Erfolgreiche Behandlung einer nekrotisierenden, multiresistenten bakteriellen Pyodermie bei einem Python mittels Kaltplasmatherapie

Christoph Klinger; Berrett Dengler; Thomas Bauer; Ralf S. Mueller

doi:10.15654/TPK-170190

Tierärztliche Praxis Ausgabe K: Kleintiere / Heimtiere, Inhaltsverzeichnis

Tierarztl Prax Ausg K Kleintiere Heimtiere 2018; 46(01): 43-48
DOI: 10.15654/TPK-170190

Kasuistik

Schattauer GmbH

Successful treatment of a necrotizing, multi-resistant bacterial pyoderma in a python with cold plasma therapy

Artikel in mehreren Sprachen: deutsch | English

Autor*innen

Christoph Klinger

¹Medizinische Kleintierklinik, Zentrum für Tiermedizin, Ludwig-Maximilians-Universität, München
Berrett Dengler

¹Medizinische Kleintierklinik, Zentrum für Tiermedizin, Ludwig-Maximilians-Universität, München
Thomas Bauer

²Tierarztpraxis für Reptilien und Exoten, München
Ralf S. Mueller

¹Medizinische Kleintierklinik, Zentrum für Tiermedizin, Ludwig-Maximilians-Universität, München

Abstract

Summary

A 4-year-old ball python was presented 3 weeks after multiple bite wounds from a prey rat with large skin lesions, a concurrent deep bacterial pyoderma and clinical signs for septicemia, including neurolo -gical symptoms. Affected tissue separated from the underlying muscular layer revealing parts of the muscles. Clinical examination and cyto -logy was consistent with bacterial pyoderma; septicemia was an additional tentative clinical diagnosis. Empirical lincomycin and marbo -floxacin (bacterial culture revealed a multi-resistant Stenotrophomonas maltophilia susceptible to fluoroquinolones) treatment improved the patient’s general condition but skin wounds deteriorated to multifocal eschars with intracellular rods. Further diagnostics were limited for financial reasons, euthanasia was considered. Cold atmospheric pressure plasma (CAPP) therapy was performed six times in 4 weeks. Within 1 week, inflammatory symptoms resolved. Re-epithelialization was completed few weeks later. In the following year, the snake sloughed three times without any signs of dysecdysis. CAPP therapy may offer a viable treatment option for bacterial (especially multiresistant) pyoderma and necrotizing dermatitis in snakes.

Keywords

Non-thermal plasma - atmospheric pressure plasma - dermatology - reptiles - Stenotrophomonas maltophilia - Xanthomonas

Volltext

Referenzen

Literatur
1 Abbott IJ, Slavin MA, Turnidge JD, Thursky KA, Worth LJ. Stenotropho -monas maltophilia: emerging disease patterns and challenges for treatment. Expert Rev Anti Infect Ther 2011; 09: 471-488.
2 Alkawareek MY, Algwari QT, Laverty G, Gorman SP, Graham WG, O’Con-nell D, Gilmore BF. Eradication of Pseudomonas aeruginosa biofilms by atmospheric pressure non-thermal plasma. PLoS One 2012; 07: e44289.
3 Arndt S, Unger P, Wacker E, Shimizu T, Heinlin J, Li YF, Thomas HM, Mor-fill GE, Zimmermann JL, Bosserhoff AK, Karrer S. Cold atmospheric plasma (CAP) changes gene expression of key molecules of the wound healing machinery and improves wound healing in vitro and in vivo. PLoS One 2013; 08: e79325.
4 Barten SL. Bites from prey. In: Reptile Medicine and Surgery. 2nd edn.. Mader DR. ed. Saint Louis: Saunders; 2006: 747-750.
5 Beco L, Guaguere E, Lorente CMendez, Noli C, Nuttall T, Vroom M. Suggested guidelines for using systemic antimicrobials in bacterial skin infections: part 2 – antimicrobial choice, treatment regimens and compliance. Vet Rec 2013; 172: 156-160.
6 Cushing A, Pinborough M, Stanford M. Review of bacterial and fungal culture and sensitivity results from reptilian samples submitted to a UK laboratory. Vet Rec 2011; 169: 390.
7 Dennesen PJ, Bonten MJ, Weinstein RA. Multiresistant bacteria as a hospital epidemic problem. Ann Med 1998; 30: 176-185.
8 Fluhr W J, Sassning S, Lademann O, Darvin ME, Schanzer S, Kramer A, Richter H, Sterry W, Lademann J. In vivo skin treatment with tissue-tolerable plasma influences skin physiology and antioxidant profile in human stratum corneum. Exp Dermatol 2012; 21: 130-134.
9 Fridman A, Chirokov A, Gutsol A. Non-thermal atmospheric pressure discharges. J Phys D: Applied Physics 2005; 38: R1
10 Funk RS. Snakes. In: Reptile Medicine and Surgery. 2nd edn.. Mader DR. ed. Saint Louis: Saunders; 2006: 42-58.
11 Harris NB, Rogers DG. Septicemia associated with Stenotrophomonas mal-tophilia in a West African dwarf crocodile (Osteolaemus tetraspis subsptetraspis). J Vet Diagn Invest 2001; 13: 255-258.
12 Hejnar P, Bardon J, Sauer P, Kolar M. Stenotrophomonas maltophilia as a part of normal oral bacterial flora in captive snakes and its susceptibility to antibiotics. Vet Microbiol 2007; 121: 357-362.
13 Hillier A, Lloyd DH, Weese JS, Blondeau JM, Boothe D, Breitschwerdt E, Guardabassi L, Papich MG, Rankin S, Turnidge JD, Sykes JE. Guidelines for the diagnosis and antimicrobial therapy of canine superficial bacterial folliculitis (Antimicrobial Guidelines Working Group of the International Society for Companion Animal Infectious Diseases). Vet Dermatol. 2014; 25 163–175, e142-163.
14 Hubner NO, Matthes R, Koban I, Randler C, Muller G, Bender C, Kindel E, Kocher T, Kramer A. Efficacy of chlorhexidine, polihexanide and tissuetolerable plasma against Pseudomonas aeruginosa biofilms grown on polystyrene and silicone materials. Skin Pharmacol Physiol. 2010; 23 Suppl: 28-34.
15 Koban I, Matthes R, Hübner NO, Welk A, Meisel P, Holtfreter B, Sietmann R, Kindel E, Weltmann KD, Kramer A, Kocher T. Treatment of Candida al-bicans biofilms with low-temperature plasma induced by dielectric barrier discharge and atmospheric pressure plasma jet. New J Phys 2010; 12: 073039.
16 Kawarai T, Narisawa N, Yoneda S, Tsutsumi Y, Ishikawa J, Hoshino Y, Sen-puku H. Inhibition of Streptococcus mutans biofilm formation using extracts from Assam tea compared to green tea. Arch Oral Biol. 68: 73-82.
17 Kerwat K, Kerwat M, Graf J, Wulf H. [Resistance to antibiotics and multi -resistant pathogens]. Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS 2010; 45: 242-243.
18 Klampfl TG, Isbary G, Shimizu T, Li YF, Zimmermann JL, Stolz W, Schlegel J, Morfill GE, Schmidt HU. Cold atmospheric air plasma sterilization against spores and other microorganisms of clinical interest. Appl Environ Microbiol 2012; 78: 5077-5082.
19 Klein MC, Gorb SN. Epidermis architecture and material properties of the skin of four snake species. J R Soc Interface 2012; 09: 3140-3155.
20 Kogelschatz U. Atmospheric-pressure plasma technology. Plasma Phys Contr F 2004; 46: B63.
21 Kramer A, Lademann J, Bender C, Sckell A, Hartmann B, Münch S, Hinz P, Ekkernkamp A, Matthes R, Koban I, Partecke I, Heidecke CD, Masur K, Reuter S, Weltmann KD, Koch S, Assadian O. Suitability of tissue tolerable plasmas (TTP) for the management of chronic wounds. Clin Plasma Med 2013; 01: 11-18.
22 Lademann J, Ulrich C, Patzelt A, Richter H, Kluschke F, Klebes M, Lade-mann O, Kramer A, Weltmann KD, Lange-Asschenfeldt B. Risk assessment of the application of tissue-tolerable plasma on human skin. Clin Plasma Med 2013; 01: 5-10.
23 Lawrence K. Drug dosages for chelonians. Vet Rec 1984; 114: 150-151.
24 Maas 3rd AK. Vesicular, ulcerative, and necrotic dermatitis of reptiles. Vet Clin North Am Exot Anim Pract 2013; 16: 737-755.
25 Mitchell MA. Therapeutics. In: Reptile Medicine and Surgery. 2nd edn.. Mader DR. ed. Saint Louis:: Saunders; 2006. 2006; 631-664.
26 Montali RJ, Bush M, Smeller JM. The pathology of nephrotoxicity of gentamicin in snakes. A model for reptilian gout. Vet Pathol 1979; 16: 108-115.
27 Montay G, Goueffon Y, Roquet F. Absorption, distribution, metabolic fate, and elimination of pefloxacin mesylate in mice, rats, dogs, monkeys, and humans. Antimicrob Agents Chemother 1984; 25: 463-472.
28 Napp M, Daeschlein G, von Podewils S, Hinz P, Emmert S, Haase H, Spitzmueller R, Gumbel D, Kasch R, Junger M. In vitro susceptibility of methicillin-resistant and methicillin-susceptible strains of Staphylococcus aureus to two different cold atmospheric plasma sources. Infect 2016; 44: 531-537.
29 Gopee NV, Adesiyun AA, Caesar K. A longitudinal study of Escherichia coli strains isolated from captive mammals, birds, and reptiles in Trinidad. J Zoo Wildl Med 2000; 31: 353-360.
30 Ash RJ, Mauck B, Morgan M. Antibiotic resistance of gram-negative bacteria in rivers, United States. Emerg inf Dis 2002; 08: 713-716.
31 Santoro M, Hernandez G, Caballero M. Aerobic bacterial flora of nesting green turtles (Chelonia mydas) from Tortuguero National Park, Costa Rica. J Zoo Wildl Med 2006; 37: 549-552.
32 Schmidt A, Wende K, Bekeschus S, Bundscherer L, Barton A, Ottmuller K, Weltmann KD, Masur K. Non-thermal plasma treatment is associated with changes in transcriptome of human epithelial skin cells. Free Radic Res 2013; 47: 577-592.
33 Smith DA, Barker IK, Allen OB. The effect of certain topical medications on healing of cutaneous wounds in the common garter snake (Thamnophis sirtalis). Can J Vet Res 1988; 52: 129-133.
34 Stewart JS. Anaerobic bacterial infections in reptiles. J Zoo Wildl Med 1990; 21: 180-184.
35 Trompeter FJ, Neff WJ, Franken O, Heise M, Neiger M, Shuhai L, Pietsch GJ, Saveljew AB. Reduction of Bacillus Subtilis and Aspergillus Niger spores using nonthermal atmospheric gas discharges. IEEE T Plasma Sci 2002; 30: 1416-1423.
36 Uetz P, Hošek J. The Reptile Database. 20 Aug 2016 http://www.reptiledatabase.org/
37 von Woedtke T, Metelmann HR, Weltmann KD. Clinical plasma medicine: state and perspectives of in vivo application of cold atmospheric plasma. Contrib Plasma Phys 2014; 54: 104-117.
38 Wende K, Barton A, Bekeschus S, Bundscherer L, Schmidt A, Weltmann KD, Masur K. Proteomic tools to characterize nonthermal plasma effects in eukaryotic cells. Plasma Med 2013; 03: 81-95.
39 Wilkinson SL. Reptile wellness management. Vet Clin North Am Exot Anim Pract 2015; 18: 281-304.
40 Young LA, Schumacher J, Papich MG, Jacobson ER. Disposition of enro -floxacin and its metabolite ciprofloxacin after intramuscular injection in juvenile Burmese pythons (Python molurus bivittatus). J Zoo Wildl Med 1997; 28: 71-79.