Molecular epidemiology of antimicrobial resistance in veterinary medicine: where do we go?

Molecular epidemiology allows us to trace specific microorganisms and mobile genetic elements and to assess their epidemiological and evolutionary relationships. Examples of molecular epidemiology investigations in veterinary hospitals are discussed. They demonstrate the great similarities with the situation in human medicine and the potential usefulness of molecular epidemiology in our fight against antimicrobial resistance and nosocomial infections in veterinary hospitals. A broad knowledge of the diversity of antimicrobial resistance determinants in some major groups of pathogens and commensals from animals such as Enterobacteriaceae, Pasteurellaceae, enterococci and staphylococci is emerging. However, there are important gaps in this knowledge, which are discussed here. Many more molecular epidemiology studies will be necessary to understand and follow the evolution of the problem in veterinary medicine and agriculture on a global scale. To be able to build useful surveillance programs and reliable epidemiological models, and to identify critical intervention points, we need to improve our understanding of antimicrobial resistance at the animal and farm levels. Studies assessing the dynamics of bacterial populations and of resistance determinants at these levels are desperately needed. Understanding the relationships between antimicrobial resistance, colonization factors, and virulence also represents a major issue for which molecular epidemiology investigations will be needed.     

Inflammatory bowel diseases in horses: What do we know?

Chronic inflammatory bowel diseases (IBDs) are a group of gastrointestinal (GI) disorders described in both humans and animals, but unlike in other species, in horses they are poorly defined and there is a lack of standardisation of the method of diagnosis. Although there is an impellent need of consensus on the nomenclature, diagnostic work-up, diet, treatment and management of horses with a suspected IBD, the aim of this review is to give initial guidelines for practitioners dealing with suspected cases. It provides a summary of the most relevant literature on the topic and presents the current knowledge on the clinical signs, diagnostic work-up, treatment and prognosis of IBDs in horses.     

Pain control in horses: What do we really know?

Currently, approaches to pain control in horses are a mixture of art and science. Recognition of overt pain behaviours, such as rolling, kicking at the abdomen, flank watching, lameness or blepharospasm, may be obvious; subtle signs of pain can include changes in facial expression or head position, location in the stall and response to palpation or human interaction. Nonsteroidal anti‐inflammatory drugs (i.e. phenylbutazone, flunixin meglumine and firocoxib), opioids (i.e. butorphanol, morphine and buprenorphine) and α₂‐adrenergic agonists (i.e. xylazine, detomidine, romifidine and medetomidine) are the most commonly used therapeutic options. Multimodal therapy using constant‐rate infusions of lidocaine, ketamine and/or butorphanol has gained popularity for severe pain in hospitalised cases. Drugs targeting neuropathic pain, such as gabapentin, are increasingly used for conditions such as laminitis. Optimal strategies for management of pain are based upon severity and chronicity, including special considerations for use of intra‐articular or epidural delivery and therapy in foals. Strategies that aim to mitigate adverse effects associated with use of various analgesic agents are briefly discussed.     

Equine glaucoma: Where are we now?

The following article discusses the pathophysiology, clinical signs, diagnosis, medical treatment and surgical management of glaucoma in the horse.     

Where do you draw the line on treatment?

With euthanasia a legitimate treatment option in veterinary medicine, at what point does treatment become overtreatment? The issues were discussed in a 'contentious issues' debate at the BVA Congress, which was held in Glasgow from September 23 to 25.     

Efficacy of vaccines against bacterial diseases in swine: what can we expect?

This paper discusses what can be expected with regard to efficacy of antibacterial vaccines used in swine, based on the present knowledge of pathogen–host interactions. First, vaccination against bacteria that mainly cause disease by production of exotoxins is considered. Vaccines containing the inactivated toxin or a non-toxic but antigenic recombinant protein derived from the exotoxin can be expected to provide protection against disease. The degree of protection induced by such vaccines varies, however, depending amongst other things on the pathogenesis of the disease. Vaccination against clostridial infections, Actinobacillus pleuropneumoniae infections, progressive atrophic rhinitis and enterotoxigenic Escherichia coli, is considered. The second part of the article deals with vaccination against extracellular bacteria. Protection against these bacteria is generally mediated by antibodies against their surface antigens and certain secreted antigens, but cellular immunity may also play a role. Efficacy of vaccines against swine erysipelas, Streptococcus suis infections, Mycoplasma hyopneumoniae infections and swine dysentery is discussed. Finally, vaccination against facultatively intracellular bacteria is considered. For protection against these bacteria cell-mediated immunity plays an important role, but antibodies may also be involved. It is generally accepted that live-attenuated vaccines are more suitable for induction of cell-mediated immunity than inactivated vaccines, although this also depends on the adjuvant used in the vaccine. As an example, vaccination against Salmonella enterica serotype Typhimurium is discussed.     

Does suckling offer protection to the lamb against Teladorsagia circumcincta infection?

This study tested the hypothesis that milk has a direct effect on the establishment of infection with Teladorsagia circumcincta, and provides information on the effects of suckling on resilience to infection in young lambs. Of 46 six-week-old twin-born lambs, one from each twin was allowed to continue suckling (S-) and its twin-weaned (W-) while both were concurrently infected with an average of either 0 (-0; n=7/group), 250 (-250; n=8/group) or 1000 (-1000; n=8/group) third stage infective larvae (L3) of T. circumcincta per day, providing six treatment groups. All groups grazed minimally contaminated pasture, and after 42 days were slaughtered for necropsy. Low pasture larval contamination was confirmed in W0 and S0 lambs by faecal egg counts (FEC) of less than 30 eggs per gram (EPG) and burdens of less than 140 worms. There was no difference in FEC between weaned and suckled lambs. Within infection regime, total worm burdens were 55-60% greater in the weaned compared with their suckled counterparts (P=0.05), and represented 27 and 17%, respectively, net establishment of larvae. The greater worm burdens of both groups of weaned animals, which compared with their suckled counterparts, and of those infected with 1000 compared with 250 larvae per day, were associated with shorter female adults that had fewer eggs in utero, perhaps indicating intra-worm population regulation, but highlighting the limitation of FEC in assessing nematode burdens of such young lambs. There was no effect of infection on live weight gain of either weaned or suckled groups and the possibility was raised that, in such young lambs, immune unresponsiveness may be responsible. The major benefit of continued milk consumption appears to lie more in providing nutrients for enhanced growth rather than in improving resilience of the lambs to infection.