MEDICAL PROTOCOLS RECOMMENDED BY THE US BALI MYNAH SSP
last updated September 16th, 2004
Terry M. Norton, DVM, Dipl. ACZM
Veterinary Advisor for the US Bali mynah SSP and Reintroduction Project
St. Catherine’s Wildlife Survival Center
Wildlife Conservation Society
182 Camelia Road
Midway, GA 31320
Ellis Greiner, PhD
Bali mynah Parasitology Advisor
University of Florida
Department of Pathobiology
College of Veterinary Medicine
2015 SW 16th Ave
Building 1017, Rm V3-240
Gainesville, Florida 32610
Ph: 352-392-4700 ext. 5861
Kenneth Latimer, DVM, PhD
Bali mynah Pathology Advisor
University of Georgia
College of Veterinary Medicine
Department of Pathology
Athens, GA 30602
Susan E. Little, DVM, PhD
Atoxoplasma PCR Research
Department of Medical Microbiology and Parasitology
College of Veterinary Medicine
The University of Georgia
Athens, Georgia 30602
Atoxoplasmosis is caused by an Isospora type coccidian parasite with a prolonged life cycle that has stages involving the intestinal mucosa and mononuclear cells and macrophages. Atoxoplasma sp. in the Bali mynah is being reclassified as Isospora rothschildi (Upton et al, 2000). For the purposes of this report, it will be referred to as Atoxoplasma sp.. Atoxoplasmosis was first reported in the Bali mynah in 1989 (Partington et al., 1989), but has been a problem in captivity in some collections for many years prior to this. Over the last 8 years, atoxoplasmosis has been documented to be a problem in Bali mynahs at several US and Indonesian zoos. Approximately 60-65% of Bali mynahs screened in US zoos have had Atoxoplasma oocysts in their feces (Greiner et al, 1995).
The primary mode of transmission of Atoxoplasma is via the fecal oral route (Flammer et al, 1989). The sporozoites are released in the intestinal lumen and invade intestinal epithelial cells, mononuclear cells, and then disseminate throughout the body. Infected adult birds may intermittently shed large numbers of oocysts for prolonged periods.
The clinical history in Bali mynahs infected with Atoxoplasma usually consists of acute death in fledgling birds most often between 3 and 8 weeks of age. Adults may rarely develop clinical signs if stressed or exposed to large numbers of oocysts (Flammer et al, 1989).
Atoxoplasma has been described in a wide range of passerine birds (Box, 1966 and 1975; Flammer et al., 1989; Partington et al., 1989; Dorrenstein, 1988 and 1995; Khan and Desser, 1971; and Levine, 1982). The species specificity of the organism is unknown. Comparative measurements of the oocysts of superb starling (Spreo superbus) and Bali mynah Atoxoplasma revealed that the superb starling oocysts were slightly smaller. A pilot study utilizing 1 superb starling as a control bird and 1 superb starling was given the Bali mynah Atoxoplasma oocysts by gavage. The oocysts given to the bird basically just passed through the gastrointestinal tract and did not disseminate to other parts of the body. Dexamethasone was given to the bird to cause immunosuppression and it was reinfected, but the organism still just passed through the GI tract and was not detected on multiple buffy coat smears. Further studies are needed in this area.
If Isospora-like coccidia are found in the feces of a Bali mynah, it is Atoxoplasma.. Hundreds of fecal samples have been performed on Bali mynahs and on only 2 occasions has another species of coccidia been observed. To definitively rule out fecal shedding, feces should be collected over several days and placed in 3-5% potassium dichromate (PDC). Periodic aeration of the PDC and feces allows the organism to sporulate in approximately 96 hours and enhances identification.
Atoxoplasma can be found on blood smears in mononuclear cells (Flammer et al., 1989). Buffy coat smears concentrate the white blood cells, thus making it more likely to find the organism when compared to routine blood smears (Flammer et al, 1989). Only a very small percentage of adult Bali mynahs shedding oocysts in the feces have been positive on buffy coat smear evaluations. Positive buffy coat smears are much more common in juvenile birds with clinical signs of atoxoplasmosis (Partington et al., 1989). Impression smears from liver biopsies (Norton et al., 1995) and /or splenic aspirates (Sutherland-Smith, Pers. Comm.) are useful diagnostic tools. Unfortunately, these 2 diagnostic tests are somewhat invasive especially in a juvenile bird showing signs of systemic disease. Wright-Giemsa stained impression smears of affected organs are more beneficial diagnostically than histopathology (Box, 1966). There is currently not an accurate antemortem test to definitively state that a Bali mynah is systemically free of this parasite. Recently funding was obtained through the Morris Foundation to develop an Atoxoplasma PCR (See section 8 for details).
As stated above, if you find Isospora sp in Bali mynah feces, it is Atoxoplasma and there is no need to send feces to Dr. Greiner. We have extensively evaluated the effects of sulfachlorpyrazine (ESB3) on fecal shedding of Atoxoplasma sp. It significantly reduces or eliminates fecal shedding; however, if the drug is not used on a regular basis as recommended, oocyst fecal shedding may reoccur. We are still interested in evaluating the effect toltrazuril (Baycox) has on fecal shedding and systemic stages of the disease. Data obtained to date indicates that this drug is not as effective against the intestinal stages of the disease as sulfachlorpyrazine and most likely does not effect the systemic stages of Atoxoplasma. Please follow the protocol below when using this drug. Diclazuril is a drug that has proven to be effective in systemic Toxoplasma in a Hawaiian crow and has been used in the foreign poultry industry. Please contact Dr. Norton if you have a bird with systemic stages of the disease and would like to use this drug. Multiple day fecal collection in PDC should be reserved for situations where a Bali mynah is in quarantine or preshipment and routine fecals are negative for Isospora spp but you still want to confirm the bird is not shedding Atoxoplasma oocysts.
Collect feces in 3% potassium dichromate for 3 days in situations described above. When evaluating Baycox therapy collect samples 1 to 10 days prior to starting treatment (if Atoxoplasma has already been diagnosed). It would be preferable to house birds individually during the collection and treatment process. This may not be possible under certain circumstances and pooled samples may be necessary. Place approximately one part feces to 10 parts potassium dichromate in the vial. Collect all feces defecated in the 24hr period. The feces from the same bird or pool of birds can be placed into the same container even if collected over 3 days. After the 3-day collection period, the sample should be aerated once daily for 5 minutes for 4 days. A small aquarium pump can be utilized for sample aeration. These samples should be sent to Dr. Greiner shortly after the 4 days of aeration. Please use the sample collection and treatment form (see section 10). Label all sample containers with species, identification number (ISIS and studbook number), dates of collection, pre- or post-treatment, and name of the institution where the bird is housed.
Atoxoplasma is shed intermittently and may be missed on fecal examination even if samples were collected over several days. If the results of the first fecal collection are negative and the clinical history is suggestive of atoxoplasmosis (acute chick and fledgling mortality), then a second screening one month after the initial testing would be appropriate. Please contact Dr. Greiner prior to sample collection so that he can be ready to process them.
NOTE: IMPORTANT HANDLING INFORMATION FOR POTASSIUM DICHROMATE (FROM MSDS):
If you feel you are capable of safely working with this product, your efforts will save Dr. Greiner considerable time. If you are uncomfortable working with this product, collect the samples in saline solution (1 part feces: 10 parts saline) for 3 days and then federal express samples to Dr. Greiner.
Processing samples will take longer. Please double bag all samples to prevent spillage.
Buffy coat smears
Two blood samples should be taken 3 to 5 days apart coinciding with the fecal collection for initial screening and pre- and post-treatment with Baycox or diclazuril. The buffy coat smear should be made from from 1 hematocrit tube onto 1 slide. Make 2-3 slides if possible. Fix the slides in absolute methanol. If the pre-treatment buffy coat samples are negative then taking the post-treatment buffy coat samples is not necessary.
Liver biopsy and splenic aspirates are more invasive diagnostic tests that can be utilized to diagnose systemic atoxoplasmosis. The systemic stages of the disease are most common in juvenile birds and uncommon in adult birds.
The most common gross pathological findings are an enlarged liver and spleen with pinpoint foci of necrosis, an edematous pancreas, and a fluid filled intestinal tract. Histopathology reveals hepatic and splenic necrosis with marked mononuclear cell infiltration (Flammer et al, 1989; Partington et al., 1989). Many other organs may be involved (Partington et al., 1989; Panigahy and Senne, 1991). Fourteen out of 70 postmortem examinations performed primarily by the SSP Veterinary Pathologist, on Bali mynahs from 1990 to 1995 attributed death to systemic atoxoplasmosis (Norton et al, 1995).
Several drugs have been used unsuccessfully to
treat Atoxoplasma in canaries (Flammer et al, 1989; Poelma et al., 1971;
Dorrenstein et al, 1985). Two drugs, sulfachlorpyrazine (ESB3) and toltrazuril
(Baycox), have been successful in reducing mortality from Atoxoplasma in
canaries (Dorrenstein, 1995), however, there is no published documentation that
the birds were cleared of the organism. Sulfachlorpyrazine only affects the
intestinal stages of the parasite (Dorrenstein, 1995), whereas, toltrazuril
appears to have some affect on systemic stages of the disease (Dorrenstein,
pers comm). It is unlikely that either drug can completely clear a bird of Atoxoplasma.
Sulfachlorpyrazine in the water has significantly reduced or totally cleared fecal oocyst shedding for an extended period of time in Bali mynahs. It is still unknown if the drug is safe to use when parents are feeding chicks. We are currently recommmending treatment for adult breeding pairs known to have chicks that have died of atoxoplasmosis in the past when they are on eggs and rearing chicks. Hopefully, if fecal shedding is inhibited, chick mortality will be decreased or eliminated.
The current treatment regimen with sulfachlorpyrazine for birds shedding the organism and long term prevention is as follows: mix 1 gram of the 30% powder in 1 liter of water and use this as the only source of drinking water for 5 days; no drug for 3 days; then repeat the 5 day treatment; this cycle is repeated 4 times, constituting one treatment. The birds should be treated three times per year if possible. Attempts should be made to treat both during the breeding season and when parents are feeding chicks through fledging. A vitamin supplement containing vitamin B6 should be utilized during the treatment period. If the regular diet already contains adequate levels of vitamin B6 then this may not be necessary.
Vetisulid (sulfachlorpyridazine) can be used as a replacement for ESB3 (sulfachlorpyrazine) at a dose of 300 mg/liter of water. Follow the same general protocol and frequency as ESB3. This can be used for other passerine birds. We would appreciate any feed back that you may have on the efficacy of this drug against atoxoplasmosis.
These are not "set in stone" guidelines, and each institution needs to assess the practicality of the treatment. Sulfachlorpyrazine is currently not available in the US, but can be obtained from the Bali mynah SSP Veterinary Advisor (TMN). Vetisulid (sulfachlorpyridazine) can be used as a replacement for ESB3 (sulfachlorpyrazine) at a dose of 300 mg/liter of water. Follow the same general protocol and frequency as ESB3. This can also be used for other passerine birds. Information on the efficacy of this therapeutic protocol (i.e. decrease in chick mortality) would be greatly appreciated. Toltrazuril has not been used extensively in the Bali mynah. It does not appear to be very effective for treating Atoxoplasma in Bali mynahs when just placed in the water. Current recommendations are to place it in a preferred food item or give it directly to the bird. It has been used in 2 Bali mynah chicks that were being hand-reared. The parents of these chicks had previously lost several clutches from atoxoplasmosis. One chick died after the treatment had been going on for several days. The dose was cut in half at this time and the other chick was raised successfully. Histopathology did not definitively reveal the cause of this chick’s death. Further studies are needed using toltrazuril in a more controlled manner to demonstrate its efficacy against systemic atoxoplasmosis. Please follow the diagnostic protocol above when using this drug. The current dosage recommendations for toltrazuril in the Bali mynah is 12.5 mg/kg SID orally for 14 days. This dosage is based on a limited number of clinical cases and any comments on its efficacy and toxicity would be very helpful. Contact Dr. Norton if you are interested in obtaining this drug. Diclazuril has been effective in systemic avian toxoplasmosis, and thus may have an effect on systemic atoxoplasmosis. Please contact Dr. Norton if you have a passerine bird with systemic stages of Atoxoplasma.
Husbandry practices are an extremely important part of the management of this parasite. Exhibits or enclosures should be designed so that they can be cleaned or stripped on a routine basis especially for breeding pairs. Coccidian parasites persist for long periods of time in soil.
Screening Schedule: A minimum of 2 fecal direct and flotation examinations should be performed yearly. It is recommended that all institutions follow the Atoxoplasma diagnostic protocol on each bird on at least one occasion. Feathers should be checked for lice during the physical examination. If endoparasites are found send them to Dr. Greiner for identification and prepare them in the following manner:
Whenever possible place parasites from different
organs into different labeled containers initially in physiological saline.
Each label should indicate identification number of the bird, organ from which
the parasite was removed, date and collector’s name.
–Trematodes and cestodes should be placed in a dish containing either tap water or physiological saline and then placed in the refrigerator for a few hours to relax. They should then be fixed in AFA (85 ml of 85% ethanol, 10-ml commercial formalin, and 5-ml glacial acetic acid). Specimens may be stored and sent to Dr. Greiner in this solution. It is best to allow large tapeworms to flatten as much as possible and not pack them too tightly, as representative sections need to be mounted flat to see structures necessary for identification. Be sure you have included scolices with tapeworms, as these structures are often lost, in most cases resulting in non-identification.
–Nematodes should be dipped in concentrated glacial acetic acid or hot 70% ethanol to fix them in as straight posture as possible. After they have stopped writhing, transfer them into glycerin-alcohol (90 ml 70% ethanol, 10-ml glycerin). They may be store indefinitely in this solution. They can be cleared for identification by adding glycerin or mount in glycerin jelly (requires ringing of coverslip). A short term, quick alternative, is to clear roundworms in lactophenol (2 parts glycerin, 1 part distilled water, 1 part melted phenol crystals and 1 part liquid lactic acid). After identification, specimens should be removed from the lactophenol and returned to glycerin-alcohol.
–The acanthocephalans require special attention due to their attachment to the gut wall by the holdfast organ. Most of these parasites can not be simply pulled loose from the gut wall without destroying the main taxonomic structure-the proboscis. These worms should either be dissected free of the host tissue or left attached to the gut wall without fixation. If separated from the host tissue, then place the parasite in tap water overnight to allow proboscis eversion, and then fix in AFA as above.
–For more information please contact Dr. Ellis Greiner.
List of Commonly Observed Parasites
Recommended Treatments for Various Parasites
–refer to the Atoxoplasma treatment protocols
–praziquantel (Droncit) 25 mg/kg orally or IM, repeat in 10 to 14 days (tapeworms)
–fenbendazole (Panacur) 50 mg/kg once daily for 3 days orally or ivermectin at 400 micrograms/kg orally (dilute with propylen glycol), repeat both drugs in 10 to 14 days (Capillaria spp and other nematodes).
Birds with chronic parasite problems may need to be placed on a rotational deworming program.
chemistry panel with emphasis on liver values
d) whole body x-ray
e) fecal bacterial culture
f) fecal exam for parasites
g) Atoxoplasma diagnostics described above; treat if indicated or discuss situation with receiving institution so that treatment can be performed while bird is in quarantine
A neonatal examination is recommended shortly after fledging occurs, as the bird is being transferred to a new enclosure. The examination should include a body weight, a thorough physical exam, complete blood count, buffy coat smear for Atoxoplasma assessment, serum biochemistry panel (if possible), and fecal examination. If the fledgling bird appears unthrifty, the Atoxoplasma diagnostic protocol should be followed.
8. ATOXOPLASMA PCR SAMPLE COLLECTION PROTOCOL
PCR testing for Atoxoplasma is now available on a fee-for-service basis from the diagnostic parasitology laboratory at the University of Georgia. The cost to the submitting institution is $25 for the first sample + $10 for each additional sample submitted at the same time. Charges will be billed to the submitter through the diagnostic parasitology laboratory. A submission form is available on-line for you to print and use, or you may obtain a hard copy form by FAXing a request to Dr. Susan Little at (706) 542-0059.
Preferred samples for testing include whole blood and fresh or frozen liver, spleen, or small intestine. However, other tissues may also be used for Atoxoplasma PCR testing. Submit 0.3-0.5 ml of whole blood in EDTA (purple top) tubes. Place blood tubes in whirl-pak or small ziplock bags prior to final packaging for shipment. Submit tissues without fixative or preservative in individual 1.5 ml plastic microcentrifuge tubes or small whirl pack bags (one tissue/tube or bag). Ship all specimens overnight with plenty of ice or ice packs. Alternatively, blood and tissue can be frozen overnight at –20°C or –70°C and shipped frozen for overnight delivery at a later date.
Fecal samples have been less rewarding for Atoxoplasma PCR assay. However, fecal samples can be examined by simple flotation and PCR if desired. Collect as much feces as possible (24-hour collection) and place in 1.5 ml microcentrifuge tubes, small serum tubes (red top), or similar container. Place the primary collection tubes in whirl-pak or small ziplock bags prior to final packaging for shipment. Ship all specimens overnight with plenty of ice or ice packs. Alternatively, feces can be frozen overnight at –20°C or –70°C and shipped frozen for overnight delivery at a later date.
Blood, tissue, and feces may all be frozen for several weeks and the samples submitted in batches to facilitate ease of submission and minimize shipping costs.
The PCR assay can also be useful in identifying Atoxoplasma in paraffin-embedded tissues with lesions. Most cases will be sent to Dr. Latimer for postmortem examination (see necropsy section below) and his lab can forward appropriate material to Dr. Little. If another laboratory has performed histopathology, the block should be placed in a whirl-pak or ziplock bag and shipped to Dr. Little. Overnight shipment is not required but may be recommended especially in the summer months. If desired, a cover letter requesting the return of the blocks once sections have been cut for PCR may be included.
To avoid thawing during shipment and subsequent leaking of packaging, please do not ship fresh or frozen material after 12 noon on Thursday or 36 hours before any standard holidays when UGA may be closed. If shipping fresh feces or fresh blood, please hold refrigerated until next possible shipment date (usually Monday). Fresh tissues can be frozen for shipment the following week. Samples should be sent, together with a thorough description of the case (MedARKS pathology and clinical notes will be fine). Make sure that all samples are labeled with the studbook number, accession number, date and species. Please call, email, or FAX prior to sending a package.
If you have any questions about submission of samples, please call Dr. Little at (706) 542-8447.
Samples from other avian species can also be tested by PCR for Atoxoplasma. Please follow the same protocols as for the Bali mynah.
A thorough necropsy should be performed on Bali mynahs that die at institutions housing this species. In addition to the institution’s regular necropsy protocol, the following protocol should be performed.
Collect a small section of all major tissues (heart, lung, airsac (on a piece of paper towel), thymus, bursa, crop, proventriculus, multiple sections of intestine, pancreas, kidney, adrenal gland, gonad, oviduct, muscle, bone marrow, and brain) in 10% buffered formalin. Three impression smears should be made of the liver and spleen and fixed. Very small chicks should be opened up and placed in 10% formalin. The University of Georgia , Department of Pathology will perform the histopathology and cytology. Refer to the above research protocols for tissue sample collection for Atoxoplasma PCR development. Please send all necropsy samples to Dr. Ken Latimer at firstname.lastname@example.org. At the same time, please send a copy of the gross necropsy report to Dr. Norton at the address above to notify him of pending histopathology. The results should be available in 4-8 weeks. If there is a rush on histopathology, please indicate this and Dr. Latimer will try to accommodate you. Please contact Dr. Norton if you have not received results within this time frame (E-mail is easiest email@example.com).
2) Include a description of the gross findings, body weight in grams at the time of death, important clinical history (including current diet).
3) Anaerobic, aerobic, and fungal cultures of various lesions should be taken when indicated. Please send a copy of the results to Dr. Norton.
4) Two sections of liver, spleen, kidney, and any tissue with obvious gross lesions should be frozen at -30 to -70 degrees C (if possible) for future viral isolation, mycobacterial, bacterial, or fungal culture.
The above protocol has been established in order to standardize necropsies performed on Bali mynahs. There is no charge for any of the above work.
Bali mynahs are predisposed to iron storage disease and should be fed a low iron diet. Please click on “Nutrition” in the Husbandry Manual for details of specific low iron diets.
Hemochromatosis or iron storage disease is caused by excessive iron accumulation that incites an inflammatory response in various body organs, especially the liver. Eventually this process may lead to fibrosis and end stage liver disease.
Hemochromatosis is relatively common in the Bali mynah as well as numerous other avian species. Fifteen out of seventy Bali mynah postmortems submitted to the veterinary advisor documented some degree of iron accumulation and inflammation and/or fibrosis. The exact cause of the disease in avian species is unknown, but appears to be multifactorial. High dietary iron has been shown to be one of the factors causing hemochromatosis in birds.
A liver biopsy is the method of choice to confirm hemochromatosis. A thorough history, physical exam, whole body radiographs, serum liver enzymes, albumin, and serum bile acid levels may aid in a presumptive diagnosis. Serum iron levels do not correlate with hepatic histopathology in birds or humans with hemochromatosis, but can be utilized to monitor therapy.
For therapy to be successful, early diagnosis of hemochromatosis is essential. Therapy consists of lowering dietary iron levels below 150 ppm. Ascorbic acid increases iron absorption from the gastrointestinal tract, thus citrus fruits should be fed only in limited quantities. The following protocol has been used successfully to treat a Bali mynah (Loomis et al., 1993) with hemochromatosis and is currently recommended by the SSP.
Protocol for treating hemochromatosis in the Bali mynah:
1. Remove a blood volume equal to 1% of the bird’s
2. Wait 2-4 days to allow iron mobilization for red blood cell production.
3. Administer Deferoxamine mesylate (Desferal mesylate, CIBA Pharmaceutical Co., Summit, New Jersey), an iron chelating agent, at a dose of 40 mg/kg IM SID for 7 days
4. Wait one week.
5. Repeat steps 1-4 five times.
6. Hematological and serum biochemical parameters should be monitored during treatment and appropriate adjustments should be made if necessary
7. If the bird is in liver failure this treatment may result in the death of the bird.
Note: tea can be placed in the bird’s water source (enough to add a tint of brown to the water) for 1 month; discontinue for 1 month, then repeat. Tea contains high levels of tannins, which bind to iron and other heavy metals. Other important nutrients will bind to tannins as well, thus it is important to follow the above protocol. This is not scientifically confirmed but has appeared to prevent or assist in reversing this disease process in certain species(TMN).
12. OTHER COMMON MEDICAL PROBLEMS
13. PHYSIOLOGICAL NORMS (normal values may be obtained from MedARKS)
14. IMMOBILIZATION (recommended drugs and dosages)
Isoflurane is the anesthetic of choice. Ketamine at a total dose of 4 mg IM in an adult birds was utilized on several Bali mynahs in Indonesia for surgical sexing. No side effects were noted and recoveries were fairly rapid (approximately 2 hrs). The birds were recovered in a small cardboard box.
Unknown in the wild. In captivity, ages up to 19 years have been recorded and 7-12 is considered a reasonable estimate of longevity.
BALI MYNAH DIAGNOSTIC SUBMISSION FORM FOR ATOXOPLASMA
Institution ID #:
Samples collected and dates:
Pretreatment sample collection: Yes or No (circle)
Postreatment sample collection: Yes or No (circle)
Treatment regimen used: drug, dose, route of administration, time period on drug, adverse side effects:
(Please submit one form for each individual for which samples are collected. This form should accompany all samples submitted to Dr. Greiner)
Send samples to:
Dr. Ellis Greiner
University of Florida
Department of Pathobiology
College of Veterinary Medicine
2015 SW 16th Ave
Building 1017, Rm V3-240
Gainesville, Florida 32610
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