Risk Assessment

Zoonotic infections are common in North America, with an estimated 4 million people infected annually. 5 These diseases are underdiagnosed, and the possibility of a zoonotic infection should be an integral part of the differential diagnosis of any patient who presents with an infectious syndrome. Specific occupations and avocations result in an increased risk of zoonotic acquisition by increased exposure to both domestic and nondomestic animals. Farmers, migrant workers, slaughterhouse workers, veterinarians, cattle ranchers, animal researchers and handlers, forestry workers, hunters, pet owners, and outdoor enthusiasts all have an inherent risk of acquiring a zoonotic infection.6 The type of animal exposure is another important factor. Dressing, skinning, or handling an animal's skin; a history of animal bite or scratch; and ingestion of animal or dairy products all carry an associated risk of zoonotic infection. Recent travel and history of habitation, particularly in an underdeveloped country or rural area, represent particular risk factors for zoonotic infection. Other factors are a patient's immunologic status and the presence of comorbid or debilitating diseases. Patients with acquired immune-deficiency syndrome, diabetes, alcoholism, intravenous drug abuse, asplenism, cancer, and a history of chemotherapy all have an increased risk of acquiring a zoonotic infection. When assessing a patient who might have a zoonotic disease, information regarding occupation, avocation, place of residence, exposure to pets and to domesticated and wild animals, immunologic status, history of debilitating illness or drug and alcohol abuse, travel history, and arthropod exposure is very important to elicit ( T§M§..,.145i,1).7

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