Objective: To determine whether the concentrations of airborne virulent Rhodococcus equi in stalls housing foals during the first 2 weeks after birth are associated with subsequent development of R equi pneumonia in those foals. Sample: Air samples collected from foaling stalls and holding pens in which foals were housed during the first 2 weeks after birth. Procedures: At a breeding farm in Texas, air samples (500 L each) were collected (January through May 2011) from stalls and pens in which 121 foals were housed on day 1 and on days 4, 7, and 14 after birth. For each sample, the concentration of airborne virulent R equi was determined with an immunoblot technique. The association between development of pneumonia and airborne R equi concentration was evaluated via random-effects Poisson regression analysis. Results: Some air samples were not available for analysis. Of the 471 air samples collected from stalls that housed 121 foals, 90 (19%) contained virulent R equi. Twenty-four of 121 (20%) foals developed R equi pneumonia. Concentrations of virulent R equi in air samples from stalls housing foals that developed R equi pneumonia were significantly higher than those in samples from stalls housing foals that did not develop pneumonia. Accounting for disease effects, air sample concentrations of virulent R equi did not differ significantly by day after birth or by month of birth. Conclusions and Clinical Relevance: Exposure of foals to airborne virulent R equi during the first 2 weeks after birth was significantly (and likely causally) associated with development of R equi pneumonia.

We evaluated the immunogenic and protective potential of a recombinant VapA/CpG oligodeoxynucleotide (ODN) 2395 vaccine in neonatal foals undergoing experimental Rhodococcus equi challenge. Foals (n = 8) were vaccinated by intramuscular injection on days 1 and 15 of the study; control foals (n = 7) received a phosphate-buffered saline (PBS) solution. All foals were challenged by intrabronchial administration of 5 × 106R. equi 103+ on day 29. Bronchoalveolar lavages were done on days 15, 29, and 36 and total cell count, differential cell count, rVapA-stimulated cell proliferation and interferon (IFN)-γ mRNA expression determined. Clinical examination, complete blood (cell) counts, serology for VapA-specific antibodies, and culture of nasal and fecal swabs were done on days 1, 15, 29, 36, 43, and 50. Foals were humanely euthanized on day 50 and severity of pneumonia scored on a 4-point scale. Vaccination resulted in a significant increase in VapA-specific immunoglobulin (Ig) production, with total IgG and IgG(T) being increased by day 15. Expression of VapA-specific IFN-γ mRNA by BAL cells was increased in the vaccinated foals following challenge. Postmortem lung severity scores did not differ between groups. Two foals shed virulent R. equi in feces; however, real-time polymerase chain reaction (PCR) revealed the isolates to be different from the challenge strain.

The effect of prior Rhodococcus equi-induced pneumonia on pulmonary health was investigated in 5 horses (< 24 months old) using endoscopy, radiography, hematologic and bronchoalveolar lavage analyses, and pulmonary function testing. Rhodococcus equi-induced pneumonia had been diagnosed in principal horses when they were foals. Diagnosis was based on positive results of transtracheal aspiration and thoracic radiography at the time of initial clinical examination. Results of reevaluation of the respiratory system of these horses (R+) were compared with those of 5 age-matched healthy horses (R-) that lacked clinical or historical evidence of foalhood pneumonia. Significant differences in variables between the 2 groups of horses were not evident. In both groups, most horses had radiographic evidence of an accentuated bronchointerstitial pattern, although results of analysis of bronchoalveolar lavage specimens were normal and mononuclear cells predominated. Variability in results of the pulmonary function tests was observed within and between the 2 groups of horses. Only normatized dynamic lung compliance was slightly lower in the previously infected horses, but this difference was not significant. We concluded that horses previously infected with and successfully treated for R equi-induced pneumonia do not have detectable evidence of residual lung damage.

Objective—To investigate the effect of opsonization of Rhodococcus equi with R equi-specific antibodies in plasma on bacterial viability and phagocyte activation in a cell culture model of infection. Sample—Neutrophils and monocyte-derived macrophages from 6 healthy 1-week-old foals and 1 adult horse. Procedures—Foal and adult horse phagocytes were incubated with either opsonized or nonopsonized bacteria. Opsonization was achieved by use of plasma containing high or low concentrations of R equi-specific antibodies. Phagocyte oxidative burst activity was measured by use of flow cytometry, and macrophage tumor necrosis factor (TNF)-α production was measured via an ELISA. Extracellular and intracellular bacterial viability was measured with a novel R equi-luciferase construct that used a luminometer. Results—Opsonized bacteria increased oxidative burst activity in adult horse phagocytes, and neutrophil activity was dependent on the concentration of specific antibody. Secretion of TNF-α was higher in macrophages infected with opsonized bacteria. Opsonization had no significant effect on bacterial viability in macrophages; however, extracellular bacterial viability was decreased in broth containing plasma with R equi-specific antibodies, compared with viability in broth alone. Conclusions and Clinical Relevance—The use of plasma enriched with specific antibodies for the opsonization of R equi increased the activation of phagocytes and decreased bacterial viability in the extracellular space. Although opsonized R equi increased TNF-α secretion and oxidative burst in macrophages, additional factors may be necessary for effective intracellular bacterial killing. These data have suggested a possible role of plasma antibody in protection of foals from R equi pneumonia.

Objective-To compare isolates of Rhodococcus equi on the basis of geographic source and virulence status by use of pulsed-field gel electrophoresis (PFGE). Sample Population-290 isolates of R equi(218 virulent isolates from foals and 72 avirulent isolates from feces, soil, and respiratory tract samples) obtained between 1985 and 2000 from horses and horse farms from 4 countries. Procedure-DNA from isolates was digested with the restriction enzyme AseI and tested by use of PFGE. Products were analyzed for similarities in banding patterns by use of dendrograms. A similarity matrix was constructed for isolates, and the matrix was tested for nonrandom distributions of similarity values with respect to groupings of interest. Results-There was little grouping of isolates on the basis of country, virulence status, or region within Texas. Isolates of R equi were generally < 80% similar, as determined by use of PFGE. Isolates from the same farm generally were rarely of the same strain. Conclusions and Clinical Relevance-Considerable chromosomal variability exists among isolates of R equi obtained from the same farm, sites within Texas, or among countries from various continents. Only rarely will it be possible to link infections to a given site or region on the basis of analysis of isolates by use of PFGE of chromosomal DNA.

Objective: To determine whether the concentration of airborne virulent Rhodococcus equi varied by location (stall vs paddock) and month on horse farms. Sample: Air samples from stalls and paddocks used to house mares and foals on 30 horse breeding farms in central Kentucky. Procedures: Air samples from 1 stall and 1 paddock were obtained monthly from each farm from January through June 2009. Concentrations of airborne virulent R equi were determined via a modified colony immunoblot assay. Random-effects logistic regression was used to determine the association of the presence of airborne virulent R equi with location from which air samples were obtained and month during which samples were collected. Results: Of 180 air samples, virulent R equi was identified in 49 (27%) and 13 (7%) obtained from stalls and paddocks, respectively. The OR of detecting virulent R equi in air samples from stalls versus paddocks was 5.2 (95% confidence interval, 2.1 to 13.1). Of 60 air samples, virulent R equi was identified in 25 (42%), 18 (30%), and 6 (10%) obtained from stalls during January and February, March and April, and May and June, respectively. The OR of detecting virulent R equi from stall air samples collected during May and June versus January and February was 0.22 (95% confidence interval, 0.08 to 0.63). Conclusions and Clinical Relevance: Foals were more likely to be exposed to airborne virulent R equi when housed in stalls versus paddocks and earlier (January and February) versus later (May and June) during the foaling season.

Objective—To determine the chemoprophylactic effect of gallium maltolate on the cumulative incidence of pneumonia caused by Rhodococcus equi infection in foals. Animals—483 foals born and raised on 12 equine breeding farms with a history of endemic R equi infections. Procedures—Group 1 foals were treated with a placebo and group 2 foals were treated with gallium maltolate (approx 30 mg/kg, PO, q 24 h) during the first 2 weeks after birth. Foals were monitored for development of pneumonia attributable to R equi infection and for adverse effects of gallium maltolate. Results—There were no significant differences in the cumulative incidence of R equi pneumonia among the 2 groups. Conclusions and Clinical Relevance—Chemoprophylaxis via gallium maltolate administered orally at approximately 30 mg/kg daily for the first 2 weeks after birth failed to reduce the cumulative incidence of pneumonia attributable to R equi infection among foals on breeding farms with endemic R equi infections. Further investigation is needed to identify strategies for control of R equi infections.

We report here two cases of Rhodococcus (R.) equi-causing pneumonia of Throughbred foals in Gyeonggi-do in 2006. R. equi was isolated from the lung lesions of the dead foals, and from the feces and soils on the farms where the clinical cases of R. equi infection occurred. The isolates were characterized by biochemical properties, polymerase chain reaction for vapA gene and antimicrobial susceptibility. In drug susceptibility test, erythromycin, gentamycin, vancomycin, and rifampin were found to be the most susceptible for all isolates. These results suggest that R. equi pneumonia may be endemic in the horse-breeding farms in inland Korea and the farm environment may be widely contaminated with virulent R. equi.

Undifferentiated distal respiratory tract disease (nasal discharge, cough, pneumonia) in foals (1 to 8 months old) is a burdensome economic problem on breeding farms yet, the infective agents associated with these episodes have not been well described. Possible causes of these episodes of illness were investigated by culturing specimens of proximal and distal airways of clinically diseased foals (n = 101), prior to any treatment, for aerobic and anaerobic bacteria and viruses (rhinoviruses, equine arteritis virus, equine herpesvirus subtype 1 [EHV-1], influenza virus, and adenovirus). Pairs of sera (n = 47) were examined for antibodies to influenza A virus, equine subtypes 1 and 2, EHV-1, and adenovirus antigens, and sera obtained from foals during acute infection were examined for antibodies (by agar gel immunodiffusion [AGID]) to equi factor antigens of Rhodococcus equi. Viruses were not isolated from the proximal (swab) or distal (bronchial lavage) airway specimens in foals, and only 2 of 47 randomly selected foals seroconverted to EHV-1. Serotiters to the other viruses were low and frequently decreasing between samples, which was compatible with maternally derived antibody. Streptococcus zooepidemicus was the predominant isolate from bronchial lavage specimens (88/101 cases), accompanied by alpha-hemolytic streptococci (8 cases), Bordetella bronchiseptica (13 cases), Staphylococcus epidermidis (9 cases), and other organisms in lesser frequency. Only Str zooepidemicus was recovered significantly (P < 0.05) more often in cases than in controls. The AGID test was found useful to detect 1/26 with presumed exposure to R equi, but positive tests results did not correspond well with bacterial culture results; positive AGID results were recorded in 34% of culture-negative foals. However, foals from which R equi was isolated were distinctive from the other foals on the basis of fever (> 39 C), lack of nasal discharge, blood neutrophilia and decreased percentage of neutrophils in bronchial lavage fluid samples. Isolation of Str zooepidemicus was significantly (P < 0.01) associated with increasing neutrophil percentage in bronchial lavage fluid. In conclusion, the pathogenic roles of Str zooepidemicus and R equi were established in this group of foals with distal respiratory tract infections by use of clinical, endoscopic, hematologic, and cytologic methods. There was no evidence of a viral cause for these infections, indicating that manifestations of distal respiratory tract infection are attributable to bacterial infection causing inflammation of the airways. Further studies are warranted to pursue more-sensitive methods for detection of viral antigen or antibody in undifferentiated distal respiratory tract disease episodes in foals.

Opsonized Rhodococcus equi activated the respiratory burst of resident alveolar macrophages (AM) from adult horses in a logarithmic-linear, mass-related manner. The effect of R equi was not significantly different from that of equal masses of opsonized zymosan A. Therefore, R equi does not appear to attenuate the respiratory burst of equine AM. The stimulatory effect of R equi was not reflected by increased production of superoxide anion (O2-), but increased activity of the hexose monophosphate shunt was observed. These results suggest a similarity between the respiratory burst of Am from horses and that of AM from rabbits. We concluded that resident AM from adult horses do not produce O2- concurrently with an increase in activity of the hexose monophosphate shunt when stimulated with either opsonized zymosan A or opsonized R equi. This suggests that O2- is not an important component of the antibacterial defenses of equine AM. Whether equine AM are incapable of producing O2- or require different stimuli to produce it was not determined.