Veterinary care of a giant lop rabbit with severe fly strike
Author(s)
Glen Cousquer
BSc (Hons), BVM&S, CertZooMed, MRCVS,
Veterinary Surgeon,
Clinique Vétérinaire, Sigean, France.
Email glencousquer@hotmail.com
Keywords
Fly strike, myiasis, domestic rabbit, presentation, wound management, hydrogel dressings
Key Points
1. Rabbits are vulnerable to fly strike, or ‘myiasis’, a condition most
probably caused by the blowfly Lucilia sericata.
2. Rabbits with soiled hair and skin are particularly attractive to flies
and such soiling can therefore predispose to fly strike. A wide range of
factors may be responsible for such soiling and the underlying cause(s)
should always be investigated.
3. An appropriate intensive care programme is required to stabilise the
rabbit with fly strike. Fluid therapy, analgesia and antibiotic therapy are
required. Sedation or general anaesthesia is often necessary for wound
cleaning and debridement. Any visible maggots should be removed. The wounds
must be cleaned, debrided and dried; this process needs to be carried out
repeatedly and thoroughly until all maggots are removed from the wound.
4. Use of hydrogel dressings will encourage wound healing.
5. Daily examination of the rabbit is necessary if fly strike is to be
identified early. Attention to the rabbit's diet, activity levels and
grooming, together with the use of a fly repellent, may help prevent
recurrence.
Heading 1
Introduction
Fly strike, or myiasis, is an extremely distressing condition affecting many rabbits during the
summer months. Flies are attracted to lay their eggs on the rabbit under certain circumstances.
The larvae on hatching are able to attack healthy tissue and are capable of causing
considerable soft tissue damage. This case report details the presentation, assessment and
treatment of an obese two-year-old neutered male giant lop domestic rabbit (Oryctolagus
cuniculus).
Heading 1
Presentation
A two-year-old neutered male rabbit was seen for a routine vaccination and health check in
February 2005. At the time he weighed 6.68kg and was receiving a high concentrate diet. A
weight loss programme, consisting of a high fibre diet and increased exercise, was advised to
get him back down to <6kg.
In October 2005, the rabbit presented as an emergency with severe fly strike. There was
extensive skin ulceration over the dorsal midline, extending down onto the perineum.
Significant numbers of first- and second-stage larvae were present. The rabbit was in a
profound state of shock, showing weakness, depression, lethargy and anorexia. The rabbit
weighed 6.76kg and had a rectal temperature of 38.8oC.
Heading 1
Management
A shock therapy plan was instituted in order to stabilise the rabbit’s condition. The rabbit was
sedated with midazolam (Hypnovel) (2mg/kg intramuscularly). Anaesthesia was then induced
by the administration of isoflurane by face mask. Intravenous fluid therapy was initiated via
the right cephalic vein. A dose of 0.9% sodium chloride was initially infused as a continuous
stream before reducing to 4ml/minute. Analgesia was provided with buprenorphine
(Vetergesic) at 0.03mg/kg and carprofen (Rimadyl) at 4mg/kg, both subcutaneously.
Antibiotic therapy consisted of enrofloxacin (Baytril) at 5mg/kg. All visible maggots were
removed manually. In view of the severity of the injuries the owners were informed that the
prognosis remained very guarded.
The rabbit remained very subdued overnight but was accepting food and passing faeces by the
morning. The rabbit remained subdued during the course of the day and was seen to pant a
lot. Analgesia was continued with buprenorphine at 0.03mg/kg three times daily. The rabbit
bit through its giving set during the morning of Day 2, forcing the suspension of intravenous
fluid therapy. Maggot checks were performed three times daily, with the removal of a number
of maggots on each occasion.
In the evening of Day 2 the rabbit was again sedated with midazolam (2mg/kg i/v
intravenously) in order to assess, further clean and debride the wounds (Figures 1-2).
Figures 1 and 2 here
Figure 1 - Extensive ulceration of tissues over hind quarters extending down to tail base
Figure 2 - Close up of maggot damage to tissues above tail base. At least one first-stage larvae
is visible in this picture
A catheter was placed in the marginal ear vein and 35ml saline together with 5ml of a
vitamin, mineral and amino acid supplement (Duphalyte) administered intravenously. The
hair over the rabbit’s hindquarters was clipped using scissors. The wounds were gently
scrubbed with a solution of dilute povidone iodine and subsequently lavaged liberally
(Figures 3-6).
Figures 3, 4, 5, 6, here
Figure 3 - Disinfection of rear end with dilute povidone iodine
Figure 4 - Intensive lavage of rear end with warm water
Figure 5 - Extent of wounds and maggot damage after hair clipping and lavage. The central
ulcer extends into dermal tissues. The surrounding skin shows pronounced erythema. There
are a number of deep wounds above the tail base and additional ulcers laterally
Figure 6 - Extent of ulceration extending laterally
Following several cleaning cycles the rabbit was dried and its hair combed through to remove
any remaining fly eggs (Figure 7). The wound was then dressed with a hydrogel (Intrasite)
and covered with a moisture vapour-permeable dressing (Opsite) (Figure 8). An insect growth
inhibitor (cyromazine – Rearguard) was applied to the skin and fur surrounding the wound
(Figure 9). Analgesia was continued with buprenorphine three times daily, together with
meloxicam (Metacam) at 0.3 mg/kg once daily. A subcutaneous injection of ivermectin
(0.2mg/kg) was also administered.
Figures 7 8 and 9 here
Figure 7 - Clumps of fly eggs in the fur need to be identified and removed. The hair should be
dried with a hair drier and can then be combed through with a flea comb or grooming knife
Figure 8 - Application of a hydrogel (Intrasite) and moisture vapour-permeable dressing
(Opsite) combination to protect the exposed dermal tissues
Figure 9 - Application of an insect growth regulator (cyromazine) to fur and skin surrounding
the wound
On Day 3, five maggot checks were performed and a single maggot removed. Analgesia with
buprenorphine and meloxicam were continued. The ear catheter was well tolerated so bolus
fluid therapy, consisting of 15ml saline plus 5ml generic (Duphalyte), was continued four
times daily. Faecal and urinalysis were unremarkable.
On Day 4 a single maggot was recovered. The wound was flushed with dilute povidone
iodine, rinsed and dried before reapplying a hydrogel/moisture vapour permeable
(Intrasite/Opsite) dressing. Buprenorphine was stopped and meloxicam used as the sole
source of ongoing analgesia. The rabbit was drinking normally and appeared to resent the ear
catheter, which was therefore removed.
Wound dressings were repeated daily for a further three days (until Day 7). During this time,
antibiotic cover with enrofloxacin was maintained at 5mg/kg once daily.
On Day 7, the rabbit was anaesthetised for the purposes of applying a more resistant wound
dressing. The rabbit was sedated with midazolam (2mg/kg) intravenously and then received
ketamine at 15mg/kg. The rabbit was then intubated and maintained on isoflurane (1-3%) and
oxygen. The wound was cleaned and debrided, before being dried. A generic (Aquacel)
dressing was applied to the exposed dermal tissues and a 10x10cm piece of thin hydrocolloid
dressing (Duoderm Extra Thin) applied over the wound. This dressing was secured in place
with simple interrupted sutures around the margin of the dressing (Figure 10).
Figure 10 here
Figure 10 - Application of a thin hydrocolloid dressing (Duoderm Extra Thin) to the wound
on Day 7. The dressing is secured to the skin with small simple interrupted sutures using
absorbable staples (Polysorb) and reinforced with strips of surgical tape (Durapore)
The rabbit was discharged the following day (Day 8) with the dressing in place. Medication
with meloxicam at (0.3mg/kg once daily) together with enrofloxacin (5mg/kg once daily) was
to be continued at home.
The rabbit re-presented on Days 11 and 15 for follow-up examinations. On Day 15, the
remains of the dressing were removed. A healthy bed of granulation tissue was established
and there was evidence of epithelialisation at the wound margins as well as at one or two
islands (Figure 11).
Figure 11 here
Figure 11 - Following removal of the dressing on Day 15, a healthy bed of granulation tissue
is evident, covering the whole of the wound. Some epithelialisation is evident at the wound
margins as well as at a small island in the top left corner. The wounds above the tail base have
all healed (Figure 12).
Figure 12 – The rabbit’s wounds above the tail base have all healed.
Heading 1
Discussion
Myiasis occurs when fly eggs are laid in damp areas of the skin or hair coat and the larvae
develop in the underlying tissue of the host. In the US, larvae of Cuterebra species (or bot
flies) may infect both wild and domestic rabbits, pupating under the surface of the skin (1). In
the UK, anecdotal evidence would suggest that the blowfly Lucilia sericata is largely
responsible for incidences of myiasis in rabbits. Hall and Wall (1995) attribute myiasis of
rabbits and other, usually debilitated, domestic and wild animals to L. sericata but no detailed
studies have been published (2).
Flies such as L. sericata are attracted to soiled hair and skin. Activation, upwind orientation
and landing appear to occur in response to putrefactive sulphur-rich volatiles originating from
bacterial decomposition products. Oviposition is elicited primarily by the presence of
ammonia-rich compounds, although moisture, pheromones and tactile stimuli are also
reported to be attractive (3). For various reasons rabbit skin and fur may become
contaminated with faeces and/or urine. This is likely to prove attractive to flies and induce
oviposition. An understanding of the factors likely to contribute to this situation is essential to
both the management and prevention of fly strike in rabbits.
The various contributing factors that can attract flies to rabbits, and thus give rise to myiasis,
are discussed by Cousquer (2006) (4). These factors need to be considered and the underlying
predisposing causes investigated. This is essential if the problem is to be prevented from
recurring in the future. In the case of this rabbit, faecal and urinary examinations were
unremarkable. This rabbit’s main problem was its obesity. Obesity can make it difficult for a
rabbit to groom itself and may make it difficult for it to demonstrate normal caecotrophy.
Caecotrophs are usually eaten direct from the anus; this may not be possible in an obese rabbit
and these soft motions may accumulate around the tail base as a result. Obese inactive rabbits
may also soil themselves with urine. They may also contaminate their fur with faeces and
urine from their hutch environment. Such contamination is likely to prove attractive to gravid
female L. sericata flies, resulting in the deposition of eggs and subsequent myiasis.
Fly strike is always an emergency in any rabbit. The therapeutic plan must take into account a
number of factors and it is suggested that the following be prioritised (4):
 Intravenous fluid therapy to combat shock
 Analgesia
 Antibiotic therapy
 Removal of all second- and third-stage maggots
 Removal of as many eggs and first-stage larvae as possible
 Treatment to kill, or halt the development of, any remaining eggs and maggots
 Wound management – debridement and dressing
 Identification and treatment of any underlying causes.
Heading 2
Intravenous fluid therapy
In the first instance, all patients require stabilisation. By the time fly strike has been noticed
and the animal presented for veterinary care, the rabbit is usually in a state of profound shock.
Intravenous fluid therapy is indicated at shock rates up to 90ml/kg/hour. During this time the
rabbit should be carefully monitored for evidence of excessive fluid load. The lungs in
particular should be auscultated regularly. Fluid rates should be reduced after 30-60 minutes
to an appropriate rate, taking into account any outstanding fluid deficit and ongoing fluid
losses. Use can be made of the cephalic or saphenous veins for this purpose. Where drip lines
are chewed through, as occurred on Day 2 in this case, it may be appropriate to administer
fluid by bolus injection. Ongoing fluid therapy is required until the rabbit is able to meet its
own needs orally.
Heading 2
Analgesia
Analgesia must be provided to combat the severe pain associated with the enzymatic burns
produced by the digestive enzymes of the larvae. Pain is often difficult to assess in rabbits and
there is a risk that it be underestimated. In this case the rabbit was hyperventilating for some
time following admission. This is likely to have been a symptom of pain. Other symptoms
included inactivity and anorexia in this case. It is safer to assume that a rabbit is experiencing
pain and to provide good analgesia. A number of opioid analgesics can be used in rabbits.
Buprenorphine provides six to eight hours of analgesia and is a good first choice (5).
Additional pain relief can be provided by the use of non-steroidal anti-inflammatory drugs
such as carprofen and meloxicam. While neither drug is licensed for use in rabbits, both are
widely used in rabbit medicine and appear to be well tolerated (5).
Heading 2
Antibiotic therapy
Where culture and sensitivity testing is not performed, use of broad-spectrum antibiotics is
indicated. L. sericata is a facultative feeder and is likely to introduce a range of environmental
bacterial contaminants. The possibility of secondary infection with clostridial species must
not be overlooked as this has been proposed as a possible cause of death in rabbits that appear
stable post-surgery (1). Secondary anaerobic bacterial infections can be treated with penicillin
G procaine (30,000-60,000 IU/kg subcutaneously once every 24 hours for five days).
Enrofloxacin and trimethoprim combinations are proposed by Harcourt Brown (2002) as safe
choices (6). In this case there was minimal necrotic tissue and the injuries did not extend
deeper than the dermis. Antibiotic cover was therefore restricted to enrofloxacin.
Heading 2
Removal of all second- and third-stage larvae
Wound care and the removal of larger maggots are best performed under sedation or
anaesthesia. The choice of sedatives will generally favour a combination that allows for a
smooth induction and rapid recovery. In this case the rabbit received a sedative with
anxiolytic properties. Anaesthesia was induced by the administration of isoflurane by face
mask. This was well tolerated and allowed for a smooth induction. Where this is resented, a
chamber induction can be less stressful. Isoflurane induction can be resented if performed
with a face mask, especially in the unsedated rabbit, and is likely to induce breath holding (5).
Fentanyl/fluanisone provides sedation and effective analgesia and is a good alternative,
favoured by some authors (6).
All second- and third-stage larvae should be identified and removed wherever possible.
Second- and third-instar larvae are considered to be most damaging and their removal should
be prioritised. These larger maggots are best removed manually using forceps and a
systematic approach. The wound, as in this case, can initially be left undressed to allow repeat
checks to be made for maggots.
Heading 2
Removal of as many eggs and first-stage larvae as possible
Ideally, all eggs and first-stage larvae will be removed. This can be very intensive and
requires repeat checks. Following wound lavage, many first-stage larvae are washed away.
The coat then needs drying and, once dry, can be combed through to remove any remaining
eggs that are left glued to the coat (Figure 7).
Heading 2
Treatment to kill, or halt the development of, any remaining eggs and maggots
Any remaining eggs and maggots are likely to develop further. Use of an insect growth
regulator can prevent the first larval instar metamorphosing into the second larval instar.
Cyromazine (Rearguard) is licensed in the UK to prevent myiasis in rabbits. It should not be
used on broken skin but can be applied to the surrounding fur and skin. In this case it was
used to prevent the development of eggs and maggots that had not been removed manually. A
number of other products have been proposed for use in rabbits suffering with myiasis. These
include ivermectin and selamectin (1) (6) and permethrin. For a more detailed discussion of
the available insecticides see Cousquer (2006) (4). While topical treatment to kill blowfly
larvae is desirable, use of a topical product in the presence of open wounds is likely to pose a
greater risk of toxicity and so care is indicated in such circumstances (4).
Heading 2
Wound management
L. sericata larvae produce a combination of proteinases with chymotrypsin-like and trypsinlike activities (7). In the rabbit epidermal and dermal tissue appears vulnerable to the activity
of these enzymes. It has been suggested that sheep and rabbits are unable to inactivate the
proteolytic enzymes secreted by the larvae of L. sericata (8), and that, unlike humans, they
are therefore vulnerable to myiasis as a primary condition. Vaccination of sheep with larval
antigens has been shown to generate some antilarval protection. This effect was shown to be
mediated by ingested ovine antibodies directed at proteins within the larval digestive tract (9).
No work has currently been conducted to determine what differences might exist between
rabbits and humans that might explain differences in the invasiveness of L. sericata larvae. It
is clear that both rabbits and sheep are capable of soiling their coats in such a way as to attract
blowflies and induce them to lay eggs. This factor contributes to the susceptibility of rabbits
to fly strike. It remains unclear, however, whether other factors make rabbits and sheep
vulnerable to myiasis.
Practically, it appears that L. sericata larvae are able to penetrate through the epidermal and
dermal layers of rabbit skin. The resultant enzymatic burns can be very extensive and require
the development of an appropriate wound management plan (4). In the first instance the
wound must be cleaned of all organic material and debrided of all necrotic tissue. The
removal of faecal and urinary contamination is required to eliminate the attraction to flies,
while repeated wound lavage is required to facilitate the removal of bacteria, maggots and
other organisms. In this case dilute povidone iodine, as proposed by Harcourt Brown (2002)
was used to wash and disinfect the wounds (6). The surrounding hair was clipped with
scissors to minimise trauma to the skin. Even with scissors, however, great care is required to
avoid nicking the skin. Once clean the coat and skin must be dried to avoid unnecessary
chilling of the patient. Drying is also indicated to eliminate excess humidity as this may
promote egg and larval development. The heat produced by a hairdryer will attract maggots
towards the heat and can further facilitate their removal (6).
Once dry the wound requires protection. A wound dressing will protect the wound from
ongoing fluid losses and minimise discomfort. The use of hydrogels such as Intrasite and NuGel not only absorb bacteria and keep wounds hydrated but has also been shown to slow
larval development (10). It is therefore appropriate to apply hydrogels to fly strike wounds
and cover the area with a moisture vapour-permeable dressing (such as Opsite, Smith and
Nephew). Repeat checks are required to ensure that any more maggots are identified and
removed. In this case no further maggots were found after Day 4. Once it has been established
that all maggots and eggs have been removed, a more permanent dressing can be applied. The
objective is to provide protection to exposed nerve endings and provide a moist wound
environment for the development of granulation tissue. Suitable dressing materials include
hydrocolloid dressings (Granuflex and Duoderm Extra Thin), which can be sutured in place
over a wound (Figure 10). The establishment of a healthy bed of granulation tissue will lead
to a stage of rapid wound healing by secondary intention. This tissue must be protected as the
rabbit hutch environment is particularly dusty. Use of non-dusty bedding during this period is
desirable, provided the rabbit continues to receive plenty of long fibre in its diet.
Heading 2
Identification and treatment of any underlying causes
Many rabbits succumb to myiasis because an underlying problem has not been identified and
addressed. Causes of faecal contamination and urine scalding are usually incriminated. It is
essential that these problems be investigated and this is discussed further (4). In this case the
patient was obese and relatively inactive. Such a large rabbit can experience difficulties
keeping itself clean, especially if the environment is dirty. Obese rabbits are reportedly
especially prone to myiasis (6). The area at the base of the spine is not easily groomed and
obese rabbits may experience particular difficulty in getting to this area; consequently this
area is the commonest site for fly strike in rabbits (6).
Heading 2
Nursing and supportive care considerations
Rabbits suffering from myiasis present clinicians and nursing staff with a number of
challenges. Shock therapy and pain relief have already been discussed. The provision of a low
stress environment is very important. Consideration must be given to what the rabbit is
familiar with as house rabbits and garden rabbits may have different requirements. Generally
speaking rabbits should not be housed in the same room as dogs and cats, as these can be
viewed as predators. A hiding place should always be provided to allow the rabbit to
demonstrate escape behaviour when it is feeling threatened. A high standard of nursing care is
required to ensure that the rabbit’s recovery is facilitated. Attention must be paid to food
intake and the provision of high fibre recovery formulas, such as Oxbow Critical Care, is to
be encouraged. Small volumes of this can be syringe fed to the rabbit. It is, however,
important that this is done patiently and calmly to minimise stress for the rabbit. In obese
rabbits there is a significant risk of hepatic lipidosis developing if the rabbit remains
inappetant. In such cases, analgesia, fluid therapy, syringe feeding and the use of motility
stimulants are often necessary (6). Food intake and faecal production must be closely
monitored to ensure that the gastrointestinal tract is functioning normally.
Heading 1
Prevention
Owners should remain alert to the risks presented by a rabbit with faecal or urine
contamination. A twice-daily check should identify any such contamination and the
underlying causes should be established in consultation with a veterinary surgeon. This point
cannot be over-emphasised. Rabbits with ‘messy bums’ should be carefully monitored and the
cause of their messy bum investigated without delay.
Once eggs have been laid, second-stage larvae can appear in as little as 38 hours. A more
detailed discussion of the development of blowfly larvae is provided by Cousquer (2006) (4)..
A single gravid female L. sericata is able to deposit about 200 eggs in a single egg batch and
this can be enough to give rise to myiasis in a rabbit. This single fly can go on to produce as
many as 21 generations (11), although in the field only three or four generations would be
expected 12). Increases in the fly population are directly proportional to environmental
temperature, once the minimum threshold or ‘base temperature’, below which pre-adult stages
do not develop and ovary maturation does not occur, has been exceeded. This base
temperature was calculated to be around 9-11oC for L. sericata (12). The season for flies
therefore runs through the summer and can extend into October, as occurred in this case, if
temperatures remain warm enough.
Biannual vaccination of rabbits allows a biannual health check to be performed. This should
review all aspects of the husbandry and should include a dental examination and an
assessment of the faeces. Clear guidance on the prevention of fly strike should be provided at
this time.
The use of licensed preventative products is recommended in vulnerable individuals. The
definition of vulnerable individuals includes all those prone to “messy bums” and should also
include any rabbit being cared for by a carer who is unfamiliar with rabbits. This situation
often arises when rabbits are left in the care of friends and family at holiday times (4). Two
products are marketed as insect repellents for use in rabbits within the UK. Xenex is a plantbased repellent containing octanoic and decanoic acid. Xenex Ultra Spot On contains
permethrin and is recommended as a repellent as well as for its ability to kill adult flies and
their larvae. Use of a fly screen may be beneficial, as may the use of a cattle fly tag
(containing permethrin). Cattle fly tags should be nailed out of reach of the rabbit. The use of
such products does not, however, obviate the need for addressing the underlying cause of
perineal soiling.
Table 1 details the preventative actions and steps that can be taken in order to minimise the
risk of fly strike in a rabbit.
Table 1: Prevention of fly strike in rabbits
Diet
• Rabbits are herbivores and require a high-fibre diet. Ideally their diet should consist of
approximately 70-80% good quality hay and fresh grass. Haylage is a good alternative if hay
is not available
• Concentrates should be kept to a minimum as these are generally designed for fattening
rather than feeding rabbits. This may be fine for a farmed rabbit but is inappropriate for a
domestic rabbit
• Sudden changes in diet may upset the flora of the rabbit’s hind gut. Any change in diet
should therefore be introduced over five to seven days. Thus, if putting a rabbit out onto fresh
spring grass, it should be allowed to graze for approximately one to two hours and then
removed. The feeding time can be progressively increased, provided faecal production
remains normal
• The diet should reflect the activity levels of the rabbit and should not lead to obesity as this
commonly predisposes to further problems.
Dental examinations
• Dental disease is common in rabbits, particularly in those rabbits that are fed a low-fibre,
low-silica diet. Rabbit teeth grow continuously and require an abrasive diet to help prevent
them becoming overgrown
• As part of an annual or biannual health check, a rabbit’s teeth should receive a thorough
examination. The cheek teeth (molars and premolars) need to be examined using an otoscope.
A more detailed examination may need to be performed under sedation or anaesthesia
• Owners should familiarise themselves with the normal chewing action of a healthy rabbit.
This will allow changes in chewing action to be identified
• If a rabbit is seen to stop chewing, if it starts dribbling or if it starts refusing food or
dropping food from its mouth, a veterinary dental examination should be requested.
Faecal checks
• Owners should familiarise themselves with the size, texture and number of faeces that their
rabbit produces when healthy
• Any reduction in the size or number of faecal pellets should be investigated
• The production of loose faeces should be investigated urgently.
Grooming
• Long-haired rabbits require particular care. Hair should not be allowed to become matted as
these mats are easily soiled and can prove attractive to flies
• Obese rabbits may require additional help to groom. The perineal area and the area
immediately above the tail base must be kept clean.
Daily checks
• During the summer months (June to October) twice-daily checks should be made on the
rabbit. The rabbit should be physically picked up and its perineal area examined
• During the winter months once-daily checks are appropriate
• Any soiling of the haircoat and skin should be investigated further.
Fly repellents
• Use of fly repellents in vulnerable rabbits is appropriate but is no substitute for the above.
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