CLINICAL AND HISTOPATHOLOGIC OCULAR FINDINGS IN AQUARIUM-HOUSED COWNOSE RAYS (RHINOPTERA BONASUS).

Cownose rays (Rhinoptera bonasus) are susceptible to ocular disease with their prominent globes, but despite being popular animals housed in aquaria, there is little published information about their normal ocular anatomy and common pathologic ocular findings. A total of 63 live cownose rays (CNR) from three unrelated, separately housed groups had ocular examinations, and 5 adult rays were selected for ocular ultrasound. All examinations were performed out of the water, and most without anesthesia. Clinical findings were described, categorized, and scored by severity. Sixty-two of 63 rays (123 eyes) had clinical abnormalities, including 110 eyes with corneal pathology (mild = 76, moderate/severe = 34) and 74 eyes with intraocular pathology (mild = 44, moderate/severe = 30). Grey-to-white corneal opacities were the most common pathology (n = 58 rays/100 eyes) followed by cataracts (n = 41 rays/58 eyes), then persistent (or dysplastic) pupillary membranes (n = 14 rays/15 eyes). Most pathologic findings appeared inactive, but one aquarium had several CNR with active ocular pathology. There was a significant association between the diagnosis of moderate/severe corneal and intraocular pathology with age (P = 0.008 and P = 0.014, respectively) and weight (P = 0.001 and P = 0.039, respectively), as well as moderate/severe corneal pathology and group sampled (P = 0.03). There were no other significant variables identified. Additionally, histopathology of 14 eyes (11 rays) from two different facilities were examined, with keratitis (n = 8) and uveitis (n = 2) as the most common lesions. This study shows a high prevalence of pathologic ocular findings in cownose ray eyes with heavier adults more likely to be affected than lighter juveniles. Comprehensive ocular evaluation is important in this species and serial ocular exams and future studies should be pursued to monitor ocular disease progression and better understand possible etiologies.

INTRAOCULAR PRESSURES OF AQUARIUM-HOUSED COWNOSE RAYS (RHINOPTERA BONASUS) WITH NORMAL AND ABNORMAL OPHTHALMIC EXAMS.

Cownose rays (Rhinoptera bonasus) are common elasmobranchs in zoos and aquaria; however, there is a lack of published information regarding ocular findings in this species. Intraocular pressure (IOP) was measured in a total of 52 cownose rays (Rhinoptera bonasus) from two unrelated aquaria (n = 22 from A1, n = 30 from A2) using a TonoVet rebound tonometer on two settings (dog = D, and unidentified species = P) as part of a full ophthalmologic examination. Adult (n = 38) and juvenile (n = 14) rays were sampled out of water briefly in sternal recumbency. Intraocular pressure (mean ± SD [range]) in the D setting (9.10 ± 2.57 [4-18] mmHg) was higher than the P setting (5.21 ± 2.32 [0-12] mmHg) (P<0.001). Statistical analysis revealed no difference in IOP between right and left eyes, and no correlation between body weight and IOP. No differences in IOP between sex, age group, and location were identified in either setting. However, a significant difference was observed between levels of severity of corneal disease in IOP D setting (P=0.006) and P setting (P=0.024), and levels of severity of intraocular disease in IOP D setting (P=0.034) only. This study provides baseline IOP values using rebound tonometry in aquarium-housed cownose rays with apparent corneal and intraocular lesions and reveals that the D setting may be more sensitive in identifying IOP changes in eyes with intraocular disease.

MORBIDITY AND MORTALITY OF BINTURONGS (ARCTICTIS BINTURONG) IN UNITED STATES ZOOLOGICAL INSTITUTIONS (1986-2019).

Veterinary literature on diseases in binturong (Arctictis binturong) is often limited to case series or reports without population-level information. Morbidity and mortality data were collected from North American institutions through survey completion or submission of medical records. Responses included information about 74 individuals (37 males, 30 females, and 7 unknown neonates) representing 22 institutions, from 1986 to 2019. Antemortem data were available from 39 individuals, and postmortem data were available from 53 individuals. Eighteen individuals had both antemortem and postmortem records available. Age (mean ± SD) at death for adults (n = 41) was 15.2 ± 4.3 yr. Morbidity events were summarized by affected organ system; 160 events were reported. The systems with the most frequently reported events were gastrointestinal (33%; 53/160), integumentary (19%; 31/160), urinary (12%; 20/160), and musculoskeletal (19 [12%] of 160). Excluding neonates, primary causes of mortality included neoplasia (51%; 21/41), infectious or inflammatory diseases (24%; 10/41), and cardiovascular disease (17%; 7/41). Neoplasms (51%; 21/41) confirmed on histopathology included renal adenocarcinoma (47%; 10/21); mammary carcinoma (14%; 3/21); pancreatic islet cell carcinoma (2 [10%] of 21); and single instances of multicentric lymphoma, uterine carcinoma, and submucosal urethral adenoma. There were three additional cases of presumed neoplasia without histopathologic confirmation; masses were detected in the liver, heart base, and pancreas. Metastases were reported in 15 (71%) of 21 neoplasms. Although neoplasia and cardiovascular disease were common causes of mortality, they were rarely diagnosed antemortem. Neoplasia was often malignant and generally diagnosed after metastasis. Preventive medicine protocols with improved renal and cardiovascular evaluation are warranted and may result in earlier detection of subclinical disease in binturong.

Drug Delivery and Safety Considerations.

Anesthetic drugs must be delivered at the appropriate dose and route of administration to produce the expected anesthetic effects. This is important for patient safety because anesthetic drugs function by depressing the central nervous and cardiovascular systems, which if improperly dosed or administered could cause potentially life-threatening effects. Several routes of administration and different drug delivery methods are available to safely and reliably anesthetize zoologic companion animal patients. Because of the nature of zoologic companion animal practice, anesthetic procedures pose risks that the anesthetist should understand to carefully plan procedures that are as safe and efficient as possible.

Severe Hydroxyapatite Deposition Disease in Binturongs (Arctictis binturong).

In a collection of 6 young binturongs (Arctictis binturong), 3 presented with anorexia, lethargy, and footpad swelling diagnosed by surgical biopsy as calcinosis circumscripta. Despite supportive care over the next 4 years, affected binturongs had progressive weight loss, hyperphosphatemia, and hyperkalemia and developed large radiodense deposits in tissues adjacent to appendicular joints, thoracolumbar vertebrae, and the sternum. Two binturongs died and necropsies showed severe periarticular mineral deposition with fibrosis and granulomatous inflammation. Additionally, binturongs had mineralization of distal renal tubules, mineralization of the renal interstitium, and marked mineralization of the pulmonary interstitium and peribronchiolar smooth muscle. Foot biopsies from the surviving binturong were evaluated by spectroscopic microanalysis and were positive for hydroxyapatite, Ca10(PO4)6(OH)2. Periarticular and footpad mineralization in these binturongs is consistent with hydroxyapatite deposition disease, which is rarely described in humans and animals as a primary familial condition or a secondary condition often associated with renal injury.

Diseases of the Reptile Renal System.

Renal disease accounts for a considerable amount of morbidity and mortality in reptiles, in part owing to inadequate husbandry practices, such as inappropriate temperature, humidity, and access to water. Inappropriate husbandry practices may lead to subclinical dehydration that can specifically impact the renal system, which relies on vascular perfusion to function. This article aims to highlight urinary pathophysiology and summarize infectious and noninfectious causes of renal disease in reptiles as a guide for differential diagnoses to consider during clinical evaluation.

COMPLICATIONS ASSOCIATED WITH PREGNANCY AND PARTURITION IN AFRICAN WHITE-BELLIED PANGOLINS (PHATAGINUS TRICUSPIS).

There are no studies to date on the normal reproductive physiology of African white-bellied pangolins (Phataginus tricuspis). As a reclusive species, little is known about normal gestation, successful parturition, and potential complications during pregnancy. Ten female P. tricuspis were diagnosed as pregnant and monitored under professional care. Five developed complications during pregnancies or during parturition and are detailed in this case series. Dystocia occurred in two dams each, with malposition of a singleton fetus. Both dams were successfully treated with surgical intervention by caesarian section. Of the two individuals, one fetus was nonviable, but the other neonate survived and was reared by the dam to weaning. A third pregnant female died during pregnancy from septicemia resulting in death of the preterm fetus. The two additional dams of the five gave birth to full-term neonates. One fetus was stillborn with evidence of fetal distress, and the other died immediately after birth (perinatal death) with undetermined etiology. Based on this case series, complications associated with pregnancy occur in P. tricuspis, indicating the need for further study and close monitoring during impending parturition.

COMPARISON OF TRANSCUTANEOUS ULTRASOUND AND COMPUTED TOMOGRAPHY EVALUATION OF KIDNEY SIZE AND EVALUATION OF ADRENAL GLAND SIZE USING ULTRASOUND IN A COLONY OF CALLIMICOS ( CALLIMICO GOELDII).

Both kidney and adrenal gland disease have been identified in callimicos ( Callimico goeldii). Ultrasonography (US) and computed tomography (CT) are routinely utilized in veterinary patients with suspected renal or adrenal disease to determine size, shape, and echogenicity of these organs. No previous US and CT kidney and adrenal gland measurements have been published for callimicos. In this study, 14 callimicos were anesthetized using isoflurane via facemask to evaluate kidney and adrenal gland size using US for both organs and CT for kidneys. Animals were considered clinically healthy based on history, physical examination, hematology, serum chemistry, urinalysis, and abdominal US. Ultrasound organ measurements for length (L), width (W), and height (H) in centimeters (mean/median, 95% confidence interval) in clinically healthy animals were right kidney (L = 1.90, 1.76-2.01; W = 1.05, 0.97-1.13; H = 1.59, 1.48-1.69), left kidney (L = 1.84, 1.72-1.95; W = 1.16, 1.04-1.28; H = 1.54, 1.43-1.65), right adrenal gland (L = 0.38, 0.33-0.57; H = 0.19, 0.15-0.31) and left adrenal gland (L = 0.36, 0.32-0.39; H = 0.18, 0.17-0.20). All kidney measurements were positively correlated with animal weight ( P < 0.05) but had no significant correlation to age. Measurements did not have any significant relationship to evaluated blood and urine parameters. Results from this study establish baseline measurements for callimico kidneys and adrenal glands to help clinicians use these imaging modalities for evaluation of these organs in this endangered species.

RADIOGRAPHIC EVALUATION OF CARDIAC SILHOUETTE IN CLINICALLY HEALTHY HUMBOLDT PENGUINS ( SPHENISCUS HUMBOLDTI).

Wild populations of Humboldt penguins ( Spheniscus humboldti) on the coasts of Chile and Peru have been declining because of food scarcity caused by the El Niño Southern Oscillation and human interference. Part of conserving this vulnerable and threatened species is maintaining the health of penguins within zoo collections. A variety of cardiovascular diseases has been reported in individuals from the Spheniscidae family including ventricular septal defects, Dirofilaria immitis infection, pulmonary hypertension, and valvular dysplasia, ultimately resulting in congestive heart failure. An accurate clinical picture of cardiovascular disease in Humboldt penguins requires diagnostics tailored to this specific species. The aim of this study was to establish a routine methodology for evaluating the cardiac silhouette of clinically healthy Humboldt penguins using vertebral heart scale (VHS), cardiocoelomic width ratio (CCWR), and a novel cardiac silhouette-to-keel ratio (CKR). Ventrodorsal and right lateral radiographs were taken of 10 mature Humboldt penguins during routine health evaluations. An echocardiographic exam of each penguin was performed to confirm that there was no evidence of cardiac structural remodeling from disease. Two penguins were excluded on the basis of echocardiographic findings; therefore, data from eight penguins were used to calculate objective cardiac measurements for the clinically healthy population. Right lateral radiographs were used to determine VHS (7.4-10.4) and CKR (3.4-4.4). Ventrodorsal radiographs were used for calculating CCWR (0.45-0.59). The excluded penguins had CCWRs that were outside the 95% confidence interval for the range generated by this study. This initial work supports that standardizing radiographic views provides objective measures for cardiac silhouette evaluation in this species. Further research in larger populations and comparison with birds having confirmed cardiac disease is needed to determine the value of these three measurement techniques in Humboldt penguins.

Rhabdomyolysis and Artifactual Increase in Plasma Bicarbonate Concentration in an Amazon Parrot (Amazona species).

A 7-year-old male Amazon parrot housed outdoors presented with acute collapse, marked lethargy, and open-mouth breathing. The patient had stiffness of the pectoral muscles, and petechiation and ecchymosis noted around the eyes and beneath the mandible. Laboratory data revealed markedly increased aspartate aminotransferase, creatine kinase, and lactate dehydrogenase activity consistent with rhabdomyolysis, as well as markedly increased plasma bicarbonate concentration. Marked clinical improvement and resolution of laboratory abnormalities occurred with fluid therapy, administration of a nonsteroidal anti-inflammatory medication, and husbandry modifications, including indoor housing and dietary alteration. A spurious increase in bicarbonate measurement as documented in equine and bovine cases of rhabdomyolysis also occurred in this avian patient and must be considered for accurate interpretation of acid-base status in exotic species presenting with consistent clinical signs.

Comparison of 3 Methods for Preventing Perianesthetic Hypothermia in Callimicos (Callimico goeldii).

Perianesthetic hypothermia is one of the most common complications in veterinary anesthesia, especially in small patients with a large body surface area to mass ratio. During anesthesia, body heat can be lost through 4 mechanisms-radiation, convection, conduction, and evaporation-but anesthetists frequently address only one mechanism at a time. Here we sought to evaluate 3 methods of preventing perianesthetic hypothermia in callimicos (Callimico goeldii). In our experience, these small NHP routinely become hypothermic under even brief inhalant anesthesia. To address multiple routes of heat loss, animals received 1 of 3 treatments: 1) placement of a reflective blanket over the patient to limit radiative heat loss to the surrounding environment; 2) placement of a reflective blanket and use of a heated anesthetic circuit, which warmed the inspired air to 104 °F (40 °C), and 3) placement under the patient of a forced-air warming blanket set at 109.4 °F (43 °C). Sources of radiative heat loss were assessed by using infrared thermography. Each animal was anesthetized with isoflurane and maintained in sternal recumbency in a temperature-controlled room (65 °F; 18.3 °C); esophageal core body temperature was monitored every 5 min for a total of 30 min. The rate of heat loss did not differ between the use of a reflective blanket with or without a heated anesthetic circuit. Animals provided the forced-air warming blanket experienced a slight increase in average body temperature. According to these findings, an underbody warm-air blanket provided the best protection against hypothermia for callimicos in sternal recumbency.

EVALUATION OF HEALTH PARAMETERS IN COWNOSE RAYS ( RHINOPTERA BONASUS) HOUSED IN A SEASONAL TOUCH POOL HABITAT COMPARED WITH AN OFF-EXHIBIT HABITAT.

Cownose rays ( Rhinoptera bonasus) are commonly displayed in zoo and aquarium touch pool exhibits; however, there is a gap in our understanding of how these practices might impact the health of these animals. The aim of this study was to evaluate and compare selected health parameters in cownose rays housed in a seasonal outdoor exhibit touch pool system with abundant public contact and an indoor off-exhibit holding system with minimal human contact. All animals underwent physical examination, ultrasound, cloacal wash and cytology, and blood collection for complete blood counts, point-of-care blood analysis, plasma protein electrophoresis, and plasma cholesterol electrophoresis in May and October 2014. Physical examination, ultrasound, and cloacal wash cytology findings were all unremarkable for both groups of animals. Significant differences in health parameters among animals by location and time point were few and included decreased heart rate ( F = 12.158, P = 0.001), increased lactate ( F = 6.838, P = 0.012), and increased low-density lipoproteins ( F = 19.961, P = 0.000) in touch pool animals over time. Based on these results, cownose rays inhabiting a touch pool exhibit and an off-exhibit system remained in comparable planes of health based on routine diagnostic modalities with few differences in measured health parameters.

TREATMENT OF DIABETES MELLITUS IN A GOLDEN LION TAMARIN (LEONTOPITHECUS ROSALIA) WITH THE GLUCAGON-LIKE PEPTIDE-1 MIMETIC EXENATIDE.

An 8-yr-old male golden lion tamarin ( Leontopithecus rosalia ) was diagnosed with diabetes mellitus based on hyperglycemia and persistent glycosuria. Initial treatment consisted of the oral antihyperglycemic medications glipizide and metformin that resulted in decreased blood glucose concentrations; however, marked glycosuria persisted. Insufficient improvement on oral antihyperglycemic therapy and poor feasibility of daily subcutaneous insulin therapy led to an investigation into an alternative therapy with extended-release exenatide, a glucagon-like peptide-1 (GLP-1) mimetic, at a dosage of 0.13 mg/kg subcutaneously once per month. Following treatment with exenatide, the persistent glycosuria resolved, the animal maintained normal blood glucose concentrations, and had lower serum fructosamine concentrations compared to pretreatment levels. Based on these findings, extended-release exenatide could be considered as a therapeutic option in nonhuman primates with diabetes mellitus that do not respond to oral antihyperglycemics and in which daily subcutaneous insulin is not feasible.

CUTANEOUS SQUAMOUS CELL CARCINOMA IN A PANTHER CHAMELEON (FURCIFER PARDALIS) AND TREATMENT WITH CARBOPLATIN IMPLANTABLE BEADS.

A 3-yr-old male panther chameleon (Furcifer pardalis) presented with bilateral raised crusted skin lesions along the lateral body wall that were found to be carcinoma in situ and squamous cell carcinoma. Similar lesions later developed on the caudal body wall and tail. A subcutaneous implantable carboplatin bead was placed in the first squamous cell carcinoma lesion identified. Additional new lesions sampled were also found to be squamous cell carcinomas, and viral polymerase chain reaction was negative for papillomaviruses and herpesviruses. Significant skin loss would have resulted from excision of all the lesions, so treatment with only carboplatin beads was used. No adverse effects were observed. Lesions not excised that were treated with beads decreased in size. This is the first description of cutaneous squamous cell carcinoma and treatment with carboplatin implantable beads in a panther chameleon.

Cardiomyopathy in a Harris hawk (Parabuteo unicinctus).

CASE DESCRIPTION An adult sexually intact female Harris hawk (Parabuteo unicinctus) housed at a wildlife hospital was evaluated because of acute collapse during an educational exhibition. CLINICAL FINDINGS Physical examination and hematologic analysis revealed no abnormalities; radiography revealed findings consistent with a previous tibiotarsal fracture. Coelioscopy with histologic examination and fungal culture of lung and air sac samples revealed anthracosis but no fungal infection. The hawk was discharged and temporarily removed from the education program; 1 month later, upon reintroduction into the program, it collapsed again. Physical examination and hematologic findings were similar to those after the first episode. Transcoelomic and transesophageal echocardiography and CT angiocardiography findings were consistent with cardiomyopathy. TREATMENT AND OUTCOME Initial cardiac treatment included furosemide (0.5 mg/kg [0.23 mg/lb], PO, q 24 h) and pimobendan (10 mg/kg [4.5 mg/lb], PO, q 12 h). After 10 days of treatment, peak and trough plasma concentrations of pimobendan were measured at 25, 196 and 715.97 ng/mL, respectively; the dosage was decreased to 0.25 mg/kg (0.11 mg/lb), PO, every 12 hours. No overt signs of toxicosis were detected. A sample was collected to reevaluate plasma pimobendan concentration after 30 days of treatment; results were not obtained prior to the patient's death but revealed a peak concentration of 16.8 ng/mL, with an undetectable trough concentration. The hawk was found dead 6 months after initial evaluation. Necropsy revealed cardiomegaly, but histologic examination did not reveal an inciting cause of cardiac dysfunction. CLINICAL RELEVANCE Cardiac disease in raptors may be underreported. Transcoelomic and transesophageal echocardiography and CT angiography provided useful information for the diagnosis of cardiac disease in the hawk of this report.

HYPERCALCEMIA AND METASTATIC MINERALIZATION INVOLVING FOOTPADS IN ROCK HYRAXES (PROCAVIA CAPENSIS).

Three rock hyraxes (Procavia capensis) maintained in a zoological collection had chronic hypercalcemia and azotemia. In addition, all animals displayed signs of lameness due to footpad lesions that were histologically characterized as marked metastatic mineralization with granulomatous inflammation, reminiscent of calcinosis circumscripta. Although the animals were managed with aggressive fluid therapy, calciuresis, and dietary modification, all were eventually humanely euthanized due to the severity of their footpad lesions and/or progression of renal disease. Metastatic mineralization was also noted in other soft tissues among the three cases, including the stomach, colon, lung, vascular wall, ovary, and kidney. Varying degrees of interstitial nephritis were confirmed on postmortem examination, and in the absence of other causes for hypercalcemia, metastatic mineralization was presumably the consequence renal dysfunction. The renal pathway is the primary mode of calcium excretion in the rock hyrax. In renal dysfunction, hypercalcemia may develop secondary to decreased calcium excretion. Footpad mineralization is an uncommon sequel to renal dysfunction in domestic animals but has not been reported in rock hyraxes. A retrospective review of mortality data in this collection revealed a notable prevalence of renal lesions, including two additional animals with metastatic mineralization and renal dysfunction. Expanding knowledge of renal diseases will further guide preventative and clinical measures, including screening for metastatic mineralization and therapeutic trials for management of hypercalcemia and calcium mineral deposition in the footpads and other soft tissues.

Comparison of NHSN-defined central venous catheter day counts with a method that accounts for concurrent catheters.

Central venous catheter (CVC) day definitions do not consider concurrent CVCs. We examined traditional CVC day counts and resultant central line-associated bloodstream infection (CLABSI) rates with a CVC day definition that included concurrent CVCs. Accounting for concurrent CVCs increased device day counts by 8.5% but only mildly impacted CLABSI rates.

Mandibular osteosarcoma in a nutria (Myocastor coypus).

A four-year-old neutered male nutria (Myocastor coypus) was presented for a one-day history of lethargy and anorexia. A right-sided facial swelling and loose right mandibular fourth molar that exuded caseous exudate from the root were noted; however, the animal continued to decline despite removal of the affected tooth and antibiotic and anti-inflammatory therapy. Radiographs showed a lytic proliferative bony lesion on the right mandible that appeared to expand in size over the course of a week. Due to its declining clinical condition and poor response to therapy, the animal was euthanized. Necropsy revealed an invasive bony neoplasm of the right mandible, histologically consistent with an osteosarcoma, that was invading the mandible and dental arcade, likely contributing to tooth root infection and osteomyelitis. Endocardiosis of the tricuspid valve was incidentally found as well with early cardiac remodeling of the right ventricle. This is the first report of an osteosarcoma and endocardiosis in a nutria.

Atypical fibrosarcoma in the skin of a Roborovski hamster (Phodopus roborovskii).

A 2.5-year-old intact male Roborovski hamster (Phodopus roborovskii) was presented with a large subcutaneous mass overlying the abdomen, affecting the animal's ambulation and access to different compartments of the cage through narrow tubing. Ultrasound examination delineated a well-circumscribed mass in the subcutis of the caudoventral abdominal region. The mass was surgically excised and on cytologic examination showed, in a background of blood, a small population of individually arranged oval to spindle-shaped cells that exhibited a moderate degree of anisokaryosis, coarsely stippled chromatin, one or more prominent nucleoli, and lightly basophilic well-defined cytoplasmic processes. Histologically, the mass was composed of interlacing streams and bundles of pleomorphic spindle cells (ganglion-like cells) with variable amounts of collagenous stroma. The neoplastic cells exhibited moderate features of malignancy. These cells stained intensely with vimentin, but not with any other markers, including antibodies to cytokeratin AE1/AE3, S100 protein, desmin, smooth muscle actin, synaptophysin, neurofilament, and androgen receptor. Based on histologic features, the mass was diagnosed as an atypical fibrosarcoma. This is the first report of an atypical fibrosarcoma in a Roborovski hamster and one of few reports of atypical fibrosarcoma in domesticated hamsters overall.