Lawsonia intracellularis-associated ulcerative and necro-hemorrhagic enteritis in 5 weanling foals

This report describes 5 cases of fatal Lawsonia intracellularis-associated ulcerative and necro-hemorrhagic enteritis in weanling Thoroughbred and Standardbred foals. The lesions are similar to those of the L. intracellularis-associated ulcerative and necro-hemorrhagic enteritis syndrome in pigs. Two foals had concurrent severe typhlo-colitis as a result of a large burden of encysted cyathostomes. The clinical, diagnostic, and therapeutic challenges, and the potential complications encountered during the management of such cases are discussed.

Lawsonia intracellularis proliferative enteropathy in a foal

A weanling foal was diagnosed with proliferative enteropathy caused by Lawsonia intracellularis based on history, clinical findings of depression, anorexia, weight loss, colic, diarrhea, and ventral edema, and a combination of serology and fecal PCR. An epidemiological investigation on the premises revealed that many of the other foals and adult horses were seropositive for L. intracellularis, despite being clinically normal, and identified a dog as a potential carrier and source of infection for the foal. The foal was successfully treated with a combination of azithromycin and rifampin.

Diagnosis of Lawsonia intracellularis infection in pigs after vaccination or antimicrobial treatment

Diagnosis of infection with Lawsonia (L.) intracellularis, the causative agent of porcine proliferative enteropathy, is routinely based on the detection of L. intracellularis in faeces and/or tissue samples by PCR. Furthermore, infection can be determined by the detection of antibodies in serum samples. The aim of this comparative study was to examine whether results from molecular biology and serological testing are influenced by applying live bacteria vaccine Enterisol Ileitis or antimicrobial treatment to pigs naturally exposed to L. intracellularis. Decreased shedding was detected in tylosin treated pigs only. Thus, the distribution of 345 pigs into groups of 0-, 1- or > or = 2-times positive by PCR was significantly influenced by the treatment (P < 0.0001). A global effect of positive PCR results on average daily weight gain was also highly significant (P < 0.0001). The serological reaction was detected by a blocking ELISA after infection but not after vaccination independent of treatment. The results indicate no influence of vaccination on applied diagnostic tests.

Enteritis and colitis in horses

Enteritis and colitis remain challenging and life-threatening diseases despite many recent advances. Successful treatment is largely dependent on early recognition and directed therapy, which is facilitated by obtaining a complete history and physical examination. A number of new therapies and methods of monitoring critically ill patients have become integral components of treatment success. The critical monitoring of equine foals and adults continues to be an exciting and emerging field.

[Literature review of the diagnosis of porcine proliferative enteropathy]

Lawsonia (L.) intracellularis is the etiologic agent of ileitis, which occurs in different forms in pigs. The infection can be demonstrated by several methods. In routine diagnosis the indirect detection of L. intracellularis is conducted by measuring antibodies performing an indirect IFT or ELISA. Furthermore, an IFT and PCR on faecal and/or tissue samples are well established for the direct detection. The suitability of PCR on faecal samples is frequently discussed. Problems are related to various inhibitors that are component of faeces. When interpreting laboratory results, the past medical history of pigs, i.e. antimicrobial treatment, has to be considered. Since 2004 a new vaccine against ileitis is licensed. A possible influence of vaccination on diagnostic testing, especially PCR and ELISA, is hardly investigated. Therefore, the interpretation of laboratory results from vaccinated animals is, considering the current literature, restrained.

In situ hybridization for Lawsonia intracellularis--specific 16s rRNA sequence in paraffin-embedded tissue using a digoxigenin-labeled oligonucleotide probe

An in situ hybridization (ISH) procedure with a digoxigenin-labeled oligonucleotide probe for detection of Lawsonia intracellularis in paraffin-embedded tissue is described. This technique recognized 71% of PCR-positive cases and was thus superior to Warthin-Starry silver stain, which only detected 41%. The presented ISH is of comparable sensitivity to previously published immunohistochemical assays and is recommended for laboratories wishing to diagnose L. intracellularis infections in tissue sections but without access to antibodies.

Isolation of Lawsonia intracellularis in Korea and reproduction of proliferative enteropathy in pigs and hamsters

Lawsonia intracellularis (L. intracellularis) was isolated from a Korean pig suffering acute proliferative enteropathy. In vitro culture conditions of L. intracellularis were established in McCoy cells. Pigs and hamsters experimentally infected with the pure culture of L. intracellularis reproduced clinical signs and intestinal lesions of proliferative enteropathy. The presence of L. intracellularis in the intestinal lesions was confirmed by immunohistochemistry with L. intracellularis-specific monoclonal antibodies.

Distinction between porcine circovirus type 2 enteritis and porcine proliferative enteropathy caused by Lawsonia intracellularis

The presence of porcine circovirus type 2 (PCV2) was studied immunohistochemically in formalin-fixed, paraffin wax-embedded samples of intestinal tissue from 80 pigs with a clinical history suggestive of Lawsonia intracellularis-associated diarrhoea. Histopathologically, enteritis of varying intensity was diagnosed in 64 of the pigs. Of these 64 animals, 34 (18%) were infected with both PCV2 and L. intracellularis. Of the remaining 30 cases of enteritis, 23 (77%) were attributed to PCV2 infection alone. The PCV2-associated enteritis cases showed necrotizing ileitis and colitis, indistinguishable macroscopically from proliferative enteritis (PE) due to L. intracellularis. Histopathologically, L. intracellularis-positive intestines showed adenomatous proliferation of crypt enterocytes, whereas PCV2 enteritis was characterized by histiocytosis of varying intensity, with PCV2-positive cells in the submucosa, lamina propria and crypt epithelium, as well as in the lymphoid tissue of the ileum and colon. Multinucleated giant cells, however, were seen in both infections. PCV2 was about three times more likely to be detected in L. intracellularis-negative than in L. intracellularis-positive samples (P<0.001). There was no association between PCV2 and other intestinal bacterial pathogens. The study demonstrated that PCV2 enteritis should be borne in mind in the differential diagnosis of L. intracellularis infection in pigs aged 2-4 months with a clinical history of diarrhoea.

Diagnostic and epidemiological features of Lawsonia intracellularis enteropathy in 2 foals

Two clinical cases of equine proliferative enteropathy are described. Both foals had a positive fecal polymerase chain reaction, but shedding of the bacterium stopped <4 days after therapy was initiated. One foal was serologically positive 3 days after onset of clinical signs and remained positive for more than 6 months.

Development of a multiplex-PCR for rapid detection of the enteric pathogens Lawsonia intracellularis, Brachyspira hyodysenteriae, and Brachyspira pilosicoli in porcine faeces

AIMS

To develop an assay to simultaneously detect Lawsonia intracellularis, Brachyspira hyodysenteriae and Brachyspira pilosicoli in pig faeces.

METHODS AND RESULTS

A multiplex-polymerase chain reaction (M-PCR) was designed to amplify a 655-base pair (bp) portion of the L. intracellularis 16S rRNA gene, a 354-bp portion of the B. hyodysenteriae NADH oxidase gene, and a 823-bp portion of the B. pilosicoli 16S rRNA gene. Specificity was assessed using 80 strains of Brachyspira spp. and 30 other enteric bacteria. Bacterial DNA was extracted from faeces using the QIAamp DNA Stool Mini Kit. The M-PCR was tested in parallel with culture and/or PCR on 192 faecal samples from eight piggeries. Faeces also were seeded with known cell concentrations of the three pathogenic species, and the limits of detection of the M-PCR tested. The M-PCR was specific, with limits of detection of 10(2)-10(3) cells of the respective species per gram of faeces.

CONCLUSIONS

The M-PCR is a rapid, sensitive and specific test for detecting three important enteric bacterial pathogens of pigs.

SIGNIFICANCE AND IMPACT OF THE STUDY

The availability of a new diagnostic M-PCR will allow rapid detection and control of three key porcine enteric pathogens.

Lipopolysaccharide-based enzyme-linked immunosorbent assay for experimental use in detection of antibodies to Lawsonia intracellularis in pigs

An enzyme-linked immunosorbent assay (ELISA) for Lawsonia intracellularis was developed and compared with a whole-cell antigen-based immunofluorescence antibody test (IFAT). The antigen-containing lipopolysaccharide (LPS) was derived from Percoll gradient purified cultures of L. intracellularis by using a modification of the Westphal hot phenol procedure. The antigen was bound directly to polystyrene 96-well microtiter plates, and the assay was performed in an indirect ELISA format. Specificity and sensitivity values based on 80 known positive and 80 known negative serum samples from controlled experimental trials were 93.7% and 88.7%, respectively. Serological results from a controlled L. intracellularis challenge exposure study confirmed the high specificity and sensitivity of this assay (100% and 99.5%, respectively). Comparisons between the LPS ELISA and the IFAT in detecting anti-Lawsonia antibodies in this controlled study revealed significantly more LPS ELISA-positive pigs than IFAT-positive pigs on days 21, 28, 35, and 42 (P = 0.003, 0.030, 0.002, and 0.006, respectively). This indirect ELISA (LPS ELISA) test is an improved method of detecting antibodies in pigs soon after exposure to L. intracellularis, regardless of isolate type (vaccine or wild type) in experimental studies. The LPS ELISA may be used as a tool to support future research trials on vaccine efficacy and to further understand the immune response induced by L. intracellularis.

Lawsonia intracellularis Proliferative Enteropathy in a Filly

Proliferative enteropathy (PE) caused by the obligate intracellular bacterium Lawsonia intracellularis is a disease of high economic impact in swine worldwide. In most other species the disease occurs as a sporadic infection. This paper reports a PE caused by L. intracellularis in a 9-month-old Pura Raza Española filly with a history of profuse diarrhoea. Pathological lesions consisted of a severe proliferative enteritis associated with argyrophilic bacteria in the apical cytoplasm of proliferating crypt epithelium. Characteristic PCR products confirmed the presumptive diagnosis of L. intracellularis infection. To our knowledge this is the first report of PE in a horse in Europe caused by L. intracellularis.

Evaluation of a novel enzyme-linked immunosorbent assay for serological diagnosis of porcine proliferative enteropathy

A specific enzyme-linked immunosorbent assay (ELISA) for detection of antibodies to the porcine pathogen Lawsonia intracellularis was developed and evaluated using sera from naïve, naturally infected as well as experimentally infected pigs. On the basis of 37 serum samples collected from experimentally infected pigs and 62 serum samples from naturally infected pigs the sensitivity of the ELISA was calculated to 98.0%. The specificity of the test was 99.3%, calculated on the basis of 273 serum samples collected in six herds free of L. intracellularis after medicated eradication. The novel ELISA was a specific and sensitive method for detecting specific antibodies, and may be a good alternative to the existing serological tests for L. intracellularis. It may be usable for diagnosis of proliferative enteropathy and for determination of a herd's epidemiologic status.

Proliferative enteritis associated with Lawsonia intracellularis in a Japanese macaque (Macaca fuscata)

A 2.5-yr-old, intact male Japanese macaque (Macaca fuscata) was observed to have a thickened ileum during exploratory laparotomy. Lawsonia intracellularis-associated proliferative enteritis was diagnosed using histopathology (Warthin-Starry stain), immunohistochemistry, and polymerase chain reaction analysis of the ileal biopsy. The animal developed transient diarrhea and severe hypoproteinemia 16 days after surgery but recovered with intensive treatment using azithromycin. Given the fact that very specific tests are required for identifying this organism, L. intracellularis may be underdiagnosed in nonhuman primates.

Detection of Lawsonia intracellularis using immunomagnetic beads and ATP bioluminescence

Lawsonia intracellularis is an obligate intracellular pathogenic bacterium that causes proliferative enteropathy in various animals. The detection of L. intracellularis in clinical and environmental samples is necessary for the diagnosis of infection and epidemiological investigations. For the detection of L. intracellularis in fecal samples, we have developed an immunological method using immunomagnetic separation and ATP bioluminescence. Magnetic beads were coated with an anti-Lawsonia surface antigen (LsaA) antibody in order to capture the L. intracellularis in fecal samples from infected rabbits and the bacteria captured by the immunomagnetic beads were assayed by means of ATP bioluminescence. Our results showed that L. intracelluraris was detected by immunomagnetic separation of bacteria-holding magnetic beads and ATP-based bioluminescence, suggesting that our methods could be useful for the diagnosis of proliferative enteropathy.

Comparison of 2 serologic tests for the diagnosis of porcine proliferative enteropathy

The purpose of this study was to compare results from 2 serological assays at the individual- and herd-level for porcine proliferative enteropathy diagnosis. Cohen's kappa coefficient (k) was used to measure agreement. The tests tend to show better agreement when used at the herd level.

Development, characterization and diagnostic application of a monoclonal antibody specific for a proteinase K resistant Lawsonia intracellularis antigen

Proliferative enteropathy (PE) is one of the most important infections in pigs caused by Lawsonia intracellularis, an obligate intracellular bacterium. The purpose of the present investigation was to develop monoclonal antibodies with specificity to L. intracellularis useful both for diagnostic purposes (by immunohistochemistry) and for bacterial characterization. Several antibody producing hybridomas were established by fusion of mouse myeloma with spleen cells from BALB/c mice immunized with mucosa scrapings of the intestinal mucosa from a L. intracellularis infected pig. A monoclonal antibody (mAb), Law1-DK, isotyped as IgG2b was selected by indirect immunofluorescence antibody test (IFAT). Histological sections of the intestines from pigs affected by proliferative enteropathy and in vitro grown bacteria in cell culture were tested positive for the presence of L. intracellularis with the mAb. A molecule at 21 kDa was recognized by the mAb in a Western blotting analysis when a whole-cell preparation of L. intracellularis was run on a sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). This antigen was released from L. intracellularis by mild heat treatment and was resistant to proteinase K digestion, suggesting it to be non-protein, e.g., lipopolysaccharide (LPS). This suggestion was supported by its presence in the aqueous phase of a phenol-water extract. The inhibitory effect of periodate oxidation on the antigen-antibody binding confirmed the participation of a carbohydrate epitope. The new mAb was tested highly specific for L. intracellularis by applying in situ hybridization with a L. intracellularis specific probe targeting 16S ribosomal RNA simultaneously with the IFAT.

Lawsonia intracellularis proliferative enteropathy in a weanling foal in Australia

A 6-month-old Quarter Horse weanling filly was presented with lethargy, weight loss, inappetance, mild diarrhoea, marked ventral oedema and severe panhypoproteinaemia. Serum antibody titres for Lawsonia intracellularis were very high but PCR to detect faecal shedding of the organism was negative. Proliferative enteropathy due to L. intracellularis infection was diagnosed. After treatment for 4 weeks with oral erythromycin and rifampicin the filly made a complete recovery.

Routine diagnostics of Lawsonia intracellularis performed by PCR, serological and post mortem examination, with special emphasis on sample preparation methods for PCR

The aim of this study was to find suitable and reliable tools for demonstrating Lawsonia intracellularis in routine clinical diagnosis. Firstly, a method to prepare tissue samples before a polymerase chain reaction (PCR) was evaluated in pigs submitted for necropsy. Secondly, seven different faecal preparation methods and four different DNA polymerases were tested in single or nested PCR, with co-amplification of a mimic molecule. Thirdly, in selected pigs submitted for necropsy, tissue and faecal samples were examined histopathologically and by PCR, and blood samples were analysed serologically. Detection of L. intracellularis in tissue preparations by PCR showed good specificity and correlated to lesions found at necropsy. The sensitivity in spiked tissue samples was 10(1)-10(2) mimic molecules per tube. In faecal samples, nested PCR on boiled lysate gave the best result with a sensitivity of 10(2)-10(3) mimic molecules per reaction tube. However, because of the time-consuming procedure and the increased risk for contamination, a commercially available kit was preferred for routine diagnoses, despite a somewhat lower detection rate in subclinically infected pigs. In a few cases, the serological results differed from those obtained by PCR and by necropsy but the reason for this is not clear. This study indicates that the best method for diagnosis of acute enteritis in growers is PCR on faecal or tissue samples. To determine the presence of the bacteria in a herd, serology or repeated faecal sampling for PCR from target animals, or both, should be used.

[Diagnosis of Lawsonia intracellularis using the polymerase chain reaction (PCR) in pigs with and without diarrhea and other animal species]

Lawsonia (L.) intracellularis, an obligately intracellular bacterium, causes proliferative enteropathy (PE) in swine and, occasionally, in other animals. To determine the spread of the agent among German pig herds pooled fecal samples of five animals each of clinically normal Hessian pig herds collected between november 1998 and february 1999 as well as feces (n = 1684) from individual animals representing 648 herds, sent to our laboratory by veterinarians from all parts of Germany, were tested for L. intracellularis using the polymerase chain reaction (PCR). In addition, fecal samples from diarrhoic foals (n = 46), dogs (n = 57), cats (n = 50), calves (n = 37), hedge hogs (n = 9), seals (n = 8) and one giraffe were also studied. DNA was extracted from feces using high concentrations of chaotropic salt and diatomaceous earth. For PCR, primers flanking a 279 bp fragment of L. intracellularis DNA were used (JONES, G. F., WARD, G. E., MURTAUGH, M. P., LINN, G. (1993), J. Clin. Microbiol. 31, 2611-2615). Amplificates were separated by agarose gel electrophoresis and visualized under UV-light. L. intracellularis was found in 26 (12.8%) samples from 21 (30.0%) of the Hessian pig herds without symptoms of diarrhoea. In feces of pigs with diarrhoea (n = 1684) the agent was present in 431 (25.6%) samples originating from 224 (34.6%) herds. Of the other animal species studied, L. intracellularis was detected in feces of 4 (7.0%) dogs, 2 (5.4%) calves, 3 (33.3%) hedge hogs and in the sample of the giraffe. The remaining species were all tested negative.

Comparison of diagnostic techniques for porcine proliferative enteropathy (Lawsonia intracellularis infection)

In studying the post-mortem diagnosis of porcine proliferative enteropathy (PPE) a "double-blind" study was performed on 77 apparently healthy "finisher" pigs at the time of slaughter, to compare the results of a polymerase chain reaction (PCR) technique with those of (1) an indirect immunofluorescence assay (IFA), (2) examination for gross proliferative lesions at slaughter, (3) histopathological study of sections stained with haematoxylin and eosin (HE), and (4) Warthin-Starry (WS) silver staining for intracellular bacteria. The IFA, with a sensitivity of 89% and a specificity of 97% (positive "likelihood ratio"=30) and an agreement of 82% with PCR, is suggested as an alternative to the PCR in the post-mortem diagnosis of PPE. Histopathological examination was shown to be of little use as a principal diagnostic method, although it appeared to be effective in diagnosing infection by Lawsonia intracellularis in cases with proliferative-type lesions (positive likelihood ratio=29.6). Finally, the values obtained from an examination of gross lesions (k=0.075; positive likelihood ratio of 1.3) and WS staining (k=0.42; positive likelihood ratio of 5.3) demonstrated the lack of validity of these tests for the diagnosis of L. intracellularis infection.

Detection of Lawsonia intracellularis in diagnostic specimens by one-step PCR

Lawsonia intracellularis is not culturable with a standard bacteriologic culture. One step PCR assay as a clinical diagnostic method was developed for the rapid detection of porcine proliferative enteritis (PPE) caused by L. intracellularis. Primers were designed based on the p78 DNA clone of L. intracellularis. The one step PCR resulted in the formation of a specific 210-bp DNA product derived from L. intracellularis. The nonspecific amplification product was not detected with swine genomic DNA or other bacterial strains causing similar symptoms to L. intracellularis infection. The one step PCR was as sensitive as 100 pg of L. intracellularis genomic DNA. We applied this method to field specimens diagnosed as PPE by macroscopic observation. Of 17 mucosal scraping specimens, 16 (94%) were identified as positive to PPE and 15 (88%) of 17 feces specimens. These results suggest that the one step PCR can be used as a rapid diagnostic method for L. intracellularis infection.