Please note: I am not a ferret expert, and I did not write, nor did I independently verify, all the information in this file. I have done my best to include only accurate and useful information, but I cannot guarantee that what is contained in this file, whether written by me or by one of the contributors, is correct, or even that following the advice herein won't be harmful to you or your ferret in some way. For advice from an expert, you may wish to consult one of several books available, or, especially in the case of a suspected medical problem, a veterinarian who is familiar with the treatment of ferrets. FERRET MEDICAL FAQ -- EPIZOOTIC CATARRHAL ENTERITIS (GREEN MYSTERY VIRUS) Last modified: 3 May 96 Version: 1.6 ------------------------------ Subject: CONTENTS *** Epizootic Catarrhal Enteritis (Green Mystery Virus) *** (1) What is ECE? (2) Comment on ECE (Dr. Brown, Aug 95) (3) More on Epizootic Catarrhal Enteritis (Dr. Williams, May 95) (4) Green Diarrhea Research Update (Dr. Williams, Feb 95) (5) The Latest on the Green Diarrhea Virus (Dr. Williams, Oct 94) (6) Treatment and precautions (7) Ferret Medical FAQ copyright and redistribution information ------------------------------ Subject: (1) What is ECE? In early 1994 or so, a mysterious disease cropped up among ferrets and spread quickly, particularly in the show circuit. It was originally called "the greenies," but its official name is "epizootic catarrhal enteritis (of ferrets)". ("Epizootic" refers to a disease which is epidemic in animals, "catarrhal" means it's an inflammation of a mucous membrane, and "enteritis" means it affects the intestine.) It is characterized by the sudden onset of bright green or yellowish diarrhea. (Note, however, that the green color just means that the food spent a very short time in the ferret's digestive tract. Ferrets do get diarrhea for other reasons, and a single day of soft greenish stool is not something to panic about.) No specific cause has been positively identified; it might not even be a virus. Ferrets who have had the disease remain carriers for some time afterward -- nobody's quite sure how long, but the best estimate is now six months, maybe longer. See the following sections for more information. ------------------------------ Subject: (2) Comment on ECE (Dr. Brown) Excerpted from Dr. Susan Brown's "Ask the Doctor" column in "Off the Paw," the newsletter of the Greater Chicago Ferret Association, August 1995: I spoke to Dr. Williams at great length about our experience and my thoughts on the disease and here is what I can tell you: The disease in question is an enteritis, or inflammation/infection of the intestine. It damages the mucosa (the delicate intestinal lining which is instrumental in absorbing nutrients and water into the body) resulting in diarrhea and excess mucous production. In severe cases there may be deep ulcerations and bleeding into the intestinal lumen. Stools can range from bright green, loose and slimy to dark red, black and tarry. Dr. Williams has seen the lining of the intestine remain abnormal for up to one year after the ferret initially showed signs of the disease. The cause is as yet unknown, but Dr. Williams, who has a great deal of experience looking microscopically at tissues affected by this problem, feels strongly that it may be a corona or rota virus. The virus can be transmitted by infected fluids from the body. It can be spread through the air on tiny fluid particles or by direct contact with an infected ferret. The incubation period, according to Dr. Williams, is about 2 days and he feels there can be carrier animals for at least 4 months after the initial onset of disease. Carriers are those ferrets that have survived the disease and appear healthy but are shedding the virus in their stools and are therefore still infective to other ferrets. The disease has a very high morbidity (number of animals affected by it) but a very low mortality (those that die as a result of infection). Ferrets do not die from the disease directly, but from a combination of factors that may have been exacerbated by the infection. In a multi-ferret household, once it enters it will affect nearly 100% of the population regardless of how sanitary the conditions are. With careful monitoring of sick animals an appropriate treatment, the mortality may be 0 to 2%. In ferrets under three years of age, that have no other major health problems, the disease is fairly swift, causing only a few days of slimy green stool and then it is gone. Most of the youngsters do not need any medications, but one should watch closely to see that they are eating, drinking and urinating. If a ferret stops eating, becomes lethargic or dehydrated, then it may be necessary to give fluids either by mouth or underthe skin by injection. Some ferrets benefit from a more bland diet until the stools form again, such as meat type baby food, or Science Diet AD. We sometimes give antibiotics to prevent secondary bacterial infections. It may also be helpful to use an intestinal coating agent such as Pepto Bismol or Kaopectate (1-2cc two to three times daily) to coat the intestinal tract and soothe potentially ulcerated areas. There are a variety of other herbal and homeopathic remedies that have been tried. None have had consistent reproducible success, but if you would like to try any remedies, please consult your veterinarian first. Some products, such as vitamin C may actually make the problem worse because it is very irritating to the intestinal lining in the presence of inflammation. The older ferrets, that likely have concurrent health problems such as lymphoma, insulinoma, adrenal disease, heart or kidney disease, may be more seriously affected. Although the percentage of animals that actually die even in this age group is very small, the disease can take a much longer time to resolve. Older ferrets are more likely to become dehydrated and develop bleeding intestinal ulcers. We treated one ferret successfully with multiple blood transfusions because her red blood cell count dropped dangerously low from intestinal bleeding. These patients need more intensive nursing care and have to be watched very carefully. Of course one will need to stay on top of all the other diseases that may be present and potentially weakening the pets immune system. There is another part to this disease that we have observed over the last few months and it has only been in the older ferret. We have seen a number of ferrets over three years of age, usually with other serious health problems, who successfully survive the diarrhea, only to lose significant amounts of weight up to three weeks later. In my discussion with Dr. Williams, he concurred that this was a problem of absorption of nutrients from the intestinal lining. As mentioned, the intestinal mucosa may continue to be abnormal for up to a year after the initial infection. These animals have good appetites and normal stools, but can't seem to keep the weight on. Each pet has to be evaluated individually, but one may be able to keep the weight from dropping by adding more fat to the diet, such as whipping cream or eggyolk along with supplemental feedings of ferret or high quality cat food. (Do NOT use dairy products when the ferret is experiencing diarrhea, as it may make the problem worse.) Using high carbohydrate foods doesn't seem to work. Ferrets use fat more efficiently for energy than carbohydrates, so in a wasting situation, it is likely more effective to increase the fat content ofthe diet. Be careful about increasing the protein content (overuse of eggs) because some of these older ferrets have underlying kidney disease which will worsen in the presence of excess protein. Dr. Williams suggested that in some cases, the use of corticosteroids may aid in keeping the weight on because it may suppress the ongoing intestinal inflammation. Please use such drugs only under the supervision of your veterinarian. ------------------------------ Subject: (3) More on Epizootic Catarrhal Enteritis (Dr. Williams) Dr. Bruce Williams, DVM, writes: More on Epizootic Catarrhal Enteritis (May 95) We know that asymptomatic ferrets can harbor this virus for four months, perhaps even longer [updated to 6 months in Jan 1996], and shed it in small amounts in the feces. When you use the term "fully recovered" I assume you mean that the ferret no longer shows symptoms. That does not mean that the virus is totally gone from the body. Just because your ferret meets a ferret with the virus does not mean that your ferret will get it -- as it is probably spread via contact with the feces, there must be oral-fecal contact to spread this disease (ferrets using the same litter, etc.) [But it is -very- contagious -- see below [3]]. The virus is most likely carried in the body for prolonged periods of time and animals may show disease over a period of time, especially under times of stress. It doesn't go dormant and hide in nervous tissue (as far as we know) like herpes viruses do, but probably maintains a low level by infecting low numbers of intestinal cells at any one given time. Latest news on the ECE research - still haven't been able to propagate this virus in the lab. It appears to be extremely finicky in its requirements for continued growth, and until we can maintain cultures of the virus, any further developments, including vaccines, diagnostic tests, etc. must wait - as all require a stock of virus to develop. Remember, research is a slow, painstaking process,and we appear to be the only facility in the country doing any work on this virus. (Remember it took YEARS to identify the HIV virus, and many many facilities all over the world were working on that one....) ------------------------------ Subject: (4) Green Diarrhea Research Update (Dr. Williams) Dr. Bruce Williams, DVM, writes: Green Diarrhea Research Update (Feb 95) There is a movie promo, I can't remember which one, which goes "Be afraid. Be very afraid." I am now into the third week of clinical research on the Green Diarrhea and am seeing first hand what this agent can do. Everything is in very preliminary stages, but I have been collecting fresh samples for a week now. Some of the information that I have put out before this is being revised based on what I am seeing in my ferrets now. Two things of special note that I want to mention tonight. 1) This agent (the microbiolgists will start trying to isolate it on Monday) is far more contagious than we had previously thought. We are using material from an outbreak in Michigan. It does NOT require direct contact. THIS AGENT CAN BE EASILY TRANSMITTED ON CLOTHING FROM A PERSON TO ANOTHER FERRET. I now take two showers between the time I leave the facility and when I get home. 2) Vomiting is an early sign of disease, where previously we thought it not. was 80% of the infected ferrets vomit as the first sign of the disease. I think the information we got from people undergoing outbreaks was in error, but then again, I am especially looking for it and the cages that we are using - smooth white plastic cages catch everything. My best characterization of the early signs of the disease are vomiting, followed by lethargy, diminished food intake, and a "drowsy" appearance. We have seen no changes in blood values in acute cases. Realize that all of this is very preliminary data and we need much more time to analyze what we are seeing. I am trying to keep everyone apprised however, of pertinent new information as we see it. I am currently receiving a lot of phone calls from other veterinarians and several government agencies, including those working with the black-footed ferrets to share their experiences, get more information, and in some cases, offer assistance. There have even been calls from companies who would like to develop a vaccine once we isolate the agent. Now that we have fresh material to work with, I am confident that we will isolate this agent, Until then, I will continue to keep everyone apprised of what is going on. Finally, although I am putting out some very disturbing news here, I don 't want everyone to panic just yet. Remember, that in most cases, this is a non-life-threatening disease, and that it is treatable. The best way to prevent your ferrets from contracting this disease is not to allow them contact with other ferrets. I am being extremely careful with my own ferrets. Please be as careful with yours. Bruce Williams (202) 782-2600 williamb@vetpath.afip.mil williamb@email.afip.osd.mil ------------------------------ Subject: (5) The Latest on the Green Diarrhea Virus (Dr. Williams) Dr. Bruce Williams, DVM, writes: THE LATEST ON THE GREEN DIARRHEA VIRUS (24 Oct 94) This item is for widest dissemination, including all newsletters. No copyright required or permitted. As the Green Diarrhea appears to be once again spreading into several new states, and concerns have been voiced on the FML, I have decided to publish this information and hope for widest dissemination to veterinarians, breeders, and rescue operators. Article by Dr. Bruce H. Williams, Department of Veterinary Pathology, Armed Forces Institute of Pathology, Washington, D.C. 20306-6000 In several states along the East Coast, including Maryland, Virginia, Pennsylvania, and New York, and more recently the Southwestern and Western U.S. (Texas, Arizona, and California), a new, highly contagious diarrheal disease has appeared in several ferret rescue/breeder operations. In outbreaks, infection rates approach 100%; however, mortality in treated animals averages less than 5%. The disease appears to strike all age groups, but is rarely reported in kits. Clinical signs include a profuse green, watery diarrhea which is rapidly dehydrating. Occasionally, affected animals may progress to coma and death within 48 hours. Death most commonly occurs in older animals with concurrent health problems, such as insulinoma or adrenal disease. Vomiting does not appear to be an associated sign; several ferrets have shown icterus in terminal stages. Complete blood counts are within or close to normal ranges. Azotemia, hyperglycemia, and elevated alanine aminotransferase and alkaline phosphatase have been seen in affected animals. Microscopic examination of tissues from deceased animals are consistent with, although not diagnostic of, a viral enteritis. Microscopic examination of intestines from affected animals have shown changes that are consistent with a viral disease which causes the cells lining the intestine to die and impairs the animal's ability to reabsorb water and nutrients. Specifically, there is necrosis of enterocytes at villar tips; crypts are moderately to markedly hyperplastic. A moderate lymphoplasmacytic infiltrate and variable degrees of villar atrophy, blunting, fusion, and loss are seen in the intestine in more long-standing cases. Intestinal changes are seen up to eight months after infection. Treatment of affected animals should include subcutaneous or intravenous fluids (affected animals may require up to 90 ml/lb/day), and systemic antibiotics Amoxicillin 10-20 mg/lb twice daily) to prevent secondary bacterial infections. Antispasmodics (Centrine, Lomotil) or gastrointestinal protectants (PeptoBismol, Kaopectate) have been used at normal cat dosages with some success in isolated cases. Recovered animals may show low body weights, poorly-formed stools, and weakness in the hind legs, which may persist for months following recovery from the acute disease. In our experience, this disease may be spread by apparently healthy carriers as long as four months after infection, and most likely longer. Naive animals being brought into close proximity with recovered animals should be expected to break with diarrhea. Care in handling of affected ferrets is paramount. This disease is most likely spread by direct and/or fecal-oral contact. Affected animals should be isolated, preferably in separate rooms. Food bowls, toys, litter boxes should be considered capable or spreading this infection and not transferred between affected and unaffected areas. Litter boxes should be kept cleaned on at least a daily basis. Cleaning of these items may be accomplished with a 1% bleach solution and thoroughly rinsed. Individuals who handle infected ferrets or new arrivals should shower and change clothes before handling uninfected animals. The best way to avoid infection is to prevent exposure to ferrets from other homes, colonies, etc. New additions to households, breeding operations, or rescue facilities should be isolated and examined for signs of diarrhea for a minimum of one week, as healthy-appearing animals may transmit this disease. Events at which large numbers of ferrets are congregated, such as ferret shows, are most likely an excellent venue for dissemination of this disease. Remember, however, that the signs of greenish diarrhea are not restricted to this disease. Other diseases that may cause profuse watery green diarrhea in ferrets include intestinal lymphosarcoma, coccidiosis, and eosinophilic gastroenteritis. Your veterinarian should evaluate all ferrets with diarrhea for these diseases also. The Department of Veterinary Pathology, Armed Forces Institute of Pathology is currently investigating this disease outbreak. As of yet, an etiologic agent has not been identified; more material is needed. If you suspect this disease in one or more of your ferrets or ferret patients, histopathology will be done at no cost to you. Additionally, we are looking for feces and/or serum from acutely ill and recovered animals in hopes of isolating the agent. [Feces should be sealed in a pill bottle or film container, frozen, and shipped to the address below by overnight or two-day mail. No weekend deliveries, please.] Full necropsies, preferably on moribund animals, are preferred. [Animals should be autopsied AS SOON AS POSSIBLE following death, as the agent appears to be very transient, and the lesions in the intestine are only visible within 12 hours after death.] Tissues from animals dead longer than 24 hours yield questionable results due to post-mortem autolysis of the intestinal mucosa. In addition to a wide range of tissues, several 2-inch loops of jejunum should be ligated and frozen, in addition to several sections of liver and 1 cc of serum. If histopathology shows lesions compatible with this entity, then we will contact you for these frozen sections at that time, in order to perform virus isolation and serology on these samples. The Department of Veterinary Pathology, Armed Forces Institute of Pathology is currently investigating this disease in hopes of finding its cause. We currently are requesting feces and/or serum from acutely ill animals, and tissues from animals that succumb to this disease. For more information on how to send specimens, please call Dr. Bruce Williams at 202 782-2600/2602. Bruce Williams, DVM williamb@email.afip.osd.mil (202) 782-2600/2602 Armed Forces Institute of Pathology Department of Veterinary Pathology Washington, D.C. 20306-6000 ------------------------------ Subject: (6) Treatment and precautions This comes from Ann Davis, August 1993, and has been slightly edited as more information has become available. Mystery Virus: Recommended Treatment and Precautions The green mystery virus that has swept across the eastern seaboard is breaking out again. While it has never completely left the New England / Pennsylvania / Maryland areas, it had died down for a while, at least in Virginia. Many new cases have been reported in the past month in places as far away as New York and Wisconsin. The symptoms are, dark to bright green stools, well formed in the mildest cases and liquid in the worst. Ferrets get lethargic and refuse to eat or drink. The older ones frequently die of dehydration. This virus attacks the lining of the intestine and destroys the mucus membranes preventing the absorption of nutrients. The only way to combat the disease is to help the ferrets live through it. They need to be hydrated constantly. They need to be given nutritional supplements - Stat, Nutrical, and Sustacal have all been used successfully. [Sustacal is meant for humans; look for it near baby formulas in your local grocery.] They need to see the vet immediately and be put on an antibiotic - the secondary infections are quite often the killers in the older ferrets. While the antibiotic does not kill the virus, it does prevent secondary infections. They need to be kept warm and dry -- one of the first things to go in an older sick ferret is its thermal system. Never leave a sick animal unattended on a heating pad! Check with your vet or local club on a safe procedure. If your ferret survives a moderate to severe form of the virus it is extremely important for them to have follow up blood work done by your vet including CBC, Hepatic function (liver) and for protein absorption. The secondary complications seen in this disease are as lethal as seen in the primary virus. The course of the disease may run from one to three weeks. There are some precautionary measures that you can take to prevent the further spread of the disease. If you are infected and are going where there will be ferrets, shower -- put on clean clothes straight from the dryer, and spray your hands and shoes with Nolvasan after you leave the house. If you are coming home from a possibly infected area, take your clothes off in the garage and spray your hands and shoes thoroughly before entering your house. Put the clothes in a plastic bag for the wash. Shower! I have used this method suggested by Susan Erdman successfully throughout the whole epidemic with 100% success. Remember, you can carry it on you! There is no way to avoid possible exposure to this disease in a crowd of ferrets, or ferret people. Until there is a cure, or at least a culture of this, people should be advised that when they go to ferret related events, it is at their own risk. Older ferrets should not be brought on outings at this time. There is no blame on any person or organization for this disease, or the spread of it. No one, no matter what club or affiliation they have, would choose to lose a beloved ferret or would wish that fate on anyone else. This "stuff" is defying the best minds in veterinary medicine. All of the information here is strictly the accumulated knowledge from breeders and shelters all over, plus bits and pieces gathered from vets who have seen it. If you think your ferret has it, please, please, take him to the vet immediately -- one day (even a few hours in worst case scenarios) delay could make the difference. Sincerely for The Love of Ferrets, The League of Independent Ferret Enthusiasts ------------------------------ Subject: Ferret Medical FAQ copyright and redistribution information This compilation is copyright 1994-1996 by Pamela L. Greene. It may be freely distributed by electronic, paper, or other means, provided that it is distributed in its entirety, including this notice, and that no fee is charged apart from the actual costs of distribution. It may not be used or included in any commercial or for-profit work without prior written permission. (For-profit service providers such as Compuserve and America Online are granted permission to distribute the file provided that no additional fee beyond standard connection-time charges is levied.) Anyone who wishes to is encouraged to include a World Wide Web hypertext link to the main Index page of this document set at wherever it might be appropriate.