The Delaware Division of Public Health (DPH) wishes to alert the Delaware medical community about the risk of salmonellosis transmission associated with handling reptiles. In Wisconsin, the state Department of Health and Family Services has identified 2 children sickened by salmonellosis after handling small turtles illegally sold by vendors in four Wisconsin counties. At this time there are no known reptile associated cases of salmonellosis in Delaware.
Salmonellosis associated with reptiles is a continuing public health concern. During the 1970s, small pet turtles were a major source of Salmonella infections in the USA. In 1975, the FDA banned commercial distribution of small (less than four inches long) turtles. Delaware prohibited the sale of such turtles. These measures prevented an estimated 100,000 cases of salmonellosis among children each year in the United States. However, reptiles remain popular pets in the U.S. The increase in pet reptile popularity has been paralleled by an increase in the number of reptile-related Salmonella serotypes isolated from humans.
Reptiles are commonly colonized with Salmonella and shed the organism intermittently in their feces. Attempts to treat reptiles with antibiotics to eliminate Salmonella carriage have been unsuccessful and might lead to increased antibiotic resistance. Salmonella survives well in the environment and can be isolated for prolonged periods from surfaces contaminated by reptile feces. For this reason, even minimal indirect contact with reptiles can result in illness. For Salmonella bacteria to spread from reptiles to humans, the bacteria must be ingested. Therefore, simply touching or holding a reptile will not result in spread of bacteria unless something contaminated with reptile feces or the reptile itself is placed in the mouth. All reptiles should be presumed to be carrying Salmonella in their intestinal tract and to be continuously or intermittently shedding it in their feces.
Most Salmonella infections in humans result in a mild, self-limiting illness characterized by diarrhea, fever and abdominal cramps. However, the infection can spread to the bloodstream, bone marrow or nervous system, leading to severe, and sometimes fatal, illness.
Those at increased risk for developing severe salmonellosis include the young, the elderly, pregnant women and those with weakened immune systems.
Incubation period is from 6 to 72 hours, but is usually between 12 to 36 hours.
Person to person communicability persists throughout the course of infection and is extremely variable. Occasionally a temporary carrier state continues for months, especially in infants.
Salmonella may be isolated from stool specimens of both symptomatic and asymptomatic individuals (three to ten grams of fecal material preferable to rectal swabs) inoculated into an appropriate enrichment medium. Specimens should be collected over days since excretion of organisms may be intermittent. In cases of septicemia, Salmonella may be isolated on enteric media from feces and blood during acute stage of illness. Serologic tests are not useful in diagnosis.
Bacterial culture of fecal specimens from reptiles to determine Salmonella infection status is discouraged. If veterinarians are called upon to assist health officials in determining the cause of salmonellosis in a person, bacterial culture of combined fecal and cloacal specimens from reptiles with which that person has had direct or indirect contact are recommended. Specimens should be collected over days since excretion of organisms may be intermittent.
The spread of Salmonella bacteria from reptiles to humans can be easily prevented by the following routine precautions:
To aid in surveillance, the Delaware Division of Public Health (DPH) requests that health care providers be suspicious of patients presenting with clinically compatible illness and those having a history of contact with a reptile. Report suspicious cases and laboratory confirmed salmonellosis infections to DPH, Bureau of Epidemiology at 1-888-295-5156. The number is available during normal business hours and during non-business hours for emergencies.
Gaps remain in the public's understanding of amphibian and reptile associated salmonellosis. Pet store owners, health care providers and veterinarians should provide information and prevention messages about salmonellosis to owners and potential purchasers of reptiles. Educational materials are available from the Pet Industry Joint Advisory Council, telephone 800-553-7387.
Questions about this health advisory can be directed to DPH, Bureau of Epidemiology at 1-888-295-5156. The number is available during normal business hours and during non-business hours for emergencies.