The Prevalence of Aeromonas Species in Feces of Horses with Diarrhea

Feces collected from 40 horses with diarrhea and 34 horses without diarrhea were examined to determine if an association existed between isolation of Aeromonas spp. and diarrhea. Samples were also examined for Salmonella spp., and identification of viruses and parasite ova. Neither Salmonella spp. nor Aeromonas spp. were isolated from the feces of 34 control horses. Aeromonas spp. were isolated from feces of 22 of 40 (55%) horses with diarrhea. Salmonella spp. were isolated from feces of 8 (20%) horses, and of these, 5 (12.5%) were also positive for Aeromonas spp. Twenty-nine isolates of Aeromonas spp. were recovered from the feces of 22 diarrheic horses. Of these isolates, more than 80% were susceptible on in vitro testing to amikacin, ceftiofur, chloramphenicol, and gentamicin. All isolates were susceptible to enrofloxacin. Diarrheic horses positive for Aeromonas were significantly (P = .04) older than diarrheic horses negative for Aeromonas spp. A significantly greater number of fecal samples were positive for Aeromonas spp. during March through August than samples examined in other months (P = .014). Results of this study indicate that Aeromonas spp. should be considered as a cause of diarrhea in horses.     

Characteristics and risk factors for failure of horses with acute diarrhea to survive: 122 cases (1990-1996)

OBJECTIVE: To characterize horses with acute diarrhea and determine risk factors for failure to survive. DESIGN: Retrospective study. ANIMALS: 122 adult horses admitted for acute diarrhea at the teaching hospital between Jan 1, 1990 and Dec 31, 1996. PROCEDURE: Medical records of horses with acute diarrhea were reviewed to abstract information regarding signalment, history, physical examination, clinicopathologic testing, treatment, and outcome. RESULTS: 91 of 122 (74.6%) horses lived and were discharged from the hospital. Horses with history of administration of antimicrobials for a problem preceding diarrhea were approximately 4.5 times less likely to survive. The following variables that had been determined at the time of admission were significantly associated with failure to survive: administration of antimicrobial drugs for another illness, serum creatinine concentration > 2.0 mg/dl, PCV > 45%, tachycardia (heart rate > 60 beats/min), and low serum total protein concentration. Prevalence of laminitis was 11.5%. CLINICAL IMPLICATIONS: Diarrheic horses that are azotemic and have clinicopathologic findings consistent with hemoconcentration and hypoproteinemia have a poor prognosis for survival. Antimicrobial administration may induce diarrhea, and antimicrobial-associated diarrhea may have a worse prognosis than other types of acute diarrhea.     

Prevalence of Clostridium perfringens enterotoxin and Clostridium difficile toxin A in feces of horses with diarrhea and colic.

OBJECTIVE: To determine prevalence of clostridial enterotoxins in feces of horses with diarrhea and colic, and to determine whether an association exists between detection of clostridial enterotoxins in feces and development of diarrhea as a complication of colic. DESIGN: Prospective case series and case-control study. ANIMALS: 174 horses with diarrhea, colic, or problems not related to the gastrointestinal tract. PROCEDURE: Horses were assigned to 1 of 4 groups: colic with diarrhea (group 1; n = 30); colic without diarrhea (group 2; 30); diarrhea without colic (group 3; 57); and control (group 4; 57). Feces were evaluated by use of ELISA to detect Clostridium perfringens enterotoxin (CPE) and C difficile toxin A (TOXA). Frequency of detection of CPE or TOXA in groups 1 and 3 was compared with that in groups 2 and 4, respectively. RESULTS: Prevalence of enteric clostridiosis in horses in group 3 was 25%. Clostridium perfringens enterotoxin was detected in 9 of 57 (16%), TOXA in 8 of 57 (14%), and both toxins in 3 of 57 (5%) fecal samples collected from these horses. Neither toxin was detected in feces of the age-matched horses in group 4. Clostridial enterotoxins were detected in feces of 7 of 60 (12%) horses with colic (groups 1 and 2), however, a significant association was not found between detection of enterotoxins in feces and development of diarrhea as a complication of colic. CONCLUSIONS AND CLINICAL RELEVANCE: Clostridia are important etiologic agents of diarrhea in horses. Additionally, changes in intestinal flora of horses with colic may allow for proliferation of clostridia and elaboration of enterotoxins regardless of whether diarrhea develops.     

Treatment of horses with chronic diarrhea: immunologic status.

All chronically diarrheal horses given (orally) 2 series of treatments with normal horse serum recovered in 2 to 4 weeks. However, mild diarrhea sometimes persisted several months in the group of horses with severe diarrhea. Weight gains were approximately 35% in horses with severe diarrhea and approximately 10% in horses with mild diarrhea. Serum specimens from 12 diarrheal and 20 normal horses were examined for immunoglobulins by single radial immunodiffusion technique. Concentration of immunoglobulin A in serum of diarrheal horses was approximately 50% lower than that in serum of normal horses. By contrast, there was more immunoglobulin G in serum of diarrheal horses than in serum of normal horses. Phytohemagglutinin (PHA-M) responsiveness of blood lymphocytes showed transient suppression during the stage of severe diarrhea. The regaining of PHA-M responsiveness of lymphocytes was observed simultaneously with the recovery process. However, the responsiveness of lymphocytes in recovered horses remained markedly lower than that in normal horses. Allergic reactions in diarrheal and normal horses were studied by observing dermal response to injections of saline extracts from some of the horse feeds. A delayed hypersensitivity reaction to streptokinase-streptodornase and PHA-M was also studied. Allergic reactions to these extracts were not induced in either diarrheal or normal horses; however, inflammatory response to the extracts was approximately 50% greater in normal than in diarrheal horses. Response to intradermal injection of either streptokinase-streptodornase or PHA-M was significantly greater in normal horses than in diarrheal horses.     

Acid-base status and electrolyte alterations associated with diarrhea in non-suckling horses

A retrospective search of medical records of 56 adult horses with diarrhea of variable duration disclosed a variety of blood gas and electrolyte abnormalities at the time of admission. The acid-base and electrolyte disturbances were analyzed and classified according to the duration of diarrhea. In horses with acute diarrhea (duration <6 days) the most common disorder was combined anion gap metabolic acidosis and metabolic alkalosis (72%)characterized by significant hyponatremia, hypochloridemia, and hyperkalemia. The most severe acidemia was found in horses with diarrheas of intermediate duration (1–2 weeks). In this group hyperchloremic metabolic acidosis was commonly found (43%). In horses with diarrhea of long duration (>4 weeks) blood gas and electrolyte values were usually within normal limits. Although the above findings suggest differing therapeutic approaches might be based on the duration of the diarrhea, many cases differed markedly from the mean with respect to their underlying disturbances and, therefore, optimal fluid therapy should be based on the patient's blood gas and electrolyte status.     

Gastrointestinal trichomonads in horses: occurrence and identification.

A survey of horses for gastrointestinal trichomonads was conducted to determine the organism's role in equine diarrhea and to establish its proper identity and morphology. Trichomonads were found by cultural examination of feces of 101 (35%) of 289 apparently healthy horses. At necropsy, trichomonads were cultured from 11 (37%) of another 30 horses which showed no signs of diarrhea at the time of death. In 4 of the 11 horses, colonies of trichomonads numbered 30,000 to 150,000/ml of cecal fluid. Diarrhea was induced in 1 of 6 horses, with the fecal fluid containing 10,000 to 110,000 trichomonads/ml. The trichomonad was identified as Tritrichomonas equi and it appears to be a normal member of the intestinal fauna of the horse. Its role as the etiologic agent of equine diarrhea is considered doubtful. The large numbers of T equi found in diarrheic feces are considered a response to, rather than a cause of, the fluidic environment of the gastrointestinal tract.     

Evaluation of changes in microbiota after fecal microbiota transplantation in 6 diarrheic horses

The purpose of this study was to characterize the fecal microbiota of horses with acute and chronic diarrhea before and after fecal microbiota transplantation (FMT). Six client-owned horses with acute and chronic diarrhea received FMT from 2 healthy donor horses. Microbiota analysis using next-generation sequencing was performed on fecal samples collected before and 2 and 7 d after FMT. Signs of diarrhea improved in 4 horses, whereas the remaining 2 horses did not survive. There was a significant difference in the number of bacterial species between donors and recipients (P < 0.05). The Order Lactobacillales and the genera Lactobacillus, Intestinimonas, and Streptococcus were increased in the microbiota of diarrheic horses, and Saccharofermentans genus increased in healthy donors. The results suggest that FMT from the healthy donors was not effective over a 7-day period as it did not change the fecal microbiota of the diarrheic horses. Further research to improve the efficacy of FMT in horses is needed.     

A Clinical Trial of Probiotic Administration for Prevention of Salmonella Shedding in the Postoperative Period in Horses With Colic

The purpose of this study was to evaluate the effects of probiotic administration on the prevalence of fecal shedding of Salmonella , the prevalence of postoperative diarrhea, the length of antimicrobial therapy, and the length of the hospitalization stay during the postoperative period in horses with colic. Two commercially available probiotics for horses were used in a double-blind prospective study of 200 horses undergoing surgery for colic. Probiotic or placebo was administered PO once a day for 7 days postoperatively, and fecal cultures for Salmonella were obtained daily for 10 days. After selection of 186 patients completing the treatment protocol, the results indicated that the commercial probiotic formulations had no effect on Salmonella shedding, prevalence of diarrhea, length of antimicrobial therapy, or length of hospitalization ( P > .05). Twenty percent of the horses yielded 1 or more positive fecal cultures for Salmonella; of these horses, 74% were classified as asymptomatic shed-ders. Twenty-six percent of all horses had fluid diarrhea postoperatively, with only 12% of these horses having positive fecal cultures for Salmonella , The most common isolate was Salmonella krefeld (24 of 39 isolates). Among the different gastrointestinal disorders, horses with feed and sand impactions appeared to be more prone to shed Salmonella .     

Acute diarrhea in horses of the Potomac River area: examination for clostridial toxins

Fecal specimens from horses in Montgomery County, Md, and in Fairfax and Loudoun counties, Va, were examined for Clostridium perfringens type A enterotoxin and for C difficile cytotoxin (92 and 108 specimens, respectively). The toxins were found in feces from horses that had experienced an acute diarrhea syndrome and from clinically normal horses. The toxins did not appear to be primary determinants of the diarrhea syndrome, although they may have contributed to the spectrum of clinical entities observed.     

Right Dorsal Colitis

Moderate to severe ulcerative colitis of the right dorsal colon was diagnosed by necropsy or by exploratory celiotomy and biopsy in 13 horses with a primary clinical complaint of either colic, diarrhea, or weight loss. Clinical signs varied from acute fulminating diarrhea (possibly with fever), colic, dehydration, endotoxic shock and death, to a chronic condition manifested by mild intermittent colic up to several months in duration, and weight loss with or without mild diarrhea. In a large percentage of the horses, those affected had been hypovolemic and received nonsteroidal anti-inflammatory drugs (NSAID) or had received inappropriately high doses of phenylbutazone before the onset of illness. Experimental treatment of two horses with high doses of a phenylbutazone oral paste preparation (6 gm once daily for 5 days) and limitation of their water intake to approximately one half of maintenance requirement (for 5 days) resulted in reproduction of ulcerative colitis involving only the right dorsal colon, which was apparent at necropsy examination 11 and 15 days after initiation of drug use. It was concluded that localized ulcerative lesions in the right dorsal colon may be a previously unreported manifestation of toxicity due to the administration of NSAID.     

Case Control and Historical Cohort Study of Diarrhea Associated With Administration of Trimethoprim-Potentiated Sulphonamides to Horses and Ponies

Trimethoprim-potentiated sulphonamides (TPS) are among the most frequently administered antimicrobials in equine medicine. Anecdotally, TPS has been implicated as a cause of mild to moderate diarrhea in horses. The purpose of this study was to document the prevalence of diarrhea in horses receiving TPS, to characterize the severity of the diarrhea, and to identify any other factors associated with the development of diarrhea. A 2–part study was designed to identify the prevalence of diarrhea associated with TPS in our clinic population. Part I was a case-control retrospective study of 135 records over a 10.5–year period from January 1, 1980 through June 30, 1990. Part II was a historical cohort study of 784 records over a 37–month period from July 1, 1990 through July 31, 1993. There was no significant difference in the occurrence of diarrhea associated with TPS therapy in either study. The occurrence of diarrhea was 21% and 3% in parts I and II, respectively. Significant factors identified in association with diarrhea in part I were duration of hospital stay, and antibiotic therapy other than TPS or penicillin. Significant factors identified in part II included other antibiotic therapy, penicillin therapy, and combined penicillin and TPS therapy. Diarrhea does occur after the administration of antibiotics, most likely because of the alteration of the patient's normal intestinal flora. Diarrhea was noted in association with administration of TPS in this study; however, its prevalence was not significantly different than that in horses receiving other antibiotics, such as penicillin and its derivatives. J Vet Intern Med 1996;10:258–264. Copyright © 1996 by the American College of Veterinary Internal Medicine .     

Efficacy of Hyperimmunized Plasma in the Treatment of Horses with Acute Colitis

Colitis in the adult horse is a life-threatening clinical condition that can be caused by any of several enteric pathogens. This study was conducted to determine whether treating horses with plasma obtained from donors that were hyperimmunized against the common equine diarrheal pathogens Clostridium difficile, Clostridium perfringens, and Salmonella sp shortens the duration of diarrhea in acute colitis. To evaluate the efficacy of plasma treatment, 42 horses with acute onset of diarrhea were studied. Horses were enrolled if they were of age >1 year, duration of diarrhea at presentation was <72 hours, and they had not received equine plasma within the last 3 months. In addition, the serum cortisol concentrations of horses with acute diarrhea were studied.Horses were randomized to receive hyperimmunized plasma, control plasma (collected from nonimmunized horses), or no plasma therapy. Clinical parameters and fecal consistency were observed until resolution, discharge, or death, and complete blood counts (CBCs) and biochemical profiles were collected throughout the study. A total of 38 horses completed the study. The mean duration of diarrhea was 40.7 ± 9.8 (mean ± SEM) hours, 119.2 ± 56.1 hours, and 72.0 ± 24.5 hours for the hyperimmunized plasma, normal plasma (NP), and control groups, respectively. Using survival analysis techniques, this difference did not achieve statistical significance (P = .374). Serum cortisol was found to be increased in all horses at presentation and to decrease with time in all treatment groups. There was no difference in cortisol concentrations between the three treatment groups studied (P = .237).     

Arthrodesis of the Distal Intertarsal and Tarsometatarsal Joints in the Horse

Arthrodesis created by destruction of the articular surfaces of the distal intertarsal and tarsometatarsal joints by repeated insertion of a drill was studied in one limb of each of nine horses. Postoperatively, the horses were housed in box stalls for 8 weeks and then confined to a paddock for 19 weeks. Clinical and radiographic evaluations were performed prior to surgery, immediately following surgery, and at 2,4, 6, 8,10,12,16, 20, and 27 weeks following surgery. There was a statistically significant positive correlation between decreasing degree of lameness and increasing radiographic evidence of bony fusion; fusion of the distal intertarsal and tarsometatarsal joints was present in five horses 27 weeks after surgery. The horses lost weight during the first 8 weeks after surgery. Flexion of the treated tarsal joints was decreased significantly at the end of the experiment.
Complications encountered included fracture of the third tarsal bone (five horses), instability of the tarsus (four horses), septic arthritis (three horses), and diarrhea (four horses).
Arthrodesis, with this method of surgical drilling of the distal intertarsal and tarsometatarsal joints, is not recommended because of severe pain, prolonged convalescence, and high incidence of complications.     

Clostridium difficile diarrhea: infection control in horses.

C difficile has emerged as an important cause of diarrheic disease in horses. C difficile diarrhea is usually diagnosed in mature horses, mostly when they are treated with antimicrobials and hospitalized. It is important for clinicians at veterinary hospitals to have knowledge about the organism and the infection. To prevent C difficile diarrhea, judicious use of antimicrobials is important, as is minimizing different stress factors at the animal hospital or clinic. Infected horses must be isolated. Routine examination for C difficile and toxin A or B is recommended in horses with antibiotic-associated diarrhea. When treating foals for R equi pneumonia, it is important to avoid accidental ingestion of erythromycin by the dams. To reduce the number of environmental spores, thorough cleaning and surface disinfection of the animal hospital and clinic are important. Routine handwashing should be performed by all staff.     

Sensitivity and specificity of western blot testing of cerebrospinal fluid and serum for diagnosis of equine protozoal myeloencephalitis in horses with and without neurologic abnormalities

OBJECTIVE: To determine sensitivity and specificity of western blot testing (WBT) of CSF and serum for diagnosis of equine protozoal myeloencephalitis (EPM) in horses with and without neurologic abnormalities. DESIGN: Prospective investigation. ANIMALS: 65 horses with and 169 horses without neurologic abnormalities. PROCEDURE: CSF and serum from horses submitted for necropsy were tested for Sarcocystis neurona-specific antibody with a WBT. Results of postmortem examination were used as the gold standard against which results of the WBT were compared. RESULTS: Sensitivity of WBT of CSF was 87% for horses with and 88% for horses without neurologic abnormalities. Specificity of WBT of CSF was 44% for horses with and 60% for horses without neurologic abnormalities. Regardless of whether horses did or did not have neurologic abnormalities, sensitivity and specificity of WBT of serum were not significantly different from values for WBT of CSF. Ninety-four horses without EPM had histologic evidence of slight CNS inflammation. CONCLUSIONS AND CLINICAL RELEVANCE: The low specificity of WBT of CSF indicated that it is inappropriate to diagnose EPM on the basis of a positive test result alone because of the possibility of false-positive test results. The high sensitivity, however, means that a negative result is useful in ruling out EPM. There was no advantage in testing CSF versus serum in horses without neurologic abnormalities. Slight CNS inflammation was common in horses with and without S neurona-specific antibodies in the CSF and should not be considered an indication of CNS infection with S neurona.     

Predisposing factors for small colon impaction in horses and outcome of medical and surgical treatment: 44 cases (1999-2004)

OBJECTIVE: To identify factors associated with development of small colon impaction in horses and with selection of medical versus surgical treatment and to determine the prognosis for affected horses following medical or surgical management. DESIGN: Retrospective case series. ANIMALS: 44 horses with primary impaction of the small colon. PROCEDURES: Medical records were reviewed for signalment, history, clinical findings, treatment (medical vs surgical), hospitalization time, and outcome. For comparison purposes, the same information was collected for 83 horses with primary impaction of the large colon. RESULTS: Diarrhea was the only factor found to be associated with development of small colon impaction. Horses with small colon impaction were 10.8 times as likely to have diarrhea at the time of initial examination as were horses with large colon impaction. Abdominal distension was the only factor associated with use of surgical versus medical treatment. Horses with small colon impaction that were treated surgically were 5.2 times as likely to have had abdominal distension at the time of admission as were horses with small colon impaction that were treated medically. Overall, 21 of 23 (91%) horses treated medically and 20 of 21 (95%) horses treated surgically survived to discharge. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that diarrhea may be a risk factor for development of small colon impaction and that horses with small colon impaction that have abdominal distension at the time of initial examination are more likely to require surgical than medical treatment.     

Equine chronic diarrhea: Traditional Chinese veterinary medicine review

Chronic diarrhea is a common problem in equine practice. Herbal medicine has been used for the treatment of gastrointestinal disease in horses for at least one thousand years. In present-day equine practice in China, the most common approach to treat chronic diarrhea is herbal medicine, or a combination of herbal medicine and acupuncture. Three types of chronic diarrhea in horses will be described in detail in term of symptoms, diagnosis and herbal treatments in this paper. Nineteen herbal formulas for treatment of different types of diarrhea will be introduced. Clinical results of each herbal formula will be evaluated. Acupuncture treatment of this problem will also be included.     

Diarrhea associated with sand in the gastrointestinal tract of horses

Four horses with diarrhea had radiographic evidence of large quantities of sand in the gastrointestinal tract. Initially, none of the horses had sufficient fecal sand quantity to suggest sand enteropathy. Diarrhea resolved in all horses within 2 days of oral administration of psyllium hydrophilic mucilloid. Historically, all 4 horses had lost weight or had difficulty maintaining weight. After treatment was administered, the horses either gained weight or were easier to maintain in good condition.     

In vitro fermentation of feces from normal and chronically diarrheal horses

Feces from 13 healthy horses and 8 horses with chronic diarrhea were subjected to an in vetro fermentation procedure that had been developed for rumen fluid. Fermentations were conducted over 6 hours in a closed system, with and without an essential amino acid (EAA) mixture being added to the basic starch-buffer medium. The addition of EAA caused no significant difference in results of fermentation of feces from healthy horses. For diarrheic animals, there was a significant (P less than 0.01) increase in gas and total volatile fatty acids production whether EAA were present or not, and alpha-amino nitrogen was utilized in significantly (P less than 0.01) greater amounts only if EAA was present. Fermentations were repeated on feces from five of the eight diarrheal horses after they had been treated with oral iodochlorhydroxyquin for 1 week, and had shown desirable clinical response. A significant difference was not shown between pre- and posttreatment fermentations, except for decreased butyrate production. The results are consistent with the hypothesis that chronic equine diarrhea is primarily a colonic disease and indicates that colonic maldigestion may, in part, be responsible for excess fecal water.     

Pitfalls in immunofluorescence testing in dermatology. III. Pemphigus-like antibodies in the horse and direct immunofluorescence testing in equine dermatophilosis

Indirect immunofluorescence testing for pemphigus-like antibodies was performed on 79 horses: 28 horses with various nonpemphigus dermatologic diseases, 21 horses with various nondermatologic diseases, and 30 normal horses. Pemphigus-like antibodies were detected in 6 horses: 3 normal horses with titers of 1:40, 2 horses with dermatophilosis at titers of 1:10 and 1:80, and 1 horse with lymphosarcoma at a titer of 1:320. It was concluded that equine pemphigus-like antibodies are a potential source of misinterpretation and misdiagnosis in indirect immunofluorescence testing. Direct immunofluorescence testing for whole immunoglobulin, IgG, IgM, and IgA was performed on skin lesions from 2 horses with dermatophilosis. Diffuse intercellular deposition of whole immunoglobulin and IgG was found in both horses. It was concluded that equine dermatophilosis is a potential source of misinterpretation and misdiagnosis in direct immunofluorescence testing.