Alabamarot.co.uk received an email today from Laura Holm of Anderson Moores Veterinary Specialists in Winchester. Laura wrote:
“I have come across comments indicating that people are concerned about CRGV being the result of radiation poisoning. All possibilities are being carefully considered, but the histopathological changes seen with CRGV are different from those seen in the kidney following radiation damage – namely with CRGV, the glomerular capillaries specifically are targeted, whereas with radiation nephropathy, the vessels throughout the interstitium undergo damage.”
Laura Holm of Anderson Moores Veterinary Specialists in Winchester today sent an email to alabamarot.co.uk. Laura wrote:
“I was looking at alabamarot.co.uk and noticed the thread about Leishmaniasis. I just wanted to let you know that we are confident that CRGV is not caused by the Leishmaniasis for a number of reasons: There are significant clinical differences between CRGV and Leishmaniasis. Additionally, Leishmaniasis can be readily diagnosed when a post mortem examination is conducted, and none of the dogs with CRGV had compatible post mortem findings.”
“Skin lesions are not commonly associated with AKI in dogs,
unless the AKI has resulted from immune-mediated disease
(Fournel and others 1992), certain neoplasms (Moore and others 1994), infectious diseases (Ferrer and others 1988) or vascular events, such as vasculopathy (Goldfarb and Adler 2001).”
The infectious disease reference by Ferrer and others 1988 is titled “Skin lesions in Canine Leishmaniasis”. It was republished (preview) in 2008:
“Canine leishmaniasis is a severe, often fatal disease of the dog caused by the protozoan parasite Leishmania donovani”
The following report stated that 20 foxhounds dogs in New York died of Leishmania in 1999/2000:
” … due to infection with the protozoan parasite
Leishmania spp… The dogs had … clinical signs including wasting, hemorrhage, seizures, weight
loss, hair loss, skin lesions, kidney failure, and
swollen limbs and joints. Testing revealed that
42% of adult dogs at the kennel were
serologically positive for antibodies against
Leishmania, and the organism was isolated from
15 seropositive dogs.” (ref: vet.uga.edu)
Infection with Canine leishmaniasis induces:
“a cytokine response which results in over-exuberant antibody production. Excessive immune-complex formation results in the development of lesions in the kidneys, joints, eye and blood vessel walls.” (ref: Leishmaniasis.info)
Dogs can take several years to show symptoms after infection:
“After being bitten, there is an interval of one month to several years before dogs become ill. In these dogs, the parasite lies dormant, sometimes for years before a stressor allows the parasite to multiply and cause disease. In virtually all dogs, it spreads throughout the body to the internal organs such as the liver, kidney and spleen, causing a chronic, debilitating, and sometimes fatal disease, with many dogs dying of kidney failure.” (ref: yourvet)
Alabama Rot attacks the skin and kidneys only, not the liver or spleen. But could Alabama Rot be similar to Leishmaniasis?
Launched on 16th June 2016, the Alabama Rot Research Fund (ARRF) aims to raise £240,000 to fund a PhD candidate and other research. The ARRF aim is to find the causes, prevention and treatments for Alabama Rot.
“Is CRGV caused by E.coli? Faeces, skin lesions, and kidneys of dogs with CRGV have been tested for E.coli, which can cause a similar illness (haemolytic uraemic syndrome, or HUS) in people. No E.coli have been found. Kidneys from affected dogs have been tested for Shiga toxin produced by E.coli – NONE has been found. Blood from affected dogs has been tested for antibodies to E.coli which cause HUS – NONE have been identified. So can we completely exclude E.coli? – Unfortunately not quite yet, because these bacteria and their toxins can be very difficult to isolate / identify, however, it currently appears to be an unlikely cause. Investigations are ongoing …”
Anderson Moores ask:-
“What other possible causes for CRGV have been investigated?”
“Is it Leptospirosis? (Weils disease)
Most dogs with CRGV were negative when tested for Leptospirosis and many were vaccinated against Leptospirosis (which helps to protect against infection with Leptospira).
Additionally, most dogs which have Leptospirosis respond well to treatment, as opposed to the poor response to therapy seen with CRGV.”
“Is it Lymes Disease? (carried by ticks)
Ticks are active in Spring and Autumn, rather than Winter (so the wrong time of year for CRGV). Some signs of Lymes disease are similar, but most importantly, the microscopic changes (pathology) in the kidney are totally different from CRGV.”
This grows in summer. It causes nasty skin lesions in sun light, but is not associated with acute kidney failure. Recent work by [a] senior botanist suggests that it is unlikely for any plants,
trees, fungi, or shrubs to cause CRGV.”
“Fish bacteria? (Aeromonas).
This is currently under investigation. Aeromonas produces a toxin (a bit like E.coli) which could cause CRGV. Aeromonas cause disease in fish, including skin lesions. There is a study checking for evidence of Aeromonas infection in dogs with CRGV.”
There has been no evidence for heavy metals, bacteria, or toxins in soil or water samples tested from the New Forest, and none identified in kidneys of affected dogs.”
The clinical signs of CRGV are not consistent with radiation poisoning. Radiation would affect all dogs equally in an affected area, which is not what we see with CRGV.”
Anderson Moores say:-
“How can CRGV be prevented? As the cause remains unknown it is very difficult to advise how best to avoid CRGV.
Washing dogs after a walk (using tepid water) might be a sensible precaution but it is unknown as to whether this is either necessary or of any benefit (please do not use strong antiseptics / disinfectants or other chemicals to bathe dogs. This could be harmful.)
There is no evidence that dogs can catch CRGV from each other (dogs which walked together were more likely to all be affected than dogs which lived together but did not go on the same walks). There is no evidence that they can catch it from a place where an infected dog has been (e.g. the vets, the dog groomer, or the boarding kennel).
It is possible that there is an environmental ‘trigger’ but this is currently unknown. It is therefore up to each individual dog walker to decide whether to avoid certain types of terrain, or certain areas.”
Anderson Moores Vet Specialists today report an Alabama Rot update: “Sadly, one further dog has been confirmed as having died as a result of cutaneous and renal glomerular vasculopathy. The dog was from Undy, Monmouthshire. ”
The two alabamarot.co.uk maps have been updated with this information.
Laura Holm of Anderson Moores Vet Specialists wrote “Noticing signs of CRGV in dogs to diagnose disease presence” in the Vet Times (March 21st 2016).
Laura Holm said that only a quarter of dogs with skin lesions go on to get acute kidney injury:
“Evidence suggests the median time from the onset of a skin lesion, to development of azotaemia [high blood Nitrogen levels], is 3 days (range 0 to 10 days) … There does, however, appear to be a subset of dogs that develop skin lesions without azotaemia (non-azotaemic CRGV) … with about 75% of cases remaining systemically well following development of skin lesions and only about 25% developing clinical signs attributable to AKI [Acute Kidney Injury].”
Blood clots result in skin ulcers and kidney failure:
“When microthrombi [small blood clots] occlude [obstruct] blood supply in dermal [an area below the skin] vessels, dermal cell death occurs and cutaneous ulceration [skin ulcers] develops, whereas microthrombi in the glomeruli [kidney capillaries] reduce glomerular blood supply and glomerular filtration rate, potentially causing azotaemia [high nitrogen levels in blood] and oliguria [production of small amounts of urine] or anuria [failure of kidneys to produce urine].”
Of the 75% dogs that have skin ulcers without kidney injury, the prognosis is excellent. Of the other 25% of dogs that have skin lesions andkidney injury, 85% die when treated at vets whilst slightly fewer (75%) die when treated at referral centres [eg Anderson Moores Vet Specialists in Winchester]:
“For CRGV cases that remain non-azotaemic [normal blood nitrogen levels], the prognosis is excellent. Although skin lesions may take weeks or months to heal, a full recovery should be expected. Unfortunately, the prognosis is significantly less favourable in dogs with CRGV that develop AKI. Overall, more than 85% of CRGV cases with azotaemia have been euthanised or died… The outlook may be slightly better for cases managed in referral centres. Approximately 25% of azotaemic-suspected CRGV cases managed in referral centres have survived. However, no single therapy has been used more commonly in surviving cases and this figure is likely to reflect the more intensive monitoring and management generally possible in the referral setting.”
Laura Holm says that CRGV has not been reported in species other than dogs but CRGV-like diseases do occur in humans:
Today Anderson Moores Vet Specialists report that sadly, one dog has been confirmed as having died as a result of cutaneous and renal glomerular vasculopathy (CRGV). The dog was from Fetcham, Surrey.
Our two Alabama Rot maps have been updated. The confirmed cases map gives the Fetcham, Surrey location (red drop). The all cases map includes the Fetcham location (red drop) and the three areas – Bookham Common, Polesden Lacey and Norbury Park (orange drops) where the dog was walked, according to Pet Doctors Fetcham.
Of the 121 reported cases of confirmed, unconfirmed and suspected Alabama Rot between December 2012 and April 2016 (at 8th May 2016), 92% were reported in Winter (52%, 63 cases) and Spring (40%, 48 cases). Only 8% (10 cases) were reported in Summer (4%, 5 cases) or Autumn (4%, 5 cases).
75 confirmed cases (confirmed by dog post mortem) were analysed in another post dated 8th May 2016 indicating that 89% cases were reported in Winter or Spring.
This post with 121 analysed cases seems to strengthen the argument for a Winter / Spring seasonality to Alabama Rot. This 121 case analysis has 46 more cases (+60%) than the 75 confirmed cases.
Chris Street of AlabamaRot.co.uk on 8th May 2016 analysed all confirmed UK Alabama Rot cases (between December 2012 and April 2016).