Snotty Nose Syndrome in Foals
Dr. Melissa Mazan
Undifferentiated distal respiratory tract infection, or snotty nose syndrome, refers to a mild to moderate bacterial infection of the lower airways. Foals develop snotty nose syndrome between the ages of two and eight months. Many different bacteria can contribute to snotty nose syndrome, rather than a specific pathogen. Nasal discharge
The bacteria that are most commonly involved are all bacteria that are NORMALLY found in the foal's nasopharynx (the passageway leading to the mouth) and larynx (the voice box, which leads to the trachea, or windpipe). The most common bacteria are Streptococcus zooepidemicus, Bordetella bronchiseptica, Klebsiella pneumoniae, and various Staphylococcal species. Over eighty percent of all cases are caused by Streptococcus zooepidemicus.
Although snotty nose syndrome is characterized by bacterial infection, the foal probably gets this infection because of intrinsic changes that are taking place within his or her own body. Ordinarily, the bacteria may make their way down into the trachea, and even into the larger bronchi (breathing tubes), but the body clears the airways and lungs of these bacteria very easily. In the healthy animal, especially the healthy older animal, no infection occurs.
Between the ages of two and eight months, several things are happening. First, the foal receives important antibodies from his dam shortly after birth. This is called passive immunity, and the foal gets it through the first milk, or colostrum. As the name implies, this is a passive situation, and the antibodies that the foal has received this way start to decline at 2 to 4 months. The foal will have started to mount his own active immune system, but the immune system simply isn't up to speed yet.
Secondly, the respiratory system has its own special immune system, called respiratory mucosal immunity. This mucosal immunity helps to repel invaders such as the bacteria that normally inhabit the upper airways. In foals, this mucosal immunity is very poorly developed.
For these reasons, there is a high likelihood that any foal between the ages of 2 and 8 months can develop snotty nose syndrome, simply because of factors intrinsic to the development of the foal.
What to Look For
If you have a large farm, you will notice that the snotty nose syndrome spreads like a very slow wave – and it is most common in the summer. This is not because it is warm, or humid, but because most foals are born in early spring and are the right age for passive immunity to be waning in the summer.
Your veterinarian will start by taking a careful medical history and physical examination, during which he will pay special attention to the respiratory system. The respiratory rate and respiratory effort are usually normal. It is rare for a foal with snotty nose syndrome to have a fever.
Your veterinarian will listen to the lungs and will usually hear a combination of crackles and wheezes over the lung area, but only with some provocation of the foal, e.g. use of the rebreathing bag. This usually consists of a loosely fitting plastic bag that fits over the foals nose. It causes the foal to rebreath their breath, which includes increasing amounts of carbon dioxide. Carbon dioxide stimulates deeper breathing. This not only makes it easier for your veterinarian to hear abnormal noises, but it also may cause your foal to give a very nice cough for your veterinarian to listen to.
Your veterinarian may also percuss the lungs. This refers to the careful technique of thumping on the chest wall while listening to the sounds produced. A normal chest should sound rather like a drum – nice and hollow. A chest that has areas of consolidation sounds muffled. Foals with snotty nose syndrome are not normal, but they seldom have lung consolidation, so chest percussion should be normal. This is in contrast to pneumonia or pleuritis, where abnormal percussion can be heard.
If your veterinarian chooses to do bloodwork, you will often find little to no evidence of infection on the complete blood count (CBC).
Although most cases of snotty nose syndrome can be diagnosed based on history and physical examination findings, your veterinarian may choose to examine your foal using the endoscope. Other possible tests include radiographs and a transtracheal aspirate.
Endoscope. There is usually quite a bit of thick whitish discharge coming up from the airways, and the lower airways are often reddened. Some foals also have an accompanying guttural pouch infection.
Transtracheal aspirate. This will usually reveal lots of bacteria and inflammatory cells.
Chest x-ray. This test may reveal that the lungs appear much whiter than normal, meaning that there is a considerable amount of inflammation in the lung. This is termed a bronchointerstitial pattern.
Because snotty nose syndrome in foals is predominantly caused by streptococcal species, it is reasonable to start with empirical treatment. This essentially means treating based on an educated guess about what the causative agent is. A common treatment regimen is either intramuscular penicillin alone, or penicillin combined with trimethoprim-sulfa. It is important to treat for a minimum of fourteen days; otherwise, relapse is common. Relapses occur in about 20 to 30 percent of foals requiring further use of antibiotics.
Because relapse is so common, it is important to continue checking for any signs of disease for at least two months after the treatment is finished. This means watching vigilantly for any signs of coughing, and having your veterinarian re-check your foal for abnormal lung sounds at least twice during that period.
Make sure that you know how to give the antibiotics that your veterinarian prescribes. Make sure that you give the antibiotics for the appropriate amount of time. Don't stop giving the antibiotic just because your foal isn't coughing any more. Antibiotic treatment tends to get rid of signs long before it actually eliminates the bacteria from the body.
Monitor your foal carefully for any sign of relapse.