Cincinnati’s medical mysteries explained – E cuniculi help!

[Boing]

Cincinnati was being treated for pinworms, as some of you know.  He had two doses of fenbendazole.  Some of it was swallowed.  Shortly after, he developed incontinence.  So I googled “fenbendazole incontinence”.  I didn’t get anything about side effects, but about E cuniculi.  So I contacted the vet.  Two titers and a protein test later, I finally have an answer.  

Everything he’s ever had is related to it: kidney problems, liver damage, two bouts of seizures years ago, cataract development, lung weakness and fluid, low immunity, failure to thrive, tiredness, and, more recently, incontinence and hind limb weakness.

He and Daisy are both going to get 28 days of fenbendazole, as per the vet’s recommendations.  Goodness knows how I’ll dose them.  Cincinnati spits stuff out, even critical care, even on professionals.  He’s an expert at not eating what is syringed.  Daisy is formidable and very opinionated.

Meanwhile, I’ve made an appointment with my doctor since it’s zoonotic.  Talk about a mess.

I guess I’m posting this hoping it helps someone else.  I’ve wondered about E cuniculi for years, but there was never any consistency and vets weren’t alarmed.

I’ve since read that some vets in the UK recommend that all new pet rabbits get 28 days of fenbendazole as a matter of course, as the parasite is so common.  Any future bunnies of mine will get that.

[kurottabun]

Glad to know that you managed to find the cause. My bunny recently lost a lot of weight and we suspected it was worms too at first. He was eating and drinking double the usual amount so we thought the nutrients may have been absorbed by worms inside his body. After some closer observation though we noticed he was lethargic, had hind leg weakness and that his rear was almost always wet with pee.

We brought him to the vet and they did bloodwork, with results showing that he had some liver damage. They couldn’t really give an accurate diagnosis, but put him on Fenbendazole anyway and gave liver supplements in pill form.

We tried crushing the pills in mashed up pellets, but Kurotta realised something was off and refused to eat it. In the end we crushed the pill in water and force fed with a syringe. He didn’t like the Fenbendazole at first too but somehow took a liking to it after two weeks or so. I find that it’s easier if you give the bunny some pellets first (or a favourite treat) so it gets their mouth moving. While they’re chewing then you can try gently shoving in the syringe from the side of the mouth followed immediately by another few pellets so that when they eat the pellets, they inevitably chew and swallow the medicine too.

[Boing]

Thank you for replying, kurottabun! I’m so sorry to hear about your bunny. Cincinnati’s first symptoms were liver damage, and over drinking and over urinating. Your vet sounds very proactive. That’s good!

The vet gave me an inch long pointy, plastic attachment for the end of the syringes. It’s so much easier! They’re eating all of their medicine. They started their 28 day course on June 20.

Does anyone know when I should notice an improvement in symptoms? I hadn’t realized how bad his incontinence was ’till I began to medicate him, as I have to brace his hind legs against my leg, with him facing away from me, to medicate him every day. They are literally wet all the time.

Since it’s urine that spreads it, I’m concerned.

When will this go away? I just read an article on e cuniculi that said if symptoms do improve, they usually start to within the first week of fenbendazole. Does this mean he’ll have this forever? If so, will he be contagious forever? Do most bunnies’ symptoms reverse with treatment?

Please, I realize I don’t post much, and I’m not one of the ‘cool’ people on the forum whose posts attract lots of replies, no matter the topic, but this is my bunny we’re talking about. If you know anything about e cuniculi, please take the time to reply. I’m begging. And I don’t usually.

[sarahthegemini]

I’m so sorry to hear about your bun’s trouble but glad you’ve got a diagnosis. I don’t personally have experience with this but a previous member Asriel_and_Bombur has dealt with this. I know she closed her account but are her threads still available to read, Mods?

[Gordo and Janice]

Posted By Boing on 6/24/2018 12:10 PM

Please, I realize I don’t post much, and I’m not one of the ‘cool’ people on the forum whose posts attract lots of replies, no matter the topic, but this is my bunny we’re talking about. If you know anything about e cuniculi, please take the time to reply. I’m begging. And I don’t usually.

I understand the feeling.  Sometimes the knowledgeable just aren’t online.  There are members here who have experience or at least a healthy knowledge of the subject. Most here are truly concerned.  I wish I could help but I am in the US with no experience with E Cuniculi.  Hopefully someone will be able to help soon.  Try to be patient.  I remember when I would post a question and then check back every 5 minutes and no one responded and I was hurt and angry both because it was my rabbit’s life and I was in desperate need of information and help.  Just sending you a note of encouragement.  I’ll be following this thread looking forward to some answers because I am curious of the responses as well.  It may take a bit for some to sign in and see and reply to your post.  Again, I hope someone can help you soon.

[sarahthegemini]

Keep in mind guys that we are all in different time zones. If you don’t get a response quickly, try not to take it personally. If you have an urgent question, go ahead and post but I would encourage you to call a rabbit savvy vet first and foremost, even if it’s just for a bit of advice over the phone

[Wick & Fable]

If you search “site: binkybunny.com asriel EC” in Google, you will see a lot of A&B’s topics relating to EC. I hope these will help you.

As Sarah says, sometimes between timezones and lack of experience, responses can be more sporadic. Hopefully you’ll find some of the information from A&B’s posts useful.

The answers provided in this discussion are for general guideline purposes only. The information is not intended to diagnose or treat your pet. Seek the advice of your veterinarian or a qualified behaviorist.

[LBJ10]

No personal experience… but I have done tons of research. EC is strange and it isn’t fully understood. From what I understand, treatment does not necessarily cure the infection. Instead, it goes into remission. It’s important to remember that somewhere around 80% of rabbits have been exposed to EC and have it inside their body. The most common mode of transmission is vertical (mother to kit). Horizontal transmission is possible, but it isn’t he primary mode. In fact, positive rabbits have lived next to negative rabbits without transmission occurring. If I remember correctly, they are only contagious to other rabbits via urine when they are actively shedding spores. This occurs shortly after exposure and then stops.

What this means is that once a rabbit has it, they have it. Most never show any signs or symptoms. A small percentage will develop symptoms, but most can be successfully treated and the EC goes into remission. An even smaller percentage develop what is known as chronic EC, where symptoms come back multiple times despite treatment. I imagine these individuals are immunocompromised in some way.

EC is technically zoonotic. However, getting EC from your rabbits is very unlikely. People who are at risk would be those who are immunocompromised (HIV/AIDS, cancer, organ transplant, etc.).

[kurottabun]

Thanks for the concern Yes Kurotta also had signs of over drinking and over urinating to the extent that his pee was almost always clear. He was drinking almost 500ml of water per day, and we felt that it was suspiciously too much for a small 800g Nethie. It was only until the bloodwork results came out that we found out about his liver issues.

I think LBJ has already covered the part on whether it will go away permanently.

As for when symptoms will start to improve, since weight loss was one of Kurotta’s symptoms, that was the best gauge I could use to determine how fast he was improving. This is the log I kept:

 

I think it was within a week that his rear area wasn’t constantly wet anymore, although it felt forever lol. By week two there was already significant improvement in his energy levels, and he got back quite a bit of his spunk. Technically we will never know if it was really EC, but the Fenbendazole and liver supplements definitely helped.

[Boing]

Thank you for replying, everyone! I appreciate the information and the encouragement.

I will look up Asriel and Bombur’s posts.

@LJB10 Does that mean that they aren’t contagious all the time and that he may not be contagious after treatment? I’m concerned, because I’m not immunocompromised, but am towards the low end of normal, based on the things I am diagnosed with.

@kurrotabun Did Kurotta ever stop over drinking and over urinating? It’d be amazing if Cincinnati did! It’s been almost five years of it, and no vet ever diagnosed E cuniculi ’till now. It’s always been by far and away the hardest to manage of his mysterious symptoms.

[Boing]

The other question I have is if anyone knows if the human immune system kills EC? Or does it just lie dormant?

So, for example, if someone has pet rabbits and accidentally gets it and then decades later comes down with cancer, does the EC suddenly flare up and infect the person, or are our immune systems able to outright do it in even if bunnies’ can’t?

[kurottabun]

Kurotta’s symptoms of over drinking and urinating didn’t exist until about two weeks before we noticed his severe weight loss. He’s gone back to normal now after the full course of Fenbendazole.

If Cincinnati has been this way since five years ago, I’m not sure if it’s a symptom of EC or that he’s just a huge drinker in general. Was he actually drinking “normally” prior to five years ago?

[LBJ10]

No, they do not shed spores all the time. Like I said, it is generally shortly after infection and then ceases. I assume this is because the immune system gets everything under control and “contains” it. Shedding of spores can occur here and there after that. Again, I assume this is because there can be periods where the immune system is weakened. If the rabbit isn’t currently shedding spores, then horizontal transmission is unlikely to occur.

As for people, I did find this. Maybe it will help.

The present results showed that the seroprevalence of E. cuniculi antibodies was significantly higher in the immunocompromised patients compared with immunocompetent controls (Table 1). Microscopic examination of Weber’s green MTS urine smears prepared from immunocompromised patients showed significantly higher number of positive subjects shedding spore compared with the immunocompetent controls (Table 1). This goes with the fact that microsporidiosis is an opportunistic human infection. Most microsporidial infections caused by E. cuniculi were recorded in immunocompromised patients like those infected with HIV, patients undergoing organ transplantation, or patients with idiopathic CD4+ T lymphocytopenia (40). The role played by the innate immunity in suppression of the microsporidian spread was proved, and the dissemination of infection in immunocompromised patients is well documented (22, 41, 42). Chronic infections caused by E. cuniculi in immunocompetent individuals are generally asymptomatic, probably reflecting a balanced parasite-host relationship. E. cuniculi represents the vast majority of the microsporidial species found in the healthy population in the Czech Republic (43). A competent immune response is unable to eliminate fully the infection even if there are no clinical signs and the carrier can be a source of infection. Unfortunately, such latent infections may be reactivated during immunosuppression (44).

Entire article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4724832/

So… it’s basically the same with humans as it is with animals. Many are exposed and some become infected… but the vast majority do not become ill. It’s really only well-documented in immunocompromised people. Exactly how immunocompromised someone has to be in order for it to be a problem, I don’t know. But people have pet rabbits all the time and there is no EC epidemic among rabbit owners. Hopefully that helps.

 

ETA: It should also be noted that the study does not indicate whether any of these individuals were actually exhibiting any symptoms. It doesn’t sound like any of them were (immunocompromised or not). The study was only looking at the presence of antibodies in blood serum and spore in urine.

[Boing]

It’s good to know that the contagion isn’t constant! It also sounds less serious than a lot of other zoonotic diseases.

I have no idea if Cincinnati was ever a normal drinker. He was taken in by the humane society mid-July of 2013. They told me when I adopted him mid-October that I’d have to get a heavy water dish as he tipped it. No problem, I thought. But no one must’ve actually observed the behaviour. He doesn’t tip his water. He doesn’t even try and never has. I think they just made the correlation and assumed causation.

He has had bouts of weight loss. The over drinking has been constant. They guessed him to be around two when they got him, but I’ve no idea how accurate that is.

[DanaNM]

I don’t have any experience with EC, so sorry you are going through this.  

I just wanted to suggest that you edit the title to say something that requests help with EC (maybe something like “Cincinnati’s EC diagnosis, help please!”), so people skimming the titles see it more easily. If you go back to your first post and click “Edit” it will allow you to change the title. 

Member vanessa also dealt with EC with her bunny Lancelot. She journaled it here: https://binkybunny.com/FORUM/tabid/54/aft/146775/afpg/5/Default.aspx

. . . The answers provided in this discussion are for general guideline purposes only. The information is not intended to diagnose or treat your pet. Seek the advice of your veterinarian or a qualified behaviorist.  

[Boing]

Thank you, Dana. I followed your instructions and changed the title. I’ll look at the E cuniculi journal you’ve linked to.

It’s day 11 of the treatment. On day 9 Cincinnati actually threatened me by putting his teeth on my wrist. He’s never done anything like that. The stuff must taste vile.

[DanaNM]

You’re welcome, and hope it will help get some more advice from folks with personal experience!

I’m actually glad to hear he’s fighting his meds (even though it’s harder on you)… usually that means they are feeling better!

. . . The answers provided in this discussion are for general guideline purposes only. The information is not intended to diagnose or treat your pet. Seek the advice of your veterinarian or a qualified behaviorist.  

[Bam]

There is a formulation of fenbendazole called Lapizole that’s supposed to be tasty for rabbits. I don’t know if its only sold in the UK though.

[Boing]

I’ve never heard of lapizole. It’d probably not work anyway. He’s not a fan of critical care even. He doesn’t like a lot of sweet things.

Yesterday, day 14, he threatened to bite my leg.

The big news is that the infectious disease specialist got back to my doctor. There’s no risk of E cuniculi for me! Apparently even in immunocompromised people they generally just see signs the person has been exposed. People are simply not developing the neurological or organ failure symptoms. So that’s excellent news! So LJB10 was right.

[LBJ10]

That’s great Boing. Yep, that is where the trail of breadcrumbs was leading me. I’m glad the specialist was able to confirm this for you. From what I can find, someone actually becoming ill from EC is extremely rare. People are exposed to EC through their bunnies all the time, yet there is no EC epidemic among rabbit owners (even immunocompromised ones).

[Author]

Messages