Long Term Infection, Draining for 6+ Months?
Long story short, A friend has a stallion she aquired recently. I dont know his exact past, just that he was successful on the track, Suffered a sessamoid fracture that ended his carreer, then at some point had "shipping fever" that progressed to a very severe case. The horse is a fighter, and the vets saw that and were able to save him, after a very difficult illness. At some point they determined he needed to have his chest cavity drained, so two holes were made, one on either side, through his rib cage.
One side healed and is just indented, the other side has a small hole still open, constantly draining yellow pus. He was put on antibiotics before, which did nothing. Friend had him on natural antibiotics - still nothing. He has been in my friends care for 2 months now, he is fed the best, wound cleaned daily, blanketed, etc.
Other than the draining wound, he is 100% healthy. great coat, nice weight, energetic, normal temp.
My friend has an amazing vet, who is currently working on the problem, but it has him stumped as well.
what could be causing this? Its seems unusuall for a young, otherwise healthy horse to not heal? Maybe a foreign peice of something in there?
Has anyone even heard of anything like this?
A couple pics:
he has gained weight since the second pic.
I would lean towards a foreign object or even a bone sliver (does not have a blood supply so the antibiotics don't touch it). He needs to be cut opened and have the area cleaned out. After 6 months, any homeopathic treatment is going to be a waste of time. Pen and sulfa drugs won't touch it either. I would culture the drainage and put him on the appropriate antibiotics which will be pricey.
An ultrasound should be able to pin point the problem & then an incision & drainage should clear it up. Something was missed & is causing the drainage.
I do not know how you could be dealing with a foreign object when the hole was made surgically and not from a puncture wound. I think the drain hole should have been made lower so it would drain everything and not just the fluids above it.
If this were my problem, I would have the wound cultured. I would have the Vet use a covered swab like one that is used for a uterine culture. I would have the Vet angle it down to the lowest spot he could get it, push off the cover and take a culture of whatever was at that lowest point.
This culture should give you an identification of the organism and a list of the antibiotics that it is sensitive to. I would expect a walled off abscess with some difficult invader like a staff, a pseudomonas or actinobacillosis or ??? You will probably find that it will take a heavy duty antibiotic like Chloramphenicol to kill it.
I would have a simple CBC blood test run just so I had a starting point showing what this horse's white count and differential is.
Then, I would put this horse on a 10 day regimen of said antibiotic at a full dose. I would take about 1/2 of another full dose of same antibiotic, dilute it in saline and flush the wound until I got back clear liquid with no puss. I would do that, also, for 10 days.
I would take a second CBC after 10 days and if the white count was not normal, I would continue the antibiotics for another week or more. I have given antibiotics for more than 30 days on horses with abscesses like this or with ******* Strangles and have had horses recover 100%.
After the white count is normal and I quit the antibiotics, I would infuse the wound with one more dose and tightly sew it up.
About 4 or 5 days after all treatment had been finished, I would take one more CBC to make sure the white count was not going to jump back up. If it comes back up, it is going to take surgical cleaning and scraping of the affected area. Some abscesses can wall themselves off from other vital organs (otherwise the animal would get septic and die) and persist for many years. This lengthy and expensive regimen is the only way we have been able to rid a horse of the infection.
Chloramphenicol has been the most effective drug we have found to use for gram negative rod infections (not for strep organisms). We have also used it for bone infections and deep hoof abscesses. If you should find that you want to use Chloramphenicol, PM me or have your Vet do so and I can explain how to mix it with saline and not have it turn into a big 'glump'. It can be very difficult to use but it is extremely effective in cases like this.
I would also suggest that if it has been determined there is no foreign object and the wound was cultured but no bacteria found, to consider some sort of auto immune syndrome. I know of a couple of instances where a wound remained unhealed and the final diagnosis was the auto imune scenario and treated accordingly (I believe that involved the use of steroids).
A CBC should also tell you if you have a invasive organism or an immune problem. It can also have a secondary invading fungi overgrowth from too many of the wrong antibiotics. But a culture should identify that, too.
The main thing is that it needs to be addressed thoroughly and not just have someone stand back and throw some antibiotics at it hoping for the best.
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