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CRS2 > Nasal Discharge & Sinusitis > Flashcards

Nasal Discharge & Sinusitis Flashcards

1
Q

Where is bilateral nasal discharge usually localised to?

A
  • Usually indicates disease behind the nasal septum
  • (Unless bilateral disease of nasal cavity which is pretty unusual)
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2
Q

Where is unilateral nasal discharge usually localised to?

A

Usually originate rostral to the caudal end of the nasal septum

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3
Q

Causes of bilateral nasal discharge?

A
  • Pharyngeal disease
    • Pharyngitis
    • URT viral and bacteria diseases
    • Guttural pouch mycosis, tympany, empyema
  • Laryngeal disease
    • Arytenoid chondritis
  • Lung disease
    • Inflammatory conditions (RAO/Asthma)
    • Infectious conditions (pneumonia)
    • Neoplasia
    • Haemorrhage
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4
Q

Causes of unilateral nasal discharge?

A
  • Nasal foreign body
  • Nasal tumour, polyp, cyst
  • Fungal rhinitis
  • Nasal trauma
  • Unilateral sinusitis
  • GP empyema
  • GP tympany
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5
Q

What does purulent nasal discharge indicate?

A
  • Indicative of infection / severe inflammation
    • Containing neutrophils
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6
Q

Purulent nasal discharge may be associated with a foul smell, if so what could this indicate?

A
  • Often due to anaerobic infection
  • Or could be due to necrotizing tissue disease, such as:
    • Fungal disease
    • Tumour
    • Oro-sinus fistulae and other dental diseases
    • Turbinate necrosis
    • Necrotizing pneumonia
    • Foreign bodies
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7
Q

What likely organisms may be associated with guttural pouch empyema?

A
  • Streptococcus equi subsp equi (need to be most concerned about this one)
  • ‘Strangles’
  • Streptococcus equi subsp zooepidemicus
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8
Q

How would you confirm a diagnosis of Guttural pouch empyema that may be due to Streptococcus equi subsp equi?

A
  • Nasopharyngeal swab (for bacterial culture)
  • Guttural pouch wash
    • Bacterial culture
    • PCR diagnosis
  • Serology (specific markers of strangles bacteria)
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9
Q

How useful is serology in terms of suspected S.equi infection?

A
  • Good at determining recent (but not necessarily current) S equi infection,
  • Determining the need for booster vaccination
  • Does not distinguish between vaccine and infection response.
  • If the animal has recently been exposed to disease this can be useful
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10
Q

If serology is low for an animal we have assumed is infected with S.equi, why could this be?

A
  • Early infection (<14 days)
  • No S.equi equi involvement
  • Not exposed to S. equi equi in previous years
  • Immunocompromised (unlikely)
  • Lab error (unlikely)
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11
Q

In what 4 ways can serology for S.equi be interpreted?

A
  • Negative
  • Weak Positive (1 : 200–1 : 400)
  • ​Moderate Positive (1 : 800–1 : 1,600)
  • High Positive (1 : 3,200–1 : 6,400)
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12
Q

What could a negative serology result for S.equi mean?

A
  • No previous exposure to S equi or
  • Recent vaccine or exposure (<7 days)
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13
Q

What could a weak positive serology result for S.equi mean?

A
  • Could be almost anything
  • May represent very recent or residual antibody from exposure or vaccine from a long time ago
  • Repeat serology in 7 to 14 days to confirm recent exposure. (if increased in this time then active disease)
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14
Q

What could a moderate positive serology result for S.equi mean?

A
  • 2 to 3 weeks after exposure
    • The animal is mounting an immune response
  • Infection occurred 6 months to 2 years previously
    • Could indicate a waning response if there was exposure a while ago and the antibodies are on their way down
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15
Q

What could a high positive serology result for S.equi mean?

A
  • 4 to 12 weeks after infection
  • 1 – 4 weeks post vaccination
    • If not then positive for Strep.equi equi
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16
Q

What would you expect to see with bacteriology for S.equi?

A
  • Gram positive cocci
    • Growing in chains
  • Demonstrating beta-haemolysis
    • With mucoid colonies (look mucosy)
  • Confirm by carbohydrate assay
    • Does NOT ferment to sorbitol and lactose
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17
Q

Is strangles gram positive or negative?

A

Gram positive

18
Q

Which groups of horses would be more likely to contract strangles?

A
  • Highly infectious particularly weanlings and yearlings
    • Rarely affects horses >5
19
Q

Why is important for owners to monitor the temperature of ALL horses on a yard regularly (at least once daily) when there has been a case of strangles?

A
  • 24 hour window of opportunity to isolate new cases on the premises.
  • Early detection of pyrexia and prompt isolation of new cases will help control spreading of the disease on the premises
  • Horses develop pyrexia 24-48 hours before becoming infectious to other horses.
20
Q

How does strangles persist in the environment following an outbreak?

A
  • In acutely infected horse nasal shedding for 3-6 weeks after the disease, even after the resolution of clinical signs
  • Others become carriers (longer term shedding)
  • Fomites and contaminated environmental sources
  • In ideal conditions may survive up to 9 weeks
21
Q

Clinical signs of strangles?

A
  • Non-specific signs initially: fever, depression, inappetence, +/- cough, mucoid to purulent nasal discharge
  • Specific signs: abscessation of mandibular, parotid or retropharyngeal lymph nodes (eventually will rupture), dyspnea and dysphagia if abscesses compress larynx or interferes with cranial nerve supply to pharynx
22
Q

Pathogenesis of strangles?

A
  • Bacteria attaches to nasopharyngeal epithelial cells > mucosa > lymphatics > lymph nodes
  • Multiplies extracellularly
  • Resistance to phagocytosis mediated by HA capsule (very thick capsule and surface proteins) and antiphagocytic SeM, Mac proteins
  • Abscess formation and rupture/drainage then recovery and (hopefully) development of immunity
23
Q

Is immunity to strangles lifelong?

A
  • Natural infection - 76% do not tend to develop the disease again for at least four years
  • After this point immunity will wane and animals may develop the disease again
24
Q

Are vaccines available for strangles in the UK?

A
  • Vaccines (submucosal) in the UK
  • Not always available, important to check if there is current availability of the vaccine
25
Q

How would you treat horses with early clinical signs of strangles?

A

Penicillin

26
Q

How would you treat strangles horses at the stage of having lymph node abscesses?

A
  • Poulticing and drainage of abscesses
  • Antimicrobials not indicated
    • ‘May prolong resolution of the abscess’
    • Will just suppress the bacterium within the LNs and will not allow natural drainage to occur
27
Q

Complications of strangles?

A
  • Anaemia (common)
    • IMHA or anaemia of chronic inflammation
    • IMHA occurs quite commonly
  • Guttural pouch empyema which can progress to chondroids
  • Neurological abnormalities (dysphagia, laryngeal hemiplegia)
  • Abscesses distant site (Bastard Strangles - rare) E.g. lungs, abdomen, distal skeletal muscle
  • Purpura Heamorrhagica (rare but serious) - Immune mediated vasculitis.
28
Q

How would you diagnose and treat abdominal abscesses (as a complication of strangles)?

A
  • Diagnosis: U/S or rectal
  • Treatment: long term antibiotics (usually penicillin or trimethoprim sulfa/rifampin) for up to 6 weeks)
29
Q

How would you treat guttural pouch empyema or Chondroids (as a complication of strangles)?

A
  • Want to get rid of chondroids
  • Surgery via guttural pouch is not ideal, so instead flushing things out of the pouch is preferred
  • Drainage via the pharyngeal openings
  • Surgical drainage
  • Antibiotics
30
Q

What is purpura hemorrhagica? How does it present?

A
  • generalized vasculitis caused by Type III hypersensitivity reaction
  • Thrombosis of small arteries causes massive plaques of oedema etc.
  • Skin and muscle necrosis may result
  • Ventral oedema, body swelling and petechial hemorrhages on mucus membranes
31
Q

What is the other main differential for strangles?

A

Streptococcus equi subsp zooepidemicus

  • Most common respiratory opportunistic pathogen
  • Much lower infectivity (commensal)
  • No need to quarantine animals
  • Lesser economical/social impact
32
Q

Diagnosis of purpura haemorrhagica?

A

Clinical signs, skin biopsy

33
Q

Treatment of purpura haemorrhagica?

A
  • Dexamethasone: 0.05 - 0.2 mg/kg iv
  • Prednisolone: 0.5 - 1 mg/kg po
  • Analgesics – NSAIDS (if active disease is present)
  • IVF
  • Palliative measures e.g. hydrotherapy, massage
34
Q

Prognosis of purpura haemorrhagica?

A

Guarded

35
Q

What should you do in an outbreak of strangles?

A
  • Isolate premises
    • Isolate horses which have shown signs for at least four weeks after the signs resolve
    • Prevent movement of staff and equipment between cases
    • Phenolics are most effective disinfectant for equipment and areas contaminated with organic matter
  • Iodophores and chlorhexidine for staff
36
Q

What measures should be used to control strangles?

A
  • Quarantine and culture of incoming horses
  • Confirm resolution of disease
  • Penicillin - will prevent the disease during initial period
37
Q

How can you confirm resolution of strangles disease?

A

3 negative nasopharyngeal swabs/GP lavages (to sample fluid from guttural pouch) over 3 weeks tested by culture and PCR

38
Q

What is Guttural Pouch Tympany?

A
  • Gas accumulation within GP
  • Abnormal eustachian tube ostea prevents drainage and acts as one way valve
  • Non-painful swelling
  • MAY AFFECT AIRWAY
39
Q

How is gutteral pouch tympany treated?

A
  • Antibiotics, NSAIDs
  • Surgery – drainage into pharynx or opposite pouch (by laser) to fenestrate the guttural pouch
  • In dwelling catheter
  • Anything to remove the air from the GP
40
Q

Clinical signs of alar fold abnormalities?

A
  • Airflow obstruction
  • Exercise intolerance
  • Abnormal respiratory noises during fast exercise
41
Q

Diagnosis and treatment of alar fold abnormalities?

A
  • Diagnosis: direct visual examination - excessively prominent alar folds/temporarily suturing the false nostril open
  • Treatment: resection of the alar folds

CRS2 (64 decks)

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