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module 15 > Disorders of the Equine Lower Resp Tract 2 > Flashcards

Disorders of the Equine Lower Resp Tract 2 Flashcards

1
Q

what are the differentials for coughing (13)

A
  1. severe equine asthma and SPA-SEA
  2. mild to moderate equine asthma
  3. URT inflammation/irritation/trauma
  4. influenza, equine herpes virus etc
  5. S. equi equi infection (Strangles)
  6. dysphagia
  7. bacterial or viral pneumonia
  8. parasitic pneumonia
  9. URT/LRT foreign body
  10. neoplasia
  11. pulmonary edema
  12. neoplasia
  13. smoke inhalation
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2
Q

when should you assume infectious respiratory disease

A
  1. pyrexia
  2. is the horse unwell?
  3. enlarged lymph nodes
  4. other animals effected
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3
Q

what is the difference between tracheal and bronchoalveolar lavage

A
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4
Q

what age of horse does mild to moderate equine asthma affect

A

young athletic horses but it can be any age

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5
Q

what are the clinical signs of horses with mild to moderate equine asthma (4)

A
  1. exercise intolerance/poor performance
  2. coughing
  3. increased resp secretions
  4. no increased expiratory effort (dyspnea) at rest –> but perhaps at exercise
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6
Q

what is the etiology of mild to moderate equine asthma (4)

A
  1. environmental dusts/organic particals/gases etc
  2. bacteria/virus
  3. genetics, immune status
  4. exercise induced pulmonary hemorrhage (EPIH)
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7
Q

how is mild to moderate equine asthma (5)

A
  1. history and clinical exam
  2. endoscopy
  3. cytology particularly of BAL
  4. pulmonary dysfunction
  5. pulmonary hypersensitiviy
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8
Q

how is mild to moderate equine asthma diagnosed on endoscopy

A

+/- tracheal mucus (often excessive)

TW with culture to rule out bacterial infection

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9
Q

what is seen on BAL cytology with mild to moderate equine asthma

A

neutrophilia

some may have increased inflammation 5-20% of differential count

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10
Q

how is mild to moderate equine asthma treated

A

similar to SEA

  1. low dust environment
  2. corticosteroids
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11
Q

what are the types of corticosteroids used to treat mild to moderate equine asthma

A

systemic

inhaled

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12
Q

how is the mild to moderate equine asthma response of treatment monitored

A

subclinical so need to repeat BAL cytology to confirm

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13
Q

how is mild to moderate equine asthma prevented in young horses

A
  1. low dust environment (feeding/housing/bedding) –>avoid peak concentrations, mucking out etc.
  2. good ventilation
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14
Q

what is the difference in signalment with mild/moderate vs severe equine asthma

A

MEA usually young adults

SEA > 7 years

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15
Q

what are the difference in clinical signs in mild/moderate vs severe equine asthma

A

MEA: no dyspnea at rest, may have tachypnea

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16
Q

what are the differences in BAL cytology in mild/moderate vs severe equine asthma

A
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17
Q

what is the difference in prognosis of mild/moderate vs severe equine asthma

A

MEA: short duration, can resolve spontaneously or with treatment, low risk of recurrence

SEA: long duration, recurrent

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18
Q

what is exercise induced pulmonary hemorrhage

A

common pulmonary disorder of the hrose

associated with strenous exercise

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19
Q

what is the pathogenesis of EIPH

A

unknown

stress failure of pulmonary capillaries

may be associated with mild/moderate equine asthma

low alveolar pressure?

upper airway obstruction?

mechanical forces associated with poor performance?

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20
Q

does EIPH cause poor performance

A

moderate to severe EIPH associated with reduced performance

BUT many horses have EPIH without impaired performance

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21
Q

what are the presenting signs of EIPH (5)

A
  1. none
  2. +/- post exercise/race epistaxis
  3. +/- poor performance
  4. +/- repeated swallowing post exercise/race
  5. +/- prlonged recovery post exercise/race
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22
Q

what are the clinical signs of EIPH

A
  1. none
  2. +/- epistaxis
  3. +/- abnormal lung sounds (rarely)
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23
Q

how is EIPH diagnosed

A
  1. endoscopy (30-60 min post exercise)
  2. BAL cytology: free red blood cells, hemosiderophages, +/- neutrophils
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24
Q

how is EIPH treated

A

aim to reduce hemorrhage, minimize sequelae (inflammation/fibrosis)

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25
Q

how can frequency of EIPH episodes

A

altered training

prophylaxis –> frusemide

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26
Q

what is interstitial lung disease

A

acute or chronic inflammatory process of primary alveolar walls and adjoining bronchiolar interstitium

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27
Q

what does acute phase interstitial lung disease

A

present in acute respiratory distress

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28
Q

how does chronic phase interstitial lung disease present

A

presents clinically like SEA

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29
Q

what are the causes of interstitial lung disease (3)

A

multifactorial

  1. toxic agents: mineral oil, silicosis
  2. infectious agents: bacteria, virus, parasite
  3. idiopathic
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30
Q

how is interstitial lung disease diagnosed

A

process of elimination and radiography

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31
Q

how is interstitial lung disease treated

A

treat infectious agent (if present) and anti-inflammatory therapy

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32
Q

what is equine multinodular pulmonary fibrosis (EMPF)

A

a progressive fibrosing lung disease associated with presence EHV-5

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33
Q

when is equine multinodular pulmonary fibrosis seen

A

typically in older horses

often intially suspected to be SEA or infectious bronchopneumonia

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34
Q

what are the signs of equine multinodular pulmonary fibrosis (EMPF) (4)

A
  1. tachypnea
  2. tachycardia
  3. weight loss
  4. pyrexia
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35
Q

what can be heard on auscultation with equine multinodular pulmonary fibrosis (EMPF)

A

wheezes and crackles

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36
Q

how is multinodular pulmonary fibrosis differentiated from SEA

A

prove it is NOT reversible –> administer short acting bronchodilator? buscopan

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37
Q

how is multinodular pulmonary fibrosis differentiated from infectious pneumonia

A

BAL cytology –> non septic neutrophilia

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38
Q

what is seen on BAL samples with multinodular pulmonary fibrosis

A

presence of EHV-5

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39
Q

what is seen on radiography with multinodular pulmonary fibrosis

A

diffuse, nodular interstitial pattern

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40
Q

what is seen on ultrasonography with multinodular pulmonary fibrosis

A

diffuse pleaural thickening

may identify nodules superficial in lung

biopsy

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41
Q

how is multinodular pulmonary fibrosis treated

A

fair to poor prognosis

dexamethasone, doxycyline, acyclovir

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42
Q

what causes lungworm

A

Dictylocaulus arnfieldi

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43
Q

what is a question you should ask when examining a horse to distinguish SEA from lungworm

A

has there been any contact with donkeys/mules

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44
Q

what is seen with horses on lungworm

A
  1. BAL cytology
  2. larvae in tracheal wash
  3. few eggs in feces as usually not patent infection in horses
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45
Q

how is lungowrm treated

A

oral ivermectin/moxidectin

46
Q

what ascarids can migrate into the lung

A

Parascaris equorum

47
Q

what does Parascaris equorum cause

A

larval migration in foals/yearlings –> lung inflammation and clinical signs

but can cause intestinal obstruction/intussusception

ill thrit and diarrhea

48
Q

how long does it take for Parascaris equorum to cause an infection

A

3 months to become patent infeciton

relatively minor

49
Q

how is Parascaris equorum diagnosed

A

fegal worm egg count when patent infection

50
Q

how is Parascaris equorum prevented

A

deworming

51
Q

what is bacterial pneumonia

A

bacterial infection of the lung parenchyma

bronchopneumonia with or without involvement of the pleural space

52
Q

what is the etiology of bacterial pneumonia

A

bacteria (normal inhabitants) from nasal or oropharynx –> reach lower airways and overwhelm the defences

53
Q

what gram positive species can cause a bacterial pneumonia

A
    1. Streptococcus equi ss zooepidemicus*
    1. Staphylococcus aures*
    1. pneumoniae*
54
Q

what gram negative species can cause bacterial pneumonia (5)

A
    1. Actinobacillus*
    1. Pasteurella species*
    1. E. Coli, Klebsiella*
    1. pneumoniae*
    1. Bordetella bronchiseptica*
55
Q

what obligate anaerobes can cause bacterial pneumonia (3)

A
    1. Bacteroides fragilis*
    1. Fusobacterium*
    1. Clostridial species*
56
Q

can fungal species cause bacterial pneumonia

A

rarely

usually immune suppression or prolonged use of antimicrobials

57
Q

what is the pathogenesis of bacterial pneumonia and what does the development require

A

transient contamination of LRT with URT bacteria common in healthy horses

potentially pathogenic and non-pathogenic bacteria (and fungi) can be isolated from tracheal washes from healthy horses

so development of pneumonia requires

  1. overwhelming bacterial challenge
  2. impairement of pulmonary defences
58
Q

what events can cause an overwhelming challenge of LRT

A
  1. aspiration
  2. head elevation (transport)
  3. laryngeal/pharyngeal dysfunction
59
Q

what aspiration events can cause bacterial pneumonia

A
  1. feed
  2. near drowning
  3. esophageal obstruction (choke)
60
Q

what events can cause laryngeal/pharyngeal dysfunction which lead to bacterial pneumonia (4)

A
  1. surgery
  2. botulism
  3. myopathies
  4. cranial nerve dysfunction causing dysphagia (GP mycosis affected CN 9 and CN 10)
61
Q

what events can cause impaired LRT defences (5)

A
  1. exercise
  2. prior viral infection
  3. transport
  4. GA and surgery
  5. environmental conditions
62
Q

what exercise events can lead to impaired LRT defences causing a bacterial pneumonia

A
  1. aspiration of dirt (racetrack)
  2. impaired local and systemic immunity (stress of intense exercise)
63
Q

how can prior viral infection cause impaired LRT defences

A

impaired mucociliary clearance

64
Q

how does transport lead to impaired LRT defences (2)

A
  1. impaired mucociliary clearance
  2. impaired leukocyte function
65
Q

how can environmental conditions lead to impaired LRT defences

A
  1. noxious gases, particulate matter, endotoxin
  2. ventilation, co-mingling, husbandry
66
Q

what are the presenting signs of bacterial pneumonia (7)

A
  1. can be subtle initially
  2. pyrexia
  3. inappetence, signs of depresion (first signs)
  4. exercise intolerance
  5. cough: usually soft, moist
  6. nasal discharge: purulent, serosanguinous, malodorous
  7. tachypnea, hypopnea, resp distress
67
Q

what are the systemic signs of bacterial pneumonia

A

Evidence of systemic inflammatory response syndrome (SIRS)

Tachycardia, mucous membranes, etc

Laminitis?

68
Q

what are the signs of bacterial pneumonia with auscultation (3)

A
  1. Exudate in trachea
  2. Increased inspiratory noise with wheezes and crackles ventrally
  3. Reduced breath sounds ventrally? Pleural effusion?
69
Q

what are most cases of bacterial pleuropneumonia extensions of

A

bacterial pneumonia

70
Q

how does bacterial pneumonia cause bacterial pleuropneumonia and what can this lead to if left untreated

A

if inflammation extends to pleural space causing sterile fluid accumulation

If not treated bacteria migrate into the fluid and multiply

Septic exudate and fibrin production

71
Q

what other things can cause bacterial pleuropneumonia

A

pulmonary abscesses

trauma

esophageal rupture

72
Q

what are the signs of severe acute bacterial pleuropneumonia (6)

A
  1. tachycardia, toxic mucus membranes —> SIRS
  2. Pleural friction rubs on auscultation
  3. Pleural fluid (diminishes as fluid accumulates)
  4. Shallow breathing depth with increased rate
  5. May present with apparent colic signs (false colic)
  6. Pain on palpation of thorax, “grunt”, reluctant to move
73
Q

what are the chronic signs of bacterial pleuropneumonia

A

intermittent fever/weight loss

74
Q

how is bacterial pleuropneumonia diagnosed (7)

A
  1. history + clinical signs
  2. hematology + biochemistry
  3. endoscopy
  4. tracheal wash
  5. ultrasonography
  6. radiography
  7. thoracocentesis
75
Q

what is seen on hematology and biochem with bacterial pneumonia/pleuropneumonia

A
  1. Leukocytosis with absolute neutrophilia: severe may have a neutropenia (gram negative bacteria?)
  2. Anemia of chronic inflammation
  3. Positive acute phase proteins: fibrinogen and serum amyloid A elevated (SAA goes up within hours of onset of infection)
  4. Negative acute phase protein: decreased albumin
  5. Increased globulins
76
Q

what is seen on endoscopy with bacterial pneumonia/pleuropneumonia

A

Laryngeal/pharyngeal abnormality?

Mucopus in trachea

77
Q

what is seen on tracheal wash cytology with bacterial pneumonia/pleuropneumonia

A

culture for aerobic and anaerobic

cytology:

  1. Increased neutrophils >40% but up to 100% possible
  2. Degenerate neutrophils and bacteria (intracellular)
78
Q

what is seen on ultrasonography with bacterial pneumonia/pleuropneumonia

A
  1. Comet tails —> pleural thickening
  2. Lung consolidation
  3. Abscesses
  4. Pleural fluid, fibr
79
Q

where are most ultrasonographic findings found with bacterial pneumonia/pleuropneumonia

A

ventral

80
Q

why are most ultrasonographic findings found ventrally in bacterial pneumonia/pleuropneumonia

A

because aspiration follows gravity –> ventral lung fields most affected

81
Q

how is the lung field scanned in bacterial pneumonia/pleuropneumonia

A

caudal to cranial

dorsal to ventral

identify end of lung field within each IC space

82
Q

which side of the thorax is more affected with bacterial pneumonia/pleuropneumonia

A

right hemithorax –> more direct route

83
Q

how is bacterial pneumonia/pleuropneumonia treated

A

broad spectrum antimicrobial therapy in interim while waiting for culture and sensitivity

84
Q

what antimicrobials are used in bacterial pneumonia/pleuropneumonia

A

Penicillin + gentamicin +/- metronidazole

(Ceftiofur?/cefquinome? +/- gentamicin +/- metronidazole)

85
Q

how long are antimicrobials indicated usualyl for bacterial pneumonia/pleuropneumonia

A

6-8 weeks or longer usually

then eventually switch to oral depending on sensitivity: TMPS/enrofloxacin/doxycycline

86
Q

what else can be used to treat bacterial pneumonia/pleuropneumonia (2)

A
  1. nebulize antibiotics (gentamicin, cefquinome, ceftiofur)
  2. Saline: breaks up the pus and gets rid of it
87
Q

what supportive therapy can be used to treat bacterial pneumonia/pleuropneumonia (8)

A
  1. Bronchodilation: clenbuterol (also helps with ciliary clearance)
  2. NSAIDs: flunixin meglumine (endotoxins floating around)
  3. Remove plural fluid: chest drain (lavage?) –> especially if in respiratory distress
  4. Fibrinolytics (tissue plasminogen activators) within pleural space
  5. Hydration: IV fluids, correction of fluid and electrolyte derangements
  6. Good ventilation
  7. Low dust environment
  8. No stress
88
Q

how can the response to treatment be monitored in bacterial pneumonia/pleuropneumonia (4)

A

Expect improvement within 48-72 hours

  1. Clinical exam: important in determining response to treatment –> are respiratory parameters returning to normal? Is body temperature within normal limits? Chest fluid level decreasing? (ultrasonography)
  2. Hematology: acute phase proteins –> fibrinogen and serum amyloid A (may be a guide when to stop antimicrobial therapy)
  3. Ultrasonography
  4. Radiography
89
Q

what complications can occur in bacterial pneumonia/pleuropneumonia (8)

A
  1. abscess formation
  2. pleural adhesion/abscess
  3. Cranial mediastinal mass/abscess
  4. Laminitis
  5. Broncho-pleural fistula
  6. Thrombophlebitis
  7. Pneumothorax
  8. Pulmonary necrosis
90
Q

what agents can cause bacterial pneumonia/pleuropneumonia in foals

A

Streptococcus zooepidemicus most common

Also Rhodococcus equi (also known as Rhodococcus hoagii/Prescotella equi)

91
Q

at what age can foals be affected by bacterial pneumonia/pleuropneumonia in foals

A

1-6 months

infected by inhalation

92
Q

what type of bacteria is Rhodococcus equi

A

gram positive faculatative intracellular organism

93
Q

where is Rhodococcus equi found

A

in the environment

wildlife reservoir

94
Q

at what age are foals affected by Rhodococcus equi

A

3 weeks to 6 months

95
Q

how are foals infected with Rhodococcus equi

A

inhaled

96
Q

what can Rhodococcus equi cause in foals

A

can be insidious and can progress to acute resp distress and death

Suppurative bronchopneumonia with abscesses

97
Q

how is Rhodococcus equi diagnosed (4)

A
  1. Auscultation
  2. Hematology and biochemistry
  3. Ultrasonography/radiography
  4. TW wash culture and cytology
98
Q

how is Rhodococcus equi treated in foals (2)

A
  1. Antimicrobial needs to have high volume of distribution –> good penetration as intracellular & long duration 4-9 weeks
  2. Supportive therapy: intranasal oxygen and IV fluids
99
Q

what antimicrobials are effective in treating Rhodococcus equi

A

Rifampin plus a macrolide (work really well together)

Rifampin and azithromycin

Rifampin and clarithromycin

Rifampin and erythromycin (used less often now —> diarrhea in mare and foal because mare eats feces of foal and can cause colitis)

100
Q

what are other causes of pleural effusions (6)

A
  1. Thoracic neoplasia: second most common
  2. Congestive heart failure: especially right sided
  3. Thoracic trauma: pleuritis, hemothorax
  4. Hypoproteinemia
  5. Coagulopathy (rare)
  6. Chylothorax (rare)
101
Q

what is the pathogenesis of pleural effusion (4)

A
  1. Increased permeability in capillary vessels:
  2. Increased in hydrostatic pressure:
  3. Decrease in osmotic pressure:
  4. Decrease in fluid removal:
102
Q

what is the pathogenesis of increased permeability of capillary vessesl that can lead to pleural effusion

A

infection

inflammation

neoplasia

103
Q

what is the pathogenesis of increased hydrostatic pressure that can lead to pleural effusion

A
  1. congestive heart failure
  2. portal hypertension
104
Q

what is the pathogenesis of decrease in oncotic pressure that can lead to pleural effusion

A
  1. hypoproteinemia
105
Q

what is the pathogenesis of decrease in fluid removal that can lead to pleural effusion

A
  1. impaired lymphatic drainage or obstruction –> neoplasia
  2. pleural or parenchymal infiltration –> neoplasia
106
Q

what is the most common neoplasia that can cause pleural effusion

A

lymphomas

107
Q

how are lymphoma neoplasias classifed (4)

A

multicentric, alimentary, cutaneous, mediastinal

108
Q

when is lymphoma neoplasia common in horses

A

More common in young adult horses (but rare overall)

5-10 years

109
Q

are lymphoma neoplasias in horses leukemic

A

not usually

110
Q

what is most common neoplasia in thorax

A

Most common neoplasia of thorax: mediastinal

Primary thoracic neoplasia

Often cranial mediastinal mass

Associated with pleural effusion

111
Q

what are other neoplasias that can cause pleural effusions (3)

A
  1. Mesothelioma: primary thoracic tumour
  2. Pulmonary granular cell tumours: primary lung tumour –> may be diagnosed as SEA. Bright red nodules may be visible in airways
  3. Metastatic neoplasia: adenocarcinoma, melanoma, hemangiosarcoma, squamous cell carcinoma

module 15 (27 decks)

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