ZOONOSES Always assume every animal is shedding pathogens

ZOONOSES Zoonoses in Shelters Zoonosis disease passed from animals to man Anthroponosis disease passed from man to animals Right-to-Know Stations Include MSDS sheets for every hazardous substance in the shelter Locate stations throughout shelter Excellent for emergencies Info about zoonoses here Viruses Bacteria Fungi Others Rickettsia Protozoa Parasites Types of Pathogens Always assume every animal is shedding pathogens How Diseases Spread Through feces: Parvo Feline panleukopenia Salmonella Toxoplasma Worm eggs (rounds, whips, hooks) Giardia and Coccidia Fecal-oral infectious organism ingested after being passed in feces How Diseases Spread 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 1

How Diseases Spread By air (aerosol) Upper respiratory infection (URIcats) Kennel cough (dogs) How Diseases Spread Animal bites or saliva Feline leukemia FIV Rabies Bacteria that can cause bite wound abscesses How Diseases Spread Through direct contact Ringworm Scabies Ear mites Hookworm larvae How Diseases Spread 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 Animal bites or saliva Saliva spread (FeLV): Grooming each other Sharing food and water bowls FIV and Rabies require bites, not just friendly casual contact How Diseases Spread 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 2

How Diseases Spread 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 Stay current on appropriate vaccinations (tetanus, rabies) Wash hands frequently with antibacterial soap 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 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 Monkeypox Avian flu (cats, dogs, horses) West Nile Virus Eastern Equine Encephalitis Hantavirus Lymphochoriomeningitis Monkeypox Carriers Rats, prairie dogs and rabbits Especially when imported from Africa direct contact Symptoms (carrier) Listlessness, respiratory infection Patchy hair loss with scabs Fever and pox-like rash 1-2 weeks after handling rodents Monkeypox 3

Monkeypox Treatment - supportive Prognosis 10% human fatality in Africa Much lower mortality in the US Prevention Avoid contact with rodents from Africa Rodents imported from Africa were banned after a 2003 outbreak Smallpox vaccine affords some protection Lymphochoriomeningitis (LCMV) Carriers Rodents - including pocket pets such as hamsters. 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 Lawsuit PetSmart 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 Carriers horses, birds and other animals mosquito bite Symptoms (horses) neurologic problems 90% do not become ill Illness in the geriatric and immunocompromised Fever, signs of meningitis (neck pain, headache, neurologic problems) Treatment - supportive Prognosis fatal in a small number of people Prevention mosquito control, vaccinate horses Bacterial Zoonoses Bartonella sp. Cat Scratch Fever Bordetella bronchiseptica Kennel Cough Borrelia burgdorferi Lyme Disease Brucella canis Undulant Fever Campylobacter spp. Chlamydia spp. Parrot Fever Clostridium tetani - Tetanus Capnocytophagia - DF2 (dysgonic fermenter 2) Bacterial Zoonoses Escherichia coli Francisella tularensis - Tularemia Leptospira interrogans Weil s Disease Mycobacterium spp. Leprosy and Tuberculosis Pasteurella multocida Salmonella spp. Shigella spp. Spirillum minus Rat Bite Fever Yersinia pestis Bubonic Plague Cat Scratch Fever Carriers - Cats infected by a flea bite Not transmitted directly from cat to cat Transmitted from cat to person by bite or scratch Symptoms (cat) Many are asymptomatic carriers May have fever and lethargy, enlarged lymph nodes for a period of time 4

Cat Scratch Fever Cat Scratch Fever 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 Prognosis good if treated Prevention 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) Prevalent only in certain areas check with your vet deer ticks - Ixodes spp. must be attached for at least 24 hours, to cause infection Lyme Disease Symptoms Early Skin rash at the tick bite Fever, muscle aches, enlarged lymph nodes Late Neurologic, Kidney, Heart disease arthritis Lyme Disease 5

Lyme Disease Treatment - antibiotics Prognosis Difficult to cure dogs People treatable if treated early Difficult to cure chronic infections in people Prevention control ticks Non-core vaccine available for dogs Undulant Fever Carriers dogs (can be asymptomatic) contact with urine, discharge of estrus (heat), afterbirth, aborted fetuses Undulant Fever 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 Fever, chills, muscle aches Weight loss Enlarged lymph nodes or spleen Treatment Antibiotics Prognosis Undulant Fever Immunocompromised people and children more likely to get infected tends to relapse and difficult to cure in dogs and people Prevention Wear gloves, wash hands when handling female dogs in heat, aborted puppies or urine Parrot Fever AKA Psittacosis, Ornithosis, avian chlamydiosis Carriers birds >> cats 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 6

Parrot Fever Symptoms (carrier) Upper respiratory Gastrointestinal & hepatitis Flu-like, respiratory Treatment - antibiotics Prognosis good with treatment Tetanus Carriers animal mouths and anything not sterile that can cause a deep puncture wound puncture by tooth or object Fever and muscle soreness, progressing to uncontrolled muscle contraction sardonic risus grimacing of facial muscles Tetanus Tetanus Tetanus Tetanus 7

Tetanus Treatment - antibiotics Prognosis Excellent if treated early Can be fatal if untreated Prevention Every shelter worker should be current on tetanus vaccination Once every 7-10 years DF2 Bacteria that can and often does live in a normal dog mouth Does not infect most people Can cause fatal infection in people who have had their spleen removed People who do not have a spleen should think very carefully about working daily with dogs Tularemia (Rabbit Fever) Infects birds, mammals, people 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 Symptoms Fever Enlarged lymph nodes or spleen Tularemia (Rabbit Fever) 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 Leprosy and Tuberculosis Carriers any warm blooded animal Direct contact with secretions from wounds Respiratory aerosols Symptoms (carrier & people) Respiratory infection Draining wounds Treatment long term antibiotics Prognosis - variable 8

Leptospirosis Carriers warm blooded wildlife, rodents, livestock, dogs Cats do not get this disease 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 Symptoms Chronic urinary tract infection Kidney failure Liver failure (jaundice) Fever Leptospirosis Treatment Treat liver and/or kidney failure Penicillins to treat disease Tetracycline to eliminate the carrier state Prognosis 85% do well if treated Prevention 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 Carriers rodents (especially rats) Urine, feces or mucous secretions Bite (slow healing, inflamed wound) Contaminated food or water recurring fever and sometimes gastrointestinal upset Rat Bite Fever Treatment - antibiotics Prognosis good with treatment Prevention rodent control Rickettsial Zoonoses 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 9

Rocky Mountain Spotted Fever Rocky Mountain Spotted Fever ticks (Dermacentor spp.) Symptoms (dogs) Fever, back pain, lethargy Swollen ears, nose, face, under belly Kidney failure Low platelet count Fever, headache, muscle pain Skin rash (red dots petechiae) Nausea, vomiting Rocky Mountain Spotted Fever Treatment antibiotics, cortisones Prognosis Can be fatal to dogs if not treated Dogs who are treated early do very well 5-10% fatal to people Prevention Control ticks Typhus Carriers fleas and lice by flea or louse bite Flu-like symptoms, backache, fever Dull red rash starting on the body & spreading Nausea, vomiting, delirium if severe Treatment - antibiotic Prognosis excellent with antibiotics, poor if untreated Prevention flea control Typhus Fungal Zoonoses Blastomyces systemic fever Coccidioides bone infection Cryptococcus skin lesions Dermatophytes (ringworm) skin lesions Histoplasma systemic fever Sporothrix schenkii skin lesions, fever 10

Ringworm Fungal infection of skin not a worm : 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 Some cats are carriers with no symptoms Especially long hair cats (Persians) Diagnosis: Sometimes can see fungal hyphae on infected hairs under the microscope Ringworm fungal culture of hairs at the edge macroconidia 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 Ringworm Ringworm macroconidia Fungal hyphae on an infected hair Fungal hyphae on an infected hair Ringworm Ringworm macroconidia Fungal hyphae on an infected hair Ringworm 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 People vary greatly in their susceptibility to ringworm 11

Protozoal Zoonoses Protozoon microscopic parasite Coccidia spp. Cryptosporidium parvum Giardia Beaver Fever Toxoplasma gondii Encephalitozoon cuniculi Cryptosporidium Affects most warm blooded animals Occasionally contaminates water supplies fecal-oral Symptoms Rarely infects healthy dogs and cats Can cause chronic diarrhea in FeLV cats Commonly causes diarrhea in calves Most people have a GI bug for a few days Rarely causes severe infection in people Cryptosporidium Treatment & Prognosis antibiotics Acute infections are usually self limiting Chronic infections can be difficult to treat Prevention good hygiene and water filtration Giardia Affects mostly dogs, but also cats Causes diarrhea and sometimes vomiting fecal-oral, including contaminated water Asymptomatic carriers possible cyst Diagnosis: fecal wet mount or flotation, ELISA trophozoite Treatment: metronidazole, fenbendazole cyst Giardia trophozoite Toxoplasmosis Carriers cats Cats are infected by hunting and eating their prey, or by coming into contact with oocysts in feces from infected cats 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 12

Toxoplasmosis Symptoms (cat) Sometimes asymptomatic Muscle pain, neurologic, eye problems, fever ouchy grouchy cats Many have no disease Fever, swollen lymph nodes, muscle aches Birth defects in pregnant women (retinochoroiditis causing blindness_ Treatment antibiotics No effective treatment for babies with birth defects Toxoplasmosis Prognosis good for cats and adults 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 Pregnant woman should be treated with antibiotics Encephalitizoon cuniculi Carriers - rabbits rabbit urine is infective Symptoms (rabbit) Often no symptoms May cause paralysis or head tilt Encephalitizoon cuniculi Encephalitizoon cuniculi Neurologic problems and seizures More of a problem in children and the immunosuppressed Treatment difficult to treat in rabbits and people Other things that can cause head tilt but not paralysis in rabbits: Ear mites Ear infection Helminth Zoonoses Helminth = worm Ancylostoma caninum - hookworms Bayliascaris procyonis Bayliascaris procyonis raccoon roundworm Tapeworms Dipilydium caninum Echinococcus granulosa Hydatid disease Taenia spp. Toxocara cati roundworm Uncinaria spp. - hookworm 13

Cutaneous Larval Migrans Larvae hatch out of eggs in the ground And then burrow into skin they come into contact with Causes intensely itchy red winding tracks Often on the feet and hands, and back side if sitting on the dirt Caused by: Hookworms Uncinaria and Ancylostoma spp. Threadworms Strongyloides stercoralis. Visceral Larval Migrans 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 Can result in pneumonia, encephalitis (brain inflammation), myocarditis (heart inflammation), diarrhea (intestinal inflammation), etc. Visceral Larval Migrans Visceral Larval Migrans 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 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 is fecal-oral REMIND KIDS TO WASH THEIR HANDS AFTER PLAYING WITH PUPPIES AND KITTENS!! Hookworms Ancylostoma spp. and Uncinaria spp. Fecal-oral (eggs) dog to dog L3 larvae can also burrow into the skin from dirt (bare feet) dog to dog, or dog to person Symptoms (dogs) Bloody or black/tarry stools Anemia can be fatal if severe Can also infect cats, but less commonly and less severe 14

Hookworms Hookworms Symptoms (people and dogs) Cutaneous larval migrans (L3 in skin) Red serpentine tracks in the skin Prevention Always wear shoes where animals eliminate Wear gloves, wash hands/skin when exposed to dog feces Hookworms Hookworms Tapeworms Dipylidium caninum People can be infected by ingesting a flea, just as dogs and cats are People can not get this tapeworm directly from cats and dogs, even by ingesting tapeworm segments passed in the pet s feces Zoonosis causes little damage and is easily treated by deworming pets and people Tapeworms 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 15

Tapeworms 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 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 Arthropod = bugs (insects & arachnids) Arachnids = ticks and spiders Chyletiella (Walking Dandruff) Fleas & Ticks Sarcoptes scabei dog scabies Lice on birds, deer, cattle, etc. Lice on cats and dogs are rare Chyletiella 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 Chyletiella Chyletiella 16

Chyletiella Scabies 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 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 Scabies Reportable Zoonotic Diseases in Shelters Some diseases must by law be reported to your local/state health department They will then notify the CDC if needed 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 DF2 (Cytocapnophagia spp.) Rabbit Fever (Tularemia Francisella tularensis) Tetanus 17

Shelter Worker Diarrhea Shelter Worker Itchy Skin Bacteria Campylobacter spp. E. coli Salmonella spp. Shigella spp. Protozoa Cryptosporidium parvum Coccidia spp. Giardia spp. 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 antirejection drugs, auto-immune 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 AVMA Toxoplasmosis Brochure Spanish AVMA West Nile Virus Brochure AVMA West Nile Virus Brochure Spanish AVMA Dog Bite Brochure 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 18