Splish Splash The Patient Was Taking A Bath . Should We Be Looking For Iguanas Rather Than Zebras?

Tahhan, Sami

SPLISH SPLASH THE PATIENT WAS TAKING A BATH . SHOULD WE BE LOOKING FOR IGUANAS RATHER THAN ZEBRAS?

MONIKA PAJHAL, MD¹, Sami Tahhan, M.D., F.A.C.P.², ¹EVMS, VA, CHESAPEAKE; ²Eastern Virginia Medical School, VA, Norfolk

Meeting: Hospital Medicine 2020, Virtual Competition

Abstract Number: 947

Sub-Category: Adult

Keywords: C.Diff- Clostridiodes Difficile, HIV/AIDS- Human Immunodeficiency Virus/ Acquired Immunodeficiency Deficiency Syndrome, MPGN- Membrano proliferative Glomerulonephritis, WBC -White Blood Cells

Case Presentation: A 32 years of male with membranoproliferative glomerulonephritis (MPGN) on immunosuppression presented with complaints of fever, abdominal pain and diarrhea. His stool had many WBCs, C. diff was negative and CT of the abdomen revealed enterocolitis. His anaerobic blood culture bottles grew Salmonella group from the nonTyphi subtypes. Further history disclosed that he had been bathing with his new pet iguana for 8 months. His abdominal pain and diarrhea improved with intravenous ciprofloxacin and his fever subsided. He was counselled and educated about handling pets like Iguanas and was discharged on oral ciprofloxacin

Discussion: Reptiles have become increasingly popular as pets with 4.7 million households owning them according to 2018 data. Pets like turtles, snakes, bearded dragons and iguanas have been proven to spread salmonella to humans. Salmonella are motile gram-negative bacilli and are routinely isolated from the gut of apparently healthy reptiles. Some of the reptile associated serotypes are S.marina, S.poona, S.arizonae, S.stanley, S.java and S.typhimurium. Food borne Salmonella is a common cause of diarrhea but reptiles are the main source of serious illnesses like bacteremia / septicemia , endovascular infections and focal metastatic infections such as osteomyelitis or abscesses.Reptiles and amphibians account for roughly 6% of all salmonella infections in adults and 12% in children <5 years according to recent studies. Studies have reported that young infants and the immunocompromised carry the highest burden amongst all infected.Reptile associated Salmonellosis is an emerging Global Health issue, making education crucial to curbing infection. Washing hands with soap and water after handling reptiles and keeping reptiles away from food prep areas can prevent most infections. Besides direct contact, even vacuum cleaners were identified as a cause of non-typhoidal salmonellosis. Social history is of paramount importance in detecting infections. Fluoroquinolones are the main stay of treatment of nontyphoidal Salmonella bacteremia .Other alternatives can be Trimethoprim-sulfamethoxazole, ampicillin and third generation cephalosporins. Duration of therapy depends upon the immune status of the patient, type of infection and is generally a 14 day course. Longer courses of antimicrobial therapy (4 to 6 weeks) are required for underlying HIV/AIDS. Surgical drainage or debridement may also be required for soft tissue or visceral foci of infections.

Conclusions: Iguana as a source of Salmonella infection has been reported and our patient being immunocompromised (on steroids and rituximab for MPGN) was at higher risk for it.This case emphasizes the importance of obtaining a comprehensive history including the presence of pets in the home to help diagnose Zoonoses and highlights the need to elicit further history once uncommon pathogens are identified. Sometimes you have to look for iguanas rather than zebras!