Difference between revisions of "Septicaemia - Foal"
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==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''''', ''Actinobacillus'', and ''Klebsiella'' species,and gram positive organisms such as '''''Streptococcus''''' and ''Staphylococcus'' species. Occasionally anaerobic organisms such ''Clostridium'' species may also cause disease. |
==Signalment== | ==Signalment== | ||
| − | + | Disease is caused following '''haematogenous''' spread of infection via the '''placenta''', '''umbilicus''', '''lungs''' or '''GI tract'''. Foals may be affected as early as the first 12 hours after birth. | |
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''' - due to failure of the foal to suckle adequate quantities of colostrum, or low volume/poor quality colostrum produced by the dam. |
| − | * Dystocia | + | * '''Dystocia''' |
| − | * Premature/Dysmature foal | + | * '''Premature/Dysmature foal''' |
| − | * Over-crowding and poor hygiene | + | * '''Over-crowding and poor hygiene''' |
| − | * 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== | ||
| − | Foals in the early stages of clinical disease may not show any specific signs, instead appearing 'off-suck' (inspecting the dams udder can give some indication of when the foal last suckled). This may be accompanied by lethargy, malaise, frequent recumbancy and pyrexia. The bacteria may localise in different organs, producing clinical signs directly related to that organ: | + | Foals in the early stages of clinical disease may not show any specific signs, instead appearing ''''off-suck'''' (inspecting the dams udder can give some indication of when the foal last suckled). This may be accompanied by '''lethargy''', '''malaise''', frequent '''recumbancy''' and '''pyrexia'''. The bacteria may '''localise''' in different organs, producing clinical signs directly related to that organ: |
* Ocular localisation produces '''hypopyon''' and '''iritis''' | * Ocular localisation produces '''hypopyon''' and '''iritis''' | ||
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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== | ||
| − | 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 '''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 with joint sepsis and oxygen therapy with pneumonia 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. | ||
==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. | + | Dependant on the severity of clinical signs and the individual organs affected. '''Early recognition and aggressive treatment''' are key to an improved prognosis. |
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[[Category:To Do - Siobhan Brade]] | [[Category:To Do - Siobhan Brade]] | ||
| + | [[Category:To Do - Manson review]] | ||
Revision as of 20:44, 27 July 2011
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.
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.
Signalment
Disease is caused following haematogenous spread of infection via the placenta, umbilicus, lungs or GI tract. Foals may be affected as early as the first 12 hours after birth.
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.
- Dystocia
- Premature/Dysmature foal
- Over-crowding and poor hygiene
- Artificial severance and ligation of the umbilicus
- Failure to treat the umbilicus immediately after birth (with tincture of iodine)
Clinical Signs
Foals in the early stages of clinical disease may not show any specific signs, instead appearing 'off-suck' (inspecting the dams udder can give some indication of when the foal last suckled). This may be accompanied by lethargy, malaise, frequent recumbancy and pyrexia. The bacteria may localise in different organs, producing clinical signs directly related to that organ:
- Ocular localisation produces hypopyon and iritis
- Integumentary localisation produces anasarca
- Locomotor localisation produces joint effusion and/or septic arthritis
- Cardiac localisation produces tachycardia
- Respiratory localisation produces polypnoea
- Gastrointestinal localisation produces ileus, colic and diarrhoea
- Urogenital localisation produces anuria
- Neurological localisation produces seizures and depression
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.
Diagnosis
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 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
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 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.
Prevention
- 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.
- Providing a clean, warm and well ventilated environment for the neonate.
Prognosis
Dependant on the severity of clinical signs and the individual organs affected. Early recognition and aggressive treatment are key to an improved prognosis.
References
Merck & Co (2009) The Merck Veterinary Manual (Ninth Edition), Merial
Captain M. Horace Hays FRCVS Veterinary Notes for Horse Owners (Revised Edition), Stanley Paul
RVC staff (2009) Urogenital system RVC Intergrated BVetMed Course, Royal Veterinary College
Mair, TS & Divers, TJ (1997) Self-Assessment Colour Review Equine Internal Medicine Manson Publishing Ltd
Stoneham, S (1997) Collection and administration of plasma to a new born foal In Practice 1997 19: 384-38