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  Discussion on Persistent discharge from one nostril - no other symptoms
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New Member:
melanieg

Posted on Friday, Oct 24, 2008 - 3:13 pm:

My twelve year old Arab gelding has had constant discharge from his left nostril for approx. 5 months. The discharge forms a crust around much of his nostril, even with daily cleaning. He has NO other symptoms and no discharge from his right nostril. He is eating fine, no cough, and the discharge has no smell. It does not seem to bother him at all. He is pastured with other horses and none of them have shown any symptoms.

We first noticed it in mid-June, and my vet (at the time) looked at it and said it was probably a cold and would run it's course. By Mid-July there was no change (better or worse) so I began trying to get the vet back to the farm. That proved to be a futile, frustrating experience that culminated in me finding a new vet because I couldn't get an appointment scheduled with the original one!

My gelding was seen by the second vet in early September. The vet couldn't determine a cause but suspected an infection, so prescribed 10 days of antibiotics - I can't remember the name at the moment, but I can find out when I get home tonight. It was a powder that was added to his food. At the end of 10 days, no change. The vet returned and took x-rays of his face, as well as checked and floated his teeth. The x-rays showed very little - a POSSIBLE (albeit slight) tooth root abscess on one of his lower molars closer to the front of his mouth. At that point, it was the vet's best guess that this was the cause of the discharge, and it was recommended that he be sent to New Bolton Center at UPenn for surgery to remove the tooth. The x-rays have been sent to Penn and the surgeon there indicated that the location of the possible abscess should not be causing discharge though.

While I've been working on scheduling an appointment at Penn, I'm not comfortable going through with this surgery to remove a tooth that MIGHT be infected and MIGHT be causing this discharge. I'm planning to schedule the Penn appointment as a diagnostics appointment instead of a surgery appointment. I hope to have him to Penn within the next 2-3 weeks, but this will depend on availability of appointments, and I also have to hire a trailer as I don't have one of my own.

In the meantime, we are trying Penicillin to see if that helps at all. He is currently getting 25 cc of penicillin twice a day (so 50 cc each day). We are on day 5 of a 10 day treatment. I noticed a significant improvement after 24 hours and then a regression back to how it was before penicillin after 48 hours. Subsequent days have shown improvement again, but not as much improvement as I saw at 24 hours.

Pictures can be seen here: https://i36.tinypic.com/5cn9zl.jpg and here: https://i37.tinypic.com/9gy1jk.jpg. Both of these pictures show an "average" day - some days are worse, rarely are they slightly better.

Is there something else we should/can look for or test for? Any ideas as to what could be causing this? This doesn't appear to bother him at all, but the fact that it has gone on so long is very concerning to me.

Thank you,
Melanie
Moderator:
DrO

Posted on Saturday, Oct 25, 2008 - 11:44 am:

Welcome Melanie,
It certainly is consistent with a chronic sinus infection. If the radiographs are not helpful the next step is to scope the horse to see where exactly the discharge is coming from and with a little luck you may see the infection itself. Unfortunately much of the sinus's is not visible even with a scope. But this does rule out the other possibility of a guttural pouch infection. I am interested in the other antibiotic used.
DrO
New Member:
melanieg

Posted on Saturday, Oct 25, 2008 - 12:04 pm:

Thank you Dr. O. The drug that was initially prescribed was Uniprim powder, 37.5 g/day for 10 days. This didn't appear to help at all.

My horse's 10 day penicillin treatment will end on Wednesday morning. I'll have the vet come back out to the farm to scope him at that time. Other than the scope, what else can be done at the farm to diagnose a chronic sinus infection? What is typical treatment for this?

Thank you,
Melanie
Moderator:
DrO

Posted on Sunday, Oct 26, 2008 - 9:41 am:

If a source of the discharge is found culture and biopsy can be very helpful in some cases. Culture at the nostrils often is confused with lots of contaminants but may be better than nothing. In difficult cases where there is little information, surgery to look into the sinus by creating a flap in the side of the bone has helped.

There is no typical treatment Melanie and this will depend on the cause. But often a beginning course of trimethoprim - sulfa (like your Uniprim) is tried. I usually use a 30 day course but would have suspected an improvement by 10 days.
DrO
New Member:
melanieg

Posted on Monday, Nov 17, 2008 - 3:12 pm:

Hello Dr. O,

Apologies for my lack of follow-up; I have returned from the Penn veterinary hospital where I finally have a diagnosis.

My horse has a guttural pouch infection. The infection is caused by Penicillium fungus, and unfortunately, the fungus is covering his internal carotid artery, so there is some concern that he could bleed out. However, he has not, in 5+ months, had any bloody nasal discharge, nor does he show any other clinical signs of guttural pouch mycosis. Because of this, the doctor has decided to treat with anti-fungal medication with surgery to follow if necessary. So far, he has responded very well to the anti-fungal medication.

Currently, my horse is back home. He is getting 400 mg (?) of Banamine paste daily for 5 days and 2 g (10 pills) of fluconazole for 30 days. After 30 days we will return to the hospital so they can re-scope him and confirm that the infection is completely gone. If it is still present, then surgery will be an option. Obviously, if he has any bloody nasal discharge, we will return to New Bolton immediately.
Member:
vickiann

Posted on Monday, Nov 17, 2008 - 5:37 pm:

Thanks for the up-date, Melanie, and hope that you will have good results with the medication.
Moderator:
DrO

Posted on Monday, Nov 17, 2008 - 7:10 pm:

Thank you for the update and sorry to hear you ended up on a tough diagnosis / treatment. I do think the lack of blood at the nose is indication of early diagnosis and a better prognosis but still this is a life threatening problem that can turn bad in a second. I guess I would have felt better with a betadine spray on that patch of fungus. Many might want to know what is the fluconazole treatment costing daily?
DrO
New Member:
melanieg

Posted on Monday, Nov 17, 2008 - 8:34 pm:

Thanks for your response. He was at the hospital for 5 days (Monday - Friday). His cavity was flushed daily Monday - Thursday, and when the culture came back on Wednesday, they did directly spray the fungus with something, but I don't know what it was. I should know when I get the bill though, as I imagine they will detail everything he was given.

When he was discharged on Friday, the discharge was virtually gone. I was told to monitor him closely and call if any bleeding occurs or if the discharge picks up again. Just tonight I was at the barn to administer his medication and noticed immediately that the discharge is back - still no blood. I will be calling them first thing in the morning; I suspect they'll want me to bring him back for further treatment at the hospital.

I'll continue to update as this progresses.

I don't have a bill yet, but I was told that the fluconazole was approximately $1/pill. He takes 10 pills a day for 30 days, so the entire treatment course will cost me around $300.
Moderator:
DrO

Posted on Tuesday, Nov 18, 2008 - 7:37 am:

That makes me feel better Melanie and thanks for the cost, it will help others make informed decisions.
DrO
Member:
maggienm

Posted on Tuesday, Nov 18, 2008 - 9:03 am:

Melanie, so sorry to hear about your gelding's illness.
What's his name? Arabs are really tough, I'm sure he'll get better.
Keep us posted.
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