Epidemiology and cost of Lyme disease‐related hospitalizations among patients with employer‐sponsored health insurance—United States, 2005–2014

An estimated 300,000 cases of Lyme disease occur in the United States annually. Disseminated Lyme disease may result in carditis, arthritis, facial palsy or meningitis, sometimes requiring hospitalization. We describe the epidemiology and cost of Lyme disease‐related hospitalizations. We analysed 2005–2014 data from the Truven Health Analytics MarketScan Commercial Claims and Encounters Databases to identify inpatient records associated with Lyme disease based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) codes. We estimated the annual number and median cost of Lyme disease‐related hospitalizations in the United States in persons under 65 years of age. Costs were adjusted to reflect 2016 dollars. Of 20,983,165 admission records contained in the inpatient databases during the study period, 2,823 (0.01%) met inclusion criteria for Lyme disease‐related hospitalizations. Over half of the identified records contained an ICD‐9‐CM code for meningitis (n = 614), carditis (n = 429), facial palsy (n = 400) or arthritis (n = 377). Nearly 60% of hospitalized patients were male. The median cost per Lyme disease‐related hospitalization was $11,688 (range: $140–$323,613). The manifestation with the highest median cost per stay was carditis ($17,461), followed by meningitis ($15,177), arthritis ($13,012) and facial palsy ($10,491). Median cost was highest among the 15‐ to 19‐year‐old age group ($12,991). Admissions occurring in January had the highest median cost ($13,777) for all study years. Based on extrapolation to the U.S. population, we estimate that 2,196 Lyme disease‐related hospitalizations in persons under 65 years of age occur annually with an estimated annual cost of $25,826,237. Lyme disease is usually treated in an outpatient setting; however, some patients with Lyme disease require hospitalization, underscoring the need for effective prevention methods to mitigate these serious cases. Information from this analysis can aid economic evaluations of interventions that prevent infection and advances in disease detection.     

IMAGING DIAGNOSIS—DORSAL MEDIASTINAL T‐CELL LYMPHOMA IN AN ALPACA

A 14‐year‐old male alpaca had refractory pleural effusion. The cause of the effusion was not apparent either radiographically or sonographically, or following a pleural fluid cytologic examination. Using computed tomographic (CT) examination, a dorsal paravertebral mass was identified and similar masses were found in the cranial mediastinum, retroperitoneal space, and adjacent to the hepatic entry of the portal vein. The histopathologic diagnosis was multicentric T‐cell lymphoma. CT examination may prove to be a valuable imaging modality in the localization and staging of neoplasia in new world camelids.     

IMAGING DIAGNOSIS—IDIOPATHIC HYOID MALFORMATION IN AN 8‐YEAR‐OLD WELSH SECTION D HORSE

An 8‐year‐old gelding was evaluated for intermittent dorsal displacement of the soft palate (DDSP) at exercise. Standing laterolateral radiographs demonstrated an abnormal crossed appearance of the stylohyoid bones. Computed tomography (CT) confirmed abnormal positioning of the left stylohyoid bone and articulations with both the left thyrohyoid and ceratohyoid bones. Surgical treatment consisted of combined left ceratohyoidectomy and thyrohyoidectomy. Postoperatively the patient's presenting complaint resolved completely, with the horse returning to full work. Standing laterolateral radiographs should be obtained prior to laryngeal or hyoid surgery to rule out hyoid anomalies, which could result in surgical failure or subsequent hyoid fracture.     

Tick bite and Lyme disease‐related emergency department encounters in New Hampshire, 2010–2014

Lyme disease (LD) is a common tick‐borne disease in New Hampshire (NH). While LD is a reportable condition and cases are counted for public health surveillance, many more people receive care for tick bites or diagnoses of LD than are reflected in surveillance data. NH's emergency department (ED) data system was queried for tick bite and LD‐related encounters. Chief complaint text was queried for words related to LD or tick bites. International Classification of Diseases 9th Revision (ICD‐9) codes were queried for the LD diagnosis code (088.81). Emergency department patient data were matched to reportable disease data to determine the proportion of ED patients reported to the health department as a suspected LD case. Data were analysed to calculate frequencies for key demographic and reporting characteristics. From 2010 to 2014, 13,615 tick bite or LD‐related ED encounters were identified in NH, with most due to tick bites (76%). Of 3,256 patients with a LD‐related ED encounter, 738 (23%) were reported to the health department as a suspected LD case. The geographic distribution of ED patients was similar to reported LD cases; however, the regions of the state that experienced higher rates of ED encounters were different than the regions that observed higher rates of reported LD cases. Seasonal distribution of ED encounters peaked earlier than reported LD cases with a second peak in the fall. While age and sex distribution was similar among ED patients and reported LD cases, the rates for children 5 years and younger and adults 65 years and older were greater for ED encounters. Patients frequently visit the ED to seek care for tick bites and suspected LD. Results of ED data analyses can be used to target education, in particular for ED providers and the public through timely distribution of evidence‐based educational materials and training programmes.     

IMAGING DIAGNOSIS—FDG‐PET/CT OF A CANINE SPLENIC PLASMA CELL TUMOR

An 8‐year‐old Shih Tzu developed abdominal pain and hyperglobulinemia. A round splenic mass was noted radiographically and sonographically. The patient was evaluated by fluorodeoxyglucose positron emission tomography coupled with computed tomography (FDG‐PET/CT). There was no evidence of metastasis or bone marrow involvement on PET/CT images. The standardized uptake value (SUV) of the splenic mass was increased over the reference range (SUV=4.83). The patient was diagnosed as splenic extramedullary plasmacytoma through immunohistopathologic study. After the splenectomy, the globulin level normalized and the patient is alive without complications.     

IMAGING DIAGNOSIS—TRANSCRANIAL COLOR‐CODED DUPLEX SONOGRAPHY IN A DOG WITH HEPATIC ENCEPHALOPATHY

We report the use of transcranial Doppler ultrasonography in a dog with hepatic encephalopathy secondary to a congenital portosystemic shunt. A severe increase in the pulsatility index was measured in the right middle cerebral artery, left middle cerebral artery, and basilar artery. These values returned to normal following medical stabilization of the patient and resolution of the neurologic signs. Transcranial Doppler ultrasonography appears to have value for monitoring the status of intracranial hypertension in patients with hepatic encephalopathy.     

IMAGING DIAGNOSIS—AORTIC ANEURYSM AND URETERAL OBSTRUCTION SECONDARY TO UMBILICAL ARTERY ABSCESSATION IN A 5‐WEEK‐OLD FOAL

A 5‐week‐old foal was evaluated for fever and hematuria of 3 days duration. Cystoscopy localized the blood to be originating from the left ureter. Abdominal ultrasonography revealed left hydronephrosis, hydroureter, and omphaloarteritis of the left umbilical artery with abscess formation that communicated with an arterial structure. Computed tomography (CT) revealed a large aortic aneurysm within the center of the abscess. An exploratory celiotomy was performed and the infection was nonresectable. The prognosis for life was grave; therefore the colt was euthanized. Necropsy findings confirmed the antemortem diagnosis. Ultrasound and CT imaging in this case provided an accurate antemortem diagnosis.     

IMAGING DIAGNOSIS—A CASE OF SPONTANEOUS HEPATIC PORTAL VEIN GAS IN AN 11‐MONTH‐OLD WEST HIGHLAND WHITE TERRIER

An 11‐month‐old female entire West Highland White Terrier presented for chronic diarrhea with acute deterioration in demeanor and progression to systemic inflammatory response syndrome. Transcutaneous abdominal ultrasonography identified colonic ulceration and secondary mucosal gas. Suspected hepatic portal vein gas and hepatic parenchyma gas were also visualized. The patient was stabilized and managed for ulcerative colitis. Based on endoscopic biopsies, the dog was diagnosed with severe, chronic, pyogranulomatous colitis. On repeat ultrasonographic evaluation the portal vein and hepatic gas had resolved but the patient deteriorated and was ultimately euthanized due to sepsis.     

IMAGING DIAGNOSIS—ECTOPIC SPLEEN MIMICKING HEPATIC TUMOR WITH INTRA‐ABDOMINAL METASTASES INVESTIGATED VIA TRIPLE‐PHASE HELICAL COMPUTED TOMOGRAPHY IN A DOG

A 10‐year‐old castrated male miniature dachshund was presented with an abdominal mass. The dog had a history of splenectomy. Triple‐phase helical computed tomography was utilized, revealing a hepatic mass and multiple intra‐abdominal solid masses. In triple‐phase helical computed tomography the images, hepatic mass and two of four intra‐abdominal masses were heterogenous in all phases. Therefore, we diagnosed a malignant hepatic tumor and presumed intra‐abdominal metastases. The masses were surgically removed and were histologically composed of normal spleen tissues, findings which were consistent with ectopic spleen.     

Effects of dietary L‐arginine supplementation to early pregnant mares on conceptus diameter—Preliminary findings

The importance of the amino acid L‐arginine (ARG) for conceptus growth and litter size has been demonstrated in various species. L‐arginine is part of embryo‐derived polyamines, a substrate for nitric oxide synthase and stimulates protein synthesis by the embryo. In the present study, we have investigated whether dietary L‐arginine supplementation stimulates early conceptus growth in mares. Warmblood mares with singleton pregnancies received either an arginine‐supplemented diet (approximately 0.0125% of body weight, n = 12) or a control diet (n = 11) from days 15 to 45 after ovulation. Diameter of the embryonic vesicle (days 14, 17, 20 of pregnancy) and size of the embryo respective foetus (length and maximal diameter, days 25–45 of pregnancy at 5‐day intervals) were determined by transrectal ultrasound. At foaling, weight and size of the foal and the placenta were determined. Blood for determination of equine chorionic gonadotrophin (eCG) and progestin concentrations was collected repeatedly. Neither eCG nor progestin concentration in plasma of mares differed between groups at any time. No effects of arginine treatment on diameter of the embryonic vesicle between days 14 and 20 of pregnancy were detected. Diameter of the embryo/foetus on days 40 to 45 of pregnancy strongly tended to be enhanced by arginine supplementation (p = 0.06). Weight and size of neither the foal nor placenta at birth differed between groups. In conclusion, L‐arginine supplementation was without negative effects on early equine embryos and may support embryonic growth at the beginning of placentation.     

Semi‐synthetic diet versus diet using natural ingredients—Comparative study in female Golden Syrian hamsters

Semi‐synthetic diets (SSD) are recommended and are widely used to carry out experiments in rodents. However, in our experiments planned to carry out generation studies in female Golden Syrian hamsters using semi‐synthetic diets, it was observed that the hamsters did not conceive as a result of decreased food intake. In this paper, we present the effects of both semi‐synthetic diets and natural source diets (NSD) on food intake, body weight and reproductive performance of this species. Four‐week‐old female hamsters were equally divided into 3 groups and initially acclimatized for 2 weeks on natural chow diet (NCD). Thereafter, they were fed either control diet, high fat diet (HFD) or low protein diet (LPD) based on semi‐synthetic/natural source ingredients until 12 weeks. Daily food intake and weekly body weights were monitored. Hamsters were kept for mating for about 2 weeks from 10th week onwards, during which the pregnancy confirmation test was done using standard vaginal smear examination. In all the groups fed SSD, the food intake was very poor, hamsters lost body weight and did not conceive, thus preventing us from carrying out further experiments. Hamsters fed NCD/NSD ingested more than twice as much as hamsters fed SSD (7–8 g/day/hamster against 3 g/day/hamster on average respectively). Based on the results of the current research, we conclude that the routinely used semi‐synthetic diet is not suitable for carrying out studies in female hamsters. We suggest that scientists must also consider the unusual biological characteristics of a given species besides other biological factors. It is therefore critical to select appropriate biological models and diets that provide optimal sensitivity and specificity to accomplish the research objectives.