Equine Neonatal Septicemia

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Equine Neonatal Septicemia

By: Dr. Mary Rose Paradis

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Section: Diagnosis In-depth

It is not difficult to diagnose the foal that is in septic shock. The challenge comes in diagnosing foals that are only beginning to show subtle signs of depression. Because there are other causes of depression in foals, and septicemia requires special treatments, it is important to distinguish septicemia.

Dr. Anne Korterba, University of Florida, developed a scoring system in the early 1980s. This is a tool that veterinarians use to assess the likelihood of a foal being septic. Information needed for using this scoring tool includes a good perinatal history, physical examination findings and some blood work, which includes a complete blood count, a serum immunoglobulin level and blood glucose. The common results from these tests in septic foals are a low white blood cell count, a low immunoglobulin level (less than 400 mg/dl) and low blood glucose. The foal receives a numeric score for these abnormalities.

Scores that are over 11 are highly suspicious of being septic. This system allows early detection of septicemia before foals develop irreversible problems.

Other diagnostic procedures include:

Chest radiographs. X-rays are important in determining the degree of respiratory compromise. Listening to the lungs with a stethoscope is helpful, but it can be misleading in come cases of pneumonia. If an area of the lung is completely filled with fluid, there will be no abnormal lung sounds heard. Radiographs, however, will show you this area.

Arterial blood gas analysis. It is important to know whether the foal is able to transfer oxygen from the air into its blood. If the blood oxygen is low then the foal probably has pneumonia. If you combine this finding with abnormal chest radiographs, you have a fairly good approximation of the degree of respiratory involvement. It also helps you determine your therapy. A foal with a low oxygen would benefit from oxygen administration.

Joint radiographs. A bone infection may not be evident in the beginning of the disease so it is important to repeat this procedure in 4 to 5 days if the foal does not respond to therapy. If bone infection is evident then the prognosis is worse.

Joint fluid analysis and culture. The fluid analysis of the foal with septic arthritis will have an increase number of white blood cells and increased protein. It will tend to be more watery than normal joint fluid. Cultures of septic joints is not always rewarding. For some reason it is more difficult to grow bacteria from joint fluid. A positive culture is probably obtained about 1/3 of the time.

Blood cultures. Blood cultures do not always show a positive result, especially if the foal has already received antibiotic prior to the culture. The cultures take several days before their results can be reported, so they are not very useful in the beginning of the disease. They are most helpful in cases where the foal does not respond to initial antibiotic therapy. It identifies the causative agent and gives information about which antibiotic should be used.

Once septicemia is suspected, treatment should start immediately. The general treatment of a septic foal is outlined below. Depending on which body system is affected, there is system specific therapy that needs to be started. Care can be quite intensive and may require that the foal be admitted to a hospital that has the ability to monitor the foal 24 hours a day.

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