Diagnosis of mycobacterial infections in the exotic pet patient with emphasis on birds

A review of avian mycobacteriosis: An emerging bacterial disease of public health concern

Avian mycobacteriosis is a chronic debilitating disease of birds which poses a public health threat. In avian species, the disease is primarily caused by Mycobacterium avium subspecies avium. Nearly all bird species are susceptible to this infection, with older birds being more susceptible than younger ones. Ingestion of feed and water contaminated by the excreta of infected or chronic carrier birds is the main route of Mycobacterium infection and transmission; however, the respiratory route is also possible. Migratory wild or free-living birds play an important role in mycobacteriosis transmission, and affected birds show severe depletion, emaciation, anemia, diarrhea, and respiratory manifestations. The appearance of characteristic tuberculous nodules in the digestive system, especially in the intestine, liver, and spleen, is pathognomonic. Confirmation of Mycobacterium infection can be achieved through isolation on specifically selected media, direct smear for detection of characteristic acid-fast bacilli, and detection of the bacterium using molecular diagnostic methods. Serological and allergic tests can also be applied. Different species of Mycobacterium, especially M. avium, have public health significance and can be transmitted from birds to humans. Such zoonosis is especially dangerous in human immunocompromised patients. Authorities and governments have implemented strict and comprehensive eradication programs for avian mycobacteriosis. These biosecurity measures, including surveillance monitoring programs and antimicrobial susceptibility testing, are essential for the prevention and treatment of Mycobacterium infection in poultry production systems. This review was designed to focus on avian mycobacteriosis in birds and humans.

Managing the Health of Captive Groups of Reptiles and Amphibians

Managing the health of reptile and amphibian collections is centered on providing appropriate environmental parameters, husbandry conditions, and nutrition as well as maintaining good welfare and careful collection planning. Disease transmission is reduced through quarantine, appropriate diagnostic testing, and annual veterinary health assessment."

Retrospective Review of Mycobacterial Conjunctivitis in Cockatiels (Nymphicus hollandicus)

The etiologic disease organism responsible for causing mycobacteriosis in avian species is an acid-fast gram-positive bacterium. This bacterium causes granulomatous disease in various internal organs, but in cockatiels (Nymphicus hollandicus) it has been commonly identified within the conjunctival tissues. Twenty-six cases of mycobacterial conjunctivitis in cockatiels were diagnosed through histopathologic assessment of diseased tissue samples, Fite acid-fast staining, and polymerase chain reaction in this retrospective study. Clinicians who saw these cases were contacted, and information was obtained regarding recommended treatment protocols prescribed for the patients, the Mycobacterium species identified, and case outcomes. All patients in this retrospective study had a biopsy performed on the affected conjunctival tissue, and because of the small size of the patients, this excisional biopsy removed the affected tissue in its entirety or significantly debulked the lesion. Of the 26 cases, 10 were lost to follow-up, 4 were euthanatized, 7 died, and 5 were alive at the time this information was submitted for publication.

Treatment of a mycobacterial infection in an Eastern Long-neck turtle (Chelodina longicollis)

BACKGROUND

Mycobacterial infections are uncommonly diagnosed in reptiles. These infections are often systemic, chronic, and well advanced before presentation and diagnosis. Turtles, both marine and freshwater, appear to have a higher prevalence of the disease than other reptiles, perhaps because of their aquatic environment.

CASE REPORT

An Eastern Long-neck turtle (Chelodina longicollis) was diagnosed with an apparently localised mycobacterial infection in the right foot. Biopsy, culture and PCR were used to make the diagnosis. Treatment with clarithromycin and rifampicin given orally for 9 months appeared to successfully resolve the infection.

CONCLUSION

Antemortem diagnosis is difficult although molecular diagnostic techniques are improving the rates of diagnosis. Treatment of mycobacteria is lengthy, difficult and challenging to the patient, the owner and the veterinarian. For this reason, and because of the potential for zoonotic infection, it is infrequently undertaken.

Case Study and Attempt of Treatment of Mycobacteriosis Caused by Mycobacterium avium in a Parental Flock of Meat-Breed Pigeons

Mycobacteriosis caused by Mycobacterium avium subsp. avium was observed in a parental loft of 70 meat-breed pigeons. It was decided to undertake treatment as the birds represented a substantial value to the owner. A multiagent therapy using azithromycin, marbofloxacin, and ethambutol was administered. After 4 mo of therapy, the desired results were not obtained. At the end of treatment, the birds were in poor general condition, with white blood cells above 20 g/L, and after clutching, 2-yr-old and older birds were euthanatized. Overall, postmortem lesions were found in 17 out of 49 necropsied individuals. Slide agglutination tests with a M. avium subsp. avium lysate were conducted in all examined pigeons. In 28 pigeons, blood count was conducted once a month during therapy, while in 24 pigeons, a tuberculin sensitivity test was conducted before the planned euthanatization. The tuberculin sensitivity test did not prove useful in the diagnosis of ill individuals. Slide agglutination yielded positive results in only four birds, all of which also had postmortem lesions. Blood count in a large number of cases allowed distinguishing between ill and healthy individuals, which was used for subsequent selection. The comparison of cultured strains with the (CCG)4-based PCR method showed the variation of M. avium isolates up to a maximum of 30%. The described case proves that the treatment of mycobacteriosis in pigeon flocks is not effective, mainly due to the high resistance to M. avium subsp. avium. In addition, therapy may contribute to an even greater increase in mycobacterial resistance to antibiotics, which may pose a potential risk to public health.

Hematologic values in domestic pigeons naturally infected with Mycobacterium avium subsp. avium

Avian mycobacteriosis is an important disease of birds and is most often caused by Mycobacterium avium or Mycobacterium genavense. However, little information on the hematologic changes associated with this infectious disease in pigeons has been published. The aim of this investigation was to compare the hematologic parameters of domestic pigeons (Columba livia var. domestica) naturally infected with M avium subsp. avium (MAA) with clinically healthy pigeons. Blood samples were collected from 12 pigeons with suspected mycobacteriosis and 12 clinically healthy pigeons. All the birds with suspect infections were necropsied, and affected organs were cultured and examined on histopathology for mycobacteriosis. Total leukocyte and erythrocyte counts were performed on each blood sample with the Natt and Herrick method using a Neubauer hemocytometer. White blood cell (WBC) differential counts were performed on Giemsa-stained blood smears. Packed cell volumes (PCVs) were measured using the microhematocrit technique. Hemoglobin concentrations were measured with a spectrophotometer using the cyanomethemoglubin method. Mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentrations (MCHCs), and mean cell volumes (MCVs) were calculated manually. All of the infected birds had typical histopathologic findings of avian mycobacteriosis, which were confirmed using microbiologic and molecular methods to detect MAA. The hematologic data from the two groups were compared. The total WBC, heterophil, lymphocyte, and monocyte counts were significantly higher, and the PCV, HGB, MCH, and MCHC values were significantly lower in the infected birds compared with the clinically healthy pigeons.

Avian Mycobacteriosis and Molecular Identification of Mycobacterium avium Subsp. avium in Racing Pigeons (Columba livia domestica) in Greece

Simple Summary

Avian mycobacteriosis a contagious, chronic and potential zoonotic List B disease of the World Organization for Animal Health, is described in two lofts of pigeons in this review. Molecular analysis identified the causative agent as Mycobacterium avium subsp. avium. This is the first case report of avian mycobacteriosis in Greece, which describes the presence of granulomatous conjunctivitis and the molecular identification of M. avium subsp. avium as the causative agent in racing pigeons. The identification of the strain will enrich the epidemiological data and will contribute to the control of avian mycobacteriosis in pigeons.

Abstract

In this report, cases of avian mycobacteriosis in two lofts of racing pigeons are described. Three racing pigeons of 2-year old from the first loft (A) and four racing pigeons of 4–5 years old from the second loft (B) were submitted to the Unit of Avian Medicine for clinical examination and necropsy. In the case history chronic and debilitating disease was reported. The clinical signs included emaciation, depression, lameness, periorbital swelling and diarrhea, although the appetite was normal. Post mortem lesions involved an enlarged spleen with multiple different sized yellow nodules. Similar lesions were also observed in the liver, conjunctiva of the inferior eyelids and in the femoral bone marrow. The suspicion of avian mycobacteriosis was based on history, clinical signs and typical lesions. In order to confirm the diagnosis, histopathology was performed on tissue sections and revealed the presence of multiple granulomas with central necrosis. In addition, Ziehl-Neelsen positive bacilli were observed in histological sections and smears from the granulomas of the affected tissues. Molecular analysis identified the causative agent as Mycobacterium avium subsp. avium. This is the first case report of avian mycobacteriosis in Greece, which describes the presence of granulomatous conjunctivitis and the molecular identification of M. avium subsp. avium as the causative agent in racing pigeons.

Isolation, Identification, and Characterization of a New Highly Pathogenic Field Isolate of Mycobacterium avium spp. avium

Avian tuberculosis is a chronic, contagious zoonotic disease affecting birds, mammals, and humans. The disease is most often caused by Mycobacterium avium spp. avium (MAA). Strain resources are important for research on avian tuberculosis and vaccine development. However, there has been little reported about the newly identified MAA strain in recent years in China. In this study, a new strain was isolated from a fowl with symptoms of avian tuberculosis by bacterial culture. The isolated strain was identified to be MAA by culture, staining, and biochemical and genetic analysis, except for different colony morphology. The isolated strain was Ziehl-Zeelsen staining positive, resistant to p-nitrobenzoic acid, and negative for niacin production, Tween-80 hydrolysis, heat stable catalase and nitrate production. The strain had the DnaJ gene, IS1245, and IS901, as well. Serum agglutination indicated that the MAA strain was of serotype 1. The MAA strain showed strong virulence via mortality in rabbits and chickens. The prepared tuberculin of the MAA strain had similar potency compared to the MAA reference strain and standard tuberculin via a tuberculin skin test. Our studies suggested that this MAA strain tends to be a novel subtype, which might enrich the strain resource of avian tuberculosis.

MYCOBACTERIOSIS IN CAPTIVE PSITTACINES: A BRIEF REVIEW AND CASE SERIES IN COMMON COMPANION SPECIES (ECLECTUS RORATUS, AMAZONA ORATRIX, AND PIONITES MELANOCEPHALA)

In 2015, three psittacines were presented within 30 days, each with differing clinical signs and patient histories. A 13-yr-old male eclectus parrot (Eclectus roratus) was presented for weakness, depression, and acute anorexia. On presentation it was determined to have a heart murmur, severely elevated white blood cell count (93.9 10³/μl) with a left shift (2.8 10³/μl bands), and anemia (30%). Severe hepatomegaly was noted on radiographs, ultrasonography, and computed tomography. A cytological sample of the liver obtained through a fine needle aspirate revealed intracellular acid-fast bacilli identified as Mycobacterium avium. A 20-yr-old female double yellow-headed Amazon parrot (Amazona oratrix) was presented for a 1-mo history of lethargy and weight loss despite a good appetite. The parrot's total white blood cell count was 16.8 10³/μl and the PCV was 35%. Following its death, a necropsy revealed a generalized granulomatous condition that involved the small intestines, lungs, liver, spleen, and medullary cavities of the long bones, with intracellular acid-fast bacilli identified as Mycobacterium genavense. The third case, an 18-mo-old female black-headed caique (Pionites melanocephala), was presented with a 1-day history of lethargy and depression. On presentation, the caique had a heart murmur, distended coelom, palpable thickening of the coelomic organs, and increased lung sounds. Following the caique's death, a complete necropsy revealed mycobacteriosis of the liver, spleen, small intestines, pericardial fat, and bone marrow. The infection was identified as Mycobacterium genavense. The importance of advances in Mycobacterium spp. identification, continued presence of this organism in captive avian populations, difficulty in obtaining a definitive antemortem diagnosis, and conflicting recommendations regarding treatment are thought-provoking areas of focus in this case series.

Evaluation of Multidrug Therapy With Azithromycin, Rifampin, and Ethambutol for the Treatment of Mycobacterium avium subsp avium in Ring-neck Doves (Streptopelia risoria): An Uncontrolled Clinical Study

An uncontrolled clinical study was conducted to evaluate the efficacy of a multidrug protocol in 16 ring-neck doves ( Streptopelia risoria ) from a flock naturally infected with Mycobacterium avium subsp avium. The doves were considered infected on the basis of a high prevalence of infection in a group of 29 birds that were euthanatized from the same flock and clinical signs and pathologic results consistent with infection in the remaining birds. All birds were treated with azithromycin (43 mg/kg), rifampin (45 mg/kg), and ethambutol (30 mg/kg) administered orally once daily for 180 days. Five birds died during treatment and were confirmed positive for mycobacteriosis on postmortem examination. Of the remaining 11 birds, infection and disease were present in 9 (81.8%) at the end of the treatment. Postmortem investigation showed that 2 mycobacterial isolates were resistant to ethambutol, intermediately sensitive to rifampin, and sensitive to azithromycin. Microscopic examination of liver sections equivalent of those that would be taken for biopsy showed that biopsy as a method of monitoring birds for treatment success had poor sensitivity. Toxicity associated with drug therapy was not observed in these doves nor in 6 outwardly healthy ring-neck doves exposed to the same treatment. The results of this study showed that this protocol of azithromycin, rifampin, and ethambutol has poor efficacy when administered for 180 days for treatment of doves infected with M avium subsp avium.

Chronic dermatitis caused by Lactobacillus jensenii infection in a blue and gold macaw (Ara ararauna)

CASE DESCRIPTION

A 5-year-old sexually intact female blue and gold macaw (Ara ararauna) was evaluated because of a swelling on the right side of the face and irritated area on the ventral aspect of the keel.

CLINICAL FINDINGS

Clinical findings were consistent with dermatitis (right facial lesion) and a coalescing subdermal granuloma (ventral keel lesion). Hematologic analysis revealed monocytosis and mild anemia. Histologic evaluation of the ventral keel lesion revealed evidence of chronic heterophilic dermatitis with multinucleated giant cells and bacterial rods and cocci. An unspeciated gram-positive rod-shaped bacterium was isolated via aerobic bacterial culture. Results of bacterial biochemical tests suggested the organism was a type of Actinomyces. A 16S rRNA gene sequence analysis was performed; results indicated the organism was Lactobacillus jensenii.

TREATMENT AND OUTCOME

Extensive surgical debridement of the branching granuloma, which extended throughout the length of the keel, followed by long-term treatment with ciprofloxacin and clindamycin provided full resolution of clinical signs. No recrudescence of clinical signs was evident for up to 18 months after the initial evaluation.

CLINICAL RELEVANCE

To the authors' knowledge, this is the first report of Lactobacillus-associated dermatitis or subdermal granuloma in the scientific literature and the second report of L jensenii in avian species. Use of 16S rRNA gene sequence analysis was instrumental in the identification of this fastidious organism, indicating the method's usefulness as a diagnostic tool.

Zoonoses in pet birds: review and perspectives

Pet birds are a not-so-well known veterinarian’s clientship fraction. Bought individually or in couples, as families often do (which is a lucrative business for pet shops or local breeders) or traded (sometimes illegally) for their very high genetic or exotic value, these birds, commonly canaries, parakeets or parrots, are regularly sold at high prices. These animals, however, are potential carriers and/or transmitters of zoonotic diseases. Some of them could have an important impact on human health, like chlamydophilosis, salmonellosis or even highly pathogenic avian influenza A H5N1. This review paper, although non exhaustive, aims at enlightening, by the description of several cases of bird-human transmission, the risks encountered by bird owners, including children. Public health consequences will be discussed and emphasis will be made on some vector-borne diseases, known to be emergent or which are underestimated, like those transmitted by the red mite Dermanyssus gallinae. Finally, biosecurity and hygiene, as well as prevention guidelines will be developed and perspectives proposed.