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  Discussion on Temp 105.4 ---- no other symptoms initially
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Posted on Tuesday, Apr 10, 2001 - 7:05 am:

History-yrling filly-vaccinated in Jan for rhino, herpes, intranasal strangles, encephalitis, tetanus. Neg Coggins at that time. No exposure to outside horses. Location La.
Filly not sweating or blowing-found down in free access stall. Gave 6cc banamine-hosed-up in an hour. Called vet---gave 6cc pen/gen, watched all night-not down---at 730a down and kicking sides.
To vet---immediately tubed and rectal. Horse gums now yellow---pushed fluid---pink urine.
To LSU vet school-within 24 hrs of fever. Ruled out lymphoma, no Heinz bodies on rbc. Steriods started---hemolysis stops---horse back on reg food-still no diagnosis--LSU testing for EIA again, acute titers for rhino, herpes, etc.
Horse has never had penicillin until this injection.
Pasture mate had yellow snots wk earlier-pen given at vets advice--fine now-lymph nodes ok
No red maple, few buttercups in pasture.
Same day dog 105 fever-Erlichiosis again. (strain not E. canis)
Not asking for a diagnosis, just any ideas.

Posted on Tuesday, Apr 10, 2001 - 8:29 am:

Penicillin has been associated with the onset of immune mediated hemolytic anemias but as your post implies, I don't think it is seen with the first injection. Was a shot of Pen given when born?

Could be just plain old immune mediated hemolytic anemia (the one we do not know why it starts up) as a primary problem: hemolysis can give you remarkable fevers or a complication of a viral or bacterial infection.

Some types of infection will cause hemolysis, but I will have to do a little research for an exhaustive list. I do believe EIA is pretty bad in good ole LA. Ehrliosis is certainly possible (see : Equine Diseases: Cardiovascular, Blood, and Immune System: Equine Granulocytic Ehrlichiosis) and easy to diagnose. Wild onions are implicated in some cases and nitrites can cause hemolysis....
DrO

Posted on Tuesday, Apr 10, 2001 - 5:49 pm:

Thank you Dr. O for your quick response.
Have talked to LSU today---Coggins neg. Spiked 105 fever again (first since a 102 temp Fri---initial fever spike Thurs night) Have her on tetracycline and still on a mid dose of steroids---no hemolysis this time. x-ray today revealed pneumonia---no snots-nothing abnormal except elevated resp rate at times. They don't think it's something she ate but are looking at plants I brought down. Will be doing a tracheal wash and culture. Vet's opinion (not diag) is that is is a flu virus. By the way, no sign of laminitis yet.
Talked to the breeder of the horse----she never gave any penicillin.
Thank you again for your response.

Posted on Wednesday, Apr 11, 2001 - 9:04 am:

I am surprised they have her on TC and dex at the same time. Tetracycline does not kill bacteria, it suppresses reproduction of the bacteria while the immune system (which is now suppressed by the dex) cleans it up. TC is one of the drugs of choice for many of the blood parasites however. I would like to know what they think about this, and please let us know how this works out.
DrO

Posted on Wednesday, Apr 11, 2001 - 11:22 am:

Thanks again, Dr. O.
They told me they put her on tetracycline to prevent sec infection and (I assume) because of possible erlichosis. Now they are going to look for an alternative to pen to give her. Too bad they didn't do the x-ray Mon as originally scheduled---were also going to repeat ultrasound of chest which was normal Fri night.
As a side note---can you believe that LSU vet school could not get PT,PTT, enzymes, direct coombs run from Fri nite to Monday morn!!!! I took sera and plasma home (120mi)-got coag and coombs run at hosp and took rest to reg vet on Sat am.

Posted on Wednesday, Apr 11, 2001 - 1:15 pm:

Just talked to LSU. Tracheal washing done-exam revealed no inflammatory cells. Cultured. Also did a nasopharyngeal culture. Did not change antibiotic-think it's viral. Horse has no fever now and looking good. Continuing to decrease the dex. Repeat ultrasound showed some changes from last one. Will update when I talk to them again.
Thanks again.

Posted on Wednesday, Apr 18, 2001 - 6:56 am:

Possibly viral, and it certainly remains on the list until proven otherwise, but the penicillin remains on it also in my mind. The association with penicillin and hemolysis is well established in both humans and horses.
DrO

Posted on Wednesday, Apr 18, 2001 - 9:07 am:

april 18th???????? Have you traveled to the future Dr0?? Its thursday the 12th!!!!

Posted on Friday, Apr 13, 2001 - 10:15 am:

No but the server had, they were doning some work on it late the night before and someone was apparently pretty tired when they reset the date..but we have returned the universe to its rightful time.
DrO

Posted on Thursday, Apr 12, 2001 - 6:56 pm:

Latest from LSU. Horse spiked 104.5 temp again this am. Within 2 hrs back to normal without treatment.
Prelim culture-no growth. We discussed that tetacycline may inhibit unless lab can inactivate.
WBC rising. I was not given figures. Was told she has never been lymphopenic. Dex to be dc in a couple of days. Considering also stopping tetracycline and drawing blood culture.
Still think it's viral but are not ruling out bacterial infection.
UHHHH-holiday weekend ahead---Labs? The veterinarian in charge is on duty this weekend.

Posted on Friday, Apr 13, 2001 - 10:59 am:

Hello Chris,
Diphasic fever spikes are very characteristic of viral infections but I would also want to know if there had been more hemolysis. I would also be very interested in the horses demeanor and appetite, few lab tests compare with these two indicators as a prognostic indicator.

Chris, fever alone is common and rarely a serious problem. As long as all other clinical signs are OK your horse is going to be fine.
DrO

Posted on Friday, Apr 13, 2001 - 8:09 am:

Thanks Nonie for your concern. As you can imagine we are beside ourselves. Each day hoping for diagnosis, prognosis, etc...
This is a very sweet TWH filly. Going to be a large mare (hopefully)--the vets are so impressed with her gentle nature and willingness to endure the prodding and poking. She's not off food and at this point is looking ok.

Posted on Friday, Apr 13, 2001 - 6:44 am:

Chris, I hope she is doing better. For a minute I thought this was the other Chris Mills' little Shadow and my heart was in my throat. Then I figured, it's a sick little horse anyway. I will keep my fingers crossed for you. Keep us posted on her progress.

Posted on Friday, Apr 13, 2001 - 4:05 pm:

There has been no hemolysis since the initial episode. The dex and tetracycline are being dc today. If she spikes a temp again, a blood culture is going to be drawn. Pneumonia still present, but horse is eating and looking good. Played today when taken out to graze.
Thank you for your continuing interest and help.
Ann

Posted on Monday, Apr 16, 2001 - 7:04 pm:

Went to LSU today---Mariah has not spiked a temp since Thursday. The tetracycline was dc on Friday but the dex not stopped until today. Horse's WBC 18,000, down from 20,000 2 days ago.
Will be doing another tracheal wash in am to check for inflammatory cells and to culture. She will be released on Wednesday if continues to improve. Vet undecided whether to send her home on antibiotic at this time. Are still not clear on diagnosis---drew acute viral titers and culture; are drawing convalescent prior to discharge. Will want her back in a couple of weeks for repeat chest x-ray.
Thank you again for your help.
Ann

Posted on Tuesday, Apr 17, 2001 - 6:44 am:

Great, I think the titers and time have the best chance of sorting this out.
DrO

Posted on Friday, Apr 20, 2001 - 6:25 am:

Just have to add a note. SHE'S HOME! And all excited about it--bucking and jumping on her daily letout. Instructed to take temp 2x/day for week---so far normal.
Hemolysis still mystery----dam had no penicillin while pg or nursing, nor has Mariah. Anyway, no penicillin or gentamycin for her ever.
Will let you know what the viral titers and culture show.

Posted on Friday, Apr 20, 2001 - 6:37 am:

Great news, Chris! Sounds like you dodged the bullet. Hope your little filly has a happy, healthy Spring.

Posted on Friday, Apr 20, 2001 - 9:34 pm:

Thanks Nonie. We are just so happy she's still with us. Was a very sick horse. Now, not too happy about being confined---wants to visit with all her friends. (We have 7.) One other horse (3 yr old) developed snots a week ago---of course we were worried but he's fine now.
Ann & Chris

Posted on Friday, Apr 27, 2001 - 10:04 pm:

Well, problems again. Mariah had a temp of 104 last evening---no snots---respirations 30---no sweating. Appetite ravenous (lol) and demeanor perky.
Took her for bloodwork this am. Chems (including ast which was 600 or so upon release from LSU) normal. Hemoglobin is 7.0 gm/dl. Lowest it DrOpped at LSU was 7; upon release was 9. No blood in urine.
Both LSU and my veterinarian are still looking for answers.
By the way she is stalled in a shaded stall with a fan on her. Temps have been cool here for La.
Has been put on antibiotic plus red cell vitamin complex. Are to take her temp 6x/day and return on Monday to recheck cbc..
Acute viral titers are nonsignificant; viral culture negative. Convalescent titers to be ready next week.

Posted on Saturday, Apr 28, 2001 - 7:01 am:

Additional information---Mariah's fibrinogen was 565 mg/dl yesterday.
Ann

Posted on Saturday, Apr 28, 2001 - 8:47 am:

You say her HB was 7 but more important is what is the hematocrit (or Pack Cell Volume)? It is the ratio of the two that tell us if hemolysis is present. I presume auoimmune hemolytic anemia, and EIA is still on the list considering you are in LA and that it takes a while for the titers to rise? Also has anybody tried to put together the dogs ehrlichia and the symptoms of the horse, since there is an equine form...
DrO

Posted on Saturday, Apr 28, 2001 - 11:42 am:

Thanks again for the response.
As far as the EIA is concerned, LSU vets felt that at the time the sample was drawn there she should have a titer. Additionally, she has not been exposed to outside horses, all ours test negative and all the ones from the breeding farm also tested negative in Feb. We are miles from other horses---at least 5 miles.
LSU never directly addressed the ehrlichia with me except to say checked a blood smear. YD, when my veterinarian was discussing the case with LSU, it appears that ehrlichia titers were done and were negative.
Will let you know what the hct was as soon as can find out. LSU apparently suggested that the change could be due to diff instruments---as a med tech, I'd say that is unlikely unless control measures in veterinary med are not utilized (obviously something I can't question.)
So far, since Thursday night her temp has remained normal---101.3 highest.
Thanks, Ann

Posted on Saturday, Apr 28, 2001 - 12:46 pm:

Dr. O----hgb 7.0gm/dl hct 20.2% on Friday

Posted on Sunday, Apr 29, 2001 - 10:04 am:

Hello CHris,
The EIA titer comment from LSU is interesting, there have been cases where the titer was not evident until after the first febrile episode (Microbiol Immunol 2001;45(1):45-50
Cross reaction of recombinant equine infectious anemia virus antigen to heterologous strains and application for serological survey among horses in the field.
Sentsui H, Inoshima Y, Murakami K, Akashi H, Purevtseren B, Pagmajav O, Sugiura T.) on both the AGID and ELISA tests.

I am assuming that they have not found Heinz Bodies on the RBCs and they are making continuing eforts at locating RBC parasites.
Hmmm...we keep getting thrown back to the Autoimmune Hemolysis (AHA) as the most likely diagnosis, but these are frequently secondary to other diseases. Have they checked Lepto titers or run a Coombs test? Leptospirosis infection has also been associated with hemolysis and occult fevers. Though the series of Coomb's test available for diagnosing autoimmune hemolysis (both intra and extravascular hemolysis) are not considered diagnostic if negative, a positive is highly supportive for AHA. Has anyone palpated the spleen?
DrO

Posted on Sunday, Apr 29, 2001 - 1:19 pm:

Direct coombs performed during hemolytic episode and was negative.
No one has mentioned lepto titers to me. Will ask my veterinarian Monday (she's much more accepting of questions/suggestions than LSU) Know in humans here lepto is not uncommon.
Assume speen was palpated, once again will ask my vet on Monday.
No Heinz bodies on Rbc when at LSU; unfortunately, my vet does not perform a diff or have stain so I can do one. Could probably arrange to have a smear examined if you think needed.
Thanks for the response and lepto suggestion.
Ann
PS We, of course, if the filly is still with us run another Coggins in a month or so if nothing turns up in meantime.

Posted on Monday, Apr 30, 2001 - 3:35 pm:

Good news, the spot where the incision was done to perform the tracheal wash started abcessing yd.
Both my vet and LSU think the 104 fever was from that. HB today 9.7 gm/dl. Hct 26.3%. Hmm, Friday's results must be questionable.
Thanks for all the advice. Hopefully, won't need any more on this horse.
Ann

Posted on Tuesday, May 1, 2001 - 7:08 am:

Good Luck Chris.
DrO

Posted on Sunday, Jun 17, 2001 - 10:21 pm:

Have to tell you the filly is doing great!
On our last visit to LSU, they found the hgb not improved---sugested red cell and recking in one month. If no improvement---bone marrow exam.

Because of human probs at home will probably have to wait a couple of weeks before we take her to have a hgb ckd. However, I will tell you we will not be taking her back to LSU. Not too happy with how this has been handled.
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