Post by katt on Aug 2, 2013 0:30:44 GMT -5
Gastrointestinal Disease in Ferrets by Veterinary Partner
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Gastrointestinal Disease in Ferrets
Authored by: Katrina D. Ramsell PhD, DVM
Gastrointestinal (GI) refers here to the entire digestive tract of an animal from the mouth to the anus. Ferrets can be affected by a variety of GI diseases but fortunately the majority of them are not life threatening.
A variety of signs can indicate that your ferret likely has some sort of GI disease, such as vomiting, diarrhea or abnormal stools, tooth grinding, weight loss or a thin body. The most helpful thing you can do as a pet owner is to be observant of any changes in your pet’s behavior.
Providing your veterinarian with basic information about your ferret such as age, diet, and environment as well as detailed information about your ferret’s specific problems, length of time that abnormalities were noted, exposure to other animals, changes in diet or environment, etc. is critically important. Your pet’s history can help your veterinarian determine what diagnostic tests and treatments may be needed.
Remember that diarrhea and/or vomiting in an animal as small as a ferret can have devastating consequences if it is not attended to right away. It is important to be able to describe the characteristics of your ferret’s stools. Vomiting behavior and the appearance of the vomit are also important in understanding your ferret’s illness. As a ferret owner, it is helpful if you understand what different stools or vomiting may indicate and having this knowledge may help save your ferret’s life one day. If possible bring a sample of the vomit and/or diarrhea with you in a plastic bag when you visit your veterinarian.
A description of the stools should include:
Consistency – e.g. watery, soft, firm and tubular, etc.
Color – e.g. brown, green, yellow, black/tarry, red/bloody
** Note: Sticky black or red bloody stools indicates that there is bleeding in the GI tract and immediate medical attention is imperative
Texture – e.g mucousy, gelatinous, or seedy
** Note: Seedy stools are seen frequently in ferrets and often indicate food that has not been completely digested.
Odor – e.g. foul smelling, mild odor, no odor
Urgency to defecate – Does your ferret have time to make it to the litter box or does he have frequent accidents on the way?
Behavior – Does your ferret strain or cry while defecating?
Amount – Are you seeing small, scant stools or is there a normal amount each time?
A description of your ferret’s vomit should include:
Consistency – e.g. does it have foam, mucous or food material
Color – clear, yellow, brown, green, red (bloody?), food-colored
Behavior – Does your ferret cry when vomiting, or does the material come up passively without effort?
Timing – Does your ferret vomit right after eating or is the vomiting independent of when your ferret has eaten?
** Note: If your ferret appears to vomit right after eating, and especially if it appears to be an effortless process, then your ferret may be “regurgitating” rather than truly vomiting. Regurgitating is most often associated with an uncommon but serious medical condition known as megaesophagus.
Onset – Did your ferret’s vomiting come on quickly and unexpectedly? Was your ferret playing with something like a rubber toy or chewing on something soft such as a shoe insole recently?
** Note: A ferret that suddenly starts vomiting (often violently) and is reluctant to eat may have been eaten a foreign object such as a piece of rubber toy. This is an extreme emergency and should be seen by a vet immediately.
The most commonly observed GI diseases in ferrets include:
Dental disease
Mouth, stomach, and intestinal ulcers
Helicobacter mustelea (bacterial infection associated with stomach ulcers)
GI foreign bodies
Inflammatory bowel disease (IBD)
Bacterial overgrowth in the intestines
Neoplasia (cancer) – most frequently lymphoma
Epizootic catarrhal enteritis (ECE, aka Green Slime Disease) (coronavirus infection)
Less commonly observed GI diseases:
Ferret Systemic Coronavirus (FRSCV) (aka “Ferret-FIP”)
Megaesophagus
Rectal prolapse
Eosinophilic gastroenteritis
Proliferative bowel disease
Parasitic infections (e.g. coccidiosis)
Rotavirus
Enterotoxemia
Toxins
Influenza
Dental Disease
Ferrets frequently have dental problems such as tartar buildup, periodontal disease and fractured or worn teeth. Occasionally a ferret will develop an abscess in a tooth root or cancer of the gums. Ferrets with dental disease may exhibit pain and refuse to eat hard food items or drop food from their mouth when attempting to eat. They may squint their eyes or have excessive tear production. The gums can be reddened or thickened and there may be an odor to the mouth.
The diagnosis of dental disease is by visual and x-ray examination. The treatment is based on the problem and may include dental cleaning, surgery and medications. There is some research to suggest that feeding a hard kibble diet may contribute to dental disease in ferrets because ferret teeth were never designed to grind and crush this texture of food. It is best if they get a variety of foods of different textures to preven this problem. At the very least we recommend moistening the dry food with some water or broth to make it less abrasive on the teeth.
Ulcers – mouth, stomach, and intestinal
GI ulcers are commonly observed in ferrets and can occur in the mouth, stomach, or intestines. Ulcers appear as reddish, raw areas that can sometimes bleed. Oral (mouth) ulcers often occur from self-trauma when a ferret paws at his mouth with his front paws in response to nausea or a bad taste in the mouth. Nausea can occur from abdominal pain (e.g. stomach ulcers or foreign bodies, from low blood sugar (glucose) levels, and from foul-tasting medications. The best way to treat oral ulcers is to address the underlying problem. Antibiotics are frequently given to minimize secondary bacterial infections and a medication called Carafate (sucralfate) can help protect the ulcerated tissue and facilitate the healing process. Trimming the front toenails short is also helpful. Follow bad tasting medication with something pleasant like meat baby food, banana baby food or a fatty acid supplement to reduce pawing at the mouth.
Most stomach and intestinal ulcers are recognized when a ferret is having black or sticky stools. The black color is digested blood, usually coming from the stomach or small intestine, but occasionally from a bleeding ulcer in the mouth. Blood from further down in the intestinal tract, such as from the colon or rectum, is usually more bright red in color. Ulcers associated with the stomach and intestines can be caused by hair balls or foreign bodies, inflammatory bowel disease, stress, cancer, infections, and toxins.
If you see black sticky stools, it is an emergency and you should get your ferret to a veterinarian as soon as possible
Helicobacter mustelea
Helicobacter mustelae is a type of bacteria commonly found in the stomach of many ferrets. Helicobacter can cause disease ranging from nothing visible to stomach ulcers and irritation of the stomach lining. Ferrets can exhibit any of the following signs when affected by Helicobacter mustelae gastritis: lymph node enlargement (especially the ones near the stomach), lethargy, painful abdomen, tooth grinding, excessive salivation, vomiting, loss of appetite, wasting and soft black stools. Tooth grinding and excess salivation may result from nausea.
Although the signs, blood work results, and response to therapy can give you an suspicion of the disease, biopsies of the lower part of the stomach and upper part of the small intestine are usually needed to get a definitive diagnosis. Medical treatment is unlikely to completely eradicate the infection; however, it can help control the signs of the disease and make the ferret more comfortable. A combination of drugs are used to treat the disease: antibiotics to try to eliminate the bacteria directly, antacid drugs to alter the stomach pH to make it harder for the bacteria to survive, and a drug to help seal and protect the ulcers so they can heal.
Foreign Bodies
Foreign bodies can be located anywhere along the GI tract. The stomach is the most common site. Gastric foreign bodies are usually rubbery objects (most commonly seen in young ferrets who tend to chew on things such as shoe insoles, pencil erasers, etc.) or hairballs (more often seen in older ferrets, especially those with underlying inflammatory GI disease and decreased GI motility). Young ferrets love to eat latex or foam rubber of any kind and these objects can sit for weeks in the stomach or become lodged in the intestinal tract.
GI foreign bodies are the most common cause of GI disease in ferrets under one year of age. Ferrets with gastric foreign bodies frequently do not show any obvious signs early on but eventually they may exhibit nausea, tooth grinding, pawing at the mouth, vomiting, abnormal stools, weight loss, and lethargy. Foreign bodies in the stomach can sometimes be felt by a veterinarian, but it can be difficult to feel soft objects such as loose hair and Styrofoam. Radiographs taken after ingesting barium can sometimes help to visualize an object in the stomach. The foreign material usually has to be surgically removed to resolve the problem.
If the foreign material slips from the stomach into the intestine and blocks the passage of food, then the signs are more dramatic and the situation becomes a true emergency. The stomach will enlarge with gas, causing the stomach to swell and feel firm to the touch. Unless the object passes on its own relatively quickly, the ferret will become lethargic, stop eating and drinking, become severely dehydrated and will die within 24 to 48 hours.
Signs of a complete GI obstruction include any of the following: sudden collapse, lethargy, vomiting, absence of stools, severe dehydration, dark or bluish colored gums, bloated and painful abdomen, seizures, and finally coma and death. Emergency surgery to remove the foreign material is the only choice.
Preventing foreign bodies should be an important consideration for any ferret owner. Restrict your ferret from access to any soft, rubbery, foamy or chewy objects. You can reduce the incidence of hairballs by brushing your ferret frequently. Some people advocate the use of a hairball laxative, which may help to move hair out of the stomach, but we have no definitive proof of this. If you are going to use something of this nature, it is better to use a pea-sized glob of petroleum jelly on the ferrets paw daily (they lick it off) rather than the sweetened hairball laxative that is not very healthy for ferrets, particularly if they have insulinoma. Petroleum jelly is the main “active” ingredient in hairball laxatives and ferrets will take it unflavored!
Another helpful prevention measure is to treat any underlying inflammatory GI disease, which may result in lower motility and thus may prevent hair from moving out normally from the stomach. Your veterinarian may take a biopsy of the stomach, intestine or surrounding lymph nodes when doing the surgery for the GI foreign body to check of this other disease.
Inflammatory Bowel Disease (IBD) (lymphocytic, plamacytic)
IBD is an inflammatory condition of the gastrointestinal tract that is quite common in ferrets. Although the cause of IBD is unknown, this chronic immune response may be associated with food allergies, dietary intolerance, bacterial overgrowth, starch overload, infectious disease, metabolic disease or other factors. There could potentially even be a genetic predisposition for the disease.
IBD is most commonly found in ferrets over two years old. This disease is associated with inflammatory changes in both the stomach and small intestine. Because the signs of IBD can resemble other common GI disease, it can be easily overlooked or misdiagnosed. Early diagnosis of IBD in ferrets is important. Chronic damage to the gut from IBD can potentially cause malnutrition and emaciation, secondary bacterial overgrowth and infection, hepatitis, and eventual development of lymphoma, which is a type of cancer.
IBD in ferrets is often diagnosed incidentally when blood work is taken for some other illness, such as adrenal disease or insulinoma. Certain blood chemistry values create suspicion of IBD. A definitive diagnosis is made with an intestinal biopsy. Many ferrets that have IBD do not display any clinical signs. Signs are more often observed when the disease becomes more advanced or when secondary disease occurs (such as bacterial overgrowth or liver disease).
Clinical signs of IBD include:
Abnormal stools – chronically green or yellow, mucoid or gelatinous, grainy, tarry or bloody, and episodes of diarrhea.
Nausea – pawing at the mouth, grinding teeth, and/or vomiting
Thin body build/muscle wasted, especially over the ribs, pelvis, and shoulder areas due to reduced muscle mass. Muscle wasting can come from the reduced ability to properly process and digest food and to absorb nutrients. It can also occur from losing protein form the intestines due to the gut being “leaky” from chronic damage and inflammation.
Decreased activity or lethargy may be observed as the disease progresses and the ferret’s overall condition declines.
Hairballs. It is likely that this occurs as a result of decreased gastric motility secondary to the underlying gastric inflammation.
Blood work values associated with IBD:
- Lipase and globulin values are often elevated in ferrets that have IBD almost always the gastrointestinal tract.
- Liver values may be elevated due to the gut inflammation spreading to the liver. It should be noted that liver infections, adrenal disease, primary liver disease, cancer, and medications such as prednisolone can also increase these values.
- The complete blood count (CBC) may reveal an increase in certain types of white blood cells that may indicate IBD, lymphoma, or an underlying disease associated with IBD.
There is currently no definitive cure for IBD, but the goal of therapy is to control the inflammation and damage to the stomach and intestines, both to alleviate signs associated with the disease and to prevent possible progression of the disease into lymphoma. Use of a hypoallergenic or novel protein diet may reduce gut inflammation if a food allergy is the cause. Low starch diets may help if starch overload and subsequent bacterial overgrowth is the cause.
However, dietary changes alone are rarely enough to control IBD. A drug called azathioprine (Imuran)is frequently used to control the inflammatory response in ferrets with IBD. Sometimes other anti-inflammatory drugs, such as prenisolone, may be used in conjunction with Imuran but with caution. Antibiotics such as Bayril and amoxicillin often reduce clinical signs like diarrhea and nausea. Other medications such as vitamin B12 and colostrum may potentially improve absorption of nutrients from the gut. Often clinical signs, if there are any, will improve as the inflammation is controlled.
Although IBD can be potentially controlled successfully with medication, some ferrets do not respond to treatment as well as others. Research is ongoing for inflammatory bowel disease in ferrets (and other species), as it is a disease seen in many species and is still not completely understood.
Bacterial Overgrowth
Bacterial overgrowth refers to an increase in the growth and aggressive behavior of otherwise normal intestinal bacteria. It is usually secondary to some underlying disease or stressful condition, such as IBS, coronavirus (ECE), Helicobacter mustelea, GI foreign bodies, inappropriate diets or sudden dietary changes, or other debilitating or stressful conditions. Prompt treatment of bacterial overgrowth is recommended, as this condition can potentially become quite serious in a short period of time. A thorough exam and appropriate diagnostics can also help determine the underlying cause for the bacterial overgrowth.
Signs observed with bacterial overgrowth typically include diarrhea, decreased appetite, weight loss, decreased activity, nausea, and occasionally vomiting. Sometimes dehydration occurs secondary to fluid loss (from diarrhea or vomiting) or from decreased fluid intake. Signs can be mild and sporadic with episodes that can occur weeks or even months apart. If repeated episodes are observed and the diet has been consistent, then there is likely an underlying disease present such as inflammatory bowel disease.
Treatment of bacterial overgrowth consists of broad-spectrum antibiotics (often a combination is used such as Baytril or Flagyl and amoxicillin) and supportive care. Supplemental feedings and/or fluids and sometimes medications are needed to help control the diarrhea itself. Although antibiotics may help with an immediate episode of bacterial overgrowth, treating the underlying disease or primary problem is always the preferable long-term treatment plan.
Neoplasia (Cancer)
Lymphoma is the most common type of GI cancer in ferrets. In many cases, it is likely due to unrecognized chronic IBD that has progressed to cancer.
Signs of lymphoma are variable and often depend on how aggressive the cancer is (high vs. low grade) and the location and extent of organ involvement. Weight loss, decreased appetite, lethargy, abdominal masses, and abdominal distension are common findings. Sometimes peripheral lymph nodes (e.g. in the neck region, in the arm pits, and on the back side of the rear legs behind the knees are firm and enlarged, and involvement with the eye can cause the eye to be pushed out. Ferrets may grind their teeth due to nausea and GI discomfort. Intestinal lymphoma often results in tissue that is more delicate than normal and is easily torn. It is not uncommon for ferrets with GI lymphoma to have a rupture in the bowel wall and secondary peritonitis with subsequent death.
Unfortunately blood work does not provide a definitive diagnosis for lymphoma, although high lymphocyte or neutrophil counts can make the veterinarian suspicious of it. If lymph nodes are firm and enlarged, biopsies should be performed to get a diagnosis as soon as possible.
Treatment of lymphoma, or any cancer in general, can be difficult. Putting the cancer into remission for a period of time and improving and extending the quality of the ferret’s life are often more realistic goals than achieving complete resolution of the disease. Ferrets generally tolerate chemotherapy well and most affected ferrets do benefit to some extent from therapy. There are several chemotherapeutic protocols for treatment of lymphoma.
Adenocarcinoma is a type of cancer that can affect any glandular area of the body. This cancer has been seen in the pylorus (the outflow area) of the stomach and in the area of the anal glands. Cancer of the pylorus constricts the area and restricts the outflow of food from the stomach. The signs seen are the same as for a GI foreign body. The diagnosis is based on an exploratory surgery and biopsy of the affected tissue. This cancer responds poorly to chemotherapy. Adenocarcinoma of the anal gland can occur in the whole gland or when just a portion is left after the gland has been removed. It causes a large swelling next to the anus and may cause compression of the stools as they pass through the rectu. The treatment issurgical removal of the tumor.
Other types of cancer, such as primary stomach cancer and cancer of the liver are occasionally observed. Disruption of liver function can also lead to GI signs including diarrhea, wasting and vomiting. A presumptive diagnosis may be acquired with an ultrasound, but a definitive diagnosis is based on a liver biopsy.
Ferret Coronavirus-Associated Diseases
Epizootic Catarrhal Enteritis (ECE) – “Green Slime Diarrhea”
ECE is an important disease to discuss as it appears to affect a vast number of ferrets not only in ferret shelters but also in many households. The disease first appeared on the East Coast in 1993 and seemed to follow shows around that region. It rapidly spread across the U.S., likely as a result of large-scale breeding facilities infected with the disease. The causative agent of ECE is a coronavirus. The virus is unusual in that younger ferrets have fewer clinical signs than older ones. Ferrets under 4 months of age often show no sign of the disease. Ferrets 4 to 18 months old usually show mild to moderate signs, and older ferrets, especially those over 4 years of age when first exposed, appear to suffer the most and have the most severe signs associated with ECE. The virus can remain in the intestinal tract for months after all signs have resolved. This produces what is referred to as a “persistent carrier,” which is highly contagious for 6 months or more.
A typical history includes recent exposure to a new, young ferret. This can include going to a pet store to play with the young ferrets and then returning home to interact with your ferrets without proper sanitation in between. Onset of clinical signs is typically 48 to 96 hours. Affected ferrets often have a loss of appetite and are lethargic. They then produce a green, mucoid diarrhea, often referred to as bright or neon green diarrhea. The diarrhea is not always green, however, and can just be loose and/or like birdseed. Mild cases may only experience brief diarrhea. Severe weight loss can be observed and loss of body fat and muscle can be extreme within the first 7 to 10 days, even if the ferret is initially still eating well. The ECE virus affects the lining of the intestine, making it difficult for the ferret to absorb nutrients and fluids properly. The virus can also cause damage to the intestine in such a way that the ferret can lose protein and therefore nutrients from their GI tract. Even after appearing to recover from ECE, some adult ferrets have persistent, intermittent diarrhea that is often “seedy.” These ferrets can show clinical signs for weeks or even months, and changing the diet to one more easily absorbed (e.g. a hypoallergic food with hydrolyzed proteins) can sometimes facilitate recovery and help them maintain their body condition.
Although fewer ferrets die from ECE these days, many ferrets (especially middle to older aged ferrets) still need to be treated fairly aggressively. Sick ferrets should be treated with antibiotics and supportive care, and some ferrets, especially those that become dehydrated, should be treated with fluid therapy. It is critical to keep sick ferrets eating. Talk to your veterinarian about foods that can easily be syringe fed if the ferret is not eating very well on his own.
Ill and recovered animals should be isolated from unexposed ferrets for 6 to 12 months. Pets already exposed are most likely now carriers, even if they are not showing signs. Extreme care must be taken not to transmit the virus on clothing, especially in shelter and hospital situations. All young ferrets should be treated as potential ECE carriers and good sanitation habits such as disinfecting hands, clothes, and cages must be practiced to help minimize the spread of this highly contagious disease.
Ferret Systemic Coronavirus (FRSCV) (aka Ferret-FIP)
FRSCV is a newly recognized disease in ferrets. It was first reported in Spain in 2004 and was soon after also described in the United States. Clinically and pathologically, the disease closely resembles a disease in cats known as feline infectious peritonitis (FIP). FIP is a fatal, immune-mediated disease of cats that involves multiple organs and is caused by a coronavirus. FRSCV has been reported mostly in young ferrets, usually less than 18 months of age. Common signs in ferrets include diarrhea, weight loss, lethargy, decreased appetite or anorexia, and vomiting. The GI signs can lead to muscle wasting and emaciation. Neurologic signs include hind limb weakness, ataxia, tremors, head tilt and seizures. Less common signs include sneezing, coughing, labored breathing, nasal discharge, dehydration, tooth-grinding, a heart murmur, jaundice, green-colored urine, areas of red skin, reddened rectal tissue, and rectal prolapse. Large abdominal masses, enlarged spleens, and enlarged kidneys are common findings. Some ferrets have enlarged peripheral lymph nodes and fevers ranging from 103°F to 105.4°F.
Clinical signs, blood work, a urinalysis, and x-rays and/or an ultrasound are helpful in making an initial presumptive diagnosis of FRSCV in a ferret. Changes in the blood are variable and reflect damage to abdominal organs such as kidneys, liver, pancreas, and GI tract. Typical blood work results include an increased globulin, decreased albumin, a nonregenerative anemia, and thrombocytopenia. It is important to rule out other diseases such as Aleutian disease, lymphoma, multiple myeloma, chronic infection (e.g. Helicobacter), or chronic inflammatory bowel disease.
Histopathology performed on biopsied tissues that show typical microscopic lesions are highly suggestive of FRSCV. A definitive diagnosis requires a positive immunohistochemistry staining of the coronavirus antigen in macrophages within areas of granulomatous inflammation. Assays using reverse transcriptase PCR (offered through The Diagnostic Center for Population and Animal Health at Michigan State University) are the current gold standard for diagnosing FRSEV in ferrets.
The prognosis for ferrets with FRSCV is generally considered poor. However, there are treatment protocols being tried that are showing promising results. Symptomatic treatment and supportive care can help alleviate some of the clinical signs associated with the disease. Some drugs serve to suppress or modulate the immune system in an effort to reduce damage caused in response to the virus or to reduce or eliminate the virus.
Megaesophagus
Megaesophagus is a disease in which the esophagus is enlarged and does not have normal motility. It is considered to be an uncommon disease. Unfortunately the cause of megaesophagus is unknown. Identifying ferrets with the disease is important as the prognosis is generally poor. Accurately diagnosing megasophagus early on is important, as there are therapies that can slow down and potentially reverse the progression of the disease.
A common clinical sign of megaesophagus is regurgitating food 5 to 10 minutes after eating. These ferrets are often distressed while eating and sometimes appear frustrated because they are hungry but are physically unable to push the food out of their esophagus into the stomach. Afflicted ferrets are often heard making a gurgling sound during or after eating, and some ferrets choke, cough or stretch their neck out after eating. Ferrets with megaesophagus generally lose weight quickly as they are effectively starving to death.
The diagnosis of megaesopagus is made based on both clinical signs and x-rays. When a ferret is suspected of having the disease, soft food with a contrast dye, such as barium, is given before an x-ray. A positive diagnosis is made if retained dye can be seen in the esophagus, and oftentimes a dilated esophagus.
Treatment for this disease is generally supportive, especially since the cause is unknown. The management of megaesophagus in ferrets is similar to that in a dog but is usually less successful. Ferrets are fed thinned, high calorie soft food in a vertical position and then held in a vertical position for a period of time. Nutritional supplements may be added to increase calorie content. An antacid medication such as Zantac can result in significant improvement, indicating that gastric reflux and secondary inflammation of the esophagus may be a factor in this disease. Sucralfate (Carafate) can be used to coat and therefore promote healing of gastric and esophageal ulcers. Drugs that increase GI motility such as metoclopramide (Reglan) may be used to help food empty from the stomach better and reduce gastric reflux. Fluid therapy may also be necessary if the ferret is unable to get adequate fluid intake and has become dehydrated.
Although the prognosis is often poor in ferrets with megaesophagus, there have been cases that have done quite well long term with proper medical and dietary management. One of the key factors in successful treatment is identifying the disease early on, before it has progressed far and before the ferret has become too wasted and weak.
Rectal Prolapse
In rectal prolapse, the rectal tissue protrudes from the anus. This is most often a disease of a young ferret who has had an anal gland removal surgery. In these cases the nerves or muscles around the anus may have been disturbed during the surgical removal of the anal gland. This leads to a relaxed anal sphincter muscle, which allows the anal tissue to protrude. Other causes of rectal prolapse are any condition that causes the ferret to strain when defecating thus pushing out rectal tissue, such as intestinal lymphoma, proliferative colitis, severe parasitism, intestinal intussusception (where the intestine telescopes on itself), and a GI foreign body.
Eosinophilic Gastroenteritis
This is a GI disease of ferrets that causes severe inflammation of the intestinal tract possibly in response to an allergen. The body sends eosinophils, a type of white blood cell often seen in allergic reactions, to the intestine. Here the eosinophils release histamine, which is a very irritating substance. The resulting irritation to the intestinal lining causes severe diarrhea and the inability to absorb nutrients. The ferret will start losing weight and will eventually become extremely thin. Some ferrets become so severely affected that they also develop swollen ears and feet and ulcerations on the skin.
The diagnosis is based on a complete blood cell count that usually shows a high number of eosinophils and a biopsy of the intestine and surrounding lymph nodes. Classically this disease has been treated with corticosteroids to reduce the inflammatory reaction and the response to the histamine release. This will, indeed, control the signs of disease, but often has to be given for the life of the pet. Making dietary changes can cause a significant reduction in the signs and it is speculated that eosinophilic gastroenteritis may be a food allergy problem. Some ferrets no longer need corticosteroids when changed to a “hypoallergenic” diet. We recommend feeding a diet completely devoid of grains.
Proliferative bowel disease
Proliferative bowel disease (PBD) is a disease that is caused by a bacterium known as Lawsonia intracellularis. This disease causes inflammation and thickening of the small intestine and/or colon. Ferrets suffering from PBD often have severe wasting that is similar to that seen with ECE (discussed previously). However, in contrast to ECE, this disease most frequently affects rapidly growing juvenile ferrets around 10 to 16 weeks of age.
Environmental and nutritional stress factors appear to be important in this disease, as the incidence of this disease appears to have decreased as the quality of care and nutrition of pet ferrets has improved. This disease has become less common and is rare in the Pacific Northwest region of the U.S. However, beginning treatment early on is crucial, as this disease can be potentially fatal.
Ferrets with PBD have chronic diarrhea that can vary in color and consistency. Feces can be dark and liquid, have streaks of bright red blood, and/or be mucoid with bright green mucus. The fur around the anus and on the tail may be wet and stained with fecal material. Straining and moaning or crying is often observed, as is protrusion of the rectal tissue. Ferrets suffering from this disease are usually dehydrated and have low blood protein levels. Since ferrets with PBD are often severely debilitated, they are more susceptible to other infectious diseases such as upper respiratory infections and they frequently develop gastritis (inflammation of the stomach) and ulcers. Without appropriate treatment, ferrets with PBD can lose half their weight in less than two weeks. As the disease progresses, ferrets with PBD become very weak and sleep most of the time.
Diagnosis of PBD is usually made based on clinical signs and being the appropriate age. Your veterinarian may be able to feel the thickened bowel tissue, especially if the colon is involved. Intestinal biopsies and histopathologic examination of the tissue can confirm the diagnosis, however surgery is not recommended in debilitated animals.
Treatment of this disease includes an antibiotic, fluid therapy, nutritional support, and other necessary supportive care. One should make sure that the ferret is housed in a clean, sanitary environment and that the ferret is on an appropriate, high quality diet. Severe damage to the intestine from a disease such as PBD could potentially initiate or result in secondary problems such as inflammatory bowel disease. Therefore, a ferret that has suffered from any severe GI disease such as PBD or ECE should be monitored carefully, both clinically and with appropriate diagnostics such as blood work, throughout its life.
Parasitic Infections
GI parasites are uncommon in the American ferret largely because the majority of ferrets are raised in large, parasite-free breeding colonies. However, parasitic problems do occasionally occur where ferrets have access to contaminated food or water or the stools of animals containing parasites. The two most common parasites encountered in the American pet ferret are coccidia and giardia, which are both one-celled protozoa. The signs of disease can range from none to diarrhea and wasting.
Coccidiosis is usually observed in stressed, juvenile ferrets. The diagnosis is made on direct microscopic examination of fresh feces or on stains that can be performed on the feces. Treatment involves the use of antiparasitic drugs for a minimum of two weeks along with environmental cleanup to remove contaminated feces.
Ferrets can also be infested with other parasites such as tapeworms, roundworms and hookworms. These parasites can be transmitted from other pets in the household. If you have other pets in the household diagnosed with a parasite problem then you should have your ferrets’ stool checked for parasites as well.
Rotavirus
This is a viral disease that can spread rapidly through a group of ferrets. The disease is usually mild and causes soft, green mucus-coated stools for two to three days. The diagnosis is made on signs and possibly by viral isolation from the stool. Treatment is rarely necessary because ferrets recover rapidly on their own. If necessary, supplemental fluids and intestinal coating agents may be used.
Enterotoxemia
Bacterial enterotoxemia is an uncommon but potentially fatal consequence of severe GI disease and disruption of the normal intestinal bacterial flora. This can occur with diseases such as IBD, bacterial overgrowth, ECE, and other GI diseases. A Clostridium species is the most likely bacterial organism responsible for enterotoxemia.
Treatment of enterotoxemia must be aggressive and rapid. A combination of broad spectrum antibiotics such as metronidazole (Flagyl) and amoxicillin or enrofloxacin (Baytril) and amoxicillin, IV fluid therapy, a toxin binding agent such as activated charcoal, nutritional supplementation, and supportive care for symptomatic treatment of diarrhea, shock, hypothermia, etc. are necessary.
Enterotoxemia is more easily prevented than treated. Therefore appropriate antibiotics and supportive care for any ferret demonstrating significant GI upset can help prevent or minimize the effects of enterotoxemia. If a ferret dies from suspected enterotoxemia, a diagnosis can be confirmed by performing a necropsy and observing large areas of the small intestine that are dark red to black in color.
Toxins
Ferrets love to investigate all kinds of things around the house including purses or trouser pockets! Ferrets have been known to eat aspirin, rat poison, toxic plants and antifreeze among other things. Signs can range from mild diarrhea and vomiting to complete collapse and coma. The diagnosis is based on the history of exposure to toxins, blood results and response to therapy.
Influenza
Ferrets are susceptible to human influenza and primarily develop upper respiratory signs. Occasionally a ferret can also exhibit diarrhea. The diagnosis is based on the history and signs of upper respiratory disease along with diarrhea. Treatment ranges from none to fluid replacement, antihistamines for the upper respiratory signs, and antidiarrheals. Most ferrets recover from influenza on their own in a week or two with little supportive care. Influenza is transmissible between ferrets and humans both ways. Take care to protect your ferret if you develop influenza by using good sanitation and a face mask when handling your companion and the same goes for when your ferret develops influenza to keep it from spreading to you.
Date Published: 2/16/2012 2:25:00 PM
Copyright 2012 - 2013 by Susan Brown, DVM. Used with permission. All rights reserved
Click here for original article: www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=3346
Gastrointestinal Disease in Ferrets
Authored by: Katrina D. Ramsell PhD, DVM
Gastrointestinal (GI) refers here to the entire digestive tract of an animal from the mouth to the anus. Ferrets can be affected by a variety of GI diseases but fortunately the majority of them are not life threatening.
A variety of signs can indicate that your ferret likely has some sort of GI disease, such as vomiting, diarrhea or abnormal stools, tooth grinding, weight loss or a thin body. The most helpful thing you can do as a pet owner is to be observant of any changes in your pet’s behavior.
Providing your veterinarian with basic information about your ferret such as age, diet, and environment as well as detailed information about your ferret’s specific problems, length of time that abnormalities were noted, exposure to other animals, changes in diet or environment, etc. is critically important. Your pet’s history can help your veterinarian determine what diagnostic tests and treatments may be needed.
Remember that diarrhea and/or vomiting in an animal as small as a ferret can have devastating consequences if it is not attended to right away. It is important to be able to describe the characteristics of your ferret’s stools. Vomiting behavior and the appearance of the vomit are also important in understanding your ferret’s illness. As a ferret owner, it is helpful if you understand what different stools or vomiting may indicate and having this knowledge may help save your ferret’s life one day. If possible bring a sample of the vomit and/or diarrhea with you in a plastic bag when you visit your veterinarian.
A description of the stools should include:
Consistency – e.g. watery, soft, firm and tubular, etc.
Color – e.g. brown, green, yellow, black/tarry, red/bloody
** Note: Sticky black or red bloody stools indicates that there is bleeding in the GI tract and immediate medical attention is imperative
Texture – e.g mucousy, gelatinous, or seedy
** Note: Seedy stools are seen frequently in ferrets and often indicate food that has not been completely digested.
Odor – e.g. foul smelling, mild odor, no odor
Urgency to defecate – Does your ferret have time to make it to the litter box or does he have frequent accidents on the way?
Behavior – Does your ferret strain or cry while defecating?
Amount – Are you seeing small, scant stools or is there a normal amount each time?
A description of your ferret’s vomit should include:
Consistency – e.g. does it have foam, mucous or food material
Color – clear, yellow, brown, green, red (bloody?), food-colored
Behavior – Does your ferret cry when vomiting, or does the material come up passively without effort?
Timing – Does your ferret vomit right after eating or is the vomiting independent of when your ferret has eaten?
** Note: If your ferret appears to vomit right after eating, and especially if it appears to be an effortless process, then your ferret may be “regurgitating” rather than truly vomiting. Regurgitating is most often associated with an uncommon but serious medical condition known as megaesophagus.
Onset – Did your ferret’s vomiting come on quickly and unexpectedly? Was your ferret playing with something like a rubber toy or chewing on something soft such as a shoe insole recently?
** Note: A ferret that suddenly starts vomiting (often violently) and is reluctant to eat may have been eaten a foreign object such as a piece of rubber toy. This is an extreme emergency and should be seen by a vet immediately.
The most commonly observed GI diseases in ferrets include:
Dental disease
Mouth, stomach, and intestinal ulcers
Helicobacter mustelea (bacterial infection associated with stomach ulcers)
GI foreign bodies
Inflammatory bowel disease (IBD)
Bacterial overgrowth in the intestines
Neoplasia (cancer) – most frequently lymphoma
Epizootic catarrhal enteritis (ECE, aka Green Slime Disease) (coronavirus infection)
Less commonly observed GI diseases:
Ferret Systemic Coronavirus (FRSCV) (aka “Ferret-FIP”)
Megaesophagus
Rectal prolapse
Eosinophilic gastroenteritis
Proliferative bowel disease
Parasitic infections (e.g. coccidiosis)
Rotavirus
Enterotoxemia
Toxins
Influenza
Dental Disease
Ferrets frequently have dental problems such as tartar buildup, periodontal disease and fractured or worn teeth. Occasionally a ferret will develop an abscess in a tooth root or cancer of the gums. Ferrets with dental disease may exhibit pain and refuse to eat hard food items or drop food from their mouth when attempting to eat. They may squint their eyes or have excessive tear production. The gums can be reddened or thickened and there may be an odor to the mouth.
The diagnosis of dental disease is by visual and x-ray examination. The treatment is based on the problem and may include dental cleaning, surgery and medications. There is some research to suggest that feeding a hard kibble diet may contribute to dental disease in ferrets because ferret teeth were never designed to grind and crush this texture of food. It is best if they get a variety of foods of different textures to preven this problem. At the very least we recommend moistening the dry food with some water or broth to make it less abrasive on the teeth.
Ulcers – mouth, stomach, and intestinal
GI ulcers are commonly observed in ferrets and can occur in the mouth, stomach, or intestines. Ulcers appear as reddish, raw areas that can sometimes bleed. Oral (mouth) ulcers often occur from self-trauma when a ferret paws at his mouth with his front paws in response to nausea or a bad taste in the mouth. Nausea can occur from abdominal pain (e.g. stomach ulcers or foreign bodies, from low blood sugar (glucose) levels, and from foul-tasting medications. The best way to treat oral ulcers is to address the underlying problem. Antibiotics are frequently given to minimize secondary bacterial infections and a medication called Carafate (sucralfate) can help protect the ulcerated tissue and facilitate the healing process. Trimming the front toenails short is also helpful. Follow bad tasting medication with something pleasant like meat baby food, banana baby food or a fatty acid supplement to reduce pawing at the mouth.
Most stomach and intestinal ulcers are recognized when a ferret is having black or sticky stools. The black color is digested blood, usually coming from the stomach or small intestine, but occasionally from a bleeding ulcer in the mouth. Blood from further down in the intestinal tract, such as from the colon or rectum, is usually more bright red in color. Ulcers associated with the stomach and intestines can be caused by hair balls or foreign bodies, inflammatory bowel disease, stress, cancer, infections, and toxins.
If you see black sticky stools, it is an emergency and you should get your ferret to a veterinarian as soon as possible
Helicobacter mustelea
Helicobacter mustelae is a type of bacteria commonly found in the stomach of many ferrets. Helicobacter can cause disease ranging from nothing visible to stomach ulcers and irritation of the stomach lining. Ferrets can exhibit any of the following signs when affected by Helicobacter mustelae gastritis: lymph node enlargement (especially the ones near the stomach), lethargy, painful abdomen, tooth grinding, excessive salivation, vomiting, loss of appetite, wasting and soft black stools. Tooth grinding and excess salivation may result from nausea.
Although the signs, blood work results, and response to therapy can give you an suspicion of the disease, biopsies of the lower part of the stomach and upper part of the small intestine are usually needed to get a definitive diagnosis. Medical treatment is unlikely to completely eradicate the infection; however, it can help control the signs of the disease and make the ferret more comfortable. A combination of drugs are used to treat the disease: antibiotics to try to eliminate the bacteria directly, antacid drugs to alter the stomach pH to make it harder for the bacteria to survive, and a drug to help seal and protect the ulcers so they can heal.
Foreign Bodies
Foreign bodies can be located anywhere along the GI tract. The stomach is the most common site. Gastric foreign bodies are usually rubbery objects (most commonly seen in young ferrets who tend to chew on things such as shoe insoles, pencil erasers, etc.) or hairballs (more often seen in older ferrets, especially those with underlying inflammatory GI disease and decreased GI motility). Young ferrets love to eat latex or foam rubber of any kind and these objects can sit for weeks in the stomach or become lodged in the intestinal tract.
GI foreign bodies are the most common cause of GI disease in ferrets under one year of age. Ferrets with gastric foreign bodies frequently do not show any obvious signs early on but eventually they may exhibit nausea, tooth grinding, pawing at the mouth, vomiting, abnormal stools, weight loss, and lethargy. Foreign bodies in the stomach can sometimes be felt by a veterinarian, but it can be difficult to feel soft objects such as loose hair and Styrofoam. Radiographs taken after ingesting barium can sometimes help to visualize an object in the stomach. The foreign material usually has to be surgically removed to resolve the problem.
If the foreign material slips from the stomach into the intestine and blocks the passage of food, then the signs are more dramatic and the situation becomes a true emergency. The stomach will enlarge with gas, causing the stomach to swell and feel firm to the touch. Unless the object passes on its own relatively quickly, the ferret will become lethargic, stop eating and drinking, become severely dehydrated and will die within 24 to 48 hours.
Signs of a complete GI obstruction include any of the following: sudden collapse, lethargy, vomiting, absence of stools, severe dehydration, dark or bluish colored gums, bloated and painful abdomen, seizures, and finally coma and death. Emergency surgery to remove the foreign material is the only choice.
Preventing foreign bodies should be an important consideration for any ferret owner. Restrict your ferret from access to any soft, rubbery, foamy or chewy objects. You can reduce the incidence of hairballs by brushing your ferret frequently. Some people advocate the use of a hairball laxative, which may help to move hair out of the stomach, but we have no definitive proof of this. If you are going to use something of this nature, it is better to use a pea-sized glob of petroleum jelly on the ferrets paw daily (they lick it off) rather than the sweetened hairball laxative that is not very healthy for ferrets, particularly if they have insulinoma. Petroleum jelly is the main “active” ingredient in hairball laxatives and ferrets will take it unflavored!
Another helpful prevention measure is to treat any underlying inflammatory GI disease, which may result in lower motility and thus may prevent hair from moving out normally from the stomach. Your veterinarian may take a biopsy of the stomach, intestine or surrounding lymph nodes when doing the surgery for the GI foreign body to check of this other disease.
Inflammatory Bowel Disease (IBD) (lymphocytic, plamacytic)
IBD is an inflammatory condition of the gastrointestinal tract that is quite common in ferrets. Although the cause of IBD is unknown, this chronic immune response may be associated with food allergies, dietary intolerance, bacterial overgrowth, starch overload, infectious disease, metabolic disease or other factors. There could potentially even be a genetic predisposition for the disease.
IBD is most commonly found in ferrets over two years old. This disease is associated with inflammatory changes in both the stomach and small intestine. Because the signs of IBD can resemble other common GI disease, it can be easily overlooked or misdiagnosed. Early diagnosis of IBD in ferrets is important. Chronic damage to the gut from IBD can potentially cause malnutrition and emaciation, secondary bacterial overgrowth and infection, hepatitis, and eventual development of lymphoma, which is a type of cancer.
IBD in ferrets is often diagnosed incidentally when blood work is taken for some other illness, such as adrenal disease or insulinoma. Certain blood chemistry values create suspicion of IBD. A definitive diagnosis is made with an intestinal biopsy. Many ferrets that have IBD do not display any clinical signs. Signs are more often observed when the disease becomes more advanced or when secondary disease occurs (such as bacterial overgrowth or liver disease).
Clinical signs of IBD include:
Abnormal stools – chronically green or yellow, mucoid or gelatinous, grainy, tarry or bloody, and episodes of diarrhea.
Nausea – pawing at the mouth, grinding teeth, and/or vomiting
Thin body build/muscle wasted, especially over the ribs, pelvis, and shoulder areas due to reduced muscle mass. Muscle wasting can come from the reduced ability to properly process and digest food and to absorb nutrients. It can also occur from losing protein form the intestines due to the gut being “leaky” from chronic damage and inflammation.
Decreased activity or lethargy may be observed as the disease progresses and the ferret’s overall condition declines.
Hairballs. It is likely that this occurs as a result of decreased gastric motility secondary to the underlying gastric inflammation.
Blood work values associated with IBD:
- Lipase and globulin values are often elevated in ferrets that have IBD almost always the gastrointestinal tract.
- Liver values may be elevated due to the gut inflammation spreading to the liver. It should be noted that liver infections, adrenal disease, primary liver disease, cancer, and medications such as prednisolone can also increase these values.
- The complete blood count (CBC) may reveal an increase in certain types of white blood cells that may indicate IBD, lymphoma, or an underlying disease associated with IBD.
There is currently no definitive cure for IBD, but the goal of therapy is to control the inflammation and damage to the stomach and intestines, both to alleviate signs associated with the disease and to prevent possible progression of the disease into lymphoma. Use of a hypoallergenic or novel protein diet may reduce gut inflammation if a food allergy is the cause. Low starch diets may help if starch overload and subsequent bacterial overgrowth is the cause.
However, dietary changes alone are rarely enough to control IBD. A drug called azathioprine (Imuran)is frequently used to control the inflammatory response in ferrets with IBD. Sometimes other anti-inflammatory drugs, such as prenisolone, may be used in conjunction with Imuran but with caution. Antibiotics such as Bayril and amoxicillin often reduce clinical signs like diarrhea and nausea. Other medications such as vitamin B12 and colostrum may potentially improve absorption of nutrients from the gut. Often clinical signs, if there are any, will improve as the inflammation is controlled.
Although IBD can be potentially controlled successfully with medication, some ferrets do not respond to treatment as well as others. Research is ongoing for inflammatory bowel disease in ferrets (and other species), as it is a disease seen in many species and is still not completely understood.
Bacterial Overgrowth
Bacterial overgrowth refers to an increase in the growth and aggressive behavior of otherwise normal intestinal bacteria. It is usually secondary to some underlying disease or stressful condition, such as IBS, coronavirus (ECE), Helicobacter mustelea, GI foreign bodies, inappropriate diets or sudden dietary changes, or other debilitating or stressful conditions. Prompt treatment of bacterial overgrowth is recommended, as this condition can potentially become quite serious in a short period of time. A thorough exam and appropriate diagnostics can also help determine the underlying cause for the bacterial overgrowth.
Signs observed with bacterial overgrowth typically include diarrhea, decreased appetite, weight loss, decreased activity, nausea, and occasionally vomiting. Sometimes dehydration occurs secondary to fluid loss (from diarrhea or vomiting) or from decreased fluid intake. Signs can be mild and sporadic with episodes that can occur weeks or even months apart. If repeated episodes are observed and the diet has been consistent, then there is likely an underlying disease present such as inflammatory bowel disease.
Treatment of bacterial overgrowth consists of broad-spectrum antibiotics (often a combination is used such as Baytril or Flagyl and amoxicillin) and supportive care. Supplemental feedings and/or fluids and sometimes medications are needed to help control the diarrhea itself. Although antibiotics may help with an immediate episode of bacterial overgrowth, treating the underlying disease or primary problem is always the preferable long-term treatment plan.
Neoplasia (Cancer)
Lymphoma is the most common type of GI cancer in ferrets. In many cases, it is likely due to unrecognized chronic IBD that has progressed to cancer.
Signs of lymphoma are variable and often depend on how aggressive the cancer is (high vs. low grade) and the location and extent of organ involvement. Weight loss, decreased appetite, lethargy, abdominal masses, and abdominal distension are common findings. Sometimes peripheral lymph nodes (e.g. in the neck region, in the arm pits, and on the back side of the rear legs behind the knees are firm and enlarged, and involvement with the eye can cause the eye to be pushed out. Ferrets may grind their teeth due to nausea and GI discomfort. Intestinal lymphoma often results in tissue that is more delicate than normal and is easily torn. It is not uncommon for ferrets with GI lymphoma to have a rupture in the bowel wall and secondary peritonitis with subsequent death.
Unfortunately blood work does not provide a definitive diagnosis for lymphoma, although high lymphocyte or neutrophil counts can make the veterinarian suspicious of it. If lymph nodes are firm and enlarged, biopsies should be performed to get a diagnosis as soon as possible.
Treatment of lymphoma, or any cancer in general, can be difficult. Putting the cancer into remission for a period of time and improving and extending the quality of the ferret’s life are often more realistic goals than achieving complete resolution of the disease. Ferrets generally tolerate chemotherapy well and most affected ferrets do benefit to some extent from therapy. There are several chemotherapeutic protocols for treatment of lymphoma.
Adenocarcinoma is a type of cancer that can affect any glandular area of the body. This cancer has been seen in the pylorus (the outflow area) of the stomach and in the area of the anal glands. Cancer of the pylorus constricts the area and restricts the outflow of food from the stomach. The signs seen are the same as for a GI foreign body. The diagnosis is based on an exploratory surgery and biopsy of the affected tissue. This cancer responds poorly to chemotherapy. Adenocarcinoma of the anal gland can occur in the whole gland or when just a portion is left after the gland has been removed. It causes a large swelling next to the anus and may cause compression of the stools as they pass through the rectu. The treatment issurgical removal of the tumor.
Other types of cancer, such as primary stomach cancer and cancer of the liver are occasionally observed. Disruption of liver function can also lead to GI signs including diarrhea, wasting and vomiting. A presumptive diagnosis may be acquired with an ultrasound, but a definitive diagnosis is based on a liver biopsy.
Ferret Coronavirus-Associated Diseases
Epizootic Catarrhal Enteritis (ECE) – “Green Slime Diarrhea”
ECE is an important disease to discuss as it appears to affect a vast number of ferrets not only in ferret shelters but also in many households. The disease first appeared on the East Coast in 1993 and seemed to follow shows around that region. It rapidly spread across the U.S., likely as a result of large-scale breeding facilities infected with the disease. The causative agent of ECE is a coronavirus. The virus is unusual in that younger ferrets have fewer clinical signs than older ones. Ferrets under 4 months of age often show no sign of the disease. Ferrets 4 to 18 months old usually show mild to moderate signs, and older ferrets, especially those over 4 years of age when first exposed, appear to suffer the most and have the most severe signs associated with ECE. The virus can remain in the intestinal tract for months after all signs have resolved. This produces what is referred to as a “persistent carrier,” which is highly contagious for 6 months or more.
A typical history includes recent exposure to a new, young ferret. This can include going to a pet store to play with the young ferrets and then returning home to interact with your ferrets without proper sanitation in between. Onset of clinical signs is typically 48 to 96 hours. Affected ferrets often have a loss of appetite and are lethargic. They then produce a green, mucoid diarrhea, often referred to as bright or neon green diarrhea. The diarrhea is not always green, however, and can just be loose and/or like birdseed. Mild cases may only experience brief diarrhea. Severe weight loss can be observed and loss of body fat and muscle can be extreme within the first 7 to 10 days, even if the ferret is initially still eating well. The ECE virus affects the lining of the intestine, making it difficult for the ferret to absorb nutrients and fluids properly. The virus can also cause damage to the intestine in such a way that the ferret can lose protein and therefore nutrients from their GI tract. Even after appearing to recover from ECE, some adult ferrets have persistent, intermittent diarrhea that is often “seedy.” These ferrets can show clinical signs for weeks or even months, and changing the diet to one more easily absorbed (e.g. a hypoallergic food with hydrolyzed proteins) can sometimes facilitate recovery and help them maintain their body condition.
Although fewer ferrets die from ECE these days, many ferrets (especially middle to older aged ferrets) still need to be treated fairly aggressively. Sick ferrets should be treated with antibiotics and supportive care, and some ferrets, especially those that become dehydrated, should be treated with fluid therapy. It is critical to keep sick ferrets eating. Talk to your veterinarian about foods that can easily be syringe fed if the ferret is not eating very well on his own.
Ill and recovered animals should be isolated from unexposed ferrets for 6 to 12 months. Pets already exposed are most likely now carriers, even if they are not showing signs. Extreme care must be taken not to transmit the virus on clothing, especially in shelter and hospital situations. All young ferrets should be treated as potential ECE carriers and good sanitation habits such as disinfecting hands, clothes, and cages must be practiced to help minimize the spread of this highly contagious disease.
Ferret Systemic Coronavirus (FRSCV) (aka Ferret-FIP)
FRSCV is a newly recognized disease in ferrets. It was first reported in Spain in 2004 and was soon after also described in the United States. Clinically and pathologically, the disease closely resembles a disease in cats known as feline infectious peritonitis (FIP). FIP is a fatal, immune-mediated disease of cats that involves multiple organs and is caused by a coronavirus. FRSCV has been reported mostly in young ferrets, usually less than 18 months of age. Common signs in ferrets include diarrhea, weight loss, lethargy, decreased appetite or anorexia, and vomiting. The GI signs can lead to muscle wasting and emaciation. Neurologic signs include hind limb weakness, ataxia, tremors, head tilt and seizures. Less common signs include sneezing, coughing, labored breathing, nasal discharge, dehydration, tooth-grinding, a heart murmur, jaundice, green-colored urine, areas of red skin, reddened rectal tissue, and rectal prolapse. Large abdominal masses, enlarged spleens, and enlarged kidneys are common findings. Some ferrets have enlarged peripheral lymph nodes and fevers ranging from 103°F to 105.4°F.
Clinical signs, blood work, a urinalysis, and x-rays and/or an ultrasound are helpful in making an initial presumptive diagnosis of FRSCV in a ferret. Changes in the blood are variable and reflect damage to abdominal organs such as kidneys, liver, pancreas, and GI tract. Typical blood work results include an increased globulin, decreased albumin, a nonregenerative anemia, and thrombocytopenia. It is important to rule out other diseases such as Aleutian disease, lymphoma, multiple myeloma, chronic infection (e.g. Helicobacter), or chronic inflammatory bowel disease.
Histopathology performed on biopsied tissues that show typical microscopic lesions are highly suggestive of FRSCV. A definitive diagnosis requires a positive immunohistochemistry staining of the coronavirus antigen in macrophages within areas of granulomatous inflammation. Assays using reverse transcriptase PCR (offered through The Diagnostic Center for Population and Animal Health at Michigan State University) are the current gold standard for diagnosing FRSEV in ferrets.
The prognosis for ferrets with FRSCV is generally considered poor. However, there are treatment protocols being tried that are showing promising results. Symptomatic treatment and supportive care can help alleviate some of the clinical signs associated with the disease. Some drugs serve to suppress or modulate the immune system in an effort to reduce damage caused in response to the virus or to reduce or eliminate the virus.
Megaesophagus
Megaesophagus is a disease in which the esophagus is enlarged and does not have normal motility. It is considered to be an uncommon disease. Unfortunately the cause of megaesophagus is unknown. Identifying ferrets with the disease is important as the prognosis is generally poor. Accurately diagnosing megasophagus early on is important, as there are therapies that can slow down and potentially reverse the progression of the disease.
A common clinical sign of megaesophagus is regurgitating food 5 to 10 minutes after eating. These ferrets are often distressed while eating and sometimes appear frustrated because they are hungry but are physically unable to push the food out of their esophagus into the stomach. Afflicted ferrets are often heard making a gurgling sound during or after eating, and some ferrets choke, cough or stretch their neck out after eating. Ferrets with megaesophagus generally lose weight quickly as they are effectively starving to death.
The diagnosis of megaesopagus is made based on both clinical signs and x-rays. When a ferret is suspected of having the disease, soft food with a contrast dye, such as barium, is given before an x-ray. A positive diagnosis is made if retained dye can be seen in the esophagus, and oftentimes a dilated esophagus.
Treatment for this disease is generally supportive, especially since the cause is unknown. The management of megaesophagus in ferrets is similar to that in a dog but is usually less successful. Ferrets are fed thinned, high calorie soft food in a vertical position and then held in a vertical position for a period of time. Nutritional supplements may be added to increase calorie content. An antacid medication such as Zantac can result in significant improvement, indicating that gastric reflux and secondary inflammation of the esophagus may be a factor in this disease. Sucralfate (Carafate) can be used to coat and therefore promote healing of gastric and esophageal ulcers. Drugs that increase GI motility such as metoclopramide (Reglan) may be used to help food empty from the stomach better and reduce gastric reflux. Fluid therapy may also be necessary if the ferret is unable to get adequate fluid intake and has become dehydrated.
Although the prognosis is often poor in ferrets with megaesophagus, there have been cases that have done quite well long term with proper medical and dietary management. One of the key factors in successful treatment is identifying the disease early on, before it has progressed far and before the ferret has become too wasted and weak.
Rectal Prolapse
In rectal prolapse, the rectal tissue protrudes from the anus. This is most often a disease of a young ferret who has had an anal gland removal surgery. In these cases the nerves or muscles around the anus may have been disturbed during the surgical removal of the anal gland. This leads to a relaxed anal sphincter muscle, which allows the anal tissue to protrude. Other causes of rectal prolapse are any condition that causes the ferret to strain when defecating thus pushing out rectal tissue, such as intestinal lymphoma, proliferative colitis, severe parasitism, intestinal intussusception (where the intestine telescopes on itself), and a GI foreign body.
Eosinophilic Gastroenteritis
This is a GI disease of ferrets that causes severe inflammation of the intestinal tract possibly in response to an allergen. The body sends eosinophils, a type of white blood cell often seen in allergic reactions, to the intestine. Here the eosinophils release histamine, which is a very irritating substance. The resulting irritation to the intestinal lining causes severe diarrhea and the inability to absorb nutrients. The ferret will start losing weight and will eventually become extremely thin. Some ferrets become so severely affected that they also develop swollen ears and feet and ulcerations on the skin.
The diagnosis is based on a complete blood cell count that usually shows a high number of eosinophils and a biopsy of the intestine and surrounding lymph nodes. Classically this disease has been treated with corticosteroids to reduce the inflammatory reaction and the response to the histamine release. This will, indeed, control the signs of disease, but often has to be given for the life of the pet. Making dietary changes can cause a significant reduction in the signs and it is speculated that eosinophilic gastroenteritis may be a food allergy problem. Some ferrets no longer need corticosteroids when changed to a “hypoallergenic” diet. We recommend feeding a diet completely devoid of grains.
Proliferative bowel disease
Proliferative bowel disease (PBD) is a disease that is caused by a bacterium known as Lawsonia intracellularis. This disease causes inflammation and thickening of the small intestine and/or colon. Ferrets suffering from PBD often have severe wasting that is similar to that seen with ECE (discussed previously). However, in contrast to ECE, this disease most frequently affects rapidly growing juvenile ferrets around 10 to 16 weeks of age.
Environmental and nutritional stress factors appear to be important in this disease, as the incidence of this disease appears to have decreased as the quality of care and nutrition of pet ferrets has improved. This disease has become less common and is rare in the Pacific Northwest region of the U.S. However, beginning treatment early on is crucial, as this disease can be potentially fatal.
Ferrets with PBD have chronic diarrhea that can vary in color and consistency. Feces can be dark and liquid, have streaks of bright red blood, and/or be mucoid with bright green mucus. The fur around the anus and on the tail may be wet and stained with fecal material. Straining and moaning or crying is often observed, as is protrusion of the rectal tissue. Ferrets suffering from this disease are usually dehydrated and have low blood protein levels. Since ferrets with PBD are often severely debilitated, they are more susceptible to other infectious diseases such as upper respiratory infections and they frequently develop gastritis (inflammation of the stomach) and ulcers. Without appropriate treatment, ferrets with PBD can lose half their weight in less than two weeks. As the disease progresses, ferrets with PBD become very weak and sleep most of the time.
Diagnosis of PBD is usually made based on clinical signs and being the appropriate age. Your veterinarian may be able to feel the thickened bowel tissue, especially if the colon is involved. Intestinal biopsies and histopathologic examination of the tissue can confirm the diagnosis, however surgery is not recommended in debilitated animals.
Treatment of this disease includes an antibiotic, fluid therapy, nutritional support, and other necessary supportive care. One should make sure that the ferret is housed in a clean, sanitary environment and that the ferret is on an appropriate, high quality diet. Severe damage to the intestine from a disease such as PBD could potentially initiate or result in secondary problems such as inflammatory bowel disease. Therefore, a ferret that has suffered from any severe GI disease such as PBD or ECE should be monitored carefully, both clinically and with appropriate diagnostics such as blood work, throughout its life.
Parasitic Infections
GI parasites are uncommon in the American ferret largely because the majority of ferrets are raised in large, parasite-free breeding colonies. However, parasitic problems do occasionally occur where ferrets have access to contaminated food or water or the stools of animals containing parasites. The two most common parasites encountered in the American pet ferret are coccidia and giardia, which are both one-celled protozoa. The signs of disease can range from none to diarrhea and wasting.
Coccidiosis is usually observed in stressed, juvenile ferrets. The diagnosis is made on direct microscopic examination of fresh feces or on stains that can be performed on the feces. Treatment involves the use of antiparasitic drugs for a minimum of two weeks along with environmental cleanup to remove contaminated feces.
Ferrets can also be infested with other parasites such as tapeworms, roundworms and hookworms. These parasites can be transmitted from other pets in the household. If you have other pets in the household diagnosed with a parasite problem then you should have your ferrets’ stool checked for parasites as well.
Rotavirus
This is a viral disease that can spread rapidly through a group of ferrets. The disease is usually mild and causes soft, green mucus-coated stools for two to three days. The diagnosis is made on signs and possibly by viral isolation from the stool. Treatment is rarely necessary because ferrets recover rapidly on their own. If necessary, supplemental fluids and intestinal coating agents may be used.
Enterotoxemia
Bacterial enterotoxemia is an uncommon but potentially fatal consequence of severe GI disease and disruption of the normal intestinal bacterial flora. This can occur with diseases such as IBD, bacterial overgrowth, ECE, and other GI diseases. A Clostridium species is the most likely bacterial organism responsible for enterotoxemia.
Treatment of enterotoxemia must be aggressive and rapid. A combination of broad spectrum antibiotics such as metronidazole (Flagyl) and amoxicillin or enrofloxacin (Baytril) and amoxicillin, IV fluid therapy, a toxin binding agent such as activated charcoal, nutritional supplementation, and supportive care for symptomatic treatment of diarrhea, shock, hypothermia, etc. are necessary.
Enterotoxemia is more easily prevented than treated. Therefore appropriate antibiotics and supportive care for any ferret demonstrating significant GI upset can help prevent or minimize the effects of enterotoxemia. If a ferret dies from suspected enterotoxemia, a diagnosis can be confirmed by performing a necropsy and observing large areas of the small intestine that are dark red to black in color.
Toxins
Ferrets love to investigate all kinds of things around the house including purses or trouser pockets! Ferrets have been known to eat aspirin, rat poison, toxic plants and antifreeze among other things. Signs can range from mild diarrhea and vomiting to complete collapse and coma. The diagnosis is based on the history of exposure to toxins, blood results and response to therapy.
Influenza
Ferrets are susceptible to human influenza and primarily develop upper respiratory signs. Occasionally a ferret can also exhibit diarrhea. The diagnosis is based on the history and signs of upper respiratory disease along with diarrhea. Treatment ranges from none to fluid replacement, antihistamines for the upper respiratory signs, and antidiarrheals. Most ferrets recover from influenza on their own in a week or two with little supportive care. Influenza is transmissible between ferrets and humans both ways. Take care to protect your ferret if you develop influenza by using good sanitation and a face mask when handling your companion and the same goes for when your ferret develops influenza to keep it from spreading to you.
Date Published: 2/16/2012 2:25:00 PM
Copyright 2012 - 2013 by Susan Brown, DVM. Used with permission. All rights reserved
