Hingeback Tortoise Sick - Low Hematocrit , protein and Albumin .

Hi All ,

My 18 years old Hingeback Tortoise Zura suddenly stopped eating about 6-7 weeks ago . I live in Ohio and temps were low in late Feb , so i assumed it could be due to that. But he did not get any better as days passed by . He was always hiding in the enclosure, not active at all and looked sick . I soaked him couple of time but it did not help. So i finally took him to vet . he has not eaten in last 2 months , so no poop to get the fecal test done.

Zura is a very shy so vet sedated him. He checked him thoroughly and also got the blood sample to run some test . Vet noticed a big lesion on the left side , near neck area where skin folds. i have attached a photo of the lesion.

We got the blood work report yesterday and Vet informed us that Zura is Anemic. Report shows low hematocrit , protein and Albumin level. Vet believe that the lesion is not the primary reason for Zura's anemia or his lethargy. Anemia could be due to inflammatory issues going inside and suggested that we try giving him a dewormer(cannot be sure as no poop to get for worms). As Zura isn't eating the only way is to put a feeding tube .We are going to drop off Zura tonight to let Vet put the feeding tube , feed him some food and some dewormer.

I am posting pic of the lesion and the Blood work report . Any advises on what could have caused the lesion ? Also any suggestion on how to treat it ? If Zura is awake , he keep his head inside the shell so cannot apply any ointment or spray .

Thanks!
Rashmi

@Yvonne G should be able to help you

Is this your only tortoise? How long have you had him for?
@turtlesteve @ajtorts @2turtletom

Can you please give us details of the enclosure, temperatures, humidity, lighting and substrate? How long have you had him? All this information may seem irrelevant to you, but we do really need it to help our experts get ideas and possible solutions for your precious tortoise Zura. Thank you!

dd33 said:

Is this your only tortoise? How long have you had him for?
@turtlesteve @ajtorts @2turtletom

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I have another 8 years old hermann's tortoise, but they have separate enclosure. i adopted Zura(Hingeback) in 2016 at a rescue shelter.

16rash said:

I have another 8 years old hermann's tortoise, but they have separate enclosure. i adopted Zura(Hingeback) in 2016 at a rescue shelter.

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When I am viewing this thread I see a similar thread from you down at the bottom of the page about a tortoise with a slimy green poop. Same tortoise?

TammyJ said:

Can you please give us details of the enclosure, temperatures, humidity, lighting and substrate? How long have you had him? All this information may seem irrelevant to you, but we do really need it to help our experts get ideas and possible solutions for your precious tortoise Zura. Thank you!

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I have him for 8 years now, adopted him at rescue shelter in cleveland in 2016 .

Enclosure is 3ftx5ft . 2 hides on either sides. Rest of the enclosure is open. Ceramic heater on either sides which maintains around 75-80F . I also have UVA tubelight on one end . A tub where he loves to soaks . i change water every 4-5 days. Added flat rocks at the bottom of the tub to give him good grip .(in the attached pic, the water tub is empty ). 2 feeding plates in the enclosure ,he generally eats from the plate near tub.

To maintain humidity , I sprinkle water in the whole enclosure every morning . Tried adding pants in the enclosure but they all died..only 2 survived

His weight last week was 920 gms. (hasn't eaten anything in 7-8 weeks) . lost around 40 gms..generally his weight is 960-970 gms when he eats well.

Substrate that i use is the mixture of organic potting soil and coco coir.

Diet consist mainly of mixed veggies includes carrots, peans, beans, corn, apple, banana, papaya, sometime pumpkin, melons, strawberry and sometime mixed greens(which he nibble sometimes) . He doen't eat mushroom, tried feeding him all varieties but never shown any interest . for animal protein , i feed around 8-10 nightcrawler earthworm every week .

Here are some more details about the lesions. These lesion started appearing in 2021 .

2021 Nov/Dec -> Lesion around his beak/mouth. Took him to vet . Vet did not tell the reason for lesions , but gave antibiotic shots. It healed .

2022 - October -> Lesion came back again , but this time around the neck where skin folds . Again took him to vet , he did the blood work, X-RAY but nothing came up. again antibiotic shots and he healed quickly.

2023 November - noticed lesion again and took him to vet. gave antibiotic and it was healed. but this time it came back again in 4 months.

Vet is also puzzled on why these lesion are coming back.

Please let me know if you need any more details. appreciate any advise/suggestion/response.

NOTE: I have dropped Zura off at the hospital . he will be admitted tonight and tomorrow VET will sedate him and put feeding tube .

dd33 said:

When I am viewing this thread I see a similar thread from you down at the bottom of the page about a tortoise with a slimy green poop. Same tortoise?

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Yes, so I took the sample of the slimy green discharge to the hospital. Vet did run a test and confirm its just undigested matter.

Any chance you have some better (not blurry) photographs? Are there other skin lesions or bumps visible anywhere? What other symptoms were present before the tortoise quit eating? Was poop normal, or was it off color, runny, etc. Any bright green poop / pee?

My thoughts are:

- It is very unlikely your vet will be able to give a diagnosis. Sadly a lot of the really nasty diseases out there right now are not well known to practicing exotic vets. Anemia is not specific and could be caused by a lot of underlying diseases.
- Austwickiosis is a bacterial disease that causes skin lesions, but those lesions are usually small, round, and yellow - not open wounds like this.
- Testudine intranuclear coccidiosis (TINC) has been recorded in imported hingebacks. This is a parasitic disease that usually starts out as lethargy + diarrhea but progresses into secondary infections, multiple organ failure and death.
- In general it is necessary to intervene more quickly when tortoises become sick. I think the odds of survival after 6-7 weeks are fairly low. It really pains me to have to say this, but if this were my tortoise I would consider euthanasia. If you don't wish to go that route I would consider antibiotics (fortaz) and a feeding tube, and then watch to see if the tortoise's digestive tract is functional. Goal being to knock back any secondary infections and get the tortoise stabilized to have time to figure out what is wrong and treat it properly. In parallel, send a swab sample to Univ. of Florida for PCR testing to have the best shot of getting an actionable diagnosis.
- If the tortoise dies or is euthanized, considering sending to U of F for a necropsy anyways (about $100) so that you can find out what the cause of death was.

Hopefully the the three people I tagged earlier chime in. I would have this tortoise screened for TINC immediately (samples collected tomorrow and shipped on Monday). Your vet can collect cloacal and choanal swabs and submit them to the University of Florida for testing. If the animal tests positive you can attempt to treat it with Ponazuril.
You can find a little more info on TINC in Hingebacks on this site.

I don't have an experience with Hingebacks but I would expect that an 18 year old animal would have died from it a long time ago if it had TINC. If it has gone this long without eating, and is about to have a feeding tube placed, I would say the chances of survival are slim.

16rash said:

Yes, so I took the sample of the slimy green discharge to the hospital. Vet did run a test and confirm its just undigested matter.

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Green discharge (urates) can also indicate liver disease in tortoises. In particular, TINC is known to cause liver disease and green urates.

I agree with dd33. You need to get a sample in for testing.

turtlesteve said:

Any chance you have some better (not blurry) photographs? Are there other skin lesions or bumps visible anywhere? What other symptoms were present before the tortoise quit eating? Was poop normal, or was it off color, runny, etc. Any bright green poop / pee?

My thoughts are:

- It is very unlikely your vet will be able to give a diagnosis. Sadly a lot of the really nasty diseases out there right now are not well known to practicing exotic vets. Anemia is not specific and could be caused by a lot of underlying diseases.
- Austwickiosis is a bacterial disease that causes skin lesions, but those lesions are usually small, round, and yellow - not open wounds like this.
- Testudine intranuclear coccidiosis (TINC) has been recorded in imported hingebacks. This is a parasitic disease that usually starts out as lethargy + diarrhea but progresses into secondary infections, multiple organ failure and death.
- In general it is necessary to intervene more quickly when tortoises become sick. I think the odds of survival after 6-7 weeks are fairly low. It really pains me to have to say this, but if this were my tortoise I would consider euthanasia. If you don't wish to go that route I would consider antibiotics (fortaz) and a feeding tube, and then watch to see if the tortoise's digestive tract is functional. Goal being to knock back any secondary infections and get the tortoise stabilized to have time to figure out what is wrong and treat it properly. In parallel, send a swab sample to Univ. of Florida for PCR testing to have the best shot of getting an actionable diagnosis.
- If the tortoise dies or is euthanized, considering sending to U of F for a necropsy anyways (about $100) so that you can find out what the cause of death was.

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Thats the only pic Vet sent me. i will try get more clear pic if possible. there were no other lesions/bump. on the skin, his shell is smooth , legs are strong . He was very active till late Jan, roaming around , eating, soaking and having fun time with the big rock in the enclosure.

Something happened starting mid Feb, i just can't figure out what. what did i do wrong.

For now Vet advised me to put feeding tube to get him some food to regain his strength.

I don’t disagree with the feeding tube. However be prepared that if it is TINC, the digestive tract is probably not functioning well. If the food is passing through quickly and doesn’t appear digested it would tend to confirm that.

I wouldn’t assume you did anything wrong per se. This is clearly a pathogen, and could be something it was already carrying. It’s possible that being cooler than normal allowed it to suddenly overtake the immune system.

Please keep us updated on how this goes. It's obvious that you care a lot about your tortoise. I really hope a right diagnosis can be found.

TammyJ said:

Please keep us updated on how this goes. It's obvious that you care a lot about your tortoise. I really hope a right diagnosis can be found.

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surely ,i will share the updates. Thank you everyone for the quick responses.

Zura is still in the hospital. Waiting for Vet to provide updates .

Vet called. They put the feeding tube and fed him . Just after the food, Zura pooped and they took the fecal sample for running some test. Vet mentioned that the poop was normal.

Vet also suture up the lesion on his neck. Medication would start once the results are back, Mostly on Monday. I will pick him up tonight and hopefully we know more details next week.

You should really consider asking your vet to take the cloacal and choanal swabs for TINC and have them submit them to the University of Florida. The test is performed via qPCR and it is very unlikely that your vet can perform that test in house.

Submission instructions:
https://cdpm.vetmed.ufl.edu/services/zmdxlab/how-to-send-samples/

Sample submission form:
https://cdpm.vetmed.ufl.edu/wordpress/files/2023/08/ZMDx-Submission-Form.pdf


Check out the video in this thread:
https://tortoiseforum.org/threads/b...idiosis-a-case-study-by-aaron-johnson.209534/

dd33 said:

You should really consider asking your vet to take the cloacal and choanal swabs for TINC and have them submit them to the University of Florida. The test is performed via qPCR and it is very unlikely that your vet can perform that test in house.

Submission instructions:
https://cdpm.vetmed.ufl.edu/services/zmdxlab/how-to-send-samples/

Sample submission form:
https://cdpm.vetmed.ufl.edu/wordpress/files/2023/08/ZMDx-Submission-Form.pdf


Check out the video in this thread:
https://tortoiseforum.org/threads/b...idiosis-a-case-study-by-aaron-johnson.209534/

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ok. I will ask the Vet to take the swab . is it just sending the sample for testing ? no testing fees ?

16rash said:

ok. I will ask the Vet to take the swab . is it just sending the sample for testing ? no testing fees ?

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No, there will be fees. Your vet will charge you for the sampling time and materials as well as overnight shipping to Florida. I believe the UF lab charges $55 for the test (it is on their website), your vet may have a markup on that as well for their time. It may be more than for the first sample, I can't recall.

If your Hingeback was a recent import and you had seen the green poop you mentioned in the past, as well as the lethargy and anorexia you see now I would say it is 100% TINC. The fact that it has lived so long in your care makes me doubt that a little bit. There are more and more examples though of tortoises breaking down with the disease many years post initial infection (~8-10yrs if I recall).

If this is something you want to do, don't delay. It will take you 1 to 2 weeks to get the test results and probably another week or more to get the medication.

Hi All.. Latest updates on Zura ...Vet took the swabs and send it to FL for testing TINC. Vet did speak with the University to get the details and how it has to be done. Vet charged around $300 for the complete process which includes sedating Zura, getting 2 swabs, shipping charges and testing fees. Waiting for the test results, which may take 2 weeks . Meanwhile Feeding tube is still in and we are feeding him "EMERAid IC herbivore" twice daily , 6 ml as directed by Vet. he has been gaining weight gradually and soaking on its own.

I will keep everyone posted once i get the test results back. THANK YOU everyone for your suggestions and responses.