5-27-04

NEONATAL DIARRHEA:

Cryptosporidium
Julia Richardson, Veterinary Student
David E Anderson, DVM, MS, DACVS

Introduction:  Cryptosporidium is a coccidian protozoan parasite that
affects a wide range of hosts.  Clinical signs it causes are more severe in
immunocompromised hosts or neonates.  It is usually a self limiting disease
but can cause a severe watery diarrhea.  If the organism is present in
substantial numbers, sites other than the small intestine where it usually
inhabits can be infected.  Unfortunately, secondary infections can occur
simultaneously, worsening symptoms and effects of the disease. One of the
most important issues with this parasite comes from its zoonotic potential -
e.g. ability to infect people!  It is resistant to chlorine and drinking
water has been suspected as a means of transmission to humans.

Life cycle:  Direct life cycle with both sexual and asexual reproduction
1. Sporozoites within an oocyst is excreted in the feces
2. Oocyst is ingested orally and excystation occurs in the small bowel
3. 4 sporozoites are released and enter the intestinal epithelial cells
4. Asexual intracellular multiplication occurs
5. Differentiation of microgametes and macrogamets occurs
6. Sexual replication and fertilization occurs
7. Oocyst develops followed by formation of new sporozoites
 
http://biology.kenyon.edu/slonc/bio38/hannahs/crypto.htm#intro
The prepatent period (from infection of the organism to presentation of
clinical signs) is approximately 4 days.  Each generation can develop and
mature in 12-14 hours.  Due to this and the autoinfection properties of the
cycle, the unchallenged organism can quickly escalate into severe disease.
The peak age for clinical cryptosporidium in crias is 7 to 14 days old.
Although disease has been seen in older crias, this is less likely because
the older cria's immune system is capable to warding off the infection
without developing severe clinical signs of disease.

Treatment:  There is no safe and effective therapy available to treat
Cryptosporidium.  Supportive measures, such as fluid therapy and electrolyte
replacement can be applied until the hosts immune system fights the disease.
Isolation is essential once a diagnosis has been made to protect others in
the herd. Limited success has been seen with lasalosid or with paromomycin
in treated crias. These drugs can be dangerous and their use should only be
attempted with the direct supervision of a veterinarian.

Diagnosis:  The cheapest diagnostic tool is direct detection of the oocyst
in the feces using an acid-fast stain. IgM, IgG and IgA can be detected
using ELISA or IFA but this is not a direct test of the organism. This test
is increasingly used because of the difficulty in finding organisms using
fecal exam. The newest method which has good sensitivity and specificity is
to detect the organisms DNA using PCR.  This is however expensive, time
consuming and often unpractical. Diagnosis is important for controlling the
disease.

Prevention: This is a "disease of domestication" and is strictly hygiene
associated. Keeping maternity and nursery areas clean is of paramount
importance. Ensuring adequate colostrums ingestion is essential to
protection of the neonatal intestine. At this time, no vaccine is available
for use.


David E Anderson, DVM, MS, DACVS
Ohio State University
College of Veterinary Medicine
E-mail: Anderson.670@osu.edu

____________________________

March 29, 2003

Neonatal Diarrhea
Giardia, Cryptosporidium and Eimeria in Crias

Shannon Bowen DVM student, Class of 2005
David E Anderson, DVM, MS, DACVS
Ohio State University
Columbus, Ohio 43210



The neonatal period of an animal's life is often the most vulnerable stage
for disease.  The most common diseases in crias are diarrhea and infectious
diseases.  Diarrhea may be caused by bacterial, viral or nutritional means,
although most commonly it is caused by the protozoal parasites Giardia,
Cryptosporidium, and Eimeria.  Neonatal diarrhea is a disease of hygiene
and is most often a problem on larger farms.  Diarrhea in crias can often
be treated successfully and outbreaks can be reduced using preventative
methods.

The Parasites

Giardia lamblia is a water borne protozoal parasite responsible for
mammalian infection.  Infection is induced via fecal-oral transmission.  G.
lamblia cysts are commonly shed in the feces of both symptomatic and
asymptomatic mammals.  These cysts are then ingested by drinking
contaminated water, milk or food.  Once ingested, the trophozoite form of
the G. lamblia is released from the cyst and attaches to the epithelial
cell lining of the small intestine.  The trophozoites reproduce and form
infective cysts that are then released out into the feces.   Clinical signs
in effected crias infected with G. lamblia most often occur at two to three
months of age, although it may be seen as early as 14 days or as late as
one year. These signs include chronic low-grade diarrhea, weight loss, and
poor growth.

Cryptosporidium parvum is a protozoal parasite that is also spread thru
fecal-oral transmission.  Infection does not usually cause the clinical
signs of diarrhea unless the host's immune system is compromised.  C.
parvum in the form of oocysts are ingested from the feces and release their
four sporozoites that invade the cells of the lower small intestine.  It is
here that C. parvum undergoes sexual reproduction and produces new oocysts
most of which are expelled in the feces. Crias develop clinical signs
between one week and ten days, however, signs can occur upwards of three
months old. Clinical signs range from mild, transient diarrhea, to
protracted diarrhea with poor growth, to acute, severe diarrhea with
dehydration, weakness, and possibly death.

Eimeria bovis is also a coccidian protozoan parasite that is transmitted
via the fecal-oral route.  Once again a host shedding the parasite in its
feces does not have to be symptomatic.  After the oocyst is ingested it
undergoes two asexual reproductive cycles.  The first cycle takes place in
the ileum and the second cycle occurs in the cecum and colon prior to
shedding the mature oocysts in the host's feces.  A cria may show symptoms
as early as three weeks and up to one year in age. Clinical coccidiosis can
be seen in adults, but rarely causes a problem unless the host's immune
system is compromised.


When Should I Can My Vet?

In addition to diarrhea, crias will exhibit lethargy, weakness, loss of
appetite, dehydration, and dullness.  If a cria develops diarrhea make sure
to weigh it daily as well as monitor systemic parameters such as heart rate
(normal is 80-120 bpm), respiratory rate (normal is 20-40), and rectal
temperature (normal is 99-102 F).  If there are abnormal systemic signs,
blood in the diarrhea and/or consistent weight loss over several days or a
total of 10% loss of body weight at anytime, consult your veterinarian
immediately.

Treatment

Owners can begin to give calf electrolyte replacers or other glucose
enriched electrolyte solutions to crias when symptoms develop.  The cria
should be isolated as soon as possible to prevent further spread of
infection.  Clean, dry bedding should be provided for the cria and
appropriate heat lamps and blankets should be used in winter to prevent
hypothermia. In summer, crias should be moved to shade to avoid hyperthermia.

In a clinical setting, the cria can be started on IV fluids and parenteral
nutrition.  Biolyte and Resorb are common calf electrolyte replacers that
are used by the OSU veterinary hospital to restore electrolyte balances as
well as provide nutritional support.

Supportive therapy, in addition to the appropriate antiparasitic drugs, can
help reestablish optimum health to an infected cria with
diarrhea.  Fenbendazole at 50 mg/kg or Albendazole at a dosage of 10 mg/kg
can be used to treat Giardia. No specific treatment is available for
Cryptosporidium, but Lasaloid, an ionophore drug, has been used with
apparent success in many crias. This drug is potentially toxic and should
only be used with the strict supervision of a veterinarian. Eimeria can be
treated with Albon at a dosage of 15 mg/kg orally, twice a day for 5 days
or Amprolium at a dosage of 10 mg/kg usually given in water over the course
of five days.


Prevention

Prevention of parasitic agents is primarily an issue of hygiene as
mentioned before.  It is recommended that parturition occurs in a clean,
dry area to lessen the likelihood of infection.  The cria should receive
adequate colostrum within 6 hours after birth.  The colostrum will help
ensure the health of the cria but it may help to decrease the infectious
agent and clinical signs.  Providing clean, dry pens for crias and allowing
each pen to dry between crias will help prevent parasite infection.  It is
imperative that a sick cria is removed from the herd or at least separated
from other crias as soon as diarrhea begins.  This, in addition to the
prevention of overcrowding will prevent the ground and water sources from
overwhelming parasite infection.

If a farm becomes infected with one of the parasites and neonatal diarrhea
becomes a problem, certain measures should be taken in an attempt to reduce
the parasite load of the herd and environment.  Pens should be cleaned
regularly.  Feeding and watering areas should be cleansed with an
appropriate disinfectant.  All animals with diarrhea should be isolated
from the rest of the herd while undergoing treatment.  Shedding of the
parasite can be an ongoing problem from both asymptomatic and treated
animals.  Hygiene as well as common sense are the best precautionary
measures.


References

Anderson, David E.  Conversational.  November 2002.

Anderson, David E.  Neonatology in Llamas and Alpacas.  May 15, 2002.
www.rmla.com/neonatology.htm

Bowman, Dwight D.  Georgi's Parasitology for Veterinarians.  W.B. Saunders
Co.  New York, 1999.

University of California Davis.  Cryptosporidiosis and Diarrhea in
Calves.  Medical Ecology and Environmental Health.  July
1997.  www.vetmed.ucdavis.edu









David E Anderson, DVM, MS
College of Veterinary Medicine
The Ohio State University

         http://www.vet.ohio-state.edu/docs/ClinSci/camelid/index.html
         http://www.internationalcamelidinstitute.org

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~`

May 15, 2002

Neonatology in Llamas and Alpacas

David E Anderson, DVM, MS, DACVS
Director, International Camelid Initiative


The newborn cria is remarkable in many ways. However, the neonatal period
(defined as the first weeks of life) is the highest risk period of a llama
or alpaca's life. These neonates are susceptible to hypothermia,
hyperthermia, hypoglycemia, septicemia, and congenital defects. The owner
and veterinarian must work together to maximize the crias ability to
thrive. In our research in the Camelid Health Program at Ohio State
University, we found that up to 36% of crias suffer some form of disease
condition between birth and weaning, and that 2 % of crias died before
weaning. The most common disease conditions were diarrhea and infectious
diseases. Crias born with difficulty were 4 times more likely to suffer a
disease event. Crias born in the spring were the least likely to suffer
from diseases. These research data show how important neonatal health care
is to the survival and ability to thrive of the cria.

The First Hours
         The first hours of life are a special bonding period between dam
and cria. During this period, minimal to no human contact is needed. Take
time to be a good observer but do not interfere with the maternal bonding
process. Observe the birthing process if possible, but do not interfere
unless absolutely necessary. The cria should be born within 30 to 60
minutes of the onset of Stage II (full strength contraction) labor. The
cria will appear disoriented at first and struggle to sit-up within 5 to 15
minutes. The cria may flare the nostrils and may even appear distressed at
times, but should not have any difficulty in breathing. Watch for abdominal
and thoracic movements  they should be in unison. If the thorax moves
inward as the abdomen moves outward, there may be an obstruction to
breathing. Observe the nostrils and face. If the nostrils are flaring
widely and the cheeks "puff" as the cria exhales, there may be obstruction
of the nasal passage. Crias do not breathe very efficiently through their
mouths and may grow increasingly desperate for air. If these signs are
noted, hold your hand or a mirror in front of the nostrils. You should be
able to feel a gust of warm air or see the mirror "fog" with each exhale.
The cria should begin to try to stand in the first 30 to 60 minutes. This
can be an uncoordinated process, but the cria should be allowed to struggle
unimpeded by human hands. The cria should try to nurse within 2 to 4 hours.
If the cria has not stood within 2 hours or nursed within 4 hours, human
intervention is warranted. At this time, I weigh the cria and "dip" the
umbilicus with 2 % tincture of iodine or thoroughly spray the umbilicus
with chlorhexidine solution. This will decrease the chance of infection via
this exposed surface. The umbilicus (navel) should be re-dipped or sprayed
12 to 24 hours after the first application.
In cold weather (ambient temperature < 40 F or 4 C), earlier intervention
is warranted to prevent hypothermia. In hot weather (ambient temperature >
90 F or 32 C), shade is desired to prevent onset of hyperthermia. Ingestion
of colostrum is required for passive transfer of immunity from the dam
(maternal immunoglobulins and white blood cells). The colostrum also
provides an energy dense meal and has a laxative effect for the meconium.
The cria should consume 5 % of its body weight in colostrum within the
first 6 hours of life and 10 % within the first 12 hours of life to gain
adequate protection from the dam.
The udder of the dam should be evaluated to determine if colostrum is
present, ensure that the udder is well developed, that the teats are open
(wax plug released), and no evidence of mastitis is present. If the dam
fails to form colostrum, supplemental immunoglobulins are needed. When
supplemental immunity is needed, colostrum from another llama or alpaca is
desired. Unfortunately, these are rarely available, but goat, sheep, or cow
colostrum may be used as an alternative. These should not be given unless
the dam does not have colostrum of her own. Plasma may be administered
orally in the first hours after birth, but the absorption of
immunoglobulins is often lower than expected via this route of
administration. Also, plasma provides little if any energy and must be
followed within 2 hours (but not sooner than 30 minutes) by milk feeding.

The First Day
         Once the cria is standing and nursing, little attention is needed
during the next 24 hours. The dam and cria must have adequate protection
from weather and the dam must have an adequate diet to optimize lactation.
Great care must be used when trying to provide supplemental heat for crias.
Only barn-safe heaters should be used to provide heat. I have seen several
cria and dams injured or killed in barn fires and these are extremely
unfortunate events. I prefer to weigh crias daily for 7 days, weekly for 4
weeks, then monthly until weaning. Crias will loose up to 1 pound during
the first 24 to 36 hours of life. Much of this weight loss is because of
drying of the hair coat and loss of internal fluids accumulated during
intrauterine life. These fluids are lost by urination, defecation, and
breathing. After this time, the cria should gain weight daily. Although
crias normally gain 0.5 to 1 pound of weight each day, smaller weight gains
are common. Failure to gain weight and, especially, loosing weight after 36
hours is abnormal. The cause of weight loss must be identified and a
determination made as to whether the dam is not lactating, the teats are
plugged or not functional, the cria is not nursing properly, or the cria is
unhealthy. We do see crias "stall", or fail to gain weight, for various
periods of time for no apparent reason. This is considered normal if the
cria is bright, alert, active, and thriving in all other respects.
The cria should pass meconium, the first feces, within 12 hours. Colostrum
has a laxative effect and facilitates passage of this "sticky" fecal
matter. Crias that receive colostrum substitutes instead of colostrum are
more likely to have difficulty passing meconium. I do not advocate routine
administration of enemas to crias. However, enemas may be helpful if the
cria is known not to have passed the meconium within 12 to 24 hours or is
straining to defecate. A "congenital defect check" should be done during
the first day of life. Check for nostrils and air movement, check for the
anus, vulva or penis, eyes, mouth, and limbs for any abnormality. A
thorough auscultation of the heart and lungs should be done to determine if
a heart murmur or any abnormality of the lungs is present.

The Second Day
         The cria is observed for behavior. A normal cria will eagerly
interact with the environment, people, and the dam. I prefer to vaccinate
crias for Clostridium perfringens types C and D and Clostridium tetani
between 48 and 72 hours old. This vaccine will prime the cria's immune
system for a booster vaccine to be given 2 weeks later. If the cria is
lethargic or seems depressed, a thorough physical examination including
heart rate (normal range, 80 to 120 bpm), breathing (normal range is 20 to
40 and is effortless), and rectal temperature (normal range, 99 to 102 F)
are indicated. Vaccination should be delayed until the cria is healthy and
normal because these vaccines can be inflammatory. The immune system will
not respond properly if the cria is stressed by disease or malnutrition.

The Second Week
         The cria should have gained 7 to 14 pounds (3.5 to 7 kgs) since
birth. The cria should be running, playing, and be vibrant. A physical
examination should be done and a booster vaccine (CD&T) given.

Weaning
         Weaning can be done at various times and is influenced by the
health of both the cria and dam. Many crias are weaned when they reach a
"target weight" of 60 pounds for alpacas or 100 pounds for llamas. In many
cases, these crias are too young to wean at this time. I advocate weaning
no earlier than 4 months, but preferably at 6 months. This time allows for
optimal development of eating habits and digestion and yields a healthier
cria through the first year of life.
However, the health of the dam must not be sacrificed. Thin females must be
allowed to regain their body weight and condition. I feel that body
condition scoring (BCS) is a valuable tool to evaluate cria and dam. Thin
crias are abnormal and a cause for poor condition should be found and
corrected. Similarly, thin females are abnormal. If a female is exceedingly
thin (BCS of 3 out of 10 or less), early weaning of the cria should be
considered. If the female has been bred back at 3 to 4 weeks post-partum,
this extra time will allow her to rebuild lost body condition in time to
produce adequate colostrum and be fit to lactate for the next cria. Thin
females are more likely to have poor quality colostrums and inadequate milk
production.

Ricketts Prevention
         Ricketts is caused by low Vitamin D concentration in the blood.
Crias are particularly prone to Vitamin D deficiency in North America.
Vitamin D deficiency causes injury to the growth plates and is recognized
clinically by crooked legs, arched back, reluctance to walk, lameness,
lethragy, and poor growth. This condition is only seen in crias during
winter months or when they are totally confined without access to sunlight.
In general, crias born in the fall need supplemental Vitamin D during
winter months. The easiest form of supplementation is by injecting Vitamin
D under the skin at 1000 units per Kg of body weight. Each injection will
provide Vitamin D for a period of 60 to 90 days. I suggest injection of
supplemental Vitamin D to crias < 6 to 9 months old in late November and
again in February. Supplementation during Spring, Summer, and Fall should
not be necessary. Vitamin D toxicity is possible and close attention to
dose, frequency, and time of year is warranted.

Neonatal Diseases seen in Llamas and Alpacas
         Hypothermia
         Hypoglycemia
         Septicemia
         Malnutrition
Diarrhea (bacterial, viral, nutritional)
Ill Thrift Syndrome
Ricketts
Congenital Defects



David E Anderson, DVM, MS
Diplomate, American College of Veterinary Surgeons
Associate Professor of Surgery, Food Animal
601 Vernon L Tharp Street
College of Veterinary Medicine
The Ohio State University
Columbus, Ohio 43210
Anderson.670@osu.edu
Phone: 614-292-6661
Fax: 614-292-3530
VISIT OUR WEB-SITES:
         http://www.vet.ohio-state.edu/docs/ClinSci/bovine/index.htm
         http://www.vet.ohio-state.edu/docs/ClinSci/camelid/index.html
         http://www.internationalcamelidinstitute.org

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