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Streptococcus myositis – A Strangles vaccine reaction, part 3

June 20, 2007 By 8 Comments

Here we are back at the story of our little horse that was vigorous and strong only 3 weeks ago and now looks like it has lost 300 lbs, has a severe anemia in which the owner has given one blood transfusion, and has a fever that is on again and off again and has spiked now to 109.5! That is not a typo – the horse’s temperature was at 109.5 degrees during the day when the outside temp was near 90. Bathing the horse and putting it under fans and giving some Banamine reduced the fever, but that was very scary!

So what happened next. Well my friend who owns this horse being a small animal veterinarain asked me a simple question, can the horse still have immune mediated anemia and have a negative Coombs test. Well I’ll be – a question I did not know the answer to – LOL. So he asked a clinical pathologist, a doctor who specializes in reading blood results and other laboratory tests. He’s the doctor we get on the phone with when all the blood results look screwy and we have no idea what way the blood is directing us. He is the guy that makes sense of it all. So the answer came as a startling yes. The horse can have immune mediated disease and still have a negative Coombs test. OK well then what now?

The clinical pathologist then asked the most important question of them all, the one that solved this mystery. When was the horse last vaccinated and with what? Did it have a strangles vaccine recently? YES, it did have a strangles vaccine at the same time the Coggins test was pulled. Well looking at the results of the blood tests and the signs and symptoms of your horse, he believes the horse has vaccine induced immune mediated anemia. Otherwise known as Streptococcus myositis caused by a reaction to the Strangles vaccine. It is much more prevalent in Quarter Horses but can happen in any breed. The theory is if the horse already has a high titer to Strangles and the vaccine is given anyway it sends the immune system into overdrive and causes purpura hemorrhagica and results in a immune mediated myositis (muscle inflammation and deterioration).

So that is what I was seeing not a trauma induced bloddy nose but rather purpura hemorrhagica. Also the horse was tying up but the cause was not because of being cast but rather an immune mediated myositis. Here is a picture of what I saw – The picture is from the Merck Veterinary Manual Website -
purpura.jpg
Notice the nose looking like it was hit with something.

The horse seems to be doing better, however, we are not out of the woods quite yet. He still needs some TLC to get better and as I said before the Rapid Response is helping this horse tremendously. I will keep you posted on the events with this horse, but hopefully this story will help you realize as to how important it is to be informed on your decisions to vaccinate with what and when. It may be more important to not vaccinate for certain diseases as is my opinion with strangles. If you are not in a high risk environment (meaning stabled with a bunch of 2 year old show horses that come and go every weekend) then it is more important to pass on this vaccine. Your horse’s life may depend on not being vaccinated!

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Streptococcus myositis – A Strangles vaccine reaction, part 2

June 19, 2007 By Leave a Comment

Heres a continuation of yesterday’s story – A strangles vaccine reaction

So what happened next? The horse spiked a fever, the very next day; oh and not just a little 103, no it went big, spiking to 105-106 degrees! OK so now I am thinking this horse has an infection most likely shipping fever. The immune system is stressed the horse had been trailered several hours, it is in a new place, new bacteria, new viruses that it has never been exposed to, so great after all this horse has been through it now has shipping fever.

Well the Banamine knocked the fever right out and we continued giving the horse iv fluids (a treatment for the tying up); the horse’s temperature was back to normal within a couple of hours. The horse feels better and starts eating. So we put the horse on antibiotics as a preventative, and yes for all my holisic followers we were doing other things such as probiotics, immune support and Rapid Response. In fact the owners and myself feel that the horse benefitted the most from Rapid Response out of anything that we tried (again hindsite is 20/20 and considering the makeup of this product it makes sense that the horse received the best results from using it).

Well after some more bloodwork we noticed that the white blood cells (WBC’s) were still normal and the red blood cells (RBC’s) were getting lower (anemia). So this horse ‘s disease is now an anemia and a fever that comes and goes. We needed more diagnostics, so in going with the possibility of shipping fever we needed radiographs of the chest to determine if we were indeed dealing with a lung infection and possibly abscesses as the fever was coming and going and the WBC’s were remaining at a normal level. So we sent the horse to another friends place that had the facility to take such a radiograph (x-ray), luckily this is a small horse so it is possible to shoot an xray. Well fortunately for the horse, but unfortunately for diagnosis, the chest films were OK. Blood work done by this veterinarian showed that the liver enzymes were elevated. It concerned him more than me. He was thinking liver infection (hepatitis), but I was thinking the horse just tied up a few days ago and has been sick for almost two weeks now, the liver enzymes are going to be elevated. After a couple days of more fluids in our friends facility and a change in antibiotics the horse was brought home, looking no better with not very many answers as to what this horse had, the next step was a liver biopsy to rule out the hepatitis.

Well that is when I put my thinking cap on…so what do we have here…the biggest sign is the anemia all the other things going on with this horse are symptoms, so lets start with the anemia. The differential diagnosis (what disease cause anemia in horses) are stomach ulcers, chronic infection, Equine Infectious Anemia (Coggins test), cancer such as lymphoma, and immune mediated. Stomach ulcers – too quick of an onset for this horse and most of the time the horse does not have a fever, but still possible. Chronic Infection – this horse was extremely healthy and very strong just prior to coming to Illinois and the WBC are normal, which in chronic infection could happen, but not likely. Equine Infectious Anemia (EIA) – Coggins test taken last month was negative but this does not mean that the horse could not have contracted the disease since then, and all the symptoms fit – intermitten fever, anemia, none responsive to antibiotics – Uh-OH could it be my first time ever seeing a postive Coggins test??? Unfortunately we would have to wait 45 days to do another test to see if it was postive or not and this horse may be dead before then. Then again the only edema (swelling) seen was in the head and usually horses with EIA have edema along there belly. So we are not sure but it is fitting the best so far. Cancer (Lymphoma) – no other signs, this horse was extremely healthy two weeks before, and it is only 4 years old, again posible but not likely. So it must be immune mediated – we need to do a Coombs test. If it is postive we have our answer, if not back to the drawing board.

After this discussion I told the owners that I was out of answers you need to consult with an internal medicine specialist at a university. SO they did, they contacted the University of Illinois and talked with one of the internal medicine doctors there, who thought the EIA did fit the entire disease process but so did immune mediated disease, so he suggested continue supportive treatment and do a Coombs test.

Well the Coombs test turned out to be negative! The story continues tomorrow and you will not believe the one simple question that solved this riddle asked by yet another doctor.

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Streptococcus myositis – A Strangles vaccine reaction

June 18, 2007 By 4 Comments

I have been saying for years that the majority of horses do not need a Strangles booster. In fact, I have been telling people that many times the reactions are just as bad as the disease itself. Well I have seen my first case of vaccine induced Streptococcus myositis. I wish I could tell you that I diagnosed it; however it was not a simple cut and dry case.

My client just purchased this horse about one month ago in Tennessee. A strong healthy horse when he bought it, he trailered it home after spending a week with it on trail. Within the first week the horses head swelled just primarily around the nose. Since I am friends with this individual he called me up wanting my opinion (he knows I no longer do traditional medicine but he values my opinion). My initial thought was trauma, but over the phone I could not rule out an allergic reaction. When I examined the horse I was positive it was trauma (WRONG, but hindsite is 20/20 – LOL), the horse had bleeding from the nostrils more on the right side than the left and swelling almost exclusively to the nose area and more to the right. It looked like the horse had smacked its nose against something. Also the right hind hock was swollen almost looking like a capped hock. So my thought was that the horse was cast and struggled to get up hitting its hock and nose. The horse would be fine.

A few days later I receive a call from my friend saying the horse is colicking! OK so we went through the treatment for colic. BTW my friend is a small animal veterinarian so he does most of the treatments himself with a little guidance. He was walking the horse, but as I told him walking has been proven not to do much of anything except for tiring a horse that is trying to recover. If your horse while colicking lies quietly there is no need to walk him, you may reduce the chances of recovery by causing exhaustion. Vets now use walking to give the owners something to do while we are on our way ;) Now of course if your horse is thrashing on the ground it is important to get the horse up and moving to prevent head and body trauma, but otherwise just leave the horse lie quietly rousing him every 20 or 30 minutes to check gut sounds, gum color and heart rate.

Back to our horse… a couple hours later a call comes to me stating that the horse is urinating blood – hematuria! WHOA – if you did not listen to me about not walking the horse you better listen now – STOP walking the horse. Your horse is tying up and it is uncomfortable thus looking like a colic! My friend drew some blood and sure enough the horse is tying up otherwise known as Azoturia. OK so I thought this confirms my diagnosis of being cast, but one thing sticks out like a sore thumb why did the horse tie up days afterward and not the next day. It kind of didn’t make sense. The blood work also showed a slight anemia – where is that coming from?

Well what happened next threw another monkey wrench into the whole works, but you’ll have to wait until tomorrow for the rest of the story.

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