Pleuropneumonia in Horses Presentation and Diagnosis

pneumonia

infection of lower resp tract

bronchopneumonia

bronchi and parenchima infection

pleuropneumonia

pneumonia into pleural space

stages of pleuropneumonia

exudative

fibrinopurulent

organization

exudative stage of pleuropneumonia

sterile transudate increased in pleural space

fibrinopurulent stage of pleuropneumonia

-bacterial invasion and fibrin deposition

organisation stage of pleuropneumonia

fibroblasts grow into exudate (pleural peel)

risk factorsfor pneumonia

-after viral infections

-strenuous exercise

-transportation and elevation of head

-GA

-overcrowding and inclement weather

-dysphagia (aspiration)

risk factors for pleuropneumonia

-long distance transport

-elevated head for prolonged time→ decreces mucocilliary ckearance of normal resp secretions

risk factor for aspiration pneumonia

-dysphagia (pharyngeal and postpharyngeal)

-oesophageal obstruction

-GA

-cleft palate

bacterial causes of pneumonia (aetiology)

-Streptococcus equi subsp zooepidemicus

-staph aureus and s.pneumoniae

-actinbacillus

-e.colli, pasteurellam, enterobacter, klebsiella, b.bronchiseptica

-bacteroides fragilis

-fusobacterium and peptostrep anaerobius

actinobacillus spp

gram negative nonenteric

clinical signs of pneumonia

-tachycardia/tachypnoea

-resp distress

-fever

-anorexia, depression

-and/or nasal discharge

-exercise intolerance

-auscultation shows crackles and dull area → rebreathing bag

clinical signs of pleuropneumonia

-pain intercostal spaces

-reluctance to walk, colic

-grunting during resp

-abduction of elbow

-ventral oedema (cehst)

-other clin signs of pneumonia

adventitious lung sounds in penumonia

-crackles and wheezes

-dull areas

-radiation of cardiac sounds

Dull area follows flat line

Pleural rubs

lung sounds of pleuropneumonia

-dull areas follow flat line (line along lung)

-pleural rub

diagnostic approach for pneumonia

-suspicion based on PE and rebreathing bag

-haem and biochem

-endoscopy

-TTW and BAL

-thoracic US

-radiography

-thoracocentesis

-thoracoscopy

clin path of pneumonia

cbc

• neutrophilic leukocytosis

• leukopenia

• anaemia (chronic cases)

increased fibrinogen and SAA

decreased iron

TTW

-culture and sensitivity (aerobic and anaerobic)

-cytology of both lungs

-obtain even if pleural fluid available

what to remember if doing TTW

stop antibiotics 48 hours before

Anaerobic culture media (do not refrigerate!)

endoscopy

• identify mucus→ bact pneumonia, asthma, others

• identify affected site/ bronchi

• abscesses

US show

-b lines (top images)

comet tails

consolidated lung with no air (middle images)

pleural fluid and fibrin (bottom 4 images)

on periphery of lung

will us always show pathology

if pathology further inside→ may not reach

radiography show

-alveolar pattern

-fluid lines

-multi nodular bronchoalveolar pattern

-abscesses

what should we do first if wanting to radiograph a horse with pleuropneumonia

remove fluid from thorax first to visualise structures better