Streptococcus equi equi: Fact and Fiction: Strangles and Related Diseases
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1 Streptococcus equi equi: Fact and Fiction: Strangles and Related Diseases Peter Heidmann DVM MPH Dipl. American College of Vet. Internal Med. Equine Internal Medicine & Disease Prevention Montana Equine Medical & Surgical Center Logan, MT
2 Streptococcus: The Organism Streptococcus equi var equi (Very similar to Strep equi var zooepidemicus) QuickTime and a decompressor are needed to see this picture. Highly contagious Gram Positive Aerobic Bacteria Spread via nasal + oral secretions Produces widespread purulent lymphadenitis of the head and neck Affects equine only (horses, donkeys, mules, zebra) QuickTime and a decompressor are needed to see this picture. Incubation: 3-21 days Typical Duration of Clinical Signs: 7-14 d It s a SNEAKY bacteria!
3 Typical Presentation Classic Clinical Signs: - Nasal Discharge - Fever (often > 102 F) - Lethargy - Inappetance - Lymphadenopathy - Submandibular - Other Areas Prevention Vaccination, 2 Disinfection Durability in the Environment More Severe Cases: - Eating Difficulties - Breathing Difficulties
4 Typical Presentation: Airway + Guttural Pouch
5 Detection & Diagnosis CBC/Chemistry Non-specific Blood Titers - Measures Immune response from M-protein - Interpretation can be difficult * Recent infections or vaccinations * Immune Mediated Disease * Bastard strangles
6 Detection & Diagnosis - Culture Via sterile sampling Aspiration, Guttural Pouch Lavage - PCR Highly Sensitive Future Applications: May all detection of specific strains
7 Atypical Infection: Guttural Pouch Empyema Guttural Pouch Filled with Pus Disease Strains Innate Immunity Requires Flushing, Antibiotics QuickTime and a decompressor are needed to see this picture. Potential for Chondroid Formation
8 Atypical Infection: Bastard Strangles - Occult Infection - Internal Infection - Thorax - Abdomen - History of Exposure - +/- Previous Clinical Signs - CBC/Chemistry (Bloodwork) - Fluid Sampling - Ultrasound!!! - Chest, Abdomen
9 QuickTime and a decompressor are needed to see this picture. Atypical Infection: Bastard Strangles & Antibiotics Myth: Antibiotics can CAUSE Bastard Strangles Truth: Bastard Strangles develops due to increased bacterial virulence and decreased host immunity There is NO cause-and-effect relationship between antibiotics and atypical infection
10 Complications: Purpura Hemorrhagica Antigen/Antibody Complexes *Immune-Mediated Vasculitis* (Inflammation of vessels) Soft-tissue swelling Kidney Damage Clotting Abnormalities Petechia/Ecchymoses
11 Other Complications: Ulcerative keratitis/panopthalmitis Septic arthritis/tenosynovitis Paravertebral abscesses Laryngeal paralysis Colic Agalactia
12 Rare Complications: Strep Myositis - Bacterial defenses trigger auto-immune response - Strep M-protein mimics Myosin Muscle Fibers - Confused Antibodies attack muscles - Topline (epaxial) muscles most often affected - Increased IgG, Muscle Enzymes
13 Persistent Infection Carriers: Asymptomatic shedders Strep organism can live >90 days in the guttural pouch May result in repeat outbreaks ID - Sterile Guttural Pouch Lavage Culture/PCR Treat - Systemic Antibiotics, Guttural Pouch Lavage Quarantine - Strict Isolation, Dedicated Tools, Clothes Re-test - Repeat GP Lavage
14 Vaccinations: To Treat or not to Treat? Any decision to vaccinate is always a Risk - Benefit Analysis How likely is exposure? How serious is the infection? How effective is the vaccine? How safe is the vaccine? If treatment is necessary, Is it likely to be expensive? Is it successful? Is prevention by other means practical? Less than 50% of U.S. equine veterinarians routinely recommend vaccination against Strep equi Strangles vaccination provides less protection than true infection
15 Vaccinations: To Treat or not to Treat Ft. Dodge s Pinnacle IN Vaccine most widely used Modified Live Strep organism - Intra-Nasal Provides local immunity in nasal passages Variable body-wide immunity Via lymphatic system Relatively High Rate of Side Effects: 1 in 27 have mild side effects: fever, lethargy, enlarged Lymph Nodes 1 in 275 have more severe side effects Boeringer-Engelheim Strepvax II Purified M-protein vaccine 3 shot primary series
16 Prevention: Identify - Disinfect - Isolate STOP all Movement on/off Ranch Quarantine cases/in-contact horses Dirty pastures Rectal Temps Fever before clinical signs Use to further segregate horses Screening recovered horses** Monitor carrier status
17 Premise Disinfection: Durability in the Environment - Use dedicated clothes, tools, wheelbarrows for infected group - Disease best spread by nose-to-nose contact - Secondary spread by fomites - Use footbath or shoe covers DISINFECTION: 1. Pressure Wash - Remove all organic material 2. 10% Bleach Solution on all surfaces 3. Pressure Wash Again 4. Spread limestone on soil of contaminated pens
18 Questions? Peter Heidmann DVM MPH Dipl. American College of Vet. Internal Med. Internal Medicine & Disease Prevention Montana Equine Medical & Surgical Center Logan, MT
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