Pathophysiology,diagnosis and treatment of neonatal sepsis

Sepsis is a major cause of death in neonatal foals and, in recent years, significant progress in the understanding of the underlying pathophysiology has been made. To achieve a successful outcome, early diagnosis and treatment focusing on supporting vital functions and neutralising the effects of the causative organisms are essential. The pharmacokinetics of many drugs differ in neonatal foals and more information for appropriate dosing of antimicrobial and anti‐inflammatory drugs for neonatal foals is now available to guide clinicians in choosing the best dosages. Prevention remains difficult and focuses on early recognition while prophylactic use of antimicrobials is discouraged.     

Assessment of the equine neonate in ambulatory practice

The ambulatory practitioner is usually the first to evaluate the equine neonate and must assess the foal and determine its health status. If there is suspicion of one or more abnormalities, then the ambulatory veterinarian must initiate appropriate treatment and determine if the foal can be successfully treated in the field or should be referred to a specialty hospital. This article will describe the examination procedure including an accurate history, a comprehensive physical examination, laboratory evaluation and application of point‐of‐care diagnostics. The initial examination is the basis for the correct determination of health or illness and informing the owner of the correct course of action for the neonatal foal.     

Pattern recognition receptors in equine endotoxaemia and sepsis

Pattern recognition receptors (PRRs) on host cells detect pathogens to activate innate immunity which, in turn, initiates inflammatory and adaptive immune responses. Successful activation of PRRs is, therefore, critical to controlling infections and driving pathogen-specific adaptive immunity, but overactivity of PRRs causes systemic inflammation, which is detrimental to the host. Here we review the PRR literature as it relates to horses and speculate on the role PRRs may play in sepsis and endotoxaemia.     

Management and treatment of the sick equine neonate in ambulatory practice

The ambulatory practitioner is usually the first to evaluate the equine neonate and must assess the foal and determine its health status. If one or more abnormalities are identified, the practitioner must initiate appropriate treatment and determine whether the foal can be managed successfully on the farm or referred to a specialty centre. This article describes the basic requirements that should be met and the limitations involved in treating compromised neonates on the farm. Treatments for common foal disorders are discussed.     

A review of equine sarcoid

Equine sarcoid is the most common tumour of horses and accounts for over half of all equine skin tumours. Six types of sarcoid based on gross appearance and clinical behaviour have been described including occult, verrucous, nodular, fibroblastic, mixed and malevolent. Common locations for sarcoid development include the periocular region, ear pinnae, lips, neck, extremities and ventrum (including groin region). Bovine papillomavirus (BPV) is causally associated with equine sarcoid with genetic haplotype, fly vectors and skin trauma identified as potential risk factors for development of the disease. Histopathology is required for definitive diagnosis of equine sarcoid but incomplete excision is thought to activate latent BPV and stimulate growth. Although there are no uniformly effective treatment options, several modalities have been successful in eliminating or managing equine sarcoid. Surgical excision, intratumoural chemotherapy, cryotherapy, hyperthermia, radiotherapy, immunotherapy and immune modulators are used with degrees of success relative to the accessibility and invasiveness of the tumour. Prevention of equine sarcoid may be facilitated by future development of vaccines against bovine papillomavirus.     

Systemic antimicrobial therapy in foals

Antimicrobial agents are commonly used in neonatal foals for the treatment or prevention of sepsis. However, due to concerns about the development of antimicrobial resistance and increasing pressure on veterinarians to rationalise antimicrobial use, we should be trying to reduce the unnecessary use of antimicrobials. This article reviews many of the important considerations when selecting an antimicrobial for use in neonatal foals. Firstly, we consider general differences in neonatal pharmacology and physiology. Secondly, we review common antimicrobial drugs and their indications. Finally, we review antimicrobial stewardship.     

Use of antiviral medications against equine herpes virus associated disorders

Numerous types of equine herpesviruses (EHV) continue to afflict horses resulting in a variety of clinical manifestations. While many of the clinical manifestations of EHV are self‐limiting or require only supportive care, some clinical expressions of EHV infections cause severe risk to the horse's overall health and can result in abortion, long‐term deficits or death. Antiviral medications are infrequently utilised therapeutics in equine medicine and their exact efficacy is largely unknown. However, the use of antiviral medications may potentially decrease convalescent time and improve outcome in horses with EHV‐related diseases. Thus, equine practitioners should consider the potential use of antiviral medications in the future. The purpose of this article is to familiarise the equine practitioner with current information in regard to antiviral medications and their potential uses in equine medicine.     

The development of equine immunity: Current knowledge on immunology in the young horse

The development of equine immunity from the fetus to adulthood is complex. The foal's immune response and the immune mechanisms that they are equipped with, along with changes over the first months of life until the immune system becomes adult‐like, are only partially understood. While several innate immune responses seem to be fully functional from birth, the onset of adaptive immune response is delayed. For some adaptive immune parameters, such as immunoglobin (Ig)G1, IgG3, IgG5 and IgA antibodies, the immune response starts before or at birth and matures within 3 months of life. Other antibody responses, such as IgG4, IgG7 and IgE production, slowly develop within the first year of life until they reach adult levels. Similar differences have been observed for adaptive T cell responses. Interferon‐gamma (IFN‐γ) production by T helper 1 (Th1)‐cells and cytotoxic T cells starts shortly after birth with low level production that gradually increases during the first year of life. In contrast, interleukin‐4 (IL‐4) produced by Th2‐cells is almost undetectable in the first 3 months of life. These findings offer some explanation for the increased susceptibility of foals to certain pathogens such as Rhodococcus equi. The delay in Th‐cell development and in particular Th2 immunity during the first months of life also provides an explanation for the reduced responsiveness of young horses to most traditional vaccines. In summary, all immune components of adult horses seem to exist in foals but the orchestrating and regulation of the immune response in immature horses is strikingly different. Young foals are fully competent and can perform certain immune responses but many mechanisms have yet to mature. Additional work is needed to improve our understanding of immunity and immune regulation in young horses, to identify the preferred immune pathways that they are using and ultimately provide new preventive strategies to protect against infectious disease.     

A review of equine laryngoplasty complications

Prosthetic laryngoplasty is a common treatment for equine recurrent laryngeal neuropathy (RLN). Complications of this surgery include immediate post operative problems, such as dysphagia, seroma formation, wound infection and sudden loss of arytenoid abduction. Longer term complications include gradual loss of arytenoid abduction, chronic coughing, arytenoid granulomas and dynamic upper airway collapse unrelated to RLN such as palatal dysfunction, and aryepiglottic fold or vocal fold collapse. However, the benefit of this procedure greatly outweighs these potential post operative complications, especially if appropriate surgical and post operative management practices are employed.     

In vitro and in vivo modulation of the equine immune response by parapoxvirus ovis

REASON FOR PERFORMING STUDY: While immune modulators are used routinely in equine medicine, their mechanism of action is not always known. OBJECTIVES: To determine the effect of a commercial preparation of inactivated parapoxvirus ovis (Orf virus; PPVO) on cytokine gene expression by equine peripheral blood mononuclear cells (PBMC) both in vitro and in vivo. METHODS: PBMC were prepared from 6 mixed-breed yearlings and cultured in vitro with PPVO with or without Concanavalin A (Con A) for 24 h. Effects on the expression of IFNalpha, IFNbeta IFNgamma, TNFalpha and IL-18 were analysed by real time quantitative PCR (RT-PCR). In addition, 12 yearling horses were treated with PPVO and whole blood RNA samples were prepared at regular intervals to assess effects on in vivo cytokine gene expression. Six of those yearlings were later treated with saline and served as treatment controls. Nine additional yearlings were injected intradermally with a single dose and their injection sites biopsied at 24 and 48 h for cytokine expression. RESULTS: In vitro culture of PBMC with PPVO led to a significant increase in IFNalpha and IFNbeta gene expression compared to mock-stimulated cultures. In addition, expression of IFNgamma and TNFalpha was significantly higher in PBMC stimulated with PPVO and Con A, than those stimulated with Con A alone. No changes were observed in IL-18 gene expression in vitro. Treatment of horses with a 3-dose regimen of PPVO resulted in elevation of IFNgamma gene expression, which was detected 24 h after the first dose and declined thereafter. Intradermal inoculation led to increased expression of IFNgamma along with IFNbeta, IL-15 and IL-18. CONCLUSIONS: Together these results indicate that PPVO stimulated IFNgamma production both in vitro and in vivo. Increased cytokine expression could account for its immunomodulatory activity. POTENTIAL RELEVANCE: The absence of adverse reactions and clear indications of increased expression of cytokine gene expression supports previous clinical uses for this immune modulator in those situations when increased expression of IFNgamma is warranted.     

A review of equine mucocutaneous squamous cell carcinoma

Squamous cell carcinoma (SCC) accounts for approximately 20% of all equine mucocutaneous (MC) tumours and continues to present a therapeutic challenge to practitioners. Most MC‐SCC are locally invasive and slow to metastasise, but metastasis to local lymph nodes is not uncommon. The most common location for MC‐SCC is the periorbital region, with the eyelid most commonly affected. Although only 13% of MC‐SCC involves the external genitalia, MC‐SCC is the most common neoplasm of male genitalia. Equine caballus papillomavirus‐2 has recently been linked to MC‐SCC and may prove to be necessary for tumour development. Risk factors may include chronic exposure to ultraviolet light and chronic skin irritation. Horses developing genital MC‐SCC tend to be older compared to those with periorbital MC‐SCC. Histopathology is required for definitive diagnosis of MC‐SCC, although horse phenotype and lesion location may suggest MC‐SCC. Several treatment modalities have been successful in eliminating or managing MC‐SCC, with surgical excision and intratumoural chemotherapy yielding the best results. Other treatment options including cryotherapy, hyperthermia, radiotherapy and photodynamic therapy are often used as adjunctive therapies. Early recognition of tumours and prompt intervention are associated with a positive outcome.     

Palmar process fractures of the distal phalanx in foals: A review

Distal phalanx fractures are well documented in adult horses, but our knowledge of such fractures in foals is limited. Recent studies showed a high incidence of distal phalanx palmar process (PP) fractures in foals, the aetiology is not yet known. Several hypotheses have been suggested as possible causes, including uneven compressive forces, unequal forces from the deep digital flexor tendon, composition and shape of the PP, and conformation. A better understanding of the aetiology and predisposing factors requires further research. Radiography is the commonly used imaging modality for diagnosis of such fractures; however, those fractures might be missed on routine radiographic projections. In order to have a high probability of identifying fractures, a series of 5 radiographs including the oblique views is required. This article reviews the incidence of distal phalanx PP fractures and discusses the diagnosis of such fractures.     

A review of approaches to assessing equine welfare

Veterinary surgeons are required to assess an animal's welfare in a range of different circumstances in the course of their daily work. These assessments may relate to the long‐term welfare of an individual animal under their care, or the current welfare of a population of animals that are unfamiliar to them as individuals. The welfare assessment made may subsequently have implications for the treatment that an animal receives or for the decision of whether or not an animal should remain in its current home. Yet welfare assessment is not straightforward. Here we review the challenges that welfare assessment presents and review the tools currently available to meet them. Lastly, we look towards the future of equine welfare assessment, with examples of current research to develop tools and optimise welfare assessment.