Syndromes and Conditions of Commonly
Kept Tortoise and Turtle Species
WalterJ. Rosskopf Jr., D VM, Dip.AB VP,
and Myra K. Shindo, BA, BS, MS, MA
Turtle and tortoise species are commonly presented to
veterinarians for diagnosis and treatment in exotic an-
imal oriented practices. The conditions and syndromes
are extremely variable, considering the diversity of the
species encountered. The conditions and husbandry in-
volved with water turtles is very different from what is
encountered with land tortoises and turtles. A thor-
ough knowledge of the subject is therefore imperative.
This article reviews the conditions most commonly en-
countered in working with aquatic and land turtles and
tortoises.
9 2003 Elsevier Inc. All rights reserved.
Key words: Turtle, tortoise, chelonian, mycoplasmosis,
bacterial diseases, nutritional disorders, parasite infes-
tation, vitamin A deficiency.
urtles and tortoises, or chelonians, are com-
T monly kept as pets worldwide. These ani-
mals are frequently presented to veterinarians
for diagnosis and treatment. Knowledge of com-
m o n syndromes and conditions is imperative to
success in m a n a g i n g the species.
Turtles and tortoises occur in a wide range of
habitatst and climatic conditions. P r o p e r diet
and a clean e n v i r o n m e n t are essential for health
in captivity. Some water turtles require brackish
water for health to be maintained. Tropical spe-
cies require a heated environment, whereas in-
dividuals f r o m n o r t h e r n climates may do well in
less climatically controlled environments.
Smaller aquatic species may do well in an aquar-
ium, whereas larger species may do better in a
large pond. Filtration systems are imperative in
the keeping of water turtles. P r o p e r ultraviolet
light with a basking area provided is important.
Overcrowding or the presence of d o m i n a n t an-
imals may p r o d u c e a stressful situation that can
result in disease. Dietary and husbandry require-
ments for chelonians are extremely variable, too.
O n e should read as m u c h as possible on all
species e n c o u n t e r e d in practice.
Dietary r e c o m m e n d a t i o n s for chelonian spe-
cies are especially variable. Even e x p e r i e n c e d
Seminars in A v i a n and Exotic Pet Medicine, Vol 12, No 3 (July), 2003: pp 149-161
zookeepers, hobbyists, and reptile specialists fre-
quently disagree on what constitutes a p r o p e r
diet for m a n y of the species. Commercial diets
for water turtles are now available and work well.
T h e authors have used commercial koi food for
water turtles of m a n y species with excellent re-
sults. T h e feeding of live food such as earth-
worms and fish, though usually safe, can be a
source o f infectious organisms. Terrestrial tur-
tles, such as Box Turtles, do well on a diet of
vegetables, live food, and some low-fat dog or cat
food (the latter foods are disparaged by many,
but have a place in the diet if used judiciously!).
Tortoises are best allowed to forage on natural
grasses and are s u p p l e m e n t e d with vegetables
and hay. Alfalfa or timothy pellets are frequently
fed to i m m a t u r e tortoises. Careful supplementa-
tion with calcium-mineral supplements helps to
avoid imbalances. Overuse of supplements can
be harmful, however. New tortoise diets (biscuit-
like) are now available and widely used.
The terminology used with turtles and tor-
toises is quite variable. We shall use the t e r m
"tortoise" to refer to the large land animals with
elephantine rear feet. Terrestrial turtles are
land-based turtles (usually smaller than tortoises
and anatomically variable). Water turtles are
fresh-water turtles that spend the majority of
their time in water. We w o n ' t use the term "ter-
rapin" (usually refers to water turtles in certain
areas of the United States) and we w o n ' t discuss
sea turtles (not kept as pets). The term "tor-
toise," for interest's sake, is often used in Great
Britain a n d Australia to refer to water turtles
(such as the Murray River Tortoise in Australia,
which is a water turtle) (Figs 1 and 2).
From Avian and Exotic Animal Hospital of Los Angeles County,
Hawthorne, CA.
Address correspondence to: Walter Rosskopf DVM, DABVP,
4871 West Rosecrans Avenue, Hawthorne, CA 90250.
9 2003 Elsevier Inc. All rights reserved.
1055-937X/03/1203-0127530.00/0
doi:l O.1053/saep. 2003. 00022- 7
149
150 RosskopfJr. and Shindo
Figure 1. Australian Snake Neck turtles. Courtesy of
Ellen Nichol.
Tortoise Conditions and Syndromes
Upper Respiratory Disease Syndrome
The respiratory disease condition that is com-
monly e n c o u n t e r e d in desert tortoises has been
known fbr decades. I would estimate that 80% of
the desert tortoises that I have seen in practice
are b r o u g h t in because of this disease. In over 33
years of practice, I have seen well over 25,000
cases (and this is a conservative estimate)! All of
us in practice in the 1970s and 1980s were per-
plexed by this condition, which was c o m m o n l y
t h o u g h t to be viral in etiology. Death rates at
that time were high. In the late 1980s, the dis-
ease began to be seen in wild desert tortoise
populations in e n o r m o u s numbers, L,2 The se-
nior author was doing contract work for the
Bureau of Land Management and was asked by
director Dr. Kristin Berry if there was a known
cause and treatment for this condition. She was
told the problem was a long-standing enigma in
pet tortoises, 3 and that Dr. ElliotJacobson of the
University of Florida, Gainesville, would be the
investigator to contact. He was invited to inves-
tigate the disease and we are forever indebted to
him for his findings.
Pathologic studies of 17 ill desert tortoises
from the Desert Tortoise Natural Area in Cali-
fornia and 1 ill desert tortoise from Utah indi-
cated that major microscopic lesions were con-
fined to the u p p e r respiratory tract (URT). 3
Electron microscopic studies revealed small
(350-900 nm) pleomorphic organisms resem-
bling mycoplasma in close association with the
surface epithelium of the URT of ill tortoises.
Mycoplasma was cultured from the nasal pas-
sageways of ill tortoises and, at the time, repre-
sented only the second report of isolation o f a
mycoplasma from a reptile. Mycoplasma tesludinis
was previously isolated from the cloaca of a Spur-
Thighed Tortoise; however, the pathogenicity of
this organism is unknown. The mycoplasma iso-
lated from the desert tortoise was n a m e d Myco-
plasma agassizii, with strain PS6 the strain type. In
a transmission study, that organism was d e m o n -
strated to be the cause of URT disease in the
desert tortoise. M. agassizii has been isolated
from the wild g o p h e r tortoises in Florida with
rhinitis, and transmission studies also have con-
firmed it as the causative agent. An enzyme-
linked i m m u n o s o r b e n t assay has been devel-
oped to determine exposure to this organism. 4
Direct contact between tortoises appears to
be an important route of transmission. Myco-
plasma can be cultured from nasal discharge
fluids of affected tortoises, and because of this,
transmission can be either direct or indirect
through objects contaminated with infective na-
sal fluids. 4
Enrofloxacin has been shown to be extremely
effective in treating tortoises with mycoplasmo-
sis. A combination of systemic medication, along
with saline-enrofloxacin (30:1) nasal flushes,
works well to control the disease. Most of these
tortoises probably remain carriers for life, but
can be retreated successfully if periodic flare-ups
occur. The use of doxycycline, which is very
effective in rat mycoplasmosis, doesn't seem to
work as well in tortoises, but it is an alternative
duug in cases of apparent resistance to Enro-
floxacin. Secondary bacteria such as Pasteurella
Figure 2. Infant Australian Snake Neck turdes. Cour-
tesy of Ellen Nichol.
 Syndromes and Conditions of Tortoise and Turtle Pet Species"
sp. 5 and other organisms may require the use of
other antibiotics, as well.
MycoDlasma sp. u p p e r respiratory infections
may be seen in a wide variety of tortoise species
worldwide. Jacobson states that mycoplasmal in-
fections with secondary Gram-negative bacterial
infection have b e e n implicated in URT disease
in Desert Tortoises (Gopherus agassizii), G o p h e r
Tortoises (G0pher, us polyphemus), Greek and Her-
m a n n ' s Tortoises ( Testudo graeca and Testudo her-
manni), L e o p a r d Tortoises (Ge0chel0ne pardalis),
Radiated Tortoises (Gopherus radiata), and In-
dian Star Tortoises (Gopherus elegans).G
Aamcdotal evidence would suggest that the
same organism or related ones cause the u p p e r
respiratory disease syndrome in Sulcata Tor-
toises (Ge0chel0ne sulcata) and m a n y others of the
world's tortoises. T h e respiratory disease seen in
box turtles and water turtles appears to be asso-
ciated with a wide variety of Gram-negative bac-
teria and not the mycoplasma agent, although
there is still some debate on the subject.
It is also interesting to note that tortoise spe-
cies seem quite variable in their susceptibility to
u p p e r respiratory disease syndrome. Anecdot-
ally, Sulcata tortoises seem to respond to treat-
m e n t m u c h faster than desert tortoises. Some
tortoise species seem relatively resistant to the
organism.
Disorders Involving the Shell
Malnutrition is widespread a m o n g captive tor-
toises. I n a d e q u a t e mineral intake with fast
growth can lead to severe deformity of the shell.
Pyramidal shell growth is a c o m m o n p r o b l e m
in raising tortoises in captivity. It is such a com-
m o n occurrence that it is rare to have a captive-
raised tortoise that grows in a n o r m a l way. W h e n
I see a normal-looking captive tortoise, I usually
quiz the client on the diet supplied. I am often
shocked at some serendipitous combination that
has luckily worked in this particular pet. T h e
etiology of pyramidal shell growth is unknown.
Suggested etiologies include excess dietary pro-
tein, t o o rapid growth, vitamin or mineral excess
or deficiency, metabolic b o n e disease, and spe-
cies predisposition, v
Traumatic injuries to the shell caused by lawn
mowers and automobiles are c o m m o n l y encoun-
tered, especially in the spring, when tortoises
come out of hibernation. Canine attack with
151
severe trauma is all too frequently seen in tor-
toises.
Shell rot (1 or m o r e erosive lesions involving
either the u p p e r or lower shell, or both) usually
occurs as a result of traumatic injury to the shell
or exposure to filthy environmental conditions,
although infectious diseases can b e associated
with the disorder. 8
Shell-repair techniques have b e e n developed
to a fine art in reptile medicine. A n u m b e r of
acrylics and patching materials work well on che-
lonian shell problems, sq~
Oral Herpesvirus Infection of Tortoises
A herpesvirus has b e e n isolated f r o m necro-
tizing oral or b e a k lesions in several species of
tortoise. 1~ Species c o m m o n l y kept in captivity
that are affected by this virus include the Argen-
tine Chaco Tortoise (Geochelone chilensis), the
Desert Tortoise of the southwestern United
States (G. agassizii), and the Greek Spur-
T h i g h e d Tortoise (T. graeca). This virus causes
necrotizing lesions in the oral cavity and b e a k
commissures of the tortoise, resulting in nasal
and ocular discharge, regurgitation, and an-
orexia. A fecal-oral transmission route is sug-
gested. ,2-14
T r e a t m e n t of lesions that a p p e a r to be
caused by the herpesvirus is suggested, even if
definitive diagnostic evidence is lacking. If
possible, however, a section of the n e c r o t i z i n g
tissue s h o u l d be s u b m i t t e d for histologic inter-
p r e t a t i o n , b e c a u s e positive identification of
the viral particles in the e p i t h e l i u m can be
a c h i e v e d with e l e c t r o n microscopy. T r e a t m e n t
of the oral lesions with a p r e p a r a t i o n of 5%
acyclovir o i n t m e n t a p p l i e d topically to the le-
sion is s o m e t i m e s effective. S o m e severe, n o n -
responsive cases r e s p o n d to oral acyclovir at a
dosage of 80 m g / k g orally q24 h o u r until the
signs clear. Antibiotics can be used to t r e a t the
s e c o n d a r y bacterial infections that typically oc-
cur b e c a u s e of irritation of the e p i t h e l i u m
s u r r o u n d i n g the b e a k a n d oral cavity. Q u a r a n -
tine of newly a c q u i r e d animals is essential to
d e t e r the s p r e a d o f this disease in tortoise
colonies. ~
In Southern California, we have seen n u m e r -
ous herpes cases in desert tortoises and Russian
(Horsefield's) Tortoises. Most have r e s p o n d e d
well to treatment, b u t some have died.
152 RosskopfJr. and Shindo
Figure 3. Adult Chinese soft-shell turtle. Courtesy of
Waiter Rosskopf, DVM.
Hypervitaminosis A--Skin Sloughing or Peeling
Syndrome of Tortoises
A specific p r o b l e m in tortoises b e c a m e evi-
d e n t in the early 1980s when vitamin A injec-
tions were frequently given to parrots with vita-
min A deficiency dietary problems. Practitioners
began to give injections of vitamin A regularly to
desert tortoises with URT infections. At the time,
we suspected the tortoises were reacting to cer-
tain antibiotics.
Hypervitaminosis A iatrogenic dermatosis,
which presents as patches of dry skin that
progresses to a generalized sloughing of the ep-
ithelium, can follow a single vitamin A injection
at a dosage higher than 10,000 I U / k g intramus-
cularly. 15 Secondary bacterial or fungal infec-
tions frequently follow this condition, and re-
quire t r e a t m e n t with systemic and topical antibi-
otics. Additional vitamin A injections are not
advisable. If the animal is generally deficient in
vitamin A, then dietary changes can be imple-
m e n t e d in lieu of the injections, because oral
s u p p l e m e n t a t i o n of vitamin A in conjunction
with n o r m a l feeding practices is not known to
cause this problem, lz
Internal Infections
A wide variety of bacterial infections occur in
captive tortoises (Fig 3). Often, multiple organs
are involved. Liver a n d / o r kidney disease is com-
m o n because of" the septic nature of tortoise
diseases and the filtering action of these 2 or-
gans. Chronic hepatitis and chronic kidney dis-
ease (the latter resulting in elevated levels of uric
acid in the blood, and gout) are routinely seen.
Infections of the heart are also c o m m o n .
Mouth Rot (Infectious stomatitis)
This condition results either as the direct re-
sult of traumatic injury to the oral cavity a n d its
lining, or secondary to systemic disease. This
condition should be treated locally (topically) as
well as systemically to prevent the possibility of
internal abscessation. Beak and jaw d e f o r m a t i o n
may occur, necessitating periodic corrective
trimming. If m o u t h rot does n o t respond in the
way the clinician would expect, herpesvirus in-
fection should be suspected. 11k14
Abscesses
Bacterial abscesses are c o m m o n , resulting
f r o m p u n c t u r e wounds and o t h e r traumatic in-
juries. Because tortoises readily develop internal
abscesses, systemic antibiotics must be used to
treat all abscesses (external or otherwise).
Organ Failure
T h e ravages of a lifetime of low-grade infec-
tions and water deprivation may result in cirrho-
sis a n d / o r o t h e r pathology of the liver, or
chronic kidney disease and failure in aged tor-
toises. Blood-chemistry analysis is necessary to
make the diagnosis.
Impactions and Foreign-Body Ingestion
Sand impaction occurs c o m m o n l y in hatch-
lings. Therefore, they should not be k e p t on
sand, but rather on hard dirt or i n d o o r - o u t d o o r
carpeting. Surgery to relieve a sand impaction or
retrieve foreign bodies f r o m the intestinal tract
is a complicated p r o c e d u r e with a p o o r outlook.
Sulcata tortoises are particularly p r o n e to rock
and substrate ingestion. Long-term laxative use
and fecal softeners along with the judicious use
of m e t o c l o p r a m i d e may be necessary in treat-
m e n t of these cases.
Reproductive Problems
Metritis, retained eggs, and egg-yolk peritoni-
tis are c o m m o n a m o n g female tortoises. S o m e of
 Syndromes and Conditions of Tortoise and Turtle Pet Species
these problems can be m a n a g e d medically. Oth-
ers require surgical intervention.
Prolapses
Prolapses of the penis, uterus, intestine, or
urinary bladder are not u n c o m m o n . General
anesthesia is necessary to correct these condi-
tions. The prolapsed organ must be carefully
replaced inside the body. Simply pushing it back
into the cloaca where it is out of sight may result
in a slow death. A t h o r o u g h diagnostic workup
(x-rays, laboratory testing, etc.) must be per-
f o r m e d to help diagnose their causes.
Bladder Stones
Bladder stones, c o m p o s e d of uric acid, re-
quire m a n y years to f o r m and may reach unbe-
lievably large sizes (baseball size is not uncom-
m o n ) . Desert tortoises are p r o n e to this disease
condition because of the urinary bladder's func-
tion of storage and resorption of water. These
functions often result in the deposition of small
particles of uric acid within the bladder and the
gradual accumulation of m o r e uric acid residues
a r o u n d this nucleus over the years. W h e n these
stones b e c o m e large e n o u g h to irritate the blad-
der lining or to mechanically impair urination,
interfere with walking, or otherwise result in
pain, m o s t desert tortoise owners will b e c o m e
suspicious that something is wrong. T h e diagno-
sis is confirmed with radiographs. Correction
involves surgical removal of the s t o n e J 5,~6
Iron Storage Disease
Some desert tortoises suffer f r o m excessive
accumulation of elemental iron within the liver.
This results in chronic hepatitis and, eventually,
cirrhosis. T h e cause is unknown but blood
breakdown in disease and enzyme deficiency are
both possible etiologies. Owners should not of-
fer iron tablets to their desert tortoises. Foods
and water supplies high in iron should also be
avoided.
Intestinal Parasites
Small pinworm-like parasites, large strongyle-
type worms, and large r o u n d w o r m s can infect
captive tortoises. F u r t h e r m o r e , several proto-
153
zoan parasites (Giardia, Trichomonas, etc.) can
cause disease. Some c o m m o n worms are consid-
ered n o r m a l by some investigators27
Entamoeba Invadens Infection in Tortoises
Amoebiasis periodically causes severe disease
in tortoises. Epidemics are not u n c o m m o n and
special m e n t i o n of the p r o b l e m is warranted.
Dysenteric diarrhea may be seen. Investigators
have described severely ill animals as icteric, ane-
mic, a n d in varying stages of circulatory col-
lapse, as
Diagnosis is m a d e by wet mounts or
T r i c h r o m e stains, tS-2~T r e a t m e n t involves metro-
nidazole and iodoquinal. 21
Myiasis (Maggot Infestation)
Fly strike and m a g g o t infestation are ex-
tremely c o m m o n , especially with w o u n d e d a n d
traumatized tortoises. These animals are virtu-
ally defenseless and flies can easily take advan-
tage of their weakened condition. Any tortoise
that is known to be ill or suffering f r o m a w o u n d
anywhere should be housed indoors or other-
wise p r o t e c t e d f r o m flies within a screened en-
closure. Long-term soakings in betadine solu-
tion a n d removal of the maggots by h a n d are
p r o c e d u r e s used in the m a n a g e m e n t of such
cases.
Ticks
Wild or newly acquired desert tortoises may
be infested with ticks. They should be carefully
removed. In April 2000, a ban was placed on the
importation of certain species of African tor-
toises into the United States. It was f o u n d that
some o f these tortoises h a r b o r e d ticks that car-
ried virulent viruses with the potential to deci-
mate h o o f e d stock. Practitioners should m a k e
owners of such tortoises aware of the potential
problem, especially if the tortoises are to be kept
n e a r h o o f e d stock. 12
Before the ban, most i m p o r t e d leopard and
Sulcata tortoises seen by the authors were in-
fested with h a r d ticks!
Diabetes Mellitus
Desert tortoises may develop diabetes melli-
tus, which requires closely m o n i t o r e d medical
154 RosshopJJy. and Shindo

care. We have e n c o u n t e r e d several cases o f dia-

betes in desert tortoises over the years. Insulin
has a long-lasting physiologic effect in these rep-
tiles, in my experience. High glucose levels may
also occur in severe kidney disease in tortoises,
as in avian species.

Ocular Disorders
A wide variety of disorders involving the eyes
and related structures afflict tortoises. S o m e of
these include cataracts, corneal ulcers, ocular
infections, p u n c t u r e wounds and o t h e r trau-
matic injuries, conjunctivitis, keratoconjunctivi-
tis, keratitis sicca (dry eye), and hatchling eye
syndrome (vascular scarring). Bacterial infec-
tion may cause some of these conditions or oth-
erwise cause secondary complications. Eye in-
volvement may a c c o m p a n y symptoms of the re-
spiratory complex. Cataracts may result fi'onl
traumatic injury or infection. Some are, no
doubt, hereditary. Unusual eye color variations
are also n o t e d f r o m time to time.
Normal Ocular Discharge in Some Tortoises
Some tortoises have no functional nasolacri-
real system and tears are lost from spillage or
evaporation. 22 Red-Footed (Geochelone carbona-
r~a) and Yellow-Footed Tortoises (Geochelone den-
ticulata) normally have a clear ocular discharge. 7
Gular Overgrowth
Older tortoises may develop large, overgrown
gular projections (forward projection of the
lower shell, u n d e r the neck). This condition can
result in a severe mechanical interference with
eating and swallowing. Correction involves trim-
m i n g of this projection with a Stryker saw.
Submandibular Sex-Gland Inflammation
During b r e e d i n g season, the large chin or sex
glands of the male desert tortoise may increase
in size and drain. T h e e n l a r g e m e n t n o t e d may
be normal, but infections of these glands may
occur. Cytology can help to differentiate be-
tween normal and infected s u b m a n d i b u l a r
glands.
Figure 4. Box turtles eating. Courtesy of Ellen
Nichol.
Ivermectin Reaction
This c o m m o n l y used vermifuge c a n n o t be
used by injection in any of the chelonian species.
T h e use of this medication will result in flaccid
paresis or paralysis of the limbs. 7,2~
Goiter in Giant Tortoises
Goiter has b e e n frequently r e p o r t e d in giant
tortoises such as the Galapagos Tortoise a n d the
Aldabran Tortoise. Little is known a b o u t its eti-
ology, and clinicians are cautioned a b o u t the
potential h a r m of dietary s u p p l e m e n t a t i o n of
iodine, e3
Box Turtles and Other
Terrestrial Turtles
Disease Resulting from Malnourishment
and Vitamin Deficiencies
Many diseases afflicting captive terrestrial tur-
tles are, at least in part, the result of malnutri-
tion (Fig 4). Turtles that do not receive all o f the
nutrients vital to sustain o p t i m u m health do not
remain healthy, and b e c o m e ill f r o m a variety of
causes. Hatchlings are the most p r o n e to disease
resulting f r o m dietary deficiencies, because their
nutritional requirements exceed those of adult
turtle, and because their rate of growth is so
rapid. Hatchling turtles often exhibit soft shells
associated with protein and mineral deficiencies,
and d e f o r m e d shells associated with abnormally
fast growth f r o m high protein diets. Adult tur-
tles, by contrast, are unlikely to exhibit soft-shell
problems, but may show signs of anemia, weight
 Syndromes and Conditions of Tortoise and Turtle Pet Species
Figure 5. Eastern male box turtle. Note the bright
red eyes of the male box turtle. Courtesy of Ellen
Nichol.
loss, m o u t h rot, internal infection, or abscessa-
tion with chronic malnourishment.
Respiratory Disease
Respiratory disease is c o m m o n in box turtles.
Epidemics may occur in populations of wild box
turtles, characterized by runny noses and pneu-
monia. The Ornate Box Turtle (Terrapene ornata
ornata) seems to be especially sensitive to respi-
ratory disease in captivity, and the respiratory
signs seem to be particularly devastating in this
species. Enrofloxacin and cefotaxime are com-
monly used antibiotics.
In Illinois, chronic bacterial p n e u m o n i a
was diagnosed in 2 wild Eastern Box Turtles
(T. carolina carolina) (Fig 5). Both turtles were
f o u n d half buried in a dry creek bed and were
severely emaciated and depressed. Histologi-
cally, chronic inflammation was identified in the
nasal sinuses and lungs. A mixture of Gram-
negative bacteria, including Morg'anella morgani,
Acinetobacter calcoaceticus, Serratia marcescens, and
Pseudomonas sp. were isolated f r o m b o t h turtles.
No other pathogens were identified. T h e bacte-
ria were considered the causative agents of the
p n e u m o n i a . 24
Aural Abscesses
Aural abscesses or abcessation of the middle
ear is a c o m m o n p r o b l e m in chelonians, partic-
ularly in box turtles. The exact cause of aural
abscesses cannot be definitely stated, but a his-
tory may include previous u p p e r respiratory dis-
155
ease. Dietary deficiency of vitamin A is consid-
ered by m a n y to be the major predisposing
cause. Squamous metaplasia, as is seen in avian
species, predisposes the turtle to colonization
and subsequent infection by a variety of bacterial
pathogensY 5
T r e a t m e n t of the condition involves lancing
the abscesses, a p p r o p r i a t e antibiotic and vitamin
therapy, and careful consideration to correcting
possible predisposing factors such as inadequate
diet, cleanliness, or stress.
Abscesses (Other Than Ear)
Bacterial abscesses are c o m m o n from punc-
ture wounds, bite wounds, and other injttries.
Injectable antibiotics must be used u n d e r these
circumstances to prevent formation of internal
abscesses or septicemia.
Internal Infections
A wide variety of bacterial infections can oc-
cur. Often, multiple organ systems are involved.
Liver a n d / o r kidney disease is c o m m o n because
of the septic nature of turtle diseases and the
filtering action of these 2 organs. Chronic hep-
atitis and chronic kidney disease (the latter re-
sulting in gout f r o m elevations of uric acid in the
blood) are routinely seen. Infections of the
heart are also c o m m o n . Blood tests are useful
for the diagnosis of these and other prob-
lems.26-29
Organ Failure
O l d e r box turtles are subject to organ failure,
most often resulting f r o m chronic infection or
other longstanding disease involving 1 or m o r e
organs. Diseases that usually a c c o m p a n y advanc-
ing age in o t h e r animals also affect elderly box
turtles (eg, arteriosclerosis)..Blood chemistry
analysis is necessary to diagnose these cases. 26-29
Bot Fly Infestation (Myiasis)
Box turtles are c o m m o n l y subject to the rav-
ages of migrating bot fly larvae. These large
parasites are different f r o m the m u c h smaller
maggots (larvae of other flies). T h e adult flies
deposit their eggs on the skin a n d / o r m u c o u s
m e m b r a n e s , a n d the newly hatched larvae pen-
156 RosskopfJr. and Shindo

etrate into the body and form large, visible

lumps where they come to rest, resembling ab-
scesses. These grubs may cause substantial tissue
damage and mechanical interference for the
turtle, and some turtles die as a result of this
infestation.

Maggot Infestation
Fly strike and maggot infestations are com-
mon, especially a m o n g wounded or sick box
turtles. These turtles are virtually defenseless,
and flies can easily take advantage of their weak-
ened condition. Traumatized or diseased box
turtles should be kept indoors or within a
screened enclosure during their convalescence.
Shell Disorders
Shell rot occurs when either the u p p e r shell
(carapace), lower shell (plastron) or both de-
velop erosions. This condition usually results
from injury or chronic exposure to filthy envi-
ronmental conditions. Malnutrition and infec-
tion are frequent predisposing factors. Meta-
bolic bone disease may result in grotesque shell
development in terrestrial turtles. ~~
Dogs, fires, lawn mowers, and automobiles
often inflict serious injuries to the shell.
Overgrown Upper Jaw
The u p p e r jaw of some captive terrestrial tur-
tles may occasionally overgrow. Abnormal wear
patterns resulting from prior injury or a steady
diet o f soft food may be involved. Periodic trim-
ming of the u p p e r mandible is necessary in these
cases. Metabolic b o n e disease may be involved in
jaw overgrowthY, S~
Foreign-Body Ingestion
The intestinal impactions occasionally seen in
tortoises are rarely a problem in terrestrial tur-
tles. However, eating snail shells occasionally
causes intestinal tract damage in box turtles.
Certain individuals seem to be plagued by this
problem, and should not be fed whole snails.
Most box turtles can eat snails and snail shells
safely.
Figure 6. Box turtle laying eggs. Courtesy of Phil
Angermeyer.
Intestinal Parasites
A variety of r o u n d w o r m and strongyle-type
worms can parasitize captive terrestrial turtles.
Reinfection results when pet turtles are permit-
ted to feed in an environment in which feces are
allowed to accumulate and contaminate food.
Numerous deaths of terrestrial turtles o c c u r ev-
ery year from intestinal rupture and peritonitis
resulting from heavy intestinal parasitism.
Few terrestrial turtles are parasite-free; there-
fore, yearly fecal exams a n d / o r routine deworm-
ings are r e c o m m e n d e d . Strict attention to hy-
giene, frequent soil changes, and periodic rota-
tions of habitats to reduce exposure to these
parasites are also r e c o m m e n d e d .
Intestinal Protozoa
These parasites can cause disease and are oc-
casionally f o u n d in captive box turtles. Diagnosis
of Giardia, Trichomonas, and other oganisms re-
quires direct microscopic e x a m i n a t i o n o f the
feces or the use of special tests, such as the
Trichrome stain, available t h r o u g h exotic ani-
mal laboratories.
Reproductive Problems
Egg-binding is a fairly c o m m o n p r o b l e m
a m o n g female turtles. This condition results
when a gravid female cannot pass an egg by
herself. She typically strains excessively against
the obstruction (Fig 6). The egg may be over-
sized or there may be metabolic or other reasons
 Syndromes and Conditions of Tortoise and Turtle Pet Species
for her inability to pass the egg without assis-
tance. Radiographs are usually taken to confirm
that the female is, in fact, fertile with eggs. Then,
calcium and h o r m o n e injections and sometimes
aspiration of the egg's contents are necessary to
expel the egg.
Several other conditions are seen in repro-
ductively active female turtles. Metritis and egg-
yolk peritonitis are the most common.
Erections in Males
During the mating season, male terrestrial
turtles periodically protrude and rhythmically
fan their penises. This copulatory organ is flower-
shaped and purple, and may appear unusual or
abnormal to those unfamiliar with turtles. It is
most often mistaken for a prolapsed organ and
may be treated as such by those unfamiliar with
turtle anatomy and mating habits.
Prolapses
Prolapses of the uterus, intestine, urinary
bladder, or penis (paraphimosis) may occur.
The last condition occurs if the engorged penis
cannot be returned inside the body cavity, due
to small vent size or previous trauma to the
enlarged organ. Administration of an anesthetic
and skillful manipulation of the organ is usually
necessary to correct the prolapse. Clumsy at-
tempts by owners may permanently damage the
involved organs.
Ocular Disorders
Various disorders involving the eyes of turtles
are noted from time to time. These include cat-
aracts, corneal ulcers, puncture wounds and
other traumatic injuries, infections, maggot in-
festation, conjunctivitis, and dry eye (keratitis
sicca).
Ivermectin Toxicity
As with other chelonians, a flaccid paralysis
that is irreversible will occur with the use of
Ivermectin.7, 21
157
Aquatic Turtles
Nutritional Disorders
Vitamin A Deficiency--Swollen Eye
Syndrome
Hypovitaminosis A is most prevalent in young
aquatic and semiaquatic turtles fed diets of un-
supplemented greens (iceberg lettuce), meat,
and poorly formulated commercial diets. T h e
turtles may be anorectic and growing poorly.
Signs include edema, inflammation, and infec-
tion of the eyes, resulting from squamous meta-
plasia of Harderian glands and respiratory dis-
ease. a2
Soft Shell
Water turtles must receive adequate levels
and proportions of many essential minerals (es-
pecially calcium), vitamin D> and unfiltered
sunlight. An abnormally soft shell will result if
any of these 3 necessities is missing, present at an
inadequate level, or totally unavailable.
An adequately balanced diet and sufficient
periods of exposure to unfiltered sunlight or to
an artificial substitute (Vita-Lite TM) should be
provided to both prevent and treat this condi-
tion. T r e a t m e n t also involves dietary supplemen-
tation and periodic injections of a calcium sup-
plement and vitamin D> Many hobbyists im-
merse turtle blocks (solid blocks of chalk or
plaster of Paris) in the water provided for their
water turtles in the hope of preventing soft-shell
problems. Unfortunately, these water turtles
cannot benefit from the calcium carbonate pro-
vided by these products unless it is ingested.
Shell Deformity (Metabolic Bone Disease)
General malnutrition (especially protein de-
ficiency and mineral imbalances or deficiencies)
in young, growing water turtles will result in 1 or
more of the following consequences: deformity,
pyramidal m o u n d i n g of the carapace (top
shell), premature cessation of shell growth, and
scoliosis of the spine. Captive water turtles rarely
possess normal-appearing shells because of the
universality of these problems among them.
158 Rosskopffi. and Shindo
Egg Binding
A n o t h e r disorder resulting, in part, f r o m min-
eral imbalance or outright mineral depletion is
egg binding. This condition results when a fe-
male water turtle is physically unable to pass 1 or
m o r e eggs without intervention or assistance.
Clinical signs include obvious straining and rest-
lessness, or p r o f o u n d lethargy.
Calcium is necessary for the p r o p e r contrac-
tion of muscles, including those of the uterus.
W h e n this particular mineral is deficient in a
gravid female, egg binding is likely. Malnutri-
tion, lack of exposure to unfiltered sunlight, and
pre-existing disease are the usual predisposing
factors that contribute to this serious, often life-
threatening condition.
Calcium and h o r m o n e injections, as well as
digital m a n i p u l a t i o n of the egg, are usually em-
ployed to relieve this condition. Sometimes, a
needle can be inserted into the egg to aspirate
its contents and collapse it, thereby m a k i n g it
easier to pass.
Bacterial Infections
Captive water turtles are p r o n e to bacterial
infections because malnutrition and p o o r hy-
giene practices are c o m m o n p l a c e . F u r t h e r m o r e ,
injuries received by water turtles in the course of
their day-to-day living tend to b e c o m e readily
infected because of the frequently high bacterial
counts in their aquatic environments.
Respiratory Infections
U R T disease and p n e u m o n i a are very com-
m o n a m o n g water turtles. Clinical signs may
include nasal discharge, swollen eyes, sneezing,
coughing, gasping, o p e n - m o u t h e d breathing,
lethargy, weakness, and listing to one side. Ag-
gressive antibiotic therapy and supportive care
are required to bring these serious cases to res-
olution.
Aural Abscesses
Infection of o n e or both middle ear canals is
a relatively f r e q u e n t occurrence. Surgery is nec-
essary to o p e n u p the infected canal and m a n u -
ally remove the pus that accumulates within its
interior. Injectable antibiotics and vitamin A
therapy, plus dietary change, is used in treat-
ment, as in terrestrial turtles. 25
Septicemia
T h e r e are a host of bacteria that are capable
of causing severe body-wide infections in water
turtles. Often, m i n o r infections, such as those
caused by wounds, increase in severity because
the bacteria that were introduced into the initial
w o u n d are capable of traveling t h r o u g h o u t the
body by way of the bloodstream. Malnourish-
m e n t ensures a weak defense against this inva-
sion on the part of the host, a n d the infection
spreads. As vital organs b e c o m e involved, addi-
tional symptoms and a general deterioration are
noted. Often, extreme redness of the skin a n d
bleeding into it will be n o t e d when a water turtle
suffers f r o m septicemia. Aggressive antibiotic
therapy and supportive care are required to
bring these serious cases to resolution. Enro-
floxacin, cefotaxime, a n d amikacin are fre-
quently used antibiotics.
Shell Rot
Lesions of the shell may result f r o m direct
injury to its surface and substance, or as a con-
sequence of malnutrition, generalized deteriora-
tion, and infection. Bacteria a n d / o r fungi may
be responsible for infections of the shell. Pri-
mary forms of shell rot may also occur f r o m the
ingestion of shellfish laden with disease-causing
bacteria ( Beneckea chitonovora) 33,34
Algae may colonize shell-rot lesions or be a
primary cause of shell rot, although it is not
u n c o m m o n for this agent to take up residence
on the carapaces (top shells) of perfectly n o r m a l
and healthy water turtles. This is usually an in-
dication that the water quality of the turtle's
enclosure needs improvement.
In water turtles, bacterial infections of the
shell can often b e c o m e systemic, resulting in
septicemic cutaneous ulcerative dermatitis, ini-
tially, shell lesions are the only external indica-
tion of this condition. Infected turtles with sys-
temic involvement may develop additional symp-
toms, however, ranging f r o m anorexia and
e x t r e m e lethargy to paralysis of limbs a n d mus-
cles (primarily in the neck). Causative agents
can be Aeromonas hydrophila, Citrobacter freundii,
and Serratia sp. If begun early enough, systemic
 Syndromes and Conditions of Tortoise and Turtle Pet Species
and topical treatment often resolves this condi-
tion. 12
The Eastern Diamondback terrapin (Mala-
clemys terrapin littoralis) is reputed to be suscepti-
ble to shell rot if the water conditions are not
brackish, as in nature. We used to see this in
practice when d i a m o n d b a c k terrapins were seen
in the pet trade. 8
Mouth Rot
Bacterial infection of the oral lining (mouth
rot or infectious stomatitis) is usually a conse-
quence of malnutrition a n d / o r body-wide ill-
ness. Excessive salivation and redness of the oral
lining are typical early symptoms of m o u t h rot.
Later, as the disease progresses, accumulations
of cheese-like pus can usually be n o t e d within
the mouth. An objectionable o d o r from the
m o u t h may be detected as well. Injectable anti-
biotics, vitamins, and appropriate supportive
care, including periodic cleaning of the mouth,
are necessary in the treatment of this serious
condition.
SalmoneUosis
In the not too distant past, water turtles, be-
fore their introduction into the pet trade, were
frequently housed in ponds and septic tanks
contaminated with h u m a n sewage and other
types of waste. Because of this environmental
circumstance, these turtles were continually ex-
posed to and became asymptomatic carriers of a
myriad of potentially harmful intestinal bacteria.
A strong resistance to many of these bacteria
(notably Salmonella spp. and Arizona spp.) en-
sured that these turtles would not b e c o m e ill and
succumb to the diseases caused by them. The
h u m a n handlers (frequently children) of these
turtles, however, did not share this same degree
of bacterial resistance when the latter reached
the pet market. Transmission of Salmonella spp.
and other harmful intestinal bacteria occurred
as a consequence of turtle handling, resulting in
n u m e r o u s cases of h u m a n Salmonellosis.
Public health laws now require that no water
turtle with a carapace (upper shell) diameter
less than 4 inches can be shipped into or sold in
the United States, with certain exceptions. Cur-
rently, in practice, we are seeing n u m e r o u s tiny
water turtles being sold on the streets of Los
159
Angeles. These are obviously illegal, and little or
n o t h i n g is being done to enforce the law.
Parasite Problems
Intestinal Parasites
A wide variety of intestinal parasites are f o u n d
in water turtles, including roundworm-type
worms, tapeworms, and flukes. Stool analysis
and white-blood-cell counts are useful in diag-
nosing parasite problems2 ~
External Parasites
Recently captured water turtles are often par-
asitized with leeches. These should be carefully
removed, and the victimized turtle should be
protected with a relatively short course of inject-
able antibiotics.
Traumatic Injuries
Most traumatic injuries to water turtles result
from aggressive encounters between turtles and
between household pets and turtles. Many water
turtles are territorial (ie, Red-Eared Sliders and
Soft-Shelled Turtles) or pugnacious (ie, Snap-
ping Turtles), and fighting between water turtles
(especially between individuals of the same spe-
cies) often results in serious wounds to the shell
a n d / o r soft tissues. Water turtles of widely vary-
ing sizes should not be housed together. Adher-
ence to this r e c o m m e n d a t i o n will help to reduce
the n u m b e r of traumatic injuries incurred.
Injuries between individuals during the mat-
ing process are c o m m o n . Males may b e c o m e
overly aggressive during copulation and inflict
bite wounds on the female. The male's rapid
and sometimes premature withdrawal of an en-
gorged penis may traumatize the female's repro-
ductive tract.
It is not at all u n c o m m o n for household pets
(especially dogs) to inflict serious, often life-
threatening wounds to the shells a n d / o r soft
tissues of water turtles during u n p r o v o k e d en-
counters.
Epoxy resins and acrylic glues are often used
in the repair of shell injuries in water turtles. 8-m
Foreign-Body Ingestion
Water turtles may ingest any n u m b e r of a
variety of foreign objects (fish hooks, gravel,
160 RosskopfJr. and Shindo
aquarium parts, etc). Rarely, if ever, is the actual
act of swallowing the foreign body witnessed.
Usually a water turtle is presented to a veterinar-
ian because of p o o r appetite, weight loss,
a n d / o r emaciation. Radiography is usually nec-
essary to confirm the diagnosis. Sometimes the
ingested foreign body does not show up on the
x-ray, and a barium study is necessary to make
the diagnosis. Surgery must be employed in
most cases to remove the foreign body.
Drowning
Hobbyists frequently house small or juvenile
water turtles within enclosures that possess water
levels that are too deep, or within enclosures
that are hazardous in some other way. All water
turtles should be provided with a resting/bask-
ing area. Failure to do so may result in exhaus-
tion and drowning. Juvenile water turtles often
b e c o m e trapped u n d e r plants and rocks or be-
hind filters and drown. All such environmental
hazards must be removed or corrected.
Emergency measures may save some drown-
ing victims because a turtle's heart will continue
to beat for many hours after apparent death has
occurred. T r e a t m e n t for drowning involves turn-
ing the turtle upside down and moving its legs to
force water from its lungs. The ambitious care-
giver may also want to perform mouth-to-nose
artificial respiration. If the turtle is successfully
revived, then antibiotics and appropriate sup-
portive care are necessary until the victim has
fully recovered.
Beak Overgrowth
Like birds, turtles and tortoises have beaks
(the h o r n y coverings of both the u p p e r and
lower jaws), which tend to grow continuously for
life. In the wild, the pursuit of day-to-day living
seems to keep the rates of wear and growth in
equilibrium. In captivity, however, these cover-
ings tend to overgrow, and require periodic
trimming.
Metabolic b o n e disease frequently results in
malformed beaks in all the chelonian spe-
cies.3L:~2
Problems Involving Reproductive Organs
(Other Than Egg-Binding)
Erections in Males
Erections of the penis, which occur most of-
ten during the mating season, may be discon-
certing or bewildering to the novice observer.
This condition is perfectly normal, but is most
often confused with a prolapse (see prolapses).
Paraphimosis
Occasionally, the fully engorged penis re-
mains so and cannot be retracted. This condi-
tion is called paraphimosis. Veterinary intmwen-
tion is necessary in these cases to prevent per-
m a n e n t damage to the penis. Ketamine usually
works well to relax the organ.
Penile Paralysis
A water turtle's penis sometimes becomes par-
alyzed. The cause of this condition is unknown.
Besides the obvious liability to the turtle, muti-
lation of the exposed and vulnerable penis by
other turtles is very likely. The penis can some-
times be replaced into the turtle's cloaca. In
most cases, however, the penis must be ampu-
tated, which creates no problems for the turtle
other than the inability to copulate, because this
organ is not used for urination.
Prolapses
A prolapse occurs when a particular organ is
allowed to invert itself and protrude t h r o u g h the
ordinary external o p e n i n g of that organ. In con-
trast to this situation with tortoises, prolapses of
the uterus or intestine are rarely seen in water
turtles. If the turtle owner suspects a prolapse,
then the involved organ should be kept moist
and protected from trauma, and veterinary at-
tention should be sought immediately.
Ivermectin Toxicity
A severe paralytic reaction occurs if Ivermec-
tin is used in water turtles, as in other cheloni-
arts.7, 21
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