From:
Bruce Williams, DVM
Date: 2001-10-23 13:51:00 UTC
Subject: Re: advice sought on Lawsonian's diagnosis
--- In Ferret-Health-list@y..., Alicia <ferretwise@m...> wrote:
> Dr Williams and other list vets,
> I am looking for some information on a personal Ferret Ashlee.
Ashlee is
> a late alter jill ( altered age 4 - having no litters as she
cohabitated
> with a v-hob). Her spay was preceded by her cagemate falling
victim to
> insulinoma and therefore could not cycle her naturally. Since the
onset of
> advanced insulinoma with cagemate Ashlee has displayed green,
thready poops.
>
> It was initially felt a stress result from the illness and death
of her
> cagemate however she did not respond to amoxy & carafate
regimen. She
> was having wobbly episodes which the vet was not sure were caused
by
> insulinoma or lack of digestive processing so Ashlee went to the
vets for
> exploratory. Her adrenals at age 5 1/2 looked perfect, her pancreas
seemed
> okay too! Her intestines were off and a section was taken and
forwarded to
> Northwest Zoopath. the diagnosis read:
> 1. Marked proliferative ileitis/ colitis
> 2. Marked reactive lymphoid hyperplasia with mild architectural and
> cellular atypia and with marked edema, lymph node.
>
> Comments: Histologic changes in the alimentary tract are severe and
vary
> somewhat from the more typical inflammatory bowel disease processes
that we
> see. I suspect there may be an infectious agent associated with
this
> condition in the ferret, and a special stain is pending in this
> regard. Changes in the lymph node are reactive and attributed to
antigenic
> stimulation associated with the gut lesion. There is some mild
atypia in
> the lymph node suggesting potential for future transformation to
lymphoma
> provided the stimulus cannot be removed.
>
> Addendum, 10/16/01: A Warthin-Starry stain reveals large numbers of
> filamentous bacteria in the apical aspects of the hyperplastic
mucosal
> epithelium. Morpholgical features of the lesion and the
microorganisms
> within the lesion are classic for Lawsonia infection. This
condition has
> been referred to as "proliferative ileitis".
>
>
> Any help in suggesting treatment would be helpful . Ashlee is
receiveing
> carafate suspension several times daily, amoxycillan, and since her
> transfer back home the loose brown stool has become dark green
droplets
> again, her appetite is off. As owner and layman I suspect a
progressive
> treatment protocol appears to be in order for any chance of
recovery and
> return to better health.
To start with, Mike made a typo - Lawsonia (also known as Ileobacter,
Desufovibrio, and previously Campylobacter-like organism.) is the
causative agent for proliferative colitis (not ileitis.) Actually,
Mike just asked me for some gross pictures of proliferative colitis
and sent me a set of his histo images - I presume it was from this
case.
This is somewhat unusual, as PC is usually seen in young ferrets less
than 2 years of age, and predominantly male. It usually causes
clinical signs of frequent painful defecation which contains mucus
and blood. However, regardless of her signs, the lesion is very
characteristic, and the diagnosis is not in doubt.
Carafate and amoxi won't touch this. This calls for chloramphenicol
(a somewhat tough antibiotic to get these days) at 50 mg/kg twice a
day. It is the only antibiotic that touches this bug. However, this
should bring it under control. PC is a disease that tends to wax and
wane, especially in periods of stress, so don't expect to eradicate
it - but you can really improve quality of life as well as establish
a long interval of health between attacks.
While the possibility of development of lymphoma is always there in
lymph nodes which are chronically inflamed, I don't think that it is
something to be overly concerned about at this point.
With kindest regards,
Bruce Williams, dVM