Risk factors for Clostridium piliforme infection in foals

An Overview of Equine Enteric Clostridial Diseases

The understanding of the pathogenesis of equine enteric clostridial organisms is an active, evolving field. Advances will improve our knowledge both from the animal welfare and human health perspectives. The zoonotic nature of this group of diseases makes them relevant in the age of One health, as a significant amount of close human-equine interactions occurs for business and pleasure. Economic and welfare reasons prompt a better understanding of enteric clostridial pathogenesis, treatment, and control of the infection in horses and ongoing efforts are needed to advance clinical outcomes.

Clostridial Diseases of Horses: A Review

The clostridial diseases of horses can be divided into three major groups: enteric/enterotoxic, histotoxic, and neurotoxic. The main enteric/enterotoxic diseases include those produced by Clostridium perfringens type C and Clostridioides difficile, both of which are characterized by enterocolitis. The main histotoxic diseases are gas gangrene, Tyzzer disease, and infectious necrotic hepatitis. Gas gangrene is produced by one or more of the following microorganisms: C. perfringens type A, Clostridium septicum, Paeniclostridium sordellii, and Clostridium novyi type A, and it is characterized by necrotizing cellulitis and/or myositis. Tyzzer disease is produced by Clostridium piliforme and is mainly characterized by multifocal necrotizing hepatitis. Infectious necrotic hepatitis is produced by Clostridium novyi type B and is characterized by focal necrotizing hepatitis. The main neurotoxic clostridial diseases are tetanus and botulism, which are produced by Clostridium tetani and Clostridium botulinum, respectively. Tetanus is characterized by spastic paralysis and botulism by flaccid paralysis. Neither disease present with specific gross or microscopic lesions. The pathogenesis of clostridial diseases involves the production of toxins. Confirming a diagnosis of some of the clostridial diseases of horses is sometimes difficult, mainly because some agents can be present in tissues of normal animals. This paper reviews the main clostridial diseases of horses.

Bacterial and viral enterocolitis in horses: a review

Enteritis, colitis, and enterocolitis are considered some of the most common causes of disease and death in horses. Determining the etiology of these conditions is challenging, among other reasons because different causes produce similar clinical signs and lesions, and also because some agents of colitis can be present in the intestine of normal animals. We review here the main bacterial and viral causes of enterocolitis of horses, including Salmonella spp., Clostridium perfringens type A NetF-positive, C. perfringens type C, Clostridioides difficile, Clostridium piliforme, Paeniclostridium sordellii, other clostridia, Rhodococcus equi, Neorickettsia risticii, Lawsonia intracellularis, equine rotavirus, and equine coronavirus. Diarrhea and colic are the hallmark clinical signs of colitis and enterocolitis, and the majority of these conditions are characterized by necrotizing changes in the mucosa of the small intestine, colon, cecum, or in a combination of these organs. The presumptive diagnosis is based on clinical, gross, and microscopic findings, and confirmed by detection of some of the agents and/or their toxins in the intestinal content or feces.

Study design synopsis: Bias can cast a dark shadow over studies

The study of free-living populations is important to generate knowledge related to the epidemiology of disease and other health outcomes. These studies are unable to provide the same level of control as is possible in laboratory studies and thus are susceptible to certain errors. The primary categories of study errors are random and systematic. Random errors cause imprecision and can be quantified using statistical methods including the calculation of confidence intervals. Systematic errors cause bias, which is typically difficult to quantify within the context of an individual study. The three main categories of systematic errors are selection, information, and confounding bias. Selection bias occurs when enrolled animals are not representative of the target population of interest in respect to characteristics important to the primary study objective. Information bias occurs when data collected from enrolled animals deviates from the true value. Information bias is most damaging when errors vary among comparison groups. Both selection and information bias are prevented through the application of good study design procedures. Researchers should select study animals after careful consideration of the primary study objective and desired target population. Investigators can reduce information bias through standardised data collection procedures and the use of blinding. Confounding bias occurs when the measured association between a predictor and an outcome ignores the influential effect of an additional variable. Confounding is common and analysts must implement the appropriate statistical adjustments to reduce the associated bias. All studies will have some errors and biased data with high precision are the most damaging to the validity of study conclusions. Authors can facilitate the critical evaluation of their research by providing text related to the limitations and potential sources of bias within the discussion section of their manuscripts.

Pathobiology and diagnosis of clostridial hepatitis in animals

Clostridia can cause hepatic damage in domestic livestock, and wild and laboratory animals. Clostridium novyi type B causes infectious necrotic hepatitis (INH) in sheep and less frequently in other species. Spores of C. novyi type B can be present in soil; after ingestion, they reach the liver via portal circulation where they persist in phagocytic cells. Following liver damage, frequently caused by migrating parasites, local anaerobic conditions allow germination of the clostridial spores and production of toxins. C. novyi type B alpha toxin causes necrotizing hepatitis and extensive edema, congestion, and hemorrhage in multiple organs. Clostridium haemolyticum causes bacillary hemoglobinuria (BH) in cattle, sheep, and rarely, horses. Beta toxin is the main virulence factor of C. haemolyticum, causing hepatic necrosis and hemolysis. Clostridium piliforme, the causal agent of Tyzzer disease (TD), is the only gram-negative and obligate intracellular pathogenic clostridia. TD occurs in multiple species, but it is more frequent in foals, lagomorphs, and laboratory animals. The mode of transmission is fecal-oral, with ingestion of spores from a fecal-contaminated environment. In affected animals, C. piliforme proliferates in the intestinal mucosa, resulting in necrosis, and then disseminates to the liver and other organs. Virulence factors for this microorganism have not been identified, to date. Given the peracute or acute nature of clostridial hepatitis in animals, treatment is rarely effective. However, INH and BH can be prevented, and should be controlled by vaccination and control of liver flukes. To date, no vaccine is available to prevent TD.

Clostridium piliforme Infection in Two Farm-raised White-tailed Deer Fawns (Odocoileus virginianus) and Association with Copper Toxicosis

Necropsy of 2 white-tailed deer fawns who died acutely revealed diarrhea and melena in case No. 1 and no gross changes in case No. 2. Histologically, the livers of both deer displayed multifocal coagulative necrosis, with infiltrations of neutrophils, macrophages, and lymphocytes. By Warthin-Starry staining, bundles of filamentous bacteria were identified within hepatocytes at the periphery of the necrotic foci in case No. 1. There was multifocal myocardiocyte necrosis in case No. 1 and multifocal lymphoid necrosis of the Peyer's patches in case No. 2. Clostridium piliforme 16S ribosomal ribonucleic acid gene was detected in both livers by polymerase chain reaction (PCR) with C. piliforme-specific primers. The liver copper levels in both cases were normal to slightly elevated. The kidney copper level in case No. 2 was elevated. This represents the first published cases of Tyzzer's disease in deer, a novel use of PCR for the diagnosis of C piliforme infection, and a possible association between copper toxicosis and Tyzzer's disease.

Evaluation of available diagnostic methods for Clostridium piliforme in laboratory rabbits (Oryctolagus cuniculus)

Recent literature has indicated that animals seropositive for Clostridium piliforme may have negative findings on polymerase chain reaction (PCR) testing. This study examines and reports on the results of serology, PCR and histopathology tests performed on a group of 20 laboratory rabbits seropositive for C. piliforme using the latest available diagnostic methodologies. The presence of the organism was not confirmed by either PCR or histopathology in this group of 20 for C. piliforme seropositive rabbits. This presents challenges for laboratory animal veterinarians and scientists wishing to establish the presence of the organism with commonly available diagnostic methods and means that clinical signs of disease in addition to diagnostic results must be interpreted together.