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Basics

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BASICS

Overview!!navigator!!

  • Chronic ingestion of Sorghum vulgare var. sudanense (sudangrass or hybrid sudangrass) causes cystitis, ataxia, and teratogenesis in horses. Grazing of sudan pastures and ingestion of freshly cut hay are associated with the syndrome but feeding of cured hay is not
  • Generally, intoxication occurs during periods of high rainfall and rapid plant growth. Fertilization has no effect on toxicity
  • The toxin is believed to be a lathyrogenic agent, γ-glutamyl-β-cyanoalanine. Onset of clinical signs is after weeks to months (average of 8 weeks) of grazing a sudangrass pasture
  • Geographically, sudangrass is most commonly used as a forage in the southwestern and central USA. Ingestion of Sorghum spp. is also associated with cyanide and nitrate toxicoses (see chapters Cyanide toxicosis and Nitrate/nitrite toxicosis for more in-depth discussion of these intoxications)

Signalment!!navigator!!

Sorghum cystitis—ataxia is more common in mares but can occur in geldings or studs. All ages are susceptible.

Signs!!navigator!!

  • Posterior ataxia and incoordination
  • Forced movement enhances ataxia
  • Falling when backed up
  • Recumbency
  • Constant urine dribbling from a full bladder
  • Urine scalding
  • Cystitis
  • Frequent opening and closing of vulva (winking)
  • Mares may appear to be in constant estrus
  • Fetal malformations (extreme flexion of joint or ankylosis) when mares graze sudangrass between days 20 and 50 of gestation
  • Secondary complications of urinary tract and kidney infection

Causes and Risk Factors!!navigator!!

  • Grazing sudangrass is the primary risk
  • Johnson grass has also been implicated

Diagnosis

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DIAGNOSIS

Differential Diagnosis!!navigator!!

  • Polyneuritis equi (cauda equina neuritis)
  • Cystitis of other causes
  • Trauma
  • Abscess
  • Neoplasia
  • Equine herpesvirus 1 myeloencephalitis
  • Equine protozoal encephalitis
  • Equine viral encephalitis
  • Rabies

CBC/Biochemistry/Urinalysis!!navigator!!

  • Leukocytosis
  • Lymphocytosis
  • Sediment—large numbers of red blood cells, white blood cells, epithelial cells, bacteria, hyaline casts, and granular casts
  • Normal pH and specific gravity
  • Proteinuria

Other Laboratory Tests!!navigator!!

Urine bacterial cultures generally isolate opportunistic bacteria such as Escherichia coli, Proteus vulgaris, Staphylococcus spp., Pseudomonas aeruginosa, or Corynebacterium spp.

Imaging!!navigator!!

N/A

Other Diagnostic Procedures!!navigator!!

N/A

Pathologic Findings!!navigator!!

  • Gross pathology—cystitis with marked thickening of the bladder wall
    • Full bladder
    • Hyperemic ureters
    • Hyperemic urethra
    • Vaginal hyperemia
    • Ulcerations of the bladder mucosa
    • External abrasions from falling
    • Areas of urine-scalded skin
    • Pyelonephritis
  • Histopathology—necrotizing cystitis
    • Pyelonephritis
    • Inflammation of the ureters, urethra, bladder, and vagina
    • Axonal degeneration of the spinal cord and cerebellum
    • Myelomalacia of the spinal cord and cerebellum

Treatment

TREATMENT

  • Treatment can be managed on an outpatient basis
  • Generally, treatment is unsuccessful in horses that exhibit incoordination and/or urine dribbling
  • Temporary cure of cystitis/pyelonephritis can be achieved but recurrence 2–3 weeks after therapy is stopped is common
  • Prevent further exposure by removing horses from access to sudangrass
  • Treat urine-scalded areas
  • Antimicrobial treatment of cystitis/pyelonephritis should be based upon culture and sensitivity tests

Medications

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MEDICATIONS

Drug(s) of Choice!!navigator!!

Antibiotics should be chosen based on culture and sensitivity tests.

Contraindications/Possible Interactions!!navigator!!

Avoid use of potentially nephrotoxic antibiotics.

Follow-up

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FOLLOW-UP

Patient Monitoring!!navigator!!

Monitor urine for evidence of bacteria/cystitis twice weekly during and after antibiotic therapy.

Prevention/Avoidance!!navigator!!

Avoid exposure to sudangrass pastures.

Possible Complications!!navigator!!

With severe ulceration and necrosis, scarring and strictures are possible.

Expected Course and Prognosis!!navigator!!

  • Recovery of clinically effected horses is extremely rare
  • Horses that do not continue to have recurrent cystitis should not be used for work or riding owing to residual nervous system damage
  • Horses may still be used for breeding, but cystitis, vaginitis, or urethritis can complicate breeding efforts

Miscellaneous

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MISCELLANEOUS

Associated Conditions!!navigator!!

N/A

Age-Related Factors!!navigator!!

N/A

Zoonotic Potential!!navigator!!

N/A

Pregnancy/Fertility/Breeding!!navigator!!

Fetal malformations (extreme flexion of joints or ankylosis) occur when mares graze sudangrass between days 20 and 50 of gestation.

Suggested Reading

Burrows GE, Tyrl RJ. Toxic Plants of North America. Ames, IA: Iowa State University Press, 2001:929.

Knight AP, Walter RG. A Guide to Plant Poisoning in North America. Jackson, WY: Teton NewMedia, 2001:242243.

Van Kampen KR. Sudan grass and sorghum poisoning of horses: a possible lathyrogenic disease. J Am Vet Med Assoc 1970;156:629630.

Author(s)

Author: Jeffery O. Hall

Consulting Editors: Wilson K. Rumbeiha and Steve Ensley