Elephant seal skin disease

We had a yearling Northern Elephant Seal come in to the Marine Mammal Center today.  She is underweight and is reported to have blood in her urine.  The most obvious issue, however, is that she has lesions all over her back and they are seeping blood tinged, grayish fluid.  And she smells.  Really bad.

Although she has not yet had an admit exam, I'm going to guess that she has Northern Elephant Seal Skin Disease (NESSD).  I did a search on this condition and found a scientific paper from 1997:
http://www.ncbi.nlm.nih.gov/pubmed/9249688

It turns out that NESSD affects Northern Elephant Seals that are 9 months to 2 years old and most cases are seen between January and May.  Moderate cases peak between December and January, severe cases are usually seen between March and May.

Northern Elephant Seal Skin Disease is graded as mild, moderate, or severe.  Mild cases have ulcers that are less than 2cm in diameter or covering less than half of the body surface.  Moderate cases have larger lesions with thickened skin, and severe cases have large ulcers that grow into one another, exude blood or fluid, and may become necrotic meaning that the tissue begins to die.

Based on the above grading scale, to me, the new elephant seal seems to have a moderate to severe case of NESSD.  Mild cases have a survival rate of 93%, 66% survive moderate cases, and less than 1% survive severe cases.  So, the chances for our new ellie aren't awesome if moderate to severe NESSD is her diagnosis.  The cause of death in cases of NESSD is most often septicemia (going "septic" or an infection that takes over the entire body).  This likely happens when bacteria enter through the skin lesions.

The next question might be what caused her condition?  The study I read found no clear cause.  Viruses were not found, bacterial cultures were taken but nothing but normal skin bacteria was found consistently.  One interesting finding, however, is that affected seals tended to be smaller than unaffected ones.  This may point to a genetic cause which could be explained by the population bottleneck that occurred in the early 1900's when the animals were down to around 100 individuals from which all present day Northern Elephant Seals arose.

It was also found that the skin lesions and blood work changes that happen in elephant seals affected with NESSD are also consistent with exposure to polyhalogenated aromatic hydrocarbons (PHAHs) including PCB's and PBB's.

According to wikipedia PCBs were used as coolants and insulating fluids for transformers and capacitors, such as those used in old fluorescent light ballasts, plasticizers in paints and cements, stabilizing additives in flexible PVC coatings of electrical wiring and electronic components, pesticide extenders, cutting oils, reactive flame retardants, lubricating oils, hydraulic fluids, and sealants, adhesives, wood floor finishes, paints, de-dusting agents, water-proofing compounds, casting agents, vacuum pump fluids, fixatives in microscopy, surgical implants, and in carbonless copy paper.  They were banned in the US in the 1970's for most uses, but their use in closed applications such as capacitors has continued in the US and high concentrations have been found in recently in both water and on land.

PBBs are used as flame retardants, added to plastics used in products such as home electrical appliances, textiles, plastic foams, laptop cabinets, etc. to make them difficult to burn.  Their use is restricted in the EU, but wikipedia says nothing about any US regulations.

Both the wikipedia articles on PCB's and PBB's list acne and skin issues among signs of exposure and apparently more research is being done on a possible link between these chemicals and Northern Elephant Seal Skin Disease.

Dr Internet

As a bright-eyed new tech who loves helping not only animals but the people who care for them I found /pets and /puppy101 on reddit.com and thought I'd share my knowledge.  I answered a question on a cat who's not using his litterbox and a guy having issues with his aquarium and I felt all warm and fuzzy inside.  Then I stumbled on "Help!  I found this on my dog!".  I clicked on it and it wasn't a photo of a tick or a flea.  It was a blurry photo of a reddened area of skin with some hair missing.  And the person added at the end that they can't take their dog to the vet because it costs too much.

I know this makes a lot of us in the veterinary medicine world really angry, but I want to look beyond that anger to see if there are ways that we can stem the tide of people seeking Dr Internet over their veterinarian.

I suppose the impression that this person got with his last vet visit was something like:  My dog was fine, I was just a little concerned about this red bald patch so I took him to the vet and came away with one dose of medication and it cost me $250!  Then they want me to come back for a recheck.  I wonder how much it'll cost for them to tell me he's fine?

And from the clinic's point of view:  The dog came in overdue for his vaccines, with a lapse in heartworm medication, sarcoptic mange was found to be the cause of the skin issue, but only after a skin scrape test.  A dose of ivermectin was given and the dog was sent home vaccinated, with heartworm preventative, and a great prognosis!

So, on one side of the equation is very little value from the perspective of the client, and lots of value seen from the perspective of the hospital.  I believe that bridging that gap is key.  Apparently people out there believe that a diagnosis can be made with a photo or a description of symptoms.  And I wonder -are they not being told about the range of possible causes and tests that are being done at their vet clinic in order to make the diagnosis?

Maybe we as vet staff need to place more of an emphasis on "we know how to get to the answer" rather than "we have the answer".  The answer to most day-to-day questions can be googled and I think clients believe the answer to their medical questions is just as easily found on google.  If that guess is correct, then I think it needs to be our job to educate people about how much work goes into making the diagnosis. That's what justifies the bill even if the answer is all they came looking for.

Alternative to No-Sorb

When you can't collect a urine sample from a cat and have to send home a kit with the owners a cheap alternative to No-Sorb is some aquarium gravel.  We put it in washed baby food jars (we use baby food to distract animals while giving them vaccines or doing other procedures) and package it with a 3cc syringe (no needle) and a red top tube for them to put it in.

Oh, and remember to remind clients to wash their litterbox thoroughly before trying to collect a sample!

Identifying demodex vs sarcoptes mange mites

To do a skin scraping you need:

• a dulled scalpel blade or other instrument for scraping
• a slide
• mineral oil
• a microscope

1. Put a drop of mineral oil on the slide and dip the blade or scraper in the oil to lightly coat it so that the debris will stick to the blade.
2. Choose an area of alopecia and scrape the skin with the blade until you begin to see blood.  This is necessary because demodex mites live in hair follicles which are fairly deep under the surface of the skin.  (Some say to pinch the skin while scraping it, but I've never seen this done in practice.)
3. Clean debris off of the blade by dipping it in the mineral oil and wiping it off on the slide -do the best you can.  
4. Repeat the procedure using 3-5 different sites.  This is important because sarcoptes (scabies) mites are hard to find.

When finished, view the slides under low (10X or "scanning") power and look for mites.  Medium power may be used if you are not used to looking for mites.  (Medium power will give you a field of view closer to the photos below.)

Demodex mites are most commonly found because a small number live on pets normally, but an abnormal immune response can cause these mites' numbers to increase enough to cause clinical signs and require treatment.  Usually these clinical signs are hair loss with or without itching that can lead to pyoderma and other secondary skin infections.  It can occur locally, usually on the face or forelimbs and paws, or be generalized.

Some say demodex mites look like cigars.  They are elongated and have eight legs that you may see moving on the front half of their body.

If demodex (demodectic mange) is diagnosed it should be noted that it is NOT contagious to humans or other pets in the household.


Sarcoptes mites are round, on the other hand, so they are easy to distinguish from demodex:

If sarcoptic mange is diagnosed it should be noted that it IS contagious to other pets who come in contact with the infected pet as well as humans.  So, wash your hands thoroughly after handling animals with sarcoptic mange or, better yet, wear gloves and protective clothing if it is suspected.

Clinical signs of sarcoptic mange is intense pruritis (itchiness) and hair loss that begins on the ventral abdomen, chest, ears, elbows, and legs and, if left untreated, can become generalized.