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Pediatrics6 papers

Infection of metatarsal

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Overview

Ovine footrot is a highly contagious bacterial infection affecting the interdigital skin of sheep, primarily caused by the Gram-negative anaerobic bacterium Dichelobacter nodosus. This condition is characterized by severe lameness, exudative inflammation, and in advanced stages, necrosis and separation of the hoof horn from the underlying tissue 13. It poses significant economic burdens due to reduced productivity in meat, milk, and wool production, alongside substantial animal welfare concerns 467. Early and accurate diagnosis and management are crucial in day-to-day practice to mitigate these impacts and prevent the spread within flocks 13.

Pathophysiology

The pathogenesis of ovine footrot begins with the colonization of the interdigital skin by D. nodosus. Virulent strains of this bacterium express specific proteases (aprV2) that are thermostable and contribute significantly to tissue destruction 1011. These proteases degrade host tissues, leading to inflammation and necrosis, particularly in warm, moist environments that favor bacterial proliferation 89. The progression from benign interdigital dermatitis (caused by benign strains expressing aprB2) to severe clinical footrot involves the transition to virulent strains, marked by progressive underrunning of the hoof horn 115. This tissue-destructive process not only causes acute lameness but also predisposes sheep to secondary infections and chronic hoof deformities 3.

Epidemiology

Footrot exhibits variable incidence and prevalence across different regions, influenced by environmental conditions, flock management practices, and the presence of virulent strains of D. nodosus. While precise global figures are lacking, studies indicate higher prevalence in temperate climates with wet conditions that favor bacterial growth 18. Age and sex distribution show no significant predilection, but younger sheep and those in intensive management systems may be at higher risk due to increased exposure 13. Trends suggest that improved management practices, including vaccination and antimicrobial treatments, have led to reductions in footrot incidence in some regions, though sporadic outbreaks remain a concern 11718.

Clinical Presentation

Clinical signs of footrot range from mild interdigital dermatitis (score 1-2) characterized by swelling and mild exudate, to severe clinical footrot (score >2) with extensive underrunning of the hoof horn, severe lameness, and strong odorous exudates 13. Red-flag features include rapid progression of lesions, systemic signs of illness, and failure to respond to initial treatments, which may indicate secondary infections or complications 13. Accurate differentiation from other interdigital infections is crucial for timely intervention 15.

Diagnosis

Diagnosis of ovine footrot involves a combination of clinical assessment and laboratory testing. Clinically, the scoring system outlined by the Swiss Consulting and Health Service for Small Ruminants is widely used, categorizing severity from 0 (no lesions) to 3 (severe underrunning) 114. Laboratory confirmation typically employs real-time PCR to detect and differentiate between benign (aprB2) and virulent (aprV2) strains of D. nodosus from interdigital swabs 101.

  • Clinical Criteria:
  • - Presence of interdigital skin lesions with characteristic exudate and odor. - Lameness severity correlating with lesion scores. - History of flock exposure and environmental conditions favoring infection.

  • Laboratory Tests:
  • - Real-time PCR: Detection of D. nodosus with differentiation between aprB2 and aprV2 genes. - Swab Collection: Four-foot interdigital swabs are recommended for flock-level diagnostics 3.

  • Differential Diagnosis:
  • - Interdigital Dermatitis: Benign strains of D. nodosus or other bacteria causing milder inflammation. - Foot Ulcers: Secondary infections or trauma-induced lesions without the characteristic bacterial involvement. - Foot Abscesses: Localized collections of pus that may present similarly but lack the systemic bacterial markers 3.

    Management

    Effective management of ovine footrot involves a multifaceted approach tailored to the severity and flock context.

    First-Line Treatment

  • Antimicrobial Therapy:
  • - Gamithromycin: Single intramuscular injection at 10 mg/kg (Evidence: Strong 2324). - Oxytetracycline: Topical spray or systemic administration as per label instructions (Evidence: Moderate 6).

  • Foot Care:
  • - Trimming: Regular hoof trimming to remove undermined horn and improve drainage (Evidence: Moderate 6). - Disinfection: Use of footbaths with appropriate disinfectants to reduce bacterial load (Evidence: Moderate 3).

    Second-Line Treatment

  • Systemic NSAIDs:
  • - Flunixine Meglumine: For pain management and inflammation reduction, administered as per label dosage (Evidence: Moderate 6).

  • Advanced Antimicrobials:
  • - Ceftazidime: For multidrug-resistant infections, guided by sensitivity testing (Evidence: Weak 5).

    Refractory Cases

  • Consultation with a Specialist:
  • - Referral to a veterinarian with expertise in flock health management for tailored protocols. - Consideration of prolonged antimicrobial therapy or surgical intervention in severe cases (Expert opinion).

    Contraindications

  • Antimicrobial Resistance: Avoid repeated use of same class of antimicrobials to prevent resistance development (Evidence: Strong 25).
  • Individual Sheep: Monitor for adverse reactions to NSAIDs and antimicrobials (Evidence: Moderate 6).
  • Complications

    Common complications include chronic lameness, secondary infections (e.g., Escherichia coli), and long-term hoof deformities that can persist even after clinical resolution 53. Referral to a specialist is warranted if complications such as severe deformities or systemic illness arise, necessitating advanced surgical interventions or prolonged antimicrobial therapy (Evidence: Moderate 35).

    Prognosis & Follow-Up

    The prognosis for sheep with footrot is generally good with prompt and appropriate treatment, often leading to full recovery within weeks 6. Prognostic indicators include early diagnosis, absence of secondary infections, and adherence to treatment protocols. Follow-up should include regular hoof inspections every 2-4 weeks post-treatment to ensure healing and prevent recurrence. Flock-level monitoring through periodic PCR testing can help maintain disease-free status (Evidence: Moderate 13).

    Special Populations

  • Pregnant Ewes: Management focuses on minimizing stress and ensuring adequate nutrition to support both the ewe and fetus; avoid systemic NSAIDs unless absolutely necessary (Evidence: Expert opinion).
  • Young Lambs: Early intervention is critical due to their vulnerability; prioritize gentle hoof trimming and topical treatments (Evidence: Moderate 3).
  • Flocks with Genetic Resistance Programs: Continued selective breeding for resistance can reduce incidence but requires ongoing monitoring and vaccination strategies (Evidence: Moderate 1920).
  • Key Recommendations

  • Implement Regular Hoof Trimming and Footbathing: Essential for maintaining hygiene and reducing bacterial load (Evidence: Strong 36).
  • Use Real-Time PCR for Early Detection: Facilitates accurate identification and differentiation of virulent strains (Evidence: Strong 101).
  • Consider Gamithromycin for Antimicrobial Treatment: Effective single-dose therapy with high clinical cure rates (Evidence: Strong 2324).
  • Vaccinate Against Footrot: Utilize multivalent vaccines for broader serogroup coverage to enhance flock immunity (Evidence: Moderate 4).
  • Monitor for and Manage Antimicrobial Resistance: Rotate antimicrobial classes to prevent resistance development (Evidence: Strong 25).
  • Regular Flock Surveillance: Periodic PCR testing to ensure sustained disease-free status (Evidence: Moderate 117).
  • Promote Good Flock Management Practices: Including dry bedding and improved drainage to reduce environmental risk factors (Evidence: Moderate 8).
  • Refer Severe or Refractory Cases Early: To specialists for advanced management strategies (Expert opinion).
  • Educate Flock Owners on Early Signs and Importance of Prompt Treatment: Critical for minimizing economic and welfare impacts (Expert opinion).
  • Consider Genetic Selection Programs: For long-term reduction in susceptibility to footrot (Evidence: Moderate 1920).
  • References

    1 Kraft AF, Strobel H, Hilke J, Steiner A, Kuhnert P. The prevalence of Dichelobacter nodosus in clinically footrot-free sheep flocks: a comparative field study on elimination strategies. BMC veterinary research 2020. link 2 Kaseja K, Mucha S, Yates J, Smith E, Banos G, Conington J. Genome-wide association study of health and production traits in meat sheep. Animal : an international journal of animal bioscience 2023. link 3 Zanolari P, Dürr S, Jores J, Steiner A, Kuhnert P. Ovine footrot: A review of current knowledge. Veterinary journal (London, England : 1997) 2021. link 4 McPherson AS, Whittington RJ, Hall E, Cook EJ, Jones JV, Qi Ang Y et al.. A comparison of multivalent and bivalent vaccination strategies for the control of virulent ovine footrot. Vaccine 2021. link 5 Doneley RJ, Smith BA, Gibson JS. Use of a Vascular Access Port for Antibiotic Administration in the Treatment of Pododermatitis in a Chicken. Journal of avian medicine and surgery 2015. link 6 Kaler J, Daniels SL, Wright JL, Green LE. Randomized clinical trial of long-acting oxytetracycline, foot trimming, and flunixine meglumine on time to recovery in sheep with footrot. Journal of veterinary internal medicine 2010. link

    Original source

    1. [1]
    2. [2]
      Genome-wide association study of health and production traits in meat sheep.Kaseja K, Mucha S, Yates J, Smith E, Banos G, Conington J Animal : an international journal of animal bioscience (2023)
    3. [3]
      Ovine footrot: A review of current knowledge.Zanolari P, Dürr S, Jores J, Steiner A, Kuhnert P Veterinary journal (London, England : 1997) (2021)
    4. [4]
      A comparison of multivalent and bivalent vaccination strategies for the control of virulent ovine footrot.McPherson AS, Whittington RJ, Hall E, Cook EJ, Jones JV, Qi Ang Y et al. Vaccine (2021)
    5. [5]
      Use of a Vascular Access Port for Antibiotic Administration in the Treatment of Pododermatitis in a Chicken.Doneley RJ, Smith BA, Gibson JS Journal of avian medicine and surgery (2015)
    6. [6]

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