From:
Sukie Crandall
Date: 2003-07-09 20:17:21 UTC
Subject: Chiclet update and trying to put the info together somewhat
To: ferrethealth@smartgroups.com, co-list@yahoogroups.com
Message-id: <a06001801bb320b62cec7@[10.0.1.27]>
There is no chance to get sleep right now so I'll muddle. I think
I'll try to write a summary about Chiclet because I've been asked to
by some folks who are confused. I can understand why they are
confused. Our vet's never seen anything like this, the consultants
are stumped, and if what Dr. Ruth Heller has run into is the same
thing rather than coincidence then her description is that it has
very low morbidity (The chances of getting it are very low -- and we
know of no situation of multiple cases presenting this way in one
household.) but it is "hot". So far, Chiclet is the only only alive
still with the symptoms and she is touch and go, going onto her 6th
week. Anyway, I'll try to answer the questions that have been
arising and point to more info.
That is as good a place to start as any.
No one knows if the 4 cases mentioned now have/had the same thing
(first two in PA who didn't have pathology but if memory serves also
looked like they had cellulitis but cause was unknown, then Chiclet,
then another in PA just recently who died due to related heart
complications and also was thought by the pathologists to have
something bacterial). Was there someone else who had one like this
in the weeks before Chiclet got sick? I am trying to remember.
There may have been and if there was I don't know if pathology was
done. I recall that there were some similar ones at the times who
turned out to have JL when pathology was done. There are real
similarities to JL in some aspects of presentation, also ones to
leiomyosarcoma and to osteoma. You can see how it may be possible
for ferrets to have something look similar but not be a bacterial
infection like this, or alternatively for a ferret to have a
bacterial infection like this and be thought to have a malignancy
instead.
Oh, bacterial infection is considered the most likely, but since it
hasn't been found it could still turn out to be something different,
so when I say bacterial that is the assumption which so far best fits
what has been found.. It is NOT mycobacterium, BTW. Specialized
pathology testing for that was done and turned out to luckily be
negative. The chances of that were always low; we don't feed raw and
she simply hasn't had exposure, plus the test results just don't mesh
well with that possibility, but it was checked, anyway. We're thrown
around a pile of ideas -- everything from different types of venom,
to heartworm with a weird presentation (This is strange mosquito year
around here and even though it's not normally a concern in our area
we'll be seeing if preventatives may make sense this year unlike most
years here for inside ferrets.), to...
Here is how it looks: One or two nodes go from being normal to being
huge -- to the point where they splint out a leg and make it immobile
in a matter of hours. A very high fever (105 +) begins. Nodal
aspirates tend to look unusually bloody somewhere along the line --
if not the first then then one or more follow-up ones. Blood work
looks like what would be expected with lympho as a possibility
(likely due to the cellulitis) but aspirates look more like what one
would expect with a bacterial infection. Mild anemia happens. It
can at times during the illness be difficult to get blood. In
Chiclet's case her respiratory rate has gone up; it's not as high now
as at her worst but is no where near normal even though she is not
doing that weird breathing that pain can cause and she does not have
ascites. Recently she is something also making a sort of
snuffly-horn noise or vocalization but fortunately yesterday's chest
x-rays (Can't even remember how many she had had during this
anymore.) continue to not show heart or lung involvement though her
pulmonary artery looks like it might -- but it is a "might" -- be a
touch large. The ferrets begin showing indications of having dips in
blood sugar (which can be from sepsis). Removed tissue looks melted
from the cellulitis. There can be improvements followed by crashes if
the ferret survives long enough. Urine and feces are fine for
Chiclet except for a stray unusual stool -- but nothing worrisome.
Leg x-rays, chest x-ray, abdominal x-rays, and an ultrasound show
nothing unusual. Ultrasound guided splenic aspirate biopsy
consistent with massive bacterial infection. Appetite for Chiclet
has continually been good; I can't recall about the others off-hand,
but there is extreme weakness with the ferrets going through long
periods of just lying there and with long periods when walking is an
impossibility. In Chiclet's case Steve and I really think that meds
and her own will have kept her alive several times during this and
everything else has been an accessory to those two essentials.
Well, she just put the lie to me by having a well formed but mucusy
green (olive and forest green) bowel movement with what looked
worm-like things on gross examination, but I think they may be mucus
because they had a lacy non-cohesiveness under 20x. So now we will
be collecting feces, too, for examinations of some of those.
Chiclet is in a 2' by 2' cage with her IV and pump and with bedding
and newspaper. She loves to eat, to cuddle, to have visitors, to be
shown things, to hear music. When asked if she wants soup she will
enthusiastically lick chops and be very alert. She also likes
carafate so does that when offered 'Belly fix". Ditto when offered
oil. The word "Meds" does not get that response. She is much
improved from a week ago but can not stand, though she can sort of
"inch-worm" and she acts like she is pround when she reaches the
paper to pass waste.
She was just doing that snuffling sound again -- it is weird sound
(snuffly but also with sort of a horn or nasal quality and could be a
vocalization) and none of us know what it is but she was sleeping
comfortably. and her chest x-ray yesterday was fine. ***** Is this a
baby sound?***** I ask because very ill individuals often behave
more baby like so I figure that is a possibility, but we haven't
known any kits younger than 5 weeks old.
Anyway, I think that is about it for what this looks like -- at least
for Chiclet. (Oh, except I forgot to menion that the skin lesions
she got turned out to be a response to one of her meds and they are
cleared up with only one needing more care than Xenodyne.) Her node
and the surrounding fat where another matter; they had cellulitis and
were melted looking. One more thing: she almost never shows any sign
of pain and has only needed her torb 5 times in 8 days (It lasts for
maybe about 8 hours before she stops being groggy.), once of those
was after the removal of her original catheter and the pain was from
that.
Maybe tomorrow she will be tried without IV and then we find out if
she crashes or not.
Anyway, I am tired and sure that I will miss something or someone may
be interested in some other aspect, like what meds are being used, so
for anyone who is interested right now I'll find the Chiclet posts,
starting with the earliest ones, in the FHL Archives:
http://fhl.sonic-weasel.org/browse.php?msg=SG4821
http://fhl.sonic-weasel.org/browse.php?msg=SG4931
http://fhl.sonic-weasel.org/browse.php?msg=SG4948
http://fhl.sonic-weasel.org/browse.php?msg=SG4977
http://fhl.sonic-weasel.org/browse.php?msg=SG4981
http://fhl.sonic-weasel.org/browse.php?msg=SG4989
http://fhl.sonic-weasel.org/browse.php?msg=SG4990
http://fhl.sonic-weasel.org/browse.php?msg=SG4998
http://fhl.sonic-weasel.org/browse.php?msg=SG5007
http://fhl.sonic-weasel.org/browse.php?msg=SG5014
http://fhl.sonic-weasel.org/browse.php?msg=SG5015
http://fhl.sonic-weasel.org/browse.php?msg=SG5048
http://fhl.sonic-weasel.org/browse.php?msg=SG5076
http://fhl.sonic-weasel.org/browse.php?msg=SG5161
http://fhl.sonic-weasel.org/browse.php?msg=SG5163
http://fhl.sonic-weasel.org/browse.php?msg=SG5164
http://fhl.sonic-weasel.org/browse.php?msg=SG5173
http://fhl.sonic-weasel.org/browse.php?msg=SG5187
http://fhl.sonic-weasel.org/browse.php?msg=SG5191
http://fhl.sonic-weasel.org/browse.php?msg=SG5231
If you are wondering why we haven't given up it's because Chicet
hasn't hasn't given up.
Here are pictures of Chiclet at home with her set-up. The individual
blow ups were fuzzy for me but the slide show worked perfectly.
http://homepage.mac.com/esc/chicklet/PhotoAlbum23.html