This is not a do-it-yourself manual on how to treat abscesses. It
does discuss what needs to be done and I relate it from a personal perspective.
But don't mess around with treating abscesses on your own until you have
been shown how by a veterinarian or trained wildlife rehabilitator. You
are cutting into a living animal, through skin and enervated and vascularized
muscle tissue. You risk cutting tendons or joints and may cause worse
problems than you started with. The treatment of abscesses is a surgical
procedure and, like most surgical procedures, is best left to those who
are trained in them, who can do them in a sterile field using sterile
instruments and proper irrigation solutions, packing, wound dressing,
and antibiotics - and anesthetics. Ask your vet if you may watch. Ask
your vet to teach you how to do minor follow-up treatment at home. The
more you learn the more you will be able to do...and the more you will
realize how important it is that the procedures be done correctly. Check
out the lists of herp societies and
reptile vets if you don't already have a
Abscesses are interesting things... They do not necessarily occur
at the site of an injury, and often do not occur in any proximity to an
injury - they may form where there was no injury, and may form months
after an injury was apparently well-healed.
Elbow abscess in a green iguana.
What is an abscess?
Abscesses are localized infections that generally occur in conjunction
with systemic infections. The site may swell noticeably,
or the abscess may reside well into the underlying tissue with little
change in the skin above. Often there is a slight swelling which begins
to ooze a yellowish liquid which may form a crust. As the skin stretches
over the underlying swelling, the scales are moved farther apart and the
skin in between may be seen. The skin may be reddish with petechia (burst
capillaries) or crusty with dried serous fluid.
Why do abscesses
speaking, bacteria that gets into a wound, say a minor scratch or puncture
wound, from claws. The body's immune system is unable to successfully
fight the invader off, and so the wound becomes infected, forming an abscess.
In healthy animals,
the immune system marshals a defense and kills the bacteria before it
can cause a problem, forming antibodies to recognize and fight it again.
A stressed animal has
a weakened immune system. As it cannot as effectively fight off infections,
some microorganisms will manage to proliferate to the point of causing
illness. (This can happen to the normal load of gut microorganisms, which
is how healthy reptiles end up needing to be treated for excessive loads
of worms or protozoans.)
Captivity itself causes
stress, no matter how perfect the captive environment and apparently well-adjusted
the captive animal. Changes in the daily routine, introduction of a new
household member or pet, moving to a new location, seasonal changes such
as breeding season, etc., can affect the reptile's stress levels. Stress-related
problems may follow relatively quickly, or may not manifest until weeks
or months after the start of the stress period or stress event.
Stresses can include
emotional stress such as being moved to a new enclosure, having the entire
enclosure moved, changing owners, too cold, poor diet, breeding season,
that occur in fleshy tissue can be lanced with a scalpel, the caseous
pus removed using dental or bone curettes and swabs, and then flushed
with an irrigation solution, such as 1% chlorhexidine diacetate (Nolvasan).
Even if all the caseous
pus is removed from the site, and the site is kept open and irrigated
daily and treated with systemic and topical antibiotics, more pus may
form at the site, sometimes within a couple of days of the initial treatment.
While this can happen even when the reptile is being given systemic antibiotics,
it is more likely to occur when only topical antibiotics are given.
Failure to start antibiotic
treatment may result in a worse infection if the site is not cleaned out
thoroughly. Even when on antibiotics, particularly resistant infections
may cause repeat abscesses to grow. This is because, even though the antibiotics
used first are broad-spectrum (effective against a wide range of bacteria),
the bacteria causing the infection may not be responsive to that particular
Baytril (enrofloxacin) is being used, the usual dose of 5-10 mg/kg daily
for 10 days can be doubled, either giving 10-20 mg/kg SID
or 5-10 mg/kg BID for 10 more days.
If the infection
remains resistant, a culture should be done, with a piece of the caseous
pus sent out for culture and sensitivity. This takes a couple of weeks,
but will identify the organism and the best antibiotic to use in treating
Abscesses in bony areas
(such as jaw, eye area or joints) may cause further problems, especially
if left untreated for some time. Not only can they affect the mobility
of the joint and adversely impact the animal's use of that limb, it can
eat away at bone and cartilage; this can get very expensive surgically
and radiographically. It is best to treat such abscesses as soon as possible,
with antibiotics and aspiration (if loose pus or fluid) or lancing and
excision (caseous pus).
There are times when, upon opening the abscess site, it is found
that the caseous material has not formed a consolidated lump, the vet
may remove what he can, and then close the wound and begin a 10 day
course of systemic enrofloxacin. This antibiotic is especially good
at reducing the blood flow to the abscess and causing it to consolidate,
both of which make it easier to remove and decrease the likelihood of
its reformation at the site. Depending on the vet's assessment of the
situation when he goes back in to remove the remaining pus, the reptile
may or may not be prescribed another course of systemic antibiotic therapy.
The antibiotics generally
used are Baytril (enrofloxacin), Piperacil (piperacillin), and Amikacin
(amiglyde sulfate). While Amikacin is particularly nephrotoxic
and must be administered with supplemental fluids, green iguanas should
receive supplemental subcutaneous or intracoelomic
injections of fluids whenever given any antibiotic.
Piperacil can cause
tissue necrosis around the injection site and
so should be diluted with saline or lactated ringers. Baytril can sting
going in and if administered subcutaneously, it too can cause painful
tissue necrosis in some species. Baytril injectable can be administered
by mouth and it can also be obtained in tablet form. Talk to your vet
about diluting the Baytril by drawing up saline into the syringe before
injecting to reduce the sting and potential necrosis.
prone to lungworm infestation (primarily fish eaters), as well as some
other species, abscesses may in fact be larvae or adult worms trying to
migrate out. The way they spread is to cause a subdermal irritation which
generally causes the host animal to scratch at it or rub it against something,
causing the "abscess" to break open, thus freeing the parasite
who then looks for another host in which to complete it's life cycle.
Working with Abscesses
on abscesses, wear disposable surgical gloves, have your Betadine or Nolvasan
solutions ready at hand, your gauze sponges, sterile swabs and and other
necessities close at hand. It is best to work with someone else who can
keep the animal wrapped and restrained while you use both your hands to
accomplish what needs to be done.
twice a day;
see the Drug Dosing glossary
for related definitions.
reptiles, especially green iguanas, form a solid, yellowish or greenish
caseous pus rather than a thick liquid pus.
in the belly;
see the Glossary for related
damage which can be mitigated by the administration of supplemental
thin watery serum
that leaks from damaged or processed cells.
once a day; see
the Drug Dosing
glossary for related definitions.
under the skin;
see the Glossary for related
in the body,
rather than on. Most abscesses, like all ulcerative
stomatitis, are signs of an underlying infection in the body,
circulated by the blood, requiring the proper antibiotics as well
as environmental support.