Antimicrobial resistance and genetic diversity of Klebsiella pneumoniae strains from different clinical sources in horses

Introduction

Klebsiella pneumoniae is a major cause of infections and reproductive disorders among horses, ranked in recent French studies as the sixth most frequently isolated bacterial pathogen in equine clinical samples. The proportion of multidrug-resistant (MDR) K. pneumoniae is therefore significant in a context where MDR K. pneumoniae strains are considered a major global concern by the World Health Organization.

Methods

In this study, we used a genomic approach to characterize a population of 119 equine K. pneumoniae strains collected by two laboratories specialized in animal health in Normandy (France). We describe the main antibiotic resistance profiles and acquired resistance genes, and specify the proportion of virulence-encoding genes carried by these strains. The originality of our panel of strains lies in the broad collection period covered, ranging from 1996 to 2020, and the variety of sample sources: necropsies, suspected bacterial infections (e.g., genital, wound, allantochorion, and umbilical artery samples), and contagious equine metritis analyses.

Results

Our results reveal a remarkable level of genomic diversity among the strains studied and we report the presence of 39% MDR and 9% hypervirulent strains (including 5% that are both MDR and hypervirulent).

Discussion

These findings clearly emphasize the importance of improving the surveillance of K. pneumoniae in routine equine diagnostic tests to detect high-risk MDR-hypervirulent Klebsiella pneumoniae strains. The circulation of these worrisome strains reveals that they are not being detected by the simple K1, K2, and K5 serotype approach currently implemented in the French horse-breeding sector.

Effect of temperature on the development of the free-living stages of horse cyathostomins

Cyathostomins are considered as the most prevalent and pathogenic parasites of grazing horses. The development on pastures of the free-living stages of these gastrointestinal worms is particularly influenced by outdoor temperature. Understanding the bionomics of free-living stages is an important prerequisite to implement mathematical models designed to assess the parasitic risk for grazing equids. The aim of this study was to assess the effect of 3 constant temperatures under laboratory conditions (10 ± 1 °C, 23 ± 2 °C, 30 ± 2 °C) and one fluctuating temperature under outdoor conditions (mean: 17 ± 4 °C) on the minimum time taken by cyathostomin eggs to develop into first/second stage larvae (L1/L2) then into infective third stage larvae (L3) in horse faeces. According to the temperatures, the minimum time taken by eggs to develop into L1/L2 was between 1 and 3 days and into L3 between 4 and 22 days. At 10 °C, the development time of eggs into L3 was the longest and at 30 °C the fastest. The results were consistent with historically available data and their compilation should lead to the improvement of parameterised models assessing the parasitic risk period in grazing equids.

Factors Associated with Owner-Reported Euthanasia in Equids in France

There is limited evidence regarding the proportion of dead equids in France that were euthanized and the factors influencing the decision-making of euthanasia. The better understanding of which could facilitate research on improvement of welfare, especially on end of life issues. The aim of this study was to estimate the proportion of euthanasia and identify associated factors in equids in France. A web-based survey was created and distributed by the French horse and riding institute to owners who reported an equine death between April 2017 and April 2018 (n = 5 158). Factors associated with euthanasia were identified using a multivariable logistic regression model. The percentage of responses was 10.6% (n = 548/5 158; 95% CI 9.8% to 11.5%). The proportion of euthanasia was 71.0% (n = 389/548; 95% CI 67.2% to 74.8%). The factors "age category", "cause of natural death or reason for euthanasia" and "the length of time during which the animal was reported to be ill by the owner" were significantly associated with euthanasia (P <0.001). The results highlighted that a large majority of owners faced euthanasia decisions and our findings could support veterinarians and owners to better prepare for such an eventuality.

Home Sweet Home: New Insights Into the Location of Equine Premises in France and Keeping Habits to Inform Health Prevention and Disease Surveillance

Identifying and tracking equines are key activities in equine health prevention. France is one of the few European countries with an operational centralized database that records information on equines, owners, and keepers but not on the location and keeping conditions of equines. The objective of our study was to collect information on keeping habits of equines and the relative location of a wide range of equines, owners, and keepers and discuss their implication for surveillance and control of outbreak improvement. A national email survey was conducted among the 1.9% of people registered as owners and 8.2% of people registered as keepers in the French national equine identification database having given their agreement to be contacted by email. It led to the collection of information from 728 owners, 121 keepers, and 2,669 owner-keepers. Most of them housed their equines in a single commune (smallest geographic administrative unit in France) at their home as private individuals. The distance between the communes of residence and of holding was, in most cases (including 79% of owners in the owner survey, 89.5% of the keepers in the keeper survey, and about 94% of the owner-keepers in both surveys), less than 30 km. More than half of the keepers kept a maximum of five equines and the majority with two different uses/destinations together, mostly leisure-retirement, leisure-breeding, leisure-sport, and sport-breeding. The main limitation of the study was that a relatively limited number of people (n = 3518) were reachable due to the low availability of an email address and contact agreement. Nonetheless, the findings provide an overview of how equines are kept by non-professional owners and keepers and complements information usually collected by the French riding institute. Additionally, information collected is very helpful to determine a realistic estimate of the spatial distribution of equines in France. This information is very important for the equine sector, for demographic knowledge and also improvement of surveillance plans and control measures and for the management and monitoring of health events to limit the spread of diseases.

Is the French SIRE equine information system a good basis for surveillance and epidemiological research? Quality assessment using two surveys

Accurate demographic knowledge of the equine population is needed to assess and model equine health events. France is one of the few European countries with an operational centralized database (SIRE) recording individual data on all declared equines living in France and on their owners and keepers. Our study aimed to assess SIRE database quality concerning the updating of information by equine owners and keepers with a view to its improvement and use in surveillance and research. Two online surveys were conducted with the participation of 6244 registered keepers and 13,869 owners. Results showed some inconsistencies between SIRE records and survey responses. The inconsistency rate for equines whose castration and death were not registered in the database was 28.7% and 5.9% respectively. Concerning owners, 11% of respondents did not own the reference equine selected considered by the survey, 33% had changed address without updating it in the SIRE. Concerning premises hosting equines, the keeper survey's inconsistency rate was 7.3%, of which 57 respondents had closed and 32 had opened premises without reporting it. Comparatively, the owner survey's inconsistency rate was 40.7% including respondents who owned and hosted an equine without reporting these equine premises, and owners who did not keep any equines on their premises. In conclusion, the SIRE database proved to be a valuable and reliable source for epidemiological research as long as some bias is taken into account. On the contrary, its use in surveillance is currently limited due some shortcomings in updating and/or reporting by owners and keepers.

Relationship between rifampicin resistance and RpoB substitutions of Rhodococcus equi strains isolated in France

OBJECTIVES

Study of the rifampicin resistance of Rhodococcus equi strains isolated from French horses over a 20-year period.

METHODS

Rifampicin susceptibility was tested by disk diffusion (DD) and broth macrodilution methods, and rpoB gene sequencing and MLST were performed on 40 R. equi strains, 50.0% of which were non-susceptible to rifampicin.

RESULTS

Consistency of results was observed between rifampicin susceptibility testing and rpoB sequencing. Strains non-susceptible to rifampicin by DD had a substitution at one of the sites (Asp516, His526 and Ser531) frequently encountered and conferring rifampicin resistance. High-level resistance was correlated with His526Asp or Ser531Leu substitutions; low-level resistance was correlated with Asp516Tyr substitution, a novel substitution for R. equi. Strains susceptible to rifampicin by DD showed no substitution in the three sites, except for two strains carrying, respectively, the His526Asn and Asp516Val substitutions (previously correlated with low-level rifampicin resistance). Both strains were isolated from an animal from which ten other strains were also isolated and found to be rifampicin-non-susceptible by DD. MLST showed the presence of 10 STs (including the novel ST43), but no association was observed with rifampicin resistance.

CONCLUSIONS

This study confirms that certain substitutions in RpoB are more likely to confer high- or low-level rifampicin resistance, describes a new substitution conferring rifampicin resistance in R. equi and suggests non-clonal dissemination of rifampicin-resistant strains in France. Standard DD may miss strains with a low-level rifampicin-resistant substitution; further studies are needed to remedy the absence of R. equi-specific clinical breakpoints.

Compilation of 29 years of postmortem examinations identifies major shifts in equine parasite prevalence from 2000 onwards

Horses are infected by a wide range of parasite species that form complex communities. Parasite control imposes significant constraints on parasite communities whose monitoring remains, however, difficult to track through time. Postmortem examination is a reliable method to quantify parasite communities. Here, we compiled 1,673 necropsy reports accumulated over 29 years, in the reference necropsy centre from Normandy (France). The burden of non-strongylid species was quantified and the presence of strongylid species was noted. Details of horse deworming history and the cause of death were registered. Building on these data, we investigated the temporal trend in non-strongylid epidemiology and we determined the contribution of parasites to the deaths of horses throughout the study period. Data analyses revealed the seasonal variations of non-strongylid parasite abundance and reduced worm burden in race horses. Beyond these observations, we found a shift in the species responsible for fatal parasitic infection from the year 2000 onward, whereby fatal cyathostominosis and Parascaris spp. infection have replaced cases of death caused by Strongylus vulgaris and tapeworms. A concomitant break in the temporal trend of parasite species prevalence was also found within a 10 year window (1998-2007) that has seen the rise of Parascaris spp. and the decline of both Gasterophilus spp. and tapeworms. A few cases of parasite persistence following deworming were identified, which all occurred after 2000. Altogether, these findings provide insights into major shifts in non-strongylid parasite prevalence and abundance over the last 29 years. They also underscore the critical importance of Parascaris spp. in young equids.

Identification of levers for improving dead equine traceability: A survey of French equine owners' perception of regulatory procedures following their animal's death

The core of the French equine traceability system is the census database (SIRE) managed by the French horse and riding institute (IFCE). Following the death of an equine, owners are legally obliged to take charge of cadaver removal by contacting a rendering company directly or after registration on the national ATM-équidés ANGEE association (ATM) website, which proposes negotiated prices for removal and recording of the death in the SIRE database. Despite these offers, ATM notes few users. Owners are also legally obliged to return the equine's passport to the IFCE, but only 30-40 % of owners comply with the regulation. Rendering companies register data on equine mortality in the fallen stock data interchange database (FSDI), but it is difficult to cross-reference these data with SIRE data. Consequently, the death of equines is not well registered in the SIRE database. The objective of the present study was to identify levers that could be used to improve dead equine traceability by i) investigating the level of satisfaction of equine owners with ATM and rendering company services; and ii) investigating the drawbacks of owners having to return the passport to the IFCE. An online survey was designed and distributed by email to the 5 158 owners who used ATM services between April 2017 and April 2018. The response rate was 16.4 %. Most owners were satisfied by ATM and rendering company services. The lack of simple and quick removal procedures and the lack of any connection between ATM and the rendering companies were among the main drawbacks identified. Regarding the return of the passport to the IFCE, most responding owners returned it through the rendering company (65 %) or directly (2 %). The passport was returned significantly more frequently when requested by the renderers. The main reason for not providing the passport was the owner wanted to keep it as a souvenir. These results suggest that ATM and the rendering companies are key players in dead equine traceability. ATM services should be developed through the establishment of a direct connection with rendering companies to accelerate the cadaver removal request and to allow the cross-referencing of data between the ATM, FSDI and SIRE databases for a better dead equine traceability. Rendering companies need regulatory support to help them ask owners for the equine's passport, formalizing their contribution to equine traceability. Finally, effective communication has to be established to inform owners about the removal procedures and the regulations.

Resumeq: A Novel Way of Monitoring Equine Diseases Through the Centralization of Necropsy Data

The French surveillance network for causes of equine mortality (Resumeq) was created in 2015 for the qualitative surveillance of equine mortality through the centralization in a national database of necropsy data and their subsequent epidemiological analysis. It was designed to identify the causes of equine mortality, monitor their evolution over time and space, and detect emerging diseases as early as possible. Resumeq is an event-based surveillance system involving various players and structures. It is organized around a steering body, a scientific and technical support committee and a coordination unit. Different tools have been developed specifically for Resumeq. These include standardized necropsy protocols, a thesaurus for the anatomopathological terms and the causes of equine death, and an interactive web application so that network contributors can display data analysis results. The four French veterinary schools, seventeen veterinary laboratories, and ten veterinary clinics already contribute to the production and centralization of standardized data. To date, the data from around 1,000 equine necropsies have been centralized. While most deaths were located in western France, the geographic coverage is gradually improving. Data analysis allows the main causes of death to be ranked and major threats identified on a local, regional or national level. Initial results demonstrate the feasibility and benefits of this national surveillance tool. Moreover, in the future, this surveillance could take an international dimension if several countries decided to jointly capitalize on their necropsy data.

Utility of examining fallen stock data to monitor health-related events in equids: Application to an outbreak of West Nile Virus in France in 2015

Few studies about the use of quantitative equine mortality data for monitoring purposes are available. Our study evaluated the utility of monitoring emerging equine diseases using mortality data collected by rendering plants. We used approaches involving modelling of historical mortality fluctuations and detection algorithm methods to analyse changes in equine mortality in connection with the West Nile Virus (WNV) outbreak that occurred between July and September 2015 along the Mediterranean coast of France. Two weeks after the first equine WNV case was detected by clinical surveillance, detection algorithms identified excess mortality. The temporal distribution of this excess mortality suggested that it was related to the WNV outbreak, which may helped to assess the impact of the WNV epizootic on equine mortality. The results suggest that real‐time follow‐up of mortality could be a useful tool for equine health surveillance.

Fallen stock data: An essential source of information for quantitative knowledge of equine mortality in France

BACKGROUND

Quantitative information about equine mortality is relatively scarce, yet it could be of great value for epidemiological purposes. In France, data from rendering plants are centralised in the Fallen Stock Data Interchange database (FSDI), managed by the French Ministry of Agriculture, while individual equine data are centralised in the French equine census database, SIRE, managed by the French horse and riding institute (IFCE).

OBJECTIVES

To evaluate whether the combined use of the FSDI and SIRE databases can provide representative and accurate quantitative information on mortality for the French equine population and to propose enhancements of these databases to improve the quality of the resulting demographic information.

STUDY DESIGN

Descriptive study.

METHODS

Mortality ratios for the French equine population were calculated per year between 2011 and 2014 and temporal variations in equine mortality modelled during the same period. Survival analyses were performed on a sample of equines traceable in both the FSDI and SIRE databases.

RESULTS

Estimates of the annual mortality ratios varied from 3.02 to 3.40% depending on the years. Survival rates of equines 2-years-old and over differed according to breed categories with the highest median age at death for the ponies. The weekly description of mortality highlighted marked seasonality of deaths whatever the category of equines. Modelling temporal variations in equine mortality also brought to light excess mortality.

MAIN LIMITATIONS

Insufficient traceability of equines between the two databases.

CONCLUSION

The FSDI database provided an initial approach to equine death ratios on a national scale and an original description of temporal variations in mortality. Improvement in the traceability of equines between the FSDI and SIRE databases is needed to enable their combined use, providing a representative description of equine longevity and a more detailed description of temporal variations in mortality.

Development of a multilocus sequence typing scheme for Rhodococcus equi

Rhodococcus equi causes pulmonary and extrapulmonary infections in animals and humans, with endemic situations and significant young foal mortality in stud farms worldwide. Despite its economic impact in the horse-breeding industry, the broad geographic and host distribution, global diversity and population structure of R. equi remain poorly characterised. In this context, we developed a multilocus sequence typing (MLST) scheme using 89 clinical and environmental R. equi of various origins and eight Rhodococcus sp. Data can be accessed at http://pubmlst.org/rhodococcus/. A clonal R. equi population was observed with 16 out of 37 sequence types (STs) grouped into six clonal complexes (CC) based on single-locus variants. One of the six CCs (CC3) is not host-specific, suggesting potential exchanges between different R. equi reservoirs. Most of the virulent equine R. equi CCs/unlinked STs were plasmid-type-specific. Despite this, marked genetic variability with the circulation of multiple R. equi genotypes was generally observed even within the same animal. Focusing on outbreaks, data indicated (i) the potential contagious transmission of R. equi during the 2012-Mayotte equine outbreak because of the poor genotype diversity of clinical strains; (ii) a potential porcine outbreak among the 30 Belgian farms investigated in 2013. This first Rhodococcus equi MLST is a powerful tool for further epidemiological investigations and population biology studies of R. equi isolates.

Identification of Pathogenic Leptospira Strains in Tissues of a Premature Foal by Use of Polymerase Chain Reaction Analysis

Studies were carried out to determine the cause of death in a prematurely born Thoroughbred foal that died 24 hours after birth. Necropsy revealed gross lesions suggestive of septicemia. A commercial Leptospira polymerase chain reaction (PCR) assay designed to specifically amplify the hemolysis-associated protein 1 ( hap1) gene present only in pathogenic Leptospira strains detected the presence of Leptospira DNA in various tissues of the foal. Histologic examination of lung, liver, kidney, and myocardium revealed numerous spirochetes in Warthin–Starry-stained tissue sections. Results of PCR analysis and histologic examination suggested a leptospiral infection in the newborn foal. At the moment of death, the infection coexisted with a streptococcal-associated aspiration bronchopneumonia and postpartum septicemia. These findings indicate that the PCR assay based on the amplification of the hap1 gene represents a useful tool for specific detection of pathogenic leptospira in field samples taken from horses.

Evaluation of a Multivariate Syndromic Surveillance System for West Nile Virus

BACKGROUND

Various methods are currently used for the early detection of West Nile virus (WNV) but their outputs are not quantitative and/or do not take into account all available information. Our study aimed to test a multivariate syndromic surveillance system to evaluate if the sensitivity and the specificity of detection of WNV could be improved.

METHODS

Weekly time series data on nervous syndromes in horses and mortality in both horses and wild birds were used. Baselines were fitted to the three time series and used to simulate 100 years of surveillance data. WNV outbreaks were simulated and inserted into the baselines based on historical data and expert opinion. Univariate and multivariate syndromic surveillance systems were tested to gauge how well they detected the outbreaks; detection was based on an empirical Bayesian approach. The systems' performances were compared using measures of sensitivity, specificity, and area under receiver operating characteristic curve (AUC).

RESULTS

When data sources were considered separately (i.e., univariate systems), the best detection performance was obtained using the data set of nervous symptoms in horses compared to those of bird and horse mortality (AUCs equal to 0.80, 0.75, and 0.50, respectively). A multivariate outbreak detection system that used nervous symptoms in horses and bird mortality generated the best performance (AUC = 0.87).

CONCLUSIONS

The proposed approach is suitable for performing multivariate syndromic surveillance of WNV outbreaks. This is particularly relevant, given that a multivariate surveillance system performed better than a univariate approach. Such a surveillance system could be especially useful in serving as an alert for the possibility of human viral infections. This approach can be also used for other diseases for which multiple sources of evidence are available.

Assessment of fallen equine data in France and their usefulness for epidemiological investigations

Quantitative information about equine mortality is relatively scarce, yet it could be of great value for epidemiology purposes. Several European projects based on the exploitation of data from rendering plants have been developed to improve livestock surveillance. Similar data are available for equines in France but have never been studied to date. The objective of this research was to evaluate the potential of the French Ministry of Agriculture's Fallen Stock Data Interchange (FSDI) database to provide quantitative mortality information on the French equine population. The quality of FSDI equine data from 2011 to 2014 was assessed using complementary data registered in the French equine census database, SIRE. Despite a perfectible quality, the FSDI database proved to be a valuable source for studying the basal patterns of mortality over time in the French equine population as illustrated by the spatial representation of the number of deaths. However, improvements in the FSDI database are needed, in particular regarding the registration of animal identification numbers, in order to detail equine mortality for epidemiology purposes.

Retrospective Study of Necropsy-Associated Coagulase-Positive Staphylococci in Horses

Coagulase-positive staphylococci (CoPS) are potential causative agents of equine infections, but they are rarely responsible for the death of the animal. In the current study, staphylococci implicated in the death or euthanasia of horses were retrospectively studied in 3,457 necropsies performed over a decade (1995-2006). Morbidity associated with CoPS was 1.7%, representing 60 isolates of CoPS, which were identified as Staphylococcus aureus (59) and Staphylococcus pseudintermedius (1). Coagulase-positive staphylococci (alone or in association with another bacterial species) were associated with the death or euthanasia of 90% of the cases (54/60). Proportions of antibiotic resistance to penicillin G and tetracycline reached 62.7% and 23.7%, respectively. Virulence genes were detected in 91.7% of the strains, with a majority of seh or sei enterotoxin genes. Finally, 3 methicillin-resistant Staphylococcus aureus (MRSA) isolates belonging to the t064 spa-type were identified. One strain was isolated in 2003 and might thus be one of the first cases of equine MRSA in France.

Detection of equine herpesviruses in aborted foetuses by consensus PCR

The major role of EHV-1 in equine abortion is widely reported in the literature but the contribution of EHV-2, EHV-3, EHV-4 or EHV-5 remains less well documented. The objective of this study is to evaluate the contribution of these five different EHVs to equine abortion in a variety of biological tissues using a consensus polymerase chain reaction (PCR). The test was validated for specificity and sensitivity in horses before screening specimens from 407 foetuses, stillbirths and premature foals collected over a 2.5-year interval. Positive results obtained with this assay were compared to other EHV type-specific PCR or by sequencing. EHV-1 was identified as the major cause of abortion in French mares (59/407 cases). However, there was evidence to suggest some variation in the potential of EHV-1 strains to induce abortion. Indeed, DNA samples from EHV-2 (in three cases) and EHV-5 (in one case) inferred a role of these viruses in abortion. The presence of viral DNA from EHV-3 or EHV-4 strains was not detected in the specimens studied. The data obtained suggest that the consensus herpesvirus PCR is an efficient screening tool. In association with a specific PCR, the test provides a rapid identification of the type of herpesvirus involved in abortion and is useful for routine diagnostic tests as it allows the identification of herpesviruses other than the EHV-1 strain.

Ultrasound-guided atlanto-occipital puncture for myelography in the horse

Complications of cervical myelography arising from the puncture of the subarachnoid space to collect the cerebrospinal fluid and to inject the contrast medium have been described in humans and animals. In this study, 2 ultrasound-guided procedures were developed for puncture of the atlanto-occipital subarachnoid space, collection of cerebrospinal fluid, and injection of contrast medium. Myelography was performed on 6 ataxic horses using these procedures. The first attempt to puncture the subarachnoid space was successful in 5 horses and in one horse, a second attempt was necessary. Collection of cerebrospinal fluid and injection of contrast medium were achieved without difficulty. Ultrasound-guided myelography allowed reduction of potential complications associated with blind percutaneous puncture of the subarachnoid space. Methods described in this study should be tried-at least initially in an experimental setting--to collect cerebrospinal fluid from the atlanto-occipital site in standing horses where it may represent an alternative method when lumbosacral cerebrospinal fluid collection has been unsuccessful or contaminated with blood.

Magnetic resonance imaging of a brain abscess in a 10-month-old filly

The purpose of this paper was to correlate the magnetic resonance imaging (MRI) characteristics of a mature brain abscess in a horse with histopathologic alterations of brain tissue. Eight months after the onset of clinical signs, MRI of the brain of a 10-month-old filly was performed. A large space-occupying lesion in the right cerebral hemisphere was identified. This space-occupying lesion was delineated by a thick and well-defined capsule that was isointense to brain parenchyma on the T1-weighted images and with a markedly hypointense on the T2-weighted images. The identification of such a capsule is highly diagnostic of a mature brain abscess. The lesion seen on MR images was confirmed at necropsy where a large abscess of the right hemisphere was observed. Streptococcus zooepidemicus and Pseudomonas aeruginosa were isolated from the abscess. Based on histopathologic examination, the signal characteristics of the capsule on T1-weighted and T2-weighted images were found to be due to the presence of numerous hemosiderin-laden macrophages. These results are in agreement with previous studies on human patients. This report confirms the value of MRI in the diagnosis of equine brain diseases.

Magnetic resonance imaging for the diagnosis of stress fractures in a horse

In humans, magnetic resonance (MR) imaging is the method of choice for the diagnosis of stress fractures. In this paper, bilateral stress fracture of the lateral condyle of the third metacarpal bone in a French trotter is described. Results of the radiographic, MR imaging, and histologic examinations are presented, with a focus on the MR signal abnormalities found. Based on this patient, the potential use of MR imaging for the diagnosis of stress fractures in horses is discussed.

Endoscopic examination of the tarsal sheath of the lateral digital flexor tendon in horses

This study was designed to develop a reliable technique for endoscopic examination of the tarsal sheath of the lateral digital flexor tendon of horses. The anatomy of the tendon sheath and associated structures was studied in detail in cadavers before determining portals for the insertion of an arthroscope into the sheath. Approaches into the sheath through the proximal pouch and through the flexor retinaculum, at the level of the sustentaculum tali, were performed and compared in cadavers. The proximal pouch portal permitted visualisation only of the proximal half of the sheath, while the approach through the retinaculum allowed examination of the entire sheath. The normal endoscopic appearance of the tarsal sheath was studied. The endoscopic approach was subsequently used to examine and treat 5 horses with tarsal sheath tenosynovitis, including 2 cases of chronic, traumatic tenosynovitis and 3 of subacute septic tenosynovitis. Four of these horses had fragmentation of the sustentaculum tali. The technique allowed adequate examination of the sheath and debridement of adhesions and lesions within the lumen of the sheath. Fragments dorsal to the medioplantar edge of the sustentaculum tali could not be visualised endoscopically and had to be removed after widening of the wound. All 5 horses survived. Follow-up enquiries (8-31 months) revealed that the horses were all reported to be sound. Four were performing at their previous level of activity, 1 was used for hacking. The 2 cases presented with chronic tenosynovitis had residual sheath distension with no associated loss of function. A prospective study, including longer term follow-up investigation, is currently being performed.