Hemorrhagic gastroenteritis

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Gram-stained section of the small intestine from a dog which died from hemorrhagic gastroenteritis, showing large numbers of clostridia-like bacilli on the surface of the mucosa and within the crypts[1]

Hemorrhagic gastroenteritis is an acute, life-threatening gastrointestinal disease of dogs caused by Clostridium perfringens enterotoxin A[2][3].

Both 'Clostridium difficile and Clostridium perfringens have been implicated as causes of canine acute and chronic large and small bowel diarrhea, as well as an acute hemorrhagic diarrheal syndrome[4], but more frequently the latter appears to be involved.

Clostridium perfringens type A-associated diarrhea and enteric disease in dogs is not well-characterized, but may range in severity from mild and self-limiting to the fatal acute hemorrhagic diarrhea[5]. C. perfringens enterotoxin is detected in 28 – 34% of diarrheic dogs and 5 – 14% of nondiarrheic dogs, while C. difficile toxin is detected in 13 – 21% of diarrheic dogs and 2–7% of nondiarrheic dogs[6].

Affected dogs may present with acute onset profuse and bloody diarrhea which may result in death within 24 hours[7].

A presumptive diagnosis is usually based on clinical history and supportive by microbial culture of fecal sample antemortem. In fatal cases, the presence of large numbers of clostridia-like bacilli in the ileum, identified as C. perfringens, adhering to mucosal surfaces is a striking finding in most cases together with the lack of isolation of other pathogens from the gastrointestinal tract and negative titres on parvoviral antibody detection assays.

Histopathologically, the principal intestinal lesion are superficial mucosal hemorrhagic necrosis at the jejunoileum[8]. Bacilli are usually present only in the intraluminal necrotic debris.

A differential diagnosis would include anticoagulant rodenticides, intestinal parasites (particularly Blastocystis spp, Giardia intestinalis, Toxocara canis, Isospora spp, Trichuris vulpis) and canine parvovirus infection[9].

Treatment is usually supportive, with aggressive IV fluid therapy, penicillin-based antimicrobials such as amoxycillin/clavulanate[10], macrolides (e.g. erythromycin and tylosin), metronidazole, and tetracyclines as well as oral protectants.

Antimicrobial administration is typically reserved for cases of severe diarrhea or for dogs with systemic manifestations of disease

References

  1. Schlegel BJ et al (2012) Clostridium perfringens type A fatal acute hemorrhagic gastroenteritis in a dog. Can Vet J 53(5):555-557
  2. Sasaki J et al (1999) Hemorrhagic enteritis associated with Clostridium perfringens type A in a dog. J Vet Med Sci 61(2):175-177
  3. Tupler T et al (2012) Enteropathogens identified in dogs entering a Florida animal shelter with normal feces or diarrhea. J Am Vet Med Assoc 241(3):338-343
  4. Kelly, CP & LaMont, JT (1998) Clostridium difficile infection. Annu Rev Med 49:375–390
  5. Marks SL & Kather EJ (2006) Clostridium perfringens- and Clostridium difficile-associated diarrhea. In: Greene CE, editor. Infectious Diseases of the Dog and Cat. 3rd ed. St Louis, Missouri: Saunders Elsevier. pp:363–366
  6. Marks, SL et al (2002) Genotypic and phenotypic characterization of Clostridium perfringens and Clostridium difficile in diarrheic and healthy dogs. J Vet Intern Med 16:533–540
  7. Weese JS et al (2001) The roles of Clostridium difficile and enterotoxigenic Clostridium perfringens in diarrhea in dogs. J Vet Intern Med 15:374–378
  8. Sasaki J et al (1999) Hemorrhagic enteritis associated with Clostridium perfringens type A in a dog. J Vet Med Sci 61(2):175-177
  9. Ju C et al (2012) Genome sequence of canine parvovirus strain SC02/2011, isolated from a puppy with severe diarrhea in south China. J Virol 86(24):13805
  10. Unterer S et al (2011) Treatment of aseptic dogs with hemorrhagic gastroenteritis with amoxicillin/clavulanic acid: a prospective blinded study. J Vet Intern Med 25(5):973-979