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Topic:Equine Protozoal Myeloencephalitis
Equine Protozoal Myeloencephalitis (EPM) is a neurological disease affecting horses, caused by the protozoan parasites Sarcocystis neurona or, less commonly, Neospora hughesi. The disease occurs when these parasites infect the central nervous system, leading to a range of neurological symptoms. Horses with EPM may exhibit signs such as ataxia, muscle weakness, and incoordination. Diagnosis can be challenging and typically involves a combination of clinical assessment, serological testing, and sometimes cerebrospinal fluid analysis. This page compiles peer-reviewed research studies and scholarly articles that explore the pathogenesis, diagnostic approaches, and management strategies for Equine Protozoal Myeloencephalitis in horses.
The diagnostic utility of cerebrospinal fluid creatine kinase activity in the horse. We evaluated creatine kinase (CK) activity in the cerebrospinal fluid (CSF) of 128 horses with various neurological disorders. No association was found between CSF CK activity and CSF red blood cell count, CSF nucleated cell count, CSF total protein concentration, or serum CK activity. The sensitivity and specificity of CSF CK activity as a diagnostic test for protozoal myelitis in horses (61% and 56%, respectively) was higher than for cervical stenotic myelopathy, degenerative myelopathy, or motor neuron disease, but was considered to be inadequate to be of use diagnostically. Contamination o...
Sequence analysis and polymerase chain reaction amplification of small subunit ribosomal DNA from Sarcocystis neurona. To identify Sarcocystis neurona-specific DNA sequences in the nuclear small subunit ribosomal RNA (nss-rRNA) gene that could be used to distinguish S neurona from other closely related protozoal parasites, and to evaluate a polymerase chain reaction (PCR) test, using broad based primers and a unique species-specific probe on CSF for detection of S neurona in equids. Methods: Sequencing of the nuclear small subunit ribosomal RNA gene from a new S neurona isolate (UCD 1) was performed. The sequence was compared with that of other closely related Sarcocystidae parasites. From this sequence, conse...
Identification of opossums (Didelphis virginiana) as the putative definitive host of Sarcocystis neurona. Sarcocystis neurona is an apicomplexan that causes equine protozoal myeloencephalitis (EPM) in North and South America. Horses appear to be an aberrant host, because the merozoites continually divide in the central nervous system, without encysting. The natural host species has not previously been identified. The small subunit ribosomal RNA (SSURNA) gene of S. neurona was compared to those of Sarcocystis muris, Sarcocystis cruzi, Toxoplasma gondii, and Cryptosporidium parvum to identify a unique region suitable for a species-specific amplification primer. The S. neurona SSURNA primer was used ...
Sarcocystis falcatula from passerine and psittacine birds: synonymy with Sarcocystis neurona, agent of equine protozoal myeloencephalitis. Equine protozoal myeloencephalitis (EPM) is a neurologic disease of horses caused by Sarcocystis neurona. The horse is a dead-end host for S. neurona and the definitive and intermediate hosts have not previously been identified. We hypothesized that S. neurona is actually Sarcocystis falcatula, a parasite that cycles in nature between Virginia opossums (Didelphis virginiana) and any of a variety of avian intermediate hosts. We extracted DNA from S. falcatula sarcocysts in the muscle of a brown-headed cowbird (Molothrus ater) and from schizonts in a fixed specimen of lung from a Moluccan cockat...
Immunohistochemical study to demonstrate Sarcocystis neurona in equine protozoal myeloencephalitis. A 5-year (1985-1989) retrospective immunohistochemical study was conducted using an avidin-biotin complex (ABC) immunoperoxidase method to demonstrate Sarcocystis neurona in histologically suspect cases of equine protozoal myeloencephalitis (EPM). Primary antibodies against S. neurona and S. cruzi were utilized for the ABC technique. The findings were compared with those from cases in which the organisms were detected by examination of hematoxylin and eosin (HE)-stained neuronal sections. HE-stained sections detected the presence of the organisms in 20% of the suspect cases; whereas the ABC te...
Equine protozoal myeloencephalitis: antigen analysis of cultured Sarcocystis neurona merozoites. Antigens of cultured Sarcocystis neurona merozoites were examined using immunoblot analysis. Blotted proteins were probed with S. cruzi, S. muris, and S. neurona antisera produced in rabbits, S. fayeri (pre- and post-infection) and S. neurona (pre- and post-inoculation) sera produced in horses, immune sera from 7 histologically confirmed cases of equine protozoal myeloencephalitis (EPM), and pre-suckle serum from a newborn foal. Eight proteins, 70, 24, 23.5, 22.5, 13, 11, 10.5, and 10 Kd, were detected only by S. neurona antiserum and/or immune serum from EPM-affected horses. Equine sera were ...
Equine protozoal myelitis in Panamanian horses and isolation of Sarcocystis neurona. Schizonts of Sarcocystis neurona were identified microscopically in hematoxylin-eosin-stained spinal cord sections from 2 native Panamanian horses that exhibited clinical signs of equine protozoal myelitis (EPM). Spinal cord homogenate from a third Panamanian horse with EPM was inoculated onto monolayers of cultured bovine monocytes (M617). Intracytoplasmic schizonts containing merozoites arranged in rosette forms surrounding a central residual body first were observed 13 wk postinoculation. Parasites divided by endopolygeny and lacked rhoptries. Schizonts from each horse reacted with Sarcocys...
Sarcocystis neurona-associated ataxia in horses in Brazil. Sarcocystis neurona-like schizonts were found in sections of brain and spinal cord of two ataxic horses from Brazil. The diagnosis was supported by staining with anti-Sarcocystis serum in an immunohistochemical test. One of the affected horses was born in Argentina and raised in Brazil, and the other horse was born and raised in Brazil.
Characterization of Sarcocystis neurona from a thoroughbred with equine protozoal myeloencephalitis. Morphological information is presented for syntype material of the etiologic agent of equine protozoal myeloencephalitis, Sarcocystis neurona. A clinical description of the horse from which the organism was isolated and the methodology used to immunosuppress the horse in an attempt to increase parasite numbers are also given. The description includes microscopic details observed both with light and transmission electron microscopy. Mainly stages from tissue are illustrated, but information is also presented on the development of the organism after inoculation onto monolayers of bovine monocyte...
Measurements of the accuracy of clinical diagnoses of equine neurologic disease. Parameters for the accuracy of clinical diagnosis of neurologic diseases in the horse were determined from 210 horses in which a definitive pathologic diagnosis was confirmed. The overall efficiency of diagnosis for all diseases was 0.95 although the validity varied from 0.79 to 1.00, the sensitivity varied from 0.73 to 0.95, and the specificity varied from 0.88 to 1.00 for individual disease categories. Equine protozoal myeloencephalitis was overdiagnosed, whereas Eastern equine encephalomyelitis, equine degenerative myeloencephalopathy, and traumatic neurologic disease were underdiagnosed. T...
In vitro cultivation of Sarcocystis neurona from the spinal cord of a horse with equine protozoal myelitis. Asexual stages of Sarcocystis neurona were seen in cultured bovine monocytes (M617) inoculated with tissue homogenates from the spinal cord of a horse with naturally acquired protozoal myelitis. Organisms first were observed as intracytoplasmic schizonts and later as motile extracellular zoites capable of infecting surrounding M617 cells. Parasites most often occurred as clusters of merozoites dispersed throughout the host cell cytoplasm; however, schizonts also contained merozoites arranged in a radial fashion surrounding a prominent residual body. Schizonts divided by endopolygeny. The paras...
Sarcocystis neurona n. sp. (Protozoa: Apicomplexa), the etiologic agent of equine protozoal myeloencephalitis. Sarcocystis neuronan n. sp. is proposed for the apicomplexan taxon associated with myeloencephalitis in horses. Only asexual stages of this parasite presently are known, and they are found within neuronal cells and leukocytes of the brain and spinal cord. The parasite is located in the host cell cytoplasm, does not have a parasitophorous vacuole, and divides by endopolygeny. Schizonts are 5-35 microns x 5-20 microns and contain 4-40 merozoites arranged in a rosette around a prominent residual body. Merozoites are approximately 4 x 1 micron, have a central nucleus, and lack rhoptries. Schizonts...
Cerebrospinal fluid creatine kinase activity in horses with central nervous system disease: 69 cases (1984-1989). The CSF creatine kinase (CK) activity was determined in 70 CSF samples from 69 horses with CNS disease. Abnormal values (greater than or equal to 1 IU/L) were determined from 32 CSF samples, and normal values (less than 1 IU/L) were found in 38 samples. Increased CK activity was most frequently associated with a diagnosis of equine protozoal myelitis; CK activity was not increased in 11 horses with cervical compressive myelopathy. Other diagnoses, in which CSF CK activity was increased included trauma (n = 1), idiopathic epilepsy (n = 2), botulism (n = 2), articular facet fracture (n = 1), int...
Epidemiology of equine protozoal myeloencephalitis in North America based on histologically confirmed cases. A report. Following a workshop on equine protozoal myeloencephalitis (EPM) convened at the Veterinary Medical Forum of the American College of Veterinary Internal Medicine in 1988, this survey of EPM in North America was developed. It is based upon 364 histologically confirmed case records from California, Florida, Illinois, Kentucky, New York, Ohio, Oklahoma, Ontario, Pennsylvania, and Texas up to 1988. The highest rate of infection was found in young Thoroughbred, Standardbred, and quarter horses. Differences in geographic location, sex, and month (season) of infection were not discernible. This repor...
A retrospective study of nineteen ataxic horses. A retrospective study of 19 ataxic horses admitted to the College of Veterinary Medicine of the University of Montreal during the period of January 1985 to December 1988 is presented. There were 11 cases of cervical vertebral malformation, four of equine degenerative myeloencephalopathy, two of equine protozoal myeloencephalitis, one each of vertebral osteomyelitis and intervertebral disc protrusion. The clinical diagnosis of ataxia in horses requires neurological, radiographic, myelographic, and laboratory examinations.
Cerebrospinal fluid changes in two horses with central nervous system nematodiasis (Micronema deletrix). Two horses with cerebrospinal nematodiasis (Micronema deletrix) had signs similar to those of other neurologic diseases resulting from parasitic (fly larvae, protozoa, or other helminths) migration through the central nervous system (CNS). In one horse (horse 1), a 13-year-old Paso Fino stallion, the cerebrospinal fluid (CSF) was slightly xanthochromic (1+), with a pleocytosis (25 nucleated cells/microliter) and a normal protein level (69 mg/dl). A CSF differential cell count showed 15% neutrophils, 56% lymphocytes, 22% macrophages, 5% eosinophils, and 2% basophils. In the other horse (horse 2...
Equine protozoal myeloencephalitis. Equine protozoal myeloencephalitis (EPM) is a disease that produces neurologic signs of brain or spinal cord dysfunction. The causative organism is believed to be a Sarcocystis species of protozoa. A definitive diagnosis can only be made on histopathology of affected spinal cord or brain. No preventive measures or documented treatment is available at this time for suspected cases of EPM.
Protozoal diseases. The clinical and pathologic findings of and therapy for such protozoal diseases as equine protozoal myeloencephalitis, toxoplasmosis, sarcocystosis, pneumocytosis, cryptosporidiosis, giardiasis, besnoitiosis, and klossiellosis are discussed. Emphasis is placed on disorders that occur with greater frequency in North America and on emerging protozoal diseases affecting horses.
Equine protozoal myeloencephalitis in a pony. A 10-year-old pony died 5 days after the onset of a nervous disorder. Necropsy revealed a yellowish area of discoloration (1.5 by 1 cm) in the medulla oblongata. Microscopically, necrosis and nonsuppurative myeloencephalitis were found in the medulla oblongata. Immature and mature meronts (25 by 10 microns) were seen in neural tissue and in capillaries of the brain stem. Organisms were similar structurally to those seen in equine protozoal myeloencephalitis of horses.
Ataxia and weakness associated with fourth ventricle vascular anomalies in two horses. Two adult horses with progressive neurologic signs were examined clinically and at necropsy. Both horses had signs of progressive ataxia and weakness, clinically diagnosed as spinal cord in origin. Differential diagnoses for cervical spinal ataxia in horses included cervical vertebral malformation, equine degenerative myeloencephalopathy, equine herpes-virus-I myeloencephalopathy, and equine protozoal myeloencephalopathy. Necropsy findings in both horses were similar and consisted of a large hematoma in the fourth ventricle, with upward compression of the cerebellum and downward compression of...
Protozoal myeloencephalitis in horses in California. Three cases of equine protozoal myeloencephalitis were diagnosed over a 12-month period in horses that had never left the state of California. These cases suggest that the disease is enzootic in California.
Verminous (Strongylus vulgaris) myelitis in a donkey. A fifth stage Strongylus vulgaris migrated through the spinal cord of a 2-year-old, male donkey resulting in progressive paraparesis and then tetraplegia. A profound neutrophilic pleocytosis was detected on analysis of cerebrospinal fluid. The parasite appeared to have entered the mid-lumbar spinal cord, migrated to the cranial thoracic segments, exited, then re-entered the spinal cord a few segments craniad. It then traveled further cranially and was found in the third cervical spinal cord segment. Some parts of the lesion were remarkably free from tissue necrosis, hemorrhage and inflammation...
Migration of a spiruroid nematode through the brain of a horse. A pregnant 10-year-old Paint mare was examined because of an acute neurologic disturbance. Physical examination revealed signs consistent with extensive, asymmetric brain stem disease. The hemogram, serum chemical panel, and results of lumbosacral spinal fluid analysis were within normal limits. A primary diagnosis of equine protozoal myeloencephalitis was considered, and the mare was placed on treatment with trimethoprim-sulfadiazine. After 5 weeks of steady improvement, an acute exacerbation of neurologic signs necessitated euthanasia of the mare. At necropsy, large, malacic tracts were foun...
Equine protozoal myeloencephalitis: a report of two cases from Western Canada. Two cases of nonsuppurative myeloencephalitis are reported which clinically and pathologically resemble equine protozoal myeloencephalitis. Lesions in both horses were associated with Toxoplasma-like organisms visible in microscopic sections. Clinical signs and lesions in one case primarily involved the brain and in the other case principally involved the spinal cord and associated meninges. Positive identification of the organisms was not achieved; however, the etiological agent is unlikely to be a species of Toxoplasma. Recently published studies suggest a species of Sarcocystis is involved....
