forget fido! serious threats from exotic pets c021... · •also harbor aspergillus niger and...
TRANSCRIPT
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Forget Fido!
Serious Threats from Exotic Pets
Ted Rosen, MD Baylor College of Medicine
Houston, Texas
Conflict of Interest Disclosure
Infectious Disease Course C021
• I have NO relevant disclosure
or conflict of interest for this talk
This talk is dedicated to
Smog Rosen 1995-2015
“The Best Pet Ever, Sorely Missed”
8-6-07
$63 Billion in 2016 http://www.americanpetproducts.org/press_industrytrends.asp
2-27-09
Pet Ownership
• ~60-65% of all US households contain
at least one pet
• ~40% of all US households contain two
or more pets
• It is estimated that about 1-2 million
American homes harbor at least one
“exotic”
J Am Vet Med Assoc 232:695, 2008
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Routine domestic pets….. …..when in close proximity
Can cause problems! (Tinea)New kitten…….
……..New problemAnimal Dermatophyte
Fur loss major sign
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Animal Dermatophyte: Rx
Miconazole spray Conofite cr/spray Dermazole shampoo
Resizole conditioner
Miconazole products
Save patient $ by giving samples of any antifungal
CATS!
• Cellulitis from bite (Pasturella multocida)
• Cat scratch disease
• Bacillary angiomatosis
• Catpox (orthomyxovirus = Cowpox)
• Sporotrichosis
• Int J Dermatol 51:434, 2012
An Bras Dermatol 66(Suppl1):S121, 2011
• Dermatol Online J 17(6):2, 2011
• Nocardia
• Cheyletiella infestation
• Cutaneous larval migrans
WHAT ABOUT EXOTIC PETS?
Petaurus breviceps
Exotic Pets
• What is an “exotic” pet?
• Strange or different in a striking
or fascinating way (dictionary)
• Non-customary (Not dog or cat)
• Amphibian: salamander, frog
Avian: cockatoo, macaw, parrot, ostrich
Carnivore: mink, weasel, raccoon
Feline: tiger, panther, bobcat, lynx
Mammal: sugar glider, hedgehog; skunk
Reptile: snake, iguana, lizard
USA Today Dec 6, 2002 US News and World Report
June 23, 2003
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China, too!
Bejing News, 2014
Exotic Pets
• 650 MILLION imported exotics into US yearly
• Tropical fish to kinkajous
• $10 billion ILLEGAL importation business as well
• No quarantine, minimal screening
• ONLY 120 full-time inspectors employed by USA to
inspect ALL arriving wildlife
• Discovery Channel News 11/27/2006
http://www.exoticanimalsforsale.net
Exotic Pets: Canada www.animallaw.ca
• Many agencies: conflicting and overlapping jurisdictions
• Canadian Constitution (92-13) deems animals as
property; provinces have primary power over property
• Various provincial Animal Welfare Acts
• Canadian Food Inspection Agency: rules regarding the
import and export of exotic animals
• Canadian Wildlife Service administers rules regarding
endangered exotic animals
• Canadian Assoc Zoos and Aquariums (voluntary membership)
• Pet Industry Advisory Council; different set of rules
Hedgehog
• 11 distinct species of nocturnal, quilled mammals
• African pygmy variety is common pet
• $50-200
• 40,000 pets in USA
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Hedgehog
• Atelerix albiventris
• “Four-toed hedgie”
• Eats roaches
• Hard to hold/pet
• May be vicious
• Quills for defense
African Pygmy Hedgehog
Hedgehog
• Hedgehogs routinely carry
T. mentagrophytes var. erinacei
• Fungi on quills and underbelly
• Inflammatory dermatomycoses:
tinea corporis, tinea manum,
tinea barbae, and tinea capitis
• Direct contact w/ hedgehog
• Mycoses 57:125, 2014
Int J Dermatol 51:283, 2012
Vet Rec 158:59, 2006
South Med J 93:936, 2000
Clin Exp Derm 17:156, 1992
African Pygmy Hedgehog
African Pygmy Hedgehog21 year-old
Int J Dermatol 51:283, 2012
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Chinchilla
• 2 distinct species of South American herbivore
• Rodents
• Raised in “farms”
• $50-150
• 80,000 pets in USA
Chinchilla
• Chinchilla laniger
• Chinchilla brevicaudata
• Hide from noise and bright light
• Susceptible to heat stroke
Chinchilla
• Many carry T. mentagrophytes and M. gypseum
• Associated with inflammatory tinea corporis
and capitis
• Also harbor Aspergillus niger and Rhizopus sp.
and therefore theoretical threat to diabetics,
leukemia & transplant patients
• Nippon Ishinkin Gakkai Zasshi 41:269, 2000
• Mycopathologia 137:107, 1997
• Vet Rec 127:119, 1990
Chinchilla
Mycoses 2013; 56 Suppl 1:33-7 Mycoses 2013; 56 Suppl 1:33-7
Mom’s Back
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Guinea pigs are
fungal cesspools
T. Mentagrophytes
var, porcellae
Inflammatory tinea
French study: 2/3 in
pet stores harboe
J Mycol Med. 2016;26:227-32
Iguana
• 13 distinct species of large lizards
• Mexican variety most common pet
• $15-50
• 700,000 in USA
$37.99 Sale!
Iguana
• Iguana iguana
• Friendly and quiet
• Will attack its own reflection
• Can grow up to six feet long
& weigh up to 100 pounds
Iguana: Serratia cellulitis
• May be bullous, simulating that
caused by beta-hemolytic strep
• Associated with ESBL
(Extended spectrum b-lactamase)
• Usually resist cephalosporins
• Quinolones & TMP-SMX are
drugs of choice
J Am Acd Dermatol 62:1075, 2010
Clin Infect Dis 28(5):1181, 1999
Iguana: Serratia Cellulitis
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Iguana: Serratia Cellulitis
Iguana
• Breeders utilize broad spectrum antibiotics as
prophylaxis against disease and discoloration
• Drug resistant bacteria may be harbored,
including multiply-drug resistant organisms
More Iguana Problems!
• Recent unexpected
discovery of venom in
two groups of lizards
• Venom chemically
similar to snake toxin
• Bite site: red, swollen
(looks like infection)
• Accompanied by
widespread purpura,
hypotension, malaise
• Nature 439:584, 2006
Green Iguana
Bearded Dragon
ICD-10
• Bitten by other nonvenomous
lizard, initial W59.01XA
• Toxic effect of venom of
other lizard, unintentional,
initial T63.121A
Bearded Dragon at County Fair
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Kinkajou (aka Honey Bear)
• Potos flavus
• Raccoon relative
• Central & S. America
• 14 subspecies
• Lifespan 25years;
some have lived 40yrs
• Shrill calls sound like
a woman: folk name
“The crying woman”
• $2000-3000 each
Kinkajou ATTACKS!
• Paris Hilton was attacked by
her pet, “Baby Luv”
• Ended up in the emergency
room with deep bite wounds
(arm) in 8/2006
• Got rid of animal (illegal in CA)
W55.81A: Bitten by other mammals, accidental, initial encounter
Kinkajou: DANGER!
• Carries a UNIQUE bacteria in its oral
flora: Kingella potus
• Gram-negative rod, related to Neisseria
spp by 16S rRNA gene typing
• DEEP destructive cellulitis/tenosynovitis
from penetrating bites
• Resistant: Doxy, TCN, clinda, TMP-SMX
Intermediate to Amoxicillin-Clavulanate
Sensitive to Ceftriaxone & Ciprofloxacin
• J Clin Microbiol 43:3526, 2005
Emerg Infect Dis 2011;17:268-70
Flying Squirrel
• 35 distinct species of gliding animals
• Southern flying squirrel and sugar glider are pets
• $100-300
• 5-8000 pets in USA
Petaurus breviceps
Flying Squirrels
• Gluaucomys volans
• Northern and
Southern types
• Southern small
and aggressive
• Leaps of 150ft
• Domesticated as
newborns only
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Flying Squirrels
• Associated with human typhus
due to Rickettsia prowazekii
• Flying squirrels are the ONLY
zoonotic source of typhus
Lancet Infect Dis 8:417, 2008
• Ectoparasites (lice/ticks) found
on flying squirrel harbor the
causative organism
• Humans infected by inhalation
of aerosolized ectoparasite feces
Flying Squirrels
• Fever, blanchable erythematous macular eruption,
headache, myalgia, nausea & vomting, and
photophobia suggest typhus
• Thus: fever, rash and systemic toxicity in owner
of a flying squirrel: think typhus!
• Vector Borne Zoonotic Dis 14:240, 2014 (Cluster)
• Clin Infect Dis 51:712, 2010
• Emerg Infect Dis 15:1005, 2009 (Cluster)
• JAMA 245:2318, 1980
This has actually happened. Who is at risk?
Camp counselors, Park rangers, Woodsmen
Tarantula
• Nearly worldwide
• Tiny to foot-long
• Cheap! Flea markets
$10-20 altho in pet
stores more costly
• Various species pets:
Brachypelma smithi = Mexican Redknee
Grammostola rosea = Chilean Rosehair
Aphonoplema seemani = Costa Rican Zebrahair
Avicularia urticans = Pinktoe tarantula
Zebrahair
https://www.jamiestarantulas.com/
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Tarantula: Risks
• They bite: painful venom, tho not
typically causing systemic rxn;
activates capsaicin receptor
• They have urticating, barbed hairs
which can cause contact urticaria
• They may flick those hairs at their
owner if threatened: go into eye and
cause uveitis, cornea clouding
• Am J Trop Med Hyg 22:130, 1973
Am J Ophthalmol 96:118, 1983
J Am Optom Assoc 68:188, 1997 Cornea 19:393, 2000
Acta Ophthalmol Scand 79:531,2001 Eye 17:433, 2003
Nature 444:208, 2006
Tarantula
Corneal opacities UveitisPhotophobia
Erythema
Tearing
Deep aching pain
Reduced acuity
ICD-10 Conundrum
• Bite: T63.321A Toxic effect of venom of
tarantula, accidental, initial encounter
• Ocular: H20.011 or H20.012 or H20.013
and….Z18.31 Retained animal quills or
spines
Gerbil
• 100 distinct species of African and Asian
herbivore rodents
• Mongolian gerbil is common pet
• Cheap! $1.00-12.00
• > 1,000,000 in USA
Gerbil
• Meriones
unguiculatus
• Can gnaw through
anything except
glass (aquarium)
• Very tame
• Epilepsy, diabetes
and lead poisoning
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Gerbil
• Almost never carry pathogenic
fungi (dermatophytes)
• Have been associated with the
transmission of avian mites to
their human owners (mites were
presumably acquired in pet store
from birds)
Arch Dermatol 137:167,2001
“Itchy” new gerbil owner
• 59 yo female
• Acquires gerbil
from local pet
store (replaces
dead husband)
• Begins to itch in
four days
• Excoriated
papules
Voila!
One on patient….
Many in gerbil cageICD 10: B88.0 = dermatitis due to bird mite
Two stage transmission
Proc Natl Acad Sci U S A. 2015;112:3020-5
Parasit Vectors. 2015;8:256. doi: 10.1186/s13071-015-0852-z.
Ear swabs, total body combing, skin scraping of 600 dogs in animal clinics
15.4% were infested; 4.3% with multiple species
Ixodes ricinus, Rhipicephalus sanguineus, Demodex canis, Sarcoptes scabiei,
Otodectes cynotis, Ctenocephalides canis, Ctenocephalides felis, Pulex
irritans, and Trichodectes canis
Ticks, mites and fleas! Parasitol Res. 2017;116:399-407
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What About Viral Diseases?
• No viral diseases: hedgehog, chinchilla, sugar glider
• BUT, some small mammals can carry zoonotic
viral diseases that are devastating to man
• Gerbil, hamster, mouse, guinea pig, vole:
Lymphocytic Choriomeningitis Virus
Vector Borne Zoonotic Dis. 2014; 14:278-83
Marmoset
• 18 species of South
American monkey
• Genus = Callithrix
• Primitive compared
to most primates
• Live 7-20 years
• Pygmy marmoset is
common pet
Callithrix pygmaea
• Expensive $2-5000
• Carriers of LCMV!
Emerg Infect Dis 7:1062, 2001
Emerg Infect Dis 8:639, 2002
Lymphocytic Choriomeningitis Virus
• Systemic viremia and illness
• Altered mental status, seizures
• Fever and leukocytosis
• Abdominal pain and diarrhea
• Thrombocytopenia, DIC
• Hepatorenal dysfunction (late)
• Death (Fatality rate in transplants = 90%)
MMWR 61:622, 2012
Lymphocytic Choriomeningitis Virus
• Systemic viremia and illness
• Altered mental status, seizures
• Fever and leukocytosis
• Abdominal pain and diarrhea
• Thrombocytopenia, DIC (skin signs)
• Hepatorenal dysfunction (late)
• Death (Fatality rate in transplants = 90%)
MMWR 61:622, 2012
Lymphocytic Choriomeningitis Virus
• Fatalities in organ transplant RECIPIENTS who
got organs contaminated with LCMV
• Organ DONORS had pets infected with LCMV
(carriers)
• Donors ASx; BUT…The organ recipients are
immunosuppressed, don’t handle virus well!
• Emerg Infect Dis 20:1443, 2014
Vet Microbiol 140:213, 2010
N Engl J Med 358:991, 2008
N Engl J Med 354:2235, 2006
MMWR 54:747, 2005
Lymphocytic Choriomeningitis Virus
• LCMV induced illness: shortly after transplant
• Deaths occur 9-76 days post-op
• Clinical clues: Peri-incisional eczematous
eruption*along with petechiae, purpura or
ecchymoses (↓platelets) and alopecia
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Cockatoo
• 21 distinct species
• Australia, Philippines, Indonesia
• Long-lived (30-80 yrs)
• Inattention leads to mental illness
(seen as self-mutilation)
• Limited vocabulary
• Expensive; > $1000
Cockatoo
• Cockatoo (and related macaw)
carry Cryptococcus neoformans
and have been source of human
infection in HIV+ and transplant
patients (Serotypes A and D)
• J Am Vet Med Assoc 187:1218, 1985
Ann Int Med 132:205, 2000
• Rarely, normal hosts as well!!!
J Intern Med 257:385, 2005
• Cockatoo may either become ill
from or often carry pathogenic
aspergillus spp.
Cockatoo Owner (HIV+)
Cockatoo Owner (HIV+)
Skin/node cultures + Cryptococcus neoformans
ICD 10 to the rescue!
B45.2 Cutaneous Cryptococcois
B45.7 Disseminated Cryptococcosis
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Cryptococcal Disease
Infliximab Associated
• Otherwise healthy
• RA arthritis patient
• Develops fatal
Cryptococcal
pneumonia
• Had pet cockatiel
• Avian excrement
cultures positive for
C. neoformans
• Respir Care 49:606, 2004
Advise patients receiving
infliximab to avoid pet
birds, especially of the
cockatoo-macaw family
Mankind craves pets…..
…….BUT any animal can bite!
~586,000 pet snakes in USA; 1.5 mean per snake-owning household J Am Vet Med Assoc 232:696, 2008
Snakes
• Vary from harmless to lethal
• Active legal and illegal trade
• ½ of states require no license to
import; even deadly foreign snakes
• No Federal mandate to inspect
imported snakes
• Variable price…$35 to $2000+
• Major problem is bite
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http://market.kingsnake.com/index.php?cat=101
Common Exotics
Aug, 2013
ICD-10: W59.13XA
Crushed by nonvenomous
snake, initial encounter
Snake Bite
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Snake Bites
• None of the usual derm maneuvers is helpful
• Tourniquet, above and below Incision and
suction drainage
• “Snake Bite Kit”
• Administration of anti-venin key!
• Zoo is most reliable source; Hospital ER short
supply (if any)
• With non-US species, Zoo ONLY place where
anti-venin might be
ICD 10: T63.001
Toxic effect of unspecified snake
venom, accidental (unintentional),
initial visit
The Elephant Who Painted
Rama: Portland Zoo
MMWR 2016;64:1398-1402
Elephants and TB
• 3.3-5.0% Captive elephants have TB
• Bi-directional transmission documented
• Outbreak of TB in Portland, Oregon zoo
• Among CLOSE contacts (19), six found
to be seroconverted (31.6%)
• Among causal contacts (96), one with
active TB
• Genotyping confirmed same strain
• Moral: Stay clear of coughing elephants
MMWR 2016;64:1398-1402
ANY pet can attack….
Gekko bite!
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Since pets are dangerous….
Get Them First!
References
Rosen T, Jablon J: Infectious threats from
exotic pets. Dermatological implications.
Dermatol Clin 21:229-236, 2003
THE REFERENCE