Guide dog attacks
Attacks on guides dogs... not by guide dogs.
The June 19th edition of Veterinary Record (Brooks et al 2010) contains a study that investigated the incidence and impact of 100 dog attacks on guide dogs in the UK. Here are some highlights:
- 61% of attacks occurred while the guide dog was harnessed and working with an owner or trainer.
- Labrador Retrievers and Golden Retriever/Flat-Coated Retriever crossbreeds were more commonly attacked than other guide dog breeds. This was disproportionate to the percentage of guide dogs that were these breeds, so it wasn't just a factor of more Labs being guide dogs so there were more to be attacked. I'm not sure why these breeds would be attacked more often.
- Most (97%) attacks occurred in public places: 26% occurred in town centres and shopping areas, and 23% occurred in public parks or exercise areas.
- 43% of attacks were considered unprovoked.
- Most (61%) of attacking dogs were off-leash and with their owners. The surprising thing to me is that 23% of attacking dogs were leashed and with their owners. 15% were roaming free.
- 38% of attacking dogs were bull breeds, which is much greater than the percentage of the general dog population that is made up of bull breeds (5.9%).
- 41% of attacked guide dogs required veterinary care.
- In 19% of attacks, a person was also injured.
- After 45% of attacks, the working performance and behaviour of the attacked (guide) dog changed. Over half of these were reported to be fearful, nervous and wary, or to display a lack of confidence. Two dogs had to stop working as guide dogs.
- The attacking dog's owner was charged in 31% of incidents.
It is clear that attacks on guide dogs can result in major problems. These include injury to the dog, injury to the handler, impacts on the performance of the dog as a guide and impacts on the emotional status of the owner. Dog bites are too common and bites from incidents like these, which occur in public places, are largely preventable with responsible ownership. Unfortunately, there are too many irresponsible dog owners out there. The threat of more serious financial penalties may be the only way to change some peoples' behaviour.
Livestock-associated MRSA in dogs
A study we just published in the journal Veterinary Record (Floras et al 2010) described an MRSA outbreak in a dog breeding kennel. That's a little unusual in itself, but considering how MRSA is spreading amongst the dog population, it's not really astounding. What was unique about this outbreak was the strain of MRSA that was involved, sequence type 398 (ST398).
ST398 MRSA is commonly referred to as livestock-associated MRSA, since this strain seems to have originated in pigs, and is commonly found in pigs and calves in some regions of the world. It can also infect people, and high rates of carriage of this MRSA strain can be found in pig farmers, pig vets and other people with close contact with livestock. In some areas of Europe, this strain is a big problem, accounting for a large percentage of human MRSA infections. Interestingly, it seems to be a rare cause of illness in people in North America (at least at the moment).
Dogs seem to be innocent bystanders when it comes to MRSA. The vast majority of MRSA strains found in dogs are common human strains, indicating that, ultimately, MRSA in dogs originated in people. There are only two other reports of dogs with ST398, both from Europe. One was a dog with a skin infection. The other was a healthy dog (a carrier) who was owned by a pig vet.
This kennel outbreak involved a larger number of dogs, including both healthy carriers and sick dogs. Overall, MRSA was isolated on at least one occasion from 23/42 (55%) dogs in the kennel. In a couple of litters, most of the puppies were identified as carriers, but fortunately most stayed healthy. MRSA caused skin infection in one puppy and mastitis in a mother dog, and was also found in the respiratory tract of a puppy that died (although it may or may not have been the cause of death).
The source of the ST398 was not identified. One of the owners worked on a pig farm, but MRSA was not isolated from either owner. It's most likely that the owner did bring MRSA home from the farm, either as a transient carrier (in their nose) or as a contaminant on their skin. Regardless, once it got into the kennel, it was able to move between dogs, either from dog-dog contact or with the help of human hands. Fortunately, ST398 MRSA carriage by dogs seemed to be transient in this situation, which is consistent with what we know about carriage of other strains. MRSA is not really adapted for long-term survival in dogs, so they only carry it for short periods of time. That's a big advantage when it comes to trying to control this pathogen.
While we have to be careful to not over-interpret data from only a few studies, this report indicates that ST398 can cause disease in dogs and it can be present in apparently healthy dogs. It can also be spread relatively easily amongst dogs in a breeding kennel situation. While a pig-link was not confirmed, it's reasonable to suspect that dogs with contact with pigs (and perhaps other livestock) might be at higher risk of developing ST398 infections, as is the case with people.
This is a perfect example of the one medicine concept, and why we need to think about infectious diseases in broad terms, not just focusing on specific populations or species. This situation involved a pig Staphylococcus aureus that somehow acquired methicillin-resistance, spread widely around the world (most likely in pigs, initially), spread to people, and then likely spread to another species, in this case dogs.
Rabies, rabies, and more rabies
It's not like we needed any evidence that rabies is still an active, deadly disease, but a recent ProMed-mail posting contains 16 different rabies notices. They include:
- An animal control worker who was bitten by a rabid, stray cat that was trapped by a person in Texas.
- Rabies exposure in an unvaccinated dog in Maryland, that resulted in euthanasia of the dog because the owners didn't want to undertake the required 6 month quarantine for exposed, unvaccinated dogs. The dog was exposed to rabies virus while killing a raccoon.
- Diagnosis of rabies in two trapped raccoons in New Jersey.
- Rabies exposure in an Arizona woman who was attacked by a rabid fox while in her yard.
- More marauding (presumably rabid) foxes attacking people and dogs in Maine and South Carolina.
- Rabid bats and skunks in Colorado.
- A rabid fox in Alabama.
- Rabid raccoons in Virginia.
- A rabid raccoon attacking a vaccinated dog.
- Rabies exposure in people bitten or scratched by rabid stray kittens in New Jersey, Nebraska and Georgia.
Common themes or take home messages:
- Rabies is here (in most areas, at least) and it's unfortunately not going away any time soon. We can reduce the number of affected animals and decrease the risk of exposure of people and domestic animals, however, with good prevention strategies.
- Vaccination of pets is a cheap and effective way of protecting them, and anyone they are in contact with.
- Keep pets away from wildlife.
- If you are bitten by a wild animal, you must consider it a potential rabies exposure unless the animal can be proven not to have rabies.
- If you see an animal that is acting strangely, stay away and call animal control.
Salmonella recall: Pet vitamins
All lots of "Pro-Pet Adult Daily Vitamins" have been recalled by United Pet Group, Inc. because of Salmonella contamination. At least one lot has tested positive for Salmonella, although there is no mention about whether the bacterium was detected during routine testing or in response to a problem. Regardless, Salmonella contamination of these products is a concern because of the potential for disease in dogs fed the vitamins. Further, people could become infected from contact with dogs that become infected from the vitamins, or from handling the vitamins directly. If you have these vitamins, stop using them immediately. If your pet has been receiving these vitamins and develops fever, diarrhea, anorexia or any other signs of illness, take your pet to your veterinarian and make sure he/she knows there has been a chance of Salmonella exposure.
Robotic pet therapy?
In 2005, "Paro," an interactive robotic pet, was introduced in Japan. It looks like a baby seal, and has 12 tactile sensors in its fur, touch-sensitive whiskers and a system of motors that silently move its parts. While this "pet" didn't really catch on in Japan, it's made its way to the US and ended up in some nursing homes.
Paro has been described as a low-maintenance alternative to dogs and cats for pet therapy. It's an intriguing idea. There are certainly some appealing aspects, in that a robotic pet won't bite or scratch, doesn't poop, doesn't need to be fed, can't be injured, doesn't have a large population of resident bacteria in and on its body and can't become infected with various microorganisms from patients. Those are appealing from an infection control standpoint. However, despite this, you can't approach Paro as a way to eliminate infectious disease risks, since the robo-pet could easily become contaminated by someone, then spread infection from person-to-person. For example, if someone has a bacterium on their hands and they touch the robot, they could transfer the bacterium to its "coat." It could then spread the bacterium to the next person that touches it. Infectious disease risks would be lower, but not zero.
Pet therapy is all about cost-benefit. We know there will never be a zero-risk pet-human interaction. However, socializing with an animal can provide significant benefits to many people, and I'm not convinced that the same degree of benefit would be provided from interaction with a robotic critter. There might be some situations where a robotic pet would be useful in a nursing home or similar environment, but I don't think they're going to replace interaction with a live animal.
Russian poop patrols
Apparently, Moscow parks are somewhat hazardous, at last in terms of where you step. Moscow dog owners have historically done a poor job of picking up after their dogs, and local officials are trying to intervene. Soon, all Moscow parks will have paper bags and plastic scoops for people to use to pick up after their dogs.
One dog owner, supportive of the plan, stated “It's absolutely essential – we really needed these bags. First of all, it's very convenient. But also, now I’m not worried anymore about leaving the poo just lying around. The park is so beautiful.” [I would have thought that if you were worried about leaving poo lying around, you'd just take the initiative to pick it up, but I guess a little boost is needed to get some people started.]
This initiative in being undertaken for two main reasons. One is the obvious unsightly nature of poop piles in parks. The other is concern about infectious diseases. Prime Time Russia states that bacteria in dog feces can cause "allergies and an infection that leads to blindness. When dog feces dries and turns to dust, these bacteria are spread. Last year, 400 people in Moscow were diagnosed with the infection. The worst is the fact that since the dust is lying on the ground, children are particularly exposed to the danger."
This is a bit confusing. Feces isn't much of a concern in terms of allergies. Further, I'm not aware of common bacterial infections from dogs that can cause blindness in people. I suspect they actually mean ocular larva migrans, a parasitic disease that can occur when a person inadvertently ingests eggs of the canine roundworm (Toxocara canis) that have been passed in feces of a dog, and that have lived in the environment for a long enough time to mature to their infective state. Regardless, there are clearly infectious disease concerns from exposure to dog feces in parks, particularly to children.
The approach of providing supplies for people to clean up after their dogs is novel. Some people might find it strange, since in many regions, people are quite good about picking up after their dogs. Providing supplies to people in those regions probably wouldn't have much of an impact, since the responsible owners bring their own and the rest probably wouldn't use them anyway. This type of initiative is potentially quite useful in areas where cleaning up after your dog is not as ingrained, and where providing supplies can act as both a reminder and as a way to assist. It will be interesting to see what kind of impact this has.
Service dog training silliness
I often write about service dogs, and I'm often fairly critical. It's not that I dislike them - on the contrary, they're incredibly important to people who need them. However, when people do stupid things with service dogs, it can ultimately hurt the people who actually depend on these animals.
I was at the grocery store today and the first thing I saw when I walked in was a woman walking around with a dog in her shopping cart (i.e. the place the next person's food is going to sit). The dog was a poodle puppy wearing the standard "guide dog in training" vest, and the woman thought nothing about walking through the store pushing this dog around. When I asked her about it she said that the dog was just a puppy and it wasn't good to have it walking around on the floor (with no explanation why). She did take the dog out of the cart, but then proceeded to walk around the store carrying the dog in her arms. The site of her holding the dog while pawing (pun intended) the fresh fruits and vegetables raised eyebrows among more than just myself. Eventually, she put the dog down, which mainly resulted in her dragging the dog around as it tried to lay down or walk the other way (which may explain why she wanted it in the cart).
Service dogs are allowed into stores. They have wide access and that's needed. Service animals in training, however, are not service animals and they do not have the same absolute right to access. Training needs to be logical and supervised. Getting these dogs out in different environments is very important. However, how does pushing a dog around a store in a shopping cart help train it to be a service dog? I'm pretty sure part of the dog's ultimate job description doesn't include this particular activity. Being carried around a store while shopping is also not likely to be part of this dog's job. If a dog is not adequately trained to walk around a store on a leash, it shouldn't be there. A little common sense would indicate that basic training in another environment should precede activities such as this.
Fostering a guide dog is a good thing to do, but it comes with a lot of responsibility. I'm certain this person was well-intentioned, although I'd certainly consider her actions misguided. The "guide dog in training" vest should not be interpreted as a free pass to take the dog wherever you want without any thought. Training such a dog is an important job, and people need to think about what they are doing.
I'd be interested in hearing from anyone that is involved in these programs. I was unable to find any information about guidelines for people fostering service dog puppies, and would love to know what type of guidance people get, and what organizers of these programs think of this incident.
Stupid, drunk and owner of a venomous exotic pet... Bad combination
A UK man is recovering from a tarantula bite that occurred when he, apparently in a drunken stupor, encouraged the venomous critter to bite him. (I suspect the "victim" has a pretty high endogenous level of stupidity, because I don't think you could get me drunk enough to say "Hey, maybe I should let an enormous venomous spider bite me!")
The character in question, Peter Saunders, stated "It was completely my own fault. I provoked the spider into biting me on my index finger so I can't complain about the consequences at all." At least the statement demonstrates some degree of logical thought. He ended up getting more than he bargained for, since the bite was a lot more painful than he anticipated. The day after the bite (presumably along with a massive hangover), Mr. Saunders' arm went numb and he was given various antibiotics to help treat a suspected secondary infection.
Unfortunately, the moment of clarity represented by his understanding that it was all his fault passed quickly since "... this incident has not put him off keeping these pets and he is considering buying more exotic creatures in the future." Let's hope he doesn't decide to see what it feels like when an African lion chews on his throat.
Photo: Fort Hall Baboon Tarantula (source: www.lotsalegs.tenczar.net)
Rabies outreak still underway in Bali
Bali's rabies outbreak continues to claim lives, largely because of inadequate access to proper healthcare. The death toll from this outbreak, which has been ongoing for about two years, is officially 58, although the true count may be higher.
The latest case was a 57-year-old temple priest who was infected after trying to break up a fight between strays dogs and his puppy. He was bitten by a stray dog in the process, but did not receive any post-exposure rabies vaccination because of a vaccine shortage. Rabies is basically 100% preventable when proper care is provided after an exposure, but inadequate access to proper treatment remains a problem, particularly in certain areas and in less developed countries. The priest started to develop signs of rabies about two months after the bite, which is a pretty typical time frame. Once signs of rabies are present, it's almost invariably fatal, and he unfortunately succumbed to the disease shortly after being hospitalized.
Despite ongoing efforts to control this outbreak, rabies remains a serious problem in Bali, and many stray dogs remain unvaccinated. Inadequate education of the public is a problem since not everyone who is bitten goes to a doctor, especially for minor bites. However, even if people go to a doctor, the shortage of rabies vaccine is a huge problem. This whole situation is clearly not under control.
Visitors to Bali need to be aware of this ongoing outbreak. If you are traveling to Bali:
- Avoid contact with stray dogs. You never know who's rabid.
- If you are bitten, promptly clean the wound and get to a physician.
- If you are bitten by a stray, make sure you get post-exposure treatment: a shot of anti-rabies-antibody and 4 (previously 5) rounds of vaccine over a few weeks. If you can't get the treatment started in Bali, get it as soon as possible. Rabies exposure is not an emergency, but you don't want to unnecessarily delay treatment. You don't need to be immediately evacuated from the country to a place you can be treated, but at the same time, you don't want to take your time, travel for a while, then get vaccinated a week or two later. You'd probably be fine, but rabies is not something with which to take chances. The incubation period is variable and the rapidity of onset depends in part on the severity and location of the bite. In particular, a severe bite to the head or neck region would be an indication for very prompt treatment. So, if you're bitten, don't panic, but try to get back home and get treated as soon as is reasonably possible.
Rabies vaccination of people planning on visiting Bali is not recommended, unless you are planning on having contact with dogs. If you are going to Bali to take part in stray dog vaccination, then rabies vaccination would absolutely be indicated. Otherwise, it's not really something that's needed. If you don't get bitten, you won't get exposed, and a little common sense goes a long way toward avoiding dog bites.
Putting "One Medicine" into action
People like to talk about the "one medicine" concept. It's a great concept, but my big issue with it is there's a lot of talk but not a lot of action.
One way of thinking about "one medicine" in terms of people and pets is to focus on the health of the entire household as a whole, because:
- People can transmit infections to pets.
- Pets can transmit infections to people.
- People and pets can be infected from the same source.
- Infection in a pet or person may indicate that others in the household are also at risk.
It's a complex dynamic. When I speak about this topic, I use a couple of different ways to make the point. One is the concept that we are not a population of people living with dogs, cats, horses etc. - we are a population of animals. Similarly, I sometimes say "pets are people too, at least microbiologically." What I'm saying is that we can't focus just on humans or just on pets. The household as a whole needs to be considered, and care of the health of the all of its members - human and animal - needs to considered together.
What does that really mean?
Physicians need to be aware of the presence of pets in the household and other animal contacts. This information might be important when considering certain diseases. For example, if someone comes to their physician with flu-like symptoms and their physician knows they have pet birds (especially psittacines), then the physician would hopefully consider psittacosis. This disease is caused by Chlamydophila psittaci, a bacterium that can be carried by healthy birds. Not realizing there is a bird in the household can lead to a missed diagnosis.
Veterinarians need to be aware of the health status of people in the household. People with close contact with the human healthcare system and people with compromised immune systems are more likely to be carrying certain infectious agents. They are also more likely to pass these pathogens on to their pets. Therefore, knowing the health status of the owner might lead the veterinarian to consider different diseases in the pet, thereby improving diagnosis. Conversely, people with compromised immune systems are at increased risk for various infectious diseases from pets. If the veterinarian knows a pet owner is at increased risk, they can provide better advice about disease prevention measures to protect the owner. Veterinarians rarely ask owners about their immune status, including pregnancy (even the "how far along are you?" question is dangerous, because eventually you're going to get the "I'm not pregnant!" response.) Ideally, people should have a positive, comfortable relationship with their veterinarian, realize that their veterinarian is a member of their (and their family's) overall healthcare team, and therefore tell their veterinarian about any relevant health issues. For this to work, they need to understand the value of this communication, trust their veterinarian and know that their personal details will be kept confidential. At the same time, the veterinarian needs to understand the issues and need for such information, and have a plan on how to use it.
Veterinarians and physicians need to communicate better. They need to know who to contact when necessary and be able to do it efficiently. This is also relevant for non-infectious disease issues. For example, there could be a situation where a veterinarian has had to euthanize a pet: the veterinarian may realize that the owner is quite distraught, but can't do much beyond offering condolences and providing contact information for resources to help them out. The physician may not know anything about the situation, but it could be of significant relevance to the person's health. If nothing else, the physician could be notified that there's a potential concern. There are privacy issues that need to be considered and sorted out, but a little conversation can go a long way. The ability of veterinarians and physicians to contact each other about relevant issues can help prevent problems with miscommunication, provide general information about certain topics and help provide optimal patient care.
One medicine needs to be one medicine in action, not just in theory.
Sequence type 398 MRSA infection from horse to human
Methicillin-resistant Staphylococcus aureus (MRSA) is a huge problem in people and is an emerging pathogen in horses. Most earlier reports of MRSA in horses involved one strain, called CMRSA-5 in Canada, USA500 in the US, and sequence type 8 (ST8) as a more general term. This human-origin strain seems to be adapted for survival in horses, and in North America, this strain has accounted for most MRSA infections in horses and MRSA infections in people linked to horse contact.
Another MRSA strain, ST398, has recently emerged as a big problem associated with livestock (particularly pigs). This strain is very common in pigs internationally, and is a major cause of infections in people in some European countries. There are also a few reports of ST398 in horses. Most are from Europe, although we have found this strain in one horse in North America. At last week's ASM Conference on Antimicrobial Resistance in Zoonotic and Foodborne Pathogens in Toronto, Dr. Engeline van Duijkeren from the Netherlands presented a case of human ST398 infection linked to a horse.
In the reported case, a 16-year-old girl had a lesion on her foot that was initial diagnosed as a spider bite infection (a common misdiagnosis of early MRSA skin infections). It didn't respond to initial treatment and MRSA was isolated on culture. The girl didn't have any history of contact with pigs or cattle, but had close contact with a foal. That foal had previously been in an equine hospital because of a wound infection, but the wound was not cultured. The same MRSA strain that caused the infection in the girl, however, was found in the foal's nose (the prime site for MRSA carriage by healthy horses). Fortunately, the girl's infection responded to treatment once treatment was adjusted for MRSA.
In some ways, this case is not too surprising, since we know ST398 MRSA can cause disease in people, and since it is found in horses, transmission from horses to people was likely inevitable. However, it's the first report of human infection with this strain associated with horse contact. MRSA exposure is a potential risk for anyone working with horses, since we know that this organism can be found in a small percentage of healthy horses. We don't have great information about how to prevent horse-human transmission, but simple things like only using antibiotics when needed and attention to hygiene (especially hand washing) when working with horses are presumably important factors.
More information about MRSA in horses can be found on the equIDblog Resources page.
This Worms & Germs blog entry was originally posted on equIDblog on 14-Jun-10.
Newborn killed by Husky
Another tragic dog bite incident has resulted in the death of a three-week-old baby in Quebec. The baby's mother (17) and grandmother (37) left the child alone in the house, strapped to her car seat on a chair, while they went outside for a smoke. There were also two Huskies loose in the house at the time. Although the women were only a few meters from the open door, and came back inside when they heard noise, by the time they reached the baby it was already too late. The paramedics found the baby "covered in deep bite marks and scratched.
It is unclear to whom the dogs belonged, as the mother and father of the baby were sharing the house with two other people. The baby's father (who was not home at the time of the attack) said that the dogs had been around ever since the baby was born and had never posed a problem. The dogs were not normally aggressive and "when strangers came to the door, they didn't even bark." He said "there was no sign that this could happen."
Dog bites are always bad, but in the case of small children in particular they can even be fatal. According to Statistics Canada, since 1990 there have been 28 fatal dog attacks in Canada, and 85% of those killed were children under the age of 12.
Dog bites often occur when people don't know how to behave around a dog, and dogs may bite out of aggression, fear, or rough play. A three-week-old baby strapped to a car seat would pose little threat to a Husky, and unfortunately we will likely never know what brought on the attack. Parents and family members need to realize that a new baby is a big adjustment for everyone in the household - and that includes pets. A dog that is normally "as good as gold" may react very differently to a small, wriggling, strange-smelling, crying baby that suddenly takes over part of the animal's home "territory." It is very important that pets and babies be introduced very carefully and slowly, and they should always be supervised. Dr. Enid Styles, a veterinarian and behaviourist, makes some very important points:
...Styles said it is possible the animal might have been startled by the child's crying or the baby might have been caught in the middle of a fight between the dogs.
In any case, a child should never be left unattended around dogs...
"Supervision needs to mean, really, that you are between your dog and your child," she said. "You can't be just on the other side of the room."
Both Huskies have been seized by the Humane Society, and tests will be done to to confirm which of the animals was responsible for the attack and whether it was suffering from any problems, such as rabies (which presumably means the dog will be quarantined for 10 days). It is likely that the dog responsible will be euthanized.
Photo source: www.cbc.ca
Tick bite irony
Canadian singer Alanis Morissette wrote a song called "Ironic" that (ironically) doesn't really describe irony: Rain on your wedding day, a free ride when you already paid, a black fly in your Chardonnay... they all suck but they're not ironic. What is ironic is Dr. Ed Breitschswerdt, an internationally renowned veterinary internist and tickborne disease expert, getting bitten and infected by a tick.
Dr. Breitschwerdt has worked on tickborne diseases for decades and is a wealth of knowledge on the subject, in terms of both animal and human infections. He regularly provides advice about how to avoid tickborne illnesses.
Dr. Breitschwerdt wrote an article about his recent tick-encounter, and here are some excerpts:
"...I do "tick checks" after outdoor activity on my farm, but I recently missed one. When I discovered the tick, I followed recommendation I've given to hundreds of individuals in lectures on tick-borne pathogens. I placed the parasite in a vial of alcohol and wrote the date of its removal on the label. This is an important step, as there are at least four tick species that attach to animals and people in North Carolina, and each species can transmit different bacteria that collectively cause a spectrum of diseases. Knowing the species can help the physician or veterinarian understand which infectious agent has been transmitted...The small tick in my armpit remained attached long enough for my body to mount an inflammatory response (itching, swelling and pain) before I noticed and removed it. Not initially feeling an attached tick is the norm, since ticks have evolved the ability to secrete chemicals that block pain and decrease the body's inflammatory response."
- The fact that the tick was present for a while is critical, since it takes time after attachment before a tick starts feeding and can pose a potential risk for disease transmission.
"Nine days after removing my tick I developed severe chills. The next day my symptoms progressed to include fever, muscle pain and headache - classic symptoms of Rocky Mountain spotted fever and human granulocytic or monocytic ehrlichiosis, the three most serious and frequent tick-transmitted diseases of dogs and people in the southeastern United States.
"Typical of the early stages of these diseases, my white blood cell count (the body's first line of defense) was low. My bone marrow responded by sending new white blood cells to fight the infection. After blood was obtained for diagnostic testing, antibiotic treatment was started immediately. This is of critical importance, as a delay in diagnosis and initiation of antibiotics for 24-48 hours greatly increases the severity of illness and the chances of death."
- Testing was performed on the tick and Dr. Breitschwerdt's blood, and Rickettsia rickettsii DNA was found in both. In combination with his clinical signs, including a rash on his arms and legs (see photo), this confirmed the suspected diagnosis of Rocky Mountain spotted fever. This is a serious disease from which approximately 6% of infected people die. Early recognition is critical, but diagnosis is often delayed because of failure to identify or report a tick bite, or failure of physicians to consider the disease.
Dr. Breitschwerdt concludes "This recent experience enhanced my belief that tick-transmitted diseases deserve respect and enhanced, comparative biomedical research. The next time you walk in the beautiful fields and valleys of North Carolina, apply a tick repellent and remember to check carefully for attached ticks when you return home."
Photo: Child's right hand and wrist displaying the characteristic spotted rash of Rocky Mountain spotted fever (source: CDC Public Health Image Library #1962)
Live every day like you have MRSA
I was giving a talk on infection control at a conference in Geneva a couple of days ago, and during a discussion with someone after the talk, I told them to "Live every day like you have MRSA." Not surprisingly, I got a bit of a strange look in response. I wasn't trying to say, "live your life to the fullest because you never know what will happen." Rather, I was trying to get the point across that healthcare workers in both the veterinary and human systems need to realize that at any point in time they could be carrying MRSA, along with various other harmful microorganisms.
People in patient care positions need to make the assumption that they are always a potential source of disease, and act accordingly while doing their jobs. If someone knew they were a carrier of a bug like MRSA, they'd likely do a better job with routine infection control practices such as handwashing. But, you rarely know whether you're carrying MRSA or not, and it's better to go on the assumption that you are and be diligent with your infection control measures.
The same basic concept applies to different situations, such as how people in the general population behave, and how they interact with other people and animals. In some ways, everyone should assume that they are carrying an infectious disease like influenza, and that every person or animal they encounter is carrying something infectious. (In reality, this is actually true, since everyone is carrying something potentially infectious in or on their body at any given time, it's just that most of the time it's not particularly serious or transmissible organisms).
There's a line between prudence and paranoia, and we don't want to create a population of germophobes who won't leave the house. However, we want to increase awareness so people do a better job of things like washing their hands and covering their mouths properly when coughing or sneezing. Assuming that you and everyone around you is mildly biohazardous maybe a way to do just that.
