Lymphocytic-plasmacytic enteritis in two horses

The primary hematologic abnormalities in 2 adult horses with chronic weight loss were hypoalbuminemia and hyperglobulinemia. One horse was anemic, had subclinical disseminated intravascular coagulation, and prolonged plasma sulfobromophthalein half-life. Small-intestinal dysfunction with malabsorption was indicated by abnormal D-xylose absorption test results. Clinicopathologic and pathologic findings were consistent with a diagnosis of malabsorption and protein-losing enteropathy, attributable to lymphocytic and plasmacytic infiltration of the intestine.     

Transient glucose malabsorption in two horses fact or artefact?

Two horses, presented for investigation of chronic weight loss despite normal to increased feed intake, had flat oral glucose absorption curves, suggesting malabsorption. The cause of the apparent malabsorption was not evident grossly or on light microscopic examination of the intestinal tract. Both horses survived long term and at follow-up examination had regained weight and their capacity to absorb glucose. These cases illustrate that flat glucose absorption curves may occur in horses with no obvious intestinal lesions, that they may revert to normal and that the results of these tests should be interpreted with caution.     

Small intestinal malabsorption in the horse: an assessment of the specificity of the oral glucose tolerance test

Specificity of the oral glucose tolerance test (OGTT) for the diagnosis of small intestinal malabsorption in the horse was assessed by comparing the results of OGTT with the results of a histopathological examination of the small intestine in 42 adult horses affected by chronic weight loss. The horses were assigned to three groups on the basis of the results of the test. Five horses were considered to have a normal OGTT absorption result (Group 1); all the horses had a histologically normal small intestine. Twenty-five horses had a partial malabsorption result (Group 2) seven of which had normal small intestinal morphology, whereas the remaining 18 had a variety of pathological lesions including lymphosarcoma, villous atrophy, granulomatous enteritis and eosinophilic gastroenteritis. Twelve of the 42 horses had a total malabsorption result (Group 3), and all had a severe infiltrative lesion in the small intestinal wall (either lymphosarcoma or granulomatous enteritis).     

Normal and abnormal xylose absorption in the horse.

The D-xylose absorption test was applied to clinically normal horses and to horses with signs of gastrointestinal disease. A dosage of 0.5 grams of xylose per kilogram of bodyweight was useful in detecting horses that absorbed the pentose abnormally. The clinical findings were correlated with gross and microscopic findings by biopsy and at necropsy. Gastrointestinal lesions associated with abnormal xylose absorption were classified as: 1) villous atrophy; 2) edema of the lamina propria or 3) necrosis of the lamina propria.     

Laboratory evaluation of malassimilation in horses

Malassimilation should be suspected in horses with weight loss in spite of a good appetite. Malassimilation is usually confirmed with oral glucose or D-xylose absorption tests, whereas the oral lactose tolerance test can be used to evaluate lactase deficiency in foals. Once malassimilation is confirmed, other diagnostic tests such as abdominocentesis, rectal mucosal biopsy, or exploratory laparotomy with intestinal biopsies may determine the etiology of malassimilation.     

Determination of lactose and xylose malabsorption in preruminant diarrheic calves.

In preliminary studies feeding the poorly absorbed carbohydrate sorbitol at 2.3 g/kg body weight as an indication of maximal fermentative capacity failed to produce the expected large increase in breath hydrogen excretion but did produce a transient diarrhea in five out of six control calves. Twelve healthy control and eighteen diarrheic calves were fed lactose or D-xylose on consecutive days at 1.15 g/kg body weight and a concentration of 46 g/L. Breath and blood samples were collected at 1 h intervals from 0 to 7 h. After administration of lactose, there was a significant increase in breath hydrogen excretion in diarrheic versus control calves. The increase in plasma glucose concentrations was delayed in diarrheic calves but the area under the absorption curve was similar in control and diarrheic calves. After administration of D-xylose, breath hydrogen excretion did not increase significantly but plasma D-xylose concentrations were significantly reduced in diarrheic calves. The pathogens commonly isolated from the feces were Cryptosporidium species, rotavirus and coronavirus. The number of pathogens and the severity of the calves' acid-base deficit were not related to the severity of carbohydrate malabsorption. Decreased absorption of lactose and D-xylose may be the result of intestinal villous atrophy caused by viral or parasite infection. It was concluded that carbohydrate malabsorption rather than a specific lactose maldigestion is a significant problem in diarrheic calves. Diarrheic calves appear to digest and absorb lactose when fed in small amounts.     

Diagnostic evaluation and short-term outcome as indicators of long-term prognosis in horses with findings suggestive of inflammatory bowel disease treated with corticosteroids and anthelmintics

Background

Recurrent colic and unexplained weight loss despite good appetite and adequate feeding and management practices are common conditions in the horse. However, little information has been published on the systematic diagnostic evaluation, response to treatment, prognostic factors or outcome of either presentation. The aims of this study were to 1) identify possible prognostic indicators and 2) report the short- and long-term response to treatment with corticosteroid therapy of a variety of horses with a presumptive diagnosis of inflammatory bowel disease (IBD).Thirty-six horses with a history of recurrent colic and/or unexplained weight loss were screened with a detailed clinical, clinicopathological and diagnostic imaging examination. Twenty horses were subsequently selected that had findings consistent with inflammatory bowel disease based on the fulfilment of one or more of the following additional inclusion criteria: hypoproteinaemia, hypoalbuminaemia, malabsorption, an increased intestinal wall thickness on ultrasonographic examination or histopathological changes in rectal biopsy. These 20 horses were treated with a standardized larvicidal anthelmintic regime and a minimum of three weeks of corticosteroid therapy.

Results

The initial response to treatment was good in 75% (15/20) of horses, with a 3-year survival rate of 65% (13/20). The overall 3-year survival in horses that responded to initial treatment (12/15) was significantly higher (P = 0.031) than in those that did not respond to initial treatment (1/5). The peak xylose concentration was significantly (P = 0.048) higher in survivors (1.36 ± 0.44 mmol/L) than non-survivors (0.94 ± 0.36 mmol/L).

Conclusions

The overall prognosis for long-term survival in horses with a presumptive diagnosis of IBD appears to be fair to moderate, and the initial response to anthelmintic and corticosteroid therapy could be a useful prognostic indicator. The findings of the present study suggest that a low peak xylose concentration in absorption testing is associated with a less favourable prognosis, supporting the use of this test.     

Fucosidosis in an English Springer Spaniel presenting as a malabsorption syndrome

A case of alpha-fucosidosis in a 2-year-old male English Springer Spaniel presented as a malabsorption syndrome without any clinical neurological abnormalities. The dog had a history of chronic weight loss, diarrhoea, mild anaemia, hypoproteinemia and reduced jejunal absorption of D-xylose. A diagnosis of fucosidosis with intestinal malabsorption was based on these findings, markedly reduced plasma fucosidase levels and the diffuse infiltration of the lamina propria and submucosa of the stomach, small intestine, Peyer's patches and mesenteric lymph nodes by macrophages with finely vacuolated cytoplasm. Cytoplasmic vacuolation was also a feature of cells of the pancreas, thryroid, parathyroid and adenohypophysis and the epithelia lining respiratory airways and the urogenital tract. Neurons of the autonomic plexuses of the gastrointestinal tract and the urinary bladder as well as those of the brain, spinal cord, spinal ganglia and retina were also vacuolated. The profound decrease in sigma-fucosidase activity in the brain, liver and kidney was accompanied by a marked increase in 6 other lysosomal enzymes, especially beta-n-acetyl glucosaminidase.     

Systemic Granulomatous Disease in a Hungarian Warmblood Gelding

An 8-year-old Hungarian warmblood gelding used for show jumping was evaluated because of poor performance and chronic weight loss. On admission, oral and gastroesophageal ulcerations and malabsorption were detected. Results of thoracic radiography, ultrasonography, bronchoalveolar lavage cytology, and positive polymerase chain reaction for equine herpesvirus 5 raised the possible diagnosis of equine multinodular pulmonary fibrosis. However, abdominal ultrasonography revealed inhomogeneous spleen with many different sized well-demarcated hypoechoic areas, which suggested further differential diagnoses such as tuberculosis, neoplasias, immune mediated diseases, systemic granulomatous disease (SGD), or toxicoses. The horse was euthanized at the owner's request because of the poor condition and possible grave prognosis. Histopathology findings were characteristic of SGD, which is a rare disorder of horses characterized by skin lesions, weight loss, and granulomatous inflammation of multiple organ systems. The lack of skin lesions in this case is an unusual finding. Systemic granulomatous disease is hypothesized to be induced by multiple conventional antigens that are not cleared from affected tissues. Equine herpesvirus 5 might have triggered the granulomatous reactions in this particular case.     

Use of nuclear scintigraphy with 99mTc-HMPAO-labelled leucocytes to assess small intestinal malabsorption in 17 horses

The diagnostic and prognostic value of nuclear scintigraphy with technetium-99m-labelled hexamethyl-propyleneamine oxime-labelled leucocytes was assessed in 17 horses with weight loss due to gastrointestinal malabsorption by comparing the results with the results obtained from 13 normal control horses. Intestinal uptake of activity was detected in 12 of the 17 cases but none of the control horses. The technique was therefore specific for intestinal pathology, but failed to detect some horses that might have had intestinal pathology. No indications of the horses' specific pathology were obtained, and their prognosis or response to treatment could not be predicted.     

Poult malabsorption syndrome. I. Malabsorption in poult enteritis.

One-day-old poults were placed on littler on which poults had previously developed diarrhea, increased mortality, and stunting. Small intestines, pancreas, and liver were evaluated histologically. Morphometric evaluations were conducted to determine villous length and crypt depth. Poults were evaluated for malabsorption utilizing D-xylose and lipid absorption tests. Compared with controls, the gastrointestinal tract of affected birds was grossly distended, was fluid-filled, and had thin, flaccid walls on days 5 and 8. Ceca were distended with brown watery fluid and gas on days 5, 8, and 12. No histologic lesions were present in the liver, pancreas, or pancreatic ducts, and only mild inflammatory changes were present in the small intestine. Villous atrophy and crypt hypertrophy were present in the small intestine on days 5, 8, 12, 16, and 21. Morphometry revealed significant decreases in villous lengths and increases in crypt depth throughout the trial. D-Xylose and lipid absorption were significantly decreased on days 8 and 11. Intestinal epithelial damage by infectious agents with subsequent villous atrophy is postulated to have produced malabsorptive diarrhea.     

Fever of unknown origin in the horse: a review of 63 cases

Fever of unknown origin (FUO) is a syndrome characterised by prolonged, unexplained fever associated with non-specific signs of illness such as lethargy, inappetence and weight loss. This paper reviews the details of 63 horses affected by FUO. The cause was found to be infection in 43 per cent of the cases, neoplasia in 22 per cent, immune-mediated diseases in 6.5 per cent and miscellaneous diseases in 19 per cent; the cause remained undiagnosed in 9.5 per cent.     

Loss of absorptive capacity for sodium and chloride in the colon causes diarrhoea in Potomac horse fever

Ehrlichia risticii, an obligate intracellular bacterium in the family Rickettsiaceae, causes Potomac horse fever which is often associated with severe watery diarrhoea. The mechanism of the diarrhoea is unknown. The aim of this study was to determine whether sodium and chloride transport, morphology and cyclic adenosine 3', 5'-monophosphate (cyclic AMP) content of colonic mucosa was altered in E risticii-infected horses. Mucosa-submucosa sheets from the large and small colon of nine infected and seven to nine uninfected horses were set up in Ussing chambers for measurement of short-circuit current and transepithelial 22Na and 36Cl fluxes. Uninfected tissues absorbed both sodium and chloride whereas absorption of sodium and chloride was abolished in infected tissues. Bethanechol and histamine evoked a concentration-dependent increase in short-circuit current in both groups, but the responses were attenuated at all concentrations in infected horses. Slight focal degeneration of colonic epithelial cells and loss of microvilli from glandular epithelial cells occurred in infected horses. There was a significant increase in cyclic AMP content in colonic mucosa of infected animals. The results suggest that E risticii infection induces focal microscopic degeneration of epithelial cells and an increase in intracellular cyclic AMP in colonic mucosa. These alterations are associated with malabsorption of sodium and chloride and could cause diarrhoea.     

Epidemiological studies of piglet diarrhoea in intensively managed Danish sow herds. IV. Pathogenicity of porcine rotavirus

Colostrum-deprived piglets inoculated with rotavirus 24 h after birth developed a profuse diarrhoea that spread to non-inoculated, colostrum-deprived litter mates and, occassionally, to colostrum-fed piglets. Case fatality rates in these 3 categories of piglets were 63.2%, 35.7% and 8.3%, respectively. Surviving piglets recovered in 1-2 weeks, but shedded virus via the faeces for up to 3 weeks p.i. The D-xylose test revealed severe malabsorption, with extremely flat absorption curves for up to 3-4 weeks p.i. Malabsorption was more marked in piglets with a long-lasting faecal virus excretion than in piglets where virus disappeared from the faeces within 10 days p.i. Infected piglets (colostrum-fed and colostrum-deprived) had decreased weight gains and were 5 days older at a bodyweight of 25 kg than non-inoculated controls. It is concluded that rotavirus is probably of significance in diarrhoeal syndromes in suckling piglets, alone or in combination with E. coli or other pathogens.     

Inflammatory bowel disease characterized by multisystemic eosinophilic epitheliotropic disease (MEED) in a horse in Saskatchewan,Canada

A 3-year-old Quarter Horse gelding was evaluated for chronic weight loss, diarrhea, and pruritus. Physical examination revealed several ulcerative lesions on the skin and mucosal membranes. Diagnostic imaging findings were consistent with enteritis, typhlitis, and colitis. Multisystemic eosinophilic epitheliotropic disease (MEED) was diagnosed upon necropsy. This disease may be considered a form of equine inflammatory bowel disease complex which can be challenging to diagnose, requiring histological assessment, and in some cases, the use of immunohistochemical markers.Key clinical message:Multisystemic eosinophilic epitheliotropic disease is challenging to diagnose but should be considered in horses with chronic weight loss that fail to respond to conventional treatment for concurrent diarrhea and skin lesions.     

Chronic granulomatous bowel disease in three sibling horses

Chronic granulomatous bowel disease was diagnosed in 3 sibling Standardbred horses. Clinical signs included weight loss, loose feces, and decreased appetite in the terminal stage of the disease. Abnormal laboratory findings included hypoproteinemia and low xylose absorption. Necropsy revealed granulomatous inflammation of the intestines, mesenteric lymph nodes, and liver. Eosinophilic infiltration of the granulomatous lesions was a prominent finding in one horse. A causative agent was not detected by special histochemical staining or bacteriologic culturing.     

Short-Term Effects of Duodenocecostomy on Body Weight,Glucose Absorption,Serum Components,and Intestinal Histopathology in Four Normal Horses

The objective of this study was to evaluate duodenocecostomy in horses performed through a ventral midline laparotomy and report its influence on body weight, glucose absorption, serum components, and characteristics of jejunum, cecum, and large colon histology. Four horses were submitted to the duodenocecostomy technique through a ventral midline laparotomy with animals in dorsal recumbency under inhalation anesthesia, followed by abdominal exploration. A side-to-side anastomosis was performed between the duodenojejunal flexure and the base of the cecum with two simple continuous suture lines of the serosal and muscular layers. The size of the opening created was approximately 2 cm in diameter. The mucosa layer was not sutured. After 30 days, animals were submitted to a second laparotomy to check the patency of the duodenocaecal fistula. During both laparotomy procedures, excisional biopsies of different segments of the gastrointestinal tract were performed. Information on physical examination findings, results of hematologic and histopathologic evaluations, and oral glucose absorption test were recorded. The horses did not have significant weight loss from baseline, and absorption curve of glucose did not significantly vary from baseline. Only triglycerides had significant alterations. Histologic evaluation of jejunum, cecum, and large colon did not show alterations of intestinal structure and morphology. We concluded that the proposed technique, principally in relation to the fistula size and not suturing the mucosa layer, allowed partial or total occlusion of the fistulae without the necessity of a second surgery and avoided the permanent bypass of ingesta and weight loss.     

Chronic enteritis associated with the malabsorption and protein-losing enteropathy in the horse

Chronic granulomatous enteritis associated with weight loss and hypoproteinemia was identified in 2 horses. Both horses continued to have normally formed feces. Malabsorption of carbohydrate and lipid, with concomitant gastrointestinal protein loss was demonstrated in 1 case. One horse was treated symptomatically and gained 108 kg. In both cases, principal gastrointestinal lesions were partial to total villus atrophy and transmural mononuclear leukocytosis, with lymphocytes and histiocytes predominating. The cause of the condition was not identified in either case.     

Influence of dietary tannic acid and polyethylene glycol on growth and intestinal D-xylose absorption of broiler cockerels and activity of serum enzymes

1. In an experiment on broiler cockerels, the influence of tannic acid (TA) and polyethylene glycol (PEG) on body weight gain (BWG), feed conversion ratio (FCR), weight of intestine and liver, the activities of serum enzymes LDH, AST, ALT and intestinal absorption function were investigated. 2. Broiler cockerels were given either a commercial diet alone (control group) or a commercial diet with TA (20 g/kg), PEG (10 g/kg) or TA plus PEG (20 + 10 g/kg), for 10 d. 3. On the last day of the experiment, all birds and remaining feed were weighed individually and a sample of blood was taken to measure the serum activities of lactate dehydrogenase (LDH), aspartate aminotransferase (AST) and alanine aminotransferase (ALT). The capacity of intestinal cells for the absorption of D-xylose was measured. Finally all birds were killed humanely and the intestine and liver were weighed. 4. The results showed that TA significantly reduced BWG and FCR, as well as the activity of LDH, AST and ALT. 5. TA also increased the relative weight of the intestine. Adding PEG alone had no effect on any of the measured parameters. 6. However, PEG improved significantly BWG, FCR and the activity of LDH and AST of TA-fed birds. 7. The plasma D-xylose concentration of experimental birds was similar for all dietary treatments most likely because of temporal separation between feeding the dietary TA and administering the D-xylose. 8. It was concluded that the presence of tannins in the GI lumen of the bird was necessary to affect the processes involved in the absorption of simple sugars such as D-xylose, at the level of intestinal absorptive cells.     

Avian mycobacteriosis in three horses

The clinical, bacteriologic and pathologic findings of three adult horses suffering from avian tuberculosis are presented. Chronic weight loss and hypoproteinemia were pertinent clinical abnormalities in all three horses. Gross pathologic lesions were characterized by chronic enterocolitis with mesenteric lymphadenopathy in two horses and hepatic granulomas in the third horse. The microscopic diagnoses were chronic, non-caseating granulomatous enterocolitis, and necrotizing, non-mineralizing granulomatous hepatitis, respectively. All three horses had granulomatous lymphadenitis of mesenteric lymph nodes with varying degrees of non-mineralizing, coagulation necrosis. Various serotypes of the Mycobacterium avium-intracellulare complex were isolated from selected tissues and feces.