Vague clinical signs in my own bunny (with bloods/rads etc)

RE: Vague clinical signs in my own bunny (with bloods/rads etc)

Ashley Sykes — Wed, 13 Sep 2017 21:46:52 GMT

Yeh - will update you once I hear from filavie!

RE: Vague clinical signs in my own bunny (with bloods/rads etc)

Marie Kubiak — Wed, 13 Sep 2017 21:39:05 GMT

I agree- I would be surprised if vaccination 5 months ago still resulted in 'abundant' RNA.

RE: Vague clinical signs in my own bunny (with bloods/rads etc)

Ashley Sykes — Wed, 13 Sep 2017 21:01:51 GMT

[quote user="Marie Kubiak"]

Interesting. On discussing your rabbit with RWAFs vet advisor, he mentioned other suspected vaccine failures so very interested to hear any more if you can get further details about PCR.

Any possibility (if false +ve) that a lobe could have torsed then righted??? It would be a limited area of necrosis affecting one lobe rather than diffuse oozing for that.

Marie

[/quote]

I have literally got a reply this afternoon. It is:

[quote]

With reference to your recent telecom regarding the RHD-2 PCR test that we did for Pepsi Sykes, I can confirm that unfortunately, we are not able to differentiate between RHDV-2 vaccine and field strains.

We have checked the RHDV-2 PCR result for 90739 and we had a Ct value of 22.75. To the best of our knowledge, it is possible but unlikely that this positive PCR result is due to detection of the vaccine strain (if the vaccination was done a couple of months ago).

In general, we store the extracted RNA for one year.

[/quote]

And online, it says:

[quote]Typically, C_t values below 29 cycles show abundant nucleic acids, and C_t values above 38 cycles indicate minimal amounts, and possibly an infection or environmental contamination[/quote]

This indicates to me active RHD2 infection is more likely than vaccine-related false positive, would you agree from this?

I will send this to Filavie this evening (but have not had a reply to my original email as of yet)

RE: Vague clinical signs in my own bunny (with bloods/rads etc)

Marie Kubiak — Wed, 13 Sep 2017 19:25:52 GMT

Interesting. On discussing your rabbit with RWAFs vet advisor, he mentioned other suspected vaccine failures so very interested to hear any more if you can get further details about PCR.

Any possibility (if false +ve) that a lobe could have torsed then righted??? It would be a limited area of necrosis affecting one lobe rather than diffuse oozing for that.

Marie

RE: Vague clinical signs in my own bunny (with bloods/rads etc)

Ashley Sykes — Tue, 12 Sep 2017 17:45:17 GMT

[quote user="Emily Rainbow"]

Reassuring in a way that there was nothing more you could do Ashley.... but not good that we've now got a documented vaccine failure! (And within 6m too!).

Have you noticed the manufacturers?

[/quote]

Emily, sorry for the delay in reply been trying to sort it all out. As it stands:

I spoke to PALS labs regarding the specificity of the RHD-2 PCR and they advise 100% (either viral DNA is there, or it is not!).

I spoke to Filavie (French company procuding Filovac RHD-2 vaccine) and gave case details. They advised that a low-false positive from vaccination is possible. He advised me to get more information about "how positive" the PCR was. He says that this information is to do with how many replications were required on the PCR to get a positive result. he says that low numbers of viral DNA may be present from vaccination (from April?!). He also wants me to keep the sample of liver.

I have spoken again with PALS and they are currently looking into this information for me and will keep the sample, and plan to get back to me in the next several days.

So once I know anything further I will update!

RE: Vague clinical signs in my own bunny (with bloods/rads etc)

Emily Rainbow — Thu, 07 Sep 2017 21:35:57 GMT

Reassuring in a way that there was nothing more you could do Ashley.... but not good that we've now got a documented vaccine failure! (And within 6m too!).

Have you noticed the manufacturers?

RE: Vague clinical signs in my own bunny (with bloods/rads etc)

Ashley Sykes — Thu, 07 Sep 2017 17:33:30 GMT

Marie: very interesting result...

VIROLOGY
RHD-1 PCR Negative
RHD-2 PCR POSITIVE

My bunnies both had the Filovac RHD2 vaccine (batch 060K60908C2A) on Aril 5th this year.

What do you make of this? My testing was done via PALS labs, they are closed currently will ring tomorrow regarding specificity of testing....

RE: Vague clinical signs in my own bunny (with bloods/rads etc)

Ashley Sykes — Mon, 04 Sep 2017 16:06:37 GMT

[quote user="Emily Rainbow"]

Maybe ring the lab and ask them? I've certainly sent defrosted samples previously (and told the lab) and had reliably results for different things.

[/quote]

[quote user="Lou Dawson"]

Fresh frozen tissue should be fine for RHD PCR but wouldn't rely on getting any useful results on histo. Sorry about your rabbit Ashley :(

[/quote]

Thanks guys. I rang PALS labs this morning and they are fine with frozen/defrosted samples so my colleague is going to take it for me this afternoon. I will update here in a few days.

RE: Vague clinical signs in my own bunny (with bloods/rads etc)

Lou Dawson — Mon, 04 Sep 2017 13:43:08 GMT

Fresh frozen tissue should be fine for RHD PCR but wouldn't rely on getting any useful results on histo. Sorry about your rabbit Ashley :(

RE: Vague clinical signs in my own bunny (with bloods/rads etc)

Emily Rainbow — Mon, 04 Sep 2017 12:03:00 GMT

Maybe ring the lab and ask them? I've certainly sent defrosted samples previously (and told the lab) and had reliably results for different things.

RE: Vague clinical signs in my own bunny (with bloods/rads etc)

Ashley Sykes — Mon, 04 Sep 2017 10:26:38 GMT

[quote user="Marie Kubiak"]

Really sorry to hear this Ashley.

It is a bizarre one, and would be worth sending a liver sample for histo to know what was going on and if there is a risk for your other rabbit. It could fit with RHD2 hepatitis but that would imply vaccine failure (which isn't impossible as we know very little about the new vaccines).

Hyperglycaemia tends to be specifically associated with small intestinal obstruction rather than all abdominal crises so I wouldn't have expected the same dramatic rise here.

I think you have done all that could have been done and it was a weird and difficult situation with very few clues as to what was going on. I'm impressed you can be so professional about your own animal- I turn in to an overemotional mess and have to get a colleague to take over.

Marie

[/quote]

Ah - to be fair I thouht the glucose thing was abdominal crisis/pain, interesting to know. THanks for your comments. I was/am very upset for sure, but I knew that if he was going to not make it I wanted to be the one operating. Then there can be no if/whats/buts....

I am 100% willing to send something - if possible. I took the clotted blood (no liver tissue) and put it in histo (not saline), and he is currently in the freezer. I guess that negates any sort of RHD2 histo? (Saline fresh liver is needed right?). Would defrosted saline liver be possible?

RE: Vague clinical signs in my own bunny (with bloods/rads etc)

Marie Kubiak — Mon, 04 Sep 2017 09:26:09 GMT

Really sorry to hear this Ashley.

Hyperglycaemia tends to be specifically associated with small intestinal obstruction rather than all abdominal crises so I wouldn't have expected the same dramatic rise here.

Marie

RE: Vague clinical signs in my own bunny (with bloods/rads etc)

Emily Rainbow — Mon, 04 Sep 2017 01:56:43 GMT

Sorry to read this Ashley. Not sure I would have done anything different myself as sounds quite odd!

RE: Vague clinical signs in my own bunny (with bloods/rads etc)

Ashley Sykes — Mon, 04 Sep 2017 00:01:48 GMT

Not good news...

Had a smooth GA (IV line / intubated / hypnovel IV premed / alfaxan induction / very smooth induction/GA), routine midline exlap.

Found all GIT contents normal. Large amounts (12 swabs worth in total) of serosanginous fluid.

Found large clot of blood/fibrin around liver - no liver lobe torsion. Gently teased away the clot/firbin to find source as worried may be perforation or such. Found bleeding on multiple areas of the inside of the liver lobe(s), but bleeding/oozing consistently from deeper into where the hepatic vessels originate - placed moistened swabs into this for 5 mins x 3 times, stopped 90% of bleeding, clotting well with fresh clots. No other abnormalities/causes seen, no tumours/lumps/coccidiosis etc.

Proceeded to close abdo etc without any serious amount of bleeding. Doing well but crashed on recovery not responsive to CPR - died.

Very sad, but I am 100% confident I did the right treatment. I guess this might explain the mildly elevated alp / mildly decreased HCT / rising retics in first 48hrs.

He is/was a VERY active bunny who jumps 6ft+ high wire mesh (and so lives in a roofed enclosure 6ft high) and I suspect he may have had liver trauma from this, causing pain initially, and then last 48hours started to bleed causing worsening of clinical symptoms?

Out of interest his glucose tonight immediately pre-op was 9.7, so still not "acute abdo" level despite it being such.

Do you also remember 2-3 years ago my OTHER bunny had liver lobe torsion? he survived surgery and is doing 100% fine and also did NOT have high glucose levels pre-op (11 ish if I recall correctly).

Rabbits never follow the rules do they. Here are some pics, you can see the large fibrin clot / bleeding deeper liver tissues and surface tissues / clot removed from body.

Thanks again so much for your help Marie I can't say how much I appreciate it.

https://i.imgur.com/CRiDT1A.jpg

https://i.imgur.com/LmEGq15.jpg

https://i.imgur.com/s5Y5d7s.jpg

https://i.imgur.com/1MUKhiE.jpg

RE: Vague clinical signs in my own bunny (with bloods/rads etc)

Marie Kubiak — Sun, 03 Sep 2017 21:34:06 GMT

Good luck, hope all goes well

RE: Vague clinical signs in my own bunny (with bloods/rads etc)

Ashley Sykes — Sun, 03 Sep 2017 21:01:05 GMT

Not the answer I wanted but the answer I knew.

I will ex-lap, wish me luck.

RE: Vague clinical signs in my own bunny (with bloods/rads etc)

Marie Kubiak — Sun, 03 Sep 2017 20:55:52 GMT

Hi,

If septic peritonitis is present then a rapid exlap is needed to find source, attempt repair/resection and flush the abdomen. If you aren't sure based on fluid appearance then cytology will be more useful. If confirmed, waiting will only make the situation harder to resolve but prognosis is guarded in a truly septic rabbit not only in the short-term but long-term due to high likelihood of adhesions.

Marie

RE: Vague clinical signs in my own bunny (with bloods/rads etc)

Ashley Sykes — Sun, 03 Sep 2017 20:45:00 GMT

[quote user="Marie Kubiak"]

Hi,

Sorry to hear things aren't going well.

Yes, 5d off baycox before next dose is due.

I wouldn't be concerned about EC currently given the lack of symptoms and the likely further drop in HCT fenbendazole will produce.

The radiographs seems to show a loss of abdominal contrast now - would be woth a quick scan to look for free fluid or serosal inflammatory changes particularly given the previous FBs and his decline.

Marie

[/quote]

Marie you are right:

https://i.imgur.com/Y3eIaF8.jpg

The scan (picture is not great sorry) suggested slight amounts of non clotting free fluid. I cautiously did an abdocentesis and aspirated 1ml of serosanginous / slightly yellow/purulent perhaps material, slighty turbid. It looks to have a "PCV" of ~4% / total protein 3.8g/dl

Do I start ABs? Or do I think exlap? I am afraid the ultrasound showed v little else in way of cause except some good peristalsis in the guts.

RE: Vague clinical signs in my own bunny (with bloods/rads etc)

Marie Kubiak — Sun, 03 Sep 2017 19:29:00 GMT

Hi,

Sorry to hear things aren't going well.

Yes, 5d off baycox before next dose is due.

I wouldn't be concerned about EC currently given the lack of symptoms and the likely further drop in HCT fenbendazole will produce.

The radiographs seems to show a loss of abdominal contrast now - would be woth a quick scan to look for free fluid or serosal inflammatory changes particularly given the previous FBs and his decline.

Marie

RE: Vague clinical signs in my own bunny (with bloods/rads etc)

Ashley Sykes — Sun, 03 Sep 2017 18:38:34 GMT

[quote user="Marie Kubiak"]

How is he today?

Maybe just try a low dose (0.03mg/kg q8hrs) as a compromise- it is hard to be confident there is no pain causing this. Plus GI distension is uncomfortable and opioids are apparently better at relieving this kind of pain than NSAIDs.

Can you post the more recent xray?

[/quote]

He is worse now: showing pain signs, rapid breathing and wide eyed. But still no cause/pain focus I can find. He had his second baycox dose today (rpt in 5 days [?]). So I have started (literally just now) bupe.

So his current meds are: buprenorphine 0.05mg/kg q 6hrs / metacam 1mg/kg q12hrs / metaclop 1mg/kg q12hrs / zantac 5mg/kg q12hrs.

Yes certainly: this is the xray taken, conscious DV, this evening. Stomach gasesous distension / markedly less food in GI tract generally / no metallic objects - those are my thoughts....

https://i.imgur.com/6Ecy8ft.jpg

THank you for your continued help. Without having a diagnosis I am struggling to decide whether it is humane to continue, given that he still takes the syringe feed well enough to keep his weight stable (2.96kg today) and happy to continue for now, but it is pressing on in time.

Would you perceive the risk of starting 20mg/kg SID fenbendazole a good idea for E. cuniculi, as it has risks for panleukopaenia (correct?) given that bloods for titres are 5-10 days away if taken tomorrow...

RE: Vague clinical signs in my own bunny (with bloods/rads etc)

Marie Kubiak — Sun, 03 Sep 2017 18:13:49 GMT

How is he today?

[quote user="Ashley Sykes"]Tried buprenorphine and had seemingly no difference so have not given it again (I use this lots generally but I don't want him too spaced if he has not got an obvious pain focus?)[/quote]

Can you post the more recent xray?

[quote user="David Mills"]Sounds like rabbit might be suffering somewhat... [/quote]

He is probably currently suffering but then arguably so are most of patients under treatment to some degree. Without any clear cause or factor that makes prognosis evidently poor I think it is perfectly reasonable to continue. I'm sure Ashley is capable of being objective, or sharing that responsibility with colleagues if need be.

[quote user="Clare Tapsfield-Wright"]Marie , I am always so impressed by how generous you are with your time in giving advice.[/quote]

Thank you Clare but I don't feel I do anything other than weighing in with my views and niche knowledge, same as everyone else on here. It just happens my niche is a bit odd so I'm a lone voice at times. (Plus I'm currently writing a book and any distraction at all is immediately seized very gratefully!)

Marie

RE: Vague clinical signs in my own bunny (with bloods/rads etc)

Ashley Sykes — Sun, 03 Sep 2017 14:26:04 GMT

[quote user="Emily Rainbow"]

Is he fully vacc including vhd2?

I'd also be starting some metoclop.

[/quote]

Yes fully vacc'd, rhd2 within last 6 months.

Yeh I will do metaclop too, can't hurt

RE: Vague clinical signs in my own bunny (with bloods/rads etc)

Emily Rainbow — Sun, 03 Sep 2017 13:08:27 GMT

Is he fully vacc including vhd2?

I'd also be starting some metoclop.

RE: Vague clinical signs in my own bunny (with bloods/rads etc)

David Mills — Sat, 02 Sep 2017 23:00:19 GMT

Sounds like rabbit might be suffering somewhat...

RE: Vague clinical signs in my own bunny (with bloods/rads etc)

Ashley Sykes — Sat, 02 Sep 2017 21:00:56 GMT

[quote user="Marie Kubiak"]

Anything picked up on scan/repeat rad/ears today? Any painful area suspected on exam? Are faeces being passed?

I'd love to be able to give more useful advice but with no obvious cause and nonspecific signs it is really tricky to make a more robust plan.

Is he on metacam, feeding and fluids alone currently? What feeding and fluid rates? If not already started then prokinetics (5mg/kg ranitidine slow iv bid is my favourite) plus opioids (buprenorphine/methadone/tramadol) would be good adjuncts to existing supportive care. Given the history starting toltrazuril is sensible given the general lack of side effects and small potential for hepatic coccidiosis. Very rarely I've seen pancreatitis present like this with high TLI picked up (there's probably more cases though given how rarely we test) so worth considering but treatment is same as supportive care. And keep repeating exam and bloods to look for any developing trends. Sorry I can't help more.

Marie

[/quote]

Sorry again for the late reply, have been doing as much as possible for him, running around on a saturday!

So:

- repeat rads: conscious DV showed all metallic material had dissappeared, so likely a mis-nomer. Stomach and intestines much emptier, and gassier, now.

- abdo ultrasound: our scanner is rubbish, but NAD (two vets looked).

- ears: looked fine, nothing abnormal and no pain on palpation

- no pain on general exam.

- faeces are being passed but are smaller and fewer. Normal/dark colour.

- glucose stable 7-ish, PCV stable 32-ish.

- currently on metacam 1mg/kg BID / zantac 3mg/kg SC BID (I will up it!) / fluids 20ml every other hour (he is having lots of oral emeraid and thus fluids via this too). Tried buprenorphine and had seemingly no difference so have not given it again (I use this lots generally but I don't want him too spaced if he has not got an obvious pain focus?)

- today I sourced some baycox and gave the first of the two doses (2.5mg/kg q24 X 2 / rpt 5 days yeh?)

I will just continue but certainly vastly worse past 48hrs than pevious 6 days.....

thanks so much for your help as always!