Curing a Strangles Carrier

[shelly19]

My new horse quickly developed Strangles after arrival which was left to run it's course. It appears very well now but pus was found in a gutteral pouch which was flushed and treated with Penicillin. Vet was confident that the follow up visit would be just a check up but found more pus. Another wash was performed but the pus wouldn't budge and vet said it must be an aggressive strain of the disease. Now the horse has a catheter up it's nose and Penicillin to be administered every 2 days for 14 days to try to clear it.
Has anyone else had a similar experience? Losing all confidence that the horse will ever be rid of this blasted disease.

 

[Equi]

If the horse is still strong and willing, push on. I hope it clears soon.

 

[shelly19]

If the horse is still strong and willing, push on. I hope it clears soon.

Thank you. The horse is 3 years old, wouldn't say strong but very willing and sweet. Managed to contain it but after 3 months people on the yard yard are not happy. They've missed shows etc and there seems to be no end in sight as the infection isn't budging.

 

[Dry Rot]

Has the vet done any sensitivity tests? Just repeating the same treatment may not be the best way to get results.

 

[shelly19]

Has the vet done any sensitivity tests? Just repeating the same treatment may not be the best way to get results.

No, they've said there's an amount of pus that won't budge and treating with Penicillin. Would appreciate any alternatives as the disease isn't budging and the vet say's they've not seen this before.

 

[Dry Rot]

If an infection doesn't clear up with one antibiotic, it may do with another. Using a sensitivity test, a vet will make a culture of the errant bacterium and test different antibiotics to see which is the most effective. As we all know, these days some don't work as well as they used to because bacteria are becoming resistant.

I first learnt about this when a surgeon friend had a dog with a sinus infection (rhinitis) which is very difficult to shift, so not disimilar to a gutteral pouch infection. Sinuses are deep pockets inside the skull and very hard to get at. I have experience of this problem in a few of my own dogs and had considered it uncurable. At least, that's what my vet said. Yet my surgeon friend cured his dog. Of course, it might have been just a coincidence, but worth mentioning? I am not a vet!

 

[ycbm]

Has your vet mentioned drilling a hole in the head to get into the infection more easily? I have seen several persistent guttoral pouch infections cleared this way.

I'm not sure your horse counts as a carrier. S/he has an active infection. Carriers are horses which can infect others while having no active symptoms themselves, I think.

 

[Shay]

Strangles can be a B to clear. But at least it sounds as if your yard are doing the right thing in staying locked down until it does.

It would be worth talking to your vet about more aggressive - or at least different! - means of treatment. But every vet has their own preferences and their own experience of strangles. One horse I was involved with recently (not on my yard - a PC Kid's horse) took about 5 months to test clear. Another on the same yard developed complications which took over a year to resolve - although they were not positive for the virus all that time.

 

[The Fuzzy Furry]

Yes, this can be cleared but it can take time, the tube through sinus will really help and does work in just about all cases.
I hope you can look back in a few weeks time and heave a big sigh that its gone - hope things go ok x

 

[Goldenstar]

I do think a senestivity test is called for .
I would asking the vet some very searching questions .
I think treating through the sinus might be the way forwards as well .
Awful for you and all the people on your yard .

 

[Murphy88]

It sounds like your vet is doing the right thing at the moment.
The sinuses are separate structures to the guttural pouches so putting a tube into a sinus is of no use, unless the horse also has sinusitis which it doesn't sound like it does. Culture and sensitivity is always an excellent idea with any infection, however in cases of guttural pouch empyema, we are restricted by what we can safely instill into the pouches. There is lots of very important nerves and vessels running through the pouches, and so you can't put anything in there that is even remotely irritating; I have seen cases left needing tie-backs after well-meaning vets put iodine and other such substances into the pouches because of the scarring causing nerve damage. The penicillin gel formulations used for these cases are safe and usually effective; strangles is a pain but on the whole Strep. equi is not a bacteria with much resistance, and it is usually very sensitive to penicillin. In fact in 5 years of practice, including 2 in specialist referral practice, I have never seen anything other than penicillin gel put in a guttural pouch to treat strangles.

 

[shelly19]

Thanks for the replies. Got to the yard this am and the catheter was on the floor outside the stable so vet is coming out yet again tomorrow to put it in and give the horse the next dose of Penicillin into the gutteral pouch. Vet says it must be a nasty strain of it and is proving hard to get rid of and I was starting losing faith that it ever would. Horse appears very well now so just need it to be safe to be with other horses.

 

[shelly19]

It sounds like your vet is doing the right thing at the moment.
The sinuses are separate structures to the guttural pouches so putting a tube into a sinus is of no use, unless the horse also has sinusitis which it doesn't sound like it does. Culture and sensitivity is always an excellent idea with any infection, however in cases of guttural pouch empyema, we are restricted by what we can safely instill into the pouches. There is lots of very important nerves and vessels running through the pouches, and so you can't put anything in there that is even remotely irritating; I have seen cases left needing tie-backs after well-meaning vets put iodine and other such substances into the pouches because of the scarring causing nerve damage. The penicillin gel formulations used for these cases are safe and usually effective; strangles is a pain but on the whole Strep. equi is not a bacteria with much resistance, and it is usually very sensitive to penicillin. In fact in 5 years of practice, including 2 in specialist referral practice, I have never seen anything other than penicillin gel put in a guttural pouch to treat strangles.

Thank you for this. Horse had catheter fitted on Tuesday which was on the floor Wed morning. Vet has been back tonight and put in a replacement one, although it was the third one she put in as the first two burst when she put the water in. Vet said she'd damaged the catheters with the metal wire that she used to guide the catheter in with and may have used too much water so used less in final one. YO phoned me half hour after leaving the yard to tell me the horse sneezed and catheter was on the floor again. Have you any advice on how to keep the catheter in please?

 

[ycbm]

I think the horse needs a hole in its head ABOVE the infection and a tube put in there. That's why it's done that way, because they don't just fall out when they sneeze. Time for a new vet, maybe, since they have not suggested either culturing and testing the infection to see what antibiotic to treat it with, or flushing from above.

 

[Murphy88]

OP - do you know which type of catheter the vet is using? Unfortunately some horses are just adept at rubbing the catheters out. It sounds like it might be the foley catheter type where you inflate the balloon once it is in the pouch to hold the catheter in? You can also get indwelling catheters with a coil, so you flatten the coil out when it's introduced into the pouch then when the guide is removed it coils back and that hooks it in pouch, because the entrances to the pouches are narrow slits. I know when I worked in the UK/general practice we didn't routinely carry the coil type catheters but maybe your vet could order them in? The other main thing is just securing it really well where it comes out of the nose, so usually taped to a head collar with a wide-holed grazing muzzle over the top. Annoying for the horse to wear a muzzle but better than pulling catheter out all the time.

ycbm - I think you are confusing the guttural pouches with the sinuses. The only surgical approach to the GPs is ventrally (from the throat latch region usually) under general anesthesia. I have no clue how to get pictures on here but if you google guttural pouch anatomy there is lots of pictures, but basically they are the bit in between the middle ear and the pharynx, so a fair way away from the sinuses. If this horse had sinusitis, then absolutely culturing the bacteria and trephining the sinus would be the way forward, but this horse has guttural pouch empyema, for which the treatment is an indwelling catheter and penicillin gel.

 

[Leo Walker]

Dunno if this helps Murphy88

 

[shelly19]

OP - do you know which type of catheter the vet is using? Unfortunately some horses are just adept at rubbing the catheters out. It sounds like it might be the foley catheter type where you inflate the balloon once it is in the pouch to hold the catheter in? You can also get indwelling catheters with a coil, so you flatten the coil out when it's introduced into the pouch then when the guide is removed it coils back and that hooks it in pouch, because the entrances to the pouches are narrow slits. I know when I worked in the UK/general practice we didn't routinely carry the coil type catheters but maybe your vet could order them in? The other main thing is just securing it really well where it comes out of the nose, so usually taped to a head collar with a wide-holed grazing muzzle over the top. Annoying for the horse to wear a muzzle but better than pulling catheter out all the time.

Yes it is they type of catheter with the balloon which she then filled with 40 ml of water. The catheter had burst at the balloon bit and vets returned last night to fit again. Vet used a thin piece of metal to guide the catheter in place and as soon as she filled it with water it burst and it happened again on a 2nd catheter. Seems she is damaging the catheter herself with the metal guide thing, she realised and managed to fit a 3rd catheter and filled with 20 ml of water.. YO rang me half an hour to inform me that the catheter was on the floor which again was burst at the balloon bit.

Vet has now been back again tonight and put Penicillin mixed with gelatine into the pouch and has injected Penicillin too as the catheter thing just isn't going to be successful. She will come back in two weeks and I'm just praying it works as every worse case scenario seems to have happened with this horse and I'm losing faith now that it will ever be rid of it.