Equine Hospital Research Articles

Surgical corrections and postsurgical complications of epiglottic entrapment in Thoroughbreds: 12 cases (2009-2015).

ABSTRACTTwelve Thoroughbred racehorses were diagnosed as epiglottic entrapment at the Korea Racing Authority equine hospital. Four different surgical correction techniques were used to treat epiglottic entrapment: the transnasal hook bistoury, transoral unshielded hook bistoury, transnasal shielded hook bistoury, and transendoscopic laser techniques. Eleven cases were surgically resolved eventually, with one case of recurrence. Five complications related to surgical correction occurred: a severe nasal passage laceration and bleeding (n=1), epiglottic laceration (n=1), epiglottis tip burns (n=2), and moderate nasal passage laceration (n=1). Intraoperative complications occurred in approximately 41.7% of cases. Thus, the possibility of surgical complication should be considered thoroughly when choosing a surgical technique for correction of epiglottic entrapment.

Treatment of a poorly differentiated sarcoma in the oropharynx of a horse

SummaryA 10‐year‐old Thoroughbred mare was referred to Tennessee Equine Hospital for evaluation and treatment of a subepiglottic mass. Physical and laboratory examinations revealed no other abnormalities. The tumour was excised through a laryngotomy site using transendoscopic laser and sharp excision. Histological evaluation revealed a poorly differentiated sarcoma with features of a leiomyosarcoma, a rarely identified neoplasm in the oropharynx of the horse. The mare developed intermittent dorsal displacement of the soft palate (iDDSP) after surgery but was able to resume full training. There was no evidence of regrowth 8 months post‐operatively.

Antimicrobial susceptibility patterns of blood culture isolates from foals in Switzerland.

We report blood culture results of 43 foals admitted to an equine hospital for medical or surgical disorders and determine minimal inhibitory concentrations (MIC) of different antibiotics. Eleven foals had a positive blood culture result despite prior administration of antibiotics in 10 of these animals. MIC values above EUCAST and/or CLSI breakpoints were identified in coagulase-negative staphylococci, methicillin-resistant Staphylococcus aureus (MRSA) and Enterococcus faecium. Gram-negative isolates were less frequently identified and did not appear to exhibit increased MIC values. This study shows that bloodstream infections in foals in Switzerland are caused by diverse bacteria including Gram-positive bacteria which exhibit resistance to several classes of antibiotics.

The use of casts in equine wound management

Russell Parker BVSc MSc DECVS MRCVS, Liphook Equine Hospital, explains their role in supporting healing and their application

Management of joint disease in horses

Russell Parker BVSc. MSc. DECVS. MRCVS, Liphook Equine Hospital, discusses the options

Laboratory advances for equine practices

Jamie Prutton from Liphook Equine Hospital outlines some of the recent diagnostic advances and new tests that will be available at their Liphook laboratory

High carriage of multi‐drug resistant ESBL‐producing E. coli isolated from horses at five equine hospitals in the UK

High carriage of multi‐drug resistant ESBL‐producing <i>E. coli</i> isolated from horses at five equine hospitals in the UK

Cor pulmonale secondary to pulmonary fibrosis in a 16‐year‐old mare

SummaryA 16‐year‐old mare was presented as an emergency to the Equine Hospital of the Veterinary School of Lyon, with a 1‐month history of respiratory distress. On admission the mare was in poor body condition, with severe inspiratory and expiratory dyspnoea associated with severe hypoxaemia and marked tachycardia. Wheezes were auscultated. A pulmonary biopsy revealed fibrosis of about 40% of the parenchyma. Following an episode of atrial fibrillation, an echocardiogram was carried out which revealed signs of pulmonary hypertension, consistent with cor pulmonale. Despite the lack of aetiologic explanation for the primary pulmonary disease, the general condition of the mare improved with the administration of high‐dosed corticoids and antimicrobial therapy.

Ethylenediaminetetraacetic acid (EDTA) anticoagulant affects the refractometric measurement of total protein concentration in equine synovial fluid

SummaryThe objectives of this study were to (i) determine the effect of ethylenediaminetetraacetic acid (EDTA) concentration on the refractometric measurement of the total protein (TP) concentration of equine synovial fluid and (ii) assess the effect of time and temperature on the refractometric measurement of TP concentration. Synovial fluid was retrieved aseptically from horses presenting to Liphook Equine Hospital either (a) immediately after euthanasia or (b) from those requiring arthrocentesis as part of their clinical investigation. Samples were aliquoted into commercially available (i) plain tubes (0.5 mL; control) and (ii) EDTA tubes (at different volumes to obtain serial dilutions of EDTA:synovial fluid). TP concentration was measured by two independent observers using a calibrated hand‐held refractometer. Samples from a separate group of horses were stored for 24 h at 4°C and 20°C before analysis to assess the effects of time and temperature. Results were compared using repeated measures ANOVA. TP concentration was significantly higher at all EDTA concentrations compared to control samples, with the greatest effect seen with higher concentrations (P&lt;0.0001 for samples with ≥3.17 mg EDTA/mL). Storage time or temperature did not significantly affect TP concentration. Refractometric measurement of small volumes of synovial fluid in commercially available EDTA tubes leads to artificially elevated TP concentrations. Delays in sample analysis and alterations in storage conditions did not significantly affect TP concentration within the parameters studied. The magnitude of overestimation of synovial total protein concentration could result in misclassification of suspect synovial sepsis cases where EDTA tubes are used.

Sun induced dermatoses in the horse

Pauline Williams Sussex Equine Hospital, discusses the difference between phototoxicity and photosensitisation and, their diagnosis and treatment

Exercise intolerance: a medical perspective

Jamie Prutton BSc (Hons) BVSc DipACVIM DipECEIM MRCVS Liphook Equine Hospital looks at some of the possible causes of exercise intolerance, their diagnosis and treatment

Distal phalangeal fractures in the horse

Russell Parker BVSc. MSc. DECVS. MRCVS Liphook Equine Hospital, discusses the diagnosis and treatment of this common, but often tricky to identify condition

Serotype Diversity and Antimicrobial Resistance among Salmonella enterica Isolates from Patients at an Equine Referral Hospital.

Although Salmonella enterica can produce life-threatening colitis in horses, certain serotypes are more commonly associated with clinical disease. Our aim was to evaluate the proportional morbidity attributed to different serotypes, as well as the phenotypic and genotypic antimicrobial resistance (AMR) of Salmonella isolates from patients at an equine referral hospital in the southern United States. A total of 255 Salmonella isolates was obtained from clinical samples of patients admitted to the hospital between 2007 and 2015. Phenotypic resistance to 14 antibiotics surveilled by the U.S. National Antimicrobial Resistance Monitoring System was determined using a commercially available panel. Whole-genome sequencing was used to identify serotypes and genotypic AMR. The most common serotypes were Salmonella enterica serotype Newport (18%), Salmonella enterica serotype Anatum (15.2%), and Salmonella enterica serotype Braenderup (11.8%). Most (n = 219) of the isolates were pansusceptible, while 25 were multidrug resistant (≥3 antimicrobial classes). Genes encoding beta-lactam resistance, such as blaCMY-2, blaSHV-12, blaCTX-M-27, and blaTEM-1B, were detected. The qnrB2 and aac(6')-Ib-cr genes were present in isolates with reduced susceptibility to ciprofloxacin. Genes encoding resistance to gentamicin (aph(3')-Ia, aac(6')-IIc), streptomycin (strA and strB), sulfonamides (sul1), trimethoprim (dfrA), phenicols (catA), tetracyclines [tet(A) and tet(E)], and macrolides [ere(A)] were also identified. The main predicted incompatibility plasmid type was I1 (10%). Core genome-based analyses revealed phylogenetic associations between isolates of common serotypes. The presence of AMR Salmonella in equine patients increases the risk of unsuccessful treatment and causes concern for potential zoonotic transmission to attending veterinary personnel, animal caretakers, and horse owners. Understanding the epidemiology of Salmonella in horses admitted to referral hospitals is important for the prevention, control, and treatment of salmonellosis.IMPORTANCE In horses, salmonellosis is a leading cause of life-threatening colitis. At veterinary teaching hospitals, nosocomial outbreaks can increase the risk of zoonotic transmission, lead to restrictions on admissions, impact hospital reputation, and interrupt educational activities. The antimicrobials most often used in horses are included in the 5th revision of the World Health Organization's list of critically important antimicrobials for human medicine. Recent studies have demonstrated a trend of increasing bacterial resistance to drugs commonly used to treat Salmonella infections. In this study, we identify temporal trends in the distribution of Salmonella serotypes and their mechanisms of antimicrobial resistance; furthermore, we are able to determine the likely origin of several temporal clusters of infection by using whole-genome sequencing. These data can be used to focus strategies to better contain the dissemination and enhance the mitigation of Salmonella infections and to provide evidence-based policies and guidelines to steward antimicrobial use in veterinary medicine.

International Survey Regarding the Use of Rehabilitation Modalities in Horses.

To define which biologic, electrophysical and other modalities are used in horses for injury or performance issues, a questionnaire regarding 38 modalities was distributed to eight veterinary groups. A total of 305 complete or partial responses were obtained from over 10 geographic regions; 75.4% from private equine practice or regional private equine referral hospitals, 14.1% from university teaching hospitals or satellite clinics, 8.2% from private mixed animal practice, and 2.3% from veterinary rehabilitation centers. The majority of respondents were located in the USA (60%), Europe (25.6%), and Canada (5.6%). Respondents reported working with athletic horses primarily in the disciplines of hunter-jumper (26.9%), dressage (16.0%), and pleasure riding (14.7%), followed by Western riding, track racing, and eventing. Warmbloods (39.7%) were the predominant breed presenting to respondents, followed by Thoroughbreds (20.3%) and Quarter Horses (17.3%) ahead of other breeds. All 38 modalities were used by respondents. The 10 most prominently utilized were controlled hand walking (97.3%), therapeutic shoeing (96.1%), ice (95.2%), compression bandaging (89.5%), platelet rich plasma (PRP; 86.5%), therapeutic exercises (84.3%), interleukin-1 receptor antagonist protein therapy (IRAP; 81.4%), stretching (83.3%), and cold water hydrotherapy (82.9%). Heat (77.6%), massage (69.0%), and acupuncture (68.3%) were also commonly utilized. The least prominently used modalities were hyperbaric oxygen therapy (9.4%), cytowave (8.3%), and radiofrequency (6.4%). Injectable modalities (IRAP, PRP, mesotherapy, stem cells) were almost solely administered by veterinarians; other modalities were variably applied by veterinarians, technicians, veterinary assistants, farriers, physical therapists, trainers, and other entities. A total of 33% of respondents reported working collaboratively with physical therapists on equine patients. Findings indicate that a broad range of invasive and non-invasive modalities are used in equine patients to address a variety of rehabilitation and performance needs, and that personnel with varying levels of expertise are involved in their administration. This suggests that further investigation to better define the delivery, efficacy and any negative effects of many of these modalities is important.

Emergency care of the equine neonate in the field

James SW Prutton BSc (Hons) BVSc DipACVIM DipECEIM MRCVS, Equine Medicine Specialist, Liphook Equine Hospital, outlines the assessment process

An evaluation of serum gentamicin concentrations and bacterial susceptibility to gentamicin in equine practice.

BackgroundTherapeutic drug monitoring and minimum inhibitory concentration (MIC) data allow more informed use of gentamicin.Hypothesis/ObjectivesTo measure peak and trough serum gentamicin concentrations in horses after a 6.6 mg/kg dose of gentamicin given IV and the MIC of gentamicin of bacteria for which gentamicin might be selected.MethodsRetrospective analysis of hospital records. Peak and trough plasma gentamicin concentrations were measured after 6.6 mg/kg gentamicin IV in 339 hospitalized horses. The MIC of gentamicin was measured for 503 isolates from ambulatory practice and 33 from hospital practice. The distribution of gentamicin concentrations and MIC results were compared to current recommendations for MIC breakpoints.ResultsThe median serum gentamicin concentration at 60 minutes after administration (C 60min) was 21.4 μg/mL with a distribution indicating that bacteria with MIC ≥2 μg/mL were unlikely to be exposed to sufficient gentamicin for effective killing. Approximately 90% of isolates from ambulatory practice and 36% of hospital isolates had MICs at or below breakpoints for susceptibility with most of the remainder unlikely to be responsive, even to higher IV doses.Conclusions and Clinical ImportanceGentamicin at a dosage of 6.6 mg/kg IV is likely to be effective against the majority of infections encountered in ambulatory practice, but less effective in an equine hospital. Because there was a dichotomy of most bacteria as being clearly susceptible or clearly resistant to gentamicin, it appears unlikely that higher doses would have been more efficacious, especially in the hospitalized population in our study.

Equine nutrition: A preliminary investigation of feeding practices in equine veterinary hospitals in the USA

Nutrition plays an important role in equine rehabilitation, with contradictory approaches existing on correct nutritional management of patients. The preponderance of information related to nutrient requirements for horses was designed for healthy horses. Very little scientific research has been undertaken to determine specific recommendations for horses with health issues. This study provides a preliminary assessment of current feeding practices within equine hospitals in the USA. A survey was distributed to equine veterinary hospitals (n=115) and the response rate was 21%. The responses provided information on the demographics of equine veterinary professionals, facilities and equine patients, and current nutritional practices. A substantial number of hospitals housed 51 to 100 patients (30%) on a short-term basis of between 1 to 3 days (38%), treating a wide variety of conditions; several of which require strict dietary management (colic, laminitis and metabolic disorders). All facilities fed hay as the forage source and 9 (38%) provided pasture turnout. Only one facility fed forage only, the rest fed supplementary feeds: including complete feeds, pelleted feeds and cereal grains. Seven facilities (30%) fed all patients the same type of feed, but none fed patients the same amount of feed. Most facilities had specific nutritional protocols in place (79%); half had conducted feed analyses and half also consulted a nutritional advisor. As the first known study to investigate the nutritional management strategies of equine hospital environments, a clear need for further research and validation of results is required.

The outcomes of epidural anaesthesia in horses with perineal and tail melanomas: Complications associated with ataxia and the risks of rope recovery

SummaryMelanoma is a common neoplasm in horses, with a high rate of incidence in the perineum and ventral tail. Surgical excision is often recommended to remove such masses and can be achieved in the standing horse either via local infiltration of local anaesthetic, or via epidural administration of a local anaesthetic and/or an adrenergic α2 receptor agonist. The clinical records of all horses with tail and/or perineal melanomas that received epidural anaesthesia at a single equine hospital, over a 7‐year period, were reviewed to determine the drugs administered and complications associated with the epidural injection. Twenty‐five cases were identified, five of which received epidural anaesthesia on two occasions. Epidural anaesthesia was insufficient to allow surgical melanoma excision in two horses; repeated epidural injection allowed sufficient loss of sensation in one of these horses and additional regional infiltration of local anaesthetic allowed completion of surgery in the other. Three horses developed significant ataxia associated with epidural anaesthesia, two of which became recumbent. Both recumbent horses were placed under general anaesthesia, and in one of these, rope‐assisted anaesthetic recovery resulted in additional complications associated with facial nerve paresis, fractured ribs and a fracture of the first coccygeal vertebra, with associated neurological dysfunction of the rectum, anus, tail and surrounding skin.

Frequency distribution of osteochondral fragmentation of the dorsoproximal articular surface of the proximal phalanx in racing Thoroughbreds in the UK.

Osteochondral fragmentation of the dorsoproximal margin of the proximal phalanx is commonly recognised in racing Thoroughbreds. Frequency distribution has been documented in racing Thoroughbreds and Quarter Horses in the USA and in European Warmbloods but no data have been published from the UK. Concurrent intra-articular soft tissue lesions and radiographic accuracy of fragment distribution in racing Thoroughbreds have not previously been reported. To document frequency distribution of dorsoproximal fragmentation of the proximal phalanx in a UK population of racing Thoroughbreds and to compare this with published data. To document concurrent intra-articular lesions identified arthroscopically and radiographic accuracy of fragment distribution. A retrospective single centre-based, observational study. Surgical reports and radiographs of all racing Thoroughbreds that underwent arthroscopic surgery for removal of fragmentation from the dorsoproximal margin of the proximal phalanx at Newmarket Equine Hospital between 2011 and 2015 were reviewed. Two hundred and forty-two (85.8%) horses were in or being prepared for flat racing. Osteochondral fragmentation of the dorsoproximal aspect of the proximal phalanx was present in 428 fetlock joints of 282 horses, consisting of 194 (45.3%) left and 188 (43.9%) right metacarpophalangeal joints, and 20 (4.7%) left and 26 (6.1%) right metatarsophalangeal joints. Fragmentation was located dorsomedially in 316 (73.8%), dorsolaterally in 32 (7.5%) and biaxially in 80 (18.7%) joints. Concurrent soft tissue lesions were identified in 168 (39.3%) joints. Radiographic evidence of fragmentation was visible in 320 joints (74.8%). Limited numbers preclude conclusions with respect to yearlings and horses in jump race training. Dorsoproximal fragmentation of the proximal phalanx occurred most frequently medially and in the forelimbs. Sidedness was not demonstrated. Although similar to previously reported data, variance in limb distribution is evident. Further research is required to determine whether concurrent intra-articular soft tissue lesions are aetiopathogenic or an additional result of the pathological changes leading to fragmentation. Fragmentation site was not always accurately identified radiographically. The Summary is available in Spanish - see Supporting information.

Inflammatory bowel disease (IBD) in horses: a retrospective study exploring the value of different diagnostic approaches

BackgroundDiagnosing IBD in horses is challenging and requires a multimodal approach, since no conclusive diagnostic test is available.The objectives of this study were to provide an overview of population characteristics, results of applied diagnostic tests, treatment modalities and outcome in a large group of horses thought to have IBD and that were presented to four large equine referral hospitals, and to provide an exploratory investigation of possible associations between results of applied diagnostic tests, applied treatment modalities and outcome.A retrospective case series was performed across four large equine referral hospitals. Seventy-eight horses, thought to have IBD were included. Case history, clinical findings, diagnostic test results including oral glucose tolerance test (OGTT) and enteral biopsies (both duodenal and rectal), applied therapy and outcome were studied. A Chi-Square test was used to identify associations between results of diagnostic tests, treatment and outcome. P-values < 0.05 were considered significant.ResultsLethargy, diarrhoea, recurrent colic and weight loss were recorded in respectively 21,8%; 14,1%; 28,2% and 78,2% of cases. Over 70% of horses thought to have IBD had an abnormal OGTT. Only weight loss was significantly associated with aberrant enteral biopsy results, but not with abnormal OGTT results or low blood total protein. There was no association between an aberrant biopsy result and a disturbed OGTT. There was no association between either OGTT results or enteral biopsy results and a low blood total protein content, presence of gastric ulcer disease or an aberrant endoscopic aspect of the duodenal entrance.ConclusionsWeight loss is a highly prevalent symptom in IBD suspected horses. Enteral biopsies may be a useful diagnostic aid in the work-up of horses thought to suffer from IBD, however further research is required to demonstrate their true diagnostic value. Until more standardized scientific research is available, one should be careful with the interpretation of enteral biopsy results There is a need for better standardization of enteral biopsy procedures and the histopathological scoring of biopsies.