Juvenile Pyoderma (Puppy Strangles) Updated 29-11-07
In any young puppy presenting with any
noticable swelling of the lymph nodes together with spots and pustular lesions
about the face,JP should be considered as a possible diagnosis. I have recently
been told by a vet, who has treated this condition, that the pustular lesions
(like blisters) may also be found on the body particularly the abdomen, the pads
of the feet, and the genitals and the anus.
(Please note a puppy could have one small
unbroken pimple on an eyelid and it could be JP, check
all of your puppies eye rims closely)
If anyone cares to look at the 1981 AFGHAN HOUND YEAR BOOK there is specific
reference to research then being undertaken at the Cambridge Vet school on this
condition. At this time whilst MANY breeders WERE aware of this disorder, little
was known about WHY it happened and what treatments were appropriate, indeed
some puppies, severely affected were euthanased, others less so severely
affected, breeders thought the condition may be related to proprietary milk
products and adverse reaction on the part of the individual puppy to such.
(Hence Hazel mentioning the term frequently used "milk spots" further down the
page)
We have come a long way since then because we we are now more tuned into the
health problems that may result from the reactions of the IMMUNE system and the
implications, viz: This IS an IMMUNE RELATED DISORDER.,and as such must be
treated with appropriate Immune suppressive doses of corticosteroids PROMPTLY!
In addition , specific ANTIBIOTICs (not synolox) also to deal with secondary
infection from the lesions .Quite an aggressive approach is necessary for a
relatively short period and it would appear that most puppies now do very well
and make a good recovery with the minimum (or no) scarring.
The use of an immunosuppressive medication must be undertaken with the CORRECT
dose being given, too little and it will NOT suppress the immune system and the
destruction will continue, too much and this can result in a variety of other
serious problems, particularly for a developing puppy.
The general doses that appear to be recommended are 2--- 4 mg of prednisilone
per kg body weight daily .
Still some owners/ breeders, and even some vets in practice may say they know
little about this disease. This is where the SHARING of information amongst us
as owners/breeders is so VERY relevant so that the Lines of Communication" are
available to help and assist in times of need....however it is important that
factual data and information to support any advice on treatments is given and
also in the relaying of personal experiences, to avoid any confusion and
misunderstanding.
SYLVIA
Juvenile Pyoderma / Cellulitis (often
misleadingly termed "Puppy Strangles") is a fairly common, but alarming disorder
that can be seen in many breeds including Afghan puppies from 3 weeks to 4
months of age. It appears initially as acute swelling of the face, primarily of
the lips, eyelids, chin, and muzzle. It may easily be confused, early on, with a
sudden allergic reaction typical of a bee sting or a vaccine reaction. However,
untreated it can progress rapidly into bumps and pustules which drain and scab.
The lymph nodes under the neck may enlarge dramatically, which is what
precipitated the term "puppy strangles." Half of the cases are lethargic. Up to
one quarter of the cases may show fever, appetite loss, and joint pain. The
cause of Juvenile Pyoderma is unknown, although an immune basis is postulated,
because of the rapid response to immune-suppressive doses of steroids. Early,
aggressive steroid treatment is needed to avoid excessive scar formation. If
evidence of concurrent bacterial infection is present, then antibiotics are
indicated. It takes a great leap of faith, but the only really good way to
treat juvenile Pyoderma is with the use of corticosteroids in combination with
antibiotics. If corticosteroids are not used early in this disease permanent
scarring of the affected areas can occur and if they are never used death is not
uncommon. The swelling of the lymph nodes cuts off the puppy's ability to
breath, hence the common name of "puppy strangles". In it's mildest form and
before it became more understood some people used to think of it as 'milk
spots'. It could be only a single pup from a litter or a whole litter that are
affected.
It is really scary to use immunosuppressive medications in the face of what
appears to be a really severe infection but it is essential IF the condition is
in fact juvenile Pyoderma. Diagnosis of this can be confirmed by skin biopsy but
it is usually best for your vet to make an educated guess and start treatment
while waiting for biopsy reports and hope for the best if the symptoms are
severe, since biopsy results usually take a while to get back.
Many vets want to try Synulox at the first signs of the problem, this usually
has proved to be a waste of valuable time on it's own and puppy should be put
onto a course of Prednisolone 2--4 mg per kilo bodyweight and Ceohalexin 250mg half
tablet twice daily. If the problem does not rapidly respond to treatment or is a
severe case then Antirobe 75mg one tablet twice daily and Cephalexin 250mg half
tablet twice daily. If the problem is severe around the eyes Fulcithalmic cream
can help soothe the eyes.
It is essential that hygiene and very good feeding are practised as poor management could escalate the problem. The good news is that once successfully treated a relapse is extremely unlikely. Although not thought to be hereditary (unproven either way ) it is now considered by some vets unwise to breed from a dog who has been affected. It is very advisable to delay any innoculations after the condition has totally cleared up to prevent any possible further complications.
Thumbnails please click for full viewing
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Showing puppy's head swollen and sticky eyes |
Clearly showing the pustles around the face |
Showing the pustles around the eyes |
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These two photo's are of the above puppy showing no scarring after the correct treatment is given, what a lovely Afghan:-) |
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Many thanks to the caring owners of these beautiful puppies for sharing these photos, very pleased to say the puppies made a total recovery
 Showing hair loss and small pustules on the more affected eye |
 Unbroken small pustules around the rim-the rest of the face was unaffected |
CASE HISTORIES
Please send us any additional histories if you have them of Afghan pups who have had Juvenile Pyoderma and photographs would be very helpful as we would like to add to this section and thank you to the people who are helping so far
Puppy 1 case history
Very healthy puppy, birth weight 1lb 2 1/2 oz who did very well up until 7
weeks. Developed two small spots on eye lid and was taken to vet for check up.
Put on Synulox for one week but condition was worsening rapidly and spreading to
lips. At 8 weeks was put onto Prednisolone 5mg 1/2 tablet once daily and
ceohalexin 250mg 1/2 tablet twice daily, condition not improving quickly and
pup's lips and eyes very swollen and sore and glands swelling but pup seemed
happy throughout. Medication changed to Antirobe 75mg 1 tablet twice daily and
continued with the Cephalexin as before.
1 week later although glands still very swollen the spots were lessening and pup
was put back onto Prednisolone along with the Antirobe and Cephalexin, Puppy
began to make rapid progress and left for new home aged 10 weeks and 5 days
fully recovered armed with a full progress chart for the new owners vet. There
was no scarring. Innoculation
was delayed until puppy was totally cleared, this pup was never bred from.
 Showing bottom lips badly affected |
 sorry but not very clear |
 starting round lips |
 Becoming worse |
 Pustules forming |
|
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Puppy 2 case history
Healthy puppy birth weight 15oz at 6 weeks. She was from a litter of 10 pups
with 2 affected. A small pimple type spot
appeared on one upper eye rim and hint of others on the lower rim (puppy milk spots?) vet suspected early Pyoderma and a skin
biopsy was taken confirmed our suspicion, pup had a short course of Prednisolone,
puppy never appeared ill and there were no further developments. Inoculation was delayed until 12 weeks to be
on the safe side. This pup later did a lot of winning but was never bred from, a
sibling produced a single Pyoderma pup from an otherwise healthy litter.
 One confirmed JP spot |
 Hint of others coming-due to early treatment they didn't develop further |
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Puppy 3 case history
Healthy puppy birth weight 1lb 5oz did extremely well up until 6 weeks when a
small spot appeared on eyelid, was thought to have been a scratch from a puppy
nail and vet was treating as such. Eyes worsened rapidly and pup was on Synulox
and eye cream, by eight weeks puppy was covered on it's face with open sores and
antibiotics were changed, owner very worried, pups head was becoming very
swollen. Puppy was still being treated for infection and swelling was so
bad in glands that the puppy was very close to death at this point as pup was
having severe breathing difficulties, stud dogs owner told the breeder to ask
the vet if it could be puppy strangles! treatment was immediately changed to Prednisolone and Antirobe and puppies health started to improve dramatically.
Puppy left home at 3 months continued a further weeks treatment from new owners
vet fully armed with all the relevant information. Inoculation was delayed until the condition was totally
cleared. There was no scarring and this pup later became a multiple BIS
winner but was never used at stud. This was the only puppy in a litter of 11 to be affected.
 Showing first tiny pimples appearing around the eyes |
 A very sick puppy - showing the foreface becoming affected and head starting to swell as his glands became very swollen |
 Closer view of the nose and pustles appearing on his muzzle |
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Puppy 4 case history (Photo's to be added ASAP)
Jared was born at the beginning
of November 1996, one of a litter of eight puppies - 6 boys, 2 girls. The birth
was easy with no stress for Emma, the mother, at all and she doted on the pups
as soon as they were born. All were normal births and normal weight for afghans
- Jared was the third puppy to be born and he weighed 18 oz.
All went well with the litter with no problems at all until they were
approaching six weeks of age and I went into them on that particular morning and
was horrified to see Jared with a swollen face and a rash on his muzzle. There
had been no sign of anything untoward until then, no spots or pimples - they had
been checked by me every day, played with constantly, several visitors and
potential owners came to look at the litter, and at no time did he look any
different to the others.
I had vaguely heard of juvenile pyoderma but had no real idea what it looked
like and my first reaction was to burst into tears as I thought he was dying!
Fortunately for me, at that very moment a friend visited whose mother was Beryl
Formstone whom some of you will remember for showing afghans in the 70’s and
80’s. Beryl was then into dachshunds, and the minute Steve saw Jared he rang his
mother. She confirmed instantly that it was JP, she knew of several people in
dachshunds who had had the problem and instructed me to get to the vets
instantly and insist the vet put him on Antirobe immediately as no other
antibiotic dealt with the problem as effectively - Synulox doesn’t touch it!
I instantly took him to the vets - our vet, Richard, had almost no knowledge of
JP but was more than willing to go along with the information given me by Beryl
and Jared was put onto Antirobe and Prednisolone. Unfortunately before long the
swelling had spread to his eyes and ears - the eyes streaming with discharge and
the ears so swollen they appeared almost totally blocked. It was an exceedingly
worrying time as gradually every gland in his body swelled before finally
reacting to the various treatments he was having. In fact he looked at that time
more like a shar pei than an afghan. His face was bathed three times a day and
this had to be fairly hard to remove the crusting of the sores and Panalog
ointment then applied, he had Lincocin drops for his eyes and Canaural for his
ears - but throughout all this he never once complained and carried on eating
and playing absolutely normally. Rather than keep him separated from his
siblings I was told to keep him with them unless he showed signs of distress -
which he never did. None of the other pups ever showed any signs of the disease.
He carried on with the various prescriptions for almost two months, weaning
gradually off all of them, though he had a blip during this time (when his
penile glands swelled up) and briefly he went back onto two Antirobe a day.
Once he had been declared fit Richard felt he could be safely vaccinated and his
course of vaccinations started. He was never able to be socialised until well
after he was eighteen weeks and we felt he missed out on this. He was shown with
success once he was six months old with only the very faintest scarring on his
muzzle which with age has disappeared.
The only sign of anything being slightly wrong is that his tear ducts do weep
occasionally, and I believe that can be a consequence of JP. When he was
declared fit and well by our vet he did warn us that he may suffer later in
life, but at the time I was so pleased that he had recovered so well I
completely forgot to ask Richard what might happen!
Needless to say he has never been bred from for although it isn’t proven to be
hereditary we didn’t want to take the risk of it possibly being so. Jared is now
10 - and lately he has been having problems with a rash on his tummy. This could
be an allergy to heat or grass but it is just a possibility that this is
what Richard meant as a potential problem as our current vet does feel that as
JP is an auto immune disease his system could be compromised, hence the rash
now.
Di Searle (Salamkhan) - 06-01-07
Puppy 5 case history
Text book birth and all puppies fit and well. Bitch and puppies checked by vet at six days who commented we had a nice healthy even litter all weighing within 100gms of each other. Bitch developed a slight touch of Mastitis in one teat at fourteen days and she was given a Synulox injection and a course of tablets. Initially this appeared to clear up but after ten days the dosage was increased. I mention this because this did not really clear until the pups were fully weaned at around six weeks, so therefore all pups were getting a low dose of Synulox from early on through bitches milk.
At four weeks of age I noticed a small mark on one of the pups lower right eye lids, no more than the size of a pinhead. The next morning, Sunday she had a small amount of rubbish in the corner of this eye, I assumed the little mark was maybe a blocked tear duct which had cleared and thought no more of it. During the course of the day the top eyelid began to swell and by the next morning, Monday, the whole eye was completely closed and the other eye was beginning to puff up, she also now had one neck gland slightly swollen. Puppy taken to see vet number one that afternoon who diagnosed an eye infection and that the swelling in her neck gland was just her immune system kicking in, she also had a slight temperature. Fulcithalmic eye ointment was prescribed to be applied twice daily to both eyes. I would like to point out that at this stage I did ask if this could be a Pyoderma puppy but somehow she managed to carry on talking and not answer the question. I do not know why to this day I connected the two as this was something I had only read about in one of my books. I had not heard of it and I certainly had no experience of it or tiny puppies in general come to that as this was my first litter. I wish now I had pushed for an answer and as they say hindsight is a wonderful thing. Appointment was made to check puppy Friday.
Wednesday puppy was not making any progress, both neck glands were up and both eyes swollen so much that she could hardly open them. I understand now this to be classic text book signs. Her eyes were obviously very painful as she fought me each time I had to pry them open to apply the ointment. I had taken to bathing them several times a day with cooled boiled water as they were stuck together more often than not. I decided I could not wait until Friday so took first available appointment that day. Saw vet number two, senior partner who decided she needed some antibiotics so prescribed a course of Synulox and to carry on with the ointment. I did not mention Pyoderma to her because I thought she surely must know an eye infection when she sees one!
Friday morning she was obviously getting worse, her whole head was now beginning to swell along with the neck glands and the tell tale pustules where on her lips and chin. I was now convinced this could not be an eye infection and started to ring a few Afghan friends seeking advice. One good friend came up with a horror story of a Pyoderma puppy she had bred years ago and I was now positive that this was indeed what I was dealing with. A few more calls and I was given the name of someone who had had a Pyoderma puppy some months previous and could give me the help I needed, unfortunately she was not in so I was unable to speak to her until after our next vets appt. Saw vet number two again and I knew by now that if this was indeed a Pyoderma puppy she required specific Steroids and antibiotics quickly as we had already wasted best part of a week. So tongue in cheek baring in mind this was a senior partner I put the puppy on the table and declared " If this is not a Pyoderma puppy then what is it because it couldn't just be an eye infection ? ". I was some what surprised when she declared she did not know much about Pyoderma puppies and proceeded to check the Internet. I explained I knew we needed specific Antibiotics and a Steroid in high doses but couldn't get hold of the one person who could give me the information. I know you don't just give any old Steroids so on her suggestion puppy was given a non Steroidal anti-inflammatory injection to help her in the mean time until I could contact this person. The surgery was closed over the weekend and vet number two was off anyway so an appointment was made to see her on Monday. I was assured that if I needed anyone over the weekend that the vet hospital was open and she would email them so they were aware what was going on. That evening I had all the information I needed for her treatment in just one phone call.
Saturday morning came and when she banged her chin and it started to ooze blood I decided not to wait for Monday and contacted the vet hospital for an appointment. Vet two had emailed as promised and they had all the details. The nurse when requested checked that the drugs I required where all available in the pharmacy and so off we went. Vet number three was seen who turned out to be an arrogant young man, he led me to believe he had seen Pyoderma in a Retriever, had heard of it in Boxers and Westies but never in Afghans ! He gave me the Steroids I wanted but refused to change the antibiotics, he told me to trust him he was the vet and I would see a change in a couple of days, he even joked that I could smack his backside if he was wrong. So she was still on Synulox. My husband will tell you he had to practically drag me from the surgery and it's not that young mans backside I'd now like to smack!
Monday morning puppy was still no better so I rang and asked to speak to vet Number two who at least took me seriously. She rang me straight back and I told her what had happened and the puppy was still very sick and that if she was not prepared to give me the antibiotics I wanted she was wasting my time and I hers and I would go elsewhere. She obviously realised I meant business and said she would work out the correct dosage for the puppies weight and they would be ready for me to collect at the appointment already made for later that day. She even agreed to just check with her vet school that nothing had changed treatment wise over the last few months.
MEDICATION
Antirobe one 75mg capsule twice a day for five weeks
Rilexine one and three quarters of a 75mg tablet twice a day for two weeks
Rilexine half a 300mg tablet twice a day for remaining three weeks
Prednisolone one 5mg tablet once a day for one week
" " one and a half once a day for one week
" " one once a day for a five days
" " half once a day for five days
" " Quarter once a day for five days
" " Quarter once every other day
Once on the correct treatment it was very straight forward and all she has to show is a slight bald patch on the end of her nose and slightly watery eyes occasionally. She was kept with her siblings as far as possible and was just rescued when it got a bit too boisterous for her, obviously her head and face were very sore but she would have been more upset by being segregated.. Jabs were delayed a month to let her immune system recover from the Steroids. She was having lots of Goats milk which lined her stomach as I understand this can be damaged with the medication. Since my experience I have spoken to many people and it would seem it is very common and has been around for many years not only in Afghans but in all sorts of breeds. Not long ago at ring training a lady told me she had lost two Westies out of several in a Pyoderma litter because the vet did not realise what he was dealing with and she herself did not know at the time. It took me five visits and three vets to get my puppy the right treatment so my advise would be if you think you are right argue your case. It might also be worth asking your vet what they know about Pyoderma puppies when you take your bitch to be checked over before you mate her, you might not get the answer you want to hear!
Liz Floyd - 09-01-07
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