Udder and teat affections in female dromedary camels: Frequency, clinical findings and treatment outcomes

Abstract

Udder and teat lesions are among the most significant health problems affecting milk production, animal welfare, and the economic sustainability of the camel industry. However, comprehensive epidemiological data on their prevalence, diagnosis, and treatment outcomes remain scarce. This study aimed to determine the frequency, diagnostic characteristics, and treatment outcomes of udder and teat lesions in dromedary camels. A total of 191 female camels presenting with udder and teat lesions were included based on clinical and ultrasonographic evaluations. Lesions were classified according to anatomical location, type, age, breed, etiology, treatment approach, and outcome. Udder lesions were significantly more frequent (78.53%; odds ratio 13.38; 95% confidence interval 8.13–21.94; p < 0.001) than teat lesions (21.47%). Mastitis was the most diagnosed udder lesion, accounting for 57 cases (38.0%), followed by fibrosis and wounds. In contrast, hyperkeratosis and teat wounds were the most frequent teat lesions. Lesions were most commonly observed in camels aged 5–10 years (OR: 3.6; 95% CI: 2.3–5.5; p < 0.001), and the vast majority were of acquired origin (98.96%). The Wadeh breed exhibited the highest proportion of udder and teat lesions (53.40%; OR: 2.6; 95% CI: 1.7–4.0; p < 0.001), followed by Sofor (30.37%) and Mejhem (16.23%). Ultrasonography proved effective in differentiating lesions based on echotexture. Overall, treatment was successful in 171 cases (89.53%; OR: 73.1; 95% CI: 38.6–134.3; p < 0.001), with complete clinical recovery. In conclusion, early clinical and ultrasonographic evaluation enables accurate diagnosis and reliable prognosis of udder and teat lesions in dromedary camels. Surgical intervention is an effective curative option for cases that do not respond to medical treatment.

Introduction

Dromedary camel (Camelus dromedarius) is an indispensable livestock species in the arid and semi-arid regions of Africa, the Middle East, and Asia, where it plays a vital role in food security, rural livelihoods, and socio-economic stability. In many pastoral and agro-pastoral systems, camels contribute approximately 30–80% of household income through milk production alone, with lactating females representing the principal economic asset within camel herds. Survey-based studies from North Africa and the Arabian Peninsula indicate that camel milk accounts for 50–70% of total livestock-derived income in nomadic and semi-nomadic systems, particularly during prolonged drought periods when the productivity of other livestock species declines [1–3]. The economic sustainability of camel herds is thus closely tied to optimal reproductive efficiency and sustained lactation performance, both of which are critically dependent on mammary gland health [1, 4].

Udder and teat-associated diseases represent some of the most economically detrimental health challenges in dairy camels. Field surveys indicate that both clinical and subclinical mammary disorders can reduce individual milk yield by 15–40% per lactation, while severe or chronic cases may result in complete cessation of milk production from affected quarters. Herd-level studies further suggest that mastitis and teat injuries account for 20–35% of the premature culling of breeding females, leading to substantial indirect losses associated with replacement costs, reduced reproductive efficiency, and genetic dilution. Moreover, the financial burden is compounded by treatment expenses, milk withdrawal losses, and increased labor costs required for prolonged wound management or surgical interventions, thereby intensifying the economic impact on camel owners [5, 6]. Conditions such as mastitis, abscesses, wounds, and teat disorders lead to significant reductions in both milk yield and quality, increase culling rates, and impose considerable treatment costs [3, 7–10]. In dairy cattle, the etiology, epidemiology, and management strategies of mammary diseases are well established and extensively documented [11, 12]. In contrast, research on dromedary camels remains relatively limited and fragmented [13]. Existing studies tend to focus on isolated conditions, especially subclinical mastitis assessed via somatic cell counts, whereas comprehensive clinical surveys addressing the full range of lesions, associated risk factors, and treatment outcomes are largely lacking [5, 6].

Diagnosis of udder and teat lesions is largely based on clinical examination; however, the incorporation of advanced non-invasive diagnostic modalities, including radiography, ultrasonography, and hematological and biochemical assessments, can significantly improve diagnostic precision and guide therapeutic decision-making [14, 15]. Management of udder and teat lesions encompasses a variety of therapeutic modalities, including both medical and surgical approaches, with surgical intervention frequently required in chronic or complicated cases [16–19]. Although udder and teat disorders in dromedary camels have been previously reported, the available literature remains largely fragmented and predominantly focused on isolated conditions particularly subclinical mastitis, bacteriological findings, and abattoir-based observations rather than offering comprehensive clinical characterization in live animals [5–8, 13]. Integrated clinical cohort studies that simultaneously document the full spectrum of gross lesions, their anatomical distribution, associated demographic risk factors, and treatment outcomes remain scarce. Furthermore, the application of advanced non-invasive diagnostic modalities to support clinical decision-making in camel mammary disorders has been inconsistently reported. Accordingly, while the present study does not claim to be the first to describe udder and teat lesions in camels, it represents one of the relatively few clinical cohort investigations providing an integrated assessment of lesion frequency, morphology, and therapeutic outcomes under field conditions. Although limited by its reliance on clinically presented cases and the absence of longitudinal milk production data, this study helps bridge an important gap between descriptive pathology and the practical clinical management of udder and teat disorders in camels.

Materials and methods

Study design and animals

A prospective clinical study was conducted between 2018 and 2025 at the University Veterinary Hospital, College of Veterinary Medicine, Qassim University, Saudi Arabia. The study cohort comprised 191 female dromedary camels (Camelus dromedarius) admitted from various owners and farms across different regions of the Kingdom of Saudi Arabia, all presenting with udder and teat disorders. The animals had a mean age of 97 ± 23 months (range: 12–140 months) and a mean body weight of 550 ± 100 kg (range: 250–700 kg). The breed distribution included Wadeh (n = 102), Asfar (Sofor) (n = 58), and Mejhem (n = 31).

Inclusion criteria

Inclusion of camels was based on clinical examination, with subsequent ultrasonographic confirmation of one or more udder or teat affections. Cases were then categorized according to anatomical location, lesion type, age, breed, etiology, treatment modality, and outcome.

Ethical approval

The study protocol received ethical approval from the Animal Welfare and Ethics Committee of Qassim University, in accordance with the Laboratory Animal Control Guidelines (No. 367).

Clinical examination

A comprehensive clinical examination was conducted for each animal upon admission. This included a systematic evaluation of the udder and teats to assess the location, extent, and characteristics of the lesions, including size, pain, discharge, and chronicity. Signalment data (breed, age, and body weight), along with clinical history, were recorded for all camels.

Ultrasonographic examination

Ultrasonographic (US) evaluation was performed using a 3.5–7.5 MHz linear array transducer (SSD-500, Aloka, Tokyo, Japan) to characterize all lesions. To minimize stress, ensure animal welfare, and obtain high-quality diagnostic images, camels were positioned in lateral recumbency under light sedation induced by intravenous administration of xylazine HCl (0.2 mg/kg). Sedation was considered necessary to reduce struggling, pain-associated responses, and sudden movements that could compromise image quality, prolong handling time, or increase the risk of injury to both the animal and the operator. The low-dose protocol was selected to provide adequate restraint while minimizing potential physiological alterations that could affect ultrasonographic findings.

Transmission gel was applied to the examination area to optimize image acquisition. Ultrasonographic assessment focused on lesion echogenicity, dimensions, margins, and internal contents (e.g., fluid, gas, and tissue components). When indicated, ultrasonography-guided fine-needle aspiration was performed for diagnostic purposes [14]. All examinations were conducted by a single investigator to ensure procedural consistency and minimize inter-observer variability.

Clinical decision criteria for treatment selection

The selection of medical versus surgical management was based on clinical examination findings, ultrasonographic evaluation, lesion chronicity, tissue viability, and the presence or absence of structural damage. Medical treatment was indicated for acute inflammatory conditions without irreversible tissue injury, including edema, early-stage mastitis, superficial abscesses, and uncomplicated lesions without fistulation or necrosis. In contrast, surgical intervention was reserved for chronic, non-responsive, or structurally destructive conditions, such as chronic abscesses, gangrene, extensive fibrosis, deep fistulas, and severe tissue necrosis, in which conservative therapy was unlikely to achieve resolution. The decision-making process was further guided by the animal’s general health status and hematobiochemical profile to ensure suitability for surgical intervention.

Medical treatment

A total of 69 cases presenting primarily with inflammatory or non-surgical conditions were managed medically. The therapeutic protocol included the following components:

1. Systemic antibiotics: Amoxicillin–clavulanic acid (Synulox RTU, Zoetis, UK) administered intramuscularly at a dosage of 1 mL/20 kg body weight once daily for 5–7 days.

2. Systemic anti-inflammatory therapy: Meloxicam (Rheumocam, Eurovet) administered intravenously at 0.5 mg/kg once daily for 5 days.

3. Topical therapy: This included cold hydrotherapy massage in combination with the application of antimicrobial (Mastijet Forte, MSD) or anti-inflammatory (Montazone, Montajat) ointments, selected according to the nature and severity of the lesion.

Surgical treatment

Preoperative preparation and anesthesia

A total of 122 cases presenting with conditions such as chronic abscessation, gangrene, fibrosis, or fistulas were managed surgically. Prior to surgery, all female camels underwent routine clinical and hematological evaluations, including assessment of body temperature, vital parameters, total and differential leukocyte counts, and biochemical profiles. All measured values fell within the normal reference ranges as described by Sadan et al., (2023) [20], confirming the animals’ suitability for surgical intervention. Food and water were withheld for 12 h prior to the procedure. Preoperative medication included systemic antibiotics and anti-inflammatory drugs as previously described. General sedation was achieved using xylazine HCl (0.3 mg/kg, IV), followed by epidural anesthesia administered at the first intercoccygeal space using 10 mL of 2% lidocaine HCl.

Surgical procedures

Mastectomy: This procedure was performed in advanced cases, including purulent mastitis, gangrene, or severe fibrosis. An elliptical incision was made around the affected gland(s), followed by careful dissection and ligation of major blood vessels using polyglactin 910. The surgical site was then closed in layers, involving the subcutaneous tissue and skin [16, 17].

Fistula repair: Following thorough debridement of the fistulous tract, the teat canal was reconstructed in two layers—mucosal/submucosal and muscular/connective tissue—using polyglactin 910. In lactating animals, a sterile teat plug was inserted, with daily milking and regular replacement of the plug. Intramammary antibiotics were administered post-repair when indicated [18].

Postoperative management and outcome assessment

Postoperative antibiotic and anti-inflammatory therapies were continued for 10 and 5 days, respectively. Animals were confined for four weeks to minimize tension on the surgical site and reduce the risk of wound dehiscence. Skin sutures were removed 14 days postoperatively.

Long-term outcomes were evaluated over a six-month follow-up period through scheduled field visits and structured owner interviews. Treatment outcomes were classified according to predefined clinical criteria to avoid oversimplification and to capture partial or delayed failures:

1. Complete recovery: Full wound healing without complications, absence of swelling, discharge, or pain, and restoration of normal udder and teat function, including milk flow in lactating animals.

2. Partial recovery: Noticeable clinical improvement accompanied by residual functional or structural abnormalities (e.g., reduced milk yield, mild fibrosis, or minor teat canal narrowing) that did not require immediate re-intervention.

3. Not recovered (treatment failure): Persistence of primary clinical signs, wound breakdown, or failure to restore functional integrity, necessitating additional medical or surgical intervention.

4. Recurrence: Reappearance of the same lesion or development of a similar pathological condition at the same anatomical site after initial clinical resolution during the follow-up period.

Data and statistical analysis

Lesions were categorized according to type, anatomical location (forequarter, hindquarter, or bilateral), age group (< 5, 5–10, and > 10 years), breed, and treatment outcome (recovered vs. recovered with complications). Statistical analysis was performed using IBM SPSS Statistics (Version 21, Armonk, NY, USA). Frequency rates were calculated, and variations in the occurrence of udder lesions in relation to age, anatomical site, breed, and etiology were analyzed using the chi-square test or Fisher’s exact test, as appropriate. Results were expressed as p-values, odds ratios (OR), and 95% confidence intervals (CI). Treatment outcomes were analyzed using similar statistical methods. A p-value of < 0.05 was considered statistically significant.

Results

Overall frequency of udder and teat lesions

Out of 191 examined camels (Table 1), udder lesions (Figs. 1, 2, 3, 4 and 5; Table 2) were identified in 150 animals (78.53%), whereas teat lesions (Figs. 6, 7 and 8; Table 3) were observed in 41 animals (21.47%). Thus, udder disorders were significantly more frequent than teat disorders (Fig. 9; Tables 1 and 2 vs. Figure 10; Tables 1 and 3) (OR: 13.38; 95% CI: 8.13–21.94; p < 0.001). Mastitis was the most commonly diagnosed udder lesion, accounting for 57 cases (38.0% of udder lesions), followed by fibrosis (23 cases; 15.33%), wounds (19 cases; 12.67%), and abscesses (17 cases; 11.33%). These findings highlight mastitis as the principal threat to udder health and milk production. The frequency of chronic mastitis was significantly higher than that of acute (27 vs. 13; p < 0.01), suppurative (27 vs. 10; p < 0.001), and gangrenous mastitis (27 vs. 7; p < 0.001). Less frequently observed conditions included edema (2.67%), necrosis (2.0%), and gangrene (4.0%). Among teat disorders, hyperkeratosis (17.07%) and teat wounds (17.07%) were the most common findings, followed by dilated teat cistern (14.64%), thelitis (12.19%), and teat gangrene (12.19%). Blocked teat was rarely encountered (2.44%).

Table 1.

Frequency rate (%) of the udder and teat lesions in 191 camels^, cohort

Anatomical site	Lesion	Number of cases	frequency (%)
Udder (n = 150)	Mastitis	57	38.00
	Abscess	17	11.33
	Hematoma	6	4.00
	Fibrosis	23	15.33
	Edema	4	2.67
	Pendulous udder	9	6.00
	Neoplasia	6	4.00
	Wounds	19	12.67
	Necrosis	3	2.00
	Gangrene	6	4.00
Teat (n = 41)	Thelitis	5	12.19
	Hyperkeratosis	7	17.07
	Teat necrosis	3	7.32
	Gangrene	5	12.19
	Wounds	7	17.07
	Dilated teat cistern	6	14.64
	Dilated teat orifice	2	4.88
	Teat stenosis	3	7.32
	Blocked teat	1	2.44
	Neoplasia	2	4.88

Fig. 1.

A. Acute mastitis in Wadeh female camel. B. Chronic mastitis in Asfar female camel. C. Purulent mastitis in Asfar female camel, please note the discharging of a small amount of pus from the teat (white arrow). D: Gangrenous mastitis in Wadeh female camel, please note blackening and corrugation of udder skin

Fig. 2.

(A) Udder abscess in Asfar female camel. (B) Ultrasonography of the udder abscess revealed anechoic to hypoechoic contents bounded by echogenic capsules. (C) Udder hematoma in Wadeh female camel and its ultrasonographic examination (D) revealed hyperechoic contents surrounded by echogenic wall, additionally decreased of anechoic fluid contents, and increased echogenicity of the contents was noted in comparison to recent one. (E) Udder fibrosis in Wadeh female camel and its ultrasonography (F) revealed homogeneous or heterogeneous hyperechoic pattern, corresponding to areas of thickened connective or scar tissue in mild and severe cases

Fig. 3.

(A) Udder edema in Asfar female camel. (B) Different forms of pendulous udder either physiological (A) or pathological (C& D) in Mejhem female camel

Fig. 4.

(A) Udder granuloma in Asfar female camel. (B) Udder and teat papilloma in Asfar female camel. (C) Udder adenocarcinoma in Wadeh female camel. (D) Surgical resection of adenocarcinoma in a female camel. Ultrasonography of adenocarcinoma (E) revealed isoechoic to hyperechoic in appearance

Fig. 5.

(A) Udder laceration in Asfar female camel. (B) Udder fistula and its surgical treatment (C) in Mejhem female camel. (D) Udder necrosis in Wadeh female camel. (E) Udder gangrene in Asfar female camels. (F) Mastectomy for treatment of udder fibrosis in Asfar female camel

Table 2.

Udder lesions in dromedary camels^, cohort according to location, age, breed, cause, and treatment outcomes

Lesion	Location			Age (Year)			Breed			Causes				Treatment		Treatment outcomes
	FQ	HQ	Both	< 5	5–10	> 10	Wadeh	Sofor	Mejhem	Congenital	Acquired			Medicinal	Surgical	R	RC
											Traumatic	Infectious	Non-infectious
Mastitis (n = 57)	18	27	12	3	39	15	31	17	9	0	1	53	3	45	12	51	6
Abscess (n = 17)	5	9	3	1	10	6	9	5	3	0	3	13	1	4	13	15	2
Hematoma (n = 6)	2	4	0	0	4	2	4	1	1	0	6	0	0	0	6	6	0
Fibrosis (n = 23)	7	11	5	0	9	14	11	8	4	0	2	20	1	3	20	22	1
Edema (n = 4)	2	1	1	1	3	0	1	2	1	0	0	3	1	4	0	4	0
Pendulous (n = 9)	1	2	6	0	3	6	4	3	2	2	1	6	0	2	7	7	2
Neoplasia (n = 6)	1	3	2	0	4	2	4	2	0	0	1	1	4	0	6	6	0
Wounds (n = 19)	11	7	1	2	12	5	8	6	5	0	19	0	0	0	19	17	2
Necrosis (n = 3)	0	3	0	0	2	1	2	1	0	0	0	2	1	1	2	3	0
Gangrene (n = 6)	2	3	1	0	5	1	4	2	0	0	0	6	0	0	6	5	1
Total (150)	49	70	31	7	91	52	78	47	25	2	33	104	11	59	91	136	14

Fig. 6.

A: Teat fistula in Mejhem female camel. B: Surgical repair in the same case in A, please note the refreshment of the fistula with suturing of submucosal and muscular layer with simple continuous sutures using braided coated polyglactin 910 No. 2 (United medical industries Co., Ltd., Riyadh) swaged on atraumatic needle, and the skin was then sutured by silk No. 2 (United medical industries Co. Ltd. Riyadh, Kingdom of Saudi Arabia) and simple interrupted stitches

Fig. 7.

A Thelitis in Wadeh female camel. B Teat hyperkeratosis in Wadeh female camel. C Teat black spot in Wadeh female camel. D Teat gangrene in Wadeh female camel

Fig. 8.

A Dilated teat cistern with stenosed teat opening in Asfar female camel. B Dilated teat orifice in Mejhem female camel. C Teat orifice necrosis in Asfar female camel. D Teat stenosis in Asfar female camel, E Teat blockage and its surgical treatment in Wadeh female camel

Table 3.

Teat lesions in dromedary camels^, cohort according to location, age, breed, cause, and treatment outcomes

Lesion	Location			Age (Year)			Breed			Causes				Treatment		Treatment outcomes
	FQ	HQ	Both	< 5	5–10	> 10	Wadeh	Sofor	Mejhem	Congenital	Acquired			Medicinal	Surgical	R	RC
											Traumatic	Infectious	Non-infectious
Thelitis (n = 5)	1	3	1	1	4	0	4	1	0	0	1	3	1	5	0	5	0
Hyperkeratosis (n = 7)	1	4	2	0	5	2	4	3	0	0	1	0	6	2	5	6	1
Teat necrosis (n = 3)	1	2	0	0	3	0	2	0	1	0	0	3	0	2	1	3	0
Gangrene (n = 5)	1	3	1	0	4	1	3	1	1	0	0	5	0	1	4	4	1
Wounds (n = 7)	2	5	0	1	4	2	3	2	2	0	7	0	0	0	7	6	1
Dilated teat cistern (n = 6)	1	1	4	0	4	2	3	2	1	0	4	2	0	0	6	4	2
Dilated teat orifice (n = 2)	1	1	0	0	1	1	1	0	1	0	2	0	0	0	2	2	0
Teat stenosis (n = 3)	1	2	0	1	2	0	2	1	0	0	1	2	0	0	3	2	1
Blocked teat (n = 1)	0	1	0	0	1	0	1	0	0	0	1	0	0	0	1	1	0
Neoplasia (n = 2)	1	1	0	0	1	1	1	1	0	0	0	1	1	0	2	2	0
Total (41)	10	23	8	3	29	9	24	11	6	0	17	16	8	10	31	35	6

Fig. 9.

Distribution of udder affections in dromedary female camels

Fig. 10.

Distribution of teat affections in dromedary female camels

Udder and teat lesions distribution, and epidemiological associations

Most udder lesions were localized to the hindquarters (OR: 3.12; 95% CI: 1.38–3.20; p < 0.01), particularly in cases of mastitis, fibrosis, and abscesses. Lesions involving both the fore- and hindquarters were more commonly observed in animals with pendulous udders and in cases of chronic mastitis, suggesting long-standing pathology. In contrast, wounds were more frequently detected in the forequarters than in the hindquarters (11 vs. 7 cases). Teat lesions were predominantly unilateral and occurred more frequently in the hindquarters than in the forequarters.

Udder and teat lesions were most commonly observed in camels aged 5–10 years (OR: 3.6; 95% CI: 2.3–5.5; p < 0.001), accounting for 62.83% of total cases, whereas animals younger than 5 years represented only 5.24% of affected cases. This distribution indicates a strong association between lesion occurrence and the productive age of the animals. However, conditions such as fibrosis and pendulous udders were more frequently observed in older camels (> 10 years). The Wadeh breed exhibited the highest proportion of udder and teat lesions (53.40%; OR: 2.6; 95% CI: 1.7–4.0; p < 0.001), followed by Sofor (30.37%) and Mejhem (16.23%). Breed-related variation was particularly evident for mastitis and fibrosis. The vast majority of lesions were of acquired origin (98.96%; OR: 4.83; 95% CI: 3.12–7.50; p = 0.001), whereas congenital lesions accounted for only 1.04%. Infectious causes predominated in cases of mastitis, abscesses, and thelitis, while traumatic and non-infectious etiologies were mainly associated with wounds, hematomas, and teat stenosis.

Clinical findings

Female camels affected by acute purulent mastitis exhibited anorexia, fever, general depression, and marked udder swelling accompanied by purulent discharge (Fig. 1A, C), along with severe inflammation and pain. In chronic cases, the udder appeared firm, enlarged, and non-painful, with a fibrotic consistency characterized by nodular indurations and atrophy of one or more quarters (Fig. 1B). In cases of gangrenous mastitis, the udder was bluish and edematous, cold to the touch, and showed blackened, corrugated skin with signs of tissue necrosis and putrefaction (Fig. 1D).

Six female camels with a history of trauma were diagnosed with udder hematomas. The appearance of the hematoma contents varied according to severity and duration. In recent cases, the udder presented with a hot, painful inflammatory swelling. In contrast, clinical examination of five cases with organized hematomas revealed well-circumscribed, firm, non-painful, and cold swellings. Exploratory puncture under strict aseptic conditions yielded fresh blood in recent cases and serosanguinous (blood-tinged) fluid in organized hematomas (Fig. 2C). Udder fibrosis was observed in 23 cases (15.33%) (Fig. 2E) and was attributed to chronic inflammation or injury. This condition was characterized by induration of one or more quarters, resulting in marked firmness and hardening of the affected tissue, often accompanied by a history of pain or discomfort during milking and a reduction in milk yield.

Udder edema was documented in four animals (2.67%) (Fig. 3A). Clinically, the udder exhibited soft, diffuse enlargement with pitting on palpation. The overlying skin appeared stretched, and the affected area was cooler than the surrounding tissues. Affected animals also showed signs of discomfort or pain during milking.

In this study, nine female camels (6%) exhibited pendulous udders (Fig. 3). The udder was observed to hang lower than normal and displayed excessive movement during locomotion, resulting in noticeable alterations in the animals’ gait. Neoplastic lesions were identified in six cases (4%), including papillomas, granulomas, and adenocarcinomas (Fig. 4).

Udder wounds were recorded in 19 cases (12.67%), including lacerations in five animals (3.33%) (Fig. 5A) and fistulas in 14 animals (9.34%) (Fig. 5B, C), with variation depending on the severity and extent of tissue damage. Fistulas were characterized by abnormal external openings in the udder, leading to continuous or intermittent leakage of milk or serous fluid. Affected animals frequently exhibited localized swelling, inflammation, and pain, particularly during milking. In chronic cases, skin irritation, crust formation around the fistulous tract, and fibrosis of the surrounding tissues were commonly observed.

Udder necrosis was observed in three cases (2%). The condition affected one or more quarters and was characterized by skin discoloration (darkening to blackening) (Fig. 5D), a cold and corrugated surface, and, in severe cases, sloughing of tissue or complete loss (amputation) of the affected quarter.

Udder gangrene was detected in six female camels (4%) (Fig. 5E, F). In the acute stage, the udder appeared hard, hot, and painful; in chronic cases, it became cold and firm, with dark red to black discoloration of the skin. The udder surface developed a corrugated appearance and was often associated with a foul odor resulting from tissue necrosis.

Clinical manifestations of teat injuries varied depending on the severity and extent of the damage. Teat wounds were diagnosed in two cases (17.07%), presenting as distinct cuts or tears in the teat skin. These lesions ranged from superficial injuries involving only the skin to deeper lesions extending into the teat canal or cistern. Affected teats exhibited localized swelling, with active bleeding in recent cases and scab formation in more chronic lesions.

Teat fistulas were observed in five cases (12.19%) (Fig. 6A, B) and were characterized by abnormal external openings of varying size on the teat, resulting in continuous or intermittent leakage of milk. Affected female camels commonly showed localized swelling, inflammation, and pain, particularly during milking. In chronic cases, additional findings included skin irritation, crust formation around the fistulous opening, and fibrosis of the surrounding tissues.

Thelitis was observed in five female camels (12.19%) and was characterized by teat swelling, tenderness on palpation, thickening and induration of the teat skin, and the presence of crusts, scabs, or ulcerative lesions (Fig. 7A). Teat hyperkeratosis was identified in seven animals (17.07%), presenting as a rough, thickened, hardened, or scaly teat surface, often accompanied by brown crust formation and narrowing of the teat orifice (Fig. 7B).

Teat necrosis was diagnosed in three female camels (7.32%) and was characterized by a cold, dry teat surface with discoloration and loss of sensation (Fig. 7C). Teat gangrene was recorded in five cases (12.19%), in which the affected teats appeared swollen, cold, and moist, with a foul odor. The skin showed dark brown to black discoloration, along with a distinct line of demarcation separating viable from necrotic tissue (Fig. 7D).

Dilatation of the teat cistern was detected in six female camels (14.64%). This condition was characterized by enlargement of the teat, particularly at the base, with a soft, fluctuant consistency on palpation, absence of pain or heat, and failure of milk ejection due to a visibly narrowed teat orifice (Fig. 8A).

A dilated teat orifice (free milker) was observed in two female camels (4.88%). This condition was characterized by an enlarged and widened teat opening, accompanied by continuous or intermittent milk leakage and persistent moisture around the teat end, sometimes with crusts of dried milk. In chronic cases, thickening of the skin surrounding the teat orifice was evident (Fig. 8B).

Teat stenosis (hard milker) was recorded in three female camels (7.32%). Clinically, the teat orifice appeared firm, narrowed, or pin-point, with increased hardness on palpation, particularly near the orifice, and slight swelling at the distal end of the teat. In chronic cases, palpable fibrous thickening around the orifice or within the teat canal was commonly observed (Fig. 8D).

A blocked teat was identified in one female camel (2.44%). The affected teat was firm, swollen, and fluctuant on palpation, eliciting pain upon pressure or during milking, and was associated with complete or markedly reduced milk flow (Fig. 8E).

Additionally, two cases of teat papilloma (4.88%) were identified in the present study.

Ultrasonographic findings

In cases of acute mastitis, ultrasonography typically revealed heterogeneous echogenicity with reduced visualization of the alveolar structures. In contrast, chronic mastitis was characterized by increased (hyperechoic) echogenicity of the udder parenchyma (Fig. 1B, D). The ultrasonographic appearance of udder abscesses varied from hypoechoic to hyperechoic contents, usually surrounded by a well-defined echogenic capsule. These cavities contained varying amounts of pus, cellular debris, or homogeneous material (Fig. 2B).

In recent udder hematomas, ultrasonographic examination demonstrated anechoic to hypoechoic fluid contents enclosed by an echogenic wall. In contrast, organized hematomas appeared more hyperechoic, with a reduction in anechoic fluid and a corresponding increase in internal echogenicity compared to recent lesions (Fig. 2D). Fibrosed udders exhibited either homogeneous or heterogeneous hyperechoic patterns, corresponding to varying degrees of connective tissue proliferation or scar formation in mild and advanced cases, respectively. In instances where fibrosis was associated with abscess formation, hyperechoic areas were interspersed with hypoechoic regions (Fig. 2F).

Neoplastic lesions, including papillomas, granulomas, and adenocarcinomas, were identified in six cases (Fig. 4E). Ultrasonographically, these lesions appeared as masses with echogenicity ranging from isoechoic to hyperechoic. Finally, ultrasonographic examination of a dilated teat cistern revealed a markedly enlarged, predominantly anechoic cavity, occasionally containing milk with increased echogenicity (Fig. 8B).

Treatment and outcomes

Medical management was primarily applied in acute cases, whereas chronic, traumatic, and neoplastic conditions required surgical intervention. Combined medical and surgical approaches were employed in selected cases with complications. Overall, treatment was successful in 171 cases (89.53%; OR: 73.1; 95% CI: 38.6–134.3; P = 0.001), resulting in complete clinical recovery. Routine postoperative complications were observed in 20 cases (10.47%), most commonly associated with mastitis, fibrosis, and teat wounds.

Discussion

The growing demand for dromedary camel milk, driven by its nutritional, functional, and perceived therapeutic benefits, has accelerated the expansion of camel dairy systems in arid and semi-arid regions. Several epidemiological studies conducted across the Arabian Peninsula and North Africa have similarly highlighted that udder health is a cornerstone of sustainable camel milk production, directly influencing milk yield, hygienic quality, and market value [20–22]. Investigations from Saudi Arabia, Sudan, and Ethiopia have demonstrated that impaired udder integrity is associated with increased somatic cell counts and bacterial contamination, thereby reducing both shelf life and commercial acceptability [2–9]. Udder and teat disorders adversely affect milk production, alter physicochemical and sensory properties, and elevate the risk of microbial contamination [5, 6, 9].

The present study provides a comprehensive epidemiological assessment of udder and teat disorders in dromedary camels, highlighting their frequency, distribution, etiological factors, and treatment outcomes. The markedly higher frequency of udder lesions (78.53%) compared with teat lesions (21.47%) indicates that the udder represents the primary anatomical site affected by pathological conditions in camels. This predominance likely reflects the udder’s greater susceptibility to infectious agents, mechanical trauma, and physiological stress associated with lactation.

Mastitis emerged as the most frequent udder disorder, accounting for nearly one-third of all examined camels. This finding is consistent with previous reports [1, 4, 6, 8, 21, 23], which identify mastitis as the most economically significant mammary gland disease in camels, particularly under intensive and semi-intensive management systems. The predominance of chronic and suppurative forms observed in the present study suggests delayed diagnosis and inadequate early intervention, as well as suboptimal milking hygiene and poor dry-period management. These factors likely contribute to reduced milk yield and increased recurrence rates.

Fibrosis (15.33%) and abscess formation (11.33%) were also frequently observed, often as sequelae of chronic inflammatory processes. Previous ultrasonographic case reports have demonstrated that chronic mastitis produces heterogeneous echotexture and hyperechoic fibrotic strands, findings that closely correspond with the imaging patterns observed in the present study [5, 10, 13]. Abscess formation has likewise been documented in earlier reports, particularly in animals exposed to penetrating injuries or secondary bacterial invasion following untreated mastitis. Surgical drainage combined with systemic antimicrobial therapy in such cases has been associated with favorable outcomes when intervention is performed promptly, which is consistent with the high recovery rates reported in this study [16–19].

The strong association between these lesions and older age groups further supports the role of cumulative tissue damage and repeated inflammatory insults across successive lactation cycles [24, 25]. Similarly, traumatic lesions including wounds (12.67%) and hematomas (4%) have been frequently reported in pastoral and semi-intensive production systems, where environmental hazards, thorn injuries, and aggressive calf behavior contribute to mammary damage [4, 21, 22]. Field observations from desert-based production systems also indicate a higher incidence of such lesions under inadequate housing or shelter conditions, underscoring the importance of proper environmental management. Although teat disorders were less frequent, they remain clinically significant.

Teat lesions, although less frequent, represent clinically important conditions that directly interfere with milk flow and milking efficiency. Hyperkeratosis and teat wounds (17.07%) were the most commonly identified disorders, likely associated with repetitive mechanical irritation, improper milking practices, or excessive negative pressure during machine milking. Comparable reports in camel dairy systems have linked hyperkeratotic changes to chronic inflammation of the teat canal and subsequent stenosis.

The relatively high frequency of dilated teat cisterns (14.64%) and teat stenosis (7.32%) further suggests the presence of long-standing functional alterations, most likely secondary to chronic inflammation or fibrosis [1, 5–7]. Such conditions often require surgical intervention to restore normal milk flow and functional integrity.

Age was a significant determinant of lesion occurrence, with the highest frequency observed in camels aged 5–10 years (120 cases, 62.83%). This age group corresponds to peak productive and reproductive activity, during which animals are exposed to maximum physiological demands and management-related stressors. A substantial proportion of cases was also recorded in animals older than 10 years (61 cases, 31.94%), likely reflecting the cumulative effects of aging, repeated lactation cycles, and chronic pathological changes. In contrast, the low frequency observed in camels younger than 5 years (10 cases, 5.24%) may be attributed to limited exposure to risk factors and lower milking pressure. The sustained frequency of lesions in older animals further supports the hypothesis of cumulative tissue degeneration. Similar patterns have been reported in previous studies [1, 10, 22].

Regarding breed distribution, udder and teat disorders were most frequently observed in Wadeh camels (102 cases, 53.40%), followed by Sofor camels (58 cases, 30.37%) and Mejhem camels (31 cases, 16.23%). While some studies suggest that management-related factors play a more prominent role than genetic predisposition, others report higher lesion frequencies in high-yielding or economically valuable breeds. The higher prevalence observed in Wadeh camels in the present study may be attributed to their wider distribution and larger population in Saudi Arabia, as well as their superior productivity, reproductive performance, and economic importance, as reported by El-Shafaey et al., 2020 [3].

About anatomical distribution, udder and teat lesions were most frequently observed in the hindquarters (HQs; 48.69%), followed by the forequarters (FQs; 30.89%). Several clinical and ultrasonographic studies have reported similar distribution patterns [4, 6, 8], supporting the functional and anatomical basis of this observation. This distribution is biologically plausible, as the hindquarters are larger, produce a greater volume of milk, and are more susceptible to trauma and environmental contamination.

The overwhelming predominance of acquired lesions (98.96%) further confirms previous findings that environmental, infectious, and management-related factors play a central role in disease pathogenesis. Comparable economic analyses have documented significant financial losses associated with reduced milk yield, milk discarded during antimicrobial withdrawal periods, and premature culling [18, 22, 23]. Collectively, these findings across studies highlight that most udder and teat disorders are largely preventable through improved management and health practices.

The predominance of acquired lesions (98.96%) underscores the critical role of environmental, infectious, and management-related factors in the pathogenesis of udder and teat disorders. This pattern suggests that many infections are persistent or inadequately treated, ultimately progressing to chronic conditions. These disorders contribute to substantial economic losses through reduced milk yield, discard of milk during antimicrobial withdrawal periods, and in severe cases, loss of functional quarters when drying-off becomes necessary, thereby diminishing the overall productivity and economic value of dairy camels [1, 20, 26]. Collectively, these findings highlight the considerable potential for prevention through improved hygienic practices, early diagnosis, and appropriate milking management.

The integration of clinical examination with ultrasonography has been increasingly advocated in camel medicine as a valuable diagnostic approach. Previous case reports and controlled studies have demonstrated that ultrasonography enhances the early detection of intraparenchymal abscesses, fibrosis, ductal obstruction, and cisternal abnormalities [5, 10, 13]. The imaging patterns observed in the present study closely correspond with those reported in earlier investigations, supporting the reliability and reproducibility of ultrasonographic evaluation under field conditions.

From a therapeutic perspective, the high overall recovery rate (89.53%) recorded in this study is consistent with previously reported outcomes of surgical management for chronic mastitis, abscesses, teat fistulas, and stenosis [16–19]. Earlier studies emphasized that prognosis improves markedly with timely surgical intervention and adherence to strict postoperative care protocols. The relatively low complication rate observed in the present study further supports the safety and practicality of surgical management in appropriately selected cases.

A wide range of clinical manifestations associated with udder and teat disorders was documented, varying according to the nature and severity of the lesions. Clinical examination, when combined with advanced non-invasive diagnostic tools (particularly ultrasonography) facilitates accurate diagnosis of mammary disorders in camels. The ultrasonographic appearance of udder and teat lesions varied depending on lesion type, underlying etiology, duration, severity, and the extent of tissue involvement. Observed patterns included homogeneous and heterogeneous echotextures, as well as anechoic, hypoechoic, and hyperechoic areas, which are consistent with findings reported in previous studies [5, 10, 13].

Recent advances in ultrasonographic imaging have significantly expanded its diagnostic applications in mammary gland disorders of large animals. In cattle, both B-mode and color Doppler ultrasonography of the supramammary lymph nodes have been shown to provide valuable insights into inflammatory and vascular changes associated with mastitis. For instance, Risvanli et al., 2019 [27] reported significant alterations in lymph node size, echogenicity, and vascular perfusion in cows affected by mastitis, suggesting that ultrasonography can serve as a reliable and non-invasive adjunct for assessing mammary inflammation. Similarly, Rişvanli et al., 2022 [28] demonstrated that pulsed-wave Doppler ultrasonographic evaluation of supramammary lymph nodes enhances diagnostic sensitivity by enabling the assessment of hemodynamic changes.

Although the present study primarily focused on the ultrasonographic evaluation of udder parenchyma, teat structures, and cisternal lesions, the observed imaging characteristics were consistent with previously reported patterns of inflammatory, fibrotic, and obstructive mammary disorders. Collectively, these findings reinforce the growing role of ultrasonography as a practical, reliable, and reproducible imaging modality for the comprehensive assessment of mammary gland pathology in dromedary camels.

Management of udder and teat lesions involved a combination of medical and surgical approaches tailored to the underlying mammary pathology. Overall, treatment outcomes were favorable, with a high recovery rate (89.53%). Medical therapy was primarily effective in early-stage, uncomplicated lesions, whereas surgical intervention proved highly successful in chronic, complicated, or irreversible conditions. Postoperative complications were relatively low (10.47%) but occurred more frequently in cases of chronic mastitis, fibrosis, and teat injuries. These findings highlight the critical importance of early diagnosis, timely intervention, and proper postoperative management to optimize clinical outcomes [5, 7, 9, 20].

In addition to its diagnostic value, ultrasonography increasingly supports the development of minimally invasive therapeutic techniques for teat disorders. Recently, Risvanli et al., (2023) [29] evaluated a novel veterinary argon plasma coagulation (APC) device for treating teat canal stenosis and reported encouraging clinical outcomes, including restoration of teat patency, improved milk flow, minimal hemorrhage, and limited postoperative complications. APC represents an emerging therapeutic modality that may offer advantages over conventional surgery by reducing tissue trauma and enabling more controlled coagulation of stenotic lesions. Although APC was not employed in the present study, surgical correction of teat stenosis and obstructive lesions yielded favorable outcomes in most affected camels. These findings underscore the importance of continued refinement of both surgical and minimally invasive techniques for teat disorders. Future studies evaluating the feasibility and clinical applicability of APC in dromedary camels may enhance preservation of teat function, minimize postoperative complications, and improve milk production efficiency in camel dairy systems.

Despite these strengths, several limitations should be acknowledged. Although mastitis and abscesses were among the principal findings, microbiological confirmation and antimicrobial susceptibility testing were not performed. Consequently, etiological diagnosis relied primarily on clinical and ultrasonographic assessments, which may limit the interpretation of treatment outcomes. Furthermore, as only clinically affected cases were included, the study design does not permit a definitive evaluation of risk factors or causal relationships. In addition, statistical analysis was limited to chi-square and Fisher’s exact tests, and no multivariate logistic regression models were applied to control for potential confounding variables. Therefore, the findings should be interpreted as descriptive and exploratory rather than indicative of independent associations or causal relationships. Moreover, all ultrasonographic examinations were performed by a single operator, which may have introduced operator-dependent bias and precluded the assessment of inter-observer variability. Future studies incorporating microbiological culture, molecular diagnostics, antimicrobial susceptibility testing, multivariate analytical approaches, case–control designs, and multiple ultrasonographic evaluators are recommended to enhance both diagnostic accuracy and the epidemiological understanding of udder and teat disorders in dromedary camels.

Conclusion

This study demonstrates that integrating systematic clinical examination with targeted ultrasonographic assessment enhances diagnostic accuracy, prognostic evaluation, and treatment planning for udder and teat lesions in dromedary camels. Early diagnosis and timely intervention particularly surgical management of chronic or non-responsive lesions were associated with favorable clinical outcomes, improved animal welfare, and reduced production losses. These findings support the value of routine ultrasonographic screening and evidence-based clinical strategies in promoting herd health and ensuring the sustainability of camel production systems.

Abbreviations

CI

Confidence Interval

FQ

Forequarter

HQ

Hindquarter

IV

Intravenous

kg

Kilogram

MHz

Megahertz

mg/kg

Milligram per kilogram

n

Number of cases/animals

OR

Odds Ratio

SPSS

Statistical Package for the Social Sciences

US

Ultrasonography

Authors’ contributions

MS, EE: Conceptualization and data curation, MS, EE, FA, MA, FSH, GA, and WR: Formal analysis, funding acquisition, and investigation, all Authors: Writing - review and editing of the manuscript.

Funding

The researchers would like to thank the Deanship of Graduate Studies and Scientific Research at Qassim University (www.qu.edu.sa) for financial support (QU-APC 2026).

Data availability

All data presented in this study are available on request from the corresponding authors.

Declarations

Ethics approval and consent to participate

All experimental procedures were conducted in accordance with the Laboratory Animal Control Guidelines of Qassim University, which adhere to the principles outlined in the Guide for the Care and Use of Laboratory Animals of the U.S. National Institutes of Health (NIH Publication No. 86–23, revised 1996). The animals included in this study were privately owned by individuals and farms across various regions of the Kingdom of Saudi Arabia, and informed consent was obtained from all owners prior to their inclusion in the study. The study protocol (Approval No. 367) was reviewed and approved by the Committee for Animal Welfare and Ethics at Qassim University, Saudi Arabia.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.