Authors declare no conflict of interest.
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Presumed immune-mediated hemolytic anemia in two foals with Rhodococcus equi infection
Article first published online: 9 MAY 2011
DOI: 10.1111/j.1476-4431.2011.00633.x
© Veterinary Emergency and Critical Care Society 2011
Additional Information
How to Cite
Johns, I. C., Desrochers, A., Wotman, K. L. and Sweeney, R. W. (2011), Presumed immune-mediated hemolytic anemia in two foals with Rhodococcus equi infection. Journal of Veterinary Emergency and Critical Care, 21: 273–278. doi: 10.1111/j.1476-4431.2011.00633.x
Present address: Dr. Imogen C. Johns, Department of Veterinary Clinical Science, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts, UK AL9 7TA.
Present address: Dr. Anne Desrochers, Marion duPont Scott Equine Med Ctr, 17690 Old Waterford Rd, PO Box 1938, Leesburg, VA 20177, USA.
Publication History
- Issue published online: 1 JUN 2011
- Article first published online: 9 MAY 2011
- Submitted May 28, 2010; Accepted March 15, 2011.
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Keywords:
- blood transfusion;
- hemolysis;
- horse;
- pneumonia
Abstract
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.