Reptile-Associated Salmonellosis, Selected States 1996-1998
Centers for Disease Control & Prevention, November 12, 1999, 48(44):1009-1013
During 1996-1998, CDC received reports from approximately 16 state health departments of Salmonella infections in persons who had direct or indirect contact with reptiles (i.e., lizards, snakes, or turtles). Salmonella infection can result in invasive illness including sepsis and meningitis, particularly in infants. Despite educational efforts, some reptile owners remain unaware that reptiles place them and their children at risk for salmonellosis. This report summarizes clinical and epidemiologic information in four cases and provides information about state regulations to prevent transmission of Salmonella spp. from reptiles to humans.
Kansas. During April 1997, a 6-year-old boy had bloody diarrhea of 10 days' duration, abdominal cramps, vomiting, and fever (104.9 F [41 C]). Stool culture yielded Salmonella serotype Typhimurium. The child was treated with ceftriaxone and amoxicillin/clavulanate. Nine days after the boy started therapy, his 3-year-old brother also developed diarrhea, and a stool sample yielded S. Typhimurium. No other family members became ill. The two boys shared a room with two corn snakes that they handled regularly. Stool cultures from the corn snakes yielded S. Typhimurium. The parents reported to health department staff that they were unaware that snakes are a source of salmonellosis.
Massachusetts. During May 1997, an 8-year-old boy with a congenital immune deficiency developed severe vomiting, abdominal cramps, bloody diarrhea, and headaches. Stool samples yielded Salmonella serotype St. Paul. The boy was ill for 14 days and received extensive supportive care at home. Three days before the boy became ill, the family had purchased two iguanas from a local pet store. The family was not informed by pet store personnel that reptiles are a source of salmonellosis; the child handled the reptiles, including putting them on his head and face. Before diagnostic testing could be performed, the reptiles were returned to the pet store. The parents informed the pet store owner of the child's illness, and the pet store owner reportedly was unaware that reptiles carry Salmonella spp.
Wisconsin. In December 1998, a previously healthy 5-month-old boy suddenly died at home. No significant macroscopic or histologic findings were revealed during autopsy; however, culture of a heart blood sample yielded Salmonella serotype Marina. The cause of death was attributed to S. Marina septicemia. The family had a pet iguana that had not come into direct contact with the infant. Culture of a stool sample taken from the iguana yielded S. Marina. Based on an interview, the parents were unaware that the infant was at risk for salmonellosis from indirect or direct contact with the iguana.
Regulations for Preventing Reptile-Associated Salmonellosis
Reported by: C Levy, MS, M Finnerty, Arizona Dept of Health Svcs. G Hansen, DVM, Kansas Dept of Health and Environment. J Cory, MPH, M McGuill, DVM, B Matyas, MD, A DeMaria, Jr, MD, State Epidemiologist, Massachusetts Dept of Public Health. G Schmunk, MD, J Grantham, MD, Brown County Medical Examiner's Office, Green Bay, Wisconsin; J Archer, MS, J Kazmierczak, DVM, J Davis, MD, State Epidemiologist for Communicable Diseases, Wisconsin Dept of Health and Family Svcs. Foodborne and Diarrheal Diseases Br, Div of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, CDC.
Rare Salmonella serotypes, such as Java, Marina, Stanley, Poona, and Chameleon associated with reptiles, increasingly have been isolated from humans (7) (Figure 1). For example, S. Marina isolates from humans increased from two in 1989 to 47 in 1998, and S. Poona increased from 199 in 1989 to 341 in 1998 (8). Isolation of rare serotypes of Salmonella spp. can alert public health staff about trends in the transmission of infection from reptiles to humans.
Most persons who contract reptile-associated salmonellosis are infants and young children. In 1994, 413 (81%) of 513 S. Marina cases occurred in children aged less than 1 year, whereas 4301 (14%) of 30,723 reported salmonellosis cases occurred in children aged less than 1 year (6). During 1989-1998, 516 (24%) of 2150 Salmonella isolates with reptile-associated serotypes were from children aged less than 4 years, whereas 50,755 (19%) of 267,131 other serotypes were from this age group (CDC, unpublished data, 1999). Because infants and immunocompromised persons are more susceptible to illness, many reptile-associated Salmonella infections involve serious complications, including septicemia and meningitis (9).
The risks for transmission of Salmonella spp. from reptiles to humans can be reduced by thoroughly washing hands with soap and water after handling reptiles or objects that have been in contact with reptiles and by preventing reptile contact with food-preparation areas. Children aged less than 5 years and immunocompromised persons should avoid direct and indirect contact with reptiles. Reptiles also should not be kept in homes of persons with children aged less than 1 year and in child care facilities (see box). All pet store personnel and reptile owners should be aware that reptiles can carry and transmit Salmonella spp. Pet stores are in a unique position to educate consumers because reptile owners obtain most of their information about their pet from pet store personnel. CDC and the Pet Industry Joint Advisory Council (PIJAC) have developed educational posters and brochures for use by veterinarians and pet stores on safe pet reptile handling.*
The effectiveness of educating the public about reptile-associated salmonellosis needs to be evaluated. To enhance efforts to educate the public in a systematic, consistent, and timely manner, the National Association of State Public Health Veterinarians and the Council of State and Territorial Epidemiologists jointly recommend "that the appropriate state and local agencies enact legislation prohibiting the sale or gift of reptiles unless there is written point-of-sale education provided to consumers on the risks for and prevention of reptile-associated salmonellosis" (10). CDC will provide assistance to states interested in developing point-of-sale educational material; however, if these educational efforts should prove unsuccessful, states may wish to adopt restrictions for the sale of reptiles similar to those for turtles.
Recommendations for Preventing Transmission of Salmonella from Reptiles to Humans
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