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synovial pathogens, a jugular phlebotomy and thrombectomy was performed standing under sedation and local anaesthesia (Russell et al. 2010). After removing the septic contents of the jugular vein through four stab incisions, three Penrose drains were placed along the lumen of the vein to prevent premature closure of the surgical sites (Fig 1). Later the same day, bilateral tarsocrural joint arthroscopic lavage was performed under general anaesthesia. On the following day, analysis of synovial fluid from both joints revealed a marked decrease in the WBC count of the right tarsocrural joint (3 9 109 cells/L) whereas the fluid from the left joint was still markedly elevated (32 9 109 cells/L). Therefore, standing through-and-through needle lavage of the left tarsocrural joint was performed daily until improvement of clinical signs (lameness, effusion and periarticular oedema) and until the synovial fluid showed a significant reduction of the WBC count (WBC count at Day 8: 10 9 109 cells/L). Intra-articular ceftiofur sodium (Excenel5) was administered daily following joint lavage. Additionally, a left tarsus i.v. regional limb perfusion with meropenem (Meronem6) was performed every 48 h via puncture of the vena saphenous for a total of six treatments. The mare then recovered progressively from both septic
conditions and haematology and serum biochemistry values also normalised over time. She was administered oral choramphenicol for a total of 4 weeks and oral phenylbutazone for 10 days. The jugular vein surgical site healed completely in 2 weeks (Fig 2) and both tarsocrural joints resumed a normal appearance by 4 weeks. The mare was discharged in the eighth week with instructions for 3 months of stable confinement in combination with controlled exercise and physical therapy. Six months after discharge the mare was reported to be back in training and in full Arabian show condition.
Discussion
Septic arthritis is a serious clinical problem. This condition is considered to be multifactorial since both host and micro- organism contribute to the severity of the clinical signs (Carstanjen et al. 2010). There are important differences between the common sources of infection in mature horses
Fig 2: The phlebotomy site 3 weeks post-surgery.
vs. foals with septic arthritis. In mature horses, the infection is usually secondary to direct synovial contamination through wounds, surgery or intra-articular injection (Carstanjen et al. 2010), whereas in neonates and young foals, the most frequent cause of septic arthritis is haematogenous spread of bacteria into a joint (Schneider et al. 1992a; Meijer et al. 2000; Morton 2005). In contrast to the incidence in foals, haematogenous septic arthritis occurs only rarely in mature horses (Schneider et al. 1992a). Polyarthritis is often present in neonates (50%) whereas septic polyarthritis is much less common in mature horses (1.5%) (Morton 2005). A tentative diagnosis of septic arthritis can be made on
Fig 1: The phlebotomy site at completion of surgery. © 2016 EVJ Ltd
the basis of clinical signs. History of a recent wound or traumatic event, arthrocentesis, joint surgery, systemic illness or immunocompromise is often reported and vital parameters are usually within normal limits (Carstanjen et al. 2010). Nevertheless, one study revealed that 54% of the horses referred to a clinic for septic arthritis presented with fever (Carstanjen et al. 2010). Typically, horses with septic arthritis are profoundly lame, to the point of nonweightbearing. Marked joint effusion, periarticular heat and swelling, and increased sensitivity to palpation and manipulation are generally observed. In foals with septic arthritis, remote sites of primary infection should be investigated; diarrhoea, umbilical infection, pneumonia or other systemic illness is frequently present (Morton 2005). The tarsocrural joint is reported to be the joint most commonly affected in all horses with septic arthritis (Schneider et al. 1992b; Meijer et al. 2000). In the present case, both tarsocrural joints were involved.
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