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Alabama Rot, also known as Cutaneous and Renal Glomerular Vasculopathy (CRGV), is a serious and potentially fatal disease that has been reported in 384 dogs in the UK to date, with 10 this year up to 8th February 2024. As the name suggests, the disease was first identified in the southern United States in the 1980s where it affected greyhounds. Whatever it is that is affecting dogs in the UK appears to be different. The first suspected cases in the UK were reported in November 2012 purely based on clinical signs. The specific diagnosis of CRGV can only be confirmed by post-mortem examination, although it wasn't until January 2014 that the outbreak in England was identified as having the same or similar histological and clinical findings to Alabama Rot as seen in the USA.
Common features
There appears to be more frequent reports from certain areas of the UK, but it is unclear whether this is a real geographical distribution, and there are no existing warnings about any specific places or areas to avoid. Those who wish to find out if there have been any cases in their local area can see an up to date map here: https://www.alabama-rot.co.uk/live-map-of-cases/.
CRGV seems more likely to develop in dogs between November and May, and when exercised in woodland areas following increased rainfall. It is important to bear in mind that there will inevitably have been dogs that were exercised in the same places as those who have developed CRGV, who have not gone on to develop symptoms themselves. There is no evidence of a contagious factor. Multiple dogs within a single household have been affected in some cases, but this is thought to be due to having all been exercised together rather than through anything contagious, as symptoms in all dogs started at the same time.
Any dog of any breed or age can be affected. Breeds like Labradors, Spaniels, and Hungarian Vizslas might be slightly more susceptible based on available data, but this might be that they are breeds more likely to frequent and exercise in the habitats more often associated with cases.
Water association
The hypothesis that Alabama Rot is spread through stagnant water is one of the leading theories, but it hasn't been definitively proven. Stagnant water might simply be a common factor in the areas where dogs contract the disease, not necessarily the direct source of the pathogen itself. The theory suggests that dogs might come into contact with the unknown causative agent while walking through, or playing in stagnant water, or something that is situated very close to stagnant water. “It” could then enter the dog's body through wounds or abrasions on the legs or paws, or potentially through ingestion. Other theories include exposure to certain plants, toxins, or even a tick-borne agent. Blue-green algae (BGA also called cyanobacteria) can be toxic to dogs if ingested and has also been suggested but not proven. The toxins from BGA can also cause serious illness or even death with symptoms including vomiting, diarrhoea, seizures, and disorientation, but differs by not showing skin lesions.
Clinical symptoms
CRGV damages blood vessels in the skin and kidneys of dogs. The cause is currently unknown. Although a number of suggestions have been put forward none have yet to be confirmed. There are common environmental factors in cases to date, but these would seem to be correlations rather than causation.
Symptoms include the following:
Unexplained skin sores or lesions, typically below the knee or elbow (but can appear on face, chest, or abdomen).
Redness, swelling, or open wounds on the skin.
Changes in appetite (reduced appetite, vomiting, lethargy) - signs of potential kidney damage.
Considerable concern has arisen because although it is a rare disease, all cases that developed symptoms of acute kidney failure following initial skin lesions have been fatal. With early treatment at the skin lesion stage, some dogs have been able to survive.
It could be that it existed sporadically before as some sort of “mystery” illness, and diagnoses have increased through increased awareness. Those vets who have seen it before will be better at identifying it more quickly, and cases will be less easily missed and overlooked now given that it has appeared extensively in the veterinary press as well as research papers, and the physical symptoms of sores associated with all the other symptoms means the differential diagnostic list is very short. Seasonal Canine Illness does not have the same skin lesions so is not the same. I can’t imagine many, if any dogs have died from CRGV without it being highly suspected, although whether all such cases have been submitted for autopsy and therefore confirmed, I don’t know. Anderson Moores vet practice offer a free of charge service to receive post mortem samples for diagnosis. They consequently hold a database of results to assist with research being carried out. I would therefore encourage owners of dogs suspected of having CRGV to ask their vet to inform Anderson Moores and to let them know about suspected cases, and to send them post-mortem samples for diagnosis should the dog not pull through. Anderson Moores and the Royal Veterinary College small animal referral service offer intensive inpatient treatment options if appropriately early in the course of the disease.
Treatment
There is no specific test for CRGV and diagnosis involves ruling out other causes and evaluating clinical signs. The current approach to treatment aims to manage symptoms and support the dog's body, but there's no known specific cure at this point in time and given the unknown nature of CRGV there are no guaranteed preventative measure other than to ensure when walking in woodlands after periods of rainfall that you wash off mud etc so that dogs do not ingest anything that might start it off. I would also discourage dogs from drinking from puddles and from scavenging within such areas as much as possible too, although it is obviously impossible to restrict their natural behaviour to investigate everything when out and about.
I’ve never been asked to treat CRGV so I cannot claim to be able to categorically heal it or help, but there are certainly some options that I would be willing to try. As with a conventional approach, the earlier treatment starts the better the chance it has to be successful, and in a serious situation the more aggressively you need to treat – ie treat it with everything you can and however you can and hope that it all works together to recover the situation, which in the case of CRGV would be to primarily support the internal environment of the body to restore function from my perspective.
Further information:
Alabama Rot Research Fund (ARRF) Registered Charity: https://www.arrf.co.uk/
The Alabama Rot Veterinary Specialist Group: https://www.rvc.ac.uk/small-animal-referrals/Media/SmallAnimalReferrals/pdf/Alabama%20rot%20PDF%20for%20vets.pdf
RSPCA Alabama Rot: https://www.rspca.org.uk/adviceandwelfare/diseases/alabamarot
RVC FAQs: https://www.rvc.ac.uk/small-animal-vet/news/alabama-rot-in-the-uk-frequently-asked-questions
Has it been found in cats?