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Home , Campylobacteriosis

Zoonosis Zoonoses: What can we get from our pets?  Infectious disease that occurs principally in animals but which may spread to  , viruses, fungi, protozoans, helminths

Toxocariasis (Visceral and Ocular Case 1 Larva Migrans)

 A 5yr.old autistic male, was brought to the ER due to seizures. On auscultation, you  Develops when ingest the eggs of canine ascarid Toxocara canis or, less commonly, the hear crackles and wheezing and physical feline ascarid Toxocara cati examination revealed hepatomegaly.  Almost all puppies are naturally infected with  CBC revealed leukocytosis (14.2/cu mm T.canis with 20 % eosinophils). The caregiver tells  Infected animals shed millions of eggs per day you that the patient is fond of playing in that can survive for months in the soil the garden with soil where their pet dog runs and plays. Toxocariasis: Epidemiology Toxocariasis: Pathogenesis

Larva hatches in  Small children are Eggs in feces Ingested in GIT especially prone to GIT acquire VLM  from intimate contact circulation with a family pet  from contaminated sandboxes or playgrounds Larva migrates in liver, lung, brain,  (+) history of other organs geophagia (pica)  exposure to puppies

Toxocariasis: Clinical Manifestations Toxocariasis: Clinical Manifestations (VLM) (VLM)

 Classic description involves a child  Larvae migrating during a primary (usually between 1 -5 yrs.old) who may be better able to damage has: host viscera without being impeded by the  host inflammatory response  Leukocytosis  therefore, more likely to reach the CNS  Eosinophilia  Children with CNS involvement: frequently  Hepatomegaly have either neuropsychiatric disturbances  Pneumonitis with wheezing and or seizures hypergammaglobulinemia Toxocariasis: Clinical Manifestations Toxocariasis: Diagnosis (Ocular Larva Migrans - OLM)

 Typically occurs in older children  VLM: usually established by clinical symptoms  Often do not have eosinophilia or elevated  EIA measures serum antibody against antigens from antibody titers T.canis  High degree of sensitivity (78%) and specificity  Larvae probably enter the anterior (92%) at a titer > 1:32 vitreous of the eye from the peripheral  OLM: diagnosed on fundoscopy by characteristic branch of the retinal artery migratory tracts and granulomata on the retina;  Common features: Unilateral vision loss larvae occasionally seen and strabismus, diffuse endophthalmitis

Toxocariasis: Treatment Toxocariasis

 VLM: usually self -  OLM: antihelminthic +  Prognosis: excellent limiting corticosteroid therapy in children  Anthelminthic of  albendazole, choice: albendazole mebendazole,  Prevention: control (10 mg/kg/day in 2 thiabendazole, and anthelminthic levamisole , and divided doses x 5 levamisole , and treatment of animal days) ivermectin reservoirs; elimination  With surgery when  For severe symptoms, appropriate (e.g., of dog feces from or for CNS and eye appropriate (e.g., involvement: vitrectomy, membrane environment peeling) add corticosteroids Other Major Helminthic Zoonotic Case 2 Disease Causative Common Modes of agent Animal Reservoir  A 12 yr.old female was brought to your Cutaneous larva Ancylostoma Cats, dogs Direct contact migrans braziliense, A. clinic with complaints of fever for 5 days, caninum associated with arthralgia, calf muscle Echinococcosis Echinococcus Dogs, Ingestion of eggs granulosus, carnivores, or food pain, headache, chills, nausea and Echinococcus livestock contaminated multilocularis (especially with fecal vomiting. The patient recently came from sheep) material the province for the summer and spent Cysticercosis Taenia solium pigs Ingestion of uncooked or her vacation lounging in the town ’s pond. partially cooked pork

Leptospirosis: Leptospirosis Clinical manifestations

 A disease of wild and domestic animals Leptospires penetrate the circulation Localized ischemia of infected blood skin, mucous membranes vessels of renal tubules, liver, meninges,  Caused by Leptospira interrogans muscles, eyes, placenta Incubation period of 1-2weeks:  Leptospires live for years in renal tubules of Initial or Leptospiremic Phase infected mammals (rats, dogs, cattle, swine, Secondary LEPTOSPIRURIC or (4-7days): goats, mice) Immune Phase (>4-30 days): • profound  Become infected when on contact with 1-5 days •Aseptic meningitis •Conjunctival suffusion asymptomatic leptospiruric animals, contaminated soil, or •Fever, headache, vomiting •Nausea/vomiting bodies of water •Isolated from the urine • •Anti-leptospira agglutinating antibodies •Fever, headache, chills are present •Neck stiffness •Disappearance of leptospires from blood •Leptospires isolated from blood & CSF Leptospirosis: Leptospirosis: Diagnosis Clinical manifestations  Suspected from the clinical manifestations +  Anicteric leptospirosis history of possible exposure  Aseptic meningitis  Confirmed by serologic testing: MAT; ELISA st  Weil ’s disease:  During 1 week:  leptospires can be isolated from blood and CSF  Classic hepatorenal disease occuring in 5 -10% of cases  During Leptospiruric phase:  More severe illness  Urine is source of positive cultures and dark -field examinations  consisting of an initial phase of fever + azotemia, jaundice, hemorrhage, anemia, mental status  Mild proteinuira, granular casts, microscopic hematuria changes, and shock  CSF analysis

Leptospirosis: Treatment Leptospirosis: Prevention

 Self -limiting in >90% of untreated Self -limiting in >90% of untreated  Avoidance of potentially patients infected areas near streams  High -dose penicillin G 300,000 and ponds U/kg/day (max 12 -24 MU) q4 IV for 7  Vaccinated domestic animals days is recommended for serious and livestock may still infection excrete the organism in the urine  doxycycline 4mg/kg/day (max  Doxycycline: prophylaxis for 200mg/day) q12 PO x 7days for those persons working in highly >9 y/o endemic areas; long -term use is not advised Case 3

 An 8 yr.old female was brought to you because of enlarged right axillary lymph nodes of 3 weeks duration. You noticed a suppurative papule along her right forearm.

Cat Scratch Disease CSD: Clinical Manifestations

Wheal/papule formation at 50-80% of cases  Caused by inoculation site have fever, henselae spread by either a 1-4wks later headache, malaise, Incubation up and anorexia cat bite or scratch to 3wks Unresolving  Transmission from cat to cat lymphadenopathy is believed to be from , (axillary, anterior cervical, Resolves spontaneously Ctenocephalides felis inguinal regions)  Worldwide, most common in 5-10 yrs. of age Suppuration, fistula formation  Symptoms: local swelling and swelling of the lymphatic system and flu like malaise CSD: Other Clinical Manifestations CSD: Diagnosis

 Hepatosplenic CSD  Suspected on the basis of:  CNS: seizures, encephalopathy in 2% of patients  clinical presentation  Onset: few days to months after lymphadenopathy  regional lymphadenopathy formation regional lymphadenopathy  (+) recent direct contact with a cat  Abnormal EEG (+) recent direct contact with a cat  CSF: lymphocytic pleocytosis  confirmed by serologic test  Parinaud ’s syndrome  Antibody titers (IFA, ELISA >1:64)  Bulbar conjunctivitis, conjunctival granuloma usually peaks at 4 -6 wks after  Preauricular lymphadenopathy development of lymphadenopathy,  In AIDS and cancer patients, , peliosis persists for 4 -5 months  Organism grows slowly, takes 10 - 40 days

CSD: Diagnosis CSD: Treatment

 Antimicrobial therapy should be considered for patients with:  PCR: highly sensitive and specific  Lymphadenopathy that does not resolve within diagnostic tool 6-8weeks  Detects Bartonella at sites of skin inoculation,  Lymphadenopathy associated with significant lymph nodes, bone, eye, conjunctivae, pain, limitation of movement, or persistence of paraspinal lesions, liver, spleen, brain debilitating symptoms  Majority of cases resolves in 1 -2 months  Severe systemic disease: encephalopathy, osteomyelitis, neuroretinitis; without any antimicrobial therapy osteomyelitis, neuroretinitis;  Underlying medical disorder complicated by CSD CSD: Treatment CSD: Prognosis and Prevention

 Some clinical response may be achieved with  Completely resolves in 1-2months even  rifampin (20 mg/kg/day in 2 divided doses x without antimicrobial 14 days), azithromycin, cotrimoxazole, therapy gentamicin, and  No deaths have been directly attributed to  Proposed treatments regimens for directly attributed to CSD bacteremia and includes  Attentiveness towards  combinations of gentamicin + ceftriaxone, avoidance of or a , and a quinolone scratches and bites from cats & kittens

CSD: Prognosis and Prevention Case 4

 No data exist to support  A 10 yr.old male was brought to your clinic usefulness of antimicrobial because of and abdominal pain. There prophylaxis for persons after cat was associated low -grade fever. On PE the contact OR use of abdomen was tympanitic with increased bowel sounds. According to the mother, the child was eradication measures eradication measures often seen playing with his older brother ’s pet  Declawing is unnecessary iguana. Nontyphoidal Salmonella: Clinical Manifestations

 Associated with pet reptile or amphibian  Most Salmonella infections are asymptomatic or contact mild  Many reptiles are  Oral ingestion of at least 100,000 viable colonized with organisms is required to cause Salmonella , intermittently shed in their feces  Short incubation period of < 1 week, usually 24 - 48 hours  Infected by ingesting Salmonella after handling  Self -limited symptoms a reptile or objects  colicky abdominal pain, nausea, vomiting, loose contaminated by reptiles stools, low -grade fever  failing to wash their  Diarrhea is often green and foul -smelling hands properly

Salmonella:Diagnosis Salmonella: Complications and Prognosis

 Occult blood is reported in 83%  High rate of among infants, with 20%  WBC is more commonly increased mortality rate  Stool cultures ae positive in >90% of  Meningitis, , or pulmonary cases involvement  Serologic testing with febrile agglutinins or  Because of increased risk of bacteremia, blood the Widal test is not recommended cultures are recommended for:  children <3 months, regardless of presence or absence of fever  for children 3 -12 months of age with fever >39 ºC  for children who appear lethargic or moderately ill Salmonella: Treatment Salmonella: Prevention

 Generally supportive treatment  Thorough hand washing with soap and water  Specific antimicrobial therapy is indicated for after handling reptiles or reptile cages  Children <5 years of age and immunocompromised  patients with bacteremia or extraintestinal persons should avoid contact dissemination  Reptiles should not be allowed to roam freely in  high -risk patients with noninvasive high -risk patients with noninvasive homes or living areas and should be kept out of including gastroenteritis including kitchens and food areas to prevent  <3months of age, immunocompromised, persons contamination with hemoglobinopathies or chronic GIT disease  Sinks or bathtubs used to bathe reptiles or to  Third -gen cephalosporins, ciprofloxacin wash their dishes should be thoroughly disinfected  Reptiles should not be kept in childcare centers

Pasteurella multocida Pasteurella: Signs & Symptoms

 Erythema, swelling,  Complications:  oral flora of dogs & tenderness & Osteomyelitis cats drainage at bite wond cats drainage at bite wond  site  Isolated after an  Tenosynovitis infected animal bite  Direct extension may  Sepsis occur to surrounding  Meningitis  Often remain localized Often remain localized tissues to the wound  Brain abscess  Lymphangitis   Regional  Endocarditis lymphadenopathy  Bacteremia Other Major Bacterial Zoonotic Pasteurella: Management Infections

Disease Causative Common Modes of transmission Bacterial agent Animal  Local wound care Diseases Reservoir  Aggressive irrigation with NSS : bubonic, Rats and other Flea bite; pneumonic, rodents Human to human:  Removal of devitalized tissue septicemic respiratory droplets  to prevent nidus of infection for inoculated organism Anthrax: Bacillus Cattle, sheep Direct contact with pneumonic, anthracis and goats infected animals or their  Penicillin G is the drug of choice malignant pustule products

 Alternatives: -Sulbactam, Relapsing fever Borrelia sp. rodents Tick bite; human to Ceftriaxone or Cefotaxime human: body louse

Other Major Bacterial Zoonotic Other Major Bacterial Zoonotic Other Major Bacterial Zoonotic Infections Infections Infections Disease Causative Common Modes of transmission Bacterial agent Animal Disease Causative Common Modes of transmission Diseases Reservoir Bacterial agent Animal Rat -bite Fever Streptobacillus Mice, rats, Bites, ingestion of Diseases Reservoir moniliformis; hamsters contaminated food or Lyme disease: Borrelia White -footed Bite of deer tick (Ixodes) Spirillum minus water erythema burgdorferi mouse nymphs chronicum migrans, arthritis, Campylobacteriosis Rodents, dogs Direct contact. Ingestion carditis, jejuni (puppies), cats, of contaminated food or neuropathy , swine water : Burkholderia Rats, mice, Inhalation or direct pneumonia, lung psudomallei rabbits, inoculation abscess, sepsis ruminants, : Francisells Rabbits, Aerosol ingestion, direct primates pneumonia, skin tularensis squirrels, dogs, contact, ingestion of lesion, adenitis cats contaminated meat, bite of fleas, deer flies. mosquitoes Other Major Bacterial Zoonotic Other Major Bacterial Zoonotic Infections Infections Disease Causative agent Common Modes of Disease Causative agent Common Animal Modes of Bacterial Animal transmission Mycobacterial Reservoir transmission Diseases Reservoir Diseases

Yersiniosis Yersinia Rodents, cattle, Direct contact, Wound infection Mycobacterium Fish, aquarium Direct contact, enterolitica, goats, sheep, ingestion of marinum, scratches Yersinia swine, fowl, contaminated foof Mycobacterium pseudotuberculosis dogs or water fortuitum, Bordetella Cats, dogs, pigs, Direct contact Mycobacterium bronchiseptica rabbits kansasii Chlamydial Diseases Erysipeloid Erysipelothrix Sheep, swine, Direct contact rhusiopathiae turkeys, ducks, fish Chlamydia psittaci Aerosol inhalation

Major Viral Zoonotic Infections Cryptococcosis

Disease Causative agent Common Modes of  Cryptococcus neoformans , Viral Diseases Animal transmission ubiquitous monomorphic Reservoir fungus resident in soil & Rabies Rabies virus Dogs, skunks, Bites, scratches feces bats raccons,  infected by inhalation of foxes, cats contaminated aerosols  In normal hosts, infection is subclinical or minor localized pulmonary disease Cryptococcosis: Clinical Manifestations Diagnosis Central Nervous Pulmonary Involvement involvement (75%)  Not well described in  India ink or  Headache. Fever children, most cases are mucicarmine stain  Nausea, vomiting disseminated at time of diagnosis  Stiff neck  Culture  Cough, chest pain  Altered consciousness,  Antigen test (latex impaired mental  Sputum production Antigen test (latex functions, cranial nerve (32%) agglutination lesions, visual deficits  Weight loss (26%) titers 1:4 or >)  Duration: < 1week - 18  Fever (26%) months  Hemoptysis (18%)

Cryptococcosis: Treatment In the Cryptococcosis: Treatment In the Immunocompetent Host ( CNS Immunocompetent Host Disease ) Pulmonary and Non -  Combination of  Spinal tap should be CNS Disease amphotericin B (0.7 to done after 2 weeks of 1.0 mg/kg/day) + therapy (60 -70% will  Most infants & children,  If azoles cannot be treatment is warranted tolerated or progression flucytosine 100mg/day have sterile spinal fluid) for 2 weeks followed by  Performing LP is essential occurs:  (+) CSF CS: require in all cases amphotericin B 0.4 to 0.7  fluconazole 100 more prolonged  Asymptomatic & mild - mg/kg/day mg/kg/day for 10 weeks treatment course moderate symptoms:  Severe infections, treated OR  Intraventricular and fluconazole 3 -6mkday for like CNS disease amphotericin + flucytosine intrathecal amphotericin 6 to12 weeks for 6 -10 weeks B for refractory cases  Alternative: itraconazole Other Major Fungal and Protozoal Cryptococcosis: Treatment In the Zoonotic Infections Immunocompromised Host Disease Causative Common Modes of agent Animal transmission Reservoir  Cryptococcal Pneumonia  Cryptococcal Meningitis Dermatophytoses Microsporum Dogs, cats, Direct contact,  fluconazole  amphoterin B + Trichophyton rabbits scratches 100mg/kg/day for life flucytosine for 2 weeks  Epidermophyton fluconazole for minimum  Alternative: itraconazole Protozoan Ingestion of oocysts of 10weeks in fecally  Severe infections: Diseases in fecally contaminated Toxoplasma Cats, livestock contaminated amphotericin B until the material of ingestion gondii material of ingestion patient is asymptomatic of tissue cysts in poorly cooked meat  fluconazole may be poorly cooked meat substituted for maintenance

Black Death The victims “ate lunch with their relatives and dinner with their ancestors in paradise. ” - Giovanni Boccaccio