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  Discussion on 2 yr old w/mild snots, fever, cough
Author Message
Member:
leec

Posted on Saturday, Mar 3, 2007 - 3:26 pm:

Hi Dr O,

My 2 year old has had a bit of the snots for the past week. First it was a bit yellowish and in both nostrils (not a lot - she had Strangles last spring and it was nothing near that...) and after 3 days it turned more white and lessened. This AM there was only a bit in one nostril. Her other symptoms were; She was less eager for her grain for a few days. However, she did eat it all, as well as her usual amount of hay. Her daily water intake, number of poops and consistency remained normal. I have heard her cough 3 times over the past week (after the snot was no longer yellowish) and her temperature was only slightly above the high end of normal for a couple of days (during the yellowish snot phase). I put her on Bute for 5 days and she has been off it now 2 days. I saw her playing in the pasture this morning, so I don’t think she feels too bad. She had her intranasal flu last fall, and is up to date on all her other vacs.

My other horse (5 yr old) also had her intranasal flu last fall, and is up to date on all her other vacs. She had a colicky episode with a high fever on Feb 7th (I had a thread about it), but was back to normal in less than 24 hours and has not had any snots etc. and the 2 horses are in contact (this horse has also had Strangles in the past). My horses have had no contact with any other horses (closest ones are a ¼ mile away) other than when my 5 year old was brought home from my Vets place in the middle of December. However, the Farrier was here on Jan 18th and he had done some horses before mine.

So, my questions are; Could the 2 horse’s illnesses be connected? Should I be more concerned about the 2 year olds 'snots'? I read your articles re: Respiratory etc. and didn’t think she was really presenting specifically to any of the infections mentioned. Is it possible to give me any ideas from the info I have given you, as to what she might have, and how she could have picked it up? Here’s probably a stupid question... Can a virus live and be contracted through hay if a sick horse had been on that field at some point?

I have my Vet booked for Mar 15th to do annual vacs/flu/check ups etc., would you suggest I try to get her here earlier? Nothing is screaming 'Emergency' to me, but perhaps I’m missing something...

Thanx,
Lee C
Moderator:
DrO

Posted on Saturday, Mar 3, 2007 - 6:12 pm:

1) No these two illness episodes are unlikely to be connected.
2) Possibly herpes either EHV-1 or 4. The article associated with this forum explains how you might have had this problem with no contact with other sick horses and provides a link to a specific article with more info.
3) No that seems unlikely.
4) Whether to call the vet or not depends on whether you feel you need help with the problem so I really cannot decide that.
DrO
Member:
leec

Posted on Saturday, Mar 3, 2007 - 6:34 pm:

Thanks Dr O - I will re-read the articles you suggested and take it from there...
Lee C
Member:
sunny66

Posted on Sunday, Mar 4, 2007 - 11:39 am:

Hi Lee, just wanted to say that I'm thinking of you (read your post on Sara's thread), and sending positive healing thoughts to you.
Member:
leec

Posted on Sunday, Mar 4, 2007 - 3:28 pm:

Thank you Aileen for your kind words.

Lee C
Member:
leec

Posted on Sunday, Mar 4, 2007 - 3:56 pm:

Hi Dr O,
I re-read the articles (I had neglected to click 'for more information...' in my earlier readings). I will discuss the situation with my vet tomorrow and see if she feels it is something we need to get on top off. Although my girl appears to be getting better, I have been watching for signs of pneumonia and I have not witnessed any neurological symptoms at this point. This morning there was no snot - the inside of her nostrils were just a bit moist, however I heard her cough once (a dry kind of cough). Her breathing is not noisy even when she exerts herself. Everything else appears normal.
Lee C
Moderator:
DrO

Posted on Monday, Mar 5, 2007 - 7:10 am:

Whatever it gets labeled sounds like a pretty normal cold from here.
DrO
Member:
leec

Posted on Monday, May 7, 2007 - 6:48 pm:

Hi Dr O,

Well, it seems this was (or became) more than a cold. When I spoke to my vet after my post on March 4th, she did not feel we needed to do anything more than keep an eye on her until her scheduled visit on March 15th. By that time she had regressed - the snot was back and her eye goopy, both on the left side only (I forgot to mention that she had the goopy left eye previously), as well the cough. The vet flushed her left tear duct and said it was tight at first. We swabbed her and a week later the culture which came back as positive for Strep (not the same strain as Strangles). We put her on an oral antibiotic (she is extremely needle shy) for 10 days that was supposedly sensitive to it. After she was off of it for 1 week, the symptoms flared up again (still only the left side). We went for another 10 day stint, but 8 days in, the symptoms were back. We switched her to an IM antibiotic (supposedly the best...). Two weeks after we completed the 8 day round of this one, again 'its back' in the same order; first eye goop, then snot nose and I don't doubt the cough will soon follow. When I spoke to my vet this morning, I mentioned that I am reluctant to throw more antibiotics at my filly without digging a little deeper. She suggested a trans-nasal tracheotomy flush (I may have screwed up the wording a bit)from which the results would be sent to the lab for more tests. Apparently that would give us a better chance of pinpointing and treating the problem. I couldn't find what she suggested on HA, but perhaps it is our 'Canadian' wording for the procedure and you call it something else??? As a second opinion, do you feel we are going in the right direction with this next step my vet has proposed (her choice might be partially based on knowing I don't have oodles of money laying around...)? If not, what would you suggest?

Thanx,
Lee C
Moderator:
DrO

Posted on Tuesday, May 8, 2007 - 6:35 am:

Hello Lee,
The part you had posted about previously was a pretty normal cold but about the middle of March it takes a turn for the worse and some area of the respiratory tract that was traumatized by the initial infection becomes complicated with a secondary infection.

Let's recount, this began in Feb as a snotty nose and no fever but several weeks later after improving clinical signs there is a sudden worsening of symptoms and since then several courses of different antibiotics has not had much effect. Everyone should note that Strangles and other strep are not reliable sensitive to potentiated sulfa drugs even if found to be sensitive on testing.

Down here we do "transtracheal washes". The idea is to introduce a needle through the skin and trachea get a uncontaminated sample of the organisms in the lower respiratory tract, but this would not be my next step. I have not seen a transnasal technique but presume it is some sort of guarded culturette and flush equipment?

The symptoms you describe snotty nose, with clear lungs suggest infection of the upper respiratory tract so I would wait on a tracheal culture in lieu of better defining the location, then culture from there. This is possibly a sinus or the guttural pouch but if it is coming form the lower tract we will find that also. So the first step from the information provided would be an endoscopic exam with the purpose being to find the location of where the snot is coming from. Besides culturing the purulence closer to where the infection is, the next step will depend on what you find.
DrO
Member:
leec

Posted on Tuesday, May 8, 2007 - 10:58 am:

Thanks Dr O,

To be honest, your answer is what I thought should be done next. Unless, there is something I am missing with the description of the flush, I don't see how it can tell us EXACTLY where the problem is. Is an endoscopic exam something that can be done in the field?

Thanx,
Lee C
Moderator:
DrO

Posted on Tuesday, May 8, 2007 - 11:25 am:

Sometimes but better done inside, where it can be darkened, and in a set of stocks where the horses movement is limited.
DrO
Member:
leec

Posted on Tuesday, May 8, 2007 - 9:14 pm:

Definitely more $$$ to the endoscopic exam, and yes it has to be done at the clinic, as she shares the equipment with another vet so it needs to stay on premises. However, I think it has to be done or my girl just isn't going to get better. Since I have to haul her with an URT infection, should I leave her untied, so she can better clear her nostril? At this point, there is not yet a lot of snot and it is not constantly present. I just had a thought... Back in October she cast herself quite badly in her shelter (knocked a wall out in her struggles to get up and was stiff in the neck and shoulders for a couple of days after). Is it possible that if she inhaled a bunch of shavings during this incident that they've been 'rotting' up there? I know quite a bit of time has passed since then, but maybe the cold weather kept the problem from showing up sooner?

Thanx,
Lee C
Moderator:
DrO

Posted on Wednesday, May 9, 2007 - 8:15 am:

I believe you would have seen symptoms upon inhaling the shavings (sneezing or coughing) Lee but that is what the scope is for. If you wanted to try one more thing you could try 30 days of TMP/SMZ. I have had this work for a sinusitis when shorter terms failed.
DrO
Member:
leec

Posted on Wednesday, May 9, 2007 - 11:06 am:

We are going to proceed with the scope tomorrow. Thank you for the tip on the drug, but I really want to know what (if anything) is in there and where. However, if she is diagnosed with sinusitus would the TMP/SMZ still be your drug of choice to treat it?

Thanx,
Lee C
Moderator:
DrO

Posted on Thursday, May 10, 2007 - 6:40 am:

Though there are problems with some strep infections the idea of giving 30 days of twice daily injections with antibiotics that cause soreness makes me reach for the SMZ/TMP tablets first. If you are a frequent user of this antibiotic, chloramphenicol and doxycycline are 2 oral choices other wide spectrum oral choices should be considered. But best therapy would be to let the culture and sensitivity direct you.
DrO
Member:
leec

Posted on Friday, May 11, 2007 - 3:18 pm:

Hi Dr O,

With the scope yesterday they found my girl to have Pharyngeal Lymphoid Hyperplasia. Everything else was clean, her guttural pouches, sinuses etc. The vet said on a scale of 1-4 with 4 being the worst, her case is a 4. So, we are going to put her on bute for a bit, try to keep her in a dust free environment and soak her hay when she isn’t on pasture. Also, 8-12 weeks of rest. This is good to know because I was going to put her in training when this cleared up. However, in a few weeks she may seem fine, but from what I understand going to work too soon could cause it to flare up again. In your experience, is there anything else we can do for her to help her heal and aid in reducing any future complications from it?

Thanx,
Lee C
Moderator:
DrO

Posted on Saturday, May 12, 2007 - 9:54 am:

This is an Ok start but if no improvement in 2 weeks I would add antibiotics (is there a persistent chronic infection in the lymph nodes), and if no improvement in 2 more weeks I would change the NSAID to a steroid (far more effective at effecting the activated and migrating WBC's that cause the hyperplasia).
DrO
Member:
leec

Posted on Friday, Jun 8, 2007 - 11:55 am:

Hi Dr O,

Since my last post my filly was on bute for 5 days, but was barely eating, noisy breathing, snots and depressed. So was put on Novo-trimel for 10 days and Dexamethasone for 4 days after which she showed improvement. She has been off all meds since May 22nd, but she still has the snots and still seems down - she just doesn't look well. Her temperature has been low to normal. She is eating quite well, but I think her throat is still sore. Occasionally she coughs while eating her grain, which is mixed with oil or her hay, which is soaked. She doesn't nicker at all and she used to be very vocal. When my other mare was out of sight the other day, she attempted a whinny and it was very harsh and painful sounding. Also, she had a trim 2 weeks ago, but seems abnormally tender on hard surfaces and gravel. Are her on-going symptoms normal for this disease? Is it like Strangles where as long as they're eating it just has to run it's course?

I have been out of town for 2 weeks and while I was gone her blood work/culture came back from blood etc. taken on May 10th. The vet is coming up today to do re-check and go over the results with me, but I wouldn't mind a second opinion.

Everything was within normal range, with the exception of:
RDW - 30.4(H)
Potassium - 6.2(H)
A/G Ratio - 1.9(H)
Alkaline Phosphatase - 282(H)

Cytology Note: 'Two slides received and evaluated that are of low cellularity with a moderate mucinous background, with scattered cellular debris and scattered RBC's. Low numbers of macrophages and rare neutrophils are noted. Low numbers of small round organisms are noted with a prominent relatively thin clear halo and central blue to purple nuclei consistent with fungal organisms. Interpretation - Mild granulomatous inflammation with organisms consistent with fungal organisms. Comments - The primary consideration of the atypical small form of Cryptococcus is given although cannot rule out other fungal species. Culture and sensitivity or serology to further evaluate is encouraged as clinically warranted.'

Bacteriology: 'Routine culture - gram strain reveals gram positive cocci, gram strain reveals gram negative rods. Bacti Organism - Heavy growth of, Streptococcus equi spp. zooepidemicus.'

Any way to better tell me what this all means? Any thoughts as to how you would proceed with this case? I really don't want to put any more drugs into her for financial reasons and because I am concerned about causing other complications.

Thanx,
Lee C
Moderator:
DrO

Posted on Monday, Jun 11, 2007 - 6:08 pm:

Lee, we have been away from an internet connection for the past 3 days. The culture says your 2 year old has Strangles. Strangles is not typically a complication from a viral infection but a primary infection. So now it appears your horse has been through 2 separate infections since March. For more information on Strangles see, Diseases of Horses » Respiratory System » Strangles & Streptococcus equi.

How has he been doing since Friday?
DrO
Member:
leec

Posted on Monday, Jun 11, 2007 - 10:14 pm:

Huh. A bit different take on it from the vets on this end, unless it's just worded differently... With regards to the recent scope, 2 vets diagnosed her with PLH with the Strep being a secondary infection, which they say she has possibly been carrying since she had Strangles last spring. When she had it last spring, (confirmed by culture), we didn’t interfere and let it run its course. Is it odd for her to have it again so soon? Six weeks after she was no longer showing any symptoms of it we did a flush and the results came back negative. We flushed my other mare as well and her results were also negative. They agree that this spring she probably had another viral infection mixed in there (possibly rhino). I am a bit confused... Did the Strangles cause the PLH or the combination of the 2 infections, or did the PLH reactivate the Strangles? Or do they have nothing to do with each other? Can she have Strangles 2 years in a row and it not be Bastard Strangles? My vet says she does not have Bastard Strangles and the scope showed her guttural pouches to be squeaky clean. What are the chances that she will abscess again? There are no lumps at this point. The good news is that she has improved hugely since Friday. She is eating and drinking well. She is no longer listless and she is once again interested in and aware of her surroundings. As well, she is happily frolicking about the pasture with my other mare as she would be normally. She nickered for her dinner tonight for the first time since she's been home. She is less snotty and it is a clear to whitish snot. During the hottest time of the day, she sounds a tiny bit wheezy. I have heard her cough only 5 times in the past 6 days. She is not on any meds and the vet says she doesn’t need be – just good quality food, no dust, no stress and rest. That sound about right to you? As for her sore feet (which are better), I found out she has only been on very soft ground since her last trim and during those 2 weeks that I was away, thus the ouchy-ness when back on our hard rocky terrain.
Lee C
Moderator:
DrO

Posted on Tuesday, Jun 12, 2007 - 11:24 am:

My confusion above lies around the use of the abbreviation "pp.". I took your bacteriological identification as meaning the specie (spp.) was zooepidemicus though you wrote "equi" before it.

This would be a recently recommended but now outdated nomenclature. In current nomenclature the Strangles organism is Streptococcus equi sub specie equip. The common respiratory contaminate and sometimes secondary invader would be Strep. equip. zooepidemicus. Your veterinarian would be more aware of what the lab is writing out, so I would go with his interpretation.

So we are back to the original viral followed by a secondary bacterial infection that sounds like it is doing well from your post.
DrO
Member:
leec

Posted on Thursday, Jun 14, 2007 - 2:58 pm:

Hi Dr O
Thanks for the feedback. She is gaining weight and continuing to improve in all other areas.
Lee C
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