Recurring neck abscess UPDATE guttural pouch?

[saitou_amaya]

I have a 24 year old Friesian gelding with Cushings who has had a recurring neck abscess, three times now, and I’m hoping someone else has gone through this.

It started back in June this year, one day I came out to the barn and the area of his throat latch, kind of behind his jaw/neck area, was swollen to about the size of a grapefruit. It was very tender to the touch and leaking a bit of yellow fluid. The vet came out, recommended hot compresses until it came to a head. A few days later, he came back out and lanced it open under ultrasound guidance. A ton of pus came out. Then he has a huge gaping flap/pouch open. It took over a month to heal and was really quite disgusting.

When the vet drained it, he sent a culture off which came back positive for streptococcus zooepidemicus https://aaep.org/horsehealth/s-zooepidemicus-infections. From what I understand, most horses are exposed to/carriers of this but because my horse was older and had Cushings, it caused this infection. The vet did drug susceptibility testing and treated him with a course of uniprim powder.

After over a month, it was nearly healed but then suddenly started to drain pus and swell again. The vet debated opening it back up again or not but decided not to and did a 10 day course of SMZ/TMP. This cleared it up pretty quick and it looks really completely healed.

But today I come out and his throatlatch is swollen to the size of a grapefruit and tender again. This literally happened overnight. The vet came back out and says it will need to drain it again and we will try a longer course of antibiotics. But he says the infection was likely never fully cleared last time. He says that depending on how things go, his recommendation may be to take him to a bigger equine hospital to have it surgically cleared out and have a drain put it.

I’m really weighing the pros and cons of hauling a 24yo horse 3 hours away for surgery and have concerns about how well he would do with surgery. Has anyone has any experiences like this before? If pictures would be helpful, I can also share those.

[2DogsFarm]

If he were mine, I’d contact the vet hospital & discuss the surgery with them.
I’m assuming your vet is familiar with the horse’s health from before the first occurrence of strep.
If horse is otherwise in good health & surgery has a good chance of eliminating the recurring strep infection, I’d go with the surgery.

I have a 22yo Hackney Pony & a 20yo TWH.
Both would get the surgery if indicated to eliminate that issue.

[Highflyer1]

As surgeries go this would be relatively minor. As long as he travels well I probably wouldn’t worry too much about that part. But I would think trying a different stronger antibiotic might be a possibility too.

[Bluey]

I knew of a 3 year old this was happening to.
Sent to the veterinary hospital, they found it was an infected back molar, took it out and horse cleared permanently.

Probably something that rare is not what ails your horse, but at least getting some diagnostics would help make further decisions.

The stays in those larger hospitals generally surprise horse owners by how little it cost, compared with what they were expecting.
Asking them when you talk to them would answer that.

I do hear your concerns, horse has Cushing’s and is 24.
An operation can end up with laminitis and possibly further problems, maybe not the quality of life you want to take chances for your horse’s last years.
Ask your vet about this, those are serious questions.

Then, if all ends up needing to take out an abscessed gland in that area, your horse may not even miss a minute with such operation.

[mbv]

It sounds like there is a high probability that there is foreign material or another issue (dental etc) that is contributing to the chronicity of the problem. Strep zooepidemicus is often an opportunistic pathogen, taking advantage of compromised tissue. It does not tend to be highly resistant to antibiotics, but with an abscess, it can sometimes be difficult for drugs to access the site of infection adequately. It sounds like it would be worth further diagnostics to see if a primary cause of the recurring problem can be identified and corrected.
This type of surgery can often be performed under standing heavy sedation +/- nerve blocks, if that helps allay your concerns about surgery in an older horse.

[TWH_Girl]

I do have a similar situation- my 20 yr old metabolic gelding has an enlarged lymph node under his throat latch area. We ultrasounded and cultured it last year and it came back as actinobacillus and fusarium. The abscess drained but never fully went away. It refilled a few weeks ago with some pus leaking so this time we put him on doxycycline. If that fails, I will probably bring him into the clinic to have it excised. He hasn’t yet tested positive for Cushings but as a 20 yr old TWH, pretty sure it’s only a matter of time. Repeated infections are certainly an issue with Cushings horses.

As for your horse, I I probably would have this excised in a surgical setting. General anesthesia is unlikely to be used so it’s not as risky. This is a tough call. I will be following this thread and will update on my guy as well.

[saitou_amaya]

Just posting some pictures as well if that’s helpful.
This picture is how it looks now.

This is what it looked like last time after the vet cut it open and drained it.

It took nearly 2 months to completely close up and heal. The vet thinks the bacteria was never totally eliminated when it healed and that’s why it has abscessed again.

[tbchick84]

If you don’t mind gross pictures, take a look at my thread below titled “horse sliced neck open” and see if your horse’s bump is in the same spot. If so, that’s a salivary gland. I’ve seen other threads where they have become infected and swollen for various reasons. Might help with your diagnosis.

[Postandrails]

I knew a horse with recurring abscess in the same area. His was due to a barley grass (spikey) seed from hay, which had lodged itself high up in the back of his mouth and worked it’s way down.

[RedHorses]

I too suspect a foreign object or other issue (like the tooth mentioned above) is the root cause. Unless that is taken care of the abscessing will continue.

I understand surgery is scary, but what’s the alternative? Can you take the horse for assessment and surgical plan so you will know exactly what is involved? It might be as simple as standing sedation similar to dental work.

[saitou_amaya]

Thanks for the responses. Whenever the abscess first appeared in June, the vet did a thorough dental exam with a speculum while sedated and didn’t see anything. But it is definitely possible he missed something, especially if it was very far back. So I’ll ask if he can look again.

If the surgery is something that can be done with standing sedation and only a couple days in the hospital, I’d have no hesitation going forward with that. Right now I haven’t really talked much with the vet about what the surgery would be like, which state vet school he’d to go, how much it would cost, etc. He just mentioned it as an option and said we’d talk about it more if that is the way we need to go.

Right now we are just kind of waiting. When he came on Friday, he wanted the abscess to get closer to ready to drain and see how it looks Monday/Tuesday. He told me to put warm compresses on it regularly this weekend. So far though, it looks the same as Friday, not any bigger or ready to drain. The horse is otherwise fine, no fever, eating, drinking, being a bully like usual and the banamine has helped with the pain.

[TWH_Girl]

I have to say, that is definitely nasty looking! I’d lean to wanting to excise that thing so I never had to deal with it again. Glad he’s eating and otherwise doing well!!

[saitou_amaya]

No kidding. I probably should have put a graphic warning before the pictures. I am not usually a squeamish person but let me tell you, the amount of stinky pus that came out of that thing when the vet cut into it was something else. And then there was just this pocket that I could fit over half my hand inside that I had to clean and put antibiotic ointment on every day. It took two months to fully heal. And he couldn’t go outside while it was open and draining so he was stuck in a stall. And became very stocked up and his sheath became insanely swollen. It was miserable for both of us.

[saitou_amaya]

The vet was out again today. The abscess is still there, not really any smaller or bigger but appears to be more painful. Vet did an x-ray of the area to make sure this wasn’t a dental issue or see what else could be going on. She said it looks like his right guttural pouch is filling with fluid and this might be a chronic guttural pouch infection. I know that is usually associated with strangles, which this is not. But apparently strepococcus zooepidemicus can also cause guttural infections.

She wants to bring him in to the clinic on Monday morning to scope his guttural pouches, collect some fluid for culture, and sensitivity and try to flush them. This is something that can be done at our nearby clinic and is done standing with sedation! Has anyone has experience with guttural pouch infections that weren’t strangles?

[TWH_Girl]

Wow! Yes, my BOs horse just had a severe fungal and bacterial gutteral pouch infection earlier this spring. I’ve reached out for details…The horse did have two minor surgeries but one clinic had the horse dead and the other saved her life. It was crazy. I’ll message with details when I hear back. Bit horse had a slight runny nose but no fever and no strangles.

[TWH_Girl]

BO said it was fungal- gutteral pouch mycosis. Horse was treated with two Salpingopharyngeal fistula procedures and anti-fungal meds. The main risk was hemorrhaging. Her daughter rode lightly when she came back to work and now is riding hard as 11 yr old cowgirls do. It sounds like bacterial gutteral pouch stuff fairs better than fungal. This little horse was definitely an inspiration! Prayers for you and your horse!

[TWH_Girl]

@saitou_amaya, any updates on how your horse is doing?

[saitou_amaya]

Well, he had the guttural pouch scope and both pouches were totally healthy and clear of any fluid. So that didn’t tell us anything. When he was at the vet clinic and sedated, the vet opened up the abscess a bit more from where he had done a DIY job of draining it the day prior (sigh) and sewed in a drain. I was really reluctant about the drain before because I was worried it would be a source of infection and get dirty and he’d rub it, etc. But it was actually really easy to maintain and better than he gaping wound he had the first time around!

We left the drain in for 2 weeks and he is finishing up week 3 of metronidazole antibiotics. The drain was removed earlier this week and the wound is nearly healed, really looks great! So right now things are looking good. But been, there done that, I’m just really hoping this time it does not come back.

Oh, edited to add: the cultures this time around came back as negative for anything besides normal skin bacteria/flora. So it seems we really don’t even know why the abscess came back again and it step. zoo had anything to do with it this time.

[TWH_Girl]

So glad to hear!

[hut-ho78]

Super!