VM172

Understanding Equine Strangles: Signs of Disease,

Management and Prevention1
Amanda M. House2

Understanding Equine Strangles discharge, and enlarged submandibular lymph nodes

(in the space between the lower jaw bones) which
Strangles is caused by bacterial infection with ultimately abscess. Purulent nasal discharge is
Streptococcus equi subspecies equi (referred to as S. typically present, although it may initially be clear.
equi). The bacteria typically infect the upper airway The retropharyngeal lymph nodes, which are behind
and lymph nodes of the head and neck. The disease the throatlatch, may also become enlarged and
has been in the equine population for centuries, and abscess. These will sometimes drain into the guttural
was first reported in 1251. The infection is highly pouches, which are air-filled spaces within the head
contagious in horse populations and can recur on that are an expansion of the Eustachian tubes.
farms with previous outbreaks of the disease. It is one Guttural pouch infection and pus accumulation
of the most commonly diagnosed contagious diseases (empyema) are often the result of retrophayngeal
of the horse worldwide. The persistence of this lymph nodes that abscess and rupture into the guttural
infection on farms is multi-factorial. The bacteria can pouches. Guttural pouch infection may also occur
survive on water sources (buckets and troughs) for from bacterial entrance through the pharynx (throat).
over a month, but the primary source of recurrent Anorexia, depression, and difficulty swallowing may
infections is most likely asymptomatic carrier horses, also accompany signs of infection.
that can shed the bacteria to other horses for months
to years. Complications of Disease
Clinical Signs of Disease Fortunately, although strangles is highly
contagious and can affect many horses on a farm,
Historically, strangles got its name because most horses with infection recover without
affected horses were sometimes suffocated from complication. The occurrence of complications will
large, infected lymph nodes that obstructed their increase the likelihood of death from the infection
upper airway or trachea. The hallmark clinical signs (from 8% to 40% of cases). Complications from
of infection are fever (temperature >101.5∫F), nasal

1. This document is VM172, one of a series of the Veterinary Medicine-Large Animal Clinical Sciences Department, Florida Cooperative Extension Service,
Institute of Food and Agricultural Sciences, University of Florida. Original publication date August 2008. Revised October 2008. Visit the EDIS Web Site
at http://edis.ifas.ufl.edu.
2. Amanda M. House, assistant professor; College of Veterinary Medicine, Large Animal Clinical Sciences, Institute of Food and Agricultural Sciences,
University of Florida, Gainesville, 32611.

The Institute of Food and Agricultural Sciences (IFAS) is an Equal Opportunity Institution authorized to provide research, educational information and
other services only to individuals and institutions that function with non-discrimination with respect to race, creed, color, religion, age, disability, sex,
sexual orientation, marital status, national origin, political opinions or affiliations. U.S. Department of Agriculture, Cooperative Extension Service,
University of Florida, IFAS, Florida A. & M. University Cooperative Extension Program, and Boards of County Commissioners Cooperating. Larry
Arrington, Dean
Understanding Equine Strangles: Signs of Disease, Management and Prevention 2

infection with S. equi include spread of the infection fever and in horses with no lymph node enlargement
to lymph nodes other than the head and neck (also may prevent infection. However, early antibiotic
known as metastatic infection or bastard strangles), treatment will also prevent these cases from
immune mediated disease (such as purpura developing immunity to the infection, and
hemorrhagica), muscle disease and pain, and lack of subsequently makes them susceptible to reinfection
milk production. Studies report complications to earlier.
occur in approximately 20% of strangles cases.
Horses that develop complicated infection typically Management of an Outbreak
require antibiotic and additional therapies based on
The first and most important thing to remember
veterinary examination.
in a suspected outbreak of strangles is to contact your
Diagnosis veterinarian right away to determine the diagnosis
and the best control practices for your particular farm.
Clinical signs of strangles strongly suggest the Strangles is a reportable disease in some states, and
diagnosis. However, definitive diagnosis is made by the state veterinarian may need to be notified as well.
culture of the bacteria from a sample of purulent Movement of any horses on or off the farm should be
discharge (from the nose or guttural pouch), a lymph stopped, and new horses should not be introduced.
node abscess, or a nasal-pharyngeal wash. Another Take the temperature of all horses on the farm twice
available test, polymerase chair reaction (PCR), is daily. Normal rectal temperature is 99-101.5°F.
very sensitive test and detects bacterial DNA. PCR Monitoring the rectal temperature and isolating
cannot tell the difference between live and dead horses at the first sign of fever is one of the most
bacteria, so is typically used in conjunction with effective ways to stop the spread of infection.
culture. However, if consecutive PCRs are negative, Infected horses can transmit the bacteria to healthy
the horse is unlikely to have strangles. The real horses 1-2 days after they develop a fever.
challenge is diagnosing horses that are asymptomatic
carriers. Anywhere from 4-50% of the horses on An isolated area should be set up for horses with
farms with recurring strangles are carriers of the fever and any other signs of illness (nasal discharge,
infection. Most horses will begin shedding (bacteria etc). Extreme care should be taken not to mix horses
can be transmitted from nasal secretions to other with infection, horses exposed to horses with
horses) the bacteria from their nasal passages a strangles, and unexposed horses. Ideally, three groups
couple of days after the onset of fever. Bacterial of horses should be created: 1) infected horses 2)
shedding occurs intermittently for several weeks. horses that have been exposed to or contacted
Some horses may continue to shed the bacteria for infected horses and 3) clean horses with no exposure.
months to even years, functioning as a continual No nose to nose contact or shared water buckets
source of new infections on the farm. All diagnostic should occur among the groups! Unexposed horses
tests and treatment of affected cases should be done should be kept in a "clean" area, and should ideally
under veterinary supervision. have separate caretakers, cleaning equipment,
grooming equipment, water troughs and pasture.
Treatment People and equipment can transfer the infection from
horse to horse. Extreme care, handwashing, and
Antibiotic therapy for the treatment of strangles disinfection of supplies must be observed by
remains controversial. Uncomplicated cases of everyone involved. If different individuals cannot
submandibular lymph node abscessation do not care for infected and healthy horses, then healthy
require antibiotic therapy in this author's opinion. horses should always be dealt with first. Dedicated
Complicated cases and those requiring tracheostomy protective clothing such as boots, gowns or coveralls,
for management of respiratory distress generally do and gloves should be utilized when dealing with
require antibiotic and other supportive therapies. infected horses.
There is some evidence that treatment with
antibiotics (such as penicillin) at the first sign of
Understanding Equine Strangles: Signs of Disease, Management and Prevention 3

Thorough cleaning and disinfection is critical infected after they are vaccinated. Available vaccines
when dealing with any infectious disease. All water can be administered by intramuscular and intranasal
troughs should be thoroughly cleaned and disinfected routes. Improper administration of the vaccination
daily during an outbreak. Read the label instructions can result in poor protection against infection and/or
on disinfectants to be sure they are used at the correct complications at the site of injection; therefore,
dilution and are active against S. equi. All surfaces and administration by your veterinarian is recommended.
stalls should be disinfected following removal of The intranasal vaccination results in the best local
manure and organic material. Manure will inactivate immunity.
bleach and iodine type solutions. Manure and waste
feed from infected horses should be composted in an Vaccination is generally not recommended
isolated location, not spread on the pastures. Pastures during an outbreak of strangles. If there are horses on
that were utilized for sick horses should be rested for the farm with no clinical signs of infection (fever,
a minimum of 4 weeks. Fortunately, S. equi does not nasal discharge) and no known contact with sick
live for a prolonged time in the soil (about 3 days). horses, vaccination may be considered. Horses that
have had the disease within the previous year also do
A serious challenge when dealing with an not need to be vaccinated. Once recovered from an
outbreak of strangles is identifying the horses that are active infection, 75% of horses have immunity for 1-2
carriers of the bacteria but are not showing any signs years. Vaccination of horses recently exposed to
of illness. These horses can shed the bacteria for strangles (that have high antibody levels) may result
weeks, months, or even years, and serve as a in purpura hemorrhagica. Purpura hemorrhagica is
continual source of reinfection for your farm. Ideally, caused by an over-active immune response within the
all horses on the farm should be tested for strangles. horse, which can result in limb swelling, swelling of
The bacterial culture combined with PCR identifies the head, and small hemorrhages on the gums.
carriers with a 90% success rate. Nasal pharyngeal Vaccination is only recommended in healthy horses
swabs or washes can be done to sample the horses for with no fever or nasal discharge.
infection. The washes improve the chance of
identifying carrier horses. Additionally, all sick So should you vaccinate your horse? The answer
horses should test negative 3 consecutive times before to that question depends on your horse's chance of
being put back with healthy horses. Previously exposure to infection, and your personal comfort with
infected horses can shed the bacteria for weeks to the level of risk. The decision should be made in
months, or even years in rare cases. That is the reason conjunction with your veterinarian. Generally, if your
3 negative test samples are recommended prior to horse travels routinely and is exposed to varied or
reintroduction to the healthy herd. For the most new populations of horses regularly, vaccination
accurate diagnosis of carriers and horses without should be considered. Broodmares on farms with a
obvious clinical signs, upper airway and guttural history of strangles should also be vaccinated prior to
pouch endoscopy can be performed. This procedure foaling. Remember that the initial vaccination
allows for identification and culture of infections that requires a booster dose before being effective against
can develop in the guttural pouch. Although infection. It takes about one month from vaccination
disinfection, isolation procedures, and diagnosis can for immunity to develop. Therefore, be certain to
be costly; they are certainly cheaper than additional vaccinate your horse in advance of transport or
outbreaks on your farm. potential exposure to new horses.

Vaccination Additional Preventative Measures

Vaccination is one method for prevention and If you have never had strangles on your farm or
control of infection with S. equi. However, in your horse, you probably don't want it either. Here
vaccination cannot guarantee disease prevention. are some additional suggestions for reducing your
With strangles, vaccination will most likely reduce horse and your farm's risk for infection:
the severity of disease in the majority of horses
Understanding Equine Strangles: Signs of Disease, Management and Prevention 4

• Require a current health certificate for new 3. Link to AAEP Infectious Disease Guidelines for
horse arrivals on the farm. S. equi
http://www.aaep.org/pdfs/control_guidelines/
• Ask owners of new horses about a history of Streptococcus%20equi%20var.pdf
strangles and consider testing new horses to see if
they are shedding the bacteria.

• If feasible, quarantine new arrivals for 2-3

weeks and monitor their temperature.

• All horses should have individual water buckets

that are routinely disinfected.

• If shared water troughs are utilized, they should

be routinely disinfected.When traveling to
shows, minimize your horse's exposure by
bringing your own feed, buckets, and equipment.
Minimize use of shared stalls or pastures at show
grounds.

• If horses are pastured together, group them

according to their age and risk level (for
example, all weanlings together, all broodmares
together).

In summary, reducing your horse's exposure to

unknown horses and utilizing routine disinfection
measures will decrease the chance of infection with
strangles. If your farm does have an outbreak,
isolation and containment of sick horses will help
reduce the spread of infection. The American College
of Veterinary Internal Medicine (ACVIM) has
developed strangles control guidelines which were
the basis for the recommendations here. That
document can be downloaded at
http://www.acvim.org/uploadedFiles/
Consensus_Statements/Strangles.pdf to assist owners
and veterinarians with detailed recommendations for
diagnosis, treatment, and control of infection.

Further Reading:
1. Sweeney CR, Timoney JF, Newton JR, and
Hines MT. Streptococcus equi Infections in
Horses: Guidelines for Treatment, Control, and
Prevention of Strangles. J Vet Intern Med 2005;
19: 123-134.

2. Loving, NS. Strangles. The Horse; Nov 1 2007,

Article #10688.