Abstract
A 11.65 kilogram juvenile Kemp’s Ridley (Lepidochelys kempii) stranded in an emaciated, hypothermic state with heavy caudal carapace epibiota growth evident of a chronic buoyancy disease process. On intake, survey radiographs show a consolidated pattern confirmed by computed tomography. Bronchoscopy performed 3 days after admission revealed blood clots and mucus, which were collected for cytology and culture, within the trachea and mainstem bronchi. Respiratory mucus, hemorrhagic discharge increased over the next 2 days with the packed cell volume decreasing from 30 to 6. The turtle was given parenteral vitamin K, dexamethasone sodium phosphate, iron dextran, oral Yunnan Baiyao, amikacin, ampicillin, and a blood transfusion resulting in a stabilization and improvement of the packed cell volume over the next week.
Cytology revealed heterophilic inflammation with a mixed bacterial infection, chronic hemorrhage, and respiratory epithelial cell hyperplasia, and acid-fast negative staining. Culture grew a Vibrio nereis, Vibrio fluvialis, and a non-enteric gram-negative bacillus all sensitive to amikacin and ceftazidime. Repeat computed tomography 2 weeks later reveals resolving lung consolidation but a more diffuse interstitial pattern. Parenteral amikacin was changed to ceftazidime and nebulization with amikacin, amphotericin B, and saline commenced. Radiographs a month later revealed a worsening interstitial pattern and a granulomatous pattern the author had previously seen with mycobacterial and fungal pneumonia. A follow-up bronchoscopy to collect samples for cytology revealed continued mucus in tracheal and mainstem bronchi. Cytology revealed continued chronic hemorrhage, tracheitis, and acid-fast positive bacilli. A PCR of tracheal cytology was positive for Mycobacterium chelonae. The turtle was isolated in a quarantine pool, a zoonotic disease protocol for handling the turtle was initiated, and the turtle was started on injectable tobramycin, oral clarithromycin, and nebulization of enrofloxacin, acetylcysteine, amphotericin B, and saline. Serial radiographs over the next 7 months of treatment showed resolution of an interstitial pattern and reduction of the granulomatous pattern to a point of static areas of consolidation so antimicrobial therapy was discontinued. Bronchoscopy 10 months after admittance was clean, cytology was normal and acid-fast staining was negative. Computed tomography was performed revealing areas of consolidation, which could be fibrosis of resolved parenchymal damage or granulomas, dispersed within normal lungs parenchyma. Based on the location and number of consolidated areas, the decision was made to base success of treatment on changes to consolidated areas and lung parenchyma with serial computed tomography.
Since discontinuing antimicrobial therapy the turtle begins to eat well, gain weight, have normal blood values, and maintain normal buoyancy and activity. Serial computed tomography continues to show no changes in the lung parenchyma and areas of consolidation.
Acknowledgements
The authors would like to thank Dr. Nicole Stacy for her assistance with cytology and the staff of the Volusia County Marine Science Center for their extensive effort in treating this turtle.
* Presenting author