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.

Aspergillosis granuloma in the mediastinum of a non-immunocompromised horse.

A National Show Horse with a mediastinal granuloma was presented with clinical signs which included fever, nasal discharge and cough. The mediastinal mass was identified radiographically and ultrasonographically. A presumptive diagnosis of aspergillosis was made following isolation of Aspergillus spp. from both transtracheal aspirate and bronchoalveolar lavage fluid samples and agar gel immunodiffusion (AGID) identification of serum antibody to Aspergillus spp. The diagnosis was confirmed by histopathologic examination of the mediastinal mass obtained at necropsy examination.

Generalized medullary infarction of the long bones in a horse.

Generalized medullary infarction of the long bones was diagnosed in a 12-year-old Tennessee Walking Horse mare. The mare was referred after a 6-week course of shifting weight on her hind limbs, and kicking. Physical examination revealed mild stifle joint distention and withdrawal reactions to digital pressure over the long bones. Radiography revealed patchy areas of medullary sclerosis in the distal portion of each femur and proximal portion of each tibia. A full-thickness cortical and cancellous tibial biopsy revealed infarcted bone marrow, with cortical and periosteal osteonecrosis. The cause of the intramedullary infarction could not be determined, but might have been attributable to cumulative bone stress resulting from mild primary hyperparathyroidism and some unidentified inflammatory factor.

Effect of hypertonic and isotonic saline solutions on plasma constituents of conscious horses.

Blood constituents and vascular volume indices were determined in 5 standing horses by use of 2-period crossover experimental design. Horses were either administered hypertonic (2,400 mosm/kg of body weight, i.v.) or isotonic (300 mosm/kg, i.v.) saline solution. Each solution was administered at a dosage of 5 ml/kg (infusion rate, 80 ml/min). Samples for determination of PCV, plasma volume, blood volume, plasma osmolality, total amount of plasma protein and plasma concentrations of protein, Na, K, and Cl were collected at 0 hour (baseline, before fluid infusion) and 0.5 hour (at the end of fluid infusion), and subsequently, at 0.25- or 0.5-hour intervals for 4.5 hours. All horses were given the predetermined dose of fluids by 0.5 hour after beginning the saline infusion. Values of P < or = 0.05 were considered significant. Administration of hypertonic saline solution was associated with decreased mean body weight by 4.5 hours, but weight change after isotonic saline administration was not significant. Other than body weight and plasma protein concentration, between-trial difference (treatment effect) was not observed for any measured variable or index. The F values indicated that increasing the number of horses would have not changed these results. A time effect was evident across both trials, so that mean (+/- SD) plasma volume increased (12.3 +/- 1.07%) and mean plasma protein concentration (-12.1 +/- 1.03%) and PCV (-11.9 + 0.67%) decreased proportionately and transiently in association with administration of either fluid at that volume. Other time effects included increased plasma osmolality and Na and Cl concentrations. Blood volume estimates and total amount of plasma protein remained unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of hypertonic vs isotonic saline solution on responses to sublethal Escherichia coli endotoxemia in horses.

Cardiovascular responses to sublethal endotoxin infusion (Escherichia coli, 50 micrograms/ml in lactated Ringer solution at 100 ml/h until pulmonary arterial pressure increased by 10 mm of Hg) were measured 2 times in 5 standing horses. In a 2-period crossover experimental design, horses were either administered hypertonic (2,400 mosm/kg of body weight, IV) or isotonic (300 mosm/kg, IV) NaCl solution after endotoxin challenges. Each solution was administered at a dose of 5 ml/kg (infusion rate, 80 ml/min). Complete data sets (mean arterial, central venous, and pulmonary arterial pressures, pulmonary arterial blood temperature, cardiac output, total peripheral vascular resistance, heart rate, plasma osmolality, plasma concentration of Na, K, Cl, and total protein, blood lactate concentration, and PCV) were collected at 0 (baseline, before endotoxin infusion), 0.25, 1, 1.5, 2, 2.5, 3, 3.5, 4, and 4.5 hours after initiation of the endotoxin infusion. Blood constituents alone were measured at 0.5 hour and cardiovascular variables alone were evaluated at 0.75 hour. By 0.25 hour, endotoxin infusion was completed, a data set was collected, and saline infusion was initiated. By 0.75 hour, saline solutions had been completely administered. Mean (+/- SEM) cardiac output decreased (99.76 +/- 3.66 to 72.7 +/- 2.35 ml/min/kg) and total peripheral resistance (1.0 +/- 0.047 to 1.37 +/- 0.049 mm of Hg/ml/min/kg) and pulmonary arterial pressure (33.4 +/- 0.86 to 58.3 +/- 1.18 mm of Hg) increased for both trials by 0.25 hour after initiation of the endotoxin infusion and prior to fluid administration. For the remainder of the protocol, cardiac output was increased and total peripheral resistance was decreased during the hypertonic, compared with the isotonic, saline trial.(ABSTRACT TRUNCATED AT 250 WORDS)

Diarrhea associated with sand in the gastrointestinal tract of horses.

Four horses with diarrhea had radiographic evidence of large quantities of sand in the gastrointestinal tract. Initially, none of the horses had sufficient fecal sand quantity to suggest sand enteropathy. Diarrhea resolved in all horses within 2 days of oral administration of psyllium hydrophilic mucilloid. Historically, all 4 horses had lost weight or had difficulty maintaining weight. After treatment was administered, the horses either gained weight or were easier to maintain in good condition.

Evaluation of a test kit for determination of serum immunoglobulin G concentration in foals.

The accuracy of an immunoglobulin (Ig) G test kit for the semiquantitative measurement of IgG concentration was evaluated with serum from 88 foals. Failure of passive transfer (IgG less than 400 mg/dl) was correctly identified in each of 34 samples, and partial failure of passive transfer (400 less than or equal to IgG less than 800 mg/dl) was correctly identified in each of nine samples. Evidence of adequate passive transfer (IgG greater than or equal to 800 mg/dl) was detected in 44 of 45 samples. One sample with 800 mg/dl or more of IgG was incorrectly classified as a partial failure of passive transfer (Kendall Tau - b = .975). The high degree of accuracy, especially without any errors of overestimation of IgG concentrations, indicated that the IgG test kit should be a useful assay for rapidly determining the passive transfer status of foals.

Cardiovascular effects of hydralazine HCl administration in horses.

Six standing awake adult horses were instrumented for measurement of mean arterial, central venous, and pulmonary arterial blood pressures (mm of Hg), thermodilution cardiac output (ml/kg/min), and pulmonary arterial blood temperature (C). Total peripheral resistance was calculated from these values. Base-line data were accumulated, and a single dose of hydralazine HCl (0.5 mg/kg) was administered IV. Horses were monitored for 420 minutes after hydralazine administration. Mean arterial and central venous blood pressures did not change from the base-line values. Cardiac output and heart rate were increased above base-line values for 260 minutes. Total peripheral resistance was decreased for 240 minutes. Pulmonary arterial blood temperature was decreased for 60 minutes after drug administration. Mean pulmonary arterial pressure relative to the base-line mean was intermittently decreased during the study. Intravenously administered hydralazine HCl appears to be an effective vasodilator, with moderate duration of action in horses.

Chronic flunixin meglumine therapy in foals.

Effects of a therapeutic dose of flunixin meglumine on gastric mucosa of horse foals were determined by endoscopy, double-contrast radiography, and gross and histologic examinations. Foals were administered 1.1 mg of flunixin meglumine/kg of body weight, PO/day for 30 days in an encapsulated form that was divided into 2 doses/day (group 1; n = 3) or by IM injection once a day (group 2; n = 7). Three control foals (group 3; n = 3) were administered capsules (n = 1) containing dextrose powder or IM injections (n = 2) of vehicle solution without flunixin meglumine. All 3 groups-1 foals given flunixin meglumine PO developed oral ulcers. Group-2 foals given flunixin meglumine IM did not develop oral ulcers. One control foal (group 3) developed 1 oral ulcer that healed during the study. Endoscopic examination revealed linear crease-like mucosal lesions in the glandular portion of the stomach in 2 group-2 foals. Radiographic evidence of gastric ulcers was observed in only 1 gastrogram of a group-1 foal. Foals were euthanatized, and necropsy revealed erosions and/or ulcers of the glandular portion of the stomach. Oral ulcers were observed in all 3 group-1 foals. Erosions of the glandular portion of the stomach developed in all 10 foals given flunixin meglumine, but did not develop in group-3 foals. Ulceration of the glandular portion of the stomach was present in 1 group-2 foal.

M-mode echocardiographs of endurance horses in the recovery phase of long-distance competition.

M-mode echocardiographic structures, and cardiac function indices, PCV, and total plasma protein values were determined for 34 endurance equine athletes before (base line) and after (after race) a 161-km endurance competition and were compared. The PCV (base-line mean, 37%; after-race mean, 46%) and total plasma protein value (base-line mean, 6.9 g/dl; after-race mean, 7.5 g/dl) increased. Compared with base-line echocardiography, after-race echocardiography indicated an increase in heart rate, as determined from the simultaneous ECG recorded on the echocardiograph (base-line mean, 41 beats/min; after-race mean, 54 beats/min), and an increase in interventricular septal diastolic thickness (base-line mean, 28 mm; after-race mean, 33 mm). The septal thickening fraction (base-line mean, 59%; after-race mean, 38%), the left atrioventricular valve E to F slope (base-line mean, 224 mm/s; after-race mean, 175 mm/s), the left ventricular diastolic dimension (base-line mean, 99 mm; after-race mean, 86 mm), the fractional shortening of the left ventricle (base-line mean, 41%; after-race mean, 37%), the aortic root dimension (base-line mean, 63 mm; after-race mean, 58 mm), the caudal aortic wall excursion (base-line mean, 19 mm; after-race mean, 11 mm) and the left atrial diastolic dimension (base-line mean, 46 mm; after-race mean, 39 mm), decreased significantly (P less than 0.05). In base-line echocardiographs, late diastolic left atrioventricular valve motion was evident in 9 horses. The aberrant left atrioventricular valve motion was not evident in after-race echocardiographs. Seemingly, central vascular volume decreased in these horses during the recovery phase of severe strenuous endurance competition.