Monetary burden of neurocysticercosis on a hospitalized population in Muli County, China.

Neurocysticercosis (NCC) is a potentially life-threatening condition caused by the zoonotic cestode, Taenia solium. Pigs are the typical intermediate hosts for T. solium but humans can become infected and develop NCC upon ingesting parasite eggs that are shed in the feces of an infected person. The objective of this study was to estimate the monetary burden of neurocysticercosis (NCC) on hospitalized patients from Muli County, China. Muli is an agricultural county in Liangshan Prefecture, Sichuan Province, China where pigs are raised and the zoonotic cestode, Taenia solium, is endemic. Demographic and treatment data were collected from the Muli County Health Insurance Department on hospitalized individuals with an NCC diagnosis between 2014 and 2021. These patients represent residents of Muli County that purchased health insurance and received treatment in a public hospital in Sichuan Province. Hospital costs were converted from Chinese renminbi (RMB) to United States dollars (US$) for month and year of hospitalization and adjusted for inflation. Individuals with missing hospital information were excluded from analysis. For indirect costs, annual average salary for Liangshan Prefecture working-age adults was obtained to calculate productivity losses based on number of hospitalization days and travel days to and from the hospital. Transportation costs were evaluated based on estimated bus fare to and from the hospital. Out of 70 patients identified from 2014 to 2021, 68 had complete records, of which 47.1% were male (n = 33) and the median age at first hospitalization was 34 years. Total estimated cost for these patients was US$228,341.98. Direct costs contributed 62.5% (US$142,785.25) and indirect costs were 37.5% (US$85,556.73) of the total cost. The estimated median cost per case was US$2,078.69. Individuals with a single hospitalization (n = 41) cost a median of US$1,572.03 and those with multiple hospitalizations (n = 27) cost a median of US$4,169.95. The median total cost per NCC case was 18.6% of the average wage for a Liangshan Prefecture resident in 2021. While the study was limited to those with insurance coverage, monetary burden on the local population is likely substantial. Public health policies aimed at reducing transmission should be implemented to decrease the economic burden of NCC on this region.

A survey of the parasites of Ural saiga antelopes and Turkmenian kulans of Kazakhstan.

Saiga antelope and Turkmenian kulans are considered critically endangered and near threatened, respectively, by the International Union for Conservation of Nature (IUCN). Due to these species' fragile status, it is important to understand the pathogens infecting their remaining populations. A total of 496 faecal samples were collected from Ural saiga antelope in western Kazakhstan during June, September, and November of 2021 and May and August of 2022 and 149 faecal samples were collected from kulans in the Altyn-Emel nature reserve in south-eastern Kazakhstan from June to August of 2021. Additionally, endo- and ecto-parasites were collected from 17 saiga that were found deceased due to natural causes. Nine helminths (3 cestodes, 6 nematodes) and two protozoans were found in Ural saiga antelope. In addition to intestinal parasites, one case of cystic echinococcosis due to Echinococcus granulosus infection and one case of cerebral coenurosis due to Taenia multiceps infection was identified on necropsy. None of the collected ticks (all Hyalomma scupense) were found positive for Theileria annulate (enolase gene) or Babesia spp. (18 S ribosomal RNA gene) via PCR. Three intestinal parasites (Parascaris equorum, Strongylus sp., and Oxyuris equi) were found in kulans. All identified parasites, in both saiga and kulans, are also found in domesticated livestock, suggesting a need for better understanding of how parasites are maintained within and between regional wild and domestic ungulate populations.

What is the value of statistical testing of observational data?

Statistical analysis of medical data aims to reveal patterns that can aid in decision making for future cases and, hopefully, improve patient outcomes. Large and bias-free datasets, such as those produced in formal randomized clinical trials, are necessary to make such analyses as reliable as possible. For a host of reasons, randomized trials are, unfortunately, relatively uncommon in veterinary medicine and surgery, implying that less ideal datasets (mostly observational data) must form the basis for much of our decision making regarding treatment of individual patients under our care. In this review, we first describe the common shortcomings of many observational veterinary datasets when viewed in comparison with their optimal counterparts and highlight how the deficiencies can lead to unreliable conclusions. We illustrate how many of the interpretative problems associated with observational data, predominantly various forms of bias, are not solved, and may even be exacerbated, by statistical analysis. We emphasize the need to examine summary data and its derivation in detail without being lured into relying upon P values to draw conclusions and advocate for completely omitting statistical analysis of many observational datasets. Finally, we present some suggestions for alternative statistical methods, such as propensity scoring and Bayesian methods, which might help reduce the risk of drawing unwarranted, and overconfident, conclusions from imperfect data.

Implementation of Taenia solium control measures in Bali, Indonesia: Survey findings and a historical overview.

Historically, cysticercosis cases caused by infection with the larval stage of the Taenia solium tapeworm have occurred sporadically in Bali, with taeniasis carriers found primarily in villages located in the Kubu subdistrict of Karangasem. As Bali is a well-known tourist destination, living standards are relatively high on the island, except for an area located beneath the northeast slope of the active volcano Mt. Agung (Alt. 3031 m), which includes Kubu. Over the last 30 years, pigs originating from this area have been found with T. solium cysticerci, whereas pigs from other parts of the island have not been shown to be infected. Out of 108 individuals screened via fecal sample examination in Kubu during 2019, 3 cases of T. solium taeniasis (2.8%) were identified. There was no significant difference in taeniasis prevalence from surveys conducted in 2011-2016 (1.0%, 11/1089) (p = 0.123). Out of 110 humans and 140 pigs tested serologically in Kubu during 2019, no cases of cysticercosis were identified. This is in contrast to a seroprevalence of 4.1% (42/1025) in humans during 2011-2016 and a seroprevalence of 13.1% (43/329) in pigs during 2011-2013. Over the last decade, improved drinking water and sanitary systems have been employed in addition to health education targeting primary school children, including emphasis on washing hands before eating and after defecation. This review provides previously unpublished survey data and a historical overview of T. solium infection in Bali and offers guidance on best practices to ensure that remaining pockets of transmission are addressed.

New insights on the Taenia solium tapeworm using molecular tools: age-based human definitive host prevalence and deliberation on parasite life span.

Information on age-based Taenia solium taeniasis prevalence is crucial for control of cysticercosis. T. solium taeniasis prevalence was determined for a village in Liangshan Prefecture, Sichuan Province, China that was co-endemic for T. solium, Taenia saginata asiatica, and Taenia saginata. Individuals who were Taenia egg-positive by stool microscopy and/or expelled tapeworms or proglottids post-treatment were diagnosed as having taeniasis. Infecting species was identified via multiplex PCR on tapeworm specimens or coproPCR followed by sequencing. In addition, initial stool samples from 10 children with taeniasis suspected of having spontaneous expulsion of tapeworms within the period between diagnosis and treatment were subject to species confirmation via coproPCR and sequencing. Of the 389 study subjects, 194 (49.9%) were diagnosed with taeniasis. Children (< 16 years of age) had a higher T. solium taeniasis prevalence (8.8%) than older individuals (2.5%) (P = 0.0127). Molecular analysis of initial stool samples from 7 of 10 children suspected of spontaneously passing tapeworms indicated 6 infections due to T. solium and 1 infection due to T. saginata. This study found that young children had a higher T. solium taeniasis prevalence than older individuals, providing additional support for the belief that adult T. solium likely has a relatively short lifespan compared to other Taenia species with human definitive hosts.

Ultrasound-based evaluation of the prevalence of abdominal cystic echinococcosis in the Turkestan region of Kazakhstan.

BACKGROUND: Human cystic echinococcosis (CE) is a zoonotic disease caused by Echinococcus granulosus sensu lato. CE is known to be endemic in some parts of Central Asia. We present findings from an ultrasound-based survey to estimate the prevalence of CE in the Turkestan oblast of Kazakhstan. METHODS: In October 2019, six villages were chosen based on records from a national surveillance dataset. Inhabitants aged 5-90 y were invited to undergo a free abdominal ultrasound to screen for CE cysts. All identified cysts were staged according to the WHO-endorsed classification for CE cysts. RESULTS: A total of 2252 individuals underwent ultrasound screening. Twenty-two (0.98%) individuals had CE, with a combined total of 33 cysts: 25 (75.7%) inactive (14 CE4, 11 CE5) and 8 (24.3%) active/transitional (2 CE1, 1 CE2, 3 CE3a, 2 CE3b). One patient had a postsurgical cavity. Sixty-eight patients (3.0%) reported CE prior to surgical treatment. In 25 (36.8%) previously diagnosed patients, albendazole prophylaxis was not used. CONCLUSIONS: CE is endemic in the study region, with ongoing transmission. The number of surgically treated CE patients suggests an underestimation of the disease burden by the current surveillance system. Further studies on local CE epidemiology and the implementation of expert treatment recommendations are needed.

Trends in the Surgical Incidence of Cystic Echinococcosis in Uzbekistan from 2011 to 2018.

Cystic echinococcosis (CE) is a zoonosis with a cosmopolitan distribution caused by Echinococcus granulosus sensu lato tapeworms. Although Uzbekistan and other countries in Central Asia are considered endemic, estimates of disease burden are lacking. We present data regarding surgically managed cases of CE obtained from Uzbekistan's national disease surveillance registry. These data are from medical centers in Uzbekistan authorized to treat the disease and reported to the Uzbek Center for Sanitation and Epidemiology from the period 2011 to 2018. Information included patient age class (children 14 years or younger versus adults 15 years and older), but no data regarding cyst location. Incidence rates were calculated using data from the national population registry, and the Cuzick nonparametric test for trends was used to test for differences in the incidence over time at the country and regional levels. A total of 7,309 CE cases were reported. Of these, 857 (11.73%) involved pediatric patients. The mean incidence rates were 4.4 per 100,000 population in 2011 and 2.3 per 100,000 population in 2018 (P = 0.016). One region (Republic of Karalpakistan) showed a nonstatistically significant increase (P = 0.824). All other regions except three showed a statistically significant decrease. We present data showing a decrease in the overall incidence of surgically treated CE in Uzbekistan from 2011 to 2018. However, the presence of cases involving children suggests ongoing parasite transmission. The absence of clinical information (starting with cyst stage and localization) needs to be addressed to improve the national surveillance system. Field studies are also needed to further explore the epidemiology of CE in the country.

Genetic Diversity of Taenia solium and its Relation to Clinical Presentation of Cysticercosis.

In this perspectives paper, we discuss fertilization strategies for Taenia saginata and Taenia saginata asiatica as well as heterogeneity in Taenia solium, the causative agent of human cysticercosis. Two different genotypes of T. solium (Asian and Afro/American) were confirmed by mitochondrial DNA analysis approximately two decades ago. Since then, outcrossings of the two genotypes have been identified in Madagascar where the two genotypes are distributed sympatrically. Outcrossings were confirmed by the presence of discordance between mitochondrial and nuclear DNA. Since multiple tapeworm infections are common in endemic areas, outcrossing events likely occur quite frequently. Therefore, mitochondrial DNA from T. solium specimens collected from humans and pigs in endemic areas should be analyzed. If variations are found between specimens, nuclear DNA analysis should be performed to confirm the presence of discordance between mitochondrial and nuclear genes. Additional outcrossings likely add complexity to understanding the existing genetic diversity. Serological surveys are also recommended since serodiagnostic glycoprotein can also differentiate between the two genotypes. Viable eggs from different genotypes or from hybrids of two different genotypes should be used for experimental infection of pigs or dogs in order to observe any pathological heterogeneity in cysticercosis development. Although genetic diversity of T. solium is expected to result in clinical heterogeneity of cysticercosis in humans and pigs, there is currently no evidence showing that this occurs. There are also no comparative experimental studies on this topic. Therefore, studies evaluating the link between parasite heterogeneity and clinical outcome are warranted.

Estimation of the monetary burden of treated human cystic echinococcosis in Pakistan.

Cystic echinococcosis (CE), caused by the larval stage of Echinococcus granulosus sensu lato tapeworms, continues to be a public health problem in many endemic countries, including Pakistan. Patient level data, including age, sex, and cyst(s) location for surgically managed CE patients for the years 2013-2016 from hospitals located in Punjab and Khyber Pakhtunkhwa provinces were obtained from medical charts. Direct and indirect costs associated with surgically managed CE patients treated in private and public hospitals were then estimated and applied to country-level case numbers estimated through the Global Burden of Disease Study. A total cost of US$4,068,666 (95% CI: US$3,097,684 - US$5,295,702) was estimated for the year 2017, with US$3,951,853 (95% CI: US$2,981,400 - US$5,177,610) attributable to direct diagnosis and treatment-related costs and US$117,137 (95% CI: US$91,841 - US$146, 979) attributable to wage losses during the treatment period. Mean direct cost per patient (US$1,056) was approximately 72% of the country's per capita gross domestic product (GDP). Surgical management continues to be the treatment of choice for CE patients in Pakistan. If physicians were to adhere to World Health Organization Informal Working Group on Echinococcosis (WHO-IWGE) cyst stage-specific treatment guidelines, it is likely that the number of surgical interventions would decrease as would treatment costs.

Evaluation of zoonotic platyhelminthe infections identified in slaughtered livestock in Iran, 2015-2019.

BACKGROUND: Platyhelminth infections of livestock can result in considerable economic losses. This study aims to evaluate the spatial frequency of cystic echinococcosis (CE), dicrocoeliasis, and fascioliasis in livestock slaughtered in Iran during the years 2015-2019 and estimate direct costs associated with organ condemnation due to these parasites. METHODS: Abattoir data from 413 abattoirs representing all 31 Iranian provinces were collected from the Iran Veterinary Organization. Infection prevalence was calculated per year at the province level. The Local Moran's I statistic was performed to evaluate spatial autocorrelation of animals positive at slaughter for the years 2015-2019. Direct costs associated with condemned livers were calculated for each parasitic condition, with costs associated with condemned lungs also included for CE. RESULTS: Overall prevalence values for the study timeframe were as follows: sheep and goat fascioliasis 1.56% (95% CI: 1.56-1.56%), cattle fascioliasis 3.86% (95% CI: 3.85-3.88%), sheep and goat dicrocoeliasis 4.63% (95% CI: 4.62-4.63%), cattle dicrocoeliasis 3.08% (95% CI: 3.07-3.09%), sheep and goat CE 5.32% (95% CI: 5.32-5.33%), and cattle CE 7.26% (95% CI: 7.24-7.28%). Northwest Iran had the highest prevalence of CE and fascioliasis. High infection areas for Dicrocoelium spp. included the provinces of Zanjan, Gilan, Qazvin, and Tehran, which are located in northern Iran. Direct economic losses for sheep and goat fascioliasis, dicrocoeliasis, and CE for the study period were US$13,842,759, US$41,771,377, and US$22,801,054, respectively. Direct economic losses for cattle fascioliasis, dicrocoeliasis, and CE for the study period were US$1,989,200, US$1,668,986, and US$2,656,568, respectively. CONCLUSION: Our findings provide valuable data for future monitoring of these important parasitic diseases in Iranian livestock. Disease control strategies are required to reduce the economic and public health impact of these platyhelminths.

Assessment of a 10-year dog deworming programme on the transmission of Echinococcus multilocularis in Tibetan communities in Sichuan Province, China.

Human alveolar echinococcosis (AE) is considered a neglected zoonotic disease by the World Health Organization (WHO). The causative pathogen, Echinococcus multilocularis, lives as an adult tapeworm in the intestinal tract of canines. AE was identified as an emerging public health issue in Tibetan communities of Shiqu County 20 years ago. On St. Lawrence Island, Alaska (USA), in the 1980s peri-domestic transmission of E. multilocularis was controlled by regular deworming of owned dogs over a 10-year period. In Tibetan communities, on the Tibetan Plateau, control of E. multilocularis transmission is challenging due to the continental setting, complex epidemiology, disease ecology, geography, and socio-cultural factors. However, a control programme based on deworming owned dogs using praziquental (PZQ) has been carried out since 2006. Assessment was conducted in townships where baseline data were available 10 years prior. Purging of dogs by oral administration of arecoline was used to measure E. multilocularis prevalence, trapping small mammals around communities was employed to assess the change in infection of pikas and voles, and analysis of human AE abdominal ultrasound-based data was used to understand the change in prevalence in the past decade. In all three evaluated townships, the E. multilocularis prevalence in owned dogs was significantly (P < 0.01) reduced from 7.23% (25/346) during 2000-2003 to 0.55% (1/181) in 2016. Human AE ultrasound-based prevalence (adjusted for age and sex) in five evaluated townships decreased significantly (P < 0.01) from 6.25% (200/3,198) during 2000-2002 to 3.67% (706/19,247) during 2015-2017. The 2016 prevalence of E. multilocularis metacestodes in small mammal intermediate hosts was not significantly different from the prevalence in 2008. The control programme was effective in reducing E. multilocularis infection in owned dogs and human AE prevalence, but did not significantly impact infection in wildlife intermediate hosts.

Perspectives on intestinal tapeworm infections: An evaluation of direct and indirect life-cycles with a special emphasis on species of Hymenolepis.

Numerous experimental studies have been conducted on the rodent tapeworm, Hymenolepis microstoma. In contrast, less is known about the life-cycle and immunobiology of the zoonotic dwarf tapeworm, Hymenolepis nana. However, H. nana appears to be unique in that; (i) it can complete its entire life-cycle within a single mammalian host, and (ii) cysticercoids that develop in beetle intermediate hosts are tailed, while those that develop in the intestinal tissue of mammals are tailless. This is in contrast to all other Hymenolepis spp., which only appear to develop tailed cysticercoids in beetles or experimentally infected immunodeficient rodents. Even though H. microstoma and H. nana are phylogenetically much closer to each other than to Hymenolepis diminuta, when mice with severe combined immunodeficiency (SCID) were inoculated with H. microstoma eggs, hatched oncospheres invaded the intestinal tissue and developed into infective tailed cysticercoids in approximately 11 days. Therefore, H. nana appears to be truly unique in its ability to develop tailed cysticercoids in beetles and tailless cysticercoids in mammals. These unique evolutionary characteristics are discussed in relation to other cyclophyllidean cestodes, including Taenia solium and Echinococcus spp.

Cystic Echinococcosis in Pakistan: A Review of Reported Cases, Diagnosis, and Management.

Cystic echinococcosis (CE) is a zoonotic disease that occurs in humans and ungulates due to infection with the larval stage of the taeniid cestode Echinococcus granulosus sensu lato. It has been estimated that approximately one million people are infected annually, resulting in US$3 billion in human and livestock-associated direct and indirect losses per year. CE is a serious public health concern in many parts of the world, including Pakistan. This review discusses the causative agent as well as the epidemiology, diagnosis, and treatment of CE in Pakistan.

First report of Echinococcus canadensis (G6/G7) by sequence analysis from the Khyber Pakhtunkhwa province of Pakistan.

Cystic echinococcosis (CE) is a zoonotic parasitic disease that can result in human and animal health problems globally. Although the disease is known to be endemic in Asia and the Middle East, there are few epidemiological studies on CE in Pakistan. The purpose of the present study was to identify the Echinococcus granulosus sensu lato species and genotypes contributing to human CE cases in the Khyber Pakhtunkhwa (KPK) province of Pakistan. A total of fifty-six formalin fixed paraffin embedded (FFPE) CE cyst samples of human origin were collected from the Pathology Department, Rehman Medical Institute (RMI), KPK for the years 2012-2017. Cyst samples came from the liver (26/56; 46.4%), lungs (3/56; 5.3%), spleen (3/56; 5.3%), pelvis (1/56; 1.8%), breast (1/56; 1.8%), and thigh (1/56; 1.8%). The organ location for 21 of the cysts was not recorded. World Health Organization-Informal Working Group on Echinococcosis (WHO-IWGE) ultrasound-based cyst staging was available for 17 of the 26 (65.4%) hepatic cysts. Five of these cysts (29.4%) were CE3 (transitional), nine (52.9%) were CE4 (inactive), and three (17.6%) were CE5 (inactive). Most of the cysts were obtained from CE patients that were ethnically Afghan Pashtuns (44/56; 78.6%), while 12.5% (7/56) were from patients that were Pakistani Pashtuns. The majority (41/56; 73.2%) of patients reported having close interactions with dogs. Using 12SrRNA primers, 33 cyst samples were identified as being caused by E. granulosus sensu stricto (s.s.). Mitochondrially encoded cytochrome C oxidase 1 (mt-CO1) was evaluated for the remaining 23 samples. PCR product was obtained from six of these 23 samples. Of these six samples, one was identified as Echinococcus canadensis (G6/7). Haplotype analysis showed high haplotype and low nucleotide diversity for the mt-CO1 gene. There were 26 polymorphic sites for the mt-CO1 sequence, of which 65.3% (17/26) were parsimony informative. The E. canadensis mt-CO1 haplotype network consisted of 11 haplotypes, with a main central haplotype. In conclusion, it appears that E. granulosus s.s. and E. canadensis (G6/7) are circulating in the northwestern region of Pakistan. Further molecular epidemiological studies are needed to explore the local genetic diversity of the parasite.

Control of Cystic Echinococcosis in Iran: Where Do We Stand?

Cystic echinococcosis (CE) is an important public health challenge in Iran that requires a One Health approach to control. Filling information gaps and research needs on different aspects of the disease, including parasite biology, disease ecology, human/animal infection, and administrative issues, is essential to address challenges faced by CE control programs.

Assessment of the direct economic losses associated with hydatid disease (Echinococcus granulosus sensu stricto) in beef cattle slaughtered at an Australian abattoir.

Bovine hydatid disease, characterised by fluid-filled hydatid cysts, is regularly found in the offal of beef cattle at slaughter. Organs found to be infected at slaughter are removed to preclude them from entering the human food chain. The organs are either downgraded to pet food or condemned. Previous studies have focussed on total economic losses, but have not calculated the cost of disease per animal, which would be useful information for producers when determining how best to manage hydatid disease. This study estimated the direct losses associated with hydatid disease in beef cattle slaughtered at an Australian beef abattoir both at the population (all cattle slaughtered) and individual animal level. Data on annual prevalence of hydatid disease in beef cattle were obtained from an Australian abattoir for the years 2011-2017. The direct losses resulting from the condemnation and downgrading of offal infected with hydatid cysts at the abattoir were estimated using data stratified by age, sex and feed-type. Official and literature-based sources of organ weight and price were used to estimate direct losses associated with hydatid disease in beef cattle slaughtered at the abattoir. Uncertainty and variability in input parameters were represented using uniform distributions and Monte Carlo sampling was used to model output parameter uncertainty. Out of 1,097,958 beef cattle slaughtered between January 2011 and December 2017, 97,832 (8.9%) were reported infected with hydatid disease. The median estimated direct loss to the abattoir for the duration of the study period was AU$655,560 (95% confidence interval [CI] AU$544,366-787,235). This equated to approximately AU$6.70 (95% CI AU$5.56-8.05) lost per infected animal. The annual median estimated direct losses due to hydatid disease at the abattoir were AU$93,651 (95% CI AU$77,767-112,462). Direct losses varied each year of the study and ranged from AU$38,683 in 2016 to AU$163,006 in 2014. This estimate of the direct losses associated with bovine hydatid disease most likely underestimates the true extent of the overall losses because indirect losses such as reduced carcass weights were not estimated in this study. Nevertheless, these estimates illustrate the negative economic impact of bovine hydatid disease and demonstrate that improved surveillance to enable control of hydatid disease should be considered both in Australia and globally. It would be worthwhile to estimate the losses in other beef abattoirs for the same time period to compare results, and to investigate the cost-benefit of control programs for bovine hydatid disease.

Surgically confirmed cases of cystic echinococcosis from Baluchistan Province, Pakistan for the years 2011-2018.

INTRODUCTION: Cystic echinococcosis (CE) is a parasitic zoonotic disease caused by the larval stage of Echinococcus granulosus tapeworms. It has a worldwide geographic distribution and can threaten the livestock industry and human health in endemic areas, including Pakistan. CE prevalence is high in Pakistan due to lack of local knowledge about disease transmission and a lack of control measures. The Pakistan province of Baluchistan shares a border with Iran and Afghanistan and is largely agricultural. However, little is known about E. granulosus transmission in this region. METHODS: Information on surgically confirmed cases of CE in Baluchistan Province was obtained through evaluation of paraffin fixed cyst samples and patient records obtained from three local hospitals for the years 2011-2018. RESULTS: A total of 22 paraffin fixed samples were collected during the study period. The majority of cysts were obtained from the liver (9/22; 40.9%), with anatomical location not available for two of the cysts. Demographic information was available for 18 cases. Females made up 61.1% (11/18) of the cases. The largest numbers of cases were found in the 31-40 years age group (5/18; 22.7%). DISCUSSION: This study shows that Echinococcus spp. parasites are circulating in the study area. In order to control the disease, a comprehensive regional surveillance and control program is needed.

Assessment of body weight for age determination in kittens.

OBJECTIVES: The objective of this study was to assess the utility of using body weight for age determination in kittens. METHODS: Medical records were reviewed for serial body weight measurements collected from neonatal kittens (up to 8 weeks of age) from a breeding colony of specific pathogen-free domestic shorthair cats and for single-point body weight measurements of privately owned pediatric kittens (6-20 weeks of age) presenting for elective sterilization. Body weights were compared with known dates of birth and age assessed by dental eruption in combination with developmental characteristics. RESULTS: The coefficient of determination (R2) between age and body weight in longitudinally sampled neonatal kittens was 0.88, while that for pediatric kittens sampled at a single time point was 0.54. Among neonatal kittens, predicted age based on the 1 lb (0.45 kg) of body weight gain per month of age guideline corresponded to within 1 week of actual age for 243 (98.8%), 234 (95.1%), 203 (82.5%) and 191 (77.6%) kittens at 2, 4, 6 and 8 weeks of age, respectively. Among pediatric kittens, predicted age based on this guideline corresponded to within 1 week of actual age for 24 (77.4%), 411 (67.5%), 170 (57.0%), 96 (46.6%), 23 (28.8%), 15 (27.8%), one (25%) and five (17.9%) kittens at 6, 8, 10, 12, 14, 16, 18 and 20 weeks, respectively. CONCLUSIONS AND RELEVANCE: Body weight was an effective means of predicting age in kittens through 10 weeks of age. Factors other than body weight should be considered when estimating kitten age beyond that time point.

Neurocysticercosis cases identified at Sanglah Hospital, Bali, Indonesia from 2014 to 2018.

Neurocysticercosis (NCC) was first reported in the province of Bali, Indonesia in 1975. Since this time, sporadic cases have been reported annually. This study reports information on 29 NCC cases (20 males and 9 females) admitted to a referral hospital in Denpasar, Bali from 2014 until 2018. Twenty-four cases were from Bali, 2 were from the province of East Nusa Tenggara, and 3 were from the Democratic Republic of Timor-Leste. Mean patient age was 37.2 years and 69.0% (20/29) were male. Epileptic seizures were the most common clinical manifestation (65.5%, 19/29). Serology (ELISA) was used in 14 cases (48.2%, 14/29), but only 6 cases, including one case with an inactive calcified lesion, were positive (42.9%, 6/14). Two cases underwent surgical resection after their lesions were initially misdiagnosed as brain tumors. These hospital-based findings are discussed along with the present status of NCC in Bali.