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

There are two situations when animals may be quarantined because of rabies concerns.

1. After biting someone
2. After potentially being exposed to a rabid animal.

The timeframe for these is quite different because what the quarantine is designed to accomplish.

Animals that have bitten someone are quarantined for 10 days so that they can be observed to see if they develop signs of rabies. This is important because most animals that bite do not have rabies and this is the easiest way of determining whether there may be a rabies risk from the bite. The reason behind the 10 day period is that if an animal was rabid and infectious at the time of biting, it would be dead within 10 days. Animals can only transmit rabies virus after it has reached the brain and started to spread outwards on nerves (it gets into saliva by working its way down nerves from the brain to the salivary glands). Once an animal gets to that stage of disease, they die quickly. So, if the animal is still alive after 10 days, it was not rabid at the time of the bite. Quarantine is important so that it can be clearly proven one way or the other whether the animal was rabid. If the biting animal was not quarantined and ran away, the recommendation would be to err on the side of caution and treat all exposed people...something we want to avoid if at all possible.

The second type of quarantine is based on less solid evidence. The idea behind it is to allow time to see if an animal that might have been exposed to rabies develops disease. For example, if an unvaccinated dog gets into a fit with a rabid raccoon, it would be considered potentially exposed. It would be quarantined (or immediately euthanized....the other option) and monitored to see if it develops signs of rabies. The length of quarantine for non-vaccinated dogs is usually 6 months but this may vary with region. This will help reduce further rabies transmission be ensuring that a dog that develops rabies during the quarantine period is not roaming at large and able to infect people or other animals. One weakness in this approach is the incubation period of rabies, which can be long. There is not a lot of objective research to base the 6 month duration on (unlike the 10 day quarantine described above). After 6 months, it's very unlikely the dog will come down with rabies but I don't think we can ever say it's 100% because of the rare cases of rabies in humans with extremely long incubation periods. In reality, it's likely that the vast majority of animals that were exposed will develop rabies, so it's a reasonable timeframe. Would it be better to use 4 or 8 months, or something else? Possibly. We just don't know.

The easiest ways to avoid hassles associated with rabies quarantine are:

• Prevent bites. If your pet is trained and observed properly, it's unlikely to bite anyone so the 10-day post-bite quarantine shouldn't be an issue.
• Vaccinate your pet. Properly vaccinated pets are not subject to the same long, strict quarantine.

More information about rabies can be found in our Resources section.

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Recently, I wrote a commentary about the need to better define what service animals are because of potential abuses and possibility that illegitimate use could impact real service animals. Here are some good comments from a reader.

As a service dog user and trainer who sometimes lectures at the University of Guelph, I am sorry to see the American-centric slant to this article.  In Canada the guideliines are even more vague and there has to be a charter challenge to support the use of a service dog that has been owner trained.

• The article was intended to discuss the American situation since I was talking about American legislation and responding to problems that people have asked me about in the US. Issues are different in various countries and the legal protections in the US certainly don't apply to Canada.
• The last point raises concerns. What constitutes 'owner trained'? Service animals are highly trained to do their specific task and to safely work in public situations. I'm not convinced owner training makes a service animal. There needs to be at least some degree of oversight of the training and certification process.

I use a service dog to mitigate the effects of my invisible disability and the vagueness of the laws related to service dogs in Canada has made travelling and working with my dog difficult.  I get comments that range from "you don't look disabled" (which I usually reply to with -thank you!
neither do you!) to "that dog doesn't look like he is doing anything and how can he help you if he is asleep (believe it or not, he does get to sleep when I stop to work somewhere, but will wake up and work if needed).

• Those are all legitimate concerns and I empathize with the problems you've had. That's why I think the 'spirit' of the US's ADA is excellent. Protections need to be in place for true service animals. As importantly, there needs to be education about what service animals are, what they do, and where they should be allowed to go. I also think your concerns support my comments...We need to make sure that service animals are properly scrutinized. If people know that service animals are properly trained and regulated, they are less likely to raise problems. If you never know whether a 'service' animal is really a service animal, then you may be less likely to give them the degree of respect and access they deserve.

I strongly feel that if you don't need a dog you won't take a dog with you; why would you?    It is too much work!  For anyone who would like to take their pet with them to the grocery store, I would be delighted to take them with me to show them what travelling through the meat aisle is like; people stop and stare.  You have to plan your route so that the grocery clerk doesn't park their cart under my dog's nose (no...he won't touch it...but why make his day harder than it needs to be).  You need to
be aware of the two year old who is covered in jam who wants to hug the doggy.    And you have to avoid hazards like the display of glass jars that tumbled and broke in front of my dog, surrounding him in glass shards with no way to safely walk out (stand stay!    what a useful behaviour).

• Sorry, but I disagree. I think that if a grocery store advertised that it was pet friendly, there would be dogs in there all the time. Some people bring their pets everywhere, not matter how much extra work it is.
• Also, the grocery store example is a great one to highlight concerns. There are public health reasons why we don't want widespread animal access in grocery stores. Check out a previous post about a 'service horse' walking through grocery store.
  

Life with a service dog is enriching for certain, but it is not something you want to do unless you need to.  I would advise anyone who is concerned about the illegitimate users to slow down, and think.  We are already protected.  If your dog is causing a problem, you can be asked to leave.

• In Canada you can. In the US you can't. That was the point of the article. In the US, you can't ask someone to make an animal leave except under very specific circumstances that a true service animal should never create. What we need is more protection in Canada and more clarity in the US.

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There's been a lot of talk (hype) in the press about pet bites and MRSA (methicillin-resistant Staphylococcus aureus). This relates to a paper in Lancet Infectious Diseases regarding infections associated with pet bites. Some press articles are more sensational than others, but most are taking the bite infection paper and building in unrelated comments about MRSA in animals to make it seem like there's a major MRSA dog bite epidemic underway.

I realize that MRSA is a hot topic that is easy for reporters to latch onto, but the problem is that the actual research related to MRSA is being blown out of context. MRSA was certainly mentioned here but was not the focus of the research nor do the authors play up concerns about pets as a source of MRSA infetions. Nevertheless, the impression people are getting from many news articles is that there is rampant MRSA transmission by infected pets.

Is MRSA infection a potential concern from a dog bite?

• Yes, but more because of the bite component than the dog. By that, I mean that MRSA infections that occur after a dog bite are probably the result of MRSA being deposited into the wound from the person's nasal passages or during a visit to the physician/hospital. It's possible that MRSA could have been in the mouth of the dog and transferred to the wound during the bite, but that's pretty unlikely. The bitten person or soemone treating the wound is a more likely source of infection. So, the bite was the ultimate cause of the MRSA infection, because the infection probably wouldn't have developed without that break to the body's normal defensive barriers, however the same thing could have happened with any similar form of trauma.

What do you do if you're worried about MRSA and dog bites?

• Worry more about dog bites than MRSA. Bites themselves are major problems, even if MRSA is not involved. The degree of trauma can be major and a variety of bacteria can cause serious bite infections, not just MRSA.
• Take measures to reduce the risk of being bitten, both in terms of how you handle and train your dog and how you interact with other dogs.
• If you are bitten, immediately clean the wound. If the bite is over a joint, tendon, prosthesis or genitals, if there is significant trauma or if you have a compromised immune system, you need antibiotics. If you have any concerns, get examined by a physician promptly.

More information on MRSA in animals can be found in our Resources section.

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At the same time that the country is drafting an animal welfare law that would ban widespread killing of dogs, a Chinese city has killed 36000 stray and pet dogs in an effort to eliminate rabies. Since late May, more than 6000 people have been bitten or scratched, and 12 have died of rabies. Certainly, that indicates multiple problems. One is the massive number of bites and scratches. Contributing factors probably include a large stray population, limited routine animal control efforts and inadequate education of the public regarding bite avoidance. The number of injuries and deaths certainly indicates that an aggressive response is needed. However, there's little evidence that culls have any effect. Efforts are probably better directed at other forms of population control, vaccination of stray and pet dogs and education of the public to keep stray dogs away and reduce the risk of bites. These types programs cost money, but the costs of treating 6000 bites and 12 fatal infections can be enormous. I don't know how many people received post-exposure treatment for rabies and what it costs in China, but it's estimated to cost ~$1500 in North America. That covers a lot of rabies vaccine for dogs.

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A recent study from the Netherlands investigated zoonotic parasites in feces and on pets' haircoats. The authors sampled feces and fur from dogs and cats, and looked for Toxocara (roundworms), Toxoplasma, Giardia and Cryptosporidium. All these are of concern from a public health standpoint because they can be found in healthy pets and can be infect people..

Toxocara eggs were found on the haircoats of 12% of dogs and 3.4% of cats. Levels were low, ranging from 1-31 eggs per sample. An important aspect of this study was that they also assessed viability of these eggs, and found that none were viable.  Therefore, even though eggs were present, they were not relevant because they were dead. Exposure to UV light and lack of humiditiy were cited as possible reasons for this.

Toxocara were found in the feces of 4.4% of dogs and 4.6% of cats, numbers that are consistent with other studies of healthy pets.

Toxoplasma was not found in the feces of any cat. (Cats are the hosts for this parasite so dogs weren't tested.)

Giardia was found in the feces of 15% of dogs and 13.6% of cats. However, when these strains were typed, the vast majority were species-specific types that do not cause disease in people. Only 2 of the 15 Giardia samples were assemblage A, a type that is transmissible from pets to people. This is very important to know because crude Giardia numbers don't tell you the whole story. 

Cryptosporidium was found in feces from 8.7% of dogs and 4.6% of cats. However, they were not able to type these to determine if they were species that are of concern for human infection or whether they were Cryptosporidium felis or C. canis, which rarely cause disease in people.

The discussion contains an interesting and relevant point about exposure to Toxocara eggs on the haircoat of pets. They state "Even in the worst case scenario of high contaminated fur, e.g. with the highest Toxocara [eggs per gram] of 300 and an embryonated rate of 4% from the study of Wolfe ad Wright, it is necessary to ingest more than 4 grams of hair, with 12 embryonated eggs per gram, to ingest 50 infective eggs." Based on these data, exposure to parasites from the haircoat of pets is quite unlikely. It might be a greater concern with stray or debilitated animals, or with puppies/kittens, who could have much greater coat contamination.

The take home message here: Normal contact with healthy pets likely poses minimal risk of transmission of zoonotic parasites. That being said, regularly washing your hands is still a good idea because of the potential for exposure to other types of microorganisms, and in rare circumstances where there may be large parasite burdens on a pet. Good deworming practices, particularly for puppies and kittens, also need to be considered.

Reference: Overgaauw et al, Veterinary Parasitology, 2009.

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Here's a recent question:

"We have a 'new' boxer age 2. The breeder believes in the raw food diet, and not many vaccinations or preventitive treatments. Recently the boxer has been shown to be heartworm positive, and she (the breeder) wants us to take a "holistic" approach to management. Are there any randomized trials to show any benefit to holistic treatment of heartworm?"

The quick answer is NO. There are no “holistic” treatments that have been shown to be effective in randomized trials, nor have any holistic treatments been shown to have any potential effect in in vitro studies. The only proven treatments are “conventional.” I consider it highly unethical to attempt other approaches because: 1) heartworm is a serious disease but one that can often be treated quite successfully and 2) untreated (or inadequately treated) dogs put other dogs at risk because they are sources of infection. Mosquitoes can transmit heartworm from infected dogs to other dogs in the area, and continue the cycle of infection. A serious and transmissible disease is not one for which unproven and likely ineffective treatments should be tried.

Heartworm is a potentially fatal disease that predominantly affects dogs, but can occasionally affect cats as well. It is most commonly caused by the parasite Dirofilaria immitis. It is spread by mosquitoes, which transmit the immature form of the parasite (microfilaria) which are found in the blood of infected animals. Upon being transmitted to a new host by a bite from an infected mosquito, the immature parasites eventually develop into adult worms. These worms lodge in the heart and the nearby blood vessels going to the lungs, and can cause a range of problems (e.g. lethargy, intolerance to exercise). Infection can be fatal - early (and effective) treatment is the key.

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Canadian Guidelines for the Treatment of Parasites in Dogs and Cats have recently been released. These guidelines were developed by an expert panel, consisting of six Canadian veterinary parasitologists and two private practitioners. They provide a good, balanced approach to the treatment of parasites, with an emphasis on the risks present in different regions and in different types of pets. There is very little objective information on which to base some of the recommendations, so many aspects are instead based on expert opinion, not necessarily hard facts, but when data are lacking, that's when opinions from independent experts are most needed. The guidelines provide an overview of recommended treatments along with an explanation of the reasoning.  This document is a useful resource for pet owners and veterinarians alike. There is also discussion about why guidelines in Canada differ from those in the US. To download these guidelines click here.

Note: Development of the guidelines was supported by a pharmaceutical company, but the information they contain was developed by the independent experts mentioned above.

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Recently, I wrote a post about the need for vets and physicians to communicate more, and about concerns that zoonotic diseases get missed because vets deal with animals and physicians deal with people, but few people pay attention to the interface between them. A reader (my father, actually) wrote this comment.

“...is the opposite also true? If I take my sick cat to the local vet, will he advise me to see my physician if I begin to feel ill effects? Are vets trained to know that pets can transfer disease to their owners or in this an emerging part of vet. science?”

It’s a good question and one that doesn’t have a straightforward answer. Vets certainly do get educated regarding zoonoses.  From what I understand from talking to colleagues in the human medical field, there is much more emphasis on zoonoses in the veterinary medical curriculum compared to the human medical curriculum. However, a lot of the focus is on foodborne and waterborne zoonoses, with much less information about companion animal (e.g. dog, cat, horse) zoonoses. Different vets have quite variable knowledge in this area, ranging from excellent to poor. It’s a huge field (I’m still learning more about it all the time), and vets and physicians alike have busy schedules and many other areas where they need to stay current as well, so it’s not unfathomable that zoonoses could get neglected.

So, to answer the question, if you take your sick cat to the vet, it’s unlikely he/she will initially ask about your health. However, if the vet suspects a zoonotic disease, hopefully he/she would tell you what it is and possibly what signs for which to watch out. Providing additional information would also be useful, which is why we're developing the information sheets that are available on our Resources page). At that point, the vet would typically (and reasonably) leave it up to you to determine whether you should see your physician and what should happen from there. In the grand scheme of things, it would be very useful for vets and physicians to have some form of dialogue or at least an understanding of each other's roles and a willingness to call each other when appropriate.

Both human and veterinary medicine have a long way to go to get to the "one medicine" concept that people like to talk about. I think we’re slowly moving in the right direction, but vets and physicians need to talk more to properly cover this important area of overlap between their professions.

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ProMed recently reported about an outbreak of canine brucellosis at a "puppy farm" in Ireland. Farm is definitely the appropriate word in this case, since this operation had about 700 breeding females. The picture on the right is not from this farm, but I imagine it's a similar operation. Beyond the concerns about humane management of dogs under these conditions, such a large operation creates perfect conditions for various infectious diseases.

"The farm's owner has refused to sign an undertaking not to move the dogs off-site before an official inspection can take place to investigate the extent of the [brucellosis outbreak]."

Lack of cooperation makes any disease investigation much more difficult. It's not surprising this person doesn't want to cooperate, given the type of operation he's running.

"Someone from the farm told the Irish Times that the 2 animal welfare agencies were involved in acts of "intimidation" against the establishment."

I suspect that "intimidation" in this case means the agencies were doing their job, because I can't see how there wouldn't be significant welfare problems at a farm of this type and size.

"'We got accurate information on Friday [2 May 2009] that this man was intending moving and selling these dogs and we acted on it,' according to Jimmy Cahill, chief executive of the DSPCA [Dublin SPCA]. 'The guards  were very helpful but the owners refused to let us see the dogs or any of the carcasses.' "

The reference to "carcasses" implies that deaths have occurred. Death from B. canis in dogs is very rare but it is possible. However, a poorly managed operation with hundreds of dogs is bound to have multiple issues that could cause deaths.

Canine brucellosis is caused by the bacterium Brucella canis. This main problem with this bacterium in dogs is reproductive disease, including abortion and infertility (in both males and females). Discospondylitis (inflammation of the discs between vertebrae in the back) can also develop.

Brucella canis is a zoonotic organism. Human infections are rarely reported but it is possible that some go undiagnosed. Brucella canis can be transmitted from dogs to people through contact with body fluids from infected dogs, including urine and vaginal fluids.  The risk of transmission is likely highest when handling animals during breeding or birthing. While the bacterium can be shed in nasal secretions and saliva, levels are low in these fluids and the risks are probably correspondingly low.

One problem with preventing B.canis transmission is that infected dogs do not necessarily show any signs of disease. In people, B. canis infection can cause flu-like disease, loss of appetite, weakness, joint and back pain, vomiting and diarrhea and various other symptoms.

To control the outbreak on this "farm," quarantine and repeated testing of all dogs is needed, and positive animals must be removed from breeding. Given the information provided above, it's pretty unlikely this will happen voluntarily. I suspect this person would likely either just get rid of these dogs and get more poor-quality breeding animals, or try to continue breeding these dogs and hope people get sick of looking into his operation.

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A UK man is on a campaign to raise awareness about Toxocara, following an infection that blinded the child of a family friend. Mike Kennedy, chairman of the Grange Residents' Association, is  raising awareness about the importance of picking up "dog dirt" (i.e. dog stool).

Toxocara canis is an intestinal parasite that can be found in a small percentage (likely 2-14% in Ontario) of healthy dogs, and a larger percentage of puppies. Toxocara cati is the feline equivalent found in a comparable proportion of cats. If a person swallows an infective egg - an egg that was passed in an animal's stool and allowed to sit around in the environment for a while - infection can occur. The parasite can migrate throughout the person's body, causing various types of problems. Migration into the eye (ocular larval migrans) can cause blindness. Migration through the brain (neural larval migrans) can cause serious brain injury. These are very rare diseases, but are obviously still a concern because of they can be so severe. The risks are highest in children and people with developmental delays, since they're more likely to swallow stool, dirt, or something else contaminated with stool.

Mr. Kennedy's emphasis on educating animal owners to pick up after their pets is the key. We know a small percentage of dogs and cats shed Toxocara in their stool. You never know exactly who is shedding the parasite at any time, so removing the source of parasite eggs, the stool, is critical.  Deworming pets regularly is also important, but it is only one component of parasite control. The frequency and type of deworming needed for dogs and cats varies between regions and animals.  Your veterinarian can design an appropriate deworming program for your pet. Such a program requires a balance between adequate deworming to reduce the risk of parasites in pets (and the associated risk for human infection) and using dewormers prudently to reduce the risk of parasites developing resistance to these drugs.

Photo credit: Michael Lazarev (Clyde, the bulldog puppy)

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Recently, I made a few comments about climate change and the potential impact on infectious diseases in horses on our sister site, equIDblog. A recent news article in New Scientist discussed concerns about climate change and pets. The main infectious disease concern regarding climate change is changes in patterns and spread of insect-borne diseases, because different insect vectors may expand their normal ranges or change their seasonality in response to climate change. Some of the examples cited in the article include:

• Babesiosis, a blood-borne disease spread by the European dog tick, is being found in areas of Europe where it was previously rare.
• Increasing populations and ranges of ticks have been reported in many countries, which is a significant concern based on the number of different diseases these ticks can carry and transmit.
• Leishmaniasis has been identified in dogs in the southern UK.  If climate change allows sandflies (the insect vector of this disease) to become established in the UK, then spread of this disease could become a major problem.
• Milder winters may result in longer periods of activity of some insects that transmit disease, thereby extending the times of the year when there is a risk of disease. In some areas, year-round risk could develop for diseases that were previously seasonal.

Climate change is a complex and still rather controversial topic. Predicting the infectious diseases implications of climate change is difficult.  Information that is already available for some diseases, combined with general knowledge about microorganisms and their hosts, can help us make some educated guesses about what may happen. While the full scope of the impact cannot be predicted, it is almost certan that climate change will result in infectious disease challenges in both veterinary and human medicine.

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Quarantining animals that have potentially been exposed to rabies is a standard practice, but quarantining a whole town is new to me. Because of a large increase in rabies cases in the Flagstaff, Arizona area, a rabies quarantine was established on April 8th by the Coconino County Board of Supervisors. The quarantine requires all dogs and cats to be enclosed or secured on their owner's property. When off the property, animals must be on a leash that is no longer than six feet in length. All dogs and cats must be vaccinated, and low-cost rabies vaccine clinics have been held to help increase compliance with this requirement. Vaccination of wildlife using baits containing an oral form of rabies vaccine will also be performed. The quarantine also restricts feeding and interacting with wildlife. Also, people cannot leave pet food outside after sunset and all compost piles must be completely enclosed.

This is an aggressive approach to rabies control in an area experiencing a wildlife outbreak of the disease. They've implemented comprehensive but still quite practical measures that should help reduce the risk of exposure of domestic animals (and people) without a significant negative impact on pet owners. I've mentioned my concerns about rabies vaccine clinics in the past, but this is a situation where I think it's a good idea.

It's always hard to evaluate the effectiveness of outbreak measures, because you never know what would have happened if nothing had been done. Regardless, it will be interesting to see how well this quarantine works, both in terms of the number of new rabies cases they see and the response of citizens to these restrictions. It would be very useful if Coconino County personnel provide information about how things went when the quarantine is over - the information might be useful for management of future rabies outbreaks.

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Over 50% of households in Canada and the US have pets, and the numbers are probably similar in many other countries. Pets are often considered part of the family socially but we need to consider them part of the family biologically as well. It's clear that diseases that be transmitted between people and pets - in both directions. Unfortunately, it's also clear that physicians and vets don't do a very good job talking to each other.

Pet contact (and animal contact, in general) should be part of the standard history obtained by any physician.  In my perfect world, every medical record would include a permanent record of contact with pets or other animals. This information is potentially useful because certain diseases that are not a big issue for non-pet owners may need to be considered (or may be higher on the list of possibilities) in pet owners. Knowing about pet contacts up front could help speed up diagnosis and proper treatment.

For example:

I have a flock of rare breed sheep. The other day, I had to assist with a lambing. Contact with newborn lambs and fetal fluids is the main source of the organism Coxiella burnetti, which causes Q-fever. If I became infected, the illness would start off with vague signs like fever and malaise. If I went to a physician at that point, I'd probably be told to go home, rest and take anti-inflammatories as needed (the old "take two aspirin and call me in the morning" type thing). If the physician knew I had sheep, he/she might ask about the risk of exposure for Q-fever. Upon hearing that I had a high risk exposure a few days earlier, Q-fever would be considered right away and appropriate measures could be taken.

Also, as strange as it sounds, in my utopian world physicians would ask about pet health. Yes, it may seem strange if your doctor were to ask "So how are you doing today? And how's your dog been feeling lately?" - but it might be important. Illness in your pet may be associated with illness in you or other members of your household. Knowing that a pet is sick might give some indication of that (a) certain disease(s) are more likely in a person. Also, if the sick pet has been to a veterinarian for testing, those results might be useful to the physician. There's no guarantee that a pet and owner that are sick have the same thing, but a general principle of medicine is that a single cause is more likely than co-incidental independent problems.

For example:

Similar to the case of psittacosis in a pet store employee that I reported about recently, let's say that you own a bird and it's been sick for a week or so. It's weak and not eating well. You then come down with a fever and cough - something that's not uncommon. However, when your astute physician asks about the health of your pets, he/she gets concerned about the fact that your bird is sick. Your doctor contacts your bird's veterinarian, and it becomes clear that the bird could be infected with Chlamydophila psittaci, the cause of psittacosis in people. Your doctor therefore puts psittacosis on top of the list of potential problems, and instead of telling you to go home and rest, he/she takes some blood samples to try to diagnose it the infection and may even start treatment right away. Because your physician identified a higher risk situation with your sick bird, you get prompt treatment, you start to feel better in 24 hours and it's unlikely you'll have any major problems. (The mortality rate from psittacosis is < 1% in people that are treated properly. If the diagnosis is missed, the mortality rate increases to 20%, and you also run the risk of complications such as heart valve damage.)

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Helicobacter species are a fascinating group of bacteria. They live in the stomach of humans and many animals, an environment that was previously thought to be completely inhospitable to bacteria. We now know that Helicobacter bacteria are beautifully adapted for survival in the stomach and are very common. In people, Helicobacter pylori is an important cause of gastritis (inflammation of the stomach), stomach ulcers and stomach cancer.

Studies looking at bacteria in the stomachs of dogs and cats have found that Helicobacter species are extremely common, with some studies finding one or more species of Helicobacter in every dog or cat that was tested. Since Helicobacter is an important problem in people, does that mean that we need to be worried about pets as a source of infection? Probably not.  Here's why:

It could be a problem because:

• A few studies have found the same Helicobacter species in infected people and their pets.

It's probably not a problem because:

• Studies looking at risk factors for Helicobacter infection in people have not identified pet ownership as a risk factor.
• A study comparing one Helicobacter species that has been mentioned as a possible zoonotic concern, H. heilmannii, reported that H. heilmannii strains from people were generally different than those from animals.
• While other Helicobacter species are common in dogs and cats, H. pylori (the main cause of problems in people) is rare in pets.
• While finding the same Helicobacter species in a person and his or her pet raises concern, studies have yet to demonstrate whether such findings are due to animal-to-human transmission, human-to-animal transmission, or infection of both person and pet from the same source.

Overall, the risks of pet-associated Helicobacter infection are probably very, very low. If there is any involvement of pets in this disease in people, it's probably sporadic at most. Avoiding contact with stool from pets and paying good attention to handwashing should decrease the risk even further.

One question that is currently unanswered is whether the mouth of a dog or cat can be a source of Helicobacter infection, because the bacterium can be found in saliva. We really don't know whether this is a risk - it's probably minimal at most, but avoiding contact with pet saliva (e.g. no sloppy wet dog kisses!) is a good idea anyway.

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ProMed mail reports two more rabies fatalities in an ongoing outbreak in Bali, Indonesia.  The first person was bitten by a stray dog, which always must be considered a potential rabies exposure, especially in an area where an outbreak is underway. He received one rabies shot but did not undergo the whole post-exposure series because of a fear of needles, and he died.

The second person was bitten by both a stray and a pet dog, another clear indication for post-exposure treatment. She refused treatment because of a fear of needles, and also died of rabies.

These were two completely preventable deaths. The decision to forgo treatment almost certainly cost these people their lives - rabies is preventable with appropriate and timely post-exposure treatment. These cases also highlight the need for proper education of the public when it comes to rabies, both in terms of avoiding strays and the need for prompt attention when there's potential exposure to the disease. I have no idea how forcefully medical or public health personnel explained the need for proper treatment. For people that want to decline treatment, aggressive and comprehensive education is needed. Ultimately, people are allowed to make bad decisions, but we need to make sure they at least make informed bad decisions.

There are various other concerning issues with this outbreak, particularly the government's response to it. Multiple sources have apparently advised the government that aggressive vaccination and halting of dog movement between the peninsula and the mainland could contain this outbreak. So far, this has not been done. Amazingly, importing rabies vaccine into Bali was illegal until December 2008, and it is still illegal to vaccinate dogs outside of the outbreak area! The cost of vaccination has been used as an excuse not to do so. Certainly, financial issues are important in developing countries. However, the estimated cost is only about $0.50 US per dog. When one considers that this area is highly dependent on the tourist industry, they need to consider this as an investment to maintain their economy. Would you like to spend your vacation in an area with an ongoing rabies outbreak?

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I guess there's now a week for absolutely everything. aPaws, the Association of Professional Animal Waste Specialists (no, I'm not making this up) has declared April 1-7 to be International Pooper Scooper Week. The overlap with April Fool's Day is apparently just a coincidence.  This group was formed in 2002 in recognition of "the growing problem in our communities, environment and water tables" associated with, yes, dog poop.

The American Pet Association estimates that over 4.4 billion pounds of poop are produced by the some-71-million dogs in the US each year. That's enough to cover 900 football fields with 12 inches of dog waste. (That is some deep do-do!)  Dog feces can contain a wide variety of bacteria and parasites, some of which can infect other dogs, and some of which can also infect people. The risk to people and other animals is greatly reduced by prompt removal of feces and proper disposal (i.e. stoop and scoop). It's a pretty simple concept: if your pet poops outside, pick it up. Use a plastic bag, seal it, deposit it in the garbage, then wash your hands (or use an alcohol-based hand sanitizer if you're out for a long walk and there's no sink handy). Most people are conscientious about this, but one look around most parks will show you that not everyone is (and unfortunately that can give those of us who do stoop and scoop a bad name!).

Photo source: http://www.freewebs.com/pooridder/

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I know this doesn't relate to infectious diseases, but it's still an interesting pet-related public health topic. The latest edition of the CDC's Morbidity and Mortality Weekly Report has a article entitled "Nonfatal fall-related injuries associated with dogs and cats - United States, 2001-2006". It contains some rather interesting information. Among the highlights:

• Based on their data, they estimate that an average of 86 629 people are injured from falls associated with dogs and cats every year. Over 26000 fractures occur.
• Injuries were most frequent in people 0-14 and 35-54 years of age, but fractures were most common in people over 75 years old. Women were 2.1 times more likely to be injured than men.
• 88% of injuries were associated with dogs.
• Most of the injuries (62% from dogs, 86% from cats) occurred at home.
• Walking and chasing pets were the most common activities associated with injuries. Falling or tripping over the pet was the most common cause of injury, followed by being pushed or pulled over by a pet.
• 11% of injuries associated with cats occurred when someone was chasing a cat. (I can relate to that, because I almost fell down the stairs once trying to catch my cat after he'd stolen an entire roast off the kitchen counter!)

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A dog park was closed because of an attempt by a dog-owner to disinfect puddles.  The woman was seen pouring a gallon of bleach into a mud puddle, sparking an investigation. The site was closed while city staff pumped out puddles. The woman told the person that witnessed and reported the incident that her dog had contracted the intestinal parasite Giardia in the park, and she was trying to sanitize the water.  However, authorities believe it may in fact have been a malicious act (i.e. an attempt to poison the dogs using the park).

• Firstly, there's no way the woman could know that the park (let alone a specific puddle) was the source of her dog's infection. Giardia can be found in the environment and in the stool of a small  percentage of healthy dogs (~7% in many studies).
• Secondly, pouring a toxic substance into the puddles in the park is obviously not an appropriate response. Bleach is a good disinfectant when it's used right, but disinfecting outdoor surfaces like this is essentially impossible. Organic debris (e.g. mud) will readily inactivate bleach, but the bleach could still make an animal sick if too much (too high a concentration) is swallowed, because it's very caustic.
• Thirdly, for this woman to take matters into her own hands like this without consulting  someone who knows something about infectious diseases, and potentially exposing a lot of animals to high levels of bleach is irresponsible. If there was concern about the park as a source of infection, the appropriate response would have been to talk to city staff.

In reality, the risk to other dogs was probably pretty low. It’s pretty obvious when there's a lot of bleach somewhere (even just based on the smell), and in general dogs would probably be very reluctant to drink bleach-contaminated water.

One officer stated that he suspects the Giardia story was an excuse contrived by the woman when confronted by the passer-by who witnessed the bleaching incident. That’s certainly possible, but I’m surprised someone would come up with a specific excuse like Giardia.  If the woman is found, that should be easy to figure out - the diagnosis would have to be in her dog's medical record.  Police stated that the woman, if identified by the authorities, could potentially face animal cruelty charges. I think that’s pretty unlikely, considering what usually has to happen for someone to actually be charged and convicted of animal cruelty. I suspect this really was an overzealous response by someone who lacks common sense. There was no comment about whether the woman would be billed for the city staff time required to deal with the clean up - that might be a more effective deterrent to similar incidents in the future!

Parks are inherently a high-risk environment for exposure to infectious diseases. Whenever you mix large numbers of animals, especially in an area where they often pass stool, there is an increased risk of disease transmission. You have to accept that when going to a park. People should also ensure that they never take a sick animal to a park, promptly clean up stool, and may sure that their pet is on an appropriate vaccination and deworming program. Disinfection of a park will never be part of the infection control program.

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

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Headlines can sometimes be very misleading. The title of this post is from a news article that implies that rabies is a foodborne disease. The first sentence of the article states:

"A new study has detailed how two people in Asia contracted rabies after eating dog or cat meat."

This is a prime example of why it is so important to read more than just the first few sentences of any article, and ideally find the original source of the information. The article refers to a paper in PLoS Medicine. The paper describes two cases of rabies in men from Hanoi, in Vietnam. One had no known history of an animal bite or other rabies exposure, while the other had been bitten a month before becoming sick by a non-rabid dog (the dog was still healthy when the man developed rabies - if the dog had been rabid at the time of the bite it would have died within two weeks). Both patients had butchered and eaten either a dog or cat, including the brain, within 3-8 weeks of becoming sick.

• The first patient had butchered and eaten a dog that had been killed in a traffic accident. He took out the dog's teeth before butchering it, thinking that this would protect him if the dog had rabies (because rabies is so often associated with bites, he likely didn't realize the virus is actually in the saliva and brain tissue).  The skull was opened to remove the brain.  The man wore work gloves, and didn't report any injuries during butchering.  All parts of the dog that were eaten were cooked first.  No one else that ate any part of the dog got sick.
• The second patient had butchered and eaten a sick cat that had been acting abnormal for a few days. Again, all parts of the cat that were eaten were cooked first, and no one else that ate any part of the cat got sick.  However, the man who developed rabies had prepared the cat's brain for cooking using his bare hands.

In both cases, the affected people were exposed to animals that were sick (cat) or may have been sick (dog hit by car). Only the people who butchered the animals got rabies, while no one else who ate the animals got sick. It is most likely that the two men were exposed to rabies virus during butchering, through contact of infected nervous tissue (e.g. brain) with any tiny bit of broken skin, or even possibly the eyes, nose or mouth, before the tissue was cooked.  In Vietnam, butchering  (not eating) dogs is a recognized risk factor for developing rabies.  It is extremely unlikely that eating cooked meat from a rabid animal would result in transmission of rabies to a person.

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A large outbreak of rabies continues to have devastating effects in Angola, Africa. While rabies outbreaks are not uncommon in some parts of the world, the number of people affected in this outbreak is remarkable. A hospital in Luanda, the nation's capital, has diagnosed rabies in at least 93 children in the past 3 months. All have died. The main source of the disease in this case is Angola's large stray dog population. Stray dogs can transmit rabies to other dogs and people through bites. The poor socioeconomic status of the country increases the risk of outbreaks like this because:

• Vaccines are not readily available (for dogs or people)
• It is difficult to organize and fund vaccination programs for stray dogs
• It is difficult to educate the general population about how to avoid and manage rabies exposure
• The healthcare system is relatively limited

These problems, all related to a poor economy, create a "perfect storm" for a rabies outbreak. The shortage of human rabies vaccine and the high cost of post-exposure prophylaxis (PEP) makes it much more likely that people will actually develop signs of rabies after being exposed. The cost of PEP is more than the average Luanda family makes in a month.

Fortunately, the outbreak seems to be waning. However, without improvements in stray dog management (including vaccination) and access to adequate PEP, future outbreaks and problems are inevitable. It was reported that "adequate" supplies of canine rabies vaccine are now available. Hopefully, a concerted effort to vaccinate as many dogs as possible will reduce the rabies load in the canine population, thereby helping to decrease the risk to the people living in the area as well.

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This rather sensational title is from a Murdoch University (Australia) news article regarding a study of intestinal parasites in Australian dogs. It certainly grabs one's attention. For me, the article brings to mind two different trains of thought:

1) Far more than 10% of dogs could make their owners sick.  Be it dogs, cats, rabbits, iguanas or anything else, every pet is carrying something that could cause an infection in a person in certain situations. If a study says that only X% of dogs/cats carry some sort of zoonotic pathogen (and X isn't 100), then they didn't test hard enough or they didn't test for enough things. Every animal - and every person - is carrying something that can make others sick. However, even though all pets carry zoonotic pathogens, most of these are of minimal concern to most people, and therefore the likelihood of most pets making their owners sick is relatively low. We have to remember, however, that there is no such thing as "no risk" pet contact, just as there's no such thing as "no risk" contact between people.

2) The 10% figure from this study refers to the percentage of dogs that were shedding the intestinal parasite Giardia. This parasite can cause disease in people and that's why there is concern. However, the 10% figure isn't really surprising, as the press release states, because previous studies from different areas in the world have reported Giardia shedding by 7-10% of healthy dogs. The real question is, what is the risk to people from these dogs? The short answer is: we don't know. Not all types of Giardia found in dogs are able to cause disease in people. Figuring out what type of Giardia a dog is shedding requires fairly specialized testing, and there's no indication that this was performed for this study. If most dogs carry strains that don't infect people, then the risk is very different than if most dogs were carrying zoonotic strains.  Furthermore, we don't know how often Giardia is transmitted between people and pets in any situation. At this point, there is actually very little information regarding transmission of Giardia from pets to people. That being said, it's better to err on the side of caution and assume that Giardia could be transmitted from pets to people, at least until we have good evidence otherwise.

I'm not trying to dismiss the potential concerns about Giardia in dogs, nor do I think the study isn't useful. It's an interesting study that has provided new information about intestinal parasite carriage in dogs in Australia. However, it doesn't really tell us anything new about the risk to humans.

Professor Andrew Thompson, Murdoch's Head of Parasitology gives some good advice when he states "As a result of these new findings, dog owners should be aware of the signs of Giardia and how to prevent infection in their pets. If you suspect that your dog may be infected with Giardia, it is important you visit your local vet for a full diagnosis.”

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

Photo: Giardia trophozoite (CDC Public Health Image Library #8698/Janice Carr)

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I read a press release today entitled "New Parasite Infection Killing Pet Dogs in Southern England". It's about the lungworm Angiostrongylus vasorum. The main reservoir for this parasite in England is the common red fox. Slugs and snails are involved in transmission of the worm as well.  Infection of dogs most likely occurs through ingestion of the parasite from contaminated water or other environmental sources. The press release mentions a study that was released last year which reported an increase in the parasite in wild foxes. It mentions (without providing any data) that infections are occurring regularly dogs in some regions. This may well be true but brings to mind an important point I mentioned the other day (among others): know the source of information you are reading. I know I'm being a bit cynical, and it's possible that they have the well being of pets in mind, but the press release is from an online veterinary pharmacy, a company that obviously benefits from increased treatment of pets with dewormers.

This is made clear by their statement "Luckily there are a number of medicines available that can provide real and lasting protection from this nasty parasite. At www.vetscriptions.co.uk we recommend that all dog owners make it their business to find out about this disease and make sure that their dogs are fully protected."

Is lungworm a real and increasing threat in the UK? It's certainly possible. I don't dismiss the possibility at all.

Would I get concerned about it at this point? No. I'd look for objective information and ask my vet if there are any concerns in my particular area. Like the press release says, people should "make it their business to find out about this disease."

So what does this tell me? It reminds me that there are a lot of potential infectious disease threats out there that I need to pay attention to, but there are also a lot of people trying to make money at the same time. It could be that this company is being benevolent and honestly trying to make sure that pet owners are aware of the risks of lungworm. It's also possible they are taking advantage of a marginally relevant problem. Information like this is good for raising some questions, but getting advice from a non-biased source is critical.

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I used the think the New York Times was a reputable newspaper and source of reasonable information. However, considering some of the articles I've seen, I no longer have a good opinion of this newspaper. One example from a few years ago came across my desk recently.  The article is basically an infomercial for an unqualified person that sells pet health products.  The person in question is an industrial designer by training - you'd think a reasonable news source would look for someone with training in veterinary medicine, nutrition or pharmacology when discussing pet health. (Given the level of expertise they require, I guess I'm qualified to comment in the New York Times about how to solve conflict in the Middle East or fix the economy). Among some of the gems in this article are:

• People "have to include raw and whole foods in their pets' diets..." and "[Pets] don't get E. coli or Salmonella." Tell that to the dogs and cats that get sick and die from Salmonella. I can't believe people that sell raw foods continue to falsely claim that pets can't get Salmonella. Outbreaks of salmonellosis associated with raw foods have been reported. Dogs have even been sickened in the recent peanut butter Salmonella outbreak.
• The big problem with the pet food industry is that people treat pets like televisions and get a new one if they're sick. Apart from the last part being ludicrous, what does that have to do with the pet food industry?
• The alley dogs this guy grew up with in the Bronx lived a long time.  Now, a dog is considered old if it lives past 7 years. Show me any evidence that feral dogs live longer than household pets. Not a chance.
  
• Pets are dying younger because of low grade nutrition and pharmaceuticals. Again, show me evidence that pets are living shorter lives. I'm certain it's the exact opposite.

People need to make sure that they critically assess things that they read about pet health and diseases. Just because something is written in a high profile newspaper doesn't mean it's necessarily correct. In the internet era, volume overload and differentiating good sources from bad sources can be difficult. Here are some tips:

• Look for advice from qualified individuals. That's not a guarantee, but I'd rather have my car fixed by a mechanic than a gardener.
• Beware of advice from people that are in a conflict of interest, such as people selling a product. For most reputable companies, representatives can be sources of good information, but unfortunately it's not always true.
• Ask your veterinarian about questions relating to animal health and nutrition.
• Use common sense. If something seems too good to be true, it probably isn't. Something that claims to cure all that ails you probably cures nothing.

A rebuttal to this article can be found here.

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A park in Orange County, Florida has been closed because a dog with canine parvovirus was found in the park.  Canine parvovirus is a potentially serious infection in dogs (mainly puppies) that can cause severe vomiting and diarrhea. In some cases, it can be fatal.  Proper vaccination against parvovirus is critical for puppies. In Orange County, they have closed the park because of concerns about parvovirus transmission. The have also apparently "bleached the dog park".

Parvovirus can live for a very long time in the environment, however disinfecting an outdoor environment is not only impractical, it's impossible! We can disinfect clean, smooth surfaces like sealed ceramic floors and smooth countertops, but we can't disinfect outdoor environments with permeable, porous surfaces and abundant organic debris (dirt). Bleach is not active in the presence of organic debris, and porous surfaces allow bacteria and viruses to escape contact with disinfectants. So, while it's good to see that they are concerned about disease transmission, this particular aspect of their control efforts isn't going to be effective.

Parvovirus exposure is an ever-present risk in areas where multiple dogs congregate. The virus can be shed in the stool of even healthy-looking dogs. In this situation (like all others) the emphasis should be on keeping high-risk dogs (e.g. unvaccinated puppies) out of these areas, not closing the park altogether and attempting to disinfect it. Parvovirus vaccination is very effective, and properly vaccinated adult dogs are quite low risk. Prompt removal of stool by dog owners helps reduce the risk further by decreasing the risk of environmental contamination. Therefore, the three most important control measures are:

• Ensure puppies are properly vaccinated.
• Keep puppies out of areas visited by numerous dogs until they have been fully vaccinated.
• Scoop poop.

And since the focus of this site is zoonotic diseases, remember that canine parvovirus is not transmissible to people.  Human parvovirus infection (Fifth disease) is caused by a completely different virus.

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I received the following question from a reader the other day: "I'm currently pregnant and was bitten by my grandmother's German Shepherd.  The bite was on my ankle and broke the skin in several places.  I went to the doctor and was prescribed antibiotics and the wound has seemed to heal fine.  This is my second pregnancy and I have been diagnosed as group B strep positive, which I wasn't with my first child.  I know that dogs can't spread strep throat to humans, but is it possible that I picked up group B strep from the bite?"

The short answer is that it's extremely unlikely there's an association.

Group B Streptococcus is predominantly a problem in people. Most people that carry this bacterium have no problems, although it can cause infections in some situations. It is of particular concern in pregnant women, because in 1-2% of exposed newborn babies the bacterium can cause serious infections such as bloodstream infections, meningitis and pneumonia. That is why pregnant women are often screened for Group B Streptococcus shortly before their due date, by taking a swab from the vagina and rectum. Approximately 10-30% of pregnant women carry Group B Streptococcus. Pregnant women that are carriers are usually given antibiotics shortly before delivery to reduce the risk of infection of the baby.

What about the role of pets? Group B Streptococcus is mainly found in people, and is quite common in healthy people. It is rare in pets, although it can cause various types of infections in animals too. Group B Streptococcus infections in dogs might actually represent human-to-dog transmission, although this hasn't been proven. In the case described above, a dog bite on a person's leg would not be a high risk for transmitting this bacterium to the intestinal tract or vagina. If a dog was carrying this bacterium in its mouth, it could cause a bite wound infection, but it is very unlikely that the bacterium would spread to other parts of the body in a healthy person.  Other bacteria in the dog's mouth would be more likely to infect such a wound, even if Group B Streptococcus was present.  If dogs were common carriers of this bacterium (which they are not), the main risk of transmission would be from regular contact, not bites.

So don't blame the dog... at least not for the Group B Streptococcus. The bite itself is another issue.

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One of my favourite stories about surgeons comes from a book by Irwin W. Sherman called "The Power of Plagues." In the pre-anesthesia and pre-antibiotic era, speed was considered the sign of a good surgeon. One surgeon, Robert Liston, was particularly renowned for his speed. However, speed sometimes lead to problems. In one surgery, he amputated a leg in 2.5 minutes, but the patient died of infection after surgery (a common event those days). During surgery, he accidentally amputated the finger of his assistant as well, who also subsequently died of infection. To top it off, he slashed the coattails of a surgeon who was watching, who "died of fright" thinking his organs had been slashed too. He's the only surgeon on record with a 300% mortality rate for a surgery.

These days, surgery is a lot more humane and safe. However, problems like surgical site infections still occur. They occur following a much smaller percentage of surgeries than they used to, but they can still be very serious.  Nowadays, more of these infections are being caused by multidrug resistant bacteria, which can affect and be transmitted between both animals and people. It's been stated that the time of maximal influence on surgical site infections beings and ends in the operating room (e.g. the most critical time for preventing infection is during the surgery itself).  However, there are things that can be done at home to help reduce the risk of infection.

• Antibiotics are usually NOT required after surgery, depending on what procedure was performed. But, if antibiotics are prescribed by your veterinarian, make sure you give the full course and follow all instructions carefully.
• Keep your pet from licking the surgery site. Trauma from licking and chewing, and bacteria from the mouth can help start an infection. If your pet is licking or chewing its surgery site, consult with your vet about ways to stop this.
• Keep an eye on the surgery site. If you see signs of infection such as excess heat, pain, redness, swelling or discharge from the site, talk to your vet as soon as possible.
• Don't touch the surgery site. You could contaminate the site with bacteria from your skin that could start an infection. Also, if an infection is present, bacteria could spread to you.  If you must touch the surgical site (e.g. if you need to change the bandage over it, or your veterinarian has instructed you to clean the site), you should wear disposable gloves.

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If your veterinarian suspects your pet may have ringworm, there are several different ways he or she may test for the causative fungus (a dermatophyte) on your animal's fur and skin.  Some of these techniques are more useful than others in different situations.

• Wood's lamp:  A Wood's lamp is simply a special ultraviolet light.  Approximately half of all Microsporum canis strains (the most common species of dermatophyte that causes ringworm in cats and dogs) will fluoresce blue-green under such a light. This type of testing is obviously very easy to perform.  However, other debris in an animal’s hair coat may fluoresce as well, and other species of fungus that cause ringworm do not fluoresce, so this test is not useful by itself in most cases.
• Microscopy: Sometimes ringworm fungus can be seen on hair shafts from an infected pet when examined under a microscope.  However, it is easy to confuse other debris and structures for dermatophytes.  Also, not every hair on an infected animal will carry the fungus, so it's possible to miss the infected hairs altogether with this test.
• Fungal culture: The best way to diagnose ringworm is to culture the fungus from the infected individual (person or animal). In animals, one of the best ways to collect a sample for culture is to comb over all the fur and skin with a new toothbrush, and then try to grow dermatophytes from the toothbrush. This allows the fur from all over the animal to tested, rather than just one little clump of fur plucked from one area.  It can also make it easier to get a sample from the face and paws of cats, which is where these animals often carry the fungus.  Although fungal culture is the best way to diagnose ringworm, remember that fungal culture takes much longer than bacterial culture – instead of days, it may take up to three weeks to grow some dermatophytes.

It's also important to remember that dogs, and more often cats, may carry dermatophytes on their fur even when they look healthy.  A positive fungal culture from an animal with skin disease, particularly a cat, does not necessarily rule out other diagnoses, so your veterinarian may still recommend other tests as well.  However, any animal with ringworm should be treated to prevent spreading the infection to other animals and people.

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

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"Some Beach, Somewhere" is not only a popular country music song AND the name of one of the best Standardbred racehorses in the world (originally Canadian, no less!), it's also the prime source of infection for a disease called cutaneous larval migrans.

Cutaneous larval migrans is a skin disease caused by migration of hookworm larvae. The most common hookworm species involved is Ancylostoma braziliense, which can be shed in the stool and dogs and cats. Ancylostoma caninum  and A. tubaeforme are other species of hookworms that parasitize dogs and cats, respectively, and can also cause the disease, but much more rarely.

Animals infected by the hookworms shed hookworm eggs in their stool. These eggs then develop into larvae, and people become infected through skin contact with hookworm larvae in the environment, particularly in sandy areas like beaches where infected animals may have defecated.

Cutaneous larval migrans is characterized by a "serpiginous (snake-like) rash" that is intensely itchy (see picture left).  This is caused by the parasite larva burrowing through the skin. In North America, the disease is most common in the southeastern US and the Caribbean. Most , if not all, cases in people in Canada are associated with travel, especially to Caribbean countries; they presumably caused by exposure to hookworm larvae on the beach. Ancylostoma braziliense is not found in Canada.

The best means of controlling cutaneous larval migrans are to promptly remove dog and cat stool from the environment and dispose of it in the garbage, and to regularly deworm dogs and cats. This is important in areas where A. braziliense is endemic, but is easier said that done in areas where feral (wild) dogs are common.

Photo source: http://www.leeds.ac.uk

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I've had this question a lot lately. Methicillin-resistant Staphylococcus pseudintermedius (MRSP), which is sometimes misidentified as methicillin-resistant S. intermedius (MRSI), is an important and increasing cause of infections in dogs and cats. After an animal has had an MRSP/MRSI infection, a question people often ask is how long they will carry the bacterium?

MRSP can be carried in the nose, intestinal tract or on the skin of a small percentage of normal animals. The implications of this are not clear, but it is reasonable to assume that carriers are more likely to develop infections in certain situations (e.g. if they sustain a wound or need to have surgery), and can transmit it to other animals (and possibly people, but that's much less of a concern with MRSP than with MRSA).

Back to the question... To be perfectly honest, we really don't know. However, I think it's reasonable to assume that some animals could carry MRSP for a long period of time - certainly weeks or months, maybe even years. Staphylococcu pseudintermedius is a common bacterium in healthy dogs and cats, and has basically evolved to survive on these animals. The methicillin-resistant versions are likely no different in this respect, so it's reasonable to assume that some animals could be long-term carriers. This makes controlling MRSP more difficult.  In contrast, MRSA appears to be only transiently carried by dogs and cats, probably because it is better adapted to living on humans than pets.

What you should do in the meantime if your pet has MRSP:

• Treat any infection as per your vet's instructions.
• Always complete the full treatment course.
• Wash your hands after contact with your pet, healthy or not.

More information about different types of staph bacteria can be found in the previous Worms&Germs post entitled Methicillin-Resistant Staph - What's In A Name?

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I'm sure you've heard about the large outbreak of salmonellosis in people in the US associated (again!) with contaminated peanut butter. Based on the extent of the outbreak, it probably should not come as a surprise that pet treats are now caught up in the recall. The FDA has announced that the recall now includes some pet food products that contain peanut paste produced by the Peanut Corporation of America (PCA) at its Blakely, Georgia processing plant. The concerns here are two-fold: the risk of disease in pets fed the treats, and risk to people handling the treats. If you have peanut butter-containing pet treats, you should stop feeding them to your pet(s) until you can determine whether or not they are affected by the recall.

The recommendation in the recall notice really applies at all times: "It is important for people to wash their hands--and make sure children wash their hands--before and, especially, after feeding treats to pets."

More information on Salmonella and pets can be found on the Womrs&Germs Resources page.

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A report in the latest newsletter from the University of Guelph Animal Health Laboratory describes a case of tuberculosis (TB) in a pet dog. The dog was a seven-year-old Bichon Frise that had an abdominal mass, low-grade fever, nasal discharge and pneumonia. Tuberculosis was diagnosed by testing a sample of the mass that was obtained during an exploratory surgery. The dog was euthanized because of the poor prognosis and because of concerns about transmission to people in the household.

Tuberculosis has historically been one of the most important infectious diseases in people and has re-emerged as a huge problem in human medicine, particularly because of the development of highly drug-resistant strains. The disease is caused by the organism  Mycobacterium tuberculosis.  It can be spread through the air over short distances by minute droplets when someone with active TB coughs, sneezes, speaks or sings. Other individuals become infected by breathing in the bacterium.

Tuberculosis is primarily a human disease. It has been reported in various animal species, but only rarely. Dogs are considered relatively resistant to TB, even so there are several reports in the scientific literature of TB in dogs. The source of the dog's infection in this case was not discussed. Presumably, the dog was infected by close contact with an infected person.

One of the reasons for euthanasia of the dog in this case was the risk to household members. At this point, we have little information about the risk that infected animals pose to their human contacts. This makes providing evidence-based advice difficult.  Many people may err on the side of caution by euthanizing the animal to prevent transmission. Important aspects that need to be considered include whether the owner can afford to attempt treatment of the animal (with no clear evidence of what works and longterm treatment being required), whether the disease is potentially treatable (i.e. what are the chances the animal will recover if it is treated), and the status of other household members with respect to TB disease or exposure. Of course, these consideration are all in addition to that of the animal's condition and quality of life, which may warrant euthanasia regardless - tuberculosis can be a devastating disease, and it is often not detected until it is quite advanced.

There's no correct answer.  Our poor understanding of this disease in dogs and the significant health risks of TB in people unfortunately make euthanasia a reasonable decision.

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An important step in diagnosing infectious diseases and determining the optimum approach to treatment and management is rapid and accurate diagnostic testing. Many different testing methods are used, particularly bacterial culture (at least for bacterial diseases). Molecular testing has revolutionized the field of microbiology, and is making inroads into the field of diagnostic testing. Polymerase chain reaction (PCR) testing is a very powerful tool that can be used to detect DNA or RNA from specific microorganisms.  This technique can be very useful, but it can also be easily misused or misinterpreted.

The potential PROS of molecular diagnostic testing include:

• Rapid turnaround time: Testing can take as little as a few hours versus a few days for other tests like bacterial culture.
• Sensitivity: Organisms that are difficult or impossible to grow in a lab can be detected, and they can often be detected at lower levels than with other diagnostic methods.

The potential CONS of molecular diagnostic testing include:

• Sample contamination: This is a common concern with highly sensitive molecular tests - even a minute amount of contamination in the sample can cause a false positive result.
• Test inhibition: Samples from complex biological sites (e.g. stool) can contain substances that interfere with the many complex molecular reactions upon which the tests rely. Without good (and proven) methods to prepare the sample, this can result in a false negative result.
• Biologically irrelevant results: Some bacteria that cause disease are also commonly found as part of the normal microflora in healthy animals - simply finding it does not tell you that it is necessarily relevant to the problem. For example, Clostridium difficile can be found in the intestine of approximately 10% of healthy dogs and cats (or more, in some situations), but the diagnosis of C. difficile diarrhea requires detection of the bacterial toxins in stool samples, not just the bacterium itself.  A molecular test that simply identifies the presence of C. difficile, even if it identifies strains that possess the genes to produce toxins, tells you nothing about whether the bacterium was actually producing toxins in the animal.
• Lack of validation: This is a common problem with many (if not most) molecular tests. Some companies, especially those that just run molecular tests, offer a huge array of completely unvalidated and sometimes illogical tests.  It is also important to remember that tests must be validated for each species in which they are used - a test that works well in people will not necessarily work on a sample from a horse or a dog.

Molecular testing can be useful in some situations. If you are unsure, here are some things to ask the lab:

• Do they have a validated test that provides relevant results?  If they don't have good data (ideally published data) that their test is useful, accurate and reproducible, I'd avoid it.
• Do they have a quality control program, which includes running positive and negative control samples with each test batch?

Finally, as with any test that we use in veterinary (or human) medicine, it's important to evaluate all  results in the context of what is happening with the animal - treat the patient, not the test result.

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Infection prevention and control is a critical component of good medicine, human or veterinary. However, veterinary infection control is a very small and underdeveloped field, and good resources for veterinary personnel are limited. To help advance this important field, a comprehensive infection control document entitled "Infection Prevention and Control Best Practices for Small Animal Veterinary Clinics" has been developed by the crew at WormsAndGermsBlog and colleagues at the Ontario Veterinary College. This document is a comprehensive overview of infection control practices and has been designed as a resource for all small animal veterinary clinics. The document can be downloaded by clicking here or through the Worms & Germs Resources page.

This effort was sponsored by the Canadian Committee on Antibiotic Resistance and the guidelines have been endorsed by the Canadian Veterinary Medical Association and University of Guelph Centre for Public Health and Zoonoses.

 

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Cheyletiella is a genus of mites that commonly affect dogs (C. yasguri), cats (C. blakei), rabbits (C. parasitovorax), and occasionally people.  Unlike Sarcoptes species (the mites that cause sarcoptic mange), these mites live on the surface of the skin and do not burrow into deeper layers.  They feed on dead skin cells and occasionally tissue fluid.  Infestation with these mites can be very itchy, but not always.  Cats in particular can carry the mites without any visible abnormalities of their skin or fur.  Typically, however, the affected animal's fur becomes crusty, scaly and inflamed, and sometimes patches of fur may be lost.  The mites are usually a little less than a half-millimetre long (so they are visible to the naked eye if you look closely) and grayish-white.  They tend to be quite active and crawl around (but they don't jump like fleas), which gives them the appearance of walking dandruff.  Diagnosis is easy if the mites are seen strolling around on a table or blanket, otherwise they may be found on a "scotch tape test" or superficial skin scraping.

People can be affected too if they have close contact with a pet carrying Cheyletiella.  Lesions, which usually take the form of single or grouped small red bumps on the skin, typically appear on the arms, trunk or thighs, and sometimes can be extremely itchy!  It is rare to see the mites themselves on a person - usually they're found on the pet.  The good news is these mites can't actually complete their life cycle or survive for long on people, and in the environment even the hardiest forms of the parasite (usually the eggs and adult females) die within about ten days.  So once the source of the mites is eliminated (by treating the pet with an appropriate anti-parasitic drug which your vet can prescribe), the signs in any affected people will resolve on their own without specific treatment (but you might want something for the itch!).

Photo: Light micrograph of C. yasguri from a dog (credit: Dr. M. Dryden, College of Veterinary Medicine, Kansas State University)

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I just received this comment from a reader of an earlier post about blastomycosis:

What should be done if a person was bit by a dog with blasto?  I was trying to pill a dog who has blasto and the dog just out of reflex shut her mouth on my finger.  What are the chances of the blasto being transmitted to me?

It's a reasonable question and one that I get periodically. If the bite didn't break the skin, the risk is essential nil.  If the bite broke the skin, the risk is still fairly low, but certainly not zero.

Simple contact with an infected dog cannot result in transmission of blastomycosis because Blastomyces is a dimorphic fungus, meaning it can take the form of either a mold or a yeast.  The highly infectious mold form is found in soil at ambient temperatures, while the minimally transmissible yeast form is present in the body of an infected animal or person. However, bites can be a different story. A bite from a dog with advanced pulmonary blastomycosis (e.g. fungal pneumonia due to Blastomyces) can result in localized blastomycosis at the site of the bite (e.g. only the person's finger might get infected).

Considering the dog in this case was already being treated for the infection (and therefore hopefully was not shedding much of the fungus), and that there are very few reports of bite-associated blastomycosis, the risk is probably quite low. However, any bite that breaks the skin can result in infection from the multitude of bacteria in an animal's mouth. Any bite on the hand should be taken seriously because it's easy for sensitive structures like joints and tendon sheaths to become infected.  Consulting your physician or getting medical attention is recommended.

More details about general issues regarding animal bites are available in our bites archives.  Relevant information is also available in the Cat Bites information sheet on the Worms & Germs Resources page.

Photo: Light micrograph of the budding yeast form of a fungus.

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I frequently get e-mails from people who are proponents of feeding raw meat to pets. The e-mails often start by calling me an idiot, and they generally go downhill from there. Some, however, go into detail about why they think there are no health concerns for themselves or their pets associated with feeding raw meat. Recently, one argument I've heard repeatedly is that using only organic meat lowers the health risks. While there are certainly merits to the organic food movement, there is absolutely no evidence that organic meat is any less likely to be contaminated with bacteria than non-organic meat, nor is there any reason to even suspect that this would be the case. Bacterial contamination occurs during slaughter and processing, and organic raising of animals has no impact on that.

More discussion about the health concerns associated with raw meat diets can be found in our raw meat archives and elsewhere. I do not recommend that people feed raw meat, particularly in certain situations such as when there are young children or people with weakened immune systems in the house. If you are considering feeding a raw meat diet to your pet, learn as much about this practice as possible so you can make an informed decision. More information about raw meat feeding and things you can do to reduce the risks that come with it can be found on the Worms & Germs Resources page.

Remember: Using organic meat is NOT an infection control measure.

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It should come as no surprise that puppies (and kittens, and pretty much any type of animal) from pet stores can carry infectious diseases. The same can be said about puppies (and kittens, and pretty much any type of animal) from other sources. It's really a question of the relative degree of risk. Particularly when you have young, stressed animals, with variable medical care, from questionable sources, being kept in groups that are frequently changing, the risk of disease increases a great deal. It's exactly these types of animals that are most commonly found in pets stores.

I certainly don't want to suggest that all pet stores are like this - some stores are run by people or companies that genuinely care about the animals, and that take precautions to only obtain healthy, well-cared for animals from ethical sources. Unfortunately, there also are many pet stores that are not run like this, and puppy mills are still alive and well because of it. In addition to having poor sources for their animals, some pet stores compound the problem by not providing adequate animal care.

A recent report about a pet store in Denver, CO, highlights this type of situation.  The report describes a number of sick animals from the pet store, failed inspections, critical and repeated sanitation violations, and inadequate veterinary care of the animals there. The store owner seemed more concerned about complaining about "bunny-squeezing, tree-hugging, slimeball animal activists" - otherwise known as normal people that were unfortunate enough to buy sick animals from the store and had the gall to complain - than actually fixing the problem.

If you're thinking about getting a new pet, here are some things to think about:

• If you want a new pet, research your options. Breeders, human societies and local classified ads are alternative (and usually cheaper) options to buying from pet stores.
• Ask specific questions about the origin and healthcare of the animals. Don't accept any vague answers.
• More expensive does not mean better. Pet stores often charge astronomical prices for mixed breed dogs.
• Beware of animals in pet stores that came from "breeders" from far away. They could be from a puppy mill.
• Take your new pet to your vet immediately to identify any potential problems as soon as possible.
• If you or someone in your house has a weakened immune system, talk to both your physician and your veterinarian about any potential new pet.  They can give you recommendations about what species, breed, age, and source of animal would be best for your household.
• Buying a pet is never an emergency. There is always time to ask questions, search for answers and look for other options.  Never buy a pet of any kind on the "spur of the moment."  A few extra days of research could save you years of heartache and expense, and could help prevent members of your family from getting sick.

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As we encounter more infections caused by antibiotic-resistant bacteria (e.g. MRSA), we need to explore treatment options other than antibiotics. While we usually focus on "new" treatments, sometimes we can look back in time for ideas to treat infections. An old treatment method that is getting increasing attention these days is the use of honey. Honey may be a safe, effective and affordable treatment option in many cases. Click on the picture below to view a video by Dr. Karol Mathews, a critical care specialist at the Ontario Veterinary College.

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A study was recently published in the Veterinary Record (O'Sullivan et al, 2008, volume 163) describing 234 dog bites in people in Ireland. Dog owners and victims of dog bites were interviewed to characterize the incidents. Bites were divided into 2 categories: bites to the dogs' owner(s) and bites to someone who didn't own the dog. Here are some parts of the study that I found interesting:

• A large number of dog breeds were involved.  The breeds most commonly involved in bites were also the most common breeds in the country, indicating that higher bite numbers for certain breeds were a reflection of the breed popularity, not a breed-associated propensity to bite.
• A large percentage of individuals that were bitten were adults, but children were more often involved when the bite was caused by a dog that was not owned by the family. The reason for this is unclear, but may relate to inadequate supervision of the interaction of children and "strange"/unfamiliar animals, or inadequate education of children about how to interact with such animals.
• Slightly over half of the bites from dogs not owned by the victim occurred off the dog's property, which demonstrates that exercising proper restraint of dogs (e.g. preventing roaming, maintining good control of dogs when walking, keeping dogs leashed when necessary) could potentially have a major impact on the number of bites.
• 27% of non-owners and 10% of owners suffered multiple bites or sustained attack from the dog involved. This is a serious concern, because multiple bites or attacks are presumably more likely to result in serious injury, and children are more often bitten by dogs not owned by their family.
• 13% of non-owners and 7% of owners were admitted to an emergency department as a result of the bite(s). Non-owners were more likely to be hospitalized and require major medical treatment.
• Bites to the hands were reported more frequently in the owner group. Bites to the hands may occur due to improper interaction with dogs, inadvertent bites when playing, or behavioural problems like dominance aggression, which can result in bites when a person tries to take away food or a toy from the dog. Proper training of pets - and owners - is critical.
• 70% of owners and 81% of non-owners described the bite as unprovoked. However, in 45% of bites to non-owners, the person was on or very near the dog's property, so territorial behaviour may have played a role. Also, some people who reported the bite as unprovoked simply may not have recognized (a) signal(s) from the dog that it was aggitated and may bite. Again, better education of people is very important, in combination with appropriate restraint and training of the animal.
• 24% of owners and 22% of non-owners were bitten on a Wednesday.  I have no idea why. Do dogs get cranky in the middle of the work-week like some people???

More information on dog bites can be found under "bites" in the Worms & Germs Archive.

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There was an interesting article in USA Today about the increasing recognition of the positive role that pets can play in patients recovering from serious disease, and how contact with pets can sometimes conflict with disease transmission concerns in these same patients. The attitude towards pet ownership among physicians is highly variable - some recognize the strong human-animal bond and its positive effects, while others see pets as unnecessary infectious disease risks. The infectious disease concerns are heightened in patients with compromised immune systems, to the point that sometimes people are told to get rid of their pets if they are severely immunocompromised.  However, more and more pet owners, veterinarians and physicians are beginning to question if this is truly the best approach.

The USA Today article describes the experiences of a cancer patient whose greyhounds were "banished to a caregiver on doctors’ orders". Considering she was at high risk for (potentially fatal) infectious disease because of chemotherapy, bone marrow transplant, stem cell transplant and immunosuppressive drugs, it’s not surprising that there was concern about the pets. After researching the risks, and measures she could take to reduce those risks, the patient convinced her doctors that the risks from her dogs were not as great as the benefits from having them around, and so the dogs returned home. While everyone’s relationship with their pets is different, the patient felt that the return of her dogs was an important step in her recovery, stating "There's no question that having (the dogs) with me these past few months made a huge difference in my recovery".

Infectious disease transmission from pets to people is certainly a real issue, and it is of particular concern in people with weakened immune systems. There is not, nor will there ever be, a "no-risk" pet. Every contact with a pet, just like every contact with another person, carries with it some degree of risk of disease transmission. What needs to be considered is the trade-off, the risks versus the benefits. In some people, the risks are greater than the benefits because of the severity of disease, type of pet, the person's ability (or more likely inability) to interact with the pet. In other people, especially those who have a very strong bond with the animal, the positive social and emotional benefits of pet ownership may greatly outweigh the associated disease risks. The article contains a great quote from Dr. Ray Pais, a pediatric hematology/oncology specialist, saying "Our young patients have already given up so much, I see no reason at that moment for them to also lose the dog."

People that have compromised immune systems need to have a serious discussion with their physician, veterinarian and family about the best thing to do with their pets while they are sick. While there is very little research in this area, taking a few common sense precautions should reduce the risks of disease transmission. These include:

• Avoiding contact with stool
• Frequent handwashing
• Preventing licking of the person by the pet
• Proper training to reduce the risk of bites and scratches
• Keeping cats indoors
• Following a good preventive medicine program for the pet

More information about Immunocompromised Pet Owners will be available soon on the Worms & Germs Resources page. The CDC also has useful information on its website about this topic.

Thanks to Dr. Doug Powell of Barfblog for forwarding this article.

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As we see more and more infections caused by antibiotic-resistant bacteria, we have to re-think our approach towards antibiotic therapy. This often involves using new drugs, but sometimes it also involves considering the use of older drugs that we haven't used very much for a long time.

One such drug is chloramphenicol. Years ago, this antibiotic was widely used, and is still used in people and animals in some situations. In some respects, it is a very good antibiotic - it is often effect against many bacteria including those that are resistant to many other drugs, such as MRSA and MRSI/MRSP.  Chloramphenicol can also be given orally, and it's relatively cheap. Unfortunately this drug can also be very toxic, both to the animals being treated with it and to people that come in contact with with it in the process. In some animals, chloramphenicol can cause suppression of the bone marrow, where red and white blood cells are produced. This is more of a concern with long term use, but if the bone marrow does become suppressed, stopping treatment with the chloramphenicol typically resolves the problem.  Unfortunately, this bone marrow suppression is much more of a concern in people - the supression is very severe, and can occur with exposure to even a very low dose (or probably single dose) of chloramphenicol.  This results in a condition known as aplastic anemia,  which it typically fatal.  Fortunately this reaction is very rare in people, but there is no way to predict who might develop this condition, and since it is usually fatal, we obviously need to be cautious about using this drug. In some countries, chloramphenicol use in banned in all animals. In many others, it cannot be used in food animals, but can be used in pets.

• Chloramphenicol should only be used as a drug of last resort. There are situations where it is useful and may be life-saving, but the human health risks cannot be overlooked.
• If chloramphenicol is being considered, it is critical that  people who would need to handle the drug understand the risk and how to safely handle the drug to avoid exposure.
• Chloramphenicol tablets should not be crushed or otherwise processed at home because of the potential for breathing in the drug when it is in powder form.

Direct contact with pills or liquids should be avoided by use of gloves or other safe handling practices.

• If a liquid form is used and is squirted onto food, the food bowl should be handled as if it is contaminated.
• If pills are being used, the animal should be observed to ensure that the pill is ingested and not spit up and left on the floor.
• Contact with the mouth and face and animals that are being treated with chloramphenicol should be avoided in case drug residues are present.

If people are unable or unwilling to follow safe handling recommendations, they should not use this drug.

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Hartz Mountain Corporation has voluntarily recalled one lot of its chicken-basted rawhide chews for dogs because of potential contamination with Salmonella. 

Rawhide treats, as the name suggests, are raw treats that  are literally made from the hide of typically cattle or pigs. The finding of Salmonella in rawhide treats is not particularly surprising, since Salmonella is commonly found in raw meat products, especially chicken.  In this case it is not known exactly how the product may have become contaminated. High rates of contamination of raw pet treats have been reported, although a recent study reported improvement in products in Canada.  This has likely occured because of action from the industry in response to outbreaks of disease in people that originated with treats. It's important to remember that any raw animal-based product that has not been treated (e.g. irradiated) to get rid of bacteria could contain harmful pathogens like Salmonella. They are best avoided, especially if high risk individuals (e.g. very young children, elderly persons or anyone with a weakened immune system) might come in contact with the treats or the pet to which the treats are fed. If you do decide to feed your pet raw animal-derived treats, care should be taken to reduce the risks of transmitting pathogens like Salmonella, as is recommended with raw meat diets. More information about raw meat feeding and Salmonella in pets can be found on the Worms & Germs Resources page.

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For more information on ringworm, see the Worms & Germs post Ringworm: Skin fungus by any other name.  The photos here show ringworm lesions on a person's arm and on a cat's face, respectively.  (Photo credits: A. Yu, Ontario Veterinary College)

Over the past several years, studies have shown that many environmental disinfectants sold and labeled for use against the fungi that cause ringworm (which are called dermatophytes) in animals and people are, in fact, not effective when used in households and veterinary clinics.  The problem is the chemicals are typically tested against a suspension of the organisms in a test tube, but in the “real world” the fungi are usually found on small fragments of infected hairs.  Its possible that the hair shaft protects the fungus from the actions of some disinfectants.

There are a few disinfectants that have been shown to be effective against dermatophytes even when they are found on infected hairs and skin cells in the environment.  The most readily available one is household bleach, used at concentrations of 1:10 to 1:100.  Other effective products include Virkon-S® (a detergent-peroxide based product) and Peroxigard® (an accelerated hydrogen peroxide product) . An environmental spray containing enilconazole (an antifungal agent that is also found in the topical medication Imaverol®) was also found to be very effective. This product is not approved for household use, but it is approved for use in catteries. It is also licensed as a topical treatment for dogs and horses in most of Europe and Canada.

Eliminating ringworm from the household or clinic environment can be difficult, because the fungus can be found anywhere that an infected animal (or person) sheds hair or skin cells.  Here are some guidelines for environmental disinfection of dermatophytes:

• All bedding, brushes, combs, rugs, cages, etc. should be vacuumed, scrubbed, and washed with hot water, detergent, and 1:100 chlorine laundry bleach, or another effective disinfectant (see above). It is best to throw out any items that cannot be thoroughly disinfected.
• Walls, floors, lamps, etc. should be scrubbed and cleaned in a similar manner.
• Carpeted areas may be impossible to effectively decontaminate. If possible, remove the carpet and either wash in hot water and bleach, or discard it. Otherwise, frequent vacuuming with immediate disposal of the collection bag is necessary.
• Vehicle interiors should be decontaminated as much as possible in a similar manner.
• Curtains can be “dry-cleaned” at a professional cleaner.
• Clean heating vents (from the house furnace) as well as possible. If the house is heated by hot air, change the furnace filter once weekly throughout the decontamination process.
• Cleaning and disinfection of the environment should be repeated at least once every 4-6 weeks (the more often, the better) until all affected animals and people have eliminated the fungal infection.

Obviously, environmental clean-up for ringworm is quite an undertaking.  If infection can be identified early, lesions can potentially be kept covered and movement of pets can be restricted to reduce the extent and amount of environmental contamination.

Special thanks to Dr. Anthony Yu (one of the veterinary dermatologists at the Ontario Veterinary College) for providing much of the information in this post, as well at the photos.

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Echinococcus granulosus is a tapeworm of dogs that causes a condition known as hydatid disease or hydatidosis in humans.  The parasite is found in many parts of the world, and is very common in some regions of southern South America, the Mediterranean, the Middle East, southwestern Asia, northern Africa and Australia.  To the best of our knowledge, E. granulosus does not occur in southern Ontario, but it is present in other parts of Canada including the western provinces and northern Ontario.  A related, but much nastier, tapeworm called Echinococcus multilocularis is much less commonly found in North America.

A previous Worms & Germs post described what is known as the sylvatic cycle of Echinococcus granulosus, which is thought to be a common route of infection for dogs in Canada.  In the sylvatic cycle, dogs become infected with Echinococcus by eating the internal organs (usually lungs and liver) of wild game such as moose and caribou.  The dogs then pass tapeworm eggs in their stool, which can cause infection in other wild animals (thus continuing the cycle) or in people who accidentally swallow the eggs.  In humans, Echinococcus forms slow-growing cysts (called hydatid cysts) in different organs of the body which can be very difficult to remove or treat in some cases.

Echinococcus also has a pastoral or domestic cycle.  In this cycle, dogs acquire the parasite by eating the internal organs of infected sheep, and sometimes other livestock such as cattle and swine.  This cycle is potentially very important in areas where there is a lot of sheep farming.  In some areas of Latin America, 20-95% of sheep at slaughter may have evidence of hydatid cysts in their organs.

It is much more difficult to tell when a dog is infected with Echinococcus compared to other tapeworms such as Taenia or Dipylidium.  An adult Echinococcus is tiny - only a few milimetres long (see picture right), very unlike the long, stringy white tapeworms that most people picture.  Dogs can carry hundreds, even thousands of these tiny tapeworms without showing any signs of illness at all.  The eggs can sometimes be difficult to detect on fecal examinations, and when they are seen they cannot be differentiated from Taenia eggs.  Nonetheless, this is still the best way to detect infection, so fecal examinations should be performed regularly.

Remember:

• In areas where Echinococcus is known to exist, it's important to have your veterinarian perform fecal examinations on your dog's stool more frequently than the usual once-a-year, because of the serious zoonotic potential of this parasite.
• Always wash your hands well after handling dog stools.
• Do not let your dog eat uncooked meat, or the organs from farm animals or wild game.

For more information on Echinococcus, see Worms & Germs post entitled Echinococcus and hydatid disease - not your average tapeworm.  There is also information available on the Michigan State Department of Natural Resources site.

Lower photo credit: Ontario Veterinary College

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It's clear that methicillin-resistant Staphylococcus aureus (MRSA) has emerged as a problem in dogs, both in terms of dog health and in terms of dogs as a potential sources of infection for people. It is thought that MRSA in pets is often (if not usually) acquired from people. Until recently, it has been unclear what makes individual dogs more likely to infected by MRSA compared to other bacteria. A study by Dr. Meredith Faires from the University of Guelph has provided some important new information in this regard. The study compared dogs with MRSA infections to dogs with infections caused by methicillin-susceptible strains of S. aureus (also called MSSA), from three large veterinary hospitals. Here are some key findings from Dr. Faires study:

• Animals that received fluoroquinolones were significantly more likely to develop an MRSA versus an MSSA infection.  Fluoroquinolones are a specific class of antibiotics that includes drugs such as enrofloxacin, orbifloxacin and marbofloxacin.
• In both groups (MRSA and MSSA), most of the infections were skin and ear infections, with no significant difference in types of infection between the groups.
• There was no difference in the proportion of animals that survived their infections between the two groups: in both groups, over 90% of the animals survived. However, it is important to bear in mind that the majority of the infections were skin and ear infections, which are not usually life-threatening.  Further study of more serious types of infection is needed to determine if MRSA is associated with a greater risk of death in dogs and cats.

This study provided more evidence that MRSA is an important problem in dogs and cats, and that the use of antibiotics is likely an important factor in the development of MRSA infections, compared to infections caused by MSSA. It also showed that the survival rate for common types of MRSA infections is high, if the infection is properly diagnosed and managed.  Hopefully the information provided by this study can be used in future studies to help evaluate more risk factors, and to identify things that can be done to reduce the impact of MRSA in dogs and cats.

More information about MRSA in pets can be found on the new MRSA information sheets posted on the Worms & Germs Resources page.

Picture: Gram stain of Staphylococcus aureus

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Methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant S. pseudintermedius (MRSP) are important causes of infection in pets, and are resistant to many different antibiotics. It's therefore very important that these bacteria are cultured and tested in a lab to determine what antibiotics may be effective.  Even then, choosing an effective medication can be difficult due to the limited number of potentially effective drugs.

Treatment selection is further complicated by problems that can occur when methicillin-resistant staphylococci are tested against certain drugs in the lab - problems that are not readily apparent unless extra testing is done.  One "problem" drug is the antibiotic clindamycin. Clindamycin can be an effective treatment for MRSA or MRSP infections, but some MRSA strains may be resistant to it despite appearing to be susceptible based on normal laboratory testing. This is because the bacteria can have "inducible resistance".  Inducible resistance can be detected by a special test called a D-test (see picture), but this test is not widely performed in veterinary laboratories.

In recent study presented by Dr. Meredith Faires (University of Guelph) at a conference last week, 55% of MRSA from dogs and cats that were reported to be resistant to erythromycin and susceptible to clindamycin were actually inducibly resistant to clindamycin.  But no MRSA that were susceptible to erythromycin were inducibly resistant to clindamycin. In contrast, inducible resistance to clindamycin was not identified in any MRSP. Therefore, in the absence of specific testing for inducible resistance (i.e. a D-test), it is wise to consider all erythromycin resistant MRSA to be clindamycin resistant as well, regardless of the results of traditional antibiotic susceptibilty testing.

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This post has been updated with new information as of October 2, 2008.

Raccoons, just like dogs and cats, can have roundworms in their intestine. Dogs are typically infected by the species Toxocara canis, and cats are infected by Toxocara cati. Raccoons are infected by a type of roundworm from a different genus, called Baylisascaris procyonis. There is one thing that all three of the parasites have in common – the larvae of these worms can infect humans, causing a condition called visceral larval migrans.

Dogs and cats are usually dewormed as puppies and kittens, and often as adults as well, which dramatically decreases the number of pets that are infected with roundworms. Raccoons are not so lucky – in the northern and northeastern parts of North America, over 70% of raccoons may be infected with Baylisascaris.  In Ontario, it has been estimated that only about 20-30% of raccoons are infected, but usually with high numbers of worms. In either case, younger raccoons are even more likely to be infected.  Infected animals may shed millions of parasite eggs in their stool, and the eggs can survive in the soil for months or even years.

After a few weeks, the eggs in the raccoon stool become infective. If a person swallows the eggs, they hatch in the small intestine and release larvae. These larvae can then burrow through the wall of the intestine and migrate through tissues all over the body, causing tissue damage and inflammation. The signs of illness are often not very specific, and may include things like fever, fatigue and nausea. If the larvae migrate through the brain or spinal cord, a person may develop neurological signs like loss of coordination and muscle control. This is called neural larval migrans, which is the most serious type of disease caused by these larvae.  If the larvae migrate through the eye, they can cause blindness.  This condition is known as ocular larval migrans.

There have been less than 25 cases of confirmed visceral larval migrans due to Baylisascaris in the USA as of 2003, but the condition is very hard to diagnose with certainty, and it is possible that many cases are mistaken for other illnesses. The disease is also very difficult to treat, and neurological damage from neural larval migrans is usually permanent, so the best thing to do is prevent infection in the first place. Here are some tips on avoiding Baylisascaris:

• Avoid contact with raccoons. Many people think raccoons are cute, but they are wild animals. Raccoons are also a risk for transmission of rabies if a person is scratched or bitten. NEVER keep a raccoon as a pet.
• Discourage raccoons from hanging around your house. Clear brush and seal access to basements and attics where raccoons may try to nest or form latrines. Keep garbage in tightly-closed garbage cans. Eliminate outdoor water sources.
• Always wash your hands well with soap and water after working with soil (e.g. in the garden).
• Clean up raccoon latrines.  This must be done very carefully - avoid getting any raccoon stool on your hands or clothes. The stool should be burned, buried or sent to a landfill. Clean the area where the stool was found with boiling water. Wash your hands very carefully when you’re done.  Follow this link for more detailed information on how to identify and clean up raccoon latrines.

Baylisascaris procyonis less commonly infects animal species other than raccoons, including skunks, and it has even been found in dogs.  It's important to have your dog's stool examined for parasite eggs on a regular basis (typically once or twice a year) and to follow your veterinarian's recommendations for deworming your dog.

More information about Baylisascaris is available on the CDC’s Baylisascaris Infection website.

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In a recent post, I discussed a study about the health effects of feeding raw meat diets to pets. Because of the significantly higher rates of shedding of certain potentially harmful bacteria by dogs that are fed raw meat, I think raw meat diets are a bad choice - especially in households with young children, elderly individuals or people with compromised immune systems. However, if you are going to feed raw meat to your pet, you should take some basic precautions.

• Only use meat that is suitable for human consumption. Don't buy 'adulterated' meat or meat labeled unfit for human consumption.
• Keep raw meat frozen until you need it. Only thaw out the portion that is need for the next feeding, and thaw the meat in a sealed container on the bottom shelf of a refrigerator.
• Handle raw meat with care. Do not allow it to contaminate kitchen surfaces or items that may come in contact with other food. Clean and disinfect any items that come into contact with raw meat.
• Wash your hands thoroughly after handing raw meat or anything that has touched raw meat (e.g. your dog's food bowl).
• If your pet does not finish all the meat fed right away, discard any uneaten raw meat promptly. Do not allow raw meat to sit in a bowl at room temperature. Some dangerous bacteria can multiply rapidly under these conditions.
• Regularly clean and disinfect your pet's food bowl, but bear in mind that  a recent study showed that it is very hard to eliminate Salmonella from raw meat in food bowls.
• Make sure your veterinarian knows that you feed raw meat. This is particularly important if your dog develops vomiting or diarrhea.
• It is very important to make sure that your pet's diet is well balanced, which can sometimes be difficult to do when feeding non-commercial or raw diets.  Read about raw meat feeding, and try to find good sources of information (which is not always easy) to reduce the risk of problems caused by feeding an unbalanced diet.
• Never feed raw meat to sick dogs, puppies or pregnant dogs.

 

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Brucellosis is an infection caused by bacteria of the genus Brucella. The most common species of Brucella in companion animals is Brucella canis, which typically causes infection in dogs. This bacterium is very rare in Ontario - in a survey of 2000 dogs, only 0.3% had evidence of exposure to B. canis. So it was unusual that a case of canine brucellosis was recently diagnosed in the province, until it was discovered that the dog originally came from a rescue shelter in the southern USA - an area where exposure to the bacterium is much more common (approximately 8% of dogs).

Brucellosis in dogs typically causes reproductive problems such as infertility and an enlarged scrotum in males, and late-term miscarriage in bitches (breeding females), with few or no other signs of clinical illness. But in some cases the bacteria have been found to infect tissues other than the reproductive tract, including intervertebral discs (leading to back problems), the eyes, the kidneys, or the tissues around the brain and spinal cord (i.e. the meninges). The bacteria, and antibodies to the bacteria, can be very difficult to detect in the early stages of infection. The infection is usually diagnosed by a blood test, but it may take 8-12 weeks before test will yield a positive result.  There are also problems with high numbers of false-positive test results due to cross-reaction with other species of Brucella.  Any positive test result should therefore be confirmed by a second, different laboratory test.

Human infection with any species of Brucella is now uncommon. When illness does occur, the signs are often non-specific (e.g. fever, headache, myalgia), but more severe infections have been reported.  Transmission of B. canis from an infected dog to a person is possible. The bacterium is transmitted by contact of a mucous membrane (e.g. eyes, nose, mouth) with blood, urine, milk, semen, or vaginal discharge from an infected animal. The highest-risk materials (i.e. most likely to contain a high number of the bacteria) are placental tissues and fluids that are passed during whelping (delivering puppies).  Treatment for infection is available, but the course is often long and recurrence of infection can occur.

Although brucellosis is very rare in dogs in Ontario (and Canada in general), here are a few things you can do to help avoid B. canis:

• Always wash your hands right away if you accidentally come in contact with blood, urine, milk, semen or vaginal discharge from any dog.
• Prevent contact between your dog and urine, milk, semen or vaginal discharge from other dogs, especially if you travel with your dog to an area where the prevalence of B. canis is relatively high (such as the southern USA).
• Dogs used for breeding should be tested for B. canis.  Many breeders will require dogs to be tested before allowing their animal(s) to be used, because the infection can be transmitted through breeding and can have such detrimental effects on fertility.
• Newborn pups should be handled as little as possible, but if you must handling them wear disposable gloves and wash your hands as soon as you take your gloves off. Exercise the same precautions when cleaning up the area where a bitch has whelped.

More information about brucellosis can be found on the CDC's Brucellosis website.

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A previous Worms & Germs post talked about the (very low) zoonotic risk of the tapeworm most commonly found in dogs and cats, Dipylidium caninum. Dogs can also carry other species of tapeworm, such as Taenia pisiformis, which cannot be naturally transmitted to people. But dogs can also carry tapeworms from the genus Echinococcus, the most common of which is E. granulosus. Echinococcus multilocularis is much less common in North America, and can also be carried by cats.

In Canada, dogs tend to be exposed to E. granulosus when they eat certain animals, particularly wild herbivores like moose and caribou. In other parts of the world, eating sheep organs is the most common way dogs are exposed.  The immature form of the worm is found in the animal’s lungs, liver and other tissues. After being eaten by the dog, the worm matures in the intestine, and tapeworm eggs can soon be found in the dog’s stool. Tapeworm segments, as seen with Dipylidium infection, are usually not seen in the stool with Echinococcus. Under a microscope, it is possible to tell Dipylidium eggs from Echinococcus eggs, but it is not possible to tell Echinococcus eggs from Taenia eggs.

If a moose, caribou, sheep or another suitable “intermediate host” swallows the eggs from the dog stool, the parasite migrates through the animal’s body and forms cysts in various tissues which contain the immature form of the worm. If the animal dies or is killed, and a dog (or a wolf or coyote or related species) eats the cysts, the cycle begins again.

Unfortunately, humans can also be an “intermediate host” for these tapeworms. If a person ingests Echinococcus eggs from dog stool, the parasite can form cysts (called hydatid cysts) in many tissues and organs, including the liver, lungs, brain and heart. If the cysts are small and there are only a few, they may not cause any problems for years, and the person may never know they’re there. But as the cysts grow, they can get very large and start to interfere with the function of organs, or their size alone may be a problem, depending on where they are located. Treatment can be difficult – drugs are frequently not effective, and large problematic cysts may need to be surgically removed, if the surgery can be done safely. If a cyst bursts it can cause anaphylactic shock, which is very dangerous.

In Canada, Echinococcus infection and hydatid disease are most common in the western provinces. Nonetheless, everyone can take a few simple steps to help prevent exposure of people to Echinococcus:

• Always wash your hands after handling dog stool, even if you use a plastic bag or a scoop to pick it up.
• Your dog should have a fecal examination for intestinal parasites at least once per year, or more frequently if your dog is at increased risk of exposure to Echinococcus. If tapeworm eggs are identified, your veterinarian can prescribe medication to treat the infection.
  • Monthly heartworm preventatives that are effective against other intestinal worms are not effective against tapeworms!
• Do not let your dog eat uncooked meat, especially the organs of sheep or wild game such as moose and caribou.

More information on Echinococcus and hydatid disease is available on the CDC’s Echinococcosis webpage.

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Many dog owners love to take their canine companions to the beach with them during the summer. Unfortunately, other people (particularly non-dog owners) sometimes take exception to having Bowser on the beach. These individuals often cite potential infectious disease risks as a reason to ban dogs from the beach.

While there are some potential infectious disease risks associated with having pet dogs at the beach, they are minimal. Also, some simple, common-sense steps can greatly reduce the risks that do exist. The infectious disease risks from feral (wild) dogs and wildlife defecating in the sand are much greater.

• The biggest health risk is actually probably from dog bites. Bites can be avoided through proper handling and training of dogs that are brought to public beaches.
• Many different bacteria (e.g. Salmonella, Campylobacter) can be passed in the stool of even healthy dogs. Some of these can be harmful to people, but only under certain circumstances, such as if they are swallowed or if they contaminate an open wound.
  • Promptly picking up any stool passed by a dog greatly reduces the risk of significant contamination of the sand. Also, sunlight is an excellent “disinfectant” and will help kill any residual bacteria left behind.

• Dogs can also have different kinds of zoonotic parasites in their stool.
  • Some of these parasites (e.g. roundworms, hookworms) are passed in a form that takes days to become infectious to people. So promptly removing dog stool from the beach minimizes the risk of transmission.
  • Other parasites, such as Giardia, are immediately infectious when passed in the stool, but must be swallowed to cause infection. Prompt removal of dog stool, good hand hygiene with soap and water or an alcohol-based hand sanitizer before eating, and avoiding sand contamination of food and drink should largely eliminate this risk as well.

Overall, the risks of having dogs on beaches are very low if people behave responsibly, specifically properly restraining their dogs and promptly picking up stool.

More information about zoonotic diseases associated with contamination of sand and Sandboxes is available on the Worms & Germs Resources page.

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Rabies is an important disease that is almost always fatal. An important part of rabies control programs is mandatory vaccination of pets such as dogs, cats and ferrets. In general, rabies vaccination is very safe and effective. Complications from rabies vaccination are rare, but in recent years concerns have been raised about vaccine-associated sarcoma, a type of tumour that can develop at the site of vaccination. Since this complication was recognized, the vaccines themselves and the way they are administered have been changed in order to decreased the likelihood of this problem occuring, but the risk cannot be eliminated completely. For this reason, some people have tried to avoid having their pets vaccinated for rabies. 

A blood test can be performed to determine antibody levels (also called a titre) against rabies virus. However, there is not enough information available to determine what antibody titre is high enough to say that an animal does not need to be re-vaccinated. Skipping rabies vaccination based on blood test results is dangerous and not recommended. While rabies is uncommon in most areas, exposure can occur, even in strictly indoor animals (e.g. if a bat gets into the house). Rabies vaccination is a legal requirement in most areas of Ontario. The implications of rabies exposure in an animal that is not "up-to-date" on its vaccines can be severe, including prolonged quarantine or euthanasia. I do not know of any jurisdictions that allow rabies antibody levels to be used in place of vaccination, and animals that are not recently vaccinated are treated as non-vaccinated, regardless of their antibody titre.  The risk to your family or your pet from rabies is greater than the very tiny risk of vaccine-associated sarcoma. If you care about your pet and your family, make sure your pet is properly vaccinated against rabies.

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

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Pet treats derived from raw animal products such as rawhides and pig ears (yes, pig ear treats are actually dried, raw pig ears) are widely available and commonly fed to pets, particularly dogs. Being a raw product, there is an inherent risk of contamination with potentially harmful bacteria such as Salmonella. In 1999, an outbreak of salmonellosis linked to contact with raw pet treats was identified in people in western Canada. A subsequent investigation found Salmonella in over 50% of pig ear treats and 38% of other animal-derived treats. Similar results were reported by a later study in the US, and other outbreaks of disease have been reported. In Canada, the pet treat industry and government groups met and made various recommendations to reduce the risk of contamination.

To evaluate the effect of these changes, a Canadian follow-up study was performed. Only 4% of treats were contaminated with Salmonella, which was a marked contrast to the earlier study. Even so, the fact that Salmonella was present in a detectable percentage of treats means that certain precautions are warranted.

• Always wash your hands thoroughly after handling pet treats such as rawhides and pig ears
• Avoid buying treats from 'bulk bins', as there may be an increased risk of cross-contamination between treats in the bin
• Buy packaged treats so that you don't have to touch them directly when buying them or bringing them home
• Never store treats in areas where other food is kept or prepared
• Ask whether the treats you are buying have been produced under the Guidelines for the Manufacturing of Natural Pet Treats for Pets.  There guidelines were developed by the American Pet Products Manufacturers Association with input from the Food and Drug Administration (FDA)
• Avoid buying raw treats if you have young children or anyone with a weakened immune system living in the household, as these treats may pose a small but unnecessary risk of exposure to Salmonella
• Contaminated treats seem to be a bigger problem for people than pets, however Salmonella can also cause disease in pets. If your pet develops diarrhea after eating an animal-product treat, be sure you tell your veterinarian

Image: Pig ear dog treat from www.foodpoisonblog.com

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A common question from owners of pets infected with methicillin-resistant Staphylococcus aureus (MRSA) is "Where did it come from?" The answer is not completely clear, but evidence strongly suggests it probably came from humans. The MRSA strains found in pets are almost always teh same as those found in people (including people that don't have pets) in the same geographic area. This strongly suggests that the MRSA came from the same source. Considering the fact that S. aureus in general is much more common in humans than in pets, and how long MRSA has been around in people, and that MRSA can sometimes be found in both people and pets in the same household, it is very likely that MRSA can move between species and originally went from humans to animal.

Even though MRSA in pets probably originated from people, now that it is in the pet population, pets can spread it to other animals and back to people. It is unclear how frequently this occurs - most people are still more likely to encounter MRSA from another person than from an animal.

The emergence and spread of MRSA in humans was largely driven by extensive antibiotic use in people.  Once MRSA crossed over to pets, antibiotic use in these animals almost certainly played a role in helping MRSA spread in the pet population. Antibiotic treatment has been identified as a risk factor for development of MRSA infection in dogs, and for MRSA carriage in horses.

Prudent antibiotic use is likely the most important factor in reducing the risk of MRSA in individual pets.  Using antibiotics prudently means doing things like:

• Only using antibiotics when they're really necessary
• Using the most basic antibiotic possible (instead of the fanciest or most powerful antibiotic)
• Finishing every prescription completely and as directed)

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