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Cowpox infections in elephants have been seen in several north/mid European countries, often with a fatal outcome. Lesions and preventive vaccination are described in this chapter. To infectious diseases Cowpox General information Cowpox virus infections (see EAZWV fact sheet info) have been reported as a cause of a severe, sometimes fatal disease in Asian elephants in European zoos. African elephants can be affected as well, but usually the lesions in this species are restricted to the skin and they tend to heal quickly. The causative virus is an orthopox virus, affecting rodents (endemic hosts), elephants, (wild felids), tapirs, okapis, antelopes, rhinoceros, primates (including humans). It causes local or generalized vesicular lesions of the skin and mucous membranes and can develop into a systemic disease, affecting the lungs and GI-tract. Intra-uterine infection in an Asian elephant has been reported. Pox infection in elephants is a zoonotic disease and has been reported in human caretakers after contact with affected elephants. Although the direct source of pox virus infections in elephants has never been found, it is generally accepted that infection takes place by consumption of roughage that has been contaminated with urine from affected rodents. Pox lesions in elephants occur on the skin (predominantly the trunk and the legs) and mucous membranes (tongue oral cavity). Lesions on the foot soles can result in complete sole detachments. One still birth case has been reported in an Asian elephant in a European zoo, that had been vaccinated twice with Modified Vaccina Ankara strain on days 293 and 322 of its pregnancy. A full-grown calf (117 kg) was born a-term with generalized pox lesions on the skin, air ways and gastro-intestinal track as well as the spleen and liver. The dam nor any of the other (vaccinated) elpehants in the same herd were affected. Treatment Treatment of a pox virus infection is symptomatic. Antibiotic treatment should be considered as a prevention of a secondary bacterial infection. Prevention Vaccination is strongly recommended for elephants living in European zoos. First injection injections (s.c. or i.m.) of 4 ml MVA at the age of 12-16 weeks. Second injection injections (s.c. or i.m.) of 4 ml MVA 4 weeks after the first injection. The producer of the vaccine advices and offers titer measurement before the vaccination and 3-4 weeks after second vaccination). In young and untrained elephants this may be not possible, and vaccination should be practiced without titer control. Booster vaccinations: generally once every 2-3 years, depending on the titer. Vaccination during pregnancy: following this vaccination advice, elephants should be immune before they become pregnant. There are no sound studies about the possible side effects of vaccination on the fetus. New non-vaccinated imports or elephants with unknown vaccination status should not be bred before they are properly vaccinated. Contact with rodents worldwide should be avoided. Literature Pilaski J, Schaller K, Matern B, Klöppel G, Mayer H. 1982. Outbreaks of pox among among elephants and rhinoceroses. Verh ber Erkrg Zootiere. 24: 257-265. Pilaski J, Rosen-Wölff R. 1987. Poxvirus infection in zoo-kept mammals. In: Darai G (ed) Virus diseases in laboratory and captive animals. Martinus Nijhoff Publishing, Boston. pp: 83-100. Pilaski J, Kulka D, Neuschulz N. 1992. Outbreak of pox disease in African elephants (Loxodonta africana) at the Thuringer Zoopark Erfurt. Verh ber Erkrg Zootiere. 34: 111-118. Wisser J, Pilaski J, Strauss G, Meyer H, Burck G, Truyen U, Rudolph M, Frölich K. 2001. Cowpox virus infection causing stillbirth in an Asian elephant (Elephas maximus). Vet Rec. 149: 244-246. Kurth A, Wibbelt G, Gerber HP, Petschaelis A, Pauli G, Nitsche A. 2008. Rat-to-elephant-to-human transmission of cowpox virus. Emerg Infect Dis. 14: 670-671. Photo gallery cowpox in elephants Typical cowpox lesions on the trunk (left) and tongue of an Asian elephant Typical cowpox lesions on the legs and the distal part of a leg after detachment of the sole. Detached sole horn of a front and a hind leg of an Asian elephant affected by cowpox virus. Pox lesion on the face of a caretaker of an elephant suffering of a cowpox infection Cowpox lesions in an old Asian elephant. In this case the lesions were restricted to the oral cavity. The elephant recovered completely. Cowpox lesions on the inner side of the trunk in a fullgrown, stillbirth Asian elephant calf (Vet Rec. 2001:149: 244-246). Ulcerated cowpox lesions in the somach of a fullgrown, stillbirth Asian elephant calf (Vet Rec. 2001:149: 244-246). To page top

This chapter describes tusk fractures, conservative and treatment by partial pulpectomy and filling with glass ionomer cement and tusk extraction. To dentistry To dentistry Tusk fractures Rose et al. 2022: Elephant tusk fractures are a management and medical challenge that can escalate into life-threatening complications. Out of 459 elephants included in a survey, 85 elephants incurred at least one fracture during a period of 10 years. The most common causes of fractures were conspecific interactions (44.6%), caught tusk in an enclosure or enrichment item (28.4%), and a strike by the elephant of a tusk with an object (12.2%). For social causes, unstable hierarchy (45.5%) and specific agonistic interactions (36.4%) were the most frequently cited fracture causes. Steel gates were associated with 23.8% of fractures caused by enclosure elements. Management changes including tusk trimming, enrichment, training, and re-arranging social groups were found to be important in reducing subsequent fractures, with odds ratios showing that a second tusk fracture was 6.37 times more likely to occur if no management changes occurred after the first fracture. The data of this survey suggests that targeted management strategies in herds with maturing males, unstable social dynamics, and/or high-risk enclosure elements could reduce the frequency of tusk fractures. Radiographic examination of the alveolus including the remaining part of the tusk still inside is important for the decision about which treatment to be followed. It can give information about the shape of the fracture end, the condition of the pulp and pulp cavity. This is also important information for monitoring the healing process during and after the treatment. Elephants can be trained to allow radiography of this part of the head, whereas the plate and the X-ray machine are kept as shown in the image below. Radiographyalveolus and tusk In 2024, a working group called Elephant Dental VETS, initiated by members of the EAZA Elephant TAG, began a collaborative effort to develop guidelines for responding to cases where an elephant breaks its tusk. This work resulted in a document outlining treatment procedures for tusk fractures. The document also includes valuable advice on preventing tusk injuries and will be updated regularly as new scientific insights become available. Click here to download the guideline Clinical cases Treatment options Tusk fracture in 36 months-old calf Tusk fracture repair in 9 yr-old bull Tusk fracture in 4 yr-old African elephant Tusk fracture repair procedure Conservative treatment (Tusk extraction) Reference Rose, J.B.; Leeds, A.; LeMont, R.; Yang, L.M.; Fayette, M.A.; Proudfoot, J.S.; Bowman, M.R.; Woody, A.; Oosterhuis, J.; Fagan, D.A. Epidemiology of Traumatic Tusk Fractures of Managed Elephants in North America, South America, Europe, Asia and Australia. J. Zool. Bot. Gard. 2022, 3, 89-101. https://doi.org/10.3390/jzbg3010008

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

This page describes eye problems in elephants and how to treat them. Blepharitis, conjunctivitis, cornea edema, keratitis, vitamin A deficiency, corneal ulcer, cataract, hypopion, uveitis, synechia, iris prolaps, and panopthalmitis. Ophthalmology Compiled by Dr. Khyne U Mar, DVM and Willem Schaftenaar, DVM Eye problems are common in elephants. They are often the result of trauma and present as superficial or deep cornea lesions and ulcers. Cataracts are also regularly seen in elephants. If the vision in one eye is reduced, the animal should be approached with care from that side. In a study in 1478 captive elephants (2956 eyes) in Thailand, 17.83% of the examined eyes from 369 elephants (24.97% of the total number of elephants) had anterior ocular abnormalities. The most common lesions in these examined eyes were frothy ocular discharge (5.85%), corneal edema (5.31%), and conjunctivitis (5.18%). In addition, epiphora, phthisis bulbi, other corneal abnormalities, anterior uveitis, and lens abnormalities were noted. Almost all lesions increased in frequency with age (Kraiwong, 2015). Regular ophthalmic examination in elephants should be included in their annual health check program. Early detection and treatment of any ocular abnormality may avoid the development of subsequent irreversible ocular pathology. Clinical examination overview and diagnostic techniques The clinical examination of the eye starts with the anamnesis (history) and observation of the animal. The eyelashes should be long in order to protect dirt and objects from touching the surface of the eye. They are located mostly superior to the eye and can be as long as 11 cm. The inferior eyelid has less and smaller (2 cm) lashes. A unique feature of the elephant eye is the lack of a lacrimal apparatus (lacrimal glands as well as nasolacrimal duct) and eye brows. Tear films simply flow towards the medial canthus and exit along a groove in the skin onto the face in Asian elephants (Wong et al. 2012). The area around the eyes is therefore often wet. A Schirmer tear test can be performed in elephants. In a research cohort of 80 healthy Asian elephants the mean value was 34.3+/- 1.7 mm/min with older elephants (>40 years) having higher values than younger ones (<20 years). The cornea should be clear, without any irregularities. The iris of an elephant varies in color from tan, yellow, brown or the combinations. Blepharospasm is a strong indication for ocular disease. Conjunctiva cultures can be taken, though the strong palpebrae can make sampling for culture a challenge. Ophthalmic anesthetics can be used safely in elephants and may facilitate clinical examination and allow ophthalmoscopic examination of the deeper ocular structures. The pupillary light response can be performed if the elephant trusts the clinician enough to approach the animal with a proper light source at the required short distance. This test should be performed in subdued light. The menace response can be performed if the animal allows the clinician at short distance by moving fingers towards the elephant's eye without causing air movement. The numerous hairs on the skin of the palpebrae are not true cilia or true eyelashes as they are not associated with the margins of the palpebrae (Wong et al 2012, J. Zoo and Wildlife Med., 43(4), pp 793-801). The lower eyelid is more developed and ascends to a greater degree than the upper lid descends (Suedmeyer, 2006). (Photo KUMar) The iris of an elephant can have several colors: tan, yellow, brown or a combination. (Photo: W.Schaftenaar) A white, circumferential ring, similar to the arcus senilis in man is noticed in 40+ yr Asian elephant (fat deposit or aging?). (Photo: KUMar) Fluorescein staining of the cornea may be difficult as the elephant will close its eye immediately when approached. A fluorescein strip can be placed in a 10 ml syringe with sterile water or saline; this solution can then be sprayed over the eye in a constant flow using a blunt small gauge needle. This should be sprayed on the eye from the medial or lateral side. It helps when at the same time a steady water stream is directed at the periocular skin, which may result in relaxation of the animal. After fluorescein has been sprayed on the cornea, the eye should be flushed with sterile saline to remove excessive fluorescin. If present, cornea defects will stain green under blacklight and even under regular light. Cataracts which appear as a white central spot and keratitis (diffuse, superficial cloudiness of cornea) are frequently seen in elephants. Vision can be checked by passing the light of a flashlight (or cell phone) from the ear over the eye to observe for a blinking reflex. Ophthalmoscopy in the untrained elephant can be quite a challenge, as the animal will usually not allow this kind of close examination that moreover uses a light source. However, the animal can be trained to allow ophthalmoscopy. The third eyelid or nictitating membrane is located at the ventro-medial aspect of the orbit. Inside the nictitating membrane, an oblong, flanged-shaped piece of hyaline cartilage supports the anterior palpebral aspect of the nictitating membrane. The harderian gland that is located here, plays a role in the lubrication of the cornea. Zeis's glands (modified sebaceous glands) are located in the margins of the lid. They produce an oily substance that helps lubricate the cornea. Blinking reflex The nictitating membrane in an Asian elephant (arrow).(Photo: KUMar) Blinking reflex using a smartphone's flash light in an Asian elephant with chronic keratitis. (Video: W.Schaftenaar) Ultrasonographic examination The clinical examination of the elephant's eye can benefit from transcutaneous ultrasonographic examination. The anterior eye chamber, the lens end the posterior eye chamber can be visualized using a 4-7 MHz convex probe (Bapodra et al. 2010). Following are descriptions of the anatomical components of the eye and the medical condition that may occur Eyelids Blepharitis is an inflammation of the eyelids than can be caused by trauma (rubbing), parasite infection or as part of a localized dermatitis. The accompanying symptoms are blepharospasm, epiphora (tearing that appears as wet skin area below the eye) and often photophobia. Sometimes lice (Haematomyzus elephantis ) or ticks (Amblyomma tholloni) can be found on the eyelids causing local skin lesions. Blepharitis in an Asian elephant. (Photo: KUMar) Small skin lesion caused by ticks (Amblyomma tholloni) (Photo: KUMar) Conjunctiva The conjunctiva is the tissue that lines the inside of the eyelids and covers the sclera (the white part of the eye ). It is composed of unkeratinized, stratified squamous epithelium with goblet cells , and stratified columnar epithelium . The conjunctiva is highly vascularized, with many microvessels . Conjunctivitis is an inflammation of the conjunctiva and is a common finding in elephants. In some cases small nodules and vesicles may be observed (lymphoid tissue on histology), possibly associated with chronic irritation. A conjunctivitis is often the result of trauma (hard object, dust, irritating liquid or smoke). Conjunctivitis is also seen in poxvirus infections. Conjunctivitis in an Asian elephant (From: Elephant care manual for mahouts and camp managers, FAO 2005 , Conjuctivitis and keratitis in an Asian elephant. Note the swollen mucosa. (Photo: KUMar) The conjunctival sac is a connection between the palpebral and bulbar conjunctiva. Under certain conditions (hypoproteinemia, trauma, insect bites or allergic reactions), a prolapse of this part of the cornea can develop, which protrudes like a mucosal sac between the eye and the lower eyelid. Prolapse of the conjuncitival sac in an Asian elephant. (Photo: KUMar) Cornea The cornea is transparent because it lacks cells and blood vessels and has no pigment. The cornea should always be wet thanks to a pre-corneal film tear. Oxygen and nutrients are available from the aqueous cornea tear film, the limbal capillary plexus and the palpebral conjunctival capillaries. Several disorders of the elephant cornea have been reported. Most of the corneal lesions seem to have a traumatic cause: trauma by rubbing, allergy by environmental irritants such as exposure to direct sunlight or continued exposure to dryness or small particles, e.g. dust, smoke, grass seed etc. that damage the corneal epithelium. Hypovitaminosis-A has also been suggested as a cause of cornea disorder as well as hypoproteinemia. Acanthamoebae Spp. has been identified in corneal swabs. It's presence has been associated with corneal ulcers (Dangolla, 2005). However, the protozoa was also found in swabs taken from healthy elephant eyes (Wijesekara, 2007). Corneal edema Corneal edema, also called corneal swelling, is a buildup of fluid in the cornea. It is caused by dysfunction of the endothelial membrane on the inner side of the cornea, that normally pumps fluid out of the cornea in order to keep it transparent and clear. This can happen after a blow to the eye or a puncture of the cornea (e.g. by small branches), or by contact with toxic substances. Cornea edema in an Asian elephant. (Photo: KUMar) Cornea edema in an Asian elephant. (Photo: KUMar) Cornea opacities - keratitis Opacities in the cornea are called keratitis and are very common in elephants. They present as whitish, "cloudy" areas usually in the central part of the cornea. It has been suggested that they are caused by trauma (thorns, heat, dust, and chemicals), direct sunlight or chronic dehydration. The cornea must be checked for foreign bodies. In severe keratitis, the entire cornea turns white. This reduces the vision of the animal to only being able to distinguish just between light and dark. This can be tested with the blinking reflex . In some cases, keratitis can be painful: the elephant shows blepharospasm and the third eyelid may be protruded (partly) over the eyeball. In that case involvement of the iris should be considered. It is recommended to perform cytology, aerobic bacterial culture, and sometimes fungal culture. When opacities are only found in the superficial epithelium, and dispersed over the entire cornea surface, it might be the result of hypovitaminosis-A (vitamin A is essential for the normal functioning of the corneal epithelium, including the production of the tear film). This condition is called "xerophthalmia". As fluid makes its way into the cornea it can accumulate and cause the formation of small bullae or "blisters." This is called bullous keratopathy. If the blisters break or rupture, a corneal ulcer will result. Mild, superficial opacity in the central area of the cornea in an Asian elephant (keratitis). (Photo: KUMar) To page top Diffuse, superficial opacities spread over the entire cornea of an Asian elephant, possibly caused by hypovitaminosis-A (xerophthalmia). (Photo: KUMar) Mild keratitis in an Asian elephant. (Photo: KUMar) Severe keratitis involving the entire cornea of an Asian elephant. (Photo: KUMar) Severe keratitis with protrusion of the third eyelid in an Asian elephant. This could be an expression of pain, in which case iris involvement should be considered. (Photo: KUMar) Corneal ulcer A cornea ulcer is an open sore on the cornea. The epithelial outer layer and the middle layer of the cornea (stroma) are disrupted. This condition is also called a melting corneal ulcer. Usually the primary cause is trauma of the cornea. This traumatic lesion can become infected by bacteria (Pseudomonas, Neisseria spp, fungi and other microbes. This condition is very painful a nd blepharospasm is often seen. The elephant may be rubbing the area around the affected eye against an object. There may be protrusion of the third eyelid. An ulcer is usually the result of trauma. Treatment of keratitis with NSAID's or glucocorticosteroids increases the risk of ulceration. As a reaction to the ulcer and to repair the lesion, blood vessels will grow into the stroma of the cornea, visible as small red lines, sometimes forming a network of small vessels. This process takes several weeks. When the cornea surface has been repaired, the remnants of these blood vessels will be visible as white connective tissue strands. The major risk in an ulcerated cornea is perforation of the entire cornea, which will result in loss of the ocular fluids and complete loss of the eye. When blood vessels fail to grow towards the ulcer, the ulcer remains in an unchanged form as an indolent corneal ulcer, needing a special treatment. Two manifestations of a severe keratitis and cornea ulcer with a prolapse of the iris in an Asian elephant. (Photo: KUMar) Hypopyon Hypopyon keratitis is an accumulation of pus (heterophils and fibrin) in the anterior eye chamber (between cornea and lens). It is accompanied by profuse discharge and signs of ocular pain. Ultrasonographic examination may be helpful for diagnosing pus in the anterior chamber. One case report describes the treatment of hypopyon in an Asian bull elephant. Hypopyon and uveitis have been described in a case of leptospirosis (Fowler. 2006. Infectious diseases. In: Fowler and Mikota, 2006, 403). Hypopyon Iris and uvea The iris is a diaphragm that regulates the influx of light. It is a very vulnerable structure that consists of two layers: the outer (anterior) pigmented fibrovascular layer (known as stroma, which lacks an epithelial layer) and the inner (posterior) surface covered by a heavily pigmented epithelial layer that is two cells thick (the iris pigment epithelium). This anterior surface projects as the dilator muscles. The high pigment content of the iris blocks light from passing through to the retina, restricting it to the pupil. The outer edge of the iris, known as the root, is attached to the sclera and the anterior ciliary body . The iris and ciliary body together are known as the anterior uvea . Uveitis Any lesions in the anterior part of the eye can result in damage to the iris. Parts of the affected iris may come into contact with the inner layer of the cornea (anterior synechia) or the lens (posterior synechia). If there is also a corneal ulcer, the iris may prolapse through the ulcer (iris prolapse). Iris lesions are considered to be very painful in all animal species. These conditions need immediate veterinary attention. Lesions of the iris and uvea are called uveitis . If only the anterior part is involved, we call it iritis . In reality it will be hard to distinguish these conditions in elephant ophthalmology, unless proper ophthalmoscopy can be performed under sedation or general anesthesia. Lens The lens is a transparent biconvex structure in the eyes that, along with the cornea , helps to refract light to be focused on the retina . Any lesions of the lens will result in white discoloration and loss of transparency (cataract). This is seen as a white area in the central pupillary space. Young cataracts will appear as cloudy structures. A mature cataract appears as a completely white pupil. A complete, mature cataract will reduce the vision of the elephant which may finally result in complete blindness of the affected eye. When an elephant is approached on the side of the blind eye, the clinician should be aware of the compensating behavior of the elephant, when it tries to keep its functional eye on the investigator. Cataracts are quite common in Asian elephants in range countries. One paper notes that 6-8% of the elephants kept in Sri Lanka suffer from this condition (Kuruwita, 1991). Several causes of cataracts are known in other animal species: trauma, overexposure to sun light, deficiency of vitamin A, C, E or riboflavin, diabetes and dehydration. Often the cause of a cataract in elephants cannot be determined. Early stage of a cataract in an Asian elephant. (Photo: KUMar) Advanced stage of a cataract in an Asian elephant. (Photo: KUMar) Advanced stage of a cataract in an Asian elephant. (Photo: KUMar) Panopthalmitis and phthisis bulbi Panophthalmitis is inflammation of all layers of the eye including the intraocular structures. It has been documented in nine eyes postmortem during a field study of eye lesions in African elephants ( McCullagh, 1969). Phthisis bulbi is a shrunken, non-functional eye. It may result from severe eye disease, inflammation or injury. Phthisis bulbi after chronically infected cornea ulcer. (Photo: KUMar) Subdermal injection of Plancentrex (0.1 mg/ml) in an Asian elephant with uveitis. (Photo: KUMar) Summary of the most frequently used drugs in ophthalmology Standard frequency of treatment applications: 3-5 per day Antibiotic treatment should be based on sensitivity test Flushing with 0.9% NaCl solution is recommended before every topical drug application The elephant's eye can be flushed using a long, small diameter tube place on a syringe. (Photo: KUMar) Treatment options in elephant ophthalmology Blepharitis: Treatments of blepharitis in elephants have not been described in the literature. A similar approach as in other mammals is recommended: elimination of the cause (parasites, dermatitis) and flushing the eye (see photo below) with saline solution, 3-5 times a day. Conjunctivitis, prolapse of the conjunctival sac : elimination of the cause and flushing the eye with saline solution, 3-5 times a day and antibiotic ointment, 3-5 times a day. Corneal edema: flushing with a hypertonic saline solution, 3-5 times a day. Keratitis in early stage: flushing with saline solution, 3-5 times a day, antibiotic ointment, 3-5 times a day. If there is no ulceration, topical application of 0.1% dexamethasone eye drops may be used; be aware that corticosteroids will stop the regeneration of the epithelial cells. Chronic keratitis: treatment will have no effect. Xerophthalmia: oral vitamin A supplementation. Corneal ulcer: flushing with saline solution, and topical application of antibiotic eye ointment 3-5 times a day. Topical application of Diclofenac sodium 1% eye solution may help reducing the pain. Promising results of the use of autologous serum have been reported (Janyamethakul, 2015), applied twice daily. Preparation of autologous serum: Five 10 ml. syringes were used to collect a total of 50 ml. Then, the blood was allowed to clot for 2 hours at room temperature before being centrifuged at 3,000 rpm for 15 minutes. The separated serum was collected (about 20-25 ml.) into a sterile container to which 1 mg. of gentamicin was added. The autologous serum was then aliquoted into sterile tubes, each containing 3 ml. Additionally, the serum was stored at 4°C and used within 7 days. Topical treatment with acetylcysteine (0.02%) was used in case of a corneal abscess along with gentamycin and atropine (Pipitwanichtham, 2023). Other treatments attempts that have been tried: Indolent (non-healing) corneal ulc ers are hard to treat. Debridement of necrotic corneal stro ma should be considered. This can be done by using a cotton tip, or in more severe cases the abnormal cornea tissue can be scraped using a corneal spatula. Theoretically, after the debridement, the cornea should be protected by a contact lens as used in horses. This has been repo rted once in a 44 yrs-old Asian elephant, in which case the lens was lost soon after application. In elephants flushing the eye and applying antibiotic eye ointment and autologous serum is probably the only possible post-debridement treatment. Stem cell application: pr omising results were seen at the Elephant Conservation Center Lampang (Thailand). Although never reported in elephants, the application of a few droplets of cyano-acrylate might be an alternative for a contact lens in elephants. Hypopyon: pain relief (NSAID), systemic antibiotics (DDX: leptospirosis!). Uveitis and Synechia: Atropine sulfate eye ointment (1%), 4-6 times a day, is a commonly used mydriatic drug in horses. It may stabilize the blood-aqueous barrier, reducing vascular protein leakage, minimizing pain from ciliary muscle spasm, and reducing the chance of synechia formation by causing pupillary dilatation. Pupil dilation is an indicator for the drug to be effective on the ciliary muscles. In horses even topical atropine has been shown to prolong intestinal transit time, reduce and abolish intestinal sounds, and diminish the normal myoelectric patterns in the small intestine and large colon of horses. Whether this also applies to elephants is unknown. Subdermal injection of placental extract (Placentrex®) is a common treatment for uveitis, hypopyon and corneal opacities in elephants in Asia (Suedmeyer, 2006). See also photo below. Iris prolapse: systemic NSAID, flushing with saline solution, 3-5 times a day. As the cornea is perforated by the prolapsed iris, the elephant should be treated systemically with antibiotics. Cataract: only 2 cases of (mature) cataract removal by phaecoemulsification have been reported (cataract surgery-UK and cataract surgery-USA). However, artificial lenses to replace the removed lens contents are not available. The significant lens instability (first noted following the initial stages of surgery in the USA-case, i.e., during creation of the anterior capsulorhexis) prevented implantation of an intraocular lens implant. See for more detailed information the references below (Cerrata, 2019 and Manchip 2020). Panophthalmitis: Enucleation is the only treatment indicated for this condition. However, there are no published data on the treatment of panophthalmitis. Placentrex Flushing References and further reading: Bapodra P, Bouts T, Mahoney P, Turner S, Silva-Fletcher A, and Waters M. 2010. Ultrasonographic examination of the Asian elephant (Elephas maximus) eye. Journal of Zoo and Wildlife Medicine , Vol. 41, No. 3, 409–417. Cerreta, A.J., McMullen Jr R.J., Scott, H.E., Ringenberg, J.R., Hempstead, J.E., DeVoe, R.S., Loomis, M.R., and Minter, L.J.. 2020. Bilateral Phacoemulsification in an African Elephant (Loxodonta africana). Hindawi Case Reports in Veterinary Medicine Volume 2019, Article ID 2506263, https://doi.org/10.1155/2019/2506263 or click here to download the manuscript. Dangolla A, JS Edirisinghe and ID Silva (2005). Association of Acanthamoeba with a corneal ulcer in a captive elephant (Elephas maximum maximus). Proceedings of 57th Annual Convention and Scientific Sessions of the Sri Lanka Veterinary Association. 33pp Fowler M. 2006. Infectious diseases. In: Biology, Medicine and Surgery of Elephants, Ed. Fowler and Mikota, 148. Janyamethakul T, Moleechat P, Gohain R, Somgird C, Pongsopavijit P, and Wititkornkul B. 2015. Efficacy of Autologous Serum as An Adjunct Treatment for A Melting Corneal Ulcer in A Captive Asian Elephant. Thai Journal of Veterinary Medicine: Vol. 45: 2, Article 18. Kraiwong, N., P. Sanyathitiseree, K. Boonprasert, P. Diskul, P. Charoenphan, W. Pintawong and A. Thayananuphat (2016). "Anterior ocular abnormalities of captive Asian elephants (Elephas maximus indicus) in Thailand." Vet Ophthalmol 19(4): 269-274. Kuruwita VY and Abeysinghe AB. 1991. Surgical correction of blindness due to mature cataract in a domesticated Asian elephant. International Seminar on Veterinary Medicine in Wild & Captive Animals, Bangalore, India, November 8 to 10, 1991; 23 Manchip, K.E.L., Sayers, G., Lewis, J.C.M., and Carter, J.W. 2019. Unilateral phacoemulsification in a captive African elephant (Loxodonta africana). Open Veterinary Journal, (2019), Vol. 9(4): 294–300. ISSN: 2218-6050 (Online) DOI: http://dx.doi.org/10.4314/ovj.v9i4.3 . or click here to download the manuscript. McCullagh, K.G. and Gresham, G.A. 1969. Eye lesions in the African elephant (Loxodonta africana). Res Vet Sci 10(6): 587–589. Pipitwanichtham S, Dittawong P, Meetipkit P, Sitdhibutr R, Pattanapon N, Kasornsri M, Phetudomsinsuk K, Thongtip N, Sripiboon S. Case report: Corneal stromal abscess in a captive Asian elephant: diagnosis and treatment regimes. Veterinary Integrative Sciences 2023; 21(3): 693 - 703 DOI; 10.12982/VIS.2023.050 . Suedmeyer Wm. K. 2006. Special senses. In: Biology, Medicine and Surgery of Elephants, Ed. Fowler and Mikota, 399-403. Use of a contact lens for horses in an Asian elephant (PDF) Wijesekara PNK, Bandara KAPA, Dangolla A, Silva ID and Edirisinghe JS. 2007. Incidence of Acanthamoebae Spp . in the eyes of a group of captive elephants in Sri Lanka. Conference: International Elephant Conservation & Research Symposium Florida USA At: Orlando, Florida USA, November 2007. Wong MA, Isaza R, Cuthbert JK, Brooks DE and Samuelson DA. 2012. Periocular anterior adnexal anatomy and clinical adnexal examinaton of the adult Asian elephant (Elephas maximus) . Journal of Zoo and Wildlife Medicine , Vol. 43, No. 4, pp. 793-80. To page top

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Edema in elephants is not uncommon. The 2 most frequently seen forms are edema in the neck, head and upper parts of the front legs (EEHV-HD) and ventral edema (general edema). Figure 1. (a) A focal moderate ventral edema. Note the smooth skin structure with reduced wrinkles in the edematous region. (0.1 African elephant, 33yrs.) (b) Focal moderate ventral edema in lateral view. (0.1 African elephant, 22yrs., 2.5 months before giving birth) (c) A moderate ventral edema extending to the external genital region. (0.1 African elephant, 46yrs., advanced pregnancy >18 months). Figure 2. Ventral edema in a 7 yr-old Asian elephant bull suffering of Salmonellosis (Photo: Willem Schaftenaar). Click here to read this case report. Figure 3. A 45 yr-old female African elephant with ventral edema showing signs of irritation (left) and sloughing of skin (right, arrow). Differential diagnosis of ventral edema In the young elephant a swelling around the umbilicus can be an indication of an umbilical hernia , sometimes accompanied by local edema. A blunt trauma of the abdominal wall can result in an abdominal hernia. Intestines can be visualized using ultrasound examination. Figure 4. Asian elephant (>35yrs) with traumatic ventral hernia. Movement of the intestines and fecal balls in the subcutaneous space could be visualized during transcutaneous ultrasound examination. Photo: Willem Schaftenaar Pathogenesis In general The body always tries to maintain the balance between intravascular and interstitial fluid, driven by four different pressures acting in the capillary bed (Fig. 5). In addition, the capacity of the lymphatic system is critical for the physiologic reabsorption of interstitial fluid and its return transport into the blood circulation (Fig. 5). Beside an increased permeability of the capillary wall, any alteration in each of these five factors can cause edema. In particular an increase in the capillary hydrostatic pressure and a decrease in the plasma oncotic pressure (= osmotic pressure induced by the plasma proteins) lead to an increased shift of fluid towards the interstitial space. If this fluid load exceeds the lymphatic capacity, fluid will accumulate and edema will develop. The aforementioned parameters do vary across different body regions, leading to a locally varying susceptibility to edema development. Therefore, edema can occur both multifocal (e.g. EEHV-HD) or focal (e.g. ventral edema) with respect to the predisposition of certain body regions and the underlying cause. The latter can be systemic or focal. The localization of edema is also determined by gravity forces and species-specific anatomical characteristics. Extracellular fluid will have the tendency to migrate downwards due to gravity. Extracellular spaces that are surrounded by tightly fitting, non-elastic tissue, are not prone to show edema, even if they are at the lowest point of the body: in humans edema can easily develop in the feet, while in elephants edema has never been reported in the distal parts of the limbs. Figure 5. Four critical parameters are determining fluid shift in the capillary bed through the semipermeable capillary wall. An increase in capillary hydrostatic pressure and interstitial oncotic pressure leads to an increased fluid shift towards the interstitial space, as well as a decrease in plasma oncotic pressure and interstitial hydrostatic pressure. The lymphatic vessels are running in parallel to the blood vessels and are collecting the interstitial fluid according to their transport capacity. In elephants According to Mikota (2006), no single underlying etiology for ventral edema in elephants has been identified so far. More likely, it presents a non-specific response to a variety of physiological stressors (Mikota 2006). In our opinion these stressors or pathological alterations can be categorized based on the general pathogenesis of an edema (Fig. 5). With this approach, each condition reported to be associated with edema in elephants so far, can be ascertained to one of the four defined etiologic categories (Fig. 6). Fowler & Mikota (2006) consider the ventral distribution of an edema in elephants caused by the gravitation of fluids into this area. But if gravitation alone would present the critical parameter for the characteristic ventral occurrence of an edema in the elephant, one would expect the swelling to occur primarily in the distal limb regions. The very thigh skin surrounding the legs with minimal elasticity may prevent this pattern. Apart from this, we assume the anatomy and physiology of the lymphatic system to explain the specific distribution pattern of ventral edema in elephants (Fig. 7). Unfortunately, anatomical knowledge on the lymphatic system in elephants is limited to one incomplete description in a fetal Asian elephant (Mariappa 1986). In this individual, a peculiarity was reported with the Cisterna chyli located in the thoracic cavity (Mariappa 1986). In humans, the horse, dogs & cats the Cisterna chyli is located in the abdominal cavity (Berens von Rautenfeld 2000, Herpertz 2013, Salomon et al. 2008). We do rather question the validity of the report for the fetal Asian elephant, than expect a significant peculiarity in the anatomy of the lymphatic system in the elephant. Figure 6. Four defined etiologic categories for edema in elephants, each with examples reported in the existing literature. Note that underlying alterations may vary extremely but result in the same clinical sign of accumulated interstitial fluid. Therefore, due to the lack of solid evidence, our line of arguments is largely based on the anatomy of the lymphatic system in horses and extrapolated to the elephant (Berens von Rautenfeld 2000, Salomon et al. 2008; Fig. 7). Assuming that the lymphatic watersheds in the elephant are running similar to the situation in the horse, it becomes obvious that the characteristic location of a ventral edema presents the region between the major transversal and horizontal watershed (Fig. 7). In this proximal part of the lymphatic territory VII, the lymphatic vessels drain towards the deep abdominal lymphatic centers and have no connection to a relevant superficial lymphocentrum. Therefore, it seems reasonable that increased abdominal pressure (e.g. during late pregnancy) may reduce the drainage of this territory. At the same time, interstitial hydrostatic pressure in the subcutaneous tissue of this body region may be low compared to the limb or the thoracic wall where bony and muscular structures are supporting the lymphatic capacity. These factors together with gravitation can serve as an explanation for the specific distribution of ventral edema in elephants. In contrast, the limbs may rarely be affected by edema, because the relatively rigid skin in combination with the underlying musculoskeletal apparatus will result in kind of a physiologic compression bandage as reported for the horse (Aurenz 2020). Figure 7. Hypothesized lymphatic territories in the elephant. The seven distinct lymphatic territories with their specific drainage areas were extrapolated from the situation in the horse (Berens von Rautenfeld et al. 2000) and numbered accordingly. The blue lines indicate the lymphatic watersheds. Note the proximal part of area VII is lacking a connection to a relevant superficial lymphocentrum. Treatment of ventral edema Given the wide diversity of underlying causes (Fig. 6) no general treatment protocol can be defined. In the literature, hot and cold pressure bandages (du Toit 2001) and increasing protein in the diet (Fowler & Mikota 2006) have been recommended. The administration of Furosemide (1mg/kg i.m.) has been unsuccessful (Martelli 2006). Considering the different etiological pathways leading to an edema, we strongly encourage the treatment of the underlying cause. To do so, an underlying cause needs to be determined or at least a classification according to Figure 6 should be strived for. The latter seems realistic by a thorough anamnesis and clinical examination. For example in cases of heart failure, positive inotropic agents may reduce the capillary hydrostatic pressure and simultaneously support the lymphatic capacity, as shown in humans (Scallan et al. 2016). In less severe cases of assumed cardiorespiratory insufficiency, which has been observed to repeatedly cause ventral edema in geriatric Asian females during hot summer days, herbal medicine can present a helpful approach (Crataegus Dilution vet.®, DHU-Arzneimittel GmbH & Co. KG, Karlsruhe, Germany; three times a day, 6.0-8.0ml orally) (personal observation in four cases). In addition to the treatment of the underlying cause, or in cases where only a symptomatic treatment is realizable, the following methods may facilitate the reabsorption of an edema. Moderate walking will centrally activate the lymphatic flow and subsequently increase the lymphatic capacity. Hence locomotion is considered a critical part of edema therapy in horses (Aurenz 2020). A sufficient amount of satisfying recumbent rest will also support the reabsorption of interstitial fluid by reducing the negative impact of gravitation. Moderate pressure washing may have a positive effect similar to manual lymph drainage in horses (Aurenz 2020). Under the assumption of a similar anatomy of the lymphatic system, adhering to the protocols established in equine lymph drainage seems a reasonable approach (Berens von Rautenfeld 2000). Given that the selectively applied pressure for manual lymph drainage could be applied by a water jet, even treating from a safe distance might become an option. Further research is needed to base such an approach on scientific findings and formulate a detailed practical guidance. Additional note With respect to our very limited knowledge on the anatomy of the lymphatic system in elephants and the corresponding physiological pathways, a major part of this compilation is very hypothetical. Although we based these hypotheses on evidence from other mammalian species, they remain to a certain amount speculative and should be interpreted with caution. References Aurenz S (2020). Manuelle Lymphdrainage beim Pferd. Hands on 2:25-31. Berens von Rautenfeld D, Rötting A, Rothe K, Lüdemann W, Boos A, Schubert T, Hertsch B (2000). Manuelle Lymphdrainage beim Pferd zur Behandlung der Beckengliedmaße - Teil 1: Anatomische Grundlagen und Behandlungsstrategien. Pferdeheilkunde 16:30-36. Caple IW, Jainudeen MR, Buick TD, Song CY (1978). Someclinico-pathologicfindings in elephants (Elephas maximus) infectedwithFasciolajacksoni. Journal of Wildlife Diseases 14:110-115. Chandrasekharan K (2002). Specific diseases of Asian elephants. J Indian Vet Assoc Kerala 7:31-34. du Toit J (2001) Veterinary care of African elephants. South Africa, South African Veterinary Foundation and Novartis. Emanuelson K, Agnew DW (2002). Wasting syndrome in a bull African elephant (Loxodonta africana). IAAAM Joint Conf, New Orleans, Louisiana. Emanuelson K, Kinzley C (2000). Salmonellosis and subsequent abortion in two African elephants. IAAAM Joint Conference New Orleans, Louisiana. Fowler ME, Mikota SK (2006). Biology, Medicine, and Surgery of Elephants. Iowa, USA, Blackwell Publishing. Fuery A, Pursell T, Tan J, Peng R, Burbelo PD, Hayward GS, Ling PD (2020). Lethal hemorrhagic disease and clinical illness associated with the elephant EEHV1 virus are caused by primary infection: Implications for the detection of diagnostic proteins. Journal of Virology 94:1-14. Heard DJ, Kollias GV, Merritt AM, Jacobson ER (1988). Idiopathic chronic diarrhea and malabsorption in a juvenile African elephant (Loxodonta africana). The Journal of Zoo Animal Medicine 19:132-136. Herpertz U (2013). Ödeme und Lymphdrainage. Stuttgart, Schattauer Verlag. Howard L, Schaftenaar W (2019). Elephant endotheliotropic herpesvirus. Fowler´s zoo and wild animal medicine: current therapy. E. Miller, N. Lamberski and P. Calle. St. Louis, Elsevier:672-679. Jensen J (1986). Paralumbar kidney biopsy in a juvenile African elephant. Proc Amer Assoc Zoo Vet, Chicago, Illinois. Lueders I, Young D, Maree L, van der Horst G, Luther I, Botha S, Tindall B, Fosgate G, Ganswindt A, Bertschinger H (2017). Effects of GnRH vaccination in wild and captive African elephant bulls (Loxodonta africana) on reproductive organs and semen quality. PLoS ONE 12:e0178270. Mariappa D (1986). Anatomy and histology of the Indian elephant. Michigan, USA, Indira Publishing House, Michigan, USA. Martelli P (2006). Veterinary problems of geographical concern - Section III Indochina and Bangladesh. Biology, Medicine, and Surgery of Elephants. M. E. Fowler and S. K. Mikota. Ames, Iowa 50014, USA, Blackwell Publishing: p. 452. Mikota SK (2006). Chapter 18 - Integument System. Biology, Medicine, and Surgery of Elephants. M. E. Fowler and S. K. Mikota. Ames, Iowa 50014, USA, Blackwell Publishing: pp. 253-261. Morris P, Held J, Jensen J (1987). Clinical pathologic features of chronic renal failure in an African elephant (Loxodonta africana). 1st Intl Conf Zool Avian Med, Turtle Bay, Hawaii. Murray S, Bush M, Tell L (1996). Medical management of postpartum problems in an Asian elephant (Elephas maximus) cow and calf. J Zoo Wildl Med 27:255-258. Perrin KL, Kristensen AT, Bertelsen MF, Denk D (2021). Retrospective review of 27 European cases of fatal elephant endotheliotropic herpesvirus-haemorrhagic disease reveals evidence of disseminated intravascular coagulation. Scientific Reports 11(1):14173 Pinto M, Jainudeen MR, Panabokke R (1973). Tuberculosis in a domesticated Asiatic elephant (Elephas maximus). VetRec 93:662-664. Salomon F-V, Geyer H, Gille U (2008). Anatomie für die Tiermedizin. Stuttgart, Enke Verlag. Scallan J, Zawieja S, Castorena-Gonzalez J, Davis M (2016). Lymphaticpumping: mechanics, mechanisms and malfunction. J Physiol 594.20:5749-5768. Seneviratna P, Wettimuny S, Seneviratna D (1966). Fatal tuberculosis pneumonia in an elephant. Vet Med Small Anim Clin 60:129-132. Windsor RS, Scott WA (1976). Fascioliasis and salmonellosis in African elephants in captivity. British Veterinary Journal 132:313-317. Edema by Christian & Linda Schiffmann Definition A local or general swelling due to excessive accumulation of fluid in the interstitial space of tissues. This condition can be caused by various underlying alterations. Depending on the composition of the fluid (in particular the protein content), an edema can be further categorized. Relevance of edema in elephants In elephants the occurrence of the so-called ventral edema is a well-known and quite common clinical symptom (Mikota 1994) (Fig. 1 and 2). Ventral edema is defined as edematous swelling in the ventral abdominal wall and tissues surrounding the external genitalia (Mikota 2006). Although the clinical impact of ventral edema is often not visible, the underlying mechanism indicates a disturbance of the internal fluid balance. In addition, edema in the submandibular region and multifocal has been described in cases of hemorrhagic disease due to herpes virus infection (EEHV-HD) (Fuery et al. 2020, Howard & Schaftenaar 2019). Clinical signs The characteristic swelling in edema may develop immediately or over the course of several days, depending on the underlying cause. Edemas caused by a local inflammatory response may be warm and painful upon palpation. The swelling in case of ventral edema without any underlying inflammatory process may feel slightly cooler compared to other body regions. Palpation is not painful and moderate pressure with the thumb may result in a dent. Such dent may also be produced if the edema is the result of an inflammatory process, in which case the pressure will provoke a pain reaction. Compared to non-edematous areas, the skin will look smoother with reduced wrinkles (Fig. 1a). If ventral edema extends from the umbilical to the genital area (Fig. 1c), the skin may become irritated through the repeated contact with the medial hind legs while walking. In severe cases, this irritation may lead to pressure necrosis and sloughing (Mikota 2006). In cases without such complications, edema may resolve without treatment within months (Mikota 1994), although this will heavily depend on the underlying cause, which should be treated accordingly. Prevention Depending on the underlying cause, the occurrence of ventral edema in elephants can be prevented. A continuous health monitoring program with focus on individuals at peculiar risk such as geriatric elephants, pregnant females or individuals suffering from cardio-respiratory or renal insufficiency will enable early supportive and/or curative treatment. Is ventral edema bad? Although ventral edema as such may not necessarily present a serious condition in an elephant, it is often associated with serious health issues and bears the risk for complications. Therefore this symptom should be investigated thoroughly and its development monitored closely.

Pasteurellosis or hemorrhagic septicemia is an often fatal disease in Asian elephants, caused by Pasteurella multocida and Mannheimia hemolictica. If diagnosed in its early stage , antimicrobial and supportive treatment should be started immediately. Elephants in certain range countries are vaccinated twice a year with commercial vaccines used in cattle. In 2020 a mass die-off of free ranging African elephants occured in Zimbabwe and Botswana, caused by Pasteurella Bisgaard taxon 45 (multocida). To infectious diseases Pasteurellosis Pasteurellosis or hemorrhagic septicemia in Asian elephants has been report in several countries in Asia, where it is a common disease in water buffalo and other ruminants. In elephants it can cause a severe generalized disease, which is often fatal. The causative pathogens are Pasteurella multocida and Mannheimia (Pasteurella) haemolytica. They are nonmotile, facultative anaerobic and may exhibit bipolar staining with Giemsa or Wright’s stain. Transmission of the pathogen can be through direct or and indirect contact and possibly through biting insects and wound contamination. It is generally assumed that Pasteurella spp. are secondary pathogens that may strike when the immune system is challenged by a primary disease or stressful condition. Higher magnification of lung impression smear showed bipolar characteristic Pasteurella sp. ( Harish, 2009) Inapparent infections have not been reported, though vaccination-induced antibodies against P. multocida can be detected using an indirect ELISA (Tankaew, 2017). This indirect ELISA was more sensitive in elephants than the indirect hemagglutination assays (IHA), which is the WHO recommended diagnostic test in farm animals. The epidemiology of hemorrhagic septicemia is not fully known. However, multiple cases were reported following periods of consecutive droughts from 2010 to 2012 and sudden heavy monsoon rains in India in 2013 (Chandranaik, 2016). Clinical symptoms Clinical symptoms may vary, ranging from its presence in foot abscess to an acute fatal disease. The FAO manual for elephant managers describes the following signs, which might be associated with hemorrhagic septicemia: There is a high fever. Take the elephant's temperature. (See page 71.) If it is over 37.8° C or 100° F, that is a sign of danger. The breath exhaled from the mouth and trunk is very hot. There is a bright red at the eyes, mouth, the end of the trunk, and other soft tissue. Swelling (edema) is found in body parts such as the throat, the shoulders, the base of the tail, the anal flap, on the belly under the legs. The elephant is listless, the trunk rests on the ground, and the ears do not flap. The elephant does not eat. The elephant frequently opens its mouth to "yawn". The body trembles and has spasms because breathing is difficult. The urine is cloudy and richly coloured. In fatal cases pneumonia, hemorrhagic tracheitis, haemorrhages on the heart, and/or lesions of acute septicemia in all other vital organs have been described (Harish, 2009; Srivastav, 2017). Pasteurellosis presents in varies forms, so many other diseases must be considered in a differential diagnosis, including anthrax, trauma, foreign-body reactions, staphylococcosis, salmonellosis, and pneumonia caused by various agents. Diagnosis Isolation and identification of Pasteurella spp. or Mannheimia haemolyticum combined with a disease presence leads to the diagnosis of hemorrhagic septicemia. If diagnosed, one should always consider that there might be involvement of another primary disease process! Confirmation of the diagnosis by PCR may lead to the source of the infection if other elephants of other animal species are involved. Treatment Immediate treatment is required when hemorrhagic septicemia is suspected. Pasteurella sp. are usually susceptible to amoxycillin, trimethoprim+sulfa an fluoroquinolones (like enrofloxacin). Antimicrobial therapy can be initiated using one of the above mentioned drugs, however samples should be taken for culture and as soon as the sensitivity of the pathogens have been determined, the therapy should be adjusted according to the antibiogram results. Supportive therapy consists of administration of fluids (rectally and/or intravenously). NSAIDs should be given if the general condition or pain reactions indicate their use. For dosages go to: https://elephantcare.org/resources/formulary/drug-index/ . Make sure that no mahouts or other people who have been in contact with the ill elephant have any contact with the healthy ele phants. The healthy elephants should be taken to a place where they have no contact with dung, urine, or uneaten food of the infected elephant. Feed the elephant with items of high nutritional value, such as bananas, unhusked rice, sugarcane, and high quality browse . When an elephant dies of hemorrhagic septicemia, the carcass must be buried or burned. The carcass should not be butchered for meat or to remove the tusks to sell because this can spread the disease to other elephants and to other animals. The FAO has elaborated an action plan for additional measures in case of hemorrhagic septicemia in elephants ( see Elephant Care Manual for Mahouts and Camp Managers ): Immediately separate the infected elephant and keep it as far away as possible from other animals. Take the infected elephant to a clean, quiet and shady spot that is easily cleaned and where run-off water and waste, such as dung and uneaten food, do not contaminate other areas. Most importantly, ensure that the water source for sick animals and healthy animals is separate. If there is only one source of drinking water, it is likely contaminated. If so, try to get the healthy animals to a new source of water. You might even have to truck water in, but you must ensure your animals are drinking pure water free of infection. Prevention In several Asian range countries elephants are vaccinated with the vaccines available for cattle, like an inactivated aluminium-precipitated vaccine used in (non-pregnant) elephants over 6 months that used to work in the timber industry in Myanmar (5ml, subcutaneous, twice a year).(pers. Comm. Khyne U Mar, 2023). Contact with susceptible farm animals, especially water-buffaloes and cattle should be avoided. Outbreak of Pasteurellosis in free ranging African elephants During a period of 4 months in 2020 a total of 35 African elephants were found dead in north-western Zimbabwe. The estimated age of the dead elephants ranged from 18 months–30 years. Elephants of both sexes were found dead (16 males, 9 females). The carcasses were in average body condition with hepatomegaly and splenomegaly as the most prominent gross pathological findings, with variable hemorrhages across the epicardium, liver, lungs, intestinal serosae, hepatic and splenic lymph nodes, and in one case, the diaphragm. Histopathological lesions in elephants were similar and consisted of acute multifocal heterophilic and necrotizing inflammation in liver, spleen, and lymph node, with presence of intralesional Gram-negative bacterial colonies of coccobacillary morphology. Specifically, one elephant displayed necrotizing lesions in spleen and liver, with the additional presence of fibrinocellular and bacterial emboli in the pulmonary vasculature. Presence of Gram-negative bacterial colonies without associated morphological changes was observed in veins and capillaries, prominently in the encephalon. Acute multifocal heterophilic and necrotizing lymphadenitis, hepatitis and splenitis with intralesional Gram-negative coccobacilli was observed in one. Most blood smears (n = 13/15) stained with Giemsa contained small to moderate numbers of bacteria with a bipolar, short-rod, or coccobacilli morphology (0.5–2 µm), and intracellular bacteria were observed. Of 15 sampled elephants, six showed molecular evidence of septicemic infection by Bisgaard taxon 45. There was no evidence of toxins, including those from cyanobacteria, or for any viral infection. The failure to identify Bisgaard taxon 45 in samples from all 15 elephants is likely due sample quality and delays in testing. The authors propose that stress from a combination of heat, drought, and population density were likely contributing factors in this outbreak. Food and water resources normally wane as temperatures rise during the dry season, and elephants must travel increasing distances between water points and foraging areas. The source of infection and route of transmission remain unknown in this outbreak. For more details about this mass die-off, click here . References Chandranaik BM., Shivashankar BP., Giridhar P., and Nagaraju DN. 2016. Molecular characterisation and serotyping of Pasteurella multocida isolates from Asiatic elephants (Elephas maximus ). Eur J Wildl Res (2016) 62:681–685 FAO: Elephant Care Manual for Mahouts and Camp Managers. Foggin, C.M., Rosen, L.E., Henton, M.M. et al. Pasteurella sp. associated with fatal septicaemia in six African elephants. Nat Commun 14, 6398 (2023). https://doi.org/10.1038/s41467-023-41987-z Harish, B.R., B.M. Shivaraj, B.M. Chandranaik, M.D. Venkatesh & C. Renukaprasad. 2009. Hemorrhagic Septicemia in Asian Elephants (Elephas maximus ) in Karnataka state, India. Journal of Threatened Taxa 1(3): 194- 195 . Preecha Phuangkum P., Lair RC., and Angkawanith T. 2002. Elephant Care Manual for Mahouts and Camp Managers. FAO. ISBN: 974-7946-71-8. Shrivastav AB., Rokde A., Agarwal S., and Shrivastav G. 2017. Pasturollesis: Complication of Metastatic Supporative Pneumonia Severe Stress in Asian Elephant (Elephas maximus ). Indian Journal of Veterinary Sciences & Bio technology (2017) Volume 12, Issue 4, 93-94. Tankaew P., Singh-La T., Titaram C., Punyapornwittaya V., Vongchan P., Sawada T., Sthitmatee N. 2017. Evaluation of an In-house indirect ELISA for detection of antibody against haemorrhagic septicemia in Asian elephants Journal of Microbiological Methods. Vol.134, pp30-34. Weston P. 2023. It took years to solve the mystery elephant deaths. Now, the threat is spreading. The Guardian, 2023 10 23.

This page describes the technique of blood collection and hematology with special attention to white blood cell counts in elephants (because of different monocytes, manual counting is required in elephants). Hematology Blood collection Hematology Blood chemistry Reference values blood Blood collection There are 3 anatomical sites on the elephants body where blood can be collected: One of the ear veins (or arteries for arterial blood sample) One of the branches of the saphenous veins (hindlegs) Cephalic vein (front legs) How to collect a blood sample: Most elephants can be trained for this procedure using positive reinforcement training. If not trained, standing sedation (or general anesthesia) in case of free ranging elephants) will be required. When alpha-2 agonists are used , vasoconstriction may hinder the access to the ear veins, especially in young calves. Combining alpha-2 agonists with butorphanol may help to increase the filling of these veins. When the environmental temperature is low, the ear veins may collapse. Flushing the inner side of the ear with large amounts of warm water (or packing the area with heated bean or rice bags) can increase the filling of these veins. The collection site should be clean and dry before blood is collected. Ear veins : press firmly on the site where you can see the shape of the vein. Press until you see the vein becoming larger in diameter. Use a small butterfly needle and collect the blood in a vacuum blood tube. If not available, you can use a small needle (23G) and a syringe and empty the syringe in the blood collection tube after removing the needle. To avoid damaging the blood cells (hemolysis), the tube should be filled slowly while flushing the blood carefully against the wall of the tube, that is slightly tilted. Saphenous and cephalic veins : these veins are larger in diameter than the ear veins, but covered by a thicker skin. A 19G or 21G needle (preferably connected to a vacuum tube) can be used and should be inserted perpendicular to the skin. Indication of the blood collection sites on the front leg (left photo, Vena cephalica) and the inner side of the hind leg (middle and right photo, Vena saphena). Blood collection from the inner side of the ear using a butterfly needle and vaccum tube. Blood cellection from the inner side of the hind leg of a well-trained adult Asian elephant bull using a vacuum bottle for collecting large amounts. Courtesy: Rotterdam Zoo Hematology This chapter includes a lab manual that was developed for a Healthcare and Welfare Workshop for elephant veterinarians given in Myanmar in 2018, organized by Elephant Care Asia (an initiative or elephant Care International - http://elephantcare.org/ . Get PDF of the manual PLEASE NOTE: white blood cell differentiation in elephants must always be done by MANUAL DIFFERENTIATION Erythrocytes: Erythrocytes in elephant whole blood EDTA samples can best be counted on an automated blood cell analyzer. Such an analyzer automatically measures the hematocrit . After centrifugation of the blood sample, a plasma evaluation should always be performed. The morphology of the erythocytes should be examined microscopically in a (preferably fresh) blood smear , stained with Wright-Giemsa. If no automated cell counter is available, manual erythrocyte count is a second option. Total white Blood count (WBC): Automated analyzers have limited value in elephant hematology. However, they can be used to measure the total amount of white blood cell. Automated cell counters come in several forms. Those used for other mammalians can only be used for total WBC in elephants. Manual WBC count can be done using a Hemocytometer Counting Chamber . Differential White Blood Cell (WBC) count: Automated analyzers cannot be used to differentiate the white blood cells of elephants. This should ALWAYS be done by manual counting the different cell types on blood smears , stained with Wright-Giemsa. See also the Manual Differential WBC Count. The use of a semi-automated machine for thge preparation of a standard blood smear (CellaVision Hema-Prep (Sysmex France, 93420 Villepinte, France) has been described by Vonfeld et al (2025). They concluded that time required for the differentials was significantly shorter (p , 0.01) and differentials were subjectively easier to perform when using the analyzer. Platelets: Estimating the platelet count is best done by calculating the average of platelets counts in 10 fields x 15,000, which gives the Estimated platelet count/µL . See also: Manual platelet count (Cornell University) . Reference values: The table below shows the normal hematology values for Asian and African elephants (Wiedner, E. 2015). References Perryn K.L. et al. 2020. Biological variation of hematology and biochemistry parameters for Asian elephant (Elephas maximus), and applicability of population-derived reference intervals. Journal of Zoo and Wildlife Medicine 51(3): 643–651 Steyrer C, Miller M, Hewlett J, Buss P and Hooijberg EH (2021) Reference Intervals for Hematology and Clinical Chemistry for the African Elephant (Loxodonta africana). Front. Vet. Sci. 8:599387 Vonfeld I, Thorel M, Maurer G, and Leclerc A. 2025. Performance of the CellaVision DC-1V for white bloodcell differentials in African elephant (Loxodonta africana) . Journal of Zoo and Wildlife Medicine 56(3): 586–598, 2025. Weisbrod T.C., Isaza R., Cray C., Adler L., and Stacy N.I. 2021. The importance of manual white blood cell differential counts and platelet estimates in elephant hematology: blood film review is essential. Veterinary Quarterly, 41:1, 30-35, DOI: 10.1080/01652176.2020.1867329. (Click here for the complete text). Wiedner E. 2015. Proboscidea. In: Fowler's Zoo and Wild animal Medicine 8. Species 360 - ZIMS 2023. Reference values To hematology gallery Back to Top To lab diagnosis Hematology Blood collection

A 1 yr-old Asian elephant suffered of colics as a result of a (traumatic) hernia mesenterialis. A torsio of the small intestines was incarcerated in the hernia. Consequently the intestine ruptured. The calf died due to acute peritonitis. To non-infectious diseases Case report Hernia mesenterialis and intestinal rupture Date: 2002 Place: Rotterdam Zoo Data provided by: Willem Schaftenaar History Species: Asian elephant Accommodation: Zoo, free contact Age, gender: 1 year, male Five years before this episode, a 3 yrs-old calf at the same zoo had died of EEHV1a . The calf (300 kg estimated BW) was heavily hit on its abdomen by a herd mate. Two days later (Day 1) it became very lethargic and stopped drinking from its mother. Day 1 08:30: Very lethargic, not eating. Laying flat on the ground, while kicking with his hind legs ( colic ). Sometimes standing with the mouth widely opened. Conjunctivae: slightly congested. Tongue: normal color. No edema on head or shoulders. Defense musculaire: normal. Rectal temperature: 36.8°C A standing sedation using xylazine (0.1 mg/kg BW IM for the calf, 0.08mg/kg BW for the dam) was performed in both the affected calf and its mother. As soon as sedation started, the calf was brought to its mothers mammary glands and it started drinking from the mother. EDTA and full blood samples were taken and rectal fluids were given during the sedation. Rectal palpation: only one handfull of soft feces in distal part of the rectum. The rectal wall is very dry. Urine sample: all values (dipstick) within normal ranges. Blood sample collected. Hematology and blood chemistry results were all within normal ranges. EDTA whole blood sample submitted for PCR on EEHV. Results: PCR-positive EEHV1a. Rx: 6 ml Finadyne (flunixinemeglumine 50 mg/ml, NL1726) i.m. 15 ml Baytril 10% (enrofloxacin 100 mg/ml, NL3489) i.m. 3000 mg famciclovir mixed with 15 ml utrasound gel per rectum. Calf during standing sedation and suckling from its mother. Note the penis relaxation, typical for alpha-2-agonist sedation. 16:30: No change. Not eating, laying. Less signs of colics. Rx: 1500 mg famciclovir mixed with 10 ml ultrasound gel per rectum. 23:00: Animal is lethargic. Laying down most of the time. Rx: 1500 mg famciclovir mixed with 10 ml ultrasound gel per rectum. Day 2 Slightly alerter than before. Treatment was continued similar to day 1. Day 3 08:30 Alerter, but no attempts to nurse from its mother. Rx: 15 ml Baytril 10% (enrofloxacin 100 mg/ml, NL3489) i.m. 1500 mg famciclovir mixed with 10 ml ultrasound gel per rectum. 16:00 Agian very lethargic. Has not eaten or nursed at all. No feces nor urine produced. Standing sedation (calf and dam, see day 1). Again the calf was drinking well during the sedation. Also defecating and urinating. Firm feces. Rx: 1500 mg famciclovir per rectum dissolved in 20 ml water. 600 ml Amynin (per ml: 50 mg glucose anhydrate, electrolytes, aminoacids and B-vitamins, NL 4137) per rectum. Blood and urine samples collected. All values within normal ranges. EDTA: EEHV-PCR signal much lower than day 1. Day 4 08:00 Alerter, has not been laying excessively long during the night. Rx: 1500 mg famciclovir per rectum (dissolved in 20 ml water). During the morning the animal has been drinking spontaneously from his mother. Treatment similar today 2. Day 5 09:00 Leaning against the poles. Rx: 1500 mg famciclovir per rectum (dissolved in 20 ml water). Keepers think his behaviour is about the same. Is drinking water from the hosepipe. Some normal feces manually removed from the rectum. 16:00 Still leaning against the poles but sometimes giving a more alert impression by moving his tail. Rx: 1500 mg famciclovir per rectum (dissolved in 20 ml water). Standing sedation (xylazin 0.1 mg/kg IM). Drinking from his mother. Day 5 08:00: Very lethargic; did not drink during the night. Tympanic, bilateral; intestinal obstruction suspected. Some dry feces were collected from the rectum. Rx: 1500 mg famciclovir per rectum (dissolved in 20 ml water). 6 ml Finadyne (flunixinemeglumine 50 mg/ml, NL1726) i.m. 15 ml Baytril 10% (enrofloxacin 100 mg/ml, NL3489) i.m. During the day the condition of the animal deteriorated. 14:00: sedated with xylazine (0.1 mg kg IM). Blood sample collected - heparin and EDTA and fluride. Rectal palpation: balloon-like intestines. The calf suddenly regurgitated and threw up stomach content. Rectal fluids were given. At 15:00 the animal died. Necropsy Necropsy hernia mesenterialis 1) Cause of death: * Rupture of the ileum resulting in peracute peritonitis. * Mesenteric hernia. * Intestinal mesentery, small intestine (jejunum), ileum: Venous infarction, acute, marked, with venous and lymphatic thrombosis, fibrinoid arterial necrosis, and interstitial haemorrhage and necrosis. * Intestinal mesentery, small intestine, hepatic capsule, pancreas: Peritonitis, fibrino-purulent, diffuse, peracute, moderate, associated with bacterial infection. 2) Significant diagnoses: * Liver: pericholangitis, eosinophilic, diffuse, chronic, severe, with bile duct hyperplasia and portal fibrosis. * Liver: hepatitis, granulomatous, eosinophilic, multifocal, chronic, moderate. 3) Incidental diagnoses: * Heart: haemorrhage, subendocardial, epicardial, multifocal, acute, mild. * Lung: pulmonary oedema, diffuse, acute, mild. * Adrenal cortex: adrenocortical necrosis, multifocal, acute. Cyanosis of the tongue and epicardial hemorrhages that are seen in EEHV-HD were also present in this case. They are the result of circulatory shock and are not pathognomitic for EEHV-HD. The intestinal contents was found freely in the abdomen. The hernia and the torio of the mesenterium is well demonstrated on the last photo. Conclusion Initially, when the PCR-result was positive for EEHV, EEHV was considered the cause of the disease and anti-EEHV treatment was started. Based on previous findings, the mother of the calf was assumed to be a carrier of EEHV1. However, the normal hemogram was not in line with what was seen in other EEHV-HD cases. At necropsy, multiple hemorrhages were seen in almost all organs, which is also seen in EEHV-HD. However, the predominant pathological conditions (hernia mesenterials, volvulus, torsio and rupture of the ileum were the cause of death. The presence of EEHV1a can only be explained as a virus reactivation due to a heavy stress respons of the calf in relation to the intestinal problems. Peritonitis in elephants has only been mentioned in a paper describing the presence of unrelated dermoid cysts in an Asian elephant (Wayn, 1991). References Wayne I., Anderson & Danny W. Scott. 1991. Epidermoid Cysts in the Skin of an Asian Elephant (Elephas maximus). Vererinary Dermarology. Vol. 2, No. 3/4, pp. 171-172. To page top

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

Perineal hernia in elephants are rare, but have been described. One surgical treatment has been described. To non-infectious diseases Perineal hernia Compiled by Willem Schaftenaar, 2020 Definition : A perineal hernia is a disruption of the pelvic diaphragm musculature that allows contents of the pelvic canal and/or abdominal cavity to herniate into the perineal subcutaneous tissues. In elephants this condition presents as a large bulging mass below the tail. Diagnose : 1. Pressure on the bulging area sometimes results in urination. This is suggestive for the presence of the urinary bladder in the perineal subcutaneous space. 2. Rectal palpation: if the urinary bladder is present in the perineal subcutaneous space, the bladder may empty when pression is used by the hand through the rectal wall. 3. Transrectal and transcutaneous ultrasonographic examination: visualization of the urinary bladder, cervix uteri or parts of the uterus in the subcutaneous space definitely confirms a hernia perinealis. History The cause of this condition in elephants is unknown. Complications: insufficient emptying of the urinary bladder may predispose for urine retention. There are no reports of urinary infection in elephants due to this condition. The first report on a perineal hernia dates from 1967 (Stehlik, 1967): a 20 yr-old female Asian elephant showed an over time increasing swelling in the perineal area, which aggravated each time the elephant had to stand on its hind legs for performance. Kuntze described a second case in 1989 and the author hypothesized that the hernia in this 6-yr-old circus Asian elephant might have been caused by the act that forced the elephant to stand on its hind legs, while supporting its front legs on another elephant ( Kuntze 1989). During this act, a 30 cm diameter ball-shaped swelling was noticed in the perineal area. As soon as the elphant stood on 4 legs, the swelling disappeared. Four years after the elephant had stopped this circus act, the swelling had disappeared. Hernia perinealis in an adult Asian elephant in a North American zoo. Treatment In the 4 cases that I am aware of, clinical signs were limited and did not cause discomfort to the elephant. These elephants were not treated for this condition. There is only one report about surgical repair of the perineal hernia, as the perineal subcutaneous mass became larger over a period of 10 years (Myanmar, 2016). Treatment results In one case in a 4 years old female Asian elephant, only the urinary bladder was involved. This case was not treated and the condition resolved within the next 3 years (Bernhardine, 1988, Rotterdam Zoo). The surgical repair in the Myanmar case was reported as a succesful intervention. Click here for the report. References Kuntze A. 1989. Arbeitsbedingter Krankheitsbilder: Hernia perinealis, bursitis praepatellaris und Tyloma Olecrani bei Zirkuselephantinnen (Elephas maximus ). 1989. 31st International Symposium on Diseases of Zoo and Wild animals, Dortmund (Germany) 1989, 185-187. Oo Z.M., et al. 2016 Surgical treatment of a cervico-vaginal prolapse in an Asian elephant in Myanmar. Gajah 44, 36-39 Stehlik M. 1967. Über zwei Fällen von Fussleiden, einen Fall von Volvulus und einen Fall von Hernia Perinealis bei indischen Elephanten. Nineth International Symposium on Diseases of Zoo and Wild animals, Prague 243-247. To page top

A 7 yr-old Asian elephant developed ventral edema when it suffered a clinical episode of salmonellosis. To Salmomellosis Case Report Next case Salmonellosis in 7 yr-old Asian elephant Place: Dak Lak elephant Conservation Center Vietnam Date: 2017 Data provided by: Van Thinh Pham, DVM History During the rainy season, a 7 yr-old orphan Asian elephant bull showed severe diarrhea, lethargy and anorexia for 1 week before it developed abdominal edema. It was kept with another orphan elephant in the open air in a range country. No parasites were found in fecal samples. Bacterial culture from feces showed growth of Salmonella typhymurium. Treatment Before Salmonella was cultured, the elephant was treated with trimethoprim sulpha (TPS) and metronidazole (dosages unknown). Based on the sensitivity found in the antibiogram, an oral antibiotic treatment with ciprofloxacin (5 mg/kg BW BID) was given for 5 days. Treatment results 36 hours after the start of the antibiotic treatment, the elephant resumed eating. feces were normal again after 3 days. The edema resolved within 7 days. To page top