Pulmonary fibrosis and gammaherpesvirus infection in horses

Pulmonary fibrosis is a devastating and often progressive condition leading to exercise intolerance and frequently the demise of the animal. Although uncommonly encountered in horses, the condition is intensely researched both in human medicine and animal models. Viral infections have long been suspected to play a part in the development of pulmonary fibrosis and neoplastic conditions in other species. In 2007, an association between equine herpesvirus 5 (EHV‐5) infection and nodular pulmonary fibrosis in horses was suggested and the name equine multinodular pulmonary fibrosis (EMPF) was introduced. Recently, the presence of EHV‐5 in equine lymphoma has also emerged. The case report by Schwarz et al. in this issue describes a horse suffering from concurrent T cell leukaemia and EMPF in association with EHV‐5. This article summarises current knowledge about EMPF and EHV‐5 infections in horses, recent developments in the understanding of pulmonary fibrosis in man and the proposed contribution of viral infections to pulmonary fibrosis and neoplastic conditions.     

Multinodular pulmonary fibrosis,pancytopenia and equine herpesvirus‐5 infection in a Thoroughbred gelding

A 21‐year‐old Thoroughbred gelding was examined for intermittent fever, lethargy, inappetance and weight loss. Initial diagnostic evaluation revealed pancytopenia (anaemia, thrombocytopenia and neutropenia), hyperfibrinogenaemia and multifocal pulmonary nodules. Bacterial and fungal culture and viral isolation on transtracheal aspirate samples were negative, consistent with either pulmonary neoplasia, idiopathic granulomatous pneumonia or equine multinodular pulmonary fibrosis (EMPF). Bone marrow evaluation was consistent with pancytopenia due to a combination of peripheral consumption/destruction and suppression/destruction of progenitor cells at the level of the marrow. Pancytopenia resolved and clinical signs improved transiently with immunosuppressive corticosteroid therapy, but the horse deteriorated rapidly one month after presentation and was subjected to euthanasia. Necropsy findings were consistent with EMPF, and equine herpesvirus‐5 (EHV‐5) DNA was found in both the lung and bone marrow. The specific role of EHV‐5 in the development of the pulmonary pathology in EMPF and the pancytopenia in this horse is unclear, but an aberrant host immune/inflammatory response to EHV‐5 infection may be important.     

Post-anaesthetic pulmonary oedema in horses: a review

OBJECTIVES: To review information on the pathogenesis, diagnosis and treatment of post-anaesthetic pulmonary oedema in horses. DATABASES USED: Pubmed 1970-present, personal files.     

Detection of asinine gammaherpesviruses in association with pulmonary fibrosis in free-ranging donkeys

A mortality event among recently captured feral donkeys (Equus asinus) occurred in south-central Utah in 2016. The deaths were sporadic, and clinical signs were indicative of respiratory disease, likely associated with an infectious etiology. Ten of 13 donkeys autopsied had moderate-to-severe interstitial fibrosing pneumonia, and one had pyogranulomatous pneumonia. Consensus PCRs directed toward the DNA polymerase and DNA packaging terminase subunit 1 for herpesviruses were performed followed by sequencing of the PCR amplicons and phylogenetic analysis. Asinine herpesvirus 4 (AsHV4) and 5 (AsHV5) were consistently identified in lung tissues of affected donkeys. No other herpesviruses were identified, and herpesviral DNA was not detected in lung tissues of 2 donkeys without evidence of respiratory disease. The detection of asinine gammaherpesviruses may have been associated with the lesions described. AsHV4 and AsHV5 have been reported in previous studies as novel gammaherpesviruses based on sequences obtained from donkeys with interstitial pneumonia and marked syncytial cell formation. Our findings suggest that the association of asinine gammaherpesviruses with respiratory conditions in equids deserves further attention.     

Radiographic aspects of exercise-induced pulmonary hemorrhage in racing horses

Abnormal pulmonary radiopacities were identified in 13 racing horses in which a diagnosis of exercise-induced pulmonary hemorrhage (EIPH) had been confirmed. The lesions were in the caudal lung lobe in all horses; seven were on the right and three on the left, and the laterality for three could not be determined. In ten horses the opacities, which were large and peripherally located, obliterated the thoracophrenic angle. They merged with the silhouette of the diaphragm and had a circular or ovoid surface directed toward the hilum. The intensity of opacification of the consolidated areas varied, and they often were not sharply marginated. Dorsal displacement of the pulmonary arteries was noted in the region of the radiopacity in seven horses. Varying volumes of pleural effusion were observed in nine horses. Serial radiographic examinations were performed in seven horses. The pulmonary radiopacities cleared within ten days in two horses. In the remaining five horses, gradual resolution, characterized by a reduction in lesion size with improved margination, occurred during several months. The central region of the radiopaque lesion commonly had a patchy appearance, suggesting cavitation. Normal pulmonary vascular and interstitial markings were evident following complete resolution of these lesions. The cause of these abnormal pulmonary opacities has not been determined. Pathologic-radiologic correlations will be required to improve understanding of the pathophysiology of EIPH in the racing horse.     

A survey of respiratory viruses in New Zealand horses

AIMS: To determine which viruses circulate among selected populations of New Zealand horses and whether or not viral infections were associated with development of respiratory disease.

METHODS: Nasal swabs were collected from 33 healthy horses and 52 horses with respiratory disease and tested by virus isolation and/or PCR for the presence of equine herpesviruses (EHV) and equine rhinitis viruses.

RESULTS: Herpesviruses were the only viruses detected in nasal swab samples. When both the results of nasal swab PCR and virus isolation were considered together, a total of 41/52 (79%) horses with respiratory disease and 2/32 (6%) healthy horses were positive for at least one virus. As such, rates of virus detection were significantly higher (p<0.001) in samples from horses with respiratory disease than from healthy horses. More than half of the virus-positive horses were infected with multiple viruses. Infection with EHV-5 was most common (28 horses), followed by EHV-2 (27 horses), EHV-4 (21 horses) and EHV-1 (3 horses).

CONCLUSIONS: Herpesviruses were more commonly detected in nasal swabs from horses with respiratory disease than from healthy horses suggesting their aetiological involvement in the development of clinical signs among sampled horses. Further investigation to elucidate the exact relationships between these viruses and respiratory disease in horses is warranted.

CLINICAL RELEVANCE: Equine respiratory disease has been recognised as an important cause of wastage for the equine industry worldwide. It is likely multifactorial, involving complex interactions between different microorganisms, the environment and the host. Ability to control, or minimise, the adverse effects of equine respiratory disease is critically dependent on our understanding of microbial agents involved in these interactions. The results of the present study update our knowledge on the equine respiratory viruses currently circulating among selected populations of horses in New Zealand.     

Equine Multinodular Pulmonary Fibrosis and Lymphoma in a Horse Associated with Equine Herpesvirus-5

A 9-year-old mare presented with a 2-week history of partial anorexia, multiple swellings in the area of the throatlatch, and purulent nasal discharge. On initial presentation, the horse had submandibular and retropharyngeal lymphadenopathy, mild ventral edema, and weight loss. Thoracic radiographs revealed a pulmonary interstitial pattern. Necropsy revealed enlarged lymph nodes throughout the body. The lung parenchyma contained multiple random, well-circumscribed nodules, which, on cut section, were pale, tan colored, and very firm with a distinct line of demarcation from the surrounding normal parenchyma. The subendocardium of the left ventricle, left atrium, and, multifocally, the right ventricle contained white, gritty areas of mineralization. There was marked subintimal mineralization of the aorta and pulmonary artery. Histopathology of the lymph nodes revealed effacement of the parenchyma by a neoplasm composed of large numbers of small mature lymphocytes, fewer large lymphocytes, and scattered moderate numbers of histiocytes. Immunohistochemistry tests for CD3, CD79a, and CD20, confirmed the lymphoma was T-cell-rich B-cell lymphoma. The lungs contained marked interstitial fibrosis with alveolar histiocytosis. Polymerase chain reaction test results of lymph node and lungs were positive for equine herpesvirus-5 (EHV-5), a gammaherpesvirus. Gammaherpesvirus infection has been associated with lymphoma and pulmonary fibrosis in other species. This report describes the association between EHV-5 and both pulmonary fibrosis and lymphoma.     

Concurrent T cell leukaemia and equine multinodular pulmonary fibrosis in a Hanoverian Warmblood mare

Equine multinodular pulmonary fibrosis (EMPF) and primary leukaemia are uncommon diseases in horses. This case report describes a horse with both diseases which might be linked via the equine γ‐herpesvirus EHV‐5. In man Epstein Barr Virus (EBV), also a γ‐herpesvirus, is associated with idiopathic pulmonary fibrosis as is EHV‐5 with EMPF. Furthermore, EBV is also associated with lymphoproliferative disease. Similarly in horses, primary leukaemia might be associated with EHV‐5. This is the first report associating EHV‐5 with primary leukaemia in horses.     

Successful outcome in a case of equine multinodular pulmonary fibrosis (EMPF) treated with valacyclovir

Equine multinodular pulmonary fibrosis (EMPF) is a progressive fibrosing interstitial lung disease, which has been associated with γ‐herpesviruses. This report describes a 22‐year‐old Warmblood stallion diagnosed with EMPF on the basis of clinical examination, laboratory results, lung radiographs and ultrasound, lung biopsy and inclusion bodies found in macrophages of broncho‐alveolar lavage fluid (BALF) as well as an identification of EHV‐5 DNA by polymerase chain reaction (PCR). The horse recovered after one week of treatment with valacyclovir (40 mg/kg bwt per os q. 8 h) and is clinically healthy 2 years later. To our knowledge this is the first report describing treatment of EMPF with valacyclovir.     

Effects of 12 and 17 cmH2O positive end-expiratory pressure applied after alveolar recruitment maneuver on pulmonary gas exchange and compliance in isoflurane-anesthetized horses

Objective

To compare static compliance (C_st) and alveolar–arterial oxygen tension difference [P(a–a)O₂] between positive end-expiratory pressures (PEEP) of 7, 12 and 17 cmH₂O applied after an alveolar recruitment maneuver (RM) in isoflurane-anesthetized horses.

Respiratory disease in the donkey

The donkey suffers from a similar range of respiratory diseases as the horse; however, there are a number of subtle variations, knowledge of which can influence the success of treatment. As an animal adapted to a semi‐arid terrain, there are variations in physiology, anatomy and disease susceptibility. The nonathletic nature of the donkey means that delayed presentation is common with many diseases and, while there may be enhanced resistance to some transboundary and parasitic diseases, there may be equal or increased severity of illness to some endemic diseases, e.g. equine influenza. Donkeys frequently live to geriatric ages and the clinician should be aware of the increased risk of conditions such as tracheal collapse, fibrosing pneumonia and neoplasia in this age group. As with any condition that causes stress and inappetance, respiratory disease in the donkey may be complicated by hyperlipaemia and good nursing care is an essential component of treatment.     

Cor pulmonale secondary to pulmonary fibrosis in a 16-year-old mare

A 16-year-old mare was presented as an emergency to the Equine Hospital of the Veterinary School of Lyon, with a 1-month history of respiratory distress. On admission the mare was in poor body condition, with severe inspiratory and expiratory dyspnoea associated with severe hypoxaemia and marked tachycardia. Wheezes were auscultated. A pulmonary biopsy revealed fibrosis of about 40% of the parenchyma. Following an episode of atrial fibrillation, an echocardiogram was carried out which revealed signs of pulmonary hypertension, consistent with cor pulmonale. Despite the lack of aetiologic explanation for the primary pulmonary disease, the general condition of the mare improved with the administration of high-dosed corticoids and antimicrobial therapy.     

Regional distribution of collagen and haemosiderin in the lungs of horses with exercise‐induced pulmonary haemorrhage

Reasons for performing study: Regional veno‐occlusive remodelling of pulmonary veins in EIPH‐affected horses, suggests that pulmonary veins may be central to pathogenesis. The current study quantified site‐specific changes in vein walls, collagen and haemosiderin accumulation, and pleural vascular profiles in the lungs of horses suffering EIPH. Hypothesis: In the caudodorsal lung regions of EIPH‐affected horses, there is veno‐occlusive remodelling with haemosiderosis, angiogenesis and fibrosis of the interstitium, interlobular septa and pleura. Methods: Morphometric methods were used to analyse the distribution and accumulation of pulmonary collagen and haemosiderin, and to count pleural vascular profiles in the lungs of 5 EIPH‐affected and 2 control horses. Results: Vein wall thickness was greatest in the dorsocaudal lung and significantly correlated with haemosiderin accumulation. Increased venous, interstitial, pleural and septal collagen; lung haemosiderin; and pleural vascular profiles occurred together and changes were most pronounced in the dorsocaudal lung. Further, haemosiderin accumulation colocalised with decreased pulmonary vein lumen size. Vein wall thickening, haemosiderin accumulation and histological score were highly correlated and these changes occurred only in the caudodorsal part of the lung. Conclusion: The colocalisation of these changes suggests that regional (caudodorsal) venous remodelling plays an important role in the pathogenesis of EIPH. Potential relevance: The results support the hypothesis that repeated bouts of venous hypertension during strenuous exercise cause regional vein wall remodelling and collagen accumulation, venous occlusion and pulmonary capillary hypertension. Subjected to these high pressures, there is capillary stress failure, bleeding, haemosiderin accumulation and, subsequently, lung fibrosis.