Prevalence of Enteric Zoonotic Agents in Cats less than 1 Year Old in Central New York State

Toxocara cati Infection in Cats (Felis catus): A Systematic Review and Meta-Analysis

Introduction: Toxocariasis is an infection caused in canines, felines, humans, and other vertebrates by species of the genus Toxocara, such as T. canis and T. cati. The embryonated eggs of these parasites are the primary means of acquiring the infection for both definitive hosts, dogs and cats, respectively, and for intermediates, such as humans and other vertebrates. When deposited on park soils, environmental contamination becomes a risk to environmental, human, and animal health. Objective: To determine the global prevalence of Toxocara cati in cats (Felis catus). Methods: A systematic review of the literature was carried out in six databases (Scopus, PubMed, ScienceDirect, SciELO and Google Scholar) to evaluate the global prevalence of Toxocara cati in cats, defined by coproparasitological, histological, and molecular techniques. A meta-analysis was performed using a random effects model to calculate pooled prevalence and 95% confidence intervals (95% CI). A two-tailed 5% alpha level was used for hypothesis testing. Results: Two hundred and eighty-nine studies were included. The global pooled prevalence of Toxocara cati in cats using coproparasitological methods was 17.0% (95.0% CI: 16.2-17.8%). In the subgroup analysis according to country, Nepal had the highest prevalence of T. cati infection (94.4%; 95% CI 89.7-99.2%). The pooled prevalence of T. cati infection by PCR in four studies was 4.9% (95.0% CI: 1.9-7.9%). Conclusions: This systematic review underscores the need for preventive action against toxocariasis due to its widespread prevalence. The interplay between animal and human health should be emphasised, necessitating measures like deworming cats, hygiene practices, and public education to mitigate risks. Safeguarding feline health can also reduce human transmission, benefiting both species.

Survey on the prevalence of intestinal parasites in domestic cats (Felis catus Linnaeus, 1758) in central Nepal

INTRODUCTION

Cats (Felis catus) are the only felines that live in close contact with humans. Since cats can act as vectors, carriers, reservoirs and definitive hosts of many gastrointestinal (GI) parasites, parasitic assessment could contribute to their survival and well-being.

AIMS

The current study aimed to assess the diversity and prevalence of GI parasites in domestic and feral cats from Ratnanagar in Chitwan in Central Nepal.

METHODS

A total of 107 fresh faecal samples of cats (90 household cats and 17 feral cats) of varied ages and sex were collected and transported to the laboratory. The copromicroscopic examination was carried out following direct wet mount, formalin-ethyl acetate sedimentation, saturated salt flotation, acid-fast staining and sporulation techniques. Furthermore, associated risk factors were evaluated to ascertain the predictor of risks for parasitic acquisition.

RESULTS

The current study revealed an overall 95.3% prevalence rate with a 100% rate in feral cats and 94.4% in household cats. Altogether, 18 (17 known and one unknown) different species of GI parasites were reported with the helminths (95.3%; 11 species) and the protozoa (55.1%; seven species). Besides age and sex, outdoor lifestyle, absence or unknown history of medication and hunting behaviour of the felines are the predictors of risk. Furthermore, mixed infection was comparatively higher than single infection in the faecal samples.

CONCLUSIONS

Cats harbour a higher prevalence and greater diversity of GI parasites, and parasitism varies with age and sex. This finding can be essential for veterinarians and public health authorities for strategic treatment and for assessing the zoonotic transmission of the parasites from these felines. Importantly, an effective medication strategy for cats and owners is recommended.

The global prevalence and risk factors of Cryptosporidium infection among cats during 1988-2021: A systematic review and meta-analysis

Cryptosporidiosis is an important zoonosis caused by Cryptosporidium. This disease causes a global public health problem. The cat is considered to be one of the potential hosts for transmitting Cryptosporidium to humans. In this study, a global meta-analysis for Cryptosporidium infection in cats was performed. The articles related to Cryptosporidium infection in cats were systematically searched in databases China National Knowledge Infrastructure (CNKI), Wanfang data, VIP Chinese Journal Database, PubMed, and ScienceDirect. Finally, 92 articles published from 1988 to 2021, which met the criteria of systematic review and meta-analysis, were collected. During the selected period, the overall prevalence of Cryptosporidium among cats was identified to be 6.0%. The prevalence of Cryptosporidium detected by microscopy, coproantigens, and molecular biology methods were 4.2%, 8.2%, and 5.0%, respectively. Among 9 species/genotypes (C. felis, C. parvum, C. muris, Cryptosporidium rat genotype IV, C. baileyi, C. ryanae, C. hominis, Cryptosporidium sp. rat genotype III and most closely related to Cryptosporidium sp. rat genotype III), the prevalence of C. parvum (4.2%) was significantly higher than that of other species/genotypes. Among five continents, the prevalence of Cryptosporidium in Africa (30.5%) was significantly higher than in other continents. We also analyzed the effects of different geographical factors (longitude, latitude, altitude, mean temperature, precipitation, and humidity) on Cryptosporidium infection among cats. The results showed that cryptosporidiosis was common in cats all over the world. This systematic review and meta-analysis has systematically introduced the global epidemiology of Cryptosporidium in cats and correlated risk factors. Health authorities, doctors, veterinarians and cat owners' awareness of the prevalence, risk factors and complications of Cryptosporidium are important for the development of effective prevention strategies for cryptosporidiosis.

Advances in molecular epidemiology of cryptosporidiosis in dogs and cats

The use of molecular tools has led to the identification of several zoonotic Cryptosporidium spp. in dogs and cats. Among them, Cryptosporidium canis and Cryptosporidium felis are dominant species causing canine and feline cryptosporidiosis, respectively. Some Cryptosporidium parvum infections have also been identified in both groups of animals. The identification of C. canis, C. felis and C. parvum in both pets and owners suggests the possible occurrence of zoonotic transmission of Cryptosporidium spp. between humans and pets. However, few cases of such concurrent infections have been reported. Thus, the cross-species transmission of Cryptosporidium spp. between dogs or cats and humans has long been a controversial issue. Recently developed subtyping tools for C. canis and C. felis should be very useful in identification of zoonotic transmission of both Cryptosporidium spp. Data generated using these tools have confirmed the occurrence of zoonotic transmission of these two Cryptosporidium spp. between owners and their pets, but have also shown the potential presence of host-adapted subtypes. Extensive usage of these subtyping tools in epidemiological studies of human cryptosporidiosis is needed for improved understanding of the importance of zoonotic transmission of Cryptosporidium spp. from pets.

Endoparasite prevalence and infection risk factors among cats in an animal shelter in Estonia

Cats are important hosts for different zoonotic parasites that can be hazardous to human health. To date, few studies have attempted to identify the factors affecting parasitic infections in shelter animals. This study aims to analyse the presence of endoparasites in shelter cats in Tartu, Estonia, and identify factors affecting endoparasite prevalence and intensity. The risk factors considered were age, location (urban vs rural cats) and time spent in shelter. In total, 290 faecal samples were collected from cats at an animal shelter in 2015-2016 and investigated for endoparasites using the concentration flotation technique. In total, 138 shelter cats (47.6%) were infected with endoparasites and their overall prevalence was: Toxocara cati (36.6%), Cystoisospora spp. (12.4%), Taeniidae gen. sp. (4.1%), Toxoplasma gondii/Hammondia hammondi (3.4%), Eucoleus aerophilus (2.1%), Cryptosporidium spp. (2.1%), Ancylostoma sp. (0.7%) and Giardia sp. (0.7%). Coinfections occurred in 38 cats (13.1%) most frequently of T. cati and Cystoisospora spp. (4.5%), Cystoisospora spp. and T. gondii/H. hammondi (2.1%). Where species identification of cestode and nematode samples was not possible according to morphology, genetic analysis of the mitochondrial cox1 gene was carried out. DNA was successfully analysed for 6 out of 13 samples that required genetic identification, revealing Ancylostoma tubaeforme in one nematode sample and Hydatigera taeniaeformis in five cestode samples. Cats from rural areas had significantly higher endoparasite prevalence than cats from urban areas. Helminth prevalence decreased to some extent due to anthelmintic treatment in cats available for adoption (held ≥15 days in the shelter), whereas the prevalence of infection with protists increased significantly in these animals. It is important to note that the analysis revealed lower infection intensity for quarantine cats (held 1-14 days in the shelter) compared with cats available for adoption. The relatively high prevalence of endoparasites (including zoonotic) in shelter cats ready for adoption suggests that current anthelminthic procedures require improvements.

Toxocara seroprevalence in the USA and its impact for individuals and society

Toxocara species are intestinal helminths of dogs and cats, the larval stages of which may infect humans and cause severe neural, ocular and visceral larva migrans disease. Such cases of severe overt disease represent only a small fraction of the of the US population who have been exposed and infected with Toxocara, subsequently developing IgG antibodies to the larvae. The true impact of exposure to Toxocara in this large group of Americans remains uncertain. Toxocara antibody positivity is associated with poverty, but other specific risk factors have been identified, including sex, age, rural residence, region of residence, race and exposure to pets. This seropositive status has also been associated with several childhood diseases, including asthma and epilepsy, increased serum lead levels, and poor neurocognitive function. Three large-scale NHANES studies have provided comprehensive datasets, while several smaller studies have explored specific disease associations. Each seroprevalence study must be interpreted in consideration of the sensitivity and specificity of the individual serological methods employed. This chapter summarizes all historical Toxocara prevalence data from dogs, cats and soil in the United States. It then carefully examines all previous human Toxocara seroprevalence surveys performed in the United States. Data from these surveys is assimilated, compared and discussed to determine the validity of findings and to accurately identify risk factors for Toxocara seropositivity. The validity of associations of exposure to Toxocara larvae and childhood diseases such as asthma and epilepsy and effects neurocognitive function within the American context are also explored.

Toxocara canis and Toxocara cati in domestic dogs and cats in the United States, Mexico, Central America and the Caribbean: A review

Toxocara prevalence ranges from 0 to >87% and 0 to >60% in dogs and cats, respectively, within the United States, Mexico, Central America and the Caribbean. Higher prevalence occurs in animals less than 1 year of age. Overall, prevalence is higher in cats compared to dogs. The lowest prevalence occurs in the US owned dog population. Specific populations in this industrialized nation, in animal shelters or resource-limited locations, have prevalences similar to those seen in populations from other regions reviewed here. Conversely, subpopulations in Central America and the Caribbean have very low prevalence. Apparent contributors to prevalence, excluding animal age and climate, are socio-economic factors, attitudes towards pet management and animal population density. The lack of data from some regions pose a challenge in assessing trends; however, with the exception of the US owned dog population, there is no strong indication of any decrease in prevalence from historical levels.

Retrospective survey of parasitism identified in feces of client-owned cats in North America from 2007 through 2018

Ownership of domestic cats in North America has been on the increase; however, there are only a few surveys conducted on the prevalence of parasitism in client-owned cats over years. Our study objective was to evaluate parasite prevalence through statistical analysis of fecal examination results for client-owned cats on samples submitted to the veterinary parasitology diagnostic laboratory of Oklahoma State University over a 12-year period. All results of centrifugal flotation, saline direct smear, sedimentation, and Baermann examinations on fecal samples submitted to the Boren Veterinary Medical Hospital and Oklahoma Animal Disease Diagnostic Laboratory of Oklahoma State University from 2007 through 2018 were included. The impacts of sex, age, and seasonality on the prevalence of infection were also analyzed. A total of 2586 client-owned cat cases were included for this study. Parasites, eggs, oocysts, larvae, or cysts were not detected in the majority of cases (75.5%; 1,953/2586). Approximately 18.8% (485/2586) of client-owned cats were infected by one parasite, and 5.7% (148/2586) of cats were infected by multiple parasites. The most common parasite stage observed was Cystoisospora oocysts (9.4%; 243/2586), followed by Toxocara cati eggs (7.8%; 202/2586), Giardia cysts (4.0%; 104/2586), Alaria eggs (3.5%; 91/2586), Ancylostoma eggs (1.2%; 32/2586), taeniid proglottids/eggs (1.2%; 30/2586), Dipylidium caninum proglottids/egg packets (1.1 %; 29/2586), and Eucoleus aerophilus eggs (0.7%; 18/2586). Less commonly, Physalopetra eggs (0.19%; 5/2586), Toxascaris leonina eggs (0.19%; 5/2586), Tritrichomonas blagburni trophozoites (0.15%; 4/2586), Ollulanus tricuspis larvae/adults (0.12%; 3/2586), Platynosomum fastosum eggs (0.12%; 3/2586), Aelurostrongylus abstrusus larvae (0.08%; 2/2323), Sarcocystis sporocysts (0.08%; 2/2586), Spirometra eggs (0.08%; 2/2586), Mesocestoides proglottids/eggs (0.08%; 2/2586), Trichuris felis eggs (0.08%; 2/2586), Cryptosporidium oocysts (0.04%; 1/2586), and Toxoplasma-like small coccidian oocysts (0.04%; 1/2586) were detected. Additionally, fecal examinations revealed some ectoparasites: Demodex mites (0.9%; 24/2586), Cheyletiella mites (0.15%; 4/2586), and Otodectes cynotis mites (0.04%; 1/2586). There was no statistical significance between different sex groups (p = 0.3316). Age affected the prevalence of Cystoisospora, T. cati, Giardia, and Alaria infections with prevalence decreasing as age increased (p < 0.0001). Statistical analyses also revealed significant differences by months; the higher prevalence of infection occurred from summer through fall (p = 0.0004). Overall, as the number of submittals increased, the prevalence of infection increased over the last 12 years (p < 0.0001). This study supports continuing the current practice of routine broad-spectrum anthelmintic and ectoparasitic treatments for client-owned cats as well as annual/biannual fecal examination.

2019 AAFP Feline Zoonoses Guidelines

AIM

The overarching purpose of the 2019 AAFP Feline Zoonoses Guidelines (hereafter referred to as the 'Guidelines') is to provide accurate information about feline zoonotic diseases to owners, physicians and veterinarians to allow logical decisions to be made concerning cat ownership.

SCOPE AND ACCESSIBILITY

The Panelists are physicians and veterinarians who worked closely together in an attempt to make these Guidelines a document that can be used to support the International One Health movement. This version of the Guidelines builds upon the first feline zoonosis panel report, published in 2003 ( catvets.com/guidelines ), and provides an updated reference list and recommendations. Each of the recommendations received full support from every Panelist. Primary recommendations are highlighted in a series of 'Panelists' advice' boxes.

Giardia is the most prevalent parasitic infection in dogs and cats with diarrhea in the city of Medellín, Colombia

Parasitic agents are a common cause of diarrhea in dogs and cats and, thus, determining their prevalence is essential to establish preventive and control measures. This retrospective study examined the fecal tests records from 1111 dogs and 203 cats with diarrhea submitted to a diagnostic laboratory in the city of Medellin between January and May 2018. The detection of parasites was carried out by direct smears and simple flotation methods. Parasitic organisms were detected in feces from 464 (41.7%) dogs and 96 (47.3%) cats. In order of decreasing prevalence, the parasites detected in dogs were: Giardia intestinalis (13%), ancylostomids (12.6%), Entamoeba spp. (6.1%), coccidian oocysts (5.8%), Toxocara spp. (5.6%) and Dipylidium caninum (1.3%). In cats, the prevalence was: Giardia intestinalis (20%), coccidian oocysts (8.9%), Entamoeba spp. (7.9%), ancylostomids (6.4%), Toxocara spp. (2.5%) and Dipylidium caninum (2%). Age, but not gender, was a predisposing factor, as puppies and kittens had significantly higher infection rates that older age categories. The majority of Giardia intestinalis positive cases occurred in puppies (109/145, 75.2%) and kittens (19/36, 52.8%), making this parasite the most prevalent in amongst animals with diarrhea. Out of 117 positive infections in the adult dog population, ancylostomids accounted for 56 cases (47.9%) and was the most common parasite in this age group. In conclusion, although these results do not imply a cause and effect relationship, they are an estimate of the type of parasites that may be most commonly associated with diarrhea in dogs and cats. The lower diagnostic sensitivity of the traditional methods used here as compared to more contemporary techniques like fecal flotation with centrifugation and PCR, may have underestimated the actual prevalence and diminished the detection of co-infections. Future studies should aim to have diagnostic panels that also screen for other enteric pathogens, including bacterial and viral agents.

•

Prevalence of parasitic infections in dogs and cats can alert of potential zoonotic diseases.

•

Giardia was the most common parasitic infection in dogs and cats with diarrhea in the city of Medellin, Colombia.

•

Puppies and kittens had greater percentage of infected animals than adults.

Diversity of Salmonella serotypes from humans, food, domestic animals and wildlife in New South Wales, Australia

BACKGROUND

Salmonella is an important human pathogen in Australia and annual case rates continue to increase. In addition to foodborne exposures, cases have been associated with animal and contaminated environment contact. However, routine surveillance in Australia has tended to focus on humans and food, with no reported attempts to collate and compare Salmonella data from a wider range of potential sources of exposure.

METHODS

Salmonella data from humans, food, animals and environments were collated from a range of surveillance and diagnostic sources in New South Wales (NSW). Data were categorised to reflect one of 29 sample origins. Serotype diversity was described for each category, and the distribution of serotypes commonly isolated from humans was examined for each sample origin. The distribution of serotypes along the livestock-food-human continuum and at the companion animal-wildlife interface was also examined.

RESULTS

In total, 49,872 Salmonella isolates were included in this analysis, comprising 325 serotypes. The vast majority of these isolates were from humans (n = 38,106). Overall S. Typhimurium was the most frequently isolated serotype and was isolated from all sample categories except natural environment and game meat. S. Enteriditis was not isolated from any livestock animal, however sporadic cases were documented in food, companion animals and a reptile. Many serotypes that were frequently isolated from livestock animals and associated food products were only rarely isolated from humans. In addition, a number of key human serotypes were only sporadically isolated from livestock and food products, suggesting alternative sources of infection. In particular, S. Paratyphi B Java and S. Wangata were more often isolated from wild animals. Finally, there was some overlap between serotypes in companion animals and wildlife, with cats in particular having a large number of serotypes in common with wild birds.

CONCLUSIONS

This is the most comprehensive description of Salmonella data from humans, food, livestock, wildlife, companion animals and various environments in Australia reported to date. Results confirm that livestock and food are important sources of salmonellosis in humans but that alternative sources - such as contact with wildlife and environments - warrant further investigation. Surveillance in NSW is largely human-focussed: major knowledge gaps exist regarding the diversity and frequency of serotypes in animals. More systematic surveillance of domestic animals and wildlife is needed to inform targeted control strategies and quantitative source attribution modelling in this state.

Prevalence of enteropathogens in cats with and without diarrhea in four different management models for unowned cats in the southeast United States

•

Most cats in shelters, sanctuaries, foster homes, and trap-neuter-return programs carried at least one enteropathogen.

•

Tritrichomonas foetus and coronavirus were more common in cats with diarrhea.

•

Other bacterial, viral, protozoal, and helminth enteropathogens were present in cats with normal feces and diarrhea.

The objective of this study was to determine the prevalence of enteropathogens in cats with and without diarrhea in four different models for managing unowned cats: short-term animal shelter, long-term sanctuary, home-based foster care, and trap-neuter-return. Fecal samples from 482 cats, approximately half of the cats with normal fecal consistency and half with diarrhea, were tested by zinc sulfate centrifugation and by real-time PCR for a panel of enteropathogens.

At least one enteropathogen of feline or zoonotic importance was detected in a majority of cats, regardless of management model. For most enteropathogens, the presence or absence of diarrhea was not significantly associated with infection, the exceptions being Tritrichomonas foetus in sanctuary cats with diarrhea (26%) and normal fecal consistency (10%), respectively (P ≤ 0.04), and feline coronavirus in foster cats (80% and 58%) (P ≤ 0.001). The types of enteropathogens detected were related to the type of management model, e.g., viral and protozoal infections were most common in shelters, sanctuaries, and foster homes (confinement systems), whereas helminth infections were most common in trap-neuter-return programs (free-roaming cats).

These results suggest that management practices for unowned cats are inadequate for control of enteropathogens and that the presence of diarrhea is a poor indicator of enteropathogen carriage. Risk-management strategies to reduce transmission to people and other animals should focus on sanitation, housing, compliance with preventive care guidelines, periodic surveillance, response to specific enteropathogens, humane population management of free-roaming community cats, public health education, and minimizing the duration and number of cats in mass confinement.

Distinct fermentation and antibiotic sensitivity profiles exist in salmonellae of canine and human origin

Background

Salmonella enterica is a recognised cause of diarrhoea in dogs and humans, yet the potential for transfer of salmonellosis between dogs and their owners is unclear, with reported evidence both for and against Salmonella as a zoonotic pathogen. A collection of 174 S. enterica isolates from clinical infections in humans and dogs were analysed for serotype distribution, carbon source utilisation, chemical and antimicrobial sensitivity profiles. The aim of the study was to understand the degree of conservation in phenotypic characteristics of isolates across host species.

Results

Serovar distribution across human and canine isolates demonstrated nine serovars common to both host species, 24 serovars present in only the canine collection and 39 solely represented within the human collection. Significant differences in carbon source utilisation profiles and ampicillin, amoxicillin and chloramphenicol sensitivity profiles were detected in isolates of human and canine origin. Differences between the human and canine Salmonella collections were suggestive of evolutionary separation, with canine isolates better able to utilise several simple sugars than their human counterparts. Generally higher minimum inhibitory concentrations of three broad-spectrum antimicrobials, commonly used in veterinary medicine, were also observed in canine S. enterica isolates.

Conclusions

Differential carbon source utilisation and antimicrobial sensitivity profiles in pathogenic Salmonella isolated from humans and dogs are suggestive of distinct reservoirs of infection for these hosts. Although these findings do not preclude zoonotic or anthroponotic potential in salmonellae, the separation of carbon utilisation and antibiotic profiles with isolate source is indicative that infectious isolates are not part of a common reservoir shared frequently between these host species.

Highly suspected cases of salmonellosis in two cats fed with a commercial raw meat-based diet: health risks to animals and zoonotic implications

BACKGROUND

Feeding raw meat-based diets (RMBD) to companion animals raises public health concerns for both animals and humans. While considerable attention has been paid to bacterial contamination of commercial pet food, few literature studies have investigated foodborne disease in companion animals. Salmonellosis is reported to be infrequent in cats but no known data or studies estimating feline salmonellosis are available or large-scale epidemiological studies assessing Salmonella risk factors.

CASE PRESENTATION

Two highly suspected cases of salmonellosis in two cats fed with a commercial frozen poultry RMBD are presented, for the first time from the same household. The clinical presentation, diagnostics, treatment and follow-up are reported and the zoonotic implications are discussed.

CONCLUSIONS

This case highlights the health risks posed to both animals and owners by feeding RMBD to pets, and suggests that these risks should be considered by veterinary practitioners.

Feline cholecystitis and acute neutrophilic cholangitis: Clinical findings, bacterial isolates and response to treatment in six cases

Clinicopathological findings from six cats with confirmed cholecystitis or acute neutrophilic cholangitis are presented. Historical findings included lethargy and anorexia or inappetence of up to five days duration. On physical examination all cats were pyrexic and four out of six were jaundiced and had cranial abdominal pain. Bile samples were obtained by cholecystocentesis at exploratory coeliotomy (two cases) or by percutaneous, ultrasound-guided cholecystocentesis (four cases). Gall bladder rupture and bile peritonitis occurred subsequent to ultrasound-guided cholecystocentesis in one case. The most common bacterial isolate was Escherichia coli (four cases); E coli was isolated alone in two cases, in combination with a Streptococcus species (one case) and in combination with a Clostridium species (one case). Streptococcus species alone was isolated from one case, as was Salmonella enterica serovar Typhimurium. The latter is the first reported case of Salmonella-associated cholecystitis in a cat. Concurrent pancreatic or intestinal disease was detected histologically in three cases. All cases were treated with antimicrobials based on in vitro susceptibility results. Treatment was successful in five cases. One cat with concurrent diffuse epitheliotropic intestinal lymphoma was euthanased. Percutaneous ultrasound-guided cholecystocentesis is an effective, minimally-invasive technique enabling identification of bacterial isolates in cats with inflammatory hepatobiliary disease.

Efficacy of a combination of febantel, pyrantel, and praziquantel for the treatment of kittens experimentally infected with Giardia species

This study evaluated the effect of two combination products containing febantel, pyrantel, and praziquantel (FPP) for the treatment of Giardia species in experimentally infected kittens. In experiment 1, five kittens were administered the United States (US) formulation of FPP at doses of 37.8 mg/kg, 7.56 mg/kg, and 7.56 mg/kg, respectively, PO, q24h, for 5 days and four kittens remained as controls. In experiment 2, five kittens were administered the European formulation of FPP at the doses of 12.5 mg/kg, 12 mg/kg, and 4.16 mg/kg, respectively, PO, q24h, for 5 days and four kittens remained as controls. In experiment 3, six kittens were administered the US formulation of FPP at 56.5 mg/kg, 11.3 mg/kg, 11.3 mg/kg, respectively, PO, q24h, for 5 days and five kittens remained as controls. Thirteen days after treatment, kittens testing negative for Giardia species cysts were administered 20 mg/kg methylprednisolone acetate, IM, weekly for a maximum of two injections. Feces were analyzed for Giardia species cysts using a direct immunofluorescence test. After experiment 3, four of the six treated kittens, but no control kittens, remained negative for Giardia species after the administration of methylprednisolone acetate.

Concomitant infestation of Toxocara cati and Ancylostoma tubaeforme in a mongrel cat

A 3½ years old mongrel female cat was brought with the history of inappetence, seizure and lateral recumbency since 4 days and motion sickness since 2 days. Faecal examination confirmed Toxocara cati and Ancylostoma tubaeforme along with un-hatched live Toxocara cati larvae. Treatment has been initiated with Pyrantel pamoate and along with supportive therapy.

A Systematic Review and Meta-Analysis of the Campylobacter spp. Prevalence and Concentration in Household Pets and Petting Zoo Animals for Use in Exposure Assessments

Animal contact is a potential transmission route for campylobacteriosis, and both domestic household pet and petting zoo exposures have been identified as potential sources of exposure. Research has typically focussed on the prevalence, concentration, and transmission of zoonoses from farm animals to humans, yet there are gaps in our understanding of these factors among animals in contact with the public who don’t live on or visit farms. This study aims to quantify, through a systematic review and meta-analysis, the prevalence and concentration of Campylobacter carriage in household pets and petting zoo animals. Four databases were accessed for the systematic review (PubMed, CAB direct, ProQuest, and Web of Science) for papers published in English from 1992–2012, and studies were included if they examined the animal population of interest, assessed prevalence or concentration with fecal, hair coat, oral, or urine exposure routes (although only articles that examined fecal routes were found), and if the research was based in Canada, USA, Europe, Australia, and New Zealand. Studies were reviewed for qualitative synthesis and meta-analysis by two reviewers, compiled into a database, and relevant studies were used to create a weighted mean prevalence value. There were insufficient data to run a meta-analysis of concentration values, a noted study limitation. The mean prevalence of Campylobacter in petting zoo animals is 6.5% based on 7 studies, and in household pets the mean is 24.7% based on 34 studies. Our estimated concentration values were: 7.65x10³cfu/g for petting zoo animals, and 2.9x10⁵cfu/g for household pets. These results indicate that Campylobacter prevalence and concentration are lower in petting zoo animals compared with household pets and that both of these animal sources have a lower prevalence compared with farm animals that do not come into contact with the public. There is a lack of studies on Campylobacter in petting zoos and/or fair animals in Canada and abroad. Within this literature, knowledge gaps were identified, and include: a lack of concentration data reported in the literature for Campylobacter spp. in animal feces, a distinction between ill and diarrheic pets in the reported studies, noted differences in shedding and concentrations for various subtypes of Campylobacter, and consistent reporting between studies.

A survey study on gastrointestinal parasites of stray cats in Azarshahr, (East Azerbaijan province, Iran)

Gastrointestinal parasites are among the most common parasitic infections found in stray cats, which might act potential helminthic parasites to domestic cats. The objective of this study was to determine the prevalence of gastrointestinal parasites in stray cats in the city of Azarshahr, which is located in East Azerbaijan province, Iran. A cross-sectional study was conducted on 50 necropsied stray cats, trapped and collected from different geographic regions of Azarshahr. From a total 50 stray cats examined, 15 (30 %) were female and 35 (70 %) were male. Overall 47 cats (94 %) were identified as infected with at least one of the endoparasites. The prevalence of parasites found were: Taenia taeniaeformis (60 %), Dipylidium caninum (58 %), Taenia hydatigera (24 %), Mesocestoides lineatus (78 %), Ancylostoma tubaeforme (14 %), Toxascaris leonina (30 %), Toxocara cati (78 %), Physaloptera praeputialis (10 %), and Syphacia obvelata (10 %). Contamination rate for zoonotic parasites of cat was greater than expected in AzarShahr region. Therefore, appropriate control measures should be taken and preventive methods should be applied.

The prevalence of Giardia infection in dogs and cats, a systematic review and meta-analysis of prevalence studies from stool samples

Giardia has a wide range of host species and is a common cause of diarrhoeal disease in humans and animals. Companion animals are able to transmit a range of zoonotic diseases to their owners including giardiasis, but the size of this risk is not well known. The aim of this study was to analyse giardiasis prevalence rates in dogs and cats worldwide using a systematic search approach. Meta-analysis enabled to describe associations between Giardia prevalence and various confounding factors. Pooled prevalence rates were 15.2% (95% CI 13.8-16.7%) for dogs and 12% (95% CI 9.2-15.3%) for cats. However, there was very high heterogeneity between studies. Meta-regression showed that the diagnostic method used had a major impact on reported prevalence with studies using ELISA, IFA and PCR reporting prevalence rates between 2.6 and 3.7 times greater than studies using microscopy. Conditional negative binomial regression found that symptomatic animals had higher prevalence rates ratios (PRR) than asymptomatic animals 1.61 (95% CI 1.33-1.94) in dogs and 1.94 (95% CI 1.47-2.56) in cats. Giardia was much more prevalent in young animals. For cats >6 months, PRR=0.47 (0.42-0.53) and in dogs of the same age group PRR=0.36 (0.32-0.41). Additionally, dogs kept as pets were less likely to be positive (PRR=0.56 (0.41-0.77)) but any difference in cats was not significant. Faecal excretion of Giardia is common in dogs and slightly less so in cats. However, the exact rates depend on the diagnostic method used, the age and origin of the animal. What risk such endemic colonisation poses to human health is still unclear as it will depend not only on prevalence rates but also on what assemblages are excreted and how people interact with their pets.

Infectious diseases in large-scale cat hoarding investigations

Animal hoarders accumulate animals in over-crowded conditions without adequate nutrition, sanitation, and veterinary care. As a result, animals rescued from hoarding frequently have a variety of medical conditions including respiratory infections, gastrointestinal disease, parasitism, malnutrition, and other evidence of neglect. The purpose of this study was to characterize the infectious diseases carried by clinically affected cats and to determine the prevalence of retroviral infections among cats in large-scale cat hoarding investigations. Records were reviewed retrospectively from four large-scale seizures of cats from failed sanctuaries from November 2009 through March 2012. The number of cats seized in each case ranged from 387 to 697. Cats were screened for feline leukemia virus (FeLV) and feline immunodeficiency virus (FIV) in all four cases and for dermatophytosis in one case. A subset of cats exhibiting signs of upper respiratory disease or diarrhea had been tested for infections by PCR and fecal flotation for treatment planning.

Mycoplasma felis (78%), calicivirus (78%), and Streptococcus equi subspecies zooepidemicus (55%) were the most common respiratory infections. Feline enteric coronavirus (88%), Giardia (56%), Clostridium perfringens (49%), and Tritrichomonas foetus (39%) were most common in cats with diarrhea. The seroprevalence of FeLV and FIV were 8% and 8%, respectively. In the one case in which cats with lesions suspicious for dermatophytosis were cultured for Microsporum canis, 69/76 lesional cats were culture-positive; of these, half were believed to be truly infected and half were believed to be fomite carriers. Cats from large-scale hoarding cases had high risk for enteric and respiratory infections, retroviruses, and dermatophytosis. Case responders should be prepared for mass treatment of infectious diseases and should implement protocols to prevent transmission of feline or zoonotic infections during the emergency response and when transferring the rescued cats to other shelters or to adopters.

Enteropathogen co-infection in UK cats with diarrhoea

Background

Individual enteropathogen infections in healthy and clinically ill cats are well described, but prevalence and patterns of enteropathogen co-infection have only been reported on a limited basis. We studied enteropathogen co-infection in diarrhoeic UK cats using results of a real time PCR assay for 8 enteropathogenic species; feline coronavirus (Co), feline panleukopenia virus (Pa), Clostridium perfringens (Cl), Salmonella enterica (Sa), Giardia spp. (Gi), Tritrichomonas foetus (Tr), Cryptosporidium spp. (Cr), and Toxoplasma gondii (To). Age, gender, breed and history were recorded. PCR panels from 1088 diarrhoeic cats were available for analysis.

Results

Overall enteropathogen prevalence was 56.9% (Co), 22.1% (Pa), 56.6% (Cl), 0.8% (Sa), 20.6% (Gi), 18.8% (Tr), 24.4% (Cr) and 1.0% (To). Prevalence of Co, Gi and Tr was higher in pedigree cats compared to non-pedigree cats (DSH) and prevalence decreased with increasing age for Co, Pa, Gi, Cr and Tr. Co-infection was common: ≥2 enteropathogens were detected in 62.5% of cats, and 13.3% of cats had ≥4 enteropathogens. Mean ( x¯) enteropathogen co-infection 2.01 (±1.3 SD), was significantly higher in pedigree cats ( x¯ =2.51) compared to DSH ( x¯ =1.68) and decreased with age ( x¯ =2.64 <6 months, x¯ =1.68 for >1 yr). More cats were negative for all 8 enteropathogens tested (12.7%) than expected. When exact combinations of co-infection were examined, Tr tended to be found in combinations with Co, Cl, and Gi.

Conclusions

Multiple infections should be considered the most likely result of faecal testing in cats, and case management needs to take this into account. In contrast, the relatively high percentage of cats negative for all 8 enteropathogens tested could indicate an innate resistance to infection. Alternatively it could indicate a lack of exposure to these 8 enteropathogens or the presence of other enteropathogens not assessed by this assay.

Cryptosporidiosis: comparison of three diagnostic methods and effects of storage temperature on detectability of cryptosporidia in cattle faeces

Three diagnostic methods (a modified Ziehl-Neelsen staining technique (MZN), a negative staining with carbol fuchsine (CF) and a commercial enzyme immunoassay (EIA) kit, ProSpecT® Cryptosporidium Microplate Assay (Remel, Lenexa, KS, USA)) for detection of Cryptosporidium oocysts in cattle faeces were compared regarding sensitivity and suitability under routine laboratory conditions, with particular emphasis on sample storage. In the 103 faecal samples examined, cryptosporidia infections were detected significantly more often by EIA (p<0.05; n=76) than by MZN (n=65) if ten random fields were evaluated microscopically, but not if the whole coverslip was scanned. In contrast, sensitivities of EIA and CF (n=69) did not differ significantly. Results were obtained very rapidly by CF. However, the hands-on time of CF is comparable to EIA, while MZN is more time consuming. EIA is more expensive than CF and MZN but easy to perform and to evaluate and does not need considerably experienced staff in contrast to CF and MZN. Moreover, 45 faecal samples stored for up to 27 days at different temperatures (+6°C, +16°C, +30°C, +40°C) were examined. The sensitivity of microscopic detection of oocysts in stained smears (CF, MZN) decreased in a temperature and time-dependent manner, while EIA results were not influenced by sample storage at any temperature.

Gene-centric metagenomics analysis of feline intestinal microbiome using 454 junior pyrosequencing

The feline gastrointestinal microbiota have direct influence on feline health and also human health as a reservoir for potential zoonotic pathogens and antibiotic resistant bacterial strains. In order to describe the feline gastrointestinal microbial diversity, fecal samples from cats have been characterized using both culture-dependent and culture-independent methods. However, data correlating total microbial composition and their functions are lacking. Present descriptive study evaluated both phylogenetic and metabolic diversity of the feline intestinal microbiota using GS Junior titanium shotgun pyrosequencing. A total of 152,494 pyrosequencing reads (5405 assembled contigs) were generated and classified into both phylogenetic and metabolic profiles of the feline intestinal microbiota. The Bacteroides/Chlorobi group was the most predominant bacterial phylum comprising ~ 68% of total classified diversity, followed by Firmicutes (~ 13%) and Proteobacteria (~ 6%) respectively. Archaea, fungi and viruses made up the minor communities in the overall microbial diversity. Interestingly, this study also identified a range of potential enteric zoonotic pathogens (0.02–1.25%) and genes involved in antimicrobial resistance (0.02–0.7%) in feline fecal materials. Based on clustering among nine gastrointestinal metagenomes from five different monogastric hosts (dog, human, mice, cat and chicken), the cat metagenome clustered closely together with chicken in both phylogenetic and metabolic level (> 80%). Future studies are required to provide deeper understandings on both intrinsic and extrinsic effects such as impact of age, genetics and dietary interventions on the composition of the feline gastrointestinal microbiome.

Prevalence of selected bacterial and parasitic agents in feces from diarrheic and healthy control cats from Northern California

BACKGROUND

Bacterial and parasitic agents are commonly implicated as causes of diarrhea in cats, but there is a paucity of information evaluating epidemiological and prevalence factors associated with most of these organisms in cats.

OBJECTIVES

Determine the prevalence of selected enteropathogens in diarrheic and nondiarrheic cats.

ANIMALS

A total of 219 diarrheic and 54 nondiarrheic cats.

METHODS

Prospective study. Fresh fecal specimens were submitted for centrifugation flotation, culture, ELISA (Giardia, Cryptosporidium, Clostridium perfringens enterotoxin [CPE], and C. difficile toxin A [TcdA]) and polymerase chain reaction (PCR) testing (Tritrichomonas foetus and Campylobacter spp.). An epidemiologic questionnaire was completed for each cat.

RESULTS

Campylobacter was isolated from significantly fewer diarrheic (21/219 or 9.6%) versus nondiarrheic cats (15/54 or 27.8%, P = .001), and was detected in 74 of 131 cats (56.5%) via PCR. Campylobacter jejuni, C. helveticus, and C. upsaliensis were detected in 6.8, 100, and 44.6% of the 74 cats. Multiple Campylobacter spp. were identified in 47.3% of these cats. All cats were negative on fecal culture for Salmonella and for C. difficile TcdA via ELISA. CPE was detected in 9/219 diarrheic (4.1%) and in 1/54 nondiarrheic cats (1.9%, P = .69). Cats < 2 years were significantly more likely to be infected with intestinal parasites (P < .001).

CONCLUSIONS AND CLINICAL IMPORTANCE

Routine fecal cultures and toxin immunoassays for detection of bacteria are of limited diagnostic value in diarrheic cats. Molecular-based testing is superior to fecal cultures for detection and identification of Campylobacter spp., but positive test results do not correlate to the presence of disease.

Enteropathogenic bacteria in dogs and cats: diagnosis, epidemiology, treatment, and control

This report offers a consensus opinion on the diagnosis, epidemiology, treatment, and control of the primary enteropathogenic bacteria in dogs and cats, with an emphasis on Clostridium difficile, Clostridium perfringens, Campylobacter spp., Salmonella spp., and Escherichia coli associated with granulomatous colitis in Boxers. Veterinarians are challenged when attempting to diagnose animals with suspected bacterial-associated diarrhea because well-scrutinized practice guidelines that provide objective recommendations for implementing fecal testing are lacking. This problem is compounded by similar isolation rates for putative bacterial enteropathogens in animals with and without diarrhea, and by the lack of consensus among veterinary diagnostic laboratories as to which diagnostic assays should be utilized. Most bacterial enteropathogens are associated with self-limiting diarrhea, and injudicious administration of antimicrobials could be more harmful than beneficial. Salmonella and Campylobacter are well-documented zoonoses, but antimicrobial administration is not routinely advocated in uncomplicated cases and supportive therapy is recommended. Basic practices of isolation, use of appropriate protective equipment, and proper cleaning and disinfection are the mainstays of control. Handwashing with soap and water is preferred over use of alcohol-based hand sanitizers because spores of C. difficile and C. perfringens are alcohol-resistant, but susceptible to bleach (1:10 to 1:20 dilution of regular household bleach) and accelerated hydrogen peroxide. The implementation of practice guidelines in combination with the integration of validated molecular-based testing and conventional testing is pivotal if we are to optimize the identification and management of enteropathogenic bacteria in dogs and cats.

A survey on endoparasites and ectoparasites of stray cats from Mashhad (Iran) and association with risk factors

As there appeared to be no data available on parasite infection of stray cats in the region and considering the potential threat of stray cats for animal and public health, the present study was carried out using biological samples and necropsy finding collected from cats captured in Mashhad city in the northeast of Iran. From a total 52 stray cats examined, 18 (34.6%) were male and 34 (65.4%) were female. Ten species of endoparasites including helminthes and protozoa and two species of ectoparasites were detected in the examined cats. There were two protozoa, five cestodes, three nematodes and two arthropods. Overall 46 cats (88.46%) have been infected with at least one of the parasites. The following parasites, with their respective prevalence, were found; Nematoda: Toxocara cati 28.84%, Toxocara leonina 7.69%, Physaloptera praeputialis 3.84%; Cestoda: Dipylidium caninum 23.08%, Mesocestoides lineatus 13.46%, Taenia taeniaformis 9.6%, Joyeuxiella echinorhyncoides 7.6% and Taenia hydatigena 1.92%; Protozoa: I. felis 23.7%, Haemobartonella felis 1.92%; Arthropoda: Ctenocephalides felis 1.92% and Cheyletiella blakei 1.92%. Based on our data, there was no significant difference in infection rate between male and female animals. However, the age of the cats were found to be an important risk factor associated with parasitic infection. Our results revealed that zoonotic agents, namely T. cati were present in stray cat colonies in the investigated area. In this respect, appropriate control measures should be taken and it is recommended to determine the most appropriate preventive methods.

Sources of microbial pathogens in municipal solid waste landfills in the United States of America

Municipal solid waste (MSW) categories, as specified by United States Environmental Protection Agency (US EPA), were evaluated for their relative contribution of pathogenic viruses, bacteria, and protozoan parasites into MSW landfills from 1960 to 2007. The purpose of this study was to identify trends and quantify the potential contribution of pathogens in MSW as an aid to the assessment of potential public health risks. A review of the literature was conducted to estimate values for the concentrations of faecal indicator bacteria and pathogens in the major categories of MSW. The major sources of MSW contributing enteric pathogens were food waste, pet faeces, absorbent products, and biosolids. During the last 47 years, recycling of glass, metals, plastic, paper and some organic wastes in MSW has increased, resulting in a decreased proportion of these materials in the total landfilled MSW. The relative proportion of remaining waste materials has increased; several of these waste categories contain pathogens. For all potential sources, food waste contributes the greatest number of faecal coliforms (80.62%). The largest contribution of salmonellae (97.27%), human enteroviruses (94.88%) and protozoan parasites (97%) are expected to come from pet faeces. Biosolids from wastewater treatment sludge contribute the greatest number of human noroviruses (99.94%). By comparison, absorbent hygiene products do not appear to contribute significantly to overall pathogen loading for any group of pathogens. This is largely due to the relatively low volume of these pathogen sources in MSW, compared, for example, with food waste at almost 40% of total MSW.

Bacterial enteritis in dogs and cats: diagnosis, therapy, and zoonotic potential

A variety of bacteria are known or suspected of being able to cause enteritis in dogs and cats. Campylobacter spp, Clostridium difficile, Clostridium perfringens, and Salmonella spp are most commonly implicated, but many other organisms are likely involved. Poor understanding of the intestinal microflora and the fact that many, if not all, of these microorganisms can also be found in healthy individuals complicates testing, thereby affecting the use of specific treatments and assessment of potential infection control and zoonotic disease risks. An understanding of the strengths and limitations of various diagnostic options is important for the management of canine and feline enteritis.

Laboratory tests for diagnosis of gastrointestinal and pancreatic diseases

The panel of laboratory tests available for diagnosis of gastrointestinal (GI) diseases in dogs and cats is wide, and, recently, several new tests have been developed. This article will focus on advances in laboratory tests that are available for the general practitioner for diagnosis of GI diseases. Laboratory tests for diagnosis of gastric and intestinal infectious diseases include fecal parasite screening tests, enzyme-linked immunosorbent assays for parvoviral enteritis, and some specific bacterial tests like fluorescent in situ hybridization for identification of specific bacteria attached to the intestinal epithelial cells. Serum concentrations of folate and cobalamin are markers of intestinal absorption, but are also changed in exocrine pancreatic insufficiency and intestinal bacterial overgrowth. Hypocobalaminemia is common in GI and pancreatic disease. Decreased serum trypsin-like immunoreactivity is a very sensitive and specific test for the diagnosis of exocrine pancreatic insufficiency in dogs and cats. Serum pancreatic lipase is currently the most sensitive and specific test to identify pancreatic cell damage and acute pancreatitis. However, serum canine pancreas-specific lipase is less sensitive in canine chronic pancreatitis. Increased serum trypsin-like immunoreactivity is also specific for pancreatic damage but is less sensitive. It is very likely that further studies will help to better specify the role of these new tests in the diagnosis of canine and feline pancreatic diseases.

Prevalence of fecal-borne parasites detected by centrifugal flotation in feline samples from two shelters in upstate New York

Over a 3.5-year period, fecal samples from 1322 cats from two shelters and affiliated foster homes in upstate New York were processed for parasite detection by both 1.18 spg zinc sulfate and 1.3 spg sugar double centrifugal flotation. In 50.9% of the samples at least one parasite was detected. Overall, 18 different parasites ranging in prevalence from 0.2% to 21% were recovered. The most prevalent parasites of foster and shelter cats in this study were Cystoisospora species and Toxocara cati (21% prevalence, each). In order of percentage of positive samples, other findings were: Giardia species (8.9%), Aelurostrongylus abstrusus (6.2%), taeniid eggs (3.9%), Cryptosporidium species (3.8%), Aonchotheca species (3.7%), Eucoleus species (2.3%), Ancylostoma species (2.2%), Cheyletiella species (2.0%), Dipylidium caninum (1.1%), Otodectes species, Toxoplasma-like oocysts and Sarcocystis species (0.8% each), Demodex and Spirometra species (0.4% each), and Alaria species and Felicola subrostratus (0.2% each).

Animal contact as a source of human non-typhoidal salmonellosis

Non-typhoidal Salmonella represents an important human and animal pathogen world-wide. Most human salmonellosis cases are foodborne, but each year infections are also acquired through direct or indirect animal contact in homes, veterinary clinics, zoological gardens, farm environments or other public, professional or private settings. Clinically affected animals may exhibit a higher prevalence of shedding than apparently healthy animals, but both can shed Salmonella over long periods of time. In addition, environmental contamination and indirect transmission through contaminated food and water may complicate control efforts. The public health risk varies by animal species, age group, husbandry practice and health status, and certain human subpopulations are at a heightened risk of infection due to biological or behavioral risk factors. Some serotypes such as Salmonella Dublin are adapted to individual host species, while others, for instance Salmonella Typhimurium, readily infect a broad range of host species, but the potential implications for human health are currently unclear. Basic hygiene practices and the implementation of scientifically based management strategies can efficiently mitigate the risks associated with animal contacts. However, the general public is frequently unaware of the specific disease risks involved, and high-risk behaviors are common. Here we describe the epidemiology and serotype distribution of Salmonella in a variety of host species. In addition, we review our current understanding of the public health risks associated with different types of contacts between humans and animals in public, professional or private settings, and, where appropriate, discuss potential risk mitigation strategies.

Prevalence and genetic characterization of Giardia and Cryptosporidium in cats from Italy

One hundred and eighty one cats living in central Italy were tested for the presence of Giardia and Cryptosporidium infection by IFAT test and specific PCRs. Overall eight (4.4%) samples were IFAT-positive for Giardia. All the IFAT-positive samples for Giardia scored positive for the PCRs, and three more samples IFAT-negative generated PCR products leading to a total 6.1% molecular positivity rate for Giardia. All the examined samples were negative for Cryptosporidium. Sequencing of samples molecularly positive to Giardia indicated that three cats harbored the zoonotic Giardia duodenalis Assemblage A, whereas all other positive animals were infected with the feline-specific G. duodenalis Assemblage F. Phylogenetic analysis carried out on the sequences obtained supported the clustering of the isolates within Assemblages A and F. The results here presented provide data on the occurrence of Giardia genotypes in cats living in close contact with humans highlighting the potential importance of this protozoan disease for the public health.

Emerging zoonoses in the southern United States: toxocariasis, bovine tuberculosis and southern tick-associated rash illness

The majority of emerging diseases in humans have been linked to zoonotic pathogens originating in domestic animals or wildlife. This is a public health concern because zoonotic infections affect several aspects of the society. The complex interactions among pathogen, host and environment also pose challenges in estimating the true burden of those infections. However, the recent development of new molecular diagnostic tools has allowed for better diagnosis of zoonotic infections. This review focuses on 3 emerging zoonoses, namely toxocariasis, bovine tuberculosis and southern tick-associated rash illness, and demonstrates that these infections may be more prevalent in the southern United States than previously recognized. This review places special emphasis on the recent epidemiologic trends, intra/interspecies transmission and clinical features of each of these zoonoses. In addition, treatment and prevention for each zoonotic pathogen are discussed. Clinicians working in the southern United States should be aware of the presence of those zoonotic infections.