BEVA primary care clinical guidelines: Equine parasite control

BACKGROUND

There is a lack of consensus on how best to balance our need to minimise the risk of parasite-associated disease in the individual horse, with the need to limit the use of anthelmintics in the population to preserve their efficacy through delaying further development of resistance.

OBJECTIVES

To develop evidence-based guidelines utilising a modified GRADE framework.

METHODS

A panel of veterinary scientists with relevant expertise and experience was convened. Relevant research questions were identified and developed with associated search terms being defined. Evidence in the veterinary literature was evaluated using the GRADE evidence-to-decision framework. Literature searches were performed utilising CAB abstracts and PubMed. Where there was insufficient evidence to answer the research question the panel developed practical guidance based on their collective knowledge and experience.

RESULTS

Search results are presented, and recommendation or practical guidance were made in response to 37 clinically relevant questions relating to the use of anthelmintics in horses.

MAIN LIMITATIONS

There was insufficient evidence to answer many of the questions with any degree of certainty and practical guidance frequently had to be based upon extrapolation of relevant information and the panel members' collective experience and opinions.

CONCLUSIONS

Equine parasite control practices and current recommendations have a weak evidence base. These guidelines highlight changes in equine parasite control that should be considered to reduce the threat of parasite-associated disease and delay the development of further anthelmintic resistance.

Biological implications of long-term anthelmintic treatment: what else besides resistance are we selecting for?

Long-term intensive use of anthelmintics for parasite control of livestock, companion animals, and humans has resulted in widespread anthelmintic resistance, a problem of great socioeconomic significance. But anthelmintic therapy may also select for other biological traits, which could have implications for anthelmintic performance. Here, we highlight recent examples of changing parasite dynamics following anthelmintic administration, which do not fit the definition of anthelmintic resistance. We also consider other possible examples in which anthelmintic resistance has clearly established, but where coselection for other biological traits may have also occurred. We offer suggestions for collecting more information and gaining a better understanding of these phenomena. Finally, we propose research questions that require further investigation and make suggestions to help address these knowledge gaps.

The Use of Molecular Profiling to Track Equine Reinfection Rates of Cyathostomin Species Following Anthelmintic Administration

Simple Summary

Cyathostomins (small strongyles) are a multispecies group of intestinal parasites in horses and the main target of deworming efforts by horse owners. It is not known whether species of cyathostomins have individual responses to dewormers. The objective of this study was to identify differences between cyathostomin species in reemergence rates following commercial dewormer treatment. This study used gene sequencing to profile the presence/absence of cyathostomin species in fecal samples at 2-week intervals following deworming to determine how quickly each species reinfected horses. Moxidectin was found to be the most effective at slowing the overall reemergence of these parasites, followed by Ivermectin, then Pyrantel. Seven species were resistant to all three deworming products. This study demonstrates that dewormer sensitivity differs between cyathostomin species, which could lead to more targeted control measures.

Abstract

Cyathostomins are a multispecies parasite ubiquitous in Equids. Cyathostomins have developed resistance to all but one class of anthelmintics, but species-level sensitivity to anthelmintics has not been shown. This study measured reinfection rates of cyathostomin species following the administration of three commercial dewormers. Nine treated horses were compared with 90 untreated controls during June-September 2017–2019. Ivermectin (IVM) (n = 6), Moxidectin (MOX) (n = 8) or Pyrantel (PYR) (n = 8) were orally administered. Fecal samples were collected every 14 d for 98 d. Fecal egg count reductions (FECR) were calculated using a modified McMaster technique. Nineteen cyathostomin species were identified by 5.8S-ITS-2 profiling using amplicon sequencing. Data were analyzed in QIIME1 and R statistical software using presence/absence methods. MOX had the lowest numbers of species present over the time course, followed by PYR then IVM (7.14, 10.17, 11.09, respectively); however, FECR was fastest for PYR. The presence of seven species: Coronocyclus labiatus, Cyathostomum catinatum, Cyathostomum tetracanthum, Cylicocylus elongatus, Cylicodontophorus bicoronatus, Cylicostephanus minutus, and Cylicostephanus goldi were unaffected by treatment (p > 0.05) points to species-specific differences in dewormer sensitivity and environmental persistence. Identifying resistance patterns at the species level will enable mechanistic understandings of cyathostomin anthelmintic resistance and targeted approaches to control them.

No Worm Is an Island; The Influence of Commensal Gut Microbiota on Cyathostomin Infections

Simple Summary

There is increasing evidence for the importance of gut bacteria in animal health and disease. This is particularly relevant for gastrointestinal infections, such as parasitic worms, which share a niche with gut bacteria. Parasitic worms are highly prevalent in domestic horses and are a significant cause of disease in this population. This commentary explores the complex relationships between the most common parasitic worm in horses (cyathostomins) and gut bacteria, based on recent studies in horses and other species. We propose novel theories and avenues for research that harness these relationships and have the potential to improve control of parasitic worms, and overall equine health, in the future.

Abstract

The importance of the gut microbiome for host health has been the subject of intense research over the last decade. In particular, there is overwhelming evidence for the influence of resident microbiota on gut mucosal and systemic immunity; with significant implications for the outcome of gastrointestinal (GI) infections, such as parasitic helminths. The horse is a species that relies heavily on its gut microbiota for GI and overall health, and disturbances in this complex ecosystem are often associated with life-threatening disease. In turn, nearly all horses harbour parasitic helminths from a young age, the most prevalent of which are the small strongyles, or cyathostomins. Research describing the relationship between gut microbiota and cyathostomin infection is in its infancy, however, to date there is evidence of meaningful interactions between these two groups of organisms which not only influence the outcome of cyathostomin infection but have long term consequences for equine host health. Here, we describe these interactions alongside supportive evidence from other species and suggest novel theories and avenues for research which have the potential to revolutionize our approach to cyathostomin prevention and control in the future.

Comparative Analysis of Intestinal Helminth Infections in Colic and Non-Colic Control Equine Patients

All around the world, intestinal helminths constitute one of the most prevalent life-long occurring infections and re-infections affecting all horse age groups. A range of parasite species among strongyles, ascarids, and tapeworms is known to have the potential to cause colic in horses. However, there is a lack of current scientific evidence on the actual relevance of helminth infection levels in the context of colic in horses kept during prevailing epidemiological conditions. Thus, a prospective case-control study on the occurrence of intestinal helminths in a total of 620 mainly adult equine clinic patients was conducted to investigate the association between colic and helminth infection. For each horse, a range of copromicroscopic, serological, and clinical data was obtained, in addition to a questionnaire on relevant anamnestic data, including previous anthelmintic treatment and husbandry. Using a FLOTAC-based copromicroscopic diagnosis, the highest infection rates were seen for strongyles (41.8%), followed by Anoplocephala perfoliata and Parascaris spp. (both 0.8%), with no significant difference between the two study groups. Employing a real-time PCR a 1.1% S. vulgaris DNA prevalence was found. Considerably higher seroprevalences were observed using S. vulgaris and A. perfoliata ELISAs, with 32.3% and 10.7%, respectively. It was noteworthy that no association concerning either serologic status was encountered with colic status. The shedding of strongyle eggs was associated with a 1.8-times increased risk of S. vulgaris seropositivity. Recent anthelmintic treatment was associated with the onset of colic, as animals who had received an anthelmintic during the previous week had a 2.4-times higher risk of signs of colic compared to those who had been treated at least eight weeks prior. Another noteworthy observation was that ponies were significantly less often affected by colic than warmbloods. The high S. vulgaris and considerable A. perfoliata seroprevalences encountered in this investigation should prompt veterinarians, farm managers, and horse owners to maintain consequent and effective worm control measures.

Outbreak of acute larval cyathostominosis - A "perfect storm" of inflammation and dysbiosis

Background

Cyathostomins are prevalent and pathogenic intestinal helminths of horses, causing acute and chronic disease, including acute larval cyathostominosis, which has a mortality rate of 50%. Factors determining individual susceptibility to acute larval cyathostominosis are unknown. Investigation of these factors could lead to novel treatment and prevention strategies.

Objectives

To investigate clinicopathological and faecal microbiota changes associated with disease in individual horses in an acute larval cyathostominosis outbreak.

Study design

Case series.

Methods

The study population was a herd of 23 mixed breed horses in Ireland. The outbreak occurred in November 2018. Fourteen horses were clinically affected. Clinical status was monitored and recorded. Blood and faecal sampling allowed clinicopathological, faecal 16s rRNA gene sequencing and faecal egg count analyses.

Results

Two horses were euthanised, whilst 12 recovered. Common clinical signs included loose faecal consistency, weight loss and pyrexia. Consistent clinicopathological findings were borderline anaemia, leucocytosis, thrombocytosis, hyperfibrinogenaemia, hyperglobulinaemia and a reverse A: G ratio. Decreased alpha‐diversity of the faecal microbiota and greater relative abundance of the genus Streptococcus, class Bacilli, order Lactobacillales and family Streptococcaceae, and family Prevotelleceae was found in clinically affected horses compared to their clinically normal cohorts. An increase in obligate fibrolytic bacteria was seen in the clinically normal group compared to the clinical group. Histopathological findings of the colon and caecum revealed a severe necrotising typhlocolitis associated with cyathostomin larvae and bacterial overgrowth in the mucosa of the large intestine.

Main limitations

The study population in this outbreak is small. There are several confounding factors limiting this to a descriptive case series. Faecal microbiota has been shown to reflect the large intestinal microbiota but do not represent changes directly.

Conclusions

These findings suggest that acute larval cyathostominosis is associated with dysbiosis of the gut microbiota as well as the inflammatory stimulus of numerous emerging larvae leading to structural and functional pathology of the large intestine.

Cytokine and goblet cell gene expression in equine cyathostomin infection and larvicidal anthelmintic therapy

AIMS

The role of the immune response to cyathostomin infections in horses remains unknown. Intestinal goblet cell hyperplasia has previously been noted as a component in cyathostomin infection; however, the function is unclear. The goal of this study was to evaluate the local and systemic gene expression to cyathostomin infections following larvicidal treatment and explore their relation to goblet cells.

METHODS AND RESULTS

Thirty-six ponies with naturally acquired cyathostomin infections were randomly allocated into three groups: fenbendazole-treated (10 mg/kg PO 5 days), moxidectin-treated (0.4 mg/kg PO once) and untreated control. Whole blood from all horses was collected weekly, and tissue samples from the large intestine collected during necropsy at 2 and 5 weeks post-treatment (WPT). Gene expression of interleukin (IL)-4, IL-5, IL-6, IL-10, IL-13, IL-17A, IL-22, IFN-γ, resistin-like molecule beta (RELM-β), Mucin 2 (MUC2) and tumour necrosis factor (TNF)-α was measured using qRT-PCR. There were statistically significant linear correlations between luminal worm burdens and MUC2 (r = -.2358) and RELM-β (r = -.2261).

CONCLUSION

This suggests an active role of immune system post-treatment in parasite expulsion, specifically in goblet cells, and that the organs respond differently to treatment and the larvae themselves. This may have implications in the disease process and treatment.

Parasites in Horses Kept in A 2.5 Year-Round Grazing System in Nordic Conditions without Supplementary Feeding

Simple Summary

Grazing horses year-round may be a means to increase biodiversity. In this study, parasite occurrence was documented on a monthly basis in 1- to 3-year-old Gotlandsruss stallions grazed year-round for 2.5 years. Horses became infected by several parasites and, when needed (>200 strongyle eggs/gram feces), horses were dewormed with the anthelmintic drug pyrantel, which has low or no ecotoxic impact on soil fauna. This strategy failed to control small strongyle occurrence. Horses excreted larger amounts of small strongyle eggs during summer–autumn than during the rest of the year, and the number of excreted eggs increased year-on-year. High small strongyle egg excretion did not seem to affect the body condition of the horses. Some horses were also infested with chewing louse, but did not scratch more than unaffected horses. We found that to keep egg excretion below 200, pyrantel was not sufficient and a substance known to be toxic to dung fauna and freshwater invertebrates had to be used on some occasions.

Abstract

Horse grazing can be favorable from a biological diversity perspective. This study documented the occurrence of endo- and ectoparasites and sought to reduce parasite egg excretion with the anthelmintic drug pyrantel in 12 Gotlandsruss stallions maintained in a year-round grazing system for 2.5 years. Feces samples were collected monthly and all horses were treated with pyrantel, the anthelmintic drug of choice in biological diversity preservation, at study population mean cyathostomin eggs per gram (EPG) of >200. The relationship between cyathostomin EPG and body condition was studied, as was horse behavioral response to Bovicola equi (chewing louse) infestation. Eggs of cyathostomins (small strongyles), Parascaris spp. (roundworm), Oxyuris equi (pinworm), Anoplocephala perfoliata (tapeworm), and Gasterophilus spp. (botfly) were detected at least once during the trial. Excretion of cyathostomin eggs was highest during summer–autumn and increased year-on-year. No relationship was found between cyathostomin EPG and body condition. Infestation with B. equi did not affect the number of scratching sessions compared with unaffected horses. Therefore, in this year-round grazing system, pyrantel treatment had to be complemented with moxidectin to reduce excretion of cyathostomin eggs, thus compromising biological diversity.

Strongyle Infection and Gut Microbiota: Profiling of Resistant and Susceptible Horses Over a Grazing Season

Gastrointestinal strongyles are a major threat to horses' health and welfare. Given that strongyles inhabit the same niche as the gut microbiota, they may interact with each other. These beneficial or detrimental interactions are unknown in horses and could partly explain contrasted susceptibility to infection between individuals. To address these questions, an experimental pasture trial with 20 worm-free female Welsh ponies (10 susceptible (S) and 10 resistant (R) to parasite infection) was implemented for 5 months. Fecal egg counts (FEC), hematological and biochemical data, body weight and gut microbiological composition were studied in each individual after 0, 24, 43, 92 and 132 grazing days. R and S ponies displayed divergent immunological profiles and slight differences in microbiological composition under worm-free conditions. After exposure to natural infection, the predicted R ponies exhibited lower FEC after 92 and 132 grazing days, and maintained higher levels of circulating monocytes and eosinophils, while lymphocytosis persisted in S ponies. Although the overall gut microbiota diversity and structure remained similar during the parasite infection between the two groups, S ponies exhibited a reduction of bacteria such as Ruminococcus, Clostridium XIVa and members of the Lachnospiraceae family, which may have promoted a disruption of mucosal homeostasis at day 92. In line with this hypothesis, an increase in pathobionts such as Pseudomonas and Campylobacter together with changes in several predicted immunological pathways, including pathogen sensing, lipid metabolism, and activation of signal transduction that are critical for the regulation of immune system and energy homeostasis were observed in S relative to R ponies. Moreover, S ponies displayed an increase in protozoan concentrations at day 92, suggesting that strongyles and protozoa may contribute to each other's success in the equine intestines. It could also be that S individuals favor the increase of these carbohydrate-degrading microorganisms to enhance the supply of nutrients needed to fight strongyle infection. Overall, this study provides a foundation to better understand the mechanisms that underpin the relationship between equines and natural strongyle infection. The profiling of horse immune response and gut microbiota should contribute to the development of novel biomarkers for strongyle infection.

A questionnaire study of equine gastrointestinal parasite control in Scotland

REASONS FOR PERFORMING STUDY

Anthelmintic resistance in equine gastrointestinal nematodes is a threat to equine health and welfare. Detailed knowledge of anthelmintic use and parasite control methods is a prerequisite to identification of potential risk factors for resistance.

OBJECTIVES

To identify parasite control practices employed by equine owners in Scotland and investigate management factors associated with anthelmintic resistance.

STUDY DESIGN

Questionnaire study of equine parasite control in Scotland.

METHODS

Questionnaires were available electronically, distributed at a conference and mailed to clients. Key areas explored included general background, grazing management, anthelmintic treatment practices and use of diagnostic tests.

RESULTS

A total of 193 responses detailing information on parasite control programmes of 993 equids were analysed. Moxidectin (MOX) and ivermectin or related combination products were the most commonly administered anthelmintics in the preceding 12 months. Treatments licensed for use against cyathostomin encysted larvae and tapeworms were administered by 80% and 90% of respondents, respectively. This was often achieved through indiscriminate use of MOX and MOX-praziquantel products. Faecal egg count (FEC) analysis had been performed on 62% of yards and regular use of FECs reduced annual anthelmintic treatment frequency. Veterinarians had the greatest influence on control practices. While 40% of respondents believed that they practised targeted dosing, this was not associated with delaying treatment beyond the egg reappearance period of the anthelmintic used.

CONCLUSIONS

Responses indicated increasing veterinary involvement and use of FECs. The majority of respondents administered anthelmintics licensed against cyathostomin encysted larvae and tapeworms. However, responses suggested that owners did not understand the definition of 'targeted' dosing regimens.

POTENTIAL RELEVANCE

The high frequency of MOX use represents a potential risk factor for macrocyclic lactone resistance. As veterinarians were the most influential factor in anthelmintic choice, awareness of macrocyclic lactone resistance and potential risk factors for its development and spread should be incorporated into client advice.