Walkthrough severe mastitis in Cattle - Vetoquinol Symposium Marseille 2013
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European Buiatric Forum Marseille (France) 27 th November 2013 Walking through grade 3 mastitis therapy considerations L. Théron; Pr. Ch. Hanzen Ruminant and Swine clinic Service of Theriogenology, Faculty of veterinary medicine, University of Liege
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Review of the parameters that could have an impact on bovine mastitis treatment and prevention in dairy medicine
Transcript of Walkthrough severe mastitis in Cattle - Vetoquinol Symposium Marseille 2013
European Buiatric ForumMarseille (France)27th November 2013
Walking through grade 3 mastitis therapy considerations
L. Théron; Pr. Ch. HanzenRuminant and Swine clinicService of Theriogenology,
Faculty of veterinary medicine, University of Liege
Here it begins…
Sick cowShowing signs of mastitis (or not)Showing signs of painJust calvedEverything good until this morning…
I WANT TO TREAT IT…The animal is sick
E. coli???
Klebsiella
S.aureus
Clostridium
Str. uberis
E. coli
Here it begins…
Local inflammationToxinsProductionHygieneCalving
Here it begins…
InflammationSomatic cells?Clinical modification of milk
Downer cow…
RecumbentLethargicPareticHyperthermic/HypoRuminal contractions downOther pathologies?
Grade 3 specific signs•Call :
–Anorexia–Downer cow
Clinical exam• Weak pulse• Tachycardia• Tachypnoa• Hyperthermia (>39,5)• Dilated capillaries• Mucosal hyperemia• Persistent skin fold• +/- Diarrhea
Grade 3 clinical signs
Clinical signs Stiff and swelling udder Altered milk(+/-)
How to approach
Septic shock on
susceptible animal
Shock
Infectious Etiology
Pain and Inflammation
Risk factors Metabolic disorders
About timing? E. coli replication : 20 min Surge for an antibiotherapy? In the first
hour Technically : The inflammation kills
Here it begins…Dehydration will modify
rehydration procedures :
Assessment of dehydration in adult cattleMild dehydration (6%–8%): slight eyeball recession, skin tent slightly prolonged (2–3 seconds), mucous membranes moist
Moderate dehydration (8%–10%): eyes obviously sunken, skin tent obviously prolonged (3–6 seconds), mucous membranes tacky
Severe dehydration (10%–12%): eyes severely sunken into orbits, skin remains tented indefinitely, mucous membranes dry
Hypertonic IV + isotonic Per os fluids Isotonic fluids
EPIN
EPH
RIN
E
…
Local and general inflammation
Anti-inflammatory drugs
Steroids have bad reputation…oNo solid evidence (?)
NSAID have good reputationo Indeed!
Etiology
Klebsiella
S.aureus
Clostridium
Str. uberis
E. coli
Complete diagnosis?
Evidence-based medicine
Though veterinary antibiotherapy is challenged by societyo Best use of critical Fluoroquinolones and
Cephalosporins on severe mastitiso Though adviced, old molecules suffers from fewer
evidence assays…o Yet it lies a risk for Streptococci (20-40%)
8) Which antibiotic is the most indicated for the treatment of a severe mastitis?
55 bovine practionners - Journées pluridisciplinaires UPV
1. Fluoroquinolones (marbo, enro, danofloxacine)2. Aminopenicillins (Ampi, amoxicilline)3. Polymyxins (colistine)4. Trimethoprim-sulfamids5. None6. All
1. Fluoroquinolones (marbo, enro, danofloxacine)2. Aminopenicillins (Ampi, amoxicilline)3. Polymyxins (colistine)4. Trimethoprim-sulfamids5. None6. All
8) Which antibiotic do you use the most for the treatment of a severe mastitis?
55 bovine practionners - Journées pluridisciplinaires UPV
Binary approach
Main risk : Death from Endotoxemia (Gram-)o Fluoroquinolones High Dose IV/IMo 3rd or 4th generation Cephalosporines IV/IMo TMP-S parenteral, BIDo Tetracycline 15 mg/kg at leasto Amoxycilline w/wo Clavulanate
Secondary risk : Persistent infection with Streps (Gram+)o Local penicillin (G, A or M)o Parenteral Penethamate
My pathology and my patient…“Why is she sick?”
o 25g IV VitC VitE (and Se) Cu T4o Propylene Glycol…o Curative? Preventive? Helpful?
So small, So important…
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Lactation contamination riskLactation cure riskDry-off cure riskPrevalenceFirst control abnormal
%
Herd status Zn (mmol/L) Cu (mmol/L) GPX (IU/gHb) PII(mg/L) Milk I (mg/L) Se (µg/L)
Adequate 14–21 13–18 220–600 45–650 80 >80Marginal 8–14 8–13 75–220 15–45 30–80 50-80Deficient <8 <8 <75 <15 <30 <50
60-80% of problem herds had heavy deficiencies
Evaluation of Shock
Rehydration
Evaluation of Shock
RehydrationEvaluation of
pain/inflammationEvaluation of
pain/inflammation
Probability of etiology
Choice for antibiotic treatment
Probability of etiology
Choice for antibiotic treatment
Zootechnical risk factors (Age, Days in
milk, Production level…)
Zootechnical risk factors (Age, Days in
milk, Production level…)
Knowing existent risk factors of therapeutic failure (nutritional status, bad management, bad
hygiene etc…
Knowing existent risk factors of therapeutic failure (nutritional status, bad management, bad
hygiene etc…
Evaluation of Shock
Rehydration
Evaluation of Shock
RehydrationEvaluation of
pain/inflammationEvaluation of
pain/inflammation
Probability of etiology
Choice for antibiotic treatment
Probability of etiology
Choice for antibiotic treatment
Zootechnical risk factors (Age, Days in
milk, Production level…)
Zootechnical risk factors (Age, Days in
milk, Production level…)
Knowing existent risk factors of therapeutic failure (nutritional status, bad management, bad
hygiene etc…
Knowing existent risk factors of therapeutic failure (nutritional status, bad management, bad
hygiene etc…
Briefly, the “toxic cow” should raise the question
“Why the animal has got mastitis?” rather than “Which mastitis is it?”…
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