Puppy appointments are one of the great perks of being a veterinarian. It’s hard to be in a bad mood when faced with an adorable bundle of exuberance, which makes puppies suffering from a disease called strangles, or juvenile cellulitis, especially pitiful. They are neither adorable nor exuberant.

Puppy strangles is an odd disease. First of all, it tends to only affect puppies younger than four months of age, and for all the world it looks like it should be caused by a bacterial infection. Affected puppies develop some combination of the following symptoms:

facial swelling

papules (small, solid, raised masses) around the face and ears

pustules (small pockets of pus) around the face and ears that usually rupture and crust over

enlarged lymph nodes behind the jaw that may rupture and drain

fever

poor appetite

lethargy

joint pain (less common)

To confuse matters, bacteria are often present when samples are taken from the skin, but these infections develop as a result of puppy strangles; they are not its cause. This explains why antibiotic therapy alone is rarely successful in eradicating the disease.

Puppy strangles appears to primarily be an immune-mediated disease. Genetics seems to play a role since it is diagnosed more frequently in some breeds (golden retrievers, Gordon setters, miniature dachshunds, and Siberian huskies) and family lines than in others.

Immunosuppression (usually with prednisone) is the cornerstone of treatment for puppy strangles, which is a little scary when we’re talking about treating a puppy with an immature immune system who is already at higher than average risk for a laundry list of infectious diseases. Many veterinarians will put puppies suffering from strangles on broad spectrum antibiotics to prevent (or treat) secondary bacterial infections. This is one of the few times that I think combination treatment with prednisone and an antibiotic makes sense.

When a veterinarian suspects that a puppy is suffering from strangles, he or she will usually want to run a handful of tests before prescribing prednisone or other immunosuppressive drugs. Deep skin scrapings to look for the mites that cause demodectic mange, skin cytology (a microscopic examination of cells), and a fungal culture for ringworm are always a good idea since immunosuppression in the face of an infectious disease can be catastrophic. Skin biopsies and other tests may also be needed to reach a definitive diagnosis.

I’ve seen a handful of puppy strangles cases in my career. It is not all that common but can lead to devastating scarring and even death if it is not treated appropriately and in a timely manner. Get your canine bundle of joy to the veterinarian ASAP if you have reason to suspect that he or she is developing puppy strangles.

Dr. Jennifer Coates

Image: Sue McDonald / Shutterstock