This page directs you to the following reproduction-related topics in elephants: -estrous cycle -normal birth process -vaginal vestibulotomy -tumors and cysts in the reproductive organs -cesarian -dystocia -fetal retention -infertility (female) -infertility (male) To dashboard Reproduction Estrous cycle Endoscopy urogenital tract Pregnancy confirmation Normal birth process Dystocia Vaginal vestibulotomy Fetotomy Tumors and cysts I need your input to write these chapters: Cesarian Infertility (female) Infertility (male)

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

This paragraph describes aspects related to lameness in elephants. Lameness is a visible disruption of the normal locomotion. Diagnostic procedures and treatment options are discribed. Orthopedic shoes can help correcting abnormal posture. Muscle-related diseases can result in abnormal locomotion. This chapter also describes bone fractures, metabolic bone disease and botulism. Sometime injuries due to snares and mines can only be treated by partial leg amputation and the use of a prosthesis. Back to index orthopedic problems Lameness This paragraph describes the aspects related to lameness in elephants. Lameness is a visible disruption of the normal locomotion. Observation of the gait and resting behavior are important. It is therefore advised to make videos from the different locomotion tests that will be performed during the clinical examination. Replaying such a video in slow motion can facilitate making the proper diagnose and also makes it possible to share data with colleagues if additional consultation is useful. Smartphones are very useful for this purpose. African elephant showing signs of lameness. Lameness: Diagnostic procedures Although lameness is considered the most important clinical sign of musculoskeletal disorders in other species, elephants have been shown to rarely express distinct lameness patterns. This might even be the case in severe lesions. Nevertheless, elephants do express specific alterations in their posture indicative of musculoskeletal disorders. These alterations are visually perceptible for the experienced observer (Schiffmann 2021). To diagnose lameness it is important to know the normal locomation of an elephant. This is described in detail in the corresponding chapter. Any abnormal form of locomotion should be regarded is lameness. Usually l ameness is a signal from the elephant that it is suffering of pain. However, abnormal anatomic abberations can also lead to lameness, which not always necessarily leads to pain responses (e.g. slight difference in leg length). If the elephant lifts it head during walking, special attention needs to be paid to the front legs, as this head movement may be usied as an extra manner to bring a painful leg forward. To find out the reason why an elephant displays abnormal locomotion, the clinician needs to follow the following diagnostic steps: Observe the locomotion while the elephant is walking straight from left to right and from right to left, towards the observer and away from the observer, in a left circle and in a right circle. A numerical rating scoring system as described by Turner e.a. (2023) can be a useful tool to evaluate the lameness. A 4-point scale with the following numerical values for each leg was used in this study: 0=clinically sound, 1=stiffness, 2=abnormal tracking, and 4=reluctance to bear weight. The maximum total score per leg is 7 (28 for all 4 legs). Observe the elephant's posture when it is in rest. For more background information about abnormal posture click here . General clinical examination . Check the pads and nails of all feet for cracks, tears, swelling and pain reaction on deep palpation. Try to evaluate the joints by palpation (temperature, swelling pain reaction during deep palpation) and bending/stretching on command. Thermography. Radiography. Click here to read about radiography of the elephant's foot. Depending on the power of the X-ray equipment, joints higher up in the leg can be visualized. Digital equipment greatly improves the image quality. Full blood tests: hematology and chemistry. Walking the elephant from left to right and vice versa will make clear if the elephant is making long steps: the hind foot needs to step into the footprint of the front foot on the same side. It also allows to observe the joints: all joints of each leg should be bent and stretched during every step the animal makes. The rhythm of the steps should be regular. If the elephant feels pain in its right front leg, it will not support on that leg as long as will support on its healthy left front leg. What the observer will see, is that the elephant "falls" on its healthy leg. Usually this is a sign of "weight-bearing lameness" . This form of lameness is usually associated with sole lesions (foreign body, abscess), fracture and the acute phase of osteoarthritis. The second form of lameness is "movement-restricted lameness" , which is seen as stiffness in one or more joints and shortening of the steps made by the affected leg (and mostly in the other legs too). This type of lameness is seen in joint and muscle problems. Most lameness cases, however, are a combination of both forms. The gallery below shows several examples of lameness in Asian and African elephants. Asian elephant displaying several forms of lameness, filmed at normal speed and in slow motion. The animal can bend the joints of the left front leg and puts a lot of its body weight on that leg. At the same time, it lifts both left legs almost simultaneously ("pacing") in contrast to its left legs. The right carpal joint is completely stiff and to bring the right front leg forward, the animal has to bring it in abduction. The right hind leg is lifted abnormally when making a step forward with this leg. Nevertheless, this leg is placed in the footprint og the right front leg (normal), while the left hind legs makes too short steps. The lameness in this elephant was most likely due to multiple degenerative osteoarthritis. 35-yrs-old Asian zoo elephant with signs of severe lameness. All steps of the hind legs land in or even anterior to the footprint of the corresponding front leg. The joints of all but the right hind leg are bending and stretching normally. The knee joint of that leg is stiff. The time during which the right hind leg is on the ground is significantly shorter than that of the other 3 legs. In order to bring the right hind leg forward, the elephant needs to abduct it, lift it by lifting the right part of the pelvis at the same time. No other details about this elephant are known. This elephant may have had a fracture of the right humerus or the pelvis. 28-yrs-old Asian zoo elephant with signs of severe lameness in its right front leg. All steps are shortened. When this condition did not improve after prolonged treatment with several pain killers (NSAIDs and opiates) the elephant was humanely euthanized. At necropsy multiple joints showed severe degenerative osteoarthritis as well as an old, partly healed fracture of the right ulna. 45 yrs-old African zoo elephant with a stiff, left front leg. This leg is brought forward by swaying it in abduction. All steps are shortened and the head is sometimes slightly lifted when the left front leg is swayed forward. NSAIDs were provided but not really with the desired effect. As this condition persisted for a prolonged period, chronic degenerated osteoarthritis is the most likely cause of this lameness. Asian zoo elephant with a stiff, slightly swollen right front leg. This leg is brought forward by swaying it somewhat in abduction. All steps are shortened. According to the zoo staff, this condition disappeared after a period of conservative treatment (reduction of movement periods). The cause of such a temporary lameness could be muscle trauma (e.g. by a blow from a herd mate) or early degenerative osteoarthritis. Asian elephant with very stiff, legs, especially the right front leg (movement-restricted lameness). After bringing this leg forward, the animal "falls" on this leg, which means that supporting on the left front leg is painful, despite the apparently better movement of the joints of that leg (weight-bearing lameness). The distal joints of both hind legs are also limited in their movements, reflecting in shorter footsteps. African elephant displaying joint instability in the carpal joints of both front legs. When the feet are placed on the ground, the distal parts of the legs show a valgus position. Radiographs taken from the same African elephant demonstrated periostal reaction 10-12 cm above the carpal joint, an osteophyte (spur, right red arrow) in the radiocarpal joint (osteoarthritis). The image to the right represents the carpal joint of a healthy African elephant. The first thermography image shows a hot area at the level of the knee joint (upper arrow), suggestive for the presence of an inflammatory proces in that area. The lower arrow indicates another large hot spot. This Asian elephant was used for carrying tourists for many years in Nepal and was chained when she was not at work. The second thermography image shows a high temperature in the area of the right elbow in an Asian elephant with a swollen right front leg, also suggestive for a n inflammation of the joint (I mages: courtesy of Susan Mikota). Degenerative osteoarthritis/ Degenerative Joint Disease (DJD) Degenerative osteoarthritis or degenerative joint disease (DJD) is quite common in elephants of advanced age. Factors that contribute to DJD are : Local infection (e.g. from nail abscess) Poor quality bedding substrate, no comfortable resting possibilities (sand heap) Generalized infection: Mycoplasma have long been mentioned as cause of DJD because it involves multiple joints, often has a shifting lameness (Clark, 1980). Rheumatoid arthritis has also been mentioned without any scientific evidence. However, lack of evidence does not necessarily exclude this form of joint disease. In humans aggravation of rheumatoid symptoms is often correlated to humidity and low temperature. As some keepers have seen a correlation between these environmental factors and pain signals of the elephant, both environmental conditions can better be avoided for elephants kept in captivity. DJD is a chronic arthritis, characterized by loss of healthy carti lage, abnormal synovia, and irregular outline of the joint bones. Cartilage acts as a soft buffer between the bones bordering a joint. When that protective layer becomes thin or has gone, the surface of the bones are exposed to each other, which is the major cause of the pain that is experienced in DJD. In the early phase, the area around the affected joint may be warm. In chronic cases (the majority that is seen by clinicians), the temperature is often normal or even lower than the surrounding area. Synovia is a yellow, viscous, thread-pulling liquid, produced by the joint cartilage (see photo below). It makes it possible for the joints to articulate smoothly. If the cartilage becomes diseased, it will form abnormal synovia with a much lower viscosity (see video below; BBC). The diagnosis of DJD is based on: Symptoms as described above. Some of the following symptoms will be present: lameness during walking, abnormal position in resting position, swollen joint. Locomotion test: see diagnostic procedures above. Palpation: warm joint, painful joint on deep palpation) Thermography: if the affected joint is warm, it will show in the thermographic image as a hot spot. Radiography: DJD can only be visualized in the smaller joint (digits, carpus, tarsus). More proximal joints are hard or impossible to visualize by X-ray. Affected joints can show a smaller joint space, irregular outlines of the bones (exostosis), osteolysis, dislocation or bone fusion (ankylosis). When an infection of the joint is suspected, aspiration biopsy from the affected joint should be considered for culture and antibiogram and evaluation of the synovia. However, one should be well aware of the risk to introduce an infection. Radiograph and post-mortem photo of the hind foot bones taken from a 21 yrs-old Asian elephant with DJD involving multiple joints. Exostosis and reduced joint space can be seen on the radiograph. At necropsy the ankylosis of the digits and tarsal bones explain why the elephant was unable to bend the joints of his feet. Positive reinforcement training made it possible to provide physiotherapy to an African elephant. Courtesy San Diego Zoo African elephant resting its head on a tree. https://geogypsytraveler.com/wp-content/uploads/2014/01/09-028-Elephant-rest-against-a-tree-Kruger-NP-SA-gfb-knp-fff44-1024x678.jpg TREATMENT OF DEGENERATIVE JOINT DISEASE Acute phase: Rest Head rest* Proper substrate (dry sand) Sand pile for sleeping at night Pain management Corticosteroids: maybe in acute phase? [Dexamethasone (1mg/5 kg BW); Prednisolone (1mg/3 kg BW)] Chronic phase: Head rest* and sand piles Physiotherapy: opportunities for walking exercises, unlimited free access to hydrotherapy (swimming pool) Pain management Weight reduction (if applicable) Correction of abnormal pressure on foot pads Monitor the condition of the lameness on a daily mobility score chart. Pain management: NSAID’s in acute phase (for 5 days as a start) and whenever needed in chronic cases: Firocoxib 0.1 mg/kg BW PO/day (tablet or paste) Meloxicam (0.03 mg/kg BW PO/day) Flunixin (1,1 mg kg BW, PO/IM/IV, BID) Ibuprofen (6 mg/kg BW PO, BID) Phenylbutazone (4,4-8,8 mg kg BW PO/day) Opiates: tramadol (0.5mg/kg PO BID) – combined with NSAID Some of the anecdotally reported treatments for DJD are: Physiotherapy: 2x30 minutes/day walking in figure 8 rounds, walking over small steps. Hydrotherapy Laser Glucosamine/chondroitin Gabapentine (anti-epileptic drug, 1.5mg/kg BID) Acupuncture Stem cells The provision of sand piles is essential for the prevention and treatment of joint problems Correction of unequal leg length: One report describes the use of a rubber sole to correct the abnormal positioning of the right front leg of an Asian elephant, caused by unequal leg length. A thick multiple-layer rubber sole was glued underneath the pad of the animal (figure below A and B) (Johnson 2018). A liquid urethane glue (also used in horses) kept the pads in place for 4 weeks. The elephant was provided with bilateral wedge pads to offload pressure from the fourth nails (C). A rubber sole can probably also be used to protect a very thin sole with a compression sore. Rubber sole Elephant glue-on shoe construction and materials. A. Paper pattern pieces for a whole foot shoe (left), and a partial wedge (right). B. A view of the side of the wedge showing the multiple layers of rubber soling material sandwiched together. C. Shoe bottom with checkerboard tread. D. Top of a used shoe. E. Another view of the shoe showing the medial height. F. Elephant wearing the oblong wedge pad on the bottom of the right foot. Elephant posture standing, before and after shoes. A. Elephant leaning on the left front foot because of asymmetry in leg length before shoes were applied. B. Elephant wearing shoes and standing square. C. Close-up of partial wedge pad on right foot (arrowheads) and elevated shoe on left foot. * Especially in case of joint disease in the fore legs, reducing the weight on these legs is a great relieve to the elephant, as the fore legas and the head form 60% of the total body weight of the elephant. A head rest is just an elevated bar, where the animal can put its head on. Any surface that is strong enough to hold the weight of the head adjusted to the right hight may relieve the pain caused by degenerative joint disease. Muscle-related problems Wound, abscess Lameness may be seen when muscles are involved in (local) infection or traumatic injury. A local infection can be caused by any perforation of the skin by and injection, arrow, gun shot, etc. This may result in abscess formation. When the elephant ahs to sleep on a concrete floor, it may develop a compression sore, that can affect the underlying muscles. Treatment of this kind of lesions includes: Creation of draining Removal of the foreign body Daily flushing of the wound with saline and mile disinfectant (e.g. diluted Betadine or chlorhexidine). In severe cases a systemic antibiotic might be indicated (after culture and sensitivity test) Black leg (Clostridium chauvoei or C. septicum This bacterial infection is described on the web page: Clostridiosis. Click here for further reading. Capture myopathy Cap t ure myopathy or exertional stress is a condition is characterized by severe lameness of all 4 legs. It is caused by a complex alteration of metabolic processes usually associated with capture, transport, restraint or work overload (timber industry). The acid-base and electrolyte balances are disturbed, which results in an acute lameness. It becomes fatal when the heart muscle is affected. The urine turns dark brown due to the presence of myoglobine that is the result of muscle necrosis (see photo). In some less severe cases and when the animal is treated adequately the muscle damage can be limited and the animal may survive. Treatment of capture myopathy: Absolute rest Deep sand layer on floor NSAID’s Easy-chewable forage, chopped Darkened environment Long-acting tranquilization Tendon laxity Tendon laxity (or flexural deformity) refers to a disorder that causes weak flexor tendons. It is not uncommon in newborn horse foals, especially premature ones. This condition usually fixes itself with controlled exercise. The orphan African elephant on this photo seems to suffer a similar condition. The outcome of treatment exercises remained unknown, as the elephant died of non-related problems. Tendon contracture (arthrogryposis) An assumed arthrogryposis was found in a stillborn calf that was delivered by fetotomy after a retention period of 13 months. Both carpal joints were firmly fixated in bent position. Stretching of the joint was only possible after cutting the flexor tendons (as done in the left front leg of the calf on the photo). Click here for the case report. Neurology-related lameness Tetanus Elephants are susceptible to Clostridium tetani. Similar to exertional myopathy, the affected elephant will have stiff legs. External stimuli will result in excitation and aggravation of the muscle contractures. For further reading click here . Botulism Botulism is a paralytic disease caused by the toxines of Clostridium botulinum . In elephants it was first reported in 1962 in a German zoo (Elze, 1962). The diagnosis was based on the successful treatment of the paralytic lameness by the timely administration of botulism antitoxines. In another outbreak 5 out of a group of 6 Asian elephant bulls died of botulism in the course of a few days. It started with a general weakness that became progressively worse. Shivering and mild salivation preceded the inability to stand and properly use of the trunk. For further reading click here . Metabolic bone disease Nutrition-related lameness Metabolic bone disease Metabolic bone disease (rickets, secondary nutritional hyperparathyroidism) has been reported in very young hand-raised elephant calves. It is a caused by an absolute deficiency of nutritional calcium (and vitamin D?), and a imbalance or lack of other minerals (e.g. phosphorus, magnesium) and proteins. There is no evidence about the potential involvement of vitamin D3 deficiency. Elephants up to the age of 9 months are susceptible to this condition, basically during the period that they should be on a 100% maternal milk diet. During lactation the fat concentration in the mother milk increases together with the calcium level ( Abbondanza, 2013) . This means that the calcium concentration in milk replacers must be increased as the calf grows older. Asian elephant calf with a distinct swelling in the left elbow region. Note the abnormal posture of the left front leg (Courtesy: Susan Mikota). Radiograph showing pathological fractures consistent with secondary hyperparathyroidism (Courtesy: Charles Reid in: Fowler en Mikota, 2006). As demonstrated by the CT-scans on these photos, the demineralisation of the growing bones will lead to pathological fractures: one fracture in the distal humerus and one fracture in the distal radius. (Photos of the CT-scans were kindly provided by the Leibniz Institute for Zoo- and Wildlife Research). Treatment and prevention of metabolic bone disease is based on maintaining the right diet (fat, proteins, Ca, P, Mg, vitamin D) and monitoring the blood total and ionized calcium levels, as well as phosphorus and magnesium. It is also recommended to make X-rays of the long bones of the growing calf on regular intervals (2-3 months) to check the bone quality and shape. Sufficient exercise of the hand-raised calf is very important for the development of a strong skeleton. Bone fractures Bone fractures Despite the solid consistency of elephant bones, fractures are not uncommon. Fractures always result in weight-bearing lameness as is clearly demonstrated on the video of the young Asian elephant bull with a fracture of the radius and ulna (Courtesy Dak Lak Elephant Conservation Center). The animal was hit by an adult female. As the distal part of the elephant's foot is missing, it was not possible to apply a splint. Possibly the shortage of the affected leg worked to his advantage, as he was able to walk on 3 legs until the fracture ends had healed. Radiographs taken from the same young Asian elephant. Note the spiral shape and dislocation of the fracture ends of the radius and ulna. The bones healed completely within a 3 months period. Several types of casts and bandages have been tried in elephants that had a fractured leg. Some of them are displayed below. An adult Asian elephant presented at the Lampang Elephant Conservation Center-Thailand with a fracture and dislocation of the left fibula (see radiographs). A cast was made locally, which remained in place for the next 5 months. During this period the elephant stayed with the owner and the cast was changed 3 times. Photos courtesy: Taweepoke Angkawanish This adult Asian elephant was also presented at the Lampang Elephant Conservation Center-Thailand. A fracture of the tibia was suspected and a splint was made just to assist the elephant by reducing full the weight on its affected leg. Photo courtesy: Taweepoke Angkawanish At Pinnawala Elephant Orphanage (Sri Lanka) a radius and ulna fracture in a 2-yrs-old Asian elephant was treated by the application of a Robert Jones bandage and a fiberglass cast (Karunarathne, 2017). The bandage and cast were renewed twice. Several sedations were required to put the cast in place. Two weeks after the 3rd cast was fixed, the calf succeeded in removing it, but at that time it was able to put weight on the affected leg with a mild limp. To reduce the pressure on fractured bone ends, it may be helpful to provide a sling in which the elephant can be supported while standing. This is only an option if the elephant is accepting such a device, which needs to be located in a trusted environment outside the reach of other, non-friendly elephants. Some improvisation skill to make such a construction will by useful. It can also be used in elephants that have a joint dislocation or other conditions in which weight reduction on one leg is required. Photo courtesy: Susan Mikota Hydrotherapy Many attempts to treat major bone fractures in elephants have failed, largely due to the animals’ immense body weight. To date, no scientific reports have documented the use of hydrotherapy in such cases. However, at the 19th International Elephant Conservation and Research Symposium of the International Elephant Foundation (Chiang Mai, 2023), Dr. K.K. Sarma, Head of the Department of Surgery and Radiology at the College of Veterinary Science in Guwahati, India, presented several cases of leg fractures in semi-wild and free-ranging Asian elephants. Remarkably, these elephants appeared to choose hydrotherapy on their own, spending extended periods—sometimes several weeks—in water bodies such as lakes or large pools. They would typically emerge only once a day to forage. No splints or orthopedic devices were applied, yet the healing outcomes were striking. Joint dislocation Traumatic joint dislocations have been reported anecdotically. A 3-yrs-old orphan Asian elephant was found in a range country after a bushfire. It was noticed that its right front leg seemed longer than the left one. It was brought up in a zoo in Asia and moved to Europe to become integrated in the EAZA breeding program. Is he grow older, the asymmetry of his front legs worsened and he developed a significant weight bearing and movement-restriction lameness. During locomotion he swayed his right front leg forward. The bull was mildly sedated and examined in a restraint chute. Ultrasonographic examination revealed excessive fluid in the right elbow joint. Radiography failed due to the large size of the animal. To check the stiffness of the left elbow joint, a long rope was tied to the left carpus while in left lateral recumbency. Three individuals tried to stretch that leg; during this attempt, a clear crack was heard while the joint stretched only a few degrees. It was concluded that the joint was severely damaged and partial ankylosis had taken place. The elephant was humanely euthanized. At necropsy a ruptured joint capsule and ruptured ligaments of the right elbow were found. The cartilage showed multiple defects, exposing the underlying bone. Another traumatic joint dislocation was reported from Myanmar (Ann-Kathrin Oerke, 2022). An adult bull got its left hind leg stuck between the fork formed by two trees when it fell down. The capsule and ligaments of the tibio-tarsal joint ruptured and the distal part of the tibia perforated the skin. Treatment was no option and the animal died under miserable circumstances. Severe traumatic leg injuries Too many elephants have suffered traumatic leg injuries due to mine explosions, snares and other forms of poaching. In recent years partial leg amputation has been practiced with some success in Asian range countries. In most cases a prosthesis is needed to enable the elephant to walk. Missing all toes of front leg A 3-4 yrs-old wild Asian elephant bull was found with an old injury on its left front leg. All toes were missing and there was a deep wound on the palmar side of the remnants of that foot. A circular scar was visible about 15 cm from the "pad"; 4 small fistulas were located in the line of this scar, each of them oozing thick purulent exudate. Most of the time (70-90% the animal displayed stereotypical behavior: touching the remnant of its left foot and beating it with its trunk. The animal was brought to a rescue place at the Dak Lak Elephant Conservation Center in Vietnam. During the following months he became accustomed to the presence of humans by positive reinforcement training. The wounds were taking care of by daily flushing with saline and antiseptic (povidone-iodine solution) solutions. Arrangements could be made to make X-rays of the affected leg, which revealed the piece metal wire. During a surgery under general anesthesia (ketamine and xylazine by IM-injection and oxygen supplementation in the trunk), a 20 cm of wire was removed. The incision was made perpendicular on the wire until the scalpel touched the wire. By slightly enlarging the wound the wire was easily removed. The wound was left open and flushed daily during the following weeks (saline and antiseptic solutions). The incision wound healed restless. Three of the 4 initial fistulas closed in the following year. However, one fistula located at the medio-palmar side of the circular scar remained oozing. Seven months after the removal of the wire, there was an opportunity again to inspect the wounds and radiographs were made again. Based on these images osteolysis of one of the carpal bone was suspected. A second surgery was done and pieces of smelling necro-purulent bone material were removed by cutting the affected carpal bone using a bone chisel and bone scraper. A large tunnel between the incision wound and the original wound was created in order to allow easy draining of necro-purulent exudate during the daily flushings. The surgical wound and fistula healed completely. To date (2025) the original wound is still being managed by weekly cutting away excessive horn and daily flushing. The animal can walk reasonably well. The episodes of displaying stereotypic behavior have significantly reduced in frequency and intensity. Several examples of a prosthesis can be found on the internet. Most of the victims lost part of the leg by the explosion of a land mine they stepped on. Chhouk, an Asian elephant in Laos has been living for several years with a prosthetic device (See also : Wildlife Alliance ) Prevention orthopedic problems Prevention of orthopedic problems Management-related factors play a major role in the development of foot problems. Two studies (one performed in European zoos and one in Nort-American zoos) found the following factors influencing one or more orthopedic issues (Wendler 2019; Miller 2016): Enclosure size: the larger the enclosure, the less problems occurred. Bedding: soft bedding reduced the number of orthopedic problems. Floor: a dry floor promotes foot health Time spend outdoor: the longer an elephant spends time in its outdoor enclosure, the better it is for its locomotion apparatus Exercise: adequate exercise by many social interactions reduces orthopedic issues Provide a headrest (see under 'treatment') Nutrition: more brows results in less foot problems. Benz (2005) could not find a correlation between the supplementation of the diet with biotin (vitamin B8) and foot health. Body condition: no negative correlation was found between overweight and orthopedic problems. Elephants that are kept in range countries are facing different management-related issues. Walking large distances on hot tar roads may result in damage to the pad. Elephants working in the logging industry may be more affected by muscle or joint injuries. As many elephants are not trained for foot care, easy-to-treat nail or pad lesions may lead to complications like foot abscesses or osteolysis of the distal phalanges. However, no data are available about the incidence of foot problems in range countries. A separate chapter about regular foot care in elephants kept in zoos can be found here . Stereotypical behaviors like "weaving (or swaying)" may result in excessive pressure on the lateral nails resulting in cracks. This stresses the importance of providing a divers social setting for elephants to live in, mimicking their natural social environment. Training of elephants to allow proper foot care is important to address early problems of foot lesions. Mahouts should have the minimum knowledge and skills to perform proper foot care. In order to monitor the effect of pedicure, it is important to describe the status of the feet. By clicking on the icon displayed below, you will find a document that can be used for this purpose (from EAZA Best Practice Guidelines for Elephants, 2020): Click here to download the foot examination form for Asian elephants Click here to download the foot examination form for African elephants No studies about the prevention of degenerative joint disease have been publish ed. As the cause of this problem in elephants is not known, it is hard take appropriate measures to prevent them. Without hard evidence some more anecdotal statements may still be useful: Provide sand piles for sleeping during the night Stimulate locomotion (free ranging elephants walk many miles per day!) Provide sufficient soft bedding. Further reading: see reference list. References Abbondanza, F.N., Power, M.L., Dickson, M.A., Brown,B. and Oftedal O.T. 2013. Variation in the Composition of Milk of Asian Elephants (Elephas maximus) Throughout Lactation. Zoo Biology 32(3):291-8. Benz, A. 2005. The elephant’s hoof: Macroscopic and microscopic morphology of defined locations under consideration of pathological changes. Master's thesis, Veterinary Faculty of the University Zürich, Switzerland. Clark H. W., Laughlin D. C., Bailey J. S. and Brown T. McP. 1980. Mycoplasma Species and Arthritis in Captive Elephants. Journal of Zoo Animal Medicine, Vol. 11, No. 1 pp. 3-15. Csuti B, Sargent E.L., Bechert U.S. (Editors) 2005. Book: The Elephant's Foot: Prevention and Care of Foot Conditions in Captive Asian and African Elephants 1st Edition. EAZA Best Practice Guidelines for Elephants. 2020. Click here for full text. Elze K. 1962. Über eine unter dem klinischen Bild van Botulismus verlaufene Erkrankung beim Elefanten. Nord.Vet.-Med. 14 (1) 259-271. Fowler M.E. and Mikota S.K. 2006. Biology, Medicine, and Surgery of Elephants. 271-290. Hess A. 2022. 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 Master's thesis, Department of Exotic Animal and Wildlife Medicine University of Veterinary Medicine Budapest, Hungary. Johnson G., Smith J., Peddie J., Peddie L., DeMarco J., Wiedner E. 2018. Use of glue-on shoes to improve conformational abnormalities in two Asian elephants (Elephas maximus ). J. Zoo&Wildl Med. 49(1): 183–188, 2018. Karunarathne H.P.R.N.S., Bandara M.R.B.N., AbeysingheA.M.N.D.B., Liyanage E.M.E., Rajapaksha R.C., Kodikara D.S. and Dangolla A.. 2017. Fixation of a Radius and Ulna Fracture in an Asian Elephant Calf by Using Fibreglass Casts. Gajah 47 (2017) 40-41. Kottwitz J, Bechert U, Cruz-Espindola C, Christensen J.M., and Boothe D. 2024. Single-dose, multiple-dose, and therapeutic drug monitoring pharmacokinetics of firoxicab in Asian elephants (Elephas maximus ). Journal of Zoo and Wildlife Medicine 55(1): 73–85, 2024. Miller M.A., Hogan J.N., Meehan C.L. 2016. Housing and Demographic Risk Factors Impacting Foot and Musculoskeletal Health in African Elephants [Loxodonta africana] and Asian Elephants [Elephas maximus] in North American Zoos. PLoS ONE 11(7): e0155223. doi:10.1371/journal.pone.0155223. Schiffmann C. 2021. Posture Abnormalities as Indicators of Musculoskeletal Disorders in 12 Zoo Elephants – a Visual Guide. Gajah 53 (2021) 20-29. Turner A., Masters N., Pfau T., Hutchinson J.R., and Weller R. 2023. Development and evaluation of a standardized system for the assessment of locomotor health in elephants under human care. J. Zoo&Wildl Med. 54(3): 529-537. Wendler, P., Ertl, N.,Flügger, M., Sós, E., Schiffmann, C., Clauss, M., and Hatt,J-M. 2019. Foot health of Asiane elephants (Elephas maximus ) in European zoos. Journal of Zoo and Wildlife Medicine 50(3): 513–527, 2019. To page top

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.

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

Necropsy index Necropsy procedure (videos) Necropsy protocol forms

Locomotion problems in elephants are usually symptoms of degenerative joint diseases and lesions of the pad or nail. This chapter describes (1) the diagnosis of orthopedic problems (observationa and video recording, radiology, thermology), (2) nail issues, (3) sole/pad issues, (4) degenerative joint disease and some miscellaneous problems related to lameness. Continue Orthopedic problems This chapter consists of the following paragraphs: Normal features of the locomotion system Sole-related clinical problems Nail-related clinical problems Lameness / abnormal locomotion Prevention of orthopedic problems Radiography elephant foot Elephants do not often show signs of lameness. Nevertheless, orthopedic problems are quite common. A survey about the causes of death in the European studbooks of African and Asian elephants over 5 years of age, revealed that in 12% and 30% respectively of the cases, orthopedic problems played a major role in the cause of death (Hess 2022). The most frequently reported problems are related to the feet, joints and muscles. A special issue is the occurrence of metabolic bone disease in bottle-raised young elephants. Normal features of the locomotion system Normal featurs Anatomical features of the skeleton The elephant has some special features that distinguishes them from other mammals. The long bones are massive, lacking the typical bone marrow cavities. Instead, the long bones of elephants are completely filled with dense cancellous bone, where hemopoiesis is taking place. In the standing elephant, the angles of the joints are almost straight. The neck is relatively short. Figure 1: Asian elephant (Green Hill Valley, Myanmar). Figure 2: African elephant skeleton (Veterinary Faculty Utrecht University, the Netherlands) Foot anatomy terms Front foot = fore foot = manus Hind foot = rear foot = pes Phalanges = toes = digits Pad = sole = slipper Palmar = front pad Plantar = back pad Carpus = wrist Tarsus = ankle Nail = horn wall + nail pad horn Fat cushions Each foot of the elephant is equipped with a large subcutaneous cushions which play an important role in distributing forces during weight bearing and in storing or absorbing mechanical forces. One study about these cushions in the African elephant was published by Weissengruber in 2006 . In both the forelimb and the hindlimb a 6th ray, the prepollex or prehallux, is present. These cartilaginous rods support the metacarpal or metatarsal compartment of the cushions. None of the rays touches the ground directly. The cushions consist of sheets or strands of fibrous connective tissue forming larger metacarpal/metatarsal and digital compartments and smaller chambers which are filled with adipose tissue. The compartments are situated between tarsal, metatarsal, metacarpal bones, proximal phalanges or other structures of the locomotor apparatus covering the bones palmarly/plantarly and the thick sole skin. Within the cushions, collagen, reticulin and elastic fibres are found. In the main parts, vascular supply is good and numerous nerves course within the entire cushion. The high concentration of sensory receptors such as Vater–Pacinian corpuscles within the cushion and Meissner corpuscles in dermal papillae of the adjacent skin might rank an elephant’s foot among the most sensitive parts of its body. Together, the mechanical and sensory functions of the feet enhance the ability of elephants effectively to move through and analyse their physical environment. The micromorphology of elephant feet cushions resembles that of digital cushions in cattle or of the foot pads in humans but not that of digital cushions in horses. Copied illustration of the foot anatomy from Weissengruber et al., 2006 (doi: 10.1111/j.1469-7580.2006.00648.x Normal locomotion Elephants predominantly support on their pads (foot soles). The nails are not used to force locomotion. This is nicely demonstrated in the slow-motion video below (BBC). During walking the head of the elephant shows minimal movements. If there is any form of lameness, especially in one of the front legs, the animal might use its head to facilitate the movement of the front leg in cranial direction. In the absence of orthopedic problems, the hind feet are placed cranial to the foot step of the front foot on the same side. This is clearly demonstrated in the slow-motion video of African elephants in the Namibian desert below (BBC) and the normal-speed video of an adult Asian elephant bull in Vietnam. Elephants can't trot, canter, gallop or jump. They always walk in normal gait. When they walk slowly, their speed is approximately 4 km/h (2.5 miles/h). However, they can reach a speed of 25-60 km/h (16-25 miles/h) over a short distance. The hind foot is placed in the foor print of the front foot or even slight more cranial. Normal anatomical features of the elephant foot Usually the forefeet of the Asian elephant have 5 nails and the hind feet only 4. The African elephant has 4 nails on the forefoot and 3 on the rear one. The weight of the body is evenly distributed over the toes by means of a thick cushion , placed between the sole and the phalanges (photo African elephant foot Kruger National Park, South Africa). The digits form a ±45° angle with the sole, as shown in the radiograph below (Fowler and Mikota 2006). This photo shows the longitudinal section of the elephant foot with the sole, nail, phalangeal bones, cushion and tendons. Note the short distance between the nail and the distal phalangeal bone (Fowler and Mikota 2006) The nails are numbered medial to lateral. If there are 4 nails in front they are numbered 2,3,4,5. The bones don’t change – there are always 5 digits so digit 1 is still there but there in no associated nail. In Asian elephants there are typically 4 nails on the rear foot so they are numbered 2,3,4,5. The African elephant's toes are numbered 5,4,3,2 (front) and 5,4,3 (rear) respectively. This diagram shows the bones of the front foot and the respective phalanges of an Asian elephant (Fowler&Mikota 2006) This diagram shows the bones of the hind foot and the respective phalanges of an Asian elephant (Fowler&Mikota 2006) Radiograph of the left front foot of an Asian elephant, showing the phalangeal bones P1,P2 and P3 (Fowler&Mikota 2006) Sixth toe The elephant has unique cartilaginous structures in the feet that are thought to have a stabilizing function. In the front foot the structure is is called a prepollex. It attaches between the first carpal bone and the first metacarpal bone and extends to the sole. In the hind foot it is called a prehallux. A recent study has claimed that this structure should be considered a sixth toe because over time the tissue becomes hard like bone. The healthy sole The sole (pad or slipper) of the elephant's foot is a thick cornified but flexible integumentory structure, with a surface relief that looks almost similar to the skin. It is important to respect this surface when performing pedicure. The thick sole must protect the elephant from penetrating trauma by foreign bodies. A healthy sole is maintained by providing a dry environment. Long periods in muddy and humid circumstances can lead to sole injuries and even sole detachment. The photos show the nicely structured sole of a (dead) wild African elephant (Kruger National Park, South-Africa) and the sole of a captive Asian elephant. The sole of the elephant foot should have a minimum thickness of 2 cm. This can be measured by ultrasound examination. Its surface should be rough with a distinct relief. The growth of the sole epithelium is from 0.5 to 1.0 cm per month. If the sole does not wear sufficiently, it becomes thickened, and because the thickening is seldom uniform, defects are produced that lead to pocket formation and overgrowth, which sets the stage for infection. The healthy nail The nail consists of two parts: the wall and the sole part, which are connected at the sole side. This junction is an important area where infections can emerge if its integrity has been severed by excessive abrasion on hard floors (concrete stable, tar roads) or wrong pedicure. This connection site is comparable with the so-called 'white zone' in hoofed mammals. The white line (or white zone) structure is illustrated in the figures and photos below (Benz, 2005). The nails should be shorter than the pad, without cracks and U-shaped. The skin in between 2 nails should be clean and flexible. When there is hyperkeratosis in this area, this may cause discomfort to the elephant as the hard hyperkeratotic tissue acts as a foreign body by pinching the interdigital skin an dirt can accumulate into the interdigital space. There should be room for at least one finger between 2 nails. The thermographic images of a healthy nails shows a regular distribution of the temperature dispersed over the entire nail. Like in hoofed mammals, the nails are connected with the underlying phalanges by lamellae or horn leaflets. Benz (2005) describes the different parts of the nail: a: corial part of the horn wall: cuticle area b: lamellae (horn leaflets) c: white zone d: sole horn Cuticle and sweat glands The cuticle of the nail is the keratinized skin at the junction with the nail. They should be soft and flexible. This is a vulnerable area as microorganisms may pass this natural barrier after (micro)trauma. The elephant seems to maintain the cuticles by rubbing them gently against objects. Elephants that are kept in moist, muddy conditions, are likely to develop problems with the cuticles. They may overgrow and become hardened when they dry, resulting in cracks and infection. During pedicure, one should be well aware of the protecting function of the cuticles and never remove more than necessary. References Benz, A. 2005. The elephant’s hoof: Macroscopic and microscopic morphology of defined locations under consideration of pathological changes. Master's thesis, Veterinary Faculty of the University Zürich, Switzerland. Fowler M.E. and Mikota S.K. 2006. Biology, Medicine, and Surgery of Elephants. 271-290. Hess A. 2022. 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 Master's thesis, Department of Exotic Animal and Wildlife Medicine University of Veterinary Medicine Budapest, Hungary. Schiffmann C. 2021. Posture Abnormalities as Indicators of Musculoskeletal Disorders in 12 Zoo Elephants – a Visual Guide. Gajah 53 (2021) 20-29. Weissengruber, G.E., Egger, G.F., Hutchinson, J.R., Groenewald, H.B., Elsässer, L., Famini, D. and Forstenpointner, G. (2006), The structure of the cushions in the feet of African elephants (Loxodonta africana). Journal of Anatomy, 209: 781-792. https://doi.org/10.1111/j.1469-7580.2006.00648.x To page top