Management of cases suffering from atypical myopathy: Interpretations of descriptive,epidemiological and pathophysiological findings. Part 2: Muscular,urinary, respiratory and hepatic care,and inflammatory/infectious status

Atypical myopathy is highly fatal, but about a quarter of affected horses survive. This highlights the need for provision of supportive treatment for these patients. This review is a practical guideline for equine practitioners and includes suggestions for close monitoring of involved organ systems and discusses options of supportive treatment based on current knowledge of the condition. Part 2 covers the muscular, urinary, respiratory and hepatic systems, and the general inflammatory/infectious status of the case.     

European outbreaks of atypical myopathy in grazing horses (2006-2009): determination of indicators for risk and prognostic factors

Reasons for performing study: Appropriate management of atypical myopathy (AM) requires the establishment of an accurate diagnosis and prognosis. Furthermore, preventive measures to avoid AM need to be refined. Objectives: The aims of the study were as follows: 1) to improve the diagnosis of AM; 2) to identify prognostic predictors; and 3) to refine recommended preventive measures based on indicators of risk factors. Methods: An exploratory analysis of cases in Europe between 2006 and 2009 reported to the Atypical Myopathy Alert Group was conducted. Based on clinical data, reported cases were allocated into 2 groups: confirmed or highly probable AM (AM group; further divided into survivors and nonsurvivors); and cases with a low probability of having AM or with another final diagnosis (non‐AM group). Using Welch's test and odds ratios corrected for multiple comparisons, the AM vs. non‐AM groups were compared to identify indicators for diagnosis and risk factors, and survivors vs. nonsurvivors in the AM group were compared to identify prognostic factors. Sensitivity, specificity and positive and negative predictive values were calculated for specific clinical signs related to final diagnosis and outcome. Results: From 600 reported cases, 354 AM cases (survival rate of 26%) and 69 non‐AM cases were identified, while there were insufficient data to categorise the remainder. Variables valuable for diagnosing AM compared with similar diseases were as follows: presence of dead leaves and wood and/or trees on pastures; sloping pastures; full‐time pasture access; no food supplementation; normal body condition; pigmenturia; normothermia; and congested mucous membranes. Nonsurvival was associated with recumbency, sweating, anorexia, dyspnoea, tachypnoea and/or tachycardia. Survival was associated with remaining standing most of the time, normothermia, normal mucous membranes, defaecation and vitamin and antioxidant therapy. Conclusions and potential relevance: This study refines the list of risk factors for AM. Clinical signs valuable for diagnosis and prognosis have been identified, enabling clinicians to improve management of AM cases.     

Welfare and health of horses transported for slaughter within the European Union Part 1: Methodology and descriptive data

Reasons for performing study: Anecdotal evidence collected by a variety of organisations has highlighted poor welfare in horses transported long distances to slaughter within the European Union. Objective: To investigate welfare of horses being transported long distances within the EU to slaughter. Methods: Data on transported horses were recorded at 2 assembly centres in Romania and at 4 abattoirs in Italy over an 8 month period in 2008. Results: A total of 1519 horses in 64 separate shipments were observed in Romania prior to transport of which 212 horses were deemed unfit for transport and only 3 shipments (5%) complied with Council Regulation (EC) no. 1/2005 with respect to both horse and vehicle compliance. The destination most commonly stated for the horses from these assembly centres was Italy. A total of 1271 horses in 63 separate shipments were observed after transport in Italy, of which 86 horses in 4 shipments had also been observed prior to transport in Romania. The majority of the horses observed at these abattoirs originated from Poland (51%) and Romania (44%). On arrival in Italy at the time of unloading, 471 of 1271 horses (37%) were deemed unfit for transport in accordance with Council Regulation (EC) no. 1/2005 and none of the shipments were compliant with respect to both vehicle and horse requirements. An average of 6 horses per shipment (28% of each shipment) had at least one acute injury on arrival in Italy. A significantly higher prevalence of severe injuries and lameness was found in animals on arrival In Italy compared with animals leaving Romania. Horses examined on arrival in Italy were twice as likely to have 1–3 acute contusions or excoriations as horses examined in Romania. There was also a 2‐fold increase in the number of animals deemed unfit for transport. Conclusion: This study has identified evidence of poor welfare in horses being transported long distances to slaughter, including severe lameness and injuries, and a high level of noncompliance with Council Regulation (EC) no. 1/2005 on the Protection of Animals during Transport.     

Musculoskeletal disease and injury, now and in the future. Part 1: fractures and fatalities

Orthopaedic injury is common in the racing Thoroughbred and is a cause of both economic loss to the industry, as well as being an obvious welfare issue. Fatal injuries sustained during racing are an obvious major concern and it is important that all is done to reduce their frequency. As a consequence of the importance of these causes of horse morbidity and mortality, the Horserace Betting Levy Board in the UK has invested considerable resources into research in recent years in this area in an attempt to decrease the frequency of such injuries. This review summarises current knowledge relating to epidemiological investigations relating to fractures, falling and fatalities in the racing Thoroughbred. Studies identify the importance of track surface conditions, the importance of pre-existing orthopaedic pathology, as well as issues relating to the horse's past training and racing experience as important determinants of both injury and death. Such findings can now be used to develop interventions to reduce racehorse injury and death for the benefit of both the industry and the horse.     

A cross-sectional study of geriatric horses in the United Kingdom. Part 2: Health care and disease

Reasons for performing study: Geriatric horses (aged ≥15 years) represent a substantial proportion of the equine population, yet very few studies have investigated the prevalence of diseases within the UK equine geriatric population. Objectives: To describe the provision of routine preventive health care measures, prevalence of clinical signs of disease and the prevalence of owner reported diseases. Additionally, the effect of increasing age on the provision of preventive health care and the presence or absence of clinical signs and disease was assessed. Methods: A cross‐sectional study was conducted, surveying a randomly selected sample of veterinary registered owners with horses aged ≥15 years, using a self‐administered postal questionnaire. Results: As geriatric horses increased in age, there was a reduction in the provision of preventive health care measures, such as vaccination, farrier care and routine veterinary checks. Only 68.7% of horses had received a routine veterinary visit within the previous 12 months. Owners frequently observed clinical signs in their animals, with 77% reporting at least one clinical sign of disease. Increasing age was associated with increased reporting of many clinical signs of disease. Over half (58%) of horses had at least one episode of disease within the previous 12 months, yet only 31% of owners reported that their animal currently suffered from a known disease or disorder. Conclusions and potential relevance: Although owners frequently observed clinical signs in their aged horse, there may be incorrect or under recognition of many diseases and health problems. Reduced frequency of routine preventive health care measures, along with suboptimal owner recognition of health and welfare problems may lead to compromised welfare in the geriatric population.     

Ultrasound findings in horses with severe eyelid swelling, and recognition of acute dacryoadenitis: 10 cases (2004-2010)

Objective To report the sonographic findings, treatment, and outcome of horses with severe eyelid swelling, to describe the sonographic appearance of enlarged lacrimal glands, and to describe the clinical features of acute dacryoadenitis. Materials and methods Medical records of all horses with severe eyelid swelling that underwent an ultrasound evaluation of the globe and periorbital structures from 2004–2010 were examined. Cases were limited to those in which the eyelid swelling was so severe that the globe could not be visualized. Results Ten horses met the criteria for inclusion in the study. All cases were unilateral and acute. Marked enlargement of the lacrimal gland was found in five cases, and supported the diagnosis of acute dacryoadenitis. Eyelid abscessation was found in three horses, accompanied by mild to moderate lacrimal gland enlargement in two of the three. Enlarged lacrimal glands were slightly heterogeneous in appearance and could be differentiated from an abscess by imaging the protrusion of the gland from beneath the supraorbital rim. Only two cases of severe eyelid swelling were soley traumatic. Conclusions Severe eyelid swelling was often associated with dacryoadenitis and/or eyelid abscessation. The detection of marked lacrimal gland enlargement in horses with an acute onset of severe painful eyelid swelling is consistent with a diagnosis of acute dacryoadenitis. Ultrasonographic evaluation of eyelid swelling of any degree is warranted to determine if enlargement of the lacrimal gland, etiology notwithstanding, is an underlying or contributing cause.     

Pathology of gastritis and gastric ulceration in the horse. Part 1: Range of lesions present in 21 mature individuals

Reasons for performing study: Gastric ulceration is now widely recognised as an important disease in high performance horses. Little is known about gastric histopathology in healthy or diseased animals; a comprehensive assessment would enhance interpretation of gross findings through assessment of their accuracy and allow for identification of lesion variety and pathogenesis in different anatomical regions of the stomach. Objectives: To investigate the true extent and variety of gastric lesions in a mixed population of mature horses at post mortem. Methods: Stomachs were removed from a mixed population of 21 horses at post mortem. Mucosal abnormalities were recorded in photographic and written form. Representative samples from all gross lesions were taken for histopathology and processed routinely. Special stains including Gram, PAS and Warthin Starry, were used when appropriate. Pathological classification of lesion type using both gross and histological appearances was performed. Results: Classification of lesions within the squamous region included hyperkeratosis, punctate scars, diffuse erosions/ulcerations and margo injuria; and within the glandular region, hyperaemia, focal erosions and ulcerations. Glandular metaplasia was recognised for the first time in the equine stomach. No Helicobacter‐like organisms were detected in association with lesion development. Conclusions and potential relevance: This study used gross and histological examination to highlight the large variety of naturally occurring gastric lesions in a mixed population of horses. Analysis of the pathogenesis of lesion development is now possible. Further research regarding the range of pathology in larger, more diverse groups of horses is required.     

Colic in geriatric compared to mature nongeriatric horses. Part 1: Retrospective review of clinical and laboratory data

Reason for performing study: It is the impression of some surgeons that geriatric horses have a lower survival rate compared to mature nongeriatric horses following colic surgery. One possible reason for this is that geriatric horses may be more critically ill at admission and have more severe disease than mature nongeriatric horses. Objective: To compare admission historical, physical examination and laboratory data for geriatric and mature nongeriatric horses referred for signs of colic. Methods: Medical records of horses admitted with a presenting complaint of colic between 2000 and 2006 were reviewed. Geriatric horses ≥16 years (n = 300) and mature nongeriatric horses 4–15 years (n = 300). Information obtained included duration of colic prior to admission, admission level of pain, heart rate, intestinal borborygmi, packed cell volume (PCV), plasma creatinine and blood lactate concentrations and peritoneal fluid total protein. Data were analysed using a Chi‐squared test or an analysis of variance. Level of significance was P<0.05. Results: There was no difference between geriatric and mature horses in the duration of colic prior to admission or in admission heart rate, PCV, or plasma creatinine or blood lactate concentrations. However, geriatric horses were more likely to be moderately painful and less likely to be bright and alert than mature horses; and less likely to have normal intestinal borborygmi than mature horses. Peritoneal fluid total protein concentration was higher in geriatric than mature horses. Conclusions and potential relevance: Geriatric horses presenting with signs of colic had a similar admission cardiovascular status based on heart rate, PCV, and plasma creatinine and blood lactate concentration to mature horses. Geriatric horses, however, may have different causes of colic, which may be more serious than mature horses based on pain, lack of intestinal borborygmi and peritoneal fluid total protein concentration.     

Diseases in neonatal foals. Part 1: The 30 day incidence of disease and the effect of prophylactic antimicrobial drug treatment during the first three days post partum

Reasons for performing study: Neonatal diseases have been grouped and analysed but up‐to‐date statistically significant information about the incidence and prevalence of diseases in foals is limited. Since the 1950s it has been a common management practice to administer a 3 day course of antimicrobial drugs to neonatal foals. This was shown to significantly reduce the incidence of infections (Platt 1977). Since then management practices have improved and it is widely believed that prophylactic antimicrobial drugs are no longer necessary in foal rearing. Objectives: To determine the 30 day incidences or prevalences (depending on case definition) of various diseases and conditions in the neonatal foal and ascertain the influence of a prophylactic 3 day treatment on the frequency of infections. Methods: The population consisted of Thoroughbred foals born on stud farms in the Newmarket (UK) area in 2005 (n = 1031). Depending on the stud farm's practice in the use of prophylactic antimicrobial drugs, 2 groups of newborn foals (treated and untreated) were identified and followed for 30 days. Results: The 30 day incidences of infectious diseases under study were between 0.2% (osteomyelitis) and 5.85% (systemic disease with diarrhoea). The overall incidence for ‘total infectious diseases’ was 8.27%. The most commonly observed noninfectious condition was limb deformities (12.11% of all foals). There was no significant difference in the incidence of infectious diseases between the 2 groups. Conclusion: Infectious diseases are still an important problem in neonatal foals requiring further investigation as to which factors other than antimicrobial prophylaxis are relevant for disease prevention. Potential relevance: The results provide an up‐to‐date overview about the frequencies of various neonatal foal diseases. They do not support the traditional prophylactic use of antimicrobials to prevent infectious diseases in healthy newborn foals. However, it should be noted that this study was not a randomised controlled trial and therefore does not provide the strongest possible evidence for this conclusion.     

Cross-sectional study of antimicrobial-resistant bacteria in horses. Part 1: Prevalence of antimicrobial-resistant Escherichia coli and methicillin-resistant Staphylococcus aureus

Reasons for performing study: The increasing prevalence of antimicrobial‐resistant bacteria such as methicillin‐resistant Staphylococcus aureus (MRSA) and antimicrobial‐resistant Escherichia coli represents a significant problem. However, the carriage of such bacteria by horses in the UK has not been well characterised. Objectives: To estimate the prevalence of nasal carriage of MRSA and faecal carriage of antimicrobial‐resistant E. coli amongst horses in the general equine community of the mainland UK. Methods: A cross‐sectional study of horses recruited by 65 randomly selected equine veterinary practices was conducted, with nasal swabs and faecal samples collected. Faecal samples were cultured for antimicrobial‐resistant E. coli. Nasal swabs were cultured for staphylococcal species; methicillin‐resistant isolates identified as S. aureus were characterised by SCCmec and spa gene typing. Multilevel logistic regression models were used to calculate prevalence estimates with adjustment for clustering at practice and premises levels. Spatial variation in risk of antimicrobial resistance was also examined. Results: In total, 650 faecal samples and 678 nasal swabs were collected from 692 horses located on 525 premises. The prevalence of faecal carriage of E. coli with resistance to any antimicrobial was 69.5% (95% CI 65.9–73.1%) and the prevalence of extended‐spectrum β‐lactamase (ESBL)‐producing E. coli was 6.3% (95% CI 4.1–9.6%). The prevalence of nasal carriage of MRSA was 0.6% (95% CI 0.2–1.5%). Spatial analysis indicated variation across the UK for risk of carriage of resistant and multidrug‐resistant (resistant to more than 3 antimicrobial classes) E. coli. Conclusions and potential relevance: Carriage of MRSA by horses in the community appears rare, but the prevalence of antimicrobial‐resistant E. coli (including ESBL‐producing E. coli) is higher. A high prevalence of antimicrobial‐resistant bacteria could have significant health implications for the horse population of the UK.     

Comparisons of computed tomography, contrast enhanced computed tomography and standing low-field magnetic resonance imaging in horses with lameness localised to the foot. Part 1: anatomic visualisation scores

Reasons for performing study: To date, few reports exist comparing magnetic resonance imaging (MRI) and computed tomography (CT) for imaging of the equine distal limb, yet clinicians are required to decide which modality to use regularly. Objectives: To report and compare anatomic visualisation scores obtained for CT, contrast enhanced CT (CECT) and standing low‐field MRI (LFMRI) in the equine foot. Hypothesis: Anatomic visualisation score discrepancies would exist between CT, CECT and LFMRI. Methods: Images of 22 lame horses (31 limbs) undergoing both CT and LFMRI of the foot were reviewed. When available, CECT images were reviewed. The deep digital flexor tendon (DDFT) was categorised into proximal to distal levels (A–D), structures were assigned visualisation scores (Grades 0–3) and technique comparisons were made using the paired marginal homogeneity test. Results: Computed tomography and LFMRI had similar visibility scores for the navicular bone, middle phalanx, DDFT‐B, collateral ligaments of the distal interphalangeal joint and collateral sesamoidean ligament of the navicular bone. The proximal and distal phalanx had lower visibility scores with LFMRI. The distal DDFT (C–D), distal sesamoidean impar ligament and synovial structures had higher scores with LFMRI. Contrast enhanced CT lowered DDFT and collateral sesamoidean ligament scores and raised distal interphalangeal synovium CT visualisation scores. Conclusions and potential relevance: Visualisation scores differ depending on imaging technique and anatomic structure of interest. This information increases our understanding of the limitations of CT, CECT and LFMRI to visualise anatomy in clinical cases.     

Canine limbal melanoma: 30 cases (1992-2004). Part 1. Signalment, clinical and histological features and pedigree analysis

OBJECTIVES: (1) To review the signalment, clinical, and histological features of canine limbal melanoma; (2) to perform pedigree analysis on breeds predisposed to limbal melanoma to establish if common ancestry exists; and (3) to investigate if any ancestral relationship exists between canine limbal melanoma and canine anterior uveal melanoma (CAUM). DESIGN: Retrospective study. ANIMALS STUDIED: Thirty dogs with limbal melanoma. METHODS: Medical records of patients were reviewed. Follow-up information was obtained by re-examination of patients or telecommunications with the referring veterinary surgeons or the owners. Pedigrees were analyzed for common ancestry amongst affected dogs. RESULTS The mean age (+/- SD) at diagnosis was 6.2 (+/- 2.75) years with a range from 1 to 11 years. There was a bimodal distribution of ages with a peak at 3-4 years and a peak at 7-10 years. There was no eye predilection or predisposition for sex or coat color. Twenty-five (83%) of the limbal melanomas occurred within a dorsal arc from the dorsomedial to the ventrolateral limbus. Golden retrievers were four times more common in the melanoma group compared to the Animal Health Trust population (P < 0.0001). Labrador retrievers were three times more common in the melanoma group (P=0.01). Pedigree analysis on eight Golden retrievers [limbal melanoma (n=5), CAUM (n=2) and diffuse ocular melanosis (n=1)], revealed a pattern of inter-relatedness consistent with the condition(s) being caused, at least in part, by a genetic mutation(s). A similar level of inter relatedness was evident in six Labrador retrievers (limbal melanoma (n=2) and CAUM (n=4)). In 5/22 cases (23%), histological features suggestive of malignancy were present including intratumor necrosis in 4/22 cases (18%) and cellular atypia in 1/22 cases (5%). CONCLUSIONS: In Golden and Labrador retrievers there is evidence that limbal melanomas, CAUM and ocular melanosis are at least in part heritable and that the same genetic mutation(s) may be causally associated with melanocytic disease at different ocular sites. The same genetic mutation(s) may be present in these two breeds. Histology should be performed on all cases to identify those with greater malignant potential.     

Epidemiology of canine glaucoma presented to University of Zurich from 1995 to 2009. Part 1: Congenital and primary glaucoma (4 and 123 cases)

Objective To investigate the epidemiology of canine congenital and primary glaucoma in the cases presented to the University of Zurich, Vetsuisse Faculty (UZH) from 1995 to 2009. Methods Information was obtained from the computer database of patients examined by members of the UZH Ophthalmology Service, between January 1995 and August 2009. Congenital and primary glaucoma was diagnosed based on the age of onset, the lack of evidence of any antecedent eye conditions, and/or the presence and severity of iridocorneal angle defects. The data was evaluated for breed, gender and age at presentation. Results A total of 5984 dogs presented to the UZH Ophthalmology service between 1995 and 2009. Four dogs of different breed were diagnosed with congenital glaucoma and 123 dogs were diagnosed with primary glaucoma. For the primary glaucomas the overall male to female ratio (M:F) was 1:1.41 and the age of onset ranged from 0.12 to 18.3 years with a mean of 7.3 ± 3.6 years. Data suggested a predisposition for primary glaucoma in the Siberian Husky, Magyar Vizsla and Newfoundland from 2004 to 2009. Conclusion The report presents the epidemiology of canine congenital and primary glaucomas presented to the UZH from 1995 to 2009. A previous suspicion of predisposition for primary glaucoma in the Newfoundland dog (n = 6) and the Magyar Vizsla breed (n = 8) was confirmed.     

Comparisons of computed tomography, contrast-enhanced computed tomography and standing low-field magnetic resonance imaging in horses with lameness localised to the foot. Part 2: Lesion identification

Reasons for performing study: No previous study compares computed tomography (CT), contrast‐enhanced computed tomography (CECT) and standing low‐field magnetic resonance imaging (LFMRI) to detect lesions in horses with lameness localised to the foot. This study will help clinicians understand the limitations of these techniques. Objectives: To determine if CT, CECT and LFMRI would identify lesions within the distal limb and document discrepancies with lesion distribution and lesion classification. Methods: Lesions in specific structures identified on CT and MR images of feet (31 limbs) from the same horse were reviewed and compared. Distributions of lesions were compared using a Chi‐squared test and techniques analysed using the paired marginal homogeneity test for concordance. Results: Lesions of the deep digital flexor tendon (DDFT) were most common and CT/CECT identified more lesions than LFMRI. Deep digital flexor tendon lesions seen on LFMRI only were frequently distal to the proximal extent of the distal sesamoid and DDFT lesions seen on CT/CECT only were frequently proximal to the distal sesamoid. Lesions identified on LFMRI only were core (23.3%) or splits (43.3%), whereas lesions identified only on CT were abrasions (29.8%), core (15.8%), enlargement (15.8%) or mineralisation (12.3%). Contrast‐enhanced CT improved lesion identification at the DDFT insertion compared to CT and resulted in distal sesamoidean impar ligament and collateral sesamoidean ligament vascular enhancement in 75% of cases. Low‐field MRI and CT/CECT failed to identify soft tissue mineralisation and bone oedema, respectively. Conclusions and potential relevance: Multiple lesions are detected with CT, CECT and LFMRI but there is variability in lesion detection and classification. LFMRI centred only on the podotrochlear apparatus may fail to identify lesions of the pastern or soft tissue mineralisation. Computed tomography may fail to identify DDFT lesions distal to the proximal border of the distal sesamoid.     

The helminth fauna of the common seal (Phoca vitulina vitulina, Linné, 1758) from the Wadden Sea in Lower Saxony. Part 1: Trematodes, cestodes and acanthocephala.

Between August 1988 and January 1989 110 common seals found dead along the coast of Lower Saxony were investigated for the occurrence of trematodes, cestodes and acanthocephala. Two fluke species, Cryptocotyle lingua Creplin, 1825 and Phagicola septentrionalis Van Den Broek, 1967, two tapeworm species Diphyllobothrium cordatum Leuckart, 1863 and Diphyllobothrium elegans Krabbe, 1865, and the acanthocephala species Corynosoma strumosum Rudolphi, 1802 were found. Phagicola septentrionalis and the cestodes were always found together with Cryptocotyle lingua. The prevalence of Phagicola septentrionalis, the diphyllobothriids and the acanthocephala increased with increasing age of the pinniped host. The worm counts of all species appeared to increase with increasing age of the host. The adult male seals were more often infested with Phagicola septentrionalis and cestodes than the female adults and the younger pinnipeds. There was no correlation between blubber thickness of the seals and parasitic infection. The prevalence of the diphyllobothriids and the intensity of the infection with acanthocephala were higher in seals found in the eastern part of the Wadden Sea.