Strangles -could be opening a can of worms!!

[asommerville]

So one of my horses has strangles. She's been really really ill. I keep them on a big yard with around 30 horses and the first horse that showed up was brought in from outside and showed signs 6 weeks ago. It was quarentined and my mare showed up signs about 2 weeks ago.

So after the first horse was confirmed the vet told us to get blood tests done on ALL the horses on the yard, I said this was a waste of time as we should wait until the sick horse was not showing signs and then get them tested as it could be a waste of money, however the vet told us we should get them done and i felt that I had to go along with the rest of them and get the blood tests done, which all came back clear. Lo and behold 3 weeks later a pony showed signs and it has kicked off from there!

I has been talking to the vet and i did say at the time that i thought that the blood tests were a waste of money and we should wait, that i had heard that the blood tests were not always accurate and would we not be better getting gutteral pouch swabs done after the sick pony was no longer showing signs. However after being told by the vet that the blood tests were fine went ahead with them (as the rest of the yard was).

The vet is now saying that I need to keep my horse quarentined for 4 weeks (but i thought it should be 6?) and has assumed without telling me anything about it that i will get a guttural pouch wash done on her. He says that this will establish whether she still has strangles and also give her antibiotics to get rid of any strangles that are lurking there! So while not wanting to sound like i dont believe the vet - I dont see the point of getting the guttural pouch wash done (again i have heard that they are not always effective)

I dont want to sound like I dont believe the vet at all however what he has told me to do is different from what i have had previous experience with, as i previously had her at a yard which had an outbreak and she didn't catch it.

The original question after this screed is has anyone had any experience of this and whether they got the guttural pouch wash done or whether i would be better getting a blood test or a swab done after 6 weeks?

Any advice appreciated!! Sorry for the long post!!

 

[crazyhorse4727]

When we had an outbreak in our yard all infected horses had a swab taken, so the vet could determin which antibiotics to use, and dosage. And we hadn't any problems with any being misdiagnosed. Though I definately would question the quarantine periods, also bearing in mind an area which has been contaminate can hold the bacteria for up to 6 months as far as I remember!
But hopefully your girl gets better soon!

 

[AmyMay]

I think as you are on a livery yard, you are going to have to follow the course of action that your YO wishes to take.

 

[asommerville]

only thing is the yard owner doesnt have an opinion or a plan so kind of stuck....

 

[AmyMay]

only thing is the yard owner doesnt have an opinion or a plan so kind of stuck....

Well he'd better devise one then - as chances are there will be further outbreaks and he will need to manage the situation in coordination with the owners and veterinary team.

 

[asommerville]

Can anyone answer my question re gutteral pouch wash vs blood test/pouch swab?

 

[Miss L Toe]

only thing is the yard owner doesnt have an opinion or a plan so kind of stuck....

Your YO has to either say "do what you want" or say "do what the vet decides". have a read of your contract, it may be that you have "persuaded"the YO to your own ideas, and she does not want to fall out with either you or the vet.
The people to ask are the experts at the Animal Health Trust, in my case [2011] the vet took the isolation period as 30 days after symptoms, and then did an endoscope, though only looked in to one G pouch, but both were rinsed and tested clear. and both had long term antibiotic gel. The horse took three months after treatment to fully recover.

 

[MardyMare]

When our yard had it we had excellent measures put into place immediately 6 horses were quarantined (25 on yard) - of them 3 had full blown strangles my little mare one of them. She had to go on antibiotics as she was struggling to swallow and breathe which may or may not have prolonged it as the other two cases abscessed and cleared within 2 weeks. All the horses were quarantined until my mare got the all clear. The others went for 3 lots of nasal swabs - I went for the guttoral swab. This came back clear and so was advised it was not necessary for the wash. You really need to get your YO on board. Mine was very good about implementing hygiene (gates were locked, foot trays, no other horses on yards no one else dealt with infected horses, bacterial wash everywhere) and between us we used 2 different vets who conferred together with our YM. Hope you manage to get it sorted.

 

[asommerville]

so 30 days from when the abcesses heal over then? I will contact them thanks. YO i think is stuck between a Rock and a hard place but has never said this is what you MUST do and am wondering whether after being so sick there is any point in putting her through the pouch wash as teh vet has only told me she should get it as it gives her immunity from Strangles for a couple of months....dont think there is any point in that though as she has had it already!

 

[Miss L Toe]

When we had an outbreak in our yard all infected horses had a swab taken, so the vet could determin which antibiotics to use, and dosage. And we hadn't any problems with any being misdiagnosed. Though I definately would question the quarantine periods, also bearing in mind an area which has been contaminate can hold the bacteria for up to 6 months as far as I remember!
But hopefully your girl gets better soon!

I think this is incorrect, swabs are useless as the disease can be intermittent, three nasal swabs are recommended, but this is still not much use, considering the time and the epidemiology.
Antibiotics tend to prolong the disease, it does not "kill" it, It is not always used in every epidemic.
The expert vet told someone on the yard that six weeks is the longest period for viability: this did not stop the yard staff puting hay bales into a previously used but not cleaned out stable.
My horse had a "quarantine field" and another horse was apparently put in to it straight after mine was removed. I considered this to be completely foolhardy, but then apparently the vet was the expert, I was only the poor sod who had to pay the bills and look after a very sick horse. The expert vet had presumably never thought to mention to this BHS approved yard with 50 horses that their isolation policy should be strictly enforced, neither apparently did the BHS inspector.
If you look at my original post on my position, most people think that I should accept that strangles is a fact of life, YES. and as long as people go about saying stupid things like "wipe all their noses with an infective hankerchief" it will continue to be endemic in the lower echelons of horse management. AND I include the BHS in the lower echelons.

 

[graliz]

Hi,

The BHS website has a couple of Strangles leaflets to download which are pretty good and detail all the isolation procedures which they reccomend if thats any help. Hope all goes ok and all your horses are well again soon...

 

[Miss L Toe]

so 30 days from when the abcesses heal over then? I will contact them thanks. YO i think is stuck between a Rock and a hard place but has never said this is what you MUST do and am wondering whether after being so sick there is any point in putting her through the pouch wash as teh vet has only told me she should get it as it gives her immunity from Strangles for a couple of months....dont think there is any point in that though as she has had it already!

I think you are confused, the GP with antibiotics is to prevent her becoming a carrier, it is to stop the spread of the disease.
The GP is washed out and the residue tested for viable Streptoccus Equi, at the same time the endoscope looks for abnormalities. The chronoids [dried pus] may also be flushed out but I am not sure that this will be effective.
The antibiotic gel is long a term antibiotic, hopefully the A/B will kill off any Streps lurking in the pouches.
At no time was my horse tested for Strep Equi, it was assumed from the symptoms that he had it. There was never any antibiotic test done on any animal, those who got treated were given five days of a penicillin thought to be effective against Strep Equi.
THE YARD WAS CLOSED AND ALL ANIMALS WERE UNDER SUPERVISION WITH TEMPERATURES TAKEN TWICE PER DAY.
The idea is to stop the spread of the disease, once your horse has it , it is "up to you" to ensure it does not infect others.
In our case, blood tests were carried out on all horses who showed no symptoms, and it was possible to identify previously/recently infected animals from this.
The positives were then given GPs with A*bs
This is a summation of a complex epidemic, and I was given next to no advice from the vet, my horse was moved three times, he was badly affected, and had to suffer dreadfully, I will not go in to the ins and outs, but poor management and cloth ears contributed to 50% of horse becoming infected, when good management and intelligence would have prevented it.

 

[Miss L Toe]

Hi,

The BHS website has a couple of Strangles leaflets to download which are pretty good and detail all the isolation procedures which they reccomend if thats any help. Hope all goes ok and all your horses are well again soon...

HUH! I could say a lot more, but then who am I, someone who has no BHS qualifications, and I don't even use the S*****rs feed
Your vet should straighten you out, you are either getting the wrong advice or you are getting the right advice but have mis-understood.

 

[alsiola]

Can anyone answer my question re gutteral pouch wash vs blood test/pouch swab?

None of the tests for strangles are perfect, but they all have uses in different situations. Blood tests are a decent, relatively inexpensive way of picking up exposed horses, and picking up long term carriers (i.e. have recovered from disease months ago). If there is an outbreak then they are one way of determining which horses may have been exposed, and therefore how to group them in terms of isolation.
GP washes are mainly used for picking up carrier status in recently recovered horses - up to 20% of recovered horses will go on to become carriers, intermittently shedding the disease for months/years afterwards. Abx are often infused at the same time, so that if results come back positive another visit and scope isn't needed to treat.
Swabs (three swabs over 14 days) can be used either for diagnosing the disease initially, or for picking up carrier status in recently recovered horses. NB one positive swab is a pretty definite positive, one negative swab means very little.

In your situation, then the point of testing is to rule out carrier status. This can be done at any point, usually recommended about 30 days after last clinical signs. It can be done earlier, but you are more likely to get false positives; it can be done later, but that means bigger delay before return to normality. In my practice, the price of 3 swabs plus lots of lab fees is very similar to 1 endoscopic wash plus 1 set of lab fees. The scope also takes 14 days less before getting results, and gives an opportunity to treat at the same time, so I would always recommend scoping.

Unfortunately the situation you describe with the YO is all to common. It is difficult because neither YO nor vet can make individual owners do the right thing. If the issue is pushed people will often just leave the yard. Ideally, the STEPS plan from the AHT is good, which divides horses into three groups - infected, in-contacts and not-in-contact. This relies on having three areas that can be separated. You need to get your YO and vet to work together and come up with a plan for the yard, then explain this to all the liveries, and withstand the onslaught of questions and complaints.

 

[alsiola]

When we had an outbreak in our yard all infected horses had a swab taken, so the vet could determin which antibiotics to use, and dosage. And we hadn't any problems with any being misdiagnosed.

I can tell you exactly what antibiotic and dose is appropriate without taking a single swab. I would try freshairicillin at around 0mg/kg.

Though I definately would question the quarantine periods, also bearing in mind an area which has been contaminate can hold the bacteria for up to 6 months as far as I remember!
But hopefully your girl gets better soon!

6 days is closer than 6 months... even under experimental conditions trying to get the bacterium to survive as long as possible, researchers struggle to get more than 10-14 days. If you are seeing cases several weeks apart, then I guarantee you there are carrier horses on the yard.

 

[foxy1]

MrsD is right, the gutteral pouch wash would be to determine if your horse is a carrier, if there are strangles bacteria flushed out then your horse needs to stay in isolation until you get a clear result.

Bloodtests are pointless as they show if your horse (and others) has been exposed to the bacteria, and of course they have. Won't tell you if they are affected though.

The other thing you can have is 3 swabs, but if the 3rd swab showed positive for strangles you would need another 3.

So I would go for a GP wash, but don't be in a rush, give the horse time to recover or you will waste your money and it's not a particularly pleasant procedure for the horse either.

 

[Miss L Toe]

It sounds as though your horse got it badly, so be very careful to bring her immune system back to normal, the antibiotic will not help her general well being, I would recommend you ask Feedmark for a supplement, they have one for horses recovering from illness, make sure she is getting a good fibre based diet and not much work, plenty of fresh air and fun.

 

[Miss L Toe]

I can tell you exactly what antibiotic and dose is appropriate without taking a single swab. I would try freshairicillin at around 0mg/kg.
6 days is closer than 6 months... even under experimental conditions trying to get the bacterium to survive as long as possible, researchers struggle to get more than 10-14 days. If you are seeing cases several weeks apart, then I guarantee you there are carrier horses on the yard.

A few horses have to have antibiotics as they are suffering severely [mine was shaking and running a very high temperature], most horses in the herd show no symptoms [this is why the temperatures are taken twice a day], these horses are infectious [ie will give it to others they are in CONTACT with] for a short period and by this method the disease is passed around the yard.
We had 50 horses, half were infected, and yet only a few actually were "ill", some had mild external symptoms, some had none, only one had "pus", and it was not the classic abscess as shown in every vet manual.
I do not think that carriers [the classic carrier has intermittent production of Streptoccocus Equi] are common, the idea of the GPouch antibiotic treatment is to kill off bacteria and the wash helps flush out chronoids, thus preventing horses becoming carriers.
The endoscope allows the vet to visually examine the GP for abnormalites, unfortunately the endoscope is relatively large compared to the GP entrance, so not all ponies can be examined internally, but they can be flushed and A/B gel inserted [the wash tube is much smaller than the endoscope itself].

Apologies if this is not the veterinary terminology, but to be honest, the vet [the one who I had to use and had to pay] said nothing to me that I did not know already, I think she was pretty fed up with me "Miss Know-it-all", but if she had been a willing communicator, ie willing to listen to me and willing to tell me what was going on, I would not have had to keep probing, it was not me who brought the disease on to the yard or allowed it to spread, it was the ignorant professionals who were running the show.

 

[asommerville]

there are so far only 3 horses who are ill at the minute, mine being the worse affected. She has everything snot and pus and had not eaten properly for a week. The abcesses starting bursting a week after she became ill but instead of staying in her throat they have travelled down her face and they are now bursting out of her lip :-( its a shame shes a poor soul. the vet wouldnt give her antibiotics as they said it could keep it in her system for longer. just have her on daniilon.

thanks for all the advice re the pouch wash, was totally confused by the vet and sure you can imagine all the advice being thrown at me from every angle whilst at the yard. Would rather keep her in for longer and then get the pouch wash as she has been so ill and dont want to subject her to it too soon!!

Desperately trying to make sure my youngster doesnt get it, think the smell of Jeyes fluid will stay in my nose forever. No doubt now got to look forward to the thought of him getting another test as well to see if he has it in his system - oh the joys of horses!!

 

[foxy1]

I nursed two horses through Strangles and also had to look after my sister's horses on a different yard while she was in hospital. I completely changed clothes, showered and washed hair, foot bathed boots between yards. Thankfully they didn't catch it. Best of luck I really feel for you as it is a really horrible illness.

BTW, Defintely don't give antibiotics, just danilon/bute and lots of TLC

 

[Monkers]

The issue with strangles is that the bacteria can remain in the gutteral pouch for some time after all other symptoms have gone.
Most horses are likely to be completley clear after a month or so, but there is evidence to suggest that some horses go on to become "shedders" of the bacteria and can harbour it in the GP for up to, and possibly beyond, two years.

I had a pony who had been clear of strangles for a month. He then had two nasal swabs a couple of weeks apart that were clear. The third one came back positive. If I had turned this pony out with others after the second swab came back, he could well have begun a second round of infection. He eventually went on to have 3 rounds of clear swabs, BUT there were no guarantees that he was completely clear, as far as I know it is impossible to be certain.

I turned out all the ones who had been sick out together as a group once better. They stayed in this group for over a year, if not two!

I never got a second round of infection. This was over 15 years ago.

I can't stress enough how important it is to keep shared water troughs clean, as this is a primary source of infection. "Healthy" shedders can blow mucous into the water, and your whole yard will go down. Even now 15 years later, I disinfect my troughs weekly in the summer and as often as is practical in the winter. All my automatic drinkers are disinfected daily all year round.

Any yard that accepts new horses is at risk. So that's all of them then! The standard two weeks isolation can never be enough for a shedder. Even if you insisted on swabs for all new horses, that wouldn't work either, as shedders shed intermittantly.
It doesn't matter how stringent you are, there is always a risk of strangles entering any yard.

 

[alsiola]

A few horses have to have antibiotics as they are suffering severely [mine was shaking and running a very high temperature]

This is no reason to use antibiotics IMO. Anti-pyretics such as bute/danilon/flunixin will bring down a temperature much more rapidly. I would personally only use antibiotics for strangles in 3 situations:
1) Swelling so severe as to cause breathing difficulty
2) History of respiratory disease e.g. RAO that may impact innate pulmonary immunity and mucociliary clearance
3) Moderate/severe cellulitis of the head

It won't do any harm to give antibiotics in other situations, but it won't get the disease gone any quicker, or make your horse feel any better. Vets have a responsibility to use antibiotics responsibly to help prevent the development of resistance issues, and handing out penicilllin to every horse with strangles is not responsible.

 

[asommerville]

The vet wouldnt give her antibiotics as he said it would possibly prolong the infection. Spoke to him yesterday regarding the holes where the abcesses have burst (as there are a few really big open ones that i can stick my finger into) and he said he would maybe consider it now BUT only if she appeared to go downhill again or they were not healing. He said he has only seen 2 horses in the past year with as bad a case - typical eh

 

[NOISYGIRL]

We had it on my yard good few years ago now, one horse had it, not a new horse, not been anywhere, competition or anything, he was isolated and a system was put in place for handling him, he was dealt with last after all other horses had been seen to so that whichever member of staff did him they never touched the other horses after. We had anti bacterial hand washes, foot soaks, no unneccessary visitors to the yard etc

We had bloods done on all, and swabs done periodically on ones that showed positive but never had it, it could have been they'd been in contact with it at some point but not had it. I believe some horses are carriers so don't actually have it themselves but can pass it on which was why we had the bloods done.

As someone else has said it can stay on fences/stables etc for many months, we scrubbed/sprayed ours and the menege fence etc stables everything

I believe you get the all clear after 2 clear swabs about a month apart if I remember rightly

It was a nightmare I do not wish to live through again, I wish it was notifiable. And find people who still ride out, go to shows etc when its on their yard disgusting, I wish people were considerate like we were. Our yard mananger shut down the yard basically, no horse was allowed on or off for the whole period, it basically wrecked our whole summer waiting for the all clear and that was from just 1 horse getting it so god knows when it goes through more than one !

 

[asommerville]

cant understand how she got it either as all the horses tested negative and the 1 that was positive was put in quarentine and unlike everyone else as soon as we were told that tehre was a horse with strangles i did mine on DIY (we're on an assisted livery yard), had foot baths and discinfected everything....so it is all a total mystery but yes i do not want to live through this EVER AGAIN!!!!

 

[Miss L Toe]

This is no reason to use antibiotics IMO. Anti-pyretics such as bute/danilon/flunixin will bring down a temperature much more rapidly. I would personally only use antibiotics for strangles in 3 situations:
1) Swelling so severe as to cause breathing difficulty
2) History of respiratory disease e.g. RAO that may impact innate pulmonary immunity and mucociliary clearance
3) Moderate/severe cellulitis of the head

It won't do any harm to give antibiotics in other situations, but it won't get the disease gone any quicker, or make your horse feel any better. Vets have a responsibility to use antibiotics responsibly to help prevent the development of resistance issues, and handing out penicilllin to every horse with strangles is not responsible.

Obviously my boy was on Danilon, do you suggest we waited to see if he died or lay down, and then say, well maybe antibiotic would have helped? His temp was rising alarmingly and he was shaking like a leaf, what would you do, stick with your own ideas or take vet advice?

 

[foxy1]

I'm pretty sure alsiola IS a vet.

 

[Miss L Toe]

I'm pretty sure alsiola IS a vet.

She may be a vet but I had no choice but to take the advice of the horse on site, most horses were not treated initially but that changed, however my horse was in a state, and something had to be done.
The temperature had risen over three days but rocketed overnight, the vet had not told me to put an extra rug on him or monitor him overnight, in fact I don't remember her giving me any advice at all.
Generally, I was not in the least happy with the vet [who I had to use as she was the one in charge] and I was given little or no advice directly, it was mostly done via the YM [the one who chose to ignore an outbreak of an infectious disease in the yard until someone had a positive swab test]

 

[Miss L Toe]

Sorry should have read:
I had no choice but to do something, and the vet I called out, had few options, I agreed to Antibiotics as something had to be done. I know it is not a good idea, but I had no option. Some of the swelling was internal.
The on-call vet was very thorough in his exam and his explanation of symptoms were detailed, and his communication skills impressive, unfortunately he was not the vet in charge of the outbreak.