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Two Common Diseases of Captive Chelonians. Trevor Zachariah & Mizue Ambo. Terminology Anatomy & Physiology Hypovitaminosis A Pneumonia. Terminology Turtles - generally aquatic Tortoises - terrestrials. Anatomy & Physiology Shell Upper shell = carapace Lower shell = platron

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slide2

Terminology

  • Anatomy & Physiology
  • Hypovitaminosis A
  • Pneumonia
slide3

Terminology

  • Turtles - generally aquatic
  • Tortoises - terrestrials
slide4

Anatomy & Physiology

  • Shell
  • Upper shell = carapace
  • Lower shell = platron
  • Scutes = superficial layer of keratin shield over
  • bony shell
slide5

Respiratory System

  • Breath in and out of nares
  • Trachea has complete cartilaginous ring
  • Short trachea bifurcates directly into the paired
  • lungs
  • The lung is dorsally attached to the ventral surface
  • the carapace
  • No true diaphgram separates the lungs from
  • the other internal organs
  • Less surface lung area
  • Large lung volume which provide buoyancy for
  • the aquatic turtles
slide7

GI System

  • Terrestrial species = hervivors
  • Aquatic species = carnivors or omnivors
  • No teeth with large fleshy tongue
  • Shorter small intestine compare to the mammals
  • Food digestion time = 3-28 days
  • Circulatory System
  • 3 chambered heart like typical reptiles
  • Renal portal system (watch out!!)
slide8

Renal System

  • No Loop of Henle
  • Aquatic = soluable urinary, nitrogenous wastes
  • need large amount of water for excretion
  • Terrestrials = insoluable urinary waste, uric acid, urate
  • salts
slide9

Hypovitaminosis A

  • Lack of vitamin A in the diet
  • Multifocal squamous metaplasia of epithelium
  • Respiratory, ocular, endocrine, GI, and genitourinary
  • system are often involved
  • Normal columnar, cuboidal epithelium is replaced by
  • flattened cells
  • Granulocyte and desquamated material fill multiple
  • cysts
  • Cellular debris accumulates underneath the eyelids
  • in the conjunctival sac, fuse eyelids if severe
slide10

Clinical Symptoms

  • “Swollen eyelids” - most commonly blepharoedema with or
  • without whitish-yellowish cellular debris underneath the
  • eyelids
  • Lethargy
  • Anorexia & weight loss
  • Nasal, ocular discharge
  • In chronic cases - irregularly thickened integument that
  • cracks and abonormal keratin growth in the seams
  • between scutes
slide11

Clinical Symptoms (cont’d)

  • Pneumonia and hypovitaminosis A are concurrent in
  • desert turtles
  • Middle ear and respiratory tract infection and egg
  • retention are common in Box turtles
  • Inguinal, axillary edema can be a sign of kidney failure
  • secondary to hypovitaminosis A (poor prognosis)
slide12

Diagnosis

  • Vitamin A assay of liver, or large quantities of blood
  • are needed for definitive diagnosis
  • Normal liver vitamin A level is over 1000 IU/gm
  • Mean plasma retinol values can be measured
  • Dietary history, clinical signs, and response to
  • treatment are crucial
slide13

Treatment

  • SQ injection of 1500-2000 IU Vitamin A /kg weekly
  • for 2-6 weeks
  • Not to give high dose of Vitamin A
  • - can result in Hypervitaminosis A
  • Symptoms can resolve between 2-6 weeks
  • Carefully remove cellular debris
  • Ophthalmic antibiotic ointment can be useful
slide14

Left: post-treatment

day 16

Right: post-treatment

day 18

slide15

Prevention / Long term treatment

  • Client education
  • Expanding diet - food rich in beta carotin
  • Yellow-orange colored vegetable or fruit, steamed winter
  • squash, carrots, sweet potatoes, and cantaloupes
  • For aquatic turtles - liver from mice or fish
  • Commercial diets suitable for reptiles are good, too
  • - Purina Trout Chow
  • - Tera Reponin
  • - Floating food sticks
pneumonia in chelonians
Pneumonia in Chelonians

Eastern box turtle

normal respiratory anatomy
Normal Respiratory Anatomy
  • dorsal and ventral attachments
  • no true diaphragm
  • internal ridging
  • large volume
  • small respiratory surface area
normal respiratory anatomy18
Normal Respiratory Anatomy
  • muscle pairs control visceral, and thus lung volume
  • head and limb movements
  • no reliance on negative thoracic pressure
pneumonia
Pneumonia
  • serious problem in chelonians—very difficult to remove secretions/foreign material out of lungs

-entrance of bronchi

-compartmentalization

-large potential space

-no diaphragm

-mucociliary elevator

Common map turtle

diagnostic plan history
Diagnostic Plan--History
  • complete and thorough
  • important points

-origin

-quarantine procedures

-other reptile species in

the collection

-environmental disinfection

-progression of clinical signs

Midland painted turtle

diagnostic plan physical exam
Diagnostic Plan--Physical Exam
  • dyspnea

-inspiratory +/- expiratory

-open mouth breathing, head and neck extended

  • RR increased
  • rales during auscultation
  • cyanotic mucous membranes
  • lethargic, depressed
diagnostic plan physical exam22
Diagnostic Plan--Physical Exam
  • less time in water
  • asymmetrical swimming
diagnostic plan radiology24
Diagnostic Plan--Radiology
  • compare R and L lung fields in craniocaudal view
  • know what normal looks like
  • pneumonia is diffuse or regionalized opacity
diagnostic plan sampling
Diagnostic Plan--Sampling
  • transtracheal wash

-not great

-fleshy, muscular tongue

  • percutaneous lung wash

-sterile saline solution (0.5-1% of BW)

-needle

-affected side down

diagnostic plan sampling27
Diagnostic Plan--Sampling
  • sample uses

-wet mount

-exfoliative cytology and special stains

-microbiologic evaluation

Desert tortoise

diagnostic plan systemic
Diagnostic Plan--Systemic
  • critical illness
  • secondary effects on other systems

-eg evaluate renal and hepatic function prior to antimicrobial administration

Hermann tortoise

differential diagnoses bacterial
Differential Diagnoses--Bacterial
  • majority of pneumonia cases
  • many are gram negative
  • often found in healthy individual
  • occurrence

-primary entity

-extension of another disease

-normal commensal established in unusual place

differential diagnoses bacterial30
Escherichia coli

Klebsiella

Pseudomonas

Proteus

Aeromonas

Salmonella

Pasteurella

Bacteroides

Peptostreptococcus

Fusobacterium

Clostridium

mycoplasma

chlamydia

mycobacteria

Differential Diagnoses--Bacterial
differential diagnoses viral
Differential Diagnoses--Viral
  • herpesvirus

-severe necrotizing bronchitis, pneumonitis, and hepatitis

Red-eared slider

differential diagnoses fungal
Aspergillus

Candida

Mucor

Geotrichum

Penicillium

Cladosporium

Rhizopus

Beauveria

Differential Diagnoses--Fungal

-most treatments are unsuccessful

differential diagnoses parasitic
Differential Diagnoses--Parasitic
  • live a portion of life cycle in respiratory tract
  • cause secondary bacterial infections
  • pentastomids (“tongue worms”)

-annulate metazoan parasites

  • trematodes

-renifers (eg Dasymetra, Lechriochis, Aeugochis, Ochestosoma, Stomatrema)

differential diagnoses other
Differential Diagnoses--Other
  • noninfectious causes

-aspiration

-inhalation

Aldabra tortoise

treatment
Treatment
  • clinical signs usually not noticed until advanced disease present
  • serious enough to mandate aggressive therapy
  • start right away with broad-spectrum antimicrobials
treatment36
Amikacin

Ceftazidime

Ceftiofur

Cefotaxime

Cefuroxime

Enrofloxacin

Piperacillin

Metronidazole

Amphotericin B

Ketoconazole

Ampicillin

Carbenicillin

Ceftazidime

Doxycycline

Trimethoprim-sulfadiazine

Gentamicin

Amikacin

Enrofloxacin

Tylosin

Ketaconazole

Nystatin

Acyclovir*

Ganciclovir*

Treatment
treatment37
Treatment
  • nebulization

-increase humidity

-increase efficiency of mucociliary system

-aid breakup of necrotic and inflammatory debris

-deliver antibiotics deep into site of infection

-Amikacin, Cefotaxime, Piperacillin

treatment38
Treatment
  • intrapneumonic catheter

-hand drill with 4mm bit

-over-the-needle catheter

-polymethylmethacrylate

treatment40
Treatment
  • other options

-mucolytic agents (eg acetylcysteine)?

-coupage?

-furosemide?

-atropine?

-oxygen therapy?

treatment41
Treatment
  • supportive care

-fluid therapy

-preferred optimal temperature

-feeding

-vitamin A

Gopher tortoise

treatment42
Treatment
  • cessation

-clinical signs

-serial hemograms

-serial radiographs

-serial transtracheal or lung washes

-patient disposition

-your judgement and intuition

thank you
Thank You!

Common snapping turtle

Alligator snapping turtle

references
References
  • Aiello, SE, ed. The Merck Veterinary Manual, Eighth Edition. 1998. Merck & Co., Inc.
  • Bartlett, RD & Bartlett, PP. Turtles & Tortoises. 1996. Barron’s Educational Series.
  • Davies, R & Davies, V. The Reptile & Amphibian Problem Solver. 1997. Tetra Press.
  • De Vosjoli, P. General Care & Maintenance of Popular Tortoises. 1996. The Herpeticocultural Library.
  • Lewis, W. How to Place Intrapneumonic Catheters in Chelonians. Exotic DVM Magazine, Vol. 3.5, Oct./Nov. 2001, pp.16-17.
  • Mader, D. Reptile Medicine & Surgery. 1996. W. B. Saunders Co.
  • Messonnier, SP. Common Reptile Diseases & Treatment. 1996. Blackwell Science, Inc.
  • Phalen, DN. The Veterinary Clinics of North America Exotic Animal Practice, Repiratory Medicine. 2000. W. B. Saunders Co.