{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T20:11:06Z","timestamp":1788984666397,"version":"build-2803163510"},"reference-count":28,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,6,11]],"date-time":"2025-06-11T00:00:00Z","timestamp":1749600000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["32302940"],"award-info":[{"award-number":["32302940"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Veterinary Sciences"],"abstract":"<jats:p>This case report detailed a rare co-infection of Pseudomonas asiatica and Enterobacter hormaechei in a 9-year-old warmblood mare, leading to severe cellulitis and secondary lymphangitis following traditional hoof blood-letting therapy. The mare exhibited acute limb swelling, fever, cutaneous ulceration, lymphatic dysfunction and unknown anemia. Comprehensive diagnostics, including bacterial culture, whole-genome sequencing, anti-elastin antibody (AEAb) ELISA, and diagnostic imaging, confirmed the pathogens causing cellulitis and secondary lymphangitis. AEAb levels were elevated, correlating with lymphatic degradation, while radiography and lymphangiography ruled out laminitis but identified tortuous lymphatic vessels. The treatment integrated systemic antimicrobials, anti-inflammatory therapy, combined decongestive therapy, and traditional Chinese herbal medicine, resulting in resolution of infection, improved hematological parameters, and restored athletic performance. The therapeutic regimen primarily included gentamicin, enrofloxacin, oxytetracycline, and the Wei Qi Booster. The case highlights the critical role of pathogen-directed antimicrobial selection and the potential benefits of combining conventional and holistic therapies. This report emphasizes the necessity of early, multifaceted interventions to prevent life-threatening complications in equine cellulitis\u2013lymphangitis cases.<\/jats:p>","DOI":"10.3390\/vetsci12060574","type":"journal-article","created":{"date-parts":[[2025,6,11]],"date-time":"2025-06-11T11:18:40Z","timestamp":1749640720000},"page":"574","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Pseudomonas-Enterobacter Co-Infection Drives Cellulitis and Lymphangitis in Equines: A Case Report"],"prefix":"10.3390","volume":"12","author":[{"given":"Xiangning","family":"Huang","sequence":"first","affiliation":[{"name":"College of Veterinary Medicine, South China Agricultural University, 483 Wushanlu, Guangzhou 510640, China"},{"name":"Guangdong Technological Engineering Research Center for Pet, 483 Wushanlu, Guangzhou 510640, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renjie","family":"Deng","sequence":"additional","affiliation":[{"name":"College of Veterinary Medicine, South China Agricultural University, 483 Wushanlu, Guangzhou 510640, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haoen","family":"Huang","sequence":"additional","affiliation":[{"name":"College of Veterinary Medicine, South China Agricultural University, 483 Wushanlu, Guangzhou 510640, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huisheng","family":"Xie","sequence":"additional","affiliation":[{"name":"Chi University, 9650 West Highway 318, Reddick, FL 32686, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5028-9055","authenticated-orcid":false,"given":"Aolei","family":"Chen","sequence":"additional","affiliation":[{"name":"College of Veterinary Medicine, South China Agricultural University, 483 Wushanlu, Guangzhou 510640, China"},{"name":"Guangdong Technological Engineering Research Center for Pet, 483 Wushanlu, Guangzhou 510640, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1542","DOI":"10.1111\/vsu.13691","article-title":"Treatment and Outcome of Eight Horses with Limb Cellulitis and Septic Tendonitis or Desmitis","volume":"50","author":"Cooper","year":"2021","journal-title":"Vet. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"E234","DOI":"10.1111\/eve.13484","article-title":"A Cross-sectional Survey of the Diagnosis and Treatment of Distal Limb Cellulitis in Horses by Veterinary Surgeons in the United Kingdom","volume":"34","author":"Braid","year":"2022","journal-title":"Equine Vet. Educ."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1696","DOI":"10.2460\/javma.231.11.1696","article-title":"Primary and Secondary Limb Cellulitis in Horses: 44 Cases (2000\u20132006)","volume":"231","author":"Adam","year":"2007","journal-title":"J. Am. Veter-Med Assoc."},{"key":"ref_4","first-page":"16","article-title":"Cellulitis and Lymphangitis","volume":"1","author":"Rendle","year":"2017","journal-title":"Medicine"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s13028-025-00792-y","article-title":"Severe Subcutaneous Infection with Clostridium septicum in a Herd of Native Icelandic Horses","volume":"67","author":"Svansson","year":"2025","journal-title":"Acta Vet. Scand."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"129","DOI":"10.3949\/ccjm.87a.19095","article-title":"Acute Lymphangitis","volume":"87","author":"Kano","year":"2020","journal-title":"Clevel. Clin. J. Med."},{"key":"ref_7","first-page":"536","article-title":"Diagnosing and treating cellulitis in horses","volume":"46","author":"Braid","year":"2024","journal-title":"InPractice"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1111\/eve.13014","article-title":"Cellulitis: Any Change?","volume":"31","author":"Adam","year":"2019","journal-title":"Equine Vet. Educ."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.jemermed.2021.09.015","article-title":"Diagnosis and Management of Cellulitis and Abscess in the Emergency Department Setting: An Evidence-Based Review","volume":"62","author":"Long","year":"2022","journal-title":"J. Emerg. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/j.cveq.2006.04.003","article-title":"Surgical and Traumatic Wound Infections, Cellulitis, and Myositis in Horses","volume":"22","author":"Adam","year":"2006","journal-title":"Vet. Clin. N. Am. Equine Pract."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"E406","DOI":"10.1111\/eve.13570","article-title":"Equine Limb Cellulitis\/Lymphangitis Resulting in Distal Limb Ischaemia and Avulsion of the Hoof Capsule","volume":"34","author":"Duggan","year":"2022","journal-title":"Equine Vet. Educ."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1136\/vr.162.8.233","article-title":"Retrospective Study of the Clinical Features of Limb Cellulitis in 63 Horses","volume":"162","author":"Fjordbakk","year":"2008","journal-title":"Vet. Rec."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"dlaf007","DOI":"10.1093\/jacamr\/dlaf007","article-title":"Surveillance of Antimicrobial Resistance in Hospitalized Companion Animals in China in 2022\u20132023","volume":"7","author":"Liu","year":"2024","journal-title":"JAC-Antimicrob. Resist."},{"key":"ref_14","first-page":"005094","article-title":"Pseudomonas Mendocina Bacteraemia Secondary to Cellulitis\u2014A Report and Brief Series of Cases","volume":"12","author":"Reis","year":"2025","journal-title":"Eur. J. Case Rep. Intern. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"44","DOI":"10.3389\/fmicb.2019.00044","article-title":"Multidrug-Resistant Enterobacter Cloacae Complex Emerging as a Global, Diversifying Threat","volume":"10","author":"Annavajhala","year":"2019","journal-title":"Front. Microbiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"699","DOI":"10.3390\/idr16040053","article-title":"A Case of Pseudomonas Straminea Blood Stream Infection in an Elderly Woman with Cellulitis","volume":"16","author":"Schaller","year":"2024","journal-title":"Infect. Dis. Rep."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e00475-19","DOI":"10.1128\/AAC.00475-19","article-title":"Emergence of Carbapenem-Resistant Pseudomonas Asiatica Producing NDM-1 and VIM-2 Metallo-\u03b2-Lactamases in Myanmar","volume":"63","author":"Tohya","year":"2019","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"3647","DOI":"10.2147\/IDR.S327595","article-title":"Molecular Mechanisms and Epidemiology of Carbapenem-Resistant Enterobacter Cloacae Complex Isolated from Chinese Patients During 2004\u20132018","volume":"14","author":"Liu","year":"2021","journal-title":"Infect. Drug Resist."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1086\/513650","article-title":"An Outbreak of Enterobacter hormaechei Infection and Colonization in an Intensive Care Nursery","volume":"24","author":"Wenger","year":"1997","journal-title":"Clin. Infect. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.1099\/ijsem.0.003316","article-title":"Pseudomonas asiatica sp. Nov., Isolated from Hospitalized Patients in Japan and Myanmar","volume":"69","author":"Tohya","year":"2019","journal-title":"Int. J. Syst. Evol. Microbiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2229","DOI":"10.2147\/IDR.S366567","article-title":"First Identification of a Multidrug-Resistant Pseudomonas Putida Co-Carrying Five \u03b2-Lactam Resistance Genes Recovered from a Urinary Tract Infection in China","volume":"15","author":"Bao","year":"2022","journal-title":"Infect. Drug Resist."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Brys, M., Claerebout, E., and Chiers, K. (2023). Chronic Progressive Lymphedema in Belgian Draft Horses: Understanding and Managing a Challenging Disease. Vet. Sci., 10.","DOI":"10.3390\/vetsci10050347"},{"key":"ref_23","first-page":"69","article-title":"Determination of anti-elastin peptide antibodies in normal and arteriosclerotic human sera by ELISA","volume":"30","author":"Fulop","year":"1989","journal-title":"J. Clin. Lab. Immunol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1016\/j.jcpa.2008.10.009","article-title":"Quantitative and qualitative evaluation of dermal elastin of draught horses with chronic progressive lymphoedema","volume":"140","author":"Affolter","year":"2009","journal-title":"J. Comp. Pathol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1053\/ejvs.2002.1750","article-title":"Serum Concentrations of Elastin-Derived Peptides in Patients with Specific Manifestations of Atherosclerotic Disease","volume":"24","author":"Petersen","year":"2002","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"418","DOI":"10.2746\/042516407X205888","article-title":"Antibodies to Elastin Peptides in Sera of Belgian Draught Horses with Chronic Progressive Lymphoedema","volume":"39","author":"Affolter","year":"2007","journal-title":"Equine Vet. J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.vetimm.2014.11.004","article-title":"Assessment of plasma anti-elastin antibodies for use as a diagnostic aid for chronic progressive lymphoedema in Belgian Draught Horses","volume":"163","author":"Berth","year":"2015","journal-title":"Vet. Immunol. Immunopathol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1111\/j.2042-3292.2011.00311.x","article-title":"Combined Decongestive Therapy Including Equine Manual Lymph Drainage to Assist Management of Chronic Progressive Lymphoedema in Draught Horses","volume":"24","author":"Powell","year":"2012","journal-title":"Equine Vet. Educ."}],"container-title":["Veterinary Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2306-7381\/12\/6\/574\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:50:23Z","timestamp":1760032223000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2306-7381\/12\/6\/574"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,11]]},"references-count":28,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["vetsci12060574"],"URL":"https:\/\/doi.org\/10.3390\/vetsci12060574","relation":{},"ISSN":["2306-7381"],"issn-type":[{"value":"2306-7381","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,11]]}}}