title: Epizootic of equine protozoal myeloencephalitis on a farm.
abstract: OBJECTIVE
  To determine the clinical findings, course of treatment, and long-term outcome of horses on a farm in central Kentucky during an epizootic of equine protozoal myeloencephalitis (EPM).
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  21 horses on a farm in central Kentucky, 12 of which developed clinical signs of EPM.
  
  
  METHODS
  Horses on the farm were serially examined for signs of neurologic disease and serum and CSF antibodies to Sarcocystis neurona. Horses were considered to have EPM if they had neurologic signs and positive test results for antibodies to S neurona in CSF. Blood values were monitored for evidence of abnormalities resulting from long-term pyrimethamine and trimethoprim-sulfamethoxazole administration Physical, neurologic, and fetal necropsy examinations were performed as needed. Horses were treated for EPM until they had negative test results for CSF antibodies to S neurona.
  
  
  RESULTS
  Of 21 horses on the farm, 12 had EPM over the course of 6 months. The duration of treatment ranged from 45 to 211 days, excluding 1 horse that persistently had CSF antibodies to S neurona. Adverse effects from pyrimethamine and trimethoprim-sulfamethoxazole administration included transient fever, anorexia, and depression (n = 2); acute worsening of ataxia (2); mild anemia (4); and abortions (3).
  
  
  CONCLUSIONS
  EPM may develop as an epizootic. In the horses of this report subtle clinical signs that were originally considered unimportant ultimately progressed to obvious neurologic signs. Adverse effects associated with EPM treatment included worsening of neurologic signs, anemia, abortion, and leukopenic and febrile episodes.
authors.affiliation: Department of Veterinary Science, College of Agriculture, University of Kentucky, Lexington 40546, USA.
authors.forename: C K
authors.initials: CK
authors.lastname: Fenger
authors.forename: D E
authors.initials: DE
authors.lastname: Granstrom
authors.forename: J L
authors.initials: JL
authors.lastname: Langemeier
authors.forename: S
authors.initials: S
authors.lastname: Stamper
mesh_terms: D000818:Animals; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000913:Antibodies, Protozoan / Q000097:blood / Q000134:cerebrospinal fluid; D000962:Antimalarials / Q000009:adverse effects / Q000627:therapeutic use; D003002:Clonixin / Q000031:analogs & derivatives / Q000627:therapeutic use; D015331:Cohort Studies; D004196:Disease Outbreaks / Q000662:veterinary*; D004679:Encephalomyelitis / Q000188:drug therapy / Q000453:epidemiology / Q000662:veterinary*; D005260:Female; D006734:Horse Diseases / Q000188:drug therapy / Q000453:epidemiology*; D006736:Horses; D007629:Kentucky / Q000453:epidemiology; D008297:Male; D009460:Neurologic Examination / Q000662:veterinary; D011739:Pyrimethamine / Q000009:adverse effects / Q000627:therapeutic use; D012522:Sarcocystis / Q000276:immunology; D012523:Sarcocystosis / Q000188:drug therapy / Q000453:epidemiology / Q000662:veterinary*; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000913:Antibodies, Protozoan; D000962:Antimalarials; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; C014558:flunixin meglumine; D003002:Clonixin; D011739:Pyrimethamine