Surgical Management of Coenurus Cyst in Palpebral Sub-Conjunctiva in a Sheep.
A two years old ram was presented with complaint of swelling over left lower eye lid. On physical examination, the bulbar conjunctiva of lower eye lid was swollen. After incising the conjunctiva, the white fluid filled cyst was removed. It was a flabby ovoid structure with many white nodules visible through a very thin wall. On morphological examination, cyst was identified as coenurus cyst. The animal thereafter recovered uneventfully
Keywords: Coenurus cyst; palpebral sub-conjunctiva; sheep
Coenurus cerebralis, the metacestodal stage of Taenia multiceps (Leske, 1780) is mainly found in brain and sometimes in spinal cord of small ruminants (Soulsby, 1982). Coenurus cerebralis has been reported from most of the countries with developed sheep industry except Americas, Australia and New Zealand (Schuster et al., 2010). This cyst affects the central nervous system (CNS) of sheep, goats and sometimes cattle and gives rise to neurological signs of coenurosis such as gid, ataxia, head deviation and blindness (Soulsby, 1982). Reports of its occurrence in tissue other than brain or spinal cord in small ruminants are rare and have been mainly reported from Asian and Middle East countries (Oryan et al., 2014). Gaiger (1907) reported cases of coenuri in the connective tissues of goats in India. In the goats, cysts may reach maturity in other organs, subcutaneously and intra muscularly and outside the CNS in goats cysts were of T. multiceps (Bhalla and Negi, 1962; Singh and Singh, 1972 and Sharma et al., 1995) or T. gaigeri (Varma and Malviya, 1989; Moghaddar, 2007). Cysts located in muscles may cause muscular pain or impaired functionality of organs involved, however, animals remain normal without clinical symptoms and the condition is usually diagnosed only after the death of the animal (Sharma and Chauhan, 2006). Apart from small ruminants, coenurosis affects cattle (Sanyal and Sinha, 1983), buffalo (Gupta and Chowdhury, 1985), horses, pigs and humans (Avcioglu et al., 2011; Desouky et al., 2011). In India 2.9% sheep have been infected with the cerebral form of C. cerebralis (Varma and Malviya, 1989) and prevalence of 1.1-2.4% of non-cerebral coenurosis in goats has been reported (Sharma et al., 1995; Godara et al., 2011). Information about location of cyst in organs other than brain is limited in sheep. The present communication reports non-cerebral location of cyst in sub palpebral conjunctiva of a sheep.
A two year old locally reared merino cross ram was presented with complaint of swelling of left lower eye lid from last several weeks and discomfort. Despite treatment the condition did not improve. On physical examination, the lower palpebral conjunctiva of left eye lid was swollen (Fig. 1). Animal was having profuse epiphora and there was difficulty in closure of eye lids. Subcutaneous mass could be palpated. During fine needle aspiration about 1 ml clear transparent fluid was removed, which gave clue about cyst in sub conjuctiva. It was decided to go for surgical incision for final diagnosis. Animal was sedated with Diazepam @ 0.5 mg/kg b.wt. intravenously, slowly. Local anesthesia 2% Ligocaine was injected as linear infiltrate in lower conjunctiva. Conjunctiva was given stab incision in middle of the swelling with 11 no. scaple blade. Then by using colibri forcep, the cyst was removed easily as it wasn't attached to any tissue. It was about 2.0 cm in diameter, having clear transparent capsule with many white nodules in it (Fig. 2). Flushing of the conjunctiva was done with normal saline solution and no suturing was undertaken (Fig.3). The animal was prescribed Ciprofloxacin eye drops for five days TID and intramuscular Meloxicam @ 0.2 mg/kg b.wt. OD for three days. The animal recovered uneventfully. Swelling of conjuctiva resolved with surgical intervention and there was no evidence of recurrence or postoperative complications over a period of a year.
The gross and morphological appearance of cyst was evaluated for identification. On gross examination, multiple scolices were found attached to thin wall. These scolices were then crushed between two slides and were seen under microscope which revealed hook like structures (Fig. 4). The cyst was thus identified as coenurus cyst.
Kashmir valley has large number of high land pastures, where sheep and goats are let to graze along with number of guard dogs by shepherds. Most of these dogs are never being dewormed and act as source of infection to small ruminants. Coenurosis, a fatal disease of sheep is caused by Coenurus cerebralis, a bladder metacestode stage of Multiceps multiceps, which inhabits the small intestine of canines and wild carnivores as the definitive hosts (Soulsby, 1982). Coenurosis in small ruminants is still present in developing countries of Africa and Asia (Yoshino and Momotani, 1988; Nooruddin et al., 1996 and Sharma and Chauhan, (2006). In the present communication, we report a clinical case of coenurosis in palpebral conjunctiva of a sheep and the site is an unusual non-cerebral location for cyst to develop in sheep. C. cerebralis has been reported from lumbar region, muscles and heart of goats (Tinaz, 1952; Coskun et al.,1990; Oge et al., 2012). Schuster et al. (2010) reported coenuri between the muscles of frontal and distal extremities and between the muscles of the back in goats. The same workers also reported cyst from fat next to kidneys and isolated coenuri attached to diaphragm or abdominal wall in goats. Sudhan and Shahardar (1999) reported occurrence of coenurus cyst in subcutaneous tissue of ear of goat and subsequently Pandit et al., 2003 have reported occurrence of coenurus cyst in pharyngo-laryngeal area of kid from Kashmir valley. Christodoulopoulos et al. (2013) reported occurrence of non-cerebral coenurosis in sheep slaughtered in Abu Dhabi but originated from India, Iran, Oman and Sudan. The prevalence of infection with non-cerebral coenurosis was 0.008%. The location of cysts were the triceps brachii muscle, diaphragm, infraspinatus muscle of shoulder, muscles of thigh and abdomen and ommentum.
The early symptoms of subconjunctival coenurosis are similar to that of asymptomatic subconjunctival mass, allergic conjunctivitis or blepharitis. The patient has suffered from pain, epiphora, chemosis and ptosis. In addition to these symptoms, subconjunctival coenurosis can cause similar symptoms of orbital cellulitis, exophthalmos and expose cornea to ulcer. If the metacestodal stage invades orbit, it leads to severe inflammation or blindness (Sen et al., 1989).
Ocular coenurosis is a surgical disease because its diagnosis depends almost entirely on demonstration of metacestode from the lesion. The diagnosis is usually confirmed by post operative histological examination. No medication has proven effective against the disease and principal therapy is surgical removal. In conclusion, although rare, this parasitic disease should be suspected in a palpable subconjuctival mass which is unresponsive to medical treatment. The reporting of this case as well as previous report from Kashmir valley clearly suggest that there is a need to evaluate the economic losses suffered by small ruminant industry due to the infection and map the prevalence of coenurosis in Kashmir for development of suitable control measures and also limit its spread to shepherds, who usually handle these animals.
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S.H. Dar (1), I.M. Allaie and Z.A. Wani
Faculty of Veterinary Sciences and Animal Husbandry
Sher-e-Kashmir University of Agricultural Sciences and Technology (SKUAST-K)
Srinagar--190006 (Jammu and Kashmir)
(1.) Corresponding author.
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|Title Annotation:||Short Communication|
|Author:||Dar, S.H.; Allaie, I.M.; Wani, Z.A.|
|Date:||Jul 1, 2016|
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