Test 3: 55+ 56 Flashcards
smooth pleural surface sliding against each other
roughened visceral pleural surface- comet tails
pleural effusion- fluid is black, part of lung is consolidated- non aerated lung- meaty
TTA
trans tracheal aspiration/wash
good for focal lung disease- takes sample from “trash can”
can culture- sterile aspiration
BAL
bronchoalveolar lavage
only samples a random very small sample of lung- good for global lung disease
heaves, EIPH, fungal pneumonia, silicosis
can not use for culture- goes through nose
which lavage technique is better for focal lung disease
TTA- trans tracheal wash- take sample from trash can
which lavage technique is better for global lung disease
BAL- bronchoalveolar lavage
— can be used to diagnosis mild asthma in horses with normal physical exam
Open plethysmography with
histamine bronchoprovocation
shows how twitchy small airways are
3 general causes of lower airway disease in horses
infectious: viral bacterial, fungal
inflammatory- equine asthma, perilla mint, silcosis
cancer: primary and metastatic
training barn
7 out of 12 sick
thin nasal discharge
cough temp
occ crackles
↑resp rate
problem list
DDx
plan
Problem list
- fever, cough nasal discharge, abn auscultation, multiple animals
Differential diagnoses
- lower airway disease (crackles)
- infection (bacterial, viral, fungal), immune-med, inflammatory (asthma), trauma, congenital
Plan:
- Ultrasound- comet tails
- PCR- equine influenza
equine influenza clinical presentation
fever ↑ 106
snot
cough (up to 3 weeks)
rarely fatal- similar to flu in humans
treatment for equine flu
rest
NO antibiotics- flu is viral
control of equine flu
vaccines after 6 months of age
equine herpes presents as
cough, nasal discharge (similar to flu)
biphasic fever
latent disease- flares with stress
EVH4- less severe
EHV1- abortion storm, neonatal death, myeloencephalopathy (EHM) fatal reportable
EHV4 can cause what reportable disease
myeloencephalopathy (EHM)
fatal
reportable
neuro signs often with urinary incontinence
treatment for equine herpes
rest
NO antibiotics- viral infection
vaccine q 6 months (does not protect against neuro EHV-1)
is EHV5 on a nasal swab and good or bad thing
normal- found in nose
flu outbreak recommendations
vaccinate q 6 months
quarantine affected horses
rest sick horses - one week for every day of fever
3 YO colt
shipped from florida last week
off feed and thick nasal dischange and cough
fully vaccinated
↑HR, resp and temp
radiating heart sounds on L
re-breathing- crackles R mid thorax
MM tachy. CRT 2.5 sec
problem list
DDx
plan
Problem list
- Cough, nasal discharge, fever, tachypnea, crackles R lung, radiating heart sounds
Differential diagnoses
* Lung dx (viral, bacterial, fungal, non-infectious?)
* Guttural pouch disease?
* Sinuses?
Diagnostic plan
* Bloodwork- neutrophilia, hyperfibrinogenemia, ↑serum amyloid A
* Imaging: xray- US
* Trans tracheal aspiration- cytology and culture
Diagnosis
pleuropneumonia- shipping fever
pleural effusion- radiating heart sounds
how to do re-breathing exam on horses
Use a large plastic
bag
* At least one minute- ventilation
* Increase CO2, not decrease O2
* Increases depth and rate of breathing
what should be here?
triangle
lung US of horse with crackles and radiating heart sounds
pleural effusion
lung consolidation- fibrin
pneumonia
if you want to culture lavage which one to use?
TTA- good for focal lung disease(trash can)- more sterile
equine pneumonia is caused by what bacteria
strep equi subsp. zooepidemicus
Klebsiella pneumoniae
— causes strangles
strep equi equi
very contagious
abscesses in the lymphnodes
how to treat step equi zoo
penicillin (strep gram + bacteria)
strep equi zoo is normal comensal, not contagious
shipping fever in horses presents as
pleuropneumonia
ADR, anorexic
± Nasal discharge
Cough? Only sometimes.
Fever, tachypnea, pleurodynea (fake colic!)
Usually pleural effusion (not like dogs)
diagnostic plan for horse with pleuropneumonia (shipping fever)
physical exam- re-breath if not distressed
Rads / U/S
CBC/fibrinogen
TTA- Bacterial culture and cytology →anaerobic culture too
tap chest- Pleural fluid- Glucose? pH? Low = septic
treatment for pleuropneumonia
antibiotics- broad spectrum (penicillin for strep equi sp zoo)
NSAIDs
drain pleural effusion
supportive care → ↑calories
what antibiotic should you not use for horse with pneumonia
baytril- enrofloxacin- does not cover strep equi zoo!
how to treat pleural effusion in horse
drain- chest tap
penicillin for strep equi zoo
when to stop treating pleuropneumonia
- Re-check with rads or U/S
- Normal fibrinogen/SAA (better than CBC)
- Afebrile off all drugs for several days?
Mild cases: usually 1-3 weeks
Abscesses/necrotic lung: 1-6 months
Can cost >$5,000 (up to $20,000)
treatment for shipping disease
antibiotics- penicillin (strep equi zoo), gentamicin, metronidazole
chest tap
NSAIDs
hydration
calories
prognosis for shipping disease in horses
92% of STB and 52% of TB raced after abscesses. Worse with pleural effusion, much worse with anaerobic bugs
anatomical location of pneumonia caused by shipping fever in horses
cranio-ventral portion of the caudal lung lobe, esp. right lung
causes by strep equi zoo- non contagious normal upper airway flora
in combo with gram + or gram-, ecoli or klebsiella
3 YO QH mare
bought last week
now lethargic, hyporexic, bilateral purulent nasal discharge
temp 105.1
facial/lymphnode swelling
ddx
plan
nasal discharge
ddx:
* Strangles (Strep equi ssp equi)
* Viral URT infection
* Bacterial pneumonia
* Equine asthma (heaves)- no fever
lymphadenopathy
ddx
* Infection (strangles)
* Reactive lmyphadenopathy (virus) – usually mild swelling
* Lymphoma
lymph + fever + discharge
* strangles (strep equi ssp equi)
plan for strangles
PCR- strep equi ssp equi
extremely contagious
can lead to persistent shedders- need to isolate
how to treat strangles
Mild
- Fever, mild anorexia, no resp distress
- Symptomatic therapy
- Drain abscesses
- Cautious NSAID use
- NO ANTIBIOTICS!
Severe
- Resp distress: tracheostomy, drain abscess
- Yes antibiotics: penicillin (kryptonite!), or ceftiofur, SMZ
prevention of strangles
isolate affected horses until PCR negative
75% are immune after infection
vaccine- intranasal
strep equi spp equi
strangles complications
bastard strangles
Abscesses in the abdomen, brain, liver, spleen, kidneys, etc.
guttural pouch: empyema and chondroids
diagnosis for bastard strangles
metastatic strangles
strep M protein titer (SEM)
history
US, CSF tap
inflammatory blood work
treatment of metastatic strangles
long term antibiotics- 1-6 months
Penicillin? 99% sensitivity. Pros and cons…
Ceftiofr (Excede) SMZ? Chloramphenicol?
what are some immune mediated complications of strep equi exposure or vaccination
Purpura hemorrhagica
* Severe pitting edema (limbs,
ventrum) + Vascultitis: severe edema
* Rx: steroids and penicillin
Equine immune-mediated myositis
(IMM)
* Quarter horses and QH-related breeds
* Rapid and severe symmetrical wasting of the topline muscles, high CK, pain
* Genetic disease: MYH1 gene
mutation (codes for 2X myosin)- body makes antibodies to its own muscle
how does body cause vasculitis after exposure to strep equi
M protein on strep equi looks similar to epithelial cell
antibodies will accidently bind to epithelial cells and cause vasculitis and edema → purpura hemorrhagica
should you vaccinate recently infected strangles horses
no
titer before vaccinating- risk of purpura hemorrhagica and equine immune mediated myosistis (IMM)
9 yo paso fino
treated for antibotic associated colitis 2 weeks ago, still in hospital
fever 103.5, occassional cough, crackles
ddx
plan
penumonia- bacterial, viral, interstitial, fungal
pulmonary edema
equine asthma (high fever would rule this out)
plan: rads/US
TTA/BAL
pleuropneumonia on xray looks like
no triangle of death (opacity in cranio-ventral portion of the caudal lung lobe, esp. right lung)
fluid or patchy alveolar pattern
this lung is milliary- diffuse interstitial
pleuropneumonia has ventral aveolar pattern
ddx
fever, cough, crackles
plan?
DDX:
fungal pneumonia
EMPF
silicosis
cancer
Plan
BAL- global disease
extensive alveolar pattern in all lung fields in only seen in diseases with very poor prognosis
fungal pneumonia
Primary
* Caused by specific fungal pathogens with discrete geographical restrictions
* Must live or have traveled in these regions!
Opportunistic (secondary)
* Immunocompromised animals
* Agents such as Aspergillus and other
environmental species
very rare
diagnosis, treatment and prognosis of primary fungal pneumonia
Diagnosis
* Must get travel history
* Rads, BAL, +/- biopsy
* Serum titers? Only show exposure, so may be hard to interpret
Treatment
* Systemic anti-fungals
* 2-4 months - $$$
Prognosis
* Generally poor
it is normal to find fungi in BAL or TTA
TTA- 70% normal
do not treat unless large numbers and xrays show extensive alveolar pattern
signalment of opportunistic fungal pneumonia
rare
immunocompromised- sick/cancer, recent GI disease
clinical signs: cough, tachypnea, fever, adventitial lung sounds, nasal discharge
diagnosis of opportunistic fungal pneumonia
rare
rads, BAL, +/- biopsy
test immune function (cornell)
treatment: anti-fungals
clinical signs of interstitial pneumonia in horses
severe, tachypnea, cyanosis, fever, cough, weight loss
diagnosis of interstitial pneumonia in horses
xray- diffuse, miliary, nodular
BAL- global disease
Lung biopsy
what can cause interstitial pneumonia in horses
equine multinodular pulmonary fibrosis (EMPF)
infectious- acute viral or bacterial: ARDS or foals with R. equi
silicosis
toxin- perilla mint
idopathic
ddx for equine multinodular pulmonary fibrosis
bacterial pneumonia
equine asthma (heaves)
diagnosis of EMPF
Consistent clinical signs and imaging and
EHV-5 (+) PCR from Biopsy or BAL
EHV5(+) on nasal swab ≠ EMPF!
histopath
post-mortem
treatment of EMPF
steroids- prenisolone
valacyclovir
guarded prognosis
