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  Discussion on "Barn" Cough
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New Member:
juggy

Posted on Monday, Mar 30, 2009 - 10:47 am:

My 7 yr old gelding starting coughing at the beginning of excercise 2 years ago. I highly suspect that it started with a batch of bad hay. It had mold, but only was detected when I would throw the hay out and watch the "smoke" rise from it. The cough never went away, but didn't get worse. Eventually I had a scope and culture pulled and we discovered he had a lung infection from bleeding (he is a barrel horse). We treated the infection and it cleared, but the cough remained. My vet has since told me to put him on Dex orally for 7 days (which stopped the cough) and then to give him Dex every other day for 1 month...which is where I am now.

Since the Dex has stopped the cough I am assuming it is safe to say it was caused by an allergy....now I have to figure out what he is allergic to. Is there a blood test or some kind of allergy test that will tell me? I have now taken him off of hay completely. He is either turned out on pasture or given soaked hay cubes. Where do I go from here?
Moderator:
DrO

Posted on Tuesday, Mar 31, 2009 - 7:32 am:

Welcome Anne,
I think it is very likely your horse is allergic to hay mold spores: 90% of the horses with your history are. I would recommend you go to the article Diseases of Horses » Respiratory System » Heaves & Chronic Obstructive Pulmonary Disease and study the treatment and management of horses that have this allergy.

If this is the cause, strictly following the management recommendations will prevent further worsening of symptoms and may even return your horse to a cough free state.
DrO
New Member:
juggy

Posted on Tuesday, Mar 31, 2009 - 9:58 am:

How long after removing the horse from the allergen, does it take for him to no longer have the side effects of the allergen?
Moderator:
DrO

Posted on Tuesday, Mar 31, 2009 - 7:20 pm:

About 21 days Anne for the acute reversible changes, say 30 just to be conservative.

Concerning the tests for allergies, there are blood tests but they are of no use what so ever. There are some skin challenge tests but in the horse it suffers from both lack of sensitivity and lack of specificity: they often give false positives and false negatives. We are not sure why this test is not as good as in humans...yet.
DrO
New Member:
juggy

Posted on Tuesday, Mar 31, 2009 - 7:57 pm:

I had made an appt to have blood pulled which my vet said would tell us what he was allergic to as far as pollen, etc....but it is a waste? Why? I certainly don't want to spend $300 on something that isn't accurate...
Moderator:
DrO

Posted on Wednesday, Apr 1, 2009 - 8:45 am:

I wouldn't want to either Anne.

I don't know why folks believe in these tests as there is no good scientific evidence to support blood testing for allergies, at least in there commonly available commercial form. Yes they often have anecdotal support or sometimes their own research which everytime I have investigated is scientifically lax. Any immunologist, veterinary or human, I have ever talked with or listened to at a lecture had a dim view of simple blood testing for allergic disease.

Recently there have been a report of a new twist to blood testing for culicoides hypersensitivity (Sweet Itch) using a histamine release assay test. The subject is challenged with culicoides antigen and the amount of histamine released measured. Research suggests that it may help identify a percentage of those not effected by the allergy but even this was not sensitive as the test identified a significant percentage of non-allergics as positive.

But let's look at your specific problem from a historical and epidemiological point of view. Your problems started up following exposure to bad hay. Horses often develop life long allergies to mold spores after being exposed to bad hay. Your horse's clinical signs are consistent with a mild or early form of COPD.

You should consider discussing these points with your veterinarian. If he wishes to continue I would want to know what type assay is being carried out and some evidence that it is sensitive and specific otherwise why it would be better than giving the horse a month in a allergen free environment. Which also happens to be good therapy for any coughing horse. But you must remember just a minute in a barn or exposure to hay causes another 21 days of hypersensitivity.
DrO
New Member:
juggy

Posted on Wednesday, Apr 1, 2009 - 1:45 pm:

To understand what all I have gone through here is a condensed version:

In March of 2007 he began this cough. Took him to a local vet and was given Ventipulmin. That vet thought it was just spring allergies and it would go away.

He began to have alley problems...refusing mildly to go in....Had a soundness exam and found nothing.

Cough continues...not on an everyday basis, but throughout the year. It seemed better in the late summer, but then the more I ran him seemed to become more frequent. Gave him the winter off...next spring when I get back on to leg him up he is still coughing some days.....

I take him to a different vet in May of 2008 and he scopes him and we see a river of mucous running down his trach and around his gluteral pouches. He puts my gelding on a round of SMZ tablets and ventipulmin.

Cough did improve after that first round of SMZ's in that it was less frequent and not as strong of a cough. He would only cough lightly 1 or 2 times every few days instead of 4-5 times really hard.

Re-scope shows improvement in mucous. He inserts penicillin gel in glut. pouches. I wait a week and cough remained. Then I ask if there is a stronger antibiotic and they give him a round of Baytril. Cough returns to as bad as it was before the SMZ's.

Finally I get a different vet to do a trach wash and culture. Here is what came back on that report: Klebsiella pneumoniae, Achromobacter xylosoxidans, and Acinetobacter lwoffi. Vet tells me that he bled on me and we hospitalize him where they give him 10 days of SMZs, 5 days of Gentocin, and 10 hyperbaric chamber treatments.

A few weeks later I get on him and he does cough lightly, but only about every 5-6 days. Vet says to do another round of SMZ's.

Still the cough remains, so I demand another culture....This time the culture finds only Klebsiella pneumoniae.

We treat him with a round of Naxcel. The cough remains.....

I can give you more from the culture/lab reports...if you can PLEASE tell me your take on all of this.
Member:
vickiann

Posted on Wednesday, Apr 1, 2009 - 5:21 pm:

Anne,

Do you have any poultry roosting around or in your barn?

Or birds nesting above stalls?
New Member:
juggy

Posted on Wednesday, Apr 1, 2009 - 11:21 pm:

Vicki-

No, I do not.
Member:
mitch316

Posted on Wednesday, Apr 1, 2009 - 11:54 pm:

Anne, it sounds like you have a antibiotic resistant Pneumonia here, but for years? I would go with COPD, which would make him very susceptible to pneumonia, influenza, and a whole host of others. If memory serves me correct, COPD is like "normal" allergies in that their are certain triggers that exasperate the symptoms, but unlike allergies the symptoms seldom go totally away...

Ok, sorry, but I just went back and read the earlier post, and Dr. O beat me to the punch on COPD, but I am not very familiar with treating it. My Mom has COPD, but that is a really bad comparison because hers is emphysema and chronic bronchitis, but is also triggered by certain substances. If your farm is anything like mine, a dust free environment would be next to impossible, and with all the pollen in the air for spring? Not a chance. I actually seen an allergen mask to put over a horses nose and mouth, kinda like an old time feed bag, but other than making me laugh out loud, I do not believe it would be at all effective, but that is just me, Dr. O may know more about them. I seen it on the site where I get most of my vet supplies, which is www.kvvet.com. Just as an aside, you cannot order everything in the site...some of the stuff you must be a vet or licensed technician, but these mask were prescription free. (Still do not think they would work. My horses would have them torn off in a second, and one filly would probably eat hers, ha)

Whatever happens, keep us informed as I would be interested in learning how this is finally successfully treated, and I believe it will be once you find out what "it" is.
Moderator:
DrO

Posted on Thursday, Apr 2, 2009 - 9:03 am:

Anne,
I don't find any of the information in your last post as compelling diagnostically as the history and response to treatment you provide in your first post. Though a bit shocked no one has suggested removing hay and barn air from his environment. I am interested in the cytology report from the transtracheal wash. Providing the whole report unedited is best. There are some other chronic lower air way diseases that can sometimes be differentiated by the type of inflammatory cells.
DrO
Member:
juggy

Posted on Thursday, Apr 2, 2009 - 11:18 am:

Jesse-

This horse was only treated with antibiotics last summer and early fall. The rest of the time we were only trying to treat the "symptoms" he was having.

DrO-

As soon as I get back home I will copy the reports for you. What also strikes me as odd is that on the first report it showed that klebsiella pnuem. was susceptible to different antibiotics than what they showed in the second report....do you think that was a type error?
Member:
juggy

Posted on Thursday, Apr 2, 2009 - 3:37 pm:

Dr. O-

Here is a copy of the 2 Reports from the 2 cultures:



Report from culture pulled on 8-5-08:
Description-
One direct and one cytocentrifuged preparations were examined. Cellular preservation was adequate. RBC numbers were reletively low in comparison to nucleated cell numbers. The cell population consisted of a large majority of macrophages and a small minority of mildly degenerate neutrophils, and small mature lymphocytes, and rare cosinophils, admixed with mucus; low numbers of extracellular bacterial rods in chains were present. No organisms were seen. No neoplastic cells were seen.

Interpretation-

Evidence of neutrophilic inflammation; evidence of increased mucus. It is not known if the bacteria were present as part of a septic process or as a contaminant that grew out during shipment; inclusion of an air dried freshly prepared slide is helpful in differentiating between actual infection and contamination, as well as in interpretation of degenerate neutrophils.



Report from culture pulled on 11-5-08:

Comments:
Heavy mixed growth

Description:
One direct and one cytocentrifuged preparations were examined. Cellular preservation was adequate. RBC numbers were relatively high in comparison to nucleated cell numbers. The cell population consisted of a large majority of variably degenerate neutrophils, and a small minority of macrophages and eosinophils, admixed with mucus; relatively high numbers of large intermediate squamous cells and relatively high numbers of a mixed population of bacterial cocci and rods were present extracellularly, sometimes in moderately sized colonies, and frequently adherent on the surface of squamous cells. Plant material was present. No neoplastic cells were seen. No organisms were seen.

Interpretation-

Evidence of neutrophilic inflammation; evidence of cropharyngeal contamination; evidence of increase mucus production. Although the organisms could theoretically be representative of sepsis, the presence of squamous cells is indicative of oropharyngeal contamination and as such the bacteria could have originated from the oral cavity and grown out in shipping.
Moderator:
DrO

Posted on Thursday, Apr 2, 2009 - 6:36 pm:

The neutrophillic response seen in both of these reports would be consistent, though not diagnostic, with hay mold allergies. The lack of symptoms of bacterial pneumonia (fever, depression, etc..) a better way to rule out bacterial pneumonia than the cytology results.
DrO
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