Sepsis in Foals - Management and Nutrition - MSD Veterinary Manual (2023)

Sepsis is a clinical syndrome defined by the development of a systemic inflammatory response syndrome (SIRS) in response to proven or suspected infection. The condition implies an extensive, whole body insult after invasion of bacteria into tissue or a body fluid or cavity. The presence of viable bacteria in the bloodstream is termed bacteremia. Sepsis and SIRS are two of the most common problems of equine neonates, while bacterial infection accounts for nearly one-third of all foal mortality.

Gram-negative bacteria, particularly Enterobacteriaceae with a predominance of Escherichia coli, remain the most common isolates (60%–70%) from neonatal foals with sepsis. However, the prevalence of gram-positive bacteria has increased throughout time, and blood cultures remain important in diagnosis and treatment. Common gram-negative pathogens include E coli, Klebsiella spp, Enterobacter spp, Actinobacillus spp, Salmonella spp, and Pseudomonas spp. Approximately 25%–40% of infections also involve gram-positive bacteria, with Streptococcus spp being the predominant isolate. Anaerobic pathogens, especially Clostridium spp, are reported in

All sepsis syndromes (eg, sepsis, severe sepsis, septic shock, multiple organ dysfunction) have a common pathogenesis that also includes endotoxemia related to gram-negative infections. Endotoxins stimulate macrophages to release an array of cytokines (eg, IL-6, IL-1, TNF-α) and activate pro-inflammatory enzymes (eg, phospholipase A2). Together, these factors lead to signs of inflammation (fever, vasodilation, myocardial depression), impaired microcirculation, capillary leak, and intravascular coagulation. Sepsis initially triggers a procoagulant state, which may lead to disseminated intravascular coagulation and secondary consumptive coagulopathy. A variety of other pathogen-derived molecules can set off similar host responses. Thus, toxic shock syndromes resulting from streptococcal or Staphylococcus aureus infection are hyperinflammatory septic syndromes that closely resemble diseases characterized by endotoxemia.

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A variety of immunologic and management factors predispose foals to sepsis. Although foals can respond immunologically in utero to bacterial or viral infections, their ability to do so is less than that of adults. Deficits in the physiologic response to infectious agents in neonates relate to reduced chemotaxis and killing capacity of neonatal neutrophils, the presence of antigenically naive T cells, and a decreased concentration and impaired function of monocytes. However, the major risk factor for sepsis in foals is failure to receive an adequate quality or quantity of colostral antibodies. If colostrum intake is insufficient and IgG levels remain low, the foal is not only deprived of specific antibody protection, but neutrophil function is also seriously impaired. Other factors that influence disease incidence include unsanitary environmental conditions, low gestational age of the foal (prematurity or immaturity), poor health and condition of the dam, difficulty of parturition, and the presence of new pathogens in the environment against which the mare has no antibodies.

The clinical presentation of sepsis depends on the duration of illness, the integrity of the host immune system, the affected body systems, and the severity and route of infection. Frequently affected organ systems include the umbilical remnants, and CNS, respiratory, cardiovascular, musculoskeletal, renal, ophthalmic, hepatobiliary, and GI organs. In the early stages of sepsis, clinical signs are often vague and nonspecific, with affected neonates merely displaying some degree of depression and lethargy. Owners report that foals appear to lie down more than usual. The mare’s udder is often distended with milk, indicating that the foal is not nursing at a normal frequency.

Clinical signs can progress to a complete loss of suckle reflex, hyperemic mucous membranes with a rapid capillary refill time due to peripheral vasodilation, tachycardia, and potentially early petechiae related to capillary leak. In the advanced stage of illness, when the infection overwhelms the host’s immune system and compensatory responses, septic shock ensues. Affected foals are severely depressed, recumbent, and hypovolemic, which manifests as cold extremities, thready pulse, and poor capillary refill time. Foals may be hyper- or hypothermic, tachycardic, or bradycardic. In the face of sepsis, bacteria spread hematogenously to various organs, manifesting as respiratory distress, pneumonia, diarrhea, uveitis, meningitis, osteomyelitis, or septic arthritis. Dysfunction of two or more organs is termed multiple organ dysfunction syndrome.

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Hypoglycemia commonly accompanies systemic infection and is associated with bacterial consumption and reduced glycogen reserves. Severely hypoglycemic foals may be unable to rise and show depression, convulsions, and eventually death. Furthermore, clinical signs suggestive of relative adrenal insufficiency have been identified in animals with prolonged sepsis. Primary relative adrenal insufficiency can occur after a direct insult to the adrenal glands (hemorrhage or adrenal ischemia), whereas chronic, illness-induced stress may exhaust the adrenal reserve and deplete the production of cortisol. Septic neonatal foals are often neutropenic with a high ratio of band (immature) to segmented neutrophils. The neutrophils may exhibit toxic changes, which are highly suggestive of sepsis. Fibrinogen levels >600 mg/dL in a foal 20 mEq/L), hyperlactatemia, hypoxemia, hypercapnia, and a mixed respiratory and metabolic acidosis may be present with arterial blood gas analysis.

Currently, there is no ideal diagnostic tool to detect early sepsis. However, a scoring system has been developed for neonatal foals to establish the likelihood of neonatal infection and aid the identification of sepsis at a treatable stage. This “sepsis score” incorporates a combination of historical, clinical, and laboratory variables and may also serve as an indicator of whole body insult, SIRS, or multiple organ dysfunction. However, the specific definition criteria for both SIRS and sepsis are most rigorously validated in people and have been conceptually applied to equine neonates only recently. Based on pediatric human and general veterinary guidelines, SIRS may be clinically defined by the presence of at least two of the following five clinical criteria, one of which must be abnormal temperature or leukocyte count: 1) core temperature below or above the normal range for the animal’s age; 2) tachycardia, defined as a mean heart rate >2 standard deviations (SD) above normal for the animal's age in the absence of external stimulus, chronic drugs, or painful stimuli; 3) bradycardia, defined as a mean heart rate below the normal range for the animal's age, in the absence of external vagal stimulus, β-blocker drugs, or congenital heart disease; 4) mean respiratory rate >2 SD above normal for age, or animals undergoing mechanical ventilation for an acute process not related to general anesthesia or underlying neuromuscular disease; 5) leukocyte count increased or depressed for age (not secondary to chemotherapy-induced leukopenia) or >10% immature neutrophils. Infection itself may be suspected or proven (by positive culture, tissue stain, or PCR) and caused by any pathogen, or refer to a clinical syndrome associated with a high probability of infection. Evidence of infection includes positive findings from clinical examination, imaging, or laboratory tests (eg, WBCs in a normally sterile body fluid, perforated viscus, chest radiograph consistent with pneumonia). Ultimately, sepsis refers to the presence of SIRS with suspected or proven infection.

Depending on the specific organ systems involved, an umbilical, abdominal, and synovial ultrasound examination; arterial blood gas analysis; arthrocentesis; cerebrospinal centesis; and chest, abdominal, and distal limb radiographs are indicated. Advanced diagnostic imaging techniques (eg, CT of the distal limbs in foals with septic arthritis) may also help with prognosis.

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Serum IgG levels should be measured in any questionably sick neonate to eliminate inadequate transfer of passive immunity as a risk factor for sepsis. IgG levels 800 mg/dL are considered normal.

A positive blood culture confirms the presence of bacteremia in septic foals, but a negative culture does not exclude the possibility of infection. Differential diagnoses include neonatal encephalopathy ( see Neonatal Encephalopathy Neonatal Encephalopathy Neonatal encephalopathy (NE) is a common, noninfectious CNS disorder of neonatal foals, resulting in clinical signs such as lethargy, inappropriate behavior, seizures, and other neurologic deficits... read more ), hypoglycemia, hypothermia, neonatal isoerythrolysis ( see Alloimmune Hemolysis Alloimmune Hemolysis Hemolytic anemia results from loss of RBCs. Immune-mediated destruction is the most common cause in dogs, although infections, tumors, and other causes also occur. Immune-mediated hemolytic... read more ), white muscle disease ( see Nutritional Myopathies in Ruminants and Pigs Nutritional Myopathies in Ruminants and Pigs Young Boer goat kid with white muscle disease. The patient can move its legs normally but is too weak to stand. CK and AST concentrations were elevated on serum biochemical evaluation. The goat... read more ), prematurity or immaturity, neonatal pneumonia, and uroperitoneum ( see Uroperitoneum in Foals Uroperitoneum in Foals Uroperitoneum is leakage of urine into the peritoneal space and is caused most often by rupture of the urinary bladder or urachus. Signs, including lethargy, tachycardia, frequent attempts to... read more ).

Foals suspected of being septic should be placed on broad-spectrum antibiotics active against both gram-positive and gram-negative organisms. Penicillin (22,000 IU/kg, IV, qid) in combination with amikacin sulfate (20–25 mg/kg/day, IV) provides good initial coverage until culture results are available. Metronidazole (10–15 mg/kg, PO or IV, tid) may be necessary if an anaerobic infection (eg, Clostridium) is suspected. A third-generation cephalosporin (eg, ceftiofur, 4.4–6 mg/kg, IV, bid-qid) may also be used as a broad-spectrum agent in foals with renal compromise. Cefpodoxime proxetil (10 mg/kg, bid-qid) has been recommended for treatment of bacterial infections in equine neonates. Cefepime (11 mg/kg, IV, tid) is a fourth-generation cephalosporin with enhanced antibacterial activity.

Early goal-directed IV fluid therapy is needed to restore tissue perfusion, attenuate the cytokine response, and reverse cellular injury. Volume expansion should be achieved using a balanced electrolyte solution (crystalloid) or plasma (colloid). Immunologic support in the form of IV plasma transfusion (1–2 L) is also indicated to raise the IgG level to >800 mg/dL. Fluid resuscitation is aimed at normalizing specific cardiovascular variables (central venous pressure, mean arterial pressure, urine output, and central venous oxygen saturation), while improving clinical parameters. Severe septic shock may require initial fluid rates of 40–80 mL/kg/hr. Because many foals are hypoglycemic, slower continuous infusions of 2.5%–5% dextrose-containing solution should be administered simultaneously with rehydration fluids.

Treatment with hyperimmune antiendotoxin serum may be considered in foals with endotoxemia. Antiprostaglandin drugs have been found to counteract several of the clinical and hemodynamic changes associated with endotoxemia and septic shock. Low doses of flunixin meglumine (0.25 mg/kg, IV, tid-qid) may help reduce signs of endotoxemia. Additionally, administration of low doses of polymyxin B (6,000 IU/kg, diluted in 300–500 mL of saline, slowly IV) is an investigational treatment used to neutralize systemic endotoxin.

Nutritional support is important, because sepsis creates a catabolic state in foals. If the foal is not nursing adequately, it should be fed mare’s milk or a mare milk substitute at 15%–25% of its body weight throughout each 24-hr period. An indwelling nasogastric tube should be placed in foals with a decreased suckle reflex. Parenteral nutrition may also be helpful to provide adequate nutrients in the face of GI dysfunction. Administration of gastric protectants (eg, ranitidine, cimetidine, omeprazole) has been proposed as an adjunct therapy in sick neonates.

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System-specific therapy includes lavage of septic joints with sterile fluids, regional limb perfusion, and nasal oxygen support (2–10 L/min) or ventilation for foals with respiratory failure or central hypoventilation. Corneal ulceration may be treated with low doses of topical atropine (although it may cause ileus), NSAIDs, and broad-spectrum topical antimicrobials. Entropion generally requires mattress sutures of the lower eyelid. Surgical removal of infected umbilical remnants may be indicated.

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Recovery from neonatal sepsis depends on the severity and manifestation of the infection. Currently reported survival rates are 50%–81% in referral centers, depending on the underlying disease. Severe neonatal pulmonary disease has been associated with a higher mortality (35%–50%). Early recognition and intensive treatment of neonatal sepsis improves the outcome, although an average of 1–4 wk of intensive care should be expected. If the foal survives the initial problems, it has the potential of becoming a healthy and useful adult. One report documented that surviving bacteremic Thoroughbred foals were as likely to start races as their siblings, although their earnings were lower. The latter retrospective case series (n=423) further identified that odds of survival were negatively associated with age at admission, band neutrophil count, and serum creatinine concentration, and positively associated with rectal temperature, neutrophil count, and arterial blood pH. Additionally, in a recent prospective multicenter study, septic foals had increased odds of nonsurvival for each 1 mmol/L increase in L-lactate concentration at admission.

FAQs

What causes a foal to be septic? ›

However, the major risk factor for sepsis in foals is failure to receive an adequate quality or quantity of colostral antibodies. If colostrum intake is insufficient and IgG levels remain low, the foal is not only deprived of specific antibody protection, but neutrophil function is also seriously impaired.

What is septicemia foal? ›

Septicemia is defined as the presence of bacteria or bacterial toxins in the bloodstream, and it is the most common cause of death in newborn foals. Septicemia can manifest as pneumonia, diarrhea, meningitis (inflammation of the membranes of the brain and spinal cord), and joint and/or umbilical infections in the foal.

Can a horse survive sepsis? ›

Although prognosis for septic mature horses depends highly on the primary disease process, the overall survival rate in septic neonatal foals ranges from 26 to 86%, with most studies indicating a survival rate of 45–60%.

Where do systemic infections like to go in the foal? ›

The bacteria can enter the foal's body through the placenta, at the umbilicus, or through the nose or mouth. The foals at greatest risk are those which don't receive the antibody-rich first milk (colostrum) from their dams.

How is sepsis diagnosed in foals? ›

Clinical Signs

It is measured by applying pressure with your finger on the gingival mucosa and calculate the time required for the mucosa to return to the original pink colour (normal <2 secs). Injected mucous membranes (generally sclerae) occur where blood vessels are clearly visible.

How much penicillin do you give a foal? ›

Penicillin G is the most common penicillin used in equine medicine. Sodium or potassium penicillin G can be administered either IV or IM every 6 hours. Procaine penicillin G can be administered IM every 12 hours. Recommended dose rates for penicillin G are 20,000 to 50,000 IU/kg.

What do you give a foal with a fever? ›

Nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed when fever is present. Treatment with oxygen is necessary in foals with severe respiratory difficulty. Prompt veterinary attention and appropriate treatment is critical.

Can you give penicillin to foals? ›

Penicillin & gentamicin is most appropriate but care should be taken in foals with impaired renal function. Trimethoprim / sulphonamide IV is an alternative.

How do you treat shock in horses? ›

Treatment: immediate fluid expansion either with crystalloid, colloid, or whole blood depending on the underlying cause for fluid loss. If hemorrhagic shock, cessation of blood loss is a critical step in treatment and management.

What causes systemic shock in horses? ›

Shock is usually a consequence of other systemic responses such as sepsis, endotoxaemia and/or Systemic Inflammatory Response Syndrome (SIRS). Sepsis is one of the most common causes of shock in the horse, leading to a high morbidity and mortality rate in critically ill patients.

What causes toxic shock in horses? ›

The presence of endotoxins in the blood is referred to as endotoxemia. These toxins are generally due to the presence of certain types of bacteria in the horse's gut that have breached the gut wall and entered the blood stream. If not treated promptly, endotoxemia can lead to shock, laminitis, and death.

Is infection in the blood sepsis? ›

Septicemia is an infection that occurs when bacteria enter the bloodstream and spread. It can lead to sepsis, the body's reaction to the infection, which can cause organ damage and even death. Septicemia is more common in people who are hospitalized or have other medical conditions.

How is sepsis treated in horses? ›

Treatment of sepsis requires an intensive care approach that includes antimicrobial drug administration, fluid resuscitation and pressure support, and treatment for inflammation, endotoxaemia and coagulopathy. Early recognition of sepsis and prompt antimicrobial drug treatment are critical for a successful outcome.

Can foals have antibiotics? ›

In foals with normal hydration status, penicillin in combination with gentamicin, or trimethoprim / sulphonamide is recommended.

How many days can you give a horse penicillin? ›

DOSAGE: The dosage for cattle, sheep, swine, and horses is 3000 units per pound of body weight, or 1.0 mL for each 100 pounds of bodyweight, once daily. Treatment should not exceed 7 days in non-lactating dairy and beef cattle, sheep, and swine, or 5 days in lactating dairy cattle.

What is a normal temperature for a foal? ›

Normal temperature in a newborn foal is 99.5-102, higher than an adult horse.

What is normal temperature for horse foal? ›

An adult horse at rest should have a body temperature of 99 - 101.5 degrees Fahrenheit. Anything above that level can indicate an active infection. The normal temperature range for a foal is 99.5 - 102.1 degrees Fahrenheit.

How do you cool down a foal? ›

You can add ice to the water to speed-up cooling for very hot horses (rectal temperatures above 105 F). Research shows using ice to cool a hot horse is safe. Ice baths reduce core body temperature and lower heart rates after hard exercise.

What is a natural antibiotic for horses? ›

In horses, garlic is most often used in products formulated to repel pests, such as flies, midges, mosquitoes and ticks. Because it is thought to be a natural antibiotic, garlic is sometimes given to horses with chronic respiratory conditions.

What is best antibiotic for horses? ›

Some of the more common oral antibiotics in horses include trimethoprim sulfa, metronidazole, enrofloxacin, and chloramphenicol. Trimethoprim sulfa (SMZ, TMS, sulfa tabs) is an antibiotic which has a broad spectrum of activity against a variety of bacteria.

What does doxycycline treat in horses? ›

Doxycycline is used in horses to treat susceptible bacterial-infections and tick-borne diseases such as Ehrlichia, Anaplasma, and Borrelia burgdorferi (Lyme disease).

What does it mean when a horse gums are white? ›

White or very pale gums can indicate shock or anemia. Dark or purple gums may indicate severe shock or toxemia (the heart isn't pumping effectively, and blood is pooling in these distant vessels in the gums).

Can a horse go into shock from cold water? ›

Giving a hot, sweaty, or overheated horse very cold water can shock their system and make them very ill, contributing to a potential colic episode (one of the leading causes of death for horses).

What does it mean when a horse is septic? ›

The mare's udder is often distended with milk, indicating that the foal is not nursing with normal frequency. In the advanced stage of illness (septic shock), the body becomes overwhelmed. Such foals are often severely depressed and dehydrated, can only rise with assistance, and have a rapid heart rate.

How do you tell if a horse has an infection? ›

Is your horse's wound infected?
  1. Swelling: After an injury, damaged capillaries leak fluids into the surrounding soft tissues, while infection-fighting cells rush to the site. ...
  2. Odor: Any “off” or pungent odor coming from a wound, especially the oddly sweet smell of dead tissue, can be a sign of infection.

What are the first signs of colic in a horse? ›

Signs of colic in your horse
  • Frequently looking at their side.
  • Biting or kicking their flank or belly.
  • Lying down and/or rolling.
  • Little or no passing of manure.
  • Fecal balls smaller than usual.
  • Passing dry or mucus (slime)-covered manure.
  • Poor eating behavior, may not eat all their grain or hay.

Where is Potomac horse fever found? ›

PHF has been reported from most states in the United States, five provinces in Canada, South America (Brazil, Uruguay), Europe (France, The Netherlands), and India. Horses of all breeds and ages may be affected, but PHF is not common in younger horses (<1 year).

What are the 5 signs of sepsis? ›

Symptoms of severe sepsis or septic shock
  • feeling dizzy or faint.
  • a change in mental state – like confusion or disorientation.
  • diarrhoea.
  • nausea and vomiting.
  • slurred speech.
  • severe muscle pain.
  • severe breathlessness.
  • less urine production than normal – for example, not urinating for a day.
14 Jul 2022

What antibiotics treat sepsis? ›

The majority of broad-spectrum agents administered for sepsis have activity against Gram-positive organisms such as methicillin-susceptible Staphylococcus aureus, or MSSA, and Streptococcal species. This includes the antibiotics piperacillin/tazobactam, ceftriaxone, cefepime, meropenem, and imipenem/cilastatin.

What is another name for sepsis? ›

Sepsis, formerly known as septicemia (septicaemia in British English) or blood poisoning, is a life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. This initial stage is followed by suppression of the immune system.

Can you give penicillin to foals? ›

Penicillin & gentamicin is most appropriate but care should be taken in foals with impaired renal function. Trimethoprim / sulphonamide IV is an alternative.

What is equine peritonitis? ›

Peritonitis is a well described illness in horses, often occurring as a secondary complication to traumatic injuries involving the abdominal cavity, rupture of bowel or abdominal surgery. Key clinical signs include colic, pyrexia and, in more chronic cases, weight loss [1, 2].

What do you give a foal with a fever? ›

Nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed when fever is present. Treatment with oxygen is necessary in foals with severe respiratory difficulty. Prompt veterinary attention and appropriate treatment is critical.

Can foals have antibiotics? ›

In foals with normal hydration status, penicillin in combination with gentamicin, or trimethoprim / sulphonamide is recommended.

What is a natural antibiotic for horses? ›

In horses, garlic is most often used in products formulated to repel pests, such as flies, midges, mosquitoes and ticks. Because it is thought to be a natural antibiotic, garlic is sometimes given to horses with chronic respiratory conditions.

What is best antibiotic for horses? ›

Some of the more common oral antibiotics in horses include trimethoprim sulfa, metronidazole, enrofloxacin, and chloramphenicol. Trimethoprim sulfa (SMZ, TMS, sulfa tabs) is an antibiotic which has a broad spectrum of activity against a variety of bacteria.

What is an SAA test for horses? ›

Serum amyloid A (SAA) is a marker of inflammation and infection in the horse that can be assessed in the field, with rapid and marked changes seen following initiation of an inflammatory stimulus.

What causes peritonitis horses? ›

Most commonly, the cause is an area of diseased gut, which becomes leaky (often due to colic) when natural defences are impaired and allows bacteria to seep out. Peritonitis can also develop as a result of a tumour, or an internal abscess following a severe bout of strangles – so-called bastard strangles.

How long does it take to recover from peritonitis? ›

If you're diagnosed with peritonitis, you'll need treatment in hospital to get rid of the infection. This might take 10 to 14 days.

What is a normal temperature for a foal? ›

Normal temperature in a newborn foal is 99.5-102, higher than an adult horse.

What is normal temperature for horse foal? ›

An adult horse at rest should have a body temperature of 99 - 101.5 degrees Fahrenheit. Anything above that level can indicate an active infection. The normal temperature range for a foal is 99.5 - 102.1 degrees Fahrenheit.

How do you cool down a foal? ›

You can add ice to the water to speed-up cooling for very hot horses (rectal temperatures above 105 F). Research shows using ice to cool a hot horse is safe. Ice baths reduce core body temperature and lower heart rates after hard exercise.

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