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  Discussion on R equi questions.
Author Message
Member:
Oscarvv

Posted on Thursday, May 26, 2005 - 8:34 am:

Hi DrO,
I had a foal born February 16th. This guy ended up at the University with Moderate pneumonia and a swollen ankle which turned out to be inflammation and not infection. He was 2 weeks old at the time and seemed to recover well.

On April 25th I had the vet out as he was acting a bit depressed and had a temp of 103.5. Vet pulled blood and started on Doxy and the next day Rifampin. WBC were slighlty elevated. Sorry, I can't remember the number. Temp was 103.1-5 the next 5 evenings and then was normal. Blood pulled May 14th which showed WBC at 18,000. We continued with treatment. It has now been a month and bloodwork is now showing wbc of 21,000. He has not coughed through any of this, is eating his little bit of grain and nursing well. Though he is not his usual super spunky self but does run and play. Temp this AM was 99.4.

So the questions...

1) Should we dump the doxy and use erythmomicin(sp)?

2) Does this seem like R equi?

3) Is turn out and romping around OK?

4) What else should we be doing?

And finally...
3) We had a foal born on May 14th. She does like 3 or 4 coughs a day that I hear....like a seal cough. My vet is not concerned. Temp and spunk normal. Her IgG was excellent but should we pull blood to be sure? Sounds like a no-brainer now that I've read what I wrote.

Thank you so much....these foals are so fragile and I don't want to let this drag out and end in a bad way because we should have done more.

-Barbara
Moderator:
DrO

Posted on Thursday, May 26, 2005 - 7:58 pm:

Hello Barbara,
First the single rise in WBCs does not necessarily indicate the treatment is failing, when we recover from infection there is often a brief rebound. But if you suspect Rhodo you need to get the ELISA test and radiographs to confirm it. If you and your vet feel it is possible you should change antibiotics while waiting for test results. If the foal is sick he should get rest.
DrO
Member:
Oscarvv

Posted on Friday, May 27, 2005 - 7:15 am:

Thank you so much for your reply DrO.

The odd thing is, my vet does think it is Rhodo and the doxy/rif. is her treatment of choice. I will ask her about the ELISA test and the x-rays.

My concern over the rise in the WBC is that it is after he has been on these antibiotics for a month.


Thanks again,
Barbara
Member:
Oscarvv

Posted on Friday, May 27, 2005 - 8:38 pm:

An update from today.

The older foal's WBC was down to 12.7 from 21.2 but the fibrinogen is 800 from 600. My vet said that the doxy/rif is the treament of choice for the big clinic she worked for and she did u/s the lungs. His lungs look and sound clear, he does have some noise in his throat though, but it sounds better than it did a month ago.

The younger foal's bloodwork, who has shown no sign of depression or fever, was high normal for the wbc's and fibrinogen was 600. This foal was born on May 14th.

Although I am not sure what to make of it, my feels we are on the right track.

Happy Holiday weekend!
-Barbara
Moderator:
DrO

Posted on Saturday, May 28, 2005 - 9:41 am:

That's great barbara, I agree the rise in fibrinogen is a bit worrying but field fibrinogens can be tricky as it breaks down in the vial until they get to the lab. The choice of doxy for R. equi suspects is interesting. I cannot find any published studies in horses but there are some for human AIDs patients. In there studies erythromycin was clearly superior but most isolates were sensitive to doxycycline. Rifampin was synegistic with the erythromycin but not the doxycyline.

J Antimicrob Chemother. 1992 Apr;29(4):383-93.
In-vitro antimicrobial susceptibility of Rhodococcus equi.

Nordmann P, Ronco E.
Service de Microbiologie, Hopital Raymond Poincare, Faculte de Medecine Paris-Ouest, Garches, France.

Rhodococcus equi is an intracellular facultative, Gram-positive cocco-bacillary organism of increasing importance as a pulmonary pathogen in HIV-positive patients. This study was carried out to evaluate the optimal antibiotic combinations for treating such infections. Four human R. equi isolates and one reference strain were tested for their susceptibilities to 36 antibiotics. In-vitro the most active antibiotics were amikacin, gentamicin, netilmicin, erythromycin, clarithromycin, roxithromycin, ciprofloxacin, sparfloxacin, rifampicin, vancomycin, teicoplanin, doxycycline, minocycline, imipenem, meropenem and trimethoprim/sulphamethoxazole. The only bactericidal antibiotics were the aminoglycosides, ciprofloxacin, sparfloxacin and vancomycin. As determined by FIC indices, four combinations were synergistic: rifampicin-erythromycin, rifampicin-minocycline, erythromycin-minocycline and imipenem-amikacin. However, no antibiotic combinations were synergistic with the time-kill kinetic method at achievable serum concentrations or at ten-fold and half-fold the MICs. Frequencies of selection of antibiotic-resistant mutants determined at concentrations of five- and ten-fold the MICs ranged from less than 1 x 10(-8) for erythromycin and trimethoprim/sulphamethoxazole to 5 x 10(-4) for amikacin. These results may be of help in selecting the antibiotics for treating infected HIV-positive patients.
DrO
Member:
Oscarvv

Posted on Friday, Jun 10, 2005 - 8:10 am:

Hi DrO,
Interesting reading about R equi and treatment in humans.
This colts WBC's and fibrinogen are normal from blood pulled 5 days ago. His rbc's were low though. He has been on ranitidine. Although he has shown no signs of having ulcers, we just wanted to cover our bases.

Is Red Cell OK to give to a 3 month old??? Farnam's website didn't give anymore info than what's on the jug.
-Barbara
Moderator:
DrO

Posted on Saturday, Jun 11, 2005 - 9:58 am:

I would be very careful with its use in foals. Red Cell is a basically a iron / vitamin supplement and we know that very young foals are very sensitive to excess iron. I have never seen how long it takes for them to grow out of this sensitivity. You can check the dosage against the toxic amounts listed in our articles on minerals (note the reference to foals in the table). I have never been a fan of Red Cell because it is based on the very human condition of iron deficiency particularly in women. The horse's diet is rich in iron and assuming no chronic blood loss this is not a problem in horses. Better may be a good vitamin supplement without the iron, perhaps 2 adult human vitamins a day.
DrO
Member:
Oscarvv

Posted on Sunday, Jun 12, 2005 - 7:30 am:

DrO,
Thank you once again for an informative answer. I will skip the Red Cell for sure and have a look at the chart on toxicity for foals.

After all my years here, this website is still such a great place for your articles, help and a great group of people.

Thanks!
Barbara
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