Puppy Strangles or Juvenile Pyoderma

by Debbie Brussaard (www.shelties.nl)

Thank you very much, Debbie Brussaard, for letting us reprint your article on Juvenile Pyoderma. We believe it would be of big help to many breeders, no matter which (dog)breeds they are in.

Thank you Anette & Christian, for letting us use youre picture of Chi-Meiling.

In 1998 and much to my regret I have become familiar with the illness “Puppy Strangles”, or as it is known officially “Juvenile Pyoderma”. For the sake of ease I will use the abbreviation PS in the rest of this essay. On August 20, 1998 Gwendy had 6 healthy puppies: 3 bitches and 3 dogs. Everything went very well and nothing warned me for what happened a couple of weeks later with one of the puppies.

This picture was taken on September 20th.

As you see, this was a beautiful and healthy puppy. This would change rapidly.
This is the story of Ezra, a little sable Sheltie-lady, in whose body suddenly everything went wrong.

20-09-98: It looks like Ezra was stung by an insect in her left upper-eyelid. In the evening, the lower eyelid swells enormously as well. This is definitely not caused by an insect!

27-09-98: The left eye is infected and full of pus. Because my own vet is on vacation, I called his substitute to ask whether I may use Terramycin on such a young puppy. This is affirmed.

28-09-98: Terramycin doesn’t help and the right eye is becoming infected as well. Ezra’s behavior changes drastically: She is phlegmatic and sick. Called the vet who tells me to come by. Against my better judgment I take Ezra. In my opinion she is too young and too sick to take her outside, but I have no choice. Because Ezra is too ill for a “normal” eye infection, I suspect that she has contracted PS. She eats well, but has diarrhea and dark urine. I informed the vet of my suspicion, but he has never heard of it!!
I return home disappointed and a little angry, armed with only CAF+ eye-balm.

29-09-98: Ezra’s condition is deteriorating rapidly. Called a fellow breeder. He came by the same afternoon and confirms my suspicion. Called the vet, who reacts a little annoyed. It’s clear he does not like it that I have come to my own diagnosis. He tells me to come by again so he can see it for himself. When he sees Ezra, he proposes to put the her out of her misery!!!!
After a lot of talk, he agrees to help and orders Antirobe for me.

30-09-98: Ezra’s condition deteriorates further. She has acute diarrhea, pimples on her lips, around her nose and on her chin. Called the vet to ask when the medicine is due: tomorrow! Took Ezra to the practice again and on my explicit wish, the vet gives Ezra a shot of antibiotics (equal to Antirobe) to counter the diarrhea and to tamper the possible PS. Ezra still eats well. Her temperature is 38,5 degrees.

01-10-98: The diarrhea is gone, but Ezra is still very sick. I clean her eyes with boiled water every hour, but the flow of pus only seems to grow. She can’t open her eyes despite the Vaseline I put on her eyelids. Her left ear is starting to get infected. Finally the medicine arrives. Ezra should take 1 capsule of Antirobe per day for the next 16 days.

02-10-98: Ezra is really very ill and the pus is flowing from her eyes. Her ear is now very swollen, red and dirty.

03-10-98: It looks like Ezra is shaping up somewhat: Her behavior is becoming more normal. The eyes look better, but there is still a lot of pus.

04-10-98: Behavior is becoming better. In the afternoon, I find a swelling in the left part of her neck: A swollen lymph gland.
In the evening this is joined by a swollen one on the right. The eyes look somewhat better.

05-10-98: The swellings in the neck look somewhat smaller. The pimple on the chin looks likes it’s drying up and the others look less infected. She was even able to open her eyes this morning. Her behavior keeps on improving: She even looks quite happy!

06-10-98: The swellings in the neck are clearly present again. Additionally Ezra’s vulva is swollen and in her right lower belly, another swelling appears. The eyes still look quite good, but she is getting more phlegmatic again.

07-10-98: The right ear is now infected as well and both ears look dirty. The pimples around nose and lips have grown and look fiery. The vulva is still swollen. Two large swellings on either side of the neck and one on the belly. I de-wormed Ezra today. Worms are the last things she needs now. In the afternoon I took Ezra to the vet for an examination. It took me a lot of trouble to convince the vet to administer Prednisolon.
He rather sees her go to the specialized clinic in Utrecht and again proposes to put the puppy out of her misery. Got a 21-day Prednisolon program in the end. Once home, found a new swelling on her breast between the front paws. The pimple on the chin has grown to double its original size. Ezra is improving what her behavior is concerned. She eats well, she weighs 1755 grams and her droppings and urine look normal.

08-10-98: Ezra is exactly 7 weeks old today. We are halfway through the Antirobe and in the second day of the Prednisolon. I start giving Ezra warm baths to counter the pimples faster (tip from a Finnish breeder). In the evening, the pimples in her neck have decreased in size. Her eyes and ears look good: She even has a couple of eyelashes left.

09-10-98: Constipation!! Ezra has great pains in trying to relieve herself, even though nothing happens to this extent. Gave her an enema of 5ml Microlax, but this doesn’t help. The left ear is very dirty. The right ear is clean and looks good. The eyes are reasonably clean but am continuing the balm treatment. The swelling on the breast is bigger and harder, just like the swelling on the belly. Found a new one on the right flank and one next to the larynx. The swelling in the neck has disappeared. The lips are now fully swollen and red. Pimples on the chin are unchanged; Those around the nose are fiery and swollen. Ezra’s temperature is 37,9 and thank goodness my own vet has returned from vacation!! He pays a house call: The left ear is literally full. The constipation is caused by the antibiotics; a few licks daily of paraffin should help. Absolutely no bathing! This causes the skin to remain wet for too long. I may try this in the case of multiple open abscesses, but not yet. The Prednisolon program is extended to 5 weeks as follows: first week full dose, 2 weeks half dose (half a tablet per day), last 2 week a quarter dose (half a tablet per two days). My own vet is fully aware of the illness and is helping me in the battle with and for Ezra! I’m regaining confidence…. J

10-10-98: Ezra’s temperature is 38,5 and has no new swellings. Her existing swelling are however becoming bigger and bigger. Her droppings are halfway normal, but she has problems getting rid of it.

11-10-98: Ezra is not running a fever anymore and her droppings are reasonable thanks to the paraffin. The eyes look fine, but the ears are still full of pus. In the evening Ezra really took a giant shit. No wonder she was in pain!

12-10-98: Called my vet: the swelling on the breast burst open. His advice is to fiddle around with it as little as possible. If the mother wants to take care of it, this is fine, but do not clean it with corrosive (cleansing) substances. This won’t help and would only cause scars if the abscess closes up again. I should keep in mind that swellings under the skin will burst open.

I ask if the Prednisolon has a negative influence on calcium levels. This seems to be true, but it is useless to supplement calcium. A new swelling on the breast appears and the one next to the larynx is getting bigger. The swelling on the belly is even bigger and has a soft top; this one won’t be closed much longer. In the afternoon, the opening in the abscess on the breast has grown bigger and is losing more fluid. The swelling between the shoulder blades has become ENORMOUS; micro-chipping her was only just possible, as the skin has become very tight. In the evening, a new, small swelling appears on the right side of the neck.

13-10-98: Under the skin a large blood clod appears above the swelling on the belly: will try to make it mature quicker with camphor. I got Otifin P.D. gel from Apharmo for the ears. New swellings on the left of the neck. Her temperature is 38,5.

14-10-98: The abscess on the belly has opened, the one on the breast is starting to heal. Shaved the two swellings between and to the right of the shoulder blades and treated them with camphor balm. The ears are still very irritated, but less swollen and dirty; Ezra now has an ear-complex. Stopped treating the eyes with gel. They look fine (just like pig eyes). Temperament: she is becoming happier by the day, plays more and is cheekier!

15-10-98: The lips and vulva look better, for the rest no change. Decided together with my vet to extend the Antirobe treatment for another 16 days. Ezra weighs 2,4 kilos.

16-10-98: Switching to a half a tablet of Prednisolon per day for the next two weeks (until 30-10-98).

17-10-98: The abscess on the breast is almost closed, now the skin has to follow suit (like the swelling on the belly). The swellings on the shoulders are big and hard and cannot be moved. The swelling next to the larynx is almost gone. The one on the right side of the neck is hard, but not as big. The ears are looking better, the eyes look fine! The lips look more appeased, dried crusts on the chin. Excrements are fine, but I’ll administer the paraffin for the time being. The vulva looks normal again.

18-10-98: No new findings. She went into the garden for the first time and loved it!

19-10-98: Abscesses between the shoulders and on the right flank are becoming soft. I expect them to open one of these days. The eyes are slightly irritated again (balm); the ears are still going strong.

20-10-98: Found another big swelling on the left side of the neck. A number of smaller swellings appear under the abscess on the breast.

21-10-98: The abscess on the breast is open again. There is a second small opening just under the original one. The abscess on the belly has another bloodstain under the opening, which has almost closed in the meantime. Everything is becoming very painful for Ezra!

22-10-98: There is a new swelling between the anus and the vulva. The three swellings on and between the shoulders are enormous and still closed (Ezra cannot lie on her back anymore), will start applying camphor balm twice per day to make the mature quicker.
The abscess on the belly has grown and opened again. On the breast, the two holes have united into one big one, started to apply camphor balm around and wound spray in the wound twice a day. The ears are better, but the eyes remain irritated. Balm twice per day. At 10.45 the swelling on the shoulders opens: A LOT of pus. Try to push out as much as possible.

23-10-98: Swelling between the shoulders does not open further; it remains a small hole. The ears and eyes are slowly getting better.

24-10-98: The swelling on the shoulder has closed already and is starting to shrink. Will treat the eyes and ears with balm only once a day.

25-10-98: Ezra looks like she is really shaping up, the swellings are stablising. Stopped applying the camphor balm on the abscess on the breast.

26-10-98: Ezra is stable and the eyes are looking better all the time: also the connective tissue (eyes) is nice and pink. At 11.30 pm, the swelling on the right part of the shoulder bursts open as well, again an enormous amount of pus. Pushed out as much as possible again. It's clear that this is a relief for Ezra. This is the start of the period of healing. Toned down the balm treatment on eyes and ears according to intuition. Stopped the camphor balm and the paraffin. Ezra is becoming fatter by the day, but acts more normally by the day as well: cheeky and playful. She goes outside a lot and plays a lot with her brothers and sisters and the grown-up shelties. The last phase of the Prednisolon: half a tablet on 01-11, 03-11, 05-11, 07-11, 09-11 and 11-11. My vet will give Ezra her first shot on 16-11-98.

10-11-98: The abscess on the breast is gone, save for a little crust. The eyes have fully recovered including hair, eyelashes and pigment. The ears look fine, but are still a little dirty. The lips are still a little crusty, but are healing nicely. The swellings are small or have vanished.

16-11-98: My vet declares Ezra for 100% healthy!! She gets a full shot, despite of her having missed the first two. She is allowed to move to her new owners in 10 days. Having a mind of my own, and also knowing how much her new owners want to have her, she may go to the them on 22-11 on condition that they regard Ezra as "quarantine-case" until 26-11: they may not walk her where she can come into contact with other dogs. Ezra looks beautiful! The abscess on her breast is just a fine, pink line of approximately 1 cm, where hair is beginning to grow again. The abscesses are almost gone and the lymph glands are small and appeased. One needs to be careful in combing and brushing as Ezra is still very sensitive. You can hardly recognize the eye infections, the ears look great. The same goes for the lips and nose. She weighs 4,5 kilos, which is too heavy for her size. I don’t really care about this: should she have a lapse or contract some kind of virus, she’ll have enough reserves to take care of that herself. Agreed with the new owners, that they will put have Ezra on a diet by the time she’s 6 months in case she hasn’t become slimmer naturally (at that time the Prednisolon has lost its effect). At the time Ezra turned one year old, the new owners had X-rays taken to check whether the Prednisolon has not harmed the bones (especially the joints). Happily, everything looks fine and she may start doing doggy-agility exercises J

On the picture you see Ezra on the left together with her half-sister Jacky. Didn’t she become a beautiful lady?

Almost no damage is visible, except for a number of tiny scars where she had open abscesses. Only someone who knows where to look will notice a couple of small scars on the eyelids. For the rest she became a great, beautiful lady. Also her seasons started normal and at this moment (May 2000) she started agility. Hopefully she will become as successful as her half-sister.

What is PS?

This is not easily explained, but in the course of things, I have learned the essentials. Simply stated, the immune system attacks the body. The Antirobe I wanted is a special antibiotic against specific bacteria that cause the infections during PS. With the benefit of perfect hindsight, I should have started with the Prednisolon. This medicine sees to it that the body’s immune system is suspended, which is of utter importance if this system goes out of control.

How do you recognize if a puppy has PS?

The first signs can vary. During Ezra’s illness, I have talked to a large number of breeders, who had encountered PS as well (a number of puppies have been put to sleep because the vet didn’t know what it was!), but in most cases it starts in the mucous membranes of ears, eyes, nose and lips. This is not surprising, as these are visible.
Swollen lymph glands (in the neck, groin and around the anus) could also be an indication of PS. I have learned from another patient that it started with a persistent infection of the spinal colon. In general, one can say that “mysterious” infections, which do not seem to go away, can be an indication of PS.

How does the disease develop?

All kinds of infections appear throughout the body. The puppy gets swellings like Ezra had in her neck. These are swollen lymph glands. Swellings under the skin will often burst open, causes a lot of pus to flow out. Some puppies had 24 abscesses, which were interconnected by corridors under the skin. Looking at it in this way, Ezra was lucky!! Genitalia tend to swell and the noted infections to eyes, ears, nose and lips are visible.

What can you do?

Well…, as you can conclude from my story: find a good vet! Once you have him/her, you can get to work. If you start by suspending the immune system quickly, the illness will be milder. So start directly with a heavy dose of Prednisolon. Apart from this an Antirobe treatment, as this has proven to be the most effective antibiotic. Apart from this, you need good medication for the eyes and ears etc., paraffin to keep the bowel movement going. You may decide to use camphor balm to rub on abscesses under the skin to make them mature quicker. Wound spray may help to treat the open abscesses with. This does not clean or disinfect, but does stimulate the healing process and prevents large scars.

Myths about PS

PS is absolutely not contagious for other dogs. The illness is caused by the body’s own immune system and not by bacteria or viruses. The puppy is naturally more sensitive to these intruders, but that’s why he takes Antirobe. It’s also important to protect the puppy against secondary infections like worms. PS is not caused by a lack of hygiene on the part of the breeder. PS is not lethal, but it can take a lot of time and money to cure the puppy. If you would leave a PS-infected puppy to his own devices, it could at long last be overcome by exhaustion and secondary infections, like worms.

Is PS hereditary?

Good question! In principle, the answer is no. There are however known cases where an ex-PS patient had a litter where regretfully a PS patient was present. Personally, I would not breed from an ex-PS patient …

Is PS widely known?

Regretfully no! There are breeders, who’ve been in the business for 30-40 years and have never heard of it. The same goes for vets. When Ezra’s owners took her to their own vet and wanted to let him read my “diary”, this was dismissed with statements like “doesn’t exist” and “the breeder probably did not adhere to hygienic standards”.
Sad, but true! Ezra’s owners immediately went to another vet, who showed more interest and offered more help. He also X-rayed Ezra to establish normal development.

If you ever encounter a puppy with PS I hope you will find a good vet in time to help you and this puppy.

Because really, puppies with PS are really worth helping!!!

Debbie Brussaard

March 2003:

Translated from Dutch by Richard Wulff (Munich Germany) after the 10 week old Labrador puppy “Bibi” contracted the same disease. Also this vet had not heard of PS, but had a healthy distrust in the diagnosed symptoms and sufficient personal courage to do literature research and consult a colleague. The vet diagnosed the illness within 24 hours of first contact and had her on correct medication immediately after. THANKS, Dr. Hübner!!