CASE 2 SIGNALMENT & HISTORY Slide 1 6 months-old Warmblood colt ------------------------------------------------------------------------------------------------ Four day history of : Fever (39.5°C) Depression Decreased appetite Lying down more than usual Treated by referring veterinarian with flunixin and trimethoprim sulfonamides for 4 days: no clinical improvement Parasite status: dewormed with a single dose of fenbendazole at 2 and 5 months of age; new horse on premises with unknown parasite status No other sick horses or other sick foals Slide 1

CLINICAL FINDINGS ON ARRIVAL Calm but alert Slightly unthrifty, poor hair coat HR 56 bpm / RR 30 bpm / T 38.6 ˚C Moist and pink mucous membranes, capillary refill time 2sec Mild to moderately enlarged submandibular lymph nodes Mild bilateral mucous nasal discharge Cardiac auscultation: normal Respiratory auscultation: crackles diffusely over both lung fields Abdominal auscultation - normal gut sounds Eating and drinking normally Soft feces List the clinical problems using information obtained from the history and physical examination Slide 2

Haematology results on arrival   Foal Reference PCV (l/l) 0.44 0.31-0.43 Haemoglobin (g/dL) 15.6 10.1-16.1 MCV (fl) 37 37.0-49 MCH (pg) 13.1 13.7-18.2 MCHC (g/dl) 35.4 35.3-39.3 WBC (x109/L) 7.9 5.5-12.1 Neutrophils (x109/L) 4.6 2.9-8.5 Lymphocytes (x109/L) 3.20 1.16- 5.1 Monocytes (x109/L) 0.10 0.0-0.7 Eosinophils (x109/L) 0.8 0.0-0.8 Platelets (x109/L) 213 117-256 Blood smear cytology: No abnormal cells seen Identify the major haematological abnormalities. What is your interpretation?

Biochemistry on arrival   Foal Reference SAA (mg/L) 3642 0-20 Fibrinogen (g/L) 5.22 0.3-3.9 Urea (mg/dL)) 25 7.0-28.0 Creatinine (umol/L) 1.1 0.96-1.86 Total bilirubin (mg/dL) 1.7 0.1-2.5 AST (IU/L) 182 102-350 GGT (IU/L) 5 1-40 Total Protein (g/L) 30 53-73 Albumin (g/L) 10 29-41 Creatine Kinase (IU/L) 531 110-250 Glucose (mg/dL) 113 77.4-140 Triglycerides (mmol/L) 0.79 0.2-1.2 Identify the major biochemical abnormalities, RANKING them in order of significance. What is your interpretation?

Blood gas analysis (venous) & electrolytes on arrival   Foal Reference pH 7.362 7.345-7.433 pCO2 (mmHg) 40.4 38-48 HCO3 (mmol/L) 21.9 22-29 Base excess (mmol/L) -2.2 pvO2 40.7 37-56 Lactate (mmol/L) 1.1 <2 Na (mmol/L) 122 134-142 K (mmol/L) 3.7 3.0-5.0 Cl (mmol/L) 95 95-103 Ca ionized (mmol/L) 1.45 1.45-1.73 Magnesium ionized (mmol/L) 0.42 0.4-0.57 Interpret the venous blood gas and electrolyte analysis

Free catch urine sample results  Dipstick Qualitative protein Very mild + Qualitative glucose - Qualitative ketones Qualitative blood pH 6.0 Specific Gravity 1.026 Cytology findings   WBC microscopy Occasional cell RBC microscopy Epithelial cells RBC casts Negative WBC casts Bacteria Crystals Occasional Interpret the urinary analysis

Abdominocentesis results   Result Macroscopic Clear and not coloured Protein (g/dL) Lactate (mmol/L) Total cell count (x109/L) 0.28 Neutrophils (%) 73.5% Interpret the abdominocentesis

What are your chief differential diagnosis in order of likelihood at this stage? Comment on which complementary examinations you would chose to further differentiate between the main differential diagnoses

Thoracic US

Pulmonary investigation Thoracic radiographs: mild broncho-interstitial pattern, no abscesses Tracheal aspirate cytology: 52.5% neutrophils (toxic & degenerative changes) 41% macrophages (active) 6.5% lymphocytes Intra- and extra cellular cocci are visible Tracheal aspirate bacteriology : pending

Fecal analysis Fecal egg count MacMaster: 340 EPG Strongyles 0 EPG Parascaris equorum Salmonella (culture) : negative Clostridium (rapid membrane bound immunoassay): Negative for Clostridial antigens Negative for Clostridial toxins Sand sedimentation test: no sand Succeed fecal occult blood test: Negative for hemoglobin Positive for protein Lawsonia PCR : positive

Abdominal ultrasonography (left ventro-caudal abdomen, 5 MHz probe) small intestinal walls up to 0.8cm

Evolution Clinical deterioration after admission More severe depression Complete anorexia Increased heart rate (80bpm) Higher fever (39.6°C)

Evolution Following treatment gradual improvement Day 4: acute, severe colic => exploratory laparotomy Euthanasia