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Equine > Eqine respiratory conditions > Flashcards

Eqine respiratory conditions Flashcards

1
Q

Which lymph nodes can we feel around the head for lymphadenopathy

A

Submandibulars
cannot feel retropharyngeals externally

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2
Q

What type of virus is equine influenza

A

ssRNA orthomyxovirus type A

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3
Q

CLinical signs of equine influenze

A

Pyrexia, inappetance, lethargy, nasal discharge
Dry persistent cough very noticeable often

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4
Q

Diagnosis of equine influenza

A

Do nasopharyngeal swabs while animal is sick

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5
Q

How does vaccination against equine influenze help

A

Reduces shedding and severity but does not prevent infection

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6
Q

Vaccine schedule for influenza

A

First vaccine
Then second one within 21-60 days
Third one 120-180 days

Then booster 6-12 monthly

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7
Q

How to deal with equine influenza case

A

Isolation for 14 days
Long rest and recovery
NSAIDs

Only do antibiotics if there is a secondary infection

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8
Q

What is the cause of strangles and what type of bacteria is it

A

Streptococcus equi v equi
= gram +ve cocci

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9
Q

Pathogenesis of strangles

A

Bacteria enter oro-nasal cavity and enter cryp cells of tonsil –> spread to regional lymph nodes and cause lymphadenopathy

Then a few days later get lymphoid hyperplasia and abscessation

From 7 days + can get rupture of the LN which causes infectious pus to come out of nose via floor of guttural pouch

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10
Q

How can we try and isolate horses before LN rupture in strangles

A

They have pyrexia before the rupture so isolate them then
Should do 2X daily temperature checks for any in contacts of a confirmed case

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11
Q

Can we get endemicity of strangles

A

Yes because a small % remain persistently infected

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12
Q

Why is strep equi v equi so important

A

Can be fatal via asphyxiation or by high cost of treatment

Can spread easily in residential premises

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13
Q

What aerosolises more out of influenza and strangles

A

Influenza
(strnalges does not aerosolise much)

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14
Q

Clinical signs of strangles

A

Pyrexia, lethargy, mucopurulent nasal discharge, submandiular/retropharyngeal lymphadenopathy, inappetance/dysphagia

+ less commonly, higher resp rate and effort, stridor, can mimic choke with water/food down nose

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15
Q

Which LNs are located near the floor of the guttural pouch

A

Retropharyngeals

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16
Q

Why can horses with strangles be dysphagic

A

1) Physical obstruction due to enlarged LNs

2) Some neuropraxia because enlargeds LNs are interfering with nerves on floor of guttural pouch

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17
Q

Are horses with strep equi v equi chondroids a large risk to population

A

Not really bceause chondroids usually PCR negative

If they have empyema though they are

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18
Q

What should we consider if we see empyema but negative strangles test

A

Probably still strangles

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19
Q

What is an appropriate screening test for strangles i.e pre-movement

A

SCoping guttural pouch and submitted aspirates

ELISAs are NOT useful if there is no clinical suspicion

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20
Q

How does strangles survive in the environment

A

Not well; especially not in summer
So leaving horses outside with it is a good idea

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21
Q

What can mild strangles look like

A

Unexplained pyrexia, mild cloudy nasal discharge

In any unexplained pyrexia should check the guttural pouches

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22
Q

What is bastard strangles

A

Where there is haematogenous or lymphoid spread of strep equi v equi

Leads to purulent material and abscessation wherever the bacteria go

e.g meningitis, skin swelling, mesenteric abscessation

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23
Q

Which animals do we typically see bastard strangles in

A

Very ill animals that haven’t been given antibioitics

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24
Q

What is purpura haemorrhagica

A

Severe vasculitis triggered by illness such as strangles
Requires high steroid doses

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25
Q

What does the strangles ELISA detect (and when might it be low or high)

A

SEM
May not be expressed in persistently infected genomes
Very high titre with purpura haemorrhagica

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26
Q

What are some potential complications of strangles

A
  • Bastard strangles
  • Purpura haemorrhagica
  • Myopathies
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27
Q

Treating strangles

A

NSAIDs +/- paracetamol

Give penicillin if horse is persistently pyrexic, dull and miserable, if there is dysphagia or stridor

Flush out guttural pouch via scope or foley catheter (may instill penicillin here)

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28
Q

WHat must we advise owners when giving antibiotics for strangles

A

Can get poorer seroconversion and may get flare up of abscess after therapy
But if they need it must give

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29
Q

What types of viruses are EHV1,4

A

alpha herpesviruses

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30
Q

Characteristics of equine herpes virus infection

A

~80% infected as youngsters
Pyrexia, nasal discharge, cough, lethargy
Abortion may be first clue

Get latency in trigeminal ganglion; rarely get recrudensce

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31
Q

Do we need to isolate latently infected herpes cases

A

No

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32
Q

What is gold standard for diagnosing equine herpes virus

A

Virus isolation (but it is slow)

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33
Q

Vaccination schedure for EHV1/4

A

1st one from 5 months, then another 4-6 weeks later, boost at 6 months

Then give at 5, 7 and 9 months gestation to mares

NB: this vaccine reduces shedding and severity but not prevent abortion or neuro signs; it is licensed for respiratory disease

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34
Q

How does EHV1,4 enter body and proliferate

A

Enters respiratory epithelial cells, goes to monocytes/lymphocytes then to blood vessels/LNs
Get a cell associated viraemia and replicatino in vessel endothelium

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35
Q

How much rest to give pyrexic horses

A

1 week for every day of pyrexia

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36
Q

What type of virus is equine viral arteritis

A

RNA alpha-arterivirus

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37
Q

What does equine viral arteritis cause

A

Pyrexia, inappetence, conjunctivitis, vasculitis so oedema, abortion

= can be maintained in carrier stallions so should not be kept for breeding

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38
Q

What is the use of a rebreathing exam

A

Increases the inspired CO2 of horses, making them breathe more heavily and improving sensitivity of auscultation

Becomes easier to hear harsh sounds, crackles from fluid
Or areas of no nosie

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39
Q

What can bloods be useful for in a respiraotry work up

A

Systemic inflammation is indicative of pneumonia

vs in asthma, the bloods will look normal

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40
Q

What tests is BAL best for

A

Cytology

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41
Q

What method can be used for resp secretion culture

A

Tracheal wash if a triple lumen catheter used
Or transtracheal wash is best

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42
Q

What areas do BALs vs TW samples and what does this make them good at identifying

A

BALs sample just a single region of lung; so good at identifying diffuse disease

TWs sample everything

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43
Q

How to do a BAL

A

Place long tube up ventral meatus
Use opioid to suppress cough (+ may ahve LA)
Instill ~300ml saline and aspirate back (discarding first syringe)
Place in EDTA tube

44
Q

What is an indication of a good BAL sample

A

It is foamy due to surfactant from alveoli

45
Q

How do we do a tracheal wash

A

requies endoscopy
Use catheter to instill 20-30ml sterile saline and reaspirate

For culture use plain tube
For cytology use EDTA tube

46
Q

What bacteria are likely to be contaminants if seen on tracheal wash

A

pseudomona, S aureus, Bacillus

47
Q

What is the difference between recurrent airway obstruction and inflammatory aidway disease

A

RAO = severe asthma i.e increased resp effort at rest, lifelong condition, see coughing too - tend to be >7y/o

IAD = mild/moderate asthma; no signs at rest but occasional cough or exercise intolerance; tends to resolve; generally young

48
Q

What do asthma BAL results look like

A

High percentage of neutrophils
- Normal is 5%
- In IAD see >10
- In RAO see >25

Tend to see elevated mast cells in IAD (mild-moderate asthma) as feature of airway hyperresponsiveness

49
Q

Management of asthma

A

Low dust; dust extracted bedding, soaked hay, maximum turn out time, improve ventilation, no straw at all

Medication: steroids, bronchodilators

50
Q

What is exercise induced pulmonary haemorrhage

A

Where horses undergoing very strenuous exercise get rupture of pulmonary capilaries (thin walled and get low airway pressures and very high vascular pressures in exercise)

If severe can affect performance

51
Q

What is a fading horse often a symptom of and how do we diagnose

A

Exercise induced pulmonary haemorrhage

Need to scope in 30-120 mins after exercise and score 0-4 based on blood in airway

52
Q

IF we see haemosiderophages on BAL what does this suggest

A

There has been historic exercise induced pulmonary haemorrhage snce this is digested blood

But note this does overestimate prevalence

53
Q

What should we do if horse has suffered exercise induced pulmonary haemorrhage

A

Rest and steroids
Want to avoid new bleeds

Can give furosemide before training to prevent bleeding occuring

54
Q

What area does the following affect: interstitial pneumonia, bronchopneumonia, pleuropneumonia

A

Interstitial = parenchyma
Bronchophneumonia = parenchyma and bronchi
Pleuropneumonia = parenchyma + bronchi + pleural space

55
Q

What are risk factors for bacterial pneumonia

A

Long distance travel because means head not let down for long periods

Cross tying (prevents head going down)

Resp tract disease

Apiration e.g from oesophageal pbstructions, dysphagia

56
Q

Which cause of bacterial pneumonia has the worst prognosis

A

Those due to aspiration as have a much larger range of aspirated bacteria vs normal commesnals strep zooepidemicus

If anaerobes involved = worse prognosis

57
Q

What is the most common bacteria to isolate on TW from bacterial pneumonia

A

Strep zooepidemicus

58
Q

Clinical signs of bacterial pneumonia

A

Tachypnoea, weight loss, pyrexia, cough, nasal discharge

If they have fetid breaths suggests anaerobes involved (worse prognosis)

59
Q

What would we see on bloods with bacterial pneumonia

A

leucocytosis +/- left shift, increased SAA, anaemia

60
Q

What is a good antibiotic selection for bacterial pneumonia

A

Penicillin + gentamycin + metronidazole

61
Q

What are some possible complications of bacterial pneumonia

A

Abscessation
Broncho-pleural fistulae
Pericarditis
Thrombophlebitis
Laminitis

62
Q

What two types of fungal pneumonia are there

A

Primary pathogens e.g histoplasma, coccidiodes, cryptococcus

Or those secondary to immunocompromise e.g aspergillus, candida

63
Q

What might a neurophilic/eosinophilic tracheal wash point towards

A

Parasitic pneumonia

64
Q

Signs of interstitial pneumonia

A
  • Exercise intolerance
  • Increased effort at rest
  • Pulmonary hypertension/cor pulmonale
65
Q

What can cause interstitial pneumonia

A

OFten not clear
- Viral e.g EHV, influenza, EVA
Smoke inhalation

66
Q

What can cause pneumothorax

A
  • Bronchopleural fistulae secondary to pneumonia
  • Penetrating thoracic injuries
  • Oesophageal peforations

Can be well tolerated if unilateral

67
Q

What is equine multinodular pulmonary fibrosis

A

= interstitial fibrosis associated with EHV-5 by unclear pathogenesis
See large discrete or multiple coalescing opacities on radiography

Diagnosis of exclusion
Poor prognosis

68
Q

Is presumed asthma is not responding to treatment what other condition should we think about

A

Equine multinodular pulmonary fibrosis

69
Q

At what temperature should we isolate a horse

A

38.5
Ideally measure temperature twice per day to get baseline normal temperature and account for diurnal variation

70
Q

What is the difference between quarantine and isolation

A

Quarantine = isolation of animals potentially incubating infections; minimum 2-3 weeks

Isolation = separation of animal with known disease to prevent transmission

71
Q

What does effective quarnatine mean

A

Physical separation of >10-20m from resident animals or more if influenza
Separate staff and equipment

72
Q

What are the three types of disease caused by herpes viruses

A

Respiratory
Abortion
Neurological

73
Q

How does complement fixation test work

A

Where antibodies bind to complement, preventing complement from causing RBC haemolysis so we see a pellet or RBCs rather than haemolysis

74
Q

If we see a horse with heart rate over 60 what does this suggest

A

Not just related to being in pain; should consider shock

75
Q

What is our primary concern with a pony which has travelled for a long time and is now pyrexic, high heart rate, high resp rate and effort

A

Pleuropneumonia
- Because head not down for long periods of time

76
Q

What is our approach to a case with suspected pleuropneumonia

A

Don’t need to isolate the horse

Pain relief; paracetamol + fluids
- Ideally check kidneys before NSAIDs

Ultrasound
Pengentmet

77
Q

What do we need to be aware of when giving an alpha-2 agonist to a horse with a temperature

A

They look very poor with panting and sweating for ~15 mins after giving sedation; just be aware of this

78
Q

Treating pleuropneumonia

A
  1. Antibiotics; penicilling, gentamcin, metronidazole
  2. Drain fluid if needed
  3. Use tissue plasminogen activator to break down fibrinour nets in lungs in some cases
79
Q

What are haemosiderophages and what do they tell us

A

Macophages with digested blood in them

Tells us that there is some chronicity to the exercise induced pulmonary haemorrhage; i.e these aren’t from this incident as take time to appear

80
Q

When should we ideally scope a horse after it has pulled up from a race to tell if EIPH is the cause of this

A

With 30 mins to 2 hours
- Then grade it on scale; if high at same time as fading episode means likely to be the cause

81
Q

What condition can lead ot high pulmonary pressures in exercise and epistaxis/pulling up

A

Atrial fibrillation

82
Q

Treatment for EIPH

A

Must have rest; no fast work
Steroids; start with oral prednisolone then move to inhalers as it works more

83
Q

What type of cells do we see on a tracheal wash from horse with EIPH

A

Very high neutrophils count
Haemosiderophages

84
Q

What is a BAL contraindicated

A

if the horse is struggling the breathe already

85
Q

If a tracheal wash shows plant material and bacteria what does this suggest

A

Aspiration pneumonia secondary to choke

86
Q

What is a heave line

A

hypertrophy of external abdominal oblique due to increased resp effort

87
Q

What does severe equine asthma mean

A

Showing obvious signs at rest; coughing, tachypnoea

88
Q

Treatment for acute asthma (rescue and maintenance)

A

Rescue therapy = IV atropine/buscapon, IV dexamethasome

Maintenance; oral preds, oral clenbutor, then inhaled steroids/bronchodilators

89
Q

Treatment of asthma after acute episode controlled

A

Management is mainstay
+ steroids; oral prednisolone or IM dex for some owners
Beta-2 agonists?

90
Q

What are the advantages of the flexineb

A

Better tolerance from the horse vs baby spacer
Medication cheap to refill once purchase made
Better amount of drug breathed in

91
Q

Out of tracheal wash and BAL which is better for cytology vs bacteriology

A

TW = better for bacteriology because no exposure to commensals on way down

BAL = better for cytology

92
Q

WHat is a normal amount of neutrophils on BAL vs TW

A

TW: <20%
BAL: <5-10% neutrophils

93
Q

Which cell type predominates in equine asthma

A

Neutrophils (NB this is different to humans)

94
Q

Why are anti-histamines not routinely used in equine arthma

A

Poor bioavailability

95
Q

Treatment of fungal pneumonia

A

Azoles
AMphotericin B (NB: can get phlebitis, anorexia, dysrhythmias, anaemia)

96
Q

How long to give antibiotics for bacterial pneumonia

A

4-6 weeks
+ want stall rest and gradual return to exercise

97
Q

What causes guttural pouch mycosis and what is the treatment

A

Aspergillus

Topical azoles e.g enilconazole
Could do systemic intraconazole

98
Q

Treatment of strangles

A

Symptomatic mostly; NSAIDs, soft foot, hot packing abscesses

Can use antibiotics in some cases

99
Q

When might we use antibiotics in a strangles case and which do we pick

A

 High fever/malaise
 Severe lymphadenopathy causing respiratory distress
 Metastatic abscessation
 Purpura haemorrhagica requiring glucocorticoids

Choose penicillin

NB: impairs immunity to stranlges developing

100
Q

Can we use prophylactic antibiotics in a stranlges outbreak

A

NO

101
Q

What to do with carrier status strangles animals

A

Treat with antiibotics
Chondroids require endoscopic removal?

102
Q

Treatment of influenza

A

Sympatomatic; rest, hydration, NSAIDs, paracetamol
+ if showing signs of resp distress more than 10 days later can give anitbioics due to high risk of secondary infection

103
Q

What is key when returning to work after influenza

A

Do not do too early; can end up with coughing and inflammation for weeks

104
Q

What antiviral drug would we use in influenza outbreaks or to deal with neurological disease in herpes virus

A

Valacyclovir

105
Q
A

Equine (19 decks)

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