Otitis externa in eight horses - clinical signs, treatment and prognosis.

BACKGROUND: Otitis externa is rare in horses and the condition is poorly described in the literature. OBJECTIVE: To describe clinical signs, treatment regimens and prognosis of otitis externa in horses. ANIMALS: Eight horses diagnosed with otitis externa during 2011-2018. METHODS: Retrospective review of medical records and follow-up contact with owners. RESULTS: Common clinical signs seen in affected horses were pruritus, ear discharge and ear droop of affected ears. The most common cytological findings were neutrophils, bacteria and yeast. All horses responded well to treatment; two horses were reported to have recurrent problems. CONCLUSION AND CLINICAL IMPORTANCE: Otitis externa in horses is a rare and treatable condition. The condition may be present for prolonged periods before owners become aware, compromising the welfare of affected horses. Untreated otitis externa is a suggested cause of otitis media and temporohyoid osteoarthropathy, emphasizing the importance of identifying and treating this condition at an early stage. For this reason, clinicians should include a brief inspection of the pinnae and external ear canal in the clinical examination of horses.

Nerve growth factor receptors in equine synovial membranes vary with osteoarthritic disease severity.

Nerve growth factor (NGF) is a neurotrophin that has been implicated in pain signaling, apoptosis, inflammation and proliferation. The resultant effects depend on interaction with two different receptors; tyrosine kinase A (TrkA) and p75NTR . NGF increases in synovial fluid from osteoarthritic joints, and monoclonal antibody therapy is trialed to treat osteoarthritis (OA)-related pain. Investigation of the complex and somewhat contradictory signaling pathways of NGF is conducted in neural research, but has not followed through to orthopaedic studies. The objectives of this study were to compare the expression of NGF receptors and the downstream regulator BAX in synovial membranes from joints in various stages of OA. The horse was used as a model. Synovial membranes were harvested from five healthy horses postmortem and from clinical cases with spontaneous OA undergoing arthroscopic surgery for lameness. Four horses with synovitis without gross cartilage changes, four horses with synovitis and cartilage damage, and four horses with synovitis and intracarpal fractures were included. Samples were investigated by immunohistochemistry and results showed that nuclear staining of TrkA, p75NTR and BAX increases in OA-associated synovitis. TrkA expression increased in early disease stages whereas increases in p75NTR were most prominent in later disease stages with cartilage damage and fibrosis. Clinical significance: Suppression of NGF may result in varied effects depending on different stages of the osteoarthritic disease process.

Serum nerve growth factor in horses with osteoarthritis-associated lameness.

BACKGROUND: Nerve growth factor (NGF) is a neurotrophin that is increased in osteoarthritic joints of horses. In humans, NGF has been associated with pain, and both synovial and serum NGF concentrations are increased in osteoarthritic patients. Studies in humans also have shown that serum NGF concentration can increase with stress. Serum NGF concentration should be evaluated in horses with osteoarthritis-associated lameness. OBJECTIVES: Quantify and compare serum NGF concentration in horses with osteoarthritis-associated lameness and sound horses. Additionally, the impact of short-term stress on serum NGF concentration was investigated. ANIMALS: Lame horses with radiographic evidence of osteoarthritis (n = 20), lame horses without radiographic changes in the affected joint (n = 20) and sound horses (n = 20). In addition, horses with acute fractures (n = 9) were sampled. To determine the effect of stress, serum from horses subjected to a stressful event (transportation, n = 5; stress confirmed by increased serum cortisol concentration) was analyzed. METHODS: Cross-sectional clinical study (lame, sound, and fracture cohorts) and experimental longitudinal study (stress cohort). Serum NGF concentration was determined using a quantitative sandwich ELISA. RESULTS: Serum NGF concentration was increased in lame horses with radiographic evidence of osteoarthritis (P < .0001; median, 238 pg/mL; interquartile range [IQR], 63-945 pg/mL) and in lame horses without radiographic evidence of osteoarthritis in the painful joint (P < .05; median, 31 pg/mL; IQR, 31-95 pg/mL) compared with sound horses (median, 31 pg/mL; IQR, 31-46 pg/mL). Serum NGF concentration did not increase with short-term stress and was low in horses with fracture-associated pain. CONCLUSIONS AND CLINICAL IMPORTANCE: Serum NGF concentration was high in the cohort with advanced osteoarthritis and should be investigated as a marker for osteoarthritis-associated pain.

Who Is Healthy? A Review of How Equine Control Groups Are Defined in Clinical Orthopaedic Research 1999-2021.

INTRODUCTION: Proper identification of healthy subjects is essential in case-control studies. However, standardized definitions of healthy controls are lacking in equine orthopaedic research. OBJECTIVES: The aim of this study was to define the non-invasive methods used for selecting healthy control horses in osteoarthritis (OA), desmitis and tendinitis research. METHODS: Systematic review. Case-control studies with a healthy control group and longitudinal studies where horses had to be healthy at the start were included. Studies where joints were visualized by arthroscopy or post-mortem examination were excluded. RESULTS: From 2,472 OA papers and 2,746 desmitis/tendinitis papers, 127 and 84 papers met the inclusion criteria respectively. For OA, 11 methods were identified for defining healthy subjects with a median of three methods used per paper. Dynamic examination, radiographic evaluation and clinical examination were the most frequent. Eight different methods were identified in the desmitis/tendinitis papers with a median of three methods per paper; ultrasonography, clinical- and dynamic examination were the most frequent. CONCLUSIONS: Overall, the OA and desmitis/tendinitis studies used similar methods for defining subjects as healthy, but the way the examinations were performed and interpreted was inconsistent. In several studies, healthy controls were not examined for lameness. The most common methods have limitations for detecting horses with early OA, which may have implications for interpretation of results. Standardized use of more sensitive and objective methods could be beneficial.

The expression of nerve growth factor in healthy and inflamed equine chondrocytes analysed by capillary western immunoassay.

Nerve Growth Factor (NGF) is a signalling molecule for pain and inflammation. NGF is increased in synovial fluid from osteoarthritic humans and animals, compared to healthy controls. Monoclonal antibody therapy directed against NGF has been approved to treat pain in osteoarthritic dogs but despite many years of trialling, therapy has not been approved for human use. One reason for this is that adverse reactions with rapidly progressing osteoarthritis has occurred in some individuals. More detailed knowledge of NGF expression in joints is needed. In this study, capillary-based Simple Western was used to analyse NGF in cultured equine chondrocytes. Chondrocytes were collected post mortem from three macroscopically healthy intercarpal joints and three intercarpal joints with mild osteoarthritic changes. The chondrocytes were expanded to passage one and seeded in chondrogenic medium to maintain the phenotype. On day four, cells were either stimulated with LPS or kept untreated in medium. All cells were harvested on day five. Wes analysis of lysates did not show mature NGF but two proforms, 40 and 45 kDa, were identified. Results were confirmed with western blot. The same proforms were expressed in chondrocytes from healthy and osteoarthritic joints. Acute inflammation induced by LPS stimulation did not change the forms of expressed NGF. Capillary Simple Western offers a sensitive and sample-sparing alternative to traditional western blot. However, confirmation of peaks is imperative in order to avoid misinterpretation of findings. In addition, in this case the method did not offer the possibility of quantification advertised by the manufacturers.

The first RT-qPCR confirmed case of tick-borne encephalitis in a dog in Scandinavia.

BACKGROUND: Tick-borne encephalitis (TBE) is a zoonotic neurological disease caused by tick-borne encephalitis virus (TBEV), a flavivirus endemic in parts of Europe and Asia. Seroconversion without signs of clinical disease is common in dogs and most of the cases previously described have been tentatively diagnosed by combining neurologic signs with serum antibody titres. Here, the first Scandinavian RT-qPCR-confirmed clinical case of TBE in a dog is reported. CASE PRESENTATION: A 4-year old castrated male Pointer Labrador cross was presented with acute-onset ataxia. During hospitalisation, the dog developed seizures. Despite aggressive treatment with steroids, antimicrobials and sedation/anaesthesia, there was continued deterioration during the following 24 h after admission and the dog was euthanised and submitted for necropsy. Histopathological changes in the brain were consistent with lymphoplasmacytic and histiocytic meningoencephalomyelitis. RT-qPCR examination of the brain was positive for TBEV, confirming infection. CONCLUSIONS: Meningoencephalomyelitis caused by TBEV should be a diagnostic consideration in dogs presenting with clinical signs of central nervous system disease such as acute-onset ataxia and seizures in areas where TBEV-positive ticks are endemic. Clinical TBE may be underdiagnosed in dogs due to lack of specific testing.

Idiopathic peritonitis in horses: a retrospective study of 130 cases in Sweden (2002-2017).

BACKGROUND: Peritonitis in horses is historically associated with prolonged treatment regimens of broad-spectrum antimicrobials and a guarded prognosis for survival. The condition is most often seen as a secondary complication to traumatic injuries involving the abdominal cavity, rupture of bowel or abdominal surgery. However, cases of idiopathic peritonitis with no such underlying cause have been described. In Sweden idiopathic peritonitis is commonly identified and, in contrast to peritonitis secondary to traumatic incidents, affected horses appear to respond well to medical treatment. The objectives of this study were to describe clinical signs, laboratory findings, bacterial culture results, treatment regimens and survival rates for horses diagnosed with idiopathic peritonitis. RESULTS: Medical records were obtained from horses diagnosed with peritonitis without identifiable cause. Diagnosis was based on macroscopically abnormal peritoneal fluid, with an elevated nucleated cell count (> 10 × 109 cells/L) or total protein (> 25 g/L). A total of 130 horses were included, presenting with pyrexia (83%), lethargy (80%), anorexia (68%) and abdominal pain (51%). Microbial cultures were performed in 84% of the cases of which 41% were positive. The most commonly recovered bacteria were Actinobacillus spp., cultured from 21% of the submitted samples. All horses received antimicrobial therapy and many responded to treatment with penicillin alone. Survival until discharge was 94%. CONCLUSIONS: Idiopathic peritonitis is a disease that should be considered in horses presented with fever, signs of colic and lethargy. Medical treatment of idiopathic peritonitis is often successful and in Sweden most cases appear to respond well to treatment with penicillin as the sole antimicrobial.

Retrospective evaluation of 155 adult equids and 21 foals with tetanus in Western, Northern, and Central Europe (2000-2014). Part 1: Description of history and clinical evolution.

OBJECTIVE: To describe clinical data of hospitalized adult equids and foals with tetanus. DESIGN: Multicenter retrospective study (2000-2014). SETTING: Twenty Western, Northern, and Central European university teaching hospitals and private referral centers. ANIMALS: One hundred fifty-five adult equids (>6 months) and 21 foals (<6 months) with tetanus. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Information on geographic, annual and seasonal data, demographic- and management-related data, clinical history, clinical examination and blood analysis on admission, complications, treatments, and outcomes were described and statistically compared between adults and foals. The described cases were often young horses. In 4 adult horses, tetanus developed despite appropriate vaccination and in 2 foals despite preventive tetanus antitoxin administration at birth. Castration, hoof abscesses, and wounds were the most common entry sites for adults; umbilical cord infections and wounds for foals. Stiffness was the commonest observed initial clinical sign. Blood analyses frequently revealed an inflammatory response, hemoconcentration, muscle damage, azotemia, negative energy balance, liver damage, and electrolyte and acid base disturbances. Common complications or clinical signs developing during hospitalization included dysphagia, dyspnea, recumbency, hyperthermia, seizures, hyperlipemia, gastrointestinal impactions, dysuria, and laryngeal spasms. Cases were supported with wound debridement, antimicrobial treatment, tetanus antitoxin, muscle spasm and seizure control, analgesia, anti-inflammatory drugs, fluid therapy, and nutritional support. Mortality rates were 68.4% in adult horses and 66.7% in foals. Foals differed from adult horses with respect to months of occurrence, signalment, management-related data, potential causative events, clinical signs on admission, blood analysis, complications, and severity grades. CONCLUSIONS: This is the first study that rigorously describes a large population of equids affected by tetanus. The information provided is potentially useful to clinicians for early recognition and case management of tetanus in adult horses and foals. Tetanus affects multiple organ systems, requiring broad supportive and intensive care. Neonatal and adult tetanus in the horse should be considered as distinct syndromes, as in human medicine.

Retrospective evaluation of 155 adult equids and 21 foals with tetanus from Western, Northern, and Central Europe (2000-2014). Part 2: Prognostic assessment.

OBJECTIVE: To identify prognostic variables for adult equids and foals with tetanus. DESIGN: Multicenter retrospective study (2000-2014). SETTING: Twenty Western, Northern, and Central European university teaching hospitals and private referral centers. ANIMALS: One hundred fifty-five adult equids and 21 foals with tetanus. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Variables from history and clinical examination were statistically compared between survivors and nonsurvivors (adults: 49 survivors, 85 nonsurvivors; foals: 7 survivors, 10 nonsurvivors). Cases euthanized for financial reasons were excluded. Mortality rates in adults and foals were 68.4% and 66.7%, respectively. Variables associated with survival in adults included: standing, normal intestinal sounds and defecation, voluntarily drinking, eating soft or normal food, lower heart and respiratory rates, high base excess on admission, longer diagnosis time, treatment and hospitalization delay, and mild severity grade. Variables associated with death included: anorexia, dysphagia, dyspnea, low blood potassium concentration on admission, moderate and severe disease grading, development of dysphagia, dyspnea, recumbency and seizures during hospitalization, treatment with glycerol guaiacolate, intravenous fluids, and intravenous glucose solutions. Variables associated with survival in foals included standing on admission, voluntarily eating soft food and drinking, older age, and longer hospitalization delay. Outcome was not different between different tetanus antitoxin (TAT) dosages, although there was a trend of increasing survival rate with increasing TAT dosages. Cases with appropriate vaccination prior to development of tetanus were rare, but had improved outcome and shorter hospitalization. CONCLUSIONS: Prognosis for equine tetanus is poor with similar outcome and prognostic factors in foals and adults. The prognostic assessment of cases with tetanus provides clinicians with new evidence-based information related to patient management. Several prognostic indicators relate to the ability to eat or drink, and more severe clinical signs relate to poor outcome. Increasing intravenous dosages of TAT has no significant effect on outcome, but the positive trend identified may support a recommendation for high intravenous TAT dosages. Further evaluation is warranted.

Medical and surgical management of an intra-abdominal abscess of hepatic origin in a horse.

CASE DESCRIPTION: A 4-year-old Arabian-cross mare was examined because of a 48-hour history of pyrexia, lethargy, and signs of abdominal discomfort. CLINICAL FINDINGS: On initial evaluation, the horse was in good body condition, but febrile, tachycardic, tachypneic, and icteric and had signs of colic. Findings on CBC and serum biochemical analysis indicated marked systemic inflammation and hepatocellular damage. Serial abdominal ultrasonographic examinations revealed progressive, localized hepatic parenchymal abnormalities in the left ventral aspect of the abdomen in proximity to the left liver lobes, and eventual identification of an irregularly marginated, hyperechoic walled region of heterogenous echogenicity consistent with an encapsulated hepatic abscess. TREATMENT AND OUTCOME: Medical treatment was initiated with administration of doxycycline and flunixin meglumine. After 7 days, the horse's clinical signs and hematologic values improved. After 14 days, the horse was discharged from the hospital and prescribed continuation of doxycycline treatment for 14 days. One week following hospital discharge, the horse was reevaluated for recurrent signs of colic and pyrexia. The horse was sedated, and the region overlying the caudal aspect of the seventh rib was desensitized with an inverted L nerve block by local infiltration with 2% lidocaine. While the horse was standing and sedated, drainage of an encapsulated intra-abdominal abscess was followed by rib resection and removal of a portion of necrotic left lateral liver lobe. The development of a pneumothorax following rib resection represented the only major surgical complication. Twelve months later, the horse was clinically normal and had returned to its previous level of performance. CLINICAL RELEVANCE: Rib resection in standing sedated horses, together with appropriate medical management, should be considered an option for removal of well-encapsulated cranially located intra-abdominal abscesses that are adherent to the ventrolateral aspect of the body wall in horses.

Equine multinodular pulmonary fibrosis in association with asinine herpesvirus type 5 and equine herpesvirus type 5: a case report.

A standardbred gelding with a history of 10 days pyrexia and lethargy was referred to the Equine Hospital at the Swedish University of Agricultural Sciences in Uppsala, Sweden.The horse had tachypnea with increased respiratory effort and was in thin body condition. Laboratory findings included leukocytosis, hyperfibrinogenemia and hypoxemia. Thoracic radiographs showed signs of pneumonia with a multifocal nodular pattern, which in combination with lung biopsy findings indicated Equine Multinodular Pulmonary Fibrosis (EMPF). EMPF is a recently described disease in adult horses with clinical signs of fever, weight loss and respiratory problems. The pathological findings include loss of functional pulmonary parenchyma due to extensive nodular interstitial fibrosis which has been related to infection with the equine herpesvirus type 5 (EHV-5). In this case, lung biopsy and tracheal wash samples tested positive for both asinine herpesvirus type 5 (AHV-5) and EHV-5 using PCR assays. The horse failed to respond to treatment and was euthanized for humane reasons. Postmortem examination confirmed the diagnosis of EMPF. This case suggests that not only EHV-5 alone should be considered in association with the development of this disease.

Radiographic parameters for diagnosing sand colic in horses.

BACKGROUND: Ingestion of sand can cause colic, diarrhoea and weight loss in horses, but these signs are unspecific and can have many other causes. The amount of sand that induces disease may vary between individuals. To avoid over-diagnosing, it is important to determine the amount of sand that can be found in horses without clinical signs of gastrointestinal disease. The aim of this study was to use previously suggested parameters for establishing a radiographic diagnosis of sand colic, and compare these findings between a sand colic group and a control group. METHODS: Abdominal radiographs were obtained in 30 horses with a complaint unrelated to the gastrointestinal tract. In addition, archived abdominal radiographs of 37 clinical cases diagnosed with sand impaction were investigated. The size of the mineral opacity indicative of sand in the abdomen was measured and graded according to a previously published protocol based on height and length. Location, homogeneity, opacity and number of sand accumulations were also recorded. RESULTS: Twenty out of 30 control horses (66%) had one or more sand accumulations. In the present study; height, length and homogeneity of the accumulations were useful parameters for establishing a diagnosis of sand colic. Radiographically defined intestinal sand accumulation grades of up to 2 was a common finding in horses with no clinical signs from the gastrointestinal tract whereas most of the clinical cases had much larger grades, indicating larger sand accumulations. CONCLUSION: Further work to establish a reliable grading system for intestinal sand content is warranted, but a previously proposed grading system based on measurements of height and length may be an alternative for easy assessment of sand accumulations in the meantime. The present study indicates that a grade 1 - 2 sand accumulation in the intestine is a frequent finding in horses. When working up a case with clinical signs from the gastrointestinal tract, one or more accumulations of this grade should not be considered the cause until other possibilities have been ruled out.

A personological examination of self- and other-forgiveness in the five factor model.

In a sample composed of 147 undergraduates (age range 18 to 55 years; M = 22), we conducted an examination of the convergent and discriminant validity of self- and other-forgiveness in the Five-factor model of personality (FFM). Using multiple measures of each construct, principal components analysis (PCA) supported a 2-component model of forgiveness. Findings for the PCA and external correlates with the FFM provided evidence for a largely orthogonal relationship between self- and other-forgiveness. Specifically, self-forgiveness was negatively related to Neuroticism and unrelated to Agreeableness, whereas other-forgiveness was unrelated to Neuroticism and positively related to Agreeableness. Overlap between the constructs was found in which both self- and other-forgiveness were negatively related to the hostility facet of Neuroticism and the order facet from Conscientiousness and positively related to the warmth and positive emotions facet scales from the Extraversion domain of the Revised NEO Personality Inventory (Costa & McCrae, 1992). Overall, these findings suggest that self- and other-forgiveness, although seemingly similar, carry very different motivational underpinnings.