Aquatic frog Salmonella update
As I mentioned in an earlier post, there's been a large and ongoing outbreak of salmonellosis in people across the US associated with pet aquatic frogs (such as African dwarf frogs). A recent edition of Morbidity and Mortality Weekly Reports provides an update on this large and concerning outbreak. Here are the highlights regarding infections reported between April 1, 2009 and May 10, 2011.
- 224 infections with the unique outbreak strain of Salmonella Typhimurium have been identified in 42 US states. Since it is estimated that only ~3% of Salmonella infections are laboratory confirmed, this means that the number of true cases is probably much higher (e.g. >8000, if the 3% estimate is accurate).
- The median age of affected people was 5 years, with a range of <1-67 years. The young age bias may be because of increased susceptibility to infection, increased likelihood of severe infection (which would more likely result in testing) or more common exposure.
- 30% of affected individuals were hospitalized. There were no deaths.
- 65% of affected people reported contact with frogs in the week before illness. 18% of those occurred outside the home (which is why we need to make sure that even non-pet-owners are educated about zoonotic disease risks associated with pets).
- The median time from acquiring a frog to onset of disease was 15 days. This means people often got sick fairly soon after acquiring their new pet.
- One breeder in California has been implicated as a common source of infected African dwarf frogs. As with many kinds of small pets (e.g. rodents, reptiles), this is a large breeder that sells to distributors who then sell to pet stores and elsewhere. This type of mass production and distribution system means that a problem with a single breeder can result in widespread disease. This has been clearly shown previously in various other outbreaks, especially with pet rodents.
What should the average pet owner know?
- High-risk households - those including kids under the age of five, elderly individuals, pregnant women or individuals with a compromised immune system - should not have pet aquatic frogs.
- High-risk people (as describe above) should not have contact with aquatic frogs in other places.
- People with aquatic frogs should consider the frogs to be infected with Salmonella until proven otherwise. Since we don't know how to prove otherwise, that means treat all pet aquatic frogs as infectious.
- Frog owners should avoid direct contact with the frogs and their water. Hands should be washed thoroughly after contact with frogs or their environment.
- Frog owners should never dump aquarium water into kitchen or bathroom sinks.
- Any spills of water during aquarium cleaning should be promptly and thoroughly cleaned up.
- Other pets should be kept away from aquaria (I remember when I used to have aquatic turtles and a cat. The cat used to drink from the aquarium and occasionally bat at the turtles. Not something I'd endorse now, but that was in my pre-DVM era).
This outbreak doesn't mean that aquatic frogs can't be good pets. It means that they shouldn't be pets for certain people, that good routine infection control practices need to be used by frog owners and that consideration needs to be given to whether mass production of pet frogs (and other species) is appropriate.
Photo: An African dwarf frog (Hymenochirus boettgeri) (photo credit: James Gathany, CDC Public Health Image LIbrary #11831).
Pet water frog warning
The US CDC is investigating a large, long-lasting and widely dispersed outbreak of salmonellosis that has been linked to contact with pet frogs, such as African dwarf frogs (see image). Between April 1, 2009 and April 5, 2011, 217 infections were identified in people in 41 states. A strain of Salmonella Typhimurium has been implicated.
Of the 217 infected people, 34% were hospitalized, which is quite a large proportion, but is probably due (at least in part) to the fact that stool samples aren't often cultured from people with milder disease (who don't go to the hospital). If you have severe diarrhea and are in hospital, you're more likely to be tested. As with most outbreaks, the 217 diagnosed cases presumably represent only the tip of the iceberg.
Of the people who got sick, 64% reported contact with frogs in the week before their illness began. Of these, 84% had contact with African dwarf frogs. This type of widespread outbreak with a single strain and a fairly clear link to a specific type of animal raises questions about whether there's a major breeder or supplier that is the source of the problem. Not surprisingly, the investigation identified a single water frog breeder in California as the source of frogs associated with this outbreak. Salmonella was identified from environmental samples at the breeder's facility. Testing is still apparently underway to confirm whether it's the outbreak strain, but it's pretty likely.
As with any other reptiles or amphibians, there are standard recommendations to avoid infections from aquatic (water) frogs:
- They should not be in households with high-risk people: children less than five years of age, the elderly, pregnant women and immunocompromised individuals.
- Care should be taken to prevent contamination of the house from aquarium/terrarium water.
- To avoid contamination, aquarium water should not be dumped down kitchen or bathroom sinks.
- Hands should be washed thoroughly after contact with aquarium water or the frogs themselves.
Photo: An African dwarf frog (Hymenochirus boettgeri) (photo credit: James Gathany).
Kissing a frog might get you more than a prince
The Hollywood effect is quite real when it comes to various trends, including pets (remember the glut of Dalmatians after 101 Dalmatians?). I can understand how seeing a cute puppy of some breed might lead to people wanting to get one. However, when Disney's The Princess and the Frog was released, I didn't really think a lot of people who watched this movie were going to start running around kissing frogs. I assumed that some degree of common sense would apply. Apparently, I was wrong.
Various news outlets are reporting that at least 50 children (mainly kids under the age of 10) have become sick in the US after copying the movie's Princess Tiana by kissing frogs. There's not a lot of information regarding what they contracted, whether the illnesses were all clearly linked to frogs, or whether these were truly associated with the movie, but there are certainly disease risks associated with kissing a frog. While we pay more attention to reptiles as a source of Salmonella, the risk is also present with frogs, and the best thing is to do is assume that all frogs are carrying this potentially harmful bacterium. Accordingly, high-risk people (e.g. kids less than 5 years of age, the elderly, people with compromised immune systems) should have no contact with frogs - they shouldn't even be in the same house. Hands should always be washed after touching a frog, and no one should ever kiss a frog. The chances of living happily ever after with a prince are much lower than the chances of a nasty bout of diarrhea (or worse)!
Salmonella from frogs
The CDC is investigating an apparent multistate outbreak of salmonellosis associated with contact with frogs. As of December 7, 48 infected people had been identified from 25 states - a pretty remarkable distribution. People got sick between June 24 and November 14, 2009. As is normal for Salmonella outbreaks linked to animals, young children have been more commonly affected, with kids under 10 accounting for 77% of cases. Fortunately, no one has died.
As part of the investigation, contact with animals was investigated and their preliminary analysis indicates contact with water frogs like African Dwarf frogs is the likely source of infection.
Amphibians often get ignored when it comes to zoonotic diseases. The risk of salmonellosis associated with reptiles is fairly well known, but not too many people think about the risk associated with amphibians. The same general guidelines for keeping and handling reptiles should be used for amphibians:
- Children under the age of five should not have contact with amphibians, nor should people with compromised immune systems.
- Hands should be thoroughly washed after handling frogs or having contact with their environment (terrarium/aquarium).
- Frogs should not be allowed to roam freely in the house.
- Aquarium/terrarium water should not be dumped out in the kitchen sink. Ideally, amphibian habitats should be cleaned outside. Care should be taken to prevent contamination of the household environment.
- Amphibians should not be kept in childcare facilities or kindergarten classrooms.
