nocardioform placentitis | Horse Racing Free Tips

Study Answers Key Questions About Nocardioform Placentitis, But Etiology Remains Elusive

A new study published in the peer-reviewed journal Theriogenology reveals more about nocardioform placentitis, a placental infection that has plagued breeders and stud farm managers for decades. Placentitis is believed to account for 19 percent of equine infectious abortions nationwide, but much remains unknown about the disease.

A research team led by Dr. Carleigh Fedorka at the Gluck Equine Research Center in Lexington, Ky., studied 264 mares — 145 who were suspected to have the disease and 119 with apparently healthy pregnancies — and compared characteristics of their pregnancies and resulting foals.

The study found that nocardioform placentitis tends to be associated with older mares, and it isn't contagious between mares in the same turnout group. One episode of nocardioform placentitis does not necessarily presuppose another in the same horse the following year, and mares did not seem to experience abnormal cycles or reduced fertility after a case of nocardioform placentitis. Mares who were given antibiotics and hormones throughout their pregnancies to stave off the disease were no less likely to develop a case of nocardioform placentitis than those who were not.

While one of the most classic symptoms of nocardioform placentitis is abortion, some mares whose placenta indicated they had the illness did produce live foals. The study found those foals were smaller than average, but were otherwise healthy and had normal blood counts at birth.

Interestingly, the size of the placentitis lesion on an infected mare's placenta seemed to vary according to the date of breeding, with mares bred later in spring showing larger lesions.

Nocardioform placentitis is believed to be caused by bacteria, but researchers don't know how the bacteria causes the inflammation of the placenta that's characteristic of the disease. It's characterized by premature mammary gland development, thickened placental and uterine walls on ultrasound, or visible separation of the placenta from the uterine walls on ultrasound. There are several forms of placentitis, but the nocardioform version is accompanied by a thick, brown mucous covering the placenta at the site of the lesion, which prevents the placenta from continuing to support the fetus in some cases. Nocardioform placentitis case numbers seem to sometimes wax and wane across breeding seasons, suggesting that season or weather conditions may play a role in its development.

Read the full study here.

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Annual UK Equine Research Showcase To Take Place Virtually

University of Kentucky Ag Equine Programs will host its 10th annual UK Equine Showcase virtually through four sessions over four dates in January and February 2021.The event will continue the “life journey” theme initiated last year and will emphasize weanling to yearling horses, presenting both completed and work-in-progress projects relevant to this age group.

“We are excited to once again put together an excellent set of lectures and continuing education featuring many of our colleagues,” said Emma Adam, assistant professor and research and industry liaison at the Gluck Equine Research Center. ““The way our industry is helped through the resources we have at the University of Kentucky is unparalleled.”

Due to the current pandemic, the event has moved to a virtual format. Organizers wanted to continue to provide information and continuing education opportunities in 2021 rather than postpone for a year. Recognizing that staying engaged for long periods of time via a virtual format is challenging, organizers chose to break up the annual event into several shorter sessions over the course of a few weeks.

Jan. 5, 6-7:30 p.m. EST, will focus on musculoskeletal issues and include the following topics and speakers:

Bisphosphonates, NSAIDs and other medicines in the juvenile horse with Scott Stanley, professor of analytical chemistry at the Gluck Equine Research Center.
Sesamoid bone maturation by the laboratory of James MacLeod, director of UK Ag Equine Programs and John S. and Elizabeth A. Knight chair and professor of veterinary science at the Gluck Center.
Bone pathology in Wobbler's Syndrome with Jennifer Janes, assistant professor of anatomic pathology at UK's Veterinary Diagnostic Laboratory.

Jan. 19, 6-7:30 p.m. EST, will focus on nutrition and pasture topics and include the following information and speakers:

Mineral requirements for a growing horse with Mieke Brummer-Holder, assistant professor in the Department of Animal and Food Sciences.
Amino acids and protein synthesis in the growing horse with Kristine Urschel, associate professor in the Department of Animal and Food Sciences.
UK Horse Pasture Evaluation Program information with Krista Lea, program coordinator, and Ray Smith, professor and extension forage specialist, both from the Department of Plant and Soil Sciences.

Feb. 2, 6-7:30 p.m. EST, will focus on parasitology, vaccination immunology and causes of mortality and include the following information and speakers:

Vaccination, immunity and immune response in weanlings with David Horohov, chair of the Department of Veterinary Science, director of and Jes E. and Clementine M. Schlaikjer Endowed Chair at the Gluck Center.
Parasitology as it pertains to weanlings and yearlings with Martin Nielsen, Schlaikjer professor of Equine Infectious Disease at the Gluck Center.
Common(est) causes of mortality in this age group with Laura Kennedy, assistant professor and veterinary pathologist at the UK VDL.

Feb. 9, 6-7:30 p.m. EST will cover hot topics in a mini session format of 10 minutes each, with updates about equine research literature resources at UK, nocardioform placentitis summary from 2020, COVID-19 economic impact and the next equine survey, lab updates, Equine Biological Passport update, genetic diversity project, updates on equine surface research, important parasitology updates and more.

“This is a unique and special outreach event. The purpose is to showcase some of what is happening at the University of Kentucky in terms of scientific discovery and service efforts relevant to the young horse,” MacLeod said. “Participants will hopefully gain new information they can apply to their programs, but importantly also a greater appreciation for some of the critical questions being addressed at UK, why these issues are important and where the cutting edge of research is on a number of very interesting topics. This annual program, now reaching 10 years, highlights our commitment to advance research, service and teaching for the benefit of horses and the equine community.”

The UK Equine Showcase is open to veterinarians, owners and managers of all horse breeds or anyone with an interest in learning more about foals and horse management. Its virtual format means that this opportunity is open to attendees from across the U.S. and even world.

The cost to attend all sessions is $25 until the early-bird registration deadline of Jan. 5. This package will include a PDF of the presentations and access to a recording of the sessions after the event has concluded. Attendees can also opt to attend only one or two of the sessions they are interested in. Individual event registration will also be available for $10 each. There are special rates for farms interested in having multiple employees attend. Students from any university can participate for free. Please contact equine@uky.edu for help in registering for those discounted or free sessions. Continuing education credit for veterinarians and veterinary technicians is pending approval by the Kentucky Board of Veterinary Examiners. Register here. Contact equine@uky.edu with questions about the event or with help registering.

UK is also accepting sponsor participation for the showcase. Presenting opportunities are available to participating organizations on a first-come, first-served basis. Email equine@uky.edu for details.

Ask Your Veterinarian Presented By Kentucky Performance Products: What We Know About This Year’s Placentitis Cases

Veterinarians at Rood and Riddle Equine Hospital answer your questions about sales and healthcare of Thoroughbred auction yearlings, weanlings, 2-year-olds and breeding stock. If you have a question for a veterinarian, email us info at paulickreport.com .

QUESTION: We saw an increased number of nocardioform placentitis in the 2020 foaling season. Why are some years worse for placentitis than others?

DR. MARIA SCHNOBRICH: In the 2020 foaling season in Central Kentucky saw an increase in the incidence of Nocardioform placentitis. The University of Kentucky Veterinary Diagnostic Laboratory reported that this was the second worst year for Nocardioform placentitis behind 2011, when they had 328 confirmed cases. In 2020 there were 207 cases confirmed. Likely these numbers represent an underrepresentation, as not all cases are submitted for evaluation.

Nocardioform placentitis is a type of placentitis that is associated with isolation of a slow-growing, gram-positive family of bacteria that are found in the placenta after delivery or abortion. These bacteria (Crosiella, Amycolytopsis, Actinomycetes) are thought to originate from the soil, but frustratingly we do not know at this time how the disease process starts or what is the reason it develops in some mares and not others. This type of placentitis usually causes well-demarcated lesions in the placenta where a mucoid plaque develops and causes the placenta to be disrupted, and may limit or severely compromise fetal development. The outcome of mares affected with this type of placentitis can range from abortion to normal foals and does not always correlate to the severity of the lesions.

Due to the increased incidence of this disease last year, many involved with the broodmare management, including veterinarians, farm managers, owners and researchers worked together to collect and compare data. The UK Gluck Equine Research Center's Dr. Barry Ball is currently compiling data from this past year and will be making his team's findings available to the public.

Dr. Maria Schnobrich

Frustratingly, despite many attempts to reproduce the disease, we do not know what causes or initiates Nocardioform placentitis in the mare. While researchers continue to work on this, we have learned several things which I will summarize below.

The incidence of Nocardioform placentitis seems to be associated with weather. When conditions are hot and dry (as they were in the late summer and early fall of 2019), there is an increase in disease. When conditions are wet and cold, we see a decrease in this type of placentitis, while other diseases like leptospirosis may increase.
Evaluations of soil samples from 2019 are pending and may help give us insight on whether this bacteria was more common. Previously the bacteria found in affected placentas could not be found in the soil from the affected farms when the soil was cultured much later in the year. The new data from 2019-20, when the soil was cultured closer to the time of possible infection, may be helpful in identifying why we had an increase.

Nocardioform placentitis does not occur only in Kentucky, as might have been previously thought. There are cases reported and diagnosed in animals that have never been in Kentucky, though we in Kentucky at the moment seem to have the highest incidence.
Natural cover is not required to produce the disease. Confirmed cases of Nocardioform placentitis occurred in mares bred by artificial insemination and even embryo transfer recipients.
Screening for the disease remains problematic as we have no sure way of identifying the issue. Diagnostic tools that may aid the owner and veterinarian in identifying affected patients include:

Clinical signs such as premature udder development, and rarely vulvar discharge.
Transabdominal and transrectal ultrasound which may identify lesions before they become advanced. The downside of ultrasound in the pregnant mare is that the entire placenta can't be visualized, so some cases may be missed. The advantage is this may allow you to identify an issue earlier in the course of the disease and implement treatment then.
Evaluation of hormones to assess pregnancy (estrogens and progesterone). Screening may result in identifying cases with significant pathology or compromise. In cases that were presented to a referral clinic, all animals had abnormalities in these values, though this needs further research to determine how useful a screening tool it may be.

This image shows the ultrasound image generated from a transabdominal screen of a pregnant mare. The blue arrow is pointing to an area where the uterus has separated from the fetal membranes and placental disruption is caused by a dense fluid. This area correlates to our findings of thick mucoid debris caused in areas affected by Nocardioform placentitis.

There seems to be little resistance to commonly used antibiotics when isolates from the disease were tested for susceptibility in vitro. Doxycycline (81-96% sensitivity) and TMS/SMZ (80%-95%) were incredibly effective when isolates from 2020 placentitis cases were tested in the lab.
The data regarding which treatment for this type of placentitis is most effective is confusing. Research by Gluck's Dr. Carleigh Fedorka demonstrated that cases that were treated actually had a worse outcome than untreated cases. Additionally, the only treatment which seemed to have a positive effect on pregnancy outcome was Firocoxib (Equioxx), an anti-inflammatory. We have to remember though that this data reflects animals that were treated because they were identified as having an issue, and so likely had more severe disease than those untreated animals. There are few situations in which an animal identified with disease would have been left untreated, as this usually results in a poor outcome.

This picture shows the brown discoloration caused from Nocardioform placentitis that can be found on the fetal membranes after delivery. Often there is thick, viscous debris that has been described as similar to “peanut butter” in consistency.

In summary, Nocardioform placentitis continues to be a sporadic but significant issue for the Thoroughbred industry. While it may affect us worse in certain years it has highlighted our need for vigilant monitoring of the pregnant mare and a continued effort to identify early markers of pregnancy compromise. As we now have seen trends related to weather this may give us an idea as to which years will be worse, but discussion with your veterinarian and farm manager about screening and treatment is recommended as it is a complicated issue without a clear recipe for management.

Dr. Maria Schnobrich grew up in Boston where visits to her grandparents' farm and riding lessons at a young age sparked her interest in horses and large animals. Dr. Schnobrich graduated Magna Cum Laude at Brown University followed by attending veterinary school at the University of Pennsylvania. She is a Diplomate of the American College of Theriogenology.

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