Canine erlichiosis - tick disease

It's three months to the day when we rushed Pippa to the vet. He struggled to move, didn't want to eat, and we thought he was dying. Turned out he was seriously ill with tick disease, but it could be treated.

So here is the lowdown on tick disease. It's on my blog rather than Pippa's as it is a serious post about pretty much most aspects of it, with some links that I found useful when I was researching it. I knew nothing about tick disease until three months ago, so maybe someone may find this post helpful/informative.

I've divided it into the following sections, in case you want to jump to particular bits and skip others which you may have read elsewhere. It may seem a back to front order, but it's the way it impacted on me, so there we go.

• What happened



• Blood test results



• Erlichia canis and erlichiosis



• Treatment



• Prevention/control



• Update



• Sources

What happened

There was nothing very obvious to suggest that Pippa was poorly. In fact he had been to the vet the previous week for his annual shots, and we'd said he didn't have any health problems. As well as the shots, our vet gave us some extra tablets to give him at home as there was an outbreak of tapeworm in the countryside in our part of Spain.

A week or so later, he started to seem a bit tired and listless. He didn't want to walk as far around the block, and although he ate his meals, he preferred them to be brought to him rather than charging around the place. As you do, well I do, I jumped to conclusions and wondered if he was having a reaction to his jabs. Plus of course, with him coming to us off the streets, we don't know how old he is. We've had him seven years and he was a young dog when we got him.

The next day he seemed slightly perkier, so although we'd discussed going to the vet, we decided to wait and see. But the following day he was clearly poorly, not wanting to go out at all in the morning, and sitting down because he was having trouble putting weight on his back legs. We didn't bother discussing anything, a sudden deterioration at his rear could mean anything. He was lifted into the vehicle well before 8am and we were on the road to the vet.

Poorly


When we arrived, he seemed a bit brighter. The clinic was empty, so we sat in the spotless waiting area while Pedro checked him over. About the only useful thing we could tell the vet was that Pippa's urine looked milky. As Pippa was lying on the floor with his head on Partner's boots, Pedro took a blood sample from his front leg. As Pippadogblog readers will know, he is such a docile dog, and didn't even move.

Then Pedro explained we would have to come back in a couple of days for the results which were being rushed to a lab in Barcelona. He gave me some tablets, and I looked at them puzzled - they were for osteoarthritis. I asked if he had arthritis. Typical medic, Pedro said he didn't know, but Pippa did have some pain in his stomach area, so he needed to take one of these a day.

By the time Saturday came around, Pippa had made a considerable improvement after taking the painkillers. I couldn't believe the difference - to be honest, I'd not expected to be taking him home with us.

Pedro explained the test results, but there was still one outstanding - erlichia canis. He gave me another ten days worth of painkillers, and some extra tablets - doxycyclin - one to be taken each day. When he got the final results through, he said he would contact me as I may need to double the dose of doxycyclin.

We asked what Pedro thought was wrong with him, and he said he thought it was an infection. 'Oh nothing serious then?' said Partner happily. Pedro looked worried and shook his hands in a very Spanish fashion which in this case, indicated that he wouldn't say that at all.

I couldn't see much point in pestering him with questions when he didn't have all the results and I could get back to Gib and do some research on the internet.

It was late Monday when he finally emailed me, apologising for the delay, and saying he had only just got the results through. I needed to double the dose of doxycyclin. The final results were attached as a PDF doc and showed that Pippa had tested positive for erlichia canis.


Blood test results

I was really impressed that these were waiting for us on the Saturday morning printed out for us to take home, and also that the final one was sent as a PDF. I don't think I've ever had so much info from a vet or medic in the UK. Perhaps things have changed?

Here are the key findings from the results. I've included the readings that are well outside the 'normal' range. The first figure is Pippa's reading, the next is the range that it should be within. As you can see, his readings were way too high.

Haematology
Leucocitos 24.96 5.95-17.2
Segmentados 18,620 3,380-11,530
Monocitos 3,245 100-1700

A sample of his blood examined under the microscope was normal.

Protein analysis
Total protein 99 52-76
Total globulins 86.3 20.6-50.6
Alfa-2 globulins 17.3 4.6-9.9
Gamma-globulins 48.3 1.2-20

Finally there were two specific tests.

1) He tested negative for leishmaniasis.

2) His results for erlichia canis were 1/1240. Values up to 1/40 could be produced by illness or some unspecific reaction. Any values higher than 1/40 were to be considered positive.

Before we'd received the final result I'd had chance to read up on his results and on erlichia canis. Classic indicators of the presence of erlichia canis were high levels of protein and leucocytes so it was no great surprise when the final result was a positive one. I should have realised that if it had been straightforward, ie negative, then the result would have been there with the others. Either it was borderline (which it clearly wasn't) or they wanted to double-check the result. In this case it was clearly a very high reading.


Erlichia canis and erlichiosis

So what is it? Technically, erlichia canis is a rickettsia which is an organism mid-way between a bacteria and a virus. It is spread by ticks which, when they bite the dog, spread the organism into the bloodstream, which then reproduces inside the white blood cells. Erlichiosis is the resultant illness. It has a number of different phases. The bad news is it can be fatal. The slightly better news is that it is treatable, and preferably caught sooner rather than later.

The disease has three phases.
1) Acute
2) Sub-clinical
3) Chronic

One thing I found interesting when I was researching on the internet, is that apparently German Shepherds are particularly prone to this disease. Pippa, as far as we know, is part GSD.

There is more than one tick disease - canine babesiosis is another one. I picked up a useful leaflet in the clinic which summarised the two.

Symptoms according to the leaflet:

Canine erlichiosis:

Apathy, vomiting, fever, loss of appetite, and finally, anaemia.

Canine babesiosis:

High fever, tiredness and red urine.

And, on this site here, is a list of all the symptoms under the sun. Whose dog has not suffered from any of these at some point?????

I know there are other tick-borne illnesses that affect dogs eg Lyme disease and Rocky Mountain Spotted Fever, but I wanted to concentrate on erlichiosis, particularly as it is world wide - and it is the one I needed to know about. Once I had done the research, it seemed sensible to share it.


Treatment

Tablets


Firocoxib

Brand name - Previcox (also Equioxx for horses).

This is a non-steroidal anti-inflammatory drug (NSAID), manufactured by Merial, which is a COX-2 inhibitor.

A lay explanation about NSAIDs is that they are mainly used as painkillers and as anti-arthritic drugs. Aspirin and ibuprofen are both NSAIDs.

NSAIDs inhibit the enzyme cyclooxygenase, which has three variants called COX-1, COX-2, and although not often mentioned, COX-3.

COX-2 inhibitors however, are a later generation drug and are selective, that means they only target the COX-2 enzyme. So they suppress the pain and inflammation associated with COX-2 while leaving COX-1 alone. Studies suggest, that by not inhibiting COX-1, there is a lower risk of the usual NSAID side effect - gastro-intestinal disorders.

With me? Pharmacology lesson for today is over anyway :)

Doxycyclin

Brand names - Proderma (Industrial Farmacéutica Cantabrica) and Vibricina (Pfizer)

This is an antibiotic and the first choice treatment for tick disease. Again, in lay terms, it prevents the bacteria from reproducing. Not much else to say about that.


Prevention/control

When we first moved to Spain and noticed a load of fleas and ticks, we started off with those little cheap collars for the dogs that prevent fleas and ticks. They didn't prevent either fleas or ticks. We spoke to our neighbours and they suggested the drops. Frontline, Spot-on, whatever you want to call it.

And once we learned about leishmaniasis, we bought leishmaniasis collars. The ones that protect against leishmaniasis for six months, ticks for four and fleas for two. Or something like that.

I read about the drops on the internet. Like all chemical products they can cause side effects. Skin irritations, or worse.

So then what do you do? Add extra chemicals to your dog? Six and two threes. Dose him up with chemicals, or risk infection with parasites, or horrid fleabites for us. Doesn't bear thinking about.

We tried to find a happy medium. Nasty chemicals in the damp warm weather of spring and autumn, leaving all dogs free in the height of hot dry summer and cold dry winter when the nasties aren't around.

In Gib, we have bought Advantix (Bayer).

The two main ingredients in this are permethrin, and imidacloprid. Both are insecticides and neurotoxins. Pyriproxyfen is an insect growth regulator (IGR) that prevents juvenile fleas developing.

In Frontline Plus (Merial) you get fipronil and S-methoprene. Fipronil is classed by the WHO as a Class 11 moderately hazardous pesticide. S-methoprene is the IGR used in the Frontline product.

There are natural alternatives, links below.

We tread a fine line when the lives of our animals and the quality of their lives are in our hands.


Update

We took Pippa back to Pedro after the ten days worth of tablets was finished. He prescribed another 20 days tablets. Although he was no longer taking Previcox as a painkiller, he was taking three capsules of doxycyclin a day. It can take some time to get rid of the organism, so it will be a few months before he has another blood test to see what improvements have been made.

'It's the disease of your pueblo,' added Pedro rolling his eyes.

'There are lots of animals,' I replied, thinking of the horses, donkeys, goats, sheep, pigs, buyo (draught oxen), cows, not to mention feral dogs and cats.

'There are lots of garrapatas (ticks),' he said Spanishly, succinctly cutting to the chase.

He is now doing boundaround for his breakfast, boundaround in the morning when he wants to go out onto his Spanish terrace, and has put on weight. So much so, that we are considering buying a new harness as the current one is extended to the limit. I am talking about Pippa here, not Pedro. I have no idea what Pedro does at breakfast time or whether he does boundaround.


Cost

Our total bill at the vet's was 116.50€ which included the lab analysis and consultation (70€) and the remaining 30 odd euros was for the first lot of tablets. I took a prescription to the pharmacy for the final 50 or 60 capsules, and the cost for those was around 14€.


Sources and links

A clinical article which provides a good summary of E. canis from a technical perspective

Another vet-type article

Written by a vet, but readable for lay people

A short but useful summary

Another good summary

Lots of detail about E.canis

Longer than my post and very good - worth a read, if pretty scary



Some wiki links about the chemicals

Permethrin

Imadoclopryd

Fipronil


Natural ideas

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