Clinical and endoscopic study to estimate the incidence of distal respiratory tract infection in Thoroughbred foals on Ontario breeding farms

Respiratory tract infections are prevalent in foals, yet the frequency with which the distal airways are affected in chemical episodes of respiratory tract disease has not been evaluated to our knowledge. The objective of the study was to determine the incidence of distal respiratory tract infection (DRTI) in foals on a sample of Thoroughbred breeding farms (n = 10) in Ontario. In a pilot study, clinical criteria commonly used to select foals for antimicrobial treatment (detection of abnormal lung sounds, plus nasal discharge, cough, fever, tachypnea, and/or lethargy) were found to segregate foals with and without endoscopically confirmed DRTI. Mucopurulent exudate and bronchial erythema were observed more frequently (P < 0.005), bronchial lavage total cell count and neutrophil concentration were significantly (P < 0.005) higher, and intracellular cocci were recovered significantly (P < 0.01) more often from bronchial lavage samples of affected foals (n = 8) than of controls (n = 8). These clinical criteria were used to identify cases in a cohort of Thoroughbred foals (n = 219) from May 1 to October 30, 1991. Case morbidity adjusted for clustering was 82 +/- 5% (95% confidence limits, 72 to 92%). Most (74%) episodes of clinical DRTI were detected in july and August, and equal numbers were detected before (53%) and after (47%) weaning of foals. Of 178 cases, 66 (48%) were selected at random for endoscopy and bronchial lavage. Grade-II pharyngeal lymphoid hyperplasia was observed commonly (60% of foals); auditory tube diverticulum (guttural pouch) discharge was observed in 18 of 86 (21%) foals, and guttural pouch infection was confirmed in 6 of 7 foals examined endoscopically. Endoscopically confirmed DRTI, defined as visual detection of bronchial exudate with microscopic detection of intracellular cocci and markedly high neutrophil count in bronchial lavage samples, was confirmed in 75 of 86 (87%) cases tested. These data indicate that DRTI might be reliably diagnosed by auscultation during a simple rebreathing exercise. The syndrome of DRTI was extremely common in Thoroughbred foals, characterized by marked inflammation of visible airways and cytologic evidence of bacterial infection. Risk factors for clinical (undifferentiated) DRTI were not identified in this study.