Unusual chest x-ray - asymptomatic respiratory infection?

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pinupchick

pinupchick

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Ula had an appointment to go under anesthesia today to get her molars trimmed. As a precaution, the vet ran chest x-rays to make sure she was a healthy anesthesia candidate.

The vet just called and said it looked like there was some congestion in Ula's lungs and that she's not going to do the anesthesia and wants to give Ula a course of antibiotics.

Ula hasn't shown any signs of respiratory illness. She sneezed a few times the other day, but not since. No discharge, no runny nose, etc. Her eyes have been just the slightest bit goopy lately but nothing that would make me think it was an infection.

Are respiratory illnesses ever asymptomatic in rabbits? What could be causing the congestion?
 
Hmmm...this is really interesting to me. I very rarely would tell anyone to go against their vet, especially if the vet is rabbit savvy (I'm guessing your vet must be). Lung congestion is a definite worry and I would never put Ula under anesthetic if they are congested. The vet I work for typically does blood work before surgery and would do an x-ray if there were hightened white cells or other findings that signal an infection. I guess I have a couple of questions before I can really try to help here.

Did your vet do blood work? If so, did it show signs of infection?
Did she get multiple views of the chest?
What antibiotic does she want to use?
Has Ula been eating and drinking properly? Any weight loss?

I've never seen a rabbit with a respiratory infection, especially one that had lung congestion, be asymptomatic, but maybe someone else has. From what I've seen, a rabbit with a lung infection is usually very sick, I've seen it where they are "putting on a show" at the vet, but you can always see some signs.

I'm going to try to research this some and get back to you. I'm going to call a friend who has been a vet tech much longer then I have. She works with a different exotics vet then I do and might have different suggestions.

Jen
 
No blood work was done. The procedure today was supposed to be diagnostic for molar problems because she's been eating less hay lately and stopped eating her Oxbow pellets (but subsequently started eating her Zupreem pellets after), and her poops have been much smaller than usual. So the vet was going to do anesthesia to do a more thorough mouth investigation and trim the molars if necessary.

I did hear her sneeze a few times yesterday. I guess several times, in a short period of time, but not after.

Her eyes have been goopier than usual. I recall picking out stringy eye goop from the corners of her eyes for the last few days, every day. The goop was whitish colored and stringy.

I didn't think infection because it wasn't consistent and she doesn't have nasal discharge.

I requested the x-ray because Ula is an older rabbit and I was a bit concerned about anesthesia risk.

The vet (who is bunny savvy, but not incredibly so), noted that Ula was fine in every other respect of her health exam (heart rate, weight has been the same since her previous checkups, eyes look fine etc.) She said that in the the x-ray that was taken the lungs were hard to see but that they weren't "as clear as she would like". Implying that they weren't very congested, but enough so that she wouldn't want to do anesthesia today. I don't know how many x-rays were taken, but I think they usually do at least two.

I'm not sure on the antibiotic - my guess is that it will be to treat pasteurella, but I haven't gotten it yet. I'm picking her up in a couple of hours.


 
Okay, I just spoke with the vet and asked about asymptomatic infections, having bloodwork done, the possibility of it being some sort of mass, etc.

She said that there was no evidence of any mass whatsoever, just a bit of congestion. She said that in her experience rabbits can have fairly asymptomatic respiratory illnesses but usually there is some change in behaviour ("they may just act out of sorts") and she said that Ula's eating issues could be a sign of infection. I also mentioned the goopy eyes and she said that sometimes the outward signs can be minor as well.

She said that because Ula wasn't having any discharge nasally, culturing would be incredibly difficult and stressful. Blood work isn't being done because she doesn't think it's a mass and even if there is an infection white cell counts could be normal. She didn't state the name of the antibiotic but said it will treat pasteurella. I'm giving her the drug for 3 weeks and then we'll repeat the x-ray.

*sigh*

After all the stuff I just went through with medicating Earl and ultimately euthanizing him, I really don't want the same outcome for Ula. :cry2
 
That sounds like the best course. The change in eating is questionable and the fact that it just seems to be minor congestion do make a lot of sense. With everything you described, antibiotics sound like the best option. As a respiratory infection can cause a change in eating, Ula's molars may not be an issue which is great news for you because dental work can become so expensive!

Jen
 
The vet showed me the x-ray and basically said that her lungs didn't look "that bad", but the lack of clarity made her hesitant to do anesthesia.

Ula's on a 3-week course of Septra.

She still may have teeth problems in conjunction with resp. illness as she is still making the weird teeth noises after she eats...but we'll re-evaluate once her Septra is done.
 
You might not notice symptoms of a lower respiratory infection, because they'd be things like shortness of breath, increased respiration and heart rate, rather than a goopy nose or eyes.

I'm not a fan of Septra since it is a sulfa drug, which most rabbit pathogens are resistant to. In addition, sulfa drugs can lead to an overgrowth of clostridium in the GI tract. Is it possible to ask for a different drug, like zithromax, Convenia, or chloramphenicol?
 
I would certainly seek a second opinion....if nothing else just based on the drug prescribed. Sulfa drugs are quite old school and our experience is that they are generally ineffective against pasteurella. They have also been linked to a serious GI condition known as Tyzzer's Disease. In their day, similar to Enrofloxacin (Baytril), they were quite effective but misuse over the years has led to resistant bacteria....and pasteurella is one of the most resistant of the commonly found pathogens in a rabbit. Our response to a confirmed pasteurella infection would be either Penicillin, Zithromax or Convenia.

If the x-rays are digital....get a copy and post. I would be very interested in taking a look at those.

Randy
 
I can ask for a different drug, but probably won't be able to get there until Monday.

Will Septra harm her in the meantime? Is it really that bad? An exotics expert (like THE exotics expert in my region, based at the OVC) just prescribed Septra to my sister's baby bunny for coccidia and he did fine with it.

The x-rays were the old school kind. I actually asked for a copy earlier and was denied.
 
I think legally they have to give you a copy, but I'm not sure.

They use SMZ (one of the components of septra) a lot at the shelter, probably because it's cheaper, but it seems that the bunnies that are on it are eventually moved to other meds because they don't improve with SMZ.

I just don't like sulfa drugs because they were literally the first drugs discovered to have antibiotic effects, and were first used in the 1930s, so it's pretty fair to assume most bacteria have gained resistance to them. They're rarely used in human medicine anymore for this reason, although I did use a pretty good anti-acne treatment that was based on them once.

Coccidia are a parasite, and many will say that they too have gained resistance to sulfa drugs, although that is what is most commonly prescribed to treat them (across all species).

The thing is that many vets (and human doctors) start with the weakest, most broad-spectrum antibiotic they can, and then work their way through a list of drugs, gradually getting ones that are more specific and/or stronger/newer. This is because the more of a drug that is used, the more likely it is that strains resistant to that drug will appear. If they use the big guns on everything, bacteria might loose susceptibility to them, so when they really need an antibiotic that works quickly and effectively (like in a quickly-progressing infection, one that's in an already immune-compromised individual, etc), they won't have the big guns available.

When it's your bunny, and she's been having problems eating, and she needs her teeth filed but has to beat this infection first, I think it's time to get this under control quickly and use the big guns. A bunny that's not eating normally is a serious issue to me--not like when I get sick and lose my appetite a bit--I can do fine with less food for a few days, but a bunny can't.
 
They said that I could borrow the x-ray if I needed to but that I would have to return it eventually. Interesting.

I just sought a second opinion by consulting with my boyfriend's sister (a veterinarian working at the Toronto zoo) and she said she thinks Septra is a decent option...she mentioned some other drugs that target pasteurella more specifically, but they weren't the ones mentioned here.

Ula's eating has been better - still lesser on the hay, but she's been eating all her pellets. I think I'll follow the prescribed regime for now and if there's no improvement and the repeat chest x-ray still looks bad next week, I'll definitely mention some of the names given here. Obviously if she starts showing more outward symptoms or her eating patterns worsen, I'll book her an appointment asap and request alternatives. I can't get back to the vet till Monday anyway, so I'll see how she does on the Septra over the weekend.

Thanks though for all the advice...I didn't have a plan b before and now I do, so that is very much appreciated! :)
 
I too am not a big fan of sulfa drugs in general, but I have seen them be effective. I've seen other drugs used more recently, but different vets like different drugs. Just like different human doctors like different drugs. (Honestly, the drug my Rheumatologist is treating my RA pain and swelling with is really old school, but it works for me. And the only antibiotic I like for reptiles is Baytril, which is old school.) It's all in what works best for Ula.

Good Luck! Keep us posted on her progress!!

Jen
 
Ula's not doing so well with the oral Septra anyway. She fights me every step of the way.

Are there any injectable (better) alternatives? I feel like she'd do better with injections than syringe medicating.

Gahhhhhh.
 
Personally, I do find injections much easier to give to a bunny than an oral medication they do not like. I do injections rather than oral when ever possible now.

You will need to talk to your vet and have them show you how to give the injections. Pretty easy to do sub-q injections (under the skin).

You can do penicillin, convenia, baytril and others by injection. Penicillin and convenia must be by injection as they can be detrimental to a rabbit's gi tract if given orally.

-Dawn
 
A lot of owners find that injections are easier because bunnies can be uncooperative. Just be careful that none of the medicine gets on the fur. If they lick it off, it can be GI toxic.
 
Pipp wrote:
If she has an infection, the best way to reach it may be antibiotics in a nebulizer.
Click to expand...
That's a fabulous suggestion! I really like using nebulizer treatments for lower respiratory infections in a lot of animals. I've never used one for a rabbit, but I have for rats with a type of pneumonia and for my dog when he developed pneumonia following heptane poisoning.

If your vet likes this idea, the best way to do it is to create a nebulizer chamber. Basically you need to have a way of making sure that the only air taken in for the length of time the medication is to be used is that from the nebulizer. I have found that an easy way to do this is to place the animal in a pet carrier of some sort, the carrier is then placed in a large plastic bag, like a garbage bag, and the nebulizer mouth piece is placed inside the bag which is then fastened tightly around the tubing. The nebulizer provides enough oxygen that there is no worry of suffocation. However, I always suggest starting by doing this for a short period and watching the animal closely because the hissing of the nebulizer combined with the strangeness of the entire situation can cause them to become agitated. So short sessions are usually a good idea at first.
 
My vet basically said that if I wanted to consider anything other than an oral antibiotic I'd have to get a referral to an exotics specialist, which is about an hour and a half away and unfortunately, out of my student budget.

So Ula is on day 6 of her oral Sulfa. It's been a hassle trying to syringe it into her...I discovered she would take it mashed into a teeny piece of banana, but that stopped yesterday. Her eating has been on and off...the past few days it's been great, but today she's off her pellets again and only eating hay. The teeth scratching noises subsided over the weekend but are back today again.

She still has no nasal discharge or anything. She sneezes when she sniffs around her litter box (Carefresh changed daily).

Could an allergy cause lung congestion on an x-ray?
 
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