Changes

==Signalment==  

==Signalment==  

Infection is via haematogenous spread following infection via the placenta, umbilicus, lungs or GI tract. Foals may be affected as early as the  

Infection is via haematogenous spread following infection via the placenta, umbilicus, lungs or GI tract. Foals may be affected as early as the first 12 hours after birthday.

Predisposing factors include:

Predisposing factors include:

* Artificial severance and ligation of the umbilicus

* Artificial severance and ligation of the umbilicus

* Failure to treat the umbilicus immediately after birth (with tincture of iodine)

* Failure to treat the umbilicus immediately after birth (with tincture of iodine)

==Clinical Signs==  

==Clinical Signs==  

The disease may then advance to '''septic shock'''. Clinical signs include prolonged recumbancy, depression, dehydration, and tachycardia with cold extremities, weak thready pulses, slow capillary refill time and muddy mucous membranes, indicative of hypotension. Dependant on the organs affected, signs of individual or multiple organ dysfunction may be present.

The disease may then advance to '''septic shock'''. Clinical signs include prolonged recumbancy, depression, dehydration, and tachycardia with cold extremities, weak thready pulses, slow capillary refill time and muddy mucous membranes; indicative of hypotension. Dependant on the organs affected, signs of individual or multiple organ dysfunction may be present.

Clinical signs can progress very rapidly therefore prompt recognition is necessary.

Clinical signs can progress very rapidly therefore prompt recognition is necessary.

==Diagnosis==

==Diagnosis==

Septicaemia scoring....

Definitive diagnosis is by positive blood culture, however a negative blood culture does not rule out septicaemia. As the foal may deteriorate quickly and the results of the blood culture are not immediate, a provisional diagnosis of neonatal septicaemia is made using a sepsis scoring system. This combines the all the physical findings and in-house test results to provide an overall clinical picture and sepsis score that then guides treatment prior to the return of the blood culture results.  

Clinical signs and history.

 

Individual tests eg US,arthrocentesis etc related to organs affected

Aspects incorporated in the sepsis scoring system are; the clinical signs and history, the results of individual tests (for example ultrasound on the umbilicus and joint arthrocentesis), haematology showing a [[Neutropenia|neutropaenia]] with toxic change, and [[FPT]] measurements - serum IgG levels of less than 4 g/litre indicate failure of passive transfer. Levels of 4g/litre and above are acceptable when coupled with good hygiene. An IgG level of 8 g/litre or more indicates successful transfer of maternal antibodies.

Bloods neutropaenic with toxic change

FPT measurements - serum IgG.....

   

   

==Treatment==

==Treatment==

The foal should be immediate treated with broad spectrum IV antibiotics until culture results are known. Multiple plasma transfusions may be required to raise IgG serum levels, and IV fluid therapy should be administered to treat endotoxic shock. Nutritional support is necessary, either by helping the foal suckle the dam or administration of the dams milk (or a substitute) via nasogastric tube. In addition, glucose levels should be measured frequently and dextrose added to the IV fluid therapy if necessary. The use of anti-endotoxin drugs (flunixin, anti-prostoglandin, polymyxin B) as an adjunct treatment has also been reported.  

If septicaemia is suspected the foal should be immediate treated with broad spectrum IV antibiotics until culture results are known. Multiple plasma transfusions may be required to raise IgG serum levels, and IV fluid therapy should be administered to treat endotoxic shock. Nutritional support is necessary, either by helping the foal suckle the dam or administration of the dams milk (or a substitute) via nasogastric tube. In addition, glucose levels should be measured frequently and dextrose added to the IV fluid therapy if necessary. The use of anti-endotoxin drugs (flunixin, anti-prostoglandin, polymyxin B) as an adjunct treatment has also been reported.  

General supportive care, recumbant foal management and TLC is also necessary - this may continue for several weeks after infection. Organ-specific treatments such as joint lavage may also be needed.

General supportive care, recumbant foal management and TLC is also necessary - this may continue for several weeks after infection. Organ-specific treatments such as joint lavage with joint sepsis and oxygen therapy with pneumonia may also be needed.

If the umbilicus is a localised source of infection, it can surgically resected to reduce the spread of infection to distant organs.

If the umbilicus is a localised source of infection, it can surgically resected to reduce the spread of infection to distant organs.

Mair, TS & Divers, TJ (1997) '''Self-Assessment Colour Review Equine Internal Medicine''' ''Manson Publishing Ltd''

Mair, TS & Divers, TJ (1997) '''Self-Assessment Colour Review Equine Internal Medicine''' ''Manson Publishing Ltd''

 

[[Category:To Do - Siobhan Brade]]

[[Category:To Do - Siobhan Brade]]