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strep equi - How best to get the 'all clear'

2K views 27 replies 4 participants last post by  Folly 
#1 ·
Well, unfortunately strep equi (strangles - yikes - hate that name) is making its way around our boarding barn. My mare got a mild case - finished 10 days of antibiotics yesterday. She was the 3rd to show mild symptoms (some mucous... but no cough, swollen lymph nodes, no loss of appetite) - the BO decided to have a culture run since this was the third occurrence. and it was positive. Several more horses have come down with it, but so far no serious effects.

Anyway, timing is unfortunate - I was just getting ready to move her to my friend's place for the summer so we can ride together. The vet advises no horses leave or come to the property for another month. I'm taking it seriously and am going to wait to move her (not worth risking her horses, especially the young and old girls).

So, the vet has advised that starting in about 2 weeks we can get 3 cultures done 3 days apart and send for a DNA test - and this should give her the all clear (at least we could be reasonably sure).

I trust the BO (they are being proactive and up front about this), and the vet. I would like your opinions though - is this the best protocol? should I wait longer before getting the next set of swabs or is 2 weeks after completion of antibiotics good? Does it matter that other horses are still coming down with it (one yesterday)?

I think my mare is perfectly fine - I'm just in a quandary about how not to spread it, but still get on with life.
 
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#2 ·
The way we always did it in the show barns was, nothing on and nothing off until the last horse to come down with it was clear for a month. Doing 3 cultures is good, if she had any abscesses near her gutteral pouches you may want to scope her too, to see if there's anything hiding in there. If there is, they'll need to lavage those pouches until they also culture clear. STRANGLES SUCKS! But good for your BO & Vet for slapping a quarantine on the place, too many try to hide it.
 
#3 ·
The way we always did it in the show barns was, nothing on and nothing off until the last horse to come down with it was clear for a month. Doing 3 cultures is good, if she had any abscesses near her gutteral pouches you may want to scope her too, to see if there's anything hiding in there. If there is, they'll need to lavage those pouches until they also culture clear. STRANGLES SUCKS! But good for your BO & Vet for slapping a quarantine on the place, too many try to hide it.
Those terrible looking exterior oozing wounds I'm finding on the internet?? No, nothing of the sort. Honestly, I commend the BO for even culturing, because the symptoms were so mild. She just got concerned when it became obvious something was going around. None of the horses have shown any bad symptoms. I have to think most people might not even have checked.

... Or are the abscesses internal? My mare hasn't lost her voracious appetite for a moment btw. She likes her kibbles....
 
#4 ·
How long has the strangles been going around? It can take a WHILE to work its way through the barn.

I bought a mare on 3/19, brought her home in my trailer and we got home very late. I had to have 3 mares at the vet at 9 am the next day and because we got home so late I never even thought about decontaminating my trailer. Mare looked and acted fine. I did put her in QT though and within 10 days, she had abscesses and was dripping 'stuff' every where. The 3 mares I took to the vet in the trailer were next. They were all down by 4/10-4/11. Gelding and stallion who have also been kept separate from every body are sick now. The original mare goes back to OSU for rescope & culture on May 8. Others varied in how bad they got it. 3 mares all seemed to just get the runny noses, never off feed, 1 coughed. It's going to be a WHILE before anyone leaves this property and obviously, no new horses coming in. Pretty well screwed my breeding season.

The 2 mares who were in foal were already in the foaling barn and foaling pasture when I got the new mare and they haven't been near any of the others, THANK GOD!
 
#5 ·
I have always been taught that you don't use antibiotics in an outbreak of strangles, unless symptoms are severe , and, if you do use antibiotics for strangles, you have to give them for an extended period, or you risk ******* strangles.
Many horses that just get mild symptoms, often already have natural acquired immunity, from previous exposure.
I only gave antibiotics for strangles once, when a horse had difficulty breathing. Have not had a case in more that 20 years.

Below is some info, and why it is not really good practice to give antibiotics if the horse has no serious complications


'Treatment and Control
Although strangles is a bacterial infection, there are pros and cons to using antibiotics to treat it. Most researchers agree that antibiotic therapy will provide temporary improvement in fever and depression; however, it may also prolong the course of the disease by delaying maturation and drainage of the abscesses. Antibiotic therapy can also reduce the horse's natural buildup of immunity, making it more susceptible to reinfection. Despite the disadvantages, antibiotic therapy is often necessary when the horse has labored breathing, difficulty swallowing, prolonged high fever, and severe lethargy or loss of appetite. Your veterinarian will weigh the pros and cons of antibiotic therapy based on your horse's specific condition.
 
#6 ·
from this site

'Although S. equi is usually sensitive to antibiotics such as Penicillin, antibiotic treatment is generally discouraged if a horse is already exhibiting signs of disease such as fever and nasal discharge. Many veterinarians believe that antibiotic treatment at this time may increase the risk of complications such as internalized abscesses.


https://extension.umaine.edu/publications/1009e/
 
#7 ·
Yup, in discussing the first case with the OSU vets, they asked if I had given anything at all, banamine or antibiotics to the horse. I had always been taught that unless the horse had internal strangles or some other indication, not to give ANYTHING because it just makes things drat on longer. I did give banamine to 2 horses who went to 104F temps but only 1 time and nothing else. They all agreed that doing nothing was better than doing something that could make it worse.
 
#8 ·
Yes, in the interest of keeping the original post short, I skipped some antibiotic info. The only symptom Dakota had was a snort once while tied that produced mucous with a yellow tint. At that time the BO did not think it was strep, but knowing that 2 other horses had experienced a mild respiratory illness she suggested a round of antibiotics as a precaution. (she obviously was hoping to keep whatever "It" was from spreading). I didn't know, but she took it upon herself to get it checked - and she was very surprised at the result. At the time it came back, she told me the risks of having treated with antibiotics and said in retrospect she probably wouldn't have advised it (she has equine vets she consults with constantly). She's been very up front and open with all of us. It's a small boarding stable but all the horses get lots of room to roam - paddocks of 2 to 4 acres, with only a few horses in each - so not crowded conditions. I'm hoping that helps in some way.

Dreamcatcher, my horse is stabled in the SW Tulsa area - not that far from you. The vet said that there's been a lot of this going around here this year.
 
#9 ·
The mare I got came from Arkansas, and either was exposed before I got her or when she got to the sale facility. She looked fine when I got her, good weight, actually very good coat, everything had been done teeth, feet, Coggins, Health Cert, Vaccinations etc. So she didn't come from a bad situation, just an unfortunate luck of the draw. I'm pretty darn unhappy about it, I've never had strangles on the property and now everyone knows why I was so strict about QT for all horses coming in.

So, based on you coming from a farm with known strangles, if I was your friend I probably wouldn't let you bring your horse in until I had word from the vet that everyone from the current barn was clear and had been for a month. It isn't to be mean or difficult, but to protect her own property and animals.

This little goat rope has cost me a fortune in vet bills. Not just for the horses who got sick, but I have mares that were bred who have to be preg checked in an isolation unit in stead of at the breeding farm. Doing it in the unit is about $200 vs being included in all the breeding fees. Not to mention having cultures and scopes done on the sick ones at close to $400 a pop. I've had to let mare owners who were booked to my stallion either carry over their breedings to next year or I've refunded for any who didn't want to wait. And of course, if anyone makes a mistake and either doesn't decontaminate or handle the mares who are due to deliver, I could end up with disastrous consequences in the foaling barn.
 
#10 ·
I'm so sorry Dreamcatcher - that sounds hideous. Yes, just luck of the draw. Yep, I'll be as picky about when my mare goes to my friend's place as she will be. I'm inclined to wait to pay for the testing on my horse until a month after the last one is cleared... almost seems pointless to do it sooner. It's too bad, this really wrecks my plan. I was working with my horse in the arenas and controlled environment to really get to know her, then the plan all along has been to move her in April so we can ride together on my friend's acreage. That's what my horse likes to do - trail ride. The arena's have been great for gaining confidence, but we are both 'chomping at the bit' to explore!
 
#11 ·
I'm so sorry Dreamcatcher - that sounds hideous. Yes, just luck of the draw. Yep, I'll be as picky about when my mare goes to my friend's place as she will be. I'm inclined to wait to pay for the testing on my horse until a month after the last one is cleared... almost seems pointless to do it sooner. It's too bad, this really wrecks my plan. I was working with my horse in the arenas and controlled environment to really get to know her, then the plan all along has been to move her in April so we can ride together on my friend's acreage. That's what my horse likes to do - trail ride. The arena's have been great for gaining confidence, but we are both 'chomping at the bit' to explore!
Well, with luck, everything will clear up before it gets too hot tor ride out in the open!

Here's a link to an article in the Merck Vet Manual:
Strangles in Horses: Respiratory Diseases of Horses: Merck Veterinary Manual

And here's the standard of care before a horse is declared clear:

Most horses continue to shed S equi for ~1 mo after recovery. Three negative nasopharyngeal swabs, at intervals of 4–7 days, should be obtained before release from quarantine, and the minimal isolation period should be 1 mo. Prolonged bacterial shedding (as long as 18 mo) has been identified in a small number of horses. Guttural pouch empyema is the source of infection in most prolonged carrier states. Bacterial culture of nasopharyngeal swab and/or guttural pouch lavage is used to identify persistent carriers.
 
#13 ·
In the UK where strangles is always circulating the yards are supposed to have strict quarantine with no horses going off or coming on until no more horses show signs of illness or have been declared infected for a month

When the horse is ill anything that keeps the temperature down and relieves pain so the horse will drink and eat soft mash type foods helps recovery
Antibiotics are usually given after the abscess has burst because it leaves an open wound and the infected 'puss' can then get into the bloodstream
 
#14 ·
No, when abbesses drain externally, they don't get into the blood stream.
In fact, you try to prevent that from happening, by inhibiting the formation of deep abscesses, or ******* strangles. They in turn, are thought to be enabled to form, by giving antibiotics initially, and when not really indicated, and also not given long enough, so that th bacteria hide out in abscesses that are internal. When these rupture, septicemia is the result, and that massive amount of bacteria dumped suddenly into the bloodstream, won't respond to just giving some IM antibiotics, and in fact, is in most cases, is fatal




With the progression of the disease, abscesses develop in the submandibular (between the jaw bones) and/or retropharyngeal (at the back of the throat) lymph nodes. The lymph nodes become hard and very painful, and may obstruct breathing ("strangles"). The lymph node abscesses will burst (or can be lanced) in 7–14 days, releasing thick pus heavily contaminated with S. equi. The horse will usually rapidly recover once abscesses have ruptured.

Although the disease process described above is classic, some horses (especially older animals) will develop a mild, short lasting disease without or with minor lymph node abscessation. This is thought to be the result of partial immunity although this may also result from infection by S. equi of relatively low virulence. Classic strangles is a severe infection that can be fatal, usually because of a variety of complications that occur.

The main and often fatal complications of strangles are:

******* strangles, which describes the dissemination of infection to unusual sites other than the lymph nodes draining the throat. For example, abdominal or lung lymph nodes may develop abscesses and rupture, sometimes weeks or longer after the infection seems to have resolved. A brain abscess may rupture causing sudden death or a retropharyngeal lymph node abscess may burst in the throat and the pus will be inhaled into the lung.
 
#15 ·
You'll have to take that up with the Vet practices in the UK Smilie - that's how they were treating strangles there when one of my horses contracted it while at a stud farm there - it came in with a shipment of young Irish horses. All of the horses that got strangles were treated that way and all but one survived.
I don't know if you've ever had a horse with strangles (as I have) but when the abscess bursts you have a hole that can be large enough to put your fist in and even with regular flushing with Povidone will take at least 3 days to drain and then several weeks to gradually heal and close, all that time you have a large raw exposed area that's perfect for secondary infections to enter, penicillin also reduces the risk of pneumonia that occurs in strangles cases after the abscess has burst
The theory that using antibiotics causes b-astard strangles is now very outdated.
 

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#18 · (Edited)
Yup, in the 40- years of raising horses, I have has strangles go through my herd 3 times, with those large abscesses that burst open, and one was an in foal mare, that did not abort



First time, i sent a mare out to be bred. Hubby picked her up, when I was in Ontario, visiting my parents. When I asked him how Annie was he told me that she had some pus draining out of her nose.
I came home to find her in full blown strangles, draining that pus into the common water trough!
Needless to say, it went through the whole herd.



Over the years, i bought the odd PMU foal, who are weaned the day they are sold, so major stress. I did keep them isolated, but twice, it managed to go through the rest of the horses anyways
Because of the sheer number of horses at some of those PMU barns, strangles was always at those places, and any stress would produce a clinical strangles baby, even though they did get passive immunity from the dam.
Nope, not a stranger to strangles at all!!!!!!!
The advise above is still given by my vet, except, of course, I now give internasal strangles vaccine, which was not available in the past
Those lymph nodes do drain,, and while there is controversy as to whether antibiotics increase the incidence of ******* strangles, it is still a fact that using antibiotics on every case is contraindicated. Yes, ugly holes when they burst, but those are surface lymph nodes, and giving antibiotics, esp not long enough, can just suppress that bacterium, which can then cause a possible problem again, plus prevents development of very effective active immunity

This is modern info:

Treatment Protocols vary depending on each horse’s disease stage and severity when detected and the treating veterinarian’s experiences. Practitioners frequently treat uncomplicated cases (those involving lymph nodes that have begun to abscess) symptomatically, with anti-inflammatory drugs to control pain and aid appetite and hot compresses or drawing agents to bring the abscesses to a head more quickly. Letting the disease run its course in this fashion offers the advantage of conferring more complete immunity against future disease.

However, draining abscesses can increase the risk of contamination and disease spread on a farm, so some veterinarians use antibiotics to treat horses with early disease to prevent abscesses from maturing, says Boyle. The downside is that horses treated with antibiotics won’t develop as good an immune response against future strangles threats.

J. Scott Weese, DVM, DVSc, Dipl. ACVIM, a professor in the Department of Pathobiology at the University of Guelph’s Ontario Veterinary College, says antibiotics “aren’t very effective once abscesses develop and are probably only justifiable early in disease and when good infection control measures are being used to prevent subsequent exposure. If you treat with antibiotics but are in a facility where S. equi is still being passed around, the horse may just get it again, and treatment might delay the inevitable.”



http://www.thehorse.com/articles/34919/strangles-dispelling-the-myths
 
#16 ·
Gruesome picture.

So, I don't really know what I'm dealing with, but here's what I do know:

- none of the horses so far have displayed anything but mild symptoms. From what I'm reading, this can likely be due to one of 3 things... either this is a mild strain, or so far all the horses have had some level of immunity, or they've been treated with antibiotics and it's been subdued but possibly driven down deeper.

- since my horse began treatment before they knew it was strep, she was given an antibiotic. It was not penicillin (which appears to be the recommended one if you are going to treat). She was given trimethoprim sulfa for 10 days. just finished 2 days ago. So, since she was given an antibiotic already, should we go another round of something (penicillin) to try to knock it out (since the ship has sailed to let this go a natural course). Or just watch.

- knowing all this, is the swab testing (3, several days apart, 1 month after the last horse has exhibited symptoms) sufficient? would you allow my horse to be around yours after this? What would it take for you to be comfortable around my horse? (it doesn't sound like these horses need to be quarantined for life... and I imagine a lot of horses out there have gotten it, and it played itself out without ever being recognized...?)

-----------------------------
If this was your horse, what would you do next? Trying to develop an intelligent (but not over-reactive) plan of action, so I can move on.
 
#17 ·
If your horse has had a positive test but no extreme symptoms then to be clear of infection he needs to be tested as such.
Strangles is also one of those infections where a horse can be a carrier but show no symptoms
Some vets use antibiotics on a horse that's not gone into the abscess stage to 'kill' the infection because it reduces the spread of the infection and obviously removes all the risks associated with the abscess. Its only successful if the antibiotic is the right strength and given for the right length of time. The 'downside' is that the horse doesn't get a natural resistance as they do if they fight the infection themselves but with the vaccination options now that isn't such a big deal
When my mare got it at a big yard I had her at nothing was moved until there'd been a month of no new incidents, after that I took her home and had no worries about her infecting any of my other horses if that's what you mean.
 
#19 ·
Folly, I would NOT treat my horse with any more antibiotics.

A side note, this is why you NEVER let anyone but a vet give your horse antibiotics or even Banamine without consulting with you first, and giving you time to consult with your vet about it before anything is given.

I would be comfortable allowing your horse around mine (assuming all of mine were healthy at the time) when you presented me with 3 clear cultures taken 1 week apart, starting 30 days after the last horse was asymptomatic. The only reason we went straight to Endoscopy with Dolly is because first abscesses to open made it look likely that the guttural pouches were involved. Endoscopy showed that they were clear but there was something that may have been an abscess in one of them, so we are redoing the scope to see if it was and ruptured or resolved. Then when everyone has been clear for 30 days, we'll start culturing.
 
#20 ·
Alright - pretty concise advice from someone who is currently in the middle of it herself, and from others who've been there. I'll go that route and swab after 30 days etc.... and then proceed from there based on the results. That basically mirrors what the vet is advising (and says is the current 'best practice'), but I wanted to get other opinions since I kept reading conflicting/confusing things online. Thanks everyone. Added some clarity.
 
#22 · (Edited)
Dreamcatcher - I know it's exhausting - I can only fit a horse into my life by entrusting others with the day-to-day care, and finally decided since it was that or nothing I'd take that. I think I'm glad, seeing what you are going through.

BTW, I don't know if you remember, but I'm the one who met up with you over a year ago to go see that gelding named "Shrek" - remember that big boy lol? That was a fun shopping trip.
I ended up buying a mft that ultimately didn't work out, and then a few months ago got the qh that I have now - and I'm crazy about her. She's a very good girl, and seems to be everything I need and exactly what I was looking for all along.
 
#23 ·
Dreamcatcher - I know it's exhausting - I can only fit a horse into my life by entrusting others with the day-to-day care, and finally decided since it was that or nothing I'd take that. I think I'm glad, seeing what you are going through.

BTW, I don't know if you remember, but I'm the one who met up with you over a year ago to go see that gelding named "Shrek" - remember that big (lazy) boy lol? I ended up buying a mft that ultimately didn't work out, and then a few months ago got the qh that I have now - and I'm crazy about her. Really want to get her all well. She's a very good girl, and seems to be everything I need.
I remember, and I'm glad you got the horse of your dreams. Sucks that you're having to deal with strangles so soon after you finally got her.
 
#26 ·
Well dang - did I just jinx this whole thing by calling her a 'good girl'??

I tell her she's the best horse in the world every time I walk her back to her pasture and it doesn't seem to have gone to her head....
 
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