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Since this is a fairly new disease, information about it is still being collected. Please keep the dates of the articles in mind as you read them; where the suggestions or theories in two articles conflict, the newer article is likely to be more accurate.
[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 and 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 under the 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 (1-2 cc two to three times daily) to coat the intestinal tract and soothe potentially ulcerated areas. [Carafate and Cytotec may also help; ask your vet.] 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 egg yolk 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 of the 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.
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].
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....)
This article is by L. Vanessa Gruden, from a late-1996 issue of Paw Printz, the newsletter of the Ferret Association of Connecticut, Inc. (FACT). It has been edited slightly.
This article is not intended to replace the advice of a good veterinarian.
We first saw this illness in our shelter in the last week of June, 1993. It was well over a month since we had attended any show, fun fest, or visited anywhere with our animals. Dr. Williams', other vets', and our own experience all indicate the virus, after exposure, manifests itself in 3 to 5 days. Also, it first hit three older ferrets who lived exclusively in our "rescue room." We have seen ourselves, and other owners have remarked upon, how any illness will travel from room to room or cage to cage when your animals are kept separate. This certainly happened here. First the rescue was hit, then our own animals.
The first few months were very hard. No one understood how the illness operated; what symptoms to watch for, or how to treat it. Two of our own animals were also hospitalized, and both lost over half their body weight. In those first six months, we lost two ferrets. One animal had insulinoma, which was the real culprit; another animal suffered severe intestinal collapse. Again, while the ECE triggered the problem, it was not the only cause. Through trial and error, we gradually learned more and more. Since that time, we have lost no further ferrets to this disease. We've had to fight to keep some going, but all the rest have struggled through.
Now we simply live with it on a daily basis, as a fact of our lives. I'm sure many of the people who were hit with it initially are doing the same thing. But now it seems to be spreading further west. Many people who only heard of it before are now being faced head-on with the problem and are understandably nervous. This article is meant to dispel some of the myths and misconceptions as well as offer care suggestions should your ferret be diagnosed with this illness. Please consult with your vet for specific treatments and medicines.
The disease was first publicly identified in the mid-Atlantic states (Virginia, Maryland) in the spring of 1993. At the time, the area was just recovering from a distemper outbreak that frightened many people and forced shows to become very strict with vaccine proof and disinfecting show tables. These were precautions that should have been enforced all along, but had become lax. In retrospect, stiffer rules probably helped prevent the spread of this virus via the East Coast show circuit. However, as people were unaware of its "contagiousness," local breeders and friends who swapped animals for stud service or visited may have unwittingly passed it on.
The primary mode of transmission seems to be ferret-to-ferret, but no method has yet to be formally documented. Direct contact with an infected animal is not the only means of infection. Our observations suggest the virus does not cling to fabric itself, as judges may brush or hold animals against their clothes and no illness has been reported to us from that exposure. However, we believe it may be found in fecal matter, which would explain one transmission we experienced via cage carpeting and how some people may have brought it into their homes -- on their shoes.
Cases have been documented of this illness affecting a home without any contact of the ferrets or owners with shows, infected animals or homes. Often someone in the home had recently recovered from the flu. Several people in the ferret community believe this virus may have begun as a mutated human flu virus. The initial outbreak coincided with a particularly nasty flu season. Two years ago, Mary Van Dahm of F.A.I.R. ferret shelter in Illinois related how a similar type of virus had been reported there some years ago, also coinciding with a flu outbreak. Further evidence of this conclusion is that when Dr. [James] Fox and Dr. Susan Erdman of the Massachusetts Institute of Technology first began to study the illness, we understand the only infection they were able to isolate was an influenza strain. I am quite sure this is how the FACT, Inc. shelter became exposed.
Early on, rumors abounded in the absence of any real information. There have been scattered reports of people claiming to have become infected at shows. Every event I have attended had required champion judges as well as specialty ring judges to disinfect tables and their hands between animals with Nolvasan or a similar bacterial cleanser, and I have heard of no instances of transmission from these specific events. Many shows also now standardly issue a health notice that warns attendees not to "pass around" ferrets and to wash hands thoroughly before and after handling another person's animal. I cannot speak for how some other events may operate; however, IF these procedures are faithfully followed, there should be little risk of exposure. Unconfirmed rumors currently exist that say some pet shop kits may recently have become carriers as well.
The illness strikes entirely at random. In the same home you may see one animal become very ill, one mildly so, and one never show a single symptom. We estimate about 70-80% of the animals we have taken in have become ill. Approximately 10% became seriously ill. 10-20% never have any signs. Elderly ferrets (6 years old and older) and those under one year usually have only a minor case, if it all. Kits may show minor symptoms for a day or two, but barely skip a hop. The group we've experienced as most at risk for serious complications is those between 2 and 4 years old.
No animals we have cared for, once recovered, have become ill again. However, all ferrets within an infected household, whether they become ill or not, appear to become carriers. The household also appears to remain infected. When we became aware it was in our shelter, we voluntarily quarantined ourselves for 3 months, scrubbed, and disinfected. As soon as we began taking in animals again, we had "green poop" again. As mentioned above, households with no infectious contacts have had illness enter their home. Short of you and your pet living in a plastic bubble, it is unlikely you can completely guard against this virus.
The dreaded "green diarrhea" is only the first and by far the lesser sign. Be aware that ferrets may get greenish diarrhea from any number of intestinal upsets. The specific diarrhea associated with ECE is a foul-smelling, neon green. It normally only lasts 2-4 days. Weak or older animals may become badly dehydrated. A healthy ferret is not usually seriously affected within this initial period. To check for dehydration, pinch the skin over the animal's shoulder blades between thumb and forefinger. It should quickly smooth back. If it "sticks" together, you may have a problem. Be aware that older ferrets normally have thinner, dryer skin. Do this pinch test with an oldie and with a youngster and you can easily see the difference. Learn what's normal for your ferret now and you will know when something becomes abnormal. In some cases, vomiting may be the first symptom, lasting up to 24 hours, followed by the "greenies."
The most serious symptom arrives several days after the diarrhea has passed. What is especially dangerous is a false sense of security -- since the "green poop" is gone, people assume everything is fine and stop monitoring their animal. Then they begin to notice severe weight loss. What has occurred is that the ferret has simply stopped eating. Ferrets have a very short, simple and acidic digestive system. The stomach acid attacks the digestive tract and begins to form ulcerations in the stomach, throat or mouth. These are uncomfortable and make the animal eat less, which makes the ulcers worse, which makes them eat even less... This downward spiral of symptoms happens very fast. Within days, the animal may be eating and drinking nothing at all.
For an animal with hypoglycemia or insulinoma, the anorexia can be quickly fatal. Any ferret either untreated or misdiagnosed may die within days if severe anorexia sets in. We have seen only one casualty of the diarrhea itself: The ferret hemorrhaged internally and nothing could be done to save him. Our vet likened it to a canine parvo virus, and the suspicion remains that some other illness or disease was also at work in this animal. Dr. Williams estimates, while 95% of ferrets will contract the illness, only 5% will die of it. Our experience has been that properly and carefully treated, only 1-2% will be fatally affected. The difference between Dr. Williams' 5 in 100 chance of fatality and our 1 to 2 in 100 estimate is early detection and the care and attention that the individual owner is willing to take on to pull their animals through.
As stated above, the diarrhea usually lasts for 2-4 days. There may be periodic recurrences on and off for a couple of weeks, or you may suddenly see one or two episodes of greenish diarrhea months later. Whether this is an after effect of the illness or some unrelated stomach upset is unknown. The anorexia, if it does set in, is highly individual. It can last for a week up to almost two months (a few may take longer). Animals may begin eating a little after a short period, but still require supplemental feedings for a couple of months to bolster their weight and speed recovery.
The effects depend greatly on how long the symptoms last. Prolonged dehydration can impact the function of the internal organs. And, obviously, if an animal is not eating there will be losses to body weight and muscle tone. In isolated cases, there appears to be damage to the intestinal system, requiring long-term monitoring of food intake and watching out for ulcer formation.
As stated above, these are the methods we at FACT, Inc. have utilized to fight ECE and are not meant to be either a substitute for qualified veterinary care or the only treatment methods. Please consult with your vet if your animal is seriously ill! Be aware that any virus will mutate and symptoms may change. Individual animals may also be affected differently, especially if there are underlying (medical) conditions. This information is offered as an aid in the hope it will be helpful; we cannot accept responsibility should it fail to save a particular animal.
A day or two after we move a new ferret into the shelter, we begin to watch out for neon green diarrhea. As noted above, we may see it only briefly, or not at all. If we've seen nothing after a week, we usually assume the animal will not be affected. The only exception is for unneutered animals - we have seen cases where a nursing jill did not become ill until after spaying. We suspect that stress - surgery or simply the stress of a new environment - may play a part in the development of the illness, but cannot confirm this. If the diarrhea is severe and profuse, and/or the animal is older or already thin, we monitor their hydration level. We may begin by supplementing with Pedialyte; if the skin appears particularly dry our vet may recommend a lactated ringer injection several times a day. (Note: we have found ferrets tolerate the subcutaneous fluid injection better if it is warm. If you can obtain a large syringe, remove the needle after filling from the ringer bag and warm the syringe and solution in the microwave.) The fluid is injected in the loose skin over the shoulders. [Make sure it isn't too hot!]
You may see the diarrhea change from neon to a darker green, then to a brown with what looks like small beige seeds in it. The "seeds" are undigested food which has passed through the malfunctioning intestinal system. It is a sign of improvement! You may see "seeds" on and off throughout the recovery period, but you probably won't see that nasty green stuff again.
Once we have identified an animal as having the diarrhea, they go "on watch" for eating disorders. The easiest way to monitor their food intake is to separate them into a clean carrier, cage, or small room. Put only a small amount of food in their bowl; if it appears that they are eating very little, you can count out exactly how many pieces of food you place in the bowl and check their intake that way. A ferret that does not eat 15-25 pieces of food overnight is not eating anywhere near enough! Note the level of water in their bowl or bottle, as well. Mary Van Dahm notes,"We have found that sick or weak animals usually do better with a water bowl [than a bottle]."
Keep an eye on their temperature. You vet can show you how to take it and rectal thermometers can be found in drug stores. A ferret's normal temperature should be between 100-102 degrees. Over 103 or under 98 is cause for serious alarm and may require immediate veterinary attention.
The faster you catch any budding problems, the less likely they are to snowball into serious conditions. At FACT, an animal not eating is immediately fed. You may try tempting them by dipping their dry kibbles in water to enhance the scent [but it does spoil much quicker when wet], or using Nutri-Cal or a treat, but these are only stopgap measures. (You may find a previously irresistible treat is now refused.) They must have the fiber and protein found in their regular food, and this is where the gruel formal detailed below is invaluable. While we usually add Ensure for taste, a ferret cannot eat only Ensure. It has far too much sugar (dangerous to those with insulinoma) and may increase the diarrhea. Since most ferrets love it, a little will encourage them to eat the gruel mix. You may need to use some imagination to get them to try it initially. Try feeding them off a spoon, or dip your finger in it. (It should be room temperature or warmer - if it feels too hot on your finger, it's too hot for them.) Many ferrets hate the liquid on their whiskers or chin, but once they become accustomed to the sensation and realize the gruel tastes good, they will begin to eat. The faster you catch the anorexia, the easier it will be to encourage eating. If necessary, you must force feed them .
Many people are squeamish about making their pet eat. However, the ulcerations that can rapidly form in their mouth, throat, and stomach and the resulting refusal to eat is extremely serious. You can either make them eat or watch them die of starvation. Be aware that only a very few ferrets must be force fed or any extended period. Most will begin licking within a day or two. However, we have handled animals that had to be force fed for almost two months. It's not a lot of fun. However, the good news is that in each case, one day they just decided to start eating and have since fully recovered.
Obviously, you must be careful when forcing any liquid into an animal's mouth. To carefully control the amount inserted, we use a small syringe. The gruel should be liquid enough to easily be pulled into it and pushed out a drop or two at a time. Again, most ferrets will begin licking at fluid dripped between their lips. However, those demon few may GRIT THEIR TEETH. Insert the syringe nozzle in the side of their mouth and squeeze out a couple drops. WAIT AND WATCH FOR THEM TO SWALLOW. When they have, insert a little more. You may very well have to scruff them to keep their head still. If they are really obstinate, they may dribble, shake their head, or outright spit it on you. Using an old towel as an apron is a smart move! For anyone especially nervous, you might ask your vet to show you how to feed the first time.
Initially, they should eat about 1 ounce (30 cc) of food. This is equivalent to about two tablespoons. A full meal is 1-1/2 to 2 ounces. We feed so many old-timers gruel daily that we purchase small 2 oz. Plastic sauce cups from our local "warehouse" store (i.e. Sam's or Price Club). They are the perfect size for one meal. While reusable, they're inexpensive enough to toss and it saves a lot of time washing dishes! You might beg or buy a dozen from any Chinese restaurant. [The WNYFLFA shelter mixes batches of its preferred "gruel" recipe and freezes individual servings in an ice cube tray, then defrosts them in the microwave in a small bowl.]
Remember that a ferret normally eats every few hours. If you can maintain a similar schedule for the worst part of their illness, great, but don't feel bad if you must work or sleep uninterrupted. They can go up to eight hours between feedings. You may not see them drinking much water when eating gruel - keep in mind it is made with water so a lot of their fluid intake will be coming from that. We rarely see our elderly ferrets who eat gruel drinking water. (But continue to leave their usual food and water available.) If the diarrhea continues, it would help to feed them extra water or electrolyte replacement fluid through the syringe once or twice a day.
Check their mouth for ulcerations. They will appear as a darker red spot, usually on the roof of the mouth or back in the throat. Your vet will be able to see farther back than you can. Ulcerations may occur deep in the throat or in the stomach, too. If you see ulcers or vomiting or signs of nausea lead you to suspect ulcers, further steps must be taken. (Pawing at the mouth is an indication of nausea.) A ferret REALLY DETERMINED not to eat should always be suspected of ulcers. When food passes the ulcerous sore, it actually hurts them to eat. A prescription for Carafate may be necessary. [Cytotec has also been suggested.] Extended vomiting is unusual, but can be treated with Regelan, a mucosal protectant your veterinarian can prescribe.
Some vets like to prescribe antibiotics for everything in sight. Before I ran a shelter, I seemed to never leave the vet - for any ailment - without a bottle of the "pink stuff" (Amoxicillin). Be a little cautious before accepting this as a cure-all. Many human doctors used to over-prescribe antibiotics as well; overused, they can cause problems as bacteria are survivalists and can mutate into more resistant strains. Antibiotics will not cure a virus (if they did, we'd already have a cure for the common cold!) and can suppress the appetite. We do use antibiotics, but only if the ulcerations refuse to heal. The standard 14 day treatment seems to have little effect on stubborn cases. We have, if necessary, kept them on medication for up to a month, which finally cured the ulcers. After antibiotic treatment is concluded, we normally put the animal on acidophilus (the enzyme found in yogurt culture) to restore the healthy bacteria that normally exists in the intestinal system and helps digest food. (There is no point giving animals acidophilus while they remain on antibiotics - you are killing the same bacteria you're trying to replace!)
A herbal remedy we've used with great success is slippery elm bark powder. A little mixed with hot water quickly forms a gelatinous goo which is very soothing to those painful ulcers. Slippery elm has been used in herbal medicine for humans for hundreds of years and all sources list it as safe. It does contain some nutrients and is so mild that even the most nauseous ferret can hold it down. Once they can take that simple mixture, you might ask your vet to prescribe a package of CliniCare, and mix the slippery elm with that. We have fed this for a day or two to very weak animals recovering from surgery or animals seriously ill with ECE, and it has literally been a lifesaver. Hopefully, your ferret simply will begin eating on its own within a couple of days. If he/she begins eating some of their regular food as well, celebrate! We normally continue to mix gruel for them in the morning and evening as a supplement until their body weight has been regained.
If the diarrhea continues to be a problem, you should consult with your vet on anti-diarrhea medications. A little Pepto Bismol might be the first step he/she suggests, or he may prescribe the stronger Tagamet. It's readily available in pill form, but have the vet request the liquid version from the pharmacists. It's a lot easier to administer. Flagyl (used to control severe diarrhea) is completely nasty. Any ferret given Flagyl will gag and paw at their mouth frantically. The report from someone who had to take Flagyl themselves for a bad case of "Montezuma's revenge" was that years afterwards, she still couldn't forget the horrible taste!
[A compounding pharmacist can prepare the medication in Flagyl (metronidazole) or Pepto Bismol in a different suspension to minimize or mask the taste. Call 1-800-331-2498 to locate the nearest compounding pharmacist.]
A tip passed along by Fara Shimbo of FURO (the Ferret Unity and Registration Organization) is to clip the hair between the legs and under the tail of an animal with severe diarrhea. This avoids matting, and cold, wet fur from frequent washing will encourage more diarrhea. If a rash should occur, ask your vet for a soothing cream. Mary Van Dahm of FAIR notes, "We have found Vitamin E creams, Silvadine (a burn ointment) or Neosporin are helpful. Stay away from zinc oxide creams since the ferret may lick off the cream and ingest too much zinc."
Your vet may also prescribe a steroid (Prednisone or Azlum) to increase appetite and help stabilize the blood sugar, particularly for a ferret that is hypoglycemic or has been diagnosed with insulinoma. [It also helps reduce the inflammation in the intestine.] While an in depth discussion of insulinoma is a subject for a whole other article [see the Medical FAQ on that subject], be aware that many ferrets over 4 years old show the staggering, staring into space, drooling, or "fainting fit" which are signs of hypoglycemia. The anorexia associated with ECE is especially dangerous for them. Again, we stress avoiding giving them too much sugar. While Ensure has a great deal of sugar, it also contains proteins and carbohydrates and we only use a small amount mixed into their gruel. (Note: Once a can of Ensure is opened, it should be used within 24 hours. To avoid waste, you can freeze it into an ice cube tray and defrost a cube a day.) Nutri-Cal also has a lot of sugar in the form of molasses. While a more complex sugar, it is still sugar. You may find that the weakened intestinal system which this illness can cause may make your ferret unable to tolerate high levels of fat in a food. Nutri-Cal also has a lot of fat. A good food option is 2nd stage infant chicken. It is high in protein, is easily digestible, and has no added sugar. Learn to read labels and you may find other foods that can be given to ill ferrets either as a treat, an enticement to eat, or a change from gruel. We'd love to hear your discoveries.
We'd also appreciate hearing any treatment suggestions from veterinarians who may read this. While the bulk of the work of treatment for this virus rests in the hands of the individual owner, the guidance and medication must come from a qualified veterinarian. Both parties must share the responsibility of helping the ferret become well, and work together to that end. We hope by publishing this article to encourage vets and owners to increase and share their knowledge and save ferrets' lives.
Should you have questions regarding this article, please contact us (Vanessa or Ann Gruden) at the Ferret Association of Connecticut, Inc. at 860-247-1275, preferably after 6:30 pm EST.
Veterinarians may contact Dr. Will Barriosnuevo of the East Hartford Animal Clinic regarding specific dosages and medical treatments at 860-568-2693. He maintains office hours from 8:00 am to 10 am, and 4:30 pm to 6:00 pm. Monday through Friday. His Saturday hours are 8:00 am to noon. Please be aware that Dr. Barrios cannot advise individual owners or prescribe medication or treatment for any animals which he cannot examine in person.
An appendix to the article by Vanessa Gruden, above.
Pedialyte: Electrolyte and mineral replacement fluid for infants with diarrhea. Available in drugstores. Other electrolyte formulas can also be obtained via your veterinarian or a major veterinary supply dealer. (Some drug stores have their own brand or generic brands.)
Lactated Ringers Solution: Subcutaneous injectable fluid solution with or without dextrose, for severe dehydration. Can be performed at vet or obtained there for those experienced with medical care.
Nutri-Cal or NutriStat: High calorie, malt flavored paste nutritional supplement available at vet or large pet supply store.
Ensure or Sustacal (or Deliver 2.0, which has almost twice the calories per ounce of the other two but is harder to find): High calorie, high protein liquid human nutritional supplement. Tastes great to most ferrets but contains no milk products. Available in drug or large grocery stores.
Gruel: Our food recipe for the ill or aged. Grind animal's regular dry food, mix with water, and microwave until "pea soup" consistency. Add Nutri-Cal or Pedialyte as needed and Ensure for taste.
Amoxicillin (AKA Amoxidrops or Miomox) or Cephlexen: Antibiotic medicine to kill bacteria. Prescription only. May suppress appetite.
Prednisone: Steroid often used to boost appetite and energy level (also used as an anti-inflammatory). Prescription only.
Azium: Injectable steroid diluted with distilled water and given orally. Often used as treatment for hypoglycemia and/or insulinoma. Quicker acting than Prednisone. Prescription only.
Flagyl (chemical name metronidazole): Prescription mediation for severe diarrhea. Foully bitter. [A compounding pharmacist can prepare metronidazole to minimize or mask the taste. Call 1-800-331-2498 to locate the nearest compounding pharmacist.]
Tagamet (cimetidine): More palatable medication for diarrhea. Now available without prescription, but check with vet for correct dosage. Available as pill, injectable, or in liquid form.
Pepto Bismol: Human antacid/diarrheal medication. Available from drug and grocery stores. [Kaopectate can also be effective, and many ferrets prefer the taste. A compounding pharmacist can work with Pepto Bismol, too.]
Carafate: Concentrated form of ingredients similar to Pepto Bismol. Prescription only.
Regelan: For vomiting. Prescription medication available in pill or injectable form.
CliniCare: Veterinary food formula gentle enough to be force fed directly into an animal's stomach. Available in powder form to mix with water. Highly palatable. Prescription only.
Slippery Elm Bark Powder: Native American herbal remedy for ulcers and sore throats. Mixed with water, becomes gelatinous. Inoffensive tasting. Available in health food stores.
Written by Angela Espinet, shelter operator and president of the South Florida Ferret Club and Rescue, Inc., in August 1997.
The following information is provided to help identify the onset of E.C.E., the signs, the stages and some simple but life-saving steps to take. Please read it in its entirety to recognize all of the signs and the effects.
You may notice that the ferret is or has been restless and irritable, sometimes digging frantically in bedding or litter box. Also, it may aggravate other cage mates.
Fast for 24 hours, feeding Pedialyte + water. Ferrets dehydrate very quickly so it is essential to start fluids right and keep them warm and quiet.
Many times this is the second stage, but often times this can be the first stage with little or no green slime. Because of this, many ferret owners and vets are not recognizing it as E.C.E. Keep feeding Pedialyte/water mix, leaving in water bottle and a bowl. Some ferrets do not have enough strength to drink from a bottle.
Start ferret on soft food diet, i.e. Science Diet A/D plus baby food, or baby food (chicken) alone.
Coax the ferret to lick from your finger then encourage it to eat from a small, shallow bowl. If it refuses, feed by syringe. Start out with 10-20cc's every 3 hours. Increase up to 30-40cc's three times a day. It is essential that your ferret eats.
Your veterinarian should be consulted and advised of your ferret's status as subcutaneous or intravenous fluids may be necessary if it refuses to eat! There is a considerable amount of water in soft foods, so you may notice a decrease in water intake. DO NOT BE FOOLED! Check frequently by pinching the scruff of the neck. If the skin does not snap right back but sticks together, your ferret could be dehydrated. If necessary, call your vet to administer fluids.
Your ferret may be extremely lethargic for at least 48 hours with eyes narrowed and watery.
Many times ferrets sleep right next to the litter box for frequent defecation. Please keep the box clean and sanitized! Always keep warm blankets or towels nearby as body temperature drops with dehydration.
If diarrhea continues, consult your veterinarian for the type of medication and amount to be given, i.e. Pepto Bismol, Pepcid AD, Immodium AD.
After 48 hours, many ferrets seem to recover. Once again, DO NOT BE FOOLED. This is the most crucial period! If the poop returns to normal and the ferret is once again eating hard food, decrease soft food feeding to 25cc, twice a day. Many young ferrets and healthy ones will heal rapidly, however, BE ALERT FOR THE NEXT STAGE.
Unmistakable!
Once again, you may never see the other two stages, but if you see this stage, GREAT DANGER EXISTS. At this point the ferret is not digesting its food and more than likely, it is not eating but using up its own stored body fat, hence a rapid decline in weight, not noticed sometimes until 10 days to 2 weeks after onset of E.C.E.
Keeping the ferret hydrated and feeding the soft food diet is imperative. Be ever watchful.
We found Carafate liquid, 1cc given about 1 hour before feeding, to be very effective. [Sukie Crandall suggests 1/8 to 1/10 of a Carafate tablet anywhere up to 3 times a day, plus 1/8 of a Cytotec pill up to twice a day, separated from the Carafate by at least an hour.]
PLEASE CONSULT YOUR VETERINARIAN
These are the signs and stages to watch for and the steps you can take.
Please consult a veterinarian familiar with the disease or a local/national
ferret shelter that has had considerable experience with E.C.E.
There are a lot of so called cures and various treatments, however, from my experience with 150 ferrets exposed at the same time, I appreciated most of all the advice given by Dr. Bruce Williams (Armed Forces Veterinary Pathologist researching the virus). Dr. Williams says "The most crucial care is supportive care!" This proved to be the case and many lives were saved.
Many times older ferrets, especially those between 2-4 years develop complications that will need careful monitoring by your and your veterinarian. Those with Insulinoma/Hypoglycemia suffered the worst. Perhaps medications will be need for secondary infections or to control a medical problem that surfaces due to the inability of the immune system to cope with the diarrhea.
The most important aspect of ferret ownership is to know your own ferret. You will then recognize any changes in its physical or behavioral petters. Keep a diary form the beginning and you may be able to save your ferrets life!
This notice was written by Mary Van Dahm at the FAIR Shelter in Westchester, IL in November of 1996.
NOTE: The following information is not meant to take the place of qualified veterinary care. Please consult with your veterinarian before starting your pet on any treatment.
No, there still isn't a "cure" or a vaccine for this scourge on our pets, but at least we ARE making progress treating the symptoms of this disease and pulling more animals through it without all the debilitating side effects that many ferrets previously experienced.
Many of you are aware that the ECE virus attacks the stomach and the intestinal linings of the ferret and inhibits absorption of fluids and nutrients. We had previously been counteracting this by providing the sick animals with a very high calorie, easily digestible diet of Hill's Prescription Diet A/D canned food mixed with Deliver 2.0, fed in 1 oz. portions 3-4 times a day. We were also giving the ferrets Pepto Bismol or Kaopectate at the rate of 1 cc 2-3 times a day.
The ferrets hated the Pepto Bismol and Kaopectate and we would often find ourselves wearing the medicines rather than the ferrets taking them. We also found that these medications did not seem to prevent the nasty mouth and stomach ulcers from forming in many of the ferrets. I was also worried that the coating action of these products would further reduce the absorption of nutrients by the ferrets' intestinal tracts.
I had heard of Pepcid A/C being used safely on ferrets with gastric ulcers, so I decided to try it on the ferrets with ECE. Eureka! It worked! Ferrets that were already severely debilitated from the virus still took a long time to recover, but most of the new cases (95% or better) that came in responded right away to treatment. We have not had a single mouth ulcer since starting this treatment and from the faster recovery rate of the animals, I would venture to guess that we have reduced or eliminated the stomach ulcers in most cases, also. Another plus is that ferrets rarely object to the taste and such a small dose is given that they generally swallow it so fast that they don't taste it at all!
The recommended dose for ferrets with gastric ulcers is .25 cc Pepcid suspension per kg (about 2 lbs) given 2-3 times daily. We have found that giving .10 cc per kg 1-2 times daily as soon as symptoms of the virus start and continuing for about 21 days (depending on the initial condition of the ferret) has apparently been adequate to prevent the ECE related ulcers from forming in most ferrets. NOTE: The Pepcid suspension is made by crushing a 10 mg tablet of Pepcid A/C and adding 10 cc of water to it. This suspension settles quickly and must be shaken WELL between each dose administered. Veterinarians may check with their local pharmacy to see if there is another medium that will suspend the ground Pepcid particles more easily.
Dr. Susan Brown of the Midwest Bird and Exotic Animal Hospital has also been trying Immodium (liquid) on some of the ferrets in her practice. It is given at a rate of .10 cc per ferret 2-3 times a day for 1-4 days (usually given for 2 days, then skipping a day, then given 1-2 more days). This treatment is still in a trial stage and she recommends it only for chronic or severe cases of diarrhea until more is known about the longterm effects of this product on ferrets. We have tried it on a few ferrets in our shelter that were responding slowly to other treatments and it seemed to work.
We have also found that administering prednisone has helped in some of the ferrets with ECE. A dose of .25 mg-.50 mg per ferret once a day for 7-14 days (and then every other day for 3 more doses) helps as an anti-inflammatory agent and increases the appetite of severely affected animals. NOTE: Prednisone a.k.a. prednisolone is a prescription drug and must be obtained from a veterinarian. We advise that a blood glucose test for your ferret prior to starting it on prednisone since prednisone can be detrimental to ferrets with hyperglycemia (diabetes).
While using the Pepcid A/C we still feed the sick ferrets the A/D and Deliver 2.0 mixture, but for most ferrets we can cut it back to only one 1 oz. feeding a day. We have also been adding a pinch of brewer's yeast to the mixture and a few drops of Pet Tinic. We also still use Amoxicillin in some ferrets (usually ones with concurrent medical problems) during the early stages of the virus to prevent bacterial "opportunists" from further complicating recovery.
We would like to hear about the results readers and veterinarians have when they try this new treatment. So far all the feedback we have received has been positive. Also, if you have other things to suggest, please call Mary Van Dahm at the FAIR shelter: 708-681-3181.
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
Dr. Bruce Williams, DVM, writes:
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. [The effectiveness of Pepto Bismol is anecdotal at best, and not every ECE case should automatically be on it. However, a bland, highly digestible food such as chicken baby food is helpful. -- from another article by Dr. Williams, Aug 1996]
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. [NOTE: This article is several years old! The AFIP may not need any more samples. PLEASE contact them before sending any.] 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.
Bruce Williams, DVM
This article is Meg Carpenter, LIFE National Health Coordinator, reprinted with permission from the December 1994 issue of The INDEPENDENT VOICE newsletter, copyright ACME Ferret Co..
Unfortunately, the diarrhea disease that has decimated our ferret population over the last two years has returned.
Cases have been reported in from the east, midwest, west, and south. Particularly California, Arizona, Texas, Georgia, Florida, New York, and the Washington D.C. metropolitan area.
The contagious time, from current cases, has dropped to 2-3 days from exposure. Some families and rescue centers have been hard hit--with one in Arizona reporting 25 cases and 5 deaths. The losses were in ferrets from 4-8 years of age and previous health problems. Most accounts describe the stool in affected ferrets as green, but in some cases it is yellowish to gold, with mucous and sometimes a frothy appearance. All of these cases have been followed by what we call "the grainies"- stools that appear to have seeds in them, or a grainy consistency. The grainy stools seem to be the definitive symptom of the disease.
Some have reported vomiting in affected ferrets, though this symptom is not currently known to be associated with the disease. Various recommended antibiotic treatments have been reported. Dr. Bruce Williams, veterinary pathologist at the Armed Forces Institute of Pathology, recommends at this time to stay with Amoxi-drop, which is generally well tolerated by ferrets. Dr. Williams is closely following the current outbreak and working hard to isolate the causative virus.
Rapid diagnosis and strong supportive nursing care is still the best bet for helping ferrets survive the illness. As you know, ferrets do suffer transient diarrhea from many different causes. However, I feel that all diarrhea in previously unaffected animals should receive prompt attention--again, the grainy appearance in stools will tell if you have it. But do not wait.
Affected animals frequently lose interest in eating and drinking. If unsupported, these ferrets can be lost in as little as 18 to 48 hours. If possible, get your affected pet to your veterinarian immediately. Your vet can run lactated ringers immediately for hydration and start whatever other treatment he or she feels necessary. All affected ferrets should be seen by a vet as soon as possible.
Home supportive care entails the following: Keep your ferret(s) hydrated by running a minimum of 60 ml. of ringers a day. CAUTION: do not use subcutaneous administered fluids unless you have been trained to do so. You should support the ferret by giving Infant Pedialyte (unflavored) orally by infant medicine dropper [or Electrolytes S.A. Powder per directions. See article elsewhere this issue--The Editor]. Give the ferret a minimum of 15 ml. of Pedialyte every two to three hours. (One teaspoon is 5 ml.) Also, give the ferret Sustacal or Ensure, vanilla flavor. Both are soy-based and easy on the digestive tract. Ensure is now formulated with soy. Stay away from lactose-based supplements. Give the ferret all the Nutri-Cal it wants. Also, I have found STAT-vme to be very good. This is available from your vet. Some have reported that Linatone seems to help, as well.
After the first few days, and as your ferret starts to recover, use "duck soup." At all times throughout the illness, keep a fresh supply of water and regular food available. Keep unaffected animals isolated from ill ones.
This virus is extremely contagious. If you have it in your house, shut down. Do not go near anyone who has not been affected or allow visitors. Follow sterilization procedures on leaving your house to prevent further spread of the illness. If you have not been affected, but have the greenies in your area, follow strict procedures before entering your home--especially if you have been to the vet, another ferret owner's home, or a pet shop. Remove your clothes and shoes before entering. Thoroughly scrub hands and arms with disinfectant solution. 1% Clorox is fine. I prefer Germicidal or Zephrin -- benzalkonium chloride.
When we contracted the illness in our home a year and a half ago, it was fairly widespread in our area. We successfully kept it away from us until the one time I did not follow sterile procedures! All of our ferrets contracted the disease, except our Canadians. We had one loss. Upon bringing a rescue Canadian kit in this past summer, I believe we had a few more cases The kit was ill with a flu-like cold which soon spread through our house. With ill ferrets, I did not pay too much attention to some loose stools until that funny-looking grainy stool started to appear. Previously affected ferrets did not contract it a second time. Our Canadians did not contract it, and the few cases I isolated out were ferrets not in our home during the previous bout.
Ferrets surviving the illness, particularly older animals, may exhibit bony backs and have a slight stagger when they walk. These ferrets should be followed very carefully by your vet and have a CBC and organ function profile.
Since I am compiling data on cases, and incidence of follow-on health problems, please report to me if possible. Also, please call me at any time if you need nursing care or advice. I am available at all hours: (703) 765-4343, or in an emergency, at work: (703) 765-3112.
The following article was written by Ann Davis of LIFE in August 1993, and has been edited as more information has become available.
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 mucous membranes preventing the absorption of nutrients.
The only way to combat the disease is to help the ferrets live through it.
There are some precautionary measures that you can take to prevent the further spread of the disease.
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.
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