Stomatitis Flashcards
What are stomatitis, glossitis, & gingivitis?
- inflammation of the mucous mbs of the oral cavity, tongue, & gingiva, respectively
what is stomatitis often accompanied by ?
- anorexia caused by painful mastication
- hypersalivation (ptyalism) from overproduction or failure to swallow
How do we classify stomatitides in domestic animals?
- superficial stomatitis (affects primarily the epithelium & immediate subepithelial tissues)
- deep stomatitis (affects deep tissues of oral cavity)
What are the different types of superficial stomatitis?
- vesicular stomatitis
- erosive/ulcerative stomatitis
- proliferative stomatitis
What are the different types of deep stomatitis?
- necrobacillosis
- actinobacilosis
- eosinophilic granulomas & ulcers
vesicular stomatitis
proliferative stomatitis
erosive dermatitis
Necrobacillosis
eosinophilic granulomas
actinobacilosis
what is the etiology of necrobacillosis?
Fusobacterium necrophorum
What is the etiology of eosinophilic granulomas?
potentially immune mediated
What is the etiology of actinobacilosis?
Actinobacillus lignieresii
What is an important cause of vesicular stomatitis?
Foot & Mouth Disease
What is foot & mouth disease?
- caused by FMD virus Aphthovirus (Picornaviridae)
- loves stratified squamous epithelium &, in young animals, myocardium
- highly contagious disease in Ru & Sw w/ great economic impact & low mortality
What are the clinical signs of FMD?
- vesicles, bullae, erosions, ptyalism, lameness, fever, anorexia
What lesions are caused by FMD?
- vesicular +/- erosive (due to mechanical impact) or even ulcerative (if infected w/ Fusobacterium necrophorum) stomatitis & occasionally esophagitis
- vesicular (+/- erosive/ulcerative) pododermatitis & thelitis (dermatitis of teats)
- in young animals, myocarditis that can present as occasional sudden death (up to 20%)
What is the pathogenesis of FMD?
- vesicle formation w/in stratified squamous epithelium is characteristic: hydropic & ballooning degeneration & necrosis of cells of stratum spinosum
- viral epithelial cytolysis creates microvesicles, which coalesce to produce intraepithelial fluid-filled vesicles (< 1cm) & bullae (> 1 cm)
- due to mastication & abrasion, vesicles rupture resulting in erosions; this stage of vesicular stomatitides is v difficult to differentiate from other erosive & ulcerative stomatitides (look for ulcerative collarettes)
- erosions may heal w/in a few days by proliferation of stratum basale, or progress to ulceration if abrasions & secondary bacterial infections damage the basement mb
what are differential diagnoses for FMD?
- vesicular stomatitis (Rhabdovirus)
- vesicular exanthema (calicivirus)
- swine vesicular disease (enterovirus - porcine variant of coxsackievirus B5 which causes hand-foot-and-mouth disease in humans)
- all of the 3 differential diagnoses have identical appearances & none are fatal, but sp susceptibility & epidemiology may vary
- final confirmatory dx is based on demo of the particular virus
- IMPORTANT: federal authorities must be informed about suspected outbreaks of vesicular diseases
What is important about vesicular stomatitides progression?
may present as erosive stomatitis (during certain stages) & can progress to ulceration secondary to abrasion & infection to the point that they cannot be distinguished from the erosive/ulcerative stomatitides
MACULE: colour change in the epithelium -> not palpable
- virus has gone here & infected these epithelial cells & then these viruses produce ballooning degeneration
- PAPULE
- damages the mb & water flushes in & causes cells to balloon
- as they expand, now you can palpate this
- then these cells are bursting & forming together a VESICLE filled w/ translucent fluid w/ a lot of virus in it
- usually these vesicles are v short-lived & what can happen here is when the animal is masticating they will burst
- when they burst, we call this EROSION
- called erosion b/c we still have a BASEMENT MB
- however, this is a special type of erosion, used to be a vesicle
- the fact that this is a special type of erosion can be seen by the presence of the epidermal collarette (red circle)
- so most likely it will regenerate
- next stage in diagram = REGENERATION HEALING
- or if it was infected by Fusobacterium necrophorum, it is going to be deep, ulcerative stomatitis
Ptyalism
erosive (vesicular?) stomatitis
erosive (vesicular?) thelitis
erosive (vesicular?) pododermatitis
ulcerative interdigital dermatitis (vesicular?)
- most likely not going to be just erosion b/c we have a lot of contamination here & Fusobacterium necrophorum is present all over in the enviro & will start to go through the basement mb w/ proteolytic enzymes
Vesicles of FMD
Erosions of FMD
FMD
healed epithelium in FMD
- in other erosive stomatitides, we have epithelial infection followed by epithelial death but not by ballooning degeneration
- by single cell necrosis instead & then sloughing of the dead tissue causing erosions
- so this is direct w/ no vesicular stage
- can result in death or if the animal doesnt die, it can be regenerated or become infected w/ Fusobacterium necrophorum & go into ulceration
Diseases that cause erosive/ulcerative stomatitis?
- BVD
- Bovine papular stomatitis (may have appearance of erosive or proliferative
- Malignant catarrhal fever
- Bluetongue
- Infectious Bovine Rhinotracheitis (IBR; virus causing systemic infection in neonatal calves - up to 1 month)
- Rinderpest
- Peste des Petits Ruminants (PPR; “pseudo-rinderpest of small ruminants”)
- feline calicivirus: oral erosions; interstitial pneumonia, conjunctivitis, & occasionally arthritis
- in primates: thrush/Candidiasis
What is Bovine Viral Diarrhea complex?
- a Pestivirus
- RNA highly mutable virus
- loves epithelium & lymphoid tissue
What are the different types of BVD?
- Classical BVD (subclinical, mild)
- fetal infection
- persistently infected (PI) calves
- mucosal disease
- thrombocytopenic syndrome
- severe (fulminant) peracute BVD
What is classical BVD?
- high morbidity & no mortality
- infection of immunocompetent, seronegative animals
- subclinical to mild clinical disease manifested by fever, leukopenia, lethargy, anorexia, transient mild drop in milk production, & potentially mild upper GI erosions
- recovered animals develop longlasting immunity
What is fetal BVD infection?
- fetuses are infected transplacentally, if a classical BVD infection occurs in a pregnant immunocompetent seronegative (non-vaccinated) cow/heifer
- outcome of the infection depends on the stage of gestation
What may fetal infection w/ noncytopathic BVD result in?
- early embryonic death, mummification, or abortion
- congenital fetal anomalies (infection btwn 90-150 days of gestation): cerebellar hypoplasia, enamel hypoplasia, hypomyelination, microencephalopathy, microophthalmia, cataracts, etc.
- PI calf (infection 50-125 days of gestation): if fetus survives infection, it remains viremic for life & is also immunotolerant for homologous noncytopathic BVD viruses, due to failure of the fetal immune system to recognize the infecting viral antigen as ‘non-self’ or foreign (infection happened before immune system was developed - up to 4 months of gestation)
What are Persistently Infected calves with BVD?
- at birth, they are normal to weak & undersized
- over time, they are unusually unthrifty, smaller size, rough hair coat, & more susceptible to infectious diseases
- PI calves are constantly viremic & shed virus all the time (MOST IMPORTANT SOURCE OF INFECTION)
- almost all PI animals succumb to Mucosal Disease before 2 years of age
What is BVD Mucosal Disease?
- PI animals have increased susceptibility to other common bovine infectious diseases
- PI animals subsequently become infected w/ a closely related cytopathic BVD virus or the non-cytopathic virus that is causing persistent infection spontaneously develops recombination
- result is overwhelming infection & destruction of epithelial & lymphoid tissues that cannot be stopped by the immune system of PI calves
What are the clinical signs of BVD mucosal disease?
- morbidity in a herd varies from 2-50%
- all affected animals die (100% mortality)
- anorexia, depression, pyrexia, profuse watery diarrhea w/ staining of the perineum & tail, rumen atony, ptyalism, etc.
- oral & interdigital erosions that may become ulcerations if infected by bacteria
what is seen on necropsy with BVD Mucosal Disease?
- multifocal erosions (or ulcers if infected w/ bacteria) in the tongue, gingiva, palate, esophagus, rumen, omasum, abomasum, & coronary bands of the hooves
- fibrinonecrotic ulceration of the intestinal mucosa over Peyer’s patches & lymphoid tissue & some cases have fibrinonecrotic colitis
- generalized lymphoid necrosis/apoptosis & depletion
what is BVD thrombocytopenic syndrome?
- animal affected by widespread hemorrhage (epistaxis, hyphema, mucosal & serosal hemorrhages) due to infection & loss of megakaryocytes that results in thrombocytopenia
What is severe (fulminant) peracute BVD?
- BVD disease has become more complicated since 1990
- highly virulent strains of BVD virus can cause high morbidity & HIGH MORTALITY (unlike classical BVD) w/ identical lesions to those described in Mucosal Disease, but in this case, in addn to PI calves, immunocompetent (non-vaccinated) animals are also affected
How do you differentiate btwn Mucosal Disease affecting PI animals & severe peracute BVD affecting immunocompetent ones?
- based on hx, epidemiological observations, & molecular characterization of BVD virus
How do you diagnose Severe Peracute BVD?
- depends on the form of the disease
- gross & histopathology
- immunohistochemistry of skin biopsies (large amounts of viral load) in PI animals - this test is not available currently due to limited availability of antibodies
- demonstration & characterization of the virus (virus isolation, PCR, etc.)
What is Rinderpest?
- caused by morbillivirus in Ru & Sw in Asia & Africa
- was eradicated in 2011
- highly contagious w/ high mortality in naive populations
What are the major lesions of rinderpest?
- erosive/ulcerative stomatitis, esophagitis, & abomasitis; hemorrhagic colitis (w/ “zebra stripes”); necrosis of lymphoid tissue (Peyer’s patches); fibrinopurulent erosive rhinitis (may extend to upper trachea); erosive vulvovaginitis;
- characteristic histopathology: intranuclear & intracytoplasmic inclusions (especially in tonsils) & multinucleated syncytial
How is Rinderpest related to BVD?
- rinderpest is eradicated
- in cattle, sheep, goats, & wild Ru, gross GIT lesions are similar as in Mucosal Disease; therefore, it cannot be distinguished from BVD based on gross exam, if upper respiratory tract & other organs are not affected
- histologically, Rinderpest is characterized by inclusion bodies & syncytial cells, neither of which is present in BVD
- epidemiology is also different
What is malignant catarrhal fever?
- caused by gamma- herpesvirus
- occurs in a variety of Bovidae (including bison) & Cervidae families
- MCFV loves epithelium, arterioles, & lymphoid tissue resulting in lymphoproliferation, vasculitis, & erosive-ulcerative mucosal & cutaneous lesions
What causes MCF in Canada & the USA?
- MCF of cattle, bison, & deer is caused by cross-infection w/ Ovine Herpesvirus 2 or Caprine Herpesvirus 2
- disease is not contagious among cattle & bison by direct contact
- this is usually a sporadic disease (w/ only occasional outbreaks, esp. in bison), but mortality in affected animals is v high
Which organ systems are affected by MCF?
- alimentary system, eyes, skin, respiratory system, urogenital system, lymphoid tissue, brain & meninges can be affected
How does MCF affect the alimentary system?
- oral ulcerations are present in most cases
- sometimes, ulcers in esophagus, forestomachs, & abomasum
- occasionally, typhlocolitis (especially in deer)
How does MCF affect the eyes?
- conjunctivitis, corneal edema, & uveitis
- if present, these lesions are important for differentiation from BVD
How does MCF affect the skin?
- erosive/ulcerative dermatitis of muzzles/nares & around hooves & horns
- sloughing of hooves may occur
- more generalized skin lesions may develop but are uncommon
How does MCF affect the respiratory system?
- nasal discharge
- occasionally mild fibrinous tracheitis & bronchitis
How does MCF affect the urogenital system?
- renal infarction or non-suppurative interstitial nephritis
- hemorrhages in urinary bladder w/ hematuria
- erosions in vagina & vulva
How does MCF affect the lymphoid tissue?
- generalized enlargement (lymphoid hyperplasia) of lymph nodes (except in bison)
How does MCF affect the brain & meninges?
- can be affected by microscopic inflammation & vasculitis; hence sometimes affected animals have CNS clinical signs
What is the pathogenesis of MCF lesions?
- it’s related to VASCULITIS/ARTERITIS (lymphoblastic & fibrinoid) (presumably causing ischemia) & subsequent erosions/ulcerations
- LYMPHOPROLIFERATION is the cause of enlarged lymph nodes
How do we diagnose MCF?
- histopathology is pathognomonic
- identification of virus by PCR
How do we differentiate btwn BVD & MCF?
- differentiation of acute severe BVD & mucosal disease from MCF is sometimes difficult on gross exam
- but MCF usually affects one or more additional organ systems or tissues (ex: eye, kidney, bladder, brain, tracheobronchial tree) not involved in Mucosal Disease,
- MCF typically produces lymphoid hyperplasia in cattle, whereas lymphoid tissue in BVD infections is depleted
What is Bluetongue?
- an arthropod (Culicoides) born Orbivirus infection that causes widespread damage to endothelial cells
- resulting in hemorrhages & microvascular thrombosis followed by ischemic necrosis characteristic for multisystemic gross changes
- ex: edema, congestion, hemorrhage, & cyanosis of gums & tongue
What is pathognomonic for Bluetongue?
- focal hemorrhage in tunica media at the base of the pulmonary artery
Who does bluetongue predominantly affect?
- sheep & wild Ru in USA
- occasionally in Okanagan Valley in BC
What causes epizootic hemorrhagic disease in deer?
- caused by a related serotype of the blue tongue virus
- present in USA & Canada
What is alimentary Infectious Bovine Rhinotracheitis (IBR)?
- IBR virus can cause systemic infection in neonatal calves (up to 1 month)
- IBR associated w/ respiratory diseases & abortions will be covered by other instructors
What are the major lesions of alimentary IBR?
- erosive stomatitis, esophagitis, rumenitis, & abomasitis
- hepatic necrosis
- mild rhinotracheitis
Symptoms of Feline calicivirus?
oral erosions, interstitial pneumonia, conjunctivitis, & occasionally arthritis
What is Peste des Petits Ruminants (PPR)?
- “pseudo-rinderpest of small ruminants”
- in goats & sheep
- lesions are similar to Rinderpest, but also pneumonia is present
- caused also by a morbillivirus different from Rinderpest (not in North America)
What are the three types of herpesvirus in primates?
- Herpesvirus B
- Herpes simplex
- Thrush
What is Herpesvirus B?
- Macacine herpesvirus 1
- causes mild stomatitis in macaque monkeys (esp. rhesus monkeys)
- in humans can result in fatal encephalomyelitis or severe neurologic impairment
- important for lab animal vets!
What is Herpes Simplex?
- Herpesvirus hominis type I
- mild stomatitis in humans (cold sores)
- but infected owl monkeys & gibbons may die due to meningoencephalitis
What is thrush?
- superficial colonization of oral mucosa by Candida spp. due to antibiotic therapy &/or high blood glucose (IV administration or diabetes mellitus)
What are noninfectious etiologies for erosive/ulcerative stomatides?
- foreign bodies, uremia in dogs, or idiopathic
What kind of foreign bodies can cause erosive/ulcerative stomatides?
- barley & foxtail awns, porcupine quills
Where do erosive or ulcerative stomatides occur w/ uremia in dogs?
- buccal & lingual erosions/ulcers often occur adjacent to the openings of the salivary ducts
What is the pathogenesis of erosive or ulcerative stomatides due to uremia in dogs?
not clear but suspected to be one of two potential processes:
- ammonia (produced from salivary urea by urease-producing bacteria in the oral cavity) has a caustic effect om the oral mucosal mbs
- experimental antibody production against urease renders some intestinal bacteria nonpathogenic & prevents uremic colitis, which indicates the importance of urease in the pathogenesis of ulceration
- however, there is poor correlation btwn the levels of blood urea & the development of uremic stomatitis, suggesting other important factors -> potentially potentiated by mechanical abrasion)
- uremic vasculitis & impaired microvascular perfusion to oral mucosa potentially contributes to pathogenesis of ulceration which may be potentiated by mechanical friction
What has an idiopathic etiology for erosive/ulcerative stomatitis?
- Lymphoplasmacytic stomatitis in cats
- hypothetically associated w/ presence of bacteria (plaque/tartar) or calicivirus in immunocompromised cats infected w/ FeLV &/or FIV
What are the clinical signs of Lymphoplasmacytic stomatitis in cats?
- red & inflamed gingiva (occasionally hyperplastic & ulcerated), halitosis, & inappetence
What are the clinical signs of FIV?
- gingivitis is most consistent, but not a specific sign of FIV infection
- associated w/ a reduction in CD4 lymphocytes, thymic atrophy, & lymph node atrophy
What are parapox stomatitides?
- proliferative stomatitides
- may look erosive but there is also epithelial proliferation
what lesions are typical of a pox viral infection?
- macules, papules, vesicles, pustules, scabs (ruptured pustules -> erosions covered w/ exudate w/ the proliferation of the epithelium)
Where are the lesions of bovine papular stomatitis?
- target lesions/erosions (in the early stage) in the mouth of young cattle, but also can occur in esophagus, rumen, & omasum as well as on the teats
- may appear erosive or proliferative
What is the zoonosis of bovine papular stomatitis?
milker’s nodules
What is contagious ecthyma?
- in sheep & goats
- aka sore mouth, infectious pustular dermatitis, or orf
What are the lesions of contagious ecthyma?
- proliferative, crusting dermatitis of mucocutaneous junction (lips commissure, eyelids, anus), udder, teats, & coronary bands
What is the morbidity, mortality, economic importance, & zoonosis of contagious ecthyma?
- high morbidity
- low mortality
- economic importance due to weightloss
- yes zoonotic (orf)
What are the different types of deep stomatitis ?
- necrotizing (necrotic) stomatitis
- noma
- Actinobacillosis
- eosinophilic stomatitis
What spp does necrotizing (necrotic) stomatitis occur in?
- cattle, sheep, pigs
What is necrotizing (necrotic) stomatitis?
- the end-stage of any forms of stomatitis when they are complicated by infection w/ Fusobacterium necrophorum that causes severe coagulation necrosis (by proteases)
What is necrotizing (necrotic) stomatitis sometimes called in cattle?
oral necrobacillosis (calf diphtheria or laryngeal necrobacillosis or necrotic laryngitis if the arytenoid cartilage is affected - barker calf)
What lesions are seen w/ necrotizing (necrotic) stomatitis?
- well demarcated foci of coagulation necrosis in the oral cavity, larynx, pharynx
What clinical signs are seen w/ necrotizing (necrotic) stomatitis?
swollen cheeks, inappetence, pyrexia, & halitosis
what can happen w/ a severe infection of necrotizing (necrotic) stomatitis?
it may become systemic
What is Noma?
- a gangrenous stomatitis associated w/ spirochetes & fusiform bacteria
What species does Noma affect?
- although rare, it affects primates, horses, & snakes
what lesions are associated w/ Noma?
- severe necrotizing gingivitis sometimes extending into the adjacent bone causing osteolysis & sometimes death
Who is Actinobacillus lignieresii?
- gram (-) bacillus that is an opportunistic invader of damaged lingual tissue, mainly in bovids & occasionally in equids & small Ru
- it can spread via lymphatic vessels to regional lymph nodes & cause a similar inflammatory response
- causes Actinobacillosis (“wooden tongue”)
What is Actinobacillosis (“wooden tongue”)?
- pyogranulomas resulting from infection w/ bacteria (centrally located actinobacilli w/in pus0 surrounded by granulomatous inflammation (hence pyogranuloma)
- inflammation & fibrosis cause increased firmness of the tongue - “wooden tongue”
What should we be careful not to confuse Actinobacillosis (“wooden tongue”) w/?
- Actinomycosis (“lumpy jaw”) which is caused by Actinomyces bovis (Gram +)
- process is the same (pyogranulomatous inflammation), but in lumpy jaw bones are affected while in wooden tongue soft tissues are
what is eosinophilic stomatitis?
- oral eosinophilic granulomas or ulcers (“rodent ulcers”) occur frequently in cats & occasionally dogs
- based on histologic appearance, considered to be an immune-mediated disease
What lesions are grouped into the eosinophilic granuloma complex of cats?
- eosinophilic oral granulomas or ulcers, cutaneous linear (collagenolytic) granulomas, & cutaneous eosinophilic dermal plaques
- the latter two lesions are strictly cutaneous & do not affect the oral cavity
hypoplastic cerebellum due to fetal BVD infection
Enamel hypoplasia in newborn calf due to fetal BVD infection
What disease causes these lesions?
BVD
disease?
BVD
Difference btwn BVD & FMD?
FMD only affects epithelial tissues which BVD affects epithelial and lymphoid tissues
What is this & what condition is it seen in?
Peyer’s Patch necrosis
- Mucosal disease of BVD
How is MCF transmitted to cattle?
- not transmitted btwn cattle, it is transmitted from sheep to cattle
hemorrhagic teats in MCF in Bo
disease & sp
MCF in Bo
ulceration of the tongue in MCF of Bo
Ptyalism due to MCF in Bo
What is fibrinous rhinitis in MCF in Bo
laryngitis in MCF in Bo
Nephritis in MCF in Bo
cystitis of the urinary bladder in MCF in Bo
conjunctivitis w/ MCF in deer
keratoconjunctivitis +/- edema of the cornea +/- uveitis w/ MCF in Bo
disease?
Bluetongue
erosive/ulcerative stomatitis from feline calicivirus
disease?
erosions in the mouth due to Herpesvirus B
Erosive/Ulcerative dermatitis due to porcupine quills
uremic glossitis
uremic stomatitis
lymphoplasmacytic stomatitis
what kind of superficial stomatitis are these?
proliferative stomatitis
target lesions of Bovine papular stomatitis
“milker’s nodules”
- zoonosis of Bovine Papular Stomatitis
- leads to smallpox immunity
what is the pattern that all poxvirus lesions follow?
contagious ecthyma (Orf)
- perioccular & perioral
contagious ecthyma (Orf)
- teats
zoonotic infection of orf
necrotizing stomatitis “oral necrobacillosis”
necrotizing laryngitis (or laryngeal necrobacillosis - barker calves)
fibronecrotic stomatitis (noma) in a python
actinobacillosis or “wooden tongue”
actinobacillosis or “wooden tongue”
eosinophilic granuloma
eosinophilic granuloma complex or “rodent ulcers”
