Diagnosis and Treatment of Enterococcus sp. Infections During Rehabilitation of Cold-Stunned Kemp's Ridley Turtles (Lepidochelys kempii): 50 Cases, 2006–2011
IAAAM 2013
Hillary Braverman1*+; Charles Innis2; Julie Cavin2; Michele Sims3; Michelle Ceresia4; Lindsey R. Baden5; Duncan Kuhn6,7; Sea Rogers Williams8; Keiko Hirokawa2,9; E. Scott Weber III2,10; Salvatore Frasca Jr11; Brian Stacy12; and Constance Merigo2
1Cornell University College of Veterinary Medicine, Ithaca, NY, 14853, USA; 2New England Aquarium, Boston, MA, 02110, USA; 3Marine Animal Rehabilitation Center, University of New England, Biddeford, ME, 04005, USA; 4Massachusetts College of Pharmacy and Health Sciences, Boston, MA, 02115, USA; 5Brigham and Women's Hospital, Boston, MA, 02115, USA; 6Whitehead Institute for Biomedical Research, Cambridge, MA, 02142, USA; 7Current affiliation: Cambridge Health Alliance, Cambridge, MA, 02139, USA; 8National Marine Life Center, Buzzard's Bay, MA, 02532, USA; 9Current affiliation: National Aquarium DC, Washington DC, 20230, USA; 10Current affiliation: University of California, Davis, School of Veterinary Medicine, Davis, CA, 95616, USA; 11Connecticut Veterinary Medical Diagnostic Laboratory, Department of Pathobiology and Veterinary Science, University of Connecticut, Storrs, CT, 06269-3089, USA; 12NOAA Fisheries, Office of Protected Resources, Gainesville, FL, 32611, USA
Abstract
Enterococcus sp. infection was diagnosed on day 10–177 (median day 24) of hospitalization in 50 cold-stunned Kemp's ridley turtles (Lepidochelys kempii) by cultures of blood (n = 38), bone/joint (n = 11), respiratory tract (n = 8), and subcutaneous mass (n = 1); with 8 turtles having two positive culture sites concurrently. Infection was corroborated in five live turtles by histologic evidence of gram positive cocci in foci of osteomyelitis. Species identification performed for 36 cases indicated Enterococcus faecalis. Four E. faecalis strains were identified by molecular typing of 13 isolates. Treatment was based on antimicrobial susceptibility testing, and most commonly included ampicillin (30 mg/kg IM SID) or clavulanate/amoxicillin (approximately 30 mg/kg PO SID). Concurrent antimicrobials, most commonly amikacin (5–10 mg/kg IM or IV q3d, n = 23) were used for management of polymicrobial infections and/or for aminoglycoside synergistic effect. Treatment duration for 19 turtles successfully treated with a single course of therapy was 40–131 days (median 60 days). Negative blood cultures were first obtained 9 to 85 days after starting treatment (median 31 days, n = 31). Modification of treatment or subsequent treatment was required for 13 turtles due to persistence (n = 9) or recurrence (n = 4) of positive cultures. Two turtles had positive blood cultures with no clinical signs, no treatment was prescribed, and each had two negative subsequent blood cultures. Thirty four turtles survived. Seven turtles died prior to starting treatment. Histologic evaluation of post-mortem samples from 13 turtles revealed a variety of pathologic changes, including gram positive cocci in association with hepatitis (n = 1), steatitis (n = 2), and cholecystitis (n = 1).
Acknowledgements
We thank the many staff and volunteers of the Massachusetts Audubon Society Wellfleet Bay Sanctuary, National Aquarium in Baltimore, Sea World Orlando, and our respective institutions for their contributions to the recovery and rehabilitation of the turtles described herein. Sea turtle rehabilitation at New England Aquarium, University of New England, Sea World Orlando, National Aquarium in Baltimore, and National Marine Life Center is authorized by the United States Department of the Interior/ Fish and Wildlife Service, and the United States Department of Commerce/National Marine Fisheries Service.
* Presenting author
+ Student presenter