Zoonosis

22/11/2010 12:29:00

What is an EMERGING INFECIOUS DX? caused by New Pathogen occurs More Often affects New Host found in New Area What causes a new Dx to emerge? change in microbial adaptation (resistance) change in host susceptibility to infxn change in climate/weather change in economic development/land use change in technologies/industries change/breakdown in public health infrastructure international travel/commerce What is ZOONOSIS? Complex group of infectious dx naturally transmissible from vertebrate animals to humans (vice-versa) Many Species Specific: o rats= plague o deer tick= Lyme dx o Elephants= TB List of ANIMALS + DX carried BATS= rabies CATS= plagues, anthrax, cowpox, tapeworm, bacterial infxns DOGS= plagues, tapeworm, rabies, Rocky Mountain S.F., Lyme Dx HORSES= anthrax, rabies, Salmonella CATTLE= anthrax, European tick-borne encephalitis, rabies, tapeworm, Salmonella, bacterial/viral dx PIGS= tapeworm, anthrax, influenza, rabies SHEEP/GOATS= rabies, European tick-borne encephalitis, Salmonella, bacterial/viral dx RABBITS= plague, Q-fever BIRDS= Campylobacteriosis, Chlamydia psittaci, Pasteurella multocida, Histoplasma capsulatum, Salmonellosis Why so many? contact b/n humans/animals

# of dx investigations New technology dx surveillance in animals New International Health Regulations (2005) Industrial farm production Biosecurity systems (occupational health, better communication) Diagnostic approach to Zoonoses? over 300 dx Hx should include: o Residence & travel hx o Occupation o Outside interests o Presence of skin lesion should include: appropriate cultures serologic specimen chemistry (help confirm) PARASITIC ZOONOSES Cysticercosis/Taeniasis o infects SWINE o Causes: seizures, headache, etc. o Latin America: 100/100,000 suffer from dx Other o Trematodosis o Echinococcosis/Hydatidosis o Toxoplasmosis o Trichinellosis Labs o o o

FUNGAL ZOONOSES Dermatophytoses o superficial mycoses that may be acquired from infected animals

o affect skin, nails, hair o cause itching, redness, scaling, hair loss Sporotrichosis

Tinea Barbae

Tinea Capitis

Tinea Corporis

Tinea Cruris

Tinea Pedis

VIRAL ZOONOSES Rabies o dx of carnivores & bats o mainly transmissible to humans by bites o human will die if not tx o 55,000 people die every yr worldwide o human deaths mainly attributed to dogs Others o Avian Influenza o Crimean-congo Hemorrhagic fever o Ebola/Rift Valley Fever

UNCONVENTIONAL (agent) ZOONOSES Prions o agent of Bovin Spongiform Encephalopathy (MAD COW DX) o thought to be cause of Creutzfeldt-Jakob Dx (vCJD): a degenerative neurological dx o lethal in humans

BACTERIAL ZOONOSES Salmonellosis & Campylobacteriosis o foodborne zoonoses o cause: fever, diarrhea, abdominal pain, malaise, nausea Other o Anthrax o Brucellosis

o o o o o o

verotoxigenic E. Coli Leptospirosis Plague Q fever Shigellosis Tularemia

YERSINIA PESTIS (Plague)

Characteristics

*French bacteriologist: Andre Yersin studied plague in far east *1st isolated plague bacillus (1984: originally Pasturella Pestis) *Infects: rodents, small mammals *2 Major cycles: Urban & Sylvantic *Clinical forms: Bubonic, Septicemic, Pnuemonic

Bacteriology

*Enterobacteriaceae

*Gram (-) Bacillus *Pathogenesis:

*Non-motile

*Pleomorphic, Bipolar staining -F1 gene=encodes capsule

*Non-spore forming -Suppresses cytokine production

-Pla gene=resistant to serum killing (Plasminogen activator: degrades C3b, C5a, Fibrin clots) -Type III secretion system: induces apoptosis in (YOPS: Yersinia Outer ProteinS) Epidemiology *3 major pandemics *Natural Resevoirs: rats, squirrels, rabbits *Humans accidental hosts (no role in maintenance of Y. pestis as a persistant pathogen in the ecosystem) *WHO: 1,000-3,000 cases/yr *World Distribution of Plague >>>>>>

Transmission

*Rodent flea bites *Exposure to humans with pneumonic plague *Handling infected animal carcasses *Scratches/bites from infected domestic cats *Exposure to aerosols

Clinical *course of dx is the same whether acquired from urban/sylvantic source

*IP: 2-7 days after flea bite *Bubonic Plague (most common form) -sudden onset of fever, chills, weakness, headache -followed by bubo: (which may precede lymph adenopathy) >intense pain/swelling lymph node area >exquisite tenderness w/o fluctuation >erythema & edema of overlying skin -inguinal region most frequently involved (axillary/cervical also)

*Septicemic Plague -hard to dx in timely fashion -febrile, extremely ill (no localizing signs) -may have GI sx: nausea, vomiting, diarrhea, abdominal pain -hypotension, DIC, multi-organ failure *Pneumonic Plague -secondary to bacteremia in bubonic/septicemic plague -1 PP: acquired from inhalation from another pt/animal/lab specimen >short IP: few hrs-days -sudden onset of dyspnea, high fever, pleuritic chest pain, cough -sputum may be clear,purulent, hemorrhagic, contain gram (-)rods -rapidly fatal -diffuse, hemorrhagic changes in skin plus cyanosis from necrotizing pneumonia produce dark skin at extremities=black death

Diagnosis

*Area of endemic dx: southwestern U.S. *Gram smears from bubo: bipolar-staining Gram(-) bacilli *Immunofluorescence *Specimens: bubo aspirate, blood, sputum *Labs must be notified *Plague bacteria in blood smear>>>

*Grows well on most standard media after 48-72 hrs: Gray-white to slightly yellow opaque, raised, irregular *Fluorecent Ab test

Tx/Prevention

*Isolation *Choice: STREPTOMYCIN *Alternatives: TETRACYCLINE, CHLORAMPHENICOL, SULFONAMIDES *Urban Plague: prevented by rat control/public health measures *Sylvantic plague: virtually impossible to eliminate, avoidance of sick/dead rodents *Chemoprophylaxis: (Tetracycline) exposure to pneumonic plague *Formaline-killed plaque vaccine: only high-risk occupation

22/11/2010 12:29:00
Francisella Tularensis

Characteristics

*Tularemia, Rabbit Fever, Glandular Fever *Dx of wild animals in Tulare County, California *Named after Edward Francis *Humans infected by contact w/ infected animals/vector (tick/deerfly) *High fever *Similar to those os plague *Gram (-) Coccobacillus *Non-motile *Small, aerobe *Facultative intracellular pathogen *CAPSULE: resists (inhibit phagosome-lysosome fusion) *ENDOTOXIN: resistant to serum killing *2-10 days for appearance of tiny, translucent colonies *CYSTEINE: required for growth *Can persist in water, mud, or animal caracasses for several weeks *World-wide distribution (highly virulent strains in N. America) *~100 cases/yr *RESERVOIRS: rabbits *TRANSMISSION: meat, water, inhalation, cat scratches/bites, splashing infected material into eye, eye rubbing with contaminated fingers *Infects >100 species of vertebrates &invertebrates (wild & domestic) *Distribution TYPE A (F. Tularensis Tularensis=red) TYPE B (F. Tularensis holartica=yellow)

logy

Bacterio

Epidemi ology

*Most common in south central U.S., Pacific NW, parts of Massachusetts

Clinical

*IP: 2-10 days *Abrupt onset of fever, chills, headache, malaise *Other sx related to portal of entry & principle organ system involved *LYMPADENOPATHY, FEVER, PHARYNGITIS, ULCER/ESCHAR/PAPULE, NAUSEA, VOMITING *Course depends on site of inoculation, infectious dose, virulence, spread, host immunity *Multiplies locally for 3-5 days>produces papule that ulcerates after several days>spreads to regional lymph nodes>to organs SYNDROMES *ULCEROGLANDULAR (most common): painful papula & enlarged lymph node *GLANDULAR: painful adenopathy w/o skin ulcer *OCULOGLANDULAR: direct infection of eye *PHARYNGEAL/GI: ingestions of contaminate food/water *PNEUMONIC: inhalation of infectious aerosols *TYPHOIDAL: systemic illness-sepsis & multiorgan involvement <<<CERVICAL LYMPHADENITIS IN PHARYNGEAL TULAREMIA -pt. had marked swelling & fluctuant suppuration of anterior cervical nodes, infxn acquired by ingestion of contaminated food/water

is

Diagnos

*Confirmed serologically by TUBE AGGLUTINATION/ ELISA *Small, pleomorphic, poorly staining, (Gram-stain>>) gram (-) coccobacillus Direct Immunoflorescence

Brucella (Brucellosis)

CHARACTERISTICS

*Undulant Fever/Malta Fever *GI trct infections of sheep, cattle, pigs, other *Humans infected by occupational contact/ consumption of contaminated products *PRIMARY
TARGET:

reticuloendothelial system *NON-ACID

FAST, NON-SPORE FORMERS

BACTERIOLOGY

*GRAM (-) *AEROBIC, *Inhibits *Impairs

COCCOBACILLUS SMALL, NON-MOTILE

*Smooth colony forms on 1 isolation

*Facultative intracellular pathogen of phagocytic cells

MYELOPEROXIDASE SYSTEM, PHAGOSOME-LYSOSOME FUSION CYTOKINE PRODUCTION

*B. Melitensis: goats & sheep *B. Abortus: cattle *B. Suis: swine EPIDEMIOLOGY *B. Canis: dogs *RESEVOIRS: goat, sheep, cattle, swine, dogs *Important cause of abortion, sterility, & milk production in goats, cattle and hogs *Spread among animals by DIRECT CONTACT TRANSMISSION *OCCUPATIONAL (Vet care/ slaughter): -direct inoculation thru cuts/abrasions -handling animal carcasses, placentas, vag secretions -via Conjunctiva -inhalation of infected aerosols *INGESTION raw meat *LAB CLINICAL
ACCIDENTS OF CONTAMINATED FOOD:

raw milk, non-pastureized milk cheeses.

*B. ABORTUS, B. CANIS: mild *B. SUIS: prolonged course *B. MELITENSIS: severe dx

*IP: 7-21 days *Few physical findings *UNDULANT FEVER

*Begins w/ malaise, chills, fever *Localized infxn in lung, brain, heart, GI

TREATMENT & PREVENTION

*Definite Dx: isolation from blood/ biopsy specimen, IF, PCR *Choice: TETRACYCLINE *Seriously Ill: STREPTOMYCIN, GENTAMICIN, RIFAMPIN added *PREVENTION: minimization of occupational exposure, pasteurization of dairy products

 Pasture lla Multocida

Characeri stics *Gram (-) coccobacillus *Capsula ted *Nonmotile *Normal flora of dogs & cat

s
DOG BITE

Clinical *Celluliti

CAT BITE

Bartone lla Henselae (cat scratch disease)

*from cat scratch/ flea bite

*selflimited regional adenopathy *Visceral organ, neurologic, ocular involvement *Crusted 1 inoculation

Diagnosi s *Gram stain of purulent drainage *based of clinical findings *Lab testing: antibody titer -PCR -(+) Warthin Starry stain

Tx

*Penicilline G *Doxycyclin e *Wound cleansed, irrigated, debrided *depends on clinical presentation *azrithrom ycin: immunocomp. pt w/ mild-mod dx *rifampin + gentamicin: hepatosplenic/ disseminated dx *doxycyclin e: -neurologic dx