Bovine haemorrhagic syndrome

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Classic inflammatory changes seen with BHS in cattle

Bovine haemorrhagic syndrome (BHS; necrotic enteritis) is a rare and often fatal disease of young cattle attributed to an acute or peracute infection with Clostridium spp bacteria. Clostridium perfringens Type A beta 2 toxin gene has been incriminated[1].

Enterohaemorrhagic Escherichia coli (EHEC) have been isolated in cattle without disease, suggesting that cattle may be a reservoir for this bacteria which causes haemorrhagic colitis in other species[2].

This disease has been reported in beef and dairy cattle across North America and Europe[3].


Risk factors associated with this disease include consumption of a high-energy diet and exposure to bacterial enterotoxins and fungal mycotoxins (e.g. Fusarium spp). It has been shown that both alpha and epsilon Clostridial spp toxins can alter the intestinal barrier in calves and are pathogenic for this species[4].

Postmortem of a cow that died from haemorrhagic bowel syndrome

Clinical signs

Acute cases manifest with abdominal pain, progressing to sternal recumbency, shock, and death.

In subacute cases, cattle show signs of depression, anorexia, agalaxia, ruminal hypomotility, abdominal pain and melaena. Many cases die within 2–4 days despite intensive fluid and electrolyte therapy. Sudden death without prior clinical findings may occur[5].

On post-mortem necrohemorrhagic jejunitis with intraluminal hemorrhage is severe. The affected segment of intestine is dark red and dilated with tags of fibrin on the serosal surface. The lumen contains a firm blood clot adherent to the mucosa, and the affected segment of intestine is necrotic.


Diagnosis is based on presenting clinical signs. Ultrasonography is considered to be a useful tool for the diagnosis of ileus. However, this imaging modality could be used to make a definitive diagnosis of haemorrhagic bowel syndrome only when a blood clot is seen in the intestinal lumen[6].

In dead cattle, postmortems are usually conclusive.

The disease must be distinguished from other causes of stomatitis including bovine mucosal disease, malignant catarrhal fever, rinderpest, peste des petits ruminants, contagious ecthyma, blue tongue, foot and mouth disease, vesicular stomatitis, coccidiosis and enteric salmonellosis.


Survival rates for this disease in cattle are poor, with 70% of cases succumbing to enterotoxaemia or requiring euthanasia[7].

Fluid and electrolyte therapy and laparotomy with resection of the affected segment of the intestine are treatment options in valuable animals. Even with such treatment, the case fatality rate is very high. No preventive strategies have been identified.


  1. Manteca C et al (2002) A role for the Clostridium perfringens beta2 toxin in bovine enterotoxaemia? Vet Microbiol 86(3):191-202
  2. Karch H et al (2009) Epidemiology and pathogenesis of enterohaemorrhagic Escherichia coil. Berl Munch Tierarztl Wochenschr 122(11-12):417-424
  3. Manteca C et al (2001) Bacterial intestinal flora associated with enterotoxaemia in Belgian Blue calves. Vet Microbiol 81(1):21-32
  4. Morris WE et al (2012) Effects of Clostridium perfringens alpha and epsilon toxins in the bovine gut. Anaerobe 18(1):143-147
  5. Ceci L et al (2006) Haemorrhagic bowel syndrome in dairy cattle: possible role of Clostridium perfringens type A in the disease complex. J Vet Med A Physiol Pathol Clin Med 53(10):518-523
  6. Braun U et al (2010) Ultrasonographic findings in 63 cows with haemorrhagic bowel syndrome. Vet Rec 166(3):79-81
  7. Braun U et al (2010) Clinical findings and treatment in 63 cows with haemorrhagic bowel syndrome. Schweiz Arch Tierheilkd 152(11):515-522