Plus-Hex CLINICAL
The patient ' s perineum and tail should be cleaned regularly and a lubricant , such as baby oil or Vaseline , can be applied to protect the skin from irritation . If the skin appears red and sore , Sudocrem , Flamazine or Bepanthen Nappy Care Ointment could be applied to ease irritation . The tail can be covered with a rectal sleeve to protect it from diarrhoea ; this should be changed daily and when soiled .
Nutrition was an important part of the recovery of the patient in this case . The nursing team spent a lot of time encouraging the patient to eat , trying different feeds and hand-picking fresh grass for the patient .
Preventative measures
Following studies in the USA , an L . intracellularis vaccine developed for pigs can now be administered to foals via an enema . The vaccine is given around 30 days before the date when cases presented in the previous season , followed by a second dose a month later [ 10 ] . Further information is available in the fact sheet cited in the further reading section at the end of this article .
Conclusions
Veterinary nurses play an essential role in the high level of intensive and supportive care that EPE patients require . Although challenging , nursing cases such as these can be very rewarding . There is usually a rapid clinical improvement once the patient begins treatment , but it can be many weeks before the hypoproteinaemia is resolved .
This case had a positive outcome : the recovered patient was sold as a yearling and went into training . However , an infection with L . intracellularis can , in certain cases , result in death , particularly if the patient develops secondary complications such as peritonitis or necrotising enteritis .
REFERENCES
1 Page AE , Slovis NM , Horohov DW . Lawsonia intracellularis and equine proliferative enteropathy . Veterinary Clinics of North America : Equine Practice . 2014 ; 30 ( 3 ): 641 – 658 . Available from : https :// doi . org / 10.1016 / j . cveq . 2014.08.001 .
2 Page AE , Fallon LH , Bryant UK , Horohov DW , Luna TW , Marsh PS , et al . Acute deterioration and death with necrotizing enteritis associated with Lawsonia intracellularis in 4 weanling horses . Journal of Veterinary Internal Medicine . 2012 ; 26 ( 6 ): 1476 – 1480 . Available from : https :// doi . org / 10.1111 / j . 1939-1676.2012.01002 . x .
3 Slovis N . Management of equine proliferative enteropathy . In Practice . 2016 ; 38 ( 6 ): 287 – 292 . Available from : https :// doi . org / 10.1136 / inp . i2797 .
4 Pusterla N , Gebhart CJ . Lawsonia intracellularis infection and proliferative enteropathy in foals . Veterinary Microbiology . 2013 ; 167 ( 1 – 2 ): 34 – 41 . Available from : https :// doi . org / 10.1016 / j . vetmic . 2013.06.017 .
5 McAuliffe SB . Neonatal examination , clinical procedures and nursing care . In : McAuliffe SB , Slovis NM . ( eds .) Colour Atlas of Diseases and Disorders of the Foal . Philadelphia : Elsevier Saunders ; 2008 . p . 43 – 78 .
6 Burgess BA , Morley PS . Infection control in equine critical care settings . Veterinary Clinics of North America : Equine Practice . 2014 ; 30 ( 2 ): 467 – 474 . Available from : https :// doi . org / 10.1016 / j . cveq . 2014.04.009 .
7 Mama KR , Hector RC . Therapeutic developments in equine pain management . The Veterinary Journal . 2019 ; 247 : 50 – 56 . Available from : https :// doi . org / 10.1016 / j . tvjl . 2019.02.010 .
8 Hassel DM , Smith PA , Nieto JE , Beldomenico P , Spier SJ . Di-trioctahedral smectite for the prevention of post-operative diarrhea in equids with surgical disease of the large intestine : results of a randomized clinical trial . The Veterinary Journal . 2009 ; 182 ( 2 ): 210 – 214 . Available from : https :// doi . org / 10.1016 / j . tvjl . 2008.06.016 .
9 Carr EA . Enteral / parenteral nutrition in foals and adult horses : practical guidelines for the practitioner . Veterinary Clinics of North America : Equine Practice . 2018 ; 34 ( 1 ): 169 – 180 . Available from : https :// doi . org / 10.1016 / j . cveq . 2017.11.012 .
10 Pusterla N , Vannucci FA , Mapes SM , Nogradi N , Collier JR , Hill JA , et al . Efficacy of an avirulent live vaccine against Lawsonia intracellularis in the prevention of proliferative enteropathy in experimentally infected weanling foals . American Journal of Veterinary Research . 2012 ; 73 ( 5 ): 741 – 746 . Available from : https :// doi . org / 10.2460 / ajvr . 73.5.741 .
Further reading
Rossdales Veterinary Surgeons . Lawsonia intracellularis infection : an emerging but manageable condition ? Available from : https :// www . rossdales . com / assets / files / Lawsonia-intracellularis-infection . pdf [ Accessed 21 February 2024 ].
Volume 39 ( 2 ) • April 2024
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