Puppy strangles is a disease of puppies, also referred to as puppy head gland disease , juvenile pyoderma and juvenile cellulitis.

Introduction

Juvenile cellulitis is a relatively rare condition and so, may not initially be considered when puppies are first presented with what appears to be staphylococcal pyoderma

Pyoderma

Pyoderma means any skin disease that is pyogenic. These include superficial bacterial infections such as impetigo, impetigo contagiosa, ecthyma, folliculitis, Bockhart impetigo, furuncle, carbuncle, tropical ulcer, etc. Autoimmune conditions include pyoderma gangrenosum...

.

Causes

The cause of juvenile cellulitis is unknown. Cytologic

Cytopathology

Cytopathology is a branch of pathology that studies and diagnoses diseases on the cellular level. The discipline was founded by Rudolf Virchow in 1858. A common application of cytopathology is the Pap smear, used as a screening tool, to detect precancerous cervical lesions and prevent cervical...

 examination of aspirates

Needle aspiration biopsy

Needle aspiration biopsy , may refer to fine needle aspiration cytology , fine needle aspiration biopsy and fine needle aspiration , is a diagnostic procedure sometimes used to investigate superficial lumps or masses...

 of affected lymph node

Lymph node

A lymph node is a small ball or an oval-shaped organ of the immune system, distributed widely throughout the body including the armpit and stomach/gut and linked by lymphatic vessels. Lymph nodes are garrisons of B, T, and other immune cells. Lymph nodes are found all through the body, and act as...

s, pustules, abscess

Abscess

An abscess is a collection of pus that has accumulated in a cavity formed by the tissue in which the pus resides due to an infectious process or other foreign materials...

es, and joint fluid rarely reveal bacteria

Bacteria

Bacteria are a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria have a wide range of shapes, ranging from spheres to rods and spirals...

, and culture results of intact lesion

Lesion

A lesion is any abnormality in the tissue of an organism , usually caused by disease or trauma. Lesion is derived from the Latin word laesio which means injury.- Types :...

s are always negative for bacterial growth

Bacterial growth

250px|right|thumb|Growth is shown as L = log where numbers is the number of colony forming units per ml, versus T Bacterial growth is the division of one bacterium into two daughter cells in a process called binary fission. Providing no mutational event occurs the resulting daughter cells are...

, suggesting a nonbacterial etiology.

Symptoms

Symptoms of juvenile cellulitis are dermatitis

Dermatitis

-Etymology:Dermatitis derives from Greek derma "skin" + -itis "inflammation" and genetic disorder.-Terminology:There are several different types of dermatitis. The different kinds usually have in common an allergic reaction to specific allergens. The term may describe eczema, which is also called...

 of the face, otitis externa

Otitis externa

Otitis externa is an inflammation of the outer ear and ear canal. Along with otitis media, external otitis is one of the two human conditions commonly called "earache". It also occurs in many other species. Inflammation of the skin of the ear canal is the essence of this disorder...

, regional lymphadenopathy

Lymphadenopathy

Lymphadenopathy is a term meaning "disease of the lymph nodes." It is, however, almost synonymously used with "swollen/enlarged lymph nodes". It could be due to infection, auto-immune disease, or malignancy....

, lethargy, depression

Depression (mood)

Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behaviour, feelings and physical well-being. Depressed people may feel sad, anxious, empty, hopeless, helpless, worthless, guilty, irritable, or restless...

 and limb lameness. It is common for symptoms to appear after the puppies' initial vaccination

Vaccination

Vaccination is the administration of antigenic material to stimulate the immune system of an individual to develop adaptive immunity to a disease. Vaccines can prevent or ameliorate the effects of infection by many pathogens...

 at about 6 weeks of age. Puppies with juvenile cellulitis are quiet, alert and responsive. Investigation into the limb lameness will reveal no abnormalities. Tests on the puppies' ears will reveal no ear mite

Ear mite

Ear mites are mites that live in the ears of animals. The most commonly seen species is Otodectes cynotis .-Contagion:...

s. Heart and respiratory rates remain within normal range

Reference range

In health-related fields, a reference range or reference interval usually describes the variations of a measurement or value in healthy individuals...

. As the condition worsens many papule

Papule

A papule is a circumscribed, solid elevation of skin with no visible fluid, varying in size from a pinhead to 1 cm.With regard to the quote "...varying in size from a pinhead to 1cm," depending on which text is referenced, some authors state the cutoff between a papule and a plaque as 0.5cm,...

s become visible on both pinnae. Small pimple

Pimple

A pimple, zit or spot is a kind of acne, and one of the many results of excess oil getting trapped in the pores. Some of the varieties are pustules or papules....

s begin to develop on the puppies' face, and severe lethargy begins to set in. Eating and drinking remain unchanged, and there is no vomiting

Vomiting

Vomiting is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose...

 or diarrhoea. Numerous pustules begin to develop on the muzzle, the pinnae and around the eyes. As the condition worsens, puppies become unwilling to walk or stand. Submandibular lymph nodes

Submandibular lymph nodes

The submandibular lymph nodes , three to six in number, are placed beneath the body of the mandible in the submaxillary triangle, and rest on the superficial surface of the submaxillary salivary gland....

 and prescapular lymph nodes become enlarged. Shoulder

Shoulder

The human shoulder is made up of three bones: the clavicle , the scapula , and the humerus as well as associated muscles, ligaments and tendons. The articulations between the bones of the shoulder make up the shoulder joints. The major joint of the shoulder is the glenohumeral joint, which...

s, elbow

Elbow

The human elbow is the region surrounding the elbow-joint—the ginglymus or hinge joint in the middle of the arm. Three bones form the elbow joint: the humerus of the upper arm, and the paired radius and ulna of the forearm....

s, and carpi

Carpus

In tetrapods, the carpus is the sole cluster of bones in the wrist between the radius and ulna and the metacarpus. The bones of the carpus do not belong to individual fingers , whereas those of the metacarpus do. The corresponding part of the foot is the tarsus...

 can be bilaterally painful on flexion

Flexion

In anatomy, flexion is a position that is made possible by the joint angle decreasing. The skeletal and muscular systems work together to move the joint into a "flexed" position. For example the elbow is flexed when the hand is brought closer to the shoulder...

 and extension

Extension (kinesiology)

In kinesiology, extension is a movement of a joint that results in increased angle between two bones or body surfaces at a joint. Extension usually results in straightening of the bones or body surfaces involved. For example, extension is produced by extending the flexed elbow. Straightening of...

.

Lesions may also appear on the feet, abdomen

Abdomen

In vertebrates such as mammals the abdomen constitutes the part of the body between the thorax and pelvis. The region enclosed by the abdomen is termed the abdominal cavity...

, thorax

Thorax

The thorax is a division of an animal's body that lies between the head and the abdomen.-In tetrapods:...

, vulva

Vulva

The vulva consists of the external genital organs of the female mammal. This article deals with the vulva of the human being, although the structures are similar for other mammals....

, prepuce

Prepuce

Prepuce may refer to:* The foreskin, which surrounds and protects the head of the penis* The clitoral hood, which surrounds and protects the head of the clitoris...

, or anus

Anus

The anus is an opening at the opposite end of an animal's digestive tract from the mouth. Its function is to control the expulsion of feces, unwanted semi-solid matter produced during digestion, which, depending on the type of animal, may be one or more of: matter which the animal cannot digest,...

. Lesions typically fistula

Fistula

In medicine, a fistula is an abnormal connection or passageway between two epithelium-lined organs or vessels that normally do not connect. It is generally a disease condition, but a fistula may be surgically created for therapeutic reasons.-Locations:Fistulas can develop in various parts of the...

te, drain, and crust. Marked pustular otitis externa is common, with the pinnae frequently being thickened and edematous. Affected skin is often painful but not pruritic. Approximately 50% of affected puppies are lethargic and depressed , as in this case. Pyrexia, anorexia

Anorexia (symptom)

Anorexia is the decreased sensation of appetite...

, and sterile suppurative arthritis, manifesting as joint pain

Arthralgia

Arthralgia literally means joint pain; it is a symptom of injury, infection, illnesses or an allergic reaction to medication....

, are inconsistent findings. Leukocytosis

Leukocytosis

Leukocytosis is a raised white blood cell count above the normal range in the blood. It is frequently a sign of an inflammatory response, most commonly the result of infection, and is observed in certain parasitic infections...

 with neutrophilia

Neutrophilia

Neutrophilia is a condition where a person has a high number of neutrophil granulocytes in their blood.-Causes:...

, and normocytic, normochromic anemia may also be seen.

Misdiagnosis

Puppies are first presented with what appears to be staphylococcal pyoderma. Definitive diagnosis requires cytologic and histopathologic

Histopathology

Histopathology refers to the microscopic examination of tissue in order to study the manifestations of disease...

 evaluations. Cytologic examination of papulopustular lesions of juvenile cellulitis reveals pyogranulomatous inflammation with no microorganisms and carefully performed cultures are negative. Biopsies of early lesions reveal multiple discrete or confluent granuloma

Granuloma

Granuloma is a medical term for a tiny collection of immune cells known as macrophages. Granulomas form when the immune system attempts to wall off substances that it perceives as foreign but is unable to eliminate. Such substances include infectious organisms such as bacteria and fungi as well as...

s and pyogranulomas consisting of clusters of large epithelioid macrophages with variably sized cores of neutrophils. Cytological analysis of joint fluid often reveals sterile suppurative arthritis.

Treatment

The condition responds dramatically to corticosteroids, suggesting an immune dysfunction

Autoimmunity

Autoimmunity is the failure of an organism to recognize its own constituent parts as self, which allows an immune response against its own cells and tissues. Any disease that results from such an aberrant immune response is termed an autoimmune disease...

. Large doses of glucocorticoids are the treatment of choice (2–3 mg/kg). When the puppy's condition has resolved, prednisone is tapered off slowly over a period of weeks. Early and aggressive therapy is indicated, otherwise scarring may be severe. If cytological or clinical evidence of secondary bacterial infection

Infection

An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...

exists, bactericidal antibiotics, such as cephalexin, cefadroxil, and amoxicillin clavulanate, should be prescribed.