recurrent abscess in an asian elephant

7/27/2019 recurrent abscess in an asian elephant

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Lee Jin-ee (151526)

DVM 5 2013/2014 Semester 1

Supervised by : Assoc. Prof. Dr. Ong Bee Lee

Recurrent abscess in an Asian elephant

Jin-ee Lee

Faculty of Veterinary Medicine,

Universiti Putra Malaysia,

43400 Serdang, Selangor.

Abstract

Boon Mee is an estimated 70-year-old, female, asian elephant(Elephas maximus). 7 months ago, on the

20th Feb 2013, a mass was found over left point of elbow, lanced and drained with a lot of pus in it. The

wound was flushed daily with diluted povidone iodine, silver sulphadiazine, and topical oxytetracycline

spray. Fortunately, the abscess resolved in 3 weeks.

However on the 1st

of June 2013, after 3 months, the mass recurred and ruptured over the left point of

elbow. The previous treatment was applied but the wound does not progress well after 3 weeks. After

another 3 weeks, the progession is minimal and therefore a surgery is planned on 12nd of July 2013 to

establish a bigger drainage ventral to the abscess.

The surgery was successful and Boon Mee was doing well after surgery.

Introduction

An abscess is defined as a localized collection of pus in a cavity formed by disintegration of tissue.(1)

Abscesses may develop in any organ or in the soft tissues beneath the skin in any area. Abscesses can be

caused by minor breaks and punctures of the skin, obstruction of sweat glands and sebaceous glands,

and inflammation of hair follicles. They contain dead cells, bacteria, and other debris, which causes

inflammation and pain. Common bacteria, such as staphylococci, are the most common cause.

Elephants in thailand are legal to be kept in captivity. This law encourages the poachers to go into the

forest to get a young calf to be trained for future purposes. In order to get the calf, usually the mother

will have to be killed. The calf will be trained to receive commands and obey to human to perform

various tasks. These include labour in logging, labour in elephant-riding, and also performer in circuses.

The elephants in captivity were deprived of their physiological and phycological need and thus develop

numerous stereotypic behaviors like head shaking and stamping. This more or less explain the low

breeding success rate in captivity due to the reasons above. In 2006, Thailand were reportedd to have

1000-1500 elephants in the wildm while it has 2231 elephants in captivity. The figure is shocking as it

shows more than 50% of the the total populations are in captive rather than in the wild.



Lee Jin-ee (151526)



Case report

Boon Mee is an estimated 70-year-old, female, asian elephant(Elephas maximus), weighing about

3000kg with the body condition score rated as very good(2). Boon Mee was a retiree from the logging

industry and was sold to the Wildlife Friends of Foundation of Thailand(WFFT) on the 5th

of November2012. She was fed daily with 8-12 banana stems supplemented with a wide range of fruits including

dragon fruit, mango, banana, watermelon and pineapple.

7 months ago, on the 20th Feb 2013, a mass was found over left point of elbow, lanced and drained with

a lot of pus in it. The wound was flushed daily with diluted povidone iodine, silver sulphadiazine, and

topical oxytetracycline spray. Fortunately, the abscess resolved in 3 weeks.

However on the 1st of June 2013, after 3 months, the mass recurred and ruptured over the left point of

elbow. When treated with daily flushing with diluted povidone iodine and topical antibiotics of silver

sulphadiazine and oxytetracycline spray, the wound does not progress well after 3 weeks. Therefore, on

the 22nd of June 2013, a swab sample was taken for bacterial culture and the result reveals presence of

Streptococcus agalactiae and Acintobacter sp. For the antibiotic sensitivity test, both are sensitive to

amoxicillin, ciprofloxacin and ceftazidine. Hence, amoxicillin was prescribed at 11mg/kg SID PO to

replace the topical antibiotics previously. The rupture hole became smaller and the drainage was

somewhat stagnate. After another 3 weeks, the progession is minimal and therefore a surgery is

planned on 12nd of July 2013 to establish a bigger drainage ventral to the abscess.

The tranquilizer being used is Acepromazine 0.005mg/kg IM (3) and the sedative is Xylazine 0.04-

0.08mg/kg IV (4). The preanaesthetic, anaesthetic and surgical procedure is demonstrated as below.

1)

The left tricep muscle was identified and

cleaned with diluted chlorhexidine scrub.

2) The left tricep muscle was subsequently

cleaned with diluted povodone iodine.



Lee Jin-ee (151526)



3) Acepromazine was administered

intramuscularly at the tricep muscle at

dosage of 0.005mg/kg.

4) Venous access was established through

the insertion of butterfly cathether ibto

the ear vein. Xylazine was administered

intravenously at the dosage of 0.04-0.08

mg/kg.

5)

The external surface of the abscess was

brushed after Boon Mee was successfully

sedated.



Lee Jin-ee (151526)



6) The external surface of the abscess was

cleaned with tape water.

7) A babcock forcep was inserted into the

small opening of the abscess at the lateralto estinate the depth of the abscess.

8) An horizontal incision was made ventral to

the abscess to establish good drainage

through the gravitational pull.



Lee Jin-ee (151526)



Discussion

My discussion will consist of 3 which are the pathogenesis, treatment options and the management of

captivity elephants.

Fistly, it is the pathogenesis of the disease to grant us a better understanding about the disease. The

pathogenesis of the disease was explained in a flow chart form as below:

Secondly, in cases of abscess in elephants, there are 3 suggested ways which are medical treatment,

surgical drainage and surgical excision.

As reported by Finagen (5), local treatment with disinfectant and local antibiotics may be sufficient,

while large abscesses in unhygienic field situation may require systemic antibiotic. As reported byMikota, large abscess may require a ventral drainage followed by a second more dorsal drainage to

facilitate lavage(6). Mikota also discourages surgical excision due to the Infection is major cause of

wound dehiscence due to numerous creases or cervices that make it difficult to obtain surgical asepsis

during skin(6).



Lee Jin-ee (151526)



Therefore, in my case, during the 1st

episode of abscess, local treatment with antibiotics and daily

cleaning was done and successfully resolved the abscess in 3 weeks. However, when the abscess

recurred at the same site, the same treatment was given but yield minimal improvement and hence a

surgical drainage was done. Contrary to what Mikota proposed to establish a ventral drainage followed

by a second more dorsal drainage to facilitate lavage, we did only the ventral drainage. This is becauseafter acessing the abscess, we believe the abscess will resolve will a single drainage. Nevertheless, if the

abscess does recurr again, perhaps 2 drainage will be performed on the next surgery. Surgical excision of

abscess is common in smaller animals like dogs and cats. In cases of elephants, its discouraged as this

may serve as the source of infection causing wound dehiscence later on.

Thirdly, I strongly believe that the formation of hygroma and abscess in captive elephant can be

prevented through good management and husbandry.

In terms of diet, captive elephants have significant fat deposits while wild elephants do not(8). This

causes the joints of the elephants to bear much more weight for a long period of time. Compared to the

ephants in wild, they go through nutritional stress due to droughts (9), while the captivity elephants arewell-fed with very limited exercise and activity. Therefore, their diet should be assessed for caloric

content and nutritional content by professional nutritionist (10), to ensure the feeding will be good

enough to provide a balanced diet without overfeeding th elephants.

In terms of exercise, wild elephants spent 50-75% of their time foraging, up to 80km/day (6). While in

enclosure, most of the elephants are fed and not require to forage which lowers their metabolic rate.

For the enclosure size, there is no known optimal enclosure size for the time being (6) and have to be

determined by reproductive success, muscle tone, weight. However, these are rarely acessed and

therefore a lot of captivity elephants became bored and tend to lie more than in wild. This leads to more

pressure on the bony prominences during lying.

In terms of feed, it need to be distributed to enhance activity level of the elephants. (6) The feed should

be hidden or hung at high areas which require the elephants to work for their food. Thus, by making

them walk and exercise more, the joints become healthier and stronger, and at the same time less

pressure will be exerted on the joints.

Conclusion

Formation of hygroma and abscess in captive elephant can be prevented through good management

and husbandry. Abscess in elephants may lead to death due to necrotizing fascitis and septicaemia if the

rupture is incomplete and spread underneath.



Lee Jin-ee (151526)



Reference

1. Douglas C.B, Virginia P.S, Clive C.G (2007), definition of aural hematoma, Saunders

comprehensive Dictionary 3rd Edition, pp. 157, Philadephia, PA : Saunders.

2. V. Krishnamurthy, C.Wemmer, J. Lehnhardt (2000) Healthcare, breeding and management of

Asian Elephants. New Delhi, project elephant. Govt. of India, p.189

3. Fowler, M. E. (1995) Restraint and handling of wild and domesticated animals, 2nd

ed. Ames

Iowa states University Press, pp. 36-56

4. Fowler, M. E. (1995) Restraint and handling of wild and domesticated animals, 2nd

ed. Ames

Iowa states University Press, pp. 36-56

5. Mikota, S. K. , Hammatt, H. and Finegan, M. (2003) Occurrence and prevention of capture

wounds in Sumatran Elephants. Proc Amer Assoc Zoo Vet, Mineapolis, Minnesota, pp. 291-293

6. Mikota, S. K. , Fowler, M. E. (2006), biology, medicine and surgery of animals, pp. 256

7. Stetter, M. , Orlando, Florida (2004 ), personal communication

8. Douglas-hamilton, I. , Douglas-Hamilton (1975 ), Among The elephants. New York, Viking Press,

pp. 99

9. Valdes, E, , Orlando, Florida (2003), personal communication

recurrent abscess in an asian elephant

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