Effectiveness of Physical Therapy as an Adjunctive Treatment for Trauma-induced Chronic Torticollis in Raptors.

Management of trauma-induced chronic torticollis in raptors has historically been challenging. Euthanasia is common in affected birds because of their inability to maintain normal cervical position, although they may be able to function normally. To assess effectiveness of physical therapy of the neck and head as an adjunct treatment for this condition, a case-control study was done in raptors admitted to the Rocky Mountain Raptor Program from 2003 to 2010. Eleven cases were identified with a diagnosis of chronic torticollis resulting from traumatic brain injury. Five cases were treated with physical therapy of the head and neck, and 6 control cases did not receive any physical therapy for the torticollis. Of the control cases, 0 of 6 had resolution of the torticollis, 0 of 6 were released, and 5 of 6 were euthanatized. Of the treated cases, 4 of 5 had complete resolution of the torticollis and 5 of 5 were released. Resolution of torticollis differed significantly between cases receiving physical therapy and controls. These results indicate that physical therapy should be used as an adjunctive therapy in cases of chronic torticollis induced by trauma in raptors because it results in better resolution of the torticollis and increased likelihood of release.

Multifocal Cryptococcus neoformans var. neoforms: infection, treatment, and monitoring by serial computed tomography in a Schmidt's red-tailed guenon (Cercopithecus ascanius schmidti).

A 9-yr-old, female, intact Schmidt's red-tailed guenon (Cercopithecus ascanius schmidti) presented with an acute swelling, consistent with an abscess over the right hip. Cytology, culture, and polymerase chain reaction (PCR) results from material within the abscess and serum titers were all indicative of a Cryptococcus neoformans infection. Thoracic radiographs and computed tomography (CT) revealed a consolidated right caudal lung lobe associated with an endobronchial mass. Pulmonary Cryptococcus infection and systemic disease was confirmed with positive brush cytology and bronchoalveolar lavage (BAL). Culture and sensitivity, minimum inhibitory concentration values, and serum fluconazole level results were used to develop and monitor treatment efficacy for this animal. Sequential thoracic radiographs, CT images, bronchoscopy, BAL, and serology were used to monitor response to therapy. Five months after initial diagnosis, pregnancy was confirmed and the frequency of immobilizations for recheck serology and diagnostic imaging was decreased to lessen radiation exposure and physiologic stress to the dam and fetus. Long-term administration of oral fluconazole was well accepted and effective at treating the multifocal C. neoformans infection. No long-term adverse effects of therapy were observed, and repeated diagnostics were well tolerated. Advanced imaging modalities and serum drug levels were critical to the assessment, monitoring, and treatment of infection in this animal and should be considered for other cases.

Lumbar hemilaminectomy for treatment of diskospondylitis in an aardvark (Orycteropus afer).

CASE DESCRIPTION A 17-year-old sexually intact male aardvark (Orycteropus afer) was evaluated because of hind limb proprioception deficits and ataxia. CLINICAL FINDINGS Results of examination and CT suggested a diagnosis of intervertebral disk disease and diskospondylitis at the L2-3 intervertebral space. Magnetic resonance imaging of the vertebral column also indicated intervertebral disk rupture with spinal cord compression and inflammation of the adjacent epaxial musculature TREATMENT AND OUTCOME Hemilaminectomy was performed according to the technique described for dogs. Anatomic variations encountered intraoperatively limited the ability to completely remove the affected disk material; however, adequate decompression of the spinal cord was achieved. Microbial culture and susceptibility testing of surgical biopsy specimens yielded a multidrug-resistant Enterococcus faecalis that was treated with a 10-week course of linezolid. Intensive postoperative care required constant rate infusions for adequate sedation, analgesia, and antimicrobial treatment. Dehiscence of the surgical site occurred 3 weeks after surgery and was treated with negative pressure wound therapy. Physical rehabilitation initiated 5 days after surgery progressed from passive range of motion to the use of an underwater treadmill. Despite initial improvement, acute deterioration occurred 5.5 months after surgery. Repeated CT revealed progression of diskospondylitis, which prompted euthanasia. CLINICAL RELEVANCE Postoperative hind limb paresis and paralysis in this species presented considerable challenges for care and rehabilitation. Patient demeanor, size, and anatomy required development of custom mechanical devices. Despite the inability to eliminate the multidrug-resistant bacterial osteomyelitis that resulted in the death of this aardvark, information gained may benefit treatment of subsequent patients.

Treatment of mandibular osteomyelitis in two red-necked wallabies (Macropus rufogriseus) by means of intensive long-term parenteral drug administration and serial computed tomographic monitoring.

CASE DESCRIPTION 2 female red-necked wallabies (Macropus rufogriseus) were evaluated because of sudden-onset mandibular swelling, ptyalism, and hyporexia. CLINICAL FINDINGS Physical examination revealed a mandibular swelling with a fluctuant center in both wallabies. Hematologic analysis revealed leukocytosis with a mature neutrophilia and monocytosis in one wallaby (case 1) and a slight neutrophilia, hyperglobulinemia, and high serum alanine aminotransferase activity in the other (case 2). Cytologic examination of the swelling revealed a uniform population of gram-negative rods in case 1 and neutrophilic inflammation in case 2. Radiography revealed a soft tissue mandibular swelling with osteolucency around mandibular incisor roots in both wallabies. Computed tomography revealed changes consistent with chronic active mandibular osteomyelitis and reactive bone formation, but also sequestra formation not appreciable via radiography. TREATMENT AND OUTCOME Long-term antimicrobial treatment was initiated with clindamycin (17 to 21 mg/kg [7.7 to 9.5 mg/lb], IV, q 12 h for 40 to 55 days) and high-dose benzathine penicillin G (80,000 U/kg [36,364 U/lb], SC, q 12 h for 150 days). Serial CT was performed to evaluate response to treatment and resolution of disease. A CT scan 18 months after the initial evaluation revealed complete resolution of osteomyelitis and sequestra. CLINICAL RELEVANCE Advanced imaging and long-term treatment and management were integral to the successful outcome for these wallabies, given that the osseous changes visible on CT images were not visible on standard radiographs, guiding therapeutic decision-making. This report provides new therapeutic and diagnostic monitoring information to assist clinicians with similar cases.

Diagnosis and treatment of chronic lymphocytic leukemia in a bat-eared fox (Otocyon megalotis).

CASE DESCRIPTION: Severe lymphocytosis and leukocytosis were detected during examination of a 10-year-old sexually intact male bat-eared fox (Otocyon megalotis) with regionally extensive alopecia. CLINICAL FINDINGS: A CBC revealed severe leukocytosis (39,100 leukocytes/µL) and marked lymphocytosis (90%). A blood smear consisted predominantly of intermediate-sized lymphocytes and few large lymphocytes, with mild to moderate nuclear atypia. These findings were highly suggestive of chronic lymphocytic leukemia (CLL). Cytologic evaluation of bone marrow aspirates revealed no evidence of overt malignancy, with 10% of all cells identified as small to intermediate-sized mature lymphocytes. TREATMENT AND OUTCOME: Treatment with chlorambucil and prednisone administered orally over a 1.8-year period decreased the leukocyte and lymphocyte counts to within reference intervals with no adverse effects. Although repeated flow cytometry revealed evidence of residual disease, the fox remained free of clinical disease, and WBC counts were within reference intervals for this species. At 22 months after initial evaluation, the fox was euthanized because of debilitating arthritis. No evidence of CLL was detected grossly or histologically during necropsy. CLINICAL RELEVANCE: To the authors' knowledge, this was the first report of CLL in a bat-eared fox and first successful treatment in a nondomestic carnivore. Treatment in accordance with a chemotherapeutic protocol successfully resolved the leukocytosis and lymphocytosis with no serious adverse effects. Description of this fox and the treatment protocol should provide a valuable reference for future cases in this and other nondomestic canine species.

Comparison of air sac volume, lung volume, and lung densities determined by use of computed tomography in conscious and anesthetized Humboldt penguins (Spheniscus humboldti) positioned in ventral, dorsal, and right lateral recumbency.

OBJECTIVE: To determine the effects of recumbency on air sac volume, lung volume, and lung densities in CT images of healthy, conscious and anesthetized spontaneously breathing Humboldt penguins (Spheniscus humboldti). ANIMALS: 25 adult (13 male and 12 female) Humboldt penguins. PROCEDURES: CT images of conscious penguins in ventral recumbency and anesthetized penguins in dorsal, ventral, and right lateral recumbency were obtained. Air sac volume, lung volume, and lung densities in CT images were calculated. A paired samples t test was used to determine whether right and left lung densities differed among recumbencies. Repeated-measures ANOVA (controlled for sex and order of recumbencies during CT) was used to determine whether air sac or lung volumes differed among recumbencies. RESULTS: Recumbency had a significant effect on air sac volume but not lung volume. Air sac volume was largest in conscious penguins in ventral recumbency (mean ± SD, 347.2 ± 103.1 cm(3)) and lowest in anesthetized penguins in dorsal recumbency (median, 202.0 cm(3); 10th to 90th percentile, 129.2 to 280.3 cm(3)). Lung densities were highest in anesthetized penguins in dorsal recumbency (right lung median, 0.522 g/cm(3); left lung median, 0.511 g/cm(3)) and lowest in anesthetized penguins in ventral recumbency (right lung median, 0.488 g/cm(3); left lung median, 0.482 g/cm(3)). CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that anesthetized Humboldt penguins had the lowest air sac volume and highest lung densities in dorsal recumbency. Therefore, this recumbency may not be recommended. Minimal changes in lung volume were detected among recumbencies or between conscious and anesthetized penguins.