Equine proliferative enteropathy--a review of recent developments.
Authors: Pusterla N, Gebhart C J
Journal: Equine veterinary journal
Summary
# Equine Proliferative Enteropathy: Clinical and Epidemiological Update Lawsonia intracellularis, an obligate intracellular bacterium, causes equine proliferative enteropathy (EPE)—an increasingly recognised disease primarily affecting weanling foals that presents with fever, lethargy, peripheral oedema, protein-losing enteropathy, diarrhoea, colic and weight loss. Pusterla and Gebhart's 2013 review synthesises emerging knowledge across the disease spectrum, examining epidemiological patterns, pathophysiological mechanisms, clinical presentation, and diagnostic and therapeutic approaches that had previously received limited systematic attention in the literature. Diagnosis typically combines findings of hypoproteinaemia, ultrasonographic thickening of small intestinal segments, positive serology, and molecular detection of *L. intracellularis* in faecal samples—though the variable sensitivity and specificity of these methods can complicate case confirmation. Understanding EPE's epidemiology and transmission dynamics is critical for stud managers, veterinarians and allied professionals, as appropriate biosecurity protocols, early recognition of clinical signs, and timely antimicrobial intervention (particularly with macrolides and rifampin combinations) can significantly improve foal outcomes and reduce morbidity in at-risk populations. The review underscores that whilst clinical diagnosis and management frameworks are now reasonably well established, ongoing surveillance and investigation of herd-level risk factors remain essential for developing effective prevention strategies on individual operations.
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Practical Takeaways
- •Suspect EPE in weanling foals presenting with fever, lethargy, diarrhoea and colic; use combination of ultrasound, serology and faecal PCR for diagnosis rather than relying on single diagnostic method
- •Monitor for hypoproteinaemia and intestinal wall thickening on ultrasound as key diagnostic indicators of EPE in affected foals
- •Implement biosecurity and management practices focused on weanling foal groups, as this age group is at highest risk of EPE
Key Findings
- •EPE is caused by obligate intracellular organism Lawsonia intracellularis and primarily affects weanling foals
- •Clinical signs include fever, lethargy, peripheral oedema, diarrhoea, colic and weight loss
- •Diagnosis relies on hypoproteinaemia, intestinal wall thickening on ultrasonography, serology and PCR detection of L. intracellularis in faeces
- •Epidemiology of EPE has remained largely unaddressed despite established clinical recognition and treatment protocols