Equine Upper Respiratory Diseases Quiz

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Questions and Answers

What type of nasal discharge is typically associated with infectious diseases of the upper respiratory tract in horses?

Mucopurulent nasal discharge

Bilateral nasal discharge (correct)

Unilateral nasal discharge

Stenotic nasal discharge

Which condition is known to cause unilateral nasal discharge in horses?

Roaring syndrome

Laryngeal paralysis

Guttural pouch empyema (correct)

Pleuropneumonia

Which of the following is NOT a common upper respiratory condition of horses?

Progressive ethmoid haematoma

Bacterial pneumonia (correct)

Rhinitis

Strangles

What is the primary clinical presentation of guttural pouch mycosis in horses?

Epistaxis Signup and view all the answers

Which diagnostic tool is most beneficial in visualizing the guttural pouches in horses?

Endoscopy Signup and view all the answers

Which treatment is commonly used for strangles in horses?

Antibiotic therapy Signup and view all the answers

In cases of epistaxis, what is a possible underlying cause?

Trauma Signup and view all the answers

What condition can cause GP empyema in horses?

Bacterial infection Signup and view all the answers

What is the primary cause of guttural pouch empyema?

Accumulation of exudate following a URT infection Signup and view all the answers

Which of the following is NOT a clinical sign of guttural pouch empyema?

Diarrhea Signup and view all the answers

What type of Streptococcus is primarily associated with strangles in horses?

Streptococcus equi equi Signup and view all the answers

Which of the following describes the transmission characteristics of Strangles?

High morbidity, low mortality Signup and view all the answers

What treatment options are recommended for non-Strangles related empyema?

Supportive therapy and lavage Signup and view all the answers

What is a common sequela to guttural pouch empyema?

Chondroid formation Signup and view all the answers

Which clinical presentation is associated with severe cases of Strangles?

Interference with breathing and swallowing Signup and view all the answers

What type of sampling is considered the best for diagnosing Strangles?

Guttural pouch wash Signup and view all the answers

What is a primary dental disease that can lead to secondary sinusitis?

Apical tooth root infection Signup and view all the answers

What is a characteristic feature of a sinus cyst?

Benign but expansile nature Signup and view all the answers

Which symptom is commonly associated with sinusitis?

Unilateral nasal discharge Signup and view all the answers

Which method is NOT used for diagnosing sinusitis?

MRI Signup and view all the answers

Which of the following dental diseases can lead to difficulty chewing as a symptom of sinusitis?

Apical tooth root infection Signup and view all the answers

What imaging technique is commonly used to assess sinus conditions?

CT scan Signup and view all the answers

Which of the following symptoms would indicate facial distortion related to sinusitis?

Facial swelling Signup and view all the answers

In cases of secondary sinusitis caused by dental issues, which teeth are primarily involved?

Maxillary molars Signup and view all the answers

What is the main reason for a false negative result in bacterial culture when diagnosing strangles?

Inadequate sample selection Signup and view all the answers

What is the peak time for serology results in cases of strangles?

5 weeks Signup and view all the answers

Which of the following statements about the use of antibiotics in treating strangles is correct?

Antibiotics may interfere with the development of natural immunity. Signup and view all the answers

What is often administered as symptomatic therapy for horses with strangles?

NSAIDs like flunixin meglumine Signup and view all the answers

Which condition is associated with the hematogenous or lymphatic spread of the organism causing strangles?

Bastard strangles Signup and view all the answers

What treatment is indicated for immune-mediated purpura hemorrhagica?

Steroids plus systemic antibiotics Signup and view all the answers

What is the purpose of using a hot pack in the treatment of abscesses associated with strangles?

To encourage drainage of abscesses Signup and view all the answers

Which diagnostic method has high sensitivity and specificity for strangles?

qPCR Signup and view all the answers

What is the primary mode of transmission for Strangles among horses?

Nasal discharge and contaminated materials Signup and view all the answers

How long does shedding of S.equi equi typically continue after clinical signs resolve?

2-3 weeks Signup and view all the answers

What is the recommended procedure for managing a confirmed Strangles case?

Strict isolation and supportive care Signup and view all the answers

What should be done with horses that have been in contact with a positive Strangles case but show no clinical signs?

Strict isolation and monitoring Signup and view all the answers

What defines a silent carrier of Strangles?

Harbours infection without clinical signs Signup and view all the answers

What treatment is commonly used for carrier horses recovering from Strangles?

Guttural pouch local antibiotic infusion Signup and view all the answers

What is the protocol to follow if a horse's status is classified as 'naive'?

Monitoring and testing if suspicious Signup and view all the answers

What is a necessary step in the test and release process for Strangles cases?

Multiple tests over a weeks period Signup and view all the answers

What is the recommended protocol for treating with penicillin gel for strangles?

1 week treatment repeated for a total of 3 weeks, then test Signup and view all the answers

Which of the following is NOT a differential diagnosis for epistaxis according to the information provided?

Chronic rhinitis Signup and view all the answers

What is the severity classification for epistaxis that is life-threatening?

Severe Signup and view all the answers

What is the common iatrogenic cause of trauma leading to epistaxis?

Nasogastric intubation Signup and view all the answers

What percentage of blood volume loss results in a heart rate of 60-80 bpm and pale mentation?

30-40% Signup and view all the answers

Which of the following is a critical action in the general approach to managing blood loss?

Identify and stop the source of blood loss Signup and view all the answers

What is the expected capillary refill time (CRT) for blood loss of up to 15%?

Normal CRT Signup and view all the answers

In the context of strangles management, what does best practice include?

Serology and GP wash test Signup and view all the answers

Study Notes

Equine Upper Respiratory Tract Disease

This presentation covers an approach to equine upper respiratory tract (URT) disease, specifically focusing on various conditions and their presentations.

Learning Objectives

Understand common conditions affecting the horse's URT.
Describe diagnostic methods for investigating respiratory conditions in horses.
Learn about the benefits and methods for different diagnostic modalities.
Outline the diagnoses, treatments, and control measures for infectious and non-infectious URT diseases.

Outline of URT Conditions

Bilateral nasal discharge: Includes URT infectious diseases.
Unilateral nasal discharge: Includes sinus disease, guttural pouch empyema, strangles, and other conditions.
Epistaxis: Includes trauma, guttural pouch mycosis, and progressive ethmoid hematoma.

Upper Airway Introduction

Nasal and paranasal regions (rhinitis, sinusitis, nasal cysts, ethmoid haematoma, and nasal/sinus neoplasia).
Trauma.
Guttural pouches (tympany, empyema, strangles, mycosis, neoplasia).
Larynx.
Lungs.
Nasal passage.
Trachea.

Infectious Diseases of URT (Bilateral Nasal Discharge)

Equine influenza virus (EIV): A common infectious disease of the URT in horses, routine vaccination is helpful for preventing outbreaks.
Equine herpesvirus (EHV): EHV 4 usually causes respiratory disease in young horses, EHV 1 can cause respiratory disease, neurological disease, late-term abortion, and early foal death.
Other viral diseases: Equine rhinitis A & B, adenoviruses.
Strangles: Streptococcus equi subspecies equi, discussed later in the presentation.

Clinical Scenario (Infectious Diseases of URT)

Risk factors: Horses of all ages, high traffic, large group herds, virus transmission through air, direct nasal droplets, and indirect transmission via people and equipment.
Clinical presentation: Nasal discharge (often bilateral), enlarged lymph nodes, fever, lethargy (typically transient).
Consider lower respiratory tract (LRT) disease if accompanied by coughing and tachypnea and possible oesophageal obstruction.

Clinical Scenario (Diagnosis, Treatment & Prevention)

Diagnosis: Nasal swab for respiratory PCR panel.
Treatment: Often self-resolving, supportive care includes palatable foods, monitoring hydration levels, and medication (NSAIDs, flunixin meglumine, phenylbutazone). Vaccination is a preventative measure.
Biosecurity: Limit nose-to-nose contact, and maintain good routine hygiene.

Unilateral Nasal Discharge

Sinusitis.
Guttural pouch empyema.
Strangles.
Other conditions.

Differential Diagnosis of Unilateral Nasal Discharge

Sinusitis: Sinus cyst, nasal/paranasal neoplasia.
Guttural pouch empyema and strangles:.

Paranasal Sinus Anatomy

The presentation details the different paranasal and conchal sinuses including the frontal, maxillary (rostral and caudal), sphenopalatine, dorsal conchal, middle (ethmoidal) conchal, and ventral conchal sinuses. Illustrations of the anatomy are included.

Aetiology of Sinusitis

Primary sinusitis: (subacute, chronic) most frequent type (45%).
Secondary sinusitis:
- Dental/oral disease (24%).
- Sinus cyst (13%).
- Other conditions: trauma, neoplasia, mycosis, ethmoid hematoma.

Pathophysiology of Sinusitis

Primary sinusitis: URT viral infection, reduced mucociliary clearance, mucus accumulation within sinus, secondary bacterial infection, and accumulation of purulent material (empyema).
Secondary sinusitis: Obstruction of drainage (trauma, cyst, neoplasia), associated with dental disease.

Secondary Sinusitis: Dental Disease

Primary dental diseases extending into the sinus (maxillary molars 9, 10, 11).
Involves the fine alveolar bone layer and sinus periosteum.
Apical tooth root infections can lead to sinusitis.
Oromaxillary fistula.

Secondary Sinusitis: Sinus Cysts

Unknown etiology.
Benign but expansile, occurring at any age.
These cysts can distort the paranasal structures.

Clinical Presentation (Sinusitis)

Serous, mucoid, or purulent unilateral nasal discharge.
Facial swelling or distortion (maxillary or frontal).
Nasal airflow obstruction (abnormal respiratory noise).
Difficulty chewing (dental issues).

Diagnosis (Sinusitis)

Physical examination (facial symmetry, sinus percussion).
Oral examination.
Imaging (radiography, endoscopy: URT, sinus, CT).

Treatments (Sinusitis)

Aims to remove infection, restore normal drainage and mucociliary clearance, and prevent recurrence.
Treatments include broad-spectrum antibiotics, mucolytics, sinus trephination, repeat lavage, the removal of the inciting cause.
Sinus trephination and lavage.
Sinus flap surgery (better access, standing surgery, and removal of cysts).

2. Guttural Pouch Empyema

Definition: Exudate accumulation within the guttural pouch.
Usually a consequence of URT infections (similar to sinus infections).
Common causative agents include Streptococcus zooepidemicus (a common opportunistic infection), and Streptococcus equi equi (strangles – highly contagious).

Clinical Signs (Guttural Pouch Empyema)

Fever and related symptoms (anorexia, lethargy).
Lymph node swelling.
Unilateral or bilateral purulent discharge.
Chronic empyema can lead to chondroid formation.

Supportive therapy (NSAIDs, palatable feed).
Lavage of material (via endoscopy).
Removal of chondroids (via endoscopy or surgery).

3. Strangles (Streptococcus equi equi Infection)

Gram-positive, B-haemolytic streptococcus, Lancefield group C.
Highly contagious URT condition in equids.
Moderate mortality but substantial morbidity.
Very significant from an economic and social viewpoint within the equine industry.

Clinical Signs (Strangles)

Initial fever followed by inappetence, dullness, lethargy, and a second fever.
URT obstruction, dysphagia, and discharge.
Systemic bacteraemia, seeding in distant lymph tissue, guttural pouch empyema, and abscess formation.

Clinical Presentation (Strangles)

Varying severity (more severe in young, old, or immunocompromised horses).
Mild case: pyrexia followed by pharyngitis and subsequent abscess formation in submandibular and retropharyngeal lymph nodes.
Severe case: swollen lymph nodes interfering with breathing and swallowing.
Strangles-related conditions: metastatic infection ("Bastard strangles"), and immune-mediated conditions like purpura haemorrhagica and myositis.

Diagnosis strangles

Nasal swab (not useful early)
Nasopharyngeal and GP swab (more effective as abscesses form)
GP wash (best early diagnosis)
Bacterial culture
Molecular diagnosis (qPCR)
Serology: SEM ELISA, Combined Antigen A & CELISA*

Treatments (Strangles)

Symptomatic and supportive therapy (NSAIDs, palatable food).
Drainage of abscesses via hot packs, surgical lancing, daily cleaning/lavage.
Use of antibiotics judiciously in acute cases.

"Bastard Strangles": hematogenous or lymphatic spread of infection, resulting in metastatic abscesses in the brain, abdomen, mammary glands, and eyes..
Immune-mediated conditions: necrotizing vasculitis, edema, petechial hemorrhage, petechia on mucous membranes, peripheral oedema, history of exposure to S. equi, and suggestive clinical signs.

Biosecurity (Strangles)

Highly contagious spread among equine families via nasal discharge, contaminated water, and equipment.
Shedding of S. equi equi usually ceases 2-3 weeks after clinical signs resolve.
Silent horse carriers harboring infection in guttural pouches also need detection and treatment.

Biosecurity detection of Strangles

Isolate horses experiencing relevant clinical signs.
Using nasopharyngeal and guttural pouch washes/abscess sampling for bacterial culture and PCR.

Biosecurity segregation

Positive horses should be strictly isolated.
In-contact horses should be monitored, and tested if suspicious.
Naive horses should be monitored and tested if suspicious.

Biosecurity – treatment of horse carriers with strangles

Carrier animals show recovery from recent infections but are still capable of silently carrying the infection.
Use guttural pouch infusions, tests and releases (e.g penicillin gel).

1. Epistaxis (Nosebleeds)

Main differentials: Trauma, Ethmoidal hematoma, Guttural pouch mycosis, Exercise induced pulmonary hemorrhage (EIPH)
Severity: Mild/temporary, intermittent, or life-threatening

Approach to Epistaxis: Trauma

Trauma to the head/nose, potentially from nasogastric intubation is a common cause
Trauma to the ethmoid bone → pass the tube ventromedially!
Treatments often self-limiting, use of supportive care, general approach to blood loss

Approach to Epistaxis: General Approach to Blood Loss

Blood loss evaluation: PCV, heart rate, CRT, BP, mentation, and other supporting information is assessed to determine seriousness.
Blood loss estimation in liters (L).
Considerations of blood transfusion and cross-matching when PCV is lower than 12%.

2. Progressive Ethmoidal Haematoma (PEH)

Progressive sub-mucosal haemorrhage of ethmoid bone.
Condition unique to horses, often associated with nasal cavity, sinuses, and/or ethmoid bones.
Clinical signs include intermittent epistaxis ("mucky" blood).
Treatment methods vary by lesion size (e.g., formalin for small lesions, surgical resection/ sinus flap for large lesions).

3. Guttural Pouch Mycosis

Fungal infection, most commonly with Aspergillus fumigatus or Emericella nidulans.
Opportunistic infection, worsened by climate factors.
Disease severity varies with location from asymptomatic to epistaxis, and more severe resulting in chronic neurological deficit, hypovolemic shock, and other symptoms.

Diagnosis (Guttural Pouch Mycosis)

Suggestive clinical signs (recurring epistaxis).
Endoscopy, to stabilize the horse prior to imaging.

Treatments (Guttural Pouch Mycosis)

Medical management (anti-fungals, topical infusion).
Surgical options (blockage of blood supply via catheter/ surgical excision, or coil embolisation).

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Description

Test your knowledge on equine upper respiratory diseases with this quiz. It covers various conditions, diagnostic tools, and treatment options related to horses' nasal issues. Perfect for veterinary students and horse enthusiasts alike!