59 pneumonias of horses glanders (farcy, malleus) · ulcerative lymphangitis. different stages of...
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59 – Pneumonias of horses
Glanders (farcy, malleus)
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Topics – morphological categorization
• (Broncho)interstitial pneumonia– equine influenza, EHV-1, EHV-4 infection
• Bronchopneumonia– catarrhal-purulent bronchopneumonia
– fibrinous bronchopneumonia, pleuropneumonia• Streptococcus equi ssp. equi, ~ zooepidemicus; Bordetella
bronchiseptica, Klebsiella pneumoniae, Staphylococcus sp.
– necrotic/gangraneous bronchopneumonia• aspiration pneumonia
• Focal/multifocal pneumonia– septic thromboembolism related pneumonia
• (Pyo)granulomatous pneumonia– Rhodococcus equi infection
– glanders (Burkholderia mallei infection)
– fungal pneumonias• aspergillosis, pneumocystosis
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(Broncho)interstitial pneumonia
• Equine influenza
– Type A virus, two subtypes
• A/equi/2 – H3N8; A/equi/1 – H7N7
– Clinical signs
• Coughing, serous to purulent oculonasal discharge,
fever, weakness
• Rarely sytemic involvement and death
– Lesions
• Hyperemia, focal erosions in the upper respiratory tract
• Bronchointerstitial pneumonia
– edema
– necrosis of bronchiolar epithelium
– secondary bacterial pneumonia
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Interstitial pneumonia
EIV infection, donkey
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(Broncho)interstitial pneumonia
• Equine herpesviruses (EHV-4, EHV-1)– Mild upper respiratory signs
– Secondary bacterial bronchopneumonia
– Systemic lesions in neonates!
• Rhinovirus, reovirus, equine arteritis virus, adenovirus– similar clinical signs and lesions
– predisposing factors for heaves (COPD)?
• African horse sickness– severe edema, vascular damage (Reoviridae, Orbivirus)
• Hendra virus– syntitial giant cells (Paramyxoviridae, Morbillivirus)
• Clamydophila psittaci
• Idiopathic proliferative interstitial pneumonia– sequel: pulmonary fibrosis, toxicosis / viral infection?
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Pulmonary fibrosis, horse
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Bronchopneumonia
• Catarrhal-purulent pneumonia
• Fibrinous (pleuro)pneumonia
– cranioventral consolidation
– predisposing factors
• stress, viral infections etc.
– secondary bacterial infection
• Streptococcus equi ssp. equi, ~ zooepidemicus;
Bordetella bronchiseptica, Klebsiella pneumoniae,
Staphylococcus sp.
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Chronic purulent bronchopneumonia, horse
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Bronchopneumonia
• Necrotic/gangrenous pneumonia
– aspiration pneumonia• anatomical predisposition
– „tracheal puddle”
• iatrogenic– nasogastric tubing
• CNS involvement!!!!!!!!– rabies, WNV or other viral encephalitides, lead
poisoning, fumonisin toxicosis etc.
– usually unilateral, foul smell, rapid autolysis, necrosis predominates, mixed bacterial flora
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Aspiration pneumonia
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Aspiration pneumonia, horse
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Pyogranulomatous pneumonia
• Rhodococcus equi infection
– Rhodococcus equi• Facultatively intracellular bacterium, complex lipids
in its cell wall
• Normal inhabitant of soil and intestinal tract of different species
• Disease in foals of 1-6 months of age
• Pathogenesis is incompletely understood
– Clinical signs• Fever, cough, nasal discharge, increased
respiratory rate
• High mortality
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Pyogranulomatous pneumonia
• Rhodococcus equi infection
– Lesions• Lungs and tracheobroncial lymphonodes
– Multiple large, firm nodules of various size
– Caseation necrosis without fibrous capsule formation (not a proper abscess!)
– Predominantly pyogranulomatous inflammation
• Intestinal tract– Ulcerative enterocolitis, involvement of mesentarial
lymphonodes
• Arthritis, dermatitis, hepatitis, vertebral osteomyelitis, ulcerative lymphangitis
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Rhodococcus equi pneumonia, horse
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Rhodococcus equi pneumonia, horse
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Rhodococcus equi pneumonia, horse
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Granulomatous pneumonia
• Mycobacteriosis
–Mycobacterium avium complex
–Mycobacterium tuberculosis
–Mycobacterium bovis
• Predominantly proliferative
tuberculosis
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Granulomatous pneumonia
• Fungal pneumonias
–Pulmonary aspergillosis
• secondary to mucosal damage
– intestines! ulcerative fungal colitis
• systemic lesions
–brain, lungs, skin
• severe disseminated fibrinonecrotic to
granulomatous pneumonia
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Pulmonary aspergillosis, horse
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Pulmonary aspergillosis, horse
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Pulmonary aspergillosis, horse
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Granulomatous pneumonia
• Fungal pneumonias
– Pneumocystosis
• Pneumocystis carinii fungus
• Secondary to immunosuppressive agents / immunodeficiencies
– SCID
– Viral infections, Rhodococcus equi inf.
• Histological diagnosis– foamy structure within alveoli
– Gömöri’s Methenamine Silver stain (GMS)
– minimal inflammatory changes
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Pneumocystosis, H-E stain
Pneumocystosis, GMS stain
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Pyogranulomatous pneumonia
• Glanders (malleus, farcy)
• Burkholderia mallei– Gram-negative, obligate aerobic, nonmotile,
obligate pathogen
– Zoonotic agent, bioterrorism!
• Occurrence– Asia, North-Africa, (far-far) East-Europe (?),
South-and Central America
• Susceptible species– Equidae (solipeds), carnivores, guinea-pig,
hamster, goat, man
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Glanders - history
• 3rd Century BC
– Described by Aristotle
• 1664: Contagious nature recognized
• 1830: Zoonotic nature suspected
• 1891: Mallein test developed
• 1900: Control programs implemented
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Glanders - history
• World War I
– Suspected use as biological agent to infect
Russian horses and mules
• Affected troops and supply convoys
– Large number of human cases in Russia
during and after WWI
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Glanders - history
• World War II
– Japanese infected horses, civilians and POW’s
– U.S. and Russia investigated use as biological
weapon
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Glanders
• Way of infection
– per os
• contaminated feed, water, carcasses of
infected dead animals
– percutaneous or conjunctival, aerogenical
– asymptomatic carriers
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Glanders
• Pathogenesis
– the disease develops through several
successive stages, each is characterised
by distinctive clinical signs and lesions
– outcome depends on the immunological
status of the host
– p. os uptake: primary complex in the
alimentary tract
• early generalisation: lungs, spleen, liver etc.
• late generalisation: septicaemia, nasal mucosa,
skin
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Glanders
• Incubation time– Few days to several months
• Clinical forms and signs– Acute form
• donkeys, mules, certain horses, carnivores, (man)
• coughing, fever, nasal discharge
• septicaemia, (pyemia), bronchopneumonia, death in days
– Chronic form• certain horses, mules, (man)
• granulomatous changes in the lungs, in the nasal mucosa, in the skin
• subclinical infection does occur (mallein-test)
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Glanders,
intradermo-palpebral test
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Glanders,
Strauss reaction,
male guinea-pig
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Draining fistulous tracts
in the skin
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Glanders, nasal and dermal lesions
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Glanders
• Lesions– Different lesions might be present in the
same animal• Lungs
• Nasal mucosa, paranasal sinuses, lips
• Skin (lymphatics)
• Lymphonodes
• Testicles, liver, spleen
• Basic forms of lesions– Malleotic nodule (granuloma)
– Predominantly exsudative form
– Predominantly proliferative form
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Malleotic nodule
• Exsudative development– pathogen in the centre, surrounded by PMNs,
exsudation and hyperemic ring around
– later histiocytes and giant cells appear
– the center becomes necrotized, fibroblasts appear on the perimeter
• Proliferative development– pathogen in the centre, surrounded by
epitheloid cells and giant cells
– more epitheloid cells accumulate
– the center becomes necrotized, fibroblasts appear on the perimeter...
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Malleotic nodule
• Developed malleotic nodule
– pyogranuloma with narrow demarcation zone
• colliquated or caseous centre with occassional calcium salt deposition, surrounded by epitheloid cells, giant cells and granulation tissue
• poppy seed to pea sized nodules with
greyish-yellow dry or liquid centre
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Malleotic nodule, lung
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Malleotic nodules, nasal septum, horse
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Malleotic ulcer
• Malleotic ulcer– nodules close to the surface
• mucous membranes, skin– nasal cavity, trachea, larynx
– necrosis, shedding of the necrotized part
– shallow to deep erosions – ulcers• uneven margin
• undermined edge
• covered with egg-white like material
– healing with scar formation
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„Farcy”,
ulcerative lymphangitis
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Different stages of malleotic nodules and ulcers, nasal septum, horse
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Malleotic ulcer on the lip,
donkey
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Malleotic nodules and ulcers, nasal septum, horse
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Chronic malleotic ulcers, nasal septum, horse
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Chronic malleotic ulcers, nasal septum, horse
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Predominantly exsudative glanders
• Lungs, other tissues
– serofibrinous inflammation around the pathogen
• bronchopneumonia
– necrosis with caryorhexis, colliquation
– healing with proliferation of malleotic granulation tissue
• may contain dry areas with calcium deposits
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Disseminated pyogranulomas, bronchopneumonia
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Thrombosis, necrotizing rhinitis
(„Zahn-lines” in the thrombus)
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Fibrinous vasculitis
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Predominantly proliferative glanders
• Mucous membranes
– proliferation of malleotic granulation
tissue
• fibroblasts
• histiocytes, giant cells
– barley seed sized greyish-white firm
nodules on mucous membranes
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Proliferative malleotic nodules, trachea, horse
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Glanders
• Differential diagnosis
– Strangles• Streptococcus equi ssp. equi
– Epizootic lymphangiitis • Histoplasma sp.
– Ulcerative lymphangiitis• Corynebacterium pseudotuberculosis
– Melioidosis• Burkholderia pseudomallei
– Blastomycosis, cryptococcosis• Blastomyces sp., Cryptococcus sp.
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Rhodococcus equi enterocolitis
• Ubiqitous bacterium, common in animal manure
• Gram-positive, partially acid-fast, facultatively intracellular organism
• Potentially zoonotic – HIV!
• Clinical disease in foals under 6 months– Predisposing factors
• helminthiasis,
• immunosuppression,
• immunodeficiency
• Sporadic or endemic occurrence
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Rhodococcus equi enterocolitis
• Intestinal tract– Pyogranulomatous ulcerative enterocolitis
• Macrophages, giant cells proliferate in the propria– intracellular organism!
• Coagulation necrosis, epithelial ulceration
• Pyogranulomatous lymphadenitis
• Other organs– Subcutaneous abscesses, purulent lymphadenitis,
suppurative arthritis, pleurisy, suppurative pneumonia with abscessation, purulent osteomyelitis
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Rhodococcus equi colitis, horse
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Rhodococcus equi colitis, horse
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Rhodococcus equi colitis, horse
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Rhodococcus equi colitis, horse