Zoonoses Zoltán Péterfi 1st Department of Internal Medicine, Dep. Infectology Pécs

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1 Zoonoses Zoltán Péterfi 1st Department of Internal Medicine, Dep. Infectology Pécs 06/10/2015

2 Zoonosis The term zoonosis was coined by Virchov (c. 1900) Now accepted by FAO and WHO (after years of wrangling) (1959) Those diseases and infections naturally transmitted between vertebrate animals and man.

3 Evolutionary classification Established zoonoses Infectious diseases with a non-human source which are occasionally transmitted to man but with little onward human-to-human transmission. e.g. rabies, hantaviruses, leptospirosis New and Emerging Zoonoses Infectious diseases with a non-human reservoir host which has only recently (or has been observed to) spread to man. e.g. Ebola, Hendra, Nipah, Schmallenberg Parazoonoses Infectious diseases, epidemic or endemic in man but which periodically change in virulence following acquisition of genes from non-human pathogens. e.g. influenza H5N1, noroviruses or hepatitis E virus

Routes of Transmission Direct contact Through animal bite Through scratch, abrasion or mucous membrane Via respiratory route Via arthropod vector By

4 Routes of Transmission Direct contact Through animal bite Through scratch, abrasion or mucous membrane Via respiratory route Via arthropod vector By ingestion Faeco-oral contamination Ingestion of meat, fish, shellfish, eggs or dairy products Disease Emergence and Resurgence: The Wildlife Human Connection

6 Re-Emerging infections Expanding Geographic Area Dengue Crimean Congo Haemorrhagic Fever Japanese Encephalitis, Melioidosis, Plague Global warming West Nile Fever Malaria Re-Emergence with social/political changes Diphtheria HIV Syphilis Tuberculosis Bioterrorism Anthrax 2001 Stupidity Monkeypox

7 Zoonoses: Bacterial Examples Anthrax* Brucellosis Campylobacteriosis Cat-scratch disease* Leptospirosis* Listeriosis Plague Psittacosis Q fever* Relapsing fevers Salmonellosis Tularemia* Lyme disease* * indicates covered in lecture Yersiniosis

8 Zoonoses: Viral Examples Colorado tick fever Ebola Equine encephalitides (WEE, EEE, VEE) Hantaviruses* Hendra Herpesvirus B Japanese encephalitis Monkeypox Nipah Rabies Rift Valley fever West Nile virus* Influenza * indicates covered in lecture Yellow fever

9 Zoonoses: Parasitic Examples PROTOZOAL Trypanosomiasis Babesiosis Cryptosporidiosis Leishmaniasis Giardiasis Toxoplasmosis* * indicates covered in lecture HELMINTHIC Baylisascariasis Cysticercosis Hydatidosis Schistosome dermatitis Trichinosis Visceral larva migrans and toxocariasis

10 Zoonoses: Mycotic Examples Aspergillosis Blastomycosis Cryptococcosis Dermatophytosis Histoplasmosis Sporotrichosis * indicates covered in lectures

11 Anthrax anthrax was described in the early literature of the Greeks, Romans, and Hindus. is primarily a disease of herbivores (eg, cattle, sheep, goats, horses). humans are relatively resistant to cutaneous invasion by B. anthracis most of the terms associated with anthrax relate to cutaneous or respiratory anthrax.

12 Pathophysiology the organisms may gain access through microscopic or gross breaks in the skin a malignant pustule develops at the infection site a black eschar forms at the ulcer site extensive edema surrounds the lesion dissemination into the bloodstream may result in bacteremia intestinal anthrax predominantly affects the cecum and produces local lesions inhalation anthrax occurs after inhaling spores into the lungs (does not cause pneumonia, but it cause hemorrhagic mediastinitis) (2001 USA)

13 Malignant pustule

14 Clinical pictures Cutaneous anthrax: develops 1-7 days (usually 2-5) after skin exposure malignant pustule Intestinal anthrax fever, nausea, vomiting, malaise, anorexia, abdominal pain, hematemesis, and bloody diarrhea Inhalation anthrax begins abruptly, usually 1-3 days after inhaling anthrax spores initially with nonspecific symptoms (low-grade fever and a nonproductive cough) after the initial improvement, progresses rapidly Septicemic anthrax massive amounts of lethal toxin cause shock and death

15 Treatment Diagnosis: ELISA, PCR penicillin is the preferred agent to treat (6x4 MU iv.) doxycycline (2x100 mg) and quinolones for bioterrorist anthrax, use any quinolone or doxycycline for 1-2 weeks doxycycline or any quinolone (eg, ciprofloxacin, levofloxacin) for postexposure prophylaxis

There are numerous types which are known to cause ONLY mild infection Leptospirosis causing bacteria are common Worldwide Infected rodents

16 Leptospirosis Leptospirosis is caused by Leptospira interrogans, a corkscrew-shaped bacterium (spirochete). There are over 200 variations of leptospira bacterium that can cause the disease. There are numerous types which are known to cause ONLY mild infection Leptospirosis causing bacteria are common Worldwide Infected rodents and other wild and domestic animals pass the bacteria in their urine. The bacteria can live for a long time in fresh water, damp soil, vegetation, and mud. Flooding after heavy rainfall helps spread the bacteria in the environment.

17 Leptospirosis All infections are classified into Icteric or Anicteric forms. The Anicteric is the most common type of infection. This type is generally not Fatal, though simultaneous infections or unrelated infections may prove fatal. The Icteric Weils infection is comparatively rare; can be fatal in severe cases, and accounts for 5 to 13% of all recorded cases.

18 Clinical pictures The infection follows a biphasic course, for the first 3 to 7 days, the septic phase, the bacterium spreads throughout the blood, CSF and most body tissues. Early symptoms are fever, chills, muscular aches and pains, loss of appetite, and nausea when lying down, conjunctivitis. Every infection has identical initial dynamics From 10 to 30 days the Immune phase sees the removal of the bacterium from the blood and CSF, but remains in the urine. During this stage many of the body systems show detriment.

19 Diagnosis and treatment Lab tests BUN, creatinine, proteinuria, microscopic hematuria AST, ALT WBC, PLT, CRP, ESR, Diagnosis: ELISA, PCR Treatment Doxycycline 2x100 mg Ampicillin 4x0,5-1 g Amoxicillin 4x500 mg

20 Hantaviruses Family Bunyaviridae RNA virus Genus Hantavirus Only genus not arthropod-borne Transmitted by murid rodents More than 25 hantavirus species Lipid envelope Deactivated by ordinary disinfectants

21 History While HPS has only been identified since 1993, HFRS has a much longer and complex history. HFRS may have been recognized in China as early as 1000 years ago. HFRS described in 1913 Russian records 1934: Sweden - Nephropathia Endemica 1950 s: Reports of Korean Hemorrhagic Fever (Korean War)

22 Hantaviruses in the Old World Serotype Host Location Hantaan Dobrava Seoul Apodemus agrarius (striped field mouse) A. agrarius, A. flavicollis (yellow neck mouse) Rattus norvegicus, R. rattus (Norway brown rat, roof rat) Asia, Far East Russia Europe Balkans Worldwide Puumala Clethrionomys glareolus (red bank vole) Europe

23 Hantaviruses in the New World Serotype Host Location Sin Nombre Peromyscus maniculatus (deer mouse) Central & West U.S., Canada Monongahela New York Bayou Black Creek Canal Peromyscus maniculatus (deer mouse) Peromyscus leucopus (whitefooted mouse) Oryzomys palustris (rice rat) Sigmodon hispidus (cotton rat) Eastern U.S., Canada Eastern U.S., Canada SE U.S. SE U.S.

24 Hantaviruses in the New World Serotype Host Location Andes Oligoryzomys longicaudatus (long-tailed pygmy rice rat) Argentina/Chile Oran O. longicaudatus NW Argentina Lechiguanas O. flavescens Central Argentina Hu39694 Unknown Central Argentina Laguna Negra Calomys laucha Paraguay/ Bolivia Juquitiba Unknown Brazil *Numerous other hantaviruses have been identified but not linked to human disease

25 Stages of Hemorrhagic Fever with Renal Syndrome (HFRS) 1. Incubation (4-40 days) 2. Febrile Phase (3-5 days) 3. Hypotensive Phase (hours to days) 4. Oliguric Phase (3-7 days) 5. Recovery: Diuretic Phase (2-21 days) Convalescent Phase (2-3 months)

26 Stages of Hantavirus Pulmonary Syndrome (HPS) 1. Incubation (4-30 days) 2. Febrile phase 3. Cardiopulmonary phase 4. Diuretic phase 5. Convalescent phase

Lyme disease Borrelia burgdorferi sensu stricto Borrelia afzelii

infected ticks belonging to a few species of the genus Ixodes

and a characteristic circular skin rash called erythema migrans.

27 Lyme disease Borrelia burgdorferi sensu stricto Borrelia afzelii and Borrelia garinii It is transmitted to humans by the bite of infected ticks belonging to a few species of the genus Ixodes early symptoms may include: fever, headache, fatigue, depression, and a characteristic circular skin rash called erythema migrans. later symptoms may involve the joints, heart, and central nervous system.

Carditis Neuroborreliosis lymphocytoma facial palsy, meningitis,

28 Lyme disease Erythema migrans Borrelial lymphocytoma (lymphyadenosis benigna cutis) Acrodermatitis chronica atrophicans Carditis Neuroborreliosis lymphocytoma facial palsy, meningitis, memory loss, sleep disturbance Arthritis EM Post-Lyme syndrome dermatitis atrophicanas

29 Erythema migrans

30 Erythema migrans

31 Treatment antibiotics duration dose amoxicillin 20 days 3x1 g cefuroxim 20 days 2x500 mg doxycyclin days 2x100 mg azithromycin 5-12 days 0,5-1 g ceftriaxon days 2 g fluoroquinolons are contraindicated

32 Q fever 1935: 1st described in Queensland, Australia Coxiella burnetii Rickettsial agent Obligate intracellular parasite Stable and resistant Killed by pasteurization Two antigenic phases Phase 1: virulent Phase 2: less pathogenic

33 Transmission Aerosol Parturient fluids 10 9 bacteria per gram of placenta Urine, feces, milk Wind-borne Direct contact Fomites Ingestion Arthropods (ticks)

34 Human Disease Incubation: 2-5 weeks One organism may cause disease Humans are dead-end hosts Usually show clinical signs of illness Disease Asymptomatic (50%) Acute Chronic

35 Acute Infection Flu-like, self limiting Atypical pneumonia (30-50%) Non-productive cough, chest pain Acute respiratory distress possible Hepatitis Skin rash (10%) Other signs (< 1%) Myocarditis, pericarditis, meningoencephalitis Death: 1-2%

36 Chronic Disease 1-5% of those infected Prior heart disease, pregnant women, immunocompromised Phase 1 IgG> phase 2 IgG Phase 1 IgG over 1:1024 Endocarditis Other Osteomyelitis Granulomatous hepatitis Cirrhosis 50% relapse rate after antibiotic therapy

37 Prognosis Overall case-fatality rate <1-2.4% 50% cases self-limiting Only 2% develop severe disease Active chronic disease Usually fatal if left untreated Fatality for endocarditis: 35-55% 50-60% need valve replacement

38 Diagnosis Serology (rise in titer) IFA, CF, ELISA, microagglutination DNA detection methods PCR Isolation of organism Risk to laboratory personnel Rarely done Treatment Treatment Doxycycline Chronic disease long course 2-3 years of medication (Hydroxychlorquin +Doxycyclin + TMP/SMX) Immunity Long lasting (possibly lifelong)

39 Tularaemia caused by the aerobic gram-negative, pleomorphic bacillus Francisella tularensis Risk Factors Handling infected animals Hunting, trapping, farming, butchering Ingestion of contaminated meat, water, soil Bitten by arthropods in endemic areas Microbiology laboratory workers lawn mowers disease

40 Pathogenesis Forms of Disease Depends on route of infection, dose, strain, virulence Ulceroglandular (UG) 45-85% of all cases Glandular 5-25% of all cases Typhoidal 5-15% of all cases Usually but not always from inhalation Most common form for lab-related disease Oculoglandular 1-5% Oropharyngeal 1-7% of cases Pneumonic Most cases develop some pulmonary symptoms Need CXR findings (pleural or parenchymal) to diagnosis Some discrepancies because many studies do not consider this to be separate entity

41 Clinical Features For all 6 forms Usually sudden onset nonspecific constitutional, flu-like sy. Fever most common feature (74-91%), chills, profuse sweats May briefly subside without treatment transiently on 3-4 th day Lasts 2-3 weeks without antibiotics Malaise, fatigue Myalgias, especially low back Headache, sometimes severe Lymphadenopathy (except in typhoidal) Most common exam finding Up to 50% suppurate Sometimes hepatomegaly

5 cm diameter Punched out with raised edges Ulcer may have eschar (thing anthrax) Can persist months

42 Clinical Features Ulceroglandular Most common form Papule at inoculation site few days after onset Maculopapular, painful, inflamed Turns pustular, necrotic core, painful ulcer over a few days 0.5 cm diameter Punched out with raised edges Ulcer may have eschar (thing anthrax) Can persist months Lymphadenopathy May be single or multiple nodes May have overlying erythema Painful, swollen, may suppurate even with antibiotics

Clinical Features Glandular Same as ulceroglandular but without

Oculoglandular Conjunctivitis Unilateral, painful, purulent

periobital edema Ocular pain, excessive lacrimation,

43 Clinical Features Glandular Same as ulceroglandular but without ulcer More likely to follow bite rather than animal contact Oculoglandular Conjunctivitis Unilateral, painful, purulent Ulcers +/- palpebral nodules with chemosis, vasculitis, periobital edema Ocular pain, excessive lacrimation, photophobia Local lymphadenopathy preauicular, cervical Complications rarely blindness

44 Clinical Features Typhoidal Fever, weight loss, other constitutional signs and symptoms, prostration, delirium No ulcer, adenopathy, or other localizing signs Often with abdominal pain Most likely form to be severe Often DIC, ARDS, sepsis, multiorgan failure, shock Pneumonic Most common symptoms Cough usually nonproductive, sometimes purulent, sometimes hemoptysis Pleuritic CP Dyspnea Signs Sometimes (25%) mild or nonexistent lung exam abnormalities out of proportion to severity of illness

45 Diagnosis Serology Serum agglutins (combined IgM and IgG) Tube agglutination standard, more common Microagglutination available in reference labs, more sensitive, can detect 10 days after illness onset Single 1:160 (tube) 1:128 (micro) in unvaccinated, presumptive of past or current infection 4-fold rise acute/convalescent Not affected by antibiotic treatment ELISA IgM, IgG,or IgA levels detected Detects LPS Now more preferred Better sensitivity (95.7%) specificity (96%) Less cross-reaction with Brucella, Yersina Becomes positive a little earlier than agglutins Biopsy materials (if available), e.g. skin ulcers

46 Treatment AG: streptomycin 2x10 mg/kg 14 days gentamycin 3-5mg/kg 7-14 days doxycycline 2x100 mg 21days. ciprofloxacin 2x750 mg 14 days Generally ineffective Not Recommended Beta lactams Macrolides

47 Psittacosis is an infection caused by Chlamydia psittaci the incubation period is generally 5-14 days. Clinical findings are variable: Fever (50-90%), Chills Malaise Cough (50-90%), usually not productive Pleuritic chest pain (rare) Dyspnea Sore throat and mild pharyngitis (common) Epistaxis (common) Severe headache (common) Photophobia (common) Agitation and lethargy Dermatological - Includes facial rash (Horder spots)

48 Psittacosis Physical: Nonspecific auscultatory findings Relative bradycardia is common. Splenomegaly occurs in 10-70% of patients. may develop meningitis, encephalitis, seizures, and Guillain-Barré syndrome macular rashes, erythema multiforme and erythema nodosum reactive arthritis that is usually polyarticular Lab tests: WBC, ALT, AST, ESR Dg: CF, MIF, ELISA, PCR Therapy: doxycyclin, azithromycin, moxifloxacin

Cat scratch disease caused by Bartonella henselae, a

inoculum site 10% of nodes may suppurate Other symptoms:

5%) Headache (13%) Sore throat (7%) Arthralgia (2.

49 Cat scratch disease caused by Bartonella henselae, a gram-negative rod lymphadenopathy develops, draining the inoculum site 10% of nodes may suppurate Other symptoms: Malaise/fatigue (29.4%) Fever (28%) Anorexia (14.5%) Headache (13%) Sore throat (7%) Arthralgia (2.5%) Therapy: azithromycin, doxycyclin ciprofloxacin, rifampicin Dg.: IFA testing (96% sensitive) and ELISA (71% sensitive)

Toxoplasmosis parasitic disease: Toxoplasma gondii, obligate intracellular parasite Spread to humans by ingestion of contaminated food or water May be infected

HIV patients, Organ transplant patients, people on chemotherapy Pregnant women s fetus are at risk if the mother acquires the infection during gestation.

50 Toxoplasmosis parasitic disease: Toxoplasma gondii, obligate intracellular parasite Spread to humans by ingestion of contaminated food or water May be infected by contaminated soil Majority of cases are asymptomatic Immunocompromized individuals are at greater risk. HIV patients, Organ transplant patients, people on chemotherapy Pregnant women s fetus are at risk if the mother acquires the infection during gestation. Blindness, hydrocephalus, seizures and mental retardation Mild fever, sore muscles, swollen glands and lymph nodes, similar to mononucleosis Dg.: ELISA (IgA, IgM, IgG) Treatment: spiramycin, pyrimethamine+sulfadiazine

West Nile encephalitis arthropod-borne viral encephalitis wild birds transmit to humans via the Culex, Aedes, and Anopheles mosquitoes is endemic in the Middle East, Africa, and Asia, emerging

51 West Nile encephalitis arthropod-borne viral encephalitis wild birds transmit to humans via the Culex, Aedes, and Anopheles mosquitoes is endemic in the Middle East, Africa, and Asia, emerging disease in USA, Canada some have suggested that Alexander the Great may have died from WNE Symptoms: flulike illness vomiting and diarrhea sore throat, backache, myalgia, and arthralgia encephalitis, aseptic meningitis (headache, mental confusion, tremors, or flaccid paralysis) Treatment: supportive care

52 Questions?

Feline zoonoses. Institutional Animal Care and Use Committee 12/09

Feline zoonoses. Institutional Animal Care and Use Committee 12/09 Feline zoonoses Institutional Animal Care and Use Committee 12/09 Cat scratch disease Bacterial infection caused by Bartonella henselae Associated with a cat bite or scratch Infection at point of injury,