FATAL ACUTE HEMOLYSIS FOLLOWING TRIAZOLE THERAPY IN AFRICAN PENGUINS (SPHENISCUS DEMERSUS).

Aspergillosis is a major cause of morbidity and mortality in penguins, with triazole antifungal drugs being commonly used for prophylaxis and treatment. This report describes 15 cases of fatal hemolysis associated with liquid itraconazole and voriconazole formulations administered to African penguins (Spheniscus demersus) from four institutions. All penguins underwent stressful events (e.g. relocation, induced molt) and were administered commercial liquid itraconazole formulations or compounded voriconazole liquid suspension. Observed clinical signs in affected penguins prior to death included hyporexia, weight loss, lethargy, dyspnea, red-tinged droppings, and obtunded mentation. Intra- and extravascular hemolysis and hemoglobinuric nephrosis were the primary pathologic manifestations on postmortem examination. The concentration-dependent hemolytic potentials of itraconazole, voriconazole, and commercial and compounded vehicle suspensions were evaluated in vitro by exposing chicken whole blood as a surrogate for penguin blood. Hemoglobin content in blood plasma was then measured by spectrophotometry. Neither itraconazole nor voriconazole alone induced hemolysis in vitro. The vehicle ingredients sorbitol and hydromellose induced hemolysis, but not at predicted plasma levels in chicken erythrocytes, suggesting neither the azole antifungals nor their major vehicles alone were likely to contribute to hemolysis in vivo in these penguins. Potential mechanisms of toxicosis include generation of an unmeasured reactive metabolite causing hemolysis, preexisting erythrocyte fragility, or species-specific differences in hemolytic thresholds that were not assessed in the chicken erythrocyte model. More research is needed on the potential for toxicosis of azole antifungal drugs and carrier molecules in this and other avian species.

Successful outcome of shell fractures in freshwater turtles treated with plate or screws and wire fixation techniques: 51 cases (2014-2019).

OBJECTIVE: To evaluate the outcome of surgical fixation of shell fractures in rehabilitated wild freshwater turtles. ANIMALS: 51 freshwater turtles with 86 shell fractures. PROCEDURES: The medical record database of a wildlife rehabilitation center in Wisconsin was searched from 2014 through 2019 for records of freshwater turtles with shell fractures repaired with a plate technique, screws and wire technique, or both. Signalment, fracture location, therapeutic approach (including the type of hardware used for repair), dry-docking duration, time to hardware removal, postremoval care, and outcome were evaluated. RESULTS: 36 of 51 (71%) turtles with shell fractures experienced successful fracture healing following surgical hardware fixation, and 33 (65%) were released. Shells of 38 (75%) turtles were repaired with plates only, 5 (10%) turtles with wire only, and 8 (16%) turtles with a combination of plates and screws and wires. Of the 51 turtles, 13 (25%) did not survive > 4 weeks following hardware repair, leaving 38 animals available to assess fracture healing. Median time to start staged removal was 42 days (range, 35 to 49 days) and to complete removal of the applied hardware was 56 days (range, 26 to 77 days). Complications associated with placement of the hardware occurred in 6 of 38 (16%) turtles. Complications included screw hole infection (4/38 [11%]), fracture necrosis (1/38 [3%]), and deep screw hole penetration (1/38 [3%]). CLINICAL RELEVANCE: Results indicated that shell fractures in freshwater turtles treated with surgical fixation techniques had a successful outcome. Most complications were minor, and fractures improved with time, resulting in acceptable fracture healing for release.