Septic arthritis of the first and second cervical vertebral articulations with vertebral osteomyelitis in a foal caused by Salmonella

A case of infectious arthritis of a cervical vertebral articulation and vertebral osteomyelitis in a foal caused by Salmonella is described. Ultrasound images of the cervical facet joints were suggestive of septic arthritis and ultrasound facilitated needle placement for arthrocentesis and joint lavage. Due to the uncommon location of the infection, diagnosis of septic arthritis was not immediate and, despite aggressive intra‐articular lavage and instillation of appropriate intra‐articular antibiotics after hospitalisation, we were unable to resolve the infection in this foal. Radiographs did not show evidence of osseous involvement until later in the course of the infection. Septic arthritis should be suspected in cases with similar clinical and laboratory findings and radiographic changes may not be present early in the course of infection. Ultrasound imaging provided the most useful diagnostic information regarding infection of the cervical joints, facilitating both diagnosis and treatment.     

Successful treatment of infectious (Salmonella type III: 44) polyarthritis and osteomyelitis in a 4‐week‐old foal

This article describes the acute onset of infectious polyarthritis and osteomyelitis in a 4‐week‐old foal. Analysis of synovial fluid obtained from the left femoropatellar and right tarsocrural joints combined with clinical signs consisting of joint effusion and lameness yielded a diagnosis of septic arthritis. Bacterial culture of synovial fluid from the left stifle revealed Salmonella type III: 44. Rapid, sustained clinical improvement was noted following discontinuation of empirical antimicrobial therapy (potassium penicillin and amikacin sulphate) and initiation of treatment with ceftiofur and ampicillin. The importance of combining knowledge of veterinary pharmacology and microbiology so that appropriate antimicrobials may be selected with regard to the local environment in which they are to eradicate infection is emphasised. Despite frequent reference to amikacin sulphate as an effective antimicrobial for treating infections in foals caused by Salmonella, factors are discussed that explain why amikacin may not be clinically effective for treating infectious arthritis caused by Salmonella.     

Chronic laminitis in a 10‐month‐old Arabian filly

The case report presented here describes in detail the treatment and clinical progression of a case of severe chronic laminitis in a 10‐month‐old Arabian filly. Starting from the acute onset of clinical signs through the severe, debilitating progression of the disease, the report describes the medical, surgical and farriery treatment over a period of 8 months. The combination of deep digital flexor tendon tenotomy, hoof wall resection, corrective trimming and shoeing was successful in halting progression of the disease. The successful treatment resulted in new healthy hoof wall growth, re‐establishment of normal third phalanx‐hoof wall alignment and reversal of the degenerative modelling changes that occurred in the third phalanx. To the best of our knowledge, this is the first study describing treatment of severe chronic laminitis in such a young filly.     

Surgical repair of a mandibular degloving injury in a 5‐month‐old colt

A 5‐month‐old colt sustained a mandibular degloving injury and penetrating cheek wound after catching his cheek on a metal hook. Avulsion of the lower left lip and cheek exposed parts of the underlying labial surface, interalveolar margin and body of the mandible. The injury prevented the colt from closing his mouth completely and food accumulated between the degloved mandible and avulsed soft tissues. Surgical repair included 7 stented, transmandibular mattress sutures placed over the length of the interalveolar margin, closing the dead space and repositioning the avulsed soft tissues. The horse recovered without complications and functional as well as cosmetic outcome were excellent.     

Septic pyomyositis,multiple pelvic osteomyelitis and thrombosis in a Thoroughbred foal

Multiple septic osteomyelitis, septic thrombi and septic arthritis are recognised as possible complications of sepsis; however, there are few reports of localised pyomyositis in association with septic arterial thrombosis in foals. A 1-month Thoroughbred colt was presented for investigation of acute and progressive left hindlimb lameness. Physical and laboratory examinations were performed. Ultrasonographic, radiographic and computed tomographic examinations revealed the presence of multiple abscesses and areas of osteomyelitis localised to the gluteal muscles, coxal bone and lumbar spine respectively. Considering the poor prognosis, the foal was subjected to euthanasia. Necropsy confirmed the diagnostic imaging findings and revealed the presence of an extensive septic thrombus, affecting the internal iliac artery, and a single pulmonary abscess. Streptococcus equi subsp. zooepidemicus was isolated from all lesions.     

Fibrinous pericarditis and cardiac tamponade in a 3‐week‐old pony foal

A 3‐week‐old Pony of the Americas foal presented with a history of respiratory distress presumed to result from Actinobacillus equuli pleuropneumonia and septic arthritis. Failure of transfer of passive colostral immunity was suspected, but not confirmed, based on a history of the foal being separated from its dam shortly after parturition. Transient improvement was noted following thoracocentesis and removal of approximately 600 ml of pleural fluid but progressive clinical signs of congestive heart failure developed. Fibrinous pericarditis with evidence of cardiac tamponade was subsequently diagnosed via thoracic ultrasonography. Early clinical signs of cardiogenic shock were identified and fibrinopurulent exudate removed through a catheter placed with ultrasound guidance into the pericardium. The foal experienced cardiorespiratory arrest during the procedure and died despite resuscitative efforts. Post mortem examination identified extensive hypertrophy of the pericardium, septic arthritis, mild pleural effusion and focal bronchopneumonia. This report details the clinical evaluation, haematology, treatment and post mortem pathology of a foal with Actinobacillus equuli associated fibrinous pericarditis, as well as a brief review of cardiac tamponade.     

Rhodococcus equi occipital bone osteomyelitis,septic arthritis and meningitis in a neurological foal

This case report describes a 3‐month‐old female Thoroughbred foal that presented following the acute onset of apparent respiratory distress, abnormal head carriage and severe neurological deficits referable to the brainstem or cranial cervical spinal cord. Ultrasonography revealed an abscessing pneumonia. Radiographs did not show evidence of bony pathology at the atlanto‐occipital region, an area consistent with the observed neurological deficits. With magnetic resonance imaging, atlantal and occipital osteomyelitis, atlanto‐occipital septic arthritis, and atlanto‐axial synovitis were diagnosed. Brainstem meningitis and extradural compression were also revealed. Culture of the right occipitoatlantal joint and cerebrospinal fluid yielded a pure culture of Rhodococcus equi. These findings and multifocal R. equi abscessation were confirmed at necropsy.     

Septic arthritis,navicular bursitis and osseous cyst‐like lesion in a foal

The purpose of this report is to describe the clinical, imaging and pathological findings in a Quarter Horse colt admitted to the Texas A&M University Veterinary Medical Teaching Hospital for lameness of the left forelimb and left hindlimb. A presumptive diagnosis of left forelimb septic navicular bursitis was made ultrasonographically. A cyst‐like lesion of the calcaneus was diagnosed radiographically and better characterised with computed tomography. The cyst‐like lesion of the calcaneus was caused by infection with Actinobacillus sp. and extended into the adjacent tarsocrural, proximal intertarsal and talocalcaneal joints causing septic arthritis. The owner elected for euthanasia due to the poor prognosis. The diagnoses were confirmed on histopathology.     

Cervical vertebral anomaly and ventricular septal defect in an Arabian foal

A male Arabian foal born with a cervical mass and no apparent clinical signs presented with a cervical vertebral anomaly and ventricular septal defect. Both congenital anomalies were diagnosed at age 3 weeks and rechecked at age 6 months with radiographs and ultrasonographic studies respectively. At 11 months, in addition to radiographs and Doppler ultrasonographic studies, a contrast ultrasonographic study and post mortem myelographic and computed tomographic studies of the cervical vertebral column revealed the appearance of this rare cervical vertebral anomaly and the severity of the ventricular septal defect. To the authors' knowledge, in the Arabian foal, both conditions have not been reported simultaneously in the same patient.     

Cervical vertebral canal endoscopy in a horse with cervical vertebral stenotic myelopathy

A 3-year-old Thoroughbred gelding presented with a history of neurological signs, including incoordination in his hindlimbs, of about 7 months' duration. On initial examination, the horse exhibited ataxia and paresis in all limbs with more severe deficits in the hindlimbs. Cervical radiographs displayed severe osteoarthritis of the articular processes between C5 and C6. On subsequent cervical myelography the dorsal contrast column was reduced by 90% at the level of the intervertebral space between C5 and C6. Cervical vertebral canal endoscopy, including epidural (epiduroscopy) and subarachnoid endoscopy (myeloscopy), was performed under general anaesthesia. A substantial narrowing of the subarachnoid space at the level between C6 and C7 was seen during myeloscopy, while no compression was apparent between C5 and C6. Epiduroscopy showed no abnormalities. After completion of the procedure, the horse was subjected to euthanasia and the cervical spinal cord submitted for histopathological examination. Severe myelin and axon degeneration of the white matter was diagnosed at the level of the intervertebral space between C6 and C7, with Wallerian degeneration cranially and caudally, indicating chronic spinal cord compression at this site. Myeloscopy was successfully used to identify the site of spinal cord compression in a horse with cervical vertebral stenotic myelopathy, while myelography results were misleading.     

Use of multi‐detector computed tomographic angiography in the diagnosis of a parapharyngeal aneurysm in a 6‐week‐old foal

Multidetector‐row computed tomographic contrast angiography (MDCTA) is routinely employed to investigate vascular masses in human patients but, to date, the use of this technique to investigate an aneurysmal mass has not been reported in an equine case. The potential of MDCTA to investigate a right‐sided parapharyngeal mass in a 6‐week‐old Thoroughbred foal was therefore investigated. A 4‐slice helical computed tomography scanner was used on a superficial, firm, ovoid mass yielding arterial blood on fine needle aspiration. MDCTA enabled identification of the vessels involved thus assisting in forming a diagnosis based on the morphology of the lesion and aided surgical planning. Histology confirmed the presence of mural thrombus and calcification within the smooth muscle wall consistent with a true aneurysm. MDCTA provided additional information to conventional imaging in this case of vascular masses of the head and neck. The technique therefore has the potential to improve diagnosis and assist in the management of such lesions.     

Mesh repair of a large traumatic lateral abdominal wall hernia in an 8‐day‐old foal

An 8‐day‐old French trotter colt was admitted with a traumatic lateral abdominal wall hernia with reducible intestinal content. A 15 cm long full thickness tear was identified in both the internal abdominal oblique and transverse abdominal muscles. This case report describes the surgical repair of the hernia using a polypropylene mesh.     

Cervical vertebral fracture in a Thoroughbred filly with minimal neurological dysfunction

Vertebral fractures in horses are relatively common and often occur due to trauma. Clinical signs may range from neck pain and mild neurological dysfunction to tetraplegia and death. Severity of signs and prognosis depends on extent of damage to the spinal cord. In this Case Report, serial radiographs, which track the bony changes associated with fracture healing, were performed over one year. Although surgical techniques have been described to repair fractures to the vertebrae, patients with minimal neurological deficit may have a favourable outcome with conservative medical management, as in this case.     

Paratracheal air cyst in a foal

A 1-day-old American Paint Horse was presented for a large air-filled mass along the ventral aspect of the neck. Bronchoscopy and oesophagoscopy revealed no sign of communication with the trachea or oesophagus. Radiographs and a computed tomography scan of the neck identified a communicating tract between the lumen of the cystic mass and mid-trachea. The foal was systemically healthy at this initial presentation, and delayed removal of the cyst was recommended to allow further maturation of the foal prior to undergoing general anaesthesia. Upon discharge, the cyst continued to grow in size and became more fluid than air-filled requiring repeat centesis and draining. The foal was then re-presented at 3 weeks of age for surgical removal. In surgery, direct communication with the trachea was identified and ligated. Histopathology demonstrated that the cyst lining was composed of squamous epithelium with goblet cells and occasional ciliated cells. The location, morphological features and congenital presentation of the mass were consistent with a paratracheal air cyst (PAC). Surgical resection resulted in excellent functional and cosmetic outcome. Although not previously reported in horses, PAC should be included in the differential diagnosis of an air-filled ventral neck mass in equine neonates. Complete surgical excision may result in a successful outcome.     

Management of equine ataxia caused by cervical vertebral stenotic myelopathy: A European perspective 2010–2015

The diagnosis and therapy of cervical vertebral stenotic myelopathy (CVSM) are challenging and have been most frequently described in racehorses. We aimed to analyse CVSM cases presented for diagnostic work‐up and treatment in a nonracing horse population. We hypothesised that our diagnostic work‐up protocol including clinical/orthopaedic/neurological/radiographic and myelographic examinations may provide practical reference points for in vivo diagnosis/prognosis and adequate CVSM management. Medical records from 2010 to 2015 were reviewed retrospectively. Cases were included if our standardised work‐up protocol was followed, there was no evidence of any infectious diseases causing the neurological signs, and native cervical radiographs and myelograms confirmed CVSM. Age/breed/sex/type of performance/degree of neurological deficits and number/sites/quality/therapy of stenosis were recorded. Sixty‐two horses met the inclusion criteria. The majority of the horses were aged 5–10 years (44%) or >10 years (35%); nine horses (15%) were 1–4 years and four <1 year (6%) old. Forty‐six horses were Warmbloods (73%), 10 ponies (16%) and six of other breeds (11%). Males were more affected (69%) than females (31%). Sixty‐one percent were pleasure‐horses, 26% were sport‐horses and no information was available for 13%. Most cases presented with mild–moderate neurological signs (grade 2/5 = 18%, grade 2–3/5 = 31%). On myelograms, 23 horses (37%) had single‐level, 22 (35%) had double‐level, and eight (13%) triple‐level stenosis, while nine cases (15%) did not have stenosis. Fifty horses (55%) showed dynamic and 41 (45%) static stenosis. Dynamic stenosis was more common (46%) than static (29%) stenosis and/or combined stenosis (25%). Stenoses were more frequently observed in the mid‐to‐caudal vertebrae. Static stenoses tended to be located more caudally. Based on our protocol, 15% of horses were subjected to euthanasia without therapy, 62% treated conservatively and 23% underwent cervical ventral interbody fusion. In conclusion, our diagnostic work‐up protocol provided practical reference points for in vivo diagnosis/prognosis and adequate management of CVSM in a nonracing horse population.     

Diffuse osteomyelitis of the fourth metacarpal bone in a horse caused by Clostridium perfringens

Osteomyelitis in adult horses, often associated with trauma or iatrogenic infection following surgery, usually presents as a focal area of infected bone. Diffuse osteomyelitis, affecting both the cortex and medulla, along the full length of a bone is encountered less frequently and treatment of such infections is not well reported in horses. The 2-year-old Warmblood mare in this case was diagnosed with diffuse osteomyelitis affecting the 4th metacarpal bone with concurrent unicortical fracture of the third metacarpal bone following traumatic injury. Computed tomography (CT) aided diagnosis in this case, providing critical additional detail to that obtained with radiography and ultrasound. This case highlights the value of CT in the diagnosis of diffuse osteomyelitis. This is the first reported case of diffuse osteomyelitis caused by Clostridium perfringens in horses. Successful treatment in this case consisted of surgical debridement of the associated abscess, followed by systemic and locoregional antimicrobial therapies.     

Caecal duplication in a 13‐year‐old Thoroughbred

A 13‐year‐old Thoroughbred gelding was presented for evaluation of recurrent colic of 4 weeks duration. These colic episodes were mild and responsive to medical therapy. Episodes of colic became more frequent and more painful. Exploratory laparotomy revealed a large intestine duplication with a cystic structure located at the caecocolic junction that was unable to be exteriorized and therefore not amenable to surgical correction. Thirty‐six hours following surgery, the horse became acutely painful, sweaty, and febrile suggesting gastrointestinal rupture. Post mortem examination showed a 0.6 × 1 m duplication and a 0.5 × 0.6 m cystic dilation that was probably associated with the caecum. There was a 10 × 30 cm area of rupture located within the duplication. Histological evaluation confirmed the presence of a true duplication.     

Localized cowpox infection in a 5‐month‐old Rottweiler

Cowpox virus (CPXV) infections are a sporadic cause of localized or disseminated skin disease in domestic animals and humans in Europe. Rodents are considered the primary reservoir host for CPXV. Cats can become infected by close contact with rodents and are the most important source of human infections. Recently, public awareness has also been drawn to CPXV infections by an outbreak of rat to human infections in central Europe. In dogs, CPXV infections are rare. Here we report a case of a 5‐month‐old Rottweiler with a focal nodule on the muzzle. The lesion was fully excised, and recovery was uneventful. The preliminary diagnosis of a CPXV infection was established by the characteristic inclusion bodies on histopathological examination. The diagnosis was confirmed by electron microscopy and polymerase chain reaction (PCR). Sequencing of the PCR product led to a 231 bp sequence of the orthopoxvirus HA gene that was identical to a CPXV strain previously isolated from a cat. This is the third documented case of a canine CPXV infection.     

Cerebellar abiotrophy in a 6‐year‐old Arabian mare

Cerebellar abiotrophy (CA) is an uncommon neurological disease that most commonly affects Arabian horses. Affected horses are typically identified within the first 6 months of life. Intention tremor, wide based stance and ataxia are common clinical signs observed in affected individuals. No treatment is available for resolution of clinical signs. Definitive diagnosis is based on histopathological examination of cerebellar tissue, which is characterised by loss of Purkinje cell layer. This report describes a case of cerebellar abiotrophy that had a delayed diagnosis until 6 years of age.