Freddie
Has Aspergillosis - July 2007
Freddie was ill in
February 2007 and was treated for a bacterial infection.
She appeared to recover but in late May appeared to be ill
again. She was fluffed, lethargic, had dull eyes, and
was twitching frequently. She appeared winded after
minimal exertion.
We took her to a local
area veterinarian who could not pinpoint the illness.
Her culture did not show any bacteria but her white blood
cell count was grossly elevated.
An antibiotic,
ciprofloxacin, was prescribed. A recheck was done
after two weeks and while her WBC had decreased, it was
still grossly elevated. We were advised to continue
the antibiotic for a full 30 days.
At the end of the 30 days
we contacted the vet for more advice as Freddie did not
appear to be better. We were told by the vet office
that the vet was out of the office and unavailable for the
next month. There was no other vet in the area we
trusted.
At wit's end, James drove
Freddie up to his former vet in the Bay area, Dr. Fern Van
Sant, at For the
Birds in San Jose, CA. Dr. Van Sant
is an avian specialist with exceptional diagnostic skills.
Within one week she had diagnosed the problem as an
aspergillosis infection.
Freddie was very sick by
this point, with a grossly elevated white blood cell count
of 63,000 that also showed many immature, toxic cells.
Dr. Vant Sant shared with us how the immune system responds
to the fungal invasion by flooding the body with high levels
of immature white cells, in a desperate attempt to deal with
it. The presence of these cells is not a good sign as
it indicates that the bird is overwhelmed by the fungus.
Freddie was started on
itraconazole (50 mg/ml, 0.01 cc orally), floxin (15 mg/ml,
0.02 cc orally), and clotrimazole (10 mg/ml, inhalation).
Freddie's initial daily
inhalation therapy in a nebulizer box (see photos below and
link to video) was three times a day for 3 minutes.
Over a period of six months, this time was gradually
increased to two times a day for 20 minutes.
Her appetite remained
reasonably good but we'd also noticed that the solid part of
her poops were extremely tiny, and the remainder very
watery. Before diagnosing the aspergillosis, Dr. Van
Sant initially thought Freddie might have an intestinal
blockage. We now believe the poops were small because
the fungus was growing in her gut, and constricting it.
So she possibly did have an intestinal blockage from the
fungal growth.
As of August 2,
2007, Freddie had been receiving treatment for almost one
week. We noticed an immediate improvement: her poops started to
return to normal, she had more energy, was more alert, and
her eyes were brighter.
However, we soon learned
that this organism is not easily defeated. Freddie continued
to receive treatments and regular vet check ups every 4
weeks.
In late October, we became very worried about
her because she seemed to be getting worse and her WBC was
very elevated again, with the immature, toxic cells reappearing.
The vet suspected she may have a granuloma (a walled-off sac
of fungal tissue) so x-rays were taken.
Fortunately,
the x-ray did not show any granulomas, only diffuse evidence
of aspergillus fungus in her lower air sacs. We
lengthened the time of her nebulizer treatments to 15 mins
twice a day and that appeared to have a positive effect.
On December 20, 2007,
Freddie had been on antifungal treatment now for 20 weeks
and was doing much better. Her white blood cell count
was down to 25,000 week and she was much more vocal and
active. She had begun flying about three weeks
previously and could
now fly about 30 feet in total. Her delayed juvenile
molt started and she was growing new primary and tail
feathers.
After seven months of
treatment, Freddie's white
count remained elevated (22,000) but all of her
other blood chemistry and results were completely normal
for the first time in months. She began flying and
talking and dancing and strutting and doing almost
everything a healthy 2-year old green-cheeked conure
should be doing.
At twelve months of
treatment, Freddie's white count, while still down, was
not near normal range. Dr. Van Sant suggested we
switch Freddie from itraconazole to voriconazole. We
saw an immediate difference in Freddie's energy levels but
after several months, her WBC remained elevated. We
doubled her dosage of voriconazole and continued to
nebulize her with chlortrimazole twice a day for 30
minutes at a time. In December 2008, she was
retested and her WBC was normal (at 8,000) for the very
first time in nearly two years. She is flying and
active all day long and her appetite remains good but she
is not as desperate in seeking food all day long. We
are hopeful that we have now controlled the aspergillosis
and will continue to treat Freddie until we are 100%
certain the fungus is gone. She may need to remain
on some sort of anti-fungal medication for the rest of her
life.
October 13, 2009
- Freddie has been on treatment now for over two years.
She is doing quite well and is active and happy and flying
around. We have begun lowering the amount of time
she spends in the nebulizer and she is now down to 15
minutes twice a day. If her white cell count remains
normal, we will gradually wean her off the nebulization
and keep her on the oral medication (voriconazole) only.
So what have we learned
that has helped Freddie survive and to beat this disease?
 |
Persistence in finding
a vet who knew how diagnose and treat this disease.
Diagnosis can be difficult and false positives from
contaminated samples occur. Treatment of
this disease requires an avian vet with extensive
experience treating aspergillosis and with many
resources to refer findings to for analysis. Dr. Van Sant worked with vets from the U.C. Davis Veterinary
School and referred Freddie’s xrays and results to these
people for advice. |
|
Consistent and
dedicated application of her medication regime. Getting
our own nebulizer was the best thing we could have
done. We don’t believe that she would have made it if
we’d relied on treatments at the vet’s office. We could
not have given her treatments twice a day otherwise. In
the last seven months, we missed only one nebulization
treatment due to work & travel schedules and this was
pre-approved by Dr. Van Sant. |
|
Absolutely excellent
nutrition. We changed Freddie’s diet completely. We
got her off the extruded Zupreem colored pellets and
onto Harrison’s pellets. She had daily access to lots
and lots of fresh fruits and veggies high in
anti-oxidants. She also got LaFeber Nutri-An cakes with
omega-3 fatty acids as treats. We cut out anything that
might promote fungal or bacterial growth. For example,
we were feeding her a warm mixed whole grain mixture
that we now think may have contributed to the growth of
fungus in her gut. But I think the most important
thing we did was to eliminate seed from her diet. |
After hearing from Dr.
Van Sant that the polyunsaturated fat in safflower and
sunflower seed could suppress a bird's immune system, I
did some research online and found several references to
the immune suppressive effect of polyunsaturated fat,
particularly from safflower seed. In fact, there
are references to people with immune dysfunction
diseases (rheumatoid arthritis, MS, lupus) who regularly
use safflower oil to suppress their overactive immune
systems. This change, made about 7.5 months into
her treatment, made a huge difference. Soon after
eliminating seed, she began to gain strength rapidly and
began flying much more frequently and strongly.
Luckily, her appetite was never
impacted that much. She ate and ate and ate. It was
like she could never get full. We took advantage of
that to make sure that everything she ate was the
highest quality it could be.
|
We got her a heater
for her cage and kept her warm at all times. She was
never in an environment colder than 78 degrees. |
|
She got lots and lots
of rest, with at least 12 hours of dark, uninterrupted
sleep every night. We did everything we could to
minimize the stress in her environment, as she was very
nervous and twitchy when she was not feeling well.
Loud noises and lights appeared to bother her so we
began covering her cage completely at night. |
|
She got a bath daily.
She generally has wanted to bathe almost every day
during her illness. Perhaps the aerosolized
medication is sticky and feels uncomfortable on her
feathers? |
|
We paid particular
attention to the air quality in her room by opening the
windows every day and airing it out, and avoiding using
anything that might impact the air quality negatively.
For example, we did not use our fireplace to burn wood
this winter. |
|
We did try some herbal
immune support supplements such as astrogalus but in
retrospect, we are not sure they did any good so we
stopped that about a month ago. |
|
Heather used healing
visualization techniques. Before she treated Freddie,
she said a prayer for her continued return to health,
then she visualized a bright pink (think of a beautiful
sunrise) light that fills her body so that she glows.
She pictured her flying around, with healthy, glossy
feathers, happy and healthy. Freddie also had the
love and prayers of support of many good friends, which
we have no doubt have helped her. |
|
Finally, we believe
that her will to live was strengthened not only through
our love but because of the love her little
friend, Phoebe, a painted
conure has for her. Phoebe has been so caring and
gentle and loving with Freddie that it brings tears to
our eyes on a regular basis. |
In conclusion, it should
be emphasized to anyone facing this illness that treatment
is a very long process. It has taken months for Freddie
to get to this point and the progress has been
discouraging at times. Success is measured in baby steps
and progress is of the “two steps forward, one step back”
kind.
How Did Freddie Get
Aspergillosis?
Until recently, we
were at a loss to explain how Freddie contracted
aspergillosis. At the time, we lived in an area of California with
very low humidity and were very careful about keeping our
home clean and free of molds and fungus. We have a
whole house air filter with a UV disinfectant system.
We now believe that
Freddie contracted aspergillosis by spending time in an
incubator /brooder during her first illness in February.
The incubator is a commercial product, the
Chick Chalet II, and was purchased from
Avey Incubators, Inc.
We purchased the unit 2.5
years ago after one of our birds was injured and we needed
to provide supportive and emergency care at home.
Because of our location, we do not have close access to a
qualified avian veterinarian and purchased the brooder so we
could provide care at home.
We would never have
discovered the cause had the brooder not failed when we used
it during Freddie's illness in February. The brooder
was sent for repair and we were told that the sealed
compartment at the top had collected moisture, resulting in
corrosion of the electronic components that control the
humidity and temperature. The owner of the company,
Jim Avey, also told us that the heater "smelled bad".
We are convinced that the
sealed compartment was a perfect environment for the
aspergillus fungus to grow and that by placing Freddie in
the unit in February, when her immune resistance was
compromised due to the bacterial infection, we exposed her
to the fungus.
Our vet agreed that a
brooder is likely the source of Freddie's aspergillosis,
calling the problem "brooder pneumonia".
If you are considering
purchasing a brooder, please ensure that all parts of the
unit can be dismantled for drying and disinfection.
Scroll down to see photos
of Freddie during her treatment. Click on the photo to view a larger image.
