Medical Management of Mixed Fungal and Nocardial Osteomyelitis in a Kemp's Ridley Sea Turtle (Lepidochelys kempi)
A hypothermic stunned juvenile Kemp's ridley sea turtle (Lepidochelys
kempi) from the 1999Cape Cod Bay, MA mass stranding event2 developed right carpal
swelling early in rehabilitation at the Karen Beasley Sea Turtle Rescue and Rehabilitation
Center in North Carolina. Osteomyelitis detected initially as a small radiolucency of the
proximal aspect of the metacarpal of digit 1, spread over the course of several weeks nearly to
obliterate the distal carpal row and affect the ulnar and pisiform carpals and metacarpals 2 and
3. Unbranching unpigmented septate fungal hyphae were observed cytologically from a fine needle
aspirate but fungal culture was unsuccessful. A Nocardia sp. was cultured from the fine
needle aspirate. Although surgical debridement was considered, concerns over postoperative
management of a submerged open contaminated wound at a mobile joint led to a decision to attempt
medical management alone. Prolonged combined treatment with fluconazole (2.5 mg/kg SC q 24 h x 1
yr; a concurrent pharmacokinetic study later determined that a 21 mg/kg SC loading dose followed
by 10 mg/kg SC q 5 d would be more suitable1) and azithromycin (5 mg/kg PO q 2 d x
162 d) resulted in a functional carpal joint with substantial remineralization of the carpal and
metacarpal bones, normal flipper contour, full range of motion and apparently normal swimming.
Anti-nocardial treatment preceding azithromycin, first with sulfadimethoxine, then with
oxytetracycline, appeared to reduce swelling but were associated with suspected adverse
reactions to the antimicrobials. Husbandry conditions with a good plane of nutrition, excellent
water quality and minimal disturbance undoubtedly contributed to the successful outcome. The sea
turtle was released 20 months after stranding.
We thank Mark Papich, Carol Lemons, Cathy Kreis, and volunteers at the
Karen Beasley Sea Turtle Rescue and Rehabilitation Center.
1. Bartlett KM, CA Harms, GA Lewbart, MG Papich. 2001. Single- and
multiple-dose pharmacokinetics of fluconazole in loggerhead sea turtles (Caretta
caretta). Proceedings of the International Association of Aquatic Animal Medicine
2. Turnbull BS, CR Smith, MA Stamper. Medical implications of
hypothermia in threatened loggerhead (Caretta caretta) and endangered Kemp's ridley
(Lepidochelys kempi) and green (Chelonia mydas) sea turtles. Proceedings of the
International Association of Aquatic Animal Medicine 31:31-35.