Presumed immune‐mediated hemolytic anemia in two foals with Rhodococcus equi infection

Objective – To describe the clinical presentation, case management, and outcome in 2 foals with Rhodococcus equi infection associated with presumptive severe immune‐mediated hemolytic anemia. Series Summary – Two foals diagnosed with R. equi pneumonia on the basis of tracheal wash cultures, thoracic...

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Bibliographic Details
Published in:Journal of veterinary emergency and critical care (San Antonio, Tex. : 2000) Tex. : 2000), 2011-06, Vol.21 (3), p.273-278
Main Authors: Johns, Imogen C., Desrochers, Anne, Wotman, Kathryn L., Sweeney, Raymond W.
Format: Article
Language:English
Subjects:
Actinomycetales Infections - complications
Actinomycetales Infections - drug therapy
Actinomycetales Infections - veterinary
Anemia, Hemolytic, Autoimmune - etiology
Anemia, Hemolytic, Autoimmune - microbiology
Anemia, Hemolytic, Autoimmune - veterinary
Animals
blood transfusion
Dexamethasone - therapeutic use
Glucocorticoids - therapeutic use
hemolysis
horse
Horse Diseases - drug therapy
Horse Diseases - etiology
Horse Diseases - microbiology
Horses
pneumonia
Pneumonia, Bacterial - complications
Pneumonia, Bacterial - drug therapy
Pneumonia, Bacterial - microbiology
Pneumonia, Bacterial - veterinary
Rhodococcus equi
Treatment Outcome
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Summary:Objective – To describe the clinical presentation, case management, and outcome in 2 foals with Rhodococcus equi infection associated with presumptive severe immune‐mediated hemolytic anemia. Series Summary – Two foals diagnosed with R. equi pneumonia on the basis of tracheal wash cultures, thoracic radiographs, and thoracic ultrasonography were concurrently diagnosed with hemolytic anemia. Both foals required whole blood transfusions, and were treated with the antimicrobial combination of rifampin and a macrolide (eg, clarithromycin, erythromycin, or azithromycin). Dexamethasone was used to prevent further hemolysis in both foals, and to treat acute lung injury/acute respiratory distress syndrome in 1 of the foals. Both foals survived, and required prolonged antimicrobial therapy. New or Unique Information Provided – Although extra‐pulmonary disorders are commonly diagnosed in foals infected with R. equi, hemolytic anemia is rarely described. Dexamethasone is considered the treatment of choice for immune‐mediated hemolytic anemia, but may be contra‐indicated in foals with severe bacterial infections. In these foals, a relatively low dose and short duration of dexamethasone was utilized in an attempt to minimize immune suppression, although early discontinuation in 1 foal precipitated a second hemolytic crisis.
ISSN:1479-3261
1476-4431
DOI:10.1111/j.1476-4431.2011.00633.x