Neonatology and Pediatrics in Orphan Raccoons

Raccoon Rehabilitation:
Neonatology and Pediatrics
Karen Bailey
Kentucky Wildlife Center, Inc.
kywildlife.org
DISCLAIMER:
No part of this presentation is intended to provide veterinary
advice or recommendations of any kind. Medications and
Protocols administered by KWC are used under the advisement
of our veterinarian of record .
Consult your own veterinarian before using any
medication and do so only under his direct supervision.
Kentucky Wildlife Center Mission
Rescue and rehabilitate native wildlife
Improve the welfare of wildlife through education
Improve the field of wildlife rehabilitation through research
Base new therapies and protocols on sound scientific research
Do no harm
Improve survivalability in the rehabilitation setting
Share information
Natural History: Raccoon Reproduction
Gestation is 63-65 days
Most babies are born in April (may vary depending on region)
Most males don’t breed until their second year
Large percentage of yearling females will breed
Adult pregnancy rates are commonly more than 90%
Nutrition influences productivity (pregnancy rates and litter sizes)
Generally have one litter per year
Late babies occur if the female fails to get pregnant during spring
estrus, aborts, or her babies die shortly after birth
Average litter size is between 3-4, but depends on location
Developmental Stages
Pediatric Stage
-Neonatal Stage: Birth until 3 weeks or when eyes open
-Infant Stage: 3 weeks until weaning
Juvenile Stage: Weaning until approximately one year of age
It’s important to realize that these stages are typically longer in
duration in comparison to puppies and kittens. Raccoons tend to
develop slower, open their eyes later, and wean later. Raccoons
can remain with their mothers through 6 months of age and often
through their first winter.
Tooth Eruption
1 month:
1.5months:
2 months:
2.5 months
3 months:
3.5 months
deciduous first, second, third incisors and deciduous canines
deciduous second, third, and fourth premolars
deciduous first premolars and permanent first incisors
permanent second incisors and first molars
permanent third incisors
permanent canines
Montgomery, G. Tooth eruption in preweaned raccoons. Journal of Wildlife Management 1964;28(3):582-584
Neonatal Physiology
Average birth weight is 60-75 grams (Zeveloff, 2002)
Birth weight and subsequent weight gain may be accurate predictors for survival
Neonates have poor ability to thermoregulate
Neonates are more prone to dehydration than adults
More prone to hypoglycemia (decreased glycogen stores)
Body weight is 75-80% water at birth
Fluid maintenance requirements are 2-3 times that of an adult (120-180 ml/kg/day)
Eyes and Ears are not open at birth-generally open at 21-23 days
Lack the ability to voluntarily urinate and defecate (must be stimulated)
Decreased renal (kidney) and hepatic (liver) function
Immunity depends on passive transfer of maternal antibodies
Normal heart rate is over 200 bpm and respiration ranges from 15-35 breaths per
minute
Mortality in Neonates
Most mortalities occur during the neonatal stage (first 3 weeks)
Orphan raccoons are already stressed
Most are dehydrated and hypothermic on intake
Many have been improperly handled or fed by the finder
Often little or no history or inaccurate information provided
Few studies of raccoon neonate mortality have been conducted. The
1999 Gehrt and Fritzell study in Texas had an estimated nestling
mortality of 52-65%.Average puppy and kitten death during the first 12
weeks is between 11-34%
Not all neonates are going to survive no matter what you do!
Managing the Neonate
Understand physiological differences between neonates and
adults and have the ability to meet the needs of the neonate
Monitor closely and recognize problems early
Have effective therapeutic plans . Have protocols outlined and
medications on hand. Rapid intervention is critical when needed.
Know Normal
Normal neonates nurse and sleep
Strong, activated sleep patterns
They respond to warmth, touch and smell
They spend most of their time with littermates and only cry briefly.
Neonates cry when they are hungry, neglected (separated), in pain, or cold
Neonates Respond To Three Things
Warmth
Touch
Odor
Necessities for Neonate Exam
Digital gram scale (with 1 gram increments)
Digital rectal thermometer
High quality stethoscope
Handling the Neonate
Be quick and efficient
Keep the baby out of the incubator for as little as time as possible
Have everything ready beforehand
Keep everything clean.
We keep a heating pad covered with a baby blanket on the exam
table to help the baby stay warm during feeding, treatment, exam, etc.
Handling should be restricted to the caregiver
Proper Hygiene is Critical
Use Safe Products
Neonate skin is more permeable than adults
High surface-to-body-mass ratio
Immature renal and hepatic function-less ability to clear chemicals and toxins
Neonates are very responsive to odor
(remember neonates respond to touch, warmth, and odor)
Use products that are for sensitive skin, fragrance free when possible
After any disinfectant use, rinse with clean water and allow to dry to avoid
chemical residue
You must be able to IDENTIFY your intakes!
Critical for monitoring health and keeping records.
It can be as simple as using fingernail polish. For example, a litter of 4 males
and 1female come in together. Mark the right ear on one male (REM), left
ear on one male (LEM), both ears on one male (BEM), no mark on one
male (NEM), and no mark on the female (NEF). We microchip once they
open their eyes.
Microchips
Weight
Be sure to have an accurate and reliable way to identify individuals
Keep good records
Note weight differences among littermates
Weigh daily prior to feeding (more frequently with sick or high risk patients)
Weight gain is a key indicator of health
Some babies may not gain weight or may even lose a slight amount in the
first 12-24 hours of intake
After intake, neonates should gain 5-10% of their birth/intake weight per
day, roughly doubling their weight by 10 days of age
Weigh . Weigh Again. Keep Weighing!
Great way to monitor health
Key indicator of health -loss of weight or failure to gain weight
can indicate illness
Necessary for fluid, caloric and medication requirements.
Need a good digital gram scale with 1 gram increments when
working with neonates
Evaluate Normal Neonate Responses
1) Righting Response: place a neonate in dorsal recumbency (on it’s side). A
healthy, awake neonate will immediately roll sternal. Delay or absence of
this response can indicate disease, dehydration, or hypothermia
2) Rooting Response: form a circle with your thumb and forefinger and place
it around the neonate’s muzzle. A healthy neonate will push firmly against
you and often rise up on their front legs
3) Suckling Response: place a finger in the neonate’s mouth to assess the
strength of the suckle response.
Freshman, Joni. Evaluating Fading Puppies and Kittens. 2005
Hyperemia in Neonates
Neonates may be hyperemic for the first week because they
are born with a higher red blood cell count. Normal.
Varies depending on number of red blood cells passed
through the placenta and umbilicus at birth
Darker red mucous membranes
Managing the Compromised Neonate
Correct Hypothermia
Correct Dehydration
Correct Hypoglycemia
Provide Nutrition
Clinical Signs of Shock in the Neonate
pale mucous membranes
slow capillary refill time (>1.5 seconds)
decreased urine output
no nursing or suckle reflex
cold extremities
limp body tone
constant crying
Thermoregulation in Neonates
Neonates lack the ability to thermoregulate (control their own
body temperature)
Shivering reflex and peripheral vasoconstriction response aren’t
completely developed until approximately 1 week of age
Relatively large surface-area-to body-mass ratio
Less insulating fat
High water composition
Can only maintain a body temperature of approximately 12° F
above the ambient temperature
Hypothermia
Common cause of death in neonates
Heart rate drops
GI motility decreases
Body temperature below 94° F results in GI ileus
Decreased ability for lymphocytes to transform and combat infection
To prevent organ failure (especially of the heart and kidneys), always warm
hypothermic animals slowly (no more than 2° F per hour)
Never feed a hypothermic animal
Normal Temperatures for Neonates
Age
Normal Temperature
Week 1
95 -99° F
Week 2-3
97-100° F
Week 4
99-101° F
Recommended Environmental Temperature
86-90° F
80-85° F
70-75° F
Humidity should be maintained between 55-65% to avoid drying of the skin and
dehydration
Neonates can only maintain their body temperature within about 12° F of
ambient temperature
Monitor rectal temperature regularly
Peterson, M; Kutzler, M. Small Animal Pediatrics. 2011
Incubators
Safe
Effective
Easily Monitored
Must provide humidity levels of 55-65%
Incubators:
Heated ICU cages:
petiatric.com
snydermfg.com
(800) 490-0118
(800) 422-1932
Humidity
Humidity should be maintained at 55-65% for neonates
Neonates are 75-80% water
Permeable skin with high surface-to-body-mass ratio
More prone to dehydration than adults
Monitor humidity with a hygrometer
Hot Water Bottle
Wrap a hot water bottle in a baby blanket (even in incubator)
Provides warmth and comfort
Babies tend to seek it out and sleep on or next to it
Heating Pads
Always put UNDER half the tub, (never in with the animal)
Always set on low
Monitor the temperature with a digital thermometer
Remember neonates are neurologically immature and may lack the ability to
move off if the temperature gets too high
Do not buy the heating pads with Automatic Shutoff
Fluid Therapy in Neonates
Neonates have higher fluid requirements and increased losses (higher
metabolic rate, higher respiratory rate, inability to concentrate urine)
compared to adults
Normal methods for assessing hydration may be unreliable in neonates
Skin turgor (tenting) may not be accurate because neonates have higher
water content and less fat than adults.
Best place to assess hydration in the neonate is on the ventral abdomen
Dehydrated adults typically have tachycardia and concentrated urine.
Neonates have a rapid heart rate normally and lack the ability to concentrate
urine
Mucous membrane color and capillary refill time are generally good
indicators of dehydration . But, neonates can have hyperemic mucous
membranes for the first week
Neonates can have normal skin turgor even when mucous membrane color
and capillary refill time indicate shock
Macintire, Douglass. “Pediatric Fluid Therapy” Vet Clin Small Anim 38 (2008) 621-627
Fluid Therapy: Overview
Determine How Much Fluid to Give
Calculate Deficit- Assume a minimum of 5%
(Replace over 24 hours in mammals)
Determine Maintenance:
70-90 ml/kg/day (Mitchell)
50 ml/kg/day (IWRC)
Neonates require 2 to 3 times the fluid of adults
120-180 ml /kg /day or 1ml/25grams of body weight q 4-6h prn
Adjust for ongoing losses- diarrhea, vomiting
Clinical experience and research studies have shown that
that unless fluid deficit is replaced promptly, mortality is
very high. One study (Azech, S. et al. 2010) showed that
failure to replace deficit adequately within 8 hours led to
poor outcome.
Subcutaneous Injection (SQ)
Good for mild to moderate dehydration
Neonatal maintenance requirements are 2-3 times that of an adult
(120-180 ml/kg/day) or 1ml/25grams of body weight q 4-6h prn
Warm the fluids
Administer in the intrascapular space (between the shoulder blades)
Continue for at least 24 hours or until full maintenance
can be given orally
Lactated Ringers Solution (LRS)
(Isotonic crytalloid)
Don’t give dextrose SQ
Wide Safety Margin
Intravenous Injection (IV)
Necessary for animals in severe shock
Catheter is placed by our veterinarian
Can be difficult to place in small neonates
We use LRS with added Dextrose and Vitamin B Complex
Oral (PO)
Never administer anything orally to an animal in shock
Always warm the fluids to approximately 100° F
In dehydrated animals, administer SQ before giving oral fluids.
Administer no more than 5% of body weight at any one time.
*Never attempt to use a stomach tube without proper training
Oral Rehydration
Use LRS, Oral Rehydration Salts, Unflavored Pedialyte
We add L-Carnitine, Glutamine, and Zinc
Intraosseous Administration (IO)
Any fluid or drug that can be administered IV can be administered IO
Good when IV access is difficult or impossible
Fluid Therapy- Keep It Simple
Know the basics, but don’t get caught up in the numbers!
The deficit, ongoing losses, age adjustment are ESTIMATES!
The most important thing is to give fluids!
Reassess regularly. When in doubt-Continue!
It truly can make the
difference whether
or not your patient
survives!
Vitamin Supplements
Vitamin K1
Neonates have little K1 reserves (necessary for blood
clotting) until the gut begins to colonize at approximately 1
week of age
.1 mg once SQ or IM
We administer to all neonates with umbilical cords or with
estimated age <1 week
Glutamine
Conditionally essential amino acid during periods of stress
or injury
Preferential energy source for cells in the gut
Helps protect gut mucosal barrier minimizing intestinal
permeability
Plasma Glutamine levels have been shown to decrease by
58% after injury or critical illness and may remain decreased
for 3 weeks with increased mortality
Glutamine supplementation has been shown to decrease
incidence of sepsis, pneumonia, and bacteremia
Dose 10 mg/kg/day
Saker, K. Nutrition and Immune Function. Vet Clin Small Animal 2006;36: 1199-1224.
Zinc Supplementation
Recommended in treating acute diarrhea by the WHO
Affects immune function, intestinal structure, & epithelial recovery
Used in conjunction with oral rehydration
In numerous clinical trials, children had a significant faster recovery
We use the recommended dosage in dogs1.5-2.5 mg/kg zinc
gluconate PO TID (Plumb’s Veterinary Drug Handbook)
We mix zinc in oral electrolytes
Hypoglycemia
Extremely common in neonates
-high glucose demands (2-4 times that of adult)
-limited glycogen stores
-low fat reserves
-immature hepatic function
Symptoms include incoordination, muscle tremors, lethargy, depression,
seizures, coma, death (similar to other disease processes….hard to know)
Treatment is recommended for all sick neonates
1-2 ml/kg of 10% dextrose orally every 15 minutes until normal
Once stabilized, give L-carnitine 50 mg/kg PO BID. Increases the liver’s
ability to convert fat into glucose. L-carnitine can be used as a preventive in
all high risk neonates.
Fortney, William. Managing and Treating Sick Neonates. CVC in Kansas City Proceedings, 2008
Key Components of Nutrition
Quality of the formula
Volume offered
Frequency of feeding
Nutrition
Use quality milk replacer like Fox Valley
Stomach capacity is approximately 5% of body weight (50ml/kg)
Feed neonates every 4 hours, 6 x a day
(in babies less than 1 week of age, feed every 3 hours)
Don’t overfeed. Baby raccoons love to suckle.
Should gain weight daily. Weight is a key indicator to health.
Always make changes to formula gradually
Only mix formula that can be used in less than 24 hours
Don’t reheat formula
Formula: Fox Valley
Species Specific
Quality Ingredients
Great Customer Service
Case Example
Neonate had been in care with another
rehabber for several weeks
Fed correct formula
Not fed frequently enough
Notice lack of subcutaneous fat , loss of
muscle mass, poor hair quality, etc. on
intake photos (left)
The picture below is of the same raccoon
To Tube or Bottle Feed
Tube Feeding
-May be too weak to nurse (weak babies may aspirate)
-Easy to monitor small amounts-crucial with tiny neonates
-Faster. A consideration during peak times.
-Gives the baby time to adjust while insuring adequate hydration and
nutrition. Baby may not nurse initially because it is afraid, milk tastes
different, nothing is like mom. Becoming an orphan is traumatic!
-Baby may not take replacement fluids or diluted formula from a bottle
-Remember the baby has no control over the temperature, amount, etc.
Bottle Feeding
-More natural. Baby raccoons love to suckle.
-Tend to gain weight faster (to be safe, don’t exceed 5% BW when
tubing, but nursing babies tend to consume a little more)
-May pick up on illness earlier because change in nursing behavior is
often one of the first clinical signs that something is not right
Tube Feeding
Overview:
Measure from tip of nose to last rib
Mark with tape or marker
Use appropriate size tube- don’t go too small!
(esophagus is larger than trachea)
Make sure the baby is sternal, nose up
Lubricate the tube
Pass down the left side of the mouth
Gently glide, never force- should slide easily
Make sure there is no air in the tube
If you’re not sure, pull out and start over
Can use a small amount of sterile saline to make sure
placement is correct (nothing should come out nose)
Give 5% of bodyweight, start with less
Pinch tube before removal and remove quickly
to prevent aspiration
Remeasure tape regularly and adjust for growth
*Don’t try without proper training!
Tube Size Guidelines
Less than 350 grams: 8 Fr
350-500 grams: 10 Fr
Greater than 500 grams: 12 Fr
Fortney, W. Caring and feeding orphaned puppies and kittens. CVC in Baltimore Proceedings, 2008.
Bottle Feeding
Never attempt to feed unless the baby is warm and hydrated
Always feed with the baby in normal nursing position (sternal)
Use human baby bottles and nipples (hole is already made)
Warm formula to approximately 100°F (use warm water, not microwave)
Weigh the bottle and monitor amount. Do NOT overfeed.
Burp immediately after feeding to decrease discomfort from ingesting air
Label bottles and don’t mix between litters. Keep bottles and nipples
clean and disinfected.
Types of Bottles and Nipples
Use bottles made for human babies. We use Playtex VentAire (personal
preference only)
Use nipples made for human babies. Pre-made holes are consistent and reliable.
Available in different levels/stages- can adjust to size/growth.
Make sure the hole in the nipple is not too big-be conservative. Don’t want to
realize the hole is too big AFTER the baby has aspirated! Milk should not flow
out when held upside down- should form one drop.
We do NOT recommend using plastic pet bottles. Too much variability in
making the hole, and the bottles are too easy to squeeze. Lots of room for human
error.
Label the bottles to prevent cross contamination
We do NOT recommend using plastic pet bottles. Too
much variability in making the hole. Human nipples have
pre-made consistent and reliable holes. Safer!
Feeding Trance
Baby will lose suction and contact with the nipple
Mouth will gape open, but appears to still be sucking
Animal is fine. Remove the bottle and the baby will resume normal
behavior in a few moments. Simply rubbing the baby helps.
Do not attempt to continue feeding until the baby latches on again
Importance of a nipple that does not flow without suction
Similar to what is seen in squirrels
Oral Fluids and Formula
Must be warmed to approximately 100°F
Check with an instant read meat thermometer
Track how much the baby is eating!
Weigh the bottle: Before and After on a Gram Scale
Difference = Intake in Milliliters
(remember: cc=ml=gram)
Keep Good Records
Weigh the baby regularly
Example: 150-130=20
Amount consumed=20 ml
This is especially critical when
monitoring intake of neonates.
Introduction of Formula
Fluids only
25% formula + 75% water
50% formula + 50% water
75% formula + 25% water
full strength formula
Neonates have minimal energy reserves.
Once dehydration and hypothermia have
been addressed, it is important to start
providing nutrition as soon as possible.
Label and Disinfect Feeding Utensils
Weaning
Many different methods
Goal: Get the baby off formula (bottle) and on to solid food
Gradual (and messy) transition
Monitor weight and make sure all babies are eating
Weaning
Can begin at 8-12 weeks in raccoons
May nurse for up to 16 weeks in wild
Monitor weight and behavior of individuals…wean at different rates
Early weaning can be associated with malnutrition, stress-related
diseases, and behavior problems (slow learning, timidness, aggression)
Diet
Opportunistic Omnivores
Metabolic Bone Disease (MBD)
Normal
MBD
Neonates can NOT voluntarily urinate or defecate
Functions are initially controlled by anogenital
reflex
Need to stimulate
Neonates have more permeable skin, so use
products for sensitive skin (lacking fragrances,
extra chemicals)
Stimulate before feeding in neonates to
prevent regurgitation from excessive movement
Constipation
Warm water enema
MiraLAX
Karo Syrup-changes the
sugar & caloric composition
of formula
Diarrhea
Overfeeding
Introduction of formula too quickly
Change in formula or food
Medication
Stress
Poor hygiene or sanitation
Spoiled formula or food
Parasites
Disease- bacterial or viral
Bloat
Build up of gas in the GI tract
Hypothermia is a leading cause of
bloat in neonates
Pressure on the diaphragm causes
labored breathing
Severe bloating can lead to
circulatory collapse and death
Stimulate to defecate/urinate
Stop feeding
Give warmed SQ fluids (LRS)
Provide warmth
Simethecone (Infant Gas Drops)
Metoclopramide (Reglan)
Hypovolemic Shock
Decreased volume of circulating fluid (plasma) in the blood
Results in decreased perfusion and decreased oxygen delivery to tissues
In neonates, most commonly results from diarrhea, vomiting, or decreased intake
Neonates have inadequate or nonexistent compensatory mechanisms for
dealing with shock. Adults compensate by increasing heart rate, concentrating
urine, and decreasing urine output. (Appropriate concentration of urine is not
seen until approximately 10 weeks of age.)
Dehydration can rapidly progress to hypovolemic shock
Must treat with aggressive fluid therapy. Give initial bolus of 45 ml/kg of
warmed isotonic fluid (LRS). Follow with maintenance level of fluids and
compensate for any ongoing losses.
McMichael, M. Pediatric Emergencies. Vet Clin Small Anim 35 (2005) 421-434
Aspiration Pneumonia
A leading cause of mortality in rehabilitated animals
Usually caused by gram negative enteric aerobes such as E. coli, Klebsiella,
or Enterobacter
Must treat aggressively. Use antibiotics by parenteral routes.Don’t give oral
medications to critically ill neonates
Treat with a combination of a penicillin (ampicillin) and an aminoglycoside
(make sure the animal is well hydrated). Combination results in a synergistic
effect and provides excellent broad spectrum coverage in severe respiratory
infections.
Provide supportive care: fluid therapy, coupage, oxygen supplementation,
pain management, nebulization (with a bronchodilator), nutrition
King, L. Managing Puppies with Pneumonia. CVC Kansas City Proceedings. 2009
Common Causes of Aspiration Pneumonia
Forcing a weak neonate to eat
Squeezing the bottle
Too large hole in nipple
Improper placement of tube
Volume Overload
Aspiration Pneumonia
Clinical Signs of Respiratory Distress
Tachypnea (rapid, shallow respiration)-most common sign
Open-mouth breathing
Cyanotic mucous membranes (bluish discoloration)
Loud breathing
Restlessness, anxiety
Glazed look
Extended head and neck
Paradoxical respiration (abdominal wall and chest wall
move opposite one another during respiration.
Macintire, DK et al. Small Animal Emergency and Critical Care Medicine.2006
Oxygen Therapy
Supplemental oxygen should be provided for any
animal with signs of respiratory distress. When in doubt,
supplement!
FIO2 is fractional inspired oxygen concentration
(room air is approximately 20%; pure oxygen is 100%).
Use lowest FIO2 necessary to provide beneficial effect.
Inspired concentrations of 40-50% are generally
considered safe for oxygen cages and incubators. It’s
generally difficult to maintain FIO2 greater than 40-50%
in an oxygen cage anyway.
In most clinical situations, FIO 2 of 30-40% provides
adequate hemoglobin saturation and is considered safe.
Check with an oxygen analyzer
Use humidifier-relative humidity should be 40-50%
Heat can be a concern with Oxygen cages. Monitor.
Camps-Palau,M. et al. Small Animal Oxygen Therapy. Veterinary
therapeutics: research in applied veterinary medicine. 1999; 21(7).
Oxygen concentrator
Oxygen analyzer
Oxygen Therapy
Oxygen supplementation is easy to administer, readily available, and
relatively safe
In compromised animals, even a small increase in oxygen can be beneficial.
When in doubt, provide oxygen supplementation!
Improvement in clinical signs include decreased respiratory rate and effort,
decreased heart rate, improved mucous membrane color, and reduced anxiety
Indications include hypoxia, decreased oxygen delivery, and increased
oxygen demand from conditions such as: pneumonia, shock, anemia,
hyperthermia, fever, sepsis, seizures, hemorrhage, head trauma.
Bersenas A. Oxygen Therapy. 79th Western Veterinary Conference. 2007;V291.
Oxygen Therapy in Neonates
Neonates are more susceptible and vulnerable to oxygen toxicity
Excess oxygen can cause retrolental fibroplasia (blindness)
Keep oxygen supplementation below FIO 2 of 40% in neonates
Bersenas A. Oxygen Therapy. 79th Western Veterinary Conference. 2007;V291.
Septicemia
Bacterial infection that overcomes the neonate’s defense mechanisms
Common pathogens include: Staphyloccus, Steptococcus, E. Coli,
Klebsiella, Enterobacter, Clostridium, and Salmonella
Symptoms include excessive crying, restlessness, weakness, hypothermia, shock,
reduced feeding ability, prolonged capillary refill time, respiratory distress
Wild animals inherently mask disease so some neonates will simply die with no
apparent symptoms
Often presents with hypothermia, hypoxia, hypoglycemia, shock, dehydration
Neonates have different pharmacological considerations that must be
considered when calculating dosages.
Do not give oral medications to critically ill neonates
Fortney, William. Managing and Treating Sick Neonates. CVC in Kansas City Proceedings, 2008
Management of Septicemia
Antibiotics-early treatment is crucial
Supportive Care
-Fluid Therapy
- Glucose Replacement
-Warmth
-Oxygen Therapy
-Nutrition
Antibiotics take 12-24 hours to show any effect, so it’s supportive
care that can make the difference whether or not the animal survives
Antimicrobial Treatment of Septicemia
Requires aggressive antibiotic therapy
We use either penicillin or ampicllin + Naxcel in neonates
Third-generation cephalosporin such as Naxcel is a good choice because it has minimal
effects on the normal GI flora
Administer 2.5mg/kg SQ BID for 5 days (Peterson, Kutzler. Small Animal
Pediatrics. 2011)
Must also address hypothermia, hypoglycemia, and dehydration
Fading Syndrome
Neonates that slowly waste away and die
Appear healthy at birth, but fail to thrive, fail to gain weight, become thin
and weak for no apparent reason and eventually die
True fading syndrome is believed to be caused by neonatal septicemia
(Peterson, et al. Small Animal Pediatrics. 2011)
Treatment must be aggressive.: antimicrobial therapy, adequate warmth,
hydration and nutrition
Fluid Therapy in Septic Neonates
Aggressive fluid resuscitation is associated with decreased mortality in
children with sepsis and in several animal models of sepsis
Septic neonates often need large volumes of fluid due to increased
capillary permeability (increased losses) and vasodilation
Start with bolus of 45 ml/kg of warm isotonic fluids
Monitor perfusion: mucous membrane color (should be less pale),
pulse quality
(should get stronger), extremity temperature (should get
warmer), mentation (improved attitude) and urine output (should increase)
Peterson, Kutzler. Small Animal Pediatrics. 2011
Drug Considerations in Neonates
All use of medications in raccoons is considered off-label (extra-label)
Neonates have a reduced ability to metabolize drugs
Decreased renal and hepatic function , lower clearance times, and longer
half-lives. Time between dosing intervals may need to be increased
Increased percentage of water so neonates would need increased dosages
of water-soluble drugs
Decreased body fat so neonates would need decreased dosages of fatsoluble drugs
Nonsteroidal anti-inflammatory drugs (NSAIDS) and aminoglycosides
should not be given to neonates because of their immature renal function
Beta-lactams (penicillins and cephalosporins) are generally safe because
they affect cell walls and mammalian cells don’t have cell walls
Reasons to Implement Antimicrobial Protocol
Neonate with umbilical cord
Neonate with eyes closed that is or has been hypothermic since being
separated from its mother- high predisposition for sepsis
Finder attempted to feed or rehydrate in any way –high risk of aspiration
pneumonia
Any animal that shows signs of shock or appears severely compromised
Obvious injury
Any neonate brought in by cat or dog, regardless of obvious injuries
Adjust Medication and Dosing
Use Insulin syringes to accurately
measure small amounts. Use small gauge
needle.
Dilute medications in sterile diluent to
accommodate small amounts needed in
dosing neonates. Remember to label and
note mg/ml.
Example: Adjusting for Neonate Dosing
Mix Naxcel (Ceftiofur Sodium)
according to label directions by adding 20 ml
sterile diluent to bottle resulting in 50 mg/ml
Pull one ml out and inject into 1 ml bottle
of sterile diluent (like used for reconstituting
vaccines). Brings concentration to 25 mg/ml
Remember to label, note concentration
and date
Good for 7 days refrigerated
May freeze for up to 8 weeks
Ampicillin
Beta-lactam antibiotic with similar spectrum as amoxicillin
Increased activity against many strains of gram-negative aerobes not covered by
natural penicillins including some strains of E. coli and Klebsiella
Minimal toxicity associated with use
Safe in neonates
Ampicillin Sodium (for injection)
Stability is concentration dependent. Generally recommended use is within one hour of
reconstitution. But, concentrations of 30 mg/ml are stable for 48 hours if refrigerated.
Ampicillin trihydrate (Polyflex)
Manufacturer states that Polyflex is stable for 3 months after reconstitution if refrigerated.
Both Plumb’s Veterinary Drug Handbook (6 th Ed.) and Saunders Handbook of Veterinary
Drugs (3rd Ed.) state that it’s stable for up to 12 months after reconstituted if refrigerated.
Polyflex (Ampicillin trihydrate for injection)
Reconstitute by injecting104.5 ml sterile water into
25 gram bottle for 200 mg/ml concentration
Inject 1 ml of 200 mg/ml into 9 ml sterile diluent for a
concentration of 20 mg/ml (more appropriate dosing
concentration for neonates)
Stable for 12 months if refrigerated (Plumb)
Remember to label, note concentration and date
Pharmacokinetics of enrofloxacin in neonatal kittens
Seguin, M. et al, Am J Vet Res. 2004;65(3):350-356.
Used dose of 5mg/kg of enrofloxacin (Baytril)
Evaluated kittens ages 2-8 weeks
Half-life was shorter and elimination was greater in kittens than adults
In neonatal kittens, IV and SQ was an effective route of administration
Oral administration did NOT result in therapeutic drug concentrations
in kittens
Baytril (Enrofloxacin)
Safety and Toxicity Considerations
Cartilage Lesions in weight bearing bones of growing
animals (potential degeneration and arthritis)
-Affects dogs, not cats
-No adverse side effects with doses of 5-25
mg/kg for 10 days in puppies ages 1-4 weeks
-In puppies older than 6 weeks, lesions were
dose and duration of treatment dependent.
-Kittens dosed with 25 mg/kg for 30 days did
not develop cartilage lesions
Retinal Degeneration (blindness)
-Affects cats, but not dogs
-Dose dependent. Doses greater than 20 mg/mg
-Studies showed dose of 5 mg/kg was safe to use
in cats
Relevance to Raccoon Rehabilitators
-Use is extra-label
-Great antimicrobial that can be given once a day
-Kentucky Wildlife Center has used the 5 mg/kg
dose for up to 14 days on many raccoons with no
adverse side effects.
Maternally Derived Antibodies (MDA)
Only a small amount of antibodies come from the placenta (<5%)
Neonates must get adequate amounts of colostrum during the first 24
hours to acquire passive immunity
No feasible way to assess in orphan raccoons
If failure of passive transfer of MDA is suspected, serum from
hyperimmunized adult raccoons can be administered at a dose of 5ml/100
grams of body weight 3 times at 6-8 hour intervals (Peterson, Kutzler 2011)
Use of Plasma in Neonates
Use fresh-frozen plasma from hyperimmunized donors (permanent residents)
for suspected failure of passive transfer
Plasma is given to all neonates admitted with umbilical cords
Although many babies will have nursed, we have no feasible way to test the
quality of the mother’s colostrum, amount of colostrum ingested, or IGG levels
of intakes: critical factors in passive immunity
Provides high levels of antibodies to infectious diseases (canine distemper,
parvovirus, etc.) commonly seen with devastating consequences in the
rehabilitation setting.
(photo of plasma donor and recipient)
Plasma Use
We maintain a fresh-frozen plasma bank year round
May not be feasible in most settings. We work with an amazing veterinarian
Great for treating dehydration, shock, severe wounds, parvovirus, etc.
Plasma Collection
Plasma Administration
Subcutaneous (SQ)
Intraperitoneall (IP)
Intravenous (IV)
Use of Adult Cat Serum to Correct Failure of Passive Transfer in Kittens
Levy JK, Crawford PC, Collante WR, et al. J Am Vet Med Assoc 2001; 219(10):1401-5
IP and SQ administration of adult cat serum in three 5-ml increments at birth, 12h and
24h resulted in IGG levels equivalent to kittens that nursed normally
Ophthalmia Neonatorum (Neonatal Conjunctivitis)
Infection beneath the unopened eyelid resulting in swelling and purulent
discharge
Staphyloccoc sp. is the usual pathogen
Gently separate the eyelid by applying a warm compress along with
gentle traction using a blunt probe to pry the lid appart
Treat with antibiotic opthalmic ointment
Kampschmidt, K. Managing the Sick Neonate. CVC in San Diego Proceedings. 2008.
Staph Infection
Usually seen on the tail as scabby sore
Caused by Staphylococcus intemedius
Susceptible to
-Amikacin
-Amoxicillin/Clavulanic Acid (Clavamox)
-Cefovicin (Convenia)
-Clindamycin
-Enrofloxacin (Baytril)
-Gentamicin
-Sulphamethoxazole/Trimethoprim
Staph Infection
Convenia is labeled for the treatment of skin infections
(abscessses and wounds) caused by susceptible strains
of Staphylococcus intermedius
Therapeutic drug concentrations are maintained for 7
days for S. intermedius. A second dose can be given 7
days after the initial dose if symptoms aren’t resolved.
Maximum treatment should not exceed 2 injections
Give SQ at dose of 3.6 mg/lb (8 mg/kg)
Pfizer Animal Health . January 2008
Stress Management
Mental Wellness
Make sure all physical needs are met (access to fresh water, good nutrition,
clean environment, freedom from injury and disease)
Social companionship. Conspecifics are critical to emotional well-being
Environmental enrichment and mental stimulation
Control and Predictability of surroundings
Reduce fear: loud noises, predators, domestic animals, etc.
Limit caregivers. Don’t allow strangers to handle animals.
Quality of Life : The Five Freedoms
Freedom from hunger and thirst by ready access to fresh water and
a diet to maintain full health and vigor
Freedom from discomfort by providing an appropriate environment,
including shelter and a comfortable resting area
Freedom from pain, injury, or disease by prevention or rapid
diagnosis and treatment
Freedom to express normal behavior by providing sufficient space,
proper facilities, and the company of the animal’s own kind
Freedom from fear and distress by ensuring conditions and
treatment to avoid mental suffering
Miller, L.; Hurley, K. Infectious Disease Management in Animal Shelters. Wiley-Blackwell;2009.
Managing Stress
Being an orphan is traumatic
Being a wild animal in captivity is stressful
Conspecifics and environmental enrichment are crucial
Provide access to nest boxes, safe hiding places and choice
Provide age appropriate caging to allow for adequate activity
Prevent overcrowding
Socialization
Critical for development
Should always be with conspecifics . Network!
Learn skills necessary to survive in wild
Social Companionship
Socialization is critical for animals to form social attachments to their own species
and create primary social bonds (Occurs 3-12 weeks of age in puppies and 2-7
weeks of age in kittens).
Interactions such as grooming, play and physical contact result in social bonding
McMillan, F. Development of a mental wellness program for animals. JAVMA. 2002;220(7):965-972.
Enrichment
Raccoons must have nest boxes
to sleep and hide in to reduce
stress. Simulates den sites. We
make these nestboxes without
bottoms so you can lift them up,
clean and replace bedding, etc.
Cheap to make.
Age Appropriate Housing
External Parasites
Most flea and tick products are not safe in neonates
Some Pyrehrins-read label instructions
Capstar can be used safely in neonates
(Macintire, et al, Small Animal Emergency and Critical Care Medicine, 2006)
Internal Parasites
Baylisascaris procyonis is always a concern in raccoon rehab because of zoonosis.
Infections from transplacental or transmammary transmission may occur in neonates.
Patent infections can occur by 3 weeks of age.
Use pyrantel pamoate (5-10mg/kg PO), repeat every 2-3 weeks. Pyrantel is
generally considered very safe in neonates but prophylactic use generally begins at 3
weeks of age
Treat Giardia with metronidazole (60 mg/kg PO q24h for 5 days). Metronidazole
should be avoided in very young neonates because of the potential for neurologic side
effects (more permeable blood-brain barrier in neonates)
Coccidia can be treated with ponazuril (Marquis) 50mg/kg or sulfadimethoxine
(Albon) 50 mg/kg on the first day and 25 mg/kg for 10 days
Baylisascaris procyonis
Raccoon Roundworm
Nematode parasite commonly found in the small intestine of raccoons
Prevalence rates can be as high as 85%, but can vary by region
Generally asymptomatic in healthy individuals but can make concurrent
diseases (such as parvo) worse. Heavy infestations may cause clinical
signs in young animals
Infected animals can shed extremely large amounts of ova. The ova are
very hard and may remain infective in the environment for many years
Zoonotic.There have been less than 20 cases of neural larval migrans
reported in the U.S. All were males and were either children or mentally
challenged individuals.
Regularly deworm all raccoons in care
Use common sense
Ramsay, E. Zoonoses of Procyonids and Nondomestic Felids.Vet Clin Exot Anim 2011;14:551-556.
Ponazuril for the Treatment of Coccidia
Dose: 50 mg/kg PO once daily for 1-5
(may repeat in 1 week)
50 mg/ml solution= 10 ml paste + 20 ml water
Dose and concentration are both 50, so
the calculations are easy!
It has been used extensively in shelters
Source: Maddie’s Shelter Medicine Program
Cornell University College of Veterinary Medicine
Ponazuril for the Treatment of Coccidia
Roadrunner Pharmacy (877) 518-4589
Ponazuril Flavored Suspension
(raccoons really like vanilla butternut flavoring )
One day treatment 227 mg/ml (dose .1 ml/lb)
Two day treatment 90 mg/ml (dose .1ml/lb)
Shelter Medicine
Animal shelters are similar to wildlife centers
High-density, high-risk population
High likelihood of exposure with possibility of devastating
consequences
We start vaccination protocol at 4 weeks of age
Revaccinate every 2 weeks
Decision is unique to each rehabber
-number of animals admitted
-current outbreaks in your area
Vaccine Protocol Considerations
Morbidity and Mortality of disease
Prevalence rate of the disease
Risk of individuals for exposure
Efficacy of the vaccine
Risks associated with vaccine
Cost
Vaccine Protocol
Essential to preventive care
Goal: Vaccinate PRIOR to exposure.
Vaccinate immediately upon intake if old enough
The risk of adverse does not outweigh the benefit
We start vaccination protocol at 4 weeks of age and
continue until 16-20 weeks of age
Revaccinate every 2-3 weeks based on risk
Decision is unique to each rehabber
-number of animals admitted
-current outbreaks in your area
Vaccine Protocol for Raccoon Rehabilitators
Vaccine selected should be based on similarity of the hosts (FPV vaccine for RPV and
CPV vaccine for mutated strains of CPV in raccoons, CDV)
Use of these vaccines in wildlife is off-label
Long history of use in wildlife with low risk of complications
The few studies of parvovirus vaccination in wild animals suggest that the response is
comparable to that in domestic animals
Vaccination protocol should be based on the principles applied to the vaccination of
domestic carnivores
Rabies, Canine Distemper and Parvovirus are the most important infectious diseases in
raccoons and should be included in all vaccination protocols
Barker I, Parrish C. Infectious Diseases of Wild Mammals: Parvovirus Infections. Blackwell Publishing;2001: 131-146
Vaccine Protocol Rationale
Prevention is definitely more time and cost efficient than treatment
Wildlife rehabilitators have a responsibility to protect their intakes and the wild
population from disease. Good vaccination protocol is the best insurance policy.
Kind to the animals. Animals in rehab are exposed to lots of potential diseases that
they may not have been exposed to in the wild and are more susceptible due to
stressful conditions
Good vaccination protocols reduce disease and improve animal health. Healthy
animals are able to be released sooner, with less potential to spread disease to the
wild population once released.
Kind to caregivers. Witnessing mass mortality that often accompanies an outbreak is
disheartening and leads to burnout.
“An ounce of prevention is
worth a pound of cure”
Henry de Bracton
Vaccine Types: Inactivated (Killed) vs. Modified Live
Inactivated (Killed) vaccines are less effective and take longer to
induce an immune response than MLV
Current research shows that Duration of Immunity (DOI) after
vaccination with MLV is 9 years or longer based on challenge and
serological studies (CDV and CPV)
MLV core vaccines are much less likely to cause adverse reactions than
(inactivated) killed vaccines
MLV vaccines are more effective against waning maternal antibodies
Source: Journal of Small Animal Practice © 2010 WSAVA
Vaccine Failure
Maternal Antibody Interference
-depends on titer of colostral antibody and the amount of antibody
absorbed after birth
-most common reason for vaccine failure
-reason boosters are needed with last dose >16 weeks in raccoons
Vaccine is Poorly Immunogenic
-manufacture (type of strain, passage history, production errors)
-administration of vaccine to animal
-incorrect storage, transportation, handling
Animal is a Poor Responder to the Vaccine
-animal fails to develop an antibody response
Vaccination of Sick & Injured Animals
EVERY animal over 4 weeks of age should be vaccinated on intake, regardless
of health status
Vaccines aren’t likely to be harmful, and the risk of exposure to deadly viruses is
high in rehab facilities
It’s possible (but unlikely) that a sick animal may not elicit an immune response.
But, it’s highly unlikely that the vaccine will adversely affect the animal . More
importantly, there is a good chance the animal will gain protection.
Source: Miller, L., Hurley, K. Infectious Disease Management in Animal Shelters. Wiley-Blackwell; 2009
Immunity Onset
MLV vaccines provide rapid immunity in the absence of maternally derived
antibodies (MDA)
With MLV and recombinant vaccines for canine distemper , immunity develops
within hours after vaccination (in the absence of MDA)
98%-99% of dogs vaccinated with MLV CPV-2 vaccine were protected when
challenged 3 days post-vaccination (in the absence of MDA)
Cats showed immunity to FPV when exposed almost immediately after MLV
vaccination
Source: Miller, L., Hurley, K. Infectious Disease Management in Animal Shelters. Wiley-Blackwell; 2009
Vaccines used by Kentucky Wildlife Center
Chosen for safety and efficacy
Protocol developed with our veterinarian of record
Combination is needed to protect against the most common
infectious diseases seen in raccoons (canine distemper, the
multiple variants of parvovirus, and rabies)
These are not the only vaccines. If you are using something
that works.....continue.
Merial Recombitek C3 or C4/CV
Combo vaccine that protects against Canine Parvovirus and
canine distemper
Canine distemper portion is canarypox vectored recombinant
Canine parvovirus portion is Modified live high titer, low passage
Recombitek C3 lacks Coronavirus but is cheaper
Very Safe
It can be used in young animals and in wildlife
Merial PureVax Feline 4
Modified live virus vaccine
Combo vaccine provides protections against Feline Panleukopenia
We Do Not Use Distox-Plus (Killed Vaccine for MEV)
MEV is closely related to FPV and RPV
We use MLV vaccine for FPV and CPV
Evidence of cross-species protection
MLV are more effective against waning maternal antibodies
Inactivated vaccines may interfere with antibody response of MLV vaccines
Summary of two studies that influenced our decision to eliminate
MEV vaccine from our Vaccine Protocol for Raccoons
(1) Full protection in mink against mink enteritis virus with new generation canine
parvovirus vaccines based on synthetic peptide or recombinant protein (Langeveld, et
al. 1995)
Two recently developed vaccines-one based on synthetic peptide and one based
on recombinant capsid protein- fully protected dogs against heavy challenge
Antigenic similarity between CPV, MEV, FPLV, and RPV suggests that the new
vaccines could protect mink, cats, and raccoons against their respective host range
variants
Both CPV vaccines were fully protective in mink against MEV
Conversely
(2) The Failure of an Inactivated Mink Enteritis Virus Vaccine in Four preparations to
Provide Protection to Dogs Against Challenge with Canine Parvovirus2 (Carman, et
al.1982)
The inactivated MEV vaccines failed to provide protection in dogs against CPV-2
challenge
Humoral Response and Protection from Experimental Challenge Following Vaccination
of Raccoon Pups with a Modified-Live Canine Distemper Virus Vaccine
Pare, et al. Journal of Wildlife Diseases 1999;35(3):430-439
Used Galaxy-D in the study (Modified Live Vaccine for Canine Distemper)
No local or systematic adverse reactions in any of the raccoons
Study used 47 wild caught baby raccoons divided into 6 groups. Of the 47
pups, 31 were seronegative & 16 were seropositive
Some of the seronegative raccoons developed titers as early as 1 week PV and
all vaccinated seronegative raccoons showed rises in titers between 2-4 weeks
PV and remained high throughout the follow-up period
Study suggests that after 5 months of age, a raccoon could benefit from a
single dose of vaccine (if booster is unfeasible). Immunity from MLV Canine
Distemper vaccine is long-lasting in the absence of maternal antibodies.
Maternal Antibodies
All of the seropositive raccoon pups were from wild unvaccinated mothers
Maternal antibodies in all seropositive raccoons declined gradually to negligible
levels by the time they had reached 20 weeks of a age
Study showed that maternal antibodies will nullify or interfere with active
immunization in raccoon pups until they reach 14-16 weeks of age
Vaccination failed to elicit a response before the 3 rd vaccination (16 weeks of age)
in 7 of the 8 raccoons with maternal antibodies
The immune status of raccoon pups is rarely, if ever, known
Vaccination protocol should extend to 16-18 weeks of age
Pare, et al. Humoral Response and Protection from Experimental Challenge Following Vaccination of Raccoon
Pups with a Modified-Live Canine Distemper Virus Vaccine . Journal of Wildlife Diseases 1999;35(3):430-439.
Challenge Study
20 raccoons were randomly selected for the challenge study
All 16 vaccinated raccoons survived the challenge with no clinical signs of
disease
3 0f 4 unvaccinated, seronegative raccoons developed clinical signs significant
enough to warrant euthanasia. The 4th raccoon had sub-clinical lesions on
necropsy suggesting that it is likely that it would have developed neurological
symptoms later.
Pare, et al. Humoral Response and Protection from Experimental Challenge Following Vaccination of Raccoon Pups with
a Modified-Live Canine Distemper Virus Vaccine . Journal of Wildlife Diseases 1999;35(3):430-439.
Canarypox Recombinant Vaccine for Canine Distemper
(rCDV)
Only uses a small portion of the genetic material of the pathogen, so
it’s impossible for the distemper virus to revert to virulence or be shed
by the vaccinated animal
Stimulates immunity without undergoing replication in mammals
Safe and effective for use in wildlife
The American Association of Zoo Veterinarians’ Distemper
Vaccine subcommittee recommends the use of canarypox-vectored
recombinant distemper vaccine (Merial) for extra-label use in exotic
carnivore species that are susceptible to canine distemper .
Serologic response to a canarypox-vectored canine distemper
virus vaccine in the giant panda (Ailuropoa melanoleuca).
Bronson, et al. Journal of Zoo and Wildlife Medicine. 2007;38(2):363-6.
Pandas at the Smithsonian National Zoo
Vaccine proved to be safe
Serum-neutralizing antibody titers interpreted as protective
Canine Distemper Vaccination is a Safe and Useful
Preventive Procedure for Southern Sea Otters
Jessup, et al. Journal of Zoo and Wildlife Medicine. 2009;40(4):705-710.
Southern Sea Otters at Marine Wildlife Veterinary Care
and Research Center and Monterey Bay Aquarium
Vaccine proved to be safe. No behavioral changes, clinical
signs of pain, anaphylaxis or side effects
Postvaccination antibody titers were considered protective
against CDV
River Otter rescued by KWC
Immunization of Puppies in the Presence of Maternally Dervived Antibodies
Against Canine Distemper Virus
Pardo, M. et al., J. Comp. Path. 2007, 137;72-5.
Study on 7-9 week old puppies with CDV serum-neutralizing antibody titers
Seroconversion was demonstrated in all vaccinated puppies
All unvaccinated (control) puppies showed signs of CDV 7-8 days post
challenge
All vaccinated puppies remained healthy when challenged with a highly virulent
strain of CDV
Vaccine immunized and protected puppies with maternally derived antibodies
Efficacy of Vaccination at 4 and 6 Weeks in the Control of Canine Parvovirus
De Cramer, K. et al., Veterinary Microbiology.2011;149:126-132
Monitored efficacy of high-titer CPV-2 vaccine (Merial) in puppies with high
levels of MDA
80% of puppies vaccinated at 4 weeks of age seroconverted even in the presence
of high levels of MDA
Early vaccination may shorten the window of susceptibility and protect young
animals in high-risk settings
Effect of vaccination with recombinant canine distemper virus vaccine
immediately before exposure under shelter-like conditions.
Larson, L. Schultz R. Vet Ther. 2006;7(2) 113-8
Puppies challenged 1 week after a single dose showed no clinical signs
Puppies challenged 15 minutes to 4 hours after vaccination showed mild to
moderate clinical signs that included diarrhea, lethargy, and anorexia, but all
recovered. None developed neurologic symptoms.
Puppies placed in a CDV-contaminated environment and allowed to comingle
with CDV infected dogs hours after vaccination did not become sick
All puppies were challenged using virulent CDV strain . All control group
(unvaccinated) puppies died
Provides protection against CDV in high-risk environments
Canine Distemper (CDV)
Incubation is typically 9-14 days, but may be as long as 6 weeks
Symptoms include fever, anorexia, depression, nasal and ocular discharge
diarrhea, ataxia, lack of fear, seizures. May not have all symptoms.
Animal often recovers from respiratory symptoms only to develop
neurological symptoms 2-3 weeks later
Consider differentials
Best to euthanize- incurable and highly contagious
Viral shedding can begin before clinical signs present and may continue for
up to six weeks postinfection
VACCINATE all animals in your care immediately on intake!
Vaccination is the most important method to prevent canine distemper.
Prevalence of Canine Distemper Antibodies in Wild Raccoons
23%
Mitchell, et al. Serologic Survey For Selected Infectious Disease Agents in
Raccoons From Illinois. Journal of Wildlife Diseases:. 1999;35: 347-355.
54%
Junge, et al.A Serologic Assessment of Exposure to Viral Pathogens and
Leptospira in an Urban Raccoon (Procyon Lotor) Population Inhabiting a Large
Zoological Park. Journal of Zoo and Wildlife Medicine. 2007;38(1):18-26.
33%
Bischof et al. Serologic Survey of Select Infectious Diseases in Coyotes and
Raccoons in Nebraska. Journal of Wildlife Diseases. 2005;41(4):787-791.
16%
Raizman et al. Serologic Survey for Selected Infectious Diseases in Raccoon
(Procyon lotor) in Indiana, USA. Journal of Wildlife Diseases. 2009;45(2):531-536.
Symptoms of Canine Distemper
Loss of appetite
Depression
Fever
Ocular and nasal discharge. Conjunctivitis
Diarrhea
Emaciation/Wasting
Lack of fear of humans or other animals
Convulsions-involuntary twitching, jerking, salivation
Seizures
Ataxia
Circling, head tilt
Paralysis
*May not have all of the symptoms, and the symptoms may
not present concurrently!
Parvovirus Overview
Smaller than most viruses: name comes from the Latin parvus (small)
Consists of a protein coat (capsid) and a single strand of DNA
Virus capsids are the primary determinants of host range
Not enveloped in fat like most viruses
Extremely stable in the environment
Resistant to most disinfectants
Attack rapidly dividing cells: intestine, bone marrow, lymph nodes
Highly contagious
Pathophysiololgy of Parvovirus
Transmitted by oral exposure to feces of infected animals
Attacks rapidly dividing cells beginning with the lymph nodes in the throat
Followed by rapid viremia leading to systemic infection
Virus attacks bone marrow causing a decrease in white blood cell count
leading to a compromised immune system
Primary site of viral replication is within the intestinal crypts resulting in
enteritis and diarrhea
The intestinal barrier is compromised resulting in translocation of bacteria
into the bloodstream leading to septicemia
Animals die of dehydration, septicemia, or endotoxemia
History of Parvovirus
Feline Panleukopenia Virus (FPLV) is also known as Feline Parvovirus (FPV) or
Feline Distemper
FPV and Raccoon Parvovirus (RPV) isolates are indistinguishable. Mink Enteritis
Virus (MEV) is a minor variant
Canine parvovirus (CPV) probably derived by mutation from FPV or a closely
related virus and first emerged in 1978 in dogs in Europe and quickly spread around the
world
Since 1978, CPV has gone through antigenic variations resulting in variant viruses
and demonstrating the virus’s ability to rapidly evolve
These variations have not influenced the efficacy of vaccination
Raccoons were not susceptible to the original strains of CPV
Barker I, Parrish C. Infectious Diseases of Wild Mammals: Parvovirus Infections. Blackwell Publishing;2001: 131-146
Host Range Similarities
Clinical presentation is almost identical in affected hosts
Gross and microscopic lesions in all species are similar
This is important to raccoon rehabilitators because we can
extrapolate a lot of information from research of other animals
Barker I, Parrish C. Infectious Diseases of Wild Mammals: Parvovirus Infections. Blackwell Publishing;2001: 131-146
Survival
Depends on how quickly it’s diagnosed, virulence of the strain, size of
virus exposure, age, health & immune status of the animal, and how
aggressive the treatment protocol is
The goal is to keep the patient alive long enough for the immune system
to recover and respond- antibodies are produced everyday that can bind
and inactivate the virus
Accomplished through supportive and symptomatic care: fluid therapy,
antibiotics, antiemetics, etc.
Survivors have life-long immunity
Differential Causes of Diarrhea
Overfeeding
Introduction of formula or food too quickly
Change in formula or food
Medication
Stress
Poor hygiene or sanitation
Spoiled formula or food
Parasites
Disease- bacterial or viral
Toxins
Symptoms of Parvoviral Enteritis
Diarrhea
Vomiting
Dehydration
Fever
Depression
Anorexia
Rapid weight loss
Shock
Hypoglycemia
Acute death
Clinical Significance
Animals may be found moribund (in dying state) or dead without
noticeable symptoms
Symptoms generally develop 4-5 days post-exposure
Animals that resume eating within 3-4 days are likely to survive
Most animals that are going to die succumb within 4-5 days
Juveniles have higher mortality rates than adults
Barker I, Parrish C. Infectious Diseases of Wild Mammals: Parvovirus Infections. Blackwell Publishing;2001: 131-146
Treatment Protocol:
Aggressive Supportive Care
Medications and Protocols administered are used under the advisement of our
veterinarian of record . Consult your veterinarian before using any medication.
Treatment of Parvoviral Enteritis
Standard (Essential) Care
-Fluid Therapy
-Antibiotic Therapy
-Management of Symptoms
-Antiemetics Pain Medication, Gastroprotectants
-Antiparasitic Therapy
Adjunctive Therapies
-Supplements (Vitamins, Probiotics)
-Tamiflu (oseltamivir)
-Early Enteral Nutrition (EEN)
-Plasma Transfer
Antibiotics
Necessary to prevent secondary infections
Do not use oral antibiotics because the GI tract is damaged
Use a combination of 2 antibiotics to provide broad spectrum coverage against
gram negative, gram positive and anaerobic bacteria that originate in the intestines
(1) Beta Lactam antibiotic: ampicillin , cefazolin , penicillin
and
(2) Aminoglycoside: gentamicin , amikacin
or Flouroquinolone: Enrofloxacin
Source: Treatment of Parvoviral Enteritis. Douglass K. Macintire, DVM, Auburn University College of Veterinary Medicine
Antibiotics Commonly Used in Parvoviral Treatment Protocol
Best to combine a Beta Lactam with either Aminoglycoside or Flouroquinolone
Beta Lactam Antibiotics
Penicillins: broad spectrum activity against Gram-positive, Gram-negative, and
anaerobic bacteria.
Cephalosporins: Classified by generation. Spectrum of activity against Gramnegative bacteria increases with each generation, but decreases for Gram-positive
bacteria. All can be used against anaerobes with varying results.
and
Aminoglycosides
Synergistic activity when used with Beta Lactam Antibiotics
Excellent against Gram-negative bacteria
Use is contraindicated in dehydrated animals- can be nephrotoxic (make sure the
animal is well hydrated)
or
Flouroquinolones
Enrofloxacin (Baytril): May cause cartilage abnormalities if used in high doses for
extended periods in young animals. Doses higher than 5 mg/kg can cause blindness in
cats. No research on safety margin in raccoons. We have used 5 mg/kg in raccoons
for short periods with no observed side effects.
Broad spectrum against Gram-positive and Gram-negative, but poor activity
against anaerobic bacteria
Antiemetic (Anti-nausea) Medications
Cerenia (Maropitant)
Reglan (Metoclopramide)
It may be helpful to administer antiemetic drugs (Reglan ) 3o minutes
before giving any oral medication (such as Tamiflu) if vomiting is
present.
Pain Management
NSAIDs: Meloxicam (Metacam), Ketoprofen (Ketofen)
-mild to moderate pain
-make sure the animal is well hydrated
Opiods: Butorphanol (Torbogesic), Buprenorphine
-moderate to acute pain
-controlled substances
Develop protocols with your veterinarian
Wild animals are adapted to mask pain and discomfort
Parvoviral enteritis can be very painful
Meloxicam (Metacam)
New Manufacturer Warning: Repeated use of meloxicam in cats has been
associated with acute renal failure and death
Not sure of the pharmacological significance in the use of raccoons
All NSAIDS should be used with caution in dehydrated animals
Consider alternatives in raccoons with parvo
Gastroprotectants
Parvo can cause ulceration of the esophagus,
stomach, and small intestine
Famotidine has longer duration of action and fewer drug
interactions than other gastroprotectants such as Cimetidine
Antiparasitic Therapy
Parasites can increase the severity of parvovirus
Raccoons should be dewormed on intake and at regular intervals anyway due
to the zoonotic potential of Baylisascaris procyonis
Fecal examination is indicated to rule out or identify parasites
Ponazuril to prevent opportunistic parasitic infections
Probiotics
Vitamin Supplements
Glutamine
Conditionally essential amino acid during periods of stress
or injury
Preferential energy source for cells in the gut
Helps protect gut mucosal barrier minimizing intestinal
permeability
Plasma Glutamine levels have been shown to decrease by
58% after injury or critical illness and may remain decreased
for 3 weeks with increased mortality
Glutamine supplementation has been shown to decrease
incidence of sepsis, pneumonia, and bacteremia
Dose 10 mg/kg/day
Saker, K. Nutrition and Immune Function. Vet Clin Small Animal 2006;36: 1199-1224.
Zinc Supplementation
Recommended in treating acute diarrhea by the WHO
Affects immune function, intestinal structure, & epithelial recovery
Used in conjunction with oral rehydration
In numerous clinical trials, children had a significant faster recovery
We use the recommended dosage in dogs1.5-2.5 mg/kg zinc gluconate
PO TID (Plumb’s Veterinary Drug Handbook)
We mix zinc in Lixotinic or in oral electrolytes
Use is anecdotal in treating parvoviral enteritis
Tamiflu (Oseltamivir)
Human drug used off-label to treat parvoviral enteritis
Use is controversial
Decision must be made with your veterinarian
Information provided is for reference purposes only and does not
constitute a recommendation for or against its use
Pharmacology of Tamiflu in the Treatment of Parvovirus
Originally developed to treat human influenza virus
Tamiflu is a neuraminidase (NA) inhibitor
CPV does not rely on NA for replication, so any beneficial effects would
not be due to direct antiviral action
Suspected beneficial mechanism of action in treating parvoviral enteritis is
the inhibition of bacterial translocation through the gut epithelial cells
Savigny MR, Macintire DK. Use of oseltamivir in the treatment of canine parvoviral enteritis.
Journal of Veterinary Emergency and Critical Care. 2010;20(1):132-142. )
Use of oseltamivir in the treatment of canine parvoviral enteritis
Savigny MR, Macintire DK. Journal of Veterinary Emergency and Critical Care. 2010;20(1):132-142.
Dose: 2 mg/kg, PO, q 12h diluted in water 1:1
Dogs that received oseltamivir had increased weight gain compared to dogs in the
control group which showed significant weight loss
Dogs that received oseltamivir did not demonstrate a decline in WBC. Dogs in
the control group showed a significant decline in WBC. A higher WBC could be
protective against the negative effects of sepsis
Suspected mechanism of action is by blocking bacterial translocation through
NA inhibition decreasing disease severity both locally in the gastrointestinal tract
and systemically
No major adverse side effects associated with the use of oseltamivir
Recommends further investigation
Directions for Use
Take (1) 75 mg capsule of Tamiflu and mix into 10 ml of juice, etc.
Keep refrigerated. Shake Well
Give .1 ml/lb every 12 hours for 10 treatments.
(If you don’t get a response after the first dose, double the starting dose)
Minimum dose should be .2 ml (even in small individuals)
Do NOT exceed 12 hours between dosing. If you do, restart for another
10 treatments
Dr. Jack Broadhurst. A New Treatment For Parvoenteritis
Early Enteral Nutrition (EEN)
Improved recovery time and decreased morbidity
Early reintroduction of food does not seem to make symptoms worse even in
severely affected animals
Must weigh the risks and benefits in the presence of vomiting
Anitemetics (such as Metoclopramide) may be beneficial if administered 30
minutes prior to feeding
Feed small amounts, several times a day
Nutrition is necessary for recovery
Effect of Early Enteral Nutrition on Intestinal Permeability, Intestinal Protein
Loss, and Outcome in Dogs with Severe Parvoviral Enteritis.
Mohr AJ, et al.Journal of Veterinary Internal Medicine. 2003;17(6):791-798.
Conventional treatment of parvoviral enteritis recommends “gut-rest”. Lack of
controlled clinical studies to support this
The most important stimulus for intestinal mucosal growth, repair, and integrity is the
presence of nutrients in the intestine
Documented benefits of EEN include:
-reduced intestinal mucosal permeability
-increased weight
-reduced incidence of bacteremia, endotoxemia, and septicemia
-reduced incidence of multiple organ failure
-improved immune status
-improved clinical symptoms: appetite, attitude, resolution of vomiting & diarrhea
-reduced catabolism and malnutrition preventing additional intestinal
inflammation
-significantly higher survival rates
Transmission
Sick animals can pass billions of infective virus per gram of feces
Transmission is by the fecal-oral route
High potential for contamination of environment
Easily spread by fomites (inanimate objects) such as clothes, shoes, feeding
utensils, litter, bedding, etc.
Possibility of transmission by insects
Prevention and Control
Practice of shelter medicine protocol in rehabilitation facilities
Vaccination to reduce the number of susceptible animals
Quarantine
-long enough to encompass the incubation period
-long enough for development of antibodies post vaccination
Minimize environmental contamination
Prevention and Disease Outbreak Management
Isolate sick animals
Quarantine exposed animals for at least 2 weeks
Clean and disinfect the entire facility
Wear protective clothing
Launder clothing, bedding, towels, etc. in hot water with detergent and
bleach and dry on high heat. Don’t overload!
Make sure each room has it’s own cleaning tools
Proper Management to Reduce Risk of an Outbreak
Quarantine new intakes
Vaccinate on intake if old enough
Reduce Stress- provide nest boxes for hiding and sleeping, provide enrichment,
reduce noise, reduce exposure to strangers and domestic animals
Segregate by conspecifics: by litter or age group
Feed the best diet possible
Keep cages and enclosures clean
Deworm regularly
Make sure you use a parvocidal disinfectant and make sure the surface is
clean (remove organic matter). The disinfectant should remain in contact
for 10 minutes.
Kennel Kare Parvocidal Disinfectant
Health Technology
htproducts.net
(800) 424-7536
Mycoplasma
First described by Dr. Ian Barker veterinary pathologist and virologist
at University of Guelph in the 1980s
Mycoplasmas are the smallest free-living microorganisms.
Contagious. Requires close contact. Does not survive long outside the
host.
Bacteria is very fragile. Hard to culture. Diagnosis is often based on
clinical signs.
Clinical symptoms include painful swelling of the joints, reluctance to
move, abscesses of toes, hands, feet, carpal joints (pus does not have a
distinct odor)
Has an affinity for the ephiphyses (growth plates of long bones, highly
vascular). Concern over long-term damage.
Susceptible to Baytril (enrofloxacin), tetracycline, doxycycline, tylosin,
erythromycin, azithromycin
Requires long-term treatment., minimum of four weeks, possibly longer
KWC Treatment Protocol: Mycoplasma
Azithromycin suspension 10 mg/kg POSID for a minimum of four weeks. Severe
clinical cases are treated for 8 weeks
Azithromycin has less adverse effects than erythromycin, more palatable than
doxycycline (studies show azithromycin may be more effective than doxycycline in
other species)
Followed by probiotic daily 8-12 hours after antibiotic
Any macrolide has potential for GI side effects. However, it was well tolerated with
no adverse side effects in up to 8 weeks of treatment
Clinical and exposed animals are quarantined for minimum of 8 weeks
All animals in our outbreak recovered with no recurrence and deemed releasable
Mycoplasma
Mycoplasma
Mycoplasma
Klebsiella pneumoniae
Anaerobic gram-negative bacterium
Opportunistic pathogen. Common in intestine but rarely causes disease.
Can cause septicemia and death in immunocompromised animals
In the absence of infectious disease (good vaccination protocol), common
cause of mortality in weaned, pre-release animals
Symptoms include lethargy, depression, anorexia, abscesses, fever. Some
animals are found moribund (in dying state) or dead.
We treat with Baytril (enrofloxacin) 5 mg/kg IM, SQ SID
Also susceptible to Amikacin, Cefovecin, Gentamicin,
Trimethoprim/Sulfamethoxazole
Cryptosporidium
Coccidian parasites that are common in the small intestine
Opportunistic pathogens, but can cause disease in young or
immunocompromised animals
Zoonotic
Symptoms include diarrhea, anorexia, weight loss
Usually self-limiting and will resolve
More than 100 compounds have been tested for treatment but none have
been able to consistently control clinical signs or completely eliminate infection
Treatment is supportive: Fluid therapy, antimicrobial therapy (to prevent
secondary infection), glutamine
Anecdotal evidence suggests that azithromycin 10 mg/kg PO SID for a
minimum of 10 days may be an effective treatment in some cases
Scorza, V. Update on the Diagnosis and Management of Cryptosporidium spp Infections in Dogs and Cats. 2010
Prevalence of Cryptosporidia
Indirect immunofluorescent detection of oocysts of Cryptosporidium parvum
in the feces of naturally infected Raccoons ( Procyon lotor)
Snyder, D. J Parasitology. 1988 Dec; 74(6):1050-2
Fecal samples from 100 raccoons
13% were positive for oocysts
All positive samples were from juveniles
Canine Distemper in Wild Raccoons (Procyon lotor) at the Metropolitan
Toronto Zoo.
Cranfield, M. et al. Can Vet J 1984; 25: 63-66.
Cryptosporidia were found in 42% of the raccoons with canine distemper
Burnout and Compassion Fatigue
No matter what you do or how hard
you try…..some animals are not going
to make it!
“We can do no great things, only small
things with great love.”
Mother Teresa
Special Thanks To:
Dr. Scott Tritsch
Central Kentucky Vet Center
Kentucky Wildlife Center-Veterinarian of Record
Dr. Colin Parrish and Dr. Andrew Allison
Baker Institute for Animal Health
College of Veterinary Medicine
Cornell University
Dr. Justin Brown
Southeastern Cooperative Wildlife Disease Study
College of Veterinary Medicine
University of Georgia
The End!
Karen Bailey
Kentucky Wildlife Center, Inc.
kywildlife.org
karen@kywildlife.org
(859) 983-4330