Tropical theileriosis (Mediterranean coast fever) is an endemic disease of cattle in Mediterranean basin and parts of Asia.1,2 A nervous form of the disease, known as cerebral theileriosis (turning disease), may develop in cattle.3,4 Cerebral theileriosis is manifested by ataxia, hypermetria, conscious proprioceptive deficits, circling, depression, head pressing, opisthotonos, nystagmus, blindness, hypersthenia, and convulsions. In this form of theileriosis, the animals become recumbent and develop severe opisthotonos, tonic-clonic seizures and coma.4,5 In rare cases the parasite may localize in the spinal cord.2-4 This paper examines the clinical and laboratory data from a rare case of newborn twin Holstein calveswith cerebral theileriosis which result in local necrosis of the brain following Arthus reaction through the walls of cerebral blood vessels.5 There were no report or study similar to the present case from cattle in previous reports.
An 8-day-old newborn female twin Holstein calves with a history of weakness, anorexia, emaciation and convulsion were presented to Tabriz University Veterinary Teaching Hospital. The calves were referred from a semi-industrial dairy farm around Tabriz suburb. In clinical examinations, recumbency, depression, severe opisthotonos, nystagmus, pedaling, blindness, hypersthenia, pale buccal and vaginal mucous mucus membranes, sunken eyes, coughing, severe jaundice in mucus membranes, profuse salivation, lacrimation, dyspnea, diarrhea and dehydration were observed. The calves had been normal at the birth time and showed ataxia and blindness within five days after it. The calves were febrile (38.5 to 39 ˚C) and physical examination revealed heart rate of 124 beats per min, respiration rate of 68 breaths per min, extended heart sound to the thorax and flank, pale buccal and vaginal mucous with numerous petechial hemorrhages. Respiratory tract examination revealed dyspnea with moist rale (crackles) and occasionally apnea and palpation of the trachea caused coughing. Laboratory evaluation included a complete blood count (Hospitex Diagnostics, Florence, Italy), and fecal flotation test (with saturated sugar solution) for the detection of parasitic infections. In addition, blood smears on the glass slides were obtained from marginal veins of the earlap of both calves, fixed in methanol 10%, stained with Giemsa and examined for the presence of Theileria piroplasms. Urine samples were obtained from one of the calves and analyzed by tape urine analysis. Cerebrospinal fluid (CSF) samples were collected from lumbosacral cisterna by a 14 gauge needle. Although initial supportive treatment with a single intramuscular injection of buparvaquone (Razak Co., Karaj, Iran) and oxytetracycline (Razak Co., Karaj, Iran) once daily were performed the animals’ condition did not improve and ultimately, the calves died after two days. Necropsy was performed within 6 hr of death. Samples of the liver, spleen, kidney, intestine, lung and brain were collected and fixed in 10% buffered formalin for 24-72 hr. The samples were cut into 5 µm sections after embedding in paraffin. These sections were stained with hematoxylin and eosin and finally evaluated by a veterinary pathologist under the light microscope.
Hematological and urological findings. Complete blood countrevealed hemoglobinemia, lymphopenia and severe non-regenerative anemia (packed cell volume, PCV 16%), (Table 1). Morphology of red blood cells (RBCs) exhibited polychromasia, poikilocytosis, anisocytosis, Howell-Jolly body and basophilic stippling. Nearly 70 percent of piroplasm organisms in erythrocytes were rod shaped. Samples of CSF were normal and did not have turbidity or other abnormalities. Urinalysis showed dark reddish brown urine in appearance, proteinuria (trace), bilirubinuria (2+) and hematuria (2+).
Macroscopic pathological and parasitological findings.At necropsy, the carcasses were apparently cachectic, edematous, pale and relatively icteric. Free bloody fluids without fibrin and clot were found in abdomen and pericardium. Numerous petechia were evident on mucus membranes especially on palpebral conjunctiva, third eyelid and under the tongue. In one of the calves, prominent swelling was seen on superficial lymph nodes such as left prescapular, precrural, iliac and retropharyngeal (8 cm in diameter) lymph nodes. On transverse section of the lymph nodes, congestion, edema, red-brown cortex with numerous focal hemorrhage and dark red-brown medullary area were observed. Hepatomegaly with distended gall-bladder, yellowish brown color, rounded edges and sub-capsular focal hemorrhages in liver were clearly apparent. The kidneys were congested with cortical hemorrhages and moist on cut surfaces. On macroscopic examination of gastrointestinal tract, ulcerative abomasitis were observed. The ulcers were irregular in shape and various in size (2 to 10 mm in diameter) and appeared as punched-out craters surrounded by elevated rolled edges and involved most of the gastric mucosa. Gross examination of CNS revealed edema, congestion, petechial hemorrhages of the brain and meninges.
Microscopic pathological findings. On tissue section of the bone marrow, liver, kidney and heart Koch’s blue bodies were present (Macroschizont, Fig. 1). The histopathological examination on lymph node and spleen smears demonstrated severe infiltration of lymphocytes with hemorrhage and fibrinous exudates throughout the cortical areas of nodes. Lymphocytolysis was prominent in germinal centers and there was a general loss of small lymphocytes with those that remained large and blastic.
Also severe edema and numerous erythrophages, large macrophages that have phagocyted parasite-infected erythrocytes, were observed (Fig. 2a). The lesions indicated hemorrhagic lymphadenitis, splenitis, massive lymphocytolysis and blastoid transformation. The ulcers of the abomasums were associated with necrosis of epithelium, adjacent epithelial hyperplastic lesions, edema, arteritis, hyaline thrombi, infiltration of polynucleated cells and hyperplastic submucosal lymphoid follicles (Fig. 2b). The bone marrow was hyperplastic with the remaining cells consisting of large, blastic, parasitized lymphocytes and atypical erythroblasts. Accumulation of macrophages containing hemosiderin and phagocyted infected and non- infected erythrocytes were present with majority of them in spleen, lymph nodes and bone marrow. There were intravenous accumulations of lymphoblasts (with and without schizonts) in the brain, with venous thrombi and perivascular infiltration by lymphocytes. Microscopically, diffuse gliosis, perineuronal and perivascular hemorrhages and/or edema, status spongiosis, hyaline thrombi in capillaries and arterials, activation of endothelial cells and sequestration of parasitized cells in vessels were noticed in brain (Figs. 2c-f). Numerous thrombus formations and parasite-infected erythrocytes and lymphoblasts sequestered in cerebral blood vessels were also apparent on brain histopathological section (Fig. 2e). Arthus reaction was also present through the walls of cerebral blood vessels, which resulted in local necrosis of the brain.