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

Veterinarians are reporting an apparent spike in cases of leptospirosis in dogs in southern Michigan. Leptospirosis is considered a re-emerging disease in many areas of North America. This disease, caused by various types of the Leptospira bacterium, can affect many different species, including dogs and people. A wide range of illnesses can result, including fatal infections. In dogs, kidney failure is a common problem. 

Classically, leptospirosis is diagnosed in dogs that spend time in the woods and similar areas, where they may be exposed to the bacterium from contact with the urine of infected wildlife. Different types of Leptospira have different animal hosts, and infected hosts can shed large numbers of bacteria in urine. These bacteria can survive in wet conditions for long periods of time, and other animals can be infected through ingestion of urine-contaminated water or contact of urine-contaminated water with broken skin (e.g. tiny cuts or open sores on their feet) or mucous membranes (eyes, mouth, nose).

Michigan vets have suggested that the recent spike in cases is the result of local highway construction, which may have driven rats out of their normal habitats and into areas that people and dogs frequent. That's possible, but it could also be increasing natural re-emergence of the disease, or increasing recognition of the disease, as more attention is being paid to it. Regardless, an understanding that this disease is a problem in the area is important to allow for prompt diagnosis (and proper treatment), as well as preventive measures.

A vaccine is available, but it is not 100% protective and only protects against certain strains of Leptospira. Nonetheless, it's still a good idea in areas where disease is caused by the strains present in the vaccine and when dogs have a reasonable chance of being exposed.

People can also get leptospirosis. Most often, they are exposed just like dogs: from the outdoor environment. However, pet-to-human transmission has been reported, mainly involving pet rats (since rats are an important reservoir host). People who have contact with an infected dog must take precautions to reduce the risk of transmission. This includes avoiding contact with urine, good attention to personal hygiene (especially hand washing), and proper cleaning and disinfection of any areas potentially contaminated with urine. Prompt diagnosis of canine lepto is very important because treatment rapidly stops the animal from shedding the bacterium. The earlier it's diagnosed, the quicker it can be treated, and the less contamination can occur.

More information about leptospirosis and Leptospira is available on the Worms & Germs Resources page, and in our archives.

(photo by costi)

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A field worker from Mexico died in Louisiana this weekend from rabies. This is the first case of human rabies in Louisiana in over 60 years, but based on the time the man had been in the country and the incubation period of rabies, it is believed that he was infected in Mexico. Human-to-human transmission of rabies is rare, but healthcare workers and other people he had recent contact with are being evaluated to determine if post-exposure treatment is required.  In the case of the man's co-workers, they could have also been exposed to the same source of rabies that infected him.

The original source of infection isn't known, or at least has not been reported. Wildlife are the main source of rabies exposure for people in the US, but dogs are the most common source of human infection internationally. Dog-associated rabies cases in people from Mexico have been previously reported in the US, and it's certainly possible here.

(click image for source)

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Yet again, a large number of people are undergoing rabies post-exposure treatment because they were exposed to a rabid raccoon that was "adopted" from the wild. In this case, a North Carolina family found a baby raccoon at the side of the road and decided to bring it home. Over the next couple of weeks, various family and friends handled the raccoon, and many were bitten or scratched in the process. The raccoon then died and was identified as being rabid. Forty-five people are now being assessed to determine whether they need to be treated for rabies exposure.

The family dog, which was unvaccinated, has been taken by Animal Control and now faces either a six-month strict quarantine or euthanasia. I suspect the dog will be euthanized.

So, this probably well-meaning but misguided action has resulted in:

• the need for costly post-exposure treatment of many people
• presumably a stressful period for many of those people
• probably the death of the pet dog (although not having the dog vaccinated played a big role here too, since if it was vaccinated, it would only face a 45 day observation period at home, not a strict six-month quarantine or euthanasia).

Fortunately, the raccoon was tested. Otherwise we might be talking about human deaths from rabies, instead of people needing post-exposure treatment. The people who took in the raccoon could also face charges since keeping wildlife without a permit is illegal, but it sounds like that's unlikely to occur.

A few take-home messages from a situation like this:

• Leave wildlife in the wild.
• Vaccinate your pets.
• If you are exposed to an animal that is acting strangely, make sure it's tested for rabies (they did this right, at least).

(click image for source)

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TheNorthwestern.com has an interesting article about "10 things not to do with pets in a vet's waiting room." They're all good points, and I've put an infectious disease/infection control spin on them below:

1. Don’t fail to contain your cats. Even if your cat is the sweetest thing on record, some other animals may not agree. The last thing we want is to see in our lobbies is an altercation in which one animal dies. Cat carriers are cheap and widely available. Use them.

2. Don’t give dogs free reign.  Don’t use retractable leashes!

• You wouldn't (hopefully) go into an emergency room and lick the face of the person puking in the corner or the kid hacking up a lung. Your pet's not as discriminating. Some pets are at the vet because they are sick. You don't want your pet to get what some other pet has. Also, not all dogs and cats are social, especially in a strange environment. You don't want to change your vaccination appointment to a "vaccinate and stitch up the big wound on my dog's face" appointment.

3. Don’t bring in animals you cannot personally control.

• As above. Lack of control equals increased risk to other animals, your animal, and potentially other people.

4. Don’t do the puppy park meet-and-greet thing. The vet’s is not the dog park. It’s a strange environment in which pets don’t always act the way you expect them to. Moreover, in a veterinary hospital the onus is on the doctor’s staff to keep your dogs safe. Please keep all pets apart. After all, no matter how well you know your pet, can you honestly say you know someone else’s?

• Same as above. More mixing and more contact equals a greater risk of disease transmission. That's acceptable in many situations where the risk of coming into contact with an infectious animal is low, but the odds are higher in a place where sick animals congregate.

6. Give the cell phone rest. In a place as potentially anxiety provoking as the vet hospital, cell phones can be a hazard. Even if you don’t feel the anxiety, your pet certainly does. She deserves the comfort of your undivided attention for her safety and her stress level.

• Not really an infectious disease issue but it's annoying.

7. Don’t walk a dog into a packed waiting room. If the lobby is crammed wall to wall with pets, don’t chance it. Ask someone to let the receptionist know you’re waiting outside. Or use your cell phone for something really useful for once.

• Good point. I'd take that a step further. Don't take a potentially infectious pet into a waiting room, packed or not. If you have an animal that might have an infectious disease (e.g. diarrhea, sudden onset of coughing and/or sneezing) it would be ideal to call when you arrive so they can take your pet right back to an exam room or isolation for examination. That way, if your pet is infectious, you won't expose other animals. We're trying to get more clinics to be proactive about doing this, and hopefully your clinic would mention it, but if they don't, feel free to bring it up yourself.

8. Don’t fail to tell the receptionist ahead of time if your pet is severely anxious or aggressive. All hospitals appreciate the warning when you make your appointment. It gives us a chance to offer you back-door alternatives or other concessions to your pet’s unique behavior issues.

• Good point. "If your pet is severely anxious, aggressive or might have an infectious disease" would be better.

9. Don’t bring small children unless you can’t help it. A busy animal hospital is tough on small kids. They’re not old enough to benefit enough from the educational experience relative to their risk of getting hurt.

• Sometimes you have to, but if you can avoid it, that's preferred. Vet clinics can be busy. There are a lot of animals around and it may be hard for a child to resist reaching out for another animal. I haven't seen any data on bites and scratches in waiting rooms, but they certainly occur. As well, if you are distracted by your child, you may not be able to tell your vet all the relevant information or ask all the questions you have.

10. Don’t be rude. Courtesy is king. Kill them with kindness. I shouldn’t have to offer so many versions of the same cliche, but the fact that they all exist is fine testament to their utility.

• Again, not necessarily an infectious disease concern, but really being polite and considerate to those around you applies to just about any situation, and generally makes everyone feel better and makes things go smoother.

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"NDM-1 superbugs" have received a lot of press the last day or two. That's lead to questions about whether there may be any risks for pets.

It's good to see that people are thinking about how this might affect other animal species. That's a thought process that would have been rare a few years ago, and which was probably fostered by the emergence of MRSA in animals.

What it NDM-1?

• NDM-1 stands for New Delhi metallo-beta-lactamase 1. It is a type of beta-lactamase, an enzyme that inactivates certain antibiotics (those of the beta-lactam class). The concern with NDM-1 is that it inactivates carbapenem antibiotics, an important class of drugs that is often used to treat serious and life-threatening infections.

Where is it a problem?

• It's currently mainly a problem in India and Pakistan.

Will is spread to other regions?

• Probably. It's easy for people to travel around the world quickly, and it's easy for new microorganisms to travel with them. A bug that originates in one region can very easily spread across the planet. NDM-1 has been found in a few other countries, including Australia, parts of Europe and Canada. There is concern that the increase in health tourism (traveling to countries like India for cheap and quick procedures like elective surgeries) will result in spread of NDM-1, since people could pick up the bug in hospitals and bring them home. Transmission of NDM-1 in hospitals from patients that had healthcare procedures abroad has been documented in the UK. People traveling to regions where the organism is present for other reasons are also possible sources.

Can it affect pets?

• Probably. Two important types of bacteria, E. coli and Klebsiella spp, can carry NDM-1 (and probably other related bacteria can as well). These can cause infections in many different species. As more people carry bacteria with NDM-1, there's a greater chance that pets will be exposed, as we've clearly seen with MRSA. Dogs that visit human hospitals and pets owned by people who visit India for healthcare are probably at greatest risk, with pets of people who have been hospitalized and pets of healthcare workers likely also at increased risk.

What can we do to reduce the risks?

• Nothing specific. The most important factor here is control of NDM-1 in human hospitals. At the animal level, there's nothing in particular we can do about NDM-1 at the moment. The keys are prudent use of antibiotics (to reduce the likelihood that resistant strains will get established in pets), good general infection control in households and veterinary hospitals (to reduce opportunistic infections by bacteria that can carry NDM-1), and making sure that cultures are taken when infections are present (to find out if/when this becomes a problem).

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A cat from Ennis, Montana, has been identified as the area's first case of plague in a pet cat this summer. Plague is a disease that conjures up images of medieval pandemics and calls of "bring out your dead" (along with calls of "I'm not dead yet" from Monty Python fans).This bacterial disease, caused by Yersinia pestis, is not just of historical interest, however. It is still an important disease in some regions. In the US, it is present in wildlife in parts of the southwestern US and circulates in wild rodents. Domestic pets mainly become infected through eating infected rodents, but the bacterium can also be spread by fleas.

Cats are quite susceptible to plague, and can develop classical bubonic plague, septicemic plague or pneumonic plague, and only about 33% of infected cats survive. Dogs are relatively resistant to the disease.

Transmission of plague from pets to people is uncommon but most often involves cats. Veterinary personnel and pet owners that care for sick cats are at highest risk. While transmission from cats to people is rare, about 20% of people infected from cats die, so it certainly warrants some precautions.

In areas where plague is present, cat owners should consider the following:

• Keep cats indoors to prevent them from hunting and eating rodents.
• Keep rodents and other wildlife out of the house.
• Have a flea control program in place to prevent or treat flea infestations in pets.
• Never catch and keep wildlife (e.g. prairie dogs) as pets.

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How likely is E. cuniculi to be trasmitted from an infected rabbit to a dog? My sister has a positive rabbit and my dog was just diagnosed with kidney insufficiency.  Now that the dog's kidneys are compromised, should we be concerned?

Encephalitozoon cuniculi is a strange little organism that is now classified as a fungus, but is also similar to some types of protozoal parasites. It is an important (and often overlooked but potentially treatable) cause of neurological disease in rabbits. It is quite common in healthy pet rabbits, and infected rabbits shed the organism mainly in urine.

Less is known about E. cuniculi in dogs. Neurological disease, stunted growth and renal failure are the most common problems that develop. Disease usually occurs in young dogs (less than 1 year of age, with most cases in dogs a couple of months old or younger). Some studies have reported antibodies against the organism in a large percentage of healthy dogs, indicating that they've been exposed at some point, but most studies have found antibodies in few or no dogs.

The risk of transmission from rabbits to dogs is not known. There are a few different types of E. cuniculi, including one type (type I) that is called the "rabbit strain" and another (type III) that is called the "dog strain." The ability of the rabbit strain to infect dogs, particularly dogs with normal immune function, is unclear. Considering the low incidence of infection in dogs (especially older dogs), the different types of E. cuniculi that predominate in dogs and rabbits, and the commonness of kidney disease in dogs, I doubt there's a link between the rabbit's infection and the dog's kidney disease in this case.

(click image for source)

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An Ocean City, Maryland man was told that he couldn't take his pet iguana on the Boardwalk because of a town ordinance banning "undomesticated" pets in public places. Instead of accepting the ruling, he "registered" his pet iguana as a "service animal". Protection of true service animals is critical but the very broad nature of the Americans with Disabilities Act (ADA) has let people get away with claiming that their pet is a service animal simply because they want to take their pet places where they are banned. The ADA just "celebrated" its 20th anniversary at the end of last month.

In this case, the owner will not disclose what his disability is or what the iguana does. That's his right according to the Act, and it lets people get away with anything they want. All he's saying is "You know it's like a cat. You put a cat on your lap and you pet it. It makes you feel good. There's a whole range of disabilities that allows you to do this." That's a pet, not a specially trained animal that is being used for a specific and necessary service activity, such as a guide dog.

The company that he's registered the iguana with is a bit of a joke. The first paragraph on their website states:

It's no secret that many businesses simply aren't pet-friendly, even though most of the population is. A large number of our clients register their dogs as Certified Service Animals or Emotional Support Animals (ESAs) not just to accompany them into stores, restaurants, motels, or on airline flights (for no extra cost), but to successfully qualify for housing where pets aren't allowed. Our Service Dog Certification documents formalize and simplify these processes and make qualifying for special housing hassle-free. If you and your service dog become certified with NSAR, both of you are immediately protected under federal law (ADA).

They're not separating service animals from pets. This is a very important distinction - service animals and pets need to be treated differently. Also, the implication that you have register to have a service animal protected is false advertising, presumably aimed at selling more registrations. You don't need to be registered by this group, or any other, to be a service animal.

To "register" your dog with this group, you have to

• Click a box saying you have a disability. (Their list of disabilities requiring service animals is vague and includes things like asthma and diabetes, to conditions for which I have seen no indication that service animals are useful).
• Click a box saying your dog can fulfill most of their required criteria (it actually says dog, not animal. Therefore, I guess this iguana is registered as a dog).
• Then - and this is the most important step - you send them money.

Fortunately, there's light on the horizon. The following clarification of the ADA has been released, and will take effect in early 2011.

Service animal means any dog that is individually trained to do work or perform tasks for the benefit of an individual with a disability, including a physical, sensory, psychiatric, intellectual, or other mental disability. Other species of animals, whether wild or domestic, trained or untrained, are not service animals for the purposes of this definition. The work or tasks performed by a service animal must be directly related to the handler´s disability. Examples of work or tasks include, but are not limited to, assisting individuals who are blind or have low vision with navigation and other tasks, alerting individuals who are deaf or hard of hearing to the presence of people or sounds, providing non-violent protection or rescue work, pulling a wheelchair, assisting an individual during a seizure, alerting individuals to the presence of allergens, retrieving items such as medicine or the telephone, providing physical support and assistance with balance and stability to individuals with mobility disabilities, and helping persons with psychiatric and neurological disabilities by preventing or interrupting impulsive or destructive behaviors. The crime deterrent effects of an animal´s presence and the provision of emotional support, well-being, comfort, or companionship do not constitute work or tasks for the purposes of this definition.

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Recent Salmonella recalls have led to some questions about the best way to diagnose salmonellosis in dogs and cats.

The first issue is when to test. In general, there is no indication to test healthy animals. Testing should be reserved for animals with diarrhea or other signs of salmonellosis (e.g. fever).

When testing is indicated, a few things should be considered:

The Sample

• A fresh sample is best. It should be submitted for testing as soon as possible, but it can be kept cool (i.e. refrigeration temperature) for a day or more if it can't be submitted right away.  (Do NOT keep a fecal sample in your fridge at home! Take it to your local vet clinic and they will keep it in a designated specimen fridge.)
• More is better. A reasonable volume of stool (e.g. a tablespoon or two) is preferred to something like a rectal swab. Testing can be performed on rectal swabs but they are lower yield because they contain a lot less stool.  See image right: standard-size 30 mL fecal sample containers (click for source).

The Test

There are two tests used to detect Salmonella in feces: culture and PCR.

Culture is used to grow and isolate the Salmonella bacterium. Usually, enrichment culture is used, whereby the sample is first cultured in a selective broth culture medium, then put on culture plates. This increases the recovery rate but takes more time.

Advantages of culture are:

• A positive is definitive - the bacterium is definitely there and alive.
• An isolate is available for subsequent testing such as determining the susceptibility to antibiotics and typing it to see what strain is involved.

Disadvantages of culture:

• Salmonella can be hard to grow for labs that don't have a lot of experience and good protocols.
• A few days are required to obtain results, particularly if proper enrichment methods are used.

PCR (polymerase chain reaction) is a molecular diagnostic test that looks for DNA from a particular organism (in this case, Salmonella).

Advantages of PCR:

• Speed. Results may be available within 24 hours.

Disadvantages of PCR:

• Tests validated for dogs and cats are not usually available.
• The test detects both live and dead bacteria, so a positive result could theoretically be from ingestion of dead (and therefore irrelevant) bacteria.
• False negative results can occur from low levels of Salmonella or substances in the stool sample that inhibit the test.
• Lab quality control is critical but not always good.

Current recommendations are to base diagnosis on culture. PCR can be used as a faster presumptive test, but culture should be performed to confirm the diagnosis and get a bacterial isolate that can be further tested for antibiotic sensitivity and typed to see what strain is involved.

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Peritoneal dialysis is used to treat some people with chronic kidney failure. Infection is a major concern, particularly peritonitis (infection of the lining of the abdomen) because peritoneal dialysis involves having an indwelling catheter that goes through the skin and body wall directly into the abdominal cavity.

Infections can occur from bacteria that inadvertently get flushed into the abdomen during dialysis treatment or potentially migrate along the side of the catheter. Accordingly, most infections associated with peritoneal dialysis are caused by bacteria that are found on peoples' skin, such as Staphylococcus aureus.

While the vast majority of peritoneal dialysis infections are human-associated, infections from pets have been reported. Multiple different pet species have been implicated, even hamsters - one case report described an infection in a child that was thought to be caused by a hamster that slept in the same bed as the child (Campos et al 2000).

A recent study in the journal Seminars in Dialysis (Broughton et al 2010) involved a review of the scientific literature for reports of pet-associated peritoneal dialysis infections, as well as a review of records from the authors' peritoneal dialysis unit.

In their review, they identified 124 reported infections caused by zoonotic microorganisms in the literature, involving 12 different microorganisms. The most common microorganisms were Campylobacter, Pasteurella, Zygomycetes, Neisseria, Rhodococcus, Listeria, Mycobacterium avium complex, Capnocytophaga spp, Salmonella, Brucella and Bordetella bronchiseptica. However, only a subset of these were probably associated with pet contact, and retrospectively determining the sources is quite difficult for some. For example, Campylobacter and Salmonella could as easily (or more easily) come from contact with raw meat as from pets. Infections were fatal in 13.5% of cases, demonstrating why this is an important issue.

The most common bacterium causing convincing pet-associated infections was Pasteurella, which can be found in the mouths (and other places) of healthy pets. It is a common cause of pet bite infections and it makes sense that Pasteurella could contaminate pet owners' hands or the dialysis catheter site. In the study of their own hospital's cases, the authors found similar findings, with a low rate of zoonotic infections and a predominance of Pasteurella among those.

Literature reviews aren't a great way of determining the true scope of a problem, because they require people to:

1. identify the infection
2. identify a pet as a possible source (often the weak link; furthermore, identifying an infection caused by a potentially zoonotic microorganism doesn't necessarily mean a pet was the source)
3. decide to write a case report
4. get that case report accepted by a journal

Studying medical records has limitations as well, since steps 1 and 2 still need to be performed (with the weak link again being thinking about a pet-association). So, care should be taken when interpreting the results of this study. However, while the results indicate that pet-associated peritoneal dialysis infections do occur, they are probably relatively uncommon.

While pet-associated infections are likely uncommon, any peritoneal infection can be a major problem, so common sense measures that would likely reduce the risk should be used:

• Avoid contact of pets with the dialysis catheter and catheter site
• Wash hands after having any contact with pets
• Don't let pets sleep in the bed
• Wash hands before touching the catheter

Additionally,

• Physicians should be aware of the potential for pet-associated infections, and pet contact by their patients
• If a pet (usually a cat) bites the tubing, this should be reported to a physician ASAP and preventative treatment for infection might be indicated
• Initial antibiotic therapy choices should cover common pet-associated pathogens if there is a history of contact of pets with the catheter or tubing.

People with peritoneal dialysis catheters shouldn't fear their pets, and there is no need for these people to get rid of pets (although they should avoid high-risk pets like reptiles). Pet owners are presumably at somewhat higher risk than non-pet-owners, but the risk appears to be fairly low. In most situations, the positive aspects of pet ownership probably outweigh the risks.

Image: Schematic diagram of peritoneal dialysis (click image for source)

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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.

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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.

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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)

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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.

(click image for source)

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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.

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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

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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.

(click image for source)

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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.

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A study we just published in the journal Veterinary Record (Floras et al 2010) described an MRSA outbreak in a dog breeding kennel. That's a little unusual in itself, but considering how MRSA is spreading amongst the dog population, it's not really astounding. What was unique about this outbreak was the strain of MRSA that was involved, sequence type 398 (ST398).

ST398 MRSA is commonly referred to as livestock-associated MRSA, since this strain seems to have originated in pigs, and is commonly found in pigs and calves in some regions of the world. It can also infect people, and high rates of carriage of this MRSA strain can be found in pig farmers, pig vets and other people with close contact with livestock. In some areas of Europe, this strain is a big problem, accounting for a large percentage of human MRSA infections. Interestingly, it seems to be a rare cause of illness in people in North America (at least at the moment).

Dogs seem to be innocent bystanders when it comes to MRSA. The vast majority of MRSA strains found in dogs are common human strains, indicating that, ultimately, MRSA in dogs originated in people. There are only two other reports of dogs with ST398, both from Europe. One was a dog with a skin infection. The other was a healthy dog (a carrier) who was owned by a pig vet. 

This kennel outbreak involved a larger number of dogs, including both healthy carriers and sick dogs. Overall, MRSA was isolated on at least one occasion from 23/42 (55%) dogs in the kennel. In a couple of litters, most of the puppies were identified as carriers, but fortunately most stayed healthy. MRSA caused skin infection in one puppy and mastitis in a mother dog, and was also found in the respiratory tract of a puppy that died (although it may or may not have been the cause of death).

The source of the ST398 was not identified. One of the owners worked on a pig farm, but MRSA was not isolated from either owner. It's most likely that the owner did bring MRSA home from the farm, either as a transient carrier (in their nose) or as a contaminant on their skin. Regardless, once it got into the kennel, it was able to move between dogs, either from dog-dog contact or with the help of human hands. Fortunately, ST398 MRSA carriage by dogs seemed to be transient in this situation, which is consistent with what we know about carriage of other strains. MRSA is not really adapted for long-term survival in dogs, so they only carry it for short periods of time. That's a big advantage when it comes to trying to control this pathogen.

While we have to be careful to not over-interpret data from only a few studies, this report indicates that ST398 can cause disease in dogs and it can be present in apparently healthy dogs. It can also be spread relatively easily amongst dogs in a breeding kennel situation. While a pig-link was not confirmed, it's reasonable to suspect that dogs with contact with pigs (and perhaps other livestock) might be at higher risk of developing ST398 infections, as is the case with people.

This is a perfect example of the one medicine concept, and why we need to think about infectious diseases in broad terms, not just focusing on specific populations or species. This situation involved a pig Staphylococcus aureus that somehow acquired methicillin-resistance, spread widely around the world (most likely in pigs, initially), spread to people, and then likely spread to another species, in this case dogs.

(click image for source)

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All lots of "Pro-Pet Adult Daily Vitamins" have been recalled by United Pet Group, Inc. because of Salmonella contamination. At least one lot has tested positive for Salmonella, although there is no mention about whether the bacterium was detected during routine testing or in response to a problem. Regardless, Salmonella contamination of these products is a concern because of the potential for disease in dogs fed the vitamins. Further, people could become infected from contact with dogs that become infected from the vitamins, or from handling the vitamins directly. If you have these vitamins, stop using them immediately. If your pet has been receiving these vitamins and develops fever, diarrhea, anorexia or any other signs of illness, take your pet to your veterinarian and make sure he/she knows there has been a chance of Salmonella exposure.

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Apparently, Moscow parks are somewhat hazardous, at last in terms of where you step. Moscow dog owners have historically done a poor job of picking up after their dogs, and local officials are trying to intervene. Soon, all Moscow parks will have paper bags and plastic scoops for people to use to pick up after their dogs.

One dog owner, supportive of the plan, stated “It's absolutely essential – we really needed these bags. First of all, it's very convenient. But also, now I’m not worried anymore about leaving the poo just lying around. The park is so beautiful.” [I would have thought that if you were worried about leaving poo lying around, you'd just take the initiative to pick it up, but I guess a little boost is needed to get some people started.]

This initiative in being undertaken for two main reasons. One is the obvious unsightly nature of poop piles in parks. The other is concern about infectious diseases. Prime Time Russia states that bacteria in dog feces can cause "allergies and an infection that leads to blindness. When dog feces dries and turns to dust, these bacteria are spread. Last year, 400 people in Moscow were diagnosed with the infection. The worst is the fact that since the dust is lying on the ground, children are particularly exposed to the danger."

This is a bit confusing. Feces isn't much of a concern in terms of allergies. Further, I'm not aware of common bacterial infections from dogs that can cause blindness in people. I suspect they actually mean ocular larva migrans, a parasitic disease that can occur when a person inadvertently ingests eggs of the canine roundworm (Toxocara canis) that have been passed in feces of a dog, and that have lived in the environment for a long enough time to mature to their infective state. Regardless, there are clearly infectious disease concerns from exposure to dog feces in parks, particularly to children.

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A UK man is recovering from a tarantula bite that occurred when he, apparently in a drunken stupor, encouraged the venomous critter to bite him. (I suspect the "victim" has a pretty high endogenous level of stupidity, because I don't think you could get me drunk enough to say "Hey, maybe I should let an enormous venomous spider bite me!")

The character in question, Peter Saunders, stated "It was completely my own fault. I provoked the spider into biting me on my index finger so I can't complain about the consequences at all." At least the statement demonstrates some degree of logical thought. He ended up getting more than he bargained for, since the bite was a lot more painful than he anticipated. The day after the bite (presumably along with a massive hangover), Mr. Saunders' arm went numb and he was given various antibiotics to help treat a suspected secondary infection.

Unfortunately, the moment of clarity represented by his understanding that it was all his fault passed quickly since "... this incident has not put him off keeping these pets and he is considering buying more exotic creatures in the future." Let's hope he doesn't decide to see what it feels like when an African lion chews on his throat.

Photo: Fort Hall Baboon Tarantula (source: www.lotsalegs.tenczar.net)

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People like to talk about the "one medicine" concept. It's a great concept, but my big issue with it is there's a lot of talk but not a lot of action.

One way of thinking about "one medicine" in terms of people and pets is to focus on the health of the entire household as a whole, because:

• People can transmit infections to pets.
• Pets can transmit infections to people.
• People and pets can be infected from the same source.
• Infection in a pet or person may indicate that others in the household are also at risk.

It's a complex dynamic. When I speak about this topic, I use a couple of different ways to make the point. One is the concept that we are not a population of people living with dogs, cats, horses etc. - we are a population of animals. Similarly, I sometimes say "pets are people too, at least microbiologically." What I'm saying is that we can't focus just on humans or just on pets. The household as a whole needs to be considered, and care of the health of the all of its members - human and animal - needs to considered together.

What does that really mean?

Physicians need to be aware of the presence of pets in the household and other animal contacts. This information might be important when considering certain diseases. For example, if someone comes to their physician with flu-like symptoms and their physician knows they have pet birds (especially psittacines), then the physician would hopefully consider psittacosis. This disease is caused by Chlamydophila psittaci, a bacterium that can be carried by healthy birds. Not realizing there is a bird in the household can lead to a missed diagnosis.

Veterinarians need to be aware of the health status of people in the household. People with close contact with the human healthcare system and people with compromised immune systems are more likely to be carrying certain infectious agents. They are also more likely to pass these pathogens on to their pets. Therefore, knowing the health status of the owner might lead the veterinarian to consider different diseases in the pet, thereby improving diagnosis. Conversely, people with compromised immune systems are at increased risk for various infectious diseases from pets. If the veterinarian knows a pet owner is at increased risk, they can provide better advice about disease prevention measures to protect the owner. Veterinarians rarely ask owners about their immune status, including pregnancy (even the "how far along are you?" question is dangerous, because eventually you're going to get the "I'm not pregnant!" response.) Ideally, people should have a positive, comfortable relationship with their veterinarian, realize that their veterinarian is a member of their (and their family's) overall healthcare team, and therefore tell their veterinarian about any relevant health issues. For this to work, they need to understand the value of this communication, trust their veterinarian and know that their personal details will be kept confidential. At the same time, the veterinarian needs to understand the issues and need for such information, and have a plan on how to use it.

Veterinarians and physicians need to communicate better. They need to know who to contact when necessary and be able to do it efficiently. This is also relevant for non-infectious disease issues. For example, there could be a situation where a veterinarian has had to euthanize a pet: the veterinarian may realize that the owner is quite distraught, but can't do much beyond offering condolences and providing contact information for resources to help them out. The physician may not know anything about the situation, but it could be of significant relevance to the person's health. If nothing else, the physician could be notified that there's a potential concern. There are privacy issues that need to be considered and sorted out, but a little conversation can go a long way. The ability of veterinarians and physicians to contact each other about relevant issues can help prevent problems with miscommunication, provide general information about certain topics and help provide optimal patient care.

One medicine needs to be one medicine in action, not just in theory.

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Another tragic dog bite incident has resulted in the death of a three-week-old baby in Quebec.  The baby's mother (17) and grandmother (37) left the child alone in the house, strapped to her car seat on a chair, while they went outside for a smoke.  There were also two Huskies loose in the house at the time.  Although the women were only a few meters from the open door, and came back inside when they heard noise, by the time they reached the baby it was already too late.  The paramedics found the baby "covered in deep bite marks and scratched.

It is unclear to whom the dogs belonged, as the mother and father of the baby were sharing the house with two other people.  The baby's father (who was not home at the time of the attack) said that the dogs had been around ever since the baby was born and had never posed a problem.  The dogs were not normally aggressive and "when strangers came to the door, they didn't even bark."  He said "there was no sign that this could happen."

Dog bites are always bad, but in the case of small children in particular they can even be fatal.  According to Statistics Canada, since 1990 there have been 28 fatal dog attacks in Canada, and 85% of those killed were children under the age of 12.

Dog bites often occur when people don't know how to behave around a dog, and dogs may bite out of aggression, fear, or rough play.  A three-week-old baby strapped to a car seat would pose little threat to a Husky, and unfortunately we will likely never know what brought on the attack.  Parents and family members need to realize that a new baby is a big adjustment for everyone in the household - and that includes pets.  A dog that is normally "as good as gold" may react very differently to a small, wriggling, strange-smelling, crying baby that suddenly takes over part of the animal's home "territory."  It is very important that pets and babies be introduced very carefully and slowly, and they should always be supervised.  Dr. Enid Styles, a veterinarian and behaviourist, makes some very important points:

...Styles said it is possible the animal might have been startled by the child's crying or the baby might have been caught in the middle of a fight between the dogs.

In any case, a child should never be left unattended around dogs...

"Supervision needs to mean, really, that you are between your dog and your child," she said. "You can't be just on the other side of the room."

Both Huskies have been seized by the Humane Society, and tests will be done to to confirm which of the animals was responsible for the attack and whether it was suffering from any problems, such as rabies (which presumably means the dog will be quarantined for 10 days).  It is likely that the dog responsible will be euthanized.

Photo source: www.cbc.ca

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Two recent news reports highlight some challenges that people with service dogs face, and some of the controversies that exist.

In one report, a Winnipeg woman was kicked out of a McDonald's restaurant because staff did not want her seeing-eye dog in the restaurant. McDonald's head office has apologized profusely, probably an indication both of damage control and a disconnect between the awareness of service animals among corporate personnel and front-line employees.

The woman involved isn't looking for apologies or a lawsuit, just increased awareness and fewer hassles for her and others that depend on service animals.  This situation is therefore being handled from a standpoint of "let's try to improve the situation." The Manitoba Restaurant and Food Services Association has contacted the CNIB for help raising awareness among restaurant staff of the rights of people with disabilities and their service animals.

A different situation has occurred in Wisconsin, where a man is threatening to sue the Oshkosh Area School District unless it fires a teacher. The man got into an encounter with the teacher while picking up his girlfriend's daughter from school. He has a dog that he takes everywhere because he's at risk of seizures (although it's not clear whether this is truly a service dog, i.e. specially trained for such situations). Anyway, as the man was approaching the school on the sidewalk, he was confronted by the teacher.  The teacher eventually called the police, claiming she was threatened by the man after telling him to stay away with the dog. There's reportedly a history of conflicts between the man and the school staff, which has evidently spiraled into this confrontational situation.  In addition to wanting the teacher fired, he intends to file a lawsuit seeking compensation for "damages," although he claims he's not interested in receiving money.

This is a very different case from the woman in Winnipeg, and there may be many underlying factors that are not being reported. It seems like a combination of a lack of understanding of where service animals can go and some major personality conflicts.

People with service animals not uncommonly (although inappropriately) get asked about their animals, particularly why they have them. They may also be (inappropriately) asked to take them away. There are also situations where people have questionable (or basically fake) service animals, something that creates problems for people with real service animals (see some examples in our "service animal" archives). A little patience, tact and education can go a long way, with education being the key component. Ignorance shouldn't be an excuse, but it's not realistic for everyone on the planet to be fully aware of service animal issues and regulations.

People in service industries (e.g. restaurants, retail) need to have better knowledge about service animals than average, and there needs to be a clear understanding that these animals should be allowed to go wherever customers go. At the same time, there needs to be scrutiny of existing service animal regulations (such as the Americans with Disabilities Act) because the vague nature of many of these regulations lead to abuses that ultimately hurt the people who truly need these animals.

Image source: www.funnydog.net

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While I hate to initiate another round of emails from raw diet supporters, here are a few of the more common questions that I get about these diets and some answers:

I use frozen raw food. Doesn't freezing kill harmful microorganisms?

• No. Freezing is an effective way to eliminate most parasites (with an adequately low temperature and adequate time, which varies between parasites). Campylobacter also does not survive freezing well. However, other bacteria, including Salmonella, tolerate freezing quite well. Studies of previously frozen raw diets have found high rates of bacteria like Salmonella.

My dog doesn't defecate in the hospital, so why are we paying attention to intestinal bacteria?

• Inadvertent exposure to fecal bacteria is common. Most gastrointestinal infections in people are from ingestion of bacteria and viruses from feces (e.g. Salmonella, Clostridium difficile, norovirus). We don't knowingly ingest feces, but we get exposed to these organisms nonetheless. Fecal bacteria can end up on pets' haircoats, people's hands and many surfaces in the general environment, and then wind up in the intestinal tract of a susceptible person.

Is there any way to eliminate Salmonella and other harmful bugs from raw meat?

• Yes. Besides the obvious (cooking), there are a couple options. One is irradition, which is a safe and highly effective way to eliminate bacteria. The main problems are cost and consumer fears of irradiation (which is actually harmless). Another approach is high pressure pasteurization. This process uses high pressure (with a slight increase in temperature) to kill harmful organisms. The effectiveness of this for raw meat hasn't been clearly determined, but it's an option, and one company is now doing this for all of their diets.

Why don't you just go into hospitals, ask nurses whether animals visit and compare infection rates, so you can see if there is a true health risk?

• It would be nice if it was that easy. Firstly, asking nursing staff doesn't give enough information. You need to know if animals visit, but also if they visited particular patients, and whether they visited before those patients developed infection. Just comparing infection rates between hospitals or wards that allow dogs to visit, and knowing the dietary status of the dogs, is useless. A proper study would require clear documentation of which animals visited which patients (something that is rarely recorded) and whether patients subsequently developed any infections that were not present before visitation (which is not easy to document), while concurrently investigating other possible sources of infection (similarly challenging). Ideally, bacteria causing human infections would be compared to those found in animals to provide stronger evidence of a link. Because the incidence of infections is relatively low, a large number of people would need to be enrolled. There are significant logistical issues, research ethics board issues, problems with the quality and availability of medical records and other things that make this very, very difficult. It needs to be done but it's not as simple as many people think. If it was easy, it would have been done by now.
  

Dogs have a short and acidic intestinal tract and are not susceptible to Salmonella.

• This statement appears thousands of times on the internet and there's absolutely no evidence supporting it. Dogs can and do get salmonellosis. For every email I've had talking about how a raw diet has made a big difference in someone's dog's health, I get at least one email from an owner or vet whose dog got salmonellosis while eating raw meat (and sometimes people in the house also got sick). A dog that eats Salmonella can shed it in its feces. The bacterium can clearly survive passage through the intestinal tract. Most dogs that ingest Salmonella do not get sick. Some do. Sometimes their owners do as well.

Wild dogs eat raw meat. That's what they've evolved to do.

• Wild dogs also have a much, much shorter lifespan than domestic dogs. It's obviously not all related to diet, but I don't want my dog to have the lifespan of a "natural" dog, I want her to have the longer and healthier lifespan of a modern pet dog. Take a look at older cemeteries and see the number of headstones of very young children. Raw milk played a big role in many of those.
• Regardless, the question isn't about the health of dogs fed raw meat. That's a completely separate issue. The issue is the risk that raw-fed dogs might pose to the highly compromised people that are found in healthcare facilities. People need to think about the health of those susceptible individuals when they get involved in this debate.

(click image for source)

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When multiple studies report the same results, it gets more and more convincing that the findings are true. This is becoming the case with antibiotic use as a risk factor for methicillin-resistant Staphylococcus aureus (MRSA) infections in dogs. Late last year, I wrote about a study of ours that identified prior antibiotic use as a risk factor in dogs for infections caused by MRSA versus those caused by methicillin-susceptible S. aureus. Recently, a similar study was published, with some similar results. This study (Magalhaes et al, Vet Res, 2010) compared dogs and cats and with MRSA infections to a group of dogs and cats with susceptible infections. They found that MRSA infections were associated with:

• the number of antimicrobial courses
• the number of days admitted to veterinary clinics
• having had surgical implants

Additionally, animals with MRSA infections more often had had contact with people that had been in hospital, but the difference was not statistically significant.

That's two studies that identified antibiotic use as a risk factor for MRSA infection. It makes sense biologically, and it's likely that antibiotic use is an important driving force for MRSA infection in pets (like it is in people).

How do we reduce the likelihood of MRSA infections? It's pretty clear that reducing antibiotic use is a key factor. Antibiotics are important drugs and are certainly needed in many situations, but they're also prone to overuse and misuse. Here are some things that can (and need to) be done:

• Only use antibiotics when necessary. Antibiotics are often used without evidence of a bacterial infection and in situations where bacterial infections are uncommon (e.g. urinary tract disease in cats, viral upper respiratory tract infections).
• Use logical and prudent peri-operative antibiotic regimens. Only use antibiotics for surgeries when there are actually needed, and only for as short a period of time as possible.
• Ensure that proper doses are given (and actually get into the animal). Unfortunately, underdosing (and overdosing) of antibiotics are not uncommon.
• Promote more research regarding effective antibiotic treatment regimens. We often use much longer courses of antibiotics in pets compared to people, in part because we have no research data telliing us whether we can use shorter treatment courses.

Another thing to consider is the fact that these studies looked at factors for methicillin-resistant versus methicillin-susceptible infections. Therefore, a dog had to have an infection to be included. While certain things are risk factors for MRSA versus susceptible infections, there are other factors that increase the chance of any infection, and reducing these will also help reduce the risk of MRSA (and other) infections (i.e. if your dog doesn't get an infection in the first place, it won't have an MRSA infection).  One very important factor is proper management of underlying skin diseases, such as controlling atopy, flea allergy dermatitis and food allergy. Proper wound care, good veterinary clinic infection control practices and myriad other factors probably also affect the risk of infection in general. Further, good general preventive medicine practices, including overall healthcare and proper nutrition, play a role by decreasing the pet's susceptibility to infections.

Fighting antimicrobial resistance isn't easy or clear cut. There is unlikely a single measures that will turn out to be the "magic bullet." To limit the impact of resistant bacteria, we need to take a multifaceted approach, and we need a lot more information to figure out what specific measures should be emphasized.

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Delta Society has recently announced a policy prohibiting animals fed raw meat or raw animal products from participating in their Pet Partners program. This policy was established because of research indicating dogs fed raw meat are much more likely to be shedding harmful bacteria like Salmonella and drug resistant E. coli in their feces compared to dogs fed commercial or home cooked diets, and the fact that these dogs come into close and frequent contact with people that are more susceptible to infections and at increased risk having severe infections.

Not surprisingly, internet chat sites are abuzz, and there's much condemnation and consternation from some. Some of the more vocal minority are stating that they'll just lie and say that they're not feeding raw.  I guess such dishonest actions would be based on a combination of ignorance and arrogance - feeding raw is your own decision, but blatantly flouting a policy that was put in place to reduce risks to those most susceptible is stupid and irresponsible.

One of the problems with peoples' reactions is the fact that they are confusing two separate issues. One debate is whether raw feeding is more healthy or more harmful to the pet. That's a controversial area, but this policy has nothing to do with that. This policy deals with the increased likelihood that raw-fed pets are shedding harmful bacteria. That's been very well proven in scientific studies. Do raw-fed pets cause disease in people in hospitals? We don't know. However, we have enough evidence to indicate there is the potential for increased risk to patients, and that added risk can be eliminated by not feeding raw meat products.

Hopefully, people will realize that this policy has been put in place for a good reason, and that it's focused on protection of people at high risk of serious illness. It's not a broad condemnation of raw diets, it's just a statement that it is not considered appropriate for dogs that will have contact with high risk populations - a recommendation that's far from new.

Details about this policy can be found here.

Disclosure: I'm a member of Delta Society's Medical Advisory Board. However, the opinions expressed here are mine and do not necessarily reflect the views of Delta Society.

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The OSPCA has changed their plans for management of the ringworm outbreak that is ongoing in a Newmarket, Ontario shelter. Now, some (hopefully all) remaining animals will be fostered out to local veterinarians while the situation is being brought under control.

One question that has been asked widely in the press and by the public is why these animals haven't simply been sent to foster homes. Particularly now, with all the attention, there would presumably be many people willing to take in these pets. However, putting animals infected or potentially infected with ringworm into foster homes is a controversial and potentially problematic situation, because ringworm can be spread easily to people and other animals in the household. Sending out an animal that is or may be shedding a zoonotic disease is a tricky situation, and one that can't be taken lightly. Additionally, proper management of these animals can take significant time and effort.

A better approach is to send the animals to places where they can be properly, safely and humanely isolated and treated. Veterinary clinics are a logical option, and a request has been sent to clinics in the area to take animals for quarantine and treatment. The reason veterinary clinics are being solicited is that many clinics have the ability to properly house these animals in isolation units and have the expertise and commitment to properly treat them.

Nonetheless, this is no small favour to ask of these veterinary clinics.  Just as taking an infected pet into a household carries some risk, taking these animals into a clinic is also associated with some risk of transmission to people and other animals. However, with proper facilities and protocols, and the donation of sufficient personnel hours to implement those protocols, the risks should be minimal. To facilitate this, we have developed an information sheet with infection control and treatment recommendations for veterinary clinics. For anyone else who is interested, the document can be found here and on the Worms & Germs Resources page under Information Sheets For Veterinarians.

Image: Ringworm lesions on the paws of a dog. Although this is how "classic" lesions tend to appear, clinical signs of ringworm in pets can be highly variable.  (click image for source)

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Never a dull moment...

This morning the Toronto Star published an article about the intended euthanasia of 350 animals at a humane society in Newmarket due to an ongoing ringworm outbreak.  This was quickly followed by another article about the same event that gave a few more details, including some comments from the OSPCA chief executive officer Kate MacDonald, who confirmed that the euthanasias had begun.  A "very aggressive strain" of ringworm and "human error" (related to a breakdown in protocols) are currently being blamed for this morning's actions.  A lot of people are (understandably) very upset.  No one ever wants to see an infectious disease outbreak come to something like this.

I’m hesitant to comment too much at this stage, because we still don’t have all the facts - apparently even the duration of the outbreak is unknown.  No one has said if all 350 animals are infected (or what percentage of them are), nor how many other animals are present at the shelter. We also don’t know what’s already been tried in terms of controlling the outbreak.

A few facts about ringworm (dermatophytosis) that people need to remember:

• Ringworm is a skin infection that can be caused by several species of fungi.  It is not a "worm" at all.  It is also very easily transmitted by direct or indirect contact with infected animals - their fur, their cages, their blankets, or anything else that may be contaminated with infected skin cells or hair.  Such infectious material can even be spread over short distances (e.g. room to room) in dust that is stirred up into the air.
• Ringworm is transmissible to people, so with a large outbreak there are also issues with staff safety, and concerns with adopting out infected animals.  For most people ringworm infection may cause itchy, uncomfortable skin lesions, but for higher-risk people (e.g. very young children, the elderly or immunosuppressed individuals) the infection can be much more serious.
• There are also a lot of animals (particularly cats) that carry ringworm without showing any signs of infection. If the Newmarket shelter has 350 animals with clinical signs of ringworm (a detail about which we have no information right now), that’s pretty bad, but even the animals who don't appear to be infected may be carrying the fungus and could spread it to others.
• Crowding, close contact and warm, humid environments are all factors that increase the risk of ringworm transmission. These are also all factors that are very hard to control in a crowded animal shelter.
• Ringworm is treatable, but it is not cheap or easy. Animals typically require systemic therapy (usually oral medication, which can be very expensive particularly in large dogs) as well as whole-body topical therapy (e.g. dips, shampoos, sprays), and they need to be treated for several weeks. Decontamination of the environment at the same time is critical to prevent reinfection.

Cleaning up a ringworm outbreak at a shelter with at least 350 animals is no small undertaking.  The second article in the Star also describes personnel at the shelter this morning wearing "white hazardous material suits, latex gloves and plastic covers over their shoes", which would be considered reasonable precautions for entering a highly contaminated environment.

I'm sure we'll hear more about this in the days to come, and hopefully that will include more details about why the mass euthanasia was deemed necessary by the OSPCA.

For more more information about ringworm, download the information sheet from the Worms & Germs Resources page, or check out our archives.

Photo source: yorkregion.ontariospca.ca via www.thestar.com

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The Galesburg Register Mail headline says "Dogs killed for eating rabid bat." It's true, but the more accurate description would be "dogs euthanized because owners failed to vaccinate them." In yet another unfortunate outcome of failure to properly vaccinate pets, two dogs from Galesburg, Illinois were euthanized after being exposed to a rabid bat. They were found chewing on the dead bat, which was subsequently diagnosed with rabies.

When an unvaccinated animal has been exposed to rabies, there are typically 2 choices:

• Euthanasia
• 6 months strict quarantine

The owners couldn't afford the cost of quarantine and decided to euthanize the two dogs.

The sad part is that this was a completely preventable problem. If the dogs were vaccinated, they would have only had to undergo a short period of owner observation, not a long and strict quarantine. Rabies vaccination is cheap insurance for your pets' (and potentially your) health.

(click image for source)

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Recent reports of a woman in Texas that "contracted rabies" are great examples of less-than-careful reporting. The headlines look dramatic, and a couple of articles state that a woman bitten by a puppy "contracted rabies", but it's far from the truth.

Here's the real story, as far as I can tell:

• A litter of stray puppies was taken to a shelter and then sent to a foster home.
• The woman who took them in was bitten in the leg.
• She received medical care and took the puppy to a vet. The vet euthanized the animal because of the aggression it was displaying and had it tested for rabies.
• The puppy was positive for rabies and the woman is undergoing post-exposure treatment.

It's not a nice situation for the person that was bitten, but it's not exactly a rare event and post-exposure treatment for rabies, when given properly, pretty much has a 100% prevention rate.

Authorities are also trying to track down any people that may have had contact with the puppies before they were taken to the shelter, to determine if more people need post-exposure treatment.

Strangely, the other puppies are being isolated for 45 days, after which time they will be put up for adoption (assuming they don't develop signs of rabies). This doesn't make a lot of sense. Standard recommendations are that unvaccinated animals exposed to a rabid animal should be euthanized or quarantined for 6 months. The 6 month quarantine is in place because rabies can take a long time to develop after exposure. Since these puppies came in with the sick one, and it's almost certain there was no information about their vaccination history, they have to be considered exposed and unvaccinated. This is true even if they were vaccinated at the time of arrival because they could have been exposed before vaccination. Further, animals are not considered protected until 28 days after vaccination, and exposure within 28 days of the first shot is the same as exposure of an unvaccinated animal.

In this case, it was pretty easy to determine that the woman didn't have rabies in some, but not all of the articles. I particularly liked how one of the stories described how rabies "eats away at the brain," a description you wouldn't expect to see from a more mainstream source.

Presumably, the woman who was bitten will be left with nothing more than some bad memories and an increased awareness of rabies. Hopefully the shelter reviews its policies to determine whether this could have been prevented and whether other measures should be in place to reduce the risk to people who foster animals. At a minimum, this would include ensuring foster homes know about the risks, know to get the animal to a veterinarian if it begins to act strangely (as this woman did) and ensure that other pets in the household are properly vaccinated.

(click image for source)

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Among the various things I've been called in response to blog posts is "anti-reptile." Actually, I like reptiles. I've owned and treated them, and think many of them are quite fascinating species. They can be reasonable pets in certain situations. The main problem is that they have high rates of Salmonella carriage and are the cause of a large number of infections in people. That's why the CDC, among other groups, recommends that people under the age of 5, the elderly, pregnant women and people with compromised immune systems avoid them.

Why do I bring this up (again)? I read an article today about the Fall River, Massachusetts, library and their resident tortoise, Franklin. Why am I concerned?

• Who goes to a library? Lots of people. Kids and elderly individuals probably go more than average. Those are the high risk groups.
• You could try to make the argument that having a tortoise in a library wouldn't necessarily pose much of a risk if it was kept in a cage or terrarium. That's probably reasonable, as long as good management and hygiene practices were used, but it's not a guarantee.  Infections have been reported in households where the reptile never leaves its enclosure and in people who never have direct contact with it.
• Regardless, Franklin doesn't spend his days in a cage of any kind. He gets out and cruises around the library, especially in the carpeted Children's Room. That's a bigger problem. This tortoise is certainly not house trained (my tortoises' repertoire was pretty much limited to eat, poop, wander around, repeat... I don't think there was an extra neuron for something like litterbox training). Tortoises can also easily contaminate their feet and shell with feces. So, we have a potentially poop-contaminated tortoise who may also leave a fecal present at any time wandering around a carpeted (almost impossible to disinfect) surface on which young kids play. Not a good combination.
• See the picture above. The person is described as a "library senior aide" and is presumably in the high-risk group based on age. The tortoise has its leg (which presumably walked over some tortoise poop sometime in the recent past) practically in her mouth. That's not good either.

What should the library do?

1) Ideally find a good home for Franklin. One with no high-risk people.

2) If that's not an option, a protocol should be in place for how to manage Franklin and reduce the risk of Salmonella transmission. This would involve:

• Keeping him in a proper enclosure. Not letting him roam around public areas. Visits outside to walk around on the grass (during the appropriate seasons) are fine, but there should be no walking around general library areas (especially not the Children's Room).
• Not letting the general public handle him. Reptiles are "look but don't touch" pets.
• Emphasizing hand hygiene for anyone that has contact with Franklin or his environment, and facilitating hand hygiene by having convenient access to a properly equipped sink or alcohol-based hand sanitizers.
• Excluding high-risk groups from contact, if people are allowed to have direct contact with Franklin at all. Any public contact should be supervised and there must be immediate washing of hands or use of a hand sanitizer afterwards. Since this is unlikely to be done properly, avoiding all public contact makes the most sense.
• Using Franklin to help teach. Perhaps he could be brought out in a small glass terrarium and people could watch him as part of stories or other events. He (and the way he's handled) could also be used to explain things about infectious diseases and infection control.

Image source: www.wickedlocal.com

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A large percentage of advice calls that I get about methicillin-resistant staph infections in dogs are regarding skin infections. Skin infections (pyoderma) are a common problem, a leading cause of antibiotic use in dogs, and an often frustrating problem for vets and pet owners alike. One problem is that, unlike many other types of infections, skin infections are often recurrent. This frequently leads to an ongoing cycle of infection-treatment-resolution-infection-treatment-resolution... The net result is some dogs get treated very regularly and for long periods of time with antibiotics, and it's not particularly surprising that highly drug-resistant bacteria like MRSA or MRSP eventually become involved.

Normal, healthy, intact skin is an excellent barrier to bacterial infection. Various bacteria normally live on the skin but do not usually cause infection. Skin infections typically (if not always) develop in response to some underlying skin disease, such as flea allergy dermatitis, food allergy, atopy, Cushing's disease or hypothyroidism. Identifying and treating a skin infection is one thing. Identifying and treating the reason for the infection is another, and that is arguably the most critical component. Ignoring the underlying cause may not be the end of the world for a single infection, because proper treatment and a susceptible bacterium can result in a successful outcome, but ultimately ignoring the real problem can lead to a difficult-to-treat, resistant infections.

Any diagnosis of pyoderma should be accompanied by consideration of the underlying cause. If a cause is apparent, this should be treated (if possible). If a cause is not readily apparent, it should be investigated. By investigated, I mean a real search for the problem, not a cursory examination, half-hearted feeding trial and little more. There is almost certainly an underlying cause and, at the end of the day, time, effort and money are better spent on trying to identify the root issue rather than just throwing round after round of antibiotics at the dog. In some cases, the cause (while it's probably there) can't be identified, but it's definitely worth trying anyway.

If your dog has been diagnosed with a skin infection, ask why it happened. If there is not a clear answer, talk to your veterinarian about the best plan to identify the cause. If at all possible, follow through with the plan. It may include certain diagnostic tests (which cost money) or dietary restriction (which  takes effort), but it should be thought of as an investment in your pet's health, as well as a potential way to keep multidrug-resistant bacteria (some of which can infect people) out of the house, to save future treatment costs, and to keep your pet much more comfortable.

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The US Food and Drug Administration has issued a warning to pet owners to avoid feeding their pets bones. I'm a little surprised the FDA would bother with this topic but I agree with the information. FDA veterinarian Carmela Stamper, states "Bones are unsafe no matter what their size. Giving your dog a bone may make your pet a candidate for a trip to your veterinarian’s office later, possible emergency surgery, or even death.”

The FDA lists 10 reasons why it’s a bad idea to give your dog a bone:

1. Broken teeth. This may call for expensive veterinary dentistry.
2. Mouth or tongue injuries. These can be very bloody and messy and may require a trip to see your veterinarian.
3. Bone gets looped around your dog’s lower jaw. This can be frightening or painful for your dog and potentially costly to you, as it usually means a trip to see your veterinarian.
4. Bone gets stuck in esophagus, the tube that food travels through to reach the stomach. Your dog may gag, trying to bring the bone back up, and will need to see your veterinarian.
5. Bone gets stuck in windpipe. This may happen if your dog accidentally inhales a small enough piece of bone. This is an emergency because your dog will have trouble breathing. Get your pet to your veterinarian immediately!
6. Bone gets stuck in stomach. It went down just fine, but the bone may be too big to pass out of the stomach and into the intestines. Depending on the bone’s size, your dog may need surgery or upper gastrointestinal endoscopy, a procedure in which your veterinarian uses a long tube with a built-in camera and grabbing tools to try to remove the stuck bone from the stomach.
7. Bone gets stuck in intestines and causes a blockage. It may be time for surgery.
8. Constipation due to bone fragments. Your dog may have a hard time passing the bone fragments because they’re very sharp and they scrape the inside of the large intestine or rectum as they move along. This causes severe pain and may require a visit to your veterinarian.
9. Severe bleeding from the rectum. This is very messy and can be dangerous. It’s time for a trip to see your veterinarian.
10. Peritonitis. This nasty, difficult-to-treat bacterial infection of the abdomen is caused when bone fragments poke holes in your dog’s stomach or intestines. Your dog needs an emergency visit to your veterinarian because peritonitis can kill your dog.

One point they could have added is that bones can be a source of infectious agents like Salmonella, Campylobacter and E. coli, both for the pet and people, depending on the source of the bones and how they are processed and handled.

I suspect that many people will not like the FDA's statement. Some will express outrage. People that have had to pay for major dental repairs or surgery will (probably silently and vehemently) agree. Most people may never have thought about it, which is why this type of press release is a good thing. It raises awareness about the potential and real problems associated with bones and will hopefully lead to fewer sick and injured dogs. While chewing on bones might be "natural", natural doesn't always mean healthy, and there are much safer alternatives.

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The May 2010 edition of Emerging Infectious Diseases contains a report about an outbreak of cryptosporidiosis in Scotland (McGuigan et al. 2010). Cryptosporidiosis is a common parasitic disease caused by Cryptosporidium, a protozoal parasite. It causes diarrhea, which is usually annoying (to say the least) but self-limiting in healthy people, but the infection is potentially fatal in people with compromised immune systems.

An investigation was launched after a single case of cyrptosporidiosis was diagnosed by a Scottish laboratory. The reason a single infection caused such concern is that it was suspected to have originated from contact with lambs at a wildlife centre, so there was potential for exposure of many people. The concerns were valid, since a total of 128 cases of cryptosporidosis were uncovered during their investigation, and 117 of the people affected had visited the wildlife centre. Another 252 unconfirmed cases were also identified.

The investigation suggested that direct contact with diarrheic lambs was the source of infection. Lambs (and calves) are high risk for shedding Cryptosporidium, even when they're healthy.  Diarrhea increase the risk of transmission from these animals even more, because diarrheic animals are more likely to (1) shed the parasite and (2) have fecal staining of their haircoats, which increases the likelihood of fecal contact for every person and animal around them. That's why young ruminants (e.g. lambs, calves) as well as young poultry are considered inappropriate for petting zoos and other similar public animal contact events. This outbreak is yet another example of why these recommendations are in place.

At the wildlife centre in this study, children were apparently encouraged to pick up the lambs, despite visible diarrhea. No handwashing facilities were near the lamb petting area and it took "considerable effort" to find a location to wash your hands anywhere on site. Alcohol hand sanitizers were available, however Cryptosporidium is resistant to alcohol. Handwashing is a critical component of disease prevention, but unfortunately it is very underused. In general, people are becoming much more aware of the need for handwashing, but even so, if handwashing facilities are not conveniently located, people tend not to go to much effort to find them. That leads to increased risk of infections, as was the case here.

Control measures at the wildlife centre implemented after the investigation included removal of the lambs (who should never have been there anyway), disinfection of the premises with bleach (although disinfecting a farm environment is very difficult, and Cryptosporidium is also resistant to bleach), and stopping direct contact between animals and visitors.

As we enter the season when there are more fairs, petting zoos and other animal contact events, facility managers need to pay attention to important factors like:

• Readily available hand hygiene facilities
• Good design to control the types of human-animal contact and to steer people towards hand hygiene stations
• Appropriate animals: no calves, lambs or chicks
• Proper supervision of people and animals

A little common sense goes a long way. The goal is to set up these events so that there is still a beneficial impact of seeing and interacting with animals while reducing (but never eliminating) the risk of disease transmission. A 100% safe petting zoo is not achievable (there's always some risk in life), but some pretty simple measures can greatly reduce the risks while still providing excellent entertainment and educational opportunities.

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My parents adopted a cat from their local OSPCA shelter the other day. He's an adult cat (maybe named by now, but not at last report) and he came:

• neutered
• vaccinated against the typical group of feline diseases
• dewormed with fenbendazole
• treated with metronidazole (an antibiotic - it wasn't clear whether this was because he had diarrhea at some point or was diagnosed with something, or whether it was just a routine practice)
• treated with Revolution for flea control

The one thing that's missing from the list is vaccinated against rabies, which I find amazing. Apparently, the cat was given everything they can give at the shelter without the need for a veterinarian. (Presumably the cat came in neutered, because that would hopefully fall under the "need a veterinarian to do it" category. Prescribing an antibiotic would also be something I'd hope would involve a veterinarian.)

Sending cats to new homes without vaccinating them for rabies is bad practice. Rabies is a rare but extremely serious disease. Vaccination is critical, safe and easy. The OSPCA website says that not all shelters vaccinate against rabies. Some shelters have veterinary staff in the facility, so rabies vaccination would be standard there. Other shelters work with local vets to do this, but that's not universal, apparently. I don't see why this isn't a mandatory policy for the OSPCA. Yes, there is a cost to it, but that should be a cost of doing business. Rabies vaccines aren't expensive and many vets would work with groups like this to keep the costs down. Adopting an animal from a shelter isn't cheap, and recovering the small added cost of the vaccine should be possible. I'm not sure whether it really is a question of cost, accessibility or simply not bothering. Getting a veterinarian involved also has benefits beyond just giving the vaccine. Potential health problems can be identified, including diseases that could be transmitted to people that adopt the animals.

It's true that lack of vaccination of adopted pets can be addressed by getting them vaccinated right after adoption. Any pet that has been adopted (or purchased, or otherwise obtained) should be promptly examined by a veterinarian to identify any potential problems, and to make sure the pet is on a proper preventive medicine program. Realistically though, not everyone does this. While you don't like to set policies according to the lowest common denominator, you need to for a deadly disease like rabies when the consequences to people and pets are so high. I find it hard to justify sending any animal out of a shelter without rabies vaccination.

Image source: www.ontariospca.ca

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A canine distemper outbreak has been identified in raccoons, dogs, coyotes, foxes and skunks in Los Angeles County. Local residents are being reminded to vaccinate their dogs against distemper and report any suspected signs of distemper to their veterinarian. (Keeping their pets away from wildlife should also be recommended.)

Distemper is an infection caused by a virus which is related to the virus that causes measles in people. It can cause different types of disease in dogs, raccoons and some other wild mammals, but neurological disease is often present and can appear similar to rabies.

Canine distemper cannot be transmitted to people, but, in a roundabout way, distemper outbreaks can be a public health concern.  This is because of the potential for rabies cases to be mistaken for (and dismissed as) distemper cases, leading to increased exposure of people to rabid animals.

Quite a few years ago, there was a cat with neurological problems under my parents front porch.  It was a stray cat that had been in the neighbourhood for a while, and which sometimes interacted with people. When the local authorities were contacted, the response was "Don't worry, it probably has distemper." This was probably true, and since there was no known direct contact with people (something that is difficult to really know in a social stray) testing for rabies wasn't done. However, the concern is that rabies cases will be missed, or, more concerningly, human exposure to rabid animals will be missed because of the assumption that it's really distemper.

Understanding disease patterns in an area is important when determining the likelihood of a particular disease and the appropriate response to a sick animal. At the same time, you can't get complacent and assume that trends are absolute. With an almost invariably fatal disease like rabies, you have to be careful not to overlook the rare case amongst large number of other, similarly appearing diseases. If someone has contact with an animal suspected of having distemper, the potential for rabies exposure must not be forgotten.

Image source: http://weblogs.baltimoresun.com

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Urinary tract infections are quite common in dogs. (They're uncommon in cats, but a lot of cats get treated with antibiotics for non-infectious urinary tract disease.) An important aspect of managing urinary tract infections (UTIs) is getting a proper diagnosis. Diagnosing a UTI involves a few different things:

• Clinical signs: Does the animal have signs that indicate something abnormal is going on in the bladder? This can include frequent urination, abnormal urination, straining to urinate or similar problems.
• Cytological: When a urine sample is examined under the microscope, are there changes consistent with an active infection, like the presence of large numbers of white blood cells and red blood cells?
• Culture: Can bacteria be grown from the urine sample?

Culture is very important to help determine if a UTI is really present. It's also very important for determining the best treatment, especially since antibiotic resistant bacteria are becoming more common. A baseline culture is also useful if the infection comes back, as it provides information about whether the first bug was not actually eliminated or whether re-infection other bacteria has occurred. Differentiating these two situations is important for determining subsequent treatment as well as the need for additional testing to see if there are any underlying reasons for recurrent infections.

Culture is also something that can be done improperly. If a person has or may have a UTI, that person will usually be asked to collect your own "mid-stream" urine sample by collecting urine into a sterile cup part-way through urination, so that any superficial bacterial contaminants get flush out before the sample is collected. That's not so easy to do in dogs and cats. Collecting midstream free-flow samples into a sterile container without the sample being contaminated by the pets hind end or haircoat, or by the person doing the collecting, is very difficult. A contaminated sample can result in misleading conclusions and potentially inappropriate treatment. Getting a proper sample is critical.

There are two main ways to deal with this problem:

1) Look at the kinds and number of bacteria grown from the urine culture. General guidelines (that are completely empirical) give cutoffs for the level of bacterial growth that should be considered clinically significant versus incidental contamination, with a grey-zone in between. This can be tough to interpret with confidence, so while looking at bacterial numbers can provide some information, it's not the preferred approach.

2) Collection of a sample by cystocentesis. This is a very quick, simple and low risk procedure that involves taking a sample directly out of the bladder using a needle and syringe. The animal is placed on it's back (no anesthesia required, and usually even sedation is unnecessary), the skin is cleaned, and a thin needle is passed through the lower part of the belly, where the bladder lies directly under the skin. Often, if an ultrasound machine is available, a quick check is performed to see the size and location of the bladder, but the procedure can be done without ultrasound assistance.

While cystocentesis may seem like a big deal for collection of a fluid that the pet passes freely on a regular basis, it provides much better information and is largely considered the standard for urine collection in dogs and cats. Unless there is a medical reason not to do it, cystocentesis should be used for collection of urine samples for culture.

Image from: http://www.e-barrett.com/page59t.htm

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PetProductNews.com reports that Nature's Variety, a raw pet food company, has unveiled results of a recent "research study" on their products. Whenever you see "research," especially on the web, you need to consider whether it's really valid scientific information or a marketing ploy. This particular case certainly doesn't seem like anything approaching real research.

Apparently the study, commissioned by Nature's Variety, involved the feeding of six adult dogs variations of different diets over a 4.5 month period. They looked at stool quality, volume and odor, blood chemistry, quality of their skin and coat and body weight.

• In research, we worry about sample size. You need to have enough animals to detect any real differences. With 6 dogs, 4.5 months of feeding and different diets, you don't have much of a chance to detect a problem (or a benefit, usually). You could have a diet that kills 10% of the dogs that eat it every year and not detect it in study of that size!
• The number of dogs and time don't even fulfill AAFCO feeding trial requirements, so this doesn't provide any information that would be accepted using standard requirements.

Nature's Variety director of research stated “It’s kind of a sigh of relief.”

• It's pretty concerning that the head of research would be relieved that there were no obvious health problems in such a small study. If they don't have real confidence in the quality of the food, why are they selling it? If you have confidence in your diet, you say "Of course, as expected, our diet was shown to be nutritious and safe..." not "Wow, we're really happy no dogs died!" Research to indicate safety and nutritional value should be done before you sell, not well after.

Duclos said she expects the study to be published in a peer-reviewed journal in about one year.

• Not likely. For one thing, from what they are releasing, it's very weak and not defensible scientifically. For another, they've already released the results. It's inappropriate for people to release results before they've undergone peer review, and releasing data in a press release will probably prevent any reasonable journal from even considering the study.

It's good that Nature's Variety is trying to do some research. It's also good that they're addressing Salmonella contamination following their recent recall. The fact that they are doing something progressive is an encouraging sign. However, they need to do proper research, and make sure it undergoes appropriate scrutiny, instead of using small and relatively useless studies to generate press releases.

Raw feeding has inherent risks of exposure for people and pets to potentially harmful bacteria like Salmonella. Raw feeding can probably be done safely for both the pet and people in some, but not all, situations. More information about raw meat feeding can be found on the Worms & Germs Resources page. 

Click image for source.

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This is a question I get a few times a week. Because methicillin-resistant Staphylococcus pseudintermedius (MRSP) infections are becoming so common and people are aware of potential concerns regarding transmission of methicillin-resistant Staphylococcus aureus (MRSA) from pets to people, it's a logical concern.

Here's my basic thought process when answering this common question:

• Staphylococcus pseudintermedius is very common on the skin and in the nose of healthy dogs. A large percentage of dogs are carrying this bacterium on any given day, and you can never tell who's a carrier by looking at them. Therefore, a large number of people are exposed to this bacterium on any given day.
• Staphylococcus pseudintermedius is a common cause of infection in dogs, particularly skin infections.
• Staphylococcus pseudintermedius can be found in the nasal passages of a small but appreciable percentage of healthy people, most likely acquired from their dogs.
• Despite the frequent exposure, S. pseudintermedius infections in people are extremely rare.

So, the risk of getting a S. pseudintermedius infection from a pet is quite low. What about the methicillin-resistant version of this bug?

• MRSP and the susceptible version differ by the presence of antibiotic resistance, and not necessarily anything else. Methicillin-resistance does not, to our knowledge, increase the virulence of this bacterium or make it more transmissible.
• If transmission of S. pseudintermedius from pets to humans is very rare, and methicillin-resistance doesn't increase the risk of transmission, there should be no greater likelihood of someone getting MRSP from a dog compared to susceptible S. pseudintermedius.

So in the end there's not too much to be concerned about. Yes, there is a reasonable chance that MRSP can be passed between people and pets, but that's different than getting sick. Transmission of MRSP from healthy and sick pets to owners probably occurs on a regular basis, but since MRSP is not a normal bacterial inhabitant of people and it is not well adapted to cause disease in humans, not much happens.

But the disclaimer I always put in is "rarely doesn't mean never." The risks are very low, but they are not zero. While the odds of me picking up MRSP from a dog are very low, I'd rather not have an infection with a highly drug-resistant bacterium. Accordingly, the use of proper hygiene and infection control measures, particularly around an animal with an active infection, is always important. These measures include:

• Frequent handwashing after contact with the pet.
• Avoiding contact with the infected site.
• Keeping the infected site covered with an impermeable dressing, whenever possible.
• Reducing contact with the nose of the infected animal, since it may also be carrying the bacterium there. In general, reducing close contact (e.g. snuggling, nuzzling, hugging, kissing) during the period of infection is a good idea.
• Regular washing (in hot water with hot air drying, whenever possible) of pet beds and other items that come into close and frequent contact with the pet.

Is all that overkill? Probably. But it's also an easy and practical plan, and a reasonable approach to reduce the already-low risks.

More information about MRSP is available on the Worms & Germs Resources page.

(Photo credit: John Haslam)

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Nature's Variety has expanded their recall based on more concerns about Salmonella contamination of their products. In a lot of ways, this makes no sense to me since you have to assume that raw meat is contaminated with Salmonella, E. coli, Campylobacter and various other pathogens. That's been clearly shown in studies of raw meat for humans and animals, and that's why we cook meat intended for human consumption and emphasize good food handling practices. It's also why there are concerns about feeding raw meat to pets, and the explanation for various studies showing pets fed raw meat have much higher rates of shedding potentially harmful bacteria like Salmonella. You have to assume that a reasonable percentage of Nature's Variety's food has been contaminated with Salmonella, not that this is an uncommon and preventable event.

Because of the problem or consumer concerns, Nature's Variety has announced that they will be treating all of their diets using high pressure pasteurization. Basically, this process uses very high pressures (with only a slight increase in temperature) to reduce bacterial levels. I can't find any scientific literature about the effectiveness of this method on Salmonella contamination of raw meat (it's mainly used with milk and cheese) but it should be able to greatly reduce bacterial levels in meat. That's a good thing, as long as it works. What's important to know, however, is whether it is really highly effective in this situation and whether all potentially harmful bacterial will be eliminated every time.

I'm concerned that if people think this food is "sterile" and it's not, they might not take the necessary food handling precautions. If this method usually, but not always, kills all of the bad bacteria, or if it reduces levels greatly but not completely, then there could still be the risk of infection of people and pets. This information is critical. In the absence of clear scientific data, I think we need to assume that some level of contamination could still be present (although probably much less often and at a much lower level), and make sure that proper food handling practices are used.

It's good to see this company taking measures to reduce the risks associated with raw meat feeding. Let's hope that some objective research is made available to indicate what risks might remain.

Image source: www.defendingfoodsafety.com

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Yesterday morning, I found part of a goose carcass in the backyard.

Yesterday afternoon, I found more of it... in a pile of dog vomit on the dining room floor. (Yes, my dog's an idiot, but that's a separate story).

Between the vomiting and my dog's rather solid gut, there hasn't been any diarrhea, at least not yet, but it not an uncommon problem in most dogs after an episode like this.

Diarrhea after dietary indiscretion can be caused by a number of different factors, including ingestion of disease-causing bacteria such as Salmonella. It can also simply be from eating too much, overloading the gut with a new substance, effects of fermenting material on the intestinal tract, and other physiological causes.

The best way to prevent this kind of diarrhea is to make sure dogs don't eat anything unusual, but that may be easier said than done. If a dog does get into something it shouldn't, odds are it's not going to be a major problem in terms of infectious diseases. Most of these become typical cases of "garbage gut," the results of which are the dog vomits and maybe has some diarrhea, but is otherwise fine and gets over it quickly. Sometimes they puke once and never look back. Other times, they need to be kept off feed or be fed a bland diet for a couple days to let their system get back to normal. During this period you should be aware that, while the cause is unlikely to be infectious, there's still certainly a possibility that the dog is shedding more harmful bacteria than normal. Vomit isn't that big of a risk, particularly compared to diarrhea, but you should clean it up promptly and wash your hands thoroughly afterwards. Cleaning up diarrhea takes a little more care, as I've previously discussed.

Garbage gut is usually more of a nuisance than a major health problem. You don't necessarily need to go running to your vet every time your dog throws up after eating something, but you also need to make sure you don't miss a potentially serious problem such as ingestion of a foreign body (e.g. bones, indigestible garbage), severe intestinal infection or pancreatitis. You should go to your vet anytime you have concerns. It's particularly important to get your dog evaluated if it has persistent vomiting or diarrhea, signs of abdominal pain (e.g. hunched up stance, crying, moving around like it hurts), doesn't want to eat or drink or is lethargic. It's also wise to get to a vet quicker if your dog has underlying health problems, has a history of pancreatitis or is very young (i.e. a puppy) or very old.

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An article in Saturday's Toronto Star discussed composting options for people without organic waste pickup or the ability to have a backyard composter, including indoor composters that can be used by apartment or condo dwellers who want to satisfy their eco-friendly side.

They mentioned that one of the composters they highlighted (NatureMill) can apparently handle pet waste, but composting animal feces is not a good idea. Pet waste (feces +/- cat litter etc.) can contain a wide range of potentially harmful parasites and bacteria. The composting process can generate enough heat to kill these bugs, but it's not guaranteed to do so, and I'd be especially concerned about small indoor composters. Having a few nasty things in the composter itself isn't necessarily a big deal, but what happens down the line? People can be exposed to these microorganisms when removing compost, and (maybe more importantly) compost usually ends up in gardens where the bad bugs can contaminate the soil, as well as anything grown in the garden.

One concerning microbe is the protozoal parasite Toxoplasma gondii. Cats are the natural reservoir of Toxoplasma and can pass it in their feces (usually only for a short period), but most people that become infected by Toxoplasma are likely exposed to the oocysts ("eggs") outside in gardens, or from contact with contaminated foods (e.g. unwashed vegetables). (Undercooked meat can also be a source of infection, but that's another story).  Composting may not kill this parasite, so when pet-waste compost is put into flower gardens or vegetable gardens in which people work, the risk of exposure to Toxoplasma may be increased. The risk of transmission from an individual cat is admittedly low, since only a very small percentage of cats are shedding the parasite at any one time (even though most have at one point), but it's a preventable risk. There are also various other microorganisms that are potential concerns. While composting is a great way to dispose of most organic wastes, it's best to keep putting dog and cat feces in the garbage or down the toilet (and wash your hands afterward, of course).

If you really feel the need to compost pet waste, the safest alternative is probably to have a separate composter for pet waste that you handle a bit differently: pay careful attention to hand hygiene after handling the compost, and make sure the compost isn't used in gardens or other areas where people might have contact with the soil.

Click image for source.

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A man from Jharkhand, India, was bitten by a dog and realized that there was the potential for rabies transmission. That's good, particularly given the huge problem with rabies in India. However, he didn't take the recommended approach of proper wound care and getting post-exposure vaccination. Rather, he killed the dog (getting bitten a few more times in the process), cut out its heart with a pair of scissors and ate it raw, exclaiming that now there would be no problem with rabies.

Not a good idea.

Rabies is widespread in India. Every year, 25 000-30 000 people die of this disease. A person in India is bitten every 2 seconds and someone dies of rabies every 30 minutes.

Every dog bite needs to be considered a possible rabies exposure. If a dog that bites someone is not available for quarantine or testing to determine whether it has rabies, post-exposure treatment is necessary. That involves an injection of anti-rabies antibodies and a series of 4 or 5 vaccines, not ingestion of the animal's heart.

Hopefully, the dog didn't have rabies and this will go down as a somewhat curious little story. Unfortunately, if the dog had rabies, there is a good chance that this person has been infected, and if infected, he will almost certainly die.

Eating an animal's heart to prevent rabies transmission may just be a bizarre belief of an unusual individual. This is something that needs to be investigated, however, because if the same belief is held by many other people in the area, they will all put themselves at risk if they are bitten by not seeking appropriate and effective treatment. Not only does killing the dog and eating its heart have no chance of preventing infection, it probably increases the risk of rabies by leading to more bites. More rabies education is often needed in problem areas, and this may be the case here.

Image: Canine heart (source: www.historyforkids.org)

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Ear mites are a common problem in dogs and cats, particularly in young animals, as well as in strays and animals in shelters. The species of mite typically involved is called Otodectes cynotis. It is transmitted between individuals by direct contact (basically hopping animal to animal, as it does not survive for long in the environment), and causes an extremely itchy ear infection (which can get even worse if there is secondary infection with bacteria or fungi).

There are a few reports of suspected infections with Otodectes in people. Considering how common ear mites are in cats and the small number of reported human infections, transmission between pets and people is probably rare, but it certainly can occur. Most of the reports are somewhat circumstantial, involving people with itchy skin lesions that developed after a pet was diagnosed with ear mites. However, one curious veterinarian took it a step further. 

Dr. Robert Lopez, of Westport, New York, intentionally infested himself with ear mites from infected animals, and described the outcome in a 1993 edition of the Journal of the American Veterinary Medical Association. First, he took a sample from the ear of a cat with ear mites and placed it in his own ear. He described the scratching sounds and movement that he could feel as the mites explored his ear canal. Severe itching developed, to the point where "sleep was impossible." The intensity of the itching and mite movement decreased over time and the infection resolved by itself within a month.

Personally, I think I would have stopped there. (Actually, I wouldn't have made it to that point, but if I did, I certainly wouldn't have tried it again.) Yet, Dr. Lopez wanted to confirm his findings so, a few weeks later, he infected himself again with mites from another cat. The same type of disease developed, although it was less severe and only lasted two weeks.

Guess what he did next - he tried again, wanting to see if the reduction in severity might indicate development of immunity. So, he infected himself a third time, with the outcome being milder disease. This suggested to him (logically so) that immunity to the mites might develop, something that fits with the fact that ear mite infestations are more common in young animals.

Self-experimentation is generally frowned upon, but has been the source of remarkably scientific discoveries, even Nobel Prize winning discoveries (e.g. the role of Helicobacter pylori in gastric ulcers in people). I don't think Dr. Lopez is in line for any prizes, but it shows how a little academic curiosity along with minimal squeamishness can provide some interesting information.

What's the relevance of all this? If your pet has signs of ear mite infestation (e.g. scratching at the ears, dirty material inside the ears), get it examined and treated. If nothing else, this needs to be done because it's a very uncomfortable problem for the pet. There's also some risk of human infection, but it's probably minimal. The mites have to make it from the pet's ear to your body to cause problems. The quicker they are treated, the lower the likelihood of this occurring. Human ear mite infestations, be they in the ear or on the skin, seem to resolve by themselves, with treatment of the animal being the most important part of control. However, it can be a pretty uncomfortable condition and one most people (with the possible exception of Dr. Lopez) would certainly rather avoid.

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A Fort McMurray (Alberta) SPCA shelter has been closed because of a Giardia outbreak. Giardia is an intestinal parasite that can cause diarrhea in dogs (and other species, including people) but can also be found in about 7% of healthy dogs. Giardia infection was confirmed in four dogs in the shelter, which led to the rather aggressive measure of closing the shelter. Shelter personnel suspect that the infection started with one dog, who spread the parasite to some other dogs that were in close contact with it. Giardia is passed in stool and animals get infected by ingesting Giardia oocysts from stool contamination in their environment or water sources.

 

Shelter personnel speculated that "If [the first dog to be infected] went for a walk with the snow melting, of course there's lots of little presents underneath the snow, so when she goes for a walk and she steps in, say another dog's feces, and then licks her paws, she can get it."

 

It's pretty unlikely that old feces revealed by thawing snow were the cause, since freezing is a pretty effective way to kill Giardia. More likely, the parasite was brought into the shelter by a healthy dog, considering that a reasonable percentage of dogs are shedding Giardia at any time. Why it spread to other dogs is a different question, as is whether the other animals were sick (with diarrhea) and whether Giardia was really the cause if they were. As with any organism that can be found in healthy animals, it's hard to say for sure whether Giardia actually caused any disease or whether there was some other cause that wasn't detected and the affected dogs just happened to be shedding Giardia at the same time.

Giardia usually causes pretty mild disease that gets better on its own or with treatment. Shelter personnel stated "We are in desperate need for help from the public as far as raising funds for medical, because obviously it costs a lot of money to treat the dogs. It's a lot of money to treat an animal with giardia." It's actually pretty cheap to treat individual cases, but this makes me wonder whether they are treating all dogs in the shelter. That's not something I'd recommend because there's little evidence that treatment of non-diarrheic animals is needed or useful. 

Presumably this outbreak (whether it was caused by Giardia or something else) will end soon, either because of or despite of what was done. You never know if you did something to control the outbreak or whether it just ran its natural course. If it truly was Giardia, I'd be surprised if there are more problems, but resolution of the outbreak won't change the fact that many dogs that they bring in will be shedding the organism.

Giardia is a cause of diarrhea in people, but we now know that dogs probably play only a minor role in human disease. The type of Giardia that is most often found in dogs is a dog-specific type (Assemblage D) that cannot infect people. Unless these dogs were infected with a strain that can infect people (uncommon but not impossible), there's no risk to people. Regardless, avoiding contact with stool, especially diarrhea, is still a good idea - for prevention of Giardia and other diseases.

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The Toronto Star had a front page article today about an ongoing distemper outbreak in raccoons, and the potential effects on dogs. Toronto's not alone, as there are distemper outbreaks underway in many different municipal regions.

Distemper is an infection caused by a virus that is related to human measles virus. It mainly affects dogs, raccoons and ferrets. It can cause intestinal, respiratory and neurological disease, with neurological problems being the most severe. Vaccination of dogs against distemper is highly effective, and has greatly reduced the impact of this virus on the pet dog population.

Distemper cannot be transmitted to people, so the disease itself is only an animal health risk. However, there's an indirect effect of which people need to be aware. Rabies always needs to be considered in dogs and raccoons that have signs of neurological disease. If there is so much distemper in an area that people assume every sick (wild) animal they find has distemper, there is a risk that the odd (but important) case of rabies may be missed, leading to human exposure. It's easy to dismiss a neurological raccoon or unvaccinated dog as having distemper, and it usually is distemper (particular in light of the current outbreak), but the implications of missing a case of rabies can be severe since it can be transmitted to people and is almost invariably fatal.

If distemper is present in your area (or, really, even if it's not currently a problem):

• Make sure your dog is vaccinated.
• Keep your dog away from wild animals, especially ones that are acting strangely.
• Keep yourself away from wild animals, especially ones that are acting strangely.
• Don't do things that will encourage raccoons to move into your yard, like leaving out food.
• If you see a wild animal that is acting strangely, call your local animal control agency.

Photo credit: The Star - Toronto edition 18-Feb-10

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Nature's Variety has recalled chicken-based raw meat products because of Salmonella contamination. After a customer complaint about "digestive problems," they tested the food and found Salmonella, prompting the recall. (For more details about the recall, click here.)  In some ways, this doesn't make a lot of sense to me. If you think Salmonella contamination should be an uncommon event and a problem, you should test routinely, not wait until animals get sick. If you think that Salmonella contamination of raw meat is expected (which it is), then why test or recall? Just assume that every raw meat sample is positive for Salmonella (and Campylobacter, and E. coli). Recalling raw meat for Salmonella isn't logical. Presumably, a large percentage of the raw meat that they have sold and which they will sell in the future is contaminated, based on various studies of commercial raw meat. Handling and feeding raw meat carries an inherent risk of human and animal infections with Salmonella, Campylobacter, E. coli and other bacteria. People that feed raw meat need to understand that risk, and consider whether it's a reasonable risk for their pets and the people in the household. I don't think feeding raw meat is a good idea, but in some situations it's a particularly bad idea (e.g. when there are infants, elderly persons or immunocompromised people in the household, when the pet is very old or very young, when the pet visits high risk people).

More information about raw meat feeding can be found on the Worms & Germs Resources page.

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A Phoenix, Arizona man is suing a pet store after he contracted rat bite fever from a rat he had purchased. It's not surprising to see a lawsuit following a serious illness, considering people in the US often try to sue for just about anything, but I'm not sure it won't get very far. I don't doubt that the man had rat bite fever, or that he got it from the rat he purchased - the question is, is the pet store really liable? Specifically, did they do anything inappropriate?

"Rats being sold to people should not have rat-bite fever," Heitzman's lawyer, M.E. "Buddy" Rake Jr., tells New Times.

Actually, the rats don't have rat bite fever... rats are healthy carriers of the bacteria that cause rat bite fever. There are two different bacteria that can cause the disease, Streptobacillus moniliformis and Spirillum minus. Streptobacillus moniliformis is presumably the cause here since it's the main cause of rat bite fever in the US. This bacterium is very commonly found in healthy rats, with upwards of 100% of healthy rats being carriers. You have to assume that every rat is carrying this bacterium.

"It wouldn't be any different if they sold someone a dog with rabies," he says. "I'm not in the nuisance-lawsuit business - he was in rough shape."

It would certainly be a different story if the store sold someone a dog that had signs of rabies. It's possible that someone could buy a dog that had been exposed to rabies but which was healthy at the time of sale, but that's pretty unlikely. However, a big difference is that there is a highly effective vaccine against rabies. There is no such thing for rat bite fever. If a pet store sells an unvaccinated dog of unknown origin that could have been exposed, despite knowing the need for rabies vaccination, there certainly could be liability issues. Selling a rat that is carrying a bacterium that we assume most or all rats carry anyway is different.

PetCo did not immediately return telephone calls this afternoon, but in its defense, there is an information pamphlet explaining exactly how to avoid contracting rat-bite fever available on the company's Web site. ...though it seems the pamphlet's best suggestion is to not get bitten in the first place.

It would be better if everyone who bought a rat was given the information sheet, but it's a start. The fact is, the best way to avoid rat bite fever IS to avoid getting bitten by a rat! Proper rat handling is a very important aspect of disease prevention, since you can never rule out the possibility that a rat is a carrier.

Our suggestion: Don't have a disgusting rat for a pet.

Whoa.  Rats can make excellent pets. They can also carry infectious diseases. However, EVERY animal can carry infectious diseases, and rats are probably no more risky than most other domestic pets. The key is to take common sense precautions to reduce the risk of injury and infection (though the risk can never be completely eliminated). For rats, this includes selection of a rat that is not aggressive or fearful, knowing how to properly take care of a rat, knowing how to take care of a bite should it happen and being aware of some diseases for which you might be at increased risk because you own a rat.

Image source: http://commons.wikimedia.org

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Urine from healthy animals is typically considered to be of little to no risk to people. This is generally true, at least for the otherwise healthy human population, but like with most things in infectious diseases, there are exceptions. An interesting one in rabbits is a bug called Encephalitozoon cuniculi. This microorganism (now classified as a fungus, but previously considered a protozoal parasite) is very common in healthy pet rabbits. In fact, the majority of rabbits have antibodies against E. cuniculi and may have it living in their bodies, particularly in the kidneys. It can cause infection of the brain, and is an important cause of neurological disease in rabbits, but more often than not it lives within the rabbit without causing any problems. Rabbits can shed spores of this organism is their urine, although they mainly do this only in the first few weeks after they've become infected, and shedding after that may be intermittent.

E. cuniculi is one of a group of microorganisms that became much more important when the HIV/AIDS epidemic hit. While rarely a cause of disease in people in the pre-HIV era, E. cuniculi is recognized as a potential cause of infection in people with compromised immune systems, particularly people with AIDS. Infections of people with normal immune systems are extremely rare.

It's always a challenge deciding what to do with a microorganism that can be shed by a large number of healthy animals. One reference "strongly advises" routine testing of rabbits, but that makes no sense to me. Here's why:

• Screening always comes down to a question of what you would do with the results. If you get a positive antibody test, it means that the rabbit has been exposed sometime in its life, but that does not mean that it is necessarily still infected or shedding spores - so it's not really convincing.
• Tests can be done to detect spore shedding but they are not particularly reliable. Since infected animals shed spores intermittently, a negative result here isn't convincing either.
• If the animal is positive, what would you do? If the household has no immunocompromised people, I'd say do what you've always done, and pay attention to good hygiene.
• If the animal was "negative," I'd say do what you've always done, and pay attention to good hygiene... same as for a positive rabbit.
• If there is an immunocompromised person in the house, I wouldn't say to get rid of the pet, since there's no evidence that's necessary. There is also no evidence that treatment is useful to eliminate E. cuniculi shedding rabbits. If the animal is positive, immunocompromised persons should avoid contact with urine and feces, and use good personal hygiene... just as they should do if the rabbit is negative!

More information about E. cuniculi in rabbits can be found in our archives.

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A recent report in the Journal of Pediatrics (Tabarani et al 2010) describes a case of infection around the brain, at the site of a previous subdural hematoma, in a five-month-old child. Four reptiles (all bearded dragons) were present in the child's foster household, but the foster parent reported that the baby did not have any contact with them. Salmonella Houtenae was identified as the cause of the infection.  The reptiles were an obvious potential source given what we know about Salmonella and reptiles, the unusual Salmonella strain that was isolated from the baby, and the lack of any other obvious risk factor. All previous human infections caused by this type of Salmonella have been associated with reptiles, and all occurred in young children. Unfortunately, the reptiles in this case were euthanized before they could be tested.

This report highlights a few important points.

• Direct contact with reptiles is not needed to cause an infection. There are many reports of people (especially infants) being infected by Salmonella from a pet reptile despite them having no direct contact with the animal. The common statement that 'there's no risk to my child because my child is never allowed to touch the animal' is completely false.
• Reptiles should not be in households with children less than five years of age. In this report, the child was in a foster home.  In some jurisdictions, reptiles are banned from foster homes for this very reason.
• The majority of reptiles carry Salmonella. This is expected and impossible to prevent. That's why people at high risk of serious infection (e.g. young children) should not be around them. It's also why euthanasia of the reptiles in this case was highly questionable. Why kill the lizards for carrying a bug that we assume they (and most other reptiles) normally carry? Finding them a new home that doesn't have high risk people would be more appropriate.

Image: Central Bearded Dragon (Pogona vitticeps) (photo credit: Eigene Arbeit, 2007)

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The latest edition of the journal Emerging Infectious Diseases contains a paper describing the 2008  Australian Hendra virus outbreak in horses and people.

In this outbreak, there were five horses infected and two humans infected. The horses predominantly had signs of neurological disease, not respiratory disease like some other reports describing this disease. Four horses died. One recovered but was euthanized for public health reasons.

Two people became infected after working with the sick horses, which represents 10% of the total veterinary staff that were exposed to the infected horses.  Both people started off with influenza-like illness, which seemed to improve initially, but then signs of severe neurological disease developed. They were treated with ribavirin, an antiviral drug, as part of an experimental treatment. One of them died after 40 days of illness, the other person survived.

The authors stressed that the effectiveness of ribavirin could not be determined, but they recommend it nonetheless because of the severity of Hendra virus infection and lack of other options. Ribavirin was also used in the 2009 outbreak, but it is clearly not 100% effective since one person died there also.

A number of concerning activities occurred that put people at risk of infection, including a "percutaneous blood exposure while euthanizing an infected horses" (they didn't explain exactly what this was, but it could have been a needlestick), low use of personal protective equipment, and contact with potentially infectious body fluids. This is unfortunately not surprising since the approach to infection control (particularly in terms of zoonotic infections) is often lax in equine medicine. That certainly has to change, particularly in areas where Hendra virus may be present.

Much more information about how to control this potentially devastating virus is needed. Fortunately, infections are uncommon and it is restricted to a fairly small geographic range in Queensland, Australia.

Image source: http://animalphotos.info/

This Worms & Germs blog entry was originally posted on equIDblog on 27-Jan-10.

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I recently attended a meeting to develop antibiotic use guidelines for dogs and cats. One recurring theme during the discussions was our paucity of scientific evidence about how to use antibiotics in certain situations. It's really interesting when you compare antibiotic treatment regimens that are used in humans and standard practices for dogs and cats. Almost invariably, we treat dogs and cats for much longer periods of time than people, even when very similar diseases are compared. Why is this?

One reason is a lack of people doing research and the difficulty performing (and funding) the large clinical trials that are needed to evaluate different treatment protocols. For example, we tend to treat urinary tract infections in dogs for 7-10 days, while in people, just 3 days of treatment is much more common. However, longer treatment courses were used in humans until various research studies showed that shorter treatment was as effective and had fewer side effects. It's likely that we could treat urinary tract infections in dogs for shorter periods of time but we don't have the data to support it at this point.

It's possible that longer treatments for certain conditions are indeed needed in dogs and cats compared to humans. An argument to this effect is that disease in pets can often be more advanced (and therefore potentially harder to treat) when first detected than similar disease in people. For example, if someone has a urinary tract infection, they are probably going to get to their physician quickly. Many owners may not notice the signs of an infection in their pets as early. More established infections may take longer to treat. Does that really happen? We don't know, but it's something we need to know to determine proper treatment durations.

"If it ain't broke, don't fix it". This isn't a very good philosophy when it comes to medicine but it's understandable. If a certain treatment plan usually works, people are hesitant to look at alternatives. The problems with longer term therapy, such as adverse effects of drugs and development of antibiotic resistance, are not necessarily considered (but they need to be).

Bottom line: We need good research to determine optimal treatment protocols for pets. It's very likely that we can greatly decrease the amount of antibiotics that we use while improving patient care, but without good evidence, it's hard to know what to do and where to start. Being too aggressive and dropping treatment times in the absence of evidence may not be a wise decision - too short a treatment period could result in treatment failures and ultimately more sick animals and overall more antibiotic use.

Click image for source.

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I assume that people wouldn't voluntarily and regularly walk around barefoot on dog feces (or feces of any type), yet it's perplexing that some people regularly clean out horse stalls in bare feet (I've seen it done!). While horse manure may not be as inherently gross as dog poop, it's still feces, and like all feces contains a huge population of various bacteria, some of which can be harmful. The risks of barefoot mucking may also extend to bare feet inside boots, although I don't think sock-averse people need to panic.

An article in the International Journal of Infectious Diseases (Friederichs et al) describes infectious arthritis of the shoulder of a horse owner that was caused by Streptococcus zooepidemicus, a bacterium commonly found in horses but rarely associated with disease in people. The person didn't have a wound in the shoulder area or any other obvious route for the bacterium to get to the shoulder joint. They searched for a source of the infection and all they found was a chronic lesion on the person's foot. This, combined with the patient's history of taking care of his horses in "bare feet in boots", led them to implicate the foot as the source of infection.

The idea, I guess, is that socks would be a barrier to help prevent contamination of the foot wound. That makes sense to a degree - the person could contaminate his foot with S. zooepidemicus from his hands (probably acquired from touching the horse's nose) while removing the boots, or manure could work its way into boots and directly contaminate the wound. Both are possible, but we have to be a little cautious in interpreting these conclusions. However, this is a bacterium that is associated with horses and the foot lesion is certainly a possible route of entry.

Overall, this should be considered an interesting report of a very rare problem, not something that indicates a major concern. However, there are a few good points to take away from this story:

• If you have a wound or chronic lesion of any sort, make sure you take measures to reduce the risk of bacterial contamination when working around horses. This might be as simple as making sure it's covered by clothing, or something more involved like using an impermeable bandage.
• Hands are probably the major source of infection transmission, and good hand hygiene is important after horse or stall contact, particularly if you have an underlying disease.

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Rabies has been diagnosed in a 6-week-old Jersey calf at a Maryland educational centre, raising concerns about exposure of farm visitors, particularly groups of school children. At least 70 kids and an unstated number other visitors had recently visited the farm.

Fortunately, the farm in question is not open to the public, so they should have an easier time identifying people who have been there (e.g. school groups). Contact tracing is underway to try to identify people that had contact with the calf. Simply petting the calf or being in the general area does not pose a risk. The main risk would be from contact of open wounds with the calf's saliva, or a bite. We don't typically associate bites and calves, but it can happen when calves are allowed to suck on someone's fingers - if the person sticks their hand in too far he/she may get chomped by the calf's sharp molars. Public health personnel are trying to identify people who had contact with the calf, then they'll determine whether there was a chance of exposure to the virus. People that were potentially exposed to rabies will undergo post-exposure prophylaxis, consisting of a shot of anti-rabies antibodies and four doses of vaccine over the course of a month. Not fun, but much better than getting this almost invariably fatal disease. At least nine students have started treatment so far.

Petting zoos and similar events are a concern in terms of disease transmission because of the large number of people that can be exposed to animals and the high percentage of children that are involved. Rabies is uncommon in petting zoo animals, but it is periodically identified at such a facility/event, often resulting in the need for post-exposure treatment of large numbers of people. Vaccination of petting zoo animals against rabies should be a standard practice. This calf, being only six weeks old, was too young to vaccinate, but if the calf's mother was vaccinated the risk of rabies would be lower (because the calf would get antibodies from the mother). There's no information about the cow's vaccination status or much else about the calf, apart from it being a recent acquisition.

The fact that a recently acquired young calf was allowed to have contact with the public is questionable management, because young calves are a high risk group for certain infectious agents like Cryptosporidium and Salmonella. The CDC recommends that children less than five years of age not have contact with young calves.  Since young kids are frequent visitors of places like this, having calves (or at least letting people have direct contact with them) is quite questionable as well. Hopefully there will be a good review of vaccination, animal acquisition and animal contact protocols for this facility to reduce the risk of future exposures to rabies or other infectious diseases.

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Just as I'm getting ready to go on vacation (that will hopefully involve some time on the beach), I read an article in the latest edition of Emerging Infectious Diseases about seagulls and beaches as reservoirs of multidrug-resistant E. coli (Simoes et al 2010). In this study, the researchers collected seagull poop from beaches in Porto, Portugal and tested them for the presence of extended spectrum beta-lactamase (ESBL) E. coli, a highly drug resistant form of this common bacterium. Thirty-two percent (32%) of the E. coli they isolated were ESBL, a pretty impressive rate in wild birds that would not be directly exposed to antibiotics. Various E. coli strains were present, including some that can cause severe disease.

In some respects this is pretty concerning, and in other respects not too surprising. We know that birds in various (including remote) regions can carry multidrug-resistant bacteria. The ability of wild birds to carry these bacteria, combined with the wide geographic range that some bird species have, raises concern about the role of birds in the spread of antibiotic-resistant bacteria, as well as the potential for contracting a nasty drug-resistant infection while on the beach. Birds certainly have the ability to help spread certain types of bacteria over wide ranges. However, their overall role is probably very limited compared to the role played by people and (domestic) animals. For birds to become carriers of these bacteria, they have to pick them up from somewhere, which presumably doesn't occur until the bacteria have built up to a good level in people and/or animals. I doubt that birds account for many human infections. Antibiotic exposure through antibiotic residues in water or food sources could also play a role in the presence of these bacteria in birds, but that's an area that's not well understood. 

So, how does this influence my time on the beach? Not much. I wasn't really planning on having contact with seagull poop, and this paper just reinforces that basic precaution. Other basic measures such as keeping open sores covered, avoiding cuts by wearing shoes in rough areas or sand that might be contaminated with sharp objects, avoiding contamination of food with sand, avoiding areas with obvious bird poop contamination, and hand washing before eating and after leaving the beach are easy to do.

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Pets as a source of pinworms in people (especially children) has been a widespread misconception. A recent article at www.medicalnewstoday.com gives a good overview of pinworms in people and has a nice section about pets.

"Pinworms that affect humans cannot infect animals or pets. However, some microscopic eggs may land on a pet's fur and then be transferred to human hands when stroking (petting). It is important to remember that the problem is not the pet, it is human hand washing and hygiene."

This nicely explains two key concepts:

• People are the source of human pinworms.
• Hand hygiene is an important routine practice around pets.

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I've never really understood the appeal of tarantulas as pets. I'm sure there are some people that think they're great pets and I can't really counter with anything beyond "I don't have any desire to have a massive spider in my house." Nevertheless, many people have them. Recently, a rather unusual health concern was reported at medpagetoday.com following publication of a peculiar case report (Norris et al) in the most recent issue of The Lancet.

Hairs on the hind end of the Chilean Rose tarantula, as well as others, have barbed tips. These spiders can release hairs as a defense mechanism. A British tarantula owner was leaning into the spider's terrarium one day when it "doused" his face with a mist of hairs.

When he presented at the ophthalmology clinic three weeks later, his right eye was red, watery, and uncomfortable in bright light. His Snellen visual acuity had degraded to 6/9, versus 6/4 in his unaffected left eye.

Carrim and colleagues reported that initial low-power examination showed diffuse conjunctival injection and multiple corneal subepithelial infiltrates, "visible as scattered white spots."

They initially suspected a viral infection, but higher magnification revealed "fine, hairlike projections" at the center of each spot, with varying depths into the cornea.

At that point, he mentioned the tarantula hair exposure. After 6 months of intensive treatment, his eye problems have greatly improved, and he now wears eye protection around the tarantula.

It's unclear how common this is. There have been other reports of this problem and certainly there must have been other unreported cases. Overall, it's probably rare for tarantula owners to be affected but it seems like a pretty nasty problem and one you'd want to avoid. Pets like tarantulas often come and go in popularity, and any upswing in tarantula numbers could result in more eye injuries. People need to be aware of this problem if they own, or are thinking about acquiring, a tarantula. Animal exhibits that have tarantulas and any other places where tarantulas may be present (e.g. schools) need to think about this as well. Wearing eye protection when handling these spiders in close quarters, keeping your face of the terrarium, avoiding stressful situations that might make the tarantula release hairs, good handling skills and restricting close contact seem like logical and practical measures to reduce the risk.

Image: Chilean Rose tarantula (source: www.wikipedia.org)

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.A Texas couple is undergoing rabies post-exposure prophylaxis after an abandoned puppy they adopted was diagnosed with rabies. They found the puppy outside and brought it into their house. One of them was subsequently bitten and they found out about the rabies diagnosis on Christmas eve.

One of the couple is quoted as saying "The doctor said 'It was a good thing they didn't wait until Monday, because it would have been too late. We couldn't have given you the shot because it wouldn't have done any good. You would have been dead within 48 hours." I really hope they completely misinterpreted what the doctor said, otherwise the doc has no clue about rabies. Prompt treatment is the goal, and you certainly don't want to wait any longer than you have to, however rabies doesn't kill in 48 hours, and you can start post-exposure treatment any time (just the sooner the better).

The couple also have seven other pets, who may also have been bitten. There wasn't any comment about what's happening to those pets. Hopefully they are properly vaccinated so they can be given a rabies vaccine booster and only undergo a short-term "quarantine" at home with the owners. (The alternative is immediate euthanasia or strict, long-term quarantine for months).

This isn't a new scenario - adopting a stray animal then finding out it has rabies. The less you know about an animal at the time of adoption, the greater the risks. I'm certainly not saying don't adopt a stray animal. But, if you are going to do it, recognize the risk, make sure you are in a low-risk household (everyone's susceptible to rabies, but some people are at greater risk for other zoonotic diseases and stray adoptions should be avoided by them), get the animal examined by a veterinarian as soon as possible, and make sure that it gets examined by a veterinarian if it develops any signs of disease.

All this leads into another another story I read a few days ago. Basically, it was a feel-good story about someone who found some puppies, stopped by a nursing home (or similar facility) and the facility adopted one or more of the puppies. This demonstrates some good points (e.g. resident's presumably had a great time watching the pups) and bad points (e.g. disease exposure, unknown temperament, injury risks from rambunctious puppies...) of animals in long-term care facilities. What if the puppies that were adopted by the home had rabies? It's happened before, and you end up having to administer post-exposure prophylaxis to a large number of people that already have enough health issues and risks. Nursing homes and other facilities should never adopt stray animals. Hopefully we don't see a news release in the next few weeks about widespread rabies exposure in that facility. 

 Video from wfaa.com

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.A public health expert has recommended that an exotic animal dealer's facility be demolished or "completely gutted and sterilized" because it is so contaminated with animal feces and vomit, as well as roach infested and swarming with uncaged animals. No evidence of infection control was present in the facility that "reeked of death and decay on a mammoth and overwhelming scale."

26 000 (yes, twenty-six thousand) reptiles, rodents and mammals were removed from US Global Exotic's Texas facility last week, in a raid prompted by an undercover investigation by PETA. An employee working undercover in the facility for PETA documented various abuses.   The company now stands accused by the city of inhumanely housing the animals as well as denying them proper food, water and medical care. Hundreds of dead animals were found, and some animals had started eating one another to survive. An SPCA spokesperson said she stopped counting at 200 dead iguanas.

Buying certain things on the internet is fine. Buying live animals over the internet is something that you shouldn't even consider. This is a multi-million dollar industry that feeds off the naivety of people, the willingness of people to ignore serious welfare issues in their desire to get a unique pet, and the suffering of animals. Exotic pets can be good pets in certain situations, but tremendous numbers of them suffer and die from inadequate care at distributors, pet stores and homes, with many (many) more dying during smuggling.

If you want an exotic pet:

• Read a lot about it first. Make sure you can properly manage the animal and that it's legal in your area.
• Learn about any infectious disease risks and whether it's appropriate for your household. In general, exotic pets should not be present in households with children under five years of age, pregnant women, elderly individuals and people with compromised immune systems.
• Find a small, local breeder. Buy the animal from a place where you can see how they are raised so you can have more confidence they are healthy and have been properly cared for.
• If you want to buy an exotic pet from a pet shop, ask clear questions about the origin of the animal and request supporting documentation. Only buy a pet that was bred locally. US Global Exotics apparently sold most of their animals through pet stores.

Don't support illegal and unethical activities by buying exotic pets - if you really want to have such a pet, remember that it requires a lot of forethought and investigation of the source.

Click image for source.

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A five-year-old Oklahoma boy is recovering after being attacked by a beaver.  Beaver and attack aren't two words that you usually put together, but in this case the boy went to pet a 60 lb beaver that he saw outside and it proceeded to attack him, taking a "chunk out of his calf" in the process. The beaver was killed with a crowbar.

This is a pretty unusual situation. Beavers aren't known for attacking people, which should raise some red flags right there. Rabies should be considered in any mammal that acts abnormally. An aggressive act by a species not known for unprovoked attacks would certainly count.

The boy's mother went to "great lengths" to get the beaver tested for rabies. I'm not sure why great lengths were required since this was a bite from an abnormally-behaving wild animal in a rabies endemic area, but it's great that she was aware of the problem and acted accordingly. While the outcome was unfortunate for the beaver, the family is lucky that the beaver was killed and available for testing. If it had gotten away, they would have had to assume that it was rabid, meaning the child would need rabies post-exposure treatment. That's expensive and somewhat unpleasant (two initial shots and 3-4 boosters) but virtually 100% effective at preventing rabies (and since rabies is almost always fatal, it's a necessary procedure).

This report highlights a two key points:

• Leave wildlife alone.
• If you are bitten by a wild animal, make sure rabies is considered. It's very rare but fatal when it occurs, so you don't want to take any chances.

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As we approach the holidays, a lot of people are going to eat and/or drink too much, and suffer the consequences. The same can happen with dogs, and sometimes both the dog and their owner pay the price. Dogs get into things they shouldn't all the time... too much food, garbage, dead critters and various other "dietary indiscretions" can easily lead to diarrhea (and sometimes more serious problems). During the holidays, there's often a greater opportunity for dogs to steal food or to be fed too many treats or leftovers. Sometimes it's dramatic - like a 60 pound Lab eating a 15 pound turkey - but often the first sign of a problem is the pile of diarrhea on the floor (usually at 3 AM, in the case of my dog).

So, after yelling at the dog, blaming someone else for leaving food out, and perhaps cleaning off your foot (depending on where you stepped), how do you clean up this mess without getting sick yourself?

The good news is diarrhea from dietary indiscretions is not usually associated with zoonotic microorganisms like Salmonella or Campylobacter. However, those and other potentially harmful bacteria can be found in any dog feces, and you have to assume that diarrhea is infectious. The risk of infection of people is probably low, but you don't want to take unnecessary chances (especially over the holidays).

First things first: Clean up as much of the diarrhea as possible. Ideally wear gloves, and clean up the diarrhea using paper towels or something else disposable. Don't wander around the house with the diarrhea-soaked items - bring a garbage bag with you to the scene of the "accident".

After the bulk of the mess has been removed, your next step depends on a few things, including the surface, what you have available, and whether any high risk people are in the house (i.e. infants, elderly, people with compromised immune systems).

• Smooth, sealed surfaces (e.g. tile, laminate, sealed wood) are easy to clean and disinfect. A general cleaner can be used to remove traces of diarrhea. If you want to disinfect the area, use a general household disinfectant or dilute bleach solution (1 part bleach to 50 parts water). While general household disinfectants may not kill everything, I'm not sure aggressive disinfection is needed in most households. Thorough cleaning does a very good job, and we aren't trying to make the house sterile. I'd be more concerned about disinfection in a household with high-risk people (particularly infants who may crawl over that part of the floor). If you are concerned about bleach damaging the surface, use something else or test it on an out-of-the-way area.
• Carpet is problematic because it's pretty much impossible to disinfect. After removing as much diarrhea as possible, use of a carpet cleaning spray might be helpful (but it's more effective for removing stains, not pathogens). A few disinfectants can be used on carpets safely. Bleach isn't a good idea unless the carpet is already (or was originally) white. Even with a good disinfectant, you're very unlikely to kill all of the bacteria present, because of the ability of microbes to hide in fabric. Steam cleaning is another option.

Once that's done, don't forget the most important step: wash your hands thoroughly. (The second-most important step might be to cordon the dog off in a more easily cleanable area for the rest of the night in case further accidents occur).

Overall, the risk of getting sick from overindulgence-associated dog diarrhea is pretty low. I focus on cleaning up the mess and don't worry about thorough disinfection.  That's probably reasonable in a low risk household, but I'd be more wary around high-risk individuals.

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If an unvaccinated person is exposed to rabies (usually by a bite), they undergo post-exposure prophylaxis (PEP), consisting of an injection of anti-rabies antibodies and a series of 4 or 5 vaccines. (It used to be 5, but it was recently recommended to drop this to 4). This is a highly effective protocol which basically guarantees that the person won't get rabies IF the person is treated promptly.

If an unvaccinated pet is exposed to rabies, the situation is much different. The two options are euthanasia or a strict six month quarantine and a single dose of rabies vaccine either immediately or after 5 (of 6) months of quarantine.

So, if there is a  post-exposure treatment for people that is basically 100% effective, why don't we do the same thing in dogs and cats?

There are a few possible explanations for this:

1) Rabies is almost invariably fatal. The significant public health risks take precedence over animal health and pet owner inconvenience, stress and pet loss.

2) There is limited information about PEP in dogs, and results have been mixed.

• In one study (Hanlon et al 2002), experimentally-infected dogs were treated with various protocols. Treatment with rabies antibodies on day 0, followed by vaccination on days 0, 3, 7, 14 and 35 was effective at preventing rabies in 5/5 dogs - a good result, but the small number of dogs tested (5) prevents us from drawing any broader definitive conclusions. Rabies antibodies alone protected 4/5 dogs. All dogs that did not receive the antibodies but were vaccinated on days 0, 3, 7, 14 and 35 died of rabies.
• In another study (Manickam et al 2008), all exposed dogs were protected by rabies vaccination on days 0, 3, 7, 14 and 28. A 3-dose regimen (days 0, 5 and 28) was protective with one vaccine but not another.

Clearly, based on the limited number and small size of these studies, and the differing results, we cannot recommend a canine PEP protocol with confidence. However, these studies strongly suggest that PEP can be effective in dogs, and I think we need to consider when and how to use it. I wouldn't necessarily use PEP to replace quarantine without more evidence (i.e. field studies). I think the use of PEP to help protect the dogs while maintaining quarantine to protect the public is a good start. If canine PEP can be shown to be as effective as PEP in people, then some day quarantine might not be needed.

Regardless, this situation highlights the need for current vaccination of all dogs and cats in rabies-endemic areas. If a vaccinated animal is exposed to rabies, there is no requirement for euthanasia or long, strict quarantine. Rather, standard guidelines recommend giving the pet a rabies vaccine (booster) and having the animal observed by their owner for a period of 45 days. Developing better PEP protocols for unvaccinated animals is useful, but I'd prefer to see it become a moot point as a result of high vaccination rates.

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I had an advice call recently about the risk of hepatitis C transmission by cat scratches. Hepatitis C is a human virus that can cause serious liver disease. It is most commonly transmitted via the blood of infected individuals. The concern with cats in this case was whether there is a risk of transmission if a cat were to scratch someone with hepatitis C and then scratch someone else.

There are no reported cases of hepatitis C transmission via a cat scratch. For transmission to occur, the following must happen:

• The cat must scratch an infected person who has hepatitis C virus circulating in their bloodstream.
• The scratch must draw blood, which then contaminates the cat's claws.
• The virus must survive on the cat's claws.
• The cat must scratch someone else deep enough to draw blood.
• Hepatitis C virus must go from the cat's claws into the person's bloodstream and survive.

The odds of this sequence happening are very low. It's similar to the concerns about HIV transmission from dog bites - theoretically possible, never proven, and probably of very little concern.

This could be seen as similar to the situation with needlestick injuries in people: someone draws blood from an infected person, and then promptly sticks his or her finger with the needle by accident. Hepatitis C is not efficiently transmitted by needlesticks; only about 1.8% of people that get stuck in this manner (with a needle contaminated with blood from a hepatitis C-positive individual) develop antibodies against the virus. The risk is highest with hollow-bore needles (such as those used for injections and blood sampling) compared to needles used for sutures, because of the greater volume of blood that could be transferred via a hollow-bore needle. Cat scratches are presumably more like surgical needle punctures - there can only be contaminated blood on the outside of the claw, not inside it.

The only time I might have any concern would be if I suffered a significant scratch injury from a cat that had immediately before that caused a major injury in a hepatitis C-positive individual, such as in a situation that might be encountered when two people were breaking up a cat fight, or when someone was trying to pry an attacking cat off another person. It's a very unlikely scenario, and the associated risk would still be extremely low.

Bottom line: Don't worry about hepatitis C when around cats and infected people. Use common sense measures to avoid being scratched at all times.

Image source: www.gooddog.co.uk

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A very poorly-written and confusing report suggests that another Streptococcus zooepidemicus outbreak is underway in dogs in a shelter in Ohio. Five of 175 dogs on the premises died suddenly of hemorrhagic pneumonia. The report variably mentioned a "virus that mutated from horses," that it's thought to be "not contagious" despite multiple dogs being affected, and that it's a "rare form of streptococcus" (a bacterium). Presumably, they are dealing with a group of dogs with Streptococcus zooepidemicus pneumonia (technically, Streptococcus equi var. zooepidemicus). This bacterium predominantly lives in horses but periodically causes infections in other species. Outbreaks in dogs are uncommon but have been reported in other shelters. I assume that cultures from the dead dogs identified the bacterium, otherwise other possible causes such as canine influenza would also have to be considered.

The statement about it not being contagious is bizzare. Obviously, it is contagious between dogs. It may have been referring to dog-to-human transmission, but while that's rare it has been reported.

The shelter is apparently treating all dogs with penicillin prophylactically (i.e. to prevent any more dogs from getting sick). There's no clear guidelines regarding management of S. zooepidemicus outbreaks in kennels. It's now known whether mass antibiotic treatment does anything helpful, but it has been used in other outbreaks. I think it's likely that these outbreaks stop on their own, rather than penicillin having a major impact, and that there's probably another underlying cause such as a viral infection to account for outbreaks of this rare disease. However, that's just speculation for now. Hopefully this outbreak will cease with whatever treatment and infection control measures they put in place (or on it's own). Hopefully a good review of routine infection control practices will be performed at the same time, as routine practices (or lack thereof) are often a major problem in shelters.

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An article in an upcoming edition of Transplant Infectious Disease (Gisel et al) describes a case of Bordetella bronchiseptica pneumonia in a person who had received a kidney and pancreas transplant. This person had to board her dogs at a veterinary clinic while she was hospitalized for a bowel obstruction that occurred after surgery. The clinic required her dogs to be vaccinated against Bordetella bronchiseptica, a cause of canine "kennel cough." They were vaccinated intranasally (i.e. up the nose) with a modified live vaccine comprised of live B. bronchiseptica that is modified so it is unlikely to cause disease but can still induce a good immune response. The owner developed pneumonia after returning home and B. bronchiseptica was isolated. Specific testing was not performed to confirm that the vaccine strain caused disease, so it's possible that she was infected by the normal (i.e. "wild type") B. bronchiseptica (which still would have presumably come from the dogs).

Immunosuppressed individuals are at high risk for infection by microorganisms that usually don't cause disease in otherwise healthy people. Bordetella bronchiseptica is a good example of this. Care should be taken around pets by anyone whose immune system is compromised. Here are some recommendations pertaining to kennel cough vaccination:

• Immunosuppressed individuals should not receive modified live vaccines themselves, and it is probably prudent to extend this recommendation to avoid modified live vaccination of their pets with vaccines like the Bordetella (kennel cough) vaccine.
• If vaccination for kennel cough is required for entering a kennel or vet clinic, an exemption should be sought because of the potential risk to the immunocompromised person.
• If vaccination must be performed, injectable vaccination is preferred. It doesn't produce as good immunity in the dog compared with intranasal vaccination but the risks to the immunocompromised owner would be much less.
• If intranasal vaccination with modified live kennel cough vaccine is used, immunocompromised owners should not be in the same room during vaccination. They should avoid contact with the dog's mouth, nose and face for at least a few days after vaccination and should wash their hands (or use a hand sanitizer) regularly after contact with the dog.
• If respiratory disease develops in someone exposed to a dog recently vaccinated against kennel cough, the potential for vaccine-associated disease should be mentioned to the physician.

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H1N1 influenza was diagnosed in two dogs in China, bringing increased calls to pay attention to other animal species when it comes to this disease.

I'm more surprised by this than finding H1N1 in a cat or ferret. Dogs are susceptible to influenza and have their own circulating influenza strain (H3N8, originally from horses) but they rarely get other types of influenza. It's just an example of "rare things happen rarely, but they do happen." As with cats, it is now apparent that dogs are susceptible to this virus, although presumably minimally susceptible given the very low incidence of reported canine infections. This doesn't change our basic recommendations for dealing with H1N1: infected people should reduce contact with all individuals in the household, human or otherwise. People should be aware but not worried about the potential for pets to acquire H1N1. The risk of animals transmitting H1N1 back to people is unclear. It's theoretically possible but in practicality, a pet that gets H1N1 most likely got it from its owner, who's already exposed the rest of the household members as well.

Vaccination against canine influenza will not provide any protection against H1N1.

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I heard this on the radio yesterday morning, I kid you not: Butterball has a "Turkey Talk" toll-free helpline, which naturally gets busy around turkey holidays like Thanksgiving and Christmas.  Like many helplines, they get stories of every kind, and this year apparently one person called in and asked if it was alright that she thawed her frozen turkey in the bathtub - while her kids were in it taking a bath!

Anyone who has read anything about food safety hopefully knows that raw meat can potentially be (and usually is) contaminated with many different pathogens - that's the biggest reason why observing proper cooking times and temperatures is so important.  Raw poultry in particular should basically be treated like it's contaminated with Salmonella and/or Campylobacter until proven otherwise.  You can just imagine the field day that these bacteria could have in a nice warm, wet bathtub - it's just the way they like it, and it's exactly what we try to avoid in the kitchen, where food is ideally kept either nice and cold or nice and hot in order to prevent (or at least minimize) bacterial growth.  Then of all things to put young children in this veritable cesspool of bacteria - turkey and all - it's just a gastrointestinal disaster waiting to happen.  You also needs to consider what the turkey could become contaminated with sitting in bathwater.  Even children who don't have diarrhea can be shedding intestinal pathogens - human pathogens which are obviously transmissible to other people.  If you really cooked that bird well (maybe deep-fried it) I suppose that should ultimatley eliminate any surface contamination anyway, but I don't think I'd be able to get past the "ick" factor.  Don't throw the baby out with the bathwater, but of there's a turkey in there (as far as I'm concerned) that can go.

I realize this is primarily a food safety issue, but it made me think about what else this person (or others) may put in a bathtub.  In previous posts in which we've talked about reptiles kept as pets (all of which should be treated as Salmonella carriers), we've mentioned that ideally (if they need a bath) they should be bathed in their own designated container (like a big rubbermaid) and not in the bathtub.  If there is no other option and the bathtub must be used, it should be thoroughly cleaned and properly disinfected (keeping contact-time with the disinfectant in mind) before it is used again by a person (especially children). 

Ideally the same precautions should be taken if you bathe a dog in the bathtub, but the risks are not as high as with reptiles (unless the dog is very dirty, has skin lesions, or has (or recently had) diarrhea).  We've talked about the limited risks of allowing dogs in backyard swimming pools (but of course there is even less chlorine in bath water).  I hope no one ever bathes their dog with their kids - we could debate the risks, which likely aren't high anyway, but in the end the risk is simply unnecessary.  The pool is one thing, but there's no reason for a dog to be in the tub at the same time as the kids (and really, how clean are the kids going to get with a dirty dog in the tub?).  If you're trying to save water you can always throw the dog in after the kids are out.

If you're attempting to bathe a cat in the tub... well, based on most feline behaviour I'd say your primary risks are bites and scratches more than enteric bacteria and parasites.  Proceed at your own risk!

A happy (and hopefully healthy) American Thanksgiving to all of our US readers!

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A recent editorial in Nature Microbiology Reviews by Dr. Didier Raoult raised questions about the potential role of probiotics in obesity.  It is based both on studies indicating weight gain in humans and farm animals in probiotic trials as well as some laboratory animal data. The conclusions based on clinical trials for treatment of disease are pretty weak, since while animals or people may have gained weight, that does not mean they gained fat (if you get better because of a probiotic, you gain weight, but that is probably a healthy response and not obesity). There is some interesting lab animal work that shows changes in fat deposition in response to some probiotics, but it's rather preliminary.

It's way too early to declare that consuming probiotics is a risk factor for obesity. Several letters to the Editor were submited by leading probiotic researchers in response to Dr. Raoult's editorial, contradicting some of the statements that were made. Personally, I don't see convincing evidence of a risk but Dr. Raoult's comments should serve as a reminder that probiotics can have broad and poorly understood effects on the intestinal bacterial population, and correspondingly broad and poorly understood effects on the body. That's why probiotics should be scrutinized like drugs, in terms of safety, effectiveness and quality control. If someone is using a probiotic for themselves or their pet for a defined reason and it seems to be working, I wouldn't recommend stopping because of these largely theoretical concerns about obesity. However, we should perhaps think about why we are using probiotics and the potential costs versus benefits. I doubt this is really going to be a major issue but it's a good one to think about.

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Campylobacter bacteria are important causes of disease in people. Many Campylobacter species exist, and these different species vary quite a bit in their ability to cause disease in people and animals. Campylobacter jejuni is one of the most common causes of diarrhea in people worldwide, and is most commonly associated with contaminated food.  However, a few studies have reported that having pets (especially pets with diarrhea) is also a risk factor for Campylobacter jejuni infection.

Another Campylobacter species that may be of concern is Campylobacter upsaliensis. This species is primarily associated with dogs and cats, and a large percentage of healthy dogs and cats may be shedding this bacterium in their stool at any time. It doesn't seem to be a cause of disease in dogs and cats, but it may be an important and overlooked cause of disease in people. One study from the US reported that C. upsaliensis was the 2nd most common Campylobacter strain found in people with diarrhea (after C. jejuni). However, the true role of this species is unclear, partly because of common laboratory testing methods. Culture is the main method used to diagnose infection with Campylobacter, but this bacterium can be difficult to grow in the lab. Usually, culture media for Campylobacter contain antibiotics to inhibit other better/faster growing bacteria. Unfortunately, C. upsaliensis is often inhibited by these antibiotics, so it's likely to be missed in these cases even if it is there. Therefore, we might be underestimating the role of this Campylobacter species in diarrhea. This is an critical issue to investigate because C. upsaliensis is so common in dogs and cats, and it's important to determine what role pets play in human disease.

Avoiding Campylobacter infection involves some basic steps: avoid contact with feces, take care when handling diarrhea from pets, wash your hands regularly after handling pets and always wash your hands thoroughly after any contact with feces. Make sure your physician knows you have pets. In particular, if you have a pet with diarrhea or have recently acquired a new pet (especially a puppy or kitten), make sure Campylobacter infection is considered if you get diarrhea. Most infections are mild and go away on their own but some require specific treatment.

More information about Campylobacter can be found on the Worms & Germs Resources page.

Image credit: CDC/ Dr. Patricia Fields, Dr. Collette Fitzgerald

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The topic of the potential for feral (stray) animals, particularly cats, to be sources of human influenza infection came up today. For feral animals to be a public health problem, the following sequence has to happen:

Feral animals need to be exposed to H1N1

• This is pretty unlikely. Influenza is spread through close contact, mainly through aerosols generated by an infectious person coughing, sneezing or breathing. Influenza only travels short distances in this manner. The likelihood of a feral animal being exposed to the H1N1 influenza virus is very low because it is rare for a feral animal to get that close to people. If there is close contact, it's probably very short term, and not high risk for exposure.

They need to become infected AND shed appreciable levels of virus

• Considering the number of infected people, how common pet cats are, and the fact that only one cat has been diagnosed with H1N1, the risk of actually transmitting the virus to a cat is very low even with close contact with an infected person. If tens of thousands of household pet cats have had close and prolonged exposure and only one infection has been diagnosed, this virus is pretty poorly transmissible to cats.

They need to be exposed to susceptible people

• As discussed above, there's not too much contact between stray cats and people. Close and prolonged contact is extremely rare. Influenza is only shed by infected individuals for a short period of time, unlike some other infections. So, the chance of an infected cat having close contact with a person during the relatively short infectious period is very low.

Each one of these events independently is very unlikely. When you combine them, it should be clear that the risks posed by feral cats are extremely low (probably about as close to zero as we get with infectious diseases).

A bigger concern might be someone infecting their indoor/outdoor cat, who would then infect a stray cat, which would then infect another indoor/outdoor cat, which could infect a family member. That's still a VERY unlikely situation - really it's nothing to worry about.

There are certainly public health issues with feral cats. H1N1 is not one of them.

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Three Louisville, Kentucky children and their father recently contracted Salmonella from two lizards (green anoles) that the kids brought home from school. Two weeks after the lizards were brought home, the youngest child got sick. Then the other kids and the father got sick.

This outbreak highlights numerous problems:

Schools are not pet stores: Why is an exotic (and difficult to care for) pet that is a known Salmonella vector being sent home with students? Apparently, the school sent home a standard letter they use when students take home pets. (I assume sending animals home must be a very common event if the school has a standard form for it.) The letter provides "caretaking tips" but apparently mentions nothing about Salmonella and reptiles. The school has now modified the letter to include a "reminder to parents that good hygiene is imperative when dealing with any kind of living organism as a pet, so they need to make sure their kids wash their hands well after handling them or cleaning them out." That's better, but if they are sending home reptiles, they need a clear statement about the risk of Salmonella exposure. They need to be direct and highlight the greater risk associated with reptiles.

Lack of education before getting a pet: Too many pets die and too many people get sick because people don't take the responsible step of finding out about the animal before they adopt it as a pet. This is particularly true with exotic pets, and death of the pet is a common outcome. It doesn't take a lot of effort to find out basic information about reptile care, and information about the risk of salmonellosis should be easy to find.

Poor knowledge (or a poor attempt at damage control) by the school: The teacher "noted that other common pets, such as dogs, can also carry salmonella. Like lizards, they're perfectly safe as long as you practice proper handwashing when you handle them." Except for the fact that 0-1% of healthy dogs carry Salmonella while very high percentages of reptiles do, that tens of thousands of cases of reptile-associated salmonellosis occur every year, that contact with reptiles is a major risk factor for salmonellosis, and that the CDC (among other groups) recommends that children less than five years of age and other high-risk groups not have contact with reptiles.  This type of statement is misleading. It's unfortunately either an indication of ignorance of the issues or an attempt to cover their butts and not take their share of the responsibility for what happened.  Certain reptiles can be good pets in certain situations, but are clearly inappropriate in others.

The "it's never happened before so it must be safe" fallacy: The school's disappointing response was that they've been using lizards in classrooms for years and no one has gotten sick. Well, their luck just ran out. Just because I could drive around without a seatbelt and not get hurt doesn't mean not using a seatbelt is a perfectly safe plan. Risky behaviours tend to catch up with you eventually.

The "it didn't happen here so it's not our fault" excuse: School officials said teachers are well-trained on the proper way to prevent students from getting Salmonella, but that's pretty debatable since three kids got sick because of their actions (i.e. sending the reptiles to the children's home). The infections may not have originated in the school but the school was still the source of the problem.

Poor hygiene associated with reptile contact: The father admitted that they didn't wash their hands regularly after handling the lizards.

There's little excuse for sending reptiles home with kids. Reptiles require specialized care and commitment, and many (many!) die each year from inappropriate care. The last thing we need is to make it easier for people to obtain them without much forethought. Reptile-associated salmonellosis is a serious problem, especially in kids. Serious, including fatal, infections can occur. Schools need to realize the liability they might assume by sending these animals into households, especially with inadequate scrutiny and education. Reptiles should not be kept in  households with kids less than five years of age, pregnant women, elderly individuals or immunocompromised individuals. I doubt they asked whether any such people lived in the household before sending the reptiles home.

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One of the common questions accompanying the onslaught of calls I've taken today is "How do you diagnose influenza in pets?"

Clinical signs, such as sneezing, coughing, fever and lethargy, are not useful for diagnosis. Influenza can produce highly variable disease, ranging from almost none to very severe - so you can't look at an animal and say it has influenza just based on the clinical signs. We don't know much about H1N1 influenza in different animal species (including pets), but this type of influenza can probably cause a wide range of disease in animals as well (at least in those it can infect).

The presence of someone in the household with influenza should get you thinking about flu in a sick pet, but it is far from diagnostic. Many, many people have influenza, but very few pets do. There are many other diseases that can produce signs similar to influenza in pets. The health of people in the household is an important thing to know, but we can't jump to conclusions based on the household history alone.

Laboratory testing is required for the diagnosis of influenza, and there are a few options:

• PCR testing of nasopharyngeal (throat) or nasal swabs, or fluid collected from the trachea: This molecular test detects influenza virus RNA. This is the fastest test and it is most sensitive when samples are taken early in disease. This is the main option for diagnosis at this time.
• Serology: This involves testing blood for antibodies against influenza. Two samples are taken 10-14 days apart. If the antibody level rises 4-fold or greater, that is indicative of influenza infection. This is considered the most reliable method of diagnosis of influenza in many species but takes time. It is not currently a viable option for pets because tests for pets are not available.
• Virus isolation from nasopharyngeal or nasal swabs, or tracheal fluid: Samples are inoculated into eggs to try to grow the virus. This can take quite a while and isolation of the virus can be difficult. This is a method used by specialized labs with laboratory containment conditions appropriate for this virus and may not be readily available.

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I've written a few times in the past about the need for better definitions and guidelines for service dogs. Service animals are incredibly beneficial for some people, but there is great potential for abuse of the "service animal" designation by people who don't really need a service animal and/or are using completely untrained and sometimes inappropriate animals.

An example of such unscrupulous behaviour is RegisteredServiceDogs.com. At this site, you can enter your pet's name and your information, and get a form for your physician to sign requesting the dog be authorized as a service animal - but there is no such process, and this company has absolutely no authorizing power! Additionally, there's a place for a vet to sign affirming  that the dog being "registered" has had all shots required by the state and that, to the best of the vet's knowledge, it will not be a threat to the general public. There is no mention about whether the dog is healthy, is well-trained, is specially trained as a service animal, has undergone any real scrutiny to determine whether it could be a "threat to the general public", or anything else that should be a requirement for a true service animal. In other words, this company does absolutely nothing to ensure that the animal is an appropriate service animal. For their overwhelming effort of providing you with a form to fill out, they charge $49.95 to send you a worthless card saying your dog is a "registered service animal".

Anyone who has a real service animal has no use for a card such as this. If they run into someone who inappropriately tries to restrict their access, they're better off with information from the agency that trained the animal or, in the US, a copy of highlights of the ADA, since restriction of service animals is illegal.

If this company was really in it to help the cause of service dogs, it would have some standard criteria to ensure that the animals it certifies as service dogs are really service dogs. Otherwise, it's a money-grab to provide a useless card to people with true service animals, and a way to help people who just want to take their pets with them to places where they are banned. None of this helps the cause of true service dogs.  It is a disgrace.

Anyone with a service dog that has questions or concerns about access should contact the agency that trained their dog or another reputable (non-profit) source of information such as Delta Society.

Image source: www.guidedogsofamerica.org

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I was asked this the other day, in regards to a post about pets and recurrent strep infections in people: "You listed a few things to remember and one of them was how the pet might be an "innocent bystander infected by a family member."  Is there any indication that a dog  might get sick from licking a person infected with Group A Strep?"

Streptococcal infections in dogs are very rare. When they occur, they are typically caused by Streptococcus canis, a Group G strep. Group B strep infections have also been reported. I'm not aware of any reports of Group A (Streptococcus pyogenes) infections in dogs, despite the fact that exposure is probably very common.

Group A strep is a predominantly, if not exclusively, human pathogen. It can be found in healthy individuals (e.g. in the throats of 10-15% of healthy kids) and is the main cause of strep throat. Group A strep also causes invasive infections such as cellulitis, various soft tissue infections, and in rare circumstances, necrotizing fasciitis (flesh-eating disease). Considering how commonly healthy people carry this bacterium and how common strep throat is, you have to assume that dogs are frequently exposed to this bacterium from household contacts.

Licking a healthy human carrier would certainly create an opportunity for a dog to be exposed. Licking wounds of patients with strep infections would probably be worse. Since exposure is probably common and we don't really identify problems in dogs with this bacterium, the risk of infection in dogs is presumably very low. However, basic measures should always be used to reduce the risk of exposure to infectious agents. Even though we don't recognize Group A strep as a problem in dogs, you don't want your dog to be the first case. Dogs shouldn't be allowed to lick infected wounds for both the health of the dog and the person. Strict avoidance of people with strep throat doesn't make sense, but licking should perhaps be avoided since the sick person could also be at higher risk for a secondary infection from the multitude of bacteria present in the dog's mouth.

Bottom line... the risk of Group A strep infection in dogs is minimal, but basic hygiene practices can make the risks even lower.

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A report from Seattlepi.com is a textbook example of what can happen to certain people after dog bites. Mike Moore tried to break up a fight involving his two dogs and received a minor bite. It barely broke the skin. No big deal, eh? Well, perhaps for most people, but unfortunately not for Mr. Moore.

He cleaned the wound and didn't think much about it. Two days later, he thought he had the flu. The next day, he was worse and went to the hospital. By the time he arrived, "his face and body had a bluish tint" ...never a good sign. When he was being examined, he was asked about the scar on his abdomen and he told the hospital staff it was from his spleen having been removed. They then asked about the bandage on his hand and he mentioned the dog bite. (Insert big ringing bells here!) The article says that the medical staff couldn't pinpoint the problem right away, but hopefully Capnocytophaga was a leading thought. Mr. Moore was critically ill by this point with multiple failing organs. He was admitted to ICU, became septic (overwhelming infection in his bloodstream) and was put on a ventilator. His hand had to be amputated, as did both legs below the knee and three fingers on the remaining hand.  But he survived. (Despite the obvious long-term problems, he's very lucky to be alive after such a severe infection).

People that have had their spleens removed or who have non-functional spleens are at much greater risk for various infections, such as Capnocytophaga infections. No one should be allowed to leave a hospital after having their spleen removed without a letter saying, among other things, if you are bitten by a dog, get thee to a physician (pronto)! If you don't have a functioning spleen, make sure you know the risks and how to protect your health. 

More information about Capnocytophaga and bites can be found on the Worms & Germs Resources page and in our archives.

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Just when all those turkeys that managed to survive Thanksgiving weekend thought their troubles were over, there's new issue: H1N1 influenza (formerly known as swine flu) has been found in an Ontario turkey flock.  The H1N1 virus was first reported in birds in Chile in late August.

This is not a reason to panic.  No one can get the flu from eating a properly-cooked Thanksgiving turkey (nor from any other type of properly-cooked turkey).  The producer has voluntarily (and very responsibly) quarantined the affected flock, and no birds or eggs have left the facility.  There is no risk to the food chain.

Pigs can be infected by human, pig and bird flu viruses, and multiple infections can result in viruses trading genes and producing new viruses that can infect more species.  So it's not too surprising that H1N1can infect people, pigs and now birds as well.  This incident serves as an important reminder that we need to remain diligent about infection control and hygiene, even around animals.  It's highly unlikely that these turkeys had contact with infected pigs - most likely the virus was spread to this flock by a person.  Poultry producers may therefore need to consider getting vaccinated for H1N1 flu not only to protect themselves, but also their flocks, and anyone who may have the flu should definitely stay off these farms.  Hopefully the virus does not become established in wild bird populations (like H5N1 has in some areas), as this would make it much harder to control.

Recommendations for avoiding the flu (H1N1 or other) remain the same:

• Wash your hands and/or use alcohol-based hand sanitizer
• Sneeze into your elbow
• Disinfect commonly touched surfaces
• Stay home if you are sick
• Get vaccinated!

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You'd think, after countless outbreak of salmonellosis associated with pet turtles, that people would learn and things would start to improve. I guess not. A paper published this week in Pediatrics (Harris et al) described a large outbreak of Salmonella Java associated with pet turtles. Between May 2007 and January 2008, 107 infections were identified. The median age (the age in the middle of the range of affected people) was seven years old. Sixty percent of infected people reported exposure to turtles during the week before they got sick; 87% were small (<4 inch) turtles, and 34% were purchased at a retail store (despite the fact that the sale of turtles less than 4 inches long is banned in the US). Five infected people, all less than 10 years of age, reported kissing the turtle or putting it in their mouths.

When they compared people with Salmonella Java infection to people without the infection, 72% of people with Salmonella reported contact with turtles versus only 4% of controls.

Salmonella is far from rare but it's nothing to ignore. Thirty-three percent of infected people were hospitalized. Fortunately, no one died.

The link between turtles and Salmonella has been known for a long time. Healthy turtles can carry the Salmonella bacterium and be a source of infection, particularly for children. The sale of small turtles is banned in the US to reduce the likelihood of close contact between turtles and kids, but this law is widely flouted. An understanding of the link between turtles and Salmonella is surprisingly uncommon - only 32% of Salmonella patients in this study (and 28% of controls) reporting knowledge of this link. Clearly, there are a lot of areas which could be improved.

• If banning the sale of small turtles is truly an effective measure, then it should be enforced. "Black market' turtles are far too easy to find.
• More public education is needed, among the general population and particularly people buying turtles. You shouldn't be able to take a turtle home from a store without an information sheet about the risk of Salmonella and how to avoid it.
• People with turtles (or any reptile) need to recognize the risk and act appropriately. Good general infection control and hygiene measures are needed to reduce the risk of Salmonella exposure.
• Households with children under five years of age, or with immunocompromised individuals should not have pet turtles.
• Antibiotics are not the solution. Attempts to create Salmonella-free turtles with drugs have just led to the production of turtles carrying antibiotic-resistant Salmonella.
• Common sense needs to be a little more common. The picture above (from http://www.familylovezone.com/js_DeepAndWide.htm) was proudly posted by a parent.

More information about infectious disease risks associated with turtles can be found on the Worms & Germs Resources page.

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When I talk about methicillin-resistant Staphylococcus pseudintermedius (MRSP), I usually say that the human health risks are low because human infections are very rare. However, rare doesn't mean it can't happen, as demonstrated by a case report entitled "Beware of the Pet Dog: A Case of Staphylococcus intermedius Infection" published in the American Journal of Medical Sciences (Kempker et al 2009).

This paper reports about a post-operative sinus infection in a 28-year-old woman. Cultures were taken and the bacterium was initially misidentified as a coagulase-negative Staphylococcus. It was then misidentified as S. aureus, and finally determined to be S. intermedius. In reality, that's probably another misidentification because the bug almost certainly was truly S. pseudintermedius. (It's become clear over the past couple years that S. intermedius is basically non-existent in dogs and that what has been called S. intermedius in the past is truly S. pseudintermedius).

It's important to remember that human infection with S. pseudintermedius is a rare event. Whenever you see a single case reported, you know it's a pretty uncommon or novel event. Further, this was a post-operative infection, not a spontaneous infection occurring in a low-risk person. At the same time, we need to make sure we don't completely ignore the potential risks. While the risk of transmission of S. pseudintermedius (including MRSP) seems to be very low, we shouldn't ignore it completely. Isolation and other strict measures aren't indicated when dealing with a pet with S. pseudintermedius infection, but general attention to basic hygiene practices and avoiding contact with the infected site is still a good idea.

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Here's a recent question: "Can a rabies virus get into the body if you pick up a dead animal the roadway and have a cut on your hand? I understand the animal has to carry the rabies virus but sometimes we don't know what killed the animal. It may be infected and didn't use due diligence or perhaps it just wasn't fast enough. After reading stories here I'm less likely to remove a dead animal. Sometimes they are so juicy, the fluids are flung about and you may get some on your clothes or skin and not know it. How likely is contracting rabies from fluids in a cut? The reason I ask is when I was younger I picked up a dead squirrel with my bare hands and then noticed I had cuts on my hands. I went to a doctor who looked at me like I was crazy but I had that uneasy feeling because I knew rabies is almost always fatal. Of course, I didn't get it but when I watch other people remove dead animals from roadways I cringe. I can't even think about eating roadkill or skinning it for the fur but that's just me."

Good question. You've covered most of the important aspects of risk, which are pretty minimal:

• Animal has to be infected
• Live rabies virus needs to be present
• Rabies virus needs to get into a person's body (not just on it)

Let's look at these individually.

Animal needs to be infected

• You never know whether this is a concern when you find a dead animal. Once it's dead, you can't tell if it's acting strange. In general, it's safest to assume that all such animals are infectious until proven otherwise.

Live rabies virus needs to be present

• I haven't come across good information about how long rabies virus can survive in a dead body outdoors.  It probably varies greatly between different situations, particularly depending on the temperature of the body. For very fresh roadkill, there's certainly a possibility that live virus is still present (if the animal had rabies).

Rabies virus needs to get into a person's body (not just on it)

• Rabies cannot be transmitted through intact skin. Rabies infection is transmitted mainly through bites, cuts and scrapes. Saliva or nervous system (e.g. brain) tissue are infectious. Blood, urine and feces are not.
• If you have contact with a dead animal, avoid any direct contact with your skin, and avoid any activities that could result in splashing of fluids. Transmission of rabies from infected fluids is possible if it comes in contact with broken skin or mucous membranes like the eyes or mouth.
• If intact skin has been contaminated with fluid, wash it thoroughly with soap and water, but don't panic - it's really of minimal concern.
• If your clothes have been contaminated with fluid, take them off right away if possible.  If that's not practical (or legal), take them off as soon as you get home. Put them in the laundry immediately and wash your hands.
• If open sores or other broken skin has been contaminated, wash the area thoroughly with copious amounts of soap and water under moderate pressure. Disinfectants can be used to help clean the wound, but there's no consensus about whether that's necessary - these chemicals can be painful to use and hard on tissue, and the flushing action of the water probably does the most to remove the virus from the area. You should go to a physician, who will get in touch with public health personnel to determine if there is any reason for post-exposure treatment.  If the animal's body is available to test, that's useful. If the brain has decayed too much to be tested properly, it's questionable whether live rabies virus would still be present even if the animal had rabies.  Public health personnel will decide whether they think there is any risk.

Bottom line: the risk of contracting rabies from roadkill is very low. Roadkill contact has never, to my knowledge, been identified as a source of infection. Rabies transmission from dead animals has been documented, however, such as a couple cases of rabies from people preparing dead animals for food.

So, if you see a dead animal by the road, leave it alone. If you are going (for some reason) to touch it, first make sure it's really dead. An injured animal might be much more likely to bite. If it's really dead and you are just trying to move it off the road, use a stick, shovel or something else that doesn't involve you having direct contact with the animal. Other than that, I'm not sure why anyone would want to touch roadkill.

Image (top) from www.michiganimaging.com
Image (bottom) from http://users.frii.com/donlight/archive/97arc.htm

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Clostridium difficile is a high-profile bacterium, being an important cause of illness and death in people. It can also be found in various animal species, including dogs and cats. In a study we published earlier this year (Lefebvre et al, Journal of the American Veterinary Medical Association, 2009), factors associated with acquisition of Clostridium difficile by dogs involved in hospital and non-hospital therapy programs were assessed. Things that were significantly associated with a dog acquiring C. difficile were:

- Contact with human hospitals: Not too surprising since it's clear that hospitals can be highly contaminated with C. difficile and the hands of some patients petting the dogs are probably also contaminated.

- Contact with children: Most parents know that kids are biohazardous (we've getting over a round of illness in our house brought home by the kids - not an unusual event). Whether the increased risk for dogs is because kids have higher rates of C. difficile carriage, or because they have closer contact with dogs (with little hygiene) or some other factor isn't clear.

- Recent use of antibiotics: No surprise here. Antibiotic use is a well-recognized risk factor for C. difficile, since antibiotics can disrupt the normal protective bacterial population of the intestinal tract and allow C. difficile to grow.

- Recent use of antibiotics by a person in the house: I think this is a fascinating result and a great example of the close inter-relatedness of people and pets microbiologically. What presumably happens is that when someone is treated with antibiotics, they are more likely to acquire C. difficile and pass it in their feces. By doing so, there is a greater chance that their dog will be exposed to C. difficile, perhaps from the person's hands or the household environment. (The toilet would be a great source if the dog's a toilet-drinker). The implications of this, for both dogs and people, are unclear. It could be primarily an academic risk (i.e. of little practical significance), or it could be that interspecies transmission of C. difficile plays a role in disease in both species. We simply don't know at this point.

This is also a good example of why educational efforts regarding prudent antibiotic use need to be directed at both animal and human healthcare.

More information about Clostridium difficile can be found on the Worms & Germs Resources page.

Image source: www.sciencedaily.com/releases/2009/05/090507101820.htm

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In yet another tragic example of why large wild species should not be kept as pets, a 37-year-old Pennsylvania woman was killed by her pet black bear. She entered the 350 pound bear's cage, a 15 by 15 foot steel and concrete enclosure (hardly a good environment for a bear) and was mauled. A neighbour then shot and killed the bear. A Bengal tiger and African lion were also present on the property. No indication was given about what might have triggered the attack.

Large carnivorous mammals don't make good pets. It's also questionable whether people can adequately and humanely care for such animals. I have a hard time believing the bear had a good quality of life living in a small steel and concrete pen. The picture above is not from this case but from another bear enclosure elsewhere  in Pennsylvania (see link here).

Every year, there are reports of these types of "pets" severely injuring or killing their owners, yet there is little effort in many regions to control the ownership of these animals. Local officials knew about these animals and the woman had permits for them. Why (and how) someone could actually get a permit to keep these species is beyond me.

Pets are great, but pet ownership has to be logical and safe, and there have to be benefits for both the human and animal. Keeping dangerous animals locked up for curiosity's sake is no longer (or at least should no longer be) socially acceptable. These animals should be in the wild or in a properly managed zoo or wildlife rehabilitation sanctuary.

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There is a recent paper in Preventive Veterinary Medicine about a study of Giardia in canine stool samples collected from urban green areas around Pisa, Italy (Papini et al). The authors went to parks and similar areas and collected stool samples off the ground. They then tested the samples for the presence of Giardia and (very importantly) tested the Giardia to determine whether they were types that typically only infect dogs or whether they were types also found in people.

They found that 31% of stool samples contained Giardia. That's higher than in some recent North American reports. The number of Giardia cysts ranged from 2 to 1428 per gram of feces. Less than 1% of the Giardia were types that are of concern for transmission to people. Therefore, they concluded that parks pose a risk to dogs, since there is a good likelihood that dogs could be exposed to Giardia. However, the risk to people from Giardia found in these parks is minimal given the types that were found.

The risks to dogs and people can be decreased by the simple act of picking up poop.

More information about Giardia can be found on the Worms & Germs Resources page, and in our archives.

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A rabies epidemic continues in Bali, with little apparent control and inadequate access to vaccination. Another person died of rabies last week. He was bitten by a dog in July and taken to a local health centre, but rabies vaccine was not administered. It's not clear whether healthcare providers recommended post-exposure vaccination and the person declined or whether they did not offer vaccination. 

Access to post-exposure treatment in such regions is a serous concern. Apparently, up to 50 people a day are denied potentially life-saving post-exposure treatment because of a lack of adequate vaccine supplies. Because of the limited availability, doctors are focusing on treatment of people bitten by dogs in areas that are heavily infected with rabies. That makes complete sense, but it's still not a good situation.  It's not only those heavily infected areas that are a concern. More rabies vaccine needs to be secured so that everyone who has been potentially exposed can be properly treated. Local officials are blaming the current shortage on a holiday weekend, but it's unclear whether the situation is truly going to improve in the near future.

People traveling to any part of Bali need to be aware of the risks. You don't need to cancel your vacation, just use common sense. Don't approach any dogs or other mammalian pets or wildlife. If you are bitten, immediately go a physician. If rabies vaccination is not offered, ask for it. If it's not given, get on the next plane out of the country and get treated. You don't need to be vaccinated immediately after exposure, so don't panic, but you don't want to unnecessarily increase the risks if you have been bitten.

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