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Pet ownership in immunocompromised children—A review of the literature and survey of existing guidelines

      Summary

      Pet ownership has been associated with both emotional and physical health benefits. However, owning pets may also pose health risks to immunocompromised patients through zoonotic transmission of disease. Our initial impression was that there is a lack of any evidence base in information given by health care professionals regarding these risks. We therefore aimed to produce evidence-based guidelines addressing this issue. A Pubmed search was undertaken and a variety of literature on zoonoses reviewed. Existing guidelines were evaluated and a survey of all Paediatric Oncology Centres in the UK performed. There is a paucity of level 1 and 2 data addressing this issue and clearly more studies, particularly Randomised Controlled Trials (RCTs), are required. Nevertheless, general themes emerged and certain specific guidance was produced based on that produced by the Centres for Disease Control and Prevention in the US. Animal-associated pathogens of concern include Toxoplasma gondii, Cryptosporidium spp., Salmonella spp., Campylobacter spp., Giardia lamblia, Rhodococcus equi, Bartonella spp., Bordetella bronchiseptica, Chlamydia psittaci and dermatophytes. Despite this, the literature would suggest that with the exception of Bartonella henselae and dermatophytes only a relatively small number of infections in people are likely to be associated with pet contact. The majority of pet species do not appear to pose a major risk to immunocompromised children. Some animals, particularly reptiles, should be avoided because of the high risk of salmonellosis. Guidelines include general advice on good hygiene practices, veterinary care, pet foods, purchasing of new pets and age restrictions. Health care professionals should actively enquire about household pets and provide accurate information and practical advice on how to minimise the risk of infection. However, the overall benefits of the human–animal bond must be considered and with proper handling and husbandry immunocompromised patients should be able to continue to enjoy the significant benefits of pet ownership.

      Zusammenfassung

      Der Besitz eines Haustieres hat offenkundig positive Auswirkungen auf den psychischen und körperlichen Gesundheitszustand des Haustierbesitzers. Bei Patienten mit abgeschwächtem Immunsystem stellen Haustiere jedoch aufgrund möglicher Übertragungen zoonotischer Krankheitserreger potentielle Gesundheitsrisiken dar. Wir haben festgestellt, dass es für Informationen, die von Medizinern bezüglich dieser Risiken erteilt werden, bislang nahezu keine wissenschaftlichen Belege gibt. Daher haben wir uns zum Ziel gesetzt, evidenzbasierte Richtlinien zu dieser Fragestellung zu entwickeln. Es wurde eine PubMed-Recherche durchgeführt und die Fachliteratur über Zoonosen gesichtet. Des weiteren wurden vorhandene Richtlinien evaluiert, und es erfolgte ein Survey sämtlicher kinderonkologischer Zentren in Großbritannien. Es besteht ein Mangel an Level-1- und Level-2-Daten zu dieser Fragestellung. Ohne Zweifel sind weitere Studien erforderlich, insbesondere randomisierte kontrollierte Studien. Nichtsdestoweniger kristallisierten sich einige allgemeine Leitgedanken heraus, und es wurden relativ präzise Anleitungen erarbeitet, welche auf denjenigen der US-amerikanischen Centers for Disease Control and Prevention basieren. Zu den Infektionserregern, die bei Tierkontakten übertragen werden können, zählen Toxoplasma gondii, Cryptosporidium spp., Salmonella spp., Campylobacter spp., Giardia lamblia, Rhodococcus equi, Bartonella spp., Bordetella bronchiseptica, Chlamydia psittaci sowie Dermatophyten. Aus der Fachliteratur geht jedoch hervor, dass abgesehen von Infektionen durch Bartonella henselae und Dermatophyten wahrscheinlich nur wenige menschliche Infektionen durch Kontakte mit Haustieren verursacht werden. Die Mehrzahl der Haustierarten stellt für Kinder, die an einer Immunschwäche leiden, kein größeres Risiko dar. Auf einige Tiere, insbesondere Reptilien, sollten jedoch wegen des relativ hohen Salmonellose-Risikos verzichtet werden. Die Richtlinien enthalten unter anderem Informationen zu Hygienefragen, tiermedizinischer Versorgung, Futter für Haustiere, den Kauf neuer Haustiere sowie Alterseinschränkungen. Mediziner müssen gezielt danach fragen, ob in dem betreffenden Haushalt Haustiere vorhanden sind. Sie müssen präzise Informationen und praktische Ratschläge erteilen, wie das Risiko von Infektionen möglichst gering gehalten werden kann. Dabei sind jedoch die Vorteile der emotionalen Bindung zwischen Mensch und Tier zu berücksichtigen. Bei adäquatem Verhalten und korrekter Tierhaltung können auch Patienten mit Immunschwäche die signifikanten Vorteile nutzen, die sich aus dem Besitz eines Haustieres ergeben.

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