Zoonoses |
Published on: 8 August 2008 |
Next update:14 November 2008
Topic Archives: 2008 | 2007 | 2006 | 2005 | 2004 | 2003 | 2002 | 2001
Common animal associated infections, England and Wales: laboratory reports,
weeks 14-26/08
Organism |
Total reports for week 14 - 26 |
Cumulative totals for weeks 01 - 26 |
||
2008* |
2007 |
2008* |
2007 |
|
Borrelia burgdorferi *, |
88 |
117 |
170 |
208 |
Leptospira hardjo , |
1 |
– |
1 |
– |
Leptospira icterohaemorrhagiae , |
6 |
6 |
7 |
14 |
Leptospira other , |
6 |
3 |
10 |
5 |
Pasteurella haemolytica |
1 |
1 |
1 |
1 |
Pasteurella multocida |
79 |
70 |
160 |
145 |
Pasteurella pneumotropica |
2 |
2 |
3 |
5 |
Pasteurella other/ spp |
24 |
16 |
52 |
41 |
Toxocara canis |
– |
– |
– |
1 |
Toxocara other/ spp |
– |
– |
– |
– |
Toxoplasma gondii |
12 |
11 |
19 |
26 |
Toxoplasma other/ spp |
12 |
16 |
17 |
27 |
Coxiella burnetii |
16 |
13 |
23 |
19 |
Chlamydia (Chlamydophila) psittaci |
13 |
14 |
25 |
19 |
Capnocytophaga spp |
4 |
4 |
14 |
8 |
Mycobacterium marinum |
5 |
7 |
5 |
10 |
Orf virus |
1 |
– |
2 |
– |
Echinococcus granulosus |
9 |
2 |
13 |
7 |
Lyme borreliosis (Borrelia burgdorferi): (88)
Reports were received from all regions in England and Wales.
Fifty-eight per cent of reports were from the South East and South West health regions of England. All age groups were represented and the near-equal male/female ratio characteristically observed in reports of Lyme borreliosis has been maintained.
Eight patients reported overseas travel. The low number of reports in the first six months of 2008 is compared with the same period in 2007 is likely to be due to the recent cold weather resulting in lower levels of tick activity and reduced levels of human outdoor exposure.
One occupational case was reported in a forestry worker and one patient reported frequent occurrences of deer in the garden.
Country visited |
Number of cases |
Slovenia |
1 |
Germany |
2 |
Italy |
1 |
Poland |
1 |
USA (Eastern seaboard) |
1 |
Leptospirosis: (13)
Indigenous cases (9):
Age group |
Males |
Females |
Total |
<10 |
– |
– |
– |
10-14 |
– |
– |
– |
15-24 |
– |
– |
– |
25-44 |
6 |
– |
6 |
45-64 |
3 |
– |
3 |
≥65 |
– |
– |
– |
Not stated |
– |
– |
– |
Total |
9 |
– |
9 |
Infections were reported from regions throughout England and Wales.
Reported serovars were: Icterohaemorrhagiae (4), Hardjo (1), not determined (4).
Imported cases (4):
Age group |
Males |
Females |
Total |
<10 |
– |
– |
– |
10-14 |
1 |
– |
1 |
15-24 |
– |
– |
– |
25-44 |
– |
– |
– |
45-64 |
3 |
– |
3 |
≥65 |
– |
– |
– |
Not stated |
– |
– |
– |
Total |
4 |
– |
4 |
Countries visited include the Dominican Republic, Nigeria and South East Asia.
Pasteurella: (106)
Pasteurella haemolytica: (1)
Pasteurella multocida: (79)
Pasteurella pneumotropica: (2)
Pasteurella aerogenes: (–)
Pasteurella spp: (24)
Age group |
Males |
Females |
Total |
<10 |
4 |
1 |
5 |
10-14 |
1 |
1 |
2 |
15-24 |
1 |
2 |
3 |
25-44 |
9 |
7 |
16 |
45-64 |
19 |
25 |
44 |
≥65 |
18 |
18 |
36 |
Not stated |
– |
– |
– |
Total |
52 |
54 |
106 |
Twelve patients reported dog bites and six patients reported cat bites and/or scratches; a further two patients reported unspecified animal contact.
Toxocara: (nil report)
Toxoplasmosis: (12)
Toxoplasma gondii: (12)
Toxoplasma spp: (12)
Age group |
Males |
Females |
Total |
<1 |
– |
– |
– |
15-24 |
4 |
2 |
6 |
25-44 |
2 |
12 |
14 |
45-64 |
1 |
2 |
3 |
65-79 |
– |
1 |
1 |
Unknown |
– |
– |
– |
Total |
7 |
17 |
24 |
Coxiella burnetii: (16)
Age group |
Males |
Females |
Total |
15-24 |
– |
– |
– |
25-44 |
5 |
– |
5 |
45-64 |
7 |
4 |
11 |
≥65 |
– |
– |
– |
Unknown |
– |
– |
– |
Total |
12 |
4 |
16 |
Two patients reported atypical pneumonia and one presented with influenza-like illness. Half of all reports were from laboratories in the South West health region of England.
Chlamydia (Chlamydophila) psittaci: (13)
Age group |
Males |
Females |
Unknown |
Total |
| 05-09 | – |
– |
– |
1 |
15-24 |
– |
– |
– |
– |
25-44 |
4 |
1 |
1 |
6 |
45-64 |
2 |
1 |
– |
3 |
65-79 |
3 |
1 |
– |
4 |
≥80 |
– |
– |
– |
– |
Total |
9 |
3 |
1 |
13 |
One patient, a sheep farmer involved in lambing, presented with fever, lethargy and sweats; one patient had recently worked on a poultry farm. Two patients presented with persistent cough and one with fever and myalgia.
Capnocytophaga spp: (4)
Age group |
Males |
Females |
Unknown |
Total |
| 5-9 | – |
– |
1 |
1 |
15-24 |
– |
– |
– |
– |
25-44 |
– |
– |
– |
– |
45-64 |
– |
– |
– |
– |
65-79 |
2 |
– |
1 |
3 |
≥80y |
– |
– |
2 |
– |
Total |
2 |
– |
2 |
4 |
No clinical or epidemiological details were available for these patients.
Mycobacterium marinum: (5)
Age group |
Males |
Females |
Total |
25-44 |
1 |
1 |
2 |
45-64 |
1 |
– |
1 |
65-79 |
1 |
– |
1 |
NK |
– |
1 |
1 |
Total |
3 |
2 |
5 |
No clinical or epidemiological details were available for these patients.
Orf: (1) Female aged between 65 and 79 years
Echinococcus granulosus : (9)
Age group |
Males |
Females |
Unknown |
Total |
15-24 |
– |
– |
– |
– |
25-44 |
1 |
1 |
– |
2 |
45-64 |
1 |
1 |
– |
2 |
≥65 |
1 |
1 |
– |
2 |
NK |
– |
– |
3 |
3 |
Total |
3 |
3 |
3 |
9 |
Toxoplasma gondii infections diagnosed by the Toxoplasma Reference Unit, England and Wales: weeks 14-26/08
The Health Protection Agency, in collaboration with the National Public Health Service for Wales (NPHSW), is currently reviewing the number of cases of Toxoplasma gondii infection diagnosed by the Toxoplasma Reference Unit (TRU) in Swansea [1]. This report describes T. gondii infections diagnosed in the second quarter of 2008 (weeks 14-26). Further data will continue to be reported quarterly in subsequent issues of Health Protection Report.
Reporting of data on a number of HIV-positive individuals is delayed this quarter as the TRU is currently experiencing difficulties in obtaining the ISAGA testing kits required for confirmation of toxoplasmosis in immunocompromised patients. Once current supply problems are resolved the cases from this quarter will be retested and results will be reported in Health Protection Report.
Table 1 Toxoplasma gondii diagnoses by age group and status, Toxoplasma Reference Unit: weeks 14-26/2008
Age group |
Status |
Total: wks 14-26/08 |
Cumulative total: wks |
|||
Acute |
Congenital |
HIV |
Organ recipient/donor |
|||
| <0 | |
3 |
|
|
3 |
3 |
<1 |
|
1 |
|
|
1 |
2 |
1-9 |
3 |
|
|
|
3 |
5 |
10-14 |
1 |
|
|
|
1 |
3 |
15-24 |
13 |
|
2 |
|
15 |
28 |
25-44 |
45 |
|
13 |
1 |
59 |
105 |
45-64 |
22 |
|
6 |
|
28 |
44 |
65-79 |
1 |
|
|
|
1 |
3 |
| ≥80 | 1 |
|
|
|
1 |
1 |
| Not known | 1 |
|
|
|
1 |
1 |
Total |
87 |
4 |
21 |
1 |
113 |
195 |
Table 1 describes the age distribution of cases of T. gondii infection diagnosed during the second quarter of 2008, by case status. A total of 113 T. gondii infections were confirmed by the TRU during weeks 14 to 26 of 2008 (31 March to 29 June). Cases are classified by the TRU using specific laboratory and clinical diagnostic criteria [2,3].
Of the 117 cases diagnosed, 87 were classed as acute cases of toxoplasmosis in immunocompetent individuals, four were cases of congenital toxoplasmosis (one hydrocephalus in an infant and three congenitally infected foetuses, confirmed post mortem), 21 were in patients with HIV infection, and one was in an organ recipient.
During the same period a total of 24cases (provisional data) were reported by NHS laboratories to the HPA national surveillance system, compared with 27 for the same period during 2007 [4], and 26 in 2006 [5].
Table 2 T. gondii diagnoses by region, Toxoplasma Reference Unit , England and Wales: weeks 14-26/2008
HPA Region |
Total: weeks |
Cumulative total: weeks |
East Midlands |
2 |
3 |
East of England |
11 |
17 |
London |
46 |
84 |
North East |
3 |
8 |
North West |
8 |
12 |
South East |
19 |
23 |
South West |
8 |
13 |
Wales |
1 |
1 |
| West Midlands | 7 |
13 |
Yorkshire and Humber |
8 |
13 |
Not known |
– |
8 |
Total |
113 |
195 |
The majority of cases diagnosed by the TRU in the second quarter of 2008 were referred by laboratories in the London (41%) and South East regions (17%) regions.
Table 3T. gondii diagnoses by age and sex, Toxoplasma Reference Unit: weeks 14-26/2008
Age group |
Female |
Male |
Unknown |
Total: weeks |
Cumulative total: |
| <0 | |
|
3 |
3 |
3 |
<1 |
1 |
|
|
1 |
2 |
1-9 |
2 |
1 |
|
3 |
5 |
10-14 |
1 |
|
|
1 |
3 |
15-24 |
7 |
6 |
2 |
15 |
28 |
25-44 |
33 |
24 |
2 |
59 |
105 |
45-64 |
18 |
8 |
2 |
28 |
44 |
65-79 |
1 |
|
|
1 |
3 |
| >80 | |
1 |
|
1 |
1 |
| Not known | 1 |
|
|
1 |
1 |
Total |
64 |
40 |
9 |
113 |
195 |
As shown in Table 3, the majority of T. gondii infections diagnosed during weeks 14-26 of 2008 were in females (57%), of which the majority were aged 25-44 (52%).
Table 4: Reported symptoms associated with toxoplasma infection, Toxoplasma Reference Unit weeks 14-26/2008
Symptoms |
Status |
Total: wks 14-26/08 |
Cumulative total: wks |
|||
Acute |
Cong-enital |
HIV |
Organ recip't/donor |
|||
Lymphadenopathy |
56 |
|
|
|
56 |
91 |
Ocular |
4 |
|
|
|
4 |
7 |
| Probable ocular ** | 1 |
|
|
|
1 |
1 |
Pyrexia |
2 |
|
|
|
2 |
4 |
Tiredness |
1 |
|
|
|
1 |
2 |
| Hepatitis | 1 |
|
|
|
1 |
1 |
Malaise |
1 |
|
|
|
1 |
1 |
Asymptomatic |
1 |
|
|
|
1 |
2 |
Abnormal LFT's |
1 |
|
|
|
1 |
1 |
Organ recipient |
|
|
|
1* |
1 |
3 |
Organ donor |
|
|
|
|
|
2 |
Congenital foetus |
|
3 |
|
|
3 |
3 |
| Congenital infant | |
|
|
|
|
1 |
Hydrocephalus |
|
1 |
|
|
1 |
1 |
| Mother of congenital foetus | 2 |
|
|
|
2 |
2 |
| Mother of congenital infant | 1 |
|
|
|
1 |
2 |
| Pregnant | 3 |
|
|
|
3 |
13 |
| Toxoplasmic encephalitis | |
|
|
|
|
2 |
| Alveolar shadowing | |
|
1 |
|
1 |
1 |
Ring enhancing brain lesions |
|
|
1 |
|
1 |
1 |
Neutropenia |
|
|
|
|
|
1 |
| Post-viral illness | |
|
|
|
|
1 |
Renal and respiratory failure |
|
|
|
|
|
1 |
Not given |
13 |
|
19 |
|
32 |
51 |
Total |
87 |
4 |
21 |
1 |
113 |
195 |
Table 4 shows the predominant symptom given on the patient's laboratory request form, by case status. The most commonly reported symptom was lymphadenopathy, which was reported in 64% of acute cases. Among the cases classed as acute, three were in pregnant women (where congenital toxoplasmosis has not been confirmed in the child to date), two were in pregnant women for whom toxoplasmosis was confirmed in the foetus post mortem, and one was in the mother of an infant with congenital toxoplasmosis.
Patients with HIV infection are often screened for T. gondii infection in the absence of clinical signs of toxoplasmosis, as reactivation of latent T. gondii infection can cause severe disease in immunocompromised individuals.
References
1. National Public Health Service for Wales website. Toxoplasma Reference Unit. Available at: http://www.wales.nhs.uk/sites3/page.cfm?orgId=457&pid=25359.
2. Health Protection Agency. Investigation of toxoplasma infection in pregnancy. National Standard Method QSOP 59 Issue 1, 2006. Available at: http://www.hpa-standardmethods.org.uk/documents/qsop/pdf/qsop59.pdf
3. Health Protection Agency. Toxoplasmosis: Information for health professionals. Available at: http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1195733799638?p=1191942176127
4. Health Protection Agency. Common animal associated infections, England and Wales laboratory reports: weeks 14-26/2008. Health Protection Report [serial online] 2008; 2 (28).Available at: http://www.hpa.org.uk/hpr/archives/2008/hpr3208.pdf
5. Health Protection Agency. Common animal associated infections, England and Wales laboratory reports: weeks 14-26/2007. Health Protection Report [serial online] 2007; 1 (27)Available at: http://www.hpa.org.uk/hpr/archives/2007/hpr2707.pdf