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Presumed immune‐mediated hemolytic anemia in two foals with Rhodococcus equi infection
Author(s) -
Johns Imogen C.,
Desrochers Anne,
Wotman Kathryn L.,
Sweeney Raymond W.
Publication year - 2011
Publication title -
journal of veterinary emergency and critical care
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.886
H-Index - 47
eISSN - 1476-4431
pISSN - 1479-3261
DOI - 10.1111/j.1476-4431.2011.00633.x
Subject(s) - medicine , rhodococcus equi , foal , hemolytic anemia , anemia , dexamethasone , clarithromycin , azithromycin , immunology , respiratory distress , ards , pneumonia , antibiotics , lung , surgery , microbiology and biotechnology , history , biochemistry , chemistry , archaeology , virulence , gene , helicobacter pylori , biology
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.