Borrelia burgdorferi Infection and Lyme Disease in North American Horses: A Consensus Statement.

Borrelia burgdorferi infection is common in horses living in Lyme endemic areas and the geographic range for exposure is increasing. Morbidity after B. burgdorferi infection in horses is unknown. Documented, naturally occurring syndromes attributed to B. burgdorferi infection in horses include neuroborreliosis, uveitis, and cutaneous pseudolymphoma. Although other clinical signs such as lameness and stiffness are reported in horses, these are often not well documented. Diagnosis of Lyme disease is based on exposure to B. burgdorferi, cytology or histopathology of infected fluid or tissue and antigen detection. Treatment of Lyme disease in horses is similar to treatment of humans or small animals but treatment success might not be the same because of species differences in antimicrobial bioavailability and duration of infection before initiation of treatment. There are no approved equine label Lyme vaccines but there is strong evidence that proper vaccination could prevent infection in horses.

Lyme neuroborreliosis in 2 horses.

Lyme neuroborreliosis--characterized as chronic, necrosuppurative to nonsuppurative, perivascular to diffuse meningoradiculoneuritis--was diagnosed in 2 horses with progressive neurologic disease. In 1 horse, Borrelia burgdorferi sensu stricto was identified by polymerase chain reaction amplification of B burgdorferi sensu stricto-specific gene targets (ospA, ospC, flaB, dbpA, arp). Highest spirochetal burdens were in tissues with inflammation, including spinal cord, muscle, and joint capsule. Sequence analysis of ospA, ospC, and flaB revealed 99.9% sequence identity to the respective genes in B burgdorferi strain 297, an isolate from a human case of neuroborreliosis. In both horses, spirochetes were visualized in affected tissues with Steiner silver impregnation and by immunohistochemistry, predominantly within the dense collagenous tissue of the dura mater and leptomeninges.

Frontier medicine: the future and integrative medicine.

Vigorous and prolonged effort is required to gain true mastery of the healing arts. Conventional and complementary medicine have complementary strengths and weaknesses. Like the yin and yang of traditional Chinese medicine, they naturally flow into one another by a process of induction, creating balance. Integrative medicine is the frontier; it is the future. If we are to progress beyond our current understanding and ability to heal, we must work with theoretic models that allow us and our perception to operate "outside the box." For some, this understanding is intuitive. It is through cooperative and collaborative efforts of intuitively adept and technologically adept minds that we can integrate and advance our understanding; increase our ability to predict, prevent, and diagnose disease; and expand our therapeutic options.

Antimicrobial therapy for respiratory disease.

Antimicrobial treatment is an important component of infectious respiratory disease management. However, across all systems in horses there is substantial deficit in definitive information concerning the efficacy of antimicrobials. This disassociation between laboratory data and antimicrobial efficacy and the obstacles to effective antimicrobial treatment should be understood.

Advanced diagnostic imaging modalities available at the referral center.

While many equine diagnostic imaging procedures can be done in field, some procedures require specialized facilities, equipment or expertise which are generally only available in referral or specialty practices. As client awareness of the availability and advantages of these diagnostic procedures increases, veterinarians are faced with the increasing opportunity to utilize these services to provide optimal patient care. A working knowledge of the value and limitations of these methods is required to help guide veterinarians and clients in the selection of additional, and sometimes costly, diagnostic tests.

Approach to the emergency equine patient.

Often in emergency situations minimal data are collected, decisions are made, manipulations are performed, and therapeutics are administered without the collection of complete data sets that would indicate a detailed history and laboratory analysis. The incomplete clinical analysis may lead to occasional mistakes, but most often expediency is necessary and admirable. This article presents a clinical approach to emergency patients that requires minimal data collection in the face of the need for timely decision development. Medicolegal considerations are addressed briefly.

Possible normokalemic variant of hyperkalemic periodic paralysis in two horses.

Hyperkalemic periodic paralysis (HPP), characterized by intermittent episodes of muscle fasciculations, profound muscle weakness, and hyperkalemia, has been described in Quarter Horses, Appaloosas, and Paints. In previous reports, the hallmark of this syndrome has been the development of hyperkalemia during each episode. Two affected horses had episodes of paralysis without associated hyperkalemia, demonstrating that normokalemia during an episode otherwise consistent with HPP does not eliminate HPP as a diagnosis. This clinical presentation appeared to be a variant of HPP.

Diagnostic techniques for evaluation of the paranasal sinuses.

Physical examination of the paranasal sinuses is often insufficient to confidently reach a conclusion concerning suspected pathology in these cavities. Often, other evaluation techniques are necessary. This article describes physical examination, rhinoscopy, sinus centesis, radiology, and sinus endoscopy of the equine paranasal sinuses. These techniques can be used to diagnosis and determine the cause of most sinus disorders.