Reptile-associated salmonellosis—selected states, 1998-2002

Morbidity and Mortality Weekly Report, Dec 12, 2003 by R Reporter, B Sun, J Monopoli, Q Phan, J Hadler, P Tiffany, Z Mulla, R Baker, PD Fiorella, K Kruger, L Shireley, D Johnson, D Steinbach, K Smith, E Salehi, N Joseph, J Archer, J Davis, N Snipes, J Ovitt, F Angulo, S Gottlieb

During 1998-2002, CDC received reports from state health departments regarding Salmonella infections in persons who had contact with reptiles (e.g., lizards, snakes, and turtles). Salmonella infections usually cause gastroenteritis but can result in invasive illness (e.g., septicemia and meningitis), especially in infants and immunocompromised persons. For decades, reptiles have been known as a source for salmonellosis (1); however, numerous reptile owners remain unaware that reptile contact places them and other household members, including children, at greater risk for salmonellosis (2). Increasing evidence suggests that amphibians (e.g., frogs, toads, newts, and salamanders) also can pose risks for salmonellosis in humans (3,4). This report describes cases of reptile-associated salmonellosis in six states *, offers recommendations on preventing transmission of Salmonella from reptiles and amphibians to humans (Box), and provides an update on state regulations mandating education at per stores about salmonellosis.

BOX. Recommendations for preventing transmission of
Salmonella from reptiles and amphibians to humans

* Per-store owners, health-care providers, and veterinarians
should provide information to owners and potential
purchasers of reptiles and amphibians about the risks
for and prevention of salmonellosis from these pets.

* Persons at increased risk for infection or serious complications
from salmonellosis (e.g., children aged < 5 years
and immunocompromised persons) should avoid contact
with reptiles and amphibians and any items that
have been in contact with reptiles and amphibians.

* Reptiles and amphibians should be kept out of households
that include children aged <5 years of immunocompromised
persons. A family expecting a child should
remove any pet reptile or amphibian from the home
before the infant arrives.

* Reptiles and amphibians should not be allowed in childcare
centers.

* Persons always should wash their hands thoroughly with
soap and water after handling reptiles and amphibians
or their cages.

* Reptiles and amphibians should not be allowed to roam
freely throughout a home or living area.

* Pet reptiles and amphibians should be kept out of kitchens
and other food-preparation areas. Kitchen sinks
should not be used to bathe reptiles and amphibians or
to wash their dishes, cages, of aquariums. If bathtubs
are used for these purposes, they should be cleaned thoroughly
and disinfected with bleach.

* Reptiles and amphibians in public settings (e.g., zoos
and exhibits) should be kept from director indirect contact
with patrons except in designated animal-contact
areas equipped with adequate hand-washing facilities.
Food and drink should not be allowed in animal-contact
areas.

Case Reports

California. During December 2001, an infant aged 3 months was taken to an emergency department (ED) after 1 day of bloody diarrhea and fever. The infant was sent home with no therapy and recovered in 2 days; a stool specimen yielded Salmonella serotype Nima. Although no reptiles lived in the home, the infant's father was a high school biology teacher who handled reptiles in the classroom, including a large snake (i.e., a boa) that he often draped over his shoulders. A stool culture from the snake grew S. Nima. When interviewed, the father indicated that he knew reptiles carry Salmonella and was careful to wash his hands after handling them or their containers. However, he did not change clothing when he came home from work before holding his child.

Connecticut. During June 2002, a child aged 21 months was admitted to a hospital with fever, abdominal cramps, and bloody diarrhea. The child received no antibiotic therapy and was discharged the next day. Blood and stool cultures yielded Salmonella serotype Poona. A sibling aged 6 years also had fever and bloody diarrhea and a stool culture that yielded S. Poona. The family had purchased an iguana approximately 1 month earlier. The children had cleaned the iguana's cage and handled the iguana 2 days before their illness onsets. A stool culture from the iguana grew S. Poona; isolates from the iguana and the two siblings were indistinguishable by pulsed-field gel electrophoresis (PFGE).

Florida. During January 2000, an infant aged 1 month visited a clinic with fever and diarrhea; the infant was not hospitalized. A stool specimen yielded Salmonella serotype Tennessee. One week before illness onset, the infant's family moved into a household that contained a bearded dragon (i.e., Pogona vitticeps). The pet reptile's cage had been washed in the kitchen near the infant's bottle nipples. A stool culture from the bearded dragon yielded S. Tennessee. Isolates from the infant and the bearded dragon were indistinguishable by PFGE. An adult in the house reported being aware that turtles and iguanas are reservoirs for Salmonella but unaware that all reptiles can carry Salmonella. The bearded dragon was placed outside the home and later donated to a zoo.

North Dakota. During March 1998, twin infants aged 2 weeks were admitted to a hospital after 1 day of poor feeding, diarrhea, and fever. They were treated intravenously with ampicillin for 6 days. The infants' mother and a child aged 3 years in the home also had diarrhea. Stool specimens from one of the twins, the mother, and the older child yielded Salmonella with the partial serotype O group 44, 45, 47, 48, of 50, H antigen G complex. The family recently had acquired an iguana, which was not allowed out of its cage. Only the mother handled the reptile and cleaned the cage. When the family learned that the iguana was the probable source of Salmonella infections, the iguana was euthanized. Culture of intestinal contents from the iguana yielded Salmonella with the same partial serotype as the patients' isolates. The clinical isolate from the twin was sent to CDC for complete serotyping and found to be Salmonella serotype IV 48:g, [z.sub.51]:-(known formerly as S. Marina).