Qualitative evaluation of selective tests for detection of Neospora hughesi antibodies in serum and cerebrospinal fluid of experimentally infected horses

The seroprevalence and risk factors for exposure to Neospora caninum and Neospora hughesi in Ontario broodmares

The seroprevalence and risk factors for exposure to Neospora caninum and Neospora hughesi in broodmares in Ontario were investigated. Sixty of the 219 (27.4%) study broodmares were seropositive for N. caninum and 65/219 (29.7%) for N. hughesi with cut-offs of ≥1:40 and ≥1:160, respectively. Thirty-one of 63 participating farms (49.2%) had at least 1 broodmare seropositive for N. caninum. Thirty-three of the 63 (52.4%) participating farms had at least 1 broodmare positive for N. hughesi. Risk factors for N. caninum included presence of farm dogs (OR = 6.70; 95% CI = 2.14-20.97; p = 0.001), and high stocking density (OR = 2.83; 95% CI = 1.27-6.30; p = 0.011). Presence of livestock, excluding cattle, was associated with reduced risk of exposure (OR = 0.17; 95% CI = 0.06-0.53; p = 0.002). The only risk factor for exposure to N. hughesi was feeding hay on the ground in the paddock (OR = 4.31; 95% CI = 1.65-11.22; p = 0.003). This study demonstrated widespread exposure to Neospora spp. in broodmares in Ontario.

Evidence of intrathecally-derived antibodies against Toxoplasma gondii in horses suspected of neurological disease consistent with equine protozoal myeloencephalitis

Among the recognized neurologic diseases in horses, equine protozoal myeloencephalitis (EPM) has been reported around the world and still presents challenges in diagnosis and treatment. Horses can present with clinical neurologic signs consistent with EPM while testing negative for the two main causative agents, Sarcocystis neurona or Neospora hughesi, and may still be clinically responsive to anti-parasitic drug therapy. This context led to our hypothesis that another protozoal parasite, Toxoplasma gondii, which is known to cause toxoplasmosis in other mammalian species, is a potential pathogen to cause neurologic disease in horses. To evaluate this hypothesis, serum and cerebrospinal fluid (CSF) were collected from 210 horses presenting with clinical signs compatible with EPM, and the indirect immunofluorescent antibody test (IFAT) was used to detect antibody titers for T. gondii, S. neurona, and N. hughesi. Additionally, the serum to CSF titer ratio was calculated for T. gondii, S. neurona, and N. hughesi infections, suggesting intrathecally-derived antibodies for each of the three agents if the serum:CSF ratio was ≤ 64. There were 133 (63.3%) horses positive for serum T. gondii antibodies using a cutoff titer of 160, and 31 (14.8%) positive for CSF T. gondii antibodies using a cutoff titer of 5. Overall, 21 (10.0%) of EPM-suspect horses had a serum:CSF ratio ≤ 64 for antibodies for T. gondii, while 43 (20.5%) and 8 (3.8%) horses had a serum to CSF ratio ≤ 64 for antibodies for S. neurona and N. hughesi, respectively. A total of 6 (2.9%) animals presented evidence of concurrent intrathecally-derived antibodies for T. gondii and at least one other apicomplexan parasite in this study. Signalment and clinical signs were not different across the groups aforementioned. These data provide evidence of intrathecal production of anti-T. gondii antibodies, indicative of T. gondii infection in the brain and/or spinal cord of horses with EPM-like disease.

Equine Protozoal Myeloencephalitis

Advances in the understanding of equine protozoal myeloencephalitis (EPM) are reviewed. It is now apparent that EPM can be caused by either of 2 related protozoan parasites, Sarcocystis neurona and Neospora hughesi, although S neurona is the most common etiologic pathogen. Horses are commonly infected, but clinical disease occurs only infrequently; the factors influencing disease occurrence are not well understood. Epidemiologic studies have identified risk factors for the development of EPM, including the presence of opossums and prior stressful health-related events. Attempts to reproduce EPM experimentally have reliably induced antibody responses in challenged horses, but have not consistently produced neurologic disease. Diagnosis of EPM has improved by detecting intrathecal antibody production against the parasite. Sulfadiazine/pyrimethamine (ReBalance) and the triazine compounds diclazuril (Protazil) and ponazuril (Marquis) are effective anticoccidial drugs that are now available as FDA-approved treatments for EPM.

Invited review: Sarcocystis neurona, Neospora spp. and Toxoplasma gondii infections in horses and equine protozoal myeloencephalitis (EPM): five decades of personal experience, perspectives, and update

Sarcocystis neurona, Neospora spp. and Toxoplasma gondii are related protozoans; they were considered the same parasite until 1970s. Two of these parasites, S. neurona and Neospora spp. are associated with a neurological syndrome in horses, called equine protozoal myeloencephalitis (EPM). The diagnosis and treatment of EPM are difficult. Most cases of EPM are related to S. neurona while only a few are due to Neospora spp. infections. There are two species of Neospora, Neospora caninum that has a wide host range and Neospora hughesi that has been found only in horses. Currently, T. gondii is not considered as a cause of EPM in horses, although it causes neurological illness in many other hosts, including humans. The present review provides an update on history, life cycle, diagnosis and treatment of these three infections in horses.

Neospora caninum, a cause of abortion in donkeys (Equus asinus) in Iran

Neospora caninum is an Apicomplexan parasite that can cause enormous economic losses due to abortions in cattle. The present study investigated the role of Neospora spp. infection in equine abortion in Iranian donkeys using molecular and phylogenetic analyses. Twenty-nine-aborted fetuses and 29 blood samples from their dams were collected from six different regions in the West and Northwest of Iran. They were tested for N. caninum by PCR at the Nc5 locus, followed by sequencing of five of the PCR products. The overall molecular prevalence was 34.5% in blood samples and the prevalence by DNA detection in the aborted fetuses was 13.8%. Evidence of transplacental transmission from positive jennies to their fetuses was detected in 40% of aborting jennies. Comparison of the five partial Nc5 sequences (227 bp length) exhibited 98-100% similarity with N. caninum GenBank sequences. This is the first molecular study and genetic characterization of N. caninum in Iranian donkeys suggests that N. caninum may be a significant cause of abortion in donkeys.

Detection of Neospora caninum Infection in Aborted Equine Fetuses in Israel

In horses, Neospora caninum and Neospora hughesi have been associated with fetal loss, and neurological disease, respectively. This study investigated the role of Neospora spp. infection in equine abortion in Israel. The presence of anti-Neospora spp. antibodies was evaluated in 31 aborting mares by indirect fluorescent antibody test (IFAT) and the presence of parasite DNA in their aborted fetuses was evaluated by polymerase chain reaction (PCR), using two target loci (ITS1 and Nc5). The seroprevalence found in aborting mares was 70.9% and the prevalence by DNA detection in the aborted fetuses was 41.9%. Transplacental transmission from positive mares to their fetuses was 45.4% (10/22), while 33.3% (3/9) of fetuses of seronegative mares also tested positive for Neospora. The use of two PCR targets improved the sensitivity of parasite detection, and positive samples were identified by sequence analyses as N. caninum. These finding suggest that N. caninum could be a significant cause of abortion in horses, and that transplacental transmission in horses is an important way of transmission of N.caninum. The results presented here demonstrated the necessity to use several tests concurrently, including serological and molecular assays in order to confirm the involvement of Neospora in mare abortions.

Global seroprevalence of Neospora spp. in horses and donkeys: A systematic review and meta-analysis

Neospora infections due to Neospora caninum and N. hughesi are prevalent among equids of the world. The disease may affect reproductive and neurological consequences. The present systematic review and meta-analysis was performed to evaluate the global Neospora seroprevalence among horses and donkeys. A number of 57 out of 1575 total retrieved studies were included by searching the PubMed, Scopus, Science Direct, Web of Science and ProQuest. A total of 25,783 horses and 4377 donkeys were examined serologically, yielding a weighted seroprevalence of 13.46 % (95 % CI: 10.26 %-17.42 %) globally. Subgroup analysis revealed that there were statistically significant differences in the overall prevalence of Neospora spp. in the examined animals according to year, continent, WHO region, country, host, and diagnostic method. Age and sex in horses as well as sex in donkeys were significantly associated with the Neospora seroprevalence (P < 0.001). Our findings showed a relatively high exposure to Neospora spp. in horses and donkeys worldwide. Considering the possible economic impact, as well as the importance in animal health, more studies are needed to clarify the species causing equine neosporosis, correlate serological findings with clinical outcomes and assess the risk factors, in order to define adequate prevention and control strategies.

Serological survey of Neospora spp. and Besnoitia spp. in horses in Portugal

Equine neosporosis is regarded to be caused either by Neospora hughesi or Neospora caninum and equine besnoitiosis is caused by Besnoitia bennetti, both of which are apicomplexan parasites. N. caninum is the only known Neospora species in Europe, where equine N. caninum infections have been reported as being associated to abortion and reproductive failure. N. hughesi is prevalent in North America and was predominantly linked to neurological disorders. B. bennetti is considered an emergent disease in donkeys in North America and evidence for B. bennetti infection was recently reported in Europe. Though N. caninum and Besnoitia besnoiti are prevalent in cattle in Portugal, little is known about neosporosis in horses and, to the best of our knowledge, no information was hitherto available for Besnoitia spp. The aim of this study was thus to carry out a serological survey to determine the seroprevalence of these parasites in naturally exposed horses in Portugal. A total of 385 animals were screened by the Indirect Fluorescent Antibody Test at the cut-off value 1:50 and positive results were confirmed by Western blot. Exposure to Neospora spp. and Besnoitia spp. was confirmed in 9.1% (95% Confidence Interval [CI]: 6.6-12.4%) and 0.3% (95% CI: 0.0-1.5%) of horses, respectively. Considering the putative economic and animal health impact of neosporosis in horses and the consequences of a possible spread of equine besnoitiosis in Europe and elsewhere, more comprehensive studies are needed to characterize the species detected in serological surveys, evaluate the geographical distribution and assess possible risk factors that could favor transmission.

Protozoal coinfection in horses with equine protozoal myeloencephalitis in the eastern United States

Background

Infection by 2 or more protozoa is linked with increased severity of disease in marine mammals with protozoan encephalitis.

Hypothesis/Objectives

To assess whether horses with equine protozoal myeloencephalitis (EPM) caused by Sarcocystis neurona also have evidence of infection with Neospora hughesi or Toxoplasma gondii. We hypothesized that horses with EPM would be more likely than horses with cervical vertebral stenotic myelopathy (CVSM) to be positive for antibodies to multiple protozoan parasites.

Animals

One hundred one horses with neurologic disease: 49 with EPM and 52 with CVSM.

Methods

Case review. Archived serum and cerebrospinal fluid (CSF) from 101 horses were examined. Inclusion criteria included neurologic disease, antemortem or postmortem diagnosis of EPM or CVSM, and availability of serological results or archived samples for testing. Additional testing for antibodies was performed on serum for T. gondii, as well as serum and CSF for N. hughesi.

Results

Horses with EPM were more likely than horses with CVSM to have positive immunologic results for S. neurona on serum (95.9% versus 76.9%, P = .0058), CSF (98.0% versus 44.2%, P < .00001), and serum : CSF titer ratio (91.8% versus 0%, P < .00001). Positive results for Neospora and Toxoplasma were uncommon, with total seroprevalence rates of 12.9% and 14.9%, respectively. The proportions of EPM cases testing positive for Neospora and Toxoplasma (16% and 12%) were not different from the proportions of CVSM cases testing positive (10% and 17%, P = .31 and .47, respectively).

Conclusion

Results do not indicate an important role for protozoal coinfection in EPM in the eastern United States.

Effects of Blood Contamination of Cerebrospinal Fluid on Results of Indirect Fluorescent Antibody Tests for Detection of Antibodies against Sarcocystis Neurona and Neospora Hughesi

The purpose of this study was to determine the effect of blood contamination of cerebrospinal fluid (CSF) on the results of indirect fluorescent antibody tests (IFATs) for Sarcocystis neurona and Neospora hughesi. The in vitro study used antibody-negative CSF collected from non-neurologic horses immediately after euthanasia and blood samples from 40 healthy horses that had a range of IFAT antibody titers against S. neurona and N. hughesi. Serial dilutions of whole blood were made in seronegative CSF to generate blood-contaminated CSF with red blood cell (RBC) concentrations ranging from 10 to 100,000 RBCs/μl. The blood-contaminated CSF samples were then tested for antibodies against both pathogens using IFAT. Blood contamination of CSF had no detectable effect on IFAT results for S. neurona or N. hughesi at any serologic titer when the RBC concentration in CSF was <10,000 RBCs/μl. At concentrations of 10,000-100,000 RBCs/μl of CSF, positive CSF results (IFAT titer ≥5) for S. neurona and N. hughesi were detected only when the corresponding serum titers were ≥160 and ≥80, respectively. The IFAT performed on CSF is reliable for testing horses for equine protozoal myeloencephalitis caused by S. neurona or N. hughesi, even when blood contamination causes the RBC concentration in CSF to be up to 10,000 RBCs/μl.

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.

Comparison of prevalence factors in horses with and without seropositivity to Neospora hughesi and/or Sarcocystis neurona

Equine protozoal myeloencephalitis is a commonly diagnosed neurological disease of horses in North America and is caused by infection with Sarcocystis neurona or Neospora hughesi. The aim of this study was to compare prevalence factors among horses seropositive or seronegative to N. hughesi and/or S. neurona. A total of 3123 submissions were included in the study, with horses originating from 49 States. Thirty-eight animals from 21 States tested seropositive for N. hughesi only, 840 horses from 40 States were seropositive for S. neurona only, 25 horses from 14 States were seropositive for both protozoa, and 2220 horses from 49 States tested seronegative for both parasites. Significant associations were found between geographical location (State), month of submission, breed and serological status.

Neospora spp. antibodies in horses from two geographical regions of the state of Santa Catarina, Brazil

The aims of this study were to determine occurrences ofNeospora spp. IgG antibodies in horses from two geographical regions of the state of Santa Catarina, southern Brazil, and identify risk factors for infection. Analyses were performed on 615 samples using the immunofluorescent antibody test (IFAT ≥ 1:50). Out of the 615 samples, 25 (4.1%) were positive for Neospora spp. The titers for Neospora spp. were distributed as follows: 1:50 (13), 1:100 (eight), 1:200 (three) and 1:400 (one). Out of the 311 samples taken in the mountain region, eight were positive (2.6%). Among the samples from the coastal region (304), 17 had Neospora spp. antibodies, thus indicating occurrence of 5.6%. Although no statistically significant difference was observed (P = 0.06704), the prevalence among animals of the coast was 2.2 times higher than that of the mountain region. Contact with dogs and/or cattle (P = 0.007596) were identified as risk factor forNeospora spp. infection.

Serum antibodies from a subset of horses positive for Babesia caballi by competitive enzyme-linked immunosorbent assay demonstrate a protein recognition pattern that is not consistent with infection

Tick-borne pathogens that cause persistent infection are of major concern to the livestock industry because of transmission risk from persistently infected animals and the potential economic losses they pose. The recent reemergence of Theileria equi in the United States prompted a widespread national survey resulting in identification of limited distribution of equine piroplasmosis (EP) in the U.S. horse population. This program identified Babesia caballi-seropositive horses using rhoptry-associated protein 1 (RAP-1)-competitive enzyme-linked immunosorbent assay (cELISA), despite B. caballi being considered nonendemic on the U.S. mainland. The purpose of the present study was to evaluate the suitability of RAP-1-cELISA as a single serological test to determine the infection status of B. caballi in U.S. horses. Immunoblotting indicated that sera from U.S. horses reacted with B. caballi lysate and purified B. caballi RAP-1 protein. Antibody reactivity to B. caballi lysate was exclusively directed against a single ∼50-kDa band corresponding to a native B. caballi RAP-1 protein. In contrast, sera from experimentally and naturally infected horses from regions where B. caballi is endemic bound multiple proteins ranging from 30 to 50 kDa. Dilutions of sera from U.S. horses positive by cELISA revealed low levels of antibodies, while sera from horses experimentally infected with B. caballi and from areas where B. caballi is endemic had comparatively high antibody levels. Finally, blood transfer from seropositive U.S. horses into naive horses demonstrated no evidence of B. caballi transmission, confirming that antibody reactivity in cELISA-positive U.S. horses was not consistent with infection. Therefore, we conclude that a combination of cELISA and immunoblotting is required for the accurate serodiagnosis of B. caballi.

Seroprevalences of Toxoplasma gondii and Neospora sp. infections in Swedish horses

Sera from 414 Swedish horses were investigated for the presence of antibodies to Toxoplasma gondii and Neospora sp. by the T. gondii direct agglutination test (DAT), and an Neospora caninum iscom-ELISA. Five sera (1%) had a titre >1:40 in DAT, but when analysed by immunoblotting against T. gondii antigens only two of them were positive, giving a seroprevalence of 0.5%. Since the Neospora iscom ELISA had not been validated for equine sera it was used for an initial screening, and all sera with an optical density exceeding 0.200 absorbance units were selected for further investigation by immunoblot analysis. Of the 39 sera tested by immunoblotting, four reacted with at least two of the immunodominant Neospora antigens recognized by the positive control sera and were judged as positive, resulting in a seroprevalence of 1%. This is the first evidence of Neospora infection in Swedish horses. The study illustrates the necessity of critically evaluating results of serological analyses performed by methods that are not validated for the animal species under investigation.

Investigation of Neospora sp. and Toxoplasma gondii antibodies in mares and in precolostral foals from Parana State, Southern Brazil

Antibodies to Neospora sp. and Toxoplasma gondii were measured in mares and precolostral foals from a farm in Parana State, Brazil. An indirect fluorescent antibody test (IFAT) was used to determine specific antibodies. Three sampling points, 2003, 2004 and at parturition were included in the study, but not all horses are represented at a parturition time point. In 2003, antibodies to Neospora were detected in 17 mares (47%) at 1:50 dilution and in 5 mares (13.8%) at 1:100 dilution. In 2004, antibodies to Neospora were found in 11/36 (30%) horses with titers of 1:50 and in 6 mares (16.6%) at 1:100 dilution. The prevalence of antibodies against T. gondii was 2.7% in mares, either in 2003 and 2004. Evidence for the role of Neospora sp. in equine reproduction failure was not observed in the farm. Immunoglobulin G antibodies to Neospora were found in two of the nine precolostrum foals. Four seronegative foals were born from seronegative mothers, and three seronegative foals were born from seropositive mothers (1:50). Two seropositive precolostrum foals were born from seropositive mothers (1:50). The foals were born clinically normal, and T. gondii antibodies were not detected in their serum samples. The total immunoglobulins values detected on seronegative precolostrum foals were lower than the levels observed in the seropositive foals. This data warrants additional studies to differentiate N. hughesi and N. caninum serologically and determination if these parasites were associated with equine neurological disease and reproductive failure.

Recombinant NhSAG1 ELISA: a sensitive and specific assay for detecting antibodies against Neospora hughesi in equine serum

Neospora hughesi is a recently identified cause of equine protozoal myeloencephalitis. However, the significance of this parasite is poorly understood. An enzyme-linked immunosorbent assay (ELISA) with a recombinant form of the N. hughesi 29-kDa surface antigen (rNhSAG1) was developed for serodiagnosis of equine N. hughesi infections. Parallel ELISA analysis showed that animals immunized or infected with N. hughesi exhibited greater antibody reactivity with rNhSAG1 than with the Neospora caninum homolog, rNcSAG1. The rNhSAG1 ELISA showed 94.4% sensitivity and 95.0% specificity when compared with N. hughesi western blot results for 1,006 samples. The N. hughesi seroprevalence was 3.4% for the 1,917 samples tested by ELISA, which is less than earlier reports. Importantly, western blot analysis of ELISA-positive sera revealed only 18 true seropositive samples for an even lower seroprevalence of 0.9%. These results imply that Neospora spp. infections are uncommon in horses. The sensitivity and specificity exhibited by the rNhSAG1 ELISA suggest that it has a potential use for serodiagnosis of N. hughesi infection in equids. Furthermore, the high-throughput capability of the ELISA will allow for screening large sample sets, which should provide a better understanding of N. hughesi epidemiology.

RISK OF TRANSPLACENTAL TRANSMISSION OF SARCOCYSTIS NEURONA AND NEOSPORA HUGHESI IN CALIFORNIA HORSES

The study objective was to assess the risk of transplacental transmission of Sarcocystis neurona and Neospora hughesi in foals from 4 California farms during 3 foaling seasons. Serum of presuckle foals and serum and colostrum of periparturient mares were tested using indirect fluorescent antibody tests for S. neurona and N. hughesi. Serum antibody titers were < or =10 in 366 presuckle foals tested. There was no serologic or histologic evidence of either parasite in aborted fetuses or placentas examined. Positivity for S. neurona and N. hughesi in mares increased with age. Mares < or =9 yr that originated from Kentucky were 3.8 and 1.4 times more likely to be positive for S. neurona and N. hughesi, respectively, than mares from California. The strength of association between positivity to either parasite and state of birth decreased as age increased. Mares positive for S. neurona and N. hughesi were 2.2 and 1.7 times more likely, respectively, to have a previous abortion than negative mares, adjusted for age and state of birth. The annual mortality rate for mares was 4%. The annual incidence rate of equine protozoal myeloencephalitis was 0.2%. In conclusion, there was no detectable risk of transplacental transmission of S. neurona and N. hughesi. Prevalence of antibodies against both parasites in mares increased with age.

Risk of postnatal exposure to Sarcocystis neurona and Neospora hughesi in horses

OBJECTIVE

To estimate risk of exposure and age at first exposure to Sarcocystis neurona and Neospora hughesi and time to maternal antibody decay in foals.

ANIMALS

484 Thoroughbred and Warmblood foals from 4 farms in California.

PROCEDURE

Serum was collected before and after colostrum ingestion and at 3-month intervals thereafter. Samples were tested by use of the indirect fluorescent antibody test; cutoff titers were > or = 40 and > or = 160 for S neurona and N hughesi, respectively.

RESULTS

Risk of exposure to S neurona and N hughesi during the study were 8.2% and 3.1%, respectively. Annual rate of exposure was 3.1% for S neurona and 1.7% for N hughesi. There was a significant difference in the risk of exposure to S neurona among farms but not in the risk of exposure to N hughesi. Median age at first exposure was 1.2 years for S neurona and 0.8 years for N hughesi. Highest prevalence of antibodies against S neurona and N hughesi was 6% and 2.1 %, respectively, at a mean age of 1.7 and 1.4 years, respectively. Median time to maternal antibody decay was 96 days for S neurona and 91 days for N hughesi. There were no clinical cases of equine protozoal myeloenchaphlitis (EPM).

CONCLUSIONS AND CLINICAL RELEVANCE

Exposure to S neurona and N hughesi was low in foals between birth and 2.5 years of age. Maternally acquired antibodies may cause false-positive results for 3 or 4 months after birth, and EPM was a rare clinical disease in horses < or = 2.5 years of age.

EVALUATION AND COMPARISON OF AN INDIRECT FLUORESCENT ANTIBODY TEST FOR DETECTION OF ANTIBODIES TO SARCOCYSTIS NEURONA, USING SERUM AND CEREBROSPINAL FLUID OF NATURALLY AND EXPERIMENTALLY INFECTED, AND VACCINATED HORSES

The objectives of this study were to evaluate the accuracy of the indirect fluorescent antibody test (IFAT) using serum and cerebrospinal fluid (CSF) of horses naturally and experimentally infected with Sarcocystis neurona, to assess the correlation between serum and CSF titers, and to determine the effect of S. neurona vaccination on the diagnosis of infection. Using receiver-operating characteristic analysis, the areas under the curve for the IFAT were 0.97 (serum) and 0.99 (CSF). Sensitivity and specificity were 83.3 and 96.9% (serum, cutoff 80) and 100 and 99% (CSF, cutoff 5), respectively. Titer-specific likelihood ratios (LRs) ranged from 0.03 to 187.8 for titers between <10 and 640. Median time to conversion was 22-26 days postinfection (DPI) (serum) and 30 DPI (CSF). The correlation between serum and CSF titers was moderately strong (r = 0.6) at 30 DPI. Percentage of vaccinated antibody-positive horses ranged from 0 to 95% between 0 and 112 days after the second vaccination. Thus, the IFAT was reliable and accurate using serum and CSF. Use of LRs potentially improves clinical decision making. Correlation between serum and CSF titers affects the joint accuracy of the IFAT; therefore, the ratio of serum to CSF titers has potential diagnostic value. The S. neurona vaccine could possibly interfere with equine protozoal myeloencephalitis diagnosis.