Need Advice for Respiratory Illness in Conure

[Karebear]

Hello All!

This is my first time on this board, and was hoping to get some advice for my lovely 5-year old Green Cheek Conure, Oscar. About one month ago, I started hearing a very faint whistling only occasionally when Oscar got worked up or was moving around a lot, but was otherwise acting his normal playful self. It was definitely out of the ordinary, so I decided to take him to my local avian vet. Many tests were run, including blood tests and an x-ray (which was difficult, because he had trouble coming out of anesthesia). Some of the noted results were high white blood cell count, slightly low liver function, and the x-rays showed congestion in the lung fields (basically when I looked at it, it was kind of cloudy all over). They hospitalized him for a couple days, which during that time he was given oxygen, twice daily nebulizing treatments, and various antifungal and antibiotic medications. When I was able to bring him home, I was assigned to give the same treatment at home for 30 days.

Three weeks later, I hadn't noticed any real positive change (but did notice slight tail bobbing that the vet had noted on the first visit), so I brought him in a little early for his follow-up check. The vet and I decided against doing another x-ray since he had trouble with that before. She said his lungs actually sounded better, and she retook blood tests. Liver function had returned to normal, white blood cell count was still high, and there was a little change in kidney function, so we reduced some of his meds. So as of right now, I'm continuing the nebulizing and oral antibiotic, and I'll bring him back to the vet in 3-4 weeks.

Other results to note:
Chlamydophila test = negative
Aspergillosis test = negative
Healthy weight

So I guess right now, I'm looking to see if anyone has been in a similar situation or has any advice. I've spent so much money already, but feel like I don't have any answers as to what's ailing my bird (and this is nothing against the vet, they have been really great through this process), and haven't noticed any changes for the better. He hasn't gotten worse either, and he still has the same energy. I just worry about the long term.

Any help is much appreciated!

 

[Mizzely]

@Hankmacaw might have some insight

I do know that asper is not always detected in the tests but not sure if the symptoms back up trying to treat for it.

 

[Karebear]

Thank you for the reply! I've been so overwhelmed with the meds I've been giving him, but I feel like one could have been for in case he did have that. I also could be wrong, not too sure. I only just received the results for this test last week, as we were not able to get enough blood for this until recently.

 

[Mizzely]

I do know that if it's asper it can be hard to detect and treat. We've had a few birds on the forum that have had it and it was a many months long process to eradicate.

I also know that some birds have been nebulized with F10 to treat it, but apart from that I don't know anything further! Hopefully someone else will be by shortly with more info. It's so hard to know they are sick but not knowing how to help them!

 

[Karebear]

Thanks so much for the insight, I really appreciate it!

 

[Lady Jane]

Only thing I know is sometimes Amphoteracin B can be nebulizer. Hope your baby gets better.

 

[Karebear]

@Lady Jane That was actually one of the meds I was adding to the nebulizer -- after we got the second blood test with the change in kidney function, the vet wanted to remove the Amphoteracin B, as she thought that it maybe caused it. So I haven't been giving that particular med for a little over a week.

 

[Karebear]

@Lady Jane Thank you for the reply and kind words =)

 

[iamwhoiam]

Sorry that your conure is ill. Hope that the medications help him and that he will be better soon.

 

[WendyN]

I hope the treatments help Oscar.

 

[Hankmacaw]

It sounds like your baby could have Asper. Ampho B can only be used for a few days in the nebulizer without risking damage to the kidneys/liver. I recommend that your Vet. run a Serum Protein Electrophoresis test along with another Asper Titer. These two tests should give you a definitive answer as to whether it is Asper or not. The xray he had is classic for Asper. Also a change in their voice and breathing problems. What he has could, of course, be a bacterial infection, but a culture and sensitivity should tell you that immediately.
If you read these two excepts (references included) you will have a much better understanding that it sometimes takes several test to diagnose Asper.

You should start giving serious supportive care to your bird - KEEP HIM WARM, do not let him exercise, hand feed him with a syringe if you see the slightest need and start giving him DMG and Red Palm Oil. Many times when a bird has Asper their immune system is highly compromised and they are susceptible to every bacterial infection that comes along.

Electrophoresis
Electrophoresis has received much attention recently as a valuable diagnostic tool in avian medicine. A serum sample is placed on a special “plate” and an electrical charge is applied. The various components of the serum migrate across the plate and are separated by their response to the charge. Once separated electrophoretically, each of the components can be evaluated and quanitated. Most frequently, electrophoretic methods are used in birds to determine the percentage of five major protein fractions in serum: pre-albumin/albumin, alpha-1 globulins, alpha-2 globulins, betaglobulins, and gammaglobulins— in serum protein.

In healthy birds, albumin is the largest protein fraction, constituting up to 40% of total serum protein in some species. An inflammatory process will result in a decrease in albumin concentrations and an increase in total protein due to elevations in the alpha-, beta-, and gammaglobulin fractions. The end result of these changes is a decrease in the albumin/globulin (A/G) ratio. Other conditions that result in a decrease in the A/G ratio include egg yolk peritonitis and chronic infectious diseases, such as aspergillosis, chlamydiosis, and tuberculosis. Frequently, the total protein concentration will be within normal range while the A/G ratio is decreased. This occurrence indicates that the A/G ratio is of greater clinical importance than total protein concentration.

A decrease in albumin level can develop due to reduced albumin synthesis in chronic liver disease or chronic infection. Albumin loss also occurs with renal disease, parasitism, gastrointestinal disease, and overhydration. Albumin increases occur with dehydration.

An increase in alpha- and betaglobulins can result from acute nephritis, severe active hepatitis, systemic mycotic (fungal) infections, and nephrotic (kidney) syndrome. An increase in gammaglobulins, which are composed primarily of immunoglobulins, will occur with antigenic stimulation, such as in cases of acute or chronic inflammation, infection, chronic active hepatitis, vaccinations, and immune-mediated disorders.

https://nilesanimalhospital.com/files/2012/05/Understanding-Avian-Laboratory-Tests.pdf

Both @Macawnutz and I had good success with voriconazole and no side effects. Even Itraconazole (.Sporonox) caused permanent damage to my birds livers. Please ask you vet about use of Voriconazole.
Abstract
To evaluate the clinical efficacy and safety of voriconazole for the treatment of aspergillosis in falcons, 20 falcons with aspergillosis admitted to the Dubai Falcon Hospital from August 2003 to May 2006 were treated with voriconazole. These falcons included 6 gyrfalcons (Falco rusticolus), 10 gyrfalcon hybrids, 1 lanner (Falco biarmicus), 1 saker (Falco cherrug), and 2 peregrine falcons (Falco peregrinus). Clinical signs were weight loss, inappetence, dyspnea, inspiratory stridor, tachypnea, and biliverdinuria. Aspergillosis was diagnosed from clinical signs, hematologic results, radiographic abnormalities, endoscopic examination of the lower respiratory tract, cytologic examination of biopsy samples from air sacs, and fungal cultures. Birds treated with voriconazole administered by crop gavage were divided into 2 groups: in group 1, birds were treated with 12.5 mg/kg q12h for 3 days (loading dose), then q24h for an additional 18 to 87 days; in group 2, birds were treated with 12.5 mg/kg q12h for the full period of 44 to 100 days. Treatment with voriconazole resulted in a successful clinical response in most cases, an acceptable survival rate, and few adverse effects. Complete clinical resolution occurred in 14 birds (70%), a partial response in 5 birds (25%), and 1 bird (5%) died during treatment. From these results, voriconazole appeared to be effective and safe for the treatment of aspergillosis in some species of falcons.
The Use of Voriconazole for the Treatment of Aspergillosis in Falcons (Falco Species) on JSTOR

 

[webchirp]

Dr. Orosz prescribes lamisil for asper. I hope your wee one feels better.

 

[Hankmacaw]

I have used Lamisil also and it doesn't have the side effects that Itraconozole does, but it also isn't as effective.

I tried nebulizing Jasper with F10 during one of her bouts with Asper and it did not do any good. The falconers in the mid-east swear by f10 and use it all of the time for Asper.

My Hank had Asper for four years (21 years ago) and my vet (who happens to be a close personal friend of Dr. Orosz) did everything possible to save his life. Hank also had recurring Asper (so did Jasper). When Hank was on death's door, my vet did a laparoscopy on him and flooded Hank's abdominal cavity with Ampho B. Hank had chronic Asper and had colonies on his testes, liver, spleen and finally his lungs. This procedure turned him around and he slooowly started improving, but damage had already been done to his liver and lungs. He was my very special boy and he died in 2012 of cancer.

 

[Karebear]

Thank you @iamwhoiam & @WendyN for the well-wishes!

@Hankmacaw @webchirp Wow, so much great information! The additional Electrophoresis test in combination with the Asper test sounds like it could be a possibility to discuss with the vet, although I'm admittedly nervous about the price since the first Asper test set me back $250+. From some of the treatments you're mentioning for Asper, I'll have to check the full records to see what he was given early on (the Lamisil sounds really familiar). I looked at the meds I do have written in front of me, and what I'm currently giving him includes:
~Nebulizing solution (combo of Baytril, Acetylcysteine, and saline) twice a day
~Azithromycin - 0.03 ml once a day
~AA Super Immune - 0.05 ml twice a day for immune support

Are any of these potential treatments for asper? If they are should I confirm the diagnosis with additional tests? Also, is the immune support enough to skip the palm oil?

I'm so sorry to hear about your baby, @Hankmacaw. I think a potential next step for Oscar that's been talked about is a laparoscopy if he hasn't gotten better. That idea really scares me =(

 

[Hankmacaw]

None of the medication he is now on are effective for Asper. Baytril is a broad scope antibiotic, Acetylcysteine is anti mucosal, saline is just a carrier and has no activity. Azithromycin is an antibiotic. I have never used the super immune, but have seen posts where others have - I have no opinion about it. Rather than dropping the Red Palm oil, while giving super immune, I would drop the DMG. Super immune and DMG are both immune system boosters.

$250 is very high for an Asper titer. Where do you live? I can't remember for sure, but it seems that the titers done by my vet were around $80-100 and the protein phoresis was about $150 - I live in AZ.

If you have faith in your Dr., don't be afraid of a laparoscopy. Both of my birds have had several with absolutely no detrimental side effects. You should probably ask your vet how many and how often he performs them ,and exactly what he would be looking for and what tests he would perform - flooding, biopsy and histology, extraction or just a look see (which isn't bad). Oh yeah, the laparoscopys have run me from $350 - 400.

 

[Karebear]

Wow, I wish mine was that price! I'm in IL, not sure if we may be generally more expensive here. I'm unfamiliar with DMG -- what does this stand for?
After reading through the information here, I took a look at Oscar's full medical record, and after reading through the notes, I actually found where the vet did the Asper test along with the protein electrophoresis -- this piece showed evidence of chronic inflammation. I've been so overwhelmed with the information coming from the vet, I didn't realize that was part of the test.

 

[rocky'smom]

DMG: A Nutrient for the New Millennium

 

[Karebear]

@rocky'smom Thank you! =)

 

[rocky'smom]

Not a problem, its good stuff for our feathered buddies

 

[Hankmacaw]

It sounds like your vet is doing a very good job. The only other information that I can think of is, if the antibiotics aren't doing the job on the lungs, the bacteria could be an antibiotic resistant one. Check to see if the vet did a culture and sensitivity and what the results were. If not, that test will tell exactly which bacteria it is and which antibiotics, specifically it is sensitive to. When a bird has been on antibiotic for awhile, sometimes nothing will grow in the culture because the bugs are dead or dying.