Advances in Reptile Clinical Therapeutics

Surveillance of Mycoplasma agassizii in Texas tortoises (Gopherus berlandieri) for translocation with emphasis on treatment and recovery

Background

Texas tortoises (Gopherus berlandieri) are a Texas-state threatened species. Translocation is often suggested as a mitigation option; however, disease status and the potential for spread must be considered prior to such efforts. Mycoplasma infection of the upper respiratory tract is a concern within tortoise populations, which requires monitoring so translocation efforts do not inadvertently spread the disease.

Objectives

We determined and compared the prevalences of Mycoplasma agassizii in Texas tortoises from donor and recipient sites in southern Texas prior to translocation, treated Mycoplasma agassizii-infected tortoises with danofloxacin, and developed alternate Mycoplasma agassizii treatments for Texas tortoises.

Methods

We collected 171 and 23 Texas tortoises from a 270-ha and a 100-ha donor site and recipient site, respectively. We began a regimen of danofloxacin (6 mg/kg body weight injected subcutaneously every other day for 30 days) for tortoises with clinical signs (N = 20). We noted an additional 10 tortoises began displaying clinical signs of upper respiratory tract disease (URTD) after translocation, so we designed a trial to test tulathromycin (5 mg/kg body weight given intramuscularly once/week for 7 weeks) or oxytetracycline (8 mg/kg body weight given subcutaneously once/day for 14 days) as Mycoplasma treatments for symptomatic tortoises.

Results

Within the donor and recipient sites, 56 (32.7%) and 8 (34.8%), respectively, had antibody titers suggestive of past exposure. Eighteen tortoises from the donor site (10.5%) and 2 from the recipient site (8.7%) displayed clinical signs (i.e., clear serous nasal discharge, conjunctivitis, and palpebral edema) consistent with Mycoplasmal URTD upon initial collection, even though all polymerase chain reaction (PCR) results were negative for active shedding of Mycoplasma agassizii. We ceased treatment after the first dose of danofloxacin due to adverse reactions, which only began to subside after 72 h from the initial dose. Neither tulathromycin or oxytetracycline caused the clinical signs of URTD to subside after a 50-day treatment period.

Conclusion

Mycoplasma is a persistent issue facing Texas tortoises. Stressors, such as translocation, can cause Mycoplasma-seropositive tortoises to display clinical symptoms of URTD, which can abate without treatment, once the stressor subsides.

Implications

Danofloxacin, the recommended treatment for Mycoplasma infection in tortoises, is too potent for Texas tortoises.

PHARMACOKINETICS OF METRONIDAZOLE IN GREEN (CHELONIA MYDAS), LOGGERHEAD (CARETTA CARETTA), AND KEMP'S RIDLEY (LEPIDOCHELYS KEMPII) SEA TURTLES AFTER SINGLE ORAL AND INTRAVENOUS DOSES

Currently there are few antibacterial dosage regimens established to be safe and effective for sea turtles. Pharmacokinetic evaluation of antibiotics is an essential step in establishing accurate dosage guidelines for a particular species. Metronidazole is an antibiotic that is effective against anaerobic bacteria and some protozoa. For most anaerobic bacteria, the minimum inhibitory concentration (MIC) for metronidazole ranges from 0.25 to 4.0 µg/ml. The MIC values for some Clostridium species are up to 8 µg/ml, and for protozoal agents of trichomoniasis (MIC of 0.05 µg/ml), amebiasis, and giardiasis the MIC ranges from 1 to 50 µg/ml. The objective of this study was to determine the pharmacokinetic parameters after administration of metronidazole to aid in the establishment of species-specific dose guidelines in green (Chelonia mydas), loggerhead (Caretta caretta), and Kemp's ridley (Lepidochelys kempii) sea turtles. After administering metronidazole at a dose of 20 mg/kg orally and IV, the pharmacokinetics were very similar for these three species of sea turtles (n = 6 for each species). For both oral and IV routes of administration, plasma metronidazole concentrations were maintained above 8 µg/ml for approximately 24 h and above 4 µg/ml for approximately 48 h; however, plasma concentrations of 8 µg/ml were reached within 5 min only for the IV route, versus 8 h for the oral route.

Diagnosis and management of Cryptococcus neoformans var. grubii detected in an oral mass in a pink-tongued skink (Cyclodomorphus gerarrdii)

Cryptococcus is an encapsulated yeast that is found in both yeast and hyphal forms. Cryptococcus neoformans and C. gattii are the most medically important species, causing disease in both immunocompromised and immunocompetent individuals. A large, friable, sublingual mass was surgically resected from the oral cavity of a pink-tongued skink (Cyclodomorphus gerarrdii). Histopathology, fungal culture and PCR testing with Sanger sequencing confirmed granulomatous inflammation containing large numbers of yeasts identified as Cryptococcus neoformans var. grubii. Surgical excision and treatment with oral amphotericin B and terbinafine was unsuccessful in managing the infection. On Day 67 after surgery, Cryptococcus DNA was detected by PCR in the blood but not oral, cloacal or skin swabs. The skink was euthanised 72 days after surgery due to anorexia, weight loss and progressive neurological signs of disease. Necropsy results showed disseminated cryptococcosis, including meningoencephalitis and ventriculitis. Two in-contact pink-tongued skinks remained asymptomatic and PCR-negative during 198 days of observation. This case suggests Cryptococcus infections should be considered for oral masses presenting with or without neurological signs in skinks. Further investigation is required to determine the best treatment options for disseminated cryptococcosis in reptiles. This report describes the third reported case of Cryptococcus in a reptile and the first case of cryptococcosis in a pink-tongued skink. It is also the first report of Cryptococcus in a reptile identified to the variety level using PCR, including in whole blood samples.

Blood recovery of wild Mekong snail-eating turtles (Malayemys subtrijuga Schlegel and Müller, 1845) in captivity from leech infestation

Blood cell counts are valuable diagnostic tools for assessing the health status of chelonians, however, reference standards for healthy blood parameters in various turtle species are lacking. In this study, forty wild female Malayemys subtrijuga were captured from ponds in Kasetsart University, and transported to laboratory for recuperating in captivity. All turtles were infected with a single leech species, Placobdelloides siamensis, with a mean of 513.7 ± 164.9 individuals per turtle, and exhibited penetrating and lesion wounds from leech infestations on both their skin and shell. Subsequently, they were cleaned and treated to eliminate ecto- and endoparasites before the recuperation period began. The turtles did not exhibit significantly differences in weight, carapace length (CL), red blood cell count (RCC), and white blood cell count (WCC) with a mean of 654.2 ± 199.9 g, 15.0 ± 2.5 cm, 327,080 ± 70,156 cells/mm3, and 73,340 ± 15,859 cells/mm3, respectively, during the initial records (week 0). However, after being maintained for 17 weeks, their health significantly improved in term of their blood parameters (RCC and WCC) and weight, except CL which remained unchanged, with a mean of 491,470 ± 16,169 cells/mm3, 18,790 ± 1496 cells/mm3, and 738.9 ± 191.5 g, respectively. Therefore, the health status obtained in this study can be used as a reference for blood parameters, weight, and recuperation period for the treatment of ill wild M. subtrijuga in captivity or as part of conservation management programs for turtles.

Neurologic Assessment and Critical Care of Exotic Animals: Approach to the Neurologic Exam, Species Differences, Prognostic Scales, Commonly Encountered Conditions, Ancillary Diagnostic Tests, and Caring for Neurologically Impaired Patients

Many disorders of other body systems have been well characterized in exotic species; however, data regarding neurologic conditions is limited. Across some of these species, correlates between feline and canine neurology can be made, but variations in the nervous system anatomy make evaluation more challenging. With accurate neurolocalization a focused list of differential diagnoses can be created. Performing the neurologic examination should be methodical for all patients, and the order and extent of examination may depend upon the patient's clinical condition and cooperation. Applications of objective scale measures (such as coma scales), and ancillary diagnostics (electrodiagnostics, advanced imaging, biopsy techniques, and BAER testing) complement physical assessment and clinicopathologic assessment in these neurologic patients. Once a neurolocalization, likely diagnosis, and prognosis have been established, specific considerations for hospitalization and care of neurologic patients can be implemented while treatment is instituted.

Determination of trace antibiotics in water and milk via preconcentration and cleanup using activated carbons

CPAC-SPE-HPLC (coconut powdered activated carbon -SPE- HPLC) has been developed for the determination of antibiotic (ABX), sulfamonomethoxine sodium (SMM), oxytetracycline (OTC), ceftiofur hydrochloride (CEF) and marbofloxacin (MAR), in water and milk. Over 99.0% SMM and OTC were recovered from 20 mL of 0.5 μg/mL ABX solution using 10 mg-CPAC for adsorption and 2 mL of 30% NH₄OH/EtOH (1/19 v/v) for elution. Similarly, over 99.0% CEF and MAR were recovered using 15 mg-CPAC and 2 mL of 30% NH₄OH/n-PrOH (1/19 v/v). Moreover, the recovery efficiencies of various ABX from 5 to 80 mL of 0.02-2.00 μg/mL medicated milk containing 10 mM EDTA are ordered as follows: OTC (99.3%), SMM (99.1%) > CEF (68.9%) > MAR (61.4%). No interference towards HPLC analysis were observed with elution using 2 mL of 30% NH₄OH/EtOH (1/19 v/v). Furthermore, much lower limit of detections (0.02 μg/mL) than the maximum residual limits from European Commission (0.075-0.100 μg/mL) were obtained.

Evaluation of glucose absorption rates following intracoelomic or subcutaneous administration in experimentally dehydrated inland bearded dragons (Pogona vitticeps)

OBJECTIVE

To evaluate glucose absorption rates as an indirect measure of fluid absorption after SC or intracoelomic (ICe) administration of 2.5% dextrose solution to experimentally dehydrated inland bearded dragons (Pogona vitticeps).

ANIMALS

9 adult bearded dragons.

PROCEDURES

In a randomized, blinded, placebo-controlled, crossover design study, bearded dragons were experimentally dehydrated with a previously described protocol and then received 2.5% dextrose solution (a 1:1 mixture of 5% dextrose in isotonic multiple electrolytes solution; 20 mL/kg), SC or ICe, or a control treatment (the same electrolytes solution without added glucose; 20 mL/kg). Blood glucose (BG) concentrations were measured at predetermined times up to 24 hours after fluid administration. There was a ≥ 14-day washout period between treatments. Mean changes in BG concentration from baseline were compared among treatments.

RESULTS

Administration of 2.5% dextrose solution by either route increased BG concentration with a significantly greater change in values within 5 minutes, compared with control treatment results. The mean change in BG concentration after ICe administration was significantly greater than that after SC administration 15 and 30 minutes after injection, with mean differences of -50 and -36 mg/dL, respectively, for the SC treatment. Within 1 hour after fluid administration, there was no significant difference in BG values between the 2 dextrose administration routes.

CONCLUSIONS AND CLINICAL RELEVANCE

Findings supported that fluid therapy by SC administration, which carries a lower risk of iatrogenic complications, can provide results similar to those achieved with ICe administration.

Pharmacokinetics of ceftazidime in Northern leopard frogs (Lithobates pipiens) at two different doses and administration routes

OBJECTIVE

To determine an optimal ceftazidime dosing strategy in Northern leopard frogs (Lithobates pipiens) by evaluation of 2 different doses administered SC and 1 dose administered transcutaneously.

ANIMALS

44 Northern leopard frogs (including 10 that were replaced).

PROCEDURES

Ceftazidime was administered to frogs SC in a forelimb at 20 mg/kg (n = 10; SC20 group) and 40 mg/kg (10; SC40 group) or transcutaneously on the cranial dorsum at 20 mg/kg (10; TC20 group). Two frogs in each ceftazidime group were euthanized 12, 24, 48, 72, and 96 hours after drug administration. Plasma, renal, and skin concentrations of ceftazidime were measured by means of reversed-phase high-performance liquid chromatography. Four control frogs were used for assay validation.

RESULTS

Mean plasma half-life of ceftazidime in the SC20, SC40, and TC20 groups was 9.01 hours, 14.49 hours, and too low to determine, respectively. Mean maximum plasma ceftazidime concentration was 92.9, 96.0, and 1.3 μg/mL, respectively. For 24 hours after drug administration in the SC20 and SC40 groups, plasma ceftazidime concentration exceeded 8 μg/mL. Renal and skin concentrations were detectable at both doses and routes of administration; however, skin concentrations were significantly lower than renal and plasma concentrations.

CONCLUSIONS AND CLINICAL RELEVANCE

Findings indicated that ceftazidime administration to Northern leopard frogs at 20 mg/kg, SC, every 24 hours would achieve a plasma concentration exceeding the value considered effective against common amphibian pathogens. Transcutaneous administration of the injectable ceftazidime formulation at 20 mg/kg warrants further investigation but is not currently recommended because of a potential lack of efficacy.

Accurate Quantification of Sulfonamide Metabolites in Goat Meat: A New Strategy for Minimizing Interaction between Sheep Serum Albumin and Sulfonamide Metabolites

To date, the determination of sulfonamide metabolites in animal-derived food has universal disadvantages of low throughput and no integrated metabolites involved. In this study, a powerful and reliable strategy for high-throughput screening of sulfonamide metabolites in goat meat was proposed based on an aqueous two-phase separation procedure (ATPS) combined with ultrahigh-performance liquid chromatography quadrupole-Orbitrap high-resolution mass spectrometry (UHPLC-Q-Orbitrap). Noncovalent interactions including van der Waals force, hydrogen bonding, and hydrophobic effect were determined to be staple interactions between the sulfonamide metabolites and sheep serum albumin by fluorescence spectroscopy and molecular docking technology, and an 80% acetonitrile-water solution/(NH₄)₂SO₄ was used as ATPS in order to release combined sulfonamide metabolites and minimize the influence of sheep serum albumin. Sulfonamide metabolites in the matrix were screened based on a mechanism of mass natural loss and core structure followed by identification combined with the pharmacokinetic. The developed strategy was validated according to EU standard 2002/657/EC with CCα ranging from 0.07 to 0.98 μg kg^-1, accuracy recovery with 84-107%, and RSDs lower than 8.9%. Eighty seven goat meat samples were used for determination of 26 sulfonamides and 8 potential metabolites. On the basis of the established innovative process, this study has successfully implemented the comprehensive detection of sulfonamide metabolites, including N⁴-acetylated substitution, N⁴-hydroxylation, 4-nitroso, azo dimers, oxidized nitro, N⁴ monoglucose conjugation, β-d-glucuronide, and N-4-aminobenzenesulfonyl metabolites, which were shown to undergo oxidation, hydrogenation, sulfation, glucuronidation, glucosylation, and O-aminomethylation.

Respiratory Disorders in Chelonians

"Respiratory tract disease in chelonians can be difficult to treat and as such proper diagnostics are paramount. Infectious agents that can affect the respiratory tract of chelonians include viral, bacterial, fungal, and parasitic organisms. Noninfectious diseases can also develop. Because chelonians lack a proper diaphragm, changes in size of celomic organs can cause compression of the respiratory system. These conditions result in clinical signs that could be attributed to the respiratory system, such as open-mouth breathing. In this article, anatomy, physiology, and current standards for diagnostics and treatments of major diseases of the respiratory tract in chelonians are discussed."

Antimicrobial susceptibility patterns for aerobic bacteria isolated from reptilian samples submitted to a veterinary diagnostic laboratory: 129 cases (2005-2016)

OBJECTIVE

To identify antimicrobial susceptibility patterns for aerobic bacteria isolated from reptilian samples and, from those patterns, identify antimicrobials that could be considered for empirical treatment of reptiles with suspected bacterial infections.

SAMPLES

129 bacterial isolates from 61 of 127 samples from 96 reptiles.

PROCEDURES

Medical records of reptiles (chelonian, crocodilian, lizard, and snake) presented to the zoological medical service of a veterinary teaching hospital between January 2005 and December 2016 were reviewed for submissions of patient samples for aerobic bacterial culture and susceptibility testing. Sample type, presence or absence of bacterial growth, and antimicrobial susceptibilities of isolated bacteria were recorded. The isolation frequency and the antimicrobial susceptibilities of bacterial genera and species were tabulated.

RESULTS

Pseudomonas spp and Enterococcus spp were the most frequently isolated gram-negative and gram-positive bacteria, respectively. Isolates of gram-negative bacteria frequently had susceptibility to amikacin (86%), gentamicin (95%), tobramycin (92%), and trimethoprim-sulfamethoxazole (83%), and gram-positive bacteria frequently had susceptibility to ampicillin (83%), chloramphenicol (92%), doxycycline (100%), and gentamicin (100%). Isolates of gram-positive bacteria were consistently resistant to ceftazidime.

CONCLUSIONS AND CLINICAL RELEVANCE

Aerobic bacterial culture and antimicrobial susceptibility results for reptilian samples in this population indicated that aminoglycosides and trimethoprim-sulfamethoxazole or ampicillin and doxycycline could be considered as options for the empirical treatment of reptiles with infections caused by gram-negative or gram-positive bacteria, respectively.

Diagnosis and Treatment of Plasmodium Infection in Captive Black and White Tegus

Malarial protozoa commonly infect both wild and captive lizards but the effects on the general health of these animals are not fully understood. We describe four clinical cases of Plasmodium infection in captive black and white tegus (Salvator merianae). The animals presented with lethargy, anorexia, dehydration and stomatitis. Plasmodium infection was identified in blood smears from all animals. Treatment with a sulphamethoxazole-trimethoprim combination resolved the infection and clinical improvement was observed within 21 days. This is the first report of successful treatment of clinical plasmodiid infection in captive tegus.

Effect of benzylpenicillin on intravenous pharmacokinetics of acyclovir in red-eared slider turtles (Trachemys scripta elegans)

The aim of this study was to determine the effect of benzylpenicillin on the pharmacokinetics of acyclovir in red-eared slider turtles (Trachemys scripta elegans). Six clinically healthy red-eared slider turtles weighing 400 and 580 g were used for the study. Acyclovir (40 mg/kg) and benzylpenicillin (30 mg/kg) were administered intravenously to turtles. In the study, the cross-pharmacokinetic design (2 × 2) with a 30-day washout period was performed in two periods. Plasma concentrations of acyclovir were assayed using the high-performance liquid chromatography with fluorescence detection. Pharmacokinetic parameters were calculated by two-compartment open pharmacokinetic model. Following the administration of acyclovir alone, elimination half-life (t_{1/2 β} ), area under the plasma concentration-time curve (AUC), total clearance (Cl_T ), and volume of distribution at steady-state (V_dss ) were 20.12 hr, 1,372 hr * µg/mL, 0.03 L hr^-1  kg^-1 , and 0.84 L/kg, respectively. Benzylpenicillin administration increased t_{1/2 β} , AUC, and V_dss while decreased Cl_T of acyclovir. These results showed that benzylpenicillin changed the pharmacokinetics of acyclovir following simultaneous administration in turtles. However, further research is needed to determine molecular mechanism of interaction in turtle.

Pharmacokinetics of levamisole in the red-eared slider turtles (Trachemys scripta elegans)

The pharmacokinetics and bioavailability of levamisole were determined in red-eared slider turtles after single intravenous (IV), intramuscular (IM), and subcutaneous (SC) administration. Nine turtles received levamisole (10 mg/kg) by each route in a three-way crossover design with a washout period of 30 days. Blood samples were collected at time 0 (pretreatment), and at 0.25, 0.5, 1, 1.5, 3, 6, 9, 12, 18, 24, 36, and 48 hr after drug administration. Plasma levamisole concentrations were determined by a high-performance liquid chromatography assay. Data were analyzed by noncompartmental methods. The mean elimination half-life was 5.00, 7.88, and 9.43 hr for IV, IM, and SC routes, respectively. The total clearance and volume of distribution at steady state for the IV route were 0.14 L hr^-1  kg^-1 and 0.81 L/kg, respectively. For the IM and SC routes, the peak plasma concentration was 9.63 and 10.51 μg/ml, respectively, with 0.5 hr of T_max . The bioavailability was 93.03 and 115.25% for the IM and SC routes, respectively. The IM and SC route of levamisole, which showed the high bioavailability and long t_1/2ʎz , can be recommended as an effective way for treating nematodes in turtles.

Pharmacokinetics of intravenous and intramuscular danofloxacin in red-eared slider turtles (Trachemys scripta elegans)

This study aimed to investigate the pharmacokinetics of danofloxacin in red-eared slider turtle (Trachemys scripta elegans) following a single intravenous (IV) and intramuscular (IM) administrations of 6 mg/kg, using a two-way crossover study with 30-day washout period. Eight clinically healthy red-eared slider turtle weighing 410-600 g (mean 490 g) were used for the study. Danofloxacin concentrations were measured using the reversed-phase high-performance liquid chromatography. The plasma concentration-time data were evaluated by a non-compartmental method. After IV administration, the elimination half-life (t_1/2ʎz), mean residence time (MRT_0-∞), area under the concentration-time curve (AUC_0-∞), volume of distribution at steady state and total body clearance in plasma were 24.17 hr, 30.64 hr, 143.31 hr·µg/ml, 1.29 l/kg and 0.04 l/hr/kg, respectively. Following IM administration, t_1/2ʎz, MRT_0-∞, AUC_0-∞, peak concentration (C_max), time to reach C_max, and bioavailability in plasma were 32.00 hr, 41.15 hr, 198.23 hr·µg/ml, 8.75 µg/ml, 1.5 hr and 139.89%, respectively. Danofloxacin has clinically superior pharmacokinetic properties, including the complete IM absorption, slow elimination and wide volume of distribution in red-eared slider turtles. However, further pharmacokinetics/pharmacodynamics studies are necessary for the treatment of diseases caused by susceptible bacteria with known minimum inhibitory concentration values in red-eared slider turtles.

Oncology of Reptiles: Diseases, Diagnosis, and Treatment

Based on necropsy review, neoplasia in reptiles has a comparable frequency to that of mammals and birds. Reptile neoplasia is now more frequently diagnosed in clinical practice based on increased use of advanced diagnostic techniques and improvements in reptilian husbandry allowing greater longevity of these species. This article reviews the current literature on neoplasia in reptiles, and focuses on advanced diagnostics and therapeutic options for reptilian patientssuffering neoplastic disease. Although most applied clinical reptile oncology is translated from dog and cat oncology, considerations specific to reptilian patients commonly encountered in clinical practice (turtles, tortoises, snakes, and lizards) are presented.