Bacterial diseases are common in reptiles, with most infections caused by opportunistic agents that infect immunosuppressed hosts. A comprehensive approach is required to ensure the success of a therapeutic plan. It is important not only to determine the causative agent but also to correct predisposing factors. Appropriate therapy in the absence of appropriate husbandry and nutrition will ultimately fail.
Culture and sensitivity are recommended in determining appropriate therapy. Most bacterial infections involve gram-negative bacteria, many of which are considered commensal. Anaerobic infections are not uncommon, but organisms can be difficult to culture. Gram-positive bacteria on smears, in conjunction with a negative culture, may indicate an anaerobic infection. Alternatively if a therapeutic choice was based on aerobic culture and sensitivity and response is poor, then the presence of an anaerobic agent should be considered.
A number of infectious conditions are similar in appearance, regardless of species. Septicemia is a common cause of death. The systemic disease may be preceded by trauma, local abscessation, parasitism, or environmental stress. Aeromonas and Pseudomonas spp are frequently isolated; the former may be transmitted by ectoparasites. Death may be peracute or follow a protracted course. Common terminal signs are respiratory distress, lethargy, convulsions, and incoordination. Petechiae may be found on the ventrum, and chelonians develop erythema of the plastron. Sanitation and husbandry can be significant factors in reducing outbreaks. Affected reptiles should be isolated, and antibiotic therapy initiated.
Septicemic Cutaneous Ulcerative Disease (SCUD)
Classically, SCUD is a shell disease of aquatic turtles caused by Citrobacter freundii; however, various bacteria have been isolated from diseased skin and shell. Serratia spp may act synergistically by facilitating entry of C freundii. The scutes are pitted and may slough with an underlying purulent discharge. Anorexia, lethargy, and petechial hemorrhages on the shell and skin are seen; liver necrosis is also common. Systemic antibiotics are recommended. Good sanitation is paramount for prevention.
Another shell disease of turtles is caused by Beneckea chitinovora, a common infectious agent of crustaceans. Erythema and pitting of the shell with ulceration is seen. Septicemia is uncommon. Topical iodine is recommended in addition to antibiotics. The practice of feeding crayfish is often implicated in this condition and should be discouraged.
Ulcerative or Necrotic Dermatitis
Ulcerative dermatitis is seen in snakes and lizards kept in unhygienic conditions with excessive humidity and moisture. Moist, contaminated bedding allows bacterial and fungal growth which, when coupled with exposure to fecal degradation products, can predispose to small cutaneous erosions. Secondary infection with Aeromonas spp, Pseudomonas spp, and a number of other bacteria may result in septicemia and death if untreated. Erythema, necrosis, and ulceration of the dermis, and an exudative discharge are common. While lesions are often sequelae of skin injuries, they more often develop from within, as is the case with classic necrotic dermatitis in the ball python. The disease can develop even when these animals are maintained under pristine conditions, so it is not simply a matter of excessive moisture and poor hygiene. The condition starts with hemorrhage into scales, followed by pustules that eventually lead to open and ulcerated lesions. Treatment with systemic antibiotics, topical antibiotic ointment, and excellent hygiene and husbandry are essential.
Blister disease has traditionally been considered a separate entity but is simply an early stage of ulcerative (necrotic) dermatitis. The cutaneous involvement is characterized by pustules or blisters that may resolve without development of ulcerative lesions if treatment is started early. A low-grade thermal injury may mimic blister disease due to the potential development of fluid-filled vesicles.
Focal infections caused by traumatic injuries, bite wounds, or poor husbandry are seen in all orders of reptiles. Subcutaneous abscesses are seen as nodules or swellings. Differential diagnoses include parasitic nodules, tumors, and hematomas. Isolates of the anaerobic organism Peptostreptococcus and of the aerobes Pseudomonas, Aeromonas, Serratia, Salmonella, Micrococcus, Erysipelothrix, Citrobacter freundii, Morganella morganii, Proteus, Staphylococcus, Streptococcus, Escherichia coli, Klebsiella, Arizona, and Dermatophilus have been recovered from reptilian abscesses, often in combinations. Small localized abscesses should be completely excised to avoid recurrence, which is frequent. Larger abscesses should be marsupialized, followed by aggressive local wound treatment. The lining of the abscess must be aggressively scraped to remove as much material as possible. Appropriate systemic antibiotics may also be indicated but are seldom necessary following complete excision. Anaerobic bacteria are common in these lesions, and an appropriate antimicrobial agent (eg, metronidazole, ceftazidime, or a potentiated penicillin product) may need to be used or added to a current regimen.
Visceral abscessation may occur as a result of hematogenous infection. Abscesses of the female reproductive system are common and may result in coelomitis. Surgical intervention is indicated; systemic antibiotics alone are rarely, if ever, successful.
Subspectacle abscessation is seen in snakes, and conjunctivitis in the other orders. The severity ranges from mild inflammation to panophthalmitis and may occur as a result of ascending infectious stomatitis (see Infectious Stomatitis). Topical antibiotic ointments are used in turtles, lizards without spectacles, and crocodilians. In snakes and lizards with spectacles, drainage is achieved by surgically removing a small wedge from the spectacle and flushing the subspectacular space and lacrimal duct with an antibiotic solution (eg, gentamicin). Some affected reptiles, especially turtles, may need supplemental vitamin A.
Infectious stomatitis is reported in snakes, lizards, and turtles and characterized early by petechiae in the oral cavity; caseous material develops along the dental arcade as the condition worsens. In severe cases, infection extends into the mandible and maxilla. Aeromonas and Pseudomonas spp, common oral inhabitants, are most frequently isolated, along with a variety of other gram-negative and gram-positive bacteria. Respiratory or GI infection may develop in poorly managed cases. Surgical debridement, irrigation with antiseptics, systemic antibiotics, and supportive therapy are indicated. In severe cases with ulceration or granuloma formation, aggressive surgery may be indicated. Vitamin supplementation, especially with vitamins A and C, has been advocated but does not always affect the disease course.
Respiratory infection are common; the incidence can be influenced by respiratory or systemic parasitism, unfavorable environmental temperatures, unsanitary conditions, concurrent disease, malnutrition, and hypovitaminosis A. Open-mouth breathing, nasal discharge, and dyspnea are frequent signs. Aeromonas and Pseudomonas spp are frequently isolated, but many respiratory infections are mixed. Septicemia may develop in severe or prolonged cases. Treatment consists of improving husbandry and initiating systemic antibiotics. Nebulization therapy with antibiotics diluted in saline, in combination with acetylcysteine, has been used together with parenteral antibiotics. Reptiles with respiratory infections should be maintained at the mid to upper end of their preferred optimal temperatures. Increased temperatures are important not only to stimulate the immune system but also to help mobilize respiratory secretions. Turtles often have an underlying vitamin A deficiency and require dietary correction. Many turtles treated for pneumonia fail to improve completely until after treatment for vitamin A deficiency.
Ear infections occur frequently in turtles, especially box turtles and aquatic turtles. Marked swelling is seen at the tympanic membrane, and caseous material is present. Proteus spp, Pseudomonas spp, Citrobacter spp, Morganella morganii, Enterobacter spp, and other bacteria have been isolated. The tympanic membrane must be incised, and aggressive curettage of the area performed. Surgical removal of the abscess is usually curative as long as all infection is removed and the Eustachian tube is patent. The open area should be flushed with diluted povidone-iodine or a similar product for a few days to prevent premature closure and to keep the area clean. Systemic antibiotics are rarely required. Ear infections may be secondary to hypovitaminosis A; dietary supplementation of vitamin A may be beneficial.
Often traumatic in origin, infectious cloacitis is characterized by edema and hemorrhagic discharge. Cloacal calculi may form in vitamin or mineral imbalances and should be manually removed and followed by dietary correction. In pericloacal abscesses, the infection often migrates cra nially. Ascending urinary or genital tract infections are common sequelae. Aggressive therapy, including surgical debridement, local wound treatment, and appropriate systemic antibiotics, is indicated. Fecal examinations should be performed to identify potential parasitic causes.
Although previously reported in the reptile literature as Paget's disease, this condition is now thought to be a chronic bacterial osteomyelitis of the spine. Traditionally, Paget's disease is characterized by repeated episodes of osteoclastic bone resorption and deposition, leading to dense, brittle bones. Commonly reported in snakes, these proliferative and progressive spinal lesions have been investigated, and are now thought to be associated with chronic bacterial infections, most commonly involving Salmonella spp. Diagnosis is by biopsy or blood culture. Longterm antibiotic therapy may be helpful, but the prognosis is guarded to poor.
Mycobacterial infections are often associated with chronic wasting in wild, imported reptiles and are seen as granulomatous lesions at necropsy. Chelonians generally exhibit pulmonary involvement, while lizards, snakes, and crocodilians commonly show visceral granulomas. The species isolated are Mycobacterium ulcerans, M chelonae, M haemophilum, and M marinum. All are cultured at reduced temperatures and may require long periods for growth. Rifampin and isoniazid are hepatotoxic, and the longterm administration required is unlikely to be safe. There are no reports of successful treatment.
Salmonella arizona and Edwardsiella Infection
These bacteria have been isolated from clinically normal reptiles. The zoonotic nature of these commensal organisms must be considered when handling or treating reptiles. Attempts to eliminate these microorganisms from reptiles and their eggs have been unsuccessful and are not recommended. Veterinarians and reptile owners should be aware of the informational brochures available from the Association of Reptile and Amphibian Veterinarians.
Last full review/revision July 2011 by Stephen J. Divers, BVetMed, DZooMed, DACZM, DECZM (herpetology), FRCVS