Reptile Salmonella Transmitted Through Platelet Donations From Apparently Healthy Owner of Asymptomatic Boa
Three articles from the general press
October 3, 2002
Salmonella Gets Into Transfusions
OKLAHOMA CITY (AP) -- Salmonella from a blood donor's pet snake was passed through transfusions to two patients, one of whom died, officials said.
Doctors are unsure if the infection caused the patient's death. The other person receiving the infected blood survived.
The tainted blood was only the third case reported in medical literature of salmonella being transmitted through a transfusion of platelets, officials at the Oklahoma Blood Institute said Wednesday. Platelets are a component extracted from blood that helps promote clotting.
The infection may also be the first recorded case of transmission from a pet reptile to a human, officials said. A report on the case is featured in Thursday's edition of The New England Journal of Medicine.
The 47-year-old snake owner donated platelets April 7, 2001. He and his daughter had been ill less than three weeks before, but exhibited no symptoms during the donation.
On April 11, some of the platelets went to a 51-year-old leukemia patient in Tulsa. She immediately became ill but later recovered. Salmonella was diagnosed two days later, although doctors suspected it came from previous health problems, or from the woman's pet cat.
On April 12, more of the platelets were given to a 50-year-old Oklahoma City woman brought to a hospital because of esophageal bleeding and severe high blood pressure. The woman, who had a history of cirrhosis, gastritis and multiple ulcers, died later that day of blood loss and other complications.
"At the time when it happened, we were concerned. We didn't know why,'" said Dr. Ron Gilcher, president and medical director of the Oklahoma Blood Institute.
Gilcher said when salmonella was found in both women, technicians called the donor and asked him to come in for testing. The man showed no sign of infection but mentioned his pet boa constrictor at some point during interviews.
"Knowing that reptiles, and specifically snakes and turtles, are known to carry salmonella, we asked him if we could culture his pet snake," Gilcher said.
Bacteria was present in a stool sample from the snake.
The two transfusions used up the infected platelets, Gilcher said. No other contamination was found in any of the man's other blood donations, he said.
"He had 50 donations in our system," Gilcher said. "This man is a wonderful person."
The Oklahoma Blood Institute will begin in December to test bacterial cultures of all donated platelets. Gilcher said no other U.S. blood centers are doing the testing.
Passes Salmonella From His Pet Snake
An Oklahoma man who caught a salmonella infection from his pet snake passed the illness to two people through transfusions of his blood platelets, a doctor reported in a journal article published today. Both recipients became ill, and one died.
The case resulted from the convergence of two public health problems, researchers said: first, that reptile pets, like snakes, lizards and turtles, often carry salmonella and can spread it to their owners, and second, that platelets can transmit infection.
Even though the case was considered extremely rare, it has prompted the Oklahoma Blood Institute, which collected the platelets, to change its practices and prepare to perform bacterial cultures on all donated platelets. The medical director of the center, Dr. Ronald O. Gilcher, said he knew of no other regional blood centers that tested platelets for the bacteria. Dr. Gilcher is an author of the article about the case published today in The New England Journal of Medicine.
Platelets, components of the blood involved in clotting, are more likely than other blood products to spread infection because they must be stored at room temperature, which gives bacteria a chance to multiply.
The Food and Drug Administration says 17 people died in 2002 and 8 in 2001 from bacterial infections transmitted by platelets. Dr. Gilcher and his colleagues said that more cases of illness and death might occur but that patients' underlying illnesses might be mistakenly blamed.
New techniques to kill germs in blood, called pathogen inactivation or pathogen reduction, are used in some parts of Europe and are being studied in the United States but have not been approved for use here.
In the Oklahoma case, the donor, who did not feel ill, donated platelets on April 7, 2001. They were given to two patients, one on April 11 and one on April 12.
The first patient, a 51-year-old woman with leukemia, became ill before the transfusion was even completed, with nausea, vomiting, chills and fever. Her kidneys temporarily failed, and she needed dialysis for several weeks, but she recovered.
The second patient, a 50-year-old woman, was given platelets to treat bleeding in her digestive tract. Within an hour, she developed chills, fever, a rapid heartbeat and such severe breathing trouble that she needed a respirator. She died that day.
On April 19, after the transfusion recipients became infected, doctors tested the donor's blood and stool for salmonella, but did not find it. Doctors assumed that even though the donor had taken antibiotics and felt fine when he donated platelets, he must have been carrying bacteria in his blood. But they wondered how he had caught salmonella.
"It took some significant and lengthy questioning before we finally hit the right question and the donor told us he had a pet snake," Dr. Gilcher said, adding that the snake was a 9-foot boa constrictor. "Then it took a brave soul to go and culture the stool of that snake. And they don't defecate very often. It took about two weeks before the snake defecated."
Salmonella grew out of the specimen from the snake, and tests revealed it to be exactly the same type found in the patients. Dr. Gilcher said that the donor was barred from giving blood or platelets - unless he got rid of the snake.
Many reptiles are natural carriers of salmonella and do not get sick from it. But they excrete the bacteria, which may spread to anyone who handles the animal. Reptile owners are advised to wash their hands after handling their pets and to keep them away from food preparation. But Dr. Gilcher's article said that pet reptiles might account for 3 percent to 18 percent of the 1.4 million salmonella infections that occur every year in the United States. And those infected people are a potential source of tainted blood.
Reptiles Can Be Source of Salmonella Infection
Salmonella infection caused by reptiles is likely to increase in the US as more people adopt snakes, iguanas and other reptiles as pets, researchers predict.
Consequently, the bacterial infection, which can go unrecognized in some individuals, could pose a threat to people who receive blood transfusions, as described in an article in the October 3rd issue of The New England Journal of Medicine.
Symptoms of Salmonella infection include fever, headache, nausea, vomiting, abdominal pain and diarrhea. The infection is not dangerous for healthy people but can be fatal for chronically ill people, the elderly or very young children.
The report documents two patients who developed sepsis, a potentially fatal reaction to infection, from Salmonella. The infection was traced back to a donor who appeared healthy but was later found to have asymptomatic Salmonella infection from handling his pet boa constrictor.
A person does not have to actually handle a reptile in order to become infected, note Dr. James N. George from the University of Oklahoma in Oklahoma City and colleagues. It's possible to contract the infection just by living in the same house as an infected pet, the study authors explain.
In the US, up to 3% of households have a pet reptile, which suggests reptiles could account for up to 18% of the roughly 1.4 million cases of Salmonella infections that occur nationwide each year.
"These estimates suggest that reptile-associated salmonellosis could pose an unrecognized risk of contamination of platelet products from apparently healthy donors," the researchers write.
Doctors, therefore, will need to recognize that blood and blood product donors with no symptoms may be carrying Salmonella, they conclude.
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