Report on deceased chimpanzee “Tiffany” Prepared 12/14/18 for Save the Chimps By Dr. Ellen Wiedner, VMD, DACVIM (LA), DACZM, DECZM (ZHM) I was asked to review the records on Tiffany, a 13-year-old female chimpanzee housed briefly at Save the Chimps, Fort Pierce, FL. Tiffany was transferred to Save the Chimps (STC) in April 2018 from a private owner in Missouri along with an older male chimp named Tuffy. She was euthanized on August 19, 2018 after prolonged illness. Prior to shipment, a physical examination was done on Tiffany under anesthesia by a veterinarian in Missouri. The physical examination also included blood sampling, which was submitted to outside laboratories. The date of the examination was April 1, 2018 and the results were sent to Molly Polidoroff, then director of STC. Several abnormalities were present on complete blood count (CBC) and serum chemistry (SBC). (See Attachment 1.) The CBC showed that Tiffany had low platelets (verified on blood smear although uncountable due to clumping) and an elevated hematocrit (51%; normal range is 34-45). She also had high numbers of eosinophils (500 /uL; Normal range is 0 to 0.8). Tuffy’s CBC was normal. On the SBC, Tiffany had very low serum phosphorus (1.8 mg/dL; normal range is 2.7 to 6.1, but commonly is around 4.4). In addition, she had low globulins (2.8; mean is 3.3). Her companion Tuffy had slightly low phosphorus (2.8) and low globulins (2.8). Results from viral serology showed that Tiffany was positive for Epstein Barr virus (EBV) and for Parainfluenza 2 (PI2). (See Attachment 2). Tiffany’s companion Tuffy was negative for EBV and positive for PI2. PI2 virus is not well characterized in chimps and its significance is unknown. EBV is well-characterized and is discussed further below. A fecal culture showed both chimps to be negative for Salmonella, Shigella, Yersinia, Clostridium, Campylobacter, and Aeromonas. Both chimpanzees were also negative on skin test for tuberculosis. I can find no information in either Airtable (the computerized record) or the paper record describing Tiffany’s diet or husbandry prior to arrival at STC although this data is a standard component of any animal transfer regardless of species. The USDA record of acquisition states that the chimps arrived at STC on April 17, 2018 and that neither chimp ate well. By April 23, 2018, the veterinarians at STC were asking keepers to keep a food log for the two chimps. This was done, although only a few pages are present in the medical records. At several points, the records mention that staff was offering coca-cola and fast food to Tiffany but she was refusing even those. A round of antibiotics did not improve her appetite. Several workups were done under anesthesia starting on July 28th, which included radiographs, repeat bloodwork, a barium study, an appendectomy surgery, and an MRI. Dates of sedation include July 28th, August 5th (the MRI), August 7, August 9th (appendectomy surgery), August 10th and August 13th. No official radiology reports are available on either the plain films or the barium study. The MRI images and the report are missing as well. Tiffany was given IV fluids during these anesthesias, and was fed by stomach tube on two occasions with Glucerna, an oral shake solution used for diabetics and on other occasions with Garden of Life, a vegan probiotic supplement, with which I am unfamiliar. During this time period, Tiffany started to have severe vomiting and diarrhea. Various medications were tried without success including motility drugs, stomach protectants, steroids, antifungals, antiemetics, and vitamins. Bloodwork continued to show low phosphorus as well as other electrolyte disturbances including low chloride and low potassium. Her albumin dropped as well. The final bloodwork dated on August 19 shows that her liver was starting to fail and was now jaundiced, the calcium/phosphorus ratio was completely abnormal, she had become panhypoproteinemic (low in all types of protein), and her muscles were rupturing (rhabdomyolysis). Her weakness became extreme, her breathing started to become labored and she was euthanized on August 19, 2018. Page 2 of 2 Report on Chimpanzee Tiffany 12/15/18 A necropsy was done at the University of Florida (UF) College of veterinary medicine by a board certified veterinary pathologist, Dr. Lisa Farina. In reviewing this record, I am struck by the lack of records. There are only three weights obtained for this animal (122 lb was recorded on the health certificate sent with her from Missouri, 87 lb on July 28, and 81 lb on August 9). I cannot find a nutrition plan. I am unable to explain why more than two months passed before any workup was done. I am unclear why endoscopy with biopsy was not done, why a nutritionist was not consulted, and why there was no effort to correct the obvious and severe electrolyte abnormalities. But an absence of written records may not necessarily mean that there was an absence of action. What I can say with certainty is that this animal was not normal when she arrived at STC. The abnormal serum phosphorus diagnosed during pre-shipment examination is a significant indicator of underlying disease. Many primates raised as pets suffer from metabolic disease due to being kept indoors which leads to a Vitamin D deficiency. Metabolic bone disease (MBD) can also reflect poor diets or a combination of diet and husbandry issues. It can even result from genetic factors. Without information about Tiffany’s diet or husbandry prior to relocation, the cause of MBD remains unknown, although the radiographs taken of her clearly show decreased bone density. Because I cannot find any formal reports, I am unclear whether this problem was acknowledged by the veterinarians or the human physicians who reviewed the radiographs and did the appendectomy surgery. The other abnormalities found during that preshipment exam are worth mentioning too. High eosinophils can be associated with a major parasite burden (of which there is no record) or with long, chronic diseases. The low platelets suggest a poorly responsive bone marrow. Globulins, which are antibodies, were low in Tiffany. Here too is evidence of immunosuppression, which may reflect the virus, metabolic bone disease, poor nutrition or a combination of these. Phosphorus levels as low as Tiffany’s are associated with severe muscle weakness and lethargy. Additionally, as she stopped eating entirely, her body would have entered a starvation mode, and her GI tract would have become less able to absorb nutrients. Tube feeding likely triggered the vomiting and diarrhea and may very well have set off a phenomenon known as refeeding syndrome; the timing of this occurs two to ten days after a starved individual is fed, which fits with Tiffany’s case. Nutrition given to a starved body must be done with great care after calculating energy requirements. Feeding multiple small meals around the clock, using parenteral routes (IV feeds) rather than oral feeds, judiciously choosing IV fluids and carefully monitoring serum electrolytes are needed and require an ICU approach to care. Finally, Tiffany was positive for EBV on arrival. EBV belongs to a group of viruses known as lymphocryptoviruses. In humans, EBV can cause mononucleosis, a variety of cancers, or immune-suppressing wasting syndromes. In great apes, the wasting syndromes are most common, and I suspect this was a component of Tiffany’s medical issues. No viral titers were done unfortunately to confirm this. In any event, Tiffany had a number of strikes against her: metabolic bone disease, phosphorus levels low enough to cause severe weakness, and EBV. Stress associated with transportation may simply have been the final straw for her. This week, I spoke to Dr. Lisa Farina about the necropsy. Dr. Farina was not informed that the animal was positive for EBV, which is awkward since the virus is zoonotic. She was also not informed that the animal had metabolic bone disease. There are two final reports because Dr. Bezner had asked that the conversation she had with Dr. Farina be removed from the record. I have compared the two reports and they do indeed only differ in that one is lacking Dr. Farina’s conversation with Dr. Bezner. Dr. Farina described the necropsy as “unsatisfying” by which she meant that an obvious cause of disease was not visible in this very emaciated animal. Tiffany did have esophageal ulcers and she also had some leakage around the appendectomy site, neither of which would have helped her comfort level, but did not explain how sick she was. However, starvation, refeeding syndrome, and metabolic bone disease in conjunction with a wasting virus does explain it rather well. RECEIVED 83/1344615 MARY CLINIC 1 0 04-01?2018 8:01 AM 999.0093 -) CLARKSON WILSON 1 ea Labuatuias Ono IDEXX Drive IDEXX Mum HHM United state; 433 BLU PEI own: BLUE CLARKSON WILSON VETERINARY ACCESSION 3 1902392013 32 CLARKSON WILSON CTR REoulsmoM a: 33517747 PRIMATE CHESTERFIELD, MISSOURI 63017-7275 DATE OF COLLECTION: M1f201l BREED: CHINPANZEE DATE OF RECEIPT: 047011201! GENDER: FEMALE INTACT ACCOUNT a: 25080 DATE OF 0410112010 AGE. 13Y11M280 ORDERED BY: CLARKSON WILSON. Atta Ch nt 1 DEX: SERVICES: 9999 SAHPLEITEST INFO NEEDED, 149 SMALL MAMHAL PROFILE #1 Potassium 6.3 m0?- HEMATOLOGY Total Protein 6.8 TEST RESULT REF. RANGE RBC 5_31 muL Albumin 4.0 9/ dL I Hematocrit 51,0 1, I I Globulln 2.3 a! I Hemoglobin 17.2 Alb:Glob Ratio 1.4 MCV 81 fL ALT 12 MCHC 33.7 gIdL ALP an UIL WBC 12.5 GGT 32 UIL Neutroph? 731) 1, Cholesterol 236 21.0 '5 Monocyte 2.0 1. ?16 Eosinophil 4.0 1. Basophil 0.0 a. Neutrophil 9125 IUL 2525 ML Monocyte 250 Eosinophil 500 Basophil 0 Platelet 101 Platelet Comments LOW AUTOMATED PLATELET COUNT WAS VERIFIED BY SCANNING OF BLOOD SMEAR. HOWEVER. DUE TO THE PRESENCE OF CLUMPS, THE ACTUAL COUNT CANNOT BE ACCURATELY DETERMINED AND MAY BE HIGHER. Remarks SLIDE REVIEWED MICROSCOPICALLY. NO PARASITES SEEN CHEMISTRY TEST RESULT REF. RANGE Glucose 76 IDEXX SDMA a 7 unldL Creatinine 0.9 BUN *1 5 I Phosphorus 1.8 "'9de I. Calcium 9.4 mgIdL Sodium 138 mmoIIL Get deeper insights: For completa access to this patients diagnostic mulls, includ . ing historic values and Final report generated April 01, 2018 mu. m. Attachment 2 J.- Sejltr'an-JO w: r? REPORT SUMMARY u. POS or INDETERMINATE NEG or PENDING ONE (Growth) (No-Growth) 23 00 INFLUENZA A ANTIBODY 0 1 0 24 oo INFLUENZA ANTIBODY 1 0 :5 oo PARAINFLUENZA TYPE-1 1 0 0 so or: PARAINFIJIRNZA TYPE-2 1 0 2' Jo mum-hi ENZA 1 0 0 a (RUBEOLASAG-AFRICAN MONKEY 0 0 1 0 00 HERPES 0 0 1 .34- man 511492.: x-zz 1 0 00 HUMAN VARICELLA - 0 0 1 0 r90 CHV Chimpanzee 0 1 0 0 00 BPSTEIN-BARR VIRUS 1 0 0