Mycobacterial Granulomatous Pneumonia in Sand Boa (Eryx Johnii): a Report

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CASE REPORT Mycobacterial Granulomatous Pneumonia in Sand Boa (Eryx johnii ): A Report

Aparna S 1, Swapna Susan Abraham 1, Nandakumar S1, Prathuish PR 1 and Jacob Alexander 2

1Centre for Wildlife Sciences, State Institute for Animal Diseases, Palode, Department of Animal Husbandry, Kerala, India. 2Zoological Garden, Thiruvananthapuram, Kerala, India.

Abstract Cold-blooded animals may carry a wide variety of zoonotic

pathogens; in particular, reptiles may pose a health risk to professionals and *Corresponding Author: handlers with whom they have contact. Reptile market is growing Aparna S worldwide with people rearing snakes as pets sharing household spaces. Email: [email protected] Mycobacteriosis is relatively uncommon in reptiles probably due to the complex nature of the disease. This document reports a case of Received: 03/10/2020 mycobacteriosis in Sand Boa which was kept under captivity. Diagnosis Accepted: 29/11/2020 was based on necropsy, microscopy and histopathological examination. The report highlights importance of improving sanitization for disease prevention among snakes kept under captivity and possible role of them

acting as source of infection to humans.

Keywords : Sand boa, Granulomatous pneumonia, Mycobacteriosis.

1. Introduction stomatitis, and respiratory tract involvement (Keil, Mycobacterial infections are commonly reported 1977). Limited research has been conducted in the in companion, domestic and wild animals. Although epidemiology of mycobacteriosis in reptiles. Aim of they also occur in reptiles like snakes, lizards, turtles, this documentation was to report the occurrence of and tortoises, it is usually manifested as sporadic mycobacteriosis in snakes and to highlight possible role disease episodes with low morbidity. Mycobacteria are they may play as potential reservoirs of this agent to gram-positive, aerobic, alcohol-acid-resistant bacteria handlers and other animals. and share the same morphological characteristics among different species, which are currently classified 2. Materials and Methods into M. tuberculosis and non tuberculous mycobacteria Two red Sand Boa (Fig 1) were presented for (NTM) (Ullman et al. , 2016). Infections are less necropsy from Thiruvananthapuram zoological garden. frequently caused by M. chelonei , M. thamnopheos. M. History sheet revealed that they showed symptoms of avium, M. chelonae, M. fortuitum, M. intracellulare, M. anorexia, lethargy and weight loss. Both were housed marinum, M. phlei, M. smegmatis and M. Ulcerans separately. Detailed necropsy was conducted. Necropsy (Oldati et al ., 2004). Mycobacterium marinum is the revealed small nodular lesions throughout the lung species most commonly isolated in reptiles (Mitchell, parenchyma and liver, ulcerative gastritis and 2012). Most of these organisms produce disease only proliferative necrotizing enteritis. Representative tissue when the host is immunosuppressed or when large samples were collected from lungs, liver, heart, numbers of organisms are introduced. Presenting kidneys, oesophagus, and small intestine, preserved in clinical signs are often related to the affected organs 10% neutral buffered formalin for histopathological and characterized by diffuse and granulomatous lesions examination. Nodules were crushed and smears were (Ebani et al ., 2012). Diagnosis is usually postmortem, prepared for prospective evaluation by Ziehl Neelsen wherein necropsy findings when visible include staining. A careful search for Mycobacterium was greyish-white nodules due to the granulomatous performed on all tissue areas with granulomatous inflammatory infiltrate with multinucleated giant cells inflammation. (Oldati et al ., 2004). Nonetheless, mycobacteriosis transmission has been poorly described and remains to be fully established in reptiles (Ebani et al ., 2012). Cutaneous mode and/or ingestion may represent the main route to susceptible animals. Impaired immune status triggered by chronic diseases, stress, poor nutrition and captivity make them susceptible. Clinical signs described are non-specific such as anorexia, lethargy and weight loss, while the main lesions found in snakes with mycobacteria include skin alteration, Fig 1: Red Sand Boa.

3. Results and Discussion individually housed, they shared common handlers, Whitish nodules 1-2mm in diameter in the lungs food and water. and liver (Fig 2), hyperemic intestines, ulcerative gastritis and proliferative necrotizing enteritis and pale kidneys during the necropsy examination led to suspicion of Mycobacterium spp . infection. Similar whitish, multifocal nodules were observed in the second sand boa also; however, randomly spread only in lungs and liver tissue. Histopathologic examination of samples revealed caseous granulomatous pneumonia (Fig 3) characterized by central core of caseation surrounded by inflammatory mononuclear infiltration

and fibroplasia. Fig 4: Lung section showing acid fast bacilli, ZN staining, 1000X.

Fig 2: Granulomatous nodules in lungs. Fig 5: Crushed nodules showing acid fast bacilli, ZN staining, 1000X.

They were fed with apparently healthy rodents. Enclosure contamination and oral ingestion can be attributed as the probable source of infection though could not be confirmed conclusively. In closed systems the presence of mycobacterial infection in one animal significantly increases the risk of infection for all animals (Maslow et al ., 2002).

Fig 3: Lung section showing multiple caseous granulomas, H 4. Conclusion and E, 200X Mycobacteriosis is an important disease worldwide. It has been reported in only a handful of However calcification, a feature of mammalian cases in reptiles. Hence this case is documented. tubercles, was not evident. Unlike mammalian Without identification of species of mycobacteria by tubercles, calcification has not been observed in reptiles molecular methods, report is undoubtedly incomplete. (Reil et al., 2017). Granulomas were present in liver However identification of Mycobacterium genus as the also. Special staining with Ziehl-Neelsen demonstrated etiological agent highlights the epidemiological clumps of acid fast bacilli in the centre of the significance of the occurrence of mycobacteria in granuloma (Fig 4). Organism is reported to have a captive reptiles, presenting them as possible hosts and predilection for liver in reptiles (Marcua et al., 1976). threat of transmission to humans. The information may Ziehl-Neelsen staining of smears of nodules collected be useful to professionals working with reptiles to from lung parenchyma revealed numerous acid fast develop best handling practices and giving bacilli (Fig 5). Besides the inflammatory alterations the recommendations to clients rearing reptiles as pets. presence of acid-alcohol-resistant bacilli stained by More studies are warranted to elucidate more on Ziehl-Neelsen, in the samples were suggestive of pathogenicity and epidemiology of Mycobacteriosis in Mycobacterial infection. Although both victims were reptiles.

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