Skip to main content
menu sluit menu
Home Home
Login
Main navigation
  • Library
  • Calendar
  • e-Learning
  • News
    • Veterinary News In this section you find veterinary news
    • Recent Additions All content that was recently added to the IVIS library
  • Get involved
    • Donate Support IVIS, make a donation today
    • Media kit Promote your e-learning & events on IVIS
    • Add your e-learning & events to the IVIS calendar
    • Publish on IVIS Publish your work with us
  • About
    • Mission Our Mission Statement
    • What we do More info about IVIS and what we do
    • Who we are More info about the IVIS team
    • Authors See list of all IVIS authors and editors
  • Contact
User tools menu
User tools menu
Main navigation
  • Library
  • Calendar
  • e-Learning
  • News
    • Veterinary News In this section you find veterinary news
    • Recent Additions All content that was recently added to the IVIS library
  • Get involved
    • Donate Support IVIS, make a donation today
    • Media kit Promote your e-learning & events on IVIS
    • Add your e-learning & events to the IVIS calendar
    • Publish on IVIS Publish your work with us
  • About
    • Mission Our Mission Statement
    • What we do More info about IVIS and what we do
    • Who we are More info about the IVIS team
    • Authors See list of all IVIS authors and editors
  • Contact
Follow IVIS
  • Twitter
  • Facebook
Support IVIS

Breadcrumb

  1. Home
  2. Library
  3. Manual of Equine Neonatal Medicine
  4. Infections
Manual of Equine Neonatal Medicine
Back to Table of Contents
Add to My Library
Close
Would you like to add this to your library?

Get access to all handy features included in the IVIS website

  • Get unlimited access to books, proceedings and journals.
  • Get access to a global catalogue of meetings, on-site and online courses, webinars and educational videos.
  • Bookmark your favorite articles in My Library for future reading.
  • Save future meetings and courses in My Calendar and My e-Learning.
  • Ask authors questions and read what others have to say.
Sign in Register
Comments
Print this article
Share:
  • Facebook
  • LinkedIn
  • Mail
  • Twitter

Infections

Author(s):
Madigan J.E.
In: Manual of Equine Neonatal Medicine by Madigan J.E.
Updated:
DEC 03, 2014
Languages:
  • EN
Back to Table of Contents
Add to My Library
Close
Would you like to add this to your library?

Get access to all handy features included in the IVIS website

  • Get unlimited access to books, proceedings and journals.
  • Get access to a global catalogue of meetings, on-site and online courses, webinars and educational videos.
  • Bookmark your favorite articles in My Library for future reading.
  • Save future meetings and courses in My Calendar and My e-Learning.
  • Ask authors questions and read what others have to say.
Sign in Register
Print this article
SHARE:
  • Facebook
  • LinkedIn
  • Mail
  • Twitter
    Read

    Epidemiologic studies of disease and death in foals up to six months of age indicate that the risk of disease is greatest in neonatal foals (first 7 days of life) [1]. The leading cause of death in this group is septicemia (blood borne bacterial infection). In most papers, failure of passive transfer is listed as the leading cause of these infections. The practice of assessing passive immunity was associated with decreased morbidity due to septicemia [1].
    Editor's Comment - Many (>25%) of confirmed septicemia foals have greater than 800 mg/dl IgG. Additionally, many foals with low IgG are sick at birth and have poor vigor and vitality. It is my opinion that this high rate of infection in this age group is best explained by delayed gut closure and bacterial invasion across the "open" gut rather than low IgG. (See How to Prevent the Leading Cause of Death in Neonatal Foals: Opinion).

    I. Septicemia [1-3]

    The most common cause of death in foals admitted for intensive care.

    1. Causative agents - US and British studies indicate majority have a gram-negative component. E. coli, Actinobacillus spp, Klebsiella spp, Enterobacter spp, Pseudomonasspp were most common. Streptococcal infection does occur but is usually in conjunction with a gram-negative.
    2. Onset within 3-4 days of age.
    1. Some infections develop in utero and will be present at birth.
    2. Foals frequently show first physical signs after infection has already been established for a considerable period of time.
    1. Predisposing conditions. Editor's Comment - What all these conditions have in common is exposure to pathogens prior to colostrum ingestion
    1. Prematurity.
    2. Delayed access to colostrum.
    3. Failure to ingest adequate quantity of colostrum and specific antibody.
    4. Maternal risk factors (See Management Approaches to the Newborn Foal Use of Risk Factors).
    5. Maladjustment syndrome (See Neonatal Maladjustment Syndrome).
    6. Twins.
    7. Adverse environmental conditions.
    1. Clinical signs - Often cannot differentiate from neonatal maladjustment syndrome.
    1. Early signs may be depression, lethargy, decreased mammary sucking and a behavior change.
    1. Fever (>102°F, 39°C) occurs in less than 50% of cases.
    2. Hypothermia <100°F (37.8°C) not uncommon.
    1. Advanced
    1. Petechiation - Pinnae of ears, mucous membranes of oral cavity, vulva, (episcleral hemorrhages are common after normal foaling from birth canal pressure).
    2. Anterior uveitis.
    3. Diarrhea.
    4. Coma, convulsions.
    5. Respiratory distress.
    6. Dehydration.
    7. Poor pulse quality.
    8. Swollen joints.
    1. Clinical pathology of septic foals [2] - Obtain Stat.
    1. <400 mg/dl serum IgG is common; some are within the 400-800 mg IgG range.
    2. Complete blood count finding - Always do a WBC differential count.
    1. Neutropenia <4000/ul. (Remember premature non-infected foals have neutropenia)
    2. Neutrophilia >12,000/ul.
    3. >50 band-neutrophils.
    4. Toxic cells - Dohle bodies, toxic granulation or vacuolization in neutrophils.
    5. Fibrinogen >400 mg/dl.
    6. Hypoglycemia -50% of cases have glucose <80 mg/dl (4.4 mmol/l).
    7. Arterial oxygen <70 mmHg in 40% of cases.
    8. Acid-base status indicating a mild to severe acidosis is common.
    1. Blood culture is indicated in any suspected case of sepsis (See Blood Culture).
    1. Required of all foals entering intensive care unit.
    2. Take before antibiotics or at trough periods before next administration.
    3. Do not delay antimicrobial treatment of suspected septicemia to complete a "series" of cultures at 2 hour intervals. Take 1 set initially upon admission -provide workup and repeat in 1-2 hours and then begin antimicrobials intravenously if laboratory work does not rule out sepsis.
    4. Negative in 50% of cases with septicemia.
    1. Sepsis Score - A method of attempting to predict infection based on history, physical exam and clinical pathology designed by Brewer et al. [4], Table 1
    2. Therapy
    1. Antimicrobial.
    1. Based on a review of UCD equine neonatal septicemia isolates from field and in-house cases, the probability for antimicrobial susceptibility:
      100%   Imipenem
      90-99%   Ciprofloxacin, Ceftazidime
      80-89%   Ceftriaxone, Amikacin, Netilmicin, Cefaperazone, Ceftizoxime
      70-79%   Aztreonam, Gentamicin
      60-69%   Ceftiofur, Chloramphenicol, Ticarcillin/Clavulanate, Trimethoprim/sulfamethoxazole, Ipericillin, Azlocillin
      50-59   Amoxicillin/clavulanate, Ampicillin/sublactam, Tetracycline, Cephalothin
      40-49%   Ticarcillin
      20-39%   Ampicillin, Penicillin G, Sulfamethazine
      <20%   Rifampin, Oxacillin, Erythromycin, Tylosin
    2. See antimicrobial therapy - Guidelines for Drug Use in Equine Neonates and Drug Formulary-Equine Neonate.
    3. Editor's Comment - The choice of starting antimicrobial therapy is a clinician’s choice. One popular combination is Cefitiofur 10 mg/kg IV slowly BID and Amikacin 21 mg/kg IV or IM once daily. This is based on our studies, with isolates we have found, and may vary geographically.
    1. Plasma therapy to increase IgG (See Plasma Therapy).
    2. Fluid therapy (See Fluid and Electrolyte Balance).
    1. Correct any hypoglycemia.
    2. Correct any acidosis and dehydration.
    3. Maintain renal perfusion.
    4. Shock and dehydration treatment (See Shock (SIRS) and Fluid and Electrolyte Balance).
    1. Nutritional Support (See Parenteral Nutrition and Enteral Nutrition).
      Prognosis is guarded with blood culture positive foals; mortality may be 50% even with intensive care. When presented collapsed in semi coma prognosis very poor.
    1. Complicating potential sequelae to septicemia. Osteomyelitis Corneal lesions Pneumonia Patent urachus Arthritis Joint infections Gastric ulcers

    II. Pneumonia

    1. Pneumonia is present in some cases of septicemia. Can be acquired in utero or develop following bacteremia and is also a complication of many compromised foals.
    1. Auscultation not well correlated with pulmonic disease. A change in resting respiratory rate may be an indicator of developing pneumonia.
    2. Pneumonia in neonatal foals is complicated by a lack of significant coughing as a symptom and defense mechanism.
    3. Meconium aspiration is seen as a greenish staining of the medial canthus of the eye or nares.
    1. Viral
    1. Equine herpes 1-congenital.
    2. Adenovirus produces anorexia, polypnea, nasal and ocular discharge. Foals recover unless immunosuppressed. Diagnosis is by inclusion body on post mortem of lung.
    1. Differentiate pneumonia from:
    1. Respiratory distress syndrome by radiographs, tracheal wash - Negative, blood culture negative. Often prematurity, dysmaturity associated.
    2. Transient tachypnea has normal chest sounds, radiographs, and CBC, blood culture negative, acid base, and glucose normal but temperature may be increased Possible lack of central control mechanism for thermoregulation. Foals are bright, alert, nursing. May last >14 days.
    3. Birth asphyxia or hypoxia.
    1. History of foaling problems or maternal risk factors.
    1. Assessment
    1. Chest radiographs.
    2. Blood gases - Arterial.
    3. Physical exam
    1. Increase in resting respiratory rate.
    2. Auscultation variable.
    3. Neonates frequently lack cough with severe pneumonia.
    1. Therapy
    1. Appropriate antimicrobial therapy for an adequate duration - Often 2-3 weeks.
    2. Physical therapy consisting of nebulization, coupage, airway hygiene.
    1. Sternal recumbency, oxygen, bronchial dilators.
    2. Early ambulation.

    III. Miscellaneous Infectious Conditions

    1. Equine Herpes I
    1. May be born fully mature and dead.
    2. May have normal birth and become weak within hours, fail to rise, and may clinically resemble septicemia cases, often with neurologic signs.
    3. Susceptible to secondary bacterial infection which can complicate diagnosis.
    4. Immunosupression, neutropenia, lymphopenia, (WBC <2000/μL), hyperplasia or necrosis of thymus or spleen.
    5. Interstitial pneumonia.
    6. Diagnosis: PCR for EHV-1 on blood and nasal swab; postmortem lung tissue.
    7. Inclusion bodies in lungs (histopathology) and postmortem PCR sensitivity found to be highest in the lungs [5].
    8. Infected foals which have not nursed may have low serum neutralized antibody to EHV-1 from in utero infection and immunological response.
    9. Acyclovir/Valacyclovir has been tried with unconfirmed success.
    10. See Management Approaches to the Newborn Foal Use of Risk Factors for vaccination protocol.
    1. Botulism [6,7] - Shaker foal syndrome - Causative organism is Clostridium botulinum, usually type B or C.
    1. Clinical Signs
    1. Onset may be gradual over 2-4 days or rapid over 12-36 hours.
    2. Dysphagia.
    3. Dribbling milk, inability to swallow.
    4. Age: birth -8 months, most common under 8 weeks of age.
    5. Dilated pupils -slowly responsive.
    6. Muscle weakness
    7. Eyelid and tail tone decreased.
    8. Muscle fasciculations after standing or walking.
    9. Ultimately collapse and respiratory failure and aspiration pneumonia.
    1. Differential Diagnosis
    1. Hypocalcemia, hypoglycemia
    2. Septicemia
    3. White muscle disease
    1. Diagnosis
    1. Toxin demonstration in serum not reliable in horses due to low amounts which cause disease.
    2. Clostridium botulinum spores in intestine not diagnostic but present in 80% of foals with Botulism.
    3. Toxin isolation from intestines.
    4. CSF is normal.
    5. Electromyography may aid diagnosis.
    1. Treatment
    1. Polyvalent equine antitoxin - Early in disease 200 ml dose - Expensive (See Plasma Therapy).
    2. Penicillin - IV QID.
    3. Nursing care.
    4. TPN or tube feeding.
    5. Aminoglycosides, 3, 4 diaminopyridine, aminopyridine, are all contraindicated.
    6. Limit movement.
    7. Provide ventilatory support if respiratory compromise develops.
    1. Prevention
    1. Botulism type B toxoid to pregnant mares three times before parturition with last dose 2-3 weeks before foaling.
    1. Tetanus
    1. Etiology
    1. Clostridium tetani organism. It may develop within 7 days of birth, most common secondary to umbilical infections.
    1. Clinical Signs
    1. Dysphagia
    2. Prolapse of 3rd eyelid
    3. Stiff, reluctant to move
    4. Tetanic muscle spasms - triggered by noise and touch
    5. Nostrils flared, ears held back, tail partially elevated
    6. Normal sensorium with convulsive type spasms
    7. Opisthotonus
    1. Differential Diagnosis
    1. Hypocalcemia
    2. Hypoglycemia
    3. Meningitis has abnormal CSF, normal in tetanus
    4. Strychnine poisoning
    5. White muscle disease
    6. Hyperkalemic periodic paralysis
    1. Diagnosis
    1. No laboratory tests to diagnose
    2. Clinical signs, vaccination history and rule out other causes
    3. Condition of umbilicus, or puncture wound to feet or body
    1. Treatment
    1. Penicillin IV QID
    2. Tetanus antitoxin - 5000 units. (Binds toxin outside CNS only. Will not reverse toxin)
    3. Sedation, muscle relaxants
    4. Rest, quiet, nursing care, nutritional support
    5. Ventilatory support - if indicated
    6. Duration 20-30 days, prognosis poor
    1. Prevention
    1. Vaccination of mare with tetanus toxoid 3-4 weeks before foaling
    2. Foals of unvaccinated dams should receive 1500 units tetanus antitoxin at birth
    3. Provides 45 days of protection
    1. Meningitis
    1. Most commonly secondary to septicemia
    2. Clinical signs initially are non-specific including depression, anorexia, weakness
    1. May be followed by neurologic signs of twitching, hyperesthesia, ataxia, hypermetria, strabismus, nystagmus, anisocoria, head tilt, opisthotonus, blindness, ear and eyelid droop, intention tremor, recumbency [8].
    1. Diagnosis - CSF tap (See Cerebrospinal Fluid Collection)
    1. Protein increase - Greater than 150 mg/dl.
    2. WBC - Mainly neutrophils >20 cells/ul.
    3. Bacteria in Gram stain intracellularly.
    4. Glucose <80% of blood glucose - May not be valid in foals.
    5. Negative findings do not rule out meningitis.
    1. Treatment
    1. Systemic antimicrobials with good CNS penetration and gram-negative spectrum.
    2. Trimethoprim sulfa - Limited spectrum.
    3. Cefotaxime 25-40 mg/kg q 6-12 hr - Penetrates CNS, good for bacterial infections of CSF [9].
    4. Other antibiotics may also penetrate an inflamed CNS.
    5. Anticonvulsants
    6. Supportive care
    7. Ceftiofur does not penetrate the non inflammed CNS and probably is not a good choice in foals.
    8. Human studies indicate dexamethasone (0.15 mg/kg) prior to antimicrobial therapy and for 4 days improves survival and decreases morbidity when used with 3rd generation cephalosporin that penetrates CNS.
    1. Prognosis: Guarded to poor depending on duration and immune status of foal.
    1. Tyzzer's Hepatitis (Clostridium piliformis infection)
    1. Age 9-42 days, found dead or present with seizures, marked depression or coma, head-pressing, with noticeable icterus.
    2. Usually a well fleshed foal; occur as individual cases.
    3. Laboratory work reveals severe hypoglycemia, acidosis and elevated liver enzymes.
    4. Palpate painful enlarged liver after i/v infusion of dextrose and bicarbonate - Biopsy liver to confirm.
    5. Most foals die; however, recent works suggest some foals may survive with intensive care treatment consisting of antibiotics, fluids and total parenteral nutrition for 5-7 days [10,11].
    6. In Arabian foals, check for SCID with this disease.
    1. Candidiasis (systemic) - Seen in foals treated in intensive care with multiple antibiotics, venous catheters, urinary catheters, and endotracheal tubes [12].
    1. Localized infection may occur on the tongue, nasal passages and intestinal tract.
    2. Systemic infection produces fever, septicemia, joint infections, panophthalmitis, glossitis.
    3. Treatment with amphotericin B; or fluconazole 4 or 5 mg/kg PO q 24 hrs for minimum of 4-6 weeks.
    1. Listeria monocytogenes septicemia has been reported in a 21 day old foal [13].

    Table 1. Modified Sepsis Score. From: Brewer, B.D., Koterba, A.M.: Equine Vet J 20:18-22, 1988. Used with permission

    Localized or generalized sepsis is likely if score > 12. The sepsis score should be repeated daily in the following instances:

    1. The score is in the questionable range on day 1 (11-14)
    2. The foal's zinc sulfate test registers under 800 or the globulins are less than 1.5 g/dl
    3. The foal's clinical condition has not improved at all by day 2 or is deteriorating

    Findings

    Number of points to assign

    4

    3

    2

    1

    0

    Placentitis, vulvar discharge, high risk foaling

     

    Yes

     

     

    No

    Premature gestational age (days)

     

    <300

    300-310

    310-330

    > 330

    Petechiation, scleral injection

     

    Severe

    Moderate

    Mild

    None

    Fever

     

     

    > 102

    <100

     

    Hypotonia, depression, coma, seizures

     

     

    Marked

    Mild

    Normal

    Uveitis, diarrhea, respiratory distress, swollen joints, wounds

     

    Yes

     

     

    No

    Neutrophil count (/μl)

     

    <2000

    2000-4000

    4000-8000

    Normal

    Band neutrophils (/μl)

     

    > 200

    50-200

    >50

    None

    Toxic changes

    Marked

    Moderate

    Mild

     

    None

    Fibrinogen (mg/dl)

     

     

    >600

    400-600

    <400

    Blood glucose (mg/dl)

     

     

    <50, >200

    50-80

    80-180

    IgG (mg/dl)

    <200

    200-400

    400-800

     

    >800

    Back to Table of Contents
    Add to My Library
    Close
    Would you like to add this to your library?

    Get access to all handy features included in the IVIS website

    • Get unlimited access to books, proceedings and journals.
    • Get access to a global catalogue of meetings, on-site and online courses, webinars and educational videos.
    • Bookmark your favorite articles in My Library for future reading.
    • Save future meetings and courses in My Calendar and My e-Learning.
    • Ask authors questions and read what others have to say.
    Sign in Register
    Print this article
    References

    Cohen ND. Causes of and farm management factors associated with disease and death in foals. J Am Vet Med Assoc 204:1644-1651, 1994. - PubMed -

    ...
    Show all
    Comments (0)

    Ask the author

    0 comments
    Submit
    Close
    Would to like to further discuss this item?

    Get access to all handy features included in the IVIS website

    • Get unlimited access to books, proceedings and journals.
    • Get access to a global catalogue of meetings, on-site and online courses, webinars and educational videos.
    • Bookmark your favorite articles in My Library for future reading.
    • Save future meetings and courses in My Calendar and My e-Learning.
    • Ask authors questions and read what others have to say.
    Sign in Register
    About

    How to reference this publication (Harvard system)?

    Madigan, J. E. (2014) “Infections”, Manual of Equine Neonatal Medicine. Available at: https://www.ivis.org/library/manual-of-equine-neonatal-medicine/infections (Accessed: 10 June 2023).

    Affiliation of the authors at the time of publication

    School of Veterinary Medicine, University of California-Davis, CA, USA.

    Author(s)

    • John Madigan

      Madigan J.E.

      Professor of Medicine and Epidemiology
      MS DVM Dipl. ACVIM ACAW
      Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California
      Read more about this author

    Copyright Statement

    © All text and images in this publication are copyright protected and cannot be reproduced or copied in any way.
    Related Content

    Readers also viewed these publications

    • Journal Issue

      Veterinary Evidence - Vol 8 N°2, Apr-Jun 2023

      In: Veterinary Evidence
      JUN 07, 2023
    • Proceeding

      NO Laminitis! Virtual Conference - 2021

      By: ECIR - Equine Cushing's and Insulin Resistance Group Inc.
      MAY 02, 2023
    • Proceeding

      BEVA - Annual Congress - Liverpool, 2022

      By: British Equine Veterinary Association
      MAR 20, 2023
    • Journal Issue

      Veterinary Evidence - Vol 8 N°1, Jan-Mar 2023

      In: Veterinary Evidence
      MAR 19, 2023
    • Proceeding

      AVEF - Conférence Annuelle - Reims, 2022

      By: Association des Vétérinaires Équins Français
      MAR 03, 2023
    • Proceeding

      EEHNC - Virtual Congress - 2021

      By: European Equine Health and Nutrition Congress
      FEB 09, 2023
    • Proceeding

      SFT - Theriogenology Annual Conference - Bellevue, 2022

      By: Society for Theriogenology
      JAN 10, 2023
    • Proceeding

      ACVIM & ECEIM - Consensus Statements

      By: American College of Veterinary Internal Medicine
      NOV 11, 2022
    • Journal Issue

      Veterinary Evidence - Vol 7 N°2, Apr-Jun 2022

      In: Veterinary Evidence
      OCT 07, 2022
    • Journal Issue

      Veterinary Evidence - Vol 7 N°3, Jul-Sep 2022

      In: Veterinary Evidence
      OCT 04, 2022
    • Journal Issue

      Veterinary Practice Management Articles - Veterinary Focus

      In: Veterinary Focus
      AUG 05, 2022
    • Chapter

      Nutrition

      In: The Clinical Companion of the Donkey (2nd Edition)
      JUL 09, 2022
    • Chapter

      Pharmacology and Therapeutics

      In: The Clinical Companion of the Donkey (2nd Edition)
      JUL 03, 2022
    • Chapter

      Sedation, Anaesthesia and Analgesia

      In: The Clinical Companion of the Donkey (2nd Edition)
      JUN 05, 2022
    • Chapter

      The Geriatric Donkey

      In: The Clinical Companion of the Donkey (2nd Edition)
      MAY 20, 2022
    • Chapter

      Euthanasia and the Post-Mortem Examination

      In: The Clinical Companion of the Donkey (2nd Edition)
      MAY 20, 2022
    • Chapter

      Appendix 7: Example Diets: for the mature, pregnant and lactating donkey

      In: The Clinical Companion of the Donkey (2nd Edition)
      MAY 12, 2022
    • Chapter

      Appendix 2: Donkey Weight Estimator

      In: The Clinical Companion of the Donkey (2nd Edition)
      MAY 12, 2022
    • Chapter

      Appendix 1: The Clinical Examination

      In: The Clinical Companion of the Donkey (2nd Edition)
      MAY 12, 2022
    • Chapter

      Appendix 5: Monitoring your Donkey’s Quality of Life

      In: The Clinical Companion of the Donkey (2nd Edition)
      MAY 12, 2022
    • Chapter

      Appendix 6: Professional record of Assessment for Quality of Life

      In: The Clinical Companion of the Donkey (2nd Edition)
      MAY 12, 2022
    • Chapter

      Appendix 3: Body Condition Scoring

      In: The Clinical Companion of the Donkey (2nd Edition)
      MAY 12, 2022
    • Chapter

      Appendix 4: Parameters: Biochemistry and Haematology

      In: The Clinical Companion of the Donkey (2nd Edition)
      MAY 12, 2022
    • Chapter

      The Care of the Foal

      In: The Clinical Companion of the Donkey (2nd Edition)
      MAY 12, 2022
    • Chapter

      Approach to the Dull Donkey

      In: The Clinical Companion of the Donkey (2nd Edition)
      MAY 07, 2022
    • Load more
    Buy this book

    Buy this book

    The Manual of Equine Neonatal Medicine can be purchased either directly from the Live Oak Publishing or via Amazon.

    Buy this book from one of the distributors listed below
    Amazon Logo
    Amazon
    https://www.amazon.com/s?k=manual%20of%20equine%20neonatal%20medicine&crid=2M7W…
    Back To Top
    Become a member of IVIS and get access to all our resources
    Create an account
    Sign in
    Leading the way in providing veterinary information
    About IVIS
    • Mission
    • What we do
    • Who we are
    Need help?
    • Contact
    Follow IVIS
    • Twitter
    • Facebook
    International Veterinary Information Service (IVIS) is a not-for-profit organization established to provide information to veterinarians, veterinary students, technicians and animal health professionals worldwide using Internet technology.
    Support IVIS
    © 2023 International Veterinary Information Service
    • Disclaimer
    • Privacy Policy