This is an old article, but I was asked about another breed that had this a few days ago so I though I would re post it. Warning, the picture of the puppy in full blown affected state is pretty awful.
Puppy Strangles (AKA, Juvenile Cellulitis)
Stormy’s Story by Teresa McMahan
Prior to May 2006, I had never heard of “puppy strangles”. I went to the Denver specialty show to both show my other dogs and to pick up my newest addition to the family. Stormy was a gorgeous little apricot Mastiff puppy that had the most precious personality. She was bought from a prominent breeder. The day I picked her up, she was perfectly healthy and happy with no hint of what would begin in the near future. She was a bundle of energy and was as healthy as anyone can ask for. Little did I know that three days later all of that would change dramatically.
Stormy had been properly vaccinated, so I felt she was afforded protection against the major lethal pathogens that a puppy might encounter. Though she was exposed to other dogs occasionally, I attempted to keep her primarily in my hotel room to avoid exposing her to too many pathogens. Unfortunately, that did not work since airborne pathogen can go anywhere.
On day three, I interrupted Stormy’s playtime with my Kodi boy so I could put her in her crate while I went downstairs. As I scratched under her neck, I noticed a couple of pea-sized lumps under her jaw where the lymph glands are located. I made a mental note to keep an eye on it, but never dreamed it would be such a serious issue so soon. Eight hours later, those lymph glands had swollen to the size of large lemons. Stormy had two pimple looking sores on her chin, but she was still running, playing, eating and drinking. Actually, I didn’t even notice the sores at that time. She occasionally would seem to gag a bit, but still did not act ill. Nonetheless, the drastically swollen glands seriously alarmed me. I took her down to the R.V area where all the Mastiff breeders were set up. After several breeders passed her around and felt of her neck, one of them said that it looked like puppy strangles. That’s the first time I had ever heard that term, so I had no idea how serious it was. However, they all told me to get her to a veterinarian right away.
Fortunately, we found the emergency veterinary clinic and checked Stormy in. She was subsequently admitted into Alameda East Animal Hospital Intensive Care Unit in Denver for 24 hours. That was the moment I realized how seriously ill my new baby was and, needless to say, I was terrified about this illness I’d never heard of. The attending veterinarian said that if I had waited until morning to bring her in, she would have been strangled to death by her own lymph glands; thus the name “puppy strangles”.
What Puppy Strangles IS and is NOT
Puppy Strangles, also known as Juvenile Cellulitis, is a massive and inappropriate autoimmune response whereby the puppy’s immune system begins to attack not only the pathogens, but the puppy’s tissues as well. If not treated quickly and appropriately, it can kill a puppy within a few hours. As I would find out later, it is often treated inappropriately due to veterinarians’ reluctance to dose with adequate doses of steroids.
One hypothesis is that it is can be triggered by the poly-vaccines given today. The all-in-one shots apparently are more apt to trigger the autoimmune response than the single entity shots spaced over a longer period of time. It can also be triggered by sudden exposure to multiple pathogens from the puppy’s environment. In Stormy’s case, it could have been either or both. Another hypothesis is that it is actually a virus, but there is very little evidence to support this theory. Also, some belief it can be genetic, but again, there is NO proof of this either.
Puppy strangles is NOT a bacterial infection. It is not a disease that can be predicted. The only preventions are not to give the poly-dose vaccines and not to expose a puppy to vast numbers of other dogs. Even though I was cautious about not taking her around other dogs, it did not occur to me that many pathogens are airborne. That is a lesson that will always be with me. I will never have a young puppy anywhere near a dog show. It is not a disease that is slow onset. If caught and treated immediately, it is curable. If not treated immediately, it is deadly.
The very first symptom of puppy strangles is swollen lymph glands. In Stormy’s case, I noticed the swelling on both side of her neck beneath the jaw. During this phase, her blood cell counts were all normal and she did not run temperature. Actually, she didn’t even act sick. The lymph glands in the neck are the glands that can swell so drastically that they suffocate the puppy within a few hours. Small pimple-like sores also begin to appear on their face, in their eyes and ears and, in Stormy’s case, on her vulva. In a male, these sores would appear on their penis. At first, I didn’t even notice the sores because they were very small and hidden under her chin. That would change over the course of the disease! On steroids, she improved slightly over the first couple of days, but then her condition began to deteriorate. Within a few days, Stormy would develop weeping, pus-filled sores in her eyes, nose, mouth, ears and all over her face. Large pus-filled knots were palpable beneath the skin on her head. I assume these knots were painful because she did not want me to touch her face. After several days of more and more pus and swelling, I began to worry that she was getting much worse instead of better. I contacted a friend whose sister teaches at a veterinary college. That is when thing finally started to turn around for little Stormy.
There are two major problems with getting proper treatment for this illness. First, you have to find a veterinarian that can properly diagnose this disease. It isn’t extremely common and some veterinarians have no experience with it. The second biggest problem with treating this disease is getting a veterinarian that is willing to dose the massive steroid doses the puppy needs to overcome the illness. Stormy was originally started on Prednisone 15mg twice per day (she weighed approximately 22lbs). At first it seemed to help, but then her condition began to deteriorate. That’s when I discovered that she was being under-dosed on the steroids. She should have been put on Prednisone 20mg twice per day at the very least. After a bit of a tug-o-war with my hometown veterinarian, she finally put her on the 20mg twice daily. Since the steroids are used to shut down the immune system, it is necessary to prevent an opportunist infection from beginning. Stormy was also put on Cephalexin 500mg twice daily as a precaution. At one point, the veterinarian changed her to Clavamox which caused Stormy to develop severe diarrhea. We treated the diarrhea with a pumpkin and yogurt mixture which worked wonderfully. She was taken off the antibiotics and remained on the steroids. At her worst, she was on antibiotic eye ointment, antibiotic ear ointment, medicated facial scrub, Prednisone, Cephalexin, Denosyl (protection for the liver from the high doses of steroids), and topical Vitamin E oil to prevent scarring. With all of this medication, she began to slowly recover. For the first 3 weeks, she had someone watching her 24 hours per day to be sure she did not suffer a re-occurrence of the swelling and suffocate. Slowly, the sores healed and the hair on her muzzle began to grow back with no scarring.
It appears that Stormy will make it through this illness, though at times, I was not so sure she would. Today, she still is on Prednisone, but we are slowly tapering it down. It is very important to taper the steroids off. Stopping steroid treatment suddenly can cause severe problems and even death. The first time we attempted to wean her off of the steroids, the swelling did return, so we had to take her back up to the original dose. Since then, however, we have been able to wean her down. She is currently taking 10mg a day. Of course, she still is suffering from the side effects of the steroids. Steroids cause extreme fluid retention and weight gain. Her belly is very swollen and her growth seems to be slightly retarded. Steroids also cause extreme thirst, so she drinks more water than normal, and therefore, urinates frequently. Nonetheless, she is the happiest, sweetest girl. She still runs and plays with Kodi as if nothing were wrong. It will be a few more weeks until she can be completely off the steroids, but we are getting there. Also, in the future, we will have to be very careful not to give her poly-vaccines. It was suggested that I should have titers drawn on her to evaluate her need for vaccines. It is possible that if her titers against various diseases are high enough that she won’t have to have yearly shots (except for Rabies, which is required by law).
Though it has been a harrowing experience, I am thankful my little girl is pulling through. I was very thankful to have friends and family who helped me pull this little angel through. I sincerely hope no one reading this ever has to see such a horrible illness.
Stormy is now almost 2 years old and is doing fine. She did have to have a large tumor removed from her side at one year old, but it was benign and no others have come up. We did spay her due to long term steroid use. We were afraid to put her body under the stresses of heat cycles or breeding. She continues to be a very happy girl and a wonderful pet. The breeder stood behind her 100% and I could not have asked more from her.
Addendum: At four years old Stormy is still with us, but not in great health. She has several hip and elbow dysplasia and spay incontinence. She tends to get urinary tract infection quite easily. Fortunately, we are still able to give her a quality life by keeping her weight on the lean side, giving her Adequin shots when her hips get pain and just giving her as much love in her life as we can.