# First Reported Case of Intranuclear Coccidiosis in a Tortoise



## deadheadvet (Nov 16, 2015)

I was doing a journal search and this is the first reported case of INC. 1994 by the world renowned Dr. Elliott Jacobson at the University of Florida College of Veterinary Medicine.

Intranuclear coccidiosis in radiated tortoises (Geochelone radiata)
J Zoo Wildl Med. March 1994;25(1):95-102.
Elliott R Jacobson1; Juergen Schumacher; Sam R Telford, 2nd; Ellis C Greiner; Claus D Buergelt; Chris H Gardiner
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*Article Abstract*
Two juvenile radiated tortoises, Geochelone radiata, maintained in an outdoor enclosure in north-central Florida with four other radiated tortoises, were examined because of anorexia and lethargy. Hematologic and plasma biochemical evaluations indicated a mild to severe anemia, elevated white blood cell counts, hyponatremia, hyperuricosemia, and hyperglycemia. Both tortoises were considered near death and were euthanized. Histologic examination of multiple tissues revealed nephritis, hepatitis, enteritis, and pancreatitis. Light microscopic examination revealed an intranuclear protozoan in renal epithelial cells, hepatocytes, pancreatic acinar cells, and duodenal epithelial cells. Electron microscopic examination revealed developmental stages of an intranuclear coccidian parasite. This report is the first of an intranuclear coccidian in a chelonian. Oocysts could not be identified in feces of cagemates or tortoises from the originating breeding family. Identification to genus could not be made, and the source of infection could not be determined.


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## Yvonne G (Nov 16, 2015)

I'm not scientifically inclined, so pardon if this is a dumb question.

Not knowing your tortoise has this parasite, but de-worming with Panacur for other knowns, would the Panacur kill the ICP?


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## deadheadvet (Nov 16, 2015)

It is a species specific coccidian. So Anhelmintics would not be effective for this organism. the only drug that shows promise is Ponazuril at up to 50mg/Kg B.W. every other day. There is anecdotal success with Toltrazuril. Treatment may be for months depending on the severity of infection. Mortality is very high and transmission is unknown at this time. There is a PCR test available at the Univ. of Florida. Over a hundred bucks for 1 sample. Some people have submitted group samples as 1 test to minimize cost, however if there is a positive, it would be unknown who the positives are with a group sample.


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## cdmay (Nov 17, 2015)

I have a long term male red-footed tortoise that tested positive for I.C. last fall and again early last spring. He had no symptoms and the parasite 'count' was fairly low-- but he had been with a female who tested positive for I.C. and later died as a result. I assume he contracted the parasites from that female that I had received on breeding loan a couple of years ago.
He was treated with Ponazuril for approximately 3 weeks every other day early this past summer. In September he was again screened for I.C. using cloacal and eye swab specimens. This time the test came out negative for I.C.
In addition, a long term female who had been maintained with this male for many years was also screened the three times along with the male. In each instance she had good swabs taken from her eyes and cloaca and yet she tested negative all thee times. 
It's hard for me to understand how this female, who produced numerous clutches of fertile eggs after breeding with the positive male, avoided becoming infected. Nevertheless, I treated her with Ponazuril too for three weeks.
The only problem I had with the Ponazuril treatment is that typically my adult male red-footed tortoises don't eat that much in the summer as they are much more interested in breeding and chasing females. So I had to sort of 'starve' him a bit during this time to ensure he would eat some banana laced with the Ponazuril. Even then he sometimes didn't get all of the medicine. But it seemed to work anyway.
I plan on having them both tested again this coming spring just to ensure they are both still clear of the coccidiosis. 
The vet I use is located very close to the University of Florida and she often works with the staff there in regards to Intranuclear coccidiosis cases.

Needless to say, I don't do breeding loans any more!


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## deadheadvet (Nov 17, 2015)

Since the transmission has not been worked out yet, we don't know how tortoises get infected. Is it through direct contact, insect vector, contaminated feces, water? Unknown at this time. Makes it difficult to battle unless all animals are separated and test periodically. Lots of fatalities reported from confirmed cases.


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## cdmay (Nov 18, 2015)

From what I've learned, I.C. is transmitted directly from breeding, contaminated feces that are ingested and food/water that is shared. Insects have not been found to carry it...at least by Zoo Atlanta, one of the first places the outbreak appeared. 
Also, from what I was told, it does not appear to be in the tortoises environment so it is not transmitted 'casually' although I would stress strict quarantine and removal of any substrate that an infected animal had been on.


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## deadheadvet (Nov 18, 2015)

A grant proposal to look into this further was submitted earlier this year by the Univ. of Florida. Maybe there will be newer information in the years to come.


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## cdmay (Nov 18, 2015)

deadheadvet said:


> A grant proposal to look into this further was submitted earlier this year by the Univ. of Florida. Maybe there will be newer information in the years to come.



Boy, that would be great!


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## allegraf (Nov 19, 2015)

I lost a few adults to this dreaded problem. I have since treated my herd four times, twice for the past two years and no more deaths. I have not found a vet willing to come and test all my torts. Needless to say, my herd is also closed-no new members. I have two females and two males that have not been exposed to my main herd and won't be until tested. They have been in quarantine from 6 months to over a year. I learned the hard way to be patient and quarantine for long periods of time. Also the discussion and general consensus seems to be that most herds probable have this within their ranks without knowing. Due to the expense of the test, it is unlikely for most hobbyists to get their herd tested. I really hope you get your grant. (And you can study my herd!)


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## allegraf (Nov 19, 2015)

The only exception is that new hatchling, but that one is not anywhere near my main herd. Also, it hasn't been determined or studied, but the vets seems to think there is a low chanceof transmission from adults to egg.


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## GatorsPancake (Dec 6, 2015)

deadheadvet said:


> I was doing a journal search and this is the first reported case of INC. 1994 by the world renowned Dr. Elliott Jacobson at the University of Florida College of Veterinary Medicine.
> 
> Intranuclear coccidiosis in radiated tortoises (Geochelone radiata)
> J Zoo Wildl Med. March 1994;25(1):95-102.
> ...



I am actually a student at the University of Florida and currently have 2 pairs of pancake tortoises with Intranuclear coccidiosis that are part of a study at the university. 
The tortoises were confiscated from smuggling operations, thus the source of the infection is unknown. However, we do know that they have it and will be taking blood samples (as intranuclear coccidiosis has not shown up in fecal samples) to determine the success of the treatment. 

We are going to be using Ponazuril with high dosages, as it was seen in other studies that for tortoises the effective doses have to be much higher than for mammals. 

This is my first post here, awesome to find something related to my tortoises and my university!


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## DeanS (Dec 7, 2015)

@Tom ...perhaps you could shed a little light here!


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## Tom (Dec 7, 2015)

DeanS said:


> @Tom ...perhaps you could shed a little light here!



I've been fortunate enough to have avoided this one so far. No experience with it.


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## cdmay (Dec 12, 2015)

GatorsPancake said:


> I am actually a student at the University of Florida and currently have 2 pairs of pancake tortoises with Intranuclear coccidiosis that are part of a study at the university.
> The tortoises were confiscated from smuggling operations, thus the source of the infection is unknown. However, we do know that they have it and will be taking blood samples (as intranuclear coccidiosis has not shown up in fecal samples) to determine the success of the treatment.
> 
> We are going to be using Ponazuril with high dosages, as it was seen in other studies that for tortoises the effective doses have to be much higher than for mammals.
> ...



Welcome to the forum GatorsPancake. Please keep us posted on what you're learning.
And also, how I can find a decent parking spot on campus when I visit the Paleontology Department at Dickinson Hall!


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## tortoperator (Dec 14, 2015)

I have a fair amount of experience with IC in tortoises. My most recent death occurred just this past week, sad to say. There is no known treatment regimen for IC in tortoises. Ponazuril is NOT EFFECTIVE. In fact, if you want to try and save your tortoise, treat with Baycox. You can import it into the country. What is the dose? 10 - 20 mg/kg. How often? Every 2 or 3 days. How long? Minimum of 30 days, maximum is not known. How to treat? Stomach tube the animal. Signs and symptoms: Weight loss, lethargy, decreased appetite, decreased libido, change from animal's normal routine, may have watery eyes, may not. may have nasal discharge, may not. May be transmitted to all in the group, may not be. Some animals may be carriers, others get full blown disease. Time from owner's onset of recognition of disease to possible death: 2 days to months. What to do: If animal is sick, treat pre-emptively and do not wait. Have animal swabbed and specimen sent for testing at University of Florida Veterinary College. Keep careful record of the weight of the animal. If you have a sick animal, chances are it will be too late to quarantine it and prevent spread to others, but in any event, all animals should be isolated from each other. All animals in your group should be swabbed and tested if you suspect IC. Again, if you suspect it, treat and swab. Prevention is probably best done by making sure the animal's environment is as clean as possible. This means stringent rodent prevention, racoons, squirrels, other critters, anything that poops in your tortoise environment and flies, mosquitoes etc. IC is present in many animals such as sheep, horses, goats, chickens. But the IC is usually species specific and not transmitted directly from say chicken to tortoise. But the carriers of the disease, like flies somehow pick it up in the environment. How do you know if your animal has benefited from treatment? The animal's activity and appetite will return to normal and weight gain will resume. Is the animal cured? Unknown as it may become a carrier or test negative.
It is my opinion that when buying any quality animal that is not a hatchling, the seller document a recent negative IC test in a microchipped animal and the buyer obtain a negative IC test with guarantees of negative to confirm the sale of the animal..


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## deadheadvet (Dec 20, 2015)

There is no structural difference between Toltrazuril and Ponazuril. They are the same drug. Your opinion about one being better than another is without merit. Unless you have a controlled study with a side by side comparison of the two drugs (makes no sense since they are the same) to say one is more effective than the other. In your discussion regarding treatment and testing, you are very correct. Higher dosing has been tried empirically with no side effects of note. Testing at U of F is our best diagnostic tool other than biopsy of pancreas and kidney where the organism is readily seen in infected animals.
On another note in the recommendation of Toltrazuril over Ponazuril, success in treatment may be related to how many organisms are present prior to treatment which would affect the outcome.


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## tortoperator (Dec 20, 2015)

deadheadvet said:


> There is no structural difference between Toltrazuril and Ponazuril. They are the same drug. Your opinion about one being better than another is without merit. Unless you have a controlled study with a side by side comparison of the two drugs (makes no sense since they are the same) to say one is more effective than the other. In your discussion regarding treatment and testing, you are very correct. Higher dosing has been tried empirically with no side effects of note. Testing at U of F is our best diagnostic tool other than biopsy of pancreas and kidney where the organism is readily seen in infected animals.
> On another note in the recommendation of Toltrazuril over Ponazuril, success in treatment may be related to how many organisms are present prior to treatment which would affect the outcome.



Actually, YOU ARE IN ERROR. You may freely google the chemical structure of Toltrazuril and Ponazuril and find that they ARE DIFFERENT. This makes the pharmokinetics and efficacy of the drugs different. In fact, toltrazuril is the preferred drug of choice in Europe, Asia and Australia. It is available in both brand name and generic forms. It is not available in the USA because no drug company is willing to go through the regulatory protocol for agricultural use knowing full well that if approved, the market will be flooded by generics from Chinese companies.
I have been in direct communication with veterinarians in Europe who treat reptiles, including tortoises with toltrazuril. You may research these sources for yourself. Toltrazuril kills IC at a higher rate than ponazuril in chickens, sheep, and other farm animals and according to European vets who lecture on treating reptiles, tortoises too.

As for your comment regarding a controlled study, it will never happen in the USA due to the fact the drug is not approved here for use. Funding would be prohibitive.

As for deciding to obtain a biopsy of the pancreas or kidney in a tortoise, I suggest if you want to do that to make a diagnosis, your tortoise will be dead.

As for the PCA test done by UF, it has limited utility in the real world due to the fact that in the USA, only a handful of vets are competent enough to be aware of the test, know how to properly collect specimens of high diagnostic value and package those specimens in a viable manner to send to UF. The pet owner and veterinarian have to suspect IC before deciding to do the test and it is this delay that can result in death of the animal.

If UF wants to do a service in this country, they will license the test to vet labs across the USA so widespread use of the test becomes common. Secondly, absent that, UF would sell a retail collection kit to the end user with instructions on specimen collection and shipment (like other home diagnostic kits sold at Walgreen's), it will be a long time before optimal treatment of a sick tortoise will be known in this country. Regular monitoring of captive tortoises populations should be the standard and norm in this country.

And, tortoise sanctuaries in the US are known to treat with toltrazuril and not ponazuril because of observed superior efficacy. However, they do not publish their infection rates and mortality rates or treatment regimens. They prefer to keep this information private for the present time. 

As for success in treatment depending on how many organisms are present affecting the outcome, even this is in doubt. Can a few organisms make an animal very sick and contagious or does it take a large load of the organism to make an animal very sick and contagious? And, do you need a 100% kill rate to cure or just get over the hump where the animal can begin to use it's own immune system to aid the task? Do all organs need to be working well for treatment to be successful or are signs of weakness and say kidney failure or GI failure mean it is too late for any drug.

So to summarize, I have no desire to get into a urination contest with you.
I provided "free advice" based on anecdotal evidence of my direct treatment of sick animals with toltrazuril. You can keep treating your sick animals with ponazuril and freely share your observations with the community as I have done. Hopefully we will all learn something.


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## FLGirl41 (Dec 20, 2015)

tortoperator said:


> As for the PCA test done by UF, it has limited utility in the real world due to the fact that in the USA, only a handful of vets are competent enough to be aware of the test, know how to properly collect specimens of high diagnostic value and package those specimens in a viable manner to send to UF. The pet owner and veterinarian have to suspect IC before deciding to do the test and it is this delay that can result in death of the animal.
> 
> If UF wants to do a service in this country, they will license the test to vet labs across the USA so widespread use of the test becomes common. Secondly, absent that, UF would sell a retail collection kit to the end user with instructions on specimen collection and shipment (like other home diagnostic kits sold at Walgreen's), it will be a long time before optimal treatment of a sick tortoise will be known in this country. Regular monitoring of captive tortoises populations should be the standard and norm in this country.



I would like to clear something up. The UF researchers who designed the qPCR test for intranuclear coccidiosis (INC) published the assay in a peer-reviewed journal publication two years ago. The specifics of the assay are described in that paper in such a manner that any molecular laboratory can be capable of using the assay. http://www.sciencedirect.com/science/article/pii/S0304401712006140 Additionally, while testing for INC may currently be rather uncommon, numerous recent cases have occurred within the U.S., and as mentioned above UF is doing the pharmacokinetic study of ponazuril in chelonians. Therefore, news is beginning to spread quickly through the zoo/exotic veterinary community about INC. I know there have been presentations this year at the American Association of Zoological Vets conference, American Association of Veterinary Pathology conference, and a few others. Conference proceedings and additional publications will help increase awareness of INC, and with this exposure, more vets will start putting INC on their differential diagnosis list.


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## michiganice91 (Aug 11, 2017)

I have no clue who you are but this post is awesome. I have successfully treated both radiated and hermanns tortoises with baycox. I took it on the advice of Dr. Paul Gibbons et al at the Behler Center to use baycox, NOT PONAZURIL as they reported much higher rates of successful treatment with toltrazuril. I used roughly the dosage you mentioned with stomach tubing. Unfortunately I had no such success with my pardalis as they succumbed to INC alarmingly fast. I totally agree with everything you wrote. 



tortoperator said:


> Actually, YOU ARE IN ERROR. You may freely google the chemical structure of Toltrazuril and Ponazuril and find that they ARE DIFFERENT. This makes the pharmokinetics and efficacy of the drugs different. In fact, toltrazuril is the preferred drug of choice in Europe, Asia and Australia. It is available in both brand name and generic forms. It is not available in the USA because no drug company is willing to go through the regulatory protocol for agricultural use knowing full well that if approved, the market will be flooded by generics from Chinese companies.
> I have been in direct communication with veterinarians in Europe who treat reptiles, including tortoises with toltrazuril. You may research these sources for yourself. Toltrazuril kills IC at a higher rate than ponazuril in chickens, sheep, and other farm animals and according to European vets who lecture on treating reptiles, tortoises too.
> 
> As for your comment regarding a controlled study, it will never happen in the USA due to the fact the drug is not approved here for use. Funding would be prohibitive.
> ...


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