Effect of intermittent oral administration of ponazuril on experimental Sarcocystis neurona infection of horses

OBJECTIVE: To evaluate the effect of intermittent oral administration of ponazuril on immunoconversion against Sarcocystis neurona in horses inoculated intragastrically with S neurona sporocysts. ANIMALS: 20 healthy horses that were seronegative for S neurona-specific IgG. PROCEDURES: 5 control horses were neither inoculated with sporocysts nor treated. Other horses (5 horses/group) each received 612,500 S neurona sporocysts via nasogastric tube (day 0) and were not treated or were administered ponazuril (20 mg/kg, PO) every 7 days (beginning on day 5) or every 14 days (beginning on day 12) for 12 weeks. Blood and CSF samples were collected on day - 1 and then every 14 days after challenge for western blot assessment of immunoconversion. Clinical signs of equine protozoal myeloencephalitis (EPM) were monitored, and tissues were examined histologically after euthanasia. Results: Sera from all challenged horses yielded positive western blot results within 56 days. Immunoconversion in CSF was detected in only 2 of 5 horses that were treated weekly; all other challenged horses immunoconverted within 84 days. Weekly administration of ponazuril significantly reduced the antibody response against the S neurona 17-kd antigen in CSF. Neurologic signs consistent with EPM did not develop in any group; likewise, histologic examination of CNS tissue did not reveal protozoa or consistent degenerative or inflammatory changes. CONCLUSIONS AND CLINICAL RELEVANCE: Administration of ponazuril every 7 days, but not every 14 days, significantly decreased intrathecal anti-S neurona antibody responses in horses inoculated with S neurona sporocysts. Protocols involving intermittent administration of ponazuril may have application in prevention of EPM.     

Sarcocystis myositis and vitamin E deficiency in a Gypsy Vanner stallion suspected of having equine motor neuron disease

A 3-year-old Gypsy Vanner stallion was presented for evaluation of intermittent recumbency, muscle fasciculations, weakness, low head carriage, shifting of weight between the hindlimbs and an elevated tail head. History, physical examination and serum alpha tocopherol concentrations were suggestive of vitamin E deficiency and equine motor neuron disease (EMND). Sacrocaudalis dorsalis medialis muscle biopsy identified myositis secondary to sarcocystosis. Treatment with alpha tocopherol, ponazuril and sulfadiazine/pyrimethamine resulted in significant improvement in muscle weakness and body condition with resolution of sarcocystosis and inflammation on repeat muscle biopsy. This case illustrates the importance of muscle biopsy in horses with neuromuscular disease as concurrent diseases may be present that require specific treatment for a positive outcome.     

Equine Protozoal Myeloencephalitis: An Updated Consensus Statement with a Focus on Parasite Biology,Diagnosis, Treatment,and Prevention

Equine protozoal myeloencephalitis (EPM) remains an important neurologic disease of horses. There are no pathognomonic clinical signs for the disease. Affected horses can have focal or multifocal central nervous system (CNS) disease. EPM can be difficult to diagnose antemortem. It is caused by either of 2 parasites, Sarcocystis neurona and Neospora hughesi, with much less known about N. hughesi. Although risk factors such as transport stress and breed and age correlations have been identified, biologic factors such as genetic predispositions of individual animals, and parasite‐specific factors such as strain differences in virulence, remain largely undetermined. This consensus statement update presents current published knowledge of the parasite biology, host immune response, disease pathogenesis, epidemiology, and risk factors. Importantly, the statement provides recommendations for EPM diagnosis, treatment, and prevention.     

Idiopathic Polyneuropathy in Alaskan Malamutes

Clinical and morphologic features of a progressive polyneuropathy in young mature Alaskan Malamutes are described. Clinical signs included progressive paraparesis, synchronous pelvic limb gait, exercise intolerance, hyperesthesia, hypore-flexia, muscle atrophy, and tetraplegia. Electromyographic testing revealed diffuse fibrillation potentials and positive sharp waves in limb muscles, especially in muscles below the elbow and stifle. Pathologic findings in skeletal muscles and peripheral nerves included neurogenic muscle atrophy, focal or diffuse loss of myelinated nerve fibers, myelinoaxonal necrosis, and variable demyelination or remyelination.
Ultrastructural changes included axonal degeneration, presence of numerous Büngner bands, and denervated Schwann cell subunits. The nature and distribution of abnormal electrophysiologic and pathologic findings were suggestive of a distal sensorimotor polyneuropathy, which we have termed idiopathic polyneuropathy of Alaskan Malamutes to distinguish this condition from hereditary polyneuropathy of Norwegian Alaskan Malamutes, last described in 1982.     

Diagnosis of Equine Protozoal Myeloencephalitis Using Indirect Fluorescent Antibody Testing and Enzyme-Linked Immunosorbent Assay Titer Ratios for Sarcocystis neurona and Neospora hughesi

The aim of this study was to compare two serologic tests used to support a diagnosis of equine protozoal myeloencephalitis (EPM). Serum and cerebrospinal fluid (CSF) samples were analyzed for antibodies to Sarcocystis neurona and Neospora hughesi by indirect fluorescent antibody testing (IFAT) and surface antigens of S. neurona and N. hughesi by enzyme-linked immunosorbent assay (ELISA). The samples originated from neurologic horses with confirmed and suspected EPM (nine S. neurona, three N. hughesi), from neurologic horses with confirmed neurologic diseases other than EPM (16 horses) and from healthy horses (10). The IFAT on CSF and ELISA titer ratios showed equal sensitivity in diagnosing EPM caused by S. neurona. The ELISA titer ratios showed slightly greater specificity in diagnosing EPM than the IFAT on CSF. Overall agreement between the IFAT on CSF and ELISA titer ratio was 90.9%. The IFAT on CSF and ELISA serum/CSF ratio are indicated to help support a laboratory diagnosis of EPM.     

Canine hip dysplasia: clinical signs and physical diagnosis.

Clinical signs of hip dysplasia include lameness, gait abnormalities, reluctance to exercise, and pelvic limb muscle atrophy with compensatory shoulder muscle hypertrophy. Because these clinical signs are not pathognomonic for CHD, a thorough orthopedic and neurologic examination is recommended for all patients with suspected CHD. Specific maneuvers, including the Barlow, Ortolani, and Barden's signs are useful to characterize the degree of coxofemoral laxity, both as screening tools in young puppies and as diagnostic aids in clinically lame dogs. None of the signs are definitive diagnostic tests for CHD, but they should be performed as sequential maneuvers in the veterinarian's workup for suspected CHD. Pelvic radiography is mandatory to definitively diagnose CHD but should not be the first step in the workup, because other diagnoses may be missed or concurrent conditions may coexist with dysplasia.     

Perception of Equine Practitioners Regarding the Occurrence of Selected Equine Neurologic Diseases in the Northeast Over a 10-Year Period

A survey was developed to examine the perception of equine practitioners regarding the occurrence of five equine neurologic diseases in the northeastern United States over the 10-year period between June 1, 1997 and June 1, 2007. This information was then compared with trends at Cornell University's Equine Hospital during the same time span, which in general agreed with practitioners' opinions. Equine herpes virus-1 (EHV-1) neurologic disease, equine motor neuron disease (EMND), and equine protozoal myelitis (EPM) have historic and current relevance. Results showed that the frequency of EMND and EPM has remained relatively stationary or decreased somewhat, whereas the frequency of the neurologic strain of EHV-1 may have increased slightly over the last decade. Less historical information on clinical disease associated with Borrelia burgdorferi infection (Lyme disease) and Parelaphostrongylus tenuis exists; however, results suggest that P. tenuis in the equine is presently emergent. Opinions regarding the existence and rate of occurrence of clinical borreliosis in horses appear divided. A better understanding of the frequency with which these diseases occur, as well as possible associated positive risk factors, will aid the equine practitioner in making an appropriate diagnosis in cases of neurologic disease in their equine patients.     

Effects of clopidogrel and aspirin on platelet aggregation, thromboxane production, and serotonin secretion in horses

Background: Critically ill horses are susceptible to thrombotic disease, which might be related to increased platelet reactivity and activation. Objectives: To compare the effect of oral clopidogrel and aspirin (ASA) on equine platelet function. Animals: Six healthy adult horses. Methods: Horses received clopidogrel (2 mg/kg PO q24h) or ASA (5 mg/kg PO q24h) for 5 days in a prospective randomized cross‐over design. Platelet aggregation responses to adenosine diphosphate (ADP) and collagen via optical aggregometry, and platelet secretion of serotonin (5HT) and production of thromboxane B₂ (TXB₂) by ELISA were evaluated. In horses receiving clopidogrel, high‐performance liquid chromatography analysis for clopidogrel and its carboxylic‐acid metabolite SR 26334 was performed. Results: SR 26334 was identified in all clopidogrel‐treated horses, although the parent compound was not detected. Clopidogrel resulted in decreases in ADP‐induced platelet aggregation persisting for 120 hours after the final dose. ADP‐induced platelet aggregation decreased from a baseline of 70.2 ± 14.7% to a minimum of 15.9 ± 7.7% 24 hours after the final dose (P < .001). Collagen‐induced aggregation decreased from a baseline of 93 ± 9.5% to a minimum of 70.8 ± 16.9% 48 hours after the final dose (P < .001). ASA did not decrease platelet aggregation with either agonist. ASA decreased serum TXB₂ from a baseline value of 1310 ± 1045 to 128 ± 64 pg/mL within 24 hours (P < .01). Conclusions and Clinical Importance: Clopidogrel effectively decreases ADP‐induced platelet aggregation in horses, and could have therapeutic applications for equine diseases associated with platelet activation.     

Equine Protozoal Myeloencephalitis

Gathering information about Equine Protozoal Myeloencephalitis (EPM) was identified by the equine industry as one of the highest priorities for the NAHMS Equine '98 study. Overall, 59.8 percent of owners/operators interviewed had never heard of EPM, and only 9.5 percent considered themselves knowledgeable about this disease. EPM was reported to have occurred on 1.0 percent of operations in the year prior to the study and on 3.3 percent of operations at any point in the operation's history. The incidence of EPM was estimated in the year prior to the study to be 14 new cases per 10,000 horses per year. The majority of operations where EPM was reported had only identified a single case at any time during their history. While this study was based on owner/operator reports of disease, 95.0 percent of cases recognized during the year prior to this study were diagnosed by a veterinarian. Onset of disease was reported most commonly to occur during the summer or fall. The most common signs reported in cases occurring during the previous year were ataxia, limb weakness, lameness, and muscle atrophy. The most common methods used to diagnose EPM in these horses were recognition of clinical signs, serology, and CSF analysis. Among the last cases recognized on operations for which duration of illness was at least 3 months, 39.7 percent were reported to recover completely, 37.4 percent improved but did not completely recover, 14.4 percent were sold or given away because they had EPM, and 7.1 percent died or were euthanatized because of EPM. For those EPM cases that completely recovered, relapsed following improvement and showed no improvement after at least 3 months' duration, the average number of days of lost use was 244 days. For those EPM cases that died because of EPM, an estimated 9.2 years of use were lost. Excluding cases that were less than 3 months in duration, the geometric mean cost to operations for diagnostic testing, veterinary care, and medications provided for the last diagnosed case of EPM was $790. EPM was reported to occur rarely in this study population, despite the use of owner reports to measure disease occurrence. Veterinarians were almost always employed in the diagnosis of this disease for cases occurring in the previous year. Despite its rare occurrence, this disease is a very serious health problem in affected horses and only about 40 percent of affected horses were reported to have recovered completely. Equine protozoal myeloencephalitis (EPM) is a serious and often fatal neurologic disease of equids.^1-6 Ammals affected by EPM can demonstrate a variety of clinical abnormalities, and signs can vary tremendously in severity. Classically, horses with EPM develop a variety of asymmetric neurologic deficits including gait abnormalities, ataxia, weakness, and focal muscle wasting.^4-6 However, symmetric neurologic abnormalities are also seen frequently. The disease may be focal or multifocal in nature and may be manifested less frequently as a head tilt, facial paralysis, seizures, or even apparent behavioral changes.^4-6 Horses of all ages can be affected, but horses are usually at least 6 months old when first diagnosed with EPM.     

Reduced tongue tone associated with degeneration of the hypoglossal nerve nucleus in a horse with equine motor neuron disease

Equine motor neuron disease (EMND) is a condition characterised by generalised weakness and muscle atrophy associated with degeneration of motor neurons in the ventral horns of the spinal cord. Despite the frequent detection of cranial nerve nuclei pathology during post mortem examination, associated clinical signs are rarely reported. This report describes a case of EMND in a pony gelding that presented with clinical signs of diffuse neuromuscular weakness associated with marked flaccidity of the tongue, making differentiation from similar neuromuscular conditions, particularly botulism, extremely challenging.     

Ocular manifestations of equine motor neuron disease

The characteristics of the ocular manifestations of equine motor neuron disease (EMND) are described. Forty-two horses with histories, clinical signs and necropsies compatible with EMND were the subjects of this study. Ophthalmoscopic lesions that varied in severity were found in 40 of 42 horses and appeared as a distinct pigmented reticulated pattern at the tapetal-nontapetal junction or throughout the fundus, depending upon severity. The pattern colours ranged from yellow brown to black. Areas of hyperreflectivity formed mosaic patterns in the tapetal fundus. ERG B-wave amplitudes were usually at least 50% reduced and many animals showed extinguished amplitudes. None of the horses had apparent visual impairment. Histopathologically, all 42 horses had retinal pigment epithelial (RPE) congestion with ceroid-lipofuscin. Retinal degeneration was variable even within the eyes. Thin layer chromatography (TLC) analysis of the RPE and neural retina identified both green and orange emitting fluorescent compounds not found in normal horses. All unsupplemented horses had plasma vitamin E levels <1.0 microg/ml. The potential significance of this report is the pathognomonic role the ocular manifestations exhibit in helping to diagnose equine motor neuron disease.     

Are mule pregnancies really longer than equine pregnancies? Comparison between mule and equine pregnancies

In equine management, it is important to predict the approximate foaling date of mares to monitor parturition and allow early identification and intervention of problems during the perinatal period. There are no studies comparing accurate gestational length (GL) when mares are carrying mule foals and no controlled comparisons between GL of mares pregnant with equine or mule foals. Therefore, the objectives of this study were to compare GL of mares pregnant with equine or mule foals and establish normal reference values for GL of mares pregnant with male and female mules. Gestational length of Mangalarga Paulista breed mares pregnant with equine (n = 54) or with mule (n = 54) foals during the breeding seasons of 2007 to 2016 was evaluated. The mean GL was 347.2 ± 1.4 days (range of 326–368 days) and 341.1 ± 1.6 days (range of 307–360 days) for equine and mule pregnancies, respectively. The normal GL reference for mule pregnancies was 316.9–365.3 days. Therefore, GL of equine pregnancies was longer than of mule pregnancies. Gestational length was not different when pregnancies resulted in females or males within each group. This study established an important reference value for normal GL of mule pregnancies, which can be used by practitioners to estimate and predict foaling dates more accurately.     

Antibody coefficients for the diagnosis of equine protozoal myeloencephalitis

Background: Diagnosis of equine protozoal myeloencephalitis (EPM) remains a challenge for equine practitioners. Current utilized methods have inadequate sensitivity and specificity, because of a high number of false positive results. Hypothesis/Objective: Evaluation of antibody indices to Sarcocystis neurona should provide high sensitivity and specificity for diagnosis of EPM. Animals: Archived samples from 29 clinical patients. Methods: Archived serum and cerebrospinal fluid (CSF) samples from clinical patients with either EPM (14) or cervical vertebral compressive myelopathy (CVM) (15) were examined and tested for anti‐S. neurona antibodies by the SnSAG2 ELISA. The results were used to calculate the antibody index (AI) and C‐value. Sensitivity and specificity were calculated, and the AI, C‐value, immunoglobulin G (IgG) concentrations, and anti‐S. neurona titers compared. In addition, negative CSF was spiked in varying concentrations with blood from a horse with a high anti‐S. neurona titer, and the tests repeated. Results: Results demonstrated that the IgG concentration, anti‐S. neurona titer, AI, and C‐value were significantly higher (P < .05) in horses with EPM than in those with CVM. Sensitivity and specificity of the AI was 71 and 100%, respectively, and that of the C‐value was 86 and 100%, respectively. In addition, the AI and C‐value from the samples spiked with S. neurona positive blood remained below 1 (eg, negative) in CSF with a red blood cell (RBC) count up to 10⁵ RBC/μL. Conclusions/Clinical Importance: Results of the study demonstrate the value of calculating the AI and C‐value in the diagnosis of EPM in horses. In addition, the test is robust in the presence of blood contamination.     

Spinal cord granuloma due to Coccidioides immitis in a cat

A6-year-old 5.5-kg female spayed domestic short-haired cat from Tucson, AZ, presented with an ˜5-day history of progressive pelvic limb weakness. The owners had returned from a weekend away to find the cat unable to use her left pelvic limb. Approximately 2 months previously, the cat had a cough and was treated for presumptive asthma with 5 mg prednisone PO q24h. The cat had a similar cough 1 year previously and seasonal allergy was suspected. The cough resolved and prednisone treatment was discontinued. Other past pertinent history included a skin problem ˜4 years previously that was described as alopecia, erythema, and pruritus of a pelvic limb. This problem had been diagnosed as an allergy and had since resolved. The cat was housed exclusively indoors and had been adopted as a kitten from a local retail store. Viral titers (FeLV and FIV) were negative, and regular vaccinations and veterinary examinations had been completed     

Clinical and pathologic findings in two draft horses with progressive muscle atrophy, neuromuscular weakness, and abnormal gait characteristic of shivers syndrome

Two Belgian geldings, 4 and 14 years old, respectively, with muscle atrophy, weakness, and abnormal gait characteristic of severe advanced shivers were examined clinically and on necropsy. Neurologic examination revealed no evidence of ataxia, and the clinical diagnosis was neuromuscular weakness and shivers. Necropsies of both horses, including examination of pituitary, brain, spinal cord, spinal roots and ganglia, and peripheral nerves, revealed no gross or histologic abnormalities. Examination of multiple skeletal muscle specimens revealed chronic myopathic changes and periodic acid-Schiff positive, amylase-resistant inclusions within muscle fibers, characteristic of equine polysaccharide storage myopathy. It is suggested that underlying metabolic myopathy may be the cause of muscle weakness and cramping in horses with shivers.     

Storage‐associated artefact in equine muscle biopsy samples

Reasons for performing study: Muscle biopsy is increasingly used in equine veterinary practice for investigating exertional, inflammatory or immune mediated myopathies and unexplained muscle atrophy. Although formalin‐fixed samples are often used, for complete evaluation, fresh‐frozen tissue is required. Freezing muscle in veterinary practice is impractical: samples sent to specialist laboratories for processing are therefore susceptible to delays, potentially leading to artefact and compromising histological interpretation. Hypothesis: Altered temperature, duration and hydration status influence the severity of storage‐induced artefact in equine muscle. Methods: Skeletal muscle obtained immediately post euthanasia was divided into 6 independent samples from each of 8 horses. One sample per horse was frozen immediately in isopentane precooled in liquid nitrogen. Additional samples were stored in conditions designed to mimic possible situations encountered in practice, including increased storage times, temperature and hydration status. Following storage, stored samples were frozen as before. Cryosections were stained using haematoxylin and eosin and ranked for artefact on 2 occasions by 2 blinded observers. The best samples were processed subsequently with a panel of routine stains and immunolabelled for collagen V to enable the measurement of minimum fibre diameters. Results: Both prolonged storage and increased hydration resulted in more storage‐associated artefact. Samples stored for 24 h chilled on dry gauze were ranked higher than those stored on damp gauze; however, a panel of routinely‐used histochemical staining techniques was unaffected by chilled 24 h storage. There was no significant effect of storage on mean fibre diameter; however, both chilled dry and damp storage for 24 h caused a significant increase in fibre‐size variability. Conclusion and potential relevance: Caution should be exercised when interpreting fibre size profiles in shipped samples. Equine muscle biopsy samples are optimally shipped in dry gauze, sealed in plastic containers and shipped on ice packs to be processed within 24 h and can thus be interpreted by the receiving laboratory with minimal artefact.     

Osteosarcoma in the proximal humerus of a mare

A 15‐year‐old Quarter Horse mare was examined for significant and progressive lameness in the right front limb. On physical examination, muscle atrophy over the scapular and pectoral regions were noted. A pain response was elicited on palpation of the scapulohumeral joint. No other abnormalities were noted on examination of the limb. Diagnostic nerve blocks ruled out a source of lameness in the distal limb. Arthrocentesis of the scapulohumeral joint was performed and results were within normal limits. Radiographs of the right scapulohumeral joint revealed an extensive, aggressive bone lesion in the proximal humerus, suspected to be an osteosarcoma. After a course of nonsteroidal anti‐inflammatory therapy, minimal improvement to the lameness was noted. The owner elected to subject the horse to euthanasia due to the lack of significant response to treatment. Post mortem radiographic and histological examinations determined a definitive diagnosis of an osteosarcoma in the proximal humerus.     

Concentrations of trace minerals in the spinal cord of horses with equine motor neuron disease

OBJECTIVE: To compare concentrations of trace minerals in the spinal cord of horses with equine motor neuron disease (EMND) with those of horses without neurologic disease (control horses). ANIMALS: 24 horses with EMND and 22 control horses. PROCEDURE: Spinal cord trace mineral concentrations in horses with EMND and control horses were analyzed by use of inductively coupled plasma atomic emission spectroscopy (calcium, phosphorus, sodium, potassium, magnesium, copper, iron, manganese, nickel, zinc, aluminum, cobalt, and chromium), atomic absorption spectrophotometry (lead and cadmium), flameless atomic absorption (mercury), and fluorometry (selenium). RESULTS: Copper concentration was significantly higher in the spinal cord of horses with EMND, compared with control horses; spinal cord concentrations of all other trace minerals were similar between groups. CONCLUSION AND CLINICAL RELEVANCE: Among spinal cord trace minerals investigated in the study, only copper concentrations were significantly different between horses with EMND and horses without neurologic disease, which suggests that copper may be involved in the pathogenesis of EMND. An hypothesis of oxidative injury in this disease is supported by the finding of increased copper concentrations in the spinal cord and by low vitamin E concentrations reported by other researchers.     

The pharmacokinetics and in vitro cyclooxygenase selectivity of deracoxib in horses

Davis, J. L., Marshall, J. F., Papich, M. G., Blikslager, A. T., Campbell, N. B. The pharmacokinetics and in vitro cyclooxygenase selectivity of deracoxib in horses. J. vet. Pharmacol. Therap. 34 , 12–16. The purpose of this study was to determine the pharmacokinetics of deracoxib following oral administration to horses. In addition, in vitro equine whole blood cyclooxygenase (COX) selectivity assays were performed. Six healthy adult horses were administered deracoxib (2 mg/kg) orally. Plasma samples were collected prior to drug administration (time 0), and 10, 20, 40 min and 1, 1.5, 2, 4, 6, 8, 12, 24, and 48 h after administration for analysis with high pressure liquid chromatography using ultraviolet detection. Following PO administration, deracoxib had a long elimination half‐life (t_1/2k₁₀) of 12.49 ± 1.84 h. The average maximum plasma concentration (C_max) was 0.54 μg/mL, and was reached at 6.33 ± 3.44 h. Bioavailability was not determined because of the lack of an IV formulation. Results of in vitro COX selectivity assays showed that deracoxib was selective for COX‐2 with a COX‐1/COX‐2 ratio of 25.67 and 22.06 for the IC₅₀ and IC₈₀, respectively. Dosing simulations showed that concentrations above the IC₈₀ for COX‐2 would be maintained following 2 mg/kg PO q12h, and above the IC₅₀ following 2 mg/kg PO q24h. This study showed that deracoxib is absorbed in the horse after oral administration, and may offer a useful alternative for anti‐inflammatory treatment of various conditions in the horse.