For dog owners & vets: noticing signs & treatment of CRGV; CRGV-like diseases in humans.

Cutaneous and renal glomerular vasculopathy lesions present on the muzzle.
Cutaneous and renal glomerular vasculopathy lesions present on the muzzle.

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).

Cutaneous and renal glomerular vasculopathy lesion affecting forelimb digits.
Cutaneous and renal glomerular vasculopathy lesion affecting forelimb digits.

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].”

Cutaneous and renal glomerular vasculopathy lesions on the body and limbs.
Cutaneous and renal glomerular vasculopathy lesions on the body and limbs.

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 and kidney injury, 85% die when treated at vets whilst slightly fewer (75%) die when treated at referral centres [specialist dog hospitals]:

“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:

In humans a group of diseases exist that are characterised by thrombotic microangiopathy (TMA) [blood clots inside blood vessels] which bear some similarities to CRGV, namely: haemolytic uraemic syndrome (HUS) [anemia caused by destruction of red blood cells, acute kidney failure, and low platelet counts], atypical haemolytic uraemic syndrome (aHUS) [uncontrolled activation of the complement immune system that removes foreign particles] and thrombotic thrombocytopenic purpura (TTP) [microscopic clots that form in the small blood vessels].

But even in humans, the causes of CRGV-like diseases are poorly understood:

“Even in humans, the aetiopathogeneses [cause] of TMA illnesses are still relatively poorly understood. Definitive diagnosis can be challenging and treatment is not always successful.”

Reported by Chris Street BSc MSc at Alabamarot.co.uk (May 26th 2016)

References

Vet Times (March 21st 2016) article by Laura Holm.

Notes

Text in [ ] is by alabamarot.co.uk

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Fetcham Surrey – dog dies of confirmed CRGV.

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.

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Is CRGV caused by Aeoromonas Hydrophila bacteria? – April 2016 update

Vet Fiona Macdonald
Vet Fiona Macdonald (Linkedin picture)

I reported in February 2015 on Fiona MacDonald’s hypothesis that CRGV might be caused by Aeoromonas Hydrophila bacteria.

In an update to her project, Fiona MacDonald wrote a letter (see below) in April 2016, to the New Forest Dog Owners Group (which provides some funds for her investigation project).

The project has two main lines of investigation, a serology test and a lesion swab culture, to see if the causal agent is Aeromonas hydrophila.

The swab of the lesion must be taken before the lesion is cleaned up because the disinfectant could kill the causative agent.

The serology ELISA test checks to see if any antibodies to Aeoromonas Hydrophila have been made by the infected dog. Twenty dogs with CRGV have been sampled for Aeoromonas Hydrophila.

Fiona Macdonald wrote about her project in the Vet Times (April 2016) and Veterinary Record here and here in 2015. They have had confirmed isolations of A hydrophila.

Fiona Macdonald April 2016 letter to NFDG

fiona-macdonald-april2016-1

fiona-macdonald-april2016-2

Letter to Vet Record May 2015

vet-record-fiona-macdonald-may2015

92% of all 121 Alabama Rot cases are in Winter or Spring

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.

alabamaRot-ALL-by-season
Winter (December, January, February), Spring (March, April, May), Summer (June, July, August), Autumn (September, October, November).

Chris Street of AlabamaRot.co.uk on 8th May 2016 analysed all confirmed UK Alabama Rot cases (between December 2012 and April 2016).

Data sources – Confirmed Cases UK map combined with Unconfirmed & Suspected cases (excludes confirmed cases) and cases-by-month spreadsheet.

Chart of All Alabama Rot cases by month between 2012 and 2016:

alabamaRot-ALL-cases-by-month

The monthly all cases were plotted by year:

alabamaRot-all-cases-by-month-by-year

The above chart shows the vast majority of Alabama Rot cases occur every year in Winter (December – February) and Spring (March – May).

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89% of the 75 confirmed Alabama Rot cases are in Winter or Spring

Of the 75 confirmed cases of Alabama Rot between December 2012 and April 2016, 89% (67 cases) were reported in Winter (51%, 38 cases) and Spring (38%, 29 cases). Only 11% cases (8 cases) were reported in Summer (4%, 3 cases) or Autumn (7%, 5 cases).

alabamaRot-by-season
Winter (December, January, February), Spring (March, April, May), Summer (June, July, August), Autumn (September, October, November).

Chris Street of AlabamaRot.co.uk on 8th May 2016 analysed all confirmed UK Alabama Rot cases (between December 2012 and April 2016).

Data Source – Confirmed Cases UK map and cases-by-month spreadsheet.

Chart of confirmed Alabama Rot cases by month between 2012 and 2016:

alabamaRot-by-month

The monthly cases were plotted by year:

alabamaRot-by-month-by-year

The above chart shows the lion’s share of Alabama Rot cases occur every year in Winter (December – February) and Spring (March – May).

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Anderson Moores at Bransgore Pet event – report by Southern Pet Services

Southern Pet Services Ltd provided this report (reposted with permission) on the talk by Laura Holm of Anderson Moores Vet Specialists on 22nd April 2016 at the Bransgore Pet Event :-

“Apologies for the long post, but below are my notes from the talk on Alabama Rot.

The main symptom is normally a lesion, and normally on the lower part of the body, including the muzzle and the tongue.

Effects any breed, although there are some breeds where there haven’t been any cases, and some more so, there aren’t enough dogs for them to be able to tell.

The lesion is due to toxins in the body forming as blood clots, which then block the blood vessels and stop blood getting to the kidneys.

The lesions are often circular, and ulcerated (very raw and sore), in some of the cases where the dogs had lesions but not the kidney failure the lesions were less sore and not so ulcerated.

The dogs tend to lick the lesion as they are painful and sore, they may also seem stiff, lame, go off food and vomit.

Research
There is a seasonal pattern with the majority of the cases being from December through to March, with only a small number in other months.

The cases are now wide spread throughout the UK, and there have been cases from dogs walked in the forest, fields, parks and beaches. The only cases they haven’t seen yet have been from road walks.

The disease is somewhat similar under a microscope to two human diseases –
HUS & TTP.  Both of these are being looked into , and the treatments used to treat these are being tested on the dogs, although nothing has been confirmed as a match yet.
HUS is caused by a E.Coli bacteria, TTP is a genetic condition.

They have looked into the possibility that Alabama Rot is caused by E.coli, but with all the bacteria they have tested so far, there hasn’t been any links found, however there are still E.Coli bacteria that they haven’t been able to obtain samples of.

There are a number of studies currently being carried out, the link to the 2 human diseases, E.coli link and another to a Fish bacteria with similar symptoms. They are also in the process of setting someone up to do a 4 year study on Alabama Rot, looking at all different angles.

They have ruled out the following;

  • Wells Disease – most dogs with Wells disease responded very well to treatment.
  • Lymes Disease – This is the wrong time of year, ticks are around mainly in spring and autumn.
  • Giant Hogweed – Again the wrong time of year, and it doesn’t tend to cause kidney failure.
  • Military Ordnance – The Environment Agency have done a lot of research into this and didn’t find anything, they also haven’t found anything in the kidneys of the infected dogs. Now the cases are a lot more spread out this is also no longer seen to be relevant.
  • Radioactivity – The Clinical signs of Radioactivity aren’t consistent with Alabama Rot, they also feel that a lot more dogs would become ill if it was due to radiation.
  • Spider Mite – Again they feel this is the wrong time of the year, as the spiders that can cause these symptoms are found in Europe and the winter here would be too cold for them. They also don’t have any reported cases from Europe.

There is no evidence that a dog can catch Alabama Rot from another dog, and that if your dog was with another with it then its very unlikely they could catch it.

They feel that it is an environmental trigger and seems to be (although not confirmed) linked to high rain fall.

75% of the cases presented with lesions, do not go on to develop kidney failure, however its quite hard to diagnose these dogs with Alabama Rot as there isn’t yet a test to be able to do so, it is confirmed once the dogs have unfortunately died and the kidneys are investigated.

If kidney failure does occur then sadly only 25% of these cases survive, this could be due to early treatment or that they respond well to the treatment compared to others.

What Next – Objectives for the research –
Define the Cause,
If there is a environmental trigger – what is it,
Are there any genetic abnormalities present in the dogs with kidney failure.,

Better Diagnostic tests

Optimal treatment Strategies
Identify a prognostic test – what is the outcome likely to be.

We can help by fundraising for the research, the New Forest Dog Owners Group help to fundraise for this cause. We will be looking to make regular donations as well.”

Midlothian, Scotland: Dog dies of suspected CRGV (Alabama Rot)

On 16th April 2016 ICR Vets posted news of a suspected  (confirmed by post-mortem?) case of Alabama Rot / CRGV that was presented early March 2016.

ICR Vets in Edinburgh said:

“We can confirm that we treated a case of Alabama Rot at the start of March. The disease is almost always fatal and our case sadly did not make it…. We are not advising any areas to avoid in Midlothian as we don’t know where the disease has come from – but the best advice is to wash and dry dogs feet after walks, and to be vigilant checking your dogs for new skin lesions. If you see any suspicious lesions please contact us on 0131 440 4229.”

aHUS bootcamp

aHUS (atypical haemolytic uremic syndrome) is  an ultra rare (less than 20 cases per million population) human disease. A laymans perspective is available from Atypical HUS Foundation which explains about types of HUS, aHUS treatment with eculizumab etc,.

A non-technical video (36m) ‘The Complement System made simple’ explains complement.

aHUS may be of use in understanding Alabama Rot – see Laura Holm et al paper.

Your dog has skin lesions? Ask your vet to contact Anderson Moores Vets (01962 767920) for a 24 hr turnaround GFR kidney test for CRGV. And don't delay!