Record settlement for pet store-associated infection
An Irish woman has won a record, multi-million Euro settlement after developing severe disease while working at a pet store. Patricia Ingle was a healthy 19-year-old when she was working in a Limerick, Ireland pet store. Then she developed psittacosis, an infection caused by the bacterium Chlamydophila psittaci, which she most likely contracted from a cockatiel at the store. It doesn't sound like the source of infection was confirmed, but the bird-associated nature of the bacterium (and presumably no other high-risk source of infection for the person) and the timing of disease with respect to contact with the cockatiel, are strongly suggestive.
Exposure to C. psittaci is an ever-present risk when working with psittacines, especially when they come from various sources and are mixed and stressed, as often occurs in pet stores. Human infections are rare, and they are usually treatable if diagnosed and managed properly. Usually, flu-like disease develops in people, however Ms. Ingle developed severe and permanent neurological disease (malpractice in management of her infection was also alleged).
This is yet another example of the need for proper education and training. Not all infections are preventable, and not all infections indicate liability. If this store had a proper training program in place, adequately informed staff of potential risks and had sound protocols in place to reduce the risk of exposure, it would have been possible to argue that this was an unavoidable infection in someone that knew the risks. In the absence of proper training, education and protocols, however, there's no way to successfully argue that any infection was not preventable, and the liability should shift to the employer. Hopefully this is a wake-up call for pet stores (as well as other facilities like veterinary clinics) that while you can never eliminate infectious disease exposure, you have a moral and legal requirement to take practical measures to protect staff, visitors and other people.
Psittacosis outbreak from a bird fair
A paper in Epidemiology and Infection (Belchior et al 2011) describes an outbreak of psittacosis (Chlamydophila psittaci infection) in people who attended a bird fair in western France in 2008.
The investigation started off with the identification of the bird-associated disease in three people at a local hospital. All three were hospitalized with respiratory disease, and all had attended the bird fair.
- A critical step in diagnosis of psittacosis and recognition of outbreaks is knowing about bird contact. If bird contact isn't questioned, psittacosis is unlikely to be considered. Too often, physicians don't inquire about animal contact, which limits their ability to detect zoonotic diseases. In this case, a survey on psittacosis was underway, which may have helped.
This finding led to an investigation of the fair to determine what happened and make sure there were no other unidentified cases.
The fair lasted one day, and had 83 exhibitors, 1500 birds and around 600 visitors. The investigators ultimately identified two confirmed cases of psittacosis in people who attended the fair, along with two probable and 44 possible cases. (Possible cases were people who developed respiratory disease and were exposed at the event, but did not necessarily have any diagnostic testing done to confirm the cause).
The reported disease characteristics were pretty typical:
- Fever in 96%
- Pneumonia and cough in 63%
- 98% visited a doctor
- 23% were hospitalized
- No one died (psittacosis can be fatal, but is quite treatable if identified in a reasonable time)
Thirty-eight percent (38%) of exhibitors and organizers got sick. That's a very high attack rate for people casually interacting with a group of (presumably) healthy birds. Poor ventilation may have played a role. The fair was held inside, windows were closed and there was no mechanical ventilation. This might have helped the bacterium build up in the air in the building and result in wider, heavier exposure.
The source of infection wasn't determined. They were only able to obtain samples from birds from six of the 83 exhibitors, and all 64 tested birds were negative. Chlamydophila psittaci can be shed by healthy birds, and identification of the source isn't always easy.
It's not guaranteed that everyone who got sick after the fair had psittacosis. You can't rule out the possibility that there were only a couple people with psittacosis and a large number with the flu or another disease, but the incidence of disease, type of disease and timing of disease are all quite suggestive.
How do we prevent outbreaks like this in the future? It's tough to prevent them completely, because you can't tell that a bird is shedding the bug just by looking at it, and testing every bird before a show is impractical. Risks can probably be reduced by ensuring proper ventilation, limiting crowding of areas, limiting unnecessary direct contact between birds and people, and improving general hygiene practices.
Thanks to Dr. Doug Powell of BarfBlog for sending the article.
More information about psittacosis is available in our archives.
Psittacosis (parrot fever) in Taipei
A 44-year-old Taipei man is recovering from psittacosis, a potentially severe infection caused by the bacterium Chlamydophila psittaci, which he may have contracted from his pet bird. This bacterium is commonly found in certain bird species, particularly psittacines (parrot family), and human infections are typically associated with bird contact. Healthy birds can shed the bacterium in their respiratory secretions or feces, and shedding rates can be particularly high in some groups of birds, particularly large breeding colonies.
The affected man had typically vague initial signs of disease... fever, chills, aches and cough. It appears that he was tested for psittacosis about 10 days later, but the diagnosis was only recently made (It's not necessarily an easy diagnosis in some cases). There's no information about the severity of disease or whether it progressed past those initial relatively mild signs, or when treatment was started, but he's apparently responding well to treatment and is recovering at home. His pet bird is the probable source of infection, but it's unclear whether it's being tested.
Psittacosis is an example of a disease for which an understanding of pet contact by the attending physician is critical. Typically, psittacosis starts off with flu-like signs. Most otherwise healthy people with fever, chills and aches that go to their doctor would probably be told to "go home, rest and take an anti-inflammatory" or, less diplomatically "get your infectious body out of my office, stay at home, and get over it." That would be reasonable advice for most people, because most people with these symptoms have a common viral infection, and a disease like psittacosis is rare. However, if the person had contact with psittacines and the physician knew it, psittacosis would hopefully come to mind and testing might be performed. Psittacosis is usually easily treated, but you have to know to test for it to diagnose it, so that proper treatment can be started. Untreated, psittacosis can cause severe, even fatal, disease.
Physicians' knowledge about their patients' animal contacts and zoonotic disease exposure is often very poor, which compromises their ability to promptly diagnose and manage zoonotic diseases. Better understanding of pet-associated zoonoses and communication between both people and their physicians, and between physicians and veterinarians, is needed to help reduce the risks.
A great psittacosis resource is the National Association of State Public Health Veterinarians' Psittacosis Compendium.
Pet bird linked to human infection?
A UK woman is both grieving the loss of her husband and battling illness she thinks came from a new pet parrot. The 67-year-old woman, who has chronic lymphocytic leukemia, obtained the bird to keep her company as her husband was dying of cancer. She says that she's never felt right since she obtained the bird. She is also upset that the bird is not very tame, saying "Jasper is clearly a wild bird, and they do carry all sorts of germs, so it is a worry for me."
Since her husband's death, the woman has had three rounds of antibiotics to treat a respiratory tract infection that refuses to go away. No more details are provided, and presumably (hopefully) her doctors have tested or treated her for psittacosis, a disease caused by Chlamydophila psitacii - a microorganism that can be acquired from birds, especially psittacine birds like parrots.
This story raises a few relevant questions:
Was it a good time to get a pet?
- That's a tough question. Getting a petting during a difficult time can help many people cope, and having the pet while a family member is sick can be very beneficial. On the other hand, bringing a new pet (with the associated new pet issues) into an already stressful situation can be a problem. Also, with both the woman and her husband being sick and having weakened immune systems, there are some infectious disease risks that need to be considered. The cost-benefit of getting a pet in a situation like this is hard to determine, and it varies greatly between households. At a minimum, anyone in such a situation who is considering getting a pet should learn about potential pet-associated disease risks first so that they can make an informed decision.
Was a bird a good pet to get for this household?
- Another question without a clear answer. Birds can be good companions, but they also carry a few diseases that are of concern, particularly for people with weakened immune systems. It's hard to say whether a pet bird is higher risk than a pet dog or cat. It probably is lower risk from some standpoints (e.g. bites, scratches) but higher risk for certain diseases. The key is, as mentioned above, being informed about potential disease risks and what can be done to reduce these risks. With that information, you can make a more educated decision about whether a specific pet is appropriate.
- Also, in high risk households like this, getting a new pet examined before it makes it to the household is a good idea. Such an exam provides an opportunity for a veterinarian to identify any concerns, ranging from obvious signs of disease to inappropriate behaviours. Identifying these problems before the pet makes it home allows them to be addressed quickly. This might involve treatment, prompt training, keeping the pet somewhere else for a short time while a problem is addressed, or a recommendation to return it to where it came from because of a major concern. It's much easier to do these things (especially returning the pet) before it has made it home and people have become attached.
Should you assume that a captive-bred bird is a disease-free bird?
- Absolutely not. Captive-bred does not equal disease-free. In fact, for some diseases, rates are higher in captive-bred birds. (I'm definitely not advocating getting wild-caught birds... just trying to make it clear that birds from breeders can carry various infectious diseases too). The point is, getting a bird from a reputable breeder is a good start, but it doesn't negate the risks. Healthy, well cared-for birds can carry a variety of microorganisms that can infect people. Risks are higher for people with compromised immune systems, such as the individuals in the household in this case.
Pet ownership always carries some risk of infectious disease transmission. Almost always, that risk is manageable and acceptable considering the positive aspects of pet ownership. However, thought needs to go into the process to ensure that the risks are minimized and acceptable in any given situation.
Image: Green Indian Ring-Necked Parakeet
Fatal psittacosis in a parrot owner
A 62-yr-old Italian woman has died from psittacosis, an infection caused by the bacterium Chlamydophila psittaci. Sometimes called "parrot fever," psittacosis is an uncommon but important disease linked to contact with birds, particularly psittacines (e.g. parrots, parakeets, cockatiels). In people, C. psittaci usually causes flu-like respiratory disease, but severe pneumonia and encephalitis (inflammation of the brain) can occur in some individuals. With prompt diagnosis and treatment, mortality (death) rates are very low (<1%), however mortality rates are higher when diagnosis and proper treatment are delayed. It's not clear in the this case whether psittacosis was considered early in disease nor when treatment was initiated.
Chlamydophila psittaci can cause illness in birds, but it's also carried by a variable percentage of healthy birds, mainly psittacines. This complicates control of the disease, since you can't tell which birds are carrying the bacterium without testing them all. In this case, the woman's parrot died a few days before she became ill. It's not clear from the brief report whether the bird was diagnosed with C. psittaci infection, however this is a good reminder of the need to consider pet and owner health in parallel. It also indicates why diagnostic testing is important when pets are sick, or even after they've died.
If a pet becomes sick, knowing what caused the disease might be of relevance to human health. Also, if physician's ask about illness of any other individuals in the house, this should include pets, as they might get some relevant information.
In a case like this, if the bird was diagnosed with C. psittaci infection and the owner developed flu-like illness shortly thereafter, it should have been a strong indication that the person might have psittacosis, allowing for early treatment. Alternatively, even without a diagnosis, knowing that the person had a pet parrot (a risk factor for psittacosis), and that the bird had died shortly before the woman got sick, could lead to recognition that both diseases could be linked, and could lead to earlier consideration of psittacosis.
This unfortunate event should be taken as yet another reminder of the need for veterinary personnel and human physicians to communicate more effectively, and that physicians need to know about pet contact and pet health when evaluating their patients.
Image: African Grey Parrot (Psittacus erithacus erithacus). (Photo credit: Eli Duke)
Doctors, pets and vets
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.)
Suspected psittacosis in a pet shop worker
People that work with animals are at increased risk for certain infectious diseases. That's pretty clear. Pet shop employees fit into this group as well, and they may be at particular risk for specific diseases because of their close contact with young animals, birds, rodents and reptiles. A suspected case of psittacosis in a Toronto pet shop worker is an example of this.
A bird in the pet store where this person worked supposedly died of avian chlamydiosis in mid-March (although the initial test results have been called into question). Avian chlamydiosis is caused by the bacterium Chlamydophila psittaci. This organism is relatively common in psttacine birds (parrot family), especially in breeding colonies, but can also be found in other types of birds. It can cause serious disease in birds, but it is also commonly carried by healthy birds. People can become infected from breathing in the bacterium, often from aersolized dust containing dried bird droppings. The disease in people is called psittacosis. The pet store worker developed signs that could be consistent with psittacosis: cough, lethargy and difficulty breathing. However, these signs are still fairly non-specific and could also be caused by numerous other respiratory pathogens. Test results are still pending.
People that have close contact with pet birds, especially psittacines, need to know that they may be at increased risk of psittacosis. They also need to ensure that their physicians know about their increased risk. This is important because early signs of psittacosis are very vague, such as fever and cough. Psittacosis would presumably not be high on the doctor's list of possible diagnoses for the average person coming in with fever and a cough. If the doctor knows a person has contact with birds, hopefully psittacosis would be considered earlier so prompt diagnosis and appropriate treatment can be given. This disease is readily treatable if diagnosed early, so awareness of the possibility on the part of the patient and physician are important.
This report also demonstrates why determining a final diagnosis for sick or dead pets is critical. While the diagnosis may not help the animal (especially if it's already dead), it may play an important role in protecting the health of people or other animals. If the bird in this case was not tested, it's hard to say how long it would have taken for psittacoiss to be considered in the case of the pet store worker.
More information about psittacosis can be found in a document from the National Association of State Public Health Veterinarians. More information about good management practices to reduce the risk of disease transmission from birds can be found in the information sheets on pet birds on the Worms & Germs Resources page.
Image from: http://www.cbc.ca/health/story/2009/04/01/parrot-fever.html
Smuggling Psittacosis
As an illustration of some of the points made in the recent Worms&Germs post on animal smuggling, an outbreak of psittacosis was recently reported in Russia, which has been linked to illegally imported decorative birds. Since December 30, 21 cases of psittacosis have been reported in the Petuhovsky district of the Kurgan region. The source of the infections was reportedly a large group of illegally imported parrots and canaries. In late 2008, another group of 15 cases were reported in the Orenburg region of Russia, which were also associated with a large group of 1500 smuggled birds. Compare this to statistics from the CDC, to which only 125 cases of psittacosis were reported from 2000 through 2006.
This report reiterates the infectious disease risks than can be associated with illegally imported animals, as well as some of the welfare issues (a second article reported that some of the birds in the illegal shipment were found dead when they reached the border). It's also important to be aware of zoonotic pathogens that can be carried by even healthy pet birds.
Psittacosis, also known as ornithosis or "parrot fever," is caused by the bacterium Chlamydophila psittaci, which is commonly carried by psittacine (pronounced "sit-a-seen") birds, often without making them sick. These birds may shed large numbers of C. psittaci in their feces. When the feces dry they become dusty, which can result in people inhaling the bacteria as they work around the birds. This is the most common way for people to become infected, and can result in pneumonia. The infection can be treated with antibiotics if it is caught in reasonable time, but it can be very serious in some cases. The bacterium can make birds sick as well in come cases, in which case the disease is called avian chlamydiosis.
More information on psittacosis is available in the National Association of State Public Health Veterinarians' Psittacosis Compendium and in the Worms & Germs archives.
Pet store sued over bird owner death
reported a pet store being sued by a woman whose husband died of lymphocytic choriomeningitis virus. Now, a pet store is being sued after a man died of psittacosis. This disease is caused by Chlamydophila psittaci, a bacterium that is most commonly found in psittacine birds (parrot family). It can cause disease in birds but can also be carried by healthy birds. The family had purchased a cockatiel prior to the man's illness, although details about the timing of disease, the bird's health and whether the bird was identified as carrying Chlamydophila psittaci aren't clear. Typically, psittacosis causes flu-like disease and is easily treated, if diagnosed properly, however more severe disease can develop. Infected birds can shed the bacterium through feces and nasal secretions. People usually become infected by inhaling aerosolized bacteria from dried feces or nasal secretion.
Psittacosis is an uncommon disease. Only 125 human cases were reported to the CDC in the US between 2000 and 2006, however many more cases probably occurred. The risk of acquiring psittacosis from a pet bird is very low.
- Bird owners should make sure that their physician is aware that they have contact with birds. Psittacosis should be considered in people with flu-like disease that have bird contact.
- Do not buy birds that look unhealthy (lethargy, nasal or eye discharge, ruffled feathers...).
- If you have other birds, isolate new birds for 30 days before allowing them to have contact with existing birds.
- Reduce aerosolization of materials when cleaning cages. Lightly wetting cage paper will reduce the risk of aerosolization.
- Wash your hands after handling birds or cleaning their cage.
Psittacosis
The National Association of State Public Health Veterinarians (NASPHV) has recently released a comprehensive document about psittacosis. This is a disease of people caused by the bacterium Chlamydophila psittaci (formerly known as Chlamydia psittaci). Psittacosis usually causes flu-like disease but can cause severe pneumonia and other problems. Chlamydophila psittaci is most commonly carried by healthy psittacine birds (those in parrot family) but can also be carried by non-psittacine birds including pigeons and doves. It is an uncommon disease in people but sporadic cases and outbreaks do occur. While treatable, psittacosis is often overlooked in the early stages of illness if the physician does not know the patient has had contact with birds. People that own or have contact with birds should know about psittacosis, and the NASPHV document is an excellent resource. This disease is another good example why people should make sure their physician knows what types of animals they own or have contact with.
