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A fractured elephant tusk can cause traumatic lesions of the tusk sulcus when the fracture site is located proximal to the sulcus. To page top 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

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

Bone fractures are not uncommon in elephants. Radiography is needed for a proper diagnosis. A case of mandibular fracture is described in this chapter. To non-infectious diseases Bone fractures Mandibular fracture Mandibular fracture Mandibular fracture Mandibular fracture Mandibular fracture Mandibular fracture Bone fractures Mandibular fracture

Nail issues in elephants are common and usually need treatment. Pedicure should be part of the management procedures. Untreated nail cracks can result in osteoarthritis of the phalangeal joints. Radiography procedures are described in this chapter. Back to index orthopedic problems Nail lesions The most common nail lesion is the crack , perpendicular to the ground. These cracks are often the result of overpressure on the nail tip, when the nail is longer than the sole. In that situation, each step the elephant makes results in heavy forces on the nail tip during the phase when the elephant unwinds its foot. As demonstrated clearly in the slow-motion video below, the tip of the elephant's nails hardly touches the ground. When the nail becomes too long like in the Asian elephant nail in this photo, the excessive pressure on the nail edge can cause a small crack that enlarges over time if not properly treated. Cracks in the nails of an African elephant When left untreated, these cracks will become larger and can affect deeper structures, resulting in an abscess , pododermatitis or even osteomyelitis of the phalangeal bones. If only the horn-producing tissue is involved, we usually call this a pododermatitis. When the infection is trapped in the underlying tissue, an abscess can easily develop. Onychia is an infection or trauma to the horn lamellae of the nail, which may result in complete loss of the nail. Pododermatitis in the nail of an African elephant. Note the excessive wear of the sole. Nail abscess with osteolysis in an Asian elephant. Nail abscess with complete loss of the 2 distal phalanges osteolysis in an Asian elephant. If phalanges are affected as the result of a deep nail abscess and pododermatitis, the recommended treatment of such an osteitis is the surgical removal of the affected bones. Click here to read more about this treatment. More examples of nail abscesses (photos: Susan Mikota). Treatment may take a long time, requiring multiple pedicure sessions, daily cleaning and foot soaks (click here for foot soak information) Traumatic onychia in an Asian elephant. Complete nail loss due to traumatic onychia in an Asian elephant. Diagnostic procedures nail lesions Use your eyes: check if there is any visible lameness. Describe the visible lesions. Use your hand: does the affected area feels warm? Is it painful when pressure is applied? Use your nose: if there is a wound, try to identify the smell of necrosis. Take a swab for bacterial culture. Additional diagnostic steps: If there is a deep lesion: radiographs should be taken to look at the integrety of the underlying bony structures (phalanges and phalangeal joints). Thermography may help to identify if the affected area has a higher temperature than the surrounding tissues. Radiography of the elephant's foot Radiography foot A powerful portable X-ray machine (100 kV or more) is required to visualize the bony structures in the elephant foot. Digital plates largely increase the quality of the image. It is important to work under safe conditions. Under free contact management , the fore foot can be positioned on a stand for the oblique palmar-dorsal shooting direction. The angle required for visualization of the phalangeal joints is indicated in the images below. Oblique palmar-dorsal image of the hind foot under free contact management condition (Mumby et al 2015) Positioning for the oblique dorsal-plantar image of the hind foot, this foot can be can be positioned on a stand (Mumby et al 2015). A different approach is required when working under protected contact management . The elephant needs to be trained to position its legs on a horizontal bar of the training wall. It should also be accustomed to the proximity of the X-ray-machine, the plate and the protective clothing of the operators. Lateral shooting position of the right front foot of an Asian elephant under protected contact. The angle of the beam depends on which phalanges need to be visualized. To avoid superposition and depending on the selected phalanges, the beam should have a more or less oblique direction. (Courtesy Rotterdam Zoo). Oblique dorsal-plantar shooting position of the left rear foot (Courtesy Rotterdam Zoo). Click here to view the radiograph. Oblique palmar-dorsal shooting postion of the right front foot of an Asian elephant under protected contact. Note that the X-ray machine is positioned upside down (use a support block to protect the electric wires)! (Courtesy Rotterdam Zoo and Emmen Zoo). Click here to view the radiograph. Lateral shooting postion of the left hind foot of an Asian elephant under protected contact (Courtesy Rotterdam Zoo). Click here to view the radiograph. Some examples of radiographs of the distal part of the right front leg of a 24 yr-old female Asian elephant at Rotterdam Zoo (the Netherlands) are shown below. The elephant is under standing sedation for an unrelated reason. Lateral shooting position of the right front leg (distal part of the radius and ulna, Courtesy Rotterdam Zoo). Click here to view the radiograph. Anterior-posterior shooting position of the right radio-carpal and ulnar carpal joint AP front leg (Courtesy Rotterdam Zoo). Click here to view the radiograph. Posterior-anterior shooting position of the right radial-carpal and ulnar-carpal joint (Courtesy Rotterdam Zoo). Click here to view the radiograph. Lateral position of the right carpal joint (Courtesy Rotterdam Zoo). Click here to view the radiograph. Lateral shooting position of the right foot (Courtesy Rotterdam Zoo). Click here to view the radiograph. Lateral shooting position of the right tarsal joint (Courtesy Rotterdam Zoo). Click here to view the radiograph. Lateral shooting position of the right tarsal joint (Courtesy Rotterdam Zoo). Click here to view the radiograph. Posterior-anterior shooting position of the right tarsal joint (Courtesy Rotterdam Zoo). Stereo radiography A technique, which is called stereo radiography can help interpreting the X-rays. Two radiographs of the same areas are made each of them taken 10 cm more lateral from the other. Digital images were converted to bitmap (BMP) format to preserve image quality. The 3D stereoradiograph images can be constructed using special software (Bentley 2021). The images can be viewed with red-cyan 3D glasses. Illustration of how 3D stereoradiograph images are produced. (a) Original radiograph that provides the ‘‘left’’ image for the 3D Anaglyph software. (b) Paired radiograph used for ‘‘right’’ image. (c) Completed stereoradiograph that has been inverted with red-cyan settings applied. (Bentley 2021) Thermography of nail lesions Thermographic imaging can be used to measure the absolute temperature and the difference in temperature between the lesion and its surrounding tissues. Below a severe case of a nail abscess-related osteomyelitis and osteolysis of Ph4 in an old Asian elephant bulls is shown. The thermografic image shows a low temperature of the skin that covers the affected are. This is suggestive for a large necro-purulent process. The thermographic image shown here demonstrates the low temperature of the skin covering the abscess, associated with deep lesions of D4 of the left front leg of an Asian elephant bull, involving a lot of necrosis and complete loss of the distal phalanx of the toe. On radiology this bone is completely missing and the distal part of the toe shows an irregular surface: Osteomyelitis and purulent arthritis of the Ph3-4 joint of D4. Treatment nail lesions Treatment of nail lesions Pedicure is usually the treatment of choice in cases of nail lesions. There are a few principles to be respected in pedicure: Use proper equipment Always remove all abnormal horn tissue (undermined, infected) and loose nail flaps. Make the transition from healthy horn to the deepest point of the lesion as smooth as possible. Directly adjacent to the lesion, the horn must be flexible and as thin as a piece of paper. Permanently check this flexibility by gently pressing the area where just cut away the horn. The most important pieces of equipment needed for pedicure are 2 hoof knives (left and right handed), a scalpel and a sharpening stone for hoof knives, preferably with round edges (see photos above). Just with hoof knives alone, most of the clinical pedicure treatment can be done. A scalpel can be useful when very small pieces of horn are to be removed adjacent to a lesion. A horse hoof rasp is a useful tool to shorten the nail and remove excessive horn from the sole. Care should be taken NOT to make the nail edges round, what is often practiced (see below). A strong nail brush is needed for cleaning the nail prior to pedicure and a smaller brush can be used to remove dirt from areas that cannot be reached by a large brush. Small wood carving knives can be used when thin layers of nail horn are to be removed (similar to the use of a scalpel). Pedicure equipment White line Very often the tip of the nails are made round by rasping the corners. There is no justification for doing so rather than a cosmetic one. However, one should avoid to remove tissue from the nail wall/nale sole junction (comparible to the "white line " in the horse hoof) as this junction is a very important barrier against infiltration of dirt and pathogens. So the advice is: do not file the nail corners to leave the entire white line in tact. Situation before a pedicure session of a deep nail crack Situation after a pedicure session of a deep nail crack Pedicure around a (deep) crack serves 2 main purposes: Draining of infected area Removing pressure on the wound, which enables the regeneration of destroyed horn lamellae. In order to achieve both goals, the deepest point of the crack has to be freed from covering horn. One should start making the horn wall thinner at a distance of several centimeters from the lesion and continue the pedicure towards the deepest point in a gradual way. Each nail crack should be considered as being a wound, because the crack has usually damaged the horn lamellae. When the pedicure has reached the wound area, it is of utmost importance that the edges bordering the wound are made as thin and flexible as possible. Check this by pressing your finger on the horn adjacent to the wound. Large cracks usually need to be treated in several sessions. Bleeding may occur when the lamellae are cut, which is no direct reason to worry! Pain reactions of the elephant will tell the operator when the session should be stopped and continued a few days later Cuticle lesions The cuticles form a natural barrier against dirt and pathogens. When they overgrow the nails, this protective barrier is weakened and infiltration of microoganisms may result in lesions in the horn lamellae underneath the nail (onychia). Sweat glands are embedded in the cuticles. Overgrown cuticles may become hard and crack or form interdigital callus. When abnormal horn tissue blocks the sweat glands, fluid pockets may be formed. This can be a painful process and needs to be treated. Minor cuticle lesion in a African elephant, which may be connected to a deeper lesion underneath the nail. Explorative pedicure is probably needed to find the cause (Courtesy: Barcelona Zoo) Extensive overgrown cuticles with feathering and interdigital callus formation (Fowler & Mikota 2006) Interdigital callus formation in an Asian elephant (Courtesy: Susan Mikota) Sweat glands are present in large numbers in the cuticles. When the cuticles are overgrown, they may form pockets in which the sweat-fluid may accumulate ("blisters"or "blebs"). When cutting in such a fluid-filled pocket, the contents may squirt out (see video; courtesy: Susan Mikota). Careful (!) trimming of the cuticles is only indicated when they have overgrown the nail (Courtesy: Susan Mikota) Applying oil on the cuticles will make them softer and may resolve the problem of cuticle overgrowth in most situations. Example of a pedicure procedure of a nail abscess in conjunction with a cuticle lesion in an African elephant (courtesy Barcelona Zoo) Nail abscess in an African elephant. Note the excessive wear of the sole and the large defect of the cuticle. Second step: follow-up the necrotic tissue and find the connection with the cuticle defect. Note that a large part of the nail was undermined, causing the cuticle defect. First step in pedicure: making the horn on each side of the lesion thinner and removing necrotic tissues. By frequently removing all necrotic tissues and keeping the edges of the wound thin, the horn lamellae can produce healthy horn again. SUCCESSFUL TREATMENT OF DIGITAL OSTEITIS BY INTRAVENOUS REGIONAL PERFUSION OF CEFTIOFUR IN AN AFRICAN ELEPHANT (Loxodonta africana ) (Dutton C.J., Delnatte P.G., Hollamby S.R., and Crawshaw G.J. Journal of Zoo and Wildlife Medicine 48(2): 554–558, 2017) A 41-yr-old African elephant (Loxodonta africana) presented with a swollen third digit of the left forelimb and a 2-cm hole in the pad. Corrective trimming, topical treatments, and an oral antibiotic resulted in apparent resolution; however, it reoccurred after 4 mo. Radiographs suggested bone lysis in the third phalanx, with the primary differential diagnosis being septic osteitis. Flushing with metronidazole solution and intravenous regional perfusion (IVRP) of the foot were commenced. A tourniquet was applied just above the carpus, an interdigital vein was identified by ultrasound, and into this vein 2 g (20 ml) of ceftiofur sodium solution, followed by 60 ml of heparinized saline, was administered. The foot was kept raised for 25 min and then the tourniquet was removed. IVRP was repeated every other day for 70 treatments over 6 mo. Healing occurred, which was confirmed radiographically. IVRP offers an excellent treatment modality in a well-trained elephant. SURGICAL REMOVAL OF INFECTED PHALANGES FROM AN ASIAN ELEPHANT (Elephas maximus ) Gage, L. Blasko D, Fowler M.E. and Pascoe J. Joint Conference AAZ/WDA/AAWV After unsuccessful antimicrobial treatment of an osteitis in a 40 yr-old Asian elephant, surgical removal of the affected phalanges resulted in the complete healing of the foot. Click here to read the report. Digital osteitis treatment Literature Bentley C.E., Cracknell J.N., Kitchener A.C., Pereira Y.M., Pizzi R. 2021. Improved diagnosis of foot osteoarthritis in elephants (Elephas maximus , Loxodonta africana ) using stereoradiography. Journal of Zoo and Wildlife Medicine 52(1): 67–74, 2021. Dutton C.J., Delnatte P.G., Hollamby S.R., and Crawshaw G.J. 2017. Successfull treatment of digital osteitis by intravenous regional prefusion of ceftiofur in an african elephant (Loxodonta africana) . Journal of Zoo and Wildlife Medicine 48(2): 554–558, 2017). Fowler M.E. and Mikota S.K. 2006. Biology, Medicine, and Surgery of Elephants. 271-290. Gage, L. Blasko D, Fowler M.E. and Pascoe J. 1995. Surgical removal of infected phalanges from an asian elephant (Elephas maximus ). Joint conference AAZV / WDA/ AAWV . Mumby, C., Bouts, T., Sambrook, L., Danika, S., Rees, E., Parry, A., Rendle, M., Masters, N. and Weller, R. (2013), Validation of a new radiographic protocol for Asian elephant feet and description of their radiographic anatomy. Veterinary Record, 173: 318-318. https://doi.org/10.1136/vr.101696 . Nigam, P., Sarma, K.K., Kumar S. and Pandey, R. (Eds.) 2025. Healthy Feet, Healthy Elephants: A Guide to Foot Care in Captive Asian Elephants . Project Elephant Division, MoEF&CC, GoI- Wildlife Institute of India. To page top

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A 14-month-old African elephant presented with colic caused by colon obstipation. Due to the severity of the symptoms, it was decided to perform abdominal surgery.  A second surgery was required after 3 months. To colic general information Case report Colic and abdominal surgery in 14-month-old African elephant Date: 2018 Place: South Africa Data provided by: History A 14-month-old African elephant presented with colic caused by colon obstipation. Due to the severity of the symptoms, it was decided to perform abdominal surgery. A second surgery was required after 3 months. Treatment The animal was anesthetized with etorphin, intubated in the trachea, maintained on isoflurane and positioned in dorsal recumbancy. A midline incision was elected to approach the intestines. An obstruction of the colon was found and surgically removed. The peritoneum and muscle layers in the ventral midline were closed in one layer with Number 1 Maxon loop sutures, used in horse colic surgery to close the abdomen. Each suture knot was thrown 5 times, instead of the normal 3 times. The subcutis was closed with 2/0 Vicryl (continuous sutures) and the skin with Number 1 Nylon (single sutures). Reaction of the wound occured both times and she developed an incisional infection . This infection was treated by keeping the wound clean and both times the wound finally healed well. Treatment results The elephant recovered completely without further complications. Paramedian incision Instead of a midline incision, aparamedian incision can be used, just several centimeters left or right of the ventral midline. The advantage of this approach is the possibility to suture more muscle tissue compared to the connective tissue of the linea alba. There may, however, be more bleeding during surgery and access may be more limited than when a midline incision is used. Diagram of the closure of a paramedian incision. A) Skin B) Abdominal tunic C) Aponeurosis of the external abdominal oblique muscles D Rectus abdominal muscle E) Aponeurosis of the transverse abdominal muscle F) Peritoneum To page top

This page directs you to the reference values of hematology and blood chemistry in Asian and African elephants, including toxicology and endocrinology. To serum chemistry Reference values (blood): - Hematology - Blood chemistry - Toxicology - Endocrinology All values (IU) All values (Conv. Un) All values (IU) All values (Conv. Un) Asian elephant African elephant One study in 10 healthy Asian elephants showed that most Asian elephant hematology and biochemistry parameters are highly individual, requiring individual normal values for accurate interpretation (Perrin, 2020).

Leptospirosis in elephants has been described in Asian elephants. This page describes clinical cases and treatment as well as serological evidence of leptospirosis in apparently healthy elephants and the presence of leptospiresin elephant urine. Leptospirosis General information Leptospirosis is a bacterial infection caused by Leptospira spp . It is a common disease in many species of domestic animals. Leptospirosis is zoonotic. The bacteria are dispersed by urine of rodents, especially rats. The organism can survive many weeks in a slightly alkaline moist environment. The route of infection is by percutaneous inoculation of wounds or through mucous membranes. Several serovars have been associated with disease. Usually the liver is the target organ of Leptospira sp . Icterus, anemia, weight loss, (ventral) edema and general malaise are the main clinical signs. Ocular involvement (uveitis and hypopyon) may also occur. In elephants only a few clinical cases of leptospirosis have been reported. In one study in Sri Lanka, urine samples from 13 healthy domesticated elephants were collected on three consecutive days and analyzed for leptospiral DNA (Athapattu, 2019). Four elephants (31%) were confirmed to shed pathogenic leptospires in their urine. DNA sequencing followed by phylogenetic distance measurements revealed that all positive elephants were infected with L. interrogans. This study reveals the possibility that elephants may act as a source of infection for humans and recommends that all domesticated elephants that are in close contact with humans be screened to detect leptospiral shedding. In a study in India, serum samples were collected from 51 captive elephants kept in three different forest ranges (Shivraj, 2009). The samples were subjected to screening for leptospirosis using the microscopic agglutination test (MAT). It was found that out of the 51 samples seven elephant sera (13.72%) showed antibody titers against two serovars of Leptospira interrogans (L. australis and L. canicola) by MAT indicating the presence of infection or due to the past exposure of captive elephants to leptospiral antigens. In Thailand serum from 113 Asian elephants residing in 10 different tourist camps were tested using the microscopic agglutination test against 22 serovars of Leptospira interrogans (Oni, 2007). A seroprevalence of 58 % was found. The prevalent serovars were L. interrogans Sejroe, L. interrogans Tarassovi, L. interrogans Ranarum and L. interrogans Bataviae and L. interrogans Shermani . These results were similar to studies in domestic livestock and stray dogs in the Bangkok district. Because of the potential risk of indirect transmission of Leptospira spp from elephants to humans, 24 environmental samples were collected from an elephant camp area in western Thailand (Chaiwattanarungruengpaisan, 2019). Eighteen samples (75%) were culture-positive for Leptospira spp . The recovered leptospires were mostly derived from water and soil samples from a river and a mud pond, the main areas for recreational activities. The majority of the isolates were classified into the “Pathogens” clade (89%, 16/18) and more than half of the isolates (61%, 11/18) contained species of the “Saprophytes” clade. Notably, two soil isolates from the river beach sampling area were found to contain leptospiral DNA with high similarity to the pathogenic L. interrogans and L. santarosai . The evidence of diverse Leptospira spp ., particularly those belonging to the “Pathogens” clade, suggest that the shared environments of an elephant camp can serve as potential infection sources and may pose a risk to the elephant camp tourists and workers. It was not clear from this study whether the elephants were the source of these Leptospira spp. Leptospirosis in elephants One clinical case described the following clinical signs: chronic weight loss (400 kg) over a 4-month period (Fowler, 2006). Anorexia was profound. Leptospirosis was included in the differential diagnosis when the elephant developed uve itis and hypopyon . Titers for multiple serovars of Leptospira reached 1:12,800. The liver was the organ system infected. Icterus was marked. The sclera and hypopyon were both bright yellow. Total bilirubin reached 160 μmol/L (9.4 mg/dl), and liver enzymes were elevated. Ventral edema became pronounced, accompanied by ulcerating lesions of the vulva and various areas of the skin. The tip of the tail necrosed from vasculitis. Blood urea nitrogen and creatinine levels remained normal throughout the course of the disease, indicating that the urinary tract was not involved. Diagnosis was based on elevated titers for Leptospira serovars plus hypopyon and uveitis. The organism was not isolated nor could antigens be detected by PCR. Two other elephants cohabitating with the ill elephant developed low titers (1:200–400) for Leptospira icterohemorrhagica , but they did not develop clinical disease. Another case was described by Govindarjan (2006): A 16 yr-old Asian elephant bull was off food for one week. He developed icteric mucous membranes and his urine stained yellow (the author of this report did not mention the color in comparison with the color of normal urine, which is yellow as well). An 8-fold increase of antibodies against L. pyrogenes was observed within a 20-day interval. Diagnosis of leptospirosis is based on serological assays (Micro Agglutination Test MAT, ELISA), PCR, dark field microscopy, and silver impregnation staining. Treatment of elephants with clinical leptospirosis consists of the administration of antibiotics (tetracycline, doxycycline). In the case described above by Govindarjan, amoxicillin was given at a dose of 30 g/day IV for 14 days. References Fowler M. 2006. Infectious diseases. In: Biology, Medicine and Surgery of Elephants, Ed. Fowler and Mikota, 2006, 148. O. Oni, K. Sujit, S. Kasemsuwan, T. Sakpuaram, D. U. Pfeiffer. 2007. Seroprevalence of leptospirosis in domesticated Asian elephants (Elephas maximus) in north and west Thailand in 2004 Veterinary Record (2007) 160, 368-371. Sjivraj, M.D. Venkatesha, Sanjeevkumar, B.M.Chandranaik, Rajkumari Sanjukta, P.Giridhar, and C. Renukaprasad (2009). Detection of leptospiral antibodies in thesera of captive elephants. Veterinary World, Vol.2(4): 2009, 133-134. T. P. J. Athapattu, B. R. Fernando, N. Koizumi and C. D.Gamage. 2019. Detection of pathogenic leptospires in the urine of domesticated elephants in Sri Lanka. Acta Tropica Vol. 195 Pages 78-82 Chaiwattanarungruengpaisan, S., Thepapichaikul, W., Paungpin, W., Ketchim, K., Suwanpakdee, S., Thongdee, M., 2020. Potentially Pathogenic Leptospira in the Environment of an Elephant Camp in Thailand. Tropical Medicine and Infectious Disease 5, 183.. doi:10.3390/tropicalmed5040183 Leptospirosis AAZV fact sheet (2018) Leptospirosis EAZWV fact sheet (2003) To infectious diseases

Tusk fractures should be treated as soon as possible. Both conservative treatment and surgical treatment, using a threaded rod and dental filling materials are described. Step by step you are guided through the entire procedure. To tusk fracture By Willem Schaftenaar (DVM) with a big thank you to the dental team of the Colyer Institute in San Diego: Jim Oosterhuis (DVM), Dave Fagan (dentist, and founder of Colyer Institute), Jeff Zuba (DVM, elephant anesthesiologist ), Allison Woody ( board certified veterinary dentist), Fred Pike (DVM, board certified veterinary surgeon) Tusk fracture repair Tusk fractures are not uncommon in elephants, both in the wild as well as under captive conditions. A tusk fracture can be the result of fights, playing with "toys" (e.g. a tire hanging on a chain), digging in the soil or hitting a wall or other heavy objects (e.g. bulls into musth). Fractured tushes in female Asian elephants usually need no treatment, as the dental pulp does not pass the tusk sulcus. However, fractures in tusks are vulnerable for pulp exposure. If not treated in due time, exposed pulp may become infected and become necrotic, finally resulting in the loss of the entire tusk. Cutting the tusk too short may also result in pulp exposure. Sulcus infection after tush fracture If a tush or tusk fractured proximal to the tush sulcus, sharp pieces of the remaining part of the tush or tusk may cause wounds in the sulcus. Treatment consists of removing these sharp edges of the tusk by rasping them off. The sulcus wounds should be treated like a superficial skin wound by daily cleaning and flushing with Ringer's lactate and an antiseptic (e.g. Betadine-iodine or Chlorhexidine 1%). WARNING: if the pulp tissue is exposed, the elephant should be vaccinated against tetanus! Pulp exposure and tusk growth Exposure of the pulp tissue always results in a bacterial pulpitis. As long as sufficient healthy pulp tissue is present in the apex of the tusk, the tusk may continue to grow. However, if the pulpitis is not treated properly, the infection will finally affect the entire pulp and the tusk will become necrotic and will need to be extracted. Treatment of open tusk fractures There are 2 approaches that are being applied as treatment of a fractured tusk: A. Conservative treatment B. Surgically filling the pulp canal A. Conservative treatment of fractures with minimal pulp exposure: daily cleaning and flushing with Ringer's lactate and an antiseptic (e.g. Betadine-iodine or Chlorhexidine 1%). This is not the preferred treatment option as it will often result in a permanent fistula, as shown here on the photo (small black spot). Nevertheless, the pulp canal was closed by newly formed secondary ivory. Conservative treatment of a tusk fracture with exposed pulp tissue, treated conservatively. The pulp canal closed in 3 months, leaving a very small fistula, which luckily that did not cause any clinical troubles during the following (6+) years. B. Surgically filling of the pulp canal The difference with a conservative treatment approach is the active closing of the pulp canal by a dental surgical procedure. This procedure consists of a partial pulpectomy, followed by closure of the pulp canal and will be described below: Tusk repair procedure Until the actual repair procedure will take place, any free hanging pulp tissue should be cut off and the exposed pulp tissue should be cleaned and flushed 3-4 times per day with saline solution. End each session by spraying Betadine solution or Chlorhexidine 1% over the pulp tissue. Antibiotics are usually not required as the wound is open and under control by flushing. However, the elephant should be vaccinated against tetanus. NSAIDs are only needed if the elephant shows signs of pain. The tusk repair procedure should be performed as soon as possible after the tusk fractured. Tusk repair procdure Fractures that are more or less perpendicular to the tusk length axis have better chances to heal than oblique fractures that extend beyond the sulcus. The best chances to heal properly are fractures with a tusk remnant that allows perpendicular shortening through healthy pulp tissue. In the photo shown here the following structures can be distinguished: exposed pulp tissue, the wall of the tusk remnant and the sulcus mucosa. If the remaining pulp tissue is hanging outside the tusk remnant immediately after the fracture, it is very likely that the proximal part of the remaining pulp tissue has detached from the inner tusk wall, which will result in pulp necrosis if not treated immediately after the tusk fractured. If sufficient pulp tissue can be removed to reach healthy tissue, the prognosis of complete healing is better than in case the pulp tissue encountered after pulpectomy is still detached from the inner tusk wall. Pulp tissue that is hanging outside the pulp canal should be cut off as soon as possible. Preparation –Check the equipment list –Prepare the area where the elephant will be treated S tanding sed ation or general anesthesia? Depending on the conditions of the facility, the procedure can be done under : - Standing sedation , using detomi di ne and butorphanol (or xylazine and butorphanol if detomidine is not available). Azaperone can be used as premedication. Xylazine alone has also been used in a range country where detomidine was not available. There must be sufficient access to the working area. Best is to chain the animal to a wall on both legs on the contra-lateral side of the fractured tusk. The use of a belly belt around the abdomen is highly recommended for safety reasons in case the elephant goes down. - General anesthesia is not strictly required, but under certain circumstances it is a good alternative if standing sedation is not an option. Once the animal is secured either in standing sedation or under general anesthesia, the tusk repair can start: Step 1: create sterile workfield 1. Scrub the affected tusk thoroughly using Povidone iodine scrub. 2. Cut off the tip of the fractured tusk using a giggli wire. Keep the soft tissue out of reach of the giggli wire!!! 3. If present, remove all abnormal (black) ivory using the Dremel. 4. Clean and brush the area (tusk and face) with soap and Betadine scrub. Flush with Betadine solution and alcohol (70%). 5. Cover the surrounding, disinfected skin with a sterile surgery sheet (secure with duct tape) 6. Put on surgical gloves and suit. Step 2: filling the pulp canal 7. Cut off 20-50 mm of the pulp tissue (depending on the diameter of the open pulp canal). If any pulp tissue has been pulled out when the tusk fractured, it is assumed that it has been separated from the tusk wall and when it snapped back in, it probably pulled in bacteria. So even if the pulp looks fresh when doing the pulpectomy, i.e., bacteria could be lurking way up the wall of the canal that you can't get to. This is a challenging part of the procedure. The pulp tissue has a rubbery consistency and needs to be cut with very sharp instruments (curved scissors and scalpels). High-speed cutters used in hip replacement procedures in dogs (Acetabular Reamer) have been used . Depending on the diameter of the pulp canal, a decision needs to be made either to fill the pulp canal at this point, or to bring in a threaded rod (or pulp insert plug) to stop the bleeding. If the pulp diameter is less than 5 mm, one can decide to skip the threaded rod method (skip steps 8, 9, 13 and 14). A threaded rod should be used in any pulp canal diameter larger than 5 mm. In that case, follow the entire procedure as written below. The aim of the plug is to stimulate normal dentinal bridge formation proximal to the plug insert. 8. Drill the pulp canal out to a perfectly round cylinder of the proper size, which corresponds with the diameter at the end of the drilled hole. A so-called step drill can be helpful to accomplish this task. 9. Tap threads into the wall of the tusk so that you have full threads of the plug in the tusk, PLUS, at least 2-3 cm of tusk wall above the plug. Handle for thread makers 10. Stop bleeding by compressing the pulp tissue gently with epinephrine-impregnated gauze (for several minutes). 11. Fill in the canal with Calcium Hydroxide or calcium hydroxy apatite with a push rod, which mixes some with the blood, and occasionally stops the bleeding for a short time. Other calcium sources that have been used successfully are: Calcium hydroxy-apatite paste (made at location by mixing powder with chlorhexidine or sterile water) and milled and sterilized Portland Cement. 12. Once the canal is full, clean out the calcium from the threads (usually the blood is oozing thru by then). 13. Screw in an inert plug. Plugs of different materials have been used, ranging from hardware store drain plugs made of PVC, ABS, polyoxymethylene to even brass. Sizes have ranged from 5-50mm diameter. The blood acts as a lubricant when the plug is screwed in. It also forms a nice clot next to the plug to aid in the formation of the dentin bridge. 14. The plug needs to be recessed at least 10 to 20 mm so tusk repair material can be placed over it. 15. Then flush the small remnant of the pulp canal with Chlorhexidine 1%. 16. Flush again with saline solution. 17. Let dry (if needed, use a hair dryer) 18. ETCHING: rub an etching agent on the dentin wall of the pulp canal (cotton-tip) for max. 15-30 seconds. 3M™ Scotchbond™ Universal Etchant Etching gel is a good choice; phosphoric acid (H3PO4 37,5%) or hypochlorite (NaOCl 3%, bleach) are alternatives. 19. Let dry again; use a hairdryer to reduce drying time. 20. Close the pulp canal with glass-ionomer cement. Fill the canal, but leave 5 mm for the composite. 21. Clean the cut-off side of the tusk or sand it with sandpaper. 22. Apply etching (15-30 sec), rinse again and apply bonding for composite application (e.g. Scotchbond Universal Etchant Etching gel (H3PO4 37,5%) and Scotchbond Universal Adhesive). 23. Cover the cement and surrounding area with a layer of dental composite self-curing or light curing, depending on availability of UV-light source (e.g. Tetric Evo Ceram/MIRIS/Filltek/…). 24. Cover the entire cut-off side of the tusk with epoxy glue for extra protection. 25. The tusk will then gradually wear down and the time the wear reaches the plug, the dentin bridge will have formed. At that point, the plug will usually pop out and if needed the hole can be again filled with your favorite tusk repair material. Final stage of tusk repair showing 5 different layers Photo gallery Right tusk fracture in a 5-yr old Asian elephant bull. No attempts to fill the pulp canal were done, resulting in a bacterial pulpitis. By daily cleaning and flushing the deeper part of the pulp remained healthy, resulting in continuous growth of the tusk for at least 2 years. In the end, t he conservative treatment resulted in complete necrosis of the tusk Tip of the fractured tusk and pulp of the same 5 yr-old Asian elephant bull Left tusk fracture in the same 5-yr old Asian elephant bull with the same development course as the left tusk (tusk necrosis) Tusk fracture in a 9-yr old Asian elephant bull that was successfully repaired. See also case report. Tusk fragments of the same 9 yr-old Asian elephant bull. Tip of the tusk after it was sawn off using a giggli wire. During sawing off the tusk tip, the sulcus was lifted using an elephant hook in order to prevent the giggli wire cutting into the skin. When the tusk tip was removed, a large crack filled with dirt became visible. A 'Dremel' hand tool with an extension cable was used to clean out the dirt from the crack. The diameter of the pulp canal was approximately 5 mm. Hence, no threaded rod was used to fill the pulp canal. Etching of the inner tusk wall was done by swapping hypochlorite on the inner surface. The hypochlorite was rinsed off with saline solution. After a layer of calcium hydroxy apatite was applied on top of the pulp, the pulp canal and the cleaned crack were filled with glassionomer cement, the tusk surface was sealed with dental composite. Despite the fact that it was still growing, this tusk of a 26-yr-old Asian elephant bull was extracted several years after it was fractured. These photos show the completely sealed pulp canal by a naturally forme dentin bridge. The decision to extract the tusk is questionable. List of equipment Instruments G iggli wire + handles Plyer to cut off the gigli wire Dremel + extension cable 20 ml syringes (1, 2, 5, 20 and 40 ml) Nail brush Tooth brush Surgical tool set: scissors (1 curved 1 straight) surgical clamps scalpel handle no.3 + blade no.11 sharp spoon Sterile dishes to prepare dental restoration products. Hair dryer High-speed cutter/acetabulum reamer Electric drill Step drill (20, 30 mm and 40 mm) Metal drills (e.g. 12.0, 14.0, 15.5, 17.5, 26.5, 32 and 36 mm diameter) Thread makers (diameters corresponding to drill) Threaded (nylon) rods (diameters corresponding to thread maker). See text above) Sealing tape Disposables Surgical gloves Surgical suit Surgical drapes Steri le cotton tips Betadine solution (10%) Betadine scrub Ringer's lactate (or Saline solution) Chlorhexidine 1% Etching products: 3M™ Scotchbond™ Universal Etchant Etching gel or Hypochlorite (3%) Calcium hydroxy-apatite powder (to make a paste) or milled and sterilized Portland cement or calcium hydroxide. Glass-ionomer cement Bonding fluid for dental composite (light curing) Dental composite 2-component epoxy or acrylic resin Cotton tips Non-sterile cotton gauze patches (10x10) to cover the eyes Sterile cotton gauze patches (10x10) Leucoplast Duct tape Sand paper Equipment list Avenir Light is a clean and stylish font favored by designers. It's easy on the eyes and a great go-to font for titles, paragraphs & more. References: Woody A.D., Fagan D.A., Oosterhuis J.E. 2022: Large mammal dental surgery. In: Surgery of Exotic Animals, First Edition. Edited by R. Avery Bennett and Geoffrey W. Pye. © 2022 John Wiley & Sons, Inc. To page top

Kidney disease is quite common in elephants. The analysis of urine is important. This page describes the routine urinalysis and some specific features related to elephant urine. Protein detection can be done by refractometry and sulfosalicylic acid (SSA)precipitation. Comparing osmolarity in serum and urine gives an indication for the presence of kidney failure. To lab diagnosis Urinalysis The routine urinalysis is a quick and relatively inexpensive test which can be readily performed in a field laboratory. Ideally urine should always be collected at the same time as blood for hematology and clinical chemistry (if possible) and before any treatment is administered. Urine should be examined as soon as possible after collection, because artifacts will occur in the urine over time (cells lyse, crystals form in vitro). If a delay is anticipated before analysis, the urine should be refrigerated. Refrigerated urine should always be brought to room temperature before testing. A complete urinalysis consists of 1) evaluation of physical characteristics, 2) measurement of specific gravity, 3) dipstick analysis and 4) examination of sediment. Equipment and Materials Microscope Refractometer Slides Urinalysis dipsticks Urine sediment stain Physical Characteristics of Urine 1. Evaluate and record urine color Normal mammalian urine is yellow to amber. Urine volume and concentration affect the depth of the color. Some examples of various urine colors and corresponding common possible causes: 2. Evaluate and record urine turbidity Fresh urine is clear to very slightly cloudy. Urine may become more cloudy if left standing or if refrigerated. The turbidity of the urine sample is reported as: clear, slightly cloudy, cloudy, opaque, or flocculent. Excess turbidity results from the presence of suspended particles in the urine. The cause can usually be determined based on the results of the microscopic urine sediment examination. Common causes of abnormal turbidity include: increased cells (RBC, WBC) numerous crystals bacteria lipiduria (lipids often rise to the surface) mucus (especially in horses) semen fecal contamination 3. Odor Ammonia is formed from urea by bacterial action. An ammonia smell may be prominent in retained or old urine samples. An acetone small may suggest ketosis. Some drugs may impart a characteristic odor. 4. Volume Urine volume may be estimated from urine specific gravity. In general, volume and specific gravity (S.G.) are inversely related in health and in most diseases. Exceptions include: Diabetes mellitus. Polyuria and high S.G. coexist because of glucosuria. Acute and chronic renal disease. Oliguria (↓ urine volume) may be accompanied by a lack of renal concentrating ability. 5. Measure specific gravity (S.G.) Specific gravity is the ratio of the refractive index of urine compared to water. Refractometry is the easiest method to measure urine S.G.Dipsticks are not as accurate. Glucose and protein may falsely ↑ urine S.G. Knowledge of the hydration status is necessary to interpret the S.G. Urine S.G. can vary from 1.001 to 1.065 in most healthy animals but this range also includes values associated with renal abnormalities. S.G. has been inadequately studied in elephants and obtaining a baseline during health and evaluating sequential samples during illness is recommended. Isosthenuria (fixed S.G.) is the constant maintenance of urine S.G in the range of the glomerular filtrate (1.008-1.012). Isosthenuria means the kidney is neither concentrating nor diluting urine. Hyposthenuria is a S.G. < 1.008. In hyposthenuria the kidneys still have some water-balance function. 6. Perform dipstick analysis and record results. Mix the urine Dip the dipstick; remove extra urine Start timing Compare to chart on bottle in good light The dipstick method is not reliable for protein detection in elephants. Using the SSA-method is more reliable (see 6.1) 6.1 Urine protein detection. "PROT-SSA" represents the reaction observed on the sulfosalicylic acid (SSA)precipitation test. The SSA reagent is added to a small volume of urine. Acidification causes precipitation of protein in the sample (seen as increasing turbidity), which is subjectively graded as trace, 1+, 2+, 3+ or 4+. Unlike the "PROT-STIX" test, the SSA reaction will detect albumin andglobulins (although it is more sensitive to albumin). In addition, the SSA detects Bence-Jones proteins, although it often underestimates them. In alkaline urine, the SSA reaction is a more accurate measure of urine protein content than the dipstick. The most accurate measurement of urine protein output is measurement of urine protein excretion over 24-hours. False positives Contrast media Antibiotics in high concentration, e.g. penicillin and cephalosporin derivatives Uncentrifuged turbid urines can look positive. Therefore, SSA should always be performed on urine supernatant. False negatives Highly buffered alkaline urine. The urine may require acidification to a pH of 7.0 before performing the SSA test. Dilute urine Turbid urine - may mask a positive reaction. https://www.klimud.org/public/atlas/idrar/web/www.diaglab.vet.cornell.edu/clinpath/modules/ua-rout/protssa.htm 7. Urine sediment examination Centrifuge a fresh urine sample for 5 minutes at about 1500 RPM Remove supernatant Add 1-2 drops of stain to sediment Tap the bottom of the tube to mix Transfer one drop to a slide and place a coverslip Examine the entire coverslip at 10X and 40X * Low maginification (10x): casts, large crystals, debris, parasitic ova are visible * High magnification (40x): leukocytes, erythrocytes, epithelial cells, fat droplets, small crystals, sperm, debris and bacteria are visible To page top

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

Colic is a condition that is often seen in elephants. This page describes the symptoms of colic and connects to several case reports To non-infectious diseases Colic Compiled by: Willem Schaftenaar Definition of colic Colic can be defined as a symptom of pain in the abdomen. Elephants that suffer of colic can show a variety of symptoms, ncluding: Frequent looking at the abdomen. Touching the abdomen with the trunk. Hitting the abdomen with the trunk. Throwing sand or water towards the abdomen. Throwing sand or water over the backside. Restlessness. Vocalization. Standing with open mouth. Frequently going down and standing up. Lifting a hind leg, supporting it on an object. Kicking a hindleg in the direction of the abdoemn. Bilateral bending the hind legs. Straining. Additional symptoms that may occur simultaneously: increased respiratory rate, increased heart beat, bloating. To colic case reports Causes of colic Gastro-intestinal tract: One of the most frequent causes of colics in elephans is sand impaction. Enteritis, gut spasms, constipation and tympany can also cause colics. Peritonitis. Torsio mesentericum. Abdominal organs: Although not reported in elephants, all abnormal conditions in abdominal organs can cause colics (inflammation, abscess, tumor). The elephant has no gall bladder, but gall stones stuck in the biliary ducts might result in colic. Reproductive tract: Normal parturition. Abnormal parturition. Herniation of the uterus. Large leiomyoma. Urinary tract: Calculi in the urethra. Herniation of the urinary bladder. Bladder stones. Treatment Text to be provided Diagnostic results Text to be provided To page top