Pharmacokinetics of Nebulized Terbinafine in Plasma and Keratin of Northwestern Pond Turtles (Actinemys marmorata) Associated with Emydomycosis
The Northwestern pond turtle (Actinemys marmorata) is native to Washington State, USA and has developed a grossly evident form of shell disease affecting a large percentage of the free-ranging population in this state. Emydomyces testavorans is a novel fungus in the order Onygenales that is the presumed causative agent for shell disease in the Northwestern pond turtle. Terbinafine hydrochloride is a lipophilic allylamine broad-spectrum antifungal that penetrates keratin and concentrates in the stratum corneum. This study evaluated the drug concentration in the plasma and keratin of 18 Northwestern pond turtles after nebulization with 18 mg terbinafine solution (2 mg/ml) once a day for 28 days. Blood and keratin samples were collected serially during the course of treatment, and for 14 days following the last dose. Plasma and keratin were analyzed by high-performance liquid chromatography. No significant concentrations of terbinafine were found in the plasma of the turtles. Terbinafine in turtle keratin peaked after 16 days of treatment and maintained therapeutic concentrations for 14 days posttreatment. Turtle shell lesions also showed signs of clinical improvement posttherapy. Nebulization of terbinafine is recommended for the treatment of shell disease secondary to Emydomyces testavorans; however, pulse antifungal therapy is likely needed to prevent disease from reoccurring.Abstract

Progression of Northwestern pond turtle (Actinemys marmorata) shell disease healing while undergoing treatment with nebulized terbinafine. (A) Immediately following surgery. (B) Six weeks postsurgery. (C) Three months postsurgery. (D) Seven months postsurgery (release).

Mean keratin concentration of terbinafine following nebulization of 18 mg of terbinafine once daily for 28 days in 18 Northwestern pond turtles (Actinemys marmorata). Samples were taken 14 days after the start of treatment and at 7 days and 14 days after final treatment. Minimum inhibitory concentration (MIC; 0.06 µg/g) denoted on graph. Error bars indicate SD.
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2 Current address: DoveLewis Veterinary Emergency & Specialty Hospital, Portland, OR 97209, USA