reptile - Articles
Stomatitis
Synonym(s): Mouth rot, Infectious stomatitis, Ulcerative stomatitis, Oral inflammation
Introduction
- Cause: bacterial, viral and fungal infections, usually secondary to suboptimal husbandry.
- Signs: purulent discharge, caseous plaques, facial swellings, anorexia, lethargy.
- Diagnosis: clinical examination, radiography, cytology and culture.
- Treatment: topical and systemic antibiotics and antifungals, surgery, analgesia and assisted feeding alogside husbandry changes.
- Prognosis: variable depending on extent and chronicity of disease and whether underlying osteomyelitis is present.
Presenting signs
- Anorexia Anorexia.
- Lethargy.
- Visible oral plaques, abscessation or discharge.
- Altered jaw carriage.
- Tongue dysfunction.
- Broken or missing teeth.
- Bleeding from the mouth.
Acute presentation
- Animals may present with visible abscesses from the mouth.
- There may be blood or pus visible.
- They may be dull or even collapsed depending on degree of disease.
Geographic incidence
- Worldwide in captive reptiles.
Breed/Species predisposition
- All species can be affected.
- Can occur secondary to rostral trauma in nervous species such as Chinese water dragons (Physignathus cocincinus) Chinese water dragon.
- Common in chelonians kept at suboptimal temperatures with underlying herpes virus or Mycoplasma infection.
Public health considerations
- None, although all reptiles potentially carry salmonella as a normal commensal organism.
- Mycobacteria are a very rare cause of stomatitis.
Cost considerations
- Chronic infections that have progressed to osteomyelitis and require surgery or placement of feeding tubes may require prolonged treatment and be expensive.
- Any husbandry and environmental deficits will need to be corrected and appropriate equipment will likely require expenditure.
Special risks
- These animals are often dehydrated and may be immunosuppressed.
Pathogenesis
Etiology
- Compromised oral mucosa due to:
- Immunosuppresion.
- Underlying viral infection, eg Herpesvirus.
- Putrefaction of food during hibernation.
- Oral, rostral and dental trauma.
- Damage to dentition.
- Damage caused by metabolic bone disease Metabolic bone disease/SNHP.
- Hypovitaminosis A Hypovitaminosis A and squamous metaplasia.
- Pentastomid infection (wild-caught animals).
- Secondary opportunistic infection:
- Pseudomonas
, Aeromonas, E. coli, Bacteriodes, Clostridia, Fusobacterium, Proteus, Devriesia, Mycobacteria, Mycoplasma. - Herpes and rana viruses (chelonians).
- Candida, Aspergillus and other opportunist fungal infections.
- Pseudomonas
- Progression to osteomyelitis Osteomyelitis and respiratory disease Lower respiratory tract disease.
Predisposing factors
General
- Suboptimal temperatures, humidity and ventilation.
- Poor calcium and vitamin D3 supplementation leading to metabolic bone disease/ SNHP.
- Hypovitaminosis A Hypovitaminosis A.
- Suboptimal UVB provision Chelonia husbandry Lizard husbandry Snake husbandry.
- Rostral trauma.
- Tooth damage and periodontal disease Periodontal disease often secondary to inappropriate diet.
- Latent herpes virus Herpes virus infection, ranavirus and mycoplasma infection in chelonia.
- Poorly implemented hibernation Hibernation / brumation, including lack of prehibernation management, lack of monitoring, excessive length and no temperature control.
- Putrefaction of food during hibernation related to poor prehibernation management.
- Gout Gout which is often secondary to renal disease Renal disease.
Specific
- Lively or nervous species kept in unsuitable enclosures may be at risk of rostral trauma, eg Chinese water dragons.
Pathophysiology
- Compromise of oral mucosa.
- Invasion by bacteria, fungi and viruses.
- Severe inflammatory reaction.
- Progression to osteomyelitis.
- Spread to eyes and respiratory tract.
- Inability to eat and starvation.
- Septicemia may follow
Timecourse
- Often chronic but not noticed by owners.
Epidemiology
- Often husbandry related therefore may be clusters in animals kept in similar conditions Chelonia husbandry Lizard husbandry Snake husbandry.
Diagnosis
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Treatment
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Prevention
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Hedley J (2016) Anatomy and disorders of the oral cavity of reptiles and amphibians. Vet Clin North Am Exotic Anim Pract 19 (3), 689–706 PubMed.
- Johnson A J et al (2008) Ranavirus infection of free-ranging and captive box turtles and tortoises in the united states. J Wildl Dis 44 (4), 851–863 PubMed.
- Soares J F et al (2004) Prevalence of Mycoplasma agassizii and chelonian herpesvirus in tortoises (Testudo sp.) in the United Kingdom. J Zoo Wildl Med 35 (1), 25–33 PubMed.
- Mans C & Braun J (2014) Update on common nutritional disorders of captive reptiles. Vet Clin North Am Exotic Anim Pract 17 (3), 369–395 PubMed.
Other sources of information
- Klaphake E, Gibbons P M, Sladky K K & Carpenter J W (2018) Reptiles. In: Exotic Animal Formulary. 5th edn. Ed: Carpenter J W & Marion C J. Saunders Elsevier, USA. pp 81-166.
- Mehler S & Bennett R A (2006) Upper Alimentary Tract Disease. In: Reptile Medicine and Surgery. Ed: Mader D R. Saunders Elsevier, USA. pp 924–930.
- McArthur S (2004) Problem-Solving Approach to Common Diseases. In: Medicine and Surgery of Tortoises and Turtles. Eds: McArthur S, Wilkinson R, Meyer J. Wiley-Blackwell, UK.
- McArthur S, McLellan L & Brown S (2004) Gastrointestinal System. In: BSAVA Manual of Reptiles. Eds: Girling S & Raiti P. BSAVA, UK. pp. 210–229.