Long-Term Management of Lymphoplasmacytic Eosinophilic Gastritis and Enteritis in a Southern Tamandua (Tamandua tetradactyla)
The captive United States tamandua (Tamandua tetradactyla) population currently consists of 18 males and 23 females housed in 26 zoos across the country, most often kept singly or in pairs. Diseases of the gastrointestinal system and inconsistencies in captive husbandry and nutrition are common causes of morbidity in the captive population. A 2.5-year-old, hand-raised female tamandua at the Houston Zoo had a 1-year history of intermittent diarrhea and vomiting. After multiple attempts at empiric treatment, mucosal biopsies of her stomach and duodenum were collected endoscopically. Biopsies demonstrated mild lymphoplasmacytic, eosinophilic gastritis and moderate lymphoplasmacytic, eosinophilic enteritis. At the time of diagnosis, the tamandua had ascites and marked hypoproteinemia (total serum protein 3.9 gm/dL, albumin 1.0 gm/dL). Initially medical management was attempted with metoclopramide (0.55 mg/kg PO BID), tylosin (28 mg/kg PO BID), sucralfate (0.05 gm/kg PO TID) and famotidine (0.44 mg/kg PO SID). Oral prednisolone (0.95 mg/kg PO BID) was initiated 2 month later when hypoproteinemia persisted, and clinical signs failed to resolve. Over the following 20-month period, her prednisolone dosage has been adjusted as we have attempted to wean her off prednisolone and clinical signs have returned. Repeatedly when prednisolone is weaned down below a total daily dosage of 0.4 mg/kg, ascites, diarrhea, lethargy and hypoproteinemia return. She is currently down to a prednisolone dosage of 0.25 mg/kg PO BID, as well as metoclopramide (0.55 mg/kg PO SID), tylosin (28 mg/kg PO BID), sucralfate (0.05 gm/kg PO BID and famotidine (0.44 mg/kg PO SID). Her condition is monitored through weekly body weights and blood samples collected from the ventral tail vein every 4–6 weeks. Her total serum protein (7.0 gm/dL) and albumin (2.5 gm/dL) remain normal and diarrhea and vomiting have resolved. Thus far she has demonstrated no adverse clinical effects from chronic prednisolone therapy, and clinical condition and quality of life are vastly improved since treatment was initiated. Though the cause of chronic or recurrent vomiting and diarrhea in captive tamanduas is likely multifactorial, the presence of these clinical signs warrants endoscopic evaluation to better characterize underlying etiology and guide treatment.