Ahmed S. Mohamed

Prevalence of intestinal nematode parasitism among pet dogs in the United States (2003-2006).

OBJECTIVE To estimate prevalence of intestinal nematode parasitism among pet dogs in the United States and characterize risk factors for infection. DESIGN Retrospective period prevalence survey. ANIMALS 1,213,061 dogs examined at 547 private veterinary hospitals in 44 states from January 1, 2003, through December 31, 2006. PROCEDURES Data were obtained from electronic medical records of all dogs that had at least 1 fecal flotation test. Risk factors for intestinal nematode parasitism were identified by means of multivariable logistic regression analysis. RESULTS 2,785,248 fecal flotation tests were performed during the study period. When results for only the first test in each dog were considered, prevalences of Toxocara, Ancylostoma, and Trichuris parasitism were 5.04%, 4.50%, and 0.81%, respectively. Dogs < 0.5 years old had higher odds of Toxocara and Ancylostoma parasitism, compared with dogs > 5.0 years old; sexually intact male and female dogs had higher odds of parasitism, compared with spayed female dogs; toy dogs had lower odds of parasitism, compared with dogs in other breed groups; and dogs living in the mountain region had lower odds of parasitism, compared with dogs living in other regions. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that age, body weight, sex, breed, and geographic region were risk factors for intestinal nematode parasitism among pet dogs in the United States.

Effect of eyelid manipulation and manual jugular compression on intraocular pressure measurement in dogs.

OBJECTIVE To determine the effect of eyelid manipulation and manual jugular compression on intraocular pressure (IOP) measurement in clinically normal dogs. DESIGN Randomized clinical trial. ANIMALS 30 dogs (57 eyes) without diseases or medications that affect IOP. PROCEDURES An applanation tonometer was used to measure IOP during eyelid manipulation or jugular compression. Six manipulations were used in each eye, including minimal eyelid manipulation, maximal dorsoventral extension of the eyelids, lateral eyelid extension, manual compression of the ipsilateral jugular vein, manual compression of both jugular veins, and lateral eyelid extension with manual compression of both jugular veins. Skull type and position of globe in the orbit were recorded. RESULTS The 2 manipulations that caused the greatest significant increase in mean IOP were lateral eyelid extension with compression of both jugular veins (difference from baseline IOP, 17.6 mm Hg; 95% confidence interval [CI], 15.7 to 19.5 mm Hg) and lateral eyelid extension alone (16.5 mm Hg; 95% CI, 14.6 to 18.4 mm Hg). Dorsoventral eyelid extension (6.42 mm Hg; 95% CI, 4.5 to 8.3 mm Hg) and compression of both jugular veins alone (3.0 mm Hg; 95% CI, 1.1 to 5.0 mm Hg) significantly increased mean IOP, compared with baseline. Compression of the ipsilateral jugular vein increased mean IOP (0.3 mm Hg; 95% CI, -1.6 to 2.2 mm Hg) from baseline, but not significantly. CONCLUSIONS AND CLINICAL RELEVANCE Traction on the eyelids or pressure on both jugular veins can significantly increase IOP values as measured by use of applanation tonometry in clinically normal dogs.

Temporal patterns of human and canine Giardia infection in the United States: 2003–2009 ☆

Giardia protozoa have been suspected to be of zoonotic transmission, including transmission from companion animals such as pet dogs to humans. Patterns of infection have been previously described for dogs and humans, but such investigations have used different time periods and locations for these two species. Our objective was to describe and compare the overall trend and seasonality of Giardia species infection among dogs and humans in the United States from 2003 through 2009 in an ecological study using public health surveillance data and medical records of pet dogs visiting a large nationwide private veterinary hospital. Canine data were obtained from all dogs visiting Banfield hospitals in the United States with fecal test results for Giardia species, from January 2003 through December 2009. Incidence data of human cases from the same time period were obtained from the CDC. Descriptive time plots, a seasonal trend decomposition (STL) procedure, and seasonal autoregressive moving-average (SARIMA) models were used to assess the temporal characteristics of Giardia infection in the two species. Canine incidence showed a gradual decline from 2003 to 2009 with no significant/distinct regular seasonal component. By contrast, human incidence showed a stable annual rate with a significant regular seasonal cycle, peaking in August and September. Different temporal patterns in human and canine Giardia cases observed in this study suggest that the epidemiological disease processes underlying both series might be different, and Giardia transmission between humans and their companion dogs seems uncommon.

Prevalence and risk factors for Giardia spp. infection in a large national sample of pet dogs visiting veterinary hospitals in the United States (2003–2009)

Estimates of the prevalence of intestinal infection of dogs with Giardia spp. in the United States vary widely. Risk factors for infection in a large sample of dogs over an extended period of time have not been well characterized. A national, electronic database of medical records was used to estimate the prevalence and identify risk factors for Giardia spp. infection among dogs visiting Banfield Pet Hospital™ located in 43 states in the United States. The overall prevalence of Giardia spp. Infection was 0.44% (95% CI: 0.43-0.45%) in approximately 2.5 million owned dogs who had a fecal flotation test performed from January 2003 to December 2009. A steady decrease in annual prevalence was observed, from a high of 0.61% in 2003 to 0.27% in 2009. Seasonal increases in prevalence were noted during the winter and summer months. Giardia spp. prevalence was highest in the Mountain region, especially Colorado (2.63%; 95% CI: 2.53-2.73%), and in puppies ≤0.5 year of age (0.63%; 95% CI: 0.61-0.64%). It was lowest for dogs of mixed breeding compared with pure breeds. Infection risk was 25-30% greater in sexually intact dogs compared to spayed and neutered dogs.

Use of ponazuril paste to treat coccidiosis in shelter-housed cats and dogs

Cystoisospora (synonym Isospora) spp. infections are common in dogs and cats worldwide, especially in crowded or unsanitary environments. Ponazuril (toltrazuril sulfone) is a widely used oral treatment, but protocols that will produce oocyst excretion below the detection limit in shelter-housed animals have not been determined. The aim of this study was to determine the efficacy of ponazuril paste at each of three dosages (dosage 1, 50mg/kg q24 h for 3 days, dogs n=14, cats n=16; dosage 2, 50mg/kg as a single dose, dogs n=13, cats n=25; or dosage 3, 20mg/kg as a single dose, dogs n=16, cats n=23) in shelter-housed dogs (n=43) and cats (n=64) with confirmed coccidiosis. Fecal oocyst counts and identification and fecal consistency scoring was performed pre-treatment (Day 1) and again at Day 3-4 and Day 8. There were higher proportions of animals with oocyst excretion below the detection limit at both Day 3-4 and Day 8 in the dosage 1 group (dogs 92.9%, cats 87.5%) than in the other two groups (dosage 2, dogs 76.9%, cats 80.0%; dosage 3, dogs 68.8%, cats 47.8%). Animals with high fecal oocyst counts at Day 1 were significantly more likely to be infected at Day 3-4 (dogs, P<0.001; cats, P=0.013). Fecal consistency score at Day 3-4 was not significantly related to infection status (dogs, P=0.898; cats, P=0.136). Further studies are warranted to investigate a ponazuril protocol that can safely reduce fecal oocyst burdens in infected dogs and cats to levels below the detection limit. Environmental decontamination is also important to reduce the likelihood of re-infection.

Interlaboratory agreement of coccidioidomycosis enzyme immunoassay from two different manufacturers.

Coccidioidomycosis, a fungal infection endemic to the Southwestern United States, is challenging to diagnose. The coccidioidomycosis enzyme immunoassay (EIA) test is the least expensive and simplest to perform to detect coccidioidomycosis antibodies in the serum. Concerns regarding falsely positive immunoglobulin (Ig) M EIA test results have led to questions about the agreement of commercially available EIA test kits among laboratories. We sought to evaluate the laboratory agreement of the EIA test at three laboratories using both IMMY and Meridian EIA test kits. Sensitivity and specificity of EIA IgM and IgG were calculated as secondary outcomes. The percent agreement of the EIA IgM and IgG test results among all three laboratories was 90% and 89% for IMMY test kits, respectively, and 67% and 80.5% for Meridian test kits, respectively. Agreement between IgM and IgG combined test results was 85.5% and 70.5%, for IMMY and Meridian, respectively. Combined IgM and IgG assays demonstrated a sensitivity of 68% (62.7%-76%) and a specificity of 99.3% (98%-100%) [IMMY] and a sensitivity of 72.4% (57.3%-87.3%) and a specificity of 91.3% (74%-100%) [Meridian]. In summary, results from the IMMY EIA test kit agreed more often across laboratories than Meridian EIA results, especially for the IgM assay. Isolated positive IgM EIA results using the Meridian test kit should be interpreted with caution and consideration of clinical information and test methodology. Further study of the sensitivity and specificity of coccidioidomycosis EIA test kits is warranted.

Temporal association of implementation of the Arizona Health Care Cost Containment System (AHCCCS) with changes in dental-related emergency department visits in Maricopa County from 2006 to 2012

OBJECTIVE To evaluate changes in emergency department (ED) dental-related visits in Maricopa County before and after the elimination of dental benefits for adult Medicaid-insured patients as of October 2010. METHODS Hospital visits extracted from a hospital discharge dataset were used to calculate a yearly rate ratio of dental-related versus non-dental-related ED visits (as a comparison group) for adults, children, and payer types. Changes in ED visits over time were evaluated from 2006 to 2012. RESULTS Overall, 1.3 percent of all ED visits (8,030,767) were for dental-related purposes. Medicaid-insured patients accounted for 41.9 percent and 44.3 percent of all dental-related ED visits in 2006 and 2012, respectively. The rate ratio for the percentage of dental-related versus non-dental-related ED visits in each age category and payer type showed little fluctuation over time indicating no evidence of change in the dental-related ED visits as a proportion of the overall number of visits due to the cuts in the dental benefits for adult Medicaid-insured patients. CONCLUSION We found no evidence that cuts in dental benefits for adult Medicaid-insured patients resulted in increased dental-related ED visits in Maricopa County during the study period. Rather, we found evidence of a shift in payer type after the 2010 policy change where dental-related ED visits by self-paid patients increased as dental-related ED visits by Medicaid-insured patients decreased. Such payer shifts will result in high uncompensated care burdens for providers and, ultimately, governmental payers.