Purulent nasal discharge, swab taken, no bacteria found???

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soloequestrian

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I can't see how this is possible, so open to offers! Horse has a discharge from one nostril that is quite thick, yellow and has a slight smell. He had a nasopharangeal swab at the end of last month, and the results have come back today with no bacteria found. I strongly suspect that something went wrong with the swab, and the vet didn't take a sample of the discharge from further down the nose, where it is really obvious. The whole process cost me £100 and I've ended up with the same antibiotics as I would have done without the swab (he had already been seen by another vet). Should I complain or is there a reasonable explanation for this that I'm missing?
Thanks!
 
I don't think you have grounds for complaint, as the vet attended, took a swab and had it analysed.

If it were me I would call the vet out again, and specify if you want the swab taking from a particular place.

OH's Charlie horse had a mystery discharge from one nostril, it was not smelly but it was nasty and yellow. We had 2 swabs taken several weeks apart, no response to antibiotics, we then had him scoped to see if there was some unseen damage, a blood test to see if there was anything strange, and finally we had a full head Xray.

Despite all this the vet could not find anything "wrong".

We just kept him in light work, and after about a year it cleared up on its own.

Despite the huge expense I could not critisise the vet at all, as the various vets all did their professional best.
 
Thanks for your reply. I've spoken to the vet now, and I think it was just a case of their not expressing themselves very well - what she had meant was that they hadn't managed to specifically identify any bacteria, not that there were none present. I have some broad spectrum antibiotics now and hope they will do the trick. Did your horse show any symptoms other than the discharge? My vet is suggesting all sorts of horrible possibilities (tooth abscess being her favourite), but my boy isn't showing any signs at all of discomfort, and the only symptom other than the discharge is that he is doing a little sort of teeth clack when there is discharge present which I think means he is swallowing some snot.. not sure though. If the antibiotics don't work my next port of call is a head x-ray, but your experience will make me think hard about the timing of that.
 
My old boy developed a very smelly purulent discherge from one nostril. Vet gave antibiotics for presumptive sinusitis and said that if, after 2 weeks, it hadn't cleared up, we'd scope and xray.

Fortunately he cleared up just fine, and apart from being a little sore in the nostril that was always wet, he didn't show any other symptoms, and was continued to be ridden lightly during treatment.
 
My old horse had a similar discharge from one nostril which was smelly. Xrays confirmed a rotten tooth and sinus infection. He had the tooth removed whilst under sedation standing which was quite a difficult procedure. He was treated with antibiotics to clear up the sinus infection but they had no effect. In the end they took some swabs to identify the bacteria but despite treating the infection his nose continued to run. Vet said that if it didn't clear up then they would take out a small piece of bone beneath his eye to get into the sinus and remove the gunk. I was not happy about that as there was the possibility of my horse having a permanent disfigurement if he managed to knock the bone whilst healing. In the end, I turned him out to grass 24/7 where he had his head down eating and also draining his nose at the same time. It cleared up.
Maybe you should ask for an Xray?
 
I hate to scare you, OP, but I would urge you to get the horse checked.

My gelding developed a thick white/creamy discharge from one nostril a couple of years ago - it came and went for a couple of weeks. There was only a a very slight, vague smell, and the horse was otherwise well. I had the vet out after a couple of weeks as the discharge became more persistent, and she prescribed a 2 week course of antibiotics and ventipulum (sp!) suspecting an infection. The absence of smell suggested against a sinus or tooth infection.

A couple of days before the end of the course of drugs, I found him one morning hemorrhaging from his carotid artery, presenting as the most god awful nose bleed ever - a picture of his stable was in the H&H reader issue a year or so ago, it looked like a murder scene. He was incredibly lucky, he had guttural pouch mycosis, and it had eaten through his carotid artery. He should probably be dead, he lost a huge amount of blood, and it was by pure chance I was late that day to turning him out, and found him, if I had turned him out at usual time, vets have told me he would have bled to death in the field.

In the absence of any obvious smell, and swabs not showing bacteria, if it were my horse I would be getting a scope done PDQ. I presume, OP, that the discharge is still occuring despite being on antibiotics?
 
Red-1 said:
I don't think you have grounds for complaint, as the vet attended, took a swab and had it analysed.

If it were me I would call the vet out again, and specify if you want the swab taking from a particular place.

OH's Charlie horse had a mystery discharge from one nostril, it was not smelly but it was nasty and yellow. We had 2 swabs taken several weeks apart, no response to antibiotics, we then had him scoped to see if there was some unseen damage, a blood test to see if there was anything strange, and finally we had a full head Xray.

Despite all this the vet could not find anything "wrong".

We just kept him in light work, and after about a year it cleared up on its own.

Despite the huge expense I could not critisise the vet at all, as the various vets all did their professional best.
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soloequestrian said:
Thanks for your reply. I've spoken to the vet now, and I think it was just a case of their not expressing themselves very well - what she had meant was that they hadn't managed to specifically identify any bacteria, not that there were none present. I have some broad spectrum antibiotics now and hope they will do the trick. Did your horse show any symptoms other than the discharge? My vet is suggesting all sorts of horrible possibilities (tooth abscess being her favourite), but my boy isn't showing any signs at all of discomfort, and the only symptom other than the discharge is that he is doing a little sort of teeth clack when there is discharge present which I think means he is swallowing some snot.. not sure though. If the antibiotics don't work my next port of call is a head x-ray, but your experience will make me think hard about the timing of that.
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My experience was shared to show why I did not think you had grounds for complaint against the vet. I was not suggesting that because my horse cleared up that you should not have further treatment for your horse. If I had the same situation again I would have all of the same investigations that I did the last time, if the initial course of antibiotics did not clear it up.
 
ester said:
how have they not managed to identify any bacteria? Did they do a sensitivity test?
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I think they just couldn't get any bacteria to grow, so nothing to do sensitivity tests on. The vet hadn't made herself very clear, in that I thought she had said there weren't any bacteria present, but what she had meant was that the couldn't identify anything. There was a small amount of yeast but that is normal.
 
OP, I could have written your opening post a year ago about my young 4 year old tb. He too started off with a purulent unilateral nasal discharge which disappeared once on antibiotics but then came back with a vengeance once the antibiotics wore off. We had numerous scopes and a head xray which revealed nothing. He too had a nasopharangeal swab which came back negative. I had lengthy discussions with my vet as he believed that it was as a result of an allergy seeing as they couldn't grow anything from the swab. I disagreed as everytime he was treated with antib's it cleared up plus the smell from the discharge was disgusting. It all came to a head several months later as he developed a nose bleed and was referred to a large Equine Hospital where he had a CT scan which revealed a tooth root infection. He was operated on immediately and he also had boneflap surgery to flush his sinuses daily for a week. He made a brilliant recovery and is now competing BD and loving life... Like your horse, mine was eating and doing everything a horse should do... My advice would be to find a hospital with a CT scanner. I wish countless times I had done this sooner than wasting hundreds of pounds and months of worry trying various antibiotics/treatments out... I wish you luck, it was an absolute nightmare last year for me and my horse but he is proof that it can be sorted...
 
I would have any horse with discharge from one nostril scoped, if only to rule out fungal infection of the gutteral pouch, its way too fatal. I know cause my mare was lucky to survive, but a lot I heard about died, another symptom is coughing when eating and choking a bit due to the fungus affecting the nerves which help the swallowing process. dysphagia or something
 
It's interesting that you should say that Tristar as in the months leading up to my horse presenting with his discharge, he too choked on a fairly regular basis... Since he has had his tooth removed he hasn't choked...
 
Having had a problem with my TB and nasal discharge, I would get the horse x-rayed for tooth problems. I had an awful time trying to get it diagnosed and treated and ended up with my horse in hospital for nearly three months.
 
My horse had this just over a year ago too. Had unilateral discharge and vets put it down to primary sinusitis. Given antibiotics no luck, given different ones and managed to stay gone a couple weeks. Came back again and eventually changed back to my original vet who did x-Rays and said he had tooth root infections. Had to get a ct scan to confirm. Had dentist out too to give me a second opinion who didn't think he had any rotten teeth so I really struggled to decide what to do as even top specialists that looked at his scan said he had root infections.

I went ahead and agreed for him to have op to remove teeth. Dropped him off at vets, Phone call later on in the day and vet said he had a fungal infection in his sinus- they had never seen before and were shocked themselves. They said they can't guarantee he won't need teeth removed as changes had shown on mri. Flushed it for 10 days and he came home and haven't had any problems since. This was in started in March 13 to sep 13.
 
Regarding you results its not that there were no bacteria present as there are bacteria well everywhere!!! its most likely that there was not any overgrowth noted of any particular species assuming of course that there is some infection there (which is likely if there is a smell as growth of some species of bacteria is associated with a fetid odour). This is the problem with culturable analysis as some species of bacteria are very difficult to grow. Molecular analysis is much better as it looks for the DNA of the bacteria but unfortunately its still in the early stages of development and isnt used as a diagnosic yet. As stated abve sensitivity can only be done if bacteria grow to check which is the best AB to use. Broadspectrum AB's are your best bet for treatment at the moment but obviously they wont help with the diagnosis. You could consider getting a cytology sample to see if they can identify any inflammation or excess immune cells which may indicate infecion though it may be a pointless diagnostic as it wont tell you where or what has caused infection, we use it for cows with uterine infecton but I dont know if vets routinely do it for horses particulary for nasal issues.
 
tristar said:
I would have any horse with discharge from one nostril scoped, if only to rule out fungal infection of the gutteral pouch, its way too fatal. I know cause my mare was lucky to survive, but a lot I heard about died, another symptom is coughing when eating and choking a bit due to the fungus affecting the nerves which help the swallowing process. dysphagia or something
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My gelding had the same thing and it started with green discharge from one nostril also, he had chondroids in his gutteral pouch about 100 of them and had to have them removed one by one through his nose, I was told if it had been left much llonger it coud have been fatal:(

I would get your horse scoped in the pouch and go from there it could be a tooth an xray will show any tooth problems but I would go for a scope first.

My horse also got choke about 9 months before the discharge started too!
 
alsxx said:
I hate to scare you, OP, but I would urge you to get the horse checked.

My gelding developed a thick white/creamy discharge from one nostril a couple of years ago - it came and went for a couple of weeks. There was only a a very slight, vague smell, and the horse was otherwise well. I had the vet out after a couple of weeks as the discharge became more persistent, and she prescribed a 2 week course of antibiotics and ventipulum (sp!) suspecting an infection. The absence of smell suggested against a sinus or tooth infection.

A couple of days before the end of the course of drugs, I found him one morning hemorrhaging from his carotid artery, presenting as the most god awful nose bleed ever - a picture of his stable was in the H&H reader issue a year or so ago, it looked like a murder scene. He was incredibly lucky, he had guttural pouch mycosis, and it had eaten through his carotid artery. He should probably be dead, he lost a huge amount of blood, and it was by pure chance I was late that day to turning him out, and found him, if I had turned him out at usual time, vets have told me he would have bled to death in the field.

In the absence of any obvious smell, and swabs not showing bacteria, if it were my horse I would be getting a scope done PDQ. I presume, OP, that the discharge is still occuring despite being on antibiotics?
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That was a lucky break.

My thought too is a guttural pouch infection.
 
2 things as all explained above. get jaws and teeth xrayed (could show nasal issues as well as teeth) and/or get nostrils scoped (maybe the slighter cheaper option. wont show teeth)!
 
My eventer had a slight nasal discharge on one side the day he was meant to go back to his rider. Not smelly and only a dribble of fairly clear liquid. Got vet in took swabs and bloods. All results clear, two weeks of antibiotics later no change. Xrayed head could see the line of liquid not sure if tooth problem or sinus. Had to put tube into sinus for twice daily flushing then had to scope and can see a fungal problem so poor chap now on anti fungal treatment and on Monday they are going to try to remove the fungal polyp etc. Biopsy it etc. Horse very fed up with his daily flushing having to sedate him to do it but has not been 'Ill' the whole way through he is just costing me a fortune as not insured! Gather these types of fungal infections can be tricky to get rid of.
 
He's had the vet and the dentist out now and both are fairly sure it's a primary sinus infection - the pus he gets is yellow and has a very faint smell which apparently is very unlike anything from a tooth infection. His mouth was in good shape and he still shows no signs of discomfort. He had a course of Norodine which knocked the infection back but didn't completely sort it, but he didn't finish the course because I couldn't get him to take the medicine. He is now having a course of IM pen & strep. Much easier to administer! So fingers crossed this will work, if not I think it will be head x-rays. I have mentioned fungal infection but no-one seems to think it's likely - would antibiotics have any effect if it was fungal? Would there be a secondary bacterial infection that they might help with? His swab didn't show any sign of fungi either though.
 
Antibiotics will not be effective against a fungal or viral infection. They only destroy bacteria. Pinpointing the specific bacterium is essential for the correct antibiotic to be prescribed. Norodine is a broad spectrum antibiotic & is normally effective against a large group of bacteria. It's important that a full course is completed otherwise the offending bacterium remaining will multiply.
 
ChesnutsRoasting said:
Antibiotics will not be effective against a fungal or viral infection. They only destroy bacteria. Pinpointing the specific bacterium is essential for the correct antibiotic to be prescribed. Norodine is a broad spectrum antibiotic & is normally effective against a large group of bacteria. It's important that a full course is completed otherwise the offending bacterium remaining will multiply.
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ETA Secondary infections are normally the result of a previous infection. E.g a viral cold resulting in a bacterial chest infection.
 
My point was that given the antibiotics do seem to be having an effect, albeit not complete yet, it would seem unlikely to be a fungal infection, unless the bacterial infection is secondary to the fungus. They tried to pinpoint the specific bacteria and failed, hence the original title of my post!
 
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