ZOONOSES Zoonoses in Shelters n Zoonosis disease passed

ZOONOSES

Zoonoses in Shelters n Zoonosis – disease passed from animals to man n Anthroponosis – disease passed from man to animals

“Right-to-Know” Stations n n Include MSDS sheets for every hazardous substance in the shelter Locate stations throughout shelter Excellent for emergencies Info about zoonoses here

Types of Pathogens Viruses n Bacteria n Fungi n Others n – Rickettsia – Protozoa – Parasites Always assume every animal is shedding pathogens

How Diseases Spread n Through feces: • • • Parvo Feline panleukopenia Salmonella Toxoplasma Worm eggs (rounds, whips, hooks) • Giardia and Coccidia n Fecal-oral – infectious organism ingested after being passed in feces

How Diseases Spread n Fecal-oral – Fecal contamination is not always obvious – Many pathogens may survive for long periods of time in the environment. – Parvovirus, ringworm and some worm eggs can survive for years

How Diseases Spread n By air (aerosol) – Upper respiratory infection (URI -cats) – Kennel cough (dogs)

How Diseases Spread n Aerosol – Aerosols travel only 3 -4 feet, so dividers between cages help – 12 -15 fresh “air exchanges” per hour minimum is recommended – “Air change” is also good » Open windows or fan brings outside air in » After moving through the room, another fan blows air back outside – Fans blowing directly on animals can spread disease by creating aerosols

How Diseases Spread n Animal bites or saliva – Feline leukemia – FIV – Rabies – Bacteria that can cause bite wound abscesses

How Diseases Spread n Animal bites or saliva – Saliva spread (Fe. LV): » Grooming each other » Sharing food and water bowls – FIV and Rabies require bites, not just friendly casual contact

How Diseases Spread n Through direct contact – Ringworm – Scabies – Ear mites – Hookworm larvae

How Diseases Spread n By insect “vectors” – Mosquitoes spread heartworms and encephalitis – Fleas spread tapeworms, cat scratch fever, plague, typhus, etc. – Ticks spread Lyme disease, Rocky Mountain Spotted Fever, and more – Vectors must be controlled in the shelter » Eliminate standing water (mosquitos) » Treat fleas on animals and in environment » Keep grass cut to limit ticks

How Diseases Spread n By infected objects (fomites) – Ringworm spread by spores on pet hair – Cage walls, toys, and bedding – Peoples’ hands – including staff!

12 Tips to Help You Avoid Zoonotic Diseases n n Stay current on appropriate vaccinations (tetanus, rabies) Wash hands frequently with antibacterial soap – – n n before eating or smoking After handling each animal or cage Wear long pants and sturdy shoes or boots Use gloves Wear safety glasses and mask when spray cleaning Disinfect scratches and bite wounds thoroughly, then cover them.

12 Tips to Help You Avoid Zoonotic Diseases n n n Don’t allow animals to lick your face or any open wounds Learn safe & humane animal-handling techniques, and user proper equipment Seek assistance when handling questionable animals Report any bites or injuries to supervisor Tell your physician where you work Consider other work if you are immunosuppressed.

Viral Zoonoses Rabies n Monkeypox n Avian flu (cats, dogs, horses) n West Nile Virus n Eastern Equine Encephalitis n Hantavirus n Lymphochoriomeningitis n

Monkeypox n Carriers – Rats, prairie dogs and rabbits – Especially when imported from Africa Transmission – direct contact n Symptoms (carrier) n – Listlessness, respiratory infection – Patchy hair loss with scabs n Symptoms (people) – Fever and pox-like rash 1 -2 weeks after handling rodents

Monkeypox Treatment - supportive n Prognosis n – 10% human fatality in Africa – Much lower mortality in the US n Prevention – Avoid contact with rodents from Africa – Rodents imported from Africa were banned after a 2003 outbreak – Smallpox vaccine affords some protection

Lymphochoriomeningitis (LCMV) n Carriers – Rodents - including pocket pets such as hamsters. n Symptoms in people – Mostly a problem in geriatric and immunocompromised people. – The early phase - flu-like symptoms – The late phase – neurologic problems like rabies and rarely death n Lawsuit – Pet. Smart was sued because they sold a hamster infected with LCMV to a person who was infected and died of a stroke. – That person’s liver was transplanted into a man who then died of LCMV.

West Nile and Eastern Equine Encephalitis n n Carriers – horses, birds and other animals Transmission – mosquito bite Symptoms (horses) – neurologic problems Symptoms (people) – 90% do not become ill – Illness in the geriatric and immunocompromised – Fever, signs of meningitis (neck pain, headache, neurologic problems) n n n Treatment - supportive Prognosis – fatal in a small number of people Prevention – mosquito control, vaccinate horses

Bacterial Zoonoses Bartonella sp. – Cat Scratch Fever n Bordetella bronchiseptica – Kennel Cough n Borrelia burgdorferi – Lyme Disease n Brucella canis – Undulant Fever n Campylobacter spp. n Chlamydia spp. – Parrot Fever n Clostridium tetani - Tetanus n Capnocytophagia - DF 2 (dysgonic fermenter 2) n

Bacterial Zoonoses Escherichia coli n Francisella tularensis - Tularemia n Leptospira interrogans – Weil’s Disease n Mycobacterium spp. – Leprosy and Tuberculosis n Pasteurella multocida n Salmonella spp. n Shigella spp. n Spirillum minus – Rat Bite Fever n Yersinia pestis – Bubonic Plague n

Cat Scratch Fever Carriers - Cats infected by a flea bite n Transmission n – Not transmitted directly from cat to cat – Transmitted from cat to person by bite or scratch n Symptoms (cat) – Many are asymptomatic carriers – May have fever and lethargy, enlarged lymph nodes for a period of time

Cat Scratch Fever n Symptoms (People) – Relapsing fever – Enlarged lymph nodes, with red lines on the skin » inflamed lymph vessels » Called “bacillary angiomatosis” – Liver and spleen infections (“peliosis”) – Infected heart valves (endocarditis) – Mostly in immunocompromised people and children

Cat Scratch Fever Treatment - antibiotics n Prognosis – good if treated n Prevention n – Control fleas and ticks – Treat cats with antibiotics – Cats owned by immunocompromised people should be tested for Bartonella

Lyme Disease Affects dogs and humans (not cats) n Prevalent only in certain areas – check with your vet n Transmission n – deer ticks - Ixodes spp. – must be attached for at least 24 hours, to cause infection

Lyme Disease n Symptoms – Early » Skin rash at the tick bite » Fever, muscle aches, enlarged lymph nodes – Late » Neurologic, Kidney, Heart disease » arthritis

Lyme Disease Treatment - antibiotics n Prognosis n – Difficult to cure dogs – People treatable if treated early – Difficult to cure chronic infections in people n Prevention – control ticks – Non-core vaccine available for dogs

Undulant Fever n Carriers – dogs (can be asymptomatic), cattle, pigs n Transmission – contact with urine, discharge of estrus (heat), afterbirth, aborted fetuses

Undulant Fever n Symptoms (dogs) – Inflamed testicles, Scrotal dermatitis – Enlarged lymph nodes or spleen – Weight loss, poor hair coat – Abortion, neonatal death, sick puppies – Eye infections – Infections in the disks in the back

Undulant Fever n Symptoms (people) – Fever, chills, muscle aches – Weight loss – Enlarged lymph nodes or spleen n Treatment – Antibiotics

Undulant Fever n Prognosis – Immunocompromised people and children more likely to get infected – tends to relapse and difficult to cure in dogs and people n Prevention – Wear gloves, wash hands when handling female dogs in heat, aborted puppies or urine

Parrot Fever AKA – Psittacosis, Ornithosis, avian chlamydiosis n Carriers – birds >> cats n Transmission n – feces and nasal discharge from infected birds – Birds can shed for several months – People infected by inhaling dried secretions, feces or mouth-to-beak contact

Parrot Fever n Symptoms (carrier) – Upper respiratory – Gastrointestinal & hepatitis n Symptoms (people) – Flu-like, respiratory Treatment - antibiotics n Prognosis – good with treatment n

Tetanus Carriers – animal mouths and anything not sterile that can cause a deep puncture wound n Transmission – puncture by tooth or object n Symptoms (people & animals) n – Horses & sheep > goats, dogs, cattle, etc. – Fever and muscle soreness, progressing to uncontrolled muscle contraction – “sardonic risus” – grimacing of facial muscles – p. 8 – not actually “neurologic signs”

Tetanus Treatment - antibiotics n Prognosis n – Excellent if treated early – Can be fatal if untreated n Prevention – Every shelter worker should be current on tetanus vaccination – Once every 7 -10 years

DF 2 Bacteria that can and often does live in a normal dog mouth n Does not infect most people n Can cause fatal infection in people who have had their spleen removed n People who do not have a spleen should think very carefully about working daily with dogs n

Tularemia (Rabbit Fever) Infects birds, mammals, people n Transmission n – Dogs, cats and people are infected by tick bites (Dermacentor spp. ) or eating raw rabbit meat – People can be infected by dog and cat bites, or rarely “kisses” from dogs – Puppies more susceptible than adults n Symptoms – Fever – Enlarged lymph nodes or spleen

Tularemia (Rabbit Fever) n n n Treatment - antibiotics Prognosis – relapse is common Prevention – – – Tick control Keep dogs and cats from hunting rabbit Wear gloves when cleaning rabbit meat carcasses Do not eat lightly cooked or raw rabbit meat Beware puppy kisses, especially if they hunt rabbit

Leprosy and Tuberculosis Carriers – any warm blooded animal n Transmission n – Direct contact with secretions from wounds – Respiratory aerosols n Symptoms (carrier & people) – Respiratory infection – Draining wounds Treatment – long term antibiotics n Prognosis - variable n

Leptospirosis n Carriers – warm blooded wildlife, rodents, livestock, dogs – Cats do not get this disease n Transmission – Shed in the urine, which contaminates standing water (including lakes used for water sports) – Dogs can shed for up to a year after infection – Animal caretakers can be exposed by contacting infected dog urine

Leptospirosis n Symptoms – Chronic urinary tract infection – Kidney failure – Liver failure (jaundice) – Fever

Leptospirosis n Treatment – Treat liver and/or kidney failure – Penicillins to treat disease – Tetracycline to eliminate the carrier state Prognosis – 85% do well if treated n Prevention n – Dog vaccine for 4 of serovars – Immunity lasts about a year – Handle dog urine with gloves, wash hands – Protect mouth and eyes when hosing kennels

Rat Bite Fever AKA – Streptobacillary fever, sodoku, epidemic arthritic erythema n Carriers – rodents (especially rats) n Transmission n – Urine, feces or mucous secretions – Bite (slow healing, inflamed wound) – Contaminated food or water n Symptoms (people) – recurring fever and sometimes gastrointestinal upset

Rat Bite Fever Treatment - antibiotics n Prognosis – good with treatment n Prevention – rodent control n

Rickettsial Zoonoses n n n Rickettsia – small bacteria like organism that lives inside the cells of its host. Often carried by ticks or fleas. Rickettsia ricketsii – Rocky Mountain Spotted fever Wolbachia spp. – a rickettsia that infects the canine heartworm, causing significant inflammation in the dog Typhus Many think Lyme Disease is a rickettsia, but it is a large bacteria

Rocky Mountain Spotted Fever n n Transmission – ticks (Dermacentor spp. ) Symptoms (dogs) – – n Fever, back pain, lethargy Swollen ears, nose, face, under belly Kidney failure Low platelet count Symptoms (people) – – – Fever, headache, muscle pain Skin rash (red dots – petechiae) Nausea, vomiting

Rocky Mountain Spotted Fever Treatment – antibiotics, cortisones n Prognosis n – Can be fatal to dogs if not treated – Dogs who are treated early do very well – 5 -10% fatal to people n Prevention – Control ticks

Typhus Carriers – fleas and lice n Transmission – by flea or louse bite n Symptoms (people) n – Flu-like symptoms, backache, fever – Dull red rash starting on the body & spreading – Nausea, vomiting, delirium if severe Treatment - antibiotic n Prognosis – excellent with antibiotics, poor if untreated n Prevention – flea control n

Fungal Zoonoses Blastomyces – systemic fever n Coccidioides – bone infection n Cryptococcus – skin lesions n Dermatophytes (ringworm)– skin lesions n Histoplasma – systemic fever n Sporothrix schenkii – skin lesions, fever n

Ringworm n n Fungal infection of skin – not a worm Puppies with infected tails and feed usually have ringworm, but this kind is often easily treated Ringworm more severe in cats than dogs Transmission: direct, fomites – Ringworm can be very difficult to eliminate from a shelter, once it is infected – Infected hairs fly through the air and infect all they land on; gets in the air ducts – All surfaces must be cleaned with strong bleach 1: 10 – Infected animals must be isolated, and probably should be removed from the shelter ASAP – Infected foster homes may need to be rested until clean – All cats in the shelter should be tested

Ringworm n Some cats are carriers with no symptoms – Especially long hair cats (Persians) n Diagnosis: – Sometimes can see fungal hyphae on infected hairs under the microscope Ringworm macroconidia – fungal culture of hairs at the edge of the round hairless lesion – DTM media turns red, and RSM turns blue-green Fungal hyphae on an infected hair – MUST examine culture growth to tell ringworm from another fungal contaminant – Ultraviolet light – infected hairs glow green (50%)

Ringworm n Treatment: – Mild cases resolve on their own or with topical treatment (Tresaderm, Lotrimin, Lymdyp) – Severe cases need oral antifungals for weeks to months (griseofulvin, itraconazole, fluconazole, terbinafine) – ITRACONAZOLE SUSPENSIONS MAY NOT BE EFFECTIVE (may not be absorbed) – Severe cases can be disastrous for herd health – Program (lufenuron) was thought to help years ago, but studies have shown that it does not n People vary greatly in their susceptibility to ringworm

Protozoal Zoonoses Protozoon – microscopic parasite n Coccidia spp. n Cryptosporidium parvum n Giardia – Beaver Fever n Toxoplasma gondii n Encephalitozoon cuniculi n

Cryptosporidium Affects most warm blooded animals n Occasionally contaminates water supplies n Transmission – fecal-oral n Symptoms n – Rarely infects healthy dogs and cats – Can cause chronic diarrhea in Fe. LV cats – Commonly causes diarrhea in calves – Most people have a “GI bug” for a few days – Rarely causes severe infection in people

Cryptosporidium n Treatment & Prognosis – – antibiotics – Acute infections are usually self limiting – Chronic infections can be difficult to treat n Prevention – good hygiene and water filtration

Giardia Affects mostly dogs, but also cats n Causes diarrhea and sometimes vomiting n Transmission – fecal-oral, including contaminated water n Asymptomatic carriers possible cyst n Diagnosis: fecal wet mount or flotation, trophozoite ELISA n Treatment: metronidazole, fenbendazole n

Toxoplasmosis n Carriers – cats – Cats are infected by hunting and eating their prey, or by coming into contact with oocysts in feces from infected cats n Transmission – People are infected by coming in contact with cat feces containing oocysts more than 24 -48 hours old. – Cats often shed for only a few weeks immediately after infection

Toxoplasmosis n Symptoms (cat) – Sometimes asymptomatic – Muscle pain, neurologic, eye problems, fever – “ouchy grouchy” cats n Symptoms (people) – Many have no disease – Fever, swollen lymph nodes, muscle aches – Birth defects in pregnant women (retinochoroiditis causing blindness_ n Treatment – antibiotics – No effective treatment for babies with birth defects

Toxoplasmosis Prognosis – good for cats and adults n Prevention – Don’t eat raw meat or unwashed vegetables – clean litter box daily, using gloves – 2 titers 2 weeks apart (cats and pregnant women) » Both high means history of infection – likely no shedding by the cat (50% of cats will be like this) » Both low means the person/cat has not been exposed » Low and then high means active infection, and cat may be shedding for the next 2 -3 weeks n Pregnant woman should be treated with antibiotics

Encephalitizoon cuniculi Carriers - rabbits n Transmission – rabbit urine is infective n Symptoms (rabbit) n – Often no symptoms – May cause paralysis or head tilt n Symptoms (people)

Encephalitizoon cuniculi n Symptoms (people) – Neurologic problems and seizures – More of a problem in children and the immunosuppressed Treatment – difficult to treat in rabbits and people n Other things that can cause head tilt but not paralysis in rabbits: n – Ear mites – Ear infection

Helminth Zoonoses Helminth = worm n Ancylostoma caninum - hookworms n Bayliascaris procyonis – raccoon roundworm n Tapeworms n – Dipilydium caninum – Echinococcus granulosa – Hydatid disease – Taenia spp. Toxocara cati – roundworm n Uncinaria spp. - hookworm n

Cutaneous Larval Migrans Larvae hatch out of eggs in the ground n And then burrow into skin they come into contact with n Causes intensely itchy red winding tracks n Often on the feet and hands, and back side if sitting on the dirt n Caused by: n – Hookworms – Uncinaria and Ancylostoma spp. – Threadworms – Strongyloides stercoralis.

Visceral Larval Migrans n When worm larvae burrow through tissues in the body, causing inflammation – Happens in the normal host species when there is a high parasite burden – Happens when the worm infects another host, can not mature, and wanders around the body n Can result in pneumonia, encephalitis (brain inflammation), myocarditis (heart inflammation), diarrhea (intestinal inflammation), etc.

Visceral Larval Migrans n Ocular Larval Migrans is a particular form of VLM that affects the eyes – can cause blindness in children – Can be confused with a bilateral malignant eye tumor called retinoblastoma in children that is treated by removing the eyes – Eyes with OLM have been removed by mistake due to misdiagnoses

Visceral Larval Migrans n VLM and OLM caused by: – Roundworms of dogs and cats – Toxacara cati, Toxacara canis – Roundworm of raccoon - Bayliascaris procyonis » Encephalitis by this parasite can be fatal Transmission is fecal-oral n REMIND KIDS TO WASH THEIR HANDS AFTER PLAYING WITH PUPPIES AND KITTENS!! n

Hookworms Ancylostoma spp. and Uncinaria spp. n Transmission n – Fecal-oral (eggs) – dog to dog – L 3 larvae can also burrow into the skin from dirt (bare feet) – dog to dog, or dog to person n Symptoms (dogs) – Bloody or black/tarry stools – Anemia can be fatal if severe – Can also infect cats, but less commonly and less severe

Hookworms n Symptoms (people and dogs) – Cutaneous larval migrans (L 3 in skin) – Red serpentine tracks in the skin n Prevention – Always wear shoes where animals eliminate – Wear gloves, wash hands/skin when exposed to dog feces

Tapeworms Dipylidium caninum n People can be infected by ingesting a flea, just as dogs and cats are n People can not get this tapeworm directly from cats and dogs, even by ingesting tapeworm segments passed in the pet’s feces n Zoonosis causes little damage and is easily treated by deworming pets and people

Tapeworms n Taenia pisiformis – People can not get this tapeworm directly from dogs and cats, even if they ingest tapeworm segments shed in the pet’s feces – Dogs and cats get this tapeworm by eating raw rabbit or squirrel – People can’t get this tapeworm, even if they ate raw rabbit or squirrel – it does not live in people

Tapeworms n Echinococcus granulosa – The only tapeworms that CAN be passed directly from dogs to people. – A person gets infected by ingesting a tapeworm segment passed in the feces – Dog is infected by ingesting larvae in raw meat of sheep and other animals – Sheep is infected by eating worm segments passed by a dog, as a person would be

Tapeworms n Echinococcus granulosa – People, sheep and other animals that ingest worm segments develop severe problems from larval cysts in the tissues called “hydatid cysts” – Cysts are treated with antiparasitic drugs and/or surgical removal – People are a dead end or “paratenic host, ” unless the person is eaten ! – This kind of tapeworm is very rare in the dog.

Arthropod Zoonoses n Arthropod = bugs (insects & arachnids) – Arachnids = ticks and spiders Chyletiella (Walking Dandruff) n Fleas & Ticks n Sarcoptes scabei – dog scabies n Lice on birds, deer, cattle, etc. n Lice on cats and dogs are rare n

Chyletiella n n n Causes very bad dandruff, which is actually “walking” if you look closely with a magnifying glass Can affect dogs, cats, rabbits and people Symptoms – itchy, scaly skin Diagnosis – flea comb and look under microscope to see mites (has CLAWS!!) Treatment – Frontline, ivermectin, lime sulfur dip, pyrethrin spray or dip (Adams Flea Off, Ovitrol) Prevention – wash hands after handling pets

Scabies n n People can get scabies from dogs by direct contact Symptoms: – Very itchy red bumps, often in warmest parts of the body – Can sometimes see a tiny dark spot within the redness where the mite is n n n Infection is usually self limiting, but can go on for weeks and is MISERABLE Treatment: permethrin/pyrethrin lotion if needed Prevention: – wash hands after handling dogs – Wear gloves when handling dogs with skin disease

Reportable Zoonotic Diseases in Shelters Some diseases must by law be reported to your local/state health department n They will then notify the CDC if needed n – Anthrax – likely only in horses, cattle – Undulant Fever (Brucellosis) – Eastern Equine Encephalitis – West Nile Virus – Hantavirus – Lyme Disease

Reportable Zoonotic Diseases in Shelters – Lyme Disease – Bubonic Plague – Rocky Mountain Spotted Fever – Rabbit Fever (Tularemia) – Leptospirosis (Weil’s Disease) is no longer reportable – Rabies – Monkeypox

Zoonoses Transmitted by Bites & Scratches – Rabies – Pasteurella multocida and many other bacteria – DF 2 (Cytocapnophagia spp. ) – Rabbit Fever (Tularemia – Francisella tularensis) – Tetanus

“Shelter Worker Diarrhea” Bacteria – Campylobacter spp. – E. coli – Salmonella spp. – Shigella spp. Protozoa – Cryptosporidium parvum – Coccidia spp. – Giardia spp.

“Shelter Worker Itchy Skin” Parasites (Worms) – Hookworms – Ancylostoma and Uncinaria spp. Parasites (Mites) – Scabies – Sarcoptes scabei – Chyletiella spp. Ectoparasites – Fleas and Lice Fungi - Ringworm

Immunocompromised Owners and Shelter Workers Disclaimer on adoption paperwork: A number of medical conditions can weaken the immune system, including but not limited to chemotherapy for cancer, organ transplant anti-rejection drugs, autoimmune disease drugs, pregnancy, very young or very old age, HIV infection, or removal of the spleen. If you are affected by any medical condition which may suppress your immune system, please ask us for more information about any special precautions that might need to be taken when making a place for your new pet in your home. If you are not sure whether you have a medical condition which may suppress your immune system, please consult with your physician before adopting a new pet.

Web Resources – www. wendyblount. com Animal Sheltering Articles: – Zoonotic Disease: The Enemy In Our Midst – Protect Your Staff, Protect Yourself – The Real Scoop on Reptile Poop

Web Resources – www. wendyblount. com Client Handouts: – Your Pregnancy and Your Cat – AVMA Toxoplasmosis Brochure – Spanish – AVMA West Nile Virus Brochure – Spanish – AVMA Dog Bite Brochure - Spanish – Safe Pet Guidelines: A Comprehensive Guide for Immunocompromised Animal Guardians

Web Resources – www. wendyblount. com Compendia: – NASPHV Compendium of Veterinary Standard Precautions for Zoonotic Disease Prevention in Veterinary Personnel 2008 – NASPHV Compendium of Measures To Control Chlamydophila psittaci Infection Among Humans and Pet Birds, 2010 – NASPHV Compendium of Measures to Prevent Disease Associated with Animals in Public Settings, 2009 – AAFP Report on Feline Zoonoses 2003