Rhodococcus equi pneumonia in an adult horse

A 20‐year‐old, Thoroughbred mare in the fifth month of gestation was examined for weight loss, pyrexia and lethargy. Physical examination, ultrasonography and radiography revealed a severe abscessing pneumonia and a dead fetus. The mare did not respond to symptomatic treatment and died suddenly. Necropsy revealed multifocal pulmonary abscessation. Rhodococcus equi was isolated from the lungs, liver and kidneys. Specific immune function of the mare and presence of the virulence associated protein A (VapA) of the R. equi isolated was not determined. It is likely that immunosuppression is required for systemic R. equi infections in adult horses; however, it is unknown if VapA is necessary to produce disease in adult horses.     

Osteomyelitis of the scapulohumeral joint associated with Rhodococcus equi and unresponsive to antibiotherapy in a foal

This case report describes the treatment and outcome of a 3.5-month-old lame foal, with a history of pneumonia associated with Rhodococcus equi. Clinical examination identified osteomyelitis of the scapulohumeral joint. The unusual location of the Rhodococcus equi osteomyelitis unresponsive to prevention and adequate treatment led to euthanasia of the patient. Post-mortem findings confirmed bronchopneumonia due to Rhodococcus equi as well as the osteomyelitis of the scapulohumeral joint. This case highlights that Rhodococcus equi should be considered as a pathogen in extrapulmonary locations such as septic arthritis and osteomyelitis in foals with history of bronchopneumonia. Early and aggressive treatment should be considered.     

Cortical Osteitis of The Humeral Diaphysis Caused by Rhodococcus Equi

Infection with Rhodococcus equi is a common cause of pneumonia in foals. Extrapulmonary manifestations occur, including gastrointestinal disease such as enterocolitis, musculoskeletal disease such as osteomyelitis, as well as other aberrant regions of abscess. Osteomyelitis predominately occurs in the metaphyseal or epiphyseal regions of long bones because of low-pressure blood flow through the sinusoids of these regions of the bone. In this report, a case of cortical, diaphyseal osteitis of the humerus caused by Rhodococcus equi and subsequent medical and surgical management is described.     

Septic osteitis of the axial border of the proximal sesamoid bones in two foals

This case report describes the history, clinical findings, clinical pathology and diagnostic imaging of 2 cases of septic osteitis of the proximal sesamoid bones in foals. Treatment with doxycycline (10 mg/kg bwt per os b.i.d.) was successful in treating both of these cases.     

Cervical vertebral osteomyelitis in a 4‐month‐old foal

Vertebral body osteomyelitis in the cervical spine secondary to Rhodococcus equi has been treated both medically and surgically. This Case Report describes a 4‐month‐old foal exhibiting severe neurological signs from R. equi vertebral body osteomyelitis. Rapid, significant resolvement of neurological signs was noted in this case with surgical debridement and use of synthetic bone filler. The outcome suggests that aggressive surgical therapy in conjunction with synthetic allograft may be indicated in treatment of cervical vertebral body osteomyelitis.     

Disseminated Rhodococcus equi in an Anglo‐Nubian goat

Disseminated Rhodococcus equi infection was diagnosed in an Anglo‐Nubian goat presenting for non‐weight bearing lameness of the right pelvic limb. Radiographs showed a moth‐eaten osteolytic lesion in the proximal tibia suggestive of an aggressive bone lesion. Two pulmonary nodules were also present on thoracic radiographs. Initial antemortem cytology of the tibial lesion was suggestive of Rhodococcosis and the goat was sent to necropsy. Necropsy and bacterial culture confirmed the diagnosis of disseminated R. equi infection in the right tibia, lungs, and liver.     

Upper respiratory signs associated with Anaplasma phagocytophilum infection in two horses

An adult Quarter Horse gelding (Case 1) was evaluated for tachypnoea and acute dysphagia. A 20-year-old Quarter Horse gelding (Case 2) was evaluated for respiratory stertor and severe, acute swelling of the head in the submandibular region. A physical examination, complete blood count, blood chemistry, upper airway endoscopy, and peripheral blood Anaplasma phagocytophilum polymerase chain reaction were completed for both horses. Both horses tested positive for A. phagocytophilum. The upper airway endoscopy for Case 1 revealed a feed contaminated pharynx, absent swallowing reflex, and left laryngeal hemiplagia. The upper airway endoscopy for Case 2 revealed severe diffuse pharyngeal swelling occluding the airway. Due to increased respiratory effort in Case 2, a tracheotomy was performed. In both horses, treatment consisted of intravenous oxytetracycline 6.6 mg/kg bwt i.v. q. 24 h for 2–3 days followed by minocycline 4 mg/kg bwt per os q. 12 h for 10–14 days. Both horses made full recoveries.     

Rhodococcus equi occipital bone osteomyelitis,septic arthritis and meningitis in a neurological foal

This case report describes a 3‐month‐old female Thoroughbred foal that presented following the acute onset of apparent respiratory distress, abnormal head carriage and severe neurological deficits referable to the brainstem or cranial cervical spinal cord. Ultrasonography revealed an abscessing pneumonia. Radiographs did not show evidence of bony pathology at the atlanto‐occipital region, an area consistent with the observed neurological deficits. With magnetic resonance imaging, atlantal and occipital osteomyelitis, atlanto‐occipital septic arthritis, and atlanto‐axial synovitis were diagnosed. Brainstem meningitis and extradural compression were also revealed. Culture of the right occipitoatlantal joint and cerebrospinal fluid yielded a pure culture of Rhodococcus equi. These findings and multifocal R. equi abscessation were confirmed at necropsy.     

Severe cryptococcal granulomas of the nasopharynx in a horse treated with standing endoscopic laser surgery and oral fluconazole

An Arabian mare was referred due to a 4-month history of bilateral mucopurulent nasal discharge, which was unresponsive to multiple courses of antimicrobials and intravenous sodium iodide. Digital radiographs revealed multiple variably sized nodular opacities within the nasopharynx. Upper airway endoscopy showed multiple, ulcerated granulomatous masses originating from the walls of the nasopharynx. Repeat culture of the exudate and from endoscopic biopsies grew only a mixed bacterial population. Standing endoscopic guided laser excision of two granulomas was performed and histopathology and culture from the center of a surgically excised granuloma identified Cryptococcus terrestris. Treatment with fluconazole (14 mg/kg bwt per os once then 5 mg/kg bwt per os q. 12 h) was administered for a total of 11 weeks. Follow-up endoscopic examination was used to guide therapy duration, and the horse has since returned to competition and remained free of infection for >1.5 years. Establishing a diagnosis of cryptococcal infection was difficult in this horse despite multiple culture attempts. This is the first report of Cryptococcus terrestris infection in a horse and treatment with oral fluconazole after surgical de-bulking was successful.     

Long-term successful outcome of a Streptococcus equi subspecies equi brain abscess

We previously described successful treatment, including surgical drainage, of a Streptococcus equi subspecies equi brain abscess that caused severe neurological deficits in a 7-year-old Quarter Horse mare. This report details the long-term successful outcome of the case, findings of a magnetic resonance imaging (MRI) study performed 14 years after surgery and necropsy findings 18 years after initial treatment. Despite persistent cerebral and midbrain lesions detected by MRI and at necropsy, the mare returned to serviceable function within a year of initial treatment and had a successful performance career for over 10 years until carpal arthritis prompted retirement. This case demonstrates that brain abscess in horses can be successfully managed by combined medical and surgical treatment.     

The use of force plate measurements to titrate the dosage of a new COX‐2 inhibitor in lame horses

Reasons for performing study: Lameness is a highly prevalent condition in horses and the principal cause of removal from athletic activity. In clinical studies to evaluate nonsteroidal anti‐inflammatory drug therapies, force plates are commonly used to assess improvement of lameness objectively. Hypothesis: To use a force plate to determine the optimal dose of a new COX‐2 inhibitor (firocoxib) that will reduce lameness, when administered orally to horses once daily. Methods: Sixty‐four horses that exhibited chronic lameness presumed due to osteoarthritis, including navicular disease, in at least one of the frontlimbs and at a stable level of severity, were included. Horses were treated per os s.i.d. for 7 days as follows: vehicle control, firocoxib at 0.05, 0.1 or 0.25 mg/kg bwt. Force plate analysis of each horse was done for the selected (most) lame frontlimb at trot. Once between Days ?19 and ?4 (initial examination), and again on Day ?2 or ?1 (baseline), pretreatment force plate assessments were performed, and thereafter horses were assessed on Days 0, 2 and 6, approximately 10 h post treatment each time. Peak vertical force (PVF) and lameness grades at initial examination and at baseline, and their change from baseline in the 4 different treatment groups were analysed statistically at a significance level of P<0.05. Results: The PVF results were found to be superior to vehicle control already at Day 0 for 0.25 mg/kg bwt and at Days 2 and 6 for 0.1 and 0.25 mg/kg bwt (P<0.05). Mean clinical lameness for both concentrations decreased >1 grade at Day 6. Conclusions and clinical relevance: With the dosage of 0.25 mg/kg bwt lameness did not improve more than with 0.1 mg/kg bwt. Thus, 0.1 mg/kg bwt s.i.d. was considered to be the effective dose at reducing chronic lameness in horses presumed due to osteoarthritis, including navicular disease.     

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.     

Medical management of Rhodococcus equi infections: A clinical epidemiology perspective

Rhodococcus equi infections cause severe pulmonary disease in foals, affecting animal welfare and increasing production costs in horse-breeding farms. Extra-pulmonary disorders (EPD) are relatively common and can occur independently of pulmonary disease; foals with EPD have a more guarded prognosis. The accompanying paper by Shaw et al. (2021) reports the successful diagnosis and medical treatment of a large abdominal abscess caused by R. equi infection. The authors report on the benefits of using gallium maltolate, a semimetal compound with antimicrobial activity, in combination with traditional R. equi infection antimicrobial treatment (combination of a macrolide and rifampicin). Experimental studies are needed to understand further the benefits of this combined therapy, to evaluate the synergistic effects and if it improves the concentration of antimicrobial drugs into infected tissues. The publication of this case report in Equine Veterinary Education is of clinical importance to equine practitioners when diagnosing and treating R. equi infected foals with or without EPD.     

Subscapular lymph node abscessation as a result of metastatic Streptococcus equi subspecies equi infection: An atypical presentation of bastard strangles in a mare

The case reported here represents an atypical presentation of bastard strangles in an 18‐year‐old Arab mare. The horse initially presented for progressive neck pain characterised by reluctance to lateral and ventroflexion of the neck. Subsequent diagnostics revealed a subscapular abscess and aspirates of the mass cultured positive for Streptococcus equi ssp. equi. Surgical drainage and debridement of the abscess was performed under general anaesthesia. Six months post surgery, the mare had made a complete recovery.     

Anaesthetic and cardiorespiratory effects of propofol at 10% for induction and 1% for maintenance of anaesthesia in horses

Reasons for performing study: Studies have demonstrated the clinical usefulness of propofol for anaesthesia in horses but the use of a concentrated solution requires further investigation. Objectives: To determine the anaesthetic and cardiorespiratory responses to a bolus injection of 10% propofol solution in mature horses. Methods: Three randomised crossover experimental trials were completed. Trial 1: 6 horses were selected randomly to receive 10% propofol (2, 4 or 8 mg/kg bwt i.v.). Trial 2: 6 horses received 1.1 mg/kg bwt i.v. xylazine before being assigned at random to receive one of 5 different doses (1–5 mg/kg bwt) of 10% propofol. Trial 3: 6 horses were sedated with xylazine (0.5 mg/kg bwt, i.v.) and assigned randomly to receive 10% propofol (3, 4 or 5 mg/kg bwt, i.v.); anaesthesia was maintained for 60 min using an infusion of 1% propofol (0.2‐0.4 mg/kg bwt/min). Cardiorespiratory data, the quality of anaesthesia, and times for induction, maintenance and recovery from anaesthesia and the number of attempts to stand were recorded. Results: Trial 1 was terminated after 2 horses had received each dose of 10% propofol. The quality of induction, anaesthesia and recovery from anaesthesia was judged to be unsatisfactory. Trial 2: 3 horses administered 1 mg/kg bwt and one administered 2 mg/kg bwt were not considered to be anaesthetised. Horses administered 3–5 mg/kg bwt i.v. propofol were anaesthetised for periods ranging from approximately 10–25 min. The PaO₂ was significantly decreased in horses administered 3–5 mg/kg bwt i.v. propofol. Trial 3: The quality of induction and recovery from anaesthesia were judged to be acceptable in all horses. Heart rate and rhythm, and arterial blood pressure were unchanged or decreased slightly during propofol infusion period. Conclusions: Anaesthesia can be induced with a 10% propofol solution and maintained with a 1% propofol solution in horses administered xylazine as preanaesthetic medication. Hypoventilation and hypoxaemia may occur following administration to mature horses. Potential relevance: Adequate preanaesthetic sedation and oxygen supplementation are required in horses anaesthetised with propofol.     

Multicentre,controlled, randomised and blinded field study comparing efficacy of suxibuzone and phenylbutazone in lame horses

Reasons for performing study: In horses, it has been demonstrated that suxibuzone (SBZ) has a lower gastric ulcerogenic effect than phenylbutazone (PBZ). However, no field trials have been reported comparing the efficacy of the drugs in alleviating lameness. Objectives: To compare the therapeutic effect of SBZ to that of PBZ when administered orally in lame horses. Acceptability of both products was also compared. Methods: Lame horses (n = 155) were used in a multicentre, controlled, randomised and double‐blinded clinical trial. Horses were treated orally with either SBZ or PBZ at equivalent therapeutic dosages. PBZ was given to 79 horses at a dose of 4.4 mg/kg bwt/12 h for 2 days, followed by 2.2 mg/kg bwt/12 h for 6 days. SBZ was given to 76 horses at 6.6 mg/kg bwt/12 h for 2 days, followed by 3.3 mg/kg bwt/12 h for 6 days. Efficacy of treatments was evaluated by clinicians in equine practices according to lameness progression throughout the study. Product ingestion was checked daily to evaluate product acceptability. Results: Although SBZ showed a statistically significant tendency to have a better efficacy than PBZ (Odds ratio = 2.7; P = 0.016), significance dissipated once the analysis was adjusted for some imbalanced baseline covariates, confirming that they were actually related to the apparent advantage of SBZ over PBZ. Product acceptability was significantly higher in the SBZ group than in the PBZ group (96.1% vs. 77.2%; P = 0.001). Conclusions: SBZ and PBZ did not show significant differences in alleviating lameness in horses. However, SBZ had better product acceptability when administered orally with some food. Potential relevance: SBZ is a good therapeutic alternative to PBZ in horses since there is no significant difference in alleviating lameness between the 2 therapies.     

Rib osteomyelitis in three foals

Three foals aged between 21 and 44 days were presented for evaluation of pyrexia and lameness. Each had subcutaneous abscessation associated with osteomyelitis of a rib at the costochondral junction and pathological fracture of the affected rib; one foal had more than one rib affected. Other localised sites of infection included other sites of osteomyelitis, omphalophlebitis, uveitis, enterocolitis, and calcaneal bursitis. The subcutaneous abscessation and rib osteomyelitis was treated surgically in two foals. Salmonella typhimurium was isolated from the subcutaneous abscess in one foal and from the faeces of another. Two of the three foals were euthanased. Ultrasonography was a more useful modality than radiography for establishing the diagnosis of costal osteomyelitis.     

Pharmacokinetics of an orally administered methylcellulose formulation of gallium maltolate in neonatal foals

Chaffin, M. K., Fajt, V., Martens, R. J., Arnold, C. E., Cohen, N. D., O’Conor, M., Taylor, R. J., Bernstein, L. R. Pharmacokinetics of an orally administered methylcellulose formulation of gallium maltolate in neonatal foals. J. vet. Pharmacol. Therap. doi: 10.1111/j.1365‐2885.2009.01150.x. Gallium is a trivalent semi‐metal with anti‐microbial effects because of its incorporation into crucial iron‐dependent reproductive enzyme systems. Gallium maltolate (GaM) provides significant gallium bioavailability to people and mice following oral administration and to neonatal foals following intragastric administration. To study the prophylactic and therapeutic effects of GaM against Rhodococcus equi pneumonia in foals, we developed a methylcellulose formulation of GaM (GaM‐MCF) for oral administration to neonatal foals. Normal neonatal foals were studied. Six foals received 20 mg/kg and another six foals received 40 mg/kg of GaM‐MCF orally. Serial serum samples were collected and serum gallium concentrations were determined using inductively coupled plasma mass spectroscopy. Gallium was rapidly absorbed (T_max of 4 h), and a mean C_max of 0.90 or 1.8 μg/mL was achieved in foals receiving 20 or 40 mg/kg respectively. Marked variability existed in C_max among foals: only half of the foals receiving 20 mg/kg attained serum concentrations of >0.7 μg/mL, a level suggested to be therapeutic against R. equi by previous studies. Mean elimination half‐life was 32.8 or 32.4 h for foals receiving 20 or 40 mg/kg respectively. The results of this study suggest that at least 30 mg/kg orally every 24 h should be considered in future pharmacodynamic and efficacy studies.     

Controversies in therapy of infections caused by Rhodococcus equi in foals

Pneumonia caused by Rhodococcus equi is one of the most important causes of disease and death in foals. R. equi can also be cultured from a large variety of extrapulmonary sites of infection. In the absence of an effective vaccine, ultrasonographic screening for early detection of pulmonary lesions has become routine practice at many farms endemic for pneumonia caused by R. equi. Consequently, the most frequently recognised form of R. equi infection at such farms is a subclinical form in which foals develop sonographic evidence of peripheral pulmonary consolidation or abscessation without necessarily manifesting clinical signs. Evidence exists that not all foals with ultrasonographic lesions will progress to develop clinical signs, and treating a large proportion of foals based on subclinical ultrasonographic findings has been linked to emergence of macrolide‐ and rifampin‐resistant R. equi at a horse farm. Selectively treating only those foals with larger lesion scores and monitoring foals with daily physical inspections and weekly thoracic ultrasonography offers an approach that could decrease antimicrobial drug use without significantly increasing mortality. Current evidence continues to support the combination of rifampin with a macrolide (azithromycin, clarithromycin or erythromycin) for treating clinical infections caused by R. equi despite recently described pharmacological interactions between these drugs. When infection with a macrolide‐resistant isolate is confirmed, limited effective alternatives exist.     

Designing a treatment protocol with voriconazole to eliminate Aspergillus fumigatus from experimentally inoculated pigeons

To investigate the efficacy of voriconazole for the treatment of aspergillosis, three groups of six racing pigeons (Columba livia domestica) were inoculated in the apical part of the right lung with 2 × 10⁷ conidia of an avian derived Aspergillus fumigatus strain. The minimal inhibitory concentration of voriconazole for this strain was 0.25 μg/ml. In two groups, voriconazole treatment was started upon appearance of the first clinical signs and continued for fourteen days. The third group was sham treated. The voriconazole-treated pigeons received voriconazole orally at a dose of 10 mg/kg body weight (BW) q12h (group 1) or 20 mg/kg BW q24h (group 2). Sixteen days post-inoculation all surviving pigeons were euthanized. Weight loss, clinical scores, daily mortality, lesions at necropsy and isolation of A. fumigatus were compared between all groups. In both voriconazole-treated groups, a significant reduction in clinical signs and lesions was observed. Administering voriconazole at 10 mg/kg BW q12h eliminated A. fumigatus and administering voriconazole at 20 mg/kg BW q24h reduced A. fumigatus isolation rates. Mild histological liver abnormalities were found in group 1 (10 mg/kg BW q12h), while mild histological as well as macroscopic liver abnormalities were found in group 2 (20 mg/kg BW q24h).In conclusion, voriconazole at 10 mg/kg BW q12h in pigeons reduces clinical signs and eliminates A. fumigatus in racing pigeons experimentally infected with A. fumigatus.