Diseases / List of Bacterial Diseases / Disease description:

Abscessation in Lagomorphs and Ferrets

Rump abscess, before and after treatment. Click here for full page view with caption Subcutaneous abscess. Click here for full page view with caption Large abscess being drained. Click here for full page view with caption Facial abscess. Click here for full page view with caption Facial abscess. Click here for full page view with caption Facial abscess surgery. Click here for full page view with caption Facial abscess recovering after surgery. Click here for full page view with caption After ear amputation and lateral wall resection. Click here for full page view with caption Abscessation of the testes. Click here for full page view with caption Healing flystrike and marsupialised abscess. Click here for full page view with caption  Lateral radiograph rabbit with pulmonary abscess. Click here for full page view with caption Dorsoventral radiograph rabbit with pulmonary abscess. Click here for full page view with caption Rabbit with pulmonary abscess. Click here for full page view with caption Rabbit pulmonary abscess. Click here for full page view with caption Rabbit pulmonary abscess. Click here for full page view with captionHealing flystrike and marsupialised abscess. Click here for full page view with caption

INFORMATION AVAILABLE

GENERAL INFORMATION

CLINICAL CHARACTERISTICS & PATHOLOGY

INVESTIGATION & DIAGNOSIS

TREATMENT & CONTROL

SUSCEPTIBILITY & TRANSMISSION

ENVIRONMENT & GEOGRAPHY

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General and References

Disease Summary

"An abscess is a localised collection of purulent exudate contained within a fibrous capsule". (B609.2.w2)
Lagomorphs
  • Abscesses are extremely common in rabbits and are the commonest cause of a subcutaneous swelling in this species. (B606.4.w4, B609.2.w2)
  • Abscesses may occur as a result of traumatic wounds or a bacteraemia secondary to various infections including:
    • oral foreign bodies; (B602.18.w18)
    • tooth root abscesses; (B602.18.w18)
      • periapical disease is the commonest cause of facial abscesses. (B601.18.w18, J213.7.w2)
    • upper respiratory tract infections; (B602.18.w18, B611.9.w9)
    • urinary tract infections. (B602.18.w18)
  • Location of abscesses: most commonly seen on the head and limbs but they can be found anywhere in the rabbit's body. (B602.18.w18)
  • Treatment:
    • Treatment of choice is surgical excision with a minimum of two weeks of antibiotic treatment. (B601.13.w13, B608.21.w21, J213.7.w2)
    • Rabbit abscesses are frequently associated with an underlying cause. Successful treatment involves identifying and resolving the underlying cause. (B609.2.w2)
  • Prognosis: Fair to poor depending on location and severity of the abscess. (B609.2.w2)
    • In some cases, the abscess may not be causing the rabbit any discomfort and it may be able to live with an abscess for several months or years whilst on long-term antibiotic therapy. (B606.4.w4)
Ferrets
  • Abscesses result from bacterial infection, most commonly following penetrating skin wounds. (B232.10.w10)

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Alternative Names (Synonyms)

Lagomorphs

See also:


Ferrets

See also:

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Disease Type

Bacterial Infection

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Infectious/Non-Infectious Agent associated with the Disease

Lagomorphs
  • Dental disease
    • Food lodged between the teeth and/or the gingival mucosa (B609.2.w2)
    • Periapical disease or tooth root abscesses (odontogenic abscesses). (B609.2.w2)
      • Periapical disease is the commonest cause of facial abscesses. (B601.18.w18, J213.7.w2)
    • Malocclusion that causes sharp points on the crowns that penetrate the oral mucosa. (B601.18.w18, B609.2.w2)
  • Foreign objects (B609.2.w2)
  • Trauma
  • Ticks - see Tick Infection (with special reference to Hedgehogs, Elephants, Bears and Lagomorphs)
    • Large Staphylococcus sp. abscesses have been described with appeared to be associated with ticks, particularly Ixodes dentatus allowing entry of the bacteria. (J40.7.w1)
  • Pyogenic bacteria (B609.2.w2)
    • Odontogenic abscesses
      • Pasteurella
        • This infective agent is generally not present. (B609.2.w2)
        • In one study of twelve rabbit abscesses (maxillary and mandibular), this organism was not isolated. (J213.7.w2)
      • Anaerobic bacteria:
        • Fusobacterium nucleatum (B602.18.w18, B608.21.w21, B609.2.w2, J213.7.w2)
        • Prevotella spp. (B602.18.w18, B609.2.w2)
        • Actinomyces israeli (B602.18.w18, B609.2.w2, J213.7.w2)
        • Peptostreptococcus heparinolytica (J213.7.w2)
        • Peptostreptococcus micros (B602.18.w18, B609.2.w2)
        • Arcanobacterium haemolyticum (B602.18.w18, B609.2.w2)
      • Aerobic bacteria:
    • Other abscesses
      • Pasteurella multocida (B64.22.w8, B609.2.w2, B611.9.w9, J213.7.w2)
        • One of the most commonly isolated bacteria from abscesses. (B601.13.w13, B602.18.w18, B606.4.w4, B615.6.w6, J213.4.w4)
        • "In the rabbit, subcutaneous abscesses are due to pasteurellosis until proven otherwise". (B608.21.w21)
      • Pseudomonas aeruginosa (B336.42.w42, B601.13.w13, B608.21.w21, B609.2.w2, B611.9.w9, J213.7.w2)
        • One of the most commonly isolated bacteria from abscesses. (B602.18.w18)
      • Staphylococcus aureus (B336.42.w42, B608.21.w21, B609.2.w2, J3.114.w9)
        • One of the most commonly isolated bacteria from abscesses. (B601.13.w13, B602.18.w18, B606.4.w4, B611.9.w9, B615.6.w6, J213.4.w4)
        • Reported to cause local abscesses in rabbits and hares. (B336.42.w42)
        • Note: MRSA has been isolated from rabbits and may be found in rabbit abscesses. (V.w121)
      • Escherichia coli (B609.2.w2)
      • Proteus (B601.13.w13, B609.2.w2)
        • One of the most commonly isolated bacteria from abscesses. (B602.18.w18)
        • Proteus vulgaris has been reported to cause subcutaneous abscesses in rabbits. (B611.9.w9)
      • Beta-haemolytic Streptococcus spp. (B608.21.w21, B609.2.w2, J213.4.w4)
      • Bacteroides spp. (B601.13.w13, B609.2.w2)
        • One of the most commonly isolated bacteria from abscesses. (B602.18.w18)
      • Clostridium pyogenes (B608.21.w21)
      • Fusiformis spp. (J213.7.w2)
      • Haemophilus spp.
        • There is a single report of this being isolated from the subcutaneous abscesses in a domestic rabbit. (B611.9.w9)
      • Actinomyces spp.
        • This is a rare cause of disease in domestic rabbits but may cause subcutaneous inflammation, boils, and fistulas of the trunk, neck and head. (B611.9.w9)
Pathophysiology

Ferrets
  • Causes of abscessation: 
    • Skin associated abscesses
      • Penetrating bite wounds from fighting, playing or mating (B602.10.w10, B631.24.w24), with lesions seen most commonly around the neck. (B631.24.w24, B652.6.w6, J16.30.w1)
      • Sharp objects in the environment, causing penetrating wounds. (B501.12.w12)
      • Less common causes of cutaneous abscessation include insect stings, snake bites, self trauma and iatrogenic causes. (B232.10.w10, B651.9.w9)
    • Oral abscesses - puncture wounds from chewing on sharp objects. (B232.10.w10, B602.10.w10) e.g. bones in the diet. (B501.12.w12)
      • Damage to the buccal cavity or the pharynx. (J16.30.w1)
      • Tooth root infections. (B652.6.w6)
    • Anal Gland Impaction and Abscessation
    • Internal abscessation
      • Can be the result of oesophageal or lower gastro-intestinal trauma due to ingestion of material such as hay or bone. (B232.10.w10, B627.14.w14, B652.6.w6)
      • Often caused by the inhalation or ingestion of Actinomyces spp. and possibly associated with immunodeficiency disorders. (B602.10.w10)
  • Infectious agents: 
    • Staphylococcus spp., Streptococcus spp., (B651.9.w9) Pasteurella spp., haemolytic Escherichia coli or Corynebacterium spp. are common causes of abscessation following bite injuries especially during mating in ferrets. (B117.w11, B232.10.w10, B602.10.w10, B627.14.w14)

Infective "Taxa"

Non-infective agents

--

Physical agents

-- Indirect / Secondary

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References

Disease Author

Nikki Fox BVSc MRCVS (V.w103); Joanne Osuagwuh BSc BVSc MSc MRCVS ( V.w147); Bridget Fry BSc, RVN (V.w143)
Click image for main Reference Section

Referees

Anna Meredith MA VetMB CertLAS DZooMed (Mammalian) MRCVS (V.w128); Brigitte Reusch BVet Med (Hons) CertZooMed MRCVS (V.w127); Richard Saunders BVSc BSc CertZooMed MRCVS (V.w121)

Major References / Reviews

Code and Title List

Lagomorphs
B64
.22.w8, B336.42.w42, B600.8.w8, B601.13.w13, B601.18.w18, B602.18.w18, B608.21.w21, B609.2.w2, B611.9.w9
J213.4.w4, J213.7.w2

Ferrets
B117.w11, B232.10.w10, B602.10.w10, B627.14.w14, B631.24.w24, B651.9.w9, B652.6.w6

Other References

Code and Title List

Lagomorphs
B615.6.w6
P601
.1.w1
J3.114.w9, J40.7.w1

Ferrets
B540.7.w7, B633.13.w13
J16.30.w1, J42.64.w1

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Clinical Characteristics and Pathology

Detailed Clinical and Pathological Characteristics

General In the majority of cases abscesses are focal walled off bacterial infections with few systemic symptoms. (B602.10.w10) On occasion a septicaemia can develop. (B232.10.w10, B602.10.w10)

Clinical Characteristics

  • The clinical signs are determined by the tissue and/or organ system affected. 
    • They are associated with a combination of:
      • Inflammation- swelling, pain, loss of function
      • Tissue destruction
      • Organ system dysfunction- due to an accumulation of exudate. 

(B609.2.w2)

Affected systems
  • Skin or exocrine: percutaneous (B609.2.w2)
  • Skeletal: particularly skull and plantar (B609.2.w2)
  • Ophthalmic: periorbital tissues (B609.2.w2)
  • Respiratory: lung parenchyma, sinuses, nasal turbinates. (B609.2.w2)
  • Cardiovascular: heart (B611.9.w9)
  • Hepatobiliary: liver parenchyma (B609.2.w2)
  • Reproductive: mammary gland, testicles (B609.2.w2, B611.9.w9)
  • Neurological: brain (B611.9.w9)
  • Also, "conceivably any organ or tissue of the body" (B611.9.w9)
Lagomorphs
  • Swelling:
    • If the affected area is visible, there may be a variably painful, rapidly appearing, soft to firm swelling. (B602.18.w18, B609.2.w2)
    • The swelling is usually minimally inflamed, not painful, and is often immovable. (B602.18.w18)
    • Abscesses can form multiple or just single subcutaneous nodules that may have a discharging sinus or associated wound. (B601.13.w13)
  • Facial abscesses:
    • Dental disease 
    • Nasal or ocular discharge
    • Ptyalism 
    • Exophthalmos 
    • Otitis media/interna/externa 
      (B609.2.w2)
  • Anorexia and depression:
    • Dental disease causing an oral abscess. (B602.18.w18, B609.2.w2)
    • Skeletal abscess pain (B609.2.w2)
    • Note: with hepatic, other intraabdominal and intrathoracic abscesses, anorexia and depression may be the only clinical signs until the abscess is of a size to cause space-occupying effects. (B609.2.w2, V.w121)
    • Secondary effects of anorexia include:
      • Dehydration 
      • Gastrointestinal hypomotility - dry, scant faeces. 
      • Firm stomach or caecal contents.
      • Gas-filled intestinal loops. 
        (B609.2.w2)
  • Lameness and reluctance to move:
  • Trauma or previous infection (B609.2.w2)
  • Dyspnoea: Large or multiple intrathoracic abscessation. (B609.2.w2)
Mandibular, retrobulbar, cheek or nasal rostrum abscessation:
  • Palpable fluctuant to firm mass, often involving and attached to the underlying bone. 
    • Ptyalism 
    • Nasal discharge 
    • Ocular discharge 
    • Anorexia 
    • Exophthalmia 
  • A chronically discharging sinus may be present. (B600.8.w8)
  • A thorough oral examination under general anaesthesia including skull radiographs, should always be performed in these cases. 
  • Occasionally, the mass may be freely movable within the subcutaneous tissue and not attached to the bone. This carries a much better prognosis and is more likely due to external trauma.
  • See: Facial Abscesses in Rabbits

(B600.8.w8, B601.13.w13, B609.2.w2)

Ear abscessation:

  • Occasionally there may be a palpable mass arising from the ear canal. 
  • Vestibular signs if there has been extension into brain or inner ear - ataxia, rolling, torticollis, nystagmus. 

(B609.2.w2)

Limb abscessation:

  • Lameness 
  • Hair loss 
  • Cellulitis - swelling and erythema 
  • Multiple masses or just a single palpable mass, particularly on the interdigital or plantar surfaces. These can rupture and form scabs with an underlying caseous exudate. 
  • See also: Ulcerative Pododermatitis

(B609.2.w2)

Superficial abscessation:

  • Variable size, fluctuant or firm, nonpainful mass that is freely movable unless it is attached to the underlying tissue.
  • Occasionally, there may be large areas of necrotic skin which may slough.
    • Skin necrosis is usually associated with a large, fast-growing abscess. (B600.8.w8)

(B600.8.w8, B609.2.w2, J3.114.w9)

Intrathoracic abscessation:

  • Absent or dull lung sounds on auscultation of the thorax. 
  • Dyspnoea 
  • Depression 
  • Anorexia 

(B609.2.w2)

  • Note: with intrathoracic abscesses (and with intra-abdominal abscesses), anorexia and depression may be the only clinical signs until the abscess is of a size to cause space-occupying effects. (B609.2.w2, V.w121)

Possible complications

  • Severe facial deformity with a chronic facial abscess. 
  • Organ function compromise. 
  • Septicaemia. 
  • Septic embolus.
  • Pleuritis or peritonitis if an intrathoracic or intraabdominal abscess ruptures. 
  • Chronic pain, recurrence, or extensive tissue destruction that warrants euthanasia due to a poor quality of life. 

(B606.4.w4, B609.2.w2)

Ferrets Clinical manifestation
  • Abscesses will normally be walled off and cause no systemic disease symptoms. (B602.10.w10)
  • The neck and mouth are common sites where abscesses are found on ferrets. (B652.6.w6)
    • Common areas of infection are lung, liver, uterus, vulva, skin, mammary tissue and the head region. (B627.14.w14)
  • Localised clinical findings:
    • Acute stage: 
      • The abscess will present as a diffuse, hard swelling. (B232.10.w10, B627.14.w14)
      • On palpation the area will often be warm and the animal show signs of localised pain. (V.w147)
    • Chronic stage:
      • Over a course of days or weeks the abscess will become more fibrous, with the possible development of a sinus tract. (B232.10.w10)
  • Systemic clinical findings with internal abscesses

Clinical pathology

Incubation

--
Lagomorphs --
Ferrets --

Mortality / Morbidity

--
Lagomorphs
  • Abscesses are very common in rabbits. (B609.2.w2)
Prognosis

Prognosis depends on the organ system involved and the amount of tissue destruction. (B609.2.w2) The long term prognosis is improved with decent husbandry including a high fibre diet and good sanitation. (B602.18.w18)

  • Superficial abscess: Good to fair (B600.8.w8, B609.2.w2)
    • Recurrence in other sites or locally is likely. (B609.2.w2)
  • Facial abscesses, osteomyelitis: This depends on the location and the severity of bone involvement. (B609.2.w2)
    • Multiple or severe maxillary abscesses, abscesses of the brain or nasal passages or ones causing exophthalmos: Guarded to poor prognosis. (B601.13.w13, B609.2.w2)
      • Most will need extensive surgery, sometimes multiple surgeries. Recurrences are common in the same site or other locations. (B602.18.w18, B608.21.w21, B609.2.w2)
      • Some rabbits may need lifelong antibiotic therapy. (B602.18.w18, B608.21.w21)
      • Euthanasia may be necessary if the animal is in pain and the quality of life is unacceptable. (B609.2.w2)
      • See also : Facial Abscesses in Rabbits
  • Internal abscesses:
    • Fair to grave, depending on the location. (B609.2.w2)
    • Generally poor. (B600.8.w8)
      • Surgical removal of abdominal abscesses is often difficult or impossible due to adhesions. (B600.8.w8)
Ferrets
  • Abscesses are the most common reason that ferrets are taken to the vet. (B652.6.w6)

Pathology

--
Lagomorphs
Exudate
  • Necrotic tissue.
  • Large numbers of neutrophils in different stages of degeneration. 
  • Other inflammatory cells. 
Surrounding tissue
  • Congested tissue with fibrin and a large number of neutrophils. 
  • Variable number of macrophages, lymphocytes, plasma cells and fibrous connective tissue. 
Causative agent
  • This is variably detectable particularly with an anaerobic infection. 

(B609.2.w2)

Ferrets
  • The fibrous capsule of a ferret abscess can be very thick-walled, with multiple adjoining pockets of pus. (B232.10.w10)

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Human Health Considerations

Lagomorphs 

--

Ferrets

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Susceptibility / Transmission

General information on Susceptibility / Transmission

Damage to the skin surface and a subsequent bacterial infection are the pre-requisites for abscess formation. 
Lagomorphs
Susceptibility
  • Immunosuppression:
    • Underlying predisposing disease, e.g. chronic kidney failure. 
    • Use of systemic or topical corticosteroids. 
    • Immunosuppressive chemotherapy. 

(B609.2.w2)

Transmission

(B600.8.w8, B609.2.w2)

Ferrets
Susceptibility
  • Ferrets are quite prone to cutaneous abscesses. (B627.14.w14)
  • Individuals housed in groups are more prone to abscesses due to injuries obtained during fighting, playing or mating with conspecifics. (B627.14.w14)
Transmission
  • Subcutaneous abscesses usually develop after bites from conspecifics.(B627.14.w14)
  • Usually abscesses are associated with penetrating skin wounds. they may also result from mucosal injury from bones in the diet. (B117.w11)

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Disease has been reported in either the wild or in captivity in:

Lagomorphs

Further information on Host species has only been incorporated for species groups for which a full Wildpro "Health and Management" module has been completed (i.e. for which a comprehensive literature review has been undertaken). Host species with further information available are listed below:

Ferrets
  • Abscesses are found in ferrets. (B117.w11, B232.10.w10, B627.14.w14)

Host Species List

Leporidae - Rabbits and Hares (Family)

Mustelidae - Weasels (Family)

(List does not contain all other species groups affected by this disease)

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Disease has been specifically reported in Free-ranging populations of:

Lagomorphs

Further information on Host species has only been incorporated for species groups for which a full Wildpro "Health and Management" module has been completed (i.e. for which a comprehensive literature review has been undertaken). Host species with further information available are listed below:

Host Species List

(List does not contain all other species groups affected by this disease)

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Environment/Geography

General Information on Environmental Factors/Events and Seasonality

Lagomorphs

--

Ferrets
  • Ferrets kept in an environment with few or no bolt-holes have a tendency to cause facial lesions from rubbing their faces on surfaces whilst trying to find a hiding place. (B232.10.w10) This can be a precursor to facial abscessation.
  • Sharp objects in the environment can cause penetrating wounds leading to infection and abscessation. (B501.12.w12) 
  • Abscesses caused by puncture wounds resulting from bites are especially common in the breeding season after mating. (B232.10.w10)
  • Poor hygiene practices resulting in dirty living conditions increase the risk of bacterial infection and hence abscess formation. (V.w147)
  • Rough or sharp edges. (B627.14.w14)
  • Hard, sharp feed items. (B627.14.w14)

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Regions / Countries where the Infectious Agent or Disease has been recorded

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Regions / Countries where the Infectious Agent or Disease has been recorded in Free-ranging populations

--

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General Investigation / Diagnosis

General Information on Investigation / Diagnosis

--
Lagomorphs Rabbits with facial abscesses must have a thorough oral examination under anaesthesia or sedation to investigate dental disease. (B609.2.w2)

Aspiration and direct smears

  • Use a 22 gauge or larger needle. 
  • A thick, caseous or creamy, white exudate. 
  • Pyogenic bacteria may be identified in cells or more frequently, in the wall of the abscess
    • A Gram's stain is useful for directing the antibiotic treatment. 
  • A high nucleated cell count primarily consisting of of degenerative neutrophils and then smaller numbers of lymphocytes and macrophages. 

(B602.18.w18, B609.2.w2)

Biopsy and histopathology

  • Abscess masses can be confused with a tumour, therefore a biopsy should be conducted to confirm the diagnosis. (B232.10.w10)
    • Biopsy is useful in ruling out granuloma, neoplasia, and other causes of masses. (B609.2.w2)
  • The sample should contain both abnormal and normal tissue in the same specimen. (B609.2.w2)

Culture and sensitivity testing

  • Unusual bacteria may be involved. (B600.8.w8)
  • Always submit samples even after antibiotic therapy of recurrent abscesses, because bacteria can develop resistance to antibiotics. (B602.18.w18)
  • Useful in directing the antibiotic therapy. (B609.2.w2)
  • Exudate and/or affected tissue should be cultured for both aerobic and anaerobic bacteria. (B602.18.w18, B609.2.w2)
    • Ideally, wall or capsule should be sampled because bacteria that are deep within the exudate are frequently nonviable. (B606.4.w4, B609.2.w2)
  • It is common to get lack of growth, particularly with anaerobic infections or a fastidious bacterial infection. (B602.18.w18, B609.2.w2)
  • "If anaerobic culture is not possible, diagnosis is often presumed". (B609.2.w2)

Blood work and urinalysis

  • These should be carried out. (B602.18.w18, B609.2.w2)
  • CBC is often normal. Total white blood cell elevations generally do not occur. What does tend to happen is the neutrophil to lymphocyte ratio may shift to a relative neutrophilia, lymphopenia. (B609.2.w2)
  • Biochemical changes depend on the system affected, e.g. if the liver is involved then there may be slight to moderate in the liver enzymes. (B609.2.w2)
Radiography
  • Useful in determining the extent of the bone involvement and essential in guiding the expected prognosis and treatment plan. (B601.13.w13, B602.18.w18, B609.2.w2)
    • Osteomyelitis will have a poorer prognosis and prolonged treatment. (B609.2.w2)
  • Thoracic and abdominal: 
    • Useful in identifying and determining the extent of any internal abscesses. (B609.2.w2)
    • If a rabbit has a head abscess then take thoracic radiographs as well as skull radiographs to check for pulmonary abscesses or pneumonia. (B602.18.w18)
  • Skull: essential in identifying the type and the extent of the dental disease in patients with facial abscesses. Radiographs must be carried out under general anaesthesia with five views for a thorough assessment (B602.18.w18):
    • ventral-dorsal 
    • lateral 
    • two lateral obliques
    • rostral-caudal 
      (B609.2.w2)
  • See: Imaging in Lagomorph Diagnosis and Treatment - Radiography
Ultrasonography
  • Useful in determining the organ system that is affected and the extent of the disease. (B609.2.w2)
  • Helpful in delineating the margins of the abscess particularly of retrobulbar abscesses. (B602.18.w18)
  • See: Imaging in Lagomorph Diagnosis and Treatment - Ultrasonography
Echocardiology
  • Useful in diagnosing a pericardial abscess. (B609.2.w2)
CT or MRI

Serology for Pasteurella spp.

  • Unfortunately, the usefulness of this test is severely limited and often not helpful in diagnosing pasteurellosis in the pet rabbit. 
  • An ELISA is available and will report results as high positive, low positive, or negative:
    • Positive result: even if the result is high, it only indicates a prior exposure to the bacteria and then the development of antibodies. It does not confirm active infection. Low positive results can occur due to a cross-reaction with another nonpathogenic bacteria giving a false-positive result.
    • Negative result: false negative results are common if it is early infection or if there is immunosuppression. 
  • There is currently no evidence to support the correlation of titres to the absence or presence of disease. 

(B609.2.w2)

Ferrets

 

  • Aspiration/drainage or biopsy should enable differentiation between abscess, neoplastic lesion or parasitic infection causing a subcutaneous mass. (B627.14.w14)
  • An initial investigation can be conducted with microscopic examination of a Gram-stained smear from the exudate. (B602.10.w10, B627.14.w14)
  • A definitive diagnosis of the organism involved can be reached by taking exudate or infected tissue for aerobic and anaerobic bacterial culture and antibiotic sensitivity testing. (B602.10.w10, B627.14.w14, J16.30.w1)
  • Note: Swabs should be taken from the internal surface wall of the abscess capsule, as the central pus is likely to be sterile. (B232.10.w10)
Related Techniques
WaterfowlINDEXDisInvTrCntr.gif (2325 bytes)

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Similar Diseases (Differential Diagnosis)

--
Lagomorphs
  • Granuloma
    • This is generally firmer than an abscess without the fluctuant centre. (B609.2.w2)
  • Neoplasia, see Cutaneous Neoplasia
    • These have variable growth and may be associated with variable pain. (B609.2.w2)
  • Cyst: This will lack the white caseous exudate of an abscess. (B609.2.w2)
  • Haematoma/seroma
    • This will be nonencapsulated and unattached to the surrounding tissues. (B609.2.w2)
    • Fluctuant and fluid-filled initially and then will become more firm with organisation. (B609.2.w2)
  • Fibrous scar tissue
    • Firm and non painful and does not enlarge. (B609.2.w2)
  • Cuterebra (B609.2.w2)
  • Some viral diseases may grossly appear to be similar to abscesses, e.g.
Ferrets

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Treatment and Control

Specific Medical Treatment

--
Lagomorphs
  • Rabbit abscesses will not be resolved with simple lancing, flushing, and draining. The thick exudate does not drain very well and antibiotics do not penetrate the thick capsule of the abscess. Recurrence of the abscess is likely. (B602.18.w18, B608.21.w21, B609.2.w2)
  • Treatment of choice is surgical excision with a minimum of two weeks of antibiotic treatment. (B601.13.w13, B606.4.w4, B608.21.w21, J213.7.w2)
  • Often both local and systemic antibiotic treatment are required. (V.w128)
  • For long term success, it is crucial to correct any underlying cause of the abscess. (B609.2.w2)
Systemic Antibiotics
  • Long term antimicrobial therapy is often necessary, especially if there is bone involvement. (B609.2.w2)
  • As a general rule in the treatment of bacterial skin conditions in rabbits, marbofloxacin, Enrofloxacin, or Trimethoprim sulfa are useful for non-suppurative infections and may be given orally. However, purulent infections respond better to the penicillin related compounds. Amoxycillin, Penicillin G, and Cephalexin are safe as long as they are not used orally. These antibiotics must always be administered parenterally. (P601.1.w1)
  • Choice of antibiotic should ideally be based on the results of culture and sensitivity tests. (B609.2.w2)
  • Duration of therapy depends on severity of infection: 
    • Four to six weeks minimum to several months / years. (B609.2.w2)
  • Use broad spectrum antibiotics, e.g.,
    • Enrofloxacin
      • 5-20 mg/kg orally or by subcutaneous or intramuscular injection every 12-24 hours. (B609.2.w2)
      • 10 mg/kg daily orally. (B606.4.w4)
      • Alternatively use in the drinking water (dilute 100mg/kg). (B606.4.w4)
    • Trimethoprim sulfa
      • 30 mg/kg orally every 12 hours
    • Chloramphenicol
      • 50 mg/kg orally every 8 hours. (B64.22.w8, B609.2.w2)
      • Avoid human contact with this drug due to potential blood dyscrasia. (B609.2.w2)
    • Oxytetracycline
      • 30 mg/kg every 3 days. (B606.4.w4)
  • Note: If a rabbit is on long term antibiotic therapy, it is important that it receives a probiotic and a healthy diet based on hay and plant fibre. (B606.4.w4)

If anaerobic infection is suspected as in most dental or facial abscesses, use:

  • Metronidazole
    • 20 mg/kg orally every 12-24 hours. (B609.2.w2)
  • Azithromycin
    • 30 mg/kg orally every 24 hours. (B609.2.w2)
    • Can use this drug alone or in combination with metronidazole, 20 mg/kg orally every 12 hours. (B609.2.w2)
  • Penicillin G benzathine / penicillin G procaine 
    • 40000-60000 IU/kg by subcutaneous injection every two to seven days. (B609.2.w2)
    • Success has been achieved with this antibiotic in the treatment of jaw abscesses. (B602.18.w18)
      • Rabbits < 2.5 kg: 75000 units by subcutaneous injection every other day. (B602.18.w18)
      • Rabbits > 2.5 kg: 150000 units by subcutaneous injection every other day. (B602.18.w18)

Contraindications

  • Oral antibiotics that select primarily against the Gram-positive bacteria:
    • Penicillins, macrolides, lincosamides and cephalosporins. (B609.2.w2)
    • These may cause a fatal enteric dysbiosis and enterotoxaemia. (B609.2.w2)
TOPICAL ANTIBIOTICS

Clindamycin

  • In some cases of head abscesses, a 25 mg clindamycin capsule can be pricked using a needle, and then sutured into the cavity of the abscess to provide a slow release antibiotic. Simultaneous probiotic use in the rabbit's diet is recommended. (B606.4.w4)
Antibiotic impregnated poly-methyl methacrylate (AIPMMA) beads
  • The beads are made of a synthetic polymer bone cement. (B602.18.w18)
  • Useful in areas where it is not possible to completely excise the abscess. (J213.4.w4)
  • Used to fill the defect in severely diseased wounds. The wound must be surgically debrided and flushed prior to insertion of beads. (B603.3.w3, B609.2.w2)
  • Selection of the antibiotic should be based on the results of culture and sensitivity tests and is limited to those antibiotics that are known to elute appropriately from the bead to the tissues. (B609.2.w2)
  • See: Production of Antibiotic-Impregnated Beads (Techniques)

Advantages

  • These beads can release a high concentration of the antibiotic into the local tissues for several months. (B609.2.w2, J213.4.w4)
  • The antibiotic will only have low systemic levels and so few systemic side effects. (B602.18.w18, J213.4.w4)
  • Useful when systemic use of the antibiotic of choice (after culture results) is contraindicated or when the patient is particularly difficult to treat. (J213.4.w4)
  • The surgical wound is closed and no further flushing or topical treatment or administration of oral or injectable antibiotics are necessary. (J213.4.w4)
  • This method is also useful in cases where the antibiotic of choice is expensive. (J213.4.w4)

Successfully used antibiotics include:

(B609.2.w2)

Method:

  • Treat the abscess surgically (see surgical techniques below) by removing pus and as much as possible of the infected tissue. After debridement, place the beads into the surgical site and then close the wound. (J213.4.w4)
  • Beads must be inserted aseptically with any unused beads being gas sterilised prior to their future use. (B609.2.w2)
  • Leave the beads in the incision site for a minimum of two months or they can be left in indefinitely. (B609.2.w2)
Antibiotic impregnated synthetic surface-active ceramic alloplast
  • (Consil, Nutramax, Baltimore, Maryland)
  • Used as an alternative to to AIPPMA beads to fill defects in debrided bone. 
  • Induces production of osteocalcin and the formation of new bone. 
  • Antibiotics added to this substance don't need to be heat stable. 

(J213.7.w2)

Impregnated Gauze
If AIPPMA beads are not an option due to lack of availability, an alternative is to pack the post-debridement deficit with gauze that has been laden with antibiotics. Choice of antibiotic should be based on results of culture and sensitivity and include:
  • Penicillin G
    • 80000 IU/kg 
  • Ampicillin
    • 20 mg/kg 
  • Cefazolin
    • 25 mg/kg 
  • Metronidazole
    • 50 mg/kg 
  • Oral antibiotic treatment is used concurrently throughout the entire treatment period. 
  • The wounds should be evaluated and the gauze removed and repacked every seven days under general anaesthesia until there is complete resolution. 
  • Efficacy is determined by the severity of the disease and owner compliance. 

(B609.2.w2)

ALTERNATIVE METHODS

50% dextrose or honey

  • Used successfully as a topical abscess treatment after surgical debridement. 
  • Dextrose or honey have bactericidal properties and promote formation of a granulation bed. 
  • Method:
    • Fill the abscess cavity with gauze soaked in honey or dextrose. 
    • Replace daily until a healthy granulation bed forms. 
    • Remove the old gauze from the cavity before instilling a fresh gauze. 
  • The treatment often needs to be continued for weeks. 
  • Effectiveness varies and will depend on disease severity and owner compliance. 

(B600.9.w9, B609.2.w2)

Doxycycline gel

  • Use following surgical debridement, to fill the abscess cavity. (V.w128)
  • The gel is marketed for use in treatment of human periodontal disease. (V.w128)
Amorphous hydrogel dressing
  • This type of dressing which contains glycol and a modified CHC polymer (Intrasite, Smith and Nephew), encourages the dissolution of any necrotic tissue and also promotes healing. (B606.4.w4)
Calcium hydroxide paste
  • This has been used historically because the high pH leads to an unsuitable environment for bacteria. However, it can cause severe soft tissue necrosis and must be used with caution. 

(B601.13.w13, B609.2.w2, J213.7.w2)

CONTRAINDICATIONS

Corticosteroids

  • Systemic or topical corticosteroid preparations may severely exacerbate an infection. (B609.2.w2)
Ferrets
  • Give appropriate antibiotics (in addition to draining the abscess). (B117.w11, B652.6.w6)

ANTIBIOTICS

  • Topical antibiotic and/or systemic antibiotics. (B627.14.w14, J16.30.w1)
    • Usually, localised abscesses can be treated with drainage and local application of antibiotics; systemic antibiotics can be used if needed. (B627.14.w14)
    • A broad spectrum antibiotic can be given. (B651.9.w9)
      • Use a broad-spectrum antibiotic while awaiting culture and sensitivity results. (B602.10.w10)
    • Metronidozole is useful for anaerobes. (J16.30.w1)
Related Techniques

 

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General Nursing and Surgical Techniques

--
Lagomorphs
SURGICAL TREATMENT

Treatment of choice is surgical excision with a minimum of two weeks of antibiotic treatment. (B601.13.w13, B608.21.w21, J213.7.w2)

  • It is necessary to remove the abscess, foreign object, or nidus of infection, for example, teeth. (B609.2.w2)
  • Penrose, or a similar drain, placement is not recommended because the exudate is too thick. (B602.18.w18, B609.2.w2)
Carbon dioxide laser sterilisation
  • One study reported this procedure followed by skin closure to be more effective than iodine surgical scrub followed by closure of the skin, in the treatment of rabbits with infected Pseudomonas abscesses. (J213.7.w2)
Superficial abscesses that do not involve teeth or bone
  • The ideal treatment for subcutaneous abscesses is excision of the abscess together with its capsule, followed by systemic antibiotic treatment. (B600.8.w8)
  • En bloc excision of the entire abscess with wide margins. Take care not to rupture the capsule. (B609.2.w2)
    • If this is not possible, then lance, remove the exterior wall and any nidus of infection, curette all the exudates and let the wound heal by secondary intention. (B602.18.w18, B608.21.w21, B609.2.w2)
    • Irrigate the wound two to three times a day until a healthy granulation bed forms. (B602.18.w18, B609.2.w2) Once the granulation bed has formed use antibiotic cream until reepithelialisation occurs. (B609.2.w2)
    • Irrigation solutions:
    • Long term antibiotic therapy is needed after excision. (B609.2.w2)
      • If the abscess is excised en bloc, it should be followed by a minimum of two weeks of antibiotic therapy. (B602.18.w18, B608.21.w21)
      • If the complete surgical excision is not possible then antibiotics will be needed for several weeks. (B608.21.w21)
  • Penrose drain placement is contraindicated because it does not facilitate the drainage and it may just act as an avenue for further infection. (B608.21.w21, B609.2.w2)
Facial abscesses
  • Jaw abscesses:
    • These are particularly difficult to treat. (B601.13.w13, B602.18.w18)
    • There is often a fistula that connects the pocket of the abscess to the teeth roots. (B602.18.w18)
    • The abscess may be due to periapical disease that causes abnormal tooth growth and the destruction of the surrounding bone. (B602.18.w18)
    • Remove, in entirety, all the teeth involved in the abscess. (B601.13.w13, B609.2.w2)
    • Remove the abscess and its capsule, and the affected bone, in entirety, whenever this is possible. (B609.2.w2)
      • If it is not possible to do this then remove the abscess at the bone level and then curette or debride all the grossly abnormal soft tissue, teeth, bone. Flush the wound copiously to remove all the exudates. (B602.18.w18, B609.2.w2)
    • Depending on the location of the abscess, either marsupialise it and leave it open to heal by secondary intention as described above, or use AIPMMA (antibiotic-impregnated polymethyl methacrylate) beads to fill the defect. (B601.13.w13, B602.18.w18, B609.2.w2, V.w128)
      • Alternatively, a synthetic bone graft particulate can be used to pack the defect (Consil, Nutramax Laboratories, Baltimore, MD). (B602.18.w18)
    • In a patient with an extensive head abscess, aggressive bone debridement is frequently indicated and so referral is recommended if AIPMMA beads or surgical expertise is not available. (B609.2.w2)
    • Long term systemic antibiotic therapy and pain management are needed. (B609.2.w2)
      • Systemic antibiotics are needed for a minimum of two weeks after surgery and possibly up to six weeks or longer. (B602.18.w18)
  • Retrobulbar abscess:
    • If an abscess extends into the retrobulbar space then enucleation may be necessary. (B602.18.w18)
Abscesses involving feet or joints
  • See Ulcerative Pododermatitis
  • As for facial abscesses, remove as much of the abscess en bloc as possible, taking care not to cause abscess rupture and further contamination of the incision site. 
  • Debride or curette all the visible abnormal tissue and then flush copiously. 
  • Treat as an open wound by flushing and debriding the wound daily at first, followed by twice a week to once a week debridement as healing occurs. Apply soft bandages after debridement. If the bandage becomes wet, it must be changed immediately. 
  • When feasible, AIPPMA beads (Production of Antibiotic-Impregnated Beads) can be used to fill a defect as described above. If they are place in a joint space, they must be removed after four to six weeks. 
  • If there is severe osteomyelitis, then amputation may be required. 
  • It is necessary to correct the underlying cause, e.g, improve the husbandry; provide soft bedding; weight loss. 
  • Long term antibiotic therapy and pain management are needed. 

(B609.2.w2)

Internal abscesses
  • Thoracic:
    • These can be occasionally amenable to surgical excision by thoracotomy. (B609.2.w2)
    • If excision is not possible, then treat with long term antibiotics and supportive care including analgesia (B600.8.w8, B609.2.w2)
  • Abdominal:
    • Ideally, surgical removal if possible and then followed by long term antibiotic therapy. (B609.2.w2, B600.8.w8)
    • Removal can be difficult to impossible due to adhesions to surrounding organs. (B600.8.w8)

NURSING CARE

See also: Treatment and Care

Acute pain management 
  • Butorphanol
    • 0.1-1.0 mg/kg by subcutaneous, intramuscular or intravenous injection every 4-6 hours. 
    • May cause profound sedation. 
    • This is a short-acting drug. 
  • Buprenorphine
    • 0.01-0.05 mg/kg by subcutaneous, intramuscular or intravenous injection every eight to twelve hours. 
    • This is a less sedating and longer acting drug than butorphanol.
  • Morphine
    • 2-5 mg/kg by subcutaneous or intramuscular injection every two to four hours. 
    • More than one to two doses can cause gastrointestinal stasis. 
  • Oxymorphone
    • 0.05-0.2 mg/kg by subcutaneous or intramuscular injection every eight to twelve hours. 
    • More than one to two doses can cause gastrointestinal stasis. 
  • Meloxicam
    • 0.2 mg/kg by subcutaneous or intramuscular injection every 24 hours. 
    • Use with care in rabbits that have compromised renal function. 
  • Carprofen
    • 1-4 mg/kg by subcutaneous injection every twelve hours. 

(B609.2.w2)

Long term pain management
  • NSAIDs 
    • These drugs have been used for short or long term treatment in rabbits to reduce inflammation and pain:
      • Meloxicam
        • 0.2-0.5 mg/kg orally every 24 hours. [Note: higher doses are now recommended]
      • Carprofen
        • 2.2 mg/kg orally every 12 to 24 hours. 

(B609.2.w2)

Fluid therapy
  • Aggressive fluid therapy is necessary if there is sepsis or peritonitis. (B609.2.w2)
  • See: Treatment and Care - Fluid Therapy
Sedation
  • Light sedation:
    • Midazolam
      • 0.5-2 mg/kg by intramuscular injection. 
    • Diazepam
      • 1-3 mg/kg by intramuscular injection.
  • For deeper sedation and longer procedures:
    • Ketamine (15-20 mg/kg by intramuscular injection) and Midazolam (0.5 mg/kg by intramuscular injection). 

(B609.2.w2)

Diet
Protection of the wound
  • Use an Elizabethan collar or protective bandage as necessary. 
    • Note: Elizabethan collars are often stressful to rabbits, and prevent normal coprophagy; they should be avoided where possible. (J213.7.w2, J83.29.w2, V.w128)

(B609.2.w2)

Ferrets SURGICAL TREATMENTS:
  • The abscess should be drained. (B117.w11, B652.6.w6)
  • Lance the abscess, and flush. A drain may put in place or a wet-to-dry dressing may be used. (B501.12.w12, B631.24.w24)
  • If an abscess is present this should be lanced and cleaned. This procedure is best done under general anaesthetic. (B232.10.w10, B631.24.w24)
    • Surgery should proceed as soon as possible, as some ferrets will be prone to septicaemia. (B232.10.w10
    • A drain can be used, but removal of interconnecting abscesses will help stop recurrence. (B232.10.w10)
    • Wet to dry dressings can also be used. (B631.24.w24)
  • For thick-walled abscesses with multiple pus pockets, removal of the whole abscess, including the capsule, is recommended. (B232.10.w10, J16.30.w1)

Protocol for skin abscess lance and flush under general anaesthetic (B602.10.w10, B232.10.w10)

  • Shave and clean the area of the abscess with a topical antiseptic.
  • Using aseptic technique: (B651.9.w9)
    • Lance the abscess and debride the area (for thin walled abscesses). (B627.14.w14, B651.9.w9, B652.6.w6)
    • Excise the complete capsulated abscess intact (for thick walled abscesses). (B232.10.w10, J16.30.w1)
      • Successful drainage is difficult in abscesses with thick walls.
      • Reoccurrence is common if thick walled abscesses are drained rather than being removed within the capsule.
    • Flush the open wound.
    • Place a drain or stent bandage (wet-to-dry bandage changes).
    • Prescribe a broad spectrum antibiotic whilst waiting for the results of the antibiotic sensitivity testing.

    (B602.10.w10, B232.10.w10, B501.12.w12, B631.24.w24)

NURSING CARE:

  • General comfort and pain relief as necessary. (V.w147) See Treatment and Care
  • Nutrition:
  • Daily wound management. See Treatment and Care - Wound Management
    • Wet-to-dry bandage changes whilst the wound is exudative. (B602.10.w10, B232.10.w10)
    • Clean the wound and drain with warm sterile saline lavage. (B540.7.w7)
    • Monitor wound health taking note of colour, swelling, warmth, odour and discharges. (B540.7.w7, B633.13.w13)
 
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Preventative Measures

Vaccination --
Lagomorphs --
Ferrets --
Prophylactic Treatment

--

Lagomorphs
  • Prevent otitis media and subsequent brain abscesses by:
    • Treatment of upper respiratory infection or otitis in the early stages. 

(B609.2.w2)

Ferrets
  • Ensure all wounds (particularly bite wounds) are properly flushed, cleaned with antiseptic solution, and a topical antibiotic applied. (B651.9.w9, B652.6.w6)
Related Techniques
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Environmental and Population Control Measures

General Environment Changes, Cleaning and Disinfection --

Lagomorphs

  • Prevent feet or joint abscesses by:
    • Provision of solid, clean surfaces and appropriate surface substrates. 
    • Prevention of obesity.
  • Prevent otitis media and subsequent brain abscesses by:
    • Treatment of upper respiratory infection or otitis in the early stages. 

(B609.2.w2)

Ferrets
  • Removal of sharp objects in the ferret's enclosure. (B627.14.w14, B501.12.w12)
  • Ensure the food does not contain sharp objects. (B501.12.w12)
  • Reduce the time that males and females spend together for mating during the breeding season. (B627.14.w14)
Population Control Measures --
Lagomorphs
  • Prevent progressive dental disease by:
    • Selection of pets without a congenital predisposition to dental disease. 
    • Provision of high fibre food and good quality hay.
    • Periodically trimming any overgrown crowns. 

    (B609.2.w2)

  • Prevent superficial abscesses by:
    • Prevention of fighting between rabbits. 

    (B609.2.w2)

  • In the colony situation, the affected animal should be eliminated from the colony to prevent spread of the infection and contamination of facilities and equipment. (B611.9.w9)
Ferrets --
Isolation, Quarantine and Screening --
Lagomorphs --
Ferrets --
Related Techniques
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