0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
From the Centers for Disease Control and Prevention |

Brief Report: Tularemia Associated With a Hamster Bite—Colorado, 2004 FREE

JAMA. 2005;293(8):925. doi:10.1001/jama.293.8.925.
Text Size: A A A
Published online

BRIEF REPORT: TULAREMIA ASSOCIATED WITH A HAMSTER BITE—COLORADO, 2004

MMWR. 2005;53:1202-1203

In April 2004, the Colorado Department of Public Health and Environment (CDPHE) was notified about a boy aged 3 years with diagnosed tularemia associated with a hamster bite. Tularemia has not been associated previously with pet hamsters. CDPHE conducted an investigation to determine whether other owners of hamsters were at risk. Clinicians and public health officials should be aware that pet hamsters are a potential source of tularemia.

During January 2–February 8, the boy was exposed to six hamsters that his family had purchased from a pet store in the Denver metropolitan area. Each hamster reportedly died from “wet tail disease” (i.e., diarrhea) within 1 week of purchase. One hamster bit the child on the left ring finger shortly before it died. Seven days later, the child had fever, malaise, painful left axillary lymphadenopathy, and skin sloughing at the bite site. After treatment with amoxicillin clavulanate failed, the patient underwent excisional biopsy of a left axillary lymph node 49 days after symptom onset for persistent painful lymphadenopathy and intermittent fever. Tissue culture yielded a suspected Francisella tularensis isolate, which was confirmed by real-time polymerase chain reaction and timed-release fluorescence at the CDPHE laboratory. Convalescent serology was positive at a titer of 4,096, and the isolate was identified by CDC as type B. No other risk factors for tularemia exposure were identified, including no other animal contact, no exposure to game meat, and no known mosquito, tick, or fly bites. The patient improved after treatment with ciprofloxacin.

Workers at the pet store reported an unusual number of deaths among hamsters but not other animals during January-February; no carcasses were available for testing. One of two cats kept as store pets had a positive serologic test for F. tularensis at a titer of 256. Neither cat had appeared ill to store employees.

Lists of employees, pet suppliers, and customers who purchased hamsters during December 2003–February 2004 were obtained from the store owner. Fifteen of 18 customers were located and interviewed. Eight of these had hamsters that died within 2 weeks of purchase, but all carcasses had been disposed of and were unavailable for testing. One customer and one employee who had febrile illness after being bitten by hamsters from the store were negative for F. tularensis by serologic testing. The same customer’s hamster was available, and it was also negative for F. tularensis by serology and culture.

Approximately 80% of the 50 hamsters at the pet store came from customers who had pets with unanticipated litters. The other 20% were purchased from two small-pet breeders. These breeders were contacted, and neither reported an unusually high number of deaths of hamsters or other animals. One breeder also supplied animals to two pet stores in Wyoming. The Wyoming Department of Health had not been notified of any tularemia cases linked to these stores.

Confirmation of a hamster as the infectious source was limited by the delay between the patient’s illness onset and diagnosis and subsequent lack of availability of implicated hamsters for testing. Nonetheless, the hamster that bit the patient was the most likely cause of infection because no other exposures or risk factors were identified. The positive serologic test for F. tularensis in a pet cat at the store suggested that other animals in the store might have been exposed to F. tularensis. In addition, the proximity of the onset of the patient’s illness to the timing of the hamster bite, reports of illness among hamsters, and the deaths of hamsters at the pet store indicated an infected hamster as the likely source of illness. A possible scenario, similar to an outbreak of tularemia that involved zoo primates,1 is that infected wild rodents infested the store and spread the infection to hamsters by urinating and defecating through metal screens covering hamster cages. The infected cat might have had a subclinical or unrecognized illness after catching or eating an infected wild rodent.

The storeowner was advised to set traps for wild rodents and to inform the state health department of any recurrent animal deaths or reports of ill customers or staff. No other cases have been identified.

Although tularemia has been associated with hamster hunting in Russia,2 it has not been associated previously with pet hamsters in the United States. However, clinicians and public health officials should be aware that pet hamsters might be a potential source of tularemia. Moreover, because F. tularensis is a potential agent of biologic terrorism,3 clinicians should have a heightened awareness of tularemia.

Reported by:

J Pape, K Gershman, MD, Colorado Dept of Public Health and Environment. J Petersen, PhD, Div of Vector-Borne Infectious Diseases, National Center for Infectious Diseases; DD Ferguson, MD, JE Staples, MD, EIS officers, CDC.

Acknowledgments

This report is based, in part, on contributions by S Dolan, Children’s Hospital, Denver; S Leach, Colorado Dept of Agriculture; staff of the Colorado Dept of Public Health and Environment laboratory.

REFERENCES
Calle PP, Bowerman DL, Pape WJ. Nonhuman primate tularemia (Francisella tularensis) epizootic in a zoological park.  J Zoo Wildl Med. 1993;24:459-468
Munnich D, Lakatos M. Clinical, epidemiological, and therapeutical experience with human tularemia.  Infection. 1979;7:61-63
PubMed   |  Link to Article
Dennis DT, Inglesby TV, Henderson DA.  et al.  Tularemia as a biological weapon: medical and public health management.  JAMA. 2001;285:2763-2773
PubMed   |  Link to Article

Figures

Tables

References

Calle PP, Bowerman DL, Pape WJ. Nonhuman primate tularemia (Francisella tularensis) epizootic in a zoological park.  J Zoo Wildl Med. 1993;24:459-468
Munnich D, Lakatos M. Clinical, epidemiological, and therapeutical experience with human tularemia.  Infection. 1979;7:61-63
PubMed   |  Link to Article
Dennis DT, Inglesby TV, Henderson DA.  et al.  Tularemia as a biological weapon: medical and public health management.  JAMA. 2001;285:2763-2773
PubMed   |  Link to Article

Letters

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 1

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Tularemia associated with a hamster bite--Colorado, 2004. MMWR Morb Mortal Wkly Rep 2005;53(51):1202-3.