Immunocompromised patients deserve special consideration and encompass a very large group: patients with congenital immunodeficiencies, diabetes mellitus, chronic renal failure, or liver failure; splenectomized patients; chronic alcoholics; cancer patients; and HIV-positive patients. Of all of these patients, those undergoing chemotherapy and those with AIDS have the greatest risk of acquiring a zoonotic infection. 7 It is estimated that 30 to 40 percent of immunocompromised patients may own pets.57 Salmonella and Campylobacter are the two most common infections acquired by immunocompromised patients from their pets,7 but the overall risk of transmission of Salmonella and Campylobacter from contact with pets is low. Additionally, Mycobacterium marinum, from aquatic pets, and Bartonella, from cats, are also commonly acquired by immunocompromised patients. Other acquired zoonotic infections that immunocompromised patients are susceptible to include
Toxoplasma gondii, Cryptosporidium, Giardia, Rhodococcus equi, Bartonella, Mycobacterium marinum, and Bordetella bronchiseptica (Table 145-9). With the exception of Bartonella (cat-scratch disease), most of these zoonotic infections are acquired by immunocompromised patients from sources other than exposure to animals.54 These sources are principally from contaminated food or water. Nevertheless, it is important for emergency physicians to inquire about animal exposure and zoonotic risk factors when evaluating immunocompromised patients. Consultation with an infectious disease specialist and a veterinarian may be warranted in evaluating immunocompromised patients in the emergency department.
TABLE 145-9 Zoonotic Infections Among HIV-Positive Patients
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