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UF veterinarians save dog with tetanus infection

By Sarah Carey

Dr. Alessio Vigani snuggles with Mocha Delight on Jan. 16 in the lobby of UF’s Small Animal Hospital.

Today a 6-month-old labradoodle from Tavares wrestles with her owners and runs like a normal puppy, but normal she will never be to anyone who watched her month-long struggle in intensive care at the University of Florida Small Animal Hospital, where veterinarians fought to save her from a severe tetanus infection.

Mocha Delight, or Mocha, as her owners call her, had the most severe case of tetanus ever seen or treated by UF veterinarians. When she arrived at UF on Nov. 13, no one thought she would survive.

“No one here can remember ever being able to treat and save an animal so severely affected by this type of infection,” said Dr. Alessio Vigani, a veterinary resident in emergency and critical care at UF. “When she arrived, she was in a constant state of tetany. All of her muscles displayed extreme rigidity and she was unable to eat. If you visualize a bearskin rug, that’s what she looked like; she was completely flat. That she could pull through at all is nothing short of a miracle.”

To her owner’s well, delight, the adorable puppy no one thought would survive was discharged to go home on Dec. 22. To see her now, “You’d never know anything had been wrong,” said Joan Standlee, Mocha’s breeder and original owner.

But in mid-November, Standlee found Mocha stiff against her cage door at the kennel where she was bred. Standlee took the dog, which had a fever of 110 degrees, to an emergency clinic and to two other veterinarians, including a neurological specialist, before bringing her to UF for treatment of muscle rigidity.

At that point, the dog had received an anti-toxin medication and penicillin injections, but UF veterinarians said these treatments are not effective once the tetanus infection has advanced to the severe stage.

Based on Mocha’s clinical signs, UF veterinarians diagnosed generalized tetanus, which is most commonly caused by the toxin spreading through the bloodstream.

Mocha, at right, with her family dog companion, Mollie, and her breeder and original owner, Joan Standlee, on Jan. 16. UF veterinary student Kyle Donnelly, at left, was one of the students who helped care for Mocha. (Photo by Maria Farias)

“We were the only ones with the facilities to be able to provide 24-hour intensive care as well as rehabilitation therapy,” said Dr. Justin Shmalberg, a clinical assistant professor who worked closely with Mocha during the rehabilitation phase of her treatment.

“She couldn’t open her mouth, so she couldn’t eat,” he said. “She received intravenous nutritional therapy and antibiotics, cooling treatments to bring down her fever and muscle relaxants to reduce spasms while the bacterial toxins worked their way through her system.”

Mocha was isolated in ICU for nearly two weeks to minimize any form of stimulation, which could lead to spasms and excruciating pain for the dog, veterinarians said.

After about 10 days, the toxins in Mocha’s body began to wear off and her muscles gradually loosened. At that point Shmalberg and a team of rehabilitation therapists began a regimen of physical therapy. For two weeks, six hours a day, veterinarians and technicians performed range of motion, ultrasound, acupuncture and even pool therapy on the young dog.

“We treated particularly sensitive spots with acupuncture,” Shmalberg said. “We did stretching exercises within the limits of what she would allow. We were just trying to assist the process. Our main concern was that her soft tissue and her muscles would ‘learn’ the abnormally flexed position, so we wanted to encourage movement as much as we could.”

Mocha’s rehabilitation treatment was as intensive as any animal has received at UF in the five years since the Small Animal Hospital began providing the service, Shmalberg said.

Tetanus is caused by a neurotoxin released by the bacterium Clostridium tetani. Spores of the bacterium can survive in the soil for years and in the body for months, and usually enter the body through minor punctures or scratches. Once in the body, the toxin spreads, causing painful muscle spasms in the neck, arm, legs and stomach.

Dr. Justin Shmalberg holds Mocha in front of the pool used for part of her rehabilitation therapy. Also gathered in the shot are other members of Mocha’s rehabilitation team. (Photo by Sarah Carey)

“While pinpointing the small break in the skin that caused Mocha’s tetanus is difficult, we think she probably acquired the infection through her umbilical stump or through small cuts in her mouth associated with teething,” Vigani said.

Dogs and cats are not regularly vaccinated to prevent tetanus because the disease is rare in those species, veterinarians say. As for Mocha, UF veterinarians say she is now fully cured and should not have any long-term consequences from the infection and intoxication.

“To us she is truly a miracle dog,” Standlee said.