Update on Bacterial Pneumonia in the Foal and Weanling

Pulse oximetry at two sensor placement sites in conscious foals

BACKGROUND

Pulse oximetry has not been thoroughly evaluated for assessment of oxygenation in conscious foals. Compared with invasive arterial blood sampling, it is a painless and non-invasive method for real-time monitoring of blood oxygen saturation. The aim of this prospective clinical study was to evaluate the usability, validity, and reliability of pulse oximetry at two measuring sites (lip and caudal abdominal skin fold) for blood oxygen saturation measurement in conscious foals with and without respiratory compromise. Thirty-two foals under one month of age were used. Nineteen foals had normal respiratory and cardiovascular function, and 13 had pneumonia. Pulse oximetry with a transmittance sensor was performed in triplicate on each foal's lip (n = 196 measurements) and/or skin fold (n = 338 measurements), and arterial blood sample was collected. The oxygen saturation values measured by pulse oximetry from the lip and skin fold were compared with each other (n = 58 measurement pairs) and with the calculated arterial oxygen saturation based on arterial blood samples (n = 93 measurement pairs). Furthermore, repeatability of the pulse oximetry measurements was assessed.

RESULTS

Measured blood oxygen saturation was clearly associated with the calculated saturation, but on average (± SD) it was 1.8 (± 3.3) percentage units higher from the lip and 5.7 (± 4.3) percentage units higher from the skin fold than the calculated saturation. In concurrent lip and skin fold measurements within a foal, the skin fold measurements were 2.4 (± 2.4) percentage units higher than the lip measurements. The repeatability of three pulse oximetry saturation measurement results was moderate to good and significantly improved when the measurement furthest from the middle-measured value was excluded. The most deviating measurement was often obtained first. Pulse oximetry in general was well tolerated and easy to perform, but as expected in conscious foals, movement and contact problems generated occasional technical difficulties in some individuals.

CONCLUSIONS

In conscious foals, pulse oximetry with a transmittance sensor attached to the lip (but not to the skin fold) is a clinically applicable and valid method for arterial blood oxygen saturation determination. Several measurements should be obtained and outliers discarded to obtain a reliable result.

Factors affecting survival of foals with pneumonia in a referral hospital

BACKGROUND

Pneumonia is a common condition in ailing neonatal foals, and it remains an important cause of morbidity and mortality in this veterinary patient group. Factors affecting the survival of young foals with pneumonia have not been thoroughly investigated. The aim of this study was to explore the potential prognostic factors associated with survival of these foals. Fifty foals under one month of age with pneumonia were included in this retrospective clinical study. The foals were divided into groups based on survival (survived to discharge or died/euthanised during hospitalisation). Multiple clinical and laboratory variables were investigated as risk factors with univariate logistic regression analyses and subsequently with multivariate analyses. If a variable showed prediction potential in regression analysis, a receiver operating characteristic (ROC) analysis was conducted.

RESULTS

In univariate analysis, odds (OR, 95% CI) of non-survival were associated with higher respiratory rate (RR) on the first day after admission to hospital (D1) (1.32, 1.07-1.62, P = 0.009, for each 5-unit increase) and positive bacterial blood culture (12.08, 1.88-77.67, P = 0.009). Odds of non-survival were decreased for Standardbred breed (0.11, 0.01-0.96, P = 0.046) and for foals with longer hospitalisation, with each additional day in hospital further reducing the odds (0.59, 0.40-0.86, P = 0.006). In multivariate analysis, odds of non-survival were associated only with higher RR on D1 (1.36, 1.07-1.71, P = 0.011, for each 5-unit increase). In ROC analysis, optimal cut-off value for RR was ≥ 55/min with sensitivity 75.0% and specificity 76.3%. Based on predictive values, RR < 55/min on D1 favoured survival.

CONCLUSIONS

Higher RR on D1 is a predictor of non-survival in foals with pneumonia in this study, increasing the odds of death by 36% for each 5-unit increase in RR. Respiratory rate below 55/min on D1 favours survival. These findings could assist in early identification of foals that are at increased risk of mortality, thereby aiding in treatment decisions.

Pilot study characterizing a single pooled preparation of equine platelet lysate for nebulization in the horse

Introduction

Platelet lysate (PL) demonstrates antimicrobial and anti-inflammatory properties offering potential for treatment of bacterial pneumonia in horses. It remains unknown whether nebulization is suitable for PL administration in horses. This pilot study characterized particle size and flow rate of pooled equine PL (single preparation) nebulized using an equine-specific nebulizer (Flexivent®).

Methods

Protein composition and antimicrobial activity were compared before and after nebulization. Protein composition was evaluated according to growth factor, antimicrobial peptide and cytokine concentrations and proteomic analysis. To evaluate antimicrobial activity, bacterial growth inhibition [maximum growth (μmax); carrying capacity (K)] were determined for E. coli, Streptococcus equi subsp zooepidemicus and Rhodococcus equi (WT and MDR) using pre- and post-nebulized PL concentrations of 50%.

Results

Flow rate and median particle size were 0.8 ml/min and 4.991 μm with 52% of particles ≤ 5 μm. Differences in PL protein composition were detected with nebulization. For E. coli and S. zooepidemicus, nebulization did not alter effect of PL on growth parameters. PL treatments decreased K for S. zooepidemicus (p = 0.009) compared to BHI. For R. equi K was increased post- vs. pre-nebulization (WT and MDR) and μmax increased pre- vs, post-nebulization (MDR). PL treatments increased K and μmax for MDR R. equi and μmax for WT R. equi compared to BHI (p ≤ 0.05).

Conclusion

Nebulization of PL in vitro is technically feasible. The results of this study support further investigation to better characterize the effect of nebulization on PL and its suitability for nebulization in horses.

Recent advancement, immune responses, and mechanism of action of various vaccines against intracellular bacterial infections

Emerging and re-emerging bacterial infections are a serious threat to human and animal health. Extracellular bacteria are free-living, while facultative intracellular bacteria replicate inside eukaryotic host cells. Many serious human illnesses are now known to be caused by intracellular bacteria such as Salmonella enterica, Escherichia coli, Staphylococcus aureus, Rickettsia massiliae, Chlamydia species, Brucella abortus, Mycobacterium tuberculosis and Listeria monocytogenes, which result in substantial morbidity and mortality. Pathogens like Mycobacterium, Brucella, MRSA, Shigella, Listeria, and Salmonella can infiltrate and persist in mammalian host cells, particularly macrophages, where they proliferate and establish a repository, resulting in chronic and recurrent infections. The current treatment for these bacteria involves the application of narrow-spectrum antibiotics. FDA-approved vaccines against obligate intracellular bacterial infections are lacking. The development of vaccines against intracellular pathogenic bacteria are more difficult because host defense against these bacteria requires the activation of the cell-mediated pathway of the immune system, such as CD8+ T and CD4+ T. However, different types of vaccines, including live, attenuated, subunit, killed whole cell, nano-based and DNA vaccines are currently in clinical trials. Substantial development has been made in various vaccine strategies against intracellular pathogenic bacteria. This review focuses on the mechanism of intracellular bacterial infection, host immune response, and recent advancements in vaccine development strategies against various obligate intracellular bacterial infections.

Hyponatremia in horses with septic pneumopathy

Background

Hyponatremia is common in horses with bacterial pleuropneumonia, but no further characterization of this abnormality has been reported.

Objectives

Describe admission plasma sodium concentration ([Na]) in horses with septic pneumopathy and evaluate any association of plasma [Na] with markers of systemic inflammation.

Animals

Medical records of horses >1 month of age that between 2008 and 2021 had a transtracheal aspirate (TTA) performed, abnormal TTA cytology, positive TTA culture, pulmonary disease on ultrasonography, radiography or both, and plasma [Na] assessed by direct ion‐selective‐electrode (dISE). Horses with concurrent diarrhea or azotemia were excluded.

Methods

Clinical and clinicopathological variables of interest between hypo‐ and normonatremic horses were compared. Spearman correlation and Fisher exact tests were used to identify significant associations (P < .05).

Results

Twenty of 35 horses had hyponatremia (median, 132 mmol/L; 25‐75th interquartile range [IQR], 129.7‐133.1 mmol/L; reference range, 134.2‐138.4 mmol/L). A higher proportion of horses with systemic inflammatory response syndrome (SIRS) had hyponatremia (P = .01). Hyponatremic patients had higher mean plasma fibrinogen concentration (461 ± 160.5 mg/dL; P = .01) and higher rectal temperature (38.8 ± 0.7°C; P = .02) than normonatremic horses. Negative correlations were found between plasma [Na] and fibrinogen (P = .001; ρ = −0.57) concentrations and between plasma [Na] and rectal temperature (P = .001; ρ = −0.51). Presence or absence of pleural effusion did not influence severity of hyponatremia. Mean duration of hospitalization was longer (P = .04) in hyponatremic horses (9.8 ± 6.6 days).

Conclusions and Clinical Importance

Hyponatremia at admission is associated with the presence of inflammation, SIRS, and with longer duration of hospitalization.

Retrospective study of pneumonia in non-racing horses in California

Pneumonia is a significant disease of horses. Although pneumonia has traditionally been studied in racehorses, little information is available for non-racing horses. Non-racing horses that died with pulmonary lesions (n = 156) were available from cases submitted for autopsy from January 2015 to June 2020. Bronchopneumonia (35%), interstitial pneumonia (29%), embolic pneumonia (21%), granulomatous pneumonia (13%), and pleuritis (2%) were observed in the examined horses. Seventy-four horses died or were euthanized because of pulmonary diseases, and 82 horses died or were euthanized because of non-pulmonary causes but had lung lesions. Of the horses that died from pulmonary causes, the most common finding was bronchopneumonia, with abscesses and/or necrosis in the cranioventral aspect of the lung. Bacteria isolated from cases of bronchopneumonia were Streptococcus equi subsp. zooepidemicus (48.5%), Klebsiella pneumoniae (12.1%), and Actinobacillus equuli subsp. haemolyticus (9.1%). The most common extrapulmonary lesions responsible for death in horses that also had lesions in the lung were mainly in the gastrointestinal system (30%), multiple systems (septicemia and/or toxemia; 27%), and musculoskeletal system (12%). The main postmortem findings in cases of bronchopneumonia of non-racing horses were similar to those reported previously in racehorses. However, some non-racing horses also had interstitial and granulomatous pneumonia, patterns not described previously in racehorses in California, likely as a result of the inclusion of extended age categories for non-racing horses. We also found that the equine lung was frequently affected in cases of sepsis and gastrointestinal problems of infectious origin.

The opportunistic intracellular bacterial pathogen Rhodococcus equi elicits type I interferon by engaging cytosolic DNA sensing in macrophages

Rhodococcus equi is a major cause of foal pneumonia and an opportunistic pathogen in immunocompromised humans. While alveolar macrophages constitute the primary replicative niche for R. equi, little is known about how intracellular R. equi is sensed by macrophages. Here, we discovered that in addition to previously characterized pro-inflammatory cytokines (e.g., Tnfa, Il6, Il1b), macrophages infected with R. equi induce a robust type I IFN response, including Ifnb and interferon-stimulated genes (ISGs), similar to the evolutionarily related pathogen, Mycobacterium tuberculosis. Follow up studies using a combination of mammalian and bacterial genetics demonstrated that induction of this type I IFN expression program is largely dependent on the cGAS/STING/TBK1 axis of the cytosolic DNA sensing pathway, suggesting that R. equi perturbs the phagosomal membrane and causes DNA release into the cytosol following phagocytosis. Consistent with this, we found that a population of ~12% of R. equi phagosomes recruits the galectin-3,-8 and -9 danger receptors. Interestingly, neither phagosomal damage nor induction of type I IFN require the R. equi’s virulence-associated plasmid. Importantly, R. equi infection of both mice and foals stimulates ISG expression, in organs (mice) and circulating monocytes (foals). By demonstrating that R. equi activates cytosolic DNA sensing in macrophages and elicits type I IFN responses in animal models, our work provides novel insights into how R. equi engages the innate immune system and furthers our understanding how this zoonotic pathogen causes inflammation and disease.

Rhodococcus equi is a facultative intracellular bacterial pathogen of horses and other domestic animals, as well as an opportunistic pathogen of humans. In human patients, Rhodococcus pneumonia bears some pathological similarities to pulmonary tuberculosis, and poses a risk for misdiagnosis. In horses, R. equi infection has a major detrimental impact on the equine breeding industry due to a lack of an efficacious vaccine and its ubiquitous distribution in soil. Given the prevalence of subclinical infection and high false positive rate in current screening methods, there exists a critical need to identify factors contributing to host susceptibility. Here, we use a combination of bacterial genetics and animal models to investigate innate immune responses during R. equi infection. We found that R. equi modulates host immune sensing to elicit a type I interferon response in a manner resembling that of M. tuberculosis. We also found that the danger sensors galectin-3, -8, and -9 are recruited to a population of R. equi-containing vacuoles, independent of expression of VapA. Our research identifies innate immune sensing events and immune transcriptional signatures that may lead to biomarkers for clinical disease, more accurate screening methods, and insight into susceptibility to infection.

Antimicrobial Selection for the Equine Practitioner

Antimicrobial drugs play an important, often central, role in the therapeutic management of mature horses and foals with a variety of illnesses, including those requiring critical care. Antimicrobial use must be based on rational principles involving thorough patient evaluation and sound clinical judgment that indicate a high likelihood that the patient has a bacterial infection and that antimicrobials are indicated to promote recovery. The aim of antimicrobial treatment is to inflict an insult on infecting bacteria sufficient to kill the organism or render it susceptible to inactivation by natural host defenses or the local microenvironment without adversely affecting the patient.

Pharmacokinetics and pharmacodynamics of doxycycline in a Streptococcusequi subsp. zooepidemicus infection model in horses

The objectives of this study were to investigate the pharmacokinetics (PK), pharmacodynamics (PD), and the efficacy of oral administration of doxycycline (DXC) in horses with Streptococcus zooepidemicus tissue infections. Tissue chambers (TC) were implanted subcutaneously in the cervical region of 7 horses and inoculated with a single S. zooepidemicus isolate with a minimum inhibitory concentration (MIC) of 0.25 µg/ml, determined by agar dilution. Doxycycline hyclate (10 mg/kg, orally, q 12 h, for 5 days) mixed with poloxamer gel was started following inoculation. The TC fluid was sampled prior to and following inoculation for cytology analysis, quantitative culture, and DXC determination. Plasma DXC concentrations were measured over 48 h following the last dose of DXC administered. The mean plasma peak concentration (C_max ) of DXC was 0.32 µg/ml, and concentrations above the MIC were only reached in 3 TC samples. In plasma, mean T > MIC was 2.4 h, mean C_max /MIC was 1.30, and mean AUC_last /MIC was 11.63 h. These PK/PD indices did not reach the suggested targets for DXC treatments of infections, and the TC abscessed in all horses. This is the first study to evaluate the recommended dose of DXC in horse in an infection model.

Pharmacokinetics and bioavailability of tildipirosin following intravenous and subcutaneous administration in horses

This study was designed to investigate the safety and pharmacokinetic (PK) profile of tildipirosin in horses after intravenous (i.v.) and subcutaneous (s.c.) injection of a single dose at 4 mg/kg of body weight (b.w.). A total of 12 healthy mixed breed horses were used in the study. Horses were monitored for systemic and local adverse effects, and whole blood samples were collected for hematology and plasma biochemistry analysis at time (0) and at 6, 24, and 72 h after drug administration. For PK analysis, blood samples were collected at pre-determined times before and after tildipirosin administration. Plasma concentrations of tildipirosin were determined using ultra-high-performance liquid chromatography-ultraviolet detection method (UHPLC-UV). All horses tolerated the i.v. injection of tildipirosin without showing any systemic adverse effects. However, a non-painful, soft swelling appeared at the s.c. injection site in 5 horses (41.7%). On average, tildipirosin reached a maximum plasma concentration (C_max ) of 1257 ng/ml (geometric mean) between 0.5 and 1.5 h after s.c. administration (T_max ). The geometric mean values for total body clearance (Cl), the apparent volume of distribution based on the terminal phase (V_z ), and the apparent volume of distribution at steady-state (V_ss ) were 0.52 L/kg·h, 22 L/kg, and 10.0 L/kg, respectively. Data collected in this study suggests that tildipirosin can be used safely in horses with caution.

Differences in pig respiratory tract and peripheral blood immune responses to Actinobacillus pleuropneumoniae

Excessive cytokine production is an important component of the acute respiratory distress syndrome and multiple organ failure. Pneumonia can lead to an overexpression of cytokines, although comparatively little is known about the relevance and differences in cytokines between blood and lung. In this study, piglets were experimentally infected intranasally with Actinobacillus pleuropneumoniae (APP), and transcriptomes of lung tissue and peripheral blood mononuclear cells determined. In addition, the levels of 30 cytokines in broncheoalveolar lavage fluid (BALF) and sera were determined by ELISA. Post infection, there was an early increase in lung monocytes, and a later rise in inflammatory cytokines in BALF. Blood lymphocytes increased early in infection and there was a rise in inflammatory cytokines in the peripheral blood of infected piglets. Genes involved in cytokine production, leukocyte migration and differentiation, lymphocyte activation, and cytokine-mediated signaling pathways in the transcriptomes of lung tissue were significantly down-regulated early in infection. At this early phase of APP infection (0-6 h), the cytokines IL-1β, MCP-1, and IL-5 in sera increased rapidly and significantly, while many cytokines in BALF decreased. At 48 h post-infection, cytokines in sera were no longer significantly increased, although some were up-regulated in BALF, and there was aggravated pathological damage in the lungs at this time. The data indicate there are substantial differences between immune cells and cytokines in the lung and peripheral blood of APP infected piglets at equivalent time points. The results increase our understanding of pig-APP host interactive biology, and will be important in formulating future therapeutic and preventative strategies to prevent disease caused by APP.

Cytological Findings in Bronchoalveolar Lavage Fluid of Foals With Pneumonia Caused by Rhodococcus equi and Other Bacteria

The distinction between lower respiratory tract infections caused by Rhodococcus equi and those caused by other pathogens is difficult. The aim of this retrospective study was to describe cytological findings in bronchoalveolar lavage fluid (BALF) of foals with pneumonia caused by R. equi or other bacteria. Nineteen foals aged from 3 weeks to 6 months with evidence of respiratory disease between 2015 and 2016 were selected from the database of the Veterinary Teaching Hospital "Mario Modenato" of the University of Pisa. Eight foals of 19 (42.1%) had R. equi pneumonia, whereas 11 of 19 (57.9%) had another bacterial pneumonia. R. equi-positive foals had statistically significant higher total nucleated cell count (P = .02) and neutrophils percentage (P = .002) than R. equi-negative ones. Macrophages proportion (P = .01) was lower in R. equi-positive than in R. equi-negative foals. Bronchoalveolar lavage is a quite easy procedure that can be performed in the field with minimal equipment required. Here we reported significant differences in the cellular composition of BALF that can be used to differentiate foals with R. equi bronchopneumonia from those with other bacterial pneumonias, whereas waiting for culture results.

Effect of Macrolide and Rifampin Resistance on the Fitness of Rhodococcus equi

Rhodococcus equi is a leading cause of severe pneumonia in foals. Standard treatment is dual antimicrobial therapy with a macrolide and rifampin, but the emergence of macrolide- and rifampin-resistant R. equi isolates is an increasing problem. The objective of this study was to determine the effect of macrolide and/or rifampin resistance on fitness of R. equi Three unique isogenic sets were created, each consisting of four R. equi strains, as follows: a susceptible parent isolate, strains resistant to macrolides or rifampin, and a dual macrolide- and rifampin-resistant strain. Each isogenic set's bacterial growth curve was generated in enriched medium, minimal medium (MM), and minimal medium without iron (MM-I). Bacterial survival in soil was analyzed over 12 months at -20°C, 4°C, 25°C, and 37°C, and the ability of these strains to retain antimicrobial resistance during sequential subculturing was determined. Insertion of the mobile element conferring macrolide resistance had minimal effect on in vitro growth. However, two of three rpoB mutations conferring rifampin resistance resulted in a decreased growth rate in MM. In soil, macrolide- or rifampin-resistant R. equi strains exhibited limited growth compared to that of the susceptible R. equi isolate at all temperatures except -20°C. During subculturing, macrolide resistance was lost over time, and two of three rpoB mutations reverted to the wild-type form. The growth of rifampin-resistant R. equi colonies is delayed under nutrient restriction. In soil, possession of rifampin or macrolide resistance results in decreased fitness. Both macrolide and rifampin resistance can be lost after repeated subculturing.IMPORTANCE This work advances our understanding of the opportunistic environmental pathogen Rhodococcus equi, a disease agent affecting horses and immunocompromised people. R. equi is one of the most common causes of severe pneumonia in young horses. For decades, the standard treatment for R. equi pneumonia in horses has been dual antimicrobial therapy with a macrolide and rifampin; effective alternatives to this combination are lacking. The World Health Organization classifies these antimicrobial agents as critically important for human medicine. Widespread macrolide and rifampin resistance in R. equi isolates is a major emerging problem for the horse-breeding industry and might also adversely impact human health if resistant strains infect people or transfer resistance mechanisms to other pathogens. This study details the impact of antimicrobial resistance on R. equi fitness, a vital step for understanding the ecology and epidemiology of resistant R. equi isolates, and will support development of novel strategies to combat antimicrobial resistance.

Antibody to Poly-N-acetyl glucosamine provides protection against intracellular pathogens: Mechanism of action and validation in horse foals challenged with Rhodococcus equi

Immune correlates of protection against intracellular bacterial pathogens are largely thought to be cell-mediated, although a reasonable amount of data supports a role for antibody-mediated protection. To define a role for antibody-mediated immunity against an intracellular pathogen, Rhodococcus equi, that causes granulomatous pneumonia in horse foals, we devised and tested an experimental system relying solely on antibody-mediated protection against this host-specific etiologic agent. Immunity was induced by vaccinating pregnant mares 6 and 3 weeks prior to predicted parturition with a conjugate vaccine targeting the highly conserved microbial surface polysaccharide, poly-N-acetyl glucosamine (PNAG). We ascertained antibody was transferred to foals via colostrum, the only means for foals to acquire maternal antibody. Horses lack transplacental antibody transfer. Next, a randomized, controlled, blinded challenge was conducted by inoculating at ~4 weeks of age ~10⁶ cfu of R. equi via intrabronchial challenge. Eleven of 12 (91%) foals born to immune mares did not develop clinical R. equi pneumonia, whereas 6 of 7 (86%) foals born to unvaccinated controls developed pneumonia (P = 0.0017). In a confirmatory passive immunization study, infusion of PNAG-hyperimmune plasma protected 100% of 5 foals against R. equi pneumonia whereas all 4 recipients of normal horse plasma developed clinical disease (P = 0.0079). Antibodies to PNAG mediated killing of extracellular and intracellular R. equi and other intracellular pathogens. Killing of intracellular organisms depended on antibody recognition of surface expression of PNAG on infected cells, along with complement deposition and PMN-assisted lysis of infected macrophages. Peripheral blood mononuclear cells from immune and protected foals released higher levels of interferon-γ in response to PNAG compared to controls, indicating vaccination also induced an antibody-dependent cellular release of this critical immune cytokine. Overall, antibody-mediated opsonic killing and interferon-γ release in response to PNAG may protect against diseases caused by intracellular bacterial pathogens.

Development of effective vaccines for diseases such as tuberculosis, brucellosis and others caused by intracellular pathogens has proved challenging, as data exist supporting both antibody and cellular immune effectors as mediators of protection. To address this problem against an important, and representative, equine intracellular pathogen, we chose to test a vaccine candidate for the ability to protect horse foals challenged at 4 weeks of age with Rhodococcus equi. To make these foals immune, their pregnant mares were immunized with a vaccine targeting the conserved surface antigen found on many microbes, termed PNAG. Antibody in the pregnant mares was transferred to their foals and, after the foals were challenged, 91% of those born to vaccinated mares were protected against R. equi pneumonia. Meanwhile, 86% of the non-vaccinated controls developed pneumonia. We also showed antibody to PNAG could kill various bacteria that produce this antigen when residing inside of human macrophage cells, a new mechanism for antibody-mediated immunity to intracellular bacteria. These results support the development of PNAG as a vaccine for intracellular bacterial pathogens.

Seroprevalence of Rhodococcus equi in horses in Israel

Rhodococcus equi is a common cause of pneumonia in foals and has extensive clinical, economic and possibly zoonotic consequences. This bacterium survives well in the environment and may be considered as normal flora of adult horses. Certain strains of this bacterium are extremely virulent in foals, and early identification and intervention is crucial for prognosis. Rhodococcus equi is endemic in many parts of the world and occasionally isolated in Israel. This study was designed to evaluate R. equi seroprevalence in adult horses in Israel to indirectly indicate the potential level of exposure of susceptible foals. Sera were collected from 144 horses during spring 2011 and from 293 horses during fall 2014, and the presence of antibodies against virulent R. equi was detected by enzyme-linked immunosorbent assay. Equine seroprevalence of R. equi was found to be 7.6% in 2011 and 5.1% in 2014. Only one farm had seropositive horses in 2011, whereas several farms had seropositive horses in 2014. No significant risk factors for seropositivity were found. Rhodococcus equi appears to be endemic in Israel. This is the first survey of R. equi in Israel that provides information on the epidemiology of this important bacterium.

Clinical Assessment of a Point-of-Care Serum Amyloid A Assay in Foals with Bronchopneumonia

Background

Despite the paucity of data available, stall‐side serum amyloid (SAA) assays are commonly used to make diagnostic and treatment decisions in foals with bronchopneumonia.

Hypothesis

Measurement of SAA concentrations can accurately differentiate pneumonic from healthy foals.

Animals

Fifty‐four pneumonic foals between 3 weeks and 5 months of age were compared to 44 healthy controls. In addition, 47 foals on a farm endemic for R. equi infections were studied.

Methods

Serum samples were collected from pneumonic foals at hospital admission. Foals were categorized as having pneumonia caused by R. equi or by other microorganisms based on culture of a tracheobronchial aspirate. In addition, serum samples were obtained at 2‐week intervals from foals born at a farm endemic for R. equi. SAA concentrations were measured by a point‐of‐care assay. Diagnostic performance of SAA was assessed by use of receiver operating characteristic curves.

Results

Concentrations of SAA in foals with bronchopneumonia were significantly (P < 0.001) higher than those of healthy foals, but 15 of 54 pneumonic foals (28%) had SAA concentrations <5 μg/mL. There was no correlation between SAA concentrations and radiographic score in foals with R. equi pneumonia. The ability of SAA to predict development of R. equi pneumonia at the endemic farm was limited with a sensitivity of 64% and a specificity of 77%.

Conclusion and clinical importance

Overall, SAA concentrations are significantly higher in pneumonic than in healthy foals. However, performance of SAA in detecting pneumonic foals is limited by the high proportion of false‐positive and false‐negative results.

Plasmid Profiles of Virulent Rhodococcus equi Strains Isolated from Infected Foals in Poland

Rhodococcus equi is an important bacterial pathogen in foals up to 6 months old, widespread in horse farms all over the world. It was found that only virulent R. equi strains expressing 15–17 kDa virulence-associated protein (VapA) and having large virulence plasmid of 85–90 kb containing vapA gene are pathogenic for horses. To date, 12 plasmid types have been reported in VapA positive strains from horses. There are no data concerning plasmid types of Polish field R. equi strains isolated from horses and horse farm environment. The aim of the study is to determine plasmid profiles of virulent R. equi strains isolated in Poland from dead foals as well as from soil samples taken from horse breeding farms. Plasmid profiles of 10 clinical strains derived from 8 farms and 11 environmental strains from 3 farms, confirmed as virulent by PCR, were compared with 12 reference strains containing the known plasmid size and type. Plasmid DNAs were analysed by digestion with the restriction endonucleases BamHI, EcoRI, EcoT22I, and HindIII for detailed comparison and estimation of plasmid sizes. The results of RFLP analysis revealed that all except one isolates used in the study are classified as VapA 85 kb type I plasmid. One strain harboured VapA 87 kb type I plasmid. This is the first report of plasmid types of Polish field R. equi strains. The results of our preliminary investigations on horse farms located in central and eastern Poland indicate that the virulent R. equi strains thus far isolated from diseased foals and horse farms environment represent a highly uniform plasmid pattern.