Utility of 2 Immunological Tests for Antemortem Diagnosis of Equine Protozoal Myeloencephalitis (Sarcocystis neurona Infection) in Naturally Occurring Cases

Background: Antemortem diagnosis of equine protozoal myeloencephalitis (EPM) is challenging. Limited information is available regarding a commercial test (surface antigen 1 SAG‐1] ELISA). Performance of another commercial test (indirect fluorescent antibody test IFAT]) using samples from an independent group has not been well described. Hypothesis/Objectives: The primary goal was to evaluate the SAG‐1 ELISA and IFAT using naturally occurring EPM cases. A secondary goal was to obtain more information regarding clinical presentation. Animals: Hospital cases were admitted over 20 months and classified into 4 groups. Confirmed positive cases (n = 9) had asymmetric or multifocal neurologic deficits or both and postmortem lesions consistent with EPM. Confirmed negative cases (n = 17) had variable clinical signs and postmortem lesions consistent with another neurologic disease (or no lesions). Suspected positive cases (n = 10) had asymmetric or multifocal deficits or both, marked improvement after treatment for EPM, and other likely diseases excluded. Suspected negative cases (n = 29) had orthopedic disease and no neurologic deficits. Methods: Results of immunological testing (SAG‐1 ELISA and IFAT on serum or cerebrospinal fluid CSF] or both), neurologic examinations, CSF analyses, and postmortem examinations were analyzed retrospectively. Results: SAG‐1 ELISA sensitivity was 12.5% (95% CI, 1.6–38.4) and specificity was 97.1% (95% CI, 84.7–99.9) using serum. IFAT sensitivity was 94.4% (95% CI, 72.7–99.9) and specificity was 85.2% (95% CI, 66.3–95.8) using serum; sensitivity was 92.3% (95% CI, 64.0–99.8) and specificity was 89.7% (95% CI, 72.7–97.8) using CSF. Conclusions and Clinical Importance: Low sensitivity of the SAG‐1 ELISA limited its usefulness for antemortem diagnosis of EPM in this patient population.