Clostridiosis, Enteric

Clostridiosis, Enteric



Basic Information image



Definition


Enteric disease caused by infection with clostridial species, primarily Clostridium perfringens and Clostridium difficile



Synonym(s)




• Necrotizing enterocolitis (typically associated with C. perfringens)


• Pseudomembraneous colitis (typically associated with C. difficile)



Epidemiology



Risk Factors


Antimicrobial use



Contagion and Zoonosis




• Occurrence is often sporadic, but outbreaks have been described on farms and in veterinary hospitals. Therefore isolation of affected horses and use of barrier precautions, such as dedicated clothes and gloves, are recommended.


• Both C. perfringens and C. difficile are recognized enteropathogens in humans. Although direct transmission between horses and humans has not been documented, horses should be treated as if infectious and control measures implemented (barrier precautions, hand hygiene, disinfectants).



Clinical Presentation



Disease Forms/Subtypes




• Variable signs depending on several factors, including the region of the gastrointestinal (GI) tract that is affected


• Acute colitis most common


• Proximal enteritis



History, Chief Complaint




• Diarrhea is the most common complaint


• Colic


• Occasionally, sudden death



Physical Exam Findings




• Colitis


• Diarrhea

• Anorexia, pyrexia

• Variable degrees of dehydration, toxemia, colic

• Cases that involve only the small intestine or cecum may exhibit similar signs without diarrhea.


• Cases that involve the proximal small intestine may present with significant reflux.



Etiology and Pathophysiology




• Gram-positive, anaerobic bacteria in the genus Clostridium, primarily C. difficile and C. perfringens.


• Transmission is by ingestion; disease is caused by the proliferation of toxigenic strains in the intestinal tract.


• Toxin production results in enterocolitis.


• C. difficile: primarily toxin A (enterotoxin) and toxin B (cytotoxin).


• Approximately 13% of equine isolates do not produce any toxin and are nonpathogenic; most pathogenic isolates produce both toxin A and B.

• Age influences colonization rates: subclinical carriage of C. difficile has been reported in 29% of foals younger than 14 days of age but in less than 1% of older foals and normal adults.

• C. perfringens: classified into different types based on the pattern of toxin production; β-2 toxin and enterotoxin may be the most important clinically.


• A normal inhabitant of the equine GI tract found in 19% to 35% of broodmares and more than 90% of 3-day-old foals

• Type A: predominant type in normal horses and horses with diarrhea

• Type C: has been associated with severe enterocolitis, especially in foals

• Limited reports of disease associated with types B and D

image

FIGURE 1 Colony morphology of Clostridium difficile on a cycloserine-cefoxitin fructose agar, a selective and differential culture medium used for isoluation of C. difficile.


(From Sellon DC, Long MT: Equine infectious diseases. St. Louis, Saunders, 2007.)


image

FIGURE 2 Gram stain morphology of Clostridium difficile. Note the long, thin rods. The variable staining appearance may be encountered in cultures over 48 hours or longer.


(From Sellon DC, Long MT: Equine infectious diseases. St. Louis, Saunders, 2007.)

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Jul 24, 2016 | Posted by in SMALL ANIMAL | Comments Off on Clostridiosis, Enteric

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