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| Discussion on Wither Abcess | |
| Author | Message |
| New Member: judgesma |
Posted on Friday, Sep 24, 2010 - 7:46 pm: Hi there,I have a 8 year old Oldenburg Gelding. Rescue case, came from an abusive, starving situation, so I don't have a lot of history on this boy. Have owned him for almost a year and a half and his only "shortcomings" once he reached his ultimate weight was very mild shivers and very oddly shaped withers. Was doing great under saddle, very sweet and gentle despite his rough past. About three weeks ago, what looked to be either a puncture wound or abcess ruptured on his withers. Scrubbed with betadine, dosed him with SMZs per the vet and it cleared up in about 5 days. At around day 7, it blew again, so this time I had the vet come to treat/do an xray, mostly because I was curious about his funny shaped withers. What we found was something I never expected. His first wither was essentially gone and after a dye injection, we followed an infection tract that turned into his neck and went roughly 26in. He tested for bruceollis as he fear fistulous withers, did a swab and we waited for a few days. Fortunately, the bruceollis was negative, however he showed "heavy" amounts of streptococcus zooepidemicus and pseudomonas aeruginosa. My vet sent his xrays off to two prominent vet schools and one great surgical center, but all basically said they really didn't want to touch it. I understand the only course of action would be surgery, to find the pocket of infection and flush the infection tract in addition to heavy doses of antibiotics and for a horse who's already freaked out about someone just looking at his withers, let alone flushing them out twice a day for who knows how long, I just don't think it's a possibility. Is the general prognosis for this sort of problem very poor and is it fair to say that an infection like that takes a very long time to form or something he probably always had? What more can anyone tell me about that pseudomonas bacteria? thank you in advance. |
| Member: rtrotter |
Posted on Friday, Sep 24, 2010 - 9:01 pm: Wendy,I am so sorry to hear about your horse. As far as the bacteria goes I am unfamiliar with the first one other than it being strep, but unfortunately very familiar with the second. It is a nasty one to say the least and not many antibiotics work on it. The one that I used was chloraphenicol( sp?). and that was after several flushes(infected knee)with direct antibiotics. This horse was a rescue as well, as I saved him from the killers, was in very poor shape, sores all over him, very skinny. It looked like they dragged him onto the trailer and then gave him a bath hoping he'd look presentable in the sale ring. I felt sorry for him, and bought him. I contacted the old owners( he was a racehorse, so I tracked him by his tattoo), and although they didn't want to give me much information, they let it slip that he had an ongoing knee infection from a bad injection. I had the vet do a culture the day after I bought him and the pseudomonas aeruginosa showed up on the culture. We eventually did clear up the infection, but by the time we did ( 10 months later), he had so many other issues going on that he never fully recovered and I eventually had to euthanize him due to quality of life issues and I know I made the right decision. Anyway, lets hope for a better outcome for your horse. Do they want to put a drain in him so that the track can be flushed? Rachelle |
| Member: gramsey1 |
Posted on Friday, Sep 24, 2010 - 9:29 pm: Did you Google the disease?https://www.buzzle.com/articles/pseudomonas-aeruginosa-infection-symptoms-and-tre atment.html Sounds like you have a tough decision, and perhaps a tough fight ahead. |
| New Member: judgesma |
Posted on Saturday, Sep 25, 2010 - 7:29 am: Thanks.Rachelle, sound like what I pretty much anticipated for this boy in dealing with this infection. The vet schools and surgery center didn't really want to mess with it, but said it would include surgery to "maybe" find the pocket, put in tubes and flush, flush, flush. Problem is, I just don't see that any treatment would be effective, or worth the trauma to him for a grim prognosis. He's scheduled to be put down next week which breaks my heart, but I think he's suffered long enough? The infection tract is so long, I don't even know that flushing would be that successful, and God only knows what damage has been done to his withers, spine and other tissues where the vets haven't yet explored. His shivers symptoms are a good clue that he has damage somewhere back there so any treatment would just be prolonging his suffering for my benefit.... 
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| Member: rtrotter |
Posted on Saturday, Sep 25, 2010 - 10:52 am: Wendy,I commend you for being so realistic about the situation, I think sometimes we lead with our hearts when trying to make these kinds of decisions, but in the long run the horse lets us know the right time. Will you be doing any treatment while you are waiting that might help him and might change your mind? Rachelle |
| Member: vickiann |
Posted on Saturday, Sep 25, 2010 - 11:51 am: Sorry to hear about this serious situation, Wendy. |
| Member: ajudson1 |
Posted on Saturday, Sep 25, 2010 - 10:19 pm: Hi Wendy,What a heart wrenching situation. I don't know anything about what you describing and my heart goes out to both of you during such a difficult time. |
| Member: frances |
Posted on Sunday, Sep 26, 2010 - 6:41 am: So sorry to hear of this. Hoping that DrO might possibly know of an entirely different and easily administered treatment.Wishing you both a good outcome, even if that can only be a peaceful end for him. |
| New Member: judgesma |
Posted on Sunday, Sep 26, 2010 - 8:04 am: Thank you everyone for your kind thoughts. I had really hoped for a better outcome for this boy given his rocky start in life, so this has all caught me by surprise. Despite his former abuse, he still was so giving and wanted to try, gentle around my kids and just enjoyed being with us.If there's an alternative out there, I am certainly willing to try, but in the meantime he is comfortable, getting lots of love and attention. |
| Moderator: DrO |
Posted on Sunday, Sep 26, 2010 - 10:13 pm: Welcome Wendy,I am sorry to meet you over such a difficult case. Degeneration of the spinous processes takes time but the time frame can best be assessed by those who can see the bones and infection. Yes the prognosis is poor to guarded. Surgery to debride out diseased tissue and establishing ventral drainage would improve the situation but aggressive local treatment and long term (several months) of antibiotics based on the sensitivity results you have a small chance of clearing this up. For more on this see HorseAdvice.com » Diseases of Horses » Skin Diseases, Wounds, and Swellings » Swellings / Localized Infection / Abscesses » Fistulous Withers & Poll Evil. DrO |
| New Member: judgesma |
Posted on Thursday, Sep 30, 2010 - 8:18 pm: Thank you Dr. O.My vet disagrees with my decision unfortunately, so just to be sure I am getting a second opinion on Monday to include all the information and xrays previously gathered. I understand exploring all treatment options, but the way it was presented to me was very grim and slim, so I feel that I am sparing this nice boy a whole lot of trauma and suffering in the long run...Not to mention what could add up to thousands of dollars. Can you tell me a little bit more about that pseudo bacteria? |
| Moderator: DrO |
Posted on Saturday, Oct 2, 2010 - 10:46 am: This is lifted almost word for word from Wikipedia. The only thing I have to add is that when treating pseudomonas infections of the outer ears or skin often tris-EDTA is added to the cleansing and flush solutions, most often in combination with dilute chlorhexidine (0.15% to 0.5%). Whether this is suitable for a large blind track that does not drain well I am uncertain. If this track can be opened and drained at its most distal aspect it will greatly improve the prognosis.DrO From Wikipedia; Diagnosis Production of pyocyanin, water-soluble green pigment of Pseudomonas aeruginosa. (left tube)Depending on the nature of infection, an appropriate specimen is collected and sent to a bacteriology laboratory for identification. First, a Gram stain is performed, which should show Gram negative rods with no particular arrangement. Then, if the specimen is pure, the organism is grown on MacConkey agar plate to produce colorless colonies (as it does not ferment lactose); but, if the specimen is not pure, then the use of a selective plate is essential. Cetrimide agar has been traditionally used for this purpose. When grown on it, P. aeruginosa may express the exopigment pyocyanin, which is blue-green in color, and the colonies will appear flat, large, and oval. It also has a characteristic fruity smell. P. aeruginosa is catalase+, oxidase+, nitrase+, and lipase+. When grown on TSI medium, it has a K/K profile, meaning that the medium will not change color. Finally, serology could help, which is based on H & O antigens. Treatment P. aeruginosa is frequently isolated from non-sterile sites (mouth swabs, sputum, and so forth), and, under these circumstances, it often represents colonisation and not infection. The isolation of P. aeruginosa from non-sterile specimens should, therefore, be interpreted cautiously, and the advice of a microbiologist or infectious diseases physician/pharmacist should be sought prior to starting treatment. Often no treatment is needed. When P. aeruginosa is isolated from a sterile site (blood, bone, deep collections), it should be taken seriously, and almost always requires treatment.[citation needed] P. aeruginosa is naturally resistant to a large range of antibiotics and may demonstrate additional resistance after unsuccessful treatment, particularly through modification of a porin. It should usually be possible to guide treatment according to laboratory sensitivities, rather than choosing an antibiotic empirically. If antibiotics are started empirically, then every effort should be made to obtain cultures, and the choice of antibiotic used should be reviewed when the culture results are available. Phage therapy against ear infections caused by Pseudomonas aeruginosa was reported in the journal Clinical Otolaryngology in August 2009[28] Antibiotics that have activity against P. aeruginosa include:
These antibiotics must all be given by injection, with the exception of fluoroquinolones and of aerosolized tobramycin. For this reason, in some hospitals, fluoroquinolone use is severely restricted in order to avoid the development of resistant strains of P. aeruginosa. In the rare occasions where infection is superficial and limited (for example, ear infections or nail infections), topical gentamicin or colistin may be used. There has been some research success with treating mice with phage therapy, raising the survival rate from 6% to 22-87%.[30] Antibiotic resistance Pseudomonas aeruginosa is a highly relevant opportunistic pathogen. One of the most worrisome characteristics of P. aeruginosa is its low antibiotic susceptibility. This low susceptibility is attributable to a concerted action of multidrug efflux pumps with chromosomally-encoded antibiotic resistance genes (e.g. mexAB, mexXY etc.[31]) and the low permeability of the bacterial cellular envelopes. In addition to this intrinsic resistance, P. aeruginosa easily develops acquired resistance either by mutation in chromosomally-encoded genes or by the horizontal gene transfer of antibiotic resistance determinants. Development of multidrug resistance by P. aeruginosa isolates requires several different genetic events including acquisition of different mutations and/or horizontal transfer of antibiotic resistance genes. Hypermutation favours the selection of mutation-driven antibiotic resistance in P. aeruginosa strains producing chronic infections, whereas the clustering of several different antibiotic resistance genes in integrons favors the concerted acquisition of antibiotic resistance determinants. Some recent studies have shown that phenotypic resistance associated to biofilm formation or to the emergence of small-colony variants may be important in the response of P. aeruginosa populations to antibiotics treatment.[14] |
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