SERUM AMYLOID A

Detect and Monitor Equine Inflammation Due To Infection in 10 Minutes

Use Stablelab® to measure Serum Amyloid A, a reliable biomarker for infection in horses

Equine influenza virus (EIV) outbreaks can be frightening for how quickly it can spread in horses. Imagine being at a horse show or at a barn where a few horses come down with fevers of 102°-105° F and nasal discharge. You suspect EIV. But how can you know for sure? And how can you quickly identify inflammation due to infection?

This was the position Holly Helbig, DVM and owner of the Hawthorne Veterinary Clinic, found herself in while caring for horses at a show. She suspected EIV due to the signs presented, and knew she needed to act quickly to protect the other horses.

“Once a case of EIV is confirmed, horse owners worry that their horses could have been exposed or possibly infected,” Helbig said. “Horse owners are looking for a quick response for peace of mind. That is where SAA testing with Stablelab comes in.”

Detecting Inflammation Due To Infection With SAA Serum Amyloid A (SAA) is a major, acute phase protein produced by the liver that is a reliable biomarker for inflammation due to infection. SAA levels rapidly and dramatically increase in response to an infection.1 Using Stablelab®, a handheld stall-side diagnostic blood test, Helbig and her team conducted SAA tests on a large population of horses at the show. In 10 minutes, Stablelab detected inflammation due to possible infection in some of the horses before they showed clinical signs such as a fever.

“At a show, I will have upwards of 700 horses under my care, so the SAA testing provided crucial information to help guide me in determining what horses needed to be isolated,” Helbig said.

Monitoring Equine Influenza With SAA Dr. Helbig developed and quickly implemented a plan of action to isolate and care for possible infected horses. SAA testing with Stablelab provided the results needed to successfully enforce the plan, which included: • Monitoring horses in different barns that potentially came into contact with an infected horse at the show. • Conducting an SAA test on horses showing EIV signs and obtaining results without leaving the horse’s side. • Isolating horses with SAA levels greater than 50 and then testing for EIV. • Quarantining EIV-positive horses to minimize the risk of spreading EIV. • Conducting follow-up SAA tests three days later to monitor treatment response. “In my practice, I use Stablelab primarily for a fever of unknown origin, cellulitis and respiratory issues when I am at horse shows. In cases like this one, where I suspected EIV, Stablelab proved itself a valuable tool to help me to monitor, isolate and treat infected horses,” Helbig said.

INCORPORATE STABLELAB INTO YOUR PRACTICE The ability to identify inflammation in infected horses before they show clinical signs is critical, not only for the health of the horse, but for your clients’ peace of mind. Here are opportunities to incorporate SAA testing with Stablelab in your practice: • Primary and ambulatory care: Stablelab was designed to be used in the field to provide results in 10 minutes without leaving the horse’s side. Anytime you use antibiotics, test their SAA levels, quantify the inflammation due to infection and then use

Stablelab to monitor the response to treatment. • Reproduction: Pregnancy, parturition and the early neonatal period are high-risk life stages for the horse. Conduct SAA testing to identify inflammation and ward off potential health challenges. • Referral hospital: Measure SAA as part of your minimum database at the time of admission.

Screen for subclinical inflammation due to infection prior to surgery and monitor the response to treatment over their hospitalization.

LEARN MORE about testing SAA with Stablelab by talking with your Zoetis representative or visit Stablelab.com.

REFERENCE 1 Jacobsen, Stine. Review of equine Acute-Phase proteins. AAEP Proceedings vol 53 2007. Pages 230 - 235.

All trademarks are the property of Zoetis Services LLC or a related company or a licensor unless otherwise noted. Stablelab is a registered trademark of Epona Biotech Limited. © 2020 Zoetis Services LLC. All rights reserved. STB-00090

“We want to counteract en- Nocardioform the prevalence and the pathogedotoxemia. So we want to block nicity in the environment, and the release of those cytokines and prostaglandins, and then placentitis usually they just flourish in a hot, dry fall. These cases are hard to diagfrom the inflamed placenta in the hopes and the goal of preventing occurs from nose prior to abortion,” she said. Diagnostics are limited to a spontaneous abortion,” she said. Because cervical exudate can November to mostly transabdominal ultrasonography but the lesions are be difficult to culture, most ther- difficult to image. There is treatapy is empiric. Antimicrobial op- June with a peak ment if accurately diagnosed, tions include potassium penicil- but mares will clear this infeclin, gentamicin and trimethoprim sulfamethoxazole, because they in January and tion spontaneously after the foal aborts, and they can be bred accumulate in allantoic fluid. Altrenogest is given to pro- February, and back normally. “We don't think of them as being at increased risk mote uterine quiescence. Dr. Sones typically doubles the stan- seems to be for repeat infections,” she said. Placentitis caused by leptodard 0.044 mg/kg for placentitis. spirosis is a biosecurity emerSome clinicians will taper the tied to weather gency for the farm. “If you have dose as the mares get closer to one positive mare on the farm, foaling. Anti-inflammatories are key patterns. you need to quickly isolate that mare because she's going to shed to prevent the inflammatory cyto- it,” Dr. Sones said. kines and prostaglandins that pro- Her urine, the aborted fetus mote uterine contractility. There and placental membrane will harare several choices, flunixin meglumine, phenylbuta- bor the pathogen and can contaminate feed and water zone or firocoxib, her preferred choice. on the farm.

“Those are some nice oral options that you can “The mare may or may not have mild illness beuse on the farm for some of these chronic cases,” Dr. fore abortion,” Dr. Sones said. Sones said. Serial serology samples looking for rising titers

Pentoxifylline, a phosphodiesterase inhibitor or can be diagnostic both before and after abortion. free radical scavenger, can be useful to promote blood Detection of maternal antibodies, spirochetes in feflow to the fetal placental unit. “I personally have used tal kidney, placenta or maternal urine or a characterit a lot and like it,” she said, adding that it is a fairly istic placental lesion—adenomatous allantoic hypersafe addition. plasia—also can be diagnostic. “Those spirochetes

Some practitioners use clenbuterol to help pre- can also be identified by dark-field microscopy in vent myometrial contractions. “But there is not a the mare's urine or by PCR after abortion,” she said. whole lot of data showing that it's really preventing Treatment with procaine penicillin G or oxytetthose myometrial contractions in the horse,” Dr. racycline may prevent fetal infection but will not Sones said. eliminate shedding, “which is the main problem on big brood mare operations.” Other Causes of Placentitis Prevention is key. The shedder must be isolatNocardioform placentitis usually occurs from No- ed—maybe for months. Lepto EQ Innovator by Zovember to June with a peak in January and February. etis prevents Leptospira interrogans serovar PomoThe causative pathogens, Crossiella equi and Amyco- na and high-risk horses, including mares, should latopsis, tend to be environmental contaminants as- be vaccinated. “It's been shown to be safely given sociated with a hot-and-dry fall prior to the breeding to pregnant mares in early, mid- and late gestation. season. Researchers at the University of Kentucky But ideally you'd give them their initial dose and traced these cases to the weather patterns in the fall. booster prior to pregnancy,” Dr. Sones said. “OfThis year “we saw a significant number of nocardio- ten that's not possible, especially if mares are very form cases this past foaling season,” she said, which quickly rebred on foal heat, but if you can even was preceded by a hot, dry fall. get 1 dose in before they get pregnant again [that

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