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Zoonoses: Cats

Zoonoses: Cats
Author:
Camille N Kotton, MD
Section Editor:
Daniel J Sexton, MD
Deputy Editor:
Keri K Hall, MD, MS
Literature review current through: Jan 2024.
This topic last updated: Feb 24, 2022.

INTRODUCTION — Pets serve valuable social roles in society [1,2]. Pets may lower blood pressure, reduce cholesterol and triglyceride levels, and improve feelings of loneliness, while increasing opportunities for exercise, outdoor activities, and socialization [1].

In a small, randomized, controlled study of 28 patients with chronic age-related disabilities living in a nursing home, patients were randomly assigned to animal interaction ("pet therapy") compared with usual activities (control group) [3]. The "pet therapy" group patients had improved symptoms of depression and a significant decrease in blood pressure values as compared with the control patients.

Despite these benefits, pets present zoonotic risks, especially for immunocompromised hosts [4-6]. The epidemiology of cat-related zoonoses will be reviewed here. The epidemiology of pet-related zoonoses other than cats is presented separately (see "Zoonoses: Dogs" and "Zoonoses: Animals other than dogs and cats"). The clinical management of specific zoonotic diseases is discussed under the appropriate topic reviews.

DEFINITION — A zoonosis is an animal disease that is transmissible to humans. Humans are usually an accidental host that acquire disease through close contact with an infected animal, who may or may not be symptomatic.

INCIDENCE — The American Pet Association estimates that there are 77 million cats in the United States (www.apapets.org). The most common route of infection related to cat contact is through bites and scratches, especially in children. (See "Animal bites (dogs, cats, and other mammals): Evaluation and management".)

Cats can harbor many of the same infections as dogs. In addition, cats may transmit zoonoses specific to felines, such as cat-scratch disease, toxoplasmosis, and Sporothrix schenckii infections.

RISK FACTORS — Clinicians should ask about pets when taking a medical history and formulating a differential diagnosis. Many of the risks posed by pet ownership can be reduced by good hygiene after handling pets, careful pet selection, and proper pet care. New pets can pose more of a health risk because health history and vaccination records may not be known. Adult pets are generally safer than younger animals, since they are less likely to be involved in playful activities that include scratching and biting. Children are at high risk for infection because they are more likely to have close contact with pets.

TRANSMISSION — Cats are responsible for the transmission of an extensive array of infectious pathogens (table 1A-B) [7,8]. As an example, free-roaming or feral cats (eg, those born in the wild) can transmit numerous infections, including rabies, toxoplasmosis, cutaneous larval migrans, Yersinia pestis, tularemia, and murine typhus [9]. In addition, exposure to such cats without veterinary care can increase the risk of clinically significant skin infections from fungal (eg, feline sporotrichosis, Microsporum canis, and Arthroderma vanbreuseghemi) and bacterial (eg, Corynebacterium ulcerans) pathogens [10,11].

Many different routes of transmission can cause infections related to pets including:

Infectious saliva that contaminate bite wounds, skin abrasions, or mucous membranes

Hand-to-mouth transfer of microorganisms, cysts, or oocysts (eggs) from feces of an infected animal

Aerosol from body fluids (eg, respiratory secretions, placenta)

Tick or flea bites when these vectors are carried into the home by pets

Direct contact with an infected cat

Infectious saliva — Saliva can transmit and contaminate bite wounds, skin abrasions, or mucous membranes. Cat bites are particularly problematic in that the cat's teeth are slender and sharp and can produce deep puncture wounds. Because of the penetrating capabilities of the teeth, contamination of bone and joint can occur and result in osteomyelitis or septic arthritis; infection complicates cat bites in about 50 percent of cases [12]. (See "Animal bites (dogs, cats, and other mammals): Evaluation and management".)

Bartonella henselae — Bartonella henselae, the etiologic agent of cat scratch disease (CSD) can cause disease in both normal and immunocompromised hosts. However, 80 percent of cases occur in children, with a peak in the incidence of cases between ages 2 and 14 years [13,14]. One survey noted a peak number of cases in January [14]. In the United States, approximately 40 percent of cats have serologic evidence of past or current B. henselae infection [15]. However, incidence in cats varies geographically, in one study of 255 cats in Northern California, B. henselae bacteremia was documented in 56 and 34 percent of cats less than one year and at least one year of age, respectively [16]. Individual reports from numerous countries suggest a worldwide distribution [13]. Infection in cats, including bacteremia, is asymptomatic. Although preliminary data suggests that asymptomatic bacteremia in cats can be successfully treated with antibiotics, this practice is not recommended [17].

CSD can result from a cat scratch or bite, as well as possibly from a fleabite. CSD is more likely to be transmitted by kittens than adult cats, as kittens are more likely to be bacteremic [16]. Human CSD most often presents as a localized cutaneous and lymph node disorder near the site of organism inoculation. In some individuals, the organisms disseminate and infect the liver, spleen, eye, or central nervous system. (See "Microbiology, epidemiology, clinical manifestations, and diagnosis of cat scratch disease".)

Pasteurella multocida — Cats are the source of infection in 60 to 80 percent of human P. multocida infections [18]. P. multocida are commensals in the upper respiratory tracts of >90 percent of felines and are the major pathogen causing infection as a result of a cat bite [19]. Pasteurella are found worldwide. Both healthy (eg, cats and dogs) and diseased (eg, rabbits) wild and domestic animals are the main reservoirs for the organism.

Pasteurella infection is most often secondary to a bite or scratch from a cat, although a lick has also caused infection [20,21]. Pasteurella can cause serious soft-tissue infections and less commonly septic arthritis, osteomyelitis, sepsis, and meningitis particularly in infants and other immunocompromised hosts [22,23]. (See "Pasteurella infections".)

Rabies — Rabies is a fatal disease in cats. In the United States in 2004, of 7170 cases in nonhuman animals, 281 (4.1 percent) cases occurred in cats [24]. However, cats rarely are implicated in rabies transmission to humans. In developing countries, dogs account for 90 percent or more of reported cases, while in the United States, bat bites account for the majority of cases. (See "Clinical manifestations and diagnosis of rabies".)

Rabies should be considered in the differential diagnosis of patients presenting with acute progressive encephalitis regardless of a history of an animal bite. Because of the nonspecific early symptoms, other more common infectious and noninfectious disorders (eg, encephalitis caused by arboviruses or enterovirus and Guillain-Barré syndrome or vasculitis) should be ruled out (algorithm 1). (See "Clinical manifestations and diagnosis of rabies".)

Capnocytophaga — Capnocytophaga was first isolated in 1976 from the blood and CSF of a patient who had received a dog bite [25]. Although more commonly associated with dog bites, Capnocytophaga canimorsus (formerly CDC group DF-2) is a fastidious, gram-negative rod that forms part of the normal oral flora of dogs and cats.

Human infection with two species, C. canimorsus and C. cynodegmi, can follow a cat bite or scratch [26-28]. C. canimorsus can cause fulminant sepsis and meningitis, particularly in asplenic patients or alcoholics. Human corneal infection with C. canimorsus has occurred following eye trauma due to a cat bite [29]. (See "Clinical features, evaluation, and management of fever in patients with impaired splenic function".)

Tularemia — Tularemia is a zoonosis caused by the gram-negative bacterium, Francisella tularensis. Cats may develop potentially fatal infection [30]. Humans are accidental hosts following contact with infected animals or vectors. In the United States, tularemia has been reported from all 49 continental states, but the majority of cases occur in the south central states, mainly Arkansas, Missouri, and Oklahoma. Vector-borne disease, especially by ticks, is the most common way the disease is transmitted in the United States. The rare transmission of tularemia from a cat bite has been reported [31,32]. (See "Tularemia: Microbiology, epidemiology, and pathogenesis".)

Patients infected with Francisella spp present with the abrupt onset of fever, chills, headache, and malaise, after an incubation period of 2 to 10 days. (See "Tularemia: Clinical manifestations, diagnosis, treatment, and prevention".)

Cowpox — Despite its name, domestic cats, not cattle, are the most commonly reported source of human cowpox infection; wild rodents are thought to be the principal reservoir of infection [33]. In cats, ulcerated, crusted focal skin lesions can occur, sometimes with mild systemic illness and concurrent oral lesions; young or immunosuppressed animals may develop severe systemic illness [34].

Transmission of cowpox from a domestic cat to a human was first reported in 1985, but cases are still observed, mainly in European countries [35-37]. In humans, cowpox is an uncommon and probably underdiagnosed infection that may mimic anthrax with its painful, hemorrhagic pustules or black eschars (picture 1) [38].

Fecal transmission — Common zoonotic pathogens causing feline gastroenteritis include Salmonella, Campylobacter, Cryptosporidium, and Giardia. Thus, cats with diarrhea should have a stool specimen examined for these pathogens [27]. In addition, numerous parasitic diseases can be transmitted from cats to humans through feces, including toxocariasis, cutaneous larva migrans (eg, Ancylostoma braziliense), echinococcosis, and toxoplasmosis. Multidrug-resistant pathogens (eg, Escherichia coli) can also be transmitted [39].

Salmonella — Infection due to Salmonella species usually results in a mild, self-limited gastroenteritis in humans. However, severe invasive illness, such as septicemia or meningitis, can occur, especially in infants and immunocompromised persons. Most cases of salmonellosis in humans are due to foodborne illness. Salmonellosis may also be transmitted from contact with animals, such as turtles and lizards. (See "Nontyphoidal Salmonella: Gastrointestinal infection and asymptomatic carriage" and "Nontyphoidal Salmonella: Microbiology and epidemiology", section on 'Modes of transmission'.)

Although contact with cats is an uncommon way for humans to get salmonellosis, an outbreak of S. typhimurium was reported in a veterinary clinic in New York State where seven human cases may have been associated with a case in a diabetic cat [40]. The cat had chronic intermittent diarrhea attributed to diabetes-related dietary changes and, in retrospect, could have contaminated the clinic. Salmonella contamination has also been implicated in over a dozen recall announcements involving more than 100 pet products such as dry dog and cat food, pet treats, and supplements [41,42].

Campylobacter — Like salmonellosis, the mode of transmission of Campylobacter infection is most often foodborne. However, in a substantial proportion of Campylobacter cases the source of infection is unknown. In a survey of 218 human cases of infection that identified the source, 6 percent were due to exposure to an animal with diarrhea [43]. (See "Campylobacter infection: Microbiology, pathogenesis, and epidemiology".)

Direct zoonotic transmission of Campylobacter from contact with infected cats and kittens has been documented [44]. A microbiologic survey of 152 cats found 37 (24 percent) positive for Campylobacter organisms in three private veterinary clinics and an animal shelter in Minnesota; carriage was higher in cats ≤1 year old compared with those >1 year (30 versus 3 percent) [45]. There was no correlation between positive cultures and clinical disease. The median duration of carriage was 44 days for nine cats surveyed.

Campylobacter enteritis in humans presents after an incubation period of one to seven days as a syndrome most commonly characterized by prominent abdominal pain and profuse diarrhea that is often bloody. (See "Campylobacter infection: Clinical manifestations, diagnosis, and treatment".)

Cryptosporidium — Cryptosporidium is an intracellular protozoan parasite that is associated with gastrointestinal diseases in all classes of vertebrates including mammals, reptiles, birds, and fish. Infected cats are asymptomatic or have a mild gastroenteritis. Fecal shedding of Cryptosporidium spp in cats ranges from 1 to 8 percent [46,47].

Cryptosporidium infection in immunocompetent individuals has a variable presentation, it can be asymptomatic, cause a self-limited gastroenteritis (usually resolving in 10 to 14 days without treatment), or can cause more severe diarrhea [48]. In immunocompromised hosts, the illness is more frequently protracted and severe, and can lead to significant malabsorption and weight loss. Cryptosporidium parvum and C. hominis are the usual pathogens in humans; immunocompromised hosts can also be infected by other Cryptosporidium spp [49]. (See "Cryptosporidiosis: Epidemiology, clinical manifestations, and diagnosis".)

Giardia lamblia — Giardia lamblia (also known as G. duodenalis or G. intestinalis) is a flagellated protozoan parasite and one of the most common gastrointestinal parasites in the United States. Water is the major source for the endemic or epidemic spread of giardiasis. However, there is some evidence supporting the zoonotic transmission of Giardia, with the greatest risk from pets, especially dogs and cats [48-50].

The spectrum of clinical disease includes asymptomatic infection, self-limited acute giardiasis, and chronic infection. (See "Giardiasis: Epidemiology, clinical manifestations, and diagnosis".)

Toxocara cati — Toxocara cati (cat roundworm) cause visceral larva migrans and ocular larva migrans in humans. These roundworms live in the small intestine of the cat in the adult stage, where eggs are passed in the feces. A seroprevalence study in North Carolina found that of 100 feral and 76 domestic cats examined, 21 and 18 percent, respectively, were positive [46].

Human infections are caused by ingestion of eggs from contaminated hands, soil, or fomites and are usually asymptomatic to mild and accompanied by a persistent eosinophilia. The larvae penetrate the intestinal wall but are unable to complete their life cycle and produce eosinophilic granulomas in host tissues. Infection produces a syndrome in humans termed visceral larva migrans or toxocariasis. This disorder may be subclinical; or may present primarily as an ocular form. (See "Toxocariasis: Visceral and ocular larva migrans".)

Systemic toxocariasis most often affects children aged one to four. Clinical manifestations include eosinophilia, rash, fever, cough, weight loss, hepatosplenomegaly, pulmonary infiltrates, seizures, and behavior disorders. Ocular larva migrans often presents in older children with a unilateral reduction in vision or strabismus and often with retinal involvement but without the systemic symptoms or eosinophilia seen in visceral disease.

Echinococcus — Dogs and other carnivorous mammals are the definitive hosts for the tapeworm echinococcus (see "Epidemiology and control of echinococcosis"). Cats appear to have only a minor role in the transmission of E. multilocularis in endemic areas, and infections in cats are of minimal public health significance [51].

Toxoplasma gondii — Toxoplasma gondii is an intracellular parasite with a worldwide distribution. In the United States, T. gondii infects 30 to 40 percent of domestic cats [52]. Felines of all types are the only host animals in which the sexual form of T. gondii can develop [53]. Following feline ingestion of any form of T. gondii, the parasite infects the gut epithelial cells and reproduces. The feline then excretes infectious oocysts in feces.

Despite the high prevalence of T. gondii infection in cats, most cats are asymptomatic. Clinical disease is rare, but more common in young cats (≤2 years of age) and in older cats where it may be associated with co-infection with feline leukemia virus or feline immunodeficiency virus.

Human infection is caused by ingestion of cysts from raw or undercooked meat of infected animals, ingestion of sporulated oocysts from cat feces (primarily through environmental exposure), and through transplacental transmission. If non-felines, including humans and other mammals, ingest T. gondii oocysts, the organisms invade intestinal epithelium and disseminate throughout the body. They then encyst and can lie dormant (but viable) in any nucleated cells within tissues for the life of the host.

Approximately one-third of the United States population is seropositive (indicating latent infection) for T. gondii [54,55]. Rates differ by population, being higher with increasing age and in those persons born outside the United States.

The proportions of infection in the United States related to different forms of transmission have been difficult to determine. The Centers for Disease Control and Prevention (CDC) estimates that about 50 percent of human infection is related to ingestion of contaminated meat [56]. The proportion associated with exposure to cats or cat feces is not known. However, a study in HIV-positive, T. gondii-seronegative patients, found that only 13 of 650 (2 percent) patients followed for a mean duration of 2.1 years, seroconverted during the study [57]. A pet history was available on 12 of the 13 patients and only one had owned or lived in a household with a cat during the period of seroconversion.

Infection in immunocompetent persons is asymptomatic in 80 to 90 percent of cases; when symptomatic infection occurs, the most common manifestation is bilateral, symmetrical, non-tender cervical adenopathy. Clinical disease is much more likely in immunocompromised patients (eg, HIV-infected or solid organ transplant recipients) and in infants of mothers infected during pregnancy. (See "Toxoplasmosis in patients with HIV" and "Toxoplasmosis: Acute systemic disease" and "Toxoplasmosis and pregnancy".)

People who are seronegative for T. gondii and who are immunocompromised or pregnant should be counseled to eat only well-cooked meats, wash fruits and vegetables before eating, wash their hands after outdoor activities involving soil contact, and avoid changing the cat litter [58].

Ancylostoma braziliense — The hookworm, A. braziliense, is an agent of cutaneous larva migrans. The eggs are shed in the feces of infected dogs or cats. Although adult animals are usually asymptomatic, puppies and kittens develop diarrhea, weight loss, and anemia. A. braziliense is found in temperate climates, including southern and Eastern Europe, the Mediterranean, North Africa, the Middle East, Pakistan and northern India, northern Australia, and parts of South America.

Humans (and pets) are infected when bare skin comes in contact with soil contaminated with the larvae. The second-stage larvae are able to penetrate the intact skin of humans and the footpads of dogs and cats. (See "Hookworm-related cutaneous larva migrans".)

A pruritic erythematous papule develops initially at the site of each larval entry. Two to three days later, and at times weeks later, severely pruritic, elevated, serpiginous, reddish-brown lesions appear as the larvae migrate at a rate of several millimeters per day (picture 2).

Dipylidium caninum — The dog and cat tapeworm, Dipylidium caninum, commonly infects domestic cats and dogs and may also accidentally infect humans. Fleas usually serve as the intermediate hosts and contain cysticercoids. If a human (usually a child) ingests cysticercoids (larva), an adult tapeworm can develop in the intestine.

This infection is usually asymptomatic. However, abdominal pain, diarrhea, pruritus ani, and urticaria can develop. In addition, parents may notice the passage of proglottids (eg, body segments of the adult tapeworm, which have a complete set of reproductive organs) that resemble cucumber seeds in their children's stool. (See "Tapeworm infections".)

Aerosol

Bordetella bronchiseptica — Bordetella bronchiseptica (the etiologic agent of kennel cough in dogs) causes a mild respiratory infection in cats, although life-threatening pneumonia may occur in kittens. The disease occurs worldwide in rodents, swine, dogs, cats and non-human primates.

Although rare, human infection with B. bronchiseptica has been documented in both healthy and immunocompromised individuals [59-61]. Of nine HIV patients from whom B. bronchiseptica was isolated, respiratory illnesses ranged from mild upper respiratory tract infections to pneumonia [62]. Two of these persons had household contact with dogs prior to their illnesses, and one had household contact with cats.

Coxiella burnetii — Coxiella burnetii, the etiologic agent of Q fever, is a worldwide zoonosis. The most common animal reservoirs are goats, cattle, sheep, cats, and occasionally dogs [63]. Infected mammals shed C. burnetii in urine, feces, milk, and birth products.

In humans, exposure results from inhalation of contaminated aerosols from parturient fluids of infected mammals, which can be present in the environment, on the coats of newborn animals, or from the placenta. A case report describes 15 members of a family who attended a reunion in Maine where they were exposed to a parturient cat [64]. Two weeks later, all 11 adults and older children developed symptoms consistent with acute Q fever.

Clinical signs of Q fever are often extremely mild or absent. Patients may be asymptomatic or can present acutely with one of three clinical presentations:

A self-limited flu-like illness

Pneumonia

Hepatitis

Chronic infection most commonly involves the heart as endocarditis.

Further information regarding Q fever can be found on the United States Centers for Disease Control and Prevention website [65,66].

Mycobacterium bovis — Mycobacterium bovis is a member of the Mycobacterium tuberculosis complex (MTBC), which also includes M. tuberculosis. Tuberculosis due to M. bovis is clinically and radiographically indistinguishable from tuberculosis due to M. tuberculosis. A report from England in 2014 demonstrated transmission of M. bovis from a cat to two humans who presented with a tuberculosis-like illness [67]. A more detailed discussion of M. bovis is found elsewhere. (See "Mycobacterium bovis".)

Tick or fleabites — Cats can transport ticks and fleas, which subsequently can bite a human host and transmit infectious diseases.

Ticks can carry many disease-producing pathogens, including Borrelia burgdorferi (Lyme disease), Ehrlichia (ehrlichiosis), Babesia microti (babesiosis), and Francisella tularensis (tularemia). Fleas carried by cats can bite a human host and transmit plague.

Lyme disease — Lyme disease is caused by B. burgdorferi, which is spread by the bite of infected Ixodes ticks. Approximately 95 percent of cases of Lyme disease in the United State are reported from twelve states: Massachusetts, Connecticut, Maine, New Hampshire, Rhode Island, New York, New Jersey, Pennsylvania, Delaware, Maryland, Michigan, and Wisconsin. In highly endemic areas, owners of cats who go outdoors should inspect their cats regularly for ticks, as tick collars have a variable efficacy. Owners should inspect their cats for ticks for two reasons. First, cats can develop symptomatic Lyme disease with painful or stiff muscles and joints, fatigue, fever, and loss of appetite. Second, cat may carry ticks indoors, and if these ticks carry B. burgdorferi and attach to a human, they may then transmit Lyme disease to the pet's human family.

Human Lyme disease is a multisystem inflammatory disease. One of the first clinical manifestations is the classic erythema migrans (EM) skin lesion (picture 3) that occurs in up to 90 percent of patients. (See "Clinical manifestations of Lyme disease in adults".)

Ehrlichiosis — The two most important human ehrlichial diseases are human monocytic ehrlichiosis (HME), which is caused by E. chaffeensis, and human granulocytic anaplasmosis (HGA), which is caused by Anaplasma phagocytophilum. The principle vector of E. chaffeensis is thought to be the Lone Star tick (Amblyomma americanum) (picture 4). A. phagocytophilum, in contrast, may be transmitted by Ixodes scapularis (picture 5), the tick that is also the vector of Lyme disease and babesiosis (see 'Babesiosis' below). Most cases of HME have occurred in the southeastern, south-central, and mid-Atlantic regions of the United States. States with the highest incidence of HGA during 2001 to 2002 were Rhode Island, Minnesota, Connecticut, New York, and Maryland. HGA is also reported in Western Europe.

A cat that goes outdoors should be inspected for ticks, as a tick carrying HME or HGA may infect the animal or the tick may attach to a human once brought indoors by the cat. Infection with A. phagocytophilum is associated with clinical illness in some cats. A report describes five cats with fever, anorexia, and lethargy from Massachusetts and Connecticut who had positive antibody titers to A. phagocytophilum and responded to treatment with doxycycline or tetracycline [68].

The clinical manifestations of HME and HGA in humans are variable. Most patients are febrile with nonspecific symptoms including malaise, myalgia, headache, and chills. (See "Human ehrlichiosis and anaplasmosis".)

Babesiosis — Babesiosis is a tick borne illness caused by malaria-like parasites that infect red blood cells and result in hemolysis. Human disease is most commonly due to Babesia microti (United States) or Babesia divergens (Europe). The vector for babesiosis is the Ixodid tick, the same vector as Lyme disease and anaplasmosis. Babesiosis occurs predominantly on the Northeast coast of the United States. A cat that goes outdoors should be inspected for ticks, as a tick carrying babesiosis may attach to a human once brought indoors by the cat.

The clinical manifestations of disease can range from asymptomatic infection to severe hemolytic anemia associated with jaundice, hemoglobinuria, renal failure, and death. (See "Babesiosis: Microbiology, epidemiology, and pathogenesis".)

Yersinia pestis — Yersinia pestis is the etiologic agent of plague. Cats can become severely ill from Yersinia pestis (plague) after been bitten by rodents' fleas [5,69]. They can carry the infected fleas, which can spread disease to humans through a fleabite. Rarely, ill cats have spread pneumonic disease to man by aerosol [70]; or bubonic disease by a bite [5]. Cat-associated plague has been reported in the western United States since 1977 [71].

Foci of plague are present on most continents other than Australia. In the United States, plague is endemic in all of the western states and has extended north and east over the years. Ninety percent of human cases in the United States have occurred in four states: Arizona, California, Colorado, and New Mexico. In 2016, six domestic cats in Idaho were found to harbor Y. pestis [72]. (See "Epidemiology, microbiology and pathogenesis of plague (Yersinia pestis infection)".)

Three generally recognized clinical syndromes are associated with human plague: bubonic, septicemic, and pneumonic. (See "Clinical manifestations, diagnosis, and treatment of plague (Yersinia pestis infection)".)

Contaminated urine

Leptospirosis — Leptospira interrogans, the etiologic agent of human leptospirosis, infects a variety of both wild and domestic mammals, including cats [73]. Animals can be asymptomatic or develop clinical infection, which can be fatal. Transmission to humans occurs by contact with water or soil contaminated with the urine of infected animals (predominantly rats). One study in Baltimore found that cat ownership may be protective against leptospirosis, perhaps because cats reduce human contact with rodents [74].

Leptospirosis in humans may manifest as a subclinical illness followed by seroconversion, a self-limited systemic infection, or a severe, potentially fatal illness accompanied by multiorgan failure. Leptospirosis usually presents with the abrupt onset of fever, rigors, myalgias, and headache, after an incubation period of 2 to 26 days (average 10 days). Many patients have an associated nonproductive cough, nausea, vomiting, and diarrhea. (See "Leptospirosis: Epidemiology, microbiology, clinical manifestations, and diagnosis".)

Direct contact

Sporotrichosis — Sporotrichosis is a subacute to chronic infection usually caused by the dimorphic fungus Sporothrix schenckii. The fungus is found worldwide in climates ranging from temperate to tropical. Most cases are reported from the Americas and Japan [75]. Infection due to S. brasiliensis has also been identified in Brazil [76]. (See "Basic biology and epidemiology of sporotrichosis", section on 'Zoonotic transmission and epidemic S. brasiliensis infection'.)

Disease in humans is usually localized to cutaneous and lymphatic structures and runs a subacute to chronic course. Infected cats develop disease similar to that seen in humans. (See "Clinical features and diagnosis of sporotrichosis".)

Clusters of cases have been reported in veterinarians, family members, and groomers who have handled cats with chronic ulcerated skin lesions [77-81]. Transmission of infection to humans can occur even without an associated penetrating injury.

Microsporum canis — M. canis is a fungus (eg, dermatophyte) that causes skin and nail infections in animals and humans. M. canis is the cause of 3 to 13 percent of human ringworm (tinea capitis) infections [82]. The disease in cats is similar to that seen in humans, with scaly or crusty skin and patches of hair loss around their ears, face, or legs, and occurs with a variable prevalence of 4 to 47 percent [47]. (See "Dermatophyte (tinea) infections".)

Methicillin-resistant Staphylococcus aureus — Methicillin-resistant Staphylococcus aureus (MRSA) is an emerging veterinary and zoonotic pathogen [83]. Transmission between infected or colonized domestic pets and humans in veterinary clinics and in households has been documented, both animal-to-human and human-to-animal [84-86]. As an example, in a study where S. aureus was isolated concurrently from humans and their pet dogs or cats, 50 percent of cases showed strains that were indistinguishable in human and their pets [86]. Thus, for patients with recurrent MRSA infection, cats may be a source of continued exposure to the organism. (See "Methicillin-resistant Staphylococcus aureus (MRSA) in adults: Epidemiology" and "Methicillin-resistant Staphylococcus aureus infections in children: Epidemiology and clinical spectrum" and "Methicillin-resistant Staphylococcus aureus (MRSA) in adults: Prevention and control" and "Methicillin-resistant Staphylococcus aureus (MRSA) in children: Prevention and control".)

PREVENTION — Although cats have been implicated in transmission of zoonoses to their owners, risk of transmission from contact with cats is low and may be further reduced by simple precautions.

Cats should be seen by a veterinarian on a regular basis, treated promptly for diarrhea and dermatoses and should be vaccinated for rabies. Feral cats should be brought for veterinary evaluation prior to introducing them into the home.

Cats who are confined indoors present a lower risk than those who roam outdoors.

Effective flea control requires treatment of affected cats, their environment, and other animals they contact.

Cats should be fed high quality commercial food and should not eat raw meat or eggs. They should not be allowed to eat garbage, feces, or hunt [6]. They should not be allowed to drink non-potable water (eg, surface water or toilet water).

Cats claws should be clipped to reduce the risk of cat scratches to owners.

Outdoor cats should be inspected for ticks regularly.

Young cats present a greater risk for disease (eg, cat scratch disease) than older cats.

Owners should wash their hands following contact with or cleaning of litter boxes, and after contact with animal food. In addition, dry cat food should not be handled in areas where human food is prepared or consumed given the risk of Salmonella contamination [41].

Additional information on how to prevent cat-associated diseases can be found on the United States Centers for Disease Control and Prevention website [84].

Immunocompromised hosts and pets — Groups at high risk for serious infection from pets include:

Persons with waning immunity (eg, older adults)

Children less than five years old

Pregnant women

Immunocompromised patients

The last group may include patients with AIDS [85] and those taking immunosuppression or without a functioning spleen. Numerous reports exist of the transmission of zoonoses to humans during and after solid organ and hematopoietic stem cell transplantation [87]. Most zoonoses present as a primary infection in the post-transplant period; immunocompromised patients are more likely to experience significant morbidity and mortality from these infections.

To avoid infections, people at higher risk should take particular precautions with any animal contact. In addition to thorough and frequent hand washing, these precautions might include avoiding contact with animals and their environment (eg, pens, bedding, and manure). For children, risk for exposure might be reduced if they are closely supervised by adults, carried by adults in animal areas, or have animal contact only over a barrier. These measures discourage animals from jumping on or nuzzling children and minimize contact with feces and soiled bedding.

The United States Public Health Service and the Infectious Diseases Society of America have issued formal recommendation for HIV positive people who desire pet contact [88]. The guidelines specify:

When obtaining a new pet, HIV-infected persons should avoid animals aged <6 months (or <1 year for cats) [89].

HIV-infected persons should be cautious when obtaining a pet from pet-breeding facilities, pet stores, and animal shelters, because of highly variable hygienic and sanitary conditions. Stray animals should be avoided.

HIV-infected persons should avoid contact with any animal that has diarrhea. HIV-infected pet owners should seek veterinary care for animals with diarrheal illness, and a fecal sample from such animals should be examined for Cryptosporidium, Salmonella, and Campylobacter.

HIV-infected persons should wash their hands after handling pets, including before eating, and should avoid contact with pets' feces.

HIV-infected persons should avoid contact with reptiles (eg, snakes, lizards, iguanas, and turtles) as well as chicks and ducklings because of the risk for salmonellosis.

Gloves should be used during aquarium cleaning to reduce the risk for infection with Mycobacterium marinum.

Contact with exotic pets (eg, nonhuman primates) should be avoided.

The Centers for Disease Control and Prevention offer more information about pets and infection risks at their Healthy Pets Healthy People webpage.

INFORMATION FOR PATIENTS — UpToDate offers two types of patient education materials, "The Basics" and "Beyond the Basics." The Basics patient education pieces are written in plain language, at the 5th to 6th grade reading level, and they answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are written at the 10th to 12th grade reading level and are best for patients who want in-depth information and are comfortable with some medical jargon.

Here are the patient education articles that are relevant to this topic. We encourage you to print or e-mail these topics to your patients. (You can also locate patient education articles on a variety of subjects by searching on "patient info" and the keyword(s) of interest.)

Beyond the Basics topics (see "Patient education: Animal and human bites (Beyond the Basics)")

SUMMARY

A zoonosis is an animal disease that is transmissible to humans. Humans are usually an accidental host that acquires disease through close contact with an infected animal, who may or may not be symptomatic. (See 'Definition' above.)

Children are at high risk for infection because they are more likely to have close contact with pets. (See 'Risk factors' above.)

Cats are responsible for transmission of an extensive array of bacterial, fungal, and parasitic zoonotic pathogens. The route of transmission can be through the saliva (eg, bites or contaminated scratches), feces, respiratory secretions, direct contact, or by the cat acting as a vehicle and source of tick or flea exposure. (See 'Transmission' above.)

Although cats have been implicated in transmission of zoonoses to their owners, risk of transmission from contact with cats is low and may be further reduced by simple precautions. (See 'Prevention' above.)

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References

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