Use of extracorporeal hemoperfusion therapy in an adult horse with Clostridioides difficile colitis and severe systemic inflammatory response syndrome.
Abstract: An 8-year-old American Quarter Horse gelding was treated with extracorporeal hemoperfusion (HP) therapy for treatment of Clostridioides difficile (C. difficile) colitis-induced systemic inflammatory response syndrome (SIRS). The gelding developed C. difficile associated peracute colitis and severe SIRS as evidenced by a positive fecal C. difficile PCR and tachypnea, tachycardia, fever, neutropenia, altered mucous membrane color, and hyperlactatemia. Concurrent acute kidney injury in the horse limited the use of routine anti-inflammatory and anti-lipopolysaccharide treatments, including flunixin meglumine and polymyxin B, because of potential for nephrosis. Extracorporeal HP therapy was performed twice within 48 hours of the onset of severe SIRS during which the horse's physical examination variables stabilized. The horse was euthanized after 4 days because of laminitis. These findings support further investigation of extracorporeal HP therapy as an adjunctive treatment for severe SIRS/sepsis in horses.
© 2024 The Author(s). Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC on behalf of American College of Veterinary Internal Medicine.
Publication Date: 2024-08-09 PubMed ID: 39122666PubMed Central: PMC11423434DOI: 10.1111/jvim.17154Google Scholar: Lookup
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Summary
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This study showcases the potential use of extracorporeal hemoperfusion therapy to treat a mature horse suffering from a severe systemic inflammatory response syndrome due to Clostridioides difficile colitis. However, further research is needed due to the horse’s eventual euthanasia as a result of unconnected laminitis.
About the Research Subject
- The subject of the study was an 8-year-old American Quarter Horse gelding which developed C. difficile induced peracute colitis and severe SIRS. This condition was determined by a positive fecal C. difficile PCR test and symptoms such as tachypnea (fast breathing), tachycardia (fast heart rate), fever, poor immune cell levels, change in mucous membrane color, and increased lactate blood levels.
Conditions Precluding Regular Treatment Options
- The horse’s acute kidney injury limited the usage of routine treatments for inflammation and lipopolysaccharides like flunixin meglumine and polymyxin B, due to the potential risk of causing nephrosis (kidney tissue damage or death).
Extracorporeal Hemoperfusion Therapy
- Instead, the scientists used extracorporeal HP therapy. This technique involves circulating the horse’s blood through a device that filters out toxins, with the help of an adsorbent compressed charcoal cartridge.
- This experimental treatment was performed twice within 48 hours after the onset of severe SIRS, after which the horse’s physical examination variables stabilized temporarily.
Post-Therapy Complications
- Despite the temporary success of the treatment, the horse eventually had to be euthanized after four days due to the unrelated development of laminitis, a painful inflammatory condition in the tissues (laminae) bounding the hoof wall to the pedal (coffin) bone in the horses’ hooves.
Research Implications
- This study suggests that extracorporeal HP therapy may have potential as an adjunctive treatment for severe SIRS/sepsis in horses and deserves more research. The observed stabilisation of the horse’s condition after HP treatment might indicate a therapeutic advantage of HP for horses with severe systemic inflammatory response syndrome.
Cite This Article
APA
Hobbs KJ, Le Sueur ANV, Hallowell K, Martin E, Sheats MK, Ueda Y.
(2024).
Use of extracorporeal hemoperfusion therapy in an adult horse with Clostridioides difficile colitis and severe systemic inflammatory response syndrome.
J Vet Intern Med, 38(5), 2790-2794.
https://doi.org/10.1111/jvim.17154 Publication
Researcher Affiliations
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA.
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA.
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA.
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA.
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA.
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA.
MeSH Terms
- Animals
- Horses
- Horse Diseases / therapy
- Hemoperfusion / veterinary
- Hemoperfusion / methods
- Systemic Inflammatory Response Syndrome / veterinary
- Systemic Inflammatory Response Syndrome / therapy
- Clostridioides difficile
- Male
- Clostridium Infections / veterinary
- Clostridium Infections / therapy
- Colitis / veterinary
- Colitis / therapy
Grant Funding
- T32 OD011130 / NIH HHS
- NIH T-32
- ORIP NIH HHS
- U.S. Department of Health and Human Services
Conflict of Interest Statement
Our group has an ongoing study using VETRESQ cartridges in large animals (funded through American Association of Equine Practitioners). The cartridges were donated with no intention or promise of publication from us. The Thoroughbred Education and Research Foundation donated money to help with clinical cases, they had no intention or promise of publication from the authors.
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Citations
This article has been cited 2 times.- Junkkari R, Mykkänen A, Sulku P, Rantala M, Pohjanvirta T, Eklund M, Pelkonen S, Grönthal T. Occurrence, antibiotic susceptibility and genetic variation of Streptococcus zooepidemicus in Finnish weanling horses with and without respiratory infection. Acta Vet Scand 2026 Jan 27;68(1):7.
- Hobbs KJ, Bayless R, Sheats MK. A Comparative Review of Cytokines and Cytokine Targeting in Sepsis: From Humans to Horses. Cells 2024 Sep 5;13(17).
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