There is no chance to get sleep right now so I'll muddle.  I think I'll
try to write a summary about Chiclet because I've been asked to by some
folks who are confused.  I can understand why they are confused.  Our
vet's never seen anything like this, the consultants are stumped, and
if what Dr. Ruth Heller has run into is the same thing rather than
coincidence then her description is that it has very low morbidity (The
chances of getting it are very low -- and we know of no situation of
multiple cases presenting this way in one household.) but it is "hot".
So far, Chiclet is the only only alive still with the symptoms and she is
touch and go, going onto her 6th week.  Anyway, I'll try to answer the
questions that have been arising and point to more info.
 
That is as good a place to start as any.
 
No one knows if the 4 cases mentioned now have/had the same thing (first
two in PA who didn't have pathology but if memory serves also looked like
they had cellulitis but cause was unknown, then Chiclet, then another in
PA just recently who died due to related heart complications and also was
thought by the pathologists to have something bacterial).  Was there
someone else who had one like this in the weeks before Chiclet got sick?
I am trying to remember.  There may have been and if there was I don't
know if pathology was done.  I recall that there were some similar ones
at the times who turned out to have JL when pathology was done.  There
are real similarities to JL in some aspects of presentation, also ones to
leiomyosarcoma and to osteoma.  You can see how it may be possible for
ferrets to have something look similar but not be a bacterial infection
like this, or alternatively for a ferret to have a bacterial infection
like this and be thought to have a malignancy instead.
 
Oh, bacterial infection is considered the most likely, but since it
hasn't been found it could still turn out to be something different, so
when I say bacterial that is the assumption which so far best fits what
has been found..  It is NOT mycobacterium, BTW.  Specialized pathology
testing for that was done and turned out to luckily be negative.  The
chances of that were always low; we don't feed raw and she simply hasn't
had exposure, plus the test results just don't mesh well with that
possibility, but it was checked, anyway.  We're thrown around a pile of
ideas -- everything from different types of venom, to heartworm with a
weird presentation (This is strange mosquito year around here and even
though it's not normally a concern in our area we'll be seeing if
preventatives may make sense this year unlike most years here for inside
ferrets.), to...
 
Here is how it looks: One or two nodes go from being normal to being huge
-- to the point where they splint out a leg and make it immobile in a
matter of hours.  A very high fever (105 +) begins.  Nodal aspirates tend
to look unusually bloody somewhere along the line -- if not the first
then then one or more follow-up ones.  Blood work looks like what would
be expected with lympho as a possibility (likely due to the cellulitis)
but aspirates look more like what one would expect with a bacterial
infection.  Mild anemia happens.  It can at times during the illness be
difficult to get blood.  In Chiclet's case her respiratory rate has gone
up; it's not as high now as at her worst but is no where near normal even
though she is not doing that weird breathing that pain can cause and she
does not have ascites.  Recently she is something also making a sort of
snuffly-horn noise or vocalization but fortunately yesterday's chest
x-rays (Can't even remember how many she had had during this anymore.)
continue to not show heart or lung involvement though her pulmonary
artery looks like it might -- but it is a "might" -- be a touch large.
The ferrets begin showing indications of having dips in blood sugar
(which can be from sepsis).  Removed tissue looks melted from the
cellulitis.  There can be improvements followed by crashes if the ferret
survives long enough.  Urine and feces are fine for Chiclet except for a
stray unusual stool -- but nothing worrisome.  Leg x-rays, chest x-ray,
abdominal x-rays, and an ultrasound show nothing unusual.  Ultrasound
guided splenic aspirate biopsy consistent with massive bacterial
infection.  Appetite for Chiclet has continually been good; I can't
recall about the others off-hand, but there is extreme weakness with the
ferrets going through long periods of just lying there and with long
periods when walking is an impossibility.  In Chiclet's case Steve and I
really think that meds and her own will have kept her alive several times
during this and everything else has been an accessory to those two
essentials.
 
Well, she just put the lie to me by having a well formed but mucusy green
(olive and forest green) bowel movement with what looked worm-like things
on gross examination, but I think they may be mucus because they had a
lacy non-cohesiveness under 20x.  So now we will be collecting feces,
too, for examinations of some of those.
 
Chiclet is in a 2' by 2' cage with her IV and pump and with bedding and
newspaper.  She loves to eat, to cuddle, to have visitors, to be shown
things, to hear music.  When asked if she wants soup she will
enthusiastically lick chops and be very alert.  She also likes carafate
so does that when offered 'Belly fix".  Ditto when offered oil.  The word
"Meds" does not get that response.  She is much improved from a week ago
but can not stand, though she can sort of "inch-worm" and she acts like
she is pround when she reaches the paper to pass waste.
 
She was just doing that snuffling sound again -- it is weird sound
(snuffly but also with sort of a horn or nasal quality and could be
a vocalization) and none of us know what it is but she was sleeping
comfortably.  and her chest x-ray yesterday was fine.  ***** Is this a
baby sound?*****  I ask because very ill individuals often behave more
baby like so I figure that is a possibility, but we haven't known any
kits younger than 5 weeks old.
 
Anyway, I think that is about it for what this looks like -- at least for
Chiclet.  (Oh, except I forgot to menion that the skin lesions she got
turned out to be a response to one of her meds and they are cleared up
with only one needing more care than Xenodyne.) Her node and the
surrounding fat where another matter; they had cellulitis and were melted
looking.  One more thing: she almost never shows any sign of pain and has
only needed her torb 5 times in 8 days (It lasts for maybe about 8 hours
before she stops being groggy.), once of those was after the removal of
her original catheter and the pain was from that.
 
Maybe tomorrow she will be tried without IV and then we find out if she
crashes or not.
 
Anyway, I am tired and sure that I will miss something or someone may
be interested in some other aspect, like what meds are being used, so
for anyone who is interested right now I'll find the Chiclet posts,
starting with the earliest ones, in the FHL Archives:
http://fhl.sonic-weasel.org/browse.php?msg=SG4821
http://fhl.sonic-weasel.org/browse.php?msg=SG4931
http://fhl.sonic-weasel.org/browse.php?msg=SG4948
http://fhl.sonic-weasel.org/browse.php?msg=SG4977
http://fhl.sonic-weasel.org/browse.php?msg=SG4981
http://fhl.sonic-weasel.org/browse.php?msg=SG4989
http://fhl.sonic-weasel.org/browse.php?msg=SG4990
http://fhl.sonic-weasel.org/browse.php?msg=SG4998
http://fhl.sonic-weasel.org/browse.php?msg=SG5007
http://fhl.sonic-weasel.org/browse.php?msg=SG5014
http://fhl.sonic-weasel.org/browse.php?msg=SG5015
http://fhl.sonic-weasel.org/browse.php?msg=SG5048
http://fhl.sonic-weasel.org/browse.php?msg=SG5076
http://fhl.sonic-weasel.org/browse.php?msg=SG5161
http://fhl.sonic-weasel.org/browse.php?msg=SG5163
http://fhl.sonic-weasel.org/browse.php?msg=SG5164
http://fhl.sonic-weasel.org/browse.php?msg=SG5173
http://fhl.sonic-weasel.org/browse.php?msg=SG5187
http://fhl.sonic-weasel.org/browse.php?msg=SG5191
http://fhl.sonic-weasel.org/browse.php?msg=SG5231
 
If you are wondering why we haven't given up it's because Chicet hasn't
hasn't given up.
 
Here are pictures of Chiclet at home with her set-up.  The individual
blow ups were fuzzy for me but the slide show worked perfectly.
 
http://homepage.mac.com/esc/chicklet/PhotoAlbum23.html
[Posted in FML issue 4204]