Haematogenous septic arthritis, physitis and osteomyelitis in foals: A tutorial review on pathogenesis, diagnosis, treatment and prognosis. Part 1

Abstract

Haematogenous septic arthritis, physitis and osteomyelitis (SAPO) is a potentially debilitating or even life-threatening disease entity encountered in foals of all ages between birth and approximately 7 months old. Correct, and complete, diagnosis and successful treatment require collaboration between specialties including medicine, anaesthesia, diagnostic imaging, surgery and rehabilitation services. However, in order to succeed, it is important that all specialties have an overall knowledge of all aspects of the disease complex. Therefore, the aim of this review is to give an overview of aetiology, presenting complaints, clinical findings, diagnostic imaging, treatment, rehabilitation and prognosis. Part one deals with all aspects of aetiology and how to make a diagnosis. Part two deals with all aspects of treatment, rehabilitation and prognosis. MethodsSince this is considered a tutorial review, the authors aim to provide a selected review of the most relevant literature combined with the authors' experiences on the subject. Consequently, it should not be seen as a systematic review, and the reference list may not be exhaustive. Classification, aetiology and pathogenesisSAPO represents slightly different presentations of infection in the joint or the surrounding bone occurring as sequelae to bacteraemia or even sepsis in neonatal or young foals. Despite the differences, they share similarities in presentation that can make discrimination challenging (Firth et al. 1980;Firth 1983). Haematogenously disseminated bacteria originate

Haematogenous septic arthritis, physitis and osteomyelitis in foals: A tutorial review on pathogenesis, diagnosis, treatment and prognosis. Part 2

“…2010; Lindegaard et al . 2021). Local analgesics can also be administered at the end of an arthroscopic procedure.…”

“…Until these results are available, choice of systemic antimicrobial therapy should be based on empirical knowledge. As SAPO can be caused by Grampositive and Gram-negative bacteria (see Part 1; Lindegaard et al 2021), and there is no reliable way to determine the infectious agent until culture results become available, it is safest to initially choose broad-spectrum antimicrobial coverage.…”

“…For optimal local analgesia and anti-inflammatory effect, morphine can be administrated intra-articularly together with local antimicrobials at the end of any joint lavage or sampling Lindegaard et al 2021). Local analgesics can also be administered at the end of an arthroscopic procedure.…”

“…Part one of this review provided an overview of the aetiology and presenting complaints as well as all aspects of how to diagnose SAPO in foals (Lindegaard et al. 2021). Part two will review all aspects of treatment including surgical options, antimicrobial and analgesic recommendations, rehabilitation, and reports on short‐ and long‐term prognosis for foals affected with SAPO.…”

“…Haematogenous septic arthritis, physitis and osteomyelitis (SAPO) are manifestations of a potentially debilitating or even life-threatening disease entity encountered in all types of foals from neonates to approximately 7 months of age. Part one of this review provided an overview of the aetiology and presenting complaints as well as all aspects of how to diagnose SAPO in foals (Lindegaard et al 2021). Part two will review all aspects of treatment including surgical options, antimicrobial and analgesic recommendations, rehabilitation, and reports on short-and long-term prognosis for foals affected with SAPO.…”