BACTERIAL SINUSITIS IN a Gracula religiosa

Muhammad Aqmal Hakim Bin Mazlan (160702)Supervisor: Dr Jalila Abu

Co-Supervisor: Dr Abraham Gabriel

Introduction

Case report

Discussion

Conclusion

INTRODUCTION

COMMON HILL MYNA

Common hill myna or ‘Tiong Mas’Green-glossed black plumage body colourThe wattles, bill and legs are bright yellowRange from the southern part of Thailand to Malaysia and IndonesiaIt is known for its ability to mimic noises including human speech.

Order: PasseriformesFamily: SturnidaeGenus: GraculaSpecies: Gracula religiosa

(Birdlife.org)

• Sinusitis is an inflammation of one or more of the paranasal sinuses, often occurring during an upper respiratory infection, by extension from the nasal cavity.

(Blood, Studdert & Gay, 2007)

• Sinus is any of various air-filled cavities in the bones of the skull, especially one communicating with the nostrils.

(Dictionary.com)

(Doneley,B. 2011)

CASE REPORT

PATIENT SIGNALMENT• ID: Tiong

• Age: Adult

• Sex: Female

• Common name: Hill Myna

• Scientific name: Gracula religiosa

• Weight: 0.26kg

• Management: Pet bird

HISTORY

Owner noticed swelling left eyelid with fluid filled mass

Visit UVH after the mass became firm upon palpation

27 October 2015

2 weeks before

PHYSICAL EXAMINATION • Bright and alert

• Body Condition Score: 3/3

• Ulcerated mass at the upper eyelid about 3cm X 2cm in diameter of the left upper eyelid.

• The eye is still functioning and responded to light.

Problem list Differential diagnosis

Plan

#1 Ulcerated mass of the left upper eyelid

1. Sinusitis2. Neoplasia

(Papilloma, Lipoma)

3. Hypovitaminosis A

1. Fine needle aspiration (FNA)

2. Complete blood count

3. Surgery of mass removal

4. Swab for bacteriology lab

FNA RESULT

Presence of cocci-shaped bacteria

INCONCLUSIVE!

COMPLETE BLOOD COUNTHaemogram Result Reference value InterpretationErythrocyte Insufficient blood 2.08-4.02Hemoglobin Insufficient blood 36-204Leucocytes 45.0 1.75-16.44 Marked

heterophilia with left shift, monocytosis, eosinophilia; indicating infection or inflammation

Seg. Heterophils 29.25 0.26-7.67Monocytes 10.35 0.06-2.38Eosinophils 1.35 0.05-0.61

Thrombocytes Insufficient bloodPlasma protein 68Icterus index Lysed

SURGICAL procedure for MASS REMOVAL OF LEFT UPPER EYELID

ANESTHETIC PROTOCOL• Induction: Isoflurane 5 % + 0.5 litre Oxygen per minute

• Maintenance: Isoflurane 2.5 % + 0.5 litre Oxygen per minute

Close up view of the mass (approximately

3cm x 2 cm)

CranialCaudal

Elliptical skin incision was made on the

mass by using blade #15

CranialCaudal

The mass was curetted by using Volkmann's spoon

CranialCaudal

The excess skin was incised and removed by

using Mayo scissors. Any bleeding was

observed and dabbed with sterile gauze.

CranialCaudal

5 mL of normal saline and 5 mL of Metrogyl was flushed into the cavity

CranialCaudal

Subcutaneous closure was done using Vicryl 5-0

absorbable suture material with

modified cushing pattern

CranialCaudal

Skin closure:Skin closure was done using Vicryl 5-0 absorbable suture material with intradermal suture pattern.

CranialCaudal

Terramycin was applied

on the suture site

Casseous material: firm and yellow

colour

POST-OPERATIVE MANAGEMENT & TREATMENT

• Monitor suture site

• Monitor appetite

• Antibiotics- Enrofloxacin, 10 mg/kg, 0.52mL, PO, BID for 10 days

• NSAIDS- Carprofen, 4 mg/kg, 0.16 mL, PO, SID for 5 days

• Supplements- Multivitamin, 0.2 mL, PO, SID, for 5 days

PROGRESSION DAY 1 POST SURGERY

Bright and alert & good appetiteSuture site was dry and intact

No discharge was observed from suture site

BACTERIOLOGY RESULT

Pure culture of E. coli

ESCHERICHIA COLI• Facultative (aerobic and anaerobic growth) gram-negative, rod shaped

bacteria that can be commonly found in animal feces, lower intestines of mammals and in the environment.

(MicrobeWiki.kenyon.edu)

FINAL DIAGNOSIS

Bacterial sinusitis due to Escherichia coli

PROGNOSIS

GOOD

DISCUSSION

Common organisms

Predisposing factors

Treatment modalities

Choice of anesthetics

2

1

34

COMMON ORGANISM

Pseudomonas sp.

E. coli

Lactobacillus sp

Micrococcus sp

Mycoplasma sp

(Phalen, 2000)

(Tully & Harrison 1994)

PREDISPOSING FACTORS

• Complex anatomy of the infraorbital sinuses

• Hypovitaminosis A

• Irritation to the sinuses

• Extreme humidity

• Choanal atresia

(Tully & Harrison 1994)

TREATMENT MODALITIES

Nasal flushing

Surgical Resection

Aerosol therapy

(Tully & Harrison 1994)

CHOICE OF ANESTHETICS

• Inhalants• Rapid induction & recovery

• Rapid and frequent adjustments in anaesthetics depth

• Minimal biotransformation

• Minimal cardiorespiratory side effects or toxicity

• Isoflurane, Sevoflurane (Gunkel & Lafortune 2005)

• Injectables • Do not require special equipments and

machines

• Can be administered through many different routes (IV,IM,SQ & IP)

• Potential for prolonged and/or rough recoveries

• Need for an accurate weight for appropriate dosing

• Propofol, Ketamine etc

(Furtado & Andrade, n,d.)

CONCLUSION

CONCLUSION

• This is a case report of a common hill myna that was diagnosed with bacterial sinusitis, where it was surgically resected and managed with good clinical outcome.

• Treatment combination of antibiotics, aerosol therapy, and surgical resection often produce successful outcomes.

• A good management of pet birds in captivity could reduce the risk of occurrence of the disease.

ACKNOWLEDGEMENT

• Allah SWT

• Dr Jalila

• Dr Abraham, Dr Shafiq, Dr Wan

• DVM5 Rotation group 3, Siti Noor Fadhilah Azihi

• Nur Arina Binti Ahmad Jelani

• DVM class 2016

• Audience

REFERENCES•

• BirdLife International. 2012. Gracula religiosa. The IUCN Red List of Threatened Species 2012: e.T22710993A39682701. http://dx.doi.org/10.2305/IUCN.UK.2012-1.RLTS.T22710993A39682701.en. Downloaded on 26 November 2015.

• Blood, D., Studdert, V., & Gay, C. (2007). Sinusitis. Saunders Comprehensive Veterinary Dictionary . Edinburgh: Elsevier.

• Curro TG: Anesthesia of pet birds. Sem Avian Exot Pet Med 7:10-21, 1998

• Furtado, KS, and FO Andrade. 'Comparison Of The Beneficial And Adverse Effects Of Inhaled And Injectable Anaesthetics: A Mini-Review.OA Anaesthetics'. Oapublishinglondon.com. N.p., 2015. Web. 29 Nov. 2015.

• Gunkel, C., & Lafortune, M. (2005). Current Techniques in Avian Anesthesia. Seminars In Avian And Exotic Pet Medicine , 14(4), 263-276. http://dx.doi.org/10.1053/j.saep.2005.09.006

• Microbewiki.kenyon.edu,. (2015). Escherichia coli - MicrobeWiki. Retrieved 23 November 2015, from https://microbewiki.kenyon.edu/index.php/Escherichia_coli

• Phalen DN: Respiratory medicine of cage and aviary birds, Vet Clin North Am Exot Anim Pract 3: 423-452, 2000

• Sinus. (n.d.) American Heritage® Dictionary of the English Language, Fifth Edition . (2011). Retrieved December 2 2015 from http://www.thefreedictionary.com/sinus

• Tully TN, Harrison GJ (1994). Pneumology. In: Avian Medicine: Principles and application. BW Ritchie , GJ Harrison, LR Harrison (eds). Wingers Publishing, Lake Worth, pp. 556-606.

THANK YOU