1. Understanding the enteritis syndrome – a guide to diagnosis

2. Bacterial Enteritis Clostridial enteritis Necrotic enteritis Cholangiohepatitis Dysbacteriosis/non- specific bacterial enteritis Clostridium perfringens The Enteritis Syndrome cocci virusesnutrition

3. Enteritis is a growing problem worldwide Particularly in flocks where: Cocci vaccines are used Antibiotic digestive enhancers have been removed Medication withdrawal times have been extended Wheat-based diets are fed

4. Economic and performance impact of enteritis Feed conversion: 4-10 point decline Live weight: reduced 30-120g/bird Mortality: increased 1-5% Condemnations: increased up to 10% The performance impact occurs at subclinical levels The cost of enteritis is estimated at at US $0.05/bird or more

5. Enteritis is not a single disease Two different causes lead to three forms: Clostridium perfringens – Clostridial enteritis/necrotic enteritis – Cholangiohepatitis Non-specific bacterial enteritis – not necessarily associated with C. perfringens – results in dysbacteriosis

6. Enteritis is not a single disease Accurate diagnosis is necessary for effective treatment, because each form requires a specific treatment protocol.

7. 1. Clostridial enteritis/Necrotic enteritis Disease of the small intestine associated with proliferation of C. perfringens causing mortality and diarrhoea. Costly sub-clinical form often goes undiagnosed. Economic losses begin early, before mortality is seen. Medication protocol : Strategically medicate with antibiotic effective against C. perfringens

8. Cholangiohepatitis Clostridial infection affecting the liver, leading to enlargement, fibrosis and often jaundice, with condemnations at processing. Medication protocol : Strategically medicate with antibiotic effective against C. perfringens

9. Dysbacteriosis Presence of abnormal flora in the small intestine that causes diarrhoea and/or malabsorption but does not increase mortality. Not usually associated with C. perfringens. Medication protocol : Treat immediately when observed. Consider using litterbox to detect wet droppings early. Strategic preventive therapy may not work.

10. Intestinal bacterial overgrowth Clostridial enteritis Necrotic enteritis Cholangiohepatitis Dysbacteriosis/non specific bacterial enteritis Clostridium perfringens Enteritis cocci virusesnutrition

11. The classical signs of necrotic enteritis Elevated mortality with intestinal necrosis

12. Wet litter, feed passage and diarrhoea: Is it enteritis? Other possible signs

13. Diagnosis You are presented with the following clinical signs Wet litter, diarrhoea Feed passage Elevated mortality ? Increased condemnations ? Examine sacrificed and dead birds

14. Is it Coccidiosis? Score 4 Eimeria acervulina Eimeria maxima Use microscopic examination to confirm or eliminate Eimeria maxima infection

15. Is it Coccidiosis? Score 3 Eimeria acervulina Eimeria maxima Use microscopic examination to confirm or eliminate Eimeria maxima infection

16. Is it Coccidiosis? Score 2 Eimeria acervulina Eimeria maxima Use microscopic examination to confirm or eliminate Eimeria maxima infection

17. Is it Coccidiosis? Score 1 Eimeria acervulina Eimeria maxima Use microscopic examination to confirm or eliminate Eimeria maxima infection

18. Is it clostridial enteritis? Score 4 Severe and extensive necrosis typical of field cases: classic necrotic enteritis

19. Diagnosis Clostridial enteritis Post-mortem: Intestinal necrosis Clinical signs: Occurs at 15-25 days – the birds stop growing – mortality – diarrhoea – huddling – depression – rough feathers

20. Treatment of Clostridial enteritis Implement a strategic medication program. (Economic losses begin in the early, before mortality)

21. Is it clostridial enteritis? Score 3 Larger patches of necrosis

22. Is it clostridial enteritis? Score 2 Focal necrosis or ulceration Erosions can be removed by gently scraping with a scalpel blade, This is not the case for Eimeria acervulina

23. What diagnosis do you give this? Score 1 Thin-walled or friable small intestine If this is your only finding and there are no enteritis scores of 2, 3, or 4

24. Consider a diagnosis of Dysbacteriosis Post mortem: Intestinal inflammation Watery intestinal contents Orange mucus in jejunum Clinical: Sticky droppings Wet litter Sometimes foamy caecal droppings Reduced feed intake Reduced physical activity Normal or increased water intake Normal mortality Selective feeding behaviour may be observed

25. Is it Dysbacteriosis? To confirm diagnosis: Use Plates Treat with antibiotic, monitor results – Does condition resolve with treatment?

26. Yes : Continue antibiotic treatment. To get the best results treatment should be initiated as early as possible No : Enteritis not related to cocci or bacterial overgrowth Viruses Feed issues, e.g. mycotoxins, fat quality, biogenic amines