Strangles and its complications

Strangles, caused by the Gram‐positive bacteria Streptococcus equi subspecies equi (S. equi), is a highly contagious upper respiratory infection in horses. The infection is transmitted by inhalation or direct contact with mucopurulent discharge from an infected animal, resulting in fever, depression, and submandibular and retropharyngeal lymph node enlargement that can lead to respiratory distress. Complications include secondary cellulitis at external abscessation sites, guttural pouch empyema and its persistence into the carrier state, purpura haemorrhagica, metastatic abscessation, emergency tracheostomies and rarely secondary S. equi pneumonia or myositis. Control of outbreaks requires strict isolation protocols and hygiene measures. Detection methods of the index case and carrier state are constantly being refined to assist in the identification and prevention of disease perpetuation.     

Unusual Patterns of Serum Antibodies to Streptococcus Equi in Two Horses with Purpura Hemorrhagica

An enzyme-linked immunosorbent assay (ELISA) was developed for use in horses to determine serum titers of antibodies of the immunoglobulin classes IgA, IgG, and IgM to Streptococcus equi M-like protein and culture supernatant protein antigens. Serum antibodies were determined in 28 adult horses, including 9 horses with recent S. equi infections, 17 horses without known exposure to S. equi, but without a history of respiratory disease in the preceding 4 months, and 2 horses with clinical purpura hemorrhagica. Serum IgA titers to culture supernatant protein antigen were highest in recently infected horses (P less than 0.001). Serial determinations of antibody titers in the horses with purpura showed that IgG antibodies to both S. equi M-like protein and culture supernatant protein antigens were undetectable initially, but later rose coincidental with clinical recovery from the disease. Possible mechanisms for these findings are discussed.     

Dynamic collapse of the upper respiratory tract: A review

Dynamic collapse of the upper respiratory tract is a common cause of poor performance in athletic horses. Most commonly, airway obstruction occurs during strenuous exercise when the upper respiratory tract is exposed to high pressure swings. In horses undertaking submaximal exercise, the pressures may also be increased due to flexion of the neck. The nasopharynx and larynx are particularly prone to dynamic collapse and a number of different forms of upper airway obstruction are now recognised. However, due to the dynamic nature of the collapse a definitive diagnosis is often not possible from resting observations alone.     

Association of owner-reported noise with findings during dynamic respiratory endoscopy in Thoroughbred racehorses

Reasons for performing study: To determine the association between owner‐reported noise and findings during dynamic respiratory endoscopy (DRE) in a large case series. Hypothesis: The sensitivity of owner‐reported noise for dynamic upper respiratory tract obstructions in horses is low, and the specificity is high. Methods: One hundred horses underwent DRE for the investigation of abnormal respiratory noise and/or poor performance. The association of abnormal noise with findings during DRE was evaluated. Results: Eighty‐five horses underwent DRE for the investigation of abnormal respiratory noise. Of these, 82% were found to have one or more obstructive upper respiratory tract abnormalities during DRE. Forty‐eight percent of horses reported to gurgle, rattle or make a rough noise were diagnosed with solitary palatal dysfunction. A further 24% with this history showed palatal dysfunction in combination with an additional abnormality. Twenty‐seven percent of horses with a history of whistling or roaring showed some degree of recurrent laryngeal neuropathy. Seven percent of horses with a history of whistling or roaring had vocal cord collapse as a solitary condition, whereas 40% had vocal cord collapse and another abnormality. The sensitivity of abnormal respiratory noise for any obstruction of the upper portion of the respiratory tract was high (84%), while the specificity was low (25%). Characteristic owner reported noise patterns showed moderate to low sensitivity for specific conditions. Whistling and roaring showed the highest specificity (≥80%) for laryngeal dysfunction. Conclusion: Diagnosis of upper respiratory tract obstructions based solely on owner‐reported noise and performance history may result in incomplete diagnoses. Clinical relevance: DRE should be performed in horses with abnormal respiratory noise to rule out complex conditions of the upper portion of the respiratory tract.     

Evaluation of upper respiratory tract function during strenuous exercise in racehorses

Forty-six racehorses with a history of poor performance underwent endoscopic evaluation of laryngeal and pharyngeal function while exercising on a high-speed treadmill. This evaluation allowed the definitive diagnosis of intermittent or continual upper respiratory tract obstruction as a cause of poor performance, as well as the documentation of the dynamic functional anatomy of the obstruction. Ten of the horses (22%) were determined to have a functional abnormality of the upper respiratory tract. These abnormalities included epiglottic entrapment (1 horse), persistent dorsal displacement of the soft palate during exercise (4 horses), and left laryngeal hemiplegia (5 horses). Thirty-two horses were observed to have signs of left laryngeal hemiparesis (asynchronous arytenoid movement) at rest that did not impair full laryngeal abduction during strenuous exercise.     

Infarctive purpura hemorrhagica in five horses

Five horses were examined because of signs of muscle stiffness, colic, or both. All 5 had been exposed to Streptococcus equi within 3 weeks prior to examination or had high serum titers of antibodies against the M protein of S equi. Horses had signs of unrelenting colic-like pain and focal areas of muscle swelling. Four horses were euthanatized. The fifth responded to treatment with penicillin and dexamethasone; after 3 weeks of treatment with dexamethasone, prednisolone was administered for an additional 10 weeks. Common hematologic and serum biochemical abnormalities included neutrophilia with a left shift and toxic changes, hyperproteinemia, hypoalbuminemia, and high serum creatine kinase and aspartate transferase activities. Necropsy revealed extensive infarction of the skeletal musculature, skin, gastrointestinal tract, pancreas, and lungs. Histologic lesions included leukocytoclastic vasculitis in numerous tissues and acute coagulative necrosis resembling infarction. These horses appeared to have a severe form of purpura hemorrhagica resembling Henoch-Sch?nlein purpura in humans and characterized by infarction of skeletal muscles. Early recognition of focal muscle swelling, abdominal discomfort, neutrophilia, hypoalbuminemia, and high serum creatine kinase activity combined with antimicrobial and corticosteroid treatment may enhance the likelihood of a successful outcome.     

Epizootiological investigation if strangles in the equine stables in tehran

Strangles is an acute disease of horses caused by infec- tion with Streptococcus equi. It is characterized by inflamma- tion of the upper respiratory tract and abscessation in the adjacent lymph nodes. The distribution of strangles is world- wide. When an outbreak does occur in a large group of horses, it is usually restricted to the younger age groups, under adverse climatic conditions, and when shelter is inadequate. When the group is made up of predominantly young horses, up to 100% may be affected. Such a high incidence is encountered soon after large numbers of susceptible horses, which may have come from many localities, are stabled to get her. The source of infection is the nasal discharge from infected animals, which contaminates the pasture and feed and water troughs. Infection occurs by ingestion or by inhalation o f droplets. During April (1990), two cases of strangles were diag- nosed at Veterinary Faculty Teaching Hospital in Tehran. An epizootiological survey commenced immediately and showed 89-100% of horses were affected. The clinical symp- toms were severe in young horses and the mortality rate was zero. All of the infected horses responded to treatment with intramuscular injection of penicillin/streptomycin.     

Use of successive dynamic videoendoscopic evaluations to identify progression of recurrent laryngeal neuropathy in three horses

CASE DESCRIPTION: 3 racehorses were evaluated because of poor performance or abnormal noise originating from the upper portion of the respiratory tract. CLINICAL FINDINGS: During maximal exercise, initial dynamic videoendoscopy of the upper respiratory tract revealed complete arytenoid cartilage abduction in 2 horses and incomplete but adequate abduction of the left arytenoid cartilage in 1 horse. Subsequent exercising endoscopic evaluation revealed severe dynamic collapse of the left arytenoid cartilage and vocal fold in all 3 horses. TREATMENT AND OUTCOME: 2 horses were treated with prosthetic left laryngoplasty and raced successfully. One horse was retired from racing. CLINICAL RELEVANCE: Idiopathic laryngeal hemiplegia can be a progressive disease. Successive dynamic videoendoscopic upper airway evaluations were used to confirm progression of left laryngeal hemiplegia in these 3 horses. Videoendoscopy of the upper respiratory tract during exercise should be considered as part of the clinical evaluation of horses with signs of upper respiratory tract dysfunction.     

Esophageal obstruction in horses: a retrospective study of 34 cases

The major purpose of this investigation was to describe the causes, possible complications, and prognoses of horses with esophageal obstruction. Of 34 cases presenting with esophageal obstruction, 28 cases were due to impaction of ingesta. Obstruction due to pre-existing esophageal disease occurred in 4 horses with megaesophagus, in 1 horse with stricture in the upper third of the esophagus, and in 1 horse with esophageal diverticulum. There was no significant difference in the contamination of the trachea between horses that subsequently developed aspiration pneumonia and those that did not. The duration of esophageal obstruction prior to admission was significantly longer in horses that developed aspiration pneumonia (median 18, range 2-48 h) than in those horses that did not (median 4, range 0.5-48 h). Although the obstruction was relieved in all 34 horses, 4 were euthanized because of recurring obstruction due to megaesophagus (n = 2), esophageal diverticulum (n = 1), and esophageal stricture (n = 1).     

Management and complications associated with treatment of cervical oesophageal perforations in horses

Six horses were evaluated for colic and anorexia, choke or suspected oesophageal rupture with and without tracheal laceration. Clinical findings were variable, but a painful ventral neck swelling was noted in all cases. Two of the horses had signs of dehydration and sepsis. Additional findings included evidence of previous trauma over the trachea and oesophagus, ventral neck abscessation, choke and aspiration pneumonia. A diagnosis of oesophageal perforation was made using endoscopy. Two horses were subjected to euthanasia without treatment. All horses where treatment was attempted received debridement of the oesophageal perforation and surrounding tissues with or without surgical closure of the oesophageal defect. Other therapies included broad spectrum antimicrobials, anti‐inflammatory drugs, fluid and nutritional support as well as additional therapeutics for sepsis and individual complications. Complications included diverticulum formation, thrombophlebitis, diarrhoea, laryngeal hemiplegia, azotaemia, aspiration pneumonia, oesophageal obstruction, weight loss and laminitis. All 4 treated horses recovered from the oesophageal perforation and are able to eat a normal diet. Two of the 4 horses have had infrequent episodes of recurrent choke. Oesophageal rupture should be considered as a differential diagnosis for horses with a painful swelling of the ventral neck. With surgical debridement and adequate supportive care, oesophageal perforation cases can have a fair to good long‐term survival, although chronic complications can occur, therapy is prolonged, and a significant economic commitment is required.     

Exercising Blood Gas Analysis, Dynamic Upper Respiratory Tract Obstruction, and Postexercising Bronchoalveolar Lavage Cytology—A Comparative Study in Poor Performing Horses

Respiratory abnormalities are common causes of decreased performance in horses presumably because of impaired pulmonary gas exchange. The objectives of the present study were to describe respiratory abnormalities in poorly performing horses and to investigate the relationships between dynamic upper respiratory tract (URT) videoendoscopy, postexercising bronchoalveolar lavage (BAL) cytology, and exercising arterial blood gas analysis. Medical records of 93 horses with exercise intolerance, which presented for treadmill evaluation, were reviewed. Relationships between horse demographics, treadmill endoscopic findings, exercising blood gas values, and BAL cytology results were examined. A total of 25 (27%) horses had a URT obstruction and 91 (98%) horses had abnormal BAL cytology; 73 (78%) had evidence of inflammatory airway disease (IAD) and 83 (89%) had exercise-induced pulmonary hemorrhage (EIPH). In all, 39 (42%) horses had abnormal blood gas values. Dynamic URT obstruction was significantly associated with exercising hypoxemia (P = .036). There were no significant relationships between gas exchange and IAD or between EIPH. Out of 24 (26%) horses with combined URT obstruction and abnormal BAL, horses with URT obstruction and EIPH were more likely to be hypoxic during exercise (P = .037). It was concluded that horses with dynamic URT abnormalities are likely to have exercising hypoxemia. Although IAD and EIPH were commonly indentified in poor performers, they were not significantly associated with abnormal exercising blood gas analysis.     

Bacterial infection of the lower respiratory tract in 34 horses

OBJECTIVE: To investigate associations between the bacteriology and aspects of history, clinical presentation, outcome and pathology of lower respiratory tract disease of 34 horses. PROCEDURE: Detailed aerobic and anaerobic bacteriological investigations were performed on clinical specimens from horses with pneumonia, lung abscessation and necrotic pneumonia with or without pleurisy in an attempt to identify those bacteria that might contribute to the initiation and progression of infection. RESULTS: Bacteria were cultured from 33 of the 34 horses. In ten cases, only aerobic/facultatively anaerobic isolates were cultured while aerobic/facultatively anaerobic bacteria and obligately anaerobic bacteria were isolated in the other 23 cases. Moderate to large numbers of anaerobic bacteria were isolated only when the estimated duration of illness was at least five days. Bacteria were not cultured from 12 of the pleural fluid samples but were always cultured from pulmonary samples (either transtracheal aspirates from live horses or pulmonary lesions at necropsy). Streptococcus equi subsp zooepidemicus was isolated in the three cases where only one bacterial species was cultured. In the other 30 cases, multiple species were isolated. These included most often and in greatest numbers, Streptococcus equi subsp zooepidemicus, Pasteurellaceae, Escherichia coli, anaerobic cocci, Eubacterium fossor, Bacteroides tectum, Prevotella heparinolytica, Fusobacterium spp, and pigmented members of the genera Prevotella and Porphyromonas. Aerobic/facultatively anaerobic organisms were isolated from 97% of horses, while obligately anaerobic organisms were cultured from 68% of horses. CONCLUSION: There was no association between the isolation of any specific bacterium and the outcome of disease. However, obligately anaerobic bacteria (such as anaerobic cocci, Bacteroides tectum, P heparinolytica and Fusobacterium spp) and the facultatively anaerobic species Escherichia coli, were recovered more commonly from horses that died or were euthanased than from those that survived. There was an association between failure of horses to recover from pleuropneumonia and delay in diagnosis and initiation of treatment.     

An investigation of the incidence of chronic obstructive pulmonary disease (COPD) in random populations of Swiss horses

The incidence of Chronic Obstructive Pulmonary Disease (COPD) in Switzerland was determined in three groups of horses selected at random. Group A (97 horses) and Group B (93 horses) had no history of respiratory disease, but Group C (113 horses) had a history of lower respiratory tract disease. All horses were examined by auscultation of the respiratory tract under forced breathing, endoscopic examination of the upper and lower respiratory tract, arterial blood gas analysis at rest and cytological examination of respiratory secretions (RS). Fifty-four per cent of the horses in Group A and 54.8 per cent of Group B were diagnosed as suffering clinical COPD and only 12.4 per cent of horses in Group A and 8.6 per cent in Group B had no detectable abnormalities in their lower respiratory tracts. In Group B, 19.4 per cent were considered to be suffering from parasitic pulmonary disease indicated by elevated numbers of eosinophils in their RS. Pharyngeal lymphoid hyperplasia was exhibited in 70.1 per cent of Group A and 74.2 per cent of Group B. Cytological examination of RS was useful to determine if the secretions found in the trachea originated from the upper or lower respiratory tract. Arterial blood gas analysis revealed no significant differences between healthy horses and those with subclinical or mild COPD.     

Efficacy of a 2-dose regimen of a sustained release ceftiofur suspension in horses with Streptococcus equi subsp. zooepidemicus bronchopneumonia

The efficacy and safety of sustained release ceftiofur administered twice, 4 days apart, for treatment of horses with naturally acquired Streptococcus equi subsp. zooepidemicus (Strep. zoo.) pneumonia was evaluated in a multicenter, placebo-controlled, double-blinded, randomized clinical trial. The study included 373 horses (278 treated and 95 placebos) with naturally acquired pneumonia. Inclusion in the statistical analyses for treatment efficacy for Strep. zoo. required recovery of ≥10(4) CFU/mL of Strep. zoo. on the primary isolation plate which resulted in 201 cases (145 treated and 56 placebos) with confirmed Strep. zoo. pneumonia evaluable for treatment success. Therapeutic success was defined by clinical improvement of lower respiratory tract infection at 4 and 9 days after initial dosing, resolution of clinical signs by 15 days, and no recurrence by 25 days. Of the 278 treated horses, 239 (85.9%) completed the 25 day study without additional therapy compared to 50 of the 95 (53.6%) placebo horses. In confirmed Strep. zoo. cases, a clinical cure was achieved in 66.9% of 145 treated horses compared to 32.1% of 56 placebo horses (P = 0.0286). Two doses of sustained release ceftiofur suspension were effective and safe in the treatment of naturally acquired lower respiratory tract infection associated with Strep. zoo. in horses under field use conditions.     

Qualitative and quantitative evaluation of equine respiratory mechanics by impulse oscillometry

REASONS FOR PERFORMING STUDY: The long-established conventional reference technique (CRT) for measuring respiratory mechanics in horses lacks sensitivity and there is a need for further refinement in new technology, such as the impulse oscillometry system (IOS). OBJECTIVES: To evaluate the potential use of the IOS as a clinical respiratory function test and compare it to the current CRT in horses suffering from common upper and lower airway dysfunctions. METHODS: Six healthy horses were tested before and after induction of a unilateral nasal obstruction (UNO) or transient left laryngeal hemiplegia (LLH). Six heaves-affected horses were tested in clinical remission and during a heaves crisis, before and after nebulisation of cumulative doses of a bronchodilator therapy (ipratropium bromide; IPB). RESULTS: As opposed to the CRT, the IOS was able to detect partial upper airway obstruction (UAO) caused by UNO or LLH in resting horses, without differentiating both conditions. Upper airway obstruction caused an upward shift of resistance (R(rs)) from 5 to 35 Hz without altering reactance (X(rs)). As for the CRT, IOS respiratory parameters measured in heaves-affected horses in crisis differed significantly from values measured during remission. The difference in frequency-dependent behaviour of R(rs) and X(rs) allowed discrimination between upper and lower airway obstructions. Bronchodilator treatment induced significant dose-dependent changes in X(rs) at 5 and 10 Hz, from the first dose. Total pulmonary resistance (RL) and R(rs) at 5 Hz were affected from the second dose and displayed similar sensitivity. Although post treatment RL values were comparable to remission, R(rs) and X(rs) remained significantly different, characterising persistent peripheral obstruction. CONCLUSIONS: The IOS was more sensitive than the CRT in detecting partial UAO in resting horses and persistent post treatment peripheral dysfunction in heaves-affected horses. The IOS is a sensitive test that provides graded quantitative and qualitative information on disease-induced respiratory dysfunctions as well as on treatment efficiency in horses. POTENTIAL RELEVANCE: The IOS could represent a practical and sensitive alternative respiratory function test for routine clinical investigations of common airway obstructive diseases and therapy in horses.     

Evaluation of high-speed treadmill videoendoscopy for diagnosis of upper respiratory tract dysfunction in horses

OBJECTIVE: To evaluate high-speed treadmill videoendoscopy as a diagnostic technique and document the abnormalities found in Australian horses referred for poor performance associated with abnormal upper respiratory tract noise but where a definitive diagnosis could not be made at rest. DESIGN: A retrospective clinical study using client-owned horses. PROCEDURE: The clinical records and videorecordings of all horses referred to the University of Sydney for poor performance associated with abnormal upper respiratory tract noise during a 13-month period were examined. Only horses with a normal physical examination including absence of lameness, and where a definitive diagnosis of the cause of the abnormal upper respiratory tract noise could not be made from the resting videoendoscopic examination were included in the study. The age, gender, breed of horse and the purpose for which the horse was used were ascertained from the record and videorecordings were reviewed by the authors and any abnormalities noted. RESULTS: There were 37 horses included in the study. An upper airway abnormality was identified during high-speed treadmill videoendoscopy in 73% of horses. One abnormality was identified in 22 horses, 2 abnormalities in 4 horses and 3 abnormalities in 1 horse. Abnormalities identified included laryngeal hemiparesis (n = 15), axial deviation of the aryepiglottic folds (n = 10), pharyngeal collapse (n = 3), dorsal displacement of the soft palate (n = 2), epiglottic collapse (n = 1), axial deviation of the vocal cord (n = 1) and laryngeal collapse (n = 1). CONCLUSIONS: The results of this study are similar to reports from overseas and suggest high-speed treadmill videoendoscopy appears to be a useful technique to diagnose the cause of upper airway dysfunction in Australian horses referred specifically for poor performance associated with abnormal upper respiratory noise. However, a diagnosis will not be made in all horses undergoing this procedure. There were five horses with two or three abnormalities none of which were apparent at rest. This would suggest that in all horses making abnormal upper respiratory noise associated with poor performance, even where an abnormality is identified at rest, high-speed treadmill videoendoscopy should be performed for a complete diagnosis.     

Pulmonary aspergillosis in horses: 29 cases (1974-1997)

OBJECTIVE: To analyze medical records and identify factors that veterinarians can use to prevent pulmonary aspergillosis in horses or that would enable them to diagnose it as early as possible. DESIGN: Retrospective study. ANIMALS: 29 horses. PROCEDURE: Medical records were reviewed for horses with pulmonary aspergillosis diagnosed on the basis of characteristic postmortem findings. Information on history, clinical signs, disease progression, and postmortem findings was obtained. RESULTS: 25 of 29 (86.2%) horses had primary (n = 20) or secondary (5) disease compatible with loss of integrity of the gastrointestinal (GI) tract. The remaining 4 horses had a non-GI tract disorder; only 1 of these 4 had clinical signs associated with the respiratory tract (i.e., pleuropneumonia). Although 22 (75.9%) horses had various signs of respiratory tract disorders, an antemortem diagnosis of Aspergillus pneumonia was made in only 1 horse and was suspected in only 1 other. Fungal organisms were seen histologically in tissues other than the lung in 12 (41.4%) horses. CLINICAL IMPLICATIONS: Horses with enteritis, colitis, typhlitis, or other diseases of the GI tract that result in mucosal compromise, and horses with clinical signs of respiratory tract disease, particularly if the horse's condition is unresponsive to treatment with antimicrobial agents; should be considered at high risk of having pulmonary aspergillosis. Immunosuppression from debilitating disease may also predispose horses to aspergillosis. Because invasive pulmonary aspergillosis can be difficult to diagnose, clinicians should be aware of clinical and epidemiologic settings in which this disease would develop.     

Thirteen cases of tetanus in dogs

The records of 13 dogs with tetanus were reviewed, 12 of the dogs survived and were discharged, but the other died as a result of the acute onset of hyperthermia. Long-term follow up was available for 10 of the survivors of which nine were reported to be normal. One case was euthanased after a cervical spine fracture four months after it was discharged. Complications encountered during management included aspiration pneumonia in three cases, urinary tract infection in two cases, and upper respiratory tract obstruction, hiatal hernia, coxofemoral luxation, seizures and respiratory arrest in one case each. None of the dogs required ventilatory support, and the complications were managed successfully. The dogs were nursed intensively and monitored carefully.     

Equine emergency upper airway management

Respiratory distress due to acute upper respiratory tract obstruction is an uncommon emergency in equine practice. However, clinicians should be confident with the approach to this truly life-threatening scenario. Clinical signs are obvious at rest and include increased respiratory effort, loud respiratory noise and recumbency as asphyxiation progresses. Many cases of upper respiratory tract obstruction involve the pharynx or larynx, though obstruction in other regions of the upper respiratory tract and other causes of respiratory distress should be considered. Generally, the obstruction can be bypassed by placing a nasotracheal tube under endoscopic guidance or by making a temporary tracheotomy to ensure a patent airway. Following this stabilisation, further investigation into the cause of airway obstruction can be performed. Endoscopy is usually the most valuable diagnostic tool, though other imaging modalities can be useful. Further empirical treatment is often required, though the specific management will vary depending on the pathology present.