Serum hepatitis associated with commercial plasma transfusion in horses

This report describes 4 fatal cases of serum hepatitis associated with the administration of commercial plasma in the horse. Serum hepatitis in the horse is characterized by acute hepatic central lobular necrosis, and it has been associated with the administration of biological products of equine origin. None of these horses had a recent history of equine biologic-origin vaccination; however, they had received 1.5-5 L of commercial plasma, and in I horse, an additional 8 L of fresh blood. Acute, severe colic unresponsive to medical therapy, lethargy, or sudden death developed in these 4 horses 41 to 60 days later. Two of the horses developed encephalopathy, confirmed in 1 horse by the presence of severe diffuse Alzheimer type II astrocytes in the brain. Although the prevalence of serum hepatitis associated with the administration of commercial plasma appears to be low in the horse, it should be considered an uncommon but potentially fatal risk factor.     

Theiler's disease associated with administration of tetanus antitoxin contaminated with nonprimate (equine) hepacivirus and equine parvovirus-hepatitis virus

An 11-year-old Trakehner gelding was presented for evaluation of lethargy, decreased appetite, mild icterus, and elevated hepatic enzyme activities. Physical examination, serum chemistry results, and liver biopsy histopathologic findings were supportive of Theiler's disease. Polymerase chain reaction (PCR) testing results of serum and liver tissue were positive for nonprimate (equine) hepacivirus (NPHV) and a novel equine parvovirus-hepatitis virus (EqPV-H). PCR testing of the lot of tetanus antitoxin administered to the gelding 3 months previously also yielded positive results for NPHV and EqPV-H. Treatment included supportive care and clinical signs resolved within 1 week, although hepatic enzyme activities remained elevated for several months. The horse successfully returned to work as a hunter/jumper for about 1 year until it developed a forelimb lameness and progressive atrophy of shoulder musculature (sweeney), prompting a decision for euthanasia 20 months after initial evaluation. Serial PCR testing of serum revealed persistent infection with both NPHV and EqPV-H and necropsy examination revealed chronic active hepatitis, mild liver atrophy, and positive PCR results for NPHV and EqPV-H in liver tissue. This case highlights the possible risk of administering potentially contaminated biologics of equine origin and the importance of screening for recently identified hepatic viruses in donors from which blood products are prepared.     

Glanders--a comprehensive review

Since 1990 the number of glanders outbreaks in race, military and pleasure horses in Asia and South America is steadily increasing. Glanders, which is eradicated in Western Europe, Australia and Northern America, is currently considered a re-emerging disease. Consequently, the disease may be introduced into glanders-free regions by subclinical carriers at any time. The causative agent of glanders, Burkholderia (B.) mallei, is highly contagious and leads to chronic disease in horses whereas in donkeys and mules the disease is acute and often fatal. Occurrence of the disease leads to international trading restrictions and infected animals immediately have to be culled and safely disposed off. In humans B. mallei infection results in a severe clinical course, and is fatal without appropriate therapy. Its pathogenicity makes B. mallei a potential biological agent that may be used in bioterroristic attacks. Due to the eradication of glanders in the second half of the last century, veterinarians in western European countries are no longer familiar with its clinical presentation in solipeds. Having these facts in mind, this review describes the epidemiology, clinical signs, pathology and the current eradication strategy of this interesting zoonosis. Pictures of imported endurance horses infected with glanders taken during an eradication campaign in Dubai, United Arab Emirates, in 2004 illustrate most typical clinical findings.     

Hendra (equine morbillivirus)

Hendra has been recognized in Australia as a new zoonotic disease of horses since 1994/5 and subsequent work has shown that the viral agent is endemic in certain species of fruit bat. The Hendra virus is the type species of a new genus within the sub-family Paramyxovirinae, which also contains another newly identified zoonotic bat virus, namely Nipah. It is assumed that contact with bats has led to the Hendra virus being transferred to horses on each of the three separate incidents that have been reported in the last five years. No evidence has been found for widespread subclinical infection of horses.Infected horses can develop a severe and often fatal respiratory disease characterized by dyspnoea, vascular endothelial damage and pulmonary oedema. Nervous signs may also occur. Fatal respiratory disease has been seen in cats and guinea pigs following experimentally induced infections. Transmission of the virus from horses to other horses or man seems to have taken place, but very close contact was required. Three human cases have been recognized, all in association with equine cases. There have been two human fatalities, one due to respiratory failure and the other from a delayed-onset encephalitis. A number of diagnostic methods have been developed, but great care must be taken in obtaining samples from suspected cases.     

3-methylindole as a model of equine obstructive lung disease

3-methylindole was administered orally and intravenously to horses and ponies in order to determine the ability of this chemical to provide a model of equine pulmonary disease. Both routes produced a severe and sometimes fatal pulmonary disease, characterised by bronchiolitis. Clinical signs developed 48 to 72 h after dosing and were most severe between Days 4 and 10 post dosing. Intravenous administration of 3-methylindole produced lung injury more rapidly and at a lower dose rate than the oral route. It is suggested that the respiratory condition induced by this chemical could become a method for standardisation of lung function techniques and interpretation in equine obstructive pulmonary disease.     

Standardised exercise testing in 17 reining horses: Musculoskeletal,respiratory, cardiac and clinicopathological findings

Exercise testing can be useful to evaluate poor performance, as a preventative medicine tool, and in the assessment of training progression. A comprehensive exercise testing protocol that simultaneously evaluates common causes of poor performance has not been described in reining horses. The objective of this study was to describe the results of a standardised exercise testing protocol in reining horses. Seventeen reining horses that were part of a western performance intercollegiate team and had met the trainer's expectations during the athletic season were evaluated using a comprehensive standardised exercise test. Systems assessed included musculoskeletal system, upper respiratory tract, lower respiratory tract and cardiovascular system. These systems were assessed by means of historical questionnaires, general physical examinations, subjective lameness examinations, gait analysis using digital body mounted inertial sensors, resting and dynamic upper airway endoscopy, bronchoalveolar lavage fluid cytology, echocardiograms, resting and exercising electrocardiography, and laboratory tests (packed cell volume, lactate, creatine kinase and serum amyloid A). Subclinical abnormalities were detected frequently. The musculoskeletal system was the most commonly affected system, but cardiovascular and upper and lower airway abnormalities were also detected in some horses. These results suggest that exercise tests may be useful to detect subclinical abnormalities in horses used for reining. Further evaluation of both normally and poorly performing horses is necessary to determine if exercise testing can improve the health, performance and welfare of horses used for reining.     

Cytology of tracheobronchial aspirates in horses.

Tracheobronchial aspirates were obtained from 27 normal horses and from 57 horses with respiratory disease. Aspirates from normal horses contained mainly ciliated columnar epithelial cells, mononuclear cells, a few neutrophils and mucus. Aspirates from horses with acute suppurative bronchopneumonias or chronic bronchiolitis had predominantly neutrophils and usually large amounts of mucus; in severe suppurative inflammatory diseases, many of the cells were degenerated, and there were coils of fibrinous material resembling Curschmann's spirals. Eosinophils were rarely found, even from horses with histories suggestive of allergic respiratory disease. Aspirates from horses with epistaxis frequently had macrophages with intracytoplasmic green globules (hemosiderin). Tracheobronchial aspirates occasionally revealed subclinical lung disease. Four horses with no clinical signs of lung disease and lungs that were unremarkable on percussion and normal on auscultation had adpirates suggestive of inflammation; histologic examination confirmed bronchiolitis.     

Hemostatic abnormalities in equine colic

Hemostatic profiles were determined in 30 horses with clinical colic. Blood samples were obtained at the time of the animal's admission, and the following hemostatic tests were done: blood platelet count, plasma fibrinogen, plasma antithrombin, prothrombin time, partial thromboplastin time, thrombin time, protamine sulfate test for soluble fibrin monomer, and fibrin-fibrinogen degradation products. The patients were categorized in retrospect, according to the cause of the colic: group 1--colic associated with colitis and/or severe diarrhea, group 2--colic associated with torsion or obstruction of the intestine, and group 3--colic associated with impaction of the intestine or the presence of enteroliths. Of the 30 horses with colic, 28 had at least 1 abnormality in their coagulogram--the most frequent abnormalities being high plasma fibrinogen concentration, high circulating soluble fibrin monomer, or a long partial thromboplastin time or thrombin time. The horses in group 1 seemed to have the most severe coagulopathies, as indicated by the average number of demonstrable abnormalities. The horses in group 3 showed the fewest abnormalities--usually a high plasma concentrations of fibrinogen and/or soluble fibrin monomer. The results indicated that hemostatic abnormalities are not uncommon in horses with gastrointestinal disease and colic--the degree of severity depending to some extent on the cause of the colic.     

Subclinical ultrasonographic abnormalities of the suspensory ligament branch of the athletic horse: A survey of 60 Thoroughbred racehorses

Reasons for performing study: Ultrasonographic (US) abnormalities of the suspensory ligament branch (SLB) have been poorly investigated but can have considerable impact on market value and career path when encountered in athletic horses. There is a need for determination of the prevalence and relationship to clinical injury of these US abnormalities in the Thoroughbred (TB) racehorse. Objectives: To establish the prevalence of, and the repeatability of an US grading system for, subclinical US abnormalities of the forelimb SLB in a population of UK TB flat racehorses. Methods: Ultrasonographic assessment of the forelimb SLBs of 60 TB racehorses free from history and clinical indication of SLB desmopathy in a single UK training yard was performed. Images were viewed independently by 2 blinded observers and graded for US abnormality. Interobserver agreement was assessed using Cohen's kappa statistic with 95% confidence intervals (95% CI). Results: Prevalence of horses with subclinical US abnormality of the forelimb SLB of moderate severity was 6.7%. Medial branches were overrepresented. Inter observer agreement was substantial for US grade (kappa = 0.743; 95% CI 0.652–0.834) and almost perfect for appearance of sesamoid bone at ligament insertion (kappa = 0.817; 95% CI 0.66–0.98). Conclusions: The study reveals that a proportion of TB racehorses in flat training free from history or clinical signs of SLB injury have US abnormalities that could negatively impact on market value and career path. Potential relevance: Clinicians should be aware that US abnormalities of the SLB may not always be related to clinical desmopathy. Further longitudinal studies are required to determine whether such findings are predictive for future injury.     

MAGNETIC RESONANCE IMAGING FINDINGS IN HORSES WITH RECENT ONSET NAVICULAR SYNDROME BUT WITHOUT RADIOGRAPHIC ABNORMALITIES

Seventy-two horses with recent onset of navicular syndrome and normal radiographs were assessed. Horses underwent magnetic resonance (MR) imaging of both front feet. All abnormalities were characterized and the most severe abnormality identified, if possible. Abnormal signal intensity in the navicular bone was the most severe abnormality in 24 (33%) horses. Pathologic change in the deep digital flexor tendon was the most severe abnormality in 13 (18%) horses. Pathologic change in the collateral sesamoidean ligament was the most severe abnormality in 11 (15%) horses. Pathologic change in the distal sesamoidean impar ligament was the most severe abnormality in seven (10%) horses. Multiple abnormalities were observed in 13 (18%) horses in which an abnormality that was more severe than the others could not be determined. Abnormalities were not observed in the navicular bone or its supporting soft tissues in four (5%) horses. Fifty-six horses had abnormalities that were most severe in one limb; in 52 (93%) horses, the most severe abnormalities were in the foot of the most lame limb. In 7% (4/56) of horses, the most severe findings were in the opposite limb, and in 16 horses, the findings on both limbs were similar. MR imaging is a useful technique for evaluating horses with navicular syndrome and can differentiate between multiple abnormalities. This provides a more specific diagnosis which affects further treatment of the horse. Pathologic changes in different locations in the foot can cause similar clinical signs that, before MR imaging, were categorized as one syndrome.     

Electroencephalographic alterations in a mare with presumed intermittent neuroglycopenia caused by severe hypoglycaemia-associated with nonislet cell tumour

The focus of this report was to document the electroencephalogram (EEG) findings associated with nonislet cell tumour-induced hypoglycaemia (NICTH) in a racing Thoroughbred mare subsequently diagnosed with renal carcinoma and carcinomatosis. We evaluated cortical cerebral activity and confirmed paroxysmal activity consistent with subclinical seizures by performing an EEG prior to onset of clinical signs of seizures. We showed that the electrical activity pattern progressed in a similar fashion as in humans with severe, progressive hypoglycaemia and presumed neuroglycopenia. The glycaemic threshold for abnormalities detected in EEG showed that abnormal electrical cortical activity appeared when blood glucose dropped to 44 mg/dL (2.4 mmol/L) and paroxysmal activity spread, becoming generalised when blood glucose dropped to 23 mg/dL (1.3 mmol/L). NICTH is an uncommon paraneoplastic phenomenon in several species. In horses, NICTH has been reported most frequently in primary renal tumours, followed by primary hepatic tumours. This report highlights the importance of investigating the possibility of hypoglycaemia in cases of horses that present altered state of consciousness with or without intermittent seizures. This case report also highlights that the diagnostic work-up for horses presenting with episodic hypoglycaemia should comprise investigation of possible neoplasia, as paraneoplastic hypoglycaemia should be included in the list of differentials of horses with hypoglycaemia.     

Electrocardiography in the horse. (A report of findings in 138 horses)

Over a period of approx. 3 years, electrocardiograms (ECG) were recorded from 138 horses referred as patients to the Medical Clinic. Of these, 22 horses (approx. 16 per cent) has ECG alterations. The 22 ECG's revealed a total of 29 ECG abnormalities. The most frequent ECG alteration was incomplete AV block, that was seen in 9 horses (31 per cent of the ECG abnormalities). Abnormal (i.e. broad, tent-like and, sometimes, inverted) T waves and deviations of the ST segment were seen each in 5 ECG's from 7 horses, 3 of which had both abnormalities which were associated with severe underlying disease (colic, enteritis, pneumonia, strangles a.o.). Premature ventricular beats were seen in 3 horses, two of which had serious cardiovascular dysfunction whereas the third showed no signs of cardiac disease. Atrial fibrillation was observed in two horses. Both were treated with chinidine sulphate but a conversion to sinus rhythm was not achieved in either case. Other ECG abnormalities observed in the study were, parasystole (1 horse), sinus arrhythmia (2 horses), sinoatrial block (1 horse) and wandering pacemaker (1 horse). Each abnormality is discussed with regard to its clinical significance and diagnosis. Cardiac murmurs were detected on auscultation of 26 horses (approx. 19 per cent). The murmurs in 15 horses were short and faint sounds most of which were diastolic. They were considered of no importance. Eleven horses, on the other hand, had distinct, loud (grade 4 or 5), holosystolic or holodiastolic murmurs that were considered pathological. Eight of these horses had actual signs of cardiac disease. Cardiac vector distribution in patients with ECG abnormalities or murmurs showed no systematic differences from vectors in horses showing no cardiac abnormality.     

Equine Protozoal Myeloencephalitis

Gathering information about Equine Protozoal Myeloencephalitis (EPM) was identified by the equine industry as one of the highest priorities for the NAHMS Equine '98 study. Overall, 59.8 percent of owners/operators interviewed had never heard of EPM, and only 9.5 percent considered themselves knowledgeable about this disease. EPM was reported to have occurred on 1.0 percent of operations in the year prior to the study and on 3.3 percent of operations at any point in the operation's history. The incidence of EPM was estimated in the year prior to the study to be 14 new cases per 10,000 horses per year. The majority of operations where EPM was reported had only identified a single case at any time during their history. While this study was based on owner/operator reports of disease, 95.0 percent of cases recognized during the year prior to this study were diagnosed by a veterinarian. Onset of disease was reported most commonly to occur during the summer or fall. The most common signs reported in cases occurring during the previous year were ataxia, limb weakness, lameness, and muscle atrophy. The most common methods used to diagnose EPM in these horses were recognition of clinical signs, serology, and CSF analysis. Among the last cases recognized on operations for which duration of illness was at least 3 months, 39.7 percent were reported to recover completely, 37.4 percent improved but did not completely recover, 14.4 percent were sold or given away because they had EPM, and 7.1 percent died or were euthanatized because of EPM. For those EPM cases that completely recovered, relapsed following improvement and showed no improvement after at least 3 months' duration, the average number of days of lost use was 244 days. For those EPM cases that died because of EPM, an estimated 9.2 years of use were lost. Excluding cases that were less than 3 months in duration, the geometric mean cost to operations for diagnostic testing, veterinary care, and medications provided for the last diagnosed case of EPM was $790. EPM was reported to occur rarely in this study population, despite the use of owner reports to measure disease occurrence. Veterinarians were almost always employed in the diagnosis of this disease for cases occurring in the previous year. Despite its rare occurrence, this disease is a very serious health problem in affected horses and only about 40 percent of affected horses were reported to have recovered completely. Equine protozoal myeloencephalitis (EPM) is a serious and often fatal neurologic disease of equids.^1-6 Ammals affected by EPM can demonstrate a variety of clinical abnormalities, and signs can vary tremendously in severity. Classically, horses with EPM develop a variety of asymmetric neurologic deficits including gait abnormalities, ataxia, weakness, and focal muscle wasting.^4-6 However, symmetric neurologic abnormalities are also seen frequently. The disease may be focal or multifocal in nature and may be manifested less frequently as a head tilt, facial paralysis, seizures, or even apparent behavioral changes.^4-6 Horses of all ages can be affected, but horses are usually at least 6 months old when first diagnosed with EPM.     

Respiratory diseases and their effects on respiratory function and exercise capacity

Given that aerobic metabolism is the predominant energy pathway for most sports, the respiratory system can be a rate‐limiting factor in the exercise capacity of fit and healthy horses. Consequently, respiratory diseases, even in mild forms, are potentially deleterious to any athletic performance. The functional impairment associated with a respiratory condition depends on the degree of severity of the disease and the equestrian discipline involved. Respiratory abnormalities generally result in an increase in respiratory impedance and work of breathing and a reduced level of ventilation that can be detected objectively by deterioration in breathing mechanics and arterial blood gas tensions and/or lactataemia. The overall prevalence of airway diseases is comparatively high in equine athletes and may affect the upper airways, lower airways or both. Diseases of the airways have been associated with a wide variety of anatomical and/or inflammatory conditions. In some instances, the diagnosis is challenging because conditions can be subclinical in horses at rest and become clinically relevant only during exercise. In such cases, an exercise test may be warranted in the evaluation of the patient. The design of the exercise test is critical to inducing the clinical signs of the problem and establishing an accurate diagnosis. Additional diagnostic techniques, such as airway sampling, can be valuable in the diagnosis of subclinical lower airway problems that have the capacity to impair performance. As all these techniques become more widely used in practice, they should inevitably enhance veterinarians' diagnostic capabilities and improve their assessment of treatment effectiveness and the long‐term management of equine athletes.     

Comparison of serum and urinary concentrations of clenbuterol with and without concomitant administration of furosemide in horses

Furosemide is frequently used to control or prevent exercise-induced pulmonary hemorrhage in performance horses. The bronchodilating agent clenbuterol is also commonly used as a treatment for inflammatory airway disease in performance horses. Use of both medications is regulated by many racing authorities. The effects of concomitant administration of furosemide and clenbuterol on the pharmacokinetics of clenbuterol have not been well characterized. A study was designed to evaluate the influence of furosemide on serum and urine concentrations of clenbuterol after oral administration of clenbuterol and intravenous administration of furosemide in horses. Results indicated that urinary concentrations of clenbuterol in horses treated concomitantly with furosemide and clenbuterol were increased, whereas serum concentrations of the drug were decreased. These effects persisted during the study period and varied among horses.     

Putative intestinal hyperammonaemia in horses: 36 cases

Reasons for performing the study: Intestinal hyperammonaemia (HA) has been infrequently reported in individual horses; however, there have been no studies describing clinical and laboratory data as well as short‐ and long‐term outcome in a larger number of cases. Objectives: To describe clinical and laboratory data and short‐ and long‐term outcome in a large group of horses with intestinal HA. Methods: Multi‐centred, retrospective study; case records of horses with HA were reviewed and any horse with a clinical or post mortem diagnosis of intestinal HA was included. Hyperammonaemia was defined as a blood ammonium (NH₄⁺) concentration ≥60 µmol/l and horses with a diagnosis of primary hepatic disease were excluded. Relevant data were recorded and, if appropriate, data from survivors were compared to nonsurvivors to identify potential prognostic indicators. Results: Thirty‐six cases, 26 mature horses and 10 foals with intestinal HA were identified. Case histories included diarrhoea, colic and neurological signs and the most common clinical diagnosis was colitis and/or enteritis. The most common clinical and laboratory abnormalities included tachycardia, increased packed cell volume, hyperlactataemia and hyperglycaemia. Fourteen horses (39%) survived to discharge; NH₄⁺ concentration on admission was the only parameter significantly associated with survival. All surviving horses and foals for which follow‐up information was available recovered completely and returned to their intended use without further complications. Conclusions and potential relevance: Intestinal HA occurs in mature horses and foals and can be associated with severe clinical and laboratory abnormalities; further studies are required to investigate predisposing factors and delineate possible differences in aetiologies.     

Serum amyloid A in equine health and disease

Serum amyloid A (SAA) is the major acute phase protein in horses. It is produced during the acute phase response (APR), a nonspecific systemic reaction to any type of tissue injury. In the blood of healthy horses, SAA concentration is very low, but it increases dramatically with inflammation. Due to the short half-life of SAA, changes in its concentration in blood closely reflect the onset of inflammation and, therefore, measurement of SAA useful in the diagnosis and monitoring of disease and response to treatment. Increases in SAA concentration have been described in equine digestive, reproductive and respiratory diseases and following surgical procedures. Moreover, SAA has proven useful for detection of some subclinical pathologies that can disturb training and competing in equine athletes. Increasing availability of diagnostic tests for both laboratory and field use adds to SAA's applicability as a reliable indicator of horses’ health status. This review article presents the current information on changes in SAA concentrations in the blood of healthy and diseased horses, focussing on clinical application of this biomarker.     

Clinicopathologic evidence of disseminated intravascular coagulation in horses with acute colitis

OBJECTIVE: To detect subclinical disseminated intravascular coagulation (DIC) in horses with colitis and to determine any association between the diagnosis of subclinical DIC and outcome or occurrence of complications in horses with colitis. DESIGN: Prospective study. ANIMALS: 37 horses admitted to a veterinary teaching hospital for treatment of acute colitis. PROCEDURE: Coagulation profiles were obtained on each horse 0, 24, and 48 hours after admission. Six tests were performed: platelet count, plasma fibrinogen concentration, prothrombin time, activated partial thromboplastin time, antithrombin activity, and serum fibrin degradation products concentration. RESULTS: A clinicopathologic diagnosis of subclinical DIC was made if 3 of the 6 tests had abnormal results at any 1 sample period. No horse had clinical signs of DIC at the time of sampling. Twelve of 37 (32%) horses met the criteria for diagnosis of subclinical DIC within a 1-year period. Outcome was defined as survival or nonsurvival. Five of 12 horses with subclinical DIC and 2 of 25 horses without subclinical DIC did not survive. Crude odds ratio analysis revealed a horse with acute colitis was 8 times as likely to die or be euthanatized if a diagnosis of subclinical DIC was made. CONCLUSIONS AND CLINICAL RELEVANCE: Clinicopathologic evidence of DIC is common and is significantly associated with a poor outcome in horses with acute colitis. Treatment of subclinical DIC may influence outcome in horses with acute colitis.     

Vitamin K3-induced renal toxicosis in the horse

Renal toxicosis attributable to vitamin K3 (menadione sodium bisulfite) was suspected in 5 young adult horses in which acute renal failure developed following parenteral administration of vitamin K3 at the manufacturers' recommended dosages. Renal disease was subsequently induced experimentally in 5 of 6 horses by administration of vitamin K3 at manufacturers' recommended dosages. Signs of renal disease in the clinical patients as well as in the horses treated experimentally included renal colic, hematuria, azotemia, and electrolyte abnormalities consistent with acute renal failure. Two clinical patients and 3 experimental horses were subsequently necropsied and found to have lesions of renal tubular nephrosis.     

Systemic antibodies to Clostridium botulinum type C: do they protect horses from grass sickness (dysautonomia)?

The aetiology of equine grass sickness (EGS) is still unknown. There is increasing evidence that toxicoinfection with Clostridium botulinum type C is involved. Epidemiological evidence shows that resistance to EGS can occur in older horses and those that have been on a particular pasture for longer or have been in prior contact with the disease. This resistance may be in the form of an immune response to the aetiological agent. Levels of systemic antibodies to the surface antigens of C. botulinum type C (using the closely related and safe C. novyi type A as a phenotypic marker) and to the botulinum type C neurotoxin (BoNT/C) were investigated in horses with and without EGS. Horses with grass sickness were found to have significantly lower levels of systemic IgG to both surface antigens and BoNT/C. Horses with low levels of systemic immunity to these antigens may be more susceptible to developing EGS. There were no significant differences in antibody levels between the different categories of EGS, suggesting systemic immunity to C. botulinum type C does not play a significant role in influencing the severity of the disease. However, horses that had been in contact with EGS or that were grazing land where it had occurred frequently in the past had significantly higher antibody levels to these antigens. These horses may have been exposed to subclinical doses of C. botulinum type C and BoNT/C, resulting in the production of a protective immune response against the putative aetiological agent. This finding is of potential significance for the prospect of prevention of EGS by vaccination against C. botulinum type C.