Detection of space-time clusters and epidemiological examinations of scabies in chamois

In this paper some methodological approaches towards the detection of temporal, spatial and space-time clusters are presented and discussed in context with epidemiological factors of scabies in chamois. This presentation comprises in particular the use of the Scan Test (Wallenstein, 1980) for the detection of temporal clusters and the tests developed by Knox (1964) and Mantel (1967) for the testing of spatiotemporal interactions. Between 1952 and 1998 a total of 1689 cases of scabies in chamois and six cases in ibex were documented in 137 game preserves of the Austrian province of Styria. The evaluations indicate the presence of spatial and temporal clusters. Some possibilities for the spread of scabies in chamois are presented and reveal ibex as a probable vector for scabies transmission between chamois populations. The information may lead to strategies for controlling the spread of the disease.     

Use of spatial statistics and monitoring data to identify clustering of bovine tuberculosis in Argentina

The spatial distribution of endemic bovine tuberculosis (TB) in Argentine cattle herds was described using recorded information on the detection of TB-like lesions in cattle slaughtered between March 1995 and 1997 at 126 slaughterhouses with federal inspection. Approximately, 47% (9472396 cattle) of the estimated total number of cattle slaughtered in Argentina during this period was included in the study. Information on the number of cattle per source herd consigned to slaughter, number of cattle with TB-like lesions per herd and the geographical location of counties from which cattle originated was used to investigate spatial clustering of TB. Overall, no evidence of clustering of TB prevalence by county was detected (Moran's autocorrelation statistic I=0.009, P=0.089). However, first- (Cuzick and Edwards' test statistic, T(k)=87, P=0.036) and second-order (T(k)=170, P=0.038) nearest-neighbor case-counties (TB prevalence>median prevalence of all counties, 6.7%) were clustered. Using the spatial scan test based on a Bernoulli model, the most-likely cluster (P=0.001) identified during the study period included 5793 cases of TB (5.2 per 1000 km(2)) in five counties. This cluster coincided with Santa Fe Province, which contains 21% of all dairy cows in Argentina and accounts for 34% of the country's milk production. Several secondary clusters of TB-also located in dairy districts-were identified. Study results demonstrate that bovine TB is clustered in Argentina, and these clusters coincide with dairy cattle production. Identification of clustering can assist efforts to eradicate bovine TB from Argentina. Further spatial investigations need to focus on the reasons why TB is clustered in Argentina. In particular, the relationship between TB clustering and management practices-such as grazing density and production systems-need to be described to assist in the development of disease-control programs. The use of spatial statistics and geographical information systems could meet these needs.     

Evaluation of clinical characteristics, diagnostic test results, and outcome in horses with internal infection caused by Corynebacterium pseudotuberculosis: 30 cases (1995-2003)

OBJECTIVE: To determine clinical signs, results of diagnostic testing, and outcome in horses with internal Corynebacterium pseudotuberculosis infection. DESIGN: Retrospective study. ANIMALS: 30 horses. PROCEDURE: Information pertaining to clinical data, results of diagnostic tests, and costs of hospitalization and treatment was extracted from medical records of affected horses. RESULTS: Internal C. pseudotuberculosis infection was diagnosed on the basis of clinical signs, diagnostic imaging, and clinicopathologic data, including results of serologic tests and bacterial culture. The most common clinical signs were concurrent external abscesses, anorexia, fever, lethargy, weight loss, and signs of respiratory tract disease or abdominal pain. Clinicopathologic abnormalities included a geometric mean reciprocal serum synergistic hemolysin inhibition titer > or = 512, leukocytosis with neutrophilia, hyperglobulinemia, hyperfibrinogenemia, and anemia. Specific organ involvement was diagnosed in 27 of 30 horses. Affected organs included the liver (18 horses), lungs (12), kidneys (7), and spleen (3); multiple organs were affected in 10 horses. Treatment with antimicrobials for a median of 36 days (range, 7 to 97 days) was usually successful, yielding an overall survival rate of 71%. CONCLUSIONS AND CLINICAL RELEVANCE: Early diagnosis and long-term antimicrobial treatment were important for a successful outcome in horses with internal C. pseudotuberculosis infection. Ultrasonographic imaging was an important technique for identifying specific organs affected, aiding in obtaining samples for a definitive diagnosis, and monitoring response to treatment. Pregnant mares with internal infections are at risk for fetal loss. Preexisting chronic organ disease may be associated with a poor prognosis.     

A serologic method for the detection of Corynebacterium pseudotuberculosis infections in horses

A serologic technique useful for detecting antibodies formed in horses in response to infection with Corynebacterium pseudotuberculosis is described. The test relies on the ability of C. pseudotuberculosis toxin to produce a wide zone of hemolysis when applied to erythrocytes previously treated with a sterile filtrate of Corynebacterium equi broth culture. The synergistic hemolytic activity can be neutralized by anti-C. pseudotuberculosis serum. This test was used to analyze sera from 616 horses for the presence of C. pseudotuberculosis antitoxin. Of 177 animals (see Table 2) found positive, there were 34 horses with bacteriologically confirmed, active infections and 18 with active but unconfirmed infections. In addition, 13 animals had a history of having had the disease and 112 had no history or evidence of having had the infection. The other 439 horses had negative titers. Statistical treatments confirmed the value of the test as an epidemiological tool but precluded using only titers for the diagnosis of active clinical disease.     

Effect of daily administration of pyrantel tartrate in preventing infection in horses experimentally challenged with Sarcocystis neurona

OBJECTIVE: To determine whether daily administration of pyrantel tartrate can prevent infection in horses experimentally challenged with Sarcocystis neurona. ANIMALS: 24 mixed-breed specific-pathogen-free weanling horses, 10 adult horses, 1 opossum, and 6 mice. PROCEDURE: Sarcocystis neurona-na?ve weanling horses were randomly allocated to 2 groups. Group A received pyrantel tartrate at the labeled dose, and group B received a nonmedicated pellet. Both groups were orally inoculated with 100 sporocysts/d for 28 days, 500 sporocysts/d for 28 days, and 1000 sporocysts/d for 56 days. Blood samples were collected weekly, and CSF was collected monthly. Ten seronegative adult horses were monitored as untreated, uninfected control animals. All serum and CSF samples were tested by use of western blot tests to detect antibodies against S. neurona. At the end of the study, the number of seropositive and CSF-positive horses in groups A and B were compared by use of the Fisher exact test. Time to seroconversion on the basis of treatment groups and sex of horses was compared in 2 univariable Cox proportional hazards models. RESULTS: After 134 days of sporocyst inoculation, no significant differences were found between groups A and B for results of western blot tests of serum or CSF There were no significant differences in number of days to seroconversion on the basis of treatment groups or sex of horses. The control horses remained seronegative. CONCLUSIONS AND CLINICAL RELEVANCE: Daily administration of pyrantel tartrate at the current labeled dose does not prevent S. neurona infection in horses.     

Use of a real-time polymerase chain reaction-based fluorogenic 5' nuclease assay to evaluate insect vectors of Corynebacterium pseudotuberculosis infections in horses

OBJECTIVE: To develop and use a sensitive molecular assay for detecting the phospholipase D (PLD) exotoxin gene of Corynebacterium pseudotuberculosis in an attempt to identify insect vectors that may be important in transmission of clinical disease in horses. SAMPLE POPULATION: 2,621 flies of various species. PROCEDURE: A real-time polymerase chain reaction (PCR)-based fluorogenic 5' nuclease (TaqMan) system (ie, TaqMan PCR assay) was developed for the detection of the PLD gene in insects. Flies were collected monthly (May to November 2002) from 5 farms in northern California where C. pseudotuberculosis infection in horses is endemic. Three of the 5 farms (which housed a total of 358 horses) had diseased horses during the study period. A total of 2,621 flies of various species were tested for the PLD gene of C. pseudotuberculosis. RESULTS: Evidence of bacterial DNA for the PLD gene was detected in skin biopsy specimens from clinically affected horses and from 3 fly species collected from farms where affected horses were housed. Farms with a high incidence of diseased horses had a high proportion of insects carrying the organism. High percentages of flies with positive results for the PLD gene were observed in October, when most clinically affected horses were observed. CONCLUSIONS AND CLINICAL RELEVANCE: Our results are consistent with the hypothesis that C. pseudotuberculosis may be vectored to horses by flies. Three potential vectors were identified, including Haematobia irritans, Stomoxys calcitrans, and Musca domestica. The organism can be identified in up to 20% of house flies (Musca domestica) in the vicinity of diseased horses.     

Musculoskeletal Corynebacterium pseudotuberculosis infection in horses: 35 cases (1999-2009)

Objective-To describe the clinical course and outcome in horses in which Corynebacterium pseudotuberculosis infections were associated with musculoskeletal disease and lameness. Design-Retrospective case series. Animals-35 horses. Procedures-Clinical and clinicopathologic data were collected from horses diagnosed with lameness associated with C pseudotuberculosis infection between 1999 and 2009. Results-32 (91.4%) horses had grade 4/5 lameness. Three (8.6%) horses had grade 5/5 lameness. Abscesses were diagnosed by clinical or ultrasonographic examination. Abscesses were located in the axillary or triceps region in 25 (71.4%) horses, the stifle region in 2 (5.7%), and the popliteal lymph node in 1 (2.9%). Diffuse lymphangitis was seen in 4 (11.4%) horses, osteomyelitis in 2 (5.7%) horses, and septic arthritis in 2 (5.7%) horses. Horses commonly had clinicopathologic abnormalities characterized by neutrophilia (96.4%), anemia (67.8%), hypoalbuminemia (66.6%), or hyperfibrinogenemia (42.8%). Treatment included surgical drainage of the abscess in 21 (60%) horses, performed under ultrasonography in 20 horses; anti-inflammatory medications in 34 (97.1 %) horses; and antimicrobials in 30 (85.7%) horses. Conclusions and Clinical Relevance-C pseudotuberculosis infection of the limbs in horses typically results in severe lameness but may have a favorable prognosis. The diagnosis may be challenging, and results of blood work consistent with inflammation are nonspecific, but anemia, hyperglobulinemia, and increased synergistic hemolysis inhibition titers are common. Ultrasonography may localize the lesions and facilitate surgical drainage to alleviate lameness. When C pseudotuberculosis musculoskeletal infection results in osteomyelitis or septic arthritis, the prognosis for survival is poor.     

Molecular epidemiologic features of Corynebacterium pseudotuberculosis isolated from horses

OBJECTIVE: To characterize isolates of Corynebacterium pseudotuberculosis from horses, cattle, and sheep in Colorado, Kentucky, Utah, and California in samples collected during perceived epidemics of infection (increased numbers of cases identified) in 2002 and 2003, and determine how closely isolates were related and their possible source. SAMPLE POPULATION: 54 isolates of C pseudotuberculosis from 49 horses, 4 cattle, and 1 sheep. PROCEDURES: Random amplified polymorphic DNA (RAPD) polymerase chain reaction (PCR) assay, PCR assay for the gene encoding the phospholipase D (PLD) toxin, biochemical analyses, and tests for susceptibility to 17 antimicrobial drugs were performed. RESULTS: All isolates reduced nitrate to nitrite, most yielded positive results for the PLD toxin gene, and all were susceptible to antimicrobial drugs. Ten genetic types were detected by use of RAPD PCR assay; types III to X were isolated from horses, cattle, or both in 1 or more states. Types III and IX were isolated from both horses and cattle. Types VII and VIII were isolated in only 1 state, but the number of isolates in these groups was small. In contrast, all other types were isolated in 2 or more states. All isolates from Utah were type III, but the other 3 states had isolates from more than 1 type. CONCLUSIONS AND CLINICAL RELEVANCE: These data are consistent with a clonally expanding epidemic of infection in Utah and an increase in number of infections caused by multiple strains of C pseudotuberculosis not derived from a single source in the other states. The increase in number of infections could be the result of reporting bias, environmental factors facilitating infection, or host factors such as greater herd susceptibility.     

Space-time clustering of, and risk factors for, farmer-diagnosed winter dysentery in dairy cattle

We used two statistical techniques for space-time cluster analysis, the Knox and the Mantel regression methods, for an analysis of whether herd outbreaks of farmer-diagnosed winter dysentery during the winter of 1987-1988 were clustered in space and time more than would be expected by chance. Using the Knox method, there was significant space-time clustering of outbreaks of winter dysentery within a 30 day time and a 5.5 km radius. There was also significant space-time clustering by the Mantel regression method.     

Identification of hyperendemic foci of horses with West Nile virus disease in Texas

OBJECTIVE: To determine whether West Nile virus (WNV) disease hyperendemic foci (hot spots) exist within the horse population in Texas and, if detected, to identify the locations. SAMPLE POPULATION: Reports of 1,907 horses with WNV disease in Texas from 2002 to 2004. Procedures: Case data with spatial information from WNV epidemics occurring in 2002 (1,377 horses), 2003 (396 horses), and 2004 (134 horses) were analyzed by use of the spatial scan statistic (Poisson model) and kriging of empirical Bayes smoothed county attack rates to determine locations of horses with WNV disease in which affected horses were consistently (in each of the 3 study years) clustered (hyperendemic foci, or hot spots). RESULTS: 2 WNV hot spots in Texas, an area in northwestern Texas and an area in eastern Texas, were identified with the scan statistic. Risk maps of the WNV epidemics were qualitatively consistent with the hot spots identified. Conclusions and CLINICAL RELEVANCE: WNV hot spots existed within the horse population in Texas (2002 to 2004). Knowledge of disease hot spots allows disease control and prevention programs to be made more efficient through targeted surveillance and education.     

Experimental Leptospira interrogans Serovar Kennewicki Infection of Horses

Background: Little information is available about experimental induction of leptospirosis in horses. Objectives: Determine serologic, hematologic responses of horses to Leptospira interrogans serovar Kennewicki infection. Animals: Four adult horses seronegative for leptospirosis. Methods: Experimental and observational study. Horses were challenged with an equine isolate of L. interrogans serovar Kennewicki at 2 different doses and different inoculation sites. After challenge, the horses were monitored for 60 days. Blood, urine, and aqueous humor samples were collected at intervals until euthanasia 60 days after infection. Results: Pyrexia (39.3–40°C) occurred as early as 1 day after challenge with 10 × 10⁸Leptospira divided equally between topical ocular and intraperitoneal injection in 2 horses. Leptospires were recovered from the blood and urine but not from the aqueous humor of the 2 febrile horses. The sera of all 4 challenged horses developed microscopic agglutination test antibody after challenge and remained relatively constant for 21 days. Titer to cross‐reacting strains declined earlier than titer to the challenge strain. Conclusions: Clinical disease in experimentally infected horses can be mild or inapparent in Leptospira infected horses. Repeated serologic testing can allow recognition of the infecting serovar. In febrile horses, Leptospira can be isolated from blood while isolation from the urine can occur after fever has subsided.     

Effects of dexamethasone on glucose dynamics and insulin sensitivity in healthy horses

OBJECTIVE: To determine effects of dexamethasone on glucose dynamics and insulin sensitivity in healthy horses. ANIMALS: 6 adult Standardbreds. PROCEDURES: In a balanced crossover study, horses received dexamethasone (0.08 mg/ kg, IV, q 48 h) or an equivalent volume of saline (0.9% NaCl) solution (control treatment) during a 21-day period. Horses underwent a 3-hour frequently sampled IV glucose tolerance test (FSIGT) 2 days after treatment. Minimal model analysis of glucose and insulin data from FSIGTs were used to estimate insulin sensitivity (Si), glucose effectiveness (Sg), acute insulin response to glucose (AIRg), and disposition index. Proxies for Si (reciprocal of the inverse square of basal insulin concentration [RISQI]) and beta-cell responsiveness (modified insulin-to-glucose ratio [MIRG]) were calculated from basal plasma glucose and serum insulin concentrations. RESULTS: Mean serum insulin concentration was significantly higher in dexamethasone-treated horses than control horses on days 7, 14, and 21. Similarly, mean plasma glucose concentration was higher in dexamethasone-treated horses on days 7, 14, and 21; this value differed significantly on day 14 but not on days 7 or 21. Minimal model analysis of FSIGT data revealed a significant decrease in Si and a significant increase in AIRg after dexamethasone treatment, with no change in Sg or disposition index. Mean RISQI was significantly lower, whereas MIRG was higher, in dexamethasone-treated horses than control horses on days 7, 14, and 21. CONCLUSIONS AND CLINICAL RELEVANCE: The study revealed marked insulin resistance in healthy horses after 21 days of dexamethasone administration. Because insulin resistance has been associated with a predisposition to laminitis, a glucocorticoid-induced decrease in insulin sensitivity may increase risk for development of laminitis in some horses and ponies.     

Effects of duration of isoflurane anesthesia and mode of ventilation on intracranial and cerebral perfusion pressures in horses

OBJECTIVE: To test the hypothesis that isoflurane-anesthetized horses during controlled ventilation and spontaneous ventilation exhibit temporal changes in cerebral hemodynamics, as measured by intracranial pressure and cerebral perfusion pressure, that reflect temporal changes in systemic arterial pressure. ANIMALS: 6 healthy adult horses. PROCEDURE: Horses were anesthetized in left lateral recumbency with 1.57% isoflurane in O2 for 5 hours in 2 experiments by use of either controlled ventilation (with normocapnia) or spontaneous ventilation (with hypercapnia) in a randomized crossover design. Intracranial pressure was measured with a subarachnoid strain-gauge transducer. Carotid artery pressure, central venous pressure, airway pressures, blood gases, and minute ventilation also were measured. RESULTS: Intracranial pressure during controlled ventilation significantly increased during constant dose isoflurane anesthesia and thus contributed to decreasing cerebral perfusion pressure. Intracranial pressure was initially higher during spontaneous ventilation than during controlled ventilation, but this difference disappeared over time; no significant differences in cerebral perfusion pressures were observed between horses that had spontaneous or controlled ventilation. CONCLUSIONS AND CLINICAL RELEVANCE: Cerebral hemodynamics and their association with ventilation mode are altered over time in isoflurane-anesthetized horses and could contribute to decreased cerebral perfusion during prolonged anesthesia.     

Recovery of Yersinia pseudotuberculosis from the faeces of healthy cattle

Attempts were made to recover and serologically identify Yersinia pseudotuberculosis from the faeces of groups of nine to twenty clinically healthy cattle eight to thirteen months old on each of 50 farms in the northern part of New Zealand. Yersinia pseudotuberculosis was recovered from 134 (26.3%) of 509 faeces samples from cattle on 42 (84%) farms and from nine of ten samples on two of these farms. Serotypes I, II, and III were identified, of which serotype III was by far the most common and accounted for 125 (93.2%) of the 134 isolates. Because of the common occurrence and widespread distribution of Y. pseudotuberculosis it is suggested that the clinical significance of isolation of this micro-organism from faeces samples or intestinal contents should be treated with caution.     

Efficacy of a commercial vaccine for preventing disease caused by influenza virus infection in horses.

OBJECTIVE: To evaluate efficacy of a commercial vaccine for prevention of infectious upper respiratory tract disease (IURD) caused by equine influenza virus. DESIGN: Double-masked, randomized, controlled field trial. ANIMALS: 462 horses stabled at a Thoroughbred racetrack. PROCEDURE: Vaccine or saline solution placebo was administered 4 times in the population at 6-week intervals. The vaccine contained 3 strains of inactivated influenza virus, and inactivated equine herpesvirus type 4. Horses received 1 or 2 doses of vaccine or placebo prior to onset of a natural influenza epidemic, and were examined 5 d/wk to identify and monitor horses with IURD. Serum antibody concentrations were determined, and virus isolation was performed. RESULTS: Vaccination of horses prior to the influenza epidemic did not result in significant decrease in risk of developing respiratory tract disease. Severity of clinical disease was not different between affected vaccinated horses with IURD and controls with IURD, but median duration of clinical disease was 3 days shorter in vaccinated horses. Serum concentrations of antibodies to H3N8 influenza viruses were lower prior to initial vaccination in horses that were sick during the epidemic, and did not increase in these horses in response to vaccination. On arrival at the racetrack, young horses had lower antibody concentrations than older horses, and did not respond to vaccination as well. CONCLUSIONS AND CLINICAL RELEVANCE: Vaccination was of questionable benefit. A greater degree of protection must be obtained for influenza vaccines to be effective in protecting horses from IURD. Objective field evaluations of commercial vaccines are needed to adequately document their efficacy.     

Effects of multiple intramuscular injections and doses of dexamethasone on plasma cortisol concentrations and adrenal responses to ACTH in horses

Adrenocortical function was assessed in horses given multiple IM doses of dexamethasone to determine the duration of adrenocortical suppression and insufficiency caused by 2 commonly used dosages of dexamethasone (0.044 and 0.088 mg/kg of body weight). Dexamethasone was administered at 5-day intervals for a total of 6 injections. Daily blood samples were collected. The plasma was frozen and later assayed for cortisol. An ACTH response test was determined 2 days before the first injection of dexamethasone and again 8 days after the last dexamethasone injection. Maximum suppression of plasma cortisol was observed in horses given both dosages of dexamethasone (0.044 and 0.088 mg/kg). Plasma cortisol concentrations returned to base-line values in all horses by 4 days after dexamethasone injection. Normal ACTH responses observed after 6 dexamethasone injections given at 5-day intervals indicated that measurable adrenal atrophy did not develop under the conditions of this study.     

Effects of intra-articular injections of bufexamac suspension on amphotericin B-induced aseptic arthritis in horses

OBJECTIVE: To evaluate effects of intra-articular (i.a.) injections of bufexamac on amphotericin B-induced aseptic arthritis in horses. ANIMALS: 24 Standardbred horses. PROCEDURE: Aseptic arthritis was induced in the right intercarpal joint by i.a. injection of amphotericin B (20 mg). One week later (day 0), horses were randomly assigned to four 6-horse treatment groups and treated with i.a. injection of 10, 20, or 40 mg of bufexamac suspension (20 mg/ml) or 2.0 ml of sterile saline (0.9% NaCl) solution (control). The treatment was repeated once after 7 days. Clinical lameness examinations and synovial fluid (SF) analyses were done prior to induction and at weekly intervals for 5 weeks (days 0, 7, 14, 21 and 28). RESULTS: Intra-articular injection of amphotericin B consistently resulted in aseptic arthritis with a lameness index (mean +/- SEM; scale 0 to 5) of 2.7 +/- 0.17 on day 0. Intra-articular injections of 20 and 40 mg of bufexamac significantly reduced the day-28 lameness index, compared with control values. Amphotericin B administration also resulted in a significant increase in SF beta-glucuronidase (BGLUC) activity, and i.a. injections of bufexamac significantly reduced day-28 activity of this enzyme, compared with control values. CONCLUSIONS AND CLINICAL RELEVANCE: 2 i.a. injections of 20 or 40 mg of bufexamac, at weekly intervals, were effective in reducing clinical signs of lameness and SF activity of BGLUC associated with amphotericin B-induced carpal joint arthritis. Bufexamac possesses anti-inflammatory properties useful for i.a. treatment of lameness associated with aseptic arthritis in horses.     

Effects of phenylbutazone and anabolic steroids on adrenal and thyroid gland function tests in healthy horses

Adrenal and/or thyroid gland function tests were evaluated in horses at various times during short-term therapy with phenylbutazone, stanozolol, and boldenone undecylenate. There were no significant treatment or time effects on mean basal plasma cortisol concentrations in horses during treatment with the following: phenylbutazone, given twice daily (4 to 5 mg/kg, IV) for 5 days; stanozolol, given twice weekly (0.55 mg/kg, IM) for 12 days; boldenone undecylenate, given twice weekly (1.1 mg/kg, IM) for 12 days; or nothing. There was no significant effect of phenylbutazone treatment on the changes in plasma cortisol concentration during the combined dexamethasone-suppression adrenocorticotropic hormone (ACTH)-stimulation test. Plasma cortisol concentration was significantly decreased from base line at 3 hours after dexamethasone administration and was significantly increased from base line at 2 hours after ACTH in all horses (P less than 0.05). Likewise, the stimulation of basal plasma cortisol concentrations at 2 hours after administration of ACTH (P less than 0.05) was not affected by treatment with stanozolol or boldenone undecylenate. There were no significant treatment effects on mean basal plasma concentrations of thyroxine (T4) or triiodothyronine (T3) among horses during the following treatments: stanozolol, given twice weekly (0.55 mg/kg, IM) for 12 days; boldenone undecylenate, given twice weekly (1.1 mg/kg, IM) for 12 days; or nothing. There was a significant time effect on overall mean basal plasma T4 and T3 concentrations (P less than 0.05): plasma T4 was lower on day 8 than on days 1, 10, and 12; plasma T3 was higher on day 8 than on days 4 and 12.(ABSTRACT TRUNCATED AT 250 WORDS)     

Risk factors for and outcomes of noncatastrophic suspensory apparatus injury in Thoroughbred racehorses

OBJECTIVE: To evaluate effects of toe grabs, exercise intensity, and distance traveled as risk factors for subclinical to mild suspensory apparatus injury (SMSAI) in Thoroughbred racehorses and to compare incidence of severe musculoskeletal injury (MSI) in horses with and without SMSAI. DESIGN: Nested case-control study. ANIMALS: 219 Thoroughbred racehorses racing or in race training. PROCEDURE: Racehorses were examined weekly for 90 days to determine incidence of suspensory ligament injury and monitor horseshoe characteristics. Every horse's exercise speeds and distances were recorded daily. Conditional logistic regression was used to compare exposure variables between incident case (n = 25) and selected control (125) horses. Survival analysis was used to compare time to MSI for horses with (n = 41) and without (76) SMSAI. RESULTS: The best-fitting logistic model for the data included age (< 5 vs > or = 5 years old), toe grab height the week of injury (none vs very low, low, regular, or Quarter Horse height), and weekly distance the week preceding injury (miles). Although the 95% confidence intervals for all odds ratios included 1, the odds for SMSAI appeared to increase with the presence of a toe grab, higher weekly distance, and age > or = 5 years. Horses that had SMSAI were significantly more likely to have a severe MSI or severe suspensory apparatus injury than were horses that did not. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that pre-existing SMSAI is associated with development of severe MSI and severe suspensory apparatus injury. Modifying training intensity and toe grab height for horses with SMSAI may decrease the incidence of severe MSI.