1. Introduction
Stomatitis is a frequently encountered disease in reptiles and represents an important clinical concern because it can cause pain, impaired feeding, deterioration of body condition, and an increased risk of secondary infection if left untreated. In captive snakes, stomatitis is often associated with predisposing factors such as suboptimal husbandry, oral trauma, and chronic stress, which may compromise local mucosal immunity and facilitate opportunistic infection [1].
The oral cavity of snakes harbors a diverse bacterial community. Jho et al. [2] demonstrated that various gram-negative bacteria, such as Pseudomonas, Proteus, and Aeromonas, as well as gram-positive bacteria, including Staphylococcus and Enterococcus, can be isolated from the oral cavity of snakes. These microorganisms are typically commensal but may become pathogenic when mucosal integrity is disrupted. Bacterial stomatitis has been reported in multiple snake species, including wild reticulated pythons and boa constrictors, highlighting the clinical relevance of opportunistic bacterial infections in reptiles [3, 4]. Severe forms such as necrotic stomatitis associated with systemic complications have also been documented in pythons [5].
In exotic animal practice, limited access to bacterial culture and antimicrobial susceptibility testing often necessitates reliance on cytology and empirical therapy as initial diagnostic and therapeutic approaches [1]. However, reports describing cytological findings and therapeutic outcomes in ball pythons (Python regius) remain scarce. Therefore, this case report aims to describe the clinical presentation, cytological findings, and response to azithromycin therapy in a ball python with suspected bacterial stomatitis.
2. Case Presentation
A ball python (P. regius) of unknown age was brought by its owner to a veterinary clinic (Urban Animal Pet Care Clinic, Bandung, Indonesia) (Figure 1).
According to the owner, the python had been anorexic for one month. On physical examination, the python weighed 0.8 kg, body temperature was not recorded, and oral lesions consistent with stomatitis were observed in the oral cavity.
Initial evaluation demonstrated marked oral mucosal inflammation and visible exudate, correlating with the prolonged anorexia observed in this case (Figure 2).
Cytological examination confirmed the presence of streptobacilli and gram-positive cocci, supporting bacterial participation in the lesion (Figure 3).
Bacterial culture and antimicrobial susceptibility testing were not performed; therefore, pathogen identification was limited to morphological characterization.
Following seven days of azithromycin therapy, substantial clinical improvement was observed. Oral inflammation and exudate were markedly reduced, and the mucosal surface appeared cleaner and closer to normal. The snake exhibited increased activity and renewed interest in feeding. No adverse reactions or clinical deterioration were observed during the treatment period (Figure 4).
3. Discussion
Stomatitis in reptiles is commonly associated with opportunistic bacterial colonization originating from the normal oral microflora. Jho et al. [2] demonstrated that the oral cavity of snakes contains diverse bacterial populations capable of becoming pathogenic under favorable conditions such as mucosal injury or immunosuppression. Similar bacterial involvement has been reported in wild reticulated pythons and captive boa constrictors, supporting the role of opportunistic bacteria in the pathogenesis of stomatitis across snake species [3, 4].
Severe manifestations of stomatitis, including necrosis and systemic involvement, have been documented in Indian rock pythons, emphasizing the importance of early diagnosis and appropriate intervention [5]. In the present case, cytological findings of streptobacilli and gram-positive cocci provided rapid evidence of bacterial involvement, enabling the timely initiation of antimicrobial therapy. This finding underscores the importance of rapid diagnostic approaches in preventing disease progression and potential systemic complications in reptile patients.
Cytology represents a practical diagnostic tool in clinical settings where microbiological culture is unavailable or delayed. Although culture and antimicrobial susceptibility testing remain the gold standard, empirical therapy guided by cytology and clinical judgment is commonly applied in exotic animal practice [1]. Azithromycin was selected based on its tissue penetration and antimicrobial spectrum, and the favorable clinical response observed supports its potential utility in similar cases.
The main limitation of this report is the absence of bacterial culture and susceptibility testing, as well as the short follow-up period and the evaluation of a single clinical case, which limits the generalization of the findings. Nevertheless, this case provides practical evidence supporting cytology-guided empirical therapy as an effective initial management strategy for suspected bacterial stomatitis in ball pythons. Future studies involving bacterial isolation, antimicrobial susceptibility testing, and larger case series are needed to further validate this approach.
4. Conclusion
Cytology-guided empirical azithromycin therapy resulted in favorable clinical improvement in a ball python with suspected bacterial stomatitis. This approach may serve as a practical initial management strategy in clinical settings where advanced microbiological diagnostics are not readily available. However, this report is limited by the absence of bacterial culture and antimicrobial susceptibility testing, the short duration of follow-up, and the evaluation of a single clinical case, which restricts generalization of the findings. Therefore, bacterial culture and susceptibility testing remain essential for definitive diagnosis and optimized antimicrobial stewardship whenever feasible.
Acknowledgements
The authors would like to express their sincere gratitude to the clinical staff of Urban Animal Pet Care Clinic, Bandung, Indonesia, for their assistance during case management and clinical documentation.
Compliance with ethical guidelines
Ethical approval was not required for this case report because all procedures were performed as part of routine clinical treatment to alleviate the animal’s suffering. Written informed consent was obtained from the owner.
Funding
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors.
Authors' contributions
Surgical procedure, clinical supervision, and ; writing the original draft: Muhammad Farid Rizal; Technical support and assistance during surgery: Hilma Luthfia Sudarsyah and Rachma Ayu Saputri; Review and editing: Itfa Alya and Suseno Amien.
Conflict of interest
The authors declared no conflict of interest.
Data availability
All data supporting the findings of this study are available within this article.
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