Has the rot set in?
Hardly a day goes by before an owner asks me about Alabama Rot. There is a lot we don’t know about this new dog disease but there are some things we do know, so let’s start with those. First, it’s quite rare with only about 60 cases so far confirmed in the UK since 2012. These cases have come from many parts of the country, although the New Forest area seems to be highlighted on the map. The name stems from a similar condition that was described in the 1980s in Greyhounds in the USA and in a Great Dane in Germany. The medical name for Alabama Rot is Cutaneous and Renal Glomerular Vasculopathy (CRGV) which means damage to the blood vessels of the skin and the kidney. Symptoms are therefore sores or ulcers on the body or in the mouth followed by signs of kidney failure (depressed, thirsty, nausea and vomiting). There is no simple diagnostic test and the cause of CRGV is not known.
Here in the UK, many different breeds have been affected and males and females are equally at risk, age appears to have no bearing either. There does, however, seem to be a seasonal factor with most cases (so far) occurring between November and June. This will only be borne out in time if more victims fall foul of this nightmare condition, something all of us hope will not happen.
Most dog owners reading about Alabama Rot may want to know how to recognise the condition or how to avoid it. The problem is, early stages can look quite innocent and just like other superficial skin damage. The Internet is awash with images that are dramatic and in hindsight have turned out to be the Rot but can you tell just by looking at a skin lesion? In medicine, both human and veterinary, we sometimes use a diagnostic system we call “pattern recognition”. Quite simply, the diagnostician combines what can be seen with other clinical clues (touch and smell) and almost instantly knows the condition. This is a powerful technique and we often just “know” the diagnosis. For diseases with unique or highly characteristic features, pattern recognition works as well as doing blood tests or x-rays. But although fast, this diagnostic technique can let you down as some things are not what they seem.
All diseases have a range of presentations that vary with the genetics of the patient and the stage of the illness. What’s more, many diseases have more than one cause and the dominance of one element over another can result in a wide variation in symptoms between patients. Throw into this mix the fact that all tissues have a limited response to injury or infection, it comes as no surprise that very different diseases can look exactly the same.
In the context of Alabama Rot, we have several challenges in the diagnostic process. First, most vets will never have seen a case (me included!) and so we have no pattern to recognise. Secondly, dogs in the countryside are always suffering minor scrapes that they lick and often make worse. Many of these minor injuries happen without the owner’s knowledge and only the excessive licking gives the clue that something is wrong. Third, we have no simple and reliable test that can rule CRGV either in or out. Possibly worse than all the diagnostic uncertainty is the fact that treatment is often unsuccessful as the kidney damage is usually severe enough to be fatal.
Oh dear, it’s all sounding a bit bleak. But do not despair! CRGV is rare so almost all skin lesions will be unrelated to Alabama Rot. However, any unexplained or unusual skin lesion that does not heal should be brought to your vet’s attention, especially if accompanied by other signs such as nausea, drinking more and being off-colour. Mouth and tongue ulcers are common in cats but not in dogs and so if you see redness or an erosion, straight to the clinic. Although we have no reliable test for CRGV, the disease often causes an unusual pattern of changes in the blood that can be detected with standard tests. Tissue samples from skin lesions will show suspicious changes and kidney function tests will reveal an “azotaemia” which means an increase in waste products in the blood.
So the take home message here is check your dog over regularly for any skin lesion and treat routine cuts and scrapes with a safe antiseptic (NOT Dettol or TCP) that we can supply or use Savlon. If any skin or mouth lesion cannot be explained by trauma and is getting worse, a blood test is essential and can be helpful to exclude CRGV, although not every case results in kidney failure. The most reliable information source is the Anderson Moores specialist veterinary clinic, who are conducting on-going research on the disease.
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