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15 Glaser Zoonotic Zoonoses Carol Glaser DVM, MD Pediatric Infectious Diseases University of California, San Francisco & Pediatric Infectious Disease Division Kaiser Permanente Oakland, CA Outline Overview of zoonotic diseases “Fact or Fiction” dealing with common misperceptions or questions Focus on zoonotic aspect of different disease (rather than Rx) Common and not-so-common illnesses, range of animal hosts/types of zoonoses Mostly practical information…but some esoteric… 1 Outline Pet related zoonoses – Cats and dogs Ringworm, toxoplasmosis, Bartonella/CSD, GAS and MRSA – Less traditional pets Pocket pets-RBF Wildlife issues Rabies What is a zoonosis? Zoonosis refers to diseases that can be passed from animals, whether wild or domesticated, to humans 2 Tick • Borreliosis • Trypanosomiasis 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 • Cryptococcus • Toxocariasis • M. avium-intracellulare • Toxoplasmosis • West Nile virus • Rabies • Rabies Mosquito • JEV • Leptospirosis • Bartonella hensleae • Chik Dog • Dengue Cat Companion Animals US households 2012 Dogs Cats Birds Horses % households 37% 30% 3% 1.5% Average/ 1.6 2.1 2.3 2.7 household Total # 69,926,000 74,059,000 8,300,000 4,856,000 https://www.avma.org/KB/Resources/Statistics/Pages/Market-research-statistics- US-pet-ownership 3 Specialty and Exotic Animals 2012 “Pocket pets”; ownership increasing { Lots of reptiles, mostly increasing since 2007 https://www.avma.org/KB/Resources/Statistics/Pages/Market-research-statistics-US-pet- ownership.aspx#exotic Zoonoses: General Many are missed because of vague clinical presentation –’viral’ On the other hand, people often worry unnecessarily and/or erroneously ascribe illness to pets Transmission complex and often ‘new twists’ For the unusual/orphan diseases, diagnosis problematic 4 A Partial List of Bacterial Zoonoses Anthrax Psittacosis Brucellosis Q Fever Campylobacteriosis Rat-bite Fever Cat Scratch Disease Relapsing Fever Rocky Mountain Spotted Ehrlichiosis Fever E. coli O157:57 Salmonellosis Glanders Tularemia Leptospirosis Typhus Listeriosis Yersiniosis Lyme Disease Zoonotic tuberculosis Melioidosis Plague A Partial List of Viral Zoonoses Arenaviruses (LCMV, Lassa, S. Herpesvirus B American hemorrhagic fevers) Influenza (avian) Bat lyssaviruses Japanese encephalitis Colorado tick fever Nipah Ebola Rabies Equine encephalitides (WEE, Rift Valley fever EEE, VEE) SARS Hantaviruses (Hantaan, Sin Vesicular stomatitis Nombre) West Nile Virus Hendra 5 A Partial List of Parasitic Zoonoses Protozoa Helminths: (roundworms, tapeworms, flukes)* Babesiosis Anisakiasis Cryptosporidiosis* Cysticercosis Leishmaniasis* Hydatidosis Giardiasis* Mesocestoidiasis Toxoplasmosis* Schistosome dermatitis Trypanosomiasis (Swimmer’s Itch) Trichinosis* Visceral Larval Migrans* Toxocariasis/Baylisascaris Emerging Infectious Diseases Estimated that 75% are zoonotic – Many viral—SARS, MERS – Many vectorborne (e.g., West Nile virus, Ebola, Zika ) -Chomel et al., Emerg Inf Dis 2006 6 Dermatophytosis “Ringworm” Pets are a common source of ringworm and are almost always symptomatic Fact or Fiction? 7 Dermatophytosis (aka Ringworm) Fungal pathogen Found world-wide, prefer hot and humid environments Infection of the hair, nails (oncyhomycosis) and/or superficial layers of the skin caused by several fungal species Classified by mode of transmission – Human-to-human (anthropophilic) – Soil (geophilic) – Animal-to-human (zoophilic) vs. “name” based on where on body Name by body site (rather than fungal species) Tinea corporis - body surfaces other than feet, groin, face, scalp, hair or beard hair – T rubrum, (T tonsurans, M canis, T interdigitael/T mentagrphytes, M gypseum, T violacerum and M audouini) – Tinea corporis from infected animals often intense; inflammatory Tinea pedis - foot, (athletes foot) – T rubrum, T interdigitale, and E floccosum (barefoot locker room) Tinea cruris - groin – T rubrum (E floccosum, T interdigitale, T mentagrophytes) – Spread from tinea pedis (risk factors obesity, diabetes, sweating, immunodeficiency) Tinea Capitis - scalp hair – Almost always small children – Trichophyton and Microsporum species are the major causes Tinea unguium - nails Tinea barbae - beard hair 8 Dermatophtosis (Ringworm) One of the most common pet-associated and occupational zoonoses Estimated that 2 million people in the US are infected each year as result of animal contact Spores from infected animals can be shed into the environment and live for up to 2 years Incubation period = 1-3 weeks Brushes, bedding, furniture, or anything that has been in contact with an infected animal or the animal's hair can contain spores Stehr-Green JK, Vet Clin N Am Small Anim Pract, 1987 Overview of “ringworm“ Mode transmission Clinical Fungal types Human-to-Human Mild to non-inflammatory, Trichophyton tonsuran (skin-to-skin or skin-to-hair) chronic T mentagrophytes interdigitale T violaceum T soudanese T schoenleinii Microsporum audouinii M ferrugineum Epedermophtyone floccosum Soil-to-human Moderate inflammation M gypseum (indirect contact with infectious M fulvum arthrospores in environment or T ajelloi fomites) T terrestre Animal-to-Human Intense inflammation • Microsporum canis (skin-to-skin or skin-to-hair) (pustules and vesicles • Trichophyton possible) mentagrophytes 9 Disease in Animals Dogs – Generally starts as alopecia – Erythema, scaling and pruritis may develop around lesions – Asymptomatic but still capable to shedding spores into environment – Microsporum canis (70%), M gypseum (20%) and Trichophyton mentagrophytes (10%) Cats – Up to 90% asymptomatic – Most commonly there are manifestations in kittens or long- haired cats – Poor hair coat or circular lesions on face/paws – Most is Microsporum canis (90%) More common in sheltered and/or young animals Clinical - Humans Anthropophilic Zoophilic human-to-human animal-to-human Tends to be more inflammatory Symptoms caused by hypersensitivity reaction of the host 10 Diagnosis & Treatment Wood lamp primarily helpful for Microsporum infection (affected areas fluoresce yellow-green) Humans - Rx dependent on fungal species and body site – Tinea capitas Terbinafine (Itraconazole or Fluconazole or griseofulvin) – Tinea corporis, cruris, pedis Topical antifungal, drying powder Optimal Rx controversial Griseofluvin for M canis Pets – Eradicating disease may be challenge if multiple animals – Response to Rx monitored by dermatophyte culture as many animals will remain culture positive while improving clinically – Topical Rx and/or systemic Rx; topical miconazole/clotrimazole, oral ketoconazole Summary Ringworm Some ringworm comes from pets but probably only minority of cases Ringworm transmitted from pets is often more inflammatory > humans Pets can harbor ‘ringworm’ and most of the time they are asymptomatic Consider asking about pets if ringworm is refractory to Rx 11 Toxoplasmosis Toxoplasmosis is generally acquired from cats and it is safest not to have cats when pregnant Fact or Fiction? 12 Toxoplasma gondii Obligate intracellular parasitic protozoan Capable of infecting all warm-blooded animals Cats definitive host (and other felines); only host where parasite undergoes sexual reproduction Worldwide distribution – Seroprevalence in US-born persons (12–49 y) (NHANES) 1988-1994: 14% 1999–2004: 9% Toxoplasmosis Life Cycle • Cats (and other felines definitive host) • Naïve cats ingest bradyzoites • Cats generally either asymptomatic or have self-limited illness • Other animals can become infected from oocysts • Tissue cysts in meat, unwashed produce or placental transmission 13 Humans and Toxoplasmosis After infection – Humans often asymptomatic or – Flu-like illness – Like other animals, tissue cysts and long term humoral response Two important groups: – Pregnant women with primary infection – Immunocompromised – primary infection or reactivation Toxoplasmosis Infection in Pregnancy Asymptomatic (50-90%) Fatigue, lymphadenopathy Fever, H/A, pharyngitis, myalgia Rarely enanthem (rash on mm mouth), retinal disease 14 Congenital Toxoplasmosis Transmission can occur during all trimesters; least likely 1st trimester but most severe Classic triad – Hydrocephalus – Intracranial calcifications – Chorioretinitis But most cases not classic-more subtle with IUGR, microcephaly High index of suspicion for diagnosis Congenital Toxoplasmosis Additional Signs/Symptoms Fever Ocular abnormalities H-S-megaly Pneumonia Lymphadenopathy Seizures Jaundice Vomiting, diarrhea Rash Hypothermia Labs: Abnormal CSF, anemia, eosinophilia, and coagulopathy 15 Toxoplasmosis Infection in Pregnancy Source of infection unknown in approx 50% Food: meat and fresh fruit, vegetables, raw eggs and rarely mussels, oysters, unpasteurized milk (and even water) Gardening Rarely: blood transfusion, laboratory-acquired Cats - how commonly is it transmitted from cats? Cats and Toxoplasma Cats are generally asymptomatic or mildly ill during acute infection Shed oocysts for ~10 days but usually only during acute infection (i.e., only once/lifetime) <1% of cats shed oocysts on any given day Oocysts are quite resistant – oocysts survived outdoors in Texas (6°C–36°C) in native cat feces, uncovered, for 46 days, for 334 days when covered, and outdoors in soil buried at the depth of 3–9 cm in Kansas
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