Clostridium difficile infection in horses: a review.
Abstract: Clostridium difficile is considered one of the most important causes of diarrhea and enterocolitis in horses. Foals and adult horses are equally susceptible to the infection. The highly resistant spore of C. difficile is the infectious unit of transmission, which occurs primarily via the fecal-oral route, with sources of infection including equine feces, contaminated soil, animal hospitals, and feces of other animals. Two major risk factors for the development of C. difficile associated disease (CDAD) in adult horses are hospitalization and antimicrobial treatment, although sporadically, cases of CDAD can occur in horses that have not received antimicrobials or been hospitalized. The most common antibiotics associated with CDAD in horses are erythromycin, trimethoprim/sulfonamides, β-lactam antimicrobials, clindamycin, rifampicin, and gentamicin. Clinical signs and intestinal lesions of CDAD infection are not specific and they cannot be used to distinguish infections by C. difficile from infections by other agents, such as Clostridium perfringens or Salmonella sp. The distribution of lesions throughout the intestinal tract seems to be age-dependent. Small intestine is invariably affected, and colon and cecum may or may not have lesions in foals<1-month old. Naturally acquired disease in older foals and adult horses has a more aboral distribution, affecting colon and sometimes cecum, but rarely the small intestine. Detection of toxin A, toxin B or both in intestinal contents or feces is considered the most reliable diagnostic criterion for CDAD in horses. Isolation of toxigenic strains of C. difficile from horses with intestinal disease is highly suggestive of CDAD. A better understanding of pathogenesis, reservoirs of infection, and vaccines and other methods of control is needed. Also further studies are recommended to investigate other possible predisposing factors and/or etiological agents of enteric diseases of horses.
Copyright © 2013 Elsevier B.V. All rights reserved.
Publication Date: 2013-04-10 PubMed ID: 23642413DOI: 10.1016/j.vetmic.2013.03.032Google Scholar: Lookup
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Summary
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This research article is a review of infection by the bacteria Clostridium difficile in horses. The paper discusses how the bacteria leads to diarrhea and enterocolitis in horses, the risk factors, potential sources of infection, the affected locations in the digestive tract, and methods for diagnostic testing.
Clostridium difficile Infection in Horses
- The primary focus of the research article is a bacterial infection in horses caused by Clostridium difficile. This bacteria is a major cause of diarrhea and inflamed intestines (enterocolitis) in horses.
- Both adults and foals are susceptible to the bacterial infection, highlighting the broad impact it can have across different horse age groups.
- The bacteria can persist in a very resistant spore form, which is the main mode of transmission, mainly through the fecal-oral route.
Transmission and Risk Factors
- The researchers discuss various sources of contamination with C. difficile. These include infected horse feces, soil contaminated with the bacteria, and environments such as animal hospitals. The bacteria can also spread through the feces of other infected animals.
- The paper identifies the main risk factors for the onset of C. difficile associated disease (CDAD) in horses. These include hospitalization and antibacterial treatment. However, some cases do occur without any of these factors being involved.
- The antibiotics linked with CDAD in horses include erythromycin, trimethoprim/sulfonamides, β-lactam antibiotics, clindamycin, rifampicin, and gentamicin.
Symptoms and Diagnosis of CDAD
- The authors remark that the clinical symptoms and intestinal damage from a CDAD infection are not unique and can coincide with infections from other bacteria, such as Clostridium perfringens or Salmonella.
- The location of the lesions throughout the intestines seems to depend on the age of the horse. In foals less than one month old, the small intestine is invariably affected and the colon and cecum may or may not have lesions. In older foals and adult horses, the disease affects the colon and occasionally the cecum but rarely the small intestine.
- The most reliable method of diagnosis is the detection of toxin A, toxin B, or both in the horse’s intestinal contents or feces.
Further Studies and Recommendations
- The research article calls for further understanding of the pathogenesis, infection reservoirs, and improved vaccines and control methods against C. difficile in horses.
- Additionally, the authors recommended further research on other possible factors that perhaps predispose horses to intestinal diseases.
Cite This Article
APA
Diab SS, Songer G, Uzal FA.
(2013).
Clostridium difficile infection in horses: a review.
Vet Microbiol, 167(1-2), 42-49.
https://doi.org/10.1016/j.vetmic.2013.03.032 Publication
Researcher Affiliations
- California Animal Health and Food Safety Laboratory, San Bernardino Branch, School of Veterinary Medicine, University of California, Davis, CA 92408, USA.
MeSH Terms
- Animals
- Clostridioides difficile
- Clostridium Infections / diagnosis
- Clostridium Infections / drug therapy
- Clostridium Infections / epidemiology
- Clostridium Infections / pathology
- Clostridium Infections / veterinary
- Horse Diseases / diagnosis
- Horse Diseases / epidemiology
- Horse Diseases / pathology
- Horse Diseases / transmission
- Horses
Citations
This article has been cited 33 times.- Petry S, Tapprest J, Maillard K, Barbut F, Duquesne F, Kozak S, Foucher N, Bernez-Romand M, Bridoux L, Poquet I. Clostridioides difficile in equidae necropsied in Northwestern France, between 2019 and 2021. Microbiol Spectr 2026 Feb 3;14(2):e0216525.
- Mineshige T, Inoue T, Yurimoto T, Sato K, Kawai K, Sasaki E. Prevalence of major diseases in common marmosets (Callithrix jacchus) at the Central Institute for Medicine and Life Science: a retrospective study. Front Vet Sci 2025;12:1548757.
- Kinoshita Y, Niwa H, Ueno T. Minimal disruption of equine gut microbiota by intravenous cephalothin treatment. J Vet Med Sci 2025 Jun 1;87(6):690-696.
- Vinay G, Seppen J, Setlow P, Brul S. Bile acids as germinants for Clostridioides difficile spores, evidence of adaptation to the gut?. FEMS Microbiol Rev 2025 Jan 14;49.
- Haywood LMB, Sheahan BJ. A Review of Epithelial Ion Transporters and Their Roles in Equine Infectious Colitis. Vet Sci 2024 Oct 7;11(10).
- Kabir A, Lamichhane B, Habib T, Adams A, El-Sheikh Ali H, Slovis NM, Troedsson MHT, Helmy YA. Antimicrobial Resistance in Equines: A Growing Threat to Horse Health and Beyond-A Comprehensive Review. Antibiotics (Basel) 2024 Jul 29;13(8).
- Talukdar PK, Alnoman M, Sarker MR. Identification of Germinants and Expression of Germination Genes in Clostridium perfringens Strains Isolated from Diarrheic Animals. Pathogens 2024 Feb 22;13(3).
- Rodriguez-Diaz C, Seyboldt C, Rupnik M. Non-human Clostridioides difficile Reservoirs and Sources: Animals, Food, Environment. Adv Exp Med Biol 2024;1435:329-350.
- Uchida-Fujii E, Niwa H, Senoh M, Kato H, Kinoshita Y, Mita H, Ueno T. Clostridioides difficile infection in thoroughbred horses in Japan from 2010 to 2021. Sci Rep 2023 Aug 11;13(1):13099.
- Lara F, Castro R, Thomson P. Changes in the gut microbiome and colic in horses: Are they causes or consequences?. Open Vet J 2022 Mar-Apr;12(2):242-249.
- Uzal FA, Navarro MA, Asin J, Henderson EE. Clostridial Diseases of Horses: A Review. Vaccines (Basel) 2022 Feb 17;10(2).
- Hain-Saunders NMR, Knight DR, Bruce M, Riley TV. Clostridioides difficile infection and One Health: an equine perspective. Environ Microbiol 2022 Mar;24(3):985-997.
- Uzal FA, Arroyo LG, Navarro MA, Gomez DE, Asín J, Henderson E. Bacterial and viral enterocolitis in horses: a review. J Vet Diagn Invest 2022 May;34(3):354-375.
- Mendonça FS, Navarro MA, Uzal FA. The comparative pathology of enterocolitis caused by Clostridium perfringens type C, Clostridioides difficile, Paeniclostridium sordellii, Salmonella enterica subspecies enterica serovar Typhimurium, and nonsteroidal anti-inflammatory drugs in horses. J Vet Diagn Invest 2022 May;34(3):412-420.
- Kopper JJ, Willette JA, Kogan CJ, Seguin A, Bolin SR, Schott HC 2nd. Detection of pathogens in blood or feces of adult horses with enteric disease and association with outcome of colitis. J Vet Intern Med 2021 Sep;35(5):2465-2472.
- Collard MK, Bardin J, Laurin M, Ogier-Denis E. The cecal appendix is correlated with greater maximal longevity in mammals. J Anat 2021 Nov;239(5):1157-1169.
- Collinet A, Grimm P, Julliand S, Julliand V. Multidimensional Approach for Investigating the Effects of an Antibiotic-Probiotic Combination on the Equine Hindgut Ecosystem and Microbial Fibrolysis. Front Microbiol 2021;12:646294.
- Lindroth KM, Dicksved J, Pelve E, Båverud V, Müller CE. Faecal bacterial composition in horses with and without free faecal liquid: a case control study. Sci Rep 2021 Feb 26;11(1):4745.
- Hernandez BG, Vinithakumari AA, Sponseller B, Tangudu C, Mooyottu S. Prevalence, Colonization, Epidemiology, and Public Health Significance of Clostridioides difficile in Companion Animals. Front Vet Sci 2020;7:512551.
- Thanissery R, McLaren MR, Rivera A, Reed AD, Betrapally NS, Burdette T, Winston JA, Jacob M, Callahan BJ, Theriot CM. Clostridioides difficile carriage in animals and the associated changes in the host fecal microbiota. Anaerobe 2020 Dec;66:102279.
- Ramos CP, Lopes EO, Oliveira Júnior CA, Diniz AN, Lobato FCF, Silva ROS. Immunochromatographic test and ELISA for the detection of glutamate dehydrogenase (GDH) and A/B toxins as an alternative for the diagnosis of Clostridioides (Clostridium) difficile-associated diarrhea in foals and neonatal piglets. Braz J Microbiol 2020 Sep;51(3):1459-1462.
- Nyaoke AC, Navarro MA, Fresneda K, Diab SS, Moore J, Lyras D, Awad M, Uzal FA. Paeniclostridium (Clostridium) sordellii-associated enterocolitis in 7 horses. J Vet Diagn Invest 2020 Mar;32(2):239-245.
- Archambault M, Rubin JE. Antimicrobial Resistance in Clostridium and Brachyspira spp. and Other Anaerobes. Microbiol Spectr 2020 Jan;8(1).
- Kachrimanidou M, Tzika E, Filioussis G. Clostridioides (Clostridium) Difficile in Food-Producing Animals, Horses and Household Pets: A Comprehensive Review. Microorganisms 2019 Dec 9;7(12).
- Arroyo LG, Gomez DE, Martins C. Equine duodenitis-proximal jejunitis: A review. Can Vet J 2018 May;59(5):510-517.
- Uzal FA, Navarro MA, Li J, Freedman JC, Shrestha A, McClane BA. Comparative pathogenesis of enteric clostridial infections in humans and animals. Anaerobe 2018 Oct;53:11-20.
- Oliver-Espinosa O. Foal Diarrhea: Established and Postulated Causes, Prevention, Diagnostics, and Treatments. Vet Clin North Am Equine Pract 2018 Apr;34(1):55-68.
- Schelle I, Bruening J, Buetepage M, Genth H. Role of p38(alpha/beta) MAP Kinase in Cell Susceptibility to Clostridium sordellii Lethal Toxin and Clostridium difficile Toxin B. Toxins (Basel) 2016 Dec 22;9(1).
- Schwarz S, Shen J, Kadlec K, Wang Y, Brenner Michael G, Feßler AT, Vester B. Lincosamides, Streptogramins, Phenicols, and Pleuromutilins: Mode of Action and Mechanisms of Resistance. Cold Spring Harb Perspect Med 2016 Nov 1;6(11).
- Rodriguez C, Taminiau B, Van Broeck J, Delmée M, Daube G. Clostridium difficile in Food and Animals: A Comprehensive Review. Adv Exp Med Biol 2016;932:65-92.
- Rodriguez C, Taminiau B, Brévers B, Avesani V, Van Broeck J, Leroux A, Gallot M, Bruwier A, Amory H, Delmée M, Daube G. Faecal microbiota characterisation of horses using 16 rdna barcoded pyrosequencing, and carriage rate of clostridium difficile at hospital admission. BMC Microbiol 2015 Sep 16;15:181.
- Uzal FA, Diab SS. Gastritis, Enteritis, and Colitis in Horses. Vet Clin North Am Equine Pract 2015 Aug;31(2):337-58.
- Malberg JA, Webb BT, Hackett ES. Colonic gastrointestinal stromal tumor resulting in recurrent colic and hematochezia in a warmblood gelding. Can Vet J 2014 May;55(5):471-4.
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