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Pet ownership in immunocompromised children--a review of the literature and survey of existing guidelines.

Pet ownership has been associated with both emotional and physical health benefits. However, owning pets may also pose health risks to immunocompromised patients through zoonotic transmission of disease. Our initial impression was that there is a lack of any evidence base in information given by health care professionals regarding these risks. We therefore aimed to produce evidence-based guidelines addressing this issue. A Pubmed search was undertaken and a variety of literature on zoonoses reviewed. Existing guidelines were evaluated and a survey of all Paediatric Oncology Centres in the UK performed. There is a paucity of level 1 and 2 data addressing this issue and clearly more studies, particularly Randomised Controlled Trials (RCTs), are required. Nevertheless, general themes emerged and certain specific guidance was produced based on that produced by the Centres for Disease Control and Prevention in the US. Animal-associated pathogens of concern include Toxoplasma gondii, Cryptosporidium spp., Salmonella spp., Campylobacter spp., Giardia lamblia, Rhodococcus equi, Bartonella spp., Bordetella bronchiseptica, Chlamydia psittaci and dermatophytes. Despite this, the literature would suggest that with the exception of Bartonella henselae and dermatophytes only a relatively small number of infections in people are likely to be associated with pet contact. The majority of pet species do not appear to pose a major risk to immunocompromised children. Some animals, particularly reptiles, should be avoided because of the high risk of salmonellosis. Guidelines include general advice on good hygiene practices, veterinary care, pet foods, purchasing of new pets and age restrictions. Health care professionals should actively enquire about household pets and provide accurate information and practical advice on how to minimise the risk of infection. However, the overall benefits of the human-animal bond must be considered and with proper handling and husbandry immunocompromised patients should be able to continue to enjoy the significant benefits of pet ownership.

Age Factors↗

Climate change and the potential for range expansion of the Lyme disease vector Ixodes scapularis in Canada.

We used an Ixodes scapularis population model to investigate potential northward spread of the tick associated with climate change. Annual degree-days >0 degrees C limits for I. scapularis establishment, obtained from tick population model simulations, were mapped using temperatures projected for the 2020s, 2050s and 2080s by two Global Climate Models (the Canadian CGCM2 and the UK HadCM3) for two greenhouse gas emission scenario enforcings 'A2'and 'B2' of the Intergovernmental Panel on Climate Change. Under scenario 'A2' using either climate model, the theoretical range for I. scapularis establishment moved northwards by approximately 200 km by the 2020s and 1000 km by the 2080s. Reductions in emissions (scenario 'B2') had little effect on projected range expansion up to the 2050s, but the range expansion projected to occur between the 2050s and 2080s was less than that under scenario 'A2'. When the tick population model was driven by projected annual temperature cycles (obtained using CGCM2 under scenario 'A2'), tick abundance almost doubled by the 2020s at the current northern limit of I. scapularis, suggesting that the threshold numbers of immigrating ticks needed to establish new populations will fall during the coming decades. The projected degrees of theoretical range expansion and increased tick survival by the 2020s, suggest that actual range expansion of I. scapularis may be detectable within the next two decades. Seasonal tick activity under climate change scenarios was consistent with maintenance of endemic cycles of the Lyme disease agent in newly established tick populations. The geographic range of I. scapularis-borne zoonoses may, therefore, expand significantly northwards as a consequence of climate change this century.

Animals↗

Evidence for the existence of two distinct species: Psammomys obesus and Psammomys vexillaris within the sand rats (Rodentia, Gerbillinae), reservoirs of cutaneous leishmaniasis in Tunisia.

A thorough taxonomic knowledge about putative animal reservoirs of transmissible diseases is an absolute prerequisite to any ecological investigation and epidemiological survey of zoonoses. Indeed, accurate identification of these reservoirs is essential for predicting species-specific population outbreaks and therefore to develop accurate ecological control strategies. The systematic status of sand rats (genus Psammomys) remains unclear despite the pivotal role of these rodents in the epidemiology of Zoonotic Cutaneous Leishmaniasis (ZCL) disease as sand rats are the main known reservoir hosts of the protozoan parasite Leishmania major. In the present work, we expose morphological, biochemical, genetic and cytogenetic evidence supporting the identification of at least two cryptic species within the genus Psammomys in Tunisia. First, significant morphometric differences were observed and were correlated associated with external features and biogeographic origins. Second, differences in patterns of two isoenzymic systems (Glutamate Oxaloacetate Transaminase (GOT) and 6-PhosphoGluconate Dehydrogenase (6PGD)) were found, which makes it possible to amount these isoenzyme characters to two diagnostic loci. Third, based on the mitochondrial cytochrome b (cyt b) gene, a high magnitude of genetic distance (13.89%) was also observed. Fourth, cytogenetic analysis showed that these two populations groups differ in their diploid chromosome numbers, i.e. 2N=46 versus 2N=48. We consider that all these variations are enough important to be considered as demonstrative and we propose that these two lineages should be considered as two distinct species that we refer to the fat sand rat Psammomys obesus Cretzschmar, 1828 and the thin sand rat Psammomys vexillaris Thomas, 1925. Implications of such results on the eco-epidemiology of ZCL in Tunisia are discussed.

Animals↗

Presence and persistence of intestinal parasites in canine fecal material collected from the environment in the Province of Chubut, Argentine Patagonia.

We investigated the presence of intestinal parasites in canine feces collected from public squares in Comodoro Rivadavia, Chubut, Argentina (45 degrees S, 68 degrees W) and determined the persistence of Echinococcus granulosus eggs in those droppings under natural environmental conditions in that region. In the first experiment, we analyzed 163 fecal samples collected from urban squares during 8 months time and found parasitic elements in 46.6%. The presence of parasites was independent of the condition of the feces (fresh or dried; P>0.05). Parasites potentially pathogenic in man were present, such as Toxocara species (spp.), Taenia spp./Echinococcus spp., Uncinarias spp., and Entamoeba spp. In the second experiment, we analyzed two canine fecal samples contaminated with E. granulosus eggs, deposited for 41 months within the natural environment. These parasitic elements persisted during the entire study as attested by light microscopy and the ELISA coproantigen test. We propose the study of the presence of intestinal parasites in canine feces within the environment as a general strategy for identifying and monitoring areas of risk for canine-related zoonoses since we were able to demonstrate the persistence of E. granulosus eggs in deposited canine feces for over 3 years within the area studied.

Animals↗

Application of a species-specific PCR-RFLP to identify Ancylostoma eggs directly from canine faeces.

Apart from their veterinary importance, the hookworms Ancylostoma caninum, Ancylostoma braziliense and Ancylostoma caninum are also capable of causing zoonotic disease in humans. A highly sensitive and species-specific PCR-RFLP technique was utilised to detect and differentiate the various canine Ancylostoma spp directly from eggs in faeces. This technique was utilised to screen 101 canine faecal samples from parasite endemic tea growing communities in Assam, India, as part as an ongoing epidemiological investigation into canine parasitic zoonoses. The prevalence of hookworms in dogs was found to be 98% using a combination of PCR and conventional microscopy. Overall, 36% of dogs were found positive for single hookworm infections with A. caninum, 24% positive for single infections with A. braziliense and 38% had mixed infections with both A. caninum and A. braziliense. No dogs were found positive for A. ceylanicum in the community under study. The high prevalence of A. caninum and A. braziliense in dogs in this community may account for the high incidence of cutaneous larva migrans (CLM) observed among the human population residing at the tea estates. The PCR-RFLP technique described herein allows epidemiological screening of canine hookworms to be conducted rapidly, with ease and accuracy, and has the potential to be applied to a number of different clinical, pharmacological and epidemiological situations.

Ancylostoma↗

Communicable disease surveillance with limited resources: the scope to link human and veterinary programmes.

Zoonoses are an important cause of human disease in much of Africa, but limitations in current diagnosis and surveillance strategies restrict the effectiveness of control and prevention programmes. Outbreaks of disease, ranging from Ebola virus infection to Rift Valley Fever, that have occurred recently in Africa have demonstrated the need for improved disease surveillance and monitoring. Strategies are suggested for co-ordinating human and animal disease surveillance programmes, at the district and regional level, to make more effective use of limited resources.

Africa↗

Detection and management of zoonotic diseases at the Kumasi slaughterhouse in Ghana.

Slaughterhouse surveys are important in the detection and management of zoonotic diseases. Routine reports from the Kumasi slaughterhouse, in the Ashanti region of Ghana, include cases of zoonotic diseases. Due to its location and size, Kumasi is the major cattle market and an important transit point for cattle trade from places within and outside Ghana. This present study was designed to examine slaughterhouse reports and to explore the nature of the knowledge, attitude and practices of butchers who operate at this slaughterhouse, in relation to zoonoses. The study was largely descriptive, employing qualitative methods and tools. Butchers were interviewed and their practices along the production line observed. The study indicates that zoonotic diseases are frequently detected at the Kumasi slaughterhouse. However the knowledge, attitudes, practices and beliefs of the butchers are largely inadequate for their profession in view of the important public health role that butchers play. The butchers have never received any form of training. It is recommended that the butchers receive training on a regular basis and that laws be formulated and implemented to protect the health of the butchers and the general public.

Abattoirs↗

Prevalence and control of zoonotic diseases: collaboration between public health workers and veterinarians in Burkina Faso.

Zoonotic diseases constitute a public health problem throughout the world, particularly in the tropics, where their control is restricted by inadequate infrastructure and financial resources. Additionally, there is a lack of information on their significance and distribution. This study, conducted jointly by the Ministries of Health and Animal Resources, aimed to assess the prevalence of zoonotic diseases in Burkina Faso. The data were taken from internal reports of each ministry covering the period January 1-December 31 1996 for the Ministry of Health and for January 1-December 31 1997 for the Ministry of Animal Resources. Zoonotic diseases were divided into viral (rabies, yellow fever, HIV infection/AIDS, and measles), bacterial (tuberculosis, brucellosis, and anthrax) and parasitic (cysticercosis, toxoplasmosis, and leishmaniasis). For the period under study, the following diseases were reported by the Ministry of Health, tuberculosis, 1314 cases; anthrax, 145 cases; leishmania, 271 cases; rabies, 110 cases; and measles, 46490 cases. The Ministry of Animal Resources reported 69% of rabies cases occurred in dogs; cysticercosis occurred in swine at a prevalence of 0.57%; the prevalence of tuberculosis in cattle, small ruminants and pigs was 0. 13, 0.013, and 0.029%, respectively; the prevalence of anthrax and echinococcosis was 0.012 and 0.007%, respectively; and finally, the prevalence of bovine brucellosis was 8% in the peri-urban areas. This study revealed that there was a lack of collaboration between the organisational structures and workers in both ministries involved in the control of zoonoses. Links between the two ministries in the field of public health need strengthening.

Abattoirs↗

The public health laboratory service (PHLS) and its role in the control of zoonotic disease.

The aetiology of zoonotic infections embraces organisms from every branch of the microbial world. In addition, zoonoses must be considered as a truly global problem, both in terms of their distribution and the measures required for their control. Within the UK, zoonotic disease is considered to be less frequent than in some less developed parts of the world. However, its contribution to overall morbidity and mortality within the UK population is not well established. In an attempt to define the impact of zoonotic infection more accurately, a multicentre prospective study of disease in farmers in England and Wales was initiated by the PHLS in 1992. The study involved the completion by participants of annual questionnaires dealing with their own health and the range and health of their livestock. Our results confirmed that some infections occur frequently in farmers. For example, ringworm and Q fever were associated with contact with cattle and orf with the handling of sheep. Some findings were unexpected; the incidence and prevalence of leptospirosis, for example, were far lower in the farmers than had been anticipated, whilst there was a higher than expected incidence and prevalence of hantavirus infection. The success of the project was largely due to the adoption of a multidisciplinary approach and the continuity of funding which enabled the study of the same cohort to continue for 7 years.

Animals↗

Anthropogenic environmental change and the emergence of infectious diseases in wildlife.

By using the criteria that define emerging infectious diseases (EIDs) of humans, we can identify a similar group of EIDs in wildlife. In the current review we highlight an important series of wildlife EIDs: amphibian chytridiomycosis; diseases of marine invertebrates and vertebrates and two recently-emerged viral zoonoses, Nipah virus disease and West Nile virus disease. These exemplify the varied etiology, pathogenesis, zoonotic potential and ecological impact of wildlife EIDs. Strikingly similar underlying factors drive disease emergence in both human and wildlife populations. These are predominantly ecological and almost entirely the product of human environmental change. The implications of wildlife EIDs are twofold: emerging wildlife diseases cause direct and indirect loss of biodiversity and add to the threat of zoonotic disease emergence. Since human environmental changes are largely responsible for their emergence, the threats wildlife EIDs pose to biodiversity and human health represent yet another consequence of anthropogenic influence on ecosystems. We identify key areas where existing expertise in ecology, conservation biology, wildlife biology, veterinary medicine and the impact of environmental change would augment programs to investigate emerging diseases of humans, and we comment on the need for greater medical and microbiological input into the study of wildlife diseases.

Animal Diseases↗

Toxoplasma gondii: from animals to humans.

Toxoplasmosis is one of the more common parasitic zoonoses world-wide. Its causative agent, Toxoplasma gondii, is a facultatively heteroxenous, polyxenous protozoon that has developed several potential routes of transmission within and between different host species. If first contracted during pregnancy, T. gondii may be transmitted vertically by tachyzoites that are passed to the foetus via the placenta. Horizontal transmission of T. gondii may involve three life-cycle stages, i.e. ingesting infectious oocysts from the environment or ingesting tissue cysts or tachyzoites which are contained in meat or primary offal (viscera) of many different animals. Transmission may also occur via tachyzoites contained in blood products, tissue transplants, or unpasteurised milk. However, it is not known which of these routes is more important epidemiologically. In the past, the consumption of raw or undercooked meat, in particular of pigs and sheep, has been regarded as a major route of transmission to humans. However, recent studies showed that the prevalence of T. gondii in meat-producing animals decreased considerably over the past 20 years in areas with intensive farm management. For example, in several countries of the European Union prevalences of T. gondii in fattening pigs are now <1%. Considering these data it is unlikely that pork is still a major source of infection for humans in these countries. However, it is likely that the major routes of transmission are different in human populations with differences in culture and eating habits. In the Americas, recent outbreaks of acute toxoplasmosis in humans have been associated with oocyst contamination of the environment. Therefore, future epidemiological studies on T. gondii infections should consider the role of oocysts as potential sources of infection for humans, and methods to monitor these are currently being developed. This review presents recent epidemiological data on T. gondii, hypotheses on the major routes of transmission to humans in different populations, and preventive measures that may reduce the risk of contracting a primary infection during pregnancy.

Animals↗

Micro-evolution and emergence of pathogens.

Changes in the epidemiology of infectious diseases are the direct result of ecological and evolutionary changes in hosts and parasites. Precisely what the causal processes are is rarely known in any particular case, and this hinders the design of appropriate control strategies. This is particularly so for emerging infections, as opportunity is rapidly lost to study the ecological parameters which might have affected initial emergence. However, molecular evolutionary studies of the pathogens can yield data which discriminate between possible causes. The current distribution of DNA sequence variation is important information which may reveal past and current changes in pathogen population structures, and can also identify adaptive changes in pathogen genes which have affected their evolution. Such studies have been quite intensively performed on particular viral and bacterial pathogens, and some of the successes of these are noted here. Approaches to understanding the recent evolution of eukaryotic pathogens are outlined, with particular reference to current problems of emerging zoonoses, and changes in virulence and drug resistance.

Animals↗

Trichinellosis: the zoonosis that won't go quietly.

Trichinellosis, is normally not included among those regarded as emerging zoonoses because it has been a public health threat for more than 150 years. However, its dramatic re-emergence in many areas around the world over the past 10-20 years, inspite of a century of veterinary public health efforts to control and eradicate it, justifies it being included in this group. The reasons for this re-emergence are diverse, and include human pertubation and manipulation of ecosystems, war and political turmoil, rapidly changing food distribution and marketing systems, and even, surprisingly, rising affluence in developing countries. These influences, and their impact on the epidemiology of both domestic and sylvatic trichinellosis, are discussed, along with recommendations for confronting this altered status as a public health threat.

Animals↗

Emerging foodborne pathogens.

The broad spectrum of foodborne infections has changed dramatically over time, as well-established pathogens have been controlled or eliminated, and new ones have emerged. The burden of foodborne disease remains substantial: one in four Americans is estimated to have a significant foodborne illness each year. The majority of these illnesses are not accounted for by known pathogens, so more must remain to be discovered. Among the known foodborne pathogens, those more recently identified predominate, suggesting that as more and more is learned about pathogens, they come under control. In addition to the emergence or recognition of new pathogens, other trends include global pandemics of some foodborne pathogens, the emergence of antimicrobial resistance, the identification of pathogens that are highly opportunistic, affecting only the most high-risk subpopulations, and the increasing identification of large and dispersed outbreaks. New pathogens can emerge because of changing ecology or changing technology that connects a potential pathogen with the food chain. They also can emerge de novo by transfer of mobile virulence factors, often through bacteriophage. Though this is rarely observed, it can be reconstructed. Better understanding of the ecology and dynamics of phage transmission among bacteria will help us to understand the appearance of new pathogens in the future. One may look for emerging foodborne pathogens among the silent zoonoses, and among the severe infections affecting the immunocompromised humans. We should expect the unexpected. In the past, separating human sewage and animal manure from human food and water supplies was critical to improving public health. Now, our health depends increasingly on the safety of the feed and water supplies for the animals themselves. The successes of the 20th century and the new challenges we face mean that public health vigilance, careful investigation of new problems, responsible attention to food safety from farm to table, and partnerships to bring about new foodborne disease control measures will be needed for the foreseeable future.

Animals↗

Prevalence of staphylococcal zoonosis in pyogenic skin infections.

S. aureus aetiology was found in 76.47% of the 102 pyoderma cases under study, with a high frequency of incidence in children below 5 years of age. The majority of the S. aureus isolates was nontypable (50.0%) and among the typable strains, phage group-III (31.0%), Group-I (20.7%) and a mixed phage group (34.5%) were predominant. 28.2% of the isolates were S. aureus var. bovis and 2.6% were S. aureus var. canis subgroups. Zoonoses in staphylococcal pyogenic skin infections were proved in 9 of the cases, which showed the history of direct animal contact supported by the isolation of S. aureus of animal host origin. Dogs, cattle and poultry were found to be the most important reservoirs transmitting S. aureus to humans, with folliculitis, furunculosis, impetigo as the frequent clinical manifestations.

Adolescent↗

Zoonotic diseases of cats.

As veterinarians, our responsibilities do not end with the care of our patients. The welfare of our clients and their families depends on our ability to detect and control potentially zoonotic diseases in their pets. Because some of these zoonoses can have devastating effects on the development of the unborn fetus or on family health in general, discussion about these diseases between veterinarian and client is often emotionally charged. Under such circumstances, the offering of inaccurate and erroneous information by the veterinarian can have drastic consequences. It is likely that other zoonotic diseases of domestic pets will be identified in the future, especially those that can cause opportunistic infections in debilitated and immunodeficient persons. In the meantime, the potential hazards of cat ownership can be significantly reduced through an increased understanding of feline diseases and an improved level of health care for our feline patients.

Adolescent↗

Feline zoonotic diseases.

Many of the feline zoonoses occur more frequently in veterinary personnel owing to their direct contact with cats and the potential for exposure to infected body tissue or fluids. Infection of humans with Afipia felis, Yersinia pestis, Francisella tularensis, and other aerobic/anaerobic bacteria may cause great discomfort and in some situations terminal illness. Although many systemic fungal agents infect humans and cats, only Sporothrix schenckii has been shown to infect humans following direct exposure to infected cats. Various parasites, enteric protozoans and bacteria, and Toxoplasma gondii infections also may cause significant human illness. Therefore, routine handling of cats may expose human personnel in a veterinary facility to an array of important or emerging feline-associated human illnesses that occur in the United States.

Animals↗

Use of animal products in traditional Chinese medicine: environmental impact and health hazards.

Traditional Chinese medicine (TCM) has been increasingly practised in many countries of the world. Some recent textbooks of TCM still recommend formulas containing various animal tissues such as tiger bones, antelope, buffalo or rhino horns, deer antlers, testicles and os penis of the dog, bear or snake bile. Usually, animal tissues are combined with medical herbs. In most of the cases, the medical use of the preparations is justified in terms of the rules of TCM. So far, little research has been done to prove the claimed clinical efficacy of TCM animal products. This paper discusses some related ecological, ethico-legal and health concerns such as hunting, breeding and trade with endangered species, risks of transmission of zoonoses, quality of the products, and alternatives to preparations from endangered species.

Animal Welfare↗