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Prevalence of IBD?
I rescued a little Nicaraguan boa the other day. She's very tiny (at two years old) and wasn't properly cared for. Otherwise, she seems healthy. That doesn't mean anything in reference to IBD per se.
Does *anyone* know the actual prevalence of IBD in boas? I have always wanted some boas, but I'm terrified to keep them, because I have a beloved collection of balls that is irreplaceable. I've heard anywhere between rare to ALL boas (I know the latter isn't true) and anywhere in between.
Right now, the little lady is on a different floor in a different room from my BPs. I handle her and shower, and don't touch my BPs for at least 12 hours.
It's driving me *insane*. The paranoia is taking the fun out of what should be a fun pet.
Ideally, I'd like to eventually keep her in the same rack system as my BP collection. She will more than likely stay very tiny from what I understand about her, her age, locale, and her upbringing.
I contacted Dr. Jacobson, who has studied IBD at the University of Florida. He basically said I should be concerned, and have two tests done. The blood test seems inaccurate -- he said more often then not "he sees false negatives more than false positives". That's an unnerving prospect.
Has anyone had the blood test done on their boas? What is the process, your experiences, etc (please share)?
How worried should I be about this situation?
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I say do the normal quarantine and go from there. I keep both my boas with my BP and all is fine. I wouldn't say IBD is that common or at least I haven't heard a lot of people having problems with it. The thing when someone does have a problem with it, you definitely hear about it on the forums but its the minority imo. Now boas can be carriers for it as in they have it but don't ever show signs. The only way to find out is put a BP with them and see what happens to the BP as its fatal in pythons. Also I think a lot of people who claim their snake has IBD might have something else like an overheated snake which cause neurological disorders too and people instantly jump to IBD. As far as I know, there is no sure fire way to check for IBD in a living boa. I think the only way is either take a liver sample which again I'm not sure on, I think I read it somewhere or a 100% way to check is like I said, put the boa in contact with a ball python for a bit under your supervision and then see if the BP dies in a few days as IBD is quick and fatal in pythons. Cruel but the only 100% way I know of. But also like I said, I don't think IBD is really as common as some people make it out to be. look at all the breeders that breed boas and pythons, you don't really hear about many IBD breakouts wiping out collections, think I read about 2-3 in the past 10-20 years. But at the end of the day, it's your collection and your choice.
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Re: Prevalence of IBD?
Quote:
Originally Posted by Running Elk
I rescued a little Nicaraguan boa the other day. She's very tiny (at two years old) and wasn't properly cared for. Otherwise, she seems healthy. That doesn't mean anything in reference to IBD per se.
Does *anyone* know the actual prevalence of IBD in boas? I have always wanted some boas, but I'm terrified to keep them, because I have a beloved collection of balls that is irreplaceable. I've heard anywhere between rare to ALL boas (I know the latter isn't true) and anywhere in between.
Right now, the little lady is on a different floor in a different room from my BPs. I handle her and shower, and don't touch my BPs for at least 12 hours.
It's driving me *insane*. The paranoia is taking the fun out of what should be a fun pet.
Ideally, I'd like to eventually keep her in the same rack system as my BP collection. She will more than likely stay very tiny from what I understand about her, her age, locale, and her upbringing.
I contacted Dr. Jacobson, who has studied IBD at the University of Florida. He basically said I should be concerned, and have two tests done. The blood test seems inaccurate -- he said more often then not "he sees false negatives more than false positives". That's an unnerving prospect.
Has anyone had the blood test done on their boas? What is the process, your experiences, etc (please share)?
How worried should I be about this situation?
As far as prevalence goes, there are two things to keep in mind:
(1) the prevalence as a function of boas being asymptomatic carriers.
(2) the prevalence as a function of boas actually becoming symptomatic.
Last time I checked on the literature, almost a third of all boas are thought to be asymptomatic carriers - which mean they harbor the virus but do not yet suffer from the effects. Some claim that number to be even higher. Many of those snakes will remain carriers and never develop the disease.
...and there is no literature as to how many asymptomatic carriers eventually develop into symptomatic victims.
There is also no proof that it strikes pythons quicker than boas or that pythons cannot also remain asymptomatic for an undefined period of time. Many of the early stories of IBD ravaging ball python collections (some of the most famous ones) were later found to be other diseases.
As for testing...the blood test is the least intrusive method. Other methods on living animals involve biopsies and are limited by the simple fact that if the inclusion bodies are not in the biopsied organ, it cannot be detected.
Many years ago I had two tarahumara boas that were diagnosed with IBD...one was symptomatic, one was not. The symptoms were mild - lack of appetite and anorexia. I had to pay for several biopsies to diagnose the first snake. I had both euthanized. None of my pythons ever came down with the disease or tested positive for it.
As with many reptile maladies, the extent of the problem is undefined - mainly because this hobby seems rife with people who don't feel the need to take their animals to a proper vet (if they go at all) or have necropsies done on animals that pass away.
This has also led to the plethora of misinformation on IBD. Someone loses a large collection of ball pythons over a short period of time to a virulent disease. They take it to a vet that is less than informed on reptiles and the first thing that gets tossed out there is IBD. Since the symptoms of IBD cover the spectrum of just about every viral or bacterial malady that affects snakes, IBD is labeled as the culprit without any proof.
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Re: Prevalence of IBD?
Quote:
Originally Posted by Running Elk
I contacted Dr. Jacobson, who has studied IBD at the University of Florida. He basically said I should be concerned, and have two tests done. The blood test seems inaccurate -- he said more often then not "he sees false negatives more than false positives". That's an unnerving prospect.
This is correct, which is why they recommend two blood tests at least 90 days apart - the likelihood of two false negative results in a critter with IBD is fairly low.
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Re: Prevalence of IBD?
I was was a bit vague; I'm absolutely referring to the prevalence of asymptimatic carriers, which is my major concern with keeping boas.
Thanks for this wonderful reply.
Quote:
Originally Posted by Skiploder
As far as prevalence goes, there are two things to keep in mind:
(1) the prevalence as a function of boas being asymptomatic carriers.
(2) the prevalence as a function of boas actually becoming symptomatic.
Last time I checked on the literature, almost a third of all boas are thought to be asymptomatic carriers - which mean they harbor the virus but do not yet suffer from the effects. Some claim that number to be even higher. Many of those snakes will remain carriers and never develop the disease.
...and there is no literature as to how many asymptomatic carriers eventually develop into symptomatic victims.
There is also no proof that it strikes pythons quicker than boas or that pythons cannot also remain asymptomatic for an undefined period of time. Many of the early stories of IBD ravaging ball python collections (some of the most famous ones) were later found to be other diseases.
As for testing...the blood test is the least intrusive method. Other methods on living animals involve biopsies and are limited by the simple fact that if the inclusion bodies are not in the biopsied organ, it cannot be detected.
Many years ago I had two tarahumara boas that were diagnosed with IBD...one was symptomatic, one was not. The symptoms were mild - lack of appetite and anorexia. I had to pay for several biopsies to diagnose the first snake. I had both euthanized. None of my pythons ever came down with the disease or tested positive for it.
As with many reptile maladies, the extent of the problem is undefined - mainly because this hobby seems rife with people who don't feel the need to take their animals to a proper vet (if they go at all) or have necropsies done on animals that pass away.
This has also led to the plethora of misinformation on IBD. Someone loses a large collection of ball pythons over a short period of time to a virulent disease. They take it to a vet that is less than informed on reptiles and the first thing that gets tossed out there is IBD. Since the symptoms of IBD cover the spectrum of just about every viral or bacterial malady that affects snakes, IBD is labeled as the culprit without any proof.
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I'm sort of waiting until I graduate in a week to deal with this. This was a terrible time to rescue a boa.
I did contact my vet though, they don't do IBD tests or work with labs that do, however if I bring her in they'll take blood and package it for shipping properly, and I can send it wherever it needs to go.
I guess I'll figure that all out next week. I basically have an idea, I just need to make some phone calls and tie up the details, payment, etc.
What a mess.
Thank you everyone for your replies. Feel free to post anything else if it comes to you -- I want to learn as much about this as I can. There is a wild amount of misinformation/conflicting information on the subject flying around the web; I'm grateful that I have gotten some very helpful and solid replies on here.
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Re: Prevalence of IBD?
I have have had several people suggest putting a BP with her to see if it dies. That seems to be a common practice. Do people who raise both boas and pythons regularly use this method? I'm not sure that any of the people who have suggested it to me have actually ever done it themselves...I didn't ask.
I don't know how I feel about this; I certainly have some ethical concerns -- technicalities on whether it's a reliable method or not aside. On the one hand, there are many things I'd sacrifice for my BP collection's safety and health. I'd most assuredly choose my BPs lives over the life of one random BP if I had to choose, right or wrong. But at that point (having to sacrifice for their safety) I'd probably just rehome the boa instead, because she could be happy elsewhere and I wouldn't have to theoretically kill a snake. I don't need to have a boa, I want to have a boa. I'd feel bad sentencing a BP to death for a want.
I guess it's probably much different if you raise and breed both species and have a notable collection of both - I have a ton invested in my BP collection and just one new boa...I just don't think that method is the right option for me or my situation.
I really like her (the boa), I'm willing to pay for the tests and see how it goes.
Quote:
Originally Posted by Sauzo
I say do the normal quarantine and go from there. I keep both my boas with my BP and all is fine. I wouldn't say IBD is that common or at least I haven't heard a lot of people having problems with it. The thing when someone does have a problem with it, you definitely hear about it on the forums but its the minority imo. Now boas can be carriers for it as in they have it but don't ever show signs. The only way to find out is put a BP with them and see what happens to the BP as its fatal in pythons. Also I think a lot of people who claim their snake has IBD might have something else like an overheated snake which cause neurological disorders too and people instantly jump to IBD. As far as I know, there is no sure fire way to check for IBD in a living boa. I think the only way is either take a liver sample which again I'm not sure on, I think I read it somewhere or a 100% way to check is like I said, put the boa in contact with a ball python for a bit under your supervision and then see if the BP dies in a few days as IBD is quick and fatal in pythons. Cruel but the only 100% way I know of. But also like I said, I don't think IBD is really as common as some people make it out to be. look at all the breeders that breed boas and pythons, you don't really hear about many IBD breakouts wiping out collections, think I read about 2-3 in the past 10-20 years. But at the end of the day, it's your collection and your choice.
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Re: Prevalence of IBD?
Quote:
Originally Posted by Running Elk
I have have had several people suggest putting a BP with her to see if it dies. That seems to be a common practice. Do people who raise both boas and pythons regularly use this method? I'm not sure that any of the people who have suggested it to me have actually ever done it themselves...I didn't ask.
Before the blood test became available recently people used to pick up a normal male BP and house it in the same room/rack with their quarantined boa to act as a "canary in the coal mine". If the BP got sick then they knew the boa was a carrier. Crude, but cheap and effective. Not something I would do though, I'd just pay for the blood test if I were concerned.
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Re: Prevalence of IBD?
Ok so if ibd was so bad dint you think they would be allowed at the expos?
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Re: Prevalence of IBD?
Quote:
Originally Posted by bcr229
Before the blood test became available recently people used to pick up a normal male BP and house it in the same room/rack with their quarantined boa to act as a "canary in the coal mine". If the BP got sick then they knew the boa was a carrier. Crude, but cheap and effective. Not something I would do though, I'd just pay for the blood test if I were concerned.
...except that ball pythons don't die first, or faster or are any less able to remain asymptomatic carriers.:confusd:
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Re: Prevalence of IBD?
Quote:
Originally Posted by frostysBP
Ok so if ibd was so bad dint you think they would be allowed at the expos?
There are much worse things than IBD....and you can get them at an Expo as well.....
....and they aren't confined to just boids.
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Re: Prevalence of IBD?
Quote:
Originally Posted by Skiploder
...except that ball pythons don't die first, or faster or are any less able to remain asymptomatic carriers.:confusd:
Is this a fact, or just that we have no absolute proof that they cannot in fact be asymptomatic carriers like boas?
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Re: Prevalence of IBD?
Quote:
Originally Posted by Skiploder
There are much worse things than IBD....and you can get them at an Expo as well.....
....and they aren't confined to just boids.
You can't be that ominous on my thread and then not tell me what those worse things are. :colbert: :P What do you have in mind?
I'm sure there are lots of really nasty things at shows. Anyone can buy a table at one.
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Re: Prevalence of IBD?
Quote:
Originally Posted by Running Elk
Is this a fact, or just that we have no absolute proof that they cannot in fact be asymptomatic carriers like boas?
No absolute proof. I asked Jacobsen myself and shared the info on this forum.
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Re: Prevalence of IBD?
Quote:
Originally Posted by Running Elk
You can't be that ominous on my thread and then not tell me what those worse things are. :colbert: :P What do you have in mind?
I'm sure there are lots of really nasty things at shows. Anyone can buy a table at one.
I'll name one per day for the next week:
1. OPMV
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Re: Prevalence of IBD?
Quote:
Originally Posted by Skiploder
I'll name one per day for the next week:
1. OPMV
http://labs.vetmed.ufl.edu/sample-re...nfections/opm/
In Australia it is also referred to as ferlavirus.
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Re: Prevalence of IBD?
Quote:
Originally Posted by Skiploder
No absolute proof. I asked Jacobsen myself and shared the info on this forum.
Despite there being no proof, is there any documented evidence leaning one way or another (that pythons can be asymptomatic carriers, or that they cannot be)? As in, has it been studied or anything? Or is the subject virtually unknown?
How is it that we know that boas can be asymptomatic carriers, but we do not know for pythons? Is it just that so far a python not showing any symptoms has not also tested positive for IBD (which, of course, doesn't mean they don't exist, it could just mean we haven't found one that does)?
If there is no proof, I find it interesting that so many people think as fact that pythons cannot be asymptomatic carriers...I wonder if this conclusion came from personal experience or mass misinformation on the subject (or both). :confusd:
This is all very interesting -- I'm really glad I started this thread.
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Re: Prevalence of IBD?
Quote:
Originally Posted by Running Elk
Despite there being no proof, is there any documented evidence leaning one way or another (that pythons can be asymptomatic carriers, or that they cannot be)? As in, has it been studied or anything? Or is the subject virtually unknown?
How is it that we know that boas can be asymptomatic carriers, but we do not know for pythons? Is it just that so far a python not showing any symptoms has not also tested positive for IBD (which, of course, doesn't mean they don't exist, it could just mean we haven't found one that does)?
If there is no proof, I find it interesting that so many people think as fact that pythons cannot be asymptomatic carriers...I wonder if this conclusion came from personal experience or mass misinformation on the subject (or both). :confusd:
This is all very interesting -- I'm really glad I started this thread.
Mass information.
Just like the mass information out there that it always shows up with corkscrewing and neuro symptoms....the myth comes from the prevalence of early stories where whole ball collections were allegedly quickly wiped out. One of the most famous and well publicized IBD accounts was later proven to be a nasty case of viral encephalitis.
That brings us to our second in a line of ailments you can bring home from a reptile show:
(2) Adenovirus
Stay tuned for our next installment, where we veer off of viruses and into the wonderful world of highly contagious bacterial infections.
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Re: Prevalence of IBD?
This is the copy of the first email exchange I had with Dr. Jacobsen. I feel comfortable sharing this openly as he has answered virtually the same to other people. I have shared it previously with some mods on this site.
(1) How long can a python or boa be asymptomatic?
No one knows. I have had snakes sent to me as control normals and they had IBD.
(2) What is the estimated infection rate among boa constrictors in the U.S.?
There is none. This would require a survey to owners and many would not tell you the truth.
(3) How long after I put my boas down can I safely assume that my pythons (mainly aspidites and antaresia) are safe?
I can't answer this because I have no data to support an answer, especially since we do not know how long a python can be asymptomatic.
(4) Can I also assume the same for my colubrids (clelia, drymarchon and rhamphiophis?).
Only one case has been seen in a colubrid and that needs to be revisited since that was based on H&E staining. We recently produced a monoclonal antibody against the IBD protein and are in the midst of validating it. There has been very limited money we have received to study this disease.
(5) Do you know of any boa breeders that are (a) either contributing to the research on this disease or (b) attempting to screen their animals?
No one recently.
I paid for liver and esophageal biopsies on random pythons at the time the disease was diagnosed in my boas all were negative. I have been a bit frustrated in talking to boa breeders as some of the better-known breeders pretty much poo-pooed the disease.
That is because they are in denial and if snakes that they sell eventually die then most people will go out and by another snake. As long as breeders can continue to sell animals, they could care less about solving health problems of these animals. That is the way this business will be for a long time to come. What is the incentive to change? Some snakes will only have IBD inclusions in the brain. Identifying these snakes before death right now is impossible.
Hope this helps,
EJacobson
This was in October of 2008.
Now with regards to some of the more publicized cases: While I was trying to make heads or tails between what I had read and what I was being told by vets, I contacted a forum member (another forum) and we discussed what he reported and what he later learned. What he had been told was IBD later turned out to be OPMV. IBD had been diagnosed based on his boas going first and necropsies finding the inclusion cells in the pharangeal esophagus. When his colubrids and elapids started dropping of, the vet then changed tack and OPMV was found to be the causative agent - the IBD was presumably there in his boas asymptomatically.
With the second case - this is the one with the old you tube videos and the lengthy write up on a popular but crappy herp info site. I tracked down the owner of the ball python collection and she said that after losing just about everything and being frustrated by her Vet's inability to contain what was going on, she got a second opinion, a new round of testing showed that (1) her biopsies never showed IBD (2) the final diagnosis was viral meningitis. Years ago I sent her an email and asked her to join here and relate her story...she never did.
It took a long time between the diagnosis of my first tarahumara and the end of the live biopsy screening of my pythons. In the interim, our vet pulled in another vet who had more experience with IBD and the veterinary staff at Davis. That is where I started hear more of what Dr. Jacobsen had related to me - that the whole python and IBD quick die-off thing was something that they hadn't seen. It was also where they informed me that OPMV and other viruses are largely unreported, mis-diagnosed (because snake owners by and large don't go for the testing) and that with all the focus on IBD, they felt that many of the virulent outbreaks with rapid die offs were OPMV or the like. More recently, the GGV virus was implicated in mass die offs....but that is another story....
What I was left with was this: IBD is often indicated in collection wide die offs. However, this was based on necropsies showing it present in boas in the collection. This was most likely coincidence as other viruses were later found that caused the deaths.
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Re: Prevalence of IBD?
How fascinating.
How do people acquire these other viruses that you've mentioned as being the culprits of various outbreaks? From outside animals (not quarantining), or do they also lay dormant in their animals until a specific time? I would think that a rapid mass die-off of animals would almost certainly indicate that they brought it in from elsewhere abruptly.
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Also, should the little boa test positive for IBD, then what should I do? It would be asymptomatic at this point.
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Re: Prevalence of IBD?
Quote:
Originally Posted by Running Elk
How fascinating.
How do people acquire these other viruses that you've mentioned as being the culprits of various outbreaks? From outside animals (not quarantining), or do they also lay dormant in their animals until a specific time? I would think that a rapid mass die-off of animals would almost certainly indicate that they brought it in from elsewhere abruptly.
OPMV can lay dormant for a period of time, as can other viruses. Other ailments - some bacterial - can actually be subclinical for a period that exceeds whatever QT period you read about in most care sheets.
You have a collection of ball pythons, you go to an expo and pick up a new caramel sugar mega pied fudge and it is an asymptomatic carrier of OPMV. At some point, past the cookie cutter QT period, the snake becomes symptomatic for whatever reason and then begins shedding the virus. Boom your whole collection is now at risk.
Quote:
Originally Posted by Running Elk
Also, should the little boa test positive for IBD, then what should I do? It would be asymptomatic at this point.
I would. Some may agree....some may disagree. That is ultimately a decision that you have to make after careful examination and weighing of the risks.
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Quote:
I would. Some may agree....some may disagree. That is ultimately a decision that you have to make after careful examination and weighing of the risks.
Something got lost in translation there -- probably because of my weird wording of things.
I was asking; when I get her tested, what should I do if she is to test positive? She would be asymptomatic as of right now.
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Re: Prevalence of IBD?
Quote:
Originally Posted by Running Elk
Something got lost in translation there -- probably because of my weird wording of things.
I was asking; when I get her tested, what should I do if she is to test positive? She would be asymptomatic as of right now.
If it was your only snake....I'd keep it.
Since it's not, I'd euthanize it.
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She could be someone's only snake.
I have a friend who wants one boa. Just one.
I'd give her to him, on the understanding that she had IBD and that should be his only snake -- and that at some point, she may fall ill.
She's in a 4 part rack by herself (it wasn't in use before I acquired her). Assuming she tests positive, will time and cleaning with a bleach solution make it safe to use again?
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This is a fascinating topic... And mildly disturbing as I have both boas, BPs, and others in my small mixed collection. All of mine did the typical quarantine period without any issues and are housed together. At this point, if any of mine happen to have IBD, I guess it's safe to assume that all of them have been exposed.
Running Elk- Maybe a cleaner like F10SC or F10SCXD would work to clean the rack with? I believe those cleaners are supposed to kill viruses, bacteria, and fungi, so I assume they would work on a virus like IBD (but have never used them to treat such). A bleach / water solution wouldn't hurt either.
Skiploder- Are you still adding animals to your collection at this point, and if so, do you have them tested for IBD before introducing them to your collection? Do you have your vet take blood samples and then send off to a lab or what is the procedure you use? Also, do you mind me asking how much you typically pay for testing to be done?
Unfortunately, there are no reptile-experienced vets in my area... I'm not even sure I'd feel confident in letting someone take a blood sample from one of my snakes, much less a biopsy... I'll have to consider this.
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Re: Prevalence of IBD?
Quote:
Skiploder- Are you still adding animals to your collection at this point, and if so, do you have them tested for IBD before introducing them to your collection? Do you have your vet take blood samples and then send off to a lab or what is the procedure you use? Also, do you mind me asking how much you typically pay for testing to be done?
I actually would like to know this as well.
Also, apparently each test is $130 through UF -- I found that out today, as I've been Emailing back and forth trying to get this all figured out.
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Re: Prevalence of IBD?
Quote:
Originally Posted by artgecko
This is a fascinating topic... And mildly disturbing as I have both boas, BPs, and others in my small mixed collection. All of mine did the typical quarantine period without any issues and are housed together. At this point, if any of mine happen to have IBD, I guess it's safe to assume that all of them have been exposed.
Running Elk- Maybe a cleaner like F10SC or F10SCXD would work to clean the rack with? I believe those cleaners are supposed to kill viruses, bacteria, and fungi, so I assume they would work on a virus like IBD (but have never used them to treat such). A bleach / water solution wouldn't hurt either.
Skiploder- Are you still adding animals to your collection at this point, and if so, do you have them tested for IBD before introducing them to your collection? Do you have your vet take blood samples and then send off to a lab or what is the procedure you use? Also, do you mind me asking how much you typically pay for testing to be done?
Unfortunately, there are no reptile-experienced vets in my area... I'm not even sure I'd feel confident in letting someone take a blood sample from one of my snakes, much less a biopsy... I'll have to consider this.
I don't have boas or pythons anymore. My vet ended up buying all of my aspidites.
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Re: Prevalence of IBD?
Quote:
Originally Posted by Running Elk
She could be someone's only snake.
I have a friend who wants one boa. Just one.
I'd give her to him, on the understanding that she had IBD and that should be his only snake -- and that at some point, she may fall ill.
She's in a 4 part rack by herself (it wasn't in use before I acquired her). Assuming she tests positive, will time and cleaning with a bleach solution make it safe to use again?
You could use bleach, F10 or any cleaner indicated as a virucide. However, if she is asymptomatic, I would not overly worry about it. Then again, being safe is better than being sorry - right?
Quote:
Originally Posted by artgecko
This is a fascinating topic... And mildly disturbing as I have both boas, BPs, and others in my small mixed collection. All of mine did the typical quarantine period without any issues and are housed together. At this point, if any of mine happen to have IBD, I guess it's safe to assume that all of them have been exposed.
Running Elk- Maybe a cleaner like F10SC or F10SCXD would work to clean the rack with? I believe those cleaners are supposed to kill viruses, bacteria, and fungi, so I assume they would work on a virus like IBD (but have never used them to treat such). A bleach / water solution wouldn't hurt either.
Skiploder- Are you still adding animals to your collection at this point, and if so, do you have them tested for IBD before introducing them to your collection? Do you have your vet take blood samples and then send off to a lab or what is the procedure you use? Also, do you mind me asking how much you typically pay for testing to be done?
Unfortunately, there are no reptile-experienced vets in my area... I'm not even sure I'd feel confident in letting someone take a blood sample from one of my snakes, much less a biopsy... I'll have to consider this.
I should clarify my previous response. I don't have boids anymore. However as a matter of course, any animals added to my collection are put through a QT period in which I have the vet do the following tests:
1. A hemagglutination-inhibition test for OPMV.
2. Fecal tests for internal parasites and crypto.
...continuing with our list of disease you can bring home from your friendly Reptile Expo, I present you with a nasty bacterial infection that can mimic a whole host of ailments. Ladies and gentlemen, I present the delightful scourge known as Osteomyelitis.
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