Dumonceaux Genevieve A, St Leger Judy, Olsen John H, Burton Michael S, Ashkin David, Maslow Joel N
Busch Gardens Tampa Bay, 3605 East Bougainvillea Avenue, Tampa, Florida 33612, USA.
J Zoo Wildl Med. 2011 Dec;42(4):709-12. doi: 10.1638/2011-0040.1.
A female Asian elephant (Elephas maximus) developed vaginal and trunk discharge. Cultures were positive for pan-susceptible Mycobacterium tuberculosis. Isoniazid and pyrazinamide were given rectally and monitored by serum levels. After being trained at 10 mo to accept oral dosing, treatment was changed and rifampin was added. Oral medications were administered for another 10 mo. A year after completion of therapy, the vaginal discharge increased and cultures yielded M. tuberculosis, resistant to isoniazid and rifampin. Treatment with oral ethambutol, pyrazinamide, and enrofloxacin and intramuscular amikacin was initiated. Although followup cultures became negative, adverse reactions to medications precluded treatment completion. Due to public health concerns related to multidrug resistant M. tuberculosis (MDR-TB), the elephant was euthanized. Postmortem smears from the lung, peribronchial, and abdominal lymph nodes yielded acid-fast bacteria, although cultures were negative. This case highlights important considerations in the treatment of M. tuberculosis in animals and the need for a consistent approach to diagnosis, treatment, and follow-up.
一头亚洲雌性象（印度象）出现阴道和象鼻分泌物。培养物检测出对所有药物敏感的结核分枝杆菌呈阳性。异烟肼和吡嗪酰胺通过直肠给药，并通过血清水平进行监测。在10个月大时经过训练接受口服给药后，治疗方案改变并添加了利福平。口服药物又持续使用了10个月。治疗结束一年后，阴道分泌物增加，培养物再次检测出结核分枝杆菌，且对异烟肼和利福平耐药。于是开始使用口服乙胺丁醇、吡嗪酰胺和恩诺沙星以及肌肉注射阿米卡星进行治疗。尽管后续培养结果转为阴性，但药物不良反应导致治疗无法完成。出于对耐多药结核分枝杆菌（MDR-TB）相关公共卫生问题的考虑，这头大象被实施安乐死。尽管培养结果为阴性，但肺、支气管周围和腹部淋巴结的尸检涂片发现了抗酸菌。该病例凸显了动物结核分枝杆菌治疗中的重要注意事项以及对诊断、治疗和随访采取一致方法的必要性。
