Worms and Germs Blog : Animal Health & Diseases : University of Guelph : Ontario Veterinary College : Zoonotic Diseases : Guelph, Hamilton, Ontario

A Florida woman is facing criminal charges after biting someone at a vet clinic. Kathleen Minneker took her two dogs to the Affordable Animal Care Clinic in Fort Myers, Florida, for grooming. She showed up an hour late and became irate when the grooming wasn't finished on time. At that point, Ms. Minneker apparently lost it, and attacked clinic owner, Gina Brashear, who ended up covered in bites, bruises and scatches. Brashear explained "a chunk is gone off my finger and a chunk off my toe." All this was from the irate customer, not the dogs. In a bit of an understatement, Brashear said "She's a biter."

Brashear is now receiving antibiotics to prevent bite-associated infection, something that can result from human bites just like from animal bites.

There's no word on whether Ms. Minneker was up to date on her rabies shots. Unlike a dog, Ms. Minneker will not be quarantined for 10 days to make sure she does not have rabies, however she may end up with a somewhat longer confinement period courtesy of the State of Florida.

(click image for source)

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An investigation is underway regarding mysterious deaths of dogs that have been walked in public areas of Sandringham, the Queen's 20 000 acre estate in Norfolk. Gastrointestinal disease, consisting of vomiting, diarrhea and lethargy, has afflicted an unknown number of dogs. One area veterinarian reports five deaths and four dogs with serious illness. No cause has been identified, but it's unclear how much testing has been done to date. There was also a cluster of sick dogs last year, but that outbreak was written off as a one-time event caused by a virus.

Outbreaks like this can have a wide variety of causes, including viruses, bacteria, parasites or toxins. Determining the cause of a diarrhea outbreak is often difficult, because of the numerous potential pathogens/toxins, significant gaps in knowledge about what's normally part of the dog's intestinal bacterial population, and limitations of existing diagnostic tests.

(Another possibility is that this isn't really an outbreak, but rather increased reporting of disease that has always been there. I doubt that's the case here, but it is a possibility - dogs get sick all the time. If the baseline level of gastrointestinal illness is just now being scrutinized, and public awareness is increasing because of news reports, you can get a spike in cases that have nothing to do with an outbreak.)

The Animal Health Trust has been called in to investigate. This will presumably involve several approaches, including getting more detailed information about the number of sick dogs, identifying any common links among sick dogs, comparing activities of sick dogs with those of healthy dogs, and testing of feces for various potential causes of disease.

There's no word about whether the Queen's corgis are being restricted from the area.

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A large whooping cough (pertussis) outbreak has been ongoing in people California in 2010. This bacterial infection, caused by Bordetella pertussis, is a highly transmissible disease that can result in serious problems (including death) in young infants. At last report, there were over 6000 cases of whooping cough, making this the largest outbreak in 60 years. Over 200 infants have been hospitalized, and there have been at least 10 deaths. Nine of the 10 deaths were in infants less than two months of age.  Infants in this age group have little to no immunity to the disease because they haven't been vaccinated, and they are more prone to severe complications.

Bordetella pertussis is a human bacterium. It does not infect animals and animals are not direct sources of infection. (Actually, experimental infection of neonatal puppies with large doses of B. pertussis can result in shedding of the bacterium by a small percentage of dogs, but that's not particularly relevant to the normal household situation). Therefore, people don't need to worry about infecting their pets and pets passing the infection on to other people. However, it's not impossible that pets could play an indirect role in transmission. A pet's haircoat could possibly become contaminated with the pertussis bacterium from someone coughing around it, or touching it with contaminated hands. The bacterium could survive on the haircoat for a while (probably days), and someone could potentially get the bacterium on their hands by petting it, and subsequently become infected.

What are the odds of this happening? Who knows. It's not something that anyone has investigated, as far as I know.

Could dogs and cats be important sources of pertussis in households? Probably not. I assume that if there is a person with whooping cough in a household, that person is more likely to be the source of infection for other people than a pet. 

Could pets spread pertussis outside the home? That might be a more realistic concern. People with pertussis might keep themselves away from others and stay at home, but if they contaminate their dog's coat and the dog meets people on a walk or at the park (or at a veterinary clinic, or anywhere else), I have to wonder whether there could be the potential for spread of the disease.

What should we do about this? Common sense should prevail, and itt's important for pertussis as well as other diseases. If someone in the household has an infectious disease that is transmissible and for which a pet could potentially be a vector, some basic precautions should be taken. Good attention to hygiene might help reduce contamination of the pet's haircoat. This includes regular handwashing (especially after coughing and before petting an animal), avoiding coughing close to the pet and not letting the pet sleep close to the person's head. Keeping the pet away from people outside the house, or at least limiting it's contact with high-risk people might also be useful. In particular, keeping pets that might have been contaminated away from infants would be wise.

Overall, the risks are very low. We don't need to fear dogs and cats as potential pertussis vectors. However, in the absence of proof that there's no risk, and with a highly transmissible and potentially serious disease, use of some simple infection control measures makes sense.

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A Wisconsin man is recovering after being attacked by a seven-year-old Siberian tiger at The Wisconsin Big Cat Rescue & Educational Center. The victim is a volunteer at the centre, and he was attacked while giving the tiger some water. He was airlifted to hospital but his injuries are described as minor.

As is often the case, it is suspected that the attack wasn't an indication of aggression. Rather, it may have been playful behaviour, something that can quickly become deadly with a large cat. People have been killed before by big cats trying to play with them - all it takes is one misplaced swat from these extremely powerful beasts to do significant harm.

Attacks by big cats are not exactly rare in North America, and are almost always associated with poorly housed "pet" big cats and roadside zoos. It is actually relatively easy to buy a big cat, and many parts of North America have few to no restrictions on ownership. The animals often suffer because of inadequate nutrition or poor housing, and public health is at risk because of inadequate housing and restraint. There's no reason for tigers to be in North America apart from accredited zoos (or similar facilities) with adequate housing for these large animals and properly trained personnel. They are not pets. You can hand raise a tiger and make it pretty tame, but they are never safe. How many cat owners are bitten, swatted, stalked or jumped on by their small-sized pet cats every day? Imagine what happens what those same feline behaviours are exhibited by a tiger that weighs a few hundred pounds.

When I first saw the headline, I thought "here's another person injured at some crappy roadside zoo that has no business keeping big cats." This facility and the circumstances around the attack seem to be different. This does seem to be a legitimate rescue facility (some "rescue" facilities for various species are just people who like to collect animals), although it's hard to say too much about how reputable the place is from a distance, and whether there is any truth to some unflattering internet reports. The attack also occurred through a fence. In properly run facilities, the likelihood of an attack is reduced by restriction of direct contact between people and cats. If someone isn't in a pen with the animal, the chances of injury are much lower. Circumstances regarding this attack aren't clear, so it's hard to say whether there are issues with the design of pens or how people interact with the animals, and whether the person really wasn't in the pen. However, the fact that this seems like a more reasonable facility than your average small zoo and a potentially serious attack still occurred underscores the danger posed by people owning these animals.

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A UK woman is both grieving the loss of her husband and battling illness she thinks came from a new pet parrot. The 67-year-old woman, who has chronic lymphocytic leukemia, obtained the bird to keep her company as her husband was dying of cancer. She says that she's never felt right since she obtained the bird. She is also upset that the bird is not very tame, saying "Jasper is clearly a wild bird, and they do carry all sorts of germs, so it is a worry for me." 

Since her husband's death, the woman has had three rounds of antibiotics to treat a respiratory tract infection that refuses to go away. No more details are provided, and presumably (hopefully) her doctors have tested or treated her for psittacosis, a disease caused by Chlamydophila psitacii - a microorganism that can be acquired from birds, especially psittacine birds like parrots.

This story raises a few relevant questions:

Was it a good time to get a pet?

• That's a tough question. Getting a petting during a difficult time can help many people cope, and having the pet while a family member is sick can be very beneficial. On the other hand, bringing a new pet (with the associated new pet issues) into an already stressful situation can be a problem. Also, with both the woman and her husband being sick and having weakened immune systems, there are some infectious disease risks that need to be considered. The cost-benefit of getting a pet in a situation like this is hard to determine, and it varies greatly between households. At a minimum, anyone in such a situation who is considering getting a pet should learn about potential pet-associated disease risks first so that they can make an informed decision.

Was a bird a good pet to get for this household?

• Another question without a clear answer. Birds can be good companions, but they also carry a few diseases that are of concern, particularly for people with weakened immune systems. It's hard to say whether a pet bird is higher risk than a pet dog or cat. It probably is lower risk from some standpoints (e.g. bites, scratches) but higher risk for certain diseases. The key is, as mentioned above, being informed about potential disease risks and what can be done to reduce these risks. With that information, you can make a more educated decision about whether a specific pet is appropriate.
• Also, in high risk households like this, getting a new pet examined before it makes it to the household is a good idea. Such an exam provides an opportunity for a veterinarian to identify any concerns, ranging from obvious signs of disease to inappropriate behaviours. Identifying these problems before the pet makes it home allows them to be addressed quickly. This might involve treatment, prompt training, keeping the pet somewhere else for a short time while a problem is addressed, or a recommendation to return it to where it came from because of a major concern. It's much easier to do these things (especially returning the pet) before it has made it home and people have become attached.

Should you assume that a captive-bred bird is a disease-free bird?

• Absolutely not. Captive-bred does not equal disease-free. In fact, for some diseases, rates are higher in captive-bred birds. (I'm definitely not advocating getting wild-caught birds... just trying to make it clear that birds from breeders can carry various infectious diseases too). The point is, getting a bird from a reputable breeder is a good start, but it doesn't negate the risks. Healthy, well cared-for birds can carry a variety of microorganisms that can infect people. Risks are higher for people with compromised immune systems, such as the individuals in the household in this case.

Pet ownership always carries some risk of infectious disease transmission. Almost always, that risk is manageable and acceptable considering the positive aspects of pet ownership. However, thought needs to go into the process to ensure that the risks are minimized and acceptable in any given situation.

Image: Green Indian Ring-Necked Parakeet

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ProMed's monthly rabies update contains some recurring themes:

• A couple of incidents of dog versus rabid raccoon. The dog usually comes out on top, but the raccoon can exact revenge at the end of the day through the need for quarantine or euthanasia. If the dog is not vaccinated, a long quarantine or euthanasia is required. If the dog is vaccinated, only a shorter observation period is needed.
• A rabid skunk was found wandering around during the day with a wobbly gait and drooling. Any wild animal that is acting strangely should be considered rabid until proven otherwise. They don't have to be showing signs of severe neurological disease. Something as simple as not being afraid of people or wandering around in areas or at times when they would not usually be found should raise the suspicion.
• A child who was sleeping outside woke up to "find a raccoon, kind of, scratching at his leg." (I  assume they mean it was "kind of scratching at the kid's leg," (whatever that means), instead of it was "kind of a raccoon.") The raccoon wasn't caught for testing but the child is undergoing post-exposure treatment because a normal raccoon wouldn't be expected to do that, so there is a significant chance of rabies exposure. Scratches are not high risk since rabies virus does not live in the claws, however it is possible that saliva from the raccoon could have been present on the animal's feet or the raccoon could have licked the child before scratching, such that the scratches could have then inoculated rabies virus into the tissues.
• A couple of reports of rabies in rabid kittens. These cute little rabies vectors cause repeated problems, and lead to public alerts notifying anyone who may have handled the kittens to get evaluated to see if they need post-exposure treatment. Handling of strays should be avoided.
• A family received post-exposure treatment after being bitten by their rabid cat. Vaccination of pets is not just for the health of the pet. It's to reduce exposure of people as well.

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You never want to be the subject of a medical case report. A 37-year-old British woman was featured in a recent edition of Lancet (Brouwer et al 2010), in a paper entitled "A horse bite to remember."

The woman was admitted to hospital with a fever, headache, neck stiffness, confusion, difficulty speaking and nausea. These signs are suggestive of meningitis and a spinal tap was supportive of that presumptive diagnosis. Blood samples were also taken, and the same bacterium, Streptococcus zooepidemicus, was isolated from both blood and spinal fluid, confirming a diagnosis of S. zooepidemicus meningitis. She was treated and improved, but did not fully recover.

Streptococcus zooepidemicus is primarily associated with horses, although it can occasionally be found in other species such as dogs. After the diagnosis, the woman's family was questioned about her hobbies and it was revealed that she was an avid horsewoman. Further, she had been bitten by her horse the previous week. That was the presumed source of infection, but it doesn't appear that any further investigation was undertaken.

Associating the meningitis with the bite is reasonable, but it's not definitive. Streptococcus zooepidemicus infections in people have occurred in the absence of bites or other clear sources of exposure to horses, so the bite wasn't necessarily the problem. Regardless, it indicates the need to be proactive and properly treat any horse-associated wound, be it a bite or any another wound that gets contaminated with bacteria from the horse or its environment.

This was a very unusual case. People shouldn't be overly concerned about getting S. zooepidemicus meningitis from their horse. However, it should serve as a reminder that bad things can happen periodically and that proper attention to general hygiene practices and bite wound care is always important.

On a side-note, I thought the title "A horse bite to remember" was a bit crass, since the woman is now unable to live independently because of severe amnesia (memory problems) as a result of the infection. Maybe they were trying to be ironic, but it seems below a journal such as Lancet.

This Worms & Germs blog entry was originally posted on equIDblog on 10-Oct-10.

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A recent edition of Morbidity and Mortality Weekly Reports described a case of travel-associated rabies in a Virginia man. The man was diagnosed with rabies in October 2009. Treatment with the “Milwaukee protocol” (a rabies treatment protocol that resulted in survival of a single patient with rabies but which has not had much success since then) was instituted, however the man died after 25 days in hospital. Thirty-two people who had had close contact with him received post-exposure treatment.

According to his family, the man had an "encounter" with a dog three months earlier in India. The nature of the encounter was not known, and family members didn’t know whether he had received rabies post-exposure prophylaxis. (Considering post-exposure prophylaxis is pretty much 100% effective, I think it’s safe to assume that he didn’t). The rabies virus variant that was isolated was consistent with the strain found in dogs in India, providing more support to the suspicion that the infection was associated with this incident.

Travel-associated rabies is an important problem. This is the 7th case of rabies (and 7th death) in the United States acquired abroad since 2000. While rabies is rare in the US (and many other developed countries) it still kills tens of thousands of people each year, most of whom are infected by dogs. Rabies is endemic in dogs in many regions, including India.

People who are traveling need to be aware of the infectious disease risks in their intended destinations, be it yellow fever, malaria, rabies or others, and take appropriate precautions. Rabies vaccination is not indicated for travelers unless they are going to be working with wildlife or feral animals. The key for travelers is to understand that rabies exposure is a risk, that they must avoid contact with stray animals, and what to do if they are bitten. Access to rabies post-exposure prophylaxis may be limited in some regions, and people who are bitten by a suspicious animal may need to travel home to get proper treatment.

Rabies exposure is considered a medical urgency, but not an emergency, meaning you usually don’t need to sprint to the airport and get treated within a few hours. Rather, it means get to a physician as soon as possible - so don’t continue the rest of your vacation and then head to a physician a week or two later. The more severe the bite and the closer to the head that the bite occurs, the shorter the incubation period might be, so there are some situations where "urgency" and "emergency" are hard to differentiate, but the key is to be aware and get proper care as soon as is reasonably possible.

Image source: Humane Society of the United States (HSUS) (click for source)

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The Public Health Agency of Canada (PHAC) has issued a public advisory regarding salmonellosis linked to frozen rodents used as pet (reptile) food. The rather vaguely-worded advisory states that there have been seven reported cases of Salmonella caused by a specific strain that has been linked to frozen rodents. No details about the cases or the origin of the rodents are provided, however it presumably involves the large international Salmonella outbreak associated with Mice Direct, a mail-order rodent company. The advisory reminds people to take basic precautions when handling rodents that are used for reptile food.

Basically, the key is to consider all such frozen rodents biohazardous, and handle them accordingly. Remember to:

• Limit contact with the rodents as much as possible.
• Thaw them in a sealed container, preventing any contact with human food.
• Keep them away from kitchen countertops and other food handling surfaces.
• Wash your hands thoroughly after handling them.

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