Ururabo's baby seemed to recover completely after his two-day episode of runny nose and soft cough. We'd been checking him daily, along with all of the mothers and infants. Magda had seen him the day before, and he'd looked normal compared to the infants of both Ruvumu and Rwandarushya, who were now coughing along with their mothers. Dufatayne had recovered and her baby had yet to show any symptoms. When I arrived to check on the group, the mothers and infants were again the priority.
Ururabo's 3-month-old infant on Day 15 of the respiratory
outbreak in Susa, before he became critically ill.
Ururabo's baby seemed to recover completely after his two-day episode of runny nose and soft cough. We'd been checking him daily, along with all of the mothers and infants. Magda had seen him the day before, and he'd looked normal compared to the infants of both Ruvumu and Rwandarushya, who were now coughing along with their mothers. Dufatayne had recovered and her baby had yet to show any symptoms. When I arrived to check on the group, the mothers and infants were again the priority.
Byishimo, one of the 4-year-old twins in Susa Group, is sick.
We hadn't yet opened our medical bags for the Susa outbreak, but we'd come close twice. Though Poppy had improved, one of her 4-year-old twins, Byishimo, had become progressively sicker. He'd been struggling with a cough and lethargy for over a week and then stopped eating. When he began lagging behind the group, our level of concern shot up.
Once again, Magda, Elisabeth and I visited as a team and brought the kit (Jean Felix felt better but still had a cough.) Fortunately, Byishimo bounced back the next day. His wet-sounding cough persisted, but his attitude and appetite had improved.
Rwandarushya's 6-month-old infant acting very quiet and
coughing lightly on Day 20 of the respiratory outbreak.
My initial impression of the group on this morning, Day 20, was that many gorillas had improved. Maybe we'd turned the corner on the outbreak. Then I cautioned myself, remembering the number of infants in the group and the time it takes for this disease to cycle through everyone.
Sure enough, Rwandarushya appeared with her baby. First she coughed and then her infant coughed. His eyes looked bright enough, but he seemed very quiet. Ruvumu had regained her appetite and looked much improved, but her infant had a thick nasal discharge and frequent cough. He's a bigger, older baby, however.
Then we found Ururabo, coughing with nearly every breath, sitting head down and not eating. The baby lay limply in her arms, eyes closed, mouth open, wheezing. They were clearly the sickest of the 39 gorillas today. This little one had come down with the disease six days earlier — plenty of time to develop pneumonia, sometimes called the silent killer.
Ururabo and her 3-month-old infant both very sick with
respiratory disease, including a near-constant cough on Day 21.
Elisabeth, the trackers and I felt we should anesthetize Ururabo, treat her and the infant as quickly as possible, collect samples and hope for the best. We called park officials, Magda and Jean Felix. All agreed we should intervene. Although this meant we might not be able to help other sick infants the following day, we'd be treating today's sickest animals and could collect the samples needed to diagnose the disease.
We'd have to wait to export the samples for virology, of course, but we could do the bacterial cultures at our lab. While waiting for the team and the kit (if only we'd all come today!), I speculated about why this mother/infant pair might be sicker than the others.
We only partially understand why some individuals develop secondary bacterial infections after viral ones. The body's immune system plays a role. If a gorilla's immune system is fighting another infection, or has been suppressed by severe stress, even a mild infection can take a turn for the worse.
Ururabo has lesions on her upper lip, thought to be
herpes-like, which are also seen in other individuals.
Ururabo did have evidence of another infection — scabby, crusty lesions along her upper lip, a problem seen in other mountain gorillas, including half a dozen in the Susa Group during this outbreak. While these lesions have long been assumed to be due to a herpes virus infection, possibly the same one that afflicts humans, the assumption has yet to be proved. If there was anything good about this intervention, it was that we'd have a chance to biopsy the lesion.
Our vet team had talked through this intervention several times already. I'd do the anesthesia and exam on the mother and monitor the infant. Elisabeth would help, making sure we kept the mother’s neck at the right angle and kept her from crushing the infant. He wasn't breathing well anyway, and we'd need to minimize any additional stress that could cause his lung function to deteriorate. He could even die. We'd decided not to try to administer oxygen. It would help only temporarily, and besides, the baby would probably fight a mask.
Magda would give each gorilla an injection of antibiotic (Ceftriaxone), take nose and mouth swabs for virus and bacteria culture, biopsy Ururabo's lip lesion, and give the baby subcutaneous fluids if needed. Jean Felix would take blood samples from the mother and work with Magda to keep all other samples organized. Obviously, we’d need to work quickly to get the mother down and up, give the antibiotic to both, and take the samples.
To be continued …
[Rwanda, 2008. Pictures: Dr. Lucy Spelman/MGVP]
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