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4 April 1999
Refereed Peer Review
Infectious and Parasitic Diseases of Raptors*
FOCAL POINT #Veterinarians working with
free-ranging raptors should be familiar with the two most common consequences of longterm hospitalization—bumblefoot and aspergillosis—and strive to prevent these conditions by providing proper nutrition, housing, and hygiene. Wildlife Conservation Society/Bronx Zoo, Bronx, New York
Sharon Lynn Deem, DVM, PhD
ABSTRACT: Free-ranging raptors may be admitted to a veterinary hospital with an infectious (e.g., aspergillosis, poxvirus) or parasitic (e.g., trichomoniasis) disease but more commonly acquire such debilitating conditions during long-term hospitalization. Clinicians should be familiar with the clinical signs, diagnostic protocols, and therapeutic approaches of these potentially fatal diseases.
I Bumblefoot is best prevented by providing appropriate perches, talon trimming, and regular examination of the plantar surfaces of the feet to detect early clinical signs, I All raptors are susceptible to aspergillosis infection, but the most susceptible species are immature red-tailed hawks, bald and golden eagles, goshawks, gyrfalcons, rough-legged hawks, and snowy owls, I The cutaneous form of poxvirus infection has been reported in both Falconiformes (diurnal raptors) and Strigiformes (owls) species, I The top five differentials for any raptor with caseous lesions in the oral cavity are candidiasis, trichomoniasis, capillariasis, bacterial abscesses, and hypovitaminosis A,
nfectious diseases of raptors are caused by bacterial, fungal, viral, and parasitic agents (see Infectious and Parasitic Agents of Free-Ranging Raptors).1–5 The most common infectious and parasitic diseases are covered in detail in this article and include bumblefoot associated with Staphylococcus aureus; aspergillosis; candidiasis; poxvirus and herpesvirus; trichomoniasis and capillariasis; and hemoparasites of the genera Plasmodium, Haemoproteus, and Leucocytozoon.
BACTERIAL INFECTION: BUMBLEFOOT A common consequence of hospitalization and confinement of raptors is pododermatitis, commonly known as bumblefoot. Bumblefoot is defined as any inflammatory condition of the foot, ranging from mild erythema to severe abscessation and osteomyelitis (Figure 1). Trauma predisposes to the development of bumblefoot; self-inflicted talon punctures, bites from prey, and improperly shaped perches are common causes. Obesity or inactivity, unsanitary cages, immunosuppression, and vitamin A deficiencies are additional causes.11,12 Bumblefoot has been presented in the literature as a noninfectious disease12; however, S. aureus is often the cause of debilitating bumblefoot with associated cellulitis and osteomyelitis.11,13,14 Falcon species tend to be more susceptible to bumblefoot than are hawks,11,15 and both of these groups are more frequently affected than are owls. The principal clinical signs are swelling and inflammation of the plantar surface of the foot that can progress to debilitating lameness associated with cellulitis, tendinitis, and osteomyelitis. Diagnosis is usually straightforward and based on physical examination, radiographic evaluation, and bacterial culture and sensitivity of lesions. Staging for prognostic assessment is usually based on the classification scheme proposed by Halliwell that consists of four categories (see Bumblefoot Classification Scheme).11 Staging is important both for prognostic assessment and development of a therapeutic plan.
*For additional information on raptor medicine, see “Raptor Medicine: Basic Principles and Noninfectious Conditions” in the March 1999 (Vol. 21, No. 3) issue of Compendium. a Information on other important bacterial infections of raptors, including Mycobacterium avium, Chlamydia psittaci, and Salmonella species, can be found in the literature.2,6–10
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Treatment of bumblefoot Nonsurgical treatments includes both nonsurgical and include vitamin A supplesurgical approaches. 12,14–16 mentation, parenteral antiTherapeutic objectives are rebiotics, and wound manageduced inflammation and ment. Parenteral antibiotics swelling, establishment of are best chosen based on culdrainage (if needed), elimiture and sensitivity results nation of bacteria, and manfrom collected exudate. Caragement of the wound to benicillin, piperacillin, and promote healing. Wound enrofloxacin have all been management is often the effective in the treatment of most challenging aspect of bumblefoot. Ball bandaging treatment and is usually acwith a dimethyl sulfoxide complished by the initial ap“cocktail” (8 ml dimethyl plication of ball bandages Figure 1—Bumblefoot (pododermatitis) in a crested caracara sulfoxide, 2 ml dexametha(Figure 2). These bandages (Polyborus plancus). Note inflammation and ulceration of the sone [2 mg/ml], and 2 ml consist of gauze sponges placed tarsometatarsal pad. piperacillin or carbenicillin on the plantar surface of the [500 mg/ml]) is often effecfoot that are incorporated tive for treating mild cases into a bandage by wrapping the digits (using cast of bumblefoot.18 Other common topical medications include udder cream to soften the feet and hemorrhoid padding and an elastic nonadhesive dressing) in a circumedication to promote epithelialization. lar–longitudinal fashion in a “ball” around the sponges. Surgical debridement, including removal of devitalIt is important to incorporate the distal tarsometatarsus ized tissue and/or amputation of bone(s) with chronic into the bandage to support the phalangeal and tarosteomyelitis, may be necessary in severe cases of bumsometatarsal joints and to use many gauze sponges to blefoot. Most raptors can function with amputation of a provide adequate cushioning of the plantar surface. The single digit as long as the hallux (first digit) is intact and contact bandage layer can be either adherent or nonadthere is no involvement of the tarsometatarsal bone. herent based on general wound-management princiBumblefoot is much easier to prevent than to treat. ples.17 Padded perches (e.g., sheepskin covered) and/or a padded floor (e.g., linen-covered foam padding or sand) Preventive foot care for captive raptors should include are also used during the healing phase. appropriate perch sizes, shapes, and material (e.g., sisal
Infectious and Parasitic Agents of Free-Ranging Raptors
Infectious Agents Bacterial
Staphylococcus aureus Escherichia coli Mycobacterium avium Chlamydia psittaci Listeria monocytogenes Salmonella species Pasteurella multocida Erysipelothrix rhusiopathiae Bacillus anthracis Francisella tularensis Proteus species Pseudomonas species
Aspergillus fumigatus Candida albicans
Parasitic Agents External Parasites
Myiasis (Calliphora and Protocalliphora species) Hippoboscid flies (Pseudolynchia species) Lice (Mallophaga) Mites Ticks
Trichomonas gallinae Capillaria species Serratospiculum amaculata Thelazia species Syngamus species Cestodes Trematodes Acanthocephala Coccidia (Caryospora and Eimeria species) Toxoplasma gondii
Avian poxvirus Herpesvirus Adenovirus Rabies Newcastle disease Marek’s disease
Plasmodium species Haemoproteus species Leucocytozoon species Trypanosoma species Babesia species
TREATING BUMBLEFOOT I BALL BANDAGES I ANTIBIOTICS
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tory (e.g., if the bird was recently hospitalized or is a highly susceptible species), Type I (most severe): Enlargement of the entire physical examination, radiogmetatarsal pad; associated with infection and cellulitis raphy, endoscopy, complete blood count, chemistry proType II: Localized encapsulated lesion; associated file, fungal culture, and with an enlarged metatarsal pad serology (ELISA). 21 Redig Type III: Enlargement of one discrete area of the foot; FUNGAL INFECTIONS states that radiographic leusually caused by a foreign body, corn, or localized Aspergillosis sions are often associated The most common fungal improper epithelial molt with a grave prognosis, and infection in free-ranging and Type IV (least severe): Enlargement of one or more the lack of radiographic captive raptors is aspergillosis. distal extremities of the phalanx; results from rupture lesions does not rule out asThe causative agent of asperpergillosis infection.21 Leuof the flexor tendons at the ends of digit II, III, or IV kocyte count is often siggillosis in raptors is most ofnificantly increased, with ten Aspergillus fumigatus, with occasional disease associated heterophilia present in the with Aspergillus flavus and early stages and monocytoAspergillus niger.20,21 All rapsis and toxic heterophils in tors can succumb to aspermore advanced cases.22 Therapy is usually protractgillosis infection, but the most ed and based on different ansusceptible species are immatifungal agents, including ture red-tailed hawks (Buteo jamaicensis), bald eagles (Halamphotericin B, 5-fluorocyiaeetus leucocephalus), golden tosine, fluconazole, and itraeagles (Aquila chrysaetos), conazole. 21,23 Itraconazole goshawks (Accipiter gentilis), with or without amphogyrfalcons (Falco rusticolus), tericin B should be used for and rough-legged hawks (Buinitial treatment of aspergilloteo lagopus).21 sis unless infection of the Aspergillosis can be classibrain is suspected; in these fied as acute or chronic and Figure 2—A ball bandage on the foot of a crested caracara for cases, fluconazole should be disseminated or localized, the treatment of bumblefoot. the drug of choice. 23 Oral itraconazole (5 mg/kg twice depending on the number of daily) has been safe and effecspores to which the raptor is tive in treating raptors with exposed, the bird’s immune aspergillosis. 24 Supportive status at the time of expocare is also an important sure, and establishment of component of therapy, inlocal aspergillomas (Figure cluding force-feeding, fluids, 3) or systemic spread of the warmth, and antibiotics. organism. The most comRemoving aspergillomas monly affected system is the from the trachea may be necrespiratory tract; birds preessary and can be accomsent with respiratory distress plished either using an endoand vocal changes. Other scopic approach (in larger common clinical signs assobirds) or via a tracheal tranciated with acute disease are anorexia, polydipsia, and Figure 3—Aspergillomas in the thoracic cavity of a snowy owl section. 25 A less invasive polyuria. Insidious, progres- (Nyctea scandiaca). (Courtesy of Dr. Scott P. Terrell, College procedure using a tracheal vacuum technique has been sive respiratory distress with of Veterinary Medicine, University of Florida) described.25,26 Abdominal airassociated emaciation is ofsac cannulation is most often advised during these proceten the presenting sign in chronic disease. dures and in cases of tracheal obstruction.27 Diagnosis of aspergillosis is accomplished using his-
rope, foam-rubber padded, or sheepskin covered)19; trimming of excessively long talons; and regular examination of the plantar surfaces of the feet to detect early clinical signs.
Bumblefoot Classification Scheme11
RADIOGRAPHIC LESIONS I LEUKOCYTE COUNT I ANTIFUNGAL AGENTS
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Like bumblefoot, preventdiagnosed in a number of ing aspergillosis in captive raptor species.1,30 raptors is much easier than Adenovirus treating it. In highly suscepThe recent fatal adenotible and/or stressed raptors, virus outbreaks in the highthe prophylactic use of antily endangered Mauritius fungals may be indicated kestrel (Falco punctatus) 31 and can include oral itra28 and aplomado falcon (Falco conazole (I use 5 mg/kg once daily) or oral 5-fluorofemoralis septentrionalis) 32 highlight the importance of cytosine (50 to 60 mg/kg this virus as a cause of high twice daily).21 Good hygiene and supportive care of hosmortality among raptors. pitalized patients is of primary importance to ensure Figure 4—Multiple raised pox lesions on the eyelid and cere Poxvirus The cutaneous (i.e., dry) immunocompetence against of a barred owl (Strix varia). form of poxvirus infection this ubiquitous organism. has been reported in both Candidiasis Falconiformes and StrigiCandidiasis (thrush), which is caused by the yeast formes.1,33 Avipoxvirus species are large DNA viruses Candida albicans, is the second most important fungal that induce intracytoplasmic, lipophilic inclusion bodinfection of free-ranging raptors.3 Candidiasis usually ies (Bollinger bodies). Epithelial cells of the oral cavity manifests as pseudomembranous patches of necrotic and integumentary and respiratory tracts are most tissue in the oral cavity, pharynx, and crop. A less comcommonly infected. Poxvirus infection presents clinimon manifestation is infection of the lower gastroincally as discrete nodular proliferations of unfeathered testinal (GI) tract with no visible lesions on physical skin around the eyes, beak and nares, and legs and feet examination. Clinical signs of candidiasis include dys(Figure 4). No cases of diphtheritic (i.e., wet) pox lephagia, regurgitation, vomiting, and depression. In cassions have been reported in raptors.1 Transmission of poxviruses requires viral contaminaes of lower GI tract infection, raptors often display tion of broken skin and is often associated with mosnonspecific signs of emaciation and anorexia. quitoes and other blood-sucking arthropods.37 Thus, Diagnosis can be confirmed by taking a swab, scrap3 poxvirus lesions have been more commonly diagnosed ing, or culture of the lesions. C. albicans is a thinwalled, oval yeast that measures 3 to 4 µm in diameter in raptors housed outdoors. and is typically deeply basophilic with Wright’s stain A tentative diagnosis of poxvirus infection can be and gram positive with Gram’s stain.29 based on clinical signs. Diagnosis can be confirmed via Uncomplicated candidiasis can be treated with oral histopathologic and electron microscopic identification nystatin (100,000 IU/kg three times daily) until lesions of the pathognomonic Bollinger bodies. Poxvirus infecare gone. Note that candidiasis is often secondary to an tion is usually self-limiting in raptors. Treatment of secunderlying immunocompromising condition. ondary bacterial infections may be warranted as well as surgical removal of lesions if they compromise the VIRAL INFECTIONS bird’s ability to properly perch, feed, or see. A number of viral infections have been diagnosed in Herpesvirus free-ranging and captive raptors.1,30–34 The detection of Herpesvirus infections in raptors include inclusionantibodies to rabies virus in an experimentally infected body hepatitis in falcons, owl hepatosplenitis, and eagle great horned owl (Bubo virginianus)35 suggests that raptors may be asymptomatic carriers of the rabies virus as herpesvirus.38 The herpesviruses in falcons and owls are serologically indistinguishable.1,38 Clinical signs are ofa result of their feeding habits and contact with such ten nonspecific (e.g., severe depression, weakness, prey animals as raccoons and skunks. However, human anorexia) and can present as peracute death (mortality rabies associated with raptors has not been documentmay approach 100%). The diagnosis of herpesvirus ined. A serologic survey of 53 newly captured birds of fection in raptors is based on clinical signs; viral isolaprey found no significant antibody titer.36 Newcastle disease, a virulent paramyxovirus commonly associated tion; and histologic lesions, including intranuclear inwith fatalities in poultry and wild fowl, has also been clusion bodies and widespread focal to diffuse necrosis
THRUSH I RABIES I BOLLINGER BODIES
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cluding protozoa, nematodes, trematodes, cestodes, and acanthocephalans.5,40 The GI and respiratory tracts are most commonly affected. Parasitic infections of the GI tract include trichomoniasis (frounce) and capillariasis. Trichomoniasis of raptors is caused by Trichomonas gallinae and is often acquired when raptors feed on infected prey (e.g., doves, PARASITIC INFECTIONS pigeons).40 The characteristic signs are raised, yellowEctoparasites Raptors harbor a variety ish, caseous plaques on the of ectoparasites. The majoritongue and oropharyngeal ty of ectoparasites cause no surfaces (Figure 5). The bird clinical signs unless a bird is may have difficulty swallowimmunocompromised. Only ing and, in severe infection, biting lice from the order Malmay be emaciated because lophaga are found on rapof its inability to eat. Diagtors. These lice spend their nosis can be confirmed by entire lives on the bird and taking a swab or scraping of can survive only for short lesions. Trichomonids are periods off the host. Most identified on a wet mount raptors normally harbor as a motile, piriform protosmall numbers of lice. If an Figure 5—Raised, yellowish, caseous plaques from Tricho- zoan with an anterior flagelinfestation becomes exces- monas gallinae infection in the mouth of a barred owl. (Cour- la, undulating membrane, sive, however, the bird may tesy of Dr. Darryl J. Heard, College of Veterinary Medicine, and prominent axostyle or become highly irritated and University of Florida) as stationary flagellates cause self-inflicted trauma. stained with Wright’s stain A topical ectoparasite powor Diff Quick® (American Scientific Products, McGraw Park, IL).29 Trichomoniader and/or ivermectin (200 µg/kg subcutaneously or sis can be treated with oral metronidazole (30 to 50 orally, repeated in 10 to 14 days) can be used on debilimg/kg twice daily for 5 to 7 days). tated raptors to minimize secondary effects associated Capillariasis is a differential for trichomoniasis but is with lice infestation. often more extensive, with lesions in the mouth, Hippoboscid flies (Pseudolynchia species) are common on raptors; these flies are generally nonpathogenic oropharynx, esophagus, crop, small intestine, and cebut may be involved in the transmission of bloodcum.5 Diagnosis is made by detecting the double-oper39 culated eggs in the feces or in a swab or scraping of the borne protozoan parasites (e.g., Haemoproteus species). Clinical myiasis is associated with such species of flies as oral lesions.29 Treatment of capillariasis in raptors is 40 with oral fenbendazole (30 to 50 mg/kg once daily for Calliphora and Protocalliphora. Myiasis is usually a 5 days). A recent report of suspected fenbendazole toxiproblem in eyasses (nestling raptors) but has occasioncity with bone-marrow suppression in several species of ally been diagnosed in adults with debilitating injuries. birds should alert practitioners to monitor raptors reA number of fleas, mites, and ticks are also found on ceiving this drug.42 raptors and generally have no negative effect on the The top five differentials for raptors with caseous lehealth status of the bird. One noted exception is a clinisions in the oral cavity are candidiasis, trichomoniasis, cal case of scaly-leg mite (Knemidokoptes mutans) in a capillariasis, bacterial abscesses, and hypovitaminosis A. great horned owl.41 It is imperative that the proper diagnosis is established Internal Parasites because each of these conditions requires a different Raptors are host to numerous internal parasites, intherapeutic approach. of the liver and throughout the hematopoietic tissue. There is no therapy for the herpesviruses of raptors, and it remains a problem in freeranging and captive populations. Marek’s disease, the lymphoproliferative condition caused by a herpesvirus that is most prevalent in chickens, has also been reported in raptors.1,34
MALLOPHAGA I MYIASIS I TRICHOMONIASIS
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Blood Parasites Common blood parasites of raptors include species in the genera Plasmodium, Leucocytozoon, and Haemoproteus.39,43 Other less frequently diagnosed blood parasites (not discussed in this article) are species of Trypanosoma and Babesia. 39 Transmission of all raptor hemoparasites requires an insect vector. Plasmodium, Haemoproteus, and Leucocytozoon species are transmitted by mosquitoes, hippoboscid flies or Culicoides species, and simuliid flies, respectively. Much debate exists regarding the pathogenicity of hemoparasites in raptors. Most investigators agree that Plasmodium species are pathogenic. Clinical signs associated with Plasmodium infections in raptors range from asymptomatic to characteristic signs of weakness, respiratory distress, and biliverdinuria. Diagnosis is based on clinical signs and blood film evaluaPENDIU M tions (Figure 6).44 Plasmodium infections can be treated ANNIVERSARY with oral chloroquine (effective against erythrocytic forms) and primiquine (effective against tissue forms). Redig suggests a loading There have been many advances dose of 25 mg/kg of chloroin our knowledge base, quine combined with 1.3 diagnostic capabilities, and mg/kg of primiquine foltherapeutic approaches to the lowed by 15 mg/kg of chloroinfectious diseases of raptors quine plus 0.75 to 1.0 mg/ during the past 20 years. The kg of primiquine at 12, 24, most important of these advances and 48 hours.45 Treatment have been directed at aspergillosis of Plasmodium infections and bumblefoot. Preventive may resolve the clinical signs but rarely eliminates the inmeasures and early nonsurgical fection. and surgical therapies have Although Haemoproteus helped to decrease complications and Leucocytozoon species that are commonly associated are often considered nonwith bumblefoot. Advances in pathogenic in raptors, one diagnosis and the pharmacologic study showed that raptors agents available for the with hemoprotozoal infecprevention and treatment of tions had longer rehabiliaspergillosis have improved the tation times and higher mortality rates than did veterinarian’s ability to handle those without hemoprotothis pervasive and potentially zoal infections. 46 Heavily fatal disease. infected debilitated raptors may benefit from the elimination of these parasites. Treatment would presumably be the same as that stated for Plasmodium.
Figure 6—Intraerythrocytic Plasmodium species schizont (ar-
9 9 9 9 - 1 1 9 7
row) in a bald eagle. (From Greiner EC, Black DJ, Iverson WO: Plasmodium in a bald eagle [Haliaeetus leucocephalus]. in Florida. J Wildl Dis 17:555–558, 1981. Reprinted with permission.)
CONCLUSION Veterinarians in clinical practice should be familiar with the diseases of free-ranging and captive raptors. Some infectious diseases (e.g., bumblefoot, aspergillosis) often result from stressful conditions during hospitalization of raptors that originally presented with a different condition (e.g., trauma, toxicosis). Clinicians should know the clinical signs, diagnostic protocols, and therapeutic approaches of these diseases. REFERENCES
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PLASMODIUM I LEUCOCYTOZOON I HAEMOPROTEUS
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About the Author
Dr. Deem is affiliated with the Field Veterinary Program, Wildlife Health Sciences, Wildlife Conservation Society/Bronx Zoo, Bronx, New York. She is a Diplomate of the American College of Zoological Medicine.