Difference between revisions of "Avian Sinusitis"

Revision as of 09:56, 28 July 2011

Introduction

This infection can occur in any psittacine with a diet deficient in Vitamin A but is particularly common in imported grey parrots.

Signalment

The specific nutrient deficiency that contributes to a sinus infection in birds is hypovitaminosis A. This can occur if the bird is fed and all seed diet, which is deficient in vitamin A, iodine and calcium, therefore it is essential that a full dietary history is taken. Vitamin A deficiency results in the failure of some cells to differentiate normally. In the sinus, the epithelial lining degenerates into squamous metaplasia resulting in a thickening of the mucus that washes the debris from the sinus. This thickening reduces flow rates and allows bacteria and debris to persist on the sinus lining until infection occurs. This deficiency can also contribute to the development of and rhinoliths, abscesses and conjunctivitis.

Clinical Signs

Early clinical signs include sneezing, proptosis and clicking. Later, swelling may develop around the eyes or between the eyes and beak over the frontal signs. Excessive secretion of serous or mucous material from the respiratory mucous membranes is often reported. It is common for the bird to be suffering from concurrent disease such as pneumonia and air sacculitis. Respiratory distress may be evident, however this should be observed in a quiet stress-free environment for reliable interpretation. Clinical exam is often better performed under general anaesthesia as the cloana should be examined for any spread of infection.

Diagnosis

Clinical signs coupled with the history of a vitamin A deficient diet should should be suggestive of sinusitis, however needle biopsy of the swellings is required to make a definitive diagnosis, as it allows for the differentiation from abscesses. Cytology, culture and sensitivity should be performed on the aspirated material to determine the presence and nature of infection. The most common infectious organisms are Pseudomonas and Mycoplasma species. Radiography of the skull can also be performed to confirm the presence of sinusitis.

Treatment

Proper treatment consists of antibiotic therapy for the infection, ideally with Baytril and a single dose of 20 000 IU vitamin A per kg body weight i.m., followed by supplementation of the diet with vitamin A. Treatment of the infection without this supplementation renders the bird likely to have a recurrence of the infection. Drainage and flushing of the sinus with antibiotics can be attempted in severe cases but due to the anatomy of the sinuses and the nature of the inspissated pus produced, it is normally unsuccessful. If rhinoliths or choanal abcesses are present they should be removed using a needle or dental instruments.

Prognosis

If the dietary deficiencies are addressed by feeding orange and dark green vegetables long term then infection is unlikely to recurr. Therefore, if the bird recovers well from the original episode of sinusitis the prognosis is good.

References

Lawton, M (1999) Management of respiratory disease in psittacine birds In Practice 1999 21: 76-8

Forbes NA & Altman RB (1998) Self-Assessment Colour Review Avian Medicine Manson Publishing Ltd

Stanford, M (2009) Respiratory Disease in Birds Royal Veterinary College Integrated Course RVC

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-{{OpenPagesTop}}
 ==Introduction==
-Sinus infection can occur in any '''psittacine''' but is particularly common in imported grey parrots. It was largely thought to be associated with a diet deficient in '''Vitamin A''' however there is now some controversy surrounding its contribution to the disease<ref name="one">Lawton, M (1999) '''Management of respiratory disease in psittacine birds''' ''In Practice 1999 21: 76-8''</ref> <ref name="three">Stanford, M (2009) '''Respiratory Disease in Birds''' Royal Veterinary College Integrated Course ''RVC''</ref>.
+This infection can occur in any '''psittacine''' with a diet deficient in '''Vitamin A''' but is particularly common in imported grey parrots.
 ==Signalment==
-'''Hypovitaminosis A''' is a nutritional deficiency thought to predispose birds to sinusitis <ref name="one">Lawton, M (1999) '''Management of respiratory disease in psittacine birds''' ''In Practice 1999 21: 76-8''</ref>. This can occur if the bird is fed and '''all seed diet''', which is '''deficient''' in '''vitamin A''', '''iodine''' and '''calcium''', therefore it is essential that a full dietary history is taken. Vitamin A deficiency causes some cells to differentiate abnormally. This occurs in the sinus, where the epithelial lining degenerates into '''squamous metaplasia'''. This causes the '''mucus to thicken''', thus preventing debris from being flushed out of the sinus. This results in a '''build-up of debris and bacteria''', eventually resulting in infection<ref name="two">Forbes NA & Altman RB (1998) '''Self-Assessment Colour Review Avian Medicine''' ''Manson Publishing Ltd''</ref>. This deficiency can also contribute to the development of and '''rhinoliths''', '''abscesses''' and '''conjunctivitis'''. Currently it is thought that sinusitis may not occur as a result of vitamin A deficiency as many parrot diets now have an excess of Vitamin A<ref name="three">Stanford, M (2009) '''Respiratory Disease in Birds''' Royal Veterinary College Integrated Course ''RVC''</ref>.
+The specific nutrient deficiency that contributes to a sinus infection in birds is '''hypovitaminosis A'''. This can occur if the bird is fed and '''all seed diet''', which is '''deficient''' in '''vitamin A''', '''iodine''' and '''calcium''', therefore it is essential that a full dietary history is taken. Vitamin A deficiency results in the failure of some cells to differentiate normally. In the sinus, the epithelial lining degenerates into '''squamous metaplasia''' resulting in a '''thickening of the mucus''' that washes the debris from the sinus. This thickening '''reduces flow rates''' and allows '''bacteria''' and '''debris''' to persist on the sinus lining until infection occurs. This deficiency can also contribute to the development of and '''rhinoliths''', '''abscesses''' and '''conjunctivitis'''.
 ==Clinical Signs==
-Early clinical signs include '''sneezing''', '''proptosis''' and '''clicking'''. Later, '''swelling''' may develop around the '''eyes''' or between the eyes and beak over the frontal signs. Excessive secretion of serous or mucous material from the respiratory mucous membranes is often reported. It is common for the bird to be suffering from concurrent disease such as pneumonia and [[Air Sacculitis|air sacculitis]]. Respiratory distress may be evident, however this should be observed in a quiet stress-free environment for reliable interpretation. Clinical exam is often better performed under general anaesthesia as the choana should be examined for any spread of infection.
+Early clinical signs include '''sneezing''', '''proptosis''' and '''clicking'''. Later, '''swelling''' may develop around the '''eyes''' or between the eyes and beak over the frontal signs. Excessive secretion of serous or mucous material from the respiratory mucous membranes is often reported. It is common for the bird to be suffering from concurrent disease such as pneumonia and air sacculitis. Respiratory distress may be evident, however this should be observed in a quiet stress-free environment for reliable interpretation. Clinical exam is often better performed under general anaesthesia as the cloana should be examined for any spread of infection.
 ==Diagnosis==
-Clinical signs coupled with the history of a vitamin A deficient diet should be suggestive of sinusitis, however '''needle biopsy''' of the swellings is required to make a '''definitive diagnosis''', as it allows for the differentiation from abscesses. '''Cytology''', '''culture and sensitivity''' should be performed on the aspirated material to determine the presence and nature of infection. The most common infectious organisms are [[:Category:Pseudomonas and Burkholderia species|''Pseudomonas'']] and [[:Category:Mycoplasmas|''Mycoplasma'' species]]. '''Radiography''' of the skull can also be performed to confirm the presence of sinusitis.
+Clinical signs coupled with the history of a vitamin A deficient diet should should be suggestive of sinusitis, however '''needle biopsy''' of the swellings is required to make a '''definitive diagnosis''', as it allows for the differentiation from abscesses. '''Cytology''', '''culture and sensitivity''' should be performed on the aspirated material to determine the presence and nature of infection. The most common infectious organisms are ''Pseudomonas'' and ''Mycoplasma'' species. '''Radiography''' of the skull can also be performed to confirm the presence of sinusitis.
 ==Treatment==
-Ideally the bird should be treated with the '''antibiotic 'Baytril'''' (enrofloxacin) as it covers the above-mentioned bacteria. Additionally the bird should receive a dose of '''Vitamin A''' by '''intramuscular''' injection. Subsequent dietary supplementation of Vitamin A by feeding '''orange''' and '''dark green vegetables''' is necessary to prevent recurrence of infection<ref name="two">Forbes NA & Altman RB (1998) '''Self-Assessment Colour Review Avian Medicine''' ''Manson Publishing Ltd''</ref> <ref name="one">Lawton, M (1999) '''Management of respiratory disease in psittacine birds''' ''In Practice 1999 21: 76-8''</ref>. Drainage and flushing of the sinus with antibiotics in severe cases is recommended  by some <ref name="three">Stanford, M (2009) '''Respiratory Disease in Birds''' Royal Veterinary College Integrated Course ''RVC''</ref> but due to the anatomy of the sinuses and the nature of the inspissated pus produced, others report that it is normally unsuccessful<ref name="one">Lawton, M (1999) '''Management of respiratory disease in psittacine birds''' ''In Practice 1999 21: 76-8''</ref>. If rhinoliths or choanal abcesses are present they should be removed using a needle or dental instruments.
+Proper treatment consists of '''antibiotic therapy''' for the infection, ideally with Baytril and a '''single dose of 20 000 IU vitamin A per kg body weight i.m'''., followed by '''supplementation of the diet with vitamin A'''. Treatment of the infection without this supplementation renders the bird likely to have a recurrence of the infection. Drainage and flushing of the sinus with antibiotics can be attempted in severe cases but due to the anatomy of the sinuses and the nature of the inspissated  pus produced, it is normally unsuccessful. If rhinoliths or choanal abcesses are present they should be removed using a needle or dental instruments.
 ==Prognosis==
-If the dietary deficiencies are addressed long term then infection is unlikely to recur. Therefore, if the bird recovers well from the original episode of sinusitis the prognosis is '''good'''.
+If the dietary deficiencies are addressed by feeding '''orange''' and '''dark green vegetables''' long term then infection is unlikely to recurr. Therefore, if the bird recovers well from the original episode of sinusitis the prognosis is '''good'''.
 ==References==
-<references />
+Lawton, M (1999) '''Management of respiratory disease in psittacine birds''' ''In Practice 1999 21: 76-8''
+Forbes NA & Altman RB (1998) '''Self-Assessment Colour Review Avian Medicine''' ''Manson Publishing Ltd''
-{{review}}
+Stanford, M (2009) '''Respiratory Disease in Birds''' Royal Veterinary College Integrated Course ''RVC''
-{{OpenPages}}
+[[Category: To Do - Siobhan Brade]]
+[[Category:To Do - Manson review]]
-[[Category:Respiratory Diseases - Birds]]
-[[Category:Expert Review - Bird]]