Bacterial culture and immunohistochemical detection of bacteria and endotoxin in cats with suppurative cholangitis-cholangiohepatitis syndrome

Abstract

OBJECTIVE To characterize the frequency and type of bacterial infection by culture- and immunohistochemical (IHC)-based methods and determine the impact of infection on clinical features and survival time in cats with suppurative cholangitis-cholangiohepatitis syndrome (S-CCHS). ANIMALS 168 client-owned cats with S-CCHS (cases). PROCEDURES Clinical features, bacterial culture results, culture-inoculate sources, and survival details were recorded. Cases were subcategorized by comorbidity (extrahepatic bile duct obstruction, cholelithiasis, cholecystitis, ductal plate malformation, biopsy-confirmed inflammatory bowel disease, and biopsy-confirmed pancreatitis) or treatment by cholecystectomy or cholecystoenterostomy. Culture results, bacterial isolates, Gram-stain characteristics, and IHC staining were compared among comorbidities. Lipoteichoic acid IHC staining detected gram-positive bacterial cell wall components, and toll-like receptor expression IHC reflected pathologic endotoxin (gram-negative bacteria) exposure. RESULTS Clinical features were similar among cases except for more frequent abdominal pain and lethargy in cats with positive culture results and pyrexia, abdominal pain, and hepatomegaly for cats with polymicrobial infections. Bacteria were cultured in 93 of 135 (69%) cats, with common isolates including Enterococcus spp and Escherichia coli. IHC staining was positive in 142 of 151 (94%) cats (lipoteichoic acid, 107/142 [75%]; toll-like receptor 4, 99/142 [70%]). With in-parallel interpretation of culture and IHC-based bacterial detection, 154 of 166 (93%) cats had bacterial infections (gram-positive, 118/154 [77%]; gram-negative, 111/154 [72%]; polymicrobial, 79/154 [51%]). Greater frequency of bacterial isolation occurred with combined tissue, bile, and crushed cholelith inoculates. Infection and gram-positive bacterial isolates were associated with significantly shorter long-term survival times. CLINICAL RELEVANCE S-CCHS was associated with bacterial infection, pathologic endotoxin exposure, and frequent polymicrobial infection in cats. Combined tissue inoculates improved culture detection of associated bacteria.

Cholecystoduodenostomy for biliary obstruction treatment in a white‐collared lemur (Eulemur cinereiceps)

“…However, concomitantly to his cholelithiasis, the lemur suffered from a biliary infection by E. casseiflavus , a bacteria commonly found in biliary pathologies in humans and non‐human primates, 3,18 which could have contributed to the formation of the calculi. It is often not possible to ascertain whether the infection of bile initiates gallstone formation or vice‐versa, but the presence of gallstones is associated to gallbladder infection in more than 69% of cases in domestic carnivores 18 and in many primate species 3 . Both perpetuate a cycle of inflammation of the duodenal papilla.…”

“…Both perpetuate a cycle of inflammation of the duodenal papilla. They may even secondarily cause a partial obstruction of the biliary tree near the duodenal papilla and therefore further increase the risk of bacterobilia by (1) increasing biliary pressure, hence damaging hepatocytes and increasing cellular entry of portal‐circulating bacteria; (2) disrupting enterohepatic bile acid flux, thus inducing a disruption in the cholesterol to bile acid ratio and favouring further infection; and (3) reducing the local immune system of the hepatobiliary system 18 . This was suspected in our case.…”

“…Consequently, early initiation of broad‐spectrum antimicrobials is indicated in case of cholelithiasis suspicion. In veterinary medicine, a trimodal antimicrobial protocol including (1) a fluoroquinolone, (2) ampicillin‐sulbactam, amoxicillin clavulanate or imipenem, and (3) metronidazole is often indicated 18 . In our case, to limit the use of antibiotics and number of treatments to administer to the animal, and according to the antibiogram obtained from the gallstone analysis, only amoxicillin and metronidazole were prescribed.…”

“…In veterinary medicine, a trimodal antimicrobial protocol including (1) a fluoroquinolone, (2) ampicillin-sulbactam, amoxicillin clavulanate or imipenem, and (3) metronidazole is often indicated. 18 In our case, to limit the use of antibiotics and number of treatments to administer to the animal, and according to the antibiogram obtained from the gallstone analysis, only amoxicillin and metronidazole were prescribed. To optimize efficiency and reduce clinical signs, antimicrobial medical therapy should be associated to supportive care treatment until a surgical removal of the gallstones can be undertaken.…”

Surgical Management Of Feline Biliary Tract Disease: Decision-making and techniques

“… 25 Nontraumatic bile peritonitis, in contrast, may be associated with a concurrent focus of infection and a septic peritonitis. 27 , 28 …”