In December 2014, a 141 kg, juvenile female Florida manatee (Trichechus manatus latirostris) presented to Tampa's Lowry Park Zoo (TLPZ) in poor body condition, with epidermal sloughing, and hypothermia (oral temp 87°F; normal 96°F). The manatee was treated according to standard protocols and administered ceftiofur crystalline free acid (7 mg/kg SQ; ExcedeTM, Pfizer, Inc. New York, NY 10017) and ketoprofen (2 mg/kg; KetofenTM, Zoetis, Inc., Kalamazoo, MI 49007). Several days after admittance follow up biochemistry and haematology revealed an elevated high white blood cell count 12530/µl; ref 6000–8000/µl) with an elevated relative and absolute monocytosis (2418/µl; ref 19.3% ref 5%), hypoglycemia (39 mg/dl; refs ∼ 55–80 mg/dl) hypoalbuminemia (3.9 mg/dl; refs 5.0 mg/dl), hyperglobulinemia, and a calcium/phosphorus inversion. Radiographic and ultrasonographic exam of the lungs were consistent with pneumonia. Tulathromycin (2.5 mg/kg x3 q 7 d SQ; DraxxinTM Zoetis, Inc., Kalamazoo, MI 49007) is standard therapy for pneumonia in manatee at TLPZ but this did not result in clinical improvement and danofloxacin (2.5 mg/kg x7 q 3 d SQ; AvocinTM, Pfizer, Inc. New York, NY 10017) was initiated. Despite an improving appetite no progress was seen in hypothermia, body condition, and nasal discharge was continuing to be frequently observed.
Several sheets of Plexiglas (48 x 96 inches) were taped together in according fold fashion to provide a cover to the channel connecting two medical pools. A lettuce feeder was placed directly below the insertion of vaporizer to allow the manatee to breathe in the medication more directly when surfacing. A combination of N-acetylcysteine (Acetylcysteine 20%, Cumberland Pharmaceuticals, Inc., 2525 West End Ave., Suite 950, Nashville, TN 37203 amikacin (Amikacin, Bedford Laboratories, Bedford, OH 44146), and albuterol (Albuterol sulfate Inhalation Solution, 0.5%; Bausch and Lomb, Bausch and Lomb Incorporated, Tampa, FL 33637) was nebulized for one hour twice daily for three weeks. During this time there was a marked decrease in nasal discharge, normalization of haematological and serum biochemistry values, and a normalization of core body temperature. Weight gain occurred during this treatment and increased exponentially following. A nebulisation chamber may provide a practical, inexpensive adjunctive therapy to non-responsive pneumonia in manatees and perhaps other marine mammals. The resolved hypothermia as a result of this therapy raises some intriguing concepts about thermoregulation via respiratory exchange in this species that may provide useful in clinical settings and perhaps in larger scale cold stress events in manatees.
We would like to gratefully acknowledge Florida Freshwater Fish and Wildlife Commission for rescuing this manatee. The authors would additionally like to thank Mrs. Virginia Edwards and her manatee rehabilitation team as well as Lowry Park Zoo clinic staff Ms. Michelle Devlin and Ms. Heather Henry.