Jasper’s Story of Pythium, A Disease of Wasting Away
Filed Under: Dogs
The technician motioned me over to room two telling me that Jasper was back to see me yet again. We had already run every test I could think of but had come up empty on anything being abnormal. I was convinced that Jasper was suffering from one of possibly two conditions, with the first option being quite a bit more favorable to the dog.
Jasper, you see, was suffering from chronic weight loss and vomiting. The poor Labrador retriever had lost about 15 pounds from his prime weight. The once perfect doggy athlete was beginning to resemble a bag of bones with some skin stretched over them. According to his owner the once avid eater was now turning up his nose to his regular science diet, and sometimes even those coveted table scraps were slow to be consumed.
Alternative diagnosis one was a possible food allergy and would be the easier diagnosis for Jasper to live with. Allergies are common and with Jasper being only 6 years of age I hoped, at least, that a food allergy would be the actual diagnosis. Diagnosis two held a much less favorable prognosis: a possible infiltrative tumor of the gastrointestinal tract such as a lymphoma or a lymphosarcoma. We had already taken radiographs or X-rays of the abdomen and had not detected any visible abnormalities. To confirm or diagnose a tumor, surgical exploration and biopsy of the abdomen would be necessary.
The owner opted to try a hypoallergenic diet to rule out food allergies first. If Jasper did not respond to the new diet, and especially if the vomiting didn’t decrease, we would have to go to surgery for our diagnostic answers.
We tried Jasper on a diet of rabbit and potato. A hypoallergenic diet is one an individual has never been exposed to previously. The theory behind such a diet is that you have to have been exposed to a protein before you can become allergic to it. The incidence of vomiting appeared to have stopped but his appetite was still surprisingly poor. At first Jasper took an interest in the new canned diet but was less enthusiastic about eating any dry food, even if it was rabbit and potato. Eating a can or two of food per day was not going to replace any of the weight Jasper had lost and we were beginning to lose additional ground.
Suddenly Jasper’s owner noticed that although the vomiting had almost stopped it was now replaced by diarrhea. Even worse, the diarrhea had become bloody.
We had already run blood chemistries but had not tested for pancreatic function. In light of the new symptoms we checked his pancreatic enzymes as well as his blood ions. All additional lab work turned out to be normal. Usually I really appreciate seeing normal chemistry values but Jasper was going down and we still had no answer as to why the chronic diarrhea was occurring. I would have appreciated any abnormal finding that would have put me closer to making a diagnosis.
We ran parasite tests on his diarrhea daily with nothing ever turning up. Not only was the diarrhea out of control, but the vomiting had returned.
Jasper had had all of his vaccinations. The condition was chronic. Blood chemistries, hematology results, radiographs, and samples for parasites were all normal. What else could we do to diagnose the problem? Intestines do not show up well on radiolographs so the only other alternative was to try a dye study of the GI tract before taking Jasper to surgery. Trying to leave surgery as a last resort, we opted for the barium series. Picture after picture of the abdomen showed an irritated bowel along the entire GI tract from the stomach to the colon. Now what? We were back to surgery. It was time to operate before he went down any further.
Could we find an answer to Jasper’s problems? I sure hoped we could! Jasper was a much-loved Labrador retriever and a good hunting dog. His owner would be hard pressed to replace him. We all hoped surgery was the answer.
Just before surgery Jasper’s owner informed us that he had a four-acre pond within spitting distance of his home. Could his pond be part of Jasper’s problem? It is impossible to separate a lab from water. Blue-green algae came to mind. Toxins produced by blue-green algae are toxic to the liver and yet Jasper’s liver enzyme levels were normal. Another dead-end, as there was no need to add blue-green algae to our differential list when his liver was operating perfectly.
The pond possibility was discussed among the veterinarians prior to surgery. The same owner had lost a previous dog to an infiltrative lung aliment. Could there be any relation? We were essentially dealing with two different body areas and yet we couldn’t help but wonder. Almost never would a primary lung problem end up in the abdomen.
I was beginning to feel like we were in a TV episode of House. Four veterinarians had reviewed Jasper’s case and yet we were still not able to help him. Finally Dr. Anderson suggested a fungal infection called Pythium. I had heard of the skin lesions Pythium produced in horses but never of an infection in the dog. When I was a veterinary student, years ago, the word was that the only place we would ever see or hear anything concerning the fungus Pythium would be in the form of a question while taking the Texas State Boards. That rumor was true by the way. I did take the Texas State Veterinary Boards in 1983 and that question was on the slide portion of the state test that year - and yes I did pass the Texas State Boards!
According to Dr. Anderson there have been rare cases of Pythium fungal GI infections in the dog. We now had 3 to 4 differentials to consider and hoped we would have all the answers soon.
The following morning Jasper was taken to surgery with three veterinarians in attendance. Placed on an IV catheter Jasper, as always, was in a great mood but perhaps not quite as active as normal. In fact, his usually bright eyes had become somewhat sunken as his muscle mass was deteriorating ever further with his continued weight loss. Jasper's once glossy coat now resembled a yellow tarp stretched across his increasingly bony frame.
Jasper was sedated and prepped for surgery, and fifteen minutes later we had our answer. In the middle of the jejunum, or central portion of the small intestinal tract, was a growth and/or hardening of the intestines approximately 11⁄2 feet long. The lumen of the intestines themselves was not obstructed, although there was what appeared to be a growth completely engulfing the intestinal wall. In some areas there were actually hard nodules protruding from the serosal surface of the intestines. Suddenly Jasper had a poor prognosis as three of the veterinarians concluded from its appearance that a tumor was engulfing the central portions of his abdomen. With heavy hearts we took samples for pathology and culture. The abdomen was closed with the tumor intact. If we were dealing with a lymphoid tumor, as we suspected, removal of that section of intestines would benefit Jasper very little. A tumor would have caused infiltration elsewhere along the digestive tract and lymphoid tissues of the body.
Pathology results would take several days to return. Fresh biopsy samples had also been taken for bacterial and fungal cultures. One of the fresh samples was used to take impression smears in the hopes of determining the diagnosis. The culture samples were sent to one lab with the pathology and impression smears going to the state lab.
Now the anxious owner and veterinarians were put on hold to wait for a diagnosis. Bacterial culture results were delivered first. Jasper had E.coli, an infamous yet often normal inhabitant of the intestinal tract. Since we were not confronted with the 0157:H7, or pathological variety, we deemed the bacteria normal but placed Jasper on Baytril just to make sure. The bacterial culture showed that the organism was sensitive to Baytril therefore we hedged our bet and gave the antibiotic that would eliminate the E coli, just in case it was adding to Jasper’s complications. Days went by yet their was no growth on the fungal culture. Pathology was still not back and Jasper was continuing to go down hill.
We had two days before the Thanksgiving Holidays and I knew if we did not get results in soon we would not receive them before the holiday was over. It was time to contact the pathologist. Going through the receptionist I was able to find the pathologist in charge of the case. After going through the mandatory round of telephone tag, we were finally able to connect.
“My patient Jasper is continuing to go downhill and I am afraid we will have to euthanize soon if we can’t get him some relief, I stated. “We feel that he has quite a mass in the abdomen and are not sure what if anything we can do for him. If you have any information or suggestions that could save him, I would appreciate your help. In fact, if you could give us some insight as to the cause of Jasper’s suffering, at least we will be able to make the difficult decision as to whether or not euthanasia is in order.”
Dr. Young explained that she had reviewed our impression slides and what we thought were large lymphocytes, a type of white blood cell that is paramount in the development of lymphoma, was actually activated inflamed, or activated white blood cells, or inflammatory cells. “Really?” “Thank goodness!” “What would cause an inflammation so severe that it resembled a tumor?” I inquired. “Have you run a fungal culture?” answered Dr. Young. “Yes, but we to date haven’t had any growth on it.” I answered. “Why do you ask?” “Have you heard about an organism called Pythium?” Dr. Young replied.
“Funny you should ask, Dr. Anderson and I had already discussed that possibility. You see, just before surgery Jasper's owner had mentioned some information about the pond that is just several feet from his house.” Dr. Anderson had mentioned Pythium before surgery and I had found some information concerning Pythium in Labrador retrievers.” I concluded. Dr. Young went on to add that the once obscure tropical disease was becoming more common in the warmer portions of the United States and they were actually seeing two to three cases of Pythium per year at the veterinary school. Although she did not detect the fungal organism itself, Dr. Young felt that the severe inflammatory reaction she had detected on the microscope slides was due to the fungus. She felt sure that therein would lie our obscure diagnosis. I needed to contact the clinical pathology lab at the veterinary school to have a titer run on Jasper for Pythium.
Thank goodness for smart pathologists! Jasper may just have a future after all. Immediately I dialed the veterinary school and received information on where to send a serum sample for a pythium titer.
Jasper didn’t mind donating a few mls of blood and our sample was off in the mail. Hopefully we would have our answer in two to three days.
I was not expecting to hear back from the lab until Thursday at the earliest, yet the Dr. Nelson who was in charge of the lab called me on Wednesday. “Thanks for getting back with me so fast, Dr. Nelson. What does my dog have?” I asked. “Jasper’s pythium titer is off our scale,” he answered. “No doubt you are dealing with the pythium organism.” “Now what do I do for Jasper to help with his condition.” I inquired. “As you are probably well aware by now Pythium, although classified as a fungus, responds very poorly, if at all, to anti-fungal drugs. The best chance for Jasper is to go back in surgically, remove the infected area of intestine, and begin him on a special protein extract, a vaccine of sorts, in order to prime his immune system against the fungus.” I’ll get you the microbiologists who manufactures the vaccine and an expert on Pythium to contact for additional information,” relayed Dr. Nelson.
We finally had our elusive diagnosis, and now had a plan of attack. After conferring with all three experts in the Pythium field as well as our original pathologist, Jasper still had a rough road ahead and and not too favorable a prognosis, even with our treatment plan. I had no doubt that Jasper’s owner wanted to give him the best chance possible but felt I owed him an explaination as to what exactly his chances were. Although the experts deemed our realistic chances for long term survival with Jasper to be around 50%, our owner was great and just couldn’t wait for us to get started!
The following day we had Jasper back in surgery. An incision was made through his previous surgical scar which had not yet had a chance to fully heal. He was relieved of exactly 1 foot 4 inches of intestinal tract. Dr. Vaught sliced through the diseased portion of intestines bringing the two healthy ends together and securing a leak-proof seal.
Day one following surgery Jasper appeared livelier and was drinking, although we did not let him test out the new intestinal tract with food. Water was allowed in small amounts and we still had him on an IV drip.
Day two he was famished. We would allow him only small amounts of canned food at frequent intervals and he was hungry. It was nice to see him with such a great appetite. I had almost considered a diagnosis of anorexia previously, but had not entertained it seriously since dogs do not have the mental body image problems people do. Jasper finally had an appetite and he was ravenous.
A few days later Jasper was reunited with his family with strict orders to stay out of the pond. Telling a Labrador retriever to stay out of water is more easily said than done. I wondered if it wouldn't be easier for his owner to fill in the pond.
Jasper has had two vaccinations from his series of three for Pythium without complication. Thankfully he has put on 12 pounds so far and hopefully more will come. He still has bouts of diarrhea which are hopefully due to the shorter intestinal tract and not to our helpful fungus.
Through Jasper's long ordeal many of our staff members became very close with this seemingly ever-optimistic dog. Sometimes seeing the perseverance of an innocent animal can inspire hope to all those who witness the event. Bonds are made and broken, but the bonds made between Jasper and our staff will be eternal. We all meet and greet him at the door every time he comes to visit and he continually puts smiles on all of our faces.
We plan on taking additional fungal titers at 3 month intervals following the conclusion of our vaccination program. If all goes well we may later be able to extend those intervals to 6 months. Our diagnostic dilemma has now become case intensive monitoring. Additional Pythium injections may be required should Jasper's blood titers rise or if we see additional complications. Jasper is returning to his own physical self and may just make the opening day of duck season!