Clinically, the disease starts with a transient fever usually occurring 3 to 6 days after infection. During this stage, blood tests may show low white blood cell counts or leukopenia. This may go unnoticed or be accompanied by anorexia (lacking appetite). Then a second fever episode starts and it can be associated with a discharge from the nose and eyes, lethargy, and loss of appetite. Other gastrointestinal and respiratory signs such as vomiting, diarrhea and cough, may follow and are usually complicated by bacterial infections. Dogs surviving the acute phase may have hyperkeratosis of the footpads and epithelium of the nasal planum, as well as enamel hypoplasia (not fully grown) in incompletely erupted teeth. There is no way to anticipate if the dog will develop neurological signs or not. Encephalomyelitis (infection on the nervous system) may occur in association with these signs, follow the systemic disease, or occur in the absence of systemic manifestations. In some cases, convulsions (seizures) with drooling and jaw chewing movements are reported. Seizures become more frequent and severe as the disease progresses. The dog may fall on its side and paddle its legs. Involuntary urination and defecation of dogs often occur. Infection may be mild with few or no signs, or it may lead to severe disease showing most of the above signs. The course of the distemper disease may be as short as 10 days, but the onset of neurologic signs may be delayed for several weeks or months.