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Discussion on Necropsy found C. Sordelli throughout gelding's body
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Member:
Jmarie
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Posted on Thursday, Jan 4, 2007 - 5:13 pm:
Dr. O, I hope you can shed some light on this for me. I posted when I first came aboard last month about a gelding who had just died and preliminary test results showed hemmorhage in his liver and intestine. Now the final necropsy report has come back and shows MASSIVE c. sordelli throughout his body--brain, spinal cord, stomach, bladder, liver, intestine . . . The vet doing the necropsy said she'd never seen anything like it in a live horse.
Can you give me some idea where this sort of infection might have come from? The horse received no injections, no blood builders, nothing but normal grain and hay. He was a 16-yo Morgan in apparently perfect health. The owner of the boarding farm is beside herself as is my daughter who still has a mare boarded there who shared a pen with the gelding. I can't seem to find anything on this online other than toxic shock synDrOme in pregnant humans. Anything you can tell me will be appreciated.
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Moderator:
DrO
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Posted on Friday, Jan 5, 2007 - 7:24 am:
Joanne, it will be more helpful if you would post this under the original post so that the case has some continuity. If you would also reproduce the lab findings it will improve the interpretation.
DrO
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Member:
Jmarie
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Posted on Friday, Jan 5, 2007 - 9:58 am:
Dr O, I've searched but can't find the original thread. It was an old one about a horse that had died suddenly, and I just posted a short "same thing happened to us this week" message, but it was my first post on the board, and I can't remember what the category of the thread was. It doesn't show under my "most recent posts", and I've looked at the threads that mention sudden death and haven't found it. Sorry. I posted it around 12/20. Is there a way to search for specific dates?
I don't have the formal lab results. My daughter, whose horse it was, lives some distance from here and reported to me the verbal she got from the vet who performed the necropsy. She has to request a copy of the actual lab report. However, she has a biology degree and her husband is a physician, so her verbal report should be fairly accurate minus the actual numbers on the blood count.
Unfortunately, the verbal report is not much more detailed than what you see above. The blood screens on both horses during the gelding's final hours indicated low white cell counts (lower for the gelding than the mare), but nothing else. The mare had a fever at the time and was taken to the clinic and pumped with DMSO. She was back to normal within hours, and is currently being treated for ulcers which were, apparently, what was causing her gastric distress.
The gelding, however, though he continued to pass manure and urinate normally, went rapidly downhill from an initial colic attack to seizures/convulsions to brain death. Six hours, tops, from start to euthanasia. The first look at the carcass indicated a dead section of intestine and liver with nothing neurological. Toxicology done after that, however, found c. sordelli even in the spinal fluid, which the administering vet says shouldn't even be possible as it's a sterile environment. In addition, the presence of anaerobic bacteria throughout the body is leaving huge question marks in everyone's mind. Lesions and hemorrhage were found in the brain, spinal cord, stomach, bladder, liver, heart and intestine. In other words, all organs were involved.
The question is where/how does a horse come into contact with c. sordelli? No one, including the vet, has a clue, and this needs to be sorted out. I'm coming up blank in my google searches with the exception of a scholarly report on the various types of clostridium. The report describes it but gives no indication of its habitat in nature. Nor does it suggest a route by which the horse could have been contaminated other than injection site (no injections have been given to this horse with the exception of October's fall vaccinations).
We are wondering if this type of infection is 1) common, 2) likely, 3) possible . . . or if the samples were more likely somehow cross-contaminated during the necropsy, which would send us back to square one in the search for a cause.
Again, anything you can tell me about c. sordelli in equines would be of tremendous value. Thanks.
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Member:
Ajudson1
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Posted on Friday, Jan 5, 2007 - 10:16 am:
Joanne,
Nothing to offer about the infection, but I do want to offer words of comfort for your daughters loss. How devastating to not only loose her horse, but also to not be able to find out why it happened.
Don't know about the rest of you, but I wish it would freeze and get rid of the nasties thriving in this mild and wet winter.
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Member:
Jmarie
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Posted on Friday, Jan 5, 2007 - 11:08 am:
Thanks, Angie. It's been quite an experience, I can assure you. I'd like to get to the bottom of it before someone else goes through the same thing. I have a feeling we're looking at something really weird here.
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Moderator:
DrO
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Posted on Saturday, Jan 6, 2007 - 8:27 am:
Devastating infections with Clostridium sordelli occurs in humans and other mammals and is often unexplained. I would suspect the most common initial site of infection would be the bowel but inactive spores have been found incidentally in horse muscle on necropsy. The only good study of the possible causes has been done in humans:
Clin Infect Dis. 2006 Dec 1;43(11):1436-46.
Clostridium sordellii infection: epidemiology, clinical findings, and current perspectives on diagnosis and treatment.
Aldape MJ, Bryant AE, Stevens DL.
Veterans Affairs Medical Center, Boise, ID 83702, USA.
Clostridium sordellii infections pose difficult clinical challenges and are usually fatal. Most commonly, these infections occur after trauma, childbirth, and routine gynecological procedures, but they have recently been associated with medically induced abortions and injection drug use. We report 2 fatal cases, one of which was associated with minor trauma, and the other of which was associated with normal childbirth, and we summarize the clinical features of 43 additional cases of reported C. sordellii infection. Of these 45 cases, 8 (18%) were associated with normal childbirth, 5 (11%) were associated with medically induced abortion, and 2 (0.4%) were associated with spontaneous abortion. The case-fatality rate was 100% in these groups. Ten (22%) of the C. sordellii infections occurred in injection drug users, and 50% of these patients died. Other cases of C. sordellii infection (in 19 patients [43%]) occurred after trauma or surgery, mostly in healthy persons, and 53% these patients died. Overall, the mortality rate was 69% (31 of 45 patients). Eighty-five percent of all patients with fatal cases died within 2-6 days of initial infection, and nearly 80% of fatal cases developed leukemoid reactions. Rapid diagnostic tests and improved treatments are needed to reduced the morbidity and mortality associated with this devastating infection.
The above report with the finding of spores in the muscles of horses suggest that beside possible extension from the bowel into the bloodstream that the spores lodge in the muscles and when some traumatic episode comes along a small area of decreased oxygen tension activates the spores that then release tissue harming toxins that allow the organism to spread through the body.
DrO
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Member:
Jmarie
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Posted on Saturday, Jan 6, 2007 - 8:50 am:
Thanks so much, Dr.O. I did come across that study in my search, but little else.
So then it would seem possible that the dead chunk of gut might have actually been the root of the infection rather than the result. He'd had no trauma, no prior illness, nothing at all to account for any of this. One day he was learning the piaffe, the next he colicked, and on the third he was dead. Bizarre!
What is the source of the spores? Do they occur naturally in the ground, or does the animal have to come into contact with a carrier? The barn owner is still beside herself over the danger to the rest of the horses if she can't locate the source of the bacteria.
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Member:
Ilona
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Posted on Saturday, Jan 6, 2007 - 9:40 am:
Dr O,
How does C.sordellii spread. You did mention that decreased oxygen activated the spread of the spores, already lodged in the body of the person/animal. Are these air-born or do they need a warm transport vehicle like HIV where certain conditions make transmission possible from one person to another? It seems that it does not lie dormant but attacks a vulnerable immune system.
Obviously this is quite uncommon, however I am very interested.
Thanx for any insight you can give. You can also just tell me to go to Medline myself!
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Member:
Jmarie
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Posted on Saturday, Jan 6, 2007 - 9:57 am:
My question exactly!
According to one biochemist I contacted, once the bacterium spores, the spores can live on for decades in a manure pile, for instance, and not be killed by the heat of composting. But where do they come from initially and how does the horse (or human) pick them up? Even more scary is the prospect that spores spread on a field which is later hayed might still be capable of killing a horse. Is that the case? And if it is, then why aren't there more reported instances of this sort of massive infection? This is driving us all nuts!
Medline has absolutely nothing on this that I can find. The Veterinary Record, Vet Pathology, Merck Manual, and on and on . . I checked as many sources as I could find and got no answer to that very important question.
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Moderator:
DrO
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Posted on Saturday, Jan 6, 2007 - 11:33 am:
There is little work on C. sordelli guys but many clostridia are normal inhabitants of the areas of the bowel where oxygens tension is low and then it passes out the stools as spores. Some seem to make it from animal to animal killing the animal then multiplying wildly, then turning to spores as decomposition comes to an end and oxygen goes back up. These can be spread by the wind just as dust is.
DrO
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Member:
Mrose
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Posted on Saturday, Jan 6, 2007 - 12:40 pm:
Isn't colstridia the same bacteria that causes a particularly nasty pnuemonia, esp. in foals?
I remember one year in the Sacramento area it was hot, dry and windy and there were many more than normal cases of bacterial pnuemonia, which if this is the same bacteria, would make sense as it could have been spread by the wind.
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Member:
Jmarie
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Posted on Saturday, Jan 6, 2007 - 3:07 pm:
So are botulism, tetanus, and one of those nasty necrotizing, flesh-eating diseases. There are about a dozen different clostridia strains, at least one of which is totally harmless. Most are pretty deadly.
Thanks for the additional information, Dr. O. Though nothing seems really definitive, at least I think it's safe to say there's no way to defend against c. sordellii. It's one of those "luck of the draw" things.
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Member:
Nastazja
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Posted on Sunday, Jan 7, 2007 - 3:42 am:
C. Sordelli is commonly spread from person to person.. usually women at gynaecologists/abortion type of procedures..
Isn't metronidazole used in some success for this condition as well as other broad-spectrums ?
Hmm.. that is only if the toxin will not travel through the passages of the whole body.
I recently found something about clostridia in my Merck Manual and how to prevent this toxin from inhabiting - vaccinating with C perfringens type C and D toxoid and antitoxin have been used in foals on problem farms.
"Clostridia are strictly anaerobic to aerotolerant sporeforming bacilli found in soil as well as in normal intestinal flora of man and animals. There are both gram-positive and gram-negative species, although the majority of isolates are gram-positive. Exotoxin(s) play an important role in disease pathogenesis"
"Engorgement with milk or grain may slow digestion, allowing bacteria time to multiply. Some clostridial bacteria need an oxygen-free environment, such as a damaged muscle, so a deep bruise, surgery such as tail docking, castration or a puncture wound can create the right conditions for rapid bacterial growth."
"Clostri Shield 7 from Novartis Animal Health is a 7-way clostridial vaccine that is proven effective against a broad spectrum of clostridial bacteria. Clostri Shield 7 aids in the prevention of blackleg caused by C. chauvoei, malignant edema caused by C. septicum, black disease caused by C. novyi, gas gangrene caused by C. sordellii and enterotoxemia caused by C. perfringens Types B, C and D."
"Antitox Tet and Clostratox can be used to treat disease as well as prevent it, but must be given at much higher doses. Antitoxins should be used in conjunction with antibiotic therapy."
Did he have any open wounds of any kind..(?)
C. botulinum and its common entry is usually by mouth.
The above vaacinations are used in cattle, some are used in combination of horse blood. There is nothing that says that is cannot be used in horses - one just has to watch for the effects of the drug in broodmares. Some vet manuals seem to be comfortable with administering such vaccinations, not necessarily intended for equine use.
DrO what do you think ?
Hope this helps.
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Member:
Jmarie
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Posted on Sunday, Jan 7, 2007 - 8:45 am:
Thanks, Nastia. That was interesting. I did come across the vaccine and sent the link out to the farm so they can consider vaccination. I hope that will put their minds at ease.
No, there were no wounds of any kind and no injuries. He was solid as a rock--the kind of horse that you just don't worry about. Easy keeper on a half-scoop of Complete twice daily and free-choice grass hay. No issues, no problems, no predisposition. He's never colicked in his life, and his only injuries have been self-inflicted--twice in his life he tore his eyelid, as a yearling, and most recently about 8 years ago.
That's why this is all so confusing. Had it been the mare who succumbed, no one would have been surprised. She's been injured repeatedly over the past year, had stitches, IV antibiotic treatment, and multiple traumas not requiring stitches. She got in with the wrong crowd, so to speak, and got the snot kicked out of her. She would have been an ideal candidate for a massive bacterial infection. Not the gelding. The mare is fine, and the gelding is dead. Go figure! 
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Moderator:
DrO
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Posted on Sunday, Jan 7, 2007 - 9:37 am:
There is no reason to believe vaccinating for C perfringens will protect against C sordelli that I am aware of so the specific clostridial vaccine would be indicated for individuals at risk. However I do not know of one approved for use in horses and the risk for this problem hard to define. The appropriate use of this vaccine in horses, if any use is appropriate, hard to judge.
In humans, gynecological procedures are associated with increased risk of C sordelli but there are other possible explanations than cross contamination. If the bowel is a common source of infection then this may be from fecal contamination: that is they are infecting themselves.
DrO
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Member:
Nastazja
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Posted on Sunday, Jan 7, 2007 - 1:18 pm:
Some people have the bacteria around the anus, so it is easily accessible during abortions and such for contamination. What is interesting is why some of the human population has it, and some do not.
Thank you DrO 
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Member:
Ilona
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Posted on Sunday, Jan 7, 2007 - 5:31 pm:
Dr O,
Thanx for your input.
IMO life tends to come down to same bottom line. Hygiene, common sense, good health maintenance and care program including nutrition and that is the best prevention you can do. I could drive myself quite crazy with all the disastrous possibilities for my horses.
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Member:
Jmarie
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Posted on Tuesday, Jan 9, 2007 - 11:03 am:
Ilona, I think you've got it nailed. There comes a point when you have to just step back and say, "Hey . . . they're horses. They're out there doing what they do, and I'm doing the best I can to be sure they're safe doing it. The end."
This looks like just such a moment. We've torn ourselves up trying to get to the root of the problem, and it appears the root is not available for inspection. Frustrating, but unavoidable.
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