Sepsis in horses is a systemic inflammatory response to infection, characterized by the presence of pathogenic microorganisms or their toxins in the blood or tissues. It can result from various bacterial, viral, or fungal infections and may lead to severe complications if not managed promptly. Clinical signs of sepsis in horses can include fever, increased heart and respiratory rates, altered mucous membrane color, and signs of organ dysfunction. Diagnosis often involves identifying the underlying infection source, alongside laboratory tests to detect inflammatory markers and organ function indicators. This page compiles peer-reviewed research studies and scholarly articles that explore the pathophysiology, diagnosis, treatment, and prognosis of sepsis in equine patients.
Lu KG, Sprayberry KA.Selected conditions affecting broodmares are discussed, including arterial rupture, dystocia, foal support with ex utero intrapartum treatment, uterine prolapse, postpartum colic, the metritis/sepsis/systemic inflammatory response syndrome complex, and retained fetal membranes. Postpartum colic beyond third-stage labor contractions should prompt comprehensive evaluation for direct injuries to the reproductive tract or indirect injury of the intestinal tract. Mares with perforation or rupture of the uterus are typically recognized 1 to 3Â days after foaling, with depression, fever, and leukopen...
Krause DM, Pezzanite LM, Griffenhagen GM, Hendrickson DA.Frequency of synovial sepsis in horses following intrasynovial injection has been reported, but not compared with respect to the environment in which the injection was performed. Objective: To describe occurrence of synovial sepsis following intrasynovial injections performed in ambulatory vs hospital settings. Methods: Retrospective cohort study. Methods: Records from the Colorado State University were evaluated (2014-2018) and horses receiving intrasynovial injections were identified. Patients presenting for septic synovial structures were excluded. Patient signalment, primary supervising se...
Haralambus R, Florczyk A, Sigl E, Gültekin S, Vogl C, Brandt S, Schnierer M, Gamerith C, Jenner F.Synovial sepsis is a commonly occurring, potentially career-ending or even life-threatening orthopaedic emergency. Diagnosis of synovial sepsis is currently primarily based on synovial fluid analysis, which often leaves diagnostic ambiguity due to overlap of clinicopathological parameters between septic and aseptic inflammatory synovitis. Objective: To evaluate the reliability of lysozyme (LYS), myeloperoxidase (MPO) and elastase (ELT) as biomarkers for synovial sepsis in horses using a photometric assay to measure increased enzyme activity. Methods: Prospective, single-blinded, analytical, cl...
Wong DM, Young L, Dembek KA.Sepsis is common in foals and several treatments are used to facilitate recovery. Evidence in people suggests an association between low blood concentrations of thiamine, ascorbic acid, and cortisol and sepsis, with further evidence suggesting that administration of hydrocortisone, thiamine, and ascorbic acid may improve outcome. No information is available with regard to these treatments in foals. Objective: To compare blood concentrations of thiamine, ascorbic acid, and cortisol in healthy and ill foals. Methods: Fifteen healthy and 27 ill (septic and sick-nonseptic [SNS]) foals were evaluat...
Colmer SF, Luethy D, Abraham M, Stefanovski D, Hurcombe SD.Plasma cell-free DNA (cfDNA) levels have been associated with disease and survival status in septic humans and dogs. To date, studies investigating cfDNA levels in association with critical illness in foals are lacking. We hypothesized that cfDNA would be detectable in the plasma of foals, that septic and sick-nonseptic foals would have significantly higher cfDNA levels compared to healthy foals, and that increased cfDNA levels would be associated with non-survival. Animals used include 80 foals of 10 days of age or less admitted to a tertiary referral center between January and July, 2020 wer...
Noll CV, Kilcoyne I, Nieto JE, Thio T, Byrne BA.To determine the ability of 0.2% polyhexamethylene biguanide (PHMB)-impregnated gauze to inhibit the growth of bacteria isolated from equine infected sites. Methods: In vitro study. Methods: Nine bacterial isolates were obtained from cultures submitted from equine patients presenting with penetrating injuries of the hoof (n = 4), septic osteitis (n = 1), synovial sepsis (n = 1), wounds (n = 2), and incisional infection following laparotomy (n = 1). Two standardized strains were also included. A standard inoculum of each isolate was placed on 12 Muller-Hinton agar plates. Squares (2.5 cm ×â€...
Mosichuk AP, Smith JS, Tatarniuk DM, Troy JR, Kreuder AJ.Septic synovitis is a critical orthopedic condition in horses. Early intervention is key, with antibiotic therapy typically initiated prior to culture and susceptibility reports becoming available. The pharmacokinetics of several antibiotics have been studied in horses for use in intravenous regional limb perfusion (IVRLP) for septic synovitis, including the carbapenem antibiotic, meropenem. For a variety of factors, some veterinary clinicians may select IVRLP meropenem as therapy for these cases. Meropenem is a vital antibiotic in human medicine, making veterinary use divisive. However, verif...
Scilimati N, Pepe M, Pressanto MC, Angeli G, Beccati F.A 4-month-old Thoroughbred filly was referred for evaluation of severe left forelimb lameness of 24 hours duration. Radiographic projections of the shoulder revealed mild irregularity and sclerosis of the proximal humeral apophysis. Ultrasonographic examination showed a moderate increase in the amount of anechogenic synovial fluid within the intertubercular bursa and scapulohumeral joint, and irregularity of the ossifying bone surface of the intermediate tubercle of the humerus. Computed tomographic (CT) examination revealed a circular hypoattenuating area at the level of the proximal apophysi...
Catunda APN, Alves GES, Paes Leme FO, Carvalho AM, Leise BS, Johnson PJ, Faleiros RR.Inflammation and apoptosis in the hoof lamellar interface both contribute to the early stages of sepsis-associated laminitis, but it is not clear whether apoptosis is occurring before the onset of inflammation or is being provoked by inflammation. Apoptosis and inflammation were therefore measured in lamellar tissues obtained at different time points throughout the early stages of experimentally induced laminitis. Apoptotic cells and leukocyte were enumerated in archived paraffin embedded lamellar tissue samples from previous experiments in which acute laminitis was induced using Black Walnut ...
Borba LA, Nogueira CEW, Bruhn FRP, da Silva GC, Feijó LS, Canisso IF, Curcio BDR.Neonatal sepsis is a leading cause of neonatal death during the first-week postfoaling. Despite recent advancements in the diagnosis and treatment of sepsis in the newborn foal, the non-specific clinical signs and subtle nature of this disease may result in delayed diagnosis until severe progression of the disease; thus, early detection of sepsis remains critical for a favourable outcome. This study aimed to identify early blood markers as predictive of sepsis on foals. Thirty-five foals were allocated into three groups: healthy control foals (n=7) and foals born from mares with placentitis: s...
Frydendal C, Nielsen KB, Berg LC, van Galen G, Adler DMT, Andreassen SM, Jacobsen S.To investigate neutrophil gelatinase-associated lipocalin (NGAL) concentrations in serum and synovial fluid (SF) from horses with joint inflammation. Methods: Experimental studies and retrospective clinical study. Methods: Serum and SF samples were available from healthy horses (n = 19), clinical cases, and horses with experimental joint inflammation. Clinical cases included horses with (n = 10) or without (n = 10) septic arthritis. Experimental intra-articular inflammation was induced by lipopolysaccharide (LPS; n = 7, severe inflammation), lidocaine (n = 6, moderate inflammation), or mepivac...
McNeal CD, Ryan CA, Berghaus LJ, Credille BC, Lo CP, Fajt VR.Cephalosporin antimicrobials can be utilized for the treatment of sepsis in neonatal foals, particularly when an aminoglycoside is contraindicated. Some cephalosporins, however, are not utilized because of cost, sporadic availability, or uncertainty about efficacy. The plasma disposition of ceftazidime, a third-generation cephalosporin with a broad spectrum of activity against a wide variety of gram-negative bacteria and minimal renal side effects has not been reported in neonatal foals. In this study, the plasma disposition of single intravenous (IV) and intramuscular (IM) doses of ceftazidim...
Barton AK, Richter IG, Ahrens T, Merle R, Alalwani A, Lilge S, Purschke K, Barnewitz D, Gehlen H.The purpose of the study was to compare the results of sepsis scoring (clinical examination and clinical pathology) to the concentrations of matrix-metalloproteinases (MMPs) -2, -8, and -9; tissue-inhibitor of metalloproteinases (TIMPs) -1 and -2; and inflammatory chemokines interleukin (IL) 1β and tumor-necrosis-factor-alpha (TNF-α) in plasma and peritoneal fluid of equine colic patients. A modified sepsis scoring including general condition, heart and respiratory rate, rectal temperature, mucous membranes, white blood cell count (WBC), and ionized calcium was applied in 47 horses presented...
Ehrmann C, Engel J, Moritz A, Roscher K.In addition to maintaining hemostasis, platelets have an important role in modulating innate and adaptive immune responses. A low platelet count has been found to be a negative prognostic factor for survival in humans and horses with critical illnesses, such as sepsis or systemic inflammatory response syndrome (SIRS). Decreased platelet aggregation, caused by in vivo activation, has been found in human patients with severe sepsis. In our prospective controlled study, we assessed platelet biology in blood samples from 20 equine SIRS cases and 120 healthy control horses. Platelet variables such ...
Swink JM, Rings LM, Snyder HA, McAuley RC, Burns TA, Dembek KA, Gilsenan WF, Browne N, Toribio RE.Information on steroids derived from the adrenal glands, gonads, or fetoplacental unit is minimal in newborn foals. Objective: To measure androgen concentrations in serum and determine their association with disease severity and outcome in hospitalized foals. Methods: Hospitalized (n = 145) and healthy (n = 80) foals. Methods: Prospective, multicenter, cross-sectional study. Foals of ≤3 days of age from 3 hospitals and horse farms were classified as healthy and hospitalized (septic, sick nonseptic, neonatal maladjustment syndrome [NMS]) based on physical exam, medical history, and laborato...
Scavone D, Sgorbini M, Borges AS, Oliveira-Filho JP, Vitale V, Paltrinieri S.Paraoxonase-1 (PON-1) is an antioxidant enzyme, whose activity decreases during the acute phase response in many species. Little is known about PON-1 and its role as a negative acute phase protein during septic inflammation in horses, but promising findings about its utility in diagnosing SIRS and predicting the outcome in diseased horses, were recently highlighted. The objective of the study was to investigate the behaviour of PON-1 in horses after experimentally induced endotoxemia. To this aim, PON-1 activity was measured on 66 plasma samples collected from six clinically healthy mares, pre...
Alonso JM, Martins ES, Peccinini RG, Rosa GS, Guerra ST, Ribeiro MG, Santos B, GarcÃa HDM, Watanabe MJ, Takahira RK, Rodrigues CA, Alves ALG....Intraperitoneal ceftriaxone administration in healthy horses results in high and prolonged peritoneal concentrations. Recent findings suggest that intraperitoneal ceftriaxone might increase survival rates in horses affected by peritonitis. The present study aimed to evaluate plasma and peritoneal concentrations of ceftriaxone after intraperitoneal administration in horses with septic peritonitis. Twenty-six horses presenting clinical, laboratorial, and sonographic findings compatible with the disease were included. All horses received daily intraperitoneal ceftriaxone (25Â mg/kg bwt) in additi...
Furr M, McKenzie H.Bloodstream infections (BSI) are common in sick foals and increase foal morbidity and mortality when they occur. Recognition of risk factors for BSI could be an important means to limit their occurrence, but studies on this topic are limited. Objective: Historical as well as maternal and foal physical examination findings will predict risk of BSI in neonatal foals. Methods: Foals <14 days of age admitted to a referral equine hospital for care. Methods: Retrospective case-control study with univariate and multivariable logistic regression analysis. Results: Four hundred twenty-nine (143 cases...
Anderson MJ, Ibrahim AS, Cooper BR, Woolcock AD, Moore GE, Taylor SD.Sepsis is associated with ascorbic acid (AA) depletion and critical illness-related corticosteroid insufficiency (CIRCI) in humans. Objective: Intravenous infusion of lipopolysaccharide (LPS) would (a) decrease endogneous AA concentrations, (b) induce CIRCI and (c) administration of a combination of AA and hydrocortisone (HC) would have decreased indices of inflammation compared to either drug alone. Methods: Thirty-two healthy horses. Methods: Randomized placebo-controlled experimental trial. Horses were assigned to 1 of 4 groups (saline, AA and HC, AA only, or HC only). Treatments were admin...
Louro LF, Milner PI, Bardell D.Opioid epidural analgesia has been shown to provide effective analgesia in horses. There is a lack of evidence regarding the effect of opioid epidural analgesia on quality of recovery in horses. Objective: Identify whether opioid epidural analgesia influences quality of recovery in horses undergoing general anaesthesia required for management of hindlimb synovial sepsis. Methods: Single-centre retrospective cross-sectional study. Methods: Data were obtained from the clinical records of horses which had undergone arthroscopic or tenoscopic surgery for management of hindlimb synovial sepsis over...
Battaglia F, Meucci V, Tognetti R, Bonelli F, Sgorbini M, Lubas G, Pretti C, Intorre L.In human medicine, procalcitonin (PCT), the precursor of calcitonin, is used for the rapid identification of the origin and severity of sepsis. In veterinary medicine, PCT has been studied in horses, cattle, and dogs, but the use of PCT in diagnostic and/or prognostic settings is not possible because of the lack of validated assays to obtain reference ranges. The aim of the present study was the investigation of commercially available ELISA kits for the detection of canine and equine PCT in plasma samples. Validation of the ELISA kits was performed by using species-specific recombinant protein...
Elzer EJ, Wulster KB, Richardson DW, Ortved KF.A 15-year-old Thoroughbred gelding was presented for investigation of fever, right temporomandibular region swelling, and progressive pain when opening the mouth. Right temporomandibular joint (TMJ) sepsis was diagnosed based on synovial fluid analysis, sonographic imaging, and standing robotic cone-beam computed tomography. Concurrent otitis media and temporohyoid osteoarthropathy (THO) were also noted. The horse was treated with arthroscopic debridement and lavage during standing sedation followed by local and systemic antimicrobial therapy. There were no complications associated with the su...
Alonso JM, Esper CS, Pantoja JCF, Rosa GDS, Giampietro RR, Dos Santos B, Guerra ST, Ribeiro MG, Takahira RK, Watanabe MJ, Alves ALG, Rodrigues CA....Difference in blood and peritoneal glucose (DBPG) is used in clinical practice to support a diagnosis of septic peritonitis in horses. It is inexpensive, easy and rapid to perform. The aim of this study was to evaluate the accuracy of the DBPG to differentiate between septic and non-septic peritonitis in horses. Blood and peritoneal fluids were harvested from suspected animals. Plasma and peritoneal glucose levels, total nucleated cell count, direct microscopic and microbiological examinations of the peritoneal fluid were evaluated. Using DBPG levels, the animals were classified into two group...
Mendoza Garcia FJ, Gonzalez-De Cara C, Aguilera-Aguilera R, Buzon-Cuevas A, Perez-Ecija A.Little information is available about endotoxemia in donkeys. Characterizing the systemic inflammatory response (SIRS) to lipopolysaccharide (LPS) in donkeys would provide valuable clinical and therapeutic information. The effects of meloxicam on endotoxemia have not been studied in this species. Objective: To study the pathophysiology and gene expression associated with experimentally induced endotoxemia, and evaluate the effects of meloxicam on experimentally induced endotoxemia in donkeys and in equine monocyte cultures. Methods: Six healthy adult female donkeys. Methods: Endotoxemia was in...
Sanmartà J, Armengou L, Viu J, Alguacil E, Civit S, RÃos J, Jose-Cunilleras E.Sparse information regarding plasma iron concentration in neonatal foals and its utility as an inflammatory marker in this population has been published. Objective: To determine the physiologic plasma iron concentration in neonatal foals. To assess its utility as an inflammatory marker to predict systemic inflammatory response syndrome (SIRS) and as a prognostic marker. Methods: Forty-seven ill neonatal foals admitted to a referral equine hospital were divided in 2 groups based on the SIRS criteria (24 SIRS and 23 non-SIRS). Two control groups of 43 hospital and 135 stud farm healthy neonatal ...
Alonso JM, Rosa GDS, Santos B, Guerra S, Ribeiro M, Watanabe MJ, Alves A, Rodrigues C, Takahira RK, Hussni CA.Intraperitoneal administration of ceftriaxone maintains therapeutic abdominal concentrations for 24 hours in healthy horses. Therefore, it is a possible treatment for septic peritonitis. The aim of this study was to evaluate the efficacy of ceftriaxone as an adjuvant treatment in horses with septic peritonitis. Methods: Twenty-six horses with clinical signs, sonography and/or laboratory findings of septic peritonitis were included. Peritoneal fluid was collected for microbiological culture and in vitro microbial sensitivity profile assessment. Daily intraperitoneal administration of ceftriax...
Flores MM, Del Piero F, Habecker PL, Langohr IM.Ocular diseases are an important category in equine medicine; however, most articles regarding histologic ocular lesions in horses are exclusive to a specific condition and do not provide a complete review of clinically significant ocular disease frequency in a diagnostic laboratory. We reviewed sections of equine eyes from 140 cases (98 enucleations [biopsies] and 42 autopsies) with clinically relevant ocular alterations at 2 diagnostic centers in the United States. The most common primary conditions were non-traumatic keratitis (36), equine recurrent uveitis (ERU; 31), traumatic injuries (22...
Sinovich M, Villarino NF, Singer E, Robinson CS, Rubio-MartÃnez LM.Serum amyloid A (SAA) concentrations in blood and synovial fluid of horses with synovial sepsis have diagnostic value. Studies suggest serial blood SAA measurements could act as a prognostic indicator. This study evaluated the use of serial blood SAA concentrations for monitoring of horses with synovial sepsis. A prospective clinical trial was performed of horses referred to a single hospital with synovial sepsis that survived (n=17), synovial sepsis that were euthanised (n=5), non-septic intrasynovial pathologies (n=14) or extensive extrasynovial lacerations (n=5). SAA concentrations were det...
Theelen MJP, Wilson WD, Byrne BA, Edman JM, Kass PH, Mughini-Gras L, Magdesian KG.Antimicrobial treatment protocols for foals with sepsis that do not improve clinically often are adjusted based on bacteriological and antimicrobial susceptibility testing results from samples collected at hospital admission. Objective: To evaluate whether hospitalization for ≥48 hours affects bacteriological and antimicrobial susceptibility testing results. Methods: Two-hundred sixty-seven foals <30 days of age admitted to a neonatal intensive care unit and diagnosed with sepsis. Methods: Medical records were reviewed retrospectively to identify foals with sepsis and positive bacteri...
Bryant CE, Ouellette A, Lohmann K, Vandenplas M, Moore JN, Maskell DJ, Farnfield BA.Sepsis and endotoxaemia are important causes of morbidity and mortality in humans. Research on sepsis focuses on rodent models most of which are poorly responsive to lipopolysaccharide (LPS), and thus do not mimic very well the high sensitivity of humans. Therefore, there is a need to develop more clinically relevant models. Horses suffer from a similar endotoxaemic syndrome to humans with high morbidity and mortality. LPS analogues that act as antagonists at Toll-like receptor 4 (TLR4) are being developed as novel treatments for endotoxaemia. Due to differences in recognition of ligands by TL...
Barsnick RJ, Hurcombe SD, Smith PA, Slovis NM, Sprayberry KA, Saville WJ, Toribio RE.Endocrine dysregulation of hormones of energy metabolism is well documented in critically ill humans, but limited information exists in septic foals. The purpose of this study was to provide information on the hormonal response to energy metabolism in critically ill foals, focusing on insulin, glucagon, and leptin. Objective: Concentrations of insulin, glucagon, leptin, and triglycerides will be higher, whereas glucose concentration will be lower in septic foals than in healthy and sick nonseptic foals. The magnitude of these differences will be associated with severity of disease and nonsurvi...
Martin EM, Messenger KM, Sheats MK, Jones SL.Pro-inflammatory cytokines including tumor necrosis factor α (TNFα), IL-1β, IL-6, and IL-8 are potent immune mediators that exacerbate multiple equine diseases such as sepsis and laminitis. Unfortunately, safe and effective cytokine-targeting therapies are lacking in horses; therefore, novel mechanisms of inhibiting cytokine production are critically needed. One potential mechanism for inhibiting cytokine synthesis is elevation of intracellular cyclic AMP (cAMP). In human leukocytes, intracellular cAMP production is induced by activation of E-prostanoid (EP) receptors 2 and 4. These recepto...
Hurcombe SD, Toribio RE, Slovis NM, Saville WJ, Mudge MC, Macgillivray K, Frazer ML.Disorders of calcium regulation are frequently found in humans with critical illness, yet limited information exists in foals with similar conditions including septicemia. The purpose of this study was to determine whether disorders of calcium exist in septic foals, and to determine any association with survival. Objective: Blood concentrations of ionized calcium (Ca(2+)) and magnesium (Mg(2+)) will be lower in septic foals with concomitant increases in parathyroid hormone (PTH), calcitonin (CT), and parathyroid-related peptide (PTHrP) compared with healthy foals. The magnitude of these differ...
Hammond RA, Hannon R, Frean SP, Armstrong SJ, Flower RJ, Bryant CE.To determine the amount of cyclooxygenase-2 (COX-2) and inducible nitric oxide synthase (iNOS) enzymes induced in vitro in equine alveolar macrophages in response to lipopolysaccharide (LPS). Sample Population-Alveolar macrophages obtained from 12 horses. Methods: Alveolar macrophages were collected by bronchoalveolar lavage from 12 horses and incubated for 6 hours with LPS (0.001 to 10 microg/ml) or vehicle. Total RNA was extracted and purified. After first-strand cDNA synthesis, mRNA induction was measured, using a polymerase chain reaction (PCR) technique for COX-2, iNOS, and glyceraldehyde...
Hawkins JF, Bowman KF, Roberts MC, Cowen P.Peritonitis was diagnosed in 67 horses between 1985 and 1990: 14 horses developed septic peritonitis after intestinal rupture, 25 horses developed peritonitis after abdominal surgery, and 28 horses had peritonitis not associated with intestinal rupture or abdominal surgery. Forty of 67 horses (59.7%) did not survive. Nonsurvivors had higher heart rates (P = 0.01), RBC count (P = 0.039), serum creatinine concentration (P = 0.036), PCV (P = 0.007), and anion gap (P = 0.005); lower venous blood pH (P = 0.002); and a greater number of bacterial species cultured from peritoneal fluid samples (P = 0...
Barton MH, Morris DD, Norton N, Prasse KW.Thirteen coagulation tests evaluating hemostatic and fibrinolytic indices and serum cytokine and plasma endotoxin concentrations were obtained in 34 foals with a positive sepsis score (septic group) and 46 age-matched healthy foals. Compared to healthy foals, the prothrombin, activated partial thromboplastin, and whole blood recalcification times were significantly longer in septic foals. The fibrinogen and fibrin degradation products concentrations, percent plasminogen, alpha-2 antiplasmin, and plasminogen activator inhibitor activities, and tumor necrosis factor and interleukin-6 activities ...
Steel CM, Hunt AR, Adams PL, Robertson ID, Chicken C, Yovich JV, Stick JA.To identify factors affecting the prognosis for survival and athletic use in foals with septic arthritis. Methods: Retrospective study. Methods: 93 foals with septic arthritis. Methods: Medical records were reviewed to obtain clinical findings, laboratory test results, radiographic findings, treatment method, and outcome. Race records for Thoroughbreds and Standardbreds were evaluated to determine whether foals subsequently raced and whether they raced successfully. Results: 43 foals had 1 affected joint, 44 foals had multiple affected joints, and number of affected joints was not recorded for...
Steelman SM, Johnson P, Jackson A, Schulze J, Chowdhary BP.Acute laminitis is an inflammatory disease of the equine foot that often occurs secondarily to sepsis or systemic inflammation associated with gastrointestinal disease. It has been suggested that laminitis is similar to multiple organ dysfunction syndrome in humans, although in horses the weight-bearing laminar epithelium of the foot appears to be the tissue most sensitive to insult and the first "organ" to fail. Metabolomics performed on serum samples collected before (Con) and after (Lmn) experimental induction of gastrointestinal-associated sepsis in six horses detected 1,177 metabolites of...
Werners AH, Bryant CE.Pattern recognition receptors (PRRs) on host cells detect pathogens to activate innate immunity which, in turn, initiates inflammatory and adaptive immune responses. Successful activation of PRRs is, therefore, critical to controlling infections and driving pathogen-specific adaptive immunity, but overactivity of PRRs causes systemic inflammation, which is detrimental to the host. Here we review the PRR literature as it relates to horses and speculate on the role PRRs may play in sepsis and endotoxaemia.
Glass K, Watts AE.Despite differences in etiology and diagnostics, the mainstay of therapy in the foal is similar to the adult: local lavage and/or debridement and local antimicrobial therapy. When musculoskeletal infection is concurrent with neonatal sepsis, the prognosis for survival is fair. When musculoskeletal infection is the primary problem, the prognosis is fair to good for survival of synovial, bony, and physeal infections with appropriate and aggressive local therapy. Recent literature may indicate that prognosis for survival and potential athleticism in foals that are treated expediently with local t...
Kamr AM, Dembek KA, Reed SM, Slovis NM, Zaghawa AA, Rosol TJ, Toribio RE.Hypocalcemia is a frequent abnormality that has been associated with disease severity and outcome in hospitalized foals. However, the pathogenesis of equine neonatal hypocalcemia is poorly understood. Hypovitaminosis D in critically ill people has been linked to hypocalcemia and mortality; however, information on vitamin D metabolites and their association with clinical findings and outcome in critically ill foals is lacking. The goal of this study was to determine the prevalence of vitamin D deficiency (hypovitaminosis D) and its association with serum calcium, phosphorus, and parathyroid hor...
Zabrecky KA, Slovis NM, Constable PD, Taylor SD.Accurate diagnostic markers for sepsis in neonatal foals are needed. Plasma C-reactive protein concentration (p[CRP]) and haptoglobin concentration (p[Hp]) are well-established biomarkers of infection in humans, but studies are lacking in foals. Objective: p[CRP]) and p[Hp] are increased in septic foals compared to sick nonseptic and healthy control foals, and are predictive of survival. Methods: Eighty critically ill foals (40 septic, 40 sick nonseptic) and 39 healthy control foals <1Â week of age. Methods: Multicenter, prospective observational clinical study. Venous blood was collected at a...
Barr B, Nieman NM.Sepsis is a significant cause of morbidity and mortality in neonatal foals, especially during the first 7Â days of life. Diagnosing sepsis in neonatal foals can be challenging because initial clinical signs are often ambiguous and non-specific. Objective: To determine if the major acute phase protein serum amyloid A (SAA) as measured by a point-of-care SAA testing device can be used as an evidence-based biomarker of sepsis. Methods: Retrospective cohort. Methods: Clinical diagnosis of sepsis based on positive bacterial blood culture or a positive sepsis score was obtained and compared to SAA v...
Reilly LK, Palmer JE.Four foals were admitted to the neonatal intensive care unit in the first 2 days of life with problems related to birth hypoxia (neonatal maladjustment syndrome, renal failure, necrotizing enterocolitis) and sepsis. Foals were hospitalized for an extended period (35 to 70 days) and received treatment with several broad spectrum antimicrobial agents. Invasive monitoring and treatment procedures included intravenous catheterization, urinary catheterization, and parenteral nutritional and ventilatory support. In each foal, infections of undetermined cause developed, and systemic candidiasis was d...
Theelen MJP, Wilson WD, Byrne BA, Edman JM, Kass PH, Magdesian KG.The study objectives were to provide cumulative antimicrobial susceptibility data at the patient level and to evaluate the effect of initial antimicrobial treatment on survival in foals with sepsis. Foals below 30days of age with a diagnosis of sepsis, confirmed by isolation of bacteria from normally sterile sites on the day of hospital admission, were included. Susceptibility testing was performed using the broth microdilution procedure. In total, 213 foals and 306 bacterial isolates were included. The likelihood of survival for foals from which all bacteria were susceptible to the initial an...
Godman JD, Burns TA, Kelly CS, Watts MR, Leise BS, Schroeder EL, van Eps AW, Belknap JK.Sepsis-related laminitis (SRL) is a common complication in the septic/endotoxemic critically-ill equine patient, in which lamellar injury and failure commonly lead to crippling distal displacement of the distal phalanx. Similar to organ injury in human sepsis, lamellar injury in SRL has been associated with inflammatory events, including the influx of leukocytes into the lamellar tissue and markedly increased expression of a wide array of inflammatory mediators at the onset of Obel grade 1 (OG1) laminitis. The only treatment reported both clinically and experimentally to protect the lamellae i...
Cotovio M, Monreal L, Armengou L, Prada J, Almeida JM, Segura D.Septicemia in human neonates frequently is complicated by activation of the coagulation system, disseminated intravascular coagulation (DIC) and multiple organ failure syndrome, which may contribute to high mortality. In adult horses with DIC, the lung has been the organ most frequently affected by fibrin deposits. In addition, in vivo studies suggest that hemostatic mechanisms may be immature in foals < 1-day old. Objective: Newborn foals with severe septicemia have fibrin deposits in their tissues independently of their age, and these fibrin deposits are associated with organ failure. Met...
Robinson CS, Timofte D, Singer ER, Rimmington L, Rubio-MartÃnez LM.Bacterial culture and antimicrobial susceptibility testing of septic synovial samples allows instigation of targeted antimicrobial therapy; however, bacterial culture takes more than 24 h and has low sensitivity. This study aimed to identify the most frequently cultured bacteria and their antimicrobial susceptibility profile from septic synovial samples in our referral equine hospital, to allow recommendations regarding appropriate initial antimicrobial therapy prior to culture results. Hospital records for all horses with synovial sepsis and a synovial sample submitted to the microbiology l...
Paltrinieri S, Giordano A, Villani M, Manfrin M, Panzani S, Veronesi MC.A field study was undertaken to investigate plasma protein electrophoresis (PPE) and serum amyloid A (SAA) concentrations at 1, 3 and 7 days of age in foals born by oxytocin-induced (group A, n =17) or spontaneous (group B, n =12) parturition. The putative diagnostic role of PPE and SAA in four septicaemic foals was also examined. At birth, beta-gamma-globulins were higher in group B, and then increased in both groups, probably due to colostrum intake. At day 3, no significant differences between the groups were detectable. In both groups, SAA values increased from day 0 to day 3, then decreas...
Nagy AD, Simhofer H.To report use of mandibular condylectomy for treatment of advanced degenerative joint disease of the temporomandibular joint (TMJ) caused by sepsis. Methods: Clinical case report. Methods: Two-year-old Noriker filly. Methods: Computed tomography (CT) was used to confirm advanced degenerative joint disease of the left TMJ and for follow-up after mandibular condylectomy and removal of necrotic meniscus. Results: Painful swelling (3 weeks duration) with drainage located just caudal to the left lateral canthus of the eye was associated with atrophy of the left masseter muscle, masticatory problems...
Dallap Schaer BL, Epstein K.To review the hemostasis literature relevant to development of coagulopathy in the critically ill equine patient. Methods: Original scientific and review articles. Results: Inflammation plays a critical role in the activation and amplification of clot formation, as well as the impairment of physiologic anticoagulant mechanisms, and fibrinolysis. Earlier identification of coagulopathy in patients at risk and restoration of physiologic hemostasis may result in better outcome. Development of scoring systems based on information other than coagulation markers alone may better identify patients wit...
McTaggart C, Yovich JV, Penhale J, Raidal SL.Flow cytometric assays were used to compare phagocytic and oxidative burst activity of neutrophils from healthy foals less than 7 days of age with the activity of cells from healthy adult horses. The phagocytosis of Staphylococcus aureus by foal neutrophils was less than that observed for adult neutrophils when autologous serum was used as the source of opsonins in the assay. The use of adult serum did not significantly improve the ability of foal neutrophils to attach bacteria. The oxidative burst activity of foal neutrophils was equivalent to that of adult cells. However, when serum or plasm...
Furr M, McKenzie H.Bloodstream infections (BSI) are common in sick foals and increase foal morbidity and mortality when they occur. Recognition of risk factors for BSI could be an important means to limit their occurrence, but studies on this topic are limited. Objective: Historical as well as maternal and foal physical examination findings will predict risk of BSI in neonatal foals. Methods: Foals <14 days of age admitted to a referral equine hospital for care. Methods: Retrospective case-control study with univariate and multivariable logistic regression analysis. Results: Four hundred twenty-nine (143 cases...
Gold JR, Perkins GA, Erb HN, Ainsworth DM.Septicemia initiates the production of pro-inflammatory (interleukin [IL] 1-beta [IL-1beta], interferon-gamma [IFN-gamma], IL-6), and anti-inflammatory (IL-4) cytokines. The transcription of some of these proteins (IL-8, IL-6) is linked to endotoxin-induced activation of the toll-like receptor 4 (TLR4) on peripheral blood mononuclear cells (PBMC). Objective: Septic foals fail to increase gene expression of IFN-gamma. Nonsurviving septic foals exhibit distinctive cytokine profiles. Methods: Twenty-one septic and 20 healthy neonatal foals. Methods: Using real-time polymerase chain reaction, gene...
Schroeder EL, Holcombe SJ, Cook VL, James MD, Gandy JC, Hauptman JG, Sordillo LM.Endotoxaemia causes substantial morbidity and mortality in horses with colic and sepsis. Ethyl pyruvate is a novel anti-inflammatory medication that improved survival in preclinical models of severe sepsis endotoxaemia and intestinal ischaemia and reperfusion in rodents, swine, sheep and dogs and may be a useful medication in horses. Objective: Ethyl pyruvate has no adverse effects in normal horses and is biologically active based on suppression of proinflammatory gene expression in endotoxin stimulated whole blood, in vitro. Methods: Physical and neurological examinations, behaviour scores, e...
Vinther AM, Skovgaard K, Heegaard PM, Andersen PH.In horses, insights into the innate immune processes in acute systemic inflammation are limited even though these processes may be highly important for future diagnostic and therapeutic advances in high-mortality disease conditions as the systemic inflammatory response syndrome (SIRS) and sepsis. Therefore, the aim of this study was to investigate the expression of 31 selected blood leukocyte immune genes in an equine model of acute systemic inflammation to identify significantly regulated genes and to describe their expression dynamics during a 24-h experimental period. Systemic inflammation ...
Raisis AL, Hodgson JL, Hodgson DR.Equine neonatal septicaemia was confirmed in 24 foals hospitalised at the Rural Veterinary Centre between 1989 and 1992 with suspected septicaemia. Septicaemia was confirmed by culture of bacteria from blood of live foals and tissues obtained at necropsy of foals that died or were euthanased. Pathogenic bacteria isolated were predominantly Enterobacteriaceae (including Escherichia coli and Salmonella serovars) and Actinobacillus equuli. Clinical manifestations of septicaemia included signs of depression, dehydration, abnormalities in body temperature and manifestations of localised infection i...
