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EQUINE PROTOZOAL MYELOENCEPHALITIS (EPM) QUICK FACTS IMPORTANT SAFETY INFORMATION Use of Protazil ® (1.56% diclazuril) Antiprotozoal Pellets is contraindicated in horses with known hypersensitivity to diclazuril. Safe use in horses used for breeding purposes, during pregnancy, or in lactating mares has not been evaluated. The safety of Protazil ® (1.56% diclazuril) Antiprotozoal Pelletswith concomitant therapies in horses has not been evaluated. For use in horses only. Do not use in horses intended for human consumption. Not for human use. Keep out of reach of children. Talk to your veterinarian if you're concerned about EPM and visit www.merck-animal-health-equine.com for more information on PROTAZIL ® – the first and only alfalfa-based pellet EPM treatment. 1 Reed SM, et al. Equine Protozoal Myeloencephalitis: An Updated Consensus Statement with a Focus on Parasite Biology, Diagnosis, Treatment and Prevention. J Vet Intern Med 2016;30:491–502. Diagnosis Diagnosing EPM is difficult because it can mimic other neurologic diseases. • Complete neurologic and physical exam to rule out other diseases • Blood and cerebrospinal fluid (CSF) analysis to detect antiprotozoal antibodies An FDA-approved EPM treatment such as PROTAZIL ® (1.56% diclazuril) Antiprotozoal Pellets will be prescribed to control infection Additional supportive treatment may be recommended based on the severity of neurologic deficits and associated complications 60-70% of horses show clinical improvement with early treatment 1 Treatment and Recovery EPM Risk Factors 1 • Exposure to wildlife; presence of opossums • Stress associated with illness, transport, strenuous exercise • Young horses (1-5 years) • Horses used for western performance, racing and other strenuous activities • Immune-compromised horses of any age • Immunosuppression associated with concurrent conditions • Commonly seen in late summer and fall, but can occur any time Gait abnormalities Ataxia (incoordination) Stumbling Muscle atrophy Weakness Depression Inability to chew or swallow Head tilt, ear droop Behavior change Blindness Seizures Watch for These Signs Contact your veterinarian immediately if your horse exhibits neurological signs. Horses that are diagnosed early and treated aggressively have the best chance for recovery. EPM is an infectious, progressive neurological disease that affects horses following environmental exposure to opossum feces. EPM can cause devastating and lasting neurological damage and any horse is susceptible. • Caused by infection with the parasite Sarcocystis neurona (S. neurona); less frequently with Neospora hughesi (N. hughesi)1 • Up to 90% of the U.S. horse population has been exposed to S. neurona, depending on geographic location1 • Not all horses infected with S. neurona or N. hughesi will develop disease • Cannot be spread from horse to horse What is EPM? Lifecycle of Sarcocystis Neurona 1 1. The sarcocyst organism is ingested by the definitive host, the opossum, by scavenging on intermediate hosts (cats, raccoons, skunks, armadillos, sea otters) that carry sarcocyst in skeletal muscle 2. The infective stage of the organism (the sporocysts) is passed in the opossum's feces The horse (dead-end host) acquires the infective sporocysts while grazing or eating contaminated feed or drinking water 3. Once ingested by the horse, the sporocysts migrate from the intestinal tract into the bloodstream and cross the blood/brain barrier 4. The resulting inflammatory response to sporocyst presence injures the horse's central nervous system (The definitive or intermediate hosts for N. hughesi have not yet been identified.) 1 Definitive Host: Opossum Intermediate Hosts: Nine-Banded Armadillo Striped Skunk Raccoon Sarcocyst in skeletal muscle Lesions in spinal cord and brain 5. 4. 1. Sexual reproduction in digestive tract (intestinal epithelium) 2. Infective sporocyst in feces 3. Dead End Host: Horse ingests contaminated feedstuffs Brought to you by: 2 Giralda Farms • Madison, NJ 07940 • merck-animal-health-usa.com • 800-521-5767 Copyright © 2019 Intervet Inc., d/b/a/ Merck Animal Health, a subsidiary of Merck & Co., Inc. All rights reserved. US/Equine/EPM Infographic/June 2019