B-Naturals Newsletter 
By
Lew Olson,
PhD Natural
Health, LMSW-ACP
September 2003
Erlichia
Dedicated
To Gil Ash’s Thunder on His Birthday
(He
would have been six on September 2nd)
A Note from Lew . . .
I would like to give to personally give
thanks to Gil for writing this very wonderful article on Ehrlichia; its cause,
its symptoms, testing for it, and treatment. I know this was very hard for her
to write after the loss of her beloved Thunder to this disease, and we can only
hope that the information included here will help other dogs and their owners.
Newsletter
Written by Gil Ash
http://nowhereelse.homestead.com/Thunder.html
In the late 1960's, military dogs in
Ehrlichiosis spread rapidly after '
geographic area; it has stricken dogs in every one of The
United States and on nearly every continent, and it is always fatal if a
diagnosis is not gotten in time for the damage it can do to be reversed. It can silently undermine the health of its
host for years until stress or some other factor brings it to light, then the
dog can die with a suddenness shocking to the grieving owner who may never have
realized anything was wrong. Perhaps for
that reason, it is practically unknown among dog owners and the level of
knowledge about it among veterinarians is abysmal.
WHAT IS IT?
Ehrlichia are parasitic organisms which are
something like a virus but are classed with bacteria. They attack the bone marrow, crippling its
ability to make the white blood cells (leukocytes) which are an important component
of the immune system.
"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 leukemia
patients. Advanced Ehrlichiosis is, in
fact, often misdiagnosed as leukemia or lymphosarcoma." http://www.srv.net/~cdm/Dale/ehrlichia.html
Since that was written, indications have
grown stronger that Ehrlichiosis either causes cancer or sets up the conditions
for cancer to develop. It has been
suggested that dogs ostensibly cured of it should be tested for cancer four
years after titering clear as so many seem to develop cancer of one form or
another in that time frame. This is no
big surprise to those of us who have seen our dogs come down with serious
illnesses after – or during - their infection with Ehrlichiosis since,
with an immune system that is essentially out of commission, the dog is
defenseless.
TRANSMISSION
Ehrlichiosis is transmitted by the nymph
and adult of the brown dog tick, rhipicephalus sanguineus, and the adult deer
tick, dermacentor variabilis. Once an
infected tick has attached and begun feeding, the disease is pumped into the
dog with the tick's saliva. Saliva keeps
the blood from coagulating so the flow of food for the tick is constant and
there is some conjecture that tick saliva contains a substance which prevents
the immune system from recognizing an invader soon enough to ward it off. At any rate, the deadly inoculation continues
until the tick is sated and detaches.
Transmission of Erhlichiosis takes from 24 to 72 hours, though on rare
occasions it has happened in less than twelve.
One strain of this difficult and hard to
pin down disease is not carried by ticks.
E. risticii, which has been renamed neorickettsia risticii to reflect
its close relationship to the organism that causes the deadly Pacific Salmon
Poisoning Disease, is transmitted by the larvae of flukes that live on river
snails. Once it infects the dog,
however, it acts like every other strain of Ehrlichiosis and requires the same
treatment.
Eight to twenty days after infection, in
the acute stage of the disease, the dog may show symptoms such as a discharge
from the nose or eyes, fever, lethargy, depression, enlarged lymph nodes,
disinterest in food or difficulty breathing.
Or it may not. The acute stage is
short, about four weeks at the outside, and many people never notice anything
to alarm them. Unfortunately, this is
the stage at which it is most easily cured.
The disease then passes into the sub
clinical stage, a term that simply means no symptoms are evident and it may
stay in this stage for up to five years while the immune system is steadily
undermined. Cure is not as easy but
still possible for most dogs at this point.
When Ehrlichiosis becomes chronic, damage
is usually extensive and curing a dog of it is difficult. Dogs may begin to bleed from the nose, they
may develop edema (swelling), blood disorders such as leukopenia (an abnormal
decrease in white blood cells), thrombocytopenia (a decrease in the number of
platelets in the blood which can lead to increased bleeding as the blood loses
the ability to clot) and abnormally high levels of antibodies in the
blood. With the immune system
effectively destroyed, almost anything from vague symptoms that go nowhere to
kidney failure, cancer and inflammation of the brain can be the result. German Shepherd Dogs are hit particularly hard
and in the late chronic stage may develop fatal hemorrhaging. Cross infections with other strains of
Ehrlichiosis or other TBDs are common.
TESTING
There are various tests that can be done to
detect Ehrlichiosis. The IFA, or
Indirect Fluorescent Antibody test, looks for the actual organisms in the
blood. The PCR, or Polymerase Chain
Reaction test, looks for DNA evidence of Ehrlichiosis; false positives and
negatives are possible with it and it should be run by experts. The western blot is capable of giving further
information on specific species.
The Snap3 Dx Test which looks for signs of
heartworm, Lyme disease and E. canis can tell you nothing about any strain
other than E. canis. If the dog has one
of the other forms of Ehrlichiosis, it will not be detected and a negative
titer will not mean the dog is not infected with one of the other strains. A positive titer for Ehrlichiosis with this
test, however, confirming a diagnosis, can be helpful since the treatment for
E. canis will work against any form of the disease.
E. canis, the most common form of the
disease, will cross-react with E. chafeensis.
Separate tests must be run for the other strains of
Ehrlichiosis: E. platys, ewingii, equi, and risticii.
A negative IFA does not mean that a dog is
free of Ehrlichosis. In the acute stage,
dogs may test negative because antibodies have not had time to form. In the chronic stage, the immune system may
be exhausted and there may no longer be any detectable antibodies.
Diagnosis is not testing alone but the evaluation
of the veterinarian; if a negative titer doesn't make sense in the picture she
is seeing, the dog should be put on doxycycline and if it improves, the diagnosis
is confirmed.
TREATMENT
Misdiagnosis is a huge problem with tick
disease because it is so often mistaken for something else entirely and
misdiagnosis in this case is more than ordinarily dangerous. If there is the slightest hint that a dog has
TBD, it should be treated for that first; if the dog improves, a diagnosis of
tick disease is confirmed and any other condition should be treated with that
in mind. Things can get sticky if the
dog also has a concurrent blood disorder like thrombocytopenia which is treated
with an immune suppresser like prednisolone;
the vet then has to walk a very fine line in deciding how much to
prescribe since steroids can kill a dog with Ehrlichiosis or any other form of
TBD. It can, however, be done. Steroids can also allow cross-infection with
babesiosis to become active, producing another complication. Anabolic steroids, though not dangerous, have
not proven particularly effective since they stimulate the bone marrow and
often enough, there is nothing left in the bone marrow to stimulate.
The drug of choice for Ehrlichiosis is
doxycycline. The Merck Veterinary Manual
recommends giving doxycycline at a dosage of 10 milligrams per kilogram of body
weight every day for a period of ten days to two weeks. The vets who deal with tick disease most
often, however, have found that a higher dose of twice that amount - 10mg given
every 12 hours for six to eight weeks - is more effective at stopping Ehrlichiosis
(as well as Rocky Mountain Spotted Fever and Lyme
disease) and preventing its recurrence.
Their recommendation is still controversial but among most dog owners
who have suffered along with their dogs through the ravages of this disease,
there is no hesitation about following it.
The thinking there is that disease resistance is more likely to build
with low doses of antibiotic; hit it hard the first time out.
Outward signs of improvement, if they are
going to happen, are almost immediate, and fortunately, doxycycline, a
semi-synthetic tetracycline antibiotic,
is relatively benign, has few, rare side effects, and can be given with food,
making it less likely that the dog will vomit it up. If that should happen, the twice daily dose
can be adjusted so that the dog can get it more often in smaller amounts less
likely to irritate the stomach. In the
event a dog cannot tolerate doxycycline, there are other drugs that can be
substituted which vary in their effectiveness and Imizol may be the best of
these for all but E. platys.
Imizol (immidocarb diproprionate) is not
approved by the FDA for the treatment of Ehrlichiosis and is used off-label but
it can be effective in knocking out stubborn cases of the disease. However, it is imperative that the vet read
the product label and balance risk against benefit for dogs that have impaired
lung, liver or kidney function.
Of the four major tick diseases in The
United States, Ehrlichiosis is the most widespread and probably the most
dangerous because of it. As noted above,
Lyme disease seldom kills but may cripple the dog if not treated. Rocky Mountain Spotted Fever comes on quickly
and can kill quickly, infection occurring in as little as six to ten hours
after the tick begins feeding; illness may become apparent in as little as two
days up to two weeks, though a week is more common. Babesiosis can be fatal but it does not seem
to be as prevalent as Ehrlichiosis and so is probably not as great a risk to
most dogs. But all should be taken
seriously and treated promptly for the health, for the life, of the dog.
Ehrlichiosis, like all tick disease, is a
huge and complicated subject; what you have read barely scrapes the surface and
if any of the above information is incorrect or out-dated, it is not intentional. Nothing about this disease is easy to be
certain about. There is just not enough
funding for research and some of what is known about it comes from experience
and anecdotal evidence, something which makes it difficult to convince many
veterinarians that it is epidemic, that it can cause or appear to be diseases
which they think they see, yet which do not respond to the approved treatments
for them, or that they should even test for TBD. Strangely, if tests are run and dogs are
found to have Ehrlichiosis, they are then often reluctant to follow the advice
of veterinarians experienced in dealing with it and treat it aggressively with
doxycycline given at a high dose for a longer period of time than the Merck
Veterinary Manual recommends. All that
being so, it is almost a necessity for the dog owner to learn as much as she
can about Ehrlichiosis and the other forms of TBD, or at least be aware that
her dog could become infected and be ready to insist that he be tested and
treated aggressively if tick disease is found.
RESOURCES
Some excellent sources of information about
Ehrlichiosis and other TBDs, given in much more depth, can be found at the
links below.
Ehrlichiosis: A Silent and Deadly Killer http://www.srv.net/~cdm/Dale/ehrlichia.html
Ehrlichosis: e-medicine.com http://www.emedicine.com/ped/topic655.htm
Newsday.com: Interview with Susan Netboy and Dr. Ibulaimu
Kakoma http://makeashorterlink.com/?M296521B5
Journal of Clinical Microbiology http://jcm.asm.org/cgi/content/full/36/7/2140
Tick Borne Ehrlichiae and Rickettsiae of
Dogs - updated may 2003 http://www.ivis.org
Document No. A0315.0503. Recent Advances in
Canine Infectious Diseases: Canine
Monocytic Erhlichiosis http://www.ivis.org/advances/Infect_Dis_Carmichael/waner/chapter_frm.aspImizol
product label http://usa.spah.com/usa/products/labels/label88.cfm?sID=0
By
Gil Ash
Proud Owner of a Black, American
Bred German Shepherd Dog Bauernhoffen's Rain
Dragon: Traveler http://nowhereelse.homestead.com/Thunder.html
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