CASE REPORT ACTINOMYCOSIS OF THE TRACHEA IN A MATURE COW R. G. STEVENSON
AND
R. G. TAYLOR'
Introduction The most frequent and obvious manifestation of infection by Actinomyces bovis in cattle is osteomyelitis of the mandible or maxilla, hence its common name "lumpy jaw" (4, 7). Infection of soft tissues does occur and infection of the alimentary tract, lungs and testes have been described (1, 3, 5). This report describes the clinical signs and lesions of actinomycosis of the trachea in a mature cow. History The subject was a seven year old Holstein cow which had been born and reared on the premises. She was housed in a stanchion barn with 43 other animals and was fed a diet consisting of diary ration (10-12 lb/day), brewer's grain (20-30 lb/day), soy bean meal (1-2 cakes/day) and hay (20-30 lb/day). For approximately four weeks prior to veterinary examination, the owners had been periodically treating the animal with penicillin and streptomycin for what they believed was pneumonia. The animal would appear to have recovered after two to three days treatment only to relapse several days later. Veterinary assistance was requested when the cow failed to respond at all to the last treatment with penicillin and streptomycin. The cow was first examined on March 19 and had severe inspiratory dyspnea and very harsh sounds over the trachea. The lung sounds were normal and there was no pyrexia. A diagnosis of tracheitis was made and the antibiotic treatment was changed to oxytetracycine. By March 22 there was no improvement and therapy was changed to chloramphenicol. The cow died on March 24. Post Mortem Examination The nostrils, laryngeal area, trachea and bronchi were filled with white frothy fluid. The lungs were very edematous and emphy'Animal Pathology Division, Health of Animals Branch, Agriculture Canada, Atlantic Area Laboratory, P.O. Box 1410, Sackville, New Brunswick EOA 3C0 (Stevenson) and Department of Forestry & Agriculture, Government of New-
foundland & Labrador, P.O. Box 7400, St. John's West, Newfoundland (Taylor).
L11~~~*¢ .U_1W_
1w
sematous. Examination of the trachea revealed the presence of a large gray mass blocking off approximately 90% of the tracheal lumen at the level of the thoracic inlet. The mass was approximately 6 cm long and 4 cm wide where it was attached to the tracheal mucosa. It was very firm and the surface was irregular. On cross section there were numerous small yellowish-white foci of necrosis (Figure 1). A representative sample was fixed in 10% formalin and forwarded for histopathological examination.
Histopathology Scattered throughout the mass of tissue were foci of basophilic clumps of bacteria surrounded by eosinophilic club-like projections (Figure 2). The cellular reaction immediately surrounding the rosettes varied. 78
CAN. VET. JOUR., vol. 18, no. 10, October, 1977
L
FIGURE 1. Cross section of the solitary large encapsulated mass containing necrotic foci which is attached to the trachea. It is divided into two unequal portions by a dense band of fibrous tissue.
ACTINOMYCOSIS
FIGURE 2. Typical rosette (R) formation surrounded by neutrophils (N), ( N), ervthrocvtes ( E) rounde mn neutlerophls and m-iononuclear cells (M). H&Er.throc2t H & E. X320.
Multinucleated giant cells were occasionally present but generally neutrophils, with or without epithelioid cells, were the predominant cell types (Figure 3). An ill-defined zone of neutrophils, erythrocytes and macrophages was next which, in turn, was surrounded by radiating bands of fibrous tissue
containing plasma cells and an occasional lymphocyte. Sections stained using a modified Brown and Brenn technique (6) revealed Gram-positive long, thin, filamentous organisms which sometimes branched and often were beaded (Figure 4). No acid-fast organisms were observed using a modified ZiehlNielsen technique. On the basis of these observations a diagnosis of actinomycosis was made. Discussion
Clinical signs were suggestive of obstructive tracheitis. The differential diagnosis included: - laryngeal edema, - aspiration or inhalation of a large foreign body, - neoplasm, - infectious agents, e.g. infectious bovine rhinotracheitis, (IBR), - granuloma or abscess.
F
FIGURE 3. The cellular exudate surrounding the rosettes (R) is composed of an inner zone of neutrophils (N) and epithelioid cells (E) and an outer zone of epithelioid cells, macrophages (M), neutronhils. r-CUI l1asma cells and occasionallv viant 51'l cells (G). H &- r E. x130. ..
L
CIa
Laryngeal edema was not observed and inhalation of a foreign body was ruled out on the basis of the history and temporary response to treatment. The clinical signs might have been caused by a neoplasm but primary neoplasms of the trachea are very rare (2). Typical clinical signs of IBR were absent and none of the other animals had clinical signs of IBR. Also IBR is not common in this area of Newfoundland. Because of the initial apparent response to treatment with antibiotics as reported by the owner, bacterial agents were presumed to be implicated although no particular organism was considered. No lesions of the head, mouth or pharyngeal area were observed which might have suggested actinomycosis or actinobacillosis. Usually granulomatous lesions of soft tissue are caused by Actinobacillus lignieresi and those of hard tissues by Actinomyces bovis. In this particular case an organism morphologically indistinguishable from A. bovis was involved. Actinomyces bovis is considered to be a normal inhabitant of the mucous membranes of the digestive and upper respiratory tracts
279
CANADIAN VETERINARY JOURNAL
_;Ft'Y, ir
a large mass in the lower third of the trachea. Actinomycosis was diagnosed on the basis of a typical granulomatous inflammatory reaction and the demonstration of Gram-positive branching, filamentous bacteria. Resume
Une vache adulte qui manifestait de la dyspnee, lors de l'inspiration, et qui laissait entendre des rales tracheaux stridents, mourut en depit d'une antibiotherapie intensive. La necropsie de la bete permit de decouvrir une masse volumineuse, dans le tiers inf6rieur de la trachee. Le diagnostic d'actinomycose reposait sur la presence d'une reaction inflammatoire granulomateuse caracteristique, qui recelait des bacteries Gram positives, filamenteuses et ramifiees.
l,~A
BrwadBrn.
an
180
t isasmdttinfci.ocr olw
FIGURE 4. Tangled mass of Gram-positive organisms, some of which show branching (arrow). Brown and Brenn. x 1280.
and it is assumed that infection occurs following trauma or ulceration of the mucosa. In the present case we were unable to demonstrate the cause of the initial damage but presume it must have been due either to inhalation or penetration of a foreign body.
Summary A mature cow with clinical signs of inspiratory dyspnea and harsh tracheal sounds died despite intensive antibiotic treatment. Post mortem examination revealed the presence of
280
References 1. BRUER, A. N. Actinomycosis of the digestive tract in cattle. N.Z. vet. J. 3: 121-122. 1955. 2. COTCHIN, E. Neoplasms of the Domesticated Mammals. A Review. p. 18. Commonwealth Agricultural Bureaux. 1956. 3. ILLING, K. and J. MARTIN. Aktinomykotische Erkrankungen ausserhalb des Kopfbereiches des Rindes. Arch. exp. VetMed. 24: 251-268. 1970. 4. JUBB, K. C. F. and P. C. KENNEDY. Pathology of Domestic Animals. Volume 1. New York and London: Academic Press. 1970. 5. KIMBALL, A., M. J. TWIEHAus and E. R. FRANK. Actinomyces bovis isolated frQm six cases of bovine orchitis. Am. J. vet. Res. 15: 551-553. 1954. 6. MANUAL OF HISTOLOGIC STAINING METHODS OF THE ARMED FORCES INSTITUTE OF PATHOLOGY. Third Edition. Lee G. Luna, Ed. p. 222. American Registry of Pathology. 1968. 7. SMITH, H. A., T. C. JONES and R. D. HUNT. Veterinary Pathology. Fourth Edition. Philadelphia: Lea & Febiger. 1972.
AND
R. G. TAYLOR'
Introduction The most frequent and obvious manifestation of infection by Actinomyces bovis in cattle is osteomyelitis of the mandible or maxilla, hence its common name "lumpy jaw" (4, 7). Infection of soft tissues does occur and infection of the alimentary tract, lungs and testes have been described (1, 3, 5). This report describes the clinical signs and lesions of actinomycosis of the trachea in a mature cow. History The subject was a seven year old Holstein cow which had been born and reared on the premises. She was housed in a stanchion barn with 43 other animals and was fed a diet consisting of diary ration (10-12 lb/day), brewer's grain (20-30 lb/day), soy bean meal (1-2 cakes/day) and hay (20-30 lb/day). For approximately four weeks prior to veterinary examination, the owners had been periodically treating the animal with penicillin and streptomycin for what they believed was pneumonia. The animal would appear to have recovered after two to three days treatment only to relapse several days later. Veterinary assistance was requested when the cow failed to respond at all to the last treatment with penicillin and streptomycin. The cow was first examined on March 19 and had severe inspiratory dyspnea and very harsh sounds over the trachea. The lung sounds were normal and there was no pyrexia. A diagnosis of tracheitis was made and the antibiotic treatment was changed to oxytetracycine. By March 22 there was no improvement and therapy was changed to chloramphenicol. The cow died on March 24. Post Mortem Examination The nostrils, laryngeal area, trachea and bronchi were filled with white frothy fluid. The lungs were very edematous and emphy'Animal Pathology Division, Health of Animals Branch, Agriculture Canada, Atlantic Area Laboratory, P.O. Box 1410, Sackville, New Brunswick EOA 3C0 (Stevenson) and Department of Forestry & Agriculture, Government of New-
foundland & Labrador, P.O. Box 7400, St. John's West, Newfoundland (Taylor).
L11~~~*¢ .U_1W_
1w
sematous. Examination of the trachea revealed the presence of a large gray mass blocking off approximately 90% of the tracheal lumen at the level of the thoracic inlet. The mass was approximately 6 cm long and 4 cm wide where it was attached to the tracheal mucosa. It was very firm and the surface was irregular. On cross section there were numerous small yellowish-white foci of necrosis (Figure 1). A representative sample was fixed in 10% formalin and forwarded for histopathological examination.
Histopathology Scattered throughout the mass of tissue were foci of basophilic clumps of bacteria surrounded by eosinophilic club-like projections (Figure 2). The cellular reaction immediately surrounding the rosettes varied. 78
CAN. VET. JOUR., vol. 18, no. 10, October, 1977
L
FIGURE 1. Cross section of the solitary large encapsulated mass containing necrotic foci which is attached to the trachea. It is divided into two unequal portions by a dense band of fibrous tissue.
ACTINOMYCOSIS
FIGURE 2. Typical rosette (R) formation surrounded by neutrophils (N), ( N), ervthrocvtes ( E) rounde mn neutlerophls and m-iononuclear cells (M). H&Er.throc2t H & E. X320.
Multinucleated giant cells were occasionally present but generally neutrophils, with or without epithelioid cells, were the predominant cell types (Figure 3). An ill-defined zone of neutrophils, erythrocytes and macrophages was next which, in turn, was surrounded by radiating bands of fibrous tissue
containing plasma cells and an occasional lymphocyte. Sections stained using a modified Brown and Brenn technique (6) revealed Gram-positive long, thin, filamentous organisms which sometimes branched and often were beaded (Figure 4). No acid-fast organisms were observed using a modified ZiehlNielsen technique. On the basis of these observations a diagnosis of actinomycosis was made. Discussion
Clinical signs were suggestive of obstructive tracheitis. The differential diagnosis included: - laryngeal edema, - aspiration or inhalation of a large foreign body, - neoplasm, - infectious agents, e.g. infectious bovine rhinotracheitis, (IBR), - granuloma or abscess.
F
FIGURE 3. The cellular exudate surrounding the rosettes (R) is composed of an inner zone of neutrophils (N) and epithelioid cells (E) and an outer zone of epithelioid cells, macrophages (M), neutronhils. r-CUI l1asma cells and occasionallv viant 51'l cells (G). H &- r E. x130. ..
L
CIa
Laryngeal edema was not observed and inhalation of a foreign body was ruled out on the basis of the history and temporary response to treatment. The clinical signs might have been caused by a neoplasm but primary neoplasms of the trachea are very rare (2). Typical clinical signs of IBR were absent and none of the other animals had clinical signs of IBR. Also IBR is not common in this area of Newfoundland. Because of the initial apparent response to treatment with antibiotics as reported by the owner, bacterial agents were presumed to be implicated although no particular organism was considered. No lesions of the head, mouth or pharyngeal area were observed which might have suggested actinomycosis or actinobacillosis. Usually granulomatous lesions of soft tissue are caused by Actinobacillus lignieresi and those of hard tissues by Actinomyces bovis. In this particular case an organism morphologically indistinguishable from A. bovis was involved. Actinomyces bovis is considered to be a normal inhabitant of the mucous membranes of the digestive and upper respiratory tracts
279
CANADIAN VETERINARY JOURNAL
_;Ft'Y, ir
a large mass in the lower third of the trachea. Actinomycosis was diagnosed on the basis of a typical granulomatous inflammatory reaction and the demonstration of Gram-positive branching, filamentous bacteria. Resume
Une vache adulte qui manifestait de la dyspnee, lors de l'inspiration, et qui laissait entendre des rales tracheaux stridents, mourut en depit d'une antibiotherapie intensive. La necropsie de la bete permit de decouvrir une masse volumineuse, dans le tiers inf6rieur de la trachee. Le diagnostic d'actinomycose reposait sur la presence d'une reaction inflammatoire granulomateuse caracteristique, qui recelait des bacteries Gram positives, filamenteuses et ramifiees.
l,~A
BrwadBrn.
an
180
t isasmdttinfci.ocr olw
FIGURE 4. Tangled mass of Gram-positive organisms, some of which show branching (arrow). Brown and Brenn. x 1280.
and it is assumed that infection occurs following trauma or ulceration of the mucosa. In the present case we were unable to demonstrate the cause of the initial damage but presume it must have been due either to inhalation or penetration of a foreign body.
Summary A mature cow with clinical signs of inspiratory dyspnea and harsh tracheal sounds died despite intensive antibiotic treatment. Post mortem examination revealed the presence of
280
References 1. BRUER, A. N. Actinomycosis of the digestive tract in cattle. N.Z. vet. J. 3: 121-122. 1955. 2. COTCHIN, E. Neoplasms of the Domesticated Mammals. A Review. p. 18. Commonwealth Agricultural Bureaux. 1956. 3. ILLING, K. and J. MARTIN. Aktinomykotische Erkrankungen ausserhalb des Kopfbereiches des Rindes. Arch. exp. VetMed. 24: 251-268. 1970. 4. JUBB, K. C. F. and P. C. KENNEDY. Pathology of Domestic Animals. Volume 1. New York and London: Academic Press. 1970. 5. KIMBALL, A., M. J. TWIEHAus and E. R. FRANK. Actinomyces bovis isolated frQm six cases of bovine orchitis. Am. J. vet. Res. 15: 551-553. 1954. 6. MANUAL OF HISTOLOGIC STAINING METHODS OF THE ARMED FORCES INSTITUTE OF PATHOLOGY. Third Edition. Lee G. Luna, Ed. p. 222. American Registry of Pathology. 1968. 7. SMITH, H. A., T. C. JONES and R. D. HUNT. Veterinary Pathology. Fourth Edition. Philadelphia: Lea & Febiger. 1972.
