Strange Medicine: Tales From a Herp Vet's Casefiles

The Eyes Have It

I examined a one-year-old, domestic bred Leopard Gecko belonging to a wonderful family. This little lizard was a pampered pet, doted on by the two little girls in the family, and cared for, by the book (literally) by their mother. When the gecko was brought to me, the primary complaint was a cloudy eye. I always use magnification when examining herps, and with the help of my loupe, I could see that the eyelids of the right eye were being pushed out, and that there was an opacity of the cornea. A drop of fluorescein stain to the eye was administered to try and ascertain if the cornea was intact or damaged. The eye picked up the fluorescent green stain, indicating corneal damage. However, the stained part of the eye was bulging and irregular, covering about a third of the cornea. Upon closer examination, it actually appeared that whatever was picking up the stain was sitting on the cornea, and not the cornea itself. I allowed the girls and their mother to look at the stained eye using a penlight and magnification.

The gecko's owner also had an eye problem, a bacterial infection, and she was concerned that she might have contracted something from their pet lizard. She had been to her ophthalmologist, and was given antibiotic eye drops to treat her condition. Could there be a connection between the eye problem of the gecko and that of the mother?

Hhhhmmmm, I thought to myself. (Vets often "hhmmm" to buy a few moments of time to think and evaluate before discussing their findings with owners when something unusual is discovered!) I told the owners that it appeared as if something was on the cornea of the affected eye. I directed a stream of eye wash into the right eye, and surprise of surprises, the green-stained "thing" started to float out of the eye. I used a saline-moistened cotton-tipped applicator and gently teased it away from the cornea and out of the eye. It began to dawn on me that this was a parasitic worm that I was removing from the eye! When it was completely unfurled, it was about 3 inches long and about as thick as a sturdy thread. Underneath it, the cornea was intact and perfect. Careful examination of the left eye showed no parasites.

I wasn't able to find anything in any of my medical books about gecko eye-worms, surprisingly enough. But, to be on the safe side, I gave the gecko two different oral dewormers that work in different ways, in case there were any other little verminous creatures on or in the gecko. There appeared to be no residual damage to the eye or lids. Fecal parasite exams were negative.

So, the deeper questions here were those perplexing me. What was a 3 inch long worm doing in the eye of a young, domestic gecko? Does this worm normally inhabit eyes, or is it found in some other location usually? Is this a gecko worm, or a worm of some other type of creature that happened to find its way to this lizard? This particular gecko came from a hobbyist/breeder that I work with, and the breeding facility is very clean. I have never diagnosed any weird parasites from this facility. Rodents and insects are well controlled (I was concerned about some insect possibly being an intermediate host for parasites). As to the burning question the mother had about the possibility of her having one of those nasty worms in HER eye, well, I can state with a high degree of confidence that if she HAD been a host to a worm, her ophthalmologist would have discovered it when she was examined.

This kind of situation still occurs in herp medicine today, although as more information is disseminated to vets, it should occur less often in the future. There are so many obscure parasites, many with unknown intermediate hosts, that there are still occasionally surprises to confound and challenge us. But since captive breeding is on the increase, and fewer herps are imported, I think we will see a decrease in problems related to many types of parasites in the future.

Frog Legs

I just love it when an animal owner has taken the time and effort to really learn about the species that they are keeping, and has gone the extra mile to ensure that their pet has all the necessities as well as the creature comforts. Such was the case of the frame store owner who brought me a small, very cute, Red-eyed Tree frog for examination. This owner maintained her frog in a terrarium with the water maintained with the proper parameters for pH, temperature, dissolved oxygen, hardness, ammonia, nitrites and nitrates. Bottled spring water was used in the habitat. She had purchased the frog, after researching its needs thoroughly, just a week before. The day before the exam, she had noticed that the frog had several red lesions on the face, trunk and limbs. She also reported that her little frog had ignored several food items over the last few days. She had not handled her frog, except to put it in its habitat, and then again to bring it to me. I swabbed the lesions for bacterial culture and sensitivity, and elected to NOT draw a blood sample, even though it is possible to draw a blood sample from these small frogs. The frog was clinically ill, not eating, and it had skin lesions. Good enough evidence for me. I was able to use a culturette to swab the lesions without handling the frog. If I must handle an amphibian for exam or sample procurement, I will wear moistened latex gloves to minimize damaging the thin epidermal skin.

Amphibian cultures should be split, and one incubated at room temperature, and a second one incubated at 98 degrees F (35 degrees C). I always make a special note on my lab requisition form to make sure that the lab is aware that I am sending in one of these samples.

Suspecting the most common bacterial infection I encounter in frogs, I formulated a plan to treat her frog for an Aeromonas sp. invader. This bacteria can cause redleg in amphibians. It can rapidly result in the amphibian developing septicemia, so it is important to not wait until the results of the cultures are back to begin treatment. I started the frog on oral doxycycline, in a somewhat unconventional form. Because I also treat many birds for chlamydiosis, and one of the drugs of choice is doxy, I always have a water-soluble form of this medication on hand. I instructed the owner to mix up the doxycycline in the same manner that I use for a medicated drinking water for birds (using bottled water). Then, the owner was to soak the frog in warmed medicated water for thirty minutes twice daily. The frog will hopefully drink the water, and maybe absorb the medication through the skin. At best, the antibiotic will come in direct contact with the skin lesions.

In addition to the systemic medication, I prescribed a cream that is made with a base of the element, silver. The generic name is silver sulfadiazine 1% cream (Silvadene ) This topical cream has remarkable antibacterial activity, and although it is water-soluble, it does tend to have some staying power on amphibian skin. It is used for humans with second and third degree skin burns. I asked the owner to apply a thin layer of it twice daily, using a cotton-tipped applicator, after the medicated bath.

Frankly, I gave the owner a poor prognosis because these infections in amphibians are quite serious and can rapidly progress. My suspicion was that the little frog had acquired the infection from the pet retailer where he was purchased and not from the owners habitat.

When the culture results were in, the infection with Aeromonas was confirmed. I called the owner, expecting the worst, but to my surprise and delight, she informed me that her frog was doing much better, had begun eating, and the lesions were not as red as before. The bacteria was sensitive to doxycycline, and the combination of systemic and topical therapy did the trick.

So, this story had a happy ending for the owner, the frog and her vet. It often seems that many amphibians die as a direct result of an owner's ignorance and an unwillingness to seek veterinary care. And, of course, many vets, although experienced in reptile medicine, are lacking in skills related to amphibians because most of us don't see many in practice, for a variety of reasons. However, for a vet with some good herp medical texts, it is possible to research amphibian diseases, and many vets network with each other to consult on unusual or difficult cases. So, it is great to have a frog presented by an educated owner, kept correctly, and presented in time to effect a cure.

These cases were presented to show herp owners that not everything presented to vets is a textbook perfect case. Common sense, creative thinking and good powers of observation are often all that are needed to diagnose and treat an unusual case.

Cadeusus
Copyright 2006 Margaret A. Wissman, D.V.M., D.A.B.V.P.
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