Botulism from a pet reptile
I've been slow getting around to this topic, which has been covered elsewhere (on Barfblog), but it's an interesting report and one that's still worth discussing. The report from Ireland involves diagnosis of botulism in a baby that was associated with a pet turtle and/or the turtle's feed.
Botulism is a very serious disease caused by a toxin produced by the bacterium Clostridium botulinum. Typically, botulism occurs when a person (or animal) eats food that was contaminated with the bacterium and then was stored improperly, allowing the bacterium to grow and produce its potent neurotoxins. The other form of botulism, one that is largely restricted to infants, occurs when the botulism bacterium itself is swallowed and starts to produce its toxins while it's in the intestinal tract. It rarely occurs in older individuals because their natural intestinal bacterial population helps suppress overgrowth of the C. botulinum.
Not much information is available about the case in Ireland. It involved quite a rare strain of C. botulinum, Type E, and there's no information provided about how the link to the turtle was made. I assume it was toxicoinfectious botulism, whereby the infant ingested the bacterium (as opposed to eating something already containing the toxin) but the reports aren't clear. Fortunately, the child is recovering, since botulism can be fatal.
Botulism isn't high on my list of potential infectious diseases you can get from reptiles, but it can happen - and it has the potential to be very, very bad. Salmonella is the main focus of reptile-associated diseases, but this report should be taken as a reminder that there are other diseases of concern as well, and that reptiles are inappropriate pets for households with children under five years of age.
Plague in Oregon
The CDC's Morbidity and Mortality Weekly Reports has a short report about two plague cases in the US. Plague, while often thought of as a historical disease (the Black Death), is alive and well in wild rodents in some areas of the world, including parts of North America, and human cases continue to occur.
Here are highlights of the CDC report (in italics) with some extra comments.
Plague, caused by Yersinia pestis, is enzootic (present in the population, typically at a low level) among rodents in the western United States. Humans can be infected through 1) the bite of an infected flea carried by a rodent or, rarely, other animals, 2) direct contact with contaminated tissues, or 3) in rare cases, inhalation of respiratory secretions from infected persons or animals. In September 2010, the Oregon Health Authority reported the first two cases of human plague in Oregon since 1995 and the only two U.S. cases in 2010.
Both illnesses began on August 21. The patients, aged 17 and 42 years, lived in the same household and might have been exposed to plague by infected fleas from one of their dogs; that dog was found to be seropositive for Y. pestis by the passive hemagglutination-inhibition assay (dilution of 1:64). One patient acknowledged sleeping in the same bed with the dog during the 2 weeks before illness onset. Both patients had high fever and multiple bilateral inguinal buboes; one patient had hypotension, tachycardia, and acute renal failure and was hospitalized. A gram-negative rod with bipolar staining was isolated from a specimen of that patient's blood.
...25 days after specimen collection, the isolate was identified as Y. pestis... Both patients recovered uneventfully after empiric therapy with doxycycline and amoxicillin clavulanate potassium, respectively, although the latter is not considered effective in treating plague.
Plague is a Category A potential bioterrorism agent. Human infections are rare but can be life-threatening. The plague case-fatality rate depends on the clinical presentation (i.e., bubonic, septicemic, or pneumonic) and timing of antibiotic therapy initiation; if untreated, the case-fatality rate is >50% for bubonic plague and approaches 100% for pneumonic plague. Rapid laboratory identification can help guide therapy.
Sleeping in the same bed with dogs has been associated with plague in enzootic areas. Plague patients with no history of exposure to rodents can be infected by Y. pestis if their pets carry infected rodent fleas into the home. Veterinarians always should recommend flea control to dog and cat owners.
This is an example of a situation where pets can play a role in human infection while not being the direct source of infection. While direct pet-human transmission can occur, this typically involves situations where someone has close contact with a pet that is sick with the plague. Most often, this kind of transmission is associated with close contact with cats with pneumonic (respiratory) plague.
Key aspects of reducing the risk of pet-associated plague in areas where plague is, or may be, present, are:
- Preventing contact of pets with wildlife, living or dead.
- Preventing roaming of pets in the wild.
- Discouraging wildlife from living in or around homes.
- Keeping cats indoors.
- Routine flea control.
More information on plague and pets is available in our archives.
Psittacosis (parrot fever) in Taipei
A 44-year-old Taipei man is recovering from psittacosis, a potentially severe infection caused by the bacterium Chlamydophila psittaci, which he may have contracted from his pet bird. This bacterium is commonly found in certain bird species, particularly psittacines (parrot family), and human infections are typically associated with bird contact. Healthy birds can shed the bacterium in their respiratory secretions or feces, and shedding rates can be particularly high in some groups of birds, particularly large breeding colonies.
The affected man had typically vague initial signs of disease... fever, chills, aches and cough. It appears that he was tested for psittacosis about 10 days later, but the diagnosis was only recently made (It's not necessarily an easy diagnosis in some cases). There's no information about the severity of disease or whether it progressed past those initial relatively mild signs, or when treatment was started, but he's apparently responding well to treatment and is recovering at home. His pet bird is the probable source of infection, but it's unclear whether it's being tested.
Psittacosis is an example of a disease for which an understanding of pet contact by the attending physician is critical. Typically, psittacosis starts off with flu-like signs. Most otherwise healthy people with fever, chills and aches that go to their doctor would probably be told to "go home, rest and take an anti-inflammatory" or, less diplomatically "get your infectious body out of my office, stay at home, and get over it." That would be reasonable advice for most people, because most people with these symptoms have a common viral infection, and a disease like psittacosis is rare. However, if the person had contact with psittacines and the physician knew it, psittacosis would hopefully come to mind and testing might be performed. Psittacosis is usually easily treated, but you have to know to test for it to diagnose it, so that proper treatment can be started. Untreated, psittacosis can cause severe, even fatal, disease.
Physicians' knowledge about their patients' animal contacts and zoonotic disease exposure is often very poor, which compromises their ability to promptly diagnose and manage zoonotic diseases. Better understanding of pet-associated zoonoses and communication between both people and their physicians, and between physicians and veterinarians, is needed to help reduce the risks.
A great psittacosis resource is the National Association of State Public Health Veterinarians' Psittacosis Compendium.
2010 Animal Rabies Summary
In Canada, rabies testing and surveillance is performed by the Canadian Food Inspection Agency (CFIA). National data for 2010 are now available and indicate there were a small number of cases in domestic animals, with more in wildlife, for a total of 123 cases.
Dogs: There were three cases, all in Saskatchewan.
Cats: Four cases, three in Manitoba and one in Alberta.
Horses: One rabid horse in Manitoba.
Cattle: One, from Manitoba.
Skunks: 60 cases, 33 in Manitoba, 17 in Saskatchewan and 10 in Ontario.
Bats: 48 rabid bats, most in Ontario (29) but also in BC, Alberta, Saskatchewan, Manitoba, Quebec, New Brunswick and Nova Scotia.
Foxes: Six from the Northwest Territories or Nunavut.
No rabid sheep, goats, raccoons (down from 58 in 2007), wolves or other species.
Manitoba seems to win the 2010 rabies prize, while Newfoundland and Labrador, Prince Edward Island and the Yukon had no cases.
As with any disease surveillance, these numbers underestimate the scope of rabies. For an animal to appear on the list, rabies had to be considered and testing performed. So, for wildlife, it's a massive underestimation of the number of cases, since most affected wildlife don't get tested. Wildlife testing (and testing in general) is typically only done when there has been the potential for human exposure. Domestic animal cases are probably a fairly close representation of the status of rabies in pet and farm animals, since it's reasonably likely that a domestic animal with rabies would be identified as such and tested (although certainly cases can be missed or neglected). As with wildlife, there is probably an under-identification of rabies in feral/stray dogs and cats, since testing would only be done on these animals if they are caught and if there was potential human exposure.
Pets in the Classroom Program
A recent press release from The Pet Care Trust reported on the status of its Pets in the Classroom program, which provides support to teachers to have pets in school classrooms. On the surface, it seems like a fine concept, helping to enrich school activities. However, it's one of those ideas that can do a lot of good, or it can also be very bad, depending on how the program is run.The Pet Care Trust has some useful information about pets in classrooms, and anyone considering having a pet in a classroom needs to be aware of a variety of concerns, including:
- Welfare of the pets (e.g. minimizing stress, preventing abuse)
- Adequacy of pet care, particularly during weekends and holidays
- Access to and cost of veterinary care
- Distraction of students
- Allergies
- Fear
- Infectious disease transmission
Given the topic of this blog, I'll focus on the last one.
Infectious disease transmission from pets in classrooms is a real problem. Zoonotic infections can and do occur in these situations. The risks are quite variable, and depending on the animal, children, classroom and pet care, can range from inconsequential to quite serious.
The type of animal is very important. Certain species are very high risk for carrying particular infectious diseases and for transmitting them to people. Reptiles are notorious for Salmonella, so it is recommended that children under five years of age and immunocompromised individuals (among others) not have contact with reptiles. Even with older kids there's a risk, and older kids have picked up Salmonella in classrooms from reptiles or a reptile's food (e.g. frozen rodents).
So, it's concerning that 435 of the 2066 grants handed out by this program were for reptiles, and included kindergarten to Grade 6 classrooms. A lot of reptiles went into classrooms with a lot of young kids. Typically, elementary school children (at least around here) eat in their classrooms, which raises even more concern. While the majority of students would be five years of age or older, immunocompromised kids are not exactly uncommon, and it's unclear whether teachers have adequate knowledge of whether kids in their classes are immunocompromised, nor whether they understand that such children are at increased risk of disease from classroom pets.
I'm not saying pets in classrooms are a bad idea. However, it's often done poorly and with little forethought. To be effective and safe, you need to consider many things, such as:
- What species should it be? From my standpoint, no reptiles or other high-risk species (e.g. baby chicks) should be in any classroom, because you can't guarantee a high-risk person won't be around. The animal needs to be small enough to be properly housed in a classroom. Its care requirements need to be basic and readily met. It shouldn't be a species that gets stressed easily, and it needs to be an animal that can tolerate all the activities that go on around it (e.g. a nocturnal species is probably not a good idea).
- What types of hygiene/infection control practices need to be used around the animal and how will they be enforced?
- What disease or injury (e.g. bite) risks are present and how will they be managed?
- Who will take care of it? This means who will take care of it for its lifespan, not just the upcoming school year.
- Who will arrange and pay for any medical expenses that arise, either for preventive medicine or treatment of disease?
- Will parents be notified?
- What happens if a child in the class is allergic to or afraid of the animal?
- Will proper supervision be available at all times?
- Who from the school or school board must give permission, and is there a standard approval process? (There should be, but there rarely is.)
- Why is the animal going to be there? Will there be any educational use or it is just there for fun/decoration?
If you can answer all these questions adequately, then a pet might be a good fit in the classroom in question. If you can't answer them, or can't be bothered to try to answer them, then there should be no pets in the classroom until you can.
Cobras make bad pets...duh!
A New Jersey man managed to avoid being a good example of Darwin's "natural selection," thanks to the help of medical professionals and the Bronx Zoo.
Eric Bortz (who, I'm sad to say, works at a veterinary clinic), purchased three snakes - a copperhead (venomous), a timber rattlesnake (venomous) and a monocled cobra (venomous) - a couple of weekends ago. (Sadly, that's not hard to do if you have a few hundred dollars.) The snakes joined his collection of pets, including a tarantula, several scorpions, a king snake, a boa constrictor and a rabbit (no word whether the rabbit was a pet or a snake-snack).
Anyway, the following Monday, he was bitten by the newly-acquired cobra. He had apparently been told that the snake had undergone a procedure to render it non-venomous, but it became apparent that it either wasn't true or it wasn't done right, when Mr. Bortz went into respiratory distress and started seizuring.
Fortunately, he received prompt medical care and his proximity to the Bronx Zoo facilitated access to antivenin. Zoos are often called in to help out when people get bitten by their venomous snakes, since zoos typically keep a supply of antivenin in case their staff get bitten.
Keeping venomous snakes is just stupid - there's no reason to do it, and t puts people at risk. The risk is not just to the owners who made the choice to keep the animals, it's also to other people that might be exposed if the snake gets out, including family members, friends and neighbours, who didn't make the choice... it's something that has happened in the past, and will no doubt happen again. Venomous snakes (and other dangerous animals) are also a potential problem for first-responders if there's been a fire or other incident in the house. There's absolutely no reason for these creatures to be kept as pets, and no reason that keeping and selling them shouldn't be met by large fines or other deterrents.
Tigers in the bedroom
A recent article in Emerging Infectious Diseases discussed infectious disease risks associated with having pets in the bedroom. It raised awareness about pets and zoonotic diseases, although some of the coverage was a bit over the top. There are risks, but for most people and most pets, the risks are quite low. Some things do increase the risk quite substantially. One is sleeping with a large predatory carnivore.
Large exotic animals such as lions and tigers are surprisingly common in small zoos, animal parks, exhibitions and even private homes. Many people get away it, but all too often it's an accident waiting to happen, as for a 17-year-old Florida girl who sleeps with a tiger in her bed.
Felicia Frisco is part of a family of animal handlers. Her father runs an "institute" that provides animals for movies, TV shows, presentations and for the public to "cuddle." Felicia has been raising Will, a now six-month-old Bengal tiger. Part of Will's training involves sleeping in Felicia's bed every night.
Felicia said her friends "think it's really cool that I have a pet tiger because most of them only have a cat or dog." Other people (the one's with common sense) think it's an appalling example of poor animal handling and weak regulations (along with poor parenting).
Will may be very friendly now, but that doesn't mean he's safe. Many people have been killed by pet lions and tigers. Sometimes it's from attacks, but sometimes it's just the result of normal playful behaviour. A playful swat to the head or neck from a large cat can be fatal. Think how aggressively some cats play. Scale that up a few hundred pounds and you can see the potential for injury or death. As Will gets older, the risks will increase based on his increasing size and natural instincts. Also, there may be behavioural changes associated with sexual maturity that could increase the risks.
Felicia's father, the ringleader of the venture, seems to be in complete denial: "She may have that young cub in her room and be taking care of him and raising him, but her mother and father who are full time professional animal trainers also live there with her and have many other tigers right outside the door that are part of their living."
- Having someone in the next room doesn't prevent an attack. They just get to see the damage first.
- Having other tigers doesn't reduce the risk. It means there are more animals to cause problems and the potential for people to be injured getting into the middle of a cat-cat quarrel.
- Being a trainer doesn't make you invulnerable to teeth and claws (remember Siegfried and Roy?)
He further distances himself from parent-of-the-year honours by saying "That Felicia is risk-free is by no means true but neither are most 17-year-olds behind the wheel of a car... they die like flies across the country. It's like having an extreme sport in your life. The potential for accident and injury is certainly there."
Jack Hanna, a famous animal trainer, summed it up nicely: "Every cat has a different killing ability, the tiger it makes no difference, it's like they can go and it's a bomb going off wherever it hits."
'Dead' raccoon takes down wrestling team
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You're driving down the road. You see a dead raccoon. Obviously, the first thing that comes to mind is "Let's pick up the carcass and take it on a road trip."
- No? Maybe only if you're a high school wrestler from North Dakota.
On the way to the finals of a tournament, a busload of wrestlers came across a "dead" raccoon. For reasons that are unclear, they thought it would be a good idea to pick up the raccoon carcass and take it with them. They put it in the storage area of their bus and continued on their way.
Not only did that group of students display some questionable judgment by picking up the carcass, they also failed to notice that their "dead" raccoon was not actually dead. When they arrived at the tournament, the raccoon got up and ran away.
So, not particularly bright (or observant), but maybe not that big of a deal. Raccoons are important rabies vectors and a raccoon that allows itself to be loaded onto a bus by a bunch of high school students, and then later runs away, must be considered potentially rabid since you can't prove otherwise. However, you don't get exposed to rabies just by riding in the same bus as a napping raccoon. You have to have close contact with it (e.g. bite that breaks the skin, exposure of an open scratch/wound or mucous membrane (nose, mouth, eyes) to raccoon saliva).
In this case, however, the team was removed from the tournament when officials found out "they had been in contact with the wild animal and feared they may have contracted rabies." This makes no sense.
- If they were exposed, they'd pose no risk to anyone else at that point. You don't become immediately infectious after exposure. These students could not have transmitted the virus to other competitors.
- There was no evidence that they were actually exposed. No one was bitten or scratched.
Carrington school superintendent Brian Duchscherer said: "Once we found out, we didn't know if there was a potential of spreading anything or if the raccoon had rabies or not but we decided to bring our kids home." I would hope that a quick call to public health would have put those concerns to rest. Either they didn't bother to try to get good information or they got bad advice.
Salmonella in pig ear treats
An Irish study has reported a high rate of Salmonella contamination in pig ear treats. Various earlier studies have identified Salmonella in pig ear treats, and human infections have been associated with contact with such treats. Recommendations for processing and handling of pig ear treats have been made and have hopefully reduced the likelihood of contamination, but there's no information about adherence to these recommendations.
In the most recent study, published in Food Research International (Adley et al. 2011), researchers purchased 102 pig ears from 4 pet shops in Limerick City, Ireland. Salmonella was detected in 28% of samples. A variety of different Salmonella types were found, including antibiotic resistant strains and types that are common causes of disease in people.
Interestingly, all of the contaminated treats were from 2 of the 4 stores. The two negative stores only sold treats sourced from within the European Union, and one of them only sold pre-packaged treats. The other two stores sold treats sourced from the EU and Brazil, and sold some in bulk bins. All positive treats were from the same distributor, and all were from bulk bins.
The high prevalence of Salmonella in these treats is concerning, particularly in light of standard guidelines for processing such treats and and EU regulation that if treats are not Salmonella-free, they must have less than 1 Salmonella bacterium per 25 g of product.
Contamination of bulk bin treats isn't surprising, as I mentioned in a post just the other day. Bulk bins allow for cross contamination, and a single positive treat (or a single contaminated hand going into the bin) can result in contamination of many other treats. Also, picking treats out of a bulk bin can potentially contaminate consumers' hands, and there's an additional concern that bulk bins are often kept at a level where young children (a high risk group) can access them.
Contact with Salmonella in pig ear treats is a risk, and people should wash their hands after any contact with a pet treat. Avoiding bulk bin treats is a good idea. Purchasing irradiated and individually packaged treats should also help reduce the risk. Unfortunately, stores do a lousy job of notifying people about the risk. As the paper states "We recommend public awareness advertising in pet shops to alert pet owners of the risks associated with pig ear pet treats and hygiene practices that should be followed."
Tularemia alert in Texas
When it comes to handling microorganisms, there are 4 biosafety levels.
- Biosafety level 1 (BSL-1) organisms are harmless.
- BSL-2 organisms include most of the commonly encountered bugs, including things like E. coli, Salmonella and Staphylococcus aureus. They can cause serious disease but infections are often treatable and they can be handled safely with standard lab protocols.
- BSL-3 organisms are a relatively small group of bad guys that require more extensive facilities and protocols to handle them. These include Coxiella burnetii (the cause of Q-fever) and Francisella tularensis, the cause of tularemia.
- BSL-4 organisms are the really bad guys that require high level containment like you see in the movies. There are a limited number of BSL-4 facilities in the world and they deal with bugs like Ebola virus.
One of the BSL-3 pathogens I mentioned was a bug called Francisella tularensis, the bacterium that causes tularemia, which is also listed as a potential bioterrorism agent. Tularemia is a very nasty disease. It's uncommon but human infections occur sporadically in many regions, typically associated with wildlife exposure. It's often associated with contact with rabbits, but the bacterium can be found in a wide range of animals (including insects) and in the environment.
Recently, people in Bell and Coryell counties in Texas (between Dallas and San Antonio) were warned about the potential for tularemia exposure from wild hogs, since 15-50% of tested feral hogs in those areas had evidence of current of past infection. While evidence of past infection (the presence of antibodies against the bacterium in their blood) does not mean that they are actively infectious, it indicates that the bacterium is circulating in the area and that hogs are being exposed. If a hog was actively infected, it could be a source of human infection if there was direct contact (i.e. hunting and butchering).
Because of the potential risk of exposure, the following recommendations have been made:
- Always wear rubber gloves and eye protection when dressing (i.e. skinning & gutting) wild game.
- Ensure that game meats are handled carefully and thoroughly cooked.
- Use insect repellent to keep ticks, biting flies and other insects at bay.
- Look for rabbit nests in tall grasses before mowing. (As unusual as it sounds, running over rabbits with a lawnmower has been associated with development of tularemia).
The risk of tularemia is pretty low, but it's a very serious disease and you don't want it. Using these basic precautions should help reduce the risk.
