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DISEASES TRANSMITTED ANIMALS TO HUMANS Arkansas Academy of Family Physicians June 21, 2014 Elton R. Cleveland D.V.M., M.D., FAAFP CAQ Sports Med, CAQ Adolescent.

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Presentation on theme: "DISEASES TRANSMITTED ANIMALS TO HUMANS Arkansas Academy of Family Physicians June 21, 2014 Elton R. Cleveland D.V.M., M.D., FAAFP CAQ Sports Med, CAQ Adolescent."— Presentation transcript:

1 DISEASES TRANSMITTED ANIMALS TO HUMANS Arkansas Academy of Family Physicians June 21, 2014 Elton R. Cleveland D.V.M., M.D., FAAFP CAQ Sports Med, CAQ Adolescent Med

2 Objectives A) Identify several human diseases associated with animals. B) Understand some occupational risks associated with animal exposure. C) Discuss an occasional reverse zoonosis

3 Disclosure Financial relationships – none with companies or personnel that would have an impact on presentation Financial relationships – married – enough said Other disclosures – wife says I am old and crotchety –probably true I love animals.

4 Animals and Sport

5 Some People ?

6 Source = San Francisco Newspaper

7 Pet Pearls 62% of U.S. households (72.9 million homes) have pets 78.2 million dogs 86.4 million cats 16.2 million birds 13.0 million reptiles

8 Pet Pearls million dogs and cats are domestic pets in USA Relationship between pets and childhood asthma is well documented

9 Pet Pearls Iguanas, ranked in the TOP TEN pets, are the most popular reptile in the USA. Especially popular with teenage boys and young men.

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11 Increasing Incidence of MRSA in the Community Rapid change over past decade Why?

12 Methicillin-Resistant Staphylococcus Aureus (MRSA) American Society of Microbiology: 2007 Toronto MRSA found in 100% of fomites in subways, buses and trains MRSA survives up to two weeks on fomites

13 Methicillin-Resistant Staphylococcus Aureus (MRSA) Airline tray tables – WORSE! Public restrooms – only 6.3% positive

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15 MRSA in Dogs and Cats Dogs and cats are the most common therapy animals used in healthcare settings. Healthcare settings that utilize animal-assisted therapy include long-term care facilities and pediatric institutions.

16 MRSA in Dogs and Cats (continued) With the emerging problem of community- acquired MRSA, we decided to re-visit local animal grooming clinics to determine if dogs and cats might be possible carriers of MRSA.

17 MRSA in Dogs and Cats (continued) All pets studied were from a local grooming clinic. They were deemed healthy and had not received antibiotics in the previous 30 days.

18 MRSA in Dogs and Cats (continued) Groomers, veterinarian, physician and student were all cultured. No personnel were found to harbor MRSA.

19 MRSA in Dogs and Cats (continued) All 42 animals were colonized with Staphylococcus aureus. Seven (16%) of the 42 isolates obtained were resistant to methicillin.

20 Animal Study Results Recovered from outer surface of cages: Staphylococcus (coagulase + and -) Bacillus E. coli Proteus spp. Serratia marcescens Other gram-negative microorganisms

21 Animal Study Results (continued) Recovered from ALL water tanks in the animal cages: Pseudomonas aeruginosa Several animals were colonized with multiple organisms

22 Post-operative MRSA Infection Two-year old, hernia repair patient with post-op incision infection (MRSA) Dog at home cultured: MRSA-positive mouth Mother had multiple abscesses: MRSA-positive abscesses Specimens for child, dog and mother sent to Tulane!

23 Pearls of Pet Therapy Study Animals are usually culture-negative for salmonella in home environments. Under travel stress (being placed into carriers, transported, or exposed to unfamiliar surroundings), they often become culture- positive for salmonella by the time they get to the hospital.

24 Recommendations If dogs and cats are used in animal-assisted therapy programs, they should be screened for pathogens, including MRSA Use of dogs and cats in institutional facilities should only be used after careful assessment of risk/benefits to all patients, staff members and visitors.

25 Animal Use Recommendations Handling of animals should only be allowed when potential risks and benefits are carefully considered. Handwashing should be strictly enforced after handling animals and / or cages.

26 Some people love their animals

27 Animal Bites Most common cause of Zoonosis. There are 2 – 4.7 million animal bites yearly. 1 out of 2 people in the U.S. (In life time) 1.5 % require an Emergency Department visit 2% require hospitalization

28 Animal Bites 80% of animal bites come from dogs. 85% of dog bites is from a family owned dog or a neighbor’s dog. Children are the most likely to get bitten. Boys ages 5 – 9 have the highest incidents of dog bites. Less than 300 deaths were attributed to dog bites between 1979 – 1996.

29 Animal Bites Little evidence for specific breed predilection but 75% of fatal attacks have been caused by Pit Bull & Rottweiler breeds. Male- dogs 3:1, Female- cats 3:1

30 Animal Bites Pasturella Multocida has been implicated as major pathogen. Infectious complications occur in approximately 20 – 50% of dog bites with a higher percentage occurring from cat bites.

31 Animal Bites Treatment medication options: Penicillin, Cefotaxime, Tetracycline, Bactrim, Ciprofloxacin and Levofloxacin. P. Multocida is resistant to Vancomycin, Erythromycin and Clindamycin.

32 Animal Bites Other organisms CDC – DF2 (“dysgonic fermenter Type 2”) Capnocytophaga Canimorsus Fastidious Growth 30% fatality rate with cases C. Septicaemia

33 Animal Bites CDC – NO1-( non – oxidizer ) – similar to Acinetobacter Proteus, Klebsiella, Enterobacter, Staph, Strep, Bacteroides, Clostridium, Erysipelas, Etc. Rabies

34 Interesting Case

35 Rabies – Myth & Movies Myth Werewolves, Vampires & Rabies Movies Old Yeller Cujo

36 Rabies May be the oldest disease known to man ~ 2300 BC The word “rabies” has many origins. Ancient Sanskrit: “rabhas” = to do violence Greek: “lyssa” or “lytta” = frenzy or madness Latin: “rabere” = to rave or rage

37 Rabies USA: 2 or 3 cases per year in humans Worldwide: >30,000 per year in humans.

38 Rabies Before 1960 cases involved domestic animals. Currently, cases are now being seen in skunks, raccoons, and bats. Most human cases of Rabies are due to bat exposure. New Carrier: Woodchuck

39 Rabies Kansas Vaccine In 2006, a horse stabled at Tennessee Walking Horse National Celebration tested positive for rabies. The CDC notified approximately 150,000 people who attended the event of possible exposure to rabies.

40 US Rabies Reservoirs

41 Rabies - Speculation Carter Administration: Wanted to continue “coonhunting” while living in Washington, D.C. Raccoons transported to Virginia forests. 1977: By Carter’s inaugural address, the first case of rabies was reported in Virginia raccoons!

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43 Rabies Treatment Wound Cleaning Rabies Immune Globulin (RIG) Rabies Vaccine Controversy USA/CDC = 5 doses vs. WHO = 3 to 4 doses.

44 Rabies RIG HDC 4 – 0, 3, 7, 14 or 28

45 Human Illnesses Associated with Animals DISEASE (organism)ANIMAL SOURCESOURCE Aeromona sp.AquaticWound infection, contaminated food Cat-Scratch (Bartonella henselae) CatsScratches, bites, fleas Brucellosis (Brucella sp.) Cattle, goats, sheep, swine, dogs (occas.) Contact with birth products Campylobacteriosis (Campylobactes jejuni) Poultry, dogs, cats, ferrets, hamsters Contaminated food, direct contact, fecal- oral

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47 Brucellosis Undulant fever B. Melitensis > B. Suis > B. Abortus> B. Canis Unpasteurized milk Contact Birth products

48 Brucellosis Sx intermittent fever headache, chills, depression, profound weakness, arthralgia myalgia, weight loss Orchitis/Epididymitis in men Spon. AB in pregnant women

49 Human Illnesses Associated with Animals (continued) DISEASE (organism)ANIMAL SOURCESOURCE Leptospirosis (Leptospica sp.) Dogs, rats, livestock Contact with urine Lyme Disease (Borrelia burgdorferi) Wild rodents, birdsTick bites Salmonellosis (Salmonella sp.) Poultry, reptiles, dogs, cats, turtles, etc. Contaminated food, direct contact, person- to-person

50 Diseases Associated with Bioterrorism DISEASE (organism)ANIMAL SOURCE SOURCE Plague (Yersinia pestis) Rodents, rabbits, cats, fleas Contact with infected animals Tularemia (Francisella tularensis) Rodents, rabbits, cats Tick bites, infected animals, claws / teeth of cats Male Xenopsylla cheopsis (oriental rat flea) engorged with blood. This flea is the primary vector of plague in most large plague epidemics in Asia, Africa, and South America. Both male and female fleas can transmit the infection. Photo Credit: courtesy of the Centers for Disease Control and Prevention

51 Diseases Associated with Bioterrorism (continued)

52 Anthrax The name Anthrax comes from the Greek word “anthrakas” which means “coal”, reflecting the black rash associated with this infection. Encapsulated Resistant Spores 200 year old remains discovered in an archeological dig Resistant to microwave irradiation at 100◦C for 30 minutes Resistant to conventional pasteurization

53 Anthrax in Humans Cutaneous Anthrax: black necrotic “eschar” Inhalational Anthrax: flu like symptoms, mediastinum wide, highly fatal. Gastrointestinal Anthrax: infection oral, → highly fatal.

54 Anthrax in Humans Outbreaks Russia – Sverdlovsk – April/May 1979 Spores were released into the air surrounding a biological weapons facility. Humans and cattle were infected.

55 Other Diseases Associated with Animals FUNGAL INFECTIONSSOURCE CryptococcosisBirds RingwormCats, dogs, rabbits, rodents SporotrichosisCats

56 Other Diseases Associated with Animals (continued) PARASITESSOURCE Dwarf TapewormHamsters, rodents CryptosporidiosisDomestic animals Cutaneous Larva MigransDogs, cats Dog TapewormDogs, cats GiardiasisDogs, cats, beavers The pork tapeworm, Taenia solium has a scolex that features a double crown of 22 to 32 rostellar hooks and four simple, round suckers. As with other cestodes, the pork tapeworm fastens onto its host (primarily muscles for this species) and absorbs nutrients through its skin.

57 Other Diseases Associated with Animals (continued) CHLAMYDIAL and RICKETTSIAL SOURCE EhlichiosisDeer, dogs, horses PsittacosisPsittacine, domestic birds Q FeverSheep, other livestock, research labs Rocky Mountain Spotted Fever Dogs, wild rodents

58 Ehrlichiosis Monocytotropic Ehrlichiosis in dogs = E. Canis Human Monocytotropic Ehrlichiosis in humans = E. Chaffeensis Symptoms include: fever, malaise, chills, headache, Arthralgia Myalgia, Anorexia, nausea, Leukopenia, Thrombocytopenia and increase in liver enzymes.

59 Anaplasmosis in Cattle Anaplasma marginale 19 different tick vectors Blood transfusion Severity of illness increases with animals age. Calves more resistant Older cows are more susceptible

60 Anaplasmosis First recognized in the mid 1990’s Reportable by the CDC in 1999 Bacterium Anaplasma Phagocytophilum CDC previously described as HGE – Human Granulocytic Ehrlichiosis

61 Group A Streptococcus (GAS) It is debated whether or not dogs in an household can serve as a source of infection for humans. Human beings are the primary reservoir for GAS, not dogs, so when an animal in an household is infected, is this an example of a reverse osmosis? (Crowder et al., 1978: Wilson et al., 1995) found zero correlation between GAS in presence of dogs in a household and human infection.

62 Group A Streptococcus (GAS) (Continued) (Mayer & VanOre, 1983, Copperman, 1982) documented resolution of chronic GAS in households after isolation of organism from, and treatment of, dogs. There has only been one case reported of Zoonosis GAS involving cats. (Roos et al., 1988)

63 Other Diseases Associated with Animals (continued) VIRAL INFECTIONS SOURCE West NileBirds HantavirusesWild rodents RabiesBats, cats, ferrets, dogs The Culex mosquito, which bites from dusk to dawn, is a vector of St. Louis encephalitis and West Nile virus; it becomes infected by feeding on birds that carry these viruses. St. Louis encephalitis and West Nile virus affect mainly older adults.

64 Other Diseases Associated with Animals (continued) Avian Influenza A (H 5 N 1 )

65 NEWS FLASH Bird Flu Hits Trailer Park in Florida Dateline: Orlando


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