Term
| Is EPM a herd problem or an individual problem? |
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Definition
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Term
| What is the typical age of horses affected by EPM? |
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Definition
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Term
| What are the clinical signs of EPM? |
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Definition
-VARIABLE: can look like anything
-muscle atrophy of quads & gluteals
-asymmetric ataxia
-gait + muscle atrophy can look like Sweeney or radial n paralysis
-brainstem involvement: dec tongue tone, head tilt, facial n paralysis, chewing m atrophy
-worse when head is elevated or when on incline |
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Term
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Definition
-SAG 2/3/4 w/ CSF Index or IFAT
-CSF & blood |
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Term
| What are some major differentials for EPM? |
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Definition
-CVSM
-WNV
-EHV
-trauma
-EEE, WEE
-EDM
-verminous myeloencephalitis
-rabies |
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Term
| Why does TMS + pyrimethamine work to tx EPM? OUtline the protocol. |
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Definition
-blocks folate metabolism in protozoan
-tx for 5m w/ bi-monthly monitoring of PCV |
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Term
| Why do we caution using TMS + pyrimethamine to treat EPM in stallions? |
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Definition
| -can block sperm folate metabolism |
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Term
| In addition to TMS + pyrimethamine, what else can we use to treat EPM? |
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Definition
-Diclazuril
-Ponazuril
-Decoquinate/Levamisole (trial phase)
-anti-inflamms: Flunixin meglumine |
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Term
| Why is the use of glucocorticoids controversial to treat EPM? |
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Definition
| -there might be an immunosuppression component & good evidence to support worsening of signs |
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Term
| What supportive care is needed for EPM horses? |
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Definition
-padded helmets
-slings
-deeply bedded/padded stall
-supportive fluids & nutrition if needed |
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Term
| What is the prognosis of EPM? |
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Definition
-60-75% improve 1 grade
<25% return to normal activity |
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Term
| What is the rate of recurrence w/ EPM? |
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Definition
-TMS-Pyrimethamine: 10-28%
-Diclazuril <5% |
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Term
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Definition
-vx is crap
-prevent wildlife access to feed
-keep premises clear of dead cats, armadillos, skunks, and raccoons
-dex exposure of horses to opossums |
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Term
| In general, describe Equine Herpes Myeloencephalopathy. |
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Definition
-diffuse, multifocal CNS lesions
-vasculitis, hemorrhage, thrombosis, ischemic neuronal injury |
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Term
| Which virus is EHM most commonly associated? |
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Definition
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Term
| EHM vx may not be protective against neuro manifestations. Which form of the vx is the best? |
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Definition
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Term
| What is the typical history of EHM? |
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Definition
-multiple horses on premises affected
-recent hx of fever, resp dz, or abortion on farm |
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Term
| True or False: The majority of horses have not been exposed to EHM. |
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Definition
| -FALSE, the majority of horses have been exposed |
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Term
| Describe the timeline of EHM. |
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Definition
-incubation period is 2-10d
-CS resolve in 1-2w |
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Term
| How long does immunity last for EHM after infection? |
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Definition
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Term
| How do horses get naturally infected w/ EHM? |
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Definition
-inhalation or ingestion of aerosolized birus
-direct contact w/ abortion fluids/tissues, nasal or ocular discharge or saliva of infected horses |
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Term
| What is the typical seasonality of EHM? |
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Definition
| -late winter, spring, early summer |
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Term
| When during pregnancy must a mare be infected w/ EHM for the neuro form to occur? Abortive form? |
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Definition
-neuro form: first two trimesters
-abortive form: last trimester |
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Term
| Neuro signs due to EHM typically develop 6-10d after infection however they can be preceded or accompanied by other signs. What are those other CS? |
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Definition
-upper resp signs
-fever
-inappetance
-hind limb edema |
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Term
| What are the neuro signs of EHM? |
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Definition
-ataxia, paresis of limbs
-hypotonia of tail and anus
-urinary incontinence
-symmetric > asymmetric
-PL affected earlier & more severely |
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Term
| What CP deficits do we see w/ milder EHM? |
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Definition
-reluctance to move
-clumsiness
-toe dragging
-knuckling
-stumbling
-pivoting
-circumduction on circling |
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Term
| What CS do we see w/ severe EHM? |
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Definition
-profound limb weakenss
-swaying of hind quarters
-paralysis of affected limbs
-dog sitting
-complete recumbency
-tetraplegia
-urinary incontinence |
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Term
| Why are EHM euthanasias particularly emotionally taxing? |
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Definition
| -horses typically remain alert & appetent |
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Term
| What are the major differentials for EHM? |
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Definition
-WNV
-EEE, WEE
-CVSM
-EPM
-trauma
-rabies
-verminous myeloencephalitis
-botulism
-EDM: depending on age |
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Term
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Definition
-CSF: xanthochromia, inc protein
-virus isolation: may be negative
-PCR
-serologic titers: 4x inc |
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Term
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Definition
-prompt isolation
-supportive nursing & nutritional care
-reduce CNS inflammation: anti-inflamm or immunosuppressives
-anti-virals |
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Term
| What kind of supportive care is needed for EHM cases? |
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Definition
-protection from self-inflicted trauma
-make food & water easily accessible
-maintain in sternal, sling if possible
-maintain hydration
-laxative diet to avoid impaction
-appropriate caloric intake
-urinary bladder catheterization
-anti-inflamm or immunosuppressives
-ANTI-VIRAL MEDS |
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Term
| What is the prognosis of EHM? |
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Definition
-god if they remain standing: variable healing rates (few days to 1y)
-poor if they become recumbent |
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Term
| What are some control measures for EHM? |
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Definition
-minimize contact: aerosol, direct contact, fomites
-minimize stress
-isolate suspect animals immediately
-isolate exposed animals for 30d, pregnant mares until they foal
-fetuses & membranes bagged & disposed of for necropsy
-vx unexposed animals |
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