Bunny with skin problems--mites, ringworm or staph infection?

Question
QUESTION: I have a rabbit who started to lose hair on his front and back legs about 5 weeks ago. The hair loss was accompanied by open cracks in his skin.  He was lethargic and grooming much more than usual. I took him to a rabbit vet and he was diagnosed with a "classic" staph infection.  No scrapings or culture tests were done.  I was given trimet. sulfa for oral administration 2x a day for 14 days and MaloKet pads to use on his skin. He was also given a dose of Revolution (for mites?)  

He continued to lose weight and hair so I took him to another recommended rabbit vet and she gave me more sulfa medication (0.7 ml 2x a day, a chlorohexidene shampoo (Resichlor) and ResiKetoChlor leave in conditioner. I was told to wash him once a week for 3 weeks an that it could take 1-3 months for this to clear up.  I dutifully washed him twice and gave him all his meds, and fed him 20cc of critical Care twice a day for the weight loss (which I am still doing), but he seemed to be getting worse, with crusting around the nose and more red areas with no fur on his sides and more weight loss.  

I took him this past Monday to another rabbit-savvy vet and she told me he has a ringworm infestation.  Fungal cultures are being done.  She gave him an ivermectin shot, switched his antibiotic to Baytril, told I should wash him every other day, do a sulfa lime dip every 7 days, and give him Grisofulvin (which still has yet to come from the compounder).  I've done all of the above, except for the antifungal medicine.  His eyes are swollen and has a whitish discharge coming from his left eye now and the left eye looks like it has a white film on it.  I think this infection has moved to his face/respiratory system and I'd like to know if there is another way to treat that part of his problem.  I'd like to at least make him more comfortable, since he won't even let me pet his face anymore and a few days ago that was something he seemed to look forward to.

What would you recommend to help this bunny?

ANSWER: Dear Pam,

In all this, I'm really surprised that none of the vets has recommended a skin biopsy to see what's really going on.  Any of these pathogens could be the culprit, but your bunny has had to suffer for a longer time because the vets didn't seem to think it was important to get a positive I.D. of the monster causing this problem.

Is your bunny on any pain medication?  It certainly sounds as if he could use some until this is resolved.

If this really is a fungal infection, it does sound as if it's really spread and become more of a systemic problem, and that means the oral medication will probably be more effective than topical creams.  But you might want to ask the vet if it would be all right to apply miconazole cream (you can get this over the counter as Monistat, sold for vaginal yeast infections) to the most severely affected and painful areas.  This will inhibit the fungi and help soften the skin to relieve pain.

Another possible drug is Program (lufenuron), originally formulated as a flea preventive, but also effective against fungi because of its ability to inhibit chitin production (chitin is the main structural component of cell wall of almost all fungi).

Griseofulvin is pretty strong stuff, so ask the vet about possible side effects to watch for.  And I would really recommend that you ask the vet about taking a skin sample for culture and sensitivity as well as histopathology, in case the fungistatic medications don't work.  At least then you will know for sure what you're dealing with.

For now, I'd ask the vet about topical miconazole and pain medication (metacam?  Banamine?) to keep bunny comfortable until the right medication is working to fix this nasty situation.

I hope he'll be better soon.  Good luck!

Dana



---------- FOLLOW-UP ----------

QUESTION: Thank you for your suggestions.  The vet that I'm going to now mentioned a skin biopsy, but didn't want to do it the last time I was in, which was last week.  We did get skin scrapings for fungal culture, but that takes weeks for a result.  The bun is on Metacam 0.3ml once a day for pain.  Is banamine a better choice for pain?  

He is still eating, and I continue to give him the Critical Care to help get more fiber and calories into him.  I've had to give him metaclopramide to help with gut motility; the baths are very stressful for him.

I don't know how much good the enrofloxicin is doing as I've been treating him with that for 7 days but the upper respiratory problems (congested nose with lots of crusting) seem to be getting worse.  Is there a better antibiotic for this?  I will ask about the cream, (although my last questions about topical creams seemed to fall on deaf ears), culturing the bacteria and doing sensitivity testing as well as using the lufenuron.  Thanks again for your insights and your thorough answer to my questions.

Answer
Dear Pam,

Well, I hope the fungal culture gives you some answers soon.  But if not, I'd still think a skin biopsy would be a good idea.  There are other conditions (e.g., sebaceous adenitis) that *could* cause the signs you describe.

Banamine is a more powerful NSAID than metacam, but if the metacam is doing the trick, I'd stick with it.  If it's not working well enough alone, ask the vet if it might be okay to add some Tramadol, a synthetic opioid.

The congestion might not be related to the skin condition, and at this point it might be a good idea to try a deep nasal culture.  Note that nasal cultures can be very unreliable unless the vet uses incredibly careful technique, cleaning off the area around the nares with disinfectant and letting it dry completely before using a swab (and avoiding the external areas as much as possible) to get a deep sample.  But if one organism shows heavy growth, it could help:

www.bio.miami.edu/hare/culture.html

Note that if the problem is entirely fungal, then antibiotics could actually make things work by removing normal, healthy bacteria that help to suppress fungal pathogens.

I hope you'll be able to get to the bottom of this soon.

Dana