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LA DX & TX I > Exam 2 - Equine Bacterial Pneumonia & Pleuropneumonia > Flashcards

Exam 2 - Equine Bacterial Pneumonia & Pleuropneumonia Flashcards

1
Q

when does bacterial pneumonia occur?

A

when pulmonary defense mechanisms are overwhelmed or suppressed

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2
Q

what are some examples of overwhelmed pulmonary defense mechanisms?

A
  1. aspiration
  2. severe bacteremia
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3
Q

what are some causes of aspiration in horses?

A

pharyngeal/laryngeal dysfunction, dysphagia, choke, general anesthesia

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4
Q

what agents are associated with severe bacteremia in respiratory diseases in horses?

A

corynebacterium pseudotuberculosis & streptococcus equi sub species equi

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5
Q

what are some examples of suppressed pulmonary defense mechanisms?

A

transportation, high intensity exercise, viral infections, stress, inhaled toxins (ammonia), poor ventilation, immunosuppressive drugs/immunosuppresive disorders, & endotoxemia/systemic disease

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6
Q

what is the pathophysiology of bacterial bronchopneumonia?

A

usually associated with opportunistic bacteria that are ubiquitous in the horse’s environment & many are normal inhabitants of URT

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7
Q

what is the pathophysiology of anaerobic pneumonia?

A

normal lung is protect from anaerobes - damaged lung from pneumonia, trauma, ischemia, virus leads to an environment for colonization & multiplication of anaerobes

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8
Q

what is the pathogenesis of anaerobic pneumonia?

A

anaerobes release endotoxins & enzymes (heparinases, collagenases)

leads to pulmonary necrosis & abscess formation

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9
Q

what are some risk factors for bacterial pneumonia?

A

any age, breed, sex, or occupation can be affected

long distance transport

strenuous exercise - racing/EIPH, inhaling dirt

general anesthesia

choke/aspiration

immunosuppresion

viral respiratory infections

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10
Q

what is the most common cause of pleural effusion in horses?

A
  1. pleuropneumonia
  2. neoplasia - bad prognosis
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11
Q

besides pneumonia, why else may a horse develop septic pleuritis?

A

penetrating wound into the thorax

esophageal rupture

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12
Q

what clinical signs are seen with bacterial pneumonia?

A

fever, tachypnea/tachycardia, nasal discharge/cough, exercise intolerance, respiratory distress, halitosis, ventral edema, endotoxemia SIRS, & pleurodynia

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13
Q

what is pleurodynia?

A

pleural pain

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14
Q

what clinical signs are associated with pleurodynia?

A

pawing/apparent colic

abducted elbows

shallow respirations

reluctance to move

painful palpation of ICS

easily misdiagnosed - colic, myopathy, laminitis

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15
Q

what can be heard upon thoracic auscultation of a horse with bacterial pneumonia?

A

crackles, wheezes, attenuated BV sounds, referred large airways sounds, & radiating heart sounds

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16
Q

what may be heard on thoracic percussion on a horse with bacterial pneumonia?

A

regional dullness in the ventral lung fields

resonance over the dorsal lung fields

may detect pleurodynia

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17
Q

what does pleural effusion look like on rads? when is it most useful?

A

ventral soft tissue opacity that obscures the diaphragm & heart borders

air-fluid interface is uncommon

after pleural drainage

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18
Q

what can be recognized on thoracic rads of horses with bacterial pneumonia?

A

increased opacity from consolidation

loss of clarity of lung fields

air bronchograms

interstitial patterns

lung abscesses

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19
Q

what pathology is seen on this thoracic radiograph?

A

pleural effusion

20
Q

other than ultrasound, what else can you do to better evaluate pleural effusion?

A

thoracocentesis

21
Q

what anatomic location is commonly used for thoracocentesis?

A

often 7-8 ICS at the point of shoulder

22
Q

what would you use an edta tube of pleural fluid for? what about a heparin tube?

A

edta - cytology, cell counts, protein concentration, & gram’s stain

heparin - biochemical testing

23
Q

what are the normal parameters for pleural fluid?

A

colorless to pale yellow, transparent, odorless, sterile, normal cell morphology

TNCC 0-10,000/uL

protein concentration 0-4.7 g/dl

24
Q

how is parapneumonic effusion characterized?

A

cloudy, yellow to bloody, may smell, exudative, neutrophilia +/- degenerative changes

TNCC > 10,000/uL

protein > 4.0 g/dl

may see bacteria on cytology

25
Q

what biochemical parameters of pleural fluid are suggestive of sepsis?

A

pH < 7.1
glucose < 40 mg/dl
increased lactate

26
Q

what is a pleuroscopy used for?

A

visual assessment of lung & pleurae

27
Q

what is the therapeutic management used for bacterial pneumonia?

A

antimicrobials, supportive care, rest, & monitoring

28
Q

why start systemic antimicrobials before culture results?

A

broad spectrum combinations used based off of prevalence & susceptibility testing to cover gram positives, gram negatives, & anaerobes

29
Q

what is the most common isolate from horses with bacterial bronchopneumonia?

A

streptococcus equi sub species zooepidemicus

30
Q

what is the most common gram-positive aerobic isolate in a horse with bacterial pneumonia?

A

streptococcus equi sub species zooepidemicus

31
Q

what are some common gram-negative aerobic isolates in a horse with bacterial pneumonia?

A

pasteurella spp. escherichia coli, klebsiella pneumoniae, enterobacter spp., & actinobacillus spp.

32
Q

what are some common anaerobic isolates in a horse with bacterial pneumonia?

A

bacteroides fragilis & peptostreptococcus anaerobius

33
Q

what should be considered after getting culture results before deciding in antimicrobials?

A
  1. specific isolates & susceptibilities
  2. drug’s ability to distribute & kill bacteria at the site of infection
  3. ease of administration
  4. toxicity & cost
34
Q

what are some systemic antibiotics that are used for the first 1-3 weeks?

A

aminoglycosides, beta-lactams, & metronidazole

35
Q

what are some systemic antibiotics that are used long-term?

A

chloramphenicol

metronidazole

enrofloxacin + metronidazole + beta-lactams or doxycycline or rifampin

36
Q

what medication should be avoided when using intrapleural antimicrobials?

A

oxytetracycline

37
Q

why use intrapleural antimicrobials?

A

achieve higher concentrations in the pleural space

combine with systemic therapy

use lavage to improve pleural micro-environment

38
Q

what are some examples of intrapleural antimicrobials?

A

gentamicin

injectable metronidazole

39
Q

why use aerosolized antimicrobials?

A

adjunct therapy

higher drug concentrations in bronchial secretions & PELF

minimize systemic toxicity

40
Q

what are some characteristics of septic pleural effusion?

A

empyematous, putrid odor, cytologically visible bacteria, positive cultures

glucose < 40mg/dl
ph < 7.1
elevated lactate

poor response to conservative therapy

41
Q

what are some indications for pleural drainage?

A

voluminous pleural effusion, respiratory distress, & poor response to conservative therapy

42
Q

why use pleural lavage?

A

facilitate drainage of thick, viscous pleural effusion, fibrin, & necrotic debris

improve pleural microenvironment - enhances penetration & action of antimicrobial agents

43
Q

what is the technique used for pleural lavage?

A

5-10 L warm LRS every 12-24 hours - monitor how well the horse tolerates lavage

44
Q

what is intrapleural fibrinolytic therapy?

A

recombinant tissue plasminogen activator - 12 mg diluted in 2 L of saline

safe, variable effect on fibrin quantity & organization

45
Q

what are some potential sequelae to pleuropneumonia in horses?

A

endotoxemia

antimicrobial associated enterocolitis

laminitis

thrombophlebitis

pneumothorax

pericarditis

LA DX & TX I (45 decks)

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