Is Staphylococcus schleiferi zoonotic?

Methicillin-resistant S. aureus (MRSA) and methicillin-resistant S. pseudintermedius (MRSP) get a lot of media attention because of the ever increasing numbers of infections in dogs and cats, and concerns about transmission to people. However, there are many other methicllin-resistant staph of varying relevances. One is an interesting related bug called Staphylococcus schleiferi.

There are actually two types of S. schleiferi:

  • S. schleiferi schleiferi: This is a coagulase-negative subspecies that occasionally causes skin and ear infections in dogs (and uncommonly cats). It can also be found in healthy animals. There are a few reports of infections in people, mainly surgical site and wound infections in individuals who are at high risk of infection because of hospitalization, surgery or other factors.
  • S. schleiferi coagulans: This is a coagulase-positive subspecies that may be more common in dogs and cats than S. schleiferi schleiferi, causing skin and ear infections and also being found in healthy animals. Human infections are very rare.

Currently, there is little to no evidence the animals are a source of human infection with S. schleferi and human infections appear to be very uncommon. However, this is an area that hasn't been studied much so it's hard to say with any confidence that there is no risk. My assumption is that the risk is very low, but not zero, so while we shouldn't be paranoid, it makes sense to use some very basic infection control practices when dealing with infected animals to reduce any possible risk. These would include:

  • avoiding contact with infected sites
  • if contact with infected sites is necessary (e.g. cleaning or treating infected ears), gloves should be worn and hands washed after glove removal
  • hands should be washed thoroughly after any contact with the infected site, and regularly after contact with the animal

Quarantine of infected animals in households isn't necessary, because of the limited evidence of transmission and because healthy dogs and cats can also carry this bacterium. In veterinary clinics, isolation of infected animals is reasonable because other animals in the clinic may be at higher risk of developing infections should they become exposed.

Frozen mice recall: Salmonella

MiceDirect, a company that sells frozen mice, rats and chicks as reptile feed, has issued a recall because of Salmonella contamination of their product. Contaminated critters have been sold across the US (except Hawaii) through mail order and pet stores, and recalled product codes can be found in the FDA recall notice. Contamination isn't a big deal for the reptiles, since carriage rates for Salmonella are already high and they are usually healthy carriers. The concern is for people who handle the frozen rodents/chicks (or who can be exposed indirectly from contaminated surfaces in the home).  There have been previous outbreaks of human Salmonella infections associated with contaminated frozen rodents.

Unlike many other recalls where the product is recalled because of contamination but without evidence of human illness, human illnesses suspected to be linked to contaminated reptile food have been identified in 17 states. In reality, reported cases may be the tip of the iceberg, and I suspect that if cases in 17 states are confirmed, there will be (or may already be) many more. Other details regarding these cases and the recall, such as the strain of Salmonella involved, haven't been released.

In response to this problem, the FDA report and the company website indicate that products from MiceDirect will be irradiated. It's not clear if this will be a standard protocol from now on, or whether it's a short-term response to the contamination problem. Considering the repeated outbreaks associated with frozen reptile food, irradiation sounds like a good standard practice. Perhaps the best way to help make (or keep) it a standard practice industry-wide is for consumers to vote with their wallets: ask for irradiated or otherwise treated (e.g. high pressure pasteurization (although I'm not sure what that would do to a mouse)) feeds to reduce the risks of contamination.

Because of recurrent problems with contaminated frozen reptile feed, if people are not buying products that are treated to eliminate contamination, they should assume that all such feed is contaminated and handle it accordingly. That means using basic practices such as:

  • keeping frozen reptile feed away from human food
  • if defrosting it in the refrigerator, keep the reptile feed in a sealed container that is not used for human food and that is disinfected afterward
  • washing hands after handling the feed
  • disinfecting any potentially contaminated surfaces that come in contact with the feed
  • discarding uneaten food promptly, since Salmonella can multiply as uneaten food sits in the open, especially in a nice, warm reptile terrarium

A link to more information about MiceDirect is available through a post on Barfblog.

(click image for source)

Iams recall: Salmonella

Proctor and Gamble has announced a recall of two lots of Iams' Veterinary Formulas Feline Renal, a prescription dry cat food. The lot numbers are 01384174B4 and 01384174B2. Anyone that has this food should stop using it immediately. Since these are prescription diets that should only be available through a veterinarian, affected customers should presumably contact their veterinarian for information about a replacement or refund. If a cat that has eaten this food develops diarrhea, Salmonella should be considered as a possible cause and a stool sample should be tested.

As with most of these recalls, no illnesses have been reported, although lack of reported cases doesn't necessarily mean lack of cases. While Salmonella contamination of dry pet food diets is quite uncommon, it can happen.  It's a good reason for people to make sure they wash their hands after having contact with any pet food or the pet's food bowl, and to make sure that pet food is kept separate from food meant for human consumption.

Pet therapy: What about the risks to the animals?

There's an interesting article in today's Pittsburgh Post-Gazette about Scooter, a paralyzed cat in a custom-made cart, that visits patients at HealthSouth Harmarville Rehabilitation Hospital. It's a nice story and it's easy to see the potential appeal of a paralyzed animal whipping around a rehab hospital as an inspiration to patients.

Obviously, people like having this cat in the hospital, and he's helped some patients. That's not surprising because we know that pet therapy can be beneficial to many. My concern in this case is for the cat's health, and the heart of the issue is whether the benefits to patients are because Scooter's a paralyzed cat or because he's a cat, and whether the benefit to patients justifies the risk to the cat.

Paralyzed animals are at increased risk for certain infections. In particular, they are at very high risk for urinary tract infections. These animals tend to get recurrent urinary tract infections and enter a downward spiral of infection / treatment / infection / treatment / resistant infection / treatment / more resistant infection... and in some cases end up with infections that are very difficult or impossible to eliminate. In some cases, urinary tract infections in paralyzed individuals can result in infection spreading to the rest of the body, which can be fatal.

Back to my concerns for Scooter: We know that the hospital environment is contaminated with various drug-resistant bacteria. We know that patients in hospitals are often carrying drug-resistant bacteria. We know that dogs that participate in visitation programs are at increased risk of acquiring drug-resistant bacteria. So, do we really want to be exposing a high-risk animal to such an environment, and potentially speed up the cycle of infection that could ultimately cause severe illness or even death in the animal?

There's no clear answer, but we need to consider the risks to visitation animals, and whether the novelty of having a paralyzed cat (instead of a normal, healthy cat) visiting patients is really a significant enough benefit to justify the potential risk to the cat.

Image: A paralyzed cat using a mobility cart (source: www.k9-carts.com)

Occupational "oops"

A couple people have learned the hard way that mixing dogs and their jobs isn't necessarily a good idea.

1) A Peterborough (Ontario) Regional Health Centre employee has been disciplined for performing an ultrasound on a pregnant dog in the hospital's emergency department. This raised various concerns, including:

  • medical equipment being used while people were waiting in the ER (no one had any tests delayed because of this)
  • inappropriate use of hospital equipment
  • infection control concerns

No one mentioned the whole aspect of practicing veterinary medicine without a license. This is a pretty minor issue here with a non-invasive technique done by (presumably) the pet's owner and with no money changing hands. It's not like a human medical ultrasound technician performing and interpreting ultrasounds on pets and charging for the service, which would be illegal in the province of Ontario.

If you want an ultrasound done on your dog, go to a veterinarian. If you want to take a dog to a hospital, do so as part of an organized hospital visitation program.

2) I've heard a lot of stories about strange things done with pets, but this morning's Toronto Star had a new one for me. It was an article about a dog that received communion last week at St. Peter's Anglican Church in Toronto. It was apparently a spontaneous act meant to make a new member feel welcome, but giving communion to a dog isn't exactly following church rules, and at least one churchgoer was offended by what he considered an affront to this sacred ritual. (I also doubt the reverend washed her hands after feeding the dog the communion wafer.)

A complaint was filed by a man who has since left the church. However, the bishop of York-Scarborough took a rather balanced approach. “Unless there is any further evidence that she is giving communion to animals, the matter is closed... we are after all, in the forgiveness and repair business,” he said.

(click image for source)

More animal smuggling

Mexican officials searching a man at the airport with a bulge under his shirt identified 18 monkeys hidden beneath his clothes. Apparently, investigators became suspicious when the guy became very nervous when questioned. (I would have thought the stench associated with having 18 monkeys plastered to your body would be another tip-off.)

He was detained for possessing the 18 titi monkeys, a protected endangered species. He claimed they were pets and that he moved the animals from his suitcase to his clothes so the x-ray machines wouldn't harm them. I suspect the fact that an x-ray screener might have flagged the image of a suitcase with 18 monkey skeletons in it as abnormal was another reason.

Anyway, that's one more smuggler caught, but many more to go. Unfortunately, it's probably the stupid, small volume smugglers that get caught most of the time, while the people involved with importing huge numbers of animals go unnoticed.

Why does animal smuggling need to be stopped?

  • It's inhumane. A large percentage of animals caught for smuggling die during transit. Many of the "lucky" ones that make it to their new owners die because of illnesses acquired during transit, stress of shipping and adaptation to a new home, and inadequate care by uninformed owners.
  • It creates a risk of infectious disease importation. Smuggling is a major risk for introduction of diseases that could hurt (even devastate) animals or humans. Smuggled animals don't go through the same degree of inspection and quarantine as legally imported animals. Smuggling may be the main risk of introduction of various infectious diseases.
  • It harms populations. Mass smuggling of endangered species can jeopardize the survival of these species in the wild.

The best way to deter smuggling is to cut down on demand. If people stop buying these animals, people will stop smuggling them because there will be no profit in it. People thinking about getting an exotic pet need to think carefully about from where the animals come. Too often, people put on blinders and conveniently forget the questionable provenance and what they are supporting in their desire to get a novel pet. At the same time, smuggling laws need to have some teeth. Huge amounts of money are made through smuggling, and the penalties need to reflect that. A slap on the wrist doesn't do much to deter someone who's making a lot of money and has little risk of being caught.

Image: Dusky titi monkeys (source: www.bbc.co.uk)

Rabies update

ProMed has a new list of recent rabies incidents. The whole report can be seen by clicking here, but these are some examples of common or important issues they touch on:

- Roaming pets + wildlife = bad news: One person's dogs killed a raccoon while out for their "romp around the yard." The raccoon was rabid. There's no mention about the vaccination status of the dogs. If they were vaccinated, they probably got a rabies booster and are under a 45-day "house arrest" for observation. If not, they either need to be placed under a strict 6-month quarantine at a separate facility, or they'll be euthanized. Another report describes a different dog that is now under a 6-month quarantine after attacking a raccoon. In yet another report, a North Carolina woman's dog was euthanized because it killed a rabid fox and was unvaccinated (the owner chose euthanasia over quarantine).  That dog is now dead mainly because the owner didn't take the simple and relatively inexpensive step of ensuring that her dog was vaccinated.

- Pissed-off wildlife bite. Sometimes they're rabid too. Get too close at your own peril: A South Carolina man is undergoing post-exposure treatment because he was bitten by a raccoon while removing it from a trap. I'm glad that he had the animal tested. It's pretty easy to see someone in a situation like this just yelling at the raccoon and letting it go, thinking they were bitten because the raccoon was upset and not realizing that they might have been exposed to rabies.

- Some people just don't get it: In response to rabies exposure of close to 50 church members from a rabid bat while on a mission trip, the mission leader stated "It's just part of being in rural America, so there's really not a lot to talk about." Ugh. Rabies exposure should not be written off as some benign, unavoidable rural American experience. It's exposure to an almost invariably fatal disease that requires a series of expensive treatments. It's also not a rural thing. Rabies exposures can occur commonly in urban areas as well.

- Stray kittens can be cute but deadly: A rabid cat and kitten were identified in Ocean City, Maryland, and authorities are looking for people that may have come into contact with them. Human exposure to rabies from handling cute but infected kittens is not uncommon, and sometimes involves a lot of people. If you see a stray kitten, it's best to leave it alone. If you feel the need to rescue it, make sure that you get it to a vet for an exam, and that it subsequently goes somewhere where it can be properly observed and taken care of. If you're bitten in the process, make sure the kitten is quarantined for 10 days to see if it's rabid, or euthanized and tested. The worse case scenario is when people play with stray kittens, get nipped in the process, dismiss it as a minor or playful bite, then release the kitten back into the wild, never knowing whether they might have been exposed to rabies.

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I have Clostridium difficile...Should my dog be tested?

I get this question surprisingly often. In one way, that's good because it shows increasing awareness of the potential for interspecies transmission of microorganisms. In some situations, when a person has an infection, the pet should be considered in case it was the source of the infection and/or in case it's at risk of becoming infected by the person.

Clostridium difficile is a very important cause of diarrhea (and sometimes more severe intestinal disease) in people. Previously it usually only affected people confined to hospitals and people being treated with antibiotics, but it's now being identified more often in people in the community.

The potential for interspecies transmission of this bacterium is real.

  • C. difficile can be found in a small percentage of healthy dogs and cats.
  • The strains of C. difficile in dogs and cats are almost always the same as those found in people. My lab has one of the largest collections of C. difficile around and we only have a couple of C. difficile isolates from dogs and cats that we have not found in people.
  • Dogs that visit human hospitals are at increased risk of shedding this bacterium in their stool, and certain types of contact with people have been identified as increasing this risk (Lefebvre et al 2009).
  • Dogs owned by an immunocompromised person are at increased risk of shedding C. difficile (Weese et al 2010), presumably because the person is more likely to shed the bacterium and subsequently infect the pet.
  • Dogs that are owned by people being treated with antibiotics are more likely to shed the bacterium (Lefebvre et al 2009). That's probably because, as with immunocompromised people, when someone's being treated with antibiotics, they have a greater likelihood of shedding C. difficile and their dog subsequently becomes infected.

However, there's currently no indication that testing is needed.

  • What would the results tell you? If you identify C. difficile in your dog and you have a C. difficile infection, does that mean that you were infected by the dog, you infected the dog or you were both infected by the same source?
  • What would you do with the results? There's no indication to treat the dog if it's positive and healthy.
  • What testing would you actually get done? Testing for diagnosis of C. difficile disease usually involves trying to detect bacterial toxins in stool. The tests aren't meant to be used on normal stool. To really know what's going on, you'd need to have the bacterium cultured from your pet's stool as well. Not many labs can do that. Furthermore, to get really useful information, you'd also need to get your stool cultured and, if C. difficile was present in both you and your dog, molecular typing would be required to show that they were the same strain. Very few places can do that. Even with that information, at the end of the day, finding the same strain in you and your pet doesn't tell you more than the fact that the bug probably moved between you and your pet, in one direction or another.

If you have C. difficile, it's reasonable to take precautions to reduce the risk of infecting other individuals, both human and animal:

  • Practice good hygiene. Wash your hands thoroughly after using the washroom.
  • Don't let your dog drink out of the toilet.
  • Use antibiotics judiciously. If your pet is being treated with antibiotics and you have C. difficile, there's probably a greater chance of your pet picking up the bacterium.
  • If you have C. difficile and your pet develops diarrhea, tell your veterinarian. It's important that they know that your pet may be at higher risk of C. difficile infection.

If you have recurrent C. difficile infections, considering the pet as a possible source might be reasonable, but we don't currently know what role pets may play. As described above, investigating your pet as a possible source would require culturing stool from both you and your pet, having both typed using molecular tests, and a joint effort involving your veterinarian and physician.

Internet advice: The good, the bad and the ugly

The internet can be a strange place at times. You can find great, reputable and unbiased information right next to complete garbage. Often, the garbage is pretty apparent, but sometimes it's dressed up well or mixed in with some good information. That's a problem with veterinary advice and information sites.

Among the creative myths identified in a couple of minutes of searching:

- Metronidazole is a proven treatment for parvovirus: No. Metronidazole is an antibiotic that doesn't have any effect on viruses. Antibiotics are sometimes used in the treatment of parvovirus, but they are drugs that are used to prevent or treat problems caused by bacteria from the gut entering the bloodstream as a result of the intestinal tract disease. Metronidazole won't do that.

- MRSA is a virus: You can't make much more of a basic mistake than confusing a virus and a bacterium. Anyone who says this when purportedly writing medical advice is completely clueless.

- If your dog gets an MRSA infection, your veterinarian will likely prescribe vancomycin: Only in extreme circumstances (if ever) should this ever happen. For more information on vancomycin and its use in treating animal and human infections, see our archives. (This gem is on a page that says it's information from infectious disease specialists).

-MRSA in dogs can easily become resistant to vancomycin so linezolid may be required: Fortunately, vancomycin resistance is extremely rare, having been found only a few times in people, in specific circumstances. It's never been found in a dog. Hopefully it will stay that way. (This site didn't even spell vancomycin correctly.)

- Cats can easily get a urinary tract infection if their litterboxes are not cleaned: No. There is no evidence of this and no reason to think it's an issue. Poor litterbox maintenance can lead to urinating outside of the litterbox or other problems like idiopathic cystitis, but not infection.

- In order to have a very healthy dog, it is often required to supplement your pet's diet to provide a high amount of probiotics: Nope. Certain probiotics might be useful in certain animals in certain situations, but we have no proof of this in dogs and cats, and they are certainly not needed for all animals.

There's no way to guarantee that a website is reputable or that the writers are knowledgeable, but here are some things I consider when scrutinizing information on the internet:

  • Who set up the website? Is it clear who's in charge?
  • Who wrote the information? Is it someone with actual credentials? For veterinary medical advice, is it a veterinarian? If it's a veterinarian, is it a specialist? If it's not a veterinarian, what expertise does the person have? Some people without veterinary degrees have expertise in some fields, but try to determine whether they truly have the qualifications to give advice on a particular topic. That's harder to do these days given the proliferation of mail-order "PhD" degrees, something that's not uncommonly encountered in unqualified people making poor veterinary recommendations. 
  • Why is the website there? Is it an educational site or is it there to make money? Commercial sites aren't necessarily bad but you have to consider any conflicts of interest or ulterior motives. If there is an article about something, and the last sentence tries to sell you a product to fix that problem, be careful.
  • Does the information make sense and is it consistent with other websites? You can probably find a site somewhere to support any notion that you have, but does it really make sense?
  • Is the site relevant to your geographical area? This is particularly important for infectious diseases since they can vary greatly between regions. A disease may be a big problem in one area, and a website might provide excellent advice... but only for that area. It may be completely irrelevant or inappropriate for other regions.
  • Can they spell? The odd typo probably isn't a major issue (I do it myself). However, rampant and blatant abuse of the English language and an inability to spell important words properly should be red flag.

Searching the internet for pet health information is certainly not a bad thing to do. But, you have to critically assess what you read and remember that it's not always right. Use the internet as a resource but make sure that it's to supplement advice from your veterinarian, not to replace it.

New service dog scam?

Miami-Dade County, like some other regions, has banned pit bulls. We have the same ban here in Ontario. While there's a lot of debate over the quality and usefulness of such bans, the law is the law... until you find a loophole. 

That appears to be the case in Miami-Dade, where a growing number of pit bulls are being registered as service animals to make them exempt from the ban. This loophole could basically render the ban irrelevant considering there are no requirements for any special certification of service animals, and people are very limited in what they can ask regarding the service animal and its owner. Basically, once someone says "that's my service animal" the case is closed, since officials may not ask about why the person needs a service animal or require any proof that it's really a properly trained bonafide service animal.

This is just one more example of problems created by the vague nature of the Americans With Disabilities Act (ADA) when it comes to service animals. Continued questionable activities like this run the risk of creating barriers for people that truly need service animals. Unfortunately, until the government addresses this issue and ensures that there is some control over what constitutes a service animal, such abuses will persist.

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Trap/neuter/release controversy

Trap/neuter/release (TNR) programs involve trapping feral (stray) cats, then spaying or neutering and vaccinating them. Some cats are adopted, while the majority are released. The goal is to reduce the feral cat population by limiting the number of breeding animals, and to increase overall vaccine coverage in order to reduce illness and deaths. One such TNR program has come under fire in a Texas town.

In Leander, Texas, trapping wild animals (including feral cats) is illegal, but authorities have ignored the rules for groups that run TNR programs. One citizen, Carmen Amaya, is leading a charge to get authorities to start enforcing this so that TNR programs can't happen. The main reason appears to be that she's upset her dog was scratched by a feral cat and ended up with $800 in vet bills (not something I'd be happy with either, but is this really the best way to direct her anger?).

A non-profit group, Shadow Cats, has led the TNR effort and has trapped, neutered and vaccinated  about 3000 cats in Central Texas since 2004. About 500 were adopted and the rest released. The organization knows they are working outside the law and have lobbied for it to be changed. That was being considered in June, but opposition from Amaya and others has led to the creation of a task force to make a recommendation, which is due next month. In the meantime, Shadow Cats has ceased activities in Leander.

I'm not sure what the opponents to TNR really want. If it's just cessation of the program, there's no benefit to them.  Without the program:

  • Stray cats will continue to be around, and there will probably be more of them.
  • Potentially adoptable cats won't be taken into homes to improve the lives of those cats.
  • Vaccine coverage of the population will decrease. That's a critical point, because it will result in lower "herd immunity."   With herd immunity, the greater the percentage of a population that is immune to a disease (i.e. vaccinated), the lower the likelihood of the disease establishing itself in and spreading through the population, even among those individuals who don't get vaccinated.

On the other hand, if these people simply want Shadow Cats to stop releasing the neutered cats back into the neighbourhood, it means either 1) finding a way to care for all those cats in shelter, which simply isn't realistic for a multitude of reasons, not the least of which is cost, 2) releasing the cats elsewhere, which doesn't actually solve the problem, it just makes it someone else's, or 3) euthanizing all the cats instead of neutering and releasing them.  If they're hoping that by objecting to the TNR program that all the cats being trapped will be euthanized instead, they need to realize:

  • It's not going to happen as long as volunteer "rescue" groups are in charge of the program. These groups aren't going to trap and kill.
  • The city is unlikely to do it either, and there's a cost to having city personnel catch the cats and take them somewhere to be euthanized.
  • Most importantly, culling has been shown time and time again to be an ineffective way to control feral animal populations. What's needed is a combined approach that includes measures such as neutering and vaccination, education to reduce the risk of human and domestic animal exposure to feral animals, and taking steps to discourage feral animals from spending time in close proximity to people and domestic animals.

Amaya states that "her" feral cat is a nuisance and she doesn't want it on her property. So what is she trying to accomplish? If anything, her actions will just help her single stray cat turn into a large extended family of stray cats that are susceptible to rabies.

There are certainly concerns with feral cats and TNR programs. They are not perfect and not always run well. Some people are opposed to them for various reasons, some of which are quite reasonable. It's a tough issue because one person's idea of success might be completely different from someone else's. Some people focus on the number of animals, while others focus on the quality of life of the animals, public health aspects, impacts of feral cats on wild bird populations and other diverse areas. A local council isn't going to be able to solve these problems, and it really comes down to an assessment of the potential usefulness of the program and the ability of the people involved to do it safely, ethically and legally.

Personally, I'd rather see well-designed, well-run and regularly-evaluated programs to try to reduce feral cat (and dog) populations, and (perhaps more importantly) increased vaccination coverage in the feral animal population, than nothing. Feral animals aren't going to disappear if we ignore them.

Image source: www.shadowcats.net

Turtle on a plane...but not for long

It's not likely going to spark a Hollywood movie, but a turtle on a plane triggered a lot of angst and controversy in the US recently.

A 10-year-old girl was traveling with her pet turtle, Neytiri, on an AirTran flight from Atlanta to Milwaukee. The airline has a no-reptiles policy (actually, a no-pets-at-all-in-the-cabin policy) and when one crew member spotted the turtle in a cage under the girl's seat, she was told that she had to get off the plane.

This is where things start to fall apart a little. Apparently, the girl and her sister threw the turtle and its cage in the trash. They say that they were told to do so, although AirTran disputes this. Regardless, the turtle was tossed and the girls got back on the plane.

Banning turtles from plane cabins makes complete sense. I'm not sure why anyone would really need to travel with their pet turtle, particularly in the cabin. Turtles are notorious vectors of Salmonella and a huge number of Salmonella infections in people are attributed to contact with pet reptiles. People under the age of five, the elderly, pregnant women and people with compromised immune systems are at particular risk and should not have contact with reptiles. The problem with a plane is you can't be sure whether or not such high-risk individuals are on it (or will be on subsequent flights). A turtle in a cage is probably of fairly low risk. The problem would be the owner handling the turtle or its cage, then touching common hand-contact sites in the plane. Those sites could then be touched by someone else, creating a theoretical risk of transmission.

What's the real risk in this situation? Probably minimal. However, you have to think about whether risks, even minimal ones, are worth taking when they are completely avoidable by keeping turtles and other high-risk species out of cramped and hygiene-limited public spaces like airplane cabins - places they don't need to be.

Did the airline over-react? I don't think so (although recommending someone toss a live animal in the garbage, if it happened, is completely unethical). They have a policy. It's a reasonable policy. If you fly on an airline, you have to abide by their rules. If you are going to do something unusual like travel with a pet, it's your responsibility to determine what the rules are.

The story has a happy ending, fortunately. It seems that an airline employee recovered the turtle from the trash, and the girl was re-united with her pet a couple of days later, after flying home on an AirTran plane... in the cargo hold.

One other interesting note about this story - the turtle, Neytiri, was only two-inches long.  In the US, the sale of pet turtles with a carapace length of less than four-inches has been illegal since 1975, due to high rates of turtle-associated salmonellosis among children, who were more likely to extensively handle tiny turtles.

Photo (left): Carley Helm and her pet turtle Neytiri.

Biohazardous cell phones

It's amazing how attached people are to their cell phones. Many people will answer them without any thought of what else is going on. It's something I've seen in veterinary hospitals where wireless or cell phones are the primary mode of internal communication. The natural tendency to answer the phone often overrides the thought process of "are my hands covered in pus, blood or some other gross material that I should perhaps remove before touching this piece of plastic that will spend a lot of time against my face and which may go home with me?" We've grown some interesting things from cell phones and pagers, as have others.

A recent paper in the American Journal of Infection Control (Sadat-Ali et al 2010) provides yet another example of this. In this study, the authors cultured cell phones of 288 health care providers over a six-month period.

  • 44% of phones were contaminated with "potentially harmful" bacteria. There's no description of what they considered "potentially harmful" and I'm surprised that the percentage wasn't even higher.
  • MRSA was isolated from 7.3% of phones, from people in wards, the emergency room and the operating room.
  • 31% of people said they occasionally wiped down their phones with alcohol swabs. People who said they did this were significantly less likely to have contaminated phones.

Is this really surprising? No, not at all. We don't live in a sterile environment, and the more contact with healthcare environments, the greater the chance of contamination with healthcare-associated microorganisms. We also know that hygiene practices associated with cell phones are certainly not very common, nor have optimal ways to reduce or remove contamination been investigated.

Is this a problem? It's hard to say. Just because cell phones can become contaminated, that doesn't mean they are sources of infection. They are one of many, many potentially contaminated environmental surfaces. However, given the close contact with them and the potential that someone would touch a cell phone and then a patient, it's something that shouldn't be ignored.

Are health care workers' phones worse than other people's phones? It's hard to say. This study didn't look at a control group of non-healthcare workers. I suspect that phones owned by the general public are often contaminated as well, though perhaps not with the same range of microorganisms.

How can we reduce the risk of contamination? It's simple: wash your hands regularly. If healthcare workers washed their hands when they are supposed to (especially before and after patient contacts), the risk of contamination and the implications of cell phone contamination would be greatly reduced.

Like a lot of things in infection control, reducing the risks of this potential problem is pretty easy in  theory, but harder in practice, because the draw of that ringing phone is pretty powerful psychologically.

Image from http://cancergrace.org

MRSP infection in a person

Methicillin-resistant Staphylococcus pseudintermedius (MRSP) is becoming a huge problem in dogs (and to a lesser degree cats). I think it can easily be called an epidemic, and probably even a pandemic, considering the degree of spread, the massive increase in cases and the international distribution of this multidrug-resistant bacterium.

Public health concerns regarding MRSP have received attention because of the huge problem with MRSA (methicillin-resistant Staphylococcus aureus) in people. My line with S. pseudintermedius in general is that while there are only periodic reports of infections in people, exposure to this bacterium is very common, since it is carried by a large percentage of healthy dogs. Given the frequent exposure and very small number of infections, it’s not a particularly pathogenic bacterium for people. The same should apply for MRSP, since methicillin resistance doesn’t’ make it inherently any more able to cause disease, it just makes it harder to treat. However, I always add the statement that, while the risk is pretty low, I’d rather not have an infection with a highly drug resistant bacterium, so we need to pay attention and try to reduce the risk of transmission.

A paper in an upcoming edition of the Journal of Antimicrobial Chemotherapy (Stegmann et al 2010) shows that these concerns are not unfounded. This report, from Switzerland, described an MRSP infection in a person that developed after sinus surgery. The bacterial strain that was involved was sequence type 71 (ST71), the predominant strain found in dogs in Europe. The affected person had a dog with various health problems, but unfortunately the dog was euthanized (presumably not because of the person’s infection) before samples could be taken to see if it carried the same strain. Since we know that S. pseudintermedius can move between pets and their owners (although usually without causing any problems), it's reasonable to assume that the dog was the source of infection here.

More information about MRSP and MRSA can be found on the Worms & Germs Resources page.

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Famous Fox bitten by rabid cat

Former British pop star and I’m a Celebrity-Get Me Out of Here reality TV character Samantha Fox was bitten by a rabid cat while vacationing in Thailand. Fox was feeding stray cats near a restaurant and was attacked.

Having contact with stray animals is a high risk activity, particularly in regions where rabies is very common. When traveling, it’s important to understand the infectious disease risks in the areas you visit, and rabies is one of them. A bite by a stray animal is usually going to be considered a potential rabies exposure, unless you’re in a rabies-free country or the animal is available for observation or testing. That’s not usually the case, and post-exposure treatment, consisting of a shot of anti-rabies antibody and a series of 4 rabies vaccinations, is usually required.

Fox wasn’t particularly impressed by the treatment: "The treatment for rabies makes you feel sick and horrible, though, really fluey and shaky." Usually, the post-exposure treatment isn't too bad (I can speak from experience here) and current rabies vaccines tend to have a much lower rate of side effects than older vaccines. Fear of adverse effects shouldn’t be a deterrent to proper treatment of this almost invariably fatal disease.

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Infection control...how things have changed

Infection control is a constantly evolving and expanding area - for the good. Paying close attention to infection control in human hospitals is a relatively recent phenomenon, and the advances in infection control are now having an impact outside of hospitals. Pandemic H1N1 influenza drove a lot of changes, but there's been a general increase in awareness of the need for routine infection control in the greater community. This applies to veterinary clinics and living with animals, but is also evident in everything from protocols in workplaces to summer camps.

We're getting ready to send my oldest daughter to summer camp for 12 days. Back in my time, I doubt there was much of an infection control plan for summer camps. If anything, it was probably "don't puke on the other campers and try not to eat too much dirt."

Oh, how things have changed! Last night, we received an email from the camp reminding us to keep our daughter at home if she is sick and outlining their infection control program. Among the infection control measures are:

  • Having 2 12-foot handwashing stations outside of the Dining Hall, with everyone required to wash their hands before eating
  • Having sinks equipped with handwashing supplies present in all buildings
  • Having hand sanitizers throughout the Dining Hall and in every cabin
  • Training staff in infection control protocols
  • Cleaning cabins every day, with daily inspections of cabins by their "Public Health Supervisors"
  • Daily spraying down of surfaces like Dining Hall tables, door handles, toilet handles, taps etc. with disinfectant
  • Screening of all kids by one of the Registered Nurses on the first day of camp

Pretty impressive effort, in my opinion. Like everything else, compliance is critical and having good facilities and plans doesn't guarantee good practices, but the efforts put into developing this program and communicating it suggest that they'll be paying attention to it. Even with a good program, camps are an excellent breeding ground for infectious diseases and are perpetually an outbreak waiting to happen, but a good infection control program should greatly reduce the risks.

Salmonella recalls

A couple of more Salmonella recalls have occurred recently. Feline's Pride Natural Chicken Formula, a raw chicken diet, has been recalled, as has Natural Balance Sweet Potato and Chicken, a kibble diet.

Finding Salmonella in commercial raw diets is expected and I'm surprised about the recalls that have happened. If you buy raw meat, you need to assume that it's contaminated with Salmonella and various other potential pathogens. Salmonella in kibble diets is more surprising, and is a concern because people do not tend to handle kibble as potentially contaminated.

These recalls highlight a few points to me:

  • Always assume you have Salmonella and other nasties in raw meat. Careful attention to handling of raw meat and personal hygiene (e.g. handwashing) is critical.
  • While lower risk, kibble is not innocuous, so wash your hands and prevent cross-contamination of kibble with human foods.
  • "Natural," along with "organic," "super premium" and other marketing catch-words tell you nothing about the quality and safety of a product. There's no evidence that any products marketed as organic, natural, or anything else along that line are at all superior to diets produced by reputable companies, particularly diets that have undergone proper development and testing, including AAFCO feeding trials.