Hello, my name is Sonia Myles, and I am an RCVS recognised advanced practitioner in zoological medicine and a certified aquatic species vet working for Highcroft Exotics. And today I'll be taking you through respiratory diseases in reptiles. It should be noted that some of the pictures included in these lectures are under the copyright of other publishers, and these lectures are intended for personal use only.
The reproduction, total or partial in colour or in black and white is not allowed. So, first off, I thought we'd start with a little introduction. So respiratory diseases in reptiles are one of the most commonly diagnosed issues that we see and a major cause of morbidity and mortality.
Now, although all species of reptiles are susceptible to respiratory diseases, produced personally, I most commonly see these in Tilonia, so both the terrestrial and the aquatic species and in snakes. And these are often acute and chronic respiratory changes. Now this is most commonly linked to suboptimal environmental conditions such as too high or too low temperatures, again, too high or too low humidity, and inadequate diet and chronic stress, so poor cage design or incompatible cage mates.
Specifically those chelonia, female Tillonia that are just constantly harassed by males. These are the ones that we'll kind of see with their incompatible cage mates. And this is going to result in an immunocompromised animal and the subsequent secondary infections.
So there are a variety of infectious agents, including viral, bacterial, fungal, and parasitic agents that have been detected associated with respiratory disease in a wide variety of species of reptile. But there's also non-infectious causes as well, such as foreign bodies or trauma. Now, respiratory diseases may be the primary disease, or they may have developed secondary to underlying disease processes that also will require treatment.
So this webinar, we're really gonna be concentrating on a holistic approach, so concentrating on the entire reptile, not just concentrating on the on the respiratory system. Now, the pathophysiology of many reptilian diseases, including respiratory tract diseases, really does differ massively from that of mammals. In addition, reptiles also respond very differently to therapeutic regimens, when compared to our mammalian species.
So prior to treatment, it is absolutely essential to determine that causative agent, which we'll get to a little later, for that respiratory disease and to correct any improper environmental changes, because if they, if we have an owner that is unwilling to provide suitable environment, why is male not bother? So respiratory anatomy. So respiratory anatomy is very different between the orders of reptiles, and even the species within those orders are massively different from mammalian anatomy.
So reptiles do not have a functioning diaphragm. They force air in during inspiration and expiration by moving muscles such as their intercostal, their pectoral and their abdominal muscles, and this causes an intrapulmonary change in the pressure. Now there is a fascia-like structure in Tilonia and crocodiles.
This separates the intestinal viscera from the pulmonary tissues, but it doesn't aid in the movement of gas. Now, regardless of the species, the respiratory tract is still separated into the upper and into the lower respiratory tracts. In snakes, well, the air passes through the external nares into the nasal sinuses and to the internal nares and enters the glottis from the into the buckle cavity.
Now the glottis is located rostrally within that oral cavity. This allows the movement of air while eating large prey items. So if you've ever seen a snake eating, you'll often see a the tubua-like structure sticking out the side of their mouth, and that's actually this highly mobile glottis that allows them to still breathe while they're eating that large rodent or that large rabbit.
Now the trachea consists of incomplete cartilaginous rings that bifurcate into short tracheal bronchi at the level of the heart. And in some snake species, they have a tracheal lung. Now this consists of vascularized respiratory tissue.
The lungs are elongated and they're really a sac-like structure with many species, apart from bovid snakes with the left lung being vestigial. Now, depending on the species and the environment that that snake is adapted to, so bearing in mind that we do have aquatic snakes, the right lung can be lined with respiratory epithelium and this joins a caudal avascular saccularlung lined with non-respiratory epithelium. Now, these lungs of aquatic snakes, for example, are lined with far more respiratory epithelium than terrestrial species, and this allows for a much more efficient gaseous exchange during prolonged periods of apnea.
Lizards in comparison. Well, carnivorous lizards specifically, their glottis is located quite rosterally, whereas herbivorous lizards, it's located more cordially at the base of a really fleshy tongue, which can actually make it quite difficult to visualise. Like snakes though, they do have incomplete tracheal rings and a trachea that bifurcates round about the base of the heart.
Now the lungs of most lizard species are sack-like. So if you ever look at them, endoscopy is a great way of doing this. It literally looks like a bag of lace.
So this is a simple single chambered structure, and it does extend quite cordially in some species. Depending on the species, obviously this is gonna occupy various degrees of salamic space. In iguanids, they have short intrapulmonary bronchus and that they actually possess a multi-chambered lung that consists of a small anterior chamber and a large posterior chamber.
In Amid lizards, they lack this intrapulmonary bronchus. So in Tilonia, the air enters through the nares and passes through the nasal cavities lined by olfactory epithelium and mucosal epithelium. Now, the glottis is located at the base of a really, really fleshy tongue, and it's most often not visualised in the awake patient.
It's pretty hard, but you can push your finger on the underside of their jaw and you'll often see it. The trachea has complete tracheal rings and bifurcates the left and right unbranched intrapulmonary bronchus at the thoracic inlet. Now, tortoises have paired multi-chambered lungs, and these are located underneath the carapace to the top part of the shell, and they are relatively rigid.
They extend cordially to the cranial pole of the kidneys as well. Now this well developed bronchial branch, they branch into smaller airways that terminate in alveolar tissue. Crocodiles, in contrast, have a, they have the epiglottis that is located behind an epiglottal flap.
Now this seals the oral cavity when they're submerged. Lungs multi-chambered like elonia, and they have a really complex lung structure, more so than any other reptilian order. So a little bit about respiratory physiology, well, it's unique and it does differ considerably between orders and the species within those orders, just the same as it differs massively from mammals.
And the major organ for gaseous exchange, just like mammals, is the lung. Although some of these species such as aquatic snakes and turtles are capable of gaseous exchange across pharyngeal, cloacal mucosa and across their skin. Cutaneous gaseous exchange is more important than rather eliminating carbon dioxide rather than the uptake of oxygen.
Many reptiles, especially aquatic species, are capable of converting to anaerobic metabolism, which we'll get to in a second. In comparison to the mammalian lungs, reptilian lungs have a very high compliance value. Now this means that they are relatively easy to inflate, but because of this greater compliance, the work of breathing is lower, meaning reptiles increase their minute volume by increasing their respiratory rate.
In comparison to mammals, reptiles have larger lung volumes independent of their structure type, but the surface area of the gas is exchanged is normally only around about 20% compared to a comparatively sized mammal. The control of ventilation in reptiles is different from mammalian and avian species. So in contrast to mammals, respiratory physiology in which high carbon dioxide concentrations stimulate respiration, with res reptilian respiration, this is controlled by hypoxia and hypercapnia as well as environmental temperatures.
Now, many species differences exist. Now this depends on the environmental adaptations of that specific reptile. They'll often have different receptors that increase ventilation during periods of low oxygen and high carbon dioxide.
In tortoises, respiratory rates increase during hypercapnia but decrease during hypoxia. And in most reptile species, hypercapnia causes an increase in tidal volume while periods of hypoxia will increase the respiratory rate. The demand for oxygen is obviously going to be very different between the species and often will increase depending on the temperature, and exposure of a reptile to high concentrations of inspired oxygen will decrease the ventilation, including a decrease in respiratory rate and tidal volume.
Reptiles have the unique ability to tolerate really low levels of oxygen and are capable, as I mentioned previously, of converting to anaerobic metabolism. They put into place intrapulmonary shunts that move a portion of pulmonary blood, bypasses gaseous exchange, and we often see this in our aquatic species. So, reception.
So really, really important to remember that our receptions are usually the primary members of the vet practise that make contact with the reptile owner and the patient. Now there should be appropriate training to allow the recognition of urgent cases that need immediate care or potentially referral to other practises. Receptionists should also be aware of who within that practise has the relevant knowledge to see these cases to make triage decisions and whether you've even got the equipment available and therefore what species can be seen.
Owners can also be instructed to bring pictures of the environment, a faecal sample, husbandry records, and nutritional supplements from home, or any home remedies that they've got. And I really like them to bring some videos along that they can email ahead of time that can be incredibly helpful when determining kind of what's going on, from rather than just having a description alone. So from a clinical history, while there are a number of problems that are due to directly or indirectly, as a result of poor environmental care.
So a full husbandry review is gonna be essential. So we're gonna need to know, well, what is the actual species that we're dealing with and where have they got that source, that that reptile from? Was it from a pet shop, a rescue centre or a private breeder?
We're gonna need information about lighting. So what is the photo period? What ultraviolet light is being provided, if any, where, what is that position of that ultraviolet lighting, and what is the life expectancy of that light source?
What thermal provision is there? So what, what type of heat source are they using? Is it a heat lamp, a heat mat, a heat rock, or a ceramic heat emitter, or a deep heat projector, for example?
What thermo gradient is being achieved and what are the reliability of these reasons? It's all being well only telling us that the the temperature is X, but if they're using one of these rubbish dial thermometers rather than a digital thermometer, then we can know that they're actually gonna be pretty unreliable. If we have an aquatic species, what water temperature is it, but also specific information about a nighttime temperature.
Temperatures should drop, they shouldn't be consistently high. And we're gonna need to know what the ambient temperature is in the room that they are kept in. We need information about the humidity.
So what are the hygrometer readings? What are the means of generating humidity? So is it a monsoon system that is kind of automated spraying, or is that owner spraying the environment?
What is the water temperature and what ventilation is being provided? What's the enclosure type? So do we have an arboreal setup, a terrestrial setup, or a semi-aquatic setup?
What is the size and what is the construction material? I want to know information on the furnishings. So are there hides, plants, are they live or artificial?
Do we have branches or rocks for climbing? We need information on the hygiene. So how often is it cleaned out and what disinfectants is that owner using?
What a little information about the nutrition. So what is the food that is provided, but most importantly, what is the food that is consumed? We're gonna need to know information on the feeding frequency, any care of live prey items that we're feeding, so gut loading methods for our insectivorous species, what supplements are used and what ways is water provided.
Does that owner have any intact animal, either in the same enclosure or on the same premises? What's the breeding history and what are the owner's quarantine protocols? Do we have any previous relevant medical information?
So, has that person been to a different practise before, so you're obviously gonna need to get the clinical history sent over. Now from a clinical examination point of view, well, I like to watch my patients from a distance. I do a head to tail approach, and I will restrain my patient in an appropriate way.
Bear in mind some of these hand tamed reptiles are used to being babied by their owner and actually can respond negatively if you kind of forcibly handle them. So just bear that in mind as well. I like to watch them ambulate and when I'm watching them from a distance, I can obviously take a respiratory rate and assess their aspiration, without handling and therefore stressing them out.
And I find that videos of the the reptile in their own environment, again, reception training will allow you to truly assess it and owners taking videos from a distance can be really helpful. And we also need to be aware of temperatures that we are performing our clinical examination in, because obviously a cold environment, we're gonna see a falsely sluggish reptile. Now, I quite like getting some specific information about the respiratory changes.
So whether there are any nasal or ocular discharges that could be sampled for cytology and cultures, are the nares of the airways changed when you're performing your examination? You can perform auscultation in some species with a stethoscope, however, if you've got thick scales, you're obviously not gonna hear much other than the scraping of the scales against your stethoscope. So, from a clinical sign point of view, well, unfortunately, many owners fail to recognise many of the early respiratory sign changes.
They often are slow and subtle to develop. Now consequently, this means that many reptiles present in an advanced state of respiratory distress, with many clinical signs with that that that aren't just respiratory, but kind of show a multi-organ system changes. Now, although respiratory disease may be the primary symptom, again, we need to be paying close attention to the whole reptilian patient, not just the respiratory system.
So I, I break this down in some of the changes that we'll see in the individual species. So in snakes, er or purulent nasal discharge, which we can see in this poor Burmese python here on the left hand side, lots of purulent discharge in this one. We can see wheezing and accumulation of respiratory secretions within the oral cavity, sometimes dermatitis is gonna be the most common clinical signs seen.
Now, in severe cases, we can see some really quite advanced, respiratory dyspnea. So these patients will lift themselves up off the floor or hold their heads up and it's almost like a telescope posture to allow themselves to, to breathe and try and, and, and get some of these respiratory secretions out. They can almost be seen to be coughing to try and clear these respiratory secretions.
In lizards, we'll often see nasal and ocular discharges, accompanied often by rhinitis, conjunctivitis, and stomatitis. We can often see bacterial abscesses within the oral cavity, and this can move the glottis around and cause severe dyspnea. And in chronically affected lizards, we can often see periorbital abscesses as well.
In Tillonia, we'll see nasal and ocular discharges, rhinitis and conjunctivitis as the most common upper respiratory tract changes. And we'll often see chronically affected tortoises with cutaneous erosions and deep pigmentation around the nares. It often looks quite pale and pink around there, just in this chronic low grade rhinitis.
Now, many rhinitises and tortoises, which we'll get to later, are caused by a variety of gram-negative organisms as well as viral changes. Stomattitis, we can see alongside necrotizing lesions and abscesses, and this may be seen in both the upper and lower respiratory tracts. And in severe and chronic cases we often have obstructive processes within the trachea that can cause quite severe dyspnea and open mouth breathing.
In our aquatic species, well, we can often see buoyancy changes. So part of our clinical examination if I have an aquatic species is I will allow them to submerge themselves, or at least attempt to submerge themselves, and often you will see them swimming in a lopsided manner. Now septicaemia is something that we'll often see with these chronic low grade changes, these, again, this whole body approach.
So septicaemia often goes undiagnosed in reptilian species. And we can often see it as petechial haemorrhages within the mouth or the undersides of them, or pink blushing and bruising to the underside of a chelonia. So we have our emergency reptilian patient.
So, we wanna be moving any of these respiratory secretions that we might be suspicious of, and we can do this with suction or my preferred method is actually endoscopic removal of any potential foreign bodies, and that includes mucal plucks. We want to establish an airway. So as you can see in this picture, this leopard tortoise here, we have placed an endratochial tube, which is fairly simple to do in comparison to some of our mammalian species, but as we mentioned in the anatomy section, they do have some big fleshy tongues that can get in the way.
All I have is a little lollipop stick in the corner of this tortoise's mouth to stop them biting down on that tube, but you can have kind of like, plastic cones or plastic syringes that go around these tubes that work really well as well. Now, if we have a tracheal obstruction, we may need to perform a tracheostomy. This is also quite published in the literature if you have a look.
And it should be noted that oxygen is of short term benefit, only refer you back to our reptile physiology section. If we have a salamic effusion, this will displace the lungs. Again, remember that some of these reptiles have got thin lace-like structures that can easily compressed.
So in some states, in some situations, we want to be draining that salamic effusion, but remember to keep samples ready for your cytologies and your cultures, just in case it's needed for later on. We have our diagnostics, so I would always recommend a systemic approach. Radiographs really, really useful for the detection of respiratory tract disease, especially in tortoises and in lizards.
It's a limited diagnostic, helpfulness in snakes, unless there are really severe changes. And this is purely because we need a lateral view to really get a full idea in snakes, and that can be quite challenging to get unless we have an anaesthetized patient. So in most species, we're gonna want orthogonal views.
We want a DV and a lateral, but in Tilonia we're gonna want a cranial cordal as well. And in Tilonia specifically, we need to be performing this with horizontal beam radiography, because if we don't have this, we're gonna have to tilt our patient. They've only got that thin, fibrous layer between their lungs and their viscera.
That means if you tilt your patient to take radiographs, you are going to be disturbing the organs, squashing the lungs and getting a false reading. Now, CT scanning and MRI scanning obviously is far superior to radiography. I'm really fortunate that I have both easily accessible, but CT would certainly be my go to, certainly from a financial point of view as well for most owners.
But magnetic resonance imaging can also be used for some cases. Ultrasonography can be considered, and this is particularly good for discrete pulmonary lesions that you may have found on your radiography or CT scanning and will allow you to visualise it for potentially taking any samples. Endoscopy also absolutely fantastic.
I normally use a combination of rigid and flexible endoscopy, mostly a 2.7 millimetre 30 degree rigid telescope. Now this is going to allow the direct visualisation and sampling of your, potential problems that you may have found.
And there are obviously various techniques in the literature, depending on the species. So haematology and biochemistry can help help you identify systemic changes and there is serology available for certain infectious diseases. PCR tests are also available for certain infectious diseases such as mycoplasma, for example.
And with your diagnostic samples, whether you take them via endoscopy or ultrasound guided FNA's, you wanna be performing cytologies and cultures. But we can also be performing lung washes and tracheal washes as well again for cytology and cultures. So I figured we would start with our non-infectious respiratory diseases.
So pretty gory picture here, but gets the point across that tortoises are by far the most common one that we're gonna see in this one, and it's gonna be our penetrating or our crushing injuries. This time of year, people letting their tortoises out in the garden and unfortunately not watching their dogs around them doesn't take much to cause damage to the shells, especially if we have underlying degrees of metabolic bone disease. In a ball pythons, we can have chondromas.
So these are cartilaginous granulomas, and these are reported to originate from the tracheal rings. Clinical signs, we're gonna have a respiratory distress in these patients, often open mouth breathing, as well as potentially a period of anorexia beforehand. And these presence of lesions, you can actually confirm them on radiography, but I prefer endoscopy because that's gonna allow you to take samples at the same time.
Now, primary respiratory neoplasia is actually rarely reported in reptiles, however, lymphoma is certainly being reported in snakes, lizards, and in Tilonia. And it's gonna be the most common one associated with our oral tissues and our lung tissues. For me, I see a lot of foreign bodies, specifically in lizards and snakes, potentially breathed in some of their bedding material.
We can, however, see free-ranging aquatic ilonia with fish hook injuries. So we've actually seen a few cases of terrapins, for example, that have been released into local ponds, got involved with fishing tackle and actually swallowed bait with hooks on the end of them. And then we have our infectious diseases.
So I'm gonna take you through viruses, bacteria, fungi and then parasites. So, starting with our viral diseases they cause considerable mortality and morbidity. They'll often go undetected for a long period of time, and the main ones that we see areillonia herpes virus and snake orphidian paramyxa virus.
So, starting with a herpes virus, this causes stomatitis, as you can see in this picture on the right hand side here. Apologies for not wearing gloves, I promise I wash my hands afterwards. It causes a rhinitis, a tracheitis and an inevitable pneumonia when these poor creatures breathe in these pus plaques that are in their mouth.
It will infect many species, and clinical signs include ser and purulent ocular nasal discharge, anorexia, and the necrotic oral lesions, as you can see in this tortoise here on the right hand side, really horrible necrotic lesions, ulcers at the top of the mouth. And this picture was taken immediately after e immediately before euthanasia, actually. We tried to debride these lesions, but actually a vast proportion of the tongue came away with it.
And diagnosis is based on intranuclear inclusions on cytology or biopsies, and we do also have a PCR available. We then got oropidian paramyxovirus. So this infection in snakes is actually well described in the literature.
The disease primarily affects virid snakes, but also non-viparid snakes, and they've also been diagnosed with it. Transmission is via respiratory secretions, and clinical signs include respiratory tract changes such as stomatitis and open mouth breathing alongside nasal discharge. We can see purulent tracheal discharge, but then in the advanced stages of the disease, we can often see central nervous system disease as well.
Now, histologically we'll see an interstitial pneumonia and a proliferation of the lining of the epithelial cells, there's significant findings in these cases. There is a serological test that has been developed, but, I, obviously if you've got the ideal thing to do would be the, the biopsies. Now there is no specific treatment available, so no vaccines being developed for this specific paramyxovirus.
And treatment is predominantly supportive with antimicrobial therapy, fluid therapy and nutritional support. However, unfortunately, euthanasia is going to be often needed, especially in these cases where we're seeing neurological changes. And as with many of these viral things, the quarantine is absolutely essential because prevention is better than cure.
And I would suggest doing this for 90 days as an absolute minimum. We then got our inclusion body disease. So inclusion body disease, primary clinical signs are gonna be regurgitation, chronic wasting, and central nervous system changes, as well as these respiratory tract issues.
We'll see secondary bacterial infections caused by gram-negative organisms, often of the upper and the lower respiratory tract. And histologically we'll see an interstitial pneumonia with the presence of typical eosinophilic intracytoplasmic inclusions within the epithelial cells. Again, no specific treatment for this infection and the isolation of the infected snake is recommended, unfortunately resulting in euthanasia.
Prevention again, much better than cure, quarantining these species for at least 90 days. We've then got our bacterial diseases. So bacterial pneumonia and bacterial infections are gonna be most commonly seen as a result of gram-negative organisms, and these are often part of the normal flora and the normal environment that these reptiles live in.
So the most common ones that we're gonna see are our Pseudomonas, lebsiela, Proteus, Aeromonas, salmonella, and our Staphylococcal species. We also need to bear in mind the presence of mycoplasma. So, mycoplasma.
So mycoplasma is being detected in captive and free range in populations of tortoises with a high morbidity and mortality. Now, the clinical signs are going to include conjunctivitis as well as serous and purulent nasal discharge. And in chronic cases, we'll often see degenerative changes to the nare.
So as we mentioned previously, that paling around the nostrils, if you're seeing that, you need to start looking for these respiratory changes. Now. This picture on the right hand side here is me demonstrating how, if you haven't got any external nasal discharge, you can check if there's any kind of lingering just behind the nets.
You have your finger on the top of the head, thumb underneath, and push gently on the underside of the chin. Anything in the nose is gonna come shooting out. Now, supportive treatment is often you often end up performing nutritional support, fluid support, and providing systemic antimicrobial therapy, with enfloxacin being a pretty good one to do, obviously basing it on cultures and sensitivities, and PCR testing for actually proving that you've got mycoplasma there.
We can be performing nasal flushes with a 1 to 10 dilution of refloxacin. We can also consider nebulizing as well, but we'll get to more specific treatments, a little later. Now we have to bear in mind that a cure is not always possible, and if we have a mycoplasma positive tortoise, we should assume that they are going to be carriers of the disease for the foreseeable future, and they should not be mixed ever with any other tortoise.
It's not going to mean that we're not gonna be able to hibernate these species, but we should be doing it in an incredibly controlled way, making sure that that patient is stable beforehand and doing it for a shorter period of time than is what is recommended for that species. On to fungal infections, so, pretty uncommonly primary pathogen, we often see it as a secondary infection, so alongside mycoplasma viruses or often alongside secondary bacterial infections as well. And it's often linked to poor environmental temperatures, high humidity, or chronic stress.
Again, these female tortoises that are just persistently harassed by males, not allowed time separated from them, and we've just got this male constantly battering them and humping them for want of a better way of putting it. It's incredibly stressful for them. And that allows low grade chronic immunosuppression, and then that's when we get these secondary fungal and bacterial infections.
And by far, tortoises are going to be the most susceptible. So we want to be sampling any discharges, exudates, any build up of materials to performing cytology and cultures. And I often see quite erosive lesions alongside these fungal infections.
You can see this, tortoise here on the right hand side. This was one of those females that was constantly harassed by a male. She had secondary bacterial infections on top of a primary mycobacterial infection.
As well as the fungal infections, and this is actually one of her nostrils now completely eroded away. Er cleaned it up, got rid of the infection with topical and systemic medications. We actually left her nebulizing with her as well, and she is going great guns.
And then onto our parasitic diseases. So primary parasitic infections of the respiratory tract are often accompanied by secondary bacterial and fungal infections, so I've seen a bit of a theme here. Pendostomids by far been the most commonly described ones in both our wild and in our captive reptiles, especially in our snake species.
Clinically, we'll see increased respiratory efforts, including open mouth breathing and severe respiratory compromise, often as a result of obstruction of the major air pathways. Now we can find these on tracheal washes that are gonna demonstrate over or even on bronchoscopy, that's gonna help us confirm a diagnosis. There is no effective chemical treatment and actually we need to be considering surgically removing the worms.
Now we can find the ingested ova in the faecal, if we're performing a faecal parasitology, we need to bear in mind that this is zoonotic. Asteroids can also kind of give us er respiratory infections if they have a high parasite load and they can cause respiratory tract diseases. Certainly the Caliphalus species.
Now we'll often see secondary bacterial infections alongside these as well, as well as severe inflammatory responses that will result in a pneumonia. So hookworm and lung worm infections are diagnosed by the detection of larvae in the faecal or in the tracheal washes. And as I've already mentioned, prevention is better than cure.
So we need to be hammering home the importance of prevention, hammering home the importance of quarantining, especially if we have multi-reptile households. So a little bit of information about the treatment options. Well, we need to be performing a full husbandry review.
I can't stress enough that if we have an owner that has sub-optimal housing and they are unwilling to change anything, there is virtually no point in you attempting to treat that reptile because it is not gonna work to its fullest extent. Reptiles need to be at their optimum environmental temperature to have a decent metabolism, and if they're not got an optimised metabolism, those drugs are not gonna work in an effective way. We want to be providing supportive care such as fluid therapy and nutritional therapy, and wherever possible, basing our antibiotic choice and our anti-fungal choice on culture and sensitivity results.
Now, briefly touched a little bit on acyclovir here. 5% acyclovir may improve lesions for a short period of time when we're dealing with viral infections, but unfortunately, no effective treatment has been demonstrated for viral infections and snakes and tortoises and lizards. So, starting with our antibiotics, thought we'd go through a little bit of the drug doses and routes and everything that we have available, highly, highly recommend the Carpenter exotic animal formulary and even the BSAVA exotics formulary, the BSAVA manual for reptiles, great information about some of the upcoming medical, the upcoming medicine information that we've provided.
Now, the pharmacokinetic data that we have for our antimicrobials and our anti-fungals, it's actually fairly limited in reptiles, unfortunately. And the effective therapeutic levels of many of these drugs aren't actually known. So there are in many cases, broad spectrum antimicrobials are effective against the known reptilian bacterial fungal bacterial pathogens that are administered.
We also have to bear in mind anaerobic infections and treating them with metronidazole, for example. We've got various routes that we can give it and as I mentioned to you previously, we have a 1 to 10 dilution of enfloxacin that can work quite well mixed with saline as an intranasal therapy. So with regards to the other medications that we've got, we've obviously got antifungals, anti-parasitics, analgesia, and oxygen therapy, which is helpful in the short term.
But regular monitoring and reassessment is going to be really, really helpful in helping you monitor these patients. So it's gonna involve lots of regular health checks, rechecks with your patient to make sure that actually we're moving in the right direction. Rarely, if we have a reptile presented to us with respiratory problems, and we're gonna give them some medications and never see them again.
We need to be warning our owners that they need to come back for regular updates, and this can be provided via email and videos if you're still kind of socially distancing everything at the moment. So these antifungal agents, well, we use them with variable success, again due to the lack of pharmacokinetic data in these species. But in many cases we have mixed fungal and bacterial infections present, so we need to often do this alongside antimicrobial therapy.
Anti-parasitics, well, parasitic infections, we need to know what the parasite is that we're treating to, to start with, and depending on that parasite, it's gonna depend on the medication and the route that we choose. We often give these alongside secondary microbial therapy as well. And then we have our nebulization.
So I tend to use this in severe and chronic respiratory disease, and it'll allow us to deliver anti antibiotics, deliver saline which will help open the airways and clear any mucus. It will help deliver F10, brilliant products that I normally use at 1 in 250 dilution, so 1 mL of F10 in 250 mL of saline, and it will help us deliver our muolytics, our proteolytics and also our bronchodilators. Now, in addition to the, the saline, the millytics and the protelytics, etc.
That we can use these bronchodilators to help. Kind of bugger, I've messed up this slide, sorry, Dawn. Don't worry.
Do you want to go to the start of this slide if that's OK? Yeah, absolutely. I was so good.
This is literally like the last one. I was like, I don't worry, just if you can just restart the slide, that'd be great. Thanks.
2 seconds, OK. So then we have our nebulization. So aerosol therapy is indicated in reptiles with severe and chronic respiratory disease, and this is going to help facilitate the delivery of antimicrobials, saline and F10 directly into the the respiratory systems.
Now with F10, I use it at a dilution of 1 in 250, so 1 mL of F10 in 250 mL of saline. And the saline is gonna help loosen any viscous respiratory secretions and help eliminate any necrotic debris. It will help alongside obviously suctioning and and everything as well that we've already mentioned.
So in addition to the antimicrobials and saline, we've got eucalytics and proteolytic agents. And we've also got the ability to use our bronchodilators. However, we need to take caution with these guys because they have the potential side effects on the cardiovascular system in these reptiles.
So most reptiles I would use a nebulization for 3 to 4 times a day for about 20 to 30 minutes. And if we do prolonged nebulization, this can actually affect pulmonary function and cause bronchospasm and pulmonary shunting, so 30 minutes absolute tops, we should be doing this for. Thank you very much for listening.
