Next-generation DNA sequencing offers diagnostic advantages over traditional culture testing.

OBJECTIVE: While the clinical utility of next-generation DNA sequencing (NGS) as a diagnostic tool for infections in humans and traditional pets has been demonstrated, there is a lack of data regarding its utility for exotic animals. For exotic patients, traditional culturing is especially challenging for anaerobic and fungal pathogens. Therefore, diagnosis often relies on PCR, which provides a high degree of sensitivity and specificity, although it targets only a predetermined, finite pathogen panel. NGS provides the same benefits as PCR, while also offering de novo identification and quantification of all bacteria and fungi present in a clinical sample, including novel pathogen discovery. PROCEDURES: Clinical samples from 78 exotic animal patients were collected simultaneously for conventional culture testing and NGS analysis. Results provided by each laboratory were compared for the presence and absence of bacterial and fungal pathogens and commensals. RESULTS: Results showed large bacterial and fungal species diversity in the study cohort and a lack of sensitivity of microbial culture testing. Culture failed to grow 15% of putative bacterial and 81% of putative fungal pathogens that were identified by NGS. The probability of a "no growth" diagnosis was 14% higher for bacteria and 49% higher for fungi with culture versus NGS testing if fungal culture was conducted. CLINICAL RELEVANCE: Culture testing failed to diagnose a substantial number of both bacterial and fungal pathogens, which were detected by NGS. This highlights the limitations of traditional culture-based testing and displays the clinically advanced utility of NGS-based diagnostics in exotic animal medicine.

Diagnosis and Treatment of Gordonia Species Infection in a Peach-Faced Lovebird (Agapornis roseicollis).

Respiratory distress is a common presentation for avian species. A 9-week-old peach-faced lovebird (Agapornis roseicollis) was presented with a 2-week history of progressive dyspnea. Computed tomographic (CT) images were suggestive of splenomegaly and bilateral granulomatous pulmonary disease. Polymerase chain reaction testing of samples from the choana, cloaca, and distal tracheal/syringeal area were positive for Mycobacterium species hsp65. A comparison search of the 400 base pair sequence in the NCBI/BLAST/blastn database revealed a best match of 93% similarity to Gordonia species and 91% similarity to Gordonia bronchialis. Gordonia is a genus in the phylum Actinomycetota, the same lineage that includes Mycobacterium species. Gordonia species can be mistaken for Mycobacterium species unless more definitive diagnostic testing is pursued. Infection caused by Gordonia species is rare in humans. Reports commonly cite infection of immunocompromised patients, and to our knowledge, no reports of treatment have been published in the veterinary literature. After the test results were obtained, the patient was treated with azithromycin and pradofloxacin for 3 months. The lovebird was presented for reexamination when the antibiotic treatment was complete. When reexamined, and a second series of CT images evaluated, it was determined that the treatment achieved clinical resolution of signs and lesions.

Liposarcoma of Probable Medullary Bone Origin in a Lovebird (Agapornis roseicollis).

A 15-year-old female peach-faced lovebird (Agapornis roseicollis) was presented to the hospital for a possible left wing injury and an inability to fly after falling in its cage. On physical examination the left elbow was swollen and painful. Radiographic images revealed left wing soft tissue swelling surrounding the elbow and lysis of the distal humerus with extensive cortical thinning. Subsequent high-definition volumetric-imaging 3-dimensional computed tomography (HDVI 3D CT) revealed a pathological fracture, cortical lysis, periosteal reaction, and abnormal intraosseous soft tissue of the left humerus with associated soft tissue swelling, suggestive of neoplasia. No evidence of metastatic disease was identified. Surgical amputation of the left wing was elected. A liposarcoma and pathologic fracture of the humerus were diagnosed histologically and by oil red O staining for lipids in the neoplastic cells. The morphologic features of the tumor suggested that it developed within the adipocyte component of the medullary bone. The incision at the amputation site healed without complication. A follow-up HDVI 3D CT performed 4 months postsurgery showed no evidence of metastatic disease. To the authors' knowledge, this is the first report of a primary liposarcoma of medullary bone origin in an avian species.

Septic Arthritis and Osteomyelitis Caused by Chryseobacterium indologenes in a Mute Swan (Cygnus olor) and a Ring-Billed Gull (Larus delawarensis).

A 20-year-old female mute swan (Cygnus olor) originally in a flock of free-living swans on a Long Island, New York, lake, was presented for facial swelling and decreased appetite. An adult male ring-billed gull (Larus delawarensis) was also presented to the same wildlife rescue center for bilateral lameness of 1-week duration. Once referred for veterinary evaluation and care, both species were diagnosed with septic arthritis and osteomyelitis caused by Chryseobacterium indologenes and treated with orbifloxacin until complete recovery. Chryseobacterium indologenes is infrequently diagnosed as an opportunistic pathogen in human medicine, and less so in veterinary medicine. In human patients, this bacterium is the cause of various infections, including meningitis, pneumonia, and implant failure. However, in veterinary medicine its pathogenicity has only been reported in fish, and sporadically mentioned as a culture result in tree frogs and turtles, where it was generally considered insignificant. In this report a clinical presentation, diagnosis, treatment, and outcome of osteomyelitis and septic arthritis caused by C indologenes is described in 1 anseriforme and in 1 charadriiforme species.

Evaluation of the effects of dorsal versus lateral recumbency on the cardiopulmonary system during anesthesia with isoflurane in red-tailed hawks (Buteo jamaicensis).

OBJECTIVE: To evaluate the effects of dorsal versus lateral recumbency on the cardiopulmonary system during isoflurane anesthesia in red-tailed hawks (Buteo jamaicensis). ANIMALS: 6 adult 1.1- to 1.6-kg red-tailed hawks. PROCEDURES: A randomized, crossover study was used to evaluate changes in respiratory rate, tidal volume, minute ventilation, heart rate, mean arterial and indirect blood pressures, and end-tidal Pco(2) measured every 5 minutes plus Paco(2) and Pao(2) and arterial pH measured every 15 minutes throughout a 75-minute study period. RESULTS: Respiratory rate was higher, tidal volume lower, and minute ventilation not different in lateral versus dorsal recumbency. Position did not affect heart rate, mean arterial blood pressure, or indirect blood pressure, although heart rate decreased during the anesthetic period. Birds hypoventilated in both positions and Paco(2) differed with time and position × time interaction. The Petco(2) position × time interaction was significant and Petco(2) was a mean of 7 Torr higher than Paco(2). The Paco(2) in dorsal recumbency was a mean of 32 Torr higher than in lateral recumbency. Birds in both positions developed respiratory acidosis. CONCLUSIONS AND CLINICAL RELEVANCE: Differences in tidal volume with similar minute ventilation suggested red-tailed hawks in dorsal recumbency might have lower dead space ventilation. Despite similar minute ventilation in both positions, birds in dorsal recumbency hypoventilated more yet maintained higher Pao(2), suggesting parabronchial ventilatory or pulmonary blood flow distribution changes with position. The results refute the hypothesis that dorsal recumbency compromises ventilation and O(2) transport more than lateral recumbency in red-tailed hawks.

Immune-mediated pure red cell aplasia in a domestic ferret.

CASE DESCRIPTION: An 8-month-old spayed female domestic ferret (Mustela putorius furo) was referred for examination to determine the cause of lethargy and severe anemia. CLINICAL FINDINGS: Initial examination revealed that the ferret was lethargic but with appropriate mentation. The only other abnormal findings were severe pallor of the mucous membranes, nasal planum, and skin and a PCV of 8%. Pure red cell aplasia (PRCA) was diagnosed on the basis of cytologic evaluation of a bone marrow biopsy specimen. TREATMENT AND OUTCOME: Medical treatment included blood transfusions, IM administration of iron dextran, oral administration of antimicrobials and gastrointestinal tract protectants, and SC administration of erythropoietin. Once PRCA was diagnosed, the ferret was orally administered prednisone, cyclosporine, and azathioprine. Nine months after onset of treatment, the PRCA was in remission and the ferret was doing well. Immunosuppressive treatment was discontinued at 14 months after onset of treatment, and 36 months after initial examination, the ferret appeared to be healthy. CLINICAL RELEVANCE: It is important that PRCA be considered as a differential diagnosis for a ferret with severe anemia. Prolonged immunosuppressive treatment was successful in the ferret described here.

Effect of body position on respiratory system volumes in anesthetized red-tailed hawks (Buteo jamaicensis) as measured via computed tomography.

OBJECTIVE: To determine the effects of body position on lung and air-sac volumes in anesthetized and spontaneously breathing red-tailed hawks (Buteo jamaicensis). ANIMALS: 6 adult red-tailed hawks (sex unknown). PROCEDURES: A crossover study design was used for quantitative estimation of lung and air-sac volumes in anesthetized hawks in 3 body positions: dorsal, right lateral, and sternal recumbency. Lung volume, lung density, and air-sac volume were calculated from helical computed tomographic (CT) images by use of software designed for volumetric analysis of CT data. Effects of body position were compared by use of repeated-measures ANOVA and a paired Student t test. RESULTS: Results for all pairs of body positions were significantly different from each other. Mean +/- SD lung density was lowest when hawks were in sternal recumbency (-677 +/- 28 CT units), followed by right lateral (-647 +/- 23 CT units) and dorsal (-630 +/- 19 CT units) recumbency. Mean lung volume was largest in sternal recumbency (28.6 +/- 1.5 mL), followed by right lateral (27.6 +/- 1.7 mL) and dorsal (27.0 +/- 1.5 mL) recumbency. Mean partial air-sac volume was largest in sternal recumbency (27.0 +/- 19.3 mL), followed by right lateral (21.9 +/- 16.1 mL) and dorsal (19.3 +/- 16.9 mL) recumbency. CONCLUSIONS AND CLINICAL RELEVANCE: In anesthetized red-tailed hawks, positioning in sternal recumbency resulted in the greatest lung and air-sac volumes and lowest lung density, compared with positioning in right lateral and dorsal recumbency. Additional studies are necessary to determine the physiologic effects of body position on the avian respiratory system.

Disseminated lymphoma of presumptive T-cell origin in a great horned owl (Bubo virginianus).

A geriatric male great horned owl (Bubo virginianus) that was a resident at a raptor center was presented for examination because of stridor and weight loss. Results of physical examination, diagnostic imaging, and biopsy were consistent with disseminated lymphoma involving the oropharynx, neck region (including thyroid and parathyroid glands), keel, spleen, and liver. Attempts to treat the owl with chlorambucil failed, and the owl was euthanatized 5 months later. Neoplastic cells from this owl were immunoreactive to CD-3 antibody, suggesting the lymphoma was of T-cell origin.

Diabetes mellitus concurrent with hepatic haemosiderosis in two macaws (Ara severa, Ara militaris).

Diabetes mellitus was diagnosed in a 5-year-old male chestnut-fronted macaw (Ara severa) and an 8-year-old female Military macaw (Ara militaris) based on persistent hyperglycaemia and glucosuria. Hepatic biopsies showed marked hepatic haemosiderosis, while pancreatic biopsies showed no inflammatory lesions. Repeatable and titratable responses to bovine or porcine protamine zinc insulin were recorded in both patients, who were followed up for more than 2 years. In addition, iron-elimination therapy was initiated by chelation or phlebotomy, and the birds' diet was changed to low-iron content pellets. Both birds responded favourably to this therapy, showing a decreased demand for extrinsic insulin. Follow-up biopsies demonstrated marked reduction in hepatic haemosiderin. Plasma fructosamine and beta-hydroxybutyric acid levels were measured periodically in both birds and compared with euglycaemic psittacines. Both tests appeared useful for monitoring treatment success. The potential association between diabetes mellitus and excessive iron storage in birds should be further investigated.