Fatal parasite-induced enteritis and typhlocolitis in horses in Southern Brazil.

Diseases related to the alimentary system are the main cause of death in horses. This retrospective study aimed to describe the pathological findings of fatal parasite-induced enteritis and typhlocolitis caused by cyathostominae, Eimeria leuckarti, Balantidium coli, and Strongyloides westeri in horses. The records of parasite-induced intestinal lesions in horses necropsied in Southern Brazil between 2005 and 2017 were reviewed. Ten horses had fatal parasitic enteritis and/or typhlocolitis, and the main causes were: cyathostominae typhlocolitis (6/10), E. leuckarti enteritis (1/10), S. westeri enteritis (1/10), B. coli colitis related to cyathostominae (1/10), and infection by multiple agents (1/10). Cyathostominae typhlocolitis showed marked mucosal thickening, with multifocal elevated nodules containing tangled filiform parasites. Microscopic examination revealed that the mucosa and submucosa had encysted parasitic structures surrounded by eosinophilic and granulomatous inflammation. E. leuckarti enteritis was microscopically characterized by macrogamonts, microgamonts, and oocysts inside the host cells. S. westeri enteritis showed microscopic atrophy of the villi with numerous mucosal encysted parasitic structures. B. coli typhlocolitis showed severe diffuse mucosal reddening, with microscopic superficial mucosal necrosis associated with multiple protozoan trophozoites. Fatal parasite-induced enteritis and typhlocolitis are important causes of death in horses in Southern Brazil.

Fatal parasite-induced enteritis and typhlocolitis in horses in Southern Brazil / Enterites e tiflocolites parasitárias fatais em equinos no Sul do Brasil

Abstract Diseases related to the alimentary system are the main cause of death in horses. This retrospective study aimed to describe the pathological findings of fatal parasite-induced enteritis and typhlocolitis caused by cyathostominae, Eimeria leuckarti, Balantidium coli, and Strongyloides westeri in horses. The records of parasite-induced intestinal lesions in horses necropsied in Southern Brazil between 2005 and 2017 were reviewed. Ten horses had fatal parasitic enteritis and/or typhlocolitis, and the main causes were: cyathostominae typhlocolitis (6/10), E. leuckarti enteritis (1/10), S. westeri enteritis (1/10), B. coli colitis related to cyathostominae (1/10), and infection by multiple agents (1/10). Cyathostominae typhlocolitis showed marked mucosal thickening, with multifocal elevated nodules containing tangled filiform parasites. Microscopic examination revealed that the mucosa and submucosa had encysted parasitic structures surrounded by eosinophilic and granulomatous inflammation. E. leuckarti enteritis was microscopically characterized by macrogamonts, microgamonts, and oocysts inside the host cells. S. westeri enteritis showed microscopic atrophy of the villi with numerous mucosal encysted parasitic structures. B. coli typhlocolitis showed severe diffuse mucosal reddening, with microscopic superficial mucosal necrosis associated with multiple protozoan trophozoites. Fatal parasite-induced enteritis and typhlocolitis are important causes of death in horses in Southern Brazil.

Resumo Doenças relacionadas ao sistema alimentar são as principais causas de morte em equinos. Esse estudo teve o objetivo de descrever aspectos patológicos de enterites e tiflocolites parasitárias fatais por ciatostomíneos, Eimeria leuckarti, Balantidium coli e Strongyloides westeri, em equinos. Foi revisado o banco de dados de lesões intestinais parasitárias em equinos necropsiados de 2005 a 2017, no Sul do Brasil. Dez equinos apresentaram enterite e/ou tiflocolite parasitária fatal, e as principais foram: tiflocolite por ciatostomíneos (6/10), enterite por E. leuckarti (1/10), enterite por S. westeri (1/10), colite por B. coli com ciatostomíneos (1/10), e infecção por múltiplos agentes (1/10). A tiflocolite por ciatostomíneos exibia acentuado espessamento da mucosa, com nódulos multifocais elevados contendo parasitas filiformes. Microscopicamente, a mucosa e submucosa apresentavam estruturas parasitárias encistadas envoltas por inflamação eosinofílica e granulomatosa. A enterite por E. leuckarti era caracterizada microscopicamente por macrogamontes, microgamontes e oocistos no interior de células do hospedeiro. Microscopicamente, a enterite por S. westeri apresentava atrofia de vilosidades com numerosas estruturas parasitárias encistadas na mucosa. A tiflocolite por B. coli exibia avermelhamento acentuado difuso da mucosa, e microscopicamente necrose superficial associada a múltiplos trofozoítos protozoáricos. Enterites e tiflocolites fatais parasitárias são importantes causas de morte em equinos no Sul do Brasil.

Clinical Presentation, Prognostic Factors, and Outcome in Neutropenic Enteropathy of Childhood Leukemia.

Leukemia patients are at risk for neutropenic enteropathy (NEP) because of the effects of intensified chemotherapy. Medical records of 18 patients having 20 episodes of NEP were reviewed retrospectively. Primary diagnosis was acute lymphoblastic leukemia in 12 and myeloblastic leukemia in 6 cases. According to prognosis, 3 patients were in the standard-risk group, 6 in the moderate-risk group, and 9 in the high-risk group. Ultrasonography detected increased bowel wall thickness in 6 patients. Abdominal x-ray revealed air-fluid levels (n=8), pneumatosis intestinalis, pneumoperitoneum (n=1), and portal venous gas (n=1). All patients received medical treatment, and 1 with unrelieved hematochezia required resection of the cecum. Two cases with appendicitis and another 1 with pneumoperitoneum responded to antibiotics and recovered without surgery. The mortality rate was 30% and related to sepsis-induced complications. The presence of hypokalemia, hypoalbuminemia, metabolic acidosis, and admission to the intensive care unit were more common in patients with mortality (P=0.01). In conclusion, NEP should be kept in mind as a treatable but potentially lethal complication of childhood leukemia. Radiologic findings should be interpreted in conjunction with clinical picture. A conservative approach should be used in all cases but surgery can be considered in some situations.

Impact of Usp18 and IFN signaling in Salmonella-induced typhlitis.

In humans, Salmonella infection causes two major clinical diseases, typhoid fever and a self-limiting gastro-enteritidis. Salmonella transmission occurs by the fecal-oral route and the interactions between the bacteria and the digestive tract epithelium are central to the outcome of the infection. Using a mouse model of typhoid fever, we previously identified a mutation in USP18 affecting type I interferon (IFN) signaling resulting in increased susceptibility to systemic Salmonella infection. In this study, we demonstrate the effects of this mutation during the early response to Salmonella using a model of typhlitis. Mutant Usp18 mice showed a minimal inflammatory response early after Salmonella Typhimurium infection that was associated with low pathologic scores and low IFN-γ production. This resulted in an increased interaction of Salmonella with the cecal epithelium and earlier systemic dissemination of the bacteria. The global transcriptional signature in the cecum of mouse during Salmonella infection showed normal expression of tissue specific genes and upregulation of type I IFN pathway in mutant mice. In control mice, there was a significant over-representation of genes involved in cellular recruitment and antibacterial activity paralleling the histopathological features. These results show the impact of USP18 in the development of Salmonella-induced typhlitis.

Typhlitis in children with malignancy: a single center experience.

In a case-control study, medical records of all children (below 18 y of age) who were diagnosed with any malignancy between January 1988 and December 2008 were reviewed. Children who developed typhlitis during the course of their malignancy were identified. Age and sex-matched controls who were diagnosed with malignancy during the same time period but did not develop typhlitis were identified (1:4 ratio). The variables that were examined included underlying malignancy, chemotherapy, and final outcome. A total of 410 children (226 males, mean age of 87.29 ± 56.8 mo) with malignancy were recruited. Nine children (0.22%) (4 boys, mean age of 87.56 ± 60.48 mo) developed typhlitis during the course of their disease. In the control group, 36 age and sex-matched children were included (mean age of 87.67 ± 57.91 mo). Children who had Clostridium difficile infection within 8 weeks before developing typhlitis were more likely to develop typhlitis compared with controls (odds ratio 7.99, 95% confidence interval 1.46-43.7, P=0.01). One patient died from typhlitis. Clostridium difficile infection is a risk factor for developing typhlitis in children with cancer. Larger multicenter trials are needed to confirm our conclusions.