Pharmacokinetics and pharmacodynamics of intravenous romifidine and propranolol administered alone or in combination for equine sedation.

OBJECTIVE: Propranolol has been suggested for anxiolysis in horses, but its sedation efficacy and side effects, both when administered alone and in combination with α2-adrenoceptor agonists, remain undetermined. This study aimed to document the pharmacokinetics and pharmacodynamics of propranolol, romifidine and their combination. STUDY DESIGN: Randomized, crossover study. ANIMALS: Six adult horses weighing 561 ± 48 kg. METHODS: Propranolol (1 mg kg-1; treatment P), romifidine (0.1 mg kg-1; treatment R) or their combination (treatment PR) were administered intravenously with a minimum of 1 week between treatments. Alertness, behavioral responsiveness (visual and tactile) and physiologic variables were measured before and up to 960 minutes after drug administration. Blood was collected for blood gas and acid-base analyses and measurement of plasma drug concentrations. Data were analyzed using repeated-measures analysis of variance or Friedman with Holm-Sidak and Wilcoxon rank-sum tests (p < 0.05). RESULTS: Systemic clearance significantly decreased and the area under the concentration-time curve significantly increased for both drugs in PR compared with P and R. Both PR and R decreased behavioral responsiveness and resulted in sedation for up to 240 and 480 minutes, respectively. Sedation was deeper in PR for the first 16 minutes. Heart rate significantly decreased in all treatments for at least 60 minutes, and PR significantly increased the incidence of severe bradycardia (<20 beats minute-1). CONCLUSIONS AND CLINICAL RELEVANCE: Although not associated with reduced behavioral responsiveness or sedation alone, propranolol augmented romifidine sedation, probably through alterations in romifidine pharmacokinetics, in horses administered PR. The occurrence of severe bradycardia warrants caution in the co-administration of these drugs at the doses studied.

Atlanto-axial approach for cervical myelography in a Thoroughbred horse with complete fusion of the atlanto-occipital bones.

A 2-year-old Thoroughbred gelding with clinical signs localized to the first 6 spinal cord segments (C1 to C6) had complete fusion of the atlanto-occipital bones which precluded performing a routine myelogram. An ultrasound-assisted myelogram at the intervertebral space between the atlas and axis was successfully done and identified a marked extradural compressive myelopathy at the level of the atlas and axis, and axis and third cervical vertebrae.

Approche atlanto-axiale pour une myélographie cervicale chez un cheval Thoroughbred avec la fusion complète des os occipito-atloïdiens. Un hongre Thoroughbred âgé de 2 ans avec des signes cliniques localisés aux 6 premiers segments de la colonne vertébrale (C1 à C6) avait une fusion complète des os occipito-atloïdiens qui empêchait la réalisation d'un myélogramme de routine. Un myélogramme par échographie à l'espace intervertébral entre l'atlas et l'axis a été réalisé avec succès et a identifié une myélopathie extradurale compressive prononcée au niveau de l'atlas et de l'axis ainsi que de l'axis et de la troisième vertèbre cervicale.(Traduit par Isabelle Vallières).

Common and atypical presentations of Anaplasma phagocytophilum infection in equids with emphasis on neurologic and muscle disease.

BACKGROUND: Comprehensive descriptions of equids with granulocytic anaplasmosis (EGA) with neurologic or muscle disease and other atypical presentations are scarce in the literature. OBJECTIVE: Describe the clinical signs, laboratory findings, treatment, and outcome of equids with EGA with emphasis on neurologic and muscle disease. ANIMALS: Thirty-eight horses, 1 donkey. METHODS: Retrospective study. Equids with EGA were included. The electronic data base was searched from January 2000 to December 2022 using the words anaplasmosis, ehrlichiosis, granulocytic, and rickettsia. Signalment and clinical data were reviewed. Data were evaluated for normality using Shapiro-Wilk test. Parametric and nonparametric statistics were used for normally and non-normally distributed data. RESULTS: Common (41%) and other (59%) presentations were seen in horses ≥ 4 years of age (median, 14 years) with an overrepresentation of males (77%). Neurologic disease was common (41%), mainly presenting as diffuse symmetrical proprioceptive ataxia. Brain disease was less common manifesting as obtundation and cranial nerve deficits. Muscle disease was less common, with QH breeds with the variant causing myosin heavy chain myopathy (MYHM) having severe disease. Cavitary effusion, cardiomyopathy and disseminated intravascular coagulation (DIC) were uncommon. Clinical laboratory results varied depending on disease stage. Muscle enzyme activities were significantly higher in horses with muscle disease. Outcome was favorable with prompt tetracycline treatment. Death and long-term sequelae were not reported. CONCLUSIONS AND CLINICAL IMPORTANCE: Common and atypical presentations of EGA have a favorable outcome with prompt tetracycline treatment. Quarter horse breeds with muscle disease should be genotyped for MYHM.

Equine Gunshot Euthanasia: Creation of a 3D-Printed Model with Integrated Sensors for Training.

Challenges and issues related to the use of pentobarbital euthanasia and disposal of animal remains within the US have recently been reviewed. Environmental and public health challenges increasingly necessitate consideration of alternative methods such as gunshots, an American Veterinary Medical Association (AVMA) "acceptable with conditions" method, for the humane euthanasia of horses. A recent study reported a correctly aimed gunshot provides a humane option for euthanizing horses. However, although aiming guidelines exist, studies examining bullet trajectories in animals euthanized by gunshot have reported that inadequate disruption of the brain is a serious welfare issue. Here, we report the development and production of a portable, reusable, equine gunshot euthanasia training model. Using 3D printing, an anatomically accurate model of an equine head has been developed, with external aiming landmarks and equipped with integrated laser sensors and LED eyes. The laser sensors are embedded in two specific anatomical tracts (pons and medulla) with aiming paths associated with the aiming landmarks to train correct aiming angle. The LED eyes are linked to the laser sensors to provide instant feedback on aiming accuracy. When a beam from a commercially available blue training gun laser travels along the correct aiming path and strikes the sensor inside the head, the lights in the model's eyes go out and there is an audible signal, providing immediate feedback on the accuracy of the shot. The model facilitates the training of veterinary personnel and first responders in successful gunshot euthanasia, providing instantaneous feedback on the likelihood of a shot causing immediate, humane death in a live animal.

Electrophysiological studies in American Quarter horses with neuroaxonal dystrophy.

OBJECTIVE: Neuroaxonal dystrophy (NAD) is a disease characterized by the sudden onset of neurologic signs in horses ranging from 4 to 36 months of age. Equine degenerative myeloencephalopathy (EDM), a disease that has been associated with low vitamin E concentrations, is considered a more advanced form of NAD. The objective of this report is to describe the electrophysiological features of NAD/EDM in American Quarter horses (QHs). HORSES: Six NAD/EDM-affected QHs and six unaffected QHs were evaluated by ophthalmic examination and electroretinography. Five of the NAD/EDM-affected QH and five unaffected QHs were also evaluated by electroencephalography (EEG). RESULTS: Ophthalmic examination, ERGs, and EEGs were unremarkable in NAD/EDM cases. CONCLUSIONS: Neuroaxonal dystrophy/EDM does not appear to cause clinical signs of ocular disease or functional ERG/EEG deficits in QHs.

Fish evacuation and emergency sheltering during wildfire disasters.

Wildfires are a serious and expanding threat in western North America, and wildfire encroachment on human populations leads to widespread evacuation and emergency housing operations for residents and their companion animals and livestock. Veterinarians are frequently part of wildfire response efforts and are called upon to assist in rescue, evacuation, and emergency housing operations as well as to provide medical care for evacuated animals. Although veterinarians are likely familiar with the principles of transporting and housing terrestrial animals, emergency response for aquatic companion animals presents unique logistic challenges. Veterinarians familiar with aquatic animal evacuation, housing, and care prior to a wildfire response can extend the scope of disaster recovery. This report offers general guidance for rescuing, evacuating, housing, and caring for aquatic animals in the wake of a wildfire.

Current Operational Model for Veterinary Care in Large Animal Shelters During Disasters.

Standardization of operating guidelines for veterinary care in evacuation and emergency animal shelters is imperative for an organized response and to facilitate treatment and prevention of medical conditions stemming from the effects of a disaster and the associated outcomes of sheltering. Safeguarding animal welfare through creating guidelines should expedite care, assure consistency, and provide appropriate safety measures for animals and veterinary medical providers. Veterinary integration into an incident command system (ICS) and response training allows for proper allocation of roles and responsibilities, as well as coordination of veterinary supplies and personnel. Central components of the operational model include guidelines for animal identification, triage, medical records, medical treatments, and discharge instructions. An outline for communication with disaster response agencies, as well as animal owners, is aimed to inform appropriate conduct. Improving the animal component of disaster response is integral in meeting societal needs and improving animal welfare in the face of a disaster.

Steroid precursors, steroids, neuroactive steroids, and neurosteroids concentrations in serum and saliva of healthy neonatal heifer Holstein calves.

BACKGROUND: Persistence of high neurosteroid concentrations in blood is associated with neonatal encephalopathy and septicemia in foals. This has not been investigated in calves. OBJECTIVES: To determine concentrations of steroid compounds in serum and saliva within the first 48 hours after birth in healthy neonatal calves, identify potential markers for disease, and investigate the association between serum steroid compounds concentrations in calves and their respective dams within 2 hours after birth. ANIMALS: Twelve healthy neonatal heifer Holstein calves and their dams. METHODS: Prospective study. Serum and saliva were collected from calves at 2, 6, 24, and 48 hours after birth. Steroid compounds were analyzed using liquid chromatography-mass spectrometry. A nonlinear regression model was used to determine half-lives of the neurosteroids. Serum concentrations of neurosteroids between the cows and calves were compared using the Wilcoxon signed rank test. RESULTS: Half-lives (95% confidence intervals) of dehydroepiandrosterone (DHEA) and 17α,20α-dihydroxyprogesterone in calf serum were 2.9 (2.1, 4.3), and 2.1 (1.3, 3.0) hours, respectively. Pregnanediol in saliva had a half-life (95% confidence interval) of 24.5 (14.2, 66.5) hours. Serum DHEA (1718.7 ± 2313 vs 57.7 ± 44) and 17α,20α-dihydroxyprogesterone (207.8 ± 198.2 vs 43.5 ± 33.5) concentrations respectively were higher (P < .05) in calves compared to cows. CONCLUSIONS AND CLINICAL IMPORTANCE: Dehydroepiandrosterone, 17α,20α-dihydroxyprogesterone, and pregnanediol could be potential markers of disease in neonatal heifer calves with unexplained failure to thrive or encephalopathy. However, because of the wide 95% confidence interval of the half-life, pregnanediol in saliva might not be a potential marker.

Disaster Medicine: Implementation of an animal health database in response to the 2018 California Camp Fire.

OBJECTIVE: To describe an animal health database used to facilitate effective disaster response and retrospective analysis of data concerning animals other than cats and dogs affected by the 2018 California Camp Fire. ANIMALS: Veterinary medical entries (n = 206) for evacuated or rescued animals (151) of various species, including avian, bovine, camelid, caprine, equine, ovine, and porcine species, temporarily housed at the Butte County fairgrounds in Gridley, Calif. PROCEDURES: Case data were collected via a standardized form by volunteers with the University of California-Davis Veterinary Emergency Response Team during triage and treatment of animals brought to the shelter. Collected data were entered into a database. Multiple correspondence analysis was used to evaluate associations among patient species, types and severity of injuries, and behavior. RESULTS: Burns, respiratory disease, gastrointestinal illnesses, and lacerations were the most prevalent illnesses and injuries among the overall shelter population for the first 12 days of the Camp Fire. Ovine patients were more likely to have had respiratory illness than were other species. The most prevalent medical conditions among equine patients were lacerations and gastrointestinal illnesses. Severe burns were most common among porcine, camelid, and avian patients. The temporal distribution of cases suggested the immediate evacuation of equine species and the delayed movement of bovine and avian species to the shelter. CONCLUSIONS AND CLINICAL RELEVANCE: Collection of animal health information through the database allowed assessment of prevalent medical conditions among various farm animals following a wildfire. Adaptation of this database to other disasters could improve emergency response protocols by providing guidance for management of resources and allow retrospective assessment for response improvement.

Comparison of four methods to quantify Equid herpesvirus 1 load by real-time polymerase chain reaction in nasal secretions of experimentally and naturally infected horses.

The objective of the current study was to compare the performance of 4 methods to quantify Equid herpesvirus 1 (EHV-1) by real-time polymerase chain reaction (PCR) in nasal secretions from experimentally and naturally infected horses. Nasal secretions were collected on the challenge day and daily thereafter for 13 days from 4 experimentally infected horses. Additional nasal swabs were collected from 30 horses with clinical signs consistent with natural EHV-1 infection. Absolute quantitation of EHV-1 target molecules was performed using standard curves for EHV-1 and equine glyceraldehyde-3-phosphate dehydrogenase, and DNA yield, and was expressed as EHV-1 glycoprotein B (gB) gene copies per million nucleated nasal cells, EHV-1 gB gene copies per entire swab, EHV-1 gB gene copies per 1 microl of purified DNA, and EHV-1 gB gene copies per 1 ng of template DNA. The study results showed that all 4 calculation methods yielded comparable results between experimentally and naturally infected horses, and that the different methods were significantly correlated with each other. Reporting of quantitative results for EHV-1 viral load in nasal swabs collected from infected horses constitutes an important advance in both the research and diagnostic fields, allowing one to determine the infectious risk of affected horses, disease stage, or response to antiviral therapy. However, protocols that normalize the PCR results against a preselected volume of DNA or nasal secretions are likely to be more prone to variations than protocols that calculate the load for the entire swab, incorporate a housekeeping gene, or use a constant amount of extracted DNA.

Equine herpesvirus-1 myeloencephalopathy: a review of recent developments.

Equine herpes myeloencephalopathy (EHM), although a relatively uncommon manifestation of equine herpesvirus-1 (EHV-1) infection, can cause devastating losses on individual farms or boarding stables. Although outbreaks of EHM have been recognized for centuries in domestic horse populations, many aspects of this disease remained poorly characterized. In recent years, an improved understanding of EHM has emerged from experimental studies and from data collected during field outbreaks at riding schools, racetracks and veterinary hospitals throughout North America and Europe. These outbreaks have highlighted the contagious nature of EHV-1 and have prompted a re-evaluation of diagnostic procedures, treatment modalities, preventative measures and biosecurity protocols for the disease. This review concentrates on these and other selected, clinically relevant aspects of EHM.

Parenteral nutrition in neonatal foals: clinical description, complications and outcome in 53 foals (1995-2005).

This retrospective study describes the use of and complications associated with parenteral nutrition (PN) administration to 53 equine neonates at the University of California Veterinary Medical Teaching Hospital. Medical records were examined and information obtained on signalment, physical examination, clinical diagnosis, outcome, total hospitalization time, insulin administration, microbiology culture results, other complications (i.e. thrombophlebitis) and necropsy findings. Complete blood count and serum biochemistry analytes, venous blood gas, serum electrolyte and glucose concentrations, and blood lactate concentration results were compared before and during PN administration in all foals. Seventeen foals (32%) developed hypertriglyceridemia (>200mg/dL). Triglyceride concentrations >200mg/dL were significantly (P=0.049) associated with non-survival. Forty-seven foals (89%) developed hyperglycemia (blood glucose >120mg/dL) and eight (15%) developed catheter-related complications (thrombosis or local sepsis). Packed cell volume, total protein, creatinine, blood urea nitrogen, and sorbitol dehydrogenase concentrations decreased while foals were on PN, while serum chloride concentration increased. This study highlighted that hypertriglyceridemia during the acute phase of neonatal illness may be detrimental to outcome, and that the safety of lipid-containing solutions in foals warrants further study.

Evaluation of deafness in American Paint Horses by phenotype, brainstem auditory-evoked responses, and endothelin receptor B genotype.

OBJECTIVE: To evaluate deafness in American Paint Horses by phenotype, clinical findings, brainstem auditory-evoked responses (BAERs), and endothelin B receptor (EDNBR) genotype. DESIGN: Case series and case-control studies. ANIMALS: 14 deaf American Paint Horses, 20 suspected-deaf American Paint Horses, and 13 nondeaf American Paint Horses and Pintos. PROCEDURES: Horses were categorized on the basis of coat color pattern and eye color. Testing for the EDNBR gene mutation (associated with overo lethal white foal syndrome) and BAERs was performed. Additional clinical findings were obtained from medical records. RESULTS: All 14 deaf horses had loss of all BAER waveforms consistent with complete deafness. Most horses had the splashed white or splashed white-frame blend coat pattern. Other patterns included frame overo and tovero. All of the deaf horses had extensive head and limb white markings, although the amount of white on the neck and trunk varied widely. All horses had at least 1 partially heterochromic iris, and most had 2 blue eyes. Ninety-one percent (31/34) of deaf and suspected-deaf horses had the EDNBR gene mutation. Deaf and suspected-deaf horses were used successfully for various performance events. All nondeaf horses had unremarkable BAER results. CONCLUSIONS AND CLINICAL RELEVANCE: Veterinarians should be aware of deafness among American Paint Horses, particularly those with a splashed white or frame overo coat color pattern, blend of these patterns, or tovero pattern. Horses with extensive head and limb markings and those with blue eyes appeared to be at particular risk.

Plasma concentrations of steroid precursors, steroids, neuroactive steroids, and neurosteroids in healthy neonatal foals from birth to 7 days of age.

BACKGROUND: Transient hypothalamic-pituitary-adrenal axis dysfunction occurs in critically ill foals with sepsis and neonatal maladjustment syndrome (NMS). Cortisol is the most commonly measured steroid. However, a complex interaction of various steroid compounds might play a role in pathophysiology of this disorder. OBJECTIVE: To identify steroid compounds present at high concentrations at birth that rapidly and steadily decrease within the first 7 days of life in healthy foals and that might be supportive diagnosis of NMS and other neonatal disorders. ANIMALS: Ten healthy neonatal Quarter Horse foals (5 females and 5 males). METHODS: Prospective study. Blood was collected in heparinized tubes within 30 minutes after birth, and at 12, 24, 48, 72, 96, 120, 144, and 168 hours of age. Plasma was separated and a panel of steroid compounds was analyzed using liquid chromatography-mass spectrometry. A nonlinear regression model was used to determine decay concentrations over time. Confidence intervals (CIs) were calculated and significance was set a P ≤ .05. RESULTS: Five compounds were identified: pregnenolone, progesterone, deoxycorticosterone, dehydroepiandrosterone, and dehydroepiandrosterone sulfate. Pregnenolone and progesterone concentrations rapidly decreased by 24 hours of age and remained low throughout the first 7 days of life. Their half-life (95% CI) was short at 3.7 (3.4, 4.0) and 4.5 (2.8, 6.1) hours, respectively. No statistical differences in the concentrations of these compounds were found between males and females. CONCLUSIONS AND CLINICAL RELEVANCE: Progesterone might be a useful marker for identifying continuous endogenous production of neuroactive steroids in foals with suspected NMS and other neonatal diseases.

Effects of magnesium with or without boron on headshaking behavior in horses with trigeminal-mediated headshaking.

BACKGROUND: Oral administration of magnesium and boron might have a beneficial effect on headshaking behavior in horses. OBJECTIVE: Evaluate the effects of oral magnesium alone or in combination with boron on headshaking behavior in affected horses. ANIMALS: Twelve geldings (6 healthy controls and 6 affected). METHODS: Prospective randomized controlled dietary trial over 42 days in 12 horses (6 horses diagnosed with trigeminal-mediated headshaking and 6 unaffected healthy controls). All horses received a hay diet and were randomized into 3 treatment groups: pelleted feed combination (PF), pelleted feed combination with magnesium (M), and pelleted feed combination with magnesium-boron (MB) with a week washout of hay only between treatments. Headshaking behavior and biochemical blood variables were assessed at baseline (hay only) and then after each week of supplementation. RESULTS: All 3 diet interventions increased blood ionized and total magnesium. Groups M and MB further increased Mg2+ when compared to PF. Horses receiving treatments had a significant reduction in headshaking behavior, as measured by incidence rate ratio (IRR), when compared to unsupplemented hay diet (44% for PF, IRR, 0.558; CI, 0.44, 0.72; P < .001; 52% for M, IRR, 0.476; CI, 0.37, 0.62; P < .001; and 64% for MB, IRR, 0.358; CI, 0.27, 0.48; P < .001). CONCLUSIONS AND CLINICAL IMPORTANCE: Magnesium in combination with boron had the greatest decrease in headshaking. Oral supplementation with magnesium or magnesium in combination with boron should be considered in horses affected with headshaking.

Luteinizing hormone concentrations in healthy horses and horses with trigeminal-mediated headshaking over an 8-hour period.

BACKGROUND: Trigeminal-mediated headshaking results from a low threshold for firing of the trigeminal nerve. A seasonal component has been implicated in onset of clinical signs, which occur during the spring and summer months. Geldings are overrepresented in the affected population and hormonal differences as compared to a healthy control population of geldings might contribute to headshaking. OBJECTIVE/HYPOTHESIS: To assess concentrations of luteinizing hormone (LH) over an 8-hour period in gelded healthy controls and horses affected with headshaking. Our hypothesis was that geldings with seasonal headshaking would have higher concentrations of LH over an 8-hour period compared to control horses during the summer when affected horses manifested headshaking. ANIMALS: Twelve geldings (6 controls and 6 affected). METHODS: Prospective controlled trial. Blood samples were drawn every 15 minutes over an 8-hour time period during summer from all horses to measure circulating LH concentrations by using a radioimmunoassay for equine LH. All affected horses were actively affected by headshaking at the time of sample collection. RESULTS: No statistically significant differences in LH concentrations were found throughout the study period in headshakers as compared to control horses. Time had no significant effect, but a slight decrease in LH concentrations was observed for all horses. The main limitation of the study was the low number of horses. CONCLUSIONS AND CLINICAL IMPORTANCE: Horses affected with headshaking did not have significant differences in circulating LH during the late summer as compared to control horses.

Intravenous infusion of magnesium sulfate and its effect on horses with trigeminal-mediated headshaking.

BACKGROUND: Trigeminal-mediated headshaking results from low-threshold firing of the trigeminal nerve resulting in apparent facial pain. Magnesium may have neuroprotective effects on nerve firing that potentially dampen signs of neuropathic pain. This hypothesis has not been investigated in horses with trigeminal-mediated headshaking. OBJECTIVE: To investigate head-shaking behavior in affected horses after IV magnesium sulfate infusion. ANIMALS: Six geldings with trigeminal-mediated headshaking. METHODS: Prospective randomized crossover study. Horses were controlled for diet and infused IV with 5% dextrose solution (DS; control solution at 2 mL/kg body weight [BW]) and MgSO4 50% solution (MSS at 40 mg/kg BW). Head-shaking behavior was recorded at times T0 (baseline, before infusion) and T15, T30, T60, and T120 minutes post-infusion. Venous blood variables such as pH, HCO3 - , standard base excess (SBE), Na+ , Cl- , K+ , Ca2+ , Mg2+ , total magnesium (tMg), glucose, and lactate were measured; strong ion difference (SID) and anion gap (AG) were calculated for each time point. RESULTS: Blood variables including pH, Na+ , Cl- , K+ , SID, AG, lactate, Ca2+ , tMg, and Mg2+ had significant changes with MSS as compared to DS treatment. Glucose, SBE, and HCO3 - did not have significant changes. A 29% reduction in head-shaking rate occurred after MSS treatment but no change occurred after DS treatment. CONCLUSIONS AND CLINICAL IMPORTANCE: Administration of MSS IV increased plasma total and ionized magnesium concentrations and significantly decreased head-shaking behavior in horses with trigeminal-mediated headshaking.

Successful treatment of head shaking by use of infrared diode laser deflation and coagulation of corpora nigra cysts and behavioral modification in a horse.

CASE DESCRIPTION: A 15-year-old Saddlebred gelding used for competitive pleasure driving had a 1-year history of head shaking while pulling a cart. CLINICAL FINDINGS: The horse had cystic corpora nigra in both eyes and concomitant classic and operant conditioned responses to wearing a bridle with bilateral eye covers (blinkers). TREATMENT AND OUTCOME: Deflation and coagulation of the cysts with an infrared diode laser and behavior modification consisting of desensitization and counter-conditioning were used to successfully restore performance. CLINICAL RELEVANCE: Behavioral changes in horses can result from a combination of physical and psychologic causes. A combination of appropriate medical treatment of physical abnormalities and a behavioral modification plan is necessary to successfully treat behavioral problems in these patients.

Effect of valacyclovir on EHV-5 viral kinetics in horses with equine multinodular pulmonary fibrosis.

BACKGROUND: Equine herpesvirus-5 is commonly isolated from the lungs of horses with EMPF, suggesting an etiological link. Valacyclovir is used empirically to treat EMPF; however, no data is available concerning its impact on EHV-5 viral kinetics. OBJECTIVES: To determine the effect of oral administration of valacyclovir on EHV-5 viral load measured by qPCR in blood, nasal secretions (NS) and BALF in horses with EMPF. ANIMALS: Six horses diagnosed with EMPF. METHODS: A prospective clinical trial was performed. Horses received 10 days of PO administered valacyclovir (loading dose 30 mg/kg, maintenance dose 20 mg/kg). Blood, NS, and BALF were collected for EHV-5 viral kinetics analyses during treatment. Blood and NS were collected every other day. BALF was collected on day 0 and day 10. RESULTS: There was no statistical difference in median EHV-5 viral load between day 0 and day 10 for all samples tested. In blood median EHV-5 viral load was 7676 (range 575-39 781) on day 0 and 6822 (range 1136-18 635) glycoprotein B (gB) gene copies per million cells on day 10. For NS median EHV-5 viral load was 2.944 × 106 (range 184 691-3.394 × 109 ) on day 0 and 8.803 × 106 (range 251 186-9.868 × 108 ) gB gene copies per million cells on day 10. For BALF median EHV-5 viral load was 59,842 (range 61-315 655) on day 0 and 185 083 (range 3562-542 417) gB gene copies per million cells on day 10. CONCLUSIONS AND CLINICAL IMPORTANCE: Valacyclovir might not be an effective short-term antiviral treatment but efficacy in treatment of EMPF is unknown.

Ehrlichioses in humans: epidemiology, clinical presentation, diagnosis, and treatment.

Human ehrlichioses are emerging tickborne infections. "Human ehrlichiosis" describes infections with at least 5 separate obligate intracellular bacteria in 3 genera in the family Anaplasmataceae. Since 1986, these agents and infections (human monocytic ehrlichiosis [HME], caused by Ehrlichia chaffeensis; human granulocytic anaplasmosis [HGA], caused by Anaplasma phagocytophilum; and human ewingii ehrlichiosis, caused by Ehrlichia ewingii) are the causes of most human ehrlichioses. Their prevalence and incidence are increasing where the appropriate tick vectors are found. The diseases generally present as undifferentiated fever, but thrombocytopenia, leukopenia, and increased serum transaminase activities are important laboratory features. Despite clinical similarities, each disease has unique features: a greater severity and a higher case-fatality rate for HME and a higher prevalence of opportunistic infections for HGA. Once an ehrlichiosis is suspected on historical and clinical grounds, doxycycline treatment should be initiated concurrently with attempts at etiologic confirmation using laboratory methods such as blood smear examination, polymerase chain reaction, culture, and serologic tests.