European outbreak of atypical myopathy in the autumn 2009

Background – Atypical myopathy is an acute, severe rhabdomyolysis occurring in grazing horses. In the beginning of October 2009, a new outbreak occurred in several European countries. Geographic, demographic and clinical data of the reported cases in the month October 2009 are described. Key Findings – The survival rate in this outbreak was 25%. The most frequently observed clinical signs were congested mucous membranes, dyspnea, tachycardia, depression, weakness, stiffness, recumbency, trembling, sweating, and myoglobinuria. Nonsurvivors were significantly more likely to be recumbent than survivors. Prognostic factors, symptomatic treatment, and preventive measures are discussed. Significance – Differences were encountered during the described outbreak of atypical myopathy in October 2009 compared with previous outbreaks reported. Equine practitioners should be aware that previous epidemiological studies have shown that after a high prevalence in the autumn, new cases are likely to occur in the following spring.     

Equine atypical myopathy: a review

Atypical myopathy (AM) is an acute rhabdomyolysis syndrome that occurs at irregular intervals in grazing equines. An increasing number of outbreaks have been reported in recent years, including some from countries where the disease has not previously been diagnosed. In this review, clinical and other details of outbreaks of AM are analysed to better define its epidemiological profile. Potential aetiologies are discussed, the short clinical course of AM is described and the main biochemical and pathological findings are considered. Recommendations for medical management are suggested, based on a review of clinical reports. Biochemical and histopathological findings have been integrated in order to characterise the physiopathology of AM. There is an ongoing requirement to record new cases of this syndrome, ideally through an epidemiological network.     

Concurrent atypical myopathy and equine dysautonomia in two horses

This report concerns 2 horses that suffered typical clinical signs of atypical myopathy (AM) and equine grass sickness (EGS) concurrently. Clinical details and pathological lesions of the cases are described. EGS and AM are relatively rare diseases and the concurrency of the diseases in the same animals is therefore considered unlikely to be a coincidence. However, it is not suggested that the evidence shows a common aetiology but rather the existence of common predisposing causes.     

Three cases of a presumptive atypical myopathy in New Zealand horses

CASE HISTORY: Three weanling Thoroughbred fillies were presented during autumn with depression, muscle rigidity and, in one case, colic symptoms and cardiovascular shock.

CLINICAL FINDINGS: All fillies had abnormal physical examinations that included elevated heart rates and respiratory rates coupled with muscle rigidity through the back and rump. Biochemistry revealed markedly elevated creatinine kinase and aspartate aminotransferase which indicated a myopathy.

DIAGNOSIS AND TREATMENT: All three horses were diagnosed with presumptive equine atypical myopathy. The horses received supportive therapy as per the literature available at the time regarding this condition; two responded to supportive therapy and survived, and one was euthanased due to a rapid deterioration in clinical status.

PATHOLOGICAL FINDINGS: Following post mortem of one case, histology of the trapezius muscle demonstrated an acute, severe myofibre degeneration.

CLINICAL RELEVANCE: Atypical myopathy and a very similar disorder termed seasonal pasture myopathy in North America are potentially fatal, pasture-related syndromes that have been described in Europe and America but have not been previously described in New Zealand. This report describes three presumptive cases of this unique syndrome in New Zealand for the first time; it outlines the characteristics of the condition; and includes recently published information regarding diagnosis and treatment.     

Morphological alterations in oxidative muscles and mitochondrial structure associated with equine atypical myopathy

REASONS FOR PERFORMING STUDY: There is a lack of well documented studies about muscular lesions in equine atypical myopathy (EAM). OBJECTIVES: To characterise morphopathological changes of striated muscles and myocardium, to progress understanding of this disease. METHODS: Thirty-two horses age 0.5-7 years kept on pasture were referred for a sudden ataxia/myoglobinuria syndrome. Clinical examination (stiffness, muscle pain, muscle fasciculations, abnormal gait, recumbency, myoglobinuria, tachycardia, sweating) and plasma CPK, LDH and AST levels were consistent with extensive myonecrosis and, together with anamnestic data, with so-called 'equine atypical myopathy' (EAM), a disease of unknown aetiology reported since 1939. Macroscopic and microscopic (histology, histoenzymology, ultrastructure) lesions were evaluated. RESULTS: Necropsic examination revealed large areas of muscle necrosis, the extent and severity of which varied between cases and muscles, but which were clearly more constant and severe in respiratory and postural muscles and in the myocardium. Histology highlighted a multifocal and monophasic process compatible with Zenker degeneration/necrosis that mostly and segmentally affected type 1 fibres. Histochemical evaluation revealed a weak and disorganised pattern of NADH tetrazolium reductase staining, the absence of calcium salts precipitates and a dramatic accumulation of lipid droplets. Ultrastructural examination often revealed fibres of which the sole modifications were altered mitochondria and sarcoplasmic lipidosis. CONCLUSIONS: Taken together, the data suggest that a primary alteration of mitochondria should be considered, although secondary mitochondrial abnormalities have yet to be ruled out. POTENTIAL RELEVANCE: The morphological features gathered here reveal that EAM shares most of the characteristics of toxic myopathies.     

Analysing hypoglycin A,methylenecyclopropylacetic acid conjugates and acylcarnitines in blood to confirm the diagnosis and improve our understanding of atypical myopathy

Owing to recent methodological validation studies, we have now the opportunity to determine hypoglycin A, methylenecyclopropylacetic acid–carnitine and acylcarnitines concentrations in equine serum. These analytes are essential to confirm the diagnosis of atypical myopathy but also to improve our understanding of the pathophysiology of the disease. In particular, they might help elucidate why some horses seem more resistant to hypoglycin A poisoning.     

Predictive value of hypoglycin A and methylencyclopropylacetic acid conjugates in a horse with atypical myopathy in comparison to its cograzing partners

Hypoglycin A (HGA) was detected in blood and urine of a horse suffering from atypical myopathy (AM; Day 2, serum, 8290 μg/l; urine: Day 1, 574, Day 2, 742 μg/l) and in its cograzing partners with a high variability (46–1570 μg/l serum). Over the period of disease, the level of the toxic metabolites (methylencyclopropylacetic acid [MCPA]‐conjugates) increased in body fluids of the AM horse (MCPA‐carnitine: Day 2, 0.246, Day 3, 0.581 μmol/l serum; MCPA‐carnitine: Day 2, 0.621, Day 3, 0.884 μmol/mmol creatinine in urine) and HGA decreased rapidly (Day 3, 2430 μg/l serum). In cograzing horses MCPA‐conjugates were not detected. HGA in seeds ranged from 268 to 367 μg/g. Although HGA was present in body fluids of healthy cograzing horses, MCPA‐conjugates were not detectable, in contrast to the AM horse. Therefore, increasing concentrations of MCPA‐conjugates are supposed to be linked with the onset of AM and both parameters seem to indicate the clinical stage of disease. However, detection of HGA in body fluids of cograzing horses might be a promising step in preventing the disease.     

Biochemical and genetic evaluation of the role of AMP-activated protein kinase in polysaccharide storage myopathy in Quarter Horses

OBJECTIVE: To evaluate whether biochemical or genetic alterations in AMP-activated protein kinase (AMPK) play a role in the development of polysaccharide storage myopathy (PSSM) in Quarter Horses. ANIMALS: 30 PSSM-affected and 30 unaffected (control) Quarter Horses. PROCEDURES: By use of an established peptide phosphotransfer assay, basal and maximal AMPK activities were measured in muscle biopsy samples obtained from 6 PSSM-affected and 6 control horses. In 24 PSSM-affected and 24 control horses, microsatellite markers identified from the chromosomal locations of all 7 AMPK subunit genes were genotyped with a fluorescent DNA fragment analyzer. Alleles of 2 of the AMPK gamma subunit genes were genotyped via DNA sequencing. Allele frequencies of DNA markers in or near the AMPK subunit genes were measured in isolated genomic DNA. RESULTS: No differences in basal or maximal muscle AMPK enzyme activities between PSSM-affected and control horses were detected. There were also no differences in allele frequencies for microsatellite markers near any of the 7 AMPK subunit genes between the 2 groups. Furthermore, previously known and newly identified alleles of 2 equine AMPK gamma subunit genes were also not associated with PSSM. CONCLUSIONS AND CLINICAL RELEVANCE: These results have provided no evidence to indicate that AMPK plays a causative role in PSSM in American Quarter Horses.