Reptile & Amphibian Forums

I'm working with my exotics vet on this one, but any useful input would be good right about now since I'm trying to get this diagnosed ASAP. The captions on some of the photos were for the vet I'm working with on this one, they're pretty self-explanatory.

The patient: My green iguana, Draco, 7.5 years old. Had MBD related to poor environment and diet before 2 mos. of age, so he's had a very pronounced kyphoscoliosis his entire life, but has been completely healthy aside from the spinal deformity up until now. He is stunted at just over 3ft STL, and weighs around 5-6lbs. He is very friendly and docile for a male ig, although from April-July every year he gets hyperactive and eats very little (during this period he is syringe-fed daily a slurry of his salad and baby food).

Lives in a 4ft x 2ft x 2ft glass enclosure with plenty of out-of-cage time and baths for exercise every other week (more frequently during the summer). UVB lighting is provided with a ReptiGlo 8.0 during spring/summer mos. and 5.0 during fall/winter mos. (occasionally interchanged if one's not available when I buy). Photoperiod during fall/winter is 12/12, during spring/summer is 14/10. Basking spot of 38-40C, cool end of enclosure at 26-28C. Entire enclosure does not typically fall below 22-24C at night.

Has a large branch, and shelf with a ramp both covered in indoor/outdoor carpeting, and many fake plants. Large, shallow water dish is on the floor of his enclosure, he likes to defecate in it, it's cleaned ASAP when there's poop. Substrate is newspaper that is changed every 1-3 days (daily when I have more time, at the most every 3 days if I'm busy, but usually every second day). Every 2-3 weeks the enclosure gets a wipe down with a 1:10 bleach:water solution (and is allowed to air out completely before replacing him). Dishes are cleaned weekly with the same solution.

Diet is fresh salad offered daily, prepared weekly. Consists mostly of dark leafy greens, 2-3 of the following: Dandelion, collard, rapini, escarole. Rest of salad is made up of 1-2 green veggies (green beans and/or snow peas) and 1-3 orange/yellow veggies (sweet potato, parsnip, yucca, butternut/acorn/kabocha/spaghetti squash). Ground alfalfa hay is included in the weekly salad (about 1 cup for every 3-4 cups of salad). Supplements include calcium 1-2x/week as diet is quite high in calcium (HerpCal w/o vit. D3) and multivitamin 1-2x/week (Herptivite). Fruit is offered every other day, and he's syringe fed 5mL of water once a week (as he refuses to drink from a water dish).

The problem: Nov. 29, noticed a small swelling, less than 1cm wide, on the ventral surface of the left side of his tongue tip. I originally assumed it was just some mild trauma, and began swabbing it daily with a 1% povidone-iodine (Betadine) solution.

Dec. 5, swelling was pussy and appeared larger.

Gently cleaned out the pus, started bleeding a little. Applied gentle pressure for bleeding to stop, then swabbed with Betadine. Also noticed that D2 on his right hind leg has a swollen joint that feels firm and painful, possibly an abcess.

Upped his basking spot to 40-42C during the day.

Dec. 6, consulted with the exotics vet at school (I'm a senior vet tech student). She suggested I do a culture of the lesion, fine needle aspirate of the swelling to determine if it's liquid-filled, and a fecal to rule out any parasitic influence (previous fecal had been done Oct. 20 with no abnormal findings).

Dec. 7, swabbed for culture, cleaned out with Betadine. Needle aspirate revealed that it is not fluid-filled, saved aspirate to examine under microscope. Took a fresh fecal sample.
Fecal float had nothing abnormal.
Fecal smear revealed an abnormally high number of flagellate protozoa, at least 60-75% of the microfauna, 1-4/oil immersion field.
Best photo I could get of one, little buggers kept moving. Bodies appear round in shape from above, but almost teardrop-shaped from a lateral view. Three distinct flagellae, but continuously moving so I could be mistaken. Looking through A Veterinary Guide to the Parasites of Reptiles (Barnard and Upton, 1994) it resembles Monocercomonas the most: (photographed at 1000x)

Fecal sediment revealed 3 amoeba cysts (appear to be Entamoeba): (photographed at 1000x)

and one unidentified cyst, possibly coccidian? Seems too small to be coccidian...: (photographed at 1000x)

Not sure what brought this whole thing on. He had a small wound this summer from being hyperactive and flipping out, caught one of his claws on his arm and ripped a 1.5cm hole. Cleaned that daily with Betadine and bandaged with a bacitracin-polymixin ointment, took about 2.5 weeks to heal.

Temps dropped drastically up here a bit, I noticed his enclosure was too cool in the morning, twice (19C instead of 22C), so I've been leaving his daytime lights dimmed low for supplemental heat.

I have a bunch of other herps but wash hands well between each cage, so although it's possible, I think cross-contamination is unlikely.

Aside from that... I'm not sure where this could have sprung up from.

The vet and I are waiting on the culture results before we act with antibiotics (most likely enrofloxacin, Baytril), and probably metronidazole (Flagyl) for the protozoa.

One of my concerns is that the antibiotics will be throwing his intestinal flora out of whack. Any comments on supplementing with Lactobacillus or Acidophillus live cultures to give him a boost? I'd like to avoid yoghurt if I can.

Also wondering how we'll prioritize the antibiotic versus the antiprotozoal, but it'll depend on the vet's decision for the duration of each therapy. I'd rather not give both at once so that his kidneys and liver don't get overworked.

Christina Miller
Herptiles.net

This morning the vet contacted me to get some metronidazole (Flagyl) and enrofloxacin (Baytril) dosed and prepared for Draco.

I also checked out the culture of the lovely pus, and it appears to be Gram negative cocci (so possibly Eschericha coli). I also started a culture and sensitivity test, and a BBL Crystal Enteric ID test kit to hopefully identify the pathogen.

Just gave him the first dose of metronidazole this evening, he'll get the first dose of enrofloxacin tomorrow morning.

Christina Miller
Herptiles.net

Excellent description of your husbandry and symptoms.

*One of my concerns is that the antibiotics will be throwing his intestinal flora out of whack. Any comments on supplementing with Lactobacillus or Acidophillus live cultures to give him a boost? I'd like to avoid yoghurt if I can.

You can get acidophilus in "live" tablet form from health food stores. The iguana should be innoculated with it after the antibiotic regimen. Also, I believe there is a company that puts out a product called, "Nutri-Bac" that replenishes gut flora with good bacteria.

*Also wondering how we'll prioritize the antibiotic versus the antiprotozoal, but it'll depend on the vet's decision for the duration of each therapy. I'd rather not give both at once so that his kidneys and liver don't get overworked.

Looks like according to your update that you are alternating medications. That should work OK--just make sure that the iguana is hydrated well during treatment.

Goodluck getting him well again.

Below is a link to the Nutribac site-
Link

Thanks for the input. I'm going to look into some live Lactobacillus cultures at the pharmacy.

I got the culture and sensitivity test results today. Chloramphenicol is the only antibiotic that it's susceptible to. We only found the enrofloxacin test discs today, so I'll have to find out tomorrow whether or not it'll be effective or not.

Sounds like a fascinating case. First question; does your vet have VIN? Being at a tech teaching hospital, they may be a bit out of touch with the ever advancing herp medicine.

You husbandry sounds A but here's a few thoughts;
what's the humidity? The diet is fabulous, but the multivitamin might be given a bit much, depending on how much you're sprinkling on (and this may relate to your problem if it turns out to be systemic). The daytime lights being dimmed, is probably still stressfull on your iggie. I would suggest using a ceramic heater during the night. ( I use one for 24hr heat and just have a fullspectrum for light during the day.)

Abscesses almost never contain a withdrawable fluid. Pus is thick, and gout is also common. The abscess and the swollen joint are likely unrelated, but I would definately get a blood panel to assess liver and kidney function. Both of these symptoms are commonly related. I don't think the parasites are related, and they probably arn't a problem at all. Use your judgement. If you think there is an overgrowth seen on the fecal, then treat. Also remember that herbivores have a large number of pseudoparasites in their diet. As for probiotics, I was at a CE seminar not to long ago with a GI expert and he was not a fan of them at all. The contents of the products are often not what's on the label, they have to pass the stomach's digestion prior to finding a spot withen the digestive tract to colonize. Furthermore he mentioned that any benefits of a probiotic would cease quickly after usage.

It sounds like you're on the right track, but definately get that blood work! (It'll also give you practice at that tail vein, I remember my first stick )

Ian

"Sounds like a fascinating case. First question; does your vet have VIN? Being at a tech teaching hospital, they may be a bit out of touch with the ever advancing herp medicine."

Unfortunately, we weren't graced with an exotics vet that has an exact interest in herp medicine (to be blunt, she knows the basics), and she also pratices on dogs and cats so her focus is even more diverse. The VIN libraries are quite useful, and it's one of the sources I forward her to when I find relevant information.

"what's the humidity?"

I realizes afterwards that I forgot that one. Humidity is around 70-80%.

"The diet is fabulous, but the multivitamin might be given a bit much, depending on how much you're sprinkling on (and this may relate to your problem if it turns out to be systemic)."

The vitamins are once a week unless the grocery stores are veggie-poor, which is when I opt for the vitamins twice a week. I use a small pinch, he eats between a 1-1.5 cups of salad a day, and I'd say that the vitamins sprinkled on are less than a quarter of a teaspoon.

"The daytime lights being dimmed, is probably still stressfull on your iggie. I would suggest using a ceramic heater during the night. ( I use one for 24hr heat and just have a fullspectrum for light during the day.)"

I am definitely worried about the stress factor, although at this point heat took priority. I like the idea of CHEs, I'm seriously considering investing in a couple to use for 24-hour heat. Sadly, at the end of every semester I'm borderline broke from school costs, so it may have to wait a while. This is also my reason for using the school vet instead of local exotics clincs. Ideally, price wouldn't be a factor, but each semester costs me $900-1000 and I do not have time to work part-time because of school, so you can see my dilemma.

Until then, more importantly for this winter, how does a hot water bottle wrapped in a towel for some nighttime heat sound? Not the best, but better than nothing.

"Abscesses almost never contain a withdrawable fluid. Pus is thick, and gout is also common. The abscess and the swollen joint are likely unrelated, but I would definately get a blood panel to assess liver and kidney function. Both of these symptoms are commonly related. ... It sounds like you're on the right track, but definately get that blood work! (It'll also give you practice at that tail vein, I remember my first stick )"

Are you thinking that the tongue swelling is an abcess, then? I think the vet's rationale for the needle aspirate was that it could be a cyst- I hope she also knows that iguanas have caseous pus. Gout came to mind, as well, but the joint swelling followed the appearance of pus, so I put it down on the list.

I did also forget to mention that I attempted to take blood from him about three weeks ago for my hematology class (I was going to do a full blood and plasma chemistry profile). I'm not too bad at hitting the tail vein, but my handler panicked when he started squirming and tail thrashing (my current lack of a car forced me to take blood at home). The max amount of blood I was to take was 0.3 mL, but with the needle slipping out and letting him bleed and the amount I had already drawn he lost about 0.2-0.25 mL of blood (and of course, before I had a chance to do a smear the blood had coagulated). I haven't found any solid figures on how long it takes green igs to recuperate from blood losses, so for now I'll err on the safe side and not risk taking blood, even though the profiles would be extremely useful.

"I don't think the parasites are related, and they probably arn't a problem at all. Use your judgement. If you think there is an overgrowth seen on the fecal, then treat. Also remember that herbivores have a large number of pseudoparasites in their diet."

When I had done a fecal in October, there wasn't such a high number of flagellated protozoa. Whether this was related or could pose a potential problem if he were to take a turn for the worse, I decided it would be better to treat.

"As for probiotics, I was at a CE seminar not to long ago with a GI expert and he was not a fan of them at all."

I'll step back from the probiotics.

I got a phone call this morning from a fellow student that I had check the enrofloxacin C&S. It seems that the Baytril has very little effect on the pathogen. I contacted the vet, on Monday I'll be putting him on chloramphenicol (the only antibiotic out of 9 tested that the bacteria were susceptible to).

The BBL Enteric ID test was inconclusive. So far the info I have on the organism is that it is a Gram negative, oxidase positive coccus. From a bit of research, it seems that it could be in the family Neisseriaceae, but nothing more specific, yet.

Christina,
Chloramphenicol is a great broad spectrum antibiotic and should work well in this case. The only thing you would need to watch with its use is the necrotic effect it has on skin tissue in reptiles. I used it with pythons in the late 80's and early 90's and unless the injections are fairly deep and all residual is cleaned from the skin surface at the site of the injection, severe scarring can result. Additionally, most gram negative cocci show the greatest susceptability to third generation cephalosporins, specifically Ceftriaxone. Another antibiotic that has shown to be highly effect on gram negative cocci is Ciprofloxacin. I am not sure of the extent of the susceptibility tests performed, but you might check to see if a third generation cephalosporin of some type or Cipro was in the group of 9 that were tested. Good luck.

Kelly

Hi Kelly,

I have a list of the antibiotics we tested:
Sulfisoxazole, trimethoprim sulfa, erythromycin, tetracycline, penicillin (not specified what type), ampicillin, chloramphenicol, amoxicillin/clavulanic acid.

At the time we were setting up the test, the head technician and I did not look up each antibiotic to check its safety in herps, but this is about the extent of the variety of test discs we have. I'll check again tomorrow whether we have some for any of the cephalosporins.

I'm not certain whether we have the oral or injectible formula for chloramphenicol available at the clinic. I'll swing the idea of the cephalosporins and Cipro by the vet, and check if we have the antibiogram test discs for them.

Thank you for the input!
Christina

Most of the antibiotics on the list have somewhat limited effectiveness against gram negatives with the exception of chloramphenicol. The susceptibility disks for Cipro and cephalosporins may need to be acquired elsewhere as many vets may not typically have these. Even though Baytril and Ciprofloxacin are both fluoroquinolone antibiotics, the Baytril disk cannot be used as a surrogate disk for Cipro susceptibility. This is because Cipro appears to have a much broader spectrum of activity than Baytril. And on the use of either oral or injectable chloramphenicol, I really do not know which would be the most effective, a vet would need to answer that question. Keep us posted, as I am interested in how this turns out. Thanks,

Kelly

Makes sense why most of the antibiogram was a dud, then. I'm hoping that we have some discs for the aforementioned antibiotics somewhere.

I just heard from the vet, she wants me to keep giving the Baytril, and is suggesting we test amikacin, as well.

Christina

You may want to reference this, but I believe enroflaxin is metabolised into ciproflaxin withen the body. Baytril is just cheaper; not used in humans for the neuro reaction it makes, thus the production of cipro.

Ian

n/t

enrofloxacin. I am not sure what the exact pharmacokinetics are of ciprofloxacin and enrofloxacin in reptiles as far as absorption, serum levels and half-life are concerned. But oral Cipro has been shown to be more effective in reptiles for some reason than Baytril given im. Not sure why, but I would be interested to know. In mammals, ciprofloxacin given orally shows an extremely rapid and efficient absorption by the gastrointestinal tract with high serum levels in a relatively short time. Enrofloxacin given im shows the expected, much more rapid peak serum concentrations, but a correspondingly shorter half-life. The effectiveness of fluoroquinolone antibiotics is concentration dependent and maybe this could have something to do with the greater effectiveness of Cipro.

Kelly

Well, it seems that the other student I had asked to check the enrofloxacin test misunderstood the instructions!

Turns out that the bacteria are indeed susceptible to Baytril. I'll be doing a fecal tomorrow to see if the metronidazole worked for the protozoa, and after that we'll just have to wait and see how the antibiotics work.

Christina

-