This is Page 5 of 8 Pages in the Canine Parvovirus Information Center
	Basic Virology A Preface	Canine Parvovirus: What Is It?	The Virus in the Environment: Disinfection	How Infection Happens
(original graphic by marvistavet.com)	The Physical Illness and It's Treatment	Diagnosis of Canine Parvovirus	Caring for the Recovered Dog	Vaccination Options /Prevention

The Physical Illness and its Treatment

Treatment for parvovirus infection centers on what is called "supportive care." This means that our job is to keep the patient hydrated, comfortable and as strong as possible so that he or she has time and ability to generate an effective immune response. We cannot kill the virus inside the patient's body; only the patient's own immune system can do that.

BE PREPARED FOR A 5-7 DAY HOSPITAL STAY AND A SUBSTANTIAL EXPENSE.
INTENSIVE CARE IS NEEDED TO TREAT THIS INFECTION.

There are certain basic treatment principles which can be viewed as “must haves” in addressing the parvo puppy. Beyond these basics are some “added pluses” which may or may not contribute to the chance for survival. In order to achieve the usual survival rate of approximately 75-80%, the basics must be delivered. Many practices will add additional treatments to their basic regimen in order to improve survival or shorten the disease interval depending on expense and preferences of the doctor. We will cover some of the treatments that may be employed.

THE BASICS

ANTIBIOTICS: The second way parvo kills is through bacterial invasion of the circulatory system (“sepsis.”) The intestine is normally full of bacteria and when the parvovirus ulcerates the intestine there is little to prevent the bacteria from marching easily into the bloodstream with little opposition. With the GI tract damaged, antibiotics cannot be given orally. They are given either as shots or are added into the IV fluid bag. There are a number of antibiotics which may be selected. The important thing is that they are given directly intravenously so as to avoid issues with attempting to absorb medication from the diseased intestinal tract or from poorly perfused peripheral tissues. Intravenous antibiotics are taken directly to the "battlefield" of the infection in the intestine where bacteria are attempting to invade. Since the patient's white blood cell count is typically drastically reduced during the height of the parvo infection, we are relying on antibiotics to keep the bacteria out.

CONTROL OF NAUSEA: Patient comfort is a very important part of treatment for any disease but is especially important for parvo treatment as these puppies feel extremely nauseated. Again, the GI tract is too damaged for oral medication so medications are given as injections. There are several popular medications for nausea control:

• Maropitant (brand name: Cerenia^®: This powerful anti-nauseal is now fully approved for puppies over age 8 weeks. It is given once daily.
• Ondansetron and dolasetron: These injectable medications are especially strong anti-nauseal medications. In the past, expense has made these medications uncommon but recent generics have made them readily available. Ondansetron is typically given 2-3 times daily while dolasetron is given only once daily.
• Metoclopramide: (best given as a continuous drip in the IV fluid set up.) If used as separate injections, relief tends to be short lasting and does not provide “around the clock” control. If a continuous drip is used, nausea control lasts as long as the drip is running.

The vomiting typical of parvo infection is not only uncomfortable but can ulcerate the esophagus. The disease itself ulcerates the stomach and small intestine. Medications called “gastroprotectants” help heal ulcers and help minimize their formation. These medications might include the injectable antacids (H2 receptor blockers or proton pump inhibitors) as well as sucralfate, which forms webbing over ulcers to facilitate healing.

HEAT SUPPORT: One might expect fever with such a serious infection (and sometimes there indeed is a fever) but usually the opposite is the problem. Little dehydrated puppies tend to get cold and with cold comes poor blood circulation. It is important to keep the puppy warm enough to maintain a normal body temperature without too much work on the puppy's part as he or she will need body resources to overcome the infection and not divert extra to body heat. Fluid warmers for the IV fluids are sometimes used and special heated blankets are common.

NUTRITIONAL SUPPORT: Originally, patients treated for parvo were kept off food in an effort to minimize the nausea since they are not able to perform much food digestion anyway. More recently it has been found that intestinal cells survive and recovery better if they receive some nutrients. Not much is necessary, just enough to lightly coat the intestinal cells. For this reason, a very tiny amount of food is now recommended early in the course of treatment and throughout until recovery. The patient will not have an appetite at first and the goal is not so much to nourish the puppy as to nourish the cells of the intestinal tract.

MONITORING

The following tests are helpful in adjusting parvovirus treatment:

Fecal flotation or deworming to rule out worms/internal parasites
The last thing these patients need is a parasite burden contributing to their nausea and diarrhea. Since parvo victims are puppies and puppies are high risk for parasitism, it is important to test for worms and microbes that can contribute to the GI upset and eliminate them if present. Alternatively, puppies can be dewormed with a broad spectrum product or products to be sure that internal parasites are not contributing to illness.

White blood cell counts/complete blood counts
One of the first acts of the parvovirus is to shut down the bone marrow production of immunologic cells (the white blood cells). White blood cell counts are often monitored as the infection is followed. The white blood cell count bottoms out at the height of the viral infection and recovers as the patient’s immune system gains the upper hand. Following the white blood cell count is helpful in tracking the course of infection and determining when the patient truly on the upswing.

Electrolytes and Glucose levels
In at least one study of parvo patients, 60% of treated puppies required potassium supplementation during treatment and 75% required glucose supplementation. Monitoring of these parameters is ideally performed regularly during the course of treatment.

Urine specific gravity/Lactate levels
In order to assess the effectiveness of the fluid therapy, some objective evaluation of dehydration is useful. If adequate IV fluids have been provided then the urine produced will be dilute (as measured by specific gravity). Similarly, blood lactate levels can be monitored to insure proper hydration as lactate will build up when tissues are not properly perfused by the circulation.

Abdominal Palpation
Abnormal motility of the intestines occurs with this infection. Sometimes an area of intestine actually telescopes inside an adjacent area in a process called intussusception. This is a disastrous occurrence as intussusception can only be treated surgically and parvo puppies are in no shape for surgery. Euthanasia is usually elected in this event. Less dramatically, some patients experience enough abdominal discomfort to require additional pain support beyond their anti-nauseal medications.

Total blood protein
Protein depletion is common when there is heavy diarrhea. If blood proteins drop too low, special IV fluids or even plasma transfusions are needed to prevent massive life-threatening edema.

EXTRA TREATMENT WHICH MAY HELP:

NEUPOGEN

“Neupogen” is the brand name of a genetically engineered hormone called “granulocyte colony stimulating factor.” This hormone is responsible for stimulating the bone marrow to produce white blood cells and its administration easily overcomes the bone marrow suppression caused by the parvovirus. In other words, neupogen helps the white cell count recover. A recent study did not find increased survival with the addition of this product to the parvo regimen; however, in sicker puppies it may make a significant difference. It is very expensive and can add substantially to the treatment cost.

FECAL TRANSPLANTATION

Transplanting fecal material from a healthy dog into the colon of an infected dog has been shown to reduce the number of days that parvo puppies experience diarrhea. Reducing the diarrhea fluid losses potentially can mean the difference between life and death so this treatment is becoming more popular. Many hospitals actually keep frozen fecal samples properly mixed in saline for this exact purpose. This treatment is emerging for many intestinal diseases and is likely to become more common in the future.

MONOCLONAL ANTIBODIES

An intravenous treatment that prevents the attachment of the virus to patient cells has been released in 2023. A single injection of monoclonal antibodies against canine parvovirus is given to the puppy as early in treatment as possible so as to minimize the virus' ability to produce infection. This treatment appears to reduce symptoms experienced as well as hospitalization time.

HOME TREATMENT FOR PARVO

Proper treatment for parvo infection involves intensive support and monitoring of numerous parameters which may require special additional treatment. Survival statistics with hospitalization are high and there no comparable treatment that can be performed at home. That said, sometimes financial concerns preclude hospitalization and home care may be a puppy's only chance. The owner will need to administer injections, manage feedings, clean up a great deal of vomiting and diarrhea. Colorado State University has published an out-patient parvovirus treatment protocol that has demonstrated good success but in this protocol, the patient returned daily for hydration assessments and blood sugar and electrolyte testing which would contribute to expense and effort. If home treatment turns out to be the only option, ask your veterinarian about the most practical options for your own situation.

Page last updated: 8/23/2023