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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.
Detection of virulent Rhodococcus equi in exhaled air samples from naturally infected foals.
Journal of clinical microbiology    January 14, 2009   Volume 47, Issue 3 734-737 doi: 10.1128/JCM.01395-08
Muscatello G, Gilkerson JR, Browning GF.Virulent Rhodococcus equi causes pyogranulomatous bronchopneumonia in foals. The route of infection of foals has been considered to be inhalation of aerosolized bacteria from soil that is contaminated with equine feces. Thus, disease caused by R. equi has been regarded as an opportunistic infection of environmental origin and not a contagious disease. In this study, we report the exhalation of virulent R. equi from the respiratory tract of naturally infected foals. A handheld air-monitoring system was used to recover virulent R. equi from the exhaled breath of foals, and the concentration of v...
Incidental isolation of Setaria equina microfilariae in preparations of equine peripheral blood mononuclear cells.
Veterinary parasitology    January 14, 2009   Volume 161, Issue 1-2 142-145 doi: 10.1016/j.vetpar.2008.12.020
Yeargan MR, Lyons ET, Kania SA, Patton S, Breathnach CC, Horohov DW, Howe DK.In the course of a vaccine experiment on horses, microfilariae were observed in cultures of peripheral blood mononuclear cells (PBMCs) isolated from eleven of fifteen study horses. The microfilariae were clearly viable as evidenced by their vigorous movements in the cultures, thus indicating that they had survived the Ficoll gradient purification and the cryopreservation method used for retaining the PBMCs. The microfilariae were identified as Setaria equina, which is a vector-borne filarial nematode that causes a relatively benign infection of equids in which the adult worms reside in the per...
Assessing techniques for disinfecting sites for inserting intravenous catheters into the jugular veins of horses.
The Veterinary record    January 13, 2009   Volume 164, Issue 2 51-55 doi: 10.1136/vr.164.2.51
Geraghty TE, Love S, Taylor DJ, Heller J, Mellor DJ, Hughes KJ.The sites of insertion of catheters into the jugular veins of six horses were investigated to determine common isolates and to assess the effectiveness of two disinfection protocols with the hair coat left long, clipped or shaved. Skin commensals (Staphylococcus, Streptococcus and Micrococcus species) and environmental contaminants (Bacillus, Enterobacteriaceae, Aspergillus and Mucor species) were the microorganisms most frequently isolated. Chlorhexidine gluconate and povidone-iodine-based skin disinfection protocols resulted in significant reductions in the number of bacterial isolates from ...
Effect of Low-Dose Human Interferon-alpha on Shipping Fever of Thoroughbred Racehorses.
Journal of equine science    January 9, 2009   Volume 19, Issue 4 91-95 doi: 10.1294/jes.19.91
Akai M, Hobo S, Wada S.To assess the effect of human interferon-alpha (IFNα) on shipping fever of Thoroughbred racehorses subjected to long-distance transportation, an IFNα preparation was orally administered to 48 horses three times (once daily, 3 successive days) before transportation (IFNα group). In the control group (25 horses), maltose was administered in the same way. These treatments induced no abnormal findings in Thoroughbred racehorses before transportation. Immediately after transportation, significant increases in rectal temperature were observed in both treatment groups, whereas the rectal temperatu...
Use of a bacteriophage lysin, PlyC, as an enzyme disinfectant against Streptococcus equi.
Applied and environmental microbiology    January 9, 2009   Volume 75, Issue 5 1388-1394 doi: 10.1128/AEM.02195-08
Hoopes JT, Stark CJ, Kim HA, Sussman DJ, Donovan DM, Nelson DC.Streptococcus equi is the causative agent of the purulent infection equine strangles. This disease is transmitted through shedding of live bacteria from nasal secretions and abscess drainage or by contact with surfaces contaminated by the bacteria. Disinfectants are effective against S. equi, but inactivation by environmental factors, damage to equipment, and toxicity are of great concern. Bacteriophage-encoded lysins (cell wall hydrolases) have been investigated as therapeutic agents due to their ability to lyse susceptible gram-positive organisms. Here, we investigate the use of one lysin, P...
Protein expression profile of Gasterophilus intestinalis larvae causing horse gastric myiasis and characterization of horse immune reaction.
Parasites & vectors    January 8, 2009   Volume 2, Issue 1 6 doi: 10.1186/1756-3305-2-6
Roelfstra L, Deeg CA, Hauck SM, Buse C, Membrez M, Betschart B, Pfister K.Little information is available on the immunological aspect of parasitic Gasterophilus intestinalis (Diptera, Oestridae) larvae causing horse gastric myiasis. The objectives of this research were to analyze the protein content of larval crude extracts of the migrating second and third larvae (L2 and L3) of G. intestinalis in order to characterize the immune response of horses. Results: The proteomic profile of L2 and L3, investigated by using one and two dimensional approaches, revealed a migration pattern specific to each larval stage. Furthermore, Western blots were performed with horse sera...
Epidemiologic analysis of nosocomial Salmonella infections in hospitalized horses.
Journal of the American Veterinary Medical Association    January 6, 2009   Volume 234, Issue 1 108-119 doi: 10.2460/javma.234.1.108
Ekiri AB, MacKay RJ, Gaskin JM, Freeman DE, House AM, Giguère S, Troedsson MR, Schuman CD, von Chamier MM, Henry KM, Hernandez JA.To examine the relationship between abdominal surgery and nosocomial Salmonella infections and the relationship between high caseload in combination with abdominal surgery and nosocomial Salmonella infections in hospitalized horses with signs of gastrointestinal tract disease. Methods: 140 horses. Methods: Case-control study. Methods: To accomplish the first objective, 1 to 4 control horses were matched with each nosocomial case horse on the basis of admission date of a primary case horse. The frequency of abdominal surgery and other investigated exposure factors were compared between nosocomi...
Effect of Amblyomma cajennense ticks on the immune response of BALB/c mice and horses.
Annals of the New York Academy of Sciences    January 6, 2009   Volume 1149 230-234 doi: 10.1196/annals.1428.028
Castagnolli KC, Ferreira BR, Franzin AM, de Castro MB, Szabó MP.This work evaluated the effect of the Amblyomma cajennense tick on the immune response of BALB/c mice and on horse lymph node cell proliferation. We observed that mice do not develop resistance to nymphs of this tick species and that lymphocyte proliferation of this host is inhibited by tick saliva, nymphal extract, or infestations. Horse lymph node cell proliferation is inhibited by tick saliva as well. Mice lymphocytes under the effect of tick saliva, nymphal extract, or infestations display a predominantly Th-2 cytokine production pattern. Observed results partially explain this tick's dise...
Effective treatment of respiratory alphaherpesvirus infection using RNA interference.
PloS one    January 5, 2009   Volume 4, Issue 1 e4118 doi: 10.1371/journal.pone.0004118
Fulton A, Peters ST, Perkins GA, Jarosinski KW, Damiani A, Brosnahan M, Buckles EL, Osterrieder N, Van de Walle GR.Equine herpesvirus type 1 (EHV-1), a member of the Alphaherpesvirinae, is spread via nasal secretions and causes respiratory disease, neurological disorders and abortions. The virus is a significant equine pathogen, but current EHV-1 vaccines are only partially protective and effective metaphylactic and therapeutic agents are not available. Small interfering RNAs (siRNA's), delivered intranasally, could prove a valuable alternative for infection control. siRNA's against two essential EHV-1 genes, encoding the viral helicase (Ori) and glycoprotein B, were evaluated for their potential to decrea...
In vitro susceptibility of ceftiofur against Streptococcus equi subsp zooepidemicus and subsp equi isolated from horses with lower respiratory disease in Europe since 2002.
Veterinary therapeutics : research in applied veterinary medicine    January 1, 2009   Volume 10, Issue 4 E1-E10 
Bade D, Portis E, Keane C, Hallberg J, Bryson L, Sweeney M, Boner P.In vitro activity of ceftiofur and six other antimicrobial agents was evaluated against 79 Streptococcus equi subsp zooepidemicus isolates collected from horses with respiratory disease in Europe during 2007 and 2008. In addition, the in vitro activity of ceftiofur and other antimicrobial drugs was assessed against 59 S. equi subsp zooepidemicus and 49 S. equi subsp equi isolates collected by veterinary diagnostic laboratories in Europe from 2002 to 2006. The lowest concentration of ceftiofur that inhibited the growth of 90% of the isolates (MIC90) was 0.12 microg/ml, with the Clinical Laborat...
[Anti-influenza vaccination in animals].
Bulletin et memoires de l'Academie royale de medecine de Belgique    January 1, 2009   Volume 164, Issue 10 275-282 
Bublot M.Until recently, Influenza was considered as a veterinary problem in avian, swine and horse only. New influenza strains able to infect and cause a disease in dogs and cats emerged these last six years. The most widely used influenza veterinary vaccines are the inactivated adjuvanted vaccines which are based on whole or split virus. New technologies have allowed the development of new generation vaccines including modified-live and vector vaccines. Modified-live influenza vaccines are available for horses only but they are in development in other species. Vector vaccines are already in use in ch...
Foal monocyte-derived dendritic cells become activated upon Rhodococcus equi infection.
Clinical and vaccine immunology : CVI    December 24, 2008   Volume 16, Issue 2 176-183 doi: 10.1128/CVI.00336-08
Flaminio MJ, Nydam DV, Marquis H, Matychak MB, Giguère S.Susceptibility of foals to Rhodococcus equi pneumonia is exclusive to the first few months of life. The objective of this study was to investigate the immediate immunologic response of foal and adult horse antigen-presenting cells (APCs) upon infection with R. equi. We measured the activation of the antigen-presenting major histocompatibility complex (MHC) class II molecule, costimulatory molecules CD40 and CD86, the cytokine interleukin-12 (IL-12), and the transcriptional factor interferon regulatory factor 1 (IRF-1) in monocyte-derived macrophages (mMOs) and dendritic cells (mDCs) of adult h...
Comparative molecular analysis substantiates zoonotic potential of equine methicillin-resistant Staphylococcus aureus.
Journal of clinical microbiology    December 24, 2008   Volume 47, Issue 3 704-710 doi: 10.1128/JCM.01626-08
Walther B, Monecke S, Ruscher C, Friedrich AW, Ehricht R, Slickers P, Soba A, Wleklinski CG, Wieler LH, Lübke-Becker A.Despite the increasing importance of methicillin-resistant Staphylococcus aureus (MRSA) in veterinary medicine, knowledge about the epidemiology of the pathogen in horses is still poor. The phylogenetic relationship of strains of human and equine origins has been addressed before, usually by analyzing results of common standard classification methods for MRSA. This work intends to go beyond the baseline of typing procedures in order to comparatively characterize equine and human MRSA strains with similar phylogenetic backgrounds. In addition to multilocus sequence typing, pulsed-field gel elec...
Blindness, optic atrophy and sinusitis in the horse.
Veterinary ophthalmology    December 17, 2008   Volume 11 Suppl 1 20-26 doi: 10.1111/j.1463-5224.2008.00642.x
Barnett KC, Blunden AS, Dyson SJ, Whitwell KE, Carson D, Murray R.The case histories described each presented with a visual deficit, varying from permanent total blindness with ophthalmoscopic evidence of optic atrophy to variable and transient visual disturbances, including occasional blindness, but with absence of ophthalmoscopic or any other ocular abnormality. Methods: Three horses of widely different age and type, but all with an original history of upper respiratory tract infection. Methods: All three cases were examined by a specialist veterinary ophthalmologist. In addition, magnetic resonance imaging (MRI) and, where possible, postmortem and histopa...
An overview of recent developments in corneal immunobiology: potential relevance in the etiogenesis of corneal disease in the horse.
Veterinary ophthalmology    December 17, 2008   Volume 11 Suppl 1 66-76 doi: 10.1111/j.1463-5224.2008.00635.x
Matthews AG.This paper overviews some recent developments in mammalian corneal immunobiology, and discusses how these may act as pointers towards understanding the immunology underlying some common corneal diseases in the horse, including infectious ulceration and presumptively immune-mediated non-ulcerative disease. Specifically, three aspects of corneal immunobiology are examined: the role of Toll-like receptors in surface immunity and in the etiogenesis of microbial ulceration, the relationship between conjunctiva associated lymphoid tissue (CALT) and immunoprotection of the corneal surface, and the me...
Ocular immunology in equine recurrent uveitis.
Veterinary ophthalmology    December 17, 2008   Volume 11 Suppl 1 61-65 doi: 10.1111/j.1463-5224.2008.00625.x
Deeg CA.Equine recurrent uveitis (ERU) is a disease with high prevalence and relevance for the equine population, since it results in blindness. Over the last decade, important advancements have been made in our understanding of the underlying immune responses in this disease. ERU is mediated by an autoaggressive Th1 response directed against several retinal proteins. Interphotoreceptor-retinoid binding protein (IRBP) and cellular retinaldehyde-binding protein (CRALBP) are capable to induce ERU-like disease in experimental horses, with the unique possibility to activate relapses in a well-defined mann...
Virion associated proteins of equine rhinitis B virus 1 (ERBV1): the non-structural protein 3C(pro) co-purifies with virions.
Virus research    December 16, 2008   Volume 140, Issue 1-2 205-208 doi: 10.1016/j.virusres.2008.11.001
Black WD, Hartley CA, Ficorilli NP, Studdert MJ.Equine rhinitis B virus (ERBV), genus Erbovirus, is most closely related to the Cardiovirus genus in the family Picornaviridae. The structural proteins (VP1-4) of erboviruses are not well described, but are predicted by sequence to be 35, 29, 26 and 7 kDa. Methods for the purification of cardioviruses (polyethylene glycol, trypsin treatment) were used to characterise the structural proteins of ERBV1. Only one of the virus proteins detected was an expected molecular mass, and this 26 kDa protein was identified as VP3 by N-terminal amino acid sequencing. N-terminal sequencing of the 56 and a 29 ...
Sharpea azabuensis gen. nov., sp. nov., a Gram-positive, strictly anaerobic bacterium isolated from the faeces of thoroughbred horses.
International journal of systematic and evolutionary microbiology    December 9, 2008   Volume 58, Issue Pt 12 2682-2686 doi: 10.1099/ijs.0.65543-0
Morita H, Shiratori C, Murakami M, Takami H, Toh H, Kato Y, Nakajima F, Takagi M, Akita H, Masaoka T, Hattori M.Four bacterial strains, designated ST18(T), HM244, HM250 and DI49, were isolated from the fresh faeces of four thoroughbred horses in Japan. Cells were Gram-positive, strictly anaerobic, catalase-negative, non-spore-forming, non-motile rods that occurred in chains. They were placed in the same subcluster based on 16S rRNA gene sequence analysis, phenotypic characteristics and levels of DNA-DNA relatedness. Their DNA G+C content ranged from 36 to 38 mol%. Lactobacillus catenaformis, Lactobacillus vitulinus and Catenibacterium mitsuokai belong to cluster XVII of the Clostridium subphylum. Strain...
Repair of abdominal wall hernias in horses using primary closure and subcutaneous implantation of mesh.
The Veterinary record    December 9, 2008   Volume 163, Issue 23 677-679 
Kelmer G, Schumacher J.Abdominal incisional hernias in over 40 horses were repaired by exposing the hernial sac and ring and closing the ring with absorbable, interrupted, inverted, cruciate sutures after inverting the hernial sac into the peritoneal cavity. A mesh was sutured, under tension, over the closed ring. Placing the mesh subcutaneously, rather than in the retroperitoneal space, simplified the dissection and minimised the likelihood of penetrating the peritoneal cavity, a problem common to techniques of hernia repair in which the mesh is implanted into the retroperitoneal space. Implanting the mesh subcutan...
Transmission of Babesia caballi by Dermacentor nitens (Acari: Ixodidae) is restricted to one generation in the absence of alimentary reinfection on a susceptible equine host.
Journal of medical entomology    December 9, 2008   Volume 45, Issue 6 1152-1155 doi: 10.1603/0022-2585(2008)45[1152:tobcbd]2.0.co;2
Schwint ON, Knowles DP, Ueti MW, Kappmeyer LS, Scoles GA.The tropical horse tick, Dermacentor nitens, is a natural vector of Babesia caballi in the Americas. B. caballi, one of the etiologic agents of equine piroplasmosis, occurs widely throughout the world, but the United States and a few other countries are considered to be free of infection. B. caballi is transovarially transmitted by the one-host tick D. nitens; we tested the hypothesis that B. caballi can persist in multiple generations of D. nitens in the absence of opportunity to reacquire infection from a susceptible equine host. Partially engorged female D. nitens were collected from a B. c...
Basal and stimulus-induced cytokine expression is selectively impaired in peripheral blood mononuclear cells of newborn foals.
Vaccine    December 3, 2008   Volume 27, Issue 5 674-683 doi: 10.1016/j.vaccine.2008.11.040
Liu T, Nerren J, Liu M, Martens R, Cohen N.Neonates are thought to be generally deficient in production of Th-1-associated cytokines at birth, and thereby more susceptible to bacterial infections. Using neonatal foals as a model, this study examined the age-dependent maturation of both basal and stimulus-induced immune responses, as reflected by the expression of a panel of Th-1-associated and pro-inflammatory cytokines. Results showed that although the basal production of IFN-gamma and IL-6 was impaired (P<0.05) in PBMCs of neonatal foals at birth, the basal production of IL-8, IL-12(p35/p40) and IL-23(p19/p40) were either in exces...
Risk factors for development of neurologic disease after experimental exposure to equine herpesvirus-1 in horses.
American journal of veterinary research    December 3, 2008   Volume 69, Issue 12 1595-1600 doi: 10.2460/ajvr.69.12.1595
Allen GP.To identify risk factors associated with development of clinical neurologic signs in horses exposed to equine herpesvirus-1 (EHV-1). Methods: 36 adult horses. Methods: Blood samples collected before and after challenge inoculation with nonneuropathogenic or neuropathogenic EHV-1 were analyzed for leukocyte-associated viremia, serum neutralizing antibody, and EHV-1-specific cytotoxic T-lymphocyte precursors (CTLPs). Associations between variables and neurologic disease and correlations between age category or breed and development of neurologic disease were examined. Results: 9 horses developed...
Development of a real-time duplex TaqMan-PCR for the detection of Equine rhinitis A and B viruses in clinical specimens.
Journal of virological methods    December 2, 2008   Volume 155, Issue 2 175-181 doi: 10.1016/j.jviromet.2008.10.009
Mori A, De Benedictis P, Marciano S, Zecchin B, Zuin A, Zecchin B, Capua I, Cattoli G.Equine rhinitis A and B viruses (ERAV and ERBV) are respiratory viruses of horses belonging to the family Picornaviridae. Although these viruses are considered to cause respiratory disease in horses and are potentially infectious for humans, little is known about their prevalence and pathogenesis. Virus isolation is often unsuccessful due to their inefficient growth and lack of cytopathic effect in cell cultures. Therefore, molecular assays should be considered as the method of choice to detect infection in symptomatic or apparently healthy horses. In the present study, a novel real-time duple...
Microbial quality of equine frozen semen.
Animal reproduction science    November 30, 2008   Volume 115, Issue 1-4 103-109 doi: 10.1016/j.anireprosci.2008.11.016
Corona A, Cherchi R.Bacteriological surveillance is little applied in management of equine frozen semen but it is quite important to verify the microbial contamination in order to find out the chance of transmission of pathology to the mare in AI. Authors describe a qualitative and quantitative analysis for bacterial contamination on long time (3-17 years) equine frozen semen stored in liquid nitrogen. The semen checked, produced in Italy and in another Europe country, was cryopreserved in liquid nitrogen inside sealed plastic straws. One hundred and ten straws were checked out for pathogenic and no pathogenic ba...
Clusters of infections in horses with MRSA ST1, ST254, and ST398 in a veterinary hospital.
Microbial drug resistance (Larchmont, N.Y.)    November 26, 2008   Volume 14, Issue 4 307-310 doi: 10.1089/mdr.2008.0845
Cuny C, Strommenger B, Witte W, Stanek C.During 2006 and 2007 small clusters of methicillin-resistant Staphylococcus aureus (MRSA) infections in horses were recorded in different clinical departments of a veterinary university. The infections were caused by different MRSA clones (ST1, ST254, and ST398). In the same time, nasal colonization of veterinarians, veterinary personnel, and students was observed indicating transmission to humans.
Pathological studies of cheek teeth apical infections in the horse: 5. Aetiopathological findings in 57 apically infected maxillary cheek teeth and histological and ultrastructural findings.
Veterinary journal (London, England : 1997)    November 20, 2008   Volume 178, Issue 3 352-363 doi: 10.1016/j.tvjl.2008.09.024
Dacre I, Kempson S, Dixon PM.Examination of 57 apically infected maxillary cheek teeth (CT) showed one or more viable pulps and minimal apical calcified tissue changes present in recently infected CT. With chronic infections, pulps were necrotic or absent, pulp horns were filled with food if occlusal pulpar exposure was present, and gross caries of dentine was occasionally present. With chronic infections, the apical changes varied from gross destructive changes in some teeth, to extensive proliferative calcified apical changes in others. Infundibular caries was believed to cause apical infection in just 16% of infected (...
Phenotypic and genotypic characterization of Arcanobacterium haemolyticum isolates from infections of horses.
Journal of clinical microbiology    November 19, 2008   Volume 47, Issue 1 124-128 doi: 10.1128/JCM.01933-08
Hassan AA, Ulbegi-Mohyla H, Kanbar T, Alber J, Lämmler C, Abdulmawjood A, Zschöck M, Weiss R.The present study was designed to characterize phenotypically and genotypically seven Arcanobacterium haemolyticum strains obtained from infections of six horses. All seven strains showed the cultural and biochemical properties typical of A. haemolyticum and were susceptible to most of the antibiotics tested. The species identification could be confirmed by amplification and sequencing of the 16S rRNA gene and the 16S-23S rRNA intergenic spacer region and by PCR amplification of species-specific parts of the gene encoding phospholipase D in A. haemolyticum. Use of the latter could possibly imp...
Pathological studies of cheek teeth apical infections in the horse: 4. Aetiopathological findings in 41 apically infected mandibular cheek teeth.
Veterinary journal (London, England : 1997)    November 18, 2008   Volume 178, Issue 3 341-351 doi: 10.1016/j.tvjl.2008.09.028
Dacre IT, Kempson S, Dixon PM.Examination of 41 extracted, apically infected mandibular cheek teeth (CT) without obvious causes of infection included radiography, computerised axial tomography and decalcified and undecalcified histology. In CT with recent infections, some pulps remained viable, with proliferative soft and calcified tissue changes confined to the apex. With more advanced CT infections, occlusal pulpar exposure was sometimes present (in 34% of the 41 CT), some infected pulp chambers were filled with necrotic pulp or food, and extensive destructive or proliferative changes were present in the calcified apical...
Natural infection by Cryptosporidium sp., Giardia sp. and Eimeria leuckarti in three groups of equines with different handlings in Rio de Janeiro, Brazil.
Veterinary parasitology    November 17, 2008   Volume 160, Issue 3-4 327-333 doi: 10.1016/j.vetpar.2008.10.103
De Souza PN, Bomfim TC, Huber F, Abboud LC, Gomes RS.To detect Cryptosporidium sp., Giardia sp. and Eimeria leuckarti in horses, fecal samples were collected from three different handling horse groups from the state of Rio de Janeiro, Brazil. Group A was composed of "Mangalarga Marchador" pure breed horses, Group B was formed by horses of a Military Corporation and Group C by stray horses captured by the Center of Zoonosis Control Paulo Dacorso Filho. A total of 396 fecal samples were collected, 212 samples from Group A, 154 samples from Group B and 30 from Group C. The material was submitted to the centrifugation - flotation technique and stain...
Prevalence of occlusal pulpar exposure in 110 equine cheek teeth with apical infections and idiopathic fractures.
Veterinary journal (London, England : 1997)    November 17, 2008   Volume 178, Issue 3 364-371 doi: 10.1016/j.tvjl.2008.09.026
van den Enden MS, Dixon PM.Examination of 110 cheek teeth (CT) that were clinically extracted (between 2004 and 2008) because of apical infection (n=79; mean dental age 3.5 years) or idiopathic CT fractures (n=31; median dental age 8.5 years), including examinations of transverse and longitudinal sections, showed the apical infections to be mainly (68%) due to anachoresis, with the residual cases caused by periodontal spread, infundibular caries spread, fissure fractures and dysplasia. The idiopathic fracture patterns were similar to previously described patterns. Occlusal pulpar exposure was found in 32% of apically in...