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CAEM Pt. 2 > Exam #4: Equine Respiratory Pt. 2 > Flashcards

Exam #4: Equine Respiratory Pt. 2 Flashcards

1
Q

DDx? 7 wk old foal with throat latch area swelling, dyspnea, stridor, mucopurulent nasal discharge, fever, tachypnea (6)

A

> Lymphadenopathy = bacterial (Strep), viral/inflam, neoplasia
Guttural pouch disease - tympany, empyema
Allergic reaction = previously sensitized older horses
Parotid gland inflammation
Severe lymphoid hyperplasia
Cyst
Goiter or thyroid tumor
Neoplasia

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2
Q

Diagnostics for suspected strangles

A

1) CBC
2) Rads
3) U/S
4) Tracheal fluid analysis and culture
5) Aspirate swelling
6) Chem panel = creatinine, albumin, Na+, K+, Cl-, TCO2 (proxy for bicarb) = previous renal damage (using aminoglycosides), acid-base

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3
Q

What happens with K+ during acidic and alkalotic processes?

A
  • Acidotic = exchange H+ for K+ intracellularly = blood becomes hyperkalemic
  • Alkalotic = expect K+ to move intracellularly, look artificially hypokalemic
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4
Q

Which is a less contaminated tracheal fluid sample - endoscopic or percutaneous?

A

Percutaneous

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5
Q

Initial treatment for strangles suspected animals

A
  • K penicillin (IV, needs to be dosed more frequently)
  • Rifampin = concentrates in WBC’s
  • Banamine
  • IV fluids to correct dehydration
  • Hot pack swelling
    +/- Tracheostomy with severe dyspnea
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6
Q

PaCO2 and PaO2 that may indicate hypoxemia and the need for a tracheostomy

A
  • PaCO2 > 50 (hypoventilation)

- PaO2 < 80

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7
Q

Etiologic agent for “strangles” - who does it commonly affect?

A

> Strep equi var. equi
- Gram + B-hemolytic Strep
+ URT inflammation, LN abscessation, “bastard” or metastatic strangles
*Primarily affects foals and young horses
- Most horses develop immunity (4-5+ years)

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8
Q

Transmission, incubation period, and pathogenesis of “strangles”

A
  • Direct contact with infected or subclinical shedders
  • Indirect contact with contaminated (nasal discharge, pus from LN’s) fomites
  • Incubation period = 3-14 days = disease can develop QUICKLY
  • Ingested/inhaled and organism adheres to buccal/nasal mucosa
  • Translocates below mucosa to local lymphatics, attracts neutrophils, disseminates
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9
Q

Which provides better immunity - natural strangles infection or Strep vax?

A

Natural infection = generates mucosal cell-mediated and humoral immunity

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10
Q

Main pathogenic factor (what vax and diagnostic testing targets) for strangles

A

SeM protein = anti-phagocytic

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11
Q

Diagnosis of strangles

A
  • History
    + Clinical signs
  • Culture of exudate from LN, nasopharyngeal swab, guttural pouch
  • Screening tests = PCR on nasopharyngeal swab/wash or exudate, serology (ELISA for SeM protein)
  • Don’t detect current or viable infections
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12
Q

What should you not do if your strangles serology/titers show up as > 1:3200

A

DO NOT VACCINATE for strangles - may induce immune mediated vasculitis (purpura hemorrhagica)

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13
Q

What can serology of strangles do for you?

A

> ELISA for SeM protein

  • Tells you about recent, but not current infections
  • May determine the need for vax (< 1:3200)
  • May ID animals at risk for purpura hemorrhagica (5-digit titers)
  • HIGH titers may give evidence of bastard/metastatic abscessation
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14
Q

Which strangle-horse situations do and don’t we treat with antimicrobials?

A

> DON’T TREAT? Let natural disease progress

  • Early clinical signs, no abscesses
  • No sign the animal is compromised or has a complicated infection

> TREAT?
- Any horse with signs of compromise - fever, ongoing throat latch or LN enlarging, anorexia, dyspnea
+/- Horses exposed to strangles to prevent “seeding” of lymph nodes
- Purpura hemorrhagic + corticosteroids
- Bastard strangles

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15
Q

How do we treat uncomplicated strangles cases?

A
  • Open, drain, and flush
  • Keep environment clean to avoid contamination
  • Hot packing to enhance maturation and drainage of abscess
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16
Q

How do we treat purpura hemorrhagica?

A

High levels of antimicrobials + corticosteroids (decrease immune mediated vasculitis with Ag+Ab)

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17
Q

Prevention of strangles

A
  • Isolate all new arrivals for 3 weeks
  • Immediately isolate any infected horses = shedding occurs for 2- weeks post recovery
  • Decontaminate infected fomites
  • Rest pastures and paddocks for 3 weeks
  • Divide horses into 3 groups if outbreak occurs: direct/indirect contact, presumed infected, not infected
  • Screen horses with nasopharyngeal swab or wash with culture/PCR
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18
Q

What can you monitor if you are nervous an exposed horse will develop strangles?

A

Watch for a fever

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19
Q

How do we confirm a “cure” of strangles?

A

Three consecutive weekly PCR and culture by nasal swab or nasopharyngeal wash

If + = confirm source, Ex: guttural pouch wash

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20
Q

Is it a good idea to vaccinate in the face of a strangles outbreak?

A

No - could trigger purpura

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21
Q

Who do we vax and not vax?

A
  • Horses previously infected = develop good immunity = don’t vax for at minimum, 1 year
  • Vax healthy, afebrile horses w/ no nasal discharge
  • Do NOT vax in the face of an outbreak
  • OPTIMAL protection = systemic (IgG) and mucosal (IgA) responses
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22
Q

Which type of vaccine has been associated with purpura hemorrhagica?

A

Strangles extract vax

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23
Q

Similarities and differences between Strep equi and Strep zoo

A

+ BOTH = fever, nasal discharge, LN enlargment

  • Pneumonia = zoo > equi
  • Higher risk of outbreak = zoo
  • Higher risk of purpura hemorrhagica = equi
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24
Q

Dx? 4 mo colt, cough, nasal discharge, abnormal bronchovesicular lung sounds, wheezes, crackles, fluid sounds in trachea, fever, tachypnea

A

Pneumonia - bacterial (Strep, R. equi)

Others = post-viral bronchiolitis, parasitic pneumonia (ascarids), inflammatory airway disease (wouldn’t have systemic signs)

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25
Q

What is an important diagnostic tool if you suspect parasitic pneumonia?

A

Fecal float

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26
Q

Interpretation of bronchial patterns, thickened bronchi, and increased alveolar opacity in cranial lung lobes

A
  • Bronchial = suggests parasitic (others = infections, allergic)
  • Alveolar opacity = bronchopneumonia
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27
Q

DDx for eosinophils seen on transtracheal wash (3)

A

1) Allergic or hypersensitivity (round bale feeding, dusty environments)
2) Parasitic etiology
3) Inflammatory airway disease

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28
Q

Deworming protocol for parasitic pneumonia

A

Deworm with ivermectin or panacur (fenbendazole), then repeat in 3 weeks

  • Add on Banamine at deworming (risk colic)
  • Deworm other weanlings in the group
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29
Q

Why is TMS not a great choice for Strep infections?

A

Doesn’t penetrate purulent material well

30
Q

Good antimicrobial choice for bacterial pneumonia, other general tx

A
  • Procaine pen (IM) = gram + and anaerobes
  • Gentamicin = gram +
  • Provide a clean environment for recuperation
  • Supportive care = nutrition, fluids
  • Rest
31
Q

Common etiologic agents for bronchopneumonia in foals and adults

A
  • Foals = Strep zoo, R. equi, Actinobacillus or E. coli due to septicemia
  • Adults = Strep zoo
  • Anaerobic infections = rare in foals
32
Q

What diagnostic imaging modality is helpful with pneumonia?

A

U/S

33
Q

Two parasites that like to migrate through the equine lung, WHO do they affect?

A

1) Parascaris equorum = foals and yearlings (develop immunity over time)
2) Dictyocaulus arnfieldi = adult horses and ponies (asymptomatic in donkey and mule reservoir)

34
Q

Reservoir for Dictyocaulus arnfieldi

A

Asymptomatic donkeys and mules

35
Q

Treatment of ascarids in foals

A

Dewormers and NSAID’s, then repeat in 3-4 weeks

36
Q

Pathogenesis of Dictyocaulus arnfieldi

A
  • Carrier mules/donkeys spread eggs on pasture
  • Ingested, L3 travel through gut to lymphatics and blood
  • Circulate through the lungs
  • Matures to L5, development arrests but inflammation occurs
37
Q

Dx of Dictyocaulus arnfieldi

A 
\+ Cough, expiratory dyspnea, crackles and wheezes in dorsocaudal lung fields (indistinguishable from RAO and IAD)
\+/- Peripheral eosinophilia
- Eosinophils on tracheal wash
- Fecal float
- Necropsy
38
Q

Treatment for Dictyocaulus arnfieldi

A
  • Menbendazole
  • Albendazole
  • Ivermectin
  • Moxidectin
    *Repeat later = drugs don’t kill larvae
    + NSAID’s
  • Treat all animals in contact with donkeys and mules
39
Q

Causative agent in immunocompromised foal bronchopneumonia

A

Pneumocystis carinii

40
Q

Treatment of neonatal respiratory distress

A
  • Humidified O2 = want PaO2 of 80-100
  • Keep in sternal recumbency
  • Coupage and suction
  • Antimicrobials
    +/- Antivirals
  • Ventilation if hypercapnic
  • NSAID’s
  • Supportive care
41
Q

DDx for acute respiratory stress in foals born from dystocia (2)

A

1) Diaphragmatic hernia

2) Rib fracture + pneumothorax

42
Q

DDx? Adult horse with recent shipment, anorexic, depressed, high fever, slow to move, small/dry fecal balls, GI sounds present, tachycardic, increased expiratory effort, no crackles or wheezes, nasal flare, inducible cough, exudate in trachea

Neutrophilic leukocytosis with left shift

A

> Pleuropneumonia and pleuritis

  • Others = viral respiratory disease (EHV-1 or 4, influenza), early bacterial pneumonia, colic
  • Primary started as pneumonia, then went to pneumonia
43
Q

Diagnostics for pleuritis or pleuropneumonia

A
  • History and clinical signs
  • CBC
  • Electrolytes
  • Chem = creatinine, albumin
  • U/S the thorax
  • Thoracocentesis w/ cytology, gram stain, C&S (aerobic and anaerobic)
  • Transtracheal or endoscopic tracheal wash
44
Q

What should you suspect if you start to see a left shift on bloodwork?

A

Gram negative involvement (gram + alone usually don’t cause it)

45
Q

What do we administer if we see endotoxemia or evidence of toxic change in neutrophils?

A

Banamine

46
Q

Treatment of pleuritis or pleuropneumonia

A
  • IV fluids
  • Drain fluid via chest tube
  • Antimicrobials = penicillin, gentamicin, +/- rifampin if abscesses are present
  • Analgesia
  • Anti-endotoxemic banamine
  • Supportive care = hydration, consider oncotics (pleural effusion), nutrition, leg supports, good bedding to avoid laminitis
  • Monitor vitals, hydration status, fecal output, attitude, appetite
  • Repeat auscultation and U/S in the morning
47
Q

Causes of equine pleural effusion

A
  • Infectious = bacterial pneumonia (Mycoplasma), viral (EIA, EHI, EHV), fungal
  • Neoplasia
  • Trauma to thoracic duct, thoracic cavity
  • Extension from pericarditis or peritonitis
  • Liver disease or severe hypoalbuminemia
  • CHF
48
Q

Number one cause of septic pleuritis

A

> Extension of pneumonia or lung abscessation
- Etiology agents = Strep, Pasteurella, Actinobacillus, E. coli, Enterobacter, Bacteroides, Clostridia, Fusobacterium, etc.

  • Others = thoracic trauma, esophageal trauma, penetration of stomach/esophagus with foreign body
49
Q

Risk factors for pleuropneumonia (7)

A

1) Long distance transport
2) Strenous exercise
3) Viral respiratory tract infection
4) Surgery
5) General anesthesia
6) Systemic illness
7) Long term non-steroidal use

50
Q

Do penicillin work on Mycoplasma? Why or why not?

A

NO - doesn’t have a cell wall

51
Q

Complications from pleuropneumonia (6)

A

1) Abscesses and adhesions in the pleural space
2) Bronchotracheal fistulas
3) Laminitis
4) Thrombophlebitis
5) Infection in other organ systems, dissemination
6) Purpura hemorrhagicum

52
Q

Dx? Tachypnea, increased respiratory effort, dyspnea, pleurodynia, hypophagia, lethargy, +/- fever, stiff gait, cough, nasal discharge, toxemia

A

Acute pleuropneumonia

53
Q

Dx? Weight loss, exercise intolerance, +/- persistent tachycardia, intermittent fever, substernal/limb edema

A

Chronic pleuropneumonia

54
Q

Why is cytology important if you suspect pleuropneumonia?

A

Helps rule out neoplasia

55
Q

When is radiographs helpful in diagnosing pleuropneumonia?

A

More chronic cases

56
Q

When do we perform a thoracotomy with regards to pleuropneumonia?

A

> As a salvage procedure = establish external drainage

  • Chronic pleuritis
  • Adhesions
  • Pleural abscess
57
Q

Dx? Biphasic fever, anorexia, lethargy, dry and harsh cough, watery to purulent nasal discharge, +/- muscle soreness, limb edema, painful glands under jaw

Lab = normocytic, normochromic anemia and leukopenia

A

Equine influenza

58
Q

True or false - equine influenza vax can prevent viral infection of horses

A

FALSE - can attenuate clinical signs but doesn’t prevent infection

59
Q

What aged horse is most at risk for influenza?

A

1-5 years old

60
Q

Risk factors for influenza

A
  • Age = 1-5 years old
  • Travel
  • Proximity to contagious horses
  • Fomites
61
Q

Transmission of equine influenza

A

HIGHLY CONTAGIOUS = spreads via inhalation of aerosolized droplets from coughing and snorting - OR - contact with contaminated fomites

62
Q

Characteristic CBC findings of equine influenza

A

Normochromic, normocytic anemia + leukopenia

DDx = chronic inflammation

63
Q

Complications from equine influenza

A
  • Bacterial pneumonia
  • Myositis
  • Myocarditis
  • Limb edema
  • May predispose the animal to EIPH, IAD, or RAO
64
Q

Diagnosis of equine influenza

A
  • Virus isolation or PCR from nasopharyngeal swabs
  • Stall side immunoassay (not great)
  • Serology = paired titers
65
Q

Treatment of equine influenza

A

Supportive = keep them hydrated, breathing easy

66
Q

Control of equine influenza

A
  • Isolation
  • Sanitation
  • Vax = IM inactivated or IN MLV
67
Q

What should you remember about influenza vaccination and age?

A

DON’T vaccinate before 6 months of age

68
Q

Dx? Fever (can be biphasic), lethargy, anorexia, nasal discharge (serous to mucopurulent), conjunctivitis, lymphadenopathy, edema, vasculitis

+/- Abortion, myelitis, neonatal foal death and chorioretinopathy

A

EHV 1 and 4

69
Q

What is the more common and more severe herpes virus in horses - EHV-1, EHV-4

A

EHV-1 = more common and more severe

70
Q

Control of EHV

A
  • No vax that prevents infection = but CAN reduce shedding and abortion storms
  • Biosecurity = hygiene, barrier precautions between affected and normal animals

CAEM Pt. 2 (27 decks)

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