Protozoal disease in cattle and sheep

Dynamics of protozoal excretion in the faeces of calves during the first 28 days after arrival at the fattening farm indicate infection before regrouping and show poor temporal correlation with diarrhoea

BACKGROUND

Calves in dairy cattle production in Switzerland are transported to a fattening farm at the age of 3-5 weeks, and frequently suffer from diarrhoea within the first 14 days after arrival. To characterise the role of intestinal protozoa in this, we investigated the excretion dynamics of Eimeria, Cryptosporidium and Giardia during the first 28 days after the arrival and regrouping of calves at fattening farms.

METHODS

A total of 610 faecal samples from 122 calves (mean age 37.3 days; mean body weight 79.8 kg) were collected on seven different fattening farms during the first 28 days after the arrival and regrouping of the animals. The farms were visited between January and April (cold season; n = 4) and between June and August (warm season; n = 3). The samples were collected rectally on days 1, 4, 7, 14 and 28, assessed for consistency, and analysed using the McMaster method for quantitative determination of the number of Eimeria oocysts per gram of faeces (OPG), flotation for morphological differentiation of the unsporulated Eimeria oocysts, a concentration method for the semi-quantitative determination of Giardia cysts, and modified Ziehl-Neelsen staining for semi-quantitative determination of Cryptosporidium oocysts.

RESULTS

Overall, 50.8% (62/122) of the animals had diarrhoea during the study period. However, the faecal excretion of protozoal pathogens was neither associated with diarrhoea nor with body weight gain of the animals. Altogether, 90.2% (110/122) of the calves were Eimeria positive. Eimeria zuernii was excreted by 51 (41.8%) and Eimeria bovis by 68 (55.7%) animals. In the warm season more animals tested positive for Eimeria and OPGs were higher than in the cold season. There was no correlation between the age of the calves and the OPG values. Overall, 64.8% (79/122) of the calves excreted Eimeria oocysts within the first 7 days, indicating that they had been infected with the parasite on the dairy farm of origin. Eighty-nine calves (73.0%) excreted Giardia cysts, with more positive animals in the cold (80.3%) compared with the warm season (64.3%). Only Giardia duodenalis assemblage E was identified. Cryptosporidium oocysts were microscopically detected in 14 animals (11.5%) on five farms. Cryptosporidium spp. were present in a total of 12 animals, i.e. Cryptosporidium parvum in nine, Cryptosporidium ryanae in two, and Cryptosporidium bovis in one animal.

CONCLUSIONS

A better understanding of the temporal dynamics of protozoal infections in calves is helpful for the implementation of appropriate measures to protect the health of these animals at a critical phase in their lives. Our results indicate that factors other than those examined in the present study contributed to the onset of diarrhoea in the calves.

Epidemiology of Gastrointestinal Parasites of Cattle in Three Districts in Central Ethiopia

Parasitic diseases are a major impediment to livestock production worldwide. However, knowledge about the epidemiology of gastrointestinal parasites in many low-income countries is still limited. An epidemiological survey on these parasites in traditionally reared cattle was performed in central Ethiopia (West Shewa Zone), from September 2019 to November 2021. Overall, 691 samples were analyzed qualitatively (flotation technique) and quantitatively (McMaster technique) to detect helminth eggs and Eimeria oocysts. Furthermore, coprocultures were conducted on pooled samples to identify the genera of gastrointestinal strongyles (GIS). The difference in prevalence according to agroecology, season, age, sex and body condition score (BCS) was investigated using univariable tests and through a multivariable logistic regression analysis, whereas abundance values were interpreted using a descriptive approach. The highest prevalence values were observed for GIS (50.2%) and Eimeria spp. (36.0%), whereas Moniezia spp. (16.3%), Strongyloides spp. (5.1%) and Schistosoma spp. (4.2%) showed lower values. Trichuris spp. and Toxocara vitulorum were sporadically found. A coproculture revealed that Haemonchus spp. (34.6%), Trichostrongylus spp. (25.9%) and Bunostomum spp. (19.1%) were the most frequent genera of GIS. A poor BCS was strongly associated with the occurrence of GIS, while seasonal variations were detected for Eimeria spp., GIS, Moniezia spp. and Schistosoma spp., with a higher prevalence and burden during the rainy season, and agroecology also strongly influenced different parasitic taxa. This present study increases the knowledge about the epidemiological features of gastrointestinal parasites in the context of a low-income country, suggesting a more tailored approach for their control. The use of a BCS as an indicator for the selective treatment of highly infested animals is supported by our findings, introducing a possible way to prevent anthelmintic resistance in areas where basic diagnostic services are rarely used by farmers.

Analysis of policies for use of medically important antibiotics in animals in Namibia: implications for antimicrobial stewardship

BACKGROUND

In Namibia, overuse of medically important antibiotics in animals is common and is a considerable driver of antimicrobial resistance. The study aims to analyze policies, resistance patterns and consumption of these antibiotics used in animals in Namibia.

RESEARCH DESIGN AND METHODS

A scoping review and retrospective descriptive analysis of policies, resistance patterns and use of these antibiotics in Namibia was conducted, and assessed against the AWaRe (Access, Watch and Reserve) antimicrobial use guidance.

RESULTS

Of the forty-five antibiotic products registered for use in animals, 77.8% are Access antibiotics, 68.9% are broad-spectrum and 60% are over-the-counter antibiotics- mainly tetracyclines, penicillins and sulfonamides. There is misalignment of antibiotic use policies for animals and humans and no guideline for antibiotic use in animals. Most medically important antibiotics are indicated for control of gastrointestinal (77.7%), musculoskeletal (71.1%) and respiratory (46.7%) infections, and for growth promotion (4.4%). There is high resistance to AWaRe Access antibiotics- sulfonamides (19.5%-100%), tetracyclines (56%-100%) and penicillin (13.5%-100%).

CONCLUSION

Whilst Namibia banned the use of antibiotics in farming, current policy frameworks are inconsistent across sectors, and promote overuse of broad-spectrum important antibiotics in animals. A multi-sectoral one health approach is required to harmonize antibiotic use policies and reduce resistance.

A survey on Apicomplexa protozoa in sheep slaughtered for human consumption

Infections with the Apicomplexa Toxoplasma gondii, Neospora caninum, and Sarcocystis spp. are common causes of reproductive disorders in sheep. However, few epidemiological studies regarding co-infections with these three protozoa are reported in sheep in Italy. For this reason, this study aims to evaluate possible co-infections with T. gondii, N. caninum, and Sarcocystis spp. in sheep slaughtered for human consumption. From April to July 2019, individual blood, brain, heart, and diaphragm samples were collected from 138 sheep after slaughtering. The presence of IgG anti-Toxoplasma in serum samples was evaluated through ELISA. DNA of the three protozoa was investigated using specific PCRs. Co-infection with T. gondii, N. caninum and Sarcocystis spp. was found in 66.7% of the examined sheep. Antibodies against T. gondii were found in the 36.2% of serum samples. The presence of T. gondii DNA was detected in the 67.4%, 77.5%, and 21.7% of the brain, heart, and diaphragm samples, respectively. Neospora caninum DNA was found in 72.5% of the examined brain samples. Sarcocystis spp. DNA was detected in 92% and 52.2% of the heart and diaphragm samples, respectively. Sequence analysis of the Sarcocystis spp. revealed the sole presence of Sarcocystis tenella. The present study demonstrates that sheep have a high risk of infection with the three Apicomplexa investigated, suggesting the need to adopt adequate measures to prevent the spread of these parasitic infections considering their clinical and economic impact on ovine production. Furthermore, the possible role sheep play in the zoonotic transmission of toxoplasmosis to humans was highlighted.

Antiprotozoal Drug Handling and Management Practices in Asella District, Central Oromia, Ethiopia

Results

The preliminary survey comprising 70 animal health professionals and animal owners was undertaken through observation, interview using a structured questionnaire, and discussion with key informants to evaluate their handling and management practices of antiprotozoal drugs. According to the finding of this preliminary survey, there was inadequate antiprotozoal drug distribution and only few drugs, namely, diminazene diaceturate, amprolium, and sulfa drugs, were available with different trade names being imported from different manufacturing countries. Among the current available antiprotozoal drugs circulating in the area, those manufactured and imported from China were highly distributed in the majority of veterinary drug shops. The assessment showed that there was a gap in achieving the required knowledge and practice of proper handling and management issues in the professionals and awareness problems in the community. The study indicated that there were inappropriate transportation and storage practices. Moreover, selling drugs without prescription, ignoring farmers without properly informing the drug withdrawal period, and administration of drugs by nonprofessionals were the other most critical and unethical practices in the area. It is emphasized that this inappropriate handling and management practice, scarcity of antiprotozoal drugs, easy accessibility, and distribution by nonprofessionals could potentially affect the quality, safety, and effectiveness of antiprotozoal drugs which may lead to drug resistance development.

Conclusion

Hence, continuous awareness creation in the community, capacity building, training, and upgrading programs to the professionals, as well as strict enforcement of drug control and administration regulation of the country, are essential in the overall effort of improving animal health and productivity through the control of protozoan diseases in and around Asella.

Effects of β-Mannanase and Bacteriophage Supplementation on Health and Growth Performance of Holstein Calves

Simple Summary

For sustainable animal agriculture, we need to find ways to increase growth efficiency without using feed antibiotics. Bacteriophages, which are only harmful to specific bacterial strains, have been suggested as a feed additive replacing antibiotics. β-mannanase, which degrades mannan, is known to promote nutrient digestibility, animal growth, or both, thus improving feed efficiency. The objective of this study was to evaluate the effects of dietary supplementation with bacteriophage and β-mannanase on health and growth performance in calves. We assigned 36 pre-weaning male Holstein calves to one of four treatments with a 2 × 2 factorial arrangement: no supplementation, 0.1% β-mannanase, 0.1% bacteriophage, and both 0.1% bacteriophage and 0.1% β-mannanase supplementation in a starter on a dry matter basis. Compared to unsupplemented, the bacteriophage supplemented group showed a tendency to improve the survival rate without growth promotion. Supplementation of β-mannanase, on the other hand, increased the starter intake and the weekly body weight (BW) gain and tended to increase the final BW. Our study indicated that bacteriophage supplementation has a positive effect on survival rate, while β-mannanase supplementation improves growth performance in calves.

Abstract

The objective of this study was to evaluate the effects of dietary supplementation with bacteriophage and β-mannanase on health and growth performance in calves. Thirty-six pre-weaning male Holstein calves were randomly allocated to one of four dietary treatments with a 2 × 2 factorial arrangement: no supplementation, 0.1% β-mannanase, 0.1% bacteriophage, and both 0.1% bacteriophage and 0.1% β-mannanase supplementation in a starter on a dry matter basis. The experiment lasted from 2 weeks before weaning to 8 weeks after weaning. Twenty-two calves survived to the end of the experiment. No interaction was observed between the two different feed additives. The bacteriophage supplementation tended to increase the odds ratio of survival (p = 0.09). The number of Escherichia coli in feces significantly decreased by bacteriophage supplementation one week after weaning. β-mannanase supplementation increased the concentrate intake (p < 0.01) and tended to increase the final BW (p = 0.08). Analysis of repeated measures indicated β-mannanase supplementation increased weekly body weight gain (p = 0.018). We conclude that bacteriophage supplementation may have a positive effect on calf survival rate, while β-mannanase supplementation may increase the growth rate and starter intake by calves just before and after weaning.

Perils and Promises of Pathogenic Protozoan Extracellular Vesicles

Extracellular vesicles (EVs) are membranous structures formed during biological processes in living organisms. For protozoan parasites, secretion of EVs can occur directly from the parasite organellar compartments and through parasite-infected or antigen-stimulated host cells in response to in vitro and in vivo physiological stressors. These secreted EVs characteristically reflect the biochemical features of their parasitic origin and activating stimuli. Here, we review the species-specific morphology and integrity of parasitic protozoan EVs in concurrence with the origin, functions, and internalization process by recipient cells. The activating stimuli for the secretion of EVs in pathogenic protozoa are discoursed alongside their biomolecules and specific immune cell responses to protozoan parasite-derived EVs. We also present some insights on the intricate functions of EVs in the context of protozoan parasitism.

Gastrointestinal parasites as a possible threat to an endangered autochthonous Portuguese sheep breed

Helminth and protozoan infections are responsible for important diseases in grazing sheep, which can be especially threatening in an autochthonous breed at risk of extinction like the Churra Galega Mirandesa Portuguese sheep breed. The aim of the present study was to determine the diversity, prevalence and burden of gastrointestinal parasites in these sheep and to assess the effects of deworming practices, cohabiting animals on the farm and feed management. Coprological qualitative and quantitative analysis (flotation, natural sedimentation and McMaster method) were used to identify and quantify gastrointestinal parasites and a questionnaire was designed and applied. A total of 512 faecal samples were collected from 49 flocks, and 49 replies to the questionnaire were received. Parasites were identified in 100% of the flocks, and in 97% of the samples. The genera or species that have been morphologically identified were: strongyle-type, Nematodirus spp., Skrjabinema spp., Moniezia expansa, Moniezia benedeni, Trichuris spp., Capillaria spp., Eimeria spp., Dicrocoelium spp. and Fasciola hepatica. This is the first report in Portugal of Skrjabinema spp. The burden of parasites' oocysts and eggs per gram in faecal samples ranged, respectively, from 50 to 17,550 for Eimeria spp., and from 50 to 6250 for strongyle-type eggs. Factors affecting parasitic infections were evaluated using a multivariate logistic regression. Grazing time and a lack of anthelmintic treatment were positively associated with Nematodirus spp. infection. This study showed that there is a high prevalence and diversity of gastrointestinal parasites in the Churra Galega Mirandesa sheep breed.

Excretion of Eimeria spp. oocysts in young lambs following iron supplementation

BACKGROUND

Iron is an essential nutrient, and iron supplementation has been shown to reduce the incidence of abomasal bloat in lambs. Additionally, iron deficiency is linked to pica, which may increase uptake of Eimeria oocysts. Coccidiosis in sheep, caused by Eimeria spp., is an important infection, leading to reduced welfare and economic losses. The aims of our study were to investigate: (1) the use of iron supplementation in Norwegian sheep flocks using a questionnaire survey, and (2) whether iron supplementation reduced excretion of Eimeria oocysts and increased the growth rates of young lambs.

RESULTS

A questionnaire regarding the use of iron supplementation, sent to all members of the Norwegian Sheep Recording System (n = 4993), showed that 152/1823 farmers iron-supplemented lambs, either orally (56.7%) or by injection (43.3%). The main purpose of supplementation was to prevent abomasal bloat (38.4%), coccidiosis (9.3%), or both (27.8%). In the field study, 102 twin lambs from five flocks were included: one twin (treated) received 600 mg of gleptoferron subcutaneously within 3 days of birth, whereas the control was given saline. McMaster analysis of individual faecal samples obtained at weekly intervals (n = 4 per lamb, starting at turnout) showed no significant difference in oocyst excretion between treatment groups at any sampling, except for one flock 14 days after turnout. Mean growth rates, measured at iron injection, 21 days after turnout, and in the autumn, differed significantly between treated and untreated lambs from iron injection to 21 days after turnout, however, no difference in growth rates was observed in the overall period from iron injection to autumn. Blood analysis suggested that the controls were at risk of developing iron deficiency anaemia during the housed period, but signs of anaemia were not observed.

CONCLUSION

Iron supplementation of lambs was used by 8.3% of the farmers responding to the questionnaire, mainly with the intention to prevent abomasal bloat, coccidiosis, or both. The field trial results indicate that iron supplementation of young lambs do not reduce oocyst excretion and only induced a transitory increase in weight gain. However further studies, including more flocks and possibly repeated iron injections, would provide more definitive information.

Field evaluation of anticoccidial efficacy: A novel approach demonstrates reduced efficacy of toltrazuril against ovine Eimeria spp. in Norway

Ovine Eimeria spp. infections cause reduced welfare, increased mortality, and substantial economic losses, and anticoccidials are crucial for their control. Recent reports of toltrazuril resistance in pigs, and anecdotal reports of reduced anticoccidial efficacy in lambs, necessitate evaluation of anticoccidial efficacy. Due to the substantial lifecycle differences between nematodes and coccidia, current WAAVP methods for assessing anthelmintic efficacy are not suitable for such evaluations. Faecal samples were collected from 8 pairs of twin lambs from 36 Norwegian sheep farms 6-8 days after turnout. One twin of each pair was then treated with 20 mg/kg toltrazuril and a second faecal sample from all lambs was collected 7-11 days later. Oocyst excretion rate in all samples was determined using McMasters. Suitability of treatment timing was investigated by evaluating the increase in mean log oocyst excretion in untreated lambs. Based on comparisons between groups, a threshold of ≥0.75 (13 farms) was used to identify farms where drug efficacy could be assessed with confidence, drug efficacy on farms with increases of ≥0.5 but <0.75 (7 farms) were evaluated with caution, and drug efficacy on farms with increases of <0.5 (16 farms) was not estimated. Reduction in oocyst excretion between samples from treated lambs compared with controls from the 20 farms with a threshold of ≥0.5 were then analysed using a generalised linear mixed model. The results were classified based on 95% CI obtained using parametric bootstrapping. Among these 20 farms, two exhibited reduced drug efficacy (upper 95% CI < 95%), 13 had good efficacy (lower 95% CI > 90%), and for 5 the results were inconclusive. This is the first evidence-based report of reduced anticoccidial efficacy in ovine Eimeria spp. Additionally, we highlight the problem of sub-optimal timing of treatment (16/36 farms), which could potentially result in incorrect conclusions being reached regarding lack of drug efficacy.

Controlled efficacy trial confirming toltrazuril resistance in a field isolate of ovine Eimeria spp

BACKGROUND

Coccidiosis due to Eimeria spp. infections in lambs causes increased mortality and substantial production losses, and anticoccidials are important for control of the infection. Anticoccidial resistance has been reported in poultry and swine, and we recently described reduced toltrazuril efficacy in ovine Eimeria spp. in some Norwegian sheep farms using a newly developed faecal oocyst count reduction test (FOCRT). The aim of the present study was to use a controlled efficacy trial to assess the efficacy of toltrazuril against a field isolate suspected of being resistant.

METHODS

Twenty lambs, 17-22 days old and raised protected against exposure to coccidia, were infected with a field isolate of 100,000 Eimeria spp. oocysts. This isolate was obtained from a farm with a previously calculated drug efficacy of 56% (95% confidence interval: -433.9 to 96.6%). At day 7 post-infection, 10 of the lambs were orally treated with 20 mg/kg toltrazuril (Baycox Sheep vet., Bayer Animal Health), while the other 10 lambs (controls) were given physiological saline. Clinical examinations were conducted, and weight gains recorded. Daily faecal samples were scored for diarrhoea on a scale from 1 to 5, and oocyst excretion was determined using a modified McMaster technique. Oocysts were morphologically identified to species level. At 17-24 days post-infection, the lambs were euthanized and necropsied.

RESULTS

The tested Eimeria isolate was resistant against toltrazuril, and resistance was seen in both pathogenic and non-pathogenic species. In addition, no significant differences in faecal score, growth, gross pathology or histological changes were identified between the two groups. The pathogenic E. ovinoidalis was the dominant species, and no significant difference in the individual prevalence of E. ovinoidalis post-treatment was found between treated (66.9%) and control lambs (61.9%). Other species identified included E. crandallis/weybridgensis, E. parva, E. marsica, E. faurei, E. pallida, E. ahsata and E. bakuensis.

CONCLUSIONS

This study confirms toltrazuril resistance in ovine Eimeria spp.; in addition, the data support the use of FOCRT as an appropriate tool for field evaluation of anticoccidial efficacy. Due to limited anticoccidial treatment alternatives, these findings may have important implications for the sheep industry, particularly in northern Europe.

Sheep management and cryptosporidiosis in central Mexico

To establish the association between sheep farm management practices and cryptosporidiosis in Central Mexico, 37 farms were invited and questionnaires answered by owners. Faeces samples were taken from lambs under 3 months old and ewes in the farms. Parasites were identified by modified Ziehl-Neelsen stain. Questionnaire included: general farm information, facilities characteristics, facilities cleaning measures, water use and farm and animal management practices. Farms were grouped in a low ( Pound 3,37%), medium (3.38-49.9%) and high basis ((3)50%) according to prevalence. Associations (OR) were calculated according to positivity, compared by chi-square test. A general prevalence of 34,33% was found. Five variables showed statistical significance (p<0.05). Associations found were: use of bed, grazing place, and bottle cleaning. The only association found between management practices and cryptosporidiosis that could represent a risk was the grazing place. This report is the first one in the country regarding predisposing conditions for cryptosporidiosis.

Epidemiology of parasitic protozoan infections in Soay sheep (Ovis aries L.) on St Kilda

The feral Soay sheep (Ovis aries L.) population on Hirta, St Kilda, is host to a diverse component parasite community, but previous parasitological studies of the population have only focussed on the metazoan species. This paper reports the first epidemiological study of the protozoan species comprising Cryptosporidium parvum, Giardia duodenalis and 11 species of Eimeria in Soay sheep across 3 years of varying host population density. Prevalence and intensity of almost all species of protozoa significantly decreased with host age, with the exception of E. granulosa, which increased in prevalence with host age. The prevalence of C. parvum appeared to vary positively with host population density but that of G. duodenalis did not vary significantly with density. Most species of Eimeria showed a distinct lag in infection level following the host population crash of 2002, taking up to 2 years to decrease. Mixed Eimeria species intensity and diversity were highest in 2002, a year of low host density. Parasite diversity decreased with host age and was higher in males. There were 5 positive pair-wise associations between protozoa species in terms of prevalence. The results of this study highlight the potential for protozoal infection to shape the evolution of parasite resistance in wild host populations harbouring diverse parasite species.

Intoxicação experimental por Ateleia glazioviana (Leg.Papilionoideae) em ovinos

Sete ovelhas receberam as folhas de Ateleia glazioviana em doses predeterminadas. Um outro ovino serviu de controle. As quantidades totais (g/kg/peso corporal) de planta consumidas pelos ovinos foram 75 por 60 dias (Ovino 6), 125 por 25 dias (Ovino 4), 130 por 13 dias (Ovino 7), 150 por 60 dias (Ovino 5), 180 por 18 dias (Ovino 3), 330 por 33 dias (Ovino 2) e 375 por 25 dias (Ovino 1). Seis ovinos receberam folhas verdes e o Ovino 7 recebeu folhas dessecadas. Cinco ovinos (Ovinos 1-4 e 7) desenvolveram sinais clínicos 8 a 16 dias após a primeira administração da planta. A evolução do quadro clínico foi de 6 a 50 dias e os sinais clínicos incluíram apatia, perda do apetite, taquicardia e taquipnéia. Os ovinos afetados apresentavam relutância em mover-se, cabeça baixa, instabilidade dos membros pélvicos e andar cambaleante. Alguns dos ovinos afetados apoiavam o corpo contra a parede da baia. Os Ovinos 1, 3 e 4 morreram espontaneamente; movimentos de pedalagem precederam a morte. Os Ovinos 2 e 7 foram submetidos à eutanásia com sinais clínicos avançados da toxicose. Os Ovinos 5 e 6 não adoeceram e foram sacrificados junto com o controle 103 dias após a primeira administração da planta. Todos os ovinos foram necropsiados e vários órgãos, incluindo coração e encéfalo, foram avaliados histologicamente. Além disso, fragmentos de miocárdio dos Ovinos 3 e 4 foram avaliados por microscopia eletrônica de transmissão. A fim de se obter mais controles para a avaliação das lesões do miocárdio, coletaram-se os corações de seis ovinos abatidos para consumo em um abatedouro que sabidamente recebe ovinos originários de uma região livre de A. glazioviana. Esses corações foram processados para histologia e examinados da mesma maneira que os outros oito. Todos os ovinos tratados (que receberam a planta) apresentaram lesões macroscópicas. Havia áreas firmes, irregulares, branco-amareladas no miocárdio de todos os ovinos tratados. Essas áreas pálidas eram mais bem vistas na superfície de corte do coração. Hidrotórax e/ou hidropericárdio foram observados em cinco animais (Ovinos 1-4 e 7). O fígado dos Ovinos 1 e 7 tinha aspecto de noz-moscada. O Ovino 7 apresentava ascite. Os principais achados histopatológicos nos ovinos tratados foram alterações degenerativas/necróticas no miocárdio. As alterações iniciais consistiam de tumefação aguda das fibras cardíacas, associada a núcleos com formas bizarras. Essa alteração aparentemente progredia até o desaparecimento do sarcoplasma, resultando num tubo sarcolemal vazio e colapsado envolto por tecido conjuntivo intersticial e fibrose. Necrose franca (hialina e flocular) associada à infiltração mononuclear e fagocitose de fragmentos de fibras foi também observada. Graus variáveis de degeneração esponjosa foram observados na substância branca do encéfalo dos Ovinos 1, 3, 4 e 7. Tumefação de mitocôndrias e perda da densidade da matriz das mitocôndrias foram as alterações ultra-estruturais mais precoces. Em lesões avançadas os cardiomiócitos apresentavam vacúolos no sarcoplasma, ruptura do sarcolema e necrose com aparecimento de macrófagos e fibroblastos associados a aumento de colágeno.