Streptociccus zooepidemicus – An Emerging Pathogen in Shelters – Full video – conference recording

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Streptociccus zooepidemicus – An Emerging Pathogen in Shelters – Full video – conference recording

I would like to recognize Pfizer animal health kind support of this last session of today so I am going to switch gears this year in the past that these conferences I’ve tended to focus on certain viral diseases particularly of dogs and shelters that had significant impact on their health and welfare this year I would take a little bit of a different tack and talk about another emerging pathogen for dogs and shelters and that’s a bacterium this time streptococcus so epidemic us a little bit of an overview I’m going to first describe what streptococcus o epidemic as’ is otherwise known as strep so probably the way y’all have heard of it referred to I’m going to provide some evidence of its emergence as a an important and fatal pathogen for dogs and shelters in the United States as well as around the world describe some of the clinical syndromes that infected dogs can present within a shelter how to diagnose this infection provide some evidence that has been accumulating now over the past two or three years that this bacteria may be actually more of a secondary bacterial pathogen following initial infection with a respiratory virus and then I’m going to conclude with some management strategies for strips of outbreaks and shelters that we have been involved with strep though is a caucus it’s a grand positive caucus it belongs specifically to Lancefield Group C the strep that we are used to dealing with as a normal inhabitant as well as an opportunistic pathogen of dogs is streptococcus canis which also can cause some terrible infections in cats strep canis is actually a Lancefield group ji gram-positive caucus and it’s strep so that belongs in Lancefield group c and this is a very significant group that contains a lot of strep pathogens on it is a normal member of the bacterial flora on the skin in the upper respiratory tract and the urogenital tract of both horses and ruminants this is a commensal organism in that in most horses and ruminants it does not cause disease it’s a benign colonizer however under certain circumstances it can become quite virulent for horses and cows sheep and goats and horses this particular strep bacterium can cause pneumonia let’s specifically in foals it’s been associated with wound abscesses as well as uterine infections and mares that lead to reproductive failure and in cows and other ruminants again it has been shown to cause pneumonia mastitis and arthritis so it’s not only a benign benign commensal inhabitant of the skin the respiratory tract and you’re a gentle track of horses and ruminants but it also can be an opportunistic pathogen under certain circumstances what about dogs and cats the strep though is it a natural inhabitant of the skin or a respiratory tract or you’re a genital tract and on healthy dogs and cats as it is in horses and ruminants so far no it is very it’s a very uncommon event to find this bacterium colonizing a dog or cat there have been only a few sporadic reports of finding strep so in the nose or a Ferengi ol cavity of dogs and cats that are healthy just recently and this was reported on this past June at the a CVI M forum in Denver there’s a was a report about a pilot study conducted in New Zealand to determine what the prevalence of strips

of in habitation of dogs and cats is because there is very little data on whether this bacterium can be found in healthy dogs and cats or if it truly is a pathogen only so this particular group in New Zealand collected pharyngeal spars from 235 healthy dogs and cats and they cultured these swabs for the presence of strep bacteria 135 of the animals lived in close contact with horses and rumens the theory being that if dogs and cats had close contact with these carrier animals of strep so then maybe the carrier animals would cross contaminate or cross colonized dogs and cats a hundred of the animals lived in an urban environment and had no contact with horses or ruminants out of the total 235 dogs and cats only four dogs were found to have strep so in their fur in geol area that’s only that’s less than two percent of the dogs and cats tested and all four dogs were were in very close contact with horses on farms so the conclusion of these authors in New Zealand was that indeed in addition to the very sporadic reports in the literature about finding strips so unhealthy dogs and cats this study also supported the fact that this is a very uncommon bacteria in dogs and cats and it suggested the possibility that those that were colonized by strep so actually got it from close contact with horses but other than this there are no real studies to korte weatherstrip so is a normal inhabitant of dogs and cats or is strictly pathogenic so they’re had in the decade of the 2000s there has been some evidence that has accumulated or emerged over the past ten years to support the fact that strips of is a pathogen of real concern for dogs and shelters the first identification of strep though in dogs and shelters occurred in a rehoming kennel in the United Kingdom in 2003 this particular shelter had an endemic kennel cough situation going on or canine infectious respiratory disease was very prominent in the dog population and the shelter’s a lot of coughing sneezing and hacking going on the veterinarians that reported this study cultured the lungs from 56 dogs for various viruses and bacteria and they found the presence of strep though and many of these 50 dogs that were tested using statistics they found that dogs with kennel cough or CI Rd were more likely to have strep so in their lungs not only that dogs with pneumonia were more likely to have strep so so this was the very first study to show that strep zone was a pathogen for dogs and was associated with a respiratory infection and correlated with severe pneumonia in 2007 a shelter in Korea an open admission municipal type shelter reported some very large dog die offs over a two-week period of time this is a shelter pretty large MIT’s 1,000 straight dogs per month and they were finding more than 30 dogs dead in their kennel per day over a two-week period necropsy is performed on the dog showed that they had a very acute occurring pneumonia that was very hemorrhagic and was the cause of the death and strep zone was recovered from the lungs of most of these dogs on by bacterial culture and it’s very frightening because this was the first report of strep so in a shelter that had so many dogs affected and dying and they were dying within two days of entry into the shelter very fast period of time that this was such an extensive fatal hemorrhagic on pneumonia currents in the dog population that the shelter had to

resort to total depopulation as a means of starting over many of y’all have heard about the lead shelter in Las Vegas on Nevada in 2007 there was discovery of strep so as a cause of fatal hemorrhagic pneumonia and more than 1,000 dogs this was the first report of strep zoo outbreak in a shelter in the United States it’s a huge shelter it’s an open admission humane society with a manís an animal control contract 50,000 dogs and cats entered this shelter per year in 2006 um this was yet another shelter that had developed a very widespread incidence of kennel cough or endemic canine infectious respiratory disease and the dog population this particular shelter at the time did not isolate dogs they do what a lot of shelters do they they just kept them in the general population probably due to lack of housing in an isolation area and treated sick dogs with doxycycline thinking they had kennel cough due to the bordetella bacterium the sitch when worsened as summer progressed the winter with the 1,000 dogs dying from hemorrhagic pneumonia again like the Koreans shelter many of them died within two days of admission and stress was recovered from the lungs of dogs that had died and it was also cultured off of all the kennel surfaces where the dogs had died in their run so all the water bowls and food bowls and the the kennel floor the chain-link fence the sinks the drains it was everywhere it was such an extensive problem that like the Korean shelter that same year 2007 this shelter had to depopulate to get out of this horrendous situation the second outbreak of strep so that occurred in the United States occurred in a shelter in our own backyard here in Florida a very large I’ve been admission on municipal shelter at the time 35,000 dogs and cats per year entered this shelter they also had a steady caseload of dogs with kennel cough or CI ard they typically house ten to twenty of these dogs on site every day and these and this shelter these actually were housed in a separate respiratory ward that was connected to the stray hold kennel and again thinking that these particular dogs had kennel cough did aboard at Ella they were all treated with doxycycline but then an early February 2008 the staff came in on one morning and found seven dogs dead in their kennel and there was blood oozing from the nose and the mouth the next day they found five four more dogs the same situation these dogs eleven dogs were scattered in different areas of the shelter so it wasn’t like it was one focal area that was supporting this event there were dogs and straight hold and adoption dogs in the isolated respiratory ward and again strep though was recovered from the lungs of all 11 dogs to deal with this situation the shelter did closed for one week and this is the situation that I’m going to use as an example of an of some strategies for managing strip so outbreak because they did a very good job of recovering from this widely publicized situation shortly after the Florida shelter in April but two months later the third strip so outbreak was reported so I think you can see and appreciate now that there’s an increasing frequency of this occurrence in shelters mostly in the US based on reports but also in other parts of the world this was a rather small open admission on adoption guarantee shelter that had seven dogs died very acutely from the hemorrhagic pneumonia over a 36-hour period of time and again it was all due to strep though infection and this particular shelter

took one month that he had to close down for one month while they were managing the situation to recover from the infection and then this year it’s been a busy year for strep so I actually haven’t listed all the occurrences or cases of strep zone pneumonia discovered in dogs and shelters so there’s in addition to a recurrence of a strep so outbreak in a Florida shelter in March of this year there have been a couple of other shelters in this state alone that have had dogs died suddenly due to strep so induced hemorrhagic pneumonia but this is the same shelter the same very large of an omission municipal shelter that had to strip so outbreak in February 2008 so it’s a recurrent one a little bit different circumstances that I’ll point out in just a minute but again on the the bottom line from this particular strip so outbreak is that the shelter and the community the adopting community and the rescue groups have been noticing over a period of weeks if not months that there were increasing numbers of dogs in the shelter with canine infectious respiratory disease and many of them were developing very severe disease leading to death or requiring euthanasia due to the severity we were asked to consult with this shelter in March and as part of the consultation we tested and I’ll get some more detail in this in minute we tested some of the sick dogs and we found that 30% of them had strep pneumonia in a very severe pneumonia 30% there was um that’s just of the 43 dogs we tested there were more than 400 dogs on site most of which were sick or exposed this particular strip so incidents shut this shelter down now instead of for one week for two months so I hope I’ve presented some evidence now of the increasing frequency of the occurrence of strep so hemorrhagic pneumonia less often fatal in dogs and shelters they are at the greatest risk group for this infection at this time as a matter fact there have been extremely few reports of strep so infection in owned pet dogs that live in the home I could only find four cases they were all reported in the United Kingdom one of them was a pet dog that was at a thick a boarding kennel and it was in contact with dogs that had kennel cough and within 24 hours of arriving home it died from strep so hemorrhagic pneumonia the other three dogs that were infected by strips were pets that lived on farms and had close contact with horses two of these dogs actually didn’t have pneumonia they had a very chronic intermittent several month long history nasal discharge and rhinitis or inflammation of the nasal passages and with proper diagnostic testing that was determined they their nose and even down into their lungs what’s colonized by strep though it’s not known why these dogs didn’t go ahead and develop pneumonia and die as the dogs and the shelter but they both resolved their infection with a long-term antibiotic treatment at the antibiotic was clever amongst one of the dogs that lived in close contact with horses had strep so recovered from the nose and or a perennial area but this dog never did develop any clinical disease so there’s only four case reports in pet dogs all of the other reports of strips have been in dogs in shelters but we don’t have any idea what the risk factors are for dogs and shelters for exposure to an infection by the spec Tyrian we could postulate several parameters or potential risk factors that we all know

exists in shelters nearly every shelter at some point in time in its history and one thing that con that characterizes all the shelters just about is it it’s a high density high population Turner high density high turnover population consisting of dogs coming from different sources all under one roof and so there’s dogs coming in there’s thoughts coming out and it’s just a cycle of in and out with time we do know that dogs and cats and shelters experience stress stress of strange housing with strange bed partners lots of noise a strange odor so everything is very stressful to dogs and cats and shelters could this cause some sort of powerful immunosuppression not experienced by pet dogs and homes and enough of an immunosuppression to render them susceptible to infection by this bacterium it could be related to poor sanitation practices poor ventilation or air exchange what about viral infections we’ve already heard a little bit about a lot of the dogs and the shelter outbreaks there was endemic kennel cough or canine infectious respiratory disease on existant and the dogs most of kennel cough is due to viral infection not bacterial so it could be that maybe an initial viral infection of the respiratory tract then predisposes to a secondary infection by strep so this is all speculation and there’s widespread antibiotic usage in shelters today most often for dogs as stocks e-cycling and as you’ve heard me say over and over nearly every dog in every shelter eats doxycycline for lunch every day for prolonged periods of time and as I’ve said before it doesn’t really cure their cold but it sure gets rid of the tick borne disease but I’m wondering if this widespread constant persistent exposure to antibiotics has resulted in some sort of selection pressure for appearance of a very virulent strips of organism in the environment don’t know this is all speculation we have no idea what the risk factors really are for dogs being exposed to this bacterium we also don’t know anything about how its transmitted but between dogs in a shelter environment we do know that with horses this bacterium is easily spread by direct horse to horse contact it can be spread from one horse to another through air sliced respiratory secretions since it does colonize their upper respiratory tract and we also know that these respiratory secretions can contaminate objects in the environment that when contacted by another horse that horse can then become colonized so we know that goes on with strep zone horses we don’t know about dogs except that it is shed from their upper respiratory tract because we can recover it from the nose and pharyngeal area of dogs during these strips so outbreaks and most recently during the one of the 2011 Australian the state we were able to find strip so in the feces of infected dogs which has not been reported before so what if this variant pathogenic strep though and an infected dog is being shed not only from the respiratory tract but author is a fecal root and the feces are causing a massive environmental contamination for exposure of other dogs so some things to think about and hopefully we’ll have some answers as time goes on what about cats I know this is focusing on dogs but can strap so in fat cats it turns out yes and it’s cats and shelters there’s been a fatal strep so infection in two cats they were in separate shelters in Canada and they got infected in two different years the both cats had a very acute on side of sort of onset of a sort of a typical URI presentation but they died within 24

hours later strep though was recovered from the lungs sinuses and the brain of both cats and it’s thought that the infection in the sinus area provides a direct route of the bacteria to penetrate into the brain and cause a brain infection in cats it’s interesting because both of these cats were housed in rooms with 10 to 15 other cats but none of the other cats were ever affected during this time period then there was a strep so infection in a cat and that the lead Las Vegas shelter during the strip so outbreak in dogs in 2008 one cat died during that outbreak and strep so was recovered from its spleen and finally there have numerous fatal strap so infections in a cat sanctuary on this one is located in Israel and these fatal infections incurred over a two-year time period and all 10% of the cats in the sanctuary died it was about a 700 cat sanctuary and more than 10 percent died from strep so infection and again just like the cats in the Canada shelters strep zone was isolated from the lungs the sinuses in the brains of these 78 cats so yes strep though can not only infect dogs and cause a very virulent and often fatal infection but it does the same thing for cats all of them in shelters how about strep so and us is there the potential for shelter staff to become infected with strips of during a strep xot outbreak and dogs or cats and shelter well human infections by strep so are very rare it’s that like dogs and cats it is not normally colonized by this bacterium the reported cases of strep so and humans have been associated with drinking unpasteurized milk from infected cows and also by direct contact with infected horses and humans get pretty sick and these can be nearly fatal infections for them if they don’t seek immediate medical care there’s pneumonia there’s sepsis infection of the joints the kidneys and actually death is due to kidney failure so this is a potentially serious so anodic infection for people there’s only been one reported case of a human infected by contacting a dog known to be infected with strep so and this happened to be one of those three farm dogs that had that very chronic intermittent rhinitis and that the nose of that dog was colonized by strep so that dog on developed a fever and was hospitalized and the veterinary technician was tasked with trying to put and there were some respiratory on compromised at this time of hospitalization so the the tech was told to put an oxygen cannula catheter into the nostril of the dog to help supply more oxygen and the dog started sneezing like crazy and it sneezed all over the face of the veterinary technician and within 48 hours that technician was in the hospital fighting for his life and he was inspected by the same strep though that was infecting the dog so there was this direct transmission and obviously during the sneezing event that bacteria got all in the mucous membranes of the eyes and up the nose and then to the mouth so it makes you kind of think gosh if I’m drooling with the strip’s though outbreak I wonder if I should be wearing safety goggles and a mask or a facial shield you know kind of sort of like when you’re preparing specimens for rabies testing all right so I wanted to get into a little bit of what these dogs look like once you’ve seen one you’ll never forget it a very common presentation reported in shelters is finding apparently healthy dogs dead in their kennel one morning and there’s a lot of blood that is oozing from their nose and their in their mouth as shown these are two dogs that that actually were found dead in

their run during the Miami 2008 Ostrom outbreak it’s a very frightening sight to see this I mean you think the first thing that comes to your mind when you walk in the run and see all this blood the stalks head and all this pull of blood is a bolivars of course that’s not what it is but has anyone seen this has anyone okay yeah sorry about that I hope you don’t have to see this it’s frightening other dogs can have a history of kennel cough for a couple of days noted by the techs nothing done yet but very shortly after onset of coffee and nasal discharge there’s a rapid progression to respiratory distress nasal hemorrhage and then usually death within 24 hours it is very similar to streptococcal toxic shock syndrome in humans which you may have heard about this toxic shock syndrome in humans is also called it’s caused by strep bacteria but it’s strep pyogenes so this is sort of a toxic shock syndrome that we’re seeing in these dogs in fact it was stripped so did you want to play one of the these are videos taking take about dr. brian de Gangi of dogs that were infected with strips what you need to notice here look at the dog’s mouth as it’s struggling to breathe that’s respiratory distress this dr. de Gangi went back later in the day I think and found the dog laying cross-state on the floor of its run and would not get up with encouragement and breathing just like this have you ever seen a dog breathe like that if you have it’s bad news for that dog we have another presentation look at the hem Ridge on this Bulldogs nose look at the snot coming out of that companions nice so but I want you to notice it’s on the white muzzle of the dog on the right there’s a lot of nasal hemorrhage it’s covering it’s puzzle look at the how it’s struggling to breathe get some comfort from its kennel mate let’s see those ribs working this dog died later that night in its kennel and it had strength up thank you so those are the two more common clinical syndromes that you will see with strep so it does cause a very vibrant Fitness separative necrotizing hemorrhagic pneumonia on in the picture on the left this is the open thoracic cavity of a dog that died from fatal that died from stretch zone pneumonia I hope you can appreciate the pool of free blood inside the thorax here’s a long here’s a long here’s a heart but what you will see are lungs that look like this very needy looking have their fullest hemorrhage they don’t float because they have no air in them and then the free blood in the chest cavity give you a little picture of what the actual lung tissue itself looks like at the microscopic level this panel on the left is a normal lung the tissue is the purple strand II those purple strands and notice all the free space on that slide that’s for air exchange lots of area to exchange oxygen here this is what a similar area looks like in the lung of a dog with strips up do you see the open Airways and here you may see what two or three but everything else is consolidated filled up clogged up with inflammatory cells the little purple dots and in hemorrhage represented by the the red blood cells here so there’s no wonder these dogs are breathing with a grimacing expression and having blood come up from the respiratory tract and really heaving them working with their

ribcage to breathe they can’t get any oxygen and through a lung that looks like this and you can actually see the little grandpas that change the gram-positive cocci embedded into the lung tissue on as part of the confirmation of cause of death so how do we diagnose this strep so infection and dogs on we recommend collecting nasal and/or pharyngeal swabs for bacterial cultures so this is using just your standard bacterial culture Rhett’s when you submit this to a laboratory such as idec’s or in an tech or any other reference laboratory when on the test requisition form you have to write in big letters please test first traps ugh because many diagnostic laboratories will not do it they will they what may poor report out streptococcus infection but they won’t give you the species is it struck heinous is it strep so is it strep December why so you have to request that also be sure to request an antibiotic sensitivity panel because this is a bacterium and if you know an antibiotic will kill it then that’s what’s gonna save the dogs get them on that antibiotic so ask for it the other thing that we recommend is to collect swabs from the nose and the throat for pcr this is the latest diagnostic test for strep though it is much more sensitive than bacterial culture if that dog has stripped so this is the test that’s going to find it however I won’t give you an antibiotic sensitivity that’s why we like swabs for culture and sensitivity testing and saws for PCR simultaneously from the same dog these swabs can be submitted to IDX or Antec they both offer a canine your respiratory pathogen pcr panel and are these panels are great the test is great and it tests at the same time on the same swab for all of these respiratory pathogens known to infect dogs so these panels have given us an opportunity now to see if dogs infected with strep so actually are infected co infected with viruses and did the bar says come first in predisposed to the struts up so this is a little bit about how to do this on swab collection especially for PCR you need just a clean sterile plain red top tube there’s no serum separator plug-in here a swab with a plastic handle this is demonstrating a swabbing the nostril of a dog and notice this technician is properly dawned with PPE wearing gloves and even has a gown on because there’s a sick dog and she doesn’t want to get what that dog has then she takes another swab and she swabs the very back of the Ferengi alaria back way beyond the tongue where the tonsils are and each one of these swabs is then ston put inside the red top tube and you could snap that plastic handle which allows the swab then to drop down into the tube and you could put two swabs in there and that way you’ll only be charged for one sample and it will maximize your opportunity for hunting pathogens so that that’s um that’s how to collect swabs and one last diagnostic technique that should be done for any dog that dies suddenly for unknown reason but particularly if it’s got blood coming from the mouth and nose it’s to do a necropsy or have someone do a necropsy for you so that you can look or someone can look inside the chest cavity for lungs that look like they’re full of blood and also allows you to pinch off some tissue from the lungs or even take on swabs and stab the tissues and submit the swabs to the laboratories for both bacterial culture antibiotic sensitivity and PCR analysis what antibiotics are the strep so strains sensitive to based on testing done today well the good news is that all strains recovered from dogs involved in strep so outbreaks and shelters in the 2000s have been shown to be sensitive to

penicillins ampicillin Travie MOX cephalexin and even good old try Brisson or tri methyl and sulfur all the common antibiotics but what’s missing in that list that’s used yes exactly so there are strains that have been shown to be resistant to doxycycline and not only doxycycline but also BAE trill or in red phlogiston or marble oxen the the fluoroquinolones so again I wonder if the widespread use of doxycycline has conferred some antibiotic resistance to some strains of strep so recovered from dogs in shelters that use that antibiotic on consistently one really good piece of news that came out of the 2011 strep zoo outbreak and the Florida shelter that we consulted with was the demonstration that the strep those strains at least from that shelter were sensitive to sefa Beeson this is a cephalosporin many veterinarians in this room know this is convenient it’s a Pfizer animal health product that’s wonderful and we love it because you only have to give a dog an injection once and it provides activity against staph and strep bacteria for two weeks so you don’t have to give them pills once or twice a day for two weeks one shot does it all and this actually was important for us to find out and Pfizer assistant provided great assistance with us to determine this because this provides a great tool for treatment of dogs either infected with strep so in a shelter or expose the dogs infected with strep so it may have the infection themselves now you just give them all in a convenient one time and it gives them a 14 day activity against strep so that’s a lot better than having your staff try to treat every dog in the shelter once a day with a penicillin injection well if you have 400 dogs to treat or to give them Clapham ox twice a day which would be horribly expensive or even cephalexin twice a day which would be cheaper but again look at the labor and look at the chance for cross-contamination of dogs as you move from dog to dog to dog treating it once or twice a day for days on them so remember convenient so I want to sort of sort of go towards the conclusion of my talk to examine the question of whether stretcheth an emerging pathogen of significance for dogs and shelters is it a primary pathogen able to cause disease by itself or is a secondary pathogen that really requires a boost from something like a viral infection in order to contribute to severity of the disease and maybe tip the dog over the balance to death it is known that secondary bacterial infections of the respiratory tract and many species is promoted by virus mediated damage to the respiratory tissues both in the upper respiratory tract and the lower respiratory tract and this virus mediated damage actually promotes bacteria sticking to the tissue and initiating a secondary infection in addition to the virus not only that but the viral infections particularly the ones that we know about and dogs can paralyze that mucosal Ameri apparatus the beating cilia lining trachea and large Airways going down into the lungs and it’s a natural defense mechanism that is constantly sweeping bacteria away from the lung and healthy dogs but viruses paralyzed that for a week two weeks sometimes 30 days and that also contributes to susceptibility to a bacterial infection so I’m going to present some evidence that I think is accumulating that this actually may be a secondary pathogen for instance if we go back to the strep Zoo outbreak in the United Kingdom shelter

in 2003 dogs with canine infectious respiratory disease were more likely to have strep though in their lungs than dogs that did not have respiratory infection as a matter of fact of the thirty-ninth dogs that had strep so in the long that were tested for other pathogens 44% were co-infected with canine parainfluenza virus canine herpes virus or canine respiratory Corona VARs not all dogs that had strep uh but almost half of them had a concurrent viral infection and then in the Las Vegas shelter in 2008 are the lungs from five dogs that died of strep so were tested by PCR for the for viral pathogens because this is about the time that PCR became available and all five dogs that were tested were infected by a virus whether it was herpes and a virus or distemper virus so here’s here’s some suggestive evidence about the role of viruses with strep so and then in 2008 almost 11 dogs that died of strep so in the Florida shelter on were tested by PCR for viral pathogens only to the eleven had a virus infection it happened to be influenza virus so within a couple of days of learning of this these dog deaths I went down and collected nose and Ferengi laws from 22 other dogs in various parts of this very large shelter and tested them by PCR for viral infection and they all had either canine influenza virus or canine respiratory coronavirus or both so this told me that canine flu was in the shelter and at at the same time dogs were dying of strep so so could it be that flu virus infection actually does predisposed to strep so and here are three points that are known I don’t know if flu does canine flu predisposes to strip sew or if it’s just associated with without cause and effect but it is known that human influenza viruses predispose people to secondary lung infections by streptococcus bacteria strep highest Rutan ammonia and people who have flu and a concurrent strep pneumoniae infection have very severe pneumonia requiring hospitalization in addition at the same scenario exists with horses horses who are infected with equine influenza bars are very predisposed to secondary lung infections by strep Sun and when this occurs the horse has very severe pneumonia and there’s been a very recently published study this year that showed that experimental infection of dogs experimental infection of dogs with canine influenza virus and a very virulent strep – so bacteria isolated from one of the outbreaks cause much more clinical disease severe clinical disease and pneumonia in those dogs with the dual pathogen infections then dogs infected with either alone so it could be that canine influenza bars and dogs just like in horses and humans may be one of those viruses that triggers susceptibility to strep so certainly more work needs to be done to examine this linkage when we consulted with the Florida shelter the one that had the recurrent strep so outbreak in 2011 we actually went down there and found that they had widespread this number and nearly four hundred dogs or more had been exposed to this virus and many of them were already symptomatic we didn’t know streps I was there we thought this is a just a distemper outbreak one of the many we have in Florida and that’s what was going on although it was a very extensive distemper outbreak but when we tested nasal and pharyngeal squads collected from 43 sick dogs using the PCR panels we found some we found strips up as a matter of fact 30% are those 43 dogs had

strep so and not only that but strep though was found in dogs that were co-infected with the stumper see none of them had strep so only without a virus or it was found in dogs that were infected with a virus other than distemper in this farces were respiratory Karenna virus herpes parainfluenza and and the virus so yes distemper was the primary pathogen and on nearly half of the tested dogs but 30% of the dogs were infected with strep so and only and those all of the strep so infected dogs were infected with a respiratory virus so this is another piece of evidence that suggests the importance of underlying viral infections for strips so what do we do to manage it couple of slides it’s like managing an infectious disease communicable infectious disease outbreak of any other nature in dogs or cats and shelters there are certain things that you need to have in the toolbox that are key points of a management strategy and success of that strategy you got to do something with the sick dogs they can’t continue to remain in the general population continuing to spread infection to all dogs around them so they need to be isolated or moved off the premises to some other facility or foster Network that can care for them exposed dogs they may not be sick yet but they certainly were exposed to the sick ones so they could be infected and sort of an incubation period and we’ll be breaking with disease at some time in the future so they need to be quarantine because they could be potentially infectious need to decontaminate the environment if you can’t completely stop intake then all dogs that have to come in the shelter because of local ordinances need to be put in some protected environment where they’re not exposed to sick or exposed dogs because if you don’t you’re just adding more logs to the fire on the whole goal is to create a clean break between this population and new missions without resorting to depopulation yes there may be some loss of life particularly dogs that are already sick and may be deteriorating but the goal is not to clean house in order to facilitate a more easily an easier return to normal so I’m going to use the 2008 outbreak in the Florida shelter we knew the dogs died on these dates we confirm strep though infection in these dogs On February 6th very rapid confirmation of infection by strips starting with the initial dogs that died that were shipped to us for diagnostic testing we confirmed the concurrent canine flu and canine respiratory coronavirus infection and dogs throughout the shelter two days later so we knew by Diagnostics what we were dealing with so to follow the principles of management the sick dogs were moved to the straw that we’re still in their straight hold period were isolated in one wing of the straight hold kennel and if they were still sick and getting progressively worse as they as their strain hold expired they were euthanized the exposed dogs on were quarantined and another wing of the stray whole building so now you have all the sick and exposed dogs and some portion of the stray whole building this emptied out their adoption building because they had moved all the exposed dogs out of there to the straight hold they moved all the sick dogs out of there and they started treatment of all the dogs on site with injectable penicillin once a day for seven days and this is before we knew that sefa Beeson or convenient it’d have been the perfect choice so can now we’re talking about 350 dogs can you imagine how it it take it took the staff ten hour days to go through and inject every single dog once

a day creating great risk for spread of infection and this particular strip zone was resistant to doxycycline the shelter did discontinued options on owner reclaims were released on on cefalexin oral therapy and instructions for Hong Kong team for 10 days so owners we’re allowed to reclaim their dogs even if it was in the sick or exposed population in addition rescue groups were very interested in taking the exposed dogs out of the shelter and they were allowed to do so again that the dogs were sent out to the rescue groups with cefalexin antibiotic and instructions for quarantine the shelter called a temporary moratorium on acceptance of owner surrendered dogs which caused a sort of transient turmoil in the community but with all the media pubs are coverage of this event on the public quickly grew to accept this as a necessity to ease the strain on the shelter since the adoption building was emptied it was stripped thoroughly disinfected and because this is a highly publicized event it caught the county commissioners on phone lines and attention and they were on the news and so the shelter director found the perfect opportunity to get the money for repainting all the kennels and that’s what that that she’d asked for it for three years and it took strips to get the commissioners to say yes well send some people right over and do it so once this was done this a building was used for housing of newly admitted stray and legal custody dogs dogs they had to take in because they’re a municipal shelter and it not only were the sick and exposed populations in the other building getting penicillin but now the staff were tasked with treating the new admits to is a sort of prophylactic approach on – for prevention of strep so infection and the the veterinarian and when the shelter veterinarians did a cool thing I really like this and I’d like to pass it on to other shelters regardless of what infectious disease out they’re having but she divided her animal care team and to stop like colors for this particular outbreak she had a red team and a green team the stray whole building was sick expose dogs was the red building for red Sun and the adoption building with newly admitted clean dogs was the Green Zone so the respective color-coded staff were only allowed to work in the matching color zone and they had to wear full PPE boots Tyvek gloves and they had color swatches on their own they’re Tyvek so that if people in the red zone saw a green person running around they would report them it was great the staff loved it they were they were really getting into Monta to self monitoring the traffic of the staff into areas where they shouldn’t be in addition all the supplies for each area were color coded so you didn’t see red mops in the Green Zone so I thought it was very good that the the staff really could follow this color scheme and there were no new cases of strep so after the initial deaths on February 6th and the shelter was able to reopen after ten days when the paint dried so I thought this this shelter did a very good job of managing this strip so outbreak and not allowing it to spread within the facility number one they recognized that quickly but it’s very dramatic to see dogs with been pools of blood dead in a kennel so that that shakes your attention and it makes you pick that phone up and reach for help and say we’ve gotten a bola down here which is what circulated believe it or not it was dog Ebola so I think I’m going to conclude with this I do I think we have one more slide or two but this this is the distemper break outbreak in the same shelter that was in 2011 so was also found but it pretty much was managed with the same strategic principles as the outbreak three years earlier except this is the one where we

finally could use convenient and the staff loved it and the dogs could go out to rescue groups or owner reclaims and they did not have to continue antibiotic therapy with me and with the animals so convenient was a great Savior here okay so I don’t know if we have time for any questions we don’t know how long it persists in the environment but it’s very easily killed by the routine quaternary ammonium products and bleach and trifecta and whiskey wash and all of that would be overkill but certainly your rope cows and arms EPS and all of those routine cots used in shelters but I don’t know how long it stays there if you don’t disinfect yes how long are the dogs sick for one to two days if they don’t just die suddenly without any forewarning visible symptoms on the dogs so far I’ve had unlike a call for nasal discharge for one or two days before progressing rapidly to death is that your question oh if they’re treated you if the dogs are not already in that dead man’s land where they’ve got this severe respiratory distress and the nose coming the blood from the nose and they probably got a thorax full of blood if they haven’t reached that state on they can be recovered by treatment with the appropriate antibiotics and fluids if necessary but well it seems once they get in that really progressive state they don’t respond to therapy they will go ahead and die does that answer your question well if you give a convenient lasts for 14 days if you use injectable penicillin it looks like once a day of the long-acting penicillin offer seven days was effective cephalexin has been given orally for ten days as well as clabber marks and other outbreaks does that answer it finally okay sorry about that yes no one knows obviously for dogs and shelters it’s not coming from contact with horses or ruminants and it’s probably not being introduced by staff member who groomed their horse the morning before they came to work so we don’t know where it’s coming from we don’t know why it’s variant and dogs much more so than in other species it’s not none