I've been bitten lots of times, some on the job (including the last dog I saw when I was in general practice) and some off (including a dog down the road a couple of years ago). Fortunately, I haven't suffered any serious consequences. That's what happens most of the time. However, bad things can and do occur after bites.
A paper in BMJ Case Reports (Tumram et al 2012) describes a rather unusual and unfortunate situation. It's about a fatal infection in a 55-year-old Indian woman who was bitten by a mongoose. She was bitten (unprovoked, it seems) on the leg by the mongoose while washing dishes. She went to the hospital a couple of hours later because of pain and swelling in her leg. It's not clear what happened there, but she went back to hospital the next day, and then received antibiotics. However, that same day, she suffered cardiac arrest (a heart attack) and died a few days later. The bacterium Streptococcus pyogenes (Group A Streptococcus) was isolated from some lesions on her legs, leading to a suspicion that she developed a severe and rapidly progressive infection from the mongoose bite.
Various aspects of this case are unusual. Fatal bite infections occur, but they are rare. Involvement of streptococci is rarer still.
Why did this woman develop a fatal infection, especially when she sought prompt medical care? It's hard to say, and there is a "bad luck" component of infectious diseases. She had diabetes and high blood pressure, which probably increased her susceptibility to infection (but lots of other people who get bitten also have these conditions and suffer no consequences). It doesn't appear that she received antibiotics when she went to the hospital originally, but a bite over the leg isn't one that would always be treated prophylactically with antibiotics.
Why did the mongoose bite? That's another good question. Unless you're a snake, mongooses are typically not aggressive.
Where did the bacteria come from? We don't know much about the oral bacterial population of mongooses, but Streptococcus pyogenes is a human-associated bacterium. It's rarely found in animals and I suspect that the strep didn't come from the mongoose. Rather, it was probably already on the woman's skin and introduced into her body by the bite, or she contaminated the wound after being bitten. It's just a guess, and it doesn't change anything, but it makes sense.
This report shouldn't make people freak out over a bite. However, it should serve as a reminder that bad things can happen. More information about dealing with bites can be found on the Worms & Germs Resources - Pets page.
Image: Dwarf mongoose (Helogale parvula) in Korkeasaari zoo (photo credit: Miika Silfverberg, click image for source)
As someone who works with zoonotic diseases, I often find myself fighting battles on both sides of the issue. One side is trying to increase awareness about zoonotic diseases (i.e. those caused by microorganisms that are transmitted between animals and humans) and getting people to think about the potential role of animals in human infection. However, I often also have to deal with trying to keep things in perspective, and prevent people from over-reacting to disease risks. Part of this is helping people understand that disease transmission is typically a two-way street. While animal-to-human transmission is usually the greatest concern, human-to-animal transmission of a variety of bugs also occurs, and this can cause problems for the animals, and for people who subsequently have contact with those animals.
A recent paper in the journal Mycoses (Van Rooij et al 2013) highlights one such scenario. The paper describes ringworm in a dog that was associated with the fungus Trichophyton rubrum, which is not the typical ringworm species (Microsporum canis) that we find in dogs. Trichophyton rubrum is a common cause of infection in people, particularly tinea pedis (athlete’s foot) and onychomycosis (fungal infection of finger and toe nails). The authors did something that’s often lacking in reports of animal-human transmission: they actually tested both the person and the pet. Here, they found that the owner was a carrier of this fungus. They were able to isolate the fungus from his skin and determined that he likely had an asymptomatic infection that was subsequently transmitted to his dog. (He’d previously had untreated and self-resolving athlete’s foot, and presumably remained a carrier after that). Since this ringworm species is predominantly found in humans, it’s a reasonable assumption that it started with the person and the problem was only identified when the dog developed disease. In this case, the dog was old and had been treated with corticosteroids, both of which probably affected it’s immune system and made it more susceptible to this uncommon cause of canine disease.
It’s important to remember that while zoonoses are important, pathogens go both ways.
In the end, we’re all animals.
I have three kids that are all now (thankfully) past the diaper stage. I have no idea how many diapers I changed, but I don't have a huge desire to start doing it again, especially for chickens.
I understand the whole urban chicken concept. I don't actually have many issues with it if it's done right - but that's a big IF, unfortunately. Keep your chickens on your property, don't do it if you have young kids or other high risk individuals in the household, use good basic hygiene practices, feed them right, don't get roosters, and don't run screaming to the newspapers or local politicians if some get eaten by carnivorous urban wildlife. The nuisance and risk of backyard poultry can be limited.
Live chickens inside the house... that's another story.
Chickens aren't house pets in my world. I'm not sure if the chickens benefit at all from living in a house with people, and it's probably actually detrimental in many ways. I'm not sure what the benefit is to people either. Although I haven't seen any studies on this specific topic, it stands to reason that keeping a chicken indoors would be associated with a fairly high risk of widespread contamination of the household with bacteria like Salmonella and Campylobacter, two bugs that cause millions of infections in humans every year.
I'm all for risk mitigation, including using creative (and sometimes off-the-wall) measures - but diapers for chickens? Not so much.
Yet, Pampered Poultry makes diapers for your indoor chickens, and not just run-of-the-mill diapers: they're (allegedly) both functional and fashionable. This isn't the only company that sells chicken diapers either, much to my surprise.
One website states "Our chicken diapers are not just for the fashion obsessed hen. They offer your and your home protection against the inevitable! Our diapers fit comfortably and allow you to enjoy your birds in the house or car [car?] without worry."
Does using chicken diapers make sense?
I have a hard time believing these diapers are very useful. They probably do reduce the burden of pathogens that are deposited in the environment, but they are presumably far from 100% effective at containing all of a bird's droppings. It's also likely that chickens are contaminated with these bacteria on other parts of their bodies. Thinking you've eliminated the risk of household contamination from your pet poultry by using diapers isn't logical. The diapers also need to be changed (risk of more contamination) and disposed (don't we have enough waste already?) or washed (risk of cross-contaminating other items).
If you want fashionable chickens, go ahead and dress them up in diapers. Nothing says haute couture like a chicken walking around the living room in pink floral undies. Just don't convince yourself that you're reducing the infectious disease risk for other animals and people in the house. Better yet, let the chickens be chickens and keep them in a proper coop outside. I've seen too many indoor goats, pigs, miniature horses and other species with profound health problems from owners thinking they're just like people.
Apart from diapers, the store also sells "saddles" for the chickens. I'm not even going to start on that one.
I’ve received a lot of emails over the past 24 hours about the recent report of equine herpesvirus type 1 (EHV-1) neurological disease in an Ontario horse. The two main questions are whether there’s an outbreak and whether horse owners in Ontario should be concerned.
I don’t have any firsthand knowledge about this case (or any information beyond what’s been written elsewhere), but as far as I know, this is just a single sporadic case. That doesn’t mean an outbreak can’t occur, but most often, these just occur singly.
Whether there’s cause for concern is a tough question to answer. Yes, EHV-1 can be a serious problem, causing neurological disease in adult horses, abortion in pregnant mares, and severe disease in neonatal foals. Yet, at the same time, it’s an endemic disease that most often occurs as sporadic cases rather than large outbreaks (people just don’t hear about single cases as often, although they are now reported a lot more than they were a few years ago). The EHV-1 virus is very common and can be found in its dormant form in a large percentage of horses, so it’s not like some pathogens with which an unexposed population can suddenly be threatened when a single case is identified. In general I pay close attention to EHV-1 cases, but they are not a cause for panic. If a case occurs, we need to see if some broader issue is at play, and put steps in place to limit the problem, but we don’t need to cause massive disruption. In short, we want to ensure that good surveillance and infection control measures are in place, but not freak out in the process.
People have really taken a 180 degree turn in how they handle EHV-1 over the past 10 years or so. I don’t think we see EHV-1 neurological disease any more than when I was a resident. Back then, we saw sporadic cases and the odd small cluster, and people didn’t get too worked up about it in terms of the risk of transmission. Outbreaks, such as one I can remember associated with a large Ontario Standardbred yearling sale, certainly got lots of attention, but it was short-lived. Things changed (for good reason) based on some large, high-profile outbreaks in the last decade. It’s not known why such outbreaks now seem to be more common.
Anyway, if you live in Ontario and have a horse, don’t panic. Your horse is probably at no greater risk today than it was last month, assuming it wasn't in contact with the affected horse (which was diagnosed in early April). Virtually every horse is at some degree of EHV risk every day, but the odds of disease occurring are very low.
Some key prevention tips include:
- Use good general infection control practices to reduce exposure of horses to pathogens brought in by newly arrived horses.
- Observe your horses regularly and if there are any problems, isolate the horse and have a veterinarian examine it ASAP.
- When travelling to shows, races or other events, take measures to reduce direct and indirect contact between horses.
The first true confirmed canine influenza virus (CIV) was the H3N8 canine flu that evloved from H3N8 equine flu. That's the virus that spread to and amongst dogs in various parts of North America. The general consensus has been that only this strain should be called CIV, since it's been the only true dog-adapted influenza virus that's developed the ability to stay and circulate in the dog population.
More recently, another canine flu virus has emerged in dogs, this time a type H3N2 in Asia. H3N2 is a common human flu type, but birds are the ultimate reservoirs of all flu viruses, and based on the genetic relationship of H3N2 from dogs and birds, it's thought that this virus came to dogs from birds.
Anytime a new infectious disease is encountered, it's important to figure out who/what it can infect. When H3N8 CIV emerged, it was shown that even though it came from horses, it was no longer adapted to readily infect horses. So, knowing a virus' origin or typical infection trends can be useful but it doesn't necessarily tell you the whole story.
Cats and ferrets are susceptible to many different types of influenza viruses, and are good species to look at when figuring out if a virus can spread to other domestic animals. A study in the recent edition of Influenza and Other Respiratory Viruses (Kim et al, May 2013) looked at transmission of H3N2 CIV between dogs, cats and ferrets.
In that study, researchers infected dogs with CIV and kept them in close proximity to cats and ferrets, but without direct contact. They also infected cats and ferrets to see whether they could transmit the virus to other cats or ferrets.
Here are some highlights from the study:
- All directly infected animals developed some degree of illness, with cats and dogs typically developing sneezing, coughing, increased respiratory effort and nasal discharge, and ferrets only developing sneezing.
- Cats could become infected by being in proximity to both infected dogs or infected cats.
- Ferrets didn't get infected when exposed to infected dogs.
- Ferrets did not develop disease after exposure to an infected ferret but 2/3 developed antibodies against CIV, meaning the virus had been transmitted, but not able to cause disease.
- Cats shed higher amounts of virus than ferrets.
- Dogs stopped shedding the virus by day 8 after infection. That's not surprising since influenza shedding is short-term with H3N8 CIV. It shows that use of good infection control measures, particularly isolation, can be a key component of canine flu control.
- Dogs with H3N2 CIV are potential sources of infection for cats and ferrets.
- Cats that are exposed to the virus can get sick and be sources of infection for other animals, presumably including dogs. Cats may be another truly susceptible host for this virus.
- Ferrets seem pretty resistant to the virus. It probably takes fairly high level exposure for them to get infected and they are less likely to be of concern for subsequent transmission.
Interspecies transmission of flu viruses, and other viruses, is obviously an issue. Most of the attention is paid to the bird-pig-human cycle, for good reason. Birds are the reservoirs of all influenza virus variants, pigs are susceptible to both human and bird flu viruses and can act as a "mixing vessel," and humans are the species we're ultimately most concerned about. However, the potential for disease in pets and for pets to be reservoirs of influenza for people or other animals shouldn't be neglected. I've frequently had discussions with colleagues in the medical and public health fields about the need for parallel companion animal surveillance when plans are made for emerging infectious disease surveillance and response (e.g. SARS, H1N1 flu, novel coronavirus). They typically respond with general enthusiasm, but interest and application aren't the same, and actually getting plans in place to perform coordinated parallel surveillance hasn't happened. Studies like this are just one more piece in the puzzle that indicate the need for broader surveillance and consideration of pets.
Surprise, surprise - Meg has a hot spot.
"Hot spots" (aka focal bacterial pyoderma) are common skin infections in some dogs. Meg has underlying skin issues and lately has spent a lot of time wallowing around in ponds (because that's what she likes to do). With her skin issues, potentially weaker immune system because of her advanced age, and frequent wetness, she's a bacterial skin infection waiting to happen.
The latest hot spot is under her neck, and was evident by some colour change in the area (picture #1) and a bit of scratching, along with an odour if you get really close. These signs can easily be missed, especially early on, as the infected site is a bit hidden. Often, people only notice when it gets really wet and stinky, or when the dog scratches at it incessantly. Clipping the area revealed a more extensively affected area (picture #2) and a couple of focal spots with some pussy discharge. (It's quite amazing what can be hiding under an animal's fur!)
A hot spot is caused by a bacterial infection, and it's almost guaranteed that it's a staph infection (most likely Staphylococcus pseudintermedius). I took a swab from the affected area for culture. That's probably not critical in a case like this, especially when I'm going to treat it topically and without antibiotics, but since I can do it myself, it never hurts to have the information with regard to what bug is responsible (particularly if the infection comes back again).
The approach to treating hot spots is pretty straightforward, and owner compliance is key. Here's the plan:
Clip the area
- This helps identify the extent of the problem. It also (very importantly) helps keep the area dry and facilitates topical treatment.
Keep the animal from traumatizing the site
- That's been easy so far with Meg since she's not really scratching at it. If she was scratching, we'd need to put on an Elizabethan collar or use some other form of protection. In some cases, corticosteroid anti-inflammatories are needed to control the itch (and thereby the scratch).
Keep it dry
- Easier said than done. Despite being old and lazy, Meg is very motivated when it comes to lounging around in whatever water she can find (including the other night at 3:00 am... don't get me started on that one). Other than that, since the site is clipped now, keeping it dry is not a major problem.
- This is a bacterial infection, but the advantage of skin infections is that skin's on the outside. We can treat it topically and avoid using oral or injectable antibiotics. There are various things that can be done this way, usually involving bathing, wiping or spraying the area with topical antiseptics. We're using an antiseptic spray on Meg.
- Nothing major. It's unlikely that the cause is something zoonotic (and if it's MRSA, she presumably got it from someone in the family!). The staph that typically cause these infections are common inhabitants of canine skin. They rarely, if ever, cause infections in the absence of some inciting cause so Merlin (the other dog) and Finnegan (the cat) are unlikely to get an infection from Meg in this situation.
- A little handwashing goes a long way.
Hopefully I don't get to write about the massively increasing hot spot next week.
Cranimals Organic Pet Supplements has launched an at-home urinary test kit for dogs and cats that lets you "Monitor and track your pets health in an accurate and economical way, avoiding costly, unnecessary trips to the vet" (while not avoiding costly, unnecessary supplements, I assume).
The test claims to diagnose urinary tract infections (UTIs) by "detecting blood, leukocytes (AKA white blood cells) and nitrite in animal urine." Unfortunately, it cant.
- Blood in the urine does not necessarily mean there is an infection (i.e. this is a non-specific sign). In fact, a minority of cats with blood in their urine have an infection. They are much more likely have another problem like idiopathic cystitis that needs to be treated differently than an infection.
- Urine test strips for white blood cells are notoriously useless in animals. Maybe they have a better, more useful version, but I doubt it. The best way to detect these cells in the urine is to look for them using a microscope.
- Nitrite can be produced by bacteria in the urine but it has little to no diagnostic value in dogs and cats.
There's no mention about any specific evaluation of the test (i.e. they haven't checked to see if the test actually does what it's supposed to). By the look of the picture, it seems to simply be a urine dipstick in a fancy holder marked up a couple thousand percent to make money. Actually, it seems to be an inferior type of dipstick since it only tests for 3 things, two of which are useless.
Not surprisingly, the test is to be used in conjunction with their supplements (which probably explains why a supplement company decided to enter the diagnostic testing business).
The test isn't exactly cheap either: $39.95 for dogs and $49.95 for cats (the only difference to me being the cat kit comes with a bit of non-absorbent litter to put in the litterbox to collect urine, with a nice markup there too). While marketed as a way to save money on veterinary bills, think hard about what it will really do. Beyond potentially providing misleading information that could impact proper care, it will probably end up costing owners more:
- If the test is negative and the pet has urinary tract issues, it needs to be seen by a veterinarian to find out what's going on.
- If the test is positive, the pet needs to be seen by a veterinarian to get treated. No competent veterinarian is going to prescribe a treatment based on an at-home test like this. So, the full range of testing will be done anyway.
Ultimately, if the pet is sick, it needs to see a veterinarian. If it's not sick, there's no indication for testing like this.
If you want to know some real facts about diagnosing UTIs in dogs and cats, check out the International Society for Companion Animal Infectious Diseases Guidelines for diagnosis and management of UTIs in dogs and cats.
If you still think this test is worth the money, I've got some great oceanfront property in Saskatoon that I'll sell you (see photo). The water skiing is particularly good in January.
This is an increasingly common question, because MRSP is increasingly common. I've had two calls about it this week, and it's only Wednesday.
It's a good question to ask because MRSP (methicillin-resistant Staphylococcus pseudintermedius) is a highly drug-resistant bacterium that causes a lot of problems in dogs, and because of the high profile of its relatively distant relative, MRSA (methicillin-resistant Staphylococcus aureus), in people.
The short answer is: Yes, MRSP can infect people
BUT... (and it's a big and important but):
It's exceedingly rare and the overall risk is very low.
Here's my reasoning behind this answer:
1) Reports of MRSP infections in people are very rare.
- I think there are only two such published reports at the moment. There have probably been more infections than the number that are published, and there's the potential for MRSP to be misdiagnosed by some human diagnostic labs (meaning some MRSP infections may be mistaken for something else), but I think it's fair to sayl this a very rare infection in humans.
2) MRSP is not well adapted to infect people.
- MRSP is not inherently any more likely to cause infection than methicillin-susceptible strains of S. pseudintermedius (MSSP).
- MSSP can be found on basically every dog.
- A large percentage of the human population has contact with dogs every day.
- So, a large percentage of people encounter MSSP every day. Yet, reports of MSSP infection in people are very rare. To me, that indicates that this bacterium is poorly adapted to be a human pathogen.
3) Veterinary dermatologists are not extinct.
- MRSP is very common in dogs with skin infections. In some practices, it's the main cause of these infections.
- That means veterinary dermatologists encounter a lot of MRSP every day.
- I have yet to hear a report of a veterinary dermatologist getting an MRSP infection (carriers yes, disease no). I wouldn't be surprised if there actually have been some infections, but dermatologists can be considered the canaries in the mine when it comes to human MRSP risk, and I'm not aware of any real issues.
4) All dogs are biohazardous
- While this may not comfort the people calling me who are worried about the health of their families, it's important to put things into perspective. All dogs are carrying multiple microorganisms that could cause disease in people under the right circumstances (and the same goes for all cats, horses, people etc. for that matter).
- If you screened the average dog, you'd find things that are of greater concern that MRSP. In fact, MRSP probably barely cracks my "Top 10 List" of things I'm worried about the average dog spreading.
So, yes, there's a risk of MRSP infection when a person has contact with a dog infected with or carrying MRSP. There's also a risk of infection from methicillin-susceptible S. pseudintermedius, the version of the bug that basically all dogs carry, and a whole range of other bugs.
There will never be a zero-risk pet when it comes to zoonotic diseases. It's impossible. The risks may be very low but we can never eliminate all risk, just like we can never eliminate all risk from walking down the street. For some people, that slight degree of uncontrollable risk might be too much to handle, and they probably shouldn't own a pet. For most, the positive aspects of pet ownership outweigh the risks, and some basic hygiene practices (e.g. handwashing, avoiding licking, avoiding contact with the dog's mouth, nose and bum) can reduce that already low risk even further.
“Show me the peer-reviewed publication.”
This is a common refrain used, particularly by the scientifically-minded, when talking to someone about the latest trendy diagnosis, treatment or other medical "discovery." It used to be relatively easy to use this method to assess the reliability of new information. If something was published in a peer-reviewed journal, it was probably at least reasonably sound (not always, but it did provide a greater level of assurance).
Now, it’s getting tougher.
One reason for this is the proliferation of online journals in particular. Some are legitimate journals that have been created by people that perceived a need in a specific area. Yes, with more research, more journals can be supported. Some good journals reject 50-90% of submissions, and many rejected papers are still valid and indeed important. Having a wide range of journal options is important because everything can’t be published in Science, Nature or the New England Journal of Medicine.
But, there’s a limit.
I review a lot of papers for journals every year. Sometimes, I end up reviewing the same study a few times for different journals, after I’ve recommended rejection previously. Some of these get accepted if they are a better fit for the journal (e.g. scope of the study, priority of the type of research for the journal) or they end up making substantial changes to improve the manuscript. However, I’ve also rejected some papers a few times and eventually seen them published in pretty crappy journals. The sad reality is that marginal research can usually be published somewhere if the authors are persistent. Most people in academia know the strengths of journals in their field and can approach a paper in a "bottom-feeder" journal with care, but the general public doesn’t know that, may not have access to the full paper, and probably wouldn’t be able to assess the quality of the study anyway. So, just knowing that something’s been published in a peer reviewed journal these days only tells you part of the story.
Even worse, thousands of new journals have been created by for-profit groups. That doesn’t inherently mean they are bad, but it’s getting clear that for some, the size of the cheque is probably more important than the quality of research. I get emails from them pretty much every day from one group advertising a new journal, asking for journal submissions or requesting that I serve on their editorial board (yet curiously, I’ve never been asked to peer-review a paper for one). Unsuspecting academics have signed onto editorial boards thinking they were legitimate and have had a hard time getting their names removed once they realize the problems.
Some of these journals use impressive sounding names or ones that are very close to highly respected journals, further confusing the reading public.
All these things make it hard for the average person who wants to explore something a bit further to know what information can be trusted. Not only do you need to think about whether a study is published, you need to figure out if the study is valid and published in a reputable journal where the research was actually scrutinized, not published just because the authors paid a few thousand dollars for the publication fee.
Some of these for-profit groups sponsor scientific conferences that have the same issues. Normally, conference presenters are invited by scientific committees made up of experts in the area and/or are chosen through submission of research abstracts that undergo review. The more dodgy conferences solicit abstracts (I probably get an email a day from these) and get people to attend conferences, but then send them a bill at the end. So, they sucker paying attendees by making the conference look real (sometimes by putting names of high profile people as organizers or presenters without their knowledge) and get more money by charging presenters (thereby getting money from people who will pay to get their research presented or others with good research that are unsuspecting). In the end, you might be left with good research or invalid research, and it’s hard for the average person to sort this out.
How do we get this get under control? I have no idea.