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ZoonosesCarol A Glaser, DVM, MPVM, MD
Division of Pediatric Infectious Diseases
University of California, San Francisco
&
Pediatric Infectious Diseases
Kaiser Permanente Oakland
I HAVE NO DISCLOSURES
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Outline
Overview of zoonotic diseases
Focus on zoonotic aspect of different disease (rather than Rx)
Common and not-so-common illnesses, range of animal hosts/types of zoonoses
Mostly practical information…but some esoteric…
“Fact or Fiction” dealing with common misperceptions or questions
Outline
Pet related zoonoses– Cats and dogs
Toxoplasmosis, Bartonella/CSD, DF-2, Pasteurella
Rabies
GI pathogens
– Less traditional petsPocket pets; Rat-bite fever
Wildlife issuesRabies
Baylisascaris
Fact or Fiction
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What is a zoonosis?
Zoonosis refers to diseases that can be passed from animals, whether wild or domesticated, to humans
Deadly plague outbreak in Madagascar has now claimed 124 lives, further 1,200 are infected
Many emerging diseases are zoonotic diseases:
-SARS -Ebola-Plague-Bird Flu-Zika-MERS
Origins in animals/+/- human-to-human
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Tick
Deer
• Borreliosis• Trypanosomiasis
Direct contact
• Tularemia
Rat
Flea
• Leptospirosis• Rat-bite fever
• Plague• Haemorrhagic fever
Bat
• Rabies
Mosquito• West Nile virus• JEV• Chik• Dengue
DogCat
• Toxocariasis• Rabies• Leptospirosis
• Toxoplasmosis• Rabies• Bartonella hensleae
Sheep
Cattle
• Q feverFood chain
Direct contact
• Salmonella• E. coli• Campylobacter• Cryptosporidum• Mycobacterium• Brucellosis
Chicken & Eggs
• Salmonella• Campylobacter• Avian flu
Pigeon / Pet Bird• Psittacosis• Cryptococcus• M. avium-intracellulare
Different routes of transmission
Infectious saliva from bite, scratch, lick
Hand-to-mouth - fecal transmission
Aerosol from body fluids (respiratory secretions/placenta)
Flea/tick on pets to people
Direct contact with animal
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Companion Animals US households 2012
Dogs Cats Birds Horses
% households 37% 30% 3% 1.5%
Average/household 1.6 2.1 2.3 2.7
Total # 69,926,000 74,059,000 8,300,000 4,856,000
https://www.avma.org/KB/Resources/Statistics/Pages/Market-research-statistics-US-pet-ownership
Specialty and Exotic Animals 2012
https://www.avma.org/KB/Resources/Statistics/Pages/Market-research-statistics-US-pet-ownership.aspx#exotic
Lots of reptiles, mostly increasing since 2007
{
“Pocket pets”; ownership increasing
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Zoonoses: General
People often worry unnecessarily and/or erroneously ascribe illness to pets
On the other hand, may be missed because of vague clinical presentation –’viral’
Transmission complex and often ‘new twists’
A Partial List of Bacterial Zoonoses
Anthrax BrucellosisCampylobacteriosisCat Scratch DiseaseEhrlichiosisE. coli O157:57GlandersLeptospirosisListeriosisLyme DiseaseMelioidosisPlague
PsittacosisQ FeverRat-bite FeverRelapsing FeverRocky Mountain Spotted FeverSalmonellosisTularemiaTyphus YersiniosisZoonotic tuberculosis
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A Partial List of Viral Zoonoses
Arenaviruses (LCMV, Lassa, S. American hemorrhagic fevers)Bat lyssavirusesColorado tick feverEbolaEquine encephalitides (WEE, EEE, VEE)Hantaviruses (Hantaan, Sin Nombre)Hendra
Herpesvirus BInfluenza (avian)Japanese encephalitisNipahRabiesRift Valley feverSARSVesicular stomatitisWest Nile Virus
A Partial List of Parasitic Zoonoses
Protozoa
BabesiosisCryptosporidiosis*Leishmaniasis*Giardiasis*Toxoplasmosis*Trypanosomiasis
Helminths:(roundworms, tapeworms, flukes)*
AnisakiasisCysticercosisHydatidosisMesocestoidiasisSchistosome dermatitis (Swimmer’s Itch)
Trichinosis*Visceral Larval Migrans*Toxocariasis/Baylisascaris
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FACT OR FICTION
Toxoplasmosis in humans is generally acquired from cats
Fact or Fiction?
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Toxoplasma gondii
Obligate intracellular parasitic protozoan
Capable of infecting all warm-blooded animals
Worldwide distribution– Seroprevalence in US-born persons (12–49 y) (NHANES)
1988-1994: 14%, 1999–2004: 9%
vs. one-third (Remington JS, Bull NY Acad Med 1974, Falusi O, Clin Infect Dis 2002)
– Highest rates in Europe, Central America, Brazil and Central Africa
Central America; 50-75% by adolescent
Cats definitive host (and other felines); only host where parasite undergoes sexual reproduction
Berger F, Rev Epi Sant Pub, 2009
Humans and Toxoplasmosis
After infection– Humans often asymptomatic or
– Flu-like illness
– Like other animals, tissue cysts and long term humoral response
Two important groups: – Pregnant women with primary infection
– Immunocompromised – primary infection or reactivation
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Congenital Toxoplasmosis
Transmission to fetus can occur during all trimesters; least likely 1st trimester but most severe
Risk highest 1st trimester as well as strain differences, parasite burden
Classic triad– Hydrocephalus
– Intracranial calcifications (scattered throughout)
– Chorioretinitis
But most infant cases not classic triad-more subtle with IUGR, microcephaly or “normal”
-Rico-Torres CP, Eur J Clin Microb Infect Dis 2016
HOW COMMONLY IS IT TRANSMITTED FROM CATS?
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Cats and Toxoplasma
Cats are generally asymptomatic or mildly ill duringacute infection
Shed oocysts for 10 days- 3 weeks but usually onlyduring acute infection (i.e., only once/lifetime)
<1% of cats shed oocysts on any given day
24 + hours for oocysts to become infectious
Oocysts are quite resistant Uncovered x 46 days (Texas)
Covered x 334 days (Texas)
Soil buried at the depth of 3–9 cm (Kansas) x 18 months
Oocysts survived at −21°C for 28 days
Toxoplasmosis Life Cycle
• Cats (and other felines) definitive host• Naïve cats ingest bradyzoites (e.g.,
ingestion of rodents) or oocysts in soil• Replication intestine of cat and then ooysts
shed by cat • Cats asymptomatic or have self-limited
illness • Other animals can become infected from
oocysts (contaminated soil) or ingestion of meat or placenta
• Once humans ingest oocysts these are ruptured and become tachyzoites and then sequestered in tissue /form bradyzoites
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Toxoplasmosis transmission
Food: meat and fresh fruit, vegetables, raw eggs and rarely mussels, oysters, unpasteurized milk (and even water)GardeningRarely: blood transfusion, laboratory-acquiredCat ownership inconsistent risk factors in various studiesSource of infection unknown in ~50%
Jones JL, Am J Epidemiol 2001
Toxoplasma & Food animals United States
Jones JL, Clin Infect Dis, 2012Will free range/organic meat increase %?
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Toxoplasmosis Summary
Although cats are the definitive host for Toxoplasmosis, pet owners rarely acquire the infection from their pet cat
The best way to prevent Toxoplasmosis is to eat meat well cooked, wash fruits and vegetables and wear gloves for soil contact
Pregnant women and Immunocompromised patients do not need to give up their cat (but should avoid cleaning litter box or wear gloves)
Cat Scratch Disease (CSD) is generally transmitted by the scratch or bite of healthy cat/kitten
Fact or Fiction?
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Bartonellosis (CSD)Cat scratch disease caused by Bartonella species Cats are main reservoir;–B. henselae, B. clarridgeiae, B. koehleraeOther animals also serve as reservoir Bartonella speciesTypically from a scratch (sometimes bite)Cat fleas involved in transmission of B. henselae among cats
Bartonella background
Prior 1990– Two named Bartonella species
Currently – 24 different Bartonella species
5 in cats
14 have been found in humans
Others in other host species
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Background
Bartonella is intraerythrocytic bacteremia, unique strategy for bacterial persistence“nearly perfectly adapted parasite”: produces high-
grade bacteremia without diseaseBartonella henselae has ‘co-evolved’ with catsBartonella vinsonii co-evolved with dogs/endocarditisBartonella bovis co-evolved with cattleLarge number of Bartonella species with rodents
Bartonellosis background
Cats –5-41% of cats positive blood culture– flea endemic areas higher, hot/humid– Intermediately positive- > kittens but also adult cats
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Bartonellosis: Clinical
Cat scratch disease (CSD);Typically localized near site of organism entry– Often lesion at inoculation site (vesicular to
erythematous to papular phases)– “Benign”, self-limiting lymphadenopathy (but
can last a long time/painful), low grade fever– Serious conditions however are in the
differential;Lymphoma, carcinoma, MTB, neuroblastoma
Bartonellosis: Clinical
Organism can disseminate liver/spleen/eye or CNS, these are often live threatening• FUO – 3rd most common ID cause
Atypical forms (more common > 60 y/o)– Erythema nodosum– Perinauds oculoglandular syndrome– Hepatic granuloma– Osteomyelitis and other musculoskeletal– Pulmonary disease– Optic neuritis– Encephalopathy
Immunosuppressed– Bacillary angiomatosis (particularly HIV+)– Peliosis hepatitis Jacobs RF, Clin Infect Disease 1998
Maman E, Clin Infect Disease 2007Hajjahi N, J Infection 2007
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Bartonellosis
Diagnosis : Clinical and serology (culture/special requirements)
For normal hosts-once immune, always immune
Treatment: – For most forms-no RX
– Immunosuppressed or severe cases: --azithromycin or doxycycline and rifampin
– Some sources say FQ + Azithromycin
Prognosis: generally excellent
Cats and Bartonella
Bartonella bacteremia is intermittent & generally healthy
Cause disease in cats very controversial– Plasma cell stomatitis
Testing in cats is controversial– Positive serology = Bartonella bacteremia
?Utility of testing?– ?Treatment of cat not efficacious?
– Positive results? Negative results?
-Breitschwerdt EB, J Comp Pathol, 2013
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CSD summaryTypically benign in humans but can be life threatening if disseminated diseaseTransmitted by healthy cats/kittensOccasionally transmitted by animals other than catsUnlike Toxoplasma, most likely acquired from pet catsUtility of testing cats is very questionable!If human illness occurs, not a reason to get rid of cat!Since fleas are considered ‘essential’ to maintenance of infection in cats good flea control;– “vigilant elimination of fleas from pets...”
Also for prevention avoid unnecessary “trauma” cats people
Many GI pathogens in pets are easily transmitted to humans
Fact or Fiction?
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10 month old boy ingests poop from puppy….parents concerned about
Toxocara canis infection; Best test to order is is ova and parasite on boy
Fact or Fiction?
SummaryGI pathogens dogs and cats
Parasitic infections– Giardia
– Cryptosporidia
– Toxocara cati/canis
Bacteria– Salmonella species
– C difficile
– Campylobacter species
Marks SL, J Vet Med, 2011
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GI pathogens dogs and catsParasitic
Parasitic infections– Giardia
risk appears to be very small from dogs and cats (vs. other animals)
– Cryptosporidiarisk appears to be very small from dogs and cats (vs. other animals)
– Toxocara cati/canisrelatively common in dogs and cats, eggs take ~ 2 weeks to become infectious so contaminated soil more likely problem than direct dog contact
Ova and parasite in people will not be positive, do serology, CDC/diff (to look for eosinophilia)
GI pathogens dogs and catsBacterial
Bacteria– Salmonella species
a small % of dogs/cats can carry, higher frequency in shelter animal and those with diarrhea
– C difficileDogs and cats can be infected
Zoonotic potential unknown
– Campylobacter species-likely biggest issue……….
-Marks SL, J Vet Med, 2011
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Campylobacter
Prevalence of Campylobacter spp. highly variable in dogs and cats: 15-40% (C upsaliensis > C jejuni)
higher rates in puppies/kittens, stray /kennel populations
Often diarrhea young animals but can be asymptomatic
Frequency of transmission from pets– 3% cases due puppy ownership (2008)
– 6% cases due to diarrheic kittens (Seattle study)
– 8% cases due to contact with cats and dogs (2010)
– 30% cases due to healthy cat (University study)
-Wielund B, J Vet Med B Infect Dis Vet Public Health 2005-Baker J, Aust Vet J, 1999-Stafford R, Emerg Infect Dis, 2008-Buettner S, Epidemiol Infect, 2010-Saeed AM, Amer J Epidemiology, 1993
Campylobacter outbreak linked to puppies
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Summary GI pathogens
Although pets carry several GI pathogens frequency of transmission fairly low with the exception of Campylobacter
Young pet, sick pet (especially diarrhea) and pets from shelter most likely to harbor
A child was bitten by squirrel in the park 2 days ago…animal can’t be
found…patient should undergo rabies PEP
FACT or FICTION
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A child picked up bat during camping trip and the bat later flew
away, no bite wound -this child needs PEP
Fact or Fiction?
Patient bitten by neighbor’s dog-unprovoked bite and dog is not current on rabies
vaccine--
Rabies PEP should be given ASAP
Fact or Fiction
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Rabies is treatable
Fact or Fiction
Rabies shots are painful and are given in the abdomen
Fact or Fiction
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• Causes a severe acute progressive
encephalitis
• One of the ‘oldest’ infectious disease
known to man
• The world’s “most deadly virus”
• Latin for: to “be mad”/”madness”
Background
RabiesThe “quintessential” zoonosis
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Etiology
• Family: Rhabdoviridae Negative-stranded RNA genome
• Genus: Lyssavirus• Envelope virus, bullet-shaped
Epidemiology
Only 1-2 recognized cases/year in the United States…so why is it so important? “Uniformly fatal” without vaccine (until
recently)
Tremendous ‘angst’: ~40,000 persons receive post-exposure prophylaxis (PEP) in the US
Many encephalitis cases are ‘rule out’ rabies …on the other hand, cases are missed
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• Most cases of rabies in India, China, SE Asia, Iran, Africa and South America
• Most are canine rabies• Estimated 50,000 cases/year
Rabies Reservoirs
• All mammals are susceptible
• However some species much more important > others, e.g., canine rabies, raccoon rabies, bat rabies, skunk, etc.
• Humans generally “dead-end” hosts
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About rodents
There have been no documented cases if rabies in humans associated with exposure to rabid rodents in the US
Caveat; if rodent extreme bizarre behavior, then consider testing and/or PEP
Bats (non-terrestrial)and Rabies
• Most common source of human infection in US
• Since 1990, > 90% of endemically acquired rabies in the US
• Exposure to bat not always recognized, especially bites
-CDC, MMWR, 2009
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Bites from bats may be overlooked
-Jackson A, Lancet, 2001
Clinical
• Incubation period ranges from few days to >1 year Most cases present between 2 and 16 weeks
• Pleomorphic manifestations, often mistaken for other CNS diseases (e.g., case 2)
• Initial symptoms are nonspecific: Fever, malaise, fatigue, anxiety, headache Half of patients have pain, itching or
paresthesias at site of the bite Lasts 2-10 days
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Clinical
After prodrome:• Furious form (aka “mad dog”) Increasing agitation, hyperactivity, seizures,
hallucinations, aggressive behavior, hydrophobia(spasm of respiratory muscles when attempting to drink)
Coma develops, then death
• Paralytic form (aka dumb rabies) Progressive lethargy, incoordination and ascending
paralysis
Respiratory muscle paralysis may occur
Coma, then death
Diagnosis of Rabies
• Always consider in case of acute onset, rapidly progressive encephalitis
• Diagnosis before death is ‘tricky’ but do-able
• Testing after death includes: Testing for viral antigen by DFA in brain tissue
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Prevention and Treatment IssuesThese issues often confused…note the differences
• Rabies pre-exposure prophylaxis Given to ‘high risk’ individuals such as veterinarians, animal
control workers, spleunkers before exposure
3 doses vaccine
• Rabies post-exposure prophylaxis (PEP) Given following a bite from rabid (or suspected rabid) animal Rabies Immune globulin (RIG) (infiltrated wound) and 4 doses vaccine
(day 0,3,7,14) IM injection deltoid /AL thigh (no longer in abdomen)
Highly effective for prevention
Vaccines not given in abdomen
• Rabies “Treatment” No known effective Rx; once symptoms develop, vaccine and RIG
of no benefit
Experimental treatment
PEP - Yes or No?
• Type of exposure (bite, non-bite) If bite: provoked vs. unprovoked Assess other circumstances of exposure,
e.g., behavior of animal• Severity of wound• Animal species involved• Animal health and vaccination history• Local animal rabies epidemiology• Animal available for observation / testing• Urgent but not “emergency”, consult local public health
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About domestic dogsin U.S.
Very few dogs in US positive in last few decades in US
– Dog-to-dog canine rabies variants eliminated US since 2004
If dog/cat located, put in ‘quarantine’ x 10 days
If animal can’t be located-that is problematic
If dog/cat rabid, they have very strange behavior
Typically have a few days to start PEP
-Blanton JD, JAVMA, 2009
Only 59 dogs in total U.S. positive in 2014<1% of rabid animals tested
6053 positive rabies; 5,588 (93%) wildlife
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“Treatment”Human Rabies Survivors -Prior Experiences in US
• Recovery without rabies PEP 15 year old female, Wisconsin, 2004Milwaukee protocol
17 year old female, Texas, 2009 (“Abortive Case”)
8 year old female, California, 2011
• Meet case definition for human rabies based on clinical manifestations and rabies virus specific antibodies in serum and CSF
• Rabies virus, antigen, nucleic acid not detected from these patients
• Antibody identified “early”
• Most recently Peru experience
-Willoughby et al., New Eng J Med, 2005-CDC, MMWR, 2010CDC, MMWR, 2011
Treatable?
6 y/o boy in FloridaContact with batNo PEP
Developed rabiesExperimental Rabies RxDied
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however
Several other investigators have attempted the Milwaukee protocol for ‘treatment’ of rabies and failed
Aramruro A, Clin Infect Dis, Sept 2011
Rabies Summary
Rodents low risk for rabies and most bites don’t require PEP – always best to discuss with public health department
Bat bites are often not noticeable and any child with bat contact (if unobserved) need to assume bite occurred and rabies PEP should be considered (test bat is possible)
For most domestic dog or cat bites, don’t need PEP, but need 10 day ”quarantine” period
Rabies is preventable
Whether rabies is ‘treatable’ is questionable
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Rat bite fever is almost always associated with a bite from rat…
FACT OR FICTION
Rat Bite Fever: Microbiology
Two distinct disease syndromes– Streptobacillus moniliformis: most cases in US
Incidence unknown since not a reportable diseaseProbably rare but likely underdiagnosedRelatively difficult to isolate
– Spirillum minor: not generally found in USMostly in AsiaDifferent syndromeSodoku or relapsing fever
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About Rodents
Approximately 3% of US households have pet rodent (gerbil, hamster, mouse or rat)
Mostly rats, however other rodents can transmit
Doesn‘t have to be pet rat, can be acquired from wild rodent (including dead rodent)
Cats that hunt rodents can harbor organism in their mouth (transiently)
Rat Bite FeverStreptobacillus moniliformis: Epidemiology
Often transmitted by bite or scratch of rats, mice, squirrels, carnivores that prey on rodentsCan be acquired through handling of dead rats50-100% wild and lab rodents harbor organismFood/water contaminated with infected rat excreta (cases called Haverhill)40% of cases have no history of bite29% of US households experience rodent problem
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Rat Bite Fever: Clinical
Incubation: ~7 days (range 1-10 days)Abrupt onset fever (irregular relapsing fever)Chills, headacheMigratory arthralgias, myalgias
Clinical features similar to other diseasesDiagnosis usually requires high index of suspicion (blood culture/add +)
Rat Bite Fever
Complications– Endocarditis, myocarditis, pericarditis– Meningitis – Pneumonia– Abscesses in “virtually every organ”
Treatment– Penicillin or Doxycycline– Untreated: 7-13% mortality
Elliot et al., Clin Microbiol Rev, 2007Dijkmans et al., Infection, 1984Pins et al., Clin Inf Dis, 1996
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Summary RBF
Transmitted by rats and other rodents
Also can be transmitted by cats
In addition to bites, can be transmitted by scratches and contact with oral secretions of rodent and ingestion
Diagnosis requires high index suspicion
Very treatable but can be deadly if not recognized and treated promptly
Human wounds can heal faster when licked by dogs
Fact or Fiction?
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Human wounds & Dog licks
“Human wounds can heal faster when licked by dogs dates all the way back to ancient Egypt, when dogs were used in healing practices. The Egyptians believed that being licked by a dog, especially on an open wound, would aid in recovery or even cure the disease causing the illness. Today, it isn’t unusual to hear a dog lover make a similar claim”
However…………….don’t encourage this…-HellaWella website, 4/27/2014
Dog & CatsBites*, Scratches & Licks
Capnocytophaga speciesPasteurella speciesStaphylococcus aureusStreptococciAnaerobesMoraxella spCornyebacterium speciesNeisseria sp
Often polymicrobial*-1% of ER visits & 10,000 inpatient hospitalizations/year
-Abrahamian FM, Am Soc Micro, 2011
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CapnocytophagaLick of Death………
About Capnocytophaga
Fastidious Gram-negative bacillus (rod shaped)
Previously known as DF-2 (dysgonic fermenter type 2, ‘carbon loving’)
9 species-C ochracea, C gingivalis, C sputignea, C leadbetteri
C canimorsus, C cynodegmi (dog and cats)
C canimorsus-oral cavity
-67-86% dogs, 55-86% cats
-Brenner DJ, J Clin Microbiol, 1989-Kullberg BJ, Medicine, 1991-Martino R, Clin Infect Dis, 2001
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Capnocytophaga
Capnocytophaga canimorsus and Capnocytophagacyndegmi
Often follow dog or cat bite/scratch, also lick
Incubation ~5-6 days (1-30 days)Most common in immunocompromised– Asplenic
– Cirrhosis or heavy ETOH use
– Steroid use
– Other; neutropenia, AML, ALL, solid tumors, SLE, multiple myeloma, CLL, s/p BMT
– + normal hosts (up to 40% cases w/o risk factors)
Capnocytophaga / Clinical
Most with Sepsis and/or meningitisOr FUO
-Janda MJ Emerg Infect Dis, 2006
Necrotizing eschar at site of bite
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Severe complication--Purpura fulminas
Acute, often fatal, thrombotic disorder manifests as bruising and discoloration skin result of coagulation blood vessel in skin and leads to skin necrosis and DIC
aka purpura gangrenosa
Diagnosis &Treatment Capnocytophaga
Can be difficult to isolate, often takes a few weeks for specific identification
Some isolates with beta-lactamase
Rx; Beta-lactam/beta-lactamase combination, 3rd
or 4th gen ceph, or carbapenem
Don’t use 1st gen ceph, anti-Staph PCN, macrolides or clindamycin for this infection
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Another infection from bite/scratch/lick
Pastuerella spp.,
Oral cavity of dogs and cats
Gram negative coccobacilli
Mostly Pastuerella multocida, but other sp
Most frequent isolates from both cat and dog bites
rate from penetrating dog bites/cat bites– 2-10%/CG find this
Can also occur scratches and licks-Chang K, Scand J infect Dis 2003-Chun ML, Am J Obstet Gynecol 2003-Talan D, New Eng J Med, 1999
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Pastuerella---Clinical
Soft tissue swelling– Very rapid development
– Intense inflammatory response
– Most within 24 hours, as early as 3 hours (cat)
– Necrotizing fasciitis can occur
Complications of SSTI:– Bone and joint
– Sepsis and PNA
– Meningitis
– Endocarditis
Treatment
Amoxicillin/Clavunate (oral)
Ampicillin/sulbactam (IV)
More severe infections
-Piperacillin/Tazo
-Carbapenem
-3rd generation + Metronidazole
• Also ensure UTD Tetanus vaccine
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LIGHTENING ROUND
Reptiles are known to carry Salmonella but recent data show that treatment can eliminate
Salmonella
Fact or Fiction?
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Fiction
Reptiles / amphibians often carry Salmonella. Salmonella can get on cages, aquariums, terrariums, and other containers that house them
Shouldn’t be allowed to roam freely throughout the house or in areas where food or drink is prepared, served, or stored, such as kitchens, pantries, or outdoor patios
Reptiles can’t be ‘cleared’ of Salmonella
Caution for children < 5 years of age, older adults, or immunocompromised individuals
Since 1975, turtles < 4 inchesIllegal to sell………….
Raccoons can make good pets, especially if acquired when they
are young
Fact or Fiction?
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Fiction
Besides being illegal, lots of other reasons not to own
Perhaps the most important is because of a type of worm they carry called – Baylisascaris procynosis-Intestinal nematode
raccoons– Ingestion of eggs in feces lead to “neural larva
migrans”/Eosinophilic meningoencephalitis
– High fatality (although some recent Rx success)
Peters et al., Pediatrics, 2012
Pai et al., Emerg Inf Dis, 2007
Parvovirus in children can be acquired from pet dogs
Fact or Fiction?
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Fiction
canine parvovirus type 2b– Highly contagious viral illness that affects
dogs
– Two formsDiarrhea form
Cardiac from
Not the same as Human Parvovirus B19
Dogs can sometimes transmit Influenza to people
Fact or Fiction?
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Canine influenza
First recognized in greyhounds ~ 2003
Since then found >36 states
Controversy about origin; some experts -horse influenza and some think from avian influenza.
Symptoms: asymptomatic- severely ill,
Respiratory, fever, lethargy, decrease appetite and vomiting
“It doesn’t spread to human” and it doesn’t seem to cross over to different species. Cats can sometimes catch the virus from infected dogs and there is no flu vaccine for cats at this time.”
Dogs can sometimes transmit Leptospirosis to people
Fact or Fiction?
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Fact
Leptospirosis can be transmitted direct contact with urine, bite wounds, ingestion of infected tissue-penetrate skin or mucous membranes
Most human hosts associated with water contact ; however reports of acquiring lepto from infected dogs (particularly in vet hospitals)
Any dog with acute renal failure; treat as suspect lepto but dogs are often asymptomatic
Pets are a common source of ringworm and are almost always
symptomatic
Fact or Fiction?
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Fiction
Some ringworm comes from pets but probably only minority of cases
Ringworm transmitted from pets is often more inflammatory > humans
Pets can harbor ‘ringworm’ and most of the time they are asymptomatic
Consider asking about pets if ringworm is refractory to Rx
MRSA in animals is a “humanosis”
Fact or Fiction?
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Fact
MRSA is a reverse Zoonosis-MRSA has “jumped from humans to household pets”
Animals can carry the bacteria on their skin and may transmit it back to the pet owner or spread it to other animals
Just like people….
Asymptomatic carrier
Most common conditions – Skin infections and ear infections
– Post-op incisional infections or wounds
– Also: UTI, auditory canal, and joints
Summary
Dogs and cats make great pets and are generally safe with a few important exception
Although cats are the definitive host for toxoplasmosis, people rarely acquire the infection from their pet cats
Important to avoid bites/scratches and licks from domestic animals
Bartonella transmitted by healthy cats/kittens generally benign but can have severe complications
Good flea control will help prevent diseases in pets and people
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Summary
Rabies very uncommon in domestic dogs/cat
Rabies also rarely found in rodents
Bats are important source of rabies
Rodents can make great pets but need to remember RBF
Wild animals never make good pets
Relative/hypothetical probability of contracting illness (not real)
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The End
Answer keyToxoplasmosis in humans is generally acquired from cats-FICTION
Cat Scratch Disease (CSD) is generally transmitted by the scratch or bite of healthy cat/kitten-FACTMany GI pathogens in pets are easily transmitted to humans)-FICTION
10 month old boy ingests poop from puppy….parents concerned about Toxocara canis infection; Best test to order is is ova and parasite on boy-FICTION
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Answer keyA child was bitten by squirrel in the park 2 days ago…animal can’t be found…patient should undergo rabies PEP-FICTION
A child picked up bat during camping trip and the bat later flew away, no bite wound -this child needs PEP-FACTPatient bitten by neighbor’s dog-unprovoked bite and dog is not current on rabies vaccine--Rabies PEP should be given ASAP-FICTION
Rabies is treatable-FICTION (mostly)
Rabies shots are painful and given in abdomen-FICTION
Answer key
Rat bite fever is almost always associated with a bite from rat-FICTION
Reptiles are known to carry Salmonella but recent data show that treatment can eliminate Salmonella‐FICTION
Parvovirus in children can be acquired from pet dogs-FICTION
Dogs can sometimes transmit Influenza to people-FICTION
Dogs can sometimes transmit Leptospirosis to people-FACT