A review of equine sepsis.
Authors: Taylor S
Journal: Equine veterinary education
Summary
Sepsis represents an exaggerated systemic inflammatory response to infection and remains a significant clinical challenge across all age groups in equine medicine. Taylor's review synthesises current understanding of sepsis pathophysiology, distinguishing between neonatal presentations—typically arising from failure of passive transfer and manifesting as bacteraemia, pneumonia, enterocolitis, omphalophlebitis, meningoencephalitis or arthritis—and sepsis in mature horses, which most commonly follows gastrointestinal mucosal disruption with subsequent bacterial translocation and endotoxaemia, though pleuropneumonia and metritis are also recognised sources. Diagnosis remains problematic due to the relatively poor sensitivity of microbial culture and subjective assessment tools, prompting ongoing investigation into biomarkers to improve diagnostic accuracy and prognostication, whilst treatment demands an intensive care approach encompassing antimicrobial therapy, fluid resuscitation with vasopressor support, and targeted intervention against inflammation, endotoxaemia and coagulopathy. Survival outcomes diverge markedly by age group: neonatal foals show variable prognosis (26–86%, with most data clustering around 45–60%), whereas adult horses' prognosis hinges substantially on the underlying primary condition, with multiple organ dysfunction syndrome—including secondary laminitis and coagulopathies—representing common severe-case complications. For practitioners, the key takeaway is that early recognition and prompt antimicrobial intervention are critical to improving outcomes, and careful monitoring for biomarkers and systemic inflammatory response syndrome criteria should inform clinical decision-making when primary infectious or inflammatory disease is suspected.
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Practical Takeaways
- •Early recognition and prompt antimicrobial treatment are critical for sepsis outcomes; intensive care including fluid resuscitation, pressure support, and management of inflammation and coagulopathy are essential components of treatment
- •In neonatal foals, ensure adequate passive transfer of colostral antibodies to prevent sepsis; monitor for multiple concurrent conditions including arthritis and meningoencephalitis
- •In mature horses, investigate gastrointestinal disease as the primary source in septic cases, and be alert for secondary complications such as laminitis and coagulopathies that require specific management
Key Findings
- •Sepsis in neonatal foals commonly results from failure of passive transfer and may present with bacteraemia, pneumonia, enterocolitis, omphalophlebitis, meningoencephalitis or arthritis
- •Sepsis in mature horses is most frequently secondary to gastrointestinal lesions causing bacterial translocation and endotoxaemia
- •Sepsis biomarkers are being studied to improve diagnosis and prognostication due to low sensitivity of microbial culture
- •Neonatal foal sepsis survival rates range from 26-86%, with most studies reporting 45-60% survival