Diffuse Fatty Infiltration Of The Liver

Clinical-Laboratory Investigation of Moldy gram poisoning in mule herd in Bajura District of Nepal.

Dr Kedar Karki Senior Veterinary Officer Central Veterinary Laboratory Tripureswor.

Dr.Ram Narayan Mandal Livestock Development officer DSLO Bajura Nepal

Abstract:

An clinical epidemiological investigation of Acute sudden death syndrome due to which 22 mules from a herd of 1400 died within the period of 0ctober to November 2009 in Bajura District Nepal. These animals were being used for good transportation work in hilly region of Nepal. On rout these animals were being fed only whole grame.Normally healthy looking animals started dying suddenly. Initially suspected for acute bacterial disease and treated with broad-spectrum antibiotics and vaccinated with bacterial vaccine.On close observation of herd their feed stuff revealed grains fed to these animal during rainy season was found 55-60% moldy in appearance. On Postmortem examination acute severe congestion and hemorrhages in liver, lung, spleen heart, and intestinal mucosa were found. While lesions in the cerebral cortex was found from none to multifocal areas of hemorrhage and necrosis, to the presence of large cavitations of liquefactive necrosis Histopathological examination of tissue from these organs revealed infiltration of mononuclear cell in tissue indicative of chronic nature of condition.Continous use of apparently 55-60% moldy grain (gram) was used as feed. On laboratory analysis of sample of same grain was found to be containing 22.00000 – 83.00000 CFU/gm of Penicillium spp of fungus. When remaining herd still using same feed treated with Antidegnala loquor toxin binder ( varishta), liver tonic like hepatocare, and immunocare controlled the mortality may be indicative of the disease syndrome being caused by moldy corn poisoning similar to condition Equine Encephalomalacia.Laboratory findings and response of treatment indicates that during rainy season and immediately after rainy season feeding of stored grains are going to be detrimental to equine species. During this period care should be taken to feeding grains to this animal if treated with any toxin binder as well as herbal immunomodulater is going to reduce the chances of occurring this syndrome.

Key word:

Equinelukoencephalomalcia, moldy gram poisoning,hepatocare,Varishta,Antidegnala liquor,immunocare,mule Bajura,Nepal, penicillium, CFU.

Background:

In Barjugad of Bajura District of Far western region of Nepal in month of October -November 2009 mules from herd of 1400 stared dying suddenly showing symptoms like excessive sweating, trembling and lying down on the ground. In a period of one month in weekly interval death of 5-6 mules was reported which did not responded the antibiotic and other supportive therapy. After obtaining a thorough history and completing a physical examination No disease-related gross lesions were present in the rest of mule in the herd. it was discovered that the mules were being fed cracked and moldy gram and rice hauls that was being scooped up from sacs piled in local warehouse. The mortality in mule herd in this area in same season was reported in year 2006 2007 and 2008 with mortality recorded as 3, 6, 33,no while this year total 22 death of mule was recorded.Post-mortem examination of death Mule revealed severe congestion of liver, lung,speen, heart,serosangqinus fluid in thoracic cavity.Haemorrhage in stomach mucosa. At necropsy, lesions in the cerebral cortex was found from none to multifocal areas of hemorrhage and necrosis, to the presence of large cavitations of liquefactive necrosis.For bacteriological culture blood.Liver, lung, spleen, heart brain tissue were collected in ice and for histopathological examination same tissues were collected in formaline.Blood Fecal samples for endoparasite examination.Feedgrains:Maize,Grame for mycological culture identification,quantitification were collected.Mules in herds were treated with 2% 5ml Antidegnala liquor S/C and followed by 2ml orally for 5 days toxinbinder Varishta 10g/100kg feed grain, Hepatocare liquid, immunomodulator immunocare liquid for 10-15 days , as treatment and preventive measure.No further mortality in the herd was reported.

Result and Discussion:

Bacteriological culture of tissue specimen, blood: revealed no growth of any bacteria.Fecal examination revealed the Mixed Strongyels spp.
Penicillium, spp on mycological media.22.00000 CFU/gm mold colonies recorded in rice haul feed samples and 83.00000CFU/gm mold colonies in gram feed sample was recorded.Histopathological changes revealed fatty degeneration of hepatocytes.Mononuclear cells infiltration in the form of few nodules in liver. Perivascular cuffing. Infiltration of mononuclear cells in the form of nodules in lungs. Deep medullary region reveals infiltration of mononuclear cells in kidney.
The number of white cells seems to be increased in the area of white pulp in spleen. There were multifocal areas of liquefactive necrosis within the cerebral cortex with infiltration of macrophages. As approximately 55-60% moldy gram infestated with Penicillium spp being fed regularly to these herd.Intermitent but acute sudden death during post rainy season suggest the death due to fungal toxin. Dr. Steve Hooser and Dr. Duane Murphy 2003 reported histopathological changes in the tissue of lung ,liver, kidney brain a center of necrosis with no recognizable structure will be observed in moldy corn poisoning in horse . The transition between normal and necrotic tissue will often show hemorrhage, edema, congested blood vessels and neuronophagia. In animals with the hepatotoxic syndrome, livers will be swollen and a diffuse yellow-brown color. Irregular nodules and pale foci can be seen in hepatic parenchyma. Karki 2003 reported the pathogenicity of Fusarium revealed that it causes hepatic congestion with mild triaditis, pulmonary congestion, and splenic lymphoid hyperplasia.Further more a positive response to treatment with toxinbinder, adaptogen,immunomdulater further confirm the sudden death was due to moldy corn poisoning. Further monitoring of finding of this investigation is suggested.
Conclusion:
Findings of this investigation indicates that moldy feed grains and ingredients are infested with toxic fungus is emerging as a new health hazard for livestock and poultry.Simultonious use of toxinbinder,adaptogen like livertonic,mineralmixture and Immunomodulaters drugs promises to help in minimizing health risk in livestock and poultry production should be looked into.
References:

1:MOLDY CORN POISONING HORSES:(Equine Leukoencephalomalacia Mark Russell, PhD, Department of Animal Sciences Don Scott, PhD, Department of Botany and Plant Pathology William Hope, DVM, Department of Veterinary Clinical Sciences Cooperative Extension Service Purdue University West Lafayette, IN 47907 , BOLETIM TACNICO No. 15 – http://www.micotoxinas.com.br/ Retrieved on 21/12/2009
2:FINAL DIAGNOSIS -Moldy Corn Poisoning (Equine Leukoencephalomalacia, Fumonisin Toxicity) in Horses : Dr. Steve Hooser, ADDL Toxicologist Dr. Duane Murphy, ADDL Pathologist Spring 2003 Newsletter http;//www.addl.purdue.edu/newsletters/2003/Spring/finaldx.shtml. Retrieved on 21/12/2009

3:Prevent mycotoxin’s harmful effects from impacting your horse’s health and performance.Mycotoxins in Equine Feed,: By Trevor K. Smith, PhD, PAg www.ecmagazine.net/…/mycotoxin2.jpg Retrieved on 21/12/2009

4:Grain Molds and Mycotoxins in Corn: Jim Stack, Extension Research Plant Pathologist Division of the Institute of Agriculture and Natural Resources at the University of Nebraska-Lincoln cooperating with the Counties and the United States Department of Agriculture.http://cbc.homestead.com/Archives.html, Retrieved on 21/12/2009
6:Varishta:www.varshagroup.com
7:Pathogenecity Assessment of Fusarium graminearum in Mice. Kedar B.Karki:pp14,Vetcon 2003, 7th national veterinary conference 2003,Nepal Veterinary Association.
Acknowledgement:
We would like to acknowledge Dr.Damodar Sedai Chief Veterinary Officer,Dr.Salina Manandhar, Dr.Krishna Raj Panday Dr.Pragya Koirala Veterinary Officer and all laboratory technician for their contribution in Laboratory work and investigation work.

Frequently Asked Questions

  1. QUESTION:
    what is diffuse fatty infiltration of the liver?
    and is it serious? the ct findings say that my liver is not enlarged and measures 28.5cm. but at the end of the report it says the impression is hepatomegaly with diffuse fatty infiltration of the liver. doesn’t hepatomegaly mean that my liver is enlarged?

    • ANSWER:

  2. QUESTION:
    what are the best way to do if i have a mild diffuse fatty infiltration of the liver?do i need to worry?
    Im scared because i always have pain in my right abdomen.swollen and drowsiness.also i do not know if the pain i felt most of the time in my left knee is connected for having a diffuse fatty infiltration of the liver.please help what to do.

    • ANSWER:

  3. QUESTION:
    diffuse fatty infiltration of the liver – what is that means.?
    Can someone please tell me in a way I can undestand (english) what is diffuse fatty infiltration of the liver. The CT scanning appears to be normar but with the above info.

    I have two previous CT with – Mosaic attenuation patter – and Mosaic perfusion. At this point I do not know if the scanning people know what they are doing or my health is fine.

    I have severe symptoms of pain on my Left Upper Quadrant Abdomen with mass in my abdomen followed by left upper back bruise (white spot – similar to bite)

    I just need your opinon of what possibilities of problems could that be. – It is over a year of testing with lots of drugs but no soluction.

    Please no website just your opionin.

    I thank you very much

    • ANSWER:
      Fatty infiltration is when the cells of an organ have absorbed fat from outside of it. In a nutshell your liver sucked up fat that surrounded it.

      Mosaic attenuation pattern has to do with what the person reading the CT scan is seeing. It is a pattern of darkness and lightness that resembles a form of art in which tiles are inlayed to form a picture. What they are seeing is the density of your liver varying in density wildly. This could be due to tumor versus healthy tissue versus fatty tissue.

      I have no idea what would cause a white spot on the outside of your body in relation to a mass inside of it though–that sounds a bit odd.

  4. QUESTION:
    “Diffuse fatty infiltration of the liver” Does this mean Cirrosis of the liver?
    Or could it mean other possibilites as well?
    I don’t drink, I have thryoid cancer, and I just had a baby.
    *correction cirrhosis

    • ANSWER:
      Not yet.

  5. QUESTION:
    I need a Dr. to interpret my CT Report. I had an ULQ CT done. I have left upper, and lower quadrant pain.?
    I had an ULQ CT done. I have left upper, and lower quadrant pain. H. Pylori Positive.
    this is a brief detail on my report:
    1. diffuse fatty infiltration of the liver, with an area of focal fatty infiltration adjacent to the falciform ligament.
    2. Low attenuation 2.1 cm splenic mass, most likely a simple splenic cyst or a lymphangioma. Clinical correlation recommeded.
    3. Minimal umbilical hernia, containing only fat.
    The liver is of diffusely diminished attenuation consistent with diffuse fatty infiltration. minimal area of focal hypodensity adjacent to the falciform ligament consistent with an area of focal fatty infiltration.
    The Spleen is not enlarged, but demonstrates a hypodense, near water density of +18HU (mass 2.1 cm size) posterosuperiorly in a subcapsular location. There is no asociated calcification or fill in on the delayed images. This is most likely represents a simple splenc cyst or lymphangioma.
    Please hlp what does this all mean?

    • ANSWER:
      It says that you have a fatty liver. There are many causes of fatty liver, the most common being alcoholism and obesity. This condition occurs when the liver is not metabolizing fat effectively. I found a Wikipedia article that lists some of the causes; see the first link. The condition is reversible if the cause can be treated.

      The radiologist feels that he cyst on the spleen is not a concern. “Lymphangioma” is an abnormal collection of lymph vessels that is present from birth, not anything to be concerned about.

      The umbilical hernia is small. Such hernias are not a concern unless there are associated symptoms. Nothing to worry about.

      It is not common for fatty liver to cause pain, except that some people feel a dull LUQ pain. Since you also have lower quadrant pain, further testing may be necessary to find the cause.

      The positive H. pylori is probably meaningless, unless you have an ulcer. About half the population carries it.

      I have found a bunch of links for you if you want more detail.

  6. QUESTION:
    What is your opinion: ultrasound findings of Diffuse Hepatocellular Disease?
    I went to a gastroenterologist back in Oct of 2010 because of pain and bloating that I was having in my upper abdomen and a 12 year history of almost daily diarrhea. I had a colonoscopy in about 1992 and again in about 2004 (all different doctors through the years because of changing of insurances) and both colonoscopies were negative for disease, even the couple dozen biopsies the one gastro dr took in 2004.

    The gastro dr I saw this last Oct ’10 ordered an ultrasound of my abdomen and a liver function test (blood test). The dr told me that the report said that I have a “very very fatty liver” and “everything else looks good”. He said because of my age (female, 51 yr old), that I should have a colonoscopy. I’ve been putting it off because I don’t like this dr. And he said that because of my pain and fatty liver, I should get a hepatitis test, so I did and came back normal.

    I got to thinking about how important it probably is for me to get a colonoscopy done but because I don’t like this gastro dr, I am going to go to a different one. (Yes I know I should have taken care of this last October) So I called his office last week and asked for a copy of my ultrasound report so I would have that in hand when I go to see a different gastro dr. I got the report in the mail the other day and was shocked to see that it says “Impression: 1. Increased echogenicity of the liver consistent with diffuse hepatocellular disease and raising the possibility of fatty infiltration. 2. Otherwise unremarkable ultrasound examination of the abdomen.”

    That dr never discussed “diffuse hepatocellular disease”. He only said I have a fatty liver. By the way, I had other blood tests done at the same time that my regular dr had ordered and the lab sent ALL of the blood test results to the gastro dr AND my PCP. I saw the gastro dr first and he told me that ALL of my tests were all normal, when they clearly are not. Here are my blood test results:

    RDW 15.4 (11.5-14.5 %)
    Monocytes 0.7 (0.11-0.59 thou/uL) (I have not been sick)
    Carbon Dioxide 33 (22-30 mmol/L)
    AST 52 (14-36 U/L)
    ALT 63 (7-56 U/L)
    And my GFR-MDRD is 70 (Greater than 90 mL/min/1.73 m2)
    (I read that a score of 70 means that I have mild kidney damage)
    These results were normal but at the high end of normal:
    WBC was 9.1 (4.8-10.8)
    Sodium 145 (137-145 mmol/L)
    Glucose 100 (70-110 mg/dL) (this was after a 13 hour fast)
    Cholesterol was good at 159 but the other lipid results were not good.

    I read that Diffuse Hepatocellular Disease is either caused by infection or cancer. So since my blood test for Hepatitis was normal… does this mean the possibility for cancer is raised? What do you think of all this? As mentioned in another yahoo answers post I made last year, I did have an ANA test done in about 2004 and it showed 1:80 Speckled Pattern.
    I drink alcohol maybe 1 to 3 times a year at the most. When I do drink, I usually don’t even drink half of a bottle of beer or half a glass of a margarita (Mexican Restaurant). My husband always finishes it for me LOL. I did get flat out drunk one time when I was a teenager but that’s the only time I can ever remember getting drunk.

    I do take about 6 prescriptions daily for a bad heart valve, allergies, asthma, etc. I do not take street drugs although I experimented with drugs as a teenager (mostly marijuana) and I have never used intravenous drugs.
    I am approx. 100 pounds overweight, most of it gained in the last 12 years. Before that, almost my whole life I was extremely thin….. I am 5′ 8″ and 251 pounds with a medium build.
    abijann, are you saying that Diffuse Hepatocellular Disease can also just be a simple case of Fatty Liver? I thought it only means infection or cancer…

    • ANSWER:
      Fatty liver disease can be caused by different
      reasons:
      weight gain, fast weight loss, obesity,
      malnourishment, diabetes, insulin resistance,
      certain types of drugs (like steriods),
      high cholesterol/triglyceride levels,
      alcohol consumption, chemical exposure and
      others.

      Fat inside the liver usually starts out as being
      “simple fatty liver” that doesn’t cause a problem.
      However, if the fat continues to build up inside
      the liver, the fat causes pressure inside the
      liver and causes liver cell damage.
      The immune system of the body may respond
      to this damage and cause inflammation to
      develop inside the liver. This is then known
      as Steatohepatitis. Steato stands for fat,
      hepat stands for liver, and itis stands for
      inflammation. It is much more serious, then.
      [Hepato means liver, and cellular means the
      liver cells]
      The inflammation inside the liver caused
      by the fat build up can lead to the liver
      enlarging in size. This is best seen on
      an ultrasound or Ct scan.

      Fatty liver is just one of the causes of liver
      cell damage; some other are alcohol
      consumption, medication toxification,
      chemical exposure, mushroom poisoning,
      biliary problem, metabolic disease,
      hereditary conditions, viral or parasite
      infections, cysts/growth/tumors/cancer,
      and many others.

      If there is inflammation inside the liver,
      if the cause isn’t found and stopped…
      it can lead to where the liver cells die off and
      form scar tissue inside the liver…this then becomes
      an irreversible, progressive disease known as
      Cirrhosis of the liver.

      I believe you need to find a doctor who you are
      comfortable with and can trust and follow whatever
      advice he give you…he may place you on a special
      diet; if this is the true cause. It would be best to
      be referred to a dietitian who will take into account
      all your medical conditions. Your liver enzymes:
      the ALT and AST are slightly high. However, they
      also check the liver function tests and liver viral
      tests and also the liver cancer test…before making
      a diagnosis.

      Here are some links to click on to learn more about
      fatty liver disease:

      http://yourtotalhealth.ivillage.com/fatty-liver.html

      http://en.wikipedia.org/wiki/Fatty_liver

      http://www.gastro.com/Gastro/liverdisease/fatty_liver.aspx

      http://www.medicinenet.com/fatty_liver/article.htm

      http://www.liverdoctor.com/index.php?page=fatty-liver

      Some terms to understand while reading:
      NASH is non alcoholic causes of steatohepatitis (which
      I mentioned above)
      NAFLD is non alcohol causes of fatty liver disease
      Hepatitis is inflammation of the liver because of any
      number of reasons.
      Hepatitis with a letter after it (like Hepatitis A,B,C) is
      a virus that enters the body and uses the liver cells
      to replicate itself
      Cirrhosis is Death of the liver cells and scar tissue
      formation inside the liver.

      The ANA test is usually done to determine if you have
      an autoimmune disease. That means that you immune
      system may be attacking your own living cells. Each
      cells has its own marker that the immune system
      recognizes as being us….most of the time, they don’t
      know why the immune system turns on its own patient.
      Here is some information from this site that explains
      your results a little better:

      http://www.medterms.com/script/main/art.asp?articlekey=2232

      Quoting from this site; something to think about and ask
      your doctor:
      “ANAs are present in approximately 5% of the normal population,
      usually in low titers (low levels). These persons have no disease.
      Titers of lower than 1:80 are less likely to be significant.
      Even higher titers are insignificant with aging over age 60 years.
      Ultimately, the ANA result must be interpreted in the specific
      context of the symptoms and other test results for the patient.
      It may or may not be significant in an individual.

      All liver patients are told, No alcohol. To be sure each
      and every doctor knows what medications you are taking
      (as medications goes through the liver first, to be broken
      down, before going to the rest of the body).
      When stating medications, this includes over the counter,
      herbs, vitamins, minerals, supplements, etc…besides
      your prescribed ones. Medications have to be watched
      closely for the dosage if there is liver cells damage.
      The liver cells are what does the function of the liver.

      I hope this information has been of help to you.
      Best wishes

  7. QUESTION:
    What does my CT Scan results mean, I am very worried?
    It says:

    CT OF THE ABDOMEN AND PELVIS WITH CONTRAST

    HISTORY: Abdominal pain.

    FINDINGS: The lung bases are clear.

    There is diffuse fatty infiltration of the liver.

    A 4 mm hypodensity in the posterior cortex of the right kidney is likely a benign cyst. Remaining intraabdominal organs have a normal appearance. There is no free fluid or lymphadenopathy.

    There is a persistent 2.2 cm segment of decreased patency of the sigmoid colon. This is likely due to anatomical variation. There is no proximal dilatation of colonic lumen that would suggest true stricture. Inflammatory or neoplastic mucosal-based lesion is felt to, therefore, be unlikely. Further evaluation could be obtained with barium enema or colonoscopy, if felt to be clinically indicated.

    IMPRESSION:

    1.No acute intraabdominal/pelvic pathology.

    2.2.2 cm segment of lack of normal luminal distention of sigmoid colon, likely representing developmental variant and/or spasm, rather than true persistent stricture. No dilatation of proximal bowel or other evidence to suggest bowel obstruction.
    I am 55 years old, overweight, T2 Diabetic, Don’t smoke or drink.
    Thanks Liza. I am still wondering why I am still having some Abdominal discomfort mostly in my lower left side.
    Since the CT results don’t sound real bad. I don’t see the Dr. again until the 21st.

    • ANSWER:
      Basically, this scan is done as your doc was suspecting some part of your intestine is blocked.

      The lung bases are clear – means no sign of infection in your lungs.

      There is diffuse fatty infiltration of the liver – There are a lot of fats growing at your liver. Obviously, you better admit you are eating a lot of junk food, most likely KFC.

      A 4 mm hypodensity in the posterior cortex of the right kidney is likely a benign cyst – means, at the back of your right kidney, there is a small grow of 4mm. However, the growth contains fluid. So it’s most likely to be a cyst and very unlikely to be cancer.

      Remaining intraabdominal organs have a normal appearance. There is no free fluid or lymphadenopathy – means – the rest of the organs inside the territory of tummy, are normal. No free fluid means no serious illness in the tummy eg cancer. No lymph nodes are found there also. That means you are unlikely to be having lymphoma, a type of cancer.

      There is a persistent 2.2 cm segment of decreased patency of the sigmoid colon. – at the large intestine (sigmoid colon), about 30cm from your anus, a part of the intestine of length 2.2cm is not flowing well, the flow is slightly slower as compared to the rest of other parts of the intestine.

      This is likely due to anatomical variation. means – this is likely to be normal due to the position of your body.

      There is no proximal dilatation of colonic lumen that would suggest true stricture. Means – (normally, after the section of blockage eg slow flow, the lower part of the intestine will be bigger.) the intestine after the block is not bigger, means it’s not block. Just slower flow.

      Inflammatory or neoplastic mucosal-based lesion is felt to, therefore, be unlikely. means – based on the above findings on the scan, you are unlikely to be having cancer in your intestine. Your intestine is not inflammed also.

      Further evaluation could be obtained with barium enema or colonoscopy, if felt to be clinically indicated. means – if need to be 100% sure what is happening at the slow flow section, will need to be find out by a scope going into your intestine from your anus. Or do a barium enema, whereby a milky radio opague fluid is push into your intestine from anus.

      No acute intraabdominal/pelvic pathology. means – no serious abnormalities found in this region.

      I am 55 years old, overweight, T2 Diabetic, Don’t smoke or drink – does not have any effects on the scan.

  8. QUESTION:
    question for a radiologist or related person?
    on ultrasound of liver, impression is

    1) ” mild diffuse increase in echogenicity without discrete mass ”
    2) ” increased echogenicity of the parenchymal pattern of the liver suggesting fatty infiltration”

    please explain
    thanks

    • ANSWER:
      It means other than having a fatty liver your liver is fine.

  9. QUESTION:
    Can someone translate my ct scan and tell me if it’s bad?
    I have non-hodgkins lymphoma. I’ve had 7 cyles of chemo. This is what my most recent ct scan report said:

    A large anterior mediastinal mass measures approximately 9cm transverse x 4cm AP x 8cm CC. This likely corresponds to the underlying lymphoma. A small to moderate pericardial effusion is seen. At the left base medially parallel to the descending aorta, there is a 3cm rounded density without significant air bronchograms. Multiple small scattered foci of interstitial edema or infiltrates are seen at the left and right upper lobes surrounding the mediastinal mass, probably related to underlying tumor. DIffuse scattered pulmonary micronodules are also identified bilaterally. The airways are patent. Heart size is normal. No large consolidation or effusion is seen. A 2cm area of low attenuation is noted in the left lobe of liver, adjacent to the falciform ligament, probably focal fatty infiltration.

    Please translate the medical words to english and tell me if it is bad. Thanks!
    P.S. Please do not answer if you have no idea. Thank you!

    • ANSWER:
      A large anterior mediastinal mass measures approximately 9cm transverse x 4cm AP x 8cm CC (mass in the chest area)

      A small to moderate pericardial effusion is seen (fluid around the heart)

      At the left base medially parallel to the descending aorta, there is a 3cm rounded density without significant air bronchograms (density lacking air is seen)

      Multiple small scattered foci of interstitial edema or infiltrates are seen at the left and right upper lobes surrounding the mediastinal mass, probably related to underlying tumor (fluids around the tumor)

      DIffuse scattered pulmonary micronodules are also identified bilaterally (nodules are seen in lungs)

      The airways are patent (airway is fine)

      A 2cm area of low attenuation is noted in the left lobe of liver adjacent to the falciform ligament, probably focal fatty infiltration (fatty mass in liver)

      That is just my interpretation, definitely check with your doctor to make sure you understand it better.