Listeria monocytogenes cholangiohepatitis in a lactating Holstein cow

OBJECTIVE

To describe a unique presentation of systemic Listeria monocytogenes infection in a lactating adult Holstein cow.

ANIMAL

3-year-old second-parity female Holstein, 200 days in milk.

CLINICAL PRESENTATION, PROGRESSION, AND PROCEDURES

A 3-year-old Holstein dairy cow was presented for decreased appetite, decreased milk production, and pyrexia. Blood work displayed marked abnormalities in liver-associated parameters. A diagnosis of L monocytogenes cholangiohepatitis was made following liver biopsy, histopathology, and bacterial culture.

TREATMENT AND OUTCOME

The cow was treated with systemic antimicrobial and antipyretic therapy. The cow was discharged to continue treatment on farm, and at time of last communication with the owner, the cow was doing very well, with full resolution of clinical signs.

CLINICAL RELEVANCE

This case report describes a novel presentation of L monocytogenes infection in an adult bovine. L monocytogenes cholangiohepatitis should be considered a rare differential diagnosis in cattle presenting with evidence of pyrexia and liver disease.

Concurrent hepatopathy in dogs with gallbladder mucocele: Prevalence, predictors, and impact on long-term outcome

BACKGROUND

Information is limited regarding the prevalence and importance of hepatic histologic abnormalities in dogs with gallbladder mucocele (GBM).

OBJECTIVES

To (a) report prevalence of hepatic histologic abnormalities in dogs with GBM (b) evaluate for association between hepatic abnormalities and outcome in dogs with GBM (c) evaluate whether neutrophil-to-lymphocyte ratio (NLR) differs in dogs with GBM with and without specific hepatic lesions.

ANIMALS

Fifty-two dogs with grossly and histologically confirmed GBM.

METHODS

Multicenter, retrospective study of dogs with GBM undergoing cholecystectomy with concurrent liver biopsy. Archived histological sections of gallbladder and liver evaluated by investigators blinded to data. Proportions of dogs with each histologic abnormality alive vs deceased at 1, 3, and 12 months post-cholecystectomy compared. Mann-Whitney U performed to determine if NLR differed in dogs with or without selected lesions.

RESULTS

51/52 (98%, 95% CI [89%, 99%]) dogs with GBM had at least 1 hepatic histologic abnormality. Hepatic fibrosis (37/51; 73%, 95% CI [59%, 83%]), biliary hyperplasia (29/52; 56%, 95% CI [42%, 68%]), and portal inflammation (25/52; 48%, 95% CI [35%, 61%]) were most common. The proportion of dogs alive vs dead differed based on the fibrosis score at 1, 3, and 12 (P ≤ .04) months post-cholecystectomy. Dogs with hepatic necrosis (P = .006) and cholangitis/cholangiohepatitis (P = .02) had higher NLRs compared to dogs without these lesions.

CONCLUSIONS AND CLINICAL IMPORTANCE

Histologic abnormalities of the liver are common in dogs with GBM. A higher portal fibrosis score might be associated with shortened long-term survival after cholecystectomy for dogs with GBM. An increase in NLR might predict hepatic necrosis and cholangitis/cholangiohepatitis in dogs with GBM.

Clinical features, concurrent disorders, and survival time in cats with suppurative cholangitis-cholangiohepatitis syndrome

OBJECTIVE

To characterize clinical features, comorbidities, frequency of bacterial isolation, and survival time in cats with suppurative cholangitis-cholangiohepatitis syndrome (S-CCHS).

ANIMALS

168 client-owned cats with S-CCHS.

PROCEDURES

Data were prospectively (1980 to 2019) collected regarding clinical features, comorbidities, bacterial infection, illness duration, and treatments. Variables were evaluated for associations with survival time.

RESULTS

Median age of cats was 10.0 years, with no breed or sex predilection observed. Common clinical features included hyporexia (82%), hyperbilirubinemia (80%), lethargy (80%), vomiting (80%), jaundice (67%), weight loss (54%), and hypoalbuminemia (50%). Comorbidities included extrahepatic bile duct obstruction (53%), cholelithiasis (42%), cholecystitis (40%), and ductal plate malformation (44%) as well as biopsy-confirmed inflammatory bowel disease (60/68 [88%]) and pancreatitis (41/44 [93%]). Bacterial cultures were commonly positive (69%) despite prebiopsy antimicrobial administration in most cats. Of surgically confirmed choleliths, diagnostic imaging identified only 58%. Among 55 cats with "idiopathic pancreatitis," 28 (51%) were documented to have transiting choleliths, and 20 had pancreatic biopsies confirming pancreatitis. Cholelithiasis (with or without bile duct obstruction) and cholecystectomy were associated with survival advantages. Survival disadvantages were found for leukocytosis, ≥ 2-fold increased alkaline phosphatase, and hyperbilirubinemia. Cholecystoenterostomy had no survival impact. Cats with ductal plate malformations were significantly younger at diagnosis and death than other cats. Chronic treatments with antimicrobials, S-adenosylmethionine, and ursodeoxycholic acid were common postbiopsy.

CLINICAL RELEVANCE

S-CCHS in cats was associated with bacterial infection and various comorbidities and may be confused with pancreatitis. Surgically correctable morbidities (ie, cholecystitis, cholecystocholelithiasis) and cholecystectomy provided a significant survival advantage.

Feline cholecystitis and acute neutrophilic cholangitis: Clinical findings, bacterial isolates and response to treatment in six cases

Clinicopathological findings from six cats with confirmed cholecystitis or acute neutrophilic cholangitis are presented. Historical findings included lethargy and anorexia or inappetence of up to five days duration. On physical examination all cats were pyrexic and four out of six were jaundiced and had cranial abdominal pain. Bile samples were obtained by cholecystocentesis at exploratory coeliotomy (two cases) or by percutaneous, ultrasound-guided cholecystocentesis (four cases). Gall bladder rupture and bile peritonitis occurred subsequent to ultrasound-guided cholecystocentesis in one case. The most common bacterial isolate was Escherichia coli (four cases); E coli was isolated alone in two cases, in combination with a Streptococcus species (one case) and in combination with a Clostridium species (one case). Streptococcus species alone was isolated from one case, as was Salmonella enterica serovar Typhimurium. The latter is the first reported case of Salmonella-associated cholecystitis in a cat. Concurrent pancreatic or intestinal disease was detected histologically in three cases. All cases were treated with antimicrobials based on in vitro susceptibility results. Treatment was successful in five cases. One cat with concurrent diffuse epitheliotropic intestinal lymphoma was euthanased. Percutaneous ultrasound-guided cholecystocentesis is an effective, minimally-invasive technique enabling identification of bacterial isolates in cats with inflammatory hepatobiliary disease.

A Multistep Approach in the Cytologic Evaluation of Liver Biopsy Samples of Dogs with Hepatic Diseases

Cytologic criteria were evaluated for their diagnostic value in liver disease in dogs. Therefore, histopathologic and cytologic examination was performed on liver biopsy samples of 73 dogs with liver diseases and 28 healthy dogs. Logistic regression analysis was used to select the measured parameters to be included in a multistep approach. With the logistic regression method, different characteristic cytologic parameters could be defined for each histopathologic diagnosis. In malignant lymphoma of the liver, the presence of large numbers of lymphoblasts with a minimum of 5% of all cells was found. Clusters of epithelial cells with several cytologic characteristics of malignancy intermixed with normal hepatocytes were indicative of metastatic carcinoma or cholangiocellular carcinoma. Liver cells in hepatocellular carcinoma were characterized by a high nucleus/cytoplasm ratio, large cell diameters, increased numbers of nucleoli per nuclei, small numbers of cytoplasmic vacuoles, and frequently, small numbers of lymphocytes. Extrahepatic cholestasis was characterized by excessive extracellular bile pigment in the form of biliary casts, an increased number of nucleoli within hepatocytes, decreased hepatic cell size, and low numbers of lymphocytes. In destructive cholangiolitis, increased numbers of neutrophils and a small mean nuclear size within hepatocytes were seen. Acute and nonspecific reactive hepatitis are diagnosed based on the presence of moderate reactive nuclear patterns, including more pronounced chromatin, prominent nucleoli, increased numbers of inflammatory cells, excluding lymphocytes, and the absence of increased numbers of bile duct cell clusters. Increased number of mast cells also was indicative of nonspecific reactive hepatitis. Important cytologic criteria for the diagnosis of liver cirrhosis, in addition to chronic hepatitis, are intracellular bile accumulation and increased numbers of bile duct cell clusters. In summary, the stepwise approach based on logistic regression presented in this study might be helpful in the objective cytologic diagnosis of hepatic diseases.

Multiple liver abscesses in a dog secondary to the liver fluke Metorchis conjunctus treated by percutaneous transhepatic drainage and alcoholization

A 1-year-old German shepherd × husky cross dog was diagnosed with multiple liver abscesses and severe cholangitis secondary to the liver fluke Metorchis conjunctus. The dog was successfully treated with 2 percutaneous transhepatic drainage and alcoholization procedures, and a prolonged course of antibiotics and praziquantel.

Immunopathological study of parasitic cholangitis in cetaceans

This paper describes the immunophenotype of cellular inflammatory infiltrates in chronic cholangitis in six common dolphins (Delphinus delphis), four striped dolphins (Stenella coeruleoalba), three Atlantic spotted dolphins (Stenella frontalis) and one pygmy sperm whale (Kogia Breviceps) found stranded along the coasts of the Canary Islands (Spain). A panel of 5 antibodies previously tested in dolphins (anti-CD3, -IgG, -MHC class II, -S100 protein and -lysozyme) were used. The present work also reports cross reactivity with dolphin antigens of two antibodies not used to date in dolphins (anti-mouse iNOS and anti-mouse Foxp3). The most common type of cholangitis found was chronic granulomatous cholangitis, associated with the presence of the parasite Campula spp., or its eggs in bile ducts. The cellular composition of the hepatic inflammatory infiltrate associated to chronic parasitic cholangitis was closely similar to that found in the cortex of control lymph nodes, including the presence of S100(+) and MHC class II(+) dendritic-like cells in lymphoid follicles and interfollicular areas. Only occasional macrophages expressed iNOS, whereas Foxp3(+) lymphocytes were not found in any of the lesions described in the different types of cholangitis.

Bacterial cholangiohepatitis in a dog

A 9-year-old female Yorkshire terrier was presented for vomiting and diarrhea. Blood chemistry tests revealed hepatic dysfunction, cholestasis, and inflammation. Liver ultrasonography and liver biopsy were consistent with cholangiohepatitis. Fine-needle aspiration of the gallbladder revealed the presence of bacteria later identified as Clostridium spp. The cholangiohepatitis was successfully treated.

Feline cholangitis: a necropsy study of 44 cats (1986-2008)

Forty-four cats diagnosed with moderate to severe cholangitis at necropsy are described. The population comprised 0.86% of all feline necropsies performed during the 22-year study period. Liver specimens were classified as acute neutrophilic cholangitis (ANC), chronic neutrophilic cholangitis (CNC), lymphocytic cholangitis (LC) or chronic cholangitis associated with liver fluke infestation (CC) based on the World Small Animal Veterinary Association (WSAVA) classification scheme. ANC (seven) and CNC (33) comprised the majority of cases. In contrast to previous descriptions, overlap was seen in clinical findings between ANC and CNC subtypes. Results suggest that liver enzyme activity may not predict degree of inflammation. Severity of inflammation varied between liver sections in individual cats, underscoring the need to obtain biopsy samples from multiple sites. Inflammatory bowel disease (50%), pancreatitis (60%), or both (32%) commonly accompanied cholagitis. We conclude that cholangitis is not a common cause of feline mortality. Most cats that succumb to cholangitis have ANC or CNC, and concurrent disease contributes to death in many.

[Cholangitis in cats: symptoms, cause, diagnosis, treatment, and prognosis]

Inflammation of the bile ducts is common in cats. This review article reports on what is currently known about the various types of cholangitis (i.e., cholangitis caused by liver flukes, neutrophilic cholangitis, and lymphocytic cholangitis). Treatment is available for cholangitis caused by liver flukes and for neutrophilic cholangitis, and the prognosis is good. However, the cause of lymphocytic cholangitis is not known and there is currently no evidence-based therapy. Several causes are mentioned in the literature, but more research is needed in order to establish the cause of this disease and to develop an appropriate therapy.

Skin fragility syndrome in a cat with cholangiohepatitis and hepatic lipidosis

A case of acquired skin fragility syndrome associated with hepatic disease in a 9-year-old, spayed female, domestic shorthair cat is described. The cat was admitted to the veterinary hospital of the University of São Paulo (Brazil) with a 6-week history of vomiting, inappetence and weight loss. Remarkable signs were weakness, lethargy and profound jaundice that had been present for 10 days according to the owner. On completion of the physical examination, when the cat was gently manipulated for blood collection the thoracic limb and interscapular skin tore. Liver enzymes and bilirubin levels were all above the normal range. On histological examination of skin and liver, Masson's trichrome stain showed collagen fibre alteration and major hepatocyte abnormalities. Findings were consistent with feline skin fragility syndrome associated with cholangiohepatitis and hepatic lipidosis.

Feline cholangitis/ chonlangiohepatitis complex secondary to Platynosomum fastosum infection in a cat

Platynosomiasis has been associated with cholangitis/cholangiohepatitis complex in domestic cats. Despite being typically asymptomatic, some individuals may develop severe disease resulting in hepatic cirrhosis. Definitive diagnosis by means of parasite eggs direct visualization is not always possible and complementary tests should be associated. This paper reports a case of a three-year-old female cat with anorexia and jaundice. Ultrasound and biochemistry laboratory findings as well as liver biopsy were not conclusive. Definitive diagnosis of intense Platynosomum fastosum infestation was only possible through direct examination of biliary fluid at necropsy, stressing the importance of including platynosomiasis, commonly an underdiagnosed disease, among differential diagnoses of feline liver diseases.

Suspected drug-induced destructive cholangitis in a young dog

A nine-month-old miniature doberman was referred for the evaluation of chronic icterus. History and clinical and histopathological findings were supportive of a diagnosis of drug-induced destructive cholangitis. The main histopathological findings were canalicular, centrilobular cholestasis and ductopenia with moderate inflammatory infiltrate. The dog had received three types of treatment for demodicosis before the onset of jaundice. Amoxicillin-clavulanate, amitraz, milbemycin oxime or an interaction between two of the three drugs may have been responsible for the destructive cholangitis.

Bacterial cholangitis/cholangiohepatitis with or without concurrent cholecystitis in four dogs

OBJECTIVES

To evaluate the clinical, clinical pathology, diagnostic imaging, microbiological and pathological features of cholangitis/cholangiohepatitis in the dog.

METHODS

The study design was a retrospective review of cases of bacterial cholangitis/cholangiohepatitis presented to the University of Bristol during the period 1995 to 2000. The diagnosis was made based on hepatic histopathological findings and positive bile culture results.

RESULTS

Four dogs met the inclusion criteria. Common presenting signs included anorexia (n=4), jaundice (n=4), vomiting (n=4) and pyrexia (n=2). All four dogs had a leucocytosis or neutrophilia reported at some time in their history along with serum bilirubin elevation. In addition, serum alkaline phosphatase and alanine transaminase activity was increased in all of the dogs in which it was measured both before and at the time of referral. In general, the diagnostic imaging findings were non-specific. Organisms cultured from bile aspirates were Escherichia coli (n=3), Clostridium species (n=2) and a faecal Streptococcus species (n=1). Two cases resolved with medical treatment alone; two with concurrent cholecystitis required cholecystectomy. Following surgery, both of these cases showed a resolution of clinical signs.

CLINICAL SIGNIFICANCE

This report highlights the fact that bacterial cholangitis/cholangiohepatitis with or without concurrent cholecystitis should be considered as a potential differential in dogs presenting with signs referable to biliary tract disease.

Vancomycin for multi-drug resistant Enterococcus faecium cholangiohepatitis in a cat

A 12-year-old, neutered male domestic shorthair cat was evaluated with a life-long history of intermittent, predominantly small bowel diarrhea and a 3 day history of hematochezia. At presentation, the cat had increased liver enzyme activities and an inflammatory leukogram. Histopathology demonstrated inflammatory bowel disease (IBD), cholangiohepatitis and pancreatitis. The cholangiohepatitis was associated with a multi-drug resistant Enterococcus faecium. Gallbladder agenesis was also documented. Treatment with vancomycin was safely instituted for 10 days. Clinical signs resolved, however, cure of the bacterial cholangiohepatitis was not achieved. The risk of vancomycin resistant enterococci (VRE) in human and veterinary medicine is discussed.

Detection of Helicobacter pylori in bile of cats

Lymphocytic cholangitis (LC) in cats is a biliary disease of unknown etiology. Helicobacter spp. were recently implicated in human primary sclerosing cholangitis (PSC) and primary biliary cirrhosis (PBC). Because of the similarities between PSC/PBC with LC, we hypothesized that Helicobacter spp. are involved in feline LC. A PCR with Helicobacter genus-specific 16S rRNA primers was performed on DNA isolated from feline bile samples. Four of the 15 (26%) LC samples were positive, whereas only 8/51 (16%) of non-LC samples were PCR positive (p=0.44). Sequence analysis of the amplicons revealed a 100% identity with the Helicobacter pylori specific DNA fragments. Our data suggest an etiological role of H. pylori in feline LC and that cats are a potential zoonotic reservoir.

Pathogenicity by parenteral injection of fowl adenovirus isolated from gizzard erosion and resistance to reinfection in adenoviral gizzard erosion in chickens

The pathogenicity of a serotype-1 fowl adenovirus (FAV-99ZH), which causes adenoviral gizzard erosion by oral inoculation in chickens, was investigated in specific pathogen-free white leghorn chickens. In trial 1, 14 chickens were inoculated intravenously with the virus at 21 days of age and euthanatized for necropsy within 1-14 days of inoculation. Gizzard erosion was grossly observed from day 7 postinoculation (PI), and histologically, FAV-99ZH antigen-positive, basophilic intranuclear inclusion bodies were seen in the gizzard lesions from day 7 to 11 PI. Necrotizing pancreatitis, and cholecystitis and cholangitis associated with the inclusions were observed from day 3 to 14 PI (pancreatitis) and from day 5 to 9 PI (cholecystitis and cholangitis), respectively. The inclusions were also observed in the epithelial cells of the cecal tonsils from day 3 to 5 PI. The virus was recovered from samples of the lesions. It was revealed that FAV-99ZH causes not only gizzard erosion but also pancreatitis, cholecystitis, and cholangitis by intravenous inoculation in chickens. In trial 2, 10 chickens were inoculated orally with the virus twice, at 13 and 36 days of age, and euthanatized for necropsy within 4-17 days after reinfection. Macroscopically, focal gizzard lesions were observed; however, neither necrosis nor inclusions were observed by microscopy. Moreover, FAV was not recovered from the gizzard or rectum of any of the chickens at necropsy. This suggests that the gizzard lesions occurred as a result of the primary infection, and that the chickens were able to resist reinfection.

Hepatic lesions in cetaceans stranded in the Canary Islands

This article describes the gross, histopathologic, and ultrastructural findings of the livers of cetaceans stranded on the coast of the Canary Islands between 1992 and 2000. A total of 135 cetaceans were included in the study, among which 25 were common dolphins (Delphinus delphis), 23 Atlantic spotted dolphins (Stenella frontalis), 19 striped dolphins (Stenella coeruleoalba), and 15 other species of dolphins and whales. The most common lesion observed in these animals was a nonspecific chronic reactive hepatitis (47/135), followed by hyaline intracytoplasmic inclusions in hepatocytes (33/135). Parasitic cholangitis was detected in 8/135 animals, whereas hepatic lipidosis was presented in 7/135 animals. The ultrastructure of hyaline hepatocytic cytoplasmic inclusions is described, and possible causes of these inclusions are discussed.

Cholangiohepatitis and pancreatitis secondary to severe gastroduodenal ulceration in a foal

A 2-month-old foal was presented with clinical signs of colic. Gastroduodenal ulceration was suspected. A poor response to medical treatment and signs of gastroduodenal obstruction led to celiotomy and an attempted bypass procedure. The foal was euthanized and postmortem examination revealed gastric ulceration, segmental duodenal stenosis, and severe chronic cholangiohepatitis and pancreatitis.

Immunophenotypic characterization of hepatic inflammatory cell infiltrates in common dolphins (Delphinus delphis)

Of 14 common dolphins, 12 showed non-specific reactive hepatitis and three chronic parasitic cholangitis with lymphoid proliferation. Non-specific reactive hepatitis was shown immunohistochemically to be associated with small clusters of CD3(+) cells in portal areas and hepatic sinusoids. Polyclonal antibody against S100 protein reacted with a variable number of lymphocytes from portal areas and hepatic sinusoids, as well as with Kupffer cells and epithelial cells of the bile ducts. The majority of plasma cells observed in portal areas and hepatic sinusoids were IgG(+). In lymphonodular lesions of chronic parasitic cholangitis, the distribution of immunoreactive cells was similar to that found in the cortex of lymph nodes. The presence of stellate cells similar to follicular dendritic and interdigitating cells expressing S-100 protein and MHC class II antigen in lymphonodular lesions suggested that these were highly organized structures developed to enhance antigen presentation to B and T cells.

Accelerated neutrophil apoptosis in 2 canine cases of hepatic disorder

Accelerated neutrophil apoptosis was confirmed by TUNEL assay in two canine cases of hepatic disorder. One dog was diagnosed as having lymphocytic hepatitis and the other lymphocytic cholangitis by histopathology of liver biopsy specimen.

Study of experimentally induced lesions in sheep by grazing Brachiaria decumbens

A histologic and ultrastructural study of the alterations found in the lymph nodes and livers of nine sheep with experimental cholangiohepatopathy by grazing on Brachiaria decumbens has been performed. Sheep were euthanized in three groups, on the 77th, 89th, and 150th days of the experimental feeding. The main gross lesions were whitish spots of multifocal distribution scattered throughout the hepatic parenchyma from all B. decumbens-grazed animals and whitish foci surrounded by reddened halos in the mesenteric and hepatic lymph nodes of sheep necropsied on the 150th. The principal histologic findings included hepatocellular cloudy swelling, marked multifocal cholangitis in the portal triads with bile duct proliferation and infiltration of macrophages and lymphocytes. Crystals were observed within bile ducts and surrounded by macrophages. Ultrastructurally, there were criytaloid structures within the macrophages and hepatocytes, which also presented hyperplasia of smooth endoplasmic reticulum. These findings suggest that hepatocytes were the initial target of the toxic effects, which depending on the degree of severity developed would cause both, subsequent cholangiopathy or occasional photosensitization. Additionally, the developmental stages of the hepatic lesions observed in this study have been presented.

Medical treatment of cholangiohepatitis and cholelithiasis in mature horses: 9 cases (1991-1998)

The medical approach to treatment of cholangiohepatitis and cholelithiasis in 9 horses is described. Seven horses were treated successfully and returned to normal use, with a minimum follow-up period of 12 months. Long-term antimicrobial therapy was believed to be critical in those cases that survived, with a median treatment duration of 51 days (range 17-124 days). Treatment failure was associated with severe periportal and bridging hepatic fibrosis from biopsy material obtained at admission in 2 horses, one of whom also presented with hyperammonaemic hepatic encephalopathy. Transabdominal ultrasound was used diagnostically in each case to obtain hepatic biopsy material for histopathology and bacterial culture, to evaluate hepatic size and echogenicity and to identify and monitor the dissolution of hepatoliths. Histologically, all horses had evidence of suppurative cholangiohepatitis with varying degrees of periportal and bridging fibrosis. Discrete hyperechoic calculi were identified in 4 cases, but all horses had ultrasonographic evidence of biliary obstruction with numerous dilated bile ducts. Aerobic and anaerobic cultures of liver biopsy material were negative from 7 horses, but 2 different species of Escherichia coli were obtained from one horse, and Bacteroides vulgatus and Escherichia coli were isolated from another. In all 7 horses that survived, clinical recovery was seen before normalisation of biochemical indices of hepatobiliary function including gammaglutamyl transaminopeptidase (GGT), alkaline phosphatase (AP), bile acids and serum bilirubin. Serum GGT levels were monitored extensively as a marker of hepatobiliary disease and actually increased during the initial period of clinical improvement in horses that recovered. Supportive medical therapy with i.v. fluids was also a critical part of the therapy of several cases in this report, both acutely and in the management of chronic cases that deteriorated clinically during treatment. Previous therapeutic failures may well be related to treatment periods of inadequate duration, and the authors recommend that antimicrobial therapy should be continued until GGT values are normal.

Isolation of steroidal sapogenins implicated in experimentally induced cholangiopathy of sheep grazing Brachiaria decumbens in Brazil

As part of an experimental study, crystal-associated cholangiopathy was induced in 9 sheep by grazing pure pastures of Brachiaria decumbens in Brazil. One of these sheep showed characteristic lesions of photosensitization. The analysis of the B decumbens samples by acidic hydrolysis followed by TLC and infrared spectrum revealed diosgenin as the principal sapogenin present in the plant. In the rumen contents samples from the B decumbens-grazing group were identified by TLC, 1H and 13C NMR and EIMS as epismilagenin, episarsasapogenin, and a mixture of smilagenin and sarsasapogenin. In the bile samples from the B decumbens-grazing group, TLC analysis demonstrated 2 compounds similar to epismilagenin and episarsasapogenin. However, by this same method, those compounds were not observed in the rumen contents and bile from 2 sheep which served as control animals. The P chartarum spore counts remained very low during the experimental period.

Enterococcus hirae enteropathy with ascending cholangitis and pancreatitis in a kitten

A 2-month-old female Persian cat that had been showing episodes of anorexia and diarrhea for the previous 4 weeks was presented in shock and died 2 days later. Numerous Gram-positive cocci were located along the brush border of small intestinal villi, without significant inflammatory infiltration. Similar bacteria were present within hepatic bile ducts and pancreatic ducts and were associated with suppurative inflammation and exfoliation of epithelial cells. Culture of the liver and lung yielded bacteria identified as Enterococcus hirae. Fecal culture from an asymptomatic adult female from the same cattery also yielded large numbers of E. hirae. To our knowledge, this is the first report of E. hirae enteropathy in a cat and the first report of ascending cholangitis and ductal pancreatitis caused by an Enterococcus spp.

Clinical features of inflammatory liver disease in cats: 41 cases (1983-1993)

OBJECTIVE

To compare the clinical and clinicopathologic findings in and prognosis for cats with lymphocytic portal hepatitis (LPH) versus cats with acute or chronic cholangiohepatitis (CH).

DESIGN

Retrospective study.

ANIMALS

25 cats with LPH; 16 cats with CH (7 acute, 9 chronic).

PROCEDURE

Cats with LPH and CH were selected by evaluating records from liver biopsy specimens submitted to the University of Minnesota Veterinary Teaching Hospital during a 10-year period. Clinical and clinicopathologic data were retrieved.

RESULTS

Cats with CH had higher segmented and band neutrophil counts, alanine aminotransferase activities, and total bilirubin concentrations than did cats with LPH. Cats with acute CH had higher segmented and band neutrophil counts and lower serum alkaline phosphatase activities and total bilirubin concentrations than did cats with chronic CH. Twelve of 14 cats with LPH or CH had coarse or nodular texture to the liver on ultrasonography, with loss of portal vein wall clarity noticed in 4 of 8 cats with LPH. Sixteen of 23 cats with LPH and 8 of 15 cats with CH survived > 1 year. Of those cats living < 1 year, all cats with LPH and 5 of 7 cats with CH had a serious concurrent illness that may have been responsible for their deaths.

CLINICAL IMPLICATIONS

LPH and CH can be detected and tentatively differentiated through evaluation of clinical laboratory test results, but histologic evaluation of liver specimens is necessary for definitive differentiation. Survival time was good regardless of the type of inflammatory liver disease.

Immunohistochemical characterization of the lesions of feline progressive lymphocytic cholangitis/cholangiohepatitis

The histopathological features of liver biopsies from 20 cats with progressive lymphocytic cholangitis/cholangiohepatitis are reported. These biopsies were subject to immunohistochemical investigation for expression of CD3, CD79. Major Histocompatibility Complex (MHC) Class II molecules, and feline IgG, IgM and IgA. Livers from five normal cats, which were also examined showed constitutive expression of MHC Class II by sinusoidal Kupffer cells and bile duct epithelium, in addition to a population of portal, and bile duct inter-epithelial, CD3+ T lymphocytes. In liver biopsies from cats with the active phase of lymphocytic cholangitis/cholangiohepatitis (n = 11), the portal lymphocytes were predominantly CD3+ T cells that infiltrated bile duct epithelium and periportal hepatic parenchyma, CD79+ B lymphocytes formed distinct aggregates or follicles within the regions of T-cell infiltration. Low numbers of plasma cells were present, and these predominantly expressed IgA. MHC Class II was expressed by Kupffer cells, infiltrating T and B lymphocytes and macrophages. There was membrane and cytoplasmic Class II expression by bile duct epithelium, some vascular endothelium, and fibroblasts within areas of fibrosis. In liver biopsies from cats with chronic lymphocytic cholangitis/cholangiohepatitis (n = 9), there was less in flammation, but the composition of the infiltrates was similar to that in the active phase of disease. The findings provide further evidence for an immune mediated pathogenesis in progressive lymphocytic cholangitis/cholangiohepatitis.

Spontaneous cholangiofibrosis in Long-Evans Cinnamon rats: a rodent model for Wilson's disease

The Long-Evans Cinnamon (LEC) rat is a rodent model of Wilson's disease characterized by ceruloplasmin deficiency, hepatic copper accumulation, and hepatocellular injury. So far, the LEC rat appears to be the only strain in which cholangiofibrosis develops spontaneously. The aim of the study reported here was to characterize the time course of development and investigate the structural and ultrastructural features of cholangiofibrosis and their possible relationship to hepatic copper and iron content. The livers of 54 rats (22 males), ages 5 to 113 weeks, were examined by light microscopy and graded for statistical analysis, with respect to extent of replacement of liver tissue by cholangiofibrosis. The study was complemented by electron microscopy, and by measurements of copper and iron contents by atomic absorption spectroscopy. Cholangiofibrosis was present in LEC rats by 20 weeks of age. The hyperplastic biliary epithelial cells varied markedly in size and shape, ranging from flat to cuboidal or elongated. Epithelial cells did not exhibit characteristics of intestinal cells. Some basement membranes had splits, duplications, or multiplications. Cytoplasmic organelles within hyperplastic biliary cells appeared unremarkable in contrast to the characteristic mitochondrial abnormalities present in neighboring hepatocytes. There was a positive correlation between histologic grades of cholangiofibrosis and ages of the animals (r = 0.68, P < 0.001), but no significant correlation between histologic grade and hepatic copper or iron content. We conclude that cholangiofibrosis is the predominant pathologic response to chronic liver injury induced by excess copper in LEC rats. The pathogenic role of copper in the development of cholangiofibrosis requires clearer definition.

Chronic hepatitis: a retrospective study in 34 dogs

The aims of this study were to characterize the histological changes observed in 34 accessioned cases of canine chronic hepatitis and to correlate these changes with the clinical pathological data. Cases of chronic hepatitis were subdivided into 6 categories: chronic active hepatitis (10/34), chronic persistent hepatitis (7/32), chronic cholestatic hepatitis (6/34), fibrosing hepatitis with cirrhosis (3/34), chronic cholangiohepatitis (3/34), and miscellaneous secondary hepatitis (5/34). Iron accumulation was a consistent finding in all livers examined. Although all cases of chronic hepatitis had elevated liver enzymes, no correlation was detected between biochemical parameters and the severity of morphologic changes. Similarly, no correlation was detected between rhodanine staining for copper and morphologic or biochemical indicators of cholestasis. However, presence of copper correlated well with reticulo-fibrosis (r = 0.8) and bile duct hyperplasia, suggesting that changes in the hemodynamics of the hepatic acini due to fibrosis could influence storage of copper.

Histopathologic evaluation of feline inflammatory liver disease

To better define the histopathologic features of feline inflammatory liver disease, we studied feline liver biopsies evaluated at the University of Minnesota Veterinary Teaching Hospital over a 10-year period. Of 175 liver sections examined, 45 had portal inflammatory infiltrates. Of these, 60% had infiltrates consisting of lymphocytes and plasma cells, 24% had infiltrates consisting of neutrophils, and 16% had mixed infiltrates consisting of neutrophils, lymphocytes, and plasma cells. Lymphocytic-plasmacytic portal infiltrates were characterized by various degrees of bile duct proliferation and fibrosis without evidence of bile duct infiltration or periportal necrosis. Sections with portal neutrophilic infiltrates were characterized by bile duct infiltration, bile duct epithelial degeneration, periportal necrosis, and infiltration of neutrophils into adjacent lobules. We propose that hepatitis characterized by portal lymphocyte and plasma cell infiltration be termed lymphocytic portal hepatitis and that hepatitis characterized by cholangitis and portal neutrophilic infiltrates with or without lymphocytes and plasma cells be termed cholangiohepatitis.

Septic cholangiohepatitis and cholangiocarcinoma in a horse

Septic cholangiohepatitis was diagnosed in an 11-year-old Warmblood gelding with a history of intermittent colic and fever. Klebsiella pneumoniae, susceptible to gentamicin, was cultured from the biopsy specimen. However, treatment with gentamicin was unsuccessful, and histologic examination and bacteriologic culture of a biopsy specimen obtained 3 weeks later revealed progression of the hepatic inflammation and yielded growth of gentamicin-resistant K pneumoniae. At this time, several discrete hyperechoic structures, suggestive of biliary calculi, were seen ultrasonographically. A change in antibiotic treatment was associated with gradual resolution of clinical signs. Five months after initial examination, the horse had a sudden onset of severe right forelimb lameness. The horse responded to treatment with antibiotics and phenylbutazone, but lameness and fever that was unresponsive to treatment recurred 7 months later, and the horse was euthanatized. Necropsy revealed nodules throughout the liver and a mass associated with the right metacarpophalangeal joint. Histologic and immunohistochemical examination revealed carcinomatous infiltration of the liver and metacarpophalangeal joint. The tumor was probably of biliary origin. Carcinoma should be considered in cases of septic cholangiohepatitis unresponsive to antibiotic treatment.

Feline cholangiohepatitis complex

Feline cholangiohepatitis complex causes a diffuse intrahepatic cholestasis of unknown etiology. Recognized histologic forms include acute suppurative cholangitis/cholangiohepatitis, long-term nonsuppurative cholangitis/cholangiohepatitis, and biliary cirrhosis. Treatment of cholangiohepatitis complex varies based on histologic type. Thus a liver biopsy is necessary for definitive diagnosis and treatment. Because cholangiohepatitis complex causes diffuse hepatic change, percutaneous needle biopsies are often sufficient for obtaining a diagnosis. Antibiotics are used to treat all forms of feline cholangiohepatitis complex, but steroids may be of equal or greater importance for use in the treatment of long-term nonsuppurative cholangiohepatitis. Prognosis is guarded for cats with any form of cholangiohepatitis complex due to the variable response to treatment seen in many cats. Spontaneous remission occasionally occurs.

Administration of vancomycin for treatment of ascending bacterial cholangiohepatitis in a cat

A 12-year-old neutered male domestic shorthair cat, being treated with methimazole for hyperthyroidism, developed chronic cholangitis with portal fibrosis and chronic cholecystitis. The common bile duct was not patent, which necessitated cholecystojejunostomy. Four days after surgery, the cat developed suppurative cholangio-hepatitis caused by a beta-lactam resistant Enterococcus. The cat's condition was further complicated by the concurrent development of hypokalemic polymyopathy. On the basis of minimum inhibitory concentrations, the Enterococcus was determined to be susceptible to vancomycin and resistant to numerous antibiotics commonly used for treatment of infections caused by Enterococcus spp. The cat recovered without evidence of adverse effects attributable to vancomycin.

A survey and review of hepatobiliary lesions in Australian macropods

This report presents information on the range of diseases and lesions that occurred in sections of livers of macropods held in the Non-Domestic Animal Registry at Taronga Zoo. Of 142 affected livers, 52 were due to parasites, 24 to bacteria, nine to Macropod Herpesvirus, four to fungal agents and ten to tumours. In addition, 17 livers had acute degenerative or necrotic lesions, 22 were affected by fibrosis or other chronic lesions and four had miscellaneous degenerative lesions. Common parasitic diseases included toxoplasmosis, coccidial cholangitis, cestode cholangitis (Progamotaenia sp.), fascioliasis and capillarial hepatitis. Bacterial diseases were varied but lesions due to anaerobic bacteria or Mycobacteria spp. were most common. Many of the acute degenerative lesions were associated with cardio-respiratory disease. Chronic lesions were often of unknown origin, although it was speculated that parasitic and bacterial organisms contributed to the aetiology. There were four primary and six metastatic tumours.

Cholangiohepatitis in a dog

Cholangiohepatitis was diagnosed in a dog with a 4-day history of anorexia, vomiting, fever, and icterus. Additional findings included signs of depression, dehydration, hepatosplenomegaly, and abdominal discomfort. Exploratory laparotomy was performed, and specimens of liver, spleen, and bile were obtained. Histologic evaluation of liver and spleen revealed acute, suppurative cholangio-hepatitis and splenitis, respectively. Cultures of liver and bile yielded Klebsiella sp. The dog responded to rehydration and intravenous administration of chloramphenicol. Although uncommon, cholangiohepatitis should be suspected in dogs with anorexia, fever, vomiting, icterus, and signs of abdominal discomfort. Definitive diagnosis requires bacterial cultures of liver and bile. Administration of an appropriate antibiotic should resolve clinical signs.

Septic cholangitis and peritonitis in a gelding

An 8-year-old Arabian gelding with septic cholangitis and peritonitis was successfully treated with trimethoprim/sulfadiazine. The gelding was referred for evaluation of signs of abdominal pain, icterus, fever, and weight loss. Peritoneal fluid analysis revealed septic and suppurative peritonitis. Culture of the peritoneal fluid yielded Escherichia coli and Klebsiella pneumoniae, which were sensitive to trimethoprim/sulfadiazine. On the basis of results of hepatic ultrasonography, a diagnosis of septic cholangitis also was made. The horse was treated with 30 mg of trimethoprim/sulfadiazine/kg, PO, q 12 h for approximately 6 weeks. The horse improved steadily, and telephone follow-up with the owner 1 year later disclosed that the horse had complete return to normal condition, appetite, and attitude. On the basis of our findings, aggressive, long-term anti-inflammatory and antibiotic treatment may result in complete return to health and normal athletic function in horses with septic cholangitis and concurrent septic peritonitis.

Mouse strain difference in bile duct lesions induced by swine serum injections

The mouse strain difference in bile duct lesions was studied on male A/J, BALB/c, C57BL/6, C3H/He, DBA/2 and DDY mice 4 weeks old given intraperitoneal injections of swine serum (0.05 or 0.2 ml per mouse) twice a week for 4 weeks. The hepatic lesions were restricted to the portal tract. Biliary epithelial cells showed hypertrophy and hyperplasia, and eosinophilic and homogeneous or needle-shaped material appeared in the cytoplasm of such hypertrophied epithelial cells and in the ductular lumen. Around these damaged biliary epithelia, eosinophil leukocyte and plasma cell infiltration with proliferation of collagen fibres was commonly detected. These changes became more apparent with increasing size of bile duct. Such histopathological characteristics of hepatic lesions were essentially the same in all strains, but the severity showed a clear strain difference: the lesion was marked in the DDY, A/J and BALB/c strains, moderate in C3H/He and slight in C57BL/6 and DBA/2. A high production of anti-swine-serum antibodies associated with a marked increase in the number of mouse IgG-producing lymphocytes in the spleen was detected in the strains showing the marked hepatic lesions.

Feline hepatic disease

Species differences in anatomy, physiology, and biochemistry lead to many dissimilarities between the canine and feline liver. Major differences exist in the interpretation of liver function tests, the significance of biochemical jaundice, the consequences of anorexia, and the efficiency of hepatic metabolic systems. Biochemical alterations in total bilirubin, ALT, and SAP may indicate the presence of disease in the feline liver. It is, however, impossible to make accurate diagnoses without liver biopsy. A liver biopsy can provide a diagnosis and prognosis and can guide the therapeutic plan. The feline hepatic diseases most frequently seen in our hospital are hepatic lipidosis, cholangiohepatitis complex, toxic hepatopathy, and hepatic neoplasia. Less common diseases of the feline liver include extrahepatic biliary obstruction, portacaval vascular anomalies, hepatic parasites, hepatic cysts, and diaphragmatic hernia. Systemic diseases that can effect the liver of cats are feline infectious peritonitis, multicentric lymphosarcoma, myeloproliferative diseases, hemolytic anemia, infectious panleukopenia, and systemic fungal infections.

Suppurative cholangitis in cats

Suppurative cholangitis in 5 aged cats was characterized clinically by weight loss, depression, dehydration, icterus, and fever. The major abnormal laboratory findings were a severe left shift of WBC and a high, conjugated bilirubin concentration consistent with an inflammatory process and cholestasis. Gross pathologic findings included periductal biliary fibrosis (4 cats), periductal pancreatic fibrosis (2 cats), cholelithiasis (2 cats), deformation of the gallbladder (2 cats), and chronic interstitial pancreatitis (2 cats). Histopathologic findings in all cases were portal hepatic fibrosis, biliary hyperplasia, and suppurative exudate within dilated intrahepatic biliary ducts. Weight loss and portal fibrosis were suggestive of chronic, intermittent illness. The pathogenesis appeared to involve invasion of the bile duct by enteric bacteria. Cholangitis was observed to occur in association with pancreatitis, cholelithiasis, or anatomic abnormalities of the biliary tract.