Demographics of Cystic Echinococcosis Patients Treated Surgically in Lahore, Pakistan: A Single Centre Study from 2007 - 2018.

Cystic echinococcosis (CE) is a zoonotic disease caused by the larval stage of Echinococcus granulosus tapeworms. These parasites have a worldwide geographic distribution and pose a serious threat to livestock industry as well as human health in the endemic areas. CE is widely distributed in Pakistan. However, very few reports are available related to the regional transmission of E. granulosus. A retrospective analysis was conducted of surgically confirmed CE patients who were treated at Shoukat Khanum Memorial Cancer Hospital and Research Centre in Lahore, Punjab Province, Pakistan from 2007 - 2018. In total, 536 CE patients were evaluated during the study period. Cases originated from the provinces of Khyber Pakhtunkhwa (n=336), Punjab (n=147), Baluchistan (n=18), Sindh (n=3), Islamabad (n=2), Gilgit Baltistan (n=1), and Azad Jammu and Kashmir (n=1). An additional 28 cases were from Afghanistan. The highest number of CE cases was reported in 2013 (n=90). Females made up a larger proportion of cases (n=310; 57.8 %) than males (n=226; 42.2 %). Most patients were members of the Pashtun (n=197; 36.7 %), Hindku (n=142; 26.5 %), and Punjabi (n=118; 22.0 %) ethnic groups. The largest number of cysts was obtained from the liver (137/536; 25.6 %). This study showed that CE is likely present throughout Pakistan. In order to control the disease, a comprehensive control program and regional surveillance are needed.

Putative Cerebral Microbleeds in Dogs Undergoing Magnetic Resonance Imaging of the Head: A Retrospective Study of Demographics, Clinical Associations, and Relationship to Case Outcome.

BACKGROUND: Cerebral microbleeds (CMBs) are focal intraparenchymal signal voids on gradient-echo magnetic resonance imaging (MRI), corresponding to regions of chronic hemorrhage. In humans, they are associated with systemic disease and shorter survival times. Although similar findings have been identified in dogs, their epidemiology and clinical correlations have not been investigated. OBJECTIVE: To determine epidemiological features, clinical associations, and associations with outcome for putative CMB-like foci (putative microbleeds [pMBs]) identified by T2*-weighted MRI in dogs. ANIMALS: Five hundred and eighty-two dogs undergoing 3T brain MRI between 2011 and 2016. METHODS: Retrospective case-control study. Demographic, diagnostic, and clinicopathological data were obtained from medical records and phone follow-up. Demographic variables were compared between dogs with and without evidence of pMBs. For dogs with such evidence, and a subset of matched controls, associations with clinical presentation, concurrent disease, and survival times were evaluated. RESULTS: Dogs with pMBs were older (P < .001) and smaller (P = .004) than unaffected dogs. Compared to matched controls, they presented more frequently for vestibular signs (P = .030). Cortical atrophy occurred concurrently with pMBs in 26% (14/54) of dogs. Diagnosed renal disease was not significantly associated with pMBs, but proteinuria was more common in dogs with pMBs than in matched controls (odds ratio = 3.01, P = .005). Dogs with pMBs had a shorter median survival time than did matched controls (P = .011). CONCLUSIONS AND CLINICAL IMPORTANCE: Putative microbleeds occurred in 54 of 582 (9.3%) of dogs undergoing brain MRI, but may not be a normal consequence of aging. They were associated with shorter survival time and proteinuria in the study population.

Geographical differences in survival of dogs with non-Hodgkin lymphoma treated with a CHOP based chemotherapy protocol.

BACKGROUND: In humans geographical differences in the incidence and presentation of various cancers have been reported. However, much of this information has not been collected in veterinary oncology. AIM: The purpose of this study was to determine if a geographic difference in progression free survival exists for dogs with lymphoma treated within the US. MATERIALS AND METHODS: Medical records of 775 cases of canine lymphoma from 3 US regions (west, south and north), treated with CHOP chemotherapy, were retrospectively evaluated. Cases were collected from referral institutions and were required to have received at least one doxorubicin treatment and have follow up information regarding time to progression. RESULTS: Significant differences in sex (p = 0.05), weight (p = 0.049), stage (p < 0.001), immunophenotype (p = <0.001), and number of doxorubicin doses (p = 0.001) were seen between regions. Upon univariate analysis, progression free survival (PFS) differed by region (p = 0.006), stage (p = 0.009), sub-stage (p = 0.0005), and immunophenotype (p = 0.001). A multivariable Cox regression model showed that dogs in the western region had a significantly shorter PFS when compared to the south and east. CONCLUSION: PFS was significantly affected by stage, sub-stage and phenotype.

The Echinococcoses: Diagnosis, Clinical Management and Burden of Disease.

The echinococcoses are chronic, parasitic diseases that are acquired after ingestion of infective taeniid tapeworm eggs from certain species of the genus Echinococcus. Cystic echinococcosis (CE) occurs worldwide, whereas, alveolar echinococcosis (AE) is restricted to the northern hemisphere, and neotropical echinococcosis (NE) has only been identified in Central and South America. Clinical manifestations and disease courses vary profoundly for the different species of Echinococcus. CE presents as small to large cysts, and has commonly been referred to as 'hydatid disease', or 'hydatidosis'. A structured stage-specific approach to CE management, based on the World Health Organization (WHO) ultrasound classification of liver cysts, is now recommended. Management options include percutaneous sterilization techniques, surgery, drug treatment, a 'watch-and-wait' approach or combinations thereof. In contrast, clinical manifestations associated with AE resemble those of a 'malignant', silently-progressing liver disease, with local tissue infiltration and metastases. Structured care is important for AE management and includes WHO staging, drug therapy and long-term follow-up for at least a decade. NE presents as polycystic or unicystic disease. Clinical characteristics resemble those of AE, and management needs to be structured accordingly. However, to date, only a few hundreds of cases have been reported in the literature. The echinococcoses are often expensive and complicated to treat, and prospective clinical studies are needed to better inform case management decisions.

The present situation of echinococcoses in Mongolia.

This review presents the historical and current situation of echinococcoses in Mongolia. Since the collapse of the Soviet Union in 1991, Mongolia's health surveillance infrastructure has been very poor, especially as it pertains to chronic diseases, including neglected zoonotic diseases (NZDs). Although there is anecdotal evidence of people dying from hepatic disease due to infection with the larval stage of Echinococcus spp., there are very few published reports. All confirmed cases of echinococcoses in Mongolia are from hospitals located in the capital city of Ulaanbaatar. Cases of cystic echinococcosis (CE), caused by either Echinococcus granulosus sensu stricto or Echinococcus canadensis are believed to be relatively common throughout Mongolia. In contrast, cases of alveolar echinococcosis (AE), caused by Echinococcus multilocularis, are believed to be rare. Recent wild-animal surveys have revealed that wolves (Canis lupus) are the major definitive hosts of E. canadensis, whereas both wolves and red foxes (Vulpes vulpes) are the primary definitive hosts of E. multilocularis. Although wild-animal surveys have begun to elucidate the transmission of Echinococcus spp. in Mongolia, there have yet to be large-scale studies conducted in domestic dogs and livestock. Therefore, further epidemiological studies, in addition to education-based control campaigns, are needed to help combat this NZD.

Cost-benefit analysis of avian influenza control in Nepal.

Numerous outbreaks of highly pathogenic avian influenza A strain H5N1 have occurred in Nepal since 2009 despite implementation of a national programme to control the disease through surveillance and culling of infected poultry flocks. The objective of the study was to use cost-benefit analysis to compare the current control programme (CCP) with the possible alternatives of: i) no intervention (i.e., absence of control measures [ACM]) and ii) vaccinating 60% of the national poultry flock twice a year. In terms of the benefit-cost ratio, findings indicate a return of US $1.94 for every dollar spent in the CCP compared with ACM. The net present value of the CCP versus ACM, i.e., the amount of money saved by implementing the CCP rather than ACM, is US $861,507 (the benefits of CCP [prevented losses which would have occurred under ACM] minus the cost of CCP). The vaccination programme yields a return of US $2.32 for every dollar spent when compared with the CCR The net present value of vaccination versus the CCP is approximately US $12 million. Sensitivity analysis indicated thatthe findings were robust to different rates of discounting, whereas results were sensitive to the assumed market loss and the number of birds affected in the outbreaks under the ACM and vaccination options. Overall, the findings of the study indicate that the CCP is economically superior to ACM, but that vaccination could give greater economic returns and may be a better control strategy. Future research should be directed towards evaluating the financial feasibility and social acceptability of the CCP and of vaccination, with an emphasis on evaluating market reaction to the presence of H5N1 infection in the country.

Cross-sectional serosurvey of avian influenza antibodies presence in domestic ducks of Kathmandu, Nepal.

Kathmandu, Nepal has been classified as a high-risk area for highly pathogenic avian influenza (HPAI) by the Nepali Government. While ducks have an important role in the transmission of avian influenza viruses (AIV), including HPAI, seroprevalence of antibodies to AIV in domestic ducks of Kathmandu has never been assessed. The objectives of this study were (i) to estimate the prevalence of seroconversion to AIV in domestic ducks in major duck-raising areas of Kathmandu and (ii) to assess the effect of age, sex, presence of swine and the number of ducks on the farm on the carriage of antibodies to AIV in these ducks. From April through July of 2011, a cross-sectional study was conducted and a total of 310 ducks in the major duck-raising areas of Kathmandu were sampled. The estimated prevalence of AIV antibodies was 27.2% [95% confidence interval (CI): 24.6-29.5]. Of 62 enrolled farms, 42% had at least one seropositive duck. Half of the enrolled farms also kept pigs of which 52% had at least one seropositive duck. Bivariate analysis indicated association between ducks' seroconversion to AIV and their age, sex and farm size. However, the final multivariable model, after controlling for clustering of ducks within farms, identified age as the only significant risk factor. Based on this model, ducks older than 1 year of age were more likely to be seropositive compared to ducks <6 months of age [odds ratio = 2.17 (1.07-4.39)]. These results provide baseline information about the AIV seroprevalence in domestic ducks in the major duck-raising areas of Kathmandu and identify a high-risk group that can be targeted in surveillance activities. Future studies should be conducted to differentiate the subtypes of AIV present among domestic ducks in Kathmandu, with particular interest in the presence of HPAI viruses.

A survey of seropositivity to antigen B, an immunodiagnostic antigen for human cystic echinococcosis, in domestic animals in Mongolia.

Cystic echinococcosis (CE) is well known to be an important zoonotic disease and national disease due to the traditional nomadic life style in Mongolia. The present study was carried out to obtain data on the seropositivity to antigen B, in domestic livestock, goats, sheep and cattle, in each province of Mongolia. The seropositivity to antigen B varied by province and ranged from 0% to 25.0% in goats, 0% to 12.5% in sheep, and 0% to 13.3% in cattle. In total, 9.2% of goats, 3.6% of sheep and 5.9% of cattle in Mongolia showed seropositivity.

A questionnaire-based evaluation of the veterinary cordon fence separating wildlife and livestock along the boundary of the Kruger National Park, South Africa.

Veterinary cordon fences are used in Southern Africa to separate wildlife from domestic animals in order to prevent transmission of infectious diseases. Such fences are a control method recognized by the World Organization for Animal Health (OIE) for establishing disease-free zones in beef exporting countries. However, few studies have evaluated the ecological impact of these physical barriers or their effectiveness at a multispecies level. We examined the permeability of one such barrier, along 357 km of the western and southern boundary of the Kruger National Park (KNP) during 2007. Information was gathered using a semi-structured questionnaire implemented among 32 teams of fence maintenance workers. Data were analyzed to identify (a) the main causes of fence damage, (b) the seasonality, location and duration of fence repairs, (c) high permeability areas for elephant (Loxodonta africana), kudu (Tragelaphus strepsiceros), impala (Aepyceros melampus), buffalo (Syncerus caffer) and warthog (Phacochoerus africanus), and (d) the influence of fence electrification, rivers and elephant damage on the frequency of observation of wildlife species outside the KNP estimated during the year. Human and elephant damage were the most common reasons for fence repairs. Elephant and buffalo were the most and least common large mammal species reported observed outside the KNP (1076 and 162 reports/year), respectively. Cattle incursions into the KNP were also reported in 44% of the fence sections. Electrification of the fence was an important factor explaining differences in estimated wildlife species observations outside the KNP during the year. Correlations between estimations of observed species suggested that fence gaps created by elephants might be used by the other wildlife species. Estimated annual counts of kudu, impala and buffalo, but not warthog, were found to correlate with elephant observations. Negative binomial regression models were developed to explore the relationships between observed estimations of different wildlife species outside the KNP the fence, electrification of fence sections and the presence of watercourses, suggesting that kudu, impala and buffalo could use elephant induced fence damage to leave the KNP. The questionnaire was able to evaluate fence integrity and identify sections where integrity was sub-optimal for separating wildlife from domestic livestock species. If combined with more quantitative methods and applied on a routine basis, it could provide an efficient and cost-effective method for monitoring the effectiveness of physical barriers to contain wildlife within protected areas such as is the case with veterinary cordon fences in Southern Africa.

Ice recrystallization kinetics in the presence of synthetic antifreeze glycoprotein analogues using the framework of LSW theory.

The Ostwald ripening of polycrystalline ice in aqueous sucrose solutions was investigated experimentally. The kinetics of this ice recrystallization process was studied at temperatures between -6 and -10 degrees C and varying ice volume fractions. Using the theory of Lifshitz, Slyozov, and Wagner (LSW), the diffusion-limited rate constant for ice recrystallization was determined. Also, the effects of synthetic analogues of natural antifreeze glycoproteins (AFGP) were studied. These analogues synAFGPmi (i = 3-5) contained monosaccharide side groups instead of disaccharide side groups that occur in natural AFGP. In order to account for the inhibition effect of the synAFGPmi, we have modified classical LSW theory, allowing for the derivation of inhibition rate constants. It was found that the investigated synAFGPmi inhibit ice recrystallization at concentrations down to approximately 3 microg mL(-1) or, equivalently, approximately 1 micromol L(-1) for the largest synAFGPmi investigated: synAFGPm5. Hence, our new method is capable of quantitatively assessing the efficiency of very similar AFGP with a sensitivity that is at least 2 orders of magnitude larger than that typical for quantitative thermal hysteresis measurements.

Assessing the burden of Taenia solium cysticercosis and echinococcosis.

This collection of articles provides an account of the papers delivered at the 19th International Conference of the World Association for the Advancement of Veterinary Parasitology (WAAVP)(held in New Orleans, LA, USA, from 10 to 14 August 2003) in a symposium session on assessing the burden of Taenia solium cysticercosis and echinococcosis organised and chaired by A. Lee Willingham III from the WHO/FAO Collaborating Center for Research and Training on Emerging and other Parasitic Zoonoses in Denmark and Peter M. Schantz from the Parasitic Diseases Division of the US Centers for Disease Control and Prevention, USA. The focus was on the persistence of the zoonotic parasitic diseases cysticercosis, caused by the pork tapeworm T. solium, and echinococcosis,caused by species of the tapeworm Echinococcus, and why these diseases are given very little attention on the national and international agendas in spite of the availability of tools to detect, treat,control and prevent them when it is quite clear in most instances that they are clearly associated with and help perpetuate poverty. A major reason for this is that in many endemic areas the presence and impact of these diseases are not known due to the lack of investigation and information thus policymakers are not aware of their burden and benefits of their control. Documentation is also needed to help increase awareness of the international community and hopefully result in financial and technical support being made available. Thus, burden assessments of cysticercosis and echinococcosis provide an essential evidence base for securing political will and financial and technical support as well as providing a basis for cost-benefit analysis of prevention and control efforts. In order to make an appropriate and full burden assessment one must consider the health, agricultural, social and other impacts of these parasitic zoonoses comprehensively. During the symposium presentations were given concerning current ongoing initiatives to assess the burden of cysticercosis and echinococcosis and examples of the impact of these diseases in both developing and developed countries were provided. In addition, cost factors related to vaccines for these cestode diseases were discussed and the possibilities for technical and financial support from multilateral agencies for assessments and interventions presented.

Echinococcosis--an international public health challenge.

This review aims to summarise some of the recent studies that have been undertaken on parasites of the genus Echinococcus and the diseases which they cause. Although the adult parasite, which inhabits the intestine of various carnivore species is not pathogenic, the larval or metacestode stages can be highly pathogenic, causing economic losses to livestock and various forms of echinococcosis in humans, some of which have a high fatality rate. There is growing evidence that there are at least 5 species of Echinococcus rather than the generally accepted 4 species. Within these species there are a number of genotypes or strains. This can have implications for surveillance and control. In some wealthy countries, cystic echinococcosis caused by Echinococcus granulosus has been successfully controlled or indeed eradicated. However, in most parts of the world it remains a serious threat to human health. In the former Soviet Union, the disease has rapidly increased in incidence after the end of communist administration. Human alveolar echinococcosis, caused by Echinococcus multilocularis, is more sporadic. However, in some Chinese communities there is a disturbingly high human prevalence and in Europe there has been an increase in the detection rate of E. multilocularis in animals in the last 10 years. Echinococcosis can present diagnostic challenges, particularly in the definitive host in areas of low endemicity. Much of the recent work relating to the use of coproantigen and PCR to overcome these difficulties is summarized. New ideas for controlling the parasite are becoming available and these include both the use of vaccination and the application of mathematical models to determine the most cost effective means of control. Effective measures that are affordable are vital if the parasite is to be controlled in poor countries.