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	<title>Nuclear Medicine &#187; Hyperplasia</title>
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		<title>Severe Biliary Hyperplasia Associated With Liver Fluke and Gastrointestinal Helminthes Infection in an Adult Lama Alpaca in Nepal</title>
		<link>http://esnms.com/severe-biliary-hyperplasia-associated-with-liver-fluke-and-gastrointestinal-helminthes-infection-in-an-adult-lama-alpaca-in-nepal/38/</link>
		<comments>http://esnms.com/severe-biliary-hyperplasia-associated-with-liver-fluke-and-gastrointestinal-helminthes-infection-in-an-adult-lama-alpaca-in-nepal/38/#comments</comments>
		<pubDate>Sun, 13 Dec 2009 02:12:57 +0000</pubDate>
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				<category><![CDATA[veterinary nuclear medicine]]></category>
		<category><![CDATA[Adult]]></category>
		<category><![CDATA[Alpaca]]></category>
		<category><![CDATA[Associated]]></category>
		<category><![CDATA[Biliary]]></category>
		<category><![CDATA[Fluke]]></category>
		<category><![CDATA[Gastrointestinal]]></category>
		<category><![CDATA[Helminthes]]></category>
		<category><![CDATA[Hyperplasia]]></category>
		<category><![CDATA[Infection]]></category>
		<category><![CDATA[Lama]]></category>
		<category><![CDATA[Liver]]></category>
		<category><![CDATA[Nepal]]></category>
		<category><![CDATA[Severe]]></category>

		<guid isPermaLink="false">http://esnms.com/?p=38</guid>
		<description><![CDATA[Abstract &#13;
An adult alpaca (Lama pacos) had a locally extensive area of hepatic atrophy involving the right lobe. Grossly, the atrophic lobe was light tan and firm and contained small, raised, white to yellow, partially mineralized circular nodules predominantly at the periphery of the atrophic tissue. Microscopically, viable hepatocytes were not present in the atrophic [...]]]></description>
			<content:encoded><![CDATA[<p>Abstract <br />&#13;</p>
<p>An adult alpaca (Lama pacos) had a locally extensive area of hepatic atrophy involving the right lobe. Grossly, the atrophic lobe was light tan and firm and contained small, raised, white to yellow, partially mineralized circular nodules predominantly at the periphery of the atrophic tissue. Microscopically, viable hepatocytes were not present in the atrophic area, and the tissue consisted of diffuse biliary epithelial proliferation without any evidence of nuclear or cellular atypia or the presence of mitotic figures. The circular mineralized nodules consisted of granulomatous inflammation with intralesional parasitic ova surrounded by fibrous connective tissue. Morphologically, the ova were compatible with those of Fasciola hepatica.Alongwith ova of Trichostorgylus spp,Cooperia spp,Chabertia spp,Trichuris spp,Oesophagostomum spp was recorded from faeces of Lama Alpaca .The severe biliary hyperplasia was unusual, and it was not clear whether it was caused by an aberrant host response to the parasitic infection or whether it was an unrelated event. <br />&#13;</p>
<p>Key words: Alpacas; biliary hyperplasia; Fasciola hepatica; Lama Pacos; liver flukes, Gastroinstinal helminthes, Nepal.<br />&#13;</p>
<p> General background History:<br />&#13;</p>
<p>Although Alpaca Lama is not native to Nepal .Some foreigner had brought it from Germany for personal interest for breeding out of 15 animal inherd.The affected animal was an adult castrated male alpaca of unknown age .The carcass was in poor nutritional state, and was ill since last week treated with routine antibiotics and supportive therapy and died during course of treatment .On postmortem examination the most significant gross lesions were present in the liver. The right lobe of the organ was markedly atrophic (approximately 30% of normal size), light tan, and firm and contained numerous small circular foci (up to 4 mm in diameter) on both the diaphragmatic and visceral surfaces .These foci were predominantly present at the periphery of the atrophic lobe and were white to yellow and raised above the capsular surface, with firm to hard consistency. Cut sections of these foci revealed partially calcified material. Similar but fewer of these foci were also seen in other parts of the liver .Multifocal irregular pale white foci were observed on the dorsal aspects of the diaphragmatic lung lobes. With about 40-50 adult Fasciola parasite were present in bile duct.The circular nodules seen on gross examination consisted of a peripheral area of dense fibrous connective tissue surrounding a central region of partially mineralized cellular debris. Variable numbers of partially degenerate parasitic ova were present in the core of some of the nodules .The ova were approximately 60–90 x 130–150 µm and were morphologically compatible with ova of Fasciola hepatica.On Coprological examination of feaces from large and small intestine revealed ova of Trichostorgylus spp,Cooperia spp,Chabertia spp,Trichuris spp,Oesophagostomum spp was recorded.</p>
<p>&#13;</p>
<p>Review of literatures:<br />&#13;</p>
<p>Pathology of the liver is not a commonly recognized problem in South American camelids, and only a limited number of etiologic agents are known to specifically affect the liver in these species. Here, we describe locally extensive hepatic atrophy with diffuse biliary hyperplasia and multifocal granulomatous hepatitis associated with ova of liver flukes in an alpaca (Lama pacos). <br />&#13;</p>
<p>Although liver disease in South American camelids is not common, a number of examples of hepatic pathology have been reported, including metabolic, toxic, infectious (parasitic, bacterial, fungal, viral), and neoplastic conditions. Among the parasitic infections, liver flukes (F. hepatica, F. gigantica), immature cysts of tapeworms (Echinococcus granulosus, Taenia helicometra, T. hydatigena), and larval stages of nematodes (Lamanema chavezi) spp have been reported as etiologic agents.and ova of Trichostorgylus spp,Cooperia spp,Chabertia spp,Trichuris spp,Oesophagostomum  spp also being causative agent of this condition.<br />&#13;</p>
<p>F. hepatica infections have been identified in a wide range of species, including the cow, sheep, horse, goat, dog, cat, rabbit, guinea pig, squirrel, deer, beaver, pig, and human. Fascioliasis has also been recognized in the llama and alpaca, both as a primary problem and as an incidental infection. Although there are no published reports of liver flukes in guanaco, F. hepatica has been identified as a significant problem in the phylogenetically related vicuña in a semicaptive research program in Argentina. Experimental infections in the llama have demonstrated that the prepatent period of 8–12 weeks is similar to that observed in other species and that uncontrolled infection can result in death. <br />&#13;</p>
<p>F. hepatica is endemic in the area where the alpaca had resided. The clinical presentation of F. hepatica infections in South American camelids is highly variable and quantitively related to the level of infection. Animals infected with a low number of parasites frequently show no clinical evidence of disease, whereas heavily parasitized animals most commonly present with symptoms of anorexia and lethargy.<br />&#13;</p>
<p>In South and North America, both acute and chronic forms of liver fluke infections have been reported in these animals, although the chronic form is most commonly observed. In this form, the flukes cause blockage of bile ducts and incite extensive fibrosis in the liver. In the affected alpaca, the findings were markedly different. The fibrotic response was minimal in the area of biliary hyperplasia but was extensive around the areas of granuloma formation. The most prominent lesion was an extensive area of biliary hyperplasia and multifocal granulomas containing parasitic ova. <br />&#13;</p>
<p>The gross nodular lesions in the liver of this alpaca were also similar to the lesions caused by Lamanema chavezi, which is an important parasite in South American camelids that has not been reported outside of South America.4 Although grossly the hepatic lesions in animals infected with L. chavezi are multifocal and partially calcified (similar to the lesions in the affected alpaca), the microscopic findings are different (i.e., intralesional parasitic ova are not seen within the partially calcified nodules). <br />&#13;</p>
<p>Although the host response to the parasitic eggs was unusual, the parasitic ova in this affected alpaca were determined to be those of F. hepatica, and the strange liver tissue reaction was attributed to individual biologic variation of the alpaca. Some may argue that the hyperplastic biliary change was the result of a blockage of a large bile duct, but no such lesion was identified at gross examination. Similarly, the hyperplasia could be attributed to an unidentified hepatotoxic agent(s). However, the biliary hyperplasia was confined to the right lobe, and the likelihood of toxins affecting a locally extensive area of liver is remote.  <br />&#13;</p>
<p>Conclusion Recommendation:<br />&#13;</p>
<p>Although Lama Alpaca is not native to Nepal there is very little information is available regarding this species .Finding of this observation may be considered as reference for disease and parasites of introduction of any exotic animal. A detail study in this regard should be looked into<br />&#13;</p>
<p>References<br />&#13;</p>
<p>1.A. N. Hamir and B. B. Smith Brief Communications and Case Reports Severe Biliary Hyperplasia Associated with Liver Fluke Infection in an Adult Alpaca Vet Pathol 39:592-594 (2002) © 2002 American College of Veterinary Pathologists</p>
<p>&#13;</p>
<p>2.Anderson DE: Liver diseases of camelids. Proc North Am Vet Conf 1998:1053-1054, 1998 <br />&#13;</p>
<p>3.Cafrune MM, Rebuffi GE, Gaido AB, Aguirre DH: Fasciola hepatica in semi-captive vicuñas (Vicugna vicugna) in northwest Argentina. Vet Rec 139:97, 1996<br />&#13;</p>
<p>4.Cornic JL: Gastric squamous cell carcinoma and fascioliasis in a llama. Cornell Vet 78:235-241, 1988<br />&#13;</p>
<p>5.Fowler ME: Unique parasitism of South American camelids in North and South America. J Camel Pract Res 4:257-260, 1997 <br />&#13;</p>
<p>6.Fowler ME: Parasites. In: Medicine and Surgery of South American Camelids, pp 195-230, Iowa State University Press, Ames, IA 1998 <br />&#13;</p>
<p>7.Hamir AN, Andreasen CB, Pearson EG: Endogenous lipid pneumonia (alveolar histiocytosis) and hydrocephalus in an adult llama (Lama glama). Vet Rec 141:474-476, 1997<br />&#13;</p>
<p>8.Jones CT, Hunt RD, King NW: Diseases caused by parasitic helminths and arthropods. In: Veterinary Pathology, pp 601-680, Williams &amp; Wilkins, Baltimore, MD 1997 <br />&#13;</p>
<p>9.Puente GL: Acute and subacute fascioliasis of alpacas (Lama pacos) and treatment with triclabendazole. Trop Anim Health Prod 29:31-32, 1997<br />&#13;</p>
<p>10.Rickard LG: Parasites. Vet Clin North Am Food Anim Pract 10:239-241, 1994 <br />&#13;</p>
<p>11.Rickard LG, Foreyt WJ: Experimental fascioliasis in llamas. J Helminthol Soc Wash 59:140-144, 1992</p>
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<p>Dr.Kedar Karki<br />&#13;<br />
M.V.St.Preventive Veterinary  Medicine<br />&#13;<br />
Veterinary Officer<br />&#13;<br />
Parasitology Unit <br />&#13;<br />
Central Veterinary Laboratory Kathmandu Nepal</p>
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