Hello, Vetaheader! Happy new year!

We are back with a brand new newsletter. This month, it’s all about reptiles.

First, we have a case report on the use of photobiomodulation (PBM) as a therapeutic tool on the management of severe ulcerative dermatitis in an Aubry’s flapshell turtle (Cycloderma aubryi). Softshell turtles like this species have a reduced bony shell with flat bony elements framing an inner cancellous core, and a shell surface covered by leathery skin rather than horny scutes. Infection of this leathery skin can progress quickly, invading the thin underlying boney structures and coelomic cavity, and present acutely.

The manuscript describes that an adult, wild-caught, intact female Aubry’s flapshell turtle, that had been in the collection for 21 months, presented with rapid onset of multifocal, tan-white, 1.5 cm and smaller, crateriform, ulcerated lesions on the carapace and plastron. Empirical antibiotic therapy, initiated on the suspicion of an infectious etiology, yielded no clinical improvement and the disease progressed. Multifocal osteomyelitis was visible deep to the dermatological lesions on the carapace and plastron on computed tomography (CT) imaging, and culture results included Stenotrophomonas maltophilia and Achromobacter xylosoxidans. No fungal culture or histopathology were performed: ulcerative dermatitis or “shell rot” is a common presenting complaint in aquatic and terrestrial chelonians often associated with bacterial septicemia, but may have bacterial, fungal, and/or viral etiologies. It is often associated with septicemia and considered a sequela of underlying husbandry or management practices or traumatic injury.

Two months after surgical debridement and ostectomy, healing of lesions was incomplete and slow to progress. PBM was initiated on some of the lesions, and the treated lesions showed grossly visible indications of progressive healing after 17 days; there were no indications of healing in the untreated lesions. All lesions were subsequently treated with PBM, and the patient made a full recovery. 

Second, we have a case report of a kidney prolapse in a kingsnake (Lampropeltis spp.). Organ prolapses through the cloacal opening are relatively common in reptiles, and have been associated with excessive amounts of straining (associated with intestinal disease), mating behavior, neoplasia, urinary calculi or cystitis, intestinal stasis secondary to hypocalcemia and/or metabolic bone disease, obesity, muscular weakness, or iatrogenic. Reported cases of organ prolapse include distal GI tract, urinary bladder, phallus/hemipenes, and oviduct.

The manuscript describes that an 8½-yr-old female kingsnake presented for apparent constipation of 1-month duration. The physical exam revealed moderate constipation based on coelomic palpation, and radiographs confirmed probable follicular tissue in the mid-coelomic region and more radiodense fecal material within the distal colon. The snake was given an enema and, in the process, prolapsed a firm mass on a pedunculated stalk. The stalk was immediately ligated and transected due to mild hemorrhaging. The patient died 48h afterwards.

Histopathology confirmed that the mass consisted of kidney tissue affected with a bacterial nephritis and contained granulomas and gouty tophi. Necropsy of the animal confirmed that the left kidney was missing within the coelomic cavity and had migrated to the cloacal lumen. Additionally, the animal had severe folliculostasis and a bacterial cloacitis with foreign material (hair shafts) imbedded within the colonic body wall. It is suspected there was a distal colonic/proximal cloacal infection either as primary infection and/or associated with penetration of hair shafts within the lumen – cloacal ulceration occurred, which led to perforation, and as kidney enlarged, it led to its evisceration. Alternatively, it could have been iatrogenic, even though they stated it was “impossible”. Hair has been reported to cause constipation, cloacal impaction, development of transcolonic membranes – never penetration of the cloacal wall leading to ulcerative bacterial cloacitis, perforation, and evisceration of the kidney, so authors suspect that something else started the cloacitis.

This was the first reported case of a kidney prolapsing through the cloacal lumen of a snake secondary to having previously eviscerated through the cloacal wall. There have been reports of kidneys being eviscerated because of excessive trauma, iatrogenic causes, or due to force (vehicle strike).

The take home message is: This is a “bewildering” case of renal prolapse through the cloaca of a kingsnake. Likely resulted from a cloacitis gone wrong.

Lastly, we have paper on the use of corticosterone, lactate, and injury severity as short-term and long-term prognostic indicators in Eastern box turtles (Terrapene carolina carolina) with traumatic injuries admitted to a wildlife rehabilitation clinic.

The hypothalamic–pituitary–adrenal axis (HPA) is often disregulated during critical illness or following traumatic injury, and both elevated and reduced glucocorticoid (GC) levels have been associated with poor prognoses in multiple species (corticosterone is the main GC of reptiles). Acute HPA axis activation has protective effects by mediating behavior and physiology to promote immediate survival, which results in a negative feedback loop via actions of GC on corticotropin releasing hormone. Chronic or persistent stressors can result in prolonged elevation in GC, which results in reduced GI emptying, inhibition of immune response, metabolic derangements due to increased gluconeogenesis.

In eastern box turtles (EBT), hyperlactatemia has been identified as a negative prognostic indicator. The manuscript examines the role of corticosterone in relation to lactate, other blood-based parameters, and triage scores during hospitalization of eastern box turtles with traumatic injuries on survival at 24 h, 1 week, and 1 month. Here are the highlights of this study:

• Blood collected at admission, 24h, and on days 7, 14, 21, and 28 – subcarapacial sinus was used.
• Lactate on Day 0 for non-survivors was 14.45 mmol/L compared to 2.6 mmol/L for those that survived past 24 hours = significantly associated with 24 hour survival.
  • Predictor of survival in 24 hours = 7-7.9 mmol/L.
• Triage score was predictive of survival at 24h and at 1 month – this supports the use of a triage score, as most turtles were BAR upon arrival.
• Corticosterone was not significant, but there was a trend for those whose values increased in first 24 hours were more likely to die in first week than those that decreased or remained the same.
• Lactate, H:L ratios, and PCV all decreased over course of 24h and 14 days.

Overall, mortality in 24h was associated with elevated lactate and higher triage scores. Within first week, was associated with increase in corticosterone. Within 1 month, was associated with higher triage scores. To summarize, severe tissue damage and/or acute stress overload contribute to poor short-term prognoses.
The take home message is: EBT admitted for trauma, tissue damage, and acute severe stress that undergo mortality have higher lactate levels and triage scores within first 24h to 1 week. Euthanasia should be considered for EBTs with triage scores of 6 or greater, and with lactate levels of 8 mmol/L or greater.

As always, hope these were useful, and I will see you next month!

Sincerely,