Welcome to Jurassic Park: Reptile-Associated Salmonellosis

Abstract & Commentary

Synopsis: It is not even necessary to travel all that far to contract diseases from lizards, snakes, and turtles, as many of us may have the opportunity to visit some of the numerous U.S. households that have included pet reptiles as part of their family—and its microbial flora.

Source: Reptile-associated salmonellosis—Selected states, 1996-1998. MMWR Morb Mortal Wkly Rep 1999;48:1009-1013.

A series of four cases, reported in a recent issue of the CDC’s Morbidity and Mortality Weekly Report, highlighted the clinical and epidemiological characteristics of salmonellosis transmitted from reptiles to humans. Many more cases had been reported from 16 state health departments (see Figure). Syndromes of fever, vomiting, bloody diarrhea, and even death in one young patient from salmonellosis, were linked to positive Salmonella cultures in pet iguanas and corn snakes. These occurred in a 3-week-old boy, a 6-year-old and his 3-year-old brother, an 8-month-old, and a 5-month-old boy who died.

Comment by Maria D. Mileno, MD

Salmonella infections can result in severe invasive illnesses, including sepsis and meningitis, particularly in infants. Despite considerable educational efforts, some reptile owners remain unaware that pet reptiles place them and their children at risk for salmonellosis. Commercial distribution of pet turtles, shorter than 4 inches long, was banned in 1975; until that time, pet turtles were an important source of salmonellosis for young pet owners. The popularity of other common and exotic reptiles is growing and continues to pose a substantial threat. More than 93,000 reported cases (7%) of Salmonella infections each year are attributable to pet reptiles for children. Most persons who contract reptile-associated salmonellosis are infants and young children who are infected with Salmonella spp. after handling either a reptile or objects contaminated by a reptile, and then failing to wash their hands properly. To draw attention to this issue for the U.S. public, several important recommendations have been made (see Table).

To make matters worse, "man’s best friend," the dog, may be also be subject to Salmonella infections acquired from dog treats that were manufactured from pig ears. To date, 30 cases of salmonellosis have been linked to such exposures, and 30% of Salmonella infantis infections occurred in children younger than 2 years of age; 48% in children younger than 4 years old. Health Canada has issued a public health warning that infants, the elderly, and immunocompromised persons should avoid handling dog treats manufactured from sources such as pig ears, which can be contaminated with Salmonella spp. (Dr. Mileno is Director, Travel Medicine, The Miriam Hospital, Assistant Professor of Medicine, Brown University, Providence, RI.)

Table-Recommendations for Preventing Transmission of Salmonella from Reptiles to Humans
Pet store owners, veterinarians, and pediatricians should provide information to owners and potential purchasers of reptiles about the risk for acquiring salmonellosis from reptiles.
Persons should always wash their hands thoroughly with soap and water after handling reptiles or reptile cages.
Persons at increased risk for infection or serious complications of salmonellosis (e.g., children aged < 5 years and immunocompromised persons) should avoid contact with reptiles.
Pet reptiles should be kept out of households where children aged < 1 year and immunocompromised persons live. Families expecting a new child should remove the pet reptile from the home before the infant arrives.
Pet reptiles should not be kept in child care centers.
Pet reptiles should not be allowed to roam freely throughout the home or living area.
Pet reptiles should be kept out of kitchens and other food preparation areas to prevent contamination. Kitchen sinks should not be used to bathe reptiles or to wash their dishes, cages, or aquariums. If bathtubs are used for these purposes, they should be cleaned thoroughly and disinfected with bleach.
Source: MMWR Morb Mortal Wkly Rep 1999;48:1012.

Which of the following is correct?

a. Pet amphibians have been identified as an important source of Salmonella infection in children in the United States.

b. Pet turtles are currently an important source of Salmonella infection in children in the United States.

c. Pet reptiles kept in child care centers can be considered not to be a potential source of salmonellosis if the reptiles appear to be healthy.

d. Immunocompromised persons and children aged younger than 5 years should avoid contact with reptiles.