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Eqine respiratory conditions Flashcards

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1
Q

Which lymph nodes can we feel around the head for lymphadenopathy

A

Submandibulars
cannot feel retropharyngeals externally

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2
Q

What type of virus is equine influenza

A

ssRNA orthomyxovirus type A

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3
Q

CLinical signs of equine influenze

A

Pyrexia, inappetance, lethargy, nasal discharge
Dry persistent cough very noticeable often

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4
Q

Diagnosis of equine influenza

A

Do nasopharyngeal swabs while animal is sick

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5
Q

How does vaccination against equine influenze help

A

Reduces shedding and severity but does not prevent infection

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6
Q

Vaccine schedule for influenza

A

First vaccine
Then second one within 21-60 days
Third one 120-180 days

Then booster 6-12 monthly

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7
Q

How to deal with equine influenza case

A

Isolation for 14 days
Long rest and recovery
NSAIDs

Only do antibiotics if there is a secondary infection

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8
Q

What is the cause of strangles and what type of bacteria is it

A

Streptococcus equi v equi
= gram +ve cocci

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9
Q

Pathogenesis of strangles

A

Bacteria enter oro-nasal cavity and enter cryp cells of tonsil –> spread to regional lymph nodes and cause lymphadenopathy

Then a few days later get lymphoid hyperplasia and abscessation

From 7 days + can get rupture of the LN which causes infectious pus to come out of nose via floor of guttural pouch

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10
Q

How can we try and isolate horses before LN rupture in strangles

A

They have pyrexia before the rupture so isolate them then
Should do 2X daily temperature checks for any in contacts of a confirmed case

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11
Q

Can we get endemicity of strangles

A

Yes because a small % remain persistently infected

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12
Q

Why is strep equi v equi so important

A

Can be fatal via asphyxiation or by high cost of treatment

Can spread easily in residential premises

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13
Q

What aerosolises more out of influenza and strangles

A

Influenza
(strnalges does not aerosolise much)

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14
Q

Clinical signs of strangles

A

Pyrexia, lethargy, mucopurulent nasal discharge, submandiular/retropharyngeal lymphadenopathy, inappetance/dysphagia

+ less commonly, higher resp rate and effort, stridor, can mimic choke with water/food down nose

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15
Q

Which LNs are located near the floor of the guttural pouch

A

Retropharyngeals

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16
Q

Why can horses with strangles be dysphagic

A

1) Physical obstruction due to enlarged LNs

2) Some neuropraxia because enlargeds LNs are interfering with nerves on floor of guttural pouch

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17
Q

Are horses with strep equi v equi chondroids a large risk to population

A

Not really bceause chondroids usually PCR negative

If they have empyema though they are

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18
Q

What should we consider if we see empyema but negative strangles test

A

Probably still strangles

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19
Q

What is an appropriate screening test for strangles i.e pre-movement

A

SCoping guttural pouch and submitted aspirates

ELISAs are NOT useful if there is no clinical suspicion

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20
Q

How does strangles survive in the environment

A

Not well; especially not in summer
So leaving horses outside with it is a good idea

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21
Q

What can mild strangles look like

A

Unexplained pyrexia, mild cloudy nasal discharge

In any unexplained pyrexia should check the guttural pouches

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22
Q

What is bastard strangles

A

Where there is haematogenous or lymphoid spread of strep equi v equi

Leads to purulent material and abscessation wherever the bacteria go

e.g meningitis, skin swelling, mesenteric abscessation

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23
Q

Which animals do we typically see bastard strangles in

A

Very ill animals that haven’t been given antibioitics

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24
Q

What is purpura haemorrhagica

A

Severe vasculitis triggered by illness such as strangles
Requires high steroid doses

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25
What does the strangles ELISA detect (and when might it be low or high)
SEM May not be expressed in persistently infected genomes Very high titre with purpura haemorrhagica
26
What are some potential complications of strangles
* Bastard strangles * Purpura haemorrhagica * Myopathies
27
Treating strangles
NSAIDs +/- paracetamol Give penicillin if horse is persistently pyrexic, dull and miserable, if there is dysphagia or stridor Flush out guttural pouch via scope or foley catheter (may instill penicillin here)
28
WHat must we advise owners when giving antibiotics for strangles
Can get poorer seroconversion and may get flare up of abscess after therapy But if they need it must give
29
What types of viruses are EHV1,4
alpha herpesviruses
30
Characteristics of equine herpes virus infection
~80% infected as youngsters Pyrexia, nasal discharge, cough, lethargy Abortion may be first clue Get latency in trigeminal ganglion; rarely get recrudensce
31
Do we need to isolate latently infected herpes cases
No
32
What is gold standard for diagnosing equine herpes virus
Virus isolation (but it is slow)
33
Vaccination schedure for EHV1/4
1st one from 5 months, then another 4-6 weeks later, boost at 6 months Then give at 5, 7 and 9 months gestation to mares NB: this vaccine reduces shedding and severity but not prevent abortion or neuro signs; it is licensed for respiratory disease
34
How does EHV1,4 enter body and proliferate
Enters respiratory epithelial cells, goes to monocytes/lymphocytes then to blood vessels/LNs Get a cell associated viraemia and replicatino in vessel endothelium
35
How much rest to give pyrexic horses
1 week for every day of pyrexia
36
What type of virus is equine viral arteritis
RNA alpha-arterivirus
37
What does equine viral arteritis cause
Pyrexia, inappetence, conjunctivitis, vasculitis so oedema, abortion = can be maintained in carrier stallions so should not be kept for breeding
38
What is the use of a rebreathing exam
Increases the inspired CO2 of horses, making them breathe more heavily and improving sensitivity of auscultation Becomes easier to hear harsh sounds, crackles from fluid Or areas of no nosie
39
What can bloods be useful for in a respiraotry work up
Systemic inflammation is indicative of pneumonia vs in asthma, the bloods will look normal
40
What tests is BAL best for
Cytology
41
What method can be used for resp secretion culture
Tracheal wash if a triple lumen catheter used Or transtracheal wash is best
42
What areas do BALs vs TW samples and what does this make them good at identifying
BALs sample just a single region of lung; so good at identifying diffuse disease TWs sample everything
43
How to do a BAL
Place long tube up ventral meatus Use opioid to suppress cough (+ may ahve LA) Instill ~300ml saline and aspirate back (discarding first syringe) Place in EDTA tube
44
What is an indication of a good BAL sample
It is foamy due to surfactant from alveoli
45
How do we do a tracheal wash
requies endoscopy Use catheter to instill 20-30ml sterile saline and reaspirate For culture use plain tube For cytology use EDTA tube
46
What bacteria are likely to be contaminants if seen on tracheal wash
pseudomona, S aureus, Bacillus
47
What is the difference between recurrent airway obstruction and inflammatory aidway disease
RAO = severe asthma i.e increased resp effort at rest, lifelong condition, see coughing too - tend to be >7y/o IAD = mild/moderate asthma; no signs at rest but occasional cough or exercise intolerance; tends to resolve; generally young
48
What do asthma BAL results look like
High percentage of neutrophils - Normal is 5% - In IAD see >10 - In RAO see >25 Tend to see elevated mast cells in IAD (mild-moderate asthma) as feature of airway hyperresponsiveness
49
Management of asthma
Low dust; dust extracted bedding, soaked hay, maximum turn out time, improve ventilation, no straw at all Medication: steroids, bronchodilators
50
What is exercise induced pulmonary haemorrhage
Where horses undergoing very strenuous exercise get rupture of pulmonary capilaries (thin walled and get low airway pressures and very high vascular pressures in exercise) If severe can affect performance
51
What is a fading horse often a symptom of and how do we diagnose
Exercise induced pulmonary haemorrhage Need to scope in 30-120 mins after exercise and score 0-4 based on blood in airway
52
IF we see haemosiderophages on BAL what does this suggest
There has been historic exercise induced pulmonary haemorrhage snce this is digested blood But note this does overestimate prevalence
53
What should we do if horse has suffered exercise induced pulmonary haemorrhage
Rest and steroids Want to avoid new bleeds Can give furosemide before training to prevent bleeding occuring
54
What area does the following affect: interstitial pneumonia, bronchopneumonia, pleuropneumonia
Interstitial = parenchyma Bronchophneumonia = parenchyma and bronchi Pleuropneumonia = parenchyma + bronchi + pleural space
55
What are risk factors for bacterial pneumonia
Long distance travel because means head not let down for long periods Cross tying (prevents head going down) Resp tract disease Apiration e.g from oesophageal pbstructions, dysphagia
56
Which cause of bacterial pneumonia has the worst prognosis
Those due to aspiration as have a much larger range of aspirated bacteria vs normal commesnals strep zooepidemicus If anaerobes involved = worse prognosis
57
What is the most common bacteria to isolate on TW from bacterial pneumonia
Strep zooepidemicus
58
Clinical signs of bacterial pneumonia
Tachypnoea, weight loss, pyrexia, cough, nasal discharge If they have fetid breaths suggests anaerobes involved (worse prognosis)
59
What would we see on bloods with bacterial pneumonia
leucocytosis +/- left shift, increased SAA, anaemia
60
What is a good antibiotic selection for bacterial pneumonia
Penicillin + gentamycin + metronidazole
61
What are some possible complications of bacterial pneumonia
Abscessation Broncho-pleural fistulae Pericarditis Thrombophlebitis Laminitis
62
What two types of fungal pneumonia are there
Primary pathogens e.g histoplasma, coccidiodes, cryptococcus Or those secondary to immunocompromise e.g aspergillus, candida
63
What might a neurophilic/eosinophilic tracheal wash point towards
Parasitic pneumonia
64
Signs of interstitial pneumonia
* Exercise intolerance * Increased effort at rest * Pulmonary hypertension/cor pulmonale
65
What can cause interstitial pneumonia
OFten not clear - Viral e.g EHV, influenza, EVA Smoke inhalation
66
What can cause pneumothorax
* Bronchopleural fistulae secondary to pneumonia * Penetrating thoracic injuries * Oesophageal peforations Can be well tolerated if unilateral
67
What is equine multinodular pulmonary fibrosis
= interstitial fibrosis associated with EHV-5 by unclear pathogenesis See large discrete or multiple coalescing opacities on radiography Diagnosis of exclusion Poor prognosis
68
Is presumed asthma is not responding to treatment what other condition should we think about
Equine multinodular pulmonary fibrosis
69
At what temperature should we isolate a horse
38.5 Ideally measure temperature twice per day to get baseline normal temperature and account for diurnal variation
70
What is the difference between quarantine and isolation
Quarantine = isolation of animals potentially incubating infections; minimum 2-3 weeks Isolation = separation of animal with known disease to prevent transmission
71
What does effective quarnatine mean
Physical separation of >10-20m from resident animals or more if influenza Separate staff and equipment
72
What are the three types of disease caused by herpes viruses
Respiratory Abortion Neurological
73
How does complement fixation test work
Where antibodies bind to complement, preventing complement from causing RBC haemolysis so we see a pellet or RBCs rather than haemolysis
74
If we see a horse with heart rate over 60 what does this suggest
Not just related to being in pain; should consider shock
75
What is our primary concern with a pony which has travelled for a long time and is now pyrexic, high heart rate, high resp rate and effort
Pleuropneumonia - Because head not down for long periods of time
76
What is our approach to a case with suspected pleuropneumonia
Don't need to isolate the horse Pain relief; paracetamol + fluids - Ideally check kidneys before NSAIDs Ultrasound Pengentmet
77
What do we need to be aware of when giving an alpha-2 agonist to a horse with a temperature
They look very poor with panting and sweating for ~15 mins after giving sedation; just be aware of this
78
Treating pleuropneumonia
1. Antibiotics; penicilling, gentamcin, metronidazole 2. Drain fluid if needed 3. Use tissue plasminogen activator to break down fibrinour nets in lungs in some cases
79
What are haemosiderophages and what do they tell us
Macophages with digested blood in them Tells us that there is some chronicity to the exercise induced pulmonary haemorrhage; i.e these aren't from this incident as take time to appear
80
When should we ideally scope a horse after it has pulled up from a race to tell if EIPH is the cause of this
With 30 mins to 2 hours - Then grade it on scale; if high at same time as fading episode means likely to be the cause
81
What condition can lead ot high pulmonary pressures in exercise and epistaxis/pulling up
Atrial fibrillation
82
Treatment for EIPH
Must have rest; no fast work Steroids; start with oral prednisolone then move to inhalers as it works more
83
What type of cells do we see on a tracheal wash from horse with EIPH
Very high neutrophils count Haemosiderophages
84
What is a BAL contraindicated
if the horse is struggling the breathe already
85
If a tracheal wash shows plant material and bacteria what does this suggest
Aspiration pneumonia secondary to choke
86
What is a heave line
hypertrophy of external abdominal oblique due to increased resp effort
87
What does severe equine asthma mean
Showing obvious signs at rest; coughing, tachypnoea
88
Treatment for acute asthma (rescue and maintenance)
Rescue therapy = IV atropine/buscapon, IV dexamethasome Maintenance; oral preds, oral clenbutor, then inhaled steroids/bronchodilators
89
Treatment of asthma after acute episode controlled
Management is mainstay + steroids; oral prednisolone or IM dex for some owners Beta-2 agonists?
90
What are the advantages of the flexineb
Better tolerance from the horse vs baby spacer Medication cheap to refill once purchase made Better amount of drug breathed in
91
Out of tracheal wash and BAL which is better for cytology vs bacteriology
TW = better for bacteriology because no exposure to commensals on way down BAL = better for cytology
92
WHat is a normal amount of neutrophils on BAL vs TW
TW: <20% BAL: <5-10% neutrophils
93
Which cell type predominates in equine asthma
Neutrophils (NB this is different to humans)
94
Why are anti-histamines not routinely used in equine arthma
Poor bioavailability
95
Treatment of fungal pneumonia
Azoles AMphotericin B (NB: can get phlebitis, anorexia, dysrhythmias, anaemia)
96
How long to give antibiotics for bacterial pneumonia
4-6 weeks + want stall rest and gradual return to exercise
97
What causes guttural pouch mycosis and what is the treatment
Aspergillus Topical azoles e.g enilconazole Could do systemic intraconazole
98
Treatment of strangles
Symptomatic mostly; NSAIDs, soft foot, hot packing abscesses Can use antibiotics in some cases
99
When might we use antibiotics in a strangles case and which do we pick
 High fever/malaise  Severe lymphadenopathy causing respiratory distress  Metastatic abscessation  Purpura haemorrhagica requiring glucocorticoids Choose penicillin NB: impairs immunity to stranlges developing
100
Can we use prophylactic antibiotics in a stranlges outbreak
NO
101
What to do with carrier status strangles animals
Treat with antiibotics Chondroids require endoscopic removal?
102
Treatment of influenza
Sympatomatic; rest, hydration, NSAIDs, paracetamol + if showing signs of resp distress more than 10 days later can give anitbioics due to high risk of secondary infection
103
What is key when returning to work after influenza
Do not do too early; can end up with coughing and inflammation for weeks
104
What antiviral drug would we use in influenza outbreaks or to deal with neurological disease in herpes virus
Valacyclovir
105

Equine (26 decks)

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