Puppy Strangles, Beau's Story

A very good client of ours came in three weeks ago with one of her 5 week old Havanese pups. She had noticed that he felt very warm, was not as playful, nor was he eating as well as he had the day before.

Sure enough he had a very high fever. He was 104 degrees, (normal for dogs is about 100-102). He certainly looked subdued, but with a fever like that I wasn't surprised that he didn't feel well. Otherwise everything looked and sounded very normal with him. We started him on antibiotics, gave him some subq fluids (to keep him hydrated and help bring down his fever) and sent him home to be back with his litter mates. I gave very explicit directions to keep a very close eye on him.

A few days later he returned not much better. His fever was not as severe but he was now more lifeless and depressed. He was switched to a stronger antibiotic and told to return in a few days if he wasn't better, or comeback immediately if he worsened.

He came back to see me a few days later looking like this;

He had a very swollen nose and muzzle, swollen eyelids, lots of discharge from the eyelids, painful all over, enlarged lymph nodes around the face, and he was very, very, cranky.

It was at this point that we decided we were going to add a steroid and start treating for what we call "puppy strangles."

Puppy strangles is our layman's term for juvenile sterile granulomatous dermatitis and lymphadenitis, juvenile cellulitis, or juvenile pyoderma. 

Juvenile cellulitis is described as an idiopathic (nice scientific way of saying we don't know why this happens), skin disease of puppies that occurs between 3 and 16 weeks of age.

The disease can vary in severity from mild, with very few clinical signs other than fever or swelling, to severe and can even cause death.

It can affect one or more in the litter. The primary clinical signs of this disease are found in the head and face, and most commonly affect the mucocutaneous areas of the eyes and mouth. 

Diagnosis is by exclusion of other causes that cause similar clinical signs, like demodicosis (mange or demodex), and blood work, skin biopsy, and lymph node aspirates. This disease is also poorly responsive to antibiotic therapy alone.

In almost all cases the initial clinical sing that is observed is facial swelling and enlarged lymph nodes around the face and neck. The swelling (edema) can be profound and is centered around the face to include eyes, mouth, and ears.

The breeder also brought in another littermate as a companion, but she serves well to show the big difference in appearance between the two puppies.

The following pictures are one week after starting a steroid. The swelling has diminished significantly around the eyes, nose, and the lymph nodes are smaller. Most notably this puppy is back to eating, playing and feeling much more comfortable.

These pictures are from the two week re-check. We have started to taper the steroid, but clearly he still has some facial swelling, so he is still on prednisone. But he is happy, eating, playing, and sick of us looking at him. An ornery impatient puppy is a puppy that feels better!

Treatment should be instituted quickly because the lesions can cause scarring and the facial swelling open tissue and abundant exudative fluid allows for secondary infections.

Treatment for this puppy included;

1. Oral steroid at a high initial dose that was tapered based on response. This puppy required two months of steroid. Published doses are oral prednisilone at 2 mg/kg every 12 hours. We try to taper at 14 days, and keep retrying as the condition improves. Do not taper fast unless the puppy has an adverse drug reaction. Most cases require 4-8 weeks of treatment. Vigilant monitoring and rechecks with the vet determine the most successful cases.
2. Antibiotic to help keep the oozing skin from becoming infected. This was done as a short course  and stopped once the steroid began to reduce the swelling of the face and skin. Recommended antibiotics include cephalexin at 22 mg/kg every 12 hours, or, amoxicillin-clavulanic acid 15 mg/kg every 12 hours.
3. Baths in an antiseptic surgical prep solution. This also helps relieve the discomfort and also acts as a topical antibiotic. We used our surgical scrub 2% chlorhexidine.

The breeder was concerned that the eyes and nose didn't look that improved because there was crusting and flaking skin around them, but I reminded her that the underlying skin was much calmer, i.e. not red, not swollen, and not painful. The skin that had been so swollen and red and the fever had literally burnt the skin and it needed to peel and flake off before the healthy skin below was apparent. In these cases the puppies will tell you before your eyes can that they are either sick, or getting well.

When it comes to puppies (I call them 'puppies' until they are a year old), the younger the more fragile they are, the more diligent, hyper-vigilant that you need to be in monitoring and seeking help if they even look sick.

Puppies with strangles should be showing significant improvement within 3 to 5 days of starting the steroid. The prognosis is much poorer if it takes them longer to respond (although my advice is TO NEVER GIVE UP ON A PUPPY OR KITTEN! They will surprise you often). It is also important to have a long term treatment plan with breeders/owners. Weekly, or more often if needed, re-checks are incredibly important because the disease can return if the steroids are stopped pre-maturely, and remember steroids have their own set of potentially damaging side effects if they are used for too long.

Update:
Four weeks after the start of treatment and this little puppy has a new home, has started his puppy shots and is looking like a full recovery is eminent. We are all so happy to see this little love bug playing, kissing, snuggling and acting like the bubbly bundle of joy he is.

Photo from Tuesday, 17 June, 2013. At first puppy visit .

These pictures are from his third puppy visit. Now almost 6 months old. He looks so amazing!!

His name is now Beau. He has been adopted by a wonderful woman who has another Havanese.
She tells me that they play constantly. I watched two videos of them scurrying around the house to prove it.

There are few things more inspiring and satisfying in the world than the joy of a healthy growing baby!

This was just taken on 8/19/13. Beau had his first official grooming!
How handsome is he??
Dashing!! (He knows it too!)

Beau is scheduled to be neutered in late August (2013). I expect he will have a completely normal long healthy life! He is a true testament to perseverance, dedication, and the glory of medicine!

XOXO Beau, from all of us at Jarrettsville Vet!

I am asked often about the long term affects and success of treating this disease. I will continue to say that if treated early and aggressively these puppies have an excellent chance at a complete recovery. I also have not seen any long term affects to their health and longevity. Scarring is possible but puppies are incredibly resilient and heal quickly. I would never discourage someone from adopting or treating these puppies.

Update: November 18, 2013. Beau was neutered today! He also had his upper deciduous canine (cuspids) teeth removed. He did wonderfully, even though I know his mom was petrified about putting him under anesthesia.

Update; Beau was at the clinic on 7/3/14 for his first year puppy visit!

He is perfect!! And soo handsome!

If you have any questions about this disease, or any pet related question that you would like answered, you can find a whole community of pet friends at Pawbly.com. Pawbly is free to use and dedicated to helping people take better care of their pets.

You can also find me at the clinic trying to save the world one wet nose at a time. Call or visit Jarrettsville Vet in beautiful Harford County Maryland, or chirp me on Twitter @FreePetAdvice.

And, my last note, believe in miracles, they do happen, but only if you try and you believe, just ask Beau.