Streptococcus equi subspecies equi (S. equi) is the
causative organism of the upper respiratory disease of equids,
strangles, characterised by pyrexia, lymphadenopathy, and mucopurulent
nasal discharge. Strangles was first reported over 750 years ago and
continues to be of significance in equine populations across the globe.
This review discusses how S. equi has adapted, the clinical
manifestation of strangles, and how clinicians and caregivers can tackle
the disease in the future. S. equi evolved from the commensal,
and occasionally opportunistic pathogen, Streptococcus equi
subspecies zooepidemicus refining its capabilities as it became host
restricted. The success of S. equi can be attributed to its
ability to cause both acute and persistent infection, the latter
occurring in about 10% of those infected. In this carrier state,
S. equi persists in the guttural pouch without causing clinical
signs, intermittently shedding into the environment, and encountering
naïve animals. Insight into the S. equi genome and lifestyle has
led to advances in diagnostic assays and the development of a safe and
efficacious recombinant-fusion vaccine, giving clinicians and caregivers
the tools to better combat this infection. Alongside rigorous
biosecurity protocols and pragmatic control measures such as screening
new arrivals for exposure and carrier status, these new technologies
demonstrate that strangles can be an increasingly preventable infection.