Anthelmintic resistance in equine helminths and mitigating its effects

Horse and donkey parasitology: differences and analogies for a correct diagnostic and management of major helminth infections

In June 2022, at the XXXII Conference of the Italian Society of Parasitology, the parallels of the main endoparasitic infections of horses and donkeys were discussed. Although these 2 species are genetically different, they can be challenged by a similar range of parasites (i.e. small and large strongyles, and Parascaris spp.). Although equids can demonstrate some level of resilience to parasites, they have quite distinct helminth biodiversity, distribution and intensity among different geographical locations and breeds. Heavily infected donkeys may show fewer clinical signs than horses. Although parasite control is primarily provided to horses, we consider that there may be a risk of drug-resistance parasitic infection through passive infection in donkeys when sharing the same pasture areas. Knowing the possible lack of drug efficacy (<90 or 80%), it is advocated the use of selective treatment for both species based on fecal egg counts. Adult horses should receive treatment when the threshold exceeds 200–500 eggs per gram (EPG) of small strongyles. Moreover, considering that there are no precise indications in donkeys, a value >300 EPG may be a safe recommendation. We have highlighted the main points of the discussion including the dynamics of helminth infections between the 2 species.

Epidemiological study on factors influencing the occurrence of helminth eggs in horses in Germany based on sent-in diagnostic samples

Gastrointestinal nematodes are ubiquitous parasites of grazing equines with Parascaris spp., and strongyles being the most relevant ones regarding the prevalence and potential disease severity. Despite their importance, epidemiological data regarding the presence and egg-shedding intensities of these parasites are scarce. Data from 1067 horse samples collected on German horse farms initially to compare diagnostic methods were used for epidemiological analyses. Due to its higher sensitivity, presence/absence data were based on a combined sedimentation/flotation technique while faecal egg counts were based on Mini-FLOTAC. For strongyles, 46.5% of the samples were positive and the median egg-shedding intensity was 40 (range 5-2590). In multivariate analyses, prevalence and egg-shedding intensity were significantly influenced by season, age group and sample type. The drug used for the last treatment and the number of foals on the yard only affected prevalence while the number of horses on the yard and sex were only significant for egg-shedding intensity. For Parascaris spp., a prevalence of 4.6% and a median egg-shedding intensity of 0 (range 5-905) were observed. In multivariate analyses, the age group, the time since the last anthelmintic treatment, presence and number of foals had significant effects on ascarid prevalence whereas egg-shedding intensity was significantly influenced by age group and season only. Parascaris occurred only on yards with foals, but with an increasing number of foals, Parascaris egg-shedding intensity decreased. Prevalence and egg-shedding intensity were influenced by different but partially overlapping variables for Parascaris and strongyles.

Comparison of FECPAKG2, a modified Mini-FLOTAC technique and combined sedimentation and flotation for the coproscopic examination of helminth eggs in horses

Background

Due to high prevalence of anthelmintic resistance in equine helminths, selective treatment is increasingly promoted and in some countries a positive infection diagnosis is mandatory before treatment. Selective treatment is typically recommended when the number of worm eggs per gram faeces (epg) exceeds a particular threshold. In the present study we compared the semi-quantitative sedimentation/flotation method with the quantitative methods Mini-FLOTAC and FECPAK^G2 in terms of precision, sensitivity, inter-rater reliability and correlation of worm egg counts to improve the choice of optimal diagnostic tools.

Methods

Using sedimentation/flotation (counting raw egg numbers up to 200), we investigated 1067 horse faecal samples using a modified Mini-FLOTAC approach (multiplication factor of 5 to calculate epgs from raw egg counts) and FECPAK^G2 (multiplication factor of 45).

Results

Five independent analyses of the same faecal sample with all three methods revealed that variance was highest for the sedimentation/flotation method while there were no significant differences between methods regarding the coefficient of variance. Sedimentation/flotation detected the highest number of samples positive for strongyle and Parascaris spp. eggs, followed by Mini-FLOTAC and FECPAK^G2. Regarding Anoplocephalidae, no significant difference in frequency of positive samples was observed between Mini-FLOTAC and sedimentation/flotation. Cohen’s κ values comparing individual methods with the combined result of all three methods revealed almost perfect agreement (κ ≥ 0.94) for sedimentation/flotation and strong agreement for Mini-FLOTAC (κ ≥ 0.83) for strongyles and Parascaris spp. For FECPAK^G2, moderate and weak agreements were found for the detection of strongyle (κ = 0.62) and Parascaris (κ = 0.51) eggs, respectively. Despite higher sensitivity, the Mini-FLOTAC mean epg was significantly lower than that with FECPAK^G2 due to samples with > 200 raw egg counts by sedimentation/flotation, while in samples with lower egg shedding epgs were higher with Mini-FLOTAC than with FECPAK^G2.

Conclusions

For the simple detection of parasite eggs, for example, to treat foals infected with Parascaris spp., sedimentation/flotation is sufficient and more sensitive than the other two quantitative investigared in this study. Mini-FLOTAC is predicted to deliver more precise results in faecal egg count reduction tests due to higher raw egg counts. Finally, to identify animals with a strongyle epg above a certain threshold for treatment, FECPAK^G2 delivered results comparable to Mini-FLOTAC.

Grpahical Abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s13071-022-05266-y.

Novel Equine Faecal Egg Diagnostics: Validation of the FECPAKG2

Simple Summary

Faecal egg counts (FECs) are the standard method of diagnosing the level of intestinal parasites in horses and other grazing animals. Testing before treatment is an important factor in slowing the appearance of drug resistance in these parasites. The FECPAK^G2, optimised for livestock, allows owners to perform FECs by tapping into remote expertise. However, the performance of the FECPAK^G2 has yet to be assessed for equids. Therefore, a comparison of the FECPAK^G2(G2) method with an accepted non-remote equine FEC method (FECPAK^G1) was performed, using samples of faeces from horses in Wales and New Zealand. The FECPAK^G2 performed equally as well as the control method (FECPAK^G1), and this was true regardless of the data’s country of origin. The mean percentage accuracy of the G2 test compared to the control values was 101%. The relative accuracy of the G2 method compared to the control method was not affected by the level of infection and it was concluded that the FECPAK^G2 method is suitable for performing FECs in horses. It is anticipated that the user-friendliness of the method will increase the uptake of FECs amongst horse owners by the direct use of the technology or through their veterinary practice, likely slowing the development of anthelmintic resistance.

Abstract

Faecal egg counts (FECs) are the standard method of diagnosing the level of parasitic helminth egg shedding in horses and other grazing animals. Testing before treatment is an important factor in slowing the appearance of anthelmintic resistance in nematode parasites. The FECPAK^G2, optimised for livestock, is reported to allow owners to perform FECs on their own animals without the need for a separate microscope or any specialist knowledge by tapping into remote expertise. However, the performance of the FECPAK^G2 has yet to be assessed for equids. Therefore, a comparison of the FECPAK^G2 (G2) method with an accepted equine FEC method (FECPAK^G1(G1)) was performed, using faecal samples from 57 horses in Wales and 22 horses in New Zealand. There was a significant correlation between the FECs obtained by the two methods (p < 0.001) and no effect of the country of origin on the data (p = 0.157). The mean percentage accuracy compared to the control values (mean G2 count as a percentage of the mean G1 count, ±SStandard Error (SE)) was 101 ± 4%. There was no significant interaction between the method applied and the country of origin of the data (p = 0.814). The relative accuracy of the G2 method compared to the control method (FECPAK^G1) was not affected by the level of infection (p = 0.124) and it was concluded that the FECPAK^G2 method is a suitable method of performing FECs in horses. It is anticipated that the user-friendliness of the method will increase the uptake of FECs amongst horse owners, either by the direct use of the technology or through their veterinary practice, likely slowing the development of anthelmintic resistance.

Characterisation of serum IgG(T) responses to potential diagnostic antigens for equine cyathostominosis

Cyathostomins are ubiquitous parasitic nematodes of horses. These worms spend substantial periods as intestinal wall stage encysted larvae, which can comprise up to 90% of the total burden. Several million larvae have been reported in individuals. Emergence of these larvae from the gut wall can lead to life-threatening colitis. Faecal egg count tests, increasingly used by horse owners to inform anthelmintic treatments, do not correlate with the intra-host burden of cyathostomins; this represents a key gap in the diagnostic toolbox. Previously, a cyathostomin Gut Associated Larval Antigen was identified as a promising marker for the intra-host stages of infection. Here, cyathostomin Gut Associated Larval Antigen and an additional protein, Cyathostomin Immuno-diagnostic antigen, were investigated to examine their value in providing information on cyathostomin burden. ELISA analyses examined serum IgG(T) responses to recombinant proteins derived from individual cyathostomin species. Receiver Operator Characteristic curve analysis was performed on the ELISA data; proteins with the highest Area Under the Curve values were selected to test protein combinations to investigate which were the most informative in identifying the infection status of individuals. Three cocktail combinations were tested, comprising: (a) Cy-GALA proteins from two species and a Cy-CID protein from a third species (CT3), (b) Cy-GALA proteins from five species (CT5), and (c) all CT5 components, plus a Cy-CID protein from an additional species (CT6). The best predictive values for infection were obtained using CT3 and CT6, with similar values achieved for both. Proteins in CT3 are derived from the most commonly reported species, Cyathostomum catinatum, Cylicocyclus nassatus and Cylicostephanus longibursatus. This combination was selected for future development since it represents a more commercially viable format for a diagnostic test.

Fatal Peritoneal Migration of Strongylus edentatus in a Foal

A 7-month-old female mixed breed foal with a 2-day history of recumbency and inability to open its mouth convulsed acutely and died and was submitted for necropsy examination. The foal was thin and large patches of haemorrhage were present throughout the peritoneal wall, the diaphragmatic surfaces and the retroperitoneum. Numerous nematode larvae were visible on the serosal surfaces and penetrated and embedded into the subserosa associated with the haemorrhages. The dorsal portion of the abdominal diaphragm had a partial tear and large numbers of nematodes were within the muscle fibres. Histologically, the larvae had a smooth cuticle, polymyarian/coelomyarian musculature and multinucleated intestinal cells, and were typically surrounded by haemorrhage, neutrophils, dense fibrovascular connective tissue and rare multinucleated giant cells. Parasitological examination identified the larvae as Strongylus edentatus based on the morphology of the buccal capsule. Additionally, there was severe muscle necrosis of the tongue and liver tissue analysis detected selenium deficiency. S. edentatus infections are uncommon in California, USA, and are typically non-lethal. In this case, the selenium deficiency may have led to immunosuppression, resulting in the hyperinfection with S. edentatus, and to the muscle damage and tear of the diaphragm. Although ivermectin treatment was indicated in the history, inadequate deworming or anthelmintic resistance may have played a role in the severity of infection.

Preliminary Observations of the Effect of Garlic on Egg Shedding in Horses Naturally Infected by Intestinal Strongyles

Intestinal strongyles are the most common endoparasites of horses, and anthelmintic treatments are the main strategy to control these nematodes. However, the development of anthelmintic resistance has led to a decreased efficacy of synthetic drugs, and for this reason, there is a growing interest in alternative control strategies as the use of medicinal plants. The aim of the present study was to determine the in vivo efficacy of garlic (Allium sativum) in horses naturally infected by intestinal strongyles. The field trial was conducted in a horse trotter farm in Southern Italy. Fifteen mares were selected based on fecal egg count >200 eggs per gram and allocated into three groups of five animals: fresh garlic group (FG group), animals received 40 g of fresh crushed garlic once daily for 15 days; dry garlic group (DG group), animals received 40 g of commercial dry garlic flakes food supplement once daily for 15 days; and control group (C group), not treated. Two weeks after the first administration of garlic, fecal egg count reduction test showed failure of garlic to reduce intestinal strongyles egg shedding (-11.7% and -19.4% for FG and DG groups, respectively). Red blood cell count values were in the normal ranges over the entire period of garlic administration. In our study model, the oral administration of garlic formulations has no effect on reducing the egg shedding of intestinal strongyles, and the garlic supplementation over a short period of time is not responsible for hematological changes in horses.

Cyathostomine egg reappearance period following ivermectin treatment in a cohort of UK Thoroughbreds

BACKGROUND

In spite of the emergence of populations of drug-resistant cyathostomines worldwide, little is known of parasite species responsible for 'early egg shedding' in cohorts of horses subjected to treatment with widely used anthelmintics, e.g. ivermectin (IVM). In this study, we determined the cyathostomine egg reappearance period (ERP) after IVM treatment in a cohort of yearlings from a large Thoroughbred (TB) stud farm in the United Kingdom, and identified species of cyathostomines with reduced ERP using a combination of fundamental parasitology techniques coupled with advanced molecular tools.

METHODS

Individual faecal samples were collected from TB yearlings with cyathostomine infection prior to IVM treatment, as well as at 14, 21, 28, 35, 42 and 49 days post-treatment. Faecal egg counts (FEC) were performed for each individual sample for determination of ERPs. In addition, individual larval cultures were performed and representative numbers of third-stage larvae (L3s) harvested from each culture were subjected to molecular species identification via PCR-Reverse Line Blot (RLB).

RESULTS

Prior to IVM treatment, 11 cyathostomine species were detected in faecal samples from TB horses enrolled in this study, i.e. Cyathostomum catinatum, Cylicostephanus longibursatus, Cylicostephanus goldi, Cylicocyclus nassatus, Cylicostephanus calicatus, Cyathostomum pateratum, Cylicocyclus radiatus, Paraposteriostomum mettami, Coronocyclus labratus, Cylicocyclus insigne and Cylicocyclus radiatus variant A. Of these, eggs of Cya. catinatum, Cys. longibursatus, Cyc. nassatus and Cyc. radiatus could be detected at 28 days post-treatment, while from day 42 onwards, cyathostomine species composition reflected data obtained pre-IVM treatment, with the exception of eggs of Cor. labratus and Cyc. insigne which could no longer be detected post-IVM administration.

CONCLUSIONS

This study provides valuable data on the occurrence of IVM-resistance in cyathostomines in the UK. Nevertheless, further investigations are needed to shed light on the prevalence and incidence of drug-resistance in this country, as well as other areas of the world where equine trade is substantial.