| Epizootic Catarrhal Enteritis (ECE)"Green Slime" by Lisa (Tashaferret)
ECE is also called the "greenies" or "green slime" disease. Its official name is "epizootic catarrhal enteritis" (of ferrets). "Epizootic" refers to a disease which is epidemic in animals, "catarrhal" means it's an inflammation of a mucous membrane, and "enteritis" means it affects the intestine.
The disease causes an inflammation/infection of the intestine. It damages the mucosa (the delicate intestinal lining which absorbs nutrients and water into the body). This results in diarrhea and excess mucous production. In severe cases of ECE, deep ulcerations and bleeding may also occur. ECE will cause sudden and profuse, watery, bright/neon green diarrhea (although the diarrhea can also be other shades of green or yellow). The diarrhea normally has a foul odor, sometimes fishy smelling. Your ferrets may also experience vomiting (in early stages of the disease), lethargy, refusal to eat or drink, or diminished eating/drinking. Blood counts remain normal.
ECE is a virus, and can be transmitted by infected fluids from the body. It can be spread through the air or by direct contact with an infected ferret.
The incubation period is about 2 days and there can be carrier animals for at least 4 months. Carriers are ferrets that have survived the disease and seem healthy but are shedding the virus in their stools and can still infect other ferrets. There are documented cases of ECE affecting a home without any contact with other ferrets. Often someone in the home had recently recovered from the flu. Several people in the ferret community believe this virus may have begun as a mutated human flu virus because the initial outbreak coincided with a particularly nasty flu season.
SYMPTOMS:
Ferrets typically show symptoms of ECE within 24 to 48 hours from exposure. Ferrets that seem to be healthy can be near death within 8 hours. ECE may take one to three weeks to run its course; however, low body weight, "birdseed" stools, the inability to properly digest food, and weakness in the hind legs may continue for months. Since the signs of green diarrhea are not restricted to ECE, your veterinarian should also consider bacterial overgrowth, lymphocytic gastroenteritis, lymphosarcoma, coccidiosis, and eosinophilic gastroenteritis when determining the diagnosis. ECE may also exaggerate other illnesses such as low blood sugar (insulinoma).
The symptoms of ECE are vomiting for one day (which may appear to be diarrhea unless you see your ferret vomiting) followed by sudden onset of profuse, watery bright fluorescent/neon green, brown or yellowish diarrhea "greenies" (usually with a foul odor), lethargy, diminished food intake or anorexia (which may start after the diarrhea stops), and severe dehydration.
Note: To check for dehydration, pinch the skin over the ferret's shoulder blades between thumb and forefinger. It should quickly smooth back. If it "sticks" together, your ferret might be dehydrated. Be aware that older ferrets normally have thinner, dryer skin. If you do this pinch test with both an older and younger ferret you can see the difference. By doing this test while your ferret is healthy, you will be able to tell easier when something might be wrong. The diarrhea usually lasts for 2-4 days. There may be periodic recurrences on and off for a couple weeks or you may suddenly see one or two episodes of greenish diarrhea months later. Whether this is an after effect of the illness or some unrelated stomach upset is unknown. You should keep in mind that ferrets may get greenish diarrhea for other reasons. Remember that the specific diarrhea associated with ECE is foul-smelling (fishy), neon green. Anorexia is a serious symptom/result of ECE. It affects every ferret differently. It can last for a week or up to almost two months. Ferrets might start to eat a little after a short period, but still require supplemental feedings for a couple months to bolster their weight and speed recovery. Remember that a ferret normally eats every few hours. You may need to syringe feed your ferret a duck soup several times daily and nightly. The most serious symptom arrives several days after the diarrhea has passed. This is a false sense of security - since the "green poop" is gone, it is easy to assume everything is fine and stop treatment. The problem is, without treatment, within 7 to 12 days, you will begin to notice severe weight loss because your ferret has stopped eating. Ferrets have a very short, simple and acidic digestive system. The stomach acid attacks the digestive tract and begins to form ulcerations in the stomach, throat, or mouth. These are uncomfortable and make them eat less, which makes the ulcers worse, which makes them eat even less... This downward spiral of symptoms happens very fast. Within days the animal may be eating and drinking nothing at all. Ferrets do not die from the disease directly, but from a combination of factors caused by ECE. In a multi-ferret household, once ECE enters it will affect nearly 100% of the population regardless of how sanitary the conditions are. With careful monitoring of sick animals and appropriate treatment, the mortality may be 0 to 2%. The infection rate is almost 100% but kits do not appear to be as susceptible. With aggressive veterinary treatment and proper follow-up care at home, the mortality rate is 1 to 5% with a higher rate (up to 50%) among older ferrets or ferrets with other existing health problems. Carriers of ECE may be asymptomatic. Uncomplicated ECE in a young, healthy ferret generally lasts 7-10 days, but in about 20% of cases, there is an extended illness due to an overaggressive immune response, which may lead to a chronic wasting syndrome for some time afterward. Ferrets that have had the disease remain carriers for some time afterward -- no one is sure how long, but the best estimate is now six months, maybe longer. It's currently believed that ferrets that have had ECE cannot get it again, but the irritated gut, especially in ferrets with the prolonged illness, is very sensitive to stress or upset, so "cured" ferrets may look like they've come down with it again when they haven't. The younger your ferret is, the fewer the symptoms and the shorter the duration of the disease. If treated properly, the fatality rate is less than 5%, and those fatalities are typically older (over 5 years) or ferrets that also have other problems such as adrenal problems, insulinoma, etc. If your ferret is young, healthy, and fat, there is less risk, as long as treatment is immediate. If treatment is not immediate, ferrets can die of dehydration. Ferrets that recover from ECE may show low body weights, poorly-formed stools, and weakness in the hind legs, which may continue for months following recovery. This disease may be spread by apparently healthy carriers as long as four months after infection and most likely longer.
Kits show few, if any symptoms. Ferrets under two years may have mild symptoms for 1-3 days. As long as they are eating, drinking, and urinating, no additional treatment may be necessary. The normal course of symptoms seems to be one to three weeks, although there are reports of some going as long as two months. Remember that after "recovery," your ferret still carries the virus and can expose others. However, once a ferret has ECE, the ferret builds up an immunity and is not likely to show severe symptoms again.
Treatment
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Seek immediate veterinary care, preferably from a veterinarian who specializes in ferrets. Call your local ferret shelter or club for a referral to a ferret specialist. If you must go to an emergency clinic or non-ferret specialist, take this information with you -
Start subcutaneous or intravenous fluids using Lactated Ringers Solution. Affected animals may require up to 90 ml/lb/day. -
Start systemic antibiotics. -
Administer digestive aids as required. Antispasmodics such as Centrine, Lomotil, or gastrointestinal protectants (Pepto-Bismol, Kaopectate) have been used at normal cat dosages. Tagamet and metronidazole (Flagyl) may also be required. -
Have blood work performed. A complete blood count (CBC), Hepatic function (liver) and protein absorption test may be required. -
Pawing at the mouth may indicate mouth or throat ulcers, nausea, or low blood sugar and should be treated appropriately. -
Provide proper nutrition and supplements. You will need to feed your ferret duck soup. The ferret will need 1-2 ounces (28-56cc), 3-6 times daily using a 20cc feeding syringe if necessary. A basic duck soup is either baby food chicken or lamb or a mixture of 1 can Hill’s Prescription Diet canine/feline a/d, 1 tablespoon Dyne, STAT, or Pounds Plus, and 1 can of filtered water. Ask your vet about other supplements such as Prozyme, Pet-Tinic, acidophilus, Ensure, Deliver, oral re-hydration, electrolyte salts, and Nutra-Stat or Nutra-Cal. Refrigerate leftovers up to 48 hours. Warm soup prior to feeding. Kibble may not be digested for months so continue to supplement with high-protein foods. -
Provide warmth. If the body temperature is low, provide a source of warmth. Never leave your ferret unattended on a heating pad! -
Keep the anal area clean, clipping hair if necessary, and use Vitamin E cream to soothe a rash. -
Prednisone may be required to increase appetite, reduce inflammation, and stabilize blood sugar levels. -
Reglan may be prescribed for extended vomiting. -
Carafate or slippery elm bark mixed with warm water is soothing to the digestive tract and mouth ulcers. -
Avoid giving them too much sugar. While Ensure has a great deal of sugar, it also contains proteins and carbohydrates. You should only use a small amount mixed into their soup. (Note: Once a can of Ensure is opened, it should be used within 24 hours)
Preventative
If your ferrets have not had ECE, you can avoid other ferret households, shows, meetings, shelters, pet stores, or ferret related events. If you cannot avoid other ferrets you can take some precautions....When coming home from an exposed location, remove your clothes and shoes in the garage, and place them in a plastic bag. Spray your hands and feet with Nolvasan, or other disinfectant, and then enter your house. Immediately take a shower. Wash your clothes in hot water, and wash or disinfect your shoes. (Another recommended disinfectant is bleach). Similarly, if you are infected and are going to visit another ferret place, shower, put on clean clothes straight from the dryer, and spray your hands and shoes with Nolvasan, or other disinfectant, after you leave the house. Also inform your vet, so the facilities can be disinfected properly. Any new fuzzies in your home should be isolated and examined for signs of diarrhea for a minimum of one week, as healthy-appearing animals may transmit this disease.
Remember, ECE is a non-life-threatening disease, if treated immediately and properly.
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