Cystitis in Cattle

CYSTITIS IN CATTLE

Inflammation of the bladders, usually associated with bacterial infection, characterized clinically by frequent, painful urination (pollakiuria and dysuria) and the presence of blood (hematuria), inflammatory cells and bacteria in the urine.

ETIOLOGY

Occurs sporadically by introduction of infection into the bladder when trauma to the bladder has occurred or when there is stagnation of the urine. In farm animals the common associations are:

• Cystic calculus
• Ascending infection of bacterial population from genital or urethra
• Descending infection from nephritis
• Exciting factors like urolithiasis, prolong gestation, difficult parturition, stagnation, stricture of urethra etc.
• Contaminated catheterization
• Some corrosive chemicals or toxic substances may reach the bladder in large amount and may set up cystitis due to irrigation.
• As a sequel to paralysis of the bladder. A special case of bladder paralysis occurs in horses grazing sudax or Sudan grass and in horses with equine herpesvirus myoencephalopathy.

In the above cases, the bacterial population is usually mixed but predominantly E. coli. There is also the accompaniment of specific pyelonephritides in cattle and pigs, associated with C. renale and Eubacterium suis, respectively (Carl & Walton 1993). Many sporadic cases also occur in pigs, especially after farrowing. Common isolates from these are E. coli, Streptococcus, and Pseudomonas spp. Corynebacterium matruchotii causes encrusted cystitis in horses. Enzootic hematuria of cattle resembles but is not a cystitis.

PATHOGENESIS

Flushing action of voided urine removes the normally invading bacteria to the bladder before they reach the mucosa. Mucosal injury facilitates invasion but stagnation of urine is the most important predisposing cause. Bacteria usually enter the bladder by ascending the urethra but descending infection from embolic nephritis may also occur.

CLINICAL FINDINGS

• The urethritis that usually accompanies cystitis causes painful sensations and the desire to urinate.
• Urination occurs frequently and is accompanied by pain and sometimes grunting; the animal remains in the urination posture for some minutes after the flow has ceased, often manifesting additional expulsive efforts.
• The volume of urine passed on each occasion is usually small.
• In very acute cases there may be moderate abdominal pain, as evidenced by treading with the hindfeet, kicking at the belly and swishing with the tail, and a moderate febrile reaction.
• Acute retention may develop if the urethra becomes blocked with pus or blood, but this is unusual.
• Chronic cases show a similar syndrome but the signs are less marked. Frequent urination and small volume are the characteristic signs. The bladder wall may feel thickened on rectal examination and, in horses, a calculus may be present.
• In acute cases no palpable abnormality may be detected but pain may be evidenced.
• Endoscopic examination of the bladder of affected horses reveals widespread inflammation of the cystic mucosa and occasionally the presence of a cystic calculus.

 CLINICAL PATHOLOGY

• Blood and pus in the urine is typical of acute cases
• Urine may have a strong ammonia odour
• In less severe cases – urine may be only turbid. In chronic cases – no abnormality on gross inspection.
• Microscopic examination of urine sediment will reveal erythrocytes, leukocytes, and desquamated epithelial cells. Quantitative bacterial culture is necessary to confirm the diagnosis and to guide treatment selection.

NECROPSY FINDINGS

Acute cystitis is manifested by hyperemia, hemorrhage and edema of the mucosa (Herenda 1990). The urine is cloudy and contains mucus. In subacute and chronic cases the wall is grossly thickened and the mucosal surface is rough and coarsely granular. Highly vascular papillary projections may have eroded, causing the urine to be bloodstained or contain large clots of blood. In the cystitis associated with Sudan grass, soft masses of calcium carbonate may accumulate in the bladder and the vaginal wall may be inflamed and coated with the same material.

TREATMENT

• Antimicrobial agents are indicated to control the infection and determination of the antimicrobial susceptibility of the causative bacteria is essential. Based on the activity on pH antibiotics should be selected. Ampicillin, Trimethoprim and sulphadiazine, Nalidixic acid, Nitrofurantoin are effective.
• Relapses are common unless treatment is continued for a minimum of 7 and preferably 14 days. Repeated bacterial culture of urine at least once during and again within 7-10 days after completion of treatment should be used to assess the success of therapy. Recurrence of infection is usually due to failure to eliminate foci of infection in the accessory gland and in the bladder wall.
• The prognosis is poor because of difficulty of completely eradication of infectious cause and common secondary involvement of the kidney. Free access of water should be permitted at all times to insure a free flow of urine.
• Irrigation of bladder with 1:1000 Glycerine-acriflavin or Glycerine-proflavin.
• Use of acidifier to alter pH – bacteriostatic action (Ammonium chloride or Sodium acid phosphate)
• Dextrose saline for more urination and washing of the bladder

DIFFERENTIAL DIAGNOSIS

The clinical and laboratory findings of cystitis resemble those of pyelonephritis and cystic urolithiasis.

• Pyelonephritis is commonly accompanied by bladder involvement and differentiation depends on whether there are lesions in the kidney, determined by rectal examination but in many cases it is not possible to make a firm decision. However, the prognosis in pyelonephritis is less favourable than in cystitis. Thickening of the bladder wall, which may suggest a diagnosis of cystitis.
• Enzootic haematuria and in poisoning by the yellow-wood tree (Terminalia oblongata) in cattle and by sorghum in horses.  The presence of calculi in the bladder can usually be detected by rectal examination, by ultrasonographic examination, by endoscopic examination in female ruminants and in both sexes of horses, or by radiographic examination in smaller animals.
• Urethral obstruction may also cause frequent attempts at urination but the urine flow is greatly restricted, usually only drops are voided and the distended bladder can be felt on rectal examination used to assess the success of therapy. Recurrence of the infection is usually due to failure to eliminate foci of infection in the accessory glands and in the bladder wall.

REFERENCES

Carr, J. and Walton, J.R. (1993) Bacterial flora of the urinary tract of pigs associated with cystitis and pyelonephritis. Vet Rec 132:575-577.

Chakrabarti, A. (2011) Text Book of Clinical Veterinary Medicine. 3rd ed. Noida: Kalyani Publishers. Pp. 394-396.

Balagopalan, T.P. et al. (2009) Surgical Management of Urinary Bladder Fibroma in a Dog – A case report. In: Bhatia, N. et al. (eds.) Intas Polivet, 10 (1), pp.101-102.

Pamukcu, A.M. (1974) Tumors of the urinary bladder. Bull World Health Organ. 501(1-2): 43-52

Herenda, D. et al. (1990) An abattoir survey of urinary bladder lesions in cattle. Can Vet 31:515-518.

Radostits, O.M. et al. (2009) Veterinary Medicine- A textbook of the disease of cattle, horses, sheep, pigs and goats. 10th ed. Noida: Elsevier. Pp. 561.