CANINE STREPTOCOCCAL TOXIC SHOCK SYNDROME
New more invasive strains of streptococci have
recently appeared, resulting in frightening new diseases in both
humans and dogs. Both humans and dogs can develop streptococcal
toxic shock syndrome, with the rapid development of symptoms of
shock, high fever (104 to 107 degrees
Fahrenheit), cough, abnormalities of coagulation and rapid death.
In humans, the mortality rate is estimated at between 60-80%. In
dogs, itmay be even higher as the course of the disease is so
rapid that a dog may be killed in as little as 1 to 4 hours from
development of the first symptoms, so that some dogs are simply
found dead in their runs, houses or yards. It's entirely possible
to leave a healthy dog in the morning and find it dead when you
come home from work. Necropsy, if done, frequently fails to
reveal the cause of death in dogs found dead,further skewing the statistics.
Treatment of acute CSTSS is often unsuccessful.
One veterinarian in Canada has noted a 50% mortality rate, which
seems to be unusuallysuccessful. Those dogs who survive have been
treated with IV antibiotics to which streptococci are
susceptible, particularly Penicillin G and Clindomycin.
Clindomycin seems to be particularly useful in acute cases
because it halts the metabolism of the
streptococci, stopping the cascade of toxins responsible for the
high fever, shock and Disseminated Intravascular Coagulation
(DIC).
Dogs can be infected by canine strains of
streptococci and sometimes by human strains. A dog handler with
pharyngitis (sore throat) was thought to be the source of
infection in a Greyhound kennel epidemic in Florida, and a human
strain was isolated from an infected dog in Canada. There
are certainly human "carriers" of streptococci, and
according to Brad Fenwick, D.V.M. of Kansas State University
Veterinary School, there are also canine carriers of virulent
streptococci who never show a symptom.
The portal of entry in dogs usually seems to be
the throat and lungs. The reproductive tract of bitches in season
is an open invitation to bacteria as well. Oddly, streptococcal
skin infections in dogs don't seem to be a problem although this
is a frequent site of entry in humans. This could be because
canine skin is better protected by the fur, because canine skin
is simply more resistant to infection, or because minor wounds or
cellulitis are overlooked because of being covered by fur.
The severe symptoms typical of CSTSS seem to result when the
bacteria invade the bloodstream, producing septicemia and
toxemia, with a cascade of toxins. In humans, the invasion
follows the pattern of classical "blood poisoning" from
streptococcal cellulitis or septicemia from "strep
throat," except for being much more toxic and much quicker.
In humans, the disease is about as contagious as bacterial
meningitis, and antibiotic prevention is recommended for both
diseases.
TRANSMISSION OF CSTSS
The known exposures and transmission factors in
Cloudy's case are as follows, and seem to be fairly typical:
Dog "A", 11 mos old Siberian female
was lethargic and vomiting small amounts (no fever) at about
5pm and was found dead in run at 6am...necropsy showed
nothing.
Two weeks later, on 9-3-99, Dog "B"
2 1/2yr old Siberian female was housed in the same indoor
kennel area, while being shown at the National Specialty in
Portland Ore. Last day at that kennel was on 9-12-99 and dog
was then transported home to another state. On 9-22-99, Dog
"B" became lethargic with vomiting, and was taken
immediately to the local vet. Blood work was negative...vet
sent the dog home on Clavamox for owner to monitor. Dog
vomited up the Clavamox and owner left dog in its crate and
went to work and then to school. Owner arrived home at 10 pm
to find Dog"B" dead in crate. Necropsy showed
nothing abnormal, but noted blood in uterus and vulva. The
cause of death in dogs "A" and "B" has
not been definitely established, although Dr. Fenwick has
spoken with dog "B's" veterinarian and both agreed
it was most likely CSTSS.
On 9-12-99, owners of Dog "A" came
into physical contact with Dog "C", 8 mo Siberian
male (Cloudy) by examining the puppy's mouth and teeth. Dog
"C" was stricken at about 11:00 a.m. on 9-23-99.
This is where my story comes in. Puppy survived. In a side
note, my puppy (and many others unaffected for that matter)
was exposed to the humans handling both Dogs "A"
& "B" during the week of 9-3-99 through
9-12-99.
Cloudy's case illustrates a typical picture
of canine streptococcal toxic shock syndrome. Cloudy went to
the Siberian Husky National Specialty in Portland, where he
is thought to have been exposed to CSTSS. About 12 days
later, Cloudy's owner took him with her to her work as a vet
tech. He was apparently in good health in the morning, but
developed some vomiting and drooling about 11 a.m. At about
noon, he became lethargic, and by 2 p.m. He developed a fever
of 106 degrees, developed shock and collapsed. He was treated
with IV fluids, dexamethasone and IV antibiotics. While this
treatment was being started he developed a deep, wet cough
and signs of DIC (disseminated intravascular coagulation) in
the form of ecchymoses on the abdomen and penis. With
intensive treatment, he improved and his temperature was back
down to 104 degrees by 6 p.m. And finally became normal by 11
p.m. Since at that time the infectious agent was unknown, he
was put on oral metronidazole as well as his other
antibiotics, to be sure of covering all the bases. The deep
wet cough persisted for three full days. He recovered much
less quickly than he became ill, with persistent weakness and
lack of energy, but was in apparent good health in about 2
weeks.
RISK FACTORS
Important risk factors in the transmission of
CSTSS seem to be:
Crowded conditions, such as racing Greyhound
kennels and conformation dog shows, especially inside and in
the fall and winter months. Conformation dogs are at higher
risk than dogs entered only in performance events.
Hygiene factors, including sharing food and
water bowls. Handlers and judges may transmit the infection
by examining/handling multiple dogs sequentially without
washing their hands. Equipment, such as muzzles used in
racing dogs should be kept clean and/or not shared by
multiple dogs.
Close physical contact: Although "social
sniffing" and running with an infected but asymptomatic
dog is reasonably safe, jaw-wrestling and play-fighting is
not. Sharing a run with an infected dog is an important risk
factor, as well as water-bowls, bedding, etc.
Crate-swapping and sharing is high risk.
Licking of genitalia of bitch in season by
infected male is another high risk factor.
Dogs kenneled in adjacent runs are not at
high risk.
Dogs licking the face of a human with a
"strep throat" or cellulitis or of a child with
impetigo are definitely at risk.
Stress factors, such as traveling long
distances, confinement, exposure to stressful situations,
estrus, etc. may reduce a dog's resistance to disease
WHAT YOU CAN DO TO PROTECT YOUR DOG
Avoid exposing your dog as much as possible to the high-risk
conditions above. If you find that one of the dogs to which your
dogs was significantly exposed develops an illness with shock,
collapse and high fever, consult your veterinarian about
antibiotics. If your dog is entered in a conformation show, crate
and groom the dog outside if possible, or in as well-ventilated
an area as is available. Try to show your dog's bite to the judge
yourself, to minimize the possibility of bacteria being carried
down the line of dogs. Remember, this is an infectious disease,
like chicken pox, and if your dog develops CSTSS it's not a
reflection on your kennel, cleanliness or management. You
wouldn't be reluctant to admit that you yourself had strep
throat, after all.
If you don't have a rectal thermometer, get one.
Know the location of the nearest 24-hour
emergency veterinary clinic as well as your veterinarian, and
memorize the phone numbers.
Print out this post or the information in
websites and carry a copy in your car or van.
Watch your dog or dogs carefully, and check them
frequently. Remember, if your dog does develop CSTSS there is no
time to waste, so make as many preparations as possible in
advance.
If you or your veterinarian have further
questions, or if you think your dog may have CSTSS, please call:
Brad Fenwick, D.V.M.
Kansas State University Veterinary School
phone: (785) 532-5650
e-mail: fenwick@vet.ksu.edu
Dr. Fenwick would like information on ANY
dog who may have or have had CSTSS, surviving or not. There
is grant money available for laboratory tests and necropsies.
Contact Dr. Fenwick to find out if you are eligible, exactly
what information , cultures and tissue samples he needs and
where to send it. Dr. Fenwick is interested in speaking to
owners and veterinarians of any dog who may have or have had
CSTSS.
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