Pigeon Fever

Introduction
Pigeon Fever is a bacterial infection caused by the gram positive bacteria
Corynebacterium Pseudotuberculosis. This disease is also referred to as Equine Distemper or
Dryland Distemper. Pigeon Fever is most commonly observed in the horse’s chest. One might
believe that pigeons are the reservoir for this disease, however, the disease coined its name from
an abscess created on the chest of the horse makes it look like the horse has a “pigeon-chest”,
which this means the breastbone is pushed outwards.Other forms of this disease can appear, for
example, as external abscesses (most common), internal abscesses and ulcerative lymphangitis,
which is the swelling and ulceration on the lower legs. Most cases occur during late
summer/early fall, the organisms tend to live and reproduce in dry soil and manure. This disease
causes abscesses in the chest or somewhere else on the horses body. The first report of pigeon
fever in horses was in California in 1915. There were outbreaks in Kentucky, Wyoming, Utah
and Colorado in 2002-2003 and outbreaks between 2005-2007 in Idaho and Oregon. The bacteria
can survive months in the soil.

Etiology
Pigeon Fever is believed by a variety of studies to be transmitted through a horn fly,
horsefly, and stable fly (Spier, 2019). These are the mechanical vectors for the transmission to
the horse. The disease can also spread from direct, horse to horse contact or from infected
susceptible horses through insects, other vectors, or contaminated soil (Spier, 2019). Cross
species transmission is rare and can only occur between horses and cattle as they can carry the
same strain (Evans, 2019). This disease is not known to be breed or sex predilection for any of
the forms (Spier, 2019). It is believed that portals of entry for the soil-dwelling organism are
through abrasions, skin wounds, or mucous membranes (Spier, 2019). It is also possible that
some horses have developed lung abscess after inhaling some sort of concentration of bacterial
organism (Spier, 2019).
The majority of Pigeon Fever cases are found in California. In recent years, more cases
have been diagnosed in areas in the western United States but all states have had low prevalence
of the disease (Evans, 2019). The higher temperatures and droughts are the conditions that have
caused all reported disease outbreaks (Evans, 2019). It is known to be a seasonal disease where
the highest case numbers tend to occur in the dry months of the year although it is possible to get
it year round (Evans, 2019). The amount of pigeon fever cases change considerably year to year
due to herd immunity and other environmental factors such as rainfall, temperature, and insect
population size (Evans, 2019).

Epidemiology
The most common effects of this disease is known to be abscesses in the pectoral area or
the dorsal area of the abdomen. This is how it gets the nickname of pigeon fever due to the
swelling of the pectoral region looking like a pigeon breast. There are also two other forms of
this disease that are internal infection and ulcerative lymphangitis (Spier, 2019). The organisms
live and multiply in dry manure and soil (Spier, 2019). You can find majority of Pigeon Fever
cases in the late summer and early fall (Spier, 2019).
The most frequently abscessation occurs in the pectoral region and along the ventral
midline of the abdomen but they can occur anywhere else on the body (Spier, 2019). Horses that
do have the external abscesses usually do not develop any types of signs to the systemic illness
other than 25% of them will develop some type of a fever (Spier, 2019). If there were some type
of systemic illness signs you would then further diagnostic to eliminate any other internal
infections. Internal infection can be diagnosed by clinical signs being shown, serology, bacterial
culture, and diagnostic imaging (Spier, 2019). You can spot clinical signs such as concurrent
external abscesses, decreased in appetite, fever, lethargy, weight loss, abdominal pain, and
respiratory disease (Spier, 2019). The least common form of pigeon fever is Ulcerative
lymphangitis which the sign of this form are limb swelling, cellulitis, and draining tracts that
follow lymphatics of the horse body (Spier, 2019). If a horse is affected with this form it can
often have severe lameness, fever, lethargy, and anorexia (Spier, 2019).

Pathogenesis
As previously revealed, Pigeon Fever is transmitted through open wounds, contact with
insect vectors, and occasionally via mucous membranes (Evans, 2019). Unfortunately, the clear
pathogenesis of the bacterial organism in the horse is not well-defined in current research.
However, the disease is most commonly observed in the external pectoral and ventral abdominal
region, featuring abscessation and swelling (Nogradi, Spier, Toth & Vaughan, 2010). About 90%
of confirmed Pigeon Fever cases develop this external abscess that fills with a purulent material
(Loving, 2011). Less commonly, similar effects may occur in the limbs if the infection reaches
deep into the musculoskeletal structures (Nogradi et al., 2010). Additionally, if a horse inhales a
concentration of the bacteria from the ground, they become susceptible to developing lung
abscesses (Evans, 2019). Regardless of the bacteria itself, Dr. Evans, DVM, concludes that it is
the immune system of the individual horse that determines whether or not it contracts the
disease.
Looking closely at the individual bacteria, Corynebacterium pseudotuberculosis, it is said
that its surface lipids have continuously contributed to its pathogenesis (Dorella, Pacheco,
Oliveira, Miyoshi & Azevedo, 2006, p. 201-218). In a study conducted to determine the general
trends of infection by Corynebacterium pseudotuberculosis and its virulence, data showed that
there was a direct relationship between the percentage of surface lipids and the establishment of
chronic abscessation in mice. Another study in the same article showed that the bacteria had a
necrotizing effect on the peritoneal macrophages, also in mice (Dorella et al., 2006, p. 211). This
could be a solid indicator of the source of swelling and purulent material formation seen in
horses with Pigeon Fever. With respect to the virulence of the infection, there is little molecular
investigation of the organism and its genus genetics. This makes it difficult to characterize its
virulence or the factors that affect it (Dorella et al., 2006, p. 212).

Overall, we know the bacteria enters the body and initiates an immune response that recruits
mediators to the site of infection. Depending on the structure of the organism (presence/lack of
surface lipids), this may influence the clinical signs and/or contraction of the disease. The
swelling seen in the various areas of the body is still not clearly defined and thus, the virulence is
difficult to measure.

Clinical Findings
With each of the three different types of Pigeon Fever, the expected clinical signs are
slightly different. According to the American Association of Equine Practitioners (AAEP), the
first type is known for external abscesses (2017). This type is characterized by pectoral swelling,
giving the disease its name, Pigeon Fever (AAEP, 2017). They are most commonly found in the
chest or pectoral region, but abscesses can also be found in the triceps, axilla, limbs, and head.
The pus from abscesses is odor free, tan and encapsulated (AEEP, 2017). Soreness can occur
once abscessation has occurred and the horse may or may not have a fever (Jessie Evans).
The second type of Pigeon Fever, Internal Infection, can have clinical signs such as
abdominal pain, signs of respiratory disease, ventral edema, hematuria, weight loss and
malfunction of organs (AAEP, 2017). According to AAEP, some common organs affected are
the liver, spleen, kidney, and lungs which is where these particular signs come from (2017).
Abortion is rare, but does occur occasionally due to the infection spreading into the placenta and
fetus.
The third type of Pigeon fever, Ulcerative Lymphangitis, shows clinical signs such as
limb swelling and cellulitis usually in the hind legs (AAEP, 2017). This is the most severe type
of Pigeon Fever and can also cause severe lameness, fever, lethargy, or anorexia (AAEP, 2017).
If not vigorously treated it could become chronic which would result in prolonged lameness from
limb edema, weakness, and weight loss (AAEP, 2017).

Diagnosis
Both External Abscessation and Ulcerative Lymphangitis is usually diagnosable by
clinical signs. With External Abscessation, bacterial cultures of exudate (AAEP, 2017).
According to AAEP, Internal Infection can be diagnosed by clinical signs, serology, diagnostic
imaging, and bacteria culture (2017). The specific serology is Synergistic Hemolysis Inhibition
which detects the IgG antibody for Corynebacterium Pseudotuberculosis (AAEP, 2017). This
serology is not helpful in detecting external abscesses. The titers of the serology should be
combined with other aspects of diagnosing before being definitive in determining active
infection from an immune response from exposure. Diagnostic imaging like abdominal
ultrasonography is used to determine what organs, if any, are infected and to what extent (AAEP,
2017). According to the AAEP, it also allows for procedures like biopsies and aspiration of
abscess fluid for a more accurate diagnosis (2017).

Treatment
The main course of treatment for Pigeon Fever is allowing the abscesses to drain. Before
any external abscesses can be drained, it needs to be mature and brought to a head. Applying
warm compresses to the chest is one way to encourage the abscesses to mature. Once the abscess
matures, a veterinarian will surgically cut it open with a scalpel and allow it to drain out the pus.
The owner can then clean and flush the area daily with a diluted Betadine solution to kill any
new or remaining bacteria. It is preferred that the abscess is surgically lanced rather than
rupturing on its own in order for easier cleaning, quicker healing, and minimizing pain for the
horse. Also, surgically lancing it allows the pus to be collected so it does not contaminate the
horse’s environment. The veterinarian may also prescribe antibiotics if they believe it is
necessary, but in most scenarios, the veterinarian will allow the horse to heal on its own.
Usually, the veterinarian will allow some time to pass before deciding if the horse needs any
antibiotics. If there are no complications, antibiotics are not required. NSAIDs such as Banamine
may also be given orally or IV if the horse is in pain from the abscessation (AAEP, 2017).
In some cases, abscesses are internal or become very deep and cannot be drained. These
horses will be given a combination of antibiotics and anti-inflammatories to help combat the pus-
forming bacteria that is invading the cells. A veterinarian will determine the specific course of
treatment depending on each scenario. Internal abscesses take much longer to treat than external
abscesses (Dawes, 2015).

Prevention
There is no vaccine for pigeon fever. Use fly repellants, practice good hygiene and
perform thorough wound care. Isolate infected horses, when dealing with sick horses always
wear protective gear and do not go touch non-infected horses without washing your hands and
taking every protection measure to not spread this disease.
 References
AAEP Infectious Disease Guidelines [PDF]. (2017). Retrieved from
https://aaep.org/sites/default/files/Documents/PIGEON%20FEVER_Finals.pdf
Dawes, M. E. DVM, PhD, DACVIM (2015). Pigeon Fever (C. Pseudotuberculosis) and
ulcerative lymphangitis in the horse [Webpage]. Retrieved from
https://vetspecialists.com/pigeon-fever-c-pseudotuberculosis-and-ulcerative-lymphangitis-in-the-
horse/
Dorella, F. A., Pacheco, L. G. C., Oliveira, S. C., Miyoshi, A. & Azevedo, V. (2006).
Corynebacterium pseudotuberculosis: Microbiology, biochemical properties, pathogenesis and
molecular studies of virulence. Veterinary Research, 37, 201-218. doi: 10.1051/vetres:2005056

Evans, J. DVM. (2019). Pigeon fever [Webpage]. Retrieved from

https://aaep.org/horsehealth/pigeon-fever

Loving, N. S. DVM. (2011). Pigeon fever in horses: Manifestations and Complications

[Webpage]. Retrieved from https://thehorse.com/119456/pigeon-fever-in-horses-manifestations-
and-complications/

Nogradi, N. DVM, Spier, S. J. DVM, PhD, Diplomate ACVIM, Toth, B. DVM & Vaughan, B.
DVM. (2010). Corynebacterium pseudotuberculosis infection as an unusual cause of lameness in
35 horses [PDF File]. Retrieved from
http://www.ivis.org/proceedings/aaep/2010/z9100110000391.pdf

Spier, S., DVM, Ph.D., DACVIM. (2019). Three Forms of Pigeon Fever | AAEP. Retrieved
April 5, 2019, from https://aaep.org/horsehealth/three-forms-pigeon-fever

Thomas H.S. (2017). 6 Things you may not have known about pigeon fever. [Webpage].
Retrieved from https://equusmagazine.com/horse-world/6-pigeon-fever-54183