2023/10/9 22:41 Proliferative Enteritis | Iowa State University --- 增殖性肠炎 |爱荷华州立大学

Veterinary Diagnostic and Production Animal Medicine

兽医诊断和生产动物药品

Proliferative Enteritis 增殖性肠炎

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Proliferative Enteritis (Porcine Proliferative Enteritis, Ileitis, Intestinal Adenomatosis, Garden-hose Gut)
增殖性肠炎（猪增殖性肠炎、回肠炎、肠腺瘤病、花园软管肠）
Definition 定义
Porcine proliferative enteritis (PPE) is an enteric disease characterized by hyperplasia of crypt enterocytes with inflammation and
sometimes ulceration or hemorrhage. Lesions always include thickening of the mucous membrane of part of the small intestine and/or
large intestine. Lesions vary considerably by location, extent, and duration. Many terms have been used to describe this disease,
including: proliferative hemorrhagic enteropathy (PHE), porcine intestinal adenomatosis (PIA), porcine proliferative enteritis (PPE),
necrotic enteritis (NE), regional or terminal ileitis (RI), ileitis, and garden-hose gut.
猪增殖性肠炎（PPE）是一种肠道疾病，其特征是隐窝肠上皮细胞增生并伴有炎症，有时会出现溃疡或出血。病变总是包括小肠和/或大
肠部分的粘膜增厚。病变因位置、范围和持续时间的不同而有很大差异。许多术语已被用来描述这种疾病，包括：增殖性出血性肠病
（PHE）、猪肠腺瘤病（PIA）、猪增殖性肠炎（PPE）、坏死性肠炎（NE）、区域或末端回肠炎（RI）、回肠炎和花园软管肠道。

Occurrence 发生
Porcine proliferative enteritis (PPE) occurs worldwide. Disease is categorized pathologically as a severe acute form (proliferative
hemorrhagic enteropathy or PHE) that is more common in young adults, and a chronic or necrotic form which occurs much more
frequently, usually during the grower phase.
猪增殖性肠炎（PPE）在世界范围内发生。疾病在病理学上分为严重急性形式（增殖性出血性肠病或 PHE），在年轻人中更常见，以及
慢性或坏死形式，发生频率更高，通常在生长阶段。
The disease occurs primarily in growing/finishing pigs but may also occur in pigs as young as 3 weeks, in market weight hogs and
adult swine. Disease often appears to be more severe with, and occurs at an increased incidence in, age-segregated herds. Similar
signs and lesions occur in other mammals (hamsters, ferrets, guinea pigs, foxes, horses, lambs, rabbits, rats, dogs, white-tailed deer,
emus) with no detectable differences in the genotype of the causative organism. Hamsters have been used in research and are readily
infected by the porcine organism.
该病主要发生在生长猪/肥育猪中，但也可能发生在 3 周龄的猪、上市体重的生猪和成年猪中。在年龄隔离的牛群中，疾病往往显得更严
重，发病率也更高。类似的体征和病变也发生在其他哺乳动物（仓鼠、雪貂、豚鼠、狐狸、马、羔羊、兔子、大鼠、狗、白尾鹿、鸸
鹋）中，而致病生物体的基因型没有可检测到的差异。仓鼠已被用于研究，并且很容易被猪生物体感染。
Historical information 历史信息
The first report of PPE was published in 1931. Neither that nor another report in 1935 stimulated much interest. In the 1970s there was
a renewed interest as marked losses from PPE became more apparent. In 1993, a method of cultivation of the confirmed etiologic
agent (Lawsonia intracellularis) in tissue culture was reported. The agent has now been used to reproduce the disease in conventional,
susceptible pigs.
第一份 PPE 报告于 1931 年发表。无论是该报告还是 1935 年的另一份报告都没有引起太大兴趣。 20 世纪 70 年代，随着 PPE 的显着
损失变得更加明显，人们重新燃起了兴趣。 1993年，报道了一种在组织培养中培养已确认的病原菌（胞内劳森菌）的方法。该试剂现已
用于在传统的易感猪中重现该疾病。

Etiology 病因学
Bent, rod-shaped, Gram-negative bacteria in crypt enterocytes of swine with PPE were recognized long ago. However, the organism
could not be grown on cell-free media and was not identified until 1993. The obligate intracellular organism, Lawsonia intracellularis(Li)
is considered to be a novel taxonomic genus and species. It is related to certain anaerobic, sulfate-reducing bacteria.
很久以前就在佩戴 PPE 的猪隐窝肠细胞中发现了弯曲的杆状革兰氏阴性细菌。然而，该生物体不能在无细胞培养基上生长，直到1993
年才被鉴定。专性细胞内生物，胞内劳森菌(Lawsonia intracellularis，Li)被认为是一个新的分类属和种。它与某些厌氧硫酸盐还原菌有
关。
Lawsonia intracellularis can be grown in a rat enterocyte cell line and inoculation of susceptible pigs with pure culture of the organism
reproduces PPE. All isolates examined from different host species and from different geographical locations appear to be quite similar.
Polymerase chain reaction (PCR) has been useful for characterization of the organism and has ruled-out involvement of
Campylobacter spp. in the disease
胞内劳森菌可以在大鼠肠上皮细胞系中生长，用该生物体的纯培养物接种易感猪可产生 PPE。从不同宿主物种和不同地理位置检查的所
有分离株似乎非常相似。聚合酶链式反应 (PCR) 可用于表征生物体，并排除了弯曲杆菌属的参与。在疾病中
Epidemiology 流行病学
The incubation, recovery, and carrier phase of L. intracellularis infection is quite long in some pigs, probably months. Undoubtedly,
there are carrier swine that disseminate L. intracellularis in their feces to susceptible pigs by fecal-oral route. Infection often results in
subclinical disease. Research also shows that L. intracellularis from experimentally infected pigs spreads to naive sentinel pigs penned

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with them or penned separately in the same enclosed area.
在某些猪中，胞内乳杆菌感染的潜伏期、恢复期和携带期相当长，可能长达数月。毫无疑问，有带菌猪通过粪便将胞内乳杆菌通过粪口
途径传播给易感猪。感染常常导致亚临床疾病。研究还表明，来自实验感染猪的胞内乳杆菌会传播到与它们一起圈养或单独圈养在同一
封闭区域的幼稚哨兵猪。
Carrier dams have been demonstrated to infect their litters as early as six days of age, a likely reason for failure of segregated early
weaning techniques to control disease. The incubation period is at least two weeks, perhaps much longer. Outbreaks often have been
associated with a variety of stresses. Lateral transmission of infection has been demonstrated but not all pigs within a population are
necessarily infected simultaneously.
事实证明，母猪早在六日龄时就会感染其仔猪，这可能是早期隔离断奶技术未能控制疾病的原因。潜伏期至少两周，甚至更长。疫情的
爆发通常与各种压力有关。感染的横向传播已被证实，但并非种群内的所有猪都必然同时受到感染。
Pathogenesis 发病
L. intracellularis infects epithelial cells and survives intracellularly. When enterocytes undergo mitosis, each cell retains some of the
bacteria, and enterocytes fail to mature. The resulting hallmark lesion is a proliferation of immature enterocytes. Whether the organism
stimulates greater proliferation, retards maturation, or both is not known. Microscopically, organisms are visible within the apex of crypt
epithelial cells. Responses to the bacteria include crypt elongation, epithelial cell hyperplasia, degeneration and necrosis of
enterocytes, fewer goblet cells, and an inflammatory response.
胞内乳杆菌感染上皮细胞并在细胞内存活。当肠上皮细胞进行有丝分裂时，每个细胞保留一些细菌，并且肠上皮细胞无法成熟。由此产
生的标志性病变是未成熟肠细胞的增殖。该生物体是否刺激更大的增殖、延迟成熟或两者兼而有之尚不清楚。在显微镜下，隐窝上皮细
胞顶端可见生物体。对细菌的反应包括隐窝伸长、上皮细胞增生、肠上皮细胞变性和坏死、杯状细胞减少以及炎症反应。
Other details of pathogenesis are speculative. Variations in the reported syndromes may correlate with different stages in lesion
development or different responses to infection, perhaps modulated by predisposing factors, stresses and saprophytic organisms.
Seroconversion occurs two weeks after infection, although lesions may not develop for three to four weeks post-infection. The
protected, intracellular environment afforded the organism probably requires a cell-mediated response to eliminate infection. Resolution
of lesions starts approximately four weeks after infection.
发病机制的其他细节是推测性的。所报道的综合征的变化可能与病变发展的不同阶段或对感染的不同反应有关，可能受到诱发因素、应
激和腐生生物的调节。血清转化发生在感染后两周，尽管感染后三到四周内可能不会出现病变。受保护的细胞内环境为生物体提供了可
能需要细胞介导的反应来消除感染。感染后约四周，病变开始消退。

Clinical signs 临床体征

There has been much confusion related to nomenclature, lesions, and clinical signs of PPE, primarily due to the variation that exists in
clinical signs, age of pig affected, and gross lesions. In addition, a syndrome (hemorrhagic bowel syndrome or HBS) of sudden death
with blood in the intestinal tract (which is not PPE) is often confused with this condition. Acute cases of PPE are most frequently
observed in late finishing pigs and young breeding stock (PHE). Acute diarrhea with brownish to black unclotted blood, pallor,
weakness, and rapid death are common; lesions include mucosal proliferation and hemorrhage. Subacute to chronic cases occur more
frequently in the grower stages, manifested by sporadic diarrhea, wasting, and variation in growth rate; lesions often include necrotic
enteritis and can be easily confused with salmonellosis. Morbidity and mortality with either presentation is variable. Some pigs may
have quite severe proliferation of mucosa of terminal small intestine yet can be clinically asymptomatic.
PPE 的命名、病变和临床症状存在很多混乱，主要是由于临床症状、受影响猪的年龄和肉眼病变存在差异。此外，肠道带血猝死综合征
（出血性肠综合征或 HBS）（不是 PPE）经常与这种情况混淆。急性 PPE 病例最常见于晚育猪和幼龄种猪 (PHE)。常见急性腹泻，伴
有褐色至黑色不凝结血液、面色苍白、虚弱和迅速死亡；病变包括粘膜增生和出血。亚急性至慢性病例多发生在生长阶段，表现为偶发
性腹泻、消瘦和生长速度变化；病变通常包括坏死性肠炎，很容易与沙门氏菌病混淆。任何一种表现的发病率和死亡率都是可变的。有
些猪可能有相当严重的末端小肠粘膜增生，但临床上可能无症状。

Lesions 病变
Lesions vary in severity and location but usually include gross thickening of some part of the mucosa of the small and/or large
intestine. The ileum is commonly affected, often with a hose-like thickening of the mucosa of terminal ileum. A cerebriform pattern
(resembling the external fissures and convolution of the brain) of intestinal thickening is visible from serosal surface. Peyer’s patches
may be hyperplastic. Bloody intestinal content, perhaps with frank blood clots, may be present, especially in PHE. Lesions occasionally
are present only in the large intestine. In these instances, the mucosa of the cecum and/or colon is thrown into thick folds, plaques or
polyps, may be covered by inflammatory exudate, and vaguely resembles lesions of swine dysentery, trichuriasis, or salmonellosis.
Healing lesions of PPE in many slaughtered hogs suggest that some affected swine may show few or no signs and recover
spontaneously.
病变的严重程度和位置各不相同，但通常包括小肠和/或大肠粘膜某些部分的总体增厚。回肠通常受到影响，常伴有回肠末端粘膜软管样
增厚。从浆膜表面可以看到肠道增厚的脑状模式（类似于大脑的外裂和回旋）。派尔氏集结可能是增生性的。可能存在血性肠道内容
物，可能伴有明显的血凝块，尤其是在 PHE 中。病变有时仅存在于大肠中。在这些情况下，盲肠和/或结肠的粘膜出现厚厚的皱襞、斑
块或息肉，可能被炎性渗出物覆盖，并且隐约类似于猪痢疾、鞭虫病或沙门氏菌病的病变。许多屠宰生猪的个人防护用品损伤愈合表
明，一些受影响的猪可能表现出很少或没有迹象，并会自行恢复。
In conventionally stained histologic sections there is severe intestinal crypt cell hyperplasia; in silver stained sections or with
immunohistochemistry, curved to rod-shaped bacteria usually can be demonstrated in the apex of some enterocytes.
在常规染色的组织学切片中，存在严重的肠隐窝细胞增生；在银染切片或免疫组化中，一些肠上皮细胞的顶端通常可见弯曲成杆状的细
菌。

Diagnosis 诊断
A tentative diagnosis often can be made on the basis of clinical signs along with the presence of characteristic gross and microscopic
lesions, although some cases of porcine circovirus type 2 (PCV2) enteritis can present themselves clinically very similar to PPE.
Laboratories use silver stains, immunohistochemistry, or fluorescent antibody tests on histologic sections to confirm the presence of the
organism within lesions. Polymerase chain reaction (PCR) testing on samples of affected mucosa or feces is also available. PCR
performed on feces from clinically affected pigs is diagnostic but negative tests do not rule out carrier status. Serology has limited

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availability and unknown sensitivity. Antibody specific for L. intracellularis appears to have low magnitude and duration but testing can
be useful on a herd basis to determine if the herd is infected and when infection may be occurring.
尽管某些猪圆环病毒 2 型 (PCV2) 肠炎病例的临床表现与 PPE 非常相似，但通常可以根据临床体征以及特征性肉眼和显微镜下病变的存
在来做出初步诊断。实验室对组织切片使用银染、免疫组织化学或荧光抗体测试来确认病变内是否存在微生物。还可以对受影响的粘膜
或粪便样本进行聚合酶链反应 (PCR) 检测。对临床感染猪的粪便进行 PCR 可以诊断，但阴性检测并不能排除携带者状态。血清学的可
用性有限且敏感性未知。胞内乳杆菌特异性抗体的强度和持续时间似乎较低，但在畜群基础上进行测试可用于确定畜群是否受到感染以
及何时可能发生感染。
Control 控制
Prevention by elimination is difficult; segregated rearing has been largely unsuccessful. There is no certainty that exposure of swine
to L. intracellularis can be avoided. More information is needed on survival of the organism under field conditions and the role other
animals may play in transmission and/or reservoirs. Presently there is no widely available way to screen large numbers of apparently
normal, suspected carriers. Serologic tests eventually may be useful for identifying infected herds. Although PCR is not yet widely
available, it can identify Lawsonia intracellularis in fecal samples from clinically affected pigs but lacks sensitivity to identify inapparent
carriers.
通过消除来预防是困难的；隔离饲养基本上不成功。尚不确定是否可以避免猪接触胞内乳杆菌。需要更多关于该生物体在野外条件下的
生存以及其他动物在传播和/或储存中可能发挥的作用的信息。目前还没有广泛可用的方法来筛查大量看似正常的可疑携带者。血清学测
试最终可能有助于识别受感染的牛群。尽管 PCR 尚未广泛应用，但它可以识别临床受影响猪的粪便样本中的胞内劳索尼亚菌，但缺乏识
别隐性携带者的敏感性。
Outbreaks sometimes appear to be stress related. Environmental and other stresses, including transportation, sorting, or commingling,
often precipitate outbreaks and should be minimized.
疾病的爆发有时似乎与压力有关。环境和其他压力，包括运输、分类或混合，常常会导致疫情爆发，应尽量减少。
Various antibiotics often are added to feed for several weeks during or after periods of stress and during outbreaks in order to control
and treat PPE. Experimental PPE can be controlled using tylosin, tetracyclines, lincomycin, tiamulin, and carbadox. Various medication
strategies have been used, including pulse dosing and continuous medication. Medication failures are common in breeding stock
where animals are not fed ad libitum, hence receive subtherapeutic doses of antimicrobials that might otherwise be effective. Control of
PPE has been a major reason for use of feed-grade antimicrobials in grow-finish swine.
在应激期间或之后以及爆发期间，通常会在饲料中添加各种抗生素，以控制和治疗个人防护用品，持续数周。实验性 PPE 可以使用泰乐
菌素、四环素、林可霉素、泰妙菌素和卡巴多来控制。已经使用了各种药物策略，包括脉冲给药和连续给药。药物治疗失败在种畜中很
常见，因为动物不随意饲喂，因此接受了亚治疗剂量的抗菌药物，否则这些抗菌药物可能会有效。对个人防护装备的控制是在生长肥育
猪中使用饲料级抗菌剂的主要原因。
An avirulent live vaccine is widely available and appears to have very good efficacy when properly administered via water or orally.
Vaccination of growing pigs as well as breeding gilts during acclimatization has been very successful in reducing or eliminating clinical
signs of PPE. In some herds, vaccination has allowed the elimination of continuous administration of feed-grade antimicrobials.
无毒活疫苗已广泛使用，并且通过水或口服正确施用时似乎具有非常好的功效。在适应环境期间对生长猪和繁殖后备母猪进行疫苗接种
在减少或消除个人防护用品的临床症状方面非常成功。在一些牛群中，疫苗接种可以消除连续施用饲料级抗菌剂的情况。
See the table Diseases Associated with Hemorrhage in Intestine
参见表格与肠出血相关的疾病

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