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Heartwater is diagnosed by making brain smears and finding the causative agent in capillary endothelial cells.

The differential diagnosis in the early stages when pulmonary edema, hydrothorax, hydropericardium, and petechial hemorrhages are prominent includes heartwater (at least in white-tailed deer), anthrax, sepsis, pasteurellosis, clostridial enterotoxemia, primarily in captive animals, and adenovirus infection in deer.


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When erosions and ulcers are present HD must be differentiated from vesicular stomatitis, bovine virus diarrhea, malignant catarrhal fever, foot and mouth disease, riderpest and peste des petits.


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Severe ruminal ulceration could be confused with severe lactic acidosis.


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Severe gastrointestinal hemorrahge could be confused with heavy metal toxisos.


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Secondary bacterial pneumonia can make the diagnosis of HD difficult.


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In pronghorn where CNS signs may be prominent, polioencephalomalacia and other diseases of the nervous system would need to be included in the differential diagnosis.

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