Reptile-associated salmonellosis - selected states, 1994-1995

Morbidity and Mortality Weekly Report, May 5, 1995

During 1994-1995, health departments in 13 states reported to CDC persons infected with unusual Salmonella serotypes in which the patients had direct or indirect contact with reptiles (i.e., lizards, snakes, or turtles). In many of those cases, the same serotype of Salmonella was isolated from patients and from reptiles with which they had had contact or a common contact. For some cases, infection resulted in invasive illness, such as sepsis and meningitis. This report summarizes clinical and epidemiologic information for six of these cases.

Connecticut. During January 1995, a 40-year-old man was hospitalized because of an acute illness characterized by constipation, lower back pain, chills, and fever. He reported having taken ranitidine and an antacid for symptoms of heartburn before onset of mild diarrhea 3 days before hospitalization. A blood culture yielded Salmonella serotype Wassenaar. A magnetic resonance image scan of the right sacrum suggested osteomyelitis. Ciprofloxacin therapy was initiated for presumed Salmonella osteomyelitis, and he was discharged after 14 days. All household contacts were asymptomatic. The family had purchased two iguanas (Iguana iguana) in October 1994; although the patient denied directly handling the iguanas, he reported having recently cleaned their aquarium. Stool samples obtained from both iguanas yielded Salmonella Wassenaar.

New Jersey. During September 1994, a 5-month-old girl was hospitalized because of an acute illness including vomiting, lethargy, and fever; on admission, she had a bulging fontanelle and stiff neck. Blood cultures and cerebrospinal fluid yielded Salmonella serotype Rubislaw. She was treated with intravenous ceftazidime for Salmonella sepsis and meningitis and discharged from the hospital after 10 days. Other members of the family were asymptomatic. The infant routinely was fed infant formula. Although the family did not own a reptile, the infant frequently stayed at a babysitter's house where an iguana was kept. Culture of a stool sample from the iguana yielded Salmonella Rubislaw. The infant was reported to have not touched the iguana; however, the iguana frequently was handled by the babysitter and other members of the babysitter's family. All members of the babysitter's family were asymptomatic, but stool cultures from two members, including a child who had-frequently played with and fed the infant, yielded Salmonella Rubislaw.

New York. In December 1994, a 45-year-old man infected with human immunodeficiency virus was hospitalized because of weakness, nausea, vomiting, and diarrhea. His CD4 T-lymphocyte count was <50 cells/[mu]l. Cultures from blood and sputum samples yielded Salmonella serotype IIIa 41:z4z23:- (S. subspecies Arizonae). He owned corn snakes and, until shortly before onset of illness, had worked at a pet store where he handled reptiles frequently. Salmonella sepsis was diagnosed, and he was treated with oral ciprofloxacin.

North Carolina. During December 1994, a 2-day-old boy born 8 weeks prematurely developed respiratory difficulties, had pneumothorax diagnosed, and was transferred to a referral hospital. Blood obtained at birth for culture had been negative, but a culture of blood obtained 9 days later because of an elevated white blood cell count yielded Salmonella serotype Kintambo. He was treated with intravenous ampicillin for Salmonella sepsis and was discharged from the hospital after 30 days. Eleven days after the positive culture was collected, Salmonella Kintambo was cultured from a blood sample obtained from a 12-day-old acutely ill boy who was born at 28 weeks' gestation and had shared a room at the referral hospital with the first infant. The second infant was treated with intravenous cefotaxime for Salmonella sepsis and was discharged after 44 days. Both infants had been in the hospital continuously from birth until onset of illness. The mother of the first infant reported having had a diarrheal illness 4 days before the birth of the infant; she frequently handled a savanna monitor lizard (Varanus exanthemapicus) that the family had purchased in September 1994 and kept in a cage in the kitchen. Culture of a stool sample from the lizard yielded Salmonella Kintambo. The second family did not own a reptile.

Ohio. During January 1994, a 6-week-old boy was hospitalized because of diarrhea, stiff neck, and fever; culture of samples of blood and cerebrospinal fluid yielded Salmonella serotype Stanley. The infant was treated with intravenous cefotaxime for Salmonella sepsis and meningitis and discharged from the hospital after 56 days. He had been fed only formula and had not attended a child-care facility; household contacts were asymptomatic. The family had purchased a 4-inch water turtle in April 1993. A culture of stool from the turtle yielded Salmonella Stanley. Although the infant had not had contact with the turtle, other family members had had direct contact, and the turtle's food and water bowls were washed in the kitchen sink.