Nail issues in elephants are common and usually need treatment. Pedicure should be part of the management procedures. Untreated nail cracks can result in osteoarthritis of the phalangeal joints. Radiography procedures are described in this chapter. Back to index orthopedic problems Nail lesions The most common nail lesion is the crack , perpendicular to the ground. These cracks are often the result of overpressure on the nail tip, when the nail is longer than the sole. In that situation, each step the elephant makes results in heavy forces on the nail tip during the phase when the elephant unwinds its foot. As demonstrated clearly in the slow-motion video below, the tip of the elephant's nails hardly touches the ground. When the nail becomes too long like in the Asian elephant nail in this photo, the excessive pressure on the nail edge can cause a small crack that enlarges over time if not properly treated. Cracks in the nails of an African elephant When left untreated, these cracks will become larger and can affect deeper structures, resulting in an abscess , pododermatitis or even osteomyelitis of the phalangeal bones. If only the horn-producing tissue is involved, we usually call this a pododermatitis. When the infection is trapped in the underlying tissue, an abscess can easily develop. Onychia is an infection or trauma to the horn lamellae of the nail, which may result in complete loss of the nail. Pododermatitis in the nail of an African elephant. Note the excessive wear of the sole. Nail abscess with osteolysis in an Asian elephant. Nail abscess with complete loss of the 2 distal phalanges osteolysis in an Asian elephant. If phalanges are affected as the result of a deep nail abscess and pododermatitis, the recommended treatment of such an osteitis is the surgical removal of the affected bones. Click here to read more about this treatment. More examples of nail abscesses (photos: Susan Mikota). Treatment may take a long time, requiring multiple pedicure sessions, daily cleaning and foot soaks (click here for foot soak information) Traumatic onychia in an Asian elephant. Complete nail loss due to traumatic onychia in an Asian elephant. Diagnostic procedures nail lesions Use your eyes: check if there is any visible lameness. Describe the visible lesions. Use your hand: does the affected area feels warm? Is it painful when pressure is applied? Use your nose: if there is a wound, try to identify the smell of necrosis. Take a swab for bacterial culture. Additional diagnostic steps: If there is a deep lesion: radiographs should be taken to look at the integrety of the underlying bony structures (phalanges and phalangeal joints). Thermography may help to identify if the affected area has a higher temperature than the surrounding tissues. Radiography of the elephant's foot Radiography foot A powerful portable X-ray machine (100 kV or more) is required to visualize the bony structures in the elephant foot. Digital plates largely increase the quality of the image. It is important to work under safe conditions. Under free contact management , the fore foot can be positioned on a stand for the oblique palmar-dorsal shooting direction. The angle required for visualization of the phalangeal joints is indicated in the images below. Oblique palmar-dorsal image of the hind foot under free contact management condition (Mumby et al 2015) Positioning for the oblique dorsal-plantar image of the hind foot, this foot can be can be positioned on a stand (Mumby et al 2015). A different approach is required when working under protected contact management . The elephant needs to be trained to position its legs on a horizontal bar of the training wall. It should also be accustomed to the proximity of the X-ray-machine, the plate and the protective clothing of the operators. Lateral shooting position of the right front foot of an Asian elephant under protected contact. The angle of the beam depends on which phalanges need to be visualized. To avoid superposition and depending on the selected phalanges, the beam should have a more or less oblique direction. (Courtesy Rotterdam Zoo). Oblique dorsal-plantar shooting position of the left rear foot (Courtesy Rotterdam Zoo). Click here to view the radiograph. Oblique palmar-dorsal shooting postion of the right front foot of an Asian elephant under protected contact. Note that the X-ray machine is positioned upside down (use a support block to protect the electric wires)! (Courtesy Rotterdam Zoo and Emmen Zoo). Click here to view the radiograph. Lateral shooting postion of the left hind foot of an Asian elephant under protected contact (Courtesy Rotterdam Zoo). Click here to view the radiograph. Some examples of radiographs of the distal part of the right front leg of a 24 yr-old female Asian elephant at Rotterdam Zoo (the Netherlands) are shown below. The elephant is under standing sedation for an unrelated reason. Lateral shooting position of the right front leg (distal part of the radius and ulna, Courtesy Rotterdam Zoo). Click here to view the radiograph. Anterior-posterior shooting position of the right radio-carpal and ulnar carpal joint AP front leg (Courtesy Rotterdam Zoo). Click here to view the radiograph. Posterior-anterior shooting position of the right radial-carpal and ulnar-carpal joint (Courtesy Rotterdam Zoo). Click here to view the radiograph. Lateral position of the right carpal joint (Courtesy Rotterdam Zoo). Click here to view the radiograph. Lateral shooting position of the right foot (Courtesy Rotterdam Zoo). Click here to view the radiograph. Lateral shooting position of the right tarsal joint (Courtesy Rotterdam Zoo). Click here to view the radiograph. Lateral shooting position of the right tarsal joint (Courtesy Rotterdam Zoo). Click here to view the radiograph. Posterior-anterior shooting position of the right tarsal joint (Courtesy Rotterdam Zoo). Stereo radiography A technique, which is called stereo radiography can help interpreting the X-rays. Two radiographs of the same areas are made each of them taken 10 cm more lateral from the other. Digital images were converted to bitmap (BMP) format to preserve image quality. The 3D stereoradiograph images can be constructed using special software (Bentley 2021). The images can be viewed with red-cyan 3D glasses. Illustration of how 3D stereoradiograph images are produced. (a) Original radiograph that provides the ‘‘left’’ image for the 3D Anaglyph software. (b) Paired radiograph used for ‘‘right’’ image. (c) Completed stereoradiograph that has been inverted with red-cyan settings applied. (Bentley 2021) Thermography of nail lesions Thermographic imaging can be used to measure the absolute temperature and the difference in temperature between the lesion and its surrounding tissues. Below a severe case of a nail abscess-related osteomyelitis and osteolysis of Ph4 in an old Asian elephant bulls is shown. The thermografic image shows a low temperature of the skin that covers the affected are. This is suggestive for a large necro-purulent process. The thermographic image shown here demonstrates the low temperature of the skin covering the abscess, associated with deep lesions of D4 of the left front leg of an Asian elephant bull, involving a lot of necrosis and complete loss of the distal phalanx of the toe. On radiology this bone is completely missing and the distal part of the toe shows an irregular surface: Osteomyelitis and purulent arthritis of the Ph3-4 joint of D4. Treatment nail lesions Treatment of nail lesions Pedicure is usually the treatment of choice in cases of nail lesions. There are a few principles to be respected in pedicure: Use proper equipment Always remove all abnormal horn tissue (undermined, infected) and loose nail flaps. Make the transition from healthy horn to the deepest point of the lesion as smooth as possible. Directly adjacent to the lesion, the horn must be flexible and as thin as a piece of paper. Permanently check this flexibility by gently pressing the area where just cut away the horn. The most important pieces of equipment needed for pedicure are 2 hoof knives (left and right handed), a scalpel and a sharpening stone for hoof knives, preferably with round edges (see photos above). Just with hoof knives alone, most of the clinical pedicure treatment can be done. A scalpel can be useful when very small pieces of horn are to be removed adjacent to a lesion. A horse hoof rasp is a useful tool to shorten the nail and remove excessive horn from the sole. Care should be taken NOT to make the nail edges round, what is often practiced (see below). A strong nail brush is needed for cleaning the nail prior to pedicure and a smaller brush can be used to remove dirt from areas that cannot be reached by a large brush. Small wood carving knives can be used when thin layers of nail horn are to be removed (similar to the use of a scalpel). Pedicure equipment White line Very often the tip of the nails are made round by rasping the corners. There is no justification for doing so rather than a cosmetic one. However, one should avoid to remove tissue from the nail wall/nale sole junction (comparible to the "white line " in the horse hoof) as this junction is a very important barrier against infiltration of dirt and pathogens. So the advice is: do not file the nail corners to leave the entire white line in tact. Situation before a pedicure session of a deep nail crack Situation after a pedicure session of a deep nail crack Pedicure around a (deep) crack serves 2 main purposes: Draining of infected area Removing pressure on the wound, which enables the regeneration of destroyed horn lamellae. In order to achieve both goals, the deepest point of the crack has to be freed from covering horn. One should start making the horn wall thinner at a distance of several centimeters from the lesion and continue the pedicure towards the deepest point in a gradual way. Each nail crack should be considered as being a wound, because the crack has usually damaged the horn lamellae. When the pedicure has reached the wound area, it is of utmost importance that the edges bordering the wound are made as thin and flexible as possible. Check this by pressing your finger on the horn adjacent to the wound. Large cracks usually need to be treated in several sessions. Bleeding may occur when the lamellae are cut, which is no direct reason to worry! Pain reactions of the elephant will tell the operator when the session should be stopped and continued a few days later Cuticle lesions The cuticles form a natural barrier against dirt and pathogens. When they overgrow the nails, this protective barrier is weakened and infiltration of microoganisms may result in lesions in the horn lamellae underneath the nail (onychia). Sweat glands are embedded in the cuticles. Overgrown cuticles may become hard and crack or form interdigital callus. When abnormal horn tissue blocks the sweat glands, fluid pockets may be formed. This can be a painful process and needs to be treated. Minor cuticle lesion in a African elephant, which may be connected to a deeper lesion underneath the nail. Explorative pedicure is probably needed to find the cause (Courtesy: Barcelona Zoo) Extensive overgrown cuticles with feathering and interdigital callus formation (Fowler & Mikota 2006) Interdigital callus formation in an Asian elephant (Courtesy: Susan Mikota) Sweat glands are present in large numbers in the cuticles. When the cuticles are overgrown, they may form pockets in which the sweat-fluid may accumulate ("blisters"or "blebs"). When cutting in such a fluid-filled pocket, the contents may squirt out (see video; courtesy: Susan Mikota). Careful (!) trimming of the cuticles is only indicated when they have overgrown the nail (Courtesy: Susan Mikota) Applying oil on the cuticles will make them softer and may resolve the problem of cuticle overgrowth in most situations. Example of a pedicure procedure of a nail abscess in conjunction with a cuticle lesion in an African elephant (courtesy Barcelona Zoo) Nail abscess in an African elephant. Note the excessive wear of the sole and the large defect of the cuticle. Second step: follow-up the necrotic tissue and find the connection with the cuticle defect. Note that a large part of the nail was undermined, causing the cuticle defect. First step in pedicure: making the horn on each side of the lesion thinner and removing necrotic tissues. By frequently removing all necrotic tissues and keeping the edges of the wound thin, the horn lamellae can produce healthy horn again. SUCCESSFUL TREATMENT OF DIGITAL OSTEITIS BY INTRAVENOUS REGIONAL PERFUSION OF CEFTIOFUR IN AN AFRICAN ELEPHANT (Loxodonta africana ) (Dutton C.J., Delnatte P.G., Hollamby S.R., and Crawshaw G.J. Journal of Zoo and Wildlife Medicine 48(2): 554–558, 2017) A 41-yr-old African elephant (Loxodonta africana) presented with a swollen third digit of the left forelimb and a 2-cm hole in the pad. Corrective trimming, topical treatments, and an oral antibiotic resulted in apparent resolution; however, it reoccurred after 4 mo. Radiographs suggested bone lysis in the third phalanx, with the primary differential diagnosis being septic osteitis. Flushing with metronidazole solution and intravenous regional perfusion (IVRP) of the foot were commenced. A tourniquet was applied just above the carpus, an interdigital vein was identified by ultrasound, and into this vein 2 g (20 ml) of ceftiofur sodium solution, followed by 60 ml of heparinized saline, was administered. The foot was kept raised for 25 min and then the tourniquet was removed. IVRP was repeated every other day for 70 treatments over 6 mo. Healing occurred, which was confirmed radiographically. IVRP offers an excellent treatment modality in a well-trained elephant. SURGICAL REMOVAL OF INFECTED PHALANGES FROM AN ASIAN ELEPHANT (Elephas maximus ) Gage, L. Blasko D, Fowler M.E. and Pascoe J. Joint Conference AAZ/WDA/AAWV After unsuccessful antimicrobial treatment of an osteitis in a 40 yr-old Asian elephant, surgical removal of the affected phalanges resulted in the complete healing of the foot. Click here to read the report. Digital osteitis treatment Literature Bentley C.E., Cracknell J.N., Kitchener A.C., Pereira Y.M., Pizzi R. 2021. Improved diagnosis of foot osteoarthritis in elephants (Elephas maximus , Loxodonta africana ) using stereoradiography. Journal of Zoo and Wildlife Medicine 52(1): 67–74, 2021. Dutton C.J., Delnatte P.G., Hollamby S.R., and Crawshaw G.J. 2017. Successfull treatment of digital osteitis by intravenous regional prefusion of ceftiofur in an african elephant (Loxodonta africana) . Journal of Zoo and Wildlife Medicine 48(2): 554–558, 2017). Gage, L. Blasko D, Fowler M.E. and Pascoe J. 1995. Surgical removal of infected phalanges from an asian elephant (Elephas maximus ). Joint conference AAZV / WDA/ AAWV . Mumby, C., Bouts, T., Sambrook, L., Danika, S., Rees, E., Parry, A., Rendle, M., Masters, N. and Weller, R. (2013), Validation of a new radiographic protocol for Asian elephant feet and description of their radiographic anatomy. Veterinary Record, 173: 318-318. https://doi.org/10.1136/vr.101696 . Fowler M.E. and Mikota S.K. 2006. Biology, Medicine, and Surgery of Elephants. 271-290. To page top

This chapter describes cases reports submitted by veterinarians worldwide. Case reports Dentistry Back to Top Tusk fracture in 36 months old African elephant Tusk fracture repair in 9 yr-old Asian elephant Tusk fracture repair in 4 yr-old African elephant Tusk (crack) fissure repair in 22 yr-old Asian elephant Tusk sulcus infection in adult Asian elephant T usk sulcus trauma after tusk fracture (2x) Tush loss in female Asian elephant Mandibular fracture Weight loss due to abnormal molar change Supernumerary tusk in an African elephant Impacted Molar Dentition in a 27 yr-old Asian elephant Dermatology Skin wounds in adult Asian elephant Wound treatment after fetotomy Wound treatment after vaginal vestibulotomy Temporal gland impaction: non-surgical treatment Temporal gland impaction: surgical treatment Temporal gland bursitis: surgical treatment Back to Top Reproduction Vaginal vestibulotomy (1996) Vaginal vestibulotomy (2014) Fetotomy Back to Top Ophthalmology Bilateral corneal opacity Back to Top Orthopedic problems Partial pad and nail loss in a 54 yrs-old female Asian elephant Back to Top Infectious diseases Salmonellosis in a group of African elephants Salmonellosis in 7 yr-old Asian elephant Colic and Salmonellosis in an adult Asian elephant Salmonella septicemia in an adult Asian elephant Elephant Endotheliotropic Herpes Virus-Hemorrhagic Disease (EEHV-HD) Fasciolasis in a group of African elephants Rabies in an Asian elephant Back to Top Non-infectious diseases Clostridium botulinum in a herd of elephants Back to Top Clostridium perfringens enterotoxemia in a 6 weeks-old African elephant Intoxication Dieffenbacchia intoxication Paraquat intoxication Back to Top Gastro-intestinal problems Esophagus spasm in an adult Asian elephant Esophagus impaction in a 4.5-yrs-old African elephant Hernia mesenterialis and intestinal rupture in an Asian elephant calf (1 year old) Intestinal impaction caused by Saccharum bengalense in a captive juvenile Asian Elephant: Implications for captive management. Back to Top Miscellaneous Hiccup Asian elephant with suspected hypocalcemia Hiccup Asian elephant with polycystic nephritis Perineal hernia Colic and abdominal surgery Allonursing in an African elephant Back to Top

Necropsy index Necropsy pictural guide Necropsy procedure (videos) Necropsy protocol forms

Many parasites have been described in elephants. Endoparasites, ectoparasites, ticks, lice, helminths, nematodes, cestodes, trematodes, and protozoa. Parasitology To infectious diseases Parasitology Compiled by Susan Mikota DVM, Vijitha Perera DVM and Willem Schaftenaar DVM Nits (lice eggs) on the skin of an Asian elephant calf Adult lice Horseflies (Tabanids) Horseflies are large blood sucking flies. They are especially active on hot, bright, humid days. Their bite is painful and irritating and may result in the formation of nodules on the surface of the skin (Dangolla 2006). Tabanids are the intermediate host for Trypanosoma evansii , a blood parasite that causes trypanosomiasis (also called surra or thut) in elephants (Fowler, 2006). Screwworm flies/maggots Screwworm flies (Chrysomya bezziana ) lay eggs in and around open wounds. When they hatch, the maggots burrow and feed on (dead) tissue. Maggot-infested wounds should be flushed and maggots removed manually. Hydrogen peroxide or ether will coax maggots from deeper wound crevices. Zoosamex spray (Wokwel Ptd. Ltd. Singapore) has been used in Sri Lanka to kill maggots that have penetrated deep into tissue (Silva and Dangolla, 2006). Remove necrotic (dead) tissue and thoroughly clean the wound at least daily. Dipterous larva may produce small nodular eruptions from which larva can be expressed ( Chakraborty, 2003) . When the larva is mature, the fly exits, leaving a small hole in the skin. Secondary infections may develop that are usually bacterial, but mycotic dermatitis has also been recorded. Chrysomya bezziana adult flies and larvae (maggots) (African species, Wikipedia) Ticks (Amblyomma sp.) Ticks may be found behind the ears, on the shoulder or upper hind leg or in the perineal area (near the anus). They should be removed manually. Species that have been found on African elephants are: Amblyoma Tholloni and Dermacentor circumguttus . Other species that have been found on elephants are: Amblyoma asterion, A. cohaerens, A. gemma, A. nuttallii, A. paulopunctatum, A. sparsum, A. variegatum, Boophilus microplus, Dermacentor rhinocerinus, Haemophysalis leachii, Rhipicephalus appendiculatus, R. compositus, R. humeralis, R. longus, R. maculatus, R. muehlensi, R. parvus, R. pulchellus, R. snegalensis, and R. simus (Fowler, 2006). Amblyoma tholloni is known to transmit Cowdria ruminantium. Amblyomma tholloni , found on elephants in Africa (Fowler&Mikota, 2006) Dermacentor circumguttatus , found on elephants in Africa (Fowler&Mikota, 2006) Rhipicephalus appendiculatus Back to Top Ectoparasites Lice Lice (Haematomyzus elephantis ) are small wingless insects about 3 mm long. They are transmitted between elephants by close body contact. Lice may be found behind the ears, at the base of the tail, or anywhere there are folds in the skin. Lice can cause dermatitis and dry scaly skin. Elephants may be restless with frequent scratching. If lice are present around the eyelids, scratching may cause damage to the cornea. Frequent bathing, making sure to scrub behind the ears and other likely sites can help to remove lice. Flumethrin, a pyrethroid insecticide commonly used in dog and cat flea products, can be used topically. Heavy infestations can be treated with ivermectin given SQ or orally (Karesh and Robinson, 1985). Ivermectin kills nymphs and adults but not eggs (also called nits) so treatment should be repeated in 3–4 weeks when the next batch of eggs hatch. Lice are host-specific. Fleas Fleas are wingless insects about 1.5–4 mm in size. Fleas are not host specific so fleas from dogs or cats may infest elephants. Elephants can become infested with fleas by walking through an area contaminated with flea eggs or pupae or by close body contact with other elephants that have fleas. Fleas may cause the elephant to scratch and swelling and redness may be seen at sites where fleas have bitten. Fleas are blood-sucking parasites so a heavy infestation could cause anemia in a small calf. Ivermectin can be administered but attempts should also be made to clean up the environment and keep flea-infested dogs or cats away. Ectoparasites The presence of adult ascarid worms in the stool. Microscopic examination of the faecal sample showing the presence of T. elephantis ova (X40). Strongyles There are several species of parasites that have strongyle-type eggs. Other than for research purposes, it is not important to determine the genus and species. Adults are found in the stomach, small or large intestine, or cecum depending on the species. Larvae hatch from eggs passed in the feces and elephants become infected by eating larvae on forage. Any of the broad spectrum anthelmintics including albendazole, fenbendazole, mebendazole, or ivermectin should be effective. A severe Parabronema smithi infection was reported in free ranging elephants in Sri Lanka (Perera et al. 2015). At necropsy intensively spread caseous ulcers were found in the stomach wall in nine animals. It was the only gross suspected lesion of eight of them. The size of those ulcers varied between 0.4 - 8 cm. The margins of ulcers were elevated and the tiny parasites were observed in the ulcers as well as nearby mucosa of the inner stomach wall. Of the nine animals, three were male and six were females. The ages of the males were 2, 6 and 14 years. The females were older: four were over 30 years and two of them about 20 years old. Four of these females were also lactating. All the infected animals were emaciated. Another member of the strogylides, Grammocephalus hybridatus , was found in the liver af a 15 yr-old female Asian elephant in India. Worm eggs were found in the rectum. Click here to read the full report. Parabronema smithi associated ulcers in the stomach of an Asian elephant cow. (Perera 2018) Comparisson of Parabronema positive with other parasite infections (Fasciola, Anoplocephala, Bathmostomum ) at post-mortem (Perera 2018) Strongyle egg in fecal sample (Dr. Jacob Alexander) Strongyle worm in elephant feces (Dr. Vijitha Perera ) Strongyle worms in the submucosa of the intestines of an Asian elephant (Dr. Vijitha Perera ) Strongyle worms in feces. Many worms can be found after a successful antihelminth treatment (Dr. Vijitha Perera ) Cyathostomides Several Cyathostomid species, belonging to the Strongylidae family, have been found in the gastro-intestinal tract in Asian elephants (Chel H.M et al, 2020). Strongyloides Strongyloides are small 1-2.5 mm) nematodes with two forms – a parasitic form that lives in the intestinal tract and a free-living form found in the soil. Elephants become infected by ingesting infective larvae or larvae may penetrate through the skin. From the intestine, larvae may migrate to other tissues including the mammary gland and may be found in milk, another means of transmission to calves. Strongyloides are usually harmless in adults but in orphans who are weak or sick they may cause a problem. Any of the broad spectrum anthelmintics including albendazole, fenbendazole, mebendazole, or ivermectin can be used. Strongyloides stercoralis Strongyloides eggs Hookworms (Bunostomum spp .) Hookworms are small and round and live in the intestines. Elephants are infected by ingesting larvae on forage or when larvae penetrate skin. They are blood sucking parasites so can cause anemia and be very harmful to young calves. Any of the broad spectrum anthelmintics including albendazole, fenbendazole, mebendazole, or ivermectin can be used. Bunostomum sp. head Bunostomum sp . tail Ankylostoma egg in elephant fecal sample (M. Ashokkumar, Centre for Wildlife Studies, Kerala Vet. and Animal Sciences University, Pookode, Wayanad Trematodes Flukes Elephants can be infected with Fasciola jacksoni unique to elephants, or Fasciola hepatica common to domestic livestock. Adult flukes live in the bile ducts. Eggs are passed in the feces and must be deposited in water for the next phase of the life cycle that also requires snails which act as an intermediary host. Elephants become infected by ingesting water or forage harboring metacercaria, the infective stage. Acute clinical signs include anorexia, constipation, diarrhea, anemia, icterus (yellow color of mucous membranes), anemia, and death. The chronic form is characterized by anemia, anorexia, weight loss and either constipation or diarrhea. Mucous membranes may be pale or icteric and ventral edema may be present (Fowler, 2006). Flukes have characteristic eggs. Because fluke eggs are heavy, sedimentation vs. flotation techniques may be needed for diagnosis. Albendazole, trichlorbendazole, or oxyclozanide can be used for treatment which should be repeated in 45-60 days. Fasciola hepatica collected from the liver from an Asian elephant (Dr. Vijitha Perera ) A case of Fasciolasis in African elephants (Windsor et al. 1976) A group of wild, young calves were imported in the UK from Africa in 1972. Shortly after arrival two died and they were found to be carrying heavy burdens of the intestinal fluke Protojasciola robusta. One male and eight females were moved and housed in another park in the UK. The females were in rather poor condition and showed marked oedema of the abdomen first apparent as a fairly discrete area around the umbilicus but spreading in one animal to include the entire ventral abdomen. No other clinical signs could be detected. Faeces samples were collected; no significant bacteria were isolated but numerous fluke eggs were seen. Although wild elephants normally carry fairly heavy parasite burdens, it was concluded that malnutrition and captivity might have allowed the parasites to assume a more significant role and cause the clinical signs. No reference to the control of this parasite could be found. Since rafoxanide (Flukanide, Merck, Sharp &Dohme) has been reported to be palatable and effective against fluke, this drug was chosen for the attempted treatment. It was arbitrarily decided to use 4 ozper head (this was equivalent to 3 mgfk, which is approximately half the recommended level for bovines), which was offered in a maize gruel to whicha large quantity of sugar had been added. Faecal examination one week later still revealed the presence of fluke eggs and the treatment was repeated. Subsequent examinations were made on three occasions at monthly intervals but no fluke eggs were seen. There was a marked improvement in appetite and physical condition though the oedema in one animal took six weeks to disappear. Paramphiostomes Paramphiostomes are flatworms/flukes with a life cycle similar to Fasciola. There is very little known about this parasite in elephants in the literature. It is commonly a problem in ruminants (stomach or rumen fluke). Paramphiostomes have a similar life cycle to Fasciola and should be susceptible to the same anthelminitics. Trematoda: Amphistomida Hawkesius hawkesi is the only representative of the amphistomata found in elephants. It has been described in Sumatran elephants (Matsua, 1997) and elephants in Vietnam (Sey, 1985). Its clinical relevance is unknown. It was found in the colon of a 17 yr-old Asian elephant in a European zoo, that had arrived 5 years before from Singapore Zoo: about 40 parasites of the species Hawkesius hawkesi (Trematoda, Digenea, fam. Paramphistomatidae) were found in the very cranial part of the colon. Many small (few mm diameter) nodules, with a darker colored central area were found in the surrounding areas (Willem Schaftenaar). Fasciola hepatica collected from the liver from an Asian elephant (Dr. Vijitha Perera ) Fasciola hepatica piled up in a hepatic bile duct of an Asian elephant (Dr. Vijitha Perera) Trematode egg in feces of Asian elephant (Dr. Jacob Alexander) Paramphistomum specimen from the liver of an Asian elephant (Dr. Vijitha Perera ) Hawkesius hawkesi specimen in the cranial part of the colon of an Asian elephant in a European zoo, 5 years after its arrival from Singapore Zoo (Willem Schaftenaar). Cestodes (Anoplocephala spp.) Anoplocephala are large flat segmented tapeworms that live in the intestines. Tapeworm segments can sometimes break off and can be seem grossly in the feces. Elephants pass tapeworm eggs in the feces which are ingested by mites in which the egg matures into a cysticercoid. Elephants become infected by eating forage harboring the mites and cysticercoid larvae. While tapeworms are generally thought to cause little pathology, heavy infections in young calves can be serious and can cause impactions (Warren et al., 1996). Praziquantel is the anthelmintic of choice. Tape worms found in the small intestines of an Asian elephant (Dr. Vijitha Perera ) Cestode eggs (Dr. Jacob Alexander) Stomach bots (gastric myiasis) Asian elephants are susceptible to infestations caused by Cobboldia elephantis . Adult flies lay eggs at the base of the tusk or tusk sulcus. Eggs are ingested and hatch in the stomach. In mild cases signs include loose stool, mouth breathing, and mud eating. Diarrhea, loss of appetite, colic, and anemia may be seen in severe cases (Mar, 2006) Heavy infestations have the possibility of causing gastric rupture. Ivermectin or trichlorfon are effective. Camphor oil or neem oil can be applied to the base of the tusks as a repellent (Mar, 2006). Click here to read more about the morphology of the larves found in the elephant's stomach. Some eggs may already hatch on the skin and the larvae may migrate to the tusk sulcus and cause a sulcus infection; click here to read a case report about such a sulcus infection. Bots (larvae) of Cobboldia sp. found in the stomach of an Asian elephant (Dr. Vijitha Perera ) Back to Top Endoparasites Elephants are affected by three major groups of parasites: Nematodes: roundworms like ascarids, stronygles, strongyloides, and hookworms Trematodes: flatworms like liver flukes (Fasciola elephantis) Cestodes: tapeworms like anoplocephala In healthy wild elephants parasites often live in balance with their hosts without causing any obvious harm. However, any number of environmental stressors can upset this balance and result in clinical disease even in adults. Orphan calves are often under tremendous physiological and/or mental stress resulting from lack of food, separation from the herd, or injuries. So it is important to determine what parasites they are harboring and to administer appropriate anthelmintic (de-worming) medications. Parasites that may not have been a problem for a healthy calf can be deadly for a traumatized orphan. If in an orphanage the eggs per gram count of nematodes is high, calves should be dewormed using fenbendazole, albendazole, levamisole, or ivermectin. If there are Fasciola eggs in the feces, they are treated with triclabendazole and if Anoplocephala eggs are found they are treated with praziquantel. The prevalence of various parasites may vary with geographical location and environmental factors. Flukes, for example require water and the presence of an intermediary host (snails). General signs of parasite infections include weakness, poor skin and body condition, diarrhea, poor appetite, a tendency to eat mud, and in the case of blood sucking parasites, anemia. Submandibular or ventral edema may be seen. Some adult parasites may be seen in the feces but most reside deep within the intestinal tract. It is always advisable to perform a fecal examination to look for parasites eggs under the microscope. The presence of endoparasites may in some instances be reflected in the consistency of the feces. Monitoring the quality of the feces is an important tool to monitor the digestion of food and the presence of endoparasites. Endoparasites Stomach bots Nematodes Trematodes Cestodes Nematodes Toxocara elephantis Toxocara elephantis infection has been reported in an Asian elephant from a zoo in Switzerland (Fowler & Mikota 2008) and in a 5 yrs-old wild Asian elephant after being rescued from a flood (Bora et al. 2019). Clinical examination revealed normal body temperature (36.4°C), congested conjunctival mucous membranes, increased pulse rate (38 bpm) and eupnoea (14 breaths/min). Microscopic examination of the faecal sample showed the presence of T. elephantis ova, which were round-shaped with a thick outer shell. The animal was treated with albendazole at 10 mg/kg, orally, once daily for 3 days and received supportive therapy for 7 days, after which it had recovered completely. Click here for the complete manuscript. Blood parasites Blood parasites Trypanosomiasis (Surra, Thut) Trypanosomiasis is a protozoan disease transmitted by biting flies and mosquitoes. It is most prevalent in Asia during the rainy season. Clinical signs may include fever, extreme weakness, lethargy, dry skin, anemia, and a progressive loss of body condition leading to emaciation. Constipation or diarrhea may be present or feces may be normal. Edema of the face, trunk, neck, lower abdomen, and limbs may be seen (Desquesnes et al., 2013). Characteristic organisms can be seen on blood smears collected during episodes of fever. An ELISA has also been developed and used for a serosurvey in Thailand (Camoin et al., 2018). Cases have been reported in Myanmar, Thailand, and India. However, Surra does not seem to be common in Sri Lanka and may be most likely to occur when elephants are in close proximity to infected cattle or buffalo. Diminazene aceturate is recommended for treatment, however the dosage is controversial. Three elephants in Thailand treated with 5 mg/kg relapsed (Desquesnes et al., 2013). A single elephant was successfully treated increasing the dosage to 7-8 mg/kg (Rodtian et al., 2012) but the drug is known to have serious side effects so should be used with caution. Trypanosoma evansi in a bloodsmear Babesia (Babesiosis, Piroplasmosis, Tick Fever) Babesiosis is a tick-transmitted protozoan disease. It has rarely been reported in Asian elephants (McGaughey, 1961) and even in African elephants there are only a few publications (Brocklesby and Campbell, 1963; King'ori et al., 2019). Clinical signs may include weakness, fever, jaundice, constipation, and hemoglobinuria. Characteristic organisms can be seen on blood smears. Three elephants diagnosed with babesiosis in Sri Lanka responded well to diminazine aceturate at a dosage of 3.5–7.0 mg/kg (personal communication Dr. ID Silva, Sri Lanka, 2005). Babesia protozoa in the erythrocytes of a mammal . Filaria parasites Filaria are a group of nematodes that live in the tissue of vertebrates; filariasis refers to the presence of microfilaria in blood and tissues. Indofilaria spp. cause a cutaneous filariasis that results in 1–2 cm nodules on the sides, lower abdomen, and limbs (Chandrasekharan, 2002). Stephanofilaria spp. cause lesions on the back and ventral areas (Bhattacharjee, 1970) or on the feet (Tripathy et al., 1989; Tripathy and Das, 1992). Microfilaria can be seen in blood that oozes from ruptured nodules and also in the peripheral blood. Other clinical signs of cutaneous filariasis may include restlessness, dry skin, and submandibular or ventral edema. Diagnosis is by observing the motile parasites on a blood smear that is best collected between 9 PM and 3 AM (Mar, 2006). Heavy infections can be treated with ivermectin given every 4–6 months (Mar, 2006) Cutaneous Filariasis in Elephants Introduction Cutaneous filariasis is a parasitic disease affecting elephants, caused by various species of filarial nematodes. These microscopic worms inhabit the skin and subcutaneous tissues, leading to chronic skin lesions in affected elephants, often associated with itching. This condition is more commonly observed in Asian elephants but can also affect African elephants. Etiology and Transmission The primary causative agents of cutaneous filariasis in elephants are nematodes from the genera Stephanofilaria, Setaria, and Onchocerca. These parasites are transmitted by blood-feeding arthropods that serve as intermediate hosts. The larvae enter the host during feeding, eventually developing into adult worms in the skin tissues. Clinical Signs Elephants with cutaneous filariasis often exhibit the following symptoms: Nodular or ulcerative skin lesions Thickened, rough, or depigmented skin Pruritus (itching) and discomfort Secondary bacterial infections due to constant irritation and scratching. Lesions are frequently found around the head, trunk, and legs, although they can occur on any part of the body. Back to Top Diagnosis Diagnosis of cutaneous filariasis involves a combination of clinical examination and laboratory analysis. Biopsies from lesions are examined under a microscope to detect microfilariae. Molecular techniques, such as PCR on blood samples, can provide more precise identification of the filarial species ( Saengsawang, 2023) . Clinically the lesions look like lumps caused by dipterous flies. Dipterous larva may produce small nodular eruptions from which larva can be expressed ( Chakraborty, 2003) . When the larva is mature, the fly exits, leaving a small hole in the skin. Secondary infections may develop that are usually bacterial, but mycotic dermatitis has also been recorded. Treatment and Management Treatment involves the administration of antiparasitic drugs such as ivermectin. This medication targets microfilariae and adult worms, reducing the parasite load. Regular application of insect repellents can help prevent further transmission by reducing vector bites. Dosage Ivermectin Guidelines for Elephants: There is no scientific study on the efficacy of ivermectin in cutaneous filariasis. Anecdotally dosages used range from 0.1-0.3 mg/kg SQ or PO (Case report: Dayashankar, 2023) . Severe or resistant Cases: up to 0.4 mg/kg Frequency: administered once every 2 weeks for 2 to 3 treatments. In some cases, monthly doses may be needed for long-term prevention. Important considerations: Microfilariae die-off: rapid killing of microfilariae can lead to inflammatory reactions or swelling. To mitigate this, anti-inflammatory medications (e.g., corticosteroids) may be given concurrently. This phenomenon, however, has never been reported in elephants. Supportive Treatment: Address secondary infections or ulcerations with antibiotics and topical antiseptics. Prevention and Control Preventive measures include minimizing exposure to biting insects through habitat management, use of insect repellents, and protective coverings for captive elephants. Routine veterinary check-ups and antiparasitic treatments can help identify and manage early infections, reducing the risk of widespread outbreaks. Cutaneous filariasis References Bhattacharjee, M.L., 1970. A note on stephanofilarial dermatitis among elephants in Assam. Sci. Cult 36, 600-601. Bora N, Ali S, Sarma K, Roychoudhury P, Eregowda C.G., Prasad H., Rajesh J.B., Mohanarao G.J., Behera S.K., Das D. and Choudhury B. 2021. Toxocara elephantis Infection in a Juvenile Asian Elephant and Its Management. Gajah, 54 (40-44). Brocklesby, D.W., Campbell, H., 1963. A babesia in the African elephant. East Afr. Wildl. J 1, 119. Camoin, M., Kocher, A., Chalermwong, P., Yangtarra, S., Thongtip, N., Jittapalapong, S., Desquesnes, M., 2018. Adaptation and evaluation of an ELISA for Trypanosoma evansi infection (surra) in elephants and its application to a serological survey in Thailand. Parasitology 145, 371-377. Chakraborty, A. 2003. Diseases of elephants (Elephas maximus) in India—A review. Indian Wildl Yrbk 2:74–82. Chel, H.M. et al. 2020. Morphological and molecular identification of cyathostomine gastrointestinal nematodes of Murshidia and Quilonia species from Asian elephants in Myanmar. IJP: Parasites and Wildlife 11, 294–301. Dayashankar and Rakesh Kumar Singh. 2023. Management of Filariasis in Asian Elephants (Elephus Maximus) Under Field Conditions. Acta Scientific Veterinary Sciences (ISSN: 2582-3183) Volume 5 Issue 5 May 2023. Desquesnes, M., Holzmuller, P., Lai, D.H., Dargantes, A., Lun, Z.R., Jittaplapong, S., 2013. Trypanosoma evansi and surra: A review and perspectives on origin, history, distribution, taxonomy, morphology, hosts, and pathogenic effects. BioMed research international 2013. Fowler, M.A., 2006. Parasitology. In: Fowler, M.A., Mikota, S.K. (Eds.), Biology, Medicine, and Surgery of Elephants. Blackwell, Ames Iowa, 159-181. Karesh, W.B., Robinson, P.T., 1985. Ivermectin treatment of lice infestations in two elephant species. J. Am. Vet. Med. Assoc 187, 1235-1236. Kavitha, K.T., C. Sreekumar & B.R. Latha (2022). Case report of hook worm Grammocephalus hybridatus and stomach bot Cobboldia elephantis infectons in a free-ranging Asian Elephant (Elephas maximus) in Tamil Nadu, India. Journal of Threatened Taxa 14(4): 20915–20920. htps://doi.org/10.11609/ jot.6910.14.4.20915-20920. Kaewchot S, Thongyuan S, Sripiboon S, Chaiyarat R, Yingyong P, Bunsermyos W, Jarudecha T, Sanyathitiseree P. 2026. Prevalence of Gastrointestinal Parasites in Wild Asian Elephants (Elephas maximus) at a National Park in Eastern Thailand. Biology (Basel). 2026 Feb 11;15(4):313. doi: 10.3390/biology15040313. PMID: 41744622; PMCID: PMC12938575. King'ori, E., Obanda, V., Chiyo, P.I., Soriguer, R.C., Morrondo, P., Angelone, S., 2019. Molecular identification of Ehrlichia, Anaplasma, Babesia and Theileria in African elephants and their ticks. PLoS One 14, e0226083. Mar, K.U., 2006. Veterinary Problems of Geopgraphical Concern: Myanmar. In: Fowler, M.A., Mikota, S.K. (Eds.), Biology, Medicine, and Surgery of Elephants. Blackwell, 4 60-464. Matsuo K, and Ssuprahman H. 1997. Some parasites from Sumatran elephants in Indonesia. J ournal of the helminthological society of Washington, 64(2), july 1997, 298,299. Perera B. V.P., Rajapakse R.P.V, Thewarage L.D., Silva_Fletcher A., 2015. Mortality of wild Sri Lankan elephants (Elephas maximus ) as a result of Parabronema smithi infestation. Proc Int Conf Dis Zoo Wild Anim 2015. Perera B.V.P., Rajapakse R.P.V.J., Abeywardana M.K. 2011. Prevalence of Cobboldia elephantis in free ranging elephants in Sri Lanka. Elephant and Rhino Conservation & Research Symposium organized by International Elephant Foundation, October 2011. Perera B.V.P., Rajapakse R.P.V.J., Abeywardana M.K., Pinidiniya M.A., Silva-Fletcher A. 2018. Population threshold and emerging parasitic disease of elephants in Sri Lanka. Joint EAZWV/AAZV/ Leibniz-IZW conference 2018. Rodtian, P., Hin-on, W., Muangyai, M., 2012. A Success Dose of Eight mg per kg of Diminazene Aceturate in a Timber Elephant Surra Treatment: Case Study. . In, First Regional Conference of the Society for Tropical Veterinary Medicine (STVM): A change in global environment, biodiversity, diseases and health, Thailand, 24. Saengsawang P, Desquesnes M, Yangtara S, Chalermwong P, Thongtip N, Jittapalapong S, Inpankaew T. 2023. Molecular detection of Loxodontofilaria spp. in Asian elephants (Elephas maximus) from elephant training camps in Thailand. Comparative Immunology, Microbiology and Infectious Diseases Volume 92 , January 2023. Sey O.1985. Amphistomes of Vietnamese vertebrates (Trematoda: Amphistomida).Parasit, Hung. 18. 1985. Tripathy, S.B., Das, P.K., 1992. Treatment of Stephanofilarial dermatitis in an Asian elephant (Elephas maximus): a case report. In: Silas, E.G., Nair, M.K., Nirmalan, G. (Eds.), The Asian Elephant: Ecology, Biology, Diseases, Conservation and Management (Proceedings of the National Symposium on the Asian Elephant held at the Kerala Agricultural University, Trichur, India, January 1989). Kerala Agricultural University, Trichur, India, 162-163. Tripathy, S.B., Das, P.K., Acharjya, L.N., 1989. Treatment of microfilarial dermatitis in an Asian elephant (Elephas maximus): a case report. Indian Journal of Indigenous Medicines, 31-33. Windsor R.S.,and Scott W. 1976. Fasciolasis and Salmonellosis in African elephants in captivity. Br. vet.]. (1976), 132, 313 . Back to Top

ElephantMedicine.info provides information about infectious and non-infectious diseases in elephants, case reports, clinical and laboratory procedures and management guidelines. -Elephant Medicine -Diseases -Treatment -Anesthesia -Dental problems -Tusk repair -Laboratory tests - Hematology -elephant disease treatment -dental problems -locomotion -diagnostic procedures -physical examination -laboratory procedures -reproduction and birth procedures -anesthesia procedure -lameness -pedicure Elephant Medicine Get started A website for veterinarians taking care of elephants Sharing your clinical experience in ELEPHANT MEDICINE with elephant clinicians worldwide This website provides information about elephant diseases, procedures and recommendations. It also includes a collection of clinical case reports, submitted by veterinarians from all over the world. You will find cases that have been successfully treated, but also cases that had a sad ending. Some basic disease information is provided as well as descriptions of clinical and laboratory procedures. The information on this website is subject to changes, as our knowledge about diseases in elephants will grow by sharing our experiences. Veterinarians involved in elephant medicine are encouraged to submit reports of their experiences. Together we can create a platform for the current and next generations of veterinarians. For the benefit of an amazing, but vulnerable species: the elephant. Disclaimer: The content of this website, such as graphics, images, text and all other materials, is provided for reference and educational purposes only. The content is not meant to be complete or exhaustive or to be applicable to any specific individual's medical condition. The information is based on scientific literature, open source information and anecdotal information provided by trusted sources. You assume full responsibility for using the information on this site, and you understand and agree that the authors are not responsible or liable for any claim, loss or damage resulting from its use by you or any user. Contact

Elephant feet in zoos need regular inspection. This chapter describes in 6 steps foot care can be addressed. Attention is paid to the nails, the pad, sole, cuticles andd the normal appearence of a health elephant foot. Back to lameness Regular foot care in zoo elephants: a practical guidance Written by Christian & Linda Schiffmann (Edit. Willem Schaftenaar) Definition Regular foot care means the functional trimming of an elephant's distal limb to prevent overgrowth of its key structures, including nail, pad, and cuticle). Aims Prevent overgrowth and the resulting changes. Maintain the foot structures in their physiological shape to support normal function, especially proper weight bearing and distribution). Figure 1. Conditions to be avoided through regular foot care: a) overgrown nails; b) overgrown pad; c) narrow interdigital space; d) overgrown and frayed cuticles Preconditions & tools Conditions and tools required: comfortable position for elephant and keeper/vet (Fig. 2), adequate light conditions, tools (Fig. 3), time and staff (at least two persons). Figure 2. Proper positioning of the foreleg (a) and hindleg (b) under the conditions of protected contact. Note: The custom-made constructions out of steel (a), or out of steel & wood (b) are facilitating a position enabling access to every aspect of the foot. Figure 3. Appropriate tools for regular foot care: a) rasp b) hoof knives in various shapes c) Swiss hoof knife, only to be used with great care! d) side cutter pliers e) set of wood carving knives e) General notes: Be aware of the potential harmful aspect of any tool. In particular less experienced persons are at risk of cutting too deep into the horn layer. This risk is increased by using the Swiss hoof knife due to its angle. Before using any tool on an elephant´s foot, the person doing the trim should have become familiar with the tool handling. We discourage the use of an electric angle grinder. Due to the high power of this tool, only experienced persons (if even) will be able to use it safely. In addition it has been speculated whether the occurring heat may have a negative impact on the tissues (Wendler et al. 2021). If applied despite this warning, an adjustable rotation speed and a serrated washer with appropriate grain size (“40” corresponding to a metric size of the grains of around 0.62mm) are of utmost importance to reduce heat development and the risk of injuries. Foot pedicure Always start a pedicure session by thoroughly cleaning the foot. By getting rid of as much dirt as possible, the tools will remain sharp for longer. Thorough cleaning can be accomplished by the use of a brush. There are four steps of pedicure in accordance with the four critical structures of the elephant foot: the nail the pad the interdigital space the cuticle The sequence of these steps is not mandatory, although a systematic approach is strongly recommended. Step 1 - Nails Shorten the solar part of the nails, check the surface of the horn wall, and bring the nail in its specific shape. Sole part of the nail: what to go for? (Tools: rasp, hoof knife) Figure 4. The solar aspect of the nail must be shortened as far as possible (a) to avoid weight bearing in standing position (b). The color and consistence of the solar horn of the nail are indicative of the appropriate depth. The deeper you go, the paler & softer the nail tissue becomes. Stop at a level where the solar horn is still firm upon palpation and no bleeding occurs. By trimming carefully, you will recognize the small vessels shining through the solar horn before bleeding occurs. a) P4 in right hind foot of a female Asian elephant, 39 yr-old; b) right hind foot of an adult Asian elephant © PS Nail wall: what to go for? (Tools: rasp, hoof knife) Figure 5. The superficial layer of the nail wall should be visually checked for discolorations that are indicative of underlying issues. The surface layer should not be removed (do not rasp!). Keep the nail in its physiological shape by only rasping/cutting the solar part of the nail (see also Step 3 on the interdigital space). Avoid rounding the edge of the nail, as that may make the white line thinner (P3 in right forefoot of a male Asian elephant, 3 yr-old). Step 2 - Pad Check the pad and eliminate flaps if required (and if feasible with respect to the nails). The natural profile of the pad as seen in healthy free-ranging elephants should be the goal (figure 6c). Pad: what to go for? (Tools: hoof knife (Swiss knife)) Figure 6. a) Trimmed pad (right hind foot) of a 39 yr-old female Asian elephant kept in a zoo. Only a minimum of sulci with a pattern of sulci is present. b) Right hind foot of a 10 yr-old male Asian elephant, cleaned to ensure there is no debris or undetermined tissue remaining. In a healthy elephant pad a clear profile covers the entire surface of the pad. c) right hind foot of a semi-captive female Asian elephants kept on natural forest grounds; note the extreme difference between the pads of the zoo-kept elephant (6a and 6b) and the pad of an elephant kept under natural environmental conditions! When conditions as seen in a & b are present, the management conditions regarding floor and substrate need urgent improvement (e.g. replace concrete by sand). Step 3- Interdigital spaces Clean and widen the interdigital spaces till you can put one finger between the nails (both the solar and the wall side) and widen the interdigital spaces (both the solar and the cranial aspect) Interdigital space: w hat to go for? (Tools: hoof knife, rasp) Figure 7. A wide, clean and dry interdigital space in both the solar (a) and wall (b) aspect. a) P3/P4 of the right hindfoot of a 41 yr-old female Asian elephant; b) P2/P3 of the right forefoot of a 10 yr-old female African elephant. Note: The edges of the nails in b) are more rounded than we recommend here. Rounding may weaken the white line of the nail. Step 4 - Cuticles Shorten the cuticle and remove debris and dirt from the nail bed. Cuticles: what to go for? (Tools: hoof knive, small wood carving knife) Figure 8. Evenly trimmed cuticle and clean nail bed area. P3 of the right hindfoot in a 10 yr-old male Asian elephant. Step 5 - Evaluation Check all structures while the elephant is standing and walking. In particular make sure that the nail wall is not weight bearing while standing and the joint movements during the walking phase are smooth. In case you are not happy with the result, go back to Step 1-4 depending on your observation. Figure 9. After completion of a foot trim, take the time to check thoroughly every structure while the elephant is standing and walking. Be particularly focused on the weight distribution. (hindfeet of an 18 yr-old female Asian elephant, right foot trimmed). Note: The edges of the nails of the right foot are more rounded than we recommend here. Rounding may weaken the white line of the nail. Step 6 - Record keeping Accurate documentation of each elephant’s foot condition is strongly recommended. It supports reassessment and helps confirm progress, especially during long-term treatment or when changes occur. Species-specific documentation forms were provided by Benz (2005), and a more objective method for scoring and monitoring foot health was described by Ertl et al. (2020). A thorough routine documentation of each nail and the pad is recommended (see Fig. 10). Examination form for African elephant feet (Benz, 2005) Click here to download the form Examination form for Asian elephant feet (Benz, 2005) Click here to download the form Practical notes: -Always keep your tools clean and sharpened. -When trimming the nails, consider the specific shape of each nail and the corresponding differences between front and rear foot. -In case of bleeding: keep calm and ensure disinfection with a wound disinfectant (e.g. chlorhexidine or povidone iodide). -Keep in mind that pedicure might not always be fun for the elephant. Therefore, do your very best to make the procedure as comfortable as possible for the elephant and make use of positive reinforcement training (Fig. 11). Figure 11. Foot care tools ready for use. Note: A variety of rewards can be very helpful in a training approach based on positive reinforcement. Additional recommendations to continuously ensure foot health in zoo elephants: -Do twice daily thorough washing (using moderate pressure) of the distal limb covering the four critical structures (nail, pad, interdigital space, cuticle) in order to reduce the negative impact of urine contamination. Elephant urine is a keratolytic substance and may cause significant alterations particularly in the pad. This negative impact can be significantly reduced through a consistent moderate pressure washing routine. In addition, this routine ensures daily monitoring of an elephant’s foot conditions. -Conduct daily inspection of all foot structures (ideally after pressure washing) -Encourage normal wearing of the foot structures through natural behaviors: walking on soft substrates, limited walking on abrasive surfaces, digging, processing of browse/branches (Fig. 12). -Avoid extended standing on hard substrates (e.g. feeding places, night quarters). -Provide soft substrates for lying rest of adequate duration. Figure 12. Digging in a sandy substrate enables a very natural wear & peeling of the horn wall, the interdigital space and the cuticles. References Benz A (2005). The elephant´s hoof: Macroscopic and microscopic morphology of defined locations under consideration of pathological changes. Veterinär-Anatomisches Institut der Vetsuisse-Fakultät. Zürich, Switzerland, Universität Zürich. Inaugural-Dissertation. Ertl N, Wendler P, Sós E, Flügger M, Schneeweis F, Schiffmann C, Hatt JM, Clauss M (2020) Theory of medical scoring systems and a practical method to evaluate Asian elephant (Elephas maximus ) foot health in European zoos. Animal Welfare 29:163-176. Wendler P, Ertl N, Flügger M, Sós E, Clauss M, Hatt JM (2021) Foot care in Asian elephants (Elephas maximus ) in European zoos. Der Zoologische Garten 89:103-119.

Locomotion problems in elephants are usually symptoms of degenerative joint diseases and lesions of the pad or nail. This chapter describes (1) the diagnosis of orthopedic problems (observationa and video recording, radiology, thermology), (2) nail issues, (3) sole/pad issues, (4) degenerative joint disease and some miscellaneous problems related to lameness. Continue Orthopedic problems This chapter consists of the following paragraphs: Normal features of the locomotion system Sole-related clinical problems Nail-related clinical problems Lameness / abnormal locomotion Prevention of orthopedic problems Radiography elephant foot Regular foot care Elephants do not often show signs of lameness. Nevertheless, orthopedic problems are quite common. A survey about the causes of death in the European studbooks of African and Asian elephants over 5 years of age, revealed that in 12% and 30% respectively of the cases, orthopedic problems played a major role in the cause of death (Hess 2022). The most frequently reported problems are related to the feet, joints and muscles. A special issue is the occurrence of metabolic bone disease in bottle-raised young elephants. Normal features of the locomotion system Normal featurs Anatomical features of the skeleton The elephant has some special features that distinguishes them from other mammals. The long bones are massive, lacking the typical bone marrow cavities. Instead, the long bones of elephants are completely filled with dense cancellous bone, where hemopoiesis is taking place. In the standing elephant, the angles of the joints are almost straight. The neck is relatively short. Figure 1: Asian elephant (Green Hill Valley, Myanmar). Figure 2: African elephant skeleton (Veterinary Faculty Utrecht University, the Netherlands) Foot anatomy terms Front foot = fore foot = manus Hind foot = rear foot = pes Phalanges = toes = digits Pad = sole = slipper Palmar = front pad Plantar = back pad Carpus = wrist Tarsus = ankle Nail = horn wall + nail pad horn Fat cushions Each foot of the elephant is equipped with a large subcutaneous cushions which play an important role in distributing forces during weight bearing and in storing or absorbing mechanical forces. One study about these cushions in the African elephant was published by Weissengruber in 2006 . In both the forelimb and the hindlimb a 6th ray, the prepollex or prehallux, is present. These cartilaginous rods support the metacarpal or metatarsal compartment of the cushions. None of the rays touches the ground directly. The cushions consist of sheets or strands of fibrous connective tissue forming larger metacarpal/metatarsal and digital compartments and smaller chambers which are filled with adipose tissue. The compartments are situated between tarsal, metatarsal, metacarpal bones, proximal phalanges or other structures of the locomotor apparatus covering the bones palmarly/plantarly and the thick sole skin. Within the cushions, collagen, reticulin and elastic fibres are found. In the main parts, vascular supply is good and numerous nerves course within the entire cushion. The high concentration of sensory receptors such as Vater–Pacinian corpuscles within the cushion and Meissner corpuscles in dermal papillae of the adjacent skin might rank an elephant’s foot among the most sensitive parts of its body. Together, the mechanical and sensory functions of the feet enhance the ability of elephants effectively to move through and analyse their physical environment. The micromorphology of elephant feet cushions resembles that of digital cushions in cattle or of the foot pads in humans but not that of digital cushions in horses. Copied illustration of the foot anatomy from Weissengruber et al., 2006 (doi: 10.1111/j.1469-7580.2006.00648.x Normal locomotion Elephants predominantly support on their pads (foot soles). The nails are not used to force locomotion. This is nicely demonstrated in the slow-motion video below (BBC). During walking the head of the elephant shows minimal movements. If there is any form of lameness, especially in one of the front legs, the animal might use its head to facilitate the movement of the front leg in cranial direction. In the absence of orthopedic problems, the hind feet are placed cranial to the foot step of the front foot on the same side. This is clearly demonstrated in the slow-motion video of African elephants in the Namibian desert below (BBC) and the normal-speed video of an adult Asian elephant bull in Vietnam. Elephants can't trot, canter, gallop or jump. They always walk in normal gait. When they walk slowly, their speed is approximately 4 km/h (2.5 miles/h). However, they can reach a speed of 25-60 km/h (16-25 miles/h) over a short distance. The hind foot is placed in the foor print of the front foot or even slight more cranial. Normal anatomical features of the elephant foot Usually the forefeet of the Asian elephant have 5 nails and the hind feet only 4. The African elephant has 4 nails on the forefoot and 3 on the rear one. The weight of the body is evenly distributed over the toes by means of a thick cushion , placed between the sole and the phalanges (photo African elephant foot Kruger National Park, South Africa). The digits form a ±45° angle with the sole, as shown in the radiograph below (Fowler and Mikota 2006). This photo shows the longitudinal section of the elephant foot with the sole, nail, phalangeal bones, cushion and tendons. Note the short distance between the nail and the distal phalangeal bone (Fowler and Mikota 2006) The nails are numbered medial to lateral. If there are 4 nails in front they are numbered 2,3,4,5. The bones don’t change – there are always 5 digits so digit 1 is still there but there in no associated nail. In Asian elephants there are typically 4 nails on the rear foot so they are numbered 2,3,4,5. The African elephant's toes are numbered 5,4,3,2 (front) and 5,4,3 (rear) respectively. This diagram shows the bones of the front foot and the respective phalanges of an Asian elephant (Fowler&Mikota 2006) This diagram shows the bones of the hind foot and the respective phalanges of an Asian elephant (Fowler&Mikota 2006) Radiograph of the left front foot of an Asian elephant, showing the phalangeal bones P1,P2 and P3 (Fowler&Mikota 2006) Sixth toe The elephant has unique cartilaginous structures in the feet that are thought to have a stabilizing function. In the front foot the structure is is called a prepollex. It attaches between the first carpal bone and the first metacarpal bone and extends to the sole. In the hind foot it is called a prehallux. A recent study has claimed that this structure should be considered a sixth toe because over time the tissue becomes hard like bone. The healthy sole The sole (pad or slipper) of the elephant's foot is a thick cornified but flexible integumentory structure, with a surface relief that looks almost similar to the skin. It is important to respect this surface when performing pedicure. The thick sole must protect the elephant from penetrating trauma by foreign bodies. A healthy sole is maintained by providing a dry environment. Long periods in muddy and humid circumstances can lead to sole injuries and even sole detachment. The photos show the nicely structured sole of a (dead) wild African elephant (Kruger National Park, South-Africa) and the sole of a captive Asian elephant. The sole of the elephant foot should have a minimum thickness of 2 cm. This can be measured by ultrasound examination. Its surface should be rough with a distinct relief. The growth of the sole epithelium is from 0.5 to 1.0 cm per month. If the sole does not wear sufficiently, it becomes thickened, and because the thickening is seldom uniform, defects are produced that lead to pocket formation and overgrowth, which sets the stage for infection. The healthy nail The nail consists of two parts: the wall and the sole part, which are connected at the sole side. This junction is an important area where infections can emerge if its integrity has been severed by excessive abrasion on hard floors (concrete stable, tar roads) or wrong pedicure. This connection site is comparable with the so-called 'white zone' in hoofed mammals. The white line (or white zone) structure is illustrated in the figures and photos below (Benz, 2005). The nails should be shorter than the pad, without cracks and U-shaped. The skin in between 2 nails should be clean and flexible. When there is hyperkeratosis in this area, this may cause discomfort to the elephant as the hard hyperkeratotic tissue acts as a foreign body by pinching the interdigital skin an dirt can accumulate into the interdigital space. There should be room for at least one finger between 2 nails. The thermographic images of a healthy nails shows a regular distribution of the temperature dispersed over the entire nail. Like in hoofed mammals, the nails are connected with the underlying phalanges by lamellae or horn leaflets. Benz (2005) describes the different parts of the nail: a: corial part of the horn wall: cuticle area b: lamellae (horn leaflets) c: white zone d: sole horn Cuticle and sweat glands The cuticle of the nail is the keratinized skin at the junction with the nail. They should be soft and flexible. This is a vulnerable area as microorganisms may pass this natural barrier after (micro)trauma. The elephant seems to maintain the cuticles by rubbing them gently against objects. Elephants that are kept in moist, muddy conditions, are likely to develop problems with the cuticles. They may overgrow and become hardened when they dry, resulting in cracks and infection. During pedicure, one should be well aware of the protecting function of the cuticles and never remove more than necessary. References Benz, A. 2005. The elephant’s hoof: Macroscopic and microscopic morphology of defined locations under consideration of pathological changes. Master's thesis, Veterinary Faculty of the University Zürich, Switzerland. Fowler M.E. and Mikota S.K. 2006. Biology, Medicine, and Surgery of Elephants. 271-290. Hess A. 2022. Lesions found in the post-mortem reports of the Asian (Elephas maximus) and African (Loxodonta africana) elephants of the European Association of Zoos and Aquaria Master's thesis, Department of Exotic Animal and Wildlife Medicine University of Veterinary Medicine Budapest, Hungary. Schiffmann C. 2021. Posture Abnormalities as Indicators of Musculoskeletal Disorders in 12 Zoo Elephants – a Visual Guide. Gajah 53 (2021) 20-29. Weissengruber, G.E., Egger, G.F., Hutchinson, J.R., Groenewald, H.B., Elsässer, L., Famini, D. and Forstenpointner, G. (2006), The structure of the cushions in the feet of African elephants (Loxodonta africana). Journal of Anatomy, 209: 781-792. https://doi.org/10.1111/j.1469-7580.2006.00648.x To page top

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CASE REPORT Dentistry

Tuberculosis is an infectious zoonotic disease with a ubiquitous distribution, caused by Mycobacterium species. The most relevant species that affect mammals belong to the group of Mycobacterium tuberculosis-complex (MTBC). The disease is relevant for elephants under human care, as transmission from man to elephant and vice versa is possible. Being a chronic disease with a long incubation time, the initial stages of the disease are often missed. To infectious diseases By Willem Schaftenaar DVM Tuberculosis in zoos Based on positive cultures of trunk washing samples or necropsy results the median point prevalence within the Asian elephant in the USA zoo population between 1997 and 2011 increased was 5.1%, with a range from 0.3% to 6.7%. Similarly, the average annual incidence was 2.4 cases per year, with a range from 0 to 7. Since 1960, a total of 45 cases of MTBC (45 M. tuberculosis) were tabulated in Asian elephants in comparison to only 5 cases in African elephants (4 M. tuberculosis and 1 M. bovis), suggesting a difference in species susceptibility (Feldman et al, 2013). The results of a survey on necropsy reports of 301 Asian elephants and 196 African elephants kept in European zoos in the period from 1980 to 2024 is shown in table 1(Hess, 2021, updated by Willem Schaftenaar, 2024). Table 1. MTBC cases confirmed at necropsy in elephants kept in European zoos from 1980-2024. One case of M. caprae has been reported in a Bornean elephant housed in a zoo in Japan. Another M.caprae case in a European zoo is included in table 1. Tuberculosis in range-countries In countries where contact between man and elephant is close, tuberculosis forms a health risk for both humans and elephants. In a study in Malaysia under 60 elephants in 6 different facilities, the overall seroprevalence of TB amongst the elephants was 23.3% and the risk of seroconversion was significantly higher among elephants with assigned mahouts. The percentage of positive responders among wildlife staff was 24.8% and the risk of infection was observed to be significantly associated with being a zoo employee or elephant handler. These findings revealed a potential risk of TB infection in captive elephants and handlers in Malaysia (Yakubu, 2016). Tuberculosis in free ranging elephants Paudel et al (2020) gave an overview of tuberculosis in free ranging elephants. The first report of TB in wild Asian elephants was from Sri Lanka in 2014. A 35-year-old female elephant was found in a moribund condition in the corridor between Udawalawe and Lunugamwehera National Parks. Three wild male Asian elephants that died between 2007 and 2013 in a wildlife sanctuary in southern India were confirmed to be TB positive. One wild Asian elephant that died of suspected TB lesions in the forest of Rajiv Gandhi National Park, Karnataka, India in 2016, was confirmed as TB positive. The first case of TB infection in wild African elephants was reported in Kenya in. This elephant was an orphaned calf rescued from a national park in Kenya and raised with other rescued orphans and then was eventually released back into the wild. Serology, using STAT-PAK on banked serum samples collected from free-ranging African elephants between 2004 and 2018 in Kruger National Park (KNP) in South Africa showed that 9.3% of 161 elephants tested were MTBC positive (Kerr et al, 2019). MTBC was isolated for the first time from a wild African elephant from KNP in South Africa in 2016 (Miller et al, 2019). Zoonotic aspects Transmission of tuberculosis to elephant caretakers, mahouts or zoo visitors should always be considered as a threat to human health. Once an elephant is suspected of tuberculosis, caretakers should seek medical assistance and be checked for this disease on a regular basis. Transmission to other mammalian species The pathogen can be transmitted to humans and other mammalian species by direct contact, contaminated food and materials. Zoo animals treated by the same animal caretakers can transmit MTBC from a shedding elephant to other species (and vice versa). In a Swedish zoo 4 different M. tuberculosis strains were found in different elephants and other zoo animals in the same period (see diagram below): strain A was present in an Asian elephant, a gibbon and a group of South American tapirs. Strain B was found in 4 Asian elephants, while strain C was detected in a giraffe and one of the elephants that also harbored strain B. Strain D was found in an Asian elephant that also carried strain B (Sternberg et al, 2005). In an Australian zoo, a diseased chimpanzee was diagnosed with tuberculosis caused by a MTBC-strain that was indistinguishable from a strain found in an Asian elephant at the same zoo. Investigations included staff and animal screening. Four staff had tuberculin skin test conversions associated with spending at least 10 hours within the elephant enclosure; none had disease (Stephans et al, 2013). TB-suspected elephants should not be in contact with animals that are considered TB-free. Separate cleaning materials and equipment must be used for TB-suspected elephants. Symptoms Tuberculosis is a slow developing disease. Most elephants with TB are older than 5 years. One of the first signs of clinical disease is persistent weight loss. Often this is the only symptom seen. If no explanation can be found for this chronic weight loss, one should consider TB as its possible cause. Although the lungs are usually the first organs that are affected, respiratory signs are usually not observed. Other organs can also become affected, like kidneys, urinary bladder, GI-tract, uterus, liver pancreas and mesenteries. Metastatic MTBC-granulomas are often found in lymph nodes that drain the affected organ system. The lesions caused by MTBC consist of granulomas. If the immune system of the elephant is functioning well, such granulomatous inflammation can be contained, and a buffer zone of defensive cells can produce a capsula around this process. In old granulomas, the original inflammation tissue can become calcified. Even in such a calcified granuloma, vital Mycobacteria can still be present. The presence of such ‘inactive’ granulomas may go completely unnoticed without causing any visible discomfort. Only immunological diagnostic assays will detect such a silent carrier. Unfortunately, many elephants that become infected with MTBC will develop multiple granulomas often with metastasis to regional lymph nodes. Once a granuloma breaks through into the air-containing space of the lung alveoli or bronchi, the elephant can spread the disease to other elephants, humans or other mammals by direct and indirect contact. Sputum that has entered the lower airways can be brought up into the higher airways and, when swallowed, reach the stomach and intestines. MTBC has been detected in fecal samples. If the infection route is orally, granulomas can develop in the GI tract. MTBC-granulomas in the kidneys, urinary tract, uterus or other organs are the result of bacteremia. Figure 1. Granulomas caused by M.tuberculosi s in an adult African elephant bull. Courtesy: Christian Wenker Figurs 2. Sputum collected from the same elephant bull tested positive for M. tuberculosis in PCR and culture. Courtesy: Christian Wenker Transmission When the granulomas affect the excretion system of the organs, the pathogens can contaminate the environment (sputum, urine, feces, fetal fluids) and transmit the disease to other animals. Transmission by breeding has never been documented in elephants. The trunk is considered a major transmission organ of Mycobacterium spp. originating from the lungs. Nevertheless, it is very difficult to find TB-organisms in trunk washes (see trunk wash procedure ). There are several anecdotal reports that a sputum sample found on the floor was confirmed TB-positive while numerous trunk wash samples from the same elephant had been tested negative. Diagnosis Test samples Any granulomatous lesion that is found at necropsy should be suspected of MTBC. Trunk wash samples are frequently used to monitor elephants for MTBC. The elephant needs to be trained for this procedure. For the description of the procedure, click here . Fluids recovered from the trunkwash must be submitted for PCR and culture. The sensitivity of this procedure is extremely low (1-2%) (Sternberg et al. 2005, Vogelnest et al. 2015), which makes the trunkwash a questionable diagnostic tool. Samples obtained by Broncho Alveolar Lavage (BAL) are considered more sensitive than trunk wash samples. However, one should realize that the probability to target an infected bronchus by the BAL-method depends on the number and severity of the lesions. An elephant suspected of carrying MTBC based on immunological tests, can harbor just one or a few encapsulated granulomas in the lung; BAL-samples taken from the area of such granulomas will yield no MTBC. Click here to read more about BAL. A disadvantage of the procedure is that it requires standing sedation or general anesthesia. Excretions like sputum (see figure 2) urine, feces and fetal fluids in MTBC-suspected elephants (chronic weight loss) should be submitted for culture and PCR. Direct tests The golden standard method to diagnose MTBC is culturing of the pathogen. This requires a lab that is certified to culture this microbe. The culturing procedure can take as long as 6 -10 weeks. The cultured isolates must be spoligotyped and preferably submitted for multilocus, variable-number of tandem repeat analysis (MLVA) and whole-genome sequencing, as described previously (Ruetten et al, 2020, Ghielmetti, 2017). PCR is next in reliability and usually carried out in conjunction with culture. Results can be obtained within one day. Positive results should still be cultured. Acid-fast stain (Zhiel-Neelson) on tissue or swab samples can demonstrate the presence of acid-fast bacteria. Confirmation needs to come from culture. Indirect tests (immunological tests) 1. Tests based on cellular immunity . The WHO recommends the following immunological tests as the first choice (for humans): Interferon Gamma Release Assay (IGRA): PBMCs are stimulated with antigens of MTBC. After incubation the amount of elephant interferon is measured in the supernatant (Angkawanish et al, 2013). This assay is currently being practiced at the Utrecht University for monitoring TB in the European elephant population (click here for more information) . Another IGRA has been developed in Japan (Paudel et al, 2016). Skin test: in individuals that have been in contact or still carry MTBC intra-cutaneous injection of MTBC- derived antigens can cause a local reaction of the skin (swelling, redness, warm) after 72 hours. Due to the unique properties of the very thick elephant’s skin, this test is not recommended for elephants (Mikota et.al. 2001). 2. Tests based on humoral immunity DPP = Dual Path Platform Assay VetTB Assay for elephants: antibodies against several MTBC-antigens can be demonstrated in a quick test, which is based on ELISA-technology. Multi Antigene Print Immuno Assay (MAPIA). This test is offered by Chembio (USA) as a confirmation test of the DPP VetTB Assay for elephants. Each antigen that is present in the DPP is individually tested in the MAPIA. ELISA- some local labs had developed their own in-house ELISA. Currently they are not being used. Note: A study in Japan concluded that the discrepancies between serological and IGRA highlight that the two methods may detect different stages of elephant TB. Therefore, employing both tests may enable them to complement each other in correctly identifying elephants that have been exposed to MTBC (Songthammanuphap et al, 2020). Cross reactions Immunological tests have the disadvantage that they do not detect the pathogen itself, but only the immunological reaction of the host to MTBC. Unfortunately, several non-tuberculous Mycobacterium spp (such as M. kansasii, M. fortuitum) have some antigens in common with MTBC. Therefore, one should always take additional circumstances into account when an immunological test turns out positive for MTBC. Chronic weight loss, a history of MTBC in the herd, a caretaker suffering from tuberculosis are factors that can help form a stronger diagnosis than just the outcome of an immunological test. Non-tuberculous Mycobacterium spp. Several non-tuberculous Mycobacteria (NTM) have been identified, e.g. M. intracellulare, M. hominnisuis, M. fortuitum, M.avium, M. flehi, M kansasii. In one study, isolates of M. avium, M. peregrinum, and M. novocastrense, three NTM species, were detected in samples from the lung or mouth (Hermes et al, 2018). One NTM, Mycobacterium szulgai, was associated with mortality in two captive African elephants (Loxodonta africana) (Lacasse et al, 2007). Treatment Treatment of MTBC has been an option when MTBC is confirmed by culture. One should realize, however, that the complete elimination of the pathogen by treatment is not guaranteed. Like in humans, MTBC can remain present in encapsulated foci and relapses after several years have occurred. Treating tuberculosis is expensive, laborious, and needs to be sustained for a long period. As some of the drugs are (nephro)toxic, negative side effects of the drugs need to be monitored closely. The elephant protocol is based on treatment regimens that are used to treat TB in humans. The basic protocol calls for 3-4 drugs for 2 months followed by 2 drugs for 10 months. Isoniazid, rifampin, ethambutol, and pyrazinamide are the first line drugs that are typically used. Administration is oral or rectal although rectal Rx has some limitations. If at all possible, serum drug levels should be monitored. Treatment details can be found in chapter 9 and 10 of the Guidelines for the control of tuberculosis in elephants 2010 . Surveillance Monitoring elephants that have been in contact with other animals suffering of MTBC (including humans) by regular TB-testing is the most effective way to detect an infection. Elephants with a TB-history (treated or in contact with MTBC-positive animals) should not be moved to a TB-free facility. Annual TB-screening of caretakers should be part of the elephant management in zoos. Moving elephants Elephants that will be moved from one zoo to another should be checked before the transfer. Click here for TB-recommendation for European zoos and click here for TB-recommendation for USA zoos. The release of orphaned elephants after rehabilitation in a management system under human care, carries a risk of transmission of tuberculosis to free ranging elephants. The disease may have been present unnoticed during the rehab period. Testing for MTBC prior to release should be a requirement without which no release should take place. Prevention A vaccine against tuberculosis in elephants is not available. The value of BCG-vaccination, used to vaccinate humans in endemic areas, has not been tested in elephants. Even in humans, it only prevents the childhood meningitis form of TB and does not protect against pulmonary TB. Government regulations Though M. bovis is just one of the MTB-complex group, for economic reasons related to the cattle industry, most governments only have strong regulations for cases of tuberculosis caused by M. bovis. In those countries, tuberculosis caused by M. bovis in elephants is notifiable. Because of the zoonotic aspects of the disease it is, however, strongly recommended to contact government officials in any case of confirmed tuberculosis. References Hess A. 2021. Lesions found in the post-mortem reports of the Asian (Elephas maximus) and African (Loxodonta africana) elephants of the European Association of Zoos and Aquaria. Thesis at the Department of Exotic Animal and Wildlife Medicine University of Veterinary Medicine Budapest, Hungary. Updated by Schaftenaar W. 2024. Unpublished data EAZA elephant TAG studbook. Paudel S, Sreevatsan S. 2020. Tuberculosis in elephants: Origins and evidence of interspecies transmission. Science direct: Tuberculosis 123 (2020) 101962. Ruetten M, Steinmetz HW, Thiersch M, Kik M, Vaughan L, Altamura S, Muckenthaler MU and Gassmann M. 2020. Iron regulation in elderly Asian elephants (Elephas maximus) chronically infected with Mycobacterium tuberculosis. Front. Vet. Sci. 7:596379. doi: 10.3389/fvets.2020.596379 Songthammanuphap S, Puthong S, Pongma C, BuakeawA, Prammananan T, Warit S, Tipkantha W, Kaewkhunjob E, Yindeeyoungyeon W, and Palaga T. 2020. Detection of Mycobacterium tuberculosis complex infection in Asian elephants (Elephas maximus) using an interferon gamma release assay in a captive elephant herd. Scientific Reports (2020) 10:14551; https://doi.org/10.1038/s41598-020-71099-3 Kerr TJ, de Waal CR, Buss PE, Hofmeyer J, Lyashchenko KP, Miller M.A. 2019. Seroprevalence of Mycobacterium tuberculosis Complex in Free-ranging African Elephants (Loxodonta africana) in Kruger National Park, South Africa. J Wildl Dis (2019) 55 (4): 923–927. Miller MA, Buss P, Roos EO, Hausler G, Dippenaar A, Mitchell E, van Schalkwyk L, Robbe-Austerman S, Waters WR, Sikar-Gang A, Lyashchenko KP, Parsons SDC, Warren R and van Helden P. (2019). Fatal Tuberculosis in a Free-Ranging African Elephant and One Health Implications of Human Pathogens in Wildlife. Front. Vet. Sci. 6:18. doi: 10.3389/fvets.2019.00018 R. Hermes R, Saragusty J, Holtze S, Nieter J, Sachse K, Voracek T, Bouts T, Göritz F, and Hildebrandt TB. 2018. Bronchoalveolar lavage for diagnosis of tuberculosis infection in elephants. Epidemiology and Infection 146, 481–488. https://doi.org/10.1017/S0950268818000122 Ghielmetti G, Coscolla M, Ruetten M, Friedel U, Loiseau C, Feldmann J. 2017. Tuberculosis in Swiss captive Asian elephants: microevolution of Mycobacterium tuberculosis characterized by multilocus variable-number tandem-repeat analysis and whole-genome sequencing. Sci Rep. (2017) 7:14647. doi: 10.1038/s41598-017-15278-9 Paudel S, Villanueva M.A, Mikota S.K, Nakajima C, Gairhe K.P, Subedi S, Rayamajhi N, Sashika M, Shimozuru M, Matsuba T, ySuzuki Y and Tsubota T. 2016. Development and evaluation of an interferon-γ release assay in Asian elephants (Elephas maximus). J. Vet. Med. Sci. 78(7): 1117–1121, 2016 Yakubua Y, Onga B.L., Zakaria Z, Hassan L, Mutalib A.R., Ngeowc Y.F., Verasahib K, Razak M.F.A.A. 2016. Evidence and potential risk factors of tuberculosis among captive Asian elephants and wildlife staff in Peninsular Malaysia. Preventive Veterinary Medicine Volume 125, 1 March 2016, Pages 147-153. Vogelnest L, Hulst F, Thompson P, Lyashchenko K.P., Vinette Herrin K.A. 2015. Diagnosis and management of tuberculosis (Mycobacterium tuberculosis) in an Asian elephant (Elephas maximus) with a newborn calf. Journal of Zoo and Wildlife Medicine 46(1): 77–85, 2015. Angkawanish T, Morar D, van Kooten P, Bontekoning I, Schreuder J, Maas M, Wajjwalku W, Sirimalaisuwan A, Michel A, Tijhaar E and Rutten V. 2013. The Elephant Interferon Gamma Assay: A Contribution to Diagnosis of Tuberculosis in Elephants. Transboundary and Emerging Diseases. 60 (Suppl. 1) (2013) 53–59. Feldman M, Isaza R, Prins C, Hernandez J. 2013.Point prevalence and incidence of Mycobacterium tuberculosis complex in captive elephants in the United States of America. Vet Q 2013; 33:25–9. Stephans N, Vogelnest L, Lowbridge C, Christensen A, Marks G.B., Sintchenko V, McAnulty J. 2013. Transmission of Mycobacterium tuberculosis from an Asian elephant (Elephas maximus) to a chimpanzee (Pan troglodytes) and humans in an Australian zoo. Epidemiol. Infect. (2013), 141, 1488–1497. © Cambridge University Press 2013 Lacasse C, Terio K, Kinsel M.J, Farina L.L, Travis D.A. D.A, Rena Greenwald, Konstantin P. Lyashchenko, Miller M, Gamble K.C. 2007. Two cases of atypical mycobacteriosis caused by Mycobacterium szulgai associated with mortality in captive African elephants (Loxodonta africana). J. of Zoo and Wildlife Medicine, 38(1 ) :101-107 (2007). Sternberg Lewerin S, Olsson S-L, Eld K, Röken B, Ghebremichael S, Koivula T, Källenius G, Bölske G. 2005. Outbreak of Mycobacterium tuberculosis infection among captive Asian elephants in a Swedish zoo. Veterinary Record (2005) 156, 171-175. Mikota SK, Peddie L, Peddie J, Isaza R, Dunker F, West G, Lindsay L, Larsen RS. 2001. Epidemiology and diagnosis of M. tb in captive Asian elephants. J. Zoo Wildl. Med. 32: 1-16 To page top Tuberculosis Tuberculosis is an infectious zoonotic disease with a ubiquitous distribution, caused by Mycobacterium species. The most relevant species that affect mammals belong to the group of Mycobacterium tuberculosis-complex (MTBC), including M. tuberculosis, M. bovis, M. pinnipedi, M. africanum, M. microti, M. canetii, M.caprae and Bacillus Calmette-Guérin (vaccine). The disease is relevant for elephants under human care, as transmission from man to elephant and vice versa is possible. TB is a chronic disease with a long incubation period, and the initial stages of the disease are often missed. To infectious diseases

The dermatology-page will direct you to the chapters about skin wounds, skin abscesses, skin infections, tempral gland infection and temporal gland surgery. To case report index Dermatology Skin wounds Abscesses (needs your input) Skin infections (needs your input) Cutaneous filariasis Vaginal vestibulotomy Temporal gland impaction Temporal gland impaction/surgery