Zoonotic Diseases Commonly Associated With lawte by jnyjhtw

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									 Zoonotic Diseases
Commonly Associated
 With Dogs and Cats
Note: The images in this presentation are for
      non-profit, educational use only.

                                   Neil Grove
                                   University of North Carolina –
                                   Chapel Hill
                                   Division of Laboratory Animal
                                   Medicine
            What we will cover
n   We will attempt to answer the following
    questions about each zoonotic disease:
n   What is it?
n   How can I get it?
n   What are the symptoms?
n   What precautions or preventive measures can be
    taken to avoid acquiring it?
     What diseases will we cover?
n   Toxocara
n   Sarcoptes
n   Cheyletiella
n   Rabies
n   Ringworm
n   Toxoplasmosis
n   Cat Scratch Disease
n   Capnocytophaga canimorsus
        Toxocariasis – What is it?
n   Toxocariasis is a
    zoonotic infection
    caused by the parasitic
    roundworms commonly
    found in the intestine of
    dogs (Toxocara canis) and
    cats (T. cati).
n   In the United States, an
    estimated 10,000 cases of
    Toxocara infections occur
    yearly in humans. (1)
                     Prevalence
n   A recent national survey of shelters revealed that almost
    36% of dogs nationwide, and 52% of dogs from
    southeastern states harbored helminths capable of
    causing human disease. 
n   Every year at least 3,000-4,000 serum specimens from
    patients with presumptive diagnoses of toxocariasis are
    sent to the Centers for Disease Control and Prevention
    (CDC), state public health laboratories, or private
    laboratories for serodiagnostic confirmation. (2)
                How Do I get it?
n   The most common Toxocara parasite of concern to
    humans is T. canis, which puppies usually contract from
    the mother before birth or from her milk.
n   The larvae mature rapidly in the puppy’s intestines;
    when the pup is 3 or 4 weeks old, they begin to
    produce large numbers of eggs that contaminate the
    environment through the animal’s stool. The eggs soon
    develop into infective larvae.(1)
                How Do I get it?
n   You or your children can
    become infected after
    accidentally ingesting
    (swallowing) infective
    Toxocara eggs from larvae
    in soil or other
    contaminated
    surfaces.(1)
n   Eggs are extremely
    resistant and can remain
    viable for years.
                                Toxacara eggs
                             Symptoms
n   There are two major forms of
    toxocariasis, Ocular larva migrans,
    and Visceral larva migrans :
n   1) Ocular larva migrans (OLM):
n   An eye disease that can cause
    blindness.
n   OLM occurs when a microscopic
    worm enters the eye; it may cause
    inflammation and formation of a
    scar on the retina. (1)


                                          Elevated granuloma in
                                          toxocariasis
                     Symptoms
n   Each year more than 700
    people infected with
    Toxocara experience
    permanent partial loss of
    vision.(1)
                      Symptoms
n   2) Visceral larva migrans (VLM):
n   Heavier, or repeated Toxocara infections, while rare, can
    cause VLM, a disease that causes swelling of the body’s
    organs or central nervous system. Symptoms of VLM,
    which are caused by the movement of the worms
    through the body, include fever, coughing, asthma, or
    pneumonia. (1)
                   Symptoms

n   In most cases, Toxocara infections are not
    serious, and many people, especially adults
    infected by a small number of larvae (immature
    worms), may not notice any symptoms. (1)
                       Symptoms
n   The most severe cases
    are rare, but are more
    likely to occur in young
    children, who often play
    in dirt, or eat dirt (pica)
    contaminated by dog or
    cat stool.(1)
           Precautions/Prevention
n   Have your veterinarian treat
    your dogs and cats, especially
    young animals, regularly for
    worms.
n   Wash your hands well with
    soap and water after playing
    with your pets and after
    outdoor activities, especially
    before you eat. Teach
    children to always wash their
    hands after playing with dogs
    and cats and after playing
    outdoors.
           Precautions/Prevention
n   Do not allow children to play
    in areas that are soiled with
    pet or other animal stool.
n   Clean your pet’s living area at
    least once a week. Feces
    should be either buried or
    bagged and disposed of in
    the trash.
n   Teach children that it is
    dangerous to eat dirt or soil.
             Review Questions
n   How do you get toxocariasis?
                      Answer
n   By accidentally ingesting (swallowing) infective
    Toxocara eggs from larvae in soil or other
    contaminated surfaces.(1)
                   Question
n   What are the two major forms of larval migrans?
                      Answer
n   Ocular larval migrans and visceral larval migrans
     Sarcoptic Mange – What is it?
n   Microscopic sarcoptic mange
    mites cause sarcoptic mange,
    also known as scabies.
n    Sarcoptic mange mites affect
    dogs of all ages, during any
    time of the year.
n   Sarcoptic mange mites are
    highly contagious to other
    dogs and may be passed by
    close contact with infested
    animals, bedding, or
    grooming tools.(3)
                How do I get it?
n   People who come in
    contact with an infected
    dog may acquire the
    mite.(3)
               Symptoms - Dogs
n   Sarcoptic mange mites
    burrow through the top
    layer of the dog’s skin
    and cause intense itching.
    (3)
              Symptoms - Dogs
n   Clinical signs include:
n   Generalized hair loss
n   Skin rash
n   Crusting
n   Skin infections may
    develop secondary to the
    intense irritation.(3)
              Symptoms - People
n   People who come in
    close contact with an
    infected dog may
    develop a rash and
    should see their
    physician.(3)
          Precautions/Prevention
n   Look for fleas, ticks, and coat abnormalities any time
    you groom your dog.
n   See your vet if your pet excessively scratches, chews, or
    licks its haircoat, or persistently shakes its head. This
    may indicate presence of external parasites or other
    conditions requiring medical care.
n   Prompt treatment of parasites lessens your pet’s
    discomfort, decreases the chances of disease
    trasnmission from parasite to pet, and may reduce the
    degree of home infestation.(3)
         Precautions/Prevention
n   Discuss the health of all family pets with your
    vet when one becomes infested. Some parasites
    cycle among pets, making control of infestation
    difficult unless other pets are considered.
    Consult your veterinarian before beginning
    treatment.
n   Tell your vet if you have attempted any parasite
    remedies, as this may impact your vet’s
    recommendation.(3)
          Precautions/Prevention
n   Be especially careful when applying insecticides to cats,
    as cats are particularly sensitive to these products.
    Never use a product that is not approved for cats , as
    the result could be lethal.
n   Follow label instructions carefully.
n   Leave treatment to the experts. Your vet offers
    technical expertise and can assist you in identifying
    products that are most likely to effectively and safely
    control your pet’s parasite problem. (3)
             Review Questions
n   Sarcoptic mange is also known as ______.
              Answer
n   Scabies
                  Question
n   How do people come in contact with the mange
    mite?
                    Answer
n   People who come in contact with an infected
    dog may acquire the mite.(3)
                 Cheyletiellosis
n   What is it?
n   Cheyletiellosis is a very contagious dermatosis
    caused by relatively large mites living on the skin
    surface.
n   Cheyletiella mites are obligate parasites and have a
    life cycle of approximately 3 to 4 wk in total.
n   They are not host specific and may transfer
    readily between dogs, cats, and rabbits. (4)
                     What is it?
n   The disease caused by Cheyletiella mites is often called
    'walking dandruff.'
n   On close observation of an infested dog, cat, or rabbit,
    it may be possible to see movement of the dandruff on
    the skin.
n   The movement is caused by the mites motoring around
    under the scales.
n   Cheyletiella mites are found on animals throughout the
    United States. They generally do not cause significant
    disease. (5)
                 How do I get it?
n   Humans in contact with
    pets carrying Cheyletiella
    spp. are at risk of
    becoming transiently
    infested.(4)
           Symptoms – Animals
n   The mites cause skin irritation, usually along the
    back of the animal.
n   Slight hair loss
n   Scales (dandruff)
n   Itching
n   Possibly some thickening of the skin.
n   Cats and rabbits may not show any signs of
    infestation (5)
           Symptoms - Humans
n   Uncomfortable, pruritic dermatosis,
    characterized by papular lesions that, typically,
    appear on the arms, legs, trunk, and buttocks.
n    Cheyletiella spp. are not capable of reproducing
    on humans, so appropriate treatment of the pet
    host should prevent further infestation, making
    human acaricidal therapy unnecessary. (4)
          Precaution/Prevention
n   How will I know if my pet has Cheyletiellosis?
n   Mites may be seen on the animal, especially if
    you use a magnifying glass.
n   Examining dandruff, hairs, or scrapings of the
    skin under the microscope can positively identify
    the mites.(5)
            Precaution/Prevention
n   If you suspect that your pet has Cheyletiellosis, seek the advice
    of your veterinarian, who will recommend appropriate treatment.

n   The mite can live for several days off the host, so the
    environment needs to be cleared of mites as well.
n    At the same time the animals are treated, the environment may
    be fogged or sprayed.
n   Since the mites only live for several days off the host, it is often
    effective to remove the rabbit, dog, or cat from the premises for
    several days until the mites die. This would prevent
    reinfestation.(5)
             Review Questions
n   Another name for the disease caused by
    Cheyletiella mites is _________.
                       Answer
n   walking dandruff
                    Question
n   Are Cheyletiella capable of reproducing on
    humans?
                       Answer
n   No - Cheyletiella spp. are not capable of
    reproducing on humans
                         Rabies
n   What is it?
n   Rabies is a preventable viral disease of mammals most
    often transmitted through the bite of a rabid animal.
n   The vast majority of rabies cases reported to the
    Centers for Disease Control and Prevention (CDC)
    each year occur in wild animals like raccoons, skunks,
    bats, and foxes.
n   Domestic animals account for less than 10% of the
    reported rabies cases, with cats, cattle, and dogs most
    often reported rabid. (6)
       What animals carry rabies?
n   Any mammal can get rabies.
n   The most common wild reservoirs of rabies are
    raccoons, skunks, bats, foxes, and coyotes.
n   Raccoons are the most common carriers in North
    Carolina.
n   Domestic mammals can also get rabies. Cats, cattle, and
    dogs are the most frequently reported rabid domestic
    animals in the United States.
n   Your pets and other domestic animals can be infected
    when they are bitten by rabid wild animals. (7)
             What about rodents?
n   Small rodents (such as squirrels, rats, mice, hamsters,
    guinea pigs, gerbils, and chipmunks, ) and lagomorphs
    (such as rabbits and hares) are almost never found to be
    infected with rabies and have not been known to cause
    rabies among humans in the United States. 
n   One case of a pet guinea pig was reported
n   Bites by these animals are usually not considered a risk
    of rabies unless the animal was sick or behaving in any
    unusual manner and rabies is widespread in your area.
              What about rodents?
n   However, from 1985 through
    1994, woodchucks accounted
    for 86% of the 368 cases of
    rabies among rodents
    reported to CDC. (7)
n   Over the last 10 years Tufts
    Wildlife Clinic has seen a
    number of large native wild
    rodents (mostly woodchucks,
    but also porcupines and
    beavers) with neurologic
    signs that have tested positive
    for rabies.(8)
               How do I get it?
n   People usually get rabies from the bite of a rabid
    animal.
n   It is also possible, but quite rare, that people may
    get rabies if infectious material from a rabid
    animal, such as saliva, gets directly into their
    eyes, nose, mouth, or a wound.(7)
              How do I get it?
n   Non-bite exposures to rabies are very rare.
    Scratches, abrasions, open wounds, or mucous
    membranes contaminated with saliva or other
    potentially infectious material (such as brain
    tissue) from a rabid animal constitute non-bite
    exposures. Occasionally reports of non-bite
    exposure are such that postexposure prophylaxis
    is given.(7)
               How do I get it?
n   Inhalation of aerosolized rabies virus is also a
    potential non-bite route of exposure, but other
    than laboratory workers, most people are
    unlikely to encounter an aerosol of rabies
    virus.(7)
              How do I get it?
n   Bites from bats can go undetected by a person.
n   If a dead bat is found in the house or the
    bedroom it is a concern for bite and rabies
    exposure.
      Can it be transmitted person to
                  person?
n   The only well-documented documented cases of
    rabies caused by human-to-human transmission
    occurred among 8 recipients of transplanted
    corneas, and recently among three recipients of
    solid organs .
n   Guidelines for acceptance of suitable cornea and
    organ donations, as well as the rarity of human
    rabies in the United States, reduce this risk. (7)
       Can it be transmitted person to
                   person?
n   In addition to transmission from cornea and organ transplants,
    bite and non-bite exposures inflicted by infected humans could
    theoretically transmit rabies, but no such cases have been
    documented.

n   Casual contact, such as touching a person with rabies or contact
    with non-infectious fluid or tissue (urine, blood, feces) does not
    constitute an exposure.

n   In addition, contact with someone who is receiving rabies
    vaccination does not constitute rabies exposure. (7)
                Symptoms – Animals
n   Animals with rabies may act
    differently than healthy animals. 
n   Wild animals may move slowly or
    act tame.
n   Also, some wild animals, like foxes,
    raccoons, and skunks, that
    normally avoid porcupines, may
    receive a face full of quills if they
    become rabid and try to bite these
    prickly rodents.
n   A pet that is usually friendly may
    snap at you and try to bite.
                Symptoms – Animals
n   There are two common types of
    rabies. One type is "furious" rabies.
    Animals with this type are hostile,
    may bite at objects, and have an
    increase in saliva. In the movies
    and in books, rabid animals foam
    at the mouth. In real life, rabid
    animals look like they have foam in
    their mouth because they have
    more saliva. (9)
n   In advanced cases animals also
    can’t swallow, causing saliva to
    pour out.
             Symptoms - Animals
n   The second and more
    common form is known
    as paralytic or "dumb"
    rabies. The dogs pictured
    have this type. An animal
    with "dumb" rabies is
    timid and shy. It often
    rejects food and has
    paralysis of the lower jaw
    and muscles.(9)
            Symptoms - Animals
n   Signs of rabies in animals include:
n   changes in an animal’s behavior
n   general sickness
n   problems swallowing
n   an increase in drool or saliva
n   wild animals that appear abnormally tame or sick
n   animals that may bite at everything if excited
n   difficulty moving or paralysis
n   death (9)
              Symptoms - People
n   In humans, signs and symptoms usually occur 30-90
    days after the bite. Once people develop symptoms,
    they almost always die.  This is why it is very important
    to go to your doctor right away if you have been bitten
    by an animal that might be rabid.

n   Early symptoms of rabies include fever, headache, sore
    throat, and feeling tired. As the virus gets to the brain,
    the person may act nervous, confused, and upset. (9)
            Symptoms - People
n   Other symptoms of rabies in humans include:
n   pain or tingling at the site of the bite
n   hallucinations hydrophobia ("fear of water" due
    to spasms in the throat)
n   paralysis
n   As the disease advances, the person enters into a
    coma and dies. (9)
         Prevention/Precautions
n   There is no treatment for rabies after symptoms
    of the disease appear.
n   There is an available rabies vaccine regimen that
    provides immunity to rabies when administered
    after an exposure (postexposure prophylaxis) or
    for protection before an exposure occurs
    (preexposure prophylaxis). (10)
         Prevention/Precautions
n   Preexposure vaccination is recommended for
    persons in high-risk groups, such as
    veterinarians, animal handlers, and certain
    laboratory workers.
n   Other persons whose activities bring them into
    frequent contact with rabies virus or potentially
    rabid bats, raccoons, skunks, cats, dogs, or other
    species at risk of having rabies should also be
    considered for preexposure prophylaxis. (10)
           Prevention/Precautions
n   What to do after a possible
    exposure:
n   If you are exposed to a
    potentially rabid animal, wash
    the wound thoroughly with
    soap and water, and seek
    medical attention
    immediately. A health care
    provider will care for the
    wound and will assess the
    risk for rabies exposure. The
    following information will
    help your health care
    provider assess your risk:
         Prevention/Precautions
n   the geographic location of the incident
n   the type of animal that was involved
n   how the exposure occurred (provoked or
    unprovoked)
n   the vaccination status of animal
n   whether the animal can be safely captured and
    tested for rabies
         Prevention/Precautions
n   Steps taken by the health care practitioner will
    depend on the circumstances of the bite.
n    Your health care practitioner should consult
    state or local health departments, veterinarians,
    or animal control officers to make an informed
    assessment of the incident and to request
    assistance. 
n   The important factor is that you seek care
    promptly after you are bitten by any animal.(10)
          Prevention/Precautions
n   What you can do to help prevent the spread of
    rabies
n   Be a responsible pet owner:
n   Keep vaccinations up-to-date for all dogs, cats and
    ferrets. This requirement is important not only to keep
    your pets from getting rabies, but also to provide a
    barrier of protection to you, if your animal is bitten by a
    rabid wild animal.
n   Keep your pets under direct supervision so they do not
    come in contact with wild animals. If your pet is bitten
    by a wild animal, seek veterinary assistance for the
    animal immediately. (10)
           Prevention/Precautions
n   Call your local animal control
    agency to remove any stray
    animals from your
    neighborhood. They may be
    unvaccinated and could be
    infected by the disease.
n   Spay or neuter your pets to
    help reduce the number of
    unwanted pets that may not
    be properly cared for or
    regularly vaccinated.
n   Avoid direct contact with
    unfamiliar animals:
           Prevention/Precautions
n   Enjoy wild animals
    (raccoons, skunks, foxes)
    from afar (including animals
    on work grounds). Do not
    handle, feed, or
    unintentionally attract wild
    animals with open garbage
    cans or litter.
n   Never adopt wild animals or
    bring them into your home.
    Do not try to nurse sick
    animals to health. Call animal
    control or an animal rescue
    agency for assistance. (10)
         Prevention/Precautions
n   Teach children never to handle unfamiliar
    animals, wild or domestic, even if they appear
    friendly. "Love your own, leave other animals
    alone" is a good principle for children to learn.
n   Prevent bats from entering living quarters or
    occupied spaces in homes, churches, schools,
    and other similar areas, where they might come
    in contact with people and pets. (10)
           Prevention/Precautions
n   When traveling abroad, avoid
    direct contact with wild
    animals and be especially
    careful around dogs in
    developing countries.
    Rabies is common in
    developing countries in Asia,
    Africa, and Latin America
    where dogs are the major
    reservoir of rabies. Tens of
    thousands of people die of
    rabies each year in these
    countries. (10)
          Prevention/Precautions
n   Before traveling abroad,
    consult with a health care
    provider, travel clinic, or
    your health department
    about the risk of
    exposure to rabies,
    preexposure prophylaxis,
    and how you should
    handle an exposure,
    should it arise. (10)
                    Local Cases
n   Rabid fox bites woman
    6/30/2005 6:23 PM
    By: News 14 Carolina Staff
    A fox with rabies attacked and bit a woman in the
    Orange Grove community near Hillsborough.
n   Authorities said the woman was walking her dogs when
    a fox started fighting one of them.
n   The woman used a stick to separate the two.

    That's when the fox bit her on the ankle.
    (20)
                        Local Case
n   In September 1997, a boy swimming at Jordan Lake State Park
    near Raleigh, NC, was attacked and bitten by a rabid beaver. This
    incident prompted Park officials to close the swimming areas
    and seek assistance from WS. State Park personnel and WS staff
    conducted intensive day and night searches and removed several
    beaver, one of which tested positive for rabies.
n   This was the second case of a rabid beaver attacking a person in
    the Park. Earlier in the summer, a rabid beaver attempted to
    climb into a boat with several fishermen. Rabies in beaver is
    extremely unusual: only 14 cases nationwide have been reported
    to the Centers for Disease Control and Prevention over the past
    40 years.
             Review Questions
n   True or False:

n   The vast majority of rabies cases occur in
    household pets.
                     Answer
n   False - domestic animals account for less than
    10% of the reported rabies cases
                    Question
n   True or False

n   Wild animals work grounds pose no threat for
    carrying rabies, so it is okay to approach them
    and pet them.
                       Answer
n   Uhhh…yeah right.
                    Ringworm
n   What is it?
n   Ringworm is a skin infection caused by a fungus.
    Ringworm can affect skin on your body (tinea
    corporis), scalp (tinea capitis), groin area (tinea
    cruris, also called jock itch), or feet (tinea pedis,
    also called athlete's foot).(11)
                  How do I get it?
n   Ringworm is contagious. It
    can be passed from one
    person to the next by direct
    skin-to-skin contact or by
    contact with contaminated
    items such as combs,
    unwashed clothing, and
    shower or pool surfaces.
n   You can also catch ringworm
    from pets that carry the
    fungus. Cats are common
    carriers. (11)
                   How do I get it?
n   Many different kinds of
    animals can transmit
    ringworm to people.
n   Ringworm is transmitted
    from direct contact with an
    infected animal's skin or hair.
n   Dogs and cats, especially
    kittens or puppies, can have
    ringworm that can be passed
    to people.
n   Cows, goats, pigs, and horses
    can pass ringworm to people
    too. (12)
              How do I get it?
n   The fungi that cause ringworm thrive in warm,
    moist areas. Ringworm is more likely when you
    have frequent wetness (such as from sweating)
    and minor injuries to your skin, scalp, or
    nails.(11)
n   Microsporum canis is the most common type.
                      Symptoms
n   The symptoms of ringworm include:
n   Itchy, red, raised, scaly patches that may blister and
    ooze. The patches often have sharply-defined edges.
    They are often redder around the outside with normal
    skin tone in the center. This may create the appearance
    of a ring. Your skin may also appear unusually dark or
    light.
n   When your scalp or beard is infected, you will have bald
    patches.
n   If nails are infected, they become discolored, thick, and
    even crumble. (11)
                                                             This is a picture of
This child's leg shows a classical-                          ringworm, tinea manum, on
appearing ringworm lesion with                               the finger. This fungal
central clearing and a slightly raised
red border. (11)
                                         Symptoms            infection is inflamed and
                                                             scaly. (11)




     Ringworm is not seen as frequently in
     adults as in children, but when          In the scalp, fungal infections
     conditions are conducive to growth,      often form circular, scaly, inflamed
     the fungus can flourish. (11)            patches. (11)
          Precautions/Prevention
n   To prevent ringworm:
n   Keep your skin and feet clean and dry.
n   Shampoo regularly, especially after haircuts.
n   Do not share clothing, towels, hairbrushes, combs,
    headgear, or other personal care items. Such items
    should be thoroughly cleaned and dried after use.
n   Wear sandals or shoes at gyms, lockers, and pools.
n   Avoid touching pets with bald spots. (11)
              Review questions
n   True or False:

n   Ringworm is a close relative to earthworms.
                     Answer
n   False - ringworm is caused by a fungus.
                     Question
n   True or False:

n   Ringworm thrives on dry skin.
                      Answer
n   False - Ringworm is more likely when you have
    frequent wetness (such as from sweating) and
    minor injuries to your skin, scalp, or nails.(11)
                 Toxoplasmosis
n   Toxoplasmosis is caused by a single-celled parasite
    called Toxoplasma gondii.
n    While the parasite is found throughout the world,
    more than 60 million people in the United States may
    be infected with the Toxoplasma parasite.
n    Of those who are infected, very few have symptoms
    because a healthy person's immune system usually
    keeps the parasite from causing illness. (13)
               Toxoplasmosis
n   However, pregnant women and individuals who
    have compromised immune systems should be
    cautious; for them, a Toxoplasma infection could
    cause serious health problems. (13)
                   How do I get it?
n   By accidentally swallowing
    cat feces from a Toxoplasma-
    infected cat that is shedding
    the organism in its feces.
    This might happen if you
    were to accidentally touch
    your hands to your mouth
    after gardening, cleaning a
    cat's litter box, or touching
    anything that has come into
    contact with cat feces. (13)
                How do I get it?
n   Eating contaminated raw
    or partly cooked meat,
    especially pork, lamb, or
    venison; by touching
    your hands to your
    mouth after handling
    undercooked meat. (13)
n   This is a far more likely
    source than the family
    cat.
                 How do I get it?
n   Contaminating food with
    knives, utensils, cutting
    boards and other foods that
    have had contact with raw
    meat.
n   Drinking water contaminated
    with Toxoplasma.
n   Receiving an infected organ
    transplant or blood
    transfusion, though this is
    rare. (13)
               How do I get it?
n   An infected pregnant
    woman can transmit the
    infection to her fetus
    (congenital
    toxoplasmosis). (14)
             Symptoms - Animals
n   Cats rarely have
    symptoms when first
    infected, so most people
    do not know if their cat
    has been infected.
n   The infection will go
    away on its own;
    therefore it does not help
    to have your cat or your
    cat's feces tested for
    Toxoplasma. (13)
             Symptoms - People
n   Symptoms of the infection vary.
n   Most people who become infected with
    Toxoplasma are not aware of it.
n   Some people who have toxoplasmosis may feel
    as if they have the "flu" with swollen lymph
    glands or muscle aches and pains that last for a
    month or more. (13)
                   Symptoms
n   Severe toxoplasmosis, causing damage to the
    brain, eyes, or other organs, can develop from
    an acute Toxoplasma infection or one that had
    occurred earlier in life and is now reactivated.
    Severe cases are more likely in individuals who
    have weak immune systems, though
    occasionally, even persons with healthy immune
    systems may experience eye damage from
    toxoplasmosis. (13)
                   Symptoms
n   Most infants who are infected while still in the
    womb have no symptoms at birth, but they may
    develop symptoms later in life.
n    A small percentage of infected newborns have
    serious eye or brain damage at birth.(13)
       Who is at heightened risk?
n   People who are most likely to develop severe
    toxoplasmosis include:
n   Infants born to mothers who became infected with
    Toxoplasma for the first time during or just before
    pregnancy.
n   Persons with severely weakened immune systems, such
    as individuals with HIV/AIDS, those taking certain
    types of chemotherapy, and those who have recently
    received an organ transplant. (13)
          Prevention/Precautions
n   There are several general sanitation and food safety
    steps you can take to reduce your chances of becoming
    infected with Toxoplasma.
n   Wear gloves when you garden or do anything outdoors
    that involves handling soil. Cats, which may pass the
    parasite in their feces, often use gardens and sandboxes
    as litter boxes. Wash your hands well with soap and
    water after outdoor activities, especially before you eat
    or prepare any food. (13)
           Prevention/Precautions
n   When preparing raw meat,
    wash any cutting boards,
    sinks, knives, and other
    utensils that might have
    touched the raw meat
    thoroughly with soap and hot
    water to avoid cross-
    contaminating other foods.
    Wash your hands well with
    soap and water after handling
    raw meat.
          Prevention/Precautions
n   Cook all meat
    thoroughly; that is, to an
    internal temperature of
    160° F and until it is no
    longer pink in the center
    or until the juices
    become colorless.
n   Do not taste meat before
    it is fully cooked. (13)
Precautions/Prevention for Pregnant
             Women
n   Have someone else change the litter box or wear
    disposable gloves if someone else can’t do it and
    wash your hands thoroughly with soap and
    water afterwards.
n   Change the litter box daily – the parasite does
    not become infected until one to five days after
    it is shed in the feces.
n   Feed your cat commercial dry or canned feed
Precautions/Prevention for Pregnant
             Women
n   Never feed cats raw meat because this can be a
    source of toxoplasma infection.
n   Keep your cat indoors.
n   Avoid stray cats, especially kittens.
n   Cover outdoor sandboxes.
n   Do not get a new cat while you are pregnant.
Precautions/Prevention for Pregnant
             Women
n   Generally if a woman has been infected with
    Toxoplasma before becoming infected, the
    infant will be infected because the mother is
    immune.
n   Some experts suggest waiting six month after a
    recent infection before becoming pregnant.
    Once infected with Toxoplasma is my cat
    always able to spread the infection to me?

n   No, cats only spread Toxoplasma in their feces for
    a few weeks following infection with the
    parasite.
n   Like humans, cats rarely have symptoms when
    first infected, so most people do not know if
    their cat has been infected.
n   The infection will go away on its own; therefore
    it does not help to have your cat or your cat's
    feces tested for Toxoplasma.
              Review Questions
n   True or false:

n   Most people with toxoplasmosis exhibit no
    clinical signs of having it.
           Answer
n   True
              Review Question
n   Are there any groups of people who are at
    heightened risk of suffering from harmful
    symptoms of toxoplasmosis?
                     Answer
n   Yes – previously uninfected pregnant women
    and individuals who have compromised immune
    systems should be cautious; for them, a
    Toxoplasma infection could cause serious health
    problems. (13)
               Cat Scratch Disease
n   What is it?


n   Cat scratch disease
    (CSD) is a bacterial
    disease caused by
    Bartonella henselae. (15)
                 How do I get it?
n   Most people with CSD
    have been bitten or
    scratched by a cat. (15)
Prevalence and Symptoms in Cats
n   Kittens are more likely to be
    infected and to pass the
    bacterium to people.
n   About 40% of cats carry B.
    henselae at some time in their
    lives.
n   Cats that carry B. henselae do
    not show any signs of illness;
    therefore, you cannot tell
    which cats can spread the
    disease to you. (15)
            Symptoms - People
n   Mild infection at the point of injury
n   Lymph nodes, especially those around the head,
    neck, and upper limbs, become swollen.
n   Fever, headache, fatigue, and a poor appetite.
                      Symptoms
n   Rare complications of B.
    henselae infection are
    bacillary angiomatosis
    (reddish elevated lesions
    often surrounded by a
    scaly ring) and Parinaud's
    oculolandular syndrome.
    (15)

                                 bacillary angiomatosis
              Heightened Risk
n   People with immunocompromised conditions,
    such as those undergoing immunosuppressive
    treatments for cancer, organ transplant patients,
    and people with HIV/AIDS, are more likely
    than others to have complications of CSD. (15)
           Prevention/Precautions
n   Avoid "rough play" with cats, especially kittens. This includes
    any activity that may lead to cat scratches and bites.
n   Wash cat bites and scratches immediately and thoroughly with
    running water and soap.
n   Do not allow cats to lick open wounds that you may have.
n   Control fleas.
n   If you develop an infection (with pus and pronounced swelling)
    where you were scratched or bitten by a cat or develop
    symptoms, including fever, headache, swollen lymph nodes, and
    fatigue, contact your physician. (15)
                    Case Report
n   In July 2000, a boy aged 5 years was admitted to a local
    hospital after having fever (with temperature reaching
    104° F [40°C]) for 12 days and left upper quadrant pain
    for 8 days. Except for fever and inflamed tympanic
    membranes, the physical examination was
    unremarkable.
n   The child had sustained a scratch from a kitten 2
    months before onset of illness. His serologic titer for B.
    henselae obtained on day 14 of illness was 1:4096. (16)
              Review Questions
n   True or False:

n   Kittens are more likely to be infected and to
    pass the Cat Scratch Disease to people.
           Answer
n   True
                   Question
n   People with ________conditions, such as those
    undergoing treatments for cancer, organ
    transplant patients, and people with HIV/AIDS,
    are more likely than others to have
    complications of CSD. (15
                  Answer
n   immunosuppressed
     Capnocytophaga canimorsus Sepsis
(previously referred to as Dysgonic fermenter -
                   2 infection)
n   What is it?

n   Dysgonic fermenter-2 is
    a fastidious, gram-
    negative, opportunistic
    pathogen that can cause
    multiorgan disease in
    human beings.
                              Capnocytophaga canimorsus
                    What is it?
n   The first case of DF-2 infection was reported in
    1976, when the organism was isolated from the
    blood and CSF of a patient who had been bitten
    by 2 dogs.
n    Dysgonic fermenter-2 is an organism of low
    virulence, usually causing serious illness only in
    people with impaired defense mechanisms
    against infection.(17)
               How do I get it?
n   In one study, DF-2 was isolated from the
    oronasal fluids of 8% of clinically normal dogs.
n   The organism has been recovered from the oral
    cavity of dogs and cats that bit persons who later
    developed DF-2 infection. (17)
                  How do I get it?
n   Most human patients with
    DF-2 infection report a
    history of a recent dog bite.
n    Many of the remaining
    patients mention a history of
    animal exposure. (17)
n   In most (77%) cases,
    infection is preceded by a
    bite or other exposure to
    dogs. (18)
                   Symptoms
n   Dysgonic fermenter-2 is an organism of low
    virulence for people with intact defense
    mechanisms
n   In most instances, dog and cat bites cause DF-2
    infection only in people in high-risk groups. (17)
                      Symptoms
n   The severity of clinical
    symptoms in DF-2
    infections varies from
    signs of fulminant
    postsplenectomy sepsis,
    to a milder disease in
    patients with intact
    spleens,in which fever        Cellulitis
    and cellulitis are the most
    common signs. (17)
                   Symptoms
n   Localizing signs in severely affected patients
    include endocarditis, purulent meningitis, and
    septic arthritis. Symmetric peripheral gangrene
    may develop, and a necrotizing eschar may form
    at the bite site.(17)
              Heightened Risk
n   Most fatal infections have occurred in persons
    with a history of asplenia, alcoholism, or
    hematologic malignancy. (18)
         Prevention/Precautions
n   People in high-risk groups, especially asplenic
    individuals, should be aware of the dangers of
    being bitten by dogs and cats and should seek
    prompt medical attention if bitten.
n   Asplenic people should consider wearing a
    bracelet to inform health care personnel of their
    condition in case of emergency.(17)
         Prevention/Precautions
n   One author has recommended that "given the
    frequency with which DF-2 is found in the oral
    microflora of dogs and cats, asplenic individuals
    should be advised not to keep dogs and cats as
    pets."
n   Although this advice may be controversial, it
    would be prudent for asplenic individuals to
    minimize the chances for dog or cat bites at
    work or at home. (17)
              Review Questions
n   True or False:

n   Capnocytophaga canimorsus Sepsis causes
    severe illness in virtually anyone who is infected
    with it.
                       Answer
n   False – it usually causes serious illness only in
    people with impaired defense mechanisms
    against infection.
                     Question
n   True or false – Alcoholism is a risk factor in
    developing serious illness relating to
    Capnocytophaga canimorsus Sepsis.
           Answer
n   True
                                     References
n   1. CDC. Toxocariasis Fact Sheet. http://www.cdc.gov/ncidod/dpd/parasites/toxocara/factsht_toxocara.htm
n   2. CDC. Guidelines for Veterinarians: Prevention of Zoonotic Transmission of Ascarids and Hookworms of
    Dogs and Cats. http://www.cdc.gov/ncidod/dpd/parasites/ascaris/prevention.htm
n   3. American Veterinary Medical Association. What You Should Know About External Parasites – Caring For
    Animals (Pamphlet). 2/04.
n   4. Chailleux, Paradis. Efficacy of selamectin in the treatment of naturally acquired cheyletiellosis in cats.
    http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=339606
n   5. Holly Nash, DVM, MS Cheyletiella yasguri, C. blakei (Rabbit Fur Mite)
                                        yasguri,
    http://www.peteducation.com/article.cfm?articleid=725
n   6. CDC. About Rabies. http://www.cdc.gov/ncidod/dvrd/rabies/introduction/intro.htm
n   7. CDC. Rabies Questions and Answers.
    http://www.cdc.gov/ncidod/dvrd/rabies/ques&ans/q&a.htm#How%20do%20people%20get%20rabies
n   8. Porkas, Mark, DVM. Pro-med mail post. November 30, 2004.
n   9. CDC. Rabies for Kids. http://www.cdc.gov/ncidod/dvrd/kidsrabies/
n   10. CDC. Rabies Prevention and Control.
    http://www.cdc.gov/ncidod/dvrd/rabies/Prevention&Control/preventi.htm
n   11. Medline Plus. Ringworm. http://www.nlm.nih.gov/medlineplus/ency/article/001439.htm
n   12. CDC. Ringworm and Animals. http://www.cdc.gov/healthypets/diseases/ringworm.htm
n   13. CDC. Toxoplasmosis Fact Sheet.
    http://www.cdc.gov/ncidod/dpd/parasites/toxoplasmosis/factsht_toxoplasmosis.htm
                                    References
n   14. Medline. Toxoplasmosis. http://www.nlm.nih.gov/medlineplus/ency/article/000637.htm
n   15. CDC. Cat Scratch Disease. http://www.cdc.gov/healthypets/diseases/catscratch.htm
n   16. CDC. Morbidity and Mortality Monthly Report. Cat-Scratch Disease in Children – Texas, September 2000
    -August 2001. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5110a4.htm
n   17. August, John R. Dysgonic fermenter -2 infections. JAVMA, Vol 193, December 15, 1988.
n   18. CDC. Morbidity and Mortality Weekly Report. Capnocytophaga canimorsus Sepsis Misdiagnosed as
    Plague – New Mexico , 1992.
n   19. USDA. Protection of Human Health and Safety. http://www.aphis.usda.gov/ws/wshl97/health.html.
n   20. http://rdu.news14.com/content/your_news/durhamchapel_hill/?ArID=71561&SecID=42
                  Disclaimer
n   This presentation was created while I was an
    employee of Priority One Services (POS) at the
    National Institute of Environmental Health
    Sciences (NIEHS). Thus, both organizations
    deserve credit for supporting the work.
n   However, opinions expressed in this
    presentation are mine and do not necessarily
    reflect those of POS, NIEHS, or UNC DLAM.

								
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