Review
Bite-related and septic syndromes caused by cats and dogs

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Summary

Bite infections can contain a mix of anaerobes and aerobes from the patient's skin and the animal's oral cavity, including species of Pasteurella, Streptococcus, Fusobacterium, and Capnocytophaga. Domestic cat and dog bite wounds can produce substantial morbidity and often require specialised care techniques and specific antibiotic therapy. Bite wounds can be complicated by sepsis. Disseminated infections, particularly those caused by Capnocytophaga canimorsus and Pasteurella multocida, can lead to septic shock, meningitis, endocarditis, and other severe sequelae. An emerging syndrome in veterinary and human medicine is meticillin-resistant Staphylococcus aureus (MRSA) infections shared between pets and human handlers, particularly community-acquired MRSA disease involving the USA300 clone. Skin, soft-tissue, and surgical infections are the most common. MRSA-associated infections in pets are typically acquired from their owners and can potentially cycle between pets and their human acquaintances.

Introduction

“Love the animals: God has given them the rudiments of thought and joy untroubled”

Fyodor Dostoyevsky

No relationship is as constant and ancient to mankind as that between human beings and their pets. Dogs were first domesticated about 15 000 years ago from wolves living in or near China.1 The first domesticated cat originated in Cyprus almost 9500 years ago.2 Today, about 75 million dogs and 88 million cats are owned in the USA alone, with pets being found in about 63% of American households.3 In the UK, there are some 27 million domestic pets, inhabiting about 43% of British households.4

However, the closeness between pet owners and their animals comes with the potential for transmission of at least 30 infectious agents.5 In 2001, more than 350 000 people were treated in US hospital emergency departments for non-fatal dog-bite-related injuries.6 Annual direct medical costs related to dog-bite injuries are estimated to be approximately US$165 million.7 Although certain zoonoses, such as bite-wound infections and cat-scratch disease are well recognised, other infections, such as device-related infections and community-acquired meticillin-resistant Staphylococcus aureus (MRSA) are newer and are increasing in prevalence. In this Review, we provide an overview of several of the most important infectious disease pathogens transmitted by dogs and cats to human beings, and in some cases, from human beings to their pets.

Section snippets

Epidemiology

In the USA, dog and cat bites comprise roughly 1% of emergency room visits annually,8, 9 with similar numbers reported in Europe. Dog bites (figure 1) cost over $1 billion per year in the USA.9 Roughly 60% of animal bites are related to dogs, with 10–20% attributed to cats. Cat bites are more common in women and the elderly.10, 11 Individuals aged under 20 years and men are associated with a higher incidence of injury.12, 13

A common and controversial topic is the risk of bite injury posed by

Septic syndromes

Sepsis can be a severe complication of bite wounds, particularly those infected with C canimorsus, P multocida, Staphylococcus spp (including MRSA), and Streptococcus spp. Meningitis, endocarditis, and peritonitis can also complicate bite-wound infections. Several other species, including Bacteroides, Fusobacterium, Neisseria, and Prevotella, might also produce bite-wound sepsis in individuals with leukaemia and lupus, and in those receiving chronic steroids. The clinical picture in these

Epidemiology

MRSA, long recognised as a human pathogen, is notorious for causing a wide variety of disease syndromes. MRSA has long been recognised as a pathogen associated with hospital or health-care settings.64 Community-acquired MRSA strains have been increasing in prevalence over the past decade. These organisms and the most common genotype, USA300, are distinct from traditional hospital-acquired strains in that they are easily transmitted in the household, are a frequent cause of skin and soft-tissue

Conclusion

Pet owners are often unaware of the potential for transmission of life-threatening pathogens from their canine and feline companions. Bite injuries are a major cause of injury in the USA and Europe each year, particularly in children. Bites to the hands, forearms, neck, and head have the potential for the highest morbidity. Common pathogens in these injuries include oral anaerobes, P multocida, C canimorsus, and MRSA. Treatment of cat and dog bites should include wound assessment, deep culture,

Search strategy and selection criteria

Data for this Review were identified by searches of Medline and UpToDate version 16.2, and references of relevant articles. The Medline database was searched from October, 1996, through April, 2008. Search terms were “pet infections”, “bites”, “wounds”, “cats”, “dogs”, “Pasteurella”, “Capnocytophaga”, “zoonoses”, and “methicillin-resistant Staphylococcus aureus”. Only English language papers were reviewed.

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