E. cuniculi from rabbit to dog?
How likely is E. cuniculi to be trasmitted from an infected rabbit to a dog? My sister has a positive rabbit and my dog was just diagnosed with kidney insufficiency. Now that the dog's kidneys are compromised, should we be concerned?
Encephalitozoon cuniculi is a strange little organism that is now classified as a fungus, but is also similar to some types of protozoal parasites. It is an important (and often overlooked but potentially treatable) cause of neurological disease in rabbits. It is quite common in healthy pet rabbits, and infected rabbits shed the organism mainly in urine.
Less is known about E. cuniculi in dogs. Neurological disease, stunted growth and renal failure are the most common problems that develop. Disease usually occurs in young dogs (less than 1 year of age, with most cases in dogs a couple of months old or younger). Some studies have reported antibodies against the organism in a large percentage of healthy dogs, indicating that they've been exposed at some point, but most studies have found antibodies in few or no dogs.
The risk of transmission from rabbits to dogs is not known. There are a few different types of E. cuniculi, including one type (type I) that is called the "rabbit strain" and another (type III) that is called the "dog strain." The ability of the rabbit strain to infect dogs, particularly dogs with normal immune function, is unclear. Considering the low incidence of infection in dogs (especially older dogs), the different types of E. cuniculi that predominate in dogs and rabbits, and the commonness of kidney disease in dogs, I doubt there's a link between the rabbit's infection and the dog's kidney disease in this case.
Eliminating E. cuniculi in the household
A recent question:
"I have two rabbits who just tested positive for E. cuniiculi... Can you please tell me how to disinfect my floors and kill the parasites? I don't think bleach is doing it."
Encephalitozoon cuniculi is a strange little bug. It a member of a unique group of organisms called microsporidia. Originally thought to be parasites like Giardia, they are now classified as a type of fungus. Regardless, E. cuniculi is common in the pet rabbit population, causing neurological disease in some rabbits but living in many others without any signs of illness.
Infected rabbits shed E. cuniculi spores in urine, feces and respiratory secretions. Other individuals are infected by ingesting (and possibly inhaling) these spores. Infected rabbits start to shed spores in urine a month or two after infection, and can continue to shed low levels of spores intermittently. This, along with close housing of pet rabbits and movement of rabbits between breeders, stores and owners, explains why, in some studies, up to 75% of tested rabbits have evidence of current or prior infection.
Disinfecting household environments can be tough because of the surfaces that are involved. Encephalitozoon cuniculi is quite hardy and can live in the environment for prolonged periods of time. It is susceptible to a several types of disinfectant, including bleach, 70% alcohol and 1% hydrogen peroxide. In general, bleach is highly effective and is probably the standard for disinfection of surfaces that can tolerate it. Obviously, bleach isn't a good option for many surfaces like carpets. Steam cleaning might help, as much for the thorough cleaning component as for the steam.
One thing to consider is whether aggressive household disinfection is really required. While humans can be infected, infections are uncommon and predominantly occur in people with compromised immune systems, especially those with HIV/AIDS. If there are no high-risk people in the household, I don't think I'd be too aggressive with disinfection. Good hygiene practices involving handling of the rabbits and their cage are probably much, much more important, and its better to focus efforts there. Household disinfection for protection of the rabbits is probably not too useful at this point. I would suspect that all rabbits in the household have already been exposed, and since infected rabbits can continue to shed intermittently, rabbits are a much greater source of infection than the household environment.
More information about E. cuniculi can be found in our archives.
Watch out for rabbit pee
Urine from healthy animals is typically considered to be of little to no risk to people. This is generally true, at least for the otherwise healthy human population, but like with most things in infectious diseases, there are exceptions. An interesting one in rabbits is a bug called Encephalitozoon cuniculi. This microorganism (now classified as a fungus, but previously considered a protozoal parasite) is very common in healthy pet rabbits. In fact, the majority of rabbits have antibodies against E. cuniculi and may have it living in their bodies, particularly in the kidneys. It can cause infection of the brain, and is an important cause of neurological disease in rabbits, but more often than not it lives within the rabbit without causing any problems. Rabbits can shed spores of this organism is their urine, although they mainly do this only in the first few weeks after they've become infected, and shedding after that may be intermittent.
E. cuniculi is one of a group of microorganisms that became much more important when the HIV/AIDS epidemic hit. While rarely a cause of disease in people in the pre-HIV era, E. cuniculi is recognized as a potential cause of infection in people with compromised immune systems, particularly people with AIDS. Infections of people with normal immune systems are extremely rare.
It's always a challenge deciding what to do with a microorganism that can be shed by a large number of healthy animals. One reference "strongly advises" routine testing of rabbits, but that makes no sense to me. Here's why:
- Screening always comes down to a question of what you would do with the results. If you get a positive antibody test, it means that the rabbit has been exposed sometime in its life, but that does not mean that it is necessarily still infected or shedding spores - so it's not really convincing.
- Tests can be done to detect spore shedding but they are not particularly reliable. Since infected animals shed spores intermittently, a negative result here isn't convincing either.
- If the animal is positive, what would you do? If the household has no immunocompromised people, I'd say do what you've always done, and pay attention to good hygiene.
- If the animal was "negative," I'd say do what you've always done, and pay attention to good hygiene... same as for a positive rabbit.
- If there is an immunocompromised person in the house, I wouldn't say to get rid of the pet, since there's no evidence that's necessary. There is also no evidence that treatment is useful to eliminate E. cuniculi shedding rabbits. If the animal is positive, immunocompromised persons should avoid contact with urine and feces, and use good personal hygiene... just as they should do if the rabbit is negative!
More information about E. cuniculi in rabbits can be found in our archives.
Neurological bunnies: Encephalitozoon cuniculi
Encephalitozoon spp. are single-celled microsporidian parasites that can cause infection in the intestinal tract of animals and people, and sometimes infection in other parts of the body (systemic infection). Cases of infection with these parasites (encephalitozoonosis) have been reported in countries all over the world. The species E. bieneusi and E. intestinalis are the most common. A much less common species, E. cuniculi, is thought to be one of the most virulent microsporidia that infects humans (i.e. it causes the most severe infections). Encephalitozoonosis is rare in healthy people, but it is a common complication in patients with weakened immune systems. Encephalitozoon cuniculi can also be found in many animal species, particularly in rabbits. Most infections in rabbits do not cause illness (i.e. subclinical infections), but when disease occurs it typically causes neurological signs. In these cases the parasite tends to attack the brain and kidneys. The primary means of transmission between rabbits is E. cuniculi spores shed in the urine. Organ damage in the few human cases that have been reported have also been primarily in the brain and kidneys.
Direct transmission of this parasite from rabbits to humans has not been reported, but because there is also no evidence that it can't be transmitted from rabbits, the disease is so severe when it does occur, and the parasite is so common in rabbits, it is still prudent to take a few simple precautions. This includes washing your hands after handling rabbits, and keeping rabbits away from food preparation areas and food meant for human consumption. Anyone with a weakened immune system should be particularly careful, and ideally should have someone else clean out their rabbit's enclosure on a regular basis.
In general, the risk of illness in a rabbit and zoonotic transmission can be reduced by proper handling, good management, personal hygiene and routine healthcare. A rabbit that is not stressed and is well cared for is less likely to be susceptible to infection, and therefore less likely to transmit infection to a person. More information about rabbits is available on the Worms & Germs Resources page.
