S e l Cf- LEARN • REVISE • REINFORCE oA ls os Much has happened in the 19 years since the publication of r e Rs the first edition of Reptiles and Amphibians: Self-Assessment Color es Reptiles and m Review. Many more scientists and clinicians have taken an interest in v reptiles and amphibians, novel radiographic techniques have been developed, iee wn and veterinary surgeons have devised operative solutions to numerous serious t conditions in both reptiles and amphibians. The time is right for an expanded Amphibians second edition that covers these developments and more. See What’s in the Second Edition: • More than 230 new and revised reptile and amphibian cases, illustrated in color 2nd Edition • Case studies with answers that fully explore the disease or disorder in question • Case selection based on common reptilian and amphibian species kept as pets or study animals Written by a foremost authority, this book presents more than 230 cases and questions at different levels of expertise, with detailed explanatory answers. The cases appear in random order, just as they would in real life, and enable you—by Fredric L. Frye solving the clinical puzzle—to make differential diagnoses, treatment plans, and prognoses. The color review includes a wealth of problem-oriented information of value—and enjoyment—for formal and informal training and continuing education. Clinical cases Problem based Fully illustrated K24103 ISBN: 978-1-4822-5760-1 90000 9 781482 257601 K24103_Cover.indd All Pages 7/6/15 4:08 PM Self-Assessment Color Review Reptiles and Amphibians Second Edition Frederic L Frye BSc, DVM, MSc, CBiol, FSB(FIBiol), FRSM Diplomate (Honorary) American Board of Veterinary Practitioners (Reptile/Amphibian) K24103.indd 1 07/07/2015 10:36 CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2016 by Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works Version Date: 20150623 International Standard Book Number-13: 978-1-4822-5761-8 (eBook - PDF) This book contains information obtained from authentic and highly regarded sources. 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Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com Dedication To Brucye, Lorraine, Erik, Noah and Ian. To Dr. Wilbur Amand, Executive Director of the Association of Reptile and Amphibian Veterinarians (ARAV), who so skillfully and generously shepherded that organization since its inception; and to my colleagues and dear friends, Professor Giovanni DiGuardo, who exemplifies the very best in professional collegialism, and Dr. Douglas R. Mader, who has achieved every potential that I recognized in him when he was a student of mine in the 1980s. Acknowledgements I want to express my appreciation to my colleague, Dr. Douglas R. Mader, for reviewing and making numerous insightful comments on the manuscript for this book. The following colleagues generously contributed case material and/or photographic or radiographic images: Case number Contributor Case number Contributor 4 Mr. Clifford Warwick 163 Dr. Christopher Katz 31 Dr. Angelo Lambiris 173 Dr. John Allan 40 Dr. Pavel Siroky 174 Dr. Robert Altman 87 Dr. Nicasio Brotons 175 Dr. Caroline Pond 98 Dr. Pavel Siroky 177 Dr. Walter Rosskopf 99 Dr. Zahi Aizenberg 180 Dr. David Huff 116 Ms. Erika Sorenson 182 Mrs. Jeri Hegenbart 118 Dr. Nathan Cohen 183 Dr. Ana Salbany 119 Dr. Fabio Faiola 184 Dr. Christopher Katz 132 Dr. Alvin Atlas 191 Dr. Howard Schwartz 134 Mr. Brian Gray 192 Dr. Betsy Rodger 136a-e Dr. Oscar Grazioli 201 Dr. Marta Avanzi 136f Dr. Stephen 204 Dr. Andi Milhaca Goldberg 213 Dr. Angelo Lambiris 153 Dr. James Corcoran 220 Dr. Bogdan Cordos 156 Dr. Chris Knott 221 Dr. Allejandro A. 157 Dr. Bogdon Serpy Bayon del Rio 158 Mr. Clifford Warrick 224 Dr. Andi Milhaca 159 Mr. Clifford Warrick 226 Dr. Rachel Blackmer 160 Dr. David Huff iii K24103.indd 3 07/07/2015 10:36 Broad classification of cases Alimentary system: 3, 10, 22, 26, 48, 103, 105, 119, 153, 165, 176, 180, 199, 220, 223 Anatomy (normal structures): 54, 67, 81, 85, 115, 117, 128, 129, 148, 193, 194, 195 Anesthesia: 161 Dermal/integumentary conditions: 4, 12, 27, 36, 53, 74, 79, 87, 98, 122, 133, 137, 141, 147, 149, 150, 185, 197, 214 Developmental anomalies: 25, 35, 52, 114, 130, 132, 134, 177, 178, 213 Endocrine disease: 72, 175 Environmental conditions: 15, 36, 100, 112, 118, 158, 207 Foreign bodies: 15, 48, 106, 162, 176, 187 Hematology: 2, 16, 29, 32, 37, 41, 62, 84, 86, 95, 107, 109, 142, 145, 190, 209, 215 Identification of animals: 31, 43, 59, 61, 65, 76, 111, 120, 123, 124, 127, 152, 168, 184, 196 Infections: 5, 24, 70, 74, 91, 99, 101, 102, 104, 105, 108, 113, 131, 137, 138, 139, 140, 142, 144, 147, 150, 153, 155, 156, 157, 164, 167, 169, 179, 218, 220, 223, 232 Neoplasia: 39, 40, 98, 172, 173, 181, 191 Neurological dysfunction: 104, 151, 153, 205, 232 Nutrition/nutritional disorders: 3, 10, 13, 14, 20, 23, 50, 56, 69, 71, 93, 97, 106, 116, 126, 149, 166, 180, 208, 227, 229 Ophthalmic disorders: 11, 15, 79, 159, 202, 208, 211, 212, 219, 221 Parasites: 9, 18, 24, 34, 38, 39, 42, 44, 45, 49, 55, 58, 60, 63, 66, 73, 77, 78, 87, 92, 110, 121, 171, 203, 204, 206, 210, 212, 216, 217, 224 Renal disorders/excretion: 1, 7, 30, 64, 88, 96, 113, 125, 126, 172, 228 Reproductive system: 19, 47, 68, 75, 80, 81, 82, 83, 85, 89, 94, 100, 115, 124, 125, 129, 136, 143, 163, 173, 177, 178, 182, 188, 198, 207, 226 Respiratory disease: 70, 139, 141, 162, 174, 225, 231 Skeletal system: 21, 33, 39, 57, 91, 99, 135, 140, 160, 169, 186, 201, 218, 230 Trauma: 11, 17, 46, 51, 75, 183, 189, 192, 200 Contents About the Author v Preface vii Abbreviations xii Cases 1 Appendix 230 Index 234 iv K24103.indd 4 07/07/2015 10:36 About the author Fredric L. Frye BSc, DVM, MSc, CBiol, FSB (FIBiol), FRSM, Hon. Dipl. ABVP (R/A) After his honorable discharge from the US Navy, where he served as a combat air crew member in a blimp squadron engaged in antisubmarine patrols, Fredric Frye earned his degrees at the University of California, Davis and served two residencies: General Surgery with an emphasis on cardiovascular surgery at the US Public Service Hospital, San Francisco, and Pathology at the University of California, Davis. He is an elected member of two scholastic honor societies: Alpha Gamma Sigma and Phi Zeta. He was an epidemiologist with the California Cancer Research Program and then engaged in private clinical practice in Berkeley and Davis, California. Dr. Frye joined the faculties of the University of California School of Medicine, San Francisco, teaching experimental surgery; University of California, Berkeley’s Lawrence Berkeley Laboratory, working on nuclear medicine, immunosuppression and space-suit design for the NASA Apollo Project; and the University of California, Davis, School of Veterinary Medicine, as a Clinical Professor of Medicine serving pro bono for 24 years. In 1977 he returned to the University of California, Davis, and earned a Master’s degree in Comparative Pathology. For 23 years, he was the principal pathologist for a biopharmaceutical research firm until they relocated to the United Kingdom in 2005. He is now a Visiting Professor of Comparative Medicine and Pathobiology at numerous Universities and Colleges in North America, UK, Italy and Japan. He is the author of 23 textbooks, four non-scientific books, 363 papers, 38 CD Rom programs; and co-author of 28 textbooks and numerous chapters in multiauthored textbooks. He has authored three humor titles, Phyllis, Phallus, Genghis Cohen – and Other Creatures I Have Known; Politicians and Diapers Should Be Changed Frequently – and for the Same Reason; and May I Inquire as to What the Chicken Did. His memoir, Pa Ba La Ba La Gum, was published in 2014. He was the 1969 recipient of the American Veterinary Medical Association’s Practitioner Research Award; he was the second Edward Elkan Memorial Lecturer at the University of Kent, the Richard N. Smith Memorial Lecturer at the University of Bristol, and the Peter Wilson Bequest Memorial Lecturer at the University of Edinburgh. He is an elected Life Member of the American Association for the Advancement of Science and an Elected Fellow of the Royal Society of Medicine and the Institute of Biology, London. He was named as a Patron of the Charles Louis Davis Foundation for International Advancement of Veterinary and Comparative Pathology and was elected to the Board of Directors of the German Society for the Study of Comparative Pathology and Oncology in Berlin. In 2001 he was elected as an Honorary Life Member of the British Veterinary Zoological Society. After developing – and maintaining – an intense interest in animals in general, and particularly reptiles, amphibians and invertebrates, he applied his clinical veterinary skills to these previously overlooked animals and has been credited by his colleagues as the ‘Father of Herpetological Medicine and Surgery’. In January 2002, he was honored as the recipient of the first Association of Reptilian and Amphibian Veterinarians (ARAV) Lifetime Achievement Award, which now is v K24103.indd 5 07/07/2015 10:36 named the Fredric L. Frye Lifetime Achievement Award. In 2010, he was named as the first Distinguished Honorary member of the Associazione Linnaeus in Italy. The multiauthored text, Invertebrate Medicine, to which he contributed a chapter on scorpions, received the 2012 TEXTY AWARD. In 2013 he was awarded a Lifetime Membership in the ARAV, and in 2014, Fred was honored with an Honorary Diplomacy in Reptiles and Amphibians by the American Board of Veterinary Practice for his contributions to Herpetological Medicine and Surgery. Retired from private practice, Fredric consults on difficult clinical cases with colleagues; mentors students; and devotes much of his time to the family certified organic farm, La Primavera, where he is engaged in pomological culture and improvement of apple, pear, peach, plum, nectarine and citrus fruit trees. In the 1980s he was successful in producing viable garlic seeds from a plant that usually reproduces only asexually. Among his avocations are designing and building fine furniture and sculpting art objects from sustainable tropical forest products, metal and stone; he has had two one-man shows of his artwork. vi K24103.indd 6 07/07/2015 10:36 Preface The first edition of this book was written with a retrospective view and deep appreciation of comparative medicine, surgery and comparative pathology in its broadest sense. As the author of this second edition, permit me to give my assessment of where I perceive herpetological medicine and surgery has come and where I think it will continue to progress into the future. ‘One Health’ was a concept emanating from joint meetings of officials of the American Medical Association and the American Veterinary Medical Association. It was a notion that was long in coming and is a most welcome advance in thought. After all, humans are animals. We share many of the same maladies. Physicians deal with but one species and two genders, while veterinarians deal with anywhere from two to several thousands of species (depending upon one’s specialty), and as many as six genders (male, female, ovariectomized females and castrated males, intersex individuals, and even uniparental parthenogenetic animals). Beyond those differences, however, both professions approach their patients in much an identical fashion, and strive to achieve the same goals employing the same diagnostic and treatment techniques. These approaches certainly apply to the so-called ‘lower’ vertebrates as well as to human and non-human mammals. Radiography, in all of its highly useful expressions including plain and contrast imaging, ultrasonography, magnetic resonance and three-dimensional computed tomographic scanning, nuclear isotope tracing, and so forth, is used for producing images as diagnostic tools. Physiological chemistry for analyzing blood, urine and other bodily fluids, and routine histological processing and, where indicated, highly specific immunohistochemical staining, are essential diagnostic laboratory techniques that aid in the precise characterization of neoplastic and other abnormal tissues. Doppler blood-flow detection and echocardiology are advances in diagnostic medicine that find ready applications in herpetological medicine and surgery. Often, the main obstacles to the application of some of these diagnostic modalities are access and cost. That stipulated, numerous academic and private practices now offer those diagnostic modalities. The advent of new and highly effective anesthetic agents, antibiotics, anti-inflammatory agents, and non-steroidal analgesic medications has brought the practice of herpetological medicine and surgery into the mainstream of veterinary medicine and surgery. When I graduated from veterinary school 50 years ago, many of these technologies and chemical agents were not available because they had not been invented! Commencing in the 1960s, a more realistic approach began to evolve, and as it did organized herpetological medicine and surgery became a reality. There were, however, sceptics who thought that treating reptiles and amphibians was a waste of their precious time and efforts. Those opinions did not prevail, and herpetological medicine and surgery eventually became a veterinary discipline that warranted formal recognition and board status – both of which it has justifiably earned. Much has happened in the 19 years since the first edition of this book was published. Many more scientists and clinicians have taken an interest in reptiles and amphibians. As a result, the membership in the Association of Reptile and vii K24103.indd 7 07/07/2015 10:36 Amphibian Veterinarians (ARAV) has grown exponentially, and more veterinary schools and colleges are now including academic coverage of the care and treatment of these non-domestic animals in their curricula. Crucially, in the years since the first edition was released, many individual species of amphibians, especially frogs, have become extinct, owing in part to habitat loss and, increasingly, the highly contagious fungal organism Batrachochytium dendrobatidis, which continues to devastate populations in Australia and South, Central, and North America. In late 2014, a second species of this mycotic pathogen, Batrachochytium salamandrivorans, was reported from European urodele amphibians.1 This species of Batrachochytium was imported with salamanders originating from Southeast Asia, some of which may represent a novel source of healthy carriers of this organism. Unfortunately, this pathogenic fungal taxon has already been isolated from tailed amphibians in The Netherlands and Belgium. Because of its inherent pathogenicity for many species of urodeles as well as populations of amphibians native to continents where native newts and salamanders lack natural immunity, this new newly discovered chytrid poses a threat to amphibians far from its point of origin. Cryptosporidiosis, because of a parasitic protozoan pathogen, is ever more frequently diagnosed in captive reptiles and, like several viral diseases of reptiles, is a major concern of captive collections and breeders. Numerous bone diseases, some of which are linked to nutritional deficiencies/excesses, and captive environmental husbandry are common in reptiles and amphibians. The precise laboratory determination of normal physiological values and the application of these analytical investigations to actual cases of infectious, nutritional, metabolic, parasitic, and neoplastic diseases are of significant importance to the early diagnosis and effective monitoring of numerous treatment regimens. During the past two decades many novel radiographic techniques have been developed and are now placed at the disposal of veterinary clinicians, especially those attached to academic institutions and, as noted previously, also in some private practices. Clever veterinary surgeons have devised operative solutions to numerous serious conditions in both reptiles and amphibians. Thus, for these reasons and the enthusiastic acceptance of the first edition, the publishers decided that the time was right for an expanded second edition. The choice of whether to include cases and images from the first edition was left to my judgment. I wanted to keep this edition fresh and of interest to my colleagues who have the first edition on their bookshelves – and in their memories. In addition, I kept in mind the value of many of those cases for training younger generations of veterinarians and students. In the first edition, and in this one, the reader is presented with the facts of the cases and may be asked to give a diagnosis, treatment or management plan, prognosis, or a rational means for preventing a certain condition; or to identify a particular parasitic organism, what measures to take in instances of multiple cases within a collection or colony situation, and so forth. As was the case with the first edition, the cases are purposely presented in a random fashion because in actual clinical practice, that is exactly how cases occur. Unless a clinician is a specialist, she or he is unlikely to see multiple or consecutive cases of a dermatological or ophthalmological condition in a series of one after another; viii K24103.indd 8 07/07/2015 10:36 nor is one likely to have an endless number of metabolic or infectious disease cases without other diagnostic challenges comprising radiological, diagnostic laboratory investigative, or surgical procedures mixed in between the others. Also, there are instances where the reader is questioned as to the identification of a particular animal, blood cell, parasitic ovum or cyst. This form of presentation is also a means for sustaining interest in pursuing the self-assessment format. Also, in the ‘real’ world, one does not have the luxury of filling out a college blue book when faced with a clinical challenge. Rather, one must think, consider the facts revealed in the history, the signs shown by the patient, the laboratory results, and so forth, and winnow through several possibilities, then formulate a rational answer that includes likely diagnoses, a cogent treatment plan, and prognosis. There is a bias in the selection of cases inasmuch as certain species of reptiles and amphibians are more often kept as ‘pets’ or study animals. Thus, there are more boa constrictors, green iguanas, Old World chameleons, certain monitor lizards, African frogs and toads, American alligators, North American and European turtles and tortoises and some other tropical and temperate-zone snakes than might be expected. These are the taxa that are more often sold by pet dealers and, consequently, are more likely to be seen by veterinarians. Pioneers of comparative medicine such as the 17th century’s Marcello Malpighi, the 18th century’s John Hunter and the 19th century’s Rudolph Virchow contributed mightily to our fund of knowledge via their experimental approaches, which included non-mammalian species. Each was a physician-pathologist, and they all shared an intense interest in investigating, in an integrated manner, the intimate anatomical and physiological relationships of cells, organs and entire organisms. Rather than merely investigating a sole entity, a solitary lesion, or an isolated organ or organ system, each explored insights that evolved into an integrated – dare I say – ‘holistic’ approach to a given patient. Individually those cells, organs or organ systems are interdependent (i.e. each and every part of an organism exerts an influence on its counterparts). The herpetological patient, be it a frog, toad, newt, salamander, snake, lizard, tortoise, crocodile or any other creature, must be seen and appreciated as the whole of its disparate parts. From this, one can see that obtaining a thorough history is absolutely essential. Not only the details of the individual patient, but also: • What environmental factors might have played a role in inducing a particular condition or disease to appear? • How many animals in the collection are unwell or have died? • Has microbiological and/or toxicological testing been carried out? • Have histological examinations occurred? • Is a quarantine program established and if so, for how long and how is it managed? • Was nutrition per se or some deficiency in a major or minor nutritive component a contributing factor? • What is the source of the dietary items fed? • Did a traumatic event occur? • Was a mixed population of animals housed together? ix K24103.indd 9 07/07/2015 10:36