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Home / Equine Research Bank / J Vet Intern Med / Clinical findings and outcome predictors for multinodular pu...
Journal of veterinary internal medicine2024; 38(3); 1842-1857; doi: 10.1111/jvim.17084

Clinical findings and outcome predictors for multinodular pulmonary fibrosis in horses: 46 cases (2009-2019).

Abstract: Prognostic indicators for equine multinodular pulmonary fibrosis (EMPF), an interstitial fibrosing lung disease, are poorly described. Objective: Describe diagnostic findings and outcome predictors for EMPF. Methods: Forty-six adult horses with EMPF. Methods: Retrospective multicenter case series from 2009 to 2019. Radiographic (n = 27) and ultrasonographic studies (n = 19) from EMPF horses and bronchoalveolar lavage fluid (BALF) cytology from 6 EMPF and 13 asthma cases were independently reviewed and blinded to diagnosis and outcome. Associations between predictor variables and survival were assessed by predictor screening followed by Fisher's exact and Wilcoxon rank sum tests. Results: Primary clinical findings were weight loss (36/46, 78%), increased respiratory effort (33/46, 72%), tachypnea (32/46, 70%), and fever (18/46, 39%). Macrophage atypia was seen in more EMPF than asthmatic horse BALF (67% vs. 8%; P = .02). Equine herpesvirus 5 (EHV-5) was detected in 24 of 30 (80%) and hyperfibrinogenemia in 25 of 28 (89%) cases. Twenty-seven of 46 horses (59%) and 11 of 45 (24%) survived to discharge and to 3 months, respectively. Three-month survival was associated with lower median (range) respiratory rates (30 [24-36] vs. 41 [30-60] breaths per minute; P = .04), and higher BALF lymphocyte:neutrophil ratios (4.7 [1.4-22] vs. 0.47 [0.11-1.9]; P = .01) and blood lymphocyte counts (1.25 [0.93-2.55] vs. 0.90 [0.70-1.24] × 109/L; P = .03). Imaging findings, EHV-5 detection, and corticosteroid treatment were not associated with survival. Conclusions: Fever is not a sensitive clinical sign of EMPF. Diagnostic testing should be pursued for horses with increased respiratory rate and effort and weight loss. The prognosis for EMPF horses is poor. Corticosteroid treatment does not improve 3-month survival.
© 2024 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC on behalf of American College of Veterinary Internal Medicine.
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Publication Date: 2024-04-15 PubMed ID: 38619130PubMed Central: PMC11099712DOI: 10.1111/jvim.17084Google Scholar: Lookup
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  • Journal Article
  • Multicenter Study

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

This research study focuses on diagnostic findings and possible outcome predictors of a lung disease in horses called Equine Multinodular Pulmonary Fibrosis (EMPF). The study finds that EMPF prognosis is generally poor, and that frequent symptoms include weight loss and increased respiratory effort. Furthermore, corticosteroid treatment was not found to improve the condition.

Objective and Methodology

  • The main objective of the research was to describe the diagnostic findings and predict the outcome for horses suffering from EMPF. Through a multicenter case series from 2009 to 2019, a population of 46 adult horses with EMPF was studied.
  • Approaches such as radiographic and ultrasonographic studies were used on the EMPF horses, concurrently with the examination of bronchoalveolar lavage fluid (BALF) cytology from both EMPF and asthmatic horse cases.
  • The process was made blinded to diagnosis and outcome, indicating the researchers did not know which horse was suffering from EMPF, making the evaluation free from bias.
  • Various statistical methods were used to assess the association between predictor variables and survival rates.

Results and Findings

  • In the horses with EMPF, the main clinical findings were weight loss, increased respiratory effort, tachypnea (rapid breathing), and fever. Moreover, macrophage atypia (abnormal changes in macrophages, a type of white blood cell) was more commonly seen in EMPF horses than in asthmatic ones.
  • Equine herpesvirus 5 (EHV-5) was detected in 80% of the cases, and hyperfibrinogenemia (excessive fibrinogen in the blood) was found in 89% of the cases.
  • Regarding prognosis, 59% of the horses survived to discharge, but only 24% survived to the three-month mark. Reduced three-month survival was associated with higher respiratory rates, lower BALF lymphocyte:neutrophil ratios, and lower blood lymphocyte counts.
  • Interesting, imaging findings, the detection of EHV-5, and corticosteroid treatment were not statistically significant predictors of survival.

Conclusions

  • The study concludes that fever is not a sensitive clinical sign for EMPF, and hence, diagnostic testing should be conducted for horses displaying increased respiratory rate and effort, and weight loss.
  • Furthermore, the prognosis for horses with EMPF is generally poor, and the use of corticosteroid treatment does not enhance the three-month survival probability.

Cite This Article

APA
Craven A, Todd-Donato A, Stokol T, Liepman R, Glasberg I, Wilkins P, Luethy D, Wong D, Schoster A, van den Brom-Spierenburg AJ, Tomlinson JE. (2024). Clinical findings and outcome predictors for multinodular pulmonary fibrosis in horses: 46 cases (2009-2019). J Vet Intern Med, 38(3), 1842-1857. https://doi.org/10.1111/jvim.17084

Publication

Journal of veterinary internal medicine
ISSN: 1939-1676
NlmUniqueID: 8708660
Country: United States
Language: English
Volume: 38
Issue: 3
Pages: 1842-1857

Researcher Affiliations

Craven, Amanda
  • Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, New York, USA.
Todd-Donato, Amy
  • Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, New York, USA.
Stokol, Tracy
  • Department of Population Medicine and Diagnostic Sciences, Cornell University College of Veterinary Medicine, Ithaca, New York, USA.
Liepman, Rachel
  • Cave Creek Equine, Phoenix, Arizona, USA.
Glasberg, Ilana
  • Department of Veterinary Clinical Medicine, University of Illinois College of Veterinary Medicine, Urbana, Illinois, USA.
Wilkins, Pamela
  • Department of Veterinary Clinical Medicine, University of Illinois College of Veterinary Medicine, Urbana, Illinois, USA.
Luethy, Daniela
  • Department of Clinical Studies, New Bolton Center, University of Pennsylvania, Kennett Square, Pennsylvania, USA.
Wong, David
  • Department of Veterinary Clinical Sciences, Iowa State University College of Veterinary Medicine, Ames, Iowa, USA.
Schoster, Angelika
  • Vetsuisse Faculty, Equine Department, University of Zurich, Zurich, Switzerland.
van den Brom-Spierenburg, Astrid J
  • Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, The Netherlands.
Tomlinson, Joy E
  • Department of Clinical Studies, New Bolton Center, University of Pennsylvania, Kennett Square, Pennsylvania, USA.
  • Baker Institute for Animal Health, Cornell University College of Veterinary Medicine, Ithaca, New York, USA.

MeSH Terms

  • Animals
  • Horses
  • Horse Diseases / pathology
  • Horse Diseases / virology
  • Horse Diseases / diagnostic imaging
  • Horse Diseases / diagnosis
  • Retrospective Studies
  • Female
  • Male
  • Pulmonary Fibrosis / veterinary
  • Pulmonary Fibrosis / pathology
  • Bronchoalveolar Lavage Fluid / cytology
  • Bronchoalveolar Lavage Fluid / virology
  • Prognosis
  • Ultrasonography / veterinary

Conflict of Interest Statement

Authors declare no conflict of interest.

References

This article includes 37 references
  1. Wong DM, Belgrave RL, Williams KJ. Multinodular pulmonary fibrosis in five horses.. J Am Vet Med Assoc 2008;232(6):898‐905.
    pubmed: 18341449
  2. Williams KJ, Maes R, Del Piero F. Equine multinodular pulmonary fibrosis: a newly recognized herpesvirus‐associated fibrotic lung disease.. Vet Pathol 2007;44(6):849‐862.
    pubmed: 18039898
  3. Easton‐Jones CA, Madigan JE, Barnum S. Effect of valacyclovir on EHV‐5 viral kinetics in horses with equine multinodular pulmonary fibrosis.. J Vet Intern Med 2018;32(5):1763‐1767.
    pmc: PMC6189341pubmed: 30221792
  4. Back H, Kendall A, Grandón R. Equine multinodular pulmonary fibrosis in association with asinine herpesvirus type 5 and equine herpesvirus type 5: a case report.. Acta Vet Scand 2012;54:57.
    pmc: PMC3511884pubmed: 23009194
  5. Marenzoni ML, Passamonti F, Lepri E. Quantification of equid herpesvirus 5 DNA in clinical and necropsy specimens collected from a horse with equine multinodular pulmonary fibrosis.. J Vet Diagn Invest 2011;23(4):802‐806.
    pubmed: 21908328
  6. Williams KJ, Robinson NE, Lim A. Experimental induction of pulmonary fibrosis in horses with the gammaherpesvirus equine herpesvirus 5.. PLoS One 2013;8(10):e77754.
    pmc: PMC3795644pubmed: 24147074
  7. Bennion BG, Ingle H, Ai TL. A human gain‐of‐function STING mutation causes immunodeficiency and gammaherpesvirus‐induced pulmonary fibrosis in mice.. J Virol 2019;93(4):e01806‐18.
    pmc: PMC6364005pubmed: 30463976
  8. McMillan TR, Moore BB, Weinberg JB. Exacerbation of established pulmonary fibrosis in a murine model by gammaherpesvirus.. Am J Respir Crit Care Med 2008;177(7):771‐780.
    pmc: PMC2277211pubmed: 18187693
  9. Lok SS, Haider Y, Howell D, Stewart JP, Hasleton PS, Egan JJ. Murine gammaherpes virus as a cofactor in the development of pulmonary fibrosis in bleomycin resistant mice.. Eur Respir J 2002;20(5):1228‐1232.
    pubmed: 12449178
  10. Tomlinson JE, Divers TJ, McDonough SP, Thompson MS. Hypertrophic osteopathy secondary to nodular pulmonary fibrosis in a horse.. J Vet Intern Med 2011;25(1):153‐157.
    pubmed: 21155888
  11. Easton‐Jones CA, Cissell DD, Mohr FC, Chigerwe M, Pusterla N. Prognostic indicators and long‐term survival in 14 horses with equine multinodular pulmonary fibrosis.. Equine Vet Educ 2020;32(s11):41‐46.
  12. Scheurer L, Bachofen C, Herteman N, Hilbe M, Wolfer N, Schoster A. A case series highlighting the role of different gamma‐herpesviruses in equine multinodular pulmonary fibrosis.. Schweiz Arch Tierheilkd 2020;162(4):245‐256.
    pubmed: 32234694
  13. Spelta CW, Axon JE, Begg A. Equine multinodular pulmonary fibrosis in three horses in Australia.. Aust Vet J 2013;91(7):274‐280.
    pubmed: 23782020
  14. Pusterla N, Magdesian KG, Mapes SM, Zavodovskaya R, Kass PH. Assessment of quantitative polymerase chain reaction for equine herpesvirus‐5 in blood, nasal secretions and bronchoalveolar lavage fluid for the laboratory diagnosis of equine multinodular pulmonary fibrosis.. Equine Vet J 2017;49(1):34‐38.
    pubmed: 26639080
  15. Couëtil LL, Cardwell JM, Gerber V, Lavoie JP, Léguillette R, Richard EA. Inflammatory airway disease of horses‐revised consensus statement.. J Vet Intern Med 2016;30(2):503‐515.
    pmc: PMC4913592pubmed: 26806374
  16. Bedenice D, Heuwieser W, Brawer R, Solano M, Rand W, Paradis MR. Clinical and prognostic significance of radiographic pattern, distribution, and severity of thoracic radiographic changes in neonatal foals.. J Vet Int Med 2003;17:876‐886.
    pubmed: 14658726
  17. Lisciandro GR, Fosgate GT, Fulton RM. Frequency and number of ultrasound lung rockets (B‐lines) using a regionally based lung ultrasound examination named vet BLUE (veterinary bedside lung ultrasound exam) in dogs with radiographically normal lung findings.. Vet Radiol Ultrasound 2014;55(3):315‐322.
    pubmed: 24382172
  18. Vezzosi T, Mannucci T, Pistoresi A. Assessment of lung ultrasound B‐lines in dogs with different stages of chronic valvular heart disease.. J Vet Intern Med 2017;31(3):700‐704.
    pmc: PMC5435052pubmed: 28370336
  19. Ollivett TL, Caswell JL, Nydam DV. Thoracic ultrasonography and bronchoalveolar lavage fluid analysis in holstein calves with subclinical lung lesions.. J Vet Intern Med 2015;29(6):1728‐1734.
    pmc: PMC4895683pubmed: 26332345
  20. Ramirez S, Lester GD, Roberts GR. Diagnostic contribution of thoracic ultrasonography in 17 foals with Rhodococcus equi pneumonia.. Vet Radiol Ultrasound 2004;45(2):172‐176.
    pubmed: 15072151
  21. Volpicelli G, Caramello V, Cardinale L, Mussa A, Bar F, Frascisco MF. Bedside ultrasound of the lung for the monitoring of acute decompensated heart failure.. Am J Emerg Med 2008;26(5):585‐591.
    pubmed: 18534289
  22. Manolescu D, Davidescu L, Traila D, Oancea C, Tudorache V. The reliability of lung ultrasound in assessment of idiopathic pulmonary fibrosis.. Clin Interv Aging 2018;13:437‐449.
    pmc: PMC5868611pubmed: 29606857
  23. Gutierrez M, Salaffi F, Carotti M. Utility of a simplified ultrasound assessment to assess interstitial pulmonary fibrosis in connective tissue disorders—preliminary results.. Arthritis Res Ther 2011;13(4):R134.
    pmc: PMC3239377pubmed: 21851634
  24. Tardella M, Gutierrez M, Salaffi F. Ultrasound in the assessment of pulmonary fibrosis in connective tissue disorders: correlation with high‐resolution computed tomography.. J Rheumatol 2012;39(8):1641‐1647.
    pubmed: 22753655
  25. Sheahan B, Lascola K, Austin S. Normal ultrasonographic pleural thickness in clinically healthy adult horses. Abstract E35 in 2016 ACVIM forum research abstract program.. J Vet Intern Med 2016;30(4):1407‐1519.
    doi: 10.1111/jvim.13952google scholar: lookup
  26. Allen KJ, Tennant KV, Franklin SH. Effect of inclusion or exclusion of epithelial cells in equine respiratory cytology analysis.. Vet J 2019;254:105405.
    pubmed: 31836172
  27. Ochi A, Sekiguchi M, Tsujimura K, Kinoshita T, Ueno T, Katayama Y. Two cases of equine multinodular pulmonary fibrosis in Japan.. J Comp Pathol 2019;170:46‐52.
    pubmed: 31375158
  28. Niedermaier G, Poth T, Gehlen H. Clinical aspects of multinodular pulmonary fibrosis in two warmblood horses.. Vet Rec 2010;166(14):426‐430.
    pubmed: 20364010
  29. Soare T, Leeming G, Morgan R. Short communications: equine multinodular pulmonary fibrosis in horses in the UK.. Vet Rec 2011;169(12):313.
    pubmed: 21881023
  30. Dunowska M, Hardcastle MR, Tonkin FB. Identification of the first New Zealand case of equine multinodular pulmonary fibrosis.. N Z Vet J 2014;62(4):226‐231.
    doi: 10.1080/00480169.2014.899933pubmed: 24597743google scholar: lookup
  31. Verryken K, Saey V, Maes S. First report of multinodular pulmonary fibrosis associated with equine herpesvirus 5 in Belgium.. Vlaams Diergeneeskd Tijdschr 2010;79(4):297‐301.
  32. Hart KA, Barton MH, Williams KJ, Flaminio MJBF, Howerth EW. Multinodular pulmonary fibrosis, pancytopenia and equine herpesvirus‐5 infection in a thoroughbred gelding.. Equine Vet Educ 2008;20(9):470‐476.
  33. Schwarz B, Schwendenwein I, Van Den Hoven R. Successful outcome in a case of equine multinodular pulmonary fibrosis (EMPF) treated with valacyclovir.. Equine Vet Educ 2013;25(8):389‐392.
  34. Leclere M, Lavoie‐Lamoureux A, Lavoie JP. Acute phase proteins in racehorses with inflammatory airway disease.. J Vet Intern Med 2015;29(3):940‐945.
    pmc: PMC4895423pubmed: 25857218
  35. Lavoie‐Lamoureux A, Leclere M, Lemos K, Wagner B, Lavoie JP. Markers of systemic inflammation in horses with heaves.. J Vet Intern Med 2012;26(6):1419‐1426.
    pubmed: 22925172
  36. Gy C, Leclere M, Vargas A, Grimes C, Lavoie JP. Investigation of blood biomarkers for the diagnosis of mild to moderate asthma in horses.. J Vet Intern Med 2019;33(4):1789‐1795.
    pmc: PMC6639487pubmed: 31099114
  37. Léguillette R. Recurrent airway obstruction—heaves.. Vet Clin North Am Equine Pract 2003;19:63‐86.
    pubmed: 12747662
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