Abstract
A 31-year-old male bottlenose dolphin (Tursiops truncatus) presented with a 3-day history of blepharospasm and decreased behavioral participation. CBC and serum chemistry showed mild inflammation with evidence of infection. Pulmonary ultrasound revealed a 2.7 cm hypoechoic mass with focal consolidation in the mid-cranial right lung field. Using ultrasound guidance, a percutaneous fine needle aspirate of the mass was performed as previously described,1 yielding 3 cc of purulent material. Cytologic examination revealed severe septic, suppurative inflammation with intracellular Gram-positive cocci. A methicillin-susceptible Staphylococcus aureus was confirmed by culture and PCR, with susceptibility to multiple antibiotics. Right-sided pleural effusion developed ventrocaudal to the abscess and follow-up percutaneous drainage of the pleural effusion yielding approximately 300 cc of fluid was also performed.
Various intravenous and oral broad-spectrum antibiotics were administered with minimal clinical and hematologic improvements seen. After consulting with infectious disease specialists at the Naval Medical Center San Diego, intravenous ertapenem was administered once daily for 19 days. Additional supportive care included oral and IV fluids, mineral and vitamin supplementation, prophylactic oral antifungal therapy, and short course low-dose prednisolone for appetite stimulation. When the clinical and hematologic presentation improved, the animal was switched to Augmentin XR® (1000 mg amoxicillin/62.5 mg clavulanic acid) for 2 weeks. Follow-up ultrasound and CT scan showed resolution of the abscess. Aggressive IV antibiotic therapy is a valuable tool and should be considered as a viable treatment option when managing critical cases in cetaceans.
Acknowledgements
We thank our colleagues at the Navy Marine Mammal Program and the National Marine Mammal Foundation, specifically Drs. Sam Ridgway and Stephanie Venn-Watson for their assistance with treatment planning and infectious disease diagnostics. The Infectious Disease Department at NMCSD provided treatment guidance and support. Special thanks go to the Risa Daniels, Celeste Benham, Kevin Carlin, and Chris Hammell for their tireless work in sample submission and data collection for this case.
* Presenting author
Literature Cited
1. Smith CR, Solano M, Lutmerding BA, Johnson SP, Meegan JM, Le-Bert CR, Emory-Gomez F, Cassle S, Carlin K, Jensen ED. 2012. Pulmonary ultrasound findings in a bottlenose dolphin Tursiops truncatus population. Dis Aqua Org. 101:243–255.