Bandit, a 7-month-old Paint colt, presented on emergency for fevers, lethargy, history of diarrhea, colic and weakness. The most striking finding in his laboratory work was an extremely low protein level in his blood, as well as a very low white blood cell count. The initial goal was to determine where and why he was losing so much protein. Because he was recently acquired by his new owners, he had never been dewormed, which is critical for weanling/yearling horses. Severe intestinal parasitism can cause the symptoms he was experiencing, as can a fairly rare intracellular bacteria that can invade the intestinal tract of horses his age (Lawsonia intracellularis). There is a treatment for Lawsonia, but if he is treated without having the disease, then it can make him much sicker. Ultrasound of his abdomen revealed to us that he did have severely inflamed loops of small intestine, and a belly tap showed us that he had signs of moderate inflammation/toxicity in his abdominal cavity. A fecal exam showed many parasite eggs confirming heavy parasitism, and his half-sister at home had begun passing dead worms in her manure following treatment. We began cautiously treating him for parasitism, as we did not want to kill all the worms at once and cause him to become impacted. Because his condition continued to deteriorate, he was treated also with aggressive supportive care including IV fluids with synthetic proteins, plasma transfusions, antibiotics, intravenous Lidocaine, drugs to control endotoxemia, and pain medication while we awaited the test results for Lawsonia intracellularis. Over a period of a few days, he slowly began to respond to the treatment, became more comfortable, and started eating more. Finally, his PCR test result came back confirming that he was shedding Lawsonia intracellularis in his manure. The combination of the two problems was likely the reason that he was so severely debilitated. He was started on the specific drug for Lawsonia and was slowly weaned off of the supportive treatments. After spending over one week in the intensive care unit, Bandit was finally released to go home. His half-sister at home who was the same age, was also tested for the bacteria, but she was luckily negative. Following a three week course of treatment, he is slowly rebuilding his protein levels, and is regaining the energy and vigor that a normal 7-month-old colt should have! Bandit was very lucky to have such dedicated owners who were determined to pull him through this life-threatening illness.

During treatment:

Postscript: Bandit returned to the clinic for reevaluation five weeks after his hospital stay. His energy and appetite had returned and the diarrhea, lethargy, and fevers were gone. Bandit and his owners left with smiles.

Five weeks later: