In human medicine, procalcitonin (PCT) is a very common and well-established biomarker for sepsis. Even though sepsis is also a leading cause of death in foals and adult horses, up to now, no data about the role of equine PCT in septic horses has been available. Based on monoclonal antibodies targeted against human PCT, we report here the development of a sandwich ELISA for the quantification of equine PCT in equine plasma samples. The ELISA was characterized for intra- and interassay variance and a working range from 25 to 1,000 ng mL(-1) was defined as within this range; both intra- and interassay variances were below 15 %. The target recovery ranged between 73 and 106 %. The ELISA was used to determine the equine PCT concentration in 24 healthy and 5 septic horses to show the potential for clinical evaluation of equine PCT. Significantly different (P = 0.0006) mean equine PCT concentrations were found for the healthy control group and the sepsis group (47 and 8,450 ng mL(-1)).
Zusammenfassung: Procalcitonin (PCT) wird in der Humanmedizin als sensitiver Marker für das Vorliegen einer Endotoxämie und bakteriellen Infektion genutzt. In dieser Studie wurde PCT bei endotoxämischen Pferden, bedingt durch eine akute Kolik, bestimmt und mit den proinflammatorischen Zytokinen IL-1b, IL-6 und TNFa verglichen. Ziel dieser Untersuchung war zu beleuchten, ob sich die PCT-Plasmakonzentration bei einer akuten Kolik im Vergleich zum gesunden Pferd erhöht, im Verlauf einer Kolik verändert und ob sie sinnvoll zur Prognosestellung herangezogen werden kann. Schlüsselwörter: Pferd / Kolik / Endotoxämie / Procalcitonin / Zytokine Procalcitonin in horses with an acute colicIn comparison to other animal species the horse is very sensitive to the systemic consequences of endotoxemia leading to a high morbidity and mortality of gastrointestinal (e.g. colic or colitis) disease. Procalcitonin (PCT) is used in human medicine as a sensitive marker for the presence of a bacterial infection and endotoxemia. In this study, PCT was determined in endotoxemic horses with an acute colic and compared to the proinflammatory cytokines IL-1b, IL-6 and TNFa. The aim of this study was to examine whether the PCT plasma concentrations increases in horses with an acute colic compared to healthy horses, changes during the next days after referral to the hospital and whether it can be used to predict survival. 13 horses with an acute colic were classified as endotoxemic based on the results of the clinical and laboratory examination upon admission to the hospital, using a modified score and compared with 20 healthy control horses. For the determination of PCT, IL-1b, IL-6 and TNFa blood was collected from all horses at the time of admission at the equine hospital. Blood samples were quantified at the Helmholtz Zentrum München using an ELISA. A strangulating ileus was diagnosed in 11 horses, an obstructing ileus and enteritis in each case a horse. Endotoxemic horses with an intestinal strangulation showed significantly higher concentrations of median PCT and IL-1b in plasma or serum than the healthy control group. Horses that underwent laparotomy also had significantly higher PCT and IL1-b-plasma or serum concentrations than healthy controls. A follow up measurement of IL-1b and PCT over a 72-hour-period at 7 horses showed no significant changes in the levels. Significantly low median IL-6 serum levels could be measured in the patients when compared to healthy horses. The median serum concentrations of TNFa showed no significant differences between endotoxaemic and healthy horses. A correlation between PCT and IL-1b and survival of patients could not be established. PCT seems to be a promising biomarker for the detection of endotoxemia for the equine medicine but further research is needed.
Background: Procalcitonin, a precursor protein of the hormone calcitonin, is a sensitive marker for sepsis in human medicine, which is used for diagnosis of bacterial pneumonia in adults and neonates to initiate antibiotic therapy. Objectives: In this study, procalcitonin was evaluated as a potential biomarker for Rhodococcus equi associated pneumonia. Methods: In four foals procalcitonin was measured at four time-points (day 0 before antibiotic therapy, day 1, 3 and 5/6 during therapy) in plasma using an equine specific ELISA. Inclusion criteria for the study were a positive sepsis score, ultrasonographic evidence of pulmonary abscesses in addition >8 cm, a positive microbiology out of tracheobronchial secretion and positive response to antibiotic treatment (azithromycin 10 mg/kg BDW 24q PO and rifampicin 10 mg/kg BDW 12q PO) within a weak including improvement of clinical status and reduction of ultrasonographic score <8 cm. Results: Procalcitonin concentrations remained below the working range of the ELISA (25 -1000 ng/ml) in all but one sample. Conclusions: Procalcitonin cannot be regarded a useful biomarker in pneumonia associated with Rhodococcus equi.
ZusammenfassungEin 11-jähriger Friesenwallach wurde aufgrund von akuten Koliksymptomen in der Klinik für Pferde vorgestellt. Bei der Erstuntersuchung nach Klinikeinlieferung wurden Apathie, Tachykardie, eine innere Körpertemperatur von 39,3°C, 2,3 x 10 9 /l Leukozyten und sonographisch vermehrt freie Flüssigkeit in der Bauchhöhle festgestellt. Durch die Untersuchung des Bauchhöhlenpunktates wurde die Diagnose einer hochgradigen Peritonitis gestellt. In der am darauffolgenden Tag durchgeführten Gastroskopie konnte ein tiefes, blutendes, großes Magenulcus in der kutanen Drüsenschleimhaut als wahrscheinliche Ursache für die Peritonitis dargestellt werden. Die Therapie erfolgte mittels Omeprazol, Antibiotika (Marbofloxacin und Sulfadiazin-Trimetoprim), nichtsteroidalen Antiphlogistika (Firocoxib) und wiederholten Peritoneallavagen (0,9% NaCl-Lösung zweimal täglich über drei Tage). Der Wallach sprach sehr gut auf die Behandlung an und wurde nach zwei Wochen Klinikaufenthalt entlassen. In den Nachkontrollen nach 4 Wochen bzw. nach drei Monaten konnte eine gute Heilungstendenz des Magenulcus festgestellt werden.Schlüsselwörter: Magenulcus / Perforation / Peritonitis / Gastroskopie / Pferd Peritonitis caused by a perforating gastric ulcer in a Friesian gelding-a case reportAn 11-year-old Friesian gelding with an acute moderate colic was referred to the equine hospital. On admission the gelding was depressed, had a high heart rate, temperature was 39,3°C, a white blood count of 2,3 x 10 9 /l leukocytes and free fluid in the abdominal cavity on ultrasound. Based on the examined peritoneal fluid a severe septic peritonitis was found. Gastroscopically a large deep ulcer in the squamous mucosa, glandular region was detected. The large ulcer could have been the reason for the severe peritonitis. The gelding received omepazole, antibiotics (marbofloxacin, sulfadiazine-trimethoprim) and non-steroidal anti-inflammatory drugs (firocoxib). A lavage of the abdominal cavity with 0,9% saline was performed two times a day for three days. The gelding was discharged after two weeks of hospitalization. The gelding was rescoped 4 weeks and 3 months after discharge and the ulcer has almost resolved.
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