1
|
Jacobsen S. Use of serum amyloid A in equine medicine and surgery. Vet Clin Pathol 2023; 52 Suppl 1:8-18. [PMID: 36336845 DOI: 10.1111/vcp.13195] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/10/2022] [Accepted: 09/06/2022] [Indexed: 11/09/2022]
Abstract
Serum amyloid A (SAA) has become an indispensable part of the management of equine patients in general practice and specialized hospital settings. Although several proteins possess acute phase properties in horses, the usefulness of SAA exceeds that of other acute phase proteins. This is due to the highly desirable kinetics of the equine SAA response. SAA concentrations exhibit a rapid and pronounced increase in response to inflammation and a rapid decline after the resolution of inflammation. This facilitates the detection of inflammatory disease and real-time monitoring of inflammatory activity. SAA may be used in all stages of patient management: (1) before diagnosis (to rule in/rule out inflammatory disease), (2) at the time of diagnosis (to assess the severity of inflammation and assist in prognostication), and (3) after diagnosis (to monitor changes in inflammatory activity in response to therapy, with relapse of disease, or with infectious/inflammatory complications). By assessing other acute phase reactants in addition to SAA, clinicians can succinctly stage inflammation. White blood cell counts and serum iron concentration change within hours of an inflammatory insult, SAA within a day, and fibrinogen within 2-3 days; the interrelationship of these markers thus indicates the duration and activity of the inflammatory condition. Much research on the equine SAA response and clinical use has been conducted in the last decade. This is the prerequisite for the evidence-based use of this analyte. However, still today, most published studies involve a fairly low number of horses. To obtain solid evidence for use of SAA, future studies should be designed with larger sample sizes.
Collapse
Affiliation(s)
- Stine Jacobsen
- Department of Veterinary Clinical Sciences, Section Medicine & Surgery, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
2
|
Neutrophil Gelatinase-Associated Lipocalin in Synovial Fluid from Horses with and without Septic Arthritis. Animals (Basel) 2022; 13:ani13010029. [PMID: 36611638 PMCID: PMC9817893 DOI: 10.3390/ani13010029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/11/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
Neutrophil gelatinase-associated lipocalin (NGAL) has been suggested to be a highly sensitive and specific marker of joint infection in humans. The aim of the study was to investigate NGAL concentrations in synovial fluid (SF) from horses with septic synovitis, horses without septic synovitis, and horses with uncertain status. NGAL was measured in 177 admission samples obtained from 152 horses. From a subset of horses (n = 35), additional samples obtained sequentially over the course of treatment were available. Concentrations of NGAL were significantly higher in septic synovitis (n = 47 samples) than in samples classified as non-septic (n = 103) or samples with uncertain status (n = 27), with median NGAL concentrations in the three groups being 1236, 16.8, and 266.4 µg/L, respectively. NGAL discriminated nearly perfectly between septic and non-septic (area under the receiver operating characteristic curve 0.98, 95% confidence interval 0.95-1.00). The optimal cut-off value for maximal sensitivity (87.2%) and specificity (75.0%) to discriminate septic samples from those with uncertain status was 444.6 µg/L, with an area under the receiver operating characteristic curve of 0.85 (95% confidence interval 0.74-0.93). Concentrations declined over time in horses undergoing treatment. NGAL is a novel biomarker that seems to have great potential for identifying septic synovitis and for monitoring the response to treatment of synovial infection in horses.
Collapse
|
3
|
Strootmann T, Spitzbarth I, della Tommasa S, Brehm W, Köller G, Troillet A. Synovial Fluid Analysis and Microscopic Assessment of Macrophage Quantities and Morphology in Equine Septic Arthritis. Tierarztl Prax Ausg G Grosstiere Nutztiere 2022; 50:377-385. [DOI: 10.1055/a-1956-5245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Objective Research and provision of data on macrophages by cytological synovial fluid analysis and light microscopy in horses with septic arthritis
Material and methods Records of 167 synovial fluid samples were evaluated and subdivided into different groups: (1) non-septic, (2) haematogenous septic arthritis in foals and (3) traumatic/iatrogenic septic arthritis. The effect of joint lavage on synovial fluid cytology and on the occurrence of macrophage phenotypes was investigated.
Results Regardless of aetiology and age of the horse, macrophage concentrations in synovial sepsis are decreased to a median of 5–6 % (unaffected joints: 23.5 %) and further diminished by joint lavage. Microscopic assessment led to the identification of 4 phenotypes. Morphological characteristics of type 1 showed similarities to monocytes and predominated in unaffected and in septic joints after lavage.
Conclusion and clinical relevance Macrophages are highly versatile by altering their phenotype. A morphological assessment by light microscopy is easily applicable. Type 1 presumably contributes to joint homeostasis.
Collapse
Affiliation(s)
- Teresa Strootmann
- Department for Horses, Faculty of Veterinary Medicine, Leipzig University
| | - Ingo Spitzbarth
- Institute for Veterinary Pathology, Faculty of Veterinary Medicine, Leipzig University
| | | | - Walter Brehm
- Department for Horses, Faculty of Veterinary Medicine, Leipzig University
| | - Gabor Köller
- Department for Horses, Faculty of Veterinary Medicine, Leipzig University
| | - Antonia Troillet
- Clinic for Horses, Faculty of Veterinary Medicine, Ludwig-Maximilians-University
| |
Collapse
|
4
|
Thurston CC, Stefanovski D, MacKinnon MC, Chapman HS, Richardson DW, Levine DG. Serum amyloid A and fibrinogen as markers for early detection of surgical site infection associated with internal fixation in the horse. Front Vet Sci 2022; 9:960865. [PMID: 36299628 PMCID: PMC9589505 DOI: 10.3389/fvets.2022.960865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/12/2022] [Indexed: 11/04/2022] Open
Abstract
The objective of this study was to determine the diagnostic ability of serum amyloid A (SAA) and fibrinogen for early detection of surgical site infection (SSI) after equine internal fixation. Horses undergoing internal fixation for fracture, arthrodesis, or osteotomy with internal fixation for limb deformity were included in the study. SAA and fibrinogen were measured on blood samples preoperatively and on days 1, 3, 5, 7, 10, and 14 postoperatively. Statistical analysis included use of Spearman's rank correlation, logistic regression, and calculating the area under the receiver operating characteristic (ROC) curve. SAA and fibrinogen measurements were both associated with SSI, with SAA being considered an excellent marker (area under the ROC curve 0.8) and fibrinogen being considered acceptable (<0.8). As the amount of time postoperatively increased, SAA elevations indicated a higher likelihood of SSI (area under the ROC curve 0.8 compared with fibrinogen 0.7). SAA and fibrinogen were predictive markers of SSI and SAA is of greater diagnostic utility when compared with fibrinogen. Persistent elevations of SAA postoperatively are associated with the development of SSI. Serial monitoring of SAA can be used to help predict the development of SSI in horses undergoing internal fixation. This may lead to earlier suspicion, and therefore recognition and treatment of SSI.
Collapse
Affiliation(s)
- Catherine C. Thurston
- New Bolton Center, Department of Clinical Studies, University of Pennsylvania, Kennett Square, PA, United States,*Correspondence: Catherine C. Thurston
| | - Darko Stefanovski
- New Bolton Center, Department of Clinical Studies, University of Pennsylvania, Kennett Square, PA, United States
| | | | | | - Dean W. Richardson
- New Bolton Center, Department of Clinical Studies, University of Pennsylvania, Kennett Square, PA, United States
| | - David G. Levine
- New Bolton Center, Department of Clinical Studies, University of Pennsylvania, Kennett Square, PA, United States
| |
Collapse
|
5
|
Müller AC, Büttner K, Röcken M. Using systemic serum amyloid A as a biomarker for synovial structure infections in horses with acute limb wounds. Vet Rec 2022; 191:e1841. [PMID: 35808823 DOI: 10.1002/vetr.1841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 05/15/2022] [Accepted: 05/23/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND In postoperative monitoring of synovial structure infection due to limb wounds, early recognition of a recurrence of synovial infection is indispensable to prevent further damage to the affected synovial structure. This study evaluated the role of serum amyloid A (SAA) as a systemic biomarker in disease monitoring and correlated this tool with clinical variables. METHODS In this prospective cohort study, 55 horses with acute limb wounds were divided into two groups: those with (group 1, n = 26) or without (group 2, n = 29) a diagnosis of synovial structure penetration. SAA, lameness and body temperature were evaluated repeatedly and compared between groups. Correlations were explored between SAA and body temperature as well as lameness. The long-term outcome was also analysed. RESULTS In both groups, SAA levels followed the characteristic rise-and-fall pattern observed in previous studies, with a significant increase up to a peak concentration within 48 hours, followed by a constant decline. Lameness and body temperature did not change significantly. SAA was not found to correlate with clinical variables at all time points. Three horses in group 1 had a recurrence of synovial sepsis with an associated increase in SAA. The long-term outcome was good. A total of 71% of the study population returned to pre-injury performance levels. CONCLUSION Repeated measurements of SAA accurately reflected the course of synovial inflammation and thus provided a reliable and rapidly available tool to monitor the disease course and to adapt the treatment regimen. SAA should be routinely added to the postoperative management of such cases.
Collapse
Affiliation(s)
| | - Kathrin Büttner
- Unit for Biomathematics and Data Processing, Justus-Liebig-University, Giessen, Germany
| | - Michael Röcken
- Equine Clinic (Surgery, Orthopaedics), Justus-Liebig-University, Giessen, Germany
| |
Collapse
|
6
|
Frydendal C, Nielsen KB, Berg LC, van Galen G, Adler DMT, Andreassen SM, Jacobsen S. Influence of clinical and experimental intra-articular inflammation on neutrophil gelatinase-associated lipocalin concentrations in horses. Vet Surg 2021; 50:641-649. [PMID: 33522003 PMCID: PMC8048826 DOI: 10.1111/vsu.13582] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 11/09/2020] [Accepted: 12/17/2020] [Indexed: 01/26/2023]
Abstract
Objective To investigate neutrophil gelatinase‐associated lipocalin (NGAL) concentrations in serum and synovial fluid (SF) from horses with joint inflammation. Study design Experimental studies and retrospective clinical study. Sample population Serum and SF samples were available from healthy horses (n = 19), clinical cases, and horses with experimental joint inflammation. Clinical cases included horses with (n = 10) or without (n = 10) septic arthritis. Experimental intra‐articular inflammation was induced by lipopolysaccharide (LPS; n = 7, severe inflammation), lidocaine (n = 6, moderate inflammation), or mepivacaine (n = 6, mild inflammation). Methods Availability of samples was based on approval from the local ethical committee and from the Danish Animal Experiments Inspectorate. Neutrophil gelatinase‐associated lipocalin was measured with a previously validated enzyme‐linked immunosorbent assay. Repeated‐measurements one‐ and two‐way analysis of variance and correlation analysis were used to analyze NGAL concentrations and white blood cell counts (WBC). Results After injection of LPS or lidocaine, SF NGAL concentrations increased 343‐ (P = .0035) and 60‐fold (P = .0038) relative to baseline, respectively. Serum NGAL also increased in both groups (P < .05) but to lower concentrations than in SF. Concentrations were higher after injection of lidocaine SF NGAL than after injection of mepivacaine (P < .05) at 6 and 12 hours. Synovial fluid concentrations of NGAL were higher in horses with septic arthritis than in the nonseptic group (P = .0070) and in healthy controls (P = .0071). Concentrations of NGAL correlated with WBC in SF (P < .0001, R2 = 0.49) and in blood (P = .0051, R2 = 0.27). Conclusion Neutrophil gelatinase‐associated lipocalin concentrations increased in SF in response to experimentally induced and naturally occurring joint inflammation. Synovial fluid NGAL concentration correlated with WBC and, thus, seems to reflect intensity of joint inflammation. Clinical significance Neutrophil gelatinase‐associated lipocalin may prove to be a useful biomarker of joint inflammation and infection in horses.
Collapse
Affiliation(s)
- Catina Frydendal
- Department of Veterinary Clinical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Katrine B Nielsen
- Department of Veterinary Clinical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lise C Berg
- Department of Veterinary Clinical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gaby van Galen
- Department of Veterinary Clinical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ditte M T Adler
- Department of Veterinary Clinical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Stine M Andreassen
- Department of Veterinary Clinical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Stine Jacobsen
- Department of Veterinary Clinical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
7
|
Sinovich M, Villarino NF, Singer E, Robinson CS, Rubio-Martínez LM. Can blood serum amyloid A concentrations in horses differentiate synovial sepsis from extrasynovial inflammation and determine response to treatment? Vet Rec 2020; 187:235. [PMID: 32098906 PMCID: PMC7591800 DOI: 10.1136/vr.105153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 01/17/2020] [Accepted: 01/29/2020] [Indexed: 11/09/2022]
Abstract
Background Serum amyloid A (SAA) concentrations in blood and synovial fluid of horses with synovial sepsis have diagnostic value. Studies suggest serial blood SAA measurements could act as a prognostic indicator. This study evaluated the use of serial blood SAA concentrations for monitoring of horses with synovial sepsis. Methods A prospective clinical trial was performed of horses referred to a single hospital with synovial sepsis that survived (n=17), synovial sepsis that were euthanised (n=5), non-septic intrasynovial pathologies (n=14) or extensive extrasynovial lacerations (n=5). SAA concentrations were determined on admission and every 24 hours thereafter. The area under the concentration–time curve from 0 to 144 hours of each group was compared by Kruskal-Wallis and post hoc Dunn’s tests (P<0.05). Results Significant difference in mean blood concentration of SAA was found between synovial sepsis that survived and non-septic pathologies in the first 48 hours, as well as between non-septic intrasynovial pathologies and non-responsive sepsis requiring euthanasia. No difference was found between extensive extrasynovial lacerations and any septic group. Conclusions While serial blood SAA is useful for monitoring clinical response of intrasynovial septic pathologies, interpretation should consider other clinical findings since blood SAA is not a specific marker for synovial sepsis.
Collapse
Affiliation(s)
- Matthew Sinovich
- Department of Equine Clinical Science, Institute of Veterinary Science, University of Liverpool, Neston, Cheshire, UK
| | - Nicolas F Villarino
- Program in Individualised Medicine, Washington State University, Washington, DC, USA
| | - Ellen Singer
- E Singer Equine Surgery and Orthopaedics, Parkgate, UK
| | | | - Luis M Rubio-Martínez
- Department of Equine Clinical Science, Institute of Veterinary Science, University of Liverpool, Neston, Cheshire, UK .,Sussex Equine Hospital, Ashington, Sussex, UK
| |
Collapse
|
8
|
Long A, Nolen-Walston R. Equine Inflammatory Markers in the Twenty-First Century: A Focus on Serum Amyloid A. Vet Clin North Am Equine Pract 2020; 36:147-160. [PMID: 32007299 PMCID: PMC7135104 DOI: 10.1016/j.cveq.2019.12.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Alicia Long
- Department of Clinical Studies, New Bolton Center, 382 West Street Road, Kennett Square, PA 19348, USA
| | - Rose Nolen-Walston
- Department of Clinical Studies, New Bolton Center, 382 West Street Road, Kennett Square, PA 19348, USA.
| |
Collapse
|
9
|
Witkowska-Piłaszewicz OD, Żmigrodzka M, Winnicka A, Miśkiewicz A, Strzelec K, Cywińska A. Serum amyloid A in equine health and disease. Equine Vet J 2019; 51:293-298. [PMID: 30565319 PMCID: PMC7163734 DOI: 10.1111/evj.13062] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 12/10/2018] [Indexed: 01/25/2023]
Abstract
Serum amyloid A (SAA) is the major acute phase protein in horses. It is produced during the acute phase response (APR), a nonspecific systemic reaction to any type of tissue injury. In the blood of healthy horses, SAA concentration is very low, but it increases dramatically with inflammation. Due to the short half‐life of SAA, changes in its concentration in blood closely reflect the onset of inflammation and, therefore, measurement of SAA useful in the diagnosis and monitoring of disease and response to treatment. Increases in SAA concentration have been described in equine digestive, reproductive and respiratory diseases and following surgical procedures. Moreover, SAA has proven useful for detection of some subclinical pathologies that can disturb training and competing in equine athletes. Increasing availability of diagnostic tests for both laboratory and field use adds to SAA's applicability as a reliable indicator of horses’ health status. This review article presents the current information on changes in SAA concentrations in the blood of healthy and diseased horses, focussing on clinical application of this biomarker.
Collapse
Affiliation(s)
- O D Witkowska-Piłaszewicz
- Department of Pathology and Veterinary Diagnostics, Faculty of Veterinary Medicine, WarsawUniversity of Life Sciences - SGGW, Warsaw, Poland
| | - M Żmigrodzka
- Department of Pathology and Veterinary Diagnostics, Faculty of Veterinary Medicine, WarsawUniversity of Life Sciences - SGGW, Warsaw, Poland
| | - A Winnicka
- Department of Pathology and Veterinary Diagnostics, Faculty of Veterinary Medicine, WarsawUniversity of Life Sciences - SGGW, Warsaw, Poland
| | - A Miśkiewicz
- Department of Pathology and Veterinary Diagnostics, Faculty of Veterinary Medicine, WarsawUniversity of Life Sciences - SGGW, Warsaw, Poland
| | - K Strzelec
- Department of Horse Breeding and Use, University of Life Sciences in Lublin, Lublin, Poland
| | - A Cywińska
- Department of Pathology and Veterinary Diagnostics, Faculty of Veterinary Medicine, WarsawUniversity of Life Sciences - SGGW, Warsaw, Poland
| |
Collapse
|
10
|
Anderson J, Phelan MM, Clegg PD, Peffers MJ, Rubio-Martinez LM. Synovial Fluid Metabolites Differentiate between Septic and Nonseptic Joint Pathologies. J Proteome Res 2018; 17:2735-2743. [PMID: 29969035 PMCID: PMC6092013 DOI: 10.1021/acs.jproteome.8b00190] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Indexed: 12/12/2022]
Abstract
Osteoarthritis (OA), osteochondrosis (OC), and synovial sepsis in horses cause loss of function and pain. Reliable biomarkers are required to achieve accurate and rapid diagnosis, with synovial fluid (SF) holding a unique source of biochemical information. Nuclear magnetic resonance (NMR) spectroscopy allows global metabolite analysis of a small volume of SF, with minimal sample preprocessing using a noninvasive and nondestructive method. Equine SF metabolic profiles from both nonseptic joints (OA and OC) and septic joints were analyzed using 1D 1H NMR spectroscopy. Univariate and multivariate statistical analyses were used to identify differential metabolite abundance between groups. Metabolites were annotated via 1H NMR using 1D NMR identification software Chenomx, with identities confirmed using 1D 1H and 2D 1H 13C NMR. Multivariate analysis identified separation between septic and nonseptic groups. Acetate, alanine, citrate, creatine phosphate, creatinine, glucose, glutamate, glutamine, glycine, phenylalanine, pyruvate, and valine were higher in the nonseptic group, while glycylproline was higher in sepsis. Multivariate separation was primarily driven by glucose; however, partial-least-squares discriminant analysis plots with glucose excluded demonstrated the remaining metabolites were still able to discriminate the groups. This study demonstrates that a panel of synovial metabolites can distinguish between septic and nonseptic equine SF, with glucose the principal discriminator.
Collapse
Affiliation(s)
- James
R. Anderson
- Institute
of Ageing and Chronic Disease, University
of Liverpool, Liverpool L7 8TX, U.K.
| | - Marie M. Phelan
- Institute
of Integrative Biology, University of Liverpool, Liverpool L69 7ZB, U.K.
- HLS
Technology Directorate, University of Liverpool, Liverpool L69 3GB, U.K.
| | - Peter D. Clegg
- Institute
of Ageing and Chronic Disease, University
of Liverpool, Liverpool L7 8TX, U.K.
| | - Mandy J. Peffers
- Institute
of Ageing and Chronic Disease, University
of Liverpool, Liverpool L7 8TX, U.K.
| | - Luis M. Rubio-Martinez
- Institute
of Veterinary Science, University of Liverpool, Leahurst Campus, Neson CH64 7TE, U.K.
| |
Collapse
|
11
|
Townsend TR. Can serum amyloid A concentrations aid diagnosis of synovial sepsis? Vet Rec 2017; 181:423-424. [DOI: 10.1136/vr.j4751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Thais Ribera Townsend
- Hospital de Referencia La Equina, Camino de Martagina; Km.1 29692 Sabinillas, Manilva, Málaga Spain
| |
Collapse
|
12
|
Cousty M, David Stack J, Tricaud C, David F. Effect of arthroscopic lavage and repeated intra-articular administrations of antibiotic in adult horses and foals with septic arthritis. Vet Surg 2017; 46:1008-1016. [PMID: 28771839 DOI: 10.1111/vsu.12696] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 03/03/2017] [Accepted: 03/04/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the effect of arthroscopic lavage and repeated intra-articular administration of antibiotic in adult horses and foals with septic arthritis. STUDY DESIGN Retrospective clinical study. ANIMALS Adult horses and foals with septic arthritis (n = 62). METHODS Age, sex, cause of septic synovitis, joint involved, hospitalization time, and outcome were recorded. Arthroscopic lavage was performed at day 0 (D 0). Synovial fluid was collected every 48 hours prior to intra-articular administration of antibiotic, and until hospital discharge. Synovial nucleated cell count, total protein, and percentage of neutrophils were compared across time and between subjects with a favorable or unfavorable outcome. RESULTS Synovial nucleated cell counts decreased progressively and were lower at all times compared to D 0. Percentages of neutrophils were lower than baseline at D 8 and 10, only. Total protein contents decreased progressively and were lower than baseline at D 2, 4, 6, 8, 10, and 14. When adult horses and foals with a favorable outcome were compared to those with an unfavorable outcome, the nucleated cell count was lower at D 10, 12, and 14 and the percentage of neutrophils was lower at D 4 only, but total protein content did not differ between groups at any time. CONCLUSION Synovial nucleated cell counts and total protein concentrations decreased after arthroscopic lavage and repeated intra-articular administration of antibiotic in horses and foals with septic arthritis. Synovial nucleated cell count is limited as a monitoring tool during treatment of septic arthritis.
Collapse
Affiliation(s)
- Matthieu Cousty
- Centre Hospitalier Vétérinaire Equin de Livet, Cour Samson, St Michel de Livet, France
| | - John David Stack
- UCD, University College Dublin Campus, Belfield, Dublin 4, Ireland
| | - Cyril Tricaud
- Centre Hospitalier Vétérinaire Equin de Livet, Cour Samson, St Michel de Livet, France
| | | |
Collapse
|
13
|
Robinson CS, Singer ER, Piviani M, Rubio-Martinez LM. Are serum amyloid A or D-lactate useful to diagnose synovial contamination or sepsis in horses? Vet Rec 2017; 181:425. [PMID: 28765498 PMCID: PMC5738594 DOI: 10.1136/vr.104386] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/16/2017] [Accepted: 06/22/2017] [Indexed: 11/04/2022]
Abstract
Synovial sepsis in horses is life threatening and accurate diagnosis allowing prompt treatment is warranted. This study assessed the diagnostic value of serum amyloid A (SAA) and D-lactate in blood and synovial fluid (SF) as diagnostic markers of synovial sepsis in horses and correlated them with total nucleated cell count (TNCC), percentage of neutrophils (%N) and total protein (TP) in SF. Blood and SF SAA and D-lactate concentrations were determined in a case–control observational study including 112 horses (38 with synovial contamination or sepsis (SCS), 66 with non-septic intra-synovial pathology (NSISP) and 8 controls). Blood and SF SAA were significantly higher in SCS than in NSISP and control horses. SAA values were similar in NSISP and control horses. SF SAA was moderately correlated with synovial TNCC, TP and blood SAA. Blood and SF SAA were 82.4 per cent and 80 per cent sensitive and 88.9 per cent and 73 per cent specific for diagnosis of SCS, with cut-off values of 60.7 and 1.14 µg/ml, respectively. Blood and SF D-lactate concentrations were not significantly different between groups. This study shows that blood and SF SAA concentrations can aid to distinguish SCS from non-septic synovial pathology; however, D-lactate was not useful.
Collapse
Affiliation(s)
- Claire S Robinson
- Department of Equine Clinical Science, Institute of Veterinary Science, University of Liverpool, Wirral, UK
| | - Ellen R Singer
- Department of Equine Clinical Science, Institute of Veterinary Science, University of Liverpool, Wirral, UK
| | - Martina Piviani
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Wirral, UK
| | - Luis M Rubio-Martinez
- Department of Equine Clinical Science, Institute of Veterinary Science, University of Liverpool, Wirral, UK
| |
Collapse
|
14
|
Haltmayer E, Schwendenwein I, Licka TF. Course of serum amyloid A (SAA) plasma concentrations in horses undergoing surgery for injuries penetrating synovial structures, an observational clinical study. BMC Vet Res 2017; 13:137. [PMID: 28532514 PMCID: PMC5441074 DOI: 10.1186/s12917-017-1057-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 05/12/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Injuries penetrating synovial structures are common in equine practice and often result in septic synovitis. Significantly increased plasma levels of serum amyloid A (SAA) have been found in various infectious conditions in horses including wounds and septic arthritis. Plasma SAA levels were found to decrease rapidly once the infectious stimulus was eliminated. The purpose of the current study was to investigate the usefulness of serial measurements of plasma SAA as a monitoring tool for the response to treatment of horses presented with injuries penetrating synovial structures. In the current study plasma SAA concentrations were measured every 48 hours (h) during the course of treatment. RESULTS A total of 19 horses with a wound penetrating a synovial structure were included in the current study. Horses in Group 1 (n = 12) (injuries older than 24 h) only needed one surgical intervention. Patients in this group had significantly lower median plasma SAA levels (P = 0.001) between 48 h (median 776 mg/L) and 96 h (median 202 mg/L) after surgery. A significant decrease (P = 0.004) in plasma SAA levels was also observed between 96 h after surgery (median 270 mg/L) and 6 days (d) after surgery (median 3 mg/L). Four horses (Group 2) required more than one surgical intervention. In contrast to Group 1 patients in Group 2 had either very high initial plasma concentrations (3378 mg/L), an increase or persistently high concentrations of plasma SAA after the first surgery (median 2525 mg/L). A small group of patients (n = 3) (Group 3) were admitted less than 24 h after sustaining a wound. In this group low SAA values at admission (median 23 mg/L) and peak concentrations at 48 h after surgery (median 1016 mg/L) were observed followed by a decrease in plasma SAA concentration over time. CONCLUSIONS A decrease in plasma SAA concentrations between two consecutive time points could be associated with positive response to treatment in the current study. Therefore, serial measurements of plasma SAA could potentially be used as an additional inexpensive, quick and easy tool for monitoring the treatment response in otherwise healthy horses presented with injuries penetrating synovial structures. However further studies will be necessary to ascertain its clinical utility.
Collapse
Affiliation(s)
- Eva Haltmayer
- Department of Small Animals and Horses, Clinic for Horses, Equine Surgery, University of Veterinary Medicine Vienna, Veterinärplatz 1, A-1210, Vienna, Austria.
| | - Ilse Schwendenwein
- Department of Pathobiology, Clinical Pathology, University of Veterinary Medicine Vienna, Veterinärplatz 1, A-1210, Vienna, Austria
| | - Theresia F Licka
- Department of Small Animals and Horses, Clinic for Horses, Equine Surgery, University of Veterinary Medicine Vienna, Veterinärplatz 1, A-1210, Vienna, Austria.,Department of Veterinary Clinical Studies, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush Campus, Midlothian, EH25 9RG, Scotland
| |
Collapse
|