Primary and secondary limb cellulitis in horses: 44 cases (2000-2006)

OBJECTIVE: To determine historical, physical, and microbiologic findings in horses with limb cellulitis and identify factors associated with short- and long-term outcome. DESIGN: Retrospective case series. ANIMALS: 44 horses with limb cellulitis. PROCEDURES: Information obtained from medical records included use, history, affected limb, diagnostic procedures, treatment, and short-term outcome. Long-term follow-up information was obtained by means of a telephone survey. RESULTS: Twenty-four horses had primary cellulitis, and 18 of the 24 (75%) had a hind limb affected. Results of microbiologic culture were positive for all 20 horses with primary cellulitis from which specimens were obtained, with coagulase-positive Staphylococcus spp recovered from 12 of the 20. Short-term survival rate was 67% (16/24) for horses with primary cellulitis; 7 of the 9 horses available for long-term follow-up were being used for their intended use, and 4 had had a recurrence. Results of microbiologic culture were positive for 13 of the 16 (81%) horses with secondary cellulitis from which specimens were obtained. Short-term survival rate for horses with secondary cellulitis was 90% (18/20). Eleven of the 17 horses available for long-term follow-up were being used for their intended use; 2 had had a recurrence. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that cellulitis can be a life-threatening condition in horses. Horses that were febrile at admission or that developed laminitis were significantly less likely to survive. The prognosis for return to function was guarded, and recurrence was a potential concern.     

Doppler ultrasonographic features of thoracic limb arteries in clinically normal horses

OBJECTIVES: To determine blood flow velocities and indices from spectral waveforms obtained by use of Doppler ultrasonography of thoracic limb arteries of horses and to assess interobserver and patient variability associated with the technique. ANIMALS: 9 clinically normal adult horses. PROCEDURE: Left thoracic limb arteries of 8 nonsedated horses were examined at 5 sites by use of pulsed-wave Doppler ultrasonography to determine a range of values for peak systolic, end diastolic, and mean velocities and resistive and pulsatility indices. Interobserver and patient variabilities were determined by 2 operators repeating similar measurements on 1 horse 8 times at weekly intervals. RESULTS: A range of values for each variable measured at the 5 selected sites was obtained. For each variable, strong positive correlations (R > or = 0.7) were detected for > 70% of the site-to-site comparisons made (excluding the coronary band). Among horses, resistive index varied least, whereas over time, mean velocity varied least. Waveform characteristics were consistent with resistive (n = 5) or nonresistive (4) patterns. In the single-horse experiment, waveform characteristics were consistent throughout the 8 weeks, and operator effects were not detected. CONCLUSIONS AND CLINICAL RELEVANCE: Doppler ultrasonography of no one site resulted in more reliable measurements of blood flow characteristics in thoracic limb arteries of horses. Mean velocity and resistive index were the least variable measurements made. Pulsed-wave Doppler ultrasonography may be a useful technique for evaluating diseases that alter normal thoracic limb arterial blood flow in horses.     

Oesophageal disorders in horses: Retrospective study of 39 cases

Oesophageal diseases are less frequently reported in equine veterinary practice in comparison with other alimentary pathologies. This paper describes the prevalence, age, breed and sex distribution, the duration of clinical presentation before admission, the diagnosis, aetiology, treatment course, complications, length of hospitalisation, and the short‐term and long‐term survival of 39 cases with equine oesophageal disorders at a referral clinic. Prevalence of oesophageal disorders was significantly higher in the group of horses up to 4 years of age in comparison with other age groups. The most common oesophageal disorder was simple obstruction represented by 22/39 cases (56.41%). The common complications of the oesophageal disorder were oesophagitis (16/39, 41.02%) and aspiration pneumonia (11/39, 28.20%); 31/39 (79.49%) of all oesophageal cases survived up to clinical discharge. Long‐term survival was 65.78% in this group of cases.     

Perisuspensory abscessation in eight horses with hindlimb cellulitis

This study reports a distinct presentation of cellulitis, which involved formation of perisuspensory abscessation in eight horses. Medical records of horses presented for cellulitis unresponsive to medical treatment were reviewed. Cases in which perisuspensory abscesses were diagnosed were included. All abscesses formed between the cannon bone and suspensory ligament and extended around one or both suspensory branches. Abscesses were diagnosed via ultrasonography upon admission in three horses and developed within a few days following admission in five horses. All horses were treated with broad-spectrum antibiotics, anti-inflammatories, topical therapies and regional limb perfusions; however, only partial improvement of clinical signs was observed with medical therapy alone. Full resolution of clinical signs was obtained in all cases once the abscess was surgically lanced and drained. The surgical drainage was performed standing in seven cases and under general anaesthesia in one. In all cases, Staphylococcus aureus was cultured. Six out of eight isolates showed at least some level of antibiotic resistance, and penicillin and trimethoprim sulfonamides were most commonly involved. Short-term complications included skin necrosis in two cases and mild impaction colic in two cases and were successfully treated. All horses were discharged from the hospital within 4–13 days and were sound upon discharge. All Thoroughbreds (n = 7) were able to return to their intended use, and the Standardbred was unraced prior to the cellulitis event and remained unraced afterwards.     

Retrospective study of primary intention healing and sequestrum formation in horses compared to ponies under clinical circumstances

In accidental wounds, trauma and infection can result in dehiscence of primarily closed wounds and in sequestrum formation when cortical bone is exposed. In experimental studies, it has been shown that second intention healing is faster and occurs with less complications in ponies than in horses. Also, a greater initial inflammatory response was seen in ponies. Based on these experimental data, it was hypothesised that accidental wounds in ponies would heal with a lower incidence of wound dehiscence and/or sequestrum formation compared to horses. A retrospective study of 89 ponies and 422 horses with traumatic wounds was performed. The animals, wounds and treatments were categorised and related to the success rate of primary closure and to the incidence of sequestrum formation. The ponies and horses were of similar age and sex. The wounds that were treated were comparable for localisation, duration, degree of contamination and depth in both groups of animals, but there were significantly more cases with ruptured extensor tendons in ponies. Antibiotics and NSAIDs were administered significantly less often to ponies. The success rate of primary closure was significantly higher in ponies than in horses, and sequestra were formed significantly less often in ponies. It was concluded that the results of healing were better in ponies although the external conditions were less favourable. This may be associated with the differences in the initial inflammatory response after injury as found in earlier experimental work, which may result in a better local defence against wound infection.     

Prognostic features and clinical presentation of acute idiopathic enterocolitis in horses

Clinical and hematological changes observed on presentation of 47 horses referred to the Ontario Veterinary College with acute idiopathic colitis were analyzed for their prognostic features. Cases of acute enterocolitis were characterized by fever, dehydration, abnormalities of serum electrolyte concentrations, azotemia, hypoalbuminemia, and increased serum concentrations of muscle enzymes. Severely dehydrated horses were seven times more likely to die or be euthanized than those that were not dehydrated. Other factors associated with failure to survive included the following: increased hematocrit, increased number of band neutrophils, increased serum creatinine and urea concentrations, and decreased blood pH and increasingly negative base excess. The results of multivariate variable analysis (stepwise logistic regression) suggested that, among the variables tested, base excess was the best predictor of death or survival. Twenty of 47 horses died or were euthanized. Reasons for death or euthanasia included: severe disseminated intravascular coagulation, unresponsiveness of severe metabolic acidosis and hypoproteinemia to treatments, and severity of colonic lesions on exploratory laparotomy. Of the surviving horses, three developed chronic laminitis (two were destroyed) and five developed jugular vein thrombosis. Fourteen of 16 horses for which subsequent histories were available returned to normal function.

Early recognition of the disease, combined with early and aggressive correction of dehydration and of acid-base imbalance, may be important determinants of survival in horses with acute idiopathic colitis.

     

Antimicrobial regional limb perfusion in horses

Regional limb perfusion involves administration of an antimicrobial solution into the vasculature of a selected portion of the limb that has been isolated from the systemic circulation by controlled application of a tourniquet. The technique provides high antimicrobial concentrations in the region of interest and greatly contributes to the elimination of infection.     

Retrospective study of the risk factors and prevalence of colic in horses after orthopaedic surgery

The records of 496 orthopaedic operations on 428 horses were reviewed to estimate the prevalence of, and identify the risk factors for, the development of colic in horses after surgery. Colic was defined as any recognised sign of abdominal pain that could not be attributed to a concurrent disease. Fourteen of the horses developed colic; eight of them were undiagnosed, three were classified as impactions, one as tympanic colic of the colon, one as incarceration of the small intestine in the epiploic foramen, and one as left dorsal displacement of the colon in the nephrosplenic space. Morphine was associated with a four-fold increased risk of colic compared with the use of no opioid or butorphanol, and out-of-hours surgery was also associated with an increased risk.     

Intramuscular injection techniques and the development of clostridial myositis or cellulitis in horses

A survey of 584 veterinarians in equine practice was performed to determine their intramuscular injection techniques and the influence of those techniques on the development of clostridial myositis or cellulitis. Usable responses were obtained from 439 veterinarians (75.2%). Of these, 414 used a new needle and syringe for each injection, 241 swabbed the site with a cleansing/disinfectant agent, and 242 swabbed the top of multidose injection bottles with a similar solution. Only 2 clipped the hair at the injection site. Twenty eight of the respondents reported that at least 1 horse developed a clostridial infection at the injection site following 1 of their injections. None of the various injection techniques had a significant influence on the development of clostridial infection at the injection site.     

Retrospective study of scintigraphic and radiological findings in 21 cases of enostosis-like lesions in horses

Records of horses admitted to a veterinary surgery in the UK for lameness investigation during 2000 to 2008 were reviewed. Twenty-one horses were identified with both scintigraphic and radiological evidence of enostosis-like lesions (ELLs), in which 68 individual foci of increased radiopharmaceutical uptake were confirmed in 57 long bones. The presenting lameness was attributed to ELLs in 15 of 21 (71 per cent) horses; the remainder were thought to be incidental findings. Five horses were subjected to a repeat examination, four of which showed the occurrence of new lesions in the same or different limbs. Hindlimbs had significantly more lesions than forelimbs, but there was no difference between the right and left limbs. All 18 horses for which follow-up information was available were treated conservatively and returned to soundness after a variable period of time. Following ELL resolution, thoroughbred horses performed at a similar level to that before investigation and diagnosis.     

Retrospective study on 30 horses with chronic proliferative pododermatitis (canker)

The medical records of 30 horses (18 Warmbloods, 7 draught horses, 3 other breeds and 2 of unknown origin) with chronic proliferative pododermatitis (canker) were reviewed and long‐term outcome was obtained by telephone questionnaire. In 28/30 cases, the owner was the first to discover the problem. The disease was initially recognised as canker in only 5/28 cases, whereas in 10/28 cases a treatment for thrush had been continued for several months before referral. There was a similar prevalence in the fore (41) and hind (44) hooves; 13/30 horses had 4 hooves affected. Treatment consisted of surgical debridement and hoof care. Duration of hospitalisation was significantly decreased in horses receiving oral prednisolone for 3 weeks compared to those without this additional systemic treatment (mean ± s.d. 24 ± 5 days, n = 7 vs. 40 ± 19 days, n = 19, respectively). Long‐term follow‐up ranged from 3 months to 6 years (36 ± 22 months) and was available for 24 horses. No recurrence was reported in 10 horses. In 14 horses problems recurred within the first year, and 6 had been subjected to euthanasia for this reason specifically, whereas the others were managed by regular trimming. There was no significant association between recurrence and the number of affected hooves or the use of any systemic treatment. Horses with delayed referral because of preceding treatments had significantly more chance to develop recurrence, highlighting the need for prompt diagnosis and subsequent treatment.     

Retrospective study of the effect of intra-articular treatment of osteoarthritis of the distal tarsal joints in 51 horses

Osteoarthritis of the distal tarsal joints, affecting the centrodistal and tarsometatarsal joints, is a common cause of hindlimb lameness in horses. This paper describes the outcome of the intra-articular treatment of 51 horses with the condition with either methylprednisolone acetate (mpa) or triamcinolone acetonide (tr), either with or without hyaluronic acid (ha). The outcome was assessed in terms of the changes in the horses' grade of lameness. Follow-up information was obtained from the owners by means of a telephone questionnaire. Horses treated once with mpa or tr, either with or without ha, improved after a median of 56 days (P<0.0001), and there was no significant difference between mpa and tr. There was no significant further improvement in the horses treated twice. In the horses in which there was a diffuse increase in the uptake of a radiopharmaceutical by the distal tarsal joints, identified by scintigraphy, the lameness tended to improve (P=0.032), whereas in the horses in which the uptake was focal, it did not. At telephone follow-up 13 of 34 horses were reported to have had a positive outcome, but the outcome in the other 21 was reported to have been negative.     

A retrospective clinical study of osteochondrosis dissecans in 21 horses

Osteochondrosis dissecans was diagnosed clinically and radiographically in 31 joints of 21 horses. The horses ranged in age from 8 months to 5 years at the time of presentation. The usual age of onset of clinical signs was 18 to 24 months. Presenting complaints included joint effusion and lameness of either gradual or sudden onset. In Thoroughbred horses, the stifle joint was the most common site of lesions and in Standardbred horses lesions occurred more commonly in the hock. In 16 of the 21 horses, the contralateral joint was radiographed and 9 of these horses had bilateral lesions. Thoroughbred horses were affected most commonly, followed by Standardbred horses. The prevalence was higher in males than females, the male: female ratio being 2.5:1.     

Thoracic limb digital extensor denervation in young horses

Low radial neurectomy in the left thoracic limb was performed in 4 mixed-breed weanling horses, with subsequent paralysis of the lateral and common digital extensor muscles. Weight bearing of the denervated and control limbs was discouraged by the use of special shoeing. Clinical signs of flexural deformity were not induced in the horses.     

Postanesthetic hind limb adductor myopathy in five horses

Five horses that underwent prolonged anesthesia (greater than 3 hours) in dorsal recumbency for a surgical procedure were unable to stand after recovery and were euthanatized. A provisional diagnosis of postanesthetic myopathy was confirmed at necropsy in all 5 horses. However, distribution of affected muscles in these horses was atypical, because there was bilateral hind limb adductor muscle involvement.