Young equine makes long recovery journey after serious illness

Alfie Dukes. (Photo courtesy of Alex Dukes and Virginia Tech)

In February, Alfie, a 6-month-old Belgian cross colt arrived at the Marion duPont Scott Equine Medical Center (EMC) in Leesburg, Virginia In very poor condition, including active signs of respiratory distress. In dire need of emergency treatment, Alfie presented with an uncertain vaccination and deworming history, nasal discharge of pus and mucus, respiratory distress, fever, numerous papilloma, and elevated serum amyloid A (SAA). According to Virginia Tech, Alfie was very quiet and dull when he arrived at the facility.¹

Alfie was purchased by Alex Dukes of Lincoln, Virginia, at an auction in December 2023. Before being shipped to Dukes, the Belgian cross colt was held in a holding facility in Arkansas. Alfie arrived at Virginia in February, already ill.

Suspected of being infectious and contagious, Alfie was immediately placed in the EMC’s isolation facility—a biosafety level 2 building that has individual stalls, each equipped with their own ventilation and heating supplies. Emily Schaefer, VMD, DACVIM (LAIM), DACVECC, clinical assistant professor of equine emergency and critical care at Virginia-Maryland College of Veterinary Medicine’s EMC, found that Alfie had a low-grade fever, an abnormally low heart rate, and signs of lower respiratory disease.

Moreover, the Belgian cross colt had many papilloma—small, gray, irregular skin protrusions that resemble warts—on his muzzle and lower lip, which suggested a potential viral infection. Alfie also had a lymph node underneath his jaw that was swollen and somewhat firm, though it did not seem to cause any discomfort, according to a news release.¹

Other clinical signs Alfie was exhibiting included wheezes and “crackles” sounds coming in his lungs when breathing, and a wet, productive cough accompanied by a loud mucous rattle in his trachea.¹

The Belgian cross colt was diagnosed with bacterial bronchopneumonia with a suspected pulmonary abscess after chest ultrasound images confirmed these suspicions. Pneumonia with the presence of a pulmonary abscess indicates a localized bacterial infection within the lung tissue, according to the release.¹

Schaefer suspected that Alfie also had a respiratory virus, considering his history of extensive travel, interactions with other horses, stress, age, and unreliable vaccination records. According to Virginia Tech, Alfie was very anemic and in poor physical condition, which Schaefer believed was caused by a mix of malnutrition and the systemic wasting disease cachexia, generally present in underfed animals, which made Alfie highly susceptible to refeeding syndrome.

According to Virginia Tech, refeeding syndrome is a dangerous condition that can be life-threatening.¹ It results from the rapid reintroduction of food following a period of malnutrition and is marked by severe electrolyte imbalances.

Diagnoses

Following regular bloodwork monitoring, the EMC team discovered early evidence of refeeding syndrome on Alfie’s 6th day of treatment.

He was also diagnosed with equine influenza virus, also known as horse flu, a highly contagious respiratory disease that is spread via droplets from an infected animal’s coughs and sneezes.² The disease, much like the seasonal flu in humans, can also be spread via infected objects. Equine influenza can spread not only in horse, but closely related animals, such as donkeys and zebras, according to the United States Centers for Disease Control and Prevention.²

“Equine influenza is a common respiratory virus in young horses experiencing stressful situations, and like many other respiratory viruses, influenza can predispose horses to secondary bacterial infections,” said Schaefer, in a news release.¹

Treatment

Alfie received close 24-hour monitoring for several days. Given Alfie’s risk of refeeding syndrome, the team at EMC had to avoid offering him unrestricted hay and grain to ensure safe weight gain, despite Alfie clearly needing calories. Alfie’s diet consisted of 1% of his estimated body weight of soaked alfalfa cubes. His response to refeeding was carefully monitored, according to the release.¹

The young equine was given antimicrobials for pneumonia, anti-inflammatories, and vitamin administration. He was also administered mineral oil and water through a nasal tube and began a 5-day deworming treatment thereafter. Alfie’s feed ration was raised once daily to avoid refeeding syndrome, and regular grass hay was introduced.

After switching to the care of Stasia Sullivan, DVM, MS, DACVS, DACVECC, Alfie’s diet was slowly replaced with a fully alfalfa one and a plan to supplement phosphorus was created.

The young equine was eventually released from the hospital and went to his new home in Virginia. With the guidance of a veterinarian, Dukes followed a comprehensive feeding, exercise, and medical plan. Alfie’s body condition was rated at 1/9, so it was anticipated that it would take up to 8 months for him to achieve his optimal body weight.

Aftermath

Six months later, Alfie is spending time in his home pastures, running happily, with a friend mule according to a release.¹ “Thanks to the awesome care he got he has made a miraculous recovery,” said Dukes, in a news release. “We weren't sure whether he'd make it, but now he is a happy little boy, spending his days prancing around his field with a new friend.”

“Alfie has an excellent mule companion who he adores and who is teaching him how to be a normal baby horse,” Dukes continued. “My sincerest thanks to everyone involved in Alfie's care—he wouldn't still be here today if it weren't for you all.”

References

1. Rough start in life sends 6-month-old Belgian cross colt to Virginia Tech equine hospital for emergency treatment. News release. Virginia Tech. August 28, 2024, Accessed September 9, 2024. https://news.vt.edu/articles/2024/08/vetmed-emc-success-story.html
2. About horse flu. United States Centers for Disease Control and Prevention. Accessed September 9, 2024. https://www.cdc.gov/flu-in-animals/about/horse-flu.html#:~:text=Equine%20influenza%20(horse%20flu)%20is,a%20low%20risk%20to%20people.