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I found this medical story in Pubmed email sent today super interesting! Always good to be well informed!!
STREPTOCOCCUS, GROUP A - USA: (WISCONSIN) FAMILY, RECURRENT PHARYNGITIS, PET CAT SOURCE, 2018
< https://www.washingtonpost.com/health/medical-mysteries/this-familys-repeated-strep-throat-infections-frustrated-their-doctors/2020/05/22/ddbaac56-7f1c-11ea-a3ee-13e1ae0a3571_story.html> - https://www.washingtonpost.com/health/medical-mysteries/this-familys-repeated-strep-throat-infections-frustrated-their-doctors/2020/05/22/ddbaac56-7f1c-11ea-a3ee-13e1ae0a3571_story.html> ;
When [the parents] and their 3 young children trooped into a Madison, Wisconsin, urgent care clinic around 8 a.m. on New Year's Day 2018, the staff didn't seem surprised to see them. The family had sought treatment several times in the previous 2 months for recurrent strep throat infections. They had taken multiple rounds of drugs, professionally deep cleaned their home, and replaced contaminated toothbrushes, but none of it worked for long. Inevitably, the infection came roaring back.
That New Year's Day, rapid tests showed that [the mother] and all 3 children had strep; [the father] did not. 3 weeks earlier [the mother] and 2 of the children were found to be infected. And 2 weeks following the New Year's visit, after everyone had taken a full course of antibiotics, 2 of the children tested positive.
Over the next 3 months, which included several more bouts of strep, [the father] began to suspect that the cause of the repeated infection was in their home. But finding medical professionals who took his controversial hypothesis seriously proved to be a challenge.
The 1st case occurred in late October 2017. 4 months before the 1st outbreak, the family had adopted Umberto, a 3-year-old cat. After a round of antibiotics, everyone seemed to recover. But 5 weeks later, his daughters complained of sore throats. This time the entire family was tested. Throat cultures revealed that all 5 had strep. Within a few days, the infection seemed to have cleared. But success was short-lived; the New Year's Day visit occurred 3 weeks later. This time the doctor prescribed a different antibiotic.
[The father] said that he and his wife were reminded of the need to finish the full course of antibiotics and of sanitation measures they had been following, including replacing the toothbrushes they had been using. But 2 weeks later, on [16 Jan 2018], [2 daughters] had strep again. And at the end of January [2018], all 3 kids tested positive.
[The father] called his mother, a retired pediatrician who had practiced in suburban Maryland, for advice. She told him about a family she had seen who kept getting strep until they got rid of their pet cat. "I started looking at the scientific literature, and everything said that cats can't transmit strep," [the father] recalled. [He] said his wife asked their doctors about the possibility that cats could be vectors of strep, while he queried his cousin, a veterinarian. "They all pretty much said the same thing: 'There's no evidence that cats can transmit strep to humans, but if you want to be safe, get rid of the cat,'" [the father] recalled.
Although there are diseases that cats can transmit to people -- including toxoplasmosis, cat scratch disease, and ringworm -- _Streptococcus_ [group] A, the bacteria that causes strep throat, is not believed to be among them. A 2002 report from the American Veterinary Medical Association noted that while doctors sometimes blame pet cats and dogs for recurrent strep throat in children "evidence doesn't support this."
Cats and dogs can infect humans with a strain called [_Streptococcus] canis_, which is present in animal saliva and is usually transmitted through a bite.
[The mother] asked their vet whether she could test Umberto for strep in case he was a conduit. The vet refused: Umberto seemed healthy and there was no reason to swab the throat of a healthy cat, which would require hooking him up to oxygen and administering general anesthesia. As a scientist, [the father] said he was frustrated that no one seemed willing to consider the possibility that in rare cases a cat might harbor strep that could be transmitted to humans. A few published reports had suggested such a scenario. Among them is a 2007 letter in the Mayo Clinic Proceedings by a Pennsylvania internist who described an experience similar to the [this father's] family [see < https://www.mayoclinicproceedings.org/article/S0025-6196 - https://www.mayoclinicproceedings.org/article/S0025-6196 (11)60988-9/abstract> His 3 young children developed recurrent strep, which was eradicated after they -- and their cat -- were treated simultaneously with antibiotics.
The [family] called a few veterinary practices to see if they'd test Umberto; all said no. In early March [2018], 3-year-old [daughter] got strep throat along with respiratory syncytial virus, which led to pneumonia, resulting in a 2-day hospitalization. After she got home, the couple was discussing the plethora of medical resources available in Madison, which includes a large and respected college of veterinary medicine. [The mother] wound up talking to Caitlin Barry-Heffernan, a 4th-year veterinary internal medicine resident. Then she handed the phone to her husband for his pitch.
"We were all kind of skeptical," recalled Barry-Heffernan, who now practices in Southfield, Michigan, outside Detroit. It is uncommon, she said, for cats to carry strep A, because the bacteria" doesn't like to live on animals." But she was intrigued by the possibility and persuaded by [the father]. He was scientifically knowledgeable and "it was a pretty believable circumstance." Barry-Heffernan said she walked down the hall to consult with a veteran microbiologist. "She was very skeptical," Barry-Heffernan recalled, but agreed that "we should be able to culture it if it's there."
On [4 Apr 2018], while the entire family was taking antibiotics for the 7th bout of strep in as many months, Umberto was seen by Barry-Heffernan and a vet student. They whisked Umberto, who Barry-Heffernan said seemed "perfectly healthy," into a nearby room and quickly swabbed his throat. Neither anesthesia nor oxygen was required. To the surprise of the vet school faculty, group A strep was found in the cat's throat; it appeared to match the strain of strep collected during [the father]'s most recent throat culture.
"Almost certainly Umberto was contributing to the family's infections," Barry-Heffernan said. She prescribed antibiotics for the cat and a disinfectant spray for his fur. And the family was given another round of antibiotics. Soon afterward they left on a previously scheduled 2-week trip to Costa Rica. In their absence, Umberto was given his medication, and the house was professionally cleaned for a 2nd time. Since then, [the father] said, no one has had strep.
"Once we identified Umberto as a carrier, it was really easy to address," Barry-Heffernan said. It seems likely that the infection was being passed among the asymptomatic cat and various members of the family; it probably originated in a human. Barry-Heffernan said she hopes that the [family's] unusual case doesn't cause people to get rid of their pets. "It was very easily treated," she noted.
[Byline: Sandra G Boodman]
-- Communicated by: ProMED-mail
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'A man who does not think and plan long ahead will find trouble right at his door.'
--Confucius
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