Avian Atherosclerosis: Parrots and Beyond

Comparison of Lipoprotein Analysis Using Gel-Permeation High-Performance Liquid Chromatography and a Biochemistry Analyzer in Normolipidemic and Dyslipidemic Quaker Parrots (Myiopsitta monachus)

Lipid accumulation disorders are common in psittacine birds and can be associated with changes in plasma lipoproteins, most notably low-density lipoprotein (LDL) and high-density lipoprotein (HDL). However, lipoprotein analysis by standard laboratory analyzers or an indirect method, such as the Friedewald formula, has not been validated in parrots. A research colony of 12 Quaker parrots (Myiopsitta monachus) were used to compare plasma values from the Roche Cobas c501 biochemistry analyzer for total cholesterol, total triglycerides, LDL, and HDL to gel-permeation high-performance liquid chromatography (GP-HPLC). To increase sample size and broaden the analytical range to include dyslipidemic samples, 2 cross-over studies were performed on a 0.3% cholesterol diet and a 20% fat diet. Agreement between methods was assessed by linear mixed models and Bland and Altman plots. The LDL concentrations calculated by the Friedewald formula and alternative formulas, and the effects of triglycerides on the biases, were also evaluated. Forty-five plasma samples were used. The cholesterol diet induced a marked increase in cholesterol and all lipoproteins, whereas the fat diet did not lead to dyslipidemia. Direct and indirect LDL measurements obtained with the clinical analyzer were not in clinical agreement with GP-HPLC, whereas HDL had acceptable agreement for normotriglyceridemic samples. Hypertriglyceridemic plasma samples were found to interfere with lipoprotein measurements. This study found LDL measured by the Roche Cobas c501 biochemistry analyzer and indirect estimations cannot be recommended in the Quaker parrot, and non-HDL cholesterol should be used instead. Lipoprotein panels obtained from hypertriglyceridemic samples should be interpreted with care.

Endogenous lipid pneumonia associated with atherosclerosis in a blue-fronted Amazon parrot (Amazona aestiva)

Endogenous lipid pneumonia is a rare inflammatory, non-infectious lung disease characterized by the accumulation of endogenous lipids in alveolar macrophages. It has been associated with bronchial obstruction, chronic lung inflammation, alveolar proteinosis and lipid storage disorders. A 14-year-old female blue-fronted Amazon parrot (Amazona aestiva) presented with intermittent dyspnoea, neurological signs and persistent lipaemia of unknown aetiology. At necropsy, the most relevant gross findings were increased rigidity of the great vessels, lungs with diffuse grey to whitish discolouration of the parenchyma and multifocal small yellowish nodules. Microscopic examination revealed typical lesions of atherosclerosis and severe multifocal accumulation of foamy macrophages filling the parabronchi, which led to a diagnosis of endogenous lipid pneumonia. Although the relationship between dyslipidaemia, atherosclerosis and endogenous lipid pneumonia in birds is not well established, the chronic dyslipidaemia of unknown origin could be involved in the pathogenesis of both the atherosclerosis and the endogenous lipid pneumonia. The present case highlights the need to better understand the relationships between various disorders of lipid metabolism in psittacine birds.

Effect of different injection rates and doses of contrast medium on the image quality of computed tomographic angiography in African grey parrots (Psittacus erithacus)

BACKGROUND

Atherosclerosis is a common cardiovascular disease in parrots but the antemortem diagnosis is challenging. In human medicine, computed tomography angiography (CTA) has been used widely for the diagnosis of atherosclerosis. By adjusting the injection rate and total dose of contrast medium, the image quality can be improved. To test the effects of different injection conditions on the image quality of major arteries, 10 African grey parrots (Psittacus erithacus) were used. Three injection rates (0.3, 0.4, 0.5 mL/s) and three doses (740, 370, 222 mg of iodine/bird) were tested while the other variables of the studies were fixed.

RESULT

A higher injection dose led to a significantly higher attenuation, image noise and diameter, with a lower signal-to-noise ratio and contrast-to-noise ratio of the six major arteries. The 370 mg of iodine/bird group showed significantly better subjective image quality. Furthermore, with increasing injection rates, the prevalence of heterogeneity decreased. However, we found an increased risk of injection failure for the 0.5 mL/s groups.

CONCLUSION

We recommend a combination of 370 mg of iodine/bird with 0.4 mL/s for clinical use to achieve better image quality for CTA.

Blood Lipid Diagnostics in Psittacine Birds

Lipids are the main biomolecular constituents of plasma and occupy a central place in the pathophysiology of several common diseases of parrots. Dyslipidemias frequently occur in psittacine birds in relation to a variety of lipid accumulation disorders and female reproductive disorders. The five main lipid classes in the plasma are sterols, fatty acyls, glycerolipids, glycerophospholipids, and sphingolipids. Most lipids are transported in the blood within lipoproteins. Lipidologic diagnostic tests to characterize dyslipidemias and risk factors of lipid disorders include routine biochemical tests such as cholesterol and triglycerides, lipoprotein testing, and newer comprehensive techniques to assess whole lipid pathways using lipidomics.

Cardiovascular Diseases in Pet Birds: Therapeutic Options and Challenges

Cardiovascular disease, including congestive heart failure, pericardial disease, and atherosclerosis, is becoming increasingly better recognized in companion birds. A wide range of medications is available to treat these conditions, including diuretics, vasodilators, positive and negative inotropes, antiarrhythmic agents, and pentoxifylline. This review systematically discusses each of these drug classes and their potential applications in avian species. Although treatment approaches remain largely empirical and extrapolated from small animal and human medicine, the management strategies presented here have the potential to both maintain quality of life and extend survival time for the avian cardiac patient.

Heart Disease in Pet Birds - Diagnostic Options

Cardiovascular diseases are common in pet birds. Diagnosis is often made postmortem only. In any case, suspicious for cardiac disease, a full diagnostic work up should be applied. First indications are given by the anamnestic data. Relative predisposition to cardiovascular diseases is associated with the species, breed, age, gender, lifestyle, and diet. Clinical signs and examination can reveal further indications of cardiovascular diseases, but may be unspecific or even without any pathologic finding. Diagnostic imaging, at least radiography, and echocardiography are always recommended. Advanced imaging methods, especially angiocardiography, can be valuable but is also more invasive and expensive.

Evaluation of Atherosclerotic Lesions and Risk Factors of Atherosclerosis in Raptors in Northern California

Atherosclerosis is a chronic inflammatory disease that has been reported to affect the cardiovascular system of many avian species. However, atherosclerosis in raptor species has not been fully evaluated. The aim of this study was to histologically characterize central and peripheral atherosclerotic lesions in raptors that were submitted to a pathology service in Northern California from 1986 to 2013. We also evaluated risk factors, including age, gender, origin, and avian family. Atherosclerotic lesions were categorized as minimal, mild, moderate, or severe, based on the severity of the lesions and their distribution within the arterial wall. Among the central arteries, lesions were determined to be of greater severity in the aorta than in the pulmonary artery. More than 50% of the peripheral arteries were affected, including 53.1% (17/32) myocardial, 52% (13/25) coronary, 62.9% (22/35) arteries in the kidney, 52.2% (12/23) gonadal and 51.7% (15/29) splenic arteries; however, hepatic and pulmonary arteries were uncommonly affected. Atherosclerosis was diagnosed in 17 raptor species representing 4 families: Accipitridae, Cathartidae, Falconidae, and Strigidae. The overall prevalence (95% CI) of atherosclerosis in raptors was 2.3% (36/1574; range, 1.63%-3.19%) with the Falconidae having the highest prevalence at 7.4% (9/122; range 3.64%-13.93%) and with 0% detected in the Tytonidae and Pandionidae families. A multiple logistic regression model that jointly accounted for differences in risk by family, age, and gender found that the risk in Accipitridae was significantly less than that of Falconidae, that adult raptors were at greater risk of atherosclerotic lesions than juveniles were, and that females were more frequently affected than males were.

Transvenous occlusion of patent ductus arteriosus in a domestic chicken (Gallus gallus)

A 2.5-year-old intact female Marans domestic chicken was presented for lethargy, open beak breathing, and hyporexia. Echocardiography noted left atrial and left ventricular enlargement and computed tomography angiography revealed a type III left-sided patent ductus arteriosus. Retrograde catheterization of the ductus was performed via percutaneous access of the right external jugular vein, and transvenous ductal occlusion was achieved using an 8-mm Amplatzer™ Vascular Plug 4. Transient bradycardia and hypotension occurred during right heart catheterization, which were successfully treated with atropine and epinephrine. A two-week follow-up postoperative cardiac computed tomography scan confirmed appropriate placement of the occluder within the ductus, and echocardiography demonstrated reduced left heart size. The chicken showed an improvement in clinical signs and remains apparently well six months after the intervention. This report describes the computed tomographic findings of a patent ductus arteriosus in an avian species, minimally invasive transvenous closure of this congenital anomaly with a low-profile occlusion device, and the associated challenges and considerations specific to cardiac intervention in an avian patient.

Pulmonary Artery Aneurysm in a Greater Flamingo (Phoenicopterus roseus) Associated with Aspergillus fumigatus Infection

We report necropsy findings in a captive 60-year-old female greater flamingo (Phoenicopterus roseus) that died suddenly following rupture of a pulmonary artery aneurysm. Histologically, there was focally extensive, intramural granulomatous inflammation with intralesional fungal hyphae, and adjacent severe mixed-cell inflammation and acute haemorrhage at the rupture site. Aspergillus fumigatus was identified as the aetiological agent following DNA PCR amplification and sequencing from paraffin-embedded pulmonary artery tissue sections. The most likely explanation is that this lesion was a consequence of haematogenous spread, secondary to mycotic pneumonia or aerosacculitis, following aspiration of A. fumigatus conidiospores. However, no further fungal-related lesions were observed on gross or histopathological examination.

Evaluation of Orally Administered Atorvastatin on Plasma Lipid and Biochemistry Profiles in Hypercholesterolemic Hispaniolan Amazon Parrots (Amazona ventralis)

Atorvastatin is a synthetic statin administered in its active form and used for the treatment of dyslipidemias. In the current study, the effects of atorvastatin were evaluated on plasma lipid profiles and the potential for adverse effects after once daily PO dosing of atorvastatin for 30 days in Hispaniolan Amazon parrots (Amazona ventralis). Sixteen adult parrots (10 female, 6 male) with hypercholesterolemia were used for this study. Birds were assigned to 2 groups (treatment and control) of 8 parrots each (3 male, 5 female) after balancing for age, sex, originating institution, and baseline plasma cholesterol values. Compounded atorvastatin oral suspension (10 mg/kg) was administered PO once daily via gavage into the crop. Equivalent volumes of placebo suspension were administered to the control group. Plasma biochemistry and plasma lipid profile analysis (total cholesterol, high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C], and triglycerides [TGs]) were analyzed on days 0, 14, and 30. Plasma samples and HDL-C fractions were evaluated for cholesterol and TG concentrations via enzymatic assays. Subtraction of HDL-C values from total cholesterol yielded the non-HDL-C concentration for each bird. Birds were routinely assessed for appetite, activity, and urofeces. Plasma atorvastatin concentrations were obtained from 7 of 8 birds in the treatment group from banked samples. Those samples were obtained on days 14 and 30, with drug administration 6 to 8 hours before collection. No significant differences were observed in total cholesterol, HDL-C, non-HDL-C, or TG between treatment and control groups at days 0, 14, and 30. Plasma atorvastatin concentrations were variable on day 14 (0.54-5.41 ng/ mL for 6 of 7 samples, with 1 outlier of 307 ng/mL) and on day 30 (0.79-6.74 ng/mL). No adverse effects were noted in any of the birds during the study period. When dosed PO at 10 mg/kg once daily, atorvastatin did not result in significant changes to plasma lipid profiles (eg, lowering of plasma total or non-HDL-C concentrations) at any time point during this study. Future studies to investigate pharmacokinetic and pharmacodynamic properties of atorvastatin in parrots may require increased doses and/or frequency of administration.

The plasma lipidome of the Quaker parrot (Myiopsitta monachus)

Dyslipidemias and lipid-accumulation disorders are common in captive parrots, in particular in Quaker parrots. Currently available diagnostic tests only measure a fraction of blood lipids and have overall problematic cross-species applicability. Comprehensively analyzing lipids in the plasma of parrots is the first step to better understand their lipid metabolism in health and disease, as well as to explore new lipid biomarkers. The plasma lipidome of 12 Quaker parrots was investigated using UHPLC-MS/MS with both targeted and untargeted methods. Targeted methods on 6 replicates measured 432 lipids comprised of sterol, cholesterol ester, bile acid, fatty acid, acylcarnitine, glycerolipid, glycerophospholipid, and sphingolipid panels. For untargeted lipidomics, precursor ion mass-to-charge ratios were matched to corresponding lipids using the LIPIDMAPS structure database and LipidBlast at the sum composition or acyl species level of information. Sterol lipids and glycerophospholipids constituted the majority of plasma lipids on a molar basis. The most common lipids detected with the targeted methods included free cholesterol, CE(18:2), CE(20:4) for sterol lipids; PC(36:2), PC(34:2), PC(34:1) for glycerophospholipids; TG(52:3), TG(54:4), TG(54:5), TG(52:2) for glycerolipids; SM(d18:1/16:0) for sphingolipids; and palmitic acid for fatty acyls. Over a thousand different lipid species were detected by untargeted lipidomics. Sex differences in the plasma lipidome were observed using heatmaps, principal component analysis, and discriminant analysis. This report presents the first comprehensive database of plasma lipid species in psittacine birds and paves the way for further research into blood lipid diagnostics and the impact of diet, diseases, and drugs on the parrot plasma lipidome.

Medical Causes of Feather Damaging Behavior

Feather damaging behavior (FDB), also referred to as feather picking, feather plucking, or pterotillomania, is one of the most common and frustrating clinical presentations in captive psittacines. The clinical approach to identify underlying medical conditions associated with FDB is reviewed. Primary feather or skin diseases as well as systemic diseases may lead to this syndrome. This article focuses on the medical causes of FDB documented in the current avian literature. Medical causes are presented using the VITAMIN D algorithm. Key components of the multifaceted therapeutic approach in managing FDB of medical origin are discussed.

Gerontology of Psittacines

With recent improvements in the husbandry, nutrition, and veterinary care of captive psittacines, the avian clinician must be familiar with common medical condition seen in geriatric parrots. A review of the theory of evolution and avian senescence is provided. Five clinically relevant medical conditions are described: organ failure, atherosclerosis, neoplasia, cataracts, and osteoarthritis.

Comparison of a Point-of-care Cholesterol Meter With a Reference Laboratory Analyzer in Companion Psittaciformes

Hypercholesterolemia is common in captive Psittaciformes. A point-of-care cholesterol analyzer would be useful to monitor hypercholesterolemia in psittacine birds. We compare a point-of-care cholesterol analyzer (PTS-Diagnostics CardioChek) with a reference laboratory analyzer (Roche Cobas c501) and provide initial assessment of precision and accuracy. A prospective method comparison study was designed to compare the CardioChek and Cobas c501 by assessment of clinical and analytical agreement using Passing-Bablock regression analysis and difference plots. Initial accuracy was assessed by running cholesterol standards, and initial precision was assessed by calculating between-run coefficient of variation on samples from selected birds. A total of 42 psittacine birds were sampled. No significant constant bias was found between the Cobas and CardioChek. However, a significant negative proportional bias was evident, suggesting that the point-of-care analyzer tended to underestimate cholesterol values. Lipemia and hemolysis had strong effects on increasing bias. Hematocrit, glucose level, and genus had no significant impact on bias, controlling for lipemia and hemolysis. Accuracy of the CardioCheck was suboptimal to that of the Cobas, but precision was good. When defining hypercholesterolemia as >8 mmol/L (309 mg/dL), the CardioChek had a sensitivity of 57% and specificity of 96%. There was neither analytical nor clinical agreement between the CardioChek and Cobas c501. Values obtained from the CardioChek cannot be used to determine or monitor hypercholesterolemia in parrots in the absence of analyzer-specific reference intervals.

Feed processing effects on digestibility, palatability, excreta fermentation products and blood parameters in blue-fronted amazon parrots (Amazona aestiva)†

Captive parrots show a high incidence of obesity and other metabolic disorders due to the consumption of unbalanced diets. Therefore, this study evaluated the digestibility and metabolic effects of transitioning blue-fronted amazons from a high fat diet (sunflower seeds) to processed diets with three degrees of starch gelatinization (SG). The same feed formulation was processed to obtain pelletized feed (PEL) at 27.1% SG; low-cooked extruded feed (EXT_L ) at 81.6% SG; and high-cooked extruded feed (EXT_H ) at 98.5% SG. Thirty adult parrots were fed sunflower seeds for 90 days, then were distributed in a completely randomized design with 10 repetitions per treatment, and fed one of the three prepared diets for 160 days. Feed palatability, apparent digestibility, excreta concentrations of volatile fatty acids, lactate and ammonia, initial and final radiographic examinations, blood cell counts and glucose, triglycerides, cholesterol, total protein, albumin, aspartate aminotransferase (AST) and uric acid levels were evaluated. The data were analysed by an analysis of variance and compared by Tukey's test (p < 0.05). Sunflower seed was more digestible than processed feeds (p < 0.05). Diet processing interfered with fat and starch digestibility (p < 0.001), being higher in the PEL than in the EXT_H and EXT_L respectively. Transitioning from sunflower seeds to balanced diets reduced serum glucose, triglycerides, cholesterol and AST (p < 0.05) and increased red blood cell, haemoglobin, lymphocyte, monocyte and leucocyte counts (p < 0.01). Radiographs indicated a decreased hourglass (p = 0.015) and a reduced heart-liver ratio after ingesting the processed feeds (p < 0.05). Feed processing did not affect blood cell counts, serum biochemistry or radiographic examinations. In conclusion, parrots preferred the extruded diet and did not require an extensive SG to properly digest the feed. Consuming the processed diets improved the birds' metabolism and health.

Cardiovascular Drugs in Avian, Small Mammal, and Reptile Medicine

Cardiovascular disease, including congestive heart failure, pericardial disease, and atherosclerosis, is becoming increasingly better recognized in companion birds, small mammals, and reptiles. A wide range of medications is available to treat these conditions, including diuretics, vasodilators, positive and negative inotropes, antiarrhythmic agents, and pentoxifylline. This review systematically discusses each of these drug classes and their potential applications in exotic species. Although treatment approaches remain largely empirical and extrapolated from small animal and human medicine, the management strategies presented here have the potential to both maintain quality of life and extend survival time for the exotic cardiac patient.

Lipoidal corneal degeneration in aged falcons

OBJECTIVE

To present a case series of idiopathic lipoidal corneal degeneration in falcons.

ANIMALS STUDIED

Five falcons including three peregrine falcons (Falco peregrinus), one prairie falcon (Falco mexicanus), and one red-naped shaheen (Falco peregrinus babylonicus) were observed to develop slowly progressive corneal opacification that began at the temporal limbus and extended centripetally across the cornea over a period of years. Four of the birds were over 20 years old.

PROCEDURES

All animals underwent complete ophthalmic examinations. A red-naped shaheen underwent ocular imaging via spectral-domain optical coherence tomography. Two peregrine falcons were euthanized due to declining health, and their eyes were examined histologically.

RESULTS

The opacities were pale and granular, with frequent vascularization associated perilimbally. Diffuse neutral lipid was observed in stromal cells throughout the corneal stroma of both clear and opaque areas of the cornea, sparing only the acellular anterior limiting lamina. Clusters of cholesterol crystals surrounded by macrophages were present in the mid-stroma. Fibrosis was evident in a subepithelial location, which separated the epithelium from the anterior limiting lamina. Ultrastructurally, diffuse vacuolization of the keratocytes was observed. No other ophthalmic or systemic abnormalities were noted.

CONCLUSIONS

Results suggest that lipid degeneration occurs rarely in captive falcons of advanced age. The underlying cause is unclear. Though unsubstantiated, possible contributing factors include dyslipoproteinemia, corneal trauma, diet, and age-related alterations in corneal metabolism. The initiation of pathology at the temporal limbus, as well as slow progression, suggests that exposure contributes to the onset and progression of this unique keratopathy.

Spontaneous diseases in captive ratites (Struthioniformes) in northwestern Germany: A retrospective study

A retrospective study was carried out to define the spectrum of spontaneous diseases in ostriches and few other captive ratites, order Struthioniformes, in northwestern Germany. The investigation included 71 ratites necropsied between 1968 and 2014. They consisted of 54 ostriches, 5 emus, and 12 rheas with 37 adults, 23 juveniles and 11 neonates and embryonated eggs. Necropsy reports were reviewed, histologic preparations were re-examined and additional histochemical and immunohistochemical stains were carried out in selected cases. In many animals more than one morphologic diagnosis attributable to different disease processes was found. In adult animals (n = 37), the most commonly altered organ systems were the musculoskeletal system (49%), the digestive system (46%), and the cardiovascular system (46%) affected by traumatic lesions, inflammatory and degenerative changes, respectively. A spongy degeneration was found in the brain (35%); however, immunohistochemistry and western blotting failed to detect pathological prion protein. In juvenile animals (n = 23), the musculoskeletal (44%) and the digestive system (43%) were mainly affected by traumatic and inflammatory lesions, respectively. In embryonated eggs and neonates (n = 11) the major cause of death was circulatory failure associated with generalized subcutaneous edema as described for improper incubation conditions (64%). Summarized, most of the findings observed in adult and juvenile ratites in northwestern Germany are related to trauma, inflammatory and degenerative disorders, whereas death in embryonated eggs and neonates was most likely related to breeding conditions. A spongy encephalopathy awaits further studies to elucidate cause and pathogenesis.

Systemic Clinical and Metabolic Diseases

Like other animals pet and companion birds are also prone to systemic illness. This is presented in the form of certain clinical signs and symptoms which is known as “ sick-bird syndrome.”

Plasma Drug Concentrations of Orally Administered Rosuvastatin in Hispaniolan Amazon Parrots (Amazona ventralis)

Atherosclerotic diseases are common in pet psittacine birds, in particular Amazon parrots. While hypercholesterolemia and dyslipidemia have not definitely been associated with increased susceptibility to atherosclerosis in parrots, these are important and well-known risk factors in humans. Therefore statin drugs such as rosuvastatin constitute the mainstay of human treatment of dyslipidemia and the prevention of atherosclerosis. No pharmacologic studies have been performed in psittacine birds despite the high prevalence of atherosclerosis in captivity. Thirteen Hispaniolan Amazon parrots were used to test a single oral dose of 10 mg/kg of rosuvastatin with blood sampling performed according to a balanced incomplete block design over 36 hours. Because low plasma concentrations were produced in the first study, a subsequent pilot study using a dose of 25 mg/kg in 2 Amazon parrots was performed. Most plasma samples for the 10 mg/kg dose and all samples for the 25 mg/kg dose had rosuvastatin concentration below the limits of quantitation. For the 10 mg/kg study, the median peak plasma concentration and time to peak plasma concentration were 0.032 μg/mL and 2 hours, respectively. Our results indicate that rosuvastatin does not appear suitable in Amazon parrots as compounded and used at the dose in this study. Pharmacodynamic studies investigating lipid-lowering effects of statins rather than pharmacokinetic studies may be more practical and cost effective in future studies to screen for a statin with more ideal properties for potential use in psittacine dyslipidemia and atherosclerotic diseases.