mouth rot

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mouth rot

Postby kl » Sun Feb 17, 2013 8:24 am

Has anyone had to treat this problem in blue tongues. It's also called Stomatitus. Symptoms are a mouth that does not fully close with a little gumline still showing and the gums tend to be red. I've had one lizard that has been fighting this for several months now. My vet treated it with a round of antibiotics last year and told me to use Hibiclens antiseptic solution on the gums daily. It still does not seem to improve. I've read articles about it on the internet where various antiseptic solutions are recommended but then when I go to the pharmacy to get them, they all say for external use only. Obviously the animal is going to ingest some of this when wiping the gums. How can it be safe when the bottle says external use only? The animal still eats and acts ok. I'm not sure what's causing it but I frequently find small slivers of substrate in the sides of the mouth. This is probably from burrowing while his mouth is not completely closed. I've removed it. Anybody have any suggestions?

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Re: mouth rot

Postby Scotts1au » Sun Feb 17, 2013 12:13 pm

My thoughts are that the infection more than skin deep, a systemically acting antibiotic might be best, but one appropriate to the bug causing the problem. I take it that you haven't been able to isolate the bug involved? What Abs have been tried. Also which species is affected? Did it start when the animal was cooled?
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Re: mouth rot

Postby kl » Sun Feb 17, 2013 1:37 pm

It's one of the Blotched offspring. This was a sick animal right from the start between prolapses, bacterial infections, not eating, etc. The mouth issue has been an issue on and off. I had it on Baytril back in Sept.. I was told by a vet to use Hibiclens for the mouth. I've been doing that. I just got another refill of Baytril. This stuff is strong and the lizard is very small so dosage is a concern. I've seen the mouth issue with a couple offspring, even from different litters. I'm not sure what's causing it. My temperatures seem ok. The cages clean. Food is fresh. I realize this mouth issue is typically caused by a bacterial problem of the stomach vs. respiratory problems. One possibility is that I've been feeding a lot in the evenings and possibly they are not digesting enough prior to heat being reduced at night. I will start feeding them earlier in the days.

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Re: mouth rot

Postby Scotts1au » Sun Feb 17, 2013 3:30 pm

Kim, when I first started with Alpine Blotched I was advised to keep them on heat 24/7. I didn't take the advice and ended up in all sorts of trouble with one death and another one ended up dying from a intestinal blockage. Several other people I'm aware of have had similar issues with them and generally seen as sudden death. There has been one common theme though, which has been that they have attempted to brumate them in the first year.

Colin H from this site told me early on that "they need to be kept going" an in his experience, if they stop eating and growing at a good rate, problems often set in and the can easily fail to thrive and die - normally blamed on infections starting in the gut. Colin has even taken it a step further, using heat pads to aid digestion/metabolism. Based on this experience and advice i keep mine at a minimum of 20C at night (I aim for 23C to stop them losing their apetite) in their first winter at the cool end (using a low wattage CHE at one end at night).

Since adopting this method I've had no problems at all (other than a little scale rot that came in with a baby bluey from another keeper). My recommendation is that with young Alpines, is not to reduce the temperature at night. Using this technque I've raised probably 80 or so babies over the last 4 years without issue. With the exception of two other animals sourced from another breeder.

I know this goes against others advice but warn against anthropomorphising about the issue of stress and ive seen some miraculous recoveries using this method. Prolonged bacterial infections will kill them through organ failure/failure to thrive and they need to be given the chance to allow their own immune systems to fight off any infection.
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Re: mouth rot

Postby kl » Sun Feb 17, 2013 4:59 pm

I did not brumate the babies from 2012. They are kept in a different room than those being brumated and night time temps have been kept in the upper 70's as I keep some heat loving species in that room as well.

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Re: mouth rot

Postby El Lobo » Sun Feb 17, 2013 5:36 pm

Kim, I haven't had to deal with stomatitis with any of the blotchies but there are similarities to other infections I have experienced with other animals. Commonly, mouth and in particular gum bacterial infections, are caused by anaerobic bacteria. Enrofloxacin (Baytil), as you said is a relatively strong abx but shows little or no efficacy against anaerobic bacteria. Maybe discussing with your vet a change to an abx with proven efficacy against anaerobic such as metronidazole may be of help.

A culture and sensitivity test of swabbed bacteria from the mouth is not all that likely to give a result if indeed the bacterium is anaerobic, as it would not be able to survive in the aerobic environment of the mouth.
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Re: mouth rot

Postby kl » Sun Feb 17, 2013 5:50 pm

Interesting. I will ask my vet about it tomorrow. I've always associated that drug with getting rid of parasites.

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Re: mouth rot

Postby El Lobo » Sun Feb 17, 2013 6:08 pm

I think a similar abx ceftazidime might be prescribed more often in the U.S. whereas metronidazole seems to be more the choice amongst vets here. It has relatively few side effects unless taken together with alcohol.... unlikely with a BTS. :)
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Re: mouth rot

Postby kl » Sun Feb 17, 2013 6:42 pm

I've heard of this drug though nobody has ever prescribed it for any of my lizards. I'll ask about this as well.

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Re: mouth rot

Postby Scotts1au » Sun Feb 17, 2013 8:01 pm

Kim good luck with your little one.

http://www.drsfostersmith.com/pic/article.cfm?aid=1558
http://www.merckvetmanual.com/mvm/index ... 171407.htm

That latter contains a tip that may be useful in using treatments for gram neg anearobic bacteria - note for potentially combining abx.

I'm guessing that the original prolapse was related to the current problem due to a gi infection causing swelling and difficulty passing faeces. The mouth swelling is probably symptomatic of what is going on inside the bluey too and why it is sickly.

Note the quote "Environmental temperatures should be maintained near the upper limit preferred by the species to enhance immune function".

Consider upping it's' temperatures further or preventing it going down the other end of the enclosure. I know other will disagree but the temperature treatment has worked for me before, particularly with Easterns with RIs when everything else seemed to fail.
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Re: mouth rot

Postby Spindown » Sun Feb 17, 2013 8:28 pm

I think a similar abx ceftazidime might be prescribed more often in the U.S. whereas metronidazole seems to be more the choice amongst vets here. It has relatively few side effects unless taken together with alcohol.... unlikely with a BTS.
:rofl: :rofl: :rofl:

I've heard a lot of people have had success with treating various maladies in reptiles that have upped heat to help out as well and its helped tremendously. I'm unsure of how much higher they raised it though.
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Re: mouth rot

Postby El Lobo » Sun Feb 17, 2013 8:57 pm

Scott, I also take the view that maintaining as close to PBT is beneficial. Everything I have read suggests it to be the means by which the immune system remains active, especially needed if the supporting abx are bacteriostatic.

The Merck references the use of aminoglycosides and suggests the drug of choice as Amikacin. I had an on-line discussion with an exotics vet from the UK some time ago and he was very opposed to the use of Amikacin with small animals due to its nephrotoxicity. I have seen some suggestions that it should not be used for any longer than 5 days even with large dogs for this reason.
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Re: mouth rot

Postby Scotts1au » Sun Feb 17, 2013 9:15 pm

I must admit, I keep coming back to this summary - it lists some nasty issues for Baytril as well, wheras I've seen it portraid as a safe drug. mmmm

I had reason to go into great detail about the pros and cons of abx use in humans a couple of years ago though discussions with infection control specialists. That is where I developed the philosophy of thinking about abx and other drugs as supportive therapies because at the end of the day the animal needs to be able to survive in the absence of treatment - because long term use is not going to end well. Abxs are poisons designed to kill -even in humans the effect of taking them is that they impact on the whole body in meausurable ways, including reduced/impared liver function. Often their mode of action is not well understood or how there affects vary from individual to individual and also defy prediction.

http://www.anapsid.org/resources/rxdose.html
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Re: mouth rot

Postby kenn » Mon Feb 18, 2013 4:09 am

El Lobo wrote: Enrofloxacin (Baytil), as you said is a relatively strong abx but shows little or no efficacy against anaerobic bacteria. Maybe discussing with your vet a change to an abx with proven efficacy against anaerobic such as metronidazole may be of help.

And it's better NOT to use in small/young animals!!!

I don't use it for stomatitis :dead:
We have other protocols..
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Re: mouth rot

Postby kl » Mon Feb 18, 2013 11:43 am

I've tried just providing optimum living conditions to the animal vs treatment. It's not been treated for almost 2 months and no sign of improvement. I do believe antibiotic treatment is needed despite concerns by some about using it. Baytril may not be best in this situation though it is still widely used by many vets. I've already just topical antiseptic treatment as well with little results. I'm going to ask my vet about the other drug mentioned in this thread. I read up on it and it does seem to be a good fit for this problem.

Ken, what other protocols for this problem are being used in Europe?
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Re: mouth rot

Postby El Lobo » Mon Feb 18, 2013 5:00 pm

Kim, the problem with vets prescribing Baytril as a first choice of abx is because it is licensed for animal use whereas most others aren't. It is a very expensive exercise for a drug company to gain a licence for veterinary use of their product. Compounding this is the obligation of vets as part of their registration to follow a protocol known as the 'prescribing cascade'.

I am somewhat familiar how that works in Australia and the UK and assume it would be the same in North America. Below are some extracts from the guide published by the British Small Animals Veterinary Association (BSAVA) and a link to the full article.

'BSAVA Guide to the Use of Veterinary Medicines > Prescribing cascade and 'off-label' use

Compliance with the cascade

A medicine prescribed in accordance with the cascade may be administered by the prescribing veterinary surgeon or by a person acting under their direction. Responsibility for the prescription and use of the medicine remains with the prescribing veterinary surgeon.

If there is no medicine authorized in the UK for a specific condition, the veterinary surgeon responsible for treating the animal(s) may, in particular in order to avoid unacceptable suffering, treat the animal(s) in accordance with the following sequence:

1. A veterinary medicine authorized in the UK for use in another animal species or for a different condition in the same species.
2. If there is no such medicine, use either:
(a) A medicine authorized in the UK for human use
(b) A veterinary medicine from another Member State or country outside the EU in accordance with an import certificate from the Veterinary Medicines Directorate (VMD).
3. If there is no such medicine, a medicine prepared extemporaneously by a veterinary surgeon, pharmacist or a person holding an appropriate manufacturer’s authorization.

Small Animal Exemption Scheme
A veterinary surgeon may choose to use a Small Animal Exemption Scheme (SAES) medicine at any time in accordance with the medicine’s recommended use, regardless of whether there is an authorized medicine available. Thus, the cascade neither compels nor prevents the use of an SAES medicine.

However, should the veterinary surgeon wish to use the SAES medicine in a different way than that recommended, because of a professional judgement that such a medicine could provide a safer or better option for treatment, then this would be considered to fall under the last of the cascade options.'

http://www.bsava.com/Advice/BSAVAGuidet ... fault.aspx

I really hope you can get this issues resolved.
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Re: mouth rot

Postby kl » Mon Feb 18, 2013 5:15 pm

That is very interesting.

I called my vet today about getting ceftazidime. He instead recommended sulfamethoxazole saying it worked better. I have no idea what is true. All I know is I'm going to go broke buying these antibiotics after just buying the Baytril yesterday.

I have started treating the mouth issue topically again but this time making sure I'm getting further inside the mouth vs. just the gum line where I had been treating. I'm not sure if this is classic Stomatitis or not because all the sites say it produces white cheesy looking lesions. I don't see that in this animal yet, only mild redness. I will try and take a few pictures to post. I do appreciate all the responses so far.

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Re: mouth rot

Postby kenn » Tue Feb 19, 2013 8:43 am

kl wrote:Ken, what other protocols for this problem are being used in Europe?

Well, now I have an ethical problem.
I want to help here, but I am not allowed to just throw advices without the fact I seen the animal.
Also I understand everybody's interest in medicine, but if I would just write down everything we use... why would people still go to a vet?

:noknow:

I really hope the stomatitis gets under control, Kim.
And as Norm said, most "reptile"vet's start with Baytril. (I try not to)
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Re: mouth rot

Postby kl » Tue Feb 19, 2013 9:16 am

It is interesting to note that since I've been using the topical antiseptic, the condition on this animal and a couple others has started to look worse. I don't know if Hibiclens is causing more irritation or helping. The animals don't actually act sick. They have good appetites. All 4 of my remaining offspring show these symptoms to some degree though a couple completely close the mouths when I disturb them. These animals are from different litters. They are in a room with several other species of which none of them show anything like this. I'm a long time keeper of reptiles and I've never seen this before. These are not WC animals and they have not been exposed to any WC animals. I use fresh foods, clean water, clean substrate, correct temperatures (low 90's basking, mid 70's nights), humidity is not an issue, etc. There does not seem to be anything that would indicate this is an infectious problem but yet Stomatitis is usually caused by something infectious. This all seemed to start when I placed these animals in a new room designed to be kept on the warmer side as all my adults were being brumated in the main room. I am wondering if these animals are not getting enough temperature fluctuations to the lower end of the scale.

KL
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Re: mouth rot

Postby kl » Tue Feb 19, 2013 9:42 am

Here are a couple pictures of the problem. They are not good pictures though.

KL
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