Zoonotic diseases: cat, and it is passed from cat to cat via the feces each having their own species, without showing Cat-scratch disease and of the cat (ctenocephalides felis). an active disease. Being able, as suggested in one report, to Causative agent toxoplasmosis pass the placental barrier in man, the impact henselae is a curved, pleomorphic, (2 CE Hours) of is not well understood and rod-shaped gram-negative, facultative intracellular deserves further study. Many arthropods have Learning objectives: bacterium infecting the cat. It is of little ! been shown to carry Bartonella in addition to ! List the risk factors for Bartonella infections. consequence in the cat, with little symptomatology. ! cat , including sand flies, human body lice, ! Explain how and where humans and animals Other species of Bartonella-infecting domestic cats rodent fleas, biting flies and ticks. Whether they can become infected. are Bartonella clarridgeiae, Bartonella koehlerae ! are actively involved in passing the organism to ! Explain how to diagnose, treat and prevent and Bartonella bovis. cat-scratch disease. mammalian hosts is not confirmed. ! In man, it produces a self-limiting disease varying ! List recommendations you can provide to pet Pathogenesis: While may be from painful regional lymphadenopathy after owners about treatment and prevention. the most common species in the cat, Bartonella ! being scratched or bitten by a cat to bacillary ! List the contraindications when prescribing clarridgeiae and Bartonella koehlerae are angiomatosis and peliosis hepatis, neuroretinitis, medications for cat-scratch disease. sometimes compromised as well and co-infections ! endocarditis, relapsing with bacteremia and ! List the risk factors for are possible. As many as six different strains of central nervous system complications. infections. Bartonella have co-habited in the same cat. !! Explain how and where humans and animals can become infected. Transmission Chronic recurrent bacteremia in the cat is !! Explain how to diagnose, treat and prevent Direct transmission from cat to cat is not known. frequent (25-41 percent) and often long toxoplasmosis. It requires an arthropod vector, with the carrier lasting, even years. Bacteremic phases will !! Describe the life cycle of these parasites. being the cat flea (Ctenocephalides felis), be interspersed with a-bacteremic ones, and !! List recommendations you can provide to pet although ticks have been considered possible the isolation of from the blood will owners about treatment and prevention. vectors as well. The cat flea sucks blood from the depend on the presence of bacteria at the time !! List the contraindications when prescribing infected cat and deposits the digested blood in of sample. Bacteremic cats do not necessarily medications for Toxoplasma gondii. its feces onto the fur coat of its host while taking show antibody, and antibody does not necessarily up its blood meal. Bacteremia for Bartonella interfere with bacteria in the blood stream, Introduction henselae is intermittent, and only blood from the possibly protected within erythrocytes and other Zoonoses are infectious diseases that are transmitted bacteremic phase will be infective. host cells. from animal to man. More than 60 percent of Flea feces appear as black specks, often comma Bartonella bacteria will attach to red blood cells emerging human pathogens are zoonotic. Causative shaped, on the cat fur. Eggs produced by the and endothelial cells of capillary walls, enter these groups of agents include parasites, fungi, bacteria flea are white. They may fall off the cat along cells and produce inflammatory tissue damage and viruses. Often of minor importance and with the flea feces, and the hatching larvae may throughout the body. In particular, they will affect producing only minor symptoms, they can lead to consume the feces and thus become infected. the mucosae of the respiratory system, including severe disease, especially in the very young and When the cat scratches the fleabite area, it picks the oral cavity, the eye, the skin and lymph nodes, those in weakened condition. up the infectious flea deposits in its claws and liver and spleen. The incidence of seropositivity in This course looks at two common diseases found nail beds. It can pass on the disease and continue cats is greater than the rates for bacteremia. mainly in cats that can be transmitted to man: its spread by scratching other cats. Even though Bartonella henselae does not appear cat-scratch disease, caused by the Bartonella The presence of Bartonella henselae DNA in to be of serious concern for human health, it is hensalae bacterium, and toxoplasmosis, caused the saliva of the cat has been confirmed by the one most widely known. by the Toxoplasma gondii parasite. While polymerase chain reaction and demonstrated the In the typical cat-scratch disease of man, the initial symptoms for both illnesses in many cases possible infectiousness of the cat bite. In fact, signs of the disease are single or multiple small are not serious, in others they can indeed be there have been suggestions that the organism bumps, developing to erythematous papules within dangerous or even fatal for humans. Veterinarians may cause plasma cell stomatitis, a progressive about 3-12 days after the infection near the cat need to understand both of these diseases and oral disease of the cat. The transmission of scratch or cat bite site, usually at hands, arms or help educate animal owners about them and the Bartonella henselae from cat to human happens face. These papules may progress, become pustules precautions they need to take. by cat scratch or bite, although there has been and ulcerate. The individual may show symptoms the occasional suggestion that the flea might Part I: Bartonellosis: Cat-scratch of fever, headache and anorexia. Within about three pass it on as well. There is one report suggesting weeks the regional, usually epitrochlear, cervical, disease transplacental transfer from mother to child. and axillary lymph nodes become inflamed, The diseases caused by the various members , causing , increase in size and become painful to the touch. In of the group Bartonella vary from insignificant is transmitted by body lice. While found in about one quarter of the cases, they may abscess and in man to deadly: the unsanitary and crowded conditions of the burst. In the immunocompetent individual, healing (Carrion’s disease), Bartonella quintana (trench trenches of , today it causes disease will take a few weeks, and within a few more weeks fever), (endocarditis), in the homeless, the drug addicted and those lead to full recovery. (retinitis), Bartonella immunosuppressed by disease or chemotherapy. About one of 10 infected patients may exhibit vinsoni (endocarditis), Bartonella washonsis In the HIV/AIDS population in particular, one (myocarditis), Bartonella clarridgiae atypical symptoms, such as encephalitis, which frequently finds and occurs in 2-4 percent of all cases. Encephalitis is (bacteremia), (Carrion’s hepatis. diseaselike syndrome) and Bartonella henselae reflected by headache, confusion, altered mental (cat-scratch disease). There is some evidence of bartonellosis in dogs, status, restlessness, combativeness, disorientation, usually associated with granulomatous disease coma and evidence of meningitis and transient There are more than 20 known species of and endocarditis in larger-breed dogs. Bartonella nuchal rigidity. This encephalitis usually follows Bartonella. Bartonella henselae is distributed is also found in the blood of numerous animal the natural course of the disease, but it can also worldwide. The cat-scratch disease it produces is species, including gray squirrels, flying squirrels, occur without precursory evidence. Fortunately, the most widely recognized form of bartonellosis. groundhog, wood rat, cattle, deer, elk and sheep, it seems to be self-limiting, not requiring special The main host of this strain of Bartonella is the treatment and rarely leaving lasting impairment.

Elite Page 1 Other atypical events, often following may be an enlarged spleen, typically an exaggerated fluid may show general elevated protein levels and lymhadenopathy and generalized influenza-like cutaneous and subcutaneous proliferation of blood mild pleocytosis. An EEG (electroencephalogram) symptoms, are: vessels and growthlike masses in visceral organs, will not bring much more. ■■ Neuroretinitis, characterized by unilateral peliosis hepatis, fever, bacteremia, granulomatous There are no general laboratory tests with a vision loss, papilledema, swelling of the optic conjunctiva, optical neuritis, neuropathy, retinitis, quick answer. Minor rises in leukocyte count disk and macular exudates. keratitis, meningoencephalitis, osteomyelitis, and increased erythrocyte sedimentation rates ■■ Parinaud’s oculoglandular syndrome arthritis, arthralgia, myositis, inflammatory bowel are unlikely to be useful. Histopathology in (granulomatous and regional, disease, lymphadenopathy, pulmonary infiltrates the swollen lymph nodes includes lymphocytic same side lymphadenopathy) appearing in 6 and heart valve infection. infiltrates, granuloma and stellate abscess percent of patients. The cutaneous lesions may take the form of formation. Warthin-Starry and ■■ Osteomyelitis (0.3 percent). globular red papules or purple nodules looking like the Brown-Hoppe gram-stains may find small ■■ Prolonged fever, joint pain, respiratory Kaposi lesions, suggesting the possibility of Kaposi gram-negative bacteria in regional lymph nodes symptoms and abdominal pain due to cancer and requiring biopsy to confirm diagnosis. or focalized inflammation processes from patients hepatitis (hepatic granuloma 0.3 percent). They may also appear subcutaneously, ulcerate with cat-scratch disease. ■■ Splenitis. and form an abscess. Lesions can be distributed Blood cultures have been used to isolate the If complicated by simultaneously occurring throughout the body, the central nervous system, bacteria from bacteremic cats. However, the immunosuppressive disease or immunosuppressive visceral organs, bone and bone marrow and the culture process may take as long as 40 days, treatment of organ recipients or radiation and intestinal tract with symptoms varying according to occasionally rendered useless by the presence cancer chemotherapy, the severity of the disease the underlying condition such as peliosis hepatis, of antibiotica in the sample being cultured. The will be greatly exacerbated. It will lead to systemic endocarditis and vegetative cardiac lesions. polymerase chain reaction (PCR) has amplified generalization, involvement of visceral organs and and identified bacterial DNA in skin lesions, in Morbidity and mortality central nervous system complications, convulsions lymph node biopsies, bacillary angiomatosis and Cat-scratch disease is self-limiting, even though and coma. in the oral cavity of cats. it may manifest occasionally a more profound Pathology and more painful symptomatology, and usually PCR amplification of Bartonella DNA is the test Infected cats are usually asymptomatic, will resolve itself within about two to five months of preference, and it can distinguish between although there may be the occasional evidence and leave no serious aftereffects. However, when different strains of Bartonella. The presence of of stomatitis. Rarely there are signs of uveitis the infected individual is immunosuppressed, Bartonella antigen can be determined utilizing and endocarditis. Even in the absence of overt either through genetic predisposition, disease or the enzyme immune assay (EIA) or enzyme- signs of the disease, there is a high incidence of medical manipulation (cancer treatment, organ linked immunosorbent assay (ELISA) and bacteremia and antibody to the infecting agent. transplantation), the situation may become much indirect fluorescent antibody (IFA). Aside from Bartonella is responsible for gingivitis, stomatitis, more serious, if not life-threatening. identifying the bacterium itself or its DNA, the oral ulcers, upper respiratory disease, rhinitis, presence of antibody to Bartonella henselae sinusitis, conjunctivitis, uveitis (inflammation of Diagnosis antigen is additional proof of its presence, as the uvea, the pigmented middle layer of the eye In cats, Bartonella henselae is usually long as you are aware that 11 percent of cats with consisting of the iris and ciliary body together asymptomatic. Fever of unknown origin and bacteremia do not have detectable antibody. with the choroid), chorioretinitis (inflammation suspected heart disease suggest bartonellosis. You In the past, delayed hypersensitive skin testing of the retina and choroid of the eye), corneal may find evidence of meningitis or encephalitis had been found useful in man: known antigen ulcers, keratitis, inflammatory bowel disease, as expressed by abnormal behavior, aggression, is placed on a fresh skin scratch, and if positive, diarrhea and vomiting, heart disease, lymphoid seizures, and myelopathy and neuropathy. there will be a measurable reaction within 48 hyperplasia, dermatitis and undefined . In man, historically, to diagnose cat-scratch hours (Arthus phenomenon similar to TB testing). In man, the classical picture near the site of a bite disease, there had to be at least three of four However, since this requires the introduction of or scratch shows local lesions, such as erythema, possible findings confirmed: the killed pathogen into the skin of the patient, minor swelling, bumps in the skin developing to 1. Cat bite or scratch. the off-chance of iatrogenic infection makes this red papules and local lymphadenopathy (lymph 2. Positive delayed hypersensitivity response an undesirable procedure. nodes swollen, tender to the touch and painful). (Arthus phenomenon) to Bartonella antigen In cats, which are poor delayed hypersensitivity Under the microscope, the local lesions comprise in the scarified skin. responders, this test has not been used. Antibody focal accumulation of immune cells, histiocytes, 3. Regional lymph nodes exhibiting assays employing ELISA (EIA) and IFA for multinucleated giant cells, lymphocytes and centralized necrotizing granulomas Bartonella have been employed with mixed results eosinophils surrounding centralized necrotized surrounded by multinucleated giant cells because of relatively low sensitivity for IgG areas and microabscesses with neutrophils. and lymphocytic infiltration. (about 50 percent). It was more promising when 4. Inexplicable lymphadenopathy. The lymph node swelling, result of a reactive measuring IgM, which showed a sensitivity of follicular hyperplasia, may exhibit centralized Today the skin test is no longer a regular diagnostic 90 percent and better. However, there was cross necrosis and suppurative granuloma. There may tool, with the opportunity of iatrogenic complications reactivity for non-Bartonella antigens: Epstein- be influenzalike symptoms: fever, headache and too great. There usually is a report of cat scratch Barr virus, cytomegalo virus, Toxoplasma gondii chills, which are overcome relatively quickly by or bite, erythema near the site of the lesion and and streptococcus pyogenes. The Western Blot the immunocompetent person. developing welts suggestive of the disease. is another antibody test that has been performed successfully, within the above parameters. Atypically, one in 10 times, the disease may Yet some 20 percent to 30 percent report no take other forms, especially when the patient is such incident or signs. There may be a single Diagnostic procedures: Biopsy samples of a immunocompromised: bacillary angiomatosis enlarged lymph node, fever and headache, or the swollen lymph node may show clusters of small and parenchymal bacillary peliosis can be found development of scattered granulomas that may gram-negative bacilli identifiable by the Warthin- relatively frequently, while it is hardly ever seen develop necrotic centers, eventually coalescing Starry silver stain, a silver nitrate-based staining in the immunocompetent individual. Bacillary and abscess forming. method used in histology, and the Brown-Hoppe gram-staining procedure. angiomatosis usually exists of lobular proliferation Seizures and altered consciousness, irritability, of capillaries with large endothelial cells, coma and stiff neck suggest the development of Bacteremia has been confirmed by isolating neutrophilic debris and clumps of bacteria. There cat-scratch disease encephalopathy. Cerebrospinal the bacteria in enrichment blood culture using Page 2 Elite Bartonella alpha growth medium Differential diagnosis In man, there is no treatment known to (BAPGM). Since bacteremia is not continuous, In the more advanced stage of the disease, specifically attack the disease or its causative several samples must be taken over time to lymphoma, neuroblastoma, carcinoma, mycobacterial agent. A cat scratch or bite wound should be bridge the occasional intermittent phase when the and fungal infection must be excluded. washed out immediately with lots of soap and hot organism is not circulating. PCR amplification of water. One is left with the generic treatment of bacteria circulating in the blood stream, though Geographic distribution the general symptoms: local inflammation with a somewhat faster test than the blood culture About one of five seemingly healthy cats in the anti-inflammatory medication, use of analgesics procedure, also requires multiple sampling for the United States is infected and likely to spread the and antipyretics, warm compresses applied to same reason. disease. Spread of the disease is more likely in hot the swollen and painful local lymph nodes. If and humid regions because that is when and where necessary to relieve pain, percutaneous needle Better diagnostic efficiency relied on enrichment fleas proliferate. Close to half the cat population aspiration on fluctuant lymph nodes and a five- culture followed by PCR testing of the product is infected in the southern states, compared to less day course of may be applicable. identifying nucleic acid sequences. Tests than a quarter in the more northern states. The to demonstrate the presence of Bartonella In the more severe cases, when the disease has incidence of cat-scratch disease reported annually antigen on biopsy samples, centrifugal or filter become systemic and in the immune-compromised ranges between 6,000 and 22,000 overall. concentrates, include the ELISA test, by which patient, chemotherapy must be considered. samples are flooded with specific antibody Arithromycin, azithromycin, cephalexin, The public health problem that had been labeled with an enzyme, such as , clarithromycin, , Bartonella organisms are found in the blood horseradish peroxidase, and rinsed to remove enrofloxacin, , gentamicin and of many animal species without producing a the unattached antibody from the test sample. rifampin (rifadin, rimactane), trimethoprim- noticeable disease. Bartonella henselae-infected The retained antibody, if any, is then allowed sulfamethoxazole, β-lactams and levofloxacin cats may be bacteremic, and indeed be infective to react with the enzyme substrate to visualize have been used as well. However, the evidence of for years and continue to be an ongoing source of the presence of antigen. This same test can be substantive effectiveness is still being questioned. the disease. Considering that rates of seropositivity modified by flooding the antigen test sample with vary from 3 to more than 60 percent in the general Antibiotica are reported to be quite effective a specific antibody, removing the unattached population of different countries, only few infected against Bartonella in vitro, while the in vivo antibody by washing it off the sample surface and individuals exhibited the actual symptoms of the responsiveness is questionable. It has been then identifying the retained antibody by specific disease (e.g. in the U.S., 3 percent would represent suggested that Bartonella may be hiding within enzyme-linked anti-gammaglobuline antibody. about 9,000,000 individuals, and only 22,000 are cells protecting it from antibiotica to a varying In essence, it sandwiches the primary antibody reported to have the disease). extent. On the other hand, that there may be a that identifies the antigen between antigen and different functional host response to the infection. Nearly 90 percent of those infected report a secondary indicator antibody. The effectiveness of antibiotica appears to be history of contact with cats, and 75 percent of The following antibody assay systems have better in the immunocompromised patient as them report scratches, bites or even licking by been used: compared to the immunocompetent host. cats. Reports of cat-scratch disease rise toward ■■ The ELISA test: Bartonella antigen attached to fall and early winter months: Kitten births are Thus the question arises: Does the cat-scratch a surface is exposed to the antibody test sample. prevalent in mid-summer, and the cat population disease symptomatology represent more the Antibody present in the test sample will adhere as well as flea infestation rise accordingly. In fall, body’s immune response to the infection rather to the antigen. After rinsing away all unattached cats are brought inside the house and, of course, than the bacterial damage per se? Accordingly, material, a secondary antibody, labeled with an children are the ones more likely infected. About the disease progression without evidence of enzyme, such as horse radish peroxidase, and 80 percent of the cases reported are in young immune responsiveness (absence of granuloma) specific for the primary or test antibody is added adults (less than 21 years old), and more males might be more responsive to the effects of and allowed to react. Enzyme substrate is then are infected than females by a 3:2 ratio. antibiotica. , amoxicillin and nafcillin added and if there is secondary, enzyme-labeled should not be used because Bartonella henselae Of the 22,000 cases of cat-scratch disease antibody retained in the sample, it will react and appears to be resistant to these drugs. In occurring in the U.S. each year, about 10 percent become visualized. immunocompromised individuals, bacteria may require hospital care with an average stay of ■■ The IFA test in which antigen or antibody enter the lymphatic system and the blood stream four days. The incidence of cat-scratch disease is can be identified by its reaction with specific and require extended hospital care. antibody, conjugated with fluorescein calculated to be about 9.3 per 10,000 ambulatory isothyanate and detected by means of a patients per year in the U.S. The question Prognosis and complications that is still lingering for scientists is what role fluorescence microscope. For example, Progress of the disease is usually uneventful does Bartonella play in the large number of antigen adhering to cells or tissue sections and mild, and recovery in both adult and child undiagnosed fevers in HIV-infected individuals? can be flushed with specific antibody that had is likely without treatment. Complications in the been labeled with the fluorochrome, rinsed immunocompetent person are rare. They may Treatment free from all unattached antibody and then appear as encephalitis, meningitis, inflammation The treatment of cats should be essentially examined under the fluorescence microscope of the spinal cord, osteomyelitis, granulomata symptomatic because the disease usually will to verify the presence of antibody remaining in the various visceral organs, disseminated resolve itself spontaneously within two to four attached to the antigen. Alternatively, anti- infection, seizures and coma. gamma globulin antibody specific for the months (unless, of course, it becomes necessary specific antibody donor animal can employed to protect immunocompromised individuals However, in the immunosuppressed patient they are to check the retention of the specific antibody. living in the household). A three-week course of much more frequent and considerably more severe. ■■ In the Western Blot test, the sample treatment with azithromycin seems to be effective Treatment with , such as azithromycin, proteins are isolated according to size by gel in only about four of five infected cats, and no is often necessary and usually will lead to full electrophoresis, transferred to nitrocellulose drug combination has been shown to reliably recovery. Unanticipated complications are the co- paper or similar, and then reacted with eliminate the contagion. existence and resurgence of other chronic diseases. enzyme-labeled specific antibody. If this It is therefore essential that all household cats be Preventive measures antibody is retained by the antigen, its monitored regularly, and that strict flea and tick Avoid cats. Do not tease or provoke them. Do not presence can be detected by its reaction control be applied. The simultaneous presence pick up stray cats, and make sure shelter cats or cats with the enzyme substrate and colorize the of feline immunodeficiency virus would require from a multi-cat household are carefully screened location of the antigen. more stringent measures. Elite Page 3 before they enter your home; preferably, they should be at least a year old and appear healthy. There is no benefit from blood culture or serology testing before acquiring a cat, and there is no need for preventive chemotherapy when scratched or bitten by a cat. Because antimicrobial therapy has only questionable effect on bacteremia in the cat, it makes little sense to do it. Wash out a scratch or bite wound with ample hot water and soap. Keep house cats inside the house as much as possible. Regular and carefully monitored flea and tick control should be enforced to minimize the cat-to-cat transfer of Bartonella and prevent bartonellosis in man. On the other hand, cat-scratch disease has also occurred without a bite or scratch, and may have been picked up by handling the cat. Keeping away from cats or thorough hand washing after handling a cat is recommended, especially for the immunocompromised person. Blood donor cats, of course, must be screened and monitored regularly and held in a flea- and Life cycle, zoonotic transmission and human disease tick-free environment. There is no vaccination The only known definitive hosts for Toxoplasma gondii are members of family Felidae (domestic cats and available, and because as many as six different their relatives). Unsporulated oocysts are shed in the cat’s feces . Although oocysts are usually only strains of Bartonella have been found to live in shed for 1-2 weeks, large numbers may be shed. Oocysts take 1-5 days to sporulate in the environment and one cat, cross protection between members of the become infective. Intermediate hosts in nature (including birds and rodents) become infected after ingesting Bartonella family appears not an option. soil, water or plant material contaminated with oocysts . Oocysts transform into tachyzoites shortly after Educating and counseling pet owners ingestion. These tachyzoites localize in neural and muscle tissue and develop into tissue cyst bradyzoites . Cats become infected after consuming intermediate hosts harboring tissue cysts . Cats may also Pet owner education regarding intestinal parasites become infected directly by ingestion of sporulated oocysts. Animals bred for human consumption and their effects on the health of both their pets and wild game may also become infected with tissue cysts after ingestion of sporulated oocysts in the and family members should be included in a well-pet exam. Pet owner education should focus environment . Humans can become infected by any of several routes: on prevention and include the following: ■■ Eating undercooked meat of animals harboring tissue cysts . ■■ Description of parasites that infect pets, early ■■ Consuming food or water contaminated with cat feces or by contaminated environmental samples signs of illness, and when pets are at greatest (such as fecal-contaminated soil or changing the litter box of a pet cat) . risk for infection (in utero and when nursing). ■■ Blood transfusion or organ transplantation . ■■ Understanding the need for regular flea and ■■ Transplacentally from mother to fetus . tick control and monitoring. In the human host, the parasites form tissue cysts, most commonly in skeletal muscle, myocardium, brain ■■ How they cause disease in humans, especially and eyes; these cysts may remain throughout the life of the host. Diagnosis is usually achieved by serology, in children whose play habits and attraction although tissue cysts may be observed in stained biopsy specimens . Diagnosis of congenital infections to pets put them at increased risk. can be achieved by detecting T. gondii DNA in amniotic fluid using molecular methods such as PCR . ■■ How prophylactic treatment of pregnant and nursing pets and their offspring can protect their pets from becoming infected, thus epithelium producing oocysts that are passed Transmission preventing them from shedding eggs into and with the feces and become infective within a day Felids can acquire the disease: contaminating the environment. or two. (Oocysts are thick-walled structures in 1. Through the ingestion of oocysts from ■■ The need for regular diagnostic examinations of which sporozoan zygotes develop and that serves contaminated cat feces and water. kittens or prophylactic treatment of older pets. to transfer them to new hosts.) 2. By catching and consuming infected rodents Part II: Toxoplasma gondii and birds. There are three forms of Toxoplasma gondii: Toxoplasma gondii, one of the world’s most 3. By vertical transmission through the placenta. ■■ Oocysts, about 10 μm -12 µm in diameter. common parasites, grows intracellularly in 4. From tachyzoites sometimes found in feces, ■■ Tachyzoites, 2 μm x 6 μm, a stage in the domestic cats and in wild felines, its primary vomitus, urine, ulcer exudates and saliva . development of the tissue phase of certain and only definitive host, and will spread to 5. By transplantation of tissue cyst containing coccidial infections, rapidly and actively intermediate hosts such as warm-blooded organs, an operation more likely to happen growing, multiplying and circulating in the vertebrates, including birds and man. Even in man. blood stream. sea otters have been found to be infected with ■■ Bradyzoites, 7 μm x 1.5 μm, a slowly Toxoplasma gondii is transmitted usually from Toxoplasma gondii. Worldwide, 2-4 billion multiplying form enclosed and protected the feces of cats and wild felines containing people are thought to be toxoplasma infected. within tissue cysts, unaffected by the Toxoplasma oocysts. Only felines produce chemotherapy, responsible for maintaining oocysts, which are products of the parasite’s The parasite immunity and protecting the host from active sexual reproductive cycle. Although infected cats Toxoplasma gondii is a coccidian protozoa, re-infection over the long term. shed oocysts only for about three weeks, they suborder eimeriina, which uses the cat and other may have millions of oocysts in one stool. felines as its natural host. It replicates asexually Bradyzoites are the source of infection for and sexually in the cells of the cat’s intestinal omnivores and carnivores. Page 4 Elite After the oocysts sporulate, they are available to micro- and macrogametocytes respectively, As the body goes through this process, it will infect any warm-blooded host, including man, represent the male (microgametocyte) and produce an immune response that will limit birds and rodents. female (macrogametocyte) part of the sexual the acute stage of the disease, shorten parasite Sporulated oocysts are very resistant to process. After the male has fertilized the female progression, establish a chronic infection and environmental influences: they have been shown gametocyte, a wall is formed around the fertilized provide enhanced resistance to future Toxoplasma to survive in soil for 18 months, in 4-degree C macrogamont producing the oocyst, which is infections. Immunocompromised individuals, seawater for two years, and in room temperature then, in its unsporulated form, shed from the following immunosuppressive therapy to support water for at least one year and six months. intestinal epithelium and excreted. Depending organ transplantation, hypogammaglobulinemia, Contaminated sources of water, soil, fresh, on oxygen tension, moisture and temperature or any kind of immunosuppressive disease (HIV/ unwashed and uncooked fruits and vegetables can in the environment, the oocysts, containing AIDS), however, may still succumb to a new carry oocysts. Oocysts have been transferred by two sporocysts each, will sporulate, i.e., each infection or allow the resurgence of an old one. sporocyst produces four sporozoites, and becomes cockroaches and flies from contaminated cat feces During the parasitemic phase in the pregnant infective within about one to five days. This entire to food and kitchen utensils and cutting boards. woman, in utero transmission can occur. The risk of process may last from three to 15 days. Other known phoretic hosts are mussels and the in utero infection rises from the first three months eastern oyster, which picks up sporulated oocysts The extra-intestinal, asexual pathway of of pregnancy to the last three months. Congenital from seawater and keeps them alive and infective replication takes place in cats as well as transmission of Toxoplasma gondii can result for more than 85 days. Earthworms have been non-feline warm-blooded vertebrates, either in considerable morbidity and mortality for the shown to carry them as well. Yard work and following direct or indirect contact with oocyst- newborn. The earlier the infection occurs during playing in soil and sand boxes frequented by non- contaminated fecal matter, water or after the course of pregnancy, the greater the congenital domesticated cats carries the risk of Toxoplasma ingesting raw or undercooked meat. damage. The worldwide incidence of vertically gondii transmission. After sporulated oocysts are consumed, they transmitted Toxoplasma gondii in live birth is close to 1 percent. While women with antibody appear The consumption of undercooked meat with enter the intestinal tract, disencapsulate, invade intestinal cells and start to replicate and produce to be safe, there have been occasional reports of tissue cysts containing bradyzoites is another congenital transmission, possibly due to inadequate source of the disease. This is probably the main tachyzoites. Tachyzoites will migrate throughout all parts of the body, the central nervous system, levels of antibody or the inability to form a source of infection for domesticated and wild satisfactory immune response. cats hunting for infected rodents. Farm animals muscle tissue and the visceral organs, replicating feeding on sporozoite contaminated grain or hay continuously, destroying every cell they occupy Chronically infected women have been known may produce tissue cysts and the opportunity for and producing a considerable amount of focalized to transmit Toxoplasma to the fetus. There is transmission with raw or under-cooked meats. necrosis and tissue damage. This phase essentially evidence that an old Toxoplasma infection in Infective tachyzoites have been found in the represents the acute phase of the disease. a woman with Toxoplasma antibody can still tissues and milk of acutely infected animals After about three weeks, with host immunity permit the infection of a newborn with all signs and in the eggs of infected poultry. However, developing, they will enter a cell to sequester of toxoplasmosis: Toxoplasma scars on the retina, tachyzoites, not having a protective shell, are and produce a tissue cyst, a meront. This calcified granuloma in the brain, Toxoplasma easily destroyed by heat or chemicals. meront, encapsulated by a well-defined host antibody. Reactivation of a previous, latent cell membrane and producing bradyzoites, can infections, such as the release of bradyzoites from Pathogenesis be found most everywhere in the body: in the their tissue capsule is a possible cause for this Domestic and non-domestic cats, which are brain, skeletal muscle, the heart and visceral event. A high percentage of infected newborns essentially carnivorous, acquire Toxoplasma organs. Bradyzoites will multiply repeatedly by will show catastrophic damage to the eye and the gondii by catching and consuming infected endodyogeny, i.e. asexual replication. central nervous system. In newborns with little rodents and birds. There are two pathways by or no evidence of infection at the time of birth, Tissue cysts containing bradyzoites may remain which Toxoplasma gondii replicates itself: The damage to the central nervous system may show protected from outside influences, including the intra-intestinal or entero-epithelial one, which is up much later. Newborn sheep, goats and cats with chemotherapeutics employed to treat the disease. sexual and only happens in its definitive natural Toxoplasma caused damages of similar nature They remain infective for years, if not for the life host, the felid, and the extra-intestinal pathway and provide evidence of their susceptibility to of the host, before they end up in raw hamburger or that is asexual and takes place in both the natural transplacental transmission of the parasite. as prey for carnivorous hunting animals or birds of as well as all the intermediate hosts. prey. Their presence also serves to immunize and Pathology The intra-intestinal pathway begins by protect their host from re-infection in the long term. While clinical symptoms are most severe in ingesting tissue cysts and digesting the cyst wall, In man, the most frequent source of infection newborn kittens, obviously in utero infected, they which encapsulates the bradyzoites in the gastric from tissue cysts are undercooked meats from may arrive stillborn or die soon thereafter. They juices of stomach and the intestine. After the sheep, goat, pig, and kangaroo and less so from may show signs of hepatitis, and bradyzoites are released, they start migrating and beef or poultry. inflammation of the central nervous system. Their invade the epithelial wall of the small intestine, abdomen may be enlarged due to hepatomegaly passing through five different stages or types The infection with bradyzoites, bypassing and ascites. Otherwise, Toxoplasma gondii of schizonts: Type A schizont through Type E the initial unsheathing of sporozoites and infections may be asymptomatic, except for schizont. They may stay at one level through the tachyzoite development phase, allows some fever and swollen lymph nodes, quickly several replicative cycles before going on to the immediate entry into the epithelial cells of the overcome in a month or two. next one. Inside their host cells they multiply small intestine and the rapid development of Others show cutaneous lesions, produced by by endodygeny and endopolygeny by which numerous tachyzoites within less than eight hours. tachyzoites: reddening of the skin and skin rash, the nucleus may divide several times before After three to six days of continued growth and prurigo, urticaria and maculopapular lesions. the cytoplasma does, completely destroying the replication, tachyzoites enter the blood stream and occupied cell. The end product of this asexual are disseminated throughout the body, producing There are a few individuals showing severe phase of reproduction are Type E Merozoites, 50- tissue damage and, sometimes, open disease. symptoms: encephalitis, hepatitis, myositis, 80 of which may appear tightly packed together, After two to three weeks, they will become pneumonia, blurred vision. There have been detaching from their mother schizont. encapsulated inside their host cell or produce suggestions of a possible connection with changes in behavior, depression, anxiety and They will lead to the sexual phase of reproduction: another meront and restart the cycle as bradyzoites. schizophrenia. The infecting organism, either the Microgamonts and macrogamonts, which produce Elite Page 5 bradyzoite, from a tissue cyst, or the sporozoite, myositis, encephalitis, hepatitis, uveitis, iritis, the finding of IgM suggests an early response to from the fecal matter of a feline, is ingested, retinitis, chorioretinitis and other damage to active infection, especially when it is accompanied enters enterocytes and multiplies in the lamina the eye may direct your diagnosis. There may with a concomitant fourfold rise of IgG over a propria and the epithelium of the intestinal tract be vomiting, diarrhea, occasional lameness and period of two to four weeks. goes on to produce tachyzoites which will rapidly signs of neurological disease. When concomitant The presence of toxoplasma antigen is more multiply through numerous replication cycles with other diseases, especially diseases that definitive. Using the enzyme-linked immune (tachy ≡ quick, fast) and within hours tachyzoites suppress the immune system, toxoplasmosis can sorbent assay (ELISA), toxoplasma antigen can appear in the blood and lymphatic system and be severely exacerbated and lead to quick death. be detected in the amniotic fluid, cerebrospinal proceed to be distributed throughout the body. Dogs are less frequently infected and seem to be fluid and in the aqueous humor of cats with uveitis. They are found in the cell population of peritoneal much more resistant to the disease unless they are Vertical transmission is known and the results are exudates, within the cells of the central nervous immunocompromised or weakened by some other often severe: stillborn or death before weaning. system, the skeletal muscles, liver, lung, kidneys, disease. Look for signs reflecting affectation of The disease is more common in sheep and goats, pancreas, the adrenals and the eye, producing muscles and the central nervous system: cranial usually affecting the reproductive process leading localized cell destruction everywhere in the body. nerve deficit, seizures, ataxia, stiffness of gait and to abortion and weak newborns. After about three weeks, along with the host’s lameness, paresis. In man, the majority of infected individuals show development of immunity, they encapsulate Blood work, including blood chemistry and no symptoms at all, and their robust immune system and commence the asexual replication of white blood cell counts, help round out the will keep the disease at bay and protect them bradyzoites in a pseudo tissue cyst (meront). disease picture: increases in white blood cells are from re-infection. Only one or two of 10 infected This encapsulation process may start somewhat suggestive of systemic infection, general tissue individuals show some influenzalike evidence later in the central nervous system, in which damage and localized necrosis in the various of disease: headache, fever, body aches, swollen the immune process is less effective than in the visceral organs, the central nervous system, lymph nodes, sore throat, fatigue, blurred vision. visceral organs and muscle tissue. skeletal muscle and red blood cells. In more severe cases, symptoms include myalgia, Tachyzoites have been found in chicken eggs and Raised levels of serum alanine aminotransferase arthralgia, generalized lymphadenopathy, in the milk of sheep, goats and cows. Fortunately, (ALT), aspartate aminotransferase (AST), serum headache, hepatosplenomegaly, pneumonia, tachyzoites are easily killed by cooking, alkaline phosphatase (ALP), serum creatine confusion, poor coordination, seizures, pasteurization, peptic enzymes and gastric kinase and serum bilirubin are usually result neurological disorders (chorioretinitis, Guillain- digestion. Infections caused by oocysts are usually of necrotic damage to liver and musculature. Barre syndrome). Immunosuppressed individuals more severe than those caused by an infected cyst. Pancreatitis will result in increased levels of and HIV/AIDS infected individuals often serum amylase and lipase activities as well as Once in the blood stream, vertical transmission develop the more severe symptoms, including proteinuria and bilirubinuria. through the placenta presents one of the most encephalitis, leading to death in 10-30 percent. serious aspects of toxoplasmosis. Thirty With lung involvement, thoracic radiography The infection with Toxoplasma gondii can percent of pregnant women infected by may show evidence of alveolar coalescence and be recognized by changes in cell count in Toxoplasma will pass it on, producing severe increased opacity in the lungs. Radiography of the cerebrospinal fluid and protein level and damage to the fetus and newborn. Congenital abdomen can point to pancreatitis and increased confirmed by the finding of rising toxoplasma toxoplasmosis may cause jaundice, intellectual density of intestines and their lymph nodes. antibody levels. Blood cell profiles and blood impairment, retinochoroidal lesions and recurrent Confirmation of toxoplasmosis, however, can chemistry are suggestive for tissue inflammation retinal disease, seizures, motor difficulties, only occur by: and damage, but are not very conclusive. microcephalus, hydrocephalus, severe eye ■■ Direct isolation of the organism. Occasionally you can find the organism in infections and hearing loss. ■■ Demonstration of the toxoplasma DNA. cerebrospinal fluid, in biopsies, in lymph nodes About one third of children surviving the ■■ Presence of oxoplasma antigen. and in the lesions of cutaneous toxoplasmosis congenital infection may show ocular ■■ The host’s antibody response to that antigen. (skin lesions, pustulas, echymoses), in amniotic toxoplasmosis. Only a small number of Direct isolation of the organism itself is not a fluid, and in the aqueous humor of the eyes from newborns show signs of the disease. Evidence very promising undertaking: cats are shedding cats with ocular toxoplasmosis. of neurological symptoms at the time of birth oocysts only for about three weeks, and they do In the absence of measurable expressions of the suggests the early development of complications. not appear to be very sick during that period, disease, the presence of specific antibody and/or Many newborns, however, do not show any unless they are affected by immunosuppressive toxoplasma antigen and DNA will aid diagnosis. signs of the disease and will develop mental treatment or some immunosuppressive Confirmation of in utero infections requires the retardation, loss of vision and hearing loss later disease, such as feline immunodeficiency demonstration of tachyzoites microscopically in life, when they reach their teens. In utero virus. On occasions, tachyzoites can be found in the amniotic fluid and/or the presence of transmissions of Toxoplasma gondii have been in cerebrospinal and amniotic fluid and in toxoplasma antigen by means of PCR. If positive, reported as well for dogs, cats, sheep and goats. peritoneal, pleural and thoracic effluents (ascites). these results should be followed by appropriate Inadvertent transplantation via blood transfusion ultrasonographic procedures to check for or an organ transplant is a possibility. The presence of toxoplasma DNA can be determined by PCR (polymerase chain reaction). congenital damage to the fetus. Diagnosis Various serological tests are available to detect Immunofluorescent antibody assays (IFA), In the cat stillbirth, weak debilitated newborns, and measure toxoplasma antibody and antigen: enzyme immune assays (EIA) also called jaundiced appearance, enlarged abdomen, hemagglutination (both direct and indirect), latex enzyme-linked immune sorbent assays (ELISA) continuous sleeping or crying of the newborn agglutination, modified agglutination, enzyme- can be used to measure the presence of antigen suggest congenital toxoplasmosis. As a rule, linked immune sorbent assay and indirect as well as IgG and IgM. Differential assays of toxoplasma infected cats show little evidence fluorescent antibody test. IgG and IgM allow you to distinguish between of disease, fever or swollen lymph nodes. There The presence of antibody in cats is not a reliable an acute infection and an old or chronic one. The may be no sign of the disease and there may be diagnostic indicator for the disease; IgG especially presence of IgM, a primary immune response sudden death in cats. only confirms a history of past toxoplasmosis. IgG gammaglobulin and a rise in titers of IgG over two to three weeks suggest a new infection, while In more severe cases fever, lymphadenopathy, usually remains detectable for years after infection, absence of IgM and level titers of IgG indicate a lethargy and loss of appetite, suggestions of reflecting the immune status of the animal and protection from re-infection. On the other hand, chronic infection. Page 6 Elite Similarly, differential agglutination of tachyzoites tachyzoites as indicator for the presence of The public health problem fixed by aceton versus those fixed by formalin tachyzoite killing antibody, is very sensitive and Home gardeners, children playing in sand boxes made it possible to distinguish agglutinating highly specific. Live tachyzoites take up alkaline frequented by domestic and feral cats, poor antibody from recent, acute infection which was methylene blue. Antibody in the presence of sanitation in underdeveloped areas and countries, binding aceton fixed tachyzoites from antibody complement will kill tachyzoites and keep them careless hygiene, cockroaches, flies and earthworms coming from more distant, chronic infections. from taking up the dye. carrying oocysts contribute to the vast distribution Since the presence of toxoplasma antigen is of the toxoplasmosis causing parasite. Moreover, Geographic distribution prerequisite for the development of antibody, sporulated oocysts are not easily affected by Worldwide incidence in humans varies greatly, its measurement is another diagnostic means. disinfection, freezing and drying. essentially based on route of transmission and Damaged tissue cells containing the antigen Adult dogs or cats may be asymptomatic or cultural demographics, such as personal hygiene, will show up by their reaction with specific mildly affected, fever, depression, loss of eating habits and the prevalence of potential immunoglobulins, while the presence of appetite, while the very young may be more carriers. This variation is thought to range from toxoplasma DNA can be determined utilizing severely affected and die in utero or early in life. 30 percent to 65 percent or more, and some say the highly specific polymerase chain reaction. Infected cats will shed oocysts and assure the as many as 4 billion people may be affected In more severe encephalitic cases, it may be spreading to other mammals. worldwide. While there are about 15,000 cases necessary for magnetic resonance imaging reported every year in the United States, there Tachyzoites can also be found in cat feces, urine, (MRI) and a brain biopsy to confirm the may be as many as 225,000 actual cases. ulcer exudates and vomit. diagnosis of toxoplasmosis. The mild, often asymptomatic infection leads Human toxoplasmosis can be congenital, with Diagnostic procedures to considerable underreporting of the extent newborns showing encephalitis, chorioretinitis and Fecal matter can be checked for oocysts. Unless of toxoplasmosis. Therefore, the presence of blindness, rash, liver enlargement and jaundice this is done within the first three weeks of toxoplasma antibody is a more meaningful It can be acquired as well: Individuals eating infection, there is little chance of finding any. indicator of past or present toxoplasma undercooked meats may pick up bradyzoites from Affected tissue of the central nervous system experiences. Immunocompromised individuals the tissue cysts present in infected animals. and lymph nodes as well as visceral effusions, and individuals under immunosuppressive Symptoms can be mild: malaise, headache, amniotic and cerebrospinal fluid, pleural lavage, therapy are more likely to exhibit symptoms of fever, sore throat, influenzalike, occasionally vitreous and aqueous humor of the affected eye the disease. lymphadenopathy similar to mononucleosis, and urine can be examined microscopically About one third of domesticated and wild felines, chorioretinitis that may lead to blindness, for trachyzoites, usually after concentration by including zoo animals, carry Toxoplasma gondii. occasionally seizures, and rarely, skin lesions. centrifugation or filtration. Simple cell staining For a short time (two to three weeks or so), they In the pregnant woman, however, toxoplasmosis (Wright-Giemsa) with immunoperoxidase or produce hundreds of thousands of oocysts per will severely damage if not kill the fetus in about immunofluorescence have been used effectively. gram of feces, and millions during their lives. 30 percent of infected mothers. The incidence of The PCR test has become a standard procedure to Oocysts are highly resistant to environmental congenital infection among United States women identify toxoplasma DNA in those same effluents. stress of temperature, disinfectants and drying is about 0.1 percent to 0.01 percent; in Europe With the immunofluorescent assay (IFA), it is and continue to remain a major cause of it has been found to be more than two times as possible to identify antigen by its reaction with toxoplasmosis around the world. high. In individuals with AIDS or otherwise specific antibody that has been conjugated with an immunoflourescent dye, such as fluorescent Table 1. Drugs for the treatment of Toxoplasma gondii infections in dogs and cats: isothiocyanate. This test can be modified by using Formulary Route / Frequency Dosage Species anti-gammaglobuline antibody that has been 50 mg PYR similarly labeled and locating specific antibody Pyrimethamine/sulfadiazine Per os / daily Man tied to its antigen. 4 g SUL Enzyme immune assays (EIA) or enzyme- Spiramycin p.o. / twice a day 25 mg/kg Man, Cat linked immune-sorbent assay (ELISA) involves Clindamycin p.o. / twice a day 25 mg/kg Cat toxoplasma-specific antibody attached to a Clindamycin p.o. / twice a day 5-10 mg/kg Dog surface exposed to and incubated with the test Monensin p.o. in dry cat food 0.02% solution Cat antigen sample. If antigen is present, it will attach to the antibody and remain behind after rinsing Toltrazuril p.o. in drinking water 2.5 mg/l Chicken, Turkeys away excess sample. More toxoplasma-specific Toltrazuril p.o. 200 ml 5% Horse antibody, this time labeled with an enzyme such Toltrazuril p.o. / Twice a day 5-10 mg/kg Cat, Dog as horseradish peroxidase, is added to the test to attach to the antigen held back by the initial layer Sulfadiazine p.o. / 4 times/day 60-120 mg/kg Man of antibody, essentially forming a sandwich. After Pyrimethamine p.o. / daily 1 mg/kg Man, Cat rinsing off excess material the indicator substrate Minocycline p.o. / twice a day 100 mg Man is added to visualize the enzyme retained. Atovaquone p.o. / 2-4x a day 750 mg Man Vice versa: Toxoplasma antigen can be labeled Trimethoprim- 80-160 mg/kg TRI with the horseradish peroxidase and used to detect p.o. / 2x a day Man antibody. The latex agglutination test consists of sulfamethoxazole 400-800 mg/kg SUL toxoplasma antigen coated polystyrene particles Azithromycine p.o. / 1x a day 1000 mg/kg Man that will be agglutinated by antibody. Considerations when using above drugs: All the medications here listed have similar side effects: Another way to titrate antibody levels is the loss of appetite, gastric upset, nausea, diarrhea, stomach pains, vomiting, dizziness, drowsiness and hemagglutination test, carried out with tanned red headache. Some produce increased sensitivity to sun light. Since pyrimethamine may prevent the blood cells sensitized with toxoplasma antigen. body from absorbing folic acid (Vitamin B-9), additional folic acid, perhaps in the form of baker’s Finally, the Sabin-Feldman dye test, not yeast, should be considered. Spiramycin should be used for the toxoplasma-infected pregnant woman much used in the field because it requires live to protect the baby. Clindamycin is especially effective in the central nervous system because it can cross the blood-to-brain barrier of the toxoplasma-infected host animal. Elite Page 7 immunocompromised individuals, it can lead to hygiene, eliminating intestinal parasites from pets References and suggested reading encephalitis and death. through early and frequent treatment and making Bartinellosis: Cat-scratch disease potentially contaminated environments, such as 1. Allerberger F, Schönbauer M, Zangerle R, Dierich. Rochalimaea henselae among Austrian cats. Eur J Pediatr Treatment of toxoplasmosis unprotected sand boxes, off limits to children. 1995;154:165. Since the disease is relatively mild and readily 2. Anderson B, Sims K, Regnery R, Robinson L, Schmidt MJ, In this context, preventive measures for dealt with by the host’s immune system, only Goral S, Hager C, Edwards K. Detection of Rochalimaea toxoplasmosis are similar to those for ascarids henselae DNA in specimens from cat-scratch disease immunocompromised individuals and individuals and hookworms and will be reiterated together. patients by PCR. J Clin Microbiol 1994; 32:942-948. with more severe and persistent symptoms should 3. Arlet G, Perol-Vauchez Y . “The current status of cat- receive treatment. The drugs here mentioned It is obvious that pet owners should clean up pet scratch disease: an update”. Comp. Immunol. Microbiol. Infect. Dis. 1991; 14 (3): 223–228. will suppress Toxoplasma gondii but they will feces on a regular basis to remove potentially 4. Bass JW, Vincent JM, Person DA. The expanding spectrum not completely eliminate it. In particular, once infective eggs and oocysts before they become of Bartonella infection. II. Cat-scratch disease. Pediatr bradyzoites are encapsulated within their tissue cyst, disseminated in the environment. Hookworm eggs Infect Dis J 1997; 16:163-179. 5. Bass JW, Freitas BC, Freitas AD, et al. Prospective they are protected from the effect of the drug. The can develop into infective stage larvae in the soil randomized double blind placebo-controlled evaluation of same holds true for oocysts prior to sporulation. in as little as five days, and ascarid eggs within two azithromycin for treatment of cat-scratch disease. Pediatr weeks, depending on temperature and humidity. To Infect Dis J 1998;17:447-452. It takes about one to two days for clinical 6. Ben-Ami R, Ephros M, Avidor B, et al. Cat-scratch disease illustrate the extent of environmental contamination symptoms to begin to subside after treatment, in elderly patients. Clin Infect Dis 2005; 41(7):969-974. that can occur as the result of one infected puppy, 7. Billeter SA, Levy MG, Chomel BB, et al. Vector transmission although it may take weeks for some of CNS a single female ascarid can produce more than of Bartonella species with emphasis on the potential for tick symptoms to be resolved. Cats having concomitant transmission. Med Vet Entomol 2008; 22(1):1-15. 100,000 eggs per day, resulting in millions of complicating diseases, such as feline immune 8. Bonilla DL, Kabeya H, Henn J, et al. Bartonella quintana potentially infective ascarid eggs per day spread in body lice and head lice from homeless persons, San deficiency virus, will take longer to recover. throughout the area the puppy is allowed to roam. Francisco, California, USA. Emerg Infect Dis 2009; 15(6): 912-915. Preventive measures Once the eggs become infective, they can remain 9. Boulouis HJ, Chang CC, Henn JB, et al. Factors associated infective in the environment for years. with the rapid emergence of zoonotic Bartonella infections. Do not adopt stray cats. Outdoor cats start Vet Res 2006; 36(3):383-410. hunting soon after they are weaned and will By comparison, toxoplasma oocysts are only 10. Breitschwerdt EB, Maggi RG, Nicholson WL, et al. Bartonella shed early in the infection process and only for sp. bacteremia in patients with neurological and neurocognitive become infected soon thereafter. For disinfecting dysfunction. J Clin Microbiol 2008;46(9):2856-2861. purposes and to kill tachyzoites and bradyzoites two to three weeks, shedding however, as many 11. Breitschwerdt EB, Maggi RG, Sigmon B, et al. Isolation of on litter boxes and kitchen utensils, the water as 100,000 oocysts per gram of feces, which are Bartonella quintana from a woman and a cat following putative relatively hardy, surviving infective for months if bite transmission. J Clin Microbiol 2007; 45(1):270-272. should be more than 70 degrees C. 12. 12.Breitschwerdt EB, Maggi RG, Duncan AW, et al. not years. Most pet owners do not know that their Careful personal hygiene mandates hand washing Bartonella species in blood of immunocompetent persons pets may carry parasites capable of infecting people. with animal and arthropod contact. Emerg Infect Dis after handling uncooked meats, washing of Therefore, practicing veterinarians can provide an 2007;13(6):938-941. cutting boards and utensils, hand washing after 13. Breitschwerdt EB, Kordick DL: Bartonella infection in important public service by recommending regular the handling of cats and the daily removal of animals: carriership, reservoir potential, pathogenicity, and fecal examinations, providing frequent treatments, zoonotic potential for human infection. Clin Microbiol Rev cat litter. Remember that oocysts remain non- counseling clients on potential public health hazards 2000; 13: 428–438. infective for the first day or so after being shed. 14. Breitschwerdt EB, Maggi RG, Chomel BB, et al. and advising them on any precautionary measures Keep cats from eating uncooked meats, bones, Bartonellosis: an emerging infectious disease of zoonotic that may be undertaken. Veterinarians are in an ideal importance to animals and human beings. J Vet Emerg Crit viscera and offal and stay with dry or canned Care 2010; 20(1):8-30. position to provide pet owners with this service foods. Earthworms, cockroaches and flies have 15. Breitschwerdt EB, Maggi RG, Varanat M, et al. Isolation because of their access to the pet-owning public, of Bartonella vinsonii subsp. berkhoffii genotype II from been known to transport oocysts. their knowledge and training and their role in the a boy with epithelioid hemangioendothelioma and a dog with hemangiopericytoma. J Clin Microbiol 2009; Wash fresh fruit and vegetables before eating, human-animal bond. 47(6):1957-1960. do not drink unpasteurized milk and make sure 16. Breitschwerdt EB, RG. 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