* This is a case discussion submitted to the Exotic DVM Yahoo group
The condition started 4 months ago, on the 16th of march, when the animal was brought to the clinic presenting one ulcerative lesion on the palmar side of one finger articulation (on the right leg).
It was treated twice a day with Clindamycin orally and a traditional chinese mix plant powder topically for one week. The ulcer got bigger and after one week we’ve started giving Synulox, Metacam and put bandage on the wound. The process deteriorated involving the underlying tissues, muscles, tendons. After 3 weeks we’ve decided to amputate 2 of the fingers and change the bandage daily under Iso anesthesia. We were not able to find enough skin to surgically close the wound properly so we left it open hopeing to heal per secondam. Topically we’ve put Bioplacenton gel (Neomicyn/ placenta extract mix) and decided to stop the systemic antibiotics.
The condition seemed to improve after 10 days, so we’ve started cleaning the wound and put the bandage without Iso anesthesia -(could hear emphysema after every procedure) , although this also seemed to be very stressful to the animal.
We’ve then decided to leave the wound open but the animal immediately started biteing it and 2 of the remaining fingers. We manage to improvise an E-collar and leave the wound open. This period there was an episode of heavy strongyl and amoebas parasitiation that we also had to treat.
It passed another week and we saw that 2 of the other fingers were getting in a bad shape, (no sensibility, tip of them rotten) and we’ve decided to amputate them (18th of may). We’ve started again with Synulox (7days), Metacam (3days) and bandage it with a antibacterial gauze dressing (Sofra-tulle (farmycetin)). It seemed to have a slow but good healing.
After 10 days we saw another skin ulceration on the lower back side. This new one we’ve try to treat it with the chinese powder for 7 days without any improvement.
On the 20th of June another ulcer appeared on the palm of the left leg; we’ve taken a swab sample from it, sent it to the lab and resulted as an infection with Klebsiela pneumoniae and secondarily with Escherichia coli (both sensitive to enrofloxacine). We’ve started Baytril systemically and cloramfenicol topically; due to the constant moisture we’ve also took a sample for our dermatophyte test medium (ACU-DTM).
Multiple ulcers appeared after one week on the back, leg and hand palm (with pus under the skin). After 5 days the dermatophyte test turned up to be positive so we’ve considered stopping changing the bandages due to moisture, leave it open (with the E-collar) and start miconasole topically.
On the 6th of July due to the ulceration the tendon of one finger was lost and could not move that finger anymore.
The ulcers continued to slowly spread but the amputation wound looked quite dry and healing.
On the 12th of July we removed by mistake the E-collar and saw that she is not biting the wound anymore, and considering all of the stress that we’ve put her during all those 4 months of daily handling, we’ve considered to leave her alone without any disturbance for a couple of days.
She started to groom and seemed pretty ok, and being a arboreal species she started hanging from the cage roof mostly all day.
Unfortunately today we’ve seen the hand full with erosion and another finger unable to close properly. This time we suspect the damage was provoked by the pressure she puts on the hands while hanging.
Last week tests just came from the lab and we saw they found Candida from the skin scraps and Klebsiella pneumonie from the pus swab. This time the bacteria presented resistance to enrofloxacin and clormafenicol. It seems thou that is sensitive to Amoxicilin-clavulanic acid.
We’ve removed the loris from the cage, put her in a room without any cage bars but with a tree and gave oral amoxicilin-clavulanic acid in the food. We are not worried about the amputation anymore but for the other ulcers.
The loris lost 150g (from 700 to 550g) in all those 4 mounts even thou it always has had a big appetite and ate the entire food given.
We’ve also sent biopsy samples to a lab to check it for leprosis, but the results will take some time.
What to do? Considering their nature to climb and hang upside-down, losing one palm and now already 2 fingers on the other and all the other lacerations puts us in a difficult medical and managerial situation.
We didn’t start yet the treatment for the candida because we would like first to hear some other opinions – from what we should have done to what is there more to do. If you think we have done something wrong please do not hesitate to tell us.
Thank you for your patience to read this case and we’ll appreciate any input!
Ovidiu Rosu
International Animal Rescue Indonesia
Try perhaps:
– DMSO (dimethyl sulfoxide) by topic medication 10% for ulcers, good transcutaneus absorption.
– Itraconazole against Candida PO (but could be resistance for Candida).
– Cefovecine or amox-clav.ac. like you already made for antibiotherapy.
spor!
see you!
Candida albicans fungi mark their territories during this population boom by causing any of these sensations: burning, itching, soreness, or tingling. Yeast infections can cause serious, sometimes even fatal, diseases. This is particularly true for sufferers with weakened or underdevelope immune systems, diabetes, the human immunodeficiency virus (HIV) and the acquired immunodeficiency syndrome (AIDS)…….
Information on yeast infection treatments and preventions are available through online medical journals and medical sites but for highly advanced states of yeast infection it’s always best to consult a physician….
Aside from the fact that yeast infection is treatable, there are also ways to prevent this from ever happening. The best is to drink a glass or two of milk daily as this ensures that there will never be an overgrowth of yeast down there…
Did you check underlying virus infections (like SIV suggested by the previous) like STLV, SRV, VZV, EBV, CMV. Also think of alpha herpes infections form other primates which can cause these symptoms.
Regards
Henk (pvd@bprc.nl)
we did not had the actual possibility to do serology…