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J Vet Clin 2022; 39(5): 272-276

https://doi.org/10.17555/jvc.2022.39.5.272

Published online October 31, 2022

Successful Management of Subcutaneous Abscess in a Captive Leopard Gecko(Eublepharis macularius)

Phyo Wai Win1 , Haerin Rhim1 , Myeongsu Kim1,2 , Seulgi Gim2 , Jae-Ik Han1,2

1Laboratory of Wildlife Medicine, College of Veterinary Medicine, Jeonbuk National University, Iksan 54596, Korea
2Jeonbuk Wildlife Center, Jeonbuk National University, Iksan 54596, Korea

Correspondence to:*jihan@jbnu.ac.kr
Phyo Wai Win and Haerin Rhim contributed equally to this work.

Received: July 9, 2022; Revised: August 17, 2022; Accepted: September 13, 2022

Copyright © The Korean Society of Veterinary Clinics.

An 8 month old leopard gecko (Eublepharis macularius) with a large nodule was referred to our hospital. During the physical examination, the nodule had an unclear boundary from the top of the left eye to the front of the left ear and prevented the opening of the left eye. A hard, cheese-like, yellow, pus-filled nodule was observed. A cytological examination of a pus swab sample revealed pyogranulomatous inflammation with rod-shaped bacteria. Ofloxacin was chosen as the empirical topical antimicrobial drug for treatment. The swab samples were inoculated in trypticase soy agar with 5% sheep blood and incubated at 37°C for 24 h. Gram-negative bacteria were identified via Gram staining, and the Kirby-Bauer antimicrobial susceptible disk diffusion test against 24 antibiotics according to protocol M100-Ed32 of CLSI showed that the fluoroquinolone group (ciprofloxacin and enrofloxacin) was susceptible to the isolated bacteria. Molecular identification based on 16S ribosomal RNA gene sequencing confirmed that the isolated bacteria had a 99.85% nucleotide similarity with Serratia surfactantfaciens (GenBank accession no. CP014948). After 1 week, the boundaries of the nodule became clear; thus, the abscess was physically removed by expanding the hole formed above the eye for drainage, and flushing was repeated. After another 1 week, new tissue restoration without scarring was observed. This is a rare case report of the successful management of a subcutaneous abscess and scar-free healing in a lizard.

Keywords: lizard, subcutaneous abscess, wound management.

Except for some legless and snake-like reptile species, lizards are quadrupedal squamates. The skin of lizards is different from that of mammals and contains classical skin layers, which can vary in morphology at different positions. They are covered by overlapping keratin scales, enabling them to live in the driest deserts on Earth (6,19). Scales have many important functions, such as playing vital roles in skin permeability and providing protection from abrasion, and therefore tend to be thicker dorsally than ventrally (2,8). The skin participates in maintaining homeostasis to protect against microbial invasion, physical trauma, and environmental damage.

Skin infections are common in lizards and can lead to fatal organ diseases and septicemia (3). Because of the regular ecdysis period, the infection of skin wounds can occur frequently because they have no scales within this period. Some common risk factors may lead to abscesses, including poor hygiene, immune suppression, and trauma (9). Subcutaneous abscesses are pus-filled sores often accompanied by inflammation, which is usually caused by bacterial infection. Other conditions that may appear as abscesses include parasitic infections, tumors, and hematomas. However, a number of species of bacteria, often more than one kind at a time, can be present in reptile abscesses (1,11,17). The present study was conducted to determine how to successfully manage subcutaneous wounds using various laboratory tests and observations of new scar-free repair tissue regeneration in lizard wound healing.

An 8-month old leopard gecko (Eublepharis macularius) with a large nodule was referred to our hospital. A physical examination revealed that the nodule had an unclear boundary from the top of the left eye to the front of the left ear opening. The nodule prevented the patient from opening his left eye. The wound was observed that hard, cheese-like, yellow pus filled the nodule. A pus swab sample of the wound was collected for laboratory tests for cytology and microbial culture. Cytology revealed inflammation consisting of heterophils and macrophages with phagocytized rod-shaped bacteria, indicating bacterial infection (Fig. 1). Ofloxacin (Ocuflox® ophthalmic ointment, Samil, Seoul, Korea) was selected as the empirical topical antibiotic for the abscess.

Figure 1.Cytology shows pyogranulomatous inflammation with phagocytized rod-shaped bacteria, along with the bacteria in the background, indicating bacterial infection. Diff-Quik stain. ×1000.

The collected swab samples were inoculated in trypticase soy agar containing 5% sheep blood and incubated aerobically at 37°C for 24 h. Under microscopic examination, rod-shaped gram-negative bacteria were revealed via Gram staining (Fig. 2). The Kiryby-Bauer disk diffusion test on 24 antimicrobials (amikacin, gentamicin, enrofloxacin, ciprofloxacin, polymyxin B, streptomycin, amoxicillin/clavulanate, cefotaxime, cefazolin, cefepime, cefovecin, ampicillin/sulbactam, oxacillin, cefoxitin, vancomycin, rifampicin, quinupristin/dalfopristin, imipenem, erythromycin, and trimethoprim/sulfamethoxazole), chloramphenicol, clindamycin, tetracycline, and doxycycline) showed that the isolated bacteria were susceptible to amikacin, gentamicin, enrofloxacin, streptomycin ciprofloxacin, cefotaxime, cefepime, cefoxitin, and trimethroprim/sulfamethoxazole. Molecular identification of the isolated bacteria based on the sequence of the 16S ribosomal RNA gene by using 27F and 1492R primer showed that the identified sequence was 99.85% similar to Serratia surfactantfaciens (GenBank accession no. CP014948). Ofloxacin which was used as the empirical antibiotic, was maintained as the antibiotic for treatment.

Figure 2.Bacterial identification and antimicrobial susceptible test. (A) Morphology of inoculated bacteria in trypticase soy agar with 5% sheep blood. (B) Gram-negative bacteria. Gram staining. ×1000.

On the second visit, the boundaries of the abscess became clear, and a crust covered the surface of the abscess. We removed the crust, followed by the inner pus of the abscess. The inside of the abscess was then flushed several times with saline. By the 4th week, new tissue restoration without scar formation was observed. (Fig. 3).

Figure 3.Wound status and condition of patient. (A) Initial condition of wound with pus. (B) Wound status in which the boundary of the wound become clear after empirical antibiotic treatment. (C) New tissue restoration of wound after 1 week of pus removal and tissue debridement.

This case demonstrates that treatment according to the appropriate diagnostic procedures for locally occurring gecko abscesses can result in rapid and scar-free healing. In particular, when an abscess develops and invades the surrounding tissues, clearing the boundaries of the abscess through rapid antibiotic treatment shows that the subcutaneous abscess aggregates in the form of a lump, making it easier to physically remove.

Abscesses in reptiles are caused by the accumulation of trapped white blood cells. This trapping is called encapsulation because white blood cells are contained in the capsule of the tissue. This encapsulation of white blood cell material typically causes firm swelling or the formation of masses. Reptiles do not have enzymes that can break down or turn white blood cell material into liquid pus as in mammals (3).

Cytologically, a mass in the skin can be formed due to neoplasia, inflammation, or both. Inflammation can be classified as infectious or non-infectious. To differentiate the etiology of wounds, cytology can also be applied to swab samples from lesions in lizards (11). Generally, in mammals, neutrophils massively infiltrate the wound during the first 24 h post-injury (14) and are attracted by degradation products from pathogens and by the numerous inflammatory cytokines produced by activated platelets and endothelial cells. Macrophages massively infiltrate the wound after the first 24 h post-injury and exacerbate intense phagocytic activity during this stage (16). Heterophils, a type of granulocyte equivalent to mammalian neutrophils, are recruited to the wound site to participate in the phagocytosis of tissue debris and defense of various microbes in reptiles. Immunostaining revealed that these heterophils inhibit rather than trigger inflammation (7). In this case, we noted pyogranulomatous inflammation consisting of heterophils and macrophages phagocytizing rod-shaped bacteria, suggesting a chronic stage of bacterial infection. Bacterial culture and antibiotic susceptibility testing indicated that S. surfactantfaciens, a member of the Enterobacteriaceae group, was the causative agent of the lesion, indicating that the infection can originate from poor hygiene in the cage. Due to fluoroquinolone susceptibility, the lizard lesion infection was well-treated 3 consecutive week with ofloxacin.

The basic methods for wound management include primary closure, secondary intention, wound healing, and delayed primary closure methods. The first step in subcutaneous wound treatment is to irrigate the injured tissue. The next step in wound management is to reduce the natural tension placed on the wound via the sharp dissection of the devitalized tissue. Aggressive debridement is the key to facilitating epithelium regeneration. Flushing and wound cleaning are then performed. Surgical removal and wound closure methods vary among veterinarians (18). Many wounds, especially those that may be contaminated, are best managed with second-intention wound healing (20); the basic nature of this healing is wound contraction from natural epithelial migration, which can take days to weeks (11). In this case report, we managed the wound using a drainage pressure method without surgical closure, and wound healing was clearly noted after 1 week of necrotic tissue removal and aggressive debridement.

Wound healing is a dynamic morphogenetic event, which includes the activation of multiple intracellular and extracellular processes. It yields two possible outcomes: (6) the wound site is repaired with fibrotic scar tissue, or (19) the wound site undergoes scar-free healing and the original tissue is restored. Scar-free wound healing, as commonly demonstrated by urodeles, restores new tissue structure and, in most instances, occurs in reptiles (4). Unlike scar formation, scar-free healing involves more a rapid closure of the wound epithelium and a delay in blood vessel development and collagen deposition within the wound bed (5,10,12). Instead of replacing damaged tissue with a fibrous infill, the lizard undergoes a tissue-specific program to restore tissue architecture and function since blood vessels exist in multiple layers in the dermic skin layer. Adequate blood supply formation for wound healing can be achieved. In addition, regeneration in lizards is often paired with structural adaptations that minimize tissue damage and facilitate recovery. Although the entire epidermis and up to 90% of the dermis are initially sloughed off, the site of mutilation is completely restored over time. A similar mode of skin shedding (60% of the total dorsal body surface area) and subsequent regeneration have been documented in spiny mice (Acomys spp.) (15). Others, such as the green iguana (Lguana iguana), cannot heal scar-free (13), indicating that scar-free cutaneous repair is not a universal trait in lizards. Wound reparative phenomena are complex, varied, and influenced by numerous features. Our case showed complete scar-free wound healing and new tissue regeneration in a lizard. This may be due to the optimal antibiotic treatment and wound management methods combined with acute diagnostic laboratory tests.

This subject was supported by a National Institute of Wildlife Disease Control and Prevention as “Specialized Graduate School Support Project for Wildlife Diseases Specialists”.

The authors have no conflicting interests.

  1. Alworth LC, Hernandez SM, Divers SJ. Laboratory reptile surgery: principles and techniques. J Am Assoc Lab Anim Sci 2011; 50: 11-26.
  2. Chang C, Wu P, Baker RE, Maini PK, Alibardi L, Chuong CM. Reptile scale paradigm: Evo-Devo, pattern formation and regeneration. Int J Dev Biol 2009; 53: 813-826.
    Pubmed KoreaMed CrossRef
  3. Divers SJ. MSD Manual Veterinary Service Web site. Mycotic diseases of reptiles. Available at: https://www.msdvetmanual.com/exotic-and-laboratory-animals/reptiles/mycotic-diseases-of-reptiles. Accessed May 18, 2022.
  4. Ferguson MW, O’Kane S. Scar-free healing: from embryonic mechanisms to adult therapeutic intervention. Philos Trans R Soc Lond B Biol Sci 2004; 359: 839-850.
    Pubmed KoreaMed CrossRef
  5. Gurtner GC, Werner S, Barrandon Y, Longaker MT. Wound repair and regeneration. Nature 2008; 453: 314-321.
    Pubmed CrossRef
  6. Halliday T, Adler K. Firefly encyclopedia of reptiles and amphibians. Richmond Hill: Firefly Books. 2002: 139-169.
    CrossRef
  7. He B, Song H, Wang Y. Self-control of inflammation during tail regeneration of lizards. J Dev Biol 2021; 9: 48.
    Pubmed KoreaMed CrossRef
  8. Kardong K. Vertebrates: comparative anatomy, function, evolution. 3rd ed. New York: McGraw-Hill. 2002.
  9. Lock B. Veterinary Partner Web site. Abscesses in reptiles. Available at: https://veterinarypartner.vin.com/default.aspx?pid=19239&catId=102919&Id=9003821. Accessed May 18, 2022.
  10. Metcalfe AD, Ferguson MW. Tissue engineering of replacement skin: the crossroads of biomaterials, wound healing, embryonic development, stem cells and regeneration. J R Soc Interface 2007; 4: 413-437.
    Pubmed KoreaMed CrossRef
  11. Mitchell MA, Diaz-Figueroa O. Wound management in reptiles. Vet Clin North Am Exot Anim Pract 2004; 7: 123-140.
    Pubmed CrossRef
  12. Occleston NL, Metcalfe AD, Boanas A, Burgoyne NJ, Nield K, O’Kane S, et al. Therapeutic improvement of scarring: mechanisms of scarless and scar-forming healing and approaches to the discovery of new treatments. Dermatol Res Pract 2010; 2010: 405262.
    Pubmed KoreaMed CrossRef
  13. Peacock HM, Gilbert EA, Vickaryous MK. Scar-free cutaneous wound healing in the leopard gecko, Eublepharis macularius. J Anat 2015; 227: 596-610.
    Pubmed KoreaMed CrossRef
  14. Rodero MP, Khosrotehrani K. Skin wound healing modulation by macrophages. Int J Clin Exp Pathol 2010; 3: 643-653.
  15. Seifert AW, Kiama SG, Seifert MG, Goheen JR, Palmer TM, Maden M. Skin shedding and tissue regeneration in African spiny mice (Acomys). Nature 2012; 489: 561-565.
    Pubmed KoreaMed CrossRef
  16. Singer AJ, Clark RA. Cutaneous wound healing. N Engl J Med 1999; 341: 738-746.
    Pubmed CrossRef
  17. Singh BR, Singh V, Ebibeni N, Singh RK. Antimicrobial and herbal drug resistance in enteric bacteria isolated from faecal droppings of common house lizard/gecko (Hemidactylus frenatus). Int J Microbiol 2013; 2013: 340848.
    Pubmed KoreaMed CrossRef
  18. Smith DA, Barker IK. Healing of cutaneous wounds in the common garter snake (Thamnophis sirtalis). Can J Vet Res 1988; 52: 111-119.
  19. Starr C, Taggart R, Evers C, Starr L. Biology: the unity and diversity of life. 15th ed. Boston: Cengage Learning. 2012: 429.
  20. Swaim SF, Henderson RA, Fowwler D. Secondary management. In: Swaim SF, Henderson RA, Pidgeon RS, editors. Small animal wound management. Philadelphia: Lea & Febiger. 1990: 17-28.

Article

Case Report

J Vet Clin 2022; 39(5): 272-276

Published online October 31, 2022 https://doi.org/10.17555/jvc.2022.39.5.272

Copyright © The Korean Society of Veterinary Clinics.

Successful Management of Subcutaneous Abscess in a Captive Leopard Gecko(Eublepharis macularius)

Phyo Wai Win1 , Haerin Rhim1 , Myeongsu Kim1,2 , Seulgi Gim2 , Jae-Ik Han1,2

1Laboratory of Wildlife Medicine, College of Veterinary Medicine, Jeonbuk National University, Iksan 54596, Korea
2Jeonbuk Wildlife Center, Jeonbuk National University, Iksan 54596, Korea

Correspondence to:*jihan@jbnu.ac.kr
Phyo Wai Win and Haerin Rhim contributed equally to this work.

Received: July 9, 2022; Revised: August 17, 2022; Accepted: September 13, 2022

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

An 8 month old leopard gecko (Eublepharis macularius) with a large nodule was referred to our hospital. During the physical examination, the nodule had an unclear boundary from the top of the left eye to the front of the left ear and prevented the opening of the left eye. A hard, cheese-like, yellow, pus-filled nodule was observed. A cytological examination of a pus swab sample revealed pyogranulomatous inflammation with rod-shaped bacteria. Ofloxacin was chosen as the empirical topical antimicrobial drug for treatment. The swab samples were inoculated in trypticase soy agar with 5% sheep blood and incubated at 37°C for 24 h. Gram-negative bacteria were identified via Gram staining, and the Kirby-Bauer antimicrobial susceptible disk diffusion test against 24 antibiotics according to protocol M100-Ed32 of CLSI showed that the fluoroquinolone group (ciprofloxacin and enrofloxacin) was susceptible to the isolated bacteria. Molecular identification based on 16S ribosomal RNA gene sequencing confirmed that the isolated bacteria had a 99.85% nucleotide similarity with Serratia surfactantfaciens (GenBank accession no. CP014948). After 1 week, the boundaries of the nodule became clear; thus, the abscess was physically removed by expanding the hole formed above the eye for drainage, and flushing was repeated. After another 1 week, new tissue restoration without scarring was observed. This is a rare case report of the successful management of a subcutaneous abscess and scar-free healing in a lizard.

Keywords: lizard, subcutaneous abscess, wound management.

Introduction

Except for some legless and snake-like reptile species, lizards are quadrupedal squamates. The skin of lizards is different from that of mammals and contains classical skin layers, which can vary in morphology at different positions. They are covered by overlapping keratin scales, enabling them to live in the driest deserts on Earth (6,19). Scales have many important functions, such as playing vital roles in skin permeability and providing protection from abrasion, and therefore tend to be thicker dorsally than ventrally (2,8). The skin participates in maintaining homeostasis to protect against microbial invasion, physical trauma, and environmental damage.

Skin infections are common in lizards and can lead to fatal organ diseases and septicemia (3). Because of the regular ecdysis period, the infection of skin wounds can occur frequently because they have no scales within this period. Some common risk factors may lead to abscesses, including poor hygiene, immune suppression, and trauma (9). Subcutaneous abscesses are pus-filled sores often accompanied by inflammation, which is usually caused by bacterial infection. Other conditions that may appear as abscesses include parasitic infections, tumors, and hematomas. However, a number of species of bacteria, often more than one kind at a time, can be present in reptile abscesses (1,11,17). The present study was conducted to determine how to successfully manage subcutaneous wounds using various laboratory tests and observations of new scar-free repair tissue regeneration in lizard wound healing.

Case Report

An 8-month old leopard gecko (Eublepharis macularius) with a large nodule was referred to our hospital. A physical examination revealed that the nodule had an unclear boundary from the top of the left eye to the front of the left ear opening. The nodule prevented the patient from opening his left eye. The wound was observed that hard, cheese-like, yellow pus filled the nodule. A pus swab sample of the wound was collected for laboratory tests for cytology and microbial culture. Cytology revealed inflammation consisting of heterophils and macrophages with phagocytized rod-shaped bacteria, indicating bacterial infection (Fig. 1). Ofloxacin (Ocuflox® ophthalmic ointment, Samil, Seoul, Korea) was selected as the empirical topical antibiotic for the abscess.

Figure 1. Cytology shows pyogranulomatous inflammation with phagocytized rod-shaped bacteria, along with the bacteria in the background, indicating bacterial infection. Diff-Quik stain. ×1000.

The collected swab samples were inoculated in trypticase soy agar containing 5% sheep blood and incubated aerobically at 37°C for 24 h. Under microscopic examination, rod-shaped gram-negative bacteria were revealed via Gram staining (Fig. 2). The Kiryby-Bauer disk diffusion test on 24 antimicrobials (amikacin, gentamicin, enrofloxacin, ciprofloxacin, polymyxin B, streptomycin, amoxicillin/clavulanate, cefotaxime, cefazolin, cefepime, cefovecin, ampicillin/sulbactam, oxacillin, cefoxitin, vancomycin, rifampicin, quinupristin/dalfopristin, imipenem, erythromycin, and trimethoprim/sulfamethoxazole), chloramphenicol, clindamycin, tetracycline, and doxycycline) showed that the isolated bacteria were susceptible to amikacin, gentamicin, enrofloxacin, streptomycin ciprofloxacin, cefotaxime, cefepime, cefoxitin, and trimethroprim/sulfamethoxazole. Molecular identification of the isolated bacteria based on the sequence of the 16S ribosomal RNA gene by using 27F and 1492R primer showed that the identified sequence was 99.85% similar to Serratia surfactantfaciens (GenBank accession no. CP014948). Ofloxacin which was used as the empirical antibiotic, was maintained as the antibiotic for treatment.

Figure 2. Bacterial identification and antimicrobial susceptible test. (A) Morphology of inoculated bacteria in trypticase soy agar with 5% sheep blood. (B) Gram-negative bacteria. Gram staining. ×1000.

On the second visit, the boundaries of the abscess became clear, and a crust covered the surface of the abscess. We removed the crust, followed by the inner pus of the abscess. The inside of the abscess was then flushed several times with saline. By the 4th week, new tissue restoration without scar formation was observed. (Fig. 3).

Figure 3. Wound status and condition of patient. (A) Initial condition of wound with pus. (B) Wound status in which the boundary of the wound become clear after empirical antibiotic treatment. (C) New tissue restoration of wound after 1 week of pus removal and tissue debridement.

Discussion

This case demonstrates that treatment according to the appropriate diagnostic procedures for locally occurring gecko abscesses can result in rapid and scar-free healing. In particular, when an abscess develops and invades the surrounding tissues, clearing the boundaries of the abscess through rapid antibiotic treatment shows that the subcutaneous abscess aggregates in the form of a lump, making it easier to physically remove.

Abscesses in reptiles are caused by the accumulation of trapped white blood cells. This trapping is called encapsulation because white blood cells are contained in the capsule of the tissue. This encapsulation of white blood cell material typically causes firm swelling or the formation of masses. Reptiles do not have enzymes that can break down or turn white blood cell material into liquid pus as in mammals (3).

Cytologically, a mass in the skin can be formed due to neoplasia, inflammation, or both. Inflammation can be classified as infectious or non-infectious. To differentiate the etiology of wounds, cytology can also be applied to swab samples from lesions in lizards (11). Generally, in mammals, neutrophils massively infiltrate the wound during the first 24 h post-injury (14) and are attracted by degradation products from pathogens and by the numerous inflammatory cytokines produced by activated platelets and endothelial cells. Macrophages massively infiltrate the wound after the first 24 h post-injury and exacerbate intense phagocytic activity during this stage (16). Heterophils, a type of granulocyte equivalent to mammalian neutrophils, are recruited to the wound site to participate in the phagocytosis of tissue debris and defense of various microbes in reptiles. Immunostaining revealed that these heterophils inhibit rather than trigger inflammation (7). In this case, we noted pyogranulomatous inflammation consisting of heterophils and macrophages phagocytizing rod-shaped bacteria, suggesting a chronic stage of bacterial infection. Bacterial culture and antibiotic susceptibility testing indicated that S. surfactantfaciens, a member of the Enterobacteriaceae group, was the causative agent of the lesion, indicating that the infection can originate from poor hygiene in the cage. Due to fluoroquinolone susceptibility, the lizard lesion infection was well-treated 3 consecutive week with ofloxacin.

The basic methods for wound management include primary closure, secondary intention, wound healing, and delayed primary closure methods. The first step in subcutaneous wound treatment is to irrigate the injured tissue. The next step in wound management is to reduce the natural tension placed on the wound via the sharp dissection of the devitalized tissue. Aggressive debridement is the key to facilitating epithelium regeneration. Flushing and wound cleaning are then performed. Surgical removal and wound closure methods vary among veterinarians (18). Many wounds, especially those that may be contaminated, are best managed with second-intention wound healing (20); the basic nature of this healing is wound contraction from natural epithelial migration, which can take days to weeks (11). In this case report, we managed the wound using a drainage pressure method without surgical closure, and wound healing was clearly noted after 1 week of necrotic tissue removal and aggressive debridement.

Wound healing is a dynamic morphogenetic event, which includes the activation of multiple intracellular and extracellular processes. It yields two possible outcomes: (6) the wound site is repaired with fibrotic scar tissue, or (19) the wound site undergoes scar-free healing and the original tissue is restored. Scar-free wound healing, as commonly demonstrated by urodeles, restores new tissue structure and, in most instances, occurs in reptiles (4). Unlike scar formation, scar-free healing involves more a rapid closure of the wound epithelium and a delay in blood vessel development and collagen deposition within the wound bed (5,10,12). Instead of replacing damaged tissue with a fibrous infill, the lizard undergoes a tissue-specific program to restore tissue architecture and function since blood vessels exist in multiple layers in the dermic skin layer. Adequate blood supply formation for wound healing can be achieved. In addition, regeneration in lizards is often paired with structural adaptations that minimize tissue damage and facilitate recovery. Although the entire epidermis and up to 90% of the dermis are initially sloughed off, the site of mutilation is completely restored over time. A similar mode of skin shedding (60% of the total dorsal body surface area) and subsequent regeneration have been documented in spiny mice (Acomys spp.) (15). Others, such as the green iguana (Lguana iguana), cannot heal scar-free (13), indicating that scar-free cutaneous repair is not a universal trait in lizards. Wound reparative phenomena are complex, varied, and influenced by numerous features. Our case showed complete scar-free wound healing and new tissue regeneration in a lizard. This may be due to the optimal antibiotic treatment and wound management methods combined with acute diagnostic laboratory tests.

Acknowledgements

This subject was supported by a National Institute of Wildlife Disease Control and Prevention as “Specialized Graduate School Support Project for Wildlife Diseases Specialists”.

Conflicts of Interest

The authors have no conflicting interests.

Fig 1.

Figure 1.Cytology shows pyogranulomatous inflammation with phagocytized rod-shaped bacteria, along with the bacteria in the background, indicating bacterial infection. Diff-Quik stain. ×1000.
Journal of Veterinary Clinics 2022; 39: 272-276https://doi.org/10.17555/jvc.2022.39.5.272

Fig 2.

Figure 2.Bacterial identification and antimicrobial susceptible test. (A) Morphology of inoculated bacteria in trypticase soy agar with 5% sheep blood. (B) Gram-negative bacteria. Gram staining. ×1000.
Journal of Veterinary Clinics 2022; 39: 272-276https://doi.org/10.17555/jvc.2022.39.5.272

Fig 3.

Figure 3.Wound status and condition of patient. (A) Initial condition of wound with pus. (B) Wound status in which the boundary of the wound become clear after empirical antibiotic treatment. (C) New tissue restoration of wound after 1 week of pus removal and tissue debridement.
Journal of Veterinary Clinics 2022; 39: 272-276https://doi.org/10.17555/jvc.2022.39.5.272

References

  1. Alworth LC, Hernandez SM, Divers SJ. Laboratory reptile surgery: principles and techniques. J Am Assoc Lab Anim Sci 2011; 50: 11-26.
  2. Chang C, Wu P, Baker RE, Maini PK, Alibardi L, Chuong CM. Reptile scale paradigm: Evo-Devo, pattern formation and regeneration. Int J Dev Biol 2009; 53: 813-826.
    Pubmed KoreaMed CrossRef
  3. Divers SJ. MSD Manual Veterinary Service Web site. Mycotic diseases of reptiles. Available at: https://www.msdvetmanual.com/exotic-and-laboratory-animals/reptiles/mycotic-diseases-of-reptiles. Accessed May 18, 2022.
  4. Ferguson MW, O’Kane S. Scar-free healing: from embryonic mechanisms to adult therapeutic intervention. Philos Trans R Soc Lond B Biol Sci 2004; 359: 839-850.
    Pubmed KoreaMed CrossRef
  5. Gurtner GC, Werner S, Barrandon Y, Longaker MT. Wound repair and regeneration. Nature 2008; 453: 314-321.
    Pubmed CrossRef
  6. Halliday T, Adler K. Firefly encyclopedia of reptiles and amphibians. Richmond Hill: Firefly Books. 2002: 139-169.
    CrossRef
  7. He B, Song H, Wang Y. Self-control of inflammation during tail regeneration of lizards. J Dev Biol 2021; 9: 48.
    Pubmed KoreaMed CrossRef
  8. Kardong K. Vertebrates: comparative anatomy, function, evolution. 3rd ed. New York: McGraw-Hill. 2002.
  9. Lock B. Veterinary Partner Web site. Abscesses in reptiles. Available at: https://veterinarypartner.vin.com/default.aspx?pid=19239&catId=102919&Id=9003821. Accessed May 18, 2022.
  10. Metcalfe AD, Ferguson MW. Tissue engineering of replacement skin: the crossroads of biomaterials, wound healing, embryonic development, stem cells and regeneration. J R Soc Interface 2007; 4: 413-437.
    Pubmed KoreaMed CrossRef
  11. Mitchell MA, Diaz-Figueroa O. Wound management in reptiles. Vet Clin North Am Exot Anim Pract 2004; 7: 123-140.
    Pubmed CrossRef
  12. Occleston NL, Metcalfe AD, Boanas A, Burgoyne NJ, Nield K, O’Kane S, et al. Therapeutic improvement of scarring: mechanisms of scarless and scar-forming healing and approaches to the discovery of new treatments. Dermatol Res Pract 2010; 2010: 405262.
    Pubmed KoreaMed CrossRef
  13. Peacock HM, Gilbert EA, Vickaryous MK. Scar-free cutaneous wound healing in the leopard gecko, Eublepharis macularius. J Anat 2015; 227: 596-610.
    Pubmed KoreaMed CrossRef
  14. Rodero MP, Khosrotehrani K. Skin wound healing modulation by macrophages. Int J Clin Exp Pathol 2010; 3: 643-653.
  15. Seifert AW, Kiama SG, Seifert MG, Goheen JR, Palmer TM, Maden M. Skin shedding and tissue regeneration in African spiny mice (Acomys). Nature 2012; 489: 561-565.
    Pubmed KoreaMed CrossRef
  16. Singer AJ, Clark RA. Cutaneous wound healing. N Engl J Med 1999; 341: 738-746.
    Pubmed CrossRef
  17. Singh BR, Singh V, Ebibeni N, Singh RK. Antimicrobial and herbal drug resistance in enteric bacteria isolated from faecal droppings of common house lizard/gecko (Hemidactylus frenatus). Int J Microbiol 2013; 2013: 340848.
    Pubmed KoreaMed CrossRef
  18. Smith DA, Barker IK. Healing of cutaneous wounds in the common garter snake (Thamnophis sirtalis). Can J Vet Res 1988; 52: 111-119.
  19. Starr C, Taggart R, Evers C, Starr L. Biology: the unity and diversity of life. 15th ed. Boston: Cengage Learning. 2012: 429.
  20. Swaim SF, Henderson RA, Fowwler D. Secondary management. In: Swaim SF, Henderson RA, Pidgeon RS, editors. Small animal wound management. Philadelphia: Lea & Febiger. 1990: 17-28.

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