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Retrospective evaluation of 155 adult equids and 21 foals with tetanus in Western, Northern, and Central Europe (2000-2014), part 1 : description of history and clinical evolution

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Abstract
Objective - To describe clinical data of hospitalized adult equids and foals with tetanus. Design - Multicenter retrospective study (2000-2014). Setting - Twenty Western, Northern, and Central European university teaching hospitals and private referral centers. Animals - One hundred fifty-five adult equids (>6 months) and 21 foals (<6 months) with tetanus. Interventions - None. Measurements and Main Results - Information on geographic, annual and seasonal data, demographic- and management-related data, clinical history, clinical examination and blood analysis on admission, complications, treatments, and outcomes were described and statistically compared between adults and foals. The described cases were often young horses. In 4 adult horses, tetanus developed despite appropriate vaccination and in 2 foals despite preventive tetanus antitoxin administration at birth. Castration, hoof abscesses, and wounds were the most common entry sites for adults; umbilical cord infections and wounds for foals. Stiffness was the commonest observed initial clinical sign. Blood analyses frequently revealed an inflammatory response, hemoconcentration, muscle damage, azotemia, negative energy balance, liver damage, and electrolyte and acid base disturbances. Common complications or clinical signs developing during hospitalization included dysphagia, dyspnea, recumbency, hyperthermia, seizures, hyperlipemia, gastrointestinal impactions, dysuria, and laryngeal spasms. Cases were supported with wound debridement, antimicrobial treatment, tetanus antitoxin, muscle spasm and seizure control, analgesia, anti-inflammatory drugs, fluid therapy, and nutritional support. Mortality rates were 68.4% in adult horses and 66.7% in foals. Foals differed from adult horses with respect to months of occurrence, signalment, management-related data, potential causative events, clinical signs on admission, blood analysis, complications, and severity grades. Conclusions - This is the first study that rigorously describes a large population of equids affected by tetanus. The information provided is potentially useful to clinicians for early recognition and case management of tetanus in adult horses and foals. Tetanus affects multiple organ systems, requiring broad supportive and intensive care. Neonatal and adult tetanus in the horse should be considered as distinct syndromes, as in human medicine.
Keywords
Clostridium tetani, epidemiology, horses, infectious disease, CLOSTRIDIUM-TETANI, HORSES, ANTITOXIN, DOGS

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MLA
van Galen, Gaby et al. “Retrospective Evaluation of 155 Adult Equids and 21 Foals with Tetanus in Western, Northern, and Central Europe (2000-2014), Part 1 : Description of History and Clinical Evolution.” JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE 27.6 (2017): 684–696. Print.
APA
van Galen, G., Saegerman, C., Rijckaert, J., Amory, H., Armengou, L., Bezdekova, B., Durie, I., et al. (2017). Retrospective evaluation of 155 adult equids and 21 foals with tetanus in Western, Northern, and Central Europe (2000-2014), part 1 : description of history and clinical evolution. JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, 27(6), 684–696.
Chicago author-date
van Galen, Gaby, Claude Saegerman, Joke Rijckaert, Helene Amory, Lara Armengou, Barbora Bezdekova, Inge Durie, et al. 2017. “Retrospective Evaluation of 155 Adult Equids and 21 Foals with Tetanus in Western, Northern, and Central Europe (2000-2014), Part 1 : Description of History and Clinical Evolution.” Journal of Veterinary Emergency and Critical Care 27 (6): 684–696.
Chicago author-date (all authors)
van Galen, Gaby, Claude Saegerman, Joke Rijckaert, Helene Amory, Lara Armengou, Barbora Bezdekova, Inge Durie, Rikke Findshøj Delany, Nathalie Fouché, Laura Haley, Michael Hewetson, Rene van den Hoven, Anna Kendall, Fernando Malalana, Jessika Muller Cavalleri, Tresemiek Picavet, Katja Roscher, Denis Verwilghen, Meret Wehrli Eser, Cornélie Westermann, and Tim Mair. 2017. “Retrospective Evaluation of 155 Adult Equids and 21 Foals with Tetanus in Western, Northern, and Central Europe (2000-2014), Part 1 : Description of History and Clinical Evolution.” Journal of Veterinary Emergency and Critical Care 27 (6): 684–696.
Vancouver
1.
van Galen G, Saegerman C, Rijckaert J, Amory H, Armengou L, Bezdekova B, et al. Retrospective evaluation of 155 adult equids and 21 foals with tetanus in Western, Northern, and Central Europe (2000-2014), part 1 : description of history and clinical evolution. JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE. 2017;27(6):684–96.
IEEE
[1]
G. van Galen et al., “Retrospective evaluation of 155 adult equids and 21 foals with tetanus in Western, Northern, and Central Europe (2000-2014), part 1 : description of history and clinical evolution,” JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, vol. 27, no. 6, pp. 684–696, 2017.
@article{8615211,
  abstract     = {Objective - To describe clinical data of hospitalized adult equids and foals with tetanus. 
Design - Multicenter retrospective study (2000-2014). 
Setting - Twenty Western, Northern, and Central European university teaching hospitals and private referral centers. 
Animals - One hundred fifty-five adult equids (>6 months) and 21 foals (<6 months) with tetanus. 
Interventions - None. 
Measurements and Main Results - Information on geographic, annual and seasonal data, demographic- and management-related data, clinical history, clinical examination and blood analysis on admission, complications, treatments, and outcomes were described and statistically compared between adults and foals. The described cases were often young horses. In 4 adult horses, tetanus developed despite appropriate vaccination and in 2 foals despite preventive tetanus antitoxin administration at birth. Castration, hoof abscesses, and wounds were the most common entry sites for adults; umbilical cord infections and wounds for foals. Stiffness was the commonest observed initial clinical sign. Blood analyses frequently revealed an inflammatory response, hemoconcentration, muscle damage, azotemia, negative energy balance, liver damage, and electrolyte and acid base disturbances. Common complications or clinical signs developing during hospitalization included dysphagia, dyspnea, recumbency, hyperthermia, seizures, hyperlipemia, gastrointestinal impactions, dysuria, and laryngeal spasms. Cases were supported with wound debridement, antimicrobial treatment, tetanus antitoxin, muscle spasm and seizure control, analgesia, anti-inflammatory drugs, fluid therapy, and nutritional support. Mortality rates were 68.4% in adult horses and 66.7% in foals. Foals differed from adult horses with respect to months of occurrence, signalment, management-related data, potential causative events, clinical signs on admission, blood analysis, complications, and severity grades. 
Conclusions - This is the first study that rigorously describes a large population of equids affected by tetanus. The information provided is potentially useful to clinicians for early recognition and case management of tetanus in adult horses and foals. Tetanus affects multiple organ systems, requiring broad supportive and intensive care. Neonatal and adult tetanus in the horse should be considered as distinct syndromes, as in human medicine.},
  author       = {van Galen, Gaby and Saegerman, Claude and Rijckaert, Joke and Amory, Helene and Armengou, Lara and Bezdekova, Barbora and Durie, Inge and Findshøj Delany, Rikke and Fouché, Nathalie and Haley, Laura and Hewetson, Michael and van den Hoven, Rene and Kendall, Anna and Malalana, Fernando and Muller Cavalleri, Jessika and Picavet, Tresemiek and Roscher, Katja and Verwilghen, Denis and Wehrli Eser, Meret and Westermann, Cornélie and Mair, Tim},
  issn         = {1479-3261},
  journal      = {JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE},
  keywords     = {Clostridium tetani,epidemiology,horses,infectious disease,CLOSTRIDIUM-TETANI,HORSES,ANTITOXIN,DOGS},
  language     = {eng},
  number       = {6},
  pages        = {684--696},
  title        = {Retrospective evaluation of 155 adult equids and 21 foals with tetanus in Western, Northern, and Central Europe (2000-2014), part 1 : description of history and clinical evolution},
  url          = {http://dx.doi.org/10.1111/vec.12668},
  volume       = {27},
  year         = {2017},
}

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