The effectiveness of benzimidazole derivatives for the treatment and prevention of histomonosis (blackhead) in turkeys

Histomonosis in Poultry: A Comprehensive Review

Histomonas meleagridis, the etiological agent of histomonosis, is a poultry parasite primarily detrimental to turkeys. Characteristic lesions occur in the liver and ceca, with mortalities in turkey flocks often reaching 80-100%. Chickens and other gallinaceous birds can be susceptible but the disease was primarily considered sub-clinical until recent years. Treating and preventing H. meleagridis infection have become more difficult since 2015, when nitarsone was voluntarily removed from the market, leaving the poultry industry with no approved prophylactics, therapeutics, or vaccines to combat histomonosis. Phytogenic compounds evaluated for chemoprophylaxis of histomonosis have varied results with in vitro and in vivo experiments. Some recent research successes are encouraging for the pursuit of antihistomonal compounds derived from plants. Turkeys and chickens exhibit a level of resistance to re-infection when recovered from H. meleagridis infection, but no commercial vaccines are yet available, despite experimental successes. Safety and stability of live-attenuated isolates have been demonstrated; furthermore, highly efficacious protection has been conferred in experimental settings with administration of these isolates without harming performance. Taken together, these research advancements are encouraging for vaccine development, but further investigation is necessary to evaluate proper administration age, dose, and route. A summary of the published research is provided in this review.

Critical Review: Future Control of Blackhead Disease (Histomoniasis) in Poultry

Blackhead disease (histomoniasis) currently has no efficacious drug approved for use in poultry in the United States. Both chickens and turkeys can get the disease, but mortality is most often associated with turkeys. The lack of any approved therapies for blackhead is of concern, especially in the case of valuable turkey breeder candidate flocks. Due to the availability of efficacious drugs for many years, research focused on blackhead was minimal. However, without any drugs or reliable additives, blackhead will continue to be an issue in turkeys and broiler breeder chickens. The American Association of Avian Pathologists annual meeting in San Antonio, Texas, August 6-9, 2016, held a mini-symposium on blackhead. The mini-symposium included university researchers and industry veterinarians discussing blackhead in the United States and Europe including insights on the disease pathogenesis and epidemiology, as well as an update on the current state of blackhead in the United States since the removal of nitarsone from the market in January 2016. This review summarizes the information presented at the mini-symposium and discusses current control measures in an era without efficacious drugs.

Histomonosis in poultry: previous and current strategies for prevention and therapy

Histomonosis is a parasitic disease of poultry with worldwide prevalence. The disease can cause morbidity and mortality in chicken and turkey flocks entailing severe economic losses. In the first half of the last century, there was a high demand to control histomonosis as the turkey industry was severely affected by the disease. Consequently, numerous chemical compounds were tested for their efficacy against Histomonas meleagridis with varying outcomes, that are summarized and specified in this review. At the same time, preliminary attempts to protect birds with cultured histomonads indicated the possibility of vaccination. Several years ago antihistomonal drugs were banned in countries with tight regulations on pharmaceuticals in order to comply with the demand of consumer protection. As a consequence, outbreaks of histomonosis in poultry flocks increased and the disease became endemic again. New approaches to prevent and treat histomonosis are, therefore, needed and recently performed studies focused on various areas to combat the disease, from alternative chemotherapeutic substances to plant-derived compounds until vaccination, altogether reviewed here. Considering existing regulations and the overall outcome of experimental studies, it can be concluded that vaccination is very promising, despite the fact that various challenges need to be addressed until the first ever developed vaccine based upon live flagellates in human or bird medicine can be marketed.

Histomonas meleagridis--new insights into an old pathogen

The protozoan flagellate Histomonas meleagridis is the etiological agent of histomonosis, first described in 1893. It is a fastidious disease in turkeys, with pathological lesions in the caeca and liver, sometimes with high mortality. In chickens the disease is less fatal and lesions are often confined to the caeca. The disease was well controlled by applying nitroimidazoles and nitrofurans for therapy or prophylaxis. Since their introduction into the market in the middle of the previous century, research nearly ceased as outbreaks of histomonosis occurred only very rarely. With the ban of these drugs in the last two decades in North America, the European Union and elsewhere, in combination with the changes in animal husbandry, the disease re-emerged. Consequently, research programs were set up in various places focusing on different features of the parasite and the disease. For the first time studies were performed to elucidate the molecular repertoire of the parasite. In addition, research has been started to investigate the parasite's interaction with its host. New diagnostic methods and tools were developed and tested with samples obtained from field outbreaks or experimental infections. Some of these studies aimed to clarify the introduction of the protozoan parasite into a flock and the transmission between birds. Finally, a strong focus was placed on research concentrated on the development of new treatment and prophylactic strategies, urgently needed to combat the disease. This review aims to summarize recent research activities and place them into context with older literature.

An outbreak of blackhead disease (Histomonas meleagridis) in farm-reared bobwhite quail (Colinus virginianus)

An outbreak of blackhead disease (Histomonas meleagridis) in farm-reared flock of 13,500 bobwhite quail (Colinus virginianus) resulted in mortality totaling approximately 1500 in 4 wk. Necropsy of 56 dead birds at midoutbreak (from a total that day of 131) revealed that 55 had severe cecal lesions typical of blackhead, and only 3 had visible lesions in the liver. Necropsy of apparently healthy birds failed to detect any signs of infection. Presence of H. meleagridis in affected ceca was proved by culture in vitro and PCR tests.

Partial sequence of the beta-tubulin of Histomonas meleagridis and the activity of benzimidazoles against H. meleagridis in vitro

The protozoan parasite Histomonas meleagridis is a member of the family Monocercomonadidae in the class Trichomonada. Due to food safety concerns, currently no prophylactic or therapeutic drug against the parasite is licensed in the European Union. Benzimidazoles are antiparasitic drugs, and some of them are licensed for use in food-producing animals. Benzimidazoles act on beta-tubulin, and the beta-tubulin sequence allows predictions about the efficacy of benzimidazoles. In this study, we sequenced and analyzed a part of the beta-tubulin gene of five H. meleagridis strains and of Dientamoeba fragilis. In each Histomonas strain, three to five different sequences were found. No clustering of sequences from the same strain was recognizable. A phylogenetic tree based on the amino acid sequences of trichomonal beta-tubulin genes placed the histomonal sequences on a branch with D. fragilis, separate from Monocercomonas sp. and Tritrichomonas foetus. All histomonal amino acid sequences predicted a susceptibility to benzimidazoles. However, when we tested the efficacy of five benzimidazoles, namely, albendazole, fenbendazole, flubendazole, mebendazole, and nocodazole, on H. meleagridis in vitro, all tested drugs showed no efficacy, even though the concentrations tested were higher than the concentrations found to be effective against Trichomonas vaginalis and T. foetus by other investigators.

In vitro effect of herbal products against Histomonas meleagridis

The ban on chemotherapeutics against Histomonas meleagridis in the European Union has left turkey producers without an effective treatment against histomonosis. It has encouraged the development of alternative control methods amongst which are a number of herbal products. In the present study the in vitro effect of four herbal products against H. meleagridis was examined. After suspension of the herbal products in Dwyer's culture medium used for subculturing of a viable culture, parasite growth was monitored by frequently counting the histomonads until 72h of incubation. The solid products Aromabiotictrade mark, Enteroguardtrade mark, and Protophyt SPtrade mark as well as the positive control products dimetridazole and Histostat-50trade mark, were tested in twofold serial dilutions ranging in concentration from 400 to 12.5mug/mL, while the liquid product Protophyt Btrade mark was tested in concentrations ranging from 0.24% to 0.008% (v/v). The herbal products Enteroguardtrade mark and Protophyt Btrade mark as well as dimetridazole and Histostat-50trade mark, two chemotherapeutics with known antihistomonal activity, inhibited the growth of H. meleagridis, while no antihistomonal effect was found for Aromabiotictrade mark and Protophyt SPtrade mark.

Histomonas meleagridis in chickens: attempted transmission in the absence of vectors

The progress and transmission of blackhead disease in chickens was studied in battery cages and floor pens in the absence of vectors. Two-week-old chicks were inoculated intracloacally with Histomonas meleagridis and allowed to commingle with others in floor pens. There was no confirmed transmission of blackhead to other birds in the pen, whether stocked at 10% or 25% with infected birds. A second experiment evaluated the effects of feed restriction of chickens on spread of blackhead within floor pens. Inoculated seeder birds had severe cecal lesions of blackhead at necropsy, regardless of feed restriction. Uninoculated birds did not develop lesions by the time of necropsy at 42 days of age, regardless of whether full-fed or limited by skip-day feeding. Chickens inoculated intracloacally with H. meleagridis and placed in battery cages became infected and had cecal lesions of blackhead, but few liver lesions. Chickens allowed to commingle with the inoculated birds in batteries had no lesions of histomoniasis at necropsy 2 wk postinoculation. Coccidial oocysts from turkeys (Eimeria adenoeides) were inoculated along with H. meleagridis from cultures to test the effects of sporozoite penetration in the ceca on progress of blackhead disease. Histomoniasis was not worsened by the interaction with sporozoites, as shown by unchanged severity of cecal lesions, the number of birds showing liver lesions, or the overall number of positive birds. Overall, blackhead infections showed no inclination to spread from bird to bird under conditions of these studies, in contrast to what has been reported for turkeys. These results suggest that the dynamics of blackhead transmission in chickens differs significantly from that of turkeys, where transmission from bird to bird is rapid and effective in the absence of vectors.

High yield of parasites and prolonged in vitro culture of Histomonas meleagridis

Dwyer's medium is a frequently employed culture medium for Histomonas meleagridis with rice powder as an essential ingredient. The effect of adding larger quantities of rice powder to the culture medium and the influence of the size of the rice particles on the growth of H. meleagridis was examined. Increasing the amount of rice powder from the standard amount of 10 to 12 mg to 50 to 100 mg per 12.5 ml medium resulted in approximately a 10-fold increase of parasites. Larger quantities of rice powder did not give better yields. The particle size of the rice powder proved relatively unimportant, although the addition of only large rice powder particles (>250 microm) resulted in a somewhat lesser yield. H. meleagridis cultures could be prolonged from approximately 4 days to at least 2 weeks without subculturing by supplementing the culture medium with rice powder only.

Metronidazole resistance in Campylobacter jejuni from poultry meat

The occurrence of metronidazole resistance was investigated among Campylobacter jejuni in raw poultry meat collected from supermarkets. MICs were determined by the agar dilution procedure in the testing range of 3 to 60 microg/ml metronidazole. The MICs showed a bimodal distribution with a significant proportion of metronidazole-resistant isolates among C. jejuni from raw broiler and turkey meat. Metronidazole resistance occurred most frequently among turkey meat isolates (P < 0.005). This is the first report of foodborne bacteria carrying metronidazole resistance.

Blackhead disease (histomoniasis) in poultry: a critical review

After its discovery in 1893 in Rhode Island, blackhead disease was reported across the continent and soon in many other countries. It decimated the turkey industry in New England and followed production like a faithful shadow. Blackhead disease causes high mortality in turkeys, sometimes approaching 100% of a flock. In chickens, the mortality may be 10%-20% with high morbidity, although many outbreaks pass unnoticed. Early workers identified Histomonas meleagridis, a protozoan related to Entamoeba histolytica, Giardia lamblia, and Trichomonas, as the causative agent. Like many other parasites, its life cycle is complex, involving as an intermediate host, the common cecal worm Heterakis gallinarum. The necessity for bacteria for Histomonas to become virulent in the turkey and chicken, notably Escherichia coli, Bacillus subtilis, and Clostridium spp., was discovered by research in gnotobiotic birds. Changes in management brought the disease under control, although it remained the first cause of mortality in turkeys until modern antihistomonal products were developed after WWII. The ban of nitroimidazole products in the United States and Europe was followed by an upsurge in reported cases in turkeys and chickens. Immunization is not an option for prevention, as birds do not reliably become resistant to reinfection after suffering a primary exposure. Recent research demonstrated that histomoniasis could spread rapidly through a flock of turkeys by direct contact, probably involving the phenomenon of cloacal drinking. Direct transmission was not demonstrated for chickens, stressing dependence on H. gallinarum as the source of infection. The lack of suitable treatment drugs or vaccines emphasizes the importance of prevention by worm control and management.

Blackhead Disease in Turkeys: Direct Transmission of Histomonas meleagridis from Bird to Bird in a Laboratory Model

The spread of Histomonas meleagridis infections through groups of turkeys in the absence of the cecal worm vector (Heterakis gallinarum) was studied in a battery cage model. Battery-reared poults were exposed at 2 wk of age by commingling with infected birds into cages that had the floor lined with paper. One treatment received no exposure, whereas other birds were commingled with two, three, or four birds/cage (25%, 37.5%, or 50%) inoculated per cloaca with cultured H. meleagridis (200,000/bird). Inoculated birds died at 7-13 days postinoculation (DPI) showing typical liver and cecal lesions of histomoniasis. By 14 DPI, 87.5% of the directly inoculated birds died or had severe lesions of histomoniasis. Turkeys commingled with two, three, or four infected birds became infected at the rate of 72%, 80%, or 75%, respectively. In another experiment, two birds/cage (25%) were inoculated with Histomonas from culture and allowed to commingle with other birds for 1, 2, 3, or 4 days. Two of 12 (16.7%) birds had minor cecal lesions after contact with inoculated birds for 1 day, but 87.5%-100% became infected if inoculated birds remained in the cage for 2-4 days. Contemporaneous inoculation with cecal coccidia (Eimeria adenoeides) as a predisposing factor in blackhead infections was studied using the model. Turkey poults directly inoculated with Histomonas were allowed to commingle for 5 days with uninoculated birds that had received inoculation with 0, 10(3), or 10(4) sporulated oocysts. The coccidian infection appeared to interfere with transmission of blackhead infection by 7 DPI, as suggested by lessened severity of cecal lesions and a lower percentage of infected birds. These studies confirm that histomoniasis is transmitted readily from directly exposed young turkeys to others in the absence of the cecal worm vector, and that this phenomenon can be reproduced in battery cages as an experimental model.

The efficacy of some drugs with known antiprotozoal activity against Histomonas meleagridis in chickens

Nine drugs with known or suspected antiprotozoal activity were tested in vitro, and in vivo for activity against Histomonas meleagridis. The nitroimidazoles dimetridazole, metronidazole, ornidazole, and tinidazole suppressed growth of H. meleagridis in vitro at 10 microg/ml or higher. Paromomycin sulfate, and carbadox were weakly effective at high levels. Quinolinol, mebendazole, diloxanide furoate, and albendazole had no demonstrable efficacy in vitro. Drugs showing some activity in vitro were tested in young chickens inoculated intracloacally with 2 x 10(5) H. meleagridis/bird. Dimetridazole, metronidazole, ornidazole, and tinidazole were highly effective at 200 ppm in feed. Paromomycin sulfate, and carbadox were ineffective in vivo, with no improvement in liver or cecal lesion scores compared to that of infected controls. Thus, the only new entities with efficacy against blackhead disease in vivo were nitroimidazoles, related to the positive control dimetridazole.

In vitro activity of therapeutic drugs against Histomonas meleagridis (Smith, 1895)

Histomoniasis or blackhead is a life-threatening disease of turkeys that is caused by a flagellated protozoan, Histomonas meleagridis. The development of an assay to measure the sensitivity of drugs traditionally used against this parasite, as reputed to be effective against other protozoan parasites, is described. The in vitro minimum lethal concentrations (MLC), time for drug efficacy, and parasite viability after removal of residual drugs were determined. Three of the 10 tested drugs, fenbendazole, albendazole, and sulfadiazine, were found to be ineffective against H. meleagridis. Nifursol, the only compound still authorized as a feed additive in Europe, is an inhibiting agent but is not lethal in vitro. Roxarsone, an arsenical derivate similar to nitarsone (the only authorized drug in United States), is effective at high concentration (200 microg/mL) after a long exposure (48 h). The lethal activity of dimetridazole, metronidazole, ronidazole, tinidazole, and furazolidone in vitro was demonstrated. Dimetridazole (MLC = 25 microg/mL after 6 h of exposure), metronidazole (MLC = 50 microg/mL after 24 h), and furazolidone (MLC = 50 microg/mL after 24 h) are rapidly effective at low concentrations. These results confirm the effectiveness of dimetridazole, a drug that has been used in the treatment and prevention of blackhead. In May 2002 this compound was removed as feed additive in Europe.