Changes

==Introduction==  

==Introduction==  

'''Septicaemia''' in the foal is a '''serious''' and '''life-threatening''' condition that requires '''prompt diagnosis''' and '''treatment'''. It is caused by the presence of '''bacteria''', or '''bacterial toxins''' in the '''blood'''. The infection can either be localised (ie to the joints or umbilicus) or generalised, with systemic signs.

'''Septicaemia''' in the foal is a '''serious''' and '''life-threatening''' condition that requires '''prompt diagnosis''' and '''treatment'''. It is caused by the presence of '''bacteria''', or '''bacterial toxins''' in the '''blood'''. The infection can either be localised (ie to the joints or umbilicus) or generalised, with systemic signs.

Several bacteria can cause septicaemia, including grams negative organisms such as '''''E-coli''''', ''Actinobacillus'', and ''Klebsiella'' species,and gram positive organisms such as '''''Streptococcus''''' and ''Staphylococcus'' species. Occasionally anaerobic organisms such ''Clostridium'' species may also cause disease.  

Several bacteria can cause septicaemia, including grams negative organisms such as '''''[[E. coli]]''''', [[:Category:Actinobacillus species|''Actinobacillus'']], and ''[[Klebsiella]]'' species,and gram positive organisms such as [[:Category:Streptococcus species|'''''Streptococcus''''']] and [[:Category:Staphylococcus species|''Staphylococcus'' species]]. Occasionally anaerobic organisms such [[:Category:Clostridium species|''Clostridium'' species]] may also cause disease.  

==Signalment==  

==Signalment==  

Predisposing factors include:

Predisposing factors include:

* '''Failure of passive transfer''' - due to failure of the foal to suckle adequate quantities of colostrum, or low volume/poor quality colostrum produced by the dam.

* [[Failure of Passive Transfer|'''Failure of passive transfer''']] - due to failure of the foal to suckle adequate quantities of colostrum, or low volume/poor quality colostrum produced by the dam.

* '''Dystocia'''

* [[Dystocia - Horse|'''Dystocia''']]

* '''Premature/Dysmature foal'''

* '''Premature/Dysmature foal'''

* '''Over-crowding and poor hygiene'''

* '''Over-crowding and poor hygiene'''

* Cardiac localisation produces '''tachycardia'''

* Cardiac localisation produces '''tachycardia'''

* Gastrointestinal localisation produces '''ileus, colic and diarrhoea'''

* Gastrointestinal localisation produces '''ileus, [[:Category:Colic in Horses|colic]] and diarrhoea'''

* Integumentary localisation produces '''anasarca'''

* Integumentary localisation produces [[Oedema|'''anasarca''']]

* Locomotor localisation produces '''joint effusion and/or septic arthritis'''

* Locomotor localisation produces '''joint effusion and/or septic arthritis'''

* Neurological localisation produces '''seizures and depression'''

* Neurological localisation produces '''[[seizures]] and depression'''

* Ocular localisation produces '''hypopyon''' and '''iritis'''

* Ocular localisation produces '''hypopyon''' and '''iritis'''

* Respiratory localisation produces '''polypnoea'''

* Respiratory localisation produces '''polypnoea'''

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.  

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.  

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.

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.

   

   

==Treatment==

==Treatment==

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.  

If septicaemia is suspected the foal should be '''immediately''' treated with '''broad spectrum IV antibiotics''' until culture results are known. Multiple '''plasma [[:Category:Transfusion Medicine|transfusions]]''' may be required to raise '''IgG''' serum levels, and '''IV [[:Category:Fluid Therapy|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 with joint sepsis and oxygen therapy with pneumonia may also be needed.

'''General supportive care''', '''recumbant foal management''' and '''TLC''' (tender loving care) 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 be surgically resected to reduce the spread of infection to distant organs.

==Prevention==

==Prevention==

* Ensuring adequate intake of '''colostrum''' in the first 12-24 hours of life. Levels can be checked by measuring serum IgG (>800mg/dl)

* Ensuring adequate intake of '''colostrum''' in the first 12-24 hours of life. Levels can be checked by measuring serum IgG (>800mg/dl)

* Appropriate treatment of the '''umbilicus''' with tincture of iodine promptly after birth.

* Appropriate treatment of the '''umbilicus''' with tincture of iodine promptly after birth

* Providing a '''clean''', '''warm''' and '''well ventilated''' environment for the neonate.

* Providing a '''clean''', '''warm''' and '''well ventilated''' environment for the neonate

==Prognosis==

==Prognosis==

Dependant on the severity of clinical signs and the individual organs affected. '''Early recognition and aggressive treatment''' are key to an improved prognosis.

Prognosis is dependant on the severity of clinical signs and the individual organs affected. '''Early recognition and aggressive treatment''' are key to an improved prognosis.

 

==References==

==References==

Stoneham, S (1997) '''Collection and administration of plasma to a new born foal''' ''In Practice 1997 19: 384-38''

Stoneham, S (1997) '''Collection and administration of plasma to a new born foal''' ''In Practice 1997 19: 384-38''

[[Category:To Do - Siobhan Brade]]

 

[[Category:To Do - Manson review]]

 

 

[[Category:Cardiovascular Diseases - Horse]]

[[Category:Expert Review - Horse]]