Cat tongue almost kills man

BMJ Case Reports has a recent paper entitled Cirrhosis, cellulitis and cats: a ‘purrfect’ combination for life-threatening spontaneous bacterial peritonitis from Pasteurella multocida” (Hey et al 2012). (I don’t think we'd be able to use a title like that in a veterinary journal, but they often get away with titles playing on the animal side in medical journals.)

The case report describes a man who had liver cirrhosis from hepatitis C infection and alcoholism. He went into hospital with a chronic infection of his leg. He’d been seen various times for this problem and various bacteria had been isolated (leading to treatment with various antibiotics). This time, he had severe swelling of his leg that went from his calf to his groin, along with significant accumulation of fluid in his abdomen. Shortly after admission, he deteriorated and became septic (he developed an overwhelming bloodstream infection) and went into liver failure. Blood samples and samples of fluid from his abdomen were tested and the bacterium Pasteurella multocida was isolated. Fortunately, he responded to aggressive treatment.

Upon subsequent investigation, they found out that the patient had a cat, and that cat "had a disturbing habit of regularly licking the serous exudate [leaking fluid] from the patient’s chronic left leg leg cellulitis." (This probably occurs much more commonly than most people think.)

Pasteurella multocida is a bacterium that’s commonly linked to cats, and it’s a frequent inhabitant of the mouth of healthy cats. The cat wasn’t tested but it’s a reasonable assumption that this infection came from the pet. The patient was given “the appropriate advice with regard to the safe cohabitation with domestic animals” but unfortunately they don’t say what that advice was.

This is just one more in a series of reports that show the importance of asking people about pet ownership and pet contact. Asking that question initially can potentially help identify zoonotic disease risks, as opposed to asking the question after the zoonotic pathogen is eventually found when they’re trying to round out the story.

The authors list some ‘learning points’. I’ve copied two important ones below.

  • Domestic animals can, under the appropriate clinical circumstances, pose a risk to an immunocompromised host, particularly if adequate hygienic practices are not adhered to.
  • Questioning regarding exposure to domestic animals should form part of the clinical history when assessing immunocompromised hosts, allowing early institution of empiric antimicrobial therapy in the appropriate clinical scenario.

They’re both good points, although I’d remove "immunocompromised." While the risk is lower in people with normal immune systems, some risk still remains and pet contact should be queried all the time.

 

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Lip Tet Ng, Hong Kong - December 6, 2012 9:31 PM

A recent outbreak of psittacosis in Hong Kong in workers exposed to infected parrots in an animal management center illustrated the importance of asking the patients if they had any animal contacts when they first consulted their physicians on their illness.

If the fact that there were contacts with parrots were known at the early stages, the disease could perhaps have been confirmed earlier. The patients would then had been put on the appropriate treatment in a timely manner thus minimizing the risk of developing into serious clinical situation that required lengthy and costly medical cares in the ICU for two of them.

It was possible that there was communication problem between physicians and patient in Australia as the patient who was holidaying in Australia when came down with the disease do not speak English.

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Hong Kong probes respiratory illness cluster at animal facility
CIDRAP
Nov 27, 2012
Authorities in Hong Kong are investigating a cluster of respiratory infections in five men who work at an animal management center in Sheung Shui, according to a statement yesterday from Hong Kong's Centre for Health Protection (CHP). The men, who range in age from 27 to 64, got sick from Nov 6 to Nov 24. All were hospitalized, some with pneumonia, and one—the 27-year-old—was discharged on Nov 22 in stable condition. So far diagnostic tests have not pinpointed the cause of the infection, and specimens from a 55-year-old man were negative for novel coronavirus. The CHP said monitoring of family contacts has turned up no other similar infections. It said that 16 seized parrots were being housed at the animal facility, and 10 of the birds were culled after 3 of them died. Animal health officials are monitoring the health of the other birds. The CHP said officials are exploring the possibility of psittacosis.

Nov 26 CHP statement http://www.info.gov.hk/gia/general/201211/26/P201211260682.htm

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Psittacosis confirmed in Hong Kong illness cluster
CIDRAP
Nov 28, 2012
Psittacosis, a bacterial infection typically acquired from birds such as parrots, has been confirmed as the cause of serious respiratory illnesses among three of five workers at an animal health center in Hong Kong, the territory's Centre for Health Protection (CHP) announced yesterday. The three patients, aged 55, 62, and 27, tested positive forChlamydophila psittaci by polymerase chain reaction, the CHP said. Two of the three remain hospitalized, but one, the 27-year-old, was released Nov 22. The three are among five men working at Hong Kong's New Territories North Animal Management Centre (NTNAMC) who were hospitalized with respiratory illnesses. They are all employees of Hong Kong's Agriculture, Fisheries and Conservation Department (AFCD). The CHP said another eight AFCD employees at the NTNAMC, among 59 who were contacted, have respiratory symptoms and will be tested for psittacosis. The cases had prompted testing for the novel coronavirus that recently infected six men from Saudi Arabia and Qatar. The CHP said earlier that 3 of 16 parrots at the animal facility had died, and another 10 were subsequently euthanized. Psittacosis disease can be treated with antibiotics.

Nov 27 CHP announcement http://www.info.gov.hk/gia/general/201211/27/P201211270488.htm

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