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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