RESUMEN
BACKGROUND: Sepsis is a significant cause of morbidity and mortality in neonatal foals, especially during the first 7 days of life. Diagnosing sepsis in neonatal foals can be challenging because initial clinical signs are often ambiguous and non-specific. OBJECTIVES: To determine if the major acute phase protein serum amyloid A (SAA) as measured by a point-of-care SAA testing device can be used as an evidence-based biomarker of sepsis. STUDY DESIGN: Retrospective cohort. METHODS: Clinical diagnosis of sepsis based on positive bacterial blood culture or a positive sepsis score was obtained and compared to SAA values in a population of neonatal foals on a breeding farm and referral hospital during four consecutive foaling seasons. A rapid, point-of-care blood test was used to measure SAA concentrations in neonatal foals <36 hours old that were clinically diagnosed as healthy, sick non-septic or septic. RESULTS: The septic foals (n = 35) had a median SAA concentration (114 µg/mL) that was significantly greater (P < .05) than that for foals in the sick non-septic (n = 117, 1.5 µg/mL) and healthy (n = 245, 0 µg/mL) groups. At a diagnostic threshold of 100 µg/mL, the SAA test had a sensitivity of 52.9% (95% CI 36.5-68.9), specificity of 97.5% (95% CI 95.0-99.0), positive predictive value of 75.0% (95% CI 56.2-87.5), negative predictive value of 93.7% (95% CI 91.2-95.5), and a test accuracy of 92.1% (95% CI 88.2-95.0). CONCLUSIONS: The results of this study indicate that SAA is a useful aid in the diagnosis of sepsis in the neonatal foal.
Asunto(s)
Enfermedades de los Caballos , Sepsis , Animales , Animales Recién Nacidos , Enfermedades de los Caballos/diagnóstico , Caballos , Estudios Retrospectivos , Sepsis/diagnóstico , Sepsis/veterinaria , Proteína Amiloide A SéricaRESUMEN
OBJECTIVE: To estimate the prevalence of extended-spectrum cephalosporin-, carbapenem-, and fluoroquinolone-resistant bacteria of the family Enterobacteriaceae in the feces of hospitalized horses and on hospital surfaces. SAMPLE: Fecal and environmental samples were collected from The Ohio State University Galbreath Equine Center (OSUGEC) and a private referral equine hospital in Kentucky (KYEH). Feces were sampled within 24 hours after hospital admission and after 48 hours and 3 to 7 days of hospitalization. PROCEDURES: Fecal and environmental samples were enriched, and then selective media were inoculated to support growth of Enterobacteriaceae bacteria that expressed resistance phenotypes to extended-spectrum cephalosporins, carbapenems, and fluoroquinolones. RESULTS: 358 fecal samples were obtained from 143 horses. More samples yielded growth of Enterobacteriaceae bacteria that expressed resistance phenotypes (AmpC ß-lactamase, OR = 4.2; extended-spectrum beta-lactamase, OR = 3.2; and fluoroquinolone resistance, OR = 4.0) after 48 hours of hospitalization, versus within 24 hours of hospital admission. Horses hospitalized at KYEH were at greater odds of having fluoroquinolone-resistant bacteria (OR = 2.2). At OSUGEC, 82%, 64%, 0%, and 55% of 164 surfaces had Enterobacteriaceae bacteria with AmpC ß-lactamase phenotype, extended-spectrum beta-lactamase phenotype, resistance to carbapenem, and resistance to fluoroquinolones, respectively; prevalences at KYEH were similarly distributed (52%, 32%, 1%, and 35% of 315 surfaces). CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that antimicrobial-resistant Enterobacteriaceae may be isolated from the feces of hospitalized horses and from the hospital environment. Hospitalization may lead to increased fecal carriage of clinically important antimicrobial-resistance genes.
Asunto(s)
Carbapenémicos , Fluoroquinolonas , Animales , Antibacterianos/farmacología , Cefalosporinas , Enterobacteriaceae , Heces , Fluoroquinolonas/farmacología , Caballos , Hospitales , Ohio , PrevalenciaRESUMEN
BACKGROUND: The hypothalamic-pituitary-adrenal axis regulates the response to sepsis-associated stress. Relative adrenal insufficiency or adrenocorticotropic hormone (ACTH):cortisol imbalance, defined as a poor cortisol response to administration of ACTH, is common and associated with death in hospitalized foals. However, information on other adrenal steroid response to ACTH stimulation in sick foals is minimal. OBJECTIVE: To investigate the response of multiple adrenocortical steroids to administration of ACTH in foals. ANIMALS: Hospitalized (n = 34) and healthy (n = 13) foals. METHODS: In this prospective study, hospitalized foals were categorized into 2 groups using cluster analysis based on adrenal steroids response to ACTH stimulation: Cluster 1 (n = 11) and Cluster 2 (n = 23). After baseline blood sample collection, foals received 10 µg of ACTH with additional samples collected at 30 and 90 minutes after ACTH. Steroid and ACTH concentrations were determined by immunoassays. The area under the curve (AUC) and Delta0-30 were calculated for each hormone. RESULTS: The AUC for cortisol, aldosterone, androstenedione, pregnenolone, 17α-OH-progesterone, and progesterone were higher in critically ill (Cluster 1) compared to healthy foals (P < .01). Delta0-30 for cortisol and 17α-OH-progesterone was lower in Cluster 1 (24%, 26.7%) and Cluster 2 (16%, 11.2%) compared to healthy foals (125%, 71%), respectively (P < .05). Foals that died had increased AUC for endogenous ACTH (269 versus 76.4 pg/mL/h, P < .05) accompanied by a low AUC for cortisol (5.5 versus 15.5 µg/dL/h, P < .05), suggesting adrenocortical dysfunction. CONCLUSION AND CLINICAL IMPORTANCE: The 17α-OH-progesterone response to administration of ACTH was a good predictor of disease severity and death in hospitalized foals.
Asunto(s)
Corticoesteroides/sangre , Hormona Adrenocorticotrópica/farmacología , Enfermedades de los Caballos/sangre , Enfermedades de los Caballos/tratamiento farmacológico , 17-alfa-Hidroxiprogesterona/sangre , Hormona Adrenocorticotrópica/administración & dosificación , Animales , Animales Recién Nacidos , Área Bajo la Curva , Análisis por Conglomerados , Enfermedad Crítica , Femenino , Enfermedades de los Caballos/mortalidad , Caballos , Masculino , Pronóstico , Estudios Prospectivos , Sepsis/tratamiento farmacológico , Sepsis/veterinariaRESUMEN
The objective of this study was to determine the prevalence of Rhodococcus equi strains resistant to macrolides and rifampin over time in clinical samples from foals submitted to diagnostic laboratories in central Kentucky. We performed a retrospective observational study of all clinical samples from foals that were submitted to veterinary diagnostic laboratories in Kentucky between January 1995 and December 2017. Samples were included if the R. equi bacterium was cultured and tested for in vitro susceptibility to erythromycin or rifampin. In vitro susceptibility testing to erythromycin was available for 2,169 isolates of R. equi, while susceptibility testing to both erythromycin and rifampin was available for 1,681 isolates. Rifampin resistance was first detected in 2000, and erythromycin resistance was first detected in 2004. Between 1995 and 2006, the proportion of resistant isolates of R. equi was 0.7% for erythromycin and 2.3% for rifampin. There was a significant (P < 0.001) increase in the proportion of resistant R. equi between 2007 and 2017, with 13.6% of isolates being resistant to erythromycin and 16.1% being resistant to rifampin. Between 2007 and 2017, isolates of R. equi resistant to erythromycin or rifampin were significantly less likely to be isolated from feces than from the respiratory tract, other soft tissues, or musculoskeletal infections. The considerable increase in the prevalence of isolates of R. equi resistant to macrolides and rifampin since 2007 is of concern for both human and animal health.
Asunto(s)
Infecciones por Actinomycetales/veterinaria , Antibacterianos/farmacología , Eritromicina/farmacología , Enfermedades Musculoesqueléticas/veterinaria , Rhodococcus equi/efectos de los fármacos , Rifampin/farmacología , Infecciones de los Tejidos Blandos/veterinaria , Infecciones por Actinomycetales/tratamiento farmacológico , Infecciones por Actinomycetales/epidemiología , Infecciones por Actinomycetales/microbiología , Animales , Azitromicina/farmacología , Claritromicina/farmacología , Farmacorresistencia Bacteriana Múltiple/efectos de los fármacos , Farmacorresistencia Bacteriana Múltiple/genética , Equidae , Heces/microbiología , Caballos , Kentucky/epidemiología , Pruebas de Sensibilidad Microbiana , Enfermedades Musculoesqueléticas/tratamiento farmacológico , Enfermedades Musculoesqueléticas/epidemiología , Enfermedades Musculoesqueléticas/microbiología , Prevalencia , Sistema Respiratorio/efectos de los fármacos , Sistema Respiratorio/microbiología , Rhodococcus equi/genética , Rhodococcus equi/crecimiento & desarrollo , Rhodococcus equi/aislamiento & purificación , Infecciones de los Tejidos Blandos/tratamiento farmacológico , Infecciones de los Tejidos Blandos/epidemiología , Infecciones de los Tejidos Blandos/microbiologíaRESUMEN
OBJECTIVES: To (1) determine the occurrence of spurious hypercreatininemia in a population of hospitalized foals<2 days old, (2) assess the resolution of the hypercreatininemia, and (3) determine its association with survival in these foals. DESIGN: Retrospective case series. SETTING: 2 Referral hospitals. ANIMALS: Foals<2 days old with an admission creatinine>442 micromol/L (>5.0 mg/dL) from 2 referral hospitals. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The medical records of 33 foals were reviewed. Twenty-eight had spurious hypercreatininemia and 5 had acute renal failure. Admission creatinine was not significantly different between the 2 groups (mean [standard deviation]). The creatinine was 1,202 micromol/L (663 micromol/L) (13.6 mg/dL [7.5 mg/dL]) versus 1,185 micromol/L (787 micromol/L) (13.4 mg/dL [8.9 mg/d]) (P=0.96) in each group, respectively, though BUN at the time of hospital admission was significantly higher for acute renal failure foals (P=0.009). In the spurious group, serum creatinine at admission decreased to 504 micromol/L (380 micromol/L) (5.7 mg/dL [4.3 mg/dL]) by 24 hours, and to 159 micromol/L (80 micromol/L) (1.8 mg/dL [0.9 mg/dL]) at 48 hours, and to 115 micromol/L (44 micromol/L) (1.3 mg/dL [0.5 mg/dL]) at 72 hours. Twenty-three of 28 foals with spurious hypercreatininemia survived to hospital discharge and there was no difference in mean admission creatinine between survivors (1176 micromol/L [628 micromol/L]) (13.3 mg/dL [7.1 mg/dL]) and nonsurvivors (1308 micromol/L [857 micromol/L]) (14.8 mg/dL [9.7 mg/dL]) (P=0.67). Twenty of 28 foals had clinical signs suggestive of neonatal encephalopathy. CONCLUSION: Creatinine decreased by >50% within the initial 24 hours of standard neonatal therapy and was within the reference interval in all but 1 foal within 72 hours of hospitalization. The diagnosis of neonatal encephalopathy was common in these foals.
Asunto(s)
Creatinina/sangre , Enfermedades de los Caballos/sangre , Enfermedades Renales/veterinaria , Lesión Renal Aguda/sangre , Lesión Renal Aguda/mortalidad , Lesión Renal Aguda/veterinaria , Animales , Animales Recién Nacidos , Nitrógeno de la Urea Sanguínea , Encefalopatías Metabólicas/sangre , Encefalopatías Metabólicas/terapia , Encefalopatías Metabólicas/veterinaria , Femenino , Enfermedades de los Caballos/mortalidad , Enfermedades de los Caballos/terapia , Caballos , Enfermedades Renales/sangre , Enfermedades Renales/mortalidad , Enfermedades Renales/terapia , Masculino , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
OBJECTIVE: To report short- and long-term survival and factors affecting outcome of foals after surgical correction of gastric outflow obstruction. STUDY DESIGN: Case series. ANIMALS: Foals (n=40) aged 5-180 days. METHODS: Clinical signs, laboratory data, diagnostic imaging, surgical findings, surgical procedures, medical treatment, and necropsy findings were retrieved from medical records. Outcome was obtained by reviewing performance, sales, and produce records or by telephone conversations with the owners. RESULTS: Gastric outflow obstruction was treated by gastroduodenostomy or by gastrojejunostomy with or without jejunojejunostomy. Long-term follow-up was available for 36 of 39 foals that survived to hospital discharge; 25 (69%) survived >2 years. All 8 foals with pyloric obstruction survived >2 years, whereas only 11 of 21 (52%) foals with duodenal obstruction survived >2 years. Six of 8 foals with obstruction of the duodenum and pylorus survived >2 years. Obstruction of the duodenum, adhesions to the duodenum, and postoperative ileus were significantly associated with decreased long-term survival. CONCLUSIONS: Long-term outcome after gastric bypass procedures was substantially improved compared with previous reports. Factors that may have contributed to improved survival include better case selection and performing the gastrojejunostomy with the jejunum aligned from left to right. CLINICAL RELEVANCE: The prognosis for long-term survival after surgical bypass of pyloric obstruction is excellent. The overall prognosis for long-term survival after surgical bypass of duodenal obstruction is fair but should be considered guarded in those with pre-existing duodenal adhesions.
Asunto(s)
Derivación Gástrica/veterinaria , Obstrucción de la Salida Gástrica/veterinaria , Enfermedades de los Caballos/cirugía , Animales , Animales Lactantes , Derivación Gástrica/efectos adversos , Derivación Gástrica/métodos , Obstrucción de la Salida Gástrica/cirugía , Caballos , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/veterinaria , Factores de RiesgoRESUMEN
OBJECTIVE: To identify risk factors for equine protozoal myeloencephalitis (EPM) among horses examined at 11 equine referral hospitals. DESIGN: Case-control study. ANIMALS: 183 horses with EPM, 297 horses with neurologic disease other than EPM (neurologic controls), and 168 horses with non-neurologic diseases (non-neurologic controls) examined at 11 equine referral hospitals in the United States. PROCEDURES: A study data form was completed for all horses. Data were compared between the case group and each of the control groups by means of bivariate and multivariate polytomous logistic regression. RESULTS: Relative to neurologic control horses, case horses were more likely to be > or = 2 years old and to have a history of cats residing on the premises. Relative to non-neurologic control horses, case horses were more likely to be used for racing or Western performance. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that cats may play a role in the natural epidemiology of EPM, that the disease is less common among horses < 2 years of age relative to other neurologic diseases, and that horses used for particular types of competition may have an increased risk of developing EPM.
Asunto(s)
Enfermedades de los Gatos/epidemiología , Encefalomielitis/veterinaria , Enfermedades de los Caballos/epidemiología , Infecciones Protozoarias en Animales/epidemiología , Factores de Edad , Animales , Estudios de Casos y Controles , Enfermedades de los Gatos/etiología , Enfermedades de los Gatos/transmisión , Gatos , Infecciones Protozoarias del Sistema Nervioso Central/epidemiología , Infecciones Protozoarias del Sistema Nervioso Central/etiología , Infecciones Protozoarias del Sistema Nervioso Central/transmisión , Infecciones Protozoarias del Sistema Nervioso Central/veterinaria , Reservorios de Enfermedades/veterinaria , Encefalomielitis/epidemiología , Encefalomielitis/etiología , Encefalomielitis/parasitología , Femenino , Enfermedades de los Caballos/etiología , Enfermedades de los Caballos/transmisión , Caballos , Modelos Logísticos , Masculino , Análisis Multivariante , Infecciones Protozoarias en Animales/etiología , Infecciones Protozoarias en Animales/transmisión , Factores de RiesgoAsunto(s)
Enteritis/veterinaria , Enfermedades de los Caballos/diagnóstico , Enfermedades de los Caballos/tratamiento farmacológico , Abdomen/diagnóstico por imagen , Animales , Antiinfecciosos/administración & dosificación , Antiinflamatorios/administración & dosificación , Clioquinol/administración & dosificación , Dexametasona/administración & dosificación , Diagnóstico Diferencial , Diarrea/etiología , Diarrea/veterinaria , Enteritis/diagnóstico , Enteritis/tratamiento farmacológico , Resultado Fatal , Fibrinógeno/análisis , Enfermedades de los Caballos/patología , Caballos , Intestino Delgado/patología , Masculino , Metronidazol/administración & dosificación , Neutrófilos , Pronóstico , Albúmina Sérica/análisis , Resultado del Tratamiento , Ultrasonografía , Pérdida de PesoAsunto(s)
Obstrucción Duodenal/veterinaria , Esofagitis/veterinaria , Derivación Gástrica/veterinaria , Enfermedades de los Caballos/diagnóstico , Úlcera Gástrica/veterinaria , Animales , Antibacterianos/administración & dosificación , Antiulcerosos/administración & dosificación , Bruxismo/etiología , Bruxismo/veterinaria , Cólico/etiología , Cólico/veterinaria , Diagnóstico Diferencial , Obstrucción Duodenal/diagnóstico , Obstrucción Duodenal/etiología , Obstrucción Duodenal/terapia , Esofagitis/complicaciones , Esofagitis/tratamiento farmacológico , Femenino , Fluidoterapia/veterinaria , Gastroscopía/veterinaria , Gentamicinas/administración & dosificación , Enfermedades de los Caballos/etiología , Enfermedades de los Caballos/terapia , Caballos , Penicilinas/administración & dosificación , Ranitidina/administración & dosificación , Sialorrea/etiología , Sialorrea/veterinaria , Úlcera Gástrica/complicaciones , Úlcera Gástrica/tratamiento farmacológicoAsunto(s)
Infecciones por Actinomycetales/veterinaria , Enfermedades de los Caballos/microbiología , Neumonía Bacteriana/veterinaria , Rhodococcus equi/aislamiento & purificación , Absceso/diagnóstico por imagen , Absceso/veterinaria , Infecciones por Actinomycetales/diagnóstico , Infecciones por Actinomycetales/tratamiento farmacológico , Infecciones por Actinomycetales/microbiología , Animales , Antibacterianos/administración & dosificación , Azitromicina/administración & dosificación , Diagnóstico Diferencial , Enfermedades de los Caballos/diagnóstico , Enfermedades de los Caballos/tratamiento farmacológico , Caballos , Pulmón/diagnóstico por imagen , Masculino , Neumonía Bacteriana/diagnóstico , Neumonía Bacteriana/tratamiento farmacológico , Neumonía Bacteriana/microbiología , Radiografía Torácica/veterinaria , Rifampin/administración & dosificación , UltrasonografíaRESUMEN
Lower respiratory tract infection is common in weanling- and suckling-aged animals. Increased susceptibility to disease in this age group can result from a delay in the establishment of a competent immune system and environmental factors, such as overcrowding, shipping, and sales. S zooepidemicus and R equi are the two most common bacterial isolates. S equi is primarily a disease of the lymph nodes and upper respiratory tract. Viral agents can compromise the natural defense mechanisms of the respiratory tract, resulting in secondary bacterial infections. The acute respiratory distress syndrome is one of unknown etiology and high mortality.