and turtles

Chapter 9 Tortoises and turtles


Chelonia, such as tortoises and their semi-aquatic relatives, terrapins (or turtles) are becoming very popular as pets, especially in Europe where there is a long history of keeping the Mediterranean Testudo species as house and garden pets. Although CITES II listed, this trade is being fuelled by the increasing availability of captive-bred specimens, especially from Eastern Europe.



Table 9.1 Commonly encountered tortoises and turtles: Key facts































Species Notes Common disorders
The Mediterranean Testudo species including the southern European Herman’s tortoise (T. hermanni), members of the north African spur-thighed complex (T. graeca) and the Horsfield’s tortoise (T. horsfeldi) These are small to moderately large species; most can be safely hibernated but see Hibernation for more details. Diet should primarily be leafy greens with added calcium supplementation. No animal protein should be given Metabolic bone disease (MBD), chelonian herpes virus (CHV), ascarids
African spur-thighed tortoise Geochelone sulcata This species from sub-Saharan Africa is a potential monster that can weigh up to 50–80 kg. They require tropical heat with relatively low humidity. Diet as for Testudo spp Metabolic bone disease (MBD), chelonian herpes virus
The leopard tortoise (G. pardalis) Another sub-Saharan African species. Requires tropical temperatures and a Testudo-like diet Metabolic bone disease (MBD)
Red-footed tortoises (G. carbonaria) Tropical South America. They need tropical temperatures, high humidity (70%) and a diet with more fruit that Testudo spp with a small amount of animal protein Metabolic bone disease (MBD)
Red-eared slider (Trachemys picta elegans) Less common in the European pet trade following several scares over Salmonella and concerns over alien releases. It is semi-aquatic and requires a dry, warm haul-out area on which to bask. They are carnivorous as hatchlings and feed on commercially available insect larvae, e.g. bloodworms; graduating up to sea foods such as prawns, fish, mussels and cockles plus calcium supplement. Commercial pelleted foods are available Metabolic bone disease (MBD), hypovitaminosis A
Box turtles (Terrapene spp). Omnivorous, requiring slugs, snails, earthworms, waxworms, mealworms, fruit, green leafed vegetables and mushrooms Metabolic bone disease (MBD), tympanic scale abscesses




Captive care


As with lizards, the long-term welfare of captive chelonia is intimately dependant upon their environment and they must be provided with appropriate temperatures, full spectrum diet and correct nutrition including a calcium supplement (see Lizards for more detail). This especially applies to hatchlings of the Testudo spp, where a vivarium is mandatory despite the relative hardiness of the adults.



image

Fig. 9.1 Internal anatomy of a tortoise (lateral).



Importance of lighting


Light in the spectrum of 290–315 nm (ultraviolet-B, UVB) is required for endogenous vitamin D3 production; ultraviolet-A (UVA) spectrum (320–400 nm) has been shown to have a beneficial influence upon normal behaviour.


Endogenous vitamin D3 production in reptiles is a many-step process that involves not only exposure to UVB, but also thermal isomerization and modification in the liver and kidneys. Therefore, correct environmental temperatures and healthy organs are required for normal vitamin D3 synthesis.


Dietary supplementation with vitamin D3 alone is not sufficient for chelonia. In addition dietary calcium supplementation is essential for all captive chelonia. The commercially available leafy greens and vegetables usually offered to tortoises are inherently low in calcium but high in phosphates. Evidence suggests that in the wild tortoise select high calcium foods. A Ca:P ratio of 3.5:1 is recommended.



Consultation and handling


Most terrestrial chelonia can be safely handled without fear of being bitten, but take care with larger terrapins, or potentially dangerous species such as snapping turtles. These should be held at the rear of the carapace, and in the case of snappers, at the base of the tail.


Start the examination at the head, as this is likely to be withdrawn into the shell precluding further examination. Grasp the head behind the back of the skull and draw it out to its fullest extent. With most tortoises the mouth can now be opened and examined using the tip of a finger as a gag. With terrapins and similar a gag must be used. The rest of the body can then be examined systematically. Useful auscultation of the lung fields can sometimes be achieved by placing a damp towel over the carapace on to which the stethoscope is placed.




Weight: length measurement as an indicator of health in mediterranean tortoises


For Herman’s tortoise (T. hermanii) and the spur-thigh complex (T. graeca), an indication of health can be gained by the following (Peter Heathcote, pers. comm.). This is achieved by the following actions:


1 Weigh the tortoise (in grams).

2 Measure the straight length of the carapace (cm) – note that this straight length of the carapace is a linear measurement from the most rostral point of the carapace to the most caudal. It is not a measurement over the dome of the carapace.

3 The weight of the tortoise (g) is then divided by the (straight length of the carapace3), i.e. tortoise weight (g)/straight length of the carapace (cm)3

4 The resultant number is compared with the straight length of the carapace:
a Straight length of carapace >15 cm; normal ratio 0.21–0.23

b Straight length of carapace <15 cm; normal ratio 0.23–0.25.

5 Tortoises with a ratio of 0.17 or less are considered critical.

6 Examples for tortoises with a high ratio are obesity (hepatic lipidosis), gravid (multiple eggs, averaging around 10 g each) or fluid retentive.



Sexing


As a general rule, males have longer tails, a slit-like opening to the cloaca and a degree of concavity to the plastron, although this varies from species to species (Fig. 9.2). Chelonia have temperature-dependant sex determination and it is likely that variations in temperature at thermally-sensitive stages of embryonic development may produce a range of such secondary sexual characteristics, meaning that in some cases sexing is not an exact science.


image

Fig. 9.2 Sexing of Chelonia.


Male red eared sliders have elongated claws on their front feet that are used to ‘tickle’ the nose of the female during courtship.



Microchipping



• Subcutaneously in the left hind leg (intramuscularly in thin-skinned species) and subcutaneously in the tarsal area in giant species. Note that haemorrhage is common with accidental intramuscular injection in smaller chelonia

• Skin closure is achieved either by suture or with tissue glue.


Blood sampling


Optimum site for collection in most chelonia is the jugular vein or brachial vein. Collection from the dorsal coccygeal vein and the subcarapacial jugular anastomosis are readily contaminated with lymph.


Note that EDTA destroys chelonian RBCs. Take sample into heparin and make a smear immediately. EDTA is, however, good for WBC preservation.



Nursing care


Provide appropriate environment including provision of:


1 Optimal temperature (basking lights, heat mats, etc., to allow thermoregulation). Use of max–min thermometers will assist in monitoring temperature ranges incumbent reptiles are exposed to

2 Full-spectrum lighting (provision of UV-A and UV-B)

3 Humidity

4 Ventilation

5 Easily cleaned accommodation; use paper substrate and disposable/sterilizable hides and other vivarium furniture (see ‘Fig. 7.3’d, in Lizards)

6 Keep individually, to minimize intra-specific stress and competition for resources.

Large terrestrial chelonia often appear to have difficulty with transparent barriers and may spend a considerable amount of time attempting to walk through, over or under glass vivarium sides and doors. Blanking off these sides with tape or paint may reduce this behaviour.


With semi-aquatic chelonia such as terrapins, for general care they should be provided with a dry haul-out area which has an overhanging heat source to allow thorough drying of the carapace and sufficient water such that the terrapin can rest with its hind feet on the bottom and its nostrils above the surface. A weak terrapin is at risk of drowning. In some cases a terrapin may need to be ‘dry-docked’ for a period of time. Where possible, this can entail only short periods in a deeper bath. This can be combined with feeding as healthy terrapins will often prefer to feed submerged. Alternatively, serious attention to and monitoring of its fluid status should be undertaking if access to water is felt inappropriate (see Fluid Therapy below).



Fluid therapy


See ‘Fluid therapy’, in Lizards.


The assessment of dehydration in chelonia can be difficult visually. An obvious sign in chelonia is sunken eyes, so it is better to monitor PCV. This varies with species, but should be around 26–32 L/L.




Fluids administration



1 Daily bathing in shallow, warm water is often beneficial; it encourages many chelonia to drink as well as defaecate and urinate. Many chelonia can absorb fluids across the cloacal lining.

2 Stomach tubing is often feasible in small to medium-sized chelonia (Fig. 9.3). Large chelonia are often physically too strong to hold for stomach tubing (Fig. 9.4).

3 Oesophagostomy tubes are often very useful for medium to long-term fluid and nutritional management.

4 All parenteral fluids should be warmed to around 26°C.

5 In chelonia, fluid can be given into the epicoelomic space by passing a 1–1.5-inch needle through the pectoral musculature such that the needle is inserted dorsal to and parallel with the plastron, but is beneath the pectoral girdle. The needle is directed towards the contralateral hind leg.

6 Another site is by intraosseous catheter into the vertical plastro-carapacial bridge.

7 Whole blood transfusions can be undertaken using blood obtained from the same or related species.

8 Oxyglobin at 10 mL/kg once only has been used successfully.

image

Fig. 9.4 Large terrestrial Chelonia such as this leopard tortoise are physically very strong.


image

Fig. 9.3 Measuring a stomach tube for tubing a tortoise.



Nutritional support


Liquidized normal diet or proprietary support diets can be used, given either by stomach tube or by oesophagostomy tube.


Analgesia (see ‘Analgesia’, in Lizards).



Anaesthesia


For general notes, see ‘Anaesthesia’, in Lizards.




Induction and maintenance of anaesthesia in chelonia



1 Propofol at 12–15 mg/kg i.v. delivered into the jugular vein, the subcarapacial jugular anastomosis or the dorsal coccygeal vein

2 Alfaxalone at 2.0 mg/kg i.v as above. Can be maintained either with further top-ups at 2.0 mg/kg or by gaseous anaesthesia

3 With prolonged IPPV the lungs may become permanently expanded so regular deflation by flexion and compression of all four legs in towards the shell should be undertaken

4 In chelonia, ultrasound can be used to monitor heartbeat by placing the ultrasound head into the clavicular fossa

5 Otherwise as for Lizards.


Skin disorders


The structure of chelonian skin of the legs, tail, neck and head is as in other reptiles. However, the chelonian shell is unique – in most species there are 54 epidermal scales covering 59 dermal bony plates. The epidermal and dermal seams rarely overlap, possibly giving increased strength to the shell structure. These epidermal scales are often referred to as scutes or shields. Even here, the skin still has epidermal and dermal components.


The scute epidermis consists of:


1 Horny material containing both pigmented and non-pigmented material. This layer contains a mixture of α- and β-type keratin

2 Pseudostratified columnar epithelium. Occasional melanophores may be seen

3 Dermis overlies the dermal bone

4 In the seam between the scutes the epidermal cell layers are three to four cells thick and it is here that differentiation into keratin-producing cells occurs, and so new horny tissue is produced. Unlike in other reptiles, the keratin is usually retained, thereby producing the typical rings on the scutes

5 Cellular proliferation and keratinization are continuous.

chelonia generally shed their skin in a piecemeal and uncoordinated fashion. Semi-aquatic chelonia will often shed the older outer scutes.


In some species such as the spur-thighed tortoise (Testudo graeca) there is hinge between the abdominal and femoral scutes of the plastron, while in others, e.g. the Russian tortoise (T. horsfieldii), there is not. Box turtles, e.g. the Eastern box Terrapene carolina, also have a hinged plastron that enables them to withdraw both the head and all four limbs within the shell, protecting them with the trapdoor-like plastron.


Following injury, exposed carapacial or plastral bone, if allowed to dry out, dies off superficially; new scutes are formed beneath the exposed bone such that eventually this outer layer is shed.




Differential diagnoses for skin disorders



Abnormal skin shedding (dysecdysis)



• In terrapins a form of dysecdysis is seen where there is a failure of the outer layers of the carapacial scutes to shed and air becomes trapped beneath these producing silvery patches. This may occur if the terrapin is unable haul out and bask properly, to dry out their shell.


Pruritus



• Ectoparasites

• Dermatitis.


Erosions, ulceration and shell deficits



• Trauma
• Often secondary to damage from another tortoise. Some males, especially the Turkish spur-thigh tortoise (Testudo ibera), are very aggressive to conspecific and heterospecific males

• Bacterial infection

• Keratinolytic bacteria from soil in the shell

• Other bacteria, e.g. Aeromonas spp in damp conditions

• Benekea chitinovora (terrapins)

• Septicaemia (opportunistic species)

• Septicaemic cutaneous ulcerative disease (SCUD)(especially softshell turtles). Often due to Citrobacter freundii or Pseudomonas spp. Other G −ves may also cause this condition in aquatic chelonia

• Mycobacteria (see Systemic Disorders)

• Fungal infections

• ‘Dry’ lesions in terrestrial chelonia are often due to soil-derived keratinolytic mycotic infections such as Geotrichum candidum and Scolecobasidium humicola

• Fusarium incarnatum (Gopher tortoises Gopherus berlandieri) (Rose et al 2001)

• Microsporum spp, Mucor spp, (ulcerative epidermitis in softshell Trionyx spp)

• Chromomycosis, e.g. Scolecobasidium humicola, Cladosporium herbarum, Phialophora spp, Hormodendrum spp, Curvularia spp, Fonsecaea spp, Rhinocladiella spp and Drechslera spp

• Saprolegnia can infect freshwater aquatic chelonia, often secondarily invading wounds and lesions. Appears as a cotton wool-like covering while submerged that collapses on removal from the water

• Paecilomyces lilacinus (Lafortune et al 2005)

• Iatrogenic hypervitaminosis A (a necrotic dermatitis leading to a full-thickness skin sloughing)

• Burns

• Spirochid flukes (terrapins)

• Renal failure (loss of scutes often accompanied by excess exudation and ascites)

• Shell fractures, see Musculoskeletal Disorders

• Dog or other predator attack

• Rat or rodent attack (gnawed lesions on the legs, especially the lateral surfaces of the front legs) (Fig. 9.5).

image

Fig. 9.5 Rat damage in a Mediterranean spur-thighed tortoise. The elbow joint has been exposed.



Nodules and non-healing wounds



• Abscess

• Granuloma (bacterial including mycobacteria, fungal)

• Cistudinomyia (Sarcophaga) cistudinis, esp. in the axillial and femoral fossae of box turtles (Terrapene spp)

• Gas bubble disease in aquatic chelonia (rare)

• Spirochid flukes (terrapins)

• Subepidermal mites

• Dermal papillomatosis (side-neck turtles – Platemys spp)

• Chelonia herpes virus (CHV) (see also Respiratory Tract Disorders)

• Pox-like virus in Testudo hermanni.


Changes in pigmentation



• Erythema (septicaemia)

• Burns

• Liver disease (and other possible aetiologies for coagulation abnormalities)

• Haemoprotozoans

• Renal failure (often accompanied by excess exudate and loss of scutes)

• Algal growths (aquatic chelonia)

• Scar tissue (depigmented)

• Fusarium semitectum is a cause of whitish skin blemishes in Gopherus berlandieri

• Failure of the scutes to be able to dry out (semi-aquatic chelonia).


Ectoparasites



• Myiasis (fly strike; maggots)

• Calliphora vicina

• Lucillia ampullacea, L. coeruleiviridis

• Cistudinomyia (Sarcophaga) cistudinis

• Bot fly larvae

• Ticks, e.g. Ambylomma sparsum, A. marmoreum

• Subepidermal mites (African spurred tortoise Geochelone sulcata) (Nicasio et al 2002)

• Spirochid flukes (terrapins)

• Spiruruids

• Leeches (wild caught or feral freshwater chelonia)

• Barnacles (Balanus spp) recorded on diamondback terrapins (Malaclemys terrapin) (Werner 2003).


Burns



Neoplasia


Shell deformities


• Excessive protein intake

• Metabolic bone disease (nutritional osteodystrophy)

• Old shell lesions, e.g. traumatic injuries

• Dyskeratosis. Cause unknown, but may be linked to systemic disease (Homer et al 2001).


Findings on clinical examination



• Reddened, thickened areas of skin suggest an underlying infection. These may be moist

• Loss of dermal structures such as toenails

• Overgrowth of dermal structures such as the toenails, beak and scutes

• Partial or complete loss of scutes

• Silvery patches on the scutes of semi-aquatic chelonia. Many of these such as red-eared terrapins (Chrysema scripta elegans) do routinely shed scutes. Failure to do so results in air trapped beneath loosened scutes

• Exposure of underlying bone

• Flaking and fissuring of the keratin scutes

• Inflammation and exudate accompanied by separation of the scutes from the underlying bone can be indicative of severe septicaemia or renal disease

• Pruritus. The reptile may scratch against objects. The body plan of chelonia means that they are rarely able to scratch themselves in any meaningful manner, nor can they self-mutilate

• Spirochid eggs cause vascular occlusion, causing focal and coalescing areas of ulcerative necrosis of the carapace and plastron

• Obvious parasites

• Penetrating injuries through scutes into underlying bone. May reach into coelomic cavity or lungs (dog bites)

• Live maggots on or around open wounds; swellings under the skin (myiasis)

• Exfoliation of skin of head and neck associated with necrotic stomatitis (CHV)

• Papular lesions around the eyes (T. hermanni) – pox-like virus.


Investigations



1 Radiography

2 Sterile swabs taken for bacterial or fungal culture

3 Impression smears or other samples taken for staining and cytology

4 Blood samples for general haematology and biochemistry

5 Biopsy of suspect lesions
a Dracunculid larvae may be present in the skin (Spirurids). Adults lie in coelomic cavity

6 Discuss environmental management with owner:
a Are calcium and vitamin D3 supplements offered routinely?

b Is full-spectrum lighting provided?

c Are fluorescent tubes changed at the correct frequency (usually every 6 months)?

d Are high-protein foods being offered?

7 Endoscopy

8 Ultrasonography.


Management



1 Any shell lesions should be investigated further by debridement around the lesion to remove fissures that could harbour persistent infections. This is potentially a very painful procedure and if large areas are to be debrided then general anaesthesia should be considered

2 Small-to-medium lesions can be managed with the application of topical iodine and/or topical antimicrobials

3 Larger lesions may require dressing:
a For terrestrial chelonia, application of a topical amorphous hydrogel dressing, e.g. IntraSite Gel (Smith and Nephew Healthcare Ltd.) topically with a covering of a non-adhesive dressing promotes granulation and coverage of the underlying bone

b For aquatic chelonia applying Orabase (Squibb) or bone wax can be used to achieve a relatively watertight protective seal

4 Consider fluid therapy if large areas of underlying bone are newly exposed and exuding

5 Attempted covering of exposed bone with products such as methylmethacrylate or fibreglass should be delayed until all signs of infection have resolved

6 Those chelonia on a high-protein diet may require burring back of excessively long toenails and upper and lower beak

7 Long-term dry-docking of aquatic chelonia is contraindicated as dehydration and anorexia are common sequelae.


Treatment/specific therapy



• Ticks and maggots
• These should be physically or surgically removed. Permethrin-based formulations are safe, although those products with synergists such as piperonyl butoxide should be avoided if possible. Fipronil may not affect a 10% kill of Amblyomma ticks (Burridge et al 2002). Do not use ivermectin as this is toxic to chelonia

• Note that ticks are vectors for Babesia/Hepatozoon and Ehrlichia-like organisms

• Note that the tick Ambyloma marmoreum can transmit Heartwater (Cowdria ruminatium) to domestic and native wildlife. This and other ectoparasites may act as vectors for other diseases.

• Bacterial and fungal infections
• SCUD in freshwater terrapins is caused by Citrobacter freundii and other G −ve bacteria. Often linked to high levels of environmental bacterial contamination so this should be addressed

• Antibiotics or antifungals as required

• Saprolegniosis. Salt solutions as low as 10 parts per thousand (ppt) (mg/100 mL) will inhibit infections

• Paecilomyces lilacinus in the freshwater aquatic fly river turtle Carettochelys insculpta was controlled (Lafortune 2005) with:
• Permanent salt bath at 5 ppt (0.5%) for 14 days then increased to 7 ppt

• Malachite green and formalin dips (0.15 mg/L of 0.038% malachite green and 4.26% formaldehyde) for 15 min b.i.d. for 33 days

• Itraconazole at 10 mg/kg p.o. every 48 h for 20 days

• Spirochid flukes: praziquantel at 10 mg/kg

• Address any dietary or environmental deficiencies

• Dog attack
• Covering antibiotics

• Non-penetrating injuries – clean with topical iodine solution

• Dress any penetrating injuries with non-adhesive dressings. Only once any secondary infection cleared should the lesion be sealed with synthetic polymers such as polymethylmethacrylate or fibreglass

• Rat or rodent attack
• Often during or shortly after hibernation when tortoises are sluggish

• Commonly affects the lateral (outer) surfaces of the front legs, which are drawn across in front of the head for protection. Other limbs and the shell may be damaged as well

• The radius and ulna may be exposed, as may the elbow joint

• Clean and debride any devitalized tissue

• Application of topical amorphous hydrogel dressings, e.g. IntraSite Gel (Smith and Nephew Healthcare Ltd.) will encourage secondary healing. A non-adhesive dressing should be applied

• Healing can take many months before re-epithelialization occurs to a sufficient extent

• If the elbow joint is exposed:
• Strap up the leg so that the tortoise cannot weight-bear on that leg

• Provide support by the attachment of a prop (e.g. half billiard ball; toy wheel) to the plastron of that quadrant

• In severe cases, one leg can be amputated at mid-humeral or mid-femoral level

• Neoplasia
• Rarely diagnosed, or at least reported in the literature

• Chemotherapy in reptiles is in its infancy and most tumours are managed surgically. Accessible cutaneous tumours can be treated by injecting cisplatin directly into the tissue mass on a weekly basis as a debulking exercise

• Radiation has been used to treat an acute lymphoblastic leukaemia in a sungazer lizard (Cordylus giganteus)

• Surgical laser has been used in the treatment of a dermal melanoma in a green iguana.


Respiratory tract disorders




Differential diagnoses for nasal tract disorders


Runny nose syndrome (RNS) is a poorly understood clinical syndrome. Linked with chelonian herpes virus, Mycoplasma agassizii and various bacteria. No single pathogenic agent as yet established.



Viral



• Chelonian herpes virus (CHV). A significant cause of RNS. Other commonly associated signs are stomatitis (with diphtheritic membranes on tongue, oropharynx and naso-pharynx. Dysphagia and hypersalivation may be seen. Less often there will be cervical oedema, diarrhoea and central nervous signs including hind limb paresis

• Iridovirus. Can present similarly to CHV, especially with stomatitis and glossitis. May cause hepatitis

• Virus X. An as yet unidentified virus or group of viruses isolated from Testudo and Geochelone spp that are linked to rhinitis, diphtheroid-necrotizing stomatitis/pharyngitis, pneumonia, enteritis and ascites (Marshang & Ruemenapf 2002).


Bacterial



• Often opportunistic bacterial infections. Consider occult abscessation

• Mycobacteria (see Systemic Disorders)

• Mycoplasmosis

• M. agassizii identified as a cause of RNS in gopher tortoises.


Fungal



• No definitive nasal fungal pathogens have been isolated, but a variety of fungi, regarded as commensals or secondary invaders, have been described in Sulawesi tortoises (Indotestudo forstenii) (Innis et al 2003).


Protozoal



• Intranuclear coccidiosis. Undescribed protozoan found in the mucosal lining of the nares, conjunctiva and Eustachian tubes. May occur elsewhere, e.g. in renal and colonic mucosal epithelial cells. Linked, along with Mycoplasma agassizii, with severe necrotizing sinusitis (Innis et al 2003).


Nutritional



• Hypovitaminosis A (see Nutritional Disorders).


Neoplasia



Other non-infectious problems


• Poor husbandry (including nutrition) plus exposure to suboptimal temperatures.


Findings on clinical examination



• Clear, serous to gelatinous or mucopurulent nasal discharge

• Necrosis of external nares, including the nasal septum that may extend several millimetres caudally. The vomer and palatine bones may be severely damaged, and oronasal fistulae may develop

• Occasionally accompanied by pharyngeal and tongue lesions

• Other, systemic clinical signs may be seen depending upon aetiology

• Aquatic and semi-aquatic chelonia may swim with one side held lower than the other (pneumonia – asymmetrical or unilateral pulmonary consolidation).


Investigations



1 Examination of discharge – wet smear plus staining for cytology and Gram staining.

2 Culture and sensitivity of discharge sample
a Submit mucus sample for mycoplasma PCR, isolation or electron microscopy

b Submit mucus sample for virus isolation

3 Radiography

4 Routine haematology and biochemistry

5 Mycoplasma serology

6 CHV serology

7 Endoscopy

8 Biopsy/necropsy
a Histopathology for intranuclear coccidiosis

9 Ultrasonography.


Management



1 Covering systemic and/or topical antibiosis. Consider nebulization

2 Topical iodine application to any areas of ulceration or exposed bone

3 Flushing of the nares. This should be attempted from both directions, with saline or an antibiotic ointment
a With a syringe placed flush with the external nares such that any mucus or accumulated material is displaced caudally into the mouth, from where it can be remove

b Retrograde flushing can be achieved by placing antibiotic ointment on to the roof of the mouth at the nasopharynx, and displacing the antibiotic up and into the nasal cavity by compression with a cotton bud

4 Surgical debridement may be required of any necrotic bone

5 Supportive treatment – may require placement of an oesophagostomy tube to bypass the buccal cavity.


Treatment/specific therapy



• Chelonian herpes virus (CHV)
• Acyclovir at 80 mg/kg s.i.d. for cases of herpesvirus. Efficacy appears variable

• Other viral infections – supportive treatment only

• Non-specific bacterial infections – appropriate antibiotics

• Mycoplasmosis
• Enrofloxacin at 5–10 mg/kg s.i.d.

• Doxycycline at 2.5–10 mg/kg p.o. s.i.d. or b.i.d. or 50 mg/kg i.m. (loading dose) followed by 25 mg/kg every 3 days

• Tylosin at 5 mg/kg i.m. or p.o. s.i.d.

• Clarithromycin at 15 mg/kg p.o. every 2–3 days.

• Intranuclear coccidiosis
• Potentiated sulphonamides (patient must be well hydrated)

• Toltrazuril at 7.5 mg/kg p.o. s.i.d. for 2 days. Repeat after 12 days.


Lower respiratory tract disorders




Respiratory anatomy


The glottis is located at the base of the muscular, fleshy tongue relatively caudal in the oropharynx. The trachea has complete cartilaginous rings. It bifurcates into two bronchi a relatively short distance along the neck and each of the two bronchi enter a lung dorsally. The lungs occupy dorsal section of shell and are adhered to the overlying dermal bones of the carapace. The lungs are paired and sac-like with the gas exchanging alveoli situated at the periphery of these organs. The lack of a functional diaphragm allows inflammatory exudates to accumulate in the dependant portions of the lungs.



Common respiratory signs


Differential diagnoses of dyspnoea:


1 Chelonia are unable to cough so respiratory disease is likely to present as a dyspnoea

2 Pneumonia

3 Severe stomatitis/pharyngitis

4 Tracheal obstruction

5 Coelomic mass

6 Overheating.

Differential diagnoses of respiratory noise:


1 Runny nose syndrome

2 Nasal foreign body

3 Tracheal obstruction/foreign body

4 Oesophageal obstruction/foreign body

5 Pneumonia.


Differential diagnoses for respiratory disorders



Viral



• Chelonian herpes virus

• Iridovirus

• Virus X.


Bacterial



• Various, especially environmental contaminants including Pseudomonas

• Mycobacteria (see Systemic Disorders).


Fungal



• Mycotic pneumonia

• Often secondary to suboptimal temperatures or prolonged antibiotic use

• Many species described including Candida albicans and Paecilomyces.


Parasitic



• Migrant ascarids (often Sulcascaris or Angusaticaecum), both in the trachea and the lungs

• Trematodes (aquatic chelonia – fish, amphibians and crustaceans can act as intermediate hosts).


Nutritional



• Hypovitaminosis A predisposes to secondary lung infections.


Neoplasia



• Metastases


Other non-infectious problems



• Obstruction. Accumulations of mucus and inflammatory material from lower respiratory tract disease can act as obstructions

• Drowning (typically terrestrial tortoises found in garden pond)

• Hyperthermia (overheating). Collapsed and may be salivating copiously.


Findings on clinical examination



• Clearly audible respiratory sounds. May be quite moist in nature.

• Dyspnoea. Exaggerated respiratory movements

• Discharge in mouth or at glottis

• Aquatic chelonia may consistently list to one side whilst swimming due to asymmetric consolidation in lungs

• Aquatic chelonia may be reluctant to enter water.


Investigations



1 Radiography.
a Lateral and cranio–caudal views more use than dorso-ventral to detect areas of consolidation

b Compression of the lung fields may indicate an extrapulmonary lesion, e.g. obesity, hepatomegaly

c Lung lesions can be accessed for swabbing, biopsy, etc., by carapacial osteotomy once position is ascertained by radiography

2 Culture and sensitivity

3 Tracheal wash. Staining of collected material and/or submission for culture and sensitivity

4 Endoscopy

5 Routine haematology and biochemistry

6 Endoscopy

7 Biopsy/necropsy

8 Ultrasonography.


Management



• Systemic antibiosis plus any specific medication

• Nebulization may be effective if there is little build up of inflammatory material

• Direct application to lesions via carapacial osteotomy.


Treatment/specific therapy



• Viral infections – supportive treatment only

• CHV (see ‘Differential diagnoses for nasal tract disorders’, in Respiratory Tract Disorders)

• Hypovitaminosis A
• Vitamin A supplementation (see Nutritional Disorders)

• Bacterial pneumonia
• As discussed under ‘Management’, above

• Mycotic pneumonia
• Difficult to treat. Use antimycotics within framework suggested under ‘Management’, above

• Ketoconazole at 10–30 mg/kg p.o. s.i.d.

• Itraconazole 5 mg/kg p.o. e.o.d.

• Griseofulvin 20–40 mg/kg p.o. every 3 days

• Ascarids
• Fenbendazole at 50–100 mg/kg. Repeat every 2 weeks if necessary. Note that fenbendazole is metabolized to oxfendazole by the liver

• Oxfendazole at 68 mg/kg. Repeat every 2 weeks if necessary

• Topical emodepside plus praziquantel preparations (Profender, Bayer) at 56 μL/100 g body weight (Mehlhorn et al 2005)

• Prevention: routine worming every 6 months (pre and post-hibernation for Mediterranean and other species where applicable), plus disposal of faeces as soon as observed

• Trematodes
• Praziquantel at 10 mg/kg p.o. i.m. Repeat after 2 weeks

• Drowning
• Vigorously pump water out of the lungs by holding the tortoise vertically with head downwards and repetitively flexing the limbs into the inguinal and femoral fossae, thereby compressing the lungs

• Place in a high oxygen atmosphere

• Furosemide at 5 mg/kg i.m. b.i.d. to encourage a diuresis

• Hyperthermia
• Place into cool water

• Dexamethasone at 30–150 μg/kg i.m., i.v. i.o. may be given.


Ear disorders




Differential diagnoses for tympanic scale (aural) abscess



Bacterial



• Ascending infection from the pharynx up the Eustachian tube so often reflects normal buccal flora. Often G −ve opportunistic bacteria especially Proteus vulgaris, E. coli and Aeromonas hydrophila (Willer et al 2003)

• Mycoplasmosis.


Fungal



• Yeasts.


Parasitic



• Ascarid (Angusticaecum spp) described in Mediterranean spur-thighed tortoise Testudo graeca (Cutler 2004).


Nutritional



• Possibly related to hypovitaminosis A.


Neoplasia



Other non-infectious problems


• Poor husbandry and suboptimal temperatures

• Exposure to organochlorine pesticides.


Findings on clinical examination



• Commoner in box turtles than other terrestrial chelonia

• Swollen tympanic scale – can be unilateral or bilateral (Fig. 9.6)

• A plug of purulent material may be visible in the pharynx at the site of the Eustachian tube.

image

Fig. 9.6 Tympanic abscess.



Investigations



1 Investigate oropharynx – if ascarid present, is likely to be visible

2 Routine culture and sensitivity of purulent material

3 Cytology

4 Radiography

5 Endoscopy

6 Routine haematology and biochemistry

7 Endoscopy

8 Biopsy/necropsy

9 Ultrasonography.


Management



1 Remove any ascarid present via the pharynx if possible

2 Either under GA or local anaesthetic, incise through tympanic scale

3 Remove purulent material and flush. Check that Eustachian tube is patent by monitoring pharyngeal ostium

4 Tympanic scale can be sutured, but often left to heal by second intention thereby allowing repeated flushing.


Treatment/specific therapy



• Bacterial infections – appropriate antibiosis

• Yeasts
• Nystatin at 100 000 units/kg p.o. daily for 10 days

• Ascarids
• Fenbendazole at 50–100 mg/kg. Repeat every 2 weeks if necessary. Note that fenbendazole is metabolized to oxfendazole by the liver

• Oxfendazole at 68 mg/kg. Repeat every 2 weeks if necessary

• Topical emodepside plus praziquantel preparations (Profender, Bayer) at 56 μL/100 g body weight (Mehlhorn et al 2005)

• Prevention: routine worming every 6 months (pre and post-hibernation for Mediterranean and other species where applicable

• Hypovitaminosis A, see Nutritional Disorders.

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Aug 21, 2016 | Posted by in EXOTIC, WILD, ZOO | Comments Off on and turtles

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