A 20 y.o. returns from spring break in Curacao. He has fever and diarrhea.

What possible exposures are found in Curacao? Hint: it has something to do with animals.

Curacao

Our patient had Salmonella typhimurium after riding ostriches.  Curacao contains one of the biggest breeding farms for ostriches outside of Africa. Ostriches are bred for meat, leather, and yes, even for riding.

Diseases of Curacao

1.      Ostrich related

Chickens, song birds  and ostriches  carry Salmonella as part of their intestinal flora.  The bacteria is spread through their feces. Birds have  a cloaca, a single chamber, that is an external opening for the digestive, urinary and  reproductive tracts.  Feces can easily contaminate eggs and meat.  

2.      Diseases of feral hogs

Curacao is also known for its feral hogs. Swimming with them is a popular tourist attraction. The hogs have been linked to leptospirosis, brucellosis, salmonella, pseudorabies, and parasitic diseases like trichinella. Pseudorabies  is a viral disease caused  by herpes that can lead to severe neurologic problems similar to rabies. In total feral swine are known to carry 30 bacterial and viral diseases and 40 parasites. Feral hogs can also transmit mycobacterium bovis and leptospirosis.

fun in Curacao

3.      Mosquito borne diseases

Dengue, zika , chikungunya, and malaria, are all present in Curacao.

FUN FACTS

Remember, there are TWO types of Salmonella:  non- typhoidal( Salmonella enteritidis and salmonella typhimurium)  and typhoidal ( Salmonella typhi) which causes typhoid fever.

Typhoid Mary had Salmonella typhi which had infected her gallbladder allowing her to spread the disease in her job as a cook. Typhoid fever is associated with a rash while non- typhoidal salmonella is not.

rose spots in typhoid fever are thought to be bacterial emboli

While most people recover from non typhoidal Salmonella in ten days, those who are immune suppressed  can develop a more severe disease with bacteremia.  The stool culture of our patient was positive for Salmonella enteriditis.  He was treated with azithromycin because of persistent fever and recovered.

Sanchez-Cordon P, Nunez A, Neimanis A, et al. African swine fever: disease dynamics in wild boar experimentally infected with ASFV isolates belonging to genotypeI and II. Viruses. 2019 Sep 13;11(9):852.

Plumb I, Schwensohn C, Gieraltowski L, et al. Outbreak of Salmonella Newport infections with decreased susceptibility to azithromycin linked to beef obtained in the United States and soft cheese obtained in Mexico United States., 2018-19 . MMWR August 23,2019/68(33):714-717.

NARMSNow: Human Data, Salmonella www.cdc.gov/NARMSNow