Percutaneous Ultrasound-guided Cholecystocentesis and Bile Analysis for the Detection of Platynosomum spp.-Induced Cholangitis in Cats

Contribution of ultrasound examination in diagnosing platynosomiasis and correlation with macro and microscopic findings in callitrichids kept under human care

BACKGROUND

Platynosomiasis in non-human primates kept under human care causes chronic disease of the bile ducts and liver, which initially presents with nonspecific signs and can culminate in the death of the animal. Diagnosing this disease is a challenge, and an ultrasound examination can be an excellent tool when it is suspected.

METHODS

This study describes the ultrasound findings from 57 marmosets with suspected infection by Platynosomum sp., the correlated hepatobiliary changes, and the anatomopathological findings that confirmed the occurrence of platynosomiasis.

RESULTS

In six marmosets (one C. aurita, two C. jacchus, and three Callithrix sp.), Platynosomum infection was confirmed macroscopically (presence of adult trematodes in the gallbladder) and microscopically (adults, larvae, and eggs in histological examinations and eggs in bile and feces). These findings were compatible with the hepatobiliary changes and with images suggestive of parasitic structures in ante-mortem assessments.

CONCLUSION

Ultrasound examination demonstrated its usefulness within the clinical routine for investigating this parasitosis.

A systematic review and meta-analysis on the global status of Platynosomum sp. (Trematoda - Dicrocoelidae) infecting domestic cats (Felis catus)

Platynosomum sp. is a parasite that infects the liver and biliary tract of domestic and wild cats, causing platynosomiasis. A systematic review with meta-analysis was performed to determine the global prevalence and distribution of Platynosomum sp. based on epidemiological studies and case reports. A total of 73 articles met the inclusion criteria, including 46 studies of an epidemiological nature and 27 case report articles, comprising 35 affected animals. Meta-analysis of epidemiological studies revealed an overall prevalence of 17.8%, with high heterogeneity. Central America had the highest prevalence at 64.1%, followed by South America at 15.1%. Necropsy was the primary diagnostic method, followed by morphological detection of eggs in faeces at 29.3% and 12.5%, respectively. The analysis of case reports highlighted a greater number in South America and confirmed the presence of the parasite in countries where no epidemiological studies were obtained. The most infected animals were those that met the criteria of being mixed-breed, over 4 years old, and having unrestricted outdoor access, but no gender predilection was observed. General comorbidities were the most observed, followed by icterus. In addition, pathological changes were observed in the necropsied animals of the case reports, and the presence of thickening of the ducts and gallbladder was mainly identified, followed by fibrosis and hyperplasia, linked to the presence of an adult parasite. In conclusion, this systematic review with meta-analysis revealed a significant prevalence of Platynosomum sp. at a global level, mainly in the Americas, and that comprehensive studies are necessary for a more reliable prevalence, considering that this is a parasite of great importance for feline medicine.

Treatment for cholangiohepatitis in cats

Acute bacterial cholangiohepatitis of cats is a common disease associated with the inflammation of bile ducts and liver parenchyma, characterized by development of a pronounced hepatodepressive syndrome (hypoalbuminemia), cytolysis (increase in serum activity of alanine and asparagine transaminase), cholestasis (increase in serum concentration of bilirubin, cholesterol, activity of alkaline phosphatase and gamma-glutamyltranspeptidase), intoxication, dehydration, mesenchymal-inflammatory and pain syndromes. The aim of the research was to study the effectiveness of treatment for acute bacterial cholangiohepatitis in cats with average severity of the pathology course. According to inclusion and exclusion criteria, the study included a cohort of cats (n = 12) with acute bacterial cholangiohepatitis. Clinical, hematological, ultrasonographic, statistical methods of investigation were used in this work. For sick cats with medium severity form of cholangiohepatitis, when administered as a complex therapy the combination of marbofloxacin, metronidazole, ursodeoxycholic acid, cyancobolamine, tocopherol acetate, infusion therapy also had a good therapeutic effect, which was accompanied by improved clinical and laboratory performance. In the blood of cats with cholangiohepatitis, in the background of intensive therapy, there was a significant decrease in white blood cell count, erythrocyte sedimentation rate, and in serum, there was an increase in albumin concentration, reduction of creatinine, aminotransferase activity, alkaline phosphatase, gamma-glutamyltranspeptidase, lipase.

Acute infection with Platynosomum illiciens (Trematoda: Dicrocoeliidae) as a clinically relevant and potentially fatal disease in Falco sparverius (Aves: Falconidae) in Brazil

Platynosomum illiciens is a dicrocoeliid trematode from the biliary tract of warm-blooded vertebrates (felines, primates, marsupials, and birds) reported in different parts of the world. Although the veterinary relevance of platynosomosis in mammals, especially in domestic felines, has been increasingly evidenced in the scientific literature, studies involving avian disease caused by P. illiciens are comparatively scarce. In the present study, a female specimen of the American kestrel, Falco sparverius L., found dead, in November 2019, in Brazil, was necropsied. Parietal biliary effusion in the celomatic cavity was observed, suggesting biliary transudation and gallbladder stasis, which possibily preceded the distension and rupture of gallbladder noted during necropsy. In the microscopic analysis of the bile content, small trematodes were found and characterized as immature stages of Platynosomum after the morphological study. Partial sequences of the cox-1 gene enabled the identification of P. illiciens, with 100% similarity with previously sequenced sympatric isolates from mammals. The finding of immature specimens in a ruptured gallbladder strongly suggests a role for the parasite in biliary flow dysfunction, indicating acute platynosomosis as a clinically relevant and potentially fatal condition that has not yet been discussed.

Ultrasonography of Parasitic Diseases in Domestic Animals: A Systematic Review

Simple Summary

The aim of this literature review was to summarize the current knowledge on the application of ultrasonography in diagnosis, staging and monitoring of helminthic diseases in domestic animals. We selected and analyzed 122 papers about the application of ultrasonography in parasitic disease in ruminants, equids, swine, and companion animals. Helminths can be recognized in ultrasound images by their morphology, size, and location. In some cases, the parasites are not directly seen by ultrasound, but the lesions caused by them can be easily visualized. Ultrasound imaging is taking on an increasingly important role in veterinary parasitology.

Abstract

The aim of this review was to summarize the current knowledge on the application of ultrasonography in diagnosis, staging and monitoring of helminthic diseases in domestic animals. Only peer reviewed papers written in English language were included in this systematic review. All papers concerning unicellular parasites, wild animals, non-domestic experimental animals, or ex vivo or in vitro applications of ultrasonography were excluded from the review. A total of 122 papers met the inclusion criteria. Among them 47% concerned nematodes, 37% cestodes, and 16% trematodes with the genus Dirofilaria, Echinococcus, and Fasciola the most represented, respectively. Helminths can be recognized in ultrasound images by their morphology, size, and location. In some cases, the parasite stages are not directly seen by ultrasound, but the lesions caused by them can be easily visualized. Ultrasound imaging is taking on an increasingly important role in the diagnosis, staging, monitoring, and control of parasitic diseases in veterinary medicine. However, it cannot replace the clinical approach and the diagnostic tests commonly used in veterinary parasitology.

Feline cholangitis/cholangiohepatitis complex - what have we learned?

Cholangitis/cholangiohepatitis complex in cats is commonly encountered in clinical practice worldwide. Diagnosis and management of cats with this complex is difficult because of the ambiguity of clinical signs, diagnostic test results and commonality of comorbid disorders. These impediments can delay disease identification and treatment, which can increase morbidity and mortality. ​In this narrative review, we aimed to provide a thorough review of the unique physioanatomic features of the biliary system as well as clinically relevant updates on cholangitis/cholangiohepatitis complex in cats.

Chronic cholecystitis: Diagnostic and therapeutic insights from formerly bile-farmed Asiatic black bears (Ursus thibetanus)

Across Southeast Asia and China, more than 17000 Asian bears are kept under suboptimal conditions and farmed for their bile to meet the consumer demand for traditional medicine products. Years of unsterile and repetitive bile extraction contribute to the development of chronic sterile or bacterial cholecystitis, a pathology commonly diagnosed in formerly bile-farmed bears. In both human and veterinary medicine, the diagnostic value of the macroscopic bile examination for assessing gallbladder disease is unclear. The objective of this study is to identify the role of gallbladder bile color, viscosity, and turbidity, while comparing them with established markers of cholecystitis. Moreover, it aims to define the optimal duration of oral antibiotic treatment for chronic bacterial cholecystitis in bears associated with bile farming. Thirty-nine adult, formerly bile-farmed Asiatic black bears (Ursus thibetanus) were examined under anesthesia and underwent percutaneous ultrasound guided cholecystocentesis. A total of 59 bile samples were collected with 20 animals sampled twice to evaluate the therapeutic success. All bile aspirates were assessed macroscopically and microscopically followed by submission for bacterial culture and antimicrobial sensitivity. In the majority of bears, samples with cytological evidence of bactibilia lacked inflammatory cells and did not always correlate with positive bacterial cultures. The most common bacterial isolates were Enterococcus spp, Streptococcus spp and Escherichia coli. Based on our findings, the optimal duration of antibiotic treatment for chronic bacterial cholecystitis is 30 days. Moreover, unlike Gamma-glutamyl Transferase (GGT) and gallbladder wall thickness, the organoleptic properties of bile were found to be reliable markers of chronic gallbladder inflammation with color and turbidity indicating cholestasis. The current study highlights the importance of cholecystocentesis for the management of gallbladder disease and provides initial results on the possible diagnostic value of macroscopic bile examination.

Platynosomum fastosum in domestic cats in Cuiabá, Midwest region of Brazil

Platynosomum fastosum, which is distributed in tropical and subtropical regions, is the main parasite in the biliary system of domestic cats. Cats can be asymptomatic or show severe signs of cholangitis. Although the infection is reported throughout Brazil, only post-mortem studies are available from the Midwest region of the country. This cross-sectional study investigated the frequency of P. fastosum parasitism in domestic cats treated at the University Veterinary Hospital in Cuiabá city, Mato Grosso, Brazil, by three coproparasitological techniques (formalin-ether sedimentation, Faust, and Hoffmann), associating clinical, laboratory (haematological, biochemical) and ultrasonographic alterations. Based on the sample calculation, 171 cats were evaluated in the clinical and laboratory and a semi-structured epidemiological questionnaire was designed and used by the tutors. The prevalence observed was 26.90%, with no significant association with sex, reproductive status, age, hunting habit, access to the street, recent anthelmintic treatment, and the guardian's lack of knowledge regarding parasitism. Of the 171 cats evaluated, 55 (32.16%) showed clinical signs suggestive of cholangitis, with a significant association of this variable. Regarding the clinical and pathological variables, mild neutrophilia and elevated serum activity of alanine amino transferase and alkaline phosphatase was observed (but not significantly), while the mean values of eosinophils, leucocytes, total protein, albumin, and globulin were normal. The ultrasound findings were like those previously described. Thus, it was observed that P. fastosum occurs in moderate prevalence in cats from Cuiabá-MT, with a significant association with clinical signs and a regular agreement between the parasitological techniques employed.

Common bile duct obstruction caused by a helminth in a cat in the UK: ultrasonographic findings, histopathology and outcome

Case summary

An 11-year-old neutered female domestic shorthair cat presented to our hospital with a 5-day history of vomiting, lethargy, anorexia and hyperbilirubinaemia, despite intravenous fluid therapy, gastroprotectants and antibiotic treatment. An abdominal ultrasound revealed a markedly distended common bile duct (diameter 6.2 mm). The cystic duct and intrahepatic bile ducts were also dilated. A linear structure formed by two parallel hyperechoic lines was identified in the common bile duct and could be traced to the duodenal papilla. The cat underwent laparotomy for surgical decompression of the biliary tree. A tubular, brown-coloured structure was retrieved from the common bile duct. Histological examination was consistent with a degenerate helminth. The cat recovered uneventfully from the surgery and its demeanour and appetite improved rapidly over the following days. Liver and gallbladder wall histopathology was consistent with bacterial cholangitis and cholecystitis. Escherichia coli was cultured from both bile and liver parenchyma.

Relevance and novel information

To our knowledge, this is the first reported case of extrahepatic biliary duct obstruction caused by a helminth in a cat in the UK. We hypothesised that the obstruction had been caused by the aberrant migration of an intestinal nematode that became lodged in the duodenal papilla. Ultrasound allowed prompt diagnosis and guided the treatment decision.

Evidence-Based Medicine: Ultrasound-Guided Percutaneous Cholecystocentesis in the Cat

Cholangitis is a common cause of hepatobiliary disease in the cat. Feline cholangitis is characterized as neutrophilic (acute or chronic), lymphocytic, or caused by liver flukes. The neutrophilic form is caused by bacterial infection of the biliary system, and identification of the specific bacterial agent guides treatment. Bile is the sample of choice for cytology and bacterial culture in these cases, and percutaneous ultrasound-guided cholecystocentesis is used to obtain that sample. This review covers the literature that provides evidence for safety and usefulness of percutaneous ultrasound-guided cholecystocentesis as part of the diagnostic work-up of cats suspected of having hepatobiliary disease.