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Equine Clinical Immunology > Chapter 18 Endotoxaemia and SIRS > Flashcards

Chapter 18 Endotoxaemia and SIRS Flashcards

1
Q

What is Inflammatory Airway Disease (IAD) in horses?

A

A condition characterized by airway inflammation, alterations in pulmonary function, and one or more clinical signs of respiratory disease.

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2
Q

What criteria define IAD according to the 2007 ACVIM consensus?

A

Poor performance, exercise intolerance, or coughing, with or without excess tracheal mucus; and non-septic inflammation detected by cytological examination of BALF or pulmonary dysfunction.

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3
Q

What are the exclusion criteria for IAD?

A

Horses with respiratory difficulty at rest, systemic illness (fever, depression, abnormal blood work), or solely tracheal inflammation are excluded.

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4
Q

What is trIAD and brIAD?

A

TrIAD refers to tracheal inflammatory airway disease, and brIAD refers to bronchoalveolar inflammatory airway disease.

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5
Q

What is subclinical IAD?

A

The presence of inflammation in BALF without concurrent clinical signs.

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6
Q

What are common clinical signs of IAD?

A

Cough, poor performance, prolonged recovery after exercise, and increased airway secretions.

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7
Q

Which horses are more commonly affected by tracheal inflammation?

A

Young racehorses, with prevalence decreasing with age or time spent in training.

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8
Q

What is the likely etiopathogenesis of IAD?

A

It is a clinical syndrome with multifactorial etiopathogenesis, including environmental disease, early stage or milder phenotype of heaves, and infectious processes with secondary lower airway inflammation.

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9
Q

What environmental factors can induce airway inflammation in horses?

A

Hay feeding, conventional barn housing, exposure to molds, mites, organic dust particles, peptidoglycans, and noxious gases.

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10
Q

What is the association between stabling and airway inflammation?

A

Stabling induces neutrophilic airway inflammation and is associated with higher endotoxin concentrations and exposure to various irritants.

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11
Q

What role do viral and bacterial infections play in IAD?

A

Active infections are unlikely to play a central role, but respiratory infections at an early age may predispose horses to IAD later in life.

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12
Q

What bacterial pathogen is most consistently associated with tracheal inflammation in young racehorses?

A

Streptococcus zooepidemicus.

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13
Q

What is the role of cytokines in IAD?

A

Different types of inflammation in BALF are associated with different cytokine profiles, indicating the involvement of innate and Th-2 immune responses.

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14
Q

What types of cells are typically increased in BALF in horses with IAD?

A

Neutrophils, eosinophils, or mast cells.

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15
Q

What is the significance of neutrophils in BALF for IAD?

A

High percentages of neutrophils are associated with cough, age, tracheal mucus, and low arterial oxygen tension during exercise.

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16
Q

What is the significance of mast cells and eosinophils in BALF for IAD?

A

Increased eosinophils and mast cells are associated with younger horses, poor performance, and altered baseline lung function.

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17
Q

What are common diagnostic methods for IAD?

A

Clinical history and physical examination, BALF cytology, lung function testing, endoscopy, and radiographic studies.

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18
Q

What is the typical cytokine profile in horses with IAD?

A

Up-regulation of IL-1β, TNFα, IL-4, and IFN-γ in association with different inflammatory cell types in BALF.

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19
Q

What is the relationship between IAD and heaves?

A

IAD shares similarities with heaves, and horses with chronic mild clinical signs of IAD may progress to develop heaves.

20
Q

What is the role of pulmonary function testing in IAD?

A

To detect mild to moderate airflow limitation, airway hyperresponsiveness, and impaired gas exchange during exercise.

21
Q

What is the significance of abnormal BALF cytology without clinical signs?

A

Inflammation is frequent in some populations of healthy, well-performing horses, so abnormal cytology alone is not sufficient to diagnose IAD.

22
Q

What environmental management strategies are recommended for IAD?

A

Reducing exposure to dust, improving ventilation, using low-dust bedding, and feeding soaked or pelleted hay.

23
Q

What pharmacological treatments are commonly used for IAD?

A

Systemic or inhaled corticosteroids and bronchodilators.

24
Q

What is the role of nebulized sodium cromoglycate in IAD treatment?

A

It benefits horses with increased mast cells in BALF by stabilizing mast cells and reducing clinical signs and respiratory scores.

25
Q

What is the effect of clenbuterol in IAD treatment?

A

It transiently increases mucociliary clearance and reduces airway sensitivity to inhaled histamine, but may cause tachyphylaxis.

26
Q

What is the role of interferon alpha in IAD treatment?

A

It decreases total protein concentrations and procoagulant activity in BALF, and has a mild positive effect in young racehorses with tracheal inflammation.

27
Q

What is the prognosis for horses with IAD?

A

IAD is considered transient in young athletic horses, and improvement can be achieved with environmental management and medical treatment.

28
Q

What are the clinical outcomes for older horses with IAD?

A

Clinical signs can be controlled in most cases, but there is no curative treatment, and horses may eventually develop heaves.

29
Q

What diagnostic tools are used to exclude other respiratory diseases in horses with IAD?

A

Complete blood count, thoracic radiographs, and bacterial culture of tracheal aspirate.

30
Q

What are common clinical signs of IAD based on history and physical examination?

A

Cough, nasal discharge, poor performance, in the absence of systemic signs of infection.

31
Q

What are the reference ranges for BALF cell counts in horses with IAD?

A

Eosinophils and mast cells are abnormal above 1% and 2%, respectively, and neutrophils are considered abnormal between 5% and 10%.

32
Q

What is the significance of bacterial colonization in the trachea in IAD?

A

Increased bacterial colonization can contribute to lower airway inflammation and cough, and may require antimicrobial treatment.

33
Q

What is the importance of environmental control in managing IAD?

A

It significantly reduces clinical signs and airway inflammation by minimizing exposure to irritants and allergens.

34
Q

What are the benefits of inhaled corticosteroids compared to systemic corticosteroids in IAD?

A

They provide targeted anti-inflammatory effects with fewer systemic side effects.

35
Q

What is the role of pulmonary function testing in diagnosing IAD?

A

To detect subtle alterations in pulmonary function that are more difficult to measure than those observed in heaves.

36
Q

What are the diagnostic criteria for IAD according to the ACVIM consensus?

A

Non-septic inflammation in BALF or pulmonary dysfunction, poor performance, exercise intolerance, or coughing with or without excess tracheal mucus.

37
Q

What are the potential side effects of long-term corticosteroid use in horses with IAD?

A

Adrenocortical suppression, laminitis, hepatopathy, muscle wasting, altered bone metabolism, and increased susceptibility to infection.

38
Q

What is the role of bronchodilators in IAD treatment?

A

They relieve bronchospasm but do not address the underlying inflammation.

39
Q

What are the common symptoms of IAD during an acute episode?

A

Increased expiratory effort, respiratory frequency, mild nasal discharge, flared nostrils, and markedly increased abdominal expiratory effort.

40
Q

What is the ‘heaves line’ in horses with IAD?

A

Hypertrophy of the external abdominal oblique muscle due to strong and continuous respiratory effort.

41
Q

What is the genetic predisposition associated with IAD?

A

Genes associated with smooth muscle remodeling, leukotriene metabolism, and IL-4 receptor polymorphisms.

42
Q

What is the significance of tracheal mucus in diagnosing IAD?

A

Tracheal mucus is associated with poor performance and airway inflammation, but tracheal inflammation alone is not sufficient to diagnose IAD.

43
Q

What are the clinical signs of severe IAD?

A

Extended head and neck positioning, flared nostrils, increased abdominal expiratory effort, and possibly fever and anorexia.

44
Q

What environmental factors contribute to the chronicity of IAD?

A

Persistent exposure to dust, molds, and other irritants in the barn environment.

45
Q

What are the potential benefits of nebulized sodium cromoglycate in IAD treatment?

A

Stabilizes mast cells and reduces clinical signs and respiratory scores in horses with increased mast cells in BALF.

46
Q

What is the prevalence of IAD in horses?

A

The exact prevalence is not clear, but it is considered higher than that of heaves.

47
Q

What are the common diagnostic methods for assessing pulmonary function in horses with IAD?

A

Forced expiration method, induced hyperventilation, and impulse oscillometry.

Equine Clinical Immunology (32 decks)

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