Chronic progressive lymphedema

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Foot of a draft horse Lymphoedeme chronique progressif chez un etalon breton de 12 ans (2).jpg
Foot of a draft horse

Chronic progressive lymphedema (CPL) is a disease of some breeds of draft horse, whereby the lower legs becomes progressively more swollen. [1] There is no cure; [1] the aim of treatment is to manage the signs and slow progression of the disease. [2] The cause of CPL is not known, although it is suspected that a genetic disorder of elastin metabolism prevents the lymphatic vessels from functioning properly, leading to edema of the lower limbs. [3] CPL resembles the human disease elephantiasis verrucosa nostra. [4]

Contents

Signs

CPL is a progressive disease, which begins below the fetlock and gradually moves up the leg. [5] All legs are affected, the hindlimbs usually more seriously so. [6] Initial signs include thickening, crusting and folding of the skin. [7] These early signs may be hidden by the long hair (feather) on the horse's lower legs. [6] Affected areas are itchy, causing the horse to stamp its feet and rub its legs, and painful, so that the horse may be reluctant to allow its legs to be touched. [4] As CPL progresses, ulcers develop on the pasterns, and fibrosis leads to hardening of the skin and the development of nodules which may become baseball sized. [6] Secondary infections with microbes or mites commonly cause complications. [6] Infestations with the mange mite Chorioptes equi are very itchy, and lead to self-trauma and dermatitis. [6]

The quality of the hoof is often poor; hooves are prone to cracks, splits and the development of thrush and abscesses; [4] horses may develop laminitis. [1] Chestnuts and ergots are often misshapen and irregular. [4]

Management

There is no cure for CPL; the aim of treatment is to relieve the signs of the disease, and to slow the progression. [5] Management requires daily care to prevent infection of the affected skin. [4] The first step is to trim the feather from the lower leg, to ensure no affected areas are missed, and to allow application of treatments directly to the affected skin. [4] Bacterial infections can be treated by gentle washing and drying of the skin. [5] Topical treatments are required to treat chorioptic mange (caused by the mite Chorioptes equi ), as the mites are not vulnerable to oral or systemic treatments when they are within the crusts on the skin. [5] Daily exercise assists with the flow of lymph. [4] Combined decongestive therapy involves massage of the leg to move the lymph, followed by specialized compression bandaging which creates a pressure gradient up the leg. [4]

Horses with CPL often have poor-quality hoof, so regular trimming is required to help keep the hoof healthy. [4]

Epidemiology

Affected breeds include the Shire, Clydesdale, Belgian, Gypsy cob, and Friesian. [5] Signs are usually only seen in horses older than two years. [5] Both sexes are affected. [6]

Related Research Articles

<span class="mw-page-title-main">Lymphedema</span> Medical condition

Lymphedema, also known as lymphoedema and lymphatic edema, is a condition of localized swelling caused by a compromised lymphatic system. The lymphatic system functions as a critical portion of the body's immune system and returns interstitial fluid to the bloodstream. Lymphedema is most frequently a complication of cancer treatment or parasitic infections, but it can also be seen in a number of genetic disorders. Though incurable and progressive, a number of treatments may improve symptoms. Tissues with lymphedema are at high risk of infection because the lymphatic system has been compromised.

<span class="mw-page-title-main">Erysipelas</span> Human disease from a bacterial infection of the skin

Erysipelas is a relatively common bacterial infection of the superficial layer of the skin, extending to the superficial lymphatic vessels within the skin, characterized by a raised, well-defined, tender, bright red rash, typically on the face or legs, but which can occur anywhere on the skin. It is a form of cellulitis and is potentially serious.

<span class="mw-page-title-main">Edema</span> Accumulation of excess fluid in body tissue

Edema, also spelled oedema, and also known as fluid retention, dropsy, hydropsy and swelling, is the build-up of fluid in the body's tissue. Most commonly, the legs or arms are affected. Symptoms may include skin which feels tight, the area may feel heavy, and joint stiffness. Other symptoms depend on the underlying cause.

<span class="mw-page-title-main">Mange</span> Type of skin disease caused by parasitic mites

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<span class="mw-page-title-main">Cellulitis</span> Bacterial infection of the inner layers of the skin called the dermis

Cellulitis is usually a bacterial infection involving the inner layers of the skin. It specifically affects the dermis and subcutaneous fat. Signs and symptoms include an area of redness which increases in size over a few days. The borders of the area of redness are generally not sharp and the skin may be swollen. While the redness often turns white when pressure is applied, this is not always the case. The area of infection is usually painful. Lymphatic vessels may occasionally be involved, and the person may have a fever and feel tired.

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<span class="mw-page-title-main">Lymphangitis</span> Medical condition

Lymphangitis is an inflammation or an infection of the lymphatic channels that occurs as a result of infection at a site distal to the channel. The most common cause of lymphangitis in humans is Streptococcus pyogenes, hemolytic streptococci, and in some cases, mononucleosis, cytomegalovirus, tuberculosis, syphilis, and the fungus Sporothrix schenckii. Lymphangitis is sometimes mistakenly called "blood poisoning". In reality, "blood poisoning" is synonymous with sepsis.

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<span class="mw-page-title-main">Strangles</span> Contagious upper respiratory tract infection of equines

Strangles is a contagious upper respiratory tract infection of horses and other equines caused by a Gram-positive bacterium, Streptococcus equi. As a result, the lymph nodes swell, compressing the pharynx, larynx, and trachea, and can cause airway obstruction leading to death, hence the name strangles. Strangles is enzootic in domesticated horses worldwide. The contagious nature of the infection has at times led to limitations on sporting events.

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<span class="mw-page-title-main">Feline acne</span> Medical condition

Feline acne is a problem seen in cats primarily involving the formation of blackheads accompanied by inflammation on the cat's chin and surrounding areas that can cause lesions, alopecia, and crusty sores. In many cases symptoms are mild and the disease does not require treatment. Mild cases will resemble dirt on the cat's chin, but the "dirt" will not brush off. More severe cases, however, may respond slowly to treatment and seriously detract from the health and appearance of the cat. Feline acne can affect cats of any age, sex or breed, although Persian cats are also likely to develop acne on the face and in the skin folds. This problem can happen once, be reoccurring, or even persistent throughout the cat's life.

Lameness is an abnormal gait or stance of an animal that is the result of dysfunction of the locomotor system. In the horse, it is most commonly caused by pain, but can be due to neurologic or mechanical dysfunction. Lameness is a common veterinary problem in racehorses, sport horses, and pleasure horses. It is one of the most costly health problems for the equine industry, both monetarily for the cost of diagnosis and treatment, and for the cost of time off resulting in loss-of-use.

Lymphatic disease is a class of disorders which directly affect the components of the lymphatic system.

Quittor is an infection of the lower leg of equines, sometimes known as graveling. A condition once common in draft horses, it is characterized by inflammation of the cartilage of the lower leg. There are two forms, subcutaneous and cartilaginous. Quittor usually results from an injury to the leg, such as an abscess on the coronary band above the hoof, that allows foreign matter to get into the leg and then collect beneath the hoof, leading to an infection. In some cases, removing this matter requires cutting away parts of the hoof. Abscesses may also form inside the hoof capsule itself from improper shoeing and trimming of the hoof, from laminitis, or from injury to the sole of the hoof, but the horse will be significantly lame for a longer period of time if the infection migrates up to the coronary band rather than down. Treatment of hoof and coronary band abscesses today usually incorporates use of antibiotics, sometimes combined with poulticing.

<span class="mw-page-title-main">Caseous lymphadenitis</span> Medical condition

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Stasis papillomatosis is a disease characterized by chronic congestion of the extremities, with blood circulation interrupted in a specific area of the body. A consequence of this congestion and inflammation is long-term lymphatic obstruction. It is also typically characterized by the appearance of numerous papules. Injuries can range from small to large plates composed of brown or pink, smooth or hyperkeratotic papules. The most typical areas where injuries occur are the back of the feet, the toes, the legs, and the area around a venous ulcer formed in the extremities, although the latter is the rarest of all. These injuries include pachydermia, lymphedema, lymphomastic verrucosis and elephantosis verrucosa. The disease can be either localized or generalized; the localized form makes up 78% of cases. Treatment includes surgical and pharmaceutical intervention; indications for partial removal include advanced fibrotic lymphedema and elephantiasis. Despite the existence of these treatments, chronic venous edema, which is a derivation of stasis papillomatosis, is only partially reversible. The skin is also affected and its partial removal may mean that the skin and the subcutaneous tissue are excised. A side effect of the procedure is the destruction of existing cutaneous lymphatic vessels. It also risks papillomatosis, skin necrosis and edema exacerbation.

References

  1. 1 2 3 Affolter, Verena K. (2015). "Chapter 24. Draft horse lymphedema". In Sprayberry, Kim A.; Robinson, N. Edward (eds.). Robinson's Current Therapy in Equine Medicine (7th ed.). W B Saunders Co. pp. 521–524. ISBN   978-1-4557-4555-5.
  2. "Chronic Progressive Lymphoedema". Chronic Progressive Lymphoedema. Retrieved 2021-07-01.
  3. Miller, Lisa M.; Gal, Arnon (2017). "Chapter 10. Cardiovascular system and lymphatic vessels. Disorders of horses. Chronic progressive lymphedema in draft horses". In Zachary, James F. (ed.). Pathologic basis of veterinary disease (6th ed.). Elsevier. p. 604. ISBN   978-0-323-35775-3.
  4. 1 2 3 4 5 6 7 8 9 Affolter, VK (December 2013). "Chronic progressive lymphedema in draft horses". The Veterinary Clinics of North America. Equine Practice. 29 (3): 589–605. doi:10.1016/j.cveq.2013.08.007. PMID   24267677.
  5. 1 2 3 4 5 6 de Keyser, K; Janssens, S; Buys, N (May 2015). "Chronic progressive lymphoedema in draught horses". Equine Veterinary Journal. 47 (3): 260–6. doi:10.1111/evj.12256. PMID   24593274.
  6. 1 2 3 4 5 6 Scott, Danny W.; Miller, William H. Jr. (2011). "Chronic progressive lymphedema". Equine dermatology (2nd ed.). Maryland Heights, Missouri: Elsevier/Saunders. pp. 431–433. ISBN   978-1-4377-0921-6.
  7. Mair, Tim S.; Divers, Thomas J. (2016). "Answers. Case 76". Self-Assessment Color Review Equine Internal Medicine (2nd ed.). CRC Press. p. 232. ISBN   978-1-4822-2537-2.