Post on 15-Apr-2017
transcript
Equine Medicine Board ReviewEquine Medicine Board Review
Prepared by:Beatrice Sponseller, Dr. med. vet., DABVP
Respiratory DiseaseRespiratory DiseaseI. Disorders of the lower respiratory tract
1. Recurrent Airway Obstruction (RAO, COPD, heaves)
2. Pneumonia / pleuropneumonia
3. Exercise-induced pulmonary hemorrhage (EIPH)
1. Recurrent airway obstructionType I / III hypersensitivity reaction to
environmental allergens (dust, mold, pollen, pasture)
Bronchiolitis, bronchoconstrictionClinical signs: expiratory effort (heave line),
chronic cough, mucopurulent nasal discharge, exercise intolerance, weight loss
Dx: - clinical signs (wheezes; afebrile) - BAL (neutrophils & mucus)
Tx: - reduce/eliminate exposure to allergen- corticosteroids (dexamethasone, prednisolone) - bronchodilators
2-agonists (clenbuterol, albuterol)
- systemic and/or inhalation therapy
2. Pneumonia/PleuropneumoniaBacterial, viralFoals: Strep. zooepidemicus, Actinobacillus spp.,
R. equi (< 6 months).[Pasteurella spp., Bordetella bronchiseptica, enterics]. Anaerobes rare.
Adults: Strep. zooepidemicus, Actinobacillus spp., gram neg. enterics. Anaerobes common.
Dx: - thoracic auscultation, U/S, radiographs- TTW, thoracocentesis
Tx: - antimicrobial & antiinfl. medication- nasal O2 insufflation- pleural drain, lavage
3. Exercise-induced pulm. hemorrhageCause unknown; stress failure of capillaries
due to pulmonary hypertension?Associated with strenuous athletic events (race
horses; 44-75% prevalence in TB)Caudodorsal lung field affectedEvidence of frank blood in <10%Dx: - endoscopy, TTWTx: - furosemide, bronchodilators
II. Disorders of the upper respiratory tract
1. Left laryngeal hemiplegia (roarer)
2. Dorsal displacement of soft palate (DDSP)
3. Sinusitis
4. Ethmoid hematoma
5. Guttural pouch disorders
6. Strangles
1. Left laryngeal hemiplegiaDistal axonopathy of recurrent laryngeal nerve
neurogenic atrophy of intrinsic laryngeal muscles Loss of abduction of arytenoid cartilage (CAD)Inspiratory noise during exercise +/- exercise
intolerance (fatigue)More common in large horsesDx: - laryngoscopy (grades 1 to 4)Tx: - Laryngoplasty +/- ventriculocordectomy
2. Intermittent DDSPInspiratory + expiratory gurgling noise Exercise intolerance, temporary asphyxiaCause: ?? - laryngopalatal instability due to airway inflammation,hypoplastic or flaccid
epiglottisDx: - laryngoscopy at rest (nasal occlusion)
and during treadmill exerciseTx: - tongue tie, figure-8 nose band
- staphylectomy, strap muscle resection (sternothyrohyoid myectomy)
3. SinusitisPaired dorsal, middle, ventral conchal, frontal, maxillary, sphenopalatine sinusesAll sinuses drain into max. sinus nasomax.
opening middle nasal meatusCause: - primary sinusitis (-hem. strep., fungal)
- dental disease (P4, M1 most common)- paranasal sinus cyst (usually <2 years)- neoplasia- ethmoid hematoma
Dx: - radiographs, sinuscopy, C&S, biopsyTx: - medical / surgical; lavage, …..
4. Ethmoid hematomaProgressive, locally destructive angiomatous massOriginating from ethmoid labyrinth (or sinus) Cause unknown; more common > 8 yearsFacial distortion, respiratory noise, brownish /
hemorrhagic nasal dischargeDx: - endoscopyTx: - 10% formalin (10cc) injections q 10 days
- laser resection, cryosurgery -Recurrence common
5. Guttural pouch disordersAuditory tube diverticula; med.>lat. compartmentAssoc. structures: CNN VII & IX-XII, int. & ext.
carotid artery, max. vein, symp. trunk, stylohyoid A. Guttural pouch tympany
- non-painful air distention; young foals - may cause stridor/resp. distress, dysphagia, aspiration pneumonia, nasal discharge - functional defect of pharyngeal opening ? - Dx: endoscopy, radiographs, -
Tx: - surgical
B. Guttural pouch empyema - exudate/pus filled GP- chondroids (inspissated pus) in chronic cases- associated with upper respiratory tract infection (Strep. equi / Strep zooepidemicus)- white, nonodorous nasal discharge, dysphagia,
lymphadenopathy, painful distention in parotid area- Dx: radiographs, endoscopy- Tx: - medical (lavage, C&S, antimicrobial tx) - surgical
C. Guttural pouch mycosis- fungal plaques on GP mucosa assoc.
with internal (70%) or ext. carotid artery; most commonly Apsergillus- bouts of severe (bilat.) epistaxis +/- dysphagia - mortality 60% (fatal hemorrhage)- Dx: endoscopy- Tx: surgical balloon catheterization of affected
artery
6. StranglesStreptococcus equi subsp. equi infectionClinical signs: fever (103-106oF), depression,
anorexia, serous mucopur. nasal discharge, abscessation of mandibular/retropharyngeal Lnn
Complications: acute URT obstruction / resp. distress, (aspiration) pneumonia, GP empyema, ‘bastard strangles’, purpura hemorrhagica, Strep. myopathy
Highly contagious; morbidity 30-100%Young horses (<5 years) more severely affected
Dx: - culture of organism from nasal swab or abscess
- radiographs (GP/retropharyngeal area)Tx: - hot packing/surgical drainage/lavage of abscesses
- antimicrobial (penicillin) therapy in severely affected animals (foals!)
- NSAIDs (antipyretic/antiinfl.)
Stringhalt Spastic intermittent hyperflexion of hindlimb(s)
Cause: Peripheral nerve trauma or ingestion of toxic weed (Hypochoeris radicata)
Tx: tenectomy of lat. digital extensor muscle
Shivers Idiopathic neuromusc. disease (draft horses: PSSM?)
Trembling of hind limb and tail (esp. backing)
Hyperkalemic periodic paralysis (HYPP) Autosomal codominant gen. dz (point mutation in
voltage gated Na channel of skeletal muscle)
Na channels fail to inactivate K+ leaves cells hyperexcitability, muscle fasciculations/spasms, recumbency, laryng./pharyng. paralysis, collapse, death “Impressive” descendents (QH, Paints, Appal.)
Dx: - DNA testing (mane/tail hair, blood)
Tx: Dextrose (insulin), sodium bicarb. (K+) Calcium gluconate
Prevention of attacks:
- low K+ diet (avoid alfalfa, molasses, timothy; feed
oat/grass hay or pasture)
- regular exercise or access to paddock
- K+ excretion (acetazolamide)
Nutritional myopathy ‘White muscle disease’, Vit.E/Se deficiency
Foals from birth to 11 months of age: muscle weakness, dysphagia, hard/painful muscles (acute and subacute forms)
Dx: CK + AST, myoglobinuria, low blood Se and/or glutathionperoxidase levels, response to Vit. E/Se.
Prevention: Se supplementation of pregnant mares and/or foals from birth to 6 months of age
Exertional rhabdomyolyis Stiff gait, muscle cramping, exercise intolerance,
recumbency, death
CK (acute myonecrosis), AST, myoglobinuriaA. Polysaccharide storage myopathy (PSSM)
QH-related breeds, warmbloods & draft horses
Accumulation of glycogen + abnormal PS due to increased insulin sensitivity of skeletal muscle
Dx: - CK>1000U/l 4h post exercise (15 min. trot)
- gluteal or semimembranosus muscle biopsy
Tx: Acepromazine, NSAIDs, IV fluids,
DMSO, Methocarbamol, Vit. E/Se, sedatives
Prevention :
- dietary management (carbohydrates: no grain,
sweet feed, alfalfa; instead feed grass/oat hay + fat
supplement [1-4 cups vegetable oil/d, or rice bran])
- regular exercise or access to paddock
- selective breeding (autosomal recessive trait)
Clostridial myositis Within 2 days of intramuscular nonantibiotic
injection (Banamine!) or injury (chest wound)
C. septicum, chauvoei, perfringens, sordelli, novii
Painful, hot, soft swelling cool, firm, +/- crepitus
Dx: needle aspirate, anaerobic culture
Tx: - antibiotics (IV penicillin, oral metronidazole)
- surgical incision and drainage
- NSAIDs
-
Neurologic DiseaseNeurologic DiseaseBotulism
Flaccid paralysis due to inhibition of ACh release from cholinergic neurons
8 distinct Clostr. botulinum strains; horses affected by types (A), B & C
Clin. signs: gen. muscle weakness recumbency, tremors, dysphagia, hypotonia of tail, ptosis, mydriasis, death
3 routes of infection
1. Forage poisoning (ingestion of preformed toxin)
- decaying vegetable matter (type B) or animal
carcasses (type C)
2. Toxicoinfectious botulism (shaker foal syndrome)
- ingestion of spores proliferation in GI
- foals from 2-8 weeks of age affected
3. Wound botulism (wound infection, anaerobic cond.)
- injection site abscess, trauma, castration, omphalo-
phlebitis
Dx: - mouse bioassay
- ELISA, PCR to detect toxin
- C. botulinum spores in feedstuff or feces
Tx: - polyvalent antitoxin
- supportive care (mechanical ventilation)
- +/- antibiotics (avoid aminoglycosides, procaine
pen., tetracyclines; metronidazole is ineffective)
Prevention: C. botulinum type B toxoid
Tetanus Spastic paralysis due to inhibition of neurotransmitter
release centrally from inhibitory interneurons
Clostr. tetani toxins: Tetanospasmin neurotoxin Tetanolysin facilitates spread of infection via
tissue necrosis Non-spasmogenic toxin symp. hypertension
Clin. signs: gen. increased muscle tone, trismus, erect ears, stiff gait, elevated tail, sawhorse stance, prolapsed nictitans, convulsions, death (resp. arrest)
Tx: - antitoxin (IV, intrathecally)
- antimicrobials (Pen. G, metronidazole,
tetracycline)
- muscle relaxation (aceprom., diazepam, pentobarb.)
- wound debridement, lavage (H2O2)
- quiet environment, sedatives
- supportive care
Prevention: Tetanus toxoid
Equine protozoal myeloencephalitis (EPM) Focal or multifocal CNS disease caused by Sarcocystis
neurona
Obligate two-host-species life cycle
Definitive host: opossum (oocysts with sporocysts in feces)
Intermediate hosts: cat, armadillo, skunk, raccoon,
(sea otter), bird
Aberrant host: horse (tachyzoites & schizonts in CNS)
Clinical signs of EPM:
Spinal cord: asymmetric ataxia (rear>front), muscle atrophy (gluteal), weakness
CN (10%): facial paralysis/vestibular signs, dysphagia, blindness
Cerebrum: Seizures, depression, central blindness
Dx: - CSF analysis (western blot, PCR, cytology)
- Serology (only neg. result diagnostic)
- Response to treatment (sulfonamide /pyrimethamine,
ponazuril)
Equine herpes myelitis neurologic form of EHV-1 infection
Vasculitis (esp. small arterioles of white matter tracts)
Symmetrical ataxia (esp. rear limbs), cauda equina syndrome (weak tail, bladder paralysis, penile prolapse)
CN deficits rare
Dx: - CSF analysis (xanthochromia, high protein,
normal cell count)
- serology ( 4x titer increase)
- nasopharyngeal swab (virus isolation, PCR)
Tx: - NSAIDs, corticosteroids, DMSO
- supportive care (bladder catheterization, etc.) - antiviral medication (acyclovir)
Prevention: EHV-1 vaccine does not prevent neurologic form (but may reduce exposure to virus).
Vaccination contraindicated in outbreaks.
Prognosis: good in most cases (if not recumbent).
Horses may recover within 7-10 days, or
gradually improve over months.
Cervical stenotic myelopathy (Wobbler syndrome) Developmental orthopedic disease
Multifactorial etiology (diet - low Cu, high Zn, high CHO; genetics – rapid growth)
TB predisposed; male>female; onset ½ - 3 years of age
Dynamic compression: vertebral instability (C3/4, C4/5)
Static compression: spinal canal narrowing (C5/6, C6/7)
Clinical signs: symmetric ataxia (rear>front), front limb involvement marked with C6/7 compression
DD: Herpes myelitis, equine degen. myeloencephalo-pathy (EDM), EPM, atlanto-occipital malformation
Dx: cervical radiographs (sagittal ratio), myelography (obliteration of 50% of ventral & dorsal contrast column), CSF analysis
Tx: - stabilization with NSAIDs, corticosteroids, DMSO
- ‘paced diet’ (<1 year old): restricted (65% NRC) energy/protein, increased vit. A, E,
Se, balanced minerals
- cervical vertebral interbody fusion
West Nile virus encephalomyelitis Arbovirus genus flavivirus; reservoir: birds (viremia)
Transmitted by mosquitoes (prim. Culex)
Short lived, low level viremia in horses
Clinical signs: ataxia (asymmetric), hypermetria, muscle tremors (triceps, facial), lip twitching, recumbency, seizures, hypersensitivity to touch/sound, +/- fever
Dx: - IgM capture ELISA (low in vaccinated horses)
- plaque reduction virus neutralization test
- post-mortem: virus isolation/immunohistochem.
DD: -virus infection (EEV, WEV, VEV), EHV-1,
EPM, rabies, leukoencephalomalacia (moldy corn pois.)
Tx: - NSAID (flunixin-meglumine)
- corticosteroids (low dose, few days)
- DMSO, mannitol
- hyperimmunized plasma (first 72 hrs)
- supportive care
Prevention: - vaccination
- eliminate mosquito breeding sites
Rabies Sylvatic reservoirs: skunks, raccoons, foxes, bats
Incubation period: 2 weeks to several months
3 forms: Brainstem (dumb), cortical (furious), spinal cord (paralytic / ataxic)
Clinical signs: ataxia, paresis, lameness, colic, fever, dysphagia, hyperesthesia, death (resp. or cardiac arrest)
Dx: FA test (tactile hair), Negri bodies in hippo-campus and Purkinje cells of cerebellum
Exposed horse: euthanize unless vaccinated (booster & observe for 3 months)
Endocrine DiseasesEndocrine DiseasesEquine Cushings Pituitary pars intermedia dysfunction due to loss of
dopaminergic inhibitory control Hypertrophy, hyperplasia, adenoma (rare) production/secretion of POMC-derived peptides
(-END, -MSH, ACTH) by melanocytes in pars intermedia
loss of circadian pattern of steroid secretion (<30% difference AM vs PM)
Age: 7-42 years (85% > 15 y), high incidence in ponies
Clinical signs:
- hirsutism (long, thick, often curly hair, won’t shed)
- PU/PD (ADH; GFR; hyperglycemia…)
- intercurrent disease problems (dental, GI parasites)
Dx: - cortisol level in PM <30% lower than in AM
- dexamethasone suppression test
Tx: - pergolide (0.5 – 2 mg PO SID)
- cyproheptadine (0.25 mg/kg PO SID)
Sudden death in parturient mare hemorrhage from ovarian artery Renal tubular necrosis aminoglycosides
Renal failure acute tubular necrosisLate abortion Herpes
Bacterial pneumonia Strep zooNeural disease EPM
Colic in minis small colon impaction Site of impaction pelvic flexure
Intussusception Ileocecal valveDegenerative heart valve aortic valve
The “Most Commons” in the Horse
The “Most Commons” in the Horse
Heart disease myocarditisFractured bone in fatigue first phalanx
Congenital heart anomaly ventral septal defect Acquired hear anomaly mitral insufficiency
Pathologic arrhythmia atrial fibrillation Physiologic arrhythmia second degree AV block
Diarrhea in foals Rotavirus Pleural effusion pleuropneumonia
Icterus anorexia, hemolysisParaphimosis trauma
DermatologyDermatologyI. Crusting and Scaling Diseases
1. Dermatophilosis (rain rot, rain scald)
2. Dermatophytosis (ringworm)
3. Pemphigus foliaceus
4. Sarcoidosis (gen. granulomatous dz)
5. Pastern dermatitis (scratches, grease heel)
1. DermatophilosisDermatophilus congolensis Moisture + mechanical irritation invasion of
Stratum corneum by zoospores proliferation of mycelium
Dx: - direct smear/gram stain: railroad tracks (grampos. filamentous bact.)
- cultureTx: - antiseborrheic/antiseptic shampoo
- Povidone/iodine, chlorhexidine - Penicillin
2. DermatophytosisTrichophyton equinum, T. verrucosum,
T. mentagrophytesMicrosporum gypseum, M. equinum, M. canisHighly contagious; highly resistant spores
invade areas of skin abrasions (girth etc.)Initially circular lesions (5-20mm) alopecia
(14 days) scabGeneralized in young, less resistant horsesWinter (crowding); wet/warm weather
Dx: - KOH prep: hyphae and spores - culture of hair plucking (fresh lesion!) on Sabouraud’s agar red color- Wood lamp/UV fluorescence: M. equinum + some M. canis only
Tx: - spontaneous resolution (6-12 weeks)- sunshine
- fungicidal washes (miconazole / chlorhexidine)- topical: 10% povidone-iodine, 2.5% lime sulfur in H2O, …
- systemic: griseofulvin efficacy???
3. Pemphigus foliaceusAutoimmune (type II) exfoliative dermatitis Appaloosa breed predisposedVesicles/pustules (face/limbs) erosions
epidermal collarettes scales, crusts, alopecia (generalized)
Fever, lethargy, weight loss, ventral/limb edemaDx: - biopsy: acantholysis, nondeg. neutrophils
- direct IFA: variableTx: - corticosteroids
- gold injections
4. Pastern dermatitisEtiology: - Dermatophilosis
- Dermatophytosis- Staphylococcus sp.
- Chorioptic mites- Photoactivated vasculitis, …
Scales, crusts, alopecia (“scratches”) exudative dermatitis (“grease heel”) chronic granulation tissue (“grapes”)
Tx: - topical antiseptic washes- antifungal/antibacterial/antiinfl. lotions- keep dry
Also go overAlso go over
Neonatal IsoerythrolysisLethal White Foal (myenteric aganglionosis)Ruptured Bladder
II. Parasitic Skin Diseases
1. Pediculosis (lice)
2. Mange (mites)
3. Habronemiasis
4. Onchocerciasis
1. PediculosisDamalinia equi (biting louse; head>thorax)Haematopinus asini (sucking louse) Life cycle 20-40 daysMore common in winterPruritic if severe infestationDx: - macroscopic/microscopicTx: - bath/spraying/pour-on anti-
ectoparasitics (pyrethrins)- repeat in 2 weeks- oral ivermectin (limited effect)
2. MangeChorioptes equi
- non-burrowing mite, feeds on skin debris- leg and tail mange - most common mite infestation in horses- in winter / horses with feathered fetlocks
Psoroptes equi - sucking mite, feeds on blood and tissue fluid- body mange (ears, mane, body, tail head)
Mange cont. Sarcoptes scabei var. equi
- digging mite, feeds on tissue fluid and cells- head/neck/ears entire body- intense pruritus, automutilation- notifiable disease; rare in horses
Dx of mange: - microscopic (skin scrapings)Tx of mange: - whole body baths with anti-
ectoparasitic drugs (tack etc.) - repeat in 2 weeks - oral ivermectin (limited)
3. Habronemiasis (summer sores)Habronema muscae, H. majus, Draschia
megastoma (stomach nematodes)Larvae can penetrate intact skinEye (conjunctival/lacrimal), legs, ventrum,
prepuce, urethral process, wounds Hypersensitivity reaction/genetic predispos.?Dx: - impression smears; ‘sulfur granules’Tx: - surgical curettage/removal
- topical/systemic ivermectin- intralesional/systemic steroids
4. OnchocerciasisOnchocerca cervicalis (microfilaria)Transmitted by Culicoides spp + biting fliesType I, III hypersensitivity dermatitisVentral midline, chest, withers, face, neckPruritus, patchy alopecia, thickened, scaly skinDx: - season, clinical signs, history
- biopsy: microfilaria (incidental?)- response to ivermectin (circular
exudative dermatitis)Tx: - oral ivermectin
III. Other Skin Diseases
1. Urticaria
2. Insect hypersensitivity
3. Sarcoid
4. Nodular necrobiosis
1. Urticaria (hives)Type I hypersensitivity IgE mediated mast cell
degranulation vascular permeability wheal formation
Etiology: Immunological : systemic/topical drugs
(Penicillin!), ingested (feed) or inhaled (dust, mold, pollen) antigens
Physical: stress, cold, heat, exercise inducedTx: - corticosteroids
- avoid causative antigen/allergen
2. Insect hypersensitivity‘Sweet itch’, ‘summer itch’, ‘Queensland itch’Type I hypersens. to culicoides (or simulium) salivaGenetic predisposition? (Welsh ponies, Icelandic
horses, Shires, Friesians)Seasonal, progressive Severe pruritus, main & tail, ventral midlineSkin thickening, severe hair loss, self mutilationPrevention: blankets, repellents, fans, stabling at dusk
and dawnTx: corticosteroids
3. Equine sarcoidFibroblastic tumor of viral etiology (bovine
papillomavirus, BPV1 and/or 2)BPV present in sarcoids and normal skin of
horses with sarcoids virus latency?Genetic predisposition, MHC-II linked (QH,
Appaloosa, Arabian)Location: head/ears, limbs, abdomen, sites of
trauma/healed woundsTypes: occult (flat), verrucous (warty),
fibroblastic, nodular, mixed
Types: - occult (flat) - verrucous (warty)
- fibroblastic - nodular
- mixed Tx: - Surgery
- Cryotherapy - Immunotherapy (BCG) - Brachytherapy (radiation) - Chemotherapy (cisplatin)
4. Nodular necrobiosis (collagenolytic granuloma)
Asymptomatic small nodules in skinCollagen necrosis and eosinophiliaEtiology: ??? (trauma, insect bites,
hypersensitivity)Tx: - none
- intralesional triamcinolone