Acute fasciolosis in an alpaca: a case report.

BACKGROUND: The popularity of new world camelids, particularly alpacas, is growing rapidly in Ireland, presenting a clinical challenge to veterinary practitioners who may not have worked with these species previously. To the authors' knowledge, the clinical course of a case of acute fasciolosis in an alpaca has not previously been reported, and fasciolosis has not been reported at all in alpacas in Ireland, making this case report a valuable addition to the current literature. CASE PRESENTATION: A three-year-old male castrated huacaya alpaca was admitted to UCD Veterinary Hospital with a two-day history of colic and tenesmus. He had been treated with albendazole, dexamethasone and potentiated amoxycillin by the referring veterinary practitioner with no response. On initial clinical exam, sensitivity to abdominal palpation was the only abnormality. However, the alpaca proceeded to show abnormal lying positions, tenesmus and reduced faecal output over the next 24 h. A general blood panel demonstrated moderate anaemia, marked hyperglobulinaemia and moderately increased hepatocellular and hepatobiliary enzyme activity. Abdominal radiography revealed enlargement of the first forestomach compartment without evidence of gastrointestinal obstruction or peritonitis. An abdominal ultrasound exam revealed an elongated, heterogenous mass in the caudoventral abdomen that appeared to be contiguous with the liver. FNA of this mass revealed that it was in fact a liver lobe with biliary stasis and inflammation. Faecal sedimentation demonstrated Fasciola hepatica eggs. In spite of treatment with triclabendazole and supportive treatment including blood transfusion, the alpaca's condition continued to deteriorate and he was euthanised. On post-mortem exam, acute fasciolosis was diagnosed. CONCLUSIONS: The clinical presentation and course of a case of acute fasciolosis in an individual alpaca is described, including the results of a range of diagnostic tests that were carried out. The final diagnosis is supported by a description of post-mortem findings. This information will serve as a resource for veterinary practitioners involved in the diagnosis and treatment of similar cases.

Enterobius vermicularis Appendiceal Colic.

Enterobius vermicularis associated appendiceal colic and acute appendicitis are rarely encountered in the United States. The 9-year-old patient described in this case presented with right lower quadrant abdominal pain, nausea, and vomiting consistent with acute appendicitis and was brought to the operating room for an appendectomy. Intraoperatively a pinworm, E. vermicularis, was visualized and the presumptive diagnosis of acute appendicitis was revised to E. vermicularis associated appendiceal colic. Retrospective review of the preoperative imaging demonstrates the first reported ultrasonographic image of pinworm inhabitance within the appendiceal lumen. The patient was treated postoperatively with a course of albendazole and recovered appropriately. This article reviews the geographic epidemiology, pathophysiology, surgical, and medical treatment recommendations in the management of E. vermicularis diseases of the appendix. Through dissemination of this ultrasonographic imaging, the authors hope to inform other providers about E. vermicularis associated appendiceal colic and reduce the incidence of avoidable surgeries.

Comparison of ELISA, nested PCR and sequencing and a novel qPCR for detection of Giardia isolates from Jordan.

Little is known about the prevalence of Giardia duodenalis in human patients in Jordan and all previous studies have used direct microscopy, which lacks sensitivity. The present study developed a novel quantitative PCR (qPCR) assay at the ß-giardin (bg) locus and evaluated its use as a frontline test for the diagnosis of giardiasis in comparison with a commercially available ELISA using nested PCR and sequencing of the glutamate dehydrogenase (gdh) locus (gdh nPCR) as the gold standard. A total of 96 human faecal samples were collected from 96 patients suffering from diarrhoea from 5 regions of Jordan and were screened using the ELISA and qPCR. The analytical specificity of the bg qPCR assay revealed no cross-reactions with other genera and detected all the Giardia isolates tested. Analytical sensitivity was 1 Giardia cyst per µl of DNA extract. The overall prevalence of Giardia was 64.6%. The clinical sensitivity and specificity of the bg qPCR was 89.9% and 82.9% respectively compared to 76.5 and 68.0% for the ELISA. This study is the first to compare three different methods (ELISA, bg qPCR, nested PCR and sequencing at the gdh locus) to diagnose Jordanian patients suffering from giardiasis and to analyze their demographic data.

Unusual presentation of cyathostomiasis in an adult Thoroughbred mare.

A recently purchased 16-year-old Thoroughbred mare with a history of recurrent colic and low body weight, also had lameness in 3 limbs, pain at the sacro-iliac joint, and increased corneal opacity of the right eye. Response to supportive therapy was poor and euthanasia was elected. A postmortem examination and histopathology confirmed cyathostomiasis within the large colon and cecum and chronic anterior uveitis of the right eye.

Présentation inhabituelle de la cyathostomose chez une jument adulte Thoroughbred. Une jument Thoroughbred, âgée de 16 ans et récemment achetée, avec une anamnèse de coliques récurrentes et de faible poids corporel souffrait aussi de boiterie à trois membres, de douleurs dans l'articulation sacro-iliaque et d'opacité cornéenne accrue de l'oeil droit. La réponse à une thérapie de soutien a été mauvaise et l'euthanasie a été choisie. Un examen post mortem et l'histopathologie ont confirmé une cyathostomose dans le gros côlon et le cæcum ainsi qu'une uvéite antérieure chronique de l'oeil droit.(Traduit par Isabelle Vallières).

Are small strongyles (Cyathostominae) involved in horse colic occurrence?

Strongyle infections have been traditionally regarded as a possible cause of colic in horses. Aim of the study was the comparison of parasitological status between subjects with or without colic syndrome, with particular attention to small strongyle infections. Coprological analyses were performed on 86 horses: 43 with colic and 43 controls. Strongyle eggs were found in 34/86 horses (prevalence 39.5%), the mean number of strongyles eggs per gram of faeces (EPG)2 was 145.34 (standard deviation 398.28). All those 34 positive animals had small strongyles infections. Negative binomial multiple regression highlighted no influence of horse sex on strongyle EPG, while there was a negative relationship between age and EPG (p <0.05); the same analysis revealed a significant difference of EPG (p <0.05) between control horses (mean EPG=178.1; standard deviation: 411.4) and horses with surgical colic (mean EPG=68.6 standard deviation: 259.8) when controlling for S. vulgaris presence including it in the model. On the contrary, the intensity of infection in horses with non-surgical colic (mean EPG=154.5; standard deviation: 480.4) did not significantly differed from controls. Similar results were obtained having estimated cyathostomine EPGs as dependent variable. Multinomial logistic regression confirmed the negative relationship between cyathostonine presence and surgical colic occurrence. It is possible that (1) the presence of adult luminal parasites, would have a protective effect against the pathogenic action exerted by the development and emergence of small strongyles larvae from intestinal mucosa; (2) the management practices able to reduce the risk of colics are the same that cause higher exposure to strongyle infective larvae.

Biliary ascariasis: an uncommon cause for recurrent biliary colic after biliary sphincterotomy and common bile duct stone removal.

Endoscopic retrograde cholangiography is the most commonly used technique for removal of common bile duct stones. Biliary sphincterotomy during the procedure facilitates stone retrieval from the common bile duct. However, sphincterotomy ablates the normal biliary sphincter mechanism. This facilitates duodeno-biliary reflex and can result in inward migration of luminal parasite into the biliary system. In areas where ascariasis is endemic there is an increased risk of biliary ascariasis in postbiliary sphincterotomy patients. We report an unusual case where a patient presented with recurrent biliary colic after cholecystectomy and common bile duct stone extraction and was diagnosed to have biliary ascariasis with the help of endoscopic ultrasound examination of the biliary system.

Biliary fascioliasis--an uncommon cause of recurrent biliary colics: report of a case and brief review.

Biliary parasitosis is one of the important causes of biliary obstruction in endemic areas, however due to migration and travel the disease is known to occur in non endemic zones as well. The spectrum of biliary fascioliasis ranges from recurrent biliary colics to acute cholangitis. The long term complications are gall stones, sclerosing cholangitis and biliary cirrhosis. We describe fascioliasis as a cause of recurrent biliary colics in a young male necessitating multiple hospitalizations over a period of four years. Investigative profile had been non-contributory every time he was hospitalized for his abdominal pain prior to the current presentation. He never had cholangitis due to the worm in the common bile duct. It was only at endoscopic retrograde cholangiopancreatography (ERCP) biliary fascioliasis was discovered to be the cause of his recurrent biliary colics. After removal of the live Fasciola hepatica from the common bile duct he became symptom free and is attending our clinic for last 11 months now. Clinical spectrum of biliary fascioliasis is discussed in this report.

Parasitism and colic.

Equids are hosts to dozens of species of internal parasites that infect no other domestic animals. Virtually all horses, especially those exposed to pasture, experience some level of parasitism continuously. Despite pathologic evidence of parasitic damage in various organs and tissues, few parasitisms are manifested systemically in well-managed horses. Contrary to conventional wisdom, only three common parasitisms of horses are likely to be manifested as colic: Strongylus vulgaris, Parascaris equorum, and Anoplocephala perfoliata. This article discusses the life cycles, pathophysiology, manifestations and clinical findings, treatment, and management of these three common parasitisms. It also discusses related aspects of several other parasitisms that are unlikely to cause colic.

Occurrence of Anoplocephala perfoliata infection in horses in Ontario, Canada and associations with colic and management practices.

Infection with the tapeworm Anoplocephala perfoliata has been found to be associated with equine colic in horses in the United Kingdom. Using a matched case-control study design, data collected from 117 pairs of horses in Ontario were examined for evidence of associations between risk of colic and A. perfoliata infection, and between seropositivity to infection and management practices. Cases were horses in southern Ontario diagnosed with colic by local veterinarians, and control horses were from the same stables as cases and were matched by age, breed and gender where possible. Infection status was defined on the basis of positive results upon coprological examination, and/or seropositivity to a 12/13 kDa A. perfoliata secretory protein. Fifty-six percent of the 234 horses were seropositive for A. perfoliata, but eggs were found in samples from only 6% of horses. Horses dependent on pasture for a large part of their diet were significantly more likely to have ELISA optical density levels above 0.600 compared to other horses (odds ratio [OR]=6.38; p=0.029). This finding identified exposure to pasture as an important source of A. perfoliata infection in the horses used in the study. In a subset of 46 pairs of horses for which control horses had no known history of colic, a statistically significant negative association was found between the risk of colic and optical density (OD) levels >0.200-0.600, relative to OD levels < or = 0.090 (OR=0.08; p=0.017). There was no other statistical evidence of an association between the risk of colic and A. perfoliata infection.

Correlation between colic and antibody levels against Anoplocephala perfoliata in horses in The Netherlands.

The importance of Anoplocephala perfoliata in horses with colic was studied in 139 horses referred for colic and 139 control horses with no signs of colic for at least three years. The serodiagnostic method of Proudman and Trees, which measures the level of A. perfoliata antibody, was used to detect A. perfoliata infection. Thirty-two horses were examined at necropsy, to determine whether the presence of A. perfoliata in the ileocaecal region was associated with the A. perfoliata antibody level. The mean A. perfoliata antibody level was significantly higher in horses with colic than in horses without colic (P < 0.001), indicating a relationship between A. perfoliata infection and colic in general. There was no relation between age and A. perfoliata antibody level. The mean A. perfoliata antibody level in 12 horses with ileocaecal disorders was significantly higher than that in control horses (P < 0.001). Of the 32 horses examined at necropsy, 7 horses with tapeworms in the ileocaecal region had a significantly higher mean A. perfoliata antibody level than the 25 horses without the parasite (P = 0.030). Lastly, examination of faeces to detect the presence of A. perfoliata infection was not useful in the present study.

Larval cyathostominosis in horses in Ontario: an emerging disease?

From 1991 to 2003, 24 cases of larval cyathostominosis were diagnosed at postmortem in equids, 15 (63%) from 2001 to 2003. Cases occurred from September to May, the majority from October to December. Median age was 12 mo. Diarrhea, colic, and weight loss were common clinical signs. Hypoalbuminemia and microcytosis were consistent findings.

An unusual cause of renal colic: hydatiduria.

Hydatid disease of the urinary tract is seen rarely. Hydatiduria may be a finding of renal involvement, but it is a rare cause of renal colic. A case is reported of renal hydatid disease that was diagnosed during the investigation of renal colic. A 38-year-old woman presented with renal colic. She had a history of episodes of renal colic and occasional voiding of grape-like material. No calculus was found in the urinary tract by plain film or ultrasonographic examination. The histopathologic examination of this material revealed daughter cysts that are pathognomonic for hydatid disease. Ultrasound and computed tomography confirmed this diagnosis and right nephrectomy was performed without cyst perforation or any spilling of cyst content. Albendazole, 10 mg/kg per day, was given for 4 weeks (2 weeks preoperatively and 2 weeks postoperatively).

Three common presentations of ascariasis infection in an urban Emergency Department.

In the United States, approximately 4 million people per year are infected with Ascaris lumbricoides. We reviewed the common presentations of complications of Ascariasis infection in the Emergency Department (ED) and the diagnostic tools and treatment available. This was a retrospective case review conducted on all patients diagnosed with Ascariasis (using ICD-9 codes) over a 6-year period at Los Angeles County and University of Southern California Medical Center. Three patients with distinct complications secondary to Ascariasis were chosen, and all ED and inpatient records were reviewed. The patient's age, sex, race, presenting symptoms, data, outcome, and ED course and diagnosis were recorded. The three cases included a periappendiceal abscess, Loeffler's syndrome, and biliary colic/choledocholithiasis. The first patient underwent a computed tomography-guided drainage of the abscess. The second patient received supportive care and antibiotic therapy secondary to a superimposed bacterial pneumonia. The third patient underwent endoscopic retrograde cholangiopancreatography with sphincterotomy. All three patients had a stool ova and parasites positive for A. lumbricoides, and all received a 3-day course of mebendazole. Symptomatic cases of Ascariasis may present to EDs in the United States. Important diagnostic tools for the ED include chest X-ray, X-ray of the kidney-ureter-bladder and ultrasonography. Single-dose medications given in the ED are very effective in eradicating A. lumbricoides infection, thus avoiding hospitalization.

Investigation of an outbreak of tapeworm-associated colic in a training yard.

A novel serological assay which measures IgG(T) specific for a 12/13 kDa protein of the equine tapeworm Anoplocephala perfoliata was used as part of a colic outbreak investigation. A training/rehabilitation yard for Thoroughbreds and Arabs was found to have an increasing incidence of colic over a 5 year period, culminating in a peak incidence of 1.15 episodes/horse year at risk. Four animals suffered from ileal impaction colic which necessitated surgical management. A case-control study design suggested a strong association between tapeworm infection and colic, with evidence of a dose-response relationship. Intervention, in the form of anticestode anthelminthics, coincided with a decrease in the incidence of colic and a fall in anti-12/13 kDa IgG(T) antibody levels of 8 horses monitored post-treatment. This study demonstrates that anthelminthic regimens, using exclusively ivermectin, may lead to an increase in tapeworm infection intensity which may in turn lead to an increased incidence of colic. Furthermore, it provides support to the hypothesis that the risk of ileal impaction colic and spasmodic colic increases with tapeworm infection intensity. The practical application of the anti-12/13 kDa IgG(T) ELISA is demonstrated by this study.

Tapeworms as a cause of intestinal disease in horses.

Until recently, the equine tapeworm Anoplocephala perfoliata was difficult to diagnose and considered to be of questionable pathogenicity. Here, Chris Proudman and Sandy Trees describe recent advances in the immunodiagnosis of this parasite that have facilitated epidemiological studies. These studies suggest that A. perfoliata may be an important cause of intestinal disease in the horse and demonstrate a dose-response relationship between infection intensity and risk of disease. If tapeworm infection is a risk factor for ileocaecal colic, the identification and treatment of infected individuals would be a rational approach to disease prevention.

A rare cause of biliary pain in Belgium.

Ascaris lumbricoides is the most frequent human helminthic parasite. Usually human ascariasis is poorly symptomatic but complications can arise due to worm migration. Erratic worm migration into the biliary tree is a rare but threatening condition regarding the associated complications: cholecystitis, pancreatitis, obstruction of bile ducts, liver abcesses and recurrent pyogenic cholangitis. We describe a case of a young belgian women suffering from recurrent biliary colics over a period of eight months with repeated normal ultrasound findings. ERCP proved being the only effective diagnostic procedure for a living biliary worm, which was successfully removed with a balloon catheter.