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Discussion on Endocarditis? | |
Author | Message |
Member: Bystrom |
Posted on Thursday, Nov 20, 2003 - 10:52 pm: Hi:About a month ago, my yearling came down with a severe case of pneumonia. He was treated, and all seemed to be going well. This morning, when he was brought into the barn, I noticed significant ventral edema (pectoral muscles and distal sheath). Checked a temp - 101.1. He seemed in no acute distress, yet was a bit lethargic. His heart rate was 80, and respirations were 20. I listened to heart tones and heard what sounded like a friction rub. Couldn't detect murmurs over the sound of the rub. Our vet was called. He felt, that the friction rub was possibly being caused by a pericardial effusion. He did an ultrasound, and although it wasn't as difinitive as an echo, he wasn't able to detect any significant amount of fluid in the pericardial sac. Upon further examination of the heart tones, he did hear a systolic murmur. Felt we may be dealing with an endocarditis, since my gelding just had pneumonia. Blood cultures are pending, and Rudy was given Naxcel IM, and Gent IV, as well as some Banamine. I'll be continuing the Naxcel pending blood culture results. His WBC count was 8.7 today with 78% neutrophils. I guess my question is what are long term effects of endocarditis? If the infection is on the valves, once the infection clears, will he have normal valve function as before? I understand it would depend upon the severity, but just wondering if the horse world is similar to the human world with subacute and acute phases of this sort of thing. Thanks for any input. Lynn |
Moderator: DrO |
Posted on Friday, Nov 21, 2003 - 7:02 pm: Really the question is, "what is wrong with your foal" and "what is your foals prognsosis"? I cannot see how we can possible answer these questions with the information you have so far.A more frequent complication of pneumonia and one usually accompanied by ventral edema would be pleuropneumonia. This should be diagnosed with ultrasound however it can occur in localized pockets and missed if not looked for intensively. This is important to rule out because surgical drainage greatly improves the prognosis. This is true for pericarditis too. If the laboratory and physical exam continue to suggest something more than simple viremia or septicemia and if advanced, expensive, techniques in the face of less than a good prognosis are an option, you should consider referral to a center that can radiograph the chest and has advanced ultrasound machinery available. DrO |
Member: Bystrom |
Posted on Saturday, Nov 22, 2003 - 7:55 pm: Dr. O:I appreciate your input. Rudy is scheduled for an echo on Monday, and nothing has up until this point grown out on the blood cultures. His lungs are clear, and there's no plerual friction rub. I guess maybe my question was misleading in that I wasn't looking for a difinitive diagnosis based on these early results, just wondering if you've seen much endocarditis over the years, and could shed some light on it. I haven't been able to find much information about it, as far as long term prognosis. Heck, maybe there isnt' a long term prognosis. We'll be findin out more on Monday. Again, thank you for your input. Lynn |
Moderator: DrO |
Posted on Sunday, Nov 23, 2003 - 7:33 pm: I know Lynn, these are worrisome times when our horses are sick. Actually I have not had a case of acute endocarditis though I have seen two chronic cases. Exercise intolerance and murmurs led us to the diagnosis. But always, first diagnose as best you can, then prognose. Between then and now realize that there are many conditions that might present this way, mostly viral diseases, with a good to excellent prognosis.DrO |
Member: Bystrom |
Posted on Monday, Nov 24, 2003 - 4:22 pm: Dr. O:Wellllllll, Rudy's heart tones are sounding better....they're more crisp, and I'm unable to detect a murmur anymore. Still has quite a bit of ventral edema, and we found out today that blood cultures did grow out Gram+ bacteria. It's appearing at this point to be strep. We had to postpone the echo scheduled for today, to later in the week. Snowstorms......UGH! I hate winter. |
Moderator: DrO |
Posted on Monday, Nov 24, 2003 - 7:09 pm: In humans strep is a big cause of endocarditis and prolonged antibiotic therapy is recommended to prevent it: 30 days? It is important to realize that even if your culture shows sensitivity to TMP-sulfa with strep it may not be effective. Stay with the penicillins if this turns out to be it.DrO |
Member: Bystrom |
Posted on Monday, Nov 24, 2003 - 8:30 pm: Dr. O:Just waiting on a call back from my vet. He's not aware that the cultures turned positive (I had them done at work. shhhhhhhhh). From what I've been reading in your medication section, something like Ancef might be more effective, if this strain isn't resistant to it. I was looking at different meds because Rudy isn't drinking near enough to keep his kidneys flushed with the TMP-SMZ...just my opinion. I also held his Lasix tonight, due to his lack of fluid intake. I think my vet went Christmas shopping......guess he's entitled to a day off. Hopefully will hear something yet tonight from him, and will also pass on your thoughts. Thank you. |
Member: Bystrom |
Posted on Saturday, Nov 29, 2003 - 10:23 pm: Rudy was euthanized tonight. He went into acute renal failure, and began to show signs of laminitis. Since my last post on Monday, we had stopped lasix, SMZ and bute. Went strictly with PCN. We won't be getting a necropsy, although I'm sure it probably would've helped science. My heart just wouldn't let me do it. |