# Strangles



## natisha (Jan 11, 2011)

This article from Alpha Horse may help you. I'm sorry your horses are sick.

By Jeffrey Rolo 

Strangles is a word that strikes fear into the hearts of many horse owners. Okay… maybe fear is too strong a word, but equine strangles is certainly an occurrence we all dread. While perhaps its reputation is deserved for the mess alone it can create, the good news is strangles is not as ominous as legend would have us believe. 
*What causes horse strangles?* 
Strangles is caused by exposure to the Streptococcus equi bacterium, and in fact Streptococcus is what also causes strep throat in humans. This bacterium is introduced through a horse's nasal passage where it proceeds to attach to the lymph nodes around the pharynx and submandibular regions (the back of the throat and under the jaw areas). The lymph nodes attempt to fight off the invading and reproducing bacteria, eventually causing a possible abscess to form. 
*How is strangles transmitted?* 
Streptococcus equi is passed on through direct exposure to the nasal discharge of afflicted horses as well as the pus that is released from abscesses. It is a highly contagious bacterium, especially among younger horses, but since direct exposure is required for it to be transmitted preventing it from spreading further is actually fairly easy. Once you have confirmed a horse is afflicted with strangles it's vital that you isolate him from all other horses – any box stall will do. 
Contaminated watering buckets, ponds, bedding, hay and even fence railings can spread the disease to healthy horses, so make sure to sanitize any areas the sick horse had contact with if possible, particularly if other horses are also present in those areas. The bacteria can survive for a few weeks given the right atmosphere. 
*What are the signs?* 
If your horse comes down with equine strangles he may lose his appetite and develop a fever. In addition the lymph nodes around the throat will swell up due to the accumulation of purulent fluid (pus) caused by the nodes fighting off the invading bacteria. As the nodes expand your horse may keep his neck outstretched to relieve the pressure in his throat area. 
As the disease progresses your horse will develop a very thick, cloudy mucous discharge that is enough to make almost anyone grimace. Depending on the severity of the disease as well as whether it has received any treatment, eventually the pus may collect enough to cause an abscess by which the pus can be drained. 
A horse will begin developing signs of the disease about 2-6 days after exposure. Usually it will take about a week and a half to two weeks for the disease to run its course, abscesses to rupture and the pus to be drained. 
*How severe is the disease?* 
Normally equine strangles isn't too dangerous; it's just awfully miserable, messy and inconvenient for both you and your horse. That being said, once you realize your horse has developed strangles you should contact your veterinarian and have him diagnose your equine since the severity can vary and complications can arise. 
Generally unless the lymph nodes swell to levels that affect the horse's ability to breathe, the disease can be allowed to run through its course. Statistics have been shown to suggest fatality rates among completely untreated strangles cases can range in 1% to 3% while another set suggested the rate was as high as 10% to 20%! I believe the latter to be significantly inflated, but in either case such statistics aren't relevant for domesticated horses since the majority of us call a veterinarian and provide care. 
*How should horse strangles be treated?* 
Much will depend on the severity and stage of your horse's case. Penicillin has been shown to be effective against Streptococcus equi, but application of it should be done during the initial stages of strangles or after any abscesses have ruptured. 
Once the disease has caused abscesses to form, penicillin can actually delay the abscesses from opening and draining the pus. As such, it's usually best to let the abscess work its course (or have the vet cut it open), then apply penicillin after the draining has begun to wipe up the remaining bacteria. 
There is some debate as to whether applying penicillin can actually inhibit a horse's ability to form a natural immunity against strangles, or worse provoke ******* strangles. Unfortunately there really isn't enough scientific proof to connect antibiotics to the increased chance of developing ******** strangles*, but I can understand why many veterinarians would rather play it safe for light cases that can be healed naturally. When a couple of my young horses developed strangles my veterinarian recommended allowing the disease to run its course naturally since the cases were not severe. A couple times a day I would clean the horses' nose, ensure they could breath easily, make sure they had plenty of clean water and food, and finally watch for potential worsening or complications. Within about a week the strangles worked its way through and the horses were fine.


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## deineria (Mar 22, 2009)

Also, one big issue we have is having HUGE doses like this 2 times a day - the horses are already so traumatized - they will not let us catch them and one filly starts to rear when my husband gets near her. . .ugh! Geez. What a mess.


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## mls (Nov 28, 2006)

deineria said:


> Also, one big issue we have is having HUGE doses like this 2 times a day - the horses are already so traumatized - they will not let us catch them and one filly starts to rear when my husband gets near her. . .ugh! Geez. What a mess.


We followed the no antibiotic until the abscess had burst proctocol. A pain to keep the horses in quarantine but the majority worked through with no need for injections.

Have you taken temps on the horses?


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## CJ82Sky (Dec 19, 2008)

i had a similar situation years ago at my barn.

strangles can last from 7 - 30 days for a horse to be symptom free. we tried different antibiotics with no help from any - for the most part they didn't make a difference at all. even tried different decongestants (like tri-meth and stuff) again for nothing.

what helped the most was warm compresses 4-6x a day on any horses that abscessed, checking temps 4x a day and using bute and/or banamine as needed (paste version of both) and putting the horses on ulcer supps to prevent colic from stress or weight loss from loss of appetite. even when horses were off their feed we found the ulcer supps in a warm bran mash with some beet pulp helped keep them hydrated and from getting too weak.

the ones that got the 4-6x a day care healed the fastest.

i also found that any horse on the property that had been vacc'd for strangles at least 2x yr for 3 or more years NEVER got symptomatic other than at most a minor fever lasting less than 24h and off their feed for 1 - 2 feedings max. to put that into perspective at the time where i was located there were approx 50 horses on the property - the ones that were regularly vacc'd were all in the barn where the worst of the outbreak was (we believe a horse that came in that was vacc'd was a carrier bc we later found out he came from a barn that had 3 outbreaks in 1.5 years... nice right?!?!? he was a pvt owned horse too ugh). so you can't even argue that the non symptomatic ones were the ones with the least exposure. my clyde-x duke i only had for 1 year at that point and he abscessed. he is stabled next to and can go nose to nose with my tb sky who i've had for a lot longer and had been vacced 2x a year as long as i owned him. sky never went symptomatic despite duke oozing next to him (gross!).

we also found that if you are careful and take temps of even non symptomatic horses 2x a day at least, you can treat with bute/banamine (depending on your vet's reco and what the horse responds to better) at the first sign of a slight fever and potentially head off the rest of the symptoms.

at the end of the day, good nursing care is a MUST, and no horses in or out for 30 days MINIMUM past the last horse's last symptom and you can keep it contained. as far as spreading on the property - even the best QT can still spread it as strangles is airborne and resistant to antibacterial agents s can travel with you from one end of the property to the other even if you spray yourself down with lysol. best thing to do is not handle horses on anyone else's property after handling any affected horses.

feel free to ask any questions you may have. we had this issue years ago but it was most definitely a learning experience and im happy to help in any way that i can. best of luck to you. best part is that strangles is rarely fatal, and usually self-limiting without meds.


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## farmpony84 (Apr 21, 2008)

mls said:


> We followed the no antibiotic until the abscess had burst proctocol. A pain to keep the horses in quarantine but the majority worked through with no need for injections.
> 
> Have you taken temps on the horses?


I think over the years, this to me, has proven to be the best approach.


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## deineria (Mar 22, 2009)

We did not take temps except on the obviously symptomatic mare - started pen g and now they are getting to where they will not let us near them because of a fear of being injected - 

I'm so afraid to watch and wait and not do an antibiotic - 
I will do banamine though, and I've called the vet about whether there
is a feed through antibiotic I can do to avoid injections.


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## corinowalk (Apr 26, 2010)

I would think a feed through would be less effective. The injections are there to insure that the horse gets every last drop of what they need. 

Strangles can get scary but try to keep in mind that it is just a nasty infection and it will clear up in time. I personally wouldn't be giving antibiotics to a nonsymptomatic horse. Seems like a waste of meds. Granted, Strangles is super contagious but if managed properly, has a low fatality rate. The contagious aspect of it is what gives Strangles its really bad rap. Once it is in your barn, you are best to just work around it and sterilize as soon as it is gone.


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## deineria (Mar 22, 2009)

Thanks - three have symptoms, and I just assume it is a matter of time before all 9 do - My vet is out of town and it is cracking me up


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## deineria (Mar 22, 2009)

ALSO: Do most cases results in the open abscesses like this:







or no?


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## mls (Nov 28, 2006)

deineria said:


> ALSO: Do most cases results in the open abscesses like this:
> 
> 
> 
> ...


What do you mean?


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## deineria (Mar 22, 2009)

Having not dealt with it before, I have been looking at photos of strangles like the one above, and I am curious if I should expect such abscesses and swelling on all of the horses. . .or do only certain cases present like that?


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## ~*~anebel~*~ (Aug 21, 2008)

Good luck is all I have to say!!!

I would be following my vet's advice and giving the antibiotic. Check to see if there are any drug reactions with your vet but if the horses are getting tough to handle, a mild sedative in their feed can really help.
I vaccinate my horses for strangles - and although I have been at barns which have had it, my horses have never contracted strangles.

As far as anything I know about treating it, set aside all the halters and blankets for those horses and have a different set of clothes and shoes for the infected horses all of which can be disinfected when the horses get better.

I know of some horses who have not abcessed with strangles (not sure if this was because of early treatment or not) but I think they usually do. Because it is a bacterial infection it makes sense that treatment with antibiotics would decrease the severity of the infection.


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## CJ82Sky (Dec 19, 2008)

antibiotic is not recommended in strangles as it can surpress the horse's ability to fight it off.

as for abscesses, it depends on the horse. some do, some do not.


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## CJ82Sky (Dec 19, 2008)

antibiotic is not recommended in strangles as it can surpress the horse's ability to fight it off.

as for abscesses, it depends on the horse. some do, some do not.

also it's always wise to check all temps:
The incubation period for strangles ranges from three to 14 days, in general. Holland notes that a horse that is developing a strangles infection usually develops a fever 1½ to two days prior to lymph node enlargement or shedding of large numbers of the organism. As soon as a fever or other signs of contagious disease occur, personnel should isolate the horse from others, in addition to taking precautions such as routing of equipment. This limits the spread of bacteria until a veterinarian examines the horse. If there is suspicion of strangles, then laboratory testing of nasal-pharyngeal swabs or lavage samples can yield specific information.


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## CJ82Sky (Dec 19, 2008)

antibiotics BEFORE symptoms is a yes, once strangles is fully present NO as per the AAEP:
"In my opinion, antibiotics given before lymph nodes enlarge may help to head off the disease," says Holland. "Antibiotics may be indicated if there has been a positive identification of Strep on at least one animal on the farm--this increases the probability that the fever is associated with S. equi. If a lymph node becomes enlarged, I stop antibiotics and begin supportive care, unless it is life-threatening, in which case I continue antibiotics and supportive care."

full article here: The Horse | Strangles Management and Prevention


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## deineria (Mar 22, 2009)

CJ82Sky said:


> antibiotic is not recommended in strangles as it can surpress the horse's ability to fight it off.
> 
> as for abscesses, it depends on the horse. some do, some do not.
> 
> ...


I know treatment and vet opinions vary vet to vet, but my vet's office said testing isn't done routinely if the signs are obvious because it is so easy to diagnose. Also, cleaning and such hasn't been recommended to me because of the small size of my farm and the exposure having already made it to the horse kept furthest away from the rescue mare - all in between were close and have had direct over the fence contact with the 1st horse to come down with it after the rescue mare.

This was what my vet's office referred me to, among other info, this study mentioned online, and the vet's info who cited it stated
"I have seen many dozens of horses respond to treatment within 24 to 48 hours of beginning penicillin while untreated horses who contracted the infection almost invariable went on to a protracted course with abscessation." :

"_J Vet Pharmacol Ther. 2003 Aug;26(4):247-52. 
*Clinical efficacy of trimethoprim/sulfadiazine and procaine penicillin G in a Streptococcus equi subsp. zooepidemicus infection model in ponies.* 

Ensink JM, Smit JA, van Duijkeren E. 
Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands. [email protected] 

Tissue chambers, implanted subcutaneously on both sides of the neck in eight ponies, were inoculated with Streptococcus equi subsp. zooepidemicus in order to compare the clinical efficacy of trimethoprim/sulfadiazine (TMP/SDZ) and penicillin G treatment in a purulent infection. The TMP/SDZ treatment consisted of one intravenous (i.v.) injection of 5 mg/kg TMP and 25 mg/kg SDZ and the same dose of TMP/SDZ per os (p.o.), both given 20 h after inoculation. The oral dose was then repeated every 12 h for 21 days. The penicillin treatment consisted of one i.v. injection of 20 000 IU/kg sodium penicillin G and intramuscular (i.m.) injection of 20 000 IU/kg procaine penicillin G, both given 20 h after infection. The i.m. dose was then repeated every 24 h for 21 days. Eight ponies, each with two tissue chambers, were used in a cross over design; in the first experiment the left tissue chamber (TC) was infected and in the second experiment the right. TMP/SDZ treatment resulted in a limited reduction of viable bacteria in the TC but did not eliminate the infection, resulting in abscessation in 10-42 days in all eight ponies. However, penicillin treatment eliminated the streptococci in seven of eight ponies, and only one pony suffered abscessation on day 10. This constitutes a significantly better efficacy of the penicillin treatment in this model. The most probable cause of the failure of TMP/SDZ to eliminate the streptococci is inhibition of the action of TMP/SDZ in the purulent TCF. Therefore, TMP/SDZ should not be used to treat purulent infections in secluded sites in horses."_


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## deineria (Mar 22, 2009)

> If a lymph node becomes enlarged, I stop antibiotics and begin supportive care
> Read more: http://www.horseforum.com/horse-health/strangles-79967/page2/#ixzz1FaD7R8N3
> ​


Yes, that is what I was told at the office, too, by the vet on call - not my vet though and she doesn't do farm calls. . .

None of the horses have swollen lymph nodes yet, so I HOPE we caught it in time - just giving these huge injections for 7 days. . .
I feel like the horses will never forgive us


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