Two Cases of Equine Multinodular Pulmonary Fibrosis in Japan.

Equine multinodular pulmonary fibrosis (EMPF) is a recently described form of interstitial pneumonia associated with equine herpesvirus type 5 (EHV-5). This disease has been reported in North and South America, Europe and Oceania but not, to our knowledge, in horses in Japan. We diagnosed EMPF in two Thoroughbred horses in Japan on the basis of gross and histopathological findings. In both cases, significant gross lesions, restricted to the lungs, consisted of numerous firm and coalescing nodules widely distributed throughout the lung. The nodules were <3 cm in diameter and pale white to tan in colour. Microscopically, they showed severe interstitial fibrosis and infiltration of macrophages, neutrophils, lymphocytes and a few eosinophils. The residual alveoli were lined by cuboidal epithelial cells (type II pneumocytes) and filled with many macrophages, which rarely displayed oval eosinophilic to amphophilic intranuclear inclusion bodies. Polymerase chain reaction and sequence analyses identified the glycoprotein H gene of EHV-5, and in-situ hybridization detected EHV-5 in the alveolar macrophages in the lesions. In one case, electron microscopy revealed herpesvirus-like particles and EHV-5 was isolated from pulmonary lesions.

Lung lesions of slaughtered horses in southern Brazil / Lesões pulmonares de equinos de matadouro-frigorífico no Sul do Brasil

Respiratory diseases cause significant veterinary costs, reduce performance and require withdrawal of horses. Yet, studies of the causes of pneumonia in horses are scant. This study aimed to describe the pathological and microbiological features of lung lesions in slaughtered horses in southern Brazil. In this study, 84 samples of lungs were examined, and a conclusive diagnosis was obtained in 74 cases. These were composed of bronchopneumonia in 50 cases, followed by granulomatous eosinophilic pneumonia (9/74), recurrent airway obstruction (7/74), lung fibrosis (4/74), lung hemorrhage (3/74) and pulmonary pythiosis (1/74). Bronchopneumonia had grossly firm focally extensive yellow to dark-red areas, which consisted microscopically of multifocal to coalescing infiltrate of degenerate neutrophils. Streptococcus equi subsp. zooepidemicus was identified in 21 of the 50 cases. Granulomatous eosinophilic pneumonia had multifocal pinpoint firm-hard yellow areas, which microscopically were composed of granulomas with a mineralized center surrounded by collagen fibers and severe infiltrate of eosinophils. Recurrent airway obstruction had mild multifocal pinpoint firm white areas that consisted microscopically of large amounts of mucus inside bronchi and bronchiole. Lung fibrosis had two patterns: focally extensive areas of consolidation and firm nodular areas. Microscopically, the first pattern had interstitial to peribronchial fibrosis, while the second had, in addition to the interstitial fibrosis, a severe pneumocyte hyperplasia and an alveolar infiltrate of neutrophils and macrophages with rare intranuclear inclusion bodies (equine herpesvirus 5, EHV-5). Pulmonary pythiosis presented a focal firm nodular area, with multiple kunkers observed in the cut surface, which corresponded microscopically to areas of necrosis surrounded by a mixed inflammatory infiltrate. At the periphery of the necrotic areas, multiple negatively stained hyphae were observed, which were evidenced through Grocott's stain and immunohistochemistry anti-Pythium insidiosum.(AU)

Doenças respiratórias causam em equinos custos significativos com tratamento veterinário, redução de performance e descarte de animais. No entanto, estudos que abordem as causas de pneumonia em equinos são escassos. O objetivo deste estudo foi descrever os aspectos patológicos e microbiológicos de lesões pulmonares em equinos abatidos em matadouro-frigorífico no Sul do Brasil. Neste estudo, 84 amostras de pulmões foram examinadas, e o diagnóstico conclusivo das condições foi obtido em 74 casos. Esses foram compostos por broncopneumonia em 50 casos, seguido por pneumonia granulomatosa eosinofílica (9/74), obstrução aérea recorrente (7/74), fibrose pulmonar (4/74), hemorragia pulmonar (3/74) e pitiose pulmonar (1/74). A broncopneumonia era caracterizada macroscopicamente por áreas focalmente extensas firmes de coloração amarelada a vermelho-escuras, as quais consistiam microscopicamente em infiltrado multifocal a coalescente de neutrófilos degenerados. Streptococcus equi subsp. zooepidemicus foi identificado em 21 dos 50 casos. A pneumonia eosinofílica granulomatosa era caracterizada por áreas multifocais puntiformes firmes a duras e amareladas, que microscopicamente eram compostas por granulomas com área central mineralizada circundados por fibras de colágeno e infiltrado acentuado de eosinófilos. A obstrução aérea recorrente era caracterizada por discretas áreas puntiformes firmes e brancacentas que consistiam microscopicamente em grande quantidade de muco no interior de brônquios e bronquíolos. A fibrose pulmonar exibia dois padrões: áreas de consolidação focalmente extensas e áreas nodulares firmes. Microscopicamente, o primeiro padrão exibia fibrose intersticial a peribronquial, enquanto no segundo padrão havia, além da fibrose intersticial, intensa hiperplasia de pneumócitos e infiltrado alveolar de neutrófilos e macrófagos com raros corpúsculos de inclusão intranucleares (herpesvírus equino 5, EHV-5). A pitiose pulmonar exibia uma área nodular firme focal com múltiplos kunkers ao corte, os quais correspondiam microscopicamente a áreas de necrose circundadas por infiltrado inflamatório misto. À periferia das áreas necróticas, múltiplas imagens negativas de hifas eram observadas, as quais foram evidenciadas através da coloração de Grocott e imuno-histoquímica anti-Pythium insidiosum.(AU)

Equine multinodular pulmonary fibrosis in southern Brazil: pathology and differential diagnosis / Fibrose pulmonar multinodular em equinos no Sul do Rio Grande do Sul: patologia e diagnóstico diferencial

Equine multinodular pulmonary fibrosis (EMPF) diagnosed at the Laboratório Regional de Diagnóstico of Faculdade de Medicina Veterinária, Universidade Federal de Pelotas (LRD/UFPel), is described. Differential aspects of other pulmonary diseases in horses with pneumonia and interstitial fibrosis were discussed. The disease occurred in a 15-year-old equine that presented with clinical signs of respiratory distress, intermittent fever, anorexia, and dyspnea. Macroscopically, there was enlargement of the lungs with whitish, pale, firm and well-delimited nodules, approximately 7-10 cm in diameter, distributed throughout the parenchyma. Histologically, the lung nodules had alveolar spaces with walls covered by cuboidal epithelium containing macrophages, neutrophils, lymphocytes, hyperplasia of type II pneumocytes and, eventually, multinucleated giant cells. The interstitium was markedly thickened by mature fibrous connective tissue and collagen. There were intranuclear inclusion bodies in the macrophages. The PCR technique for detecting the EHV-5 DNA was positive. In a retrospective study of pneumonia cases in horses with interstitial fibrosis diagnosed in the LRD/UFPel, two animals had macroscopic and histological lesions similar to those with EMPF, but they were negative for EHV-5 in PCR. Four cases diagnosed with pneumonia and interstitial tissue fibrosis had a histological pattern that was different from that observed in the EMPF animal, thus eliminating the possibility of EMPF. It is concluded that EMPF is a sporadic disease that should be considered in cases of respiratory disease in horses. Reports of such cases are important to alert technicians about the occurrence of rare diseases in Brazil. It is also necessary to establish the true role of EHV-5 in the pathogenesis of EMPF. Cases of pulmonary fibrosis such as EMPF, in which the virus is not present, should be studied to establish whether it could be an idiopathic form of the disease.(AU)

Descreve-se a fibrose multinodular pulmonar equina (EMPF) diagnosticado no Laboratório Regional de Diagnóstico da Faculdade de Veterinária da Universidade Federal de Pelotas. Foram discutidos a patologia da doença e os aspectos diferenciais de outras enfermidades pulmonares de equinos que cursam com pneumonia e fibrose intersticial. A doença ocorreu em um equino sem raça definida de 15 anos de idade que apresentou sinais clínicos de dificuldade respiratória febre intermitente, anorexia e dispneia, com evolução de aproximadamente 10 dias. Macroscopicamente havia aumento de volume dos pulmões e nódulos esbranquiçados, pálidos, firmes e bem delimitados, de aproximadamente 7-10 cm de diâmetro, distribuídos pelo parênquima. Histologicamente, o tecido pulmonar apresentava nódulos caracterizados pela presença de espaços alveolares, com paredes revestidas por epitélio cuboidal achatado, contendo macrófagos e neutrófilos e havia, também, linfócitos e hiperplasia de pneumócitos tipo II e eventualmente células gigantes multinuacleadas. O interstício estava acentuadamente espessado por tecido conjuntivo fibroso maduro e por colágeno. Havia corpúsculos de inclusão intranucleares em macrófagos. A técnica de PCR para detecção do DNA de herpes vírus equino-5 (EHV-5) resultou positiva. Em um estudo retrospectivo de casos de pneumonia com fibrose intersticial diagnosticados no LRD entre 2000 e 2015, dois equinos apresentaram lesões macroscópicas e histológicas similares às de EMPF, porém resultaram negativos na PCR para detecção de EHV-5. Quatro casos de pneumonia com fibrose do tecido intersticial apresentaram padrão histológico diverso da EMPF descartando-se a possibilidade de tratar-se da doença. Conclui-se que EMPF é uma enfermidade esporádica, no entanto deve ser levada em consideração em casos de doença respiratória em equinos. A descrição dos casos diagnosticados é importante para alertar técnicos sobre a ocorrência da mesma no Brasil. É necessário estabelecer o real papel do EHV-5 na patogenia da doença. Casos de fibrose pulmonar semelhantes à EMPF em que não esteja presente o vírus, devem ser estudados a fim de ficar estabelecido se poderia ser uma forma idiopática da mesma doença.(AU)

Assessment of quantitative polymerase chain reaction for equine herpesvirus-5 in blood, nasal secretions and bronchoalveolar lavage fluid for the laboratory diagnosis of equine multinodular pulmonary fibrosis.

REASONS FOR PERFORMING STUDY: The ante mortem diagnosis of equine multinodular pulmonary fibrosis (EMPF) relies on histopathological results and polymerase chain reaction (PCR)-positive equine herpesvirus (EHV)-5 testing of lung tissue. Polymerase chain reaction detection of EHV-5 in bronchoalveolar lavage fluid (BALF) is commonly used to support a diagnosis of EMPF. However, the diagnostic power of EHV-5 testing on BALF and other biological samples such as blood and nasal secretions has yet to be shown to support a diagnosis of EMPF. OBJECTIVES: To determine the frequency of detection and the viral loads of EHV-5 by quantitative PCR (qPCR) in blood, nasal secretions and BALF from horses confirmed with EMPF, healthy horses and horses with non-EMPF pulmonary diseases. STUDY DESIGN: Prospective study. METHODS: The study population consisted of 70 adult horses divided into 4 groups based on a combination of clinical findings, cytology of BALF, imaging studies of the thoracic cavity and histopathology of pulmonary tissue: control group (n = 14), EMPF group (n = 11); inflammatory airway disease group (n = 32); and non-EMPF interstitial lung disease group (n = 13). For each horse, whole blood, nasal secretions and BALF were available for EHV-5 qPCR testing. Sensitivities, specificities and their respective 95% confidence intervals were calculated for viral loads from blood, nasal secretions and BALF. In addition, these measures were calculated for combined use of blood and nasal secretions. RESULTS: The detection of EHV-5 in BALF was strongly associated with EMPF (sensitivity 91%, specificity 98.3%). Detection of EHV-5 in blood was, independent of the viral loads, strongly associated with EMPF with a sensitivity of 91% and specificity of 83.1%. The detection of EHV-5 in nasal secretions displayed the highest sensitivity (72.7%) and specificity (83.1%) at a level of >245,890 glycoprotein B target genes/million cells to support a diagnosis of EMPF. Dually positive blood and nasal secretions at any viral loads in support of EMPF yielded a sensitivity and specificity of 90% and 89.8%, respectively. CONCLUSIONS: Although histopathological confirmation (lung biopsy) is considered the gold standard for EMPF diagnosis, results of qPCR testing of BALF or a combination of whole blood and nasal secretions should be regarded as clinically useful in support of this diagnosis. The latter testing may be relevant when dealing with horses in respiratory distress, for which invasive procedures such as BALF collection or lung biopsies may be detrimental to their health.

Identification of the first New Zealand case of equine multinodular pulmonary fibrosis.

CASE HISTORY: A 10-year-old polo mare presented with a history of weight loss, poor condition and inappetance. CLINICAL FINDINGS: The mare was tachycardic, tachypnoeic and febrile. Harsh lung sounds were auscultated over all lung fields. The mare initially responded to treatment with antibiotics, anti-inflammatory drugs and bronchodilators. Throughout the course of treatment, there was a variable lymphocytosis, monocytosis and fluctuation in concentrations of fibrinogen. The mare also developed a mild anaemia, most likely due to chronic disease. Despite treatment, the mare's condition deteriorated over the following 2 months, and she was subject to euthanasia. PATHOLOGICAL FINDINGS: On post mortem examination, white to pale tan, large coalescing fibrous nodules up to 5 cm in diameter were found distributed throughout the lungs. Histopathology revealed a multifocally severe interstitial pneumonia with superimposed bronchiolar or alveolar inflammation, fibrosis, Type II pneumocyte hyperplasia and histiocytic intranuclear inclusion bodies, consistent with the findings previously reported for cases of equine multinodular pulmonary fibrosis (EMPF). DIAGNOSIS: Equine multinodular pulmonary fibrosis based on characteristic gross and histopathological findings. The diagnosis was strengthened by detection of DNA for equine herpesvirus 5 in the lung tissue. CLINICAL RELEVANCE: This report describes the first recognised case of EMPF in New Zealand. The affected horse did not respond to treatment and was subject to euthanasia. The prognosis for horses with EMPF, based on a limited number of cases worldwide, is currently considered poor.