Vol. 21, No.
4 April 1999
CE Refereed Peer Review
FOCAL POINT
★Veterinarians working with
free-ranging raptors should
be familiar with the two most
common consequences of long-
term hospitalization—bumblefoot
and aspergillosis—and strive
to prevent these conditions
by providing proper nutrition,
housing, and hygiene.
KEY FACTS
■ Bumblefoot is best prevented by
providing appropriate perches,
talon trimming, and regular
examination of the plantar
surfaces of the feet to detect
early clinical signs,
■ All raptors are susceptible to
aspergillosis infection, but the
most susceptible species are
immature red-tailed hawks, bald
and golden eagles, goshawks,
gyrfalcons, rough-legged hawks,
and snowy owls,
■ The cutaneous form of poxvirus
infection has been reported in
both Falconiformes (diurnal
raptors) and Strigiformes (owls)
species,
■ The top five differentials for any
raptor with caseous lesions in
the oral cavity are candidiasis,
trichomoniasis, capillariasis,
bacterial abscesses, and
hypovitaminosis A,
20TH ANNIVERSARY
Infectious and Parasitic
Diseases of Raptors*
Wildlife Conservation Society/Bronx Zoo, Bronx, New York
Sharon Lynn Deem, DVM, PhD
ABSTRACT: Free-ranging raptors may be admitted to a veterinary hospital with an infectious
(e.g., aspergillosis, poxvirus) or parasitic (e.g., trichomoniasis) disease but more commonly
acquire such debilitating conditions during long-term hospitalization. Clinicians should be fa-
miliar with the clinical signs, diagnostic protocols, and therapeutic approaches of these poten-
tially fatal diseases.
I
nfectious diseases of raptors are caused by bacterial, fungal, viral, and para-
sitic agents (see Infectious and Parasitic Agents of Free-Ranging Raptors).1–5
The most common infectious and parasitic diseases are covered in detail
in this article and include bumblefoot associated with Staphylococcus aureus;
aspergillosis; candidiasis; poxvirus and herpesvirus; trichomoniasis and capillar-
iasis; and hemoparasites of the genera Plasmodium, Haemoproteus, and Leuco-
cytozoon.
a
BACTERIAL INFECTION: BUMBLEFOOT
A common consequence of hospitalization and confinement of raptors is podo-
dermatitis, commonly known as bumblefoot. Bumblefoot is defined as any inflam-
matory condition of the foot, ranging from mild erythema to severe abscessation
and osteomyelitis (Figure 1). Trauma predisposes to the development of bumble-
foot; self-inflicted talon punctures, bites from prey, and improperly shaped perches
are common causes. Obesity or inactivity, unsanitary cages, immunosuppression,
and vitamin A deficiencies are additional causes.11,12 Bumblefoot has been presented
in the literature as a noninfectious disease12; however, S. aureus is often the cause of
debilitating bumblefoot with associated cellulitis and osteomyelitis.11,13,14
Falcon species tend to be more susceptible to bumblefoot than are hawks,11,15
and both of these groups are more frequently affected than are owls. The princi-
pal clinical signs are swelling and inflammation of the plantar surface of the foot
that can progress to debilitating lameness associated with cellulitis, tendinitis,
and osteomyelitis.
Diagnosis is usually straightforward and based on physical examination, radio-
graphic evaluation, and bacterial culture and sensitivity of lesions. Staging for
prognostic assessment is usually based on the classification scheme proposed by
Halliwell that consists of four categories (see Bumblefoot Classification
Scheme).11 Staging is important both for prognostic assessment and develop-
ment of a therapeutic plan.
*For additional information on raptor medicine, see “Raptor Medicine: Basic Principles and
Noninfectious Conditions” in the March 1999 (Vol. 21, No. 3) issue of Compendium.
a
Information on other important bacterial infections of raptors, including Mycobacterium
avium, Chlamydia psittaci, and Salmonella species, can be found in the literature.2,6–10
Small Animal/Exotics 20TH ANNIVERSARY Compendium April 1999

Treatment of bumblefoot Nonsurgical treatments

includes both nonsurgical and include vitamin A supple-
surgical approaches. 12,14–16 mentation, parenteral anti-
Therapeutic objectives are re- biotics, and wound manage-
duced inflammation and ment. Parenteral antibiotics
swelling, establishment of are best chosen based on cul-
drainage (if needed), elimi- ture and sensitivity results
nation of bacteria, and man- from collected exudate. Car-
agement of the wound to benicillin, piperacillin, and
promote healing. Wound enrofloxacin have all been
management is often the effective in the treatment of
most challenging aspect of bumblefoot. Ball bandaging
treatment and is usually ac- with a dimethyl sulfoxide
complished by the initial ap- “cocktail” (8 ml dimethyl
plication of ball bandages Figure 1—Bumblefoot (pododermatitis) in a crested caracara sulfoxide, 2 ml dexametha-
(Figure 2). These bandages (Polyborus plancus). Note inflammation and ulceration of the sone [2 mg/ml], and 2 ml
consist of gauze sponges placed tarsometatarsal pad. piperacillin or carbenicillin
on the plantar surface of the [500 mg/ml]) is often effec-
foot that are incorporated tive for treating mild cases
into a bandage by wrapping the digits (using cast of bumblefoot.18 Other common topical medications
padding and an elastic nonadhesive dressing) in a circu- include udder cream to soften the feet and hemorrhoid
lar–longitudinal fashion in a “ball” around the sponges. medication to promote epithelialization.
It is important to incorporate the distal tarsometatarsus Surgical debridement, including removal of devital-
into the bandage to support the phalangeal and tar- ized tissue and/or amputation of bone(s) with chronic
sometatarsal joints and to use many gauze sponges to osteomyelitis, may be necessary in severe cases of bum-
provide adequate cushioning of the plantar surface. The blefoot. Most raptors can function with amputation of a
contact bandage layer can be either adherent or nonad- single digit as long as the hallux (first digit) is intact and
herent based on general wound-management princi- there is no involvement of the tarsometatarsal bone.
ples.17 Padded perches (e.g., sheepskin covered) and/or a Bumblefoot is much easier to prevent than to treat.
padded floor (e.g., linen-covered foam padding or sand) Preventive foot care for captive raptors should include
are also used during the healing phase. appropriate perch sizes, shapes, and material (e.g., sisal

Infectious and Parasitic Agents of Free-Ranging Raptors

Infectious Agents
Bacterial
Staphylococcus aureus
Escherichia coli
Mycobacterium avium
Chlamydia psittaci
Listeria monocytogenes
Salmonella species
Pasteurella multocida
Erysipelothrix rhusiopathiae
Bacillus anthracis
Francisella tularensis
Proteus species
Pseudomonas species
Parasitic Agents
Fungal External Parasites Internal Parasites
Aspergillus fumigatus Myiasis (Calliphora and Trichomonas gallinae
Candida albicans Protocalliphora species) Capillaria species
Hippoboscid flies Serratospiculum
Viral
(Pseudolynchia species) amaculata
Avian poxvirus
Lice (Mallophaga) Thelazia species
Herpesvirus
Mites Syngamus species
Adenovirus
Ticks Cestodes
Rabies
Trematodes
Newcastle disease Blood Parasites
Acanthocephala
Marek’s disease Plasmodium species
Coccidia (Caryospora
Haemoproteus species
and Eimeria species)
Leucocytozoon species
Toxoplasma gondii
Trypanosoma species
Babesia species

TREATING BUMBLEFOOT ■ BALL BANDAGES ■ ANTIBIOTICS

Compendium April 1999 20TH ANNIVERSARY Small Animal/Exotics

rope, foam-rubber padded, tory (e.g., if the bird was re-

or sheepskin covered)19; trim- Bumblefoot Classification Scheme11 cently hospitalized or is a
ming of excessively long tal- highly susceptible species),
Type I (most severe): Enlargement of the entire
ons; and regular examination physical examination, radiog-
metatarsal pad; associated with infection and cellulitis
of the plantar surfaces of the raphy, endoscopy, complete
feet to detect early clinical Type II: Localized encapsulated lesion; associated blood count, chemistry pro-
signs. with an enlarged metatarsal pad file, fungal culture, and
serology (ELISA). 21 Redig
FUNGAL INFECTIONS Type III: Enlargement of one discrete area of the foot; states that radiographic le-
Aspergillosis usually caused by a foreign body, corn, or localized sions are often associated
The most common fungal improper epithelial molt with a grave prognosis, and
infection in free-ranging and Type IV (least severe): Enlargement of one or more the lack of radiographic
captive raptors is aspergillosis. distal extremities of the phalanx; results from rupture lesions does not rule out as-
The causative agent of asper- pergillosis infection.21 Leu-
of the flexor tendons at the ends of digit II, III, or IV
gillosis in raptors is most of- kocyte count is often sig-
ten Aspergillus fumigatus, with nificantly increased, with
occasional disease associated heterophilia present in the
with Aspergillus flavus and early stages and monocyto-
Aspergillus niger.20,21 All rap- sis and toxic heterophils in
tors can succumb to asper- more advanced cases.22
gillosis infection, but the most Therapy is usually protract-
susceptible species are imma- ed and based on different an-
ture red-tailed hawks (Buteo tifungal agents, including
jamaicensis), bald eagles (Hal- amphotericin B, 5-fluorocy-
iaeetus leucocephalus), golden tosine, fluconazole, and itra-
eagles (Aquila chrysaetos), conazole. 21,23 Itraconazole
goshawks (Accipiter gentilis), with or without ampho-
gyrfalcons (Falco rusticolus), tericin B should be used for
and rough-legged hawks (Bu- initial treatment of aspergillo-
teo lagopus).21 sis unless infection of the
Aspergillosis can be classi- brain is suspected; in these
fied as acute or chronic and Figure 2—A ball bandage on the foot of a crested caracara for cases, fluconazole should be
disseminated or localized, the treatment of bumblefoot. the drug of choice. 23 Oral
depending on the number of itraconazole (5 mg/kg twice
spores to which the raptor is daily) has been safe and effec-
exposed, the bird’s immune tive in treating raptors with
status at the time of expo- aspergillosis. 24 Supportive
sure, and establishment of care is also an important
local aspergillomas (Figure component of therapy, in-
3) or systemic spread of the cluding force-feeding, fluids,
organism. The most com- warmth, and antibiotics.
monly affected system is the Removing aspergillomas
respiratory tract; birds pre- from the trachea may be nec-
sent with respiratory distress essary and can be accom-
and vocal changes. Other plished either using an endo-
common clinical signs asso- scopic approach (in larger
ciated with acute disease are birds) or via a tracheal tran-
anorexia, polydipsia, and Figure 3—Aspergillomas in the thoracic cavity of a snowy owl section. 25 A less invasive
polyuria. Insidious, progres- (Nyctea scandiaca). (Courtesy of Dr. Scott P. Terrell, College procedure using a tracheal
sive respiratory distress with of Veterinary Medicine, University of Florida) vacuum technique has been
associated emaciation is of- described.25,26 Abdominal air-
ten the presenting sign in chronic disease. sac cannulation is most often advised during these proce-
Diagnosis of aspergillosis is accomplished using his- dures and in cases of tracheal obstruction.27

RADIOGRAPHIC LESIONS ■ LEUKOCYTE COUNT ■ ANTIFUNGAL AGENTS

Small Animal/Exotics 20TH ANNIVERSARY Compendium April 1999

Like bumblefoot, prevent- diagnosed in a number of

ing aspergillosis in captive raptor species.1,30
raptors is much easier than
treating it. In highly suscep- Adenovirus
tible and/or stressed raptors, The recent fatal adeno-
the prophylactic use of anti- virus outbreaks in the high-
fungals may be indicated ly endangered Mauritius
and can include oral itra- kestrel (Falco punctatus) 31
28
conazole (I use 5 mg/kg and aplomado falcon (Falco
once daily) or oral 5-fluoro- femoralis septentrionalis) 32
cytosine (50 to 60 mg/kg highlight the importance of
twice daily).21 Good hygiene this virus as a cause of high
and supportive care of hos- mortality among raptors.
pitalized patients is of pri-
mary importance to ensure Figure 4—Multiple raised pox lesions on the eyelid and cere Poxvirus
immunocompetence against of a barred owl (Strix varia). The cutaneous (i.e., dry)
this ubiquitous organism. form of poxvirus infection
has been reported in both
Candidiasis Falconiformes and Strigi-
Candidiasis (thrush), which is caused by the yeast formes.1,33 Avipoxvirus species are large DNA viruses
Candida albicans, is the second most important fungal that induce intracytoplasmic, lipophilic inclusion bod-
infection of free-ranging raptors.3 Candidiasis usually ies (Bollinger bodies). Epithelial cells of the oral cavity
manifests as pseudomembranous patches of necrotic and integumentary and respiratory tracts are most
tissue in the oral cavity, pharynx, and crop. A less com- commonly infected. Poxvirus infection presents clini-
mon manifestation is infection of the lower gastroin- cally as discrete nodular proliferations of unfeathered
testinal (GI) tract with no visible lesions on physical skin around the eyes, beak and nares, and legs and feet
examination. Clinical signs of candidiasis include dys- (Figure 4). No cases of diphtheritic (i.e., wet) pox le-
phagia, regurgitation, vomiting, and depression. In cas- sions have been reported in raptors.1
es of lower GI tract infection, raptors often display Transmission of poxviruses requires viral contamina-
nonspecific signs of emaciation and anorexia. tion of broken skin and is often associated with mos-
Diagnosis can be confirmed by taking a swab, scrap- quitoes and other blood-sucking arthropods.37 Thus,
3
ing, or culture of the lesions. C. albicans is a thin- poxvirus lesions have been more commonly diagnosed
walled, oval yeast that measures 3 to 4 µm in diameter in raptors housed outdoors.
and is typically deeply basophilic with Wright’s stain A tentative diagnosis of poxvirus infection can be
and gram positive with Gram’s stain.29 based on clinical signs. Diagnosis can be confirmed via
Uncomplicated candidiasis can be treated with oral histopathologic and electron microscopic identification
nystatin (100,000 IU/kg three times daily) until lesions of the pathognomonic Bollinger bodies. Poxvirus infec-
are gone. Note that candidiasis is often secondary to an tion is usually self-limiting in raptors. Treatment of sec-
underlying immunocompromising condition. ondary bacterial infections may be warranted as well as
surgical removal of lesions if they compromise the
VIRAL INFECTIONS bird’s ability to properly perch, feed, or see.
A number of viral infections have been diagnosed in
free-ranging and captive raptors.1,30–34 The detection of Herpesvirus
antibodies to rabies virus in an experimentally infected Herpesvirus infections in raptors include inclusion-
great horned owl (Bubo virginianus)35 suggests that rap- body hepatitis in falcons, owl hepatosplenitis, and eagle
tors may be asymptomatic carriers of the rabies virus as herpesvirus.38 The herpesviruses in falcons and owls are
a result of their feeding habits and contact with such serologically indistinguishable.1,38 Clinical signs are of-
prey animals as raccoons and skunks. However, human ten nonspecific (e.g., severe depression, weakness,
rabies associated with raptors has not been document- anorexia) and can present as peracute death (mortality
ed. A serologic survey of 53 newly captured birds of may approach 100%). The diagnosis of herpesvirus in-
prey found no significant antibody titer.36 Newcastle fection in raptors is based on clinical signs; viral isola-
disease, a virulent paramyxovirus commonly associated tion; and histologic lesions, including intranuclear in-
with fatalities in poultry and wild fowl, has also been clusion bodies and widespread focal to diffuse necrosis

THRUSH ■ RABIES ■ BOLLINGER BODIES

Small Animal/Exotics 20TH ANNIVERSARY Compendium April 1999

of the liver and throughout cluding protozoa, nema-

the hematopoietic tissue. todes, trematodes, cestodes,
There is no therapy for the and acanthocephalans.5,40 The
herpesviruses of raptors, and GI and respiratory tracts are
it remains a problem in free- most commonly affected.
ranging and captive popula- Parasitic infections of the
tions. Marek’s disease, the GI tract include tricho-
lymphoproliferative condi- moniasis (frounce) and cap-
tion caused by a herpesvirus illariasis. Trichomoniasis of
that is most prevalent in raptors is caused by Tricho-
chickens, has also been re- monas gallinae and is often
ported in raptors.1,34 acquired when raptors feed
on infected prey (e.g., doves,
PARASITIC INFECTIONS pigeons).40 The characteris-
Ectoparasites tic signs are raised, yellow-
Raptors harbor a variety ish, caseous plaques on the
of ectoparasites. The majori- tongue and oropharyngeal
ty of ectoparasites cause no surfaces (Figure 5). The bird
clinical signs unless a bird is may have difficulty swallow-
immunocompromised. Only ing and, in severe infection,
biting lice from the order Mal- may be emaciated because
lophaga are found on rap- of its inability to eat. Diag-
tors. These lice spend their nosis can be confirmed by
entire lives on the bird and taking a swab or scraping of
can survive only for short lesions. Trichomonids are
periods off the host. Most identified on a wet mount
raptors normally harbor as a motile, piriform proto-
small numbers of lice. If an Figure 5—Raised, yellowish, caseous plaques from Tricho- zoan with an anterior flagel-
infestation becomes exces- monas gallinae infection in the mouth of a barred owl. (Cour- la, undulating membrane,
sive, however, the bird may tesy of Dr. Darryl J. Heard, College of Veterinary Medicine, and prominent axostyle or
become highly irritated and University of Florida) as stationary flagellates
cause self-inflicted trauma. stained with Wright’s stain
A topical ectoparasite pow- or Diff Quick® (American
der and/or ivermectin (200 µg/kg subcutaneously or Scientific Products, McGraw Park, IL).29 Trichomonia-
orally, repeated in 10 to 14 days) can be used on debili- sis can be treated with oral metronidazole (30 to 50
tated raptors to minimize secondary effects associated mg/kg twice daily for 5 to 7 days).
with lice infestation. Capillariasis is a differential for trichomoniasis but is
Hippoboscid flies (Pseudolynchia species) are com- often more extensive, with lesions in the mouth,
mon on raptors; these flies are generally nonpathogenic oropharynx, esophagus, crop, small intestine, and ce-
but may be involved in the transmission of blood- cum.5 Diagnosis is made by detecting the double-oper-
39
borne protozoan parasites (e.g., Haemoproteus species). culated eggs in the feces or in a swab or scraping of the
Clinical myiasis is associated with such species of flies as oral lesions.29 Treatment of capillariasis in raptors is
40
Calliphora and Protocalliphora. Myiasis is usually a with oral fenbendazole (30 to 50 mg/kg once daily for
problem in eyasses (nestling raptors) but has occasion- 5 days). A recent report of suspected fenbendazole toxi-
ally been diagnosed in adults with debilitating injuries. city with bone-marrow suppression in several species of
A number of fleas, mites, and ticks are also found on birds should alert practitioners to monitor raptors re-
raptors and generally have no negative effect on the ceiving this drug.42
health status of the bird. One noted exception is a clini- The top five differentials for raptors with caseous le-
cal case of scaly-leg mite (Knemidokoptes mutans) in a sions in the oral cavity are candidiasis, trichomoniasis,
great horned owl.41 capillariasis, bacterial abscesses, and hypovitaminosis A.
It is imperative that the proper diagnosis is established
Internal Parasites because each of these conditions requires a different
Raptors are host to numerous internal parasites, in- therapeutic approach.

MALLOPHAGA ■ MYIASIS ■ TRICHOMONIASIS

 Small Animal/Exotics 20TH ANNIVERSARY Compendium April 1999

Blood Parasites
Common blood parasites of raptors include species
in the genera Plasmodium, Leucocytozoon, and Haemo-
proteus.39,43 Other less frequently diagnosed blood para-
sites (not discussed in this article) are species of Try-
panosoma and Babesia. 39 Transmission of all raptor
hemoparasites requires an insect vector. Plasmodium,
Haemoproteus, and Leucocytozoon species are transmit-
ted by mosquitoes, hippoboscid flies or Culicoides
species, and simuliid flies, respectively. Much debate ex-
ists regarding the pathogenicity of hemoparasites in
raptors. Most investigators agree that Plasmodium
species are pathogenic.
Clinical signs associated with Plasmodium infections Figure 6—Intraerythrocytic Plasmodium species schizont (ar-
in raptors range from asymptomatic to characteristic signs row) in a bald eagle. (From Greiner EC, Black DJ, Iverson
of weakness, respiratory distress, and biliverdinuria. Di- WO: Plasmodium in a bald eagle [Haliaeetus leucocephalus].
agnosis is based on clinical in Florida. J Wildl Dis 17[4]:555–558, 1981. Reprinted with
MPENDIU signs and blood film evalua- permission.)
M’

20th

CO

tions (Figure 6).44 Plasmodi-

S

1 9 7
9 - 1
9 9 9
ANNIVERSARY
A LookBack
There have been many advances
in our knowledge base,
diagnostic capabilities, and
therapeutic approaches to the
infectious diseases of raptors
during the past 20 years. The
most important of these advances
have been directed at aspergillosis of Plasmodium infections
and bumblefoot. Preventive
measures and early nonsurgical
and surgical therapies have
helped to decrease complications
that are commonly associated
with bumblefoot. Advances in
diagnosis and the pharmacologic
agents available for the
prevention and treatment of
aspergillosis have improved the
veterinarian’s ability to handle
this pervasive and potentially
fatal disease.
um infections can be treated
with oral chloroquine (effec-
tive against erythrocytic
forms) and primiquine (ef-
fective against tissue forms).
Redig suggests a loading
dose of 25 mg/kg of chloro-
quine combined with 1.3
mg/kg of primiquine fol-
lowed by 15 mg/kg of chloro-
quine plus 0.75 to 1.0 mg/
kg of primiquine at 12, 24,
and 48 hours.45 Treatment
may resolve the clinical signs
but rarely eliminates the in-
fection.
Although Haemoproteus
and Leucocytozoon species
are often considered non-
pathogenic in raptors, one
study showed that raptors
with hemoprotozoal infec-
tions had longer rehabili-
tation times and higher
mortality rates than did
those without hemoproto-
zoal infections. 46 Heavily
infected debilitated raptors
may benefit from the elimi-
nation of these parasites.
Treatment would presum-
ably be the same as that
stated for Plasmodium.
CONCLUSION
Veterinarians in clinical practice should be familiar
with the diseases of free-ranging and captive raptors.
Some infectious diseases (e.g., bumblefoot, aspergillo-
sis) often result from stressful conditions during hospi-
talization of raptors that originally presented with a dif-
ferent condition (e.g., trauma, toxicosis). Clinicians
should know the clinical signs, diagnostic protocols,
and therapeutic approaches of these diseases.
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About the Author
Dr. Deem is affiliated with the Field Veterinary Program,
Wildlife Health Sciences, Wildlife Conservation Soci-
ety/Bronx Zoo, Bronx, New York. She is a Diplomate of
the American College of Zoological Medicine.