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- The next day, he had some numbness, tingling and other progressive signs, so he went back to emergency, where he was diagnosed with a herniated disc and sent home with more drugs.
- That night, his symptoms got worse. He became anxious and fearful, and started hallucinating, and was taken back to the hospital. There, he was diagnosed with a reaction to the drugs he was on.
- The next day, he couldnâ€™t swallow hisÂ medications, and he developed more signs of neurological disease. He ended up on a ventilator shortly thereafter because of respiratory failure.
- Nine family members and friends, and seven healthcare personnel were identified as having high-risk exposure and received post-exposure prophylaxis for rabies.
- The rabies virus strain that was isolated was a bat rabies strain found predominantly in the tricolored bat (Perimyotis subflavus). The man had apparently reported seeing a bat in his home a few weeks before he got sick. When the trailer was inspected, bats were not found but there were several places where a bat could get it. There was also the potential for exposure at work, since we worked in a warehouse where bats wereÂ occasionally seen.
Hereâ€™s where a basic epidemiology term comes in: specificity.
- Basically, the specificity of a test tells us how often we get false positive results (a positive result in an individual that does not have the disease). If the test is 95% specific, 1 in 20 positive tests will be a false positive (95% will be right, 5% will be wrong).
Another epidemiological term also comes into play: positive predictive value.
- This is the likelihood that a positive test means that the individual really has the disease.
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- How specific is the test?
- How low would the positive predictive value be in a healthy animal?
- What would the response be to a positive result?
So can testing this dog for blasto beÂ justified?
If the result is negativeâ€¦
- Thatâ€™s great. Thatâ€™s the expected and hoped-for result. If the dog is healthy and the urine test is negative, it is very unlikely this dog has blastomycosis.
If the result is positiveâ€¦
- Thatâ€™s not great. That doesnâ€™t mean the dogÂ has blasto, but it means that more work is needed. ToÂ me, that would involve a thorough physical examination and a chest radiograph to look for the characteristic lung lesions. If those were normal, odds are it is a false positive test but we still couldn’t rule out early disease. Iâ€™d probably recommend re-doing the urine test to see if the positive result was consistent and, perhaps more importantly, whether the value increased over time. If the latter, Iâ€™d be concerned that the dog was developing disease.
- I would not take a positive urine test and embark directly on a prolonged and expensive course of treatment in a clinically normal animal.
But, what is the real risk?
Can animals get infected with Zika virus?
- It depends on what you include in “animals.” We could be technicalÂ and say that humans are animals.
- Beyond that, non-human primates are susceptible. Zika was first identified in 1947 when yellow fever researchers working in the Zika forest in Uganda stumbled onto it. They had a macaque in a cage and it developed a febrile illness from something that was transmissible. The virus was described as Zika virus in 1952 and then found in people a couple of years later.
But can domestic animals get infected with Zika virus?
- Again, we need to think about the question. Infected means they get exposed to the virus and it replicates in the body. That mayÂ occur, but we donâ€™t have any evidence of it at this point.
- The more relevant question is whether animals can get sick from Zika virus exposure, and thereâ€™s also no evidence of that to date.
- A third aspect is whether infected (but potentially healthy) animals could be a reservoir for the virus, being able to pass it on toÂ mosquitoes. Thereâ€™s no evidence of that, either.
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To answer the question, we need to think about how diseases are diagnosed and reported.
Hereâ€™s whatâ€™s involved if I get Salmonella from my imaginary chickens.
- I have to get sick (the easy part)
- I have to be sick and/or motivated enough to go to a doctor.
- The doctorÂ has to ask for a fecal sample for testing.
- I have to actually collect the sample and drop it off.
- The lab has to grow Salmonella from the sample.
- That gets reported to Public Health.
- Public Health investigates and finds out I have chickens.
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- If itâ€™s 4 infections from 4000 houses with chickens, thatâ€™s different than if itâ€™s 4 infections from 8 houses with chickens.
- Itâ€™s also much different if itâ€™s 4 chicken owners vs 4 neighbours of chicken owners (who didnâ€™t choose to have chickens).
As is common, a lack of good data doesnâ€™t help the decision-making process.