Abstract

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.

Acknowledgements

We thank Mark Papich, Carol Lemons, Cathy Kreis, and volunteers at the Karen Beasley Sea Turtle Rescue and Rehabilitation Center.

References

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 32:80.

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.