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Friday, November 16, 2012

Pythiosis!

The endoscopic images below are of the pharynx of a horse with a 30 day history of a bloody nose. The nasal discharge consisted of bright red blood mixed with some purulent debris. The middle-aged gelding lives in a pasture that includes multiple low-lying areas that have been flooded with stagnant water. In addition, the gelding has suffered from failure to thrive most likely due to a poor appetite.


Figure 1
The endoscopic exam revealed bleeding tissue that surrounded the pharynx but was most severe along the dorsal wall of the pharynx. There was purulent debris mixed with the bleeding tissue and multiple small, white granuoles were noted within the bleeding tissue (Figure 2) .  Possible disease processes for this condition include fungal granuloma, cancer, bacterial abscess, and pythiosis.  Pythiosis is caused by the invasion of tissues by the pathogen pythiosis insidiosum and may affect external and internal tissues. The pathogen typically gains access to the horse via exposure to stagnant water that contains p. insidiosum.  As such the lower limbs (pasterns, coronary bands, and fetlocks) are most commonly affected. Once infected, the wound becomes increasingly inflamed with persistent bloody discharge. In addition, the lesions are very puritic resulting in additional inflammation via the horse biting and scratching at the wounds. Within the large areas of inflammation are firm, yellow granuoles also known as "kunkers".  This condition can be very deadly and requires aggressive treatment. For external cases, surgical removal and topical treatment are common. In addition a vaccine is available that has proven effective for cases of equine pythiosis.

Figure 2
However, pythiosis of the pharynx is not treatable with surgical resection or the common topical medications. Fortunately, systemic antifungals have proven effective if treated early and for the appropriate amount of time. The endoscopic images below are from the same horse approximately 4 weeks into the systemic anti-fungal treatment protocol. I recommend a specific protocol that involves  6 weeks of a tapering dose and a follow up endoscopic exam. In the past 8 years I have treated nearly a dozen cases of pharyngeal pythiosis. In every case there was a body of stagnant water available to the horses and all but 1 case responded to the systemic anti-fungal medication. For more information regarding the condition and the vaccine check out the following link: http://pythium.pavlab.com/subpage5.html


Figure 3

Figure 4





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