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  Discussion on Pigeon fever
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New Member:
Mullenss

Posted on Wednesday, Nov 2, 2005 - 10:23 am:

My 22 year old arab mare was diagnosed with pigeon fever about 2 months ago, along with a number of other horses at the ranch where she was pastured. At that time, she had a large abscess on her belly which spontaneously drained, had no energy and moved with difficulty, all the typical signs from what I have read. She also had a smaller abscess on her chest which had not burst. My vet put her on a 10 day course of sulfamethoxazole and trimethoprim and she seemed to feel much better. The abscess on her belly was healing nicely and a week later, the vet lanced the chest abscess. Several days after stopping the antibiotics, she acted sluggish again and developed a fever. The chest abscess was still draining but not a lot. Bute made a dramatic difference in the way she acted. However, because she wasn't making progress, the vet put her back on the antibiotics and she bounced back again. As soon as we stopped them again after 10 days, she relapsed again with a fever of 104. The vet just started her on IV injections of antibiotics and the improvement has been dramatic. Clearly she is responding to the antibiotics.

Does anyone know how to tell if she might have developed internal abscesses? Could this be why she continues to relapse, even after the resolution of her external abscesses and no sign of any others developing? And most importantly, what is the treatment if she does have internal abscesses or for what ever reason continues to relapse? Which antibiotics and for how long? Thank you for any help or suggestions.
Moderator:
DrO

Posted on Thursday, Nov 3, 2005 - 9:44 am:

I think that continued clinical signs of illness do to infection with resolution of the external abscesses is a sign you probably have internal abscesses. The article of this disease associated with this forum gives you methods to monitor resolution of the disease and best treatment and treatment times for internal abscesses. To access it click on » Pigeon Fever, Dryland Strangles,& Distemper » on the navigation bar above.
DrO
New Member:
Mullenss

Posted on Sunday, Nov 6, 2005 - 12:22 pm:

My vet agreed that my mare probably has internal abscesses and started her on 20 cc of Naxcel, IM once a day after she spiked another fever of 104 on Friday, the 4. Fever came down that night and she ate pretty well and looked good the next morning. However, Sat evening she looked depressed and wasn't much interested in food although she ate some. Her temp was 100. Sunday morning she continued to look depressed, ate a little but now is just standing around quietly. Temp, 99.8. She doesn't appear to be in pain, has bowel sounds and has been passing more gas than usual. Some manure but not a lot, but she hasn't eaten much in the last couple of days. I read that Naxcel can sometimes cause a horse to go off feed. Do you think this might be what's going on?

My vet drew blood to check for pigeon fever titres. If this is what she has, the plan is to continue her on the Naxcel for up to three months. In the meantime, I'm not sure how to get her to eat and feel better. I'd hate to lose her to colic or something else after all this.

Thanks for any help or suggestions.
Moderator:
DrO

Posted on Monday, Nov 7, 2005 - 7:58 am:

Without examining the horse Sherry I really cannot say why she is off feed but yes this can be a side effect of Naxcel. I think the reasons are 2 fold the pain at the injections site and possibly an upset stomach. 90 injections even at just one a day is quite a few, is there a reason that you are not using TMP-SMZ? I am uncertain if Naxcel is a clearly better choice.
DrO
New Member:
Mullenss

Posted on Monday, Nov 7, 2005 - 11:53 am:

Well, it looks like she's off Naxcel. She spiked another temp of 104, later Sunday, after her third shot. Vet gave her penicillin and a few other things to bring her fever down last night and she is much better this morning, no temp, alert and eating better. We stopped the TMP_SMZ because she relapsed on them too. But maybe if we kept her on them long-term? Vet was concerned about stomach problems with long-term erythromycin and rifampin. He mentioned Batril as another possible choice. What is your experience with any of these drugs long-term? You mentioned that internal abscesses sometimes need to be treated for up to 6 months. I'm sure all antibiotics have side effects and toxicity of one sort or another. Obviously, I'd rather give pills by mouth than injections every day. I gave my first two shots this weekend and found the suggestions on your website very helpful.
Moderator:
DrO

Posted on Tuesday, Nov 8, 2005 - 9:02 am:

As I read your first post Sherry it seems clear she relapsed after you discontinued the TMP-SMZ, is that incorrect? You can read about erythromycin and rifampin and all these antibiotics at Equine Medications and Nutraceuticals » Antibiotics and Antimicrobials. It is important to select an antibiotic that has shown efficacy against this form of the disease because it is difficult to treat abscesses.
DrO
New Member:
Mullenss

Posted on Wednesday, Nov 9, 2005 - 1:03 pm:

Dr. O, The mare was still getting moderately high fevers while on the second 10 day course of TMP_SMZ so that's why we switched antibiotics. The choice of Naxcel and Baytril was because other horses in the area with the suspicion of internal pigeon fever abscesses had responded well to them. Since Sunday night my mare has been on 20 ccs Baytril IM once a day and 40ccs Penicillin (procaine) IM once a day. I am also giving her 1/2 gram bute 2 times a day with tagamet. Her fever has been normal now for two days but I think she is sore from the shots, moves slowly, and is not eating much. She is interested in food but takes a few bites and leaves. She is certainly more alert than when she had the fevers of 104, (ears perked) which is good. She is drinking, urinating and pooping so far. We are still waiting for the titres to come back which maybe will give us a clearer long-term plan. At the moment I believe the plan is 10 days of Baytril and hoping we are through with the penicillin. If we are still using the wrong antibiotic, would it bring down the fever for a couple of days and then lose its effectiveness so the fever goes up again? This has been such a roller coaster!
New Member:
Mullenss

Posted on Wednesday, Nov 9, 2005 - 4:58 pm:

Just got the titres back and hers are 127 for pigeon fever which I guess is suspicious. Could it be that they are not higher because we have been trying to treat it and that they have actually gone down? she is also anemic which might account for her lack of energy. She is alert though and just awhile ago started eating eagerly for the first time in days. The plan from my vet is to continue the penicillin for a total of 8 days and the Baytril for at least ten. Do you think I could switch to oral Baytril at this point?
Moderator:
DrO

Posted on Thursday, Nov 10, 2005 - 10:09 am:

Hmmm are these reciprocal serum synergistic hemolysin inhibition (SIH) test numbers Sherry? Though false negatives are known this is suspicious low for what other reports have given even after several weeks of treatment. I am uncertain how fast titers will fall and if there are remarkable differences between labs but do know of one case where a horse with a low titer had internal pigeon fever abscesses.

I am uncertain as to the efficacy of enrofloxacin (Baytril) against these abscesses. We know the organism is usually sensitive but does it penetrate the abscess wall well? This is the known advantage of the erythro/rifampin combination. In an excellent review of 30 cases of internal abscesses the University of CA at Davis has taken the position that ceftiofur (Naxcel) with rifampin may be the best combination if antimicrobial sensitivity is not available.
DrO
Member:
Mullenss

Posted on Thursday, Nov 10, 2005 - 12:01 pm:

Having no experience reading these lab results, I believe the SHI report said titers >1:256 have a high association with internal abscesses. My mare's were 1:128. My vet also is wondering whether we might be dealing with another bacteria. Originally a month ago we thought she was over the pigeon fever because external abscesses healing well and no new ones. Then she got sick again and we assumed it was a relapse. She has now been on penicillin and Baytril almost 4 days and continues to do better. Her other lab results WBC 14.2, RBC 5.14, HGB 10.1 and HCT 28.6. I believe that these numbers have pretty much remained the same from the first test two weeks earlier. Other abnormal results: Neutrophil seg was 86, lymphocytes 9. "Neutrophils appear slightly toxic". Fibrinogen 600

I will ask my vet about rifampin. So far the penicillin and baytril seem to be working, ie no fever and she's feeling better.
Member:
Mullenss

Posted on Friday, Nov 11, 2005 - 9:48 am:

She's still looking better this morning and was eager to eat, but she moves slowly and stiffly which I assume is because she is sore from all the injections. I lowered her bute from 2 grams a day to 1gram a day yesterday, and her temperature had remained high normal, 101. this morning before the bute, temp was 101.5. now I'm worried that her temp is going back up. Maybe I'll give her 1 gram of bute this morning instead of 1/2, but i also am wondering whether the bute might be masking a fever. is this a concern. any advice?
Member:
Mullenss

Posted on Saturday, Nov 12, 2005 - 10:01 am:

Temp was up again this morning to 102, but with bute it comes right down, and stays down during the day. After the bute, she looks and eats well and in fact looks like she's put back some weight in last week. She will finish out 8 days of penicillin and baytril and vet has also given her a couple of shots of sodium iodide, and I guess we will then figure out what comes next.

she hasn't been wormed for a couple of months because she has been sick. I'm thinking maybe I should go ahead and worm her, just in case this might be a problem. Any reason not to in a horse with fever and on antibiotics? Also, wondering whether I should blanket her at night. It's getting down to the low 50s and although I usually only blanket when it's in the 30s, she is sick!
Moderator:
DrO

Posted on Saturday, Nov 12, 2005 - 10:39 am:

The lab report remains consistent with ongoing internal abscesses and as stated earlier it is difficult to assess treatment success or failure with short term changes. I think the blanket is OK if she sweats, she does not need it. Unless you think there is a reason for a large parasite exposure I would wait to deworm.
DrO
Member:
Mullenss

Posted on Tuesday, Nov 15, 2005 - 6:45 pm:

Dr. O, My mare has now been sick for a month with fever, lethargy, not eating well. For this last go around of antibiotics, she has been on 40cc penicillin and 20cc baytril a day IM for 9days and although she doesn't look worse, she doesn't look better either. I know internal abscesses with pigeon fever take up to 6 months to resolve, but what does the clinical course look like? when can I expect to see some significant improvement? Are we just missing the boat here? My vet is getting rifampin so we will try that. I know you said in your last post that short term changes don't mean much, but I"m getting very discouraged and it is very hard to see my girl so down for so long. Every once in awhile she perks up and I get hopeful. She will even nicker for treats. Still running a fever though first thing in the morning (103.7 this morning), then with her a.m 1/2 gram of bute, it goes right down and she starts to eat some. She moves very slowly but likes to go out and eat grass along the driveway. She doesn't seem in distress, just doesn't feel well.

I should mention that when she was first diagnosed with pigeon fever and had the external abscesses, I immediately brought her home so she is no longer at the ranch on pasture. I think she is much less stressed at home although she is by herself. (Her stable mate died last spring at age 30). She is also anemic so that adds to the lethargy and increased respiration rate, I'm sure. I am just so confused!!! Maybe I should be concerned with her diet but I'm giving her whatever she'll eat, senior feed, lite pellets, mixed grain, alfalfa hay and grass hay. I'm trying to start her on red cell. I feel like we're trying everything but not making much progress. the only health problem she has had up until now is melanomas (she's a grey) which we have been treating with cimetidine for years. they seem to have remained stable. Could this be adding to her problems now?

I have not wormed her although she was on pasture and was wormed while there. I am putting a light blanket on at night. She does not sweat as far as I know.

Sorry for the jumble of questions. I just don't know what to think at this point.
Moderator:
DrO

Posted on Wednesday, Nov 16, 2005 - 5:48 pm:

It is difficult Sherry,
The clinical course of internal abscesses is very different from case to case. Often the clinical signs depend on the location of the abscesses, number, size, maturity of the abscesses, organism, and its sensitivity to the antibiotics being used. Obviously each of these are different for each case. If you have not seen a definite improvement in fever and other vital signs within 10 days of therapy I too would be rechecking my diagnosis and if it still seems to be internal abscesses looking for alternative antibiotics and I would go with the recommendation listed above.
DrO
Member:
Mullenss

Posted on Tuesday, Nov 22, 2005 - 10:28 am:

I think she is starting to improve somewhat. We started her back on 20 ccs Naxcel IM on Friday and will add the rifampin today. We had to wait for awhile to get the rifampin in. She still has a low-grade fever and is stiff and slow in her walking, but bute really helps. My vet said to go ahead with 1 gram in the am and 1/2 or 1gram in the pm if it makes her feel better, at least for the next few days. I am also giving her a lot of cimetidine. (I just posted a plea for more ideas for giving nasty tasting powder over the long term.) She is eating better and doesn't seem overall as depressed as she had been. So once again I have my fingers crossed. Vet is doing another blood check to see how liver and kidney functions are holding up, but so far she seems to be holding her own.

If she continues to improve and it seems like we've finally got the right combination of antibiotics, can we give them for several months? It seems like they all say up to ten days, and you had indicated in a previous post some concern about 3 months of daily injections of Naxcel. Everything I read about pigeon fever though says it is a long term proposition. Maybe with these new drugs it won't take as long????
Moderator:
DrO

Posted on Wednesday, Nov 23, 2005 - 6:21 am:

Average treatment time in one study of a large number of cases of internal abscesses was 37 days but you should use the parameters in the article for determining when you can discontinue treatment.
DrO
Member:
Mullenss

Posted on Wednesday, Nov 23, 2005 - 11:53 am:

Dr. O, We got back the latest blood work and it shows some problems with the liver. Alk Phos was 794 (80-280 U/L), AST (SGOT) was 1023 (180-570 U/L) and GGT was 224 (5-30 U/L). Total protein was high, 7.5 (5.7-7 g/dl) and TCO2 (Bicarb) was 20 (25-34 mEq/L). Globulin, 4.3 and total bilirubin 2.7. Everthing else in this panel was within normal range. On the CBC, WBC has come down a bit to 12,000 and HCT went up a bit to 30.9 so her anemia is not getting worse. Neutrophil seg is 90 (30-65) and lymphocytes are 6 (25-70).

Last month, Alk Phos was 188, AST was 136 and GGT was 27. Total protein was 7.4, globulin was 4.4 (2.4-4.3 g/dl) and total bilirubin was 1.3 (1.9-3.7 mg/dL)

My vet obviously was not pleased with the liver results, but said since she looked a bit better it made sense to continue antibiotic treatment for another few weeks. She still is not eating much but has not lost as much weight as he thought she might have. She is still a sick looking horse, moving better but slowly and I think she might have some pain in her belly (maybe from the liver) when she gets in certain positions. She tends to stand with her right hind leg pretty far forward as if to take pressure off). But fever now seems to be staying in the high normal range and she is more alert and interested in food.

I am looking for some hope here now. Could these liver lab results indicate an abscess on the liver that if resolved would allow the liver to go back to normal? Do these lab results still suggest to you that there is an infection going on which might preclude the possibility of an internal melanoma on her liver which at this point I think would be untreatable? She does have a peach sized melanoma behind one ear and one on her croup which the vet has described as atypical, but they have remained unchanged for years now.

Any observations and reasons to remain hopeful would be greatly appreciated. Obviously I am beginning to wonder how much more of this I want to put her through or how much more she can take without jeopordizing her future quality of life.

Thank you, DR. O. Your observations and info have been very helpful.
Moderator:
DrO

Posted on Friday, Nov 25, 2005 - 7:50 am:

The liver enzyme results should not be looked upon as a prognostic indicator nor does it relate in anyway to liver function. Relatively minor but wide spread insults to the liver can cause large increases while on the other hand chronic degenerative processes can result in little change in the liver though the liver is failing.
DrO
Member:
Mullenss

Posted on Wednesday, Nov 30, 2005 - 10:25 am:

I hope a vaccine for pigeon fever is developed soon because this can be an awful disease when it becomes internal. My mare is still sick and very weak after 2 months although she now has been on 20cc Naxcel, IM per day for 12 days now and Rifampin 40cc PO per day for 7days, (after other trials of antibiotics up until now). Everything I have read about this disease indicates that the internal abscesses are very hard to treat and that the course is variable and that it can take a long time to fully recover. Although my mare I believe has made some progress in the last week since starting the combo of antibiotics, she still looks very sick. She is more alert if not bright, and she started to eat as if she was hungry a few days ago, but her walking looks very unsteady and I keep thinking she will trip and fall and not be able to get up. I don't think she has layed down for weeks. And just when I think she is doing a bit better, her temp goes up to 104 the past few mornings. (It usually goes down late morning). I just got a new thermometer to be sure so I think this is correct. Maybe this is why she moves so slowly and clumsily, but she doesn't look as depressed as I would think she would with such a high fever. She is eating. I am also giving her 1 gram of bute twice a day with omeprazole and bismuth salicylate.

Again I am very confused and frustrated. I really wonder and worry about how much more she can take and when I should call it quits for her sake. I can't seem to get any information about whether her course of illness is typical or whether it looks like we're losing ground. I would think after two months of aggressive treatment (albeit not all that time with the preferred combo of antiobiotics) she would look better. Dr. O, you said that the course can look very different depending on the size, location and ripeness of the abscesses but I really don't know what that means.

Could it be that her abscesses when they are ripe cause the fever to go up and we should just wait a bit because they may be resolving? when articles say that it can take up to 6 months to fully recover do they mean that the horse is very ill for 6 months?

Thanks for your comments. Any suggestions about management would be appreciated too!
Member:
Beezle

Posted on Wednesday, Nov 30, 2005 - 3:10 pm:

Sherry - I had a older horse get pigeon fever a few years ago (I have a couple of posts on this site about it). Luckily, she did not have internal abscesses as far as we know, but she continued to have external ones for about 9 months. One was very deep in the front of the chest muscle and it would not drain - had to cut into the muscle about an inch deep to drain it finally. Wonder if there is some way to locate where the internal abscesses are and drain them surgically somehow?

It seems some horses are able to get over this quickly and others take a while.

Hang in there!

Becky
Moderator:
DrO

Posted on Thursday, Dec 1, 2005 - 9:20 am:

It means Sherry that no 2 cases are the same because the abscesses can be in different areas of the body, there can be a different number of abscesses and the size of the abscesses can be different. All of these can effect the appearance, prognosis, and treatment time therefore it is difficult to compare your case easily with other cases. I would not look at the daily variation in temperature alone as a sign to give in, but instead take heart your horse is showing improvement and on this regimen U of CA had a pretty good recovery rate.
DrO
Member:
Mullenss

Posted on Thursday, Dec 1, 2005 - 10:07 am:

Thanks, Becky and Dr. O for the encouragement. It does help with getting through the ups and downs.
Member:
Mullenss

Posted on Tuesday, Dec 6, 2005 - 3:50 pm:

My beloved grey Arabian mare, Bethsheba, was put to sleep yesterday. She was beautiful, graceful and dignified even at the end. She fought hard during her illness and we fought hard for her, and I am so sorry that she had to be so sick for the last few months of her life. She was my equine partner for 16 years and I am very grateful for that.

She just never recovered from the downhill track of the last two months. We would have occasional 1/2 days when she ate some and looked better, and sometimes even several in a row, but the overall course as I look back at my notes was steadily downhill. She stopped eating several days before the end and was so thin and weak she could barely stand. Clearly the aggressive treatments of the last couple of months never took hold.

I t does make me think, and the vet wonders too, that something besides the pigeon fever was going on. Her titers for the bacteria were relatively low and I'm wondering if perhaps the initial infection caused her melanomas to metastasize internally and eventually that's what caused her to decline. I don't know whether, Dr. O, her lab results would be consistent with a cancer diagnosis or whether you think that would be unlikely. I know there is no way to know for sure, but I would be interested in what you think. Maybe it was just the pigeon fever and she was one of the unlucky ones who could not recover.

Anyway, I am grateful for your website and I think you do a wonderful job. My vet was terrific, experienced, knowledgable and kind, but it was comforting to have a second opinion on the internet.
Member:
Beezle

Posted on Tuesday, Dec 6, 2005 - 4:22 pm:

I am so sorry Sherry.
Moderator:
DrO

Posted on Tuesday, Dec 6, 2005 - 4:44 pm:

My deep condolences Sherry and thank you for the kind words during this difficult time for you. There is nothing in the work that I have seen that says it could not be cancer and an autopsy will often answer your most difficult questions.
DrO
Member:
Hwood

Posted on Wednesday, Dec 7, 2005 - 2:13 am:

I'm so sorry to hear of your loss, Sherry. You tried so hard to make sure she had all she needed, and I know this last couple of months has been very difficult for you.
Peace to you.
Member:
Frances

Posted on Wednesday, Dec 7, 2005 - 9:18 am:

What a sad outcome to all your efforts, Sherry. You have my deepest sympathy.

Lynn
Member:
Mullenss

Posted on Wednesday, Dec 7, 2005 - 9:41 am:

Thank you, all. The grief is no less painful, but certainly easier to bear with support and understanding.
Member:
9193

Posted on Wednesday, Dec 7, 2005 - 12:33 pm:

Oh Sherry,

I send you hugs and deepest condolences on the loss of your beloved Bethsheba. Your love and dedication to her was most evident thru out your posts and I am sorry you had to make the most difficult, loving decision any of us may have to face.

You are in my thoughts,
Debra
Member:
Mrose

Posted on Wednesday, Dec 7, 2005 - 1:07 pm:

I[m so sorry to hear you had to let Bethsheba go. I've been following your posts, in my mind picturing Bethsheba to look like my sweet older gray Arab mare. I know how much you loved her, and the two of you certainly put up a good fight. Sometimes there is just no other choice but to let go. I'm sure she will always have a special place in your heart, for there is nothing like an Arab mare to really make a special place for herself.

Best wishes and hugs.
Member:
Sonoita

Posted on Wednesday, Dec 7, 2005 - 2:22 pm:

Sherry,
So very sorry for your loss. My prayers are with you.
Member:
Lilo

Posted on Wednesday, Dec 7, 2005 - 4:30 pm:

Sherry,

It is so hard to make that final decision, isn't it. The way your beloved Bethsheba acted at the end reminds me of my daughters beloved gelding near the end. He just could not eat anymore - he was diagnosed with lymphosarcoma, and I guess it metastasized at the end.

With sincere sympathy,
Lilo
Member:
Warwick

Posted on Wednesday, Dec 7, 2005 - 4:52 pm:

Very sad news, Sherry. My thoughts are with you during this very hard time.

Sue
Member:
ceceb

Posted on Tuesday, Sep 1, 2009 - 10:59 am:

Sherry, My friend just lost her very healthy 5 year old mare to something similar, go to Fever of Unknown Origin with a post starting from Cecilia Bulkley on about August 21, 2009. Vet thinks it was an internal abscess, or some form of cancer that metastasized. She started out with what we thought was colic, then continued with fever up and down for almost a month before giving up.
She lost 200 lbs in 26 days. We will not ever know what it was that took her life.
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