Diseases Transmitted Animals to Humans

1. Diseases Transmitted Animals to Humans Arkansas Academy of Family Physicians June 21, 2014 Elton R. Cleveland D.V.M., M.D., FAAFP CAQ Sports Med, CAQ Adolescent Med

2. Objectives • A) Identify several human diseases associated with animals. • B) Understand some occupational risks associated with animal exposure. • C) Discuss an occasional reverse zoonosis

3. Disclosure • Financial relationships – none with companies or personnel that would have an impact on presentation • Financial relationships – married – enough said • Other disclosures – wife says I am old and crotchety –probably true • I love animals.

4. Animals and Sport

5. Some People ?

6. Some People ? • Source = San Francisco Newspaper

7. Pet Pearls 62% of U.S. households (72.9 million homes) have pets • 78.2 million dogs • 86.4 million cats • 16.2 million birds • 13.0 million reptiles

8. Pet Pearls • 164.6 million dogs and cats are domestic pets in USA • Relationship between pets and childhood asthma is well documented

9. Pet Pearls • Iguanas, ranked in the TOP TEN pets, are the most popular reptile in the USA. • Especially popular with teenage boys and young men.

11. Increasing Incidence of MRSA in the Community • Rapid change over past decade • Why?

12. Methicillin-Resistant Staphylococcus Aureus (MRSA) American Society of Microbiology: 2007 Toronto • MRSA found in 100% of fomites in subways, buses and trains • MRSA survives up to two weeks on fomites

13. Methicillin-Resistant Staphylococcus Aureus (MRSA) • Airline tray tables – WORSE! • Public restrooms – only 6.3% positive

15. MRSA in Dogs and Cats • Dogs and cats are the most common therapy animals used in healthcare settings. • Healthcare settings that utilize animal-assisted therapy include long-term care facilities and pediatric institutions.

16. MRSA in Dogs and Cats(continued) • With the emerging problem of community-acquired MRSA, we decided to re-visit local animal grooming clinics to determine if dogs and cats might be possible carriers of MRSA.

17. MRSA in Dogs and Cats(continued) • All pets studied were from a local grooming clinic. • They were deemed healthy and had not received antibiotics in the previous 30 days.

18. MRSA in Dogs and Cats(continued) • Groomers, veterinarian, physician and student were all cultured. • No personnel were found to harbor MRSA.

19. MRSA in Dogs and Cats(continued) • All 42 animals were colonized with Staphylococcus aureus. • Seven (16%) of the 42 isolates obtained were resistant to methicillin.

20. Animal Study Results Recovered from outer surface of cages: • Staphylococcus (coagulase + and -) • Bacillus • E. coli • Proteus spp. • Serratia marcescens • Other gram-negative microorganisms

21. Animal Study Results (continued) Recovered from ALL water tanks in the animal cages: • Pseudomonas aeruginosa • Several animals were colonized with multiple organisms

22. Post-operative MRSA Infection • Two-year old, hernia repair patient with post-op incision infection (MRSA) • Dog at home cultured: MRSA-positive mouth • Mother had multiple abscesses: MRSA-positive abscesses • Specimens for child, dog and mother sent to Tulane!

23. Pearls of Pet Therapy Study • Animals are usually culture-negative for salmonella in home environments. • Under travel stress (being placed into carriers, transported, or exposed to unfamiliar surroundings), they often become culture-positive for salmonella by the time they get to the hospital.

24. Recommendations • If dogs and cats are used in animal-assisted therapy programs, they should be screened for pathogens, including MRSA • Use of dogs and cats in institutional facilities should only be used after careful assessment of risk/benefits to all patients, staff members and visitors.

25. Animal Use Recommendations • Handling of animals should only be allowed when potential risks and benefits are carefully considered. • Handwashing should be strictly enforced after handling animals and / or cages.

26. Some people love their animals

27. Animal Bites • Most common cause of Zoonosis. • There are 2 – 4.7 million animal bites yearly. • 1 out of 2 people in the U.S. (In life time) • 1.5 % require an Emergency Department visit • 2% require hospitalization

28. Animal Bites • 80% of animal bites come from dogs. • 85% of dog bites is from a family owned dog or a neighbor’s dog. • Children are the most likely to get bitten. Boys ages 5 – 9 have the highest incidents of dog bites. • Less than 300 deaths were attributed to dog bites between 1979 – 1996.

29. Animal Bites • Little evidence for specific breed predilection but 75% of fatal attacks have been caused by Pit Bull & Rottweiler breeds. • Male- dogs 3:1, Female- cats 3:1

30. Animal Bites • PasturellaMultocidahas been implicated as major pathogen. • Infectious complications occur in approximately 20 – 50% of dog bites with a higher percentage occurring from cat bites.

31. Animal Bites • Treatment medication options: Penicillin, Cefotaxime, Tetracycline, Bactrim, Ciprofloxacin and Levofloxacin. • P. Multocidais resistant to Vancomycin, Erythromycin and Clindamycin.

32. Animal Bites • Other organisms • CDC – DF2 (“dysgonic fermenter Type 2”) • CapnocytophagaCanimorsus • Fastidious Growth • 30% fatality rate with cases C. Septicaemia

33. Animal Bites • CDC – NO1-(non – oxidizer) – similar to Acinetobacter • Proteus, Klebsiella, Enterobacter, Staph, Strep, Bacteroides, Clostridium, Erysipelas, Etc. • Rabies

34. Interesting Case

35. Rabies – Myth & Movies Myth Werewolves, Vampires & Rabies Movies • Old Yeller • Cujo

36. Rabies • May be the oldest disease known to man ~ 2300 BC • The word “rabies” has many origins. • Ancient Sanskrit: “rabhas” = to do violence • Greek: “lyssa” or “lytta” = frenzy or madness • Latin: “rabere” = to rave or rage

37. Rabies • USA: 2 or 3 cases per year in humans • Worldwide: >30,000 per year in humans.

38. Rabies • Before 1960 cases involved domestic animals. • Currently, cases are now being seen in skunks, raccoons, and bats. • Most human cases of Rabies are due to bat exposure. • New Carrier: Woodchuck

39. Rabies • Kansas • Vaccine • In 2006, a horse stabled at Tennessee Walking Horse National Celebration tested positive for rabies. • The CDC notified approximately 150,000 people who attended the event of possible exposure to rabies.

40. US Rabies Reservoirs

41. Rabies - Speculation • Carter Administration: Wanted to continue “coonhunting” while living in Washington, D.C. • Raccoons transported to Virginia forests. • 1977: By Carter’s inaugural address, the first case of rabies was reported in Virginia raccoons!

43. Rabies • Treatment • Wound Cleaning • Rabies Immune Globulin (RIG) • Rabies Vaccine • Controversy • USA/CDC = 5 doses vs. WHO = 3 to 4 doses.

44. Rabies • RIG • HDC 4 – 0, 3, 7, 14 or 28

45. Human Illnesses Associated with Animals

47. Brucellosis • Undulant fever • B. Melitensis > B. Suis > B. Abortus> B. Canis • Unpasteurized milk • Contact Birth products

48. Brucellosis • Sx intermittent fever • headache, chills, depression, profound weakness, arthralgia myalgia, weight loss • Orchitis/Epididymitis in men • Spon. AB in pregnant women

49. Human Illnesses Associated with Animals(continued)

50. Diseases Associated with Bioterrorism Male Xenopsylla cheopsis (oriental rat flea) engorged with blood. This flea is the primary vector of plague in most large plague epidemics in Asia, Africa, and South America. Both male and female fleas can transmit the infection.Photo Credit: courtesy of the Centers for Disease Control and Prevention