Zoonotic Infections I Have Nothing to Disclose
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Zoonotic Infections I have nothing to disclose Carol Glaser, DVM, MPVM, MD Pediatric Infectious Diseases University of California, San Francisco Outline What is a Zoonosis? Overview of Zoonoses Potpourri of topics Case presentation of different zoonotic disease cases with different: – Mode of transmission – Reservoir hosts – Severity of illness Illustrates the diversity of zoonotic diseases Emerging topics -from Wikipedia Tick • Borreliosis • Trypanosomiasis Companion animals Sheep Direct contact •Q fever Food chain Cattle Direct • Salmonella Deer contact • E. coli • Tularemia • Campylobacter • Cryptosporidum • Leptospirosis • Mycobacterium • Rat-bite fever •Brucellosis / Rat • Salmonella • Campylobacter Flea • Avian flu Chicken & Eggs • Plague • Haemorrhagic fever • Rabies Bat Pigeon / Pet Bird • Psittacosis • Ctyptococcus • M. avium-intracellulare • Toxocariasis • Toxoplasmosis https://www.avma.org/KB/Resources/Statistics/Pages/Market- •West Nile virus • Rabies Mosquito •JEV • Rabies research-statistics-US-pet-ownership • Leptospirosis • Bartonella hensleae •Chik Dog • Dengue Cat 1 Specialty and Exotic Animals Zoonosis: General Many are missed because of vague clinical presentation –’viral’ Lack of awareness Diagnosis is often problematic – Tests not widely available – Orphan diseases “new twists” https://www.avma.org/KB/Resources/Statistics/Pages/Market-research- -Handout slightly different > PowerPoint statistics-US-pet-ownership.aspx#exotic A Partial List of When you hear hoof beats… Bacterial Zoonoses Anthrax Psittacosis Brucellosis Q Fever Campylobacteriosis Rat-bite Fever Cat Scratch Disease Relapsing Fever Rocky Mountain Spotted Ehrlichiosis Fever E. coli 0157:57 Salmonellosis Glanders Tularemia Leptospirosis Typhus Fever Listeriosis Yersiniosis Lyme Disease Zoonotic Tuberculosis Melioidosis Plague A Partial List of A Partial List of Viral Zoonoses Parasitic Zoonoses Arenaviruses (LCMV, Lassa, S. Herpesvirus B Protozoa Helminths: (roundworms, American hemorrhagic fevers) Influenza (avian) tapeworms, flukes)* Bat lyssaviruses Japanese encephalitis Babesiosis Anisakiasis Cryptosporidiosis* Colorado tick fever Nipah Cysticercosis Leishmaniasis* Ebola Rabies Hydatidosis Giardiasis* Equine encephalitides (WEE, Rift Valley fever Mesocestoidiasis Toxoplasmosis* Schistosome Dermatitis EEE, VEE) SARS Trypanosomiasis (Swimmer’s Itch) Hantaviruses (Hantaan, Sin Vesicular stomatitis Nombre) Trichinosis* West Nile Virus Visceral Larval Migrans* Hendra Toxocariasis/ Baylisascaris 2 Emerging infectious diseases Estimated that 75% are zoonotic – Many viral Case 1 – Many vector borne (e.g., West Nile virus) -Chomel et al., Emerg Inf Dis 2006 Girl with Fever & Rash 8 year old female – Developed headache, fever , sore throat – 4 days later: macular rash on hands/feet--later petechial – 1 week: severe arthralgias, refusal to walk – Seen by several physicians; primary MD, rheumatologist, oncologist, dermatologist – Pediatric ID consulted just before bone marrow Girl with Fever & Rash Girl with Fever & Rash CBC, urinalysis: normal When asked specifically about rodents - Blood / urine culture negative patient owned a rat but no bite history (mother didn’t consider it a “pet”) Unremarkable PMH except allergy to PEN No recent travel Blood culture repeated with RBF diagnosis in mind (micro lab can optimize isolation of No tick bites, denied pet ownership organism with special techniques): No unusual dietary history – Blood culture positive for Streptobacillis moniliformis 3 Rat Bite Fever Rat Bite Fever: Microbiology Streptobacillus moniliformis: Epidemiology Two distinct disease syndromes – Streptobacillus moniliformis: most cases in US Typically transmitted by bite or scratch of rats, Incidence unknown since not a reportable disease mice, squirrels, carnivores that prey on rodents Probably rare but likely underdiagnosed Can be acquired through handling of dead rats Relatively difficult to isolate 50-100% wild and lab rodents harbor organism Food/water contaminated with infected rat – Spirillum minor: not generally found in US excreta (cases called Haverhill) Mostly in Asia Different syndrome Sodoku or relapsing fever 40% of cases no history of bite Rat Bite Fever: Clinical Incubation: ~ 7 days (range 1-10 days) Abrupt onset fever (irregular relapsing fever) Chills, headache Migratory arthralgias, myalgias Clinical features similar to other diseases Diagnosis usually requires high index of suspicion Rat Bite Fever Complications – Endocarditis, myocarditis, pericarditis – Meningitis Case 2 – Pneumonia – Abscesses in “virtually every organ” Untreated: 7-13% mortality Treatment – Penicillin or Doxycycline Elliot et al., Clin Microbiol Rev, 2007 Dijkmans et al., Infection, 1984 Pins et al., Clin Inf Dis, 1996 4 11 m/o male with Encephalopathy 11 m/o male with Encephalopathy History of present illness Examination findings – 5 days PTA: developed irritability – Right eye – 2 days PTA: unable to sit deviated medially Other history diffuse serpiginous lesions – no major illnesses; vaccines UTD – Hypertonicity extremities – 1 older sibling, both parents healthy Lab findings – travel to Sierra Nevada 4 weeks PTA – CBC: 18K WBCs, 50% lymph, 17% eosin – lives in Pacific Grove – CSF: 50 WBCs, 45% eosin – spends much time outdoors; occasional pica noted Cranial MRI – “patchy” disseminated white matter 11 month old male with 11 m/o male with Encephalopathy Encephalopathy Hospitalized for workup and treatment Serology/PCR: negative Serum sent to Purdue University: – Toxocara, Coccidioides, Varicella, HSV – Positive for Baylisascaris procyonis Cultures: negative – blood, CSF, urine Treatment – acyclovir, erythromycin, steroids, clonazepam, albendazole Balamuthia vs. Bayilsascaris Baylisascaris procyonis Balamuthia: Free-living amoeba Intestinal nematode Natural hosts Bayliascaris: a worm – adult raccoons Transmission Both can cause CNS illness but very – eggs shed in feces (millions of eggs shed) different – require 3-4 weeks to become infectious – ova extremely resistant to dessication/destruction; may remain viable in the environment for years 5 Baylisascaris procynosis Baylisascaris procynosis Human infections rare – Despite high potential for exposure, few cases 3 forms reported A. organs: visceral larva migrans (VLM) – Infected animals shed millions eggs/day, ~90% juvenile raccoons infected in some areas [only one documented case] – ~20 human cases reported B. brain: neural larval migrans (NLM) [typically young children, but case reports of older individuals] Risk factors for infection – Contact with raccoon feces or an environment contaminated by C. eye: Ocular larva migrans (OLM) [adults] infected feces and geophagia or pica – “Suspect vehicles” include soil, wood, leaves and other vegetation, bark, and stone - Chun et al., Pediatr Inf Dis, 2009 Gavin et al., Clin Microbiol Rev 2005 Wise et al., Microbes and Infection, 2005 Wise et al., Microbes and Infection 2005 An emerging parasite.. Who is at risk? Contact with raccoon feces or an environment contaminated by infected feces and geophagia or pica Typically young children, males > female Other cases; Developmental delay with history of pica Teenager with substance abuse 73 year old with Alzheimer-type dementia -Hung et al., Emerg Infect Dis, 2012 -Chung et al., Pediatr Infect Dis J, 2009 Epidemiology Baylisascaris NLM Raccoon defecate in “latrines” Often devastating outcome with death or -outside or inside: severe neurologic sequelae However, a few ‘promising’ case reports – 14 month old boy with NLM from MA, some residual deficits and Eggs of Baylisascaris very hardy moderate speech delay but overall good – Highly resistant to desiccation – 4 year old boy from New Orleans, LA with NLM, “full recovery” – Both Rxed with steroids and anti-helminthic – Viability not affected by freeze/thaw – However relatively low thermal death point (<62 C) Peters et al., Pediatrics, 2012 Pai et al., Emerg Inf Dis, 2007 -Shafir et al., Emerg Infect Dis, 2011 6 Baylisascaris procynosis More severe than Toxocara Male – larger larvae (1-2 mm) – extensive migration (brain, eye, heart) Clinical – eosinophilic meningoencephalitis – death or long-term DD in children Pathology Female – deep cerebral white matter granulomas Adult Baylisascaris procyonis Other potential hosts opossums Kinkajous Olingos 72 y/o male with lethargy and ascending paralysis Case 3 . Onset of headache/fever . 5 days later hospitalized with lethargy, somnolence and ascending paralysis . Clinician thought it was probably a stroke but wanted to rule out encephalitis 7 72 y/o male with lethargy and 72 y/o male with lethargy and ascending paralysis ascending paralysis . Exposure history: . Admit labs/Neuroimaging: . Born and raised in the Philippines and had been . LP: WBC = 10 WBCs/mm3, Protein = 172 mg/dL, there 10 months prior to onset of illness Glucose = 60 mg/dL . US resident for 10 years . MRI: mild atrophy (appropriate for age), otherwise normal . No known mosquito bites . Died 11 days after hospitalization . No known animal exposures . No autopsy, cause of death: “cerebral vascular accident” 72 y/o male with lethargy and ascending paralysis Background • Causes a severe acute progressive • Rabies antibody positive and rabies PCR positive from “throat swab” (contaminated with saliva) encephalitis • Sequenced strain: canine strain/Philippines • One of the ‘oldest’ infectious disease known to man • Patient originally from Philippines, was there 10 months prior to onset of illness • The world’s “most deadly virus” • Latin for: to “be mad”/”madness”