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An adult Asian elephant suffered form a severe infection of Salmonellosis (S. saintpaul). It went down and was unresponsive. Hematology and treatment results are discussed. To Salmonellosis Next case Next case Case Report Next case Salomonella saintpaul septicemia in an adult Asian elephant Next case Date: 2021 Location: Italy (zoo) Submitted by: Fieke Molenaar DVM and Pasqualino Silvestre DVM History Three months after the move to another zoo, a 37 year-old female Asian elephant (Elephas maximus) presented mild lethargy and a reduction of food and water intake. Mild colics were suspected and the elephant was treated with non-steroidal anti-inflammatories (NSAID, meloxicam i.m. ~ 0.2 mg/kg) and spasmolytics (metamizole and butylscopolamine bromide i.m., ~ 80 and 5mg/kg). As no improvement was noticed on Day 2, a standing sedation was carried out (detomidine i.m., ~ 0.018 mg/kg, and butorphanol (i.m., ~ 0.017 mg/kg). Rectal fluids (20 L of hand-warm tap water) and i.v. fluids (4 L of 0.9% saline solution) were administered, as well as i.m. injections with amoxicillin (~ 15 mg/kg), vitamin B-complex and vitamin E/selenium. Flunixin meglumine was given in the auricular vein. Sedation was reversed using atipamezole (i.m., ~ 0.05 mg/kg). Blood was collected during this procedure. Unfortunately, the elephant collapsed 9 hours later in lateral recumbency. The animal was unresponsive and could be approached while it kept its eyes wide open (see videos). The araol mucosa was very pale. After 25 minutes it managed to stand up without any assistance but remained lethargic. Respiration was shallow. During the night the elephant went down in lateral recumbency again. During the following 5 days, the elephant was sedated every day for treatment and blood collection. Next case Collapsed Asian elephant due to septicemia caused by Salmonella saintpaul . Note the pale oral mucosa. The state of paralysis very much looks like the paralysis seen in botulism ( see case report ). Laboratory results: Hematology: Leucopenia was evident on the first blood smear that was made, with a clear increase of bands and a reduction of matured heterophils. An interesting finding was the presence of immature granulocytes (myelocytes) that could not be identified exactly. The platelet count was low and schistocytes (fragments of erythrocytes) were observed in each view. The presence of schistocytes is suggestive for the presences of a coagulopathy. In conclusion: based on the hemogram, a diffuse intravascular coagulopathy (DIC) was suspected, most likely associated with septicemia caused by a bacterial infection or a toxicosis. Interestingly, EEHV 3/4 was detected by a combined PCR test for subtype 3 and 4 in a blood sample and in trunk swabs. The elephant had been tested PCR positive for EEHV4 previously. A trunk swab taken from the conspecific that shared the enclosure was PCR-negative. For photos of elephant heterophils, bands, platelets and schitsocytes: click here . Human myelocyte, containing both primary (azurophilic) and secondary/specific (pink or lilac) cytoplasmic granules. The proportion of secondary granules increases as the cell matures. The nucleus is round and lacks a nucleolus. Courtesy: ASH Image Bank Myelocyte of the Asian elephant in this case report. The quality of this photo is poor as it was taken with a cell-phone through the ocular lens of the microscope. Urinalysis: Daily urine samples were taken and analyzed using a dipstick and refractometer from Day 3 onwards. Initially a high specific gravity with a low pH was determined, suggestive for severe dehydration and metabolic acidosis. Fecal culture and treatment: A fecal sample collected on Day 3 was submitted for bacteriology. The treatment plan focused on the suspected septicemia. Treatment with NSAID was continued and the antimicrobial treatment was switched to enrofloxacin (per rectum, ~ 2.5 mg/kg) and metronidazole (per rectum, ~ 11 mg/kg). Administration of vitamin B-complex and E/selenium was repeated on day 4 and day 5. Preventive measures In an attempt to find the causative agent of the suspected septicemia, stored hay was inspected for mould and other conditions that favor (an)aerobic growth of toxin producing bacteria, more specifically Clostridium spp. All sand in the enclosure was replaced; drains and surfaces were disinfected with 5% sodium hypochlorite before new sand was brought in. Treatment (continuation) On Day 9 Salmonella saintpaul sensitive for enrofloxacin was isolated from the feces. Until Day 6, dehydration was getting worse, based on hematological findings (increased Ht) and urinalysis (increased specific gravity). On Day 7 no feces were produced (probably caused by the anorexia and repeated administration of detomidine) and diphteric necrotic tissue was observed during the administration of rectal fluids. In the mean time, hematology results started to show evidence of recovery from the septicemia: bands had dropped from 36% (Day 5) to 11%, while platelets increased from 320 (Day 2) to 437 x109/L. WBCs increased from 3.3 (Day3) to 10.5 x 106/L. Interestingly, the number of myelocytes increased to 35% on Day 7, but sharply dropped to 5% on Day 8 and they totally disappeared after that day. All hematological parameters were normal when checked again on Day 48 and 55. In order to stimulate the appetite and the intake of fibrous food, daily sedations were discontinued as from Day 8, and the focus of treatment moved to provide gastro-protection and stimulation of the duodenal motility by the administration of ranitidine (oral, ~ 0.25 mg/kg) twice daily. Water soaked bran and hay ad lib, bamboo browse and banana tree-trunks were offered as much as possible. Sugar-containing food items were restricted to treats for compliance to vocal commands by the keepers in order to get cooperation from the elephant for the necessary treatment procedures. The animal regained its strength and body condition over the 3 month-period following this clinical episode. The presence of EEHV3/4 in the blood and trunk swab can be explained by a virus reactivation due to the sudden deficiency of the immune system as a result of the septicemia and DIC. No clinical impact is to be expected from this finding, as the animal known to be a carrier of EEHV4. References Molenaar, F.M. and Silvestre S. 2021. Clinical approach to colic and collapse in an Asian elephant ( Elephas maximus ) with Salmonella saintpaul septicaemia and subsequent ileus. Vet Rec Case Rep. 2021;e214. https://doi.org/10.1002/vrc2.214 . To page top

Rabies has been diagnosed in a few elephants and was fatal in all reported cases. The source of the infection was attributed to canids (Wimalaratne et al. 1999, Nanayakkara et al. 2003, Sharma et al. 2005, Aravind et al. 2006). The incubation time for rabies in elephants is unknown. Depending on the distance between the bite wound and the elephant's brain, a long incubation period can be expected. Rabies should be included in the differential diagnosis whenever there are neurological signs. To infectious diseases Rabies General information Rabies is a viral disease that is usually fatal. It is caused by a neurotropic Lyssa virus. Several species of Lyssaviruses have been identified, of which the rabies virus (worldwide), the Mokola virus (Africa), the Duvenhage virus (South Africa) and the European and Australian bat lyssaviruses are responsible for fatal encephalomyelitis. Rabies is transmitted by a percutaneous bite from a rabies-infected animal or by wound contamination with saliva from a rabid animal (MSD, 2021). Air born infection through aerosols can occur when visiting bat caves. Reservoir hosts vary geographically. In the U.S. hosts include skunks, bats, raccoons, foxes, and coyotes. Civets, mongooses and hyenas are the main hosts in Africa; domestic dogs are hosts in Asia, South America, and Africa. Certain bat species in southern Africa are host for a Lyssa virus After infection of the bite wound, the virus migrates from the wound to the brain via the nerves that run from the wound area, resulting in neurological signs. Virus replication takes place in the brain, from where the virus migrates to the salivary glands. The incubation period varies from 3 weeks to many months. In most species affected by rabies, the animal shows an increase of aggressive behaviour and will try to bite other animals. Hydrophobia can be one of the accompanying symptoms. In a few species (e.g. domestic cat), the animal becomes more quite or even soporous. Once the virus has reached the brain, there is no cure. Treatment is only possible in the short period between infection and start of the migration. In this short time window, the animal should be treated daily with a rabies vaccine (described below). If available, locally anti-rabies serum should be injected around the wound area. Diagnose of rabies is based on PCR or histopathology of brain tissue by demonstrating the presence of typical Negri bodies using a special stain especially in pyramidal cells within the Ammon's horn of the hippocampus. Wound tissue, saliva and cerebrospinal fluid can be used when the animal is still alive (CDC, 2021). Rabies in elephants Rabies has been diagnosed in a few elephants and was fatal in all reported cases. The source of the infection was attributed to canids ( Wimalaratne et al. 1999, Nanayakkara et al. 2003, Sharma et al. 2005, Aravind et al. 2006). The incubation time for rabies in elephants is unknown. Depending on the distance between the bite wound and the elephant's brain, a long incubation period can be expected. Rabies should be included in the differential diagnosis whenever there are neurological signs. The initial signs of rabies in elephants may be vague but most often the elephant (FAO 2005): Is listless. Prefers to stay in dark places. Eats very little. As the disease progresses the elephant likely: Writhes in pain. Does not recognize the mahout. Chases and attacks humans and animals. Has eyes that roll and wander. Does not eat. Walks unsteadily and the legs lose strength. Goes to the ground in paralysis. Has locked jaws and the tail hangs still. Has saliva flowing continuously. Death may shortly follow the appearance of these more severe signs. The differential diagnose in case of rabies comprises any disease that can cause central nervous system symptoms, like: Tetanus Trauma Snakebite Toxicity (e.g. heavy metal; pesticide) Anytime an elephant is bitten, particularly if the bite has drawn blood, the mahout and owner should take four actions: 1. Write the day on a calendar; then you will be able to predict when the elephant may show clinical signs if it was infected. 2. Talk to people who know the dog and ask about its behaviour in the days prior to the attack; if the dog has been acting strangely (staring fixedly, foaming at the mouth, etc.) there is a good chance the dog is rabid. 3. Inform everybody in the community of the health hazard, because the disease also attacks humans, and ask them to help track down the dog. 4. Very carefully capture the dog, confine it securely, and observe its condition; if after ten days it is normal then the elephant does not have rabies. If the elephant dies, consult Disposal of carcasses, page 55 of the FAO manual . Treatment of rabies in elephants Immediately after a suspected dog bite, wash the wound intensively with soap and water. Then apply tincture of iodine or Povidone-iodine 1% in and around the wound (FAO 2005). There is no effective treatment once the symptoms have appeared. Even though the disease is not contagious to other elephants, separate the elephant, taking it to a shady, clean and quiet place. Make sure the elephant is chained tightly and securely (FAO 2005). Although there is no report on post-exposure vaccination, emergency vaccination of the elephant can be considered, if a rabies vaccine is available. One study describes the successful post-exposure treatment in pigs that where heavily exposed to rabies. The affected pigs were repeatedly vaccinated with an inactivated rabies vaccine 0, 3, 7, 14 and 30 days after the bite incident, while equine rabies immune globulins were injected in and around the bite wound (Mitmoonpitak et al. 2002). When an elephant is exposed to rabies, consider to inject the animal intramuscularly with a 2 ml dose of an (inactivated = killed) rabies vaccine as soon as possible after it was bitten by a rabid animal. These vaccinations should to be given daily for at least 5 days. During this period the elephant should be kept under close observation. Anytime an elephant is bitten, particularly if the bite has drawn blood, the mahout and owner should take four actions: Write the day on a calendar; then you will be able to predict when the elephant may show clinical signs if it was infected. Talk to people who know the dog and ask about its behaviour in the days prior to the attack; if the dog has been acting strangely (staring fixedly, foaming at the mouth, etc.) there is a good chance the dog is rabid. Inform everybody in the community of the health hazard, because the disease also attacks humans, and ask them to help track down the dog. Very carefully capture the dog, confine it securely, and observe its condition; if after ten days it is normal then the elephant does not have rabies. If the elephant dies, consult Disposal of carcasses, page 55 of the FAO manual . Prevention Regular rabies vaccination is recommended for all elephants kept under human care in areas where rabies is endemic. Because rabies is incurable the best prevention is to annually vaccinate all the dogs and cats in the community. For many years, following the recommendation for rabies vaccination in horses has been considered prudent: (inactivated!) vaccine (2 ml IM) given from the age of 6 months, to be repeated after 3-4 weeks and annually boostered. When using this vaccination schedule in elephants, antibodies against rabies could be demonstrated after 24 months (Isaza et al. 2006, Miller et al. 2009). However, this rabies vaccination strategy was evaluated in a herd of 9 African elephants, including two calves, four subadults, and three adults which lead to new conclusions about rabies vaccination strategy. Prior to 2017, elephants were vaccinated opportunistically IM. Starting in 2018, calves at least 4 months of age were administered 2 ml of a commercially available inactivated vaccine and received boosters at 1 y of age. Adults and subadults underwent annual vaccination at the same dose. After 1 year, neutralization titers in five of nine elephants were below levels considered protective in domestic animals (< 0.5 IU/ml). Therefore the dose of rabies vaccine was increased to 4 ml, which resulted in titers more consistently greater than or equal to 0.5 IU/ml for at least 6 months. Institutions with elephants under human care may consider performing rabies vaccination neutralizing titers when possible to help guide vaccination. See also: vaccination. References Aravind B., Anilkumar M., Raju S., and Saseendranath M.R. 2006. A case of rabies in an Indian elephant (Elephas maximus) . Zoo's print journal 21 (2) 2170. Browning G.R., Peters R., and Howard L.L. 2021. Rabies vaccination and antibody response in African elephants ( Loxodonta africana ) as part of a comprehensive program of veterinary care. Joint AAZV EAZWV Conference Proceedings 2021. CDC 2021: https://www.cdc.gov/rabies/diagnosis/animals-humans.html FAO 2005: Elephant care manual for mahouts and camp managers. 2005. Isaza R., Davis R.D., Moore S.M., and Briggs D.J. 2006. Results of vaccinat i on of Asian elephants (Elephas maximus) with monovalent inactivated rabies vaccine. AJVR, Vol 67 (11), 1934-1936, 2006 Miller M.A. and Olea-Popelka F. 2009. Serum antibody titers following routine rabies vaccination in African elephants. JAVMA, Vol 235 (8),978-981 2009 Mitmoonpitak C., Limusanno S., Khawplod P., Tepsumethanon V, and Wilde H. 2002. Post-exposure rabies treatment in pigs. Vaccine 20 (2002) 2019–2021. MSD, 2021: https://www.msdmanuals.com/home/brain,-spinal-cord,-and-nerve-disorders/brain-infections/rabies Nanayakkara S, Jean S. Smith, and Charles E. Rupprecht. 2003. Rabies in Sri Lanka: Splendid Isolation. Emerging Infectious Diseases • Vol. 9, No. 3, March 2003. Sharma A.K., Choudhury B, and Singh K.P. 2005. Rabies in a captive elephant . Indian Journal of Veterinary Pathology 29(2): 125-126 Wimalaratne O, and Kodikara D.S. 1999. First reported case of elephant rabies in Sri Lanka. Vet. Rec. 144 (4): 98. To page top

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Foot and sole or pad lesions are common in elephants and should be treated. Abnormal wear of the pad can be the result of joint disease. Sole lesions can result in fistulas. Pedicure must be part of the management. Foot and mouth disease and cowpox virus can cause complete slaughing of the pad. Back to index orthopedic problems Foot problems Foot problems in elephants under human care are frequently seen. Several anatomical structures can be involved in foot problems: the sole (pad or slipper), the nails, the joint ligaments, the tendons, the distal phalanges and the joints. Many of the problems are management-related. Abnormal wear, inappropriate substrate, stereotypic repetitive movements and lack of space to move around are some of the major causes of orthopedic problems in elephant feet. A separate chapter on regular foot care in elephants under human care can be found here . An elephant suffering of foot problems will often demonstrate one or more of the following symptoms: Swelling, pain Lameness, reluctance to move Black tracts on or beneath nails Discharge / bad odor Nail cracks Overgrowth / over-wear (nails and/or sole) Dry or overgrown cuticles Examination of the foot If the animal is well trained, it should lift its legs to allow inspection of the nails and pad of each foot. Alternatively the feet can be examined with the elephant in lateral recumbency. Check the nail cuticles. Remember that elephants have sweat glands in their cuticles. Cuticles should not be too short as this may facilitate the invasion of microorganisms. However, they should also not be too long. Elephants seem to care for their nails by rubbing them along hard objects or their own legs. Overgrown cuticles may result in accumulation of sweat: when trimmed or when pressure is exerted on the cuticles, watery fluid may be discharged ( see video ). The nails and the sole are interconnected by a structure that is an equivalent of the white area in horses and cattle. It forms a delicate connection, where microbes can penetrate into deeper layers to cause an infection (pododermatitis) ultimately resulting in osteitis and arthritis of the interphalangeal joints. The nails should never be longer than the pad, as they should not bear weigth when the elephant is standing still nor during walking (see video) . Long nails can easily develop a tear, giving access to microbes. The pad of the sole must be thick and have a distinct pattern of grooves. When wear is insufficient, the grooves may become too deep and form an easy entrance for stones, dirt and microbes, which may result in a sole abscess. Too much wear results in a smooth surface and a thin pad, vulnerable for deeper sole lesions. African elephant walking in Namibian desert (slow motion). Note how the pad and the nails form one supporting surface. The nails are not used for support. (Footage of BBC documentary) Sole lesions Sole lesions Normal sole of an Asian elephant kept in a zoo Normal sole of an Asian elephant semi-free ranging in the forest. Normal sole preparation of a free-ranging African elephant (Kruger National Park, South Africa) In order to maintain a healthy sole and nails, there should be a balance between wear and (re)growth of sole and nail tissues. The main factors that determine the wear are the type of substrate, activity of the elephant and the humidity. Best Practice Guidelines The EAZA Best Practice Guidelines for Elephants recommend: Indoor and outdoor substrates should: 1. Provide choice to the elephant, allowing elephants to explore and investigate a range of substrates within their enclosure. This can provide increased activity and the cognitive benefits of decision-making. 2. Provide a degree of flexibility and accommodate the vast body mass of an elephant. Flexible ‘soft substrate’ works to absorb impact, easing the pressure on the joints and feet. 3. Provide good drainage which is beneficial for respiratory, skin and foot health. Soft substrate (such as sand) can act as a “bio floor”, allowing drainage of urine and ensuring animals are not standing in their own quite aggressive urine or lying on wet/cold floors. 4. Provide opportunities for enrichment, such as digging/hiding food which can improve musculature. 5. Allow dust bathing which provides enrichment and is beneficial for skin health. Hard floors Should be used only in places where long standing of elephants is not expected to occur and the elephant’s time in these areas should be minimised where possible. Concrete or rubber floors should have a non-abrasive but not smooth finish. Solid floors should be cleaned regularly and disinfected where appropriate and should provide appropriate drainage to avoid pooling of urine where elephants stand. Sand floors If used, type of sand should be considered. It should not be dusty, should drain well and not be able to compact (in the enclosure or gut). Sand that includes fine sand, silt or clay grades is likely to result in a dusty enclosure and compact into a solid floor. Sand grains need to be of a single size to reduce compaction. A grain with a round, rather than angular, shape will reduce compaction and will not be over wearing on the feet. Sand depth should be of 0,8 m minimum depth, but 1,5 m is recommended. Daily maintenance of sand includes daily watering to prevent excessive dust. Sand must be regularly turned to prevent compaction and build-up of bacteria that can grow in anoxic conditions. Sand floors need to be easily accessed by specially designed heavy machinery (such as truck loaders), and purposely built concrete ramps are a must. Where sand is retro fitted into enclosures, drains should be protected with permeable membranes and sand depths maximised where possible. Door runners should be subject to increased maintenance procedures to mitigate sand ingress. Alteration of door runners can be considered in preference to removal of substrates. Benefits of sand include the ability to build up pillows or mounds which may be used by older animals to sleep against or aid older/arthritic elephants when getting up. Animals also can benefit from rolling/ playing in or on mounds and they can act as visual barrier. The drainage provided is beneficial to aid calves in standing up quickly post birth. Sand can be used in outdoor areas, in all weather, and can withstand extreme cold or wet weather (with appropriate drainage). Grass If possible (i.e. space available will not be significantly compromised with paddock rotation technique), allow grazing access for elephants, which prolongs foraging times. Under improper environmental conditions the following sole lesions can develop: Figure 1. Excessive wear: too much wear results in a smooth surface and a thin pad, vulnerable for deeper sole lesions.The sole of an adult elephant should be at least 20 mm thick. Figure 2. Insufficient wear: the grooves may become too deep and form pockets, which are an easy entrance site for stones, dirt and microbes and can lead to a sole abscess. Figure 3. Crack/tear Figure 4. Sole fistula/ulcer/abscess Figure 5. Sole detachment (partial or complete) Result from primary infection (cowpox and Foot-and-mouth disease) Secondary infection after trauma, moisture, weight overload, dirt: Figure 1. The sole of this zoo-kept African elephant is too thin and health a smooth surface, making it vulnerable to cracks, perforations and nail lesions. Note the small cracks in the nails. Figure 2. Overgrown pad and nails. See also: International Elephant Foundation. Figure 3. Crack in sole of African elephant kept on a concrete floor Figure 4. Fistula/ulcer/abscess in the sole of an Asian elephant spending most of the time on the streets in Laos. Figure 5. Partial sole detachment in an Asian elephant orphan at the Dak Lak Elephant Conservation Center (Vietnam), caused by keeping him on a wet floor (rainy season). Injuries to the sole of the foot are particularly difficult to manage because it is hard to keep them clean and prevent infection. Careful pedicure of the sole may reveal bruces in the soft horn tissue, that resulted from abnormal local pressure on the sole. (Courtesy: Susan Mikota). These bleedings are blood lines in the horn lamellae (not to be confused with sole bruses) that may be seen when abnormal forces have been excerted on the nail (e.g. too long nail) (Courtesy: Susan Mikota). Perforated, infected sole lesions due to trauma (Courtesy: Susan Mikota) Partial pad and nail loss in a 54-yrs-old female Asian elephant. Click here to read the case report. Foreign body pad perforation One case report describes the treatment of a pad abscess resulting from the penetration of a wire through the pad in a 19-yr-old female Asian elephant (Elephas maximus ) housed at the Paris Zoo (Ollivet-Courtois 2003). The cow presented with acute right forelimb lameness and swelling that persisted despite 4 days of anti-inflammatory therapy. Under anesthesia, a 10 x 0.5 x 0.5 cm wire was extracted from the sole of the right foot. There was a 2-cm-deep, 7-cm-diameter abscess pocket that was subsequently debrided. Regional digital i.v. perfusion was performed and repeated 15 days later, using cefoxitin and gentamicin on both occasions. Between treatments, the cow received trimethoprim–sulfamethoxazole and phenylbutazone orally. Within 2 days of administering anesthesia and the first perfusion treatment, the lameness improved dramatically. When phenylbutazone was discontinued 1 wk after the first treatment, the lameness had completely resolved. At the second treatment, there was no evidence of further soft tissue infection, and the abscess pocket had resolved. A 10 x 0.5 x 0.5 cm piece of curved wire was found penetrating the right front foot of a female Asian elephant. A rope tourniquet was placed above the right carpus, and venous access was obtained using a 21-gauge, 0.8 mm butterfly catheter in a palmar superficial vein of the right foot to perform regional interdigital perfusion. Complete sole detachment can be caused by: Foot-and-Mouth disease (FMD) Generalized Cowpox infection. Foot and Mouth disease Both elephant species are susceptible to FMD. However, severe disease has been reported (anecdotically) more in Asian elephants than in African elephants. A description of FMD in African elephants after experimental (!) infection is found here (Howell, 1973). In range countries it is important to avoid direct and indirect contact between cattle and elephants, especially during FMD-outbreaks in the cattle population. Vaccination of cattle is important to reduce the risk of FMD to elephants living in the same area as cattle. For vaccination data, see also: The use of Vaccination of FMD in zoo animals (Schaftenaar, 2002) Complete sole detachment in an African elephant after experimental infection with FMD-virus. Cowpox Both elephant species are susceptible to cowpox infections, though more severe clinical impact is seen in Asian elephants. Symptoms can range between external pox lesions on the skin to complete sole detachment, as well as internal pox lesions in various organs. Vaccination is practiced in European zoos (for vaccine information, click here ). NB: Cowpox disease is a zoonotic disease! To reduce the pressure on a thin or perforated sole, a rubber sole can be glued on the thin sole. This material can last for 2-6 weeks when properly glued to the sole. Avenir Light is a clean and stylish font favored by designers. It's easy on the eyes and a great go-to font for titles, paragraphs & more. A more frequently used tool to reduce the pressure on the sole, is a sandal or boot made locally, fitting the foot of the elephant. This shoe should be removed daily to inspect and treat the injury. Custom-made sandal, Fowler & Mikota 2006 Custom-made boots, Singapore zoo 2007 Another example of custom-made sandals to protect an injured sole (Myanmar. Courtesy Susan Mikota) These sandals were made by commercial companies Teva and Nike (Courtesy Susan Mikota) Edges of the sole bordering the sole defect were thinned (Dak Lak Elephant Conservation Center, Vietnam) Treatment of sole lesions Excessive wear: the thin and smooth horn layer has to regrow. This means that wear has to be reduced. This can be achieved by reducing the time spent by the animal on a hard floor, changing the floor surface and substituting it by softer materials; i.e. concrete floors can be covered by an epoxy layer or deep sand. A concrete sleeping area should be replaced by a sand floor (see EAZA Best Practice Guidelines for Elephants) . The thickness of the pad can be measured by ultrasound examination. Overgrown sole: horn can be trimmed away using a hoof knife. Usually the nails will also need trimming. The use of a drawknife is not recommended, as it easily removes too much from the sole. Make sure that the nails are always shorter than the sole! Crack/tear: as these are usually the result of a too thin sole, measures to increase the sole thickness should always be taken. If the crack hasn't perforated the sole completely, the edges of the crack can be cut away using a hoof knife with the aim to prevent accumulation of dirt and to reduce the pressure on the thinnest part of the crack. A sandal should be considered is there is a risk of sole perforation. Sole fistula/ulcer/abscess: if the sole is perforated, microbes will have entered the underlying tissue. Frequent pedicure will be required in order to drain the affected tissues. The edges of the fistula need to be made as thin as possible with a smooth transition to the thicker part of the sole. This will reduce the pressure on the infected area. The fistula/ulcer/abscess must be flushed daily with saline solution and a mild disinfectant. Soaking the foot in a foot bath should be considered (see images below). Several solutions have been used in elephants (see table below). Epsom salt is probably superior to the other solutions, while copper sulfate might be too caustic for this type of injury. As long as the effluent is sufficiently drained with the help of frequent trimming, the use of systematic antibiotics is not indicated. List of foot bath solutions as described in Fowler & Mikota 2006 Simple foot soaking bath by a well trained Asian elephant, Dak Lak Elephant Conservation Center (Vietnam) Custom-made foot soaking bath, Laos (courtesy Dionne Slagter) Partial sole detachment: this condition can be the result of long exposure of the sole to water and dirt. Standing on a hard floor will predispose for this lesion. P arts of the sole that are detached from the underlying tissue must be entirely trimmed away using a hoof knife. Leaving a sole flap - even a small one - will result in extension of the infected area. The edges of the sole bordering the defect, must be made thin and smooth in order to avoid pressure of the remaining sole on the fragile exposed tissues. Regular trimming of the edges of the sole around the defect and daily flushing and foot bath are required. In some cases the use of a sandal or boot may be needed. Foot bath Complete sole detachement: this condition is usually the result of trauma or a viral infection : Foot and Mouth Disease and Cowpox have been associated with complete sole detachment, always accompanied by other severe symptoms caused by these viruses. As there are no specific treatment options for these viral diseases, only symptomatic treatment can be given. Bandaging the affected legs has been practiced, but one should not be optimistic about the results. In some cases, humane euthanasia will be the only option to prevent the animal from suffering. Traumatic sole detachment can be expected if the elephant has been trapped in a snare. Cleaning, disinfection (mild solution soaking foot bath) and sometimes bandaging of the affected foot will be necessary until the wound has closed. In some cases, the regenerated tissue that covers the wound is strong enough to withstand the pressure of the body weight. If that is not the case, a prosthesis will be needed to provide sufficient protection. References: Cowpox infection in elephants. 1996. Proceedings of the annual conference of the European Association of Zoo and Wildlife Veterinarians. Fowler ME 2006. Foot disorders. In: Biology, Medicine, and Surgery of Elephants. Fowler & Mikota, 271-290. Howell P.G. , Young E , Hedger R.S . 1973. Foot-and-mouth disease in the African elephant (Loxodonta africana ). Onderstepoort J Vet Res. 1973 Jun;40(2):41-52. Johnson G., Smith J., Peddie J., Peddie L., DeMarco J., Wiedner E. 2018. Use of glue-on shoes to improve conformational abnormalities in two Asian elephants ( Elephas maximus ). J. Zoo&Wildl Med. 49(1): 183–188, 2018. Nigam, P., Sarma, K.K., Kumar S. and Pandey, R. (Eds.) 2025. Healthy Feet, Healthy Elephants: A Guide to Foot Care in Captive Asian Elephants . Project Elephant Division, MoEF&CC, GoI- Wildlife Institute of India. Ollivet-Courtois, F., Lécu, A., Yates R.A., Spelman L.H. 2003. Treatment of a sole abscess in an Asian elephant (Elephas maximus ) using regional digital intravenous perfusion. Journal of Zoo and Wildlife Medicine 34(3): 292–295, 2003 Schaftenaar W. 2002. Use of vaccination against foot and mouth disease in zoo animals, endangered species and exceptionally valuable animals. Rev. sci. tech. Off. int. Epiz., 2002, 21 (3), 613-623. To page top

This chapter describes the feeding ingredients, fibre, protein, fatty acids, minerals, vitamins, food presentation and diet examples. -Nutrition -Elephants Nutrition Written by Christian Schiffmann & Marcus Clauss Contents of this chapter: General feeding ecology and feeding behaviour Digestive physiology Nutritional management of elephants in captivity and recommendations for feeding Feed storage and preparation Feed items Staff behaviour Food analyses Examples for daily ration quantities Diet monitoring Fecal quality control References General feeding ecology and feeding behaviors Both elephant species are herbivores and consume a wide variety of plant material including grasses, leaves, twigs, fruits, barks, herbaceous material and soil (Sukumar 1990; Kabigumila 1993). A thorough review of diet breakdown, feeding behaviour, seasonal variation and summary data on broad nutrient ranges in natural diets for African elephants (Loxodonta africana) is covered in Sach et al. (2019). Variance between species does occur, with Asian elephants consuming a greater proportion of grasses in the diet when available (Sukumar 1990; Cerling et al. 1999). However, in our view, this does not mean that elephant species should be considered fundamentally different in their nutritional ecology. Although described as generalist herbivores, consuming over 400 species of plants, it appears populations may vary regionally and seasonally in their plant choice. However, it is clear that elephants are predominantly seasonal grazers and browsers with fruit, barks and soil being consumed as secondary food choices (Kabigumila 1993). The natural diet is characterised by a high fibre content (crude fibre 30-50%) and a low to moderate protein content (crude protein 8-12%). In summary, elephants are designed to eat large quantities of nutrient poor fibrous material which passes quickly through the gastrointestinal tract. Several studies indicate free living elephants of both species spend a considerable proportion (48-76.4%) of their day feeding, although where feeding conditions are improved and food availability increased, elephants have been seen to reduce the total amount of time spent feeding (Dougall and Sheldrick 1964; Beekman and Prins 1989). There is debate surrounding the feeding pattern; several reports indicate that elephants feed almost continuously throughout a 24-hour period (Laws 1970; Beekman and Prins 1989). However, there is also evidence that elephants feed in distinct peaks (Sukumar 1990). It is thought the feeding pattern may vary depending upon food availability, temperature (time spent in shade) and migration (usually to water). It has been suggested that free-ranging elephants make use of specific sites where they eat soil (geophagy) in order to cover their nutritional requirements of minerals (Holdo et al. 2002; Holdo and McDowell 2004). The body weight ranges overlap; however, Asian elephants (Elephas maximus) tend to be lighter than African elephants (Loxodonta africana). The weight range of wild adult Asian elephants is 1,800-5,000 kg compared with a range of 2,700-6,000 kg for adult African elephants (Wittemyer 2011). Individual body weights are influenced by age, sex, health, food availability and according to recent findings by the molar state (Schiffmann et al. 2019b). General feeding Back to Top Digestive physiology Digestive physiology With respect to their high-fibre and low-energy diet, elephants express a relatively high daily dry matter intake of 1-2% of body weight (Ullrey et al. 1997; Clauss et al. 2003). Feeding trials have shown a significantly reduced digestibility in elephants compared to horses (Clauss et al. 2003). Although heavily dependent on the provided diet, digestibility in elephants seems to range between 40 and 60% of dry matter. But even a digestibility as low as 22-32% has been detected in free-ranging African elephants (Rees 1982). According to an experimental study, digestibility decreases with increasing fiber content of an elephant’s diet (Clauss et al. 2003). Studies have demonstrated that passage of food through the elephant’s digestive tract is rapid compared to other monogastric hindgut digesters such as horses. Total gut transit time is 11-46 hours (Bax and Sheldrick 1963; Rees 1982; Hackenberger 1987; Loehlein et al. 2003), and they have a correspondingly low digestive efficiency (Clauss et al. 2003; Hatt and Clauss 2006). Elephants have a single stomach and a short but voluminous hindgut fermentation chamber (similar to equids), inhabited by anaerobic bacteria and protozoa similar to those found in the rumen and reticulum of the ruminant. These micro-organisms digest plant fibre that otherwise could not be used, since elephants, like other herbivores, have no fibre-digesting enzymes of their own (Ilmberger et al. 2014). Microbial fermentation of plant fibre in the hindgut provides the main energy source for these animals. They are adapted to eat complex plant fibres and thus in captivity, high fibre components must contribute a very significant part of their diet. As herbivores, elephants fulfil their needs in vitamins through their plant diet. This is the case for fat soluble as well as water soluble vitamins. Our knowledge on vitamin nutrition in elephants is still very limited and further research is needed (Fowler and Mikota 2006). Monitoring the quality of the feces is an important part of the health surveillance in each individual elephant. Body mass (BM, kilograms) and length measurements (meters) of an African (Loxodonta africana ) and Asian (Elephas maximus ) elephant (Clauss et al. 2007). Back to Top Nutritional management Nutritional management of elephants in captivity and recommendations for feeding Within each zoo, captive elephant diets should be formulated in line with the zoo’s dietary management programme using the skills of zoo nutritionists, curators, veterinary staff and keepers. The diet should be reviewed at least annually by appropriate staff, and proposed modifications raised in line with the individual institution’s diet management strategy. Forage consisting of grass, hay and browse should be the staple dietary ingredient, comprising a minimum of 80% of the total dry matter (Ullrey et al. 1997). Nutritionally appropriate pellets should be fed according to the individual dietary needs, but in the range of no more than approx. 20% of the total dry matter. Exceeding this may lead to excess energy consumption. Dietary items that deliver readily digestible energy, such as grains, bread, fruits, vegetables and low-fibre pellets should not be used in any significant quantity, although they may have uses for the administration of medication, or in geriatric animals. We want to emphasize that training should generally not be used as an excuse to feed unnatural feeds such as bread, fruits or sweets, and that training can often be done successfully using fresh green vegetables as well. This is not because a single piece of fruit is dangerous, but because often, one excuse leads to another. Excluding these items as training incentives is thus based on the concern about dietary drift. All food fed to the animal as part of the daily routine as well as used for training, enrichment or public activities must be included in the daily diet ration calculations. A review of the nutrient recommendations for both elephant species was published by Sach et al. (2019). Although species-specific differences may be present in the physiology of African and Asian elephants, evidence-based findings on corresponding requirements for are lacking and further research is recommended (Bechert et al. 2019). Hence, based on the current knowledge we consider our recommendations to be valid for both elephant species kept in European facilities, and emphasize that the difference to other herbivores is much greater than that between the two elephant species. Back to Top Feed storage Feed storage and preparation As with all animal feed, appropriate storage conditions are essential to retain product quality, including appropriate insect and rodent control measures. All food storage must be designed in such a way to enable safe access by staff and limit wastage. A clear system for stock control and product traceability must be implemented. Forage – must be protected from the weather (wet) and with good ventilation to prevent mould and degradation Browse- must be protected from weather (wet) to prevent mould/degradation and consumption from other pest species Pellets - purchased supplies should not exceed the amounts needed over a 4 to 6-month period to prevent degradation of vitamins, assuming ideal storage conditions. Most vitamins within pelleted feeds are stabilized for shelf life of up to 1 year – products must be individually checked and an inventory with record of expiry date, maintained within the animal feed store. Produce – must be kept under refrigeration Feed items Feed items Back to Top Forages 1. Fresh grass paddocks Ideally, access to grass paddocks should be provided to all elephants within the collection, although this may not be possible for some zoos due to space limitations, and in those with paddocks, not consistently throughout the year due to weather limitations. Paddocks must have appropriate drainage, especially around high use areas, such as gateways and feeding stations to maximise the amount of time in which they may be used by animals. A paddock management system must be in place for maintaining the paddock and preventing overgrazing. The time taken for elephants to consume small amounts of food via grazing is extremely important from a behavioural perspective and can assist in increasing the proportion of an elephant’s time spent foraging. For facilities without copious grass paddocks, implementation of a comprehensive feeding enrichment as a substitute is imperative. The latter may present an opportunity to compensate for limited space as recently reported by Scott and LaDue (2019). 2. Hay and fresh forages Grass hay is an ideal forage source for species adapted to eating plants high in fibre. It is important that the hay is of high hygienic quality, properly dried and cured. Hay should look green, and be free of weeds, insects, mould, twine, wire or any other foreign objects. Hay must be visually inspected before a delivery is accepted, and should be rejected if found to be substandard (mouldy, excessively dry and dusty, off-colour). During the process of unloading a delivery, this testing should continue, and not only be applied to the first few bales or batches that may have been deliberately chosen by the merchant to give a good impression. Given that elephants should have hay available at all times, and that obesity rather than energy deficiency is the primary concern, the hay used should be of a low nutritional quality (e.g., crude protein 5-8%, neutral detergent fibre 60-70%, acid detergent fibre 40-50 % in dry matter). Ideally, the grass should have been cut at a very late growth stage, with long, lignified stems. Hay typically used for production animals, with cut at an earlier growth stage with soft, pliable stems and a high proportion of grass leaves, is not ideal for elephants due to its high energy content. Because hay suitable for elephants is typically not produced for the hay market, and because farmers cannot sell the same amount of hay if cutting their fields as late as reasonable for elephant hay compared to what they could sell cutting the same field several times, prospective contracting of farmers and fostering long-term relationships is recommended. Notably, local farming conditions, e.g. subsidies for an extensive land use with late cuts, will influence costs and practicalities. Considering differences in the dietary needs of individual elephants (e.g. breeding vs. non-breeding females), it is recommended to have various badges of hay with differing energy content/digestibility on site. Differences in energy requirements should rather be met by different hay qualities than by the addition of other feedstuffs. Hay of peculiar grass species, such as reeds, has been used successfully by some elephant facilities. For the use of fresh forage, the same principles apply (grass of late maturity stage with long, lignified stems). If at all possible, the use of fresh forage should receive priority over dried forage, but will be necessarily limited to the non-winter season. Reedgrass or elephant grass, or other tall grasses, may be suitable. In theory, using whole maize plants without the cobs would also represent a suitable elephant feed. When feeding fresh forages, their dry matter content needs to be accounted for in ration calculation. 3. Browse Browse is an essential dietary component, both nutritionally and from a behavioural perspective. It must be fed daily to all elephants throughout the year and may contain twigs, branches and stems up to entire tree logs. Consuming browse increases foraging time and has additional benefits for dental health. A plan must be in place for adequate browse provision throughout the year, including the winter months when leafy material is not available. Browse can be preserved for other species by silaging, freezing or drying, but for elephants, due to the volumes required, this is mostly not feasible. Rather, stems and twigs without leaves should be provided on a daily basis, as well as evergreen species such as evergreen oak(Quercus ilex), bramble (Rubus fruticosus) or stinging nettle (Urtica spp.). Feeding conifers has proven successful for some collections. It may be logistically beneficial to additionally use branches that have been plucked clean of leaves and small twigs by other species of the same zoological institution for final consumption by the elephants, given that no hygienic concerns speak against this. 4. Straw Straw can be a suitable low-caloric fibre addition to the diet of elephants and can be mixed in with the hay ration to prolong foraging time, especially in high feeding nets. Due to the high amount of forage required by elephants, mixing of hay and straw generally appears the less feasible option compared to the acquisition of long-stem grass hay of low nutritional (but high hygienic) quality. If mixing of hay and straw is done, the ratio should be determined in accordance with the dietary needs of the individual elephant. Like hay, straw must be of high hygienic quality, free of weeds, insects, mould, twine, wire or any other foreign objects and should be visually inspected before a delivery is accepted. Wheat or barley straw should be preferred, because oat straw typically contains a higher energy content. 5. Lucerne The elephants’ requirements for bulky, low-energy roughage can be easily met with grass hay and straw, so that the more costly lucerne hay is typically not required. The feeding behaviour of elephants makes a loss of leafy material particularly likely when dealing with lucerne hay. Therefore, fresh lucerne or lucerne haylage would be considered more suitable due to the reduced leaf losses. Fresh lucerne or lucerne haylage might be used to increase the calorie and protein content of a specific animal’s diet under specific circumstances such as with geriatric animals or animals of compromised health. However, providing a grass hay of higher nutritional quality most likely is a more feasible solution. For all forage items, gradual changes with a slow introduction of new material over the course of two weeks is recommended. In other words, the amount of the new diet item should be gradually increased so that only after one week, it represents 50% of the forage portion, and is given as the only forage only after the second week. Other feed items 6. Pellets Except for special circumstances of particularly low forage quality or mishaps (e.g., sudden detection of forage spoilage due to roof leakage), there should be no need to provide elephants with pellets for maintenance energy requirements. A variety of pelleted feedstuffs is available. Some are manufactured specifically for elephants and are designed to be fed in very small quantities, with forage making up most of the diet (hay, grass, browse, straw). These pellets provide high levels of vitamins, minerals and protein, in a concentrated form so only a small amount is required to meet the elephants’ nutritional needs. A combination of such a product with forages represents an easy and comparatively safe approach, because potential variation especially in the mineral composition of the forages is of little concern, given the baseline provision by the mineralized pellet. With this approach, the individual provision of specific amounts to each individual, according to its body mass, is prerogative. It is advised that pellet selection is made by the zoo’s nutritionist or, if no nutritionist is on staff, by a nutritional consultancy service, which is sometimes also provided by renowned manufacturers. To avoid digestive upsets, the introduction of any pellet into the diet should be gradual (increasing slowly over 2 weeks). 7. Fruits and vegetables (produce) These should be fed in very limited amounts (less than 1 kg per elephant per day) and be documented as part of the daily diet ration. Produce is comparatively expensive, and amounts fed should not be required to contribute to vitamin and mineral provision. Even small quantities of higher sugar fruits, however, may significantly contribute to energy levels in the diet, adding to the risk of obesity. High sugar fruits should be replaced with vegetables – ideally leafy greens. In appropriate quantities, their use in training may be valuable. As it is easy to condition animals to the use of high-sugar items, but difficult to then reverse the conditioning, it appears prudent to refrain from the use of such items from the very beginning, and establish the use of leafy greens as training items. 8. Bread This should be avoided – should this be required for the administration of medication, use must be monitored. 9. Bran Elephants can be reluctant to consume unfamiliar foods- therefore it is appropriate to offer potential carriers for medication such as a bran mash periodically, so they will be consumed when needed. However, it should not be necessary to offer such items daily. 10. Vitamin and mineral supplements The dietary concentrations of minerals and vitamins recommended for horses should in the most part be sufficient for elephants (Ullrey et al. 1997). Mineral deficiencies have rarely been reported and are best avoided through the adequate use of appropriate forages, supplemented with pelleted feed, rather than additional external supplementation where consumption is more challenging to ensure and monitor. In specific situations such as an expected birth, the monitoring of serum calcium levels is recommended in order to avoid dystocia due to hypocalcemia (Hermes et al., 2008). Although the species-specific vitamin D and calcium metabolism in elephants is not fully understood so far (Childs-Sanford et al., 2020), efficacy of a dietary calcium supplementation has been reported (van Sonsbeek et al., 2013). Back to Top Staff behaviour Food analysis Staff behaviour In particular when changing the diet of elephants, it may be appropriate to avoid eating those diet items (apples, bread) within their range of vision. In doing so, negative reactions by the elephants may be avoided. Food analyses Typically, it is recommended to analyse all feeds on a regular basis. However, the question each zoo has to ask itself is, how will that information be used. Analysing feeds appears mainly reasonable if there is a nutritionist on staff that makes use of that information. Yet, even with a nutritionist on staff, or the use of a consultancy service, it may be a more cost-efficient approach to design a diet based on forages and a concentrated pelleted food that covers a range of possible nutrient values of the forages, rather than adapting the pelleted component each time a batch of forage is analysed. Having stated the potentially limited use of nutrient analyses, there is no excuse at all not to perform hygienic assessments of all feeds delivered to the zoo. Even if there is no nutritionist on staff, or even if there is no dedicated commissary manager, it cannot be excused if there is no personnel trained in evaluating the hygienic quality of forages, vegetables and pellets. In particular for forages, given their relevance and bulk in herbivore diets, personnel dedicated to evaluating and either accepting or rejecting a delivery, and dedicated to proper storage and assessment of storage quality, is indispensable. Food presentation Food presentation It is commonly accepted that feeding in captivity must mimic feeding behaviour of wild counterparts. A variety of complex feeding opportunities to prolong foraging time throughout the day and night must be provided. Provision for food delivery in evening/early morning must be made when personnel is typically absent. With respect to the temporal occurrence of major sleep periods, no additional food should be presented between midnight and 6.00am to avoid sleep disturbance (Schiffmann et al. 2018b), which is evidently not difficult to achieve. Keepers must periodically monitor this via night-time video recording of all animals, to ensure all animals are able to obtain access to food and ensure feeding events do not encourage anticipatory or stereotypical behaviours. Examples for daily ration quantities Please note that the following daily rations serve as examples, making individual adaptation necessary before application. Ideally, a zoo should have a nutritionist on staff. If that is not the case, this task may fall to a veterinarian with some basic nutritional training, or can be outsourced – for a simple ration calculation – to a nutritional consultancy, of which there is a growing number in Europe. Alternatively, several manufacturers of zoo diets also provide nutritional consultancy. As with any business, the credibility of the service should be assessed, by asking for references from other zoos, and by plausibility checks. In particular, advice that appears to be tuned to use a maximum of pellets should be viewed with caution. Target overall diet composition (ingested roughage and non-roughage items) may be in the area of crude protein 10%, neutral detergent fibre 60%, acid detergent fibre 40 % in dry matter. Accurate calculation of the quantities required to cover the individual needs of an elephant would require constant analysis of the diet as well as monitoring roughage intake (by measuring offer and refusals) to allow estimation of the proportion of roughage and non-roughage diet items, which is impractical – all the more so if the recommendation of multiple feeding stations spread across the whole enclosure is heeded. Hence, continuous monitoring of an elephant’s physical condition by weighing and body condition scoring is strongly recommended (Schiffmann et al. 2019a). Subsequently diet composition and quantities can be adapted accordingly. Examples of ration Back to Top A Adult breeding female, body mass: 3´348kg, Body Condition Score (BCS): 5/10 Estimated daily dry matter intake [kg]: 3´348kg * 0.015 -> 50.22kg B) Adult breeding male, body mass: 5´278kg, BCS: 7/10 Estimated daily dry matter intake [kg]: 5´278kg * 0.01 -> 52.78kg C) Geriatric (non-breeding) female, body mass: 2´934kg, BCS: 4/10 Estimated daily dry matter intake [kg]: 2´934kg * 0.015 -> 44.01kg D) Sub-adult male/female, body mass: 2´237kg, BCS: 8/10 Estimated daily dry matter intake [kg]: 2´237kg * 0.01 -> 22.37kg Calculations based on the following parameters: maintenance requirement of daily dry matter intake 1-1.5% of an elephants body mass (Ullrey et al. 1997). Dry matter hay: 90% (Ullrey et al. 1997); recommended quantity pellets: elephant pellets, KasperFaunafood: 1kg/1´000kg BM per day. Diet monitoring Diet monitoring Appropriate monitoring of body condition and weight is essential and should be conducted at least four times per year. Visual body condition scoring has been demonstrated as a practical and simple monitoring tool (Fernando et al. 2009; Schiffmann et al. 2018a; Chusyd et al. 2019) and is of peculiar importance if weighing is not feasible. Records must remain with the animal throughout its life and be recorded as appropriate e.g. via ZIMS. Consequences of obesity in captive elephants are extremely serious and will affect the animal’s long term captive health and welfare. There is strong evidence that obese animals are at increased risk of foot and joint lesions, altered metabolic markers and reduced reproductive success with increased labour length, dystocia, stillbirths and ultimately cow and calf death (Olson 2004; Freeman et al. 2009; Chusyd et al. 2018; Norkaew et al. 2018). Where animals are not achieving an optimum Body Condition Score (BCS), a documented plan must be in place to achieve this with records kept of progress made. Daily, keepers must monitor diet consumption and report variations as appropriate. Individual diet plans must be made for each elephant and recorded. Regular fecal check Regular fecal check is strongly recommended as an integral part of continuous health monitoring in elephants under human care. Click here for more information. Fecal quality control References References Bax P, Sheldrick D (1963) Some preliminary observations on the food of elephant in the Tsavo Royal National Park (east) of Kenya. East African Wildlife Journal 1: 40-53 Bechert US, Brown JL, Dierenfeld ES, Ling PD, Molter CM, Schulte BA (2019) Zoo elephant research: contributions to conservation of captive and free-ranging species. International Zoo Yearbook 53: 1-27 Beekman JH, Prins H (1989) Feeding strategies of sedentary large herbivores in East Africa with emphasis on the African buffalo, Syncerus caffer. Journal of African Ecology 27: 129-147 Cerling TE, Harris JM, Leakey MG (1999) Browsing and grazing in elephants: the isotope record of modern and fossil proboscideans. Oecologia 120: 364-374 Childs-Sanford, S. E., Makowski, A. J., & Wakshlag, J. J. (2020). The vitamin D status of Asian elephants (Elephas maximus) managed in a Northern temperate climate. Journal of Zoo and Wildlife Medicine, 51, 1-12. Chusyd DE, Brown JL, Hambly C, Johnson MS, Morfeld KA, Patki A, Speakman JR, Allison DB, Nagy TR (2018) Adiposity and reproductive cycling status in zoo African elephants. Obesity 26: 103-110 Chusyd DE, Brown JL, Golzarri-Arroyo L, Dickinson SL, Johnson MS, Allison DB, Nagy TR (2019) Fat mass compared to four body condition scoring systems in the Asian elephant (Elephas maximus). Zoo Biology: Clauss M, Loehlein W, Kienzle E, Wiesner H (2003) Studies on feed digestibilities in captive Asian elephants (Elephas maximus). Journal of Animal Physiology and Animal Nutrition 87: 160-173 Clauss M, Steinmetz H, Eulenberger U, Ossent P, Zingg R, HummEl J, Hatt JM (2007). Observations on the length of the intestinal tract of African Loxodonta africana (Blumenbach 1797) and Asian elephants Elephas maximus (Linné 1735). Eur J Wildl Res (2007) 53: 68–72 Dougall H, Sheldrick D (1964) The chemical composition of a day´s diet of an elephant. Journal of African Ecology 2: 51-59 Fernando P, Janaka HK, Ekanayaka SKK, Nishantha HG, Pastorini J (2009) A simple method for assessing elephant body condition. Gajah 31: 29-31 Fowler ME, Mikota SK (2006) Biology, Medicine, and Surgery of Elephants. Blackwell Publishing, Iowa, USA Freeman EW, Guagnano G, Olson D, Keele M, Brown JL (2009) Social factors influence ovarian acyclicity in captive African elephants (Loxodonta africana). Zoo Biology 28: 1-15 Hackenberger MK (1987) Diet digestibilities and ingesta transit times of captive Asian (Elephas maximus) and African elephants (Loxodonta africana), MSC Thesis University of Guelph, Guelph Hatt JM, Clauss M (2006) Feeding Asian and African elephants Elephas maximus and Loxodonta africana in captivity. International Zoo Yearbook 40: 88-95. Hermes, R., Saragusty, J., Schaftenaar, W., Göritz, F., Schmitt, D., & Hildebrandt, T. B. (2008). Obstetrics in elephants. Theriogenology, 70, 131-144. Holdo RM, Dudley JP, McDowell LR (2002) Geophagy in the African elephant in relation to availability of dietary sodium Journal of Mammalogy 83: 652-664 Holdo RM, McDowell LR (2004) Termite mounds as nutrient-rich food patches for elephants. Biotropica 36: 231-239 Ilmberger N, Güllert S, Dannenberg J, Rabausch U, Torres J, Wemheuer B, Alawi M, Poehlein A, Chow J, Turaev D, Rattei T, Schmeisser C, Salomon J, Olsen PB, Daniel R, Grundhoff A, Borchert MS, Streit WR (2014) A comparative metagenome survey of the fecal microbiota of a breast- and a plant-fed Asian elephant reveals an unexpectedly high diversity of glycoside hydrolase family enzymes. PLoS ONE 9: e106707 Kabigumila J (1993) Feeding habits of elephants in Ngorongoro Crater, Tanzania. Journal of African Ecology 31: 156-164 Laws R (1970) Elephants and habitats in North Bunyoro Uganda. Journal of African Ecology 8: 163-180 Loehlein W, Kienzle E, Wiesner H, Clauss M (2003) Investigations on the use of chromium oxide as an inert, external marker in captive Asian elephants (Elephas maximus): passage and recovery rates. In: Fidgett A, Clauss M, Ganslosser U, Hatt JM, Nijboer J (eds) Zoo animal nutrition, vol 2. Filander, Fuerth, Germany Norkaew T, Brown JL, Bansiddhi P, Somgird C, Thitaram C, Punyapornwithaya V, Punturee K, Vongchan P, Somboon N, Khonmee J (2018) Body condition and adrenal glucocorticoid activity affects metabolic marker and lipid profiles in captive female elephants in Thailand. PLoS ONE 13: e0204965 Olson D (2004) Elephant husbandry resource guide Rees PA (1982) Gross assimilation efficiency and food passage time in the African elephant. African Journal of Ecology 20: 193-198 Sach F, Dierenfeld ES, Langley-Evans S, Watts M, Yon L (2019) African elephants (Loxodonta africana) as an example of a mega-herbivore making movement choices based on nutritional needs. PeerJ: Schiffmann C, Clauss M, Fernando P, Pastorini J, Wendler P, Ertl N, Hatt JM (2018a) Body condition scores of European zoo elephants (Elephas maximus and Loxodonta africana): Status quo and influencing factors. Journal of Zoo and Aquarium Research 6: 91-103 Schiffmann C, Hoby S, Wenker C, Hard T, Scholz R, Clauss M, Hatt JM (2018b) When elephants fall asleep: A literature review on elephant rest with case studies on elephant falling bouts, and practical solutions for zoo elephants. Zoo Biology 38: 1-13 Schiffmann C, Clauss M, Hoby S, Hatt JM (2019a) Body Condition Scores (BCS) in European zoo elephants´ (Loxodonta africana and Elephas maximus) lifetimes - a longitudinal analysis. Journal of Zoo and Aquarium Research 7: 74-86 Schiffmann C, Hatt JM, Hoby S, Codron D, Clauss M (2019b) Elephant body mass cyclicity suggests effect of molar progression on chewing efficiency. Mammalian Biology 96: 81-86 Scott NL, LaDue CA (2019) The behavioral effects of exhibit size versus complexity in African elephants: A potential solution for smaller spaces. Zoo Biology: Sukumar R (1990) Ecology of the Asian elephant in Southern India - II. Feeding habits and crop raiding patterns. Journal of Tropical Ecology 6: 33-53 Ullrey D, Crissey SD, Hintz H (1997) Elephants: nutrition and dietary husbandry. In: Allen M, Edwards M, Roocroft A (eds) Nutrition Advisory Group Handbook, pp 1-20 Van Sonsbeek, G. R., van der Kolk, J. H., van Leeuwen, J. P. T. M., Everts, H., Marais, J., & Schaftenaar, W. (2013). Effect of calcium and cholecalciferol supplementation on several parameters of calcium status in plasma and urine of captive Asian (Elephas maximus) and African elephants (Loxodonta africana). Journal of Zoo and Wildlife Medicine, 44, 529-540. Wittemyer G (2011) Order Proboscidea. In: Wilson DE, Mittermeier RA (eds) Handbook of the Mammals of the World - Volume 2. Lynx Edicions, pp 50-79 Back to Top

Sharing clinical cases amongst elephant veterinatians and caretakers will increase our knowledge, so we can treat elephants better. Knowledge Elephant medicine is a specialism that is usually obtained after many years of working with elephants. Compared to the amount of literature that is available for equine practicioners, the amount of literature about elephant medicine is very limited. Recognition On this website we collect clinical data from field workers in range countries and zoos. By showing these experiences on this website, we hope to help you, veterinarians and elephant care takers, when you are confronted with a clinical problem. Maybe you recognize similar symptoms and syndromes in your sick animal and learn how your case might be treated. Sharing By using the contact button, you can share your information and questions with us, so we can add new opinions to the existing case reports or add a new report. WHY THIS WEBSITE?

This chapter describes (standing) sedation, general anesthesia, intubation and epidural anesthesia using xylazin, ketamine, azaperone, detomidine, medetomidine, etorphin, carfentanil, gas anesthesia and lidocain. To procedures This page describes the following procedures Standing sedation General anesthesia Epidural anesthesia Anesthesia Standing sedation Sedation: In case the elephant does not cooperate voluntarily with the manipulations needed for the diagnosis or treatment the animal should be sedated (including herd mates if needed to reduce stress in the herd) Standing sedation can be performed using xylazine or (preferred) detomidine in combination with butorphanol. Medetomidine works as good as detomidine, but is more expensive. Young elephants need the higher dose range compared to older elephants. Elephants that are excited can be premedicated with azaperone (Asian elephant 0.024-0.038 IM, African elephant 0.056-0.107 IM, IV). Detomidine 0.01-0.022 mg/kg IM (can be reversed by atipamezole at 3-5 times the dose of detomidine). Young calves may need a higher dose of detomidine (0.02-0.04 mg/kg). AND Butorphanol 0.015-0.025 mg/kg given at same time as detomidine. Butorphanol can be reversed with naltrexone at 2.5-5 times the dose of butorphanol in emergency situations, but reversal is not essential and should preferably not be carried out if the calf is considered to be in pain. Alternative option for sedation (if the above mentioned drugs are not available): Xylazine : 0.04-0.08 mg/kg IM for adult Asian elephants and 0.08-0.1 mg/kg for African elephants. Juvenile Asian elephants: 0.09–0.15 xylazine mg/kg IM (Jansson 2021) If insufficient sedation is obtained by xylazine alone, an additional (low) dose of ketamine (0.03 – 0.06 mg/kg) can be given IM or IV. Xylazine can be reversed with yohimbine (0.073-0.098 mg/kg slowly IV) or atipamezole (0.1 x xylazine dose IM or 30/70 IV/IM) Another alternative option for sedation of Asian elephants: Dexmedetomidine : 2 μg/kg BM IM will provide sufficient standing sedation for approximately 70 minutes. (Buranaprim, 2022). Dexmedetomidine can be antagonized by atipamezole (10 times the dexmedetomidine dosage). If a young calf needs to be sedated, it may be necessary to sedate the dam or other adult herd mates so they are not stressed during manipulations on a calf. This can be done by the administration of: Butorphanol 0.006 mg/kg IM and detomidine 0.0026 mg/kg IM (In adult female Asian elephants, 20mg butorphanol and 10mg detomidine have been effective) Sedation can be reversed as described above but is not necessary Alternatively, xylazine (0.04–0.08 mg/kg) or other sedative agents (e.g. Azaperone at 0.024–0.038 mg/kg) can be used if detomidine is unavailable. Laubscher LL et a. 2021 described a fixed drug combination of butorphanol, azaperone and medetomidine (BAM) for African elephants. The dose is given per cm shoulder height. The composition of this anesthetic mixture is: 30 mg/ml butorphanol, 12 mg/ml azaperone, and 12 mg/ml medetomidine. The use of this combination can be recommended in captive, trained African elephants at a dose of 0.006 6 ± 0.001 ml/cm shoulder height. Oral or rectal administration of detomidine in the form of a gel (Domosedan gel, 20-50 mcg/kg) to obtain mild sedation has been described (2020, Molter). The gel must be rubbed into the oral mucosa or rectal wall. Initial, mild sedation is seen after 15-20 minutes. The maximal effect is at 30-45 minutes. A full standard sedation is characterized by the following signs: Salivation Relaxation of the trunk; the tip of the trunk will touch the ground. Relaxation of the penis and (less obvious) relaxation of the vulva. Snooring sounds. It is important to cover the eyes with gauze pads (taped to the skin with Leucoplast or ducttape) and put cotton plugs in the ears. This will deepen the sedation and reduce the risk of sudden wakening. One should always be prepared that the elephant may wake up. Safety procedures need to be discussed in advance with everyone involved in the procedure. Summary agonist - antagonists Xylazine can be reversed by atipamezole : 0.1 x xylazine dose or yohimbine : 0,05-0,13 mg/kg IV Detomidine is reversed by: atipamezole: 3-5 times the detomidine dose IM or slow IV (30/70 IV/IM) Butorphanol is reversed by naltrexone: 2.5-5 x butorphenol dose IV. Skip naltrexone if pain relieve is desirable. The naltrexone dosage provided by Laubscher LL et a. 2020 is much lower: 1 mg naltrexone per mg butorphanol. References: Buranapim, N., Kulnanan, P., Chingpathomkul, K., Angkawanish, T., Chansitthiwet, S., Langkaphin, W., Sombutputorn, P., Monchaivanakit, N., Kasemjai, K., Namwongprom, K., Boonprasert, K., Bansiddhi, P., Thitaram, N., Sharp, P., Pacharinsak, C., Thitaram, C., 2022. Dexmedetomidine Effectively Sedates Asian Elephants (Elephas maximus ). Animals 12, 2787.. doi:10.3390/ani12202787 Fowler M.E. and Mikota S.K. 2006. Chemical restraint and general anesthesia. In: Biology, medicine and surgery of elephants. Blackwell Publishing. Jansson T., Vijitha P.B., Edner A., and Fahlman A. 2021. Standing sedation with xylazine and reversal with yohimbine in juvenile Asian elephants ( Elephas maximus ). Journal of Zoo and Wildlife Medicine, 52(2) : 437-444. Liesel L. Laubscher , Silke Pfitzer , Peter S. Rogers , Lisa L. Wolfe , Michael W. Miller , Aleksandr Semjonov , Jacobus P. Raath. 2021. Evaluating the use of a butorphanol-azaperone-medetomidine fixed-dose combination for standing sedation in African elephants (Loxodonta africana). J. of Zoo and Wildlife Medicine, 52(1) :287-294 (2021). Molter C. 2020. Diagnosis and treatment of EEHV-hemorrhagic disease. Proceedings of the annual AAZV- symposium 2020. Neiffer D.L. , Miller M.A., Weber M., Stetter M., Fontenot D.K., Robbins P.K., and Pye G.W. 2005. Standing sedation in African elephants (Loxodonta africana) using detomidine–butorphanol combinations. Journal of Zoo and Wildlife Medicine 36(2): 250–256, 2005. E. Wiedner. 2015. Proboscidea. In: Fowler's Zoo and Wild animal Medicine 8. Standing sedatin General Anesthesia General remarks: General anesthesia is required in those cases where standing sedation alone or in combination with local anesthesia does not suffice for the intervention that needs to be done. We can devide the indications in: Capture immobilization Immobilization for painful procedures Capture immobilization is mostly done in range countries. However, the escape of a captive elephant may also require capture immobilization. Elephants from this category have not been prepared for the immobilization. This means that they have been able to take food an water shortly prior to the immobilization. It aslo nmeasn that the circumstances have not (or insufficiently) been prepared for the procedure as compared to an immobilization under full captive conditions. Preparation : If possible, prepare a safe area for the people and elephant involved. Avoid an area with water and select a place that is reachable for heavy equipment. Provide shadow whenever possible. Make sure you can ccol the elephant with cold water when necessary. Heavy equipment to position the elephant in lateral recumbancy may be needed, as sternal recumbancy is highly associated with anesthetic death. If an elephant has gone down in sternal position and cannot be rolled over in lateral recumbancy, the anesthesia must be reversed immediately. Whenever possible, provide a soft bedding, preferably a deep sand layer covered by a deep layer of straw or matrasses. Straps or belts are required in case the elephant needs to be rolled over. It is important to thraw them under the elephant before the animal will go down. It helps if the elephant lays on sand and straw to get straps or a belt under the elephant's body with the help of a hooked steel wire. To protect the tusks against fractures, a car tyre can be placed under the head just before the elephant goes down. Trained elephant can be anesthetized when brought lateral recumbency. If the elephant is trained to ly down in sternal position, general anesthesia can be induced but this is very risky! Once the drugs have reached their effect, the elephant MUST be rolled over into lateral recumbency, which requires heavy equipment. Especially in trained elephants, ropes can be used to guide the elephant into lateral recumbency. Trained captive African elephant brought under general anesthesia while guided by ropes. Courtesy: Osterhaus and Fagan. For correct positioning of the elephant during general anesthesia, the use of a crane is highly recommended. First, a standing sedation is induced. After a net has been brought into position, this can be connected to the crane. This will support the elephant when the general anesthesia is induced by IV or IM injection of the narcotic drug (etorphine or ketamine). By lifting the elephant it can be positioned in the correct lateral recumbancy. Protecting cushions, matrasses and soft bedding materials should be placed underneath the head and the body. See the images of the use of a net below (Courtesy basel Zoo): Elephants should be fastened for 24-48 hours prior to anesthesia. Water should be withheld for 24 hours before the procedure. Capture immobilization is mostly done in range countries. The escape of a captive elephant may also require capture immobilization. Elephants from this category have not been prepared for the immobilization. This means that they have been able to take food an water shortly prior to the immobilization. It also means that the circumstances have not or insufficiently been prepared for the procedure as compared to an immobilization under full captive conditions. Preparation: if possible, prepare a safe area for the people and elephant involved. Avoid an area with water and select an area that is reachable for equipment. Provide shadow whenever possible. Make sure you cool the elephant with cold water when necessary. Heavy equipment to position the elephant in lateral recumbancy may be needed, as sternal recumbancy is highly associated with anesthetic death. If an elephant has gone down in sternal position and cannot be rolled over in lateral recumbancy, the anesthesia must be reversed immediately. Whenever possible, provide a soft bedding, preferably sand covered by a deep layer of straw or matrasses. If straps are required in case the elephant needs to be rolled over, it is important to thraw them under the elephant just before the animal will go down. It helps if the elephants lays on sand and straw to get straps or a belt under the elephant's body with the help of a hooked steel wire. The use of a suitable net is highly recommended as slings may slide away from the desired place of the elephant's body. Oxygen supplementation Oxygen must always be provided, even if the anesthetized elephant is not intubated. Arterial blood pressure will drop if no oxygen is provided (Heard 1986). An oxygen flow of 10-15 L/min for a juvenile up to 39-40 L/min for an adult elephant is required for maintaining arterial blood pressure at an acceptable level. Oxygen supply during general anesthesia of a 5 yr-old Asian elephant under field conditions. Due to lack of proper equipment, intubation was not possible. Oxygen was provided at a flow rate of 10 L/min via a small tube inserted in the trunk. Drugs used for general anesthesia: Captive elephants that are excited can be premedicated with azaperone (Asian elephant 0.024-0.038 IM, African elephant 0.056-0.107 IM, IV). Fast acting immobilizing drugs that are used for capture immobilization: Etorphine : 0.002-0.004 mg/kg IM (Asian elephant) and 0.0015-0.003 mg/kg IM (African elephant) OR Carfentanil : 0.002-0.004 mg/kg (Asian elephant) and 0.0013-0.0024 mg/kg IM (African elephant) These drugs can be antagonized with naltrexone 0.004 mg/kg IM (or 50/50 IV/IM) If carfentanil and etorphine are not available, xylazine (0.1 mg/kg) and ketamine (0.3-0.7 mg/kg) can be given together. The disadvantage is the large volume required for an adult elephant. For capture immobilization this combination is therefore not recommended. At the end of the procedure xylazine can be reversed with atipamezole (0.1 x dose of xylazine IM or slowly IV) or yohimbine (0.05-0.13 mg/kg IV). Under controlled conditions (if a crane is available) a standing sedation can be induced first, allowing to put a net or slings in place. When well secured, ketamine can be given i.m. (0.3-0.7 mg/kg). or i.v. using a long infusion tube for safety reasons. Once in lateral recumbancy, the elephant can be intubated and anesthesia can be maintained on isoflurane or halothane (1.5-3%). Inhalation anesthesia and intubation: Intubation in elephants is straightforward. A 30-50 mm diameter cuffed endotracheal tube can be inserted into the trachea. A rope around the lower jaw can be used to open the mouth. A gloved hand can reach the epiglottis and advance a lung tube (e.g. stocha tube for horses) into the trachea, while pushing the soft palate upward. Once in place, the endotracheal tube can be advanced into the trachea guided by the smaller tube. A special portable pressure ventilater has been developed and described by William et al. Jeff Zuba made some modifications to this design, which is now commercially available (http://www.incaseofanesthesia.com/Home_Page.html ). Schematic overview of a portable pressure ventilation device for elephants. "Zuba" ventilator used in an adult African elephant under field conditions Captive African elephant intubated for gas anesthesia using a "Zuba" ventilator. "Zuba" ventilator Under less favorable circumstances when a pressure ventilator is not available, intubation can be done in the trunk using 2 cuffed horse endotracheal tubes and 2 separate (portable) anesthetic machines (Tamas 1983). The advantages of this method are the easy intubation and the ample space in the oral cavity in the absence of the large tube. However the disadvantages are substantial: Two tubes increase the airway resistence Risk of regurgitation and aspiration of stomach contents An elephant can breath through its mouth, which will bypass the inhalation of the anethetic gas General anesthesia in a captive Asian elephant using bilateral trunk intubation (Rotterdam Zoo, 1989) Monitoring: Pulse oximetry is a reliable tool for monitoring heart frequency and venous oxygen saturation. A capnagraph is recommended to monitor the respiration. If not available, one individual should be assigned just to monitor respiratory rate and depth. ECG and arterial blood gases are recommended. As hypotension is quite common in anesthetized elephants, blood pressure measurement is also recommended. Hypotension has been treated successfully with ephedrine and dobutamine. Recovery support: Weak or debilitated animals may need help to get back on their feet during recovery. A deep sand layer is essential for the elephant to getting grip on the ground. A crane may be needed to lift the animal from the ground, using straps or belts applied around the body. References. Fowler M.E. and Mikota S.K. 2006. Chemical restraint and general anesthesia. In: Biology, medicine and surgery of elephants. Blackwell Publishing. Heard D.J., Jacobson E.R., and Brock K.A. 1986. Effects on oxygen supplementation on blood gas values in chemically restraint juvenile African elephants. J Am Vet Med Ass 189 (9)1071-1074. Tamas PM. and Geiser D.R. 1983. Etorphine analgesia supplemented by halothane anesthesia in an adult African elephant. JAVMA 183, 11 (1312-1314) . Wiedner E.. 2015. Proboscidea. In: Fowler's Zoo and Wild animal Medicine 8. Zuba J.R., Osterhaus J.E. 2012. Anesthetic complications and clinical intervention in opiod anesthetized captive elephants. In: Proceedings of the AAZV Conference, Oakland (1-6). Zuba J.R. http://www.incaseofanesthesia.com/Home_Page.html General anesthesia Always bring the elephant into LATERAL RECUMBANCY for general anesthesia Epidural anesthesia Epidural anesthesia in elephants is recommended when a vaginal vestibulotomy is performed in order to reduce tail movements of the elephant and provide additional analgesia in the perineal region. Procedure: Restrain the elephant as appropriate in a chute and sedated if necessary. Disinfect the injection site. Move the tail up and down to determine the position of the most mobile intercoccygeal space. Inject local anaesthetic (2% Lidocaine) into the skin over the injection site. Palpate the intercoccygeal space wearing a sterile glove and insert the needle (14 gauge, 3 inch) at approximately a 60 - 70 degree angle cranially. The epidural space is about 6.5 cm below the skin surface. Inject Lidocaine : 30 ml was sufficient to produce tail relaxation in a 3,000 kg elephant, and the elephant remained standing. Epidural anesthesia

A series of videos guides you through the aspects of a full elephant necropsy. These recordings were made for a workshop given in Myanmar in 2019 and are kindly provided by the MIchigan State University. To necropsy report index Necropsy Procedure EAZA Necropsy protocol Videos elephant necropsy These videos were prepared for workshops given to elephant veterinarians in Myanmar by Elephant Care International. http://elephantcare.org Necropsy procedure Preparation Ante/postmortem changes Sample collection Circulatory system Respiratory system Reproductive system Brain + neural system Integument Multi-systemic Musculo-skeletal Foot Tusks and molars Renal and urinary To page top

We developed this website with the input of Elephant Veterinarians worldwide. -Willem Schaftenaar, DVM -Susan Mikota, DVM -Elephant Medicine This website is the joined effort of numerous veterinarians, who work with elephants world-wide. The name(s) of the vet(s) who contributed to a particular topic is mentioned in the left upper corner of each topic page. Some authors may wish to remain anonymous. In that case, the name has not be filled in. Some cases have been published online as open source manuscript and are incorporated in this website via an internet-link. You are encouraged to critically read the information and the clinical cases described on this website and send us your comments! Please submit your clinical cases, no matter whether they have a happy or a sad ending. By sharing our experience we can all learn from each other. Willem Schaftenaar, DVM Website moderator Worked for 30 years at Rotterdam Zoo as clinical veterinarian. Veterinary advisor to the EAZA elephant TAG Associate researcher Elephant Care International. Susan Mikota,DVM Co-founder and Director of Veterinary Programs & Research for Elephant Care International Contributions have been made both anonymously as by name. All the names are known to the moderator. Named contributors are (in alphabetic order) : Dalen Agnew DVM, PhD, DACVP, Department Chair and Associate Professor Pathobiology and Diagnostic Investigation at Michigan State University (USA) Marcus Clauss , University of Zürich (Switzerland) Thittaya Janyamethakul (Tip), DVM., MS, Patara Elephant Farm, Chiang Mai (Thailand) Christine Kaandorp, head veterinarian Rotterdam Zoo (The Netherlands) Arne Lawrenz DVM, director of Wuppertal Zoo (Germany) Susan Mikota DVM, Co-founder and Director of Veterinary Programs & Research for Elephant Care International (USA) Fieke Molenaar DVM, senior veterinary officer Zoological Society of London Zoo (UK) Joost Philippa DVM, zoo veterinarian at Rhenen Zoo (The Netherlands) Tina Risch DVM, Thüringer Zoopark Erfurt, Am Zoopark 1 D-99087 Erfurt (Germany) Ann-Kathrin Oerke , PhD, researcher at Göttingen Primate Center (Germany) and Research advisor to the EAZA elephant TAG Vijitha Perera DVM, Senior veterinarian Elephant Transit Home, Sri Lanka Van Thin Pham DVM, head veterinarian at Dak Lak Elephant Conservation Center (Vietnam) Christian Schiffmann DVM, veterinarian (Germany), research advisor to the EAZA elephant TAG Linda Schiffmann , zoo keeper, TBZ - Tierbegegnungszentrum, Hochrhein (Germany). Linda van Sonsbeek, DVM, head veterinarian Rotterdam Zoo (The Netherlands) Taweepoke Angkawanish PhD,DVM, Lampang Elephant Conservation Center (Thailand) Francis Vercammen DVM, zoo veterinarian at Antwerp and Planckendael zoo (Belgium) Jürg Völlm DVM, Basel Zoo (Switzerland, † 2021) Christian Wenker DVM, Basel Zoo (Switzerland) Kasper Willebrands, elephant headkeeper Rotterdam Zoo (The Netherlands) Malin Wiklund , area manager Colosseum and Savanna/Desert Kolmarden zoo (Sweden) About Us

Esophageal spasms are rarely seen in elephants. This case reports describes this condition in an Asian elephant. Water regurgitation indicated the blockage of water, while the animal was unable to swallow any food. A home-made endoscope greatly facilitated the visualization of the esophagus and stomach wall. A standing sedation using detomidine and butorphanol was used during the treatment procedure. No mouth gag was needed to open the mouth. Continue To non-infectious diseases Case report Esophagus spasm Place: Selwo Zoo, Spain Date: 2019 Data provided by: Cecilia Sierra Arqueros, DVM History Species: Asian elephant Accommodation: Zoo Age, gender: 54 years, female For several years this female Asian elephant had episodes of rhythmic contractions in the ventral area of the neck at the entrence to the thorax (video 1). These contractions were only observed during in the cold seasons of the year. At the age of 54 years, she suddenly became unable to swallow her food and water (video 2). Video 1. Rhythmic contractions in the ventral neck area of an Asian elephant Day 1: The elephant tried to drink water. After 10-20 seconds the water came out her mouth again (regurgitation). The regurgitated water was clear and had no abnormal smell (no stomach smell). Appetite: in the morning she ate horse pellets and some roughage, but then she refused bread and apple slices (her favorites!). She tried to eat fresh gras, but after chewing on it, it came out; no smell of stomach contents. Refused to eat anymore. Regular defecation, though the fecal balls became smaller during the following day. The digestion of the fibers had not changed. Water regurgitation Day 2: No change. Oral inspection: 2 small (5 mm Ø) ulcerations on the tongue base, that were not there the day before. The animal did not cooperate as good as she did on the first day. A standing sedation was performed using detomidine and butorphanol. A 2.4 m plastic tube and flexible endoscope could be advanced into the esophagus, reaching the stomach. No mouth opener or gag was used. Gastric fluids were seen, but no obstruction in the esophagus was encountered. Video 2. Regurgitation of water. Endoscope Plastic tube with endoscope advanced into the esophagus. Treatment Rectal fluids Antibiotic + flunixin meglumine + Vit E/selenium Day 3: Standing sedation using detomidine and butorphanol. Treatment: antibiotics, dexamethasone, vitamin B complex, 240 L rectal fluids Day 4: In the morning, the elphant was able to drink water. Nevertheless another standing sedation was performed using detomidine and butorphanol. 3.5 meter tube inserted in esophangus with mini-camera. Antibiotic + dexametasone +vit- sel + complex B + Buscopan Thirty minutes after finishing the procedure, the elephant started to drink and she ate a melon. From that moment on her appetite came back and she did not regurgitate anymore. Differential diagnosis: Esophagus spasm Esophagus constriction: unlikely because this would have been confirmed by endoscopic examination. Botulism . Botulism had occured in the same environment 200 kilometers from this place, resulting in paralysis of the entire body and the death of the 4 affected elephants. Comments: Esophagus spasms in elephants have not been described before. There is only anecdotal evidence of this phenomenon in horses (van der Kolk, pers. comm. 2021). Hypocalcemia is high on the list of the differential diagnoses. Hypocalcemia has also been associated with " hiccups " in Asian elephants, occuring in the cold seasons. The total calcium concentration in this elephant was 2.7 - 2.9 mmol/l while the hematocrite was 48-50% (average normal value 35%), which is an indication that the elephant was dehydrated. The actual total serum calcium concentration in non-dehydrated condition was probably lower: 35/50 x 2.7 = 1.89 mmol/l. Conclusion: Hypocalcemia may have played a major role in this case of esophagus spasm. To page 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