of an atresia ani et recti and urogenital agenesis in a calf N

BUSRA KIBAR KURT1, DVM, PHD

Summary

The purpose of this study was to describe the surgical correction of anorectal and urogenital agenesis in a Holstein calf. Clinical examination revealed the absence of anal and urinary openings, testicles or vulvar openings, and suggested the possibility of atresia ani et recti. The complete blood count, blood gas analysis, and biochemistry were evaluated and revealed the presence of a mild respiratory acidosis with a pH of 7.29 and pCO2 level of 62.7 mmHg. The surgery was performed under general anesthesia. During the intraoperative exploration, it was noted that the internal genital organs were not developed and there was a band-like structure between the urinary bladder and the blind pouch colon. Defecation was achieved by performing a ventral colostomy. The band between the urinary bladder and the colon was separated from the colon, a Foley catheter was passed through it by blunt dissection, and it was made to act as the urethra. By using the band-like structure and the Foley catheter, a urethral opening was fashioned and placed caudal to the colostomy opening, which resulted in successful urination. A follow-up checkup after one week showed the calf had no urination or defecation problems and was in good condition. Four weeks later, the owner reported that the calf was doing well and gaining weight. Early surgical treatment can lead to successful outcomes in cases of intestinal atresia and urethral agenesis. The condition known as the imperforate anus, or atresia ani occurs when the anal membrane and perineal skin fail to break down during development, either alone or in combination with other defects. The aim of this study was to present a case of extraordinary atresia ani et recti and urogenital agenesis and its surgical treatment. In small farms, even one calf is important. It should also be considered that the breeder’s emotional attachment to the calves may lead to a preference for treatment.

Key Words

Anorectal anomaly, bovine, colostomy, intestinal atresia, urethral agenesis.

Introduction

According to the World Health Organization, congenital defects can be defined as abnormalities that occur during intrauterine life. Congenital anomalies can be detected prenatally, at birth, or after birth 1. Intestinal atresia, a congenital defect, has been reported in humans and various domestic animals such as pigs, sheep, and calves. In calves, this abnormality results from abnormal development of the intestinal wall and can affect the rectum/anus, colon, ileum, or jejunum. Intestinal atresia results in a complete blockage of the intestinal lumen, preventing the normal movement of intestinal contents and the passage of fecal material 2,3. Obstruction can occur in different parts of the intestine, such as the duodenum, jejunum, ileum, colon, or anus.

Corresponding Author: Busra Kibar Kurt (busrakibar@yandex.com) (busra.kibar@adu.edu.tr) ntestinal atresia is a common congenital defect in calves 4,5. Atresia ani et recti is a congenital abnormality with a lack of anal opening and rectum. Vulvar and urethral anomalies are rare. The urorectal septum divides the cloaca into a ventral and a dorsal part. With the differentiation of the cloacal folds, the ventral part forms the urogenital system and the dorsal part forms the digestive system. Urethral agenesis occurs as a result of malformation of this region 6-8. This paper reports an extraordinary case of atresia ani et recti associated with urethral and genital agenesis.

Materials And Methods

A 1-day-old Holstein calf (42 kg) was brought to the faculty hospital with a history of not passing meconium or urine since birth. The calf was quite active. Clinical examination confirmed the absence of anal and urinary openings, and testicles or vulvar openings (Figure 1A, B). There was no perineal swelling on

178Treatment of an atresia ani et recti and urogenital agenesis in a calf abdominal compression. The absence of swelling in the anal region strengthened the possibility of it being a case of atresia ani et recti. The body temperature of calf was 38.5°C measured from the mouth. Heart rate was 128/min and respiratory rate was 37/min. The abdomen was slightly distended, but there were no signs of colic. Complete blood count, blood gas, and biochemical analysis and results are detailed in Table 1. Mild respiratory acidosis was observed (pH:7.29, pCO2: 62.7 mmHg).

Meloxicam was administered 0,5 mg/kg (Maxicam, Sanovel, Türkiye). The surgical treatment was performed under general anesthesia. Propofol was administered at 5-6 mg/kg (Propofol-PF 2%, 20ml, Polifarma, Türkiye) by intravenous infusion. Then, endotracheal intubation was performed and 2-3% isoflurane (Isoflurane Usp 100%, 100ml, ABD) was used for inhalation anesthesia. For surgery, the calf was positioned in dorsal recumbency and abdomen was prepared for ventral midline laparotomy. The incision was started caudal to umbilicus to reach vesica urinaria. Intraoperative exploration revealed that the internal genital organs were not developed and there was a band-like structure between the urinary bladder and the end of the colon (Figure 2). The colon was ending as blind pouch. An enterotomy was performed approximately 4-5 cm in front of the blind end of the colon. The band-like structure extending from the vesica urinaria and a 4-5 cm colon section were used for the urethral opening. The enterotomy side was irrigated with a warm saline. A Foley catheter was passed through the colon section to the urinary bladder with blunt dissection and the cuff of the Foley catheter was inflated (Figure 3A, B). The wall of the colon section was sutured to the skin with simple interrupted sutures (USP:0, Monosorb, Sutures) to act as a urethra. The Foley catheter was removed from the abdominal wall caudal to the colostomy opening and urination was achieved. Ventral colostomy was performed. The colon was sutured to the abdominal wall and skin with simple interrupted sutures (USP:0, Monosorb, Sutures) to avoid peritonitis (Figure 4). In the first postoperative week control, it was determined that the calf did not have urination and defecation problems and was in good general condition (Figure 5). When the owner of the patient was contacted by phone 4 weeks later, it was learned that the calf was in good condition and had gained weight.

LaboratoryFindingsReferance

LYM%43.5 %45-75

MON%1.3 %2-7

NEU%55.2 %15-65

RBC x1012/l10.895-10

HGB11.18-15

HCT%40.05 24-46

MCV3740-60

MCHC27.830-36

PLT x109/l289100-800

ALT: Alanine aminotransferase, AST: Aspartate aminotransferase, ALP: Alkaline Phosphatase, GGT: Gamma glutamyl transferase, pH: Actual blood pH, pCO2: Partial pressure of carbon dioxide, pO2, Partial pressure of oxygen, K+: Potassium, Na+: Sodium, Cl-: Clor, WBC: White blood cells; LYM: Lymphocytes, MON: Monocytes, NEU: Neutrophils, RBC: Red blood cells, HGB: Haemoglobin, HCT: Hematocrit, MCV: Mean corpuscular volume, MCHC: Mean corpuscular haemoglobin concentration, PLT: Platelet.

Discussion

Atresia ani and urogenital agenesis develop during the embryonic stage as a result of malformation of the cloacal folds. Atresia ani is a developmental anomaly caused by an autosomal recessive gene. Atresia ani et recti may be associated with recto-vaginal fistula, vagino urethral agenesis, absence of tail, and diphallus 9-11. In this case, the reason could not be certain. The calf was suffered from atresia ani et recti, uretrhral agenesis and absence of the genital organs. This con-

180Treatment of an atresia ani et recti and urogenital agenesis in a calf dition is a rare occurrence 8,12

Previous studies have reported atresia of vagina-urethra and anus 13 in a hybrid calf, atresia ani with recto vestibular fistula and vulvar agenesis in buffalo calf 14, in another buffalo calf atresia ani et recti with agenesis of the vulva and terminal urethra 8, and agenesis of the vulva with atresia ani-et-distal recti in a heifer calf 7. Vahar et al 15 reported a case of colonobladder fistula in a lamb. In the present case, there was a band-like structure between the colon and the urinary bladder, but this structure was not a channel like a fistula. Studies have reported that in cases of intestinal and urethral agenesis, the patient can survive with early surgical treatment. Surgical treatment should be performed before the condition leads to death from autointoxication, circulatory failure, or fecal peritonitis following intestinal and/or vesica urinary rupture 4,7,8,16. When the calf was brought to the clinic at 1 day of age, blood analyses and general condition were found suitable for surgical treatment. Surgical correction was performed under general anesthesia. The patient awoke from the anesthesia without any problems, and in the follow-up 1 week later, the general condition of the patient was good. When the owner of the patient was contacted by phone 1 month later, he reported that he could not bring the calf, but that the calf was healthy.

Due to high frequency of multiple malformations and the role of genetic inheritance in calves with intestinal atresia, it is recommended not to breed these animals, as continued breeding of such animals may have an impact on the persistence of the malformation in the population; even some researchers even recommend the euthanasia for these calves 16. In the present study, the patient was only a livestock animal, as the calf had no genital organs. Patients often do not accept euthanasia, especially because they are more emotional about calves. In this case, the owner of the patient stated that he wanted treatment without considering the cost.

Because atresia ani is often associated with one or more malformations, a careful and complete physical examination should be performed. If perineal bulging does not occur with abdominal pressure, atresia recti should be suspected in addition to atresia ani. Atresia ani et recti with urogenital agenesis are rare cases. Surgical treatment should be aimed at achieving urination and defecation. Treatment should be done in the first few days before problems with food and urea accumulation occur.

Conflict of Interest

The authors declare no conflicts of interest related to this report.

References

1. WHO Congenital anomalies. [Online] World Health Organization.

2. Mee J.F. (2021). Congenital Defects in Calves. In: Szenci O, Mee J, Bleul U, Taverne M, editors. Bovine Prenatal, Perinatal and Neonatal Medicine. 67 Budapest: Hungarian Association for Buiatrics 2021;

3. Keane O.M., Carthy T.R., Hanrahan J.P., Matthews D., McEwan J.C., Rowe S.J., et al. (2023). Risk factors for, and genetic association with, intestinal atresia in dairy calves. Animal Genetics. 54(2), 104-112.

4. Azizi S., Mohammadi R., Mohammadpour I. (2010). Surgical repair and management of congenital intestinal atresia in 68 calves. Veterinary Surgery. 39(1), 115-120.

5. Kaya M., Okumuş Z., Doğan E., Çetin E.M., Yanmaz L.E. (2011). Erzurum Yöresindeki Buzağılarda Doğmasal Anomalilerin Görülme Sıklığı ve Sağkalım Oranları. Fırat University Veterinary Journal of Health Sciences. 25(2), 83-93.

6. Vianna M.L., Tobias K.M. (2005). Atresia Ani in the Dog: A Retrospective Study. Journal of the American Animal Hospital Association. 41(5), 317-322.

7. Wamaitha M.N., Kihurani D.O., Kimeli P., Mwangi W.E., Mande J.D. (2015). Surgical management of agenesis of the vulva with atresia aniet-distal recti in a heifer calf: A case report. Journal of Advanced Veterinary and Animal Research.

8. Hari Krishna N.V.V., Devi Prasad V., Mallikharjuna Rao C. (2009). Agenesis of vulva and terminal urethra with atresia ani et recti in a buffalo calf. Buffalo Bulletin. 28, 165-167.

9. Loynachan A.T., Jackson C.B., Harrison L.R. (2006). Complete diphallia, imperforate ani (type 2 atresia ani), and an accessory scrotum in a 5day-old calf. Journal of Veterinary Diagnostic Investigation. 18(4), 408412.

10. Bademkiran S., çen H., Kurt D. (2009). Congenital Recto Vaginal Fistula with Atresia Ani in a Heifer : A Case Report. Y.Y.U. Vetriner Fakulties Dergisi. 20, 61-64.

11. Köm M., Eröksüz Y. (2013). Urorectal septum malformation sequence in a calf. Kafkas Universitesi Veteriner Fakultesi Dergisi. 19(SUPPL.A).

12. Tyagi R., Singh J. (1999). Ruminant Surgery. 222, New Delhi, India: CBS Publishers;

13. Shetty B., Nigam J., Singh G. (1978). Surgical correction of vagino-urethral and anal agenesis in a calf. Indian Veterinary Journal. 55, 234-236.

14. Sreenu M., Rao M., Naidu K., Rao T. (1998). Atresia ani associated with rectovestibular fistula and vulvar agenesis in a buffalo calf. Buffalo Bulletin. 17(2), 41-42.

15. Vahar M., Hosseni S.M., Omidzahir S., Kenari E.O., Iraee M.A., Ziabari A. reza H. (2015). Report of congenital colonobladder fistula with atresia ani in a lamb and treatment by surgery. Asian Pacific Journal of Tropical Disease. 5(S1), S181-S183 Asian Pacific Tropical Medicine Press;

16. Meylan M. (2008). Surgery of the Bovine Large Intestine. Veterinary Clinics of North America - Food Animal Practice. 24(3), 479-496 Elsevier Ltd;

ÖMER TARıK ORHUN1, YAKUP KOCAMAN*1, SıTKıCAN OKUR1, LATIF EMRAH YANMAZ2, CIHAN ÖZ3,

1 Department of Surgery, Faculty of Veterinary Medicine, Atatürk University, Erzurum, Turkey

2 Department of Surgery, Faculty of Veterinary Medicine, Burdur Mehmet Akif Ersoy University, Burdur, Turkey

3 Department of Microbiology, Faculty of Veterinary Medicine, Atatürk University, Erzurum, Turkey

Summary

Septic arthritis, defined as joint inflammation, is common in newborn calves when the passive transfer of maternal immunoglobulins fails. An unhygienic environment, lack of umbilical care and insufficient colostrum after birth predispose to the formation of septic arthritis. Arthrotomy and through-and-through needle joint lavage techniques are employed in the management of septic arthritis. This study aimed to evaluate the effect of two different joint lavage techniques on survival rate in calves with septic arthritis presented to Atatürk University Veterinary Faculty Animal Hospital between 2018-2021. A total of 248 calves with septic arthritis were included in the study. One hundred twenty (48.4%) of the 248 calves had a complete bacterial analysis of the infected joint. Two different lavage methods (through-and-through needle [n = 138] and arthrotomies [n= 96]) were used for joint lavage. A through-and-through lavage method was performed on 138 calves. Out of these, 114 (82.6%) animals made a full recovery, while 24 (14.4%) were humanely euthanized or died. Conversely, arthrotomy was employed in 96 calves, with 81 (84.4%) animals making a full recovery, while 15 (15.6%) calves were humanely euthanized or died. Additionally, Of the 248 calves, 120 (48.5%) obtained a thorough bacterial examination of the affected joint. Eighty-nine out of 120 (74.1%) calves had at least one bacterial isolate found during bacterial culture. Two bacterial isolates were discovered from synovial samples of 31 (25.8%) calves. Staphylococcus aureus (30%), Escherichia coli (25.8%), Trueperella pyogenes (24.1%), and other pathogens (13.4%), including Enterococcus species, Bacillus species, Proteus species, and Corynebacterium species, were the most commonly isolated bacteria in the infected joint of calves. There was no statistically significant difference in the survival rates between the two joint lavage techniques (P = 0.72). The chances of success of treatment are related to whether the patient has been treated before, and the stage of the disease, but both treatment methods can be used successfully in the treatment of arthritis since the success rates are more or less the same.

Key Words

Calves, Septic arthritis, Joint, Hematogenous.

Introduction

Septic arthritis is a very important disease that frequently affects newborn calves, especially within the first eight weeks of their life. It is thought to be the result of secondary bacterial colonization, especially in the joints affected by the disease. Especially common in newborn calves and is defined as a joint disease that causes by direct trauma, hematogenous dissemination, and extension of periarticular infections. It is a common cause of lameness, which is responsible for significant economic losses in the livestock and dairy industries (1,2). Systemic infections in calves may also be a cause of septic arthritis (2,3). Also, it can result from periarticular wound infection, inoculation of the joint by an open or puncture wound, and by

Corresponding Author: Yakup Kocaman (yakup.kocaman@atauni.edu.tr) hematogenous or lymphomatous inoculation. The higher incidence of septic arthritis in calves is due born in an unhygienic environment, lack of disinfection of the umbilicus, and inadequate intake of colostrum in the first few hours after birth. An inflammatory response occurs in the infected joint. Microorganisms are destroyed by neutrophils and their enzymes such as collagenase, cathepsin, elastase, and gelatinase that come to the site (4,5). Which enzymes cause damage to joint components and cartilage tissues (6).

Early treatment in calves with septic arthritis significantly affects the prognosis of the disease. As the disease progresses, the chances of success decrease. Several methods for septic arthritis treatment have been described. Antibiotic and anti-inflammatory therapy, joint lavage, arthroscopy, arthrotomy, and arthrodesis methods are used in the treatment of septic arthritis. If there is no recovery in the joint after medical therapy, surgical methods may be a good option. Joint lavage is an effective invasive method, the application of which is based on surgical asepsis procedures in cases that do not respond to par-

182Comparison of the effect of two different joint lavage techniques on survival rate in calves with septic arthritis: 248 cases enteral antibiotic therapy (2,7). Arthrotomy, like arthroscopy, is indicated in very serious and chronic cases where joint lavage fails or medical treatment has a low chance of success. Surgical opening of the joint may be required when the presence of fibrin formations blocks. Surgical management serves as a supplement to medical treatment and attempts to relieve synovial pressure and bacterial strain (8). Joint lavage is aimed at irrigation and evacuation of infected contents in cases of purulent-septic arthritis. In chronic cases, joint lavage is insufficient, as the joint is often filled with compact fibrin. The prognosis is poor in cases with soft tissue, bone necrosis, and osteomyelitis. In such cases, the recommended treatment options can be listed as arthroscopy, arthrotomy, or arthrodesis (6,9,10,11).

Clinical signs of septic arthritis include lameness, distension, increasing heat, redness, and signs of pain during palpation of the affected joints. The diagnosis of septic arthritis is confirmed based on arthrocentesis findings (bacterial culture results, cytological assessment of synovial fluid, and biomarker measurement), ultrasonographic and radiographic examination of the affected joints (1,12).

There are insufficient data on the comparison of the arthrotomy and through-and-through joint lavage methods of septic arthritis in calves. This study aimed to compare the effect of arthrotomy and through-and-through joint lavage techniques on survival rate in 248 newborn calves with septic arthritis.

Materials And Methods

The medical record database of the Atatürk University Veterinary Faculty of Animal Hospital was reviewed to identify the records of calves that were examined from 2018 through 2021 for which septic arthritis was diagnosed at ≤ 90 days old. Cases were divided into treatment groups according to clinical, radiographic, and ultrasonographic examination findings. The

exclusion criteria are specified in Table 1.

Clinical Examination

The general condition of the presented animals is slightly and moderately impaired. After the inspection and palpation examination, treatment options were applied as indicated in Table 1.

Radiographic Examination

A radiographic examination was performed on the anteriorposterior and latero-medial positions of the infected joints. For the examination were used a stationary X-ray machine (Mex100, Oberhausen-Germany). In acute cases, the presence of radiolucent area in the joint and increased joint space were observed. In chronic cases, decreased joint gap, bone lysis on the subchondral joint surface, periosteal reaction, and bone proliferation were observed.

Ultrasonographic Examination

The affected joints were shaved, cleaned, and contact gel was used before the ultrasonographic examination. Joints were investigated by using a 5 MHz sector and 7.5 MHz linear probes (GE Vivid S6, Milwaukee, USA). No anesthetic drug was used during both examinations. In some cases, on ultrasonographic examination, the joint contents were seen as hyperechogenic and anechogenic areas. Again, in cases, fibrin structures were determined from mild to severe.

Microbiological Examination

Before the infected joint treatment, calves were administered with intramuscular 40 µg/kg detomidine (Domosedan, Zoetis, NJ, USA). The affected joint was prepared for aseptic conditions using standard sterilization procedures. A sterile puncture of the affected joint using a 16-gauge needle was performed and 2 ml synovial fluid was collected with a 2.5 ml syringe. To determine the presence of Mycoplasma spp. in the samples, they were inoculated into Mycoplasma selective medium. The medium contains yeast extract, thallium acetate, penicillin G, and phenol red solutions. For routine isolation of Mycoplasma, the specimen should be inoculated into broth and agar. The inoculated medium (broth and agar) is incubated in a humid atmosphere at 37 C, under 5% CO2, and 48 and 96 hours. The Petri dishes are viewed under a stereoscopic microscope or the low-power objective of a light microscope, for the characteristic mycoplasmal ‘fried-egg’ microcolonies. The cultures can be regarded as negative if no microcolonies are seen after 14 days of incubation.

For routine diagnosis, two milliliters of synovial fluid were inoculated onto Columbia agar with 7% defibrinated sheep blood and MacConkey agar. Specimens plates were incubated at 35 ± 2 C in a normal atmosphere for 24 to 48 hours. The morphological and hemolytic characteristics of the colonies, catalase, coagulase, and oxidase tests, gram staining, and specific biochemical assays were used to identify any growth on agars. According to the Clinical Laboratory Standards Guide, antibiotic susceptibility testing was performed using the Agar Disc Diffusion technique. The colonies were suspended in a 0.9% NaCl saline solution. Turbidity was corrected to the 0.5 McFarland standard (approximately 108 CFU/mL) and utilized as the antibiotic test inoculum. Following that, 0.1 mL of bacterial solution was put over Muller Hinton agar, followed by antibiotic disks. Disks containing Amoxicillin-clavulanic acid (20/10 g), ampicillin-sulbactam (10/10 g), streptomycin (10 g), tetracycline (30 g), trimethoprim (5 g) were collected from Oxoid® (Hampshire, England) and plates were incubated at 37 °C for 24 h. According to the Clinical Laboratory Standards Guide, inhibition zones were assessed and classified as susceptible, moderately resistant, or resistant.

Treatment

Medical treatment

Amoxicillin-clavulanic acid (10 mg/kg, Intramuscular (IM), q 24 h) or Marbofloxacin (2 mg/kg, IM, q 24 h) were administered for antibiotic therapy for 5 days until culture results were obtained. For anti-inflammatory effects, Flunixin meglumine (2.2 mg/kg, IM, q 24 h) was applied for 3 days during the treatment.

Through-and-Through Joint Lavage

The a-16-gauge needle was inserted into the two opposite points of the involved joint until reaching the synovial membrane. Then, a large volume of NaCl 0.9% (Bioflex, Istanbul, Turkey) solution was used for joint lavage. To create pressure in the joint, the synovial sac was inflated at some times by grabbing the caudal outlet. The joint contents were completely evacuated. In cases deemed necessary, the procedure was repeated 2 to 3 times. Joint lavage was continued until the aspirated fluid becomes clear. No bandage was applied after the procedure.

Arthrotomy

The animals were placed on the operating table in the lateral position. The involved joint was shaved circularly. The joint area was washed to remove solid dirt. Then, povidone-iodine was used for antisepsis. Detomidine (Domosedan, Zoetis, NJ, USA) at a dose of 80 mcg/kg was used for sedation, and intravenous (IV) 2 mg/kg ketamine hydrochloride (Ketasol, Interhas, Turkey) was used for general anesthesia. General anesthesia was maintained with boluses of ketamine hydrochloride

IV administered every 20 minutes at the initial dosage. The procedure was started with a 1-2 cm incision using the number 12 scalpel of the relevant joints. After skin and muscle incisions in the region, the synovial membrane was incised to approach the joint. Fibrinous or purulent contents and destroyed bone fragments in the infected joint were removed by gentle curettage. The joint chambers were debrided continuously with isotonic saline solution throughout the entire procedure. After arthrotomy, the incision sites were not closed to allow drainage. The area was protected with a window bandage. During this procedure, the tendons, adjacent ligaments, vessels, and nerves were protected from trauma.

Outcome

The calves were not hospitalized. If the patient performed following the owner’s expectations 1 year after discharge from the hospital, the long-term result was considered positive. This information was obtained by a researcher by calling the patient owners by phone. The result was defined as negative if the calf died in the hospital or afterward, was euthanized, or did not meet the owner’s expectations during the telephone survey.

Statistical Analysis

All data were analyzed using Medcalc version 20.011 (Medcalc Software, Ostend, Belgium) and values of <0.05 were considered significant. The results of different lavage techniques on survival rate were also compared by chi-square analysis. The results of the treatment of calves with septic arthritis are presented.

Results

The study was conducted on 248 cases. All of the cases were evaluated clinically, radiographically, and ultrasonographically as in Table 1. Joint radiographs were determined abnormal in 182 (73.4%) cases, including periarticular soft tissue swelling, decrease or increase in joint space, bone proliferation, and subchondral lysis. The ultrasonographic examination was performed in 40 (16.1%) calves and inflammatory effusions with varying echogenicity-echogenicity were found.

A total of 234 animals were treated with either thorough-andthrough lavage or arthrotomies. A through-and-through lavage method was performed on 138 calves. Out of these, 114 (82.6%) animals made a full recovery, while 24 (14.4%) were humanely euthanized or died. Conversely, arthrotomy was employed in 96 calves, with 81 (84.4%) animals making a full recovery, while 15 (15.6%) calves were humanely euthanized or died. There was no statistically significant difference in the survival rates between the two joint lavage techniques (P = 0.72). Twelve animals (4.8% of the total 248) were excluded from the study groups due to severe calcified joint content, advanced bone destruction, and refusal of treatment by the animal owners. One hundred twenty (48.4%) of the 248 calves had a complete bacterial analysis of the infected joint. During bacterial culture, eighty-nine of 120 (74.1%) calves had at least one bacterial isolate identified. Thirty-one (25.8%) calves had two bacterial isolates identified from synovial specimens. The most isolated bacteria in the infected joint of calves was Staphylococcus aureus (30%), followed by Escherichia coli (25.8%), Trueperella pyogenes (24.1%), and other pathogens (13.4%) such as Enterococcus spp., Bacillus spp., Proteus spp., and Corynebacterium spp

184Comparison of the effect of two different joint lavage techniques on survival rate in calves with septic arthritis: 248 cases

Discussion

Septic arthritis, commonly observed in calves, results from umbilical disease or deficiency of passive transfer of maternal immunoglobulins after birth or postnatal trauma (1). The current study evaluated that calves aged less than 3 months with septic arthritis presented to Ataturk University Animal Hospital were described. Lameness, swelling, pain, hyperthermia, and loss of appetite are common clinical findings in calves with septic arthritis (1,6,13). In this study, all of these clinical findings were present.

A total of 248 calves were diagnosed using ultrasonography or radiography examination in this study. Although radiography and ultrasonography are considered specific in the diagnosis of septic arthritis, no abnormalities were detected on ultrasonography or radiography of the joints of 20 calves with septic arthritis. The most common radiographic findings of infected joints were increased or decreased joint space, bone proliferation, periarticular soft tissue swelling, and subchondral lysis in this study, and were similar to those reported in the previous studies in calves with septic arthritis (7,14,15).

Joint lavage is an important treatment method in the treatment of septic arthritis. Aggressive antibiotic therapy, along with joint drainage and/or lavage can be effective in early cases, but arthrotomy is considered to give better results in any chronic cases or severe infections (16). In this study, the through-and-through joint lavage method was used in calves aged 1-2 weeks and the arthrotomy method was used in calves aged 2-12 weeks. Experimental studies have shown that fibrin clots develop in the joint after the seventh day (17). But depending on the severity of the disease, it may be necessary to use different lavage methods. The most effective way to remove the formed fibrin clots is arthrotomy. Arthrotomy allows precise debridement of tissues inside the joint, and removal of infected synovia, bone, and bone fragments. The success of the arthrotomy method is higher than other applications. Therefore, in this study, the arthrotomy method was preferred in animals aged 2-12 weeks with dense fibrin accumulation. In severe cases, total curettage and arthrodesis performed to ensure immobilization of the joint give successful results. But joint immobilization is not recommended in young animals (17). Arthroscopy, which is another surgical method, is limited in chronic cases. Because the fibrin in the joint can impair vision and manipulation. On the contrary, arthrotomy provides better access to all joint faces. Increases the success in the removal of exudate and necrotic tissues. However, the surgical approach is difficult because of its proximity to adjacent tissues such as muscles, vessels, and nerves (2).

As reported in previous studies (13,18), at least one bacterial pathogen was identified in joints with septic arthritis in 120 of the 248 (48.4%) calves in the current study. The most isolated bacteria in infected joints were Staphylococcus aureus (30%), followed by Escherichia coli (25.8%), Trueperella pyogenes (24.1%), and other pathogens (20.1%) in calves, which seems similar to bacteriological findings in previous studies (13,19).

The treatment of septic arthritis includes reducing the bacterial load and preventing the increase in inflammation, and pain management. The bacterial load, the duration of the affected joint, and the disease are important for determining case management (1). The successful treatment for septic arthritis is the removal of purulent debris from the infected joint. There are several techniques described in calves including tidal irrigation, through-and-through needle lavage, performing arthrotomies, or flushing the joint under arthroscopic guidance. As mentioned in previous studies, needles were inserted into the bulging joint while applying joint through-and-through joint lavage. A previous study conducted on humans with septic knee arthritis reported that needle aspiration and arthrotomies method did not cause a change in survival rate (20). Similarly, the current study stated that there was no difference between through-andthrough needle lavage and arthrotomies in the survival rate. A lot of biomarkers have been studied in vacationing the diagnosis and prognosis in cases of septic arthritis (1). Although bacterial culture and antibiogram analysis were performed in our study, synovial fluid analysis, hematological analysis, and total nucleated cell count analyses from synovial fluid could not be performed.

In this study, the survival rate of through-and-through joint lavage and arthrotomy, which are one of the treatment options, were evaluated on calves. No significant difference was found between the effect of the two methods on survival rate. As a result, the success rate of joint lavage methods in the treatment of calves with septic arthritis is increased by early diagnosis and treatment. The choice of treatment method should be decided by clinical, radiographic, and ultrasonographic examination findings. The chance of success of the treatment is related to the stage of the disease, whether the patient has been treated before or not, and scientific studies should be conducted on more animal numbers and species to compare the success of these two different treatment methods.

Author’s contribution

ÖTO, YK, and SO conceptualization, investigation, data curation, writing-original draft preparation, formal analysis; LEY, MGS and UE, supervision, writing – review & editing, methodology, investigation, visualization; CÖ, MFK, and AE supervision, visualization, and microbiological analysis.

Funding

This research received no external funding.

Declaration of Competing Interest

The authors declare no conflict of interest.

Acknowledgment

The authors thank Ayse Golgeli and Ferda Turgut for their advice and support in conducting the research.

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