Zoonoses of Companion

Animals Zoonoses 2: The GIT

Lecture_04
 Gastro-intestinal Truck System (GIT)
• A significant problem in human and animals/pets
• Increasing numbers of cases of people with
immunosuppression e.g. cancer therapy, HIV infection
• Causative agents: bacterial, viruses, parasites (protozoa,
helminthes) resulting in diarrhoea and other effects in humans

Most of these infections have a reservoir in production animals,

which are frequently the major reservoir of these organisms
 Causative agents
BACTERIA: Campylobacter jejuni, Salmonella spp,
Yersinia enterocolitica, Y. pseudotuberculosis,
Helicobacter pylori

PROTOZOA: Cryptosporidium sp, Giardia spp

Toxoplasma gondii

VIRUSES: Enterovirus ( eg, rotavirus)

PARASITES: Strongyloides stercoralis, Gnathostoma

spingerum, Echinococcus granulosa
 Giardiasis
Aetiology:
• Giardia lamblia, G. intestinalis, G. duodenalis

Source
• Domestic and wild animals
• Survives in the environment for prolonged
periods – in soil or surface water
• Higher proportions of kittens are infected (up to
8.1%)
• Human asymptomatic excretors of cysts are also
an important source
 Giardiasis…

Transmission
1. Organism is immediately infectious
once excreted in faeces – directly
zoonotic
2. Ingestion of cysts from food/water
contaminated with human/animal
faeces
3. Person-person transmission important,
especially for children (e.g. Day care
centres, swimming pools and hot tubs
– organism is resistant to chlorine)
4. Human and animal feces used as
fertilizer contaminate vegetables and
fruits.
5. Flies are possible carriers of infectious
cysts.
• Cysts may survive in cold water for several months
• 10-100 cysts is sufficient to cause clinical symptoms in humans.
• Lack of treatment in municipal drinking water treatment
Clinical Signs
• Prepatent period : 6 to 15 days
• Incubation period: 7 to 21 days
• Infections may be asymptomatic
• Can cause acute severe diarrhoea, nausea, stomach cramps
• Usually lasts 2-6 weeks but may become chronic (diarrhoea)
extending to malabsorption

Diagnosis
• Identification of oocysts or trophozoites in faeces or duodenal
secretions
• Immunofluorescence assays also used
Therapy
• Tinidazole, Nitazoxanide, Metronidazole, Paromomycin
• Antibiotics are contraindicated, as the survival time of Giardia is
prolonged in largely abacterial environments

Prophylaxis
1. Food must be protected from contamination with Giardia oocysts
2. Good water hygiene - production, processing, and control
3. Animal and human feces should be used as treated fertilizers ???
4. Drinking water should be filtered or boiled (10 min) - Giardia cysts resist
chlorine.
5. Avoid uncooked food (e.g., salads)
6. Fruit should be peeled
 Helicobacter
Aetiology
• Helicobacter pylori, H. felis
• H. pylori - average prevalence of 50%
Source
• Found in the stomach, intestine and
liver of humans, dogs, cats, pigs and
non-human primates
• Prevalence:
– 20 - 90% of humans
– 70 - 97% of cats
– 100% of dogs
• H. pylori in cats and dogs cause gastritis
• Farm animals (pigs, cattle) act as sources
for H. pylori-related species
Transmission
1. Spread to humans by domestic pets
2. Humans - main reservoir of infection of H. pylori
3. Transmitted by faecal-oral or oral-oral route through close
personal contact
4. House flies – can transmit H. pylori

Clinical Signs
• May be asymptomatic
• Chronic gastritis, gastro-duodenal ulcers, neoplasia
• H. pylori cause 60-80% of gastric ulcers, 90% of duodenal ulcers
• H. pylori associated with gastric cancers
Diagnosis
• Endoscopically obtained biopsy specimens
• Tests
– Histopathology
– Rapid urease testing
– PCR
– Culture
• Other tests:
– Serological testing
– Urea breath test

Treatment of H. pylori infections

• Combinations of:
– Two or three antimicrobials (amoxicillin with or without
clavulanic acid, clarithromycin, metronidazole)
– Proton pump inhibitor (PPI) have been used.
 Barry James Marshall

2005 Nobel Prize in Physiology

 Hydatidosis
Echinococcus granulosus

• Distribution: Worldwide,
highest prevalence in Turkana,
Kenya
• Definitive host (DH): Dogs &
carnivores - small intestine
• Intermediate host (IH):
Ruminants, Man (liver & lungs)
• Metacestode: hydatid cyst
 Transmission and spread of E. granulosus

Basic life-cycle pattern

• Echinococcus spp. require two mammalian
hosts for completion of their life-cycles
• Carnivore [definitive host] - Segments
containing eggs (gravid proglottids) or free
eggs are passed in the faeces
• Eggs are ingested by an intermediate host
[Ungulates] , in which the metacestode stage
and protoscoleces develop
• Cycle is completed if such an intermediate
host in eaten by a suitable carnivore.
Domestic cycle
• Most important cycles for
perpetuating E. granulosus
– Involve domestic ungulates
– Most important cycle:
domestic dogs and sheep
Sylviatic cycle
Wild animals are involved
– Wild ungulates of
several species –
intermediate hosts

– Wild canids eg.,

hunting dogs, jackals ,
hyaenas & lion -
definitive hosts
Intermediate and Aberrant (accidental) hosts
Man is the abberant | Accidental | Blind end host

• Acquire the infection by the ingestion of eggs

• Oncosphere is released from the embryophore in the
stomach and small intestine
• Bile activitates the oncosphere & penetrates the wall of the
small intestine
• Penetration is then aided by the hook movements &
secretions of oncosphere
• Oncosphere enters blood vessel- transported to the liver,
where some are retained
• Others reach the lungs, kidneys, spleen, muscles, brain etc
• Oncosphere develops into a cyst (the metacestode)
Metacestode stage
• Oncosphere in final location develops into metacestode
• Protoscoleces are produced (fertile metacestode)
• Several thousand protoscoleces within a single cyst
• Each single protoscolex is capable of developing into a
sexually mature adult worm
• Not all metacestodes produce protoscoleces (sterile
metacestode).
• Protoscoleces - ingested by DH evaginate due to action of:
– Pepsin in the stomach
– Duodenum - change in pH, exposure to bile & increased
temperature
• 4-6 Weeks post infection - Develop to the sexually mature
adult tapeworm
SYSTEMIC ZOONOTIC DISEASES – Dogs & cats
• BACTERIA:
– Bacteria associated with Bites: Pasteurella multocida
– Borrelia burgdorferi (Lyme Disease)
– Bartonella henselae (Cat Scratch Fever)
– Leptospira spp. (Leptospirosis)
• FUNGAE:
– Cryptococcus neoformans- Cryptococcosis
– Histoplasma capsulatum (Histoplasmosis)
• PARASITES:
– Echinococcosis (Hydatids)
– Toxoplasma gondii (Toxoplasmosis)
– Toxocara canis (Visceral Larval Migrans)
– T. cati " Visceral Larval Migrans“
– Toxascaris leonina " Visceral Larval Migrans“
– Strongyloides stercoralis (Strongyloidosis),
– Trichuris vulpis (Trichuriasis)
– Dirofilaria immitis (Heart Worm)
– Schistosomiasis,
– Dipylidium caninum (Tapeworm)
Clinical signs of E. granulosus
• DH: Heavy Infections - diarrhea, constipation, enteritis.
• IH: Depends on organ of location eg., liver fibrosis, jaundice
(liver), respiratory problems (lung)
• Rupture of a cyst can lead to anaphylactic shock

Diagnosis:
Definitive host:
• Eggs: differential diagnosis from other Taenia sp
• Do purgation using arecoline hydrobromide (1-2 mg/kg) to
obtain the adults worms

Intermediate host:
• Postmortem/meat inspection – typical cysts unilocular
• Immunodiagnostic tests
• Radiography
 Treatment of humans and animals
• Praziquantel (5mg/kg of body weight) administered once,
orally or intramuscularly
• Benzimidazole compounds - Larval echinococcosis in
intermediate hosts
• Surgery + albendazole –
– Therapy to prevent recurrence
– Prior to surgical excision, the lesions aspirated and
injected with a protoscolicidal agent (95% alcohol) to
reduce the chance for leakage of anaphylactogenic or
infectious contents during surgery
 Control of Hydatidosis

1. Creation of public awareness through health education,

2. Meat inspection in farms and abattoirs to identify and remove
affected organs so that they are not sold for human consumption,
3. Periodic diagnostic testing of dogs.
4. Control of livestock slaughter by centralization of slaughtering to
ensure animals and carcasses are inspected,
5. Efficient meat inspection and proper disposal of affected offal (e.g.
disposal in properly constructed ‘condemnation pits’.)
6. Dog owners to control movement of their dogs.
7. Regular deworming of dogs with suitable anthelmintics e.g
praziquantel
8. Prevent dogs from gaining access to infected offal in slaughterhouse
and surroundings.
9. Reduction of dog numbers by elimination of stray and surplus dogs
Community education on control of hydatidosis
1. People should not feed dogs with infected/ condemned meat or organs
2. Always wash hands before eating. Children, in particular, should wash
their hands thoroughly after playing with dogs and before eating.
3. Avoid contact with dog faeces
4. Do not allow dogs to lick utensils used in the house
5. Do not allow dogs to drink from wells or containers used by human
6. Do not allow dogs to sleep in areas where people sleep
 Toxoplasmosis
Aetiology:
• Toxoplasma gondii - an intestinal coccidian of cats
Special Importance in:
1. Pregnant women
2. Immunocompromised people

• Vets & AHPs - asked for counselling by cat owners

regarding the dangers of having a cat during pregnancy &
HIV-positive
Final/Definitive hosts:
• All felids, domestic cat is the most important.
Intermediate hosts:
• Any mammal including man, or birds
• Cat may also be an IH and harbour extra-intestinal stages
Sites
• FH: Schizonts & gametes in the small intestine
• IH: Tachyzoites & bradyzoites in extra-intestinal tissues
including muscle, liver, lung, uterus, brain
Sources of Infection in Man

1. Ingestion of material contaminated with sporulated oocysts excreted

by cats
2. Children of crawling and dirt-eating ages are believed to be at higher
risk for infection.
3. Gardening activities or unwashed fruits or vegetables, water-borne
outbreaks
4. Ingestion of undercooked meat (esp Mutton and pork) containing
tissue cysts or tachyzoites
5. Few isolated reports of Toxoplasma being transmitted via tachyzoites
in unpasteurised goat's milk.
6. Toxoplasma can also be transmitted from mother to fetus, often with
dire consequences
7. Congenital transmission can only occur during an acute infection (ie,
tachyzoites) acquired during pregnancy.
8. Transmission from infected organ transplants. Tissue cysts from a
chronically infected organ donor may reactivate when transplanted
into a previously uninfected organ recipient.
9. Immunosuppressive therapy could also reactivate a latent infection in
the recipient.
10. Acquisition of tachyzoites from an acutely infected person via blood
transfusion is also possible.
 Clinical Signs in Humans and Animals
• Most infections in
immunocompetent adults are
subclinical
• Occasionally - fever, malaise,
myalgia, rash, headaches, night
sweats, lymphadenopathy,
hepatosplenomegaly and
chorioretinitis
• Termination of parasitaemia in
most normal individuals
coincides with the appearance
of antibody and usually
indicates life-long immunity
• However, antibody does not
eradicate the tissue cysts that
remain predominantly in
muscular and neural organs
1. Congenital Toxoplasmosis

• 33 - 60% of women infected with T. gondii during pregnancy will

transmit the infection to their foetus, but antibiotic therapy during
pregnancy can reduce this by 60-75%
• The age at which the foetus becomes infected determines the
severity of subsequent disease
• Pregnant women are at greatest risk of delivering a severely
affected infant if infection occurs during 1st trimester (weeks 10-14)
• Whereas infection of the mother at 26-40 weeks (third trimester) is
more likely to result in infection, but the this infection results in less
damage (and therefore a less severely affected baby)
• The effect on the foetus can include spontaneous abortion,
chorioretinitis and blindness, hydrocephalus and psychomotor
deficits, epilepsy, and mental retardation
2. Acquired Toxoplasmosis
• Toxoplasmosis is a devastating disease in immunosuppressed hosts,
and is one of the major causes of mortality in HIV/AIDS patients,
patients on chemotherapy, or organ transplantation

• Patient often showing signs of diffuse encephalopathy

• Most people are seropositive; disease is a result of a recrudescence
(reactivation) of pre-existing subclinical infection
• Up to 50% of AIDS patients who are seropositive for T. gondii (ie
previously infected) develop toxoplasma encephalitis during the
course of their disease
• Recrudescence also in immunosuppressed people or if an organ
with tissue cysts is transplanted to a patient receiving chemotherapy
and who is seronegative
• Severely affected patients may also develop generalised
lymphadenopathy, myocarditis, splenomegaly, encephalitis,
hepatomegaly and retinochoroiditis
Clinical toxoplasmosis…
Animal Toxoplasmosis - Clinical Signs
• Most cats – subclinical infection - passage of oocysts
• Sheep, goats, pigs, cattle - stillbirth, abortion and
reproductive wastage
Diagnosis
1. Microscopy - Parasites can be detected in biopsied
specimens, buffy coat cells, or cerebral spinal fluid
2. Mouse bioassay: These specimens can also be used to
inoculated mice or tissue culture cells
3. PCR
4. Serologic tests (IgG, IgM) are a recommended
component of diagnosis. But compromised by maternal
IgG due to previous exposure
5. Imaging techniques (CT, MRI) may also be useful in the
diagnosis of toxoplasmic encephalitis.
Prevention of human toxoplasmosis
1. Serological Surveillance of Patients at High Risk (pregnant
women, HIV patients)
• Determine baseline T. gondii titre esp in pregnancy
• Those seronegative before conception retested at 20-22
weeks and near or at term for risk of transmitting infections
• Any pregnant woman with a IFA titer of 1:80 or greater
should be considered as recently acquired infection

2. Prevention of Infection through Personal Hygiene

• Least expensive and most effective method of minimizing
cases of congenital toxoplasmosis
• Need for patient education- by the family practitioner,
obstetrician and veterinarian
 Other Preventative measures should include:

1. Handling meat: cooking at 61oCfor 4 minutes, smoking and brine

preservation procedures, freezing at -21oC for 24 hours then thaw
2. Meats should not be eaten or tasted raw, and hand washing is
important after handling raw meat (Abbyssinia culinary tatses…)
3. Cutting boards, knives rinsed thoroughly after contact with raw meat

4. Fruit and vegetables eaten raw should be thoroughly washed

5. Pet cats should not be fed uncooked meat scraps, especially pork
6. Cats should be discouraged from hunting and scavenging

7. Cat faeces should be disposed off appropriately and regularly (daily)

before the development of infective sporozoites from oocysts (which
takes 1-5 days depending on environmental conditions)
8. Faeces should be disposed of carefully (burning or burying), litter
pans should be disinfected daily e.g. boiling water, gloved hands
9. Outside sandpits should be covered when not in use and gloves worn
when gardening