C O N F E R E N C E 11 5 December 2018

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C O N F E R E N C E 11 5 December 2018 Joint Pathology Center Veterinary Pathology Services WEDNESDAY SLIDE CONFERENCE 2018-2019 C o n f e r e n c e 11 5 December 2018 Conference Moderator: Charles W. Bradley, VMD, DACVP Assistant Professor, Pathobiology University of Pennsylvania School of Veterinary Medicine 4005 MJR-VHUP 3900 Delancey Street Philadelphia, PA, 19104 CASE I: P15/141 JPC 4066260) macrophages, eosinophils and neutrophils (exocytosis), and rare, multifocal, discrete, Signalment: 2.5-year-old, Aubrac bull, Bos shrunken, hypereosinophilic keratinocytes taurus with pyknotic nuclei (apoptosis). The superficial dermis and a variable part of the History: The bull presented to Veterinary adjacent deep dermis are markedly and Teaching Hospital with history of chronic diffusely expanded by a moderate, skin lesions of unknown reason. coalescing, perivascular, and nodular to diffuse infiltration of macrophages, plasma Gross Pathology: Multifocal areas of cells, lymphocytes, eosinophilic alopecia granulocytes and to a locally variable extent also neutrophilic granulocytes, as well as a Laboratory results: PCR positive for B. low to moderate, coalescing amount of besnoiti, ELISA positive for B. besnoiti bundles of fibroblasts and fibrocytes within a collagenous stroma (fibrosis). There is a Microscopic Description: marked coalescing to diffuse loss of Haired skin. The epidermis displays low to moderate, diffuse, orthokeratotic hyperkeratosis, moderate, diffuse, epidermal hyperplasia characterized by acanthosis and irregular rete ridge formation, rare, multifocal, individual, intraepidermal 1 Haired skin, ox. The dermis is diffusely expanded by numerous apicomplexan tissue cysts ranging from 200- 400um. (HE, 5X) follicular and adnexal structures (alopecia). disease in the central and northern part of Within the superficial and upper deep Europe.1,5,7,8 In endemic areas dermis are numerous round protozoal cysts seroprevalence rates are ~ 50% whereas the characterized by a diameter of ~ 250 µm, a ~ incidence of clinical cases of 1-10% per 12 µm thick, distinctly bordered, pale year, as well as the mortality rate of less eosinophilic, hyaline outer capsule, a than 1% are obviously low. Prevalence and subcapsular ~ 10 µm thick ring of incidence may be higher in areas where the eosinophilic cytoplasm containing multiple disease is emerging.1,11 fusiform nuclei, and a central round vacuole containing myriads of densely packed, ~ 4 B. besnoiti is commonly believed to have a µm in diameter, distinctly bordered, heteroxenous life cycle, however until today crescent-shaped bradyzoites with pale only homoxenous transmission from eosinophilic cytoplasm and a central, intermediate to intermediate host has been hyperchromatic nucleus. The dermal shown experimentally. The most important collagenous stroma, adjacent to the cysts intermediate host are cattle, but wildebeest, show a mild, laminar zone of shrinkage and kudu and impala are also affected.11 The hypereosinophilia (compression atrophy). epidemiological importance of wild ruminants in northern Europe is currently Contributor’s Morphologic Diagnoses: unknown. Although roe deer and red deer Haired skin. Dermatitis nodular to diffuse, can be seropositive in areas of endemic granulomatous and eosinophilic, chronic, bovine besnoitiosis, the strong cross coalescing, moderate with numerous reactivity of B. besnoiti, B. tarandi and B. intradermal, intracellular, apicomplexan bennetti prevents differentiation of these cysts (etiology consistent with Besnoitia species employing serological methods.6 besnoiti), adjacent laminar compression Although many authors have suggested that atrophy, dermal fibrosis, alopecia, epidermal the final host of B. besnoiti could be the hyperplasia and orthokeratotic domestic cat or wild carnivores, attempts to hyperkeratosis. proof this hypothesis have been unsuccessful so far.10 Therefore the final Contributor’s Comment: Etiology: The host of B. besnoiti remains currently apicomplexan protozoan parasite Besnoitia unknown, as is true for most other species of besnoiti (B. besnoiti; Family: Sarcocystidae) the genus Besnoitia (Table 1). is the etiologic agent of bovine besnoitiosis (Synonyms: bovine cutaneous globidiosis, Whether transmission from the currently bovine cutaneous sarcosporidiosis, elephant unknown definitive host to the intermediate skin disease of cattle) and has been host occurs in via oocytes shed in the feces described first by Cadéac in 1884.1 The remains unknown. In contrast, horizontal closely related Besnoitia species B. caprae, mechanical transfer between intermediate B. bennetti and B. tarandi induce a hosts by blood-sucking insects including comparable disease mainly in goats, equids tsetse flies (Glossina brevipalpis), tabanids and wild ruminants, respectively (Table 1).11 (Tabanocella denticornis, Atylotus nigromaculatus, Haematopota albihirta), Besnoitiosis is an endemic disease in the mosquitoes (Culex simpsoni, Culex spp.) southern part of Europe, the subtropical and stable flies (Stomoxys calcitrans) has areas of Asia, and sub-Saharan Africa, but been experimentally proven and is suggested has also been reported as an emerging to be an important mode of transmission.5 2 Furthermore, transmission by other dermis and submucosa, as well as various arthropods, iatrogenic transfer and direct other tissues.8 A detailed description of the contact including sexual transfer are sequential steps of tissue cyst formation can possible other routes of transmission.1 be found in Langenmayer et al. (2015).8 Rapid asexual intracellular proliferation of The clinical disease can be subdivided into B. besnoiti tachyzoites occurs mainly within two phases. The acute phase (“anasarca the intermediate host´s endothelial cells phase”) of bovine besnoitiosis occurs 11-13 during the acute phase after the first days after infection and lasts for 6-10 days, infection. This leads to vasculitis and and is characterized by fever, subcutaneous thrombosis of capillaries and smaller veins, edema, lymphadenitis, conjunctivitis, nasal especially within the dermis, and subsequent discharge, salivation, laminitis and generalized subcutaneous edema.2,8 One to depression.2,8 two weeks after the onset of the acute phase, the infection reaches the subacute to chronic In contrast, the chronic phase (scleroderma stage which is characterized by evolving phase) is characterized by macroscopically intracellular tissue cysts containing myriads detectable tissue cysts in connective tissues, Haired skin, ox. Tissue cysts are surrounding by the thick hyaline wall ranging from 10 to 20um. Within cyst the wall, a thin rim of cell cytoplasm with peripheralized nuclei surrounds a parasitophorous vacuole contain innumerable zoites. Tissue cysts are separated by moderate numbers of lymphocytes, histiocytes, and eosinophils, as well as down projecting rete ridges of the hyperplastic epithelium (HE, 159X) of bradyzoites within vimentin-positive, especially the pathognomonic pin-head sized MAC387-negative, mesenchymal cells cysts in the dermis and submucosa of (suggested to be fibroblasts or conjunctiva, nasal cavity and vagina, as well myofibroblasts), especially within the 3 as lichenification, hyperkeratosis and tissue of the subcutis, intermuscular fascia, alopecia.5,8 mesentery and scrotum.2,4,5 Histologically, crescent-shaped 6-7,5 x 2,5- Overt clinical disease most often affects 2- 3,9 µm sized B. besnoiti tachyzoites with to 4-year old adults and chronically infected eosinophilic cytoplasm and a round animals may partially recover but are basophilic nucleus may be visible within thought to remain infected for the rest of endothelial cells, blood and lymph vessels, their lifes.1 Although only a small and extracellular spaces during the acute percentage of less than 1% of the affected stage. Notably, these tachyzoites are cattle die, bovine besnoitiosis may lead to indistinguishable from Neospora caninum or major economic losses due to weight loss Toxoplasma gondii by light microscopy.2,4,8 and decreased milk production, abortion, male infertility, and reduced value of the The B. besnoiti tissue cysts of the chronic hides. Currently there are no therapeutic phase exhibit a diameter of up to 600 µm, treatment options available. An attenuated and a characteristic double-walled live vaccine is available in some countries morphology which allows differentiation for prophylaxis. from the similar cysts of Sarcocystis spp. and Eimeria spp.11 The outer 10-12 µm, pale Macroscopic changes in the acute phase of eosinophilic, hyaline cyst wall is comprised besnoitiosis are rather unspecific and of host-derived collagenous material and its include coalescing to generalized outer surface blends irregularly into the subcutaneous edema (anasarca), multifocal surrounding connective tissue. The inner to coalescing, lymphohistioplasmacytic and cyst wall is a thin pale gray-bluish band with eosinophilic perivascular dermatitis, dermal distinct histochemical staining hemorrhages, generalized swelling of lymph characteristics in between the outer cyst wall nodes (lymphadenopathy), and swollen and the outer cell membrane of the host cell. testicles (orchitis).2,8 The outer cyst wall stains blue with Masson´s trichrome and pale white with The characteristic tissue cysts start to Giemsa stain, whereas the inner cyst wall develop in the subacute stage concurrent stains pale white with Masson´s trichrome with the decline of dermal edema. The tissue stain and deeply violet with Giemsa stain.8 cysts become clearly macroscopically The large host
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