Livestock Research International | April-June, 2016 | Vol 4 | Issue 2 | Pages 75-78 © 2016 Jakraya Publications (P) Ltd

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CASE REPORT

Clinical Case of Severe Anaemia in a Sheep Due to Parasitic Gast-ro-Enteritis (PGE) Infection Concurrent with Eperythrozoonosis *1Faez Firdaus Jesse Abdullah, 1Eric Lim Teik Chung, 1Lina Sabrina, 2Yusuf Abba, 1Muhammad Abubakar Sadiq, 1Konto Mohammed, 1Idris Umar Hambali, 2Asinamai Athliamai Bitrus, 1Abd Wahid Haron and 2Mohd Azmi Mohd Lila 1Department of Veterinary Clinical Studies, 2Department of Veterinary Pathology and Microbiology, Faculty of Veterinary Medicine, University Putra Malaysia, 43400 Serdang, Selangor, Malaysia. *Corresponding Author: Faez Firdaus Jesse Abdullah Email: jesseariasamy@gmail.com

Received: 15/05/2016

Revised: 22/06/2016

Accepted: 27/06/2016

Abstract Parasitic gastro-enteritis and eperythrozoonosis are important

diseases in small ruminants that may lead to chronic anaemia, weakness, emaciation and progressive weight loss. This case report describes the clinical management of severe anaemia in a doe. The ewe was presented with primary complain of depression, inappetance and diarrhea. The vaccination and deworming status were not up-to-date. Physical findings revealed the ewe was on lateral recumbency with pale and dry mucous membrane. There were pasty faeces soiling around the perineal region and severe lice infestation. Haematology and biochemistry findings revealed that the ewe was having anaemia with totalerythrocytes count of 4.22 x1012/L, haemoglobin (45.1g/L) and PCV (12%), hypoglycaemia (2.0mmol/L), hypoalbuminaemia (21.3g/L), increased ALT (150U/L) and hypocalcaemia (1.9mmol/L). Thin blood smear and McMaster Technique results describes the ewe were positive for Eperythrozoon and Parasitic-gastroenteritis at 2000 e.p.g. The clinical management for this case was to increase the PCV level via blood transfusion along with treatment for parasitic-gastroenteritis and eperythrozoonosis. Keyword: Ewe, Severe anaemia, Parasitic Gastro-enteritis, Eperythrozoonosis, Blood Transfusion.

1. Introduction The gastro-intestinal tract of sheep and goatmay

be inhabited by many species of parasites (Kahn and Line, 2005). In Malaysia, the main gastrointestinal worms infesting small ruminants include Haemonchus, Trichostrongylus, and Oesophagostomum which lead to parasitic gastro-enteritis or also known as PGE. PGE is a chronic complexdisease associated with number of nematode species mostly strongyles which are transmitted by fecal-oral route (Jesse et al., 2013; Mohammed et al., 2016). In general, small ruminants affected by PGE will show signs of weakness, anaemia, progressive weight loss and persistent diarrhea. Besides that, eperythrozoonosis is a haemolytic disease caused by rickettsiae of the genus Eperythrozoon (Kahn and Line, 2005). In goats and sheep, eperythrozoonosis is commonly due to Eperythrozoon ovis which can be transmitted by lice, flea or mosquitoes. The disease is often subclinical with mild anaemia, but stress in affected animals will result in severe clinical symptoms

such as inappetence, wasting, anaemia, malaise and depression. Blood transfusion is the introduction of whole blood or blood components directly into the blood stream (Blood et al., 2011). The safe use of blood component therapy requires knowledge of blood groups and antibody prevalence and knowledge of the means to minimize the risk of adverse reactions. According to Soldan (1999) administration of blood transfusion in cases of life threatening anaemia in ruminant is relatively simple and clinically very rewarding. This case report describes the clinical management of severe anaemia in a doe due to parasitic gastro-enteritis (PGE) infection concurrent with eprythrozoonosis. 2. Case Report 2.1 History

A one year old ewe weighing 30kg was presented with primary complaint of depression,

Abdullah et al...Clinical Case of Severe Anaemia in a Sheep Due to Parasitic GastroConcurrent with Eperythrozoonosis

Livestock Research International | April© 2016 Jakraya Publications (P) Ltd

inappetance and diarrhea that lastedvaccination and deworming status were not upThe doe was managed intensively, where cut and carry system was practise in the farm. 2.2 Physical Examination

Physical examination findings revealed that all the vital signs of the doe were within The doe was on lateral recumbency with(torticollis) and a stiff neck. The mucous membrane was pale and dry with capillary refill time two seconds. There were pasty faeces soiling the perineal region. The doe was alsoinfestation (Fig 1). The differential point of time wasparasitic-gastroenteritis, blood parasitism and tetanus.

2.3 Diagnostic Work-Ups and Results

Blood samples were haematological and biochemical analysis, as well as parasite identification through the use of thin blood smear stained with Wright-Lieshman stain. Fecal samples were collected and sent for parasitidentification. Haematology and biochemistry findings revealed that the doe was having erythrocytes count of 4.22 x10(45.1g/L) and PCV (12%)(2.0mmol/L), hypoalbuminaemia (21.3g/L)ALT (150U/L) and hypocalcaemiablood smear was positive for Eperythrozoon, while the fecal analysis showed the presence (2000 e.p.g). Based on the laboratory findings, the doe

Fig 1: Damalinia caprae

Clinical Case of Severe Anaemia in a Sheep Due to Parasitic GastroConcurrent with Eperythrozoonosis

April -June, 2016 | Vol 4 | Issue 2 | Pages 75-78 2016 Jakraya Publications (P) Ltd

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that lasted for three days. The vaccination and deworming status were not up-to-date.

where cut and carry

Physical examination findings revealed that all the vital signs of the doe were within the normal range. The doe was on lateral recumbency with the head tilted

. The mucous membrane with capillary refill time of more than

There were pasty faeces soiling the The doe was also having lice

The differential diagnosis at that gastroenteritis, blood

and Results submitted for

and biochemical analysis, as well as parasite identification through the use of thin blood

Lieshman stain. Fecal nt for parasitogical

and biochemistry findings revealed that the doe was having anaemia with total

4.22 x1012/L, haemoglobin ), hypoglycaemia (21.3g/L), increased

emia (1.9mmol/L). The smear was positive for Eperythrozoon, while the

fecal analysis showed the presence of strongyleeggs 2000 e.p.g). Based on the laboratory findings, the doe

was diagnosed with haemolytic parasitic gastroenteritis and e 2.4 Treatment

The therapeutic plan for this case wasincrease the PCV level via blood transfusiontreatment for parasiticeperythrozoonosis. On day one of hospitalization, antihistamine 1mL/50kg was giveminutes prior to blood transfusion. With a desired PCV of 20% to be achieved, 600mLfrom a donor goat with PCV of 24% using the formula stated by Kahn and Line, 2005

Volume Required

=

Weight in Kg (desired recipient PCV) x Blood Volume/Kg

Donor PCV

Blood transfusion was then administeredintravenously at the rate of 1 drop/second for the first 15 minutes to monitor for adverse reactional., 2010). The infusion rate was then increased to 2drop/second throughout the whole blood transfusion(Fig 2 and 3). Dextroseadministered intravenously at maintenance rate of 50mg/kg for dehydration and Furthermore, Oxytetracycline 2administered intramuscularlyeperythrozoonosis; Flunixin megluminewas given intramuscularly SIDinflammatory; and Fercobsang intramuscularly SID for four days as On day two of hospitalization,performed where the PCV increased from 12% to 19%. However, the doe was having bloatwas performed to allow for herbal debloat medication wasorally. On day four, the doe was administered 1ml/50kg of Ivermectin, subcutaneously to control endoparasites and ectoparasiteswas no improvement in the doe’s condition and the doe died on the fifth day of hospitalization. 3. Discussion

Anaemia is a reduction below normal in the number of erythrocytes orconcentration of haemoglobin in the bloodal., 2011). Clinically it is manifested by weakness and pale mucous membrane, which case. The severity of anaemiaPCV level, where PCV below 16% is considered to be life threatening and require immediate blood transfusion (Weiss et al., 2010).the ewe was having a PCV of 12%

Damalinia caprae

Clinical Case of Severe Anaemia in a Sheep Due to Parasitic Gastro-Enteritis (PGE) Infection

was diagnosed with haemolytic anaemia due to parasitic gastroenteritis and eperythrozonosis.

The therapeutic plan for this case was to increase the PCV level via blood transfusion along with treatment for parasitic-gastroenteritis and

On day one of hospitalization, antihistamine 1mL/50kg was given intramuscularly 30 minutes prior to blood transfusion. With a desired PCV of 20% to be achieved, 600mL of blood was collected from a donor goat with PCV of 24% using the formula stated by Kahn and Line, 2005.

Weight in Kg (desired PCV-recipient PCV) x Blood Volume/Kg

Donor PCV

Blood transfusion was then administered ously at the rate of 1 drop/second for the first

15 minutes to monitor for adverse reaction (Weiss et ion rate was then increased to 2

the whole blood transfusion Dextrose saline 50% was also

administered intravenously at maintenance rate of for dehydration and hypoglycaemia.

Oxytetracycline 20mg/kg, was administered intramuscularly SID to treat

Flunixin meglumine (2.2mg/kg), SID for four days as anti-

and Fercobsang (1ml/10kg), was given for four days as iron supplement.

ation, a quick PCV test was performed where the PCV increased from 12% to 19%.

the doe was having bloat and stomach tubing for gastric reflux. 25ml of

ebloat medication was then administered orally. On day four, the doe was administered 1ml/50kg of Ivermectin, subcutaneously to control endoparasites and ectoparasites. Nevertheless, there was no improvement in the doe’s condition and the doe died on the fifth day of hospitalization.

is a reduction below normal in the number of erythrocytes or circulating in the

of haemoglobin in the blood (Blood et . Clinically it is manifested by weakness and

which was observed in this anaemia can be determined by the

where PCV below 16% is considered to be and require immediate blood

2010). In this clinical case, PCV of 12% and blood-

Abdullah et al...Clinical Case of Severe Anaemia in a Sheep Due to Parasitic GastroConcurrent with Eperythrozoonosis

Livestock Research International | © 2016 Jakraya Publications (P) Ltd

transfusion was performed immediately on the day of presentation. Sheep have 8 blood groups which R-O, A, B, C, D, M, R, X and Z (SmithBlood typing prior to blood transfusion in large animals is not practical due to the high variability of blood groups and limitation of donorsis done instead (Weiss et al., 2010).done to identify compatible donor for blood transfusion. However, blood transfusion was done immediately in this case without performing cross matching. According to Smith (2009), cross matching is not usually practiced in ruminants, so References Blood DC, Studdert VP and Gay CC (2011).

Comprehensive Veterinary Dictionary, 4Saunders, London.

Jesse FFA, Adamu L, Jamal MHA, OsmanAwang DN, and Roslim N (2013). Parasitic gastroenteritis (PGE) concurrent with eperythrozoonosis in a

Fig 2: General condition of the sheep during hospitalization.

Fig 3: Infusion rate of 1 drop/second for the first 15 minutes and 2 drops/second throughout the whole blood transfusion.

Clinical Case of Severe Anaemia in a Sheep Due to Parasitic GastroConcurrent with Eperythrozoonosis

Livestock Research International | April-June, 2016 | Vol 4 | Issue 2 | Pages 75-78 2016 Jakraya Publications (P) Ltd

77

immediately on the day of 8 blood groups which include,

, B, C, D, M, R, X and Z (Smith et al., 2009). lood typing prior to blood transfusion in large animals

is not practical due to the high variability of blood limitation of donors where cross matching

2010). Cross matching is done to identify compatible donor for blood

blood transfusion was done without performing cross

According to Smith (2009), cross matching is not usually practiced in ruminants, so it is usually

done only when multiple transfusions are expected, like in chronic anaemia. Adverse reactiontransfusion may occur due to reacting towards the donor’s blood.include hiccough, tremor, dyspnea, lacrimation, fever or hemoglobinurua. Nonewere observed throughprocess in this case.

Although blood transfusion was conducted, the prognosis of the ewe in this case was poor due to the long standing concurrent infection gastro-enteritis and eperythrozoonosisJesse et al. (2013) parasitic gastroeperythrozoonosis are chronic diseases which lead to chronic anaemia, weakness, emaciation and progressive weight loss which were gastro-enteritis and eperythrozoonosisanaemia and haemolyticanaemiaLine, 2005). As a resultcarrying capacity of significantly leading to circulatory or respiratory failureresulting in death. Ideally, cases of acute responsive or regenerative anaemia are restored by blood transfusion, while non-responsive anaemiaFor this clinical case, the presence of eperythrozoon may have caused a haemolytic and even though blood transfusion was given to restore the blood loss, the infection persisted andmore hemolysis and death of the 4. Conclusion

Blood transfusion in cases of life threatening anaemia in ruminant is relatively simple and clinically very rewarding. However, blood transfusions are economically impractical for most sheep farmers and may not always result in cases of long standing paraanaemia should always be treated by correcting the causal problem first in orderof the clinical case. Acknowledgement

The authors wish to acknowledge the supporting staff of University Veterinary Hospital, University Putra Malaysia for their technical help and support.

and Gay CC (2011). Saunders Comprehensive Veterinary Dictionary, 4th Edition,

Jesse FFA, Adamu L, Jamal MHA, Osman AY, Wahid A, Awang DN, and Roslim N (2013). Parasitic gastro-enteritis (PGE) concurrent with eperythrozoonosis in a

goat: A case report. IOSR Veterinary Science, 4(1): 63

Kahn CM, and Line S (2005). 9th Edition, Merial, USA

Lanevschi A and Wardrop KJ (2001). Principles of transfusion medicine in small animals. Veterinary Journal, 42: 447

Fig 2: General condition of the sheep during hospitalization.

Fig 3: Infusion rate of 1 drop/second for the first 15 minutes and 2 drops/second throughout the whole

Clinical Case of Severe Anaemia in a Sheep Due to Parasitic Gastro-Enteritis (PGE) Infection

done only when multiple transfusions are expected, like Adverse reactions during blood

due to the recipient’s antibody reacting towards the donor’s blood. The signs may include hiccough, tremor, dyspnea, lacrimation, fever or hemoglobinurua. None the less, no adverse reactions

throughout the blood transfusion

Although blood transfusion was conducted, the in this case was poor due to the

concurrent infection with parasitic enteritis and eperythrozoonosis. According to

(2013) parasitic gastro-enteritis and erythrozoonosis are chronic diseases which lead to

, weakness, emaciation and progressive observed in this case. Parasitic

enteritis and eperythrozoonosis cause blood loss anaemia respectively (Kahnand

result, blood volume and oxygen- the animal were reduced circulatory or respiratory failure

. Ideally, cases of acute responsive or are restored by blood transfusion, anaemias are difficult to correct.

the presence of eperythrozoon may have caused a haemolytic anaemia in the sheep

transfusion was given to restore , the infection persisted and resulted in

more hemolysis and death of the ewe.

Blood transfusion in cases of life threatening in ruminant is relatively simple and clinically

very rewarding. However, blood transfusions are economically impractical for most sheep farmers and

result in proper solution, especially in cases of long standing parasitic infections. Thus,

should always be treated by correcting the in order to have a better prognosis

The authors wish to acknowledge the supporting

Veterinary Hospital, University for their technical help and support.

goat: A case report. IOSR Journal of Agriculture and 4(1): 63-66.

Kahn CM, and Line S (2005). The Merck Veterinary Manual, Merial, USA.

and Wardrop KJ (2001). Principles of transfusion medicine in small animals. Canadian

42: 447-454.

Abdullah et al...Clinical Case of Severe Anaemia in a Sheep Due to Parasitic Gastro-Enteritis (PGE) Infection Concurrent with Eperythrozoonosis

Livestock Research International | April-June, 2016 | Vol 4 | Issue 2 | Pages 75-78 © 2016 Jakraya Publications (P) Ltd

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Mohammed K, Abba Y, Ramli NSB, Marimuthu M, Omar MA, Abdullah FFJ, Sadiq MA, Tijjani A, Chung ELT and Lila MAM (2016). The use of FAMACHA in estimation of gastrointestinal nematodes and total worm burden in Damara and Barbados Blackbelly cross sheep. Tropical Animal Health and Production, DOI 10.1007/s11250-016-1049-y.

Smith MC, and Sherman DM (2009). Goat Medicine 2nd Edition, Wiley-Blackwell, USA.

Soldan A (1999). Blood transfusion in cattle. Journal of the British Veterinary Association, 21(10): 590-595.

Weiss DJ and Wardrop KJ (2010). Schalm’s Veterinary Hematology, 6th Edition, Wiley-Blackwell, USA.