Chapter 5 - Amphibians

Natalie Mylniczenko
C H A P T E R 5
AMPHIBIANS
COMMON SPECIES KEPT

fossorial Mexican caecilian (Dermophis mexicanus) and Varagua
IN CAPTIVITY caecilian (Gymnopis multiplacata).1
The class Amphibia is divided into three orders: Anura (frogs
and toads), Caudata (salamanders, newts, and sirens), and
Gymnophiona (caecilians). There are over 4000 extant species,
BIOLOGY
but very few (one tenth) are ever held in captivity.1 Amphibian body plans are consistent with those of other ver-
The frogs and toads are the most represented of these orders tebrates. However, as with any exotic animal species, knowl-
in captivity. The distinction between frogs and toads, accord- edge regarding the nuances of species variation for some
ing to most veterinarians, is whether the animals are found in anatomical and physiological traits can be helpful when devel-
or around water (frogs) or not (toads). Common species in oping a diagnostic or treatment plan for an amphibian patient.
captivity include the firebelly toads (Bombina spp.) (Figure For example, amphibians do not have distinct thoracic and
5-1), African clawed frogs (Xenopus laevis), dwarf clawed frogs abdominal cavities. Instead, they have a single coelomic cavity.
(Hymenochirus spp.), ornate horned frogs (Ceratophrys spp.), This information is important when considering surgery (e.g.,
true toads (Bufo spp.), poison dart frogs (Dendrobates spp., no loss of negative pressure as would be the case with mammals).
Phyllobates spp., Epipidobates spp.), true frogs (Rana spp.), and The following comments on anatomy and physiology will
tree frogs (Hyla spp.). focus on salient clinical features. See other amphibian texts for
Newts and salamanders (grouped as caudates) have greater detail.2,3
gained in popularity as vivarium pets in the past decade. The
defining characteristic of a newt versus a salamander is that Unique Anatomy of Frogs
a newt maintains an aquatic lifestyle throughout both its
larval and adult stages.1 The redbelly or firebelly newt (Cynops
and Toads3,4
pyrrhogaster) (Figure 5-2), water dog or tiger salamander MUSCULOSKELETAL
(Ambystoma tigrinum), axolotl (Ambystoma mexicanum), Four limbs are present, but there may be variable hindlimb
mudpuppy (Necturus maculosus), rough-skinned newt (Taricha lengths. The length depends on species locomotory modes;
granulosa), red-spotted newt (Notophthalmus viridescens), longer hindlegs occur in animals that jump (Figure 5-4). The
and members of the Triturus genus are common to the pet forelimbs possess a fused radius and ulna (radioulna), whereas
trade. Sirens are a lesser known subset of this order and are the hindlimbs have a fused tibia and fibula (tibiofibula). The
not typically held in captivity except in some zoological forefeet possess four phalanges on each foot, whereas the hind-
facilities. feet have five phalanges. The hyoid apparatus in some species
Caecilians are infrequently kept in amphibian collections. is adapted to eject the tongue for prey capture. Vertebrae are
When observed in zoos or aquaria, the most common species separated into three fused regions: presacral, sacral, and post-
found are the aquatic Typhlonectes natans (Figure 5-3) and the sacral (note that a sacrum is not present). The pelvic girdle is
73
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74 MANUAL OF EXOTIC PET PRACTICE
Figure 5-1 Firebelly toad (Bombina sp.).
Figure 5-3 Aquatic caecilian (Typhlonectes natans).
Figure 5-4 Skeleton of Rana catesbeiana.
Figure 5-2 Firebelly newt (Cynops pyrrhogaster). may also indicate a pathological condition. Ecdysis occurs
regularly, and keratophagy (e.g., consuming the shed skin) may
occur. The skin may contain venom glands for predator avoid-
fused with the last presacral vertebra, and a fused urostyle (or ance. In bufonids, the large parotid glands dorsocaudal to the
coccyx) is found caudal to the girdle. Some animals possess eyes can produce noxious chemicals. Anurans have a patch of
pigments that result in a blue coloration of the bones (Phry- skin on the ventral pelvis that is highly water absorptive. Vet-
nohyas resinifictrix). Amphibians do not have diaphragms. erinarians may use this patch to facilitate fluid absorption in
dehydrated amphibians.
INTEGUMENT SYSTEM
Anatomical modifications of the skin are highly variable among RESPIRATORY SYSTEM
species, but the basic integument has a thin keratin layer Three modes of respiration occur in anurans: buccopharyn-
(usually one cell layer thick) and a relatively thin basal epider- geal, pulmonic, and cutaneous; the mode used depends on
mal layer (approximately eight cell layers thick). There is a species variability and environment. Anurans have a short
significant subcutaneous layer that can accumulate fluid. In trachea, thus impacting clinical procedures such as tracheal
some species, this is normal (as a fluid reservoir); however, it intubation and washes. Two equally sized lungs are present.
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Chapter 5 Amphibians 75
ammonia (ammonotelic), because conserving water is not

important. Urea-excreting animals (ureotelic), like toads, will
have some contact with water. They produce dilute urine when
they are in freshwater and typically do not urinate on land
(thus, their plasma urea elevates). Uric acid–excreting animals
(uricotelic) have the least contact with water (e.g., the tree
frog).
Amphibians have mesonephric kidneys and cannot concen-
trate urine above the solute concentration of the plasma. The
kidney is a dual filter for coelomic and vascular fluid (there are
connections to the coelom via a nephrostome), and this has
implications when administering drugs via the coelomic
cavity.
Figure 5-5 Gastrointestinal system (liver removed) of the frog REPRODUCTIVE SYSTEM
(Rana pipiens). Some anuran species possess intromittent organs, but most do
not. External fertilization is the primary reproductive strategy
of anurans. However, internal fertilization may occur in some
The lungs of anurans are thin, sac-like structures. Care should viviparous toads. Corpora lutea develop in some species. Males
be taken when positive pressure ventilating these animals to in the genera Bufo have a Bidder’s organ, which is a rudimen-
prevent pulmonary rupture. tary ovary. Sexual dimorphism may be seen in anurans and is
usually characterized by color changes, size differences (males
CARDIOVASCULAR SYSTEM (ARTERIAL, are typically smaller), and the presence of spines, tubercles, and
VENOUS, AND LYMPHATIC) tusks. Some males will have nuptial pads that develop during
Anurans have a three-chambered heart, and it is encased in the the breeding season or have larger toes than females.
pectoral girdle. Both renal and hepatic portal venous systems
are found in anurans. All amphibians possess lymph hearts, HEMATOPOIETIC SYSTEM
which beat in synchrony at about 50 beats per minute (bpm) All amphibians possess a thymus throughout their adult life.
independently from the cardiac system. Lymph accumulation Terrestrial animals have functional bone marrow, but only
typically implies illness. Fluid can be absorbed directly into the lymphocytes and myelocytes are produced there. The spleen is
lymphatics and then into the kidneys, so some care must be the major site for erythropoiesis. Some red cell production
used when administering drugs cutaneously or subcutaneously. can occur in the liver, kidney, and bone marrow in various
The differences between lymph and blood are not well studied, species.
but overall, the components (e.g., chemistries) are similar with
the exception of the erythrocytes. ENDOCRINE SYSTEM
Endocrine glands of all amphibians are similar to those of other
GASTROINTESTINAL SYSTEM vertebrates.
Teeth are absent in some frogs; others lack tongues (e.g., Pipa
pipa, which uses negative pressure to create a vacuum to catch OTHER
prey). Occasionally, frogs evert their stomachs in order to wipe Amphibians have two discrete lipid storage organs: coelomic
noxious substances from their stomach mucosa. It is not fat bodies and inguinal fat bodies. Lipids are also stored in
unusual to see undigested insect skeletons, bones, or plant various cutaneous and subcutaneous fat deposits around the
fibers in the feces of anurans. All amphibians (note: within this heart, in the liver, and in the tail of some plethodontid
text, “all” amphibians will include caudates and caecilians) salamanders.
have a simple, short alimentary system that empties into a
cloaca (Figure 5-5). A large bilobed liver (which can fill up to Unique Anatomy of Newts
50% of the coelom) encases the pericardium. There are typi-
cally two lobes, though a third will occur in some species. The
and Salamanders3,4
color and shade varies from pale gray to brown to black. Mela- MUSCULOSKELETAL
nomacrophages are present and can result in the dark color- Unique species features include the lack of a pelvic girdle in
ation of the liver. In the larval amphibian, the liver is the the sirens and greatly reduced limbs in Amphiuma spp. The
primary hematopoietic organ, switching to bone marrow after vertebral column is not well differentiated in these animals,
metamorphosis. Anurans have a large gall bladder. but it is not fused as with the anurans.
URINARY SYSTEM INTEGUMENT SYSTEM

The end products of protein catabolism in anurans may be In some species of aquatic salamander, there is no keratin cell
ammonia, urea, or uric acid. Typically, aquatic anurans excrete layer. The dermis is firmly attached to muscle, and therefore
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there is no subcutaneous layer. Glandular secretions may

contain toxic compounds. Folding of the skin and similar
anatomical modifications may increase the available surface
layer for respiratory purposes.
RESPIRATORY SYSTEM
There are four forms of respiration in caudates, and they are
species dependent: branchial, cutaneous, buccopharyngeal,
and pulmonic. Animals with gills may have short or long fila-
ments depending on their natural environment. Animals with
short gills are typically located in stream areas and thus have
higher requirements for dissolved oxygen. Cutaneous respira-
tion can occur in these animals because of a high surface area
on the skin and a low metabolic rate; additionally, anaerobic
glycolysis can occur. Behavioral responses, such as rocking, Figure 5-6 Basic anatomy of the caudate (Ambystoma
allow a current to run across the skin, optimizing contact with mexicanum).
dissolved oxygen in the water. Most salamanders possess two
lungs, with either single lobes (aquatic) or sacculated lobes
(terrestrial). There is a lungless salamander. Costal grooves
(skin folds along the ribs) also increase the integumentary occurs (sexual maturity in juveniles); the adult form can be
surface area. Buccopharyngeal respiration technically is cutane- induced by using thyroxine or drying.
ous respiration occurring within the oral cavity. The trachea of
caudates is very short and should prompt the clinician to SENSORY SYSTEMS
exercise caution when performing procedures like intubation Lateral lines are present; occasionally electroreceptors are also
and tracheal washes. present. The lateral line is used to detect movement/motion in
the water column (e.g., prey motion).
CARDIOVASCULAR SYSTEM (ARTERIAL,
VENOUS, AND LYMPHATIC) HEMATOPOIETIC SYSTEM
A three-chambered heart is found encased within the pectoral The ventral meninges in some species act as hematolympho-
girdle. Renal and hepatic portal vein systems are present in poietic tissue; otherwise, it is similar to that of anurans.
these amphibians. Numerous lymph hearts are present, usually
around 11 in the head and coelom and 4 caudal to the
sacrum.
Unique Anatomy of Caecilians2-5
MUSCULOSKELETAL SYSTEM
GASTROINTESTINAL SYSTEM Caecilians lack both a pectoral and pelvic girdle. Most of the
The liver is elongate and single lobed; it may have scalloped ribs are double headed. Locomotion occurs by vertically
edges. The intestinal anatomy of newts and salamanders has directed musculature and hydrostatic motion.
no relevant clinical differences from other amphibians (Figure
5-6). The oral cavity hinges such that the maxilla is mobile INTEGUMENT SYSTEM
while the mandible is static. The skin has one layer of keratinized cells. Some species possess
dermal scales. The glandular secretions of caecilians contain
URINARY SYSTEM hemolysins and can prove to be very irritating to human
Caudates possess secondary tubules in their kidneys, which mucous membranes, as well as to other caecilians. The skin is
attach to the primary tubules; however, they do not have many shed regularly and appears as thin strands of white mucoid
nephrostomes and thus rely heavily on vascular filtration. They material. Keratophagy may occur. As with salamanders, there
possess variably shaped bladders (bilobate, bicornate, and is no subcutaneous area.
cylindrical). The primary excretory product in the aquatic
caudate is ammonia, whereas in the terrestrial animal it is RESPIRATORY SYSTEM
urea. Three forms of respiration occur in caecilians, and are again
dependent on species variation and environment: pulmonic,
REPRODUCTIVE SYSTEM buccopharyngeal, cutaneous. Some animals can use multiple
In the dorsal aspect of the female cloaca resides the spermatheca modes. Caecilian lungs can have one or two (most aquatic
(site for sperm storage). Males produce a spermatophore, animals) lobes, although one species, Atretochoana eiselti, does
which is a gelatinous structure (e.g., sperm packet) that is taken not possess any lung. Because the aquatic animals use pul-
into the female’s cloaca. This is loosely considered “internal” monic breathing as a primary means of respiration, care for
fertilization (the male technically has no intromittent organ). depth of the animal’s enclosure must be considered (especially
External fertilization does occur in some species. Neoteny with ill or neonatal animals).
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Figure 5-7 Caecilian (Typhlonectes natans) uterus with Figure 5-8 Caecilian (Typhlonectes natans) newborn with
fetuses. external gills.
CARDIOVASCULAR SYSTEM (ARTERIAL,

VENOUS, AND LYMPHATIC)
Caecilians have a typical amphibian three-chambered heart.
Caecilians can have over 200 lymph hearts. A renal portal
system is presumed to exist, but it has not been documented.
OTHER
GASTROINTESTINAL SYSTEM Adipose color can vary from tan to very bright orange in
Caecilians possess small sharp teeth that are positioned in two Typhlonectes natans, and it should not be misclassified as
layers. The alimentary system tends to be elongated, as with abnormal.
snakes, due to their compact and long body size.
URINARY SYSTEM Basic Premetamorphic Anatomy2-5

Aquatic caecilians rely on the kidney for ammonia and water ANURANS
excretion, whereas terrestrial animals must excrete urea or uric Tadpoles are markedly different from their postmetamorphic
acid. Caecilians have mesonephric kidneys, but they lack the counterparts. They possess a large oval head and a laterally
secondary tubules found in caudates and anurans. Some cae- compressed tail. Gills are the primary respiratory organs for
cilians have bilobate bladders. tadpoles. Most tadpoles have a very long digestive tract to
accommodate a largely herbivorous lifestyle, although car-
REPRODUCTIVE SYSTEM nivory may occur in tadpoles either facultatively or in over-
Male caecilians possess a phallodeum (intromittent organ), crowded conditions.
enabling them to practice internal fertilization. Caecilian
ovaries are paired and are closely connected with the kidneys. CAUDATES
Viviparous animals have an oviductal lining where embryos Larvae possess large heads with external gills (three pairs).
feed off the lining (Figure 5-7). Oviparity occurs in most cae- Terrestrial forms begin to resorb the gills as metamorphosis
cilians, with some species-specific parental care occurring until reaches completion. Neoteny occurs in some species (Ambys-
hatching. toma mexicanum and Necturus maculosus). This is the process
in which the internal organs mature and allow reproduction
SENSORY SYSTEMS while the external features remain larval.
There is a chemosensory and tactile tentacle between the eye
and the nostril that is attached to the tear duct and the vomero- CAECILIANS
nasal organ (Jacobson’s organ). These animals rely heavily on this Aquatic caecilians are viviparous. Larval animals are born fairly
structure, as their vision is poor or absent. Audition is limited precocious, although they do have gills (Figure 5-8) present
because many caecilians lack outer and middle ear cavities, but for the first day after birth. Oviparous caecilian larvae also have
they are capable of detecting low-frequency vibrations. external gills that are quickly resorbed, but they also possess
larval fins, which disappear shortly before hatching. The larval
HEMATOPOIETIC SYSTEM caecilian has a pronephric kidney that changes to a mesoneph-
Caecilians lack bone marrow and are thus dependent on the ric kidney during metamorphosis. This change alters the
liver, spleen, thymus, and kidneys to produce red and white kidney’s function from a filtration system to a more complex
blood cells. excretory and water resorptive system.
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General Clinical Physiology pump or airstone) can lead to oxygen absorption via the ventral
of Amphibians3 patch.
TEMPERATURE REGULATION
Amphibians are ectotherms. The ability of these animals to
HUSBANDRY
regulate their body temperature is highly variable among Illness in captive amphibians is largely due to poor husbandry
species but, overall, is regulated by behavior. Failure to main- practices. It is outside the scope of this chapter to discuss the
tain body temperature can result in failure to thrive. Hyper- intimate details of building a successful vivarium for all the
thermia can cause agitation, changes in skin color, inappetence, diverse species. Rather, the emphasis will be on general con-
immunosuppression, and weight loss with good appetite. siderations for housing to educate the clinician in basic require-
Hyperthermia is often rapidly fatal in amphibians. Hypother- ments and for designing hospital tanks. For information on
mia can result in lethargy, inappetence, bloating (decomposi- captive amphibian husbandry, see Wright and Whitaker.6,7
tion of ingesta), immunosuppression, and poor growth. Additionally, examining natural habitat can be exceptionally
Hypothermia is more often associated with the development useful in determining captive husbandry standards.
of chronic disease.
OSMOTIC BALANCE Environmental Considerations4-8

Amphibian skin plays an important role in homeostasis. Sig- Amphibians can be aquatic, semiterrestrial, fossorial, terres-
nificant water loss can occur through the skin. Because of this trial, or arboreal; thus, it is important for veterinarians to
concern, the skin must be kept moist in order for gas exchange emphasize the importance of species-specific requirements.
to occur (especially with lungless animals). Some amphibians,
like tree frogs, have lipid glands that leave a waxy waterproof AQUATIC
coating on their skin to prevent desiccation. Those amphibians Animals that live in ponds versus streams have very different
with thicker skin, like toads, are more resistant to water loss. tolerance levels for water quality. Stream-dwelling animals gen-
The gastrointestinal tract in most anurans does little to resorb erally have a greater need for more dissolved oxygen and higher
water; thus, oral fluids are likely not as effective as intracoelo- quality water. In general, water quality should be maintained
mic or transdermal fluids. The pelvic skin patch of amphibians as for fish. Table 5-1 provides basic parameters to observe with
on the ventral abdomen can account for up to an 80% uptake most amphibians.
of fluids. Because of this, it is possible to rehydrate animals by Dissolved oxygen should be greater than 80% (>5 mg/L)
soaking them in appropriate fluids. to maintain the biological filter (e.g., aerobic cycle). Water
filtration (bacterial and mechanical) should be maintained
METABOLISM as with fish. Under-gravel filters are acceptable if the tubing
In comparison to mammals and birds, amphibians have a rela- does not allow animals to get underneath the plates. Some
tively low metabolism. Amphibians typically rely on aerobic amphibians do not tolerate vibration well; therefore, care
metabolism. However, when a burst of activity occurs, these should be taken to place filters away from the enclosure if
animals can accumulate high concentrations of lactate. Sudden possible. A 10% to 20% water change should be done every
collapse has been reported once oxygen depletion occurs and week or two with aged or dechlorinated water. For caecilians,
fatigue sets in. Repeat handling may predispose an amphibian water depth should be shallow enough to allow animals to
to collapse, especially in critically ill animals. Affected animals obtain air without much effort, especially newborns. For most
should be placed in a shallow quantity of dechlorinated and amphibians, there should be a basking/dry-out area where
aerated water. Infusing oxygen into the water (e.g., by air the animals can leave the water.
TABLE 5-1 Water Chemistry Parameters for Amphibians

Parameter Normal Sublethal Lethal
Dissolved oxygen ≥5 mg/L 2-4 mg/L <2 mg/L
Ammonia (un-ionized) <0.01 mg/L 0.5 mg/L >1 mg/L
Nitrite <0.1 mg/L 0.015-0.1 mg/L >0.1 mg/L
Nitrate 0-5 mg/L 20-50 mg/L Species dependent
pH Species specific (∼6.5-8.5) 5.5-6.5; 8.6-9.5 5.5-6.5; 8.6-9.5
Gas pressure 28 mmHg 28-78 mmHg >78 mmHg
Hardness 75-150 mg/L >150-250 mg/L skin lesions can occur Unknown
Alkalinity 20-100 mg/L >100 mg/L Unknown
Chlorine (tadpoles) 0-2 ppm 2-4 ppm >5 ppm
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SEMITERRESTRIAL (STREAMSIDE
ANIMALS) BOX 5-1 Environmental Temperature Ranges for
Amphibians Based on Natural Habitat
Semiaquatic animals need standing water as well as areas to
haul out. By providing this, it is possible to create humidity Tropical lowland 24°-30° C
gradients that enable the animal to regulate its moisture. Tropical montane (moist, cool, coniferous 18°-24° C
Aquaria can be tilted or accessories placed such that the strata)
bottoms have standing water and top layers are drier and well Subtropical 21°-27° C
drained. Temperate, summer 18°-24° C
Hibernation 10°-16° C
FOSSORIAL AND TERRESTRIAL Aquatic, tropical lowland 24°-30° C
Fossorial and terrestrial vivaria are similar in every regard, Aquatic, tropical montane 18°-24° C
except that there should be deeper soil for fossorial animals. Aquatic, subtropical 21°-27° C
Aquatic, temperate stream (summer) 16°-21° C
Standing water receptacles are reasonable in these settings, but
Aquatic, temperate pond (summer) 18°-24° C
the water level should not be deeper than the animal is tall.
Moisture gradients in the soil are very important for fossorial
animals, and this is easily accomplished by tilting the aquarium
to retain different levels of moisture. Leaf litter placed on the should be provided vertical enclosures. Aquatic and fossorial
surface will allow the animal to forage while remaining covered. species should be provided an enclosure with a large surface
Live plants are not recommended for fossorial species, as the area (length × width).
plants may be uprooted when the amphibian forages.
TEMPERATURE
The environmental temperature range provided an amphibian
ARBOREAL should be based on its natural habitat (Box 5-1).6,7 There
The enclosure should be tall with accompanying tall branches should always be a gradient with a range of 5° to 8° C. When
and plants. It is important to provide an adequate number of changing water, make sure the temperature matches the enclo-
plants to provide ample hiding places. sure. Basking spots are necessary, and ceramic heaters (which
produce no light) or spotlights can usually provide the neces-
sary temperatures. Care and diligence are required for appro-
Creating a Vivarium priate wattage and distance. Spot heaters are best placed outside
Glass tanks are commonly used to house amphibians. They are of the enclosure to avoid trauma via thermal burns. Do not
well accepted because they allow excellent visualization of the use heat rocks for amphibians.
amphibians, are relatively inexpensive, and hold moisture. The Aquarium heaters may cause thermal burns for caecilians if
primary disadvantage associated with them is that they are not they wrap around these devices. To prevent this, place mesh
well ventilated. One way to improve ventilation is to have a or PVC piping around the heater to prevent contact. It is ideal
secure, well-ventilated lid. The lid also helps prevent escape. to use a thermometer that dually measures the warmest and
Plastic tanks are also appropriate for making vivaria and may coolest spot; the more advanced thermography units allow
be more flexible for modification, though scratches can occur detection of temperature gradients as well.9 Hibernation is
that obscure direct visualization of the animal. Lids that are important in some species for stimulating breeding, but it is
hinged allow servicing to a portion of the enclosure while unknown whether it is necessary for long-term health and
maintaining cover for the rest of the area. Solid plastic or glass success in captivity.6 Many salamander species prefer cooler
lids should be considered when maintaining a high humidity temperatures,10 and some vivaria might require chillers.
is important. When these types of lids are used, it is important
to still place some ventilation holes in them to prevent stagnant HUMIDITY
airflow. A fine mist can be sprayed into the vivarium several times daily
Volatile organic compounds, such as those found in glues, (manually or via misting systems). When doing so, distilled or
need to be cured appropriately (under strict manufacturer aged water should be used. An air stone in a bowl of water or
conditions) before being used around amphibians; otherwise live plants can also be used to help maintain the environmental
the fumes can leach into the environment and be irritating to humidity. Relative humidity above 70% will suit most amphib-
the skin and respiratory epithelium. ians. Tree frogs have a natural behavior to adduct their heads
Deionized water should not be used in an amphibian’s and press against surfaces to retain water—if they do this
vivarium, as it can disrupt osmolarity. Chlorinated tap water exclusively, the environmental humidity is not adequate. Con-
also is not recommended. Distilled water or reverse osmosis versely, waxy tree frogs may develop dermatitis with excessive
water is ideal. environmental humidity.6
ENCLOSURE SIZE LIGHTING

Enclosure sizes are highly variable and largely dictated by the Full-spectrum lights are generally recommended for amphibi-
environmental re-creation that is attempted. Arboreal species ans, but most do not provide radiation in the wavelengths
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consistent with vitamin D3 synthesis. Ultraviolet B (UVB) overfurnishing a vivarium may make prey capture difficult for
(290-320 nm) radiation may be important for vitamin D3 the animal. Plastic plants can be used to landscape a vivarium
metabolism in amphibians, but the role of UVB radiation has and are easily disinfected. Live plants can also be used and have
not been fully examined. I prefer to be conservative and recom- the benefit of increasing environmental humidity. It is impor-
mend the use of full-spectrum lights. Replacement of the bulbs tant to only use live plants that are known to be nontoxic, as
is recommended every 9 months to ensure that the appropriate prey being offered to amphibians may eat the live plants and
wavelength is emitted. UVB does not transmit through glass transfer any toxin to the amphibian.6 If live plants are chosen,
or plastic, and the depth at which it transmits is typically no the pet owner should check to see if harmful pesticides or fertil-
greater than 9 to 18 inches away from the source. Care must izers have been used. Live plants may be contaminated with
be taken that the lighting does not adversely affect the animals. parasitic ova (e.g., from Florida, where tree frogs live in the
Low-level nocturnal lighting (moonlight simulation) may be plants). Recently acquired live plants should be cleaned and
useful for nocturnal species to ensure that the animals are not their soil should be replaced to reduce the likelihood of con-
startled when the lights are turned on or off. Dimming lights taminating the vivarium with unwanted pathogens. Aquatic
gradually is ideal. plants can harbor snails, which can introduce parasites to a
Amphibians should be provided with a natural photoperiod vivarium as they serve as intermediate hosts for a number of
of 12 hours of light and 12 hours of darkness. If animals are parasites.
going to be bred, the light cycle may need to be altered to “Furniture” considerations for a vivarium may include large
mimic the normal reproductive season of the animal. rocks, branches, shelters, and waterfalls. Traumatic injuries
may occur with such items if they are not secured, and all
SUBSTRATE furnishings should have smooth edges. These items should also
Substrate selection is an important consideration for a vivar- be conducive to sterilization or disinfection. Bear in mind that
ium. When considering different types of substrates, it is porous objects may retain disinfectants. Proper rinsing is criti-
important to try to mimic an amphibian’s natural habitat. cal. Shelter type will depend on the natural camouflage of the
Smooth or small pebble gravel may be used as a substrate, but animal and should be provided. Such accessories are easily
it can become a gastrointestinal foreign body if it is ingested. created (Figure 5-9).
This can be prevented by using large pieces of gravel (e.g.,
bigger than can fit in the oral cavity) or feeding animals away
from such substrates. Soil substrates should be organically rich
and pH balanced (neutral). For burrowing caecilians, soil
depth should be 3 to 10 cm.5 For fossorial species, there should
be a moisture gradient and the soil should be loose enough to
allow for tunnel formation. Soil should be replaced every 2 to
3 months. Substrates that need to be sterilized should be
baked. Soil and leaf litter substrates should be sterilized to
prevent arthropod and helminth infestation. To sterilize soil,
bake at 200° F (95° C) in a thin layer (<2 cm) or place in
direct sunlight for several hours. In general, soil substrates are
very difficult to maintain. If sand is used, horticultural silver
sand is recommended. Sphagnum moss is a useful substrate
because it retains moisture, is soft and pliable, and is easily
discarded. Sphagnum moss should be changed every 2 to 4
weeks to avoid compacting the substrate and breeding undesir-
able organisms. Living moss does not usually do well in
amphibian vivaria because the water needs of moss cannot be
met while maintaining a healthy amphibian. Certain substrates
should be avoided. Rotting wood can be a good living sub-
strate, but the risks of introducing disease may outweigh the
benefits.6 Vermiculite is not recommended because it can cause
a gastrointestinal impaction. Peat moss and manure are not
recommended because they are acidic and irritating to the skin.
Mulch can be used, but aromatic woods (cedar, pine) should
be avoided as they can be toxic and irritating.
ACCESSORIES
It is important to take time and consider what accessories are
needed in a vivarium, as these items can be used to mimic an
animal’s natural habitat and reduce stress. Overplanting and Figure 5-9 Frog housing made out of PVC and moss.
Ch005-X0119.indd 80 12/4/2007 12:00:57 PM

Hospital Tank ambush predators should be offered food every 2 weeks).

Larval animals and smaller frogs should be fed daily. Nocturnal
Veterinarians working with amphibians should maintain hos- animals should be fed at night or late in the day; diurnal
pital tanks to treat cases presented to their facility. Smaller animals should be fed once a day, and sometimes twice daily,
plastic containers with snap-on lids and small doors on the lid depending on species.
make access to the animal easy and safe. Bubble wrap placed The list of possible invertebrates to offer amphibians is
on the bottom of the hospital tank provides a soft substrate, extensive.12 In general, the most common food items offered
which stays moist and is atraumatic. Plastic wrap placed around to terrestrial amphibians include earthworms, red worms,
the entire tank can be used to help maintain humidity, but the mealworm larvae, waxworm larvae, crickets, fruit flies, other
habitat should be serviced enough to provide adequate ventila- larvae, occasionally small reptiles (e.g., anoles), and amphibian
tion. This is not recommended for permanent or semiperma- eggs and larvae. For aquatic species, these same foods are
nent housing, where the air may stagnate and predispose offered, but bloodworms, blackworms, and crustaceans, such
amphibians to conditions like pneumonia. Sphagnum moss, if as crayfish and brine shrimp, may be offered as well. Some
used, should be thrown out weekly or when soiled, or more animals have very specific diets, like the termite-eating caeci-
frequently if the patient has a known infectious disease. The lian (Boulengerula spp.), and can be difficult to maintain in
hospital tank should be easily disinfected. captivity.5 Avoid brightly colored insects,6 as they may be natu-
rally toxic. Finally, although wild-caught invertebrates would
provide enrichment and balance for an amphibian, caution
NUTRITION must be exercised not to feed out organisms that have been
Premetamorphic anurans are typically herbivorous, although subject to pesticides or other such toxins.
obligate (e.g., poison dart frogs) and opportunistic carnivory Feeding pelleted diets intended for fish or reptiles may not
occur. Once metamorphosis is complete, amphibians become be appropriate for amphibians, as these diets may be intended
carnivorous. Although primarily insectivorous, anurans may for herbivores or omnivores and will not meet the fat, protein,
also consume fish, other amphibians, reptiles, rodents, and and vitamin requirements of amphibians.12 Rodents can be
birds. In caudates and caecilians, larval and adult forms are offered on occasion, but vitamin A levels are often too high in
carnivorous. these prey items, and secondary nutritional hyperparathyroid-
Recently imported animals may have difficulty converting ism can occur without supplementation of vitamin D3. On the
from a live prey to pre-killed prey diet, and some animals never other hand, oversupplementation with vitamin D3 may cause
convert. Weighing animals and assessing body condition are mineralization of organs. Unfortunately our knowledge regard-
useful for assessing whether an animal is eating. When live prey ing vitamin D3 metabolism in amphibians is limited.
items are offered, they should be removed after the animal Supplementing amphibian diets with vitamins and minerals
has stopped feeding, as prey can attack or feed on the is a questionable but necessary practice. With a truly well-
amphibian. balanced diet, supplementation is unnecessary and may even
cause problems (e.g., hypervitaminosis A and D). Unfortu-
nately, with the limited number of commercially available food
Feeding Mechanisms items, providing a well-balanced diet is difficult. Based on this
Larval anurans are filter feeders.11 Water is pumped through limitation, it is best to offer the largest variety (e.g., multiple
the mouth, and then planktonic algae are extracted and prey species) of food types to provide the best nutrition. Most
entrapped by a mucus-covered filter in the pharynx and then supplements target calcium and vitamin D3 in an attempt to
directed into the esophagus. Adult, terrestrial amphibians use balance the Ca : P ratio (1.5 : 1 or 2 : 1). Contrary to that
their tongues to capture prey. These animals have glands on target, most invertebrates, with the exception of earthworms,
their tongues, which produce a sticky substance that helps have an inverse Ca : P ratio.12 Invertebrates must therefore be
apprehend prey until it is securely placed in the mouth. Some “gut-loaded” with vitamins and minerals by feeding them a
anurans can shape their tongue into a tube to assist in feeding diet that is high in Ca and low in P (available commercially)
on ants, termites, and worms. Aquatic salamanders direct prey in the 24 hours before offering that prey item. Some of these
to their mouths by creating an inward flow of water into the diets can result in death of the prey item if fed longer than 24
oral cavity. Pipa pipa direct food and water into their mouth hours. Additionally, these diets are not balanced for inverte-
with hypobrachial pumping movements. Some aquatic brates and should not be used long term. Another product used
amphibians use their long phalanges to direct the food into for increasing the nutritional value of invertebrates is to “dust”
their oral cavity. them with a supplement. Placing the supplement and inverte-
brates in a brown bag and gently shaking the bag will result in
the invertebrate being covered with the supplement. Dusting
Feeding and Diet can be used with small invertebrates where gut loading is not
Obesity can occur in amphibians. In captivity, there is a ten- practical or lethal, and this should be done immediately before
dency to overfeed animals, either by offering too much food feeding.12 Dusting larger invertebrates with these supplements
or offering food too frequently. As animals get older, the fre- does not successfully achieve the calcium levels that gut loading
quency with which food is offered can be decreased (e.g., does. When feeding frozen fish, it is necessary to supplement
Ch005-X0119.indd 81 12/4/2007 12:00:58 PM

the diet with thiamine as the fish produce natural thiaminases Disinfection and Sanitation
that destroy the thiamine in the tissues.
Utensils, accessories, enclosures previously occupied by
amphibians, and enclosures with known disease entities,
PREVENTIVE MEDICINE should be disinfected to prevent the spread of disease. Removal
of all debris is necessary before application of a disinfectant,
Quarantine13 as some products are deactivated in the presence of proteins
All new animals must be quarantined before being added to and other organics. Warm water and surfactants can be used
an extant collection of animals. Transporting animals and to help break down organics during the cleaning process.
moving them into a new environment are exceptionally stress- Numerous classes of disinfectant are available, each with
ful events. Even though it is impossible to completely remove variable effectiveness against certain organisms (Table 5-2).
these stressors, they can be minimized once the animal is in Some products absorb the chemicals and can leach out while
quarantine. This can be accomplished by providing a quiet the amphibian is present (e.g., iodine products). Ammonia
room, appropriate furniture in the new enclosure (e.g., a hiding and chlorine bleach are good general disinfectants. With all
spot, such as a film canister or plastic plants), and not over- chemical products, thorough and repeat rinsing is mandatory.
crowding animals. Accessories must be easily disinfected. Par- For most disinfectants, a minimum contact time of 10
tially covering the enclosure can also help reduce visual stressors. minutes is recommended. For more fastidious organisms,
Multicolored papers (comic sections of newspaper) taped to longer contact times are recommended. Porous objects
the outside of the enclosure are excellent covers because a single should be discarded rather than reused, not only because
color may not be easily perceived; avoid black, as it may act as they harbor pathogens but also because it is difficult to
a mirror and stimulate striking behavior. thoroughly rinse and remove the chemicals from these
Quarantine should last a minimum of 30 to 60 days for materials. Humidifiers should be disinfected weekly, as should
captive raised animals but should be extended to 90 days for any aerosolizing tools. Povidone iodine, chlorhexidine,
wild-caught specimens. All in/all out principles should apply. isopropyl alcohol, and quaternary ammonium compounds
Animals in quarantine should be serially examined for pathogens are known to cause skin lesions and to be toxic in amphibians
and parasites. A standard schedule may include three fecal at high concentrations, and thus should be used with
examinations conducted a week apart. Prophylactic treatment is caution.13
warranted when an animal is in poor body condition, has In a healthy biologic environment (vivarium or aquarium)
a normal appetite, and has a fecal exam that shows excessive with normal microflora, the opportunity for pathogens to be
numbers of flagellates, nematodes, trematodes, or cestodes. a problem is minimal. To assist in maintaining a healthy bio-
Whereas some of these organisms are normal or incidental flora, logic system, unnecessary organic loads can be reduced by
large numbers in a compromised patient may warrant a course spot-cleaning feces and other organic material in the enclosure
of antiparasitics (e.g., metronidazole). Utensils used for an enclo- and by changing out sections of soil, sand, and leaf litter regu-
sure should not be shared with another group of animals. larly. Water changes of 10% to 20% should be performed
Fecal samples can be collected by placing the animal into a weekly in aquatic systems to reduce both organic and inorganic
disinfected and rinsed opaque, covered plastic container. The loads on the system.
container should be well ventilated, and animals should not be
kept in the containers longer than 12 hours. Several fecal
samples should be collected to evaluate the status of the animal.
It is important to remember that some parasites shed tran-
RESTRAINT
siently, so multiple (serial) samples may be required to confirm When handling amphibians, moistened, wet gloves should be
a diagnosis. I perform the following exams when screening worn to minimize the likelihood of damaging the animal’s
amphibian feces: fecal floatation with commercial hyper- skin. If gloves are not worn, then hands should be rinsed with
osmotic agent, direct saline smear, acid-fast stain, and Gram aged or dechlorinated water. As an indictment to the delicacy
stain. of amphibians’ skin, smokers who handle smaller frogs can
cause them to die, due to the nicotine residue on the smokers’
skin.14 Preparing water to use with amphibians is easily accom-
Routine Exams plished by retaining tap water in a bucket of water and aerating
A baseline examination on any amphibian presented to a vet- it with an air stone for an hour. The water can also be passed
erinarian is recommended. In large colonies, or cases with through charcoal to remove contaminants. Alternately, water
exceptionally small animals, this may be impractical. The can be dechlorinated by allowing it to degas in a nonaerated
minimum database collected during an amphibian examina- reservoir for 48 to 72 hours. After handling amphibians, clini-
tion should include a physical exam, radiographs, weight, and, cians should thoroughly wash their hands, as many species
if possible, blood examination. Individual or group fecal exam- produce toxins that can irritate human skin and mucosa.
inations should be performed at least yearly. Visual examina- Gloves should be changed between handling animals to
tions of every animal should be performed daily. decrease disease transmission and toxin transmission.
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TABLE 5-2 Disinfectants Commonly Used to Clean Amphibian Environments

Target
Disinfectant Example organism(s) Contact time Dilutions Comments
Ethyl alcohol Ethanol B, T, F, V, no 1-3 min 60%-90% Evaporates rapidly
spores (before disinfection is
successful); hardens
rubber, corrodes
metal
Isopropropyl Isopropanol B, T, F, some V, 1-3 min 60%-90%
alcohol no spores
Glutaraldehyde Cidex (Johnson B, M, F, V, no 45 min 2-week shelf life; good
and Johnson) spores for Pseudomonas
and Mycobacterium;
removes debris from
cleaning area
Cidex Plus B, M, V, T 20 min
Cidex OPA B, M, V, T 12 min
Formaldehyde Formaldehyde B, F, V, spores 1-15 min 37% Carcinogenic
Chlorhexidine Nolvasan solution B, some V 10 min 0.2%-2% Long residual action;
not for Pseudomonas
or Mycoplasma
Sodium Bleach B, F, V, P Seconds to 1 : 10-1 : 100 Corrosive to metal;
hypochlorite hours, organic matter
depending on decreases
concentration effectiveness
Iodine Betadine B, M, F, V, spores 15 sec 1% Organic matter
decreases
effectiveness
3 min 10%
Phenols Lysol B, M, some V; no Not listed 1 : 256
spores
1-stroke Environ B, T, V 10 min See below
(Steris)
Stat III (Ecolabs) B, F, V, M 10 min See below
Quaternary Roccal-D Plus B, F, V 10 min 1 : 256
ammonium (Pharmacia/Upjohn)
(ammonia, Unicide 256 (Brulin) B, V, F, mildew 10 min 1 : 256
benzalkonium
chloride)
B, bacteria; F, fungi; M, mycobacteria; P, protozoa; T, Trichophyton; V, viruses.
Manual Restraint15 of the hand for limited access or, while in this grip, gently
Animals can be placed into containers for close visual examina- restrained by the hindlimbs and caudal coelom using the
tion without touching the animal. Suitable containers include opposing hand. When handling an animal in this way, it is
small clear jars or boxes and plastic bags. Occasionally animals important to take care not to squeeze or traumatize the animal
will feign death, but this must be distinguished from exhaus- (Figure 5-10, B). Expect anurans to urinate when handled,
tion. Under such a circumstance, place the animal in its travel- and be prepared to collect the sample if desired. Additional
ing enclosure and wait. Avoid handling larval amphibians if behavioral manifestations identified after handling may include
possible. breath holding or air sac insufflation, color change, and
Large frogs should be handled by firmly grabbing the vocalizing.
animal around the inguinal region just cranial to the hindlimbs Salamanders and newts should be handled at the pectoral
(Figure 5-10, A). Smaller frogs can be cupped into the palm girdle initially, then the hindlimbs (Figure 5-11). Tail
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A
B
Figure 5-10 A, Handling technique for a large frog. B, Handling technique for a small frog.
Figure 5-11 Two-hand technique for handling a newt.
Figure 5-12 Handling technique for a caecilian using a sealed

plastic storage bag.
autotomy can occur in these animals, and care should be taken
to not hold the animal by its tail.
Caecilians are very difficult to manage with manual restraint. The most common general anesthetic agent used for
Clear tubing or a plastic bag can limit the mobility of these amphibians is tricaine methane sulfonate (MS-222) (Finquel,
animals and facilitate examination (Figure 5-12). For a more Argent Chemical Laboratories, Redmond, WA). The drug
thorough examination, the animal should be sedated. comes in a powdered form and is usually reconstituted in dis-
tilled water. MS-222 acts by reverting transient sodium ion
permeability and decreasing excitability and blocking conduc-
Chemical Restraint tion of nerve impulses.16 This compound is very acidic and
Before immobilizing an amphibian, fasting the animal is gen- should be buffered with an equal volume of baking soda to
erally recommended to avoid aspiration pneumonia; however, stabilize the pH. Unbuffered MS-222 can be highly irritating
this has not been described as a common complication. In an to the amphibian, causing excitability and erythema. Unbuf-
urgent situation, immediate anesthesia is recommended over fered MS-222 can also result in a more rapid induction because
delaying to fast the animal. uptake across the skin is more rapid in the ionized form.
Local anesthesia can work very well on amphibians. Lido- Although buffering the agent will result in slower uptake, it is
caine can be injected or placed topically in the perimeter of a far safer for the animal (e.g., hyperglycemia and tachycardia
lesion. Emla cream (Astra Pharm, Westborough, MA) may have been reported with unbuffered MS-222).17 Induction at
also be used and can induce local anesthesia in minutes. Both 100 to 200 mg/L will achieve steady state levels in most
may result in general anesthesia or death if caution is not amphibians, but induction may be prolonged for more than
exercised and too much product is used. 25 minutes. Higher doses (1-5 g/L) may induce anesthesia
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Figure 5-13 Anesthetic induction of a frog using a small animal

facemask as a gas chamber.
Figure 5-14 Anesthetic induction of a frog using a gauze
soaked in isoflurane and water-soluble gel.
faster, but these levels are considered potentially lethal. Higher
dosing levels can also prolong recovery. At induction, animals
may try to jump out of the solution, as it can be irritating. the salamanders (0.23 ml of 85% clove oil/500 ml dechlori-
Anesthetic deaths are rare with MS-222, but they are possible. nated water) is much higher than in the frogs (333 mg/L).
Under MS-222 anesthesia, pulmonary ventilation is dimin- Propofol was also evaluated in both species. Delivery in the
ished or absent. Gas exchange across the skin is usually ade- frogs via the lingual vessels was difficult and produced only
quate to prevent hypoxia at low (<74° F) environmental mild effects. When Propofol was administered intracoelo-
temperatures. Once anesthetized, the animal’s nares and oral mically in the tiger salamanders (35 mg/kg), surgical anesthesia
cavity must be kept out of the water to avoid drowning. was achieved in the majority (73%, 8/11) of test subjects.20
Keeping the animal at room temperature (74°-78° F) usually
results in acidosis and hypercarbia. Oxygen can be aerated into
the immersion solution, and this usually helps the animal
Monitoring the Anesthetized Patient
compensate. MS-222 has been used intramuscularly (IM) and The amphibian heart rate can be monitored using a pulse
intracoelomically (ICe); however, I have not used these routes. oximeter, Doppler, or ultrasound. Respirations can be difficult
When using these alternative routes, expect prolonged to monitor. The best methods to use are to evaluate the excur-
recoveries. sion of the rib cage or the gular area. Oxygen supplementation
Gas anesthesia has been used in a variety of forms.16-18 is important, as hypercarbia and hypoxia are common during
Using the vaporized form results in direct exposure to the anesthesia. However, too much oxygen may limit respirations,
inhalant, as with a face mask (Figure 5-13), and can induce based on the theory that these animals are stimulated to breathe
hypothermia and/or dehydrate the animal. Therefore, when based on low oxygen levels and not high carbon dioxide
using this form of anesthesia, it is important to monitor the levels. Based on this, it is generally preferred to recover these
animal’s hydration status and body temperature. Using direct animals on room oxygen (21%). Readings of 95% oxygen
exposure appears to be more successful in toad species than saturation or greater are expected in a normoxic patient.15 If
frog species. Dosing anurans percutaneously with topical iso- bradycardia occurs, reduce or end the anesthetic event.
flurane and halothane has also been successfully done, but it Atropine (IM or IV) can be used to increase the heart rate. If
can induce a very deep plane of anesthesia and prolonged asystole occurs, begin cardiac compressions. Cardiac compres-
recoveries. Although some clinicians report that aerating an sions can be used to re-stimulate the cardiac function. There
inhalant directly into water is useful, I have not had success are two methods that may be used: (1) Place the animal in
with this method. Another potential complication with aerat- dorsal recumbency. Then place an index finger on the cranio-
ing the anesthetic into the water is that scavenging excess gas ventral rib cage (e.g., level of the pectoral girdle) and compress
may not be possible, posing a human health risk. Finally, a gel downward. This will press the heart against the spine and act
mixture of a sterile KY jelly lubricant with isoflurane or sevo- as a stimulus to restart the heart. (2) Grasp the lateral rib cage
flurane and water mixed in a 3 : 3 : 1 ratio can be utilized. The at the level of the pectoral girdle and squeeze inward. Epineph-
mixture may be applied directly on the animal or via a gauze rine can be given intratracheally, intracardiacally, or intrave-
(Figure 5-14). This method results in rapid induction and nously to initiate cardiac function.
recovery. When monitoring the depth of anesthesia in amphibians,
Clove oil (eugenol) has been used to anesthetize leopard it is important to follow a consistent pattern and record all
frogs (Rana pipiens) and tiger salamanders (Ambystoma tigri- measurements. The following measurements are generally
num).19,20 The dose required to induce surgical anesthesia in used: righting reflex, escape response, palpebral reflex,
Ch005-X0119.indd 85 12/4/2007 12:01:01 PM

superficial pain response (e.g., pinch skin over dorsum of foot),

and deep pain response (e.g., apply pressure to one of the rear
digits). It is important to evaluate those reflexes before starting
the anesthetic event, to provide a baseline for that animal. The
generally accepted method for characterizing these reflexes is
based on an ordinal scale: 0-present, 1-mild loss, 2-loss. Based
on this scale, surgical anesthesia is achieved when all of the
reflexes are recorded as a 2 (loss).
Recovery from water-bath–based anesthesia (e.g., MS-222,
clove oil) can be accomplished by placing the animal into fresh,
dechlorinated, anesthetic-free water or thoroughly rinsing the
anesthetic off of the animal with the same type of water. When
recovering the animal in a clean water bath, the animal should
be monitored closely to prevent accidental drowning. The
amphibian should be considered recovered when all of the Figure 5-15 Oral examination of an amphibian using a piece
reflexes have returned (0-present) and the heart rate and res- of radiographic film.
piration rate are not different from the preanesthetic exam.
lesions (e.g., ulcers, erosions, and lacerations). Damage to the

PERFORMING A PHYSICAL integument opens an animal to opportunistic infections.
An ocular examination can be performed using an ophthal-
EXAMINATION moscope and slit lamp to examine the cornea, iris, and anterior
The amphibian patient should be evaluated from a distance and posterior chambers.21
before it is handled. An initial “hands-off” examination can Palpebrae are present in all amphibians except caecilians,
provide significant information regarding the animal’s well- where ocular examination is impossible in most species due to
being. Items to note include respiration rate and quality, animal a lack of adnexa. Corneas of giant salamander species are vas-
posture and body position, ocular anatomy, and the presence cularized. Amphibian pupils can take on various shapes,
of skin lesions. This may direct how the animal should be dependent on species, but are generally circular when dilated.
handled, if it is handled at all. Sloughing skin, large ulcers, Amphibians have voluntary control of their pupil size, so
fractures, tissue or organ prolapse, and extreme lethargy may examination of pupillary light reflexes is not possible. Fundu-
warrant not handling the animal by traditional manual restraint scopic exams are not rewarding in amphibians, as the pupils
methods. are usually not dilated. Given that the animal can control pupil
Before handling an amphibian, it is important to consider size, mydriatics are generally unrewarding. Research to evalu-
the role of handling on the production and removal of lactate. ate the effectiveness of topical or intracameral muscle paralysis
If an animal is repeatedly handled, lactate may accumulate, on the iris needs to be completed.
and it can take a long time for this compound to be removed An oral exam can be accomplished using a variety of tools
from the amphibian body.3 In severe cases, an amphibian with as potential specula (Figure 5-15). Such tools may include
excess lactate levels may collapse or develop a myopathy. To radiograph film that is cut and rounded at the edge, standard
prevent this, restrict handling times, and be prepared to metal bird specula, guitar picks, a rubber spatula, and credit
perform an examination and collect diagnostics at the same cards.22 Animals may bite, and therefore caution must be exer-
time. cised when examining these animals. Salamanders use their
Body weight should be recorded at the time of physical maxilla to hinge upward rather than downward at the mandi-
exam. Amphibian body weight may fluctuate due to hydration ble, which is the opposite of what is observed in most amphib-
status and the volume of the urine in the urinary bladder, but ians. Overmanipulation of an amphibian’s jaws can lead to
establishing trends is important. Body condition should be fractures, so care should be exercised. The oral cavity of an
noted. Animals with reduced muscle mass on the extremities amphibian should be moist and free of thick, ropy mucus.
and over the spine suggest a chronic course of disease. Evaluate Excessive mucus often suggests dehydration. Look closely in
the animal’s symmetry, musculature, and posture. Obesity can the oral cavity for fractured teeth and oral abscesses.
be distinguished from fluid accumulation by the animal. Coelomic palpation can provide significant informa-
When performing a “hands-on” physical examination, it is tion regarding an animal’s condition. Some animals will “puff
important to be thorough and consistent to reduce the likeli- up” when in a defensive mode, which can make palpation
hood of misclassifying an exam finding. Amphibian skin may challenging, but patience will often result in success.
become hyperemic with handling, and dehydration is possible After palpating the coelomic cavity, muscle tone and body
with prolonged examination, so it is important to keep the condition should be assessed. With poor body condition,
patient moist during the examination. Hyperemia needs to be the clinician must examine the environment and the animal’s
distinguished from red-leg syndrome (see section titled caloric intake and pursue diagnostics for chronic infectious/
Common Diseases). Evaluate the entire integument for any parasitic diseases (recurrent bacteremia/septicemia, mycobac-
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Figure 5-17 Blood draw from the ventral abdominal vein of an

anuran.
Figure 5-16 Female amphibians can be transilluminated to
evaluate their reproductive status.
of blood that can be safely collected from an amphibian is 1%

teriosis, and parasitism). Skeletal confirmation should be of its body weight (1 ml/100 g body weight). In sick amphib-
evaluated and the long bones and rostrum palpated to assess ians, a smaller volume (0.5 ml/100 g body weight) of blood
for metabolic bone disease (e.g., secondary nutritional should be collected.23
hyperparathyroidism). Once collected, blood is best placed in a lithium heparin
Gender determination can be challenging, but it should be microtainer. Microtainers are strongly recommended because
done at the time of physical examination. Sexual dimorphism they have an appropriate amount of anticoagulant for small
can occur, but it is not present in most of the species found blood volumes. Ideally, for blood cultures, there should be no
in captivity. Transillumination of the abdomen may reveal anticoagulant. Wright-Giemsa or Diff-Quik stain can be used
eggs (Figure 5-16). In male salamanders, the base of the tail to evaluate amphibian white and red blood cells; I prefer the
may become enlarged. Wright-Giemsa stain.
Vital signs such as heart rate and rhythm can be evaluated Coelomic fluid can contain important information
using a Doppler and will help the clinician become aware of regarding the health state of an amphibian. A sample of coe-
rate and quality. Though changes in rate can be anticipated lomic fluid can be collected by placing the animal in dorsal
during handling, a trend may be established for the clinician recumbency. The area should be prepared using aseptic tech-
that can be used for preanesthetic evaluation. Auscultation of nique and a 25- to 26-gauge needle fastened to a 1-ml or 3-ml
the lungs may be possible with larger animals. syringe inserted paramedially in the caudal coelomic cavity
A neurologic examination should be performed but is often (avoiding the midline abdominal vein). The sample should be
limited to evaluating the palpebral blink reflex, superficial and submitted for fluid analysis (total protein, specific gravity),
deep pain reflexes, and the righting reflex. cytologic exam, culture, and plasma chemistries. Amphibian
coelomic fluid can be clear, blue, or green. The presence of
blood urea nitrogen (BUN) in the fluid may suggest renal
DIAGNOSTIC TESTING disease.23
Washes and lavages can be very valuable diagnostic tools.
Clinical Pathology Tracheal washes can be obtained in the anesthetized animal by
SAMPLE COLLECTION infusing a small volume of sterile 0.9% saline using a tomcat
In frogs and toads, blood can be obtained from the ventral or IV catheter into the trachea and recollecting the fluid by
abdominal vein (Figure 5-17), lingual venous plexus, and the aspiration. The trachea is short in anurans and caudates; there-
saphenous and femoral veins. Cardiocentesis may also be fore, care must be taken not to puncture the lungs. Gastric
attempted but may be associated with asystole and death. Sala- washes can be performed in larger animals by inserting an
manders and newts can be bled from the ventral midline appropriate sized red rubber tube into the stomach, infusing
abdominal vein and the ventral caudal tail vein. Caecilians are sterile 0.9% saline, and then re-aspirating the infusion solu-
most limited, and cardiocentesis is the only method available. tion. Cloacal lavages can be attempted to collect feces by
Doppler can facilitate locating the heart when an apex beat lubricating an appropriately sized red rubber tube and admin-
cannot be found. A small volume of blood can provide useful istering a small amount of 0.9% sterile saline (0.5-1.0 ml/100 g
information (e.g., hemoparasites, an estimated white blood cell body weight). Examine all washes by performing a wet mount,
count, hematocrit, and total protein). The approximate volume cytology, and possibly culture.
Ch005-X0119.indd 87 12/4/2007 12:01:04 PM

Urine can be collected when the animal is handled or by cytize bacteria. Bands are not typically seen. Lymphocytes and
rubbing the cloaca. Interpretation of the results is dependent monocytes are the common agranulocytes of amphibians.
on comparison with the same species, under the same environ- Lymphocytes are easily confused with thrombocytes and
mental conditions, and at the same time of the year, as the monocytes. Large lymphocytes can be distinguished from
composition of urine is greatly affected by many parameters.24 monocytes by evaluating the nuclear-to-cytoplasmic ratio.
Typically, amphibian urine is hypoosmotic (specific gravity: Lymphocytes have a higher nuclear-to-cytoplasmic ratio.
1.001-1.008) and devoid of protein. White blood cell (WBC) counts in amphibians can range
Cytologic examinations should be performed on all integu- from 4.5 to 13.0 × 103 cells/ml. Elevated WBC counts can
mentary lesions. Additionally, cultures should be performed result from stress and inflammation. Handling an amphibian
on chronic lesions or if multiple animals are affected. In non- may cause a specific increase in the monocyte count due to
healing wounds, acid-fast staining should be performed. skin damage. Stress and glucocorticoids may result in a lym-
Although collected less frequently, lymph and joint fluid phopenia and neutrophilia (heterophilia and neutrophilia
can be collected and analyzed. Lymph fluid is chemically combined). The most important factor to consider when eval-
equivalent to serum. The lymph hearts are located under the uating a hemogram is the cell morphology.
scapula and near the urostyles, and may become prominent An unexplored aspect of amphibian blood is immunoglob-
with hydrocoelom. For joint fluid analysis, aseptically prepare ulin (Ig) analysis. Three types of Ig are produced: IgM, IgY
the area as for a coelomic tap and collect the sample.25 A 25- to (IgG-like), and IgX. IgM increases with bacterial infections,
27-gauge needle fastened to a 1-ml or 3-ml syringe can be used whereas viral infections often produce IgM followed by IgY.
to collect these samples.
PLASMA BIOCHEMISTRIES
23,26 Highlights of plasma biochemical findings are included in this
Interpretation section; however, as with the hemogram, a high degree of vari-
Complete blood counts (CBC) and plasma chemistries can be ability can occur. Median glucose is typically around 50 mg/dl
difficult to interpret. Significant species, gender, and seasonal and may increase as much as 25% because of handling. The
differences can result in a high degree of variability among liver predominantly produces bilirubin, although small
samples. Regardless, these tests should be performed and trends amounts of biliverdin may also be present. Most hepatic dis-
evaluated between individual animals’ conspecifics under orders diagnosed at necropsy suggest that a liver biopsy is more
similar circumstances. valuable than blood work for evaluating the liver. The enzymes
generally used in other species to evaluate the liver, including
ERYTHROGRAM gamma glutamyltranspeptidase (GGT), aspartate aminotrans-
Erythrocytes are typically nucleated, though a few amphibian ferase (AST), and alanine aminotransferase (ALT), do not
species have plasmocytes that are enucleated red blood cells. appear to be specific for the hepatocytes in amphibians. GGT
Morphology is important. The majority of amphibian eryth- can fluctuate greatly with season. Bile acids have not been
rocytes are nucleated with centrally located nuclei. Viral inclu- examined in amphibians. Standard renal parameters do not
sions, bacteria, and parasites (e.g., trypanosomes, microfilaria) appear to be as significant in amphibians for evaluating renal
can be seen in diseased animals as well as nonclinical animals; disease. Ammonia can be measured in the plasma if there is a
therefore, the total clinical picture is important to establish a suspicion of ammonia intoxication, but as with small animal
diagnosis. Hematocrit is highly variable, usually ranging from practice, the samples must be kept on ice and processed within
20% to 40%. Amphibian thrombocytes are nucleated and 30 minutes. The plasma osmolality of amphibians should be
highly variable in shape. They may appear similar to small greater than 200 mOsm/L.
lymphocytes. The primary distinctions are that thrombocytes
have a pale clear cytoplasm and a higher cytoplasmic-to-nuclear
ratio.
Diagnostic Imaging27
Radiographs can be accomplished using a variety of tech-
LEUKOGRAM niques. Standard and dental radiography, as well as mammog-
There is a general lack of information regarding changes in the raphy, have all been utilized. Although mammography provides
amphibian leukogram with disease. Granulocytes in the the crispest detail, most practices do not have access to such a
amphibian include heterophils, neutrophils, basophils, eosino- tool. Standard radiography film can be adequate for even the
phils, and azurophils; however, their function may not be the smallest patients, as long as ultra detail film (single emulsion
same as in other species and using the terms should not lend and high detail rare earth screens) is used. Dental films can be
to extrapolation or overinterpretation of the differential. used with standard radiographic units or a dental unit. Animals
Amphibian eosinophils have shown activity against trematode can be placed directly on plates, within plastic bags, or in
integument, but there is no evidence that they have a role in plastic boxes. A minimum of two views should be taken
bacterial or fungal disease. Basophils may have a similar role; (Figures 5-18 and 5-19). Contrast radiography (Figure 5-20)
they tend to degranulate readily and may serve to recruit can be accomplished using iodinated compounds or barium.
eosinophils to parasitic infections. Mast cells may represent a These liquids can be administered orally or cloacally (e.g.,
stage of the basophil cycle. Heterophils and neutrophils phago- enema). Pneumocoelograms and double contrast coelograms
Ch005-X0119.indd 88 12/4/2007 12:01:05 PM

Figure 5-18 Radiographic dorso-ventral survey of an axolotl.
Figure 5-21 Caecilian radiograph for a caudal body mass that

was diagnosed as a sarcoma.
Figure 5-19 Radiographic lateral survey of an axolotl.
Figure 5-22 Metabolic bone disease in Ceratophrys sp.
are few comparisons for reference images, and they can be

costly.
Ultrasound
Figure 5-20 Radiographic barium contrast study of an
axolotl. Ultrasonography can be an invaluable tool for evaluating the
heart, liver, gallbladder, stomach, gastrointestinal tract, repro-
ductive organs, kidneys, and bladder of amphibians.28 It can
(e.g., air and iodinated compound in coelom) can be used also be used to assess abnormal masses and fluid accumulation.
to further characterize disease processes. Various disease Because of the small size of most amphibian patients, a 7.5- to
processes can be easily identified using radiography (Figures 12-mHz translinear probe is generally required to thoroughly
5-21 through 5-25). evaluate a patient. Note the image of a Dendrobates terribilis
Advanced imaging techniques including computed tomog- (Figure 5-26). A fluid-filled pocket can be visualized in the
raphy and magnetic resonance imaging may be used, but there gular region of the animal; this pouch resolved within days,
Ch005-X0119.indd 89 12/4/2007 12:01:05 PM

Figure 5-23 Fractured femur in a hylid frog.
Figure 5-25 Gastric bezoar delineated by barium contrast

material.
Figure 5-24 Gastric foreign body (rocks) in a leptodactylid.
Figure 5-26 Ultrasound image showing fluid collection within

the gular pouch.
suggesting a normal phenomenon (possibly stress). The larger
ultrasound probes (2.5-5 mHz) may be used for larger animals,
such as bullfrogs (Rana catesbeiana). The benefit of this proce-
dure is that it can be done without anesthesia, and most Thioglycollate broth may also be a good investment, as it will
patients can be placed into a water medium to facilitate crisp grow scant or fastidious microorganisms. To ensure growth of
images (Figures 5-27 and 5-28). amphibian microorganisms, incubation should occur at 37° C
despite originating from an ectotherm. Pathogenic bacteria will
grow faster at high temperatures. Anaerobic cultures require
Microbiology special handling instructions and should be carried out as per
There is an excellent review of amphibian microbiology tech- the laboratory to which the specimens are being sent. Fungal
niques; clinicians with a strong interest in pursuing in-house culture can be accomplished with the same culturette system
culturing should consult this resource.29 For the practical mentioned previously. Mycobacterial cultures should be
clinician, collection of culture material into a culturette pursued if there is a trend of acid-fast organisms being isolated
(Mini-tip culturette, Becton Dickinson Microbiology Systems, or identified from animals within a given collection. Isolated
Cockeysille, MD) with transport medium is most versatile. cases of acid-fast organisms are not unusual, but certain myco-
Ch005-X0119.indd 90 12/4/2007 12:01:06 PM

soil, food, and water to identify a potential source of the

infections.
Parasitology
A fecal parasitologic examination should include both a wet
mount and a flotation. Protozoans can encyst with environ-
mental change, so rapid evaluation is critical. Wright’s-Giemsa
stain, Gram stain, and acid-fast stains can also be used to
thoroughly evaluate gastrointestinal disorders.
To assist in the collection of a fecal sample, assist-feed the
animal with a prepared food slurry, like a pelleted food product
mixed with water. Place the animal in a covered, well-
ventilated plastic container and wait (a few hours) until a fecal
sample is produced.
The normal microflora of amphibians includes flagellates,
Figure 5-27 Ultrasound of a caecilian that is submerged in opalinids, ciliates, and nematodes. Distinguishing between
water within a plastic bag. pathogens and normal organisms is often difficult. Frequently,
the clinician must rely on the relative numbers of organisms
and on the clinical presentation of the animal. If there are
numerous flagellates in an emaciated animal that is not behav-
ing normally, treatment should be considered. Treatment
should always be considered when abnormal feces are observed.
Like the flagellates, nematodes can also be a component of the
amphibian indigenous flora or act as obligate parasites. Sepa-
rating these diagnostic guidelines can be difficult but can gen-
erally be done by characterizing the nematode to species and
evaluating the health and condition of the host. For example,
amoebiasis is generally distinguished by the presence of WBCs
and amoeboid trophozoites in the feces.
Anytime leukocytes or erythrocytes are seen in the feces,
there should be concern about mucosal damage and occult
parasitism (such as apicomplexa).30
Cryptosporidium is not commonly found in amphibians,
but it should be screened for during quarantine due to its
potential risk to an animal collection and zoonotic potential.
Figure 5-28 Ultrasound image of a caecilian neoplasm within Acid-fast staining will accomplish this but has low sensitivity.
a cyst. A commercially available test may also be used, but this has
not been generally applied.13
bacterial species do pose a zoonotic risk and should be

characterized.
Miscellaneous Diagnostics
Culture samples should be collected from any abnormal Electrocardiograms (ECGs) can be measured in amphibians,
lesions or fluids, abnormal organs identified on postmortem, but are not generally done because of the animals’ small size.
and for blood culture (tryptic soy broth or thioglycollate There are some reviews of ECG results available to the inter-
broth). Skin lesion cultures may lead to the characterization of ested clinician.24 Endoscopy and laparoscopy are invaluable
an organism, although more commonly, superficial surface diagnostic tools that can be used to evaluate the internal organs
samples can be difficult to interpret as they are frequently and to collect biopsies antemortem. These diagnostic tools
overwhelmed by contaminants. Deep integumentary swabs are should be considered when more conventional diagnostic tools
recommended. Avoid the perimeter of the skin when swabbing prove unremarkable.
a lesion. Alternately, a second culture of normal skin can be
taken as a comparison, but this may not be practical under
some circumstances. Fecal culture is often unrewarding (unless
Water Quality
it is a pure culture of a single organism) because the indigenous Amphibians may display variable responses to poor water
flora can include Salmonella sp., Aeromonas sp.,24 and other quality. In general, truly aquatic amphibians are more likely
bacteria considered to be opportunistic pathogens. If any bac- to suffer from the negative impacts of poor water quality than
terial epizootic occurs in a collection, consider culturing the are semiaquatic amphibians. Any time multiple animals from
Ch005-X0119.indd 91 12/4/2007 12:01:07 PM

a single enclosure are presented with similar clinical signs, areas where hardness levels are high, the water can be diluted
water quality should be evaluated. Water testing for an amphib- with deionized water.
ian vivarium should, at minimum, include ammonia, nitrite, Alkalinity measures the buffering capacity of a system. This
pH, alkalinity, and temperature. is an important component of the water column because it can
Testing methods frequently produce highly variable and be used to predict the variability of the pH. Alkalinity can vary
sometimes inaccurate results. At-home testing kits may not among water sources. Again, most commercial test kits measure
provide results measured in fine units; therefore, to err on the alkalinity. If the alkalinity of the water is low (<60 ppt), then
side of caution, certain tests should read zero (e.g., as ammonia buffer can be added. Buffers are commercially available in local
and nitrite). See Table 5-1 for reference values. pet retail stores.
Supersaturation of different gasses can occur when there is Ammonia is a natural by-product of protein catabolism and
a leak in a pipe fitting or a pump. In these situations, when can be toxic when accumulated. Biological filtration, by way
air mixes with water under pressurization, the water becomes of the nitrogen cycle, removes ammonia from the water column
supersaturated and the gas can be absorbed by the amphibians. by conversion into nitrite, then nitrate. The system is based
Affected animals will have obvious, grossly discernable bubbles on the presence of denitrifying bacteria. The most commonly
under their skin. A saturometer is required to confirm gas satu- discussed genera of this group are Nitrosomonas spp. and Nitro-
ration and is not readily accessible to most individuals. Clinical bacter spp. It is important to understand this cycle, and that it
signs are usually sufficient to make a diagnosis. Supportive care takes approximately 6 weeks for the filter to establish in a new
should be provided, and the water source used for the vivarium system. (See Chapter 4, Ornamental Fish, to learn more about
corrected. establishing these systems.) Ammonia is especially toxic to
Dissolved oxygen levels in the water column of amphibians larval amphibians, because it is highly irritating to the gills.
are a special concern for larval amphibians (e.g., gilled animals) Microscopic examination of the gills of an affected animal
and neotenic species that capture oxygen from the water. This often reveals inflamed swollen gill filaments. The natural
becomes less important in amphibians that primarily respire response of the host is to produce mucus, which creates a
with lungs. Animals that are maintained in water with low barrier between the water and the gill. These different responses
oxygen levels will often be seen gasping for air at the water’s by the host lead to a reduced ability to transfer oxygen across
surface. Dissolved oxygen cannot be effectively measured with the gill epithelium. Affected animals are often seen gasping for
at-home kits, despite the availability of such tests. Aerating the air at the water’s surface. Ammonia can also be irritating to the
water with air stones and making regular water changes are integument. Again, the natural response of the host is to
usually sufficient to provide appropriate oxygen levels. produce excess mucus as a protectant. Affected animals may
Amphibians’ water is best maintained at neutral pH be observed rubbing against various rough surfaces because
(7.0-7.5). When the pH becomes strongly acidic (<5.5) or of the irritation or pruritus generated by the ammonia.
basic (>8.5), the water becomes very irritating to the amphib- Treatment can be accomplished by moving the animal to an
ian, and it may attempt to leave the water. Affected animals ammonia-free water source, establishing a biologic filter in
may produce excess mucus on the skin as a protectant. It is the primary vivarium, and reducing ammonia loads on the
important to pretest water being used for a vivarium. Water system (e.g., reduce feeding, decrease animal density). In
pH and alkalinity can vary between municipalities. There are testing for ammonia, identify if the commercial kit being used
a variety of methods that can be used to measure pH. Several measures total ammonia nitrogen (TAN) or un-ionized
different commercially available kits are readily available at ammonia (NH3). TAN is a measure of both the ionized (NH4+)
local retail pet stores. All aquatic systems naturally start to and un-ionized (NH4+) forms of ammonia. NH4+ is the less
lower their pH as buffers in the system are used. It is for this toxic form and is found in higher concentrations at lower pH
reason that it is important to measure alkalinity (buffering levels. Most kits measure TAN, and the actual value of the
capacity). There are two common methods for altering pH more toxic form (NH3) can be identified based on pH and
in an aquatic habitat: (1) adding commercial buffers or temperature. A chart showing this is available elsewhere.8
(2) making water changes that have a good alkalinity Regardless, if a level of zero is targeted, it is irrelevant whether
(>100 ppm). the clinician is measuring TAN or NH3.
Hardness is a measure of cations (e.g., calcium, magnesium) Nitrite, while not as critical as ammonia, can also be prob-
in the water. These cations serve as the basic building blocks lematic in amphibians. Nitrite is primarily produced from the
of minerals that amphibians can obtain from the water column, denitrification of ammonia by Nitrosomonas spp. Nitrite, like
especially larval amphibians. Low levels of hardness (e.g., ammonia, can be readily absorbed across the surface of the
calcium) may result in nutritional deficiencies (e.g., metabolic gills. Amphibians affected with nitrite toxicity can develop
bone disease, secondary nutritional hyperparathyroidism) in methemoglobinemia (brown blood disease). Test kits are avail-
growing amphibians. Elevated levels of hardness (e.g., high able to test for nitrogen. Methemoglobinemia results in a
mineral content) can be irritating to amphibians, especially reduced carrying capacity for oxygen. Again, affected animals
caecilians. Commercial water testing kits routinely have hard- are often observed gasping for air at the water’s surface. A
ness as one of their testing parameters. Hardness levels vary diagnosis can be made by measuring nitrite levels in the water.
between water sources (e.g., municipalities). In areas where A blood sample from the animal can be used, in addition to
hardness levels are low, additional minerals can be added. In the water test, to confirm the presence of brown blood, or
Ch005-X0119.indd 92 12/4/2007 12:01:08 PM

methemoglobinemia. Treatment is similar to that described for

ammonia toxicity. Salting the water (100 ppm) is also protec-
tive. Commercial test kits are available that measure ammonia,
nitrite, and nitrate.
Other Diagnostics
Serologic testing and advanced molecular testing (e.g., poly-
merase chain reaction assays) are currently not widely used
or easily available to the exotic animal clinician. Rather, post-
mortem examinations provide the most valuable diagnostic
tool. Necropsy must be performed shortly after death as autol-
ysis occurs rapidly. Veterinarians should establish a good rela-
tionship with a pathologist who has experience interpreting the Figure 5-29 Hydrocoelom in a Surinam toad (Pipa pipa).
histopathology of amphibians.
Differentials: historically considered only a bacterial disease;

COMMON DISEASE Iridovirus, Ranavirus, Chlamydophila psittaci, Basidiobolus
PRESENTATIONS ranarum, other bacteria, chytridiomycosis
General treatment scheme: fluid therapy, parenteral or bath
Infectious antibiotics, improved environmental conditions
BACTERIAL
In general, bacterial disease is very common in captive amphib- Disease: Edema syndrome31
ians, and the majority of pathogens encountered in captivity Etiology: bacterial septicemia (esp. Flavobacterium spp.); renal,
are Gram-negative organisms. Bacterial disease can be focal cardiac, or hepatic failure; toxic insult; poor water quality
(skin, liver) or systemic. The epidemiology of bacterial diseases Clinical signs: hydrocoelom (Figure 5-29), anasarca, or local-
in amphibians is highly correlated to environmental risk ized subcutaneous edema
factors, including suboptimal environmental condition (e.g., Diagnosis: marked excess fluid subcutaneously and in coelom
low or excessive temperature, poor water quality, overcrowd- General treatment scheme: furosemide, hypertonic amphibian
ing), stress, and transport. Ringer’s solution, correct underlying etiology if possible
Disease: Red-leg bacterial syndrome31,32 Disease: Chlamydiosis33

Etiology: Aeromonas hydrophila, A. aerogenes, A. aerophila, Etiology: Chlamydophila psittaci
A. salmonicida, Citrobacter freundii, Flavobacterium sp., Clinical signs: as for red-leg syndrome
Klebsiella sp., Proteus sp., Pseudomonas sp. Diagnosis: histologic evidence of intracytoplasmic inclusion
Clinical signs: hyperemia of the ventral skin (thighs, abdomen, bodies, culture, PCR
digits), subcutaneous edema, full thickness cutaneous ulcer- Differentials: other systemic bacterial, viral, fungal diseases
ation, petechial and ecchymotic hemorrhage, hypopion/ General treatment: doxycycline, oxytetracycline
hyphema, death (including mass mortalities in a popula- Other: Zoonotic potential is unknown but is probably limited.
tion). Red-leg syndrome is a clinical presentation. Viral and Another chlamydial organism that affects frogs is Chla-
fungal pathogens can also produce these clinical signs. mydophila pneumoniae, which causes skin sloughing and
Diagnosis: culture from blood or tissue of the aforementioned bloating.
organisms plus clinical signs. Note that many of these bac-
teria are indigenous florae and can be contaminants. Disease: Mycobacterium spp.31,34-36
Differentials: historically considered only a bacterial disease; Etiology: Mycobacterium cheloniae ssp. abscessus, M. avium
Iridovirus, Ranavirus, Chlamydophila psittaci, Basidiobolus complex, M. ranae, M. marinum, M. fortuitum, M. tham-
ranarum, other bacteria, chytridiomycosis nospheos, M. xenopi
General treatment scheme: fluid therapy, parenteral antibiotics Clinical signs:
based on culture and sensitivity, topical treatment on open Focal disease: nonhealing cutaneous lesion (Figure 5-30),
wounds, improving environmental conditions granulomatous mass, occasionally liquefactive pus
Systemic disease: chronic weight loss or wasting, nodules or
Disease: Bacterial septicemia granulomas in viscera and subcutaneously
Etiology: any number of potential bacterial pathogens Diagnosis: acid-fast staining of lesions (Figure 5-31), histologic
(primarily Gram-negative) and opportunistic organisms evidence of acid-fast organisms, culture (not always reward-
Clinical signs: lethargy, anorexia, red-leg syndrome, death ing). In my experience, a monocytosis or increased total
Diagnosis: culture of blood and organ tissues, bacteremia on white cell count does not always accompany systemic
blood smear, histology disease.
Ch005-X0119.indd 93 12/4/2007 12:01:08 PM

available to characterize these organisms today. The prevalence

of viruses is considered higher in wild populations, and this is
primarily based on diagnoses made during epizootics. Again,
this could be misleading, because diagnosis of viral disease is
more likely to be pursued in these cases. The following is a list
of traditional viral diseases of amphibians:
Tadpole edema virus (TEV or Ranavirus type 3) results in
edema, and skin, subcutaneous, and visceral hemorrhages.
Basophilic intranuclear inclusions may be present.
Frog virus 3 (Ranavirus type 1) causes multifocal hemor-
rhages and basophilic intranuclear inclusions.
Bohle iridovirus (BIV) causes viral hemorrhagic septicemia
of frogs resulting in multifocal necrosis of the liver, spleen,
stomach, and lungs. Dermal hemorrhage and ulceration,
Figure 5-30 Ulcerative pododermatitis secondary to myco- systemic hemorrhage and ulceration, and systemic hemor-
bacteriosis. rhage and gastroenteritis also can occur. Paralysis may occur
secondary to neuronal degeneration. This disease is trans-
missible to fish.
Frog erythrocytic virus is associated with limited clinical signs
but may not include anemia. Inclusions are visible in eryth-
rocytes and leucocytes.
Herpes-like virus can cause small white to dark dorsal cutane-
ous vesicles and epidermal hyperplasia.
Lucke’s disease is a herpes virus that causes a temperature-
dependent renal adenocarcinoma (Lucke tumor herpes
virus [LTHV]). Hypothermic animals shed more virus and
are more likely to contract the disease. The virus is highly
lethal in tadpoles, whereas most adults seem immune to
new infection.
Cutaneous papillomas of Japanese newts can cause a single
epidermal tumor; a virus is suspected as an etiological
agent.
Pox virus–like particles have been found in European
common frogs (Rana temporaria) and can cause a red-
leg–like, hemorrhagic gastroenteritis.
Lymphosarcoma viruses are not well described but fairly well
accepted.
Figure 5-31 Acid-fast organisms on a skin smear from ulcer-
ative dermatitis.
FUNGAL 39,40
The soils used in vivaria generally support many different types
Differentials: neoplasia, chronic inflammatory disease of fungi. In the healthy animal, these organisms do not pose
General treatment scheme: With systemic disease there is no a problem. However, in the compromised individual (e.g.,
effective treatment. Focal disease may be cured with com- stress, trauma, immunosuppression), ubiquitous organisms
plete surgical removal of the infected area (such as amputa- have the potential to become opportunistic pathogens. How
tion); however, it may be impossible to determine whether and when an infection occurs is dependent on fungal species,
the organism has been disseminated to other tissues, unless individual host tolerance to disease, and presumably fungal
serial biopsies are taken. In these cases, the animal may still load in the environment. Mycotic dermatitis should be sus-
pose a health risk to other animals in the collection or to pected as a cause in any amphibian cases with ulcerative der-
their human caretakers. matitis. Systemic infections are less common than the fungal
Other: zoonotic potential. Mycobacteria are ubiquitous in the dermatitides, but should be considered when diseases are
aquatic environment, and the nonpathogenic strains can be apparently refractive to antibiotic treatment. There are excel-
found on the surface of the skin or in the feces. lent reviews and photographs on mycoses in amphibians
available.39-40
VIRAL 36-38
Diagnosing viral disease is not an easy or practical task. Disease: Basidiobolomycosis
Although the prevalence of infection in captive amphibians is Etiology: Basidiobolus ranarum, zygomycete fungus found in
considered low, this may be misleading as there are few tests soil and amphibian gastrointestinal tract
Ch005-X0119.indd 94 12/4/2007 12:01:09 PM

Clinical signs: variable, but can be subtle as in slight paling

of the skin. In one case series, dwarf African clawed frogs
sought terrestrial areas. In other cases, the disease resembles
red-leg syndrome.
Diagnosis: wet mount of lesions showing septate hyphae and
fungal spherules with beaked zygospores, positive periodic
acid-Schiff stain and negative Gomori’s methenamine stain;
histology shows spherules in outermost layers of epidermis,
culture. Amphibians may be asymptomatic carriers.
Differentials: red-leg bacterial syndrome, other mycotic der-
matitides, chlamydiosis
General treatment scheme: itraconazole
Disease: Mucormycosis
Etiology: Mucor amphibiorum, a zygomycete fungus from the
soil; usually considered nonpathogenic Figure 5-32 Skin lesions secondary to chytridiomycosis.
(Photo credit Disney’s Animal Programs, Deidre Fontenot).
Clinical signs: multifocal red nodules on skin which can be
raised and ulcerated; white, fuzzy material primarily on the
ventral abdomen; lethargy, reluctance to move, lack of Disease: Ichthyophonus sp.
coordination, or emaciation, death Etiology: pleomorphic fungus, probably Ichtyophonus hoferi
Diagnosis: uniform fungal spherules (diameter of spherules Clinical signs: prominent swellings over body with normal skin
and length of hyphae) noted in granulomas, culture over the nodules and lethargy
Differentials: ulcerative bacterial dermatitis, red-leg syndrome Diagnosis: histopathology, specific to muscle cells
General treatment scheme: None has been attempted because General treatment scheme: none
clinical disease is uncommon and onset is very rapid (within Other: Free-ranging newts are susceptible.
days).
Disease: Chromomycosis (chromoblastomycosis)
Disease: Saprolegniasis Etiology: brown or black pigmented septate fungal hyphae,
Etiology: ubiquitous oomycete (water mold), opportunistic including Cladosporium sp., Phialophora sp., Exophiala sp.,
pathogen and Fonsecaea sp.42 They are saprophytes present in soil and
Clinical signs: white cotton or fuzzy growth over open lesions; decaying vegetation but can become opportunistic
animal usually collapses when removed from water; rare pathogens.
systemic infection Clinical signs: nodular dermatitis that is slow growing. The
Diagnosis: wet mount containing zoospores (flagellated lesions can be gray-black and associated with ulcers.
oospore) and nonseptate branching hyphae; large numbers Diagnosis: histopathology and culture
in a small section General treatment scheme: None has been successfully treated.
Differentials: other oomycetes Consider amphotericin B (1 mg/kg intracoelomically [ICe]
General treatment scheme: benzalkonium chloride, sodium q24h).
chloride. Treat skin lesions and correct for osmotic losses
with appropriate fluid therapy. Disease: Dermocystidium sp. (protozoan-like fungi)
Other: primary pathogen for amphibian eggs Etiology: Dermocystidium pusula has been mistaken for a pro-
tozoan (12-14 μm).
Disease: Chytridiomycosis Clinical signs: small white nodules less than 1 mm in diameter
Etiology: Batrachochytrium dendrobatidis, zoosporic fungus on skin and gills, possible increased respiratory rates, pos-
related to oomycete watermolds; ubiquitous in soil and sible death as sequela
water Diagnosis: skin scrapes and gill clips, cytologic and histopatho-
Clinical signs: nonspecific, excess shedding, sloughing skin on logic review of samples
ventral abdomen and legs, death (Figure 5-32) Differentials: miliary abscesses in integument
Diagnosis: readily detected in wet mounts, spherical single- General treatment scheme: none developed, possibly mimick-
celled intracellular organism; positive for periodic acid- ing behavioral fever by elevating temperature
Schiff and positive for Gomori’s methenamine stain
General treatment scheme: 1% itraconazole bath, trime- PARASITIC 30
thoprim-sulfa. Treat secondary skin lesions and correct for Protozoa and nematodes can be both commensal and parasitic,
osmotic losses with appropriate fluid therapy. depending on the species of the parasite and general condition
Other: significant in global population declines in Australia, of the host. It can be difficult to assess when endoparasites are
North America, and Central America. Some animals are causing problems. Numerous histopathologic reports suggest
carriers.38 Can affect captive animals, including Dendroba- that mild to moderate loads of metazoans (nematodes) or
tids and White’s tree frogs.41 trematodes can be found encysted in various tissues. Therefore,
Ch005-X0119.indd 95 12/4/2007 12:01:11 PM

to confirm that a protozoan, trematode, or nematode is Amoeba

associated with disease, histopathologic changes should be Approximate size: 10-60 μm.
confirmed. Chronic parasitism may have an overall negative Location: intestinal tract, liver, kidney (Entamoeba ranarum,
effect on the host. Monitoring and surveying feces for micro- most are nonpathogenic)
organisms is a good way to characterize and understand the Clinical signs: anorexia, weight loss, diarrhea ± hemorrhage,
indigenous flora of amphibians. Knowledge of different life dehydration, anasarca, ascites
cycles of parasites is necessary to assess clinical disease and Life cycle: direct
establish effective treatment plans. Diagnosis: Wet mount shows presence; if there are no clinical
The best time to treat amphibians against parasites is during signs and no leukocytes or erythrocytes, then probably it is
quarantine, before they are introduced into a collection. When nonpathogenic.
prophylactically treating for parasites, there is a risk of massive Histopathology: organisms within organs
death caused by thromboemboli after a sudden kill-off of Treatment: metronidazole high dose 100 mg/kg PO every 14
parasites or treatment toxicity. General treatment principles days
should be followed. After treatment, animals should be moved
to a clean environment. Remove/eliminate any parasitic vectors, Apicomplexa
including live plants, substrates, or porous accessories. Approximate size: ∼20 × 30 μm
Location: blood (Hemogregarina sp., Hepatozoon sp.), tissues
ENDOPARASITES (Isospora sp., Eimeria sp.)
Ciliates (Nyctotheroides spp., Tetrahymena sp., Balantid- Clinical signs: asymptomatic, anemia rare with blood forms,
ium sp., Cepedietta sp., Trichodina sp.) weight loss, diarrhea
Approximate size: variable 15-140 μm Life cycle: Hematologic organisms have an indirect cycle with
Location: gastrointestinal tract (GI) (Nyctotheroides), skin, gills, invertebrate intermediate hosts (e.g., mosquito and leech).
urinary bladder (trichodinids) Direct life cycle occurs with tissue-invading species.
Clinical signs: asymptomatic, stimulate excess production of Diagnosis: Blood smears, uncommon finding on feces, sporu-
mucus (irritant) lation can be induced in suspects with the potassium
Life cycle: direct dichromate method.30
Diagnosis: wet mount shows macronucleus and infundibulum, Histopathology: Generally found within cells with minimal
trichodinids in urinary bladder response.
Treatment: not usually required unless there is suspicion that Treatment: none if there are no clinical signs (e.g., no anemia
the host is negatively affected. GI: metronidazole or paro- with high load of hemoparasites), amprolium unrewarding.
momycin; skin/bladder: baths with saltwater or distilled Trimethoprim sulfamethoxazole places clinical disease into
water remission but does not cure.
Opalinids (Opalina sp., Zelleria sp.) Microsporidia

Approximate size: 20 × 150 μm Approximate size: 5-20 μm
Location: gastrointestinal tract Location: striated muscle, connective tissue, oocytes, and
Clinical signs: incidental finding on fecal exam Bidder’s organ. Obligate intracellular organisms (Pleis-
Life cycle: direct tophora sp., Microsporidium sp., Alloglugea sp.). Hyper-
Diagnosis: confused with ciliates; opalescent, have two nuclei trophied host cells are called xenomas.
that are the same size, no cell mouth Clinical signs: emaciation, muscle atrophy, death; one new
Treatment: none necessary case in Phyllomedusa sp. with ulcerative dermatitis
Life cycle: direct
Flagellates (Trypanosomes, H. sp., P. sp., trichomonads) Diagnosis: Transillumination of muscles may yield white
Approximate size: ∼20-80 μm streaks in striated muscles; these streaks will be seen on gross
Location: skin/gills (dinoflagellates; Ichthyobodo sp. [Costia necropsy. Impression smears of lesions yield refractile pear-
sp.]), gastrointestinal (Giardia sp. and Trichomonas sp.), shaped organisms. Gram stain results in red-purple color
and blood (trypanosomes, Hexamita sp.) (vs. other protozoa, which do not take up stain).
Clinical signs: asymptomatic, dermatitis, death caused by Treatment: depopulation, chloramphenicol injectable and
osmoregulatory imbalance, anemia topical oxytetracycline with polymyxin B sulfate for derma-
Life cycle: direct for most, indirect for trypanosomes titis, treatment not generally successful
Diagnosis: wet mount of skin/feces or gastrointestinal washes
and blood smear. Myxosporidia
Treatment: Skin/gills—many are commensals: distilled water, Approximate size: 7-10 μm oblong
saltwater, sodium chlorite. Trypanosomes: no treatments Location: gallbladder, urinary tract, kidneys, testes, ovaries
attempted, but suggestions include quinine baths (30 mg/ Species: Chloromyxum sp., Leptotheca sp., Myxidium sp.,
L), oral quinolones 50 mg/kg PO once weekly. Gastroin- Myxobolus sp.; most nonpathogenic
testinal: metronidazole PO, bath for larval amphibians. Clinical signs: none usually; possibly organ specific
Ch005-X0119.indd 96 12/4/2007 12:01:11 PM

Life cycle: indirect and direct, depending on species (variable Species: Rhabdias bufonis (lung), Strongyloides spp., Pseudocap-
even within a genus) illaroides xenopi (capillarid nematode in skin, Xenopus
Diagnosis: histology of affected organs; squash preps of organs. laevis), Foleyella sp. (microfilaria in tissues, coelom, vessels,
Pear-shaped or spherical refractile organism with two polar lymph sacs, and blood), others
capsules. Clinical signs: depends on affected organ system. Increased
Treatment: no treatments available, prevention with disinfec- respiratory effort, ulcerative skin lesions, intestinal prolapse,
tion and good husbandry weight loss, diarrhea, anemia, and failure to thrive are all
possible signs.
Trematodes, Monogenea (flukes with hooklets, suckers, or Life cycle: indirect and direct (most)
clamps; Gyrodactylus sp.) Diagnosis: frequent finding on fecal examination, skin scrapes,
Location: skin, gills, urinary tract, intestinal tract tracheal washes, blood smears, and coelomic fluid. Deter-
Clinical signs: irritation, increased mucus production, increased mining pathogenicity is challenging. Always use fresh feces;
respiratory rate active strongylid larvae may implicate Rhabdias sp., and
Life cycle: direct Capillarids have bipolar plugs on the egg. Filaria generally
Diagnosis: skin scraping and transillumination of the bladder. observed in blood and coelomic aspirate.
Few organisms in an otherwise healthy individual are not Treatment: When clinical signs match a significant nematode
generally considered a problem. load, fenbendazole, ivermectin, or levamisole may be used.
Treatment: praziquantel baths, consider diflubenzuron for at Most treatments call for repeated treatments at least every
least 8 weeks in a system infected with the organism as the 14 days for at least 3 treatments.
hooks of the parasite are made of chitin. Other: Feeding live fish can be detrimental because it is the
intermediate host for eustrongyloides.
Trematodes, Digeneans (flukes)
Location: subcutaneous tissues, skin, heart, kidney, liver, intestine, Acanthocephala (thorny-headed worms)
lungs. Pathology is uncommon; however, encysted organisms Location: intestines; causes intestinal perforation, coelomitis,
can pose a later threat. Possible commensal in large intestine. sepsis, weight loss
Clinical signs: melanophores surround the worms in the skin, Clinical signs: weight loss, lethargy, hydrocoelom
renal damage associated with heavy infestations (Gorgodera Life cycle: indirect, crustacean or insect intermediate host
sp., Gorgoderina sp.) Diagnosis: fecal exam, spindle-shaped eggs in feces
Life cycle: Indirect, larval, and adult digeneans can use amphib- Treatment: no effective treatment, consider loperamide
ians as hosts. Intermediate hosts can be tadpoles, snails, and 50 mg/kg PO q24h × 3 treatments
insect larvae; sometimes three or four hosts are required. Other parasites include Pentastomids, common reptile para-
Diagnosis: heavy infestation witnessed usually postmortem; sites that may occur in amphibians. Characteristics are
transillumination may visually display organisms in tissues unmistakable: an oral region with a mouth and four
Treatment: usually unsuccessful; prophylactic treatment with retractine hooks and an annulated body with no true
corticosteroids 3 days before anthelminthic, then prazi- segments. On gross examination these parasites are more
quantel PO, IM or ICe every 14 days × 3 treatments like crustaceans than helminths. Monocystis sp. and
Other: Halipegus spp. trematodes can be found in the oral earthworm parasites can be found in the feces of amphi-
cavity of frogs (Rana sp.) that are infected by the ingestion bians that ingest invertebrates. Monocystis is a sporozoan
of dragonflies.12 that measures 60 × 200 μm and is not considered parasitic
in amphibians.
Cestodes (tapeworms)
Location: Larvae can be found in muscle, skin, connective tissue, ECTOPARASITES
viscera, and coelom. Adults can be found in the intestine. As with other vertebrates, there are many types of amphibian
Pathology is uncommon; encysted organisms can pose a later ectoparasites. Protozoans (e.g., ciliates and flagellates) can be
threat. Nematotaenia sp. may cause intestinal obstruction. found on and in skin lesions and are most likely opportunistic
Clinical signs: possible proglottids hanging from cloaca pathogens or commensals. Crustacean parasites, such as trom-
Life cycle: indirect biculid mites (chiggers) (1-2 mm orange-red vesicles), cope-
Diagnosis: proglottids and/or eggs observed in feces, possible pods, and lice (branchiurans, Argulus sp., a fish parasite), are
verminous granulomas in the intestine on transillumina- large and easily identifiable. Leeches and ticks (Ixodidae) may
tion, incidental finding on necropsy be found on wild-caught specimens.
Treatment: Praziquantel can be used to eliminate adult worms Insect problems can include bot flies that burrow
in the intestine, whereas larvae are encysted and usually subcutaneously, maggots that infest open wounds, and
refractory to anthelminthics. larval anurans that parasitize the nasal cavity (toadfly larvae,
Lucilia sp.).
Nematodes (roundworms) A diagnosis of ectoparasitism can be made by close exami-
Location: lungs, gastrointestinal tract, skin. Larval forms may nation of the skin, impression smears from skin scrapes, or
be found migrating through most tissues. biopsies. In cases of nasal myiasis, a nasal flush is required.
Ch005-X0119.indd 97 12/4/2007 12:01:11 PM

General treatment strategies for these patients include balanced with fats and fatty acids (even with good levels of
manual removal of large organisms, hypertonic baths (salt- Ca, P, and D3) may cause problems. The role of ultraviolet
water), anthelminthics, and diflubenzuron for crustaceans. B radiation and vitamin D3 is not well documented but
Other baths, including formalin baths can be used, but they may be a factor in some species.
are considerably more irritating and potentially harmful to the Diagnosis: Plasma calcium levels are generally unremarkable
amphibian host. In addition to treating the amphibian, the because it is the tendency of the body to maintain available
enclosure must also be treated to prevent reinfection. plasma levels of calcium. Radiographs are diagnostic.
Affected animals will have a reduced cortical bone
density.
Nutritional Treatment: calcium supplementation, correction of diet, pro-
Disease: Nutritional secondary hyperparathyroidism (meta- vision of ultraviolet B radiation
bolic bone disease)43,44
Clinical signs: skeletal deformity (Figures 5-33 and 5-34), Disease: Hypervitaminosis D332
abnormal posture, splay leg, fractures, tetany, bloating, Clinical signs: anasarca, anorexia, weakness
hydrops, subcutaneous edema, gastrointestinal prolapses Etiology: Comet goldfish prey fed to frogs that are fed a com-
Etiology: low calcium in diet or water, hypervitaminosis A, mercial fish flake food.
and/or fat and fatty acid imbalance. Hypocalcemia can Pathogenesis: Calcium salts deposit in organs, causing multi-
cause tetany, reduce gastrointestinal peristalsis, and result in focal soft tissue mineralization.
bloating. Diagnosis: usually a postmortem diagnosis
Pathogenesis: Amphibians use lipoproteins as a transport Treatment: none
mechanism for vitamin D3; therefore, diets inappropriately
Disease: Hypervitaminosis A45
Clinical signs: similar to metabolic bone disease
Etiology: rodent diet
Pathogenesis: Excess vitamin A interferes with absorption and
utilization of vitamin D3.
Diagnosis: correlates with radiographs and diet
Treatment: Supplement rodent diet with calcium and vitamin
D3 (2.7 μg/g of prey body weight). This treatment has not
been tested, and its long-term safety is unknown. Feed
fewer rodents.
Disease: Hypovitaminosis A12

Clinical signs: xerophthalmia, corneal lesions, inability to use
tongue for prey capture
Etiology: deficiency in diet
Pathogenesis: keratinizing squamous metaplasia and secondary
keratomalacia in mammals and birds; epidermal hyperpla-
sia and hyperkeratosis also associated
Figure 5-33 Metabolic bone disease in an anuran. Diagnosis: histopathology
Treatment: vitamin A supplementation to diet
Disease: Corneal lipidosis21,44,45

Clinical signs: cloudy haze to white tissue accumulation in the
cornea(s)
Etiology: Commercial chows can contain high levels of cho-
lesterol, which can be transferred through the food chain
to captive amphibians.
Pathogenesis: Tree frogs are commonly affected, and females
may be overrepresented in a diseased population.
Diagnosis: Visual examination of eye(s) will show raised and
opaque, white corneal lesions, which are associated with
high serum cholesterol (e.g., 1000 mg/dl for severely
affected frogs).
Figure 5-34 A survey radiograph of the frog with metabolic Treatment: Surgical removal of one or both coelomic fat
bone disease from Figure 5-33. Note the thin cortices and the bodies may be warranted. Invertebrate diets should com-
folding femoral fracture. prise only vegetables for 48 hours before offering them to
Ch005-X0119.indd 98 12/4/2007 12:01:11 PM

amphibians. Topical ophthalmic antibiotic and antiinflam-

matory drops may be used, especially with keratotomy.
Debulking the corneal lesions may cause an inflammatory
response with increased infiltration of inflammatory cells in
the local tissue. Enucleation may be required.
Disease: Thiamine deficiency44

Clinical signs: neuropathy, blindness
Etiology: a diet comprised of frozen-thawed fish
Pathogenesis: freezing results in leeching of vitamins from the
food source. Fish have thiaminases that are not destroyed
by freezing and therefore break down thiamine (a very labile
protein).
Diagnosis: response to treatment
Treatment: Animals with neurologic dysfunction and a history
consistent with thiamine deficiency can be given a dose of
250 mg thiamine/kg of fish.
Disease: Iodine deficiency44

Clinical signs: Tadpoles do not metamorphose; rather, they get
very large.
Etiology: diets deficient in iodine or the consumption of excess Figure 5-35 Gross appearance of a frog with aerocoelom.
goitrogens (e.g., cabbages and spinach)
Treatment: iodine and thyroxine
Disease: Steatitis44 evaluation. Blood work may prove to be useful in evaluating

Clinical signs: Abdominal discomfort is the presenting sign. protein loss12 and hypocalcemia.
Etiology: Improperly stored or frozen fish or other whole prey Treatment: depends on initiating cause. Generally, make the
may become rancid. Steatitic nodules develop in fat patient comfortable by removal of impaction, decreasing air
bodies. if excessive.
Treatment: Removal of the fat body is recommended.12 Treat-
ment with vitamin E and selenium may be useful. Disease: Calculi44
Clinical signs: lethargy, weight loss, hydrocoelom, edema
Etiology: (1) renal: oxalates in food items (terrarium plants
Other Diseases that prey feed on) and (2) bladder (Figure 5-36): stones
Disease: Acclimation and maladaptation syndrome tend to occur in dehydrated uricotelic anurans. Both dis-
(AMS)13 eases may be exclusive to uric acid–producing organisms
Etiology: failure to thrive or adapt to captivity usually due to and are uncommonly seen.
inappropriate husbandry, including unacceptable habitat, Diagnosis: palpation (bladder stones), radiographs, postmor-
low environmental temperature and humidity, low-grade tem finding
nutrition Treatment: cystotomy, diet change, supportive therapy
Clinical signs: emaciated, anorexic, lethargic animal
Diagnosis: exclusion of other disease processes Disease: Gastrointestinal impaction
Treatment: Provide supportive therapy until the animal can be Clinical signs: lethargy, abdominal bloat, failure to pass feces;
acclimated. Screen for parasitic diseases and look for myco- common problem in larger frogs
bacteria in animals that continue to suffer weight loss. Etiology: consuming an overly large prey item or ingesting a
foreign body (e.g., stones, coins, or accessories of the vivar-
Disease: Bloated animal ium), bezoars (e.g., accumulated invertebrate skeletons).
Clinical signs: generalized enlarged body shape, focal enlarge- Large coelomic masses may cause decreased respiratory
ment around coelom volume and consequent hypoxia and hypercarbia.
Etiology: (1) hydrocoelom, edema, anasarca (e.g., organ failure, Diagnosis: Palpation may reveal the foreign body, and radio-
metabolic derangement, sepsis, hypocalcemia, protein defi- graphs (with and without contrast) and ultrasound can be
ciency); (2) aerocoelom (gastrointestinal gas, subcutaneous useful in confirming the location and origin of the foreign
emphysema [Figure 5-35], pulmonary bullous rupture32); body.
and (3) gastric impaction Treatment: Removal of the prey or foreign item from the
Diagnosis: ballotment, palpation, radiographs, ultrasound, stomach may be relatively simple, as the stomach is a large
laparoscopy with biopsy of liver and kidney, postmortem organ, and anurans have a short esophagus. Manual removal
Ch005-X0119.indd 99 12/4/2007 12:01:12 PM

Figure 5-36 Bladder stones in a tree frog (Photo credit Figure 5-38 Liver cysticercoid.
Disney’s Animal Programs, Deidre Fontenot).
migrans) (Figure 5-38). Specific diseases that affect the liver

include mycobacteriosis, chlamydiosis, chromomycosis
(fungal hepatitis), recurrent septicemia, parasitism, trauma,
and toxic insults (e.g., griseofulvin, chloroquine, prima-
quine, and aflatoxin [which can produce tumors]).
Diagnosis: radiographs, ultrasound, liver biopsy
Treatment: targeted to symptomatic treatment of clinical signs
and disease process
Disease: Ocular disease21,46,47

Clinical signs: corneal haze, globe size change, anisocoria,
visual deficits, lens opacity
Etiology: glaucoma, cataract, nematode migration, uveitis,
Figure 5-37 Mycobacterial abscess at the elbow of a frog.
panophthalmitis with septicemia, congenital abnormality
(microphthalmia, anopthalmia, cyclopia) possibly linked to
environment, corneal lipidosis
Diagnosis: impression smears, culture, postmortem analysis
or stomach lavage may be sufficient. For impactions in the Treatment: topical antibiotics, topical antifungals, enucleation.
intestinal tract, surgical intervention may be required. If There are some concerns about swallowing difficulties after
there is evidence of normal peristalsis or the animal appears enucleation, though many animals do well. Therapy is often
otherwise normal, mineral oil or laxatives may be attempted. futile by the time ocular lesions develop.
If the animal is not defecating, or is obviously adversely
affected by the impaction, surgery or endoscopy is Disease: Paralysis48
warranted. Clinical signs: flaccid paralysis of the hindlimbs, with some
animals presenting with rigid paralysis
Disease: Joint disease Etiology: frequently unknown etiology. There are no salient
Clinical signs: swollen or painful joints pathologic features. Some cases may be attributed to toxins;
Etiology: Differentials for joint disease should include myco- many zoological institutions have faced colony problems
bacterial disease, sepsis, gout, neoplasia, articular infection with no causative agent. The disease carries a poor prognosis
(Figure 5-37), and arthritis. unless there is a firm etiology (e.g., ivermectin overdose).
Diagnosis: palpation of the affected joints, aspiration of joint There is a possible vitamin B/thiamine link. Botulism,
fluid for cytologic examination, radiographs hypocalcemia, and exposure to pesticides and other neuro-
Treatment: target inciting cause, amputation may be logic toxins should also be in the differential list.
necessary Diagnosis: clinical signs. A full work-up should be performed
if possible, and a complete postmortem examination per-
Disease: Liver disease26 formed if the opportunity presents itself.
Clinical signs: anorexia, lethargy, hepatomegaly, ascites, death Treatment: Vitamin B complex, corticosteroids, antibiotics,
Etiology: Liver disease generally occurs as a sequela to other botulism antitoxoid, and calcium have been used as a
disease complexes (e.g., bacterial septicemia or parasitic “shotgun” therapy cocktail. Supportive care is sometimes
Ch005-X0119.indd 100 12/4/2007 12:01:13 PM

Figure 5-39 Cloacal prolapse in a caecilian.
the only treatment; some animals do survive, but the course

of treatment can last for more than a month.
Disease: Prolapse
Clinical signs: obvious exposure of tissue (e.g., stomach)
through the oral cavity or, more likely, the cloaca (e.g.,
rectum, oviduct, or urinary bladder)
Etiology: Gastric prolapse can be a transient occurrence in a Figure 5-40 Rostral abrasions (“cage nose”) in a dendrobatid.
healthy animal. It is not uncommon for anurans to evert
their stomachs to expel noxious prey items. In the diseased
animal it can be a terminal event. Gastric prolapse can also Disease: Respiratory disease49,50
occur secondary to increased intraabdominal pressure (e.g., Clinical signs: increased respiratory rate, open-mouth breath-
handling). Causes for cloacal prolapse may include hypo- ing, cyanosis
calcemia (decreased peristalsis), gastrointestinal impaction, Etiology: Upper airway obstruction, pulmonary disease (bacte-
parasites, toxins, unsuitable bulky diets, substrate-based rial or verminous pneumonia, Rhabdias sp.), pulmonary
foreign bodies, persistent parasitism or bacteremia, and as rupture and collapse, thoracic wound, and a space occupy-
a result of anesthesia. Caecilians have been reported with ing coelomic mass will all cause respiratory disease. Gill
cloacal prolapse (Figure 5-39) of unknown etiology. damage can easily occur to neotenic caudates.
Diagnosis: visual examination of the tissue. Knowledge of the Diagnosis: radiographs, tracheal wash, gill clip
normal anatomy is required to differentiate affected Treatment: must target specific disease process
tissues.
Treatment: Resolution may occur uneventfully if the animal Disease: Rostral lesions51
is kept quiet and moist. If the prolapse persists for more Clinical signs: “Cage nose” is an ulcerative dermatitis of the
than a few hours, it should be further evaluated. Performing rostrum (Figure 5-40).
the evaluation under anesthesia is preferred. Treatment of a Etiology: May be observed with red-leg syndrome cases. More
urinary bladder prolapse32 requires disinfecting the bladder often it is caused by traumatic injuries sustained during
with 0.5% chlorhexidine (Fort Dodge Animal Health, Fort escape attempts from an enclosure. It is frequently prompted
Dodge, IA), aspirating any urine to reduce the size of the by irritation (e.g., secondary smoke, avoidance of conspe-
the bladder, inserting an object into the bladder to replace cifics, high temperature, loud noises, glue fumes, etc.).
it internally, and placing a suture to tack the bladder to the Lesions may take weeks to months to resolve.
coelomic wall. Rectal or oviductal prolapse requires gentle Diagnosis: visual examination, impression smears to evaluate
cleaning and reduction of swollen tissue. This can be microorganisms, bacterial and fungal culture
accomplished by liberally flushing the tissue with a hyper- Treatment: topical antibiotic and antifungal therapy. Debride-
tonic solution (e.g., sugar, honey, or ophthalmic saltwater ment may be necessary and involves dissection of necrotic
drops). Reduction can be accomplished by applying gentle tissues.
pressure with an atraumatic, blunt instrument and placing Other: Wright51 described a syndrome in captive redback sala-
purse string or interrupted sutures around the vent. Again, manders (Plethodon cinereus) termed atrophic mandibular
this procedure should be done under anesthesia. stomatitis. The injuries are caused by burrowing activity in
Ch005-X0119.indd 101 12/4/2007 12:01:15 PM

Figure 5-41 Spindly leg syndrome in a dendrobatid. (Courtesy

Lincoln Park Zoo, Kathryn Gamble).
an inappropriate habitat. Wright also described a similar

condition in crocodile newts (Tylototriton shanjing) follow-
ing shipment. Newts with mandibular fractures carry a poor
prognosis because they are not able to suction feed. Phar-
yngostomy tubes have been used to allow supportive care
during healing.12
Figure 5-42 Caecilian with thermal burns secondary to contact
Disease: Skin lesions with an aquarium heater.
Clinical signs: discoloration of skin, ulcerations, increased
mucus production, sloughing of skin
Etiology: numerous causes possible, including poor environ- feces, and serum should be frozen. Brain, liver, kidney,
ment, bacteria, parasites (ectoparasites and larval migrans), digestive tract contents, urine, and skin should also be col-
fungus, trauma lected for histopathology.
Diagnosis: skin scrape and cytology, culture, evaluation of Treatment: Remove animal from source and rinse. A sodium
environment thiosulfate soak (1% solution) can be used for halogen
Therapy: Fluid therapy is critical because of osmotic losses. exposure. Assess heart rate and treat with atropine if neces-
After disinfection of lesion, consider application of liquid sary (0.1 mg/kg IM, SC, or ICe).
bandage or other covering. Appropriate therapy should be
based on diagnosis. Disease: Trauma51
Clinical signs: skin lesions, hemorrhages, skeletal deformities,
Disease: Spindly leg syndrome (Skeletal and muscular under- lethargy
development [SMUD])48 Etiology: Crushing injuries can occur from human handling
Clinical signs: underdevelopment of forelimbs (Figure 5-41), and the environment. Fractures can also occur with these
when other anatomical features are normal events, and animals with MBD are more susceptible. Prey-
Etiology: nutrition (vitamin B deficiency), genetics, toxin, induced trauma (e.g., crickets attacking amphibian) is
overcrowding, low oxygen levels, trauma common when leftover food items are not removed.
Diagnosis: physical examination, detailed history Diagnosis: history, physical examination, radiographs
Treatment: None. Feeding rich vegetation (algae) reduces Treatment: Limit the number of crickets fed so that the
incidence. animals can consume them with no leftovers. Remove any
uneaten live prey. Fractures can be stabilized in larger
Disease: Toxins52 animals.52
Clinical signs: irritation, hyperexcitability, neuropathies
Etiology: PVC glues (methyl-ethyl-ketone, tetrahydrofuran, Disease: Other
cyclohexane), nicotine (injected into air pumps), pesticides, Ultraviolet A and metal halide lights may be too intense
disinfectants, anthelminthics for amphibians, causing corneal opacities, erythema, excessive
Diagnosis: challenging; history of exposure, possible toxico- mucus production, and skin damage resulting in dermatitis.
logic analysis of organ tissue (limited samples). If there is a Sunburn may occur if direct sunlight is offered, resulting
suspicion of toxicity, collect urine, feces, serum, and blood in ulcerative dermatitis. Thermal burns may also occur (Figure
in ethylenediaminetetraacetic acid (EDTA). The urine, 5-42), secondary to direct or close contact with a heating
Ch005-X0119.indd 102 12/4/2007 12:01:17 PM

element. Clinical signs may include agitation, lethargy,

ataxia, and death. Lesions may heal as white scars (fibrous
tissue), but progressive dermatitis must be considered an
outcome with severe wounds. Electric shock can occur if
heating elements or other electrical gear break and have direct
contact with animals. Death is a frequent outcome, and
resuscitation may be attempted but is often unrewarding.
Drowning can occur in animals kept in an inappropriate
vivarium. Immediate clearance of the airways (e.g., massaging
the animal, hold the head down) should be done to remove
fluid. Articular and visceral gout48 occurs, but the etiology is
unknown. Dehydration and excessive dietary protein may play
roles in the development of diseases, but these are speculative.
Molchpest is a classic European newt disease associated
with incomplete shedding and failure to consume a shed. Figure 5-43 Oral myxoma in a Budgett’s frog.
Affected animals become hyperemic, and skin nodules may
form. To some veterinarians, this is not considered a real exchange of ions across the skin of amphibians, the com-
disease. ponents in the water are intimately involved with these
animals. Treatments for all water quality problems involve
improving dissolved oxygen levels by aerating the water and
Neoplasia53,54 by performing water changes. Occasionally, supportive care
The majority (50%) of all amphibian tumors are integumen- and prophylactic treatments may be necessary depending on
tary. Epidermal papillomas, also referred to as squamous papil- symptoms.
lomas, infectious warts, and epitheliomas, are described most Low dissolved oxygen may cause an animal to gasp at the
frequently in urodelans. These papillomas are sessile, hypopig- water’s surface, and stagnation of the water may be evident.
mented, and well demarcated with a folded or convoluted Conversely, high dissolved gasses (e.g., nitrogen and oxygen)
surface. Most are solitary lesions, pose little health concern, can be forced into the water and supersaturate the system,
and are readily debulked or excised for diagnosis. Squamous causing gas bubble disease. Affected animals may have small,
cell carcinomas have also been reported in amphibians and are subcutaneous bubbles accumulating in their webbing, eyes, and
characterized grossly as hypopigmented, raised, sessile, or skin. Occasionally, animals may succumb to air embolism.
pedunculated masses, 0.3 to 1.5 cm in diameter. Surgical Chlorine and chloramines are present in water from the tap.
removal is recommended. Melanophoromas, also referred to as They are more toxic to tadpoles than adults. Sodium thiosul-
melanoma, melanocytoma, and melanosarcoma, are described fate can be used to neutralize chlorine, as can aging the water
in multiple species of urodelans and anurans. These neoplasms for 72 hours or aerating the water for an hour.
vary greatly in behavior and gross morphology, ranging from Amphibians can generally tolerate shifts in pH; however,
solitary to multicentric, hypopigmented to pigmented, non- this can be a significant stressor. When the pH falls to less than
palpable to nodular, and regressive to invasive masses. 6.0, skin irritation can occur; when the pH increases to greater
Myxoma32 (Figure 5-43) is a common, proliferative neoplasm than 8.5, excess mucus production and hyperemia can occur.
in tree frogs, and recurrence is frequent after excision, but it is Long-term pH imbalance can also cause alterations in the acid-
slow growing. base status of the animal.55,56
T-cell lymphomas in Xenopus laevis involve the thymus, Elevated ammonia can cause skin irritation (e.g., erythema),
resulting in a unilateral swelling in the cephalic area. Lym- kidney damage, liver damage, and neurologic disease. Ammonia
phoma may progress to leukemia. Diagnosis is made with a also can diminish the oxygen carrying capacity of the blood.
complete blood cell count and examination of a blood smear. Clinical signs can include hyperemia/erythema, gasping at the
Lucke’s renal adenocarcinoma of Rana pipiens is the best- water’s surface, excess mucus production, color change, and
known amphibian neoplasm. It is caused by a herpesvirus death.
(Rana herpesvirus type 1 or Lucke’s herpesvirus) and is preva- Very little is reported on the effects of nitrite toxicity in
lent under laboratory conditions where animals are maintained adult anurans; however, methemoglobinemia can occur and be
at high ambient temperatures. fatal. Nitrates, on the other hand, may cause developmental
Other tumors have been sporadically reported. In general, abnormalities in tadpoles. Although unusual in adults, nitrates
published treatments seem exclusively reliant on surgery. may convert to nitrite and cause methemoglobinemia (brown
blood disease).
Water Quality and
Amphibian Disease5,8,37 THERAPEUTICS
Water quality has a huge impact on amphibian disease, espe- When considering a treatment regime, a holistic approach is
cially semiaquatic or fully aquatic animals. Because there is free necessary. Husbandry, behavior, diet, and specific treatments
Ch005-X0119.indd 103 12/4/2007 12:01:19 PM

must be organized. With amphibians, it is also important to cally on the animal require no handling. Ophthalmic drops
minimize stress, as this can lead to reduced immune frequently have high concentrations, and repeat dosing
function. throughout the day may result in overdose.24 To prevent this,
the drops can be diluted. Baths are an excellent method for
delivering fluid therapy and medicating an animal (Figure
Temperature Change as a Therapy 5-45). When treating an amphibian via a bath, the ventrum
Always provide an amphibian an optimal environmental tem- must be immersed and care taken not to drown the animal. A
perature during convalescence. Behavioral fevers are not well covered container is ideal, and plastic bubble-wrap can be used
explored, but they may prove useful under some circumstances. to cover the animal and prevent jumping. The pH of a solution
In these cases, placing the animal into the high end of its must be considered with any bath. The addition of chemicals
temperature range may provide a benefit toward healing and to a vivarium to create a bath in the animal’s habitat can be
disease resolution.57,58 Alternately, going outside the range of done, but large water changes must be performed that can
the organism (without detriment to the patient) may be a useful disrupt the biologic filter and can stress the animal. Addition-
control mechanism, as with Saprolegnia sp., which prefers ally, the drugs chosen for the treatment may kill or shock the
colder temperatures. Raising the temperature above 25° C5 can bacteria in the filter. Activated carbon filters, protein skim-
help decrease the load of organisms in the system. mers, and sterilization tools will affect the drug in the water
by deactivating it. Baths should be mixed in 0.5% saline and
made fresh daily. Amphibian ringers can be used as well.
Administration of Medications22,24 There are five parenteral routes for administering medica-
The route by which a drug is administered is important. For tion to amphibians: subcutaneous (SC), intramuscular (IM),
example, the percutaneous uptake via a droplet or a bath is intravenous (IV), intracoelomic (ICe), and lymph sac injec-
effective, but not as much as an injection. However, the former tion. In caudates and caecilians, the SC space is not present.
requires no handling. The clinician must make choices based In caecilians, IV actually means intracardiac (IC). ICe injec-
on the patient, the diagnosis, and the ability to execute a tions should be performed with the animal in dorsal recum-
treatment. bency, and the injection given in the caudal quadrant. Injection
Oral treatment is most efficient when it can be adminis- into the lymph sacs is rapidly absorbed (within minutes). IM
tered with a food item and swallowed voluntarily. Invertebrate is straightforward, given the existence of a renal portal system.
prey items can be injected with medications; however, this IV injections can be difficult to administer in amphibians, and
frequently renders them incapable of moving and the prey may are generally not practical except for administering drugs for
be rejected. If necessary, medications can be administered euthanasia (intracardiac).
by manual restraint and by gavage (Figure 5-44). Tools for Nebulization is a potential22 treatment modality, but it is
assisting in the delivery of oral medications can include a not routinely done to treat amphibians. It is possible that
micropipette, metal gavage tubes made for birds, intravenous animals with pneumonia may benefit greatly from this modal-
catheters, and red rubber feeding tubes. ity. In one case, animals were nebulized with levamisole, and
Topical treatment is a very effective and noninvasive method fatalities were recorded. However, it was not known whether
for administering medications to amphibians. The permeable the dose of levamisole or the nebulization procedure was
skin of amphibians allows for percutaneous absorption via responsible for the deaths.59
direct drops or via baths. Some drugs have irritating carriers,
and their pH is a concern. Drops of medication applied topi-
Figure 5-45 Medicating a large group of animals using

Figure 5-44 Administration of a prepared liquid food via a a bath. (Photo credit Disney’s Animal Programs, Deidre
pipette. Fontenot).
Ch005-X0119.indd 104 12/4/2007 12:01:20 PM

Intratracheal and intrapneumonic infusion of therapeu- amphibians have low metabolic rates and would be expected
tics also could be used to treat pulmonic parasitism. Intra- to require lower dosing levels compared to other vertebrates,
osseous catheters can also be used. Long-term use of catheters they also have a high fluid turnover, which affects drug distri-
(IV or IO) has not been documented in amphibians, especially bution and can increase a required dose. More research is
given the permeability and high success rate of delivery by needed to elucidate the therapeutic needs of these animals.
bath. Detailed formularies are available for amphibians,58-60 but for
Keep in mind that bioavailability and pharmacokinetic rapid reference, a small formulary is provided in this text
studies for amphibians are largely unavailable. Although (Table 5-3).
TABLE 5-3 Formulary of Common Therapeutics Used to Treat Amphibians

Drug Dosage Route Frequency Duration
Bath or topical treatment

Benzalkonium chloride 2 mg/L Bath q48h for 30 min 3 days, 5-day rest, retreat
Calcium glubionate 2.3% Bath q24h for 1-2 h
(Neo-Calglucon)
Chloramphenicol 10 μg/ml Bath q24h
Ciprofloxacin 5-7 mg/L Bath q24h for 6-8 h 7 days
Dexamethasone sodium 0.1-0.5 mg/kg Topical q24h 3-5 days, then taper
phosphate
Dimilin (diflubenzuron) 0.1 mg/L Continuous Repeat with every 3 treatments
immersion water change or
every 2 weeks
Enrofloxacin 10 mg/kg Topical q24h 10 days
Formalin 10% 1 ml/L Bath q48h for 10 min To effect
Formalin/malachite green 0.007 ml/L Bath q48h, for 24 h 4 treatments
Gentamycin sulfate 8 μg/ml Bath q24h
Itraconazole 1% 0.01% Bath q24h for 5 min 11 days
suspension
Ivermectin 10 mg/L Bath Every 7 days, 60 min
Ivermectin 0.2-2 mg/kg Topical
Ivermectin 2 mg/kg Topical
Levamisole 100-300 mg/L Bath q24h; repeat in 2 wk 3 treatments
Levamisole 10-100 mg/L Bath in tank Continuous 3-5 days
water; carbon
filter at end
of treatment
Levamisole 10 mg/kg Topical
Levamisole 94 mg/kg Topical Rinse 1 h
(50 μl of 3.767 mg/ml)
Levamisole in caecilians 50-100 mg/L Bath q24h for 1-8 h Every 7 days
and Pipa (per animal
tolerance)
Metronidazole 28 mg/kg Topical q24h Rinse after 1 h
(50 μl of 1.008 mg/ml)
Morphine 20-160 mg/kg Topical As needed
NaCl 1%-2.5% Bath
NaCl 20 mg/L Bath q24h for 6-8 h
Nalidixic acid 10 μg/ml Bath q24h
Nitrofurantoin 50 μg/ml Bath q24h
Oxytetracycline 100 mg/L Bath q24h for 1 h
Praziquantel 10 mg/L Bath 3h
Praziquantel 8-24 mg/kg Topical Every 7-21 days
Regranex light coat Topical As needed
Sodium chlorite (NaOCl2) 20 mg/L Bath 6-8 h Once
Tetracycline hydrochloride 10 μg/ml Bath q24h
Trimethoprim-sulfa 20-80 μg/ml Bath q24h
Ch005-X0119.indd 105 12/4/2007 12:01:21 PM

TABLE 5-3 Formulary of Common Therapeutics Used to Treat Amphibians—cont’d

Drug Dosage Route Frequency Duration
Injectable drug
Amikacin 5 mg/kg IM, SC, ICe q24h, q48h
Buprenorphine HCl 0.35-0.75 mg/kg IM q12h
Butorphanol 0.05-1 mg/kg IM, SC q12h
Calcium gluconate 10% 100 mg/kg IM, IV, ICe q4-6h 24 h
Calcium gluconate 10% 100 mg/kg IM, IV, ICe q4-6h 24 h
Ceftazidime 30 mg/kg IM q72h
Dexamethasone sodium 0.1-0.5 mg/kg IM, ICe q24h 3-5 days, then taper
phosphate
Enrofloxacin 5-10 mg/kg IM q24h
Fentanyl 0.5 μg/g (ED50) IM
Flunixin meglumine 1 mg/kg IM, SC q24h
Furosemide 5 mg/kg IM As needed
Ivermectin 0.2-0.4 mg/kg IM
Ketoprofen 2 mg/kg IM, SC q24h 5 days
Meperidine 200 μg/g IM q16h
Morphine 20-160 mg/kg IM, SC As needed
(as much as
100 μg/g)
Oxytetracycline 50-100 mg/kg IM q48h
Praziquantel 8-24 mg/kg SC, ICe Every 7-21 days
Selenium 0.1 mg/kg IM
Thiamine 25-100 mg/kg IM, ICe Once; then PO
Trimethoprim-sulfa 39 mg/kg SC q24h
Vitamin D3 1000 IU/kg IM
Vitamin E 1 mg/kg IM Once; then PO
Oral drugs
Butorphanol 0.05-1 mg/kg PO q12h
Calcium glubionate 1 ml/kg PO q24h 30 days
Doxycycline 5-10 mg/kg PO q12h, q24h
Fenbendazole 100 mg/kg PO Every 7-14 days
Fenbendazole 50 mg/kg PO q24h for 3-5 days Repeat 2-3 wk
Itraconazole 2-10 mg/kg PO q24h
Ivermectin 0.2 mg/kg PO Every 14 days 2-12 treatments
Metronidazole 50 mg/kg PO q24h 3 days, then reduce dose
Metronidazole 10 mg/kg PO q24h 5-10 days
Oxytetracycline 50 mg/kg PO q24h
Paromomycin 50-75 mg/kg PO q24h
Praziquantel 8-24 mg/kg PO Every 7-21 days
Tetracycline 50 mg/kg PO q12h
Thiamine 25 mg/kg PO Each meal Until resolution of signs
Trimethoprim-sulfa 30 mg/kg PO q24h
Trimethoprim-sulfa 15 mg/kg PO q24h 21 days
Vitamin B complex 0.1 ml/300 g PO q24h for 7 days,
then q48h
Vitamin D3 100-400 IU/kg PO
Vitamin E 100-400 IU/kg PO Every 7 days
ICe, intracoelomic; IM, intramuscular; IV, intravenous; PO, per os; SC, subcutaneous.
Ch005-X0119.indd 106 12/4/2007 12:01:21 PM

Fluid Therapy24 Antimicrobials

Integumentary disease in amphibians is a very important con- There is not a great deal of pharmacokinetic data available for
dition, as the skin is an important organ in respiration and ion amphibians, and most doses are extrapolated from reptile
transport. When the skin is compromised, osmotic losses can medicine. Tetracyclines are not effective as a bath; ICe injec-
be phenomenal. In cases of dehydration, amphibians may tion can cause local inflammation. The oral route is effective,
develop enophthalmia (sunken eyes), tacky mucous mem- but the drug is bitter and may not be accepted by the patient.
branes, increased ropy mucus in the oral cavity, and wrinkled, Skin discoloration, irritation, and sloughing can occur with
discolored or tacky skin. Sometimes there is a “tightening” of injection of enrofloxacin. In general, however, there are not
the skin over the dorsum. Weight loss and a lack of urination many side effects reported at the published doses. Doses for
during handling may also be indications of dehydration. antibiotics commonly used to manage amphibians can be
Aquatic amphibians rely on their kidneys for water excre- found in Table 5-3.
tion and solute retention. Should these organs fail, the animal
cannot maintain ion, solutes, or fluid balances. In these cases, Antiparasitics
fluid therapy can be challenging. Replacement therapy may
cause volume overload, which overextends the heart’s capacity The goal of treatment should not be to eliminate all protozoa,
and can result in death. The key is to maintain electrolyte as many are considered indigenous flora; rather, when protozoa
balance. The plasma osmolality should be greater than are considered a problem, treatment goals should be geared
200 mOsm/L. When the skin, kidney, or gills are damaged (as toward the reduction of protozoal numbers. Metronidazole is
with infection), fatal electrolyte imbalances can occur. Fluid an effective drug for most protozoal infections. Paromomycin
therapy is essential when there are obvious skin lesions or renal and sulfa drugs (SMZ-TMP) may be useful, especially with
disease is suspected. Again, fluid overload is very common; coccidia. Topical protozoal infections can be effectively dealt
therefore, isotonic solutions are critical. Freshwater is too with using immersion baths in saltwater, dyes, and formalin
hypotonic, whereas standard mammalian fluids are hypertonic. (e.g., though this can be toxic and fatal). Doses for antiproto-
There are a number of amphibian isotonic solutions available, zoals commonly used to manage amphibians can be found in
with the easiest for the clinician to make being amphibian Table 5-3.
ringer’s solution (Box 5-2). When fluid overload is obvious Levamisole has been used topically in a number of animals;
(e.g., edema, ascites), then a more hypertonic solution is however, flaccid paralysis can occur in caecilians and Surinam
appropriate (Box 5-3). Wright24 recommends keeping an toads with prolonged exposure. If used topically, the drug
amphibian no longer than 4 hours in a hypertonic solution should be rinsed off with aged water after 1 hour of contact.61
without reassessment. In a pinch, a 3 : 1 nonlactated balance Oronasal flushes of levamisole can be used to treat the
electrolyte solution using 5% dextrose and 0.9% sodium chlo- larvae of the toadfly, which infest nasal passages, at a dose of
ride can be used for ICe administration in life-threatening situ- 100 mg/L. Praziquantel can cause injection site reactions in
ations (e.g., very depressed, dehydrated animal; blood loss). Typhlonectes sp. Ivermectin can be used to eliminate nema-
Alternately, a 9 : 1 ratio (0.9% saline: sterile water) solution todes, acariasis, and ticks. Some ivermectins have propylene
can be used but is not ideal. glycol, which may irritate amphibian skin. Species-specific
reactions can occur, and some animals may succumb at doses
of 0.2 mg/kg. Paralysis can occur with high doses (200 mg/kg)
BOX 5-2 The Recipe for Amphibian of ivermectin, which can occur with inappropriate dilutions.
Ringer’s Solution62 Given supportive care and time, many animals recover. Iver-
mectin flushes of nasal passages can be performed at 10 mg/L
Distilled water 1L for fly larvae. Fenbendazole is very effective against nematodes.
NaCl 6.6 g Doses for anthelminics commonly used to manage amphibians
KCl 0.15 g can be found in Table 5-3.
CaCl2 0.15 g Don’t neglect to clean or treat the environment when there
NaHCO3 0.2 g
is a heavy parasite load. It is best to remove and replace soil
and porous items.
BOX 5-3 The Recipe for Hypertonic Amphibian Antifungals39

Ringer’s Solution62
Immersion baths with salts, benzalkonium chloride, and dyes
Distilled water 1L (malachite green) are useful for treating topical fungal infec-
NaCl 7.3 g tions. Anecdotal information suggests that caecilians may be
KCl 0.17 g sensitive to methylene blue, but this is untested.5 Preparations
CaCl2 0.17 g of miconazole or ketoconazole cream can be applied to focal
NaHCO3 0.22 g lesions. Daily, 5-minute baths in a 0.01% itraconazole solution
(Sporanox, Janssen Pharmaceuticals, Beerse, Belgium; 1%
Ch005-X0119.indd 107 12/4/2007 12:01:21 PM

suspension diluted with 0.6% saline) for 11 days has been therapy can be administered by soaking an animal in amphib-
found to be curative for chytridiomycosis. ian ringers (see Box 5-2), ensuring that the head stays above
Documented reports of mucormycosis in amphibians have the water line. If the animal has fluid overload (e.g., ascites,
not addressed treatment options. Long-term systemic anti- anasarca), then use hypertonic amphibian ringers (see Box
fungal therapy may be attempted with amphotericin, which 5-3). Fluid overload might occur with hypotonic fluids, like
has shown good in vitro activity against Mucor species. Mor- a freshwater bath. Supplemental oxygen can also be used and
tality from Basidiobolus was greatly reduced when dwarf African administered directly or nebulized, taking care not to dry the
clawed frogs were bathed in benzalkonium chloride (2 mg/L) animal out. There has been suggestion that cooling an animal59
for 30 minutes every other day for three treatments, given a in the first 3 to 4 days after presentation may reduce the growth
5-day rest, and then retreated. Treatment of chromomycosis of potential pathogens and allow the medications to work.
has been unsuccessful. In human cases, itraconazole is used However, many bacteria are capable of regeneration at a range
with cryosurgery or surgical excision of lesions. of environmental temperature, and lowering an ectotherm’s
body temperature will reduce its metabolic rate and, in turn,
the distribution of various chemotherapeutics. Broad spectrum
Antivirals antibiotic therapy should be initiated and focused on Gram-
Reports using antivirals to treat amphibians are rare. The negative and anaerobic organisms. If there is a suspicion of
primary reason for this is that viral diseases are rarely diag- chytrids or Chlamydophila, then antifungals or doxycyclines
nosed, because of a general lack of testing and because there should be given. Overall, the goals of emergency therapy are
are few affordable antiviral agents available in veterinary medi- to isolate the animal, ensure appropriate temperature zones,
cine. Veterinarians considering an antiviral for an amphibian provide oxygen, correct fluid deficits, and initiate treatment
should extrapolate the dose from the reptile literature. for an appropriate differential.
An entire chapter dedicated to critical care in the amphibian
has been written;62 salient points will be summarized. Hypo-
Analgesics tension in the amphibian can be recognized by pallor of the
Pain medication should be preemptive when there is an mucous membranes, collapse of the intraoral vessels (e.g.,
anticipation of pain (e.g., as with surgery). Opioids,55,63 alpha- lingual plexus), and lack of definition of the ventral abdominal
adrenergic, and nonsteroidal antiinflammatory agents can be vein. A cut down to the abdominal vessel may be necessary for
used to provide pain relief (see Table 5-3). Pain in the amphi- catheterization. Catheters have been placed this way experi-
bian can be recognized by the following signs:63,64 immobility, mentally, but not practically, in clinical medicine. Systemic
lethargy, closed eyes, vocalization, color change, abnormal corticosteroids may offset adrenal exhaustion and possibly
behavior, flick foot at affected area, aggression, lameness, and increase the survivability of a patient.
rapid respiration. Much more research is needed to fully com- The principles of the ABCs (airway, breathing, cardiac) of
prehend the best methods to manage pain in amphibians. emergency medicine cannot be readily applied to amphibians;
however, intubation and ventilation in addition to some drug
therapies may prove successful (Box 5-4).
Miscellaneous Drugs and Products
For amphibians, bandages or wraps can be difficult to apply
and unrewarding. However, temporary liquid bandages or
dental products can be used to provide a solid barrier against
osmotic losses and a protective covering over abrasions and
lacerations due to trauma. Products that are useful include BOX 5-4 Emergency Drug Doses for Amphibians
Orabase (Colgate Inc., Canton, MA), Ilex (Medcon Biolab
Technologies, Grafton, MA), facilitator (Idexx Corp., Elgin, Drug Dose
IL), and Band-Aid Liquid Bandage (Johnson and Johnson Inc., Prednisolone sodium 5-10 mg/kg IM
Somerville, NJ), as well as other cyanoacrylate products. succinate
Regranex (Johnson and Johnson) and Carravet (Veterinary Epinephrine 1 : 1000 0.01-0.05 ml/100 g
Product Laboratories, Phoenix, AZ) are additional wound care Doxapram 5 mg/kg
products that can be used to facilitate healing. Finally, the Dexamethasone 1 mg/kg IM, IV
Calcium gluconate 10% 100 mg/kg IM, IV, ICe
application of an artificial slime layer (Shield-X, Malibu, CA)
Atropine 0.1 mg/kg SC, IM
before and after handling can be used to reduce the likelihood Fluids 9 : 1 (0.9% saline: 2%-5% body weight ICe
of further injuring the skin. sterile water); use only
if isotonic solutions are
Emergency Treatment not available
Furosemide 5 mg/kg IM, IV
When an amphibian presents for an emergency, a minimum
database should be collected if the animal can tolerate it. Fluid ICe, intracoelomic; IM, intramuscular; IV, intravascular; SC, subcutaneous.
Ch005-X0119.indd 108 12/4/2007 12:01:21 PM

NUTRITION and death occurs within 30 minutes; intracardiac phenobarbi-

tal results in rapid death. The coelomic method may result is
Assisting an animal through anorexia and illness by the provi- some histologic artifacts. Pithing an anesthetized animal into
sion of calories is a critical therapy to institute. The first goal the foramen magnum is rapid, but it precludes histopathology
of nutritional support is to feed a highly digestible product, as on the brain. To ensure death, open the body cavity and
a sick animal may not be able to digest food at the same level remove the heart.
as a healthy animal. The second most important goal is to Hypothermia is not considered a humane method of eutha-
make sure the food can pass through a feeding tube. This can nasia. Freezing an anesthetized animal has been done but only
be a problem with smaller animals and can be overcome by in small animals (<40 g), and the process must be rapid. A
thoroughly grinding food or using powdered food products. standard freezer (−20° C) is unacceptable, as it is too slow and
Some clinicians base caloric replacement on a calculation some amphibians can tolerate short-term cold temperatures.
derived from the animal’s body weight (∼10% of the body CO2 is considered by some to be inhumane because amphibi-
weight q24h). It is more appropriate to calculate the basic ans tolerate hypercarbia.
requirements of the animal and give nutritional support in
volumes that support the patient’s digestion and comfort level
(e.g., regurgitation may occur with assist feeding). The follow-
SURGERY62,67
ing formula can be used to calculate an amphibian’s basal Surgery should not be a daunting prospect to the exotic animal
metabolic rate (BMR):62 clinician. Amphibians heal well, tolerate blood loss, and tend
to have fewer postsurgical complications than do higher
BMR = 5 × BWkg0.75 to BMR = 10 × BWkg0.75
vertebrates.
For diseased animals this should be increased to 1.25-2 ×
BMR. Additional species-specific and temperature-specific
BMR formulas have been published12,44 and may serve as a
Preoperative Considerations
more specific tool. In general, monitoring weight is a good way Animals should be fasted before surgery. For small amphibi-
to assess a feeding strategy. Observe trends and reevaluate the ans, a 4-hour fast is sufficient, whereas for larger amphibians
patient weekly. If there is weight loss in the face of caloric (>20 g), a 24- to 48-hour fast is more appropriate. The patient
replacement, reconsider the quantity of calories, types of calo- should be soaked before surgery in amphibian Ringer’s solu-
ries, and frequency of feeding, taking care not to overload the tion for 60 minutes. Prophylactic antibiotics should be
animal. Feeding a patient daily is not required to maintain considered as appropriate, such as in cases of coeliotomy.
condition, and it may cause unnecessary stress. Most prey Preemptive analgesia should be administered.
items are 1 to 2 kcal/g.44 It is very difficult to maintain a moist patient in a sterile
Nutritional products that are commercially available include field. Most amphibian surgeries are considered “clean-
Hill’s A/D (Hill’s, Topeka, KS), baby food that is meat based contaminated.” After soaking, the animal can be coated in
(note that these foods need supplementation to maintain Ca : P ShieldX. Lubrication should not be used, as it can interfere
ratio), feline liquid CliniCare (Pet-Ag. Elgin, IL), Repta-Aid with cutaneous respiration. Alternately, the patient can be
(Fluker Farms, Port Allen, LA), and Emeraid I or Emeraid II moistened regularly with distilled or aged water during the
(Lafeber, Cornell, IL). Most of these are 0.6 to 1.4 kcal/ml. procedure.
A gruel can also be made from a gel food normally offered A 0.5% to 1% chlorhexidine solution should be used to
to amphibians (Amphibian & Carnivorous Reptile, Mazuri/ gently disinfect the surgical site, avoiding active scrubbing. A
PMI Nutrition International, St. Louis, MO). disinfectant-soaked gauze can also be placed on the animal and
Whole foods can be offered, but should be prepared in allowed contact for 5 to 10 minutes. Draping is not easy in
advance to maximize the nutritional value. Predigesting the small patients, but it may be possible with larger animals.
foods with pancreatic enzymes may be useful for amphibians Ophthalmic instruments are preferred for amphibian surgery
with gastrointestinal disease (Prozyme, San Leandro, CA because they are delicate on tissues and enable the clinician to
94577-1258). Insects should have their heads removed to manipulate small tissues.
speed digestion. Whole rodents should be skinned to reduce
digestion time. Frozen foods are easier to digest than nonfrozen
foods due to cell lysis.
Postsurgical Considerations
Everting sutures should be used when closing an incision.
15,64 Absorbable sutures absorb faster in a moist environment;
EUTHANASIA therefore, nonabsorbable monofilament can be used instead.
There are many different methods of euthanasia considered In most clinical cases, I observe healing before using suture
acceptable in amphibians. Barbiturates, MS-222, and isoflu- absorption. Interrupted sutures should be used, as amphibians
rane can all be used for euthanasia. MS-222 (overdose 200 mg/ dehisce readily. Cyanoacrylate tissue adhesives can be used over
kg ICe) is rapid and does not harm organs for pathology. sutured incisions to ensure a waterproof barrier and to prevent
Phenobarbital can be used at 100 mg/kg ICe or via lymph sacs, bacterial colonization.
Ch005-X0119.indd 109 12/4/2007 12:01:21 PM

Common Surgical Procedures cause disease in amphibians can also be zoonotic and cause
atypical mycobacteriosis in humans.
Common, minor surgical procedures include biopsies, identi-
fying animals by marking or tagging, and performing cryo-
surgery (e.g., removal of cutaneous masses). Laparoscopy is a
Acknowledgments
minimally invasive tool that is used for reproductive assess- I would like to personally thank all of the individuals that
ment and for internal organ biopsies. Insufflation may not be helped to see this chapter to completion, including Hilary
necessary, but if it is, CO2 insufflation is appropriate as long Corcoran, Marty Greenwell, Diedre Fontenot, Kathryn
as the animal is deflated after the procedure. Gamble, Leigh Clayton, Michael Yuratovac, Alice Bereman,
Amputation of the hindlimb can be done successfully and Ashley VanSimpa, Tom Meehan, Amy Shima, Ann Manharth,
usually results in the return to all functions but reproductive. and Robert VanValkenburg. Many special thanks go to Kevin
The entire femur should be removed; a stump should not be Wright and Brent Whitaker for their insight and their editor-
left, because it can become abraded and develop into an infec- ship of Amphibian Medicine and Captive Husbandry, the “ency-
tion. Forelimb amputation can be done, but some animals clopedia of amphibian medicine,” which I strongly suggest for
need both forelimbs for posture, ambulation, and manipula- the exotic animal veterinary bookshelf.
tion of food. Strong consideration for a species’ natural behav-
ior must be taken into account before performing amputation.
Newts can regenerate missing limbs. Tail amputations can also REFERENCES
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Enucleation is considered a last resort and is used primarily 14. Lewbart GA, Stoskopf MK: Amphibian medicine, selected topics, Exot
as a pain management tool. There is a membrane between the DVM 4(pt 3):36-39, 2002.
eye and buccal cavity, which must not be damaged. Hemosta- 15. Wright K: Restraint techniques and euthanasia. In Wright KM, Whitaker
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Chapter 5 - Amphibians

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Natalie Mylniczenko

COMMON SPECIES KEPT

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Figure 5-1 Firebelly toad (Bombina sp.).

Figure 5-3 Aquatic caecilian (Typhlonectes natans).

Figure 5-4 Skeleton of Rana catesbeiana.

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ammonia (ammonotelic), because conserving water is not

URINARY SYSTEM INTEGUMENT SYSTEM

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there is no subcutaneous layer. Glandular secretions may

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CARDIOVASCULAR SYSTEM (ARTERIAL,

URINARY SYSTEM Basic Premetamorphic Anatomy2-5

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OSMOTIC BALANCE Environmental Considerations4-8

TABLE 5-1 Water Chemistry Parameters for Amphibians

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ENCLOSURE SIZE LIGHTING

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Hospital Tank ambush predators should be offered food every 2 weeks).

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TABLE 5-2 Disinfectants Commonly Used to Clean Amphibian Environments

B, bacteria; F, fungi; M, mycobacteria; P, protozoa; T, Trichophyton; V, viruses.

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Figure 5-11 Two-hand technique for handling a newt.

Figure 5-12 Handling technique for a caecilian using a sealed

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Figure 5-13 Anesthetic induction of a frog using a small animal

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superficial pain response (e.g., pinch skin over dorsum of foot),

lesions (e.g., ulcers, erosions, and lacerations). Damage to the

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Figure 5-17 Blood draw from the ventral abdominal vein of an

of blood that can be safely collected from an amphibian is 1%

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Figure 5-18 Radiographic dorso-ventral survey of an axolotl.

Figure 5-21 Caecilian radiograph for a caudal body mass that

Figure 5-19 Radiographic lateral survey of an axolotl.

Figure 5-22 Metabolic bone disease in Ceratophrys sp.

are few comparisons for reference images, and they can be

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Figure 5-23 Fractured femur in a hylid frog.

Figure 5-25 Gastric bezoar delineated by barium contrast

Figure 5-24 Gastric foreign body (rocks) in a leptodactylid.

Figure 5-26 Ultrasound image showing fluid collection within

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soil, food, and water to identify a potential source of the

bacterial species do pose a zoonotic risk and should be

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methemoglobinemia. Treatment is similar to that described for

Differentials: historically considered only a bacterial disease;

Disease: Red-leg bacterial syndrome31,32 Disease: Chlamydiosis33

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available to characterize these organisms today. The prevalence