Worms & Germs Blog

Leptospirosis from Puerto Rico Hurricane Dogs

Posted in Dogs

When Puerto Rico was devastated by the recent hurricane, I got a few calls from groups thinking about bringing in dogs and wanting to know what infectious diseases I’d be concerned about. Leptospirosis was the top of my list. Unfortunately, that’s turned out to be true as several puppies brought in by a Vermont rescue developed leptospirosis, a potentially serious bacterial infection that can be transmitted from dogs to people (although that’s fortunately uncommon.

Importation always carries some inherent risk. That’s we (should) use some common sense practices to reduce that risk. This can involve selection of animals, pre-screening before exportation for certain diseases, testing on arrival and infection control practices during the period shortly after arrival. They’re no guarantee but that should reduce the risk.

One noteworthy thing from a news article about this situation:

A couple of days later, the puppies were taken to the outdoor patio at Ramunto’s Brick and Brew Pizzeria so that the patrons and customers could interact with them.

  • Not a great idea. Adopted animals need time to adapt. They also need to be quarantined for a while to see if they have any problems and to reduce the risk of them transmitting anything. Here, they’ve created risk by taking newly imported puppies out in public rather than isolating them for a short period.

More information about leptospirosis is available in our Resources section.

Dog Bites, Irony and Injured Kids

Posted in Dogs

If it wasn’t for the injured child, this would be a funny story.

There was a hearing in Hillsborough County, Florida about a proposed ordinance requiring dog trainers to get licensed. Not surprisingly, that didn’t go over well with all trainers. One of the main opponents was waiting in line to get into the hearing, and (you can guess where this is going), the dog he brought with him lunged at a 5 yr old boy and bit him in the face. The article was sent to me by a reader in response to a recent fake service dog post and….yes….you can guess again where this is going….the dog was wearing a service dog vest. So, a badly behaved dog owned by a ‘trainer’ who was wearing a presumably fake service dog vest attacked a child, during a hearing where the dog’s owner was protesting scrutiny of dog trainers.

So, now we have a child with bite wounds and a dead dog (it was euthanized shortly after the bite), all because someone who thinks they’re a trainer and don’t need any regulation didn’t know how to train or handle their dog.

Yes, reality is more bizarre than fiction.

For a better story about service dogs, click here to see a video of a dog being trained by America’s VetDogs, a group providing therapy dogs to military veterans, dropping the puck at a NY Islanders game.

Influenza from a cat (and no we’re not all going to die)

Posted in Cats

A paper in December’s Emerging Infectious Diseases (Marinova-Petkova et al. 2016) follows up on last year’s outbreak of avian influenza (H7N2) in cats in a New York shelter and one associated human infection (the findings were also summarized in a post from earlier this year). This paper describes investigation of the virus from the infected person and from a cat at the shelter.

The take home message is that the virus from the person and the cat were almost identical, meaning it’s pretty certain that the person was infected by an animal at the shelter. The study also showed that the virus was very similar to a low pathogenicity avian flu strain that was circulating in the US in the early 2000s.

Presumably, this strain is still circulating in birds, and it happened to spill over into a cat (outdoor cats that hunt are at risk of exposure). Then, an infected cat (during the short period it was infectious) happened to enter the shelter, have contact with other cats (again, during that short period when it’s infectious), with transmission to more cats and ultimately a person working with them.

It’s an interesting scenario, for sure. However, it’s not overly concerning.

  • We know various flu viruses can periodically infect cats.
  • This outbreak burned itself out pretty quickly.
  • There was just one known human infection, and it was in someone with close contact with the cats.
  • The fact that a cat could get infected, go into a shelter and have contact with other cats in the shelter during what is likely a window of just a few days when it’s infectious is pretty unlikely. Often, strange disease events are “perfect storm” manifestations like this. The odds of any given cat carrying influenza virus at any time are exceptionally low.

This is a good reminder of the potential for inter-species transmission of influenza virus and the potential for pets to act as disease bridges between wildlife and humans. However, it’s important to keep things in context and realize this is an oddball scenario, not a sign of a new serious problem

Airport dog bite

Posted in Dogs, Rabies

While waiting in line to check-in for a flight in Orlando, a JetBlue passenger was bitten by a dog. This raises lots of issues and questions, and for the bitten individual, she’s dealing with a pretty nasty bite and also the potential need for rabies post-exposure prophylaxis.

  • She was bitten while checking in, so it was a public area. Who knows why the dog was there, since JetBlue says the owner is unknown and wasn’t a passenger on one of their flights (not sure how they can say that with much confidence). A bite-prone dog in a busy place like an airport is a recipe for disaster. On a plane would be worse, and I have to wonder if this was a typical “fake” service dog.  I’ve ranted about this before, but the proliferation of these animals is astounding. It’s so common, especially in the US, to see dogs wearing vests identifying them as service dogs, and I recognize a few of those from companies that sell them online as a way for people to bring their pet dogs everywhere. (It’s sad to say, but a general rule for me is that if a dog wearing a “service dog” vest, it’s probably a fake).

The response to the bite raises other issues. No one has been able to identify the dog’s owner.  JetBlue has offered to cover her medical bills and gave her a travel voucher, but has said there’s nothing they can do to identify the person, who promptly left the terminal. Any bite from a dog has to be considered a potential rabies exposure, even though the risk in the US is exceptionally low. However, since rabies is almost invariably fatal, “exceptionally low” is still usually too high. So, if it cannot be proven that the dog is healthy 10 days after the bite, and therefore couldn’t have been shedding rabies virus at the time, a series of post-exposure shots will be indicated.

The article about the bite incident states: Langlois has been on a course of pain meds and antibiotics for the last week, but the real pain may still be ahead if she’s forced to undergo a series of rabies shots, something even her doctor is hesitant to do. “He’s like ‘it’s an extremely painful shot and it’s a series of three, I wouldn’t want you to go through that that if you didn’t have to.”

  • That’s pretty overblown, and scaring people about rabies treatment isn’t good. It’s just a series of vaccines, plus a shot of antibodies (given just like a vaccine). Yes, it hurts a bit but for most people it’s not a big deal. (Yes, I can say this from experience). There are many things I’d rather do than get a rabies shot, but it’s a minor inconvenience.

Most likely, the dog will not be found unless JetBlue and the airport decide to put the time and energy into looking. There’s almost certainly video and a picture of that (or a warning that if the person doesn’t come forward, they’ll have to broadcast the picture to help find him or her) would potentially help track the person down. It doesn’t sound like that’s going to happen, so most likely, the woman will have to get post-exposure prophylaxis and she’ll be fine.

Hopefully that dog stays away from airports now.

Antibiotic Awareness Week commentary

Posted in Uncategorized

Imagine a world without antibiotics: deaths and complications from simple wound infections, routine surgical procedures would become high-risk, immunosuppressive therapy such as those used for cancer treatment would be as life-threatening as the disease itself.  Such was life in the pre-antibiotic era, and we could be facing the same situation in the post-antibiotic era if we’re not more careful.

It’s Antibiotic Awareness WeekClick here for the complete commentary from Clinician’s Brief.

Antimicrobial use surveillance: Canada

Posted in Animals

The 2017 Canadian Antimicrobial Resistance Surveillance System (CARSS) report was just released, and as always it contains a lot of data (up to and including 2016). Some are interesting, some are concerning, some are encouraging.

I’m not going to try to distill a 90 page report into a quick blog post, so I’ll cover a few part separately. Let’s start with the Antimicrobial Use in Animals section. Here are some highlights (and some comments):

In 2016, ~1 million kgs of medically important antimicrobials (MIAs) were distributed for sale in Canada.

  • This misses some antibiotics that get used via certain regulatory loopholes, but those are being closed soon and this number is probably a pretty good overall estimate.
  • The great news is this is 14% lower than 2007 and 17% lower than 2015

600,000 kg of ionophores and chemical coccidiostats were also distributed in 2016.

  • These drug categories are often lumped in with other antimicrobials (sometimes to make things look scarier) but they are irrelevant from antibiotic-resistance and public health standpoints because they are not used or even related to any drugs used in human medicine. So, it’s good to see them separated out (and to essentially ignore them).

99% of antimicrobials used in animals were intended for use in food animals, based on weight (kg).

  • This is always hard to interpret and sometimes leads people to think that companion animal use is irrelevant. We have to be a bit wary focusing just on kilogram data (1 kg of antibiotic treats a lot more Chihuahuas than cattle). The main antibiotic classes used in companion animals were cephalosporins, beta-lactams and trimethoprim-sulfa – all drug classes of high importance.
  • What this shows to me is that we can have a huge impact on overall use by focusing on food animals. However, the drugs that are used in pets are often the same as those used for serious infections in people, and we share bacteria more readily with our pets. So this number shouldn’t be taken as an indication to ignore them.

Fluoroquinolone use decreased by 56% from 2015 to 2016.

  • Wow. That’s great, since this is one of the biggest classes we’re worried about. They’re important drugs (for both humans and some animal species) but are prone to overuse.

Antibiotics intended for use in feed accounted for 76% of the overall volume of antimicrobials distributed. At the opposite end of the spectrum, intramammary drugs (used for mastitis in cattle) accounted for <1%.

When everything is put together, based on weight, 78% of antimicrobials distributed or sold in 2016 were for food animals, 20% were for humans, 1% for crops and 1% for companion animals.

  • Again, be somewhat wary of these crude numbers.  Remember that the relevance of a kg of tetracycline is probably much, much less than a kg of a fluoroquinolone, and that there are approximately 19 times more animals in Canada (excluding farmed fish) than humans (also based on weight).  Still, these data provide some idea of how we use antimicrobials in this country and they give us numbers for comparison over time. (The 2nd figure below is an interesting one to think about.)

Some people will take these numbers and use them to spin certain agendas. However, we’re better off using them as the basis for more surveillance, more interventions and more research to reduce and improve use of antibiotics in Canada, whatever species they go into (including humans).

WHO Guidelines on Use of Medically Important Antimicrobials in Food-Producing Animals

Posted in Other animals, Other diseases

The World Health Organization has released new guidelines on the use of “medically important antimicrobials” (MIAs) in food animals. Here’s a list of their recommendations, along with the strength of each recommendation and quality of evidence behind it.

  1. We recommend an overall reduction in use of all classes of medically important antimicrobials in food-producing animals (Strong recommendation, low quality evidence)
  2. We recommend complete restriction of use of all classes of medically important antimicrobials in food-producing animals for growth promotion (Strong recommendation, low quality evidence)
  3. We recommend complete restriction of use of all classes of medically important antimicrobials in food-producing animals for prevention of infectious diseases that have not yet been clinically diagnosed (Strong recommendation, low quality evidence)
  4. We suggest that antimicrobials classified as critically important for human medicine should not be used for control of the dissemination of a clinically diagnosed infectious disease identified within a group of food-producing animals (Conditional recommendation, very low quality evidence)
  5. We suggest that antimicrobials classified as highest priority critically important for human medicine should not be used for treatment of food-producing animals with a clinically diagnosed infectious disease (Conditional recommendation, very low quality evidence)

They also included 2 “Best Practices” statements:

  1. Any new class of antimicrobials or new antimicrobial combination developed for use in humans will be considered critically important for human medicine unless categorized otherwise by WHO. 
  2. Medically important antimicrobials that are not currently used in food production should not be used in the future in food production including in food-producing animals or plants.

One thing that stands out is the low quality of evidence. Lack of strong evidence doesn’t always mean recommendations shouldn’t be made – important decisions sometimes have to be made before the evidence is solid. However, we need to make sure the evidence follows. Much of what’s stated above is common sense, to a degree; however, sometimes things that make sense at first don’t turn out to be completely true in the end. That’s one of the reasons CANresist is being developed – to help provide the evidence and help translate both best practice and evidence-based guidelines into action.

The table shown here (left) displays the WHO classification of medically important antimicrobials (MIAs).  It is worth noting that there are some differences between this classification and classification of MIAs used by Health Canada.

 

Antibiotics and dairy calves

Posted in Other animals, Other diseases

From CANresist.blog:

Reducing Antibiotic Use in Dairy Calves

This topic’s huge, and there’s always a risk of trying to oversimplify the problem or solutions.

However, some solutions for some issues might be fairly straightforward. Whether it’s on a farm, in a hospital or in a doctors office, there are situations where I think it’s widely accepted we don’t need to use antibiotics, yet for various reasons they still get used. Getting over those barriers sometimes requires a combination of medicine, behavioural science, communications, psychology, economics and a range of other fields. Sometimes, though, the answer seems fairly simple…

Click here to read the full post.

CANresist

Posted in Birds, Cats, Dogs, Horses, Other animals

Introducing CANresist, a new initiative aimed at fostering antibiotic stewardship in Canada across the human and animal health fields and beyond, in order to maintain the effectiveness of these life-saving drugs.

Follow us at CANresist.com or CANresist.blog, or on Facebook. Also check out our Twitter feed @CANADAresist, including our #mylastantibiotic tag to talk about the last time you used an antibiotic on yourself or a patient, and its importance.

‘Tis the season for leptospirosis in dogs

Posted in Dogs, Vaccination

Leptospirosis is a potentially nasty bacterial infection that can cause severe kidney disease (among other things) and is acquired from the environment, in cool damp areas that are contaminated with urine from infected reservoir hosts (e.g. rats, raccoons, other wildlife). It can also potentially be transmitted to people through contact with urine from an infected dog.

We’ve called leptospirosis a “re-emerging disease” in dogs in North America for probably 10-15 years. In reality, it’s past the “re-emerging” point and is a well “re-established” disease in many areas. However, it’s been a strange fall for lepto. I’ve gotten more emails and calls about cases in the past few months than ever before, including some places where very high rates of disease are being found. Outbreaks appear to be underway in a few different areas, including a large ongoing problem with lepto in Nova Scotia and what seems to be a fairly high incidence in parts of Ontario. Getting a clear picture is tough because it’s not a reportable disease, and diagnosis can be challenging. Regardless, it’s pretty clear that we’re seeing more cases than normal.

Avoiding lepto exposure is tough, since it can be found in lots of different environments. Staying away from areas densely populated by raccoons and rats isn’t a bad idea, but identifying those is hard, and given the proliferation of raccoons in many urban areas, it’s a challenge.

What can pet owners do?

  • Vaccinate your dog. Vaccination isn’t a guarantee but it will greatly reduce the risk of disease.

What can veterinarians do?