Tuesday, September 29, 2009

Human Health Concerns

Accidents and injuries can happen, both to the reptile and the reptile handler. Not only can bites happen, but there are diseases that can be transmitted between animals - and that means between reptiles and humans. As a teacher, you need to be aware of what they are and how to protect yourself and your students and how to use the information to reassure other teachers, administrators, and parents who express grave concern about your reptile due to the news reports they hear.

Zoonoses are diseases or organisms that can be passed between disparate animal groups. Humans can get toxoplasmosis from their cats, rabies from squirrels, Campylobacter and brucellosis from dogs, Lyme disease from deer ticks, Q Fever from snake ticks, Cryptosporidium from birds or your child's day care facility, and Salmonella from just about everything - reptiles, chicken nuggets, alfalfa sprouts, dad's barbecue, and mom's apple pie. If you are a healthy adult (relatively stress-free, with a strong immune system), you are unlikely to get more than a mild flu-like illness from these things if you experience any symptoms at all.

However, fetuses are at risk if their mother is infected with toxoplasmosis or some other organisms and parasites (wildlife rehabilitators, for example, do not work with raccoons or skunks if they are pregnant or trying to get pregnant due to fetal risk). Newborns are at risk from just about everything as their immune systems are not well developed and, when they get diarrhea, they dehydrate much faster as they have less fluid volume to lose. The overall disease process in infants and toddlers may be different, such as salmonellosis causing meningitis. Anyone who is immune-compromised, be it a cancer patient, organ donor or recipient, someone who is just getting over a serious illness, is HIV positive, or has one of the many autoimmune disorders is also at risk for serious illness from these organisms.

To become infected, one needn't even come into direct contact with the infected animal's feces. Indirect contact works just fine, thank you, as these organisms and parasites live for long periods of times outside the body of their host. If you cleaned an infected animal's enclosure, inadvertently splashing water on the counter where a student later momentarily sets down an apple he is eating, he may get sick. If a student who has a small cut on her hand is helping you clean an enclosure, and she get feces-contaminated water on her hands--and the cut--she may get infected even if she washes her hands afterwards with hot, soapy water. A student who holds a snake, one whose enclosure isn't cleaned all that often and so it has no choice but to rub up against its own feces, and that student rubs his eye, or eats a potato chip, or opens a bottle of juice before washing his hands, is at risk. You may even pass it to students by your apparently clean-but-contaminated hands coming into contact with the papers you graded and returned.

Salmonella has been in the news a great deal lately, mostly due to the infant deaths traced back to the Salmonella they were infected with by their parents who were themselves not aware that reptiles carried zoonotic diseases. While iguanas have been named in these news reports, the CDC has documented cases where other reptiles, including savannah monitors and corn snakes, were responsible for infections in adult humans serious enough to result in their hospitalization.

But your reptiles couldn't possibly have Salmonella, you say? Dr. Cathy A. Johnson-Delaney, DVM, who writes about zoonoses in her chapter, Reptile Zoonoses and Threats to Public Health (in Reptile Medicine and Surgery, Douglas Mader, (Ed.), W.B. Saunders Co., Philadelphia, PA, 1996), has researched the literature and found the following infection rates in pet trade reptiles:

Turtles 12.1 - 85%
Snakes 16 - 92%
Lizards 36 - 77%

Even if you take an average of these figures, the numbers are unsettling. Of a survey of veterinary necropsies in Canada during 1979-83, she writes, "150 pet reptiles were submitted for necropsy: 51% of the snakes, 48% of the lizards, and 7% of the turtles cultured positive for Salmonella spp., with 31 different serotypes identified." Indeed, it is thought by many researchers that, based on the fact that Salmonella (and some other organisms) are so common in so many different species of reptiles that it may be saprophytic: the organisms live benignly inside the animals, feeding on dead organic matter in their bodies.

Salmonella lives a long time outside a digestive tract. Viable organisms have been found on snake skin shed years after those sheds had been hanging, forgotten in a college lab. The researchers in the same lab cultured Salmonella from an clean, empty, wooden reptile enclosure six months after the last inhabitant left. Johnson-Delaney reports that viable Salmonella organisms have been found after:

89 days in tap water
120 days in pasture soil
280 days in garden soil
28 months in bird feces
30 months in cow manure

Besides Salmonella (of which there are hundreds of different serotypes, some relatively harmless, some extremely virulent), the most commonly occurring reptile-related zoonoses are Aeromonas, Campylobacter, Citrobacter, Coccidia, Clostridium, Corynebacterium, Edwardsiela tarda, E. coli, Enterobacter, Enterobacter, Klebsiella, Leptospira, Mycobacterium, Neisseria, Pasturella, Proteus, Serratia, Staphlococcus, and Strepococcus.

Most of the above cause diarrhea, vomiting, cramps, and other Salmonella-like symptoms in humans. Health authorities have already traced many of these infections in children and adolescents back to their reptiles.

The reptiles may themselves not look or act ill; they may not have diarrhea. You cannot determine whether or not any animal is infected just by looking at it. In fact, testing for these organisms is notoriously ineffective as the organism may not appear in every fecal mass deposited by the reptile. You will need have testing done repeatedly over a period of a couple of months to even begin to feel somewhat confident that your reptile may not carrying the organism being tested for; for some of these organisms, blood testing may detect their presence. Treating asymptomatic reptiles is not recommended as that just creates antibiotic resistant organisms. A new strain of Salmonella has recently hit the United States, found in school and other milk supplies. It has already infected several (and killed a couple) of young children in the United Kingdom. The latest and best antibiotic we now have available is ineffective against it. As fast as we can develop and produce new antibiotics, the bacteria out there are mutating resistance even faster. The only way to reduce or eliminate the risk of any zoonotic infection is to not be casual about cleaning, disinfecting, and handling.

Reality Check

Okay, that was the bad news. The good news is that, if you know that you may be working with infected animals and that you and your students may be infected if you don't think about what you are doing when you clean their enclosures, you will greatly reduce the risk of anyone who is otherwise healthy getting sick (extreme care must always be taken when anyone is in the high-risk category for infection).

Appendix C discusses proper cleaning and disinfecting procedures, including those necessary when working with obviously sick animals and animals in quarantine. The other things you can do, and make sure your student-helpers do, include:

* Wear disposable gloves when cleaning enclosures. Make it easy on everyone: keep a box near your reptile area. If you have several reptile enclosures spread throughout your classroom, keep several boxes out. They can be purchased in boxes of 100s from medical supply stores.

* Dispose of contaminated water by flushing it down a toilet after first lifting the seat; spray the rim and inside of the bowl with your disinfectant when done, after first wiping up any splashes.

* When removing furnishings from an enclosure for any reason, set them down on sheets of newspaper; once you are done with the newspaper, fold it up and put it in the covered garbage container, pushing it down out of the way of casual contact by students who later come to deposit trash in the same container.

* Regularly clean and disinfect water bowls, rocks, branches, etc. Bowls can be cleaned and disinfected with the same soap and disinfectants you use for the enclosure, rinsing them off thoroughly before use. Rocks can be boiled for 20 minutes, or washed in hot, soapy water, then sprayed thoroughly with disinfectant, then rinsed thoroughly before use. Small branches can be baked in a 250ยบ F oven, or soaked in disinfectant for 24 hours, then rinsed thoroughly, soaked in fresh water for 24 hours, then rinsed and allowed to dry thoroughly, preferably in the sun.

* If working with aquatic or semi-aquatic enclosures, prevent accidental splashes into the eyes, nose and mouth by wearing safety goggles and face-mask protection.

* Antibacterial soaps and cleaners inhibit the replication of existing bacteria - they do not kill them. To kill bacteria on a surface you must disinfect it.

Note: Not all antibacterial soaps may be doing the job you think they are. There should be an EPA number on the label of these products; you can call the EPA to check to see if in fact it is effective. As of 1996, triclosan, found in Dial® and some other antibacterial hand and dish soaps, was one of the few effective antibacterials used in soaps when used properly (meaning it must be left on the surface for at least ten minutes - read the fine print on the container). Note that some people who think they are allergic to their reptiles are in fact allergic to something in the antibacterial soap they are using. So, if one brand gives you a rash, try another.

* An easy and inexpensive way to make antimicrobial hand-wipes to keep around the classroom: pour a pint of rubbing alcohol into a container of baby-wipes. After hands are washed, they can be wiped with the antimicrobial wipes.

* Think carefully before deciding to keep reptiles in any child-care facility where toddlers and pre-schoolers are cared for. Check your state school and facility licensing codes to make sure that animals are not expressly prohibited from being kept in schools and other facilities caring for young children.

* Reptiles kept in classrooms should not be handled unless appropriate handwashing and clean-up facilities are available and made accessible to children and staff and they are used whenever any contact with the reptiles or their enclosures occurs. If you cannot assure the necessary facilities for cage cleaning and disinfecting, or for you and your students to be able to quickly wash with hot, soapy water after contact with the reptiles, then reptiles should not be housed in the classroom.

* Disinfectant lotions, pump sprays or similar products should be carried whenever reptiles are going to be handled in the field, in the classroom, at swap meets or other locations where handwashing facilities may be absent. Note that some of these disinfectant or antibacterial products may not be effective against the Salmonella commonly found in reptiles.

Bites And Scratches

When you do get bitten or scratched by a reptile:

* Flush well with warm water. Soap it to remove any debris. If the bite is deep, it should be power flushed (several 30-60 cc syringes full of sterile saline (sodium chloride) should be pumped into deep or jagged bites to flush out bits of skin, muscle and bacteria). Keep in mind that if a bite is bad enough to require power-flushing, it is bad enough to be seen by a doctor to be evaluated for stitches and antibiotics. Another reason for seeing a doctor is that, since some reptiles may leave teeth behind in the wound, such bites should be probed to find and remove them before healing starts.

* Swab the wound with Betadine(r) (povidone-iodine). Hibiclens(r) (chlorhexidine gluconate, available at supermarkets or pharmacies), Nolvasan(r) (chlorhexidine diacetate, the veterinary form of Hibiclens, available at feed stores and through mail-order animal supply houses), Bactine(r), or other antiseptic products are available if you are allergic to iodine products. Top the wound with an antibiotic ointment or cream.

* After the first 24-48 hours, try to leave the wound unbandaged as much as possible every day, wearing instead just a light film of antibiotic ointment over it. Cover it when you are preparing human food, doing human dishes, handling reptiles, feeding reptiles, and when cleaning reptile enclosures. If the bite or scratch is on your hand, wear a disposable glove over the bandage when working with the reptiles.

* If the scratch or bite is deep, soak it several times a day, for 20-30 minutes, in water, as hot as you can tolerate, to which Betadine, Hibiclens, or Nolvasan has been added. If the bitten or scratched body part is not easily soakable, apply hot compresses soaked in the water/antiseptic solution instead.

* At night, clean the wound with warm water, then apply an antibacterial ointment before covering with a bandage. This process promotes rapid healing as both the anaerobic and aerobic bacteria are dealt with.

* Bag Balm(r), an antibiotic ointment sold in supermarkets, pharmacies, and feed stores, promotes rapid healing from the outside in. This reduces the risk of wound contamination from other bacterial and fungal sources during the healing process. When used on very deep wounds, the healing tissues under the healed up skin may continue to be tender, even painful, for a while as those tissues heal. The one problem with forcing such rapid healing is that if there is any infection festering deep inside, recovery will be delayed, even if you are on systemic antibiotics, and you may require minor surgery to have the site opened up and cleaned out.

If the bite is deep enough to be a potential problem (rather than a nice neat row of tooth punctures, or minor laceration because you jerked your hand/arm/leg away), then you should seek medical attention. There is a difference of opinion as to whether animal bites should be stitched or not. Stitched animal bites seem to run a higher risk of infection. (Note: If it does need stitches, they must be done within 4-6 hours of the incident.) Part of the problem may be the medical community's lack of knowledge as to what type of organisms typically inhabit the biter's mouth, or perhaps because the wound wasn't flushed out well enough, leaving debris and a tooth or two in there to start festering along with any bacterial organisms ground in during the act of biting itself. If you have any doubt about whether you should seek medical attention, go get medical attention. It is better to err on the side of caution than to risk a potentially serious and long-lasting infection.

When you do see your physician, tell him or her that reptiles carry gram negative bacteria in their mouths. This may affect the type of oral antibiotic they prescribe for you if they are going to prescribe any - and be prepared: these antibiotics are expensive, even in their generic form. Take the full course of antibiotics prescribed, even if there is no sign of infection and your wound seems to be healing well. Failure to complete the course of antibiotics means that the bacteria in your system who managed to survive the amount you did take will become resistant to that antibiotic. Antibiotic-resistant bacterial strains have become an increasing health problem in the U.S. and elsewhere, so be smart and finish the whole thing - it may help you in the future. (Does the term "flesh-eating bacteria" ring a bell? This is one of the more extreme examples of antibiotic-resistant bacterial strains we have fostered.)

If you work with animals, especially untamed ones, or wild or exotic ones, it makes sense to keep your tetanus boosters up to date. Here, too, are two schools of thought: those physicians who feel that the titers in your blood remain viable enough to fend off infection for 7-10 years, and those who feel that you need to get your boosters every 5 years. Discuss this with your doctor, preferably before you are bleeding all over one of his or her exam rooms.

Avoiding Bites

Bites don't "just happen." Something triggers them. Reptiles, like other animals, will generally let you know that they are going to bite. They may not give you a lot of warning, but if you are alert and sensitive to their body posture, movements and behavioral cycles, you will be able to read them as easily as you do a book.

Green iguanas, who have to be the reptile most responsible for humans seeking medical attention for bites, are extremely communicative. Their head cocked to one side, the eyelids lowered slightly, mouth just barely agape, hatcheted body (lateral compression) balanced on slightly crouched legs, tail raised, twitching slightly from side to side like a cat's...they do everything but wave a sign that says "It's showtime!" During breeding season, humans may unwittingly trigger attacks through the colors they wear, nodding or bobbing their heads, messing with an iguana's diurnal schedule, not providing suitable outlets for aggression and lust (who knew that caring for a male iguana was often an "R" rated endeavor!). Watch carefully, be observant of subtle changes in their color, behavior, and posture, be careful to not present any triggers, and be prepared. Do all this and you will greatly reduce your risk of being bitten. That's not to say that you won't be bitten - you may react too slowly, or you may just get stupid and let yourself get distracted for a second (which is why I am still typing with nine fingers a year after getting a bite that I knew was coming but acted stupidly and so got exactly what I knew was coming) - but at least you won't become a close personal friend of the entire emergency room, radiology department, and pharmacy staff at your local hospital!

When you keep animals and interact with them, you will, at some point, get bitten. The chances of being bitten increase significantly when the animals with whom you are interacting are not domesticated animals, defined as species who have been bred for docility and reduction of inherited traits that would lead to owner injury (biting, scratching). Aside from some farm animals, the only other animals who truly qualify for these abnormal (from the standpoint of undomesticated animals) traits are dogs, house cats, some parrots and small song birds, white rats and mice, house rabbits, and corn snakes. All other animals, whether you are talking about iguanas, sugar gliders, hedgehogs, ferrets or other pets du jour who are not derived from domesticated stock, always remain, at a level just beneath the thin veneer of tameness, wild animals equipped with the reflexes and responses of wild animals. In the vast majority of cases, when a human gets bitten by a tame or wild animal, the reason why the bite happened can generally be traced to something the human did, or didn't, do. Animals are rarely malicious or capricious. They are reacting to perceived threats or other stimuli. It's not their fault if we don't speak their "language."

Thus, the more you learn and the more observant and thoughtful you are, the more you will reduce the risk of being bitten. When you do get bitten, keep in mind that the animal isn't necessarily being malicious, or nasty, or biting because it enjoys biting (something that is important to communicate to your students). It chomped on you for a reason. It is up to you to figure out why the bite happened so that it doesn't happen again. It is also up to you to deal with the animal appropriately after the bite. Hitting the reptile, throwing it against the wall--any physical act of retribution or punishment--is meaningless to the animal and constitutes animal cruelty, no matter how much better such an act may temporarily make you feel. If the reptile is a highly socialized animal, just knowing that you are mad (through your tone of voice and deprivation of normal physical or proximity contact for a short time, such as several hours) is generally enough to get the point across. This may not stop raging hormones and reflexive responses from taking its toll again in the future, but getting deeply mad and resentful at such an animal is like getting mad at an earthquake or a flood. Like a force of nature, you do what you can to prevent damage, mitigate its effects once you see that you may not escape unscathed, but once it happens, you regroup and get on with your life.

Source: http://www.anapsid.org/humheal.html

by zahidah,malyanah,zatil,atikah,nana,dayah


Post a Comment