joint infections, vet school notes
- Joint infections in foals are often secondary to failure of passive
transfer of maternal antibodies (horses get ALL of their maternal
antibodies in the colostrum, or first milk. this is due to the
structure of their placenta). Although the prognosis is good for
adults with joint infections, it's not as good for foals, who are
usually systemically ill.
These patients usually present as 3 legged lame, because
these infections are very painful.
In adult horses, joint infections are often caused by intraarticular
injections. Owners and trainers sometimes like to give their own
IA injections, and they don't do a sterile prep on the area first.
When vets do it, the rate is quite low (.08%) because they
surgicaly prep the area and often put an antibiotic right in the
Speaking of antibiotics--oral antibiotics are not appropriate for
these infections. IV and / or IA is the way to go. Penicillins are
not appropriate either, because most of these are staph
infections, and penicillin doesn't get staph. Amikacin or gentacin
is preferred. Baytril is known to be chondrotoxic, and shouldn't be
given to foals or lactating mares. It's safe for adults however,
unless they are on it for unusually long periods.
Cytology is the best test to confirm a joint infection, and the cutoff
is 30,000 cells per microliter, with more than 75% of them being
Most of these cases should be referred, as they are very difficult
to treat. The average bill here is $3,000.
If necrotic bone is present , it MUST be debrided. Otherwise
treatment will not succeed.
PMMA beads are a promising new treatment. they are
impregnated with antibiotic, and placed in the joint where they
release the med over a period of about 3 weeks. sometimes
they will migrate into a place in the joint capsule where they can't
be removed, but this doesn't seem to cause much trouble.
Infected joints should be flushed to remove bacteria and fibrin.
- I am trying to learn what else I can do to get this foal healthy.
She has a good attitude and eats well but her left hind is a mess.
She has had ankle, hock and stifle flushed and has been on several
different meds. Ankle appears to be fine, hock and stifle have
osteomyelitis, stifle is badly swollen. She's on chloramphenicol and
ketofen right now. She's pretty comfortable when the ketofen's in
her, badly lame without it. She had her stifle flushed again this
morning so hopefully that will improve. She's an orphan being raised
on Mare's Match milk replacer, with access to milk pellets, creep
feed and fresh grass. I've been adding Vit E and mare EPIC to her
milk to try to boost her immune system. I am tempted to try
echinacea, Vit C and/or GlutaSyn, but don't want to waste the money
if they're not likely to help or might be a problem with her meds.
Ideas or thoughts?
- A couple for starters.
<I've been adding Vit E and mare EPIC to her
> milk to try to boost her immune system. I am tempted to tryWhat are her IgG levels? joint infection makes me think maybe she
> echinacea, Vit C and/or GlutaSyn, but don't want to waste the money
> if they're not likely to help or might be a problem with her meds.
> Ideas or thoughts?>
didn't get colostrum. I don't know if at 5 weeks old a colostrum
deprived foal could be expected to have normal IgG levels. I'd love
to look it up, but I have exams coming up--sorry!! If you know,
please tell us.
I keep getting booted offline, so I'm going to post this, then look
up some foal joint infection info, then post again.
You're a vet, I'm assuming.
- The following is from my vet school notes. Is a culture and
sensitivity possible? Is this foal low in IgG, would a plasma
transfusion maybe help?
Septic arthritis in foals is an emergency. Immediate assessment and
institution of treatment should be performed. The systemic condition
of the foal must be addressed. Management of failure of passive
transfer, and all other problems associated with foal septicemia,
should be done.
The principles of treatment of septic arthritis in foals are:
systemic broad-spectrum antibiotics; local joint lavage and
debridement; and local antibiotics. The most common organisms
isolated in foal septic arthritis are: Actinobacillus; E.coli;
Klebsiella sp; Pseudomonas sp; and Salmonella. In older foals, gram-
positive organisms such as Strep sp may be isolated. In older foals
with physeal lesions Rhodoccoccus equi is often involved. In young
foals, systemic antibiotics should be effective against gram-negative
organisms. A combination of a B-lactam and an aminoglycoside is a
good choice, until results of culture are obtained. In older foals,
gram stains of a physeal aspirate or of a trans-tracheal wash are
helpful to identify Rhodoccoccus equi. If present, appropriate
therapy with erythromycin and rifampin should be instituted.
Local lavage can be preformed by through-and-through needle
technique, with the foal under heavy sedation or short-term
intravenous anesthesia. This technique may be sufficient in joints
where the diagnosis was made early, where the infection is not
severe, and in simple joints (fetlock, carpus). In joints with
multiple compartments (stifle, hock), in cases of severe infection,
or in cases of longer duration or lack of response to joint lavage,
arthroscopic debridement is indicated. Arthroscopy has several
advantages over simple needle lavage. It allows thorough debridement,
removal of fibrin and lavage of all compartments; and it allows
evaluation and debridement of cartilage lesions. Arthroscopy may have
prognostic value in cases where radiographic lesions are equivocal.
Intra-articular antibiotics are advocated for the management of
septic arthritis. Aminoglycosides have been shown to maintain levels
above MIC for 24 hours following a single intra-articular injection.8
Other local treatment modalities include antibiotic-impregnated PMMA
beads, or biodegradable antibiotic-impregnated disks. Regional
intravenous or intraosseous perfusion has recently been advocated for
the treatment of septic arthritis complicated with osteomyelitis. The
potentially detrimental effects of temporary vascular occlusion on
foal bone circulation need to be investigated.
The presence of osteomyelitis may warrant the use of an antibiotic
combination that reaches effective bone levels. Rifampin is often
used for that purpose. Other antibiotics that reach effective bone
concentrations include tetracyclines, chloramphenicol, and
cephalosporins. Third-generation cephalosporins should be used, as
they are more effective against gram-negative bacteria.
Fluoroquinolones should not be used in foals, as there is enough
evidence of cartilage lesions developing in immature animals with the
use of this class of drugs.
In the case of extensive physeal lesions, curettage, bone graft and
external coaptation may be required. Angular limb deformities may
result from growth disturbances, or collapse of the physis on the
- She started on Cephalexin for 5 days at 5 days old for a 450 IgG and
a high white count. 450 is "normal" but if I had been told a number
instead of a description I would've had her transfused and probably
saved a lot of headache. (Always use 800 as your cutoff). But
hindsight is 20/20 so moving on.
Temp went down to normal, things went fine while waiting for a
nursemare. Finally got one at 3 weeks old, ended up yet another
problem. Mare would stand and let her nurse so long as the mare was
held or tied. When she was turned loose with foal, she kicked the
hell out of it. (Back to bucket). The next day hock swelled. Temp
went to 105.5. Gave her Gentocin and Penicillin, temp started coming
down. Next morning (Tuesday) took her to clinic. Ankle had swollen
overnight. Xrays - NSL. Clinic flushed hock and ankle and started
her on LA200 IV. Went back Thursday to flush hock again.
Friday night she stopped eating. Pharmacy closed Derby day so had to
leave her off meds until I could get new ones Sunday. Started her on
Gentocin and Cefazolin IV. Stifle swelled Monday with heat and
without lameness. Friday she went lame. Sunday wouldn't use leg to
get up but would bear weight once up. Monday, wouldn't bear weight.
Tuesday, took her back to clinic for stifle flush. Xrays of hock and
stifle showed osteomyelitis starting, flushed stifle and switched to
chloramphenicol and ketofen. Worse lame after Tuesday's flush, fine
with the ketofen. Better after today's flush, not sound but less
I believe the clinic was avoiding plasma transfusions because of an
usually high number of reactions this year, so at this point I'm
exploring boosting her immune system nutritionally.
- I still think a culture and sensitivity is in order. I think bad
nutrition can undermine a good medical plan, but good nutrition
can't take the place of one.
I would not abandon the idea of a plasma transfusion, either.
Preventing rxns is what cross matching is for.
- It's sensitive to amikacin and chloramphenicol. But she's improving
very slowly and questionably. I listed the other drugs since we went
one by one through the list you mentioned in your reference. I
forgot to mention that she has had Amikacin injected directly into
the joint and is of course now on the chloramphenicol. I think I'm
going to have a fight on my hands for plasma at this stage. I would
really appreciate any nutritional thoughts. Obviously not as a
replacement for the medical plan but as a supplement. I am looking
for what has been tested and may prove helpful in nutritional support
given that it's a young foal getting its' nutrition in an abnormal
way and having a lowered immune system.
Thanks for your help.
- Potential Uses of Omega-3 Fatty Acids in Equine Diseases
Compend Contin Educ Pract Vet 20:637-641 May'98 Review Article 13
* Margaret E. McCann, DVM, PhD and Joan B. Carrick, BVSc, PhD
* Dept. of Large Animal Medicine, College of Veterinary Medicine,
University of Georgia, Athens, GA
- Biochemical and epidemiologic studies demonstrate that omega-3
fatty acids have potent antiinflammatory properties. Although
clinical trials show that these fatty acids are beneficial in
treating several human and canine diseases, few studies have been
conducted to investigate the use of omega-3 fatty acids in diseases
of horses. This column considers studies in which omega-3 fatty acids
have been used to modify human or canine diseases and suggests
possible uses for these fatty acids in the treatment of equine
diseases. The principal antiinflammatory effects of ingestion of
diets enriched with omega-3 fatty acids are reduction in overall
eicosanoid production and modification of the spectrum of eicosanoids
that are produced. Potential therapeutic applications of omega-3
fatty acids in horses include cardiovascular disease, dermatologic
disease, arthritis, respiratory disease, renal disease,
gastrointestinal disease, systemic inflammatory response syndrome,
and reproduction and neonatal care. Ongoing clinical investigations
of the use of omega-3 fatty acids in the treatment of orphaned foals
and horses with endotoxemia, chronic respiratory disease, and
arthritis may provide equine practitioners with a useful adjunct in
the management of patients with these conditions. (Author Abstract)
- The foal is still alive and appears fully on the road to recovery
with all 3 joints looking better. In contrast 2 other foals cared
for by other family members on other farms with only the same stifle
infected are not expected to make it. All received the same surgical
treatment and were susceptible to the same drugs, all had the
infection move into the bone. The differences in treatment as far as
I can tell are small. None of the foals have access to fresh grass,
only mine received Vit E (several 400 IU caplets a day, ate them
right out of my hand). Mine recieved her chloramphenicol at 8 AM,
4:30 PM and 11 PM, as close to the 8 hr intervals as was
maneageable. One of the others gets 4 doses from 7AM through 7 PM
and then nothing through the evening. I don't know the 3rd's
medication schedule. Mine also receives a double dose of mare EPIC
daily, one scoop AM and one scoop PM. I don't know if the benefit
from the EPIC came from the fatty acids, the immune factors or the
high quality of the protein or if it helped at all though the timing
of her improvement suggests to me that the mare EPIC had a
significant effect. She'll be on the same schedule for another 2
weeks and then be reevaluated at the clinic.
The foal is willing to bear almost full weight on the leg at the walk
though still carries it if she goes faster. The swelling to the side
of the stifle is gone, there is still some bulging tight swelling
across the front of the stifle where the groove should be. The
swelling in the hock is smaller pockets instead of around the whole
joint, slight swelling in front and a pocket on each side in the
dip. The side pockets are decreasing slowly, the front swelling
comes and goes and seems to be related to her activity level. The
ankle seems fine with no swelling or heat for over a week. Her
attitude and appetite are excellent. She's drinking 1.5 gallons of
milk replacer diluted to 3 gallons of half strength to keep her
hydrated since she was staying slightly dehydrated on her own. She's
also picking at alfalfa and grass hay and eating 5 milk replacer
measuring cups of grain a day. Her back is almost but not quite
level so I while I would prefer a little more weight, I am not
worried as she is gaining nicely and catching up out of the stunted
- It's not really possible to pin down the reasons for the different
outcomes in this case. That's why good experiments have as many
subjects as possible.
There are just too many variables. Genetics, amount of colostrum
received, species and strain of the bacteria, which way the wind was
Just say a prayer of thanks to whatever god looks after little foals.
- --- In equineveterinarymedicine@y..., "smith2267" <smith2267@y...>
> It's not really possible to pin down the reasons for the differentwas
> outcomes in this case. That's why good experiments have as many
> subjects as possible.
> There are just too many variables. Genetics, amount of colostrum
> received, species and strain of the bacteria, which way the wind
> Just say a prayer of thanks to whatever god looks after little
One other thing I forgot to note as a comparison was that mine had
450 IgG and the other 2 had over 800. But you are absolutely right
we'll never be able to know what the deciding factor was. On another
list the listowner's motto is "what works is real" Sometimes, a
study can't be found to back up an experience but multiple
experiences suggest that a particular action may make a difference.
That's the main reason I posted the follow-up, just in case something
in it could prove useful to someone else. I definitely am not trying
to go down any wild and crazy miracle cure path. :)