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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

Vampireted@aol.com