Prevention and control of infection

Association of the neutrophil-lymphocyte ratio with outcome in sick hospitalized neonatal foals

BACKGROUND

The neutrophil-lymphocyte ratio (NLR) in human medicine is an objective biomarker that reflects prognosis. The NLR as an independent biomarker to help predict nonsurvival in hospitalized neonatal foals has not been thoroughly interrogated.

OBJECTIVES/HYPOTHESIS

Retrospectively evaluate if the NLR at admission is associated with nonsurvival in sick hospitalized foals <4 days old. We hypothesized that a lower NLR will be associated with nonsurvival.

ANIMALS

One thousand one hundred ninety-six client-owned foals <4 days old of any breed and sex: 993 hospitalized foals and 203 healthy foals.

METHODS

Retrospective multicenter study. Medical records of foals presenting to 3 equine referral hospitals were reviewed. Foals were included if they had complete CBCs, sepsis scores, and outcome data. The NLR was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count. Data were analyzed by nonparametric methods and univariate analysis.

RESULTS

Of the 993 sick hospitalized foals, 686 were sick nonseptic and 307 were septic. The median NLR was lower in sick hospitalized foals (median [95% confidence interval], 3.55 [0.5-13.9]) compared with healthy foals (6.61 [3.06-18.1]). Septic foals had the lowest NLR (2.00 [0.20-9.71]). The NLR was lower in nonsurviving (1.97 [1.67-2.45]) compared with surviving foals (4.10 [3.76-4.33]). Nonsurviving septic foals had the lowest NLR (1.47 [1.70-3.01]). Foals with a NLR of <3.06 or <1.6 at admission had odds ratio of 3.21 (2.24-4.29) and 4.03 (2.86-5.67) for nonsurvival, respectively.

CONCLUSIONS AND CLINICAL IMPORTANCE

A NLR < 3.06 at admission in sick hospitalized foals is readily available and clinically useful variable to provide prognostic information.

Evaluation of Different Methods to Estimate the Transfer of Immunity in Donkey Foals Fed with Colostrum of Good IgG Quality: A Preliminary Study

Simple Summary

Little is known about the passive transfer of immunity in donkey foals and about the different types of analysis that can be performed to assess it. The aims of the present study were to evaluate the correlation between IgG Serum Radial Immunodiffusion, Electrophoresis Gamma Globulins, Electrophoresis Total Protein and the Serum Total Protein analyzed by Refractometry and by Dry Chemistry Analyzer (Biuret) and to estimate serum IgG concentrations using Serum TP. IgG Serum Radial Immunodiffusion showed a good correlation with Electrophoresis Gamma Globulins and a high correlation with Total Protein Electrophoresis, Biuret and Refractometry. All the tests performed may be a useful to estimate the serum IgG in donkey foals’ blood in the first day of life using a specific equation.

Abstract

The aims of the present study were to evaluate the correlation between IgG Serum Radial Immunodiffusion (SRID), Electrophoresis Gamma Globulins (EGG), Electrophoresis Total Protein (ETP) and the serum total protein (TP) analyzed by refractometry and by a dry chemistry analyzer (Biuret) and to estimate serum IgG concentrations using serum TP. A total of 36 samples collected at four different times (birth, 6, 12, 24 h after birth) from nine Amiata donkey foals were evaluated with SRID, EGG, ETP, serum TP Biuret and refractometry. SRID IgG concentration increased significantly over time until T12. Serum TP analyzed with refractometry, electrophoresis and Biuret showed a statistically significant difference between T0 and T6 vs. T12 and T24. A good or strong correlation was found between different tests performed. Equations to quantify serum IgG were created and can be used for estimating the donkey foals’ serum IgG in the first day of life. Serum TP refractometry showed a high correlation with SRID IgG (0.91) which may be a particularly useful and economic instrument to estimate the transfer of immunity in donkey foals during the first day of life. Further studies evaluating a high number of animals are needed in order to set specific cut-off values.

Effect of plasma transfusion on neutrophil function in healthy and septic foals

OBJECTIVE

To evaluate the effect of plasma transfusion on phagocytosis and oxidative burst activity of peripheral blood neutrophils from healthy and septic equine neonates with sub-optimal passive transfer of maternal immunity.

ANIMALS

Nine healthy and seven septic foals with suboptimal passive transfer of maternal immunity (serum IgG < 8 g/L) presented to participating veterinary hospitals for plasma transfusion, and seven healthy foals less than 7 days of age and with circulating IgG concentrations > or = 8 g/L.

PROCEDURE

Foals with serum IgG concentrations < 8 g/L were assessed as healthy or septic. Sepsis was recognised by positive bacterial cultures and/or sepsis scores of > or = 11. All foals received between 1 and 3 L of plasma to boost circulating IgG concentrations to > or = 8 g/L. Serum IgG concentrations were determined before and following transfusion by glutaraldehyde coagulation test and confirmed by single radial immunodiffusion assays. Neutrophil phagocytosis and oxidative burst activity were determined before plasma transfusion and at 0 h, 12 h, 24 h, 48 h and 5 d following treatment. Neutrophil function from seven healthy foals less than 7 d of age and with circulating IgG concentrations of > or = 8 g/L was similarly evaluated on a single occasion.

RESULTS

Plasma treatment significantly increased circulating IgG concentrations for healthy and septic foals. Oxidative burst activity of neutrophils from septic foals was significantly increased 5 days following treatment, relative to 0 h post treatment. Other differences were not significant but suggested a transient decrease in phagocytosis by neutrophils from healthy foals and increased phagocytosis by neutrophils from septic foals immediately following transfusion. Oxidative burst activity of neutrophils from septic foals tended to be less than that of healthy foals at all sampling times. Serum IgG concentrations were not correlated with neutrophil phagocytosis, but were correlated with oxidative burst activity.

CONCLUSIONS

Plasma transfusion did not improve neutrophil function of healthy foals, suggesting that such treatment may be of equivocal benefit for healthy neonates. Conversely, improved neutrophil function was observed following treatment of septic foals, suggesting that plasma transfusion was beneficial for these foals. Oxidative burst activity of neutrophils from septic foals was lower than that of neutrophils from healthy foals and was significantly improved 5 days post treatment, when compared with values obtained immediately following treatment.

Secondary immunodeficiencies of horses

FPT of immunoglobulin in foals is the commonest form of acquired immunodeficiency in horses. FPT predisposes foals to bacterial infections and septicemia and easily is preventable and treatable if breeding farms and veterinarians are attentive to optimum foaling management practices. Other forms of acquired immunodeficiencies are uncommon in horses, although immune function may be transiently suppressed by a wide variety of drugs, infections, or other conditions. As immunologic testing becomes more sophisticated and more readily available to equine practitioners, acquired immunodeficiencies are likely to be characterized more frequently in horses.

Pharmacologic considerations in the treatment of neonatal septicemia and its complications

This article focuses on the pharmacologic properties of drugs commonly used in the treatment of neonatal septicemia and its complications. Rational therapy demands an awareness of not only the pharmacology of individual drugs but also the interactions and anticipated fate of such drugs in the rapidly changing physiologic environment of the neonate. Further research in the area of equine neonatal pharmacology should greatly assist our understanding of the impact of the disease state on the unique physiology of the newborn and should allow us to better predict the ultimate fate of drugs commonly used for such purposes. Careful dosing and close monitoring of pharmacologic effects are critical for a successful outcome. In the future, newer therapeutic strategies that are safe and efficacious may provide a means to circumvent many of the problems currently encountered with treating the septicemic newborn foal.

The incidence and consequences of failure of passive transfer of immunity on a thoroughbred breeding farm

Circulating IgG concentration was determined between 12 and 24 hours after birth for 323 foals born on a Thoroughbred breeding farm over 3 consecutive years. The incidence of failure of passive transfer (FPT) of maternal immunoglobulins (foal circulating IgG concentration < 8 g/L) was found to be 9.6%. Foals born late in the season (October to December) were found to be at increased risk for the development of FPT. The degree of assistance required at parturition and the presence of a periparturient problem in the mare or foal also significantly influenced the subsequent incidence of FPT. Passive immune status significantly influenced the likelihood of foals developing septic illness (joint ill, septicaemia, pneumonia) in the first month of life, but had no significant effect on the development of diarrhoea or Rhodococcus equi pneumonia. The results of the current study support the value of routine monitoring of passive immune status and the early speculative treatment of foals considered to be at risk for the development of FPT.

Equine neonatal septicaemia: 24 cases

Equine neonatal septicaemia was confirmed in 24 foals hospitalised at the Rural Veterinary Centre between 1989 and 1992 with suspected septicaemia. Septicaemia was confirmed by culture of bacteria from blood of live foals and tissues obtained at necropsy of foals that died or were euthanased. Pathogenic bacteria isolated were predominantly Enterobacteriaceae (including Escherichia coli and Salmonella serovars) and Actinobacillus equuli. Clinical manifestations of septicaemia included signs of depression, dehydration, abnormalities in body temperature and manifestations of localised infection including diarrhoea, pneumonia, and septic arthritis. Most common haematological abnormalities were neutropenia and increase of circulating band neutrophils. Survival rate of foals with confirmed septicaemia was 70.8%. Survival was found to be less likely in the presence of pneumonia, severe signs of depression, marked haematological changes or septic arthritis at the time of admission. Seven foals were confirmed to have septic arthritis without concurrent septicaemia. Of these, 4 had multiple joint involvement. Bacteria isolated from infected joints were predominantly Salmonella serovars. Four foals with septic arthritis failed to survive, due to multiple joint infection, which was unresponsive to treatment. The clinical and haematological abnormalities present in foals with confirmed septicaemia and septic arthritis were consistent with those observed in other studies. The bacterial isolates from foals with confirmed septicaemia were similar to those isolated in other studies. In contrast, the bacteria isolated from foals with septic arthritis without concurrent septicaemia were different from other studies.

A prospective study of septicaemia in colostrum-deprived foals

Fourteen mares and their foals were attended at parturition. After mare-foal bonding, 8 colostrum-deprived (CD) foals were removed from their dams, deprived of colostrum, and provided with an alternative milk source for the first 24 h of life. The mares were milked out every 2-4 h during this period to remove colostrum, after which the CD foals were returned to their mares and allowed to nurse. Six colostrum-fed (CF) foals were allowed to suck colostrum in the normal manner. Foal serum IgG concentration was determined by single radial immunodiffusion (means, CD = 0 mg/dl; CF = 1,508 mg/dl). Accepted methods were used to minimise infections in the neonatal foals. Of the 8 CD foals, 7 demonstrated clinical signs of sepsis. Septicaemia was confirmed in 5 of the 7 septicaemic CD foals by ante-mortem blood culture or by culture of tissue at necropsy. Organisms isolated included: Actinobacillus equuli, Escherichia coli, undifferentiated coliforms, Pseudomonas spp., and Actinomyces pyogenes. Clinically ill foals were treated with antimicrobial drugs, intravenous fluid therapy, flunixin meglumine, and anti-endotoxin hyperimmune serum. Three septicaemic CD foals survived. Four of 7 septicaemic CD foals died or were destroyed. Post-mortem lesions included bacterial embolic pneumonia, glomerulonephritis/nephritis, lymphoid depletion/atrophy, splenic and lymphoid necrosis, hepatitis, septic arthritis, and systemic bacterial embolism. None of the CF foals became septicaemic. One CF foal had foal heat diarrhoea and 1 CF foal had a serum IgG concentration of 160 mg/dl (i.e. failure of passive transfer), but both foals were otherwise normal.(ABSTRACT TRUNCATED AT 250 WORDS)

Influence of age on neutrophil function in foals

Functional activities (phagocytosis and killing) of neutrophil leucocytes (NL) and immunoglobulin G concentrations were evaluated in six healthy foals from birth to 6 months of age. Peripheral blood NL were reacted with Streptococcus equisimilis in 20 per cent pooled equine serum for 30, 60 and 90 mins and functional activities of NL were determined using a fluorochrome microassay. Values for foal NL function were compared with those of healthy adult horses (n = 28). Foal neutrophil function was influenced by age. Killing capacity of NL decreased, whereas phagocytic capacity increased, until 113 days of age, after which a reversal in trends became apparent. Immunoglobulin G concentrations changed significantly over time and were lowest at 29 to 56 days of age. All foal values for NL function fell within the range of normal values established for healthy adult horses.

Evaluation of a test kit for determination of serum immunoglobulin G concentration in foals

The accuracy of an immunoglobulin (Ig) G test kit for the semiquantitative measurement of IgG concentration was evaluated with serum from 88 foals. Failure of passive transfer (IgG less than 400 mg/dl) was correctly identified in each of 34 samples, and partial failure of passive transfer (400 less than or equal to IgG less than 800 mg/dl) was correctly identified in each of nine samples. Evidence of adequate passive transfer (IgG greater than or equal to 800 mg/dl) was detected in 44 of 45 samples. One sample with 800 mg/dl or more of IgG was incorrectly classified as a partial failure of passive transfer (Kendall Tau - b = .975). The high degree of accuracy, especially without any errors of overestimation of IgG concentrations, indicated that the IgG test kit should be a useful assay for rapidly determining the passive transfer status of foals.