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Diarrhea

BASICS

DEFINITION/OVERVIEW

Diarrhea is the production of unformed or liquid fecal matter. It is often associated with increased fecal volume and frequency of defection.

ETIOLOGY/PATHOPHYSIOLOGY

Diarrhea is usually associated with enteritis due to primary infectious (e.g., endoparasites) or non‐infectious (e.g., dietary) causes.

In tortoises with a natural diet high in dietary fiber (e.g., African and European tortoises) ingestion of diets high in fermentable carbohydrates (e.g., fruits) and/ or insufficient fiber ingestion can result in dysbacteriosis, which can result in diarrhea.

Environmental factors, such as low temperatures, lead to decreased gastrointestinal motility, dysbacteriosis and diarrhea due overgrowth of opportunistic pathogens.

Diarrhea is common in tortoises, but uncommon in freshwater turtles, which normally have unformed liquid feces.

Most commonly kept tortoise species require a high‐fiber, low sugar, and low protein diet, and therefore feeding large amounts of fresh fruits and starch containing vegetables will frequently lead to unformed feces or diarrhea.

The following endoparasites can be associated with diarrhea in tortoises:nematodes: oxyurids are very common in tortoises; ascarids are reported in wild‐ caught Testudo spp. (European tortoises) in captivity; other nematodes such as Strongyloides and Capillaria are uncommoncoccidia: uncommonciliated protozoa: Nyctotherus spp., Balantidium spp., Entamoeba spp. (E. invadens)flagellates: Trichomonas spp.

Bacteria: Proteus and Salmonella spp. are often asymptomatic carriers, but can lead to diarrhea.

SIGNALMENT/HISTORY

Diarrhea is more common in tortoises than in turtles.

Inappropriate husbandry: low environmental temperatures and overcrowding (stress) can lead to enteritis and diarrhea.

Inappropriate diet: tortoises fed a low‐fiber diet, high in fermentable sugars and protein, are prone to develop diarrhea.

Owners report liquid feces, frequently malodorous, with increased frequency of defecation.

Straining to defecate, anorexia, and cloacal prolapse may also be reported.

CLINICAL PRESENTATION

Depending on duration (acute vs. chronic), severity and etiology of diarrhea.

Fecal staining around cloaca, and ventral aspects of proximal hind limbs and tail base.

Presence of abnormally soft or liquid fecal matter in transport container.

Tortoises with diarrhea caused by an inappropriate diet might show no other clinical signs or may show unspecific clinical signs, such as lethargy, reduced food intake, or dehydration.

Chronic diarrhea can lead to weight loss and cachexia due to malabsorption of nutrients.

Cloacal tissue prolapse, such as rectal/distal colon prolapse, or true cloacal prolapse.

RISK FACTORS

Husbandry

In most tortoises (except red‐ and yellow‐ footed tortoises)—diet low in fiber and/or high in fermentable simple carbohydrates (e.g., fruits).

Change in diet

Poor sanitation can lead to high endoparasite load due to the direct lifecycle of many intestinal parasites of chelonians.

Overcrowding results in stress

Inappropriate (too low or too high) environmental temperatures.

Others

Wild‐caught animals often have a high endoparasite load and are often stressed during acclimatization to captivity.

Lack of fecal parasitology screening after acquisition.

DIAGNOSIS

DIFFERENTIAL DIAGNOSIS

Enteritis - bacterial, parasitic, dietary DIAGNOSTICS

DIAGNOSTICS

Fecal direct wet mount to evaluate for motile protozoa.

Fecal flotation to evaluate for helminths and protozoa (e.g., amoeba cysts).

Fecal cytology to rule out fungal infections

Diagnostic imaging (radiographs, CT, ultrasound) as needed.

Fecal bacterial cultures are rarely useful in the diagnosis and treatment of chelonians with diarrhea.

PATHOLOGICAL FINDINGS

Enteritis

Malodorous and liquid intestinal content

Emaciation

TREATMENT

APPROPRIATE HEALTH CARE

N/A

NUTRITIONAL SUPPORT

Correct diet to ensure sufficient fiber intake in herbivorous tortoises.

Provide nutritional support to emaciated and/or anorexic animals.

Provide fluid therapy to dehydrated animals.

CLIENT EDUCATION/HUSBANDRY RECOMMENDATIONS

N/A

MEDICATIONS

DRUG(S) OF CHOICE

Metronidazole: 40–100 mg/kg PO repeat 10–14 days or 25 mg/kg PO q24h for 5 days. Effective against motile protozoal organisms.

Emodepside/praziquantel (Profender®, Bayer DVM, Pittsburgh, PA): 1 ml/kg topical on skin. Repeat after 14 days. Effective against nematodes, trematodes and cestodes. Recommended in particular in animals that cannot be dosed orally. Animals should not be soaked for 24 hours after topical administration. Apply to skin around forelimbs and neck.

Fenbendazole: 20 mg/kg PO q24h for 3–5 days. Effective against nematodes and flagellates.

Pyrantel pamoate: 25 mg/kg PO q24h for 5 days, repeat in 3 weeks. Effective against nematodes including pinworms and ascarids.

Keep on newspaper until treatment is completed and recheck fecal samples.

Immediate removal of feces to prevent ingestion, bathing the tortoises, and cleaning of the pericloacal region to remove feces and eggs or cysts are strongly recommended.

Prevention of reinfection is critically important during and following treatment against parasites with a direct lifecycle.

PRECAUTIONS/INTERACTIONS

Fenbendazole has been shown to result in heteropenia and biochemical abnormalities in Testudo hermanni following administration of two courses of 50 mg/kg q24h for 5 days.

Fenbendazole has been shown in other reptiles to cause bone marrow suppression and temporary pancytopenia. Avoid doses > 20 mg/kg.

Do not use ivermectin or other macrocyclic lactones (e.g., selamectin) in chelonians.

FOLLOW‐UP

PATIENT MONITORING

Return to normal fecal consistency.

Weight gain and maintenance of hydration.

Repeat fecal exams to ensure treatment effectiveness.

EXPECTED COURSE AND PROGNOSIS

If dietary causes are responsible for the diarrhea, then prognosis is good to excellent.

Animals in good body condition with no concurrent morbidities have a good to excellent prognosis.

Animals in poor body condition with signs of systemic illness (dehydration, lethargy, etc.) have a guarded to poor prognosis.

MISCELLANEOUS

COMMENTS

Diarrhea is a clinical sign associated with an underlying diseases, improper husbandry, or nutrition.

Identification of the underlying cause is necessary to improve outcome and reduce the risk of reoccurrence.

Correction of husbandry is always recommended to in help improve the outcome.

ZOONOTIC POTENTIAL

Salmonella spp. are commonly shed from chelonians with and without diarrhea.

SYNONYMS

N/A

ABBREVIATIONS

CT = computed tomography

PO = per os