When someone says Enzepahlitazoon Cuniculi, most rabbit owners get a shiver of discomfort. One of the most dreaded illnesses.
Encephalitazoon Cuniculi (EC) is a protozoa parasite that mostly affects the central nervous system and kidneys but can also affect all organs.
We deal with a minimum of 40 EC rabbits directly on a yearly basis. Seeing that we handle and care for far over 1000 rabbits yearly, it is worrying. However, The cases are increasing all over South Africa, and we have seen a trend that it is season-bound, or linked to certain weather patterns and temperatures. We live in an area with a hugely increased EC number, where EC strikes predominantly in Autumn in the Western Cape and Gauteng, and in winter in KZN.
Seeing your bunny with head tilt, unstable and wobbly or paralyzed need not be as daunting to you as it seems, though.
If you have a better understanding of what is happening, you may find it easier to deal with.
First, it is needed to ensure that it is indeed EC. In many countries, there are no tests available. And in countries like ours, where so many carry it, it can give a false reading. So, it is important to make sure that alternatives, eg
– ear infection,
– trauma to the head, brain or neck or
– even a stroke is ruled out.
And if you are unsure, treat for EC, as the treatment also covers others.
More than 70% of rabbits in our area in the Southern Cape are carriers of this protozoa parasite, but it is not showing any symptoms. Their immune system is keeping it controlled. Sometimes the protozoa lie in clusters, surrounded by white blood cells, esp in the lungs, kidneys and even in the eye. We have often seen a white cluster in the eye of a rabbit.
Signs and symptoms
• Some bunnies do not give obvious signs until a certain point. Then, it is usually seen in torticollis, or HEAD TILT, where the protozoa have already affected the central nervous system. It can be really hard seeing your bunny with the head tilt.
• Depending on the strain of EC (there are 4 strains) it may start to show as conjunctivitis (eye infection) too, or as a “liquid moving cataract”. In some rabbits, a small white fleck, an EC Cluster, is usually the first sign of the disease, where it lay in a contained spot. Cataracts forming at a younger age is usually a sign of EC, and baby bunnies that had a mom fighting EC (Either immunity getting it back under control, or a full outbreak) during her pregnancy, will show conjunctivitis and Cataracts from about 2 weeks, where fully developed cataracts can be possible as young as 6 weeks.
• Renal impairment – the kidneys take strain, and this may cause less wee. Pitting forms on the kidneys if the rabbit is not supported with enough fluids, taking away some of the renal function, and making the rabbit drink more water after healing, but suffering from renal (kidney) impairment or even renal failure.
• Clumsy movements, shivering or falling over – exactly like in ear infections, the balance of the actively infected bunny will be off.
• Seizures – depending on the severity of the infection already, the bunny may seizure. It is important to know if this was a seizure because of low blood sugar, a stroke, or because of EC.
• Lung impairment – because the central nervous system is affected, the bunny may have an increased heart rate and breathing rate. However, if EC clusters are present in the lungs, it may be more severe as the lungs labour to breath; and a respiratory infection may be caused as well.
• Liver disease. Not only does the parasite clusters block certain areas of the liver and kidneys, but the EC can also damage the liver if the bunny is not kept properly hidrated and the system flushed.
Important to know:
• If EC is suspected and not treated immediately, your bunny has a much lower chance of surviving. EC is deadly. hours can count, and you do not have long to start a treatment. EC regresses fast.
• Your bunny needs pain meds and antibiotics as well, not just fenbendazole (panacur)
• Your bunny WILL get worse before they get better, especially between day 5-7 after EC started showing symptoms. This is due to increased brain activity and swelling, and the body’s immune response to what is happening.
• Many bunnies can become totally paralysed while having EC. You need to turn them often to prevent bedsores. (They will be able to swallow their food)
• Most bunnies will have a good appetite still, and you need to ensure that they get water. If they cannot drink on their own, you need to syringe them – even in the night. If you see they do not drink enough, you have to assist them in drinking. Many EC bunnies will use a water bottle to drink from, and if they have a slight head tilt after healing, will need a big bottle as they will not be able to drink from a bowl.
So how does my bunny get infected?
• Many bunnies carry EC even since birth, but it lies dormant in their systems until they experience a huge stressful event that will lower their immunity and give the protozoa time to spread and break out. This is most common in our area.
• From the wee or mucus of an infected friend that shares litterbox or grooming.
• Cats! Yes, cats. Cats do carry EC and a few cats have even got sick as well from EC. A cat that either caught a carrier bunny or stepped in his wee, can transport the spores and give it to another bun either through urine (esp spraying) or when he bites. We have even found that puppies with a weak immunity can carry it or get sick from it. (Cats are also the biggest spreader of Pasteurella to baby bunnies from a single tooth puncture). Stray cats in our area is the biggest spreader of EC.
What to expect when taking your bunny to the vet:
The vet will first check the ears and head for any signs of trauma, infection or anomaly if there is head tilt (torticollis)
If the bunny is not moving well, he or she may feel up and down the spine of the bunny. They may opt to take an x-ray to rule out any acute happening, like compressed disk or stenosis. They may take an x-ray to see the spine and check for calcifications or lesions in the lungs or kidneys. They will ask you some questions to establish history, eg did the bunny go for an unusual outing 1 week to 4 weeks ago, etc. They may opt to take a sonar scan to ensure about the lungs, liver and kidneys. They may opt to take a blood test to check for the presence of certain bacteria.
If the diagnosis rules out everything else, and it is said to be suspected EC, they will give you the following meds:
– Pain meds for 7 days or more if needed. (MELOXICAM)
– Antibiotics for 11 days minimum (baytril or metronidazole works best, we found,)
– Fenbendazole (eg Panacur) for 28 days
– We often use Milk thistle to support the Liver during Panacur treatment.
Why pain meds?
Because if there is a fight going on in the brain, the brain may have pressure and they may feel a “headache”.
Why Antibiotics?
Antibiotics, to ensure that a secondary infection does not start while your bunny’s immunity is fighting elsewhere. Also, when the zoonites start to die off, they can lie in the bloodstream and organs, and cause infections in both the liver and kidneys.
Why Panacure?
Panacur (Fenbedazole) will be for 28 days, to ensure the spores all die before they can “hatch”. In a few cases, we had to extend to 36 days, however. Your bunny’s bonded mate or friends that had been in contact with should get either a 9 or 14-day course of panacur, depending on their level of sharing litterboxes and getting wee transfers. Also watch them closely for any EC signs. If signs appear, they need to do the 28 days.
What to expect in the first weeks:
• In most cases, the bunny regresses esp in the first week, rather than progress. This is normal. To explain it easier, think of this: when you spray poison into an ant colony, the ants all get angry and scatter and attack, in a way of self defense – and then they start dying. The same with EC, where Panacur is the poison and the Zoonotics are the “ants”.
• Your bunny may lose eye reflexes and go temporarily blind. Keep your bunny contained and safe.
• Your bunny may become paralysed from the neck down. Some bunnies only get lame in the hind legs. Then you need to put your bunny on very soft thick blankets and keep turning him or her so pressure sores do not happen.
• In bunnies with head tilt, you need to ensure that you rub the trapezoid and neck muscles to keep them flexible so that they do not permanently retract during the course of illness. Put on a hot compress – a light warm cloth / beanbag etc.
• You need to ensure that the eye that is lying to the bottom (the down eye) does not get something in it, dry out or lie against the blankets while open. Always check this eye, and ensure both eyes are moist. We often find the Up-eye gets dry. You may need some moisturizing eye drops for this, like the drops used for contact lenses (please ensure your vet advises on what you can give)
• You need to cut the food smaller so the bunny can easily pick it up. and eat it.
• You need to ensure that bunny poop and wee, and you need to clean this up ensuring bunny is dry and clean. Corn flour helps to dry stained wet hair. Unfragranced baby wipes can also help, but make sure there are no unsafe detergents on there.
Eating and drinking:
EC bunnies usually eat by themselves without any problem. They may struggle to drink, however, esp if they have head tilt. So, you need to make sure to help hydrate your bunny.
Prognosis: Some bunnies will always have signs to show they survived. There may be blindness, (cataracts often form in bunnies that had EC) lameness, tremours or head tilt.
Some bunnies, when caught early, may have no signs.
It can take up to 60 days to fully heal, and remnants or disabilities left after this is seen as seen as permanent. Giving Panacur for longer than the 36 days, is not beneficial. It can harm the liver and the kidneys. After 28 days there will not be active protozoa anymore.
Treatment – for Vets
CROCODILE ROLLS –
see week 2-3 support, although some bunnies can start after just a few days if your bunny has less severe EC. Many owners opt to euthanise their bunny in this stage, which lasts about 3 days. We found giving padded support (keeping them in a basket with padding, ensuring they cannot get stuck on anything, and removing all hay etc that can harm or damage them, is the best. This is really hard to see, but this is your bunny healing and getting equilibrium.
Physical support:
Week 1 & 2 : confinement, massage of all muscles, esp neck and trapezoid muscles, syringe water and tea to make sure he gets a LOT of moisture in. If the kidneys do not flush, they get pitting and most buns pass from secondary effects of EC later in life (EC kidneys).
Week 2-3 – passive supportive exercise, then physio. Actively working and rubbing the leg muscles etc. You help the bun along to walk as active therapy when he is up, you support him to find his feet and walk along. Keep him upright with the sides of your hands. Try and limit crocodile rolls. (Aligator rolls)
From week 3 to 4 you can start slight balance training. Never before that. Most of them find their feet in week 2-3 and move along normally week 3-4 except severe cases, or cases where EC had secondary effects.
Balance takes between 10 and 14 days since treatment starts, whereafter the rabbit will start staying on his feet longer and longer. I have a 9-year-old bun who survived in 2023 May, and it took him 18 days to get to his feet, and 22 before he could wash himself. Today he runs all over my bed, lives on my couch and have a serious tilt, but is as energetic, playfull and lively as any young bunny.
Deciding on quality of life and letting them sleep:
We believe that if they try and fight, we fight. If they eat, they fight. The decision is yours, and the timespan too, not for the vet, as they do not see your rabbit every day and know about his care.
BUT: Many vets will suggest to rather PTS (Put to sleep) if they are not sure about the care or life conditions. Also with full right, as it takes a lot to assist your bunny through this. Outside, wilder bunnies do not cope well with being contained and handeled, and the stress of suddenly being inside can cause the disease to flare. This will cause immense stress, and it will be kinder to let them go. Your bun will need to be a most cherished pet, inside, to win this disease, and may need to be cared for, for the rest of his/her life if there are residual effects. So I fully agree and understand about the suggestion from the vet, but you have to also look at the bun and his life forward.
If you love your bunny, and he/she is an inside companion, please fight for them. Many regain a slight heat tilt, and this makes them unfit to stay outside. Forever. The tilted head will cause him to not to correctly see and hear predators, and not being able to flee, and also water and wind to affect the up eye and up ear, to be chronically infected. You will need to be able to look after your bunny full time, for the first 2 weeks, or have them at the vet for this time, to ensure medications, turning when paralised, etc. If you cannot ensure this care, your rabbit will suffer and it will be better for them to go, If you can ensure this care, your rabbit has a 90% chance of survival, with residual effects depending on various factors including age, timespan before treatment, overall immunity, etc.
Thus, discuss the way of his future life care with the vet before deciding too fast. Inside bun, extra care ❤️
The quality of life:
Head tilt bunnies, like most disabled, are not quality-compromised.
They just have a different perspective. Just like humans, many bunnies cope amazingly when dealing with a disability. Some however not. So its really important to see how they cope, how they try. Just like some humans, some see it as a drawback and get depressed. We have to check up on them often, and then make decisions. But we find over 90% of bunnies cope very well if supported correctly. Wrong or faulty support reduces quality of life by more than half though.
EC that have affected the kidneys very badly – renal pitting etc, has a very poor prognosis and quality of life. Its often called the silent killer. We do extensive flushing of the system during EC, to protect the kidneys as much as we can. Also, dietary requirements differ afterwards, with very little franc herbs like basil or coriander. We give rooibos tea, a natural South African Herb tea that has great rehydration, antioxidant properties, good nutrition, and a good flushing mechanism. Note that this is NOT for everyday use, and reserved as a treat every now and then, or when ill.
Head tilt is the least of the remnants of EC to worry about. The extras during the treatment, like flushing and nutrient supplements, are most important.
Can EC be Prevented?
No, not really prevented, just contained, or treated prophylactically. Bunnies with dormant EC can have it break out the moment their immune system drops – eg after a house move, a big fright, anaesthetic, spay, even a stasis. The immune system’s white blood cells may contain the little polypses or clusters of EC, and the moment they are needed elsewhere, the EC may break out. EC in the head area is visible much faster than EC in the liver and spine. So treatment can start faster. It can be from 5 days to 3 weeks after a happening that EC becomes visible. We do a Panacur course every 4 months here, to ensure any clusters in viable areas that is out of boundaries can be treated. EC clusters hiding in the eye for example, cannot be reached by Panacur through the system.
We treat Prohylactically by giving Panacur for 9 days every 4 to months, and definitely every 4 months to those with the telltale white fleck in the eye.
The long and the short of EC:
- It’s treatable
- It needs immediate attention
- It needs Full-time care, esp the first 2 weeks
- Its not good to try and treat wilder outside bunnies.
- Fluids and flushing is seriously important to stop renal damage
Please ensure to take your bunny in to the vet, as es the eye examination is really important.
This is our treatment plan, that we have found effective over and over, and these bunnies did not have any remnants of EC, or any new infections during the past 3 years that we have started with this specific dosages.
Panacur: 1st 3 x days at 0.7ml per kg, 2 x per day, then day 4 – 14 at 0.7ml once daily, and day 15 – 28 (normaly) at 0.4ml per kg once daily.
Meloxicam – day 1 – 7 at 0.4ml per kg, 2 x daily, at least 30 minutes BEFORE panacur and antibiotics, but 30 mins after food. If needed, prescribe more meloxicam after this timespan. We give meloxicam extra during crocodile rolls. Please also supply Pet Remedy spray for a blanket or soft toy in the basket for the session during crocodile rolls, as they do get stressed, which can flare the disease.
Antibiotics – We find an 11-day course per kg works best. Many of the post EC symptoms including renal pitting is due to the lack of antibiotics to help prevent infections from the degrading zoonites.
Supportive measures: We do advise to give milk thistle from day 7, as well as echinacea (together with honey and rooibos) to help build the immune system, from day 14. Also, honey and rooibos for the antioxidizing effects in the tummy, and the nutrients, and to ensure stable blood sugar. EC uses a LOT of blood sugar and will be easier if honey is given in the first 3 days esp so the zoonites affect the brain and spinal tissues less.
Need any more info? Please contact us at 060 466 2810.