Squirrel Pox

WARNING
PHOTOS AT THE BOTTOM OF THIS PAGE ARE GRAPHIC AND UPSETTING TO SOME

First off, a disclaimer.  I am by no means an expert on treating squirrel pox.  I have, to date, treated just one case, albeit a severe one.  However, if what I have learned and researched is shared and it saves just one squirrel from this abhorrent disease, I will be grateful that I was able to provide some information.  My hope is to encourage those treating squirrels with this virus to persist with their treatment.  It IS possible to bring them through it, even in severe cases.

On October 9, 2016, I was contacted by a fellow rehabilitator about a  juvenile male Eastern grey squirrel that had begun showing signs of “lumpiness” and hair loss around his right eye.  The orphan squirrel had been in her care, housed with three others, for several weeks.  I did not see a clear picture of him but suggested at that point she treat him for mange.  (I recommended a single drop of Revolution near the shoulder blades.)  I asked that the rehabber contact me if his condition did not improve.  The rehabber isolated him from all other squirrels.

On October 18, the rehabber informed me that is condition had not improved and I was given a photo and video showing a very inflamed eyelid.  I was still unclear as to what I was looking at but it was clear the animal was very sick and I offered to take him and do what I can.  Upon seeing him in person on 10/20, it was clear this was squirrel fibroma (SQFV), commonly called “squirrel pox”.  He returned home with me and was affectionately dubbed “Typhoid Mark”.  Squirrel pox does NOT infect humans but is highly contagious to squirrels and is fatal in about half of the grey squirrels it infects.  Subsequently, Mark was quarantined and strict sanitation controls were put in place.  (More on that below.)

There is a great deal of information available online about the use of acyclovir and valacyclovir in treating squirrel pox, however, the Veterinary Information Network has stated that those antivirals, commonly used to treat viruses in the herpes family, are ineffective on pox.  Pox is NOT a herpes virus but is, instead, in the Poxviridae family.  Both antivirals appear to require the presence of the herpes virus for their antiviral properties to activate. The only antiviral currently used, but not approved for, treatment of poxviruses is cidofovir.  As of this writing, cidofovir is an injectable antiviral only used in clinical settings, is prohibitively expensive, toxic and has no established dosage in this context, so its usage is impractical for most wildlife rehabilitators.  It also appears to only be effective with very early treatment. That said, because of the sheer volume of “success stories” from those using it, I began a twice daily dose of valacyclovir.  (The pox blisters continued to spread and armed with the knowledge that it was unlikely to be effective, I discontinued it after three days.)  I have read that valacyclovir and acyclovir may be somewhat useful if started with the very first symptoms but, again, I could find no research to support that theory.

Pox virus is primarily spread through insect vectors.  Ending flea, mite or other insect infestation is critical in preventing the spread of this disease.  While he had no obvious infestation, it wasn’t worth the risk of microscopic parasites spreading the virus to other squirrels in my care.  A topical dose of selemectin (Revolution for puppies and kittens) was applied.

Clavamox at a dose of 30mg/kg twice daily was started to address infection to Mark’s eye and stave off any other infection in his open pox lesions.  Meloxicam was started at a dose of 0.2mg/kg once daily for inflammation and pain.  A prescription Bausch & Lomb antibiotic eye ointment was started on his right eye.  I was concerned that the blister may have abraded the eye to the point that his vision might be permanently compromised if the eye had not eroded completely.

In addition to those medications and in my desperation, I sought out immune boosters of any type that might show some ability on the pox viruses.  On 10/22, I began giving Mark a twice daily dose of “Wellness Herbal Kids” – a non-alcoholic herbal liquid with a mix of well known holistic herbs for treating a range of illness.  He received 0.3ml twice daily.

Mark’s appetite was not as good as I would have liked and he had a blister right near a lip, so I suspected he had lesions inside of his mouth that made eating solid food uncomfortable.  I began feeding him a soft food “goo” made of steamed vegetables, fruit, monkey biscuit and squirrel blocks pureed into a soft mush and added a small amount of Fox Valley 20/50 formula to thin it out.  A small amount of nutrical, was added to provide additional calories.  He seemed to be able to eat his “goo” without discomfort and cleaned his dish when I provided it for him twice daily.  The “goo” also provided an excellent medium for a few additives. L-Lysine is often taken to reduce the length of cold sore blisters and seems to inhibit the replication of some viruses so, in the form of about 50mg of crushed tablet, lysine was mixed into the goo.  Powered Bene-bac was added to his goo to lessen the harsh effects of the clavamox.
A kaolin and pectin anti-diarrheal liquid was also given two him twice daily at this point as clavamox is hard on the stomach.

Mark’s pox blisters continued to spread, burst and scab.  His appearance worsened alarmingly.  I suspected the spread was largely a result of the itching and scratching of the scabs on his face so I started him on Children’s Liquid Benadryl, three times daily at a dose of 2mg/kg.  My hope was that he would scratch less and sleep more, allowing more healing time and much needed rest.

After reading about the success other rehabbers had with California Academy of Health’s Liquid Immune Booster (http://www.caoh.com/liqimbarecbe.html ), some was ordered and started on 10/29.  Dosage was 0.5ml twice daily.

On 10/29 I also started treating his wounds with YS Organic Bee Farm’s Royal Jelly/Propolis in Raw Honey paste.  The idea behind this stemmed from three research articles:  Antiviral Activities of Honey, Royal Jelly, and Acyclovir Against HSV-1, In vitro antiviral activity of propolis (pdf) and Functional Properties of Honey, Propolis, and Royal Jelly.  (There are many, many scholarly articles about the efficacy of Propolis against various viruses if you are into that kind of stuff!  Honey is also an excellent wound dressing.)

Unfortunately, pox blisters can spread to the lungs and by 10/29, Mark was showing some signs of congestion and difficultly breathing when stressed.  SMZ-TMP at a dosage of 25mg/kg twice daily was added to the growing list of medications.

On the evening of 11/1, Mark’s condition had worsened to the point where I was close to giving up and euthanizing him.  (Video below – be warned, it’s upsetting.)  He was gasping for air with audible clicks.  The decision was made to continue his treatment, switching an antibiotic out and waiting through 2-3 doses to see if there was any sign of improvement.  If there was none, I was prepared to end his misery.  Clavamox was discontinued in exchange for enrofloxacin.at a high dose of 20mg/kg twice daily.

Mid-day on 11/2, I received a bottle “Six Gentlepets” from another rehabber.  This is a Chinese herbal Qi boosting liquid.  Researching the ingredients list, there are several herbs in the potion that are good for reducing mucus and was started immediately.  Mark received 0.15ml 3-4 times daily.
By evening, Mark’s breathing appeared much less labored so treatment continued.  By the next morning, 11/3, Mark seemed to show improvement.

Within days, lesions on his face slowly began shrinking.  While he still had a number of blisters on his body, new ones were no longer appearing.  His eye was open and did not appear to have any permanent damage.  All medications were continued, including the honey blend to any open or scabbed over wounds and the eye ointment to his right eye, which still had some minor discharge.

Benadryl was discontinued on 11/11/16.
Enrofloxacin was discontinued on 11/15/16.
Antidiarrheal was discontinued on 11/16/16.
Final scab fell off on 11/19/16.
SMZ-TMP, meloxicam and propolis/honey dressing were discontinued on 11/20/16 – exactly one month from day of intake.
Immune boosters and L-lysine were discontinued on 11/27/16.

Early in his treatment, Mark was a little subdued but overall exhibited typical behavior.  Only on November 1-2 did he truly seem sick but he became increasingly active in the days that followed.

I considered Mark’s treatment “complete” as of December 1.

Dietary Considerations
While undergoing treatment, Mark’s diet was limited to two Henry’s Healthy Pets Squirrel Blocks (a homemade version was used incorporating ingredients purchased from Henry’s Pets) as well as Purina rodent blocks, primate biscuit and the steamed mashed vegetable “goo” mentioned above.  NO supplementary nuts or seeds were given.  Nuts and seeds contain large amounts of L-arginine, a vital amino acid but one that seems to be able to assist the replication of viruses in the lab.  While the Henry’s blocks are largely compromised of nut meal, I believed the nutritional benefits of feeding two blocks daily outweighed removing them from the diet altogether.  However, to prevent an abundance of L-arginine in his system, his diet was restricted.

Sanitation
Pox viruses are lipid enveloped viruses.  Consequently, freezing is not an effective way to “kill” the virus.  Exposing the virus to heat over 150°F for 30 minutes, 10% bleach solution, 10% iodine, non-ionic surfactants and oxidizing agents (such as hydrogen peroxide) will inactivate the virus.  In our case, we employed Oxyfresh cleansing gele, Dawn (original) dish detergent, Tide with oxyboost and a bleach solution to prevent the spread of the virus.  Bedding was laundered and dried with high heat.  Dishes and dosing syringes were washed in the “sani-cycle” of the dishwasher.

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Video taken 11/1/16

And finally, I could not have helped Mark without the group of people who contributed to his recovery.  A tremendous thank you to Lisa Germaine and Katie Chicione of Safe and Sound Wildlife Rehabilitation, Julianna Parker of Otter Creek Wildlife Rescue and Bear Swamp Veterinary Services (who made it possible for me to access needed medications during a week in which they were closed and out of town!).  Thank you to the many people who sent prayers, good wishes, healing light, whatever they could offer to help Mark.
A very special thank you to my mentor – my “Yoda” and my “Obi-Wan” – who wishes to remain anonymous.  Without your guidance, I am certain I would not have been able to help Mark.  The animals of this world are truly blessed with your gifts.

 

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