Clinical Pathology of Parrots
-autotutorial programs
Marie Gunnarsson
Handledare: Harold Tvedten Institutionen för biomedicin och veterinär folkhälsovetenskap avd för bilddiagnostik och klinisk kemi
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Sveriges lantbruksuniversitet Examensarbete 2006:8 Fakulteten för veterinärmedicin och ISSN 1652-8697 husdjursvetenskap Uppsala 2006 Veterinärprogrammet
Swedish University of Agricultural Sciences Degree project 2006:8 Faculty of Veterinary Medicine and ISSN 1652-8697 Animal Sciences Uppsala 2006 Veterinary Medicine Programme
INNEHÅLLSFÖRTECKNING
SUMMARY...... 1 SAMMANFATTNING...... 1 INLEDNING ...... 1 Collecting Samples for Testing ...... 2 Avian Hematology ...... 2 Avian Biochemistry...... 2 Common Avian Diseases ...... 2 Avian Cases ...... 3 LITTERATURFÖRTECKNING...... 4 Internetkällor...... 4
SUMMARY At the Veterinary Medicine Programme there is very little time allotted paid to exotic pets, which include psittacine birds, compared to other kinds of animals. However parrots are quite often seen as patients in the animal clinics in Sweden currently. Many veterinarians have unfortunately not enough knowledge to take care of such patients in a proper manner.
The aim of this degree project was to put together a CD with information about hematology and clinical chemistry in parrots. The information is supposed to be easily available and designed for interested veterinary students and veterinarians. The CD also includes information about how to collect blood samples and common avian diseases. It consists of five Power Point presentations: Collecting Samples for Testing, Avian Hematology, Avian Biochemistry, Common Avian Diseases and Avian Cases. The language is English to make this project also available for foreign students and veterinarians.
SAMMANFATTNING På veterinärutbildningen vid Sveriges lantbruksuniversitet ägnas knappt någon tid alls åt de udda sällskapsdjuren, dit papegojor räknas, i jämförelse med andra djurslag. Det är dock inte så ovanligt att papegojor kommer in som patienter till djurklinikerna. Många veterinärer har inte de kunskaper som krävs för att kunna ta hand om de här patienterna på ett proffesionellt sätt.
Syftet med det här examensarbetet var att skapa en CD-rom där information om framför allt hematologi och klinisk kemi hos papegojor ska finnas lättillgänglig för veterinärstudenter och yrkesverksamma veterinärer. Även information om provtagning och vanliga sjukdomar ingår. På CD-skivan ingår fem Power Point- presentationer: Collecting Samples for Testing, Avian Hematology, Avian Biochemistry, Common Avian Diseases och Avian Cases. Språket som används är engelska för att även utländska studenter och veterinärer ska kunna ta del av utbildningsmaterialet.
INLEDNING Papegojor tillhör den grupp djur som brukar kallas exotiska eller udda sällskapsdjur i veterinärmedicinska sammanhang. På veterinärutbildningen vid Sveriges lantbruksuniversitet är de utan tvekan exotiska, men denna beskrivning stämmer allt sämre när man ser till vilka typer av patienter som dyker upp på djurklinikerna i Sverige. Allt fler djurägare har sina papegojor försäkrade och uppsöker veterinär när fåglarna blir sjuka. Det växande behovet av kunskap hos veterinärer inom detta område möts enligt min mening inte upp av veternärutbildningen.
Eftersom undervisningen på veterinärprogrammet inte tar upp udda sällskapsdjur i någon större utsträckning och detta är ett område som speciellt intresserar mig har jag valt att under min sista termin på veterinärprogrammet fördjupa mig inom ämnet. Jag har inriktat mig framför allt på hematologi hos papegojor.
1 För att andra veterinärstudenter och även färdigutbildade veterinärer ska kunna ta del av mina nyförvärvande kunskaper på ett lättillgängligt och inspirerande sätt har jag skapat en CD-rom som innehåller fem olika Power Point-presentationer. Dessa presentationer är utformade så att den intresserade ska kunna följa dem på egen hand i valfri turordning. För bästa utbyte bör presentationerna ses i fullbildsformat. De flesta bilder som ingår är tagna för det här projektet av min handledare Harold Tvedten eller utvalda ur hans arkiv och några är tagna av veterinärstudent Torvald Netterby. Resten av bilderna är bilder från internet som inte är upphovsrättsskyddade. Mer information om dessa bilders ursprung finns på CD-skivan. Språket som används är engelska för att även utländska studenter och veterinärer ska kunna ta del av utbildningsmaterialet. Nedan följer en kort beskrivning av de olika Power Point-presentationerna.
Collecting Samples for Testing En förutsättning för att kunna undersöka papegojornas blod är naturligtvis att ett blodprov ska kunnas tas. Detta kan säkert skrämma många som inte är vana att hantera fåglar. Det är dock viktigt att komma ihåg att det inte är svårare att ta ett blodprov från en papegoja än vad det är att ta ett blodprov från en hund eller en katt. Naturligtvis underlättar det om en van person håller i fågeln och lämplig utrustning används. Den här presentationen går igenom förberedelser inför provtagning, provtagningsförfarande och rutiner efter provtagning till exempel hur ett blodutstryk utförs.
Avian Hematology Den största skillnaden mellan fågelblod och blod från däggdjur är att alla blodceller i perifert fågelblod är kärnförande. Detta innebär alltså att hos fåglar har både erytrocyter och trombocyter kärnor. En annan skillnad är att fåglar saknar neutrofila granulocyter som finns hos däggdjur. Istället har de en celltyp som kallas heterofila granulocyter. Dessa två olika celltyper motsvarar varandra. Den här presentationen går framför allt igenom den normala morfologin hos de olika celltyperna, men även lite mer speciella fynd såsom toxiska heterofiler och reaktiva lymfocyter tas upp. Anemi och artefakter är två andra ämnen som också ingår i presentationen. Presentationen avslutas med frågor och svar som får läsaren att tänka till och kontrollera sin kunskaper.
Avian Biochemistry Vilka biokemiska analyser som är meningsfulla att genomföra skiljer sig mellan djurslag. Presentationen som handlar om biokemi tar upp de analyser som oftast genomförs på papegojor enligt Gunnel Andersson, som arbetar som veterinär på Djurkliniken Roslagstull i Stockholm, där de är specialiserade på papegojor och andra udda sällskapsdjur. Även hur provsvaren sedan ska tolkas ingår i stora drag i presentationen.
Common Avian Diseases Papegojor drabbas till viss del av samma sjukdomar som däggdjur, men det finns en del sjukdomar som är specifika för fåglar. De sjukdomar som tas upp i den här presentationen är bland de vanligaste som förekommer hos fågelpatienter på djurklinikerna. Psittacine beak and feather disease är inte vanligt förekommande i Sverige, men ingår ändå eftersom det är en så pass viktig sjukdom. Vissa
2 sjukdomar som drabbar papegojor är zoonoser, t.ex. chlamydios eller papegojsjuka som den även kallas. Dessa sjukdomar är kanske extra viktiga att känna till när man arbetar med fågelpatienter.
Avian Cases Denna presentation tar upp två autentiska fall som är hämtade ur patientunderlaget på Regiondjursjukhuset Strömsholm. Bilderna på blodutstryken är tagna av Harold Tvedten från de blodutstryk som tillhör de riktiga patienterna. Syftet med presentationen är att visa typiska fall så att läsaren kan bilda sig en uppfattning om hur det kan vara att ha en papegoja som patient. Det sista fallet visar även att det inte alltid blir riktigt som man tänkt sig.
3 LITTERATURFÖRTECKNING Andersson, Gunnel. Legitimerad veterinär, Djurkliniken Roslagstull, Stockholm. Udda sällskapsdjur. Föredrag 2005-10-15. Austic RE & Scott ML. (1991) Nutritional diseases. In: Calnek BW, Barnes HJ, Beard CW, Reid WM & Yoder HW Jr. (Eds.) Diseases of poultry. 9 ed. 45-71. Ames: Iowa state university press. Campbell TW. (1988) Avian hematology and cytology. Ames: Iowa state university press. Campbell TW. (1994) Hematology. In: Ritchie BW, Harrison GJ & Harrison LR. (Eds.) Avian medicine: Principles and applications. 176-198. Lake worth: Wingers Publishing, Inc. Coles BH. (1991) Cage and aviary birds. In: Beynon PH. & Cooper JE. (Eds.) Manual of exotic pets. 150-179. Cheltenham: British Small Animal Veterinary Association Fudge AM. (2000) Laboratory medicine avian and exotic pets. Philadelphia: W.B. Saunders Company. Girling SJ. (2003) Veterinary nursing of exotic pets. Oxford: Blackwell Publishing. Harcourt-Brown NH. (2000) Pcittacine birds. In: Tully TN, Lawton MPC & Dorrestein GM (Eds.) Avian medicine. 112-143. Oxford: Butterworth-Heinemann. Harris DJ. (2000) Clinical tests. In: Tully TN, Lawton MPC & Dorrestein GM (Eds.) Avian medicine. 43-51. Oxford: Butterworth-Heinemann. Hawkey CM, Hart MG, Knight JA, Samour JH & Jones DM. (1982) Haematological findings in healthy and sick African grey parrots (Psittacus erithacus). Vet Rec18/25, 580-582. Kazacos EA & Van Vleet JF. (1989) Sequential ultrastructural changes in the pancreas in zinc toxicosis in ducklings. Am J Pathol 134, 581-595. Lu J. & Combs GF Jr. (1988) Effects of excess dietary zinc on pancreatic exocrine function in the chick. J Nutr 118, 681-689. Lucas AM. & Jamroz C. (1961) Atlas of avian hematology. Washington: United States department of Agriculture. Lumeij JT & Remple JD. (1991) Plasma urea, creatinine and uric acid concentration in relation to feeding peregrine falcons (Falco peregrinus). Avian Pathol 20, 79-83. Samour JH. (2000) Avian Medicine. London: Mosby. Zdziarski JM, Mattix M, Bush RM & Montali RJ. (1994) Zinc toxicosis in diving ducks. J Zoo Wildl Med 25, 438-445. Zinkl JG. (1986) Avian hematology. In: Nemi JC. (Ed.) Schalm’s veterinary hematology. 256-273. Philadelphia: Lea & Febiger.
Internetkällor http://www.californiaavianlaboratory.com/artifact.html. (2005-03-11) http://www.californiaavianlaboratory.com/bileac.html. (2005-03-11) http://www.californiaavianlaboratory.com/chempro.html. (2005-03-11) http://www.californiaavianlaboratory.com/chempro.html. (2005-03-11) http://www.californiaavianlaboratory.com/leukocount.html. (2005-03-11)
4 http://www.merckvetmanual.com/mvm/htm/bc/170304.htm (2005-12-04) http://www.merckvetmanual.com/mvm/htm/bc/170310.htm (2005-12-04) http://www.merckvetmanual.com/mvm/htm/bc/170318.htm (2005-12-04) http://www.merckvetmanual.com/mvm/htm/bc/170319.htm (2005-12-04) http://www.merckvetmanual.com/mvm/htm/bc/170322.htm (2005-12-04) http://www.merckvetmanual.com/mvm/htm/bc/206100.htm (2005-12-04)
5 Birds have nucleated Erythrocytes erythrocytes. The cell is oval with an oval centrally positioned Avian hematology nucleus. Avian erythrocytes are much larger than Marie Gunnarsson most mammalian Institute for Clinical Chemistry erythrocytes. The Swedish Agricultural University size varies among species.
This 1.5 year old African grey parrot had a problem with feather plucking but had The chromatin Erythrocytes normal appearing erythrocytes. in the nucleus is uniformly clumped and becomes more condensed with age. The cytoplasm has a uniform texture and stains orange-pink.
These are normal erythrocytes from a In avian blood Erythrocytes healthy 11 year old African grey parrot. smears variations from the typical erythrocyte are occasionally seen. The shape can vary (poikilo-cytosis) from irregular to round or elongated. Changes limited to certain areas are often artifactual.
1 The occasional abnormally formed erythrocyte was from the same normal Erythrocytes African grey parrot seen previously. It is important to seperate artifact from true morphologic changes. Erythrocytes missing nuclei are called erythroplastids. They are often due to preparation artifact.
This blood is from a healthy 11 year old Occasional Erythrocytes immature African grey parrot. polychromatophilc erythrocytes are normally seen. Their cytoplasm is more basophilic and chromatin more dispersed than in mature erythrocytes.
Erythrocytes Erythrocytes
Immature Answer: erythrocytes are also This is the most more round than immature mature erythrocytes. erythrocyte.
Question: The blood is from Which one of these a healthy African erythrocytes is the grey parrot. most immature?
2 Anemia Anemia
An indication of erythrocyte regeneration Anisocytosis (variability in cell size) (bone marrow response to an anemia) is occurs normally in blood smears from the degree of polychromasia. 1-5 % healthy birds. With an active bone erythrocyte polychromasia is normal in a marrow response to anemia, anisocytosis healthy bird. In a blood smear from a bird increases and it is characterized by with regenerative anemia the degree of younger larger and rounder erythrocytes. polychromasia will increase.
This is blood from a 3 month old male red Anemia fronted kakariki with hemolytic anemia. This is an example of regenerative anemia. Notice that about half of the erythrocytes are immature polychromatophilic cells.
Anemia Anemia Increased erythrocyte destruction, Nonregenerative anemia has no or little decreased erythrocyte production or increase immature erythrocytes and a low blood loss can result in anemia. degree of polychromasi which indicates a lack of effective bone marrow response. Blood loss anemia may result from One should identify the underlaying trauma, bloodsucking ectoparasites, cause to allow a better prognosis. gastrointestinal parasitism, coagulopathies, ulcerated neoplasms or rupture of internal organs.
3 This is blood from the red fronted kakariki Anemia with hemolytic anemia. Increased erythrocyte destruction may be associated with bacterial septicemias, acute aflatoxicosis, toxemias or blood parasites.
Anemia Anemia
Decreased erythrocyte production may be associated with chronic infectious diseases This picture such as tuberculosis, chlamydiosis, present anemia aspergillosis and chronic hepatic disease. and hypochromic erythrocytes Other causes are nutritional deficiencies (iron, caused by lead folic acid), chemicals and toxins (lead, poisoning. aflatoxin). It may also be associated with neoplasias, such as lymphoid neoplasia.
Thrombocytes are Thrombocytes Compared to Thrombocytes nucleated and the erythrocyte function like nuclei, mammalian thrombocyte Thrombocyte platelets in nuclei are more hemostasis. rounded and Thrombocytes are have a higher smaller and more nuclear/ rounded than Lymphocyte mature cytoplasmic erythrocytes. ratio.
4 Avian thrombocytes Thrombocytes Thrombocytes are often The cytoplasm is mistaken for clear but not lymphocytes homogenous. by beginning Thrombocytes hematologists contain specific and even granules in automated variable number, hematology size and position Lymphocyte analyzers. in the cell. They take a pink to reddish color.
This is blood from a 3 month old female Thrombocytes kakariki with signs of liver disease. The Thrombocytes tend thrombocytes look normal. to clump, so it is difficult to do a thrombocyte count. A subjective estimation can be made. Seeing 1-2 thrombocytes in an average monolayer oil immersion field is normal.
Thrombocytes Leukocytes
Enlargement of the thrombocyte’s cytoplasm indicates a reactive change. Thrombocytes have a phagocytic defense function and the reactive changes are thought to be associated with this function.
5 Leukocytes Leukocytes
Differential white Disease or physiologic changes such as cell count: ”stress” may cause leukocytosis Interspecies Heterophils 30-75% (increased number of leukocytes in Lymphocytes 20-65% variations are great blood). Infection is the most common and these Monocytes 0-5% cause to disease related leukocytosis. reference values Basophils 0-5% are only a very Eosinophils 0-4% rough guide.
Leukocytes Leukocytes
Stress leukocytosis occur in species like Mild leukocytosis: bacterial, fungal and macaws, cockatoos, African greys and chlamydial infections. ratites. Stress causes endogenous release Moderate leukocytosis: yolk peritonitis, of cortisone which has many effects on granulomatous disease, some phases of blood and other tissues. Treatment with septicemia. corticosteroids can also result in stress hemograms. Elevated leukocyte counts Severe leukocytosis: active chlamydiosis, are common although the bird may not be aspergillosis, tuberculosis, leukemia. diseased.
Leukocytes Leukocytes
Leukopenia is reduced leukocyte True leukopenia is usually a result of numbers which are often an artifact overwhelming bacterial infection, severe related to sample handling such as: viral disease or toxic substances. • Blood clots before placement in anticoagulant Consider the variation of leukocyte count • Lysis due to excessive shipping and between species. Smaller birds tend to storage time have lower leukocyte count than larger • Poor quality blood films birds.
6 This is a heterophil from an 11 year old Heterophils Heterophils, the African grey parrot. cells analogous with mammalian neutrophils, are the most common leukocyte in avian blood. They are round with colorless cytoplasm and eosinophilic rod- shaped granules.
The nucleus is Heterophils This is another heterophil from the same 11 lobed in mature year old African grey parrot as seen heterophils with clumped previously. chromatin that stains purple. The cytoplasmic granules often hide the nucleus. Heterophils show a little variability in size.
These are two toxic heterophils from a 17 Toxic heterophils year old Amazon parrot with respiratory disease. Heterophils may exhibit toxic changes, including cytoplasmic basophilia, nuclear hypersegmentation, vacuolization and basophilic cytoplasmic granules.
7 Toxic heterophils Toxic Left shift are seen with heterophils septicemias, Immature heterophils viremias and when seen indicates severe inflammation. chlamydial Both toxic infections. More heterophils and severe toxic immature heterophils change indicates have cytoplasmic basophilia and it is more severe and easy to confuse these often infectious two. disease.
It is important to These heterophils were from a cockatoo recognize a Artifacts with no clinical signs of disease. normal cell even if there is a technique artifact involved. Stain that is too old may cause this artifact where heterophil granules fail to stain. This is an artifact and not toxic change in these heterophils.
This is a eosinophil from an 1.5 year old Eosinophils male African grey parrot. Eosinophils tend to be more irregular than heterophils. They are typically round and have round granules. Eosinophil cytoplasm is pale blue. Granules may be red, blue or clear. Cell size varies quite a lot.
8 This is an eosinophil from a healthy Eosinophils African grey parrot. The nucleus of the eosinophil often stains more blue and is more noticeable than the heterophil nucleus. Eosinophil nuclei are lobed with clumped chromatin that stains purple.
Basophils Lymphocytes In some avian Avian basophils are species round with a round lymphocytes are nucleus. The the most common nucleus is centrally leukocyte. They are located and light round but can blue. The sometimes look cytoplasmic irregular due to granules stain molding around deeply basophilic other adjacent and often hide the cells. The nucleus nucleus. is round.
Antigenic Reactive Lymphocytes stimulation transforms lymphocytes lymphocytes into The amount of reactive cytoplasm may vary lymphocytes. from a narrow band Viral and to abundant chlamydial cytoplasm in large infections may be lymphs. The nuclear responsible but to cytoplasmic ratio the is high. The nonspecifically indicate an cytoplasm is light immune blue and hyaline. response.
9 This is a reactive lymphocyte from a 15 year old parrot. Reactive lymphocytes The cytoplasm of reactive lymphocyes is darker blue reflecting protein synthesis. The nucleus often has an immature appearance.
This is another reactive lymphocyte from a Avian monocytes 15 year old parrot. are large and round Monocytes or irregular. The nucleus is eccentrically placed in many monocytes and may be round or bilobed. The chromatin is delicate and lacelike, but chromatin clumps can be present.
This is a monocyte from an 1.5 year old male African grey parrot. Monocytes The cytoplasm has a finely granular appearance and stains blue-gray. Sometimes it contains vacuoles.
10 This is a monocyte from an 11 year old male African grey parrot. Question
One of these leukocytes is a heterophil. Which one is the heterophil and what type of leukocytes is the other one?
Answer Question
One of these This is the leukocytes is a heterophil (arrow) monocyte. and the other Which one is the leukocyte is a monocyte and lymphocyte. what type of leukocytes is the other one?
Answer Question
This is the monocyte (arrow) How many and the other lymphocytes do leukocyte is a you see in this heterophil. picture?
11 Answer Question
There are four What caracterize an immature lymphocytes in erythrocyte? this picture. It´s easy to get confused by the immature erythrocyte (arrow).
Answer Question
Immature erythrocytes are polychromatophilic with basophilic cytoplasm. They are also rounder than What kind of mature erythrocytes. leukocytes can you see in this picture?
Answer Question
This is a monocyte Identify (arrow). The these other two leukocytes. leukocytes are lymphocytes.
12 Answer Question The two leukocytes to Name a disease that causes severe the left are leukocytosis. heterophils (arrows) and the two leukocytes to the right are lymphocytes.
Answer Question
Active chlamydiosis, aspergillosis, tuberculosis and leukemia are some examples of diseases that causes severe Identify these leukocytosis. blood cells.
Answer Question
All the cells are This blood is from a erythrocytes. The bird with anemia. one in the upper How can you left corner is the differentiate between most immature. non-regenerative anemia and regenerative anemia in a blood smear?
13 Answer Question
In regenerative anemia the degree What kind of of polychromasi leukocyte is this? and anisocytosis increases.
Answer Question
This is an Identify these eosinophil (arrow). leukocytes.
Answer Question
The two leukocytes are What kind of normal leukocyte is heterophils. Their this? abnormal appearance is due to an artifact.
14 Answer Question
This is a basophil What kind of cell (arrow). is this?
Answer Question
What is the cause This is a reactice of reactive lymphocyte. lymphocytes?
Answer Question
Antigenic stimulation causes Identify these the transformation blood cells. of resting lymphocytes to reactive lymphocytes.
15 Answer Question
The two smaller cells in the middle Identify this are thrombocytes leukocyte. and the cells surrounding them are erythrocytes.
Answer Good luck!
This is a toxic This was a good heterophil. Notice start but continue the dark and round reading the and irregularly litterature for more shaped granules. information about avian hematology.
16 Avian biochemistry The most common analyses are: • AST – aspartate aminotransferase Avian Biochemistry • CK - creatine kinase • Bile acids •Glucose • Protein Marie Gunnarsson • Uric acid • Calcium Institute for Clinical Chemistry •Amylase Swedish Agricultural University • Cholesterol • Triglycerides • Lead and zinc
Aspartate aminotransferase Aspartate aminotransferase
AST will get elevated within days following AST has high liver or muscle damage. If both AST and CK sensitivity but lower are elevated the bird can suffer from liver specificity for it and/or muscle damage. If only AST is elevated leaks from both liver liver damage is indicated. and muscle when those tissues are Severe hemolysis in the serum sample is damaged. another reason for high AST.
Creatine kinase Bile acids Elevated CK can be From cholesterol bile acids are synthesized in a sign of active the liver. Bile acids are released from the muscle damage. It has both high gallbladder after a meal. Even in birds without specificity and high gallbladder there is an increased release after sensitivity for muscle eating. disease. An elevation of CK Elevation in bile acids is a sign of reduced can also be due to hepatic function. Liver-related enzymes are not severe sample hemolysis. as sensitive as bile acids when it comes to detecting reduced hepatic function.
1 Chronic hepatic Bile acids Bile acids damage with persistant loss of liver Persistant elevation function may be in bile acids is an detected by measuring indication for a bile acids. AST will hepatic biopsy. A often return to normal biopsy can give a after acute insult if more specific there is not continuing morphologic or damage to hepatocytes etiologic diagnosis. with leakage of AST.
Glucose Glucose
Birds have a much higher normal glucose Glucocortiocoid hormones may cause value than mammals. hyperglycemia by increased glucose production. Adenergic hormones are The main regulatory hormone is glycogenolytic and result in increased glucagon, rather than insulin. glucose release.
Glucose Glucose
Diabetes mellitus Granivorous birds can not maintain is a possible constant plasma glucose levels as long as diagnosis when carnivorous species. glucose is elevated to very high Very low values are often due to bacterial concentrations contamination or samples stored too long (>1000mg/dL). before analysed.
2 Protein Acute blood loss or Protein protein losing Inflammatory enteropathies should disorders and cause hypo- hemoconcentration proteinemia. due to dehydration Starvation may cause can result in hypoproteinemia but absolute and homeostasis often relative elevations maintains plasma of protein. protein normal.
Uric acid Uric acid Uric acid is synthesized in the kidney, but to a greater extent in the liver. It is filtered Uric acid by the glomerules and secreted by the concentration is not proximal tubules. Elevated blood uric acid a sensitive renal indicates either extensive proximal tubular function test, but it damage (renal azotemia) or severe is the best way to dehydration (prerenal azotemia) in the assess the renal noncarnivorous bird. Significant function in birds. elevations of blood uric acid occur after a Urea and creatinine high-protein meal in carnivorous birds. are not useful.
Calcium Malnutrition may be Calcium cause hypocalcemia but During ovulations normal serum values do large elevations of not rule out disorders in calcium can be calcium metabolism. seen. Neurological Homeostasis can often signs may be hold calcium and caused with phosphorus hypocalcemia. concentrations within normal limits.
3 Calcium Calcium Good-quality Hypocalcemia is often related to specific sample is needed nutritional deficiencies. Nutritional for calcium imbalance is most commonly due to seed analysis. diets. The classic seed mix contains little Hemolysis, or no vitamin D3, excess fat, small lipemia, bacterial contamination and amounts of calcium, and excess unseparated phosphorous giving a low Ca/P ratio in samples adversely the diet. affect calcium assays.
Amylase Cholesterol and triglycerids Plasma amylase By measuring elevations can be cholesterol and associated with triglycids the fat pancreatitis. As in metabolism can be mammals some cases assessed. of enteritis may result in amylase Obesity is a elevations. To obtain common problem a specific diagnosis for birds that eat to pancreatic biopsy is much seeds with indicated. excess fat.
Cholesterol and triglycerids Lead
Elevated cholesterol levels are associated Lead is a toxic heavy metal of no with hypothyroidism, hepatic lipidosis, nutritional value. It is absorbed through high fat diets and starvation, especially in the intestine into the blood and affects a obese birds. But unfortunately there are variety of systems. no clear indicators to determine whether or not an abnormal cholosterol level is Common clinical signs of lead poisoning associated with a particular condition. are neurological signs, vomiting and fatigue.
4 Lead Zinc
Whole blood should Zinc is an essential element. It is required be collected for for many enzymatic systems but can hematology and lead analysis. Different cause toxicity if the intake is too high. laboratories require Excess zinc exposure interferes with the different sample normal exocrine function of the pancreas, sizes and some reduce egg production and initiates moult laboratories prefer a particular among other things. anticoagulant.
Hopefully these Zinc comments on avian Good luck! biochemical When zinc toxicosis analyses helped. is suspected radiography, Much work still hematology and needs to be done to analysis of whole aid in avian blood, plasma or diagnosis so keep serum should be reading and even used for diagnosis. think of projects to improve our knowledge.
5 Collecting Samples for Testing Clinical procedures Handling birds stresses and occasionally kills them. Minimize how often you catch a bird or restrain it.
Marie Gunnarsson Have all the equipment you´ll Institute for Clinical Chemistry need to take blood Swedish Agricultural University ready before clinical examination commences.
Clinical procedures Clinical procedures
If the best quality equipment is used the risk Following sample for erroneous results decreases. Anticoagulant collection the bird bottles for example, should have been stored should be carefully properly. monitored. This provides further information on the Since human health may be at risk when taking condition of the bird samples appropriate guidlines should be and also makes sure followed. Be aware of zoonotic infections! of the well-being of the bird.
The following techniques can be Collection of blood samples carried out on avian blood: • Hematology The total blood volume of a bird is • Biochemistry approximately 10% of its body weight • Parasitology and in a healthy bird it is safe to remove • Toxicology 10% of the blood volume. In a severely • Microbiology ill bird this volume should be reduced. • DNA and chromosomal studies • Blood gas analysis
1 Collection of blood samples Collection of blood samples
A 30 g bird will The blood collected is usually of venous have origin and can be approximately 3 taken from the right jugular vein which is ml of blood and larger than the left. therefore 0,3 ml On the right side of can be safely the neck there is an area without feathers removed. where you usually easy find the vein.
Collection of blood sample Collection of blood samples It is not necessary to Blood can also be drawn from the collect blood during basilica vein (wing or brachial vein) anestesia but it can reduce the stress for where it crosses the elbow on the inside the bird. If the bird of the wing, but this often results in large has to go through further examination, hematomas. Another alternative is the x-ray for example, it caudal tibial vein on the medial side of can be a good idea to the tibiotarsus above the tarsal joint. do all diagnostic investigations at once during anesthesia.
Collection of Collection of blood samples For biochemistry a blood samples tube with heparin is The blood is taken usually used. A drop using a thin needle of fresh blood should and a 1-2 cc syringe immediately be or an ”insulin placed on a slide and syringe”. The blood spread for is drawn into the differential white cell syring and then count. Since all transferred into the bloodcells have different tubes nuclei the count has needed depending on to performed choice of analysis. manually.
2 Preparation of blood smear Preparation of blood smear
A plain capillary tube is used to place a Before the blood small drop of blood at one end of a slide. reaches the sides At an angle of 45 degrees a spreader slide of the slide the is positioned in front of the drop. The spreader is pushed spreader is then moved backwards and forward in a touches the drop of blood which will run steady movement across the edge of the slide. and creates a uniform blood smear.
Preparation of blood smear Preparation of blood smear
If excessive pressure is applied to the Another method is the use of a microscope spreader it results in an increased amount slide and a coverglass. A drop of blood is then placed on the slide and a coverglass is of cellular rupture. To minimize the cell immediately dropped onto it. The slide and the damage a bevel-edged microscope slide coverglass are pulled apart horizontally to should be used. Avian blood cells are produce the smear as the blood spreads more sensitive for pressure than between the two. The spread of the smear should be initiated before the blood reaches the mammalian blood cells. edge of the slide. This method will minimize cell damage even more.
Processing of hematology Good luck! samples On the same day of collection the It is not more samples should be processed in the difficult to collect laboratory. If this is impossible blood blood from a bird smears should be made and air dried at than from a cat or a dog if you use the the time of collection. Air dried smears correct equipment are stable for days, but it is important that and the bird is held they do not come into contact with in a proper manner. moisture or formalin fumes.
3 Common avian diseases Common diseases
Common diseases in caged parrots: •Trauma • Toxicosis • Neoplastic disease • Compulsive egg laying • Egg-binding Marie Gunnarsson • Respiratory disease Institute for Clinical Chemistry • Aspergillosis Swedish Agricultural University • Chlamydiosis
Common diseases Trauma
Common diseases in caged parrots: Injuries is mostly • Obesity seen among birds • Ingluvitis that are allowed to fly freely inside the • Hepatitis house. The most • Proventricular dilatation syndrome important advice is • Mites (scaly beak and tassle foot) to prevent the • Psittacine beak and feather disease injuries before they happen. • Feather plucking
Trauma Trauma
Common causes to trauma: Common causes to trauma: • The bird sits on top of a door that is being • The bird is being chased/captured by the closed and fractures a leg or toe. family’s cat or dog and gets bitten. Remember that a cat bite is always life • The bird flies into a window and gets a threatening to the bird. The bird can die conclusion or fractures a wing. from an infection within 12 h. • The bird lands onto the stove or into a • The bird sits on top of another bird’s cage boiling pot and gets burn injuries. and gets bitten in the toes.
1 Toxicosis Lead poisoning
The most common causes to toxicosis: Lead is for example • Heavy metals (lead and zinc) found in foil • Smoke (from fire or an owner smoking) surrounding wine bottles, weights in • Teflon (birds can die within a couple of toys for birds, frames hours from a gas that develops when food to old mirrors or is burnt in a frying pan with teflon windows, weights to surface.) curtains and in old • Avocado paint.
Lead poisoning Lead poisoning
Clinical signs Diagnosis
Clinical signs of lead poisoning include: A blood sample to measure the level of lead in weakness, lethargy, vomiting, passage of the blood is required to diagnose lead blood in the faeces, seizures, kidney and poisoning. Radiography can be helpful if a liver damage, chronic non-regenerative radio dense particle can be seen in the gizzard anemia due to bone marrow suppression or ventriculus. However, a negative and death. radiographic examination does not rule out the diagnosis lead poisoning.
Lead poisoning Zinc poisoning
Treatment Zinc can be found in galvanized metal The goal with the treatment is to remove the which include a lot lead from the blood and the gastrointestinal of things in the bird’s tract to prevent further uptake. Ca-EDTA surroundings for binds metal in the blood and is given example zippers, intramuscular. To prevent uptake from the paper clips, wires in intestine activated charcoal and laxative like bird cages and bowls peanut butter is given. for water and food.
2 Zinc poisoning Diagnostic tests and Zinc poisoning treatment are the same as with lead Clinical signs poisoning.
Clinical signs of zinc poisoning include: Treatment should be initiated as soon as hemolytic anemia, kidney and liver lead or zinc damage, weakness, lethargy, vomiting, poisoning are suspected since it seizures, convulsions, feather plucking will pass several and death. days before diagnosis is confirmed.
Neoplasitic disease Neoplasitic disease
Tumors occur mostly in elderly birds. An Renal adenocarcinoma in budgerigars is a exception to this rule is budgerigars who leading cause of death in males. In females ovarian tumors are more often have tumors already from one year common. Males can also have testicular of age. cancer. Clinical signs are in all cases lameness, weight loss and a palpable abdominal mass. Radiographs are helpful in diagnosis.
Neoplasitic disease Neoplasitic disease
Lipomas are most Caged birds often have fibrosarcomas commonly seen among budgerigars. that have affinity for wings, legs and The lipoma face. Some of these can be treated with eventually gets amputation. troublesome for the bird as it apply pressure on Lymphosarcomas and avian leukosis-like surrounding organs syndromes are also commonly reported in and changes the bird’s centre of pet birds. gravity.
3 Compulsive egg laying Compulsive egg laying
Compusive egg laying is a rather It is not easy to common problem in cockatiels and break the bird’s lovebirds. Instead of laying an ordinary unnatural large litter of 3-5 eggs she continues to behaviour but it lay egg after egg. To accomplish this a can be done great amount of calcium and nourishment without medical is required. Eventually the egg laying treatment or leads to malnutrition with egg-binding as surgery. a possible result.
Compulsive egg laying Compulsive egg laying
To break the behavior, the daylight length Unfortunately these should be reduced to 6-8 hours the first three manipulations are weeks. The following weeks the light can be seldom enough to turned on 10-12 hours a day. Nesting boxes inhibit the compulsive egg have to be removed. The eggs are supposed to laying. In those cases be left in with the hen to inhibit further laying. medical treatment For some birds it is enough to move around the with hormones or things in the cage or to move the cage to surgical spaying are different rooms now and then. indicated.
Egg-binding Diagnostics include Egg-binding history, clinical signs, palpation of Egg-binding is most commonly seen the egg and among cockatiels, budgerigars and radiography. lovebirds. It can be caused by many different factors like age, obesity, cold, Treatment by giving dry air, poor diet, calcium deficiency, the bird calcium and compulsive egg laying and salpingitis. provide suitable The hen bird often sits on the floor of its nesting material and cage and becomes lethargic. Sometimes a warm damp they breath heavily and get staggering. environment may be adequate.
4 Respiratory diseases Respiratory Egg-binding are very common disease among caged birds. In more difficult Several factors cases the egg has to contribute to be collapsed with developing disease. needle and syringe Examples of such either per cloaca or factors are vitamin A via midline through deficiency, dry the abdominal wall. indoor air, polluted This procedure is air from smoking and obviously performed food containing during anesthesia. mold.
Respiratory disease Aspergillosis
Common respiratory diseases: (Mycotic pneumonia, Pneumomycosis) • Chronic rhinitis Aspergillosis is caused by Aspergillus spp • Sinusitis frequently Aspergillus fumigatus. Inhalation of • Airsacculitis spores from contaminated litter or feed causes infection. The fungal spores settle out in the region of the syrinx, the abdominal air sacs • (Aspergillosis) and the lung. • (Chlamydiosis)
Aspergillosis Aspergillosis Diagnosis Clinical signs • Markedly elevated WBC count Clinical signs of Aspergillosis include: • Radiographs to show thickening of air sacs dyspnea, hyperpnea, inappetence, • Endoscopy to examine syrinx and internal air sacs emaciation, increased thirst, somnolence • Tracheal and lung washes and other neurological signs. If aflatoxin is produced the bird can contract liver damage, failure and death.
5 Aspergillosis Chlamydiosis
By culture or by (Psittacosis, Ornithosis, Papegojsjuka) microscopical examination of fresh preparations the Chlamydiosis is a zoonosis easily spread fungus can be to people. It is caused by the bacterium demonstrated. Chlamydophila psittaci. Birds may carry Treatment is it and develop disease under stress. difficult. It may have Shortly after purchase birds should be to go on for the rest tested. of the bird’s life.
Chlamydiosis Chlamydiosis
Clinical signs Diagnosis
Clinical signs of chlamydiosis include weight loss, depression, lime-green • Radiography – enlarged liver and/or urates, loose feces, emaciated when spleen examined and respiratory signs usually • Hematology – elevated WBC count, related to an airsacculitis. monocytosis • Biochemistry – elevated AST
Chlamydiosis Chlamydiosis
Diagnosis All birds with a positive test result have to be treated • Serology – can only show if the bird has even if they show no been in contact with the disease. sign of disease. • Antigen in feces – risk for false negative Treatments with doxycycline are very • Culture – difficult, often false negative effective but require 45 days of therapy.
6 Obesity Obesity
Obesity is a very Obesity increase the risk for: common disease • Hepatic lipidosis among budgerigars and amazons. The • Atherosclerosis problem is related to •Lipoma the fact that the seed • Xanthomatosis diets commonly fed to the birds have excess fat.
Ingluvitis Diagnosis of the Ingluvitis causal agent can be made by cytology or Ingluvitis means inflammation of the culture of a crop crop. It can be caused by a variety of wash. pathogens; yeast such as Candida albicans, bacteria such as E.coli and Clinical signs of ingluvitis may parasites such as Trichomonas spp. include vomiting, Regurgitation of seed in budgerigars and weight loss, depression and a cockatiels is often caused by palpable crop filled Trichomonas spp. with fluid.
Hepatitis Hepatitis
Hepatitis is a very common disease among pet birds. It is often caused by a Hepatitis caused combination of an increased number of by bacteria can be bacteria in the environment and poor treated with feed. antibiotics for a Clinical signs include vomiting, long period of inappetence, loose feaces and yellow- time in green urates. combination with improved feed.
7 Proventricular dilatation Proventricular dilatation syndrome syndrome The disease was initially seen in macaws Clinical signs and therefore also referred to as macaw wasting syndrome (arasjuka). Later on it The disease is characterized by lethargy, has been seen in other species as well. A regurgitation, chronic weight loss, viral etiology is suggested, although this enlarged proventriculus, nervous signs, remains unproven. abnormal droppings and crop impactions.
Proventricular dilatation Proventricular dilatation syndrome syndrome Diagnosis There is no Diagnosis is based on clinical signs, treatment for this radiographs showing an enlarged disease. It has proventriculus and exclusion of always a deadly differential diagnoses. For a certain outcome. diagnosis a biopsy of the gizzard or crop is required.
Cnemoidocoptes Mites Mites pilae is common on budgerigars and rare The mites cause conditions known as on all other scaly beak and tassle foot. The signs in psittacines. The the face are crusting of eyelids, corners of disease is thought to depend on a the mouth and cere at the base of the beak immunodeficiency often causing beak deformities. and is therefore not Thickening and crusting of the skin are thought to be signs of disease on the legs. contagious.
8 Psittacine beak and feather The mites can Mites be recovered disease from skin This disease is caused by psittacine scraping and circovirus. It may infect any psittacine demonstrated bird. Primarily birds <3 years old appears by microscopy. to be affected.
Ivermectin is an The disease is not common in Sweden. effective When it occurs it is mostly in african grey treatment. parrots and lovebirds.
Psittacine beak and feather Psittacine beak and feather disease disease Clinical signs Diagnosis
Typical signs are feather loss, abnormal • Clinical signs pin feathers, abnormal mature feathers, • Detect virus in blood lack of powder down, beak abnormality, • Biopsies of affected feather follicles pigment loss in colored feathers and immunosuppression.
Psittacine beak and feather Feather plucking disease There is no treatment It is thought that for this disease. Most 25% of the birds that birds die within four have a problem with years in other feather plucking infections due to suffer from an actual immunosuppression. African grey parrots clinical disease. 75% usually die within a are due to few days due to psychological severe hematological reasons. changes.
9 Initially disease has Feather plucking to be excluded by Feather plucking performing a Possible triggering factors: complete • Small cage dermatological •Boredom examination. If no disease is found the • Sexual or social stress or frustration bird´s environment • Attention seeking has to be • Fear, nervousness investigated and • Changed diet hopefully the triggering cause can • Compulsive egg laying be found. • Lack of privacy
Treatment of Feather plucking Good luck! feather plucking birds with psycological Please turn to the problems implies reference litterature gradually changing the birds for more information environment. Most about the mentioned often the birds diseases or if you are unfortunately interested in other become constant avian diseases. feather pluckers.
10 Avian cases
The following two cases are authentic cases from Regiondjursjukhuset Avian cases Strömsholm.
Marie Gunnarsson The laboratory reference ranges used are Institute for Clinical Chemistry taken from Fudge AM. (2000) Laboratory Medicine Avian and Exotic Swedish Agricultural University Pets.
Case 1 History Case 1
Signalment Three female amazons had died within three days. They sat in different cages a 20 year old male couple of meters from each other. The amazon. owner never noticed they were ill. The patient eats ”Nutribird”, apples, oranges, This is a picture of pasta, rice, broccoli and carrots. It drinks another amazon community water. The day he came to the clinic he seemed ill and sat with his eyes shut.
Case 1 Case 1
Blood was collected from the bird without Lymphocytes 25 % 20-67 anesthesia. Heterophils 62 % 31-71 Results from blood analyses: Basophils 0 % 0-2 Eosinophils 0 % 0-0 Hematocrit 42 % 41-53 Monocytes 13 % 0-2 Leukocytes 29.8 x10.9/l 5-17 AST 3.3 ukat/l 2.6-5.9 Polychromasia 12-13% Uric acid 119 umol/l 132-618 Moderate poikilocytosis The polychromasia indicates regenerative anemia
1 Case 1 Prominent polychromasia: Regenerative anemia This is a picture of a blood smear from the amazon with the unknown illness.
The polychromasia of the erythrocytes indicates regenerative anemia.
Case 1 Case 1
Blood was also sent Chlamydial in for lead and zinc diagnostics analyses, but the • Culture – negative results from those • Serology – low titer analyses take several days to receive. This is a picture of blood collection Note polychromasia from another bird. of the erythrocytes.
Case 1 Case 1
If this bird Treatment had Chlamydia The amazon was infection, treated with then what enrofloxacin, Na- kind of EDTA, vitamin K anemia and fed via a crop should that tube. infection cause? This is a picture of yet another amazon.
2 Case 1 Case 1
The amazon was hospitalized for three The results from the lead and zinc analyses: days. When he went home he was feeling a lot better. The owner continued to treat Zinc 53 mmol/l 0-30 the bird with Na-EDTA and enrofloxacin at home. Lead 0.10 mmol/l 0-1
The amazon was suffering from Diagnosis? zinc poisoning!
Case 1 Case 2
Zinc poisoning causes a hemolytic Signalment anemia. Hemolytic anemia is a regenerative anemia. Infections cause a Female moluccan nonregenerative anemia, so the cockatoo, age hematology results should have steered unknown. us away from just an infection like chlamydiosis. A metal foreign body This is a picture of containing zinc was not reported. another cockatoo.
Case 2 Case 2
History Results from blood analyses: Leukocytes 14.1 x10.9/l 8-12 This bird lived in a zoological park and Lymphocytes 19 % 19-50 came to the clinic for a health check up. Heterophils 78 % 44-71 Blood was collected for a number of Basophils 1 % 0-1 analyses. Eosinophils 1 % 0-2 Monocytes 1 % 0-1 AST 1.3 ukat/l 2.3-6.2 Uric acid 446 umol/l 190.3-632.9
3 Case 2 Case 2
A few reactive lymphocytes were This is another found in the blood picture of the blood smear from the smear. The two cockatoo. This is a leukocytes are an picture of a reactive eosinophil (left) and lymphocyte and an a heterophil (right). erythrocyte.
Case 2 Case 2
In this picture you Chlamydial can see one diagnostics eosinophil (arrow), • Culture – negative two thrombocytes • Serology – high titer (upper left corner) and one lymphocyte (upper right corner). The rest of the cells This is a picture of are erythrocytes. yet another cockatoo.
Case 2 Case 2 The cockatoo was also tested for Since the serology test for chlamydiosis psittacine beak and showed high titer for the disease the bird feather disease. This test was negative. was treated with doxycycline.
This is a picture of After a few weeks the bird died. Why? another reactive lymphocyte from the Had something been missed at the health patient. check up?
4 Case 2 Good luck!
Autopsy The two previous cases illustrate some of the diseases of The autopsy showed a stenosis in trachea. parrots. Unfortunately the This turned out to be caused by second bird had 2 aspergillosis. infections/diseases. We often have trouble diagnosing the second unexpected disease.
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