---start---- four handouts today! viral diseases, zoonoses, bacterial disease, ultrasound next week's quiz: will have some stuff on radiology from the handout; bacterial and viral infections; not really mycoplasma or fungal infections; a little about zoonosis. quiz one: 30 quiz two: 34 quiz three: 36 total: 100 points Bacterial infections: the old adage - a ruffled feathered, puffed up bird probably has a bacterial disease. do not take that at face value. parasites, viruses also have this effect. but bacterial disease is common. may be primary or secondary infection. because we tend to do that quickly when dealing with only a single caged bird with a history of illness coming on suddenly (within last 8 hrs to 18 months, depending on owners...); owners often will try treating the bird by picking up something at the pet store. this can go on for some time. may go back and forth b/w medications. even without owner having given meds, vets in general sort of look toward antimicrobials as first line of defense. this is where we get into a fair amount of trouble - we're too quick to pull an antibiotic off the shelf with no sound basis for so doing. or we change drugs too often. in birds, this leads quickly to problems, if none other than secondary fungal and yeast overgrowth which only complicate things. try to be more cautious, wrt when and what you treat with abx. the tendency is often to use the big gun, strong, powerful drugs first which may not be the best option. if you have done cultures, fine. there may be other drugs less rigorous or strong which do a fine job for you. if you do choose a big gun first, may see resistance and lack of efficacy of other drugs, and you are now at a loss as to what drug to use. this is true for any species, not just birds, or reptiles. also it is true that often you see it said that a particular bacteria causes disease x in the bird, or caused the death of a bird, when in fact in the literature there are few primary bacterial pathogens described in birds. we often do not know what is going on. bacterial epidemics are uncommon, except perhaps in aviaries. when only one or two or four birds in a home, it's unlikely for all birds to have bacterial infection simultaneously. a number of spp (bacterial spp) can cause complex problems (see list- chlamydia, mycobacteria, pasteurella, salmonella, yersinia) may cause epidemic like outbreaks, but not common. when you are considering making a dx of a bacterial dz, must know something about the nromal flora. a culture isn't helpful without knowing what should be there. if you culture nares, oral cavity, choanal slit, cloaca - most likely you will grow something. what it is is the question. is it part of normal flora? is it there in overwhelming number sor small numbers? is there a pure growth? is there no growth? all are issues that have to be taken into account before you finally choose to call it a bacterial infection or not. birds that are well set in a household who have not been ill before or exposed to other birds or new birds coming in are unlikely to suddenly come down witha bacterial infection, unless there has been an environmental disturbance - cold stress, heat stress, nutritional problem, age may be a factor, concurrent disease even that is undiagnosed, anything causing some change in that bird's immune status, making it immune compromised in some way. we certainly seem to find that in situations where you encounter a bird like that, an adult or hatchling or juvenile which hasn't retained full immunocompetency yet - even nonpathogenic forms of bacteria may in those circumstances opportunistically create infections. so organisms you think aren't a primary or secondary pathogen can become so in those conditions. bacterial dz and signs of same are usually fairly nonspecific. there may be depression, anorexia. may be discharge from nares, cloaca. may be diarrhea, blood tinged or not, may be swelling of abdomen if organs are affected like liver (hepatitis) or kidneys, or if spleen is enlarged which it may be. too often, really hot bacterial infections become peracute, and all you see is a bird that was fine and is now dead. or, it may be that it's a fairly mild infection that causes a chronic disease, and the bird gets better and worse and better and worse over time and bird starts wasting away. one question to ask yourself when you do a culture or grow an organism: is the bird clinically ill? do the signs of disease match a potential bacterial infection by the organism(s) that you cultured? or if you have a breeding aviary, are the signs you see reproductive problems, are there problems with reproductive performance, and can this organism cause repro tract disease to the extent it would cause this? understand - just b/c bird looks like it might have a bacterial disease (ruffled, hunched, etc) does not mean it has one. what else do you look for if you suspect bacterial dz? many of the infections will produce heterophilia. heterophile = avian homolog of neutrophil. very high WBC. high heterophil count. if bird is tending toward sepsis, heterophils may have toxic change, toxic vacuoles. if bird was in good shape when it became ill and all was fine up to then, you might suddenly see an increased fibrinogen and elevated globulin or TP, but certainly the globulin fraction will increase. and if dealing with an infection that causes hepatic insult then enzymes that are liver indicative may be increased. we'll talk more about that next week, when Dr Josh someone will lecture on use of hematology and chemistry in diagnosis. you can use the standard diagnostic techniques on birds, just need small amounts of blood. p 2 - normal flora - listed there sometimes it is surprising that as normal flora there may be clostridia or corynebacteria (?) as part of the blend of organisms (but not as pure growth or predominant organism). same is true of gram negative organisms. we used to think birds only had gram positive flora in oral cavity or cloaca. you should expect in pet birds only gram positives from these sites, however, if you find a gram negative organism you should not freak out. the birds you deal with as a pet bird, psittacines, small passerines, etc - will have mostly gram positives. if you find some e.coli, klebsiella - not a big deal. BUT if bird has signs of respiratory disease, labored breathing, is off food, dyspneic, etc - and you do a tracheal wash and culture out pure klebsiella, then you have a big problem!! consider perhaps there has been some insult resulting in a klebsiella infection of the respiratory tract. do a sensitivity and choose an appropriate drug or drug combination. finding e.coli isn't a horrible thing, unless that is all you find. remember that when you culture and you get this report back that there is no growth, when you obviously took a fecal culture...or if you took sample from an obviously infected soft tissue wound with suppurative discharge, you expect some growth - but how you took the sample, processed and shipped it, etc - can all be a factor. what you get back depends on what you put in. a parrot presenting with slightly open mouthed breathing, ruffled feathers, in good body weight but just sitting on perch, dull eyed looking, not doing much - has discharge from nares - you go "aha! respiratory disease" and you culture the discharge. you culture a garden of perhaps no relativity to the condition you try to diagnose, though, because it may be contaminated, it may be mixed with stuff from food, or whatever...you can clean it up, clean the whole area, swab it down, wait for fresh d/c to come out - culture that...there are very small microswabs you can use to enter small orifices too, like the nares of a larger parrot. on parakeet you can't really do that. or if you swab the oral cavity, if you are looking for respiratory bug, the choanal slit is a good place to culture but you have to be precise, carefully restrain bird and then use the right sized swab and go precisely for the slit. you can get good, reliable information from that. smears are easy to do - as an office technique - you can get a lot of reliable information from the smears you make, if you make them correctly. diagnostic cytology will be discussed next week. if you highly suspect viral or bacterial dz - bird dies or comes in dead or you suspect infectious disease for whatever reason - from the get go when you do a necropsy, it's best to do a sterile necropsy rather than being unclean about the whole thing then suddenly realize it might be infectious and try to culture it after it's all contaminated. the organs are so small, if you sear them you just as well might be cooking them. trying to sterilize surface of organ by searing it usually will kill the bugs hiding inside, so it is just better to do a sterile necropsy, using a sterile instrument pack, etc. once it's contaminated, it's all suspect. handout lists most common sites of sample collection - pretty straightforward. interpretation of those results. things you must consider. species of bird, if you are recovering a lot oof gram negatives from the cloacal swab or fresh feces from a bird of prey, and you have mostly gram negs, you don't worry too much b/c th emore carnivorous the animal, the more likely to get more gram negative organisms. however, if it isn't carnivorous, that's more concerning. the issue of fixed or permanent flora is touched upon at the top of page 4. even within the spp we look at, psittacines and passerines, a fixed or permanent gram negative flora is considered abnormal, but in Cockatoos, you tend to see more gram negs. other considerations when interpreting cultures - age of bird, is it old enough to be immunocompetent, hatchling or aged bird, malnourished bird, what's the sanitation like, have you discerned any concomitant dzs that may be affecting the bird? diet, environment - how is it fed? bowl? cage floor? is perch over bird? is it eating from the dirt in the yard like a pet chicken might? soft vs seed diet? aquatic birds have different flora than land birds... not all gram positives are non pathogenic either. -staph aureus -listeria spp -erysipelothrix sp and not all gram negs are dangerous all the time -e.coli -enterobacter sp -klebsiella (depends on site) pseudomonas, salmonella, nad proteus are usually- almost invariably- associated with clinical disease. some gram positives: clostridia: part of normal flora in raptors, water fowl, gallinaceous birds. can cause botulism - think ducks. not usually in pets...but we know it can colonize the GI tract when there is reduced motility, and cause necrotic enteritis, gangrenous dermatitis, or botulism. lorikeets - fledgelings/under a year of age - can get acute or chronic necrotic enteritis. also other nectar feeding birds. if you have multiple deaths associated with diarrhea, weight loss, anorexia - consider this. necropsy findings noted in handout - highly related to GI tract, also associated with liver, kidney, spleen necrosis and swelling. liver kidney and spleen are associated with many diseases so not that specific but the type of necrosis you find in intestinal tract is more pathognomonic though still not absolute for clostridial infection. birds that have skin trauma, accidentally or self-trauma or whatever, can get gangrenous dermatitis. skin is edematous, painful, discolored blue-red to black and causes death from toxemia. on necropsy you see emphysema, edema, and hemorrhage in the subcu, skeletal, and cardiac muscle. when dealing with ornamental waterfowl, fancy game birds housed in large numbers - you may encounter botulism outbreaks - more often due to lack of sanitation or husbandry, decaying organic matter attracting flies or fly strike and maggots on a dead bird not removed...organism is in soil, maggots feed on carcass and get toxin concentrated in theml...birds eat maggots and get infected. good husbandry/sanitation helps to prevent. the mouse protection test - take serum from potentially infected bird, inject into mouse, mouse will die if bird is infected. some vaccines have been tried; type C neurotoxin antitoxin isn't readily available but sometimes you can get a C/D combination and that is something to consider if you are dealing with waterfowl collections. other organisms: enterococcus - part of normal flora of many areas of body but can be secondary infecting agent under some circumstances as described, may lead to septicemia. note that one organism in particular, e. fecalis, is primary infection for respiratory tract of canaries. erysipelothrix - if a problem, usually seen in waterfowl, though other spp may be infected. listeria: canaries, psittacines, others. CNS signs - in chronic phase, blindness, torticollis, tremor, stupor, paresis/paralysis. notable monocytosis is found. recently, there has been attention given to "megabacteria" which we can't culture but it's a large rod found in the proventriculus. most often dx on smears. seems to have predilection for proventriculus even in normal birds; if there is a lot of it that is abnormal. most commonly causes dz in budgies, cockatiels, lovebirds, canaries. not large birds. signs: chronic emaciation 12-18 mos long, intermittent periods of "recovery". some birds appear to have recovered completely, not have recurrence...those are in the minority and maybe original dx was wrong? on rads you see proventricular dilation and thinning. this isn't to be confused with a viral disease that also has predilection for proventriculus and other parts of GI tract...that occurs with a whole different set of birds, large psittacines, esp macaw. look for how many of these megabacteria are on the slide. gram stain of feces may show organism or may be able to culture proventriculus itself. doesn't seem to respond to any antimicrobials we've tried, though. so dx is sort of sad, you can't treat it. Mycobacterium avium: all spp susceptible esp common in gray cheeked parakeets and waterfowl also common in budgies, amazon parrots, canaries, toucans, and other pet birds primarily affects GI tract - pigeons and waterfowl get lung lesions. signs include chronic wasting, good appetite, diarrhea, PU, anemia, lameness, poor feathering, abdominal distension, skin and oropharyngeal masses/ulcers. dx: high WBC, cytology (acid fast stains), rads, endoscopy/bx, culture. signs are referable to GI tract, liver, spleen and only rarely to respiratory tree except in waterfowl, pigeons. in most pet birds- chronic wasting disease is what you see; owner doesn't notice problem early b/c bird is eating well. rads - look at lumens of long bone - may be increased density, whiteness ,splotchiness. aspergillus could do that to, so if you see lameness consider that too. another thing with avian TB - often elicits a very high white count - up to 30,000. two more, then a break: staph and strep. staph is part of normal flora of skin, resp, and GI tract but can be primary or secondary pathogen in some conditions. strep - beta hemolytic strep are more pathogenic. also normal flora; may act as pathogen in immunosuppressed individuals. --break--- chlamydia: if you see a lot of birds or do a lot of aviary work or pet shop work, you need to be aware of chlamydia b/c it can be zoonotic and it can make you quite sick. the old parrot disease once seen in imported birds; captive breeding probably cuts down the amount of cases; but we still see a lot of chlamydia so maybe that wasn't true... incidence of chlamydia speaks to how well aviary is functioning with respect to hygeine, sanitation. psittacosis/ornithosis is the same disease - just different patients. that's an interesting issue - a court case was going on with an owner claiming to have developed psittacosis from a pet shop, and then in the court testimony was introduced regarding ornithosis b/c that is what the pathology report said and the judge threw it out b/c it wasn't the same disease but it IS the same disease, caused by an obligate intracellular organism that is difficult to grow requiring a particular type of media. few labs will deal with it b/c people get sick from it and it requires strict handling protocol. many avian spp have been documented as having had psittacosis/ornithosis - new world parrots, psittacines seem more susceptible than African/Australian parrots. in study where source of infection was known, 70% were from pet caged birds so potential is high, esp for people working in turkey plants and also moderate 10% from people dealing with pigeons. younger birds more susceptible than adults. carrier state exists. budgie, cockatiel - common carriers. also commonly birds showing least clinical signs when actually infected and in a disease state. not always easy to tell - not all birds have lime green diarrhea (classic sign). maybe just more an upper respiratory dz, ddx mycoplasma...TB...bird may get better, relapse, etc. then consider psittacosis. small birds are handled mroe closely by owners - the budgie may then present an increased risk - these birds often sit on owner shoulder, drink out of owner's cup, etc. can pass dz to owner and you may dx it long before the MD does although of course you legally can't...but if listless, tired, chest pain, pneumonic signs - tell them to tell MD they have a bird and request chest rads. nothing pathognomonic wrt signs, symptoms - does cause a flulike syndrome in owner - chill, fever, cough, malaise, myalgia. similar to Q fever, tularemia, histoplasmosis, influenza...interesting thing to note is that dz in humans often causes a very typical "atypical pneumonia" with a distribution in lung fields typical for the organism - but atypical than that seen with other bacterial or viral pneumonias. from a standpoint of cost to medical profession or client who is the one infected, many casese require hospitalization before being cleared up. fatality is low, but morbidity is high, protracted. the bad things are the meningitis and cardiac complications with chronic human infection. transmission in birds probably via aerosol route. if dealing with a number of birds or if dealing with an aviary or zoo, and you want to try to clean it up, you really have to consider that all birds sharing the airspace with the infected bird are "suspect" and "exposed." however, just like with other diseases, exposure doesn't translate into "will develop the disease." but you should monitor them closely. in an aviary or zoo, you should quarantine them all for a long time. at least 6 mos to a year. monitor WBC, watch for increase. handout outlines clinical signs typical in..one of the things you must consider by way of ddx and reportable disease is when chlamydia causes CNS dz, tremors, seizures, paralysis - must consider Newcastle's Dz or exotic VVND, and submit to lab which can tell apart forms of newcastle virus. key organs to look at for clinical assessment, radiographic assessment and necropsy are the liver, spleen, and serous surfaces of air sacs and pericardium. those are key areas where the organism does much damage and can be seen. hepato/splenomegaly and serositis occur. airsacculitis. with cockatiels, parakeets, lovebirds - consider psittacosis with recurrent sinusitis that resolves/relapses again and again. tx in birds- tetracyclines - historically chlortetracycline used in imported parrots for 60 days while in quarantine. formulation, though, was such that birds did not accept the ration very well and therefore the birds were given very very high concentrations in the feed. it's now difficult to get people too excited about a case of psittacosis - the health department seems to have other things they'd rather deal with - but the disease isn't going away, is getting more prevalent. doxycycline seems to be as or more effective than chlortetracycline. chloromycetin may work but isn't' so available. doxy probably drug of choice. that's it about bacterial conditions... remember many look similar and not all birds will show all the signs of a given disease....you have to culture and look at signs with the culture... viral diseases - it wasn't long ago that we had only a very short list of pet bird viruses. now we have a longer list. there are adenoviruses, herpesviruses, arenaviruses, hepadnaviruses, orthomyxoviruses, paramyxoviruses, flavirviruses, picornaviruses, parvoviruses, poxviruses, rhabdoviruses, and many more types of viruses which infect birds. we see enveloped and nonenveloped, single stranded and double stranded DNA and RNA viruses in birds. not all show inclusions. probalby under half cause inclusion bodies. as far as psittacines go, focus on Psittacine beak and feather dz virus (PBFD), the papovaviruses (polyoma and papillomaviruses), herpesviruses, and poxviruses, and paramyxoviruses when dealing with breeder, pet shop, etc - keep in mind that the issue of different species from different geographic areas is important - these are general things but it is better for a breeder to focus on what they want to do. not good to breed sulfur crested cockatoos from australia and african grey and amazon from central america! that's a formula for poor success, possibly disaster, b/c the problems experienced by those birds, how they respond to viral exposure, are very different - some are carriers while some get fatal infections. best to concentrate on one geographic region - just central american birds or just african birds..certainly do not mix them in an exhibit situation. from owner's point of view - be careful of impulse buying at bird shows or pet shops. you may already know how often people will buy a bird or any other animal that is sick b/c they want to help it. sure, they mean well but they often buy a pack of trouble this way and there are no guarantees on that animal re: returning it in most cases. so try to counsel people to buy only from reputable people, commercially raised birds, even if everything seems right the whole issue of quarantine, isolation, is very important. fi you already have birds at home, why bring in a new bird and expose your other bird to something if you do not have to or if you know better? you wouldn't, yet often people do not know better. try to fill people in on things like this. tell them the proper precautions before introducing a new bird. at very least, keep in separate rooms a good 60-90 days while new bird acclimates to new home; even a bird who looks quite normal at pet shop, if it is harboring a virus or something it will get stressed by move and diet change and that can allow a virus to become clinically apparent. as time goes on, more and more good diagnostic procedures become available. if your index of suspicion is there and you get good samples....but sometimes have to use a special lab for these tests. vaccines are getting available, slowly. slow is operative word here, haven't really taken off but they are coming, slowly. hopefully eventually we can have a comprehensive preventive medical program for birds. tx of viral disease in birds is fairly limited to tx of secondary infections. some viruses we can tx with antiviral agents like acyclovir for pacheco's (herpes) when disease isn't severe - but you have to treat early. have to separate birds into appropriate tx groups too. Circovirus: PBFD: psittacine beak and feather disease: some years ago it was noted that in this country, there were some parrots/cockatoos, esp the large cockatoos like sulfur crested, etc. that the chicks bred here had abnormal plumage at fledging or within the first year after fledging would get more and more abnormal feathers with each molt. this went on to the point where the bird had no or very few feathers left. often the crown was affected as well. they looked at this and over time found the PBFD virus. we eventually found more than cockatoos being affected. disease wasn't just a disease of captivity but birds in the wild had this also. dz is a feather/beak dysplasia; birds usually are immunocompromised in some way; there is no known tx, so the owner who wants to keep the bird despite disease has a situation which requires increased environmental attention - have to keep it warmer since bird w/o feathers can't thermoregulate well, need increased vigilance to prevent secondary infections with normally nonpathogenic organisms. beak has dystrophic growth and may require repeated trims so bird can eat. tx of secondary infections is prolonged and may require antifungal as well as antibacterial therapy. it's challenging to manage these cases. right now there is no good hope for a cure for these birds. we are working on vaccines which will be a great thing. from an aviary point of view, it's a real nightmare b/c you have to identify the carriers and separate them out. can do this with DNA probes. must isolate all noninfecteds from infecteds, test all offspring as they are produced from the "clean" group. lots of time and financial investment. route of transmission seems to be via inhalation/ingestion of particles passed in feces, or dust created by feather dander, or crop secretions that may get aerosolized; some suspicion of horizontal transmission; incubation period days-months. differential: polyomavirus, nutritional disease, endocrine disease. another dz with feather implications - polyoma virus: two types: budgie type and other psittacine type budgie polyomavirus: sudden deaths in nestlings, high mortality. in older budgies, fewer deaths but progressive feather changes, abdominal distension, hemorrhage under skin; reduced reproduction capability. non-budgie form: more subclinical - peracute death with no signs can occur. acute death 12-48 hrs after depression can occur. but mostly subclinical. you don't usually see these as individual patients; more likely aviary. with budgies, those that survive, as they grow, with each molt they have more feather abnormality until they lose all their contour feather structure and look fluffier than normal. can't fly - end up hopping around. this may be "french molt" disease which used to be talked about a lot. dx: DNA probe papillomavirus: (papovavirus): skin tumors - warts on feet, legs, head, eyelids no one has found viral cause for this papillomatosis here which is much more serious than the more benign wartlike growth seen on the skin: GI papillomas/papillomatosis: mucosal surfaces of cloaca, in amazon parrots and macaws; broad based masses, can obstruct cloaca; subject to recurrent prolapse of cloaca. sometimes can surgically resect, cryotherapy, etc. can see masses in oral or esophageal area - commissures of mouth, just inside oral cavity, sticking out of mouth - depends on size, location, number- but has an effect on ability to eat, may traumatize the papillomas when eating causing bleeding. we're still not sure if these are caused by viruses. Pacheco's disease: a herpes virus - biggest sign is acute death. if the animal lives for a day or two or longer, then there can be hepatic enlargement - viral focus is liver - lipemia, elevated liver enzymes. incubation under a week. few animals survive. some spp differ though - recall many conures are great carriers for this virus but rarely show signs. other psittacines who do survive it risk carrier status. dx: DNA probe. enlarged yellow/brown liver is prominent, enlarged spleen is prominent ddx chlamydia, bacterial hepatitis, polyomavirus, adenovirus tx: acyclovir- may help birds that have been exposed prior to onset of clinical signs; not that helpful in birds already showing signs, fluids, nonhepatotoxic antibiotics amazon tracheitis virus: laryngotracheitis virus common in poultry but this form is adapted to psittacines; signs similar to those in poultry. poxvirus - two forms canarypox - wet or diphtheritic form, infects oral cavity, lumen of esophagus, trachea, down into lung. more severe form. high morbidity and mortality. psittacinepox - dry form, less severe - dry crusty lesions around eye margins, other featherless areas, sometimes on tongue but still not severe form. morbidity but not much mortality vaccinations exist for canary breeders to use amazons more botherd by pox than australian or african parrots. support them, get them through - many will recover. a few things about Newcastle disease - paramyxovirus- the virus itself is in a number of forms - 9 forms altogether - there are about 5 forms that affect psittacines. widely varied spp susceptibility. paramyxovirus one is the common one in poultry; that form also has several forms and can be velogenic or neurotropic or both, this is the one in which exotic newcastle dz is referred to, the severe dz that gets into commercial poultry flocks. PMV 1 through 9 exist, though. infected birds shed a long time if psittacines - up to 85 or 100+ days. canaries clear quickly. forms most commonly encountered are 1, 2, 3, and 5. 5 is pretty much just in budgies. the others are seen in psittacines, passerines - most common is 1. there is some zoonotic potential, it is reportable, if you think you see a case you have to TELL the state and federal authorities who will help you deal with it. if it hits a pet shop or breeder there is a lot of traceback to find any shipped birds. lots of exposed birds get destroyed. note to self: get lyrics to Holman! ----end---