down on the farm zoonosis - aad.org c021... · 2/17/2018 1 barnyard zoonoses tammie ferringer, md...
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2/17/2018
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Barnyard Zoonoses
Tammie Ferringer, MDDepts of Dermatology and Pathology
Section Head and Fellowship Directory, Dermatopathology
Danville, [email protected]
Tammie Ferringer , MD
Infectious Diseases
DISCLOSURES
I do not have any relevant relationships with industry.
DISCLOSURE OF RELATIONSHIPS WITH INDUSTRY
Down on the Farm Zoonosis
Infectious diseases transmitted
animals humans
Direct contact, fomite, vector-borne, oral and aerosol
Bacteria Cat Scratch Disease
Gram negative Bartonellahenselae
Cats are asymptomatic
1-2 weeks after a scratch a red papule develops
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Cat Scratch Disease
Tender regional adenopathy develops 2 weeks later
Cat Scratch Disease
Diagnosis
Difficult and delayed culture
Serologic testing
PCR
Histology: Stellate abscess and/or granuloma
Warthin-Starry silver stain, tissue Gram stain, or IHC
Cat Scratch Disease
Spontaneously resolves in 2-4 months
Treatment is supportive
Antibiotics may not alter the course of disease
Anecdotal antibiotics
Azithromycin, trimethoprim-sulfamethoxazole, ciprofloxacin
Which is a zoonosis?
BACILLARY ANGIOMATOSIS ROSAI DORFMAN
BA
Bacillary Angiomatosis
Bartonella henselae or B. quintana
Most in immunocompromised
Single or multiple red papules
Bacillary Angiomatosis
Histology
Vascular proliferation
Neutrophils and granular aggregates of organisms that can be highlighted by Warthin-Starry
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Bacillary Angiomatosis
Internal involvement of liver, lung, bone
Unlike CSD, untreated disease can be life threatening
Responds to erythromycin
May be the anti-angiogeniceffect more than the antimicrobial effect
Erysipeloid
Confusing terms
Erysipeloid: Gram + rod, Ersipelothrix rhusiopathiae
Human erysipelas: Gram + cocci, streptococci
Swine erysipelas: Gram + rod, Ersipelothrix rhusiopathiae
Erysipeloid
1-7 days after exposure a red to violaceous macule develops, usually on the hands
Disproportionate pain
Rare septicemia or endocarditis
Erysipeloid
Associated with exposure to fish, marine animals, swine, or poultry
Diagnosis May not be demonstrated in tissue Culture may be misinterpreted as alpha hemolytic streptococci
Treatment Untreated resolves in 3-4 weeks Treatment may hasten healing and reduce systemic complications Penicillin or amoxicillin
Resistant to vancomycin and tmp-smx
Tularemia
Gram negative coccobacillus Francisella tularensis
Ingest contaminated meat or water
Inhaled in dust
Inoculated with a bite or scratch of an infected animal or bite of an arthropod
Tularemia
Animal transmission by
Rabbits (most)
Cat scratch or bite
Potential bioterrorism agent
Ease of dissemination, ability to infect with as few as 10 organisms
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Tularemia
Ulceroglandular
Flu-like symptoms
Papule at inoculation site eventually pustular then ulcerates
Eschar may or may not form
Typically regional lymphadenopathy +/-fluctuance and rupture
Tularemia
Diagnosis Serology
PCR
Routine culture often negative
Treatment Prevention
Streptomycin
Tetracyclines
Ciprofloxacin
Beta lactams are ineffective
Anthrax
Spore forming Gram positive Bacillus anthracis
Susceptible animals
Herbivores
Potential bioterrorism by aerosolized dispersal of spores
Anthrax
GI, inhalational, or cutaneous
Cutaneous is usually from handling sick animals or contaminated wool or animal hides
Recent reports in Europe associated with IVDU
Painless papule develops a vesicle and finally an ulcer with black eschar
Anthrax
Diagnosis
Culture of unroofed blister/eschar or ulcer base
Treatment
Ciprofloxacin
Doxycycline
Mycobacterium
Mycobacterium marinum
Infection follows trauma and exposure to an aquarium, salt water, or fish
Ulcers, fin erosion, and unusual coloration are signs of disease in
fish
Infected fish may show no external signs
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Mycobacterium
A papule develops 2-16 weeks after inoculation
Subsequent lesions develop along the lymphatic drainage (sporotrichoid)
Mycobacterium
Diagnosis
Culture takes 4 to 6 weeks
Biopsy may show acid fast organisms
Treatment
Often self limited
Minocycline or clarithromycin
Address aquarium if causative
Bites
Infection typically a mixture
Pasturella multocida
Capnocytophaga canimorsus
Anaerobes
Streptococci and human skin flora
Bites
Pasteurella multocida Most common cause of infection
Inflammation begins within
hours of the bite
After 24 hours Staph and Strep are more likely
Bites
Tetanus and rabies immunization should be considered
Aerobic and anaerobic cultures
Wound irrigation
Amoxicilllin/clavulanate
Not cephalexin or clindamycin
Rabies
5-6 mm skin biopsy from the back of the neck at the
hairline, containing at least 10 hair follicles
CDC on sterile saline-moistened gauze for RT-PCR assay
and immunofluorescent staining of frozen sections
Schupbach A. JAADl. 2012 Aug;67(2):321-3.
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LA-MRSA
An emerging zoonotic pathogen
Dogs, cats, rabbits, pigs, horses and livestock have contracted or carried MRSA
Humans Animals
Human infection may not be eradicated until the animal is also treated
Viral
Orf
Also known as ecthyma contagiosum
Poxvirus
Sheep and goats
Humans usually develop a single lesion on the hand 2-6 days after inoculation
Orf
Six stages each lasting one week
1) Erythematous maculopapular
2) Targetoid
3) Acute weeping nodule
4) Dry crusted nodule
5) Papillomatous
6) Regressive
Milker’s Nodule
Poxvirus-Paravaccinia
Cows have crusted erosions and papules around the nose and teats
Same six stages as orf
Lesions typically smaller than orf
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Bovine Papular Stomatitis
Different but closely related paravaccinia virus
Red erosive lesions
May not be readily observable
Calf muzzle, mouth, lips, tongue
In humans, similar to orf and milker’s nodule
14-year-old feverish girl
Ulcerated nodules, molluscum-like lesions, black crusts
Kept turtles, hamsters, guinea pigs,
birds, ducks, cats, and a dog
Cared for an ill wild rat
Cowpox
Orthopoxvirus
Hosts include rodents, cows, and cats
Cats can have a small scabbed wound to a large abscess, usually on the head or forelimb
Cowpox
Umbilicated vesicles with surrounding erythema and evolve to ulcer with eschar
Lymphadenopathy
Regress with scarring after 6-8 wks
Treatment is supportive
Deer Associated Parapoxvirus
Roess AA. NEJM Dec 30,2010.
Which is a Zoonosis?
A
B
NEONATAL LUPUS TINEA
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Fungal
T mentagrophytes Rodents
T equinum Horses
T erinacei Hedgehogs
T gallinae Birds
M nanum Pigs
Tinea
T verrucosum
Cattle and horses have discrete plaques of hair loss with thick, whitish gray crust
Human infection from direct contact or fomites
Highly inflammatory, usually involving scalp or beard
M canis
Infection in cats can be subclinical or variable with crusting and erythema to alopecia
Humans can have classic ringworm or tinea capitis
Sporotrichosis
Sporothrix schenckii
Cats with sporotrichosis skin lesions can transmit infection to humans even without penetrating injury
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Ectoparasites
“Mange” is an infestation by mites
Sarcoptic mange (burrowing)
Intense pruritus, hair loss, ears and limbs most
Cheyletiella (non-burrowing) Less host specific than
sarcoptes
Asymptomatic to dry scale and pruritus on the back and shoulders
Scabies and Cheyletiella
Bite and run
Do not burrow
Pruritic, papular eruption in areas of contact
1/3 of human contacts are susceptible
Scabies and Cheyletiella
Treatment consists of eradication of the source
Involve the vet
Avoid lindane
Treat all in contact animals with Cheyletiella
Treat same species with scabies
Which is a Zoonosis?
A
LARVA MIGRANS JELLYFISH
B
Parasites Cutaneous Larva Migrans
Ancylostoma braziliense Dog and cat hookworm
Animal infection can be asymptomatic
Exposure at the beach, in crawl spaces, or sandbox contaminated by animal feces
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Cutaneous Larva Migrans
Larvae penetrate the skin but lack the enzyme to penetrate the DEJ preventing completion of the life cycle
Migrates a few millimeters per day resulting in pruritic, erythematous serpiginous tracts
Cutaneous Larva Migrans
Treatment
Self limited
Topical thiobendazole
Oral thiobendazole or ivermectinfor diffuse disease
Take Home Points
Ask about animal exposure
Transmission can occur from clinically normal animals in some cases
Consider pets and livestock when managing MRSA