Zoonotic Diseases of Various Species

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Zoonotic Diseases of Various Species

• Part II

Note The images in this presentation are for
non-profit, educational use only.
Neil Grove University of North Carolina Chapel
Hill Division of Laboratory Animal Medicine
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What We Will Cover

• Baylisascaris
• Rocky Mountain Spotted Fever
• Lyme Disease
• Avian Influenza
• Mycobacterium marinum

3
For each disease we will answer these questions

• What is it?
• How do I get it?
• What are the symptoms?
• What preventive measure can be taken?

4
Baylisascaris Infection What is it?

• Baylisascaris, an intestinal raccoon roundworm,
  can infect a variety of other animals, including
  humans. The worms develop to maturity in the
  raccoon intestine, where they produce millions of
  eggs that are passed in the feces. (1)

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Baylisaccaris Infection What is it?

• Released eggs take 2-4 weeks to become infective
  to other animals and humans.
• The eggs are resistant to most environmental
  conditions and with adequate moisture, can
  survive for years.(1)

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Baylisascaris Infection What is it?

• Infected raccoons have been found throughout the
  United States, mainly in the Midwest, Northeast,
  middle Atlantic, and West coast.
• Infection rarely causes symptoms in raccoons.
  Predator animals, including dogs, may also become
  infected by eating a smaller animal that has been
  infected with Baylisascaris. (1)

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How Do I get It?

• People become infected when they accidentally
  ingest infective eggs in soil, water, or on
  objects that have been contaminated with raccoon
  feces.
• When humans ingest these eggs, they hatch into
  larvae in the person's intestine and travel
  throughout the body, affecting the organs and
  muscles.(1)

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Heightened Risk

• Anyone who is exposed to environments where
  raccoons live is potentially at risk.
• Young children or developmentally disabled
  persons are at highest risk for infection when
  they spend time outdoors and may put contaminated
  fingers, soil, or objects into their mouths. (1)

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Heightened Risk

• Hunters, trappers, taxidermists, and wildlife
  handlers may also be at increased risk if they
  have contact with raccoons or raccoon
  habitats.(1)

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How Common is Human Infection?

• Infection is rarely diagnosed. Fever than 25
  cases have been diagnosed and reported in the
  United States as of 2003.
• It is believed that cases are mistakenly
  diagnosed as other infections or go undiagnosed.
• Cases have been reported in Oregon, California,
  Minnesota, Illinois, Michigan, New York, and
  Pennsylvania.
• Five of the infected persons died.(1)

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Symptoms

• Symptoms of infection depend on how many eggs are
  ingested and where in the body the larvae migrate
  (travel to).
• Once inside the body, eggs hatch into larvae and
  cause disease when they travel through the liver,
  brain, spinal cord, or other organs.
• Ingesting a few eggs may cause few or no
  symptoms, while ingesting large numbers of eggs
  may lead to serious symptoms. Symptoms of
  infection may take a week or so to develop.(1)

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Symptoms

• Symptoms include
• Nausea
• Tiredness
• Liver enlargement
• Loss of coordination
• Lack of attention to people
• and surroundings
• Loss of muscle control
• Coma
• Blindness (1)

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Prevention

• Avoid direct contact with raccoons especially
  their feces. Do not keep, feed, or adopt raccoons
  as pets! Raccoons are wild animals.
• Discourage raccoons from living in and around
  your home or parks by
• preventing access to food
• closing off access to attics and basements
• keeping sand boxes covered at all times, (becomes
  a latrine)
• removing fish ponds they eat the fish and drink
  the water
• eliminating all water sources
• removing bird feeders
• keeping trash containers tightly closed
• clearing brush so raccoons are not likely to make
  a den on your property (1)

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Prevention

• Stay away from areas and materials that might be
  contaminated by raccoon feces.
• Raccoons typically defecate at the base of or in
  raised forks of trees, or on raised horizontal
  surfaces such as fallen logs, stumps, or large
  rocks.
• Raccoon feces also can be found on woodpiles,
  decks, rooftops, and in attics, garages, and
  haylofts.
• Feces usually are dark and tubular, have a
  pungent odor (usually worse than dog or cat
  feces), and often contain undigested seeds or
  other food items. (1)

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Prevention

• To eliminate eggs, raccoon feces and material
  contaminated with raccoon feces should be removed
  carefully and burned, buried, or sent to a
  landfill.
• Care should be taken to avoid contaminating hands
  and clothes.
• Treat decks, patios, and other surfaces with
  boiling water or a propane flame-gun. (Exercise
  proper precautions!)(1)

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Prevention

• Newly deposited eggs take at least 2-4 weeks to
  become infective. Prompt removal and destruction
  of raccoon feces will reduce risk for exposure
  and possible infection.
• Contact your local animal control office for
  further assistance. (1)

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Case Description

• In January 2000, a boy aged 17 years with an
  8-year history of severe developmental
  disabilities was admitted to a Los Angeles
  hospital comatose and with generalized hypertonia
  and hyperreflexia. His mouth was tightly
  clenched, his eyes wandered rapidly, and he
  responded only to painful stimuli. Two days
  before admission, he had a low-grade fever,
  drowsiness, and problems with coordination. Tests
  on CSF and blood failed to identify an infectious
  agent. On examination by a pathologist, a brain
  biopsy revealed sections of a nematode consistent
  with Baylisascaris species. The patient's
  condition deteriorated and he had progressive,
  deep white matter abnormalities of the brain on
  MRI. After a 2-month hospitalization, he was
  transferred to a long-term--care facility where
  he remained comatose until he died a year later.
  (2)

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Case Description

• The patient had resided in a group home for
  developmentally handicapped adolescents and
  adults in Los Angeles County. In February 2000, a
  field study conducted in the yard in which the
  patient regularly played revealed several sites
  containing raccoon feces a sample of sandbox
  soil was positive for BP eggs. Multiple sites in
  the adjoining yard, to which he also had access,
  contained raccoon feces with BP eggs. (2)

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Review Questions

• Released eggs take ________ to become infective
  to other animals and humans.

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Answer

• Released eggs take 2-4 weeks to become infective
  to other animals and humans.

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Question True or False

• Human Baylisascaris infection is quite common,
  with an average of one diagnosed case per week
  throughout the northeastern United States.

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Answer

• False - Infection is rarely diagnosed. Fewer than
  25 cases have been diagnosed and reported in the
  United States as of 2003.

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Rocky Mountain Spotted Fever What is It?

• Rocky Mountain spotted fever (RMSF) is the most
  severe tick-borne rickettsial illness in the
  United States. This disease is caused by
  infection with the bacterial organism Rickettsia
  rickettsii.(3)

Gimenez stain of tick hemolymph cells infected
with R. rickettsii
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Rocky Mountain Spotted Fever What is It?

• Rocky Mountain spotted fever has been a
  reportable disease in the United States since the
  1920s.
• In the last 50 years, approximately 250-1200
  cases of Rocky Mountain spotted fever have been
  reported annually, although it is likely that
  many more cases go unreported. (3)

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Annual incidence per million population for Rocky
Mountain spotted fever by state in the United
States for 2002, as determined on the basis of
cases reported to the National Electronic
Telecommunications System for Surveillance.
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Rocky Mountain Spotted Fever Where is It?

• Over half of Rocky Mountain spotted fever
  infections are reported from the south-Atlantic
  region of the United States (Delaware, Maryland,
  Washington D.C., Virginia, West Virginia, North
  Carolina, South Carolina, Georgia, and Florida).
• Infections also occur in The Pacific region
  (Washington, Oregon, and California) and west
  south-central (Arkansas, Louisiana, Oklahoma, and
  Texas) region. (3)

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Rocky Mountain Spotted Fever Where is It?

• The states with the highest incidences of Rocky
  Mountain spotted fever are North Carolina and
  Oklahoma these two states combined accounted for
  35 of the total number of U.S. cases reported to
  CDC during 1993 through 1996.
• Although Rocky Mountain spotted fever was first
  identified in the Rocky Mountain states, less
  than 3 of the U.S. cases were reported from that
  area during the same interval (1993-1996). (3)

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How Do I Get It?

• The organism that causes Rocky Mountain spotted
  fever is transmitted by the bite of an infected
  tick. Less commonly, infections may occur
  following exposure to crushed tick tissues,
  fluids, or tick feces.
• In the case of Rocky Mountain spotted fever,
  ticks are the natural hosts, serving as both
  reservoirs and vectors of R. rickettsii. (3)

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How Do I Get It?

• Because ticks on dogs can be infected with R.
  rickettsii, dogs and people can get Rocky
  Mountain spotted fever from the same ticks. These
  ticks can also bite other animals and pass Rocky
  Mountain spotted fever to them. (3)

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How Do I Get It?

• The American dog tick (Dermacentor variabilis)
  and Rocky Mountain wood tick (Dermacentor
  andersoni) are the primary athropods (vectors)
  which transmit Rocky Mountain spotted fever
  bacteria in the United States. (3)

American Dog Tick
Rocky Mountain Wood Tick
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How Do I Get It?

• The brown dog tick Rhipicephalus sanguineus has
  also been implicated as a vector as well as the
  tick Amblyomma cajennense in countries south of
  the United States.(3)

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How Do I Get It?

• Over 90 of patients with Rocky Mountain spotted
  fever are infected during April through
  September.  This period is the season for
  increased numbers of adult and nymphal
  Dermacentor ticks.
• A history of tick bite or exposure to
  tick-infested habitats is reported in
  approximately 60 of all cases of Rocky Mountain
  spotted fever.(3)

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Symptoms

• Initial symptoms may include fever, nausea,
  vomiting, severe headache, muscle pain, lack of
  appetite.
• The rash first appears 2-5 days after the onset
  of fever and is often not present or may be very
  subtle when the patient is initially seen by a
  physician.(3)

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Symptoms

• Younger patients usually develop the rash earlier
  than older patients. Most often it begins as
  small, flat, pink, non-itchy spots (macules) on
  the wrists, forearms, and ankles. These spots
  turn pale when pressure is applied and eventually
  become raised on the skin.(3)

Early (macular) rash on sole of foot
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Symptoms

• Later signs and symptoms include rash, abdominal
  pain, joint pain, diarrhea.
• The characteristic red, spotted (petechial) rash
  of Rocky Mountain spotted fever is usually not
  seen until the sixth day or later after onset of
  symptoms, and this type of rash occurs in only
  35 to 60 of patients with Rocky Mountain
  spotted fever. (3)

Late (petechial) rash on palm and forearm
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Symptoms

• The rash involves the palms or soles in as many
  as 50 to 80 of patients however, this
  distribution may not occur until later in the
  course of the disease. As many as 10 to 15 of
  patients may never develop a rash.(3)

Characteristic rash of late-stage Rocky Mountain
spotted fever on legs of a patient
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RMSF - Hospitalization

• Rocky Mountain spotted fever can be a very severe
  illness and patients often require
  hospitalization.
• Because R. rickettsii infects the cells lining
  blood vessels throughout the body, severe
  manifestations of this disease may involve the
  respiratory system, central nervous system,
  gastrointestinal system, or renal system. (3)

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RMSF - Hospitalization

• Host factors associated with severe or fatal
  Rocky Mountain spotted fever include advanced
  age, male sex, African-American race, chronic
  alcohol abuse, and glucose-6-phosphate
  dehydrogenase (G6PD) deficiency. (3)

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RMSF - Hospitalization

• Deficiency of G6PD is a sex-linked genetic
  condition which occurs with highest frequencies
  in people of African, Middle Eastern, and
  Southeast Asian origin it affects approximately
  12 of the U.S. African-American male population
  deficiency of this enzyme is associated with a
  high proportion of severe cases of Rocky Mountain
  spotted fever.
• This is a rare clinical course that is often
  fatal within 5 days of onset of illness. (3)

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Long-Term Health Problems

• Long-term health problems following acute Rocky
  Mountain spotted fever infection include partial
  paralysis of the lower extremities, gangrene
  requiring amputation of fingers, toes, or arms or
  legs, hearing loss, loss of bowel or bladder
  control, movement disorders, and language
  disorders.
• These complications are most frequent in persons
  recovering from severe, life-threatening disease,
  often following lengthy hospitalizations.(3)

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Prevention

• Limiting exposure to ticks reduces the likelihood
  of infection with Rocky Mountain spotted fever.
• In persons exposed to tick-infested habitats,
  prompt careful inspection and removal of crawling
  or attached ticks is an important method of
  preventing disease.
• It may take extended attachment time before
  organisms are transmitted from the tick to the
  host.(3)

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Prevention

• Wear light-colored clothing which allows you to
  see ticks that are crawling on your clothing.
• Tuck your pants legs into your socks so that
  ticks cannot crawl up the inside of your pants
  legs.
• Apply repellents to discourage tick attachment.
  Repellents containing permethrin can be sprayed
  on boots and clothing, and will last for several
  days. Repellents containing DEET can be applied
  to the skin, but will last only a few hours
  before reapplication is necessary. Use DEET with
  caution on children.  Application of large
  amounts of DEET on children has been associated
  with adverse reactions. (3)

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Prevention

• Conduct a body check upon return from potentially
  tick-infested areas by searching your entire body
  for ticks. Use a hand-held or full-length mirror
  to view all parts of your body. Remove any tick
  you find on your body.
• Parents should check their children for ticks,
  especially in the hair, when returning from
  potentially tick-infested areas.  Ticks may also
  be carried into the household on clothing and
  pets and attach later, so both should be examined
  carefully to exclude ticks. (3)

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Review Questions

• _________ and_______ these two states combined
  accounted for 35 of the total number of U.S.
  cases reported to CDC during 1993 through 1996.

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Answer

• North Carolina and Oklahoma

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Question

• The __________ and Rocky Mountain wood tick are
  the primary athropods (vectors) which transmit
  Rocky Mountain spotted fever bacteria in the
  United States.

47
Answer

• American Dog Tick

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Question

• Over 90 of patients with Rocky Mountain spotted
  fever are infected between the months of _______
  and ________.

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Answer

• April and September

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Lyme Disease What is it?

• Lyme disease is caused by the bacterium Borrelia
  burgdorferi

Borrelia burgdorferi
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How Do I Get It?

• The Lyme disease bacterium, Borrelia burgdorferi,
  normally lives in mice, squirrels and other small
  animals. It is transmitted among these animals
  and to humans -- through the bites of certain
  species of ticks. (4)

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Symptoms

• Within 1 to 2 weeks of being infected, people may
  have a "bull's-eye" rash with fever, headache,
  and muscle or joint pain. Some people have Lyme
  disease and do not have any early symptoms. Other
  people have a fever and other "flu-like" symptoms
  without a rash. (4)

Bulls-eye Rash
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Symptoms

• After several days or weeks, the bacteria may
  spread throughout the body of an infected person.
  These people can get symptoms such as rashes in
  other parts of the body, pain that seems to move
  from joint to joint, and signs of inflammation of
  the heart or nerves. (4)

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Symptoms

• If the disease is not treated, a few patients can
  get additional symptoms, such as swelling and
  pain in major joints or mental changes, months
  after getting infected.(4)

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Prevention

• Whenever possible, you should avoid entering
  areas that are likely to be infested with ticks,
  particularly in spring and summer when nymphal
  ticks feed.
• If you are in an area with ticks, you should wear
  light-colored clothing so that ticks can be
  spotted more easily and removed before becoming
  attached.
• If you are in an area with ticks, wear
  long-sleeved shirts, and tuck your pants into
  socks. You may also want to wear high rubber
  boots (since ticks are usually located close to
  the ground). (4)

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Prevention

• Application of insect repellents containing DEET
  (n,n-diethyl-m-toluamide) to clothes and exposed
  skin, and permethrin (which kills ticks on
  contact) to clothes, should also help reduce the
  risk of tick attachment. DEET can be used safely
  on children and adults but should be applied
  according to Environmental Protection Agency
  guidelines to reduce the possibility of toxicity.
  (4)

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Prevention

• Since transmission of B. burgdorferi from an
  infected tick is unlikely to occur before 36
  hours of tick attachment, check for ticks daily
  and remove them promptly. Embedded ticks should
  be removed by using fine-tipped tweezers. Cleanse
  the area with an antiseptic.
• You can reduce the number of ticks around your
  home by removing leaf litter, and brush- and
  wood-piles around your house and at the edge of
  your yard. By clearing trees and brush in your
  yard, you can reduce the likelihood that deer,
  rodents, and ticks will live there(4)

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Question

• Being bitten by a _____ is the most common cause
  of Lyme disease.

59
Answer

• tick

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Question

• To repel ticks, insect repellents should contain
  ______.

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Answer

• Deet

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Avian Influenza What is it?

• Avian influenza, or bird flu, is a contagious
  disease of animals caused by viruses that
  normally infect only birds and, less commonly,
  pigs.
• Avian influenza viruses are highly
  species-specific, but have, on rare occasions,
  crossed the species barrier to infect humans.(7)

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Avian Influenza What is it?

• Influenza A (H5N1) is an influenza A virus
  subtype that occurs mainly in birds, is highly
  contagious among birds, and can be deadly to
  them. Outbreaks of H5N1 among poultry are ongoing
  in a number of countries. (6)
• H5N1 is associated with human illness.

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Avian Influenza What is it?

• Influenza viruses are grouped into three types,
  designated A, B, and C. Influenza A and B viruses
  are of concern for human health. Only influenza A
  viruses can cause pandemics (worldwide
  outbreaks).(7)While H5N1 does not usually
  infect people, human cases of H5N1 infection
  associated with these outbreaks have been
  reported.(6)

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Avian Influenza What is it?

• Wild waterfowl are considered the natural
  reservoir of all influenza A viruses.
• Considerable circumstantial evidence suggests
  that migratory birds can introduce low pathogenic
  H5 and H7 viruses to poultry flocks, which then
  mutate to the highly pathogenic form.(7)

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Avian Influenza What is it?

• Of the few avian influenza viruses that have
  crossed the species barrier to infect humans,
  H5N1 has caused the largest number of cases of
  severe disease and death in humans.
• Unlike normal seasonal influenza, where infection
  causes only mild respiratory symptoms in most
  people, the disease caused by H5N1 follows an
  unusually aggressive clinical course, with rapid
  deterioration and high fatality.
• Primary viral pneumonia and multi-organ failure
  are common. In the present outbreak, more than
  half of those infected with the virus have died.
  Most cases have occurred in previously healthy
  children and young adults.(7)

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Avian Influenza What is it?

• A second risk, of even greater concern, is that
  the virus if given enough opportunities will
  change into a form that is highly infectious for
  humans and spreads easily from person to person.
  Such a change could mark the start of a global
  outbreak (a pandemic).(7)

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How do I get it?

• Direct contact with infected poultry, or surfaces
  and objects contaminated by their feces, is
  presently considered the main route of human
  infection.
• To date, most human cases have occurred in rural
  or periurban areas where many households keep
  small poultry flocks, which often roam freely,
  sometimes entering homes or sharing outdoor areas
  where children play. (7)

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How do I get it?

• As infected birds shed large quantities of virus
  in their feces, opportunities for exposure to
  infected droppings or to environments
  contaminated by the virus are abundant under such
  conditions. (7)

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How do I get it?

• Because many households in Asia depend on poultry
  for income and food, many families sell or
  slaughter and consume birds when signs of illness
  appear in a flock, and this practice has proved
  difficult to change.
• Exposure is considered most likely during
  slaughter, defeathering, butchering, and
  preparation of poultry for cooking.(7)

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How do I get it?

• Because all influenza viruses have the ability to
  change, scientists are concerned that H5N1 virus
  one day could be able to infect humans and spread
  easily from one person to another. (6)

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How do I get it?

• Because these viruses do not commonly infect
  humans, there is little or no immune protection
  against them in the human population.
• If these H5N1 viruses gain the ability for
  efficient and sustained transmission among
  humans, an influenza pandemic (world wide) could
  result, with potentially high rates of illness
  and death. (6)

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How do I get it?

• It is likely that H5N1 infection among birds has
  become endemic in certain areas and that human
  infections resulting from direct contact with
  infected poultry will continue to occur. (6)

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Does the virus spread easily from birds to
humans?

• No. Though more than 100 human cases have
  occurred in the current outbreak, this is a small
  number compared with the huge number of birds
  affected and the numerous associated
  opportunities for human exposure, especially in
  areas where backyard flocks are common.
• It is not presently understood why some people,
  and not others, become infected following similar
  exposures.(7)

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Since January, 2004 WHO has reported human cases
of avian influenza A (H5N1) in the following
countries

• East Asia and the Pacific
• Cambodia
• China
• Indonesia
• Thailand
• Vietnam

• Europe Eurasia
• Azerbaijan
• Turkey
• Near East
• Egypt
• Iraq

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Symptoms

• The reported symptoms of avian influenza in
  humans have ranged from typical influenza-like
  symptoms (e.g., fever, cough, sore throat, and
  muscle aches) to eye infections (conjunctivitis),
  pneumonia, acute respiratory distress, viral
  pneumonia, and other severe and life-threatening
  complications. (6)

78
Symptoms

• The majority of known human H5N1 cases have begun
  with respiratory symptoms. However, one atypical
  fatal case of encephalitis in a child in southern
  Vietnam in 2004 was identified retrospectively as
  H5N1 influenza through testing of cerebrospinal
  fluid, fecal matter, and throat and serum
  samples. (6)

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What precautions can be taken to reduce the risk
for infection from wild birds in the United
States?

• As a general rule, the public should observe
  wildlife, including wild birds, from a distance.
  This protects you from possible exposure to
  pathogens and minimizes disturbance to the
  animal.
• Avoid touching wildlife. If there is contact with
  wildlife do not rub eyes, eat, drink, or smoke
  before washing hands with soap and water.
• Do not pick up diseased or dead wildlife. Contact
  your state, tribal, or federal natural resource
  agency if a sick or dead animal is found.(6)

80
What precautions can hunters take to reduce the
risk for infection when hunting birds in the
United States?

• Hunters should follow routine precautions when
  handling game, including wild birds. The National
  Wildlife Health Center recommends that hunters
• Do not handle or eat sick game.
• Wear rubber or disposable latex gloves while
  handling and cleaning game, wash hands with soap
  and water (or with alcohol-based hand products if
  the hands are not visibly soiled), and thoroughly
  clean knives, equipment and surfaces that come in
  contact with game.
• Do not eat, drink, or smoke while handling
  animals.
• Cook all game thoroughly. (6)

81
Precautions

• There is currently a ban on the importation of
  birds and bird products from H5N1-affected
  countries. The regulation states that no person
  may import or attempt to import any birds whether
  dead or alive, or any products derived from
  birds. (6)

82
Question 1

• ____ and ____ influenza viruses are of concern
  for human disease.

83
Answer

• A and B

84
Question 2

• What does pandemic outbreak mean?

85
Answer

• global

86
Question 3

• True or False The H5N1 virus spreads easily
  from birds to humans.

87
Answer

• False

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Mycobacterium marinum what is it?

• Mycobacterium marinum (M. marinum) is a slowly
  growing bacteria that may cause disease in fish
  and people. The bacteria is normally found in
  bodies of fresh or salt water in many parts of
  the world.
• Skin infection with Mycobacterium marinum is
  relatively rare and is usually acquired from
  swimming pools, aquariums, or fish-handling. This
  bacteria does not grow at normal body
  temperature. That is why it remains localized to
  the cooler skin surface. (8)

89
How do I get it?

• Human infections with M. marinum under normal
  circumstances are rare. However, people who have
  breaks in the skin such as cuts and scrapes are
  at increased risk
• When in contact with water from an aquarium or
  fish tank
• When handling, cleaning, or processing fish, or
• While swimming or working in fresh or salt water.
• M. marinum infection is not spread from person to
  person.

90
What are the Symptoms?

• When M. marinum infects the skin, it causes
  localized microscopic nodules to form. These
  nodules are called granulomas. They occur at
  sites of skin trauma where there are scratches,
  cuts, and the like.(8)

91
What are the Symptoms?

• The most frequent sign is a slowly developing
  nodule (raised bump) at the site the bacteria
  entered the body. Frequently, the nodule is on
  the hand or upper arm.
• Later the nodule can become an enlarging sore (an
  ulcer). Swelling of nearby lymph nodes occurs. (8)

92
What are the Symptoms?

• Multiple granulomas may form in a line along the
  lymphatic vessel that drains the site.  These
  lesions will usually spontaneously heal in
  several months.
• This infection can also involve the joints
  (septic arthritis) and bones.(8)

93
Symptoms

• The granulomas usually appear within 2-3 weeks of
  exposure. Some reported cases have developed 2 to
  4 months or more after exposure to M. marinum
  because of the very slow-growing nature of this
  bacterium. 
• A health care provider should be consulted if a
  skin nodule or reddened sore (ulcer) develops
  following direct skin contact with fresh or salt
  water or after handling or processing fish.(8)

94
Heightened Risk

• For people with compromise of the immune system,
  M. marinum infection can be especially serious
  and involve disseminated (widespread) disease. If
  an infection is suspected under such
  circumstances, a health care provider should be
  promptly consulted.(8)

95
Prevention/Precautions

• Avoid fresh or salt water activities if there are
  open cuts, scrapes, or sores on your skin,
  especially in bodies of water where this
  bacterium is known to exist.
• If you have a weakened immune system, you can
  reduce the risk of infection by carefully
  covering cuts, scrapes, or sores during fresh or
  salt water activities and while cleaning fish
  tanks or handling, cleaning or processing fish.(8)

96
Prevention/Precautions

• Wear heavy gloves (leather or heavy cotton) while
  cleaning or processing fish, especially fish with
  sharp spines that may cause cuts, scratches, or
  sores to the hands and skin. Wash hands
  thoroughly with soap and water after fish
  processing or use a waterless cleanser.
• Wear waterproof gloves while cleaning home
  aquariums or fish tanks. Wash hands and forearms
  thoroughly with soap and running water after
  cleaning the tank, even if gloves were worn.
• Ensure regular and adequate chlorination of
  swimming pools to kill any bacteria that may be
  present. (8)

97
References

• 1. CDC. Baylisascaris Infection Fact Sheet.
  http//www.cdc.gov/ncidod/dpd/parasites/baylisasca
  ris/factsht_baylisascaris.htm
• 2. CDC. Morbidity and Mortality Monthly Report.
  Raccoon Roundworm Encephalitis --- Chicago,
  Illinois, and Los Angeles, California, 2000.
  January 4, 2002 / 50(51)1153-5
• 3. CDC. Rocky Mountain Spotted Fever Home.
  http//www.cdc.gov/ncidod/dvrd/rmsf/index.htm
• 4. CDC. Lyme Disease and Animals.
  http//www.cdc.gov/healthypets/diseases/lyme.htm
• 5. CDC. Avian Influenza Infection in Humans.
  http//www.cdc.gov/flu/avian/gen-info/avian-flu-hu
  mans.htm
• 6. CDC. Key Facts About Avian Influenza (Bird
  Flu) and Avian Influenza A (H5N1) Virus
  http//www.cdc.gov/flu/avian/gen-info/facts.htm
• 7. WHO. Avian influenza frequently asked
  questions http//www.who.int/csr/disease/avian_inf
  luenza/avian_faqs/en/index.html
• 8. MedicineNet.com. Mycobacterium marinum.
  http//www.medicinenet.com/mycobacterium_marinum/a
  rticle.htm

98
Disclaimer

• This presetation was created while I was an
  employee of Priority One Services (POS) at the
  National Institute of Environmental Health
  Sciences (NIEHS). Thus, both organizations
  deserve credit for supporting the work.
• However, the opinions expressed in this
  presentation are mine and dont necessarily
  reflect those of POS, NIEHS, or UNC DLAM.