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  Discussion on Research Summary: Equine Multinodular Pulmonary Fibrosis
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Moderator:
DrO

Posted on Thursday, Apr 10, 2008 - 12:45 pm:

I find this condition interesting because of its similarity to the very common recurrent obstructive airway disease (COPD or RAOD) of horses. Though treatment is similar it does not always respond well and may require more prolonged steroid therapy. It should be suspected in acute cases where there is no history of exposure and does not respond well to proper management and corticosteroid therapy.

J Am Vet Med Assoc. 2008 Mar 15;232(6):898-905.
Multinodular pulmonary fibrosis in five horses.

Wong DM, Belgrave RL, Williams KJ, Del Piero F, Alcott CJ, Bolin SR, Marr CM, Nolen-Walston R, Myers RK, Wilkins PA.

Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA 50011.

Case Description-5 horses were evaluated because of decreased appetite, weight loss, fever, cough, tachypnea, and respiratory distress. Clinical Findings-Tachycardia, tachypnea, increased respiratory effort, lethargy, fever, poor body condition, and nasal discharge were detected in various combinations on initial physical examination. Evaluation of the lower portion of the respiratory tract via radiography and ultrasonography revealed a severe nodular interstitial pattern. Histologic examination of lung tissue revealed interstitial expansion of alveolar parenchyma with collagen, intraluminal accumulation of neutrophils and macrophages within the alveoli, and occasional intranuclear inclusion bodies within alveolar macrophages. Equine herpesvirus type 5 was detected in samples of lung tissue, bronchoalveolar lavage fluid, or both via polymerase chain reaction assay in all cases. A diagnosis of equine multinodular pulmonary fibrosis (EMPF) was established. Treatment and Outcome-Horses were provided supportive treatment and were administered a variety of medications including corticosteroids and acyclovir. Two horses survived and returned to their previous level of activity. Three horses were euthanized because of either deterioration of clinical condition (n = 2) or failure to improve within 4 weeks of initiation of treatment (1). Clinical Relevance-EMPF should be considered as a differential diagnosis for adult horses with interstitial pneumonia and should be suspected on the basis of characteristic radiographic, ultrasonographic, and histopathologic findings. Equine herpesvirus type 5 is found in association with EMPF; although the exact pathogenic role this virus plays in EMPF is unknown, equine herpesvirus type 5 may be an etiologic agent or cofactor in the development of EMPF.
Member:
judyhens

Posted on Monday, Feb 3, 2014 - 6:40 pm:

Any further info on this? Our 20 year old mare might have it. Tests pending...
Member:
judyhens

Posted on Tuesday, Feb 4, 2014 - 10:09 am:

Neither the tracheal wash nor the BAL has grown anything, although there is a lot of mucous in her lungs and her white count is elevated. Another specialist looked at the ultrasounds of her lungs and thinks it is a severe case of COPD (or whatever the horse equivalent is). He suggested steroids. They may be continuing the antifungals. She was on antibiotics for a long time without resolution. Anyway, this guy thinks that she may do ok with steroids and Ventipulmin. He is experienced in lung disease and presentations. If steroids don't help, they will do a biopsy to R/O EMPF and cancer. With the exception of WBC, blood values are WNL apparently. Scope of stomach (because of not eating well and decreasing body condition) revealed very minimal ulcers. She was put on gastrogard, but the vet thought that the problem was so minimal that it wasn't responsible for the lack of appetite. Apparently when antifungals, ventipulmin,and Banamine were started last Saturday the mare perked up, started eating, started standing more, and went away from the vet for the first time when she came to give her meds. We have been out of state. Just got back. Plan to go to the hospital to see her this afternoon after work. Have you ever heard of obstructive airway disease presenting without fever, with mucous in the lungs without anything growing, with poor body condition, weight loss, and lethargy, but with an elevated WBC? We are crazy with worry. Every one of this mare's babies have made national champion Andalusian if the owners showed them. Best producer we have had. She weaned a foal at the end of the summer. Was underweight despite eating like crazy. Then this hit and, with loss of appetite, her body condition score has DrOpped dramatically. Our goal for this mare is to recover and become a pasture ornament, retire to the good life, and be a babysitter horse for our weanlings. Clearly, if she doesn't respond to the steroids and the biopsy shows a very poor prognosis, we will have tough decisions to make. Any insights? Can you have airway disease without infection but have an elevated WBC?
Moderator:
DrO

Posted on Saturday, Feb 8, 2014 - 9:28 am:

Hello Judy,
COPD, also known as Recurent Obstructive Airway Disease, is NOT a infectious disease, it is a allergy to inhaled particles that make it to the lungs, see HorseAdvice.com » Diseases of Horses » Respiratory System » Heaves & Chronic Obstructive Pulmonary Disease.

What was the cytology, what type white blood cells and relative numbers, of the BAL? Many of the questions you raise is answered by the answer. You can read more about this in the article associated with this discussion area.
DrO
Member:
judyhens

Posted on Saturday, Feb 8, 2014 - 10:48 am:

Well she went down hill again when the meds were stopped. I do not know the relative percentages of the WBCs or the BAL. They are thinking that she has about a 90% chance of having EMPF since EHV-5 DNA was identified in the BAL. So they started steroids. Because the antivirals are cost prohibitive she was not started on them. On steroids alone she clinically has turned a corner. She is eating and bright again. Loving those carrots when we visit her in the hospital. Ultrasound done a couple of days ago continues to show minimal progression of the lesions. They are repeating that on Monday or Tuesday. If the lungs continue to look worse they may restart antibiotics and antifungals since she did respond to those initially and there is a small possibility that use of steroids has increased her risk for a secondary infection. However - she is definitely perky, in no apparent respiratory distress now, and is eating.... well - like a horse. Since the steroids are treatment of choice for either disease, her response is not really helping re dx. I saw that there will be an interspecies workshop associated with the Kentucky Derby on EMPF since it also affects humans and dogs. Would like more info. Have contacted several universities and authors and have read your article with interest. We can but hope Electra continues to improve.
Member:
judyhens

Posted on Tuesday, Feb 11, 2014 - 10:20 am:

Follow up: Clinically Electra continues to do well on steroids. However, they feel that by ultrasound she is slowly losing ground. Since she is perky, eating, not struggling to breathe at all, they sent her home yesterday. We are getting chaffhaye for her to minimize dust in her hay. I am looking for a dust free bedding product we can purchase in Texas. Ideas anyone?
Moderator:
DrO

Posted on Wednesday, Feb 12, 2014 - 6:23 pm:

Here is the latest I can find on EMPF. This is an important paper because it takes the third step of the 4 Koch's postulates to support the hypothesis that EHV5 causes EMPF:

PLoS One. 2013 Oct 11;8(10
Experimental induction of pulmonary fibrosis in horses with the gammaherpesvirus equine herpesvirus 5.
Williams KJ, Robinson NE, Lim A, Brandenberger C, Maes R, Behan A, Bolin SR.

Gammaherpesviruses (γHV) are implicated in the pathogenesis of pulmonary fibrosis in humans and murine models of lung fibrosis, however there is little direct experimental evidence that such viruses induce lung fibrosis in the natural host. The equine γHV EHV 5 is associated with equine multinodular pulmonary fibrosis (EMPF), a progressive fibrosing lung disease in its natural host, the horse.

Experimental reproduction of EMPF has not been attempted to date. We hypothesized that inoculation of EHV 5 isolated from cases of EMPF into the lungs of clinically normal horses would induce lung fibrosis similar to EMPF. Neutralizing antibody titers were measured in the horses before and after inoculation with EHV 5. PCR and virus isolation was used to detect EHV 5 in antemortem blood and BAL samples, and in tissues collected postmortem. Nodular pulmonary fibrosis and induction of myofibroblasts occurred in EHV 5 inoculated horses. Mean lung collagen in EHV 5 inoculated horses (80 µg/mg) was significantly increased compared to control horses (26 µg/mg) (p < 0.5), as was interstitial collagen (32.6% ± 1.2% vs 23% ± 1.4%) (mean ± SEM; p < 0.001). Virus was difficult to detect in infected horses throughout the experiment, although EHV 5 antigen was detected in the lung by immunohistochemistry. We conclude that the γHV EHV 5 can induce lung fibrosis in the horse, and hypothesize that induction of fibrosis occurs while the virus is latent within the lung. This is the first example of a γHV inducing lung fibrosis in the natural host.
Member:
judyhens

Posted on Thursday, Feb 13, 2014 - 11:22 am:

Electra passed away yesterday morning. We went out to check on her and she had apparently just died. She appeared peaceful, had eaten well the day before and there was no sign of struggle. She showed no significant breathing difficulty the night before. The vets said that she also had pulmonary hypertension secondary to the lung disease. It’s hard to believe that she is gone. She has always been a favorite and well loved. Her loss hurts so much!

We had been in communication with the lead investigator of the article you sent, Kirk Williams, prior to Electra's death. Tissue samples of her lungs are being sent to his lab. We can only hope that they are able to identify the cause - and ultimately the prevention - of this devastating disease. Thanks for your support.
Member:
gramsey1

Posted on Thursday, Feb 13, 2014 - 2:06 pm:

Sorry to read of Electra's death. Peace.
Member:
mrose

Posted on Thursday, Feb 13, 2014 - 3:38 pm:

I haven't commented but have been following this thread. I am so sorry to hear of Electra's passing. I know well the hole she leaves in your hearts. I had hoped, as you did, that she would recover as it seemed she was doing better.

If you get anything decisive in the lab work, I'd be interested in knowing about it, so I hope you'll be willing to post what, if anything, the lab work shows.

How old was Electra? I'm glad it looks like she didn't suffer. Is there a possibility the heart could have been stressed from the effort of breathing and she died of heart attack?

Again, hugs to you all. She is in good company; too many lovely horses have recently gone before her.
Member:
juliem

Posted on Thursday, Feb 13, 2014 - 3:45 pm:

Godspeed Electra. So sorry to hear the sad outcome, but I'm glad it appeared she didn't struggle or suffer on her last day. And keep in mind how many good days she had.
Member:
judyhens

Posted on Thursday, Feb 13, 2014 - 5:29 pm:

Thanks for everyone's support and thoughts. Will be happy to post the outcome of the lab tests. I thought that she might have had a heart attack too, but the vet said the lung had collapsed, so which came first I don't know.
Sara, Electra was 20. So she had enjoyed many years of good days. She also produced many national champions and was a phenomenal mom and, until recently, herd leader. I am not sure if we are allowed to attach links here, but my husband just cced me on three videos of her last 3 babies, the final one being weaned last October. I will include the links in case we are allowed to do this. She was an amazing mare and is so very missed. And you are right, she is joining a herd of lovely horses who have gone before her recently.
2012 colt:
https://www.youtube.com/watch?v=zWluy0H349o&list=HL1389716508

2013 colt:
https://www.youtube.com/watch?v=25MIwR1XXeE

2011 filly:
https://www.youtube.com/watch?v=FrdBUu88izU

Another son is 3 Xs National Ch, USDF Champion, and has 2 Lifetime Achievement Awards. He is turning 8.



Thanks again for everyone's kind words. You are appreciated.
Member:
mrose

Posted on Thursday, Feb 13, 2014 - 6:59 pm:

I loved looking at the above links. What nice offspring she had. Love the action on the colt, and his eyes. As you know, I'm an Arabian person, but from what I know of PRE these babies have excellent conformation. Do you own any of her offspring, or did you sell them all?
Member:
judyhens

Posted on Thursday, Feb 13, 2014 - 8:58 pm:

Actually all of her babies sold quickly - but 2 are staying within the family. :-) I don't know if you remember the problem one of our sons, Chris, in Scottsdale, had with his PRE mare, Barbara, when she got stuck with cactus spines. She has completely recovered and is a great therapy horse. Anyway, he was looking for a stallion prospect and ended up buying the 2013 colt. So that baby is now his. The 2012 baby was purchased by our Dutch dressage trainer and his fiancé. He is pretty much like a puppy rather than a coming 2 year old stallion prospect. The 2011 filly was purchased by our daughter and son-in-law as one of their foundation mares. They own the ranch next to ours, so we will be able to enjoy her every day. We did retain some breedings to the 2012 colt and of course will be able to breed to the 2013 baby.

Thanks for your kind words re: conformation. We think that the combination of Electra with Saltador - two "foundation" type PREs - produced some amazing little ones. - And, I must say, I love the Arabian presence, sculptured head, and movement too! To me they look like a work of art.
Blessings,
Judy
Member:
mrose

Posted on Thursday, Feb 13, 2014 - 9:13 pm:

Judy, I remember Barbara very well. I wanted to go see her and it just didn't work out. I remember her so well; just from her pictures she is one of those horses that just "hit you" if you know what I mean.

Do you know Elizabeth Kaufman in Colorado? She raises PREs also. And, if you don't mind, I have a cousin that is newly interested in them ( she now has a young Azteca that is very cute but a handful!) and I would love to share your videos with her.

One of these days I'm going to meet Barbara! It seems like when we go to Scottsdale there is so much going on I never leave the show grounds except to sleep. This year we aren't showing there; if I go out for the awards ceremony, maybe I'll have a little free time.

You are so lucky that you have family interested in the horses and carrying on your lines!
Member:
judyhens

Posted on Thursday, Feb 13, 2014 - 11:40 pm:

Yes, very lucky to have a husband, son, and daughter who are committed to horses. It would be hard to have an unshared passion! If you do make it to Scottsdale I will give you Chris's contact info. I know he would love to show you Barbara and his other fillies. The little guy is staying with us for awhile.

Sure, share the links! Your cousin could also go to our website at https://www.ranchodellago.net. We have other links she might enjoy. I just looked at your website. Gorgeous Arabians! They just take your breath away!
Member:
frances

Posted on Friday, Feb 14, 2014 - 10:50 am:

I'm so sorry for your loss, Judy. What a lovely and exceptional mare she was, and what a wonderful ranch you have.
Member:
mrose

Posted on Friday, Feb 14, 2014 - 2:33 pm:

Judy, is Artemis your stallion? I think I'm in love with him! Aside from the fact that I'm a sucker for a beautiful gray, he really is stunning with great movement imo. Do you have mares that are daughters of Electra? She was truly a beautiful mare that produced great offspring.
Member:
vickiann

Posted on Friday, Feb 14, 2014 - 7:43 pm:

So very sorry for your loss, Judy.

Thanks for sharing this information so that other horses and their owners may learn more.
Member:
judyhens

Posted on Friday, Feb 14, 2014 - 11:49 pm:

Thank you everyone for your kind words of support. This group is always so compassionate and helpful!

Sara, Artemis is actually a filly,with very "foundation" type conformation. She belongs to our daughter who owns the ranch next door.

Electra was a special mare who seemed to produce those "look at me" babies. I only remember her being sick twice in her lifetime and neither were of any lasting consequence. Until this last one. So she was just a fixture around the ranch. Didn't really think about keeping a daughter as a potential replacement. Sort of makes you rethink things when something like this happens.

Hope everyone had a happy Valentine's Day.
It was gorgeous here.
Member:
mrose

Posted on Saturday, Feb 15, 2014 - 1:09 am:

I had to go back and look again; Artemis is lovely - beautiful! I misremembered and thought that was the name of the filly's sire however. HE is magnificent! I'm glad he wasn't a filly! LOL I was beginning to wonder if I was getting dotty in my old age! I can certainly see why you bred to him.

Artemis reminds me of some of the beautiful old Egyptian lines that we used to breed - although she of course is bigger when she matures - good conformation is good conformation.

Do you know anyone that has crossed the PRE type with old Arab type? I'd be very curious to see that.
Moderator:
DrO

Posted on Saturday, Feb 15, 2014 - 9:33 am:

My condolences Judy and I look forward to the report,
DrO
Member:
judyhens

Posted on Sunday, Feb 16, 2014 - 12:10 pm:

Sara, Here's a link to a Hispano-Arab filly - Offspring of our senior stallion Magico. Thought you might enjoy it. This filly has done very well at Arabian shows as a cross. She was shown in La. and in the NW I think. Actually a very nice cross!

https://www.youtube.com/watch?v=V1Ru1lpxDsI
Member:
mrose

Posted on Sunday, Feb 16, 2014 - 4:48 pm:

I LOVE her!! Ah..if only I was30 yrs younger! I would so breed this cross for fun. She's lovely with great movement. Thanks for posting.
Member:
judyhens

Posted on Monday, Feb 17, 2014 - 11:02 am:

You are very welcome! She is quite pretty! We have done several of these crosses for other people with amazing resultant offspring. :-) All great movers.

Yep! We are in the same boat... If we were only 30 years younger.... :-)

Blessings,

Judy
Member:
mrose

Posted on Monday, Feb 17, 2014 - 11:21 am:

Just sad! LOL I'll let you know if I head for Scottsdale. Thanks again.
Member:
dccranch

Posted on Wednesday, Oct 22, 2014 - 1:19 pm:

Any updates on the report? I have a 14 year old gelding with what "had" been diagnosed as COPD but my new vet is now testing specifically for EMPF. We are located in North Texas and are looking for commercial dust free hay if anyone has any suggestions.
Moderator:
DrO

Posted on Sunday, Oct 26, 2014 - 7:46 pm:

Nothing really new DCCR but here is a review of a case:
DrO

N Z Vet J. 2014 Jul;62(4):226-31.

Identification of the first New Zealand case of equine multinodular pulmonary fibrosis.

Dunowska M1, Hardcastle MR, Tonkin FB.

CASE HISTORY:

A 10-year-old polo mare presented with a history of weight loss, poor condition and inappetance.

CLINICAL FINDINGS:

The mare was tachycardic, tachypnoeic and febrile. Harsh lung sounds were auscultated over all lung fields. The mare initially responded to treatment with antibiotics, anti-inflammatory drugs and bronchodilators. Throughout the course of treatment, there was a variable lymphocytosis, monocytosis and fluctuation in concentrations of fibrinogen. The mare also developed a mild anaemia, most likely due to chronic disease. Despite treatment, the mare's condition deteriorated over the following 2 months, and she was subject to euthanasia.

PATHOLOGICAL FINDINGS:

On post mortem examination, white to pale tan, large coalescing fibrous nodules up to 5 cm in diameter were found distributed throughout the lungs. Histopathology revealed a multifocally severe interstitial pneumonia with superimposed bronchiolar or alveolar inflammation, fibrosis, Type II pneumocyte hyperplasia and histiocytic intranuclear inclusion bodies, consistent with the findings previously reported for cases of equine multinodular pulmonary fibrosis (EMPF).

DIAGNOSIS:

Equine multinodular pulmonary fibrosis based on characteristic gross and histopathological findings. The diagnosis was strengthened by detection of DNA for equine herpesvirus 5 in the lung tissue.

CLINICAL RELEVANCE:

This report describes the first recognised case of EMPF in New Zealand. The affected horse did not respond to treatment and was subject to euthanasia. The prognosis for horses with EMPF, based on a limited number of cases worldwide, is currently considered poor.
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