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Vol. 21, No. 4 April 1999 20TH ANNIVERSARY CE Refereed Peer Review Infectious and Parasitic
Vol. 21, No. 4 April 1999
20TH ANNIVERSARY
CE
Refereed Peer Review
Infectious and Parasitic
Diseases of Raptors *
FOCAL POINT
Wildlife Conservation Society/Bronx Zoo, Bronx, New York
Sharon Lynn Deem, DVM, PhD
★Veterinarians working with
free-ranging raptors should
be familiar with the two most
common consequences of long-
term hospitalization—bumblefoot
and aspergillosis—and strive
to prevent these conditions
by providing proper nutrition,
housing, and hygiene.
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 fa-
miliar with the clinical signs, diagnostic protocols, and therapeutic approaches of these poten-
tially fatal diseases.
I nfectious diseases of raptors are caused by bacterial, fungal, viral, and para-
sitic agents (see Infectious and Parasitic Agents of Free-Ranging Raptors). 1–5
The most common infectious and parasitic diseases are covered in detail
KEY FACTS
in this article and include bumblefoot associated with Staphylococcus aureus;
aspergillosis; candidiasis; poxvirus and herpesvirus; trichomoniasis and capillar-
■ 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,
iasis; and hemoparasites of the genera Plasmodium, Haemoproteus, and Leuco-
cytozoon.
BACTERIAL INFECTION: BUMBLEFOOT a
A common consequence of hospitalization and confinement of raptors is podo-
dermatitis, commonly known as bumblefoot. Bumblefoot is defined as any inflam-
matory condition of the foot, ranging from mild erythema to severe abscessation
■ 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,
and osteomyelitis (Figure 1). Trauma predisposes to the development of bumble-
foot; 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 disease 12 ; 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 princi-
■ The cutaneous form of poxvirus
infection has been reported in
both Falconiformes (diurnal
raptors) and Strigiformes (owls)
species,
pal 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, radio-
graphic evaluation, and bacterial culture and sensitivity of lesions. Staging for
prognostic assessment is usually based on the classification scheme proposed by
■ The top five differentials for any
raptor with caseous lesions in
the oral cavity are candidiasis,
trichomoniasis, capillariasis,
bacterial abscesses, and
hypovitaminosis A,
Halliwell that consists of four categories (see Bumblefoot Classification
Scheme). 11 Staging is important both for prognostic assessment and develop-
ment 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 includes both nonsurgical and surgical approaches. 12,1416 Therapeutic objectives are re- duced inflammation and swelling, establishment of drainage (if needed), elimi- nation of bacteria, and man- agement of the wound to promote healing. Wound management is often the most challenging aspect of treatment and is usually ac- complished by the initial ap- plication of ball bandages (Figure 2). These bandages consist of gauze sponges placed

on the plantar surface of the foot that are incorporated into a bandage by wrapping the digits (using cast padding and an elastic nonadhesive dressing) in a circu- larlongitudinal fashion in a ballaround the sponges. It is important to incorporate the distal tarsometatarsus into the bandage to support the phalangeal and tar- sometatarsal joints and to use many gauze sponges to provide adequate cushioning of the plantar surface. The contact bandage layer can be either adherent or nonad- herent based on general wound-management princi- ples. 17 Padded perches (e.g., sheepskin covered) and/or a padded floor (e.g., linen-covered foam padding or sand) are also used during the healing phase.

padding or sand) are also used during the healing phase. Figure 1— Bumblefoot (pododermatitis) in a

Figure 1—Bumblefoot (pododermatitis) in a crested caracara (Polyborus plancus). Note inflammation and ulceration of the tarsometatarsal pad.

Nonsurgical treatments include vitamin A supple- mentation, parenteral anti- biotics, and wound manage- ment. Parenteral antibiotics are best chosen based on cul- ture and sensitivity results from collected exudate. Car- benicillin, piperacillin, and enrofloxacin have all been effective in the treatment of bumblefoot. Ball bandaging with a dimethyl sulfoxide cocktail(8 ml dimethyl sulfoxide, 2 ml dexametha- sone [2 mg/ml], and 2 ml piperacillin or carbenicillin

[500 mg/ml]) is often effec- tive for treating mild cases of bumblefoot. 18 Other common topical medications include udder cream to soften the feet and hemorrhoid medication to promote epithelialization. Surgical debridement, including removal of devital- ized tissue and/or amputation of bone(s) with chronic osteomyelitis, may be necessary in severe cases of bum- blefoot. Most raptors can function with amputation of a single digit as long as the hallux (first digit) is intact and there is no involvement of the tarsometatarsal bone. Bumblefoot is much easier to prevent than to treat. Preventive foot care for captive raptors should include appropriate perch sizes, shapes, and material (e.g., sisal

Infectious and Parasitic Agents of Free-Ranging Raptors

Infectious Agents

Parasitic Agents External Parasites

 

Bacterial

Fungal

Internal Parasites

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

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

Viral

Avian poxvirus

Herpesvirus

Adenovirus

Rabies

Newcastle disease

Blood Parasites

Mareks disease

Plasmodium species Haemoproteus species Leucocytozoon species Trypanosoma species Babesia species

TREATING BUMBLEFOOT

BALL BANDAGES

ANTIBIOTICS

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rope, foam-rubber padded, or sheepskin covered) 19 ; trim- ming of excessively long tal- ons; and regular examination of the plantar surfaces of the feet to detect early clinical signs.

FUNGAL INFECTIONS Aspergillosis

The most common fungal infection in free-ranging and captive raptors is aspergillosis. The causative agent of asper- gillosis in raptors is most of- ten Aspergillus fumigatus, with occasional disease associated with Aspergillus flavus and Aspergillus niger. 20,21 All rap- tors can succumb to asper- gillosis infection, but the most susceptible species are imma- ture red-tailed hawks (Buteo jamaicensis), bald eagles (Hal- iaeetus leucocephalus), golden eagles (Aquila chrysaetos), goshawks (Accipiter gentilis), gyrfalcons (Falco rusticolus), and rough-legged hawks (Bu- teo lagopus). 21 Aspergillosis can be classi- fied as acute or chronic and disseminated or localized, depending on the number of spores to which the raptor is exposed, the birds immune status at the time of expo- sure, and establishment of local aspergillomas (Figure 3) or systemic spread of the organism. The most com- monly affected system is the respiratory tract; birds pre- sent with respiratory distress and vocal changes. Other common clinical signs asso- ciated with acute disease are anorexia, polydipsia, and polyuria. Insidious, progres- sive respiratory distress with

Bumblefoot Classification Scheme 11

Type I (most severe): Enlargement of the entire metatarsal pad; associated with infection and cellulitis

Type II: Localized encapsulated lesion; associated with an enlarged metatarsal pad

Type III: Enlargement of one discrete area of the foot; usually caused by a foreign body, corn, or localized improper epithelial molt

Type IV (least severe): Enlargement of one or more distal extremities of the phalanx; results from rupture of the flexor tendons at the ends of digit II, III, or IV

of the flexor tendons at the ends of digit II, III, or IV Figure 2 —

Figure 2A ball bandage on the foot of a crested caracara for the treatment of bumblefoot.

foot of a crested caracara for the treatment of bumblefoot. Figure 3 — Aspergillomas in the

Figure 3Aspergillomas in the thoracic cavity of a snowy owl (Nyctea scandiaca). (Courtesy of Dr. Scott P. Terrell, College of Veterinary Medicine, University of Florida)

tory (e.g., if the bird was re- cently hospitalized or is a highly susceptible species), physical examination, radiog- raphy, endoscopy, complete blood count, chemistry pro- file, fungal culture, and serology (ELISA). 21 Redig states that radiographic le- sions are often associated with a grave prognosis, and the lack of radiographic lesions does not rule out as- pergillosis infection. 21 Leu- kocyte count is often sig- nificantly increased, with heterophilia present in the early stages and monocyto- sis and toxic heterophils in more advanced cases. 22 Therapy is usually protract- ed and based on different an- tifungal agents, including amphotericin B, 5-fluorocy- tosine, fluconazole, and itra- conazole. 21,23 Itraconazole with or without ampho- tericin B should be used for initial treatment of aspergillo- sis unless infection of the brain is suspected; in these cases, fluconazole should be the drug of choice. 23 Oral itraconazole (5 mg/kg twice daily) has been safe and effec- tive in treating raptors with aspergillosis. 24 Supportive care is also an important component of therapy, in- cluding force-feeding, fluids, warmth, and antibiotics. Removing aspergillomas from the trachea may be nec- essary and can be accom- plished either using an endo- scopic approach (in larger birds) or via a tracheal tran- section. 25 A less invasive procedure using a tracheal vacuum technique has been

described. 25,26 Abdominal air- sac cannulation is most often advised during these proce- dures and in cases of tracheal obstruction. 27

associated emaciation is of- ten the presenting sign in chronic disease. Diagnosis of aspergillosis is accomplished using his-

RADIOGRAPHIC LESIONS

LEUKOCYTE COUNT

ANTIFUNGAL AGENTS

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Like bumblefoot, prevent- ing aspergillosis in captive raptors is much easier than treating it. In highly suscep- tible and/or stressed raptors, the prophylactic use of anti- fungals may be indicated and can include oral itra- conazole 28 (I use 5 mg/kg once daily) or oral 5-fluoro- cytosine (50 to 60 mg/kg twice daily). 21 Good hygiene and supportive care of hos- pitalized patients is of pri- mary importance to ensure immunocompetence against this ubiquitous organism.

 

diagnosed in a number of raptor species. 1,30

Adenovirus

Figure 4 — Multiple raised pox lesions on the eyelid and cere of a barred

Figure 4Multiple raised pox lesions on the eyelid and cere

of a barred owl (Strix varia).

The recent fatal adeno- virus outbreaks in the high- ly endangered Mauritius kestrel (Falco punctatus) 31 and aplomado falcon (Falco femoralis septentrionalis) 32 highlight the importance of this virus as a cause of high mortality among raptors.

Poxvirus

The cutaneous (i.e., dry)

Candidiasis

form of poxvirus infection has been reported in both Falconiformes and Strigi- formes. 1,33 Avipoxvirus species are large DNA viruses that induce intracytoplasmic, lipophilic inclusion bod- ies (Bollinger bodies). Epithelial cells of the oral cavity and integumentary and respiratory tracts are most commonly infected. Poxvirus infection presents clini- cally as discrete nodular proliferations of unfeathered skin around the eyes, beak and nares, and legs and feet (Figure 4). No cases of diphtheritic (i.e., wet) pox le- sions have been reported in raptors. 1 Transmission of poxviruses requires viral contamina- tion of broken skin and is often associated with mos- quitoes and other blood-sucking arthropods. 37 Thus, poxvirus lesions have been more commonly diagnosed in raptors housed outdoors. A tentative diagnosis of poxvirus infection can be based on clinical signs. Diagnosis can be confirmed via histopathologic and electron microscopic identification of the pathognomonic Bollinger bodies. Poxvirus infec- tion is usually self-limiting in raptors. Treatment of sec- ondary bacterial infections may be warranted as well as surgical removal of lesions if they compromise the birds ability to properly perch, feed, or see.

Candidiasis (thrush), which is caused by the yeast Candida albicans, is the second most important fungal infection of free-ranging raptors. 3 Candidiasis usually manifests as pseudomembranous patches of necrotic tissue in the oral cavity, pharynx, and crop. A less com- mon manifestation is infection of the lower gastroin- testinal (GI) tract with no visible lesions on physical examination. Clinical signs of candidiasis include dys- phagia, regurgitation, vomiting, and depression. In cas- es of lower GI tract infection, raptors often display nonspecific signs of emaciation and anorexia. Diagnosis can be confirmed by taking a swab, scrap- ing, or culture of the lesions. 3 C. albicans is a thin- walled, oval yeast that measures 3 to 4 µm in diameter and is typically deeply basophilic with Wrights stain and gram positive with Grams stain. 29 Uncomplicated candidiasis can be treated with oral nystatin (100,000 IU/kg three times daily) until lesions are gone. Note that candidiasis is often secondary to an underlying immunocompromising condition.

VIRAL INFECTIONS

A number of viral infections have been diagnosed in free-ranging and captive raptors. 1,3034 The detection of antibodies to rabies virus in an experimentally infected great horned owl (Bubo virginianus) 35 suggests that rap- tors may be asymptomatic carriers of the rabies virus as a result of their feeding habits and contact with such prey animals as raccoons and skunks. However, human rabies associated with raptors has not been document- ed. A serologic survey of 53 newly captured birds of prey found no significant antibody titer. 36 Newcastle disease, a virulent paramyxovirus commonly associated with fatalities in poultry and wild fowl, has also been

Herpesvirus

Herpesvirus infections in raptors include inclusion- body hepatitis in falcons, owl hepatosplenitis, and eagle herpesvirus. 38 The herpesviruses in falcons and owls are serologically indistinguishable. 1,38 Clinical signs are of- ten nonspecific (e.g., severe depression, weakness, anorexia) and can present as peracute death (mortality may approach 100%). The diagnosis of herpesvirus in- fection in raptors is based on clinical signs; viral isola- tion; and histologic lesions, including intranuclear in- clusion bodies and widespread focal to diffuse necrosis

THRUSH

RABIES

BOLLINGER BODIES

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of

the liver and throughout

Figure 5 — Raised, yellowish, caseous plaques from Tricho- monas gallinae infection in the mouth

Figure 5Raised, yellowish, caseous plaques from Tricho- monas gallinae infection in the mouth of a barred owl. (Cour- tesy of Dr. Darryl J. Heard, College of Veterinary Medicine, University of Florida)

cluding protozoa, nema- todes, trematodes, cestodes, and acanthocephalans. 5,40 The GI and respiratory tracts are most commonly affected. Parasitic infections of the GI tract include tricho- moniasis (frounce) and cap- illariasis. Trichomoniasis of raptors is caused by Tricho- monas gallinae and is often acquired when raptors feed on infected prey (e.g., doves, pigeons). 40 The characteris- tic signs are raised, yellow- ish, caseous plaques on the tongue and oropharyngeal surfaces (Figure 5). The bird may have difficulty swallow- ing and, in severe infection, may be emaciated because of its inability to eat. Diag- nosis can be confirmed by taking a swab or scraping of lesions. Trichomonids are identified on a wet mount as a motile, piriform proto- zoan with an anterior flagel- la, undulating membrane, and prominent axostyle or as stationary flagellates

the hematopoietic tissue. There is no therapy for the

herpesviruses of raptors, and

it

remains a problem in free-

ranging and captive popula- tions. Mareks disease, the lymphoproliferative condi- tion caused by a herpesvirus that is most prevalent in chickens, has also been re- ported in raptors. 1,34

PARASITIC INFECTIONS Ectoparasites

 

Raptors harbor a variety

of

ectoparasites. The majori-

ty

of ectoparasites cause no

clinical signs unless a bird is immunocompromised. Only

biting lice from the order Mal- lophaga are found on rap- tors. These lice spend their entire lives on the bird and can survive only for short periods off the host. Most raptors normally harbor small numbers of lice. If an infestation becomes exces- sive, however, the bird may

become highly irritated and cause self-inflicted trauma.

 

stained with Wrights stain

A

topical ectoparasite pow-

der and/or ivermectin (200 µg/kg subcutaneously or orally, repeated in 10 to 14 days) can be used on debili- tated raptors to minimize secondary effects associated with lice infestation. Hippoboscid flies (Pseudolynchia species) are com- mon on raptors; these flies are generally nonpathogenic but may be involved in the transmission of blood- borne protozoan parasites (e.g., Haemoproteus species). 39 Clinical myiasis is associated with such species of flies as Calliphora and Protocalliphora. 40 Myiasis is usually a problem in eyasses (nestling raptors) but has occasion- ally been diagnosed in adults with debilitating injuries. A number of fleas, mites, and ticks are also found on raptors and generally have no negative effect on the health status of the bird. One noted exception is a clini- cal case of scaly-leg mite (Knemidokoptes mutans) in a great horned owl. 41

or Diff Quick ® (American Scientific Products, McGraw Park, IL). 29 Trichomonia- sis can be treated with oral metronidazole (30 to 50 mg/kg twice daily for 5 to 7 days). Capillariasis is a differential for trichomoniasis but is often more extensive, with lesions in the mouth, oropharynx, esophagus, crop, small intestine, and ce- cum. 5 Diagnosis is made by detecting the double-oper- culated eggs in the feces or in a swab or scraping of the oral lesions. 29 Treatment of capillariasis in raptors is with oral fenbendazole (30 to 50 mg/kg once daily for 5 days). A recent report of suspected fenbendazole toxi- city with bone-marrow suppression in several species of birds should alert practitioners to monitor raptors re- ceiving this drug. 42 The top five differentials for raptors with caseous le- sions in the oral cavity are candidiasis, trichomoniasis,

capillariasis, bacterial abscesses, and hypovitaminosis A. It is imperative that the proper diagnosis is established

Internal Parasites

 
 

Raptors are host to numerous internal parasites, in-

because each of these conditions requires a different therapeutic approach.

MALLOPHAGA

MYIASIS

TRICHOMONIASIS

Small Animal/Exotics 20TH ANNIVERSARY Compendium April 1999 Blood Parasites Common blood parasites of raptors include
Small Animal/Exotics
20TH ANNIVERSARY
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Blood Parasites
Common blood parasites of raptors include species
in the genera Plasmodium, Leucocytozoon, and Haemo-
proteus. 39,43 Other less frequently diagnosed blood para-
sites (not discussed in this article) are species of Try-
panosoma and Babesia. 39 Transmission of all raptor
hemoparasites requires an insect vector. Plasmodium,
Haemoproteus, and Leucocytozoon species are transmit-
ted by mosquitoes, hippoboscid flies or Culicoides
species, and simuliid flies, respectively. Much debate ex-
ists 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. Di-
agnosis is based on clinical
D
N
signs and blood film evalua-
Figure 6—Intraerythrocytic Plasmodium species schizont (ar-
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[4]:555–558, 1981. Reprinted with
permission.)
I
20th
tions (Figure 6). 44 Plasmodi-
9
E
ANNIVERSARY
9
CONCLUSION
U
9
1
A
Look
Back
-
1
9
9
7
P
M
There have been many advances
in our knowledge base,
diagnostic capabilities, and
therapeutic approaches to the
infectious diseases of raptors
during the past 20 years. The
most important of these advances
have been directed at aspergillosis
and bumblefoot. Preventive
measures and early nonsurgical
and surgical therapies have
helped to decrease complications
that are commonly associated
with bumblefoot. Advances in
diagnosis and the pharmacologic
agents available for the
prevention and treatment of
aspergillosis have improved the
veterinarian’s ability to handle
this pervasive and potentially
fatal disease.
Veterinarians in clinical practice should be familiar
with the diseases of free-ranging and captive raptors.
Some infectious diseases (e.g., bumblefoot, aspergillo-
sis) often result from stressful conditions during hospi-
talization of raptors that originally presented with a dif-
ferent condition (e.g., trauma, toxicosis). Clinicians
should know the clinical signs, diagnostic protocols,
and therapeutic approaches of these diseases.
M
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S
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with hemoprotozoal infec-
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the Study of Raptor Diseases. West Yorkshire, England, Chi- ron Publications, 1981, pp 1519.

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About the Author

Dr. Deem is affiliated with the Field Veterinary Program, Wildlife Health Sciences, Wildlife Conservation Soci- ety/Bronx Zoo, Bronx, New York. She is a Diplomate of the American College of Zoological Medicine.

29. Campbell TW: Cytology of the upper alimentary tract: Oral cavity, esophagus, and ingluvies, in Avian Hematology and