I have dealt with it several times at my farm in N. CA, including internal pigeon fever. First, it’s not the end of the world most of the time.
Prevention: Most important is to protect midline fly sores with SWAT or such, as I suspect this is a common entry point.
Causes: Bacteria can stick around for years; I’m told properties that previously had cattle or previous horse cases may be more prone, not sure if that is true. It may hang out in soil. It’s cyclical – some years worse than others.
Treatment: Tincture of time and basic support. Most horses weather it well enough. Most need some TLC and babying as they won’t feel well. It can take weeks to run its course, or you can notice a swelling one day and the next it’s draining. For the abscess, hot packing can help. After obsessing over a few horses I simply stopped hot packing and let nature take its course.
Development/maturing/rupture of abscess: The abscess has a fat wall around it, the body’s way of isolating the bacteria. It can take time for this to develop. As it does, you’ll feel that fat wall get more and more hard and defined, and as the abscess matures the skin in the middle will thin out and the center will soften. When it has the consistency of a water balloon when you tap it (jiggly and soft), and the skin in center is very thin, it’s close to rupturing. Many rupture on their own. After a while I dispensed with calling the vet and got good at lancing them. The horse usually feels better immediately after rupture, unless he has others brewing.
Aftercare: Cleaning, hosing, keeping open wound draining and clean, SWAT, general supportive care. My vet had me flush the wound with a dilute nolvasan solution. Watch the horse for signs he is feeling bad again, running fever, off feed – can be a sign of internal pigeon fever, which is very serious.
Isolation: Many places isolate. I couldn’t do it easily, so didn’t. I had a small gelding herd and kept them together. I figured I can’t control the flies and I suspect main risk is from bacteria in the soil – infection happens long before they show signs of sickness. One compromised gelding and one old gelding got it; the other horses were fine.
Hope that helps. I’m not a vet and this is not medical advice, just info from someone who has dealt with PF ranging from mild (you barely notice) to deadly (internal form). Again, most horses do OK with it. Old or compromised ones have the hardest time. Be PATIENT, provide supportive care, work with a vet who has experience with PF (doesn’t get too excited, yet knows symptoms and treatment for internal PF), and ride it out.