Equine Bacterial and Fungal Diseases: A Diagnostic and Therapeutic Update

Stephen D. White, DVM, Diplomate ACVD

Bacterial and fungal skin diseases are important in the horse. Bacterial skin diseases (pyoderma) are most often caused by Staphylococcus species, Corynebacterium pseudotuberculosis or Dermatophilus congolensis. The most common clinical signs associated with bacterial skin infections are crusts, papules, abscesses, and draining tracts; the latter two lesions are more commonly associated with C. pseudotuberculosis. Ideally, antibiotic treatment should be based on bacterial culture and sensitivity. Fungal infections are most commonly caused by dermatophytes (ringworm) or Sporothrix schenkii, although the role of Malassezia in equine skin disease is beginning to be investigated. The clinical signs of fungal infections are variable and may include alopecia, crusts, papules, pruritus, nodules, ulcers, and draining tracts. The latter three lesions are more commonly associated with S. schenkii infection. Treatment is dependent on the organism cultured and may include both topical and/or systemic treatment. Clin Tech Equine Pract 4:302-310 2005 Elsevier Inc. All rights reserved. KEYWORDS horse, skin, bacteria, fungi, Staphylococcus, Corynebacterium, Dermatophilus, dermatophyte, ringworm, Sporothrix, Malassezia

Bacterial Skin Disease (Pyoderma)

Staphylococcus sp.

acterial folliculitis (supercial pyoderma) is usually caused by a coagulase-positive Staphylococcus species. Both S. aureus and S. intermedius have been isolated.1,2 In one study, S. aureus accounted for twice as many isolates as S. intermedius; interestingly, the same study isolated some strains of S. hyicus as well.3 Many isolates are resistant to penicillin G. In another study, lysozymes from equine neutrophils were only slightly bactericidal for S. aureus.4 Recently, methicillin-resistant, coagulase-negative staphylococcal species were cultured from healthy horses in Japan; the authors concluded, These organisms must be considered a potential threat to horses and veterinarians who care for them.5 In another study, occurrence of pyoderma was linked to poor nutrition and husbandry.6 The author feels that supercial pyoderma secondary to allergies is underdiagnosed in the horse. Clinical signs include crusts and/or alopecia, usually in a circular pattern suggestive of dermatophytosis, which is perhaps the reason that equine pyoderma is under-diagnosed.

Circular skin lesions with an exfoliative border, as seen in dogs with supercial pyoderma representing epidermal collarettes, or encrusted papules, similar to the miliary dermatitis reaction pattern in cats, can also be seen (Figures 13).7 These infections tend to be variable in their intensity of pruritus. Histology usually shows folliculitis and/or furunculosis, but bacterial colonies are not always seen.1 A truncal form

Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA. Address reprint requests and correspondence to Stephen D. White, Room 2108 Tupper Hall, UC Davis, Davis, CA 95616. E-mail: sdwhite@ucdavis.edu

Figure 1 Staphylococcal folliculitis: crusts in a circular pattern.

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Figure 2 Staphylococcal folliculitis: epidermal collarettes.

Figure 4 Corynebacterium pseudotuberculosis folliculitis: circular areas of crust and alopecia.

of bacterial folliculitis (contagious acne, contagious pustular dermatitis, Canadian horsepox) is often associated with poor grooming and trauma from tack and saddle, warm wet weather, and heavy work. It is painful and interferes with working and riding. It is usually caused by a coagulase positive Staphylococcus species but may also be attributable to Corynebacterium pseudotuberculosis (Figure 4).8 Folliculitis often develops in the saddle and lumbar region, particularly in the summer (Figure 5). The affected area initially may be swollen and very sensitive; this is followed by formation of follicular papules and pustules, which may become conuent or rupture, forming plaques and crusts. Bacterial pastern folliculitis, often caused by a coagulasepositive Staphylococcus species, must be considered as one of the multiple differential diagnoses of the disease presentation commonly referred to as grease heel or scratches. The lesions are usually limited to the posterior aspect of the pastern and fetlock regions, and one or more limbs may be involved. The initial lesions consist of papules and pustules. If left untreated, the lesions coalesce and may produce large areas of alopecia, erythema, ulceration, and suppuration, which may be quite painful (Figure 6). Diagnosis of supercial pyoderma is based on clinical presentation, ruling out dermatophyte infection, and response to antibiotics. Although skin biopsy for histopathology is

often not performed in a clinical setting, it may be helpful when the clinical signs are not classic or the horse has not responded to empirical use of antibiotics. In a recent retrospective report, cocci were found on the surface of specimens from 23% of horses with skin disease but only 7% from horses with healthy skin. Bacterial folliculitis had a higher prevalence of surface bacteria than any other disease.9 Whether this could translate into excessive numbers of cocci on cytology remains unknown. Deep pyoderma, furunculosis as well as folliculitis, caused by Staphylococcus species is uncommon in the horse. It may present as a nodular disease termed botryomycosis, which mimics a deep fungal infection (Figure 7). These lesions may require surgical excision as well as long-term antibiotics. Diagnosis of deep pyoderma is based on clinical presentation and biopsy. Antibiotic treatment of staphylococcal skin infections should be based on bacterial culture and susceptibility; however, empiric use is common. The most commonly used antibiotic in equine bacterial dermatitis is trimethoprim-sulfa (30 mg/kg q12 hour PO for 2-6 weeks; longer for deep infections). Interestingly, dosing intervals for intravenous administration of trimethoprim-sulfamethoxazole in horses may

Figure 3 Staphylococcal folliculitis: widespread, coalescing areas of alopecia and scaling.

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Figure 5 Bacterial folliculitis: circular areas of alopecia in the saddle area (used with the permission of Dr. P. Bourdeau).

not be appropriate for use in donkeys or mules. Donkeys eliminate the drugs rapidly, compared with horses.10 In cases of Staphylococcus sp resistance to TMS, enrooxacin may be given (7.5 mg/kg PO once daily; poultry or large animal injectable formulation). Use of enrooxacin in young horses (less than 2 years old) should be avoided, due to concerns of articular cartilage damage.11 Recent work in four horses identied a novel plasmid-

borne gene (designated qacJ) encoding resistance to quaternary ammonium compounds in three staphylococcal species associated with chronic infections.12 This suggests horizontal transfer within and between different equine staphylococcal species. If this is applicable to antibiotic resistance as well, clinicians may nd the use of empiric antibiotics compromised in the future. For localized lesions, mupirocin ointment 2% (Bactoderm Pzer) or silver sulfadiazine cream (Silvadene, Marion Merrell Dow) may be effective. For an antibacterial shampoo, the author nds ethyl lactate (Etiderm, VIRBAC) helpful, although preparations containing chlorhexidine (24%) may also be used.

Corynebacterium Pseudotuberculosis
Solitary or multiple abscesses, or nodules with many draining tracks that progress to diffuse cellulitis, are often caused by C. pseudotuberculosis. When the disease affects the pectoral region or inguinal regions, it is sometimes termed pigeon fever and dry land distemper, respectively, in the USA. The draining nodules or abscesses are especially common in the pectoral region, and occasionally affect the face, neck, axilla, groin, and limbs; they begin deep and enlarge, often with much edema, and rupture in 1-4 weeks, discharging viscid, creamy pus, a major source of contamination (Figure 8). These may sometimes be the sequella of wounds.13 Abscesses most often rupture externally. This type of deep C. pseudotuberculosis infection may be contracted from areas where caseous lymphadenitis is common in sheep, although proximity to sheep is not a requirement. Various strains of this organism are responsible for different outbreaks14; these seem to occur more commonly in the western USA. The disease may be seen seasonally when insect populations are elevated. In a recent report using a sensitive molecular assay for detecting the phospholipase D exotoxin gene of C. pseudotuberculosis, potential insect vectors were identied, including Hematobia irritans (horn y), Stomoxys calcitrans (stable y), and Musca domestica (house y). C. pseudotuberculosis was identied in up to 20% of house ies in the vicinity of diseased horses.15 Diagnosis is based on clinical signs, with the infection

Figure 6 Pastern folliculitis.

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Figure 7 Botryomycosis (deep pyoderma) (used with the permission of Dr. V. Fadok).

readily identied by bacterial culture of aspirate samples from abscesses. The synergistic hemolysis inhibition test is useful for diagnosis of internal abscesses; however, it is unreliable for the diagnosis of external abscesses.16 Treatment depends on the area of the body affected. For example, if the abscess is in the axilla and thus painful on movement and/or preventing locomotion, establishment of drainage is very important and antibiotics are indicated. Procaine penicillin (20,000-50,000 IU/kg/d) with rifampin (3-5 mg/kg 12q hour PO) or trimethoprim sulfa (30 mg/kg q12 hour PO) may be used. Treating with TMS and rifampin concurrently may lead to a greater incidence of colitis, and should be avoided. If the decision is made to use antibiotics, but drainage cannot be readily established (for example, an axillary abscess where the owner is unwilling to allow the veterinarian to use a trocar and drain), the antibiotics must be used for a minimum of 1 month. If the abscess is solitary and not causing pain or fever, antibiotics are usually not necessary; rather, bringing the abscess to a head with hot packs or heat-inducing agents (ich-

thymol) is important. Once any abscess has drained, gentle cleaning with tamed-iodines or chlorhexidine is indicated.

Dermatophilus Congolensis
This actinomycete bacteria ia a well-known cause of skin disease in horses. Three conditions must be present for Dermatophilus to manifest itself: a source of infection, moisture, and skin abrasions. Chronically affected animals are the primary source of infection; however they only become a serious source of infection when their lesions are moistened, which results in the release of zoospores (infective stage). Mechanical transmission of the disease occurs by both biting and nonbiting ies, ticks, and possibly fomites. Dermatophilosis is usually seen during the fall and winter months, corresponding to rainfall. The dorsal surface of the animal is most commonly affected (Figure 9). Occasionally, the lesions involve the lower extremities when animals are kept in wet pastures (dew poisoning), or if horses are left in

Figure 8 Corynebacterium pseudotuberculosis: draining abscesses on the ventrum of a horse.

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Figure 9 Dermatophilosis: severe scaling and alopecia (used with the permission of Dr. V. Fadok).

the stall while the stall is cleaned with high-pressure water hoses. In the early stages of the disease, thick crusts under the hair coat can be palpated more than they can be seen. Removing the crusts and attached hair exposes a pink, moist skin surface. The under surface of the crusts are usually concave with the roots of the hairs protruding, often in the shape of a paintbrush (Figure 10). Diagnosis is made by impression smears whereby a portion of one of the crusts is minced and mixed with a few drops of sterile water on a glass slide, gram stained (a modied Wrights stain such as Hema 3 Solution; Fisher Scientic, Houston, TX may also be used), and examined microscopically for the characteristic railroad track pattern of cocci (Figure 11). Alternatively, bacterial culture or histopathology may be utilized for diagnosis. The latter reveals a thick crust composed of alternating layers of parakeratotic stratum corneum, dried serum, and degenerating neutrophils with a supercial folliculitis.1 In gram stained histologic sections, the branching, lamentous organisms can be observed in the crusts and in the follicles. Treatment is removal of the horse from the wet environment, removal of crusts (carefully, as

this may be painful), washing with iodophors or lime sulfur, and antibiotics (penicillin: 22,000 mg/kg procaine penicillin G intramuscularly twice daily or trimethoprim-sulfa orally: as above for staphylococcal pyoderma) for 7 days.17 As the crusts are an important contagion, these should be disposed of rather than simply brushed on to the ground.

Miscellaneous Infections
Other bacteria causing skin disease in equines have been recently reported. These have been deep or systemic infections, with Streptomyces sp causing stulous withers in donkeys and systemic infection with Salmonella sp caused infarction and cutaneous necrosis.18,19

Fungal Skin Disease

Dermatophytes (Ringworm)
The most common equine dermatophyte species isolated from horses are Trichophyton equinum, M. equinum, T. mentagrophytes, and T. verrucosum.1,3,20 Tack (bridles, halters, sad-

Figure 10 Dermatophilosis: Paintbrush lesion of hair, crust, and pus (used with the permission of Dr. M.M. Sloet van Oldruitenborgh-Oosterbaan).

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Figure 13 Dermatophytosis: circular alopecia in a foal due to Trichophyton equinum (used with the permission of Dr. J. Traub-Dargatz). Figure 11 Dermatophilosis: branching chains of cocci (railroad tracks) modied Wrights stain, 100 (used with the permission of Dr. V. Fadok).

dle blankets) often act as fomites. The lesions usually appear rst in the axillary/girth area and may spread over the trunk, rump, neck, head, and limbs. Lesions may be supercial or deep. Supercial infections are much more common and are manifested by the development of thick crusts, or more generally a diffuse moth-eaten appearance with desquamation and alopecia, sometimes in a ring pattern (Figures 12 and 13). A small crust may form over the follicle and the hair is lost, but extensive alopecia and crust formation do not occur; this process may cause some irritation and pruritus. Occasionally, the initial lesions may be very urticarial in nature, progressing to multiple focal sharply demarcated areas of alopecia and scaling (Figures 14 and 15). Rarely, dermato-

phytes may be a cause of coronary band disease (Figure 16). Infections of Trichophyton verrucosum in humans due to transmission from horses have recently been reported.21 Diagnosis is by fungal culture; biopsy is less reliable.1 Interestingly, Trichophyton species occasionally may cause acantholysis, mimicking pemphigus foliaceus on histopathology.22 For fungal culture, use forceps to acquire hairs that appear stubbled and broken, especially at the advancing periphery of an active, nonmedicated lesion. In addition, forceps or skin scrapings may be used to gather surface keratin from similar areas. The hair and surface keratin of horses have large numbers of saprophytic fungi and bacteria. Hence, some clinicians recommend gently cleansing the area to be sampled with water or alcohol, and allowing it to air dry before sampling. The veterinarian may choose to send the samples to a microbiology laboratory or perform in-house culture. If the

Figure 12 Dermatophytosis: circular alopecia and scaling due to Trichophyton mentagrophytes infection.

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Figure 16 Dermatophytosis: scaling of the coronary band due to Microsporum gypseum infection (used with the permission of Dr. V. Fadok).

Figure 14 Dermatophytosis: urticarial lesions due to Trichophyton mentagrophytes infection.

latter, Dermatophyte Test Medium (DTM) is often used. DTM is essentially modied Sabourauds dextrose agar to which the pH indicator phenol red has been added. However, T. verrucosum does not grow on DTM.23 Topical treatment alone is often curative. Whereas 50% captan (2 tablespoons of the powder in 1 gallon of water) has been recommended in the past, and is certainly safe for tack, its potential for carcinogenicity and effectiveness has been questioned. Lime Sulfur (LymDyp; DVM, Miami, FL) 1 cup to 1 gallon of water, or bleach 1:10 with water, are both effective, but messy, odiferous, and staining. Miconazole shampoos are becoming more widely used, and may be as effective. In Europe and Canada, an enilconazole rinse (Imaverol; Merial) is highly effective.

Systemic treatment is occasionally needed. The efcacy and proper dose of griseofulvin in horses has not been thoroughly researched. However, a dosage of 100 mg/kg daily for 7 to 10 days has been advocated, and has been used with good success on a small number of horses by the author. Griseofulvin is a teratogen, and should not be used in pregnant mares. Alternatively, 20% NaI may be given IV (250 mL/500 kg horse every 7 days, 1 to 2 times). This also is contraindicated in pregnant mares as it may cause abortion. Vaccination to T. equinum may reduce the incidence of new infections and protect a high percentage (80%) of vaccinates from infection. These data are based on results with an inactivated vaccine containing both conidia and mycelial elements.24 Such vaccines are not available in the US.

Malassezia
The exact species of Malassezia yeast growing on horses skin is beginning to be investigated.25 In one study, the Malassezia sp. isolated were identied as M. furfur, M. sloofae, M. obtusa,

Figure 15 Dermatophytosis: urticarial lesion due to Trichophyton mentagrophytes infection, transitioning into circular area of alopecia.

Figure 17 Intermammary debris in a pruritic mare with Malassezia sp infection.

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Figure 18 Cytology of Malassezia sp from intermammary debris from a healthy mare.

M. globosa, and M. restricta.26 The author has examined several mares with intense pruritus due to a Malassezia infection between their mammary glands. The mares rubbed their tail, perineum, and ventral abdomen. Physical examination showed a dry, greasy-to-the-touch crust and exudate (Figure 17). Cytology of the exudate showed numerous yeast organisms, which were identied on culture as Malassezia species (Figure 18). Treatment with a topical 2% miconazole/chlorhexidine shampoo was curative. The author is aware of other, similar cases. However, healthy nonpruritic mares may also have large numbers of yeasts in the intramammary area. In these cases, M sloofae and a species tentatively named Malassezia equi have been identied.27

Figure 20 Sporotrichosis causing severe ulceration (used with the permission of Dr. M-R. Paradis).

Sporotrichosis
A more serious disease is caused by another yeast, Sporothrix schenkii. This condition presents as a nodular to ulcerative, lymphatic-cording disease, often initially noted on the distal legs (Figures 19 and 20). S schenkii gains access at wound sites; the organism has been reported from most geographic areas. Diagnosis is by demonstrating the fungus on histopathology, impression smears, and/or culture. This disease is a zoonosis, so care should be taken in handling suspected samples. The organism may be difcult to nd on histopathology, even with special stains. Successful therapy with a number of different systemic iodine preparations (NaI, KI) has been reported. The organic iodides have proven to be superior in efcacy to the inorganic iodides in the treatment of

Figure 19 Sporotrichosis causing multiple ulcers and distal limb edema.

Figure 21 Pythiosis: severe ulcerative, nodular lesion on the ventrum of a horse (used with the permission of Dr. V. Fadok).

310 equine sporotrichosis, with ethylene diamine dihydroiodide (EDDI: EDDI Equine; The Butler Company, Dublin, OH) being the drug of choice. This product is in the form of a feed additive and can be mixed with a small amount of grain and administered at a dosage of 1 to 2 mg/kg of the active ingredient given once to twice daily for the rst week, then reduce the dosage to 0.5 to 1.0 mg/kg once daily for the remainder of the treatment. In general, lesions will begin to regress during the rst month of treatment; treatment should be continued for at least 1 month beyond the complete resolution of all cutaneous nodules and the healing of any ulcerated lesions. Discontinuing therapy prematurely will invariably result in an unnecessary relapse of the disease. During treatment, the horse should be closely observed for any evidence of iodide toxicity (iodism): excess scaling and alopecia, a serous ocular or nasal discharge, excess salivation, anorexia, depression, coughing, nervousness, or cardiovascular abnormalities. Should any of these signs develop, the treatment should be discontinued for 1 week, and the treatment resumed at threequarters of the dosage at which the iodism was noted. In most instances, the treatment is subsequently well-tolerated.28

S.D. White
negative staphylococci isolated from healthy horses in Japan. Am J Vet Res 61:1451-1455, 2000 Inokuma H, Kanaya N, Fujii K, et al: Equine pyoderma associated with malnutrition and unhygienic conditions due to neglect in a herd. J Vet Med Sci 65:527-529, 2003 White SD, Brown AE, Chapman PL, et al: Aerobic bacterial culture of epidermal collarettes in dogs. J Am Vet Med Assoc 226:904-908, 2005 Heffner KA, White SD, Frevert CW , et al: Corynebacterium folliculitis in a horse J Am Vet Med Assoc 193:89-90, 1988 Cook CP, Scott DW, Erb HN, et al: Bacteria and fungi on the surface and within noninamed hair follicles of skin biopsy specimens from horses with healthy skin or inammatory dermatoses. Vet Dermatol 16:47-51, 2005 Peck KE, Matthews NS, Taylor TS, et al: Pharmacokinetics of sulfamethoxazole and trimethoprim in donkeys, mules, and horses. Am J Vet Res 63:349-353, 2002 Egerbacher M, Edinger J, Tschulenk W: Effects of enrooxacin and ciprooxacin hydrochloride on canine and equine chondrocytes in culture. Am J Vet Res 62:704-708, 2001 Bjorland J, Steinum T, Sunde M, et al: Novel plasmid-borne gene qacJ mediates resistance to quaternary ammonium compounds in equine Staphylococcus aureus, Staphylococcus simulans, and Staphylococcus intermedius. Antimicrob Agents Chemother 47:3046-3052, 2003 Farstvedt EG, Hendrickson DA, Dickenson CE, et al: Treatment of suppurative facial cellulitis and panniculitis caused by Corynebacterium pseudotuberculosis in two horses. J Am Vet Med Assoc 224:1139-1142, 2004 Foley JE, Spier SJ, Mihalyi J, et al: Molecular epidemiologic features of Corynebacterium pseudotuberculosis isolated from horses. Am J Vet Res 65:1734-1737, 2004 Spier SJ, Leutenegger CM, Carroll SP, et al: Use of a real-time polymerase chain reaction-based uorogenic 5= nuclease assay to evaluate insect vectors of Corynebacterium pseudotuberculosis infections in horses. Am J Vet Res 65:829-834, 2004 Aleman M, Spier SJ, Wilson WD, et al: Corynebacterium pseudotuberculosis infection in horses: 538 cases (1982-1993). J Am Vet Med Assoc 209:804-809, 1996 Outerbridge CA, Ihrke PJ: Folliculitis: Staphylococcal pyoderma, dermatophilosis, and dermatophytosis, in Robinson NE (ed): Current Therapy in Equine Medicine 5. Philadelphia, PA, Saunders, 2003, pp 197-200 Elzein S, Hamid ME, Quintana E, et al: Streptomyces sp, a cause of stulous withers in donkeys. Dtsch Tierarztl Wochenschr 109:442443, 2002 Pellegrini-Masini A, Dolente BA, Habecker PL, et al: Myonecrosis and cutaneous infarction associated with Salmonella serovar Infantum infection in a horse. J Am Vet Med Assoc 225:722-725, 2004 Kane J, Padhye AA, Ajello L: Microsporum equinum in North America. J Clin Microbiol 16:943-947, 1982 Roman C, Massai L, Gianni C, et al: Case reports. Six cases of infection due to Trichophyton verrucosum. Mycoses 44:334-337, 2001 Scott DW: Marked acantholysis associated with dermatophytosis due to Trichophyton equinum in two horses. Vet Dermatol 5:105-110, 1994 Scott DW, Miller WH: Equine Dermatology. St. Louis, MO, WB Saunders, 2003, p. 96 Pier AC, Zancanella PJ: Immunization of horses against dermatophytosis caused by Trichophyton equinum. Equine Pract 15:23-27, 1993 Nell A, James SA, Bond CJ, et al: Identication and distribution of a novel Malassezia species yeast on normal equine skin. Vet Rec 150:395398, 2002 Crespo MJ, Abarca ML, Cabanes FJ: Occurrence of Malassezia spp. in horses and domestic ruminants. Mycoses 45:333-337, 2002 White SD, Vandenabeele SIJ, Drazenovich NL, et al: Malassezia species isolated from the intermammary and the preputial fossa areas of horses. J Vet Int Med 2006 (in press) Rosser EJ Jr: Sporotrichosis, in Robinson NE (ed): Current Therapy Equine Med 5. Philadelphia, PA, Saunders, 2003, pp 213-214 Hubert JD, Grooters AM: Treatment of equine pythiosis. Compend Contin Ed Pract Vet 24:812-815, 2002 Mendoza L, Mandy W, Glass R: An improved Pythium insidiosum-vaccine formulation with enhanced immunotherapeutic properties in horses and dogs with pythiosis. Vaccine 21:2797-2804, 2003

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7. 8. 9.

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Pythiosis
Not a true yeast, but rather a protista, Pythium sp (Pythium insidiosum) is considered to be the causative agent of swamp cancer (aka Florida horse leech, bursattee, kunker). This organism is found in tropical and subtropical areas around the world. The pythiosis lesions occur most commonly on the limbs, abdomen, neck, and lips, and consist of dense granulation tissue containing masses of yellow gray necrotic tissue, which are sometimes calcied with the masses often being present as cores in the stulae that can be removed intact. Such masses are known as leeches or kunkers. The granuloma ulcerates and extends peripherally and may reach a very large size in a short time (Figure 21); the overlying and adjacent skin is destroyed both by the inammatory reaction and self-mutilation by the horse. Pythiosis and habronemiasis (summer sore) may produce similar lesions. Histopathologic examination of affected tissue reveals pyogranulomatous inammation directly surrounding the organism. Isolation of organisms from the lesions is necessary for their further identication and study, but histologic demonstration of the protozoa within tissues that are obviously reacting to its presence is critical in establishing the causal relationship in an individual lesion. Recent advances in ELISA or molecular techniques offer better potential for organism detection and identication.29 Wide surgical excision combined with immunotherapy has the best chance of success, although recent work using a vaccine alone is promising.30

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20. 21. 22. 23. 24. 25.

References
1. Scott DW, Manning TO: Equine folliculitis and furunculosis. Equine Pract 2:11-32, 1980 2. Shimizu A, Kawano J, Ozaki J, et al: Characteristics of Staphylococcus aureus isolated from lesions of horses. J Vet Med Sci 53:601-606, 1991 3. Chiers K, Decostere A, Devriese LA, et al: Bacteriological and mycological ndings, and in vitro antibiotic sensitivity of pathogenic staphylococci in equine skin infections. Vet Rec 152:138-141, 2003 4. Pellegrini A, Waiblinger S, Von Fellenberg R: Purication of equine neutrophil lysozyme and its antibacterial activity against gram-positive and gram-negative bacteria. Vet Res Commun 15:427-435, 1991 5. Yasuda R, Kawano J, Onda H, et al: Methicillin-resistant coagulase-

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