Diseases / List of Parasitic Diseases / Disease description:

Gizzard Worm Infection in Waterfowl

INFORMATION AVAILABLE

GENERAL INFORMATION

CLINICAL CHARACTERISTICS & PATHOLOGY

INVESTIGATION & DIAGNOSIS

TREATMENT & CONTROL

SUSCEPTIBILITY & TRANSMISSION

ENVIRONMENT & GEOGRAPHY

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General and References

Disease Summary

WATERFOWL Common parasitic worm (nematode) infection of the gizzard which may cause ill thrift and debilitation.

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Alternative Names (Synonyms)

  • Stomach worm infection
  • Ventricular nematodiasis
  • Amidostomiasis
  • Ventricular worm infection

N.B. Also see Streptocariasis

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Disease Type

 Parasitic - roundworms

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Infectious/Non-Infectious Agent associated with the Disease

Nematodes: Amidostomum spp., Epomidiostomum spp.

N.B.also see Streptocariasis.

Infective "Taxa"

Non-infective agents

--

Physical agents

-- Indirect / Secondary

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References

Disease Author

Debra Bourne
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Major References / Reviews

Code and Title List

B10.26.w11, B11.39.w7, B11.40.w8, B12.55.w1, B13.46.w1, B14, B15, B18, B24, B36.32.w32, B37.x.w1, B48.20.w20, B78
J7.43.w1, J7.33.w4
J14.11.w1, J14.19.w1

Other References

Code and Title List

B9.6.w1, B91
J1.16.w8, J1.31.w6, J1.32.w1, J1.33.w
J7.30.w4, J7.34.w1, J7.50.w1
J8.17.w1
J36.44.w1
J37.13.w1

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Clinical Characteristics and Pathology

Detailed Clinical and Pathological Characteristics

General

WATERFOWL Extensive damage to the gizzard in severe infections may interfere with food digestion and result in ill thrift, debilitation, increased susceptibility to other diseases and to predation, and deaths of young birds.

N.B.also see Streptocariasis.

Clinical Characteristics

WATERFOWL
  • Usually subclinical in adults.
  • Listlessness and ill-thrift, anorexia, emaciation, general weakness, diarrhoea, anaemia. Interference with gizzard function may lead to poor growth and poor weight gain in young birds, or weight loss; sometimes prostration and deaths in young birds with heavy infection. Apparent lameness has also been described.

(J3.121.w4, J8.17.w1, J14.11.w1, B10.26.w11, B11.39.w7, B11.40.w8, B12.55.w1, B13.46.w1, B14, B18, B24, B37.x.w1, B48.20.w20, B78)

Incubation

WATERFOWL Disease may be seen as early as ten days old (B11.40.w8). Prepatent period 14 to 25 days (B24, B48.20.w20), as early as 12 days in goslings (B78).

Mortality / Morbidity

WATERFOWL Infection is common. High percentages of populations of some species may be infected but mortality is generally low (B15).

Pathology

WATERFOWL General Pathology: emaciation, sometimes fibrinous peritonitis

Gizzard:

  • Severity of lesions depends on the number of nematodes present. Can be extensive damage to both gizzard lining and muscle.
  • Brownish discolouration, erosion, haemorrhage and catarrhal inflammation of the gizzard lining. Heavy infection may result in complete erosion and haemorrhagic ulceration of the gizzard epithelium, degeneration of the koilin layer and necrotic granulomas of the gizzard muscle, which may be extensive: oblong tissue cavities have been described, containing granular material. Blood-stained mucus containing worms may be found at the gizzard-proventriculus junction.
  • Nematodes - fine, hair-like, off-white to reddish, about 2cm long - may be visible under the remaining epithelium or embedded in the red-brown friable mass that remains of the lining in heavy infections.

Proventriculus, oesophagus:

  • May also be affected. Oesophageal impaction may be seen associated with gizzard lesions.

Cloaca:

  • Amidostomum anseris associated with areas of necrotic mucosa in the cloaca has been described (J3.121.w4).

(J1.33.w4, J7.33.w4, J8.17.w1, J14.11.w1, J14.19.w1, J36.44.w1, J37.13.w1, B11.39.w7, B11.40.w8, B12.55.w1, B14, B15, B18, B24, B36.32.w32, B37.x.w1, B48.20.w20, B49)

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Human Health Considerations

None (B36.32.w32, B37.x.w1).

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Susceptibility / Transmission

General information on Susceptibility / Transmission

WATERFOWL Susceptibility:
  • Infection is seen in ducks, geese and swans, but most commonly in geese and least frequently in diving ducks. The swan goose (Anser cygnoides - Swan goose) Canada goose (Branta canadensis - Canada goose) and snow goose (Anser caerulescens - - Snow goose) appear to be particularly susceptible.
  • Severe infection and severe disease is seen more commonly in juveniles than in adults, and in debilitated individuals.
  • Effects of infection may be seen particularly in association with overcrowding and poor nutrition.
  • Clinical signs may be seen even with relatively low parasite burdens (B12.55.w1).

Transmission

  • Is direct or via transport hosts such as earthworms, by the faeco-oral route: embryonated eggs are passed in the faeces, hatch, moult twice, and are ingested when eating or drinking.
  • Larvae may also penetrate the web of goslings (B78).

(J1.31.w6, J7.43.w1, B10.26.w11, B11.39.w7, B11.40.w8, B13.46.w1, B14, B15, B18, B36.32.w32, B37.x.w1, B48.20.w20, V.w3)

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

Disease has been reported in:
  • Various species of waterfowl, with effects widely varying in degree, including:
  • Swan geese - appear particularly susceptible (V.w3).
  • Canada goose Branta canadensis in Illinois (J1.31.w6).
  • Canada goose Branta canadensis, snow goose Anser (Chen) caerulescens and white-fronted goose Anser albifrons in Texas (J1.33.w4).
  • Lesser snow goose goslings, Anser caerulescens caerulescens Hudson Bay, Canada (J1.32.w1).
  • Barnacle goose Branta leucopsis in a collection in the UK (J7.3.w1).
  • Chinese goose Cygnus cygnoides domesticus, greylag goose Anser anser, greater snow goose Anser caerulescens atlanticus, upland goose Chloephaga picta in a collection in the UK (J7.4.w1).
  • Kelp goose Chloephaga hybrida and Barrow's goldeneye Bucephala islandica in a collection in the UK (J7.5.w1).
  • Upland goose Chloephaga picta, Barnacle goose Branta leucopsis, Brent goose Branta bernicla in a collection in the UK (J7.6.w1).
  • Whistling swan Cygnus (Olor) columbianus and trumpeter swans Cygnus (Olor) buccinator, lesser snow geese Anser caerulescens caerulescens and Canada goose Branta canadensis (J14.19.w1).
  • Anas acuta Northern pintail, Anas platyrhynchos Mallard, Anas querquedula Garage, Anser albifrons white-fronted goose, Anser anser domesticus domestic goose, Anser erythropus lesser white-fronted goose, Branta canadensis Canada goose, Chloephaga poliocephala Ashy-headed goose, Cygnus olor Mute swan, Anas strepera Gadwall, Aythya (Fuligula) marila greater scaup , Melanitta nigra common scoter, Mereca (Anas) penelope Eurasian wigeon, Somateria mollissima common eider, Somateria spectabilis King eider, Anas (Spatula) clypeata Northern shoveler (B48.20.w20).
  • Greater Magellan goose (Upland goose) Chloephaga picta - a major cause of illness in the Falkland islands population (B10.26.w11).
  • May be found in "all the swans", but usually causing little damage (B9.6.w1).
  • Cause of death in black swan Cygnus atratus, black-necked swan Cygnus melanocoryphus and trumpeter swan Cygnus buccinator (J7.43.w1).
  • Sheldgeese, particularly Magellan (Upland) goose Chloephaga picta , ashy-headed goose Chloephaga poliocephala and ruddy-headed goose Chloephaga rubidiceps in the UK; (N.B. NOT seen in Andean goose Chloephaga melanoptera or Abyssinian blue-winged goose Cyanochen cyanopterus in the same collection) (J7.30.w4).
  • Javan (lesser) whistling-duck Dendrocygna javanica in a collection in the UK (J7.33.w2).
  • Pinkfoot goose Anser brachyrhynchus, Ross's goose Anser rossii, barheaded-goose Anser indicus, Canada goose Branta canadensis, Barnacle goose Branta leucopsis, red-breasted goose Branta ruficollis, swan goose Anser cygnoides, greylag goose Anser anser, snow goose Anser caerulescens, white-fronted goose Anser albifrons in the UK (J7.34.w1)
  • Wild mute swans Cygnus olor in Scotland (J7.50.w1).
  • Whistling swan Cygnus (Olor) columbianus, trumpeter swan Cygnus (Olor) buccinator, common goldeneye Bucephala clangula, Barrow's goldeneye Bucephala islandica, all wild in Canada (J14.11.w1).
  • Wild swans, lesser snow geese Anser caerulescens caerulescens and Canada goose Branta canadensis in British Columbia, Canada (J14.19.w1).
  • Mute swan Cygnus olor in Scotland (J36.44.w1).
  • Greater Magellan (upland) geese Chloephaga picta leucoptera on the Falkland Islands (J7.33.w4).
  • Bean goose Anser fabalis goslings in captivity in Minnesota, USA (J37.13.w1).
  • Canvasbacks Aythya valisineria, Canada geese Branta canadensis, lesser snow geese Anser caerulescens (B15).

Infection reported in:

  • Wild northern shovelers Anas clypeata in southwest Texas, USA (J1.13.w7).
  • Wild American wigeon Anas americana and blue-winged teal, Anas discors in Oklahoma, USA (J1.16.w8).
  • Wild green-winged teal Anas crecca in southwest Texas, USA (J1.17.w6).
  • Wild Mexican ducks Anas platyrhynchos diazi (J1.22.w4).
  • Canada goose Branta canadensis, snow goose Anser (Chen) caerulescens and white-fronted goose Anser albifrons wintering in Texas (J1.33.w4).
  • Anseranas semipalmata - Magpie goose, Dendrocygna fulva - Fulvous whistling-duck, Dendrocygna javanica - Lesser whistling-duck, Dendrocygna viduata - White-faced whistling-duck, Anser anser - Greylag goose (Amidostomum acutum, Amidostomum anseris, Amidostomum spatulatum, Epomidiostomum crami, Epomidiostomum orispinum, Epomidiostomum uncinatum), Anser anser domesticus - Domestic goose (Amidostomum anseris, Amidostomum spatulatum, Epomidiostomum orispinum, Epomidiostomum uncinatum), Anser albifrons - Greater white-fronted goose (Amidostomum acutum, Amidostomum anseris, Amidostomum spatulatum, Epomidiostomum crami, Epomidiostomum orispinum, Epomidiostomum uncinatum), Anser brachyrhynchus - Pink-footed goose (Amidostomum anseris, Amidostomum spatulatum), Anser canagica - Emperor goose, Anser caerulescens - Snow goose (Amidostomum anseris, Amidostomum cygni, Epomidiostomum crami), Anser cygnoides - Swan goose, Anser cygnoides domesticus - Chinese goose, Anser erythropus - Lesser white-fronted goose (Amidostomum anseris, Amidostomum spatulatum, Epomidiostomum orispinum), Anser fabalis - Bean goose (Amidostomum anseris, Amidostomum spatulatum, Epomidiostomum crami, Epomidiostomum orispinum, Epomidiostomum uncinatum), Anser indicus - Bar-headed goose (Amidostomum spatulatum), Anser rossii - Ross's goose (Amidostomum anseris, Amidostomum spatulatum, Epomidiostomum crami), Branta bernicla - Brent goose, Branta canadensis - Canada goose (Amidostomum anseris, Amidostomum spatulatum, Epomidiostomum crami, Epomidiostomum uncinatum), Branta leucopsis - Barnacle goose (Amidostomum anseris, Epomidiostomum orispinum), Branta ruficollis - Red-breasted goose, Branta sandvicensis - Nene (Amidostomum anseris), Coscoroba coscoroba - Coscoroba swan, Cygnus atratus - Black swan (Amidostomum cygni), Cygnus columbianus - Tundra swan (Amidostomum acutum, Amidostomum anseris, Amidostomum cygni, Amidostomum spatulatum, Epomidiostomum crami), Cygnus cygnus - Whooper swan (Amidostomum anseris, Amidostomum spatulatum, Epomidiostomum uncinatum), Cygnus cygnus buccinator - Trumpeter swan (Amidostomum acutum, Amidostomum anseris, Amidostomum cygni, Amidostomum spatulatum, Epomidiostomum uncinatum), Cygnus olor - Mute swan (Amidostomum anseris, Amidostomum cygni, Epomidiostomum uncinatum), Cygnus melanocoryphus - Black-necked swan (Epomidiostomum orispinum), Cereopsis novaehollandiae - Cape barren goose (Amidostomum anseris), Alopochen aegyptiacus - Egyptian goose, Neochen jubata - Orinoco goose, Chloephaga picta - Upland goose (Amidostomum anseris), Chloephaga poliocephala - Ashy-headed goose (Amidostomum anseris), Tadorna cristata - Crested shelduck (Extinct) (Amidostomum anseris), Cyanochen cyanopterus - Blue-winged goose, Lophonetta specularioides - Crested duck, Tadorna ferruginea - Ruddy shelduck (Amidostomum acutum, Amidostomum anseris, Epomidiostomum uncinatum), Tadorna tadorna - Common shelduck (Amidostomum acutum, Amidostomum anseris, Epomidiostomum crami, Epomidiostomum uncinatum), Tadorna tadornoides - Australian shelduck, Anas platyrhynchos - Mallard (Amidostomum acutum, Amidostomum anseris, Epomidiostomum crami, Epomidiostomum orispinum, Epomidiostomum uncinatum), Anas platyrhynchos domesticus - Domestic duck (Amidostomum acutum, Amidostomum anseris, Epomidiostomum uncinatum), Anas acuta - Northern pintail (Amidostomum acutum, Amidostomum anseris, Epomidiostomum crami, Epomidiostomum uncinatum), Anas americana - American wigeon (Amidostomum acutum, Epomidiostomum uncinatum), Anas angustirostris - Marbled teal (Amidostomum acutum, Epomidiostomum uncinatum), Anas bahamensis - White-cheeked pintail, Anas capensis - Cape teal, Anas castanea - Chestnut teal, Anas clypeata - Northern shoveler (Amidostomum acutum, Amidostomum anseris, Epomidiostomum uncinatum), Anas crecca - Common teal (Amidostomum acutum, Amidostomum anseris, Epomidiostomum orispinum, Epomidiostomum uncinatum), Anas cyanoptera - Cinnamon teal (Amidostomum acutum, Epomidiostomum uncinatum), Anas discors - Blue-winged teal [taken to be synonymous with Anas erythrorhyncha in this reference] (Amidostomum acutum, Amidostomum anseris, Epomidiostomum uncinatum), Anas falcata - Falcated duck (Amidostomum acutum, Epomidiostomum uncinatum), Anas formosa - Baikal teal (Amidostomum acutum, Epomidiostomum uncinatum), Anas georgica - Yellow-billed pintail (Amidostomum acutum), Anas gibberifrons - Sunda teal (Epomidiostomum uncinatum), Anas leucophrys - Ringed teal, Anas penelope - Eurasian wigeon (Amidostomum acutum, Amidostomum anseris, Epomidiostomum crami, Epomidiostomum orispinum, Epomidiostomum uncinatum), Anas platalea - Red shoveler, Anas poecilorhyncha - Spot-billed duck (Amidostomum acutum, Epomidiostomum uncinatum), Anas punctata - Hottentot teal, Anas querquedula - Garganey (Amidostomum acutum, Amidostomum anseris, Epomidiostomum uncinatum), Anas rhynchotis - Australian shoveler, Anas rubripes - American black duck (Amidostomum anseris, Epomidiostomum uncinatum), Anas sibilatrix - Chiloe wigeon (Amidostomum acutum), Anas sparsa - African black duck (Amidostomum anseris), Anas specularis - Spectacled duck (Amidostomum anseris), Anas strepera - Gadwall (Amidostomum acutum, Amidostomum anseris, Epomidiostomum uncinatum), Anas superciliosa - Pacific black duck, Anas versicolor - Silver teal, Somateria fischeri - Spectacled eider, Somateria mollissima - Common eider (Amidostomum acutum, Amidostomum anseris, Epomidiostomum orispinum), Somateria spectabilis - King eider (Amidostomum acutum, Amidostomum anseris, Amidostomum cygni), Aythya affinis - Lesser scaup (Amidostomum acutum, Amidostomum anseris), Aythya americana - Redhead (Amidostomum acutum, Epomidiostomum uncinatum), Aythya collaris - Ring-necked duck (Amidostomum acutum), Aythya australis - Hardhead, Aythya baeri - Baer's pochard, Aythya ferina - Common pochard (Amidostomum acutum, Amidostomum anseris), Aythya fuligula - Tufted duck (Amidostomum acutum, Amidostomum anseris, Epomidiostomum orispinum, Epomidiostomum uncinatum), Aythya marila - Greater scaup (Amidostomum acutum, Amidostomum anseris, Epomidiostomum uncinatum), Aythya novaeseelandiae - New Zealand scaup, Aythya nyroca - Ferruginous pochard (Amidostomum acutum, Epomidiostomum uncinatum), Aythya valisineria - Canvasback (Amidostomum acutum, Epomidiostomum uncinatum), Netta erythrophthalma - Southern pochard, Netta peposaca - Rosy-billed pochard, Netta rufina - Red-crested pochard (Amidostomum acutum, Epomidiostomum crami, Epomidiostomum uncinatum), Aix galericulata - Mandarin duck (Amidostomum acutum, Epomidiostomum uncinatum), Aix sponsa - Wood duck (Amidostomum acutum, Amidostomum anseris), Amazonetta brasiliensis - Brazilian teal, Cairina moschata - Muscovy duck, Chenonetta jubata - Maned duck (Amidostomum anseris), Nettapus coromandelianus - Cotton pygmy-goose (Amidostomum acutum), Nettapus pulchellus - Green pygmy-goose, Plectropterus gambensis - Spur-winged goose, Sarkidornis melanotos - Comb duck (Epomidiostomum uncinatum), Bucephala albeola - Bufflehead (Amidostomum acutum), Bucephala clangula - Common goldeneye (Amidostomum acutum, Amidostomum anseris, Epomidiostomum orispinum), Bucephala islandica - Barrow's goldeneye, Clangula hyemalis - Long-tailed duck (Amidostomum acutum, Epomidiostomum uncinatum), Histrionicus histrionicus - Harlequin duck (Amidostomum acutum), Melanitta fusca - White-winged scoter (Amidostomum acutum, Amidostomum anseris, Epomidiostomum orispinum, Epomidiostomum uncinatum), Melanitta nigra - Black scoter (Amidostomum acutum, Amidostomum anseris, Epomidiostomum orispinum, Epomidiostomum uncinatum), Melanitta perspicillata - Surf scoter, Mergus albellus - Smew (Amidostomum acutum), Mergus cucullatus - Hooded merganser, Mergus merganser - Common merganser, Mergus serrator - Red-breasted merganser, Mergus squamatus - Scaly-sided merganser, Biziura lobata - Musk duck, Oxyura jamaicensis - Ruddy duck (Epomidiostomum uncinatum), Oxyura leucocephala - White-headed duck (Amidostomum anseris, Epomidiostomum uncinatum). (B91)

WATERFOWL Host Species List

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

Disease has been reported in:
  • Various species of waterfowl, including
  • Canada goose Branta canadensis in Illinois (J1.31.w6).
  • Lesser snow geese Anser caerulescens in Canada (J1.32.w6).
  • Whistling swan Cygnus (Olor) columbianus and trumpeter swans Cygnus (Olor) buccinator, lesser snow geese Anser caerulescens caerulescens and Canada goose Branta canadensis in Canada (J14.19.w1).
  • Mute swans Cygnus olor in Scotland (J7.50.w1).
  • Whistling swan Cygnus (Olor) columbianus, trumpeter swan Cygnus (Olor) buccinator, common goldeneye Bucephala clangula, Barrow's goldeneye Bucephala islandica, in Canada (J14.11.w1).
  • Mute swan Cygnus olor in Scotland (J36.44.w1).
  • Greater Magellan (upland) geese Chloephaga picta leucoptera on the Falkland Islands (J7.33.w4).
  • Canvasbacks Aythya valisineria, Canada geese Branta canadensis, lesser snow geese Anser caerulescens (B15).

Infection reported in:

  • Wild northern shovelers Anas clypeata in southwest Texas, USA (J1.13.w7).
  • Wild American wigeon Anas americana and blue-winged teal, Anas discors in Oklahoma, USA (J1.16.w8).
  • Wild green-winged teal Anas crecca in southwest Texas, USA (J1.17.w6).
  • Wild Mexican ducks Anas platyrhynchos diazi (J1.22.w4).
  • Canada goose Branta canadensis, snow goose Anser (Chen) caerulescens and white-fronted goose Anser albifrons wintering in Texas (J1.33.w4).

WATERFOWL Host Species List

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Environment/Geography

General Information on Environmental Factors/Events and Seasonality

  • Parasitism may be present at any time of the year, with migratory birds first becoming exposed to gizzard worms on their breeding grounds, and captive juveniles being exposed while grazing areas used by infected birds in the previous year.
  • Severe effects and deaths in juveniles may be particularly high during the autumn and winter due to the effects of large worm burden combined with the stresses of migration and of competition for food.
  • Due to the direct life cycle of Amidostomum spp. and Epomidiostomum spp., the disease may be of greatest concern in areas of heavy faecal contamination: captive populations, colonial nesting grounds and densely-populated wintering grounds.
  • Extremely low temperatures and drying prevent eggs and larvae from surviving.

(B11.40.w8, B15, B36.32.w32)

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

Worldwide (B24).

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

Worldwide (B24).

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General Investigation / Diagnosis

General Information on Investigation / Diagnosis

WATERFOWL
  • Diagnosis of infection in live birds is by the demonstration of the eggs in faeces (oval, thin-walled, embryonated and slightly larger than ascarid eggs).
  • At post mortem examination, severe lesions in the gizzard lining or muscle, together with large numbers of hair-like worms, is highly suggestive of gizzard worm infection as the cause of death or a contributory factor. Worms should be preserved in 10% formalin for specific identification by an appropriate parasitologist.

(J14.11.w1, B11.39.w7, B11.40.w8, B13.46.w1, B14, B37.x.w1, B48.20.w20, B49).

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Similar Diseases (Differential Diagnosis)

WATERFOWL Acuaria (Echinuria) (Echinuriasis (Acuariasis)), thorny-headed worms (Acanthocephala) (Acanthocephala Infection) (B37.x.w1).

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Treatment and Control

Specific Medical Treatment

WATERFOWL Anthelmintics, e.g. ivermectin 200µ g/kg, a single oral dose or subcutaneous injection, or mebendazole in-feed (1.2kg/tonne for 14 days) or flubendazole (2.4kg/tonne for seven days) before the breeding season and after the summer moult. Mebendazole, 5-15mg/kg orally for two days, piperazine 45-200mg/kg orally, single dose, or 6-10g in 4 litres of drinking water, thiabendazole 200-500mg/kg orally, levamisole 25-50mg/kg orally (1ml/kg of 1.5% w/v solution).

N.B. re-infection is likely if birds are not moved to fresh ground.

(J7.43.w1, J8.17.w1, B11.39.w7, B13.46.w1, B15, B37.x.w1, B78)

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General Nursing and Surgical Techniques

WATERFOWL Iron injection may be used in the treatment of anaemia associated with the infection (B18).
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Preventative Measures

Vaccination WATERFOWL --
Prophylactic Treatment

WATERFOWL

Anthelmintics, e.g. ivermectin 200µ g/kg, a single oral dose or subcutaneous injection, or mebendazole in-feed (1.2kg/tonne for 14 days) or flubendazole (2.4kg/tonne for seven days) before the breeding season and after the summer moult.

(B11.39.w7, B18, B78).

For information on routine parasite control see Preventative Medicine for Birds - Parasite screening and Routine Control Measures

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Environmental and Population Control Measures

General Environment Changes, Cleaning and Disinfection

WATERFOWL

General improvement of hygiene. Heavily grazed areas should be rested periodically, preferably for a full year. Moving birds from infected areas may be useful (J7.43.w1, B11.39.w7, B24, B37.x.w1).

Population Control Measures WATERFOWL
  • Avoid high stocking densities.
  • Hold birds in a confined area during treatment and release onto a 'clean' area three days after treatment.
  • Prevent access of wild waterfowl to ponds of goose farms.

(B18, B48.20.w20, B78).

Isolation, Quarantine and Screening WATERFOWL Birds entering a collection should be screened by faecal examination, treated with anthelmintics if required and quarantined until treatment is completed or screenings are negative.
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