Foal with sepsis

Question 1

you visit a foal on a farm:

• No IgG yet performed.
  You examine the foal:
• Dark red mucous membranes
• Increased heart rate – 110 beats per minute, increased resp rate (36 bpm) and increased rectal temperature (39.0oC)
• Poor borbogrymi and poor suck reflex
• Cold extremities
• Right tarsocrural joint swollen as is umbilicus.

What diagnostics will you run?
What do you suspect is happening?
What would you recommend to do next?

Answer 1

SNAP Test for IgG.
Foal likely has failure of passive transfer, sepsis and is sick.

Needs intensive care. Discuss referral.

If no referral:
- bacteriocidal antibiotics
- plasma and hartmanns fluids

Question 2

You visit a foal with sepsis:

SNAP test for IgG performed and <4g/L (normal >8g/L)
Abnormal blood work includes:
- Lactate 5mmol/L (normal <2)
- WBCC 20x109/L (normal 6-12)
- Neutrophil count 16x109/L (normal 4-9)
- Urine specific gravity 1.030 (normal for foal <1.008)
Physical examination findings suggest a fluid deficit of 10%
Blood taken for blood culture
Synoviocentesis also performed

Describe a fluid and initial therapeutic plan for this foal.

Answer 2

Fluid plan – resuscitate with 1L boluses of Hartmanns until clinical parameters improve. Provide 1-2L hyperimmune (or other plasma) – initially given slowly to avoid transfusion reaction and then faster.

Repeat SNAP test in 12hrs

Therapeutics -
Bacteriocidal broad spectrum antibiotic due to likely sepsis – penicillin/gentamicin e.g. and NSAID for anti-inflammatory effects (no problems re kidneys as fluid resuscitation underway) – flunixin/meloxicam

Question 3

interpret these radiographs of the lungs and hock of a septic foal

Answer 3

Marked interstitial pattern in the caudodorsal lung fields – likely haematogenous spread of pneumonia. Bones of the tarsus are ossified.

Question 4

A septic foal is treated with broad spectrum antibodies.
Cough and temperature improve whilst treated with antibiotics for two days.
On the third day the foal is pyrexic again and the right tarsocrural joint is more swollen and hotter.

What do you think is wrong?
How will you confirm your diagnosis
What treatment would you consider?

Answer 4

Septic joint secondary to sepsis/systemic bacteraemia.
Sample the joint, look at under the microscope and do cell and protein count.
Flush joint, change systemic antibiotics, use different antibiotics locally (into joint or as IVRA)

Question 5

What can be seen in this joint fluid sample?

Answer 5

Degenerate neutrophils

Question 6

What is the role of TLR-4?

Answer 6

TLR-4 plays a fundamental role in pathogen recognition and activation of innate immunity
e.g., a foal with septicemia might show increased levels of TLR4

Question 7

Interpret this qPCR test for TLR-4

Answer 7

Negative Control (Flat Line at the Bottom):
- negative control remains flat
- confirms no contamination or non-specific amplification, ensuring the reliability of the results.

Positive Control (1st Steep Increase in Fluorescence):
- A sample with a known target gene rapidly increases in fluorescence, indicating successful DNA amplification.
- This acts as a reference to confirm that the qPCR process worked correctly.

Test Sample (TLR-4 Expression in the Foal):
- The presence of amplification curves similar to the positive control indicates that the gene TLR-4 was expressed in the foal.
- Multiple lines in the test suggest repeated replicates, improving accuracy.
- The fact that these lines are close together means the test is reproducible and reliable.