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Zoonotic parasitic infections contracted from

dogs and cats: How frequent are they?
Your clients probably don't know that their lovable pets can transmit parasitic infections to them and their
children, so it is up to you to educate them. Being aware of the gastrointestinal parasites with the most
zoonotic potential will enable you to give clients the best advice for zoonosis prevention.
Mar 01, 2007
By Peter M. Schantz, VMD, PhD
The popularity of dogs and cats as pets in the United States continues to
increase. Recent surveys estimated that there were 73 million owned dogs
and 90 million owned cats in the United States, and almost 60% of U.S.
1
households owned a pet. The highest rates of dog and cat ownership occur
in households of families with young children. Dogs and cats are hosts to
many intestinal parasites that may be transmitted to humans through direct
contact with infected pets or exposure to environments contaminated with
infected animals' feces (Table 1). Children are often at greatest risk of
zoonotic infections because of their play habits and affection for pets.

Veterinarians in practice are on the front lines in preventing transmission of

Table 1: pet-associated zoonotic parasite infections because of their knowledge of the
potential risks and through their contact with pet owners. Practicing
Gastrointestinal veterinarians' services should include preventive treatments to eliminate
Parasitic Infections in parasites as well as advice to owners on minimizing the risk of zoonotic
Dogs and Cats in transmission. This article summarizes data on the modes of transmission of
potentially zoonotic intestinal parasites of dogs and cats and the available
North America That data on the frequency at which they infect and cause disease in humans in
Are Transmissible to the United States.*
People
HELMINTH INFECTIONS

Potentially zoonotic gastrointestinal parasites of dogs and cats include the maternally
transmitted intestinal roundworms and hookworms whose infective stages may
contaminate and persist in the peridomestic environment (i.e. in proximity to humans).

Ascarids

Infection of humans by Toxocara canis and Toxocara cati, the common roundworms of
dogs and cats, respectively, cause larva migrans syndromes (visceral and ocular larva
migrans and covert toxocariasis) in humans who accidentally ingest infective eggs
2
from contaminated environments. Toxocariasis ranks among the most common of all
zoonotic infections; the results of numerous published surveys document
seroprevalences in humans ranging from 1% to 20%, depending on the age,
Peter M.
socioeconomic status, and pet ownership status of the tested populations. Toxocaral Schantz,
3-5

larva migrans, or infection by the common ascarid worms of dogs and cats, is arguably VMD, PhD
the most common zoonotic infection associated with pets in the United States and
4
other industrialized countries. It has been estimated that every year in the United States this infection
causes hundreds of cases of unilateral blindness and uncountable numbers of less permanent forms of
3,4
illness in children. The severity and type of disease in humans produced by Toxocara species infection
depend on how many larvae are ingested, the frequency of reinfection, and other factors still poorly
understood. Most human infections with Toxocara larvae are well-tolerated, even asymptomatic; however,
a proportion of infected people develop larva migrans syndromes that may be systemic or confined to the
eye. When a larva invades the eye, it almost always leaves the individual partially or totally blind in that
eye. Based on data obtained from the Centers for Disease Control and Prevention (CDC) serologic
diagnostic reference service, an estimated minimum of 750 cases of ocular larva migrans are diagnosed
4
by physicians every year in the United States. Chart review of patients with a diagnosis of uveitis at the
University of California Medical Center determined that ocular larva migrans accounted for 1% of cases of
5
uveitis seen between 1977 and 1996. All cases were associated with vision loss in the affected eye. The
number of cases of toxocaral visceral larva migrans syndrome is much greater; however, estimates of
4
these are quite imprecise.

Epidemiologic investigations have consistently determined that the principal risk factor for infection was the
presence of a household dog, particularly a pup, in a patient's household within six months of onset of
2,3,6
illness. When this condition is combined with pica, especially dirt eating, the statistical association
becomes very strong.

Hookworms

Infections with the hookworms Ancylostoma braziliense and Ancylostoma caninumremain common in dogs
and cats, with the highest prevalences in the southern United States, mainly in coastal areas from
southern New Jersey to the Florida Keys and westward along the Gulf of Mexico to Texas. Infections in
people are acquired from contact with moist or wet sand or loam soil containing filariform larvae of
hookworms generated from the feces of dogs and cats, usually in unprotected sandboxes, on bathing
beaches, and under houses where workers lie prone while repairing leaking water pipes. Larval invasion of
skin in humans produces pruritic papules. In two or three days, these papules become serpiginous tunnels
in the epidermis caused by inflammation resulting from intradermal migration of larvae (cutaneous larva
7
migrans). Without treatment, migration may continue for several weeks or months before the immune
system kills the larvae. Zoonotic hookworm infection may also be acquired through ingestion of the larvae
in soil or in tissues of paratenic hosts. Infection in humans acquired by these latter routes, especially A.
caninum, may occasionally lead to enteric localizations of zoonotic hookworms, causing eosinophilic
8
enteritis. Although eosinophilic enteritis has been diagnosed with relative frequency in Australia where it
9
was first noted, it has rarely been diagnosed in the United States. The eosinophilic enteritis syndrome
requires clinical experience and technical sophistication to diagnose and may occur more frequently than
currently recognized and documented.

Tapeworms

Dipylidium caninum. Zoonotic tapeworm infections associated with dogs and cats include the flea
tapeworm, Dipylidium caninum. Infection is acquired when a person, usually a young child, accidentally
ingests a flea carrying the larval stage of the tapeworm. Dipylidium caninum infection can lead to diarrhea
and pruritus in infected humans. This infection rarely causes serious symptoms; however, the stress
10
associated with seeing tapeworm segments in a child's stool or diapers can be considerable.

Echinococcus species. Echinococcus species of dogs may infect humans with larval stages that cause
cystic or tumorous growths in the liver and other visceral organs. Cystic echinococcosis, or hydatid
disease, is caused by infection with larval stage Echinococcus granulosus. Cases of cystic echinococcosis
acquired in the northernmost regions of North America, especially Canada and Alaska, are caused by the
northern sylvatic genotype maintained in cycles involving wolves, dogs, moose, caribou, and other
11
cervids. The practice of feeding the viscera of moose and caribou to working and pet dogs leads to
infection in dogs and subsequent exposure to humans. Infection continues to be relatively commonly
diagnosed in most Canadian provinces. A review of hospital records in Edmonton, Alberta, noted 42 cases
12
diagnosed and treated between 1991 and 2001.

Foci of local transmission involving a variety of domestic intermediate hosts have been described in
11
various regions of the United States. Distinct foci of E. granulosus transmission were noted in the 1970s
in western states including California, Utah, New Mexico, and Arizona. Epidemiologic investigations
revealed that transmission was associated with unique cultural practices involving home slaughter of
sheep and the access of dogs to discarded viscera of these hosts. Human populations at risk in these
settings were transhumant sheep ranchers, including Basque-Americans in California, Mormons in central
Utah, and Navajo and Zuni Indians in New Mexico and Arizona. Active transmission appears to have been
eliminated in some of those foci; however, local hospital records indicate that an average of one to four
cases continue to be diagnosed each year among Native American communities in Arizona and New
11
Mexico.

Echinococcus multilocularis, the cause of the alveolar form of human hydatid disease, is an emerging
zoonotic parasite in the United States. The life cycle of E. multilocularis involves foxes and coyotes and
their rodent prey in ecosystems generally separate from that of humans. However, there is ecologic
overlap with humans because fox and coyote populations have increasingly encroached upon suburban
and urban areas of many regions, and domestic dogs or cats may become infected when they eat infected
11
wild rodents. Infections in domestic pets increase the risk of human exposure. Humans may acquire
infection when they accidentally ingest eggs by direct or indirect fecal-oral contamination from infected
definitive hosts. Human alveolar echinococcosis in North America has been mainly confined to certain
Eskimo populations in northern coastal Alaska in which annual diagnostic incidence rates during the 1970s
13
and 1980s were among the highest ever reported for this infection (7 to 98 per 100,000 population). A
control intervention in endemic Alaskan villages initiated in 1990 involving education, improved housing,
14
and preventive treatments of dogs has greatly reduced or eliminated transmission to humans. No new
14
cases have been diagnosed in humans since that time.

This tapeworm also occurs in a large area of central North America, and its geographic range and
prevalence may be increasing. Before 1964, there were no reports of E. multilocularis in North America
south of the Arctic tundra zone, but, in that year, it was reported in foxes and rodents in North
15
Dakota. Subsequent surveys revealed that the cestode was enzootic in cycles involving red foxes,
coyotes, and deer mice in North and South Dakota, Minnesota, Montana, Iowa, Wyoming, Nebraska,
16,17
Wisconsin, and Illinois. The most recent surveys have extended the range eastward to Indiana,
18,19
Michigan, and Ohio. Prevalence of infection in foxes and coyotes in the northern Great Plains (25% to
90%) is as high as in any region in the world. To date only two persons are known to have acquired their
infections in the endemic region in central North America—a 54-year-old man from Manitoba, Canada, and
20
a 60-year-old woman from Minnesota —however, the potential exists for a more serious public health
problem as domestic dogs and cats become involved in the life cycle.

Taenia species. Coenurosis is an infection by larval forms of several related tapeworms of the
genus Taenia (formerly designated Multiceps). The coenurus is a fluid-filled cyst that measures from a few
millimeters to 2 cm or more in diameter. Dogs and other canids (wolves, coyotes, foxes) are the final hosts
of Taeniatapeworms. Taenia serialis, the only coenurid-forming cestode currently present in North
America, uses rodents or hares as intermediate hosts, and the coenuri are typically found in the
intermuscular fascia and subcutaneous tissues. Humans become infected when they accidentally ingest
tapeworm eggs in the feces of infected canids. The symptoms of coenurosis are due to the physical
presence of the cyst and depend on the site of localization. In North America, fewer than 10
autochthonous (locally acquired) human cases have been documented; three involved the central nervous
21
system or the eye, and the others involved intramuscular or subcutaneous localization.

PROTOZOA INFECTIONS

Toxoplasma gondii

Toxoplasma gondii is a coccidian parasite widely dispersed in nature. Cats are the definitive hosts for this
protozoan, which they acquire when they eat infected intermediate hosts (rodents and many other
mammals) or ingest oocysts excreted in the stools of other infected cats. Infected cats are important in the
epidemiology and public health importance of toxoplasmosis because they excrete and widely disperse the
22
environmentally resistant oocysts. Numerous herbivorous and omnivorous animals become infected
when they ingest infective oocysts in soil or contaminated food.

Humans become infected by ingesting food and water contaminated with oocysts shed in the feces of
infected cats, by eating undercooked meat from infected animals, or in utero (by congenital transmission
from infected mothers). Rarely, humans become infected through blood transfusion or organ
transplantation. Recent serosurveys of the U.S. population have documented antibodies (evidence of
23
current or past infection) in about 23% of the U.S. population. Ingestion of oocysts shed in the feces of
infected cats is believed to directly account for up to 50% of human cases in the United States. Clinical
disease caused by toxoplasmosis is generally mild following primary infection of immunocompetent
people. Self-limiting fever, malaise, and lymphadenopathy are the most common clinical abnormalities,
and most infected people never realize when their first T. gondii infection occurred. However, acute
infections acquired by pregnant women can be transmitted to the fetus and cause severe illness
(e.g. mental retardation, blindness, epilepsy) and death. According to a 1999 report by the CDC, an
estimated 400 to 4,000 cases of congenital toxoplasmosis occur each year in the United
24,25
States. Another permanent manifestation of toxoplasmosis is ocular disease, which is estimated to
occur in up to 12,000 people per year in the United States. Toxoplasmosis can cause more severe or fatal
illness in people who are immunosuppressed (people with human immunodeficiency virus [HIV], transplant
recipients).

Giardia species
Giardia duodenalis (synonyms Giardia lamblia, Giardia intestinalis) is a protozoan parasite that infects the
intestinal tract of many animal species including humans. Motile trophozoite stages occur in the intestines,
and environmentally resistant cysts are passed in the feces of infected animals, which are immediately
infective if ingested by other susceptible hosts. In all hosts, G. duodenalis can cause acute gastrointestinal
signs as well as chronic disease, including chronic malabsorptive and allergic manifestations and
26
childhood failure to thrive. Transmission of infection occurs by fecal-oral routes either by direct contact or
by ingestion of contaminated food or water. Giardia species infections are common in dogs and cats
throughout North America; however, prevalences are often underestimated because the parasite detection
27,28
methods commonly used in practice have low sensitivity. Giardia species have long been considered
zoonotic because morphologically similar organisms infect humans and a variety of mammals and
29
birds. However, evidence of giardiasis being directly transmitted from one host species to an
immunocompetent host of another species is limited. Although variants of Giardiaspecies in human,
canine, and feline hosts lack differentiating morphologic characters, the application of molecular tools
(e.g. PCR) has revealed genetic differences in isolates from different hosts such that it has become clear
29,30
that the genotypes commonly infecting dogs and cats are not those commonly infecting humans. Most
confirmed infections in humans with Giardia species acquired from dogs or cats have been reported in
29
individuals with recognized immunodeficiency disease (e.g. HIV infection).

Cryptosporidium species

Protozoan parasites belonging to the genus Cryptosporidium are ubiquitous and among the most common
nonbacterial causes of diarrhea in a wide range of vertebrates, including
humans. Cryptosporidium species are transmitted via the fecal-oral route by environmentally resistant
cysts that are shed in the feces, contaminating soil and water, and, thus, providing multiple routes into the
30
food chain. In an immunocompetent host, cryptosporidiosis of the intestinal tract may be asymptomatic or
lead to self-limiting diarrhea, but in an immunocompromised host, it can be life-
31
threatening. Cryptosporidium species have been reported in numerous mammals and,
like Giardia species, appear to have evolved with their respective hosts such that they do not readily cross-
infect and develop in hosts of other species. The application of molecular tools has revealed
that Cryptosporidium species are a phenotypically and genotypically heterogeneous assemblage of
30,31
species and genotypes that are morphologically similar. In humans, the most commonly detected
species are the anthroponotic Cryptosporidium hominis and the zoonoticCryptosporidium parvum (cattle).
Both Cryptosporidium canis and Cryptosporidiumfelis, whose natural hosts are dogs and cats,
32
respectively, have also been demonstrated in infected humans suffering diarrhea. Young children and
immunocompromised individuals are at greatest risk. Information regarding the role of pets in zoonotic
transmission of Cryptosporidium species in immunocompetent humans is insufficient. While it is clear that
most outbreaks and individual cases of cryptosporidiosis in humans are related to the contamination of
water, food, or fomites with organisms of human or cattle origin, it is also clear that inter-species
transmission from dogs or cats to humans can occur in certain situations, especially among very young
30
children or immunodeficient individuals.

CONCLUSION

Dogs and cats are infected with a number of helminths and protozoa that can infect and sometimes cause
life-threatening illness in humans. Awareness of these infections and their zoonotic potential is essential
for practicing veterinarians in order to diagnose and treat the infections in pets as well as to provide
preventive advice to pet owners.

*None of the zoonotic parasitic infections acquired from dogs and cats are reportable diseases in the
United States; consequently, no systematically collected data on the frequency of these zoonotic parasitic
infections exist.

Peter M. Schantz, VMD, PhD

Division of Parasitic Diseases
National Center for Zoonotic, Vectorborne and Enteric Diseases
Centers for Disease Control and Prevention
Atlanta, GA 30333

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