Salmonellosis is a zoonotic disease that affects many vertebrate species. It has been described for the first time as a pathogen in elephants in 1940 (Matzek 1940). The symptoms of salmonellosis can range from mild depression, colic, diarrhea, ventral edema, weight loss, cachexia to death. To infectious diseases Salmonellosis General information General information Salmonellosis is a zoonotic disease that affects many vertebrate species. It has been described for the first time as a pathogen in elephants in 1940 (Matzek 1940). The symptoms of salmonellosis can range from mild depression, colic, diarrhea, ventral edema, weight loss, cachexia to death. A fatal Salmonella hadar infection in an 18-year-old African elephant has been described, including necrosis and sloughing of the region above the toes (Scott 1984). Subclinical infections do also occur (Scharling 2021). One case of abortion in an African elephant has been described (Emanuelson 2000). Salmonellosis can manifest itself as an acute illness as well as a chronic disease. Different serotypes have been associated with intestinal disease and death (S. typhimurium , S. blockley ) (Matzke 1940, Windsor 1972 and 1976, Chooi 1988). S. saintpaul was associated with septicemia in an adult Asian elephant (Molenaar 2021). The source of the infection is not always found, but can be contaminated food, infected conspecifics, care takers and other species sharing the exhibit with the elephant. Diagnosis of salmonellosis Detection of Salmonella spp. in feces is by culture or PCR the most common way to demonstrate the presence in an elephant. However, shedding of the pathogen is intermittent, which means that multiple fecal samples taken in a period of at least 3 days are required. Salmonella spp. are more likely to be detected in elephants with abnormal feces. Selective media like selenite cystine broth and MacConkey agar are part of the routine culture method for Salmonella spp . (FAO 1992). To detect Salmonella in food samples in general, molecular testing in addition to conventional culture-based methods can be used. Multiplex quantitative PCR (qPCR) has proven to be a fast, easy to perform, and sensitive molecular technique for the detection of Salmonella species and various Salmonella serovars (Heymans 2018). Treatment of salmonellosis The decision to treat an elephant for salmonellosis depends on the clinical situation. Subclinical infections may be hard to clear. If attempted, treatment should be based on an antibiogram. In humans, common first-line oral antibiotics for susceptible Salmonella infections are fluoroquinolones (for adults) and azithromycin (for children). Ceftriaxone is an alternative first-line treatment agent (CDC 2018). In order to reduce the risk of antibiotic resistance to these antibiotics, their use in elephants should be considered only after the antibiogram has demonstrated that other antibiotics (e.g. sulfonamides) are not effective. Information on dosage and administration of antibiotics can be found on: https://www.elephantcare.org/formulary References: Chooi K.F., and Z. Z. Zahari. 1988. Salmonellosis in a Captive Asian Elephant. The Journal of Zoo Animal Medicine, Vol. 19, No. 1/2 (1988), pp. 48-50 Matzke, M. 1940. Salmonella typhimurium Infection in Elephants. Tierarztliche Rundschau 1940 Vol.46 pp.521-522 Emanuelson K.A., Kinzley C.E. 2000. Salmonellosis and subsequent abortion in two African Elephants ( Loxodonta africana ). IAAAM 2000. Heymans R, Vila A, van Heerwaarden C.A.M., Jansen C.C.C., Castelijn G.A.A.,van der Voort, Biesta-Peters E.G. (2018). Rapid detection and differentiation of Salmonella species, Salmonella Typhimurium and Salmonella Enteritidis by multiplex quantitative PCR. PLOS ONE 13(10) 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. Scharling F.S., Bertelsen M.F., Sós E., Bojesen A.M. 2021. Prevalence of Salmonella species, and Clostridium difficile in feces of healthy elephants (Loxodonta africana and Elephas maximus ). Journal of Zoo and Wildlife Medicine 51(4), 752-760. Scott W.A. 1984. Salmonellosis in an African elephant. Vet. Rec. October 13, 391. Windsor R.S. and Ashford W.A. 1972. Salmonella infection in the African elephant and the black rhinoceros. Tropical Animal Health and Production volume 4, pp 214–219. Windsor R.S. and W. A. Scott. 1976. Fascioliasis and Salmonellosis in African elephants in captivity. Br. vet., 132, 313 Websites: http://www.fao.org/3/T0610E/T0610E.pdf https://www.cdc.gov/salmonella/infantis-10-18/advice.html https://www.elephantcare.org/formulary Salmonellosis Case reports Abdominal pain and salmonellosis Salmonellosis in 7 yr-old Asian elephant Salmonella septicemia in adult Asian elephant

Hiccup in elephants has been reported anecdotically several times in conjunction with renal disease (kidney failure), hypocalcemia and low environmental temperature. To non-infectious diseases Case report 'Hiccup' in an adult female Asian elephant Date: 2008 History Adult female Asian elephant showing hiccup-like periodic movements of the abdomen. This phenomenon occured only during the cold period of the year. Treatment The calcium concentration in the food was increased. Unfortunately no calcium blood levels are available. Treatment results The hiccup was not observed anymore during the cold seasons following the increase of the calcium intake. A similar result was obtained in a herd mate of the same age. To page top Hiccup hypocalcemia Hiccup in an adult female Asian elephant with polystic nephritis Case report Date: 2016 Place: Planckendael Zoo Data provided by: Francis Vercammen DVM History Adult female Asian elephant, mid term pregnancy of 6th calf showing hiccups since several months. Chronic weight loss (600 kg decrease), hypercalcemia (35% increase). At transrectal ultrasonographic examination, muticystic nephrophathy was diagnozed. Treatment The diet was adapted (low protein,high energy). A healthy calf was born a term. However, during lactation the condition of the dam deteriorated and the animal was humanely euthanized. Further reading: Vercammen F, Lueders I, Schaftenaar W. 2020. Multisystemic disease in a pluriparous Asian elephant (Elephas maximus). Proc Zoo Wildlife Health Conf 2020 Hiccup kidney disease To page top

A variety of clinical procedures are described here: anesthesia, standing sedation, necropsy, broncho-alveolar lage, trunk wash, body condition score, serum banking, monitoring estrous cycle, pedicure, plasma transfusion, tusk repair, injection technique. Blood collection Hand-rasing Fecal quality control Foot care - curative Foot Care - regular Necropsy procedure Plasma transfusion Surgery Trunk wash procedure Tusk repair procedure Clinical Procedures Anesthesia Banking serum Body condition score Broncho-alveolar & Gastric lavage Injection techniques Monitoring estrous cycle Procedures

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

Dirt, foreign bodies, a short tusk remnant after a tusk fracture and parasites (Cobboldia sp) can cause a purulent sulcus infection in elephants. To parasitology To dentistry case report Tusk sulcus infection Place: Dak Lak elephant Conservation Center Vietnam Date: 2017 Data provided by: Van Thinh Pham, DVM History Purulent discharge from the dental sulcus in an adult Asian elephant bull since a few days. The area around the sulcus was itching, demonstrated by the bull by frequent rubbing the tusk base against trees. Diagnosis Frequent blowing sand in the sulcus area may also be the cause of this problem. in this case, no sand or dirt was present in the sulcus. An infection with larvae of the stomach bot ( Cobboldia sp. ) was suspected. Treatment The dental sulcus area was cleaned with cotton wool and flushed with Betadine and the bull was treated with ivermectin SQ, 0,2 mg/kg BW Treatment results The sulcus lesion healed completely within 7 days. Cobboldia (stomach bot) larvae 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

A mouth gag or mouth opener is needed for any procedure that investigates the deeper oral structures, endoscopic examination (esophagus obstruction, BAL) under standing sedation or general anesthesia. To documents How to make an Elephant Mouth Opener (Gag) Written by Willem Schaftenaar December 2020 This device was developed by Christopher Stremme in Indonesia for tube feeding elephants with tetanus (Lüders 2022). It has been used since then for bronchoscopy and broncho-alveolar lavage (BAL) (Imke Lüders, Willem Schaftenaar, Jan Bos). The models shown here (figure 2,3,8 and 9) are made of (stainless) steel and are based on two 400 mm long threaded steel rods (20 mm diameter), preferably with a thread like in tie rods used in scaffolding (figure 4). Normal thread can also be used, but will require more rotations (=time) to open the mouth. Figure 1. Elephant mouth opener, originally designed and used by Christoffer Stremme Figure 2. Type 1 elephant mouth opener (gag), pushing the upper mouth piece up, including 2 detachable handles (ratchet spanners). Note: the 2 rings on the upper mouth plate are still missing. Figure 4. Steel tie rod (used for scaffoldings) Figure 3. Type 2 elephant mouth opener (gag), pushing the lower mouth piece down, including 2 fixed handles. Figure 5. Anchor nut Each rod is independently but simultaneously turned by an assistant so the upper mouth plate is moved up parallel to the lower (type 1) or the lower plate is moved down (type 2). There are 2 options for the connection of a turning handle: In the device shown in figure 1 an anchor nut is welded to the end of each rod. Two ratchet spanners are used for turning the rod. Once in position, the spanners are taken off. This option is easier to make than option 2. In the device shown in figure 2, the an anchor nuts are welded to the lower mouth piece each rod has one handle welded to the rod. The advantage is the ease to turn the rods. The disadvantage is the place these handles occupy during manipulations. They can also be made as detachable handles. The dimensions of the mouth pieces are 600x50x7 mm. A 50 mm wide plastic strip with rounded edges can be glued or screwed on the outside of each plate to protect the mucosa of the mouth. These plates should not be too thick: the thicker the total diameter of the piece is, the more difficult it is to place the device between the jaws. Four rings should be welded to the mouth plates as shown in figure 3. The straps to attach the device to the elephant are fixed to these rings. For type 1 an anchor nut is welded on each edge of the upper side of the upper mouth plate (figure 6). A normal steel nut (35 mm) is welded to the lower and upper end of each steel rod. A steel ring (30 mm diameter, 8 mm thick) is welded on the threaded rod as indicated in figure 7. For reasons of stability, a steel tube (30-50 mm) can be welded on each side of the the lower mouth piece (figure 7). Figure 6. Detail of the upper mouth plate Figure 7. Detail of the lower mouth plate Figure 8. Type 1 mouth opener used in an adult Asian elephant for molar inspection. Figure 9. Type 2 mouth opener used in an adult African bull for BAL. References : Lueders I., Stremme C. 2022. Construction of a full mouth speculum, facilitating oral examination, bronchoscopy and gastric tubing in elephants. Tierärtzliche Praxis Grosstiere/Nutztiere. 2022. To page top

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

A fractured elephant tusk can cause traumatic lesions of the tusk sulcus when the fracture site is located proximal to the sulcus. To tusk fracture Case report Tusk fracture and sulcus trauma (Asian elephant) Place: Planckendael Zoo Date: 2016 Data provided by: Francis Vercammen DVM History 6 yrs-old female Asian elephant with mucosal damage due to the sharp edges of the distal part of a fractured tush. Note the swollen sulcus mucosa. The pulp tissue was not exposed Treatment As the pulp tissue was not exposed, treatment was limited to grinding sharp edges away using a round-topped milling cutter on a hand-held drill (Dremel). The sulcus was flushed 3 times per day with a mild antiseptic solution (Iso-Betadine Gynecology) Treatment results The sulcus healed and the tusk continued to grow. Tusk fracture and sulcus trauma (Asian elephant) Date: 2020 History A 30 mo-old Asian elephant kept in a zoo fractured its right tusk. The pulp cavity was not exposed, but the sharp edges of the tusk remnant caused wounds on the sulcus mucosa. The sharp edges of the fractured tusk are often the cause trauma to the sulcus mucosa, resulting in a prulent infection. The sharp edges of the fractured tusk have caused a purulent infection of the sulcus. Treatment A conservative treatment was elected, consisting of flushing the wound several times per day with a saline solution and a 10% Betadine solution. Treatment result Within 3 months the tusk had grown out of the sulcus again and the wounds had healed completely. To page top

Clostridiosis in elephants: The following manifestations of clostridiosis have been described in elephants: Tetanus (C. tetani) Enterotoxemia (C. perfringens) Enterocolitis (C. difficile) Malignant edema (C. septicum) Blackleg  (C. chauvoei, C. septicum) Botulism (C. botulinum) CLOSTRIDIOSIS General information Clostridiosis represents a group of diseases caused by members of the Clostridium species. They occur worldwide and can affect many mammalian species, including elephants. Clostridium spp. are gram-positive, rod-shaped, anaerobic bacilli. They form spores that may persist in the soil for months or years. Some of these organisms may be found in the normal flora of the digestive tract and become pathogenic only if accessible tissue is damaged as a result of deep penetrating trauma to the muscle bundles or a compromised gastrointestinal mucosa. Clostridial organisms produce exotoxins, with local and/or systemic effect; including hemolysis and local tissue necrosis. These toxins are produced when the organism grows in the host tissues with the exception of the toxin of Clostridium botulinum , which is formed outside the body and ingested orally by the host. Some Clostridial organisms can produce multiple toxins, each with a specific activity. Clostridiosis in elephants The following manifestations of clostridiosis have been described in elephants: Tetanus (C. tetani) Enterotoxemia (C. perfringens) Enterocolitis (C. difficile) Malignant edema (C. septicum) Clostridium novyi Blackleg (C. chauvoei, C. septicum) has been reported once, but this report could not be tracked down (Prescott, C.W. 1971. Blackleg in an elephant. Vet Rec 88:1971) Botulism (C. botulinum ) Elephant care manual for mahouts and camp managers Preecha Phuangkum Richard C. Lair and Taweepoke Angkawanith Tetanus Tetanus is caused by a long-living anaerobic bacterium that is found in the soil and in moist areas. Tetanus is usually found in elephants that have suffered deep wounds, usually in the foot and particularly through the footpad being pierced by a metal object such as an old, rusty nail. After the bacteria have entered the elephant's body they thrive and, after an incubation period of 15-20 days, neurotoxins are produced that damage the nervous system and cause typical muscular spasms. Between about 1977 and 1992 Thailand experienced, on a massive scale, thieves cutting off elephants' tusks by stealth in order to sell them. One result was that many tuskers contracted tetanus and died. Path of infection: Infection proceeds from stepping on a piece of metal or other contaminated object that causes a deep wound. With elephants, however, the wound might not be obvious because elephants can and do use their trunks to gather dirt (which might be contaminated) to stuff in wounds, including cut tusks. When tetanus enters a tusk's pulp cavity, it spreads very quickly because it thrives in environments where there is no oxygen. All wounds must, of course, be carefully cleaned but be especially careful where the puncture is from nails or rusty old metal, especially in an area that has long housed many animals. After infection, the disease does not progress quickly and the elephant will appear normal for 15-20 days (sometimes even longer) before symptoms appear. Even if the elephant receives treatment, the survival rate is very low. Clinical signs: The elephant often has a temperature of over 37.8° C or 100° F, although this is not certain. The breath will be noticeably hot to feel. The eyes will be very red, and the soft tissue inside the mouth and the trunk will be a dark red. The elephant is listless and does not eat or drink water. The nervous system is affected, and the leg muscles harden in muscular contraction; the tail has a supple, snake-like feel. There are periodic spasms, particularly when the elephant is startled, as by a loud noise or bright light. In following days, it becomes difficult for the elephant to walk and stand because of the contraction of the leg muscles. The jaws lock tightly, making it difficult to chew food. Eating and drinking become very difficult and the elephant dies. Treatment: Consult a veterinarian immediately. Even though tetanus is not contagious to other elephants, separate the elephant from other animals as it will be more peaceful. Take the elephant to a shady shelter with a clean surface, such as a concrete floor (it should not be slippery) to prevent it from introducing earth or other unclean materials into the wound or the pulp cavity. The area should have good ventilation. In cases of an exposed pulp cavity, it is best to clean it with running tap water through a hose. Wash all wounds thoroughly with clean water then flush with an antiseptic solution such as Betadine or Povidine-iodine 1% in a 20:1 solution. Finally, apply an anti-insect powder that includes an antibiotic, such as Negasunt. Hand feed the elephant with small amounts of easy to eat foods with high nutritional value, such as ripe bananas, sticky rice, ripe papayas, etc. Clean the wound every day. Prevention: For elephants that have open wounds or exposed pulp cavities in tusks, prevent the elephant from contracting tetanus by daily cleaning of the wound and by keeping the elephant on a clean surface. Otherwise the elephant is likely to introduce dirt or other unclean material that could contain tetanus germs into the wound. No vaccine yet exists for elephants but if an elephant with a wound seems to have been exposed to tetanus, a veterinarian can inject an antitoxin to prevent infection from the bacteria. To page top Tetanus Tetanus is a potentially fatal disease characterized by muscular spasms caused by a neurotoxin produced by the bacterium Clostridium tetani (vetmed.ucdavis.edu, 2021). These organisms, and their spores, are found in the intestinal tract of several mammalian species and are abundant in the soil, where they can survive for many years. The spores can enter open wounds, particularly puncture wounds, where they proliferate under the right anaerobic conditions. When the spores die, they release the tetanospasmin neurotoxin that is responsible for clinical signs. The size of the wound does not correlate to risk of developing tetanus. Even superficial wounds have been associated with clinical cases. Clinical signs of tetanus in horses usually include history of a wound (typically within the preceding month) and stiffness, lameness, or colic. These signs generally progress quickly to an abnormal gait, trembling, and muscle spasm. An inability to open the mouth, known as “lockjaw”, may occur. Horses can exhibit profuse sweating, saliva accumulation in the mouth, and may aspirate feed material. Excitement, including loud sounds or bright light, often exacerbates clinical signs. Horses may become very sensitive to touch. Stiffness in the leg muscles may result in a characteristic “sawhorse” stance. Affected horses can progress to severe muscle rigidity, making it difficult to rise, urinate, or defecate. Respiratory failure can occur. Tetanus in elephants Only a few cases of clinical tetanus in elephants have been described in the literature (Goss 1947, Burke 1975, Fowler & Mikota 2006) or have been reported anecdotally for Asian elephants in Southeast Asia. Inspection of the pads and nails is imporatant for the detection of wounds. Sharp objects, like steel nails may have penetrated the pad. (Illegaly) cut off tusks may provide an opportunity for C. tetani to infect the tusk pulpa. After an incubation period of 7-20 days, the elephant will show symptoms similar to those seen in horses. Spasms are usually aggravated when the elephant is startled. Burke reports an 8-year-old female that was unable to open her mouth: "She was hypersensitive to noise and touch, becoming tense and raising her tail. Her body temperature was 37°C (98.6°F, normal range 36–37°C /97–99°F). An elevated body temperature can be expected when there are spasms. Although there were several cracks around the toenails, none of the wounds were thought to be anaerobic. 100,000 units of tetanus antitoxin (TAT) were administered and the next day she seemed somewhat relaxed. However, on the third day she was found in lateral recumbency and in tetanic spasms. A sedative (112 grams of chloral hydrate per rectum) was administered. Periodic sedation was necessary to keep her relaxed. She was raised to her feet with a sling and left in the sling overnight. On the fifth day she was unable to stand without the sling. Over the previous 5 days 360,000 units of TAT were administered subcutaneously. The elephant was kept in a sling and force-fed a slurry of bran mash through a stomach tube for 29 days, at which time she began to masticate and swallow feed"(Fowler & Mikota 2006). Treatment Tetanus antitoxin should be administered at a dose of 225 units/kg body weight, half intravenously, the other half intramuscularly. Anaphylactic shock is a hazard of this therapy because tetanus antitoxin is a horse serum product. Be prepared to administer epinephrine Broad-spectrum antibiotics should be administered to kill organisms that may not be reached with wound cleansing. The elephant should be placed in a non-stimulating environment and tranquilized as appropriate. Supportive care is crucial to success. Be prepared to sling the elephant. Water may be administered by rectal lavage. For food, the author uses a slurry of quick-cooking rolled oats. The quantity of the breakfast cereal selected is put into boiling hot water, allowed to cool, and then diluted to a consistency that may be pumped through a stomach pump. (Fowler & Mikota 2006). Vaccination In a preliminary study, measurable titers against tetanus were achieved in Asian elephants vaccinated with a 1 ml dose of monovalent equine tetanus toxoid followed by a booster at 4 weeks. The titers remained elevated for >1 year; however, the appropriate vaccination interval has not yet been determined. Annual vaccination is commonly practiced, although it is likely that the duration of immunity may be longer. In a study in which 9 Asian elephants were involved, Muir et al (2021) demonstrated that the antibody titers in these elephants remained at adequate levels with little fluctuations when 3-5 years intervals were applied. It is therefore recommended to adhere to the suggested vaccination regime for horses with booster vaccinations every 2-3 years. References tetanus Goss, L.J. 1942. Tetanus in an elephant. Elephas maximus. Zoologica NY 27:5–6. Burke, T.J. 1975. Probable tetanus in an Asian elephant. JZ&WM, vol 6 – 1 22-24 Fowler, M.E. and Mikota, S.K. 2006. Preventive health care and physical examination / Chemical Restraint and General Anesthesia in. In: Biology, Medicine, and Surgery of Elephants. 2006. Ed. Fowler & Mikota page 68-84, 147-148. Lindsay, W. A., Wiedner, E., Isaza, R., Townsend, H. G., Boleslawski, M., Lunn, D. P. 2010. Immune responses of Asian elephants (Elephas maximus) to commercial tetanus toxoid vaccine. Vet Immunol Immunopathol 133 (2-4), 287-289 Transmissible Diseases Handbook. 2019. Infectious diseases Fact sheet TETANUS (Annex 4) Muir, Y.S.S., Bryant, B., Campbell-Ward, M., Higgins, D.P., 2021. Retrospective anti-tetanus antibody responses of zoo-based Asian elephants (Elephas maximus) and rhinoceros (Rhinocerotidae). Developmental & Comparative Immunology 114, 103841.. doi:10.1016/j.dci.2020.103841 https://ceh.vetmed.ucdavis.edu/health-topics/tetanus Tetanus Enterotoxemia (C. perfringens) Enterotoxemia is caused by the toxin of Clostridium perfringens . There are 4 subtypes of C. perfringens, all grwoing under anaerobic conditions that have been associated with elephants: type A, C, D and E. The diagnosis 'enterotoxemia' in based on culture and PCR of the toxin-associated genes in the histological lesions. Clinical manifestation in elephants Although there are few reports of enterotoxemia caused by C. perfringens in elephants , it might be an underreported disease in this species (see references below). Usually the disease has an acute course, with symptoms like diarrhea, colic, lethargy, anorexia and finally collaps in lateral recumbancy. If not treated agressively in time, the elephant usually dies. C. perfringens is an environmental bacterium which can be present in the elephant's gut without doing any harm. Under certain conditions (gastric pH decrease by nutritional overload of easily digestable carbohydrates or badly fermented silage products) it can overgrow the natural gut flora and produce large amounts of toxins that lead to the symtoms described above. Septicemia can lead to multiple abdominal organs involvement, as well as muscles. When young elephants are affected, the disease resembles Elephant Endotheliotropic Herpes Virus-Hemorrhagic Disease ( EEHV-HD ) as the symptoms in both diseases are associated with Disseminated Intravascular Coagulopathy (DIC). In some reports C.perfringens enterotoxemia and EEHV-HD were simultaneously diagnosed in diseased elephants (Boonsri et al. 2018, Costa et al, 2022). The prevalence of C. perfringens in European zoos was studied in 2020: in fecal samples of 86 healthy Asian elephants the presence of type A and type E was PCR-confirmed in 3 animals (2.2%). All fecal samples obtained from 50 African elephants were negative. In an overview of necropsy reports of 226 Asian elephants and 110 African elephants kept in the European Taxon Advisory Group between 1985 and 2018, 4 Asian elephants and 1 African elephant were reported to have died from an ulcerative enteritis caused by C. perfringens (Hes 2022). Few reports on enterotoxima in elephants are available in the literature. One author described the outbreak of C. perfringens in a group of African elephants kept in a European zoo (Göltenboth et al 1974): 2 days after feeding fresh grass, a young elephant developed diarrhea and was lying down more frequently. It was treated with a spasmolytic and vitamin C. The following morning it seemed much better and was returned to the group of 4 young elephants, where it deteriorated within 1 hour and died. At necropsy, severe blood staint edema and gas accumaltion was found in the subcutis of the neck, pharynx and larynx as well as a severe cathharal enteritis and gas accumulation in all internal organs, from which C. perfringens was cultured. A second case in a young elephant of the same herd occured 5 weeks later, again 2 days after feeding fresh grass. Symptoms were even more pronounced and C. perfringens was cultured form all organs (septicemia). The third elephant of the group fell ill a few days later. This animal did not develop diarrhea, but was lethargic and refused to eat and drink for 5 days. Despite of treatment with antibiotics and all kinds of supportive medications (including IV-administration of Clostridium antitoxin), it died after 10 days of illness. At necropsy more chronic lesions were found: enteritis, fatty liver degeneration, bronchopneumonia and myocardial degeneration. In this animal C. perfringens could not be detected. In one fatal case, acute myonecrosis was found in an 8 yr-old Asian elephant, resembling blackleg/ black quarter(C. chovoei) or malignant edema (C. septicum) (Rahman, 2009) . The elephant calf showed clinical signs of sudden illness characterised by loss of appetite with high fever (39°C) and reluctance to walk. The animal was treated with an intramuscular injection of enrofloxacin, 5 mg/kg body weight. The animal did not respond to treatment and its condition deteriorated rapidly. The animal stopped taking feed and water, became recumbent and finally died within 48 h of the onset of clinical signs. At necropsy, dark, discoloured, swollen muscles with rancid odour from the affected region and intramuscular aspirates were observed. C. perfringens was cultured from these lesions and the presence of alpha-toxin genes could be demonstrated by PCR. One case reports describes a fatal infection of Clostridium perfringens type C in an adult Asian zoo elephant (Costa et al. 2022). Evidence of involvement of EEHV4 was demonstrated by qPCR and the presence of intranuclear inclusion bodies in the endothelial cells of the intestinal blood vessels. Treatment of C. perfringens enterotoxemia In most cases it will be hard to make the diagnose in the living elephant. When enterotoxemia is suspected, agressive antimicrobial therapy, preferably based on an antibiogram and supportive therapy is mandatory. Depending on their bioavailability, antibiotics should be given IV or IM. Oral administration might result in low absorption from the intestines due to the enteritis. IV and rectal administration of fluids and IM NSAIDs are highly recommended. Early treatment of enterotoxemia is essential for the survival of the elephant. The list of recommended drugs is shown below. The clinician should not hesitate to administer all these drugs and should even sedate the sick elephant if needed for its treatment. Circulatory support: Rectal fluids: Luke-warm water 10-20 ml/kg BW TID or QID, up to every 2 hours Crystalloids: I V as a bolus of 0.3-4 ml/kg BW Antibiotic treatment: Penicillins are the first choice antibiotics. Penicillin G can be given IV and will have a quick action. Amoxicilline is a good representative as well ( 11 mg/kg IM q 24 h). Pain management: Pain management (opioids, NSAIDs) is recommended if there are clear signs of pain or discomfort: Butorphanol: 0.008-0.014 mg/kg IM Q 4 hrs Flunixin: 0.25 to 0.5 mg/kg IM SID Omiprazole: 0.7 to 1.4 mg/kg PO SID Anti-inflammatory treatment: Gluco-corticosteroid drugs are indicated in case of suspicion of DIC. Dexamethasone: 0.05-0.1 mg/kg IV or IM SID for 1-3 days. Prevention Although there is no scientific data on the efficacy of preventive vaccination, several zoos do practice annual vaccination with a multivalent vaccine. Care should be taken not to use an oil-based adjuvant, as these may cause necrosis around the injection site . As a general precaution, major diet changes should always be introduced slowly. When large amounts of easily digestible carbohydrates (like fresh grass, large amount of vegetables and silage) become available as a major food component, the diet change should be made over period of 7-10 days in order to allow the intestinal flora to adapt to the new diet. References: Bacciarini, L.N., Pagan, O., Frey, J., Grone, A., 2001. Clostridium perfringens b2-toxin in an African elephant (Loxodonta africana) with ulcerative enteritis. Vet. Rec. 149, 618–620. Boonsri, K., Somgird, C., Noinafai, P.,Pringproa, K., Janyamethakul, T., Angkawanish, T., Brown, J.L., Tankaew, P., Srivorakul, S., and Thitaram, C. 2018. Elephant Endotheliotropic herpes Virus associated with Clostridium perfringens infection in two Asian elephants (Elephas maximus) calves. Journal of Zoo and Wildlife Medicine 49(1): 178–182, 2018. Costa T, Rocchigiani G, Zendri F, Drake G, Lopez J, Chantrey J and Ricci E. 2022. Elephant Endotheliotropic Herpesvirus 4 and Clostridium perfringens Type C fatal Co-infection in an adult Asian Elephant (Elephas maximus). Animals 2022, 12, 349. https://doi.org/10.3390/ani12030349. Das A, Mazumder Y, Dutta B.K., Shome B.R., Bujarbaruah K.M. and Sharma G.D. 2008. Clostridium perfringens type A beta2 toxin in elephant (Elephas maximus indicus ) and pygmy hog (Sus salvanius ) with haemorrhagic enteritis in Assam, India. Afr. J. of Microb. Res. Vol.(2) pp. 196-201 2008. Goltenboth, R. and Klos, H.-G. 1974. On several diseases and causes of death in elephants in the Berlin Zoo (Zu einigen erkrankungen und todesfallen bei elefanten des Zoologischen Gartens Berlin. XVI Verhandlungsbericht Internationalen Symposiums Erkrankungen Zoo und Wildtiere, Berlin, Akademie Verlag, pp. 175–179. Hes. A 2022.Thesis: Lesions found in the post-mortem reports of the Asian (Elephas maximus) and African (Loxodonta africana) elephants of the European Association of Zoos and Aquaria. University of Veterinary Medicine BudapestBudapest, 2022. Rahman H., Chakraborty A., Rahman T., Sharma R., Shome B.R. and Shakuntala I. 2009. Clostridial myonecrosis clinically resembling black quarter in an Indian elephant ( Elephas maximus ) Rev. sci. tech. Off. int. Epiz., 2009, 28 (3), 1069-1075, 2009. To page top Enterotoxemia Clostridioides difficile (previous name: Clostridium difficile ) Another potential pathogenic Clostridioides sp . is C. difficile . Clostridia are commonly encountered in the intestinal tract without being associated with disease, as soil and feedstuffs seem to be natural habitats for these organisms. However at rare occasions C.difficile can cause a severe, fatal enterocolitis. As in entertoxemia, the disease can have a fast fatal outcome within 2-3 days. A more chronic course of enteritis was associated with the same strain of C.difficile that had killed 2 adult Asian elephants in the same herd a few days before. This elephant recovered over a period of 5 weeks of severe illness with diarrhea. It was speculated that the feeding of large quantities of broccoli, a rich source of sulforaphane, which has been shown to inhibit the growth of many intestinal microorganisms might have triggered a subsequent overgrowth by C. difficile (Bojesen et al. 2006). The diagnose of C.difficile associated disease is based on aerobic and anaerobic culture and PCR, including the demonstration of toxins. Special culture media have been developed to grow C. difficile . Treatment Metronidazole and vancomycin are used to address clinical disease caused by C.difficile . The sensitivity to these drugs was studied in 6 isolates of C.difficili obtained from feces of clinically healthy Asian elephants (Sthitmatee et al. 2013). There was no evidence of resistance of these isolates to metronidazole and vancomycin. However, sensitivity may vary per country, depending on the antimicrobial policy followed. References Bojesen A.M., Olsen K.E.P. and Bertelsen M.F. 2006. Fatal enterocolitis in Asian elephants (Elephas maximus) caused by Clostridium difficile . Veterinary Microbiology 116 (329–335), 2006. Sthitmatee N., Warinrak T. and Wongkalasin W. 2013. Susceptibility of Clostridium difficile Isolated from Healthy Captive Asian Elephants to Metronidazole and Vancomycin. Thai J Vet Med. 43(2): 313-316. To page top Clostridium difficile Malignant edema Malignant edema (Clostridium septicum ) There is one report on malignant edema in an adult Asian elephant that lived in a European zoo (Goltenboth et al, 1974). The elephant died within 48 hours after the onset of the symptoms, that consisted of lethargy and general malaise. Severe edema was found in the entire intestinal tract. Clostridium novyi Report by Dr. Arun Zachariah et al. (Kerala Forests and Wildlife Department, Kerala, India) 19th International Elephant Conservation and Research Symposium, 2023 Chiangmai - International Elephant Foundation Since 2014, unusual mortality was observed in Asian elephants in Kerala state of South India.26 per acute mortalities were observed in a wild elephant population within a span of two years. Whereas two captive elephants were found dead with similar lesions but sporadic in nature. These animal deaths were per acute with quick autolytic changes and discharge of serosanguineous fluids from external orifices mainly anus. Possibility for Anthrax was ruled. Detailed autopsies were conducted in all the animals. Gross pathological lesions were identified as, petechial to echymotic hemorrhages in major organs, liver was friable with accumulation of gas in the parenchyma, blackening of the sub-cutaneous muscles and accumulation of serosanguineous fluid in the abdominal and pericardial cavity. Gram-positive spore bearing bacteria were seen in blood smear examination. Histologically, there was coagulative necrosis surrounded by inflammatory cells and large numbers of gram-positive rods were observed. High throughput sequencing of conserved 16S ribosomal gene revealed abundance of C.novyi in various tissue samples. Further, liver samples tested by PCR were positive for C. novyi type B flagellin and alpha toxin genes, but negative for other pathologic clostridia. Clostridium novyi type B causes infectious necrotic hepatitis in sheep and less frequently in other species. However reports of C.novyi infections in wild animals were scanty except for few species like Bighorn sheep and farmed Reindeer but not in outbreak proportions. This is the first report of C. novyi infection and mortality in Asian elephants in a large scale. Clostridium novyi Black leg Black leg (Clostridium chauvoei, C. septicum ) There is one report of black leg in a 50 yr-old Asian elephant kept in Australia (Prescott, 1971). The animal was on a diet of fresh grass (grazing), eucalyptus and lucerne hay. Two days before it died, the elephant had been off food and fell against a round timber pallisade, hurting its right shoulder. The following day it was depressed and fell down again and was unable to stand up. It died 52 hours after the first signs of illness. At necropsy the right foreleg was swollen from carpus to shoulder. On incision of the swollen muscles, sero-sanguineous fluid and gas bubbled from the emphysematous tissues. Clostridium septicum was cultured from this fluid. The wall of the stomach and large parts of the intestines was thickened, edematous and inflamed, while the spleen was very distended. References 1. Goltenboth, R. and Klos, H.-G. 1974. On several diseases and causes of death in elephants in the Berlin Zoo (Zu einigen erkrankungen und todesfallen bei elefanten des Zoologischen Gartens Berlin. XVI Verhandlungsbericht Internationalen Symposiums Erkrankungen Zoo und Wildtiere, Berlin, Akademie Verlag, pp. 175–179. 2. Prescott C.W> 1971. Black leg in an elephant. Veterinary Record 83, pp 598-599. To page top To page top Botulism Botulism is caused by the toxin of Clostridium botulinum (FAO). Clostridial organisms are strict anaerobes, meaning they do not grow in the presence of oxygen or in healthy, well-oxygenated tissues. Clostridium botulinum produces seven different neurotoxins, each of which is distinct and different enough from the others that antibodies against one type do not protect an animal against botulism from another type. Botulinum toxin is one of the most potent biotoxins known. Sometimes the onset of Clostridial disease is so rapid that no clinical signs are ever manifested; animals are simply found dead. The toxin is formed by the organisms outside the elephant under certain circumstances, characterized by an anaerobic environment (pH ± 4) and an environmental temperature between 10 and 50°C (FAO). Examples of these sources are poor-quality silage or poor-quality drinking water (anaerobic conditions in a pond without streaming water). Botulism in elephants Botulism was first reported in Asian elephants in a German zoo (Elze 1962). One adult elephant became paralyzed and died within one day. A cause of this sudden death could not be determined. Four days later an adult herd mate started to show the first signs of paralysis. Initially the animal remained standing with the neck stretched in forward direction, mouth opened, salivating and teeth grinding. The elephant only ate some fruits and was extremely weak in all its legs and the trunk. Pulse frequency was 68/minute. The animal went down sleeping several times, but with great strength it managed to get up by itself. On the second day a Botulism-antitoxin serum (Sachsisches Serumwerken A.G. Dresden, DDR) is administered (3x50 ml s.c.). On the next the animal is given 37 x 50 ml of this antitoxin serum, partly s.c., partly intramuscular in 50-100 ml portions in a time span of 2.5 hours. The total dose given was 20-40 times the dose given to humans. No adverse reactions were observed. During the first 8 hours after the administration of the antitoxin, the elephant went down and was almost unresponsive, until it managed to stand up again with the help of human manpower. In the following hours it started eating some fruits and hay. In the following week the animal recovered completely. The diagnosis ‘Botulism’ was made based on the symptoms and the positive reaction on the administration of the Botulism antitoxine. Other drugs that were given throughout the disease episode were caffeine, metamizole, calciumgluconate, Methiovert® (?), Algopyrin®, papaverine and streptomysine-penicilline. A second case of botulism in elephants was reported by Gart et.al (1977). Unfortunately, no details of that report could be retrieved. In 2017 a severe outbreak was reported in a captive bachelor herd of 6 Asian elephant bulls in Spain, which resulted in the death of 5 of the elephants. For the case report “Botulism in elephants”, click here . Botulism has been reported in horses that were exposed to botulism toxin in the feed, usually involving type B and C toxin. Toxin might be present as a contaminant in feed, or if there are droppings or carcasses of small rodents in the feed bunk or water tub. One problem occurs when rodents or other animals die in a field of forage, and a carcass is incorporated into a bale during baling. Contaminated hay cubes have been responsible for at least one large outbreak of botulism in horses. Even if a carcass has undergone dessication (it’s dried out) or is unrecognizable in a flake of hay, enough spores can remain to kill a horse. Toxico-infectious botulism is the second most common form of botulism in horses, and this arises when the bacterium itself is ingested from soil and colonizes the gastrointestinal tract. As it grows inside the body, it produces the toxin, and signs of disease become apparent as toxin is absorbed into the bloodstream from the intestinal tract. Clostridium botulinum type B has been associated with this form of botulism. Symptoms of botulism in elephants The typical symptoms include flaccid muscle paralysis. The major clinical signs consisted of gradually increasing general weakness, shivering, muscle fasciculations (involuntary contractions) or trembling and shaking, particularly in the shoulder and flank muscles, mild to heavy salivation, inability to swallow and stand and properly use the trunk and dilated pupils that respond poorly on light. Death can occur within a few days as a result of respiratory distress. Click here to see for a full description of the histological lesions in the case report described here . Treatment, diagnosis and prevention Treatment of botulism is very challenging: when treatment is started in the early phase of the disease, the administration of specific antitoxins might be helpful, as suggested in the 1962 case. In horses respiratory support is important, however challenging in elephants. Soft bedding should be provided. Eye protection with an eye ointment is important when the elephant has gone into lateral recumbency. During the phase of complete paralysis, the administration of oxygen through the trunk will probably support the oxygen exchange in the elephant’s lungs. A definitive diagnosis of botulism can only be made by performing a mouse bioassay test. Prevention: there is no commercially available vaccine against botulism, except for type B (AAEP) References Andrés Gamazo PJ, Pavón E, Stumpel J, Bouts T, Schaftenaar W, Kik M, de los Ángeles Jiménez Martínez M. 2023. Botulism outbreak in Asian elephants: histopathological findings at necropsy. Poster at ESVP-ECVP Congress, August 2023, Lisbon. Elze, K. 1962. Botulism in an elephant (Über Eine Unter dem klinischen bild des botulismus verlaufend Erkrankung beim elephanten). 4th Verhandlungsbericht Internationalen Symposiums Erkrankungen Zoo und Wildtiere, Berlin, Akademie Verlag, pp. 259–271. Fowler M.E. 2006. Infectious diseases. In: Biology, Medicine and Surgery of Elephants, Ed. Fowler and Mikota, Chapter 11, Infectious diseases Garlt, C., Kiupel, H. and Ehrentraut, W. 1977. Botulism in elephants (Ein beitrag zum Botulismus bei elefanten). 21st Verhandlungsbericht Internationalen Symposiums ErkrankungenZoo und Wildtiere, Berlin, Akademie Verlag, pp. 207–211. Websites: FAO: https://www.fao.org/3/t0756e/T0756E03.htm American Association of Equine Practicioners (AAEP): https://aaep.org/guidelines/vaccination-guidelines/risk-based-vaccination-guidelines/botulism Botulism

The morphology of elephant blood cells is described and demonstrated by photos. To hematology Hematology gallery Compiled by: Willem Schaftenaar and Fieke Molenaar On this page we give examples of normal blood cells stained with Wright-Giemsa. An excellent description of normal and abnormal white blood cells in elephants was published by Stasi et al in 2017. Click here to read that article. Morphology of blood cells, stained with Wright-Giemsa Wright-Giemsa stained blood smear of a healthy adult Asian elephant displaying normal erythrocytes, 1 heterophil, 1 bi-lobed monocyte and several thrombocytes (Courtesy: Rotterdam Zoo). Wright-Giemsa stained blood smear of a healthy adult Asian elephant displaying normal erythrocytes, 1 bi-lobed monocyte, 1 lymphocyte and several thrombocytes (Courtesy: Rotterdam Zoo). The images below were published in the Proceedings of the Zoo and Wildlife Health Conference 2020, 23-31: Molenaar F.M. 2020. Developing haematology skills to enable decision making in suspected cases of Elephant Endotheliotropic Herpesvirus hemorrhagic disease. Heterophil (H), single lobed and bi-lobed monocytes (M), lymphocyte (L). The arrows pont at platelets (Courtesy: Fieke Molenaar). Immature heterophils: bands (Courtesy: Fieke Molenaar). Eosinophil (Courtesy: Fieke Molenaar). Lymphocyte (Courtesy: Fieke Molenaar). Immature lymphocyte (Courtesy: Fieke Molenaar). Monocyte (Courtesy: Fieke Molenaar). Monocytes (Courtesy: Fieke Molenaar). Immature monocytes (Courtesy: Fieke Molenaar). Lymphocyte and 2 monocytes (Courtesy: Fieke Molenaar). Platelets (arrows) (Courtesy: Fieke Molenaar). Erythrocytes: "codocytes" (target cells with a bulls-eye appearance) occur naturally in elephants (Courtesy: Fieke Molenaar). Fragmented erythrocytes Fragments of erythrocytes (schistocytes) as can be seen in elephants suffering of Disseminated Intravascular Coagulation (e.g. EEHV-HD) (Courtesy: Fieke Molenaar). To page 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?