Bacteremia in equine neonatal diarrhea: a retrospective study (1990-2007)

Background: Bacteremia in sick foals is associated with survival, but the association of bacteremia and diarrhea is not reported.
Hypothesis: Neonatal foals with diarrhea will commonly be bacteremic.
Animals: One hundred and thirty-three neonatal foals.
Methods: Records of all foals <30 days of age presenting with diarrhea between January 1990 and September 2007 were reviewed.
Results: Sixty-six of 133 foals (50%) were bacteremic at admission, with 75 isolates from the 66 samples. The blood culture from a further 18 foals (13.5%) grew coryneform bacteria. Nine foals (6.8%) had 2 or more organisms grown on blood culture. One foal had 5 different organisms, interpreted as contamination. Forty-eight foals (36%) had no growth on admission blood cultures. No cultures isolated fungal organisms. Excluding coryneform bacteria, 43 isolates (57%) were Gram-negative organisms and 32 isolates (43%) were Gram-positive organisms. The most common isolate was Enterococcus spp. (22 isolates, 29%), followed by Pantoea agglomerans (13 isolates, 17%). IgG concentration at admission was not associated with blood culture status. Blood culture status was not associated with survival to hospital discharge.
Conclusions and Clinical Importance: Bacteremia is common in neonatal foals with diarrhea. Decisions regarding antimicrobial selection should be made with these differences in mind.     

Comparison of bacteriologic culture of blood and necropsy specimens for determining the cause of foal septicemia: 47 cases (1978-1987)

Diagnosis of bacterial septicemia was confirmed by results of bacteriologic culture of antemortem blood samples and/or necropsy specimens obtained from 47 foals up to 8 days old. Gram-negative bacteria were isolated from all 47 foals, and mixed infections with more than one organism were involved in 26 (55%). Escherichia coli, Actinobacillus spp, and Klebsiella pneumoniae were the most frequent isolates, infecting 55, 34, and 23% of foals, respectively. Gram-positive bacteria and anaerobic bacteria were isolated only from foals with mixed infections with gram-negative organisms. Clostridium perfringens was the only anaerobe isolated. In 38 (81%) of 47 foals with confirmed septicemia, blood samples were culture-positive. Thirty-two septicemic foals subsequently died, allowing a comparison to be made between the species of bacteria isolated by culture of blood with those recovered by culture of internal organs at necropsy. Blood failed to yield any gram-negative organisms in 12 (37.5%) of 32 foals from which a gram-negative pathogen was isolated at necropsy. Forty-three percent of the gram-negative bacteria, including 59% of the E coli, and 10% of the gram-positive bacteria found in septicemic foals at necropsy were not detected earlier by results of bacteriologic culture of blood.     

A retrospective study of the clinical presentation of 140 dogs and 39 cats with bacteraemia

OBJECTIVES: To evaluate retrospective data from 140 dogs and 39 cats with positive blood cultures that were presented to the Clinic for Small Animal Medicine in Munich from 1995 to 2004. METHODS: The identity of bacteria isolated from blood cultures of dogs and cats with bacteraemia was determined, and clinical and laboratory findings and outcome of animals with Gram-negative versus Gram-positive bacteraemia were compared. RESULTS: Sepsis was diagnosed in 81.7 per cent of dogs and 59.5 per cent of cats with bacteraemia. Escherichia coli was isolated in one third of the animals. Dogs with bacteraemia more often showed monocytosis and increased alkaline phosphatase activity, while in cats, hyperglycaemia was found more commonly. Dogs with Gram-negative bacteraemia had hypoalbuminaemia significantly more often than dogs with Gram-positive bacteraemia, while among the remaining parameters, there were no statistically significant differences. CLINICAL SIGNIFICANCE: Not all dogs and cats with a positive blood culture met the criteria for sepsis. Bacteraemia caused by Gram-positive versus Gram-negative bacteria cannot be distinguished based on clinical or laboratory parameters, and bacterial culture and susceptibility testing have to be performed for the right choice of antibiotic treatment.     

Blood culture isolates and antimicrobial sensitivities from 427 critically ill neonatal foals

OBJECTIVE: To assist correct decision-making about antimicrobial treatment of equine neonates with septicaemia. DESIGN: Retrospective study of microbial blood culture results obtained from foals less than 7 days of age. METHODS: Microbial blood culture results from foals less than 7 days of age admitted to an intensive care unit between July 1999 and December 2004 were reviewed. Antimicrobial sensitivity was assessed by the Kirby Bauer disc diffusion method. Antimicrobials were defined as an effective first-line choice antimicrobial if greater than 70% of isolates were susceptible. Multiple drug resistance (MDR) was defined as resistance to at least three antimicrobials in different chemical classes or with different mechanisms of resistance. RESULTS: Of the 427 Thoroughbred foals included in the study, a positive blood culture was obtained in 110 foals and 124 microorganisms were isolated. Gram-positive isolates, predominantly Streptococcus/Enterococcus spp, were obtained in 41% of foals. Gram-negative isolates were predominantly of the Enterobacteriaceae family, in particular Escherichia coli. The overall antimicrobial sensitivity of the isolates was low. The Gram-positive organisms had unpredictable sensitivity patterns. MDR was recorded in 32% of isolates. In total, 81% of foals were discharged from hospital and 74.5% of foals with a positive blood culture were discharged. CONCLUSION: With the increasing prevalence of Gram-positive microorganisms and their unpredictable sensitivity patterns, blood cultures remain important in the diagnosis and treatment of equine neonatal septicaemia.     

Arterial lactate concentration, hospital survival, sepsis and SIRS in critically ill neonatal foals

REASONS FOR PERFORMING STUDY: Blood lactate concentration has been shown to be a useful clinical indicator in human patients, but has not been formally investigated in critically ill foals. OBJECTIVE: To investigate the association of blood lactate with hospital survival, markers of cardiovascular status, metabolic acid base status, sepsis and systemic inflammatory response syndrome (SIRS). METHODS: A database containing clinical, haematological, plasma biochemical and hospital outcome data on neonatal foals referred to an intensive care unit in 2000-2001 was analysed. Seventy-two foals for which arterial lactate was measured at admission were included in the study. RESULTS: Sixty-one foals had an admission lactate concentration > 2.5 mmol/l. Admission lactate was statistically associated with hospital survival, mean arterial pressure, blood creatinine concentration, bacteraemia, anion gap, lactate concentration at 18-36 h after admission and evidence of SIRS, but not with packed cell volume or heart rate. Lactate at 18-36 h was also associated with survival and evidence of SIRS. Anion gap, base excess, base excess due to unidentified anions (BEua), simplified strong ion gap or bicarbonate correctly classified foals for presence of hyperlactaemia (> 5 mmol/l) in < or = 80% of animals. CONCLUSIONS: Admission blood lactate gives important prognostic information. Lactate should be measured rather than assumed from the anion gap, base excess, BEua, simplified strong ion gap or bicarbonate. POTENTIAL RELEVANCE: Blood lactate concentrations at admission are clinically relevant in neonatal foals and warrant further investigation. This should include the clinical value of measuring changes in lactate in response to treatment.     

Bacterial isolates from blood and their susceptibility patterns in critically ill foals: 543 cases (1991-1998)

OBJECTIVE: To assess microorganisms isolated from blood specimens obtained from critically ill neonatal foals and to evaluate their antimicrobial susceptibility patterns. DESIGN: Retrospective study. ANIMALS: 543 neonatal foals. PROCEDURE: Medical records of foals that were < 1 month old and were admitted to a referral neonatal intensive care unit were reviewed for results of bacteriologic culture of blood and antimicrobial susceptibility patterns. RESULTS: At least 1 microorganism was isolated from 155 of 543 (28.5%) foals. Escherichia coli was the most commonly isolated bacterium. A single gram-positive organism was detected in 49 foals. Although 90% of the E coli isolates were susceptible to amikacin, some gram-negative and gram-positive organisms had resistance against multiple antimicrobials. CONCLUSIONS AND CLINICAL RELEVANCE: Gram-negative bacteria remain the most common isolates from blood of neonatal foals; however, gram-positive organisms were also found, and with greater prevalence than reported elsewhere. Susceptibility patterns may vary, and resistance to multiple antimicrobials may develop. This is especially true for organisms such as Enterobacter spp and Enterococcus spp. Prudent empirical treatment for neonatal sepsis should include broad-spectrum antimicrobials.     

Antimicrobial susceptibility of bacteria isolated from neonatal foal samples submitted to a New Zealand veterinary pathology laboratory (2004 to 2013)

AIMS: To describe antimicrobial susceptibility, and identify antimicrobial resistance (AMR), in bacteria isolated from New Zealand foals.

METHODS: A database search was performed of submissions to a veterinary pathology laboratory between April 2004 and December 2013 for bacterial culture of samples from foals <3 weeks of age. Culture and susceptibility results were compiled with demographic information. Susceptibility results were as defined for the Kirby-Bauer disk diffusion susceptibility test based on Clinical Laboratory Standards Institute guidelines. Multi-drug resistance (MDR) was defined as non-susceptibility to ≥3 of a panel of antimicrobials (ceftiofur, enrofloxaxin, gentamicin, penicillin, tetracycline, trimethoprim-sulfonamide); penicillin susceptibility was not included for Gram-negative isolates.

RESULTS: Submissions from 102 foals were examined, and 127 bacterial isolates were cultured from 64 (63%) foals. Of the 127 isolates, 32 (25%) were Streptococcus spp., 30 (24%) were Staphylococcus spp., 12 (10%) were Enterococcus spp. and 26 (21%) were Escherichia coli. Of 83 Gram-positive isolates, 57 (69%) were susceptible to penicillin. Over all isolates, 92/126 (73%) were susceptible to gentamicin and 117/126 (93%) to enrofloxacin; 62/82 (76%) of Gram-positive, and 22/42 (52%) of Gram-negative bacteria were susceptible to ceftiofur; 53/81 (65%) of Gram-positive, and 23/44 (52%) of Gram-negative bacteria were susceptible to tetracycline; 59/82 (72%) of Gram-positive, and 23/44 (43%) of Gram-negative bacteria were susceptible to trimethoprim-sulfonamide. Of 126 isolates, 33 (26%) had MDR; >1 isolate with MDR was cultured from 24/64 (38%) foals, and ≥2 isolates with MDR were recovered from 8/64 (13%) foals.

CONCLUSIONS: Multi-drug resistance, including resistance to commonly used antimicrobials, was found in bacterial isolates from foals in New Zealand.

CLINICAL RELEVANCE: The results of this study are of concern from a treatment perspective as they indicate a potential for antimicrobial treatment failure. For future surveillance of AMR and the creation of national guidelines, it is important to record more data on samples submitted for bacterial culture.     

A retrospective study of 192 horses affected with septic arthritis/tenosynovitis.

The medical records of 192 horses with septic arthritis/tenosynovitis 1979-1989 were reviewed. Forty-three horses developed infection after an intra-articular injection, 46 following a penetrating wound, 25 following surgery, 66 were foals less than 6 months old, and 12 were adult horses without a known aetiology. Haematogenous infection of a joint occurs in adult horses and should be considered as a differential diagnosis in horses with an acute onset of severe lameness. The aetiology of the infection had a significant effect on the type of bacteria identified by culture. Staphylococcus was cultured from most of the horses that developed infection following a joint injection or surgery, 69% of the horses from which an organism was identified. Horses that developed infection secondary to a penetrating wound frequently provided cultures of more than one organism; Enterobacteriaceae and anaerobes were more frequently isolated in this group. The most common organisms isolated from foals were Enterobacteriaceae; E. coli was identified in more than 27% of the foals. The hock was the most frequently involved joint. Multiple treatments were used over the 10-year period of study. Survival rates were lowest in foals; only 45% survived to be released from the hospital. Survival was greater in adult horses; 85% of the horses that were treated were released from the hospital. Survival was significantly greater in horses with septic tenosynovitis; all 14 of the horses that were treated survived. Survival was not significantly affected by the joint involved or by the type of bacteria cultured from the synovial fluid.(ABSTRACT TRUNCATED AT 250 WORDS)     

Clinical, ultrasonographic, and surgical findings in foals with umbilical remnant infections

Infection of umbilical arteries, umbilical vein, and/or urachus was diagnosed ultrasonographically in 33 foals 1 to 90 days old (mean, 17.7 +/- 17.3 days). In these foals, the most common initial problems were umbilical abnormalities, septic arthritis, and/or neonatal septicemia. In 16 foals, abnormalities of the external umbilical stalk were noticed on admission. Abnormalities of the internal umbilical structures were identified when enlargement and echogenic material (fluid and/or gas) were imaged ultrasonographically within these structures. Multiple structures were affected in 23 foals, with the urachus the most commonly affected structure. Surgical findings confirmed ultrasonographic identification of infected umbilical structures in 23 foals. Twenty-two samples from affected umbilical remnants submitted for culture at surgery were positive for bacterial growth. Multiple organisms were isolated in 15 cultures. Escherichia coli and beta-hemolytic streptococci were the most common isolates. Two foals died of late complications associated with surgical resection, 1 foal treated surgically and 3 foals treated medically died or were euthanatized because of other complications, and the remaining 27 foals lived.     

Use of closed-suction drains to treat generalized peritonitis in dogs and cats: 40 cases (1997-1999)

OBJECTIVE: To determine outcome of dogs and cats with generalized peritonitis treated by means of closed-suction drainage. DESIGN: Retrospective study. ANIMALS: 30 dogs and 10 cats with generalized peritonitis. PROCEDURE: Medical records were reviewed, and information on signalment, clinicopathologic abnormalities, contamination source, results of microbial culture, surgical procedure performed, postoperative management, complications, and outcome was obtained. RESULTS: The gastrointestinal tract was the most common source of contamination. Abdominal fluid collected from 34 patients at the time of surgery was submitted for bacterial culture; results were positive for 28 (82%). The most commonly isolated organism was Escherichia coli. Postoperative complications included anemia (n = 21), hypoproteinemia (21), vomiting (9), edema (7), and diarrhea (5). Total solids concentration did not decrease during the first 48 hours after surgery, and all drains remained functional until removal. Twenty-eight patients survived to the time of discharge; 8 of the 12 animals that died did so within 18 hours after surgery. The only factor significantly different between patients that survived and patients that died was postoperative systolic blood pressure. Factors that were not significantly associated with outcome included detection of bacteria in the abdominal fluid, number of organisms cultured from the abdominal fluid, selection of antimicrobials for empiric treatment, and source of contamination. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that closed-suction drainage may be a useful method for treating generalized peritonitis in dogs and cats. No clinically important complications were associated with their use.     

Comparison of viscoelastic coagulation analysis and standard coagulation profiles in critically ill neonatal foals to outcome

Objective – To determine if changes in viscoelastic variables are associated with abnormalities observed in the standard coagulation profile and patient outcome in foals with suspected septicemia. Design – Prospective clinical trial during 2003 and 2004 foal season. Setting – Neonatal intensive care unit at a veterinary teaching hospital. Animals – Thirty critically ill foals <72‐hour‐old admitted sequentially meeting criteria for systemic inflammatory response associated with infection. Interventions – Hemostatic evaluation, using standard coagulation testing and viscoelastic analysis, was performed at admission, 24 hours following admission, and 48 hours following admission in critically ill foals. Standard coagulation tests included platelet count, prothrombin time, activated partial thromboplastin time, fibrinogen, fibrin(ogen) degradation products, and antithrombin. Data collected from viscoelastic analysis included time to initial clot formation (ACT), clot rate, and platelet function. Signalment, blood culture results, clinicopathologic data, and outcome were collected from medical records. Equality of populations test was used to determine associations between coagulation tests and blood culture status/outcome, as well as between viscoelastic parameters and coagulopathy, blood culture status, and outcome. Logistic regression was used to quantify associations. A significance level of P<0.05 was used. Measurements and Main Results – Foals with decreasing clot rate (CR) over the sample period were more likely to be euthanized or die (P=0.02). Foals with prolonged ACT (P=0.03), and decreased CR at admission (P=0.047), were more commonly coagulopathic. Identification of coagulopathy on admission (P=0.02), or persistence of hemostatic dysfunction 48 hours later (P=0.04), was associated with death. Conclusions – Viscoelastic coagulation evaluation could be used in a neonatal intensive care unit setting to further characterize coagulopathy, and identify foals at higher risk for poor outcome.     

Blood arginine vasopressin, adrenocorticotropin hormone, and cortisol concentrations at admission in septic and critically ill foals and their association with survival

BACKGROUND: Sepsis is an important cause for neonatal foal mortality. The hypothalamic-pituitary-adrenal axis (HPAA) responses to sepsis are well documented in critically ill humans, but limited data exist in foals. The purpose of this study was to evaluate the HPAA response to sepsis in foals, and to associate these endocrine changes with survival. HYPOTHESIS: Blood concentrations of arginine vasopressin (AVP), adrenocorticotropin hormone (ACTH), and cortisol will be higher in septic foals as compared with sick nonseptic and healthy foals. The magnitude of increase in hormone concentration will be negatively associated with survival. ANIMALS: Fifty-one septic, 29 sick nonseptic, and 31 healthy foals of < or =7 days of age were included. METHODS: Blood was collected at admission for analysis. Foals with positive blood culture or sepsis score > or =14 were considered septic. Foals admitted with disease other than sepsis and healthy foals were used as controls. AVP, ACTH, and cortisol concentrations were measured using validated immunoassays. RESULTS: AVP, ACTH, and cortisol concentrations were increased in septic foals. Septic nonsurvivor foals (n = 26/51) had higher plasma ACTH and AVP concentrations than did survivors (n = 25/51). Some septic foals had normal or low cortisol concentrations despite increased ACTH, suggesting relative adrenal insufficiency. AVP, ACTH, and cortisol concentrations were higher in sick nonseptic foals compared with healthy foals. CONCLUSIONS AND CLINICAL IMPORTANCE: Increased plasma AVP and ACTH concentrations in septic foals were associated with mortality. Several septic foals had increased AVP : ACTH and ACTH : cortisol ratios, which indicates relative adenohypophyseal and adrenal insufficiency.     

Bacteraemia in man and animals: An overview

Bacteraemia signifies invasion of the bloodstream by bacteria. In most systemic infections in man and animals, bacteria enter the blood at some stage during the infection and are rapidly distributed throughout the body. A wide variety of organisms have been associated with bacteraemia. Prompt detection of the aetiological agents of bacteraemia is of prime importance in clinical microbiology. There are no defined recommendations for blood cultures in animals but both conventional and improved methods are available for detection of bacteraemia in man. The consequences of bacteraemia are as diverse as the potential aetiological agents. Monoclonal antibodies to the core glycolipid (lipid A) seems very promising for the treatment of bacteraemia and septic shock caused by Gram-negative bacteria in man and animals.     

Evaluation of the relationship between causative organisms and clinical characteristics of infective endocarditis in dogs: 71 cases (1992-2005)

OBJECTIVE: To evaluate microbiologic findings in dogs with infective endocarditis (IE) and determine whether there were differences in clinical features of disease caused by different groups of infective agents. DESIGN: Retrospective case series. ANIMALS: 71 dogs with suspected or definite IE. PROCEDURES: Medical records were reviewed for results of bacterial culture and susceptibility testing, serologic assays for vector-borne disease, and PCR testing on vegetative growths. Cases were grouped by causative organism and relationships among infectious agent group, and various hematologic, biochemical, and clinical variables were determined. Survival analyses were used to determine associations between infecting organisms and outcome. RESULTS: Causative bacteria were identified in 41 of 71 (58%) dogs. Gram-positive cocci were the causative agents in most (21/41; 51%) infections, with Streptococcus canis associated with 24% of infections. Gram-negative organisms were detected in 9 of the 41 (22%) dogs. Infection with Bartonella spp was detected in 6 of 31 (19%) dogs with negative results for microbial growth on blood culture. Aortic valve involvement and congestive heart failure were more frequent in dogs with endocarditis from Bartonella spp infection, and those dogs were more likely to be afebrile. Infection with Bartonella spp was negatively correlated with survival. Mitral valve involvement and polyarthritis were more frequent in dogs with streptococcal endocarditis. CONCLUSIONS AND CLINICAL RELEVANCE: Streptococci were the most common cause of IE and were more likely to infect the mitral valve and be associated with polyarthritis. Dogs with IE secondary to Bartonella spp infection were often afebrile, more likely to develop congestive heart failure, rarely had mitral valve involvement, and had shorter survival times.     

Serum lactoferrin and immunoglobulin G concentrations in healthy or ill neonatal foals and healthy adult horses

BACKGROUND: Lactoferrin is a colostral glycoprotein with antimicrobial properties. HYPOTHESES: (1) Serum lactoferrin and immunoglobulin G (IgG) concentrations are correlated and increase in healthy foals after ingestion of colostrum; (2) compared to healthy foals, ill foals will have lower lactoferrin concentrations that correlate with their IgG concentration, neutrophil count, the diagnosis of sepsis, and survival; and (3) plasma concentrations of lactoferrin will be less than serum concentrations. ANIMALS: Healthy foals (n = 16), mature horses (n = 10), and ill foals 1-4 days old (n = 111) that were examined for suspected sepsis were used for blood collection. Colostrum was obtained from 10 healthy mares unrelated to the foals. METHODS: Blood was obtained from the healthy foals at birth and 1-3 days of age and from the ill foals at admission. Serum IgG was quantified by single radial immunodiffusion (SRID). Lactoferrin concentrations in colostrum and blood were determined by an enzyme-linked immunosorbant assay. The sepsis score, blood culture results, neutrophil counts, and survival were obtained on ill foals. RESULTS: The mean colostral lactoferrin concentration was 21.7 microg/mL. Compared to values at birth, serum IgG (18+/-2 versus 2,921+/-245 mg/dL, SEM) and lactoferrin (249+/-39 versus 445+/-63 ng/mL, SEM) concentrations were significantly greater in healthy foals 1-3 days old. Serum lactoferrin concentration in 1-3-day-old healthy foals was not different from mature horses or ill foals. IgG and lactoferrin concentrations were significantly correlated only in healthy foals. Serum lactoferrin concentrations were significantly lower in ill neutropenic foals. The serum IgG concentration was significantly lower in ill foals as compared to healthy foals. Only serum IgG was significantly less in ill foals with a positive sepsis score and in nonsurvivors, Plasma lactoferrin concentrations were lower than serum concentrations, although values were significantly correlated. CLINICAL IMPORTANCE: Although both serum IgG and lactoferrin concentrations increase in healthy foals after ingestion of colostrum, only serum IgG is significantly correlated with the sepsis score and outcome.     

Insulin, glucagon, and leptin in critically ill foals

Background: Endocrine dysregulation of hormones of energy metabolism is well documented in critically ill humans, but limited information exists in septic foals. The purpose of this study was to provide information on the hormonal response to energy metabolism in critically ill foals, focusing on insulin, glucagon, and leptin. Hypothesis: Concentrations of insulin, glucagon, leptin, and triglycerides will be higher, whereas glucose concentration will be lower in septic foals than in healthy and sick nonseptic foals. The magnitude of these differences will be associated with severity of disease and nonsurvival. Animals: Forty‐four septic, 62 sick nonseptic, and 19 healthy foals <7 days of age. Methods: In this prospective multicenter cross‐sectional study, blood samples were collected at admission. Foals with positive blood culture or sepsis score ≥12 were considered septic. Results: Septic foals had lower glucose and insulin and higher triglyceride and glucagon concentrations than did healthy foals. Glucagon concentrations were not different between septic foals that died (n = 14) or survived (n = 30). Higher insulin and lower leptin concentrations were associated with mortality. Quantitative insulin‐sensitivity check index was higher in septic foals. Conclusions and Clinical Importance: Energy metabolism and the endocrine response of related hormones in septic foals are characterized by hypoglycemia, hypertriglyceridemia, low insulin concentration, and high glucagon concentration. Leptin and insulin may have prognostic value for nonsurvival in septic foals. The hormonal response related to energy metabolism in critical illness differs between foals and humans.     

Comparison of three techniques for the diagnosis of urinary tract infections in dogs with urolithiasis

OBJECTIVES: To identify an appropriate sampling technique(s) to accurately detect the bacteria causing urinary tract infections in dogs with urolithiasis. METHODS: Twenty-one dogs with urolithiasis were included in the study. Three types of samples were taken from each dog. Urine was collected by cystocentesis, and a urinary bladder mucosal biopsy and urolith were retrieved during cystotomy. The samples were then cultured on blood agar and MacConkey's agar to identify the bacteria associated with urinary tract infections. RESULTS: Bacterial urinary tract infection was found in 16 cases (76.19 per cent). The most prevalent bacteria found to cause urinary tract infection were Escherichia coli (n=7), followed by coagulase-positive Staphylococcus species (n=4), Klebsiella pneumoniae (n=2), Pseudomonas aeruginosa (n=2) and Proteus mirabilis (n=1). In the case of a positive urine culture, the same bacteria were also cultured from the urinary bladder mucosal biopsy alone or from both the urinary bladder mucosal biopsy and urolith. However, in the case of a negative urine culture, bacteria were found to be present in the urinary bladder mucosal biopsy or urolith cultures in 23.81 per cent of dogs. The uroliths that gave positive culture results were either infection-induced uroliths composed of struvite and calcium carbonate phosphate, ammonium acid urate only or metabolic uroliths composed of calcium oxalate and calcium phosphate, or calcium phosphate only. All the uroliths that gave negative culture results were metabolic uroliths composed of calcium oxalate and/or calcium phosphate, and uric acid and calcium phosphate. CLINICAL SIGNIFICANCE: When the culture from the urine obtained by cystocentesis is negative, cultures of urinary bladder mucosal biopsy and urolith are recommended in dogs with urolithiasis in order to accurately assess the microbiological status of the urinary tract.     

The first reported case of equine nocardioform placentitis in South Africa

Since the late 1980s a distinct form of focally-extensive mucoid to mucopurulent uterine body chronic placentitis,caused by nocardioform organisms, hasbeen recognised in horses in the USA state of Kentucky and possibly in other areas. This disease has led to increasing numbers of foal losses from late abortions, still-births, prematurity, or early neonatal deaths. The foals are usually not infected, but may be small or emaciated. Modes of infection and transmission are as yet unknown. Nocardia spp. and related nocardioform bacteria as causes of equine infertility, endometritis and foal death are briefly reviewed. A case of near full-term abortion involving a Friesian mare in the Pretoria district of Gauteng Province in South Africa during February 2000, with the same placental lesion as described in the Kentucky cases, is presented. Nocardioform organisms were visualised on impression smears and histological sections of affected foetal membranes, and were also cultured. The organism has been identified at the Livestock Disease Diagnostic Center of the University of Kentucky as an Amycolatopsis sp. of the less-commonly diagnosed group of nocardioforms causing placentitis in the USA. The organism was cultured from the uterus of the mare 18 days post-foaling, but after a 2-week course of oral trimethoprim and sulphamethoxazole, based on antibiogram sensitivity testing, a uterine flush yielded no growth. A semen sample from the sire of the aborted foal did not yield any Gram-positive filamentous branching bacteria. The mare subsequently conceived to a single insemination.     

Serum amyloid A (SAA) as an aid in the management of infectious disease in the foal: comparison with total leucocyte count,neutrophil count and fibrinogen

Differentiation between infectious and noninfectious disease and rapid initiation of accurate treatment are essential in managing diseases in the neonatal and young foal. Identification of useful inflammatory markers for these purposes is, therefore, of great importance. The aim of this study was to compare the responses of the acute phase protein serum amyloid A (SAA) with the responses of fibrinogen and total leucocyte and neutrophil counts in infectious diseases encountered in the young foal, and to assess whether SAA measurements give additional information useful in the management of these diseases. In a prospective study, foals (n = 25) showing clinical signs indicative of infectious disease were blood sampled on admission and then daily or every second day during hospitalisation. The main presenting signs were neonatal weakness (n = 9), pneumonia (n = 6) and diarrhoea (n = 10). SAA and fibrinogen concentrations on admission were higher in foals with bacterial infections (n = 8) than in foals with nonbacterial or uncertain diagnoses (n = 17). On admission, weak foals with negative blood cultures (n = 3) had normal SAA and fibrinogen concentrations and varying total leucocyte and neutrophil counts. Foals with positive blood cultures (n = 2) had markedly increased SAA, decreased or increased fibrinogen concentration and leuco- and neutropenia. Those with ambiguous blood cultures (n = 3) had moderate to markedly increased SAA concentrations and normal fibrinogen concentration, leucocyte and neutrophil counts on admission. All foals with negative or ambiguous blood cultures recovered and had normal or decreasing SAA concentration on discharge. Both foals with a positive blood culture were subjected to euthanasia. One foal born with equine herpesvirus-1 infection had moderately increased SAA and normal fibrinogen concentration and leuco- and neutropenia. Foals with Rhodococcus equi pneumonia had increased concentrations of all parameters on admission. On discharge, recovered foals had normal SAA concentrations, whereas fibrinogen and total white blood cell count and neutrophil counts were still increased. There were no consistent inflammatory changes in the parameters measured in diarrhoeic foals and there was no statistical difference between rotavirus-positive (n = 4) and -negative (n = 6) foals in this respect. The results of this investigation suggest that SAA might be an aid in the differential diagnostic procedure of neonatally weak foals and in foals with diarrhoea as the main presenting clinical sign and that SAA measurements could add information in the monitoring of treatment in Rhodococcus equi pneumonia by responding more rapidly than the markers used to date.     

Factors associated with prognosis for survival and athletic use in foals with septic arthritis: 93 cases (1987-1994).

OBJECTIVE: To identify factors affecting the prognosis for survival and athletic use in foals with septic arthritis. DESIGN: Retrospective study. ANIMALS: 93 foals with septic arthritis. PROCEDURE: Medical records were reviewed to obtain clinical findings, laboratory test results, radiographic findings, treatment method, and outcome. Race records for Thoroughbreds and Standardbreds were evaluated to determine whether foals subsequently raced and whether they raced successfully. RESULTS: 43 foals had 1 affected joint, 44 foals had multiple affected joints, and number of affected joints was not recorded for 6 foals. The femoropatellar and tarsocrural joints were most commonly affected. Osteomyelitis or degenerative joint disease were detected in 59% (46/78) of foals. Failure of passive transfer, pneumonia, and enteritis were common. Foals were treated with lavage, lavage and intra-articular administration of antibiotics, lavage and arthroscopic debridement with or without partial synovectomy, or lavage and arthrotomy to debride infected bone and systemic administration of antibiotics. Seventy-three foals survived to be discharged from hospital, and approximately a third raced. Isolation of Salmonella spp from synovial fluid was associated with an unfavorable prognosis for survival and multisystem disease was associated with an unfavorable prognosis for survival and ability to race; other variables were not significantly associated with survival and ability to race. CONCLUSIONS AND CLINICAL RELEVANCE: With treatment, the prognosis for survival of foals with septic arthritis was favorable, whereas prognosis for ability to race was unfavorable. Multisystem disease, isolation of Salmonella spp from synovial fluid, involvement of multiple joints, and synovial fluid neutrophil count > or = 95% at admission may be of prognostic value.