key: cord-0818403-hn64bboa authors: Kleinschmidt, Laura M.; Kinney, Matthew E.; Hanley, Christopher S. title: Treatment of disseminated Strongyloides spp. infection in an infant Sumatran orangutan (Pongo abelii) date: 2018-03-01 journal: J Med Primatol DOI: 10.1111/jmp.12338 sha: 3b43b258b097f6323f2ff1291a1aa5a369ad0027 doc_id: 818403 cord_uid: hn64bboa Strongyloides nematodes have been reported in all species of great apes with orangutans ≤5 years old most susceptible to severe clinical disease. This brief communication describes the first published case of antemortem diagnosis and treatment of disseminated strongyloidiasis in a clinically affected 5‐month‐old Sumatran orangutan (Pongo abelii). Strongyloides nematodes affect millions of people worldwide and have been reported in all great ape species and some Old World primates. [1] [2] [3] [4] [5] [6] The most common species affecting great apes are Strongyloides stercoralis and Strongyloides fuelleborni. 1, 4 Most infected animals and humans are asymptomatic shedders; however, immunocompromised or immunologically-naïve individuals are most likely to be affected with clinical disease that can develop into a fulminant fatal illness. 2, 3, 7, 8 This parasite can survive for months in the environment, and increased skin contact with infected soil substrates is a risk factor for infection. 2, 3, 6 Transmammary transmission of Strongyloides spp. has been documented in dogs, sheep, rats, pigs, and in a single human case. [9] [10] [11] [12] [13] While the complex life cycle of this parasite has been published in detail elsewhere, it is the migration of the Strongyloides larvae through the respiratory system and then gastrointestinal tract that causes clinical symptoms. 2, 3 Many fatal human cases involve hyperinfection, a state of accelerated autoinfection, characterized by increased larval migration and larval loads in the gastrointestinal and pulmonary systems. 3, 8 Symptoms vary greatly depending on the parasite load and host health and can include non-specific signs such as lethargy or more specific signs like cough, dyspnea, diarrhea, constipation, inappetence, and abdominal pain. 2, 3, 14 Of the great apes, orangutans ≤5 years old appear to be the most susceptible to severe clinical disease, likely due to their immunologically-naïve status. 4, 6, [14] [15] [16] Several fatalities have been reported in the literature in this species, 6,15,16 as well as in young chimpanzees and gorillas. 5 While other reports have described effective eradication strategies in asymptomatic adults utilizing preventative deworming schedules, 17 this is the first published report to describe antemortem diagnosis and treatment of disseminated strongyloidiasis in a clinically affected great ape infant. On May 29, 2015, a 5-month-old female Sumatran orangutan, Pongo abelii, presented with acute lethargy and a periodic dry, non-productive cough. This animal was housed in a zoological institution with its family group consisting of 2.2 adults, where the animal health department must provide best-practice veterinary care for all animals. This orangutan family group was provided both indoor and outdoor housing. The outdoor yards consisted of natural substrates, while the indoor housing was composed of artificial trees, concrete rockwork, fire-hoses, hammocks, and platforms for climbing and various enrichments for mental stimulation in compliance with USDA requirements. The orangutans were also provided wood wool, hay, blankets, and browse. The orangutans were fed a balanced diet overseen by a PhD-certified nutritionist which was provided in variable ways day-to-day including during training sessions, in enrichment devices, via scatter-feeding, etc. Oral amoxicillin (10 mg/kg mg BID, 50 mg/mL suspension; Virbac Parameter iStat CG4 iStat CG8 Abaxis Serum chemistry CBC Neut (*10 3 cells/ μL) Mono(*10 3 cells/ μL) No pathogens were isolated on fecal culture. Fecal direct examination was negative for parasites. Modified Wright-Giemsa stain showed gram-positive bacilli and megabacteria were present. Fecal gram stain and modified Wright-Giemsa stain revealed 7 larval parasites morphologically consistent with Strongyloides species (Figure 1 ). 4 The animal was diagnosed with pneumonia and icterus due to disseminated Strongyloides infection and was prescribed oral The day after anesthesia, the orangutan was nursing well and taking all medications. By the next day, the infant was less bloated, appeared brighter, and was more active. poor if patients require oxygen support or mechanical ventilation. 3, 8 Treatment in this case was likely successful due to intervention prior to severe respiratory compromise. 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