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By Carol A. Kemper, MD, FACP, Clinical Associate Professor of Medicine, Stanford University, Division of Infectious Diseases; Santa Clara Valley Medical Center, Section Editor, Updates; Section Editor, HIV, is Associate Editor for Infectious Disease Alert.
Pathogens and Pet Therapy
Source: Lefebvre SL, Weese JS. Contamination of pet therapy dogs with MRSA and Clostridium. difficile (letter). J Hosp Infect. 2009 March 28. [Epub ahead of print].
Much is being written about the transmission of MRSA between animals and humans. These investigators explored this problem from another angle, examining colonization of pet therapy dogs with MRSA, VRE, and C. difficile during visits to acute and long-term care facilities.
Forepaw and hand samples were obtained from 26 pet-therapy dogs and their handlers before and after each visit. Twelve pairs had visited acute--care facilities and 14 had visited long-term care facilities. One investigator, who cleansed her hands with alcohol before examining each dog, sampled colonization of haircoats by petting each dog from head to tail for one minute after each visit, and then cultured her hands.
None of the pathogens were identified on the paws or hands of the teams before deployment. During visits to the hospital, however, one dog acquired C. difficile on its paws. PCR studies determined this organism was the epidemic strain NAP1/ribotype 027, and carried genes for all three toxins, including binary toxin CDT. This animal had "shook paws" with multiple patients. MRSA was detected on the investigator's hands after petting a pug that had visited a long-term care facility (USA 100). The pug had been placed on the beds of multiple patients and was kissed on the head by two patients. No VRE was identified on any dog or handler.
This small survey demonstrates how readily these organisms can be acquired, even with simple contact with patients' hands, beds, and the floor, and demonstrates the potential for transmission of these organisms between patients and to handlers during pet-therapy visits. The patients these pets visited presumably had unrecognized colonization with these pathogens, as pet-therapy pets are not allowed into contact isolation rooms. This survey also demonstrates how readily visiting family members might acquire these organisms.
Of note, only half the handlers were observed to cleanse their hands between patient rooms. Infection control personnel may wish to consider these data when drafting pet therapy protocols.
Chimps Vulnerable to Human Flu
Source: ProMED-mail post, April 2, 2009; http://www.promedmail.org
Differing strains of influenza are generally species-specific, such as canine influenza causing infection in dogs, although human influenza B has been known to colonize and infect other mammals, such as harbor seals. Chimpanzees and gorillas share much of their DNA in common with humans and, as such, are vulnerable to many human respiratory pathogens, including influenza.
This brief alert describes an outbreak of flu-like illness in a Congolese primate sanctuary just outside of Kinshasa, suspicious for human Influenza. Kinshsasa had just experienced a surge in flu cases in February. At least 10 of 60 Bononos (pygmie chimpanzees) were hard hit with severe respiratory and flu-like symptoms, and four have died. The sanctuary receives 30,000 visitors per year, many of whom are school-aged children. Animal handlers and researchers are now wearing face masks in hopes of limiting spread of this respiratory illness. This brief alert shows how quickly certain human illnesses can threaten vulnerable wildlife.
An Eel on the Loose
Source: Lin CY, et al. Esophageal perforation, mediastinitis, and retropharyngeal abscess after eel intrusion. Pediatr Infect Dis J. 2009 March 23. [Epub ahead of print].
Stories seldom get more bizarre that that of Steve Irwin's death from cardiac laceration from a ray tail, but this one does.
A two-year old was standing next to the kitchen table, looking at some eels brought home for dinner, when one of the eels jumped into her mouth and down her esophagus by about 15 cm. The eel was quickly retrieved by her aunt and measured about 47 cm. Although the aunt probably prevented acute respiratory arrest, eels are covered by small teeth and scales, which can lodge in tissues. What kind of bacterial pathogens would you anticipate from this kind of eel attack?
The next day the child was brought to the emergency room with fever and odynophagia, with apparent swelling of the anterior neck. Bulging of the posterior pharyngeal wall was observed on laryngoscopy, and widening of the mediastinum and retropharyngeal abscess was observed on chest CT. Emergent drainage was performed. She subsequently developed empyema, and an esophagram demonstrated a perforation with fistulization. Purulent drainage was observed in the esophagus about 10 cm below the incisors. Following an extensive hospitalization and five surgeries, she was finally discharged to home. Cultures yielded Pseudomonas aeruginosa. Various organisms have been described with Moray eel bits and other infections from aquatic animals, including Vibrio, pseudomonas, and aeromonas spp. For this reason, injuries occurring in saltwater should be treated with docycline plus anti-pseudomonal therapy.
Syphilis in Children: A Novel Means of Transmission
Source: Zhou P, et al. Nonvenereal transmission of syphilis in infancy by mouth-to-mouth transfer of pre-chewed food. Sex Transm Dis. 2009;36:216-217.Syphilis in children in the pre-antibiotics era was not uncommon, but has since become so rare that it may readily escape detection. In the Bay Area last year alone, only one case of congenital syphilis infection was reported. Aside from congenital infection, syphilis in children may be acquired through breastfeeding, handling, and oral contact, such as kissing. In the developing world, without access to prepared baby food or food processors, pre-chewing food for infants is commonplace. Pre-chewed food has been associated with transmission of strep infection as well as HIV.
These authors describe two cases of acute, primary syphilis occurring in two infants, ages 10 months and 18 months. Both were accidentally infected by family members recently diagnosed with active syphilis. One infant presented with mucous patches of the tongue, palate, and cheeks, with marked lymphadenopathy. Both grandparents had been recently diagnosed with syphilis, and grandma had signs of secondary syphilis (grandpa admitted to extracurricular activities). The grandmother was in the habit of chewing the baby's food, even when she had oral lesions.
The second infant presented with acute pharyngitis and posterior auricular adenopathy. The mother had been diagnosed two days earlier with secondary syphilis, with oral mucous patches and lingual papules, although she had tested negative for syphilis during her pregnancy (dad also tested positive but wasn't talking). Mom was also in the habit of chewing baby's food.
Acutely, children with syphilis can present with pharyngitis, lymphadenopathy, and headache — pretty common, but not specific, symptoms in children. With the recent re-emergence of syphilis, especially in large urban areas, clinicians should be alert to the presence of children in the home, especially if the parents have oral involvement or secondary syphilis.
Pseudomonas, Sex, and Oozinator Hot Tubs
Source: Dulabon LM, et al. Pseudomonas aeruginosa acute prostatitis/urosepsis after sexual relations in a hot-tub. J Clin Microbiol. 2009 March 18. [epub ahead of print].
A previously healthy 38-year-old man hospitalized with fever, dysuria, and suprapubic discomfort was diagnosed with a UTI and pseudomonas bacteremia. Examination demonstrated a boggy, tender prostate. CT confirmed significant soft tissue inflammation surrounding the prostate and seminal vesicles, consistent with acute prostatitis.
How does a healthy man, without a history of instrumentation, acquire pseudomonas prostatitis and bacteremia? He had just purchased an oozinator hut tub one week earlier, and disclosed having had sexual intercourse with his wife in the hot tub three times that week. Although oozinators require less chlorine, and the man stated that he had shock-disinfected the tub per the manufacturer's recommendations, he had filled the tub with water from a stream behind his home. Such systems are designed for potable city or well water, not non-potable water with presumably higher bacterial colony counts (one also wonders how high the phosphate level from fertilizers was). Analysis of the water from the hot tub yielded three morphotypes of pseudomonas, one of which was identical to the blood stream isolate by PFGE.
Pseudomonas has a broad growth temperature range of 4-42° Celcius, and while its growth is inhibited by higher concentrations of chlorine, the organism can flourish (with up to 104-106 colonies/mL) if chlorine levels fall below 1 ppm. Aeration can actually help dissipate the chlorine, one of the reasons some individuals favor oozinator tubs.