Table 3 . In-house laboratory test results .
Test
White blood cell count (× 10 9 / l )
Red blood cell count (× 10 12 / l )
Result
Reference range
8.5 6.7 – 11.9
13.8 ↑ 7.5 – 11.5
Packed cell volume ( l / l ) 44 ↑ 30 – 41 Total protein ( g / l ) 28 ↓ 52 – 64 Glucose ( mmol / l ) 11.3 ↑ 3.4 – 5.9 Lactate ( mmol / l ) 3.8 ↑ < 2 Triglycerides ( mmol / l ) 1.94 0.26 – 2.6
Table 4 . External laboratory test results .
Test Result
Reference range
Total protein ( g / l ) 28 ↓ 52 – 64 Albumin ( g / l ) 17 ↓ 31 – 38 Globulin ( g / l ) 11 ↓ 18 – 29 AST ( iu / l ) 164 ↓ 232 – 441 GGT ( iu / l ) 4 ↓ 10 – 30 SAP ( iu / l ) 157 ↓ 500 – 1200 Urea ( mmol / l ) 14.3 ↑ 4.6 – 8.0 Creatinine ( mmol / l ) 180 ↑ 93 – 128 Serum amyloid A ( mg / l ) 2219.7 ↑ 0 – 10 Calcium ( mmol / l ) 2.2 ↓ 2.7 – 3.3 Sodium ( mmol / l ) 127 ↓ 130 – 140 Potassium ( mmol / l ) 3.2 ↓ 3.6 – 4.0 Chloride ( mmol / l ) 86 ↓ 97 – 105 Magnesium ( mmol / l ) 0.44 ↓ 0.6 – 0.9
Reference ranges given are for a Thoroughbred weanling / yearling . AST = aspartate transaminase ; GGT = gamma-glutamyl transferase ; SAP = serum alkaline phosphatase .
Initial blood evaluation revealed marked hypoproteinaemia with hypoalbuminaemia and hypoglobulinaemia , raising concern of a proteinlosing enteropathy . Serum amyloid A ( SAA ), an inflammatory marker , was increased and there were several electrolyte abnormalities . Peripheral lactate was measured to check tissue perfusion , with hyperlactataemia noted at 3.8 mmol / l . The blood biochemistry profile revealed a significant degree of azotaemia , with urea at 14.3 mmol / l and creatinine at 180 mmol / l , likely due to the patient ' s dehydration .
The L . intracellularis serology had a low positive titre , at the cut-off level , which supported a weak antibody response to exposure – either to infection or to L . intracellularis vaccinations . Tests were performed for other enteropathogens as co-infection can occur , but the redworm and tapeworm serology were negative .
Faecal samples were obtained over 3 days and sent to the external laboratory to test in a diarrhoea panel ( older foal ). The results are detailed in Table 5 .
Table 5 . Diarrhoea panel ( older foal ).
Test
Clostridium difficile / perfringens ELISA
Salmonella culture (× 3 samples ) L . intracellularis PCR Worm egg count
Ultrasound imaging showed thickening of the small intestinal wall ( approximately 8 mm ) and thickening of the large intestinal wall ( up to 1 cm ). Normal mural thickness of the small intestinal wall is 3.5 mm [ 5 ] , but has not been defined specifically for the weanling age group .
Diagnosis
The differential diagnoses are presented in Table 6 .
Table 6 . Differential diagnoses .
Diagnosis L . intracellularis infection Malnutrition
A diagnosis of L . intracellularis infection was confirmed by PCR and serology . This diagnosis was consistent with the clinical signs , significant hypoproteinaemia and hypoalbuminaemia , and ultrasonographic findings .
Treatment
Initial treatment and nursing care plan
Result
Infectious diarrhoea of other aetiology Parasitism
Negative
Negative Positive None seen
A 14 G × 20 cm single-lumen long-stay over-thewire polyurethane intravenous catheter ( IVC ) ( Mila International ) was inserted into the left jugular vein aseptically . For a plasma transfusion , 2 litres of frozen
22 Veterinary Nursing Journal