Zoonotic Diseases Commonly Associated With Dogs and Cats

1
Zoonotic Diseases Commonly Associated With Dogs
and Cats
Note The images in this presentation are for
non-profit, educational use only.
Neil Grove University of North Carolina Chapel
Hill Division of Laboratory Animal Medicine
2
What we will cover

• We will attempt to answer the following questions
  about each zoonotic disease
• What is it?
• How can I get it?
• What are the symptoms?
• What precautions or preventive measures can be
  taken to avoid acquiring it?

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What diseases will we cover?

• Toxocara
• Sarcoptes
• Cheyletiella
• Rabies
• Ringworm
• Toxoplasmosis
• Cat Scratch Disease
• Capnocytophaga canimorsus

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Toxocariasis What is it?

• Toxocariasis is a zoonotic infection caused by
  the parasitic roundworms commonly found in the
  intestine of dogs (Toxocara canis) and cats (T.
  cati).
• In the United States, an estimated 10,000 cases
  of Toxocara infections occur yearly in humans. (1)

5
Prevalence

• A recent national survey of shelters revealed
  that almost 36 of dogs nationwide, and 52 of
  dogs from southeastern states harbored helminths
  capable of causing human disease. 
• Every year at least 3,000-4,000 serum specimens
  from patients with presumptive diagnoses of
  toxocariasis are sent to the Centers for Disease
  Control and Prevention (CDC), state public health
  laboratories, or private laboratories for
  serodiagnostic confirmation. (2)

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How Do I get it?

• The most common Toxocara parasite of concern to
  humans is T. canis, which puppies usually
  contract from the mother before birth or from her
  milk.
• The larvae mature rapidly in the puppys
  intestines when the pup is 3 or 4 weeks old,
  they begin to produce large numbers of eggs that
  contaminate the environment through the animals
  stool. The eggs soon develop into infective
  larvae.(1)

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How Do I get it?

• You or your children can become infected after
  accidentally ingesting (swallowing) infective
  Toxocara eggs from larvae in soil or other
  contaminated surfaces.(1)
• Eggs are extremely resistant and can remain
  viable for years.

Toxacara eggs
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Symptoms

• There are two major forms of toxocariasis, Ocular
  larva migrans, and Visceral larva migrans
• 1) Ocular larva migrans (OLM)
• An eye disease that can cause blindness.
• OLM occurs when a microscopic worm enters the
  eye it may cause inflammation and formation of a
  scar on the retina. (1)

Elevated granuloma in toxocariasis
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Symptoms

• Each year more than 700 people infected with
  Toxocara experience permanent partial loss of
  vision.(1)

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Symptoms

• 2) Visceral larva migrans (VLM)
• Heavier, or repeated Toxocara infections, while
  rare, can cause VLM, a disease that causes
  swelling of the bodys organs or central nervous
  system. Symptoms of VLM, which are caused by the
  movement of the worms through the body, include
  fever, coughing, asthma, or pneumonia. (1)

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Symptoms

• In most cases, Toxocara infections are not
  serious, and many people, especially adults
  infected by a small number of larvae (immature
  worms), may not notice any symptoms. (1)

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Symptoms

• The most severe cases are rare, but are more
  likely to occur in young children, who often play
  in dirt, or eat dirt (pica) contaminated by dog
  or cat stool.(1)

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Precautions/Prevention

• Have your veterinarian treat your dogs and cats,
  especially young animals, regularly for worms.
• Wash your hands well with soap and water after
  playing with your pets and after outdoor
  activities, especially before you eat. Teach
  children to always wash their hands after playing
  with dogs and cats and after playing outdoors.

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Precautions/Prevention

• Do not allow children to play in areas that are
  soiled with pet or other animal stool.
• Clean your pets living area at least once a
  week. Feces should be either buried or bagged and
  disposed of in the trash.
• Teach children that it is dangerous to eat dirt
  or soil.

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Review Questions

• How do you get toxocariasis?

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Answer

• By accidentally ingesting (swallowing) infective
  Toxocara eggs from larvae in soil or other
  contaminated surfaces.(1)

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Question

• What are the two major forms of larval migrans?

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Answer

• Ocular larval migrans and visceral larval migrans

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Sarcoptic Mange What is it?

• Microscopic sarcoptic mange mites cause sarcoptic
  mange, also known as scabies.
• Sarcoptic mange mites affect dogs of all ages,
  during any time of the year.
• Sarcoptic mange mites are highly contagious to
  other dogs and may be passed by close contact
  with infested animals, bedding, or grooming
  tools.(3)

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How do I get it?

• People who come in contact with an infected dog
  may acquire the mite.(3)

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Symptoms - Dogs

• Sarcoptic mange mites burrow through the top
  layer of the dogs skin and cause intense
  itching. (3)

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Symptoms - Dogs

• Clinical signs include
• Generalized hair loss
• Skin rash
• Crusting
• Skin infections may develop secondary to the
  intense irritation.(3)

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Symptoms - People

• People who come in close contact with an infected
  dog may develop a rash and should see their
  physician.(3)

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Precautions/Prevention

• Look for fleas, ticks, and coat abnormalities any
  time you groom your dog.
• See your vet if your pet excessively scratches,
  chews, or licks its haircoat, or persistently
  shakes its head. This may indicate presence of
  external parasites or other conditions requiring
  medical care.
• Prompt treatment of parasites lessens your pets
  discomfort, decreases the chances of disease
  trasnmission from parasite to pet, and may reduce
  the degree of home infestation.(3)

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Precautions/Prevention

• Discuss the health of all family pets with your
  vet when one becomes infested. Some parasites
  cycle among pets, making control of infestation
  difficult unless other pets are considered.
  Consult your veterinarian before beginning
  treatment.
• Tell your vet if you have attempted any parasite
  remedies, as this may impact your vets
  recommendation.(3)

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Precautions/Prevention

• Be especially careful when applying insecticides
  to cats, as cats are particularly sensitive to
  these products. Never use a product that is not
  approved for cats , as the result could be
  lethal.
• Follow label instructions carefully.
• Leave treatment to the experts. Your vet offers
  technical expertise and can assist you in
  identifying products that are most likely to
  effectively and safely control your pets
  parasite problem. (3)

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Review Questions

• Sarcoptic mange is also known as ______.

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Answer

• Scabies

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Question

• How do people come in contact with the mange mite?

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Answer

• People who come in contact with an infected dog
  may acquire the mite.(3)

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Cheyletiellosis

• What is it?
• Cheyletiellosis is a very contagious dermatosis
  caused by relatively large mites living on the
  skin surface.
• Cheyletiella mites are obligate parasites and
  have a life cycle of approximately 3 to 4 wk in
  total.
• They are not host specific and may transfer
  readily between dogs, cats, and rabbits. (4)

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What is it?

• The disease caused by Cheyletiella mites is often
  called 'walking dandruff.'
• On close observation of an infested dog, cat, or
  rabbit, it may be possible to see movement of the
  dandruff on the skin.
• The movement is caused by the mites motoring
  around under the scales.
• Cheyletiella mites are found on animals
  throughout the United States. They generally do
  not cause significant disease. (5)

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How do I get it?

• Humans in contact with pets carrying Cheyletiella
  spp. are at risk of becoming transiently
  infested.(4)

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Symptoms Animals

• The mites cause skin irritation, usually along
  the back of the animal.
• Slight hair loss
• Scales (dandruff)
• Itching
• Possibly some thickening of the skin.
• Cats and rabbits may not show any signs of
  infestation (5)

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Symptoms - Humans

• Uncomfortable, pruritic dermatosis, characterized
  by papular lesions that, typically, appear on the
  arms, legs, trunk, and buttocks.
• Cheyletiella spp. are not capable of reproducing
  on humans, so appropriate treatment of the pet
  host should prevent further infestation, making
  human acaricidal therapy unnecessary. (4)

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Precaution/Prevention

• How will I know if my pet has Cheyletiellosis?
• Mites may be seen on the animal, especially if
  you use a magnifying glass.
• Examining dandruff, hairs, or scrapings of the
  skin under the microscope can positively identify
  the mites.(5)

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Precaution/Prevention

• If you suspect that your pet has Cheyletiellosis,
  seek the advice of your veterinarian, who will
  recommend appropriate treatment.
• The mite can live for several days off the host,
  so the environment needs to be cleared of mites
  as well.
• At the same time the animals are treated, the
  environment may be fogged or sprayed.
• Since the mites only live for several days off
  the host, it is often effective to remove the
  rabbit, dog, or cat from the premises for several
  days until the mites die. This would prevent
  reinfestation.(5)

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Review Questions

• Another name for the disease caused by
  Cheyletiella mites is _________.

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Answer

• walking dandruff

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Question

• Are Cheyletiella capable of reproducing on humans?

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Answer

• No - Cheyletiella spp. are not capable of
  reproducing on humans

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Rabies

• What is it?
• Rabies is a preventable viral disease of mammals
  most often transmitted through the bite of a
  rabid animal.
• The vast majority of rabies cases reported to the
  Centers for Disease Control and Prevention (CDC)
  each year occur in wild animals like raccoons,
  skunks, bats, and foxes.
• Domestic animals account for less than 10 of the
  reported rabies cases, with cats, cattle, and
  dogs most often reported rabid. (6)

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What animals carry rabies?

• Any mammal can get rabies.
• The most common wild reservoirs of rabies are
  raccoons, skunks, bats, foxes, and coyotes.
• Raccoons are the most common carriers in North
  Carolina.
• Domestic mammals can also get rabies. Cats,
  cattle, and dogs are the most frequently reported
  rabid domestic animals in the United States.
• Your pets and other domestic animals can be
  infected when they are bitten by rabid wild
  animals. (7)

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What about rodents?

• Small rodents (such as squirrels, rats, mice,
  hamsters, guinea pigs, gerbils, and chipmunks, )
  and lagomorphs (such as rabbits and hares) are
  almost never found to be infected with rabies and
  have not been known to cause rabies among humans
  in the United States. 
• One case of a pet guinea pig was reported
• Bites by these animals are usually not considered
  a risk of rabies unless the animal was sick or
  behaving in any unusual manner and rabies is
  widespread in your area.

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What about rodents?

• However, from 1985 through 1994, woodchucks
  accounted for 86 of the 368 cases of rabies
  among rodents reported to CDC. (7)
• Over the last 10 years Tufts Wildlife Clinic has
  seen a number of large native wild rodents
  (mostly woodchucks, but also porcupines and
  beavers) with neurologic signs that have tested
  positive for rabies.(8)

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How do I get it?

• People usually get rabies from the bite of a
  rabid animal.
• It is also possible, but quite rare, that people
  may get rabies if infectious material from a
  rabid animal, such as saliva, gets directly into
  their eyes, nose, mouth, or a wound.(7)

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How do I get it?

• Non-bite exposures to rabies are very rare.
  Scratches, abrasions, open wounds, or mucous
  membranes contaminated with saliva or other
  potentially infectious material (such as brain
  tissue) from a rabid animal constitute non-bite
  exposures. Occasionally reports of non-bite
  exposure are such that postexposure prophylaxis
  is given.(7)

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How do I get it?

• Inhalation of aerosolized rabies virus is also a
  potential non-bite route of exposure, but other
  than laboratory workers, most people are unlikely
  to encounter an aerosol of rabies virus.(7)

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How do I get it?

• Bites from bats can go undetected by a person.
• If a dead bat is found in the house or the
  bedroom it is a concern for bite and rabies
  exposure.

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Can it be transmitted person to person?

• The only well-documented documented cases of
  rabies caused by human-to-human transmission
  occurred among 8 recipients of transplanted
  corneas, and recently among three recipients of
  solid organs .
• Guidelines for acceptance of suitable cornea and
  organ donations, as well as the rarity of human
  rabies in the United States, reduce this risk. (7)

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Can it be transmitted person to person?

• In addition to transmission from cornea and organ
  transplants, bite and non-bite exposures
  inflicted by infected humans could theoretically
  transmit rabies, but no such cases have been
  documented.
• Casual contact, such as touching a person with
  rabies or contact with non-infectious fluid or
  tissue (urine, blood, feces) does not constitute
  an exposure.
• In addition, contact with someone who is
  receiving rabies vaccination does not constitute
  rabies exposure. (7)

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Symptoms Animals

• Animals with rabies may act differently than
  healthy animals. 
• Wild animals may move slowly or act tame.
• Also, some wild animals, like foxes, raccoons,
  and skunks, that normally avoid porcupines, may
  receive a face full of quills if they become
  rabid and try to bite these prickly rodents.
• A pet that is usually friendly may snap at you
  and try to bite.

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Symptoms Animals

• There are two common types of rabies. One type is
  "furious" rabies. Animals with this type are
  hostile, may bite at objects, and have an
  increase in saliva. In the movies and in books,
  rabid animals foam at the mouth. In real life,
  rabid animals look like they have foam in their
  mouth because they have more saliva. (9)
• In advanced cases animals also cant swallow,
  causing saliva to pour out.

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Symptoms - Animals

• The second and more common form is known as
  paralytic or "dumb" rabies. The dogs pictured
  have this type. An animal with "dumb" rabies is
  timid and shy. It often rejects food and has
  paralysis of the lower jaw and muscles.(9)

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Symptoms - Animals

• Signs of rabies in animals include
• changes in an animals behavior
• general sickness
• problems swallowing
• an increase in drool or saliva
• wild animals that appear abnormally tame or sick
• animals that may bite at everything if excited
• difficulty moving or paralysis
• death (9)

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Symptoms - People

• In humans, signs and symptoms usually occur 30-90
  days after the bite. Once people develop
  symptoms, they almost always die.  This is why it
  is very important to go to your doctor right away
  if you have been bitten by an animal that might
  be rabid.
• Early symptoms of rabies include fever, headache,
  sore throat, and feeling tired. As the virus gets
  to the brain, the person may act nervous,
  confused, and upset. (9)

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Symptoms - People

• Other symptoms of rabies in humans include
• pain or tingling at the site of the bite
• hallucinations hydrophobia ("fear of water" due
  to spasms in the throat)
• paralysis
• As the disease advances, the person enters into a
  coma and dies. (9)

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Prevention/Precautions

• There is no treatment for rabies after symptoms
  of the disease appear.
• There is an available rabies vaccine regimen that
  provides immunity to rabies when administered
  after an exposure (postexposure prophylaxis) or
  for protection before an exposure occurs
  (preexposure prophylaxis). (10)

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Prevention/Precautions

• Preexposure vaccination is recommended for
  persons in high-risk groups, such as
  veterinarians, animal handlers, and certain
  laboratory workers.
• Other persons whose activities bring them into
  frequent contact with rabies virus or potentially
  rabid bats, raccoons, skunks, cats, dogs, or
  other species at risk of having rabies should
  also be considered for preexposure prophylaxis.
  (10)

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Prevention/Precautions

• What to do after a possible exposure
• If you are exposed to a potentially rabid animal,
  wash the wound thoroughly with soap and water,
  and seek medical attention immediately. A health
  care provider will care for the wound and will
  assess the risk for rabies exposure. The
  following information will help your health care
  provider assess your risk

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Prevention/Precautions

• the geographic location of the incident
• the type of animal that was involved
• how the exposure occurred (provoked or
  unprovoked)
• the vaccination status of animal
• whether the animal can be safely captured and
  tested for rabies

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Prevention/Precautions

• Steps taken by the health care practitioner will
  depend on the circumstances of the bite.
• Your health care practitioner should consult
  state or local health departments, veterinarians,
  or animal control officers to make an informed
  assessment of the incident and to request
  assistance. 
• The important factor is that you seek care
  promptly after you are bitten by any animal.(10)

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Prevention/Precautions

• What you can do to help prevent the spread of
  rabies
• Be a responsible pet owner
• Keep vaccinations up-to-date for all dogs, cats
  and ferrets. This requirement is important not
  only to keep your pets from getting rabies, but
  also to provide a barrier of protection to you,
  if your animal is bitten by a rabid wild animal.
• Keep your pets under direct supervision so they
  do not come in contact with wild animals. If your
  pet is bitten by a wild animal, seek veterinary
  assistance for the animal immediately. (10)

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Prevention/Precautions

• Call your local animal control agency to remove
  any stray animals from your neighborhood. They
  may be unvaccinated and could be infected by the
  disease.
• Spay or neuter your pets to help reduce the
  number of unwanted pets that may not be properly
  cared for or regularly vaccinated.
• Avoid direct contact with unfamiliar animals

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Prevention/Precautions

• Enjoy wild animals (raccoons, skunks, foxes) from
  afar (including animals on work grounds). Do not
  handle, feed, or unintentionally attract wild
  animals with open garbage cans or litter.
• Never adopt wild animals or bring them into your
  home. Do not try to nurse sick animals to health.
  Call animal control or an animal rescue agency
  for assistance. (10)

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Prevention/Precautions

• Teach children never to handle unfamiliar
  animals, wild or domestic, even if they appear
  friendly. "Love your own, leave other animals
  alone" is a good principle for children to learn.
  
• Prevent bats from entering living quarters or
  occupied spaces in homes, churches, schools, and
  other similar areas, where they might come in
  contact with people and pets. (10)

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Prevention/Precautions

• When traveling abroad, avoid direct contact with
  wild animals and be especially careful around
  dogs in developing countries. Rabies is common
  in developing countries in Asia, Africa, and
  Latin America where dogs are the major reservoir
  of rabies. Tens of thousands of people die of
  rabies each year in these countries. (10)

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Prevention/Precautions

• Before traveling abroad, consult with a health
  care provider, travel clinic, or your health
  department about the risk of exposure to rabies,
  preexposure prophylaxis, and how you should
  handle an exposure, should it arise. (10)

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Local Cases

• Rabid fox bites woman6/30/2005 623 PMBy News
  14 Carolina StaffA fox with rabies attacked and
  bit a woman in the Orange Grove community near
  Hillsborough.
• Authorities said the woman was walking her dogs
  when a fox started fighting one of them.
• The woman used a stick to separate the two.
  That's when the fox bit her on the ankle.(20)

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Local Case

• In September 1997, a boy swimming at Jordan Lake
  State Park near Raleigh, NC, was attacked and
  bitten by a rabid beaver. This incident prompted
  Park officials to close the swimming areas and
  seek assistance from WS. State Park personnel and
  WS staff conducted intensive day and night
  searches and removed several beaver, one of which
  tested positive for rabies.
• This was the second case of a rabid beaver
  attacking a person in the Park. Earlier in the
  summer, a rabid beaver attempted to climb into a
  boat with several fishermen. Rabies in beaver is
  extremely unusual only 14 cases nationwide have
  been reported to the Centers for Disease Control
  and Prevention over the past 40 years.

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Review Questions

• True or False
• The vast majority of rabies cases occur in
  household pets.

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Answer

• False - domestic animals account for less than
  10 of the reported rabies cases

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Question

• True or False
• Wild animals work grounds pose no threat for
  carrying rabies, so it is okay to approach them
  and pet them.

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Answer

• Uhhhyeah right.

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Ringworm

• What is it?
• Ringworm is a skin infection caused by a fungus.
  Ringworm can affect skin on your body (tinea
  corporis), scalp (tinea capitis), groin area
  (tinea cruris, also called jock itch), or feet
  (tinea pedis, also called athlete's foot).(11)

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How do I get it?

• Ringworm is contagious. It can be passed from one
  person to the next by direct skin-to-skin contact
  or by contact with contaminated items such as
  combs, unwashed clothing, and shower or pool
  surfaces.
• You can also catch ringworm from pets that carry
  the fungus. Cats are common carriers. (11)

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How do I get it?

• Many different kinds of animals can transmit
  ringworm to people.
• Ringworm is transmitted from direct contact with
  an infected animal's skin or hair.
• Dogs and cats, especially kittens or puppies, can
  have ringworm that can be passed to people.
• Cows, goats, pigs, and horses can pass ringworm
  to people too. (12)

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How do I get it?

• The fungi that cause ringworm thrive in warm,
  moist areas. Ringworm is more likely when you
  have frequent wetness (such as from sweating) and
  minor injuries to your skin, scalp, or nails.(11)
• Microsporum canis is the most common type.

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Symptoms

• The symptoms of ringworm include
• Itchy, red, raised, scaly patches that may
  blister and ooze. The patches often have
  sharply-defined edges. They are often redder
  around the outside with normal skin tone in the
  center. This may create the appearance of a ring.
  Your skin may also appear unusually dark or
  light.
• When your scalp or beard is infected, you will
  have bald patches.
• If nails are infected, they become discolored,
  thick, and even crumble. (11)

80
Symptoms
This is a picture of ringworm, tinea manum, on
the finger. This fungal infection is inflamed and
scaly. (11)
This child's leg shows a classical-appearing
ringworm lesion with central clearing and a
slightly raised red border. (11)
Ringworm is not seen as frequently in adults as
in children, but when conditions are conducive to
growth, the fungus can flourish. (11)
In the scalp, fungal infections often form
circular, scaly, inflamed patches. (11)
81
Precautions/Prevention

• To prevent ringworm
• Keep your skin and feet clean and dry.
• Shampoo regularly, especially after haircuts.
• Do not share clothing, towels, hairbrushes,
  combs, headgear, or other personal care items.
  Such items should be thoroughly cleaned and dried
  after use.
• Wear sandals or shoes at gyms, lockers, and
  pools.
• Avoid touching pets with bald spots. (11)

82
Review questions

• True or False
• Ringworm is a close relative to earthworms.

83
Answer

• False - ringworm is caused by a fungus.

84
Question

• True or False
• Ringworm thrives on dry skin.

85
Answer

• False - Ringworm is more likely when you have
  frequent wetness (such as from sweating) and
  minor injuries to your skin, scalp, or nails.(11)

86
Toxoplasmosis

• Toxoplasmosis is caused by a single-celled
  parasite called Toxoplasma gondii.
• While the parasite is found throughout the
  world, more than 60 million people in the United
  States may be infected with the Toxoplasma
  parasite.
• Of those who are infected, very few have
  symptoms because a healthy person's immune system
  usually keeps the parasite from causing illness.
  (13)

87
Toxoplasmosis

• However, pregnant women and individuals who have
  compromised immune systems should be cautious
  for them, a Toxoplasma infection could cause
  serious health problems. (13)

88
How do I get it?

• By accidentally swallowing cat feces from a
  Toxoplasma-infected cat that is shedding the
  organism in its feces. This might happen if you
  were to accidentally touch your hands to your
  mouth after gardening, cleaning a cat's litter
  box, or touching anything that has come into
  contact with cat feces. (13)

89
How do I get it?

• Eating contaminated raw or partly cooked meat,
  especially pork, lamb, or venison by touching
  your hands to your mouth after handling
  undercooked meat. (13)
• This is a far more likely source than the family
  cat.

90
How do I get it?

• Contaminating food with knives, utensils, cutting
  boards and other foods that have had contact with
  raw meat.
• Drinking water contaminated with Toxoplasma.
• Receiving an infected organ transplant or blood
  transfusion, though this is rare. (13)

91
How do I get it?

• An infected pregnant woman can transmit the
  infection to her fetus (congenital
  toxoplasmosis). (14)

92
Symptoms - Animals

• Cats rarely have symptoms when first infected, so
  most people do not know if their cat has been
  infected.
• The infection will go away on its own therefore
  it does not help to have your cat or your cat's
  feces tested for Toxoplasma. (13)

93
Symptoms - People

• Symptoms of the infection vary.
• Most people who become infected with Toxoplasma
  are not aware of it.
• Some people who have toxoplasmosis may feel as if
  they have the "flu" with swollen lymph glands or
  muscle aches and pains that last for a month or
  more. (13)

94
Symptoms

• Severe toxoplasmosis, causing damage to the
  brain, eyes, or other organs, can develop from an
  acute Toxoplasma infection or one that had
  occurred earlier in life and is now reactivated.
  Severe cases are more likely in individuals who
  have weak immune systems, though occasionally,
  even persons with healthy immune systems may
  experience eye damage from toxoplasmosis. (13)

95
Symptoms

• Most infants who are infected while still in the
  womb have no symptoms at birth, but they may
  develop symptoms later in life.
• A small percentage of infected newborns have
  serious eye or brain damage at birth.(13)

96
Who is at heightened risk?

• People who are most likely to develop severe
  toxoplasmosis include
• Infants born to mothers who became infected with
  Toxoplasma for the first time during or just
  before pregnancy.
• Persons with severely weakened immune systems,
  such as individuals with HIV/AIDS, those taking
  certain types of chemotherapy, and those who have
  recently received an organ transplant. (13)

97
Prevention/Precautions

• There are several general sanitation and food
  safety steps you can take to reduce your chances
  of becoming infected with Toxoplasma.
• Wear gloves when you garden or do anything
  outdoors that involves handling soil. Cats, which
  may pass the parasite in their feces, often use
  gardens and sandboxes as litter boxes. Wash your
  hands well with soap and water after outdoor
  activities, especially before you eat or prepare
  any food. (13)

98
Prevention/Precautions

• When preparing raw meat, wash any cutting boards,
  sinks, knives, and other utensils that might have
  touched the raw meat thoroughly with soap and hot
  water to avoid cross-contaminating other foods.
  Wash your hands well with soap and water after
  handling raw meat.

99
Prevention/Precautions

• Cook all meat thoroughly that is, to an internal
  temperature of 160 F and until it is no longer
  pink in the center or until the juices become
  colorless.
• Do not taste meat before it is fully cooked. (13)

100
Precautions/Prevention for Pregnant Women

• Have someone else change the litter box or wear
  disposable gloves if someone else cant do it and
  wash your hands thoroughly with soap and water
  afterwards.
• Change the litter box daily the parasite does
  not become infected until one to five days after
  it is shed in the feces.
• Feed your cat commercial dry or canned feed

101
Precautions/Prevention for Pregnant Women

• Never feed cats raw meat because this can be a
  source of toxoplasma infection.
• Keep your cat indoors.
• Avoid stray cats, especially kittens.
• Cover outdoor sandboxes.
• Do not get a new cat while you are pregnant.

102
Precautions/Prevention for Pregnant Women

• Generally if a woman has been infected with
  Toxoplasma before becoming infected, the infant
  will be infected because the mother is immune.
• Some experts suggest waiting six month after a
  recent infection before becoming pregnant.

103
Once infected with Toxoplasma is my cat always
able to spread the infection to me?

• No, cats only spread Toxoplasma in their feces
  for a few weeks following infection with the
  parasite.
• Like humans, cats rarely have symptoms when first
  infected, so most people do not know if their cat
  has been infected.
• The infection will go away on its own therefore
  it does not help to have your cat or your cat's
  feces tested for Toxoplasma.

104
Review Questions

• True or false
• Most people with toxoplasmosis exhibit no
  clinical signs of having it.

105
Answer

• True

106
Review Question

• Are there any groups of people who are at
  heightened risk of suffering from harmful
  symptoms of toxoplasmosis?

107
Answer

• Yes previously uninfected pregnant women and
  individuals who have compromised immune systems
  should be cautious for them, a Toxoplasma
  infection could cause serious health problems.
  (13)

108
Cat Scratch Disease

• What is it?
• Cat scratch disease (CSD) is a bacterial disease
  caused by Bartonella henselae. (15)

109
How do I get it?

• Most people with CSD have been bitten or
  scratched by a cat. (15)

110
Prevalence and Symptoms in Cats

• Kittens are more likely to be infected and to
  pass the bacterium to people.
• About 40 of cats carry B. henselae at some time
  in their lives.
• Cats that carry B. henselae do not show any signs
  of illness therefore, you cannot tell which cats
  can spread the disease to you. (15)

111
Symptoms - People

• Mild infection at the point of injury
• Lymph nodes, especially those around the head,
  neck, and upper limbs, become swollen.
• Fever, headache, fatigue, and a poor appetite.

112
Symptoms

• Rare complications of B. henselae infection are
  bacillary angiomatosis (reddish elevated lesions
  often surrounded by a scaly ring) and Parinaud's
  oculolandular syndrome. (15)

bacillary angiomatosis
113
Heightened Risk

• People with immunocompromised conditions, such as
  those undergoing immunosuppressive treatments for
  cancer, organ transplant patients, and people
  with HIV/AIDS, are more likely than others to
  have complications of CSD. (15)

114
Prevention/Precautions

• Avoid "rough play" with cats, especially kittens.
  This includes any activity that may lead to cat
  scratches and bites.
• Wash cat bites and scratches immediately and
  thoroughly with running water and soap.
• Do not allow cats to lick open wounds that you
  may have.
• Control fleas.
• If you develop an infection (with pus and
  pronounced swelling) where you were scratched or
  bitten by a cat or develop symptoms, including
  fever, headache, swollen lymph nodes, and
  fatigue, contact your physician. (15)

115
Case Report

• In July 2000, a boy aged 5 years was admitted to
  a local hospital after having fever (with
  temperature reaching 104 F 40C) for 12 days
  and left upper quadrant pain for 8 days. Except
  for fever and inflamed tympanic membranes, the
  physical examination was unremarkable.
• The child had sustained a scratch from a kitten 2
  months before onset of illness. His serologic
  titer for B. henselae obtained on day 14 of
  illness was 14096. (16)

116
Review Questions

• True or False
• Kittens are more likely to be infected and to
  pass the Cat Scratch Disease to people.

117
Answer

• True

118
Question

• People with ________conditions, such as those
  undergoing treatments for cancer, organ
  transplant patients, and people with HIV/AIDS,
  are more likely than others to have complications
  of CSD. (15

119
Answer

• immunosuppressed

120
Capnocytophaga canimorsus Sepsis(previously
referred to as Dysgonic fermenter -2 infection)

• What is it?
• Dysgonic fermenter-2 is a fastidious,
  gram-negative, opportunistic pathogen that can
  cause multiorgan disease in human beings.

Capnocytophaga canimorsus
121
What is it?

• The first case of DF-2 infection was reported in
  1976, when the organism was isolated from the
  blood and CSF of a patient who had been bitten by
  2 dogs.
• Dysgonic fermenter-2 is an organism of low
  virulence, usually causing serious illness only
  in people with impaired defense mechanisms
  against infection.(17)

122
How do I get it?

• In one study, DF-2 was isolated from the
  oronasal fluids of 8 of clinically normal dogs.
• The organism has been recovered from the oral
  cavity of dogs and cats that bit persons who
  later developed DF-2 infection. (17)

123
How do I get it?

• Most human patients with DF-2 infection report a
  history of a recent dog bite.
• Many of the remaining patients mention a history
  of animal exposure. (17)
• In most (77) cases, infection is preceded by a
  bite or other exposure to dogs. (18)

124
Symptoms

• Dysgonic fermenter-2 is an organism of low
  virulence for people with intact defense
  mechanisms
• In most instances, dog and cat bites cause DF-2
  infection only in people in high-risk groups.
  (17)

125
Symptoms

• The severity of clinical symptoms in DF-2
  infections varies from signs of fulminant
  postsplenectomy sepsis, to a milder disease in
  patients with intact spleens,in which fever and
  cellulitis are the most common signs. (17)

Cellulitis
126
Symptoms

• Localizing signs in severely affected patients
  include endocarditis, purulent meningitis, and
  septic arthritis. Symmetric peripheral gangrene
  may develop, and a necrotizing eschar may form at
  the bite site.(17)

127
Heightened Risk

• Most fatal infections have occurred in persons
  with a history of asplenia, alcoholism, or
  hematologic malignancy. (18)

128
Prevention/Precautions

• People in high-risk groups, especially asplenic
  individuals, should be aware of the dangers of
  being bitten by dogs and cats and should seek
  prompt medical attention if bitten.
• Asplenic people should consider wearing a
  bracelet to inform health care personnel of their
  condition in case of emergency.(17)

129
Prevention/Precautions

• One author has recommended that "given the
  frequency with which DF-2 is found in the oral
  microflora of dogs and cats, asplenic individuals
  should be advised not to keep dogs and cats as
  pets."
• Although this advice may be controversial, it
  would be prudent for asplenic individuals to
  minimize the chances for dog or cat bites at work
  or at home. (17)

130
Review Questions

• True or False
• Capnocytophaga canimorsus Sepsis causes severe
  illness in virtually anyone who is infected with
  it.

131
Answer

• False it usually causes serious illness only in
  people with impaired defense mechanisms against
  infection.

132
Question

• True or false Alcoholism is a risk factor in
  developing serious illness relating to
  Capnocytophaga canimorsus Sepsis.

133
Answer

• True

134
References

• 1. CDC. Toxocariasis Fact Sheet.
  http//www.cdc.gov/ncidod/dpd/parasites/toxocara/f
  actsht_toxocara.htm
• 2. CDC. Guidelines for Veterinarians Prevention
  of Zoonotic Transmission of Ascarids and
  Hookworms of Dogs and Cats. http//www.cdc.gov/nci
  dod/dpd/parasites/ascaris/prevention.htm
• 3. American Veterinary Medical Association.
  What You Should Know About External Parasites
  Caring For Animals (Pamphlet). 2/04.
• 4. Chailleux, Paradis. Efficacy of selamectin in
  the treatment of naturally acquired
  cheyletiellosis in cats. http//www.pubmedcentral.
  gov/articlerender.fcgi?toolpmcentrezartid339606
  
• 5. Holly Nash, DVM, MS Cheyletiella yasguri, C.
  blakei (Rabbit Fur Mite) http//www.peteducation.
  com/article.cfm?articleid725
• 6. CDC. About Rabies. http//www.cdc.gov/ncidod/
  dvrd/rabies/introduction/intro.htm
• 7. CDC. Rabies Questions and Answers.
  http//www.cdc.gov/ncidod/dvrd/rabies/quesans/qa
  .htmHow20do20people20get20rabies
• 8. Porkas, Mark, DVM. Pro-med mail post.
  November 30, 2004.
• 9. CDC. Rabies for Kids. http//www.cdc.gov/ncid
  od/dvrd/kidsrabies/
• 10. CDC. Rabies Prevention and Control.
  http//www.cdc.gov/ncidod/dvrd/rabies/PreventionC
  ontrol/preventi.htm
• 11. Medline Plus. Ringworm. http//www.nlm.nih.g
  ov/medlineplus/ency/article/001439.htm
• 12. CDC. Ringworm and Animals.
  http//www.cdc.gov/healthypets/diseases/ringworm.h
  tm
• 13. CDC. Toxoplasmosis Fact Sheet.
  http//www.cdc.gov/ncidod/dpd/parasites/toxoplasmo
  sis/factsht_toxoplasmosis.htm

135
References

• 14. Medline. Toxoplasmosis. http//www.nlm.nih.g
  ov/medlineplus/ency/article/000637.htm
• 15. CDC. Cat Scratch Disease.
  http//www.cdc.gov/healthypets/diseases/catscratch
  .htm
• 16. CDC. Morbidity and Mortality Monthly
  Report. Cat-Scratch Disease in Children Texas,
  September 2000-August 2001. http//www.cdc.gov/mmw
  r/preview/mmwrhtml/mm5110a4.htm
• 17. August, John R. Dysgonic fermenter -2
  infections. JAVMA, Vol 193, December 15, 1988.
• 18. CDC. Morbidity and Mortality Weekly Report.
  Capnocytophaga canimorsus Sepsis Misdiagnosed as
  Plague New Mexico , 1992.
• 19. USDA. Protection of Human Health and
  Safety. http//www.aphis.usda.gov/ws/wshl97/health
  .html.
• 20. http//rdu.news14.com/content/your_news/durham
  chapel_hill/?ArID71561SecID42

136
Disclaimer

• This presentation was created while I was an
  employee of Priority One Services (POS) at the
  National Institute of Environmental Health
  Sciences (NIEHS). Thus, both organizations
  deserve credit for supporting the work.
• However, opinions expressed in this presentation
  are mine and do not necessarily reflect those of
  POS, NIEHS, or UNC DLAM.