A recent weekend at the Emergency Veterinary Hospital of Ann Arbor, Mich., owned by Lindsay Ruland, DVM, saw a dozen patients with signs of the mystery canine illness reported in Ohio and Michigan. "Some had milder forms and were treated on an outpatient basis if they lived within 10 minutes of our hospital; others were so critical they came in unresponsive and were immediately admitted," Ruland told dvm360.

Ruland says that although public attention surrounding the still-unidentified disease began with cases in Ohio late this summer, she's been seeing the gastrointestinal and respiratory signs in her patients for the past year – upwards of 100 cases. Last year, however, she says the signs weren't as severe. "This year it's definitely worse," she says.

Recently, Ruland says, she and her staff saw firsthand how aggressive the disease is. "We had a 5-month-old mixed-breed dog who had been having diarrhea for less than 24 hours, and it suddenly became bloody," she says. Coincidentally, the owner's cousin's dog had died suddenly two weeks earlier of hemorrhagic diarrhea. Ruland performed radiographs immediately, and while she was reviewing them with the owner, the dog turned gray. "He began breathing heavily and collapsed and was unresponsive," Ruland says.

She rushed an IV catheter and resuscitated the dog with crystalloids and Hetastarch. "He required oxygen supplementation and after 30 minutes finally became responsive," Ruland says. "He went home 24 hours later, but it just showed us how fast this thing moves. If that dog had done that at home, he would have certainly died."

Nearly a dozen dogs have been reported dead in association with the illness in Ohio and Michigan, according to state officials. Ruland says her hospital has seen six dogs die from the illness since the end of August. "And that's just our clinic," she says. She thinks it's a problem at other veterinary hospitals as well, but people may not know what they're seeing.

After local media picked up on the illness reports in Ohio, Ruland went public with her own cases to bring more attention to the illness with the hope it would hasten a diagnosis. Since then, Ruland says she's heard from several pet owners who were not her clients that their pets had exhibited the signs and died suddenly within 24 hours. "The other clinics never had a diagnosis for the owners and oftentimes told the owners that their dog must have had cancer if it was an older dog, or they blamed the owners for feeding the dogs some fatty human food and causing severe pancreatitis," Ruland says. "So the other clinics are seeing these cases, they just aren't seeing them."

According to Tony Forshey, DVM, state veterinarian at the Ohio Department of Agriculture, the most common, consistent clinical signs of the illness have been vomiting and bloody diarrhea, which could have a wide range of contributing factors. After ruling out common causes, Ruland began looking for answers for the increasing number of patients presenting with the illness. Her hospital performed abdominal exploratory surgery in 36 dogs with the same findings – varying degrees of vasculitis. "Vasculitis, edema to all the major organs – it's really impressive," she says. Testing by the Ohio Department of Agriculture found evidence of vasculitis as well.

However, Ruland says her cases seemed to present not only a GI component but a respiratory component as well. She contacted the Animal Industry Division of the Michigan Department of Agriculture and Rural Development for advice on what to test for and what samples to collect. She kept a spreadsheet of her cases.

As cases continued to come in, Ruland says she began to notice another component of the illness. "Owners started saying that they had been sick," she says. Clients would joke they had the same symptoms as their pet.

Ruland realized that cases had begun coming in around the start of fair season and human influenza season. Swine flu had been reported in the state. "The owners were getting sick themselves; my staff was getting more sick the more they handled the cases as well," she says. Then Ruland herself got sick.

She says the illness in people starts with the sudden onset of severe abdominal pain, high in the abdomen. It progresses to lethargy, vomiting and bloating. After a couple days of GI symptoms, it turns respiratory with shortness of breath and coughing. "It definitely seems flulike," Ruland says. She and her team have also noted postviral neurological issues.

"We're pretty certain this is zoonotic here," Ruland says. "I'm not going to put my reputation on the line just for nothing. I do believe in this. I got sick myself."

Ruland doesn't want to cause a panic as there is no scientific evidence yet that the canine illness is zoonotic other than what she, her employees and her clients have experienced. But until she's proved wrong, Ruland and her staff are taking precautions. If doctors and team members shake hands with clients, they sanitize after. They bleach down the clinic once a day. "We've taken a lot more precautions and we're still coming down with this," Ruland says.

And now her boys are sick. Ages 2 and almost 4, her sons are battling respiratory infections and intermittent GI symptoms. Ruland says they had full respiratory panels conducted to look for the common illnesses like influenzas and respiratory syncytial virus (RSV), but all came back negative. Her youngest has suffered bloody diarrhea and the oldest was rushed to the emergency room after he woke up nearly purple with respiratory distress, she says.

Ruland and her husband, who co-owns the hospital, now change clothes in the garage after work and put their hospital clothing right into the laundry before entering their house. They have hand sanitizer everywhere. "It must be airborne or traveling on clothes or something," she says.

Ruland also says her sons' pediatrician told her she's sent more children by ambulance to the intensive care unit in the past couple of weeks than she has in the past five years. "She is certain something serious is going around in humans right now, and it just seems too coincidental that it is also going around in our animals," she says.

Ruland realizes she's putting her neck on the line with her belief that this illness is zoonotic. She's hoping science will back up what she's seeing and experiencing at her clinic. "We've been taught viruses don't cross species," she says. "It's very scary if this is passing readily. We don't want to cause a panic until we know exactly what we're dealing with."

While a spokesperson with the Diagnostic Center for Population and Animal Health at Michigan State's College of Veterinary Medicine says officials there are in contact with other agencies about how the illness might affect public health, Thomas Mullaney, MVB, MS, PhD, director of the Diagnostic Center, says he doesn't see any evidence of zoonosis whatsoever. To his knowledge, neither the Centers for Disease Control (CDC) nor any other public health organization is conducting an investigation concerning the canine illness at this time. Officials in Ohio and Michigan have stated they do not believe the illness is spreading.

However, Ruland says epidemiologists and other public health specialists interested in a possible zoonotic component have contacted her. She is working with them and other private agencies to investigate the possible human side of the illness while continuing to work with the MSU Diagnostic Center on the animal side.

With so much unknown about the illness – researchers have ruled out canine circovirus as a primary cause – Ruland feels it's important to explore what she is witnessing and experiencing at her hospital. "It's not proven in scientific fact, but it's strong enough we needed to get the word out to people," she says. She says other veterinarians and former classmates are contacting her, sharing cases they now believe could be tied to the illness.

While testing continues at the Diagnostic Center and other laboratories, Ruland's partnerships with private researchers continue as well. "The research group we are working with is working on deep DNA sequencing to try and figure out if the canine samples show circovirus or an entirely new virus," Ruland says. She may have her sons tested for circovirus, both porcine and canine if possible, if their respiratory symptoms persist.

"We're seeing a lot of these cases still," Ruland says. "We are very alarmed at the sheer number of animals who have this illness right now and expect it to only increase as the flu season goes on. We are trying to obtain answers quickly to see if there is a way we can prevent this from continuing."

Ruland is footing the bill for all samples her hospital has submitted for testing. She says she doesn't care what it costs. There are 20 different samples in the refrigerator right now. "I don't want my staff getting sick; I don't want these dogs getting sick. I just want an answer," she says.