New insights in the diagnosis and treatment of equine piroplasmosis: pitfalls, idiosyncrasies, and myths.
Authors: Mendoza Francisco J, Pérez-Écija Alejandro, Kappmeyer Lowell S, Suarez Carlos E, Bastos Reginaldo G
Journal: Frontiers in veterinary science
Summary
# Editorial Summary: Equine Piroplasmosis — Diagnostic and Therapeutic Challenges Equine piroplasmosis remains a significant global threat to equine health and international trade, caused by three apicomplexan parasites (*Theileria equi*, *Babesia caballi*, and the recently identified *Theileria haneyi*) transmitted primarily through tick vectors but also via contaminated needles and vertical transmission. Mendoza and colleagues conducted a comprehensive review of current diagnostic and therapeutic approaches, examining both their efficacy and limitations within clinical practice. The authors identified critical weaknesses in existing protocols: imidocarb dipropionate, the traditional first-line treatment, carries considerable toxicity and toxicokinetic side effects with documented treatment failures, whilst buparvaquone demonstrates inferior efficacy against *T. equi* and lacks availability in many regions. Diagnostic vulnerability was highlighted as a particular concern, with non-standardised PCR protocols and serological test limitations creating genuine risks of disease export despite current regulatory testing requirements. The authors recommend implementing standardised, multiplex PCR-based techniques combined with improved serological assays to enhance diagnostic accuracy in international trade situations, and identify the urgent need for novel therapeutics that move beyond unsustainable acaricide-dependent tick control strategies, which increasingly face resistance issues and environmental constraints. For equine professionals involved in performance assessment, pre-export health screening, or treating atypical presentations of poor performance or fever, understanding these diagnostic pitfalls and the limitations of current treatments is essential for both animal welfare and compliance with international health regulations.
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Practical Takeaways
- •Current antiparasitic drugs have significant limitations—imidocarb causes toxicity and failures, buparvaquone is unreliable for T. equi—so expect treatment challenges and plan accordingly
- •Pre-export diagnostic testing is unreliable with current methods; use combined PCR and serology rather than single tests to reduce risk of unknowingly trading infected horses
- •Tick control alone is unsustainable due to environmental concerns and resistance development; integrated control strategies and novel therapeutics are needed and under development
Key Findings
- •Equine piroplasmosis is caused by three intraerythrocytic apicomplexan parasites (T. equi, B. caballi, T. haneyi) transmitted by multiple tick species and through iatrogenic/vertical routes
- •Imidocarb dipropionate (ID) has significant side effects and recurrent treatment failures, while buparvaquone (BPQ) is less effective against T. equi and unavailable in some countries
- •Current diagnostic limitations include lack of standardized PCR tests and serological assay limitations, creating risk of exporting infected animals
- •Combination of standardized PCR-based techniques and improved serological tests are proposed to enhance diagnostic accuracy and trade safety