Rough start in life sends 6-month-old Belgian cross colt to Virginia Tech equine hospital for emergency treatment

As Alfie cheerfully runs across his home pastures with his mule pal, there is little indication today what dire straits the year-old Belgian cross colt was in just six months ago. 

“Thanks to the awesome care he got he has made a miraculous recovery,” said Alfie’s owner Alex Dukes of Lincoln, Virginia. “We weren't sure whether he'd make it, but now he is a happy little boy, spending his days prancing around his field with a new friend.”

Alfie was presented to the Marion duPont Scott Equine Medical Center (EMC) in February for emergency treatment of respiratory distress and general ill thrift.   

The EMC, located in Leesburg, is a 24-hour emergency equine hospital. It is also one of three teaching hospitals and animal healthcare facilities of the Virginia-Maryland College of Veterinary Medicine, located on Virginia Tech’s campus in Blacksburg.   

Alfie was purchased at auction in December 2023 and was held in a holding facility in Arkansas before being shipped to Dukes.    

When he arrived in Virginia in February he was in very poor condition with an uncertain vaccination and deworming history. Alfie displayed active signs of respiratory distress, with nasal discharge of mucus and pus, an elevated temperature and serum amyloid A (SAA).   

Serum amyloid A (SAA) is a blood protein produced mainly in the liver that increase in volume in horses during the early phase of inflammation. 

Mia Lee DVM ‘05, from Solstice Equine Veterinary Services in Lovettsville, evaluated Alfie on the farm, and then referred him to the EMC for emergency evaluation and treatment.   

When Alfie arrived at the EMC, he was very quiet and dull and in very poor body condition. He was immediately placed in the EMC’s isolation building due to the high suspicion of infectious and contagious causes of his respiratory disease. This biosafety level 2 facility contains individual stalls with separate ventilation and heating supply.

Alfie was initially evaluated by Emily Schaefer, clinical assistant professor of equine emergency and critical care, who ascertained that he had a low-grade fever, an abnormally low heart rate, and obvious signs of lower respiratory disease. He also had numerous papilloma – small, gray, irregular skin bumps that look like warts - on his muzzle and lower lip, indicating the possibility of a viral infection. A lymph node under Alfie’s jaw was enlarged and slightly firm, but did not appear to be painful.   

Alfie’s respiratory disease manifested as fresh and dried nasal discharge from both nostrils, wheezes and “crackles” heard in his lungs as he breathed, and a wet, productive cough with a loud mucous rattle in his trachea. 

Chest ultrasound images confirmed the suspicions of pneumonia with a possibility of pulmonary abscess, which is a more discrete bacterial infection within the pulmonary tissue.   

Based on these initial findings Alfie was diagnosed with bacterial bronchopneumonia, with a suspected pulmonary abscess.  His history of long-distance travel, commingling with other equines, stress, age, and unreliable vaccination history, led Schaefer to believe that he also had a respiratory virus. Alfie was also markedly anemic and in very poor body condition, likely due to a combination of malnutrition and systemic disease (cachexia – a wasting disease in underfed animals), putting him at high risk of refeeding syndrome.   

Refeeding syndrome is a potentially fatal condition caused by rapid initial refeeding after a period of undernutrition, characterized by severe electrolyte disturbances. Despite the colt’s obvious need for calories, the team had to resist giving him free-choice hay and grain to get him to gain weight. Alfie’s diet was closely regulated and his response to re-feeding was closely monitored.    

Medical management that consisted of antimicrobials for pneumonia, anti-inflammatories, controlled feedings, and other supportive care such as vitamin administration and regular monitoring was recommended. Alfie was started on a restricted diet -- totaling just 1% of his current estimated body weight -- of soaked alfalfa cubes.   

The next day, Alfie remained stable and under the care of Megan Marchitello, clinical instructor of equine medicine, and was administered mineral oil and water via a nasal tube before starting a five-day de-worming treatment.  Alfie’s feed ration was increased only once per day to attempt to prevent refeeding syndrome and regular grass hay was added, which he seemed to tolerate well.  He always had a great appetite.  

Over several days, Alfie’s anemia and electrolyte levels steadily improved. Diagnostic testing confirmed the suspicion of a respiratory virus – equine influenza virus – and a repeat chest ultrasound revealed that his pneumonia was not improving as intended. In animals with upper respiratory viruses, the lungs can suffer secondary consequences, necessitating treatment changes. The antibiotic regimen was changed at this time, and although Alfie remained quiet, he became more interactive over the following days of treatment and continued to enjoy his feed.   

This highly contagious respiratory disease is spread by contact with other infected horses that spread the virus by coughing and through nasal secretions.   

“Equine influenza is a common respiratory virus in young horses experiencing stressful situations, and like many other respiratory viruses, influenza can predispose horses to secondary bacterial infections,” said Schaefer 

On day six of treatment, early evidence of refeeding syndrome became apparent from the regular monitoring of bloodwork.  Alfie was then under the stewardship of Stasia Sullivan, locum emergency and critical care veterinarian, who discontinued the orchard grass hay and gradually replaced it with a completely alfalfa-based diet. Sullivan and her team calculated Alfie’s electrolyte derangements and developed a plan to supplement phosphorus, the critical element in refeeding syndrome, among others.   

Close 24-hour monitoring continued and gradually Alfie improved enough to be released from the hospital to his new home in Virginia. A comprehensive feeding, exercise, and medical plan was identified, and owner Dukes handled Alfie’s continuing care under the supervision of equine veterinarian Lee. As Alfie’s body condition was scored at 1/9, it was expected to take up to eight months for Alfie to reach his ideal body weight.    

Dukes tried to track down Alfie’s mother without success. 

“Alfie has an excellent mule companion who he adores and who is teaching him how to be a normal baby horse,” Dukes said.  

“My sincerest thanks to everyone involved in Alfie's care—he wouldn't still be here today if it weren't for you all.”