Diseases and other miscellaneous conditions

1. Diseases and other miscellaneous conditions Medical Environmental Research Learning INstitute

2. Emaciation • Not a disease itself, but the result of other conditions such as fractures, chronic disease, etc. • Accompanied by immuno-compromise • Usually seen in Dec-Feb • First year birds experiencing their first winter • Mid-winter anemia (Redig) Medical Environmental Research Learning INstitute

3. How bad can it get? • Keel score of 1 out of 5 • RTHA 650-750 g (Normal > 1100) • GHOW 900-1000 g (Normal > 1300) • Total solids < 1 (we’ve seen 0.2) • PCV < 20 (we’ve seen < 10) • Extreme lethargy, hypothermia Medical Environmental Research Learning INstitute

4. Keel scores Medical Environmental Research Learning INstitute

5. Treatment • Rehydration is critical • LRS IO\SQ\PO route • 2 x maintenance • Can use D5W IO • Add B vitamins to fluids • Supplmental heat Medical Environmental Research Learning INstitute

6. Fluid Therapy • Daily maintenance = 50 ml\kg\day • Can provide in multiple routes • IO catheter • Distal ulna • Can maintain for 3 days max • Max bolus = 25 ml\kg Medical Environmental Research Learning INstitute

7. Fluid Therapy • Daily maintenance = 50 ml\kg\day • Can generally assume either 5 or 10% dehydration • Replace deficits in 48 hours • Can provide in multiple routes • IO catheter • Distal ulna • Can maintain for 3 days max • Max bolus = 25 ml\kg Medical Environmental Research Learning INstitute

8. Fluid Therapy • Example • 900 g bird, 10% dehydrated • Deficit = 900 X 10% = 90 • Maintenance = 45 ml\day • Bird needs 90 + 90 = 180 over next 48 hours Medical Environmental Research Learning INstitute

9. Treatment • Iron Dextrans 0.1 ml\kg IM q10d x 2 • Fenbendazole 50 mg\kg SID x 5 d • Broad-spectrum antibiotics? • Itraconazole 10 mg\kg BID for juvenile RTHAs Medical Environmental Research Learning INstitute

10. Feeding • Furless whole mice • Begin after 18-24 hours • Start slow 10-30 g\kg TID • Ramp up over next three days • Continue aggressive hydration • Monitor PCV\TP • Formulas • Useful if regurgitating whole food • Oxbow Carnivore diet Medical Environmental Research Learning INstitute

11. Prognosis • Generally good if there isn’t a serious underlying cause. • Recovery is quick Medical Environmental Research Learning INstitute

12. Bumblefoot • Refers to injuries or lesions on the pads of feet and toes. • Usually husbandry related • Improper perch size or covering • No perch variability • Poor ground substrate • Can also be secondary to leg fractures or any other cause of lameness. Medical Environmental Research Learning INstitute

13. Bumblefoot • Clinical signs • Redness, smoothening, loss of scale • Swelling and visible inflammation • Necrosis and open wounds • Osteomyelitis, sepsis Medical Environmental Research Learning INstitute

14. Bumblefoot • Grades • Flatten, smooth epithelium. May be a little pink • Infection of SQ tissue but no gross swelling • Infected, hot, swollen foot without involvement of tendons or bone • Involvement of tendon and\or bone • End stage with loss of function. Medical Environmental Research Learning INstitute

15. Bumblefoot Medical Environmental Research Learning INstitute

16. Bumblefoot • Treatment • Pressure relieving bandages such as ball wraps or corn pads • Topical meds • Preparation H, Silvidine • CEH Cream – Calendula, Echinacea, Hypericum Medical Environmental Research Learning INstitute

17. Bumblefoot • Treatment (continued) • Aggressive surgical debridement • Systemic antibiotics (Clavamox + Baytril) • Chlorhexidine soaks Medical Environmental Research Learning INstitute

18. Wrist wounds • Husbandry related due to improper enclosures • Leads to exposure of carpal joint\bones. Medical Environmental Research Learning INstitute

19. Wrist wounds Medical Environmental Research Learning INstitute

20. Wrist wounds • Treatment • Daily flushes • Staged surgical debridements\parial closure • Protect with telfa and tegaderm • Prognosis is surprisingly good Medical Environmental Research Learning INstitute

21. Barbed-wire injuries • Usually Great-Horned Owls • Can cause massive soft tissue trauma and patagial tendon transection. Medical Environmental Research Learning INstitute

22. Barbed-wire injuries • Treatment must be aimed at protecting the tendon from exposure and desiccation. • Silvidine cream is helpful Medical Environmental Research Learning INstitute

23. Barbed-wire injuries Medical Environmental Research Learning INstitute

24. Barbed-wire injuries Medical Environmental Research Learning INstitute

25. Barbed-wire injuries Medical Environmental Research Learning INstitute

26. Tendon anastomosis • Patagial transection was once thought to be hopeless. A recent case (GHOW 13112) has proven otherwise. • Freshened edges • Anastomosis with 6-0 Vicryl • No PT for 2 weeks then very gradual increase in extension exercises under anesthesia for 6-8 weeks. Medical Environmental Research Learning INstitute

27. Aspergillosis • Very important disease in raptors, especially juvenile RTHA’s • Fungus:Aspergillusfumigatus Ubiquitous Saprophytic Opportunistic Infectious Not contagious Not zoonotic, but… Medical Environmental Research Learning INstitute

28. Aspergillosis – acute form • Inhalation of a large mass of spores • Tracheal granuloma • Causes voice change, dyspnea and death Medical Environmental Research Learning INstitute

29. Aspergillosis – chronic form • Due to immuno-suppression or secondary to weakened state • Emaciation, anorexia, depression, anemic • “Ain’t doin’ right” • Granulomas\fungus in air sacs and lungs • Respiratory signs not seen until late in disease Medical Environmental Research Learning INstitute

30. Aspergillosis - diagnosis • CBC • Total count can be 30,000+ • Monocytosis • Cytology – cotton blue stain • Tracheal culture • Serology • Histopathology • Endoscopy Medical Environmental Research Learning INstitute

31. Aspergillosis - diagnosis Medical Environmental Research Learning INstitute

32. Aspergillosis – risk factors • Damp organic bedding • Poor ventilation • Immuno-suppresion • Stress • Poor nutrition (Vit A deficiency) • Extended antibiotic use • Other illness like lead poisoning • Species: Juvenile RTHA, GOSH, GYRF, RLHA, GOEA Medical Environmental Research Learning INstitute

33. Aspergillosis – treatment • Difficult, expensive and long-term • Acute cases • Place air-sac tube • Can attempt to remove granulomaendoscopically or blindly with suction. • IntratrachealAmphotericin B (1 mg\kg TID) Clinical signs due to tracheal obstruction Medical Environmental Research Learning INstitute

34. Aspergillosis – treatment • Chronic cases • Lower stress • Supportive – fluids, nutrition • Reglan\tube feeding if necessary • Amphotericin B 1.5 mg\kg IV\IO TID x 3 days. Dilute in D5W (maximum allowable bolus) • Nebulize saline or F10 (1:250 dilution in NaCl) 20 minutes BID x 7 days • Itraconazole (Sporonox) 10 mg\kg BID x 3 months. Monitor for liver problems (AST,CK) • Compounded products are much cheaper but don’t work (studies done at NC State) • Broad spectrum antibiotics • Monitor CBC’s, weight Medical Environmental Research Learning INstitute

35. Aspergillosis - Prevention • Prophylactic itraconazole 10 mg\kg PO BID x 21 days (Especially in highly-susceptible species) • Start 1 week before a stressful change • Don’t use organic bedding • Provide good ventilation • Keep birds in good health • Keep stress to a minimum Medical Environmental Research Learning INstitute

36. West Nile Virus • 1999 - first seen in western hemisphere • Now in most states • Affects many bird species, humans, horses • Mosquito vector, bird is a carrier. • Clinical signs develop 10-12 days post infection. • Can see all types of neurologic disease • Retinal pathology • Diagnosis • Can shed virus in both oral and cloacal cavities. Oral and chloacal swabs can be used for both ante- and postmortem diagnosis. • It is not uncommon to see no gross changes at necropsy Medical Environmental Research Learning INstitute

37. West Nile Virus • Treatment is purely supportive • Prognosis is poor • Prevention • Vaccine - Fort Dodge for horses • Control mosquito exposure Medical Environmental Research Learning INstitute

38. Trichomoniasis • Carried by pigeons – called “canker”. Raptors are infected when eating pigeons. Don’t feed pigeons. • Called “frounce” in falcons • Clinical signs • Affects the upper digestive and respiratory tracts • Caseous lesions in oral cavity (under tongue, near choanal opening) and sinuses. • Diagnosis – PE + cytology Medical Environmental Research Learning INstitute

39. Trichomoniasis • Diagnosis – PE + cytology [Cytology Picture of kestel?] • DDx include capillaria or candida. • Treatment – Carnidazole (Spartrix) 100-200 mg\kg PO once. May need to repeat in falcons. • Surgical debridement Medical Environmental Research Learning INstitute

40. Trichomoniasis • Diagnosis – PE + cytology [Cytology Picture of kestel?] • Treatment – Carnidazole (Spartrix) 100-200 mg\kg PO once. May need to repeat in falcons. Medical Environmental Research Learning INstitute

41. Candidiasis • Caused by Candida albicans • Associated with malnutrition (Vit A deficiency) and long-term antibiotic use • Will see white necrotic lesions in mouth, pharynx and crop and it causes with dysphagia and regurgitation. • Diagnosis based on clinical signs, endoscopy of crop (may see “Turkish towel” appearance) and cytology (Gram +, oval, budding yeast) Medical Environmental Research Learning INstitute

42. Candidiasis • Treatment – Nystatin 300,000 IU\kg PO BID x 10 days. Needs contact time so oral lesions may require systemic antifungal treatment Medical Environmental Research Learning INstitute

43. Lead Poisoning • Sources: Gunshot, ingestion of contaminated prey • Note that gunshot embedded in the musculature will not lead to system lead levels. • Eagles\Ospreys more likely affected Medical Environmental Research Learning INstitute

44. Lead Poisoning • Clinical signs • Can be acute or chronic • Generalized weakness, anorexia, emaciation • Regurgitation • Ataxia, tremors, seizures, paresis, paralysis, blindness • Hematuria, hemoglobinuria Medical Environmental Research Learning INstitute

45. Lead Poisoning • Diagnosis • Blood lead level > 20 ug\dl • Radiographs • Treatment • Supportive • Stomach gavage, endoscopic removal • Surgical removal • CaEDTA 35 mg\kg SQ\IM BID, 4 days on, 3 days off for 4 weeks Medical Environmental Research Learning INstitute

46. Other Poisonings • OP toxicity • SLUD not seen in birds • Pupils not affected in birds • Depression, seizures • Treatment is supportive, atropine, valium to control seizures Medical Environmental Research Learning INstitute

47. Other Poisonings • Rodenticide toxicity • Pulmonary hemorrhage and dyspnea are not commonly seen in birds. • Bleeding from superficial wounds is more common • Treatment: Vit K1 2.5 mg\kg SQ\IM BID for 3-4 days, then PO SID for 4 weeks. Medical Environmental Research Learning INstitute

48. Mycobacterium (Avian TB) • Mycobacterium Avium Complex (MAC) • Generalized, chronic, granulomatous disease • Infection usually by fecal-oral route • Clinical signs • Chronic emaciation • Dyspnea • SQ granulomas\tubercles • Diarrhea – tubercles in intestine is a common presentation • Arthritis or tubercle formation in leg muscles? Medical Environmental Research Learning INstitute

49. Mycobacterium (Avian TB) • Diagnosis • Leukocytosis with monocytosis • Histology or cytology – Acid fast organisms • Acid fast stain of feces (5 days) • Look for non-staining “ghosts” with Dif-Quick • Culture is very difficult • Treatment • Not recommended due to zoonotic potential • Note that the risk to an immunocompetent person is low Medical Environmental Research Learning INstitute

50. Avian Pox • Important disease in raptors • Worldwide distribution • Survive in dried scabs and in environment for years • Three forms – dry, wet and septic Medical Environmental Research Learning INstitute