Puppy Strangles

Overview of Puppy Strangles

Puppy strangles is a disorder that affects pups less than four months of age and is not completely understood. Several names have been used. They include juvenile pyoderma, juvenile cellulitis and lymphadenitis, juvenile sterile glaucomatous dermatitis and lymphadentitis, and puppy strangles.

The disorder is a pustular and crusting dermatitis or skin inflammation that occurs in puppies less than three to four months of age. Pustules are usually present on the muzzle, inside the ear and on the lip margins. Swelling of the muzzle may be severe. The wounds begin draining after a few days and are replaced by scabs. Many dogs also develop swollen lymph nodes.

Puppies feel depressed and may have a fever and joint pain. This condition is not a bacterial infection but more a type of hypersensitivity or immune dysfunction although a secondary bacterial infection is possible. It does not respond to antibiotic therapy alone. A good response is usually seen with antibiotics and high doses of steroids.

A familial history exists and golden retrievers, Gordon setters and dachshunds seem to be predisposed.

It is important to rule out other diseases that may appear similar to puppy strangles so the puppy receives proper treatment. The main disease to rule out is demodicosis. This type of mange can occur in young animals causing lesions of their face and high doses of steroids would be highly contraindicated.

Diagnosis of Puppy Strangles

Early diagnosis and treatment are important with this condition, as scarring can be severe.

• Deep skin scrapings are necessary to rule out demodicosis.
• Skin biopsies are necessary to establish a final diagnosis. Samples are used for histopathology to detect specific changes in the tissues and for cultures to ensure that infections are not missed. Failure to do so may have severe consequences.
• Skin biopsies are generally taken under sedation to minimize the discomfort and stitches are placed to ensure proper healing.

Treatment of Puppy Strangles

Treatment will usually include high doses of steroids such as prednisone and antibiotics as coverage to prevent development of secondary bacterial infections. You will be required to administer oral medications several times a day.

The most severe adverse effect of high doses of steroids is the development of gastrointestinal ulcers. It is important that you monitor the appetite of your pet, the development of vomiting and the appearance of the stools. If diarrhea develops or if the color of the stool changes to dark brown or black, your veterinarian needs to be informed as it may be a sign of an ulcer.

Relapse after discontinuation of therapy is not common and it is often due to a rapid and premature decrease in the dose of steroids. Rarely it has been reported that some dogs relapse multiple times despite appropriate therapy and more aggressive immunosuppressive therapy is required.

Scarring is very common consequence of this disease. Avoid any aggressive topical treatment of the area.

No prevention exists. Relapses after treatment are very uncommon.

In-depth Information on Puppy Strangles

Several names have been used to describe this disease. They include: puppy strangles, juvenile pyoderma, juvenile cellulitis, and juvenile sterile granulomatous dermatitis, and lymphadenitis.

The observation of canine juvenile cellulitis in clusters of dogs between one and four months of age and its apparent systemic nature suggest an infectious cause. The condition occurs in young dogs (one to four months of age), but in rare cases, it could occur in older animals.

The exact cause is not known. Bacterial, fungal or viral agents have not been isolated from affected lymph nodes. Attempts to transfer the disease by inoculation of neonatal puppies with tissue from affected dogs have also been unsuccessful.

Golden retrievers, Gordon setters, yellow Labrador retrievers, and dachshunds seem to be predisposed. However, this condition has been described in a variety of breeds, including mixed-breed dogs. Familial history is present in many cases suggesting a hereditary component.

The good response to steroids suggests a hypersensitivity or immune dysfunction.

What to Watch for with Puppy Strangles

• Swelling and pustules are found around the mouth, eyes, inside the ears, on the chin and muzzle. Swelling of the muzzle may be severe.
• Ear infection is commonly associated with pustules on the ear.
• Scarring and hair loss are common consequences of this condition.
• Mucocutaneous junctions like the edges of the lips may be affected. Lesions drain within 24 hours and scabs develop.
• Lymphadenopathy, or swollen lymph nodes, is common. Swelling of the lymph nodes under the jaw may be observed even without any association with skin wounds.
• Lethargy, fever and anorexia may be present but are not consistent findings.
• Joints may be painful.
• Nodules may be found on the body suggesting a concurrent hair follicle inflammation.

Diagnosis In-depth for Puppy Strangles

Diagnosis is made by a combination of history, clinical signs and biopsy. It is important to rule out other diseases that may appear similar. Some of these include demodicosis, angioedema, severe bacterial infection, pemphigus foliaceous, drug eruption and sterile nodular panniculitis. Your veterinarian may recommend the following:

• Complete blood counts (CBC). This test may reveal a high white blood cell count and anemia.
• Deep skin scrapings. It is important to rule out demodicosis, which could also cause similar signs. Demodicosis occurs in young animals and treatment with steroids would be contraindicated. This test is recommended in all puppies with skin disease.
• Cytology of the aspirate of pustules or abscesses. This test may reveal many white blood cells without bacteria. Staphylococcus may be isolated from draining lesions but intact abscesses and lymph nodes are usually negative for bacterial growth.
• Cytology of the aspirates of joints. In dogs with joint pain, this test reveals infective arthritis with no bacteria and the aspirates are usually negative for bacterial growth on culturing.
• Multiple biopsies from fresh, intact lesions
• Skin samples should be used for both histopathology and cultures. The inflammation may be so severe that the normal dermal architecture is destroyed, including hair follicles and glands.
• When secondary infection is present, neutrophils becomes the prevalent cell. The infiltrate surrounds the hair follicles forming large granulomas. In severe and more chronic cases, the inflammation may be very deep. The same inflammatory process may be seen in lymph nodes, even when anatomically distant from the site of apparent disease.
• Tissue samples should be submitted for cultures (aerobic, anaerobic, fungal and mycobacterial) to confirm the sterile nature of the disease and ensure that an infection isn’t missed.
• Mycobacterial infections are not commonly seen at such a young age but may cause severe dermatitis. Special staining (acid fast stain) should be used to detect the organisms on histopathology. Most organisms would grow rapidly (within 7 days) on appropriate media.
• Demodicosis may present with similar histopathological changes but usually fragments of mites can be identified in the center of the granulomas.
• Pemphigus foliceous (immune skin disease) has been reported to occur in young animals. In those cases, pustules are seen on face and ears. Lymph nodes may be enlarged but usually not to the extent seen in puppy strangles. Animals may feel depressed and lethargic.

Treatment In-depth for Puppy Strangles

• Concurrent treatment with bactericidal antibiotics with a broad spectrum and prednisone at immunosuppressive doses is the most consistently effective for this condition. Response to antibiotics is favorable in only 1/3 of cases confirming that the bacterial infection is secondary and not the primary cause of this condition. Common antibiotics used are cephalexin and amoxicillin-clavulanic acid (Clavamox). The induction phase of prednisone usually lasts 10 to 14 days. The most severe adverse effect of high doses of steroids is the development of gastrointestinal ulcerations. Pets should be carefully monitored for vomiting, diarrhea, dark tarry stools or the presence of blood in the stools.
• Relapses after treatment is discontinued are not common but have been reported. In rare cases, it may be necessary to add another immunosuppressive drug (e.g. oral azathioprine or cyclosporine) besides the glucocorticoids. In these cases, close monitoring of complete blood cell count is recommended, due to the potential for severe bone marrow suppression. Pancreatitis and liver inflammation have been reported with this drug.
• If azathioprine is not tolerated, chlorambucile may be tried. It is considered safer than azathioprine but still has the potential of causing bone marrow suppression.
• Concurrent arthritis resolves with treatment of the juvenile cellulitis.
• Frequent gentle bathing with antiseptic solutions can help wound healing.
• Topical therapy is not recommended, due to the pain and the increased risk for scarring.

Prognosis for Puppy Strangles

Relapse after discontinuation of therapy is not common and it is often due to a rapid and premature decrease in the dose of steroids. Rarely it has been reported that some dogs relapse multiple times despite appropriate therapy and more aggressive immunosuppressive therapy is required.
Therapy often lasts 4 to 8 weeks and relapses are rare.

With early aggressive treatment, the prognosis is good for a full recovery.