Clostridia-Associated Enterocolitis in Foals

Clostridia-associated enterocolitis (inflammation of the small intestine and colon) affects both humans and horses, young and old alike. According to Nathan Slovis, DVM, Dipl. ACVIM, of Hagyard-Davidson-McGee (HDM) Associates veterinary clinic i

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Clostridia-associated enterocolitis (inflammation of the small intestine and colon) affects both humans and horses, young and old alike. According to Nathan Slovis, DVM, Dipl. ACVIM, of Hagyard-Davidson-McGee (HDM) Associates veterinary clinic in Lexington, Ky., more than 20% of foals within the first six months of age will have an infectious diarrhea. He said that several authors have reported associations between enteritis (inflammation of the intestine) and diarrhea in foals and the various clostridial organisms. Slovis discussed the pathogenesis, clinical signs, diagnosis, and treatment of enterocolitis associated with Clostridium difficile and Clostridium perfringens at the HDM Bluegrass Equine Reproduction Symposium on Oct. 24, 2002.


Clostridium difficile
His presentation began with a discussion on Clostridium difficile, a gram-positive anaerobic bacillus that is believed to be responsible for almost all cases of pseudomembranous colitis (an acute inflammation of the colon) and 20% of antibiotic-induced colitis in humans. In antibiotic-induced colitis, the C. difficile disrupts the normal flora in the colon. C. difficile is able to form heat-resistant spores in the environment that can persist for years. These spores convert to a vegetative form in the colon. When established, disease-causing strains will produce toxins–toxin A, toxin B, and a recently found third toxin.


Many cases of human infection come from C. difficile in hospitals, and colonization in newborns can be common, but newborns are usually asymptomatic. C. difficile has been implicated in an outbreak of colitis among horses at veterinary teaching hospitals, said Slovis. Slovis reported that a small percentage of foals (0-3%) are asymptomatic carriers, similar to adult humans. From less than 1% to 15 percent of adult horses are asymptomatic, and these numbers are similar to statistics for humans. Slovis cautioned that sometimes a foal might be harboring C. difficile despite never having received antibiotics. He cited one study in which 10 out of 25 horses which developed acute colitis had C. difficile.


Foals with C. difficile might have symptoms ranging from a low-grade diarrhea to violent colitis with decreased motility of the intestines, anorexia, dehydration, rapid breathing, fever, lowered blood pH, lowered amounts of protein and sodium in the blood, and lowered circulating plasma in the body. Diagnosis is confirmed by isolating C. difficile from feces. Because about 25% of C. difficile do not cause disease (they do not have the necessary toxins), a cytotoxin assay, with a sensitivity of 94-100%, can be performed to determine if the organism is pathogenic. This test can be expensive. Therefore, it is not used often, Slovis said. He mentioned that there are now two new enzyme immunoassays that can be used to detect either the toxins or the antigens. (Slovis cautioned not to use sytrofoam when submitting a fecal sample since this can bind the toxins.) In addition, a polymerase-chain reaction (PCR) test can be done; however, like the cytotoxin assay, these are expensive as well as time consuming

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Sarah Evers Conrad has a bachelor’s of arts in journalism and equine science from Western Kentucky University. As a lifelong horse lover and equestrian, Conrad started her career at The Horse: Your Guide to Equine Health Care magazine. She has also worked for the United States Equestrian Federation as the managing editor of Equestrian magazine and director of e-communications and served as content manager/travel writer for a Caribbean travel agency. When she isn’t freelancing, Conrad spends her free time enjoying her family, reading, practicing photography, traveling, crocheting, and being around animals in her Lexington, Kentucky, home.

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