Walkthrough severe mastitis in Cattle - Vetoquinol Symposium Marseille 2013

European Buiatric ForumMarseille (France)27th November 2013

Walking through grade 3 mastitis therapy considerations

L. Théron; Pr. Ch. HanzenRuminant and Swine clinicService of Theriogenology,

Faculty of veterinary medicine, University of Liege

Here it begins…

Sick cowShowing signs of mastitis (or not)Showing signs of painJust calvedEverything good until this morning…

I WANT TO TREAT IT…The animal is sick

E. coli???

Klebsiella

S.aureus

Clostridium

Str. uberis

E. coli

Here it begins…

Local inflammationToxinsProductionHygieneCalving

Here it begins…

InflammationSomatic cells?Clinical modification of milk

Downer cow…

RecumbentLethargicPareticHyperthermic/HypoRuminal contractions downOther pathologies?

Grade 3 specific signs•Call :

–Anorexia–Downer cow

Clinical exam• Weak pulse• Tachycardia• Tachypnoa• Hyperthermia (>39,5)• Dilated capillaries• Mucosal hyperemia• Persistent skin fold• +/- Diarrhea

Grade 3 clinical signs

Clinical signs Stiff and swelling udder Altered milk(+/-)

How to approach

Septic shock on

susceptible animal

Shock

Infectious Etiology

Pain and Inflammation

Risk factors Metabolic disorders

About timing? E. coli replication : 20 min Surge for an antibiotherapy? In the first

hour Technically : The inflammation kills

Here it begins…Dehydration will modify

rehydration procedures :

Assessment of dehydration in adult cattleMild dehydration (6%–8%): slight eyeball recession, skin tent slightly prolonged (2–3 seconds), mucous membranes moist

Moderate dehydration (8%–10%): eyes obviously sunken, skin tent obviously prolonged (3–6 seconds), mucous membranes tacky

Severe dehydration (10%–12%): eyes severely sunken into orbits, skin remains tented indefinitely, mucous membranes dry

Hypertonic IV + isotonic Per os fluids Isotonic fluids

EPIN

EPH

RIN

E

…

Local and general inflammation

Anti-inflammatory drugs

Steroids have bad reputation…oNo solid evidence (?)

NSAID have good reputationo Indeed!

Etiology

Klebsiella

S.aureus

Clostridium

Str. uberis

E. coli

Complete diagnosis?

Evidence-based medicine

Though veterinary antibiotherapy is challenged by societyo Best use of critical Fluoroquinolones and

Cephalosporins on severe mastitiso Though adviced, old molecules suffers from fewer

evidence assays…o Yet it lies a risk for Streptococci (20-40%)

8) Which antibiotic is the most indicated for the treatment of a severe mastitis?

55 bovine practionners - Journées pluridisciplinaires UPV

1. Fluoroquinolones (marbo, enro, danofloxacine)2. Aminopenicillins (Ampi, amoxicilline)3. Polymyxins (colistine)4. Trimethoprim-sulfamids5. None6. All

1. Fluoroquinolones (marbo, enro, danofloxacine)2. Aminopenicillins (Ampi, amoxicilline)3. Polymyxins (colistine)4. Trimethoprim-sulfamids5. None6. All

8) Which antibiotic do you use the most for the treatment of a severe mastitis?

55 bovine practionners - Journées pluridisciplinaires UPV

Binary approach

Main risk : Death from Endotoxemia (Gram-)o Fluoroquinolones High Dose IV/IMo 3rd or 4th generation Cephalosporines IV/IMo TMP-S parenteral, BIDo Tetracycline 15 mg/kg at leasto Amoxycilline w/wo Clavulanate

Secondary risk : Persistent infection with Streps (Gram+)o Local penicillin (G, A or M)o Parenteral Penethamate

My pathology and my patient…“Why is she sick?”

o 25g IV VitC VitE (and Se) Cu T4o Propylene Glycol…o Curative? Preventive? Helpful?

So small, So important…

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Lactation contamination riskLactation cure riskDry-off cure riskPrevalenceFirst control abnormal

%

Herd status Zn (mmol/L) Cu (mmol/L) GPX (IU/gHb) PII(mg/L) Milk I (mg/L) Se (µg/L)

Adequate 14–21 13–18 220–600 45–650 80 >80Marginal 8–14 8–13 75–220 15–45 30–80 50-80Deficient <8 <8 <75 <15 <30 <50

60-80% of problem herds had heavy deficiencies

Evaluation of Shock

Rehydration

Evaluation of Shock

RehydrationEvaluation of

pain/inflammationEvaluation of

pain/inflammation

Probability of etiology

Choice for antibiotic treatment

Probability of etiology

Choice for antibiotic treatment

Zootechnical risk factors (Age, Days in

milk, Production level…)

Zootechnical risk factors (Age, Days in

milk, Production level…)

Knowing existent risk factors of therapeutic failure (nutritional status, bad management, bad

hygiene etc…

Knowing existent risk factors of therapeutic failure (nutritional status, bad management, bad

hygiene etc…

Evaluation of Shock

Rehydration

Evaluation of Shock

RehydrationEvaluation of

pain/inflammationEvaluation of

pain/inflammation

Probability of etiology

Choice for antibiotic treatment

Probability of etiology

Choice for antibiotic treatment

Zootechnical risk factors (Age, Days in

milk, Production level…)

Zootechnical risk factors (Age, Days in

milk, Production level…)

Knowing existent risk factors of therapeutic failure (nutritional status, bad management, bad

hygiene etc…

Knowing existent risk factors of therapeutic failure (nutritional status, bad management, bad

hygiene etc…

Briefly, the “toxic cow” should raise the question

“Why the animal has got mastitis?” rather than “Which mastitis is it?”…

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