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Polling Place: Immune-Compromised Clients and Cats

Vicki L. Thayer, DVM

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You have asked...

What do you advise your clients who are immune-compromised about owning cats and caring for their pets and themselves?

Our readers say ...

Some Specific Concerns
The protocol for immune-compromised clients and their pets depends on the client's condition. However, here are some examples of specific concerns.

With pregnant cat owners, the most apparent concern is toxoplasmosis. The best policy is to have the husband (or another person), clean the litter box so that the pregnant woman is not exposed to the cat's stool. Many women like this suggestion! Another recommendation is to have a "toxo" titer run on the pregnant owner which indicates whether she has been previously exposed to toxoplasmosis. If the test shows that she has not been exposed, she is much more susceptible to this disease.

With young children and cats, one concern is Streptococcus infection, which is hard to diagnose due to lack of clinical signs in the cat. When treating for Streptococcus, both the children and cats need to be treated at the same time. If only the children are treated, they risk becoming reinfected by the cat.

With HIV owners, the most prevalent concern is Cryptosporidium which flourish in humans under conditions of intense immunosuppression. Fecal cultures can detect this protozoan in cats, and these cats should not be exposed to HIV-infected individuals.

Of course, all immune-compromised clients should be advised to consult their physician. In addition, good hygiene goes a long way toward providing a safe environment for both owner and cat.
Joseph E. Thompson, VMD
Buckingham, Pennsylvania

The Proper Precautions
Two issues that I would address would be toxoplasmosis and oral disease. The client would be given advice on cleaning the litter box as well as maintaining good dental hygiene in the cat. If a client asked for my opinion on getting a cat, I would not recommend against it, but I would definitely advise them to take the proper precautions.
Christopher Church, DVM
Cheyenne, Wyoming

Focus on the Individual
My advice would depend on the disease situation. I would first perform the appropriate checks on the animals, making sure that they were free of diseases such as feline leukemia and FIV. Further research on the client's condition would help determine what advice I would give them concerning handling and owning cats. I would advise them to consult their physician to gain additional advice about safely interacting with their pets. Also, I would be sure that parasite control was appropriate and discuss any zoonotic concerns with the client.
David Jackson, VMD
Fairfax, Virginia

The Top 5 Pointers
The top five recommendations I would make to an immune-compromised client:
1. Keep the cat inside to decrease the chance of the cat and subsequently the client being exposed to disease.
2. It is not necessary to declaw the cat, but its nails should be kept trimmed.
3. Have someone else clean the litter box, or, if the client must clean the litter box, gloves should be worn.
4. If the cat has any history of parasites, continue to prevent and screen for parasitic disease.
5. Recommend that the client bring any new cat immediately to the clinic before taking it home to have it screened for feline leukemia, FIV, and ringworm in addition to having a fecal examination performed. Immune-compromised clients should avoid kittens unless they are very familiar with the animal's background and history.
Jennifer Prince, DVM
Wausau, Wisconsin 

What the expert says ...
Safe Cat Ownership
Veterinarians are often faced with questions from cat-owning clients about special health problems of their own. In 24 years of cat practice, I have found this frequently among the elderly, families with small children, and immune-suppressed individuals undergoing chemotherapy. People who are immune-compromised due to HIV infection, diabetes mellitus, or splenectomy or because of immunosuppressive medication for other illnesses are also at risk.1 Recent surgery can also lead to increased sensitivity to infections.

Stepping Up to the Plate
Veterinarians can be a ready source of information about safe cat ownership for these clients. We often take a low-key role in discussing zoonoses, but a more visible effort is increasingly necessary. A sympathetic and understanding ear can help immune-suppressed clients who are reluctant to discuss their condition by encouraging them to ask questions about such matters during office visits. A thorough discussion with clients about these concerns avoids unnecessary euthanasia, relinquishment, or declawing. Hospital handouts, brochures, and Web sites can also include information on this topic.

Zoonotic diseases can seriously affect the health of an immune-compromised individual. People can be exposed when interacting with a cat, usually through gastrointestinal or skin injury exposure. Most of these diseases are associated with kittens or free-roaming cats, which have a higher risk for exposure.

Among the Risks
Among enteric zoonoses are Campylobacter jejuni, Cryptosporidium parvum, Salmonella species, Giardia species, and Toxoplasma gondii. All of these are immediately infectious except for T. gondii, which is transmitted in the form of oocytes that become infectious within 1 to 5 days after exposure to air.2, 3 Thus, the recommendation is to clean the litter box twice daily. In general, several of these agents are more likely to be found in young animals from shelters or rescue agencies. Fecal examination for oocysts may determine which cats are shedding. Serologic testing for T. gondii does not accurately predict oocyst-shedding status. Acid-fast stains of rectal swabs, fecal IFA or ELISA, or a newer ELISA test on serum is necessary to detect Cryptosporidium; PCR is also being evaluated. Frequent fecal examinations using zinc sulfate solution or fecal antigen testing can detect Giardia infections. Fecal cultures for Salmonella species and Campylobacter parvum may also be indicated, especially in cats with diarrhea.

Sanitation & Other Safeguards
Exposure to these gastrointestinal agents can best be prevented with good sanitation and hygiene. It is recommended to wash hands after handling cats. Cats should be kept indoors to prevent hunting or exposure to other sources of infection. Contaminated water and food appear to be the primary areas of risk to people; thus, more important actions include appropriate cooking and handling of food, cleaning cooking surfaces, and using caution with regard to sources of drinking water.

Elderly clients and cat owners with young children are generally most concerned about infections from skin injuries. Adopting an older, calmer cat can reduce risk. Since bite or scratch wounds frequently become infected, they should be thoroughly cleansed and treated. At-risk individuals should immediately contact their physician. Pasteurella species are the most common bacteria associated with wound infections and are susceptible to systemic therapy, such as penicillin-derived antimicrobials.2

Flea Control
Bartonella henselae is associated with cat scratch disease in humans, regardless of immune status, and bacillary angiomatosis and bacillary peliosis occur in immunosuppressed persons. As flea infestation is a major source of exposure to Bartonella for kittens and cats, flea control is critical. Serologic testsa,b and blood culturesc are used to identify seropositive cats. Those in question can be treated for 3 weeks with either azithromycin or doxycycline to suppress infection, but relapse can occur after primary treatment.2, 4

Superficial dermatophytosis is a common zoonotic problem requiring diagnosis and treatment. Screening newly adopted cats or kittens for dermatophyte infection should be part of their first examination.

Being owned by a cat is a wonderful experience. By following basic health guidelines, potentially immune-compromised people can also enjoy cat ownership.

Guidelines for Immune-Compromised Persons
• Keep cats indoors.
• Feed processed foods only.
• Cover sandboxes.
• Avoid cleaning the litter box; if there is no alternative, gloves and ideally a face mask should be worn. Another household member should clean the litter box at least once a day (twice is preferable), use box liners, and periodically clean it with scalding water.
• Do not let cats lick open skin lesions on people.
• Wash hands and wear gloves when handling meat and when gardening.
• Cook meat for consumption to 175º F for 15 minutes.
• Adopt cats over 1 year of age.
• Avoid cats from crowded environments with a history of ectoparasites and diarrhea.
• Control ectoparasites, especially fleas.
• Perform work-up for enteric zoonoses.
• Administer anthelmintics routinely.
• Test cats new to household/those with history of fleas for Bartonella.
• Perform annual physical exam; seek veterinary care promptly if cat shows signs of respiratory, gastrointestinal, dermatologic, or genitourinary problems.2


SAFE CAT OWNERSHIP • Vicki L. Thayer

References
1. Diseases of concern to the immunocompromised client. Moeller R Jr. Western States Veterinary Conference Proceedings. Veterinary Information Network, pp 1-4, 2001.
2. Cat ownership by immunosuppressed people. Lappin MR. In August JR (ed): Consultations in Feline Internal Medicine, vol. 4. Philadelphia: WB Saunders Co, pp 18-25, 2001.
3. Emerging diseases: Human concerns? Wolf A. WSAVA Proceedings, pp 321-324, 2001.
4. Bartonella infections in domestic cats. Dorsey K, Breitschwerdt EB. In Bonagura J (ed): Kirk's Current Veterinary Therapy, vol. 13. Philadelphia: WB Saunders Co, pp 302-307, 2000.

Other Resources
http://www.cdc.gov/healthypets/extra_risk.htm
a National Veterinary Laboratory c Wampole Laboratories
P.O. Box 239, 1 Tice Road Cranbury, NJ 08512
Franklin Lakes, NJ 07417
b Tick-Borne Disease Laboratory
NCSU-CVM, Room C-321
4700 Hillsborough St.
Raleigh, NC 27606

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