The mystery of fungal infection in the guttural pouches.
Authors: Lepage O M, Perron M-F, Cadoré J-L
Journal: Veterinary journal (London, England : 1997)
Summary
Guttural pouch mycosis represents a significant clinical challenge in equine practice, with Aspergillus spp. being the predominant causative organism, yet the factors triggering its pathogenic behaviour remain poorly understood. Lepage, Perron and Cadoé's 2004 review synthesises current knowledge of guttural pouch physiology—notably their proposed thermoregulatory function in cooling blood to the brain below core body temperature—alongside emerging therapeutic innovations for managing this life-threatening condition. Transarterial coil embolisation of the internal carotid, external carotid and maxillary arteries has demonstrated rapid and effective disease regression in both clinically normal and affected horses, achieving lesion resolution without concurrent antifungal therapy. For acute, uncontrollable epistaxis in field situations, bilateral common carotid artery occlusion remains the most reliable haemorrhage-control measure. The paradox at the heart of this review is that whilst arterial occlusion clearly succeeds clinically, the mechanism by which it resolves mycotic infection in the absence of antifungal medication remains unexplained—a gap highlighting the need for further investigation into guttural pouch pathophysiology and the relationship between vascular supply, local immunity and fungal colonisation.
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Practical Takeaways
- •Consider transarterial coil embolization as a rapid and safe alternative to conventional antifungal therapy for guttural pouch mycosis in horses with appropriate vascular access
- •Bilateral common carotid artery occlusion is an effective emergency field treatment for life-threatening epistaxis when other options are unavailable
- •The mechanism by which arterial occlusion resolves fungal infection without antifungal drugs suggests novel immunological or physiological processes worth investigating
Key Findings
- •Guttural pouches may function in regulating arterial blood temperature by cooling circulation to the brain below body temperature
- •Aspergillus spp. is the major organism causing guttural pouch mycosis, but the mechanism of pathogenesis remains unclear
- •Transarterial coil embolization of internal carotid, external carotid, and maxillary arteries induces regression of mycotic lesions without antifungal medication
- •Occlusion of both common carotid arteries is effective for managing acute, uncontrollable epistaxis in the field