Pretty Eyes

Patches belongs to Anna Kucera who goes to Kansas State University.

Case Report: Periocular Conjunctivitis in a group of Laboratory Swine (Sus scrofa)

Submitted by Curtis Rheingold from Tufts University Cummings School of Veterinary Medicine

History & Clinical Presentation
Eight, adult, female, Yorkshire pigs (Sus scrofa) arrived to the University Laboratory Animal Resources at The Ohio State University for use in an Institutional Animal Care and Use Committee (IACUC) approved dermatologic wound-healing research study. Initial visual assessments performed by veterinary technical staff revealed bilateral periocular conjunctivitis. Closer examination performed by facility veterinarian revealed chemosis (OU), mucopurulent discharge (OU), scleral injections (OU), and blepharospasm (Fig 1). No other significant findings were reported upon completion of physical exam. All animals were quarantined into a separate room and started on empirical therapy which involved daily eye flushing using ophthalmic solution eyewash (Medi-First, Medique Products, Fort Myers, FL) BID (OU) and topical neomycin-polymyxin B sufates and bacitracin zinc ophthalmic suspension (Bausch+Lomb, Rochester, NY) TID (OU). A more in depth ophthalmic exam was also scheduled to be performed at each subject’s next experimental anesthetic event. After 72hr of treatment, all subjects were reevaluated. Reexamination revealed no significant improvement of ocular clinical signs. Clinical staff reported difficultly administrating topical ophthalmic medications in subjects.

Within 7-14 days all subjects were anesthetized for study-related events. At this time a more thorough ophthalmic examination was performed. All previously reported clinical signs (i.e., conjunctivitis, chemosis, and mucopurulent discharge) were still present. Both affected eyes were rinsed with ophthalmic eye wash, had conjunctival scrapes performed for cytology interpretation and swabbed with sterile curettes for bacterial culturing and sensitivity testing (aerobic and mycoplasma spp. specific). All samples were submitted to The Ohio State University Clinical Pathology Laboratories, Veterinary Medical Center (Columbus, OH) and Antech Diagnostics (Oak Brook, IL).

Fluorescein staining was also performed using ophthalmic strips (Bio Glo, Fluorescein Sodium 1 mg strips U.S.P., Hub Pharmaceuticals, Rancho Cucamonga, CA)  and revealed no signs of superficial corneal ulceration. At this time, empirical treatment was discontinued, and all subjects were started on a combination of enrofloxacin (Baytril® 100, 100 mg/mL, Bayer, Shawnee Mission, Kansas) and dexamethasone-SP (DexaJect SP, 4 mg/mL, Henry Schein®, Dublin, OH) solution (1:1 ratio) administered subconjunctivally in the bulbar and palpebral regions, while still under general anesthesia (Fig 2). This was performed using a 1 mL syringe with 27 gauge needle attached. Total volume of each injectable solution was 0.15 mL respectively. Additionally, 2-3 drops of topical ophthalmic neomycin-polymyxin B sulfates and dexamethasone suspension (Bausch+Lomb, Rochester, NY) were applied. This therapy regimen was continued until return of all diagnostic testing.

Analysis and findings
Twenty percent of the animals were selected to undergo diagnostic testing in order to capture the overall herd health.

              Cytological findings

Two slides prepared from conjunctival scrapes revealed occasional to modest numbers of intact nucleated cells with minimal hemodilution on a pale eosinophilic background with copious amount of magenta staining, granular material, presumed lubrication or eye ointment. There were occasional anucleate and nucleated squamous epithelial cells that often have a mixed bacterial population consisting of small rods and cocci. Additionally, occasional to modest numbers of variably degenerate neutrophils were present. No overtly neoplastic cells were seen.

Impression

Mild to moderate neutrophilic inflammation with mixed bacterial infection that consistent of small rods and cocci (Fig 3).

Antibiotic sensitivity testing of cultured aerobic bacteria revealed that all species were susceptible to both gentamicin and tobramycin.

Morphologic diagnosis

Mycoplasmic conjunctivitis with associated ocular and conjunctival sequelae.

Post-diagnostic testing: treatment and results
Upon diagnostic findings and results, the current medical therapy was discontinued and subjects were started on gentamicin sulfate (40 mg/mL, APP Pharmaceuticals, Schaumburg, IL) /dexamethasone solution (DexaJect SP, 4 mg/mL, Henry Schein®, Dublin, OH) was injected into the bulbar and palpebral conjunctiva of both eyes in a similar 1:1 ratio as previously described. Two to three drops of topical 0.3% tobramycin ophthalmic solution (Akorn Inc, Lake Forest, IL) was also applied to the globe.

Upon examination 24 hours after treatment, all pigs’ eyes showed significant improvement with reduction in gross clinical signs (Fig 4). Weekly treatment of gentamicin/dexamethasone and tobramycin continued during research-related anesthesia until each pig’s euthanasia endpoint. At euthanasia, final aerobic and mycoplasma cultures from each pig were sent for further diagnostic testing. Culture results from the last pig showed no remaining Mycoplasma spp., approximately two months after initiating treatment.

Discussion:
The conjunctiva of domestic animals is rarely sterile, and the microbial species found in pig conjunctiva are similar to other domestic species. In a study of a commercial swine operation, bacteria were found in 98% of healthy pigs tested (1). The most common bacteria included alpha-Streptococcus spp (89% of pigs), Staphylococcus epidermidis (39%), and Staphylococcus spp (39%). Chlamydia spp. were also identified in 28% of pigs (2). Mycoplasma species were not identified in any of these healthy pigs.

Mycoplasmosis has been implicated in spontaneous conjunctivitis and keratoconjunctivis in swine (3, 4), as well as in other domestic animals such as cats and dogs (5). In our group of pigs, Mycoplasma spp. was the only pathogen identified with reports of causing clinical disease. The recommended treatment in companion animals is tetracycline (5,6). Intramuscular oxytetracycline is typically used in production swine with a 28-day withdrawal period. Our group was limited on treatment options due to the risk of interfering with the approved IACUC study protocol, with systemic antibiotics and tetracyclines not available. Additionally, while we would have normally used diclofenac or a similar non-steroidal anti-inflammatory drug (NSAID) to alleviate inflammation and discomfort associated with the conjunctivis, all NSAIDs were contraindicated by the research protocol as well.

Diseases in research animals present a unique challenge for laboratory animal veterinarians since all diagnostic procedures and medical treatments must be carefully considered as to not interfere with the research protocol. The present case illustrates how coordination between research and veterinary staff can result in improved welfare for research animals. After initial treatment with empirical therapy did not affect any clinical signs, we were able to collaborate with the research group to evaluate and treat the pigs under general anesthesia. Topical ophthalmic administration is not consistently feasible in an awake, active pig.  Since the research protocol involved weekly anesthetic episodes, allowing the veterinary staff to examine and treat the animals while they were still under general anesthesia eliminated the need for additional sedation. With tetracyclines contraindicated by the research group, we elected to treat the susceptible aerobic bacteria with antibiotics recommended by sensitivity testing.

Treating non-research related diseases is vital from both an ethical and a data quality perspective. Preventing and relieving pain and disease is a vital mission for all health-related staff, veterinarians and technical staff alike. The Guide for Care and Use of Laboratory Animals, which sets standards and guidance for NIH-funded animal research, states that, “Pain is a stressor, and if not relieved, can lead to unacceptable levels of stress and distress in animals”. Even though certain treatments may not be possible in the context of a certain study, it is up to the laboratory animal veterinarian to devise a treatment plan that is both usable and effective. Treatment of diseases in research animals also ensures that data collected is free of any confounding factors. A sick or injured animal is drastically different from a healthy animal on many dimensions, including behavior, immune responses, and even gene expression. These differences can affect the reliability or reproducibility of study results and hinder collaboration between research labs.

In summary, a group of laboratory swine presented with periocular conjunctivitis and several other ocular clinical signs. Through collaboration with the research group, diagnostic testing and ophthalamic treatment were successfully conducted without any additional anesthesia or sedation. The present case demonstrates how coordination between veterinary and technical staff can lead to better outcomes for laboratory animals’ health and therefore augment the research process.

References

1. Davidson HJ, Rogers DP, Yeary TJ, Stone GG, Schoneweis DA, Chengappa MM. 1994. Conjunctival microbial flora of clinically normal pigs. Am J Vet Res 55(7): 949-951.
2. Zimmerman JJ, Karriker LA, Ramirez A, Schwartz KJ, Stevenson GW, editors. 2012. Diseases of Swine. Ames (IA): Wiley-Blackwell.
3. Rogers DG, Frey ML, Hogg A. 1991. Conjunctivitis associated with a Mycoplasma-like organism in swine. J Am Vet Med 198(3): 450-452.
4. Friis NF. 1976. A serologic variant of Mycoplasma hyorhinis recovered from the conjunctiva of swine. Acta Vet Scand 17(3): 343-353.
5. Maggs D, Miller P, Ofri R. 2017. Slatter’s Fundamentals of Veterinary Ophthamology, 6^th edition. St. Louis (MO): Saunders.
6. Schaer M. 2009. Clinical Medicine of the Cat and Dog, Second Edition. Boca Raton (FL): CRC Press.

It's Saturday! Treat Yo' Self!

Submitted by Kelly Kwon from Texas A&M University

Outstanding in Her Field

Lauren Engeman from the University of Missouri submitted these beautiful pieces. The first is an acrylic painting and the next two are colored pencil.

Flower GirlA Roll in the MudSilversmith

ARCAS Guatemala

ARCAS Guatemala

When I was interviewed for vet school, one of the questions my interviewer asked me was “what do you think the most difficult part of vet school is going to be?”. After taking 4 years off from school to work at various zoos and sanctuaries – hard work, on my feet, for 10+ hours per day and usually with a second job to make ends meet – my answer was easy: “sitting in a classroom every day and expecting to learn well that way.” That proved to be incredibly true, to the point that I was questioning why I ever chose to be a vet when I was so happy with my life beforehand. I’ve spent the last year being stressed out, sitting in a classroom, studying for hours on end, feeling like I’m not learning anything, and being incredibly unhappy.

Then I went to ARCAS and remembered why I wanted to become a veterinarian in the first place.

ARCAS is a non-profit Guatemalan GNO formed in 1989 by a group of Guatemalan citizens who became concerned as they saw their natural habitat and the wildlife that lived in it rapidly declining. They exist to help injured or confiscated wildlife recover enough to rejoin their conspecifics back in the wild and provide a permanent home or find a permanent home at a proper facility for those animals that are non-releasable. When the Guatemalan government stops illegal wildlife traffickers, they confiscate the smuggled animals and bring them to ARCAS for care. When locals find injured wildlife, they bring the animal to ARCAS for care. The most common intakes are howler and spider monkeys and parrots and macaws, though we were also able to work with anteaters, coatimundi, crocodiles, ocelots, jaguars, and a few raptors. It can take up to a decade to properly and successfully rehabilitate a primate so that it is ready to live a wild life, especially if the animal came in at a very young age. Each individual animal that comes in requires intensive and potentially long-term care.

Nestled in the middle of the forest near Flores, Guatemala, ARCAS is isolated from cell phone service and internet signal. The property is totally natural and the work day starts bright and early at 6am to avoid working in the heat of the day if possible. We arrived the morning after 2 flights and a 9-hour overnight bus ride and were given a tour, but the next day we dove into the daily work routine. Three students were assigned to the vet clinic each day while the rest of us tended to the daily husbandry of the animals. In a clinical setting, most of the illnesses presented by exotic and avian cases are illnesses that are prevented by proper husbandry. Because of this, it’s very important for us as veterinarians to know the basic natural history of an exotic animal or bird, and we got to learn just that by participating in their daily routine. We rotated animals so that each of us could get experience with different species. After 6am rounds, we ate breakfast and convened in the outdoor library for discussion-based lectures. Lecture topics ranged from primate care and bird husbandry to the exotic pet trade, to what the government requires before an animal can be released, and how ARCAS maintains medical records. We followed lecture with another round of animal care, lunch, and then afternoon close-up. Being at a wildlife facility meant that although there was a schedule for us every day, that schedule could easily be interrupted. There were at least 2 instances of our morning lectures being interrupted by a new animal intake or because a wild boa constrictor was found stuck in the fence one of the spider monkey habitats. Even daily “routine” in the clinic was subject to change.

Clinic cases included daily medication, fecal floats, CBCs, and tube feeding a variety of animals. Each of us got a different experience during our clinic days, but Dr. Morales also made sure we were able all able to get experience with birds, crocodiles, and goats during our “all-clinic” days. On these days, all of us students participated in a mass treatment procedure. One day, we caught up all the birds in quarantine for vaccination and dewormer. Another day, we drained the reptile pond to catch, weigh, and measure a handful of turtle species and catch, restrain, measure and weigh, and draw blood on crocodiles, including a Cayman. Later in the week we went to visit a private collection of wild animals nearby. We literally chased all of their goats around, caught them, trimmed their hooves and gave them preventatives. I was able to catch an emu before we all went to vaccinate the flock of Currosow. Everyone got their hands on a large bird, and half of us got pooped on by a large bird. We visited the peccaries and tapirs on the property as well, but just to see them.

Over the weekend, our group visited Tikal, the oldest and largest excavated Mayan ruin site in Central America. We went on a tour in the middle of the day and most of us got up at 4am the next morning for the sunrise tour. We hiked to the top of one of the Mayan temples for the sunrise, but it was too foggy to see. We did, however, hear a troop of Howler monkeys in the distance, making the fog slightly spookier. We enjoyed touring around the ruins, relaxing in the pool of the hotel, and hanging out getting to know each other in a beautiful country. We had one day to kill between finishing the program at ARCAS and coming back to St. Kitts, so naturally we spent it at La Aurora Zoo in Guatemala City. I knew most of the people I went on the trip with, but I’m happy to say that I became friends with all of them during the trip. I couldn’t have asked for a better group of people to go adventuring with.

The unpredictable nature of working with wildlife was a refreshing change of pace from the classrooms at Ross. The staff was great: always eager to help me learn more, challenge me, and make me a better caretaker, student and veterinarian, and they appreciated by enthusiasm for Star Wars Day (and how can you not love a staff that approves of your Star Wars scrubs?). I am very thankful for the opportunity to learn from Dr. Morales, Dr. Hernadez, Anna, and Nele, and for the chance to be a small part of such an amazing organization. I was constantly learning, applying, and loving every second of my experience. This is why I want to be a veterinarian. I want to be constantly learning, having fun, and making an impact on the world through wildlife.

Thank you to Taylor Tvede from Ross University for this awesome experience piece!