Avian Patients Research Articles

Indications and Techniques for Blood Transfusion in Birds

There is growing medical care related to emergency presentations and procedures used to treat companion and wild birds. These critical care procedures (e.g., blood transfusion) can be life-saving. To maximize the beneficial effects of blood transfusions administered to avian patients, it is necessary to have an understanding of avian hematology and erythropoiesis, recognize clinical conditions in which one performs a blood transfusion, know the proper procedures and techniques, and rapidly identify possible adverse reactions.

Mycobacterial Infection in a Fairy Bluebird (Irena puella): A Diagnostic Conundrum

An adult male, wild-caught fairy bluebird (Irena puella) was evaluated after diagnosis of hepatic mycobacterial disease in a bird sharing the same quarantine space. Initial results did not reveal leukocytosis or acid-fast organisms in a liver biopsy. However, Mycobacterium avium was found in the liver via polymerase chain reaction (PCR). After euthanasia, acid-fast stains remained negative in the liver, although PCR was positive and M. avium complex (identified by high-performance liquid chromatography) was isolated from the liver. PCR could offer a relatively sensitive and rapid diagnostic test in the investigation of mycobacterial disease in avian patients.

Bovine and human-derived passive immunization could help slow a future avian influenza pandemic

An epidemic of human transmitted avian influenza could have casualties on a scale seen in the great Spanish influenza pandemic of 1918. This paper proposes that should such occur before effective vaccines and antiviral drugs are available, the outbreak could be significantly slowed by consumption of raw milk produced by herds of pathogen-free lactating cows intranasally inoculated with heat-sterilized sputa pooled from avian influenza patients, supplemented by parenteral serum immune globulin from the same cows. Efficiency of bovine antibody production could be enhanced using cholera toxin subunit b, and milk production could be rapidly accelerated using recombinant bovine somatotropin hormone. In this way, it would be possible to quickly create and distribute large quantities of milk-based and serum-based passive immune globulin active against the strains of avian influenza present in a particular geographic area and gain time for production of human convalescent plasma and other public health measures. This novel approach might also have utility for other serious respiratory infectious diseases, including non-avian influenza, SARS, hantavirus, respiratory syncytial virus, antibiotic-resistant Streptococcus pneumoniae and pneumonia-causing Staphylococcus aureus.

Distinctly different expression of cytokines and chemokines in the lungs of two H5N1 avian influenza patients

The pathogenesis of human H5N1 influenza remains poorly understood and controversial. 'Cytokine storm' has been hypothesized to be the main cause of the severity of this disease. However, the significance of this hypothesis has been called into question by a recent report, which demonstrates that inhibition of the cytokine response did not protect against lethal H5N1 influenza infection in mice. Here we showed discrepant findings in two adult H5N1 autopsies and a fetus obtained at autopsy which also raise doubt about this hypothesis. Antigens of 10 cytokines/chemokines which were found to be significantly elevated in previous H5N1-infected patients and in vitro experiments, and mRNA of eight of these, were absent from the lungs of a pregnant woman and her fetus. In contrast, antigens of seven cytokines/chemokines and mRNA of six of these were found to be increased in the lungs of a male autopsy. The cells expressing these cytokines and chemokines were identified as type II pneumocytes, bronchial epithelial cells, macrophages and vascular endothelial cells. Levels of cytokines and chemokines in the serum of the male case were also significantly higher than those of infectious (infection other than by H5N1) and non-infectious controls. In comparison with results from our previous study, it appeared that the male case had increased cytokine/chemokine expression but reduced viral load, while the pregnant female had diminished cytokine/chemokine expression but a significantly increased viral load in the lungs. These disparate findings in these two cases suggest that 'cytokine storm' alone could not be a sufficient explanation for the severe lung injury of this newly emerging disease.

The effect of a single intravenous fluid bolus on packed cell volume and plasma total solids concentration in Red‐collared Lorikeets (Trichoglossus haematodus rubritorquis)

To determine the effect of a single intravenous (IV) fluid bolus on the hydration of an avian patient, using packed cell volume (PCV) and plasma total solids (TS) to estimate hydration. Ten birds were allocated randomly to one of three groups, and administered 30 mL/kg or 50 mL/kg intravenous fluid, or were part of a control group and did not receive IV fluid. Blood was collected before the IV fluid bolus was administered, and at 1 minute, 3 hours and 6 hours after administration of the fluid. Samples were used to determine PCV and TS and results were compared between groups and between the different time points. Administration of 30 mL/kg or 50 mL/kg compound sodium lactate solution caused a statistically significant decrease in PCV. Within 3 hours, the PCV was not significantly different to the initial value or to the PCV of control birds. Administration of 30 mL/kg compound sodium lactate solution did not result in a significant decrease in TS. However, administration of 50 mL/kg produced a significant decrease in TS, which was still significantly less than controls 6 hours after the fluid was administered. These findings suggest that an intravenous bolus of fluid may be safely administered to an anaemic bird, since PCV is significantly decreased for less than 3 hours. Up to 50 mL/kg of fluid may be administered as an intravenous bolus to a bird, to produce significant haemodilution that persists for up to 6 hours.

Pituitary-dependent hyperadrenocorticism in a cockatoo

A 13-year-old female intact Moluccan cockatoo (Cacatua moluccensis) was evaluated because of coelomic distention, presumed to be secondary to an abdominal hernia. The patient also had a history of rapid weight gain and polyuria and polydipsia. Ultrasonography was used to confirm the existence of a pseudohernia that appeared to contain the small intestines, pancreas, and reproductive tract. Results of plasma biochemical analysis revealed hyperglycemia, hypophosphatemia, and high nonfasting bile acid concentrations and aspartate aminotransferase activity. A CBC revealed a relative heterophilia with a concomitant lymphopenia and mild monocytosis. Histologic evaluation of a liver biopsy specimen indicated chronic hepatic lipidosis. Despite a strong clinical suspicion of hyperadrenocorticism, ACTH stimulation test results were equivocal. The pseudohernia was strengthened with a prolene mesh. Despite ongoing medical and surgical care, the patient developed complications associated with the herniorrhaphy and was euthanatized. The clinical suspicion of hyperadrenocorticism was confirmed on the basis of histologic evaluation of the pituitary gland by use of special stains. To our knowledge, pituitary-dependent hyperadrenocorticism has not been previously confirmed in Psittaciformes. The condition should be considered in birds with clinical signs consistent with those observed in mammals. For the cockatoo of this report, ACTH stimulation test results were equivocal and additional diagnostic tests should be developed for avian patients.

A rationale for using steroids in the treatment of severe cases of H5N1 avian influenza

Acute hypercytokinaemia represents an imbalance of pro-inflammatory and anti-inflammatory cytokines, and is believed to be responsible for the development of acute respiratory distress syndrome and multiple organ failure in severe cases of avian (H5N1) influenza. Although neuraminidase inhibitors are effective in treating avian influenza, especially if given within 48 h of infection, it is harder to prevent the resultant hypercytokinaemia from developing if the patient does not seek timely medical assistance. Steroids have been used for many decades in a wide variety of inflammatory conditions in which hypercytokinaemia plays a role, such as sepsis and viral infections, including severe acquired respiratory syndromes and avian influenza. However, to date, the results have been mixed. Part of the reason for the discrepancies might be the lack of understanding that low doses are required to prevent mortality in cases of adrenal insufficiency. Adrenal insufficiency, as defined in the sepsis/shock literature, is a plasma cortisol rise of at least 9 microg dl(-1) following a 250 microg dose of adrenocorticotropin hormone (ACTH), or reaching a plasma cortisol concentration of >25 microg dl(-1) following a 1-2 microg dose of ACTH. In addition, in the case of hypercytokinaemia induced by potent viruses, such as H5N1, systemic inflammation-induced, acquired glucocorticoid resistance is likely to be present. Adrenal insufficiency can be overcome, however, with prolonged (7-10 or more days) supraphysiological steroid treatment at a sufficiently high dose to address the excess activation of NF-kappaB, but low enough to avoid immune suppression. This is a much lower dose than has been typically used to treat avian influenza patients. Although steroids cannot be used as a monotherapy in the treatment of avian influenza, there might be a potential role for their use as an adjunct treatment to antiviral therapy if appropriate dosages can be determined. In this paper, likely mechanisms of adrenal insufficiency are discussed, drawing from a broad background of literature sources.

Evaluation of the i-STAT Portable Clinical Analyzer in Chickens (Gallus Gallus)

The i-STAT portable clinical analyzer (PCA) was evaluated for performance in avian species. With the EG7+ cartridge, which provided results for hydrogen ion concentration, oxygen tension, carbon dioxide tension, sodium, potassium, ionized calcium, hematocrit, and various calculated parameters, analytical accuracy and precision were tested by comparing obtained values to those of established traditional blood gas and chemistry analyzers. Deming's regression and bias plots were used to compare i-STAT results with those obtained by laboratory professionals using benchtop analyzers. The reliability of the i-STAT PCA with EG7+ cartridges was good, with 0-5.7% system failures in measured values. Regression statistics were good for all blood gas analytes and acceptable for electrolytes and calculated parameters, except for potassium and base excess, for which the regression data or the discrepancy between the methods was too large. The system was reliable and easy to use and had an overall acceptable accuracy in avian species. These features, together with portability and small required blood volumes, make the i-STAT suitable for point-of-care use in critical avian patients, although single values require careful interpretation.

Pharmacotherapy for Behavioral Disorders in Pet Birds

The effective use of psychoactive medications in avian patients is limited by the lack of controlled studies. Appropriate dosages, predictable therapeutic effects, pharmacokinetic data, and information about toxicity are often lacking. A variety of psychoactive agents have been used in avian patients to treat disorders such as feather chewing or picking, self-mutilation of soft tissue, and anxiety, but larger clinical trials and placebo-controlled trials are needed to determine efficacy and safety of these agents. The decision to use psychoactive medication in an avian patient and the choice of medication should be based on existing data for the particular species and an understanding of the drug’s mechanisms and indications. For any behavioral disorder, the need for pharmaceutical intervention requires the following: a thorough physical examination and baseline pretreatment laboratory testing, as indicated by physical examination findings and symptoms; an established diagnosis based on complete behavioral and medical histories; a signed owner consent statement; a behavior modification plan with appropriate environmental modifications; knowledge of the drug, side effects, indications, and mechanisms of action; and realistic expectations about treatment outcomes. Use of antipsychotic agents, serotonin reuptake inhibitors, tricyclic antidepressants, opioid antagonists, benzodiazepines, and hormonal therapies are described.

Avian influenza: an osteopathic component to treatment.

Avian influenza is an infection caused by the H5N1 virus. The infection is highly contagious among birds, and only a few known cases of human avian influenza have been documented. However, healthcare experts around the world are concerned that mutation or genetic exchange with more commonly transmitted human influenza viruses could result in a pandemic of avian influenza. Their concern remains in spite of the fact that the first United States vaccine against the H5N1 virus was recently approved. Under these circumstances the fear is that a pandemic of avian influenza could result in the kind of mortality that was seen with the Spanish influenza pandemic of 1918–1919, where the number of deaths was estimated to be as high as 40 million people.Retrospective data gathered by the American Osteopathic Association shortly after the 1918–1919 influenza pandemic have suggested that osteopathic physicians (DOs), using their distinctive osteopathic manipulative treatment (OMT) methods, observed significantly lower morbidity and mortality among their patients as compared to those treated by allopathic physicians (MDs) with standard medical care available at the time. In light of the limited prevention and treatment options available, it seems logical that a preparedness plan for the treatment of avian influenza should include these OMT procedures, provided by DOs and other healthcare workers capable of being trained to perform these therapeutic interventions. The purpose of this paper is to discuss the characteristics of avian influenza, describe the success of DOs during the 1918–1919 Spanish influenza pandemic, describe the evidence base for the inclusion of OMT as part of the preparedness plan for the treatment of avian influenza, and describe some of the specific OMT procedures that could be utilized as part of the treatment protocol for avian influenza patients.

Issue Topics

The treatment of avian liver disease requires a full assessment of the avian patient before specific therapy. Adequate stabilization and appropriate supportive care is vital to producing a successful outcome, and these procedures are described. Specific therapies of bacterial, fungal, parasitic, and viral infections affecting the avian liver are discussed. Noninfectious injuries to the liver such as toxicities, metabolic disorders, and neoplasia are also discussed with regard to treatment options.

A Method for Resolving Subcutaneous Emphysema in a Griffon Vulture Chick ( Gyps fulvus)

Subcutaneous emphysema is a common presentation affecting avian species. This condition occurs when tissue overlying an air sac is compromised and allows for direct communication to the subcutaneous space. Although not life-threatening in most cases, it can cause discomfort to the avian patient and affect the bird's quality of life, immune status, and, in the case of wildlife, to prevent disease. A Teflon stent has been advocated as a means to reduce the buildup of air under the skin of chronic avian subcutaneous emphysema cases. In the case presented here, a Teflon stent was used as a temporary treatment modality until the underlying muscle layers healed. One month after placement, the stent was removed. The bird recovered with no evidence of subcutaneous emphysema and was eventually released.

That First Impression

This paper discusses the avian patient and the unique requirements for their veterinary hospital experience. It emphasizes the need for exceptional customer service that is provided by a well trained and helpful staff. The use of the computer to provide information for the client and help the veterinarian and the entire staff in managing the case is explored. Additional recommendations for supplemental income through product sales are discussed.

Evolution and healthcare impact of a 21st Century avian flu pandemic

The risk of an outbreak of avian flu is greater now than at any time since 1968. This article will explore the history of influenza and will discuss the evolution and healthcare impact of a 21st Century avian flu pandemic. It highlights the need for healthcare professionals to be adequately prepared for such a pandemic and discusses the responses and infection control precautions required for dealing with avian flu patients.

Avian Analgesia

Avian pain is likely analogous to pain experienced by most mammals. Approach to pain management for the avian patient involves considering the duration, type, and extent of injury along with physical, environmental, and behavioral management. Invasive, painful procedures should always be accompanied by appropriate analgesia and anesthesia. Although pain management in birds is in its infancy, research and clinical studies demonstrate benefit for use of opioids, steroidal and nonsteroidal anti-inflammatory drugs, as well as other analgesics such as α 2-agonists, ketamine, and local anesthetics. Ongoing assessment of pain and analgesic efficacy is extremely important, because the dosage and choice of analgesic may vary widely between species.

Avian Influenza H5N1 and Healthcare Workers

Avian Influenza H5N1 and Healthcare Workers

Small intestinal foreign body in an adult Eclectus parrot (Eclectus roratus) : clinical communication

A 14-month-old female Eclectus parrot (Eclectus roratus) was presented with a 4-week history of bloody diarrhea and depression. No additional information could be gained from physical examination. Only selected diagnostic tests (faecal examination, haematocrit, aspartate aminotransferase, and uric acid) could be performed due to financial constraints, but all where within reference range. Unspecific antibiotic treatment was started and the bird responded well initially, but had to be readmitted 2.5 weeks after initial presentation. Four weeks after initial presentation the owner finally consented to taking whole body radiographs and a diagnosis of an intestinal foreign body could be made. The foreign body was surgically removed 2 days later. The bird recovered uneventfully after surgery and was still in good health 1 year after surgery. This article emphasises the importance of diagnostic imaging in the avian patient. A brief review of avian gastrointestinal foreign bodies is given (concentrating on the psittacine patient) and the importance of distinguishing metallic from non-metallic gastrointestinal foreign bodies are discussed.

Genetic Analyses Suggest Bird Flu Virus Is Evolving

New genetic analyses of samples from recent human H5N1 avian influenza patients reinforce epidemiological evidence suggesting that new strains of the virus may be emerging in northern Vietnam.

Tracheostomy in the Avian Patient

Tracheostomy is a routine procedure used in human medicine to maintain a patent airway in cases of severe tracheal trauma, neoplasia, congenital abnormalities, or disease processes requiring long-term mechanical ventilation. Tracheostomy has been documented in veterinary medicine, including a single case in a prairie dog. However, use of this procedure in birds had not been previously described. The following report describes similar permanent tracheostomy procedures in two parrots, with slightly differing outcomes, and illustrates that tracheostomy can be considered in avian patients with nonresolving obstructive tracheal disease.

Emergency and Critical Care of Small Psittacines and Passerines

Abstract Small psittacines, such as cockatiels, budgerigars, and lovebirds, and passerines, such as canaries and finches, are commonly presented to the avian veterinarian on an emergency basis. Their diminutive size makes accurate assessment and initial supportive care essential for a favorable outcome. Techniques for handling, emergency procedures, and supportive care of small psittacines and passerines are reviewed in the first part of this article. Most birds in this group weigh less than 100 g, limiting the diagnostic tests and procedures that can be performed. Familiarity with common diseases affecting small psittacines and passerines and their presentation will allow for timely assessment and maximization of diagnostic tests increasing the probability for an accurate diagnosis. Common causes of emergency clinical presentations, recommended diagnostic procedures and treatment protocols are reviewed in the second part of this article. Lastly, quick reference tables that overview normal biological parameters, guidelines for tube feeding, etiologies of dyspnea, oral and respiratory medication regimens, emergency drugs, and the equipment necessary for handling the small avian emergency patient also are included to facilitate emergency care and treatment of these species.