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Thread: Abscesses in reptiles

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    Abscesses in reptiles

    DERMATOLOGY

    The lesions in reptiles that are usually termed abscesses generally appear as raised, hard, and well-circumscribed sub-cutaneous swellings. Histologic examination of such lesions usually reveals a central core containing bacteria surrounded by fibrosis and inflammatory cells. Huchzermeyer and Cooper suggested that such lesions might be better termed "fibriscesses" and postulated that the fibrinous core might entrap bacteria and thus discourage systemic spread. Other swellings are more cellular and essentially granulomas. Elkan and Cooper coined [made up] the term "pseudotumours" for some such lesions on the grounds that they superficially resemble neoplasms.
    The cause of abscesses is usually a bacterial infection, often after trauma such as a bite wound or an injection. A mixed infection may occur, particularly by two or more gram-negative bacteria. Aeromonas and Pseudomonas are commonly involved but other organisms may be isolated, amongst them Actinobacillus, Arizona, Corynebacterium, Edwardsiella, Escherichia (coli), Klebsiela, Neisseria, Pasteurella, Proteus, and Providencia spp. Seratia was first reported as a cause of abscesses in reptiles more than 60 years ago and is one of the most common organisms isolated and an initiating factor in septicemic cutaneous ulcerative disease (SCUD; see subsequent). Anaerobes and salmonellae are discussed subsequently.
    Definitive diagnosis of an abscess usually requires aspiration and culture and either cytologic or histopathologic examination. Differentiation from fungal, parasitic, and neoplastic lesions is vital.
    Abscesses are best excised in toto , and this procedure must include removal of the fibrous capsule. Recurrence may be discouraged by the use of an appropriate antibacterial agent (systemic) and local antiseptics, coupled with high standards of hygiene.
    Cellulitis (referred to by Rossi as "carbuncles") is an underrunning of the skin by an infective process and can result in a whole network of infected sinuses and tracts within the dermis. Various organisms may be involved, among them some of those listed previously. Such lesions are often difficult to treat, and repeated surgery with antibiotics may be necessary.
    Mycobacterium spp. can on occasion cause localized abscess-like lesions but are more often associated with deep infections, including those of bone and digits. Salmonella spp. are sometimes isolated from abscesses or other skin lesions on reptiles. Appropriate precautions may need to be instigated to view the zoonotic potential of some of the organisms. Nevertheless, the risk must be seen in the context of other dangers, including the fact that other apparently less pathogenic bacteria may cause disease in immunocompromised humans.




    ABSCESSES

    Abscesses can be found in all species, although their presentation may vary. In mammals, the result of abscessation is usually a purulent liquefied exudate. In reptiles, however, abscesses take on an entirely different form.
    An abscess is defined as a localized collection of purulent material (pus) in a confined cavity formed by the disintegration of tissues, In mammals, this pus is often a milky, variably colored exudates composed of primarily degenerate or toxic neutrophils, macrophages, lymphocytes, serum, and liquefied necrotic tissue. In reptiles, the heterophils posses a different killing mechanism than that seen in mammals. The exact pathway is not known, but the oxidative pathways seen in the mammalian neutrophil do not exist. As a result, the reptilian abscess is usually not liquefied . Reptilian pus is caseous, forming hard, "cheese-like" plugs that are nearly impenetrable to antimicrobial therapy. Typical presentation of a reptilian abscess is lamellar, similar in appearance to a cross-sectional cut through an onion . Most reptilian abscesses not only are solid but also are well encapsulated.



    INCITING CAUSES
    Many causes are found for abscesses. Pyogenic organisms (bacteria, fungi, parasites) or foreign bodies embedded in tissue can lead to the formation of the excudates. If the organisms are not cleared or removed from the body, accumulation of the exudates stimulates the formation of a fibrinous capsule. In mammals, the increase in pressure from accumulation of the purulent exudate may ultimately result in the abscess rupturing, either externally (skin) or internally (intestinal, perineal). If a prolonged abscess is present, rather than rapture, a rigid fibrous wall forms around the abscess. If this occurs, eventual healing of the lesion requires filling of the evacuated cavity with granulation tissue. If the inciting cause (organism, foreign body) is not totally removed, a chronic or intermittent discharge or abscess recurrence is likely.
    Abscesses can be found throughout the body. The portal for entry of the pathogenic organisms can be the skin, the gastrointestinal tract, or the lungs. Once inside the body, hematogenous spread can disseminate the pathogens to the internal organs, tissues, retrobulbar regions, and the brain.
    Reptiles are exposed to pathogens on a regular basis. Bites, scratches, and environmental trauma can all predispose these animals to abscess formation . Healthy animals can withstand minor insults with no prolonged effects. However, as is often the case with captive reptiles, an immunocompromised individual is more prone to disease development.
    Foreign bodies such as plant material (thorns, bark) and other manmade products (plastics, metals) can all lead to abscess formation.
    Pyogenic organisms can vary, and bacteria (aerobic and anaerobic), fungi, and parasites (protozoan and metazoan) may all be involved. Bites from prey are a frequent source for anaerobic infections. Nocardia, Chlostridium, and myobacteria have also been isolated.



    CLINICAL SIGNS

    All reptiles are susceptible to abscess formation. No age or sex predilections exist. Husbandry factors seem to play a significant role in the development of abscesses. Poor lighting, inadequate temperature regulation, nutritional deficiencies, and overcrowding are common factors.
    Swelling is the hallmark of abscess formation. Unlike what is noted in mammals, heat and erythema are not associated with the development of an abscess in the reptile patient. Fever, as seen in mammals, also is not a part of the reptilian clinical disease. Behavioral fever may be involved but is beyond the scope of this discussion.
    Depending on the organ system involved, the clinical signs may vary. Cutaneous or subcutaneous abscesses manifest as obvious, generally localized, swellings. Cellulitis, a deep diffuse suppurative infection in areas of low oxygen tension, can have a similar presentation to large abscesses but does not have the solid core center.
    Internal abscesses can have varying clinical signs depending on the organ system involved. Intestinal and hepatic abscess may have gradual wasting, brain abscess with neurological signs, pulmonary abscess with evidence of respiratory difficulty etc.



    DIAGNOSIS

    The differential diagnoses include any "mass lesions", such as tumors, hematomas, scar tissue, and parasitic cysts. Pain on palpation (not always obvious), internal structure (fluid-filled versus solid), and previous history help with the determination.
    Laboratory analysis has limited use in the diagnosis of an abscess. A complete blood count (CBC) and a serum chemistry analysis are usually unremarkable. Animals with generalized abscessation may have normal values, whereas apparently normal animals may have a leukocytosis.
    Aspiration of the mass, including cytology and bacterial culture/sensitivity testing, again may have questionable results. Cytology usually reveals amorphous debris. Because of the solid nature of abscesses, exfoliative cytology is usually nonproductive. Stains should include Gram, Wright's-Giemsa, acid-fast (mycobacteria and Nocardia), and periodic acid shift (fungal).
    Culture results are usually negative, especially if routine culture techniques are used. Culture submissions can be enhanced with anaerobic and fungal evaluations. Sample collection should be from the inner lining of the fibrous capsule, non the center of the lesion, because the center has often outgrown any blood supply and rarely produces positive culture results.
    Radiography, ultrasonography, and advanced imaging, such as magnetic resonance imaging (MRI) or computed tomography (CT) , can all be used to help evaluate the presence of internal abscesses.



    TREATMENT

    The key to successful treatment of the reptilian abscess is complete removal of the abscess cavity and surrounding fibrous capsule. Simple lancing and curettage, or removal of the internal caseous material, is not enough to prevent recurrence. Once the abscess capsule has been removed, the wound is left open to heal by secondary intention and granulation. Healing times vary depending on many factors but in general can take anywhere from 4 to 6 weeks. Scar tissue ensues but usually shrinks over time, leaving minimal changes to the skin.
    Unlike mammals, in which lancing, and in some cases, placement of a drain, is enough to facilitate healing, the reptilian abscess needs thorough debridement. In most cases, this may mean general anesthesia. A small abscess can be potentially treated with local analgesia (lidocaine, bupivacaine). Caution must be taken not to accidentally overdose small patients with the analgesic for example, local infiltration should not exceed 10mg/kg of lidocaine).
    Laser ablation of the abscess bed helps sterilize any material left behind after the debridement. Daily topical debridement and application with an iodine-based solution chemically cauterizes any bacteria that remain on the surface.
    Antibiotic therapy, preferably based on bacteriologic culture and sensitivity data, is an essential adjunct to surgical debridement. Antibiotics vary in ability to penetrate abscesses or work in anaerobic or acidic environments. Amikasin and enrofloxacin, two of the most commonly used antibiotics in reptilian medicine, are generally ineffective in the treatment of abscesses.
    Chloramphenicol, a lipophilic bacteriostatic antibiotic, effectively penetrates tissue that is inaccessible to many other antibiotics. It is effective in both anaerobic and acidic conditions. It has a limited spectrum of activity, so its use should be based on supportive bacterial sensitivity testing. Other medications that may prove useful in the treatment of abscesses include potential penicillins (e.g., amoxicillin/clavulanic acid), trimethoprim-sulfa, and metronidazole, and some of the newer generation cephalosporins and flouroquinolones can be considered. Drug dosages for these medications have not been established pharmacokinetically, so their use is empirical.



    FOLLOW-UP

    Drug therapies should continue for a minimum of 14 days. Recheck evaluations are recommended at that time., and the medication can be continued pending the results of the examination. Owners must keep the abscess site clean and debrided on a daily basis during the treatment period.
    Underlying deficiencies in husbandry practices must be corrected to prevent future occurrence of disease. The owner should be given a cautiously optimistic prognosis, with the potential for possible recurrence of the abscess or development of new lesions at different locations.
    Last edited by Johnny; 14-05-17 at 20:34.
    Hello all my name is Mariana, mother to the green iguana Johnny

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    Snr Moderator dimzel's Avatar
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    Marianne, thank you very much !!! Very useful information on abscesses.
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    My name is Irina. Sorry my mistakes in English.

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    Moderator Johnny's Avatar
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    I hope it helps Boris.
    Hello all my name is Mariana, mother to the green iguana Johnny

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    Yes, I copy all the information to convey to my vet. I hope this helps. I will add a photo of the operation to remove the abscess.
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    My name is Irina. Sorry my mistakes in English.

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    Mariana, thank you!!!!! This is EXCELLENT!
    Irina, I'm interested to know after abscess is removed if they will do the ablation to the tissue/abscess bed, to make sure everything that needed to be removed, is gone. The article said it was done by laser. This is like an insurance policy, to make sure it has little to no chance of coming back.
    It appears you will have to derbride the wound for the duration of treatment to remove necrosis/dead tissue. There may be a cream for that or you may physically have to.do this by scraping. You vet will guide you on after care.
    As well, surgery.seems to.be the ONLY means of permanently eradicating this due to the sac having to come out...so It does not fill.up again.
    Many things can cause it, I wasn't aware how it could occur in reptiles.
    Marianna, thank you a million times over being so helpful and sharing this! You are a true gem with a loving heart!


    Sent from my SAMSUNG-SM-G935A using Tapatalk

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    Snr Moderator dimzel's Avatar
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    Oh, Michel. God grant that I persuaded the veterinarian to have surgery. Name:  Отчаяние.gif
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Size:  270 BytesI hope she will learn the information about the operation.
    My name is Irina. Sorry my mistakes in English.

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    Moderator Johnny's Avatar
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    Johnny had a small abscess, very close to the surface. It came off by shedding in the area and the vet told me to leave it open and keep it clean. There was no reason to see him. To this day the abscess has not re-appeared but with every shedding there is a little skin (I think it is skin) that comes off from the inside.

    So there are chances that, even without laser cleaning, the abscess stay away for years.
    Hello all my name is Mariana, mother to the green iguana Johnny

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    Snr Moderator dimzel's Avatar
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    Thank you, Marianne. Similarly, the boy had an abscess. There was no laser cleaning. But there was a small abscess. In any case, we will use the available methods. There will not be a laser, unfortunately. But I'll be happy if the veterinarian agrees to do the operation.
    My name is Irina. Sorry my mistakes in English.

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    Snr Moderator dimzel's Avatar
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    Simple lancing and curettage, or removal of the internal caseous material, is not enough to prevent recurrence. Once the abscess capsule has been removed, the wound is left open to heal by secondary intention and granulation. Healing times vary depending on many factors but in general can take anywhere from 4 to 6 weeks.
    Scar tissue ensues but usually shrinks over time, leaving minimal changes to the skin.
    See the series in Fig. 42-7, A-L, to monitor the excision and healing of a typical reptilian abscess.
    Marianne, there is a photo, how it happens? I can not understand how to leave the wound open.
    My name is Irina. Sorry my mistakes in English.

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    Moderator Johnny's Avatar
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    Half a moment, please. Let me check.

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    Hello all my name is Mariana, mother to the green iguana Johnny

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