Reptile-Associated Salmonellosis — Selected States, 1996-1998

Morbidity and Mortality Weekly Report, Nov 12, 1999

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.

Case Reports

Arizona. During October 1996, a 3-week-old boy was admitted to a hospital emergency department with fever (103.6 F [40 C]), vomiting, and bloody diarrhea of 15 days' duration. Stool and blood cultures yielded Salmonella serotype IV 44:z4,z23-, an extremely rare serotype. The infant was hospitalized for 10 days and treated with intravenous fluids and amoxicillin. To determine the cause of the infant's illness, a stool specimen was obtained from the family's pet iguana, which also yielded Salmonella IV 44:z4,z23-. In an attempt to prevent reinfection, local health officials informed the parents of the importance of the infant avoiding direct and indirect contact with the reptile, and the iguana was moved to a relative's home. One month later, the infant spent 2 days in the relative's home where the iguana was housed; 48 hours after this visit, the infant was again treated at an emergency department for fever and diarrhea. A stool culture again yielded Salmonella IV 44:z4,z23-.

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.

State Regulations for Preventing Reptile-Associated Salmonellosis

During March 1999, CDC contacted all 50 state health departments to determine whether state regulations existed for sale of reptiles and distribution of information about salmonellosis. Of the 48 states that responded, three (California, Connecticut, and Michigan) had regulations requiring pet stores to provide information about salmonellosis to persons purchasing a turtle; two states (Kansas and Maryland) require salmonellosis information to be provided to persons purchasing any reptile. Three states (Arizona, Minnesota, and Wyoming) prohibit reptiles in day care centers and long-term--care facilities.

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.