New Parvovirus Associated with Serum Hepatitis in Horses after Inoculation of Common Biological Product.

Equine serum hepatitis (i.e., Theiler's disease) is a serious and often life-threatening disease of unknown etiology that affects horses. A horse in Nebraska, USA, with serum hepatitis died 65 days after treatment with equine-origin tetanus antitoxin. We identified an unknown parvovirus in serum and liver of the dead horse and in the administered antitoxin. The equine parvovirus-hepatitis (EqPV-H) shares <50% protein identity with its phylogenetic relatives of the genus Copiparvovirus. Next, we experimentally infected 2 horses using a tetanus antitoxin contaminated with EqPV-H. Viremia developed, the horses seroconverted, and acute hepatitis developed that was confirmed by clinical, biochemical, and histopathologic testing. We also determined that EqPV-H is an endemic infection because, in a cohort of 100 clinically normal adult horses, 13 were viremic and 15 were seropositive. We identified a new virus associated with equine serum hepatitis and confirmed its pathogenicity and transmissibility through contaminated biological products.

Randomised controlled trial of tetanus treatment with antitetanus immunoglobulin by the intrathecal or intramuscular route.

OBJECTIVE: To evaluate the effect of intrathecal therapy with human antitetanus immunoglobulin on clinical progression of and mortality from tetanus. DESIGN: Randomised controlled trial. SETTING: Intensive care unit of a university hospital, Pernambuco, Brazil. PARTICIPANTS: 120 patients with tetanus allocated to antitetanus immunoglobulin by either the intrathecal and intramuscular route (n = 58) or the intramuscular route (n = 62; control group). MAIN OUTCOME MEASURES: Clinical progression of disease, duration of hospital stay, duration of occurrence of spasms, complications, respiratory infection, respiratory failure or mechanical ventilation, duration of respiratory assistance, and mortality. RESULTS: Patients in the treatment group showed a better clinical progression than those in the control group (chi2 for trend 7.752, P = 0.005; difference in proportion of patients with improvement 20%, 95% confidence interval 4% to 35%). The duration of occurrence of spasms, hospital stay, and respiratory assistance were all shorter in patients the treatment group: respectively, 14.96, 0.0001 (difference in proportion of patients with spasms lasting < or = 10 days 36%, 18% to 55%); 4.56, 0.03; and 6.56, 0.01 (proportion of patients who needed assistance for < or = 10 days 69.2% in the treatment group and 30.8% in the control group (difference 38%, 12% to 65%)). CONCLUSION: Patients treated with antitetanus immunoglobulin by the intrathecal route show better clinical progression than those treated by the intramuscular route.

Acute disseminated encephalomyelitis (ADEM) presenting with seizures secondary to anti-tetanus toxin vaccination.

Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disease of the central nervous system (CNS) that is known to occur spontaneously in association with specific and non-specific viral illnesses and after vaccination against various pathogens. Although it is often a self-limited monophasic illness, the fatality rate is estimated to be as high as 20%, and many patients suffer residual neurologic impairment 1. The diagnosis is mainly based on clinical and radiological findings. The clinical presentation varies from merely, an asymptomatic condition to loss of consciousness, seizures, ataxia, optic neuropathy, cranial nerve palsies, and motor dysfunction. MRI of the brain is the single most important diagnostic radiological investigation and can facilitate early diagnosis and prompt treatment. This case report describes a patient with ADEM presenting with only seizures after vaccination with anti-tetanus toxin.

Hepatic disease associated with administration of tetanus antitoxin in eight horses.

Seven horses developed clinical or subclinical hepatitis 48 to 87 days after administration of tetanus antitoxin. One horse had mildly high hepatic enzyme activity 120 days after inoculation with tetanus antitoxin. The first horse developed signs of depression, lethargy, and anorexia. During hospitalization, signs of hepatoencephalopathy were noticed, and laboratory data were consistent with hepatic disease. Another horse that was found dead had gross and histologic lesions compatible with serum hepatitis. Screening of serum gamma-glutamyltransferase (GGT) and aspartate transaminase activities were used to investigate the remaining horses in the herd. High GGT activities (71 to 206 IU/L) were detected in 5 additional herd members. These horses appeared clinically normal, apart from 2 reports of nasal photosensitization and an aborted fetus. In 3 horses, high serum GGT activity persisted over a 44-day testing period. All affected horses had been given tetanus antitoxin within 12 hours of parturition, and a common source of vaccine was identified for 7 horses. Findings in this group of horses indicate that clinical and subclinical serum hepatitis can develop after administration of tetanus antitoxin.

Serum hepatitis in two brood mares.

Two adult Quarter Horse mares from the same farm developed signs of hepatic disease approximately 2 months after parturition. Both mares had received tetanus antitoxin at the time of foaling. One mare developed subcutaneous edema of the distal aspect of all 4 limbs, photodermatitis involving unpigmented areas of skin, and high serum activities of liver-specific enzymes. The other mare had signs of acute hepatic failure, including icterus, hepatic encephalopathy, and high serum activities of liver-specific enzymes, and died. The second mare had signs typical of serum hepatitis (Theiler's disease) and the first mare was believed to have had an atypical, less-severe form of serum hepatitis. Hepatotoxic agents (eg, poisonous plants, aflatoxins, toxic chemicals) were not found on the farm.

Idiopathic acute hepatic disease in horses: 12 cases (1982-1992).

Acute hepatic disease was diagnosed in 16 horses during the study period. Twelve of those cases were characterized as idiopathic acute hepatic disease (IAHD). In 9 of the 12 (75%) cases of IAHD, the horses were female, and 7 of the 9 females were lactating and had been treated with tetanus antitoxin at parturition. Diagnosis of IAHD was based on anamnesis, clinical signs, and results of serum biochemical analyses, hepatic biopsy, and postmortem examination. Within 1 year of the illness, 75% (9/12) of the horses had died or had been euthanatized. Not all horses had the typical fulminant signs associated with IAHD and in those horses, serum biochemical analyses were particularly helpful in diagnosis. Because tetanus antitoxin administration seemed to be associated with IAHD, use of tetanus antitoxin is not without risk, and routine administration of tetanus antitoxin, particularly to parturient mares, should be discouraged.

Penicillin-induced hemolytic anemia and acute hepatic failure following treatment of tetanus in a horse.

Acute, severe hemolytic anemia occurred in a horse being treated for tetanus with intravenous penicillin and tetanus antitoxin. During treatment, the horse developed a positive direct antiglobulin test and a high titer (maximum 1:1024) of IgG anti-penicillin antibody. The horse recovered from the tetanus and penicillin induced hemolytic anemia, but later developed acute hepatic failure, probably resulting from the administration of equine origin tetanus antitoxin.

[Drugs in Poland: a review of literature on the symptoms of side effects]. / Arzneimittel in Polen: Eine Literaturübersicht über die Symptome von Nebenwirkungen.

The present paper gives a review of the data published in Poland concerning side effects of drugs. The most numerous observations concern antibiotics (particularly penicillin), sulfonamides, salicylates and antitetanic serum. The most frequent complications were: shock, urticaria, erythema multiforme and exanthema maculopapulosum.