Duodenitis‐Proximal Jejunitis in Horses After Experimental Administration ofClostridium difficileToxins

Abstract

BackgroundDuodenitis‐proximal jejunitis (DPJ) is an acute sporadic gastrointestinal disorder of horses of unknown cause.Hypothesis/ObjectivesWe hypothesize that Clostridium difficile toxins are involved in the pathogenesis of DPJ in horses. The objective of this study was to determine whether experimentally delivered C. difficile toxins cause clinical signs and histologic lesions similar to those of naturally occurring DPJ.AnimalsSix healthy mature mixed breed horses.MethodsExperimental study: animal model of animal disease. Fasted horses were administered crude C. difficile toxins via gastroscopy and monitored for up to 48 hour. Blood was collected for complete blood cell count, biochemistry profile, and plasma fibrinogen assay, and abdominal fluid was collected for cytologic analysis and total solids before and after toxin administration. Physical examination and abdominal ultrasonography were performed throughout the study period. Tissues were collected from the gastrointestinal tract and processed for routine histologic analysis, and lesions were scored.ResultsClinical signs were observed in 2 of 6 horses that are typical although not specific for horses with naturally occurring DPJ. Histopathologic lesions were observed in 6 of 6 horses and were similar to those reported in horses with naturally occurring DPJ. Two horses were severely affected.Conclusions and Clinical ImportanceDuodenitis‐proximal jejunitis is likely a syndrome with multiple causes that result in the same clinical and pathologic findings, and our data suggest that the toxins of C. difficile represent one cause of this syndrome. Toxin dose and variation in individual animal susceptibility might affect the clinical signs and lesions after administration of C. difficile toxins.

Clostridial Diseases of Horses: A Review

“…Recently, C. difficile has been associated with the so-called duodenitis-proximal jejunitis (DPJ) syndrome, a sporadic gastrointestinal process for which a specific cause is largely unknown [35]. DPJ was successfully reproduced by inoculation of C. difficile toxins via gastroscopy [36]. Affected horses may present with ileus and colic of variable severity accompanied by nasogastric reflux [35].…”

Clostridium (Clostridioides) difficile in animals

“…14 Clinical and histologic changes consistent with that disease were reproduced experimentally by administration of a C. difficile toxin suspension. 13…”

Clostridioides difficile infection and One Health: an equine perspective

“…Further infection development may result in a progression to severe CDI, with additional features of haemodynamic instability, pseudomembranous colitis and severe anorexia (Bartlett et al, 1978). In horses, C. difficile is also a known cause of duodenitis-proximal jejunitis and necrotizing enteritis (Arroyo et al, 2004;Arroyo et al, 2017). Extracolonic manifestations such as bacteremia and organ failure can also develop and extreme cases can result in death (Dallal et al, 2002;Arroyo et al, 2004;Napolitano and Edmiston, 2017).…”