Syndromes and Conditions of Commonly

Kept Tortoise and Turtle Species

WalterJ. Rosskopf Jr., D VM, Dip.AB VP,
and Myra K. Shindo, BA, BS, MS, MA

Turtle and tortoise species are commonly presented to zookeepers, hobbyists, and reptile specialists fre-
veterinarians for diagnosis and treatment in exotic an- quently disagree on what constitutes a p r o p e r
imal oriented practices. The conditions and syndromes
diet for m a n y of the species. Commercial diets
are extremely variable, considering the diversity of the
for water turtles are now available and work well.
species encountered. The conditions and husbandry in-
volved with water turtles is very different from what is T h e authors have used commercial koi food for
encountered with land tortoises and turtles. A thor- water turtles of m a n y species with excellent re-
ough knowledge of the subject is therefore imperative. sults. T h e feeding of live food such as earth-
This article reviews the conditions most commonly en- worms and fish, though usually safe, can be a
countered in working with aquatic and land turtles and source o f infectious organisms. Terrestrial tur-
tortoises.
tles, such as Box Turtles, do well on a diet of
9 2003 Elsevier Inc. All rights reserved.
vegetables, live food, and some low-fat dog or cat
food (the latter foods are disparaged by many,
Key words: Turtle, tortoise, chelonian, mycoplasmosis,
bacterial diseases, nutritional disorders, parasite infes- but have a place in the diet if used judiciously!).
tation, vitamin A deficiency. Tortoises are best allowed to forage on natural
grasses and are s u p p l e m e n t e d with vegetables
and hay. Alfalfa or timothy pellets are frequently
urtles and tortoises, or chelonians, are com-
T monly kept as pets worldwide. These ani- fed to i m m a t u r e tortoises. Careful supplementa-
tion with calcium-mineral supplements helps to
mals are frequently presented to veterinarians avoid imbalances. Overuse of supplements can
for diagnosis and treatment. Knowledge of com- be harmful, however. New tortoise diets (biscuit-
m o n syndromes and conditions is imperative to like) are now available and widely used.
success in m a n a g i n g the species. The terminology used with turtles and tor-
Turtles and tortoises occur in a wide range of toises is quite variable. We shall use the t e r m
habitatst and climatic conditions. P r o p e r diet "tortoise" to refer to the large land animals with
and a clean e n v i r o n m e n t are essential for health elephantine rear feet. Terrestrial turtles are
in captivity. Some water turtles require brackish land-based turtles (usually smaller than tortoises
water for health to be maintained. Tropical spe- and anatomically variable). Water turtles are
cies require a heated environment, whereas in- fresh-water turtles that spend the majority of
dividuals f r o m n o r t h e r n climates may do well in their time in water. We w o n ' t use the term "ter-
less climatically controlled environments. rapin" (usually refers to water turtles in certain
Smaller aquatic species may do well in an aquar- areas of the United States) and we w o n ' t discuss
ium, whereas larger species may do better in a sea turtles (not kept as pets). The term "tor-
large pond. Filtration systems are imperative in toise," for interest's sake, is often used in Great
the keeping of water turtles. P r o p e r ultraviolet Britain a n d Australia to refer to water turtles
light with a basking area provided is important. (such as the Murray River Tortoise in Australia,
Overcrowding or the presence of d o m i n a n t an- which is a water turtle) (Figs 1 and 2).
imals may p r o d u c e a stressful situation that can
result in disease. Dietary and husbandry require- From Avian and Exotic Animal Hospital of Los Angeles County,
ments for chelonians are extremely variable, too. Hawthorne, CA.
O n e should read as m u c h as possible on all Address correspondence to: Walter Rosskopf DVM, DABVP,
4871 West Rosecrans Avenue, Hawthorne, CA 90250.
species e n c o u n t e r e d in practice. 9 2003 Elsevier Inc. All rights reserved.
Dietary r e c o m m e n d a t i o n s for chelonian spe- 1055-937X/03/1203-0127530.00/0
cies are especially variable. Even e x p e r i e n c e d doi:l O.1053/saep. 2003. 00022- 7

Seminars in A v i a n and Exotic Pet Medicine, Vol 12, No 3 (July), 2003: pp 149-161 149
150 RosskopfJr. and Shindo

sageways of ill tortoises and, at the time, repre-

sented only the second report of isolation o f a
mycoplasma from a reptile. Mycoplasma tesludinis
was previously isolated from the cloaca of a Spur-
Thighed Tortoise; however, the pathogenicity of
this organism is unknown. The mycoplasma iso-
lated from the desert tortoise was n a m e d Myco-
plasma agassizii, with strain PS6 the strain type. In
a transmission study, that organism was d e m o n -
strated to be the cause of URT disease in the
desert tortoise. M. agassizii has been isolated
from the wild g o p h e r tortoises in Florida with
rhinitis, and transmission studies also have con-
Figure 1. Australian Snake Neck turtles. Courtesy of
Ellen Nichol. firmed it as the causative agent. An enzyme-
linked i m m u n o s o r b e n t assay has been devel-
oped to determine exposure to this organism. 4
Tortoise Conditions and Syndromes Direct contact between tortoises appears to
Upper Respiratory Disease Syndrome be an important route of transmission. Myco-
plasma can be cultured from nasal discharge
The respiratory disease condition that is com- fluids of affected tortoises, and because of this,
monly e n c o u n t e r e d in desert tortoises has been transmission can be either direct or indirect
known fbr decades. I would estimate that 80% of through objects contaminated with infective na-
the desert tortoises that I have seen in practice sal fluids. 4
are b r o u g h t in because of this disease. In over 33 Enrofloxacin has been shown to be extremely
years of practice, I have seen well over 25,000 effective in treating tortoises with mycoplasmo-
cases (and this is a conservative estimate)! All of sis. A combination of systemic medication, along
us in practice in the 1970s and 1980s were per- with saline-enrofloxacin (30:1) nasal flushes,
plexed by this condition, which was c o m m o n l y works well to control the disease. Most of these
t h o u g h t to be viral in etiology. Death rates at tortoises probably remain carriers for life, but
that time were high. In the late 1980s, the dis- can be retreated successfully if periodic flare-ups
ease began to be seen in wild desert tortoise occur. The use of doxycycline, which is very
populations in e n o r m o u s numbers, L,2 The se- effective in rat mycoplasmosis, doesn't seem to
nior author was doing contract work for the work as well in tortoises, but it is an alternative
Bureau of Land Management and was asked by duug in cases of apparent resistance to Enro-
director Dr. Kristin Berry if there was a known floxacin. Secondary bacteria such as Pasteurella
cause and treatment for this condition. She was
told the problem was a long-standing enigma in
pet tortoises, 3 and that Dr. ElliotJacobson of the
University of Florida, Gainesville, would be the
investigator to contact. He was invited to inves-
tigate the disease and we are forever indebted to
him for his findings.
Pathologic studies of 17 ill desert tortoises
from the Desert Tortoise Natural Area in Cali-
fornia and 1 ill desert tortoise from Utah indi-
cated that major microscopic lesions were con-
fined to the u p p e r respiratory tract (URT). 3
Electron microscopic studies revealed small
(350-900 nm) pleomorphic organisms resem-
bling mycoplasma in close association with the
surface epithelium of the URT of ill tortoises. Figure 2. Infant Australian Snake Neck turdes. Cour-
Mycoplasma was cultured from the nasal pas- tesy of Ellen Nichol.
 Syndromes and Conditions of Tortoise and Turtle Pet Species" 151

sp. 5 and other organisms may require the use of severe trauma is all too frequently seen in tor-
other antibiotics, as well. toises.
MycoDlasma sp. u p p e r respiratory infections Shell rot (1 or m o r e erosive lesions involving
may be seen in a wide variety of tortoise species either the u p p e r or lower shell, or both) usually
worldwide. Jacobson states that mycoplasmal in- occurs as a result of traumatic injury to the shell
fections with secondary Gram-negative bacterial or exposure to filthy environmental conditions,
infection have b e e n implicated in URT disease although infectious diseases can b e associated
in Desert Tortoises (Gopherus agassizii), G o p h e r with the disorder. 8
Tortoises (G0pher, us polyphemus), Greek and Her- Shell-repair techniques have b e e n developed
m a n n ' s Tortoises ( Testudo graeca and Testudo her- to a fine art in reptile medicine. A n u m b e r of
manni), L e o p a r d Tortoises (Ge0chel0ne pardalis), acrylics and patching materials work well on che-
Radiated Tortoises (Gopherus radiata), and In- lonian shell problems, sq~
dian Star Tortoises (Gopherus elegans).G
Aamcdotal evidence would suggest that the
Oral Herpesvirus Infection of Tortoises
same organism or related ones cause the u p p e r
respiratory disease syndrome in Sulcata Tor- A herpesvirus has b e e n isolated f r o m necro-
toises (Ge0chel0ne sulcata) and m a n y others of the tizing oral or b e a k lesions in several species of
world's tortoises. T h e respiratory disease seen in tortoise. 1~ Species c o m m o n l y kept in captivity
box turtles and water turtles appears to be asso- that are affected by this virus include the Argen-
ciated with a wide variety of Gram-negative bac- tine Chaco Tortoise (Geochelone chilensis), the
teria and not the mycoplasma agent, although Desert Tortoise of the southwestern United
there is still some debate on the subject. States (G. agassizii), and the Greek Spur-
It is also interesting to note that tortoise spe- T h i g h e d Tortoise (T. graeca). This virus causes
cies seem quite variable in their susceptibility to necrotizing lesions in the oral cavity and b e a k
u p p e r respiratory disease syndrome. Anecdot- commissures of the tortoise, resulting in nasal
ally, Sulcata tortoises seem to respond to treat- and ocular discharge, regurgitation, and an-
m e n t m u c h faster than desert tortoises. Some orexia. A fecal-oral transmission route is sug-
tortoise species seem relatively resistant to the gested. ,2-14
organism. T r e a t m e n t of lesions that a p p e a r to be
caused by the herpesvirus is suggested, even if
definitive diagnostic evidence is lacking. If
Disorders Involving the Shell possible, however, a section of the n e c r o t i z i n g
Malnutrition is widespread a m o n g captive tor- tissue s h o u l d be s u b m i t t e d for histologic inter-
toises. I n a d e q u a t e mineral intake with fast p r e t a t i o n , b e c a u s e positive identification of
growth can lead to severe deformity of the shell. the viral particles in the e p i t h e l i u m can be
Pyramidal shell growth is a c o m m o n p r o b l e m a c h i e v e d with e l e c t r o n microscopy. T r e a t m e n t
in raising tortoises in captivity. It is such a com- of the oral lesions with a p r e p a r a t i o n of 5%
m o n occurrence that it is rare to have a captive- acyclovir o i n t m e n t a p p l i e d topically to the le-
raised tortoise that grows in a n o r m a l way. W h e n sion is s o m e t i m e s effective. S o m e severe, n o n -
I see a normal-looking captive tortoise, I usually responsive cases r e s p o n d to oral acyclovir at a
quiz the client on the diet supplied. I am often dosage of 80 m g / k g orally q24 h o u r until the
shocked at some serendipitous combination that signs clear. Antibiotics can be used to t r e a t the
has luckily worked in this particular pet. T h e s e c o n d a r y bacterial infections that typically oc-
etiology of pyramidal shell growth is unknown. cur b e c a u s e of irritation of the e p i t h e l i u m
Suggested etiologies include excess dietary pro- s u r r o u n d i n g the b e a k a n d oral cavity. Q u a r a n -
tein, t o o rapid growth, vitamin or mineral excess tine of newly a c q u i r e d animals is essential to
or deficiency, metabolic b o n e disease, and spe- d e t e r the s p r e a d o f this disease in tortoise
cies predisposition, v colonies. ~
Traumatic injuries to the shell caused by lawn In Southern California, we have seen n u m e r -
mowers and automobiles are c o m m o n l y encoun- ous herpes cases in desert tortoises and Russian
tered, especially in the spring, when tortoises (Horsefield's) Tortoises. Most have r e s p o n d e d
come out of hibernation. Canine attack with well to treatment, b u t some have died.
152 RosskopfJr. and Shindo

acid in the blood, and gout) are routinely seen.

Infections of the heart are also c o m m o n .

Mouth Rot (Infectious stomatitis)

This condition results either as the direct re-
sult of traumatic injury to the oral cavity a n d its
lining, or secondary to systemic disease. This
condition should be treated locally (topically) as
well as systemically to prevent the possibility of
internal abscessation. Beak and jaw d e f o r m a t i o n
may occur, necessitating periodic corrective
trimming. If m o u t h rot does n o t respond in the
Figure 3. Adult Chinese soft-shell turtle. Courtesy of
Waiter Rosskopf, DVM. way the clinician would expect, herpesvirus in-
fection should be suspected. 11k14

Hypervitaminosis A--Skin Sloughing or Peeling Abscesses

Syndrome of Tortoises
Bacterial abscesses are c o m m o n , resulting
A specific p r o b l e m in tortoises b e c a m e evi-
f r o m p u n c t u r e wounds and o t h e r traumatic in-
d e n t in the early 1980s when vitamin A injec- juries. Because tortoises readily develop internal
tions were frequently given to parrots with vita-
abscesses, systemic antibiotics must be used to
min A deficiency dietary problems. Practitioners treat all abscesses (external or otherwise).
began to give injections of vitamin A regularly to
desert tortoises with URT infections. At the time,
we suspected the tortoises were reacting to cer- Organ Failure
tain antibiotics.
T h e ravages of a lifetime of low-grade infec-
Hypervitaminosis A iatrogenic dermatosis,
tions and water deprivation may result in cirrho-
which presents as patches of dry skin that
sis a n d / o r o t h e r pathology of the liver, or
progresses to a generalized sloughing of the ep-
chronic kidney disease and failure in aged tor-
ithelium, can follow a single vitamin A injection
toises. Blood-chemistry analysis is necessary to
at a dosage higher than 10,000 I U / k g intramus-
make the diagnosis.
cularly. 15 Secondary bacterial or fungal infec-
tions frequently follow this condition, and re-
quire t r e a t m e n t with systemic and topical antibi- Impactions and Foreign-Body Ingestion
otics. Additional vitamin A injections are not
advisable. If the animal is generally deficient in Sand impaction occurs c o m m o n l y in hatch-
vitamin A, then dietary changes can be imple- lings. Therefore, they should not be k e p t on
m e n t e d in lieu of the injections, because oral sand, but rather on hard dirt or i n d o o r - o u t d o o r
s u p p l e m e n t a t i o n of vitamin A in conjunction carpeting. Surgery to relieve a sand impaction or
with n o r m a l feeding practices is not known to retrieve foreign bodies f r o m the intestinal tract
cause this problem, lz is a complicated p r o c e d u r e with a p o o r outlook.
Sulcata tortoises are particularly p r o n e to rock
and substrate ingestion. Long-term laxative use
Internal Infections and fecal softeners along with the judicious use
A wide variety of bacterial infections occur in of m e t o c l o p r a m i d e may be necessary in treat-
captive tortoises (Fig 3). Often, multiple organs m e n t of these cases.
are involved. Liver a n d / o r kidney disease is com-
m o n because of" the septic nature of tortoise
Reproductive Problems
diseases and the filtering action of these 2 or-
gans. Chronic hepatitis and chronic kidney dis- Metritis, retained eggs, and egg-yolk peritoni-
ease (the latter resulting in elevated levels of uric tis are c o m m o n a m o n g female tortoises. S o m e of
 Syndromes and Conditions of Tortoise and Turtle Pet Species 153

these problems can be m a n a g e d medically. Oth- zoan parasites (Giardia, Trichomonas, etc.) can
ers require surgical intervention. cause disease. Some c o m m o n worms are consid-
ered n o r m a l by some investigators27
Prolapses
Entamoeba Invadens Infection in Tortoises
Prolapses of the penis, uterus, intestine, or
urinary bladder are not u n c o m m o n . General Amoebiasis periodically causes severe disease
anesthesia is necessary to correct these condi- in tortoises. Epidemics are not u n c o m m o n and
tions. The prolapsed organ must be carefully special m e n t i o n of the p r o b l e m is warranted.
replaced inside the body. Simply pushing it back Dysenteric diarrhea may be seen. Investigators
into the cloaca where it is out of sight may result have described severely ill animals as icteric, ane-
in a slow death. A t h o r o u g h diagnostic workup mic, a n d in varying stages of circulatory col-
(x-rays, laboratory testing, etc.) must be per- lapse, as
f o r m e d to help diagnose their causes. Diagnosis is m a d e by wet mounts or
T r i c h r o m e stains, tS-2~T r e a t m e n t involves metro-
nidazole and iodoquinal. 21
Bladder Stones
Bladder stones, c o m p o s e d of uric acid, re- Myiasis (Maggot Infestation)
quire m a n y years to f o r m and may reach unbe-
Fly strike and m a g g o t infestation are ex-
lievably large sizes (baseball size is not uncom-
tremely c o m m o n , especially with w o u n d e d a n d
m o n ) . Desert tortoises are p r o n e to this disease
traumatized tortoises. These animals are virtu-
condition because of the urinary bladder's func-
ally defenseless and flies can easily take advan-
tion of storage and resorption of water. These
tage of their weakened condition. Any tortoise
functions often result in the deposition of small
that is known to be ill or suffering f r o m a w o u n d
particles of uric acid within the bladder and the
anywhere should be housed indoors or other-
gradual accumulation of m o r e uric acid residues
wise p r o t e c t e d f r o m flies within a screened en-
a r o u n d this nucleus over the years. W h e n these
closure. Long-term soakings in betadine solu-
stones b e c o m e large e n o u g h to irritate the blad-
tion a n d removal of the maggots by h a n d are
der lining or to mechanically impair urination,
p r o c e d u r e s used in the m a n a g e m e n t of such
interfere with walking, or otherwise result in
cases.
pain, m o s t desert tortoise owners will b e c o m e
suspicious that something is wrong. T h e diagno-
sis is confirmed with radiographs. Correction Ticks
involves surgical removal of the s t o n e J 5,~6 Wild or newly acquired desert tortoises may
be infested with ticks. They should be carefully
Iron Storage Disease removed. In April 2000, a ban was placed on the
importation of certain species of African tor-
Some desert tortoises suffer f r o m excessive toises into the United States. It was f o u n d that
accumulation of elemental iron within the liver. some o f these tortoises h a r b o r e d ticks that car-
This results in chronic hepatitis and, eventually, ried virulent viruses with the potential to deci-
cirrhosis. T h e cause is unknown but blood mate h o o f e d stock. Practitioners should m a k e
breakdown in disease and enzyme deficiency are owners of such tortoises aware of the potential
both possible etiologies. Owners should not of- problem, especially if the tortoises are to be kept
fer iron tablets to their desert tortoises. Foods n e a r h o o f e d stock. 12
and water supplies high in iron should also be Before the ban, most i m p o r t e d leopard and
avoided. Sulcata tortoises seen by the authors were in-
fested with h a r d ticks!
Intestinal Parasites
Diabetes Mellitus
Small pinworm-like parasites, large strongyle-
type worms, and large r o u n d w o r m s can infect Desert tortoises may develop diabetes melli-
captive tortoises. F u r t h e r m o r e , several proto- tus, which requires closely m o n i t o r e d medical
154 RosshopJJy. and Shindo

care. We have e n c o u n t e r e d several cases o f dia-

betes in desert tortoises over the years. Insulin
has a long-lasting physiologic effect in these rep-
tiles, in my experience. High glucose levels may
also occur in severe kidney disease in tortoises,
as in avian species.

Ocular Disorders
A wide variety of disorders involving the eyes
and related structures afflict tortoises. S o m e of
these include cataracts, corneal ulcers, ocular
infections, p u n c t u r e wounds and o t h e r trau- Figure 4. Box turtles eating. Courtesy of Ellen
matic injuries, conjunctivitis, keratoconjunctivi- Nichol.
tis, keratitis sicca (dry eye), and hatchling eye
syndrome (vascular scarring). Bacterial infec-
Ivermectin Reaction
tion may cause some of these conditions or oth-
erwise cause secondary complications. Eye in- This c o m m o n l y used vermifuge c a n n o t be
volvement may a c c o m p a n y symptoms of the re- used by injection in any of the chelonian species.
spiratory complex. Cataracts may result fi'onl T h e use of this medication will result in flaccid
traumatic injury or infection. Some are, no paresis or paralysis of the limbs. 7,2~
doubt, hereditary. Unusual eye color variations
are also n o t e d f r o m time to time.
Goiter in Giant Tortoises
Goiter has b e e n frequently r e p o r t e d in giant
Normal Ocular Discharge in Some Tortoises tortoises such as the Galapagos Tortoise a n d the
Aldabran Tortoise. Little is known a b o u t its eti-
Some tortoises have no functional nasolacri-
ology, and clinicians are cautioned a b o u t the
real system and tears are lost from spillage or
potential h a r m of dietary s u p p l e m e n t a t i o n of
evaporation. 22 Red-Footed (Geochelone carbona- iodine, e3
r~a) and Yellow-Footed Tortoises (Geochelone den-
ticulata) normally have a clear ocular discharge. 7
Box Turtles and Other
Terrestrial Turtles
Gular Overgrowth
Disease Resulting from Malnourishment
Older tortoises may develop large, overgrown and Vitamin Deficiencies
gular projections (forward projection of the
Many diseases afflicting captive terrestrial tur-
lower shell, u n d e r the neck). This condition can
tles are, at least in part, the result of malnutri-
result in a severe mechanical interference with
tion (Fig 4). Turtles that do not receive all o f the
eating and swallowing. Correction involves trim-
nutrients vital to sustain o p t i m u m health do not
m i n g of this projection with a Stryker saw.
remain healthy, and b e c o m e ill f r o m a variety of
causes. Hatchlings are the most p r o n e to disease
resulting f r o m dietary deficiencies, because their
Submandibular Sex-Gland Inflammation
nutritional requirements exceed those of adult
During b r e e d i n g season, the large chin or sex turtle, and because their rate of growth is so
glands of the male desert tortoise may increase rapid. Hatchling turtles often exhibit soft shells
in size and drain. T h e e n l a r g e m e n t n o t e d may associated with protein and mineral deficiencies,
be normal, but infections of these glands may and d e f o r m e d shells associated with abnormally
occur. Cytology can help to differentiate be- fast growth f r o m high protein diets. Adult tur-
tween normal and infected s u b m a n d i b u l a r tles, by contrast, are unlikely to exhibit soft-shell
glands. problems, but may show signs of anemia, weight
 Syndromes and Conditions of Tortoise and Turtle Pet Species 155

ease. Dietary deficiency of vitamin A is consid-

ered by m a n y to be the major predisposing
cause. Squamous metaplasia, as is seen in avian
species, predisposes the turtle to colonization
and subsequent infection by a variety of bacterial
pathogensY 5
T r e a t m e n t of the condition involves lancing
the abscesses, a p p r o p r i a t e antibiotic and vitamin
therapy, and careful consideration to correcting
possible predisposing factors such as inadequate
diet, cleanliness, or stress.

Figure 5. Eastern male box turtle. Note the bright Abscesses (Other Than Ear)
red eyes of the male box turtle. Courtesy of Ellen
Nichol. Bacterial abscesses are c o m m o n from punc-
ture wounds, bite wounds, and other injttries.
Injectable antibiotics must be used u n d e r these
loss, m o u t h rot, internal infection, or abscessa- circumstances to prevent formation of internal
tion with chronic malnourishment. abscesses or septicemia.

Respiratory Disease Internal Infections

Respiratory disease is c o m m o n in box turtles. A wide variety of bacterial infections can oc-
Epidemics may occur in populations of wild box cur. Often, multiple organ systems are involved.
turtles, characterized by runny noses and pneu- Liver a n d / o r kidney disease is c o m m o n because
monia. The Ornate Box Turtle (Terrapene ornata of the septic nature of turtle diseases and the
ornata) seems to be especially sensitive to respi- filtering action of these 2 organs. Chronic hep-
ratory disease in captivity, and the respiratory atitis and chronic kidney disease (the latter re-
signs seem to be particularly devastating in this sulting in gout f r o m elevations of uric acid in the
species. Enrofloxacin and cefotaxime are com- blood) are routinely seen. Infections of the
monly used antibiotics. heart are also c o m m o n . Blood tests are useful
In Illinois, chronic bacterial p n e u m o n i a for the diagnosis of these and other prob-
was diagnosed in 2 wild Eastern Box Turtles lems.26-29
(T. carolina carolina) (Fig 5). Both turtles were
f o u n d half buried in a dry creek bed and were
Organ Failure
severely emaciated and depressed. Histologi-
cally, chronic inflammation was identified in the O l d e r box turtles are subject to organ failure,
nasal sinuses and lungs. A mixture of Gram- most often resulting f r o m chronic infection or
negative bacteria, including Morg'anella morgani, other longstanding disease involving 1 or m o r e
Acinetobacter calcoaceticus, Serratia marcescens, and organs. Diseases that usually a c c o m p a n y advanc-
Pseudomonas sp. were isolated f r o m b o t h turtles. ing age in o t h e r animals also affect elderly box
No other pathogens were identified. T h e bacte- turtles (eg, arteriosclerosis)..Blood chemistry
ria were considered the causative agents of the analysis is necessary to diagnose these cases. 26-29
p n e u m o n i a . 24

Bot Fly Infestation (Myiasis)

Aural Abscesses
Box turtles are c o m m o n l y subject to the rav-
Aural abscesses or abcessation of the middle ages of migrating bot fly larvae. These large
ear is a c o m m o n p r o b l e m in chelonians, partic- parasites are different f r o m the m u c h smaller
ularly in box turtles. The exact cause of aural maggots (larvae of other flies). T h e adult flies
abscesses cannot be definitely stated, but a his- deposit their eggs on the skin a n d / o r m u c o u s
tory may include previous u p p e r respiratory dis- m e m b r a n e s , a n d the newly hatched larvae pen-
156 RosskopfJr. and Shindo

etrate into the body and form large, visible

lumps where they come to rest, resembling ab-
scesses. These grubs may cause substantial tissue
damage and mechanical interference for the
turtle, and some turtles die as a result of this
infestation.

Maggot Infestation
Fly strike and maggot infestations are com-
mon, especially a m o n g wounded or sick box
turtles. These turtles are virtually defenseless,
and flies can easily take advantage of their weak- Figure 6. Box turtle laying eggs. Courtesy of Phil
ened condition. Traumatized or diseased box Angermeyer.
turtles should be kept indoors or within a
screened enclosure during their convalescence.
Intestinal Parasites
Shell Disorders A variety of r o u n d w o r m and strongyle-type
worms can parasitize captive terrestrial turtles.
Shell rot occurs when either the u p p e r shell
Reinfection results when pet turtles are permit-
(carapace), lower shell (plastron) or both de-
ted to feed in an environment in which feces are
velop erosions. This condition usually results
allowed to accumulate and contaminate food.
from injury or chronic exposure to filthy envi-
Numerous deaths of terrestrial turtles o c c u r ev-
ronmental conditions. Malnutrition and infec-
ery year from intestinal rupture and peritonitis
tion are frequent predisposing factors. Meta-
resulting from heavy intestinal parasitism.
bolic bone disease may result in grotesque shell
Few terrestrial turtles are parasite-free; there-
development in terrestrial turtles. ~~
fore, yearly fecal exams a n d / o r routine deworm-
Dogs, fires, lawn mowers, and automobiles
ings are r e c o m m e n d e d . Strict attention to hy-
often inflict serious injuries to the shell.
giene, frequent soil changes, and periodic rota-
tions of habitats to reduce exposure to these
parasites are also r e c o m m e n d e d .
Overgrown Upper Jaw
The u p p e r jaw of some captive terrestrial tur-
tles may occasionally overgrow. Abnormal wear Intestinal Protozoa
patterns resulting from prior injury or a steady These parasites can cause disease and are oc-
diet o f soft food may be involved. Periodic trim- casionally f o u n d in captive box turtles. Diagnosis
ming of the u p p e r mandible is necessary in these of Giardia, Trichomonas, and other oganisms re-
cases. Metabolic b o n e disease may be involved in quires direct microscopic e x a m i n a t i o n o f the
jaw overgrowthY, S~ feces or the use of special tests, such as the
Trichrome stain, available t h r o u g h exotic ani-
mal laboratories.
Foreign-Body Ingestion
The intestinal impactions occasionally seen in
Reproductive Problems
tortoises are rarely a problem in terrestrial tur-
tles. However, eating snail shells occasionally Egg-binding is a fairly c o m m o n p r o b l e m
causes intestinal tract damage in box turtles. a m o n g female turtles. This condition results
Certain individuals seem to be plagued by this when a gravid female cannot pass an egg by
problem, and should not be fed whole snails. herself. She typically strains excessively against
Most box turtles can eat snails and snail shells the obstruction (Fig 6). The egg may be over-
safely. sized or there may be metabolic or other reasons
 Syndromes and Conditions of Tortoise and Turtle Pet Species 157

for her inability to pass the egg without assis- Aquatic Turtles
tance. Radiographs are usually taken to confirm
Nutritional Disorders
that the female is, in fact, fertile with eggs. Then,
calcium and h o r m o n e injections and sometimes Vitamin A Deficiency--Swollen Eye
aspiration of the egg's contents are necessary to Syndrome
expel the egg.
Several other conditions are seen in repro- Hypovitaminosis A is most prevalent in young
ductively active female turtles. Metritis and egg- aquatic and semiaquatic turtles fed diets of un-
yolk peritonitis are the most common. supplemented greens (iceberg lettuce), meat,
and poorly formulated commercial diets. T h e
turtles may be anorectic and growing poorly.
Erections in Males Signs include edema, inflammation, and infec-
tion of the eyes, resulting from squamous meta-
During the mating season, male terrestrial plasia of Harderian glands and respiratory dis-
turtles periodically protrude and rhythmically ease. a2
fan their penises. This copulatory organ is flower-
shaped and purple, and may appear unusual or
abnormal to those unfamiliar with turtles. It is
Soft Shell
most often mistaken for a prolapsed organ and
may be treated as such by those unfamiliar with Water turtles must receive adequate levels
turtle anatomy and mating habits. and proportions of many essential minerals (es-
pecially calcium), vitamin D> and unfiltered
sunlight. An abnormally soft shell will result if
Prolapses any of these 3 necessities is missing, present at an
inadequate level, or totally unavailable.
Prolapses of the uterus, intestine, urinary An adequately balanced diet and sufficient
bladder, or penis (paraphimosis) may occur. periods of exposure to unfiltered sunlight or to
The last condition occurs if the engorged penis an artificial substitute (Vita-Lite TM) should be
cannot be returned inside the body cavity, due provided to both prevent and treat this condi-
to small vent size or previous trauma to the tion. T r e a t m e n t also involves dietary supplemen-
enlarged organ. Administration of an anesthetic tation and periodic injections of a calcium sup-
and skillful manipulation of the organ is usually plement and vitamin D> Many hobbyists im-
necessary to correct the prolapse. Clumsy at-
merse turtle blocks (solid blocks of chalk or
tempts by owners may permanently damage the
plaster of Paris) in the water provided for their
involved organs. water turtles in the hope of preventing soft-shell
problems. Unfortunately, these water turtles
cannot benefit from the calcium carbonate pro-
Ocular Disorders vided by these products unless it is ingested.
Various disorders involving the eyes of turtles
are noted from time to time. These include cat-
aracts, corneal ulcers, puncture wounds and Shell Deformity (Metabolic Bone Disease)
other traumatic injuries, infections, maggot in-
General malnutrition (especially protein de-
festation, conjunctivitis, and dry eye (keratitis
ficiency and mineral imbalances or deficiencies)
sicca).
in young, growing water turtles will result in 1 or
more of the following consequences: deformity,
pyramidal m o u n d i n g of the carapace (top
Ivermectin Toxicity
shell), premature cessation of shell growth, and
As with other chelonians, a flaccid paralysis scoliosis of the spine. Captive water turtles rarely
that is irreversible will occur with the use of possess normal-appearing shells because of the
Ivermectin.7, 21 universality of these problems among them.
158 Rosskopffi. and Shindo

Egg Binding therapy, plus dietary change, is used in treat-

ment, as in terrestrial turtles. 25
A n o t h e r disorder resulting, in part, f r o m min-
eral imbalance or outright mineral depletion is
egg binding. This condition results when a fe- Septicemia
male water turtle is physically unable to pass 1 or
T h e r e are a host of bacteria that are capable
m o r e eggs without intervention or assistance.
of causing severe body-wide infections in water
Clinical signs include obvious straining and rest-
turtles. Often, m i n o r infections, such as those
lessness, or p r o f o u n d lethargy.
caused by wounds, increase in severity because
Calcium is necessary for the p r o p e r contrac-
the bacteria that were introduced into the initial
tion of muscles, including those of the uterus.
w o u n d are capable of traveling t h r o u g h o u t the
W h e n this particular mineral is deficient in a
body by way of the bloodstream. Malnourish-
gravid female, egg binding is likely. Malnutri-
m e n t ensures a weak defense against this inva-
tion, lack of exposure to unfiltered sunlight, and
sion on the part of the host, a n d the infection
pre-existing disease are the usual predisposing
spreads. As vital organs b e c o m e involved, addi-
factors that contribute to this serious, often life- tional symptoms and a general deterioration are
threatening condition. noted. Often, extreme redness of the skin a n d
Calcium and h o r m o n e injections, as well as bleeding into it will be n o t e d when a water turtle
digital m a n i p u l a t i o n of the egg, are usually em- suffers f r o m septicemia. Aggressive antibiotic
ployed to relieve this condition. Sometimes, a therapy and supportive care are required to
needle can be inserted into the egg to aspirate bring these serious cases to resolution. Enro-
its contents and collapse it, thereby m a k i n g it floxacin, cefotaxime, a n d amikacin are fre-
easier to pass. quently used antibiotics.

Bacterial Infections Shell Rot

Captive water turtles are p r o n e to bacterial Lesions of the shell may result f r o m direct
infections because malnutrition and p o o r hy- injury to its surface and substance, or as a con-
giene practices are c o m m o n p l a c e . F u r t h e r m o r e , sequence of malnutrition, generalized deteriora-
injuries received by water turtles in the course of tion, and infection. Bacteria a n d / o r fungi may
their day-to-day living tend to b e c o m e readily be responsible for infections of the shell. Pri-
infected because of the frequently high bacterial mary forms of shell rot may also occur f r o m the
counts in their aquatic environments. ingestion of shellfish laden with disease-causing
bacteria ( Beneckea chitonovora) 33,34
Algae may colonize shell-rot lesions or be a
Respiratory Infections
primary cause of shell rot, although it is not
U R T disease and p n e u m o n i a are very com- u n c o m m o n for this agent to take up residence
m o n a m o n g water turtles. Clinical signs may on the carapaces (top shells) of perfectly n o r m a l
include nasal discharge, swollen eyes, sneezing, and healthy water turtles. This is usually an in-
coughing, gasping, o p e n - m o u t h e d breathing, dication that the water quality of the turtle's
lethargy, weakness, and listing to one side. Ag- enclosure needs improvement.
gressive antibiotic therapy and supportive care In water turtles, bacterial infections of the
are required to bring these serious cases to res- shell can often b e c o m e systemic, resulting in
olution. septicemic cutaneous ulcerative dermatitis, ini-
tially, shell lesions are the only external indica-
tion of this condition. Infected turtles with sys-
Aural Abscesses temic involvement may develop additional symp-
Infection of o n e or both middle ear canals is toms, however, ranging f r o m anorexia and
a relatively f r e q u e n t occurrence. Surgery is nec- e x t r e m e lethargy to paralysis of limbs a n d mus-
essary to o p e n u p the infected canal and m a n u - cles (primarily in the neck). Causative agents
ally remove the pus that accumulates within its can be Aeromonas hydrophila, Citrobacter freundii,
interior. Injectable antibiotics and vitamin A and Serratia sp. If begun early enough, systemic
 Syndromes and Conditions of Tortoise and Turtle Pet Species 159

and topical treatment often resolves this condi- Angeles. These are obviously illegal, and little or
tion. 12 n o t h i n g is being done to enforce the law.
The Eastern Diamondback terrapin (Mala-
clemys terrapin littoralis) is reputed to be suscepti- Parasite Problems
ble to shell rot if the water conditions are not
brackish, as in nature. We used to see this in Intestinal Parasites
practice when d i a m o n d b a c k terrapins were seen A wide variety of intestinal parasites are f o u n d
in the pet trade. 8 in water turtles, including roundworm-type
worms, tapeworms, and flukes. Stool analysis
Mouth Rot and white-blood-cell counts are useful in diag-
nosing parasite problems2 ~
Bacterial infection of the oral lining (mouth
rot or infectious stomatitis) is usually a conse- External Parasites
quence of malnutrition a n d / o r body-wide ill-
Recently captured water turtles are often par-
ness. Excessive salivation and redness of the oral
asitized with leeches. These should be carefully
lining are typical early symptoms of m o u t h rot.
removed, and the victimized turtle should be
Later, as the disease progresses, accumulations
protected with a relatively short course of inject-
of cheese-like pus can usually be n o t e d within
able antibiotics.
the mouth. An objectionable o d o r from the
m o u t h may be detected as well. Injectable anti-
biotics, vitamins, and appropriate supportive Traumatic Injuries
care, including periodic cleaning of the mouth, Most traumatic injuries to water turtles result
are necessary in the treatment of this serious from aggressive encounters between turtles and
condition. between household pets and turtles. Many water
turtles are territorial (ie, Red-Eared Sliders and
SalmoneUosis Soft-Shelled Turtles) or pugnacious (ie, Snap-
ping Turtles), and fighting between water turtles
In the not too distant past, water turtles, be- (especially between individuals of the same spe-
fore their introduction into the pet trade, were cies) often results in serious wounds to the shell
frequently housed in ponds and septic tanks a n d / o r soft tissues. Water turtles of widely vary-
contaminated with h u m a n sewage and other ing sizes should not be housed together. Adher-
types of waste. Because of this environmental ence to this r e c o m m e n d a t i o n will help to reduce
circumstance, these turtles were continually ex- the n u m b e r of traumatic injuries incurred.
posed to and became asymptomatic carriers of a Injuries between individuals during the mat-
myriad of potentially harmful intestinal bacteria. ing process are c o m m o n . Males may b e c o m e
A strong resistance to many of these bacteria overly aggressive during copulation and inflict
(notably Salmonella spp. and Arizona spp.) en- bite wounds on the female. The male's rapid
sured that these turtles would not b e c o m e ill and and sometimes premature withdrawal of an en-
succumb to the diseases caused by them. The gorged penis may traumatize the female's repro-
h u m a n handlers (frequently children) of these ductive tract.
turtles, however, did not share this same degree It is not at all u n c o m m o n for household pets
of bacterial resistance when the latter reached (especially dogs) to inflict serious, often life-
the pet market. Transmission of Salmonella spp. threatening wounds to the shells a n d / o r soft
and other harmful intestinal bacteria occurred tissues of water turtles during u n p r o v o k e d en-
as a consequence of turtle handling, resulting in counters.
n u m e r o u s cases of h u m a n Salmonellosis. Epoxy resins and acrylic glues are often used
Public health laws now require that no water in the repair of shell injuries in water turtles. 8-m
turtle with a carapace (upper shell) diameter
less than 4 inches can be shipped into or sold in
Foreign-Body Ingestion
the United States, with certain exceptions. Cur-
rently, in practice, we are seeing n u m e r o u s tiny Water turtles may ingest any n u m b e r of a
water turtles being sold on the streets of Los variety of foreign objects (fish hooks, gravel,
160 RosskopfJr. and Shindo

aquarium parts, etc). Rarely, if ever, is the actual Problems Involving Reproductive Organs
act of swallowing the foreign body witnessed. (Other Than Egg-Binding)
Usually a water turtle is presented to a veterinar- Erections in Males
ian because of p o o r appetite, weight loss,
a n d / o r emaciation. Radiography is usually nec- Erections of the penis, which occur most of-
essary to confirm the diagnosis. Sometimes the ten during the mating season, may be discon-
ingested foreign body does not show up on the certing or bewildering to the novice observer.
This condition is perfectly normal, but is most
x-ray, and a barium study is necessary to make
often confused with a prolapse (see prolapses).
the diagnosis. Surgery must be employed in
most cases to remove the foreign body.
Paraphimosis
Occasionally, the fully engorged penis re-
mains so and cannot be retracted. This condi-
Drowning tion is called paraphimosis. Veterinary intmwen-
Hobbyists frequently house small or juvenile tion is necessary in these cases to prevent per-
water turtles within enclosures that possess water m a n e n t damage to the penis. Ketamine usually
levels that are too deep, or within enclosures works well to relax the organ.
that are hazardous in some other way. All water
Penile Paralysis
turtles should be provided with a resting/bask-
ing area. Failure to do so may result in exhaus- A water turtle's penis sometimes becomes par-
tion and drowning. Juvenile water turtles often alyzed. The cause of this condition is unknown.
b e c o m e trapped u n d e r plants and rocks or be- Besides the obvious liability to the turtle, muti-
hind filters and drown. All such environmental lation of the exposed and vulnerable penis by
hazards must be removed or corrected. other turtles is very likely. The penis can some-
Emergency measures may save some drown- times be replaced into the turtle's cloaca. In
most cases, however, the penis must be ampu-
ing victims because a turtle's heart will continue
tated, which creates no problems for the turtle
to beat for many hours after apparent death has
other than the inability to copulate, because this
occurred. T r e a t m e n t for drowning involves turn-
organ is not used for urination.
ing the turtle upside down and moving its legs to
force water from its lungs. The ambitious care- Prolapses
giver may also want to perform mouth-to-nose
artificial respiration. If the turtle is successfully A prolapse occurs when a particular organ is
allowed to invert itself and protrude t h r o u g h the
revived, then antibiotics and appropriate sup-
ordinary external o p e n i n g of that organ. In con-
portive care are necessary until the victim has
trast to this situation with tortoises, prolapses of
fully recovered.
the uterus or intestine are rarely seen in water
turtles. If the turtle owner suspects a prolapse,
then the involved organ should be kept moist
Beak Overgrowth and protected from trauma, and veterinary at-
tention should be sought immediately.
Like birds, turtles and tortoises have beaks
(the h o r n y coverings of both the u p p e r and
lower jaws), which tend to grow continuously for
Ivermectin Toxicity
life. In the wild, the pursuit of day-to-day living A severe paralytic reaction occurs if Ivermec-
seems to keep the rates of wear and growth in tin is used in water turtles, as in other cheloni-
equilibrium. In captivity, however, these cover- arts.7, 21
ings tend to overgrow, and require periodic
trimming. References
Metabolic b o n e disease frequently results in
l. Jacobson E, GaskinJM, Brown MB, et at: Chronic upper
malformed beaks in all the chelonian spe- respiratory tract disease of free ranging desert tortoises,
cies.3L:~2 Xerobatesagassizii.J Wildl Dis 27:296, 1991
 Syndromes and Conditions of Tortoise and Turtle Pet Species 161

2. Knowles C: A Survey for Diseased Desert Tortoises in and dens roundtable discussion, j Herpetolog Med Surg II:
Near the Desert Tortoise Natural Area, Spring, 1989. 17-22, 2001
Report prepared for The Bureau of Land Management, 19. Cranfield MR, Graczyk TK, Denver MC, et al. New ap-
Riverside, CA, June 1989, Contract No. CA950-[T9-23] proaches for the diagnosis of entamoeba infections in
3. RosskopfJr WJ: The upper respiratory syndrome in cap- captive reptiles. Proceedings of the ARAV, 1999, pp
tive desert tortoises: diagnosis, treatment, and manage- 17-18
ment. Proceedings of the First International Symposium 20. Fudge AM (ed): Laboratory Medicine: Avian and Exotic
on Turtles and Tortoises, Conservation and Captive Hus- Pets. Philadelphia, Saunders, 2000
bandry, Chapman College, Orange, CA, 1990, pp 108- 21. Carpenter J, Mashima T, Rupiper D: Exotic Animal For-
112 mulary. Manhattan, KS, Greystone, 1996
4. Origgi F, Jacobson E: Diseases of the respiratory tract of 22. Lawton MPC: Neurological diseases. Opthalmology, in
chelonians. Vet Clin North Am Exotic Anim Pract 3:537- Beynon PH, Lawton MPC, Cooper JE (eds): Manual of
549, 2000 Reptiles. Gloucestershire, UK, British Small Animal Vet-
5. Snipes KP, Biberstein EL: Pasteurellatestudinis: a parasite erinaty Association, 1992, pp 128-134
23. Donoghue S, LangenbergJ: Nutrition, in Mader D (ed):
of desert tortoises. IntJ Sys Bact 32:201, 1984
Reptile Medicine and Surgery. Philadelphia, Saunders,
6. Jacobson E: The desert tortoise and upper respiratory
1996, pp 148-174
tract disease. Bull Assoc Reptile Amphib Vets 4:6, 1994
24. Evans RH: Chronic bacterial pneumonia in free-ranging
7. Boyer TH: Turtles, tortoises, and terrapins, in Mader D
Eastern box turtles (Terrapene carolina carolina). ) Wild/
(ed): Reptile Medicine and Surgery. Philadelphia, Saun-
Dis 19:349, 1983
ders, 1996, pp 332-336
25. Murray M: Aural abscesses, in Mader D (ed): Reptile
8. RosskopfJr WJ: Shell disease in turtles and tortoises, in
Medicine and Surgery. Philadelphia, Saunders, 1996, pp
Kirk RW (ed): Current Veterinary Therapy, Small Ani-
349-352
mal Practice, IX. Philadelphia, Saunders, 1986, pp 751-
26. Hawkey CM, et al: The diagnostic value of hematology in
759 reptiles. Proceedings of the Third International Collo-
9. Kishimori J, Lowbart T, et al: Chelonian shell fracture
quium on the Pathology of Reptiles and Amphibians,
repair techniques. Exotic DVM 3.5:35-41, 2001
Orlando, FL, 1989, pp 56-57
10. Barten S: Shell damage, in Mader D (ed): Reptile Med- 27. Montali RJ, et al: Leukocytes and inflammation in rep-
icine and Surgery. Philadelphia, Saunders, 1996, pp 413- tiles. Proceedings of the Third International Collo-
417 quium on the Pathology of Reptiles and Amphibians,
11. CooperJE, Geschmeissner S, Bone RD: Herpes-like virus Orlando, FL, 1989, pp 64-65
particles in necrotic stomatitis of tortoises. Vet Rec 123: 28. Rosskopf WJ, Woerpel RW: Hematology and the use of
554, 1988 serum chemistry profiles in reptile diagnostics. Proceed-
12. Havkewicz K: Dermatology of reptiles: a clinical ap- ings of the Third International Colloquium on the Pa-
proach to diagnosis and treatment. Vet Clin North Am thology of Reptiles and Amphibians, Orlando, FL, 1989,
Exotic Anim Pract 4:441-461, 2001 pp 58-61
13. Jacobson, E: Diagnosis of reptilian viral disease. Proceed- 29. RosskopfWJ: Disorders of reptilian lenkocytes and eryth-
ings of the AAZV, Columbus, OH, October 1999, pp 1-5 rocyte, in Fudge AM (ed): Laboratory Medicine: Avian
14. Posthaus H, Marschang R, et al: Study on herpesvirus and Exotic Pets. Philadelphia, Saunders, 1999, pp 198-
infections in land tortoises in Switzerland. Proceedings 204
of the AAZV, 1997, pp 17-18 30. Boyer TH: Metabolic bone disease, in Mader D (ed):
15. Frye F: Biomedical and Surgical Aspects of Captive Rep- Reptile Medicine and Surgery. Philadelphia, Saunders,
tile Husbandry, 2nd Ed, Vols. I and II. Melbourne, FL, 1996, pp 385-392
ga-eiger Publishing, 1991 31. Mader D: Metabolic bone disease in caplive reptiles.
16. RosskopfJr WJ, Woerpel RW, et al: Abdominal surgery in Vivarium 2:12, 1990
turtles and tortoises. Compend Contin Educ Pract Vet 32. Donoghue S, McKeown S: Nutrition of captive reptiles.
4:326-329, 1983 Vet Clin North Am Exotic Anita Pract 2:69-91, 1999
17. Johnson J, Averill-Murray R, Jarchow J: Captive care of 33. WallachJD: The pathogenesis and etiology of ulcerative
the desert tortoise Gopherusagassizii.J Herpetolog Med shell disease in turtles. Aquatic Mammals 4:1, 1976
Surg II:8-16, 2001 34. Wallach, JD: Ulcerative shell disease in turtles. Identifi-
18. Bouner B, Denver M, Garner M, et ah Entamoeba inva- cat Prophylaxis Treat Inti Zoo Yearbook 17:170, 1977