment.
Treatment with proper antibiotics can be quite dramatic in these cases,
whereas treating an ehrlichiosis patient with steroids or drugs other than the
tetracycline family will almost certainly lead to tragedy.
But today it is apparent she is very worried about her pet. You glance at the
dog - a middle-aged pleasant animal who looks a bit tired. "Doctor", the owner
begins, "He just isn't himself lately - he doesn't want to play anymore, and he
always enjoyed retrieving his ball. His coat isn't as nice as usual - he seems
to be turning gray early - he's only 5 years old! We've noticed his breath is
really bad, and sometimes he doesn't want to eat. Then he will eat fine for a
few days, but he will throw up yellow stuff. His eyes are really red too - and
sometimes they have a glassy reflective look like they do at night in a
headlight. He used to love to sleep with us, but now he seems to have trouble
getting up on the bed. And he's always drinking water - I don't remember him
ever drinking so much water. And I've never known him to have so many accidents;
he always used to be so clean - now sometimes he doesn't even ask to go out - he
just goes on the floor like he doesn't care. What could be wrong with him
Doctor? I'm really worried...."
O.K. Doctor, what do you think? Impossible for one dog to have so many
problems? Neurotic owner? Better take a look.....with the dog up on the table,
you take his temp - normal. Eyes are pretty red - allergies? Coat does look a
bit dull, but you've seen worse. You ask about the food he is eating - how much
exercise he is getting - has his routine changed lately?
Chances are good that this dog may be sent home with different food, vitamins
or a coat additive, advice to cut back on the evening water so there won't be so
many accidents. Maybe he is just bored and needs more attention. Still, it
wouldn't be a bad idea to do a CBC. What about his difficulty in getting up on
the bed - could he be developing arthritis? Seems kind of young - but maybe he's
just getting old before his time. Then the CBC comes back within normal limits -
white count is a little depressed,but not that bad. He seemed to have a slight
cough - could be a mild case of kennel cough that he just can't shake.
Amoxicillin for a couple of weeks should take care of that.
Sound familiar? This is beginning to happen in veterinary clinics all over
America every day. Because the signs are run-of-the-mill, it is not the sort of
case that even the most detailed veterinarian is going to get too excited about.
We would like to change that, because there is a very good chance that the dog
just described is suffering from a type of infection often considered as rare -
ehrlichiosis. The fact is, ehrlichiosis is not rare at all, and through this
paper, we hope to dispel that myth - because that myth is resulting in countless
deaths of pet dogs and even cats - and each and every one of these pets was
someone's special friend. It doesn't have to be that way.
Perhaps the most critical thing for the clinician to remember is to look at
the big picture. Does a client's pet really have several ailments affecting
different systems, or could it be suffering from ehrlichiosis which in essence,
affects all systems?
What about the purebred show dog with autoimmune disease? It is easy to
assume this is a genetic problem inherent in the breed but why not give the dog
the benefit of the doubt and consider ehrlichiosis as a possible cause. Response
to treatment with proper antibiotics can be quite dramatic in these cases,
whereas treating an ehrlichiosis patient with steroids is almost certainly
signing its death warrant.
Today's veterinarian will also acknowledge that today's pets travel far and
wide with their owners. As a result, the diseases and vectors are no longer
limited to specific regions. Ticks thrive in cold as well as warm climates and
where the tick goes, so goes the ehrlichiosis.
Even more surprising is that the rapid spread and reports of the disease have
only occurred in the last few years. Today it has been and continues to be
reported in all 50 states, Canada, Europe, Asia, South America and Africa.
Ehrlichiosis is related to Rocky Mountain Spotted
Fever and shares similar signs, though rarely does a victim of ehrlichiosis
display the rash that is associated with RMSF. Lyme disease also shares some of the same
signs, but technically is in a separate category. Lyme disease is caused by a spirochete (a
spiral shaped bacteria) and although it is transmitted by ticks, as are most of
the rickettsias,
Lyme disease is sensitive to a wider range
of antibiotics, and Lyme disease has never
been linked to fatalities as are many of the rickettsias. The rickettsial group
is unique in that it's members share some traits of a virus, and some traits of
a bacteria, but they are classified with bacteria.
While doxycycline is frequently used to treat Lyme disease other drugs have been used.
Amoxicillin is a recent trend in the treatment of Lyme disease but has no effect whatsoever on
ehrlichiosis. As both Lyme disease and
ehrlichiosis share some signs a misdiagnosis of ehrlichia as Lyme disease could prove fatal to both dogs
and humans if not treated with the proper drug.
Rickettsias actually parasitize the white blood cells, which is why they are
so devastating to their victims. Essentially, they cripple the immune system by
inhibiting the basic function of the bone marrow - that of making new cells to
replace old and dying cells.
Once a human or animal is stricken with ehrlichiosis, white cells die off
faster than the bone marrow can replace them. These dead cells migrate primarily
to the spleen which enlarges as a result. Frantically, the bone marrow works to
form new, healthy cells. In its haste, it sends out immature cells which do not
work efficiently. Quite often these immature cells are almost indistinguishable
from those seen in leukemic patients. Advanced Ehrlichiosis is, in fact, often
misdiagnosed as leukemia or lymphosarcoma.
To complicate things further, ongoing research suggests that chronic
ehrlichiosis may lead to various cancers, especially leukemia and lymphosarcoma.
There is speculation that it may predispose animals to other forms of cancer as
well. Because of its effect on the nervous system, ehrlichiosis is also
sometimes misdiagnosed as brain cancer. It does, in fact, affect many dogs
neurologically and can cause seizures, problems with coordination, changes in
temperament, or obsessive-compulsive behavior (such as repeated licking or other
repetitive behaviors.)
Causes of death by ehrlichia are usually due to internal hemorrhage including
hemorrhage into the brain, severe autoimmune disease, multiple secondary
infections due to a compromised immune system or complete failure of one or more
internal organs such as heart, liver, spleen, etc.
Carriers (reservoirs) of the disease may include mice, rats and other mammals
who have constant exposure to various insects (but are themselves unaffected by
the disease). It was once thought that cats and even dogs could act as
reservoirs for E. risticiiand not develop signs of disease. In the last
few years this has not proven to be consistent as more and more domestic dogs
and cats have developed serious illness after natural infection with E.
risticii.
Newly infected domestic animals (who may ultimately succumb to the disease)
may serve as carriers for insect vectors, who then pass the infection to another
animal. At least one of the species, E. risticii, can be passed through
the placenta to puppies. It can also be passed from infected donor animals used
in veterinary clinics. None of the species are thought to be passed through
breeding, but we have been unable to locate any current research in this area.
The two species that have, to date, been most commonly reported in dogs are
E. canis and E. risticii. It is possible to be infected with
both species which presents a particularly nasty challenge. It is fortunate that
both respond to the same method of treatment.
There is no breed that has shown either a greater or lesser immunity to the
disease and there are a great variety of breeds, including mixed breeds, that
have contracted ehrlichiosis.
While it was initially found primarily in the Southwestern States, today it
is found throughout the US. The human form has had the highest number of
reported cases in Wisconsin and Minnesota but it too is found in many other
locations in the US.
It should also be noted that it has been fatal in humans whereas Lyme disease has yet to claim its first
victim.
Once the chronic stage is reached, the rickettsial organism has taken up
residence within the bone marrow. At this point the damage done is often
irreversible. It is not unusual for dogs in this final stage to suffer massive
internal hemorrhage, or succumb to sudden stroke, heart attack, renal failure,
splenic rupture or liver failure, resulting in death. A peculiarity about the
disease is - these dogs often do not look or act as though they are in a
terminal stage of disease until their final hour.
Regardless of the what the titer is, any positive should be considered
indicative of infection and treated quickly and aggressively. A dog with a
negative titer who has signs should still be treated, then re-tested at a later
date.
Although E. canis and E. risticii appear to be the most
common species to infect dogs, other species are out there which won't be
detected if the laboratory is testing strictly for E. canis or E.
risticii. (Another reason to treat the signs even if the titer test is
negative.) CBC panels have been used but they are too non specific to be
reliable. There are many cases where a dog's CBC has been "within normal limits"
yet the dog died of ehrlichiosis!
CBC Panel abnormalities are often so borderline, they may be overlooked by
the vet as inconsequential. An example could be a dog who appears to have
sufficient platelets, yet is showing signs of internal hemorrhage (blood in
urine, bruising on mucosal surfaces, coughing, bloodshot eyes etc.) This can
happen because the platelets have lost their ability to function normally - they
can actually lose their adhesiveness which hinders their ability to form a
normal blood clot.
When abnormalities are seen in a CBC Panel, they may include a reduction in
platelets, mild anemia, high WBC (usually in new infections), low WBC (usually
in chronic cases), high sedimentation rate (due to dead cells outnumbering
healthy cells), high alkaline/phosphatase ratio, and other slight abnormalities.
Kidney function tests may show high BUN and creatinine. In these cases, the diet
should be altered to lessen the strain on the kidneys.
The following laboratories are experienced in running the IFA test for
various species of ehrlichia, including E. risticii. In some
laboratories discounts may be available, either when testing for several species
of ehrlichial infection in the same dog (a "rickettsial panel") or if multiple
dogs (such as in a breeding kennel) are tested at the same time ("bulk
testing"). Be sure to inquire about any discounts before blood is sent.
Blood must be spun down to seperate the serum component which is then shipped
via overnight mail in a cold pack. Direct any questions about this procedure to
the laboratory where you are sending the sample.
Perhaps the greatest challenge in battling ehrlichiosis is in detecting and
accurately assessing the signs. This has been one of the major reasons for the
disease being under-reported and misdiagnosed. In most cases the early signs are
very subtle. In all cases the signs mimic those caused by other diseases.
In the acute phase of infection, ehrlichiosis appears much the same as any
viral infection. The animal often runs a fever, may lose his appetite and/or act
depressed, the eyes may have a glassy appearance, etc. These signs may even
disappear of their own accord in a few days time. Animals who are especially
stoic may pass through this phase without anyone even noticing. This stage of
the disease almost always clears up without treatment. It is, however, during
this stage that treatment can be most effective in eliminating the disease.
Virtually any unusual sign is worthy of note as there are generally more than
one. The animal may act depressed or tired with a diminished interest in
playing. Acute infections of E. risticiiwill sometimes involve diarrhea
and/or vomiting (often this is vomiting of bile only). The animal usually
refuses food for a few days, may lose weight, and will probably want to be left
alone. E. risticii is often misdiagnosed as parvo or corona infection,
and occasionally the signs of E. risticiiare very similar to those of
kennel cough.
It is when ehrlichiosis is not treated in this first stage with the proper
antibiotics that it goes on to wreak havoc in the system of its canine victim.
The following list of signs should be carefully reviewed as recognition of the
signs will more than likely be the first indication of the disease. Remember
that while few dogs display all of the signs, most will show several. Again,
stoic dogs are the most difficult to diagnose; trust your instincts and remember
that you are the best judge of what is normal in your own dog and what isn't. In
one case of a Border Terrier who had both E. canis and E.
risticii, the only sign noticed by the owner was the dog lost interest in
play - something he had always enjoyed to the utmost. As we have indicated, any
change in behavior is enough to warrant precautionary measures.
Breeders may observe unique signs due to their experience with pregnant and
nursing bitches as well as puppies. A female dog with signs previously too
subtle to be noticed, may develop serious illness during pregnancy, or she may
deliver dead or ailing puppies. In these cases, breeder and veterinarian must
work in cooperation with one another in order to make the correct diagnosis.
We would like to thank and are eternally grateful to Susan Netboy for the
excellent job she has done in compiling the following list. Susan is very active
in greyhound rescue and was one of the first to realize the scope of
ehrlichiosis as well as babesiosis in rescued greyhounds. It should be of
concern to all that greyhounds make up a very large percentage of the blood
donor dogs, both at university veterinary school hospitals, and at many
veterinary clinics. Rickettsias are readily spread through blood transfusion.
EHRLICHIOSIS is an infectious blood disease. A reduction in cellular blood
elements is the primary characteristic of the disease. Although the organism
lives and reproduces in the white blood cells (leukocytes); it has a
particularly devastating effect on the lymphatic system and will ultimately
affect multiple organs, systems, and cells: respiratory, circulatory, central
nervous system, kidney, brain, liver, spleen, endothelium.
Additionally, the severe depression of the immune system created by the
disease opens the door to secondary bacterial infections and other
complications. Because the onset of visible signs is likely to be gradual in the
chronic phase and subtle in appearance, alertness to the following conditions is
imperative in order to catch the disease while it is still treatable:
Certain features of ehrlichiosis may mimic the following diseases:
It is recommended that ehrlichiosis be ruled out before accepting these
diagnoses as a definitive cause of the illness or condition. Ehrlichiosis is
known to be prevalent in racing greyhounds; there is no question amongst
veterinarians who have dealt with the disease that it must be taken seriously
and aggressively treated. Testing is simple and definitive; a positive titer at
any level needs to be treated. Very good results can be obtained with readily
available, inexpensive treatment of a 7 to 8 week course of tetracycline or
doxycycline at the correct dosage. (For further information contact: Susan
Netboy at (800) 446-8637) Contents Copyright (c) 1995, Greyhound Friends For
Life. Last Modified: August 15, 1995.
If the titers return as negative, but the animal is responding to treatment,
he should be kept on the antibiotic and re-tested in a couple of weeks. The IFA
test looks for the presence of antibodies produced by the dog's immune system
and it may take as long as 30 - 45 days for the immune system to respond with
the production of enough antibodies to detect. As doxycycline does not affect
the production of antibodies it will not interfere with the test results.
We strongly advise against waiting for a positive result before
treating with doxycycline. Vets should also be cautioned about the use of
steroids in a dog who may have ehrlichiosis. If Lyme disease is the suspect then treat with
doxycycline. Although some chronically-infected dogs may need steroid treatment,
this should always be done in conjunction with doxycycline treatment and only as
a last resort measure. In cases where the vet feels more than one disease may be
involved, ehrlichiosis should be given the first priority.
In acute cases there is usually a dramatic response to treatment. A case in
point involved a Border Terrier owned by one of the authors. He presented with
signs consistent with renal failure, and renal failure is not usually treated
with doxycycline. However, the owner was aware that the dog had been exposed,
and the signs had come on quite suddenly. There was also apparent (though
slight) enlargement of the spleen and liver. The vet then reluctantly agreed to
treat with doxycycline along with other supportive therapy.
When the test results came back 48 hours later, the vet was alarmed at the
apparent indication of chronic renal failure. However, re-examination and
testing of the patient showed dramatic improvement - 2 days on doxycycline had
brought kidney function back within the normal range, the heart rate had
returned to normal, and dehydration was no longer evident. Subsequent IFA titer
tests showed the dog was indeed positive for both E. canisand E.
risticii. Due to the decision to treat immediately, this dog is still
alive, enjoys excellent health, and has normal kidney function at age 7 1/2
years. This also makes the drug a diagnostic tool as well as treatment. If the
signs disappear with treatment it is almost a virtual certainty that the dog has
been infected and blood tests should be run to make the confirmation.
Most cases have shown a good response to treatment with the tetracycline
family of antibiotics. Doxycycline is the preferred drug as it has less
potential side effects and better penetration of certain bacteria (Merck).
Inoculations as well as injectable antibiotics should not be administered to a
dog suspect for ehrlichial infection, as reactions have been reported, some of
which proved fatal to the patient (the immune system is already taxed due to the
action of the disease.)
Another drug, ImizolŪ, has also proven very effective, but unfortunately it
is not readily available in the US and is still considered experimental.
(Since the article was written in 1996 , unfortunately, little has changed.
However, one important change is the fact that Imizol is now available and your
vet should be able to easily obtain it. This drug is given by injection in a
series, normally, of two shots two weeks apart. - Bob Wilson 1/14/2000).
The suggested treatment with doxycycline has been 5 to 10mg per day per Kg.
(according to the Merck Manual.) Some dogs have been treated at a rate of 20 mg
per kg body weight per day (or 200 mg for the typical 22 pound dog, divided into
two daily doses given 12 hours apart) with excellent results. Most cases have
shown that the higher dosage is more effective, but its use will be dictated by
the animals tolerance. It should be administered for at least a 6 week period.
Due to the high dosage Merck also suggests vitamin supplementation with vitamins
B and K due to the reduction in the animals ability to synthesize those vitamins
in the large intestine. In some cases wrapping the tablet in a piece of bread or
adding to rice will facilitate administering the drug as well as helping to
prevent nausea which may occur in some animals on the high dosage.
For those who read this and can influence pharmaceutical companies to develop
a vaccine as has been done for Lyme
disease, we will consider our mission complete.
Questions regarding this article may be directed to the authors:
Mr. Bob Wilson Mrs. Jan Hendricks
A very special thanks has to go to Dr. Ibulaimu Kakoma who is an Associate
Professor of Microbiology/Immunology at the College of Veterinary Medicine at
the University of Illinois Champaign. Dr. Kakoma is a Doctor of Veterinary
Medicne as well as a microbiologist and is an expert on the subject of tick
borne diseases. He has written many articles on the subject of ehrlichiosis and
continues his research today. He took many hours out of his busy schedule to
discuss various issues and agreed to write the Foreword at the beginning of this
article. Dr. Kakoma is fully dedicated to the eradication of ehrlichiosis and
has been instrumental in providing technical assistance, not only for this
document, but to our mutual attempts to attract and convince drug manufacturers
to develop a vaccine.
WE DEDICATE this paper to our memories of Saucy, Jake, Bonnie,
Clancey, Duke, Keeley, Pajti, Emma, Penny and the many many other beloved pets
who lost their battle with ehrlichiosis, and left an empty spot in the hearts of
their owners that can never be filled. All of these dogs succumbed to an
insidious killer we now know as ehrlichiosis because, at the time, there was not
enough widespread knowledge to prevent it. We created this paper to provide that
knowledge to help prevent others from the same fate and dedicate this paper to
those stoic little animals so they will not have died in vain.
In the process of putting this document together I was asked by several
people around me as to why I seemed so focused on the subject. Many who have
experienced this type of tragedy would prefer to move on and try to forget the
incident. My answer was that I guess that I preferred to learn from history
rather than be doomed to repeat it.
There is no question that it is a valid answer but the real reason was that
you had to know Jake. She came into my life at a time when turmoil was the norm
and I was finding myself emotionally drained. While Jake's arrival five and a
half years ago didn't solve the problem it made my life bearable and gave it a
purpose. I found myself changing my lifestyle to adapt to hers. We were constant
companions and virtually inseparable. Jake went to the office with me, spent
countless hours in the car with me and slept with me. It was almost a joke
amongst many of my friends as they knew that if they invited me somewhere where
there was any possibility of bringing Jake that she had to have an invitation or
I might not show. She gave me more love than I knew existed and in return I gave
her more love than I knew I had. She read me like a book and knew when I needed
a friend and when I needed to go play ball with her. She was my best buddy.
On October 30, 1995 that relationship came to an abrupt and sad end with her
death from what we now know as ehrlichiosis. It was only 30 days prior to her
death that I learned about this insidious killer and by then it was too late. If
life was 36" in diameter I had just had a 34" hole blown in mine. There has
never been the death of any living thing that has so profoundly affected me. It
is a loss that still haunts me to the depth of my soul.
Because there seemed to be no clear-cut reason for the disease I went on a
quest to learn all I could about it. Unquestionably Jan Hendricks, a co-author
of this document, was my major source of both information and consolation. Jan
is a Border Terrier breeder and was where Jake came from. Her dedication to the
breed and maintaining its' high standards is nothing short of awesome. It was
through our discussions that we decided to try to put all of the known
information in one place. This document very simply would not be if it were not
for her dedication.
There are many others who provided information to this document that space
does not allow us to mention. Several, however, simply have to be recognized.
Susan Netboy who is involved with Greyhound Friends for Life which is a
rescue organization has done a great deal of work in "spreading the word". A
significant part of her work on ehrlichiosis is contained in this article. A
very special thanks to Lynda
Adame who runs the "Tick Net" on the Internet. That group now has over 55
members who regularly share information on ehrlichiosis and babeiosis and it's
treatment.
We hope that this document will help you avoid the pain , sorrow and problems
that we have all experienced with this silent and insidious killer.
January 1996
Foreword
Dr. Ibulaimu Kakoma DVM PhD
Urbana IL.
January, 1996
PURPOSE
The purpose of this document is to help dog owners as well as
their veterinarians become aware and learn more about a dreaded and deadly
killer that is claiming the lives of dogs in all 50 states.
THE TRIP TO THE VET
This section is for the clinician. Please form a
picture in your mind of the following: A client comes into your clinic with her
dog. She is a good client, her dog gets his vaccinations regularly, is on
heartworm preventive, and is obviously well cared for.
EHRLICHIA - WHAT IS IT?
Surprisingly, Ehrlichia has been around for a
lot longer than most people realize. It was first described in 1935 in Algerian
dogs. However, in 1962 , a number of military dogs (German Shepherds) that had
been stationed in Vietnam died from complications of Hemorrhagic Fever. It was
later determined to have been caused by the ehrlichia species E. canis.
HOW IS IT TRANSMITTED?
With the exception of E. risticii, most
rickettsias are believed to be spread through contact with ticks. E.
risticii is particularly difficult as no vector (the insect agent of
transmission) has been clearly identified. Ongoing research indicates that a
tick could be implicated but a variety of possible vectors exist. Flies,
mosquitoes, chiggers, and fleas, are all being considered as possible insect
vectors.
THE STAGES OF EHRLICHIOSIS
The disease typically courses through three
stages. The first is the early or acute stage (which usually mimics a mild viral
infection.) The signs in this stage may be very subtle and could go unnoticed.
Without proper treatment the animal will go on to a subclinical (second) stage
or may advance to the chronic (final) stage. During the acute stage most, if not
all, damage is reversible and a full recovery is possible. It is during this
stage that treatment is most effective, which emphasizes the need for early
detection.
DETECTION OF EHRLICHIA
If there is any one element of this disease that
makes it especially deadly, it is the ability it possesses to mimic other
diseases. Perhaps the best description of ehrlichiosis is "the AIDS of the
canine world". The detection of the
disease has, so far, only been successfully accomplished through IFA
(indirect fluorescent antibody test) which detects the presence of antibodies.
This test is, however, not infallible; dogs sometimes test negative in the acute
phase due to their immune system's delay in forming antibodies. They may also
test negative, or with a low titer, when in the chronic stage (the immune system
at this point may be giving up the battle.)
Colorado State University's Veterinary Diagnostic Laboratory
University of Illinois
Laboratory of Veterinary Diagnostic Medicine
ATTN:
Dr. Kakoma
P.O. Box "U", 2001 S. Lincoln
Urbana, IL 61801
PH:
217/333-1620 or 217/333-1859
FAX: 217-222-4628
Protatek Reference Laboratories
ATTN: Dr. Cynthia Holland
574 E. Alamo
Street
Chandler, AZ 85225
PH: 602/545-8499
Dr. T. McElwain
Washington State University
Vet Diagnostic Lab
Pullman,
WA 99164
Dr. E.B. Brietschwerdt
Dr. M.G. Levy
North Carolina State
University
College of Vet Medicine
4700 Hillsborough Rd.
Raleigh, NC
27606
Dr. D. Huxsoll
Louisiana State University
School of Vet Medicine
Baton
Rouge, LA 70803
SIGNS OF THE DISEASE
Information gathered by Susan Netboy:
TREATMENT OF EHRLICHIOSIS
Due to the rapid spread and inadequate
publicity the single biggest failure has been the failure to recognize and test
for the disease. Perhaps the strongest recommendation that can be made is to
eliminate ehrlichiosis first as a possible cause by treating with
appropriate antibiotics to see if the animal responds. If an animal has any of
the above signs an excellent path would be to take blood for a Indirect
Fluorescent Antibody (IFA) test and start the animal on doxycycline immediately.
CONCLUSION
We hope that this will be a help in spotting the signs and
treating ehrlichiosis early and effectively. More importantly, we hope that it
will create an awareness in owners, breeders and veterinarians to watch for the
subtle signs of this disease. If caught early it is curable.
Wilson Marketing, Inc.
PMB 3300 1467 W.
Washington
Marquette, MI 49855
PH: 1-906-228-0000
FAX :1-906-226-8702
(FAX)
e-mail: wmc@chartermi.net
26065 S. Kankakee Street
Manhattan, IL 60442
PH:
815/478-5959
e-mail: jecasse@aol.com
ACKNOWLEDGEMENTS
WE THANK the many veterinarians, veterinary
technicians, breeders and owners who have shown genuine concern for the animals
suffering from ehrlichiosis, and share our determination to push for more
widespread testing, treatment, and hopefully a vaccine. We would also like to
make a special mention and thanks to Michelle Tjaden who, in addition to
providing a great deal of reseach information, had the first dog (Border
Terrier) from which the first culture of E. risticii was grown by Dr.
Kakoma. We would also like to thank Barbara Mair who has researched this disease
with a vengeance and was instrumental in getting DNA testing underway; and to
Dr. Jutta Hammermuller, who, working closely with Mrs. Mair and Dr. Kakoma, gave
generously of her time and expertise to figure out how to conduct PCR/DNA tests
on dogs.
POSTSCRIPT
by
Bob Wilson - Border Terrier Owner