Hepatitis in horses refers to inflammation of the liver, which can arise from various causes including infectious agents, toxins, or immune-mediated processes. This condition affects the liver's ability to perform essential functions such as detoxification, metabolism, and protein synthesis. In horses, hepatitis can manifest in different forms, including acute and chronic, each with distinct clinical presentations and pathological findings. Diagnostic approaches often involve a combination of clinical evaluation, biochemical testing, imaging, and liver biopsy to determine the underlying cause and severity of the disease. This page compiles peer-reviewed research studies and scholarly articles that explore the etiology, pathophysiology, diagnostic methods, and management strategies for hepatitis in equine patients.
Smith MR, Stevens KB, Durham AE, Marr CM.Liver disease is fairly common in horses and, although previous literature suggests that fatality rates are high, impressions gained from current clinical practice suggest that this is no longer the case. Objective: A case-control study was undertaken in 2 hospitals to investigate whether age, gender or breed type predisposed horses to developing hepatic disease, with the additional aim of determining whether these factors and disease category had any effect on outcome. Methods: Eighty-eight cases were identified by review of computerised archives at 2 hospitals. Three cases admitted immediate...
Haechler S, Van den Ingh TS, Rogivue C, Ehrensperger F, Welle M.Congenital hepatic fibrosis with autosomal recessive or dominant inheritance has been described in humans, cats, piglets, and dogs. In horses, only two cases of congenital hepatic fibrosis have been previously reported. This retrospective study of records from the Institute for Animal Pathology, University of Berne, identified 30 foals with liver lesions compatible with congenital hepatic fibrosis. Anamnestic data revealed clinical signs of severe liver injury in most affected animals. Pathologic examination showed severely enlarged, firm livers with thin-walled cysts. Histologically, the live...
Peek SF, Divers TJ.The medical approach to treatment of cholangiohepatitis and cholelithiasis in 9 horses is described. Seven horses were treated successfully and returned to normal use, with a minimum follow-up period of 12 months. Long-term antimicrobial therapy was believed to be critical in those cases that survived, with a median treatment duration of 51 days (range 17-124 days). Treatment failure was associated with severe periportal and bridging hepatic fibrosis from biopsy material obtained at admission in 2 horses, one of whom also presented with hyperammonaemic hepatic encephalopathy. Transabdominal ul...
Davis CR, Barr BC, Pascoe JR, Olander HJ, Dubey JP.Hepatic sarcocystosis was diagnosed in a horse in association with refractory bacterial osteomyelitis and plasma cell tumor of the maxilla and hepatic salmonellosis. Gross lesions included pleural, pericardial, and peritoneal effusions, hepatomegaly, gastric ulceration, colonic edema, and proliferative tissues filling 2 maxillary dental alveoli. Histologically, liver was characterized by severe suppurative, necrotizing, periportal hepatitis, and severe periacinar necrosis. Hepatocytes frequently contained protozoal schizonts in various stages of development. In mature schizonts, merozoites wer...
Cryz SJ.At the time the Swiss Serum and Vaccine Institute Berne (BERNA) was found in 1898, few vaccines or immune globulins were available. This short list included vaccines against cholera, typhoid fever, plague, smallpox and rabies and equine anti-tetanus and diphtheria immune globulins. Furthermore, their use was restricted due to limited production capacity, uncertainty regarding safety and no public health infrastructure to promote their utilization. Today, safe and effective vaccines exist for more than 30 infectious diseases while human hyperimmune globulins exist to treat or prevent rabies, te...
McGorum BC, Murphy D, Love S, Milne EM.The clinicopathological features of 50 cases of equine hepatic disease were reviewed. There was a wide range of clinical signs and at least 50 per cent of the animals exhibited either dull demeanour, anorexia, abdominal pain, cerebral dysfunction and/or weight loss. Life-threatening complications of hepatic failure recorded were: gastric impaction in 10 cases, bilateral laryngeal paralysis in seven cases and coagulopathy in five cases. All the cases had high activities of gamma-glutamyl transferase (GGT) and most had high activities of glutamate dehydrogenase (GLDH) and high concentrations of ...
Hess S, Gulati R, Peluso JJ.The present studies showed that sequential treatment with equine CG (eCG) and hCG not only induced an increase in ovarian weight, but also caused an estimated 4.6-fold increase in the number of ovarian surface epithelial cells. In addition, eCG-hCG treatment increased ovarian hepatocyte growth factor (HGF) messenger RNA levels. These studies also demonstrated that rat primary ovarian surface epithelial cells as well as a cell line derived from rat ovarian surface epithelium (i.e. ROSE-179 cells) do not express the LH (hCG) receptor. Both of these cells express c-Met, the receptor for HGF. To a...
French RA, Meier WA, Zachary JF.Tissues from a 9-year-old American Standardbred gelding with a history of anorexia, mild colic, and unexpected death were submitted to the Laboratories of Veterinary Diagnostic Medicine at the University of Illinois for histopathologic examination. Microscopic diagnoses were severe subacute, diffuse eosinophilic colitis with intralesional protozoa and a subacute to chronic eosinophilic portal hepatitis with granuloma formation. Two tissue-invading, ciliated protozoa were identified in large numbers within the colonic mucosa. The ciliates were Polymorphella ampulla and Cycloposthium sp., Phylum...
Huygelen C.Two hundred years ago Edward Jenner inoculated James Phipps with vaccinia and 181 years later smallpox had disappeared from the surface of the earth as a result of generalized vaccination. Compared to the requirements of modern vaccinology, the procedures used by Jenner and his successors, were extremely primitive because of an almost total lack of knowledge in the field of microbiology and immunology. The active principle of smallpox vaccine is vaccinia virus, which in many respects, differs from that of natural cowpox; the term "cowpox" has been used for more than a century and a half to des...
Guglick MA, MacAllister CG, Ely RW, Edwards WC.Seven horses developed clinical or subclinical hepatitis 48 to 87 days after administration of tetanus antitoxin. One horse had mildly high hepatic enzyme activity 120 days after inoculation with tetanus antitoxin. The first horse developed signs of depression, lethargy, and anorexia. During hospitalization, signs of hepatoencephalopathy were noticed, and laboratory data were consistent with hepatic disease. Another horse that was found dead had gross and histologic lesions compatible with serum hepatitis. Screening of serum gamma-glutamyltransferase (GGT) and aspartate transaminase activities...
Messer NT, Johnson PJ.Acute hepatic disease was diagnosed in 16 horses during the study period. Twelve of those cases were characterized as idiopathic acute hepatic disease (IAHD). In 9 of the 12 (75%) cases of IAHD, the horses were female, and 7 of the 9 females were lactating and had been treated with tetanus antitoxin at parturition. Diagnosis of IAHD was based on anamnesis, clinical signs, and results of serum biochemical analyses, hepatic biopsy, and postmortem examination. Within 1 year of the illness, 75% (9/12) of the horses had died or had been euthanatized. Not all horses had the typical fulminant signs a...
Messer NT, Johnson PJ.Two adult Quarter Horse mares from the same farm developed signs of hepatic disease approximately 2 months after parturition. Both mares had received tetanus antitoxin at the time of foaling. One mare developed subcutaneous edema of the distal aspect of all 4 limbs, photodermatitis involving unpigmented areas of skin, and high serum activities of liver-specific enzymes. The other mare had signs of acute hepatic failure, including icterus, hepatic encephalopathy, and high serum activities of liver-specific enzymes, and died. The second mare had signs typical of serum hepatitis (Theiler's diseas...
Pearson EG, Hedstrom OR, Poppenga RH.Hemochromatosis, an iron storage disease, was diagnosed in 3 horses with hepatic cirrhosis. Each horse had bridging portal fibrosis and abundant iron deposits in the cytoplasm of hepatocytes. Serum concentrations of liver-derived enzymes and total bile acids were high. However, serum iron concentration was not high, and iron binding capacity was only 46% saturated in the 1 horse in which it was measured. However, the concentration of iron in the liver of this horse was 20 times the reference limits. Hemochromatosis is common in mynah birds and human beings. There are several types of this iron...
Cornick JL, Carter GK, Bridges CH.Chronic hepatic disease was diagnosed in 6 horses with history of anorexia and weight loss. These horses consistently had abnormally high serum gamma-glutamyltransferase activities, total and direct bilirubin and blood ammonia values, and sulfobromophthalein clearance times, whereas serum iditol dehydrogenase, aspartate transaminase, and alkaline phosphatase activities were variable. In the 6 horses, histologic examination of the liver revealed lesions of chronic hepatitis with varying degrees of fibrosis. All 6 horses had ingested kleingrass (Panicum coloratum) for variable periods. Three hea...
Slocombe RF, Slauson DO.Invasive pulmonary aspergillosis was identified in 19 horses. In 16 cases mycotic lesions were associated with enterocolitis; 14 cases appeared to result from Salmonella infection. Pulmonary lesions included multifocal areas of acute necrosis, leukocytoclastic vasculitis, and thrombosis with fibrinosuppurative inflammation surrounding mycelial masses. Thromboemboli with fungi were in the brain and kidneys of three cases. Factors which appeared to predispose to pulmonary aspergillosis included corticosteroid therapy, disseminated neoplasms, hepatitis, pleuritis, and peritonitis. This study sugg...
Mullaney TP, Brown CM, Watson GL, Brandt LA.An apparently new and emerging fatal hepatic disease affecting foals is described. Characteristics included evidence of hepatic failure, marked biliary hyperplasia, hepatocellular necrosis and occasionally fibrosis. Generally, the features of the disease appear to differ markedly from other hepatic diseases of neonatal foals.
Acland HM, Mann PC, Robertson JL, Divers TJ, Lichtensteiger CA, Whitlock RH.Six foals of three different breeds, born to healthy mares, appeared normal at birth, and died at two to five days of age with icterus, ataxia, head pressing, and terminal hepatic coma. Their livers were less than one-half normal weight. Most of the liver was dark red-brown and slightly rubbery. Histologically, these areas were characterized by severe bile ductule proliferation, mild portal tract fibrosis, and massive hepatocellular necrosis and lobular collapse. A small proportion of the liver, usually on the peripheral part of the lobes, was grossly light brown and slightly raised. Histologi...
Acland HM, Gunson DE, Gillette DM.Seven foals aged 18 days to 3 1/2 months had either single or multiple full-circumference segments or long antimesenteric bands of necrotizing duodenitis, sharply delineated from adjacent viable duodenum. Perforation of the necrotic wall had occurred in all foals, leading to acute fibrinous peritonitis. On the mucosal surface severe diffuse, acute inflammation and ulceration involved the anterior half of the duodenum. Two further foals, aged 28 and 30 days, had lesions that are believed to be a chronic form of this disease. Both foals had a thickened duodenal wall, with large areas of mucosa r...
Dickie CW, Regnier JO.Myositis and septicemia caused by Acinetobacter calcoaceticus were diagnosed in a mare. The infection was characterized clinically by ventral swelling and edema, diarrhea, listlessness, and rectal temperature of 39.4 C. The mare was treated symptomatically for 2 days but died on the 3rd day. Conditions seen at necropsy were myositis, enteritis, typhlitis, colitis, and hepatitis. Lymph nodes were moderately enlarged throughout the body. Gross lesions in musculature were edema, scarring, petechiae, and an occasional exxhymosis. The enteritis was catarrhal, with excessive mucus and moderate hyper...
Whitwell KE.A rodent pathogen, Bacillus piliformis, has been recognised as causing a rapidly fatal hepatitis in 4 foals in England. The disease in foals has been recognised in America since 1973. A clinico-pathological account of the 4 cases is given and the differential diagnosis discussed. The 4 foals' ages fell within a very narrow range (24-34 days). Some of the properties of this unusual intracellular pathogen are reviewed. For the first time in the equine the bacillus was seen in association with myocardial lesions. There are marked differences in the epidemiology of the disease in the mouse and in ...
Tomlinson JE, Van de Walle GR.Equine parvovirus hepatitis (EqPV-H) is highly prevalent and causes subclinical to fatal hepatitis, which can occur in outbreaks. Whereas iatrogenic transmission is well documented, the mode of horizontal transmission is not known. The virus is shed in nasal, oral and fecal secretions, and PO transmission has been reported in a single horse. Objective: Investigate the efficiency of PO and nasal transmission of EqPV-H in a larger cohort. Methods: Prospective experimental transmission study. Eleven EqPV-H-negative horses were inoculated with 5 × 10 genome equivalents EqPV-H. Serum PCR and s...
Papapetrou MA, Arroyo LG, Meister TL, Baird JD, Steinmann E, Lillie BN.Equine parvovirus-hepatitis (EqPV-H) was first reported from the serum and liver tissue of a horse diagnosed with Theiler's disease in the United States in 2018. Theiler's disease, also known as equine serum hepatitis, is a severe hepatitis with fulminant hepatic necrosis. The disease has most frequently been reported following the administration of equine-origin biological products; however, it has also been reported in in-contact horses with no prior biologic administration. EqPV-H has been detected in clinically healthy horses in North America (USA, Canada), Europe (Germany, Austria, Sloven...
Zehetner V, Cavalleri JV, Klang A, Hofer M, Preining I, Steinborn R, Ramsauer AS.There is strong evidence that equine parvovirus-hepatitis (EqPV-H) is associated with the onset of Theiler's disease, an acute hepatic necrosis, in horses. However, the impact of this virus on other hepatopathies remains unknown. The objective of this retrospective study was to evaluate the prevalence and quantify the viral loads of EqPV-H in formalin-fixed, paraffin-embedded equine and donkey livers with various histopathologic abnormalities. The pathologies included cirrhosis, circulatory disorders of the liver, toxic and metabolic hepatic diseases as well as neoplastic and inflammatory dise...
Grondin TM, DeWitt SF, Keeton KS.A 9-year-old Arabian mare was evaluated for a 7-day history of malaise. Results of a CBC included a leukocyte concentration within the reference interval (8.4 x 10(3)/microL, reference interval 6.0-14.0 x 10(3)/microL) with an apparent degenerative left shift (segmented neutrophils 1.2 x 10(3)/microL, reference interval 2.5-7.5 x 10(3)/microL; hyposegmented neutrophils 1.8 x 10(3)/microL, reference interval 0.0-0.2 x 10(3)/microL). Serum clinical chemistry results included increased aspartate transaminase, alkaline phosphatase, and gamma-glutamyltransferase activities. A presumptive diagnosis ...
Huygelen C.Two hundred years ago Edward Jenner inoculated James Phipps with vaccinia and 181 years later smallpox had disappeared from the surface of the earth as a result of generalized vaccination. Compared to the requirements of modern vaccinology, the procedures used by Jenner and his successors, were extremely primitive because of an almost total lack of knowledge in the field of microbiology and immunology. The active principle of smallpox vaccine is vaccinia virus, which in many respects, differs from that of natural cowpox; the term "cowpox" has been used for more than a century and a half to des...
Jager MC, Choi E, Tomlinson JE, Van de Walle G.Equine parvovirus-hepatitis (EqPV-H) is the causative agent of Theiler's disease, or severe acute hepatic necrosis, in horses. However, it is poorly understood whether EqPV-H is associated with other histologic findings in horses with clinical liver disease. The objective of this study was to examine the prevalence and severity of EqPV-H infections in diagnostic liver samples. Archived formalin-fixed, paraffin-embedded (FFPE) liver samples (n = 98) from Cornell University and University of California, Davis, collected between 2007 and 2022 were evaluated for 15 individual histologic features a...
Fortier C, El-Hage C, Normand C, Hue ES, Sutton G, Marcillaud-Pitel C, Jeffers K, Bamford N, Oden E, Paillot R, Hartley C, Gilkerson J, Pronost S.Reports of newly discovered equine hepatotropic flavi- and parvoviruses have emerged throughout the last decade in many countries, the discovery of which has stimulated a great deal of interest and clinical research. Although commonly detected in horses without signs of disease, equine parvovirus hepatitis (EqPV-H) and equine hepacivirus (EqHV) have been associated with liver disease, including following the administration of contaminated anti-toxin. Our aim was to determine whether EqPV-H and EqHV are present in Australian horses and whether EqPV-H was present in French horses and to examine ...
Costa LRR, Swiderski C, Palm C, Aleman M.To investigate if hepatitis A virus cell receptor 1/kidney injury molecule 1 (HAVCR1/KIM1) in urine is detectable concurrently with increases in serum creatinine concentrations in horses receiving a recommended dose of phenylbutazone (PBZ) for 7 days. Methods: Preliminary study. Methods: Ten clinically healthy horses with normal physical examination and laboratory work were randomly assigned to PBZ or placebo groups (5 each). The PBZ group received PBZ at 4.4 mg/kg mixed with corn syrup orally every 12 hours. The placebo group received corn syrup orally every 12 hours. Both groups were tre...
Smith MR, Stevens KB, Durham AE, Marr CM.Liver disease is fairly common in horses and, although previous literature suggests that fatality rates are high, impressions gained from current clinical practice suggest that this is no longer the case. Objective: A case-control study was undertaken in 2 hospitals to investigate whether age, gender or breed type predisposed horses to developing hepatic disease, with the additional aim of determining whether these factors and disease category had any effect on outcome. Methods: Eighty-eight cases were identified by review of computerised archives at 2 hospitals. Three cases admitted immediate...
Buote M.A 2-month-old foal was presented with clinical signs of colic. Gastroduodenal ulceration was suspected. A poor response to medical treatment and signs of gastroduodenal obstruction led to celiotomy and an attempted bypass procedure. The foal was euthanized and postmortem examination revealed gastric ulceration, segmental duodenal stenosis, and severe chronic cholangiohepatitis and pancreatitis.
Ellero N, Lanci A, Avallone G, Mariella J, Castagnetti C, Muscatello LV, Di Maio C, Freccero F.Seizures, coma and death rapidly appeared after admission in a one ‑month‑old foal with a history of lethargy, fever and anorexia. Severe icterus and necrotizing hepatitis were observed at necropsy. Clinical signs, laboratory and postmortem findings were compatible with a suspect of clostridial hepatitis. Tyzzer’s disease was confirmed by the presence of organisms morphologically consistent with Clostridium piliforme in the hepatocytes at the margins of multiple areas of hepatic necrosis. To the authors’ knowledge, this is the first reported case of clostridial hepatitis caused by Clos...
Corrêa WM, Nilsson MR.Five livers of equine fetuses, aborted due to the action of equine abortion virus, five livers from men, two of whom died of epidemic hepatitis and three obtained by needle biopsies, 5 livers of dogs with infectious canine hepatitis and 7 livers of ducklings that had hepatitis, were studied histopathologically. The foals' livers were studied by several staining methods and the others by H. E. only. The results indicate that the lesions are quite similar in the four species with the appearance of nuclear inclusion bodies only in foals and dogs. The strong staining properties of the nuclear incl...
Tirosh-Levy S, Perl S, Valentine BA, Kelmer G.Hepatoblastoma was diagnosed in a 3-year-old Thoroughbred gelding presented with forelimb lameness with bilateral fatigue fractures of the proximal third metacarpal bones. An abdominal mass was detected on ultrasound examination of the abdomen. Absolute erythrocytosis was diagnosed after clinical and haematological evaluation. The fractured metacarpal bones were surgically removed but complications after surgery were fatal. The liver mass was diagnosed as a hepatoblastoma based on histology and immunochemical staining. The combination of hepatoblastoma and fatigue fractures has not been descri...
Dickie CW, Regnier JO.Myositis and septicemia caused by Acinetobacter calcoaceticus were diagnosed in a mare. The infection was characterized clinically by ventral swelling and edema, diarrhea, listlessness, and rectal temperature of 39.4 C. The mare was treated symptomatically for 2 days but died on the 3rd day. Conditions seen at necropsy were myositis, enteritis, typhlitis, colitis, and hepatitis. Lymph nodes were moderately enlarged throughout the body. Gross lesions in musculature were edema, scarring, petechiae, and an occasional exxhymosis. The enteritis was catarrhal, with excessive mucus and moderate hyper...
Jager MC, Tomlinson JE, Henry CE, Fahey MJ, Van de Walle GR.Theiler's disease, a.k.a. equine serum hepatitis, is a devastating, highly fatal disease of horses. Equine parvovirus-hepatitis (EqPV-H) has been identified as the likely cause of this disease. While the incidence of Theiler's disease is low, the prevalence of EqPV-H DNA in horses is high, with up to 37% in some regions, suggesting that subclinical or persistent infection is common. To determine the prevalence and pathogenicity of EqPV-H infection at New York racetracks, DNA was extracted from archived formalin-fixed, paraffin-embedded liver tissues from racehorses submitted for necropsy to th...
Olsman AF, Sloet van Oldruitenborgh-Oosterbaan MM.The clinical signs of liver disease are highly variable and non-specific. Irrespective of the cause or the duration of liver disease, more specific clinical signs, e.g. hepatic encephalopathy, become apparent in the advanced stages of the disease. Due to the non-specific clinical signs, the possible diagnosis of liver disease is frequently not taken into consideration. However, measurement of the plasma or serum concentrations of total bile acids and gamma glutamyl transferase (gamma GT) may provide valuable diagnostic information. The specific diagnosis can be confirmed by ultrasound examinat...
Yoon J, Park T, Kim A, Park J, Park BJ, Ahn HS, Go HJ, Kim DH, Lee JB, Park SY, Song CS, Lee SW, Choi IS.Equine parvovirus-hepatitis (EqPV-H) is one of the etiological agents of Theiler's disease, causing fulminant hepatitis; however, its transmission route and pathogenesis remain unclear. In the present study, we aimed to determine EqPV-H shedding in oral/nasal/vaginal swabs or semen samples from horses living in Korea using nested polymerase chain reaction. We then used the data obtained to investigate various risk factors associated with EqPV-H including viral shedding, hepatopathological changes, and genetic diversity. Our data revealed occurrence of EqPV-H shedding in these animals (oral: 3/...
French RA, Meier WA, Zachary JF.Tissues from a 9-year-old American Standardbred gelding with a history of anorexia, mild colic, and unexpected death were submitted to the Laboratories of Veterinary Diagnostic Medicine at the University of Illinois for histopathologic examination. Microscopic diagnoses were severe subacute, diffuse eosinophilic colitis with intralesional protozoa and a subacute to chronic eosinophilic portal hepatitis with granuloma formation. Two tissue-invading, ciliated protozoa were identified in large numbers within the colonic mucosa. The ciliates were Polymorphella ampulla and Cycloposthium sp., Phylum...
Cryz SJ.At the time the Swiss Serum and Vaccine Institute Berne (BERNA) was found in 1898, few vaccines or immune globulins were available. This short list included vaccines against cholera, typhoid fever, plague, smallpox and rabies and equine anti-tetanus and diphtheria immune globulins. Furthermore, their use was restricted due to limited production capacity, uncertainty regarding safety and no public health infrastructure to promote their utilization. Today, safe and effective vaccines exist for more than 30 infectious diseases while human hyperimmune globulins exist to treat or prevent rabies, te...
Nardini R, Pacchiarotti G, Svicher V, Salpini R, Bellocchi MC, Conti R, Sala MG, La Rocca D, Carioti L, Cersini A, Manna G....Equine hepacivirus (EqHV, Flaviviridae, hepacivirus) is a small, enveloped RNA virus generally causing sub-clinical hepatitis with occasional fatalities. EqHV is reported in equids worldwide, but for Italy data are limited. To address this, a survey study was set up to estimate prevalence at a national level and among different production categories (equestrian; competition; work and meat; reproduction) and national macro-regions (North, Central, South, and Islands). Data obtained testing 1801 horse serum samples by Real-Time RT PCR were compared within the categories and regions. The NS3 frag...
Iranmanesh M, Sato AF, Tenney W, Brinker EJ, Cortez K, Mazan M.A 1-year-old Miniature Horse filly was presented for chronic lethargy and hyporexia. Elevated liver enzymes, bile acids, and ammonia were noted on bloodwork. The primary differential diagnosis was a portosystemic shunt (PSS). Three-phase computed tomographic angiography findings were consistent with a transhepatic portosystemic shunt. Percutaneous liver biopsy confirmed severe diffuse hepatic changes, most likely due to chronic pyrrolizidine alkaloid toxicosis, and medical management was elected. Based on an extensive literature review, this is the first report of a transhepatic portosystemic ...
