Zoonoses of birds, reptiles, and pocket pets

CVM 6923 Lauren Bernstein, MVB VPHPM Resident Learning Objectives

● Provide common recommendations to prevent C. psittaci transmission ● Know reporting rules for avian chlamydiosis and regulations regarding placement of pet birds in nursing homes and day care facilities ● Provide client education to prevent salmonellosis associated with handling backyard poultry, reptiles, and hedgehogs ● Provide client education about zoonotic diseases associated with rodents In general...

Clients most at risk include:

1. Very young (<5 yo) 2. Very old 3. Immunocompromised

Photo Credit Background

● Nomenclature: ○ Psittacosis = disease in humans ○ Avian chlamydiosis = disease in birds ○ psittaci (formerly ) = bacterial agent of disease ● 70% of human result from exposure to pet birds (parrots, macaws, cockatiels and parakeets), but poultry also important ● Decline of psittacosis since 1988 with better prevention and education ○ BUT! Often unreported! Clinical signs: birds

● “General sick-looking bird” ○ Listless, fluffed up, anorexia, weight loss ○ Diarrhea with greenish-colored urates ● Conjunctivitis, ocular or nasal discharge ● Chronically infected birds may appear normal, but can still be infectious ○ Shed the when stressed Photo credit Diagnosis and treatment: birds

● Difficult to diagnose in live birds, but should always be a differential ○ No single test ○ Preferred sample for bacterial culture or PCR is a conjunctival, choanal, or cloacal swab ● Treatment: ○ Doxycycline x 45 days ○ Biosecurity Photo credit Transmission to people

● Inhalation: particles from dried feces or respiratory secretions from infected birds ● Direct contact: ○ Handling feathers or other infected tissues of live or dead birds ○ Mouth-to-beak (kissing) ○ Biting ● Bacteria shed in feces, or ocular and nasal discharges can remain viable for months Symptoms: people

● Asymptomatic ● Mild flu-like illness with self-resolution ● Atypical pneumonia ○ Antibiotic therapy required ● Reactive arthritis ● <1% mortality with treatment Diagnosis: people

Usually a diagnostic challenge:

● Physicians may not inquire about animal

exposures Pneumonia before treatment ● Serological tests often do not differentiate between C. psittaci and C. pneumoniae ● Limited number of laboratories provide diagnostic testing ● Most cases go undiagnosed or unreported

Pneumonia after treatment

https://doi.org/10.1016/j.jfma.2012.08.017 Treatment: people

● Preferred: tetracycline or doxycycline PO x 3 weeks ● Alternate: macrolides PO x 3 weeks ○ Children or pregnant women ● Supportive treatment if pneumonia severe Why do we care?: occupational disease

● Poultry processing plants ● Turkey and duck farms ● Pigeon fanciers ● Pet store employees ● Veterinarians and veterinary staff Why do we care?: human-animal bond

State Health Department Regulations for Pet Birds in Family Day Care (4638.0200 and 9502.0435)

“All pets housed within the residence shall be maintained in good health and limited to dogs, cats, fish, guinea pigs, gerbils, rabbits, hamsters, rats, mice, and birds if the birds are free of .”

Photo credit Why do we care?: outbreaks

1995: Atlanta, GA August-October 2018: Georgia, Virginia

● 46 people from 29 households ill in ● Poultry plant workers at two slaughter outbreak linked to Florida bird broker plants and large pet store chain ● 13 cases; no deaths ● ~60 birds died ● Both plants closed for several days

Photo credit

*Moroney, JF, et al. Detection of Chlamydiosis in a shipment of pet birds,... Clin Inf Dis 1998;26:1425-9. Why do we care?: REPORTABLE DISEASE

● Veterinarians and laboratories are required to report a diagnosis of C. psittaci in a bird to the Board of Animal Health ● Representatives from the State Health Department assesses human health risks ● Compendium of measures to control Chlamydia psittaci infection among humans (psittacosis) and pet birds, 2017 Prevention

PREPARE

● Do not purchase or sell birds that have signs of illness ● Isolate newly-acquired birds for 30-45 days ○ Test or treat before mixing them with resident birds. ○ Birds that have been to fairs or shows are considered “newly acquired.” ● Position cages to prevent spread of droppings and discharges between cages Prevention

HUSBANDRY

● Clean all cages and bowls daily ● Keep good records ● Weigh birds once or twice a week ○ If not maintaining weight, seek veterinary attention ● Limit stress ● Disinfectants effective against C. psittaci: 1% Lysol or bleach solution, Roccal®, Zephiran®, 70% isopropyl alcohol Control

● Isolate suspect case(s) away from other birds ● Clean and disinfect room and cages thoroughly ○ Throw away all items that can’t be disinfected ● Do NOT vacuum. Spray floor with water or disinfectant, then sweep. ● Treat all symptomatic and exposed birds for 45 days. Any other health risks for the backyard flock owner? Salmonellosis (Not just a foodborne illness) Symptoms: people

● Diarrhea, fever, and stomach cramps ● Symptoms 6 hours to 6 days after exposure ● Often a self-limiting illness lasting 4-7 days ● Hospitalization required for severe infections

(More in Dr. Kincheloe’s foodborne illness lecture next week) Why do we care?

LIVE POULTRY CONTACT

● Higher risk of infection among backyard flock owners ○ 49% (196/400) reported snuggling baby birds ○ 13% (53/400) reported kissing baby birds ● Often acquire chicks around Easter ● Higher risk individuals should not handle or touch chicks, ducklings or other live poultry Prevention

DO DON’T

● Wash your hands after handling live ● Do not let live poultry in the house poultry or anything in their coops ● Do not let immunocompromised people ● Have separate shoes and clothing for handle live poultry working in the coop ● Do not consume food where there is live ● Clean equipment outdoors poultry ● Buy live poultry from hatcheries that participate in National Poultry Improvement Plan Prevention

SAFE EGG HANDLING

● Wash your hands after handling eggs ● Keep the coop clean ● Collect eggs often and dispose of cracked eggs ● Clean eggs with a fine sandpaper, brush, or cloth ○ DO NOT wash eggs, because colder water can pull bacteria into the egg ● Refrigerate eggs after collection ● Cook eggs thoroughly ● Know the local regulations around sale of eggs Salmonellosis (Not just a foodborne illness) Background

● Most reptiles carry Salmonella in their intestinal tracts and shed it intermittently or continuously in their feces ● Animals, enclosures, and bowls can be contaminated ● Each reptile and amphibian species has specific husbandry requirements ○ Know the husbandry to minimize stress ● Prevention similar to poultry Transmission to people

● Fecal-oral route ○ Direct contact with reptile ○ Indirect contact through contaminated surfaces ○ Contact with feeder rodents Why do we care?

● Occupational disease ● Client education ● Reptiles are not appropriate pets in child-care centers What about those tiny turtles?

● Since 1975, FDA has banned the sale of turtles in the U.S. with a shell length less than 4 inches ● Overarching goal was to reduce Salmonella infections ● May still be found at flea markets, street vendors, etc. Salmonellosis (Not just a foodborne illness) Background

● Human salmonellosis cases and outbreaks linked to pet and wild African pygmy and European hedgehogs in the U.S., Canada, Norway, and Denmark ● Salmonella cultured from healthy hedgehogs Photo credit Why do we care?

2018-2019: multistate oubreak

● S. Typhimurium outbreak associated with pet hedgehogs ● 23 states! ● 54 cases; 8 hospitalized ● Ages 2-95 yo; median 18 yo

● No common source identified cdc.gov Prevention

● Client education! ● Wash hands after handling hedgehog, enclosure, bedding, toys, food bowls, food sources, etc. ● Do not kiss or snuggle the hedgehog ● Do not let hedgehogs roam freely in areas where food is prepared A final point on Salmonella

It doesn’t stay in the pet’s cage! Rat bite fever Background

● moniliformis: common commensal in the nasopharynx of rats ○ A possible concern in other rodents (gerbils, mice, Guinea pigs) ● Incubation period: 3 to 21 days, typically 3-10 days Diagnosis and treatment: rats

● All rats should be considered carriers- usually no signs of illness ● No reliable test ● No effective antimicrobial treatment in rats Transmission to people

● Contact with rodents carrying S. moniliformis (handling, biting, scratching, kissing, cuddling) ● Consumption of food or water contaminated with rodent urine or droppings (Haverhill fever) Symptoms: people

● Fever, vomiting, headache, joint pain, muscle pain ● Maculopapular rash on hands and feet occurs 2-4 days after fever onset ● Polyarthritis in 50% of patients ● 1 in 10 people die without treatment Diagnosis and treatment: people

● Isolation from blood or synovial fluid ● Presumptive diagnosis based on clinical presentation, history, or pleomorphic gram negative bacilli in body fluids ● Effectively treated with Why do we care?

● Occupational disease ● Appropriate clinical recommendations for owners if a human is bitten: ○ Educate about proper rat handling and bite avoidance ○ Reinforce good hand washing after handling rats ○ Euthanasia or rehoming are options What to advise following a rat bite

● Wash the bitten or scratched area thoroughly ● Rat bite fever is rare! ○ Not reportable ○ No prophylactic antibiotics ○ Fever watch for 21 days ● If fever occurs without clear etiology, consult physician for and antibiotic therapy Lymphocytic choriomeningitis virus (LCMV) Background

● Virus in Arenaviridae family ● Primary host: common mouse ● Other rodents such as hamsters can become infected from mice ● Clinical signs: decreased activity, poor coat, sometimes convulsions and death Transmission to people

● Exposure to urine, droppings, saliva, or nested materials from infected rodents Symptoms: people

● Most people are asymptomatic or have a mild fever ● Others have a biphasic illness: fever followed by neurological disease ● In pregnant women: pregnancy termination, fetal death, birth defects ● Organ transplant recipients ○ 3 of 4 patients died following receipt of organs from a donor exposed to a hamster with LCMV Shutterstock Prevention

● Avoid contact with wild mice ● Advise pet owners, pet stores, or rodent breeders to prevent wild rodent infestations ● Wash hands after handling pet rodents, their enclosures, or their bedding Other pocket pet ● Pasteurella sp. ● Yersinia enterocolitica zoonoses ● Campylobacter ● Summary

● Strategies exist to control Chlamydia psittaci in birds and prevent transmission to people ● Owners should be aware of the risk of Salmonella from backyard poultry and take appropriate steps to minimize these risks ● Owners should employ the same understanding and hygiene when handling reptiles ● Risks of zoonotic infections from pocket pets are rare, but possible. ● Client education is essential for appropriate husbandry and hygiene. Acknowledgements

Dr. Stacy Holzbauer, Minnesota Department of Health

Tory Whitten, Minnesota Department of Health