Fungal Infections in Reptiles—An Emerging Problem

Snakes as sentinel of zoonotic yeasts and bio-indicators of environmental quality

Reptiles in the wild or as pets may act as spreaders of bacteria, viruses, fungi and parasites. However, studies on the mycobiota of these animals are scanty. This study investigates the occurrence of yeasts from the cloacal swabs of snakes of different origins and the antifungal profile of the isolated strains. A total of 180 cloacal samples of snakes were collected from Morocco (Group I: n = 68) and Italy (Group II: n = 112). Yeast species were biochemically and molecularly identified. A total of 72 yeast strains belonging to 13 genera, 8 from snakes in Group I and five from snakes in Group II were identified. The most frequently isolated species were Trichosporon asahii (22.2%) and Candida tropicalis (15.3%) from snakes in Group I and Debaryomyces spp. (16.7%) and Metahyphopichia silvanorum (11.1%) from snakes in Group II. Multiple azole and amphotericin B (AmB) resistance phenomena were detected among isolated yeasts. Azole multi drug resistance phenomena were detected among yeasts from Group I and Rhodotorula mucilaginosa from Group II, whereas AmB resistance phenomena among those from Group II. Data suggest that snakes may harbor pathogenetic yeasts, being potential reservoirs and spreaders of these organisms in the environment. Since the yeast species community from different groups of animals as well as their antifungal profile reflects the epidemiology of human yeast infections in the same geographical areas, the results indicate that snakes may be considered as sentinels for human/animal pathogenic microorganisms and bio-indicators of environmental quality.

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.

Reptile Dermatology

Reptiles are being presented more frequently to veterinarians because they increase in popularity. As with domestic pets, dermatologic conditions are common findings in captive reptiles and can be associated with husbandry and nutritional deficiencies, infectious diseases, and neoplasia. To have success with these cases, it is important to take a stepwise and strategic approach, starting with a thorough anamnesis and physical examination. From there, diagnostic tests should be pursued, with an understanding of the limitations of each diagnostic test. By understanding these limitations, the veterinary scientist can determine the best path to a diagnosis and treatment for the case.

Infections by entomopathogenic fungi in common green iguanas (Iguana iguana) in captivity in Brazil

Entomopathogenic fungi, widely available biological agents used to control agricultural pests, are sporadically reported to cause focal or disseminated infection in reptiles and mammals, including humans. This study summarizes the clinical presentation, histopathological and molecular findings by panfungal polymerase chain reaction and sequencing of four cases of hypocrealean fungal infections in captive common green iguanas (Iguana, iguana). One case of granulomatous pneumonia, hepatitis and serositis was related to Metarhizium flavoviride complex infection. Two disseminated fungal infection cases, with scarce inflammatory cell infiltration, were caused by Beauveria bassiana while there was one case of multifocal granulomatous and necrotizing pneumonia by Purpureocillium spp. To the best of our knowledge, this is the first report of fatal mycosis infection due to entomopathogenic fungi in captive common green iguanas.

Pathology and Prevalence of Antibiotic-Resistant Bacteria: A Study of 398 Pet Reptiles

Reptiles are potential reservoirs of bacteria that could be transmitted, thus becoming a zoonotic hazard. (1) Background: This three-year investigation surveyed the pathological status of 398 pet reptiles: chelonians, snakes (venomous/non-venomous), and lizards. The main pathological entities found were related to the skin, the sensory organs, the digestive system, the respiratory system, the cardiovascular system, the urinary system, the genitalia, the osteo−muscular tract, surgical issues, tumors, and intoxications. (2) Methods: In 25 individuals treated with antibiotics, no clinical healing was recorded, for this reason, an antimicrobial resistance profile analysis of the 43 samples gathered was processed. An antibiogram was performed using the VITEK®2 ID-GP (bio-Mérieux, Marcy l’Etoile, France) automated platform, with 22 bacterial strains being isolated. (3) Results: The statistics (ANOVA) revealed that the most common disease category was diseases of the digestive system, followed by diseases of the skin, respiratory system, nervous system, and reproductive system. A significant correlation (p < 0.01) between disease incidence and reptile species was reported, with correlations found between all species and diseases diagnosed. The most common bacteria isolated were Enterococcus faecalis, Pseudomonas aeruginosa, Stenotrophomas (Xanthomonas) maltophilia, Escherichia coli, Klebsiella oxytoca, and Salmonella spp., but Beta-hemolytic Streptococcus, Staphylococcus aureus, Citrobacter spp., and Proteus spp. were also identified. (4) Conclusions: These microorganisms revealed degrees of resistance against penicillins, cephalosporins, macrolides, lincosamides, aminoglycosides, and tetracyclines. The animals can be categorized according to their sensitivity to diseases in the following order (most sensitive to least sensitive): chelonians, venomous snakes, non-venomous snakes, and lizards.

Disseminated Fungal Infection and Fungemia Caused by Trichosporon asahii in a Captive Plumed Basilisk (Basiliscus plumifrons)

Trichosporon spp. are heavily arthroconidiating fungi and widely distributed in nature. Due to the similar fungal morphology, confusion among Trichosporon spp., Geotrichum spp., and Nannizziopsis spp. in reptiles is apparent and cannot be overlooked. Although few reptile Trichosporon isolates have been examined using the newer speciation criteria, the information on Trichosporon asahii in reptiles is still scarce. In the present study, we report the case of disseminated fungal infection and fungemia caused by T. asahii in a captive plumed basilisk (Basiliscus plumifrons). Multiple 0.2-0.5 cm, irregularly shaped, ulcerative nodules on the left hind foot were observed. The animal died due to the non-responsiveness to treatment. A microscopic evaluation revealed the fungal infection that primarily affected the left hind foot and right lung lobe with fungal embolisms in the lung and liver. The molecular identification of the fungal species by the DNA sequences of the ITS regions and D1/D2 gene from the fungal culture and ITS regions, from formalin-fixed paraffin-embedded (FFPE) lung tissues, were completely matched to those of T. asahii. The current report describes the first confirmed case of disseminated fungal infection and fungemia caused by T. asahii in a captive plumed basilisk.

Recommended Health Care and Disease-Prevention Programs for Herds/Flocks of Exotic Animals

Preventative health care is an essential part of the ownership and veterinary management of exotic animals. This article provides an overview of the current recommendations for health care and disease-prevention programs for herds or flocks of exotic animals, specifically companion and aviary birds, backyard poultry; snakes, lizards, chelonians, and amphibians; rabbits, ferrets, and common exotic small mammals. Husbandry practices, disease screening suggestions and techniques, and vaccination strategies, where appropriate, are reviewed.

Antibiotic stewardship for reptiles

This review discusses the general principles underlying responsible antibiotic usage in reptiles. Very little evidence underlies antibiotic usage in reptiles, and there are no published guidelines for responsible antibiotic usage. A literature search was performed to review the evidence for bacterial involvement in the pathology of selected common diseases of reptiles, allowing the development of recommendations for responsible antibiotic treatment of those diseases.

TERBINAFINE PHARMACOKINETICS FOLLOWING SINGLE-DOSE ORAL ADMINISTRATION IN RED-EARED SLIDER TURTLES (TRACHEMYS SCRIPTA ELEGANS): A PILOT STUDY

In this pilot study, the pharmacokinetics of terbinafine were determined in six apparently healthy red-eared slider turtles (Trachemys scripta elegans) after a single PO administration. Terbinafine suspension (15 mg/kg, once) was administered via gavage tube to all turtles. Blood samples were collected immediately before (time 0) and at 1, 2, 4, 8, 24, and 48 h after drug administration. Plasma terbinafine concentrations were quantified by ultra-performance liquid chromatography-mass spectrometry, and noncompartmental pharmacokinetic analysis was performed. None of the animals showed any adverse responses following terbinafine administration. Mean area under the curve from time 0 to 24 h was 1,213 h × ng/ml (range 319-7,309), mean peak plasma concentration was 201.5 ng/ml (range 45.8-585.3), mean time to maximum plasma concentration was 1.26 h (range 1-4), mean residence time was 7.71 h (range 3.85-14.8), and mean terminal half-life was 5.35 h (range 2.67-9.83). The administration of terbinafine (15 mg/kg, PO) may be appropriate for treatment of select fungal organisms with low minimum inhibitory concentrations in red-eared slider turtles but may require q12h administration even for organisms with low minimum inhibitory concentrations. Multiple-dose studies as well as clinical studies are needed to determine ideal dosages and efficacy.

Infection with Nannizziopsis guarroi and Ophidiomyces ophiodiicola in reptiles in Taiwan

Fungal infection is an emerging threat to reptiles. The main pathogens are fungi of the genera Nannizziopsis, Paranannizziopsis and Ophidiomyces. The clinical symptoms range from mild skin lesions to the dissemination of internal organs and even death. Most of the reported cases are from Europe, North America and Australia. In this study, we report the Nannizziopsis guarroi infection in one captive inland bearded dragon (Pogona vitticeps), one captive green iguana (Iguana iguana) and Ophidiomyces ophiodiicola infection in one wild red-banded snake (Dinodon rufozonatum) and one wild Chinese cobra (Naja atra) in Taiwan. The infections were confirmed by the presence of fungal elements in the tissue. The pathogens were identified based on their morphological and DNA sequence characteristics. The susceptibility profiles of the fungal strains to nine antifungal drugs were obtained using broth microdilution methods. The presence of both fungal species in Asia highlights the urgent need for surveillance and close monitoring of reptile infections to prevent them from spreading and to the possible collapse of reptile populations in the wild.

Outbreak of Paranannizziopsis australasiensis Infection in Captive African Bush Vipers (Atheris squamigera)

We report the epidemiological, clinical and pathological features of an outbreak of Paranannizziopsis australasiensis (order Onygenales) in captive African bush vipers (Atheris squamigera) (ABVs) that died suddenly. The snakes had multifocal, raised, white-grey to dark brown discoloured cutaneous patches. Microscopically, all had integumentary lesions characterized by multifocal to coalescent necroheterophilic epidermitis with superficial and intraepidermal fungal elements and bacteria. Concurrent epidermal hyperplasia, hyperkeratosis and intracellular and intercellular oedema, often leading to vesiculation, and fasciitis/superficial myositis, were consistent findings in all snakes, while ulceration (9/11) and dysecdysis (5/11) varied. A panfungal polymerase chain reaction targeting the internal transcribed spacer-2 region, and gene sequencing, confirmed P. australasiensis infection in three cases. This is the first report of P. australasiensis in the USA and the first record of paranannizziopsis infection in African bush vipers. P. australasiensis should be considered in the differential diagnosis of dermatomycosis in snakes and represents a potential threat to reptile conservation programmes.

Metastatic Cholangiocarcinoma in a Bearded Dragon (Pogona vitticeps)

A 6.5-year-old female bearded dragon (Pogona vitticeps) was presented with a swollen right pelvic limb. A tissue core biopsy from the swollen area was performed and a presumptive histopathological diagnosis of adenocarcinoma was made. This diagnosis was confirmed after limb amputation. Two months after amputation a sudden deterioration in the overall health of the patient occurred. Ultrasound examination of the coelomic cavity revealed hypoechoic lesions in the liver. The patient was euthanized and submitted for necropsy which revealed a severely enlarged liver with multiple coalescing yellowish nodules. Cholangiocarcinoma of the liver with metastases to the spleen, left mesovarium and right pelvic limb was diagnosed after histopathological examination.

Identification of hypocrealean reptile pathogenic isolates with MALDI-TOF MS

Biotyper analysis of Nannizziopsis guarroi, a fatal fungal pathogen in lizards, was described recently. Hypocrealean fungal infections in captive reptiles appear with an increasing frequency during the last decade. Therefore, the aim of this study was to proof Matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF MS) as diagnostic tool for the identification of reptile pathogenic hypocrealean fungi. Ten fungal isolates obtained from nine reptiles with fungal glossitis, disseminated visceral mycosis, pneumomycosis, and fungal keratitis were analyzed. Phylogeny consisted of fragments of the large subunit of nuclear encoded ribosomal DNA (D1/D2, LSU) and the internal transcribed spacer region 1 of nuclear encoded ribosomal DNA (ITS1) as well as the protein coding gene translation elongation factor 1 alpha (TEF). Results revealed unanimously two Metarhizium granulomatis genotypes in a total of three isolates, various M. viride genotypes (n = 3), two different Purpureocillium lilacinum isolates as well as one isolate of each P. lavendulum and Beauveria bassiana. Purpureocillium lilacinum and B. bassiana are likewise frequently employed as a mycoinsecticide and mycoacaricide in agriculture on a worldwide scale and have occasionally been reported in man, causing fungal keratitis, sclerokeratitis, nosocomial infections in immunosuppressed patients, as well as cavitary pulmonary disease and cutaneous hyalohyphomycosis in immunocompetent patients. According to the results establishment of Biotyper analysis for faster differentiation of reptile-associated fungal pathogens is entirely justified.

Purpuriocillium lilacinum infection in captive loggerhead sea turtle hatchlings

This paper reports a case of Purpureocillium lilacinum infection in seven loggerhead sea turtle (Caretta caretta) hatchlings kept in an aquarium under inadequate condition. The fungus was isolated from skin and pulmonary lesions. Metilene blue and NaCl solutions, Schinus terebinthifolius and eucalyptus essential oils Minimum Inhibitory Concentrations were determined indicating new possibilities for treatment.

Molecular identification and phylogenetic analysis of Bothrops insularis bacterial and fungal microbiota

Bothrops insularis, known as the golden lancehead snake, has its natural habitat restricted to Queimada Grande Island on the southern coast of Brazil. This culture-dependent study aimed to identify microorganisms obtained from the mouth, eyes, and cloaca of this species. Swabs from 20 snakes were collected for fungal and bacterial isolation. DNA was extracted from all samples, and identification was performed by amplifying the ITS1-5.8S-ITS2 regions and the 16S rDNA gene, respectively. All strains were identified and deposited in the GenBank nucleotide database. MEGA v6.0 software was utilized to construct phylogenetic trees. In total, 100 strains were isolated and characterized, from which 42 fungi were distributed into 23 species and 58 bacteria into 13 species. The genus Fusarium was predominant since 11 strains and probably a new species was isolated from this fungus. Pseudomonas aeruginosa and Enterococcus faecalis were the predominant groups of aerobic bacteria isolated. Phylogenetic analyses between bacterial and fungal sequences suggest a similarity between the microorganisms found on the island and on the continent. These findings may be attributed to anthropic actions resulting from both expeditions to the island and actions of migratory birds, which are the main sources of food for snakes.

Fatal Purpureocillium lilacinum pneumonia in a green tree python

A 10-y-old female green tree python ( Morelia viridis) died of fungal pneumonia caused by Purpureocillium lilacinum, which was confirmed histologically and by PCR and subsequent DNA sequencing. The same fungal species was cultivated from a swab taken from the terrarium in which the snake was housed. Clinical and environmental P. lilacinum isolates were indistinguishable by the typing method applied, strongly suggesting clonal relatedness of both isolates. Because no other underlying predisposing respiratory infection could be detected by virus-specific PCR or histopathology, P. lilacinum was considered a primary pulmonary pathogen in this tree python.

Disseminated Nannizziopsis obscura infection in a renal transplant patient- The first reported case

This is a presentation of a case of disseminated fungal infection in a renal transplant patient with Nannizziopsis obscura, a species not previously reported as having caused disseminated disease in humans and not previously reported in the UK. The fungus was isolated from a intramuscular collection and from a lymph node. The patient responded well to a course of posaconazole.

Characterization of Metarhizium viride Mycosis in Veiled Chameleons (Chamaeleo calyptratus), Panther Chameleons (Furcifer pardalis), and Inland Bearded Dragons (Pogona vitticeps)

Metarhizium viride has been associated with fatal systemic mycoses in chameleons, but subsequent data on mycoses caused by this fungus in reptiles are lacking. The aim of this investigation was therefore to obtain information on the presence of M. viride in reptiles kept as pets in captivity and its association with clinical signs and pathological findings as well as improvement of diagnostic procedures. Beside 18S ribosomal DNA (rDNA) (small subunit [SSU]) and internal transcribed spacer region 1 (ITS-1), a fragment of the large subunit (LSU) of 28S rDNA, including domain 1 (D1) and D2, was sequenced for the identification of the fungus and phylogenetic analysis. Cultural isolation and histopathological examinations as well as the pattern of antifungal drug resistance, determined by using agar diffusion testing, were additionally used for comparison of the isolates. In total, 20 isolates from eight inland bearded dragons (Pogona vitticeps), six veiled chameleons (Chamaeleo calyptratus), and six panther chameleons (Furcifer pardalis) were examined. Most of the lizards suffered from fungal glossitis, stomatitis, and pharyngitis or died due to visceral mycosis. Treatment with different antifungal drugs according to resistance patterns in all three different lizard species was unsuccessful. Sequence analysis resulted in four different genotypes of M. viride based on differences in the LSU fragment, whereas the SSU and ITS-1 were identical in all isolates. Sequence analysis of the SSU fragment revealed the first presentation of a valid large fragment of the SSU of M. viride According to statistical analysis, genotypes did not correlate with differences in pathogenicity, antifungal susceptibility, or species specificity.