Severe caudal infection in wild T. hermanni awaiting translocation

[Richard Harrison-Cripps]

Any medical advice on the following would be hugely appreciated ...

We have a small number of adult Hermann's rescued from development sites here in Montenegro and awaiting relocation to a reserve in the spring. Two of the females appear to have, to varying degrees, tissue infection in the caudal cavity. In one female, most of the visually affected area is in the soft tissue between the tail and the underside of the supracaudal. Additionally, there appears to be an aperture or puncture through this tissue where it meets the shell that possibly contains additional necrotic material beneath. Could this be a conduit into the body cavity? I ask this as there seem to be debris and maggots flushing out that are don't seem to be from the more visible external infected area. There are also raw patches on both hind legs (see photos) as well as a strong smell of infection. The tortoise is also noticeably light for its size.

The second female appears healthy and heavy and there are no obvious signs of infection. However there is a faint smell of corruption and there are fly eggs around the base of the tail.

In the absence of competent vets (or actually more or less any vets!) I have flushed the infected area of both individuals with 0.05% Chlorhexidine (in the form of antiseptic mouthwash ... I hope the flouride and menthol won't have a harmful effect!).

The wounds in both animals were initially flyblown and, in the case of the more seriously infected individual, contained a number of maggots. After several Chlorhexidine flushes there still appear to be one of two maggots remaining. I have on hand 0.1% gentamicin cream which I intend to apply as soon as the wound is fully clean (still some debris, discolored antiseptic and the odd maggot coming out).

At this point I'm guessing that the infection was a result of injuries sustained during reproduction. These rescue tortoises (4m / 2f) were housed in a 12x6 metre enclosure with semi-natural habitat. The enclosure was divided into two for most of the season with males and females separated, but there were times in the year when both sexes co-habited and matings were regular.

I should add that both animals are active, feeding and defecating, and that the more seriously affected individual has been brought into indoor accommodation with a view to overwintering.

Unfortunately there is no opportunity here in Montenegro for adequate veterinary treatment, and a limited availabilty of appropriate drugs (although I return to the UK every so often so it is possible to stock up on necessary supplies) so I am rather dependent on the experience and advice of the good folk of forums such as this!

Any advice regarding the cause / nature of the infection, as well as what I should be doing that I'm not, would be hugely appreciated.

Please note attached photos.

Thank you very much in advance.

 

[crimson_lotus]

I've never seen an injury in that location before, especially on more than one tortoise. My guess is that it is some serious viral or bacterial skin infection as the existence of the sores take away from the damaged in reproduction theory. In my non-professional opinion, and I'd say cleaning and applying ointments is the best way to go since you have no access to antibiotics.

@deadheadvet may have more information - I sure hope some others chime in with some solid help.

 

[wellington]

Maybe @Yvonne G can help here. She takes in rescues, maybe she's had to treat a few.
I agree with above. Get it cleaned out, tweezers out any maggots you can see an apply the ointment. Keep her on paper substrate until healed and of course keep her and that area clean.
Good luck and keep us posted.

 

[KevinGG]

@zovick

 

[K8E K]

Can you identify the species of fly (it's a bit tricky via any larval stage, did you see an adult)? I'd not be overly concerned about the fly larvae, most species stick to necrotic tissue and that would not be harmful, beyond that they are an indicator of the tissue damage. I think you're right to disinfect as far as possible, though! Good luck.

 

[Richard Harrison-Cripps]

Thank you for the replies both.

Just a brief update:
Both tortoises are now in an indoor hospital enclosure with basking lights, UVB strip lights and a clean paper-towel substrate. I've changed from the chlorhexidine (which I feel is possibly too dilute at 0.05%?) to 1% povidone iodine (Betadine) which I'm flushing into the cavity twice per day. I'm also trying to apply gentamicin cream in the evening, but having problems getting it to adhere to the affected areas in the sicker animal as the wounds are too wet. The infected areas still appear very raw but are at least now free from maggots and visible necrotic tissue (although the smell is very much still there!).

The sicker animal appears dehydrated with sunken eyes so I'm trying to get fluids into both tortoises via long morning soaks in warm water (not huge amounts of success today, although yesterday was more successful ... is there a generic electrolyte solution I could look out for to aid in rehydration?). Neither have eaten today but that's possibly due to having recently be taken from outdoors where it is now quite cool and almost hibernation time.

I'll keep up with the updates (probably to the point of everyone's exhaustion!!) and in the meantime I would of course be really grateful for any additional advice. On a related note, does anyone know of any reptile vet who is happy to field enquiries such as this online? I know that the Tortoise Protection Group has / had a "liaison vet", Kevin Eatwell, but his contact links seem to be out of date.

Thank you once again.

Richard

 

[Richard Harrison-Cripps]

@K8E K ... apologies ... I must have been typing as you posted!

The flies, to my very untrained eye, appeared to be like largish houseflies. I'm afraid that's the best I can do! Yes, I figured that the larvae weren't a danger to the living tissue but nice to be rid of them all the same!

 

[mark1]

even a willing incompetent vet can supply you with antibiotics , i'd guess fortaz , the dosages are not hard to figure out ...... subcutaneous fluids may make a difference in getting them to feel better to drink on their own ..... lactated ringer's is usually safe , just don't overdose them , again the dosages are not hard to find ..... http://www.anapsid.org/fluids.html ........the fluid dosages I believe are per day ..... just under the skin at the shoulders works .......

 

[Richard Harrison-Cripps]

Thanks mark.

Sadly the tortoise with the more advanced infection / virus died this morning, so all efforts are now on the other female who seems at a far earlier stage of infection. I will pay a visit to the vet tomorrow, as he is not available on a Sunday believe it or not, and ask him to take a blood sample on the remaining female, as well as a possible necropsy on the dead one. I will use the information you provided and try to get the antibiotic situation sorted too.

The remaining tortoise was given an electrolyte bath this morning where she drank heavily and then defecated, although with some effort, presumably as a result of dehydration and / or pain from the infection. I will continue the twice-daily dilute povidone iodine flushes until advised otherwise.

Thank you everyone so far for the advice. Still desperately trying to identify what this is. Maybe blood samples (if the facilities exist here) or further commentary from people in the know here can uncover something.

 

[mark1]

I personally doubted either would make it without antibiotics .......as far as blood test , I would think if they wanted to go to that extent , they could just swab the wounds , look at what they get under a scope , or culture it and look , rather than further stress a very sick tortoise and cost you more money ..... i'd guess amikacin , and sub q fluids everytime you dose her , keep her warm and unstressed ......... as far as vets guessing , personally that's what i'm expecting everytime I go to the vet , human doctors guess most of the time, my vet guesses on my dogs more than they don't , they're a hundred times better at treating dogs and millions of times better at treating people than reptiles .......as for a necropsy i'd guess sepsis from the same infection the live one got .......

 

[Richard Harrison-Cripps]

Thanks Mark. I understand your point about vets guessing. Without meaning to be unnecessarily critical of them the levels of experience, competence and care of vets in Montenegro are several levels below what we're used to in the west. Having said that I do understand that it's a lottery either way and there are no other realistic options.

I'm sure you're right that antibiotics are the only way to go with this, and thank you for the dosages links. I've printed them off and will take them to the vet tomorrow.

 

[zovick]

Thanks Mark. I understand your point about vets guessing. Without meaning to be unnecessarily critical of them the levels of experience, competence and care of vets in Montenegro are several levels below what we're used to in the west. Having said that I do understand that it's a lottery either way and there are no other realistic options.

I'm sure you're right that antibiotics are the only way to go with this, and thank you for the dosages links. I've printed them off and will take them to the vet tomorrow.

Hello Richard,

Sorry for the late response. I have been away for a week.

The lesions on the tortoises look very similar to fungal skin infections I have seen in Chersine angulata. The lesions were probably secondarily visited by the flies after the integrity of the skin was compromised by the fungus. The lesions might be best treated with Nystatin (Mycolog) and/or Furacin Ointment or cream. It can be applied fairly well with a tongue depressor or any flat bladed item, even a butter knife. If you can get both, I would alternate treatments of the areas using one in the AM and the other one in the PM to get the best coverage for possible causes of the lesions as well as secondary infections.

I don't think Fortaz (ceftazidime) will be that helpful in this case as it is used mainly for respiratory infections, but that is said without being able to examine the animal.

Good luck,

Bill Z

 

[Richard Harrison-Cripps]

@zovick ... thank you. I've got hold of the Nystatin but the pharmacies here no longer stock Furacin or apparently anything similar. Would you recommend any similar antibiotic / bactericide ointment, or would it conflict with the course of treatment below?

The tortoise went to the local vet today who diagnosed septicemia and is planning to swab the animal tomorrow morning and conduct a necropsy on the dead individual. She prescribed Mediflox (enrofloksacin) in oral form via drinking water at effectively 0.06ml per day for 5 days (does that seem right?). I was surprised that she didn't give the antibiotic by injection as it seems like an urgent case.

Whilst the vet was inspecting the tortoise, it passed some very brown urine / fluid followed immediately by a stool. This was the first time I've noticed urine this colour. Previously she had been drinking heavily and then immediately passing huge amounts of completely clear urine, before drinking heavily and urinating immediately again.

So, with any luck at least the swab analysis and / or necropsy will come up with something. I'm starting to hope this isn't contagious but will treat it as such until I'm 100% certain.

Thank you so much for the comments and advice so far. Please don't stop!

 

[Richard Harrison-Cripps]

A correction to the above ... 0.12ml of enrofloksacin daily rather than 0.06. It's been a long day!

 

[Yvonne G]

You can get a furasin product at any feed store. It's for horses.

 

[teresaf]

I would check the males over very carefully. Chances are they were breeding with the girls and if it is contagious the males will get it too.

 

[mark1]

i'd think enrofloxacin is a good choice , I personally would never go home with anything less than an injectable antibiotic , it's the only way to accurately dose them , unless they are eating good , most sick animals aren't ...... I've had to give drugs which have to be given orally , they are stressful to the animal , and there is no way they can be dosed anywhere near as accurately as an injection , I've seen them spit up an unmeasurable amount placed directly in their stomach's ..... putting it in the drinking water i'd think is a complete shot in the dark ........ the infection you see on the outside is not what will kill the turtle ........there is little doubt it is not bacterial , so it would be contagious , doesn't mean other will get it , I think most of these animals are exposed to most of the bacteria that causes these infections anyway .......

 

[Richard Harrison-Cripps]

Thanks as always for the feedback ...

@Yvonne G ... Unfortunately we have no feed stores here, in fact there are virtually no horses or livestock in general bar subsistence-level goats, sheep and the odd cow. Under normal conditions, for me at least, the "primitiveness" and simplicity here is what is so appealing, but at times like this I would gladly change that!

@teresaf ... The males appear, from external inspection anyway, to be in perfect condition. It's very close to hibernation season here and I am reluctant to bring them inside unless its strictly necessary. These are animals rescued from a local development site and due for relocation to a protected area in the spring (unless of course there's a risk of them transmitting disease to the existing population). As such they are wild animals and although we have the facilities to overwinter them if necessary, it wouldn't be an ideal preparation for release. That said, I will continue to monitor them carefully throughout hibernation.

@mark1 ... Very valuable advice, thank you. I will make sure we get the injectable antibiotic at the vet tomorrow. I'm struggling to imagine how the infection was picked up unless it had a long period of dormancy. Although i have virtually no experience of chelonian medication (clearly!), I'm an ecologist and have been surveying tortoises in Montenegro for over ten years and have never seen these symptoms in the wild population. Maybe this is a foolish question but do you think we can assume that it's completely coincidental that the infection has turned up in both (ie. all) of the females on site and none of the four males ... so far at least?!