Lee Jin-ee (151526) DVM 5 2013/2014 Semester 1 Supervised by : Assoc. Prof. Dr.

Ong Bee Lee Recurrent abscess in an Asian elephant Jin-ee Lee Faculty of Veterinary Medicine, Universiti Putra Malaysia, 43400 Serdang, Selangor.

Abstract
Boon Mee is an estimated 70-year-old, female, asian elephant(Elephas maximus). 7 months ago, on the 20th Feb 2013, a mass was found over left point of elbow, lanced and drained with a lot of pus in it. The wound was flushed daily with diluted povidone iodine, silver sulphadiazine, and topical oxytetracycline spray. Fortunately, the abscess resolved in 3 weeks. However on the 1st of June 2013, after 3 months, the mass recurred and ruptured over the left point of elbow. The previous treatment was applied but the wound does not progress well after 3 weeks. After another 3 weeks, the progession is minimal and therefore a surgery is planned on 12nd of July 2013 to establish a bigger drainage ventral to the abscess. The surgery was successful and Boon Mee was doing well after surgery.

Introduction
An abscess is defined as a localized collection of pus in a cavity formed by disintegration of tissue.(1) Abscesses may develop in any organ or in the soft tissues beneath the skin in any area. Abscesses can be caused by minor breaks and punctures of the skin, obstruction of sweat glands and sebaceous glands, and inflammation of hair follicles. They contain dead cells, bacteria, and other debris, which causes inflammation and pain. Common bacteria, such as staphylococci, are the most common cause. Elephants in thailand are legal to be kept in captivity. This law encourages the poachers to go into the forest to get a young calf to be trained for future purposes. In order to get the calf, usually the mother will have to be killed. The calf will be trained to receive commands and obey to human to perform various tasks. These include labour in logging, labour in elephant-riding, and also performer in circuses. The elephants in captivity were deprived of their physiological and phycological need and thus develop numerous stereotypic behaviors like head shaking and stamping. This more or less explain the low breeding success rate in captivity due to the reasons above. In 2006, Thailand were reportedd to have 1000-1500 elephants in the wildm while it has 2231 elephants in captivity. The figure is shocking as it shows more than 50% of the the total populations are in captive rather than in the wild.

Lee Jin-ee (151526) DVM 5 2013/2014 Semester 1 Supervised by : Assoc. Prof. Dr. Ong Bee Lee

Case report
Boon Mee is an estimated 70-year-old, female, asian elephant(Elephas maximus), weighing about 3000kg with the body condition score rated as very good(2). Boon Mee was a retiree from the logging industry and was sold to the Wildlife Friends of Foundation of Thailand(WFFT) on the 5th of November 2012. She was fed daily with 8-12 banana stems supplemented with a wide range of fruits including dragon fruit, mango, banana, watermelon and pineapple. 7 months ago, on the 20th Feb 2013, a mass was found over left point of elbow, lanced and drained with a lot of pus in it. The wound was flushed daily with diluted povidone iodine, silver sulphadiazine, and topical oxytetracycline spray. Fortunately, the abscess resolved in 3 weeks. However on the 1st of June 2013, after 3 months, the mass recurred and ruptured over the left point of elbow. When treated with daily flushing with diluted povidone iodine and topical antibiotics of silver sulphadiazine and oxytetracycline spray, the wound does not progress well after 3 weeks. Therefore, on the 22nd of June 2013, a swab sample was taken for bacterial culture and the result reveals presence of Streptococcus agalactiae and Acintobacter sp. For the antibiotic sensitivity test, both are sensitive to amoxicillin, ciprofloxacin and ceftazidine. Hence, amoxicillin was prescribed at 11mg/kg SID PO to replace the topical antibiotics previously. The rupture hole became smaller and the drainage was somewhat stagnate. After another 3 weeks, the progession is minimal and therefore a surgery is planned on 12nd of July 2013 to establish a bigger drainage ventral to the abscess. The tranquilizer being used is Acepromazine 0.005mg/kg IM (3) and the sedative is Xylazine 0.040.08mg/kg IV (4). The preanaesthetic, anaesthetic and surgical procedure is demonstrated as below.

1) The left tricep muscle was identified and cleaned with diluted chlorhexidine scrub.

2)

The left tricep muscle was subsequently cleaned with diluted povodone iodine.

Lee Jin-ee (151526) DVM 5 2013/2014 Semester 1 Supervised by : Assoc. Prof. Dr. Ong Bee Lee 3) Acepromazine was administered intramuscularly at the tricep muscle at dosage of 0.005mg/kg.

4)

Venous access was established through the insertion of butterfly cathether ibto the ear vein. Xylazine was administered intravenously at the dosage of 0.04-0.08 mg/kg.

5) The external surface of the abscess was brushed after Boon Mee was successfully sedated.

Lee Jin-ee (151526) DVM 5 2013/2014 Semester 1 Supervised by : Assoc. Prof. Dr. Ong Bee Lee 6) The external surface of the abscess was cleaned with tape water.

7)

A babcock forcep was inserted into the small opening of the abscess at the lateral to estinate the depth of the abscess.

8)

An horizontal incision was made ventral to the abscess to establish good drainage through the gravitational pull.

Lee Jin-ee (151526) DVM 5 2013/2014 Semester 1 Supervised by : Assoc. Prof. Dr. Ong Bee Lee

Discussion
My discussion will consist of 3 which are the pathogenesis, treatment options and the management of captivity elephants. Fistly, it is the pathogenesis of the disease to grant us a better understanding about the disease. The pathogenesis of the disease was explained in a flow chart form as below:

Secondly, in cases of abscess in elephants, there are 3 suggested ways which are medical treatment, surgical drainage and surgical excision. As reported by Finagen (5), local treatment with disinfectant and local antibiotics may be sufficient, while large abscesses in unhygienic field situation may require systemic antibiotic. As reported by Mikota, large abscess may require a ventral drainage followed by a second more dorsal drainage to facilitate lavage(6). Mikota also discourages surgical excision due to the Infection is major cause of wound dehiscence due to numerous creases or cervices that make it difficult to obtain surgical asepsis during skin(6).

Lee Jin-ee (151526) DVM 5 2013/2014 Semester 1 Supervised by : Assoc. Prof. Dr. Ong Bee Lee Therefore, in my case, during the 1st episode of abscess, local treatment with antibiotics and daily cleaning was done and successfully resolved the abscess in 3 weeks. However, when the abscess recurred at the same site, the same treatment was given but yield minimal improvement and hence a surgical drainage was done. Contrary to what Mikota proposed to establish a ventral drainage followed by a second more dorsal drainage to facilitate lavage, we did only the ventral drainage. This is because after acessing the abscess, we believe the abscess will resolve will a single drainage. Nevertheless, if the abscess does recurr again, perhaps 2 drainage will be performed on the next surgery. Surgical excision of abscess is common in smaller animals like dogs and cats. In cases of elephants, its discouraged as this may serve as the source of infection causing wound dehiscence later on. Thirdly, I strongly believe that the formation of hygroma and abscess in captive elephant can be prevented through good management and husbandry. In terms of diet, captive elephants have significant fat deposits while wild elephants do not(8). This causes the joints of the elephants to bear much more weight for a long period of time. Compared to the ephants in wild, they go through nutritional stress due to droughts (9), while the captivity elephants are well-fed with very limited exercise and activity. Therefore, their diet should be assessed for caloric content and nutritional content by professional nutritionist (10), to ensure the feeding will be good enough to provide a balanced diet without overfeeding th elephants. In terms of exercise, wild elephants spent 50-75% of their time foraging, up to 80km/day (6). While in enclosure, most of the elephants are fed and not require to forage which lowers their metabolic rate. For the enclosure size, there is no known optimal enclosure size for the time being (6) and have to be determined by reproductive success, muscle tone, weight. However, these are rarely acessed and therefore a lot of captivity elephants became bored and tend to lie more than in wild. This leads to more pressure on the bony prominences during lying. In terms of feed, it need to be distributed to enhance activity level of the elephants. (6) The feed should be hidden or hung at high areas which require the elephants to work for their food. Thus, by making them walk and exercise more, the joints become healthier and stronger, and at the same time less pressure will be exerted on the joints.

Conclusion Formation of hygroma and abscess in captive elephant can be prevented through good management and husbandry. Abscess in elephants may lead to death due to necrotizing fascitis and septicaemia if the rupture is incomplete and spread underneath.

Lee Jin-ee (151526) DVM 5 2013/2014 Semester 1 Supervised by : Assoc. Prof. Dr. Ong Bee Lee

Reference
1. Douglas C.B, Virginia P.S, Clive C.G (2007), definition of aural hematoma, Saunders comprehensive Dictionary 3rd Edition, pp. 157, Philadephia, PA : Saunders. 2. V. Krishnamurthy, C.Wemmer, J. Lehnhardt (2000) Healthcare, breeding and management of Asian Elephants. New Delhi, project elephant. Govt. of India, p.189

3. Fowler, M. E. (1995) Restraint and handling of wild and domesticated animals, 2nd ed. Ames Iowa states University Press, pp. 36-56 4. Fowler, M. E. (1995) Restraint and handling of wild and domesticated animals, 2nd ed. Ames Iowa states University Press, pp. 36-56

5. Mikota, S. K. , Hammatt, H. and Finegan, M. (2003) Occurrence and prevention of capture wounds in Sumatran Elephants. Proc Amer Assoc Zoo Vet, Mineapolis, Minnesota, pp. 291-293 6. Mikota, S. K. , Fowler, M. E. (2006), biology, medicine and surgery of animals, pp. 256

7. Stetter, M. , Orlando, Florida (2004 ), personal communication 8. Douglas-hamilton, I. , Douglas-Hamilton (1975 ), Among The elephants. New York, Viking Press, pp. 99

9. Valdes, E, , Orlando, Florida (2003), personal communication