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Topic:Infection

Infections in horses encompass a range of diseases caused by various pathogens, including bacteria, viruses, fungi, and parasites. These infections can affect different systems within the horse, such as the respiratory, gastrointestinal, and integumentary systems, leading to a variety of clinical signs depending on the pathogen and the severity of the infection. Common infectious diseases in horses include equine influenza, strangles, and equine herpesvirus. Diagnosis often involves clinical examination, laboratory testing, and sometimes imaging, to identify the causative agent and assess the extent of the disease. Treatment strategies may include antimicrobial therapy, supportive care, and preventive measures such as vaccination and biosecurity practices. This page aggregates peer-reviewed research studies and scholarly articles that explore the pathogenesis, diagnosis, treatment, and prevention of infectious diseases in equine populations.
Length of tick repellency depends on formulation of the repellent compound (icaridin = Saltidin®): tests on Ixodes persulcatus and Ixodes ricinus placed on hands and clothes.
Parasitology research    May 9, 2015   Volume 114, Issue 8 3041-3045 doi: 10.1007/s00436-015-4506-z
Abdel-Ghaffar F, Al-Quraishy S, Mehlhorn H.The present study had the aim to test the repellent potential of the compound icaridin = Saltidin® against the tick species Ixodes ricinus and Ixodes persulcatus using different formulations of the compound. Tests were done on backs of impregnated human hands, on impregnated linen cloth and versus impregnated dog hair. It was found that 1. Ixodes persulcatus-the common Eastern European, Russian Ixodes species is significantly sensitive to icaridin = Saltidin® as I. ricinus protecting for the test period of 5 h. This is an important finding, since I. persulcatus is the vector of agents of the...
Assessment of risk factors associated with prevalence of strongyle infection in equines from Central Plain Zone, Punjab.
Journal of parasitic diseases : official organ of the Indian Society for Parasitology    May 8, 2015   Volume 40, Issue 4 1381-1385 doi: 10.1007/s12639-015-0695-8
Singh G, Singh NK, Singh H, Rath SS.A total of 311 equine faecal samples (190 horses and 121 mules) collected from six districts of Central Plain Zone, Punjab were examined using standard coprological methods. The results showed an overall prevalence of 27.33 % for strongyles with rare to mild type of infection as evident from egg per gram of faeces. In particular, amongst the examined samples, 17.90 % of horses and 42.14 % of mules were infected and the difference was statistically significant (P < 0.01). Identification of the faecal culture harvested larval stages, showed 56 % and 46 % of horses and mules, respectively, ...
Sarcocystis fayeri-Induced Granulomatous and Eosinophilic Myositis in 2 Related Horses.
Veterinary pathology    May 8, 2015   Volume 52, Issue 6 1191-1194 doi: 10.1177/0300985815584073
Herd HR, Sula MM, Starkey LA, Panciera RJ, Johnson EM, Snider TA, Holbrook TC.This report describes 2 genetically related paint mares, case Nos. 1 and 2, presented to the Oklahoma State University Boren Veterinary Medical Teaching Hospital for chronic weight loss and abnormal gait, respectively. Notable findings in both cases included marked persistent eosinophilia and multiple intramuscular lateral thoracic masses. Histologic examination of masses revealed eosinophilic, centrally necrotic granulomas and marked eosinophilic myositis. Granulomas in case No. 1 also contained intralesional Sarcocystis sp material, and adjacent muscle fibers contained intact protozoal cysts...
Evaluation of Baermann apparatus sedimentation time on recovery of Strongylus vulgaris and S. edentatus third stage larvae from equine coprocultures.
Veterinary parasitology    May 8, 2015   Volume 211, Issue 1-2 99-101 doi: 10.1016/j.vetpar.2015.05.001
Bellaw JL, Nielsen MK.Traditional methods of diagnosing equine Strongylinae infections require culturing feces, sedimenting the culture media in Baermann apparatuses, collecting the sediment, and morphologically identifying recovered third stage larvae. However, this method is plagued by low negative predictive values. This study evaluated sedimentation time within the Baermann apparatus by comparing larval recovery from the traditionally collected sediment, "sediment 1", and from the usually discarded remaining fluid contents, "sediment 2", of the Baermann apparatus after 12, 24, and 48 h. A grand total of 147,482...
Limited similarity between plasmids encoding CTX-M-1 β-lactamase in Escherichia coli from humans, pigs, cattle, organic poultry layers and horses in Denmark.
Journal of global antimicrobial resistance    May 7, 2015   Volume 3, Issue 2 132-136 doi: 10.1016/j.jgar.2015.03.009
Jakobsen L, Bortolaia V, Bielak E, Moodley A, Olsen SS, Hansen DS, Frimodt-Møller N, Guardabassi L, Hasman H.CTX-M-1 is a common extended-spectrum β-lactamase (ESBL) in Escherichia coli from animals and is often detected among human clinical isolates. The objective of this study was to investigate the epidemiological relationship between CTX-M-1-producing E. coli isolated from patients and animals in Denmark between 2006 and 2010. In total, 65 CTX-M-1-producing isolates from patients (n=22), pigs (n=21), cattle (n=4), organic poultry layers (n=3) and horses (n=15) were typed by pulsed-field gel electrophoresis (PFGE). Plasmids harbouring bla were characterised by S1 PFGE, PCR-based replicon typing, ...
A new trivalent SnSAG surface antigen chimera for efficient detection of antibodies against Sarcocystis neurona and diagnosis of equine protozoal myeloencephalitis. Yeargan M, de Assis Rocha I, Morrow J, Graves A, Reed SM, Howe DK.Enzyme-linked immunosorbent assays (ELISAs) based on the SnSAG surface antigens of Sarcocystis neurona provide reliable detection of infection by the parasite. Moreover, accurate serodiagnosis of equine protozoal myeloencephalitis (EPM) is achieved with the SnSAG ELISAs by measuring antibodies in serum and cerebrospinal fluid (CSF) to reveal active infection in the central nervous system. Two independent ELISAs based on recombinant (r)SnSAG2 or a chimeric fusion of SnSAG3 and SnSAG4 (rSnSAG4/3) are currently used together for EPM serodiagnosis to overcome varied antibody responses in different...
Endothelin 1 in healthy foals and in foals affected by neonatal diseases.
Theriogenology    May 4, 2015   Volume 84, Issue 5 667-673 doi: 10.1016/j.theriogenology.2015.04.026
Giordano A, Castagnetti C, Panzani S, Paltrinieri S, Freccero F, Veronesi MC.In newborn babies, endothelin 1 (ET-1), a potent vasoconstrictor, increases during septicemia and severe respiratory syndromes. Because equine neonatal sepsis (ENS) and perinatal asphyxia syndrome (PAS) are major causes of morbidity and mortality in newborn foals and because no information on the concentration of ET-1 in healthy and sick foals has been reported yet, the aims of this study were (1) to define the serum concentration of Big ET-1 in healthy neonatal foals during the first week of age; (2) to preliminarily explore the diagnostic and prognostic role of Big ET-1 during ENS and PAS. S...
Pathology in Practice. Ependymoma of the right lateral ventricle with internal hydrocephalus in a horse.
Journal of the American Veterinary Medical Association    May 2, 2015   Volume 246, Issue 10 1067-1069 doi: 10.2460/javma.246.10.1067
Lindsey C, Aschenbroich SA, Credille BC, Barton MH, Howerth EW.No abstract available
Equid herpesvirus type 1 (EHV-1) disrupts actin cytoskeleton during productive infection in equine leukocytes.
Polish journal of veterinary sciences    May 2, 2015   Volume 18, Issue 1 107-112 doi: 10.1515/pjvs-2015-0014
Drebert Z, Golke A, Cymerys J, Słońska A, Chmielewska A, Tucholska A, Bańbura MW.Equid herpesvirus type 1 (EHV-1) is a prevalent causative agent of equine diseases worldwide. After primary replication in the respiratory epithelium the virus disseminates systemically through a peripheral blood mononuclear cell (PBMC)-associated viraemia. EHV-1 is the only alphaherpes- virus known so far which is capable of establishing latent infection not only in neurons but also in immune system cells (mainly in lymphocytes and macrophages). Since leukocytes are not the target cells for viral replication but are used to transport EHV-1 to the internal organs, the questionremains how the v...
Development of a novel molecular detection method for clustered regularly interspaced short palindromic repeats (CRISPRs) in Taylorella organisms.
Journal of medical microbiology    May 1, 2015   Volume 64, Issue 7 782-787 doi: 10.1099/jmm.0.000079
Hara Y, Nakajima T, Akamatsu M, Yahiro M, Kagawa S, Petry S, Matsuda M, Moore JE.Contagious equine metritis is a bacterial infectious disease of horses caused by Taylorella equigenitalis, a Gram-negative eubacterium. The disease has been described in several continents, including Europe, North America and Asia. A novel molecular method was developed to detect clustered regularly interspaced short palindromic repeats (CRISPRs), which were separated by non-repetitive unique spacer regions (NRUSRs) of similar length, in the Taylorella equigenitalis EQ59 strain using a primer pair, f-/r-TeCRISPR-ladder, by PCR amplification. In total, 31 Taylorella isolates (17 T. equigenitali...
Neutrophil function in healthy aged horses and horses with pituitary dysfunction.
Veterinary immunology and immunopathology    April 30, 2015   Volume 165, Issue 3-4 99-106 doi: 10.1016/j.vetimm.2015.04.006
McFarlane D, Hill K, Anton J.Immunosuppression leading to opportunist bacterial infection is a well-recognized sequela of equine pituitary pars intermedia dysfunction (PPID). The mechanisms responsible for immune dysfunction in PPID however, are as of yet poorly characterized. Horses with PPID have high concentrations of hormones known to impact immune function including α-melanocyte stimulating hormone (α-MSH) and insulin. α-MSH and related melanocortins have been shown in rodents and people to impair neutrophil function by decreasing superoxide production (known as oxidative burst activity), migration and adhesion. T...
In vivo assessment of equine arteritis virus vaccine improvement by disabling the deubiquitinase activity of papain-like protease 2.
Veterinary microbiology    April 30, 2015   Volume 178, Issue 1-2 132-137 doi: 10.1016/j.vetmic.2015.04.018
van Kasteren PB, Knaap RC, van den Elzen P, Snijder EJ, Balasuriya UB, van den Born E, Kikkert M.Arteriviruses are a family of positive-stranded RNA viruses that includes the prototypic equine arteritis virus (EAV) and porcine reproductive and respiratory syndrome virus (PRRSV). Although several vaccines against these viruses are commercially available there is room for improvement, especially in the case of PRRSV. The ability of arteriviruses to counteract the immune response is thought to decrease the efficacy of the current modified live virus vaccines. We have recently shown that the deubiquitinase (DUB) activity of EAV papain-like protease 2 (PLP2) is important for the inhibition of ...
The ubiquitin proteasome system plays a role in venezuelan equine encephalitis virus infection.
PloS one    April 30, 2015   Volume 10, Issue 4 e0124792 doi: 10.1371/journal.pone.0124792
Amaya M, Keck F, Lindquist M, Voss K, Scavone L, Kehn-Hall K, Roberts B, Bailey C, Schmaljohn C, Narayanan A.Many viruses have been implicated in utilizing or modulating the Ubiquitin Proteasome System (UPS) to enhance viral multiplication and/or to sustain a persistent infection. The mosquito-borne Venezuelan equine encephalitis virus (VEEV) belongs to the Togaviridae family and is an important biodefense pathogen and select agent. There are currently no approved vaccines or therapies for VEEV infections; therefore, it is imperative to identify novel targets for therapeutic development. We hypothesized that a functional UPS is required for efficient VEEV multiplication. We have shown that at non-tox...
Proteomics of endometrial fluid after dexamethasone treatment in mares susceptible to endometritis.
Theriogenology    April 29, 2015   Volume 84, Issue 4 617-623 doi: 10.1016/j.theriogenology.2015.04.019
Arlas TR, Wolf CA, Petrucci BP, Estanislau JF, Gregory RM, Jobim MI, Mattos RC.Corticotherapy is a common treatment in mares susceptible to endometritis. Isoflupredone improves pregnancy rates and affects the protein profile of endometrial fluid in comparison to untreated mares. Dexamethasone decreases postbreeding fluid accumulation and uterine edema; however, its effects on the protein profile of the endometrial fluid have not yet been studied. The aim of the present study was to verify the effect of dexamethasone on the protein profile of endometrial fluid, in the presence or absence of infection, from mares susceptible to persistent postbreeding endometritis. Nine su...
Characterising Non-Structural Protein NS4 of African Horse Sickness Virus.
PloS one    April 27, 2015   Volume 10, Issue 4 e0124281 doi: 10.1371/journal.pone.0124281
Zwart L, Potgieter CA, Clift SJ, van Staden V.African horse sickness is a serious equid disease caused by the orbivirus African horse sickness virus (AHSV). The virus has ten double-stranded RNA genome segments encoding seven structural and three non-structural proteins. Recently, an additional protein was predicted to be encoded by genome segment 9 (Seg-9), which also encodes VP6, of most orbiviruses. This has since been confirmed in bluetongue virus and Great Island virus, and the non-structural protein was named NS4. In this study, in silico analysis of AHSV Seg-9 sequences revealed the existence of two main types of AHSV NS4, designat...
The occurrence and genetic characterization of Cryptosporidium and Giardia species in foals in Belgium, The Netherlands, Germany and Greece.
Veterinary parasitology    April 27, 2015   Volume 211, Issue 3-4 170-174 doi: 10.1016/j.vetpar.2015.04.018
Kostopoulou D, Casaert S, Tzanidakis N, van Doorn D, Demeler J, von Samson-Himmelstjerna G, Saratsis A, Voutzourakis N, Ehsan A, Doornaert T....Faecal samples were collected from foals between the age of 1 week and 6 months in Belgium, The Netherlands, Germany and Greece. A quantitative direct immunofluorescence assay based on the commercial MERIFLUOR Cryptosporidium/Giardia kit was performed to evaluate the presence of (oo) cysts. Parasite positive samples were genotyped, based on the 18S ribosomal DNA gene and the heat shock protein (HSP70) gene for Cryptosporidium and on the β-giardin gene and the triose phosphate isomerase (TPI) gene for Giardia. In total, 134 foals from Belgium, 44 foals from The Netherlands, 30 foals from Germa...
Optimization of a Fluorescence-Based Assay for Large-Scale Drug Screening against Babesia and Theileria Parasites.
PloS one    April 27, 2015   Volume 10, Issue 4 e0125276 doi: 10.1371/journal.pone.0125276
Rizk MA, El-Sayed SA, Terkawi MA, Youssef MA, El Said el Sel S, Elsayed G, El-Khodery S, El-Ashker M, Elsify A, Omar M, Salama A, Yokoyama N....A rapid and accurate assay for evaluating antibabesial drugs on a large scale is required for the discovery of novel chemotherapeutic agents against Babesia parasites. In the current study, we evaluated the usefulness of a fluorescence-based assay for determining the efficacies of antibabesial compounds against bovine and equine hemoparasites in in vitro cultures. Three different hematocrits (HCTs; 2.5%, 5%, and 10%) were used without daily replacement of the medium. The results of a high-throughput screening assay revealed that the best HCT was 2.5% for bovine Babesia parasites and 5% for equ...
Efficacy of Mechanical versus Non-Mechanical Sterile Preoperative Skin Preparation With Chlorhexidine Gluconate 4% Solution.
Veterinary surgery : VS    April 24, 2015   Volume 44, Issue 5 648-652 doi: 10.1111/vsu.12335
Davids BI, Davidson MJ, TenBroeck SH, Colahan PT, Oli MW.To compare the efficacy of sterile preoperative skin antisepsis using either a 5-minute mechanical preparation or 5-minute non-mechanical preparation with chlorhexidine gluconate 4% solution. Methods: Matched design, ANOVA. Methods: Healthy adult Thoroughbred horses (n = 30). Methods: Each horse had both surgical preparation methods randomly assigned to identical sites on the left or right upper thigh. Prepared sites were sampled and cultured for bacteria after each preparation step. Results: Mechanical and non-mechanical preparation techniques significantly reduced bacteria isolated from ...
Equid herpesvirus type 1 activates platelets.
PloS one    April 23, 2015   Volume 10, Issue 4 e0122640 doi: 10.1371/journal.pone.0122640
Stokol T, Yeo WM, Burnett D, DeAngelis N, Huang T, Osterrieder N, Catalfamo J.Equid herpesvirus type 1 (EHV-1) causes outbreaks of abortion and neurological disease in horses. One of the main causes of these clinical syndromes is thrombosis in placental and spinal cord vessels, however the mechanism for thrombus formation is unknown. Platelets form part of the thrombus and amplify and propagate thrombin generation. Here, we tested the hypothesis that EHV-1 activates platelets. We found that two EHV-1 strains, RacL11 and Ab4 at 0.5 or higher plaque forming unit/cell, activate platelets within 10 minutes, causing α-granule secretion (surface P-selectin expression) and pl...
Rapid and accurate identification of Streptococcus equi subspecies by MALDI-TOF MS.
Systematic and applied microbiology    April 23, 2015   Volume 38, Issue 5 315-322 doi: 10.1016/j.syapm.2015.02.010
Kudirkiene E, Welker M, Knudsen NR, Bojesen AM.Streptococcus equi includes very important animal and human pathogens. S. equi subsp. equi (SEE) is a highly pathogenic equine specific subspecies, while S. equi subsp. zooepidemicus (SEZ) and S. equi subsp. ruminatorum are opportunistic pathogens of various animal species and humans. Due to great phenotypic and sequence similarity between three subspecies their discrimination remains difficult. In this study, we aimed to design and validate a novel, Superspectra based, MALDI-TOF MS approach for reliable, rapid and cost-effective identification of SEE and SEZ, the most frequent S. equi subspec...
Response to Richards letter.
Equine veterinary journal    April 22, 2015   Volume 47, Issue 3 377 doi: 10.1111/evj.12405
Riggs CM, Preston S.No abstract available
Getah Virus Infection among Racehorses, Japan, 2014.
Emerging infectious diseases    April 22, 2015   Volume 21, Issue 5 883-885 doi: 10.3201/eid2105.141975
Nemoto M, Bannai H, Tsujimura K, Kobayashi M, Kikuchi T, Yamanaka T, Kondo T.An outbreak of Getah virus infection occurred among racehorses in Japan during September and October 2014. Of 49 febrile horses tested by reverse transcription PCR, 25 were positive for Getah virus. Viruses detected in 2014 were phylogenetically different from the virus isolated in Japan in 1978.
Equine and Canine Influenza H3N8 Viruses Show Minimal Biological Differences Despite Phylogenetic Divergence.
Journal of virology    April 22, 2015   Volume 89, Issue 13 6860-6873 doi: 10.1128/JVI.00521-15
Feng KH, Gonzalez G, Deng L, Yu H, Tse VL, Huang L, Huang K, Wasik BR, Zhou B, Wentworth DE, Holmes EC, Chen X, Varki A, Murcia PR, Parrish CR.The A/H3N8 canine influenza virus (CIV) emerged from A/H3N8 equine influenza virus (EIV) around the year 2000 through the transfer of a single virus from horses to dogs. We defined and compared the biological properties of EIV and CIV by examining their genetic variation, infection, and growth in different cell cultures, receptor specificity, hemagglutinin (HA) cleavage, and infection and growth in horse and dog tracheal explant cultures. Comparison of sequences of viruses from horses and dogs revealed mutations that may be linked to host adaptation and tropism. We prepared infectious clones o...
Seroprevalence and Potential Risk Factors Associated with Neospora spp. Infection among Asymptomatic Horses in Jordan.
The Korean journal of parasitology    April 22, 2015   Volume 53, Issue 2 163-167 doi: 10.3347/kjp.2015.53.2.163
Talafha AQ, Abutarbush SM, Rutley DL.This study aimed to determine the seroprevalence and to identify risk factors associated with Neospora spp. infection in horses in Jordan. Management related data were collected from each farm and individual horses. Sera from 227 horses from 5 of 6 climatic regions in Jordan were analyzed for the presence of antibodies to Neospora spp. by ELISA kit. The study was performed during spring of 2010. The association between seropositivity and risk factors was analyzed. A total of 7 (3%) of 227 sera had antibodies for Neospora spp. There was a significant regional difference (P=0.018) between the 5 ...
Anthelmintic resistance in equine helminth parasites – a growing issue for horse owners and veterinarians in New Zealand?
New Zealand veterinary journal    April 20, 2015   Volume 63, Issue 4 188-198 doi: 10.1080/00480169.2014.987840
Scott I, Bishop RM, Pomroy WE.There is growing concern that given the high frequency with which anthelmintics are being administered to many horses, anthelmintic resistance amongst equine helminth populations will be an increasing problem, rendering many of the currently available products unusable with little prospect of new products becoming available, at least in the near future. Worldwide, much reliance has been placed on the macrocyclic lactone (ML) group of anthelmintics, but resistance has been reported to these products as well as to the two other major anthelmintic classes used in this species, the benzimidazoles ...
[Infection control and hygiene management in equine hospitals].
Berliner und Munchener tierarztliche Wochenschrift    April 16, 2015   Volume 127, Issue 11-12 486-497 
Walther B, Janssen T, Gehlen H, Vincze S, Borchers K, Wieler LH, Barton AK, Lübke-Becker A.With the rising importance of nosocomial infections in equine hospitals, increased efforts with regard to biosecurity and infection control are necessary. This even more since nosocomial infections are often associated with multi-drug resistant pathogens. Consequently, the implementation of targeted prevention programs is essential. Since nosocomial infections are usually multifactorial events, realization of only a single measure is rarely effective to overcome nosocomial spread in clinical practice. Equine patients may be colonized at admission with multi-drug resistant pathogens such as met...
Intra-host viral variability in children clinically infected with H1N1 (2009) pandemic influenza. Bourret V, Croville G, Mansuy JM, Mengelle C, Mariette J, Klopp C, Genthon C, Izopet J, Guérin JL.Recent in-depth genetic analyses of influenza A virus samples have revealed patterns of intra-host viral genetic variability in a variety of relevant systems. These have included laboratory infected poultry, horses, pigs, chicken eggs and swine respiratory cells, as well as naturally infected poultry and horses. In humans, next generation sequencing techniques have enabled the study of genetic variability at specific positions of the viral genome. The present study investigated how 454 pyrosequencing could help unravel intra-host genetic diversity patterns on the full-length viral hæmagglutin...
Identification of phlebotomine sand fly blood meals by real-time PCR.
Parasites & vectors    April 16, 2015   Volume 8 230 doi: 10.1186/s13071-015-0840-3
Sales KG, Costa PL, de Morais RC, Otranto D, Brandão-Filho SP, Cavalcanti Mde P, Dantas-Torres F.Phlebotomine sand flies are blood-feeding insects of great medical and veterinary significance acting as vectors of Leishmania parasites. Studying the blood-feeding pattern of these insects may help in the understanding of their interactions with potential reservoir hosts of Leishmania parasites. In this study, we developed real time PCR assays for the identification of sand fly blood meal. Methods: Six pairs of primers were designed based on cytochrome b gene sequences available in GenBank of the following potential hosts: dog, cat, horse, chicken, black rat, and human. Firstly, SYBR Green-ba...
Suspected nosocomial infections with multi-drug resistant E. coli, including extended-spectrum beta-lactamase (ESBL)-producing strains, in an equine clinic.
Berliner und Munchener tierarztliche Wochenschrift    April 16, 2015   Volume 127, Issue 11-12 421-427 
Walther B, Lübke-Becker A, Stamm I, Gehlen H, Barton AK, Janssen T, Wieler LH, Guenther S.Enterobacteriaceae such as Escherichia coli are common commensals as well as opportunistic and obligate pathogens. They cause a broad spectrum of infectious diseases in various hosts, including hospital-associated infections. In recent years, the rise of extended spectrum beta-lactamase (ESBL)-producing E. coli in companion animals (dogs, cats and horses) has been striking. However, reports on nosocomial infections are mostly anecdotic. Here we report on the suspected nosocomial spread of both ESBL-producing and non-ESBL-producing multi-drug resistant E. coli isolates in three equine patients ...
Gallium maltolate as an alternative to macrolides for treatment of presumed Rhodococcus equi pneumonia in foals.
Journal of veterinary internal medicine    April 13, 2015   Volume 29, Issue 3 932-939 doi: 10.1111/jvim.12595
Cohen ND, Slovis NM, Giguère S, Baker S, Chaffin MK, Bernstein LR.Macrolide-resistant isolates of Rhodococcus equi are emerging, prompting the search for clinically effective alternative antimicrobials. Objective: The proportion of foals with ultrasonographic evidence of pneumonia presumed to be caused by R. equi that had a successful outcome when administered gallium maltolate (GaM) PO would not be more than 10% inferior (ie, lower) than that of foals receiving standard treatment. Methods: Fifty-four foals with subclinical pulmonary abscesses among 509 foals at 6 breeding farms in Kentucky. Methods: Controlled, randomized, prospective noninferiority study. ...