Making a Case: UC Davis Vet School Helps a Foal with Botulism
The second differential diagnosis would be acute non-septic trauma, which can also increase neutrophil counts, although not usually to the degree seen in this foal Question 2. A polyarthritis is more likely due to hematogenous spread, whereas monoarthritis usually indicates a localized problem, such as trauma or direct extension.
The most common clinical signs associated with a septic joint in foals and horses are acute moderate to severe non-weight bearing lameness, joint swelling and pain 2, 3. In foals with septic arthritis, the tarsal joint is the most commonly affected site, with the hip joint being a rare site of infection 2,4. In this foal, the suspected route of infection of the hip joint was the recent trauma Question 2.
These changes were evident in the foal of this report. One retrospective study evaluated the sensitivity and specificity of high fibrinogen concentrations as an indicator of physeal or epiphyseal osteomyelitis in foals with septic arthritis 5. The anemia in the foal of this report was attributed to inflammatory disease because there was evidence of systemic inflammation high SAA, fibrinogen and peripheral neutrophil count.
The microcytosis was an age-expected finding normal for young foals due to a physiologic iron deficiency.
The decrease in joint viscosity is believed to be due to bacterial production of hyaluronidase, which degrades hyaluronic acid 6. Neutrophils may or may not be degenerate and are typically non-degenerate in adult horses and degenerate in foals as they were in this case , for unknown reasons.
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In one retrospective study, foals with degenerate neutrophils in the joint fluid were more likely to not survive 2. On cytologic examination, it is common to not be able to find a pathogen, particularly in adult horses, therefore, the absence of a pathogen or degenerate neutrophils on cytologic examination does not rule out an infection.
Bacteria may or may not be cultured from fluids with septic arthritis, but this should always be performed in suspected cases Question 3. In this case, bacteria were identified in the fluid by cytologic examination and were cultured from the joint fluid of the foal.
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Synovial glucose concentrations are not frequently measured but results can be informative. A difference in the synovial to blood glucose concentration of 1. As such, important information aiding in the diagnosis and monitoring of inflammatory conditions can be obtained by further characterizing the globulin fraction by electrophoresis ELP of serum proteins SPE. While only a few electrophoretic patterns are pathognomic for a specific disease, useful information of a more general nature often can be found.
The globulin value on the chemistry panel is not measured, but is calculated by the equation:. The principal behind this method of quantification is the fact that all serum proteins, except albumin, are considered to be globulins.
The certainty of the globulin concentration is limited by the accuracy of calculated total protein and albumin concentrations. To circumvent this issue globulins can also be measured quantitively and qualitatively with electrophoresis. Radial immunodiffusion is used for accurate quantification of immunoglobulins and has also replaced immunoelectophoresis for determining the immunoglobulin comprising a monoclonal gammopathy.
The conversion equation is shown below:.
New Born Foals
Increases in total globulins can result from increases in any or all of the fractions as determined by electrophoresis. Decreases in alpha and beta globulins are not significant. Decreased gamma globulins are seen when there is a deficiency of immunoglobulins dependent on class of immunoglobulin involved and severity of the decrease.