Studies on Histoplasmosis Farciminosii (Epizootic Lympbgitis) in Egypt: III. Application of a skin test (‘Histofarcin’) in the diagnosis of epizodic Iymphangitis in horses.: Untersuchungen über Histoplgmosis Farciminosii (Lyrnphangitis Epizootica) in Ägyp

Participatory appraisal of the impact of epizootic lymphangitis in Ethiopia

Epizootic lymphangitis (EZL) is reported to have a significant impact upon livelihoods within resource-poor settings. This study used a participatory approach to explore peoples' experiences of EZL and examine the perceived impact of disease, owner knowledge and understanding of EZL, lay management of disease and, attitudes and strategies towards disease prevention. Focus-group discussions were held with 358 cart-horse owners and drivers recruited from 7 towns attended by SPANA (Society for the protection of animals abroad) mobile veterinary clinics and 2 unexposed towns where no SPANA clinics were available. Focus group discussions explored four main research questions: (1) Is EZL recognised by animal owners, and is this considered an important disease in equids? (2) What factors do animal owners associate with the development of disease? (3) What happens to an animal with clinical disease and how does this impact upon the owner/community? (4) Are measures taken to reduce disease occurrence? These key areas were explored using photographs, disease ranking, matrices and open discussion. Data were analysed using descriptive statistics and thematic analysis. The results are presented thematically and include: recognition and descriptions of EZL, treatment strategies used, disease priorities and ranking, impact of disease, disease transmission and attitudes and approaches to disease prevention. EZL was widely recognised and ranked highly as an important disease of equids. However, there was uncertainty around identifying early cases of EZL, and this could impact upon the timing of initiating treatment and separating potentially infectious animals. People had varying knowledge of effective methods for disease prevention and reported particular difficulties with isolating infected animals. The impact of EZL was multi-dimensional and encompassed effects upon the horse, the individual owner and the wider society. Working equids provide a vital utility and source of income to many people in resource-poor settings. Often, infection with EZL resulted in a reduction in working ability which had a direct impact upon the livelihoods of owners and their dependent family members. EZL also impacted upon the welfare of the horse as sick animals continued to be worked and, in advanced cases, horses were abandoned due to ineffective or unavailable treatment. This study conceptualises the importance of EZL due to the effects of the disease on the horse and its impact upon human livelihoods. Epizootic lymphangitis is a neglected disease that requires further investigation in order to develop practical and sustainable disease control strategies within endemic regions.

Histofarcin test for the diagnosis of epizootic lymphangitis in Ethiopia: development, optimisation, and validation in the field

Histofarcin, a skin test antigen for the diagnosis of epizootic lymphangitis, was locally produced from the mycelial form of Histoplasma capsulatum var. farciminosum (HCF) in disease-endemic districts of Ethiopia and tested for its application in the field between April 2002 and May 2003. The test was evaluated using 108 mules, 84 in endemic and 24 in disease-free districts. Microscopic and mycological examinations of clinical lesions were used as the "gold standard" for the validation of the test. The concentration of histofarcin that caused an optimum reaction was 0.2-0.4 mg/mL in a 0.1 mL dose and this was attained 24-48 h post-injection. The sensitivity and specificity of the histofarcin test were 90.3% (CI = 73.1, 97.5) and 69% (95%, CI = 48.1, 84.9%) in disease-endemic districts. On the other hand, specificity was 100% (CI=94.8, 100) in disease-free districts. Positive and negative predictive values of the histofarcin test were 77.78% (95% CI = 60.4, 89.3) and 85.71% (95% CI = 62.6, 96.2), respectively. A marginal substantial agreement (kappa = 0.61, P = 0.0000) was observed between the clinical status and the result of the histofarcin test. A large proportion (31%) of 'false positives' was recorded in endemic districts, which could be due to the pre-clinical stage of the disease. The latter ended in lower specificity and positive predictive value of the test since the true infection status of a 'false positive' could not be known on the basis of clinical features. Therefore, standard test validation procedures including slaughtering and isolation of HCF is required. After proper validation, we conclude that the histofarcin test could play a significant role in detecting early infection, and differentiating of EL from glanders, ulcerative lymphangitis, and sporotrichosis.