(pleuro) pneumonia Flashcards
what are the three stages of pleuropneumonia ?
◦ Exudative stage – sterile transudate ↑ in pleural space
◦ Fibrinopurulent stage - bacterial invasion + fibrin deposition
◦ Organisation stage – Fibroblasts grow into exudate (pleural peel)
what are the risk factors for the development of pneumonia?
- After viral infections
- Strenuous exercise
- Transportation & elevation of the head
- General anesthesia
- Overcrowding & inclement weather
- Dysphagia (aspiration)
what are the risk factors for the development of pleuropnumonia?
- Long distance transportation
- Elevated head for prolonged periods of time?
what are the risk factors fo th development of aspiration pneumonia?
- Dysphagia
◦ Pharyngeal & postpharyngeal - Oesophageal obstruction
- General anaesthesia
- Cleft palate
what are the pathogens that cause pneumonia in horses?
- Streptococcus equi subsp. zooepidemicus
- Staphilococcus aureus & S. pneumoniae
- Actinobacillus spp (gram negative nonenteric)
- Escherichia coli, Pasteurella spp, Enterobacter spp, Klebsiella spp & Bordetella bronchiseptica
- Bacteroides fragilis
- Fusobacterium & Peptostreptococcus anaerobius
what are the clinical signs of pneumonia?
- Tachycardia /tachypnea
- Respiratory distress
- Fever
- Anorexia, depression
- +/- nasal discharge
- Exercise intolerance
- Auscultation
◦ crackles
◦ dull areas
Pleuropneumonia additionally can have:
* Pain intercostal spaces
* Reluctance to walk, colic
* Grunting during respiration
* Abduction of elbows
* Ventral edema
what adventitious lung sounds can be heard with pneumonia?
- Crackles & wheezes
- Dull areas
- Dull area follows flat line (pleuropneumonia)
- Pleural rubs (pleuropneumonia)
- Radiation of cardiac sounds (due to fluid or consolidation)
what is the diagnostic approach used for pneumonia? what is seen on clinical pathology?
- Suspicion based on PE & rebreathing bag
- Haematology & biochemistry
- Endoscopy
- TTW & BAL
- Thoracic ultrasonography
- Radiography
- Thoracocentesis
- Thoracoscopy
Clinical pathology
* CBC
◦ Neutrophilic leukocytosis
◦ Leukopenia
◦ Anaemia (chronic cases)
* ↑ Fibrinogen & SAA
* ↓ Fe2+
what is seen on ultrasonography of pneumonia?
- B lines (commit tails)
- consolidation
- pleural fluid
- hyperechoic fibrin
what is the treatment for pneumonia in horses?
Antibiotic treatment
1st line
* Penicillin + Gentamicin IV
* Penicillin + Gentamicin + Metronidazole (aspiration pneumonia)
Adjustments based on Culture + Sensitivity
Inhaled drugs:
* Gentimicin
* Ceftiofour
* Cefquinome
inhailed drugs can be given via, jet, ultrasonic or mesh nebuliser
when shoudl referal be consided with pneumonia?
◦ No initial response to antibiotics
◦ Systemic or respiratory compromised
◦ Require intensive care
what samples should culture and sensitivity be performed on with pneumonia?
- Culture & sensitivity should always be performed
◦ TTW & Pleural effusion! (both if available)
◦ Include anaerobic coverage
how is throacocentesis performed in horses? what is the diagnostic value of this ? what is the therapeutic value of this?
- identify the site to drain with US (avoid thoracic vein)
- 7/8 ICS above costochondral junction
- Clip, prep aseptically & local anaesthetic, under the skin and into the muscle. Often done under standign sedation
- Stab incision cranial edge of rib
- Advance drain through incision (pop!)
- Withdraw trocar, advance blunt tube
- Secure w/ Chinese finger trap suture (Heimlich valve!)
Diagnostic value
* Culture & sensitivity
* Cytology
Therapeutic
* Drain proinflammatory products
* Remove bacteria
* Help decrease adhesion formation
* Respiratory function improvement
what procedure should be done to horses with pleuropneuminia?
drainage