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1 Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado 80526, USA
2 National Marine Mammal Laboratory, Alaska Fisheries Science Center, National Marine Fisheries Service, NOAA, 7600 Sand Point Way NE, Seattle, Washington 98115, USA
3 Department of Veterinary Science, Gluck Equine Research Center, University of Kentucky, Lexington, Kentucky 40546, USA
4 Corresponding author (email: terry.spraker{at}colostate.edu)
| ABSTRACT |
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| INTRODUCTION |
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| MATERIALS AND METHODS |
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All pups were weighed and axial girth, standard length, and sternal blubber thickness were measured. Pups with a sternal blubber thickness of
5 mm were considered to be in good body condition and pups with less were considered to be in poor body condition (DeLong and Spraker, pers. obs.). Selected tissues were collected and preserved in 10% neutral buffered formalin, and then they were embedded in paraffin, sectioned at 5 µm, stained with hematoxylin and eosin, and examined under light microscopy.
Hookworms were collected from the intestines of all pups to assess the prevalence and intensity of infections in individual animals (Lyons et al., 2005). The hookworms were identified as Uncinaria spp. according to characteristics published in keys to genera of nematodes by Lichtenfels (1980). Representative adult specimens of Uncinaria spp. (USNPC nos. 094029.00, 094030.00, and 094031.00) from Z. californianus pups were deposited in the US National Parasite Collection (USNPC, Agricultural Research Service, US Department of Agriculture, Beltsville, Maryland, USA).
Swabs for bacterial culture were collected from selected tissues and lesions during necropsies conducted on five of the seven trips. Cultures were not taken on the trips in July and November. Two to eight pups were cultured per trip, and one to three swabs were taken per pup. Swabs were only taken from extremely fresh pups still in rigor or pups that died during the 10- to 20-min hike back to the necropsy station. Solid tissues were cultured by first cutting the organ with a sterile blade, and then swabs were taken on the cut surface. Intestines were cultured by cutting the wall open with a sterile blade and inserting a swab into the lumen. Swabs were placed in transport media (BBL culturettes [BBL Microbiology, BD Biosciences, Cockeysville, Maryland, USA] and Port-A-Culs [BioQuest, BD Biosciences]) and kept cool in a refrigerator until transported to the laboratory in a cooler. Tissues cultured included intestine, peritoneal, and thoracic cavities; brain; eyes; lung; liver; joints; and blood. Blood was cultured by collecting 5 cc of peripheral blood from the caudal gluteal vein from four moribund pups. Bacterial cultures were done at veterinary diagnostic laboratories (Veterinary Teaching Hospital, University of California, Davis, California, USA, and Colorado State University, Fort Collins, Colorado, USA).
| RESULTS |
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Hookworm enteritis/bacteremia complex
Hookworm enteritis with evidence of bacteremia was found in 133 of the 186 pups. The primary gross lesions associated with this condition were a hookworm infection and multiple systemic organ infections including peritonitis, polyarthritis, pleuritis, multifocal hepatitis, and hematogenous pneumonia.
The most common and consistent gross lesion was multifocal 24 mm circular red foci located under the serosa of the small and large intestines; associated with these foci of hemorrhage were small 24 mm firm nodules. The majority of lesions were located in the mid small intestine; however, a few also were present in the large intestine.
These red foci were hookworm feeding sites characterized by tracks through the mucosa and inflammation in the submucosa (Fig. 2
). It was common to find feeding tracks that penetrated deep into the submucosa and some even into the muscular wall of the intestines. Feeding sites contained varying degrees of hemorrhage and edema with a mild-to-moderate infiltration of neutrophils, lymphocytes, eosinophils, and plasma cells. Usually, little inflammation was present within the muscular layers; however, inflammation both within and between the muscle layers and under the serosa associated with small focal areas of peritonitis was found in several cases.
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On gross examination, the lungs were collapsed and dark maroon. Mild edema was seen in bronchi and bronchioles in most pups. Edema and fibrin was found in alveoli of the lung. Pneumonia was found on gross examination in one pup with hookworm enteritis, but an additional nine cases were found after histologic examination. Bacteria were seen in alveolar spaces, small vessels, and capillaries. In four cases, multifocal areas of necrosis were found scattered throughout the pulmonary parenchyma. Pyothorax with no evidence of pneumonia was found in three pups.
The mesenteric and axillary lymph nodes were enlarged in nearly all pups. A spectrum of lesions was found histologically and ranged from severe follicular and parafollicular lymphoid hyperplasia to total depletion. This spectrum of proliferation and depletion of lymphoid tissue also was observed in the spleen. Extra-medullary hematopoiesis was present within the red pulp of the spleen in most animals, but it was especially prominent in the anemic animals. Thymic atrophy was found in nearly all of the pups.
Twenty-six of the 133 pups had gross evidence of anemia (pale, mottled internal organs and thin blood); packed cell volumes were not measured on any of the pups. Histologically, 19 of these 26 pups also had mild-to-moderate central lobular fatty degeneration of the liver. Mild-to-moderate multifocal hepatitis was found in 54 pups, suggesting antemortem bacteremia.
On gross examination, five pups with hookworm enteritis had severe swelling of the brain. However, inflammation of the brain was found histologically in 42 pups: meningitis (n = 9), encephalitis (n = 13), and meningoencephalitis (n = 20). Multi-focal areas of necrosis were commonly found in the thalamus. Bacteria often were seen in small cerebral vessels and occasionally in septic thrombi.
Suppurative arthritis was found in eight pups. Affected joints included atlanto-occipital (n = 4), scapulo-humeral (n = 2), humeroradial (n = 1), and carpal/tarsal joints (n = 1). Incidental lesions found in pups with hookworm enteritis included multifocal necrosis of the heart (n = 5), adrenal glands (n = 4), thyroid glands (n = 2), kidneys (n = 2), and tongue (n = 1). Anterior uveitis (n = 4), panophthalmitis (n = 1), suppurative myelitis (n = 1), splenitis (n = 1), and pyelonephritis (n = 1) also were found.
Numerous bacteria were isolated from multiple organs, including the small intestine, mesenteric lymph nodes, liver, lung, brain, thoracic cavity, eye, stomach, spleen, abscess, peritoneal cavity, joints, and blood (Table 2
). Bacteria isolated that were considered significant included Klebsiella spp. (42 sites), Salmonella spp. (11 sites), and hemolytic Escherichia coli (eight sites). Klebsiella pneumoniae was most commonly isolated from the small intestine, brain, eyes, and blood.
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Emaciation/starvation was considered the primary cause of death in 48 pups. The primary gross lesions included moderate-to-severe emaciation, total absence of adipose tissue, thymic atrophy, and a small dark liver. The stomach and intestinal tract were empty except for the presence of bile. Histologically, the primary lesions included atrophy of parenchyma cells, especially hepatocytes, myocytes, pancreas, and myocardial cells. Lipid was absent in lipocytes.
Miscellaneous causes of death
Of the 50 pups placed in the bite wounds, miscellaneous, and no gross lesions categories on gross examination, all but five pups were placed in the hookworm enteritis/bacteremia complex category after histopathologic examination. Causes of death in these five pups included one 8-mo-old pup with a neuroblastoma multiformes of the brain (primarily located within the thalamus), one pup with severe blunt trauma, two pups with acute massive bite wounds to the neck and chest, and one pup born premature.
| DISCUSSION |
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Early reports of Uncinaria spp. (Uncinaria hamiltoni) in California sea lions were published by Fiennes (1966) and Dailey and Hill (1970). The life cycle is not known, but all available data suggest that it is similar to northern fur seals in which transmammary transmission has been demonstrated (Fiennes, 1966; Dailey and Hill, 1970; Lyons et al., 1997, 2000, 2001, 2003, 2005). Reference to hookworms perforating the intestinal wall and bacteremia was not found in any of this literature.
Major lesions found in pups in this study were a combination of hookworm enteritis with bacteremia, which resulted in infections in multiple organs and cavities. Bacteremia was most likely secondary to the damage caused by the deep penetration and transmural intestinal migration of hookworms that had bacteria adhered to the cuticle. Thus, the term hookworm enteritis/bacteremia complex was coined for this condition in California sea lions because of differences of this condition compared with that originally described for Uncinaria infections.
Taxonomy of Uncinaria spp. in pinnipeds is inconclusive at this time. Two species have been described, U. lucasi and U. hamiltoni (Dailey and Hill, 1970). However, Dailey and Hill (1970) have reported intermediate types of Uncinaria from California sea lions and molecular and morphometric differences between hookworms (Uncinaria spp.) in northern fur seals and California sea lions on San Miguel Island. Identification of the species of Uncinaria in California sea lions in the present study is uncertain and the behavior of these hookworms is unorthodox (transmural migration through the intestinal wall with bacteremia). It was not possible to compare the hookworms found in the California sea lions in the late 1960s and 1970s with the hookworms found in this investigation.
The intensity of hookworm infection in these pups was low (mean 94 worms; n = 30 pups) in June 2002 and was highest in July (mean 629 worms; n = 50), but then decreased throughout the rest of the year (reported in Lyons et al. [2005]. Mean counts were 320 (n = 31) in August, 160 (n = 30) in October, 109 (n = 30) in November, 38 (n = 30) in December, and 11 (n = 9) in January 2003 (reported in Lyons et al. [2005]). The mortality of pups peaked in JulySeptember, and then mortality started to decline (DeLong, unpubl. data). After histologic examination, the primary distinction that could be found in pups that had high hookworm infections (i.e., pups examined in July to pups with lower hookworm infections examined in October through January) was the degree of enteritis and the number of cross sections of hookworms found in the intestinal tract. The numbers of cross sections of worms were not counted, but the overall impression was that the worms were more prevalent in July and August compared with later months.
The importance of hookworm enteritis/bacteremia complex as a cause of sea lion mortality seems to be a relatively recent event (DeLong, unpubl. data). Hookworm enteritis/bacteremia complex in California sea lions may be an example of a density-dependent disease. Over the past 30 yr, the California sea lion population has increased about 5% annually with about 100,000 sea lions on San Miguel Island. The life cycle of Uncinaria spp. and their infectivity are probably sensitive to sea lion abundance and density. The prevalence of hookworms in dead pups in this study was 100%, as reported by Lyons et al. (2005), and prevalence was high in live pups in this population in summer 2000 (Lyons et al., 2001). With high-prevalence and high-intensity infections, the greater the number of pups, the greater the number of eggs passed in the feces, resulting in large numbers of infective third-stage larvae in the sandy substrate. Consequently, juveniles and adults have higher body burdens of parasitic third-stage larvae in the ventral abdominal blubber, which are passed in increasing numbers to pups through the milk of females. This process, in turn, increases the intensity of infection of adult hookworms in pups and apparently increases the probability of mortality.
High density of animals on the rookery also would lead to higher fecal contamination of the sandy beaches, which could increase the number of pathogenic bacteria in the environment. Pups commonly swallow sand that gets into their mouth, thereby resulting in a continual high exposure to numerous species of bacteria. The hookworm feeding sites in the small intestinal wall apparently allow invasion of the blood by enteric bacteria, resulting in bacteremia.
A relatively small population of northern fur seals competes for rookery space with the California sea lions on San Miguel Island during pupping and breeding seasons. Northern fur seals at San Miguel Island also have Uncinaria spp. (Lyons et al., 1997, 2000, 2001). The Uncinaria spp. of the northern fur seals possibly could infect California sea lions, and infection of an abnormal host may explain the unusually deep penetration into the submucosa and muscular layers by the worms with some worms penetrating into the peritoneal cavity (Spraker et al., 2004). Infection of an abnormal host also may explain the presence of dead worms in the deep muscular layers and the cases of hookworm-associated bacteremia, which have not been observed in other hosts. Moreover, the hookworm infection in these pups may be a combination of the Uncinaria spp. of California sea lions and northern fur seals; this aberrant relationship may explain why bacteremia can be associated with relatively low hookworm counts. However, based on molecular and morphometric data of a few hookworms, differences were found in Uncinaria spp. collected from the intestines of California sea lion and northern fur seal pups on San Miguel Island (Nadler et al., 2000).
Pups dying from emaciation/starvation were found primarily in June when they were less than 2 wk of age and in December when they were 67 mo of age. The overall number of pups with this condition was considered to be within normal limits for this population of California sea lions (DeLong, unpubl. data). The primary cause of emaciation/starvation was thought to be due to lack of maternal care.
Five pups were placed in the miscellaneous category. One of these pups had a neuroblastoma multiformes in the thalamus of the brain. Tumors are rare in marine mammals, but there has been 93 reported with 15 recorded in California sea lions (Gulland et al., 2001). The neuroblastoma multiformes in this 8-mo-old pup is the first neural tumor reported in California sea lions. The finding of this tumor was considered an interesting finding of undetermined etiology, but it did not have any significance in the overall mortality of pups. This was the first case of neoplasia found in a pup (less that 1 yr of age) in 500600 pups examined at necropsy on San Miguel Island since 1990 (Delong and Spraker, unpubl. data).
The cause of death in three of the five pups was related to trauma. Numerous types of trauma have been reported in marine mammals, especially pinnipeds (Gulland et al., 2001). The number of deaths in this study due to intraspecific and interspecific trauma was considered extremely low, even though the rookeries were crowded.
The fifth pup was a premature birth found in January 2003. The cause of this premature birth was not investigated; however, premature births associated with high organochlorine residue levels have been reported in California sea lions (DeLong, 1973).
Cause (agents) and effect (disease) are difficult to determine in many field studies investigating causes of mortality in populations. In this situation, two probably equally important and pathogenic etiologic agents were consistently found in otherwise large, well-fed pups that were found dead. The two agents were hookworms (Uncinaria sp.) and bacteria (Klebsiella spp., Salmonella spp., and hemolytic E. coli), and it is speculated that both components (hookworms and bacteria) played a role in this condition called hookworm enteritis/bacteremia complex. Although no "control pups" (pups without hookworms) were examined in this study, healthy pups on San Miguel Island have been cultured in the past and similar bacteria, including Klebsiella spp., Salmonella spp., and hemolytic E. coli have been isolated (Gilmartin et al., 1979; Spraker, unpubl. data [19901992]). These organisms also have been isolated from stranded California sea lions from the California coast (Thornton et al., 1998). Likewise, healthy-looking California sea lion pups have been found infected with hookworms (Lyons et al., 2001). Therefore, the disease in this report that was associated with high pup mortality was likely caused by the combination of infections with hookworms and several species of bacteria. The bacteria were allowed to invade systemic tissues via the gut wall damaged by the hookworms, even in pups with relatively low hookworm counts as seen in the winter (Lyons et al., 2005). There is the possibility that either of these two agents (hookworms and bacteria) could kill a pup alone, but the gross and histologic examinations of these pups did not suggest this scenario, but rather synergism of the two agents.
| ACKNOWLEDGMENTS |
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| LITERATURE CITED |
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Received for publication 7 October 2005.
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