Transcript Zoonotic Diseases of Various Species

Zoonotic Diseases of
Various Species
Part II
Note: The images in this presentation are for
non-profit, educational use only.
Neil Grove
University of North
Carolina – Chapel Hill
Division of Laboratory
Animal Medicine
What We Will Cover
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Baylisascaris
Rocky Mountain Spotted Fever
Lyme Disease
Avian Influenza
Mycobacterium marinum
For each disease we will answer these
questions:

What is it?

How do I get it?

What are the symptoms?

What preventive measure
can be taken?
Baylisascaris Infection – What is it?

Baylisascaris, an intestinal
raccoon roundworm, can
infect a variety of other
animals, including
humans. The worms
develop to maturity in the
raccoon intestine, where
they produce millions of
eggs that are passed in
the feces. (1)
Baylisaccaris Infection – What is it?

Released eggs take 2-4
weeks to become infective
to other animals and
humans.

The eggs are resistant to
most environmental
conditions and with
adequate moisture, can
survive for years.(1)
Baylisascaris Infection – What is it?
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Infected raccoons have been
found throughout the United
States, mainly in the
Midwest, Northeast, middle
Atlantic, and West coast.
Infection rarely causes
symptoms in raccoons.
Predator animals, including
dogs, may also become
infected by eating a smaller
animal that has been
infected with Baylisascaris.
(1)
How Do I get It?
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People become infected when they
accidentally ingest infective eggs in soil,
water, or on objects that have been
contaminated with raccoon feces.
When humans ingest these eggs, they
hatch into larvae in the person's intestine
and travel throughout the body, affecting
the organs and muscles.(1)
Heightened Risk


Anyone who is exposed to
environments where
raccoons live is potentially
at risk.
Young children or
developmentally disabled
persons are at highest risk
for infection when they
spend time outdoors and
may put contaminated
fingers, soil, or objects into
their mouths. (1)
Heightened Risk

Hunters, trappers,
taxidermists, and
wildlife handlers may
also be at increased
risk if they have
contact with raccoons
or raccoon habitats.(1)
How Common is Human Infection?
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Infection is rarely diagnosed. Fever than 25 cases
have been diagnosed and reported in the United
States as of 2003.
It is believed that cases are mistakenly diagnosed
as other infections or go undiagnosed.
Cases have been reported in Oregon, California,
Minnesota, Illinois, Michigan, New York, and
Pennsylvania.
Five of the infected persons died.(1)
Symptoms

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Symptoms of infection depend on how many eggs
are ingested and where in the body the larvae
migrate (travel to).
Once inside the body, eggs hatch into larvae and
cause disease when they travel through the liver,
brain, spinal cord, or other organs.
Ingesting a few eggs may cause few or no
symptoms, while ingesting large numbers of eggs
may lead to serious symptoms. Symptoms of
infection may take a week or so to develop.(1)
Symptoms
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Symptoms include:
Nausea
Tiredness
Liver enlargement
Loss of coordination
Lack of attention to people
and surroundings
Loss of muscle control
Coma
Blindness (1)
Prevention
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Avoid direct contact with raccoons — especially their feces. Do not
keep, feed, or adopt raccoons as pets! Raccoons are wild animals.
Discourage raccoons from living in and around your home or parks
by :
preventing access to food
closing off access to attics and basements
keeping sand boxes covered at all times, (becomes a latrine)
removing fish ponds — they eat the fish and drink the water
eliminating all water sources
removing bird feeders
keeping trash containers tightly closed
clearing brush so raccoons are not likely to make a den on your
property (1)
Prevention
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Stay away from areas and materials that might be
contaminated by raccoon feces.
Raccoons typically defecate at the base of or in raised forks
of trees, or on raised horizontal surfaces such as fallen logs,
stumps, or large rocks.
Raccoon feces also can be found on woodpiles, decks,
rooftops, and in attics, garages, and haylofts.
Feces usually are dark and tubular, have a pungent odor
(usually worse than dog or cat feces), and often contain
undigested seeds or other food items. (1)
Prevention
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To eliminate eggs, raccoon feces and material
contaminated with raccoon feces should be
removed carefully and burned, buried, or sent to a
landfill.
Care should be taken to avoid contaminating
hands and clothes.
Treat decks, patios, and other surfaces with
boiling water or a propane flame-gun. (Exercise
proper precautions!)(1)
Prevention
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Newly deposited eggs take at least 2-4
weeks to become infective. Prompt removal
and destruction of raccoon feces will
reduce risk for exposure and possible
infection.
Contact your local animal control office for
further assistance. (1)
Case Description
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In January 2000, a boy aged 17 years with an 8-year history of
severe developmental disabilities was admitted to a Los Angeles
hospital comatose and with generalized hypertonia and
hyperreflexia. His mouth was tightly clenched, his eyes wandered
rapidly, and he responded only to painful stimuli. Two days before
admission, he had a low-grade fever, drowsiness, and problems
with coordination. Tests on CSF and blood failed to identify an
infectious agent. On examination by a pathologist, a brain biopsy
revealed sections of a nematode consistent with Baylisascaris
species. The patient's condition deteriorated and he had
progressive, deep white matter abnormalities of the brain on MRI.
After a 2-month hospitalization, he was transferred to a long-term-care facility where he remained comatose until he died a year later.
(2)
Case Description

The patient had resided in a group home for
developmentally handicapped adolescents and
adults in Los Angeles County. In February 2000, a
field study conducted in the yard in which the
patient regularly played revealed several sites
containing raccoon feces; a sample of sandbox
soil was positive for BP eggs. Multiple sites in the
adjoining yard, to which he also had access,
contained raccoon feces with BP eggs. (2)
Review Questions

Released eggs take ________ to become
infective to other animals and humans.
Answer
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Released eggs take 2-4 weeks to become
infective to other animals and humans.
Question – True or False

Human Baylisascaris infection is quite
common, with an average of one
diagnosed case per week throughout the
northeastern United States.
Answer
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False - Infection is rarely diagnosed. Fewer
than 25 cases have been diagnosed and
reported in the United States as of 2003.
Rocky Mountain Spotted Fever –
What is It?

Rocky Mountain
spotted fever (RMSF)
is the most severe
tick-borne rickettsial
illness in the United
States. This disease is
caused by infection
with the bacterial
organism Rickettsia
rickettsii.(3)
Gimenez stain of tick
hemolymph cells infected
with R. rickettsii
Rocky Mountain Spotted Fever –
What is It?
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Rocky Mountain spotted fever has been a
reportable disease in the United States
since the 1920s.
In the last 50 years, approximately 2501200 cases of Rocky Mountain spotted
fever have been reported annually,
although it is likely that many more cases
go unreported. (3)
Annual incidence per million population for Rocky Mountain spotted
fever by state in the United States for 2002, as determined on the basis
of cases reported to the National Electronic Telecommunications
System for Surveillance.
Rocky Mountain Spotted Fever –
Where is It?
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Over half of Rocky Mountain
spotted fever infections are
reported from the south-Atlantic
region of the United States
(Delaware, Maryland, Washington
D.C., Virginia, West Virginia, North
Carolina, South Carolina, Georgia,
and Florida).
Infections also occur in The Pacific
region (Washington, Oregon, and
California) and west south-central
(Arkansas, Louisiana, Oklahoma,
and Texas) region. (3)
Rocky Mountain Spotted Fever –
Where is It?
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The states with the highest incidences of Rocky
Mountain spotted fever are North Carolina and
Oklahoma; these two states combined accounted
for 35% of the total number of U.S. cases
reported to CDC during 1993 through 1996.
Although Rocky Mountain spotted fever was first
identified in the Rocky Mountain states, less than
3% of the U.S. cases were reported from that
area during the same interval (1993-1996). (3)
How Do I Get It?
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The organism that causes Rocky Mountain
spotted fever is transmitted by the bite of an
infected tick. Less commonly, infections may
occur following exposure to crushed tick tissues,
fluids, or tick feces.
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In the case of Rocky Mountain spotted fever, ticks
are the natural hosts, serving as both reservoirs
and vectors of R. rickettsii. (3)
How Do I Get It?
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Because ticks on dogs can be infected with
R. rickettsii, dogs and people can get
Rocky Mountain spotted fever from the
same ticks. These ticks can also bite other
animals and pass Rocky Mountain spotted
fever to them. (3)
How Do I Get It?

The American dog tick
(Dermacentor variabilis)
and Rocky Mountain wood
tick (Dermacentor
andersoni) are the primary
athropods (vectors) which
transmit Rocky Mountain
spotted fever bacteria in
the United States. (3)
American Dog Tick
Rocky Mountain
Wood Tick
How Do I Get It?

The brown dog tick
Rhipicephalus
sanguineus has also
been implicated as a
vector as well as the
tick Amblyomma
cajennense in
countries south of the
United States.(3)
How Do I Get It?
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Over 90% of patients with Rocky Mountain
spotted fever are infected during April
through September. This period is the
season for increased numbers of adult and
nymphal Dermacentor ticks.
A history of tick bite or exposure to tickinfested habitats is reported in
approximately 60% of all cases of Rocky
Mountain spotted fever.(3)
Symptoms
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Initial symptoms may
include fever, nausea,
vomiting, severe
headache, muscle pain,
lack of appetite.
The rash first appears 2-5
days after the onset of
fever and is often not
present or may be very
subtle when the patient is
initially seen by a
physician.(3)
Symptoms
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Younger patients usually
develop the rash earlier
than older patients. Most
often it begins as small,
flat, pink, non-itchy spots
(macules) on the wrists,
forearms, and ankles.
These spots turn pale
when pressure is applied
and eventually become
raised on the skin.(3)
Early (macular) rash on sole
of foot
Symptoms
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Later signs and symptoms
include rash, abdominal pain,
joint pain, diarrhea.
The characteristic red, spotted
(petechial) rash of Rocky
Mountain spotted fever is
usually not seen until the sixth
day or later after onset of
symptoms, and this type of
rash occurs in only 35% to
60% of patients with Rocky
Mountain spotted fever. (3)
Late (petechial) rash on palm
and forearm
Symptoms
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The rash involves the
palms or soles in as
many as 50% to 80%
of patients; however,
this distribution may
not occur until later in
the course of the
disease. As many as
10% to 15% of
patients may never
develop a rash.(3)
Characteristic rash of late-stage
Rocky Mountain spotted fever
on legs of a patient
RMSF - Hospitalization
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Rocky Mountain spotted fever
can be a very severe illness
and patients often require
hospitalization.
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Because R. rickettsii infects
the cells lining blood vessels
throughout the body, severe
manifestations of this disease
may involve the respiratory
system, central nervous
system, gastrointestinal
system, or renal system. (3)
RMSF - Hospitalization
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Host factors associated with severe or fatal
Rocky Mountain spotted fever include
advanced age, male sex, African-American
race, chronic alcohol abuse, and glucose-6phosphate dehydrogenase (G6PD)
deficiency. (3)
RMSF - Hospitalization
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Deficiency of G6PD is a sex-linked genetic
condition which occurs with highest frequencies
in people of African, Middle Eastern, and
Southeast Asian origin; it affects approximately
12% of the U.S. African-American male
population; deficiency of this enzyme is
associated with a high proportion of severe
cases of Rocky Mountain spotted fever.
This is a rare clinical course that is often fatal
within 5 days of onset of illness. (3)
Long-Term Health Problems
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Long-term health problems following acute Rocky
Mountain spotted fever infection include partial
paralysis of the lower extremities, gangrene
requiring amputation of fingers, toes, or arms or
legs, hearing loss, loss of bowel or bladder
control, movement disorders, and language
disorders.
These complications are most frequent in persons
recovering from severe, life-threatening disease,
often following lengthy hospitalizations.(3)
Prevention
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Limiting exposure to ticks reduces the likelihood
of infection with Rocky Mountain spotted fever.
In persons exposed to tick-infested habitats,
prompt careful inspection and removal of crawling
or attached ticks is an important method of
preventing disease.
It may take extended attachment time before
organisms are transmitted from the tick to the
host.(3)
Prevention
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Wear light-colored clothing which allows you to see ticks that are
crawling on your clothing.
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Tuck your pants legs into your socks so that ticks cannot crawl up
the inside of your pants legs.
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Apply repellents to discourage tick attachment. Repellents
containing permethrin can be sprayed on boots and clothing, and
will last for several days. Repellents containing DEET can be
applied to the skin, but will last only a few hours before
reapplication is necessary. Use DEET with caution on
children. Application of large amounts of DEET on children has
been associated with adverse reactions. (3)
Prevention
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Conduct a body check upon return from
potentially tick-infested areas by searching your
entire body for ticks. Use a hand-held or fulllength mirror to view all parts of your body.
Remove any tick you find on your body.
Parents should check their children for ticks,
especially in the hair, when returning from
potentially tick-infested areas. Ticks may also be
carried into the household on clothing and pets
and attach later, so both should be examined
carefully to exclude ticks. (3)
Review Questions
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_________ and_______; these two states
combined accounted for 35% of the total
number of U.S. cases reported to CDC
during 1993 through 1996.
Answer
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North Carolina and Oklahoma
Question
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The __________ and Rocky Mountain
wood tick are the primary athropods
(vectors) which transmit Rocky Mountain
spotted fever bacteria in the United States.
Answer
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American Dog Tick
Question
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Over 90% of patients with Rocky Mountain
spotted fever are infected between the
months of _______ and ________.
Answer
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April and September
Lyme Disease – What is it?

Lyme disease is
caused by the
bacterium Borrelia
burgdorferi
Borrelia
burgdorferi
How Do I Get It?
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The Lyme disease
bacterium, Borrelia
burgdorferi, normally
lives in mice, squirrels
and other small
animals. It is
transmitted among
these animals – and to
humans -- through the
bites of certain
species of ticks. (4)
Symptoms
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Within 1 to 2 weeks of
being infected, people
may have a "bull's-eye"
rash with fever, headache,
and muscle or joint pain.
Some people have Lyme
disease and do not have
any early symptoms.
Other people have a fever
and other "flu-like"
symptoms without a rash.
(4)
“Bull’s-eye” Rash
Symptoms
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After several days or weeks, the bacteria
may spread throughout the body of an
infected person. These people can get
symptoms such as rashes in other parts of
the body, pain that seems to move from
joint to joint, and signs of inflammation of
the heart or nerves. (4)
Symptoms
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If the disease is not treated, a few patients
can get additional symptoms, such as
swelling and pain in major joints or mental
changes, months after getting infected.(4)
Prevention
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Whenever possible, you should avoid entering areas that are
likely to be infested with ticks, particularly in spring and
summer when nymphal ticks feed.
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If you are in an area with ticks, you should wear light-colored
clothing so that ticks can be spotted more easily and
removed before becoming attached.
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If you are in an area with ticks, wear long-sleeved shirts, and
tuck your pants into socks. You may also want to wear high
rubber boots (since ticks are usually located close to the
ground). (4)
Prevention
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Application of insect repellents containing
DEET (n,n-diethyl-m-toluamide) to clothes
and exposed skin, and permethrin (which
kills ticks on contact) to clothes, should also
help reduce the risk of tick attachment.
DEET can be used safely on children and
adults but should be applied according to
Environmental Protection Agency
guidelines to reduce the possibility of
toxicity. (4)
Prevention
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Since transmission of B. burgdorferi from an
infected tick is unlikely to occur before 36 hours of
tick attachment, check for ticks daily and remove
them promptly. Embedded ticks should be
removed by using fine-tipped tweezers. Cleanse
the area with an antiseptic.
You can reduce the number of ticks around your
home by removing leaf litter, and brush- and
wood-piles around your house and at the edge of
your yard. By clearing trees and brush in your
yard, you can reduce the likelihood that deer,
rodents, and ticks will live there(4)
Question

Being bitten by a _____ is the most
common cause of Lyme disease.
Answer
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tick
Question

To repel ticks, insect repellents should
contain ______.
Answer

Deet
Avian Influenza – What is it?
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Avian influenza, or “bird
flu”, is a contagious
disease of animals caused
by viruses that normally
infect only birds and, less
commonly, pigs.
Avian influenza viruses
are highly speciesspecific, but have, on rare
occasions, crossed the
species barrier to infect
humans.(7)
Avian Influenza – What is it?
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Influenza A (H5N1) is an influenza A virus
subtype that occurs mainly in birds, is
highly contagious among birds, and can be
deadly to them. Outbreaks of H5N1 among
poultry are ongoing in a number of
countries. (6)
H5N1 is associated with human illness.
Avian Influenza – What is it?

Influenza viruses are grouped into three types,
designated A, B, and C. Influenza A and B viruses
are of concern for human health. Only influenza A
viruses can cause pandemics (worldwide
outbreaks).(7)
While H5N1 does not usually infect people,
human cases of H5N1 infection associated with
these outbreaks have been reported.(6)
Avian Influenza – What is it?
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Wild waterfowl are
considered the natural
reservoir of all influenza A
viruses.
Considerable
circumstantial evidence
suggests that migratory
birds can introduce low
pathogenic H5 and H7
viruses to poultry flocks,
which then mutate to the
highly pathogenic form.(7)
Avian Influenza – What is it?
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Of the few avian influenza viruses that have crossed the
species barrier to infect humans, H5N1 has caused the
largest number of cases of severe disease and death in
humans.
Unlike normal seasonal influenza, where infection causes
only mild respiratory symptoms in most people, the disease
caused by H5N1 follows an unusually aggressive clinical
course, with rapid deterioration and high fatality.
Primary viral pneumonia and multi-organ failure are common.
In the present outbreak, more than half of those infected with
the virus have died. Most cases have occurred in previously
healthy children and young adults.(7)
Avian Influenza – What is it?

A second risk, of even greater concern, is
that the virus – if given enough
opportunities – will change into a form that
is highly infectious for humans and spreads
easily from person to person. Such a
change could mark the start of a global
outbreak (a pandemic).(7)
How do I get it?
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Direct contact with infected
poultry, or surfaces and
objects contaminated by their
feces, is presently considered
the main route of human
infection.
To date, most human cases
have occurred in rural or
periurban areas where many
households keep small poultry
flocks, which often roam freely,
sometimes entering homes or
sharing outdoor areas where
children play. (7)
How do I get it?
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As infected birds shed large quantities of
virus in their feces, opportunities for
exposure to infected droppings or to
environments contaminated by the virus
are abundant under such conditions. (7)
How do I get it?
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Because many households in Asia depend
on poultry for income and food, many
families sell or slaughter and consume
birds when signs of illness appear in a
flock, and this practice has proved difficult
to change.
Exposure is considered most likely during
slaughter, defeathering, butchering, and
preparation of poultry for cooking.(7)
How do I get it?

Because all influenza viruses have the
ability to change, scientists are concerned
that H5N1 virus one day could be able to
infect humans and spread easily from one
person to another. (6)
How do I get it?

Because these viruses do not
commonly infect humans,
there is little or no immune
protection against them in the
human population.
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If these H5N1 viruses gain the
ability for efficient and
sustained transmission among
humans, an influenza
pandemic (world wide) could
result, with potentially high
rates of illness and death. (6)
How do I get it?

It is likely that H5N1 infection among birds
has become endemic in certain areas and
that human infections resulting from direct
contact with infected poultry will continue to
occur. (6)
Does the virus spread easily from birds
to humans?
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No. Though more than 100 human cases have
occurred in the current outbreak, this is a small
number compared with the huge number of birds
affected and the numerous associated
opportunities for human exposure, especially in
areas where backyard flocks are common.
It is not presently understood why some people,
and not others, become infected following similar
exposures.(7)
Since January, 2004 WHO has reported human cases of avian
influenza A (H5N1) in the following countries:
East Asia and the
Pacific:
 Cambodia
 China
 Indonesia
 Thailand
 Vietnam
Europe & Eurasia:
 Azerbaijan
 Turkey
Near East:
 Egypt
 Iraq
Symptoms

The reported symptoms of avian influenza
in humans have ranged from typical
influenza-like symptoms (e.g., fever, cough,
sore throat, and muscle aches) to eye
infections (conjunctivitis), pneumonia, acute
respiratory distress, viral pneumonia, and
other severe and life-threatening
complications. (6)
Symptoms

The majority of known human H5N1 cases
have begun with respiratory symptoms.
However, one atypical fatal case of
encephalitis in a child in southern Vietnam
in 2004 was identified retrospectively as
H5N1 influenza through testing of
cerebrospinal fluid, fecal matter, and throat
and serum samples. (6)
What precautions can be taken to reduce the risk for
infection from wild birds in the United States?

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As a general rule, the public should observe
wildlife, including wild birds, from a distance. This
protects you from possible exposure to pathogens
and minimizes disturbance to the animal.
Avoid touching wildlife. If there is contact with
wildlife do not rub eyes, eat, drink, or smoke
before washing hands with soap and water.
Do not pick up diseased or dead wildlife. Contact
your state, tribal, or federal natural resource
agency if a sick or dead animal is found.(6)
What precautions can hunters take to reduce the risk for
infection when hunting birds in the United States?


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
Hunters should follow routine precautions when handling
game, including wild birds. The National Wildlife Health
Center recommends that hunters:
Do not handle or eat sick game.
Wear rubber or disposable latex gloves while handling and
cleaning game, wash hands with soap and water (or with
alcohol-based hand products if the hands are not visibly
soiled), and thoroughly clean knives, equipment and surfaces
that come in contact with game.
Do not eat, drink, or smoke while handling animals.
Cook all game thoroughly. (6)
Precautions

There is currently a ban on the importation
of birds and bird products from H5N1affected countries. The regulation states
that no person may import or attempt to
import any birds whether dead or alive, or
any products derived from birds. (6)
Question 1

____ and ____ influenza viruses are of
concern for human disease.
Answer

A and B
Question 2

What does “pandemic” outbreak mean?
Answer

global
Question 3

True or False – The H5N1 virus spreads
easily from birds to humans.
Answer

False
Mycobacterium marinum – what is it?

Mycobacterium marinum (M.
marinum) is a slowly growing
bacteria that may cause
disease in fish and people.
The bacteria is normally found
in bodies of fresh or salt water
in many parts of the world.

Skin infection with
Mycobacterium marinum is
relatively rare and is usually
acquired from swimming
pools, aquariums, or fishhandling. This bacteria does
not grow at normal body
temperature. That is why it
remains localized to the cooler
skin surface. (8)
How do I get it?





Human infections with M.
marinum under normal
circumstances are rare.
However, people who have
breaks in the skin such as cuts
and scrapes are at increased
risk:
When in contact with water
from an aquarium or fish tank
When handling, cleaning, or
processing fish, or
While swimming or working in
fresh or salt water.
M. marinum infection is not
spread from person to person.
What are the Symptoms?

When M. marinum infects the skin, it
causes localized microscopic nodules to
form. These nodules are called
granulomas. They occur at sites of skin
trauma where there are scratches, cuts,
and the like.(8)
What are the Symptoms?


The most frequent sign is
a slowly developing
nodule (raised bump) at
the site the bacteria
entered the body.
Frequently, the nodule is
on the hand or upper arm.
Later the nodule can
become an enlarging sore
(an ulcer). Swelling of
nearby lymph nodes
occurs. (8)
What are the Symptoms?


Multiple granulomas may form in a line
along the lymphatic vessel that drains the
site. These lesions will usually
spontaneously heal in several months.
This infection can also involve the joints
(septic arthritis) and bones.(8)
Symptoms


The granulomas usually appear within 2-3 weeks
of exposure. Some reported cases have
developed 2 to 4 months or more after exposure
to M. marinum because of the very slow-growing
nature of this bacterium.
A health care provider should be consulted if a
skin nodule or reddened sore (ulcer) develops
following direct skin contact with fresh or salt
water or after handling or processing fish.(8)
Heightened Risk

For people with compromise of the immune
system, M. marinum infection can be
especially serious and involve
disseminated (widespread) disease. If an
infection is suspected under such
circumstances, a health care provider
should be promptly consulted.(8)
Prevention/Precautions


Avoid fresh or salt water
activities if there are open
cuts, scrapes, or sores on
your skin, especially in
bodies of water where this
bacterium is known to
exist.
If you have a weakened
immune system, you can
reduce the risk of infection
by carefully covering cuts,
scrapes, or sores during
fresh or salt water
activities and while
cleaning fish tanks or
handling, cleaning or
processing fish.(8)
Prevention/Precautions

Wear heavy gloves (leather or heavy cotton) while cleaning
or processing fish, especially fish with sharp spines that may
cause cuts, scratches, or sores to the hands and skin. Wash
hands thoroughly with soap and water after fish processing or
use a waterless cleanser.

Wear waterproof gloves while cleaning home aquariums or
fish tanks. Wash hands and forearms thoroughly with soap
and running water after cleaning the tank, even if gloves were
worn.

Ensure regular and adequate chlorination of swimming pools
to kill any bacteria that may be present. (8)
References








1.
CDC. Baylisascaris Infection Fact Sheet.
http://www.cdc.gov/ncidod/dpd/parasites/baylisascaris/factsht_baylisascaris.htm
2. CDC. Morbidity and Mortality Monthly Report. Raccoon Roundworm Encephalitis --- Chicago,
Illinois, and Los Angeles, California, 2000. January 4, 2002 / 50(51);1153-5
3. CDC. Rocky Mountain Spotted Fever Home. http://www.cdc.gov/ncidod/dvrd/rmsf/index.htm
4. CDC. Lyme Disease and Animals. http://www.cdc.gov/healthypets/diseases/lyme.htm
5. CDC. Avian Influenza Infection in Humans. http://www.cdc.gov/flu/avian/gen-info/avian-fluhumans.htm
6. CDC. Key Facts About Avian Influenza (Bird Flu) and Avian Influenza A (H5N1) Virus
http://www.cdc.gov/flu/avian/gen-info/facts.htm
7. WHO. Avian influenza frequently asked questions
http://www.who.int/csr/disease/avian_influenza/avian_faqs/en/index.html
8. MedicineNet.com. Mycobacterium marinum.
http://www.medicinenet.com/mycobacterium_marinum/article.htm
Disclaimer


This presetation was created while I was an
employee of Priority One Services (POS) at the
National Institute of Environmental Health
Sciences (NIEHS). Thus, both organizations
deserve credit for supporting the work.
However, the opinions expressed in this
presentation are mine and don’t necessarily
reflect those of POS, NIEHS, or UNC DLAM.