Ask An Expert: Dr. Brian Speer, DVM

Answered by Dr. Brian Speer, DVM:

Hi, Daniel,
It is challenging to clearly visualize what you may be seeing, unfortunately. Here are a few suggestions, however. I would recommend that you video record the behavior, and present this as well as your bird for a repeat examination to your veterinarian. Presuming that there may be pain and discomfort present (from whatever the primary cause may be), you may want to enquire about the use of anti-inflammatory treatments or pain management for your bird. You may also want to inquire about the possibility of a problem within the cloaca itself, which in some circumstances could require additional maneuvers for visualization of this area.

Good on you for enriching this bird's life, adding to its behavioral inventory and doing such a good level of stewardship!

Answered by Dr. Brian Speer, DVM:

Hi, Cindi -

There are a number of investigations that need to be considered with this set of clinical signs. It is good that basic blood testing is being performed as a start. Although this is far from a perfect thing, it is a really good initial component. There are behavioral reasons (psychogenic), and other medical reasons including some viral infections, cardiovascular disease, and malnutrition to name a few. Toxicoses from the artificial dyes used in a formulated product of any brand, to the best of my knowledge, are not a documented event - and exist only in anecdote and belief out there. I am sure that the veterinarian involved will pursue the levels and types of additional diagnostic testing needed to help dramatically narrow down, if not determine a cause of these clinical signs, with time.

Answered by Dr. Brian Speer, DVM:

Hi, Trevor - The unilateral nature of this presentation speaks more to an acquired disorder of some sort. You describe two clinical signs that may or may not be related: A cracked and discolored lesion on the foot, and abnormal foot posture / weight bearing.

In general, scrapings of those types of foot lesions that you describe, and various types of analyses of those samples may predispose you to miss your primary diagnosis here. You may want to ask your veterinarians to consider obtaining full thickness skin biopsies from these lesions, seeking histological evidence of what specifically may be going on. Aerobic bacterial and fungal cultures should be also considered from these surgically obtained biopsy samples, and additional biopsies, if possible, should be saved frozen for further evaluation - if indicated based on your histopathology findings. Regarding the abnormal gait and weight bearing - I would suggest you ask your veterinarian to consider good, detailed shole body radiographic images as a part of your medical workup, as some forms of chronic osteoarthritis certainly may be involved. A careful neurologic examination should also be repeated.

Answered by Dr. Brian Speer, DVM:

Hi, Simone - In general, Aspergillosis is an infectious disease that occurs in an individual or population of individual birds out of an interaction between characteristics of the host (the birds themselves), their environment and the agent. Mere exposure to Aspergillus spores, alone, should be unlikely to cause disease unless there was a very large amount of fungal spores - enough to overcome the bird's normal immunologic defense systems. Chronic respiratory irritation, inadequate vitamin A nutrition, and other concurrent disease processes all can function as causal contributors in an individual with this disease.

Overall, I would be doubtful if the environment that you keep your birds should be fairly presumed to be unsuitable for them - there are far too many other similar parrot species doing overall well in the Rome area. Although treatment with water-based antifungal medications through the drinking water for a few weeks may seem to be a safe maneuver, you should have reason to question if this treatment would be effective, should those birds have actual infection, as well as if the duration of treamtent and manner of drug delivery (in the water) is optimal. Most aerosolized forms of treatment (nebulization) do not reach the lower aspects of the respiratory systems of birds, and this form of prophyllactic treatment also is open for debate in regards to its merit in asymptomatic but potentially exposed individuals. You may want to speak with your veterinarian(s) about the use of the oral antifungal drugs Itraconazole or even Voriconizole, if any of your other birds show signs of disease, or if screening laboratory diagnostic testing supports the probability of disease.

Overall, my suspicions would be that there is more likely to have been an environmental event that resulted in a large amount of fungal spore exposure to your birds, and resultant infection and disease. The correlation of the hepatic lesions as a "cause" of a secondary Aspergillosis would be a more challenging step to do, particularly viewing the absence of this finding in 2/3 of the necropsied birds. It sounds like the cause of the hepatic lesion is not identified in that single bird, and it is possible that this lesion could be an incidental finding - even potentially unrelated to the apparent cause of death - pulmonary Aspergillosis.

Answered by Dr. Brian Speer, DVM:

Hi, Diego -

Your Quaker parakeets, it sounds, are basically eating a diet of a seed mixture with bread related products. This is, overall, not what we would typically regard as a healthy long-term maintenance diet. There is going to be considerably excess fat, an unclear balance of the micronutrients, and the processed grains in those bread products are adding to the bird's ability to make fat and cholesterol. This species is known to have considerable health problems whem matintained on this type of a diet. I am not sure what you are referring to as a marrow seed - but am assuming that you are referring to those that have a considerable larger amount of meat contained within them. These often include sunflower, pumpkin and squash, and safflower seeds - all of which are quite high in fat content.

Ideally, I would suggest that you feed a lower-energy diet, consisting of lower fat content items predominately. If available where you are, a fair base for your bird's diet will be some of those commercial formulated (pellet) diets, to which you can add vegetables. Your use of the seeds that the birds prefer to eat as a positive reinforcement for training and enrichment is excellent, and done properly, there should not be an excessive amount of fat intake that results from their use in that manner.

Answered by Dr. Brian Speer, DVM:

Hi, Abel -

It is impossible to provide much accurate information for you with an ill bird that really seems to require accurate diagnosis and treatment. The examining veterinarian involved here is best posed to answer many of your questions. Here are a few questions that you may want to consider asking when you see your veterinarian again: What is the diagnosis? What types of treatment have been administered? Why? Is referral to a specialist recommended? Outside consultation?

Not trying to be challenging, but good medicine is based on an accurate physical assessment of the patient in question, a narrowed diagnosis, applied treatment plan, and followup to assure that the desired goal(s) have been achieved - and this, to some extent, is limited when there is no ablility to actually see the patient in question.

Answered by Dr. Brian Speer, DVM:

I envision that what you are describing is within normal limits for this species. However, should you have concerns, or if your bird is past due for its routine veterinary examination, this is a very fair question to bring up for discussion with your avian veterinarian.

Answered by Dr. Brian Speer, DVM:

It is impossible for me to be able to provide any form of accurate medical recommendations for your bird in the absence of direct consultation with your attending veterinarian or physically seeing your bird. The combination of clinical data that you mention, I agree, is not classically consistent with Proventricular Dilation Disease (PDD). Alterations in the choanal area and its papillae are non-specific, and do not necessarily correlate with any specific disease. Enlargement of the proventriculus, when seen radiographically, can be seen in Eclectus parrots that sometimes have no clear disease - their proventricular silouettes are sometimes larger than many other parrot species. Bloody feces are not typically noted with PDD. Alterations in complete blood count may suggest stress, or an inflammatory reaction to something, but are not necessarily clearly indicative of infection in and of themselves. The details are interpretively important, and all are dependent on the clinical history and physical examination findings of your veterinarian.

Clinical signs are grouped into two general systemic categories: neurological and gastrointestinal. Neurological signs of PDD include ataxia, blindness, abnormal head movements, seizures, loss of balance, depression and paralysis. Gastrointestinal signs of PDD include the passage of undigested seeds in feces, proventricular enlargement, diarrhea, lethargy, weakness, weight loss, starvation and death. All of these clinical signs can progress at variabe rates, and technically *any* clinically ill bird could have this disease as a possible inclusion in its differential diagnosis list. PDD at present time, is definitively diagnosed by biopsy of the effected organs, allowing for identification of the classic inflammatory lesions that are used to define the disease. The location of biopsy is dependent on clinical signs that are noted, and the level of concern and need for definitive diagnosis. Although avian bornavirus (ABV) has recently been identified as an etiologic agent of Proventricular Dilation Disease (PDD), testing for its presence, alone, does not confirm the presence of PDD. Only ABV 2 and ABV 4 have been strongly associated with PDD, and ABV types 1, 3, and 5 have not been associated with disease at present time. Surveyed populations of parrots can easily show a prevalence of 30-60% in apparently healthy birds. This disease is technically described as as one that is not treatable, although high doses of non-steroidal anti-inflammatory drugs including celebrex or meloxicam can sometimes show clinical improvement in individuals. These birds typically do not show improvement in as short a time as you have described in your bird here.

It sounds like there may no clearly established diagnosis at present time, and that your bird is feeling better after a course of antibacterial and non-steroidal anti-inflammatory drug treatment. This information, alone, is fairly far removed from clear evidence of PDD and a need for absolute quarantine from other birds. It still, however, should be possible that this disease could be present.

I would suggest that you speak with your veterinarian about your concerns, and also ask for specific recommendations about your relative risks of continuing to have your bird overlooked by your bird sitter.