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Prevalence, symptoms, treatment and vaccination against anthrax (Bacillus anthracis) in elephants are described. To infectious diseases Anthrax This figure gives a nice overview of the epidemiological cycles of Bacillus anthracis (https://anipedia.org/resources/anthrax/1203 ). Anthrax infection in humans Human anthrax infections are often contracted during work activities in oneofthe following fields: Tanneries Wool sorters Bone processors Slaughterhouses Laboratory workers When humans become infected, the disease is usually presented as skin wounds that heal very slowly. The bacteria can penetrate the skin if they come in contact with a fresh skin wound. These photos demonstrate the type of wound that results from such an infection. The person with the wound on the left image worked on a cattle carcass that died from anthrax. While handling this carcass, he injured himself by a sharp bone fragment that was infected with the anthrax bacteria ( https://www.microbiologybook.org/ghaffar/anthrax-pennsylvania.htm ). The person on the right image is probably a tannery worker, who infected himself by rubbing his knuckles on the skin of an animal that died of anthrax ( http://www.fao.org/ag/againfo/programmes/en/empres/news_070212.html ) If untreated or if the infected wound is big, the bacteria can spread in a large area around the wound, as is shown here. This severe wound needs immediate treatment with the right antibiotic. Anthrax spores can also be inhaled. In the lungs the anthrax bacteria can cause a very severe inflammation. On the left image you can see an X-ray of healthy lungs, with a clear heart shadow. On the right X-ray you can distinguish a big mass in the thorax that does not allow the x-rays to get through. If this disease is left untreated until obvious symptoms occur, it is usually fatal. This patient had a business where he made drums using cattle and goat skins imported from Africa. He died 1 day after this X-ray was made. (https://www.microbiologybook.org/ghaffar/anthrax-pennsylvania.htm ) Anthrax infection in animals Typically, the incubation period is 3–7 days (range 1−14 days). The clinical course ranges from peracute to chronic. The peracute form (common in cattle and sheep) is characterized by sudden onset and a rapidly fatal course. Staggering, dyspnea, trembling, collapse, a few convulsive movements, and death may occur in cattle, sheep, or goats with only a brief evidence of illness. Often, the course of disease is so rapid that illness is not observed and animals are found dead. A very characteristic feature of acute anthrax is free non-coagulating blood running from body openings, due to the disturbed coagulation. The disease in horses may be acute. Signs may include fever, chills, severe colic, anorexia, depression, weakness, bloody diarrhea, and swellings of the neck, sternum, lower abdomen, and external genitalia. Death usually occurs within 2–3 days of onset. Anthrax bacteria disturb the natural blood coagulation. This results in bleedings in the skin and all internal organs. Non-coagulated blood is collected in the lymph nodes, while free-running blood appears from all openings. These symptoms usually lead to a sudden death. Anthrax can affect multiple species, like cattle and wild ruminants (greater kudu), zebras as well as predators (lion). Note the running blood from nostrils or eyes in all these animals and the small bleedings in the skin of the kudu. (https://anipedia.org/resources/1203) Multiple outbreaks of anthrax in wild hippopothamus has been reported in several southern African countries ( https://www.sciencealert.com/anthrax-outbreak-suspected-to-have-killed-more-than-100-hippos-in-namibia ) Animal to animal transmission There are several ways of transmission of B. anthracis between animals. Animals grazing in areas where anthrax victims have been buried, can be infected when the carcass remnants are digged up either by the feeding animal or through human activities (road or building constructions). Flies that have fed on an anthrax-carcass can easily spread the bacteria through their droppings that remain on leaves. Predators (big cats) that feed on infected carcasses can become infected and die of anthrax. Flies that feed on an infected carcass may spread B.anthacis through their droppings as illustrated on these images (https://anipedia.org ). Anthrax in elephants Anthrax in elephants is usually a gastro-intestinal infection. The animal ingests the spores while feeding food or water contaminated with spores. After an incubation period of a few days, the animal dies of septicemia. Multiple cases have been reported from several range countries in Asia (Kumaraguru A. et al. 2015). In some areas Asian elephants play a role in the transmission of anthrax between wildlife and farm animals (Walsh M.G. et al. 2019). Like in other mammals, symptoms consist of rapid detoriation after infection. Usually the elephant is found dead before symptoms were observed. Running blood from the trunk, mouth, eyes, rectum or vagina should alarm the finder of the carcass for this being an anthrax case. Anti-PA antibodies were detected in elephants, which suggests that they can mount adaptive immune responses against anthrax. In addition, these results suggest that elephants can be infected with anthrax and survive infection under some circumstances (Cizauskas et al. 2014). A fatal case of anthrax in a 15-yrs-old African elephant was reported from a wildlife park in Nigeria (Okewole, 1993). Frequent urination, restlessness and weakeness of the hind quarters were observed prior to death. A co-infection with Cowdria ruminatium was diagnosed at post mortem examination (coccoid intracytoplasmatic bodies in the endothelia of the brain). A wild Asian elephant that died of anthrax in the forest of Myanmar. Note the amount of free running blood around the head. Photo courtesy: Myanmar Forest Police A wild Asian elephant that died of anthrax in the forest in India (Kumaraguru A. 2015) Treatment Early detection of the disease is essential, though difficult. Multiple classes of antibiotics can be used if treatment is started in time: oxytetracycline, penicillins, aminoglycosides, fluoroquinolones, macrolides, and sulfonamides. Dosages can be obtained from the website of Elephant Care International: https://www.elephantcare.org/formulary Diagnosis (post-mortem) Post mortem findings in elephants are: Bleedings In and under the skin Around muscles In organs Free blood in the intestines Free blood in the lungs Free blood in the abdomen Edematous swelling of the skin Swollen spleen with bleedings Liver and lymph nodes are swollen and contain a lot of blood Disposal of an anthrax carcass If a dead elephant is suspected of anthrax, a full necropsy is not recommended. A blood smear from a small incision made in an ear should first be made and examined microscopically for the presence of Gram-positive stained rods, lying in chains, sometimes accompanied by spores. The carcass should be disposed off as soon as possible in a proper way. The disposal must be done following the next steps: To minimize the spread of blood, you should try to plug the openings (trunk, ears, mouth, anus, vulva) with non-absorbent material. You can also wrap the head of the elephant in plastic and tape it with duct tape or tie it with a rope to the skin of the neck. Don’t move the animal around Incinerate the carcass if possible If incineration is not possible, burry the carcass as deep as possible. Use heavy excavating equipment (backhoe loader) to dig a deep, large hole, at least 2 meters deep Disinfect all materials that have been in contact: 10% formalin or 5% lime solution (sodium hydroxide) Necropsies of any animal should always be performed with great care. If there are signs of anthrax, a peripheral blood smear should always be examined first. If accidently the diagnose was missed, any signs of internal bleedings should alarm the prosector. B. anthacis can be cultured quite easily. Every necropsy should be performed with adequate body protection: proper eye protection, a respiration mask, long gloves, rubber boots and protective clothing. Vaccination Elephants can be vaccinated against anthrax with commercially available vaccines. This is highly recommended in areas where anthrax is seen in farm animals or if there is a history of anthrax in elephants in that area. References/further reading Berry HH. 1993. Surveillance and control of anthrax and rabies in wild herbivores and carnivores in Namibia. Rev Sci Tech 12(1):137–146.Cizauskas CA, Bellan SE, Turner WC, Vance RE, Getz WM. 2014. Frequent and seasonally variable sublethal anthrax infections are accompanied by short-lived immunity in an endemic system. J Anim Ecol 83(5):1078–1090 Hanna P., 1998. Anthrax pathogenesis and host response. Curr Top Microbiol Immunol 225:13–35 Turnbull PC, Bell RH, Saigawa K, Munyenyembe FE, Mulenga CK, Makala LH. 1991. Anthrax in wildlife in the Luangwa Valley, Zambia. Vet Rec 128(17):399–403. Kumaraguru A., Kumaraguru Arumugam , N.S. Manoharan , Ramakrishnan Balasundaram . 2015. Prevalence and disease management with reference to anthrax in the Asian elephant (Elephas maximus) in the Sathyamangalam Wildlife Santuary, Tamil Nadu, India & Indash; A case study. Scientific Transactions in Environment and Technovation, 5(1): 48-51. Okewole P.A., Oyetunde I.L., Irikanulo E.A., Chima J.C., Nwankpa N., Laleye Y., Bot C. 1993. Anthrax and cowdriosis in an African elephant (Loxodonta africana). Walsh, M.G., Mor, S.M., Hossain, S., 2019. The elephant–livestock interface modulates anthrax suitability in India. Proceedings of the Royal Society B: Biological Sciences 286 EAZWV Transmissible Disease Fact Sheet ANTHRAX American Association of Zoo Veterinarians Infectious Disease Manual ANTHRAX Recommended websites: Merck Veterinary Manual. 2021. https://www.merckvetmanual.com/generalized-conditions/anthrax/overview-of-anthrax OIE (Organization for Animal Health: https://anipedia.org/resources/anthrax/1203 FAO: http://www.fao.org/home/search/en/?q=anthrax Microbiology and Immunology On-line: https://www.microbiologybook.org/ghaffar/anthrax-pennsylvania.htm To page top General information Merck Veterinary Manual (2021) : Anthrax is a zoonotic disease caused by the sporeforming bacterium Bacillus anthracis . Anthrax is most common in wild and domestic herbivores (eg, cattle, sheep, goats, camels, antelopes) but can also be seen in people exposed to tissue from infected animals, to contaminated animal products, or directly to B anthracis spores under certain conditions. Depending on the route of infection, host factors, and potentially strain-specific factors, anthrax can have several different clinical presentations. In herbivores, anthrax commonly presents as an acute septicemia with a high fatality rate, often accompanied by hemorrhagic lymphadenitis. In dogs, people, horses, and pigs, it is usually less acute although still potentially fatal. Toxins are the source of most of the disease symptoms associated with anthrax. Edema toxin complex (EdTx) causes the fluid and edema seen in cutaneous anthrax infections, and lethal toxin complex (LeTx) causes shock and death from systemic anthrax (Hanna, 1998). B anthracis spores can remain viable in soil for many years. During this time, they are a potential source of infection for grazing livestock but generally do not represent a direct risk of infection for people. Grazing animals may become infected when they ingest sufficient quantities of these spores from the soil. In addition to direct transmission, biting flies may mechanically transmit B anthracis spores from one animal to another. The latter follows when there have been rains encouraging a high fly hatch and reporting has been delayed on the index ranch, such that there are 4–6 moribund or dead cattle for the flies to feed on. Feed contaminated with bone or other meal from infected animals can serve as a source of infection for livestock, as can hay muddy with contaminated soil. Raw or poorly cooked contaminated meat is a source of infection for zoo carnivores and omnivores; anthrax resulting from contaminated meat consumption has been reported in pigs, dogs, cats, mink, wild carnivores, and people. Human cases may follow contact with contaminated carcasses or animal products (raw meat, skins of animals that died of anthrax). Flies that have fed on a carcass from an anthrax victim can spread the disease over longer distances. Diagnosis Anthrax can be diagnosed in fresh blood smears taken from the ear. Microscopically, B. anthracis can be recognized as long chains of Gram-positive bacteria. If the smear has been exposed to air, the bacteria may have formed spores that can be easily detected. B. anthracis differs in shape from other Bacillus species, that may contaminate the sample in case the animal has been dead for a longer period. Whereas the bacteria chains of B. anthracis seem to be sharply cut off with a knife, the chains of B. cereus have round edges.

Resting behavior and allonursing in elephants are described in this page. Resting in lateral recumbancy requires a trustful social environment. Comfortable resting is promoted by the provision of sand piles. A case of allonursing (drinking milk from a non-mother) describes this phenomenon in an African elephant that never produced offspring herself. Behavior & Training Resting behavior Behavior & Training Resting behavior Allonursing Case Report: Spontaneous Lactation and Allonursing in a Captive African Elephant (Loxodonta africana ) Date: December 2024 Place: Erfurt Zoo Data provided by: Tina Risch, DVM Introduction Allomothering, the care of an infant by an individual other than the biological mother, is a well-known behavior in social animals, including African elephants (Loxodonta africana). However, allonursing—the act of an allomother providing milk to a non-biological calf—is rare and typically observed in females with previous reproductive experience. This case report describes an unusual instance of allomothering and allonursing by a nulliparous (never pregnant) adult female African elephant in a zoo setting. Case Presentation As a neonate, a male captive African elephant calf (Banjoko) started looking for drinking opportunities from 3 adult females, including its mother. When he was 5 month-old, the 29-year-old female herd member, named Csami, admitted him unrestrictedly (figure 1). Csami, a wild-caught elephant, arrived at the zoo at the age of four and had never been pregnant. The calf's biological mother, Chupa, continued to actively nurse her offspring while at the same time Csami's involvement progressively intensified. Notably, Csami had previously shown nurturing behaviors towards Chupa's older calf, a 4-year-old female. However, Csami's maternal instincts towards the youngest calf manifested to the extent that she began producing a milk-like fluid. Figure 1. The 7-month-old African elephant calf, Banjoko, nursing from Csani, the allomother that never produced a calf herself (Erfurt Zoo, Germany, 2024) Clinical Observations and Milk Analysis A sample of the fluid secreted by Csami was collected and analyzed for fat, protein, lactose, and pH levels. These values were compared to a milk sample obtained from Chupa. The results are summarized in Table 1. The results indicate that Csami's milk-like fluid closely resembled Chupa's milk in composition, suggesting that the fluid could adequately support the calf's nutritional needs with regard to fat, protein and lactose. Table 1. Comparative analysis of milk composition from Chupa (dam) and Csami (allomother). Discussion The phenomenon of allomothering is widely observed in species that rely on cooperative group dynamics, such as lions, seals, and elephants. While allonursing is less frequent, it has been documented in elephants, typically involving females with prior lactation experience. This case represents a rare instance of spontaneous lactation and allonursing by an elephant with no prior reproductive history. The physiological mechanism behind Csami's lactation remains unclear but is must be linked to hormonal or social factors triggered by the presence of the calf. This behavior may enhance calf survival by providing supplemental nutrition and fostering stronger social bonds within the herd. To the best of our knowledge, this case is one of only two recorded instances of allonursing by a nulliparous elephant. The first case was reported from Gangala-na-Bodio Elephant station in Congo, documented by Harald H. Roth in 1961 (figure 2). Figure 2. A 32-month-old African elephant nursing from an allomother that never produced a calf herself (Der Zoologische Garten, 1961) Conclusion This report highlights the complex social structures and nurturing behaviors of African elephants. Csami's spontaneous lactation and allonursing underscore the adaptability and cooperative nature of elephants in captivity. Reference Roth HH. Short communication. Der Zoologischen Garten 26, 1.2, pg 123. 1961. Allonursing

Anchor 1 To necropsy procedure Necropsy reports EEHV-HD Mesenteric hernia Tuberculosis ...............................

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

Abdominal surgery for male castration, laparoscopic ligation of the ovarian pedicles, umbilical hernia and abdominal surgery to treat repeated colics are described here. To procedures Surgery Surgery in elephants usually follows the rules that are applicable to surgery in horses. Standing sedation with or without local anesthesia is required for minor procedures, while general anesthesia (in lateral or dorsal recumbancy) is required for large procedures (such as abdominal surgery) and if standing sedation poses a risk for the surgeons. See for anesthetic procedures the anesthesia page . Abdominal surgery in elephants Access to the elephant's abdomen is restricted to a relatively small area between the last ribs on the cranio-dorsal side, the hind leg on the caudal side fusing together in the ventral midline. Indications for abdominal surgery described in the literature are limited: cesarean sections have all resulted in the death of the dam. However, a dorso-lateral approach has been used for castration of male African and Asian elephants (Fowler 1973, Byron 1985, Fourner 1994). Fourteen male African elephants (12–35 years old) were anesthetized with etorphine and supported in a sling in a modified standing position, and positive pressure ventilated with oxygen (Rubio-Martinez 2014). Anesthesia was maintained with IV etorphine. Vasectomy was performed under field conditions by bilateral, open‐approach, flank laparoscopy with the abdomen insufflated with filtered ambient air. A 4‐cm segment of each ductus deferens was excised. Behavior and incision healing were recorded for 8 months postoperatively. Successful bilateral vasectomy (surgical time, 57–125 minutes) was confirmed by histologic examination of excised tissue. Recovery was uneventful without signs of abnormal behavior. Large intestine lacerations (3 elephants; 1 full and 2 partial thickness) were sutured extracorporeally. One elephant that was found dead at 6 weeks, had no prior abnormal signs. Skin incisions healed without complication. Laparoscopic ligation of the ovarian pedicles has been performed in free ranging African elephants (Stetter 2004). A specially designed 90 cm long operating laparoscope was used to reach for the ovaries. An umbilical hernia was diagnosed in a 2-wk-old Asian elephant (Elephas maximus) by physical and ultrasonographic examinations (Abou-Madi 2004). Umbilical herniorrhaphy was elected because the defect was large (approximately 7 cm long and 10 cm deep) and could potentially lead to incarceration of an intestinal loop. General anesthesia was induced with a combination of ketamine, xylazine, and diazepam and maintained with isoflurane in oxygen. The hernial sac was explored and contained fibrous tissue, fat, and an intestinal loop but no adhesions. The hernial sac was resected and the body wall closed using the technique of simple apposition. Following a superficial wound infection, the surgical site healed with no further complications. There is one anecdotal report on successfull abdominal surgery in a 14-month-old African elephant suffering of repeated colics ( click here for the case report). References Abou-Madi, N., Kollias G.V., Hackett R.P., Ducharme N.G., Gleed R.D., and Moakler J.P. 2004. Umbilical herniorrhaphy in a juvenile Asian elephant (Elephas maximus ). J. Zoo & Wildl. Med35(2): 221–225, 2004. Byron H.T., Olsen J., Schmidt M., Copeland J.F. and Byron L. 1987. Abdominal surgery in three adult male Asian elephants. J. Am. Vet. Ass. 187, 11. Foerner J.J., Houck R.I., Copeland J.F., Schmidt M.J., Byron H.T. and Olsen J.H. 1994.Surgical castration of the elephant (Elephas maximus and Loxodonta africana ). J. Zoo & Wildl. Med. 25 (3), pp 355-359. (Click here for summary) Fowler M .E., Hart R. 1973. Castration of an Asian elephant, using etorphine anesthesia. J. Am. Vet Ass 163, 6. Rubio- Martinez L.M. Hendrickson D.A., Stetter M., Zuba J.R. and Marais H.J. 2014. Laparoscopic Vasectomy in African Elephants (Loxodonta africana ). Veterinary Surgery 43 (2014) 507–514. Stetter M.D. 2004. Laparoscopic surgery in elephants. Int. Elephants Res. Symp. Fort worth, Texas. December 2-5, 2004 Non-abdominal surgery in elephants Surgical procedures not associated with open access to the abdomen are more common. Despite the enormous healing capacity of the elephant skin, wound healing often takes place per secundam, because it is hard to protect the sutured wound against negative mechanical and biological influences. However, even large wounds (like in vaginal vestibulotomy ) will heal completely per secundam, leaving at most a 2 mm fistula ( click here for wound healing in vaginal vestibulotomy). Trunk injuries are hard to repair because of the extreme mobility of this organ. Many attempts to suture large perfortaing trunk wounds have have failed or at best resulted in partial adhesion of the sutured sites. Repair of a perineal hernia has been described ( click here to read this case report).

Broncho-alveolar lavage (BAL) describes: gastroscopy, bronchoscopy, esophagus, trachea, mouth-opener, mouth gag. Approach is done either via the trunk or via the via, always under standing sedation. The purpose of a BAL is to collect samples for culture/PCR (tuberculosis) or histology. To physical examination Sample collection Trunk wash Broncho-alveolar lavage Trunk wash procedure Trunk wash procedure Compiled by Willem Schaftenaar Background The trunk wash procedure was developed as a method for diagnosing tuberculosis or the detection of Elephant Endotheliotropic Herpes Virus. This procedure is an active manipulation at the elephant trunk, which can be performed in free and protected contact systems in non-immobilized elephants after they are conditioned for this procedure. The principle is that a sterile 0,9% saline solution (approx. 100 ml) is injected in each nostril of the trunk. The trunk has to be lifted actively by the elephant or passively by the keeper so that the solution is running up to the base of the trunk. The mixture of the solution and trunk mucus is collected in sterile plastic bags by active blowing of the elephant through its trunk (training required). The staff should protect themselves against spilling trunk content into their face. A full trunk wash procedure requires 3 different trunk washes performed within a period of 7 days. Each sample must be sealed and stored at 4°C. Depending on the quality of the samples, the diagnostic lab can decide to pool the samples for culture/PCR. Samples must be shipped to the TB-diagnostic lab immediately after the 3-rd sample has been taken. The maximum storage period at 4°C is 7 days. NB: follow the EU guideline for shipment of potentially hazardous biomaterials. For the (q)PCR detection of EEHV, the sample can be shipped directly or kept frozen at -20°C until shipment. Trunk wash in a non-contact situation requires a full anesthesia of the elephant and a portable fluid pump and sucking system, which allows the operation under sterile condition. The external pump and sucking system will be connected to a sterile PVC tube (1 cm diameter, with distance markers) with a length of approx. 2 meter. The amount of sterile solution and the collection bag are like described before. In non-contact situations, a bronchoalveolar lavage (BAL) under standing sedation is the preferred procedure. Training for a trunkwash procedure Broncho-alveolar lavage (BAL) and Gastroscopy Broncho-alveolar lavage Compiled by Willem Schaftenaar Procedure A bronchoalveolar lavage (BAL) may be indicated when a sample from the deeper regions of the lungs is required, such as for the diagnosis of tuberculosis (TB). Gastroscopy is a procedure that allows direct visualization of the esophagus and stomach. It enables the collection of biopsy specimens and stomach contents, and it can also be used to perform a lavage for TB diagnosis. Fluids obtained through BAL are additionally used for the isolation of mononuclear cells and for cytological evaluation (Engel, 2005). The procedure has been performed in free-ranging savanna African elephants under general anesthesia (Engel, 2005). The protocol described here outlines a workflow for the successful isolation and characterization of alveolar cells, predominantly alveolar macrophages, from BAL fluid. Differential cell counts and cellular characterization were carried out. This technique for isolating alveolar mononuclear cells provides a foundation for further investigation into the functions of respiratory immune cells. Under more controlled conditions, the procedure can also be performed under standing sedation . There are 2 ways to approach the alveoli: 1. Trunk approach An endoscope measuring 10–12 m in length is advanced through the trunk ( Hermes et al, 2017 ). The main advantage of this method is that the operator can remain outside the enclosure. However, the procedure requires an extra-long endoscope, which is not readily available. To facilitate passage of the endoscope alongside the cartilage plate in the trunk, bilateral block anesthesia of the nerve rami at the base of the trunk has been recommended (Hildebrandt et al.). Nonetheless, D. Schmidt has reported performing a similar procedure without block anesthesia (pers. comm., 2019). Once advanced, the endoscope allows visualization of the inner walls of the trachea and bronchi for bronchoalveolar lavage; biopsy samples can also be collected if required. In addition, the endoscope can be directed into the esophagus to perform gastroscopy or gastric lavage. 2. Oral Approach In this method, a 5 m long endoscope is introduced through the mouth. The primary disadvantage is that the operator must remain inside the elephant enclosure. A specialized mouth opener for elephants is required to provide access to the oral cavity. The endoscope may be guided manually into the trachea or introduced through a rigid plastic tube, which can be advanced relatively easily into either the trachea or the esophagus. Once within the trachea, the bronchial branches can be examined. Abnormalities may be assessed, and biopsy samples collected. Bronchoalveolar lavage samples are obtained by instilling 50–60 ml of 0.09% sterile saline into a bronchus, followed by aspiration of the fluid. For TB diagnosis, this procedure is repeated three times in each lung. Collection of stomach fluid and broncho-alveolar lavage in an adult African elephant by Dr. Imke Lueders ( https://www.geolifes.com/en/services/index.html) References: Engel S.C., Kerr T.J., van der Spuy G.D., Jooste T., Buss P.E., Johns J.L., Miller M.A., Kleynhans L.2025. Optimisation of bronchoalveolar lavage fluid preparation for mononuclear cell isolation and cytologic evaluation in free-ranging African elephants (Loxodonta africana ). Veterinary Immunology and Immunopathology, Volume 286 , August 2025, 110974. https://doi.org/10.1016/j.vetimm.2025.110974 Hermes R et al. 2018. Bronchoalveolar lavage for diagnosis of tuberculosis infection in elephants. Epidemiology and Infection https://doi.org/10.1017/S0950268818000122 To page top

This page contains the links to official documents of the European Association of Zoos and Aquaria (EAZA) and the American Association of Zoos and Aquaria (AZA) with regards to elephant management and disease control: - EEHV-monitoring of calves -EEAV-treatment protocol -EEHV-antibody monitoring -Necropsy forms -Reproduction guideline -TB-recommendations -Elephant transport protocol -Vaccination advice -How to make a blowpipe -How to make a mouth opener Best Practice Guideline EAZA EEHV EEHV monitoring calves EAZA EEHV treatment protocol EAZA EEHV antibody monitoring EAZA Necropsy form EAZA Necropsy form AZA Reproduction guidelines EAZA TB recommendations USA TB recommendations EAZA Transport protocol EAZA Vaccination advice EAZA EDV Tusk fracture guideline How to make a blow pipe syringe How to make a mouth opener Urine collection for progesterone Hematology and urinalysis manual Elephant Care Manual (FAO) Musth management and Care Hand-raising manual Documents

This case report describes a colic episode in an adult Asian elephant. Salmonella sp. was identified in a fecal sample taken during this period of colic. - colic -Salmonella To colic general information CAse report Colic and Salmonellosis in an adult Asian elephant Date: Place: Data provided by: History This adult multiparous female had been on GnRH-vaccine for over 4 years. Because of chronic joint disease, the elephant had been on phenylbutazone for over 1 year in combination with omeprazol. Sudden onset of apathy, anorexia and hardly drinking water. Normal feces. Occasionally the elephant goes into a sitting position or lateral recumbancy, showing moderate straining activities. After this labor-like behaviour, herd mates investigate the perineal area of the elephant with their trunk. Differential diagnose: Labour, colics (intestinal, uterine or urinary) Treatment The administration of phenylbutazone was discontinued No specific treatment was given on the first day. Treatment results During the night the elephant became more active and the symptoms decreased. The next morning, the animal behaved normal. Diagnostic notes Salmonella sp. was cultured from the feces on the day it showed the above mentioned symptoms To page top

A ±4.5-yrs-old male African elephant calf had been rescued from the wild after being injured in a bush fire. While in the rescue facility, it developed episodes of “choke”, caused by impaction of the esophagus with ingested foodstuff. This resulted in regurgitation, and the inability to eat and drink without the food or liquid dribbling out of the animal’s mouth. Multiple treatment interventions under general anesthesia are described. Case report Esophagus impaction in a 4.5-yrs-old African elephant Date: 2019-2021 Place: Botswana Data provided by: Rob Jackson DVM History “Choke” symptoms can be associated with: Congenital abnormalities of the upper digestive system; symptoms usually show up when the animal is weaned and starts eating solid food. Megaesophagus, which can be congenital or acquired; Foreign bodies that get stuck in the upper digestive system; Impaction or blockage of the stomach/duodenum; Abnormal function of the cardiac sphincter which is the valve allowing food to flow into the stomach. Blockage of the upper digestive system can cause damage to the esophagus resulting in strictures and narrowing, which makes the problem worse or even necrosis and rupture of the oesophagus. Regurgitation can result in food and liquid entering the trachea and the lungs. This causes a foreign body pneumonia, which in chronic cases can result in the eventual death of the animal. A ±4.5-yrs-old male African elephant calf had been rescued from the wild after being injured in a bush fire. While in the rescue facility, it developed episodes of “choke”, caused by impaction of the esophagus with ingested foodstuff. This resulted in regurgitation, and the inability to eat and drink without the food or liquid dribbling out of the animal’s mouth. “Choke” symptoms can be associated with: Congenital abnormalities of the upper digestive system; symptoms usually show up when the animal is weaned and starts eating solid food. Megaesophagus, which can be congenital or acquired; Foreign bodies that get stuck in the upper digestive system; Impaction or blockage of the stomach/duodenum; Abnormal function of the cardiac sphincter which is the valve allowing food to flow into the stomach. Blockage of the upper digestive system can cause damage to the oesophagus resulting in strictures and narrowing, which makes the problem worse or even necrosis and rupture of the oesophagus. Regurgitation can result in food and liquid entering the trachea and the lungs. This causes a foreign body pneumonia, which in chronic cases can result in the eventual death of the animal. Treatment At first consultation, the elephant was not eating and was salivating. Under standing sedation, a stomach tube was advanced into the esophagus which immediately created passage. Painkillers, antibiotics, and Buscopan were given The cause of the blockage could not be determined. Ten weeks later, the animal showed similar symptoms, however, they were more severe and they had possibly been going for longer than the previous episode. Awaiting the arrival of the vet, the animal was given Buscopan, antibiotics and anti-inflammatories. As there was no improvement, the elephant was sedated again. This time, 4 sedations during 2 days were required before the blockage of the esophagus could be cleared. High volumes of fluids were given intravenously, tubes of different diameters were introduced (one for flushing with water and one for drainage), and foodstuff was removed mechanically. The impaction could be visualised with a three-meter endoscope as twigs and leaves jammed proximal to the cardiac sphincter. The esophagus appeared enlarged and flaccid. The wall of the stomach looked normal at endoscopic inspection. The animal was treated with a long course of antibiotics, liquid food slowly changing to solids over two months and he recovered well. Four months later the animal once again showed signs of discomfort, inappetence, regurgitation and salivation. Finally he vomited chewed bark and milk. He did not respond to the treatment with antibiotics, NSAIDs and Buscopan. He was sedated again for three hours, initially standing and then recumbent. The esophagus was blocked and passage of a tube failed. However, large volumes of chewed bark could be removed manually from the oro- and nasopharynx. The pharynx and esophagus were completely blocked with chewed bark. A large-bore tube was introduced into the proximal esephagus and a small-bore tube within it attached to a hose pipe was used to flush the esophagus and pharynx. At the same time high volumes of intravenous fluids and rectal fluids were administered. After this procedure, antibiotics and NSAIDs, steroids were given for several days. Sildanefil rectally was used to try and relax the cardiac sphincter. The following day the elephant was anesthetized and went into lateral recumbency. Medetomidine/butorphanol was used for induction of anaesthesia, which was maintained with intravenous ketamine. A cuffed endotracheal tube was inserted into the trachea. The two tubes as described above were introduced into the esophagus. Large volumes of finely chewed bark were flushed from the esephagus, through the mouth and trunk. A handful of 12 mm gravel was also recovered. Eventually the esophagus and the stomach were cleared from these materials. No abnormalities gross lesions were seen with the endoscope. The esophagus was suspected to be flaccid and dilated, with possible damage at the level of the cardiac sphincter, possibly caused by impaction with gravel. During anaesthesia high volumes of intravenous and rectal fluids were given. Grey, hard stools were being passed irregularly. A secondary impaction as a result of pain and dehydration was suspected. No discomfort was observed. Fluid, intravenous and rectal continued during several days after anaesthesia. Finadyne was given at lower dose to treat the impaction. Oral fluids were being swallowed and volumes were slowly increased. The administration of antibiotics was continued as complications in the form of a regurgitation pneumonia were anticipated. The prognosis for full recovery was guarded as recurrence was anticipated. In the following 2 months, the elephant went through several similar episodes, which luckily resolved on their own. Repeated bouts of pneumonia were expected, which need to be treated aggressively each time they occur. This follows a classic congenital abnormality/megaesephagus pattern but in this case the damage resulting in the impaction may be the result of injuries from the original fire, possibly by inhalation. However, it cannot be ruled out that this animal is just a naughty, hand-reared baby elephant eating strange objects. Treatment results Two months after the last treatment the elephant calf is recovering well, tired but improving. Showing some discomfort in one leg. Suspect an infection or damaged areas of skin with secondary infection. He showed ventral oedema which improved with a course of antibiotics. It appears that areas of skin are sloughing off. Antibiotic treatment has been instituted. The skin problems are suspected to be part of a systemic infection originating from a regurgitation pneumonia. Another theory to explain the skin necrosis is the involvement of an autoimmune circulatory component as there had been peripheral lesions on the ears at the start of treatment, which later also showed oedema. To page top

This page describes the normal birth process in elephants, including progesterone and ultrasound monitoring, preparation, list of requirements for veterinary assistance, transrectal massage to induce the Ferguson reflex and post-partem care. To reproduction Normal birth process This chapter is based on the EAZA Guidelines for the reproduction-related management of female elephants . Taken care at the birth process means that the pregnancy has been confirmed. More detailed information is provided in the chapter: pregnancy confirmation. After a pregnancy period of 87- 95 weeks (610- 670 days, 20-22 months), parturition is sometimes announced by subtile changes in the behaviour of the elephant. Twentyfour hours observation including the use of a (time-lapse) video recorder starting in week 85 may add to information about relevant events prior to parturition: night pacing, kneeling down, climbing, short periods of separation from the group, beating the vulva with the tail, frequent production of small-sized feces and small quantities of urine, loss of mucous plug, playing with mucous plug, rupture of the allantois sac, labour waves. Preceding any recommendation in this chapter, the following remarks need to be made: It is a myth to think that a multiparous elephant does not need to be monitored and assisted during parturition according to this protocol. Too many calves have been born dead or very weak because of the fact that parturition had started unnoticed and stopped unnoticed. In our view, this protocol should be followed in ALL cases of elephant parturition as much as the elephant management allows. It is a also myth that oxytocin is a harmless drug to be used in elephant parturitions. In at least 3 cases the administration of oxytocin has been associated with the occurrence of an uterus rupture because of insufficient cervix dilatation. It should never be used without ultrasonographic examination of the cervix uteri. The visible presence of the allantois sac as a subcutaneous bulging mass under the tail is not a guarantee for a sufficiently dilated cervix. Many elephants, including very experienced multiparous elephants may just stop the parturition process, often unnoticed. Hypocalcemia is one of the main causes for this phenomenon to happen.This will compromise the health of the calf. Don’t relay only on what you see from the outside! For a proper judgment about the presence of labor activities or the progress of parturition, your professional judgment should be based on the results of progesterone tests and ultrasonographic examinations. If you do not believe in the above mentioned statements, you may find yourself confronted with a dead elephant calf or a dead elephant mother or both. So, discuss this item with your staff and make your decision before you start breeding your elephants. If the management of elephants in your zoo does not allow blood sampling or ultrasonographic examinations, you must be aware of the risks associated with a silently interrupted birth process, no matter the reproductive experience of the animal involved. Safety for the personnel should never be challenged by unacceptable risks. Predicting the time of parturition, measures and observations: Daily blood sampling from week 89: every other a day progesterone assay, until week 91 (637 days). From week 91 (637 days): daily assays and as soon as progesterone starts to decrease: sample twice daily. Daily monitoring of progesterone is only possible if you have a nearby facility that runs these assays on a daily basis. Find out from your nearby hospital in the early stage of pregnancy! Many veterinary labs do not have tests that are sensitive for levels of progesterone (P4) in elephants 1-3 days prior to delivery. Also check the availability during the weekend. NOTE: a decrease of progesterone to baseline level is not always occurring. A 23-yrs-old Asian elephant at the Rotterdam zoo (with a baseline progesterone level < 0.6 nmol/l) delivered a healthy calf while her progesterone remained above 0.65 nmol/l. Progesterone plasma concentration during pregnancy. After a gradual decrease in the last months of gestation, progesterone drops to baseline level a few days before parturition. Note that the absolute height of the progesterone concentration depends on the assay used! Different assays measure different metabolites = different levels! Signs of an approaching parturition may include: ·Loss of mucous plug (not seen in many facilities) ·Pre-and post-parturition ventral edema may be noticed. ·Group members may react differently (vocalizations, restlessness) ·In most cases (75%) rupture of allantois sac and loss of allantois fluid (looks like urine) is seen within 2 hours prior to birth. ·The size of fecal balls may get smaller towards the end of pregnancy. ·Frequency of urination may increase around parturition, resulting in more “watery” consistency of the urine, resembling more like allantois fluid . ·Development of mammary gland and production of milk shortly before birth is often seen, however this may also occur in a much earlier stage of pregnancy . Milk accumulation can be visualized using transcutaneous ultrasonography several hours prior to parturition. ·Softening of the pelvic ligaments (due to estrogen surge) may result in slightly abnormal locomotion of the hind legs. Parturition/Preparations for calving: ·Training and/or desensitizing of the pregnant elephant for veterinary intervention, like blood sampling, injections, IV-infusions, milking and rectal manipulations ·If possible, store some colostrum (freezer) or store plasma obtained from the dam in weeks prior to parturition. ·Have artificial milk available (Salvana GmbH, Germany; hand raising has been done at Emmen Zoo and Berlin Zoo) ·Check restraint chains and fixation points for the legs and one extra fixation point between the hind legs for pulling devices. Soft ropes for pulling the calf away if needed should be available. The use of a calf harness has been described. ·Check the stable and place bars where a calf could possibly escape. Block all possible escaping routes for the calf (not for staff!!). ·Take out all obstacles. ·Be prepared for closing the elephant house for the public (sign post, etc.) ·Make sure there is a good stock of commercial cat litter or saw dust to be used on a concrete floor as soon as the calf is born. This will absorb much of the allantois fluids and prevent the animals from slipping on the wet floor. ·2 or 3 pairs of keeper-gloves (soccer) to get a better grip on the wet, slippery calf when needed ·Plastic hose pipe (with pump, if necessary) for rectal cleaning with lukewarm water ·3 birth-chains with proper handles (2 for the legs, 1 for trunk or tail); find a way to avoid back sliding when manual extraction (vaginal vestibulotomy) is required. ·Drugs to be kept in store: ·Ca-borogluconate for I.V. infusion ·Estradiol gel (EstroGel® 0.06%) ·Oxytocin ·Lidocain ·Xylazine, detomidine or medetomidine ·Butorphanol ·Azaperone ·Atipamezole ·Doxapram ·Oxygen ·(Betadine®-)iodine solution for navel disinfection (umbilical infection is a major cause of perinatal complications) ·Lubricant (many liters). J-lube®, a concentrated lubrication powder, has proven to be very useful. The normal calving process should take place within 2 hours after rupture of membranes (release of fetal fluids). If the plasma progesterone level decreases to below base line concentration, this is a signal that calving should take place within 48 hours. Prolonged intervals have been reported (as long as 14 days) still resulting in the birth of a living calf, but it is very likely that this is due to a disturbance of the normal birth process that should be corrected before the health of the calf is jeopardized. There is one report of a parturition taking place without a complete drop to base line level. The calving process is a natural process. Elephants should give birth in their own social environment, excluding any external disturbing factors (e.g. noisy building in the neighborhood, visits of unknown individuals, etc.). With a well trained animal, blood sampling and ultrasonographic examinations can be done while the animal is temporarily separated from the group. Immediately afterwards, the animal should return to its group. All efforts should be made to make sure that the calf is born in the group while the mother is NOT chained! This will stimulate the acceptance of the calf by the mother and group members and is an investment for future breeding successes for the entire elephant group. To determine the right moment when calving starts, 2 parameters are essential: - The progesterone blood level - The relaxation of the cervix, monitored by ultrasonographic examination. Progesterone: the sensitivity of the equipment and the time needed to run the assay are the bottleneck for using the progesterone concentration as a reliable tool. Today many human hospitals use advanced equipment with a very low detection level that can provide results in less than 2 hours. Make sure that you have made arrangements with a lab long before you expect the parturition. Ultrasonography: to use this technique as a reliable tool, it is indispensable for the veterinarian to gain experience long before the elephant birth is expected. This will enable the veterinarian to distinguish a normal cervix from the relaxed cervix (figure 4a + b) from the normal cervix. Preferably a 3.5 MHz probe should be used transrectally. Longitudinal, transrectal ultrasonographic image of the vagina and the closed cervix of a pregnant e lephant. The same image as with the vagina and cervix indicated with white lines. Transversal, transrectal ultrasonographic vagina and cervix of a pregnant elephant. Allantois sac with cloudy fetal fluid in the (partly) dilated cervix of an Asian elephant 12 hours prior to delivery (transverse section, white arrows: allantois sac, open arrow: pelvic bone) The same image with the vagina and the closed cervix indicated by white lines. Note the folds in the cervix uteri. Allantois sac with cloudy fetal fluid in the (partly) dilated cervix of an Asian elephant 12 hours prior to delivery (longitudinal section, white arrows: allantois sac, open arrow: pelvic bone) During the last 2 weeks of gestation, the mucous that is present in the vagina during gestation will be discharged gradually. This is a clear indication for a pending parturition. Recognizable onset of parturition occurs normally within 24-48 hours after progesterone has dropped to below base-line level. In these guidelines the absence of visible signs of parturition in the same time frame is considered an abnormal condition; this status requires veterinary intervention. At this point 2 situations may occur: the parturition process has started but has been interrupted without or with spontaneous rupturing of the allantois sac. Interpretation of findings and action to be taken 1. No rupture of allantois sac noticed If the calf is not born by natural way 24 hours after blood progesterone has dropped to baseline level, rectal palpation and ultrasonographic examination of the cervix is highly recommended. This will demonstrate the rate of relaxation of the cervix, the presence of the allantois sac or parts of the fetus in the cervix or vagina and should be repeated at least every 8 hours. A blood sample should be taken to measure the calcium level. If below 2.5 Mmol/l, calcium should be administered as an IV-infusion (NB: when given in an ear vein, it should be given strictly IV in order to avoid damage to the vein) or orally (suggestion: calcium syrup concentrate for human use, enveloped in the carton core of toilet paper, covered and sealed with fresh tamarind paste has worked well; most elephants will eat it, including the carton material). The effect of the calcium administration should be confirmed by rectal palpation (increase of contractibility of the uterus) and determination of the blood calcium level. Store an EDTA and heparine sample for herpes virus diagnostic purpose (both cells and plasma in freezer after separation). Transrectal ultrasonographic examination at 48 hours: A. No relaxation of the cervix at 48 hours: search for calf movements and nail position of the fetus (palpation and ultrasound) and blood flow in fetal vessels (ultrasound). Transcutaneous ultrasonographic examination (both flanks have a small ”window” where visualization of fetal movements may be seen) may help to determine the status of the fetus. Apply estrogens rectally. Good results have been obtained by the rectal and transdermal (perineum) application of an estradiol containing estrogen gel (Estrogel 0,06%, total dose 700-800 mg estradiol). The effect on the cervix dilatation should be monitored closely by transrectal ultrasonography! At this time, at least 1 hour after the local application of estradiol, rectal massage should be applied to test and stimulate the contractibility of the uterus. Technique: remove feces from rectum, flush out the rectum, use abundant lubrification, keep both gloved hands (NB: the rectal mucosa is vulnerable due to estrogens) with the fists joined in a firm grip and press with the wrists or the dorsal sides of the hands against the pelvic ring to stimulate the pelvic receptors until strong labor waves appear or at least 10 minutes. When labor waves occur, continue this massage for 3 hours (if needed change operator). Check regularly by means of ultrasound the condition of the cervix. If there is still no cervix relaxation, continue monitoring the viability of the calf. If no fetal parts can be detected, consider the presence of pseudopregnancy (ovarian tumor, dysfunction of the pituitary gland, etc.). The application of estradiol gel (total dose: 400-500 mg 17-β-estradiol) as described above may be repeated 3-4 hours after the first treatment if the cervix dilatation is still incomplete. B. Partial or complete relaxation of the cervix at 48 hours or later as a result of the situation described under 1A: Apply rectal massage to test contractibility of the uterus. If limited or no reaction, the administration of oxytocin is contra-indicated. In this case, the administration of calcium is recommended (even when blood calcium level is within normal ranges). After 2 hours the use of estradiol as described under 1.A is recommended. Only if uterus contraction can be provoked by the rectal massage, the use of oxytocin may be considered using the following dosage: 25-50 IU oxytocin s.c. or i.m. (if needed use a blow dart). Oxytocin should be used with care, as it may dramatically exhaust the contractibility of the uterus muscles as well as the general condition of the female. There might also be the risk of reduced blood circulation in the umbilical chord, due to the spasms in the myometrium. Prostaglandine E (dinoproston) has been used on a few occasions for cervix dilatation (after the administration of estradiol) and to stimulate uterus contractions. As there is still limited knowledge of its efficacy after transrectal administration and the risk of stormy uterus contractions, it should only be used when any obstructions or abnormalities of the calf can be ruled out. Depending on the progress obtained, rectal massage and the administration of oxytocin are the 2 major treatments to follow from this point. In between these treatment events, the animal should be exercised to relieve the pain and stimulate position changes of the calf and preferably it should be kept in the group. Only when the animal cannot be separated whenever required, the cow should be kept separated from the group, but with as much physical contact as possible. Oxytocin should be given in intervals of at least 2 hours for a maximum of 12-24 hours under the guidance of ultrasound to evaluate tAhe progress. Continue this approach of treatment until parts of the calf have entered the pelvic cavity. If the efforts remain unrewarded and no access to fetal parts is possible, not much can be done. Continue monitoring the viability of the calf. If the calf has died, while the membranes are still intact, the risk of intoxication is limited, but immunosuppresion could be a complication for the cow. To date, no proper data are available. The dosage of oxytocin may only be increased to 100 I.U. after parts of the calf have entered the pelvic area and progress is clearly observed. At this time, a bulge containing parts of the body under the tail of the dam should be visible. Progress of parturition must be monitored strictly at this stage. If this increased dose of oxytocin does not result in parturition a vaginal vestibulotomy should be performed soon to get better access to the calf. See next chapter. Expulsion of the calf should follow soon after the bulge appears under the tail of the dam. The allantois sac usually ruptures during the (induced) passage through the pelvic canal. One complication described at this stage, is reduced passage space as a result of edema in the urogenital canal resulting in a “catching effect” of the head and/or shoulder of the calf inside the soft part of the distal (vertical part) genital tract. Suffocation of the calf is a realistic complication. This condition has been observed several times in primiparous elephants of more advanced age. Elephants in this category should be prepared by the local application of J-Lube in the distal part of the vaginal vestibulum and massage of oestrogel/creme in the skin between anus and vulva. If this condition occurs, quick intervention is required by applying firm manual pressure from the outside on the calf in the sliding direction of the calf. Be aware of the risk of kicking by the mother. 2. Ruptured allantois sac A significant event in the parturition process is the rupturing of the allantois sac, which – when intact - acts as a hydraulic dilatator for the cervix, a natural lubrication for the dam and a pressure protection for the calf. NB: The amniotic sac that covers the body directly, usually remains intact during the expulsion of the calf and ruptures during the final passage through the birth canal and is actively removed by the dam. NB: a chained dam, may not be in the position to remove these membranes, possibly resulting in suffocation of the calf. Differentiation between urine and fetal fluids is extremely difficult; smell, creatinin test strips and possibly protein concentration could be helpful. If no progress in parturition is observed, major complications should be considered, like a dead calf, malposition of the calf (which is often dead), oversized calf, malformation and twin pregnancy. Because of the urgency of this situation, the calf should be born within 2 hours after rupture of the allantois sac and loss of allantois fluid. If not so, veterinary intervention has to take place. Two situations may occur: No fetal parts positioned in the pelvic area: treatment should aim on the urgent relaxation of the cervix. Calcium status should be determined and treated accordingly (see above). The further approach is according to 1A, however the situation is more critical for both the dam and the calf. Fetal parts have entered the pelvic area: Calcium status should be determined and treated accordingly (see above). Ultrasound is essential to determine which fetal parts have entered the birth canal, determine the position of the calf (visualization of the nails, posterior or anterior position, number of nails, trunk) and viability. Malposition (e.g. only one leg in birth canal, no head while in anterior position) is an indication for vaginal vestibulotomy or fetotomy. If no abnormalities are found during ultrasound, 50-100 I.U. of oxytocin should be given i.v. or i.m. and rectal massage should be practiced. Birth should be completed within 1 hour. Other drugs used Uterine laxants have been used in elephants on rare occasions. There are some anecdotal reports about the use of denaverinehydrochloride (Sensiblex®, Veyx) at a dose of 0,04 – 0,05 mg/kg BW (i.m.). Isoxsuprinelactate (Duphaspasmin. Fort Dodge Animal Health, 6290AA Vaals, The Netherlands) was used in a fetotomy case at 0,15 mg/kg BM (i.m.). Carbetocine (Depotocin®, Veyx), a long acting oxytocine has been used in 3 occasions dosage (0,09 µg/kg BW) i.m. Presentation of the calf A study in 46 elephants demonstrated that the overall ratio between anterior and posterior presentation was 12:34. In dystochia cases the situation was quite different: 6:3. In normal birth procedures the ratio was 6: 29. Anterior presentation has a higher risk of dystochia than posterior presentation of the calf. (Ilic D. et al. 2021. The incidence of anterior and posterior presentation at birth in Asian (Elephas maximus ) and African elephants (Loxodonta africana ): A Review Study. Indian Journal of Animal Research.DOI: 10.18805/IJAR.B-1319) It has been observed that the calf may rotate during the final phase of the expulsion, similar to what happens in horses and cattle (see video). This may be important in case of a dystocia, if the calf has remained in complete 'horizontal position' and a vaginal vestibulotomy is indicated. Note that the calf has rotated during the final phase of the expulsion. Transrectal massage: Transrectal massage is a very effective method to stimulate uterine contractions if the uterus is prepared for it . Certain conditions (especially hypocalcemia) may impair the contractions. This should be solved first. Stimulation of the pelvic wall by rectal massage is known as the Ferguson reflex . Transrectal massage of the pelvic wall is best performed by firmly pressing the closed fost against the roof and sides of the pelvic cavity and on the dorsal side of the vagina making the movements as shown in this video. Post-partum care Disinfection of the navel with Betadine® iodine is strongly recommended (if the mother allows its application). The afterbirth usually comes off within 12 hours. There are a few reports on retained (parts of) placenta for several weeks, without major complications for the dam. Hygienic measures should be applied to reduce the infectious burden for the calf. Be aware of the fact that a second calf can still be present in the dam. There are reports that second calves were born between several hours up to 3 months (the prevalence of twins in elephants is 1:3000). The calf should drink (colostrum) as soon as possible, at least within 24 hours. If not, or when the calf makes a weak impression, the banked serum (or freshly taken serum) should be given to it orally. Try to find out the reason why the calf is not drinking successfully: e.g. too small, weak, painful mammary glands, malbehaviour of the dam. If for any reason the mother is rejecting the calf, lactating herd member can take care of the calf. There is evidence that the mother takes over from this surrogate mother during the first 72 hours. If no lactating elephant is present in the herd, training for bottle feeding should start after 12 hours and continued for 72 hours. If the mother still rejects her calf, the best option for the calf is to move it to another herd with a lactating elephant. If introduction to this herd fails too, bottle feeding is the last option. To date very few bottle-raised elephants have reached the age of puberty. To page top

Hand-raising Medical Procedures Anesthesia and sedation Basic supplies and equipment Blood collection Blood culture Breast milk collection manually and using a pump Culture collection Enema Fecal analysis Feeding tube placement Fluid therapy - IV / rectal IM injections IV injections IV catheter placement Oxygen therapy Plasma collection and administration – ref EEHV Urine collection (analysis will Vaccinations Wound treatment Postmortem exam Centrifuge, paperfuge, refractometer – simple tests Antibiotics / medications ANESTHESIA AND SEDATION Anesthesia may be required for diagnostic and treatment procedures. The health risks of an anesthetic procedure in young elephants is usually acceptable as long as good procedures are being followed. Most invasive procedures can be done under standing sedation . For larger surgeries, general anesthesia wil be required. BASIC SUPPLIES AND EQUIPMENT Following is a comprehensive list of equipment and supplies that may be needed to carry out the medical procedures that are discussed in this chapter. Larger facilities dedicated to elephant/wildlife rescue and with veterinarians on staff will likely have more of these items on site; small facilities may only need to stock basic items (indicated with a *) and use nearby veterinary clinics or universities for special needs. Equipment Stethoscope Thermometers * ( Click here to see how to measure temperature) Scale * Ophthalmoscope Flashlight/Headlamp* Pulsoximeter Oral speculum Laryngoscope Basic instruments (hemostats, forceps, scissors) Endotracheal tubes and stylets Masks to fit over trunk Oxygen tank and regulator Heat lamps or heated blankets* Chemistry unit (or use local human lab) Hematology unit (or use local human lab) Refractometer Centrifuge Xray machine (preferably digital) The separate clip of this type of pulsoximeter fits on the septum in the trunk tip. A 20 liters tank of medical oxygen can be connected to an oxygen reduction valve. A thin flexible tube can be advanced into the trunk (20-30 cm deep). A permanent flow of 10 liters/minute will increase the oxygen supply to the lungs during general anesthesia

The most important zoonotic disease in elephants is tuberculosis. Other examples of zoonotic pathogens are cowpox, Salmonalla, Anthrax, and Pasteurella. Several microbes are opporunistic pathogens, like rabies, leptospirosis, foot and mouth disease, and organisms involved in local processes (abscess, feces, urine, exudate). Zoonoses Zoonotic diseases in elephants. Zoonotic diseases are defined as infectious disease of humans caused by a pathogen (an infectious agent, such as a bacterium, virus, parasite or prion) that can jump from a non-human (usually a vertebrate) to a human and vice versa. Some of these pathogens can be considered as opportunistic, others as primary infections. Relevant primary pathogens in elephants are : Bacterial diseases Mycobacterium tuberculosis complex (MTBC). The prevalence of MTBC in captive elephants in European zoos is relatively high. A study of the post-mortem reports between 1985 and 2024 showed that 20/301 Asian elephants and 12/196 African elephants had died of MTBC (Data from EAZA elephant TAG, WS). From 1997 through 2011, the median point of prevalence within the Asian elephant population in USA-zoos was 5.1%, with a range from 0.3% to 6.7%. In contrast, the annual point prevalence during the same time period within the African elephant population was 0. Although exact data about the prevalence of MTBC in range countries are not known, there are many reports of MTBC in captive and to (a lesser degree) wild Asian elephants. Data on MTBC in African elephants in range countries are limited. Click here to read more about tuberculosis in elephants. Non-tuberculous mycobacteriosis: Mycobacterium elephantis ; only found in humans, never in elephants. However, the strain is genetically related to Mycobacterium confluentis and M. smegmatis cultured form lung lesions in an elephant (Lacasse, 2007) . Bacillus anthrax: Click here to read more about anthrax in elephants. Pasteurella multocida: Click here to read more about Pasteurellosis in elephants. Salmonella spp .: Click here to read more about salmonellosis in elephants. Leptospira interrogans found in urine of captive elephants in Asia. This is a potential risk for humans in close contact with these elephants (Athapattu 2019). Click here to read more about leptospirosis in elephants. Viral diseases: Cowpox virus (Orthopoxvirus bovis) . Asian elephants are very sensitive to a pox virus infection, African elephants to a lesser degree. The fluid that fill the pox vesicles are full of virus. Once the fluid is exposed, humans can become infected. Click here to read more about pox virus infections in elephants. Foot and Mouth disease virus (FMD-virus): Asian elephants are very sensitive to FMD. There is only one report of FMD in an African elephant that was experimentally infected. Click here to read more about FMD in elephants. Rabies: transmission of rabies virus from elephants to humans have never been reported, but saliva of diseased rabid elephant is a potential risk for humans. Click here to read more about rabies in elephants. Opportunistic pathogens: Opportunistic pathogens can be found in the environment, but when concentrated in a pathological condition in an animal (abscess, feces, urine, exudate), they can cause disease in humans: Escherichia coli Pseudomonas Bacteroides spp. Staphylococcus aureus Streptococcus spp. Klebsiella spp. Mycobacterium avium Fungi: there are no reports on fungus infections in humans acquired through contact with elephants. Serological responses detected in elephants without evidence of causing disease: Elephants may be (temporary) silent carriers of several potentially pathogenic microbes. The historical contact is expressed by the presence of antibodies in the blood of the elephant. Examples of these conditions are: African horse sickness virus : the presence of antibodies in African elephants has been described (Barnard, 1995). Humans are usually not affected. However, severe disease has been reported in lab workers who were producing a AHSV-vaccine (van der Meyden, 1991; Reid,1991). Influenza type A : 1 serologically positive elephant reported (Schröder 1992). Eastern equine encephalitis: 1 serologically positive elephant reported (Christy, 2009) Bluetongue : antibodies were detected in 7 out of 109 serum samples of captive Asian el ephants in India (Bhat, 1998). Canine distemper: antibodies were detected in 25 out of 144 serum samples of captive Asian elephants in Thailand (Ono, 2006). Yersinia pestis (plague); In one study in wild African elephants 0.3% of the cohort animals were found seropositive for antibodies against Yersinia pestis (Gordon, 1979). No transmission of plague from elephants to humans has been reported. Toxoplasma gondii : 35% of captive elephants in a study in Thailand was serologically positive (Udonsom 2022). As the elephant is not an end-host for toxoplasmosis, transmission of toxoplasmosis from elephants to humans is unlikely to occur. Cryptosporidium spp .: found in African elephants at a European zoo (Gracena, 2002). No transmission to humans has been reported. References Athapattu TPJ, Fernando BR, Koizumi N, Gamage CD. Detection of pathogenic leptospires in the urine of domesticated elephants in Sri Lanka. Acta Trop. 2019 Jul;195:78-82. doi: 10.1016/j.actatropica.2019.04.029. Epub 2019 Apr 29. PMID: 31047864. Barnard BJH, Bengi RG, Keet DF, Dekker EH, Verwoerd DW. 1995. Epidemiology of African horsesickness: antibodies in free-living elephants (Loxodonta africana) and their response to experimental infection. Onderstepoort journal of Vet. Res. 62, 1995. Bhat N, Manickam R, Arunp W.1998. Detection of bluetongue antibody and antigen in Indian elephants, spotted deer and blackbucks. Indian Journal of Animal Sciences 68 (2) : 135, February 1998 Christy L. Rettenmund CL, Terrell SP, Miller M. 2009 Eastern Equine Encephalitis Virus (EEEV) Titers in African Elephants (Loxodonta africana) At Disney’s Animal Kingdom. American association of Zoo Veterinarians Conference 2009 Feldman M, Isaza R, Prins C, Hernandez J. 2013. Point prevalence and incidence of Mycobacterium tuberculosis complex in captive elephants in the United States of America, Veterinary Quarterly, 33:1, 25-29. Gordon DH, Isaacson M, Taylor P. 1979. Plague Antibody in Large African Mammals. Infection and Immunity, Nov. 1979, p. 767-769 Gracenea M, Gómez M., Torres J, Carné E, Fernández-Morán J. 2002. Transmission dynamics of Cryptosporidium in primates and herbivores at the Barcelona zoo: a long-term study. Veterinary Parasitology, 104(1), 19–26. doi:10.1016/s0304-4017(01)00611-2. 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Internationalen Symposiums uber die Erkrankungen der Zoo- und Wildtiere, Santander-Spain, pp. 119–125. Udonsom R, Nishikawa Y, Fereig RM, Topisit T, Kulkaweewut N, Chanamrung S, Jirapattharasate C.2022. Exposure to Toxoplasma gondii in Asian Elephants (Elephas maximus indicus) in Thailand. Pathogens 2022, 11, 2. van der Meyden, CH, Erasmus, BJ, Swanepoel, R. and Prozesky, OW. 1991. Encephalitis and chorioretinitis associated with neurotropic African horsesickness virus infection in laboratory workers. Part I. Clinical and neurological observa[1]tions. S Afr Med J 81:451–454. Zachariah A, Pandiyan J, Madhavilatha G, Mundayoor S, Chandramohan B, Sajesh P, et al. Mycobacterium tuberculosis in Wild Asian Elephants, Southern India. Emerg Infect Dis. 2017;23(3):504-506. https://doi.org/10.3201/eid2303.161741 To page top