editorials Salmonella perils of pet reptiles Linda Ward S almonella enterica is a major cause of gastroenteritis in humans, and many of the infections originate in foodproducing animals that are infected with salmonella Members of the public are less likely to know that domestic pets, birds, and rodents also harbour salmonellas Cold blooded animals, including tropical fish and reptiles (which are becoming more common as ‘exotic’ pets), have been recognised as a source of human salmonellosis for almost forty years S enterica was isolated from snakes in 1944 and from ‘turtles’ (definition includes tortoises and terrapins) and lizards in 1946 The first human salmonella infection associated with a turtle was reported in the United States (US) in 19633 Well over 90% of all reptiles may carry S enterica4,5 and up to five different serotypes have been isolated from a single reptile 6,7 Infections in reptiles are usually asymptomatic and excretion rates for the organisms may vary considerably, making it difficult to establish whether the reptile is a carrier There have also been reports of symptomatic salmonellosis in reptiles, but feeding experiments in snakes, tortoises, and lizards failed to produce disease and resulted only in faecal shedding of the pathogen8 While reptiles must be considered to be asymptomatic carriers of S enterica the organisms they shed intermittently in faeces can cause serious illness in humans There are over 2400 different salmonella serotypes Most belong to subspecies I and cause infection mainly in humans and other warm blooded animals S enterica carried by reptiles are Linda Ward is head of the Salmonella Reference Unit at the PHLS Laboratory of Enteric Pathogens VOL NO MARCH 2000 usually rare serotypes and often belong to S enterica subspecies II, S enterica subspecies IIIa and IIIb, (the Arizonae group), and to S enterica subspecies IV S enterica Paratyphi B variant Java (= S Java), which belongs to subspecies I, however, has been linked to reptiles (particularly tortoises and terrapins) for many years and has been responsible for many infections in children10 In recent years this serotype has also caused human infections in association with tropical fish tanks (author’s unpublished data) ‘ over 90% of all reptiles may carry S enterica ’ Young children who acquire salmonella infections from reptiles may develop invasive illness including sepsis and meningitis11,13 An increase in the numbers of cases of salmonellosis associated with exotic pets in children and infants is causing concern in England and Wales In the past three months the PHLS Laboratory of Enteric Pathogens reported on six cases (5 children and adult) who acquired infection from reptiles Three infants developed meningitis, and one died following infection with S Rubislaw An outbreak of S Tel-el-kebir infection in Ireland associated with terrapins imported from America affected seven children and one adult14 In the US the numbers of reported cases of reptile-associated salmonellosis rose fivefold in the late 1990s 11,12 Exotic pets such as iguanas and snakes are becoming popular in the United Kingdom Reptiles are not generally thought to be cuddly, but children like to handle and pet them, which may result in their hands and fingers becoming contaminated Infants may be infected indirectly by parents and other family members who have handled the reptile and not washed their hands before feeding or handling the child Infants and small children may also acquire infection from reptile droppings, particularly if the pet is free to roam around the family rooms The following recommendations for reducing risk of transmission of Salmonella spp from reptiles to humans based on guidelines developed by the Association of Reptilian and Amphibian Veterinarians (ARAV) and the Centers for Disease Control and Prevention15 in the US could be applied to England and Wales • People at increased risk of infection or serious complications of salmonellosis (for example, pregnant women, children of under years of age, and those with impaired immunity), should avoid contact with reptiles • Reptiles should not be kept in childcare centres and may not be appropriate pets in households whose occupants are at increased risk of infection • Veterinarians and pet shop owners should provide information to potential purchasers and owners of reptiles about the risk of acquiring salmonellosis from reptiles They should also advise reptile owners always to wash their hands after handling reptiles and reptile cages • Reptiles should be kept out of food preparation areas Kitchen sinks should not be used to bathe reptiles or to wash reptile dishes, cages, or aquariums If bath tubs are used for these purposes, they should be cleaned thoroughly and disinfected with bleach Personal hygiene and publicity about the inherent risk of salmonella infection associated with exotic pets are vital if these serious salmonella infections are to be avoided COMMUNICABLE DISEASE AND PUBLIC HEALTH Anderson HW, Young W, Clark MH, et al Turtle associated salmonellosis I An estimation of the magnitude of the problem in the United States, 19701971 Am J Epidemiol 1972; 95: 511-7 Seibeling RJ, Neal PM, Granberry WD Evaluation of methods for the isolation of Salmonella and Arizona organisms from pet turtles treated with antimicrobial agents Applied Microbiology 1975; 29: 240-5 Chiodini R, Sundberg JP Salmonellosis in reptiles: a review Am J Epidemiol 1981; 113: 494-9 Rowe B, Hall MLM Kauffman-White scheme 1989 London: PHLS, 1989 10 Orton WT, Henderson WG The infected terrapin Community Medicine 1972; 127: 89-91 11 CDC Reptile-associated salmonellosis – selected states, 1994-1995 MMWR Morb Mortal Wkly Rep 1995; 44: 347-50 12 CDC Reptile-associated salmonellosis – selected states, 1996-1998 MMWR Morb Mortal Wkly Rep 1999; 48: 99-103 13 Cyriac J, Wozniak ER Infantile salmonella meningitis associated with gecko-keeping Commun Dis Public Health 2000; 3: 66-7 14 Lynch M, Daly M, O’Brien B, Morrison F, Cryan B, Fanning S Salmonella tel-el-kebir and terrapins J Infect 1999; 38: 182-4 15 Association of Reptilian and Amphibian Veterinarians Guidelines for reducing risk of transmission of Salmonella spp from reptiles to humans JAMA 1998; 213: 51-2 editorials Hinshaw WR, McNeil E Gopher snakes as carriers of salmonellosis and paracolon infections Cornell Vet 1944; 34: 248-54 McNeil E, Hinshaw WR Salmonella from Galapagos turtles, a gila monster and an iguana Am J Vet Res 1946; 7: 62-3 Communicable Disease Center Reports of isolations from the states Salmonella Surveillance 1963; (10): 22-4 Iveson JB, Mackay-Scollay EM, Bamford V Salmonella and arizona in reptiles and man in Western Australia Journal of Hygiene 1969; 67: 135-45 Koopman JP, Janssen FGJ The occurrences of salmonellas and lactose-negative arizonas in reptiles in the Netherlands, and a comparison of three enrichment methods used in their isolation Journal of Hygiene 1973; 71: 363-71 Lamm SH, Taylor A Jr, Gangarosa EJ, Address for correspondence: Linda Ward Salmonella Reference Unit PHLS Laboratory of Enteric Pathogens 61 Colindale Avenue London NW9 5HT tel 020 8200 4400 ext 3132 fax 020 8905 9929 email: lward@phls.nhs.uk All the history that you can remember from the twentieth century therefore may have heard stories about what life was like early in the twentieth century The twentieth was the first century in which photographic and sound records were available from start to finish, increasing the range of material that could be archived Motion Stuart Handysides picture records were available for most of the century and the development of radio and n a previous article I noted that exposure by those who find it television broadcasting (and more landmarks had been valuable or diligence of individuals more recently the internet) offered for the twentieth or institutions that keep good created previously unimaginable century than for all the preceding records Increasingly, the problem opportunities for spreading The parallel centuries put together Two is accessibility Eight years ago the information reasons for this – these events had then editor of JAMA estimated that development of powered transport occurred too recently to have been two million biomedical articles on land and in the air increased the forgotten and scientific activity had were published each year (6000 a mobility both of people and of increased in the twentieth century day)2 Even if the entire body of infectious diseases The twentieth century began – were offered recently in the scientific knowledge were Lancet ‘Much of the material accessible, who would have the when the germ theory of infection record of modern medicine must be time to read and evaluate even the was relatively young, and several landmarks in its first 50 years deliberately discarded so that a parts relevant to their field? concerned the discovery and use of manageable amount remains for chemotherapeutic ‘magic bullets’ use by present and future ' as the century fought back by historians’, the author wrote2 He ended, the medical Microorganisms acquiring resistance to noted that between 80% and 90% antimicrobials and, as the century of all the scientists who have ever world was on the ended, the medical world was on lived are alive today, and that the defensive ' the defensive, devising policies to medical publishing record doubles hold back the advance of every 12 to 15 years2 Somehow, resistance the author argued, the fittest A century, in comparison with antimicrobial science survives, through repeated a millennium or with all recorded Chromosomes were discovered in history, seems a very short period 1902, and 50 years later their Stuart Handysides is medical editor at I expect that most readers in 2000 structure was elucidated In the PHLS Communicable Disease will have known people who were another ten years the genetic code Surveillance Centre born in the nineteenth century and was cracked, and by the end of the I COMMUNICABLE DISEASE AND PUBLIC HEALTH VOL NO MARCH 2000