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P

Exotic Pet
R A C T

VOLUME 3
SCIENTIFIC ARTICLE

ISSUE 5

MAY 1998
Meaningful normal reference leukogram values are difficult to obtain in reptiles because of the variables affecting the hemic cells and the lack of standard methods for assessing the leukocytes. In general, total and differential leukocyte counts must differ greatly from the norm to be considered significant. In some cases, the morphologic features of the leukocytes may be more valuable than the actual cell counts in the assessment of the reptilian patient. The value of hematologic studies is in the assessment of the reptilian patients response to treatment or the examination of the course of the disease. Favorable responses include the resolution of an anemia, leukocytosis, leukopenia, lymphopenia, heterophilia, monocytosis, and thrombocytopenia. The disappearance of toxic heterophils and reactive lymphocytes from blood films is also a favorable response.
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Interpretation of the Reptilian Blood Profile


Terry Campbell, D.V.M., Ph.D. Hematologic and blood biochemical evaluations are frequently used to assess the health of the reptilian patient.1 The hemic response of reptiles is influenced by a wide array of variables that include the age, sex, season, species, environment, sample handling, nutritional status, physiological status, method of testing, and blood sampling technique (blood samples are frequently contaminated with lymphatic fluid). There are normal reference values available in the literature for a few species of reptiles; however, information concerning environmental conditions, physiological parameters, and sample handling methods is often omitted.2, 3 Because of a general lack of experimental study involving the hematology, blood biochemistries, and meaningful reference values of reptiles, interpretation of the results can be challenging. In general, interpretation of changes in the blood profile of reptiles is similar to that of domestic mammals and birds. Ideally, a unique set of normal reference values should be obtained for the reptilian patient during times of health and under a given set of environmental and nutritional parameters for comparison when that animal becomes ill. The sample size may limit the blood profile to a few tests, so the clinician must decide which tests may provide the most useful information. In general, information evaluating liver, kidneys, glucose, proteins, calcium, phosphorus, and the hemogram are the most useful in the assessment of the reptilian patient. Reptiles have larger but fewer numbers of circulating erythrocytes compared with birds and mammals. Among reptiles, there is an inverse relationship between erythrocyte size and total red blood cell count (TRBC). For example, lizards have smaller red blood cells but higher TRBC than snakes and chelonians. The TRBC, hemoglobin concentration, and packed cell volume (PCV) vary according to sex, nutritional status, environmental conditions, and sample collection and handling. In general, the PCV of most normal reptiles ranges between 20% and 40%. A PCV less than 20% is suggestive of an anemia. Anemias are classified as hemorrhagic, hemolytic, or depression, depending on their cause and response. Regenerative responses to anemia include moderate to marked polychromasia, anisocytosis, poikilocytosis, immature erythrocytes, and stippled basophilia. Marked regenerative responses demonstrate binucleate erythrocytes, abnormal nuclear shapes, and mitotic activity. Hemolytic and hemorrhagic (blood loss) anemias usually demonstrate a regenerative response depending on the duration of the anemia. Hemorrhagic anemia is often caused by traumatic injury, ulcerated lesions, and blood-feeding parasites. Hemolytic anemia is frequently associated with toxemia, septicemia, and parasitemia. Depression anemia results from chronic inflammation, renal or hepatic diseases, or chemical toxicity and exhibits little or no regenerative response. Hypochromatic erythrocytes are associated with dietary iron deficiency or chronic inflammation. A PCV greater than 40% usually suggests dehydration; however, a true polycythemia is possible.

ISSUE HIGHLIGHTS:
Clinical Chemistries
ROUNDTABLE

page 35 Abdominal Tumors in Budgerigars


FROM THE LITERATURE

page 37 Food Allergy in a Ferret


CASE REPORT

page 39

EXOTIC PET PRACTICE

VOLUME 3 ISSUE 5 MAY 1998

Editor in Chief
Shawn Messonnier, D.V.M.
Paws and Claws Animal Hospital Plano, Texas

Interpretation of the Reptilian Blood Profile


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Editorial Board
Terry Campbell, D.V.M., Ph.D.
Department of Clinical Science Colorado State University Fort Collins, Colorado

James K. Morrisey, D.V.M.


Special Species Medicine and Surgery University of Wisconsin School of Veterinary Medicine Madison, Wisconsin

Wm. Kirk Suedmeyer, D.V.M.


Senior Staff Veterinarian Kansas City Zoological Gardens Adjunct Assistant Professor of Zoological Medicine UMC College of Veterinary Medicine Kansas City, Missouri

Valarie V. Tynes, D.V.M.


Punta Gorda Animal Hospital Punta Gorda, Florida

Amy Beth Worell, B.S., D.V.M., Diplomate A.B.V.P.-Avian Specialist


All Pets Medical Centre West Hills, California

Advisory Board
Michael A. Dutton, D.V.M., Diplomate A.B.V.P.-Companion Animal Practice
Weare Animal Hospital Weare, New Hampshire

Cathy A. Johnson-Delaney, D.V.M.


Senior Veterinarian, Primate Medicine Washington Regional Primate Research Center University of Washington Seattle, Washington

ISSN 1086-4288 May 1998 by Mosby, Inc. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher. Vol. 3, No. 5, May 1998. Exotic Pet Practice (ISSN 1086-4288) is published monthly by Mosby, Inc., 11830 Westline Industrial Drive, St. Louis, MO 63146-3318. POSTMASTER send address changes to Exotic Pet Practice, 11830 Westline Industrial Drive, St. Louis, MO 63146-3318. Annual subscription rates for 1998: individual $49.00, resident $31.00, institutional $77.00. For multiple-copy pricing, contact Journal Subscription Services, Mosby, Inc., 11830 Westline Industrial Drive, St. Louis, MO 63146; (800) 453-4351. periodical.service@mosby.com Editorial address: Tania Banak, Mosby, Inc., 11830 Westline Industrial Dr., St. Louis, MO 63146; (800) 325-4177.

The blood biochemical profiles of reptiles often resemble those of mammals and birds. The clinician must choose which may be more appropriate for the reptilian patient. The primary nitrogen excretory product of a reptile depends on its natural environment. For example, terrestrial reptiles excrete uric acid, whereas semi-aquatic turtles excrete urea. Because most pet reptiles are terrestrial, uric acid is often used to investigate the presence of renal disease. Normal plasma uric acid concentrations of reptiles are less than 10 mg/dL. Uric acid is not a sensitive nor a specific test for renal disease in reptiles. Hyperuricemia can result from gout, recent ingestion of a high protein diet, or severe renal disease (loss of renal function greater than 75%). In reptiles, normal plasma urea nitrogen values are typically less than 15 mg/dL; however, healthy desert chelonians, to increase the plasma osmolarity for water conservation, often have values as high as 100 mg/dL. Because few critical studies have been performed to evaluate reptilian liver diseases, plasma enzymes and biochemical tests used to evaluate liver disease in birds and mammals are applied to reptiles. Aspartate aminotransferase (AST) has high activity in the reptilian liver, but is not a specific test for liver disease. Increases in plasma AST activity above 250 IU/L can be associated with hepatocellular or muscle disease and often occur with general diseases, such as septicemia and toxemia. Plasma creatine kinase activity is muscle-specific and is used along with AST to rule out coexistent muscle injury when searching for the presence of liver disease in reptiles. Plasma AST activity increases above 275 IU/L with trauma, systemic infections, intramuscular injections, and exertion, such as occurs with handling. Lactate dehydrogenase has a wide tissue distribution and normal high plasma activity. Increases in plasma lactate dehydrogenase activity above 1,000 IU/L occur with hemolysis or with insult to the liver, skeletal muscle, or cardiac muscle. Alanine aminotransferase activity is usually less than 20 IU/L in the plasma of normal reptiles, and increases are not reliable in the detection of hepatocellular disease. There has been little study of plasma alkaline phosphatase activity in reptiles; however, increased activity may reflect osteoblastic activity and not hepatic disease. Biliverdin is the primary bile pigment of reptiles, and plasma elevations may indicate liver disease. Most commercial veterinary laboratories do not test for biliverdin. A green plasma is suggestive of hyperbiliverdinemia and severe liver disease. The total plasma protein values (biuret method) of normal reptiles usually ranges from 3 to 7 g/dL. Healthy female reptiles demonstrate a hyperproteinemia (primarily a hyperglobulinemia) during active folliculogenesis, and the protein concentration returns to normal following ovulation. Pathologic increases in protein include dehydration and hyperglobulinemia associated with chronic inflammation. Hypoproteinemia usually occurs with chronic malnutrition but can also result from maldigestion, malabsorption, protein-losing enteropathies, and chronic liver or kidney disease. The normal glucose concentration of reptiles ranges between 60 and 100 mg/dL but is subjected to marked physiologic variation. In general, hypoglycemia is associated with starvation, malnutrition, severe liver disease, and, more commonly, septicemia. Hyperglycemia usually occurs with glucocorticosteroid excess or iatrogenic delivery of excess glucose. The normal plasma calcium concentration of most reptiles ranges from 8 to 11 mg/dL. Hypercalcemia (2- to 4-fold increase in calcium) normally occurs in healthy females during active folliculogenesis, and calcium concentrations return to normal after egg laying. Hypocalcemia occurs with alkalosis, hypoalbuminemia, excessive dietary phosphorus, secondary nutritional
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VOLUME 3 ISSUE 5 MAY 1998

EXOTIC PET PRACTICE

R O U N D TA B L E

Clinical Chemistries in the Exotic Patient


Q. What clinical chemistries do you recommend for the avian patient? Dr. Campbell: I recommend testing glucose, calcium, phosphorus, potassium, uric acid, aspartate aminotransferase (AST), creatine kinase (CK), and protein (using the biuret method). An albumin test may be requested, but results may be unreliable when tested on plasma vs. serum. Protein electrophoresis may be preferred for testing albumin and globulin. Cholesterol and fasting bile acids may be needed if hepatobiliary disease is suspected; electrolytes can also evaluated. Dr. Tynes: At minimum I recommend testing AST, CPK, glucose, uric acid, bile acids, and lactate dehydrogenase (LDH). Total protein and calcium are usually included on most profiles. Q. What clinical chemistries do you recommend for the reptile patient? Dr. Campbell: I recommend the same profile as for avian patients. Blood urea nitrogen (BUN) tests are preferred for aquatic turtles, whereas uric acid tests are preferred for terrestrial turtles. Dr. Tynes: I like to get the same information as for my avian patients, including a test for calcium and phosphorus. If I can get enough blood, I also like to check electrolytes. Q. What clinical chemistries do you recommend for the small mammal patient? Dr. Campbell: I recommend the

same profile as for canine and feline patients. If only a small sample size is obtained, the more valuable tests include glucose, calcium, phosphorus, total protein, blood urea nitrogen, and AST or alinine aminotransferase (ALT). Dr. Tynes: Sometimes the size of the patient limits blood testing and the amount of blood that can be safely removed. If I can get a CBC, that is fine. If more blood is available, I will ask for ALT, BUN, glucose, and total protein tests. Q. What abnormalities do you expect in the bird or reptile with renal disease? Dr. Campbell: Birds with severe renal disease may have increased uric acid, phosphorus, and potassium; less severe renal disease may not be detected on the biochemical profile. At least three fourths of the renal mass must be destroyed before uric acid concentration increases. Hyperuricemia may also occur with gout, starvation, and postprandially after ingestion of a high-protein meal. Reptiles with renal disease would also be expected to have increased levels of phosphorus and potassium. Hyperuricemia in terrestrial reptiles and increased BUN concentration in aquatic reptiles may occur. Acidemia, hyponatremia, hyperkalemia, hyperphosphatemia, and hypocalcemia may also occur in birds and reptiles with severe renal disease. Dr. Tynes: There is no sensitive indicator of renal disease in birds and reptiles, but once the kidney damage is advanced, uric acid levels will be high. Hyperphosphatemia also occurs with renal disease in reptiles. Q. What abnormalities do you expect in the bird or reptile with liver disease?
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W H AT S Y O U R D I A G N O S I S ? ? ?
A 2-year-old male ferret (Mustela putorius furo) was evaluated during his annual visit; the owner said the animal had been feeling sick. The results of the physical examination were unremarkable, the microscopic fecal examination came up negative, and blood was drawn for a CBC and biochemical profile. The ferret was vaccinated and discharged. Results of the blood tests showed elevated -glutamyl transferase (75 IU/L) and alinine aminotransferase (354 IU/L) and slightly icteric serum; other test results were normal. Symptomatic treatment with oral amoxicillin (10 mg/kg PO q12hr for 1 week) resulted in an improvement in the ferrets attitude and appetite. After the positive response to amoxicillin, the owner declined a recheck of the blood. Eight months later, the ferret was again feeling sick and had lost 0.3 pounds. A recheck of the blood profile showed elevated alinine aminotransferase (381 IU/L), -glutamyl transferase (116 IU/L), serum alkaline phosphatase (117 IU/L), and decreased glucose (57 mg/dL; normal, 90130 mg/dL). Radiographs appeared normal. An exploratory laparotomy was recommended. Because of scheduling problems, the procedure was performed 2 months later. At that time, the ferret was pawing at his mouth and exhibiting weakness in his hindlimbs. Questions 1. What are possible explanations for the abnormal laboratory results? 2. What are common geriatric diseases in ferrets? 3. What are common signs and laboratory findings in ferrets with insulinoma? 4. If the owner declines exploratory and surgical treatment of insulinoma, what is the recommended medical treatment?
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Interpretation of the Reptilian Blood Profile


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hyperparathyroidism, and lack of adequate exposure to ultraviolet B light. Plasma calcium concentrations greater than 20 mg/dL occur with excessive dietary or parenteral calcium or vitamin D3. Most reptiles have phosphorus concentrations ranging from 1 to 5 mg/dL. Hypophosphatemia occurs with starvation and nutritional lack of phosphorus. Hyperphosphatemia

occurs with excess dietary phosphorus, hypervitaminosis D3, and renal disease. A false increase in phosphorus can occur with failure to quickly separate the plasma from the cells. In conclusion, the cellular and biochemical responses in reptilian blood are less predictable than those of endothermic mammals and birds whose cellular microenvironments are more stable than reptilian ones. Variables such as age, sex, sample handling, blood collection, environmental conditions, and analytical methods

must be considered when interpreting the blood profile of the reptilian patient.
References
1. Campbell TW: Clinical pathology, in Mader DR (ed): Reptile Medicine and Surgery. Philadelphia, WB Saunders, 1996, pp 248257. 2. Frye FL: Biomedical and Surgical Aspects of Captive Reptile Husbandry, ed 2. Malabar, Fla, Krieger Publishing, 1991. 3. Stein G: Hematologic and blood chemistry values in reptiles, in Mader DR (ed): Reptile Medicine and Surgery. Philadelphia, WB Saunders, 1996, pp 473483.

Clinical Chemistries
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Dr. Campbell: Increases in AST, cholesterol, and fasting bile acids may be seen in birds with severe hepatobiliary disease. Hyperbiliverdinuria (green urates) might also be seen. Tests performed on reptiles reveal similar findings, although there are fewer studies validating results in reptiles. Decreased glucose and protein concentrations may also occur with chronic hepatic disease in birds and reptiles.

Dr. Tynes: Elevated bile acids occur in birds with hepatic disease. In birds and reptiles, AST and LDH levels will usually elevate, yet the CPK level will usually be normal. Q. What are expected abnormalities in the bird with chlamydiosis? Dr. Campbell: Increased AST and fasting bile acid levels can occur when the liver is involved. Hyperproteinemia with hyperglobulinemia also is seen. Hyperbiliverdinuria or hyperbiliverdinemia may occur with

severe hepatic insult, which may indicate end-stage disease. A marked leukocytosis, heterophilia, and possible monocytosis may occur. The heterophils may appear toxic and reactive lymphocytes may be seen. Dr. Tynes: Abnormal lab results depend on the organ affected. Usually, increases in AST, LDH, bile acids, or uric acid will result. Diagnosis of chlamydiosis cannot be definitively made solely on the basis of clinical chemistries.

HOW I ...

Force-feed Ferrets
Shawn Messonnier, D.V.M. Hospitalized ferrets are occasionally anorectic. Feeding is necessary to prevent further catabolism of body tissue, which is responsible for an overall decline in the ferrets condition and a worsening prognosis. Force-feeding can be done orally with a syringe or, alternatively, with an esophagostomy tube for longer term nutritional support. Several products are available, depending on the diagnosis. Hills a/d is a popular brand of supplement for dogs and cats and can be used in ferrets. Meat-based baby foods are also applicable. Human enteral products such as Ensure or Isocal brand supplements are also popular; different flavors can be tried to see which is preferred by the ferret. I prefer to dilute the diets with Pedialyte or intravenous fluids (e.g., lactated Ringers solution, Normosol-R brand) rather than plain tap water to add extra electrolytes. The human enteral products are dense in quick calories; they should probably be diluted at least 1:1 when first fed to the ferret. On average, feeding at least 5 mL per feeding 34 times per day is a good guideline. When using feline supplements, you can use the guidelines established for cats and kittens. As its appetite improves, the ferret may take the supplement directly from a bowl. After discharge from the hospital, a pets owner can be taught to force-feed the ferret. Or, for those who prefer not to do so, outpatient therapy can be made available.

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VOLUME 3 ISSUE 5 MAY 1998

EXOTIC PET PRACTICE

F R O M T H E L I T E R AT U R E

Abdominal Tumors in Budgerigars


Budgerigars (Melopsittacus undulatus) have a high incidence of abdominal tumors, many of which are primary renal tumors. These may be adenomas, lymphomas, or adenocarcinomas. Common signs of these tumors include unilateral or bilateral lameness and abdominal distention. The lameness results from sciatic nerve compression by the tumor as the nerve passes over the kidney. Early diagnosis is difficult because signs are usually not seen until the bird is brought in with lameness from organ enlargement. Hematuria, but not usually polyuria, is seen. The cranial pole of the kidney is the most common location for the tumor. The ventriculus, which is displaced caudally by the tumor, may often be palpated during the physical examination. Radiology, laparoscopy, and ultrasonography can be used for definitive diagnosis. The tumor is usually not able to be resected by the time the diagnosis is reached. Symptomatic therapy including analgesics may offer temporary benefit.
Newsletter of the AAV Sept/Nov:22, 1997.

Editors Note: I frequently see budgerigars with lameness; the lameness is usually unilateral. Most owners think the bird has fractured a leg. Although this may be the cause of the lameness, in my experience renal or gonadal enlargement caused by a tumor is the most common cause. The ventriculus is usually palpable, and many birds have pasting of the feces or urates around the cloaca. Diarrhea may be present from compression of the colon. I rarely perform diagnostic testing such as radiology because I am fairly confident of the diagnosis. Although I offer radiology to my clients, most decline because of the expense. I have had short-term resolution of the lameness in some birds by using prednisolone (0.250.50 mg/kg PO q24hr); with this treatment the tumor seems to shrink or neural inflammation is temporarily resolved. The long-term prognosis is grave for recovery.

Chinchilla Dermatology
Skin disorders commonly seen in chinchillas (Chinchilla lanigera) include barbering, dermatophytosis, fur slip, poor haircoats, and bite wounds with abscesses. Dermatophytosis is usually caused by Trichophyton mentagrophytes but may be caused occasionally by Microsporum gypseum or Microsporum canis. Small scaly spots of alopecia are seen. Oral griseofulvin (25 mg/kg PO q24hr for 34 weeks) is the treatment; captan mixed with the dust bath (1 tsp/2 cups of dust) or lime sulfur dips can also be used concurrently. Abscesses caused by Streptococcus spp. and Staphylococcus spp. resulting from bite wounds are seen in chinchillas housed in groups. Surgical dbridement and administration of antibiotics based on culture and sensitivity test results are indicated. Barbering may result from cagemates or self-trauma; poor coats may be caused by improper environmental humidity, failure to provide a dust bath, or fatty acid or zinc deficiency. Fur slip can occur if the chinchilla is handled roughly and may occur during the veterinary examination.
Hoefer H: Chinchillas, in The Veterinary Clinics of North America: Small Animal Practice: Exotic Pet Medicine II. Philadelphia, WB Saunders, 1994, p 107.

Editors Note: A thorough physical examination, medical history, and diagnostic testing are important parts of the assessment of dermatologic disorders in all exotic pets. As in dogs and cats, skin scrapings, fungal cultures, and skin biopsies (when indicated) can reveal a cause. Skin abscesses from bite wounds should be treated early and aggressively using safe antibiotics. Providing the proper diet and environment will prevent many skin disorders.

Whats Your Diagnosis ???


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Answers 1. The decreased glucose level is suggestive of insulinoma. Hypoglycemia can also be seen with sepsis, starvation, and liver disease. Increased hepatic enzymes are associated with hepatic damage and cholestasis. In this case, they were caused by hepatic lipidosis. 2. Common geriatric diseases include insulinoma, lymphosarcoma, renal failure, and adrenal disease. Blood values associated with insulinoma include decreased blood glucose (less than 60 mg/dL) and normal or elevated insulin levels. The amended insulinglucose ratio, though contro-

versial, may assist in the laboratory diagnosis of insulinoma. 3. Common signs of insulinoma include seizures, collapse, weight loss, a normal or decreased appetite, weakness (especially of the rear limbs), and nausea (hypersalivation, pawing at the mouth, jaw chomping). 4. Medical treatment can be used in lieu of surgical therapy. Treatment begins with oral prednisolone or prednisone (0.52.0 mg/kg q12hr). When symptoms can no longer be controlled with corticosteroids, the dosage can be increased or oral diazoxide (510 mg/kg q12hr) can be added to the regimen. The prognosis for ferrets with insulinoma is guarded; therapy is

not usually considered curative but rather prolongs the life of the pet. Exploratory laparotomy revealed a single nodule in the right limb of the pancreas that was removed using the shelled out technique. Numerous small round yellow nodules were detected in the liver. These were presumed to be metastatic lesions from the pancreatic lesion. However, hepatic biopsy showed hepatic lipidosis. Because of the advanced nature of the disease, the ferret was discharged with oral prednisolone syrup (0.5 mg/kg q12hr). A follow-up visit 2 weeks later showed the ferret was doing well. Further follow-up was not possible. 37

EXOTIC PET PRACTICE

VOLUME 3 ISSUE 5 MAY 1998

Client Teaching Guide

Bird CARE SHEET


Te r r y C a m p b e l l , D . V. M . , P h . D . Aspergillosis in Birds Aspergillosis is a disease caused by fungi Aspergillus. These fungi are ubiquitous in nature; birds are exposed to them continuously. A healthy bird with a normal immune system is resistant to aspergillosis. The disease may develop in any birds that have a poor immunity; however, certain birdswaterfowl, mynah birds, captive penguins, African grey parrots, blue-fronted Amazon parrots, and several of the birds of preyare especially prone to developing aspergillosis. Conditions that cause a birds immune system to fail and predispose them to aspergillosis include chronic stress, poor husbandry, respiratory irritants, and overuse of certain medications. A bird can be chronically stressed when subjected to an improper environment, such as overcrowded conditions, inadequate temperature, abnormal photoperiods, and constant exposure to potential predators or aggressive cagemates. Malnutrition and poor hygiene will also predispose a bird to aspergillosis. Poor ventilation and exposure to toxic chemicals (cigarette smoke, disinfectant fumes, aerosol sprays) will damage the respiratory system, making the bird more susceptible to aspergillosis. Young and geriatric birds and birds that are sick from other diseases are also susceptible to the disease. Aspergillosis usually affects the respiratory tract of birds but can also occur in other parts of the body. Birds with aspergillosis typically exhibit chronic weight loss and difficulty breathing as indicated by open-mouthed breathing, tail bobbing when breathing, and labored breathing after mild exercise. Sometimes affected birds make unusual noises when breathing. Infections in the nasal cavity result in the development of a dry mass in the swollen nostril. Birds with systemic aspergillosis appear extremely ill and generally have a poor appetite. Other signs include regurgitation, abnormal droppings, neurological disorders, and a change in the voice. Whenever a bird becomes ill or demonstrates a significant weight loss (greater than 10% of its body weight), it should be examined by a veterinarian. Diagnosis of aspergillosis can be challenging, and often the veterinarian relies on a number of tests that include serology, cytology, endoscopy, radiographs, blood profile, fungal culture, and exploratory surgery. Treatment of aspergillosis can be difficult, and the success depends upon the location and extent of the infection. Obviously, the earlier the diagnosis can be made the better the chances of a positive response to treatment. Treatment may require surgery as well as antifungal medications. In general, bird owners know their birds behavior better than anyone else because they live with the pet and can detect subtle changes in its behavior. Any abnormal change in the birds behavior should be brought to your veterinarians attention.

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Copy and use in partnership with your clients.

VOLUME 3 ISSUE 5 MAY 1998

EXOTIC PET PRACTICE

CASE REPORT

Food Allergy in a Ferret


Michael A. Dutton, D.V.M., Dipl. A.B.V.P.Companion Animal Practice A 15-month-old, 0.5 kg male neutered ferret (Mustela putorius furo) was referred for intense facial pruritis and facial edema and excoriations. Two weeks previously, the referring veterinarian had placed him on amoxicillin suspension for a swollen lip. The animal was housed with numerous other ferrets, none of which exhibited similar symptoms. The ferrets diet was approximately 75% meat-based kitten chow (Excel Kitten Chow) and 25% ferret kibble (Totally Ferret, Performance Foods, Dayton, OH) with water given as desired. Physical examination revealed pitting edema of the face, serous nasal discharge, bilateral conjunctivitis in both eyes, and excoriations on the facial skin, most notably on the ears. Auscultation of the heart and lungs had normal results. Diagnostic testing included thoracic radiographs, skin scrapings (negative for mites), and a complete blood count (hemocrit = 24.8%; white blood cell count = 15,800/L; platelets = 768,000). The radiographs revealed normal lung and heart silhouette. Rule-outs for the facial symptoms included scabies, contact allergy, drug eruption, and other allergic diseases. The ferret was given an injection of dexamethasone (2 mg/kg SC) and diphenhydramine (20 mg/kg SC). A recheck in 2 weeks revealed significant reduction in symptoms with the excoriations healing. Minimal pruritis was present, and the edema had resolved. A routine examination 4 months later revealed total resolution of symptoms and no new recurrence. Eleven months after the initial visit, the patient was brought in for numerous excoriations on the ventral and dorsal neck. The left pinna was edematous. A skin scraping was negative for scabies. The patient was given both a injection of prednisolone (2 mg/kg) and ivermectin (200 g/kg). A recheck visit was scheduled for 2 weeks. At the recheck visit, the history revealed improvement during the first week after the injections, but worsening since. The physical examination revealed minimal improvement. At the owners request the prednisolone and ivermectin injections were repeated and any diagnostic testing postponed. Another recheck visit was scheduled. Two weeks later, the symptoms had not changed. The patient was admitted for a dermal punch biopsy. A complete blood count had normal results. The ferret was premedicated with acepromazine (20 mg/kg SC) and anesthetized with isoflurane by mask. A 6-mm bakers dermal punch was used for the biopsy and the sample fixed in formaldehyde solution (Formalin). Numerous skin scrapings proved negative for scabies. The biopsy revealed moderate epidermal hyperplasia with mild orthokeratotic and focal parakeratotic hyperkeratosis. Moderate mixed superficial dermal and periadnexal inflammatory cells infiltrated with a predominance of mononuclear cells were also present. No evidence of infectious, parasitic, or endocrine disease was noticed. Allergic disease could not be ruled out. A presumptive diagnosis of a food allergy was made based on histopathology and poor response to previous therapies. The patient was started on a meat-based high-protein diet with main ingredients of lamb and rice (Natures Life Kibble). The protein

level was 26%, the fat was 15%, and it was palatable to the ferret. The patient was started on prednisone elixir (fed orally) to control the pruritis pending the outcome of the elimination diet trial. The swelling regressed in 7 weeks, and the ferret was weaned off of the prednisone elixir. The ferret was reintroduced to the original meat-based kitten chow, and the facial edema recurred within 5 days. Prednisone was started again and the diet switched back to the lamb/rice product. The edema resolved in 2 weeks. One month later the ferret was fed a commercially available chicken baby food. The facial edema recurred within 1 week. The edema resolved when the ferret was again placed on the lamb/rice product. Discussion A definitive diagnosis of adverse food reaction is made if the animals former diet and other ingested substances subsequently offered as a challenge are associated with a return of clinical signs within a few minutes to a week.1 In this case, this criterion was satisfied and demonstrates that food allergy should be considered as a rule-out for facial pruritis in a ferret. The diagnostic approach to pruritis in a ferret is similar to that used with dogs and cats. And as in dogs and cats, the diagnosis of a food allergy needs to be substantiated by the use of an elimination diet. This can be particularly difficult in the case of a ferret because the protein requirements are higher than those commonly found in pet foods. Palatability is also a consideration, given the limited choices available for ferret foods.
Reference
1. Roudebush P: Diagnosis and management of adverse food reactions, in Bonagura JD (ed): Kirks Current Veterinary Therapy XII Small Animal Practice. Philadelphia, WB Saunders, 1995, p 62.

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Q & A

Answer by Shawn Messonnier, D.V.M.

What are common dental problems in rabbits and rodents? The most commonly seen problem is malocclusion, leading to overgrown molars, incisors, and premolars. Far less commonly, we will see apical abscesses and dental tartar. On occasion, we will see fractured or chipped teeth, often present with overgrown teeth. Rodents, especially guinea pigs, are especially susceptible to malocclusion problems. These animals also often experience more apical abscesses than do rabbits.1
Reference
1. Brown SA: Rabbit Dentistry. Proceedings of the Small MammalReptile Medicine and Surgery for the Practitioner. Middleton, Wis, 1990.

MEETINGS
Association of Avian Veterinarians Annual Conference and Expo, St. Paul, MN; August 2529. (303) 7568380. Central Veterinary Conference, Bartle Hall Convention Center, Kansas City, MO; August 2931. (800) 2556864. Dr. Shawn Messonnier will be speaking.

UPCOMING

Readers: We welcome your questions, practice tips, and case reports. Please submit any materials to Tania Banak, Mosby, Inc., 11830 Westline Industrial Drive, St. Louis, MO 63146; tania.banak@mosby.com; (800)325-4177; fax (314)453-4191.

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