Use of computerised tomography to diagnose a Rhodococcus equi mediastinal abscess causing severe respiratory distress in a foal.
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Abscess↗
Biomedical subjects
D M Ainsworth
Publications and source records attributed to D M Ainsworth.
Effects of pulmonary abscesses on racing performance of horses treated at referral veterinary medical teaching hospitals: 45 cases (1985-1997).
OBJECTIVE: To determine whether results of physical or radiographic examination or biochemical analyses in adult racehorses with primary lung abscesses were associated with ability to race following treatment. DESIGN: Multiple-center retrospective study. ANIMALS: 25 Standardbreds and 20 Thoroughbreds. PROCEDURE: Medical records of horses with a primary lung abscess that were admitted to any of 4 veterinary teaching hospitals were reviewed. Results of physical examination, laboratory testing, and thoracic radiography were reviewed. Racing performance after treatment was compared with performance before illness and with performance of the general population of racehorses of similar age, sex, and breed. RESULTS: 23 of 25 Standardbreds and 13 of 20 Thoroughbreds raced after diagnosis and treatment of a lung abscess. Most horses had a solitary abscess in the dorsal to caudodorsal lung fields. Results of initial physical examination, biochemical analyses, and culture and identification of the microbial isolate were not associated with whether a horse returned to racing. For horses that had raced prior to the illness, race performance after treatment of the lung abscess was not significantly different from performance before the illness. CONCLUSIONS AND CLINICAL RELEVANCE: On the basis of racing performance in those horses that resumed racing after treatment, long-term residual lung damage did not develop in horses with primary lung abscesses that were treated appropriately. It is not known whether horses that recovered would be more likely to bleed from the site of a prior infection when resuming strenuous exercise and whether lung abscesses contributed to a failure to resume racing.
Animals↗
Clinical, haematological and biochemical findings in foals with neonatal Equine herpesvirus-1 infection compared with septic and premature foals.
A retrospective multicentre study comparing historical, clinical, haematological, acid-base and biochemical findings of foals with Equine herpesvirus-1 (EHV-1) infection, septicaemia or prematurity was performed to determine if early diagnosis of EHV-1 foals was possible. Fifty-three foals were studied and were assigned to one of 2 groups: herpes positive (n = 14) or herpes negative (n = 39). The latter group included 20 septic, 11 premature, and 8 premature and septic foals. The presence of herpes antigen was confirmed by immunoperoxidase histochemical staining of tissues from necropsied foals. A nonparametric statistical analysis followed by a backwards elimination logistic regression was performed to establish a model at a P value of <0.05. All herpes positive foals died, while 47% (9/19) of the septic foals survived. Based upon our analysis, herpes positive foals were more likely to have total white blood cell counts less than 3 x 10(9)/l and to be icteric as compared to the septic and premature foals. Despite profound hepatic necrosis in the herpes positive foals, liver enzymes were not elevated and were not significantly different from the controls.
Acid-Base Equilibrium↗
Pulmonary capillary pressure in horses undergoing alteration of pleural pressure by imposition of various upper airway resistive loads.
We hypothesized that changes in pleural pressure induced by resistive breathing would affect transmural pulmonary artery, pulmonary capillary, and pulmonary wedge pressures. Seven horses were assigned to exercise with each of 4 upper respiratory resistive loads in random order at intervals of at least 2 days: 1) control--no added resistive loads; 2) inspiratory resistive load (Iobst)--left laryngeal hemiplegia; 3) expiratory resistive load (Eobst)--one-way valve in the right nostril; and 4) combined inspiratory and expiratory resistive loads (CIEobst)--left nostril occlusion. On each occasion, the horses performed an incremental exercise protocol consisting of exercise episodes of 3 min duration at 75, 90, and 100% of maximal heart rate (HRmax). Pulmonary artery and oesophageal pressures were recorded continuously. Subsequent analysis was carried out on the pulmonary arterial pressure signal with the oesophageal pressure signal subtracted, hence the pulmonary vascular pressures in this paper approximate transmural pressures. Pulmonary vascular pressures, heart rate, and arterial blood gas tensions were measured at each level of exercise. Pulmonary capillary and pulmonary wedge pressures were determined from the pulmonary artery waveform after dynamic occlusion of a branch of the pulmonary artery. During exercise, peak expiratory oesophageal pressure was more positive in horses with Eobst and CIEobst (adjusted means = 43, and 39 mmHg, respectively) compared with control (adjusted mean = 23 mmHg) (P = 0.0001). Peak inspiratory oesophageal pressure was more negative in horses at exercise with Iobst and CIEobst (adjusted means = -42 and -39 mmHg, respectively) compared with control (adjusted mean = -26 mmHg) (P = 0.0012). Eobst was associated with an increase in mean oesophageal pressure while Iobst was associated with a decrease in mean oesophageal pressure. There were significant increases in mean pulmonary artery pressure in horses with CIEobst (adjusted means = 82 mmHg) and in pulmonary wedge pressure in horses with CIEobst and Iobst (adjusted means = 51, and 55 mmHg, respectively) when compared to control (73 and 42 mmHg, respectively) (P = 0.0001). Pulmonary capillary pressure was significantly increased in horses with CIEobst or Iobst (adjusted means = 61 mmHg, 63 mmHg, respectively) when compared to control (adjusted mean = 50 mmHg)(P = 0.0001). At maximal exercise intensity with inspiratory obstruction, the mean oesophageal (pleural) pressure was -17 mmHg while the mean pulmonary capillary pressure was 77 mmHg. The latter exceeds the reported 75 mmHg threshold for capillary failure in horses. We conclude that inspiratory resistive breathing can lead to a significant increase in transmural pulmonary capillary pressure which may contribute to loss of capillary integrity and rupture.
Airway Resistance↗
Effects of extrathoracic airway obstruction on intrathoracic pressure and pulmonary artery pressure in exercising horses.
OBJECTIVE: To determine whether dorsal displacement of the soft palate (DDSP) results in pulmonary artery hypertension and leads to increases in transmural pulmonary artery pressure (TPAP); to determine whether pulmonary hypertension can be prevented by prior administration of furosemide; and to determine whether tracheostomy reduces pulmonary hypertension. ANIMALS: 7 healthy horses. PROCEDURE: Horses were subjected to 3 conditions (control conditions, conditions after induction of DDSP, and conditions after tracheostomy). Horses were evaluated during exercise after being given saline (0.9% NaCl) solution or furosemide. RESULTS: Controlling for drug, horse, and speed of treadmill, DDSP-induced increase in intrathoracic pressure was associated with a significant increase in minimum (36 mm Hg), mean (82 mm Hg), and maximum (141 mm Hg) pulmonary artery pressure, compared with values for control horses (30, 75, and 132 mm Hg, respectively). Increases in pulmonary artery pressure did not induce concomitant increases in TPAP. Tracheostomy led to a significant reduction of minimum (53 mm Hg), and mean (79 mm Hg) TPAP pressure, compared with values for control horses (56 and 83 mm Hg, respectively). When adjusted for horse, speed of treadmill, and type of obstruction, all aspects of the pulmonary artery and TPAP curves were significantly decreased after administration of furosemide, compared with those for horses given saline (0.9% NaCl) solution. CONCLUSIONS: DDSP was associated with increases in pulmonary artery pressure but not with increases in TPAP. CLINICAL RELEVANCE: Expiratory obstructions such as DDSP are likely to result in pulmonary hypertension during strenuous exercise, but may not have a role in the pathogenesis of exercise-induced pulmonary hemorrhage.
Airway Obstruction↗
Associations between physical examination, laboratory, and radiographic findings and outcome and subsequent racing performance of foals with Rhodococcus equi infection: 115 cases (1984-1992).
OBJECTIVE: To determine whether physical examination, laboratory, or radiographic abnormalities in foals with Rhodococcus equi infection were associated with survival, ability to race at least once after recovery, or, for foals that survived and went on to race, subsequent racing performance. DESIGN: Retrospective study. ANIMALS: 49 Thoroughbreds and 66 Standardbreds admitted to 1 of 6 veterinary teaching hospitals between 1984 and 1992 in which R equi infection was positively diagnosed. PROCEDURE: Results of physical examination, laboratory testing, and thoracic radiography were reviewed. Indices of racing performance were obtained for foals that recovered and eventually raced and compared with values for the US racing population. RESULTS: 83 (72%) foals survived. Foals that did not survive were more likely to have extreme tachycardia (heart rate > 100 beats/min), be in respiratory distress, and have severe radiographic abnormalities on thoracic radiographs at the time of initial examination than were foals that survived. Clinicopathologic abnormalities were not associated with whether foals did or did not survive. Forty-five of the 83 surviving foals (54%) eventually raced at least once, but none of the factors examined was associated with whether foals went on to race. Racing performance of foals that raced as adults was not significantly different from that of the US racing population. CLINICAL IMPLICATIONS: R equi infection in foals is associated with a decreased chance of racing as an adult; however, foals that eventually go on to race perform comparably to the US racing population.
Actinomycetales Infections↗
Pulmonary-locomotory interactions in exercising dogs and horses.
In exercising quadrupeds, limb movement is often coupled with breathing frequency. This finding has lead some investigators to conclude that locomotory forces, associated with foot plant, abdominal visceral displacements or lumbo-sacral flexion, are the primary determinants of airflow generation. Analysis of respiratory muscle electrical activation (EMG) and contraction profiles in chronically instrumented dogs and horses, along with measurements of esophageal pressure (Pes) changes and limb movements, provide evidence that each breath during the exercise hyperpnea is determined by respiratory neuromuscular events. Specifically: (1) Phasic diaphragmatic EMG and tidal shortening are always synchronous with decreases in Pes; (2) decrements in Pes are always associated with inspiratory flow generation; and (3) strict phase coupling between breathing and stride frequency is not obligatory. Thus, although locomotory-associated forces may minimally assist with flow generation, they are not the primary determinants of breathing during exercise.
Animals↗
Clinical remission of granulomatous enteritis in a standardbred gelding following long-term dexamethasone administration.
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Animals↗
Effects of airway obstruction on transmural pulmonary artery pressure in exercising horses.
OBJECTIVE: To determine whether laryngeal hemiplegia would increase transmural pulmonary artery pressure (TPAP). ANIMALS: 6 horses. DESIGN: Horses were studied under 5 conditions: control conditions, after induction of left laryngeal hemiplegia, during obstruction of the left nostril, after placement of an instrumented tracheostomy, and after placement of an open tracheostomy. Horses were evaluated after being given saline solution and after being given furosemide. PROCEDURES: Horses were exercised on a high speed treadmill, using a maximum speed of 13 m/s. During each exercise, airway pressures, airflow, esophageal and pulmonary artery pressures, and blood gas partial pressures were measured. RESULTS: When adjusted for horse, speed, and obstruction condition, mean TPAP (pulmonary artery pressure-esophageal pressure) and minimum TPAP were significantly lower after administration of furosemide than after administration of saline solution. In horses given saline solution, respiratory obstruction that increased intrapleural pressure significantly increased mean TPAP, and respiratory obstruction that decreased intrapleural pressure significantly decreased minimum TPAP. CONCLUSIONS: Changes in intrapleural pressure appear to play an important role in pulmonary artery pressure and TPAP. CLINICAL RELEVANCE: Because induction of laryngeal hemiplegia did not increase TPAP, laryngeal hemiplegia is unlikely to contribute to development of exercise-induced pulmonary hemorrhage.
Airway Obstruction↗
The effect of exercise on diaphragmatic activation in horses.
Horses chronically-instrumented with costal diaphragmatic electromyographic electrodes were studied during exercise while unencumbered by a breathing mask. Exercise-associated changes in esophageal (Pes), gastric (Pga) and transdiaphragmatic (Pdi) pressures were measured and related to diaphragmatic electromyographic activity (CS EMG) and to left forelimb impact. In all breaths examined, CS EMG always coincided with decrements in Pes. For all exercise trials, linear increases in CS EMG, Pga and Pdi and linear decreases in Pes, as a function of exercise intensity, always occurred. During all gaits, breathing frequency (fR) was entrained with stride frequency (fS) one for one. However, a constant phase-coupling relationship between fR and fS, observed when horses cantered and galloped, was absent when horses walked or trotted. We conclude that biomechanical forces contribute minimally to ventilation in exercising horses, that the diaphragm is always phasically active during each breath and its total electrical activity and mechanical output are proportional to the exercise hyperpnea.
Animals↗
Respiratory muscle perfusion and energetics during exercise.
The oxygen cost of breathing and blood flow requirements of the respiratory muscles during exercise are discussed along with the implications for limitation of locomotor muscle and exercise performance. Findings show that the oxygen cost of the hyperpnea achieved during very heavy exercise may approach 15% or more of VO2max under conditions that require extraordinary levels of ventilatory work. These conditions include those in the highly trained endurance athlete (at VE > 150 l.min-1), the older athlete at VE of 110-120 l.min-1), and athletic cursorial mammals at VO2max--all of whom experience significant expiratory flow limitation and sometimes even complete ventilatory limitation during heavy or maximum exercise. Rates of blood flow to the respiratory muscles under these peak exercise conditions may equal or exceed those to the limb locomotor muscles. The hypothesis is advanced that excessive requirements of ventilatory work (and therefore VO2 and blood flow) during heavy exercise may cause reflex vasoconstriction of locomotor muscles resulting in curtailment of endurance exercise performance.
Animals↗
Breathing during exercise in dogs--passive or active?
The activation patterns of the costal and crural diaphragm and transversus abdominis muscle and their relationship to esophageal pressure (Pes) changes and footplant were examined in five chronically instrumented dogs which breathed at high frequencies at rest and during exercise. In two tracheostomized dogs, measurements were made of diaphragmatic length via sonomicrometry and of airflow and were related to diaphragmatic electrical activity and Pes. Dogs exhibited either a high-frequency breathing pattern, characterized by Pes changes occurring at 2-6 Hz, or a mixed-frequency breathing pattern, characterized by low-amplitude Pes oscillations (4-6 Hz) superimposed on a slower breathing rate of 0.5-1 Hz. Regardless of the type of breathing pattern elected or of the various breathing-to-stride frequency ratios observed during exercise, decreases in Pes were always associated with phasic electromyographic activity of the costal and crural diaphragm and with phasic diaphragmatic muscle shortening. The transversus abdominis electromyographic activity coincided with an increasing Pes from peak negative values in resting dogs and exhibited both an expiratory and a locomotory modulation during exercise. Although footplant may have contributed to some airflow generation when dogs utilized the mixed-frequency pattern, these data demonstrate that the movement of air into and out of the lungs in stationary or exercising dogs requires phasic neural activation of the diaphragm and other respiratory muscles.
Animals↗
Regulation of respiratory muscle activities during chemoreceptor stimulation in adult horses.
We examined the electromyographic activity of the costal portion of the diaphragm and the transverse abdominal and external oblique muscles in 6 chronically instrumented awake adult horses during eupneic breathing, during 2 levels of hypercapnia (fractional concentration of inspired CO2; FICO2 = 0.4 and 0.6), and during 2 levels of hypocapnic hypoxia (FIO2 = 0.15 and 0.12). Using the inert gas technique, we also measured the end-expiratory lung volumes of the 6 horses during eupnea, 6% CO2 challenge, and 12% O2 breathing. During eupneic breathing, phasic electrical activity of these 3 muscles was always present and was preceded by the onset of mechanical flow. At progressive levels of hypercapnia, the magnitude of inspiratory and expiratory electrical activity increased, and for the expiratory muscles, this recruitment coincided with significant (P < 0.05) increases in peak expiratory gastric pressure. However, during hypocapnic hypoxia, differential recruitment patterns of the respiratory muscles were found. The electrical activity of the diaphragm increased in magnitude and occurred sooner relative to the onset of mechanical flow. The magnitude and onset of abdominal expiratory activity failed to increase significantly during these episodes of hyperpnea and this pattern of activity coincided with decrements in peak expiratory gastric pressure. Despite alterations in muscle recruitment patterns during these hyperpneic episodes, end-expiratory lung volume remained unchanged. Thus, we conclude that adult horses respond similarly to awake dogs during peripheral and central chemoreceptor stimulation.
Animals↗
Breathing in exercising quadrupeds. There ain't no such thing as a free breath!
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Diaphragm↗
Respiratory emergencies in the adult horse.
Responding to an equine respiratory emergency requires rapid localization of the problem and appropriate choices for therapy. Localizing the cause of respiratory distress is aided by history and thorough physical examination. When examining the patient, one must focus on the presenting signs as indicators of URT or LRT dysfunction. Table 3 summarizes the characteristic presenting signs based on respiratory tract location and suggests the initial treatment course indicated. Respiratory distress in the absence of signs related to the pulmonary system suggests inadequate oxygen delivery secondary to a nonpulmonary problem such as shock or severe anemia, which is just as compromising to the animal but requires an entirely different therapeutic approach (see Allen and Schertel, this issue). Thus, localization of the source of respiratory distress is always the first step in determining successful treatment.
Animals↗
Repeatability and normal values for measurement of pharyngeal and tracheal pressures in exercising horses.
Repeatability of measurements of peak and mean tracheal and pharyngeal pressures in exercising horses was determined. Five athletically fit horses were subjected to repeated (n = 5) standardized exercise trials. Static pressures in the trachea, nasopharynx, and mask were determined. At least 96% of all mean pressure measurements were within 5 cm of H2O of the mean value for any horse. Peak pressure measurements were less repeatable, but at least 96% of all measurements were within 10 cm of H2O of the mean peak measurements for any horse. In 10 horses galloping at 14 m/s, the 95% confidence interval for peak tracheal and pharyngeal inspiratory pressures ranged from -40 to -50 cm of H2O and -20 to -26 cm of H2O, respectively. During expiration, the 95% confidence interval for peak tracheal and pharyngeal pressure at the same speed ranged from 15 to 28 cm of H2O and 10 to 24 cm of H2O respectively. During inspiration, horses with induced laryngeal hemiplegia had static pressure measurements generally outside that range. We conclude that determination of tracheal and pharyngeal pressures is a potentially useful adjunct for assessment of the proximal portion of the respiratory tract.
Animals↗
Recognition of Pneumocystis carinii in foals with respiratory distress.
Five 3-month-old foals presenting with fever and respiratory disease were found to have pulmonary abscesses with patchy to diffuse alveolar and interstitial pneumonia on post-mortem examination. All affected foals had evidence of Rhodococcus equi infection and had few to abundant Pneumocystis carinii cysts in the sections of affected lung. Of the 5 foals examined radiographically, 3 had a distinct reticulonodular (miliary) pattern which may aid in the ante-mortem diagnosis of P. carinii pneumonia (PCP). Leukocyte counts of foals with PCP were significantly greater than in the control group of foals with uncomplicated bacterial pneumonia. Foals with PCP tended to be more tachypnoeic than the control foals and 4 of the 5 PCP+ foals appeared dyspnoeic before death. The ante-mortem recognition of PCP may be expedited by bronchoalveolar lavage and successful treatment of foals with PCP may require the administration of adequate levels of potentiated sulphonamides.
Actinomycetales Infections↗
Lack of residual lung damage in horses in which Rhodococcus equi-induced pneumonia had been diagnosed.
The effect of prior Rhodococcus equi-induced pneumonia on pulmonary health was investigated in 5 horses (< 24 months old) using endoscopy, radiography, hematologic and bronchoalveolar lavage analyses, and pulmonary function testing. Rhodococcus equi-induced pneumonia had been diagnosed in principal horses when they were foals. Diagnosis was based on positive results of transtracheal aspiration and thoracic radiography at the time of initial clinical examination. Results of reevaluation of the respiratory system of these horses (R+) were compared with those of 5 age-matched healthy horses (R-) that lacked clinical or historical evidence of foalhood pneumonia. Significant differences in variables between the 2 groups of horses were not evident. In both groups, most horses had radiographic evidence of an accentuated bronchointerstitial pattern, although results of analysis of bronchoalveolar lavage specimens were normal and mononuclear cells predominated. Variability in results of the pulmonary function tests was observed within the between the 2 groups of horses. Only normalized dynamic lung compliance was slightly lower in the previously infected horses, but this difference was not significant. We concluded that horses previously infected with and successfully treated for R equi-induced pneumonia do not have detectable evidence of residual lung damage.
Actinomycetales Infections↗