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Barnyard Zoonoses

Tammie Ferringer, MDDepts of Dermatology and Pathology

Section Head and Fellowship Directory, Dermatopathology

Danville, PAtferringer@geisinger.edu

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