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SteerforthD, MarutsovP. Vet Rec Case Rep 2017;5:e000454. doi:10.1136/vetreccr-2017-000454
SUMMARY
Morbidity due to Corynebacterium pseudotuberculosis
infection occurred in a 320 Holstein dairy herd in
south-eastern Bulgaria during 2014. All established
cases (n=43) were of multiple abscess formation and
cellulitis predominantly localised on the hindlegs. The
pyogranulomatous and ulcerative lesions in all cases
were associated with mastitis. The disease was treated
with parenteral antibiotics and local antiseptics, without
any satisfactory outcome, and most of the affected
animals were culled. Presumptive laboratory diagnosis
of C pseudotuberculosis was made in November 2014,
when 43 cases (herd prevalence 23.9 per cent) were
recorded on the farm. The culling rate reached 95.3 per
cent. All reported cases were in first calving cows (n=31;
case prevalence 72.1 per cent), and cows between
second and fifth lactation (n=12; case prevalence 27.9
per cent). Younger cattle appeared to be less susceptible
to the infection. In first calving cows, all cases with
lesions and mastitis occurred shortly after calving.
BACKGROUND
Caseous lymphadenitis caused by Corynebacterium
pseudotuberculosis is a chronic contagious disease
of domestic ruminants (sheep, goats and came-
lids). This aetiological agent also causes ulcerative
lymphangitis in cattle and horses, and more recently
has been described in pigs.1
C pseudotuberculosis has been the topic of much
research as it has zoonotic potential2 3 with certain
toxigenic biovars producing potentially lethal
toxins in human beings. The infection rarely occurs
in cattle, although it was described for the first time
by Edmond Nocard in 18884 and later by Hugo von
Preïsz in 1891 as the cause of bovine lymphangitis
(‘Preïsz–Nocard bacillus’).
The clinical disease has been well documented in
small ruminants (sheep and goats)5 and occasionally
in horses, but bovine cases are rare. The few known
reports have been from Israel, USA and Kenya.6–9
To our knowledge, there have been no bovine
cases reported in the UK or elsewhere in Europe,
and descriptions of the clinical presentation and
diagnostics of this disease may be of value to cattle
practitioners.
This is an economically important disease associ-
ated with considerable losses resulting from reduced
weight gain, reproductive disorders, and the deval-
uation or scrapping of carcases and skins.
C pseudotuberculosis is a Gr+, intracellular,
non-motile, facultative anaerobic rod (0.5–
0.6×1.0–3.0 µm) that grows slowly on blood agar,
forming small, white to greyish, dry and waxy
colonies (figure 1). In smears, these rods frequently
group together in a characteristic way, which has
been described as ‘Chinese letters’ arrangement.10
The optimum growth temperature of this
organism is 37°C. Both toxigenic and non-toxigenic
strains cause infections in human beings.
Similar to C diphtheria, toxigenic strains
(harbouring the phage-born diphtheria tox gene
required for the production of toxin) can cause
diphtheria-like illness in human beings, and
non-toxigenic strains can cause pulmonary infec-
tions, leukaemia and endocarditis.
The laboratory diagnosis of C pseudotuberculosis
is still problematic as it is a fastidious organism. It
grows slowly even on blood-enriched medium, and
it may require the addition of potassium tellurite to
sheep blood agar for differentiation.
Isolates of C pseudotuberculosis, from primary
cultures, are identified by colonial appearance
and Gram-staining and by four preliminary tests—
nitrate, urease, catalase and pyrazinamidase tests,
which permit the presumptive identification of the
potentially toxigenic strains. Once a toxigenic strain
is identified, further identification can be achieved
by toxin testing. C pseudotuberculosis, however, can
give a variable nitrate test result because it consists
of two biovars: biovar equi (isolated from horses
and cattle), which reduces nitrates; and biovar ovis
(isolated from sheep and goats), which does not
reduce nitrates.11
The clinical forms of C pseudotuberculosis infec-
tion in cattle include pyogranulomatous lymphan-
gitis, abscesses, ulcerative lymphangitis and mastitis
(Adekeye and others, 198012), as well as visceral
metastasis form.9 13 14 Yeruham and others15 have
described an additional form—necrotic and ulcer-
ative dermatitis on the heel of the foot accompanied
by oedematous swelling and lameness.
This case report describes the pathogenesis of a
herd case of ulcerative lymphangitis in Bulgarian
Holstein-Friesian cows with specific cutaneous
lesions on the hindlegs (figure 2), multitudinous
abscessations, ulcerative lymphangitis (figure 3) and
mastitis. The herd outbreak was associated with
substantial economic losses due to unsatisfactory
treatment and consequential culling of animals.
CASE PRESENTATION
Case history
In April 2014, cases of abscess formation and
cellulitis were established in a dairy herd in south-
eastern Bulgaria. These were localised predom-
inantly on the hindlegs. The disease was treated
FOOD/FARMED ANIMALS
Ulcerative lymphangitis due to Corynebacterium
pseudotuberculosis in Bulgarian Holstein dairycows
Daniel Steerforth,1 Plamen Marutsov2
Veterinary Record Case Reports
To cite: SteerforthD,
MarutsovP. Vet Rec Case
Rep Published Online
First: [please include Day
Month Year]. doi:10.1136/
vetreccr-2017-000454
1Royal Veterinary College, Farm
Animal Health and Production,
London, UK
2Department of Veterinary
Microbiology, Infectious and
Parasitic Diseases, Trakijski
Universitet Stara Zagora, Stara
Zagora, Bulgaria
Correspondence to
Dr Daniel Steerforth;
dsteerforth@ rvc. ac. uk,
sforthdaniel@ hotmail. com
Received 21 February 2017
Revised 12 July 2017
Accepted 24 July 2017
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Veterinary Record Case Reports
2SteerforthD, MarutsovP. Vet Rec Case Rep 2017;5:e000454. doi:10.1136/vetreccr-2017-000454
with parenteral antibiotics and local antiseptics but without any
satisfactory outcome, and most of the affected animals were
eventually culled. The first three cases occurred in April 2014,
and more cases were established during the summer and early
autumn, but laboratory confirmation of the pathogen was not
achieved until November 2014.
The farm was visited for the first time when the problem was
referred to the University Clinic of Trakia University in Stara
Zagora on November 3, 2014.
The investigation was undertaken at a time when an outbreak
of lumpy skin disease (LSD) was occurring in the region. Weekly
visits were required to all dairies as part of the national plan for
eradication and control of LSD. To fulfil this epidemiological
and legislative requirement, the farm was visited multiple times
during November and December 2014.
LSD was not diagnosed on the premises, but these visits
allowed for detailed observations, epidemiological investigation
and sample collections from the affected animals.
At the end of November 2014, 320 cattle were present on the
farm, of which 180 were milking cows. This was a closed herd
with no new animals introduced in the previous 12 years. The
dairy herd was housed in free stall barns with concrete floors,
and the cows were milked two times daily in a 2×5, side-by-side
milking parlour.
Clinical presentation
The clinical examination of the affected animals showed ulcer-
ative lymphangitis, abscesses and pyogranulomatous lesions
predominantly at the dorsal aspects of the hindlegs, below the
hock and distally to the interdigital space (figures 4 and 5).
Some animals had nodular lesions on the flanks or as high as
the stifle joints, on both the dorsal and palmar aspects of the
hindlegs.
Occasional lesions were observed on the front legs, with
individual abscesses forming high in the scapular or pectoral
regions. In recently affected animals, the observed abscesses
were multiple, more pronounced, doughy on palpation or with
palpable fluid inside, and painful. Later on, these abscesses
reached a diameter of 10–15 cm and developed fibrous tissue
capsule and firmer consistency (figure 6).
Abscesses that have not yet ruptured were punctured with
a fine needle, and serosanguineous exudate was withdrawn.
However, once ulceration developed, there was a secretion
(drainage) of yellowish pus.
FIGURE 1 Growth of Corynebacterium pseudotuberculosis on blood
agar, forming small, white to greyish, dry colonies.
FIGURE 2 Caseous lymphangitis in a Holstein heifer.
Pyogranulomatous lesion on the front right leg above the dew claw.
FIGURE 3 Caseous lymphangitis in a Holstein heifer. Ulcerative and
pyogranulomatous lesions on the caudal aspect of the right front limb.
FIGURE 4 Caseous lymphangitis in a Holstein cow. Granulomatous
lesions on the dorsal aspect of the distal limb.
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During November 2014, 43 cases of the disease were found
(herd prevalence of 23.9 per cent). The culling rate was excep-
tionally high and reached 95.3 per cent of all clinical cases. For
comparison, the total number of animals culled in 2017 was 24
(13.3 per cent of the milking herd). Most of these culls were due
to infertility and mastitis, and only four animals were removed
due to skin lesions (2.2 per cent).
All reported cases were in first calving cows (n=31) and older
cows between second and fifth lactation (n=12). Younger cattle
appeared to be less susceptible to the infection—no cases were
observed among the replacement heifers (aged between 0 and
15 months).
MATERIALS AND METHODS
Strains of C pseudotuberculosis were isolated through culturing,
presumptively identified based on Gram reaction, morphology
and differential biochemical tests, and additionally confirmed
through molecular genetic-based identification (multiplex PCR
(mPCR)).
Cytology
Swabs from the superficial peripheral lesions and aspirates
(punctates) from the deeper palpable abscesses were collected
and submitted for culture. These were obtained from 12 heifer
cows with cutaneous lesions, and C pseudotuberculosis was
isolated from seven of these animals.
Impression smears made with material taken from the
pyogranulomatous lesions revealed the presence of many
degenerated neutrophils, occasional lymphocytes and bacillary
rods arranged at times either as ‘Palisades’ or ‘Chinese letters’.
Neutrophils containing Gram-positive rods (active phagocytosis)
were present whenever the material was from recently infected
animals.
Isolation and presumptive identification
The swabbed or aspirated material was directly inoculated on
to 5 per cent sheep blood agar and was incubated aerobically
at 37°C for 48 hours. Small, white to greyish, dry and waxy
colonies (with granular appearance), well-marginalised and with
opaque centres were observed after 48 hours of incubation.
The microscopic picture revealed Gram-positive, pleomor-
phic rods arranged in a typical ‘Chinese letters’ arrangements of
Corynebacterium spp. Metachromatic granules in the bacterial
cells (that are believed to represent regions of stored phosphate)
were also observed.
Additionally, the clinical specimens were inoculated on to
Hoyle’s tellurite blood agar and incubated in air at 35°C–37°C
for 16–46 hours. Characteristic pinpoint black colonies were
observed after 48 hours.
The bacteria were catalase, glucose, maltose and nitrate reduc-
tion positive, but negative for mannitol and oxidase. The isolate
fermented all the simple sugars (glucose, lactose, etc) with the
exception of sucrose. Inhibition of the effect of staphylococcal
beta-haemolysins was observed (positive reverse Christie–
Atkins–Munch-Petersen ((CAMP)) test).
It is desirable that clinically significant coryneforms should
also be confirmed with genetic-based identification systems (see
Markey and others16), and mPCR assays were also employed for
identification.
Systems targeting the pld (BactoReal Kit from ingenetix,
Austria) and the 16S rNA genes were used. These confirmed a
non-toxigenic C pseudotuberculosis.
The results were independently confirmed through submission
to an external reference laboratory where commercial Analytical
Profile Index (API) identification technique was used.
Sensitivity testing revealed resistance to cloxacillin and
sulphonamide/trimethoprim but susceptibility to streptomycin,
ampicillin, ceftiofur, oxytetracycline and penicillin G.
Ethics and animal welfare
All clinical procedures, diagnostic and treatment interventions
were considered in line with the national (Bulgarian) and Euro-
pean legislation on animal welfare. The professional code of
conduct and institutional guidelines on ethics (Trakia University,
Stara Zagora) were strictly followed.
INVESTIGATIONS
Caseous lymphadenitis due to C pseudotuberculosis is diag-
nosed serologically in sheep, but this method for detection is
not equally well researched in cattle. In low prevalence sheep
flocks, serology testing for subclinical infection with subsequent
FIGURE 5 Caseous lymphangitis on the right hindlimb in Bulgarian
Holstein cow. Multiple pyogranulomatous lesions are visible below the
hock.
FIGURE 6 Caseous lymphangitis in a Holstein heifer. Abscessation and
ulcerative lesion on the lateral aspect of the hindlimb, in the region of
the hock joint.
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4SteerforthD, MarutsovP. Vet Rec Case Rep 2017;5:e000454. doi:10.1136/vetreccr-2017-000454
segregation or culling of the positive cases has been successfully
tried.17 18
By approximation only (with herd eradication protocols
designed for sheep), serology could be very useful on dairy
farms. Several serodiagnostic tests for detection of antibodies to
C pseudotuberculosis could potentially be used to detect visceral
abscessation or subclinical cases or to inform on the prevalence
in the herd. These include ELISA,19 complement fixation20 or
immunodiffusion21 and other tests.
In this case, due to the use of autogenous vaccination in the
herd, no serodiagnostic tests were practical, and their use was
not considered.
Instead, clinical cases were established based on the presence
of cutaneous lesions, mastitis, febrility or other systemic clin-
ical signs (if present), and the treatment and control plan put
in place, emphasised on culling out of the clinically affected
animals and extensive disinfection of the facilities.
DIFFERENTIAL DIAGNOSIS
Differential diagnoses for caseous lymphangitis include
pyoderma, abscesses or lymphangitis due to other skin pathogens
(eg, Staphylococcus aureus, Streptococcus spp or Dermatophilus
spp).
Specifically, bovine dermatophilosis (Dermatophilus congo-
lensis) has been reported in Bulgaria with characteristic painful
exudative skin lesions.22 However, smears taken from the lesions
were negative for the characteristic ‘railroad track’ coccoid
bacteria. Further culturing was also negative for Dermatophilus
spp.
Other differential diagnoses are skin conditions such as
dermatophytosis, sporotrichosis, cryptococcosis, blastomycosis
and onchocerciasis.
To our knowledge, no bovine cases of blastomycosis and
onchocerciasis (river blindness) have been documented in
Bulgaria.
The virus neutralisation test and PCR results were negative
for LSD.
These specific conditions were excluded based on the specific
clinical presentation, lesion location, and laboratory results and
the absence of other signs that are specific for these diseases.
Historically the incidence of mastitis in this herd was very
low. In this case, the animals with cutaneous lesions have also
developed mastitis, and due to this association no other mastitic
pathogens were considered relevant to this outbreak. However,
in the absence of specific testing, the presence of other mastitic
pathogens could not be ruled out.
TREATMENT AND CONTROL
Due to the chronic nature of the infection and the high herd
prevalence, the control of this C pseudotuberculosis outbreak
was a considerable challenge.
Empirical evidence from outbreaks of caseous lymphadenitis
in small ruminants suggests that in herds with high disease prev-
alence, vaccination combined with rigorous sanitary measures
should be effective.23
The referring cattle practitioners attempted surgical drainage
of abscesses in individual severely affected animals (following
strict antisepsis to avoid environmental contamination), followed
by chemical cauterisation with 10 per cent iodine solution, but
this was not effective and did not prevent the development of
new abscesses. The same animals were treated initially with
20,000 IU/kg of penicillin G (intramuscularly) and later on with
oxytetracycline (10 mg/kg daily for five days). Sensitivity testing
had shown in vitro susceptibility to oxytetracycline, but none
of the systemically treated animals responded and were subse-
quently culled.
Since antibiotic treatment on a herd level is inviable due to
high costs (including withdrawal of milk), low efficacy and the
need for prolonged treatment, the main component of our treat-
ment protocol was autogenous vaccination.
Inactivated autogenous vaccine (bacterin) was trialled and
administered to a small group of clinically healthy animals
after the initial outbreak in 2014. According to the manufac-
turer, 24-hour culture of C pseudotuberculosis (obtained from
the same farm) with 9.0×108 colony-forming units/ml was
inactivated in 0.4 ml/100 ml of formalin, and then aluminium
hydroxide (Alhydrogel, Brenntag Biosector) was added as an
adjuvant to prepare the inoculum. As prescribed, 2 ml of this
vaccine was administered subcutaneously in the thoracic skin
fold, caudal to the elbow, followed by a second dose 21 days
later.
No adverse reactions were observed, and subsequently all
animals on the premises were vaccinated. The youngest animals
vaccinated were heifers at 14 months of age (including those
with lesions). Revaccination was performed after four months,
followed by second revaccination six months later. This autoge-
nous vaccination protocol was repeated in 2016 with the aim to
prevent the occurrence of new cases.
OUTCOME AND FOLLOW-UP
Control and preventive measures
Control and preventive measures for caseous lymphangitis could
include any or all of the following:
►Segregation of infected animals
►Serology
►Treatment
►Culling
►Vaccination
►Fly control
►Measures to reduce the risk of injury to animals
►Individual disposable needles and instruments
►Improving hygienic conditions of the stalls and disinfection
Each one of these control measures can have an effect on the
establishment, progression and outcome of the disease in the
herd.24
No attempts to segregate the affected animals were made on
this farm, and no serodiagnostic tests were used. However, all of
the other preventive and control measures described above were
carefully considered and implemented.
Advice to install mosquito and fly screens on all barn windows
and doors was given.25 An environmental source of the infec-
tion was suspected because this was a closed herd and advice
was given on using appropriate parlour and stall disinfectants.
Additionally, measures for reducing minor cuts and scrapes were
discussed with the herd owners.
These measures included eliminating sharp corners on the way
in and out of the parlour, eliminating sharp metallic edges in
the stall barns, troughs and other facilities, disinfection of all
surgical instruments, systemic use of disposable needles, disin-
fection of newborns navels and wounds with strong (10 per cent)
iodine solution, discontinuation of the use of barbed wire for
fencing, etc.
Terminal disinfection of buildings is possible, however difficult
on a dairy farm. Ten per cent formaldehyde has been proposed
for disinfection of herd facilities.26 However, formaldehyde is
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SteerforthD, MarutsovP. Vet Rec Case Rep 2017;5:e000454. doi:10.1136/vetreccr-2017-000454
toxic to human beings and a tissue irritant, and therefore its use
cannot be recommended.
One per cent chlorhexidine or 1 per cent calcium hypochlo-
rite can also be used to disinfect the stalls and other areas in the
barns, similarly to disinfecting sheep pens and sheds.27 28
If organic bedding material is used (eg, straw), bedding mate-
rials can be completely removed and the area treated with 20 per
cent calcium hypochlorite.
In this case, all barns were cleaned and treated with chlorine
powder (a stable mixture of calcium hypochlorite, lime and
calcium chloride).
Replacing the organic bedding material with inorganic mate-
rial (eg, sand) would improve hygiene, but it was considered
impractical on this farm. The farmers were instructed to admin-
ister antimicrobials or vaccines using individual disposable
needles and all hoof trimming equipment and other instruments
to be cleaned from debris, and a strong disinfectant applied
(chlorine bleach).
Outcome and follow-up
Following the autogenous vaccination of all animals in the prem-
ises in 2014 and 2015, there were reduced number of cases in
2016 (n=10) and in 2017 (n=4).
Full reassessment of the herd and premises was done in January
2017. Only four cases were observed, with single lesions at the
distal hindlegs and two of those were with oedematous lesions
at the level of the fetlock joints and in between the dew claws.
Samples obtained from these lesions were cultured but were
negative for C pseudotuberculosis and with a mixed growth of
other environmental pathogens.
Clinical material from these animals was submitted sepa-
rately to an accredited reference laboratory for culturing, mPCR
testing and independent confirmation.
The lab reported the presence of C amycolatum, iden-
tified based on biochemical tests, differentiating it from C
pseudotuberculosis.
These two species can easily be confused. C amycolatum is a
frequently isolated non-lipophilic Corynebacterium, also associ-
ated with clinical and subclinical mastitis in dairy cows.29
However, PCR performed on clinical material from these
same cows was negative for C pseudotuberculosis, and this was
tentatively interpreted as herd case resolution.
DISCUSSION AND CONCLUSIONS
Caseous lymphadenitis predominantly affects sheep and goats,
3 5 30 and these animals can be a source of natural infection.5
However, no causal link with sheep or goats was identified on
the affected cattle farm. Previously, it has been proposed that
C pseudotuberculosis infection in sheep and goats begins with
bacterial penetration through superficial skin wounds or mucous
membranes, followed by extension to the regional lymph nodes,
and perhaps further organ dissemination.31
Such skin injuries can occur for example during shearing of
sheep,32 and it can be speculated that minor abrasions and cuts
can similarly initiate the infection in cattle. Once an animal
is infected, the spread of C pseudotuberculosis can continue
through the movement of infected animals within the herd and
from one barn to another. (This was a closed herd, and introduc-
tion of the infection from another herd was considered unlikely.)
Apart from direct contact with infected animals, houseflies
and seasonality have also been implicated33 34 35 in the spread of
C pseudotuberculosis.
During the summer and autumn, houseflies abound in this
Bulgarian region and may have contributed to the spread of C
pseudotuberculosis in the herd.25
However, infected animals are not the only reservoir of
infection, and it has been documented that C pseudotubercu-
losis survives well in the environment.36 Hence environmental
contamination may also be the source of infection in some cattle
cases, without any cross-species contamination.
In this case, the specific means of entry of the infection to the
farm and spread within the milking herd were never identified.
Ulcerative lymphangitis in cattle is not a highly contagious
disease but can become a serious health and economic problem
if it becomes stationary.37 In a survey covering a period of 13
years,15 reported ulcerative lesions in 45 Israeli herds with a low
morbidity rate (6.4 per cent), lack of treatment response and a
culling rate of 16.3 per cent.
The outbreak of caseous lymphangitis in this south Bulgarian
herd was associated with mastitis and significant produc-
tion losses. Since this was an intensive high yielding herd, the
majority of affected primiparous cows and older cows with
painful lesions, increased somatic cell count (SCC) and mastitis
were culled (95.3 per cent of all cases).
In our opinion, the significant time lapse of more than six
months between the first reported case and referral (definitive
diagnosis) played a role in the herd dynamics, contributed to
raising costs and delayed outbreak resolution.
The summer of 2014 was particularly dry, and apart from
increased populations of houseflies presumably contributing to
the dissemination of the pathogen,25 38 cows were subjected to
foot dipping because of increased incidence of white line disease.
The exact effect of frequent foot bathing is unclear in this case.
However, C pseudotuberculosis can penetrate macerated but
otherwise intact skin,39 and infect superficial tissues during
dipping or otherwise wet conditions.
C pseudotuberculosis is excreted in milk and can cause disease
in human beings (minor zoonosis), but in this case no attempts
to isolate the pathogen from milk were made.
Sensitivity testing indicated in vitro susceptibility to all major
antibiotics except cloxacillin and sulphonamide/trimetho-
prim, but the antibiotic treatment of individual animals with
oxytetracycline was unsuccessful. The lack of success could
be explained by the ability of Corynebacterium spp to form
biofilms or survive intracellularly, making antimicrobials
inefficient.40
In this case, we adopted the view of other authors9 15 40 that
antibiotic treatment is unsustainable on a herd level (due to high
cost and low efficacy and the need for prolonged treatment), and
opted to use autogenous vaccination instead.
It has been previously reported that young animals are more
susceptible than older ones38 41; however, there were no affected
heifer calves on this farm. Also, results from our study revealed
higher prevalence in first calving cows (72.1 per cent) than
in older cows (27.9 per cent), which is in disagreement with
Yeruham and others38—higher prevalence in cows (80.6 per
cent), and 16.2 per cent and 3.2 per cent in first calving cows
and heifers, respectively.
Most cases of caseous lymphangitis due to C pseudotubercu-
losis occurred shortly after calving. This case presentation can be
explained by immunosuppression in the immediate postcalving
and transition period and was consistent with previous studies.38
Abortions have also been reported with caseous lymphan-
gitis,9 but no instances of abortion were linked to any of the
presented 43 cases.
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6SteerforthD, MarutsovP. Vet Rec Case Rep 2017;5:e000454. doi:10.1136/vetreccr-2017-000454
This could be because the affected animals were culled in a
relatively short period due to a reduction in milk yield, a substan-
tial increase in SCC and/or refractory mastitis.
Finally, based on feedback from the abattoirs and abattoir
reports, there was no visceral involvement in this outbreak of
cases, with lesions predominantly affecting the superficial and
subcutaneous tissues (cutaneous lesions form).
Contributors Both authors have contributed to the conception and conceptual
design for publication of this case report. PM has equal and substantial contribution
to the acquisition of the clinical data, and the analysis and interpretation of the
clinical and laboratory data results. As a first author DVS has drafted the manuscript,
and all relevant details in revising the manuscript critically for intellectual content
has been communicated and shared between the authors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.
© British Veterinary Association (unless otherwise stated in the text of the article)
2017. All rights reserved. No commercial use is permitted unless otherwise expressly
granted.
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Bulgarian Holstein dairy cows inCorynebacterium pseudotuberculosis
Ulcerative lymphangitis due to
Daniel Steerforth and Plamen Marutsov
doi: 10.1136/vetreccr-2017-000454
2017 5: Vet Rec Case Rep
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