FARM ANIMAL PRACTICE

Determining the cause of

an outbreak of diarrhoea in
adult cows requires thorough
evaluation of management
and feeding practices, as well
as the collection of suitable
samples from several animals
for laboratory investigation

Differential diagnosis of diarrhoea

in adult cattle

ARTHUR OTTER AND MICK CRANWELL

DIARRHOEA is a relatively common clinical sign in cattle and the most frequent reason for the
submission of diagnostic samples from adult cows to veterinary laboratories. There are several
infectious and parasitic diseases that manifest primarily as diarrhoea and others in which diarrhoea
is one of the features. These must be distinguished from non-infectious, toxic and nutritional causes.
A range of laboratory tests is available to the diagnostician, which vary in sensitivity and specificity,
factors that should be considered when negative results are obtained. Furthermore, confirmation
of the cause of diarrhoea is not always possible in live animals and, in some cases, postmortem
examination may be warranted, especially if there are concerns about the health status of the
remainder of the herd. This article reviews the causes of diarrhoea in adult cattle, with particular
emphasis on the clinical aspects and laboratory tests that will help to establish a definitive
diagnosis.

MAJOR INFECTIOUS CAUSES

world with the traffic in animals and animal products,

and veterinary surgeons should bear this in mind.

RINDERPEST
Rinderpest is a highly infectious disease of ruminants
and is notifiable. It has not been seen in the UK since
1877 and a worldwide eradication campaign has resulted
in it being restricted to relatively small areas of Central
Africa, the Middle East, and South-western and Central
Asia. However, recent unexpected outbreaks of disease,
such as bluetongue in northern Europe and the migration
of avian flu, show that disease can spread around the

Key considerations
When investigating cases of diarrhoea, a number of
key factors must be considered to help point to a
likely differential diagnosis:
How many animals are affected?
Is the condition acute or subacute/chronic in
onset?
Are animals housed or at pasture?
Is the condition affecting only adult animals or
all age groups?
Are there any additional clinical signs?
Are feeding and other management factors
involved?
Is a zoonotic disease suspected?

In Practice

JANUARY 20 07

Clinical signs

Rinderpest varies from peracute to subacute, and atypical cases can occur. Generally, there is pyrexia, depression, anorexia, hyperpnoea and tachycardia, reddening
of mucous membranes, intense mucopurulent lacrimation and excessive salivation, necrosis/ulceration and
erosion of oral mucosa. Profuse haemorrhagic diarrhoea,
with necrotic debris and mucus, and severe tenesmus
is seen two to three days later. Mortality is high, with
death resulting in eight to
12 days.
Laboratory tests

Tests are undertaken in

dedicated laboratories. Virus
detection by antigen capture ELISA, RT-PCR or
cell culture techniques is
employed. Serological methods (competition ELISA
and virus neutralisation)
are available.
Diarrhoea is a common
presenting clinical sign
in adult cattle and can
be a diagnostic challenge

SALMONELLOSIS
Infection by salmonellae
is regularly encountered
9

Arthur Otter
graduated from
Cambridge in 1985
and holds a PhD for
studies on ovine
listerial encephalitis.
He has worked
for the Veterinary
Laboratories
Agency (VLA) since
1991, first in the
Cambridge and
Carmarthen Regional
Laboratories
before moving to
Shrewsbury in 2001.
He is a member
of the VLA Cattle
Group.

Mick Cranwell
qualified from
Cambridge in 1972
and subsequently
spent eight years
in general practice
and a year as a large
animal intern at the
University of Guelph,
Canada. He joined
the VLA Carmarthen
in 1981 and moved
to Starcross in 1982
where he has been
ever since. He has
been a member of
the VLA Cattle Group
since its inception in
1996.

In Practice (2007)
29, 9-19

Surveillance for existing and novel causes of diarrhoea

Bovine virus diarrhoea Coccidiosis
The possible introduction of a notifiable disease, emerMucosal disease
gence of a novel disease or a significant change in the pattern of existing diseases in UK cattle are a major concern
Johnes disease
and underline the importance of sustained and thorough
(positive serology)
disease surveillance efforts. Much of the diagnostic and
Diagnosis not reached
investigative laboratory work on cattle in this country is
undertaken at Veterinary Laboratories Agency (VLA) and
Scottish Agricultural College Veterinary Services (SAC VS)
laboratories. Analysis of data from submissions is an essential part of the ongoing scanning surveillance, and there
are two main databases involved in this process:
Dietary problem
The Veterinary Investigation Diagnosis Analysis (VIDA)
Other
database records disease trends in England, Wales and
Winter dysentery
Scotland, and began in 1975. It has regularly been modified with the recognition of further diseases. Its limitaFasciolosis
Johnes disease
tion, however, is the lack of denominator data.
(acid-fast bacteria)
Since 1999, the VLA has been using a database, known
Salmonellosis: other Salmonella species
as Farmfile, which utilises the increased data provided
Parasitic gastroenteritis
Salmonellosis: Salmonella Dublin
with laboratory submissions from farms in England and
Salmonellosis: Salmonella Typhimurium
Wales. Disease trends can be compared more accurately
by analysis of the diseases as a percentage of diagnosable
submissions. In addition to the monitoring of recognised
Detailed analysis and monitoring of various age groups of anidiseases, the Farmfile database enables analysis of those submismals is conducted on an annual basis and by season. The pie chart
sions received in the VLA diagnostic laboratories where a diagnoabove shows the diagnoses, and submissions where no diagnosis
sis was not established, for which a diagnosis not reached or DNR
was reached, for VLA submissions in 2005 for adult cattle presentcode is recorded. These are subdivided according to the principal
ing with diarrhoea as the main clinical sign, and where reasonable
presenting sign (eg, diarrhoea, respiratory disease, nervous disease).
testing was undertaken.

in diagnostic laboratories in the UK, where two serovars

Salmonella Dublin and Salmonella Typhimurium
predominate in cattle. In the 1990s, there was an upsurge
in the number of outbreaks of S Typhimurium infection
in farmed livestock, chiefly cattle, caused by phage-type
DT104, which showed multiple antibiotic resistance.
More recently, S Dublin has re-established itself as the
predominant isolate.
S Typhimurium outbreaks are not uncommonly asso-

ciated with the purchase of animals. The importation of

stock can also be a source of infection with S Dublin;
however, in many herds, infection becomes established
in chronically infected animals and can remain latent for
years without manifesting clinically, before emerging to
cause disease again.
Occasional outbreaks with other salmonellae, such as
Salmonella Newport, Salmonella Agama and Salmonella
Enteritidis, have also been identified.

MOST COMMONLY DIAGNOSED INFECTIOUS AND PARASITIC CAUSES OF DIARRHOEA IN ADULT CATTLE IN THE UK
History

Clinical signs

Diagnostic tests

Salmonellosis

Often associated with purchased stock,

especially from markets or dealers. Infection
with S Dublin can arise in herds after periods
of no disease, due to chronic carrier animals

Diarrhoea and/or abortion. Occasionally

results in systemic disease, with signs
including pyrexia, milk drop, tachypnoea,
depression

Bacterial culture using selective media.

Serology is not diagnostic, but can confirm
exposure

Bovine virus
diarrhoea

Usual source of herd infection is the

introduction of persistently infected animals,
including the purchase of pregnant cows
carrying persistently infected calves. Other
sources include acutely infected cattle,
contaminated equipment and, possibly, sheep

Acute infection is often subclinical, with

occasionally severe, rarely haemorrhagic,
diarrhoea. In cases of mucosal disease,
illthrift, oral and/or coronary band
ulceration, and watery, sometimes bloody,
diarrhoea may be seen

Virus detection in heparin blood by ELISA

or RT-PCR. Virus isolation from blood in cell
culture. Serology shows rising titres in acutely
infected cattle, while persistently infected
animals remain seronegative

Johnes disease
(paratuberculosis)

Initial cases in herds in purchased cows.

Subsequent cases in homebred stock

Intractable watery diarrhoea, loss of

condition and decreased milk yield

Microscopy on faeces (ZiehlNeelsen). Faecal

culture using selective media. RT-PCR on
faeces. Serology

Winter dysentery

Usually occurs in housed dairy herds in

winter. Up to 100 per cent of the herd,
including young stock, may be affected
over a short period

Rapidly spreading herd outbreak of

diarrhoea bloody in some herds, watery
in others with associated milk drop.
Spontaneous recovery within a few days

Coronavirus ELISA on faeces is rarely positive.

Serology shows rising titres in paired samples

Fasciolosis

Peak incidence is seen in autumn and winter,

but clinical cases can occur throughout the
year. Most prevalent in the west of the UK

Diarrhoea, occasionally dysentery. Loss of

condition and reduced milk yield. Oedema
and anaemia in chronic cases. Can precipitate
black disease

Fluke ova detection in faeces by

sedimentation or flotation methods.
Serology indicative of exposure although
may be historical

Gastrointestinal
nematode parasitism

Typically seen in first season grazing

cattle. Possible in animals reared indoors
(eg, bulls) or those previously given blanket
anthelmintic treatments

Diarrhoea, weight loss, depression, reduced

performance

Worm egg count using the McMaster or

modified improved McMaster flotation
method

Coccidiosis

Rare cases seen in dairy cows and heifers,

often soon after turnout

Diarrhoea, sometimes profuse, tenesmus

and blood staining

Coccidial oocyst count using the McMaster

or modified improved McMaster method

10

In Practice

JANUARY 20 07

Diphtheresis and haemorrhagic inflammation of the

intestines of a calf with Salmonella Typhimurium DT104
infection

Postmortem appearance of the intestine of a cow with

haemorrhagic enteritis caused by acute BVDV infection.
Picture, VLA Bury St Edmunds

Clinical signs

associated with mild, often unnoticed, diarrhoea. A

more severe, and sometimes fatal, enteritis occasionally occurs. The most damaging economic effects of
infection are seen in pregnant cows, which may abort or
produce persistently infected (PI) animals. PI animals
are the chief source of infection, excreting BVDV constantly throughout life. They usually develop mucosal
disease, a fatal form of illness, which occurs most often
between the ages of six and 24 months, but can be
seen in younger calves and in older animals. Disease is
usually encountered in herds following contact with
BVDV-infected stock, and often after the purchase of PI
animals, although some infections are presumed to have
been introduced by acutely infected animals, or pregnant
cows carrying a PI fetus.

Diarrhoea is the most common presenting sign in cases

of salmonellosis, and disease often occurs in freshly
calved animals. Several animals can be affected in an
outbreak. Infection with S Dublin can result in abortions in the same herd, but this is less common in
S Typhimurium outbreaks. For both organisms, disease
may be seen in calves and other species on the same
premises. Zoonotic disease can also occur, not uncommonly with S Typhimurium but rarely with S Dublin.
S Typhimurium chiefly causes gastrointestinal signs
in cows and calves, but S Dublin can potentially cause
pneumonia, polyarthritis, meningitis, osteomyelitis, tail
and ear tip necrosis, or any combination of these signs,
in affected calves. Septicaemic disease is rarely encountered in adult cattle. The number of affected animals
varies from single cows to widespread cases in some
outbreaks, particularly if animals are crowded. Mortality
rates in adults are low, compared with calves, although
occasional outbreaks can be associated with the deaths
of several cows.
Laboratory tests

The diagnosis of salmonellosis is relatively straightforward and there are a number of selective media that are
employed to culture the bacteria. Brilliant green agar
and selenite broth are routinely used in the Veterinary
Laboratories Agency (VLA). Slide agglutination testing
groups the isolates, which are then serotyped at a VLA
reference laboratory. Additionally, sensitivity to a panel
of 16 antimicrobials is determined for all isolates for the
purpose of epidemiological surveillance.
Under the Zoonoses Order 1989, all isolates from
food-producing animals in England and Wales must be
reported to the local nominated officer, who is usually a
senior veterinary investigation officer in the VLA, and
to the local divisional veterinary manager (DVM) for
isolates in Scotland. The relevant health authorities are
also informed.
Problems with laboratory diagnosis by bacterial culture arise occasionally if animals have received antibiotics
prior to sampling or in those with chronic infections.
Serology is also available for S Typhimurium and
S Dublin, but is of no value diagnostically other than for
the detection of S Dublin in chronically infected herds.

BOVINE VIRUS DIARRHOEA

AND MUCOSAL DISEASE
Bovine virus diarrhoea virus (BVDV) infection of naive
animals (ie, acute BVD) is usually asymptomatic or
In Practice

JANUARY 20 07

Clinical signs

Most infections in naive cattle cause no or only mild

diarrhoea, with few other recognisable clinical signs
of illness. A transient reduction in milk production and
appetite may occur. Cows in the first trimester of pregnancy undergo embryonic loss or abortion, while there
are more variable outcomes in mid-gestation; infection
is usually asymptomatic in late pregnancy. Infection in
the first trimester may also result in persistent infection
of the fetus. Acute BVDV infection occasionally causes a
more severe disease characterised by profuse diarrhoea,
which is occasionally blood-tinged and dysenteric terminally, pyrexia, agalactia and weight loss. Erosions may be
detectable on the oral mucous membranes, but these are
usually small and easily missed. Mortality can reach 10
per cent.
Mucosal disease occurs in PI animals when, it is
believed, there is a mutation of non-cytopathic BVDV to
a cytopathic variant. PI animals fail to respond immunologically and affected animals suffer an overwhelming BVD viraemia and invariably die or are euthanased.
Illthrift may be recognised in some PI animals, but others are indistinguishable from their cohorts. Disease is
characterised by usually profuse, watery and intractable
diarrhoea, weight loss and depression. Oral/nasal erosions and ulceration are more common and more severe
than with acute BVDV infection, although not present in
all cases. Ulceration of the coronary bands and interdigital tissue, usually affecting all feet, may also be seen,
and can be the predominant lesion in some animals.
Several animals will usually be affected in a cohort
over a period of a few months. Clinical disease begins
suddenly and animals may be affected for two to three
weeks before death occurs.
11

Mucosal disease. (left) Ulceration of the oral mucosa at the

junction with the hard pad and below the incisor teeth.
(above) Diffuse multifocal superficial ulceration of the
abomasal mucosa

Laboratory tests

Understanding the epidemiology of BVD and mucosal

disease, and the characteristics of the various tests available, is important in the selection and interpretation of
laboratory tests. It is difficult to detect BVDV in acutely
infected animals as the virus titre in such animals is low
and virus detection tests (eg, ELISA or immunoperoxidase staining [IPX]) are unlikely to be successful unless
sampling coincides with the height of the viraemia. The
TaqMan RT-PCR (Applied Biosystems) is more likely to detect virus in blood samples from such animals
although, again, this will depend on when sampling is
undertaken.
Using an ELISA for antibodies to BVDV on blood
samples collected at least two or, preferably, more than
three weeks apart, seroconversion is readily apparent in
acutely exposed animals. Postmortem, virus isolation or
RT-PCR undertaken on tissues may be attempted and
histopathology with immunocytochemistry on freshly
fixed samples should be diagnostic.
For animals with mucosal disease, and for the detection of clinically unaffected PI animals, the titre of
BVDV in peripheral blood is much higher and the
BVDV antigen ELISA, IPX and RT-PCR all demonstrate high sensitivity. There is the potential for virus
to be masked in younger animals that have a high titre
of passively acquired BVDV antibody through colostral
intake and, in such cases, testing at six months of age, or
older, has been advocated. Virus isolation has the benefit that subtypes can be compared by genetic analysis. In
older animals, there are few problems with the detection
of virus in peripheral blood samples using any of the
available tests. RT-PCR results can be obtained within
a few hours and the test differentiates type 1 and type
2 isolates and cases of border disease virus infection.
This has important implications for disease surveillance
because, to date, all isolates in the UK have been type 1,
with the exception of seven incidents where type 2 was
identified. Serology in cases of mucosal disease and PI
animals by ELISA should confirm persistent seronegative status, although occasional animals may show very
low antibody titres in some tests. In the USA, immunocytochemical testing of ear punch samples, collected
when ear tags are fitted to cattle, is used to screen for PI
animals.
Postmortem examination of cases of mucosal disease is diagnostic. Erosive or ulcerative mucosal lesions
may occur at any level of the gastrointestinal tract, but
12

are most readily identifiable in the mouth, oesophagus,

reticulum, rumen, abomasum and ileum. In some animals, lesions may also be seen on the coronary bands,
teats and vaginal mucosa. Typical histopathological features and immunohistochemistry for BVDV antigen in
various tissues, including the brain, confirm diagnosis.

JOHNES DISEASE
Johnes disease (paratuberculosis) has increasingly been
diagnosed in dairy and beef herds in England, Wales and
Scotland over the past five years. The reason for this is
uncertain, but it may be associated with increased stock
movement, increasing herd size and intensification in the
industry over this period, as well as increasing disease
awareness. There is also currently much more concern
and interest because of the possibility that the causative bacterium Mycobacterium avium paratuberculosis
(commonly referred to as Map) may be associated with
Crohns disease in humans.
Clinical signs

Typically, Johnes disease affects cattle over three years

of age, but in heavily infected herds it may be seen in
growing animals as young as 12 months. There is persistent and profuse diarrhoea with associated gradual
weight loss, and reduced milk yield in lactating cows.
Signs sometimes lessen or resolve in pregnancy only to
recur after calving.
Laboratory tests

Diagnosis of Johnes disease should be possible on clinical grounds alone in herds where several previous cases
have been confirmed. It is essential to make a definitive

Poor condition associated with chronic diarrhoea in an

adult cow with Johnes disease. Picture, VLA Penrith

In Practice

JANUARY 20 07

Faecal smear from a cow with Johnes disease.

Note the typical appearance of Mycobacterium avium
paratuberculosis, an intracytoplasmic organism that is
found in small clumps and often only in small numbers.
ZiehlNeelsen stain

(above) Thickened ridged appearance of the ileal mucosa

from an animal with Johnes disease. (below) Note the
associated heavy infiltration of epithelioid macrophages
and multinucleate giant cells in a sample of thickened ileal
mucosa

diagnosis in herds where disease has not been confirmed

or suspected before and it should be borne in mind that
disease is highly unlikely in closed herds where it has
never occurred. However, recent evidence that Map can
be found in wild rabbits associated with clinical disease
indicates the possibility of spread from wildlife. Sheep
can also develop Johnes disease, and although transmission of infection between cattle and sheep is thought to
be rare, work in the field is ongoing to determine whether the S (sheep-associated) and B (bovine-associated)
strains of Map are absolute.
FAECES
Microscopical examination of ZiehlNeelsen stained
faecal preparations for the acid-fast Map is traditionally the most commonly performed test. This relies on
the identification of typical small acid-fast organisms
appearing in characteristic clumps. The test has a relatively high specificity when undertaken by experienced
examiners and a result is achievable within an hour but,
because the organism is passed in low numbers and
intermittent shedding is common, the sensitivity of this
method is poor (around 25 to 35 per cent). Hence, only
one in four or, at best, one in three clinically affected
animals will be diagnosed by this method. The sensitivity of the test is even poorer for subclinically infected
animals, so the technique is of no value for screening.
Faecal culture of Map is generally regarded to be the
gold standard. It is 100 per cent specific, but has the
disadvantage that intermittent or low shedders may not
be detected and takes between six and 16 weeks to complete. Detection of infection by faecal culture depends
on the particular procedure used, the stage of infection
25

Percentage

20
15
10
5

of the animal tested and whether it is infected but not

shedding, infected and a low shedder or infected and a
high shedder. If the animal is a florid clinical case and
a high shedder, the sensitivity may approach 80 per cent
or higher.
An RT-PCR test system for bovine faeces has recently been developed for Map. This has the great advantage
of providing results within a week of samples being
received, compared with the three months that may be
needed for culture. The sensitivity of this method is
comparable to bacteriological cultural techniques on
solid media, while the specificity of both methods is
very high.
SEROLOGY
A complement fixation test has historically been used
and is still required by some importing countries. For
supporting clinical diagnosis and control programmes,
antibody ELISAs have been employed. These are good
for confirming infection in animals with clinical disease, when the sensitivity is quoted to be around 90 per
cent. The sensitivity of the absorbed ELISA is highest for animals that are both high shedders and exhibiting clinical signs of disease. When used in control
programmes for screening clinically normal livestock,
the sensitivity is reported to be much lower, at around 15
to 25 per cent. The specificities of the tests are reportedly high and figures of 99 per cent have been quoted.

0
1999

2000

2001

2002

2003

2004

2005

VIDA-recorded incidence of Johnes disease (based

on detection of Map and serology) in adult cattle (aged
two years) as a percentage of diagnosable submissions
from 1999 to 2005; the vertical bars indicate 95 per cent
confidence limits

In Practice

JANUARY 20 07

POSTMORTEM EXAMINATION
Gross lesions in affected cattle are strongly suggestive
of Johnes disease, with histopathology confirming the
diagnosis. Lesions can be widespread in the intestine,
but are usually most obvious in the ileum, caecum and
13

milk yield is reported in affected milking herds. Mild

respiratory disease may also accompany the outbreak of
diarrhoea. Disease is sporadic and up to 100 per cent of
the herd can be affected. Mortality is not reported.
Laboratory tests

Submandibular fluid accumulation (bottle

jaw) in a Limousin cow. This is a clinical
manifestation of hypoproteinaemia and
can occur in cases of Johnes disease,
fasciolosis and chronic nematode
parasitism. Picture, VLA Bury St Edmunds

proximal colon. Thickening of the wall of the intestine

and a ridged appearance of the mucosa are characteristic; lymphatics are usually prominent. Local lymph
nodes, particularly the ileocaecocolic node, are usually
enlarged. On histopathological examination, infiltrates
of epithelioid macrophages and sometimes multinucleate
giant cells are found in the lamina propria and submucosa of the intestine and the lymph node. Intracytoplasmic
acid-fast bacilli are visible in ZiehlNeelsen stained
sections, although the organisms are sparse and can be
difficult to find in some cases.

WINTER DYSENTERY
Winter dysentery is a highly contagious disease that is
thought to be associated with bovine coronavirus infection. As the name suggests, it is most commonly seen in
housed animals and although all ages of livestock can be
affected, it usually affects adult cattle.

Coronavirus is shed in faeces. However, due to the dilution factor in adult cows and probably because virus
shedding largely precedes clinical signs, antigen ELISAs
to detect the causative virus in faeces are often negative. Antibodies to coronavirus are commonly detected
in cattle, so single sample serology is unhelpful. Paired
serology by ELISA for rising antibody titres on blood
samples collected two to four weeks apart is more likely
to be diagnostic. BVDV serology is also worth undertaking as BVD is the most likely differential diagnosis, and
seroconversion to both coronavirus and BVDV has been
reported in some herds.

PARASITIC CAUSES

FASCIOLOSIS
Fasciolosis in the UK has
traditionally been most prevalent in western parts of
Wales, south-west England
and south-west Scotland.
However, recently and
increasingly, it has been
diagnosed across the UK Adult Fasciola hepatica
into East Anglia. Changes liver flukes collected
from an infected carcase.
in climate, with wetter Picture, VLA Carmarthen
warmer winters, may well
be responsible by affecting the habitat of the intermediate snail host Galba (Lymnaea) truncatula. Although
the life cycle favours infection in late summer through
autumn until housing, disease is usually chronic and so
may manifest in cattle at any time of the year.
Clinical signs

Winter dysentery is characterised by a sudden onset of

severe diarrhoea (sometimes, but not always, containing
blood) or dysentery in housed cattle. Affected animals
are rarely pyrexic although they may be depressed and
lose condition. The disease may spread rapidly to susceptible animals and clinical signs usually resolve spontaneously in two to three days. A marked reduction in

Chronic illthrift and anaemia are often reported in cattle with fasciolosis, but diarrhoea has tended to be the
most common main presenting sign recorded for submissions to VLA diagnostic laboratories where fasciolosis is confirmed. This is usually accompanied by weight
loss, reduced milk yield and a variably reduced appetite.
Anaemia and subcutaneous oedema may also occur in
chronic cases. The disease is rarely fatal in cattle on a

Marked fibrosis and calcified thickening of bile ducts in the

liver of a cow chronically infected with Fasciola hepatica.
Picture, VLA Thirsk

Galba (Lymnaea) truncatula, the intermediate snail host

of Fasciola hepatica

Clinical signs

14

In Practice

JANUARY 20 07

reasonable plane of nutrition, but can be more serious in

outwintered animals receiving little supplementary feed.
Many infected cattle show no overt clinical signs, but
may not be performing as well as expected for the diet
available. Black disease, caused by Clostridium novyi
infection, may occur, as the necrotic tracts in the liver
caused by parasite migration favour bacterial growth and
toxin production.

Laboratory tests

FAECES
Flotation and sedimentation can be used to examine faeces for liver fluke ova. Flotation is a more rapid method
and useful for screening faeces of large numbers of animals, but sedimentation has been found to be much more
sensitive and can be used to examine pooled faeces as
part of a herd health screening programme. For individ-

Diagnostic samples and laboratory tests

The submission of clinical samples to a
diagnostic laboratory is essential for confirmation of most of the common causes
of diarrhoea, or as part of a comprehensive
investigation when non-infectious causes
are suspected. It is important to obtain the
most appropriate samples from affected
animals and factors that should be considered include:
THE NUMBER OF ANIMALS TO BE SAMPLED. For
herd problems, a minimum of three to six
animals is recommended;
SAMPLE SELECTION. Submitting faeces and a
blood sample from diarrhoeic cows increases the chance of a definitive diagnosis;
THE TIME IN THE DISEASE COURSE.
For chronic diarrhoea, the initiating cause

may be difficult to detect. For example, in

the case of fasciolosis, egg numbers can be
low and excretion intermittent;
For peracute disease (eg, coccidiosis,
type II ostertagiasis), diarrhoea may occur
before the causative agent can be demonstrated in faeces;
PRIOR TREATMENT. Prior use of antibiotics
(eg, in cases of salmonellosis) or recent
parasiticidal dosing (eg, with a flukicide
when testing for fasciolosis) will influence
the laboratory test and negative results
should be interpreted with caution;
POTENTIAL LIMITATIONS OF LABORATORY TESTING.
For example, coronavirus detection in
faeces of cows with winter dysentery is
rarely successful;

The chance of detecting liver fluke eggs

is improved if the optimum amount of faeces is submitted for examination (eg, up to
40 g for the sedimentation method);
THE SENSITIVITY AND SPECIFICITY OF THE
LABORATORY TESTS (see table below).
The best tests are those with the highest sensitivity and specificity characteristics
(ie, they optimise the chance of detecting
an organism and minimise the chance of
cross reacting with others);
A high chance of false negative results
should be considered for tests with poor
sensitivity (eg, examination of faecal smears
for acid-fast Map organisms in Ziehl
Neelsen stained preparations to identify
Johnes disease).

SENSITIVITY AND SPECIFICITY CHARACTERISTICS OF THE TESTS AVAILABLE FOR THE MOST COMMON CAUSES OF DIARRHOEA IN ADULT CATTLE
Cause of diarrhoea

Sample

Laboratory test

Sensitivity

Specificity

Salmonellosis

Faeces

Bacterial culture

Unknown. Will depend on the stage of disease,

prior treatment, and so on

100%

BVD/mucosal disease

Heparin blood

Antigen ELISA

95-99%

98-100%

BVD/mucosal disease

Heparin blood

RT-PCR (TaqMan)

95-99%

98-100% (and differentiates BVDV type 1

and type 2 and Border disease virus)

BVD/mucosal disease

Clotted blood/serum

IPX

95-99%

98-100%

BVD/mucosal disease

Clotted blood/serum
or heparin blood

ELISA (serology)

~95-100%

~95-100%

Johnes disease

Faeces

Microscopical
examination

25-35%

High for experienced observers

Johnes disease

Faeces

Bacterial culture

Around 80% for florid clinical cases; approximately

45 per cent overall for infected animals

100%

Johnes disease

Faeces

RT-PCR

Very similar to bacterial culture on solid media

100%

Johnes disease

Clotted blood/serum

ELISA (serology)

90% for clinically affected animals, but

15-25% for subclinically affected animals

99%

Winter dysentery

Faeces

ELISA

Poor

No data

Winter dysentery

Clotted blood/serum

ELISA (serology)

No data

No data

Fasciolosis

Faeces

Egg sedimentation

High (greater sensitivity than flotation method).

Egg excretion by Fasciola hepatica is variable;
negative result in prepatent stage of disease

High for experienced observers

Fasciolosis

Clotted blood/serum

ELISA (serology)

98%

96%

Parasitic
gastroenteritis

Faeces

Modified improved
McMaster worm
egg count

High. The result is a measure of adult egg-laying

population (ie, acquired at least three weeks
earlier). Does not detect immature parasites

High for the differentiation of

trichostongyle-type eggs from other
species (eg, Nematodirus species), but
not possible to differentiate individual
trichostrongyle species (eg, Ostertagia
species, Trichostrongylus species) from
eggs (larval development required)

Parasitic
gastroenteritis

Abomasal and
intestinal content
(collected at
postmortem
examination)

Total worm count

Moderate. The worm count is a screening

method to indicate the total worm burdens
in abomasum and intestine. Many immature
parasites can only be detected by pepsin
digestion of the mucosa

High for experienced observers

Coccidiosis

Faeces

Oocyst count
(modified improved
McMaster)

High. Absolute counts are not diagnostic and do

not differentiate pathogenic and non-pathogenic
oocyst species this can be done microscopically
on the basis of oocyst morphology

High for experienced observers

In Practice

JANUARY 20 07

15

ual animals, examination of 40 g of faeces optimises the

sensitivity of the test; for composite samples, 5 g aliquots of faeces collected from 10 animals are required.
SEROLOGY
ELISAs that have a high specificity for antibodies to
Fasciola hepatica in cattle sera or bulk tank milk have
been developed. The detection of antibodies to liver fluke
is evidence of infection within the last nine months, but
does not necessarily indicate current infection.
BIOCHEMISTRY AND HAEMATOLOGY
F hepatica infection results in variable hepatocyte damage, biliary inflammation and resultant protein loss.
Eosinophilia may be identified and used as a screening test for prepatent infection, but is less useful once
the parasites invade the biliary tree, and is also nonspecific. Chronically, there may also be anaemia, which
is usually non-regenerative and normocytic. The activity of liver enzymes (notably glutamate dehydrogenase
[GLDH], which is released by damaged hepatocytes, and
L-gamma glutamyl transferase [GGT], which is an indicator of biliary stasis/inflammation) may be increased
in the prepatent stage of disease, but there is often no
increased enzyme activities or eosinophilia during the
patent/chronic stage of infection.

PARASITIC GASTROENTERITIS
Parasitic disease largely occurs in first season grazing animals and is therefore rarely seen in adult cattle.
However, the recent re-emergence of husk as a significant cause of respiratory disease in adult dairy cows
indicates the potential for changes in the pattern of diseases. Significant gastrointestinal parasite numbers can
occasionally be found in animals that are compromised
due to concurrent disease, are receiving inadequate
nutrition or are in poor condition. Disease may also be
identified in show animals or bulls bred for sale that
have been reared indoors and not exposed to parasites.

Worm egg counts

Worm egg counts are performed on faeces, or
samples of lower intestinal contents from animals following postmortem examination, using
McMaster or modified improved McMaster flotation techniques. Detection of helminth eggs indicates that adult parasites are present in the gastrointestinal tract of the animal. Determination
of the species requires additional culture to thirdstage (L3) larvae. Trichostrongyle-type eggs may
include Ostertagia, Trichostrongylus, Cooperia,
Bunostomum and Haemonchus species.
Egg counts can be influenced by a number of
factors, particularly the age and nutritional status
of the animal, and the species of parasites present.
Faecal consistency should be considered when
attempting to interpret egg counts: high egg numbers in liquid samples are of greatest significance.
The timing of sampling must also be borne in
mind, especially after recent anthelmintic administration. It is important to consider all of these factors when interpreting the significance of worm
egg counts (see table below).
Note that, with all worm egg counts, only
mature egg-laying female parasites are detected.
The count gives no indication of the immature
parasite burden.
SIGNIFICANCE OF WORM EGG COUNTS IN CATTLE
Eggs per gram

Interpretation and treatment

0 to 200

Light infection

300 to 700

Moderate level of parasite infection.

Anthelmintic treatment may be beneficial

700+

Heavy parasite infection. Anthelmintic

treatment is recommended

COCCIDIOSIS
Abomasal and intestinal parasitism essentially causes similar disease, with diarrhoea, often profuse and
watery, being the chief presenting sign. Reduced appetite and poor production can also result.

Coccidiosis is typically diagnosed in young calves, and

is the most common enteric diagnosis in animals aged
three to 12 weeks old. Rare outbreaks of diarrhoea occur
in older animals and are associated with acute-onset disease, which usually resolves spontaneously in a few days.

Laboratory tests

Clinical signs

Determination of faecal worm egg counts using the

McMaster or modified improved McMaster flotation
method is reliable in experienced hands and provides a
useful guide. Counts would be expected to be high with
heavy parasite burdens, but this will depend on the species of parasite, the chronicity of disease and the consistency of the faeces (see box, above right).
Total worm counts can be performed on fresh carcase samples of abomasal and small intestinal contents.
However, pepsin digestion is required to detect many of
the immature parasites and should be carried out for suspected type II ostertagiasis. Type II ostertagiasis is more
likely in housed animals after a first grazing season if
they have not received effective larvicidal anthelmintic
treatment at housing. Estimation of serum pepsinogen
concentration is a useful biochemical indicator of abomasal glandular inflammation. However, definitive diagnosis relies on histopathological examination of freshly
fixed tissue.

The principal clinical sign is diarrhoea, with or without

tenesmus and blood. Variable depression and appetite
reduction may also be seen. Reduced production can
occur in dairy cows.

Clinical signs

16

Laboratory tests

Coccidial oocyst counts are determined by the

McMaster or modified improved McMaster technique.
Occasionally, very high counts in excess of 1,000,000
oocysts per gram are detected although low numbers of
oocysts may also be significant. As disease is atypical in
adult cattle, the species of oocysts should be determined
to establish whether they are pathogenic (Eimeria bovis,
Eimeria zuerni or Eimeria alabamensis). Histopathology
is useful although mortality is unlikely in adult animals
unless there are secondary complications. It is undertaken on freshly fixed ileum, caecum and proximal
colon samples, which show a significant inflammatory
response with destruction of crypts.
In Practice

JANUARY 20 07

TOXIC CAUSES

A range of chemicals,
plants and mycotoxins can
cause enteritis and diarrhoea in adult cows. The
key features of these conditions are summarised
in the table below. All of
these conditions are rare
and diagnosis of most
intoxications depends on
knowledge of possible
exposure with detection
of toxic concentrations or
causative agents on postmortem examination.

(left) Ragwort (Senecio jacobaea), one of several plants

that can cause intoxication in cattle. Clinical signs include
diarrhoea or constipation, abdominal pain, tenesmus,
weight loss, inappetence and, occasionally, nervous signs.
(above) Collapsed diarrhoeic Limousin cow with salt
poisoning. Picture, VLA Bury St Edmunds

TOXIC CAUSES OF DIARRHOEA

Molybdenosis/copper
deficiency

Characteristics of disease and laboratory

tests R. H., WELLS, S. J., SWEENEY, R. W. & VAN TIEM, J.
WHITLOCK,
(2000) ELISA and faecal culture for paratuberculosis (Johnes
More commonly diagnosed in the past
and seen
in specific
areas suchof
as each
the teart
pastures
of
disease):
sensitivity
and specificity
method.
Veterinary
Somerset. Copper binds to antagonists
in the soil,
particularly
Microbiology
77,
387-398 sulphur and molybdenum, which
renders much of the ingested copper unavailable for absorption. A variety of clinical signs is
possible in cattle of all ages, with diarrhoea a more common feature in calves. Low liver and
blood copper (measured in heparin samples preferably) and improved health status after copper
supplementation support the diagnosis

Salt poisoning

Seen on the marshes of Norfolk and in other coastal areas where grazing cattle drink from
drainage ditches contaminated by sea water and have no alternative water source. In acute
disease, there is diarrhoea, thirst, dehydration, prostration and death. In more chronic cases,
there may be staggering, muscle tremors, reduced appetite and failure to thrive. Laboratory tests
to support the diagnosis include sodium, chloride (lithium heparin blood samples) and packed cell
volume (heparin or EDTA blood samples) estimations. Testing water salinity using a conductivity
meter is also helpful

Lead poisoning

Diarrhoea is a feature of chronic lead toxicity, in addition to depression, loss of condition and
performance, and infertility. Lead analysis of heparin blood samples, or kidney samples in animals
that die, is diagnostic

Copper poisoning

Diarrhoea is an occasional sign. Haemolytic crisis occurs causing haematuria and jaundice most
consistently. Liver and, preferably, kidney copper analysis is required to confirm diagnosis. Whole
blood (heparin) copper concentrations in excess of 50 mol/litre are highly suggestive of toxicity

Nitrite poisoning

Typically occurs after eating brassicas or after access to fertiliser. Acute toxicity manifests as
diarrhoea, abdominal pain, muscle tremors and weakness, dyspnoea, rapid weak pulse, brownish
coloured mucous membranes and convulsions. Detection of methaemoglobin in fresh blood
(clotted or heparin) samples provides supportive evidence

Arsenic poisoning

Arsenicals are now rare, but are sometimes used in horticulture. Old mine waste used in farm
walls can also be a source. Poisoning results in profuse diarrhoea (which is often haemorrhagic),
weakness, salivation, incoordination, vomiting and abdominal pain. Extremely reddened abomasal
mucosa is seen on postmortem examination. Analysis of heparin or EDTA blood samples, urine,
faeces and milk is possible to indicate recent exposure, and of hair samples for chronic intoxication.
Arsenic detection in the rumen content or liver of animals that die should be carried out

Mercury poisoning

Organomercury compounds have been used as seed dressings and intoxication is possible if stock
access stores. Clinical signs include diarrhoea, inappetence, incoordination and blindness. Raised
mercury concentrations may be detected in heparin blood samples, urine and faeces. Analysis of
mercury concentrations in samples of liver and kidney collected at postmortem examination is
also possible

Oak/acorn poisoning

Constipation is seen early on in the disease process, with diarrhoea, often dark/tarry or bloody,
developing later. Diagnosis based on detecting acorns in rumen contents collected at postmortem
examination can be difficult as disease can occur some time after ingestion. Elevated blood urea
and creatinine concentrations are indicative of compromised renal function and can be used
prognostically

Other plant poisons

DOGS MERCURY (MERCURIALIS PERENNIS). Principal signs include watery diarrhoea, sometimes preceded
by constipation, salivation and loss of appetite. Later, weakness, jaundice and the production of
pinkish or blood-stained urine is seen
R AGWORT (SENECIO JACOBAEA). Principal signs include diarrhoea or constipation, abdominal pain,
tenesmus, weight loss, inappetence and, occasionally, nervous signs
HEMLOCK WATER DROPWORT (OENANTHE CROCATA). Principal signs include diarrhoea, abdominal pain,
excess salivation or foaming at the mouth, hyperpnoea, dilated nostrils, bellowing, pupillary
dilation, rapid pulse, staggering gait, circling, muscle tremors and convulsions
RHODODENDRON (ERICACEAE SPECIES). Principal signs include diarrhoea, depression, anorexia, salivation,
abdominal pain, bloat, vomiting (sometimes projectile) and dyspnoea
BRACKEN (P TERIDIUM AQUILINUM). Principal signs include haemorrhagic diarrhoea, depression, anorexia,
haematuria, and bleeding from other mucous membranes, such as eyes, nose and/or vagina

Potato poisoning

Waste potatoes that are green or decayed and sprouting/seed potatoes can cause poisoning
in cattle. Typically there are nervous signs, including restlessness, incoordination, appetite
loss, excess salivation, vomiting and diarrhoea or constipation

Mycotoxicosis

A range of toxic metabolites, most produced by Fusarium species, which are the most common
contaminants of cereals, have the potential to cause disease in cattle, which may include diarrhoea
as a clinical sign

In Practice

JANUARY 20 07

17

There are many other

potential causes of diarrhoea in cattle. Several
infectious agents have
been identified in the faeces of diarrhoeic cattle, but
their significance has not
been clearly established.
Diarrhoea can be a feature
of dietary changes and a
sign of systemic disease.
The features of various of
these conditions are summarised in the table below.

Picture, Martin Sheldon

OCCASIONAL
INFECTIOUS AND
MISCELLANEOUS
CAUSES

Endometritis can cause systemic

endotoxaemia, which may be
associated with diarrhoea

(above left) Many, but not all, cases of malignant catarrhal fever develop the typical
head and eye form of the disease with opacity of the cornea. (above right) Variable,
often severe, oral ulceration can confuse the diagnosis of malignant catarrhal fever
with mucosal disease, acute BVDV infection and foot-and-mouth disease

OCCASIONAL INFECTIOUS AND MISCELLANEOUS CAUSES OF DIARRHOEA

History

Clinical signs

Diagnostic tests

Clostridium tertium

Originally isolated from fattening cattle

showing rapid-onset ataxia, and death
within 12 hours. Experimental infection
of calves has induced diarrhoea

Haemorrhagic enteritis. Diarrhoea, usually

bloody

Anaerobic bacterial culture of faeces or

intestine samples collected at postmortem
examination

Yersinia pseudotuberculosis

Outbreaks reported in cattle on waterlogged pastures in Australia in winter

and early spring

Profuse, foul-smelling, watery, brown

to green-coloured diarrhoea, sometimes
blood-tinged

Bacterial culture and histopathology

demonstrating necrotising enterocolitis

Escherichia fergusonii

Sporadic cases of diarrhoea, mastitis

and abortion, clinically suggestive of
salmonellosis

Diarrhoea, abortion or mastitis

Pure isolates of E fergusonii in the absence

of other recognised infectious or parasitic
causes

Rotavirus

Rapidly spreading watery diarrhoea, which

resolves spontaneously in affected cattle,
reported in Japanese dairy cows

Rapidly progressive outbreak of watery

diarrhoea in adult cattle, recovery in
three to five days, reduced milk yield

Detection of group C rotavirus in faeces by

PAGE or electron microscopy

Malignant catarrhal fever

Usually sporadic although occasional

outbreaks have been seen. Adults or young
stock may be affected. In most cases,
there is a history of contact with sheep
in the previous three months. Note some
cases are difficult to differentiate clinically
from mucosal disease. Recent cases of
bluetongue in Europe have been considered
similar to malignant catarrhal fever

Most disease is acute and rapidly fatal.

Lesions are typically seen on the eyes,
nose and mouth, and, occasionally, skin
and feet. Variably extensive ulceration of
tongue, hard pad and gums, unilateral or
bilateral corneal opacity, and diarrhoea
(occasionally haemorrhagic) may be seen

Seroconversion demonstrable using an

immunofluorescent antibody test (IFAT)
by the time animals are presented for
examination. Occasional peracute cases
will not have seroconverted. RT-PCR for
ovine herpesvirus 2 on heparin blood
or lymphoid tissues. Histopathology on
viscera and brain collected at postmortem
examination

Endotoxaemia

Coliform mastitis, endometritis or other

coincidental illnesses

Acute diarrhoea or dysentery

Clinical history and failure to identify other

causes of diarrhoea

Haemorrhagic bowel
syndrome

Acute collapse and death of dairy cows,

usually in early lactation

Acute-onset depression, reduced milk

production, tachycardia, ruminal stasis,
abdominal distension and tar-like or
bloody faeces, rather than overt diarrhoea

Postmortem examination confirms jejunal

haemorrhage, isolation of Clostridium
perfringens in anaerobic culture and
exclusion of alternative diagnoses

Renal amyloidosis

Rare. Usually occurs in older cows, with an

insidious history that may include previous
suppurative illness

Diarrhoea, reduced yield and appetite,

weight loss, palpably enlarged kidneys

Hypoproteinaemia and increasing

azotaemia. Histopathology required to
confirm and differentiate from nephritis
or nephrosis

Acidosis

Excess intake of grain or concentrates

(eg, after access to food stores)

Diarrhoea, depression, ataxia/drunkenness,

laminitis

Rumen liquor pH <45 (stomach tube or

postmortem sampling). Blood biochemistry
can be helpful, demonstrating an increased
anion gap ([Na+ + K+] [Cl + HCO3], reference
range in cattle = 10 to 20 mmol/litre; values
>30 mmol/litre in cases of acidosis)

Excess dietary protein

High protein/low energy diets

Diarrhoea, reduced production

Biochemistry (blood urea) may yield

supportive evidence. No definitive
diagnostic tests other than to rule
out other causes

Lush pasture

More likely in spring and in herds that are

not buffer-fed

Diarrhoea

No diagnostic tests other than to rule out

other causes

Poor quality roughage

Poor quality feed availability

Diarrhoea and loss of condition, poor

production in dairy cows

No diagnostic tests other than to rule out

other causes

Cold cow syndrome

Sporadic reports in dairy herds in spring

after turnout. May be associated with
particular pastures on some farms

Ataxia or drunkenness, anorexia,

depression, hyperpnoea, agalactia.
In some cows, perineal oedema, muscular
stiffness, cold to touch. Diarrhoea, which
is occasionally profuse, generally occurs

No diagnostic tests other than to rule out

other causes. Typical signs and history of
recent turnout. Recovery occurs within
a few days of being moved off affected
pasture

PAGE Polyacrylamide gel electrophoresis

18

In Practice

JANUARY 20 07

SUMMARY

Diarrhoea in adult cattle presents a considerable diagnostic challenge. Arguably, very few cases can be confidently diagnosed on clinical grounds alone. Laboratory
tests are essential for confirming or ruling out several
of the infectious and parasitic causes of diarrhoea when
considering differential diagnoses. It is, however, important to bear in mind that few tests are 100 per cent sensitive and that, in some cases (eg, faecal screening for
Johnes disease), a negative result does not rule out the
diagnosis, rather it remains unconfirmed. Repeated testing of individuals and, with herd outbreaks, testing of
a representative number of affected animals, are often
necessary to make a definitive diagnosis.
Acknowledgements
The authors would like to thank colleagues who have provided
photographs and commented on aspects of this article.

Further reading
AL-MASHAT, R. R. & TAYLOR, D. J. (1984) Sporolactobacillus
spp. In enteritis of cattle. Proceedings of the 4th International
Symposium on Neonatal Diarrhoea. Veterinary Infectious Disease
Organisation Conference, University of Saskatoon, Saskatoon,
Canada, October 3 to 5, 1983. pp 654-665
BAIN, M. S. & GREEN, C. C. (1999) Isolation of Escherichia
fergusonii in cases clinically suggestive of salmonellosis.
Veterinary Record 143, 511
CALLINAN, R. B., COOK, R. W., BOULTON, J. G., FRASER, G. C. &
UNGER, D. B. (1988) Enterocolitis in cattle associated with Yersinia
pseudotuberculosis infection. Australian Veterinary Journal 65,
8-11
DANIELS, M. J., HENDERSON, D., GREIG, A., STEVENSON, K.,
SHARP, J. M. & HUTCHINGS, M. R. (2003) The potential role
of wild rabbits Oryctolagus cuniculus in the epidemiology of
paratuberculosis in domestic ruminants. Epidemiology and
Infection 130, 553-559
DENNISON, A. C., VANMETRE, D. C., CALLAN, R. J., DINSMORE, P.,
MASON, G. L. & ELLIS, R. P. (2002) Hemorrhagic bowel syndrome

In Practice

JANUARY 20 07

SUMMARY OF THE CAUSES OF DIARRHOEA

Acute diseases
Individual animals
Herd outbreaks

Fasciolosis
Salmonellosis
BVD: mucosal disease

Rinderpest
Fasciolosis
Salmonellosis
BVD: acute infection
Winter dysentery

Chronic diseases
Individual animals
Herd outbreaks

Fasciolosis
Salmonellosis
Johnes disease
BVD: mucosal disease

Fasciolosis

Molybdenosis/
copper deficiency
Coccidiosis
Parasitic
gastroenteritis

Parasitic
gastroenteritis

Malignant catarrhal
fever
Ragwort poisoning

Ragwort poisoning

Acorn poisoning
Acidosis
Endotoxaemia
Renal amyloidosis
Dietary problems
(eg, lush pasture,
feed change)

Dietary problems
(eg, excess protein,
poor quality
roughage)

Salt poisoning
Arsenic poisoning
Mercury poisoning
Plant poisoning
Cold cow syndrome

in dairy cattle: 22 cases (1997-2000). Journal of the American

Veterinary Medical Association 221, 686-689
GUNNING, R. F. & WESSELS, M. E. (1996) Clinical coccidiosis in
a herd of dairy cows. Veterinary Record 139, 497-498
MAWATARI, T., TANNEICHI, A., KAWAGOE, T., HOSOKAWA, M.,
TOGASHI, K. & TSUNEMITSU, H. (2004) Detection of a bovine
group C rotavirus from adult cows with diarrhea and reduced milk
production. Journal of Veterinary Medical Science 66, 887-890
SILVERA, M., FINN, B., REYNOLDS, K. M. & TAYLOR, D. J. (2003)
Clostridium tertium as a cause of enteritis in cattle. Veterinary
Record 153, 60

19