Sugar gliders

Sugar gliders (Petaurus breviceps) are a relatively new addition to the pet-keeping hobby. Native to Australia, Papua New Guinea, and parts of Indonesia, with seven subspecies recog­nized, it is likely to represent a species complex rather than a single wide-ranging species.

At the time of writing only limited baseline information on this species is available, so the clinician may have to make inferences when dealing with sugar gliders. This is expected to change over the next few years as their popularity grows and they are presented to the veteri­narian more frequently.

In the United States state permits may be required for the possession, breeding, trade, or display of sugar gliders. The same is true for Canada and Australia.

Table 7-1 Sugar gliders: Key facts

Average life span (yrs)

9-15

Males: 115-160

Females: 90-130

36.2 ± 0.4

16-40

200-300

16

2

10

110-120 days (35-60 days out of pouch)

Males: 12-14

Females: 8-12

Weight (g)

Body temperature (° C) (see “Thermoregulation”)

Respiratory rate (per min)

Heart rate (beats per min)

Gestation (days)

Average litter size

Time in pouch (weeks)

Age at weaning

Sexual maturity (months)

Consultation and handling

Sugar gliders vary markedly in their tolerance of routine handling and examination. Some are used to handling; others will bite and make efforts to escape. They are fast and can grip extremely well and can readily elude the veterinarian's grasp. A loose sugar glider can be covered with a towel and restrained gently but firmly through the towel, simultaneously minimizing the risk of a bite. A sugar glider is small enough to be restrained in one hand, facing out from the palm with a thumb under the jaw and index finger on top of the head and the body cupped in the palm of the hand.

Some individuals may develop a mild urticarial reaction triggered by the sharp points of sugar glider claws.

Blood sampling

Up to 1% body weight (g) can be safely taken. The preferred site is the cranial vena cava at the thoracic inlet. Alternatively the medial tibial artery just distal to the stifle.

Sugar gliders should be kept at an ambient temperature of 24° to 27° C, with nighttime temperatures not dropping below 21° C. They maintain their body temperature by a combi­nation of social thermoregulation (huddling), good insulation, and low-cost locomotion. Core body temperature fluctuates naturally between 32° and 34° C at rest, increasing up to 38° C when active (Kortner and Geiser 2000).

Cool sugar gliders may exhibit torpor; this appears to be a physiologic adaptation to mini­mize energy consumption at times of poor energy availability—in wild sugar gliders, torpor is triggered on cold and wet days, typically when environmental temperatures fall below 10° C, although heavy rain can trigger torpor at temperatures of 15° C or below (Kortner and Geiser 2000).

Torpor should be distinguished from lethargy or shock; a good clinical history especially with regard to ambient environmental conditions, as well as response to gentle warming, should help to differentiate torpor from clinical conditions. Periods of torpor usually last between 2 and 23 hours.

For general principles see “Thermoregulation” under Nursing Care in Chapter 2.

Fluid therapy

Fluid requirements are 60 to 100 mL/kg per day. Subcutaneous fluids can be given at 2% of body weight 2 to 4 times daily; note that fluids may pool in the patagium. Hyaluronidase (150 IU∕mL) 0.5 to 1.0 mL/L of fluids may improve fluid absorption. Intraosseous fluids can be given into the femur; alternatively, small bolus volumes may be given into the cephalic or lateral saphenous vein.

Nutritional support

Use commercial powdered recovery diets that reconstitute into a paste. Some sugar gliders may accept fruit juice, yogurt, or baby foods (0- to 3-month-old fruit purees—avoid milk­containing products) fortified with vitamins and/or calcium.

Basal energy requirements (BER) = 49 (BW in kg⁰'⁷⁵)

(Note the different constant for marsupials.)

Actual energy requirement (MER) = 1.25 (BER)

because the glider's actual energy requirements will vary from 1 to 2 times the BER depending on the condition.

Analgesia

Analgesics are especially important to prevent postoperative self-mutilation.

Anesthesia

Ideally starve for 4 hours prior to surgery. Induction and maintenance with isoflurane are safe and effective. Initiate anesthesia in an induction chamber and maintain with a small mask. Atropine at 0.02 to 0.04 mg/kg can be given to control salivation during induction.

Parenteral anesthesia with tiletamine-zolazepam at doses ranging from 8.4 to 12.8 mg/kg IM is cited as being safe (Carboni and Tully 2009), although the same combination at 10 mg/ kg has been linked with neurologic signs and death in the related squirrel gliders (Petaurus norfolcensis) (Fig. 7-1).

• Intraoperative care

• Keep warm (see “Thermoregulation”).

• Fluids (see “Fluid Therapy”)

• Postoperative aftercare

• Analgesia (see “Analgesia” above)

• Must be offered food as soon as recovers

• Keep warm.

Fig 7-1. Anesthetic monitoring of small mammals like sugar gliders can be challenging. Note the cloacal thermometer and Doppler ultrasound probe taped to the chest to monitor heart rate. (Courtesy of Sophie Jenkins, MRCVS.)

Cardiopulmonary resuscitation

1. Intubate and ventilate at 20 to 30 breaths/min.

2. If cardiac arrest, external cardiac massage at around 100 compressions/min.

a. Epinephrine at 0.2 mg/kg intracardiac, IV, or IO

3. Fluid therapy (see above)

4. If bradycardic, atropine at 0.05 mg/kg IV.

Behavioral disorders

Sugar gliders are communal animals that need the company of conspecifics where possible, and if kept individually they need a great deal of attention. Social deprivation can lead to loss of appetite, irritability, and self-mutilation and has been used experimentally to induce a serotonin-deficient model for the study of depression (Jones et al 1995). Where possible keep at least two sugar gliders; if not possible or as a temporary arrangement (e.g., after the loss of a companion), give plenty of time and attention, plus multiple toys to distract and provide environmental enrichment. Self-mutilation may also be triggered by stress, as well as postoperative irritation (see “Analgesia”). Fluoxetine 1 mg/kg PO every 12 hours may prove useful, but treatment is likely to take 4 to 8 weeks. Collars may need to be fashioned to temporarily prevent self-mutilation, although this is not a remedy in itself, and underlying issues need to be addressed.

Other stressors include unsuitable diet, sexual frustration, overcrowding, and unsanitary conditions.

Skin disorders

Sugar gliders have a thick fur covering. They possess a patagium on each side—a skin flap well supplied with muscles that connects the lateral edge of the foreleg with the tarsi to provide a gliding plane when outstretched (Fig. 7-2). Sugar gliders possess a well-developed tibiocarpalis muscle along the most lateral area of the patagium.

Male sugar gliders have a scent gland at the base of the neck ventrally (gular scent gland) (Fig. 7-3) and over the frontal bone between the eyes (frontal scent gland); these, especially the frontal gland, should not be confused with an area of alopecia. These glands are under sex hormonal influence; the size varies with reproductive status and is reduced following castration (Stoddart and Bradley 1991). Both sexes possess an anal gland. Females have a scent gland in their pouch (marsupium), which also contains four teats.

Pruritus

• Ectoparasites

• Self-mutilation (see Behavioral Disorders)

• Aberrant visceral larval migrans (see Gastrointestinal Disorders)

• Parastrongyloides (see Gastrointestinal Disorders)

Alopecia

• Self-inflicted trauma

• Dermatophytosis (Trichophyton spp.)

• Hair loss at base of tail/head

Fig 7-2. The patagium, or gliding membrane, of sugar gliders stretches between the front and hind legs. (From Ness RD, Johnson-Delaney CA. 2012. Sugar gliders. In: Quesenberry KE, Carpenter JW (eds.). Ferrets, rabbits, and rodents: Clinical medicine and surgery, 3rd ed. Saunders, St. Louis.)

Fig 7-3. The male glider also has a gular scent gland, located at the base of the neck. (From Ness RD, Johnson-Delaney CA. 2012. Sugar gliders. In: Quesenberry KE, Carpenter JW (eds). Ferrets, rabbits, and rodents: Clinical medicine and surgery, 3rd ed. Saunders, St.

Scaling and crusting

• Dermatophytosis (Trichophyton spp.)

Erosions and ulceration

• Bite wounds

Nodules and nonhealing wounds

• Lumpy jaw (Actinomyces—see Gastrointestinal Disorders)

• Abscessation

• Pasteurella multocida abscess

Ectoparasites

• Rare in captive sugar gliders

• Choristopsylla tristis (flea)

• Acanthosylla pavida (flea)

• Guntheria kowanyam (trombiculid mite)

• Petauralges rackae (astigmatid mite)

• Atopomelid mites

• Ixodes tasmani (tick)

Neoplasia

• Cutaneous lymphosarcoma (Hough et al 1992); see also Systemic Disorders

• Dermal hemangiosarcoma (Rivas et al 2014)

Other findings on clinical examination

• Damage to the partagium (laceration, bite wounds)

Investigations

1. Microscopy: Examine fur pluck, acetate strips, or skin scrapes to affected area and examine for ectoparasites and ringworm.

2. Cytology: Stain with lactophenol blue for ringworm.

3. Bacteriology and mycology: Hair/quill pluck or swab lesions for routine culture and sensitivity.

4. Fine-needle aspirate followed by staining with rapid Romanowsky stains

5. Biopsy obvious lesions.

6. Ultraviolet (Wood's) lamp: Positive for Microsporium canis only (not all strains fluoresce).

7. Radiography

8. Routine hematology and biochemistry

9. Endoscopy

10. Biopsy

11. Ultrasonography

Treatment/specific therapy

• Lumpy jaw ( see “Disorders of the Oral Cavity” in Gastrointestinal Disorders)

• Patagial damage

• Repair; covering antibiosis if bite wound/infected

• Abscessation

• Remove intact if possible; lance, debride, and flush if not.

• Appropriate antibiosis

• May be secondary to skin-penetrating injury

• Dermatophytosis

• Griseofulvin 20 mg/kg PO s.i.d. for 30 to 60 days

• Itraconazole 5 to 10 mg/kg PO b.i.d.

• Hair loss at tail base/head

• Linked with increased sexual activity

• Ectoparasites

• Ivermectin 0.2 mg/kg PO or SC once; repeat after 2 weeks.

• Selamectin 6 to 18 mg/kg applied topically; repeat in 30 days.

• Carbaryl powder in nest

• Ticks

• Physical removal of individual ticks

• Ivermectin 0.2 mg/kg PO or SC once; repeat after 2 weeks.

• Neoplasia

• Surgical resection

• Chemotherapy

Respiratory tract disorders

Bacterial

• Pneumonia

• Pasteurella multocida

• Streptococcus pneumoniae

• Klebsiella spp.

• Mycobacteriosis (see Systemic Disorders)

Fungal

• Cryptococcosis (see Systemic Disorders)

Protozoal

• Toxoplasmosis (see Neurologic Disorders)

Parasitic

• Marsupostrongylus spp. (lungworm)

• Rileyella petauri (pentastomes)

Neoplasia

Other noninfectious problems

• Trauma

• Aspiration pneumonia

• Cardiovascular disease (see Cardiovascular and Hematologic Disorders)

• Iron storage disease (see Nutritional Disorders)

Findings on clinical examination

• Dyspnea

• Cyanosis

• Abnormal lung sounds

• Abnormal heart sounds (see Cardiovascular and Hematologic Disorders)

• Ocular and nasal discharge

Investigations

1. Tracheal wash/bronchoalveolar lavage

2. Culture and sensitivity

3. Cytology

4. Pleural tap and cytology

5. Radiography

6. Serology

7. Endoscopy

8. Biopsy

9. Ultrasonography

Management

1. Supportive treatment (e.g., fluids, covering antibiosis)

2. Nebulization either with antibiotics or general antimicrobial (e.g., F10, Health and Hygiene Ltd.)

3. Oxygen therapy if needed

4. Reduce stress levels. Hospitalize away from dogs and noisy cats; keep in darkened position.

TreatmentZspecific therapy

• Bacterial pneumonia

• As for other small animal species including antibiosis, anti-inflammatories

• Nebulization

• Pasteurella often associated with stress

• Pentastomes (Rileyella)

• Believed to have direct life cycle (Spratt 2003)

• Ivermectin at 0.2 mg/kg SC, topically repeated every 2 weeks for three injections

• Anti-inflammatories may reduce risk of inflammation following parasite die-off.

• Marsupostrongylus

• Fenbendazole at 20 to 50 mg/kg PO in a single daily dose for 3 days; repeat after 2 weeks.

• Ivermectin 0.2 mg/kg PO or SC once; repeat after 2 weeks.

• Selamectin 6 to 18 mg/kg applied topically; repeat in 30 days.

• Consider covering antibiotics and anti-inflammatories as large worm mortalities can trigger a serious pneumonia.

• Parastrongyloides trichosuri

• Parasite of the brush-tailed possum Trichosurus vulpecula; experimentally readily infects sugar gliders

• Parasitic adults found in small intestine.

• Eggs passed out in feces; develop into free-living adults; in conditions of starvation and crowding infective L3 larvae develop that penetrate skin and seek out the small intestine, where they become parasitic adults.

Gastrointestinal tract disorders

Sugar gliders are diprotodont and are considered primarily as insectivore/gumnivores and have a fairly simple gastrointestinal tract, although the cecum is enlarged for gum fermentation.

Permanent dental formula

Sugar gliders have teeth designed for stripping bark off branches. The teeth do not grow continuously; they have distinct anatomical roots. The mandibular incisors are longer than the maxillary. The molars are larger and wider than the premolars.

Disorders of the oral cavity

• Dental disease

• Periodontal disease: Can be plaque-induced. Radiography to assess root resorption/ bone disease. Clean and polish; extract problem teeth. Incisor extraction frequently results in mandibular fracture.

• Oral abscesses

• Typically in young sugar gliders

• Usually enteric bacteria isolated

• Lance, debride, and administer appropriate antibiosis.

• Thought to be initiated from fecal bacteria on claws introduced during scratching of head and mouth

• Lumpy jaw (Actinomyces spp.)

• Radiography to assess extent of underlying pathology

• Associated tooth extraction

• Surgical resection

• Debride as much as possible if unable to resect completely.

• Appropriate antibiosis; clindamycin-impregnated methylmethacrylate beads may be useful (Brust 2013).

Differential diagnoses for gastrointestinal disorders

Bacterial

• Actinomyces (lumpy jaw)

• Fusobacterium necrophorum (lumpy jaw)

• Bacterial overgrowth

• Clostridium spp.

• Yersinia pseudotuberculosis

• Salmonella spp.

• Paracloacal and cloacal abscessation

Protozoal

• Cryptosporidium

• Giardia

• Trichomonas

• Coccidiosis

Parasitic

• Worms (see also “Pruritus” in Skin Disorders and Neurologic Disorders)

• Parastrongyloides spp. (Nolan et al 2007)

• Paraustrostrongylus spp.

• Paraustroxyuris spp.

• Capillaria spp.

Nutritional

• Excess sugar content in diet

Neoplasia

• Transitional cell carcinoma (Marrow et al 2010)

• Cloacal and paracloacal gland enlargement

Other noninfectious problems

• Constipation

• Obstruction

• Rectal prolapse

• Megacolon

Findings on clinical examination

• Vomiting

• Diarrhea

• Lack of feces (reduced food consumption, constipation, obstruction)

• Dehydration

• Lethargy

• Swelling of mandible/maxilla (lumpy jaw)

• Rectal mucosa prominent (rectal prolapse)

• Swollen abdomen, lethargy, dehydration, (intussusception, megacolon/gastric dilatation-volvulus (GDV)∕impaction∕constipation)

• Palpable mass, straining to defecate, reduced appetite, self-mutilation of the perineal skin (neoplasia)

• Swellings around cloaca, pain, dyschezia (cloacal/paracloacal gland enlargement/ abscessation)

Investigations

• Fecal examination

• Gram stain

• Modified Ziehl-Neelsen staining for Cryptosporidium

• Motile flagellated protozoa (Trichomonas, Giardia)

• Worm eggs

• Radiography

• Foreign body

• Osteomyelitis/osteolysis of maxilla/mandible (lumpy jaw)

• Cloacal narrowing, intestinal and colonic distension (pericloacal neoplasia)

• Intussusception/megacolon/GDV

• Routine hematology and biochemistry

• Culture and sensitivity

• Endoscopy

• Biopsy

• Ultrasonography

Management

1. Fluid therapy (see Nursing Care)

2. Gut motility enhancers (e.g., cisapride 0.25 mg/kg PO daily to q.i.d.)

3. Gastroprotectants (e.g., sucralfate)

4. If vomiting:

a. Use antiemetics (e.g., metoclopramide at 0.05-0.1 mg/kg SC t.i.d.).

b. Monitor blood glucose; consider dextrose/saline fluids.

TreatmentZspecific therapy

• Lumpy jaw (see Disorders of the Oral Cavity)

• Bacterial overgrowth

• Appropriate antibiosis

• Correct any dietary predisposing factors.

• Cloacal and paracloacal abscessation

• Appropriate antibiosis

• Lance and debride if appropriate.

• Excess dietary sugar

• Diarrhea may be due to bacterial overgrowth.

• Possible osmotic diarrhea

• Correct diet and consequential disease.

• “Stress diarrhea” of joeys—see Neonatal Disorders

• Coccidiosis

• Potentiated sulfonamides at 15 mg/kg PO b.i.d.

• Toltrazuril 7.0 mg/kg PO for 2 days; repeat weekly for 3 weeks.

• Cryptosporidium

• No effective treatment recognized

• Potentiated sulfonamides may be of use, as may nitazoxanide at 5 mg/kg PO s.i.d.

• Potential zoonosis, so consider euthanasia.

• Trichomonas

• Metronidazole at 10 to 20 mg/kg PO daily.

• Giardia

• Metronidazole 25 mg/kg PO b.i.d.

• Intestinal worms

• Fenbendazole at 20 to 50 mg/kg PO in a single dose for 3 days; repeat after 2 weeks.

• Ivermectin 0.2 mg/kg PO or SC once; repeat after 2 weeks.

• Rectal prolapse

• Replace under general anesthesia.

• May need vertical sutures to temporarily retain; ensure that the urinogenital slit remains unobstructed.

• Analgesia: meloxicam 0.2 mg/kg PO daily. An E-collar may be needed.

• Feed low-bulk foods during recovery.

• Megacolon

• No etiology elucidated.

• Stool softeners and cisapride 0.25 mg/kg PO daily to q.i.d. may prove useful.

• Intussusception

• Secondary to chronic diarrhea; more common in younger gliders

• Surgical correction

• GDV

• Surgical correction

• Constipation

• Laxatives (e.g., soft paraffin-based gut lubricants, lactulose)

• Gut motility enhancers (see “Management”)

• Surgery

• Possible causes include insufficient dietary liquids or fiber, generally overall diet, stress, lack of exercise, or gut disease/problems.

• Pericloacal neoplasia

• If caught sufficiently early, may respond to surgery/chemotherapy

• Likely to require euthanasia

Nutritional disorders

Note that sugar gliders will seasonally gain weight, peaking in the late autumn and winter, with weight increases as much as 20 to 30 g (Holloway and Geiser 2001).

Sugar glider nutrition

In total, aim to offer approximately 15% to 20% of the sugar glider's body weight.

Diet 1

1. 75% sugar glider kibble/pellet. Should be available at all times.

2. 25% fresh fruit and vegetables, placed in the enclosure at night and removed each morning. Items should not be diced or chopped to maintain moisture content.

3. A calcium-based multivitamin should be sprinkled over fresh fruits or vegetables 3 to 4 times per week.

Diet 2

1. 50% Leadbeater's Mixture

2. 50% insectivore/carnivore diet/pellet

Leadbeater's Mixture:

• 150 mL warm water

• 150 mL honey

• 1 shelled hard-boiled egg

• 25 g high-protein baby cereal

• 1 tsp vitamin/mineral supplement

Mix warm water and honey. In a separate container, blend the egg until homogenized, then gradually add honey/water mixture followed by the vitamin powder, then baby cereal. Blend after each addition until smooth. Refrigerate.

• Aflatoxicosis (see Hepatic Disorders)

• Iron storage disease (Clauss and Paglia 2012)

• Sudden-onset dyspnea and death

• May be due to excessive scavenging of dietary iron in a species that feeds naturally on an iron-deficient diet; the lack of naturally occurring tannins may also contribute.

• May also be related to feeding of homemade diets, possibly with high dietary vitamin C. Linked with obesity also; alternatively can be triggered by chronic inflammatory disease. Hypervitaminosis C and chronic inflammation can increase transferrin levels.

• Recommended dietary iron levels of 50 pg/g of dry diet and 100 mg/kg vitamin C.

• Dierenfeld et al (2006) report postfeeding trial iron levels of 1.5 ± 0.7 pmol/L, which they consider to be elevated.

• Iron was also detected in the feces of sugar gliders.

• Metabolic bone disease (nutritional osteodystrophy)

• Muscle weakening of hind legs, progressing to paralysis; lameness (pathological fractures); seizures

• Pneumonia, heart disease

• Radiography: Pathological fractures; poor bone density

• Biochemistry: Normal blood calcium 2.1 to 2.2 mmol/L;

phosphorus 1.4 to 2.0 mmol/L;

normal range of 25-hydroxyvitamin D unknown, but Dierenfeld et al (2006) report a range of 44.9 to 132.3 nmol/L.

• Strict rest for fractures

• Emergency treatment

- Calcium gluconate 100 mg/kg SC b.i.d. for 3 to 5 days followed by calcium glubionate 23 mg/kg PO daily

- If normocalcemic then calcitonin at 50 lU/kg weekly for 3 weeks (see Corriveau 2015)

• Dietary calcium and vitamin D₃ supplementation

• Obesity

• Common with captive diets; likely an imbalance between high caloric intake and reduced energy expenditure (reduced exercise, nonbreeding)

• Weigh weekly and record the weights so as to avoid obesity.

• Limit amount offered so that all is consumed overnight with none left over.

• Polioencephalomalacia (see Neurologic Disorders)

• Hepatic lipidosis

• Likely associated with obesity and anorexia

• Aggressive fluid therapy

• Parenteral nutrition with glucose and vitamins

• Assisted feeding by syringe (see Nursing Care)

• Calcium gluconate PO or propylene glycol PO may be of use.

• Dexamethasone at 0.2 mg/kg IV, SC, or PO

Hepatic disorders

Bacterial

• Hepatitis

• Listeriosis (see Neurologic Disorders)

Parasitic

• Athesmia spp. (trematode—liver fluke)

Nutritional

• Aflatoxicosis

• Hepatic lipidosis

• Iron storage disease (see Nutritional Disorders)

• Ketosis (see Reproductive Disorders)

Neoplasia

• Lymphoma/lymphosarcoma (see Systemic Disorders)

• Hepatic adenocarcinoma

Other noninfectious problems

• Lymphocytic hepatitis

• Cholangiohepatitis

Findings on clinical examination

• Reduced or loss of appetite

• Vague signs of ill health

• Abnormal feces

• Hepatomegaly

• Jaundice (rare)

• Ascites

• Seizures

• Anorexia, anemia, jaundice, lethargy, and diarrhea

Investigations

1. Radiography

2. Fecal examination

a. Trematode eggs (Athesmia spp.)

3. Routine hematology and biochemistry

4. Culture and sensitivity

5. Endoscopy

6. Biopsy

7. Ultrasonography

Management

1. Fluid therapy (see Nursing Care)

2. Lactulose at 150 to 750 mg/kg PO b.i.d. or t.i.d.

3. Milk thistle (Silybum marianum) is hepatoprotectant. Dose at 4 to 15 mg/kg PO b.i.d. or t.i.d.

TreatmentZspecific therapy

• Hepatitis

• General supportive management (see Management)

• Appropriate antibiosis

• Athesmia spp.

• Praziquantel at 5 to 10 mg/kg PO or SC single dose

• Aflatoxicosis

• Treat as above in Management.

• Typical sources include contaminated foodstuffs (e.g., peanuts; also crickets fed on contaminated sources), so investigate possible sources. Change all suspect food items for fresh.

• Hepatic lipidosis (see Nutritional Disorders)

Splenic disorders

Splenomegaly

• Hemangiosarcoma and hemangioma

• Cardiac disease (see Cardiovascular and Hematologic Disorders)

• Lymphoma/lymphosarcoma (see Systemic Disorders)

• Splenic erythroid hyperplasia

• Idiopathic splenomegaly

Treatment

• Address underlying cause.

• Splenectomy

• Splenic rupture

• Splenic torsion

• Neoplasia

• Splenitis

Pancreatic disorders

Neoplasia

• Pancreatic exocrine adenocarcinoma

Investigations

1. Radiography

2. Routine hematology and biochemistry

3. Culture and sensitivity

4. Urinalysis

5. Endoscopy

6. Exploratory surgery and biopsy

7. Ultrasonography

TreatmentZspecific therapy

• Pancreatic exocrine adenocarcinoma

• Readily metastasize; surgery is a possible option but metastasis highly likely before diagnosis is confirmed.

Cardiovascular and hematologic disorders

Bacterial

• Bacteremia/septicemia

• Endocarditis

Protozoal

• Toxoplasma gondii (myocarditis—see Neurologic Disorders)

• Hepatozoon spp.

Parasites

• Ophidascaris robertsi (larva migrans) (Gallego Agundez et al 2014)

Neoplasia

• Lymphoma (see Systemic Disorders)

Other noninfectious problems

• Cardiomyopathy

• Valvular heart disease

• Congenital disorders

Findings on clinical examination

• Cyanosis or pallor of the mucous membranes

• Anemia

• Slow capillary refill time

• Dyspnea

• Precordial thrill

• Arrhythmia

• Lack of thoracic percussion with auscultation

• Abnormal lung sounds

• Abnormal heart sounds

• Exercise intolerance

• Ascites

• Hepatomegaly, splenomegaly

• Weight loss

• Sudden death

• Nematodes in heart chambers (ultrasound/postmortem—Ophidascaris spp.)

Investigations

1. Auscultation

2. Blood pressure

3. ECG

4. Radiography

5. Ultrasonography/echocardiography

6. Routine hematology and biochemistry

7. Serology for Toxoplasma

8. Culture and sensitivity

9. Endoscopy

10. Biopsy

Management

• Reduce stress (e.g., keep in a cool, shaded, or darkened area away from potential stressors such as dogs).

• Provide a high oxygen environment.

• For pleural effusion, consider tube thoracostomy.

TreatmentZspecific therapy

• Cardiomyopathies

• Dilated (congestive) cardiomyopathy

- Furosemide at 1 to 4 mg/kg PO, SC b.i.d.

- Enalapril at 0.2-0.5 mg/kg PO s.i.d.

- Digoxin at 0.01 mg/kg PO daily

- Pimobendan at 0.2 mg/kg PO daily

• Valvular heart disease

• Treat as for dilated cardiomyopathy.

• Ophidascaris robertsi

• History of potential indirect contact with usual snake host

• Ivermectin at 0.2 mg/kg SC, topically repeated every 2 weeks for three injections

• Treatment may trigger thromboembolism.

• Ivermectin given monthly may be preventative.

Systemic disorders

Bacterial

• Bacteremia/septicemia

• Pasteurella multocida

• Mycobacteriosis

Fungal

• Cryptococcosis

Parasitic

• Ophidascaris robersti (larva migrans—see Cardiovascular and Hematologic Disorders)

Neoplasia

• Lymphoma/lymphosarcoma

Other noninfectious problems

Findings on clinical examination:

• Multiple abscesses, sudden death (pasteurellosis)

• Chronic weight loss, also possibly dyspnea, lameness, abscesses, neurologic signs, and blindness (mycobacteriosis)

• On postmortem: multiple organ abscessation (pasteurellosis, mycobacteriosis, cryptococcosis)

• Polylymphadenopathy (lymphoma/lymphosarcoma)

Investigations

1. Radiography

2. Routine hematology and biochemistry

3. Abdominocentesis and cytology

4. Endoscopy

5. Biopsy/necropsy

6. Ultrasonography

Management

• See Nursing Care.

TreatmentZspecific therapy

• Bacteremia/septicemia

• Appropriate antibiosis

• Supportive therapy as necessary (see Nursing Care)

• Mycobacteriosis

• Potential zoonosis, so consider euthanasia.

• Cryptococcosis

• Itraconazole at 5 to 10 mg/kg SC PO b.i.d.

• Lymphoma/lymphosarcoma

• Typically affects liver and lymph nodes

• Treat as for other small animals. Steroids may give temporary remission, but gliders are very susceptible to the effects of glucocorticoids (Bradley and Stoddart 1990).

• For potential chemotherapy, consult modern chemotherapeutic protocols.

Musculoskeletal disorders

Nutritional

• Metabolic bone disease (see Nutritional Disorders)

• Polioencephalomalacia (vitamin B₁ deficiency—see Neurologic Disorders)

Neoplasia

Other noninfectious problems

• Traumatic fractures

• Toe injuries

• Any causes of weakness

• See Neurologic Disorders.

• See Cardiac and Hematologic Disorders.

• See Systemic Disorders.

Findings on clinical examination

• Pain

• Lameness

• Swelling

• Hind-leg paresis/paralysis

Investigations

1. Radiography

Traumatic fractures

2. Routine hematology and biochemistry

3. Culture and sensitivity

4. Endoscopy

5. Biopsy

6. Ultrasonography

TreatmentZspecific therapy

• Traumatic fractures

• Repair using standard small animal techniques.

• Toe injuries

• Usually require digit amputation; dressings poorly tolerated

• Neoplasia

• Surgical resection, amputation, chemotherapy, or radiation therapy as for other small animals

Neurologic disorders

Bacterial

• Bacterial meningitis or other CNS infection

• Clostridium piliforme

• Pasteurella multocida

• Listeria monocytogenes

• Otitis media/interna

Protozoal

• Toxoplasmosis

Parasitic

• Self-mutilation (aberrant visceral larva migrans—see Gastrointestinal Disorders)

Nutritional

• Hypoglycemia

• Polioencephalomalacia (possibly vitamin B_j deficiency)

• Hind-limb paralysis syndrome (see “Metabolic Bone Disease” in Nutritional Disorders)

• Head tilt, ataxia, depression (Pasteurella)

Neoplasia

Other noninfectious problems

• Toxins

• Spinal lesions—e.g., intervertebral disc prolapse, fractures

• Polioencephalomalacia

Findings on clinical examination

• Apparent weakness

• Posterior paralysis/paresis

• Inappetence, weight loss, lethargy, weakness, ataxia, disorientation, tremors, and gradual paralysis (polioencephalomalacia)

• Otitis externa (see also “Ectoparasites” in Skin Disorders)

• Ataxia, tremors, head tilt, diarrhea, inappetence and weight loss, loss of energy, hypothermia, dyspnea, and sudden death (toxoplasmosis)

• CNS signs, vomiting, self-mutilation, pinpoint necrosis of liver (listeriosis)

Investigations

1. Full neurologic examination

2. Radiography

3. Routine hematology and biochemistry

4. Serology for Toxoplasma

5. Culture and sensitivity

6. Endoscopy

7. Biopsy

8. Ultrasonography

Management

• Seizures: Diazepam at 2.0 mg/kg PO, IV, or IM to effect

TreatmentZspecific therapy

• Bacterial CNS infection (including Pasteurella, Clostridium piliforme, and listeriosis)

• Appropriate antibiosis

• Supportive care

• Note: Listeriosis is a zoonosis.

• Toxoplasmosis

• Clindamycin at 12.5 mg/kg PO b.i.d. for at least 2 weeks.

• Combination therapy consisting of:

- Co-trimoxazole at 30 mg/kg PO b.i.d.

- Pyrimethamine at 0.5 mg/kg PO b.i.d.

- Folic acid at 3.0 to 5.0 mg/kg s.i.d. daily

Or

- Co-trimoxazole at 30 mg/kg PO daily

- Toltrazuril at 7.0 mg/kg PO daily for 2 consecutive days

- Treat for 3 weeks.

• Polioencephalomalacia

• May respond to vitamin B₁ supplementation

• Aberrant visceral larva migrans

• Larvae in CNS

• Treat with fenbendazole (see Gastrointestinal Disorders)

• Treat neurologic signs symptomatically.

• Hypoglycemia

• For management of hypoglycemic episodes, see Pancreatic Disorders.

• Orthopedic conditions

• Treat as for other small animals.

Ophthalmic disorders

As a nocturnal marsupial, sugar gliders have relatively large and pronounced eyes, which can lead to an increased risk of trauma.

Bacterial

• Uveitis

Protozoal

• Toxoplasmosis (see Neurologic Disorders)

Nutritional

• Poor nutrition (blindness, cataracts)

• Corneal fat deposits

Neoplasia

Other noninfectious problems

• Corneal trauma/damage

• Idiopathic cataracts

• Idiopathic uveitis

• Senescent cataracts

Findings on clinical examination

• Corneal ulceration

• Corneal trauma

• Corneal fat deposits in young

• Cataracts (poor nutrition, idiopathic)

Investigations

1. Ophthalmic examination

2. Topical fluorescein to assess extent of ulceration

3. Tonometry

4. Skull radiography

5. Routine hematology and biochemistry

6. Serology for Toxoplasma

7. Culture and sensitivity

8. Biopsy

9. Ultrasonography

TreatmentZspecific therapy

• Corneal ulceration

• Topical and systemic antibiosis

• Once infection is cleared, treat as for other small animals (e.g., scarification to encourage healing, conjunctival grafts, etc.).

• Corneal trauma

• As for corneal ulceration

• May require tarsorrhaphy

• Uveitis

• Topical ophthalmic steroid or NSAID preparations

• Topical ophthalmic antibiotic preparations plus systemic antibiosis if appropriate

• Enucleation if severe

• Cataracts

• May be seen in hand-reared young and in joeys from obese mothers. Hypovitaminosis A may be involved.

• Supplement with vitamin A.

• Neoplasia

• Enucleation

• Toxoplasmosis—see Neurologic Disorders

Endocrine disorders

None described as yet, but the clinician should remain aware of the possibility, especially thyroid and adrenal disease.

Urinary disorders

Bacterial

• Nephritis

• Cystitis

Protozoal

• Klossiella

Nutritional

• Urolithiasis

Neoplasia

Other noninfectious problems

• Bladder rupture secondary to urinary obstruction

Findings on clinical examination

• Depression

• Anorexia

• Weight loss

• Polydipsia/polyuria

• Oral ulceration

• Hematuria (urolithiasis, cystitis, neoplasia)

• Hind-leg weakness

• Melena

• Dysuria/polyuria

• Urine dribbling, wet perineum, constant licking at genitalia (urolithiasis)

• Painful urination, stranguria (urolithiasis, cystitis)

• Death

Investigations

1. Radiography

a. Useful to differentiate uncomplicated cystitis from urolithiasis

2. Routine hematology and biochemistry

a. Creatinine 41.6 to 52.2 pmol/L; urea 5.4 to 6.5 mmol/L

3. Cytology

a. Renal casts, neoplastic cells

4. Culture and sensitivity

5. Endoscopy

6. Biopsy

7. Ultrasonography

Management

1. Fluid therapy (see Nursing Care)

2. Appropriate antibiosis

TreatmentZspecific therapy

• Klossiella spp.

• Asymptomatic

• Attempt treatment with toltrazuril at 7.0 mg/kg PO once daily for 2 days; repeat weekly over 3 weeks.

• Nephritis

• As for “Management”

• Treat as for other small animals.

• Urolithiasis

• If urethral obstruction:

- Attempt catheterization (can be difficult in males due to J-shaped os penis)

- Cystocentesis

- Surgical cystotomy

- If unable to clear urethra, create a perineal urethrostomy.

• Cystic calculi

• Cystotomy

• Submit any stones/sand for analysis.

• Antibiosis (usually has accompanying cystitis) and other supportive care

• Address dietary change depending on urolith analysis/assess water management.

• Neoplasia

• Guarded prognosis

• As for other small animal species

Reproductive disorders

Male sugar gliders have a pendulous scrotum that hangs cranial to the penis (Fig. 7-4). The penis is bifurcated. Castration will prevent breeding but also reduces odor and urine marking behavior and reduces the development (and the associated hair loss) of the scent glands on the head and chest.

Fig 7-4. Sugar gliders have a pendulous scrotum located cranial to the penis. (Courtesy of Sophe Jenkns,

MRCVS.)

Female sugar gliders have an usual reproductive tract anatomy—a single urogenital sinus branches into a single median and two lateral vaginas. Of surgical significance is that the left and right lateral vaginas encircle the ureter on that side before rejoining the median vagina proximally at the cervices. Therefore ovariohysterectomy necessitates careful avoidance of the ureters. Approach via a midline abdominal incision, although this is complicated by the ventrally located pouch. Females possess a marsupium. Pregnancies may be palpable as abdominal masses. One to two joeys are born at a time (Fig. 7-5).

Bacterial

• Pouch infections

Fungal

• Candidiasis (pouch infection)

Neoplasia

• Mammary carcinoma (Keller et al 2014)

Other noninfectious problems

• Dry/necrotic penis (septicemia/trauma)

Findings on clinical examination

• Irritation and/or unpleasant smell from pouch (pouch infection)

• Firm mammary swelling (mammary carcinoma)

Investigations

1. Radiography

2. Routine hematology and biochemistry

3. Urinalysis

4. Culture and sensitivity

5. Endoscopy

Fig 7-5. The female sugar glider raises one or two joeys in its pouch. (From Ness RD, Johnson-Delaney CA. 2012. Sugar gliders. In: Quesenberry KE, Carpenter JW (eds.). Ferrets, rabbits, and rodents: Clinical medicine and surgery, 3rd ed. Saunders, St. Louis.)

6. Biopsy

7. Ultrasonography

a. Prostatic hyperplasia/cysts

Management

1. Fluid therapy (see Nursing Care)

2. Prophylactic antibiotics

TreatmentZspecific therapy

• Necrotic penis

• Amputate (does not impede urination).

• Covering antibiotics and analgesia

• Pouch infections

• Appropriate antibiosis

• Itraconazole 5 to 10 mg/kg PO b.i.d.

• Topical antibiotics/antifungals

• Testicular neoplasia

• Castration

• Metritis

• Induce uterine contractions with 0.5 mg prostaglandin F_2α SC.

• Antibiosis

• Pyometra

• Ovariohysterectomy

• Antibiosis

• Mastitis

• Acute mastitis

- Antibiosis and fluids

- NSAIDs may have anti-endotoxin effects (see “Analgesia” in Nursing Care)

- Debride or surgically resect affected mammary tissue.

- Fostering joeys may spread pathogens to other females, so may need to hand-rear (see Neonatal Disorders)

• Chronic mastitis

- Often nonresponsive to therapy

• Joeys may need supplemental feeding (see Neonatal Disorders).

Neonatal disorders

• Some normal developmental parameters of joeys (after Brust 2009) are shown in Table 7-3.