Khan: advice for positive S. Fayeri test result


Jessica Gunderson
 

Hello,

EPM test for Khan came back negative but positive for S. Fayeri (result was 8 without units).

For background I requested the test because Khan has some muscle wasting and sometimes her symptoms seem like they may not be entirely contributable to ongoing laminitis. Hard to explain but sometimes she seems almost a bit shaky, walks up on her tippy toes with very short movements like a ballerina, widens the walking stance of her back feet though not entirely straight, kind of goes off to the side in her back feet, her resistance to movement and gait compensations seem like they are driven by something outside of her front feet and possibly more like a soft tissue lameness then a bone issue, again apologies its hard to explain without seeing her but long story short that is why I requested the test as she mildly reminded me of a TWH/MFT cross I knew that had EPM. I do think some muscle wasting from inactivity is to be expected and she has developed thrush in all 4 feet (quite bad in the back) so some abnormality is to be expected but still I wanted to rule EPM out as an unwanted complication.

First question is can protozoal infections such as S. Fayeri contribute to or worsen laminitis or lameness, and if so what would the symptoms signs be in these horses considering she definitely had laminitis?

Second question is should she be treated and if so is using off market compounded anti-protozoal medicine safe given there is no Marquis to be had anywhere?

I will post the test result directly to her case history.

Thank you!
--
Jessica and Khan
N.D., 2021
https://ecir.groups.io/g/CaseHistory/files/Jessica%20and%20Khan
CaseHistory@ECIR.groups.io | AlbumCaseHistory@ECIR.groups.io | Album


Eleanor Kellon, VMD
 

Where is her muscle wasting? Is it symmetrical?

S.fayeri used to be considered nonpathogenic but cases involving neuromuscular or granulomatous disease have also been described. What we don't know is how many horses testing positive might actually have disease related to the infection.

I doubt there's any connection with laminitis flare, but that could be ignorance. Do you have a current insulin? Assuming insulin is not up in the acute laminitis range, it's possible what you are seeing is related to the  S. fayeri and treatment is reasonable. The good news it this has been reported to respond favorably within 15 days.

The severity of her laminitis is disproportionate to the insulin levels. She also doesn't "look" like an EMS horse. I would check Lyme bloodwork and CBC with fibrinogen looking for evidence of infection somewhere.

--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Sherry Morse
 

Hi Jessica,

Would you be able to take a video and post it on YouTube or Dropbox so you could share the link with us?  As far as the S. Fayeri the only message I could find in the archives here that might be relevant is this one: Re: Dianne and Beau - looking for advice on PPID treatment (groups.io) and the important bit: it is treated the same as EPM but there is very little information available on length of treatment or outcome - actually only one case published although there are multiple reports of the problem. 

I know that doesn't address your question but looking at the overall picture of EPM I would consider the lameness seen with it (usually gait abnormalities/unsteadiness) to be an effect of the disease.  Off the top of my head even when EPM was first being diagnosed/over-diagnosed in our area laminitis was not considered a symptom of it.  Dr. Kellon might be able to speak to that better than I can.  

I would think that this is something you'd want to treat knowing that she has it but '8' means nothing without a context - is that considered a low level, or is anything other than 0 mean there's a treatable infection? I'm a bit confused by the 'recheck titers in 1 month' recommendation when that doesn't seem to refer to the test result that you have.





Eleanor Kellon, VMD
 

Regarding EPM and laminitis, they can be confused looking at the horse. EPM often causes the horse to assume a wide stance because of unsteadiness and many are reluctant to move.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Bobbie Day
 
Edited

Jessica
I too would love to see a video of Kahn, I had never heard of this and really couldn’t find much to read up on except one study that I didn’t enjoy.
Did you have a vet familiar with this? And was the test done by muscle biopsy? I’m just wondering how you came upon this in particular?

Sorry for all the questions I’m just really curious.

--

Bobbie and Maggie 
Desi (over the rainbow bridge 7/21) 
Utah, Nov 2018
NRC Plus 2020, NAT, C&IR March 2021
ECIR Group Primary Response 

https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Maggie
https://ecir.groups.io/g/CaseHistory/album?id=271156

https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Desi 
https://ecir.groups.io/g/CaseHistory/album?id=78821


Jessica Gunderson
 

Answer re: symmetry - muscle wasting is not perfectly symmetrical but definitely on both sides and fairly equivalent. Its most pronounced in the croup, but also top of neck and around gaskin, the rest I think is just being underweight.

Answer re: insulin – was in the low 20s in January (non-fasting Cornell test), my vet gave me that via paper and I am terrible with paper, need everything digitally.

Answer re: video – of course, it may just take me some time as I need a helper to get a good video.

Answer re: test – I don’t know what 8 means either and my vet is not an expert so she is consulting with the SME on context and treatment, I also don’t know why they highlighted retest titers in 1 or 3 months as that seems like it is designed for retesting of treated horses but still waiting to hear back on my vet’s consultation with their SME on the test results/treatment. The test is done via blood draw.  I had the test run because Khan has been pretty much unresponsive to the ECIR protocol, she slightly reminded me of EPM horses I have seen and every now and again she has movement abnormalities that are not severe but mildly similar to neurological horses.

Answer re: Lymes – Khans Lymes test was negative, I need to get it from my vet they just called me on that one.

--
Jessica and Khan
N.D., 2021
https://ecir.groups.io/g/CaseHistory/files/Jessica%20and%20Khan
CaseHistory@ECIR.groups.io | AlbumCaseHistory@ECIR.groups.io | Album


Eleanor Kellon, VMD
 

I agree with you that there's something else going on here. Not sure I believe the ACTH of 340 either, at least not as an isolated finding. Thinking Multiple Endocrine Neoplasia Syndrome with pheochromocytoma. Just throwing some possibilities out there. ACTH of 340 is high for a stress response but she also had two episodes of hyperglycemia which can be from stress and is a feature of pheochromocytoma. There is also a high T4 reading. Laminitis has been described with pheochromocytoma https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4913635/ . So has weight loss. Has she had any unusual sweating or trembling?  High pulse?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Eleanor Kellon, VMD
 

Another thing that caught my attention was that wound below the hock. Chronic infection/abscess  could explain her issues. Your vet could ultrasound the inguinal/groin area to look for enlarged nodes and also check rectally.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Eleanor Kellon, VMD
 


Jessica Gunderson
 

Since I started checking her pulse regularly in December it has always been between 44-48.  I asked my vet about this because I was concerned about it always being over 40 and she responded that Khan had a  regular pulse in the 30s prior to laminitis however when she was in acute laminitis it was much higher up in the 60s+.

I have not noticed trembling.  She does occasionally have spasms in the front of her neck into her shoulders and is shaky when starting to walk but not what I would call trembling.

I have not noticed much unusual sweating, occasionally she sweats in and behind the pits of her front legs for what seems like no reason.

--
Jessica and Khan
N.D., 2021
https://ecir.groups.io/g/CaseHistory/files/Jessica%20and%20Khan
CaseHistory@ECIR.groups.io | AlbumCaseHistory@ECIR.groups.io | Album