PREVENTATIVE MEDICINE
The focus of a preventative medicine program for paediatrics is to ensure the mother’s health and welfare is optimised (managed animals) or in the case of orphans, to encourage meticulous husbandry, hygiene and nutrition.
Rearing techniques that minimise imprinting and promote normal behaviour and social interactions are to be encouraged (Englefield et al. 2019). This is especially important for animals destined for release back to the wild. A postrelease study in hand-reared brush-tailed possumsTable 15.3. Clinical signs, aetiology, diagnosis and treatment of common paediatric presentations.
| Reason for presentation | Clinical signs | Aetiology | Diagnosis | Treatment |
| Recent orphan | Dependent young presented without mother | Deceased or ill mother; abandoned | History | Correct hydration deficits and hypothermia; assess for injuries; provide nutrition appropriate for species and stage Ofdevelopment |
| Failure to thrive;1 inadequate nutrition | Weight loss; Iackofweightgain; poor body condition; poor growth rate; poor pelage; reduced activity; weakness; lethargy | Malnutrition (inappropriate diet, quantity, frequency, temperature of feed, equipment); poor suck reflex; inappropriate thermal environment- psychological stress;2 mismothering; sibling competition; congenital/ hereditary abnormality; disease; parasitism | History; detailed husbandry and diet review; physical examination; faecal examination; CBC, biochemistry; work-up for systemic disease based on other clinical signs (e.g. imaging) | Correct or modify diet; nutritional support (may include tube feeding); correct or modify environment (e.g. additional thermal support); treat underlying disease |
| Diarrhoea | Soft, loose or watery faeces inappropriate to stage of development (note: normal early PY typically have soft faeces that may be mistaken for diarrhoea); increased frequency of defecation or tenesmus; cloacal/rectal prolapse | Inappropriate diet (e.g. feed containing lactose in lactose- intolerant species), poor feeding management (sudden changes in diet e.g. after being orphaned, transitioning between formulae or at weaning, incorrect feed temperature, excessive feed volumes, irregular routine); poor hygiene; environmental stress;2 pathogens (bacteria, fungi, protozoa); helminths | History and signalment; detailed husbandry and diet review; obtain description of duration, type and nature of diarrhoea; consider stage Ofdevelopment; faecal wet mount, Gram stain and faecal flotation; faecal culture if not responsive to husbandry modification, supportive care and treatment | Correct hydration; consider electrolyte supplementation (e.g. between formula feeds); good nursing/hygiene; barrier creams to cloaca to prevent skin maceration; treat specific pathogens if identified; consider concurrent prophylactic anti-yeast therapy if antibiotics prescribed; faecal Slurryfrom healthy adult conspecific; commercial probiotics of limited value; avoid antimotility agents; identify and reduce stressors |
| Acute abdomen | Abdominal distension; marked abdominal pain (may present as bruxism) | Bloat; Gl obstruction (e.g. intussusception Secondaryto diarrhoea, foreign body); severe ileus; bacterial enteritis; peritonitis | History; detailed husbandry and diet review; physical examination; plain ± contrast radiography; ultrasonography | Stabilise; if fails to respond to medical therapy (fluids, analgesia, gastroprotectants, motility agents) in 24-48 hr consider surgical exploration and correction if indicated; dietary correction |
| Skin disease | Dry, rough cracking scaly skin; localised inflammation; alopecia; poor hair coat; cutaneous swellings | Inadequate moisturisation; selfsucking of a body part or being sucked by a buddy; environmental stress;2 inappropriate pouch environment; malnutrition; ectoparasites; bacterial, fungal or viral infection | Age/stage Ofdevelopment; history; Stickytape preps, skin scrapes; swabs for cytology and culture; biopsy for histopathology and/or culture | Correct husbandry; routine moisturiser application; omega 3 supplementation; provide a dummy Ifsucking body part (e.g. teat); bandaging; antimicrobials as appropriate |
Table 15.3. (continued)
| Reason for presentation | Clinical signs | Aetiology | Diagnosis | Treatment |
| Trauma | Wounds; contusions; fractures; haemorrhage; hernia | Vehicle/road trauma; predator attack; fence collision or entanglementgunshot wounds | History; physical examination; radiography | Stabilise; wound care; medical (e.g. sedation, analgesia, antibiotics) or surgical treatment as indicated; assess severity of injuries and eventual fate to determine prognosis |
| Limb or tail fractures | Lameness, swelling; inability to stand | Trauma; metabolic bone disease (inadequate calcium intake/ inappropriate formula or Gl disease resulting in malabsorption or vitamin D deficiency and/or inadequate or inappropriate exercise for stage of development) | Historyand husbandry/dietary review; physical examination; radiography; review medical history; nutritional analysis of feed | Reduce and stabilise fractures according to small animal orthopaedic principles; calcium supplementation; consider euthanasia for severe cases of metabolic bone disease or where fracture type/ location will result in significant dysfunction |
| Respiratorydisease | May be subtle (e.g. lethargy, inappetence); dyspnoea; nasal discharge; respiratory stertor and/or stridor | Rhinitis; aspiration pneumonia; infectious pneumonia; parasitism | History and husbandry review; physical examination; thoracic radiography (Fig. 15.6); samples for microscopy and culture and susceptibility testing; endoscopy | Oxygen therapy; antimicrobials ideally on the basis of culture and susceptibility (oral, nebulised, systemic); anthelmintic if indicated |
| Corneal ulceration | Blepharospasm; ocular discharge; Visiblecorneal lesions | Trauma; exposure/dehydration; entropion | Physical examination including ophthalmic assessment with fluorescein staining | Topical ophthalmic antibiotics; analgesia; debridement and nictitating membrane flap if severe and refractory |
| Cataracts | Unilateral or bilateral lens opacity | Trauma; nutrition (e.g. galactosaemia, vitamin A deficiency); metabolic disease; infection; congenital | History and husbandry review (especially nutritional); thorough ophthalmic examination; serum biochemistry; urinalysis | Surgery but prognosis is guarded in some cases/species and dependent on degree of pathology and surgical technique used (see Chapter 10); rarely spontaneous resolution |
| Oral disease | Inappetence; halitosis; facial swellings; malocclusion; oral plaques; loose or fractured teeth | Candidiasis; malocclusion; trauma; inappropriate feeding technique; dental or soft tissue bacterial infections | History, husbandry and diet review; thorough oral examination (may require anaesthesia); radiography (extra- and intraoral) | Fluid and nutritional support if unable or unwilling to feed; treat underlying problem; corrective burring (wombats); dental extraction; euthanasia (e.g. severe malocclusion) |
1Defined as inadequate caloric intake, inadequate caloric absorption or excessive caloric expenditure (Cole and Lanham 2011).
2PsychoIogicaI and environmental stressors include an inappropriate artificial pouch environment, excessive handling, petting and playing with children, contact with Unfamiliarenvironments and noises, sudden changes in routine (e.g. prolonged pouch deprivation during the process of pouch weaning), sudden changes in feeding schedule, sudden withdrawal of contact with carer or buddy.
268 CurrentTherapyin MedicineofAustraIian Mammals
Fig. 15.6. Respiratory disease is common in hand-reared marsupial orphans; thoracic radiography is a valuable diagnostic tool. (a) Lateral thoracic radiograph of a juvenile eastern grey kangaroo (Macropus giganteus) with severe aspiration pneumonia.
Image: Timothy Portas. (b) Ventrodorsal thoracic radiograph of a juvenile bare-nosed wombat (Vombatus ursinus) with bacterial pneumonia and secondary pneumothorax. Image: Taronga Western Plains Zoodemonstrated that the majority of human habituated possums failed within 2 wk of release to the wild (Mella et al. 2023). Failure included being killed by a predator,
Fig. 15.7. Dorsoventral radiograph of the pelvis and pelvic limbs of a hand-reared eastern grey kangaroo (Macropusgiganteus) PY with metabolic bone disease. Note the generalised osteopenia, multiple pathological fractures and resultant pelvic limb deformity. Image: Taronga Western Plains Zoo
requiring rescue due to an inability to self-sufficiently forage or sustaining an injury necessitating veterinary treatment. To improve outcomes the authors suggest the development of anti-predator training programs and recommend limiting the time orphans spend in care, as time in care is positively correlated with the degree of eventual habituation. Exposure during rearing to wild foods and their natural acquisition is critical to promoting behavioural feeding competence and the maturation of a wellfunctioning gastrointestinal microbiome (Blyton et al. 2022; Goldenberg et al. 2022).
Appropriate housing is crucial to prevent injuries and misadventure, and spaces need to be large and complex enough to encourage the development of species-relevant skills such as climbing, burrowing, gliding, swimming and foraging. Preventing pest or intermediate host access to aviaries and yards is important for the prevention of some conditions (e.g. angiostrongyliasis in possums) (Ma et al. 2013).
For hand-reared PY excellent hygiene is important to minimise the risk of infectious disease; this includes proper sterilisation of feeding utensils, maintenance of joey cleanliness and freshness of milk formula fed (Rich 2012). Avoiding stress, overcrowding and heavy faecal loads in yards housing emergent and emerged eastern grey kangaroos (Macropus giganteus) and isolating unwell animals are important measures to reduce the risk of coccidiosis; plasma transfusions and various pulse dosing regimens with coccidiocidal agents have also been trialled as prophylactic measures, but their efficacy remains untested.
Vaccination against clostridial organisms using a multivalent livestock vaccine can be given to macropods at pouch emergence, with a second dose given at least 4 wk later. Preliminary research suggests a second dose 14 wk after the first produces a higher and more persistent tetanus antibody titre than a second dose given at 4 wk (Phillips et al. 2012). Vaccination may also be considered prudent for other young animals in a managed care setting (e.g. against erysipelas and clostridial enteritis in cetaceans and against canine viruses such as canine parvovirus, infectious canine hepatitis and canine distemper in dingoes) (Blyde and Vogelnest 2008; Hulst 2008).
Routine endoparasitic treatment or prophylaxis is not necessary for many species. Although juvenile kangaroos often have reasonable GI helminth burdens, the clinical significance of these appears to be minimal (Cripps et al. 2014). Most marsupial orphans arrive into care before pouch emergence and so have had limited exposure to environmentally acquired parasites. Neonatal and juvenile animals should be monitored closely, and regular health evaluations scheduled, as early detection and intervention improves prognosis if health or developmental issues arise.
6.