Hemorrhagic bowel syndrome Hemorrhagic bowel syndrome

(HBS)(HBS)

S. Perl, J.Brenner, D. Elad, D. Lahav,

N. Edery and N. Sheikhat.

Kimron Veterinary Institute

P.O.Box12, Bet Dagan 50250

Veterinary Symposium, Israel 2004

Hemorrhagic bowel syndrome Hemorrhagic bowel syndrome

(HBS)(HBS)

� HBS is a sporadic acute intestinal disease of

milking cows

� Characterized by large blood clots in the intestinal lumen

� Obstruction and enlargement of the bowel

� Synonyms: “bloody gut”

“jejunal hemorrhagic syndrome”

Hemorrhagic bowel syndromeHemorrhagic bowel syndrome

(HBS) (HBS) � Clinically:

clotted blood in feces

profound depression

sudden drop in milk production

loss of appetite

abdominal distention and pain

severe anemia

extreme weakness

death within 24 hours

cases of sudden death are often reported

Hemorrhagic bowel syndromeHemorrhagic bowel syndrome

(HBS)(HBS)

� Ultrasound exams

dilated loops of small intestine

clotted blood in the lumen

� Treatment

medical or surgical unsuccessful

HBS has a high fatality rate

Hemorrhagic bowel syndromeHemorrhagic bowel syndrome

(HBS(HBS� First reported in 1991by Dr.Bruce Anderson in Idaho in five high-producing Holstein cows from one dairy farm

- Sub-mucosal hematomas in the jejunum(4)

- Ruptured hematoma with exanguination(1)

� Since 1991 HBS cases were diagnosed in various states in the US: Minnesota, New York

Pennsylvania, Washington, Colorado, Iowa etc.

Hemorrhagic bowel syndromeHemorrhagic bowel syndrome

(HBS)(HBS)� Evaluated nationally for the first time during the

National Animal Health Monitoring System’s Dairy 2002 study in the USA

� Farmers/ vets. from 21 States were asked to

describe their familiarity with HBS

only 1% have knowledge about the disease

2.5% had some basic information

8.7% recognized the name

87.8% had not heard of HBS

Hemorrhagic bowel syndromeHemorrhagic bowel syndrome

(HBS)(HBS)� Etiology:

not known

Clostridium perfringens Type A suggested

- has been found in 85% of HBS cases

- not yet determined as primary involved

because Clostridium Type A is common in

the environment and in bovine GI tract

Aspergillus fumigatus recently implicated

Hemorrhagic bowel syndromeHemorrhagic bowel syndrome

(HBS)(HBS)

� Proposed risk factors for HBS:

- increasing milk production

- feeding a high carbohydrate ratio

- decrease in dietary fiber

- most cases in winter season

- poorly fermented ensiled feeds

HBS - Case of 2001

מכון ולקני

Obstructed lumen of the small intestine by blood clots

HBS - Case of 2001

HBS - Case of 2003

Obstructed lumen of the small intestine by blood clotsכפר שמואל

HBS- case of 2004

Obstructed lumen of the small intestine by blood clots

HBS – case of 2004

Obstructed lumen of the small intestine by blood clots

Obstructed intestinal segment

Blood clots in the intestinal lumen

Hemorrhagic bowel syndromeHemorrhagic bowel syndrome

(HBS) cases in Israel(HBS) cases in Israel

(10/08/00) 3

(22/08/96) 6

5

(22/06/94) 8

4

4

(27/09/95) 6

(23/11/95) 6

(25/09/98) 3

גיל

425339

384090

351536

339948

348615

344637

342069

340286

325021

ח"דו' מס

23.02.04

11.02.03

13.06.02

22.06.02

15.05.02

09.04.02

13.03.02

21.02.02

9.11.010

- PMתאריך

כפר שמואל

כפר שמואל

ניר עוז

פלמחים

לוטן

גבעתי

אורטל

ניר גלים

בית דגן

ישוב

E. Coli hemolitic

NPB found

ND

Cl. Perfringens

ND

ND

NPB found

NPB found

NPB found

בקטריולוגיה

Histology

Normal Necrosis and hemorrhage

Jejunal mucosal necrosis and hemorrhage

Hemorrhagic bowel syndromeHemorrhagic bowel syndrome

(HBS)(HBS)Conclusions

� HBS is a highly fatal intestinal disease

� Intraluminal hemorrhage and obstruction

� Adult cows on the second lactation or more

� Primary cause not yet determined

� HBS is under diagnosed in Israel

� Tens of dead cows are incinerated each day at the

“Ein Hamifratz” incinerator with out PM examination

Hemorrhagic bowel syndromeHemorrhagic bowel syndrome

(HBS)(HBS)

Thanks to the clinicians:

, אלפרטניר ' דר, דגוניאילן ' דר, נחום שפיגל' דר

מאיר למפרט' תמיר גושן ודר' דר, חןגילד' דר