Zoonotic diseases and their transmission modes.
Abstract
Zoonotic diseases, transmitted between animals and humans, have significant implications on public health, including oral health. This chapter aims to provide a comprehensive overview of the oral manifestations of zoonotic diseases and their prevention, highlighting the importance of early recognition and management by dental professionals. The chapter will discuss the various oral manifestations associated with common zoonotic diseases, such as periodontal manifestations, mucosal lesions, and salivary gland disorders, emphasizing the need for accurate diagnosis and timely referral to appropriate healthcare providers. Moreover, the chapter will delve into the role of dental professionals in preventing zoonotic disease transmission in clinical settings. It will explore the significance of education and training in recognizing and managing the oral manifestations of zoonotic diseases. Additionally, the chapter will emphasize the implementation of preventive measures, including the appropriate use of personal protective equipment, adherence to stringent infection control protocols, and the development of animal handling policies. By highlighting the intricate relationship between oral health and zoonotic diseases, this chapter aims to underscore the critical role of dental professionals in safeguarding the health and well-being of their patients and communities.
Keywords
- zoonotic diseases
- oral manifestations
- disease prevention
- dental professionals
- infection control
- diagnosis
- periodontal disorders
- interdisciplinary collaboration
1. Introduction
Zoonotic diseases, also known as zoonoses, are infectious diseases that can be transmitted between animals and humans. These diseases are caused by a variety of pathogens, including viruses, bacteria, parasites, and fungi. Zoonotic diseases can be spread through various mechanisms, such as direct contact with animals, contact with animal products or waste, ingestion of contaminated food or water, and transmission by vectors like insects [1]. Zoonotic diseases have been a part of human history for centuries, with some of the most well-known examples being rabies, Lyme disease, and the H1N1 influenza (swine flu) [2]. The emergence and spread of zoonotic diseases are influenced by several factors, including human encroachment on wildlife habitats, increased interactions between humans and animals, climate change, and global trade and travel [3]. As the human population continues to grow and expand, there is increasing pressure on ecosystems and natural habitats. This encroachment often leads to closer interactions between humans, domestic animals, and wildlife, creating more opportunities for zoonotic diseases to emerge and spread. Urbanization, deforestation, and changes in land use are some of the factors that contribute to this phenomenon [4].
1.1 Oral health and zoonotic disease
Oral health plays a crucial role in the overall well-being of individuals. While it is often overlooked, oral hygiene has significant implications not only for dental health but also for general health, including the prevention and control of zoonotic diseases. Zoonotic diseases are infectious diseases that can be transmitted between animals and humans, with pathogens including viruses, bacteria, parasites, and fungi. Oral health and zoonotic diseases are closely interconnected, with various mechanisms linking the two. Poor oral hygiene can create an environment conducive to the growth and proliferation of harmful microorganisms, including those responsible for zoonotic diseases [5]. Moreover, some zoonotic pathogens can be transmitted through saliva, making oral health an essential factor in preventing disease transmission. For instance, rabies, a viral zoonotic disease, is primarily transmitted through the saliva of infected animals via bites or scratches [6]. A compromised oral health status can weaken the immune system, making individuals more susceptible to infections, including zoonotic diseases [7]. A healthy oral environment is essential for maintaining a strong immune system and reducing the risk of contracting and spreading zoonotic diseases. Table 1 describes zoonotic diseases and their transmission modes.
Sl No | Condition | Causative organism | Vector | Transmission mode |
---|---|---|---|---|
1 | Monkeypox | Monkeypox virus | Rodents and primates | Human-to-human transmission through respiratory droplets or contact with bodily fluids |
2 | COVID-19 | SARS-CoV-2 virus | Originated in bats, transmitted to humans through an intermediate host, possibly a pangolin | Transmission through respiratory droplets or contact with bodily fluids |
3 | Hand, foot, and mouth disease | Coxsackie A virus | Not a zoonotic disease itself, but the virus can infect animals and be transmitted to humans | Close personal contact, coughing, contact with infected objects |
4 | Herpes B Virus infection | Herpes B virus (Macacine herpesvirus 1) | Macaque monkeys | Contact with infected saliva, feces of the macaque monkeys |
5 | Candidiasis | — | Contact with contaminated hands or medical devices. | |
6 | Histoplasmosis | Cattle, sheep, horses (target animals) | Infected by inhaling fungal spores from contaminated soil | |
7 | Blastomycosis | Direct animal-to-human transmission is rare. Dogs, cats, horses, marine mammals (target animals) | Infected by inhaling fungal spores from moist soil and decaying organic matter | |
8 | Paracoccidiodomycosis | Direct animal-to-human transmission is rare. Dogs and domesticated wild animals, especially armadillos and monkeys (target animals) | Infected by inhaling fungal spores from the environment, injuries of the skin and mucosal membranes | |
9 | Sporotrichosis | Cats; occasionally dogs, horses, cows, camel, dolphin, goat, mule, bird, pig, rat, armadillo (target animal) | Through contact with infected plant material, soil, or animals, especially cats | |
10 | Aspergillosis | All domestic animals and birds | By inhaling fungal spores from the environment | |
11 | Cryptococcosis | Found in the environment, particularly in soil or bird droppings, such as those from pigeons | Mainly by inhalation of fungus, occasionally through breaks in the skin | |
12 | Zygomycosis (mucormycosis) | fungi from the Mucorales order | Not directly transmitted from animals to humans | Inhalation of spores from the environment. |
13 | Cat-Scratch Disease | Infected cats, particularly kittens | Through contact with cat saliva on broken skin or mucous membranes, such as the eyes, nose, or mouth | |
14 | Plague | Rodents such as rats, mice, and squirrels | Inhaling respiratory droplets from infected individuals |
2. Zoonotic viral diseases with oral manifestations
Viral zoonotic diseases are caused by viruses and can be spread through direct contact with infected animals, consumption of contaminated food, or through vectors like mosquitoes or ticks [8, 9].
2.1 Monkeypox
Monkeypox is a rare viral zoonotic disease primarily found in Central and West Africa. The disease is caused by the Monkeypox virus, a member of the Orthopoxvirus genus, which also includes the now-eradicated smallpox virus (Variola virus). Monkeypox is similar to smallpox in terms of symptoms and clinical presentation, but it is generally less severe. The virus is transmitted to humans from animals, primarily rodents and primates, and human-to-human transmission can occur through respiratory droplets or contact with bodily fluids. Monkeypox can cause fever, headache, and a rash that progresses to pustules [10].
Monkeypox typically presents with a prodromal phase characterized by fever, headache, muscle aches, and general malaise. This is followed by the development of a characteristic rash, which begins as macules and progresses to papules, vesicles, pustules, and finally crusts. The rash commonly involves the face, palms, and soles but can also spread to other parts of the body, including the oral cavity. Oral lesions in monkeypox may present as painful ulcers or vesicles on the tongue, buccal mucosa, palate, or gingiva (Figure 1). These lesions can be accompanied by inflammation and bleeding of the gingiva (gingivitis) or severe inflammation and destruction of the supporting structures of the teeth (periodontitis). In some cases, the oral lesions may precede or coincide with the onset of the characteristic skin rash. The presence of oral lesions can contribute to difficulty eating, drinking, and swallowing, which may result in dehydration and malnutrition, particularly in severe cases [12]. The presence of oral manifestations in monkeypox patients can be a valuable diagnostic clue, particularly in the early stages of the disease when the characteristic rash may not be fully developed. Identifying oral lesions in conjunction with systemic symptoms can help healthcare professionals differentiate monkeypox from other conditions that may present with similar symptoms, such as chickenpox, measles, or other viral infections [13].
2.2 COVID-19
COVID-19 is caused by the SARS-CoV-2 virus; this pandemic began in 2019 and has affected millions worldwide. The virus is believed to have originated in bats and transmitted to humans through an intermediate host, possibly a pangolin [14]. The SARS-CoV-2 virus, responsible for COVID-19, can cause a wide range of symptoms, including oral manifestations [15, 16]. Some patients with COVID-19 have reported symptoms such as dry mouth, loss of taste (ageusia), tongue pain, and oral ulcers [17].
Although respiratory symptoms are the most common manifestations of COVID-19, recent studies have identified various oral symptoms associated with the infection. Some of these oral manifestations include:
Xerostomia (dry mouth): COVID-19 patients may experience a reduction in salivary flow due to dehydration, fever, or mouth breathing during the illness. This can lead to dry mouth, which increases the risk of dental caries and periodontal disease.
Dysgeusia (altered taste): Many COVID-19 patients have reported a loss or alteration of taste sensation, which could be related to the virus’s impact on the taste buds or the central nervous system.
Oral ulcers and lesions: Some COVID-19 patients have presented with oral ulcers, blisters, or other lesions, which may be related to the virus’s direct effect on oral tissues or a secondary response to the systemic inflammation caused by the infection (Figure 2).
Gingivitis and periodontitis: The inflammatory response associated with COVID-19 may exacerbate pre-existing periodontal diseases or contribute to the development of new periodontal problems [16].
2.3 Hand, foot, and mouth disease (HFMD)
HFMD is caused by the Coxsackie A virus, which is not a zoonotic disease itself, but the virus can infect animals and be transmitted to humans. HFMD primarily affects infants and young children. The disease is caused by several strains of enteroviruses, most commonly Coxsackievirus A16 and Enterovirus 71 [19]. HFMD is characterized by the presence of a rash and/or blisters on the hands, feet, and mouth, as well as fever, sore throat, and other flu-like symptoms. The disease is characterized by fever, sore throat, and small painful blisters or ulcers in the mouth [20, 21].
Oral manifestations of HFMD can be one of the first and most noticeable symptoms of the disease. Some common oral manifestations include:
Oral vesicles and ulcers: The primary oral manifestation of HFMD is the appearance of small, painful vesicles and ulcers in the mouth. These lesions typically form on the buccal mucosa, tongue, and soft palate. As the vesicles rupture, they leave shallow, red ulcers with a white or yellow base (Figure 3).
Gingivitis: Inflammation of the gingiva (gingivitis) may occur in conjunction with the oral lesions, resulting in red, swollen, and painful gingiva that may bleed easily.
Difficulty seating and drinking: The oral lesions and gingivitis associated with HFMD can cause significant discomfort, making it challenging for affected individuals to eat, drink, and swallow. This can lead to dehydration, malnutrition, and weight loss, particularly in young children who may be unable or unwilling to communicate their pain.
The oral manifestations of HFMD can significantly impact the quality of life and overall health of affected individuals [23]. The pain and discomfort associated with oral lesions and gingivitis can lead to poor oral hygiene, as the individual may avoid brushing and flossing due to pain. This, in turn, can exacerbate gingival inflammation and increase the risk of secondary bacterial infections. Furthermore, the difficulty in eating and drinking due to oral lesions can have severe consequences for the overall health and well-being of the affected individual, particularly in young children [24]. Proper nutrition and hydration are crucial for maintaining a healthy immune system and supporting the body’s ability to fight off the viral infection.
2.4 Herpes B virus infection
Herpes B virus, also known as Macacine herpesvirus 1, is a virus that primarily infects macaque monkeys but can also infect humans. In humans, Herpes B virus infections are rare but can be serious, even fatal [25]. In humans, the virus can cause vesicular lesions in the oral cavity, similar to those caused by herpes simplex virus [26].
Oral manifestations of Herpes B virus infection in humans can include:
Oral ulcers: Herpes B virus infection can cause painful ulcers to develop on the gingiva, tongue, or inside the cheeks.
Gingivitis: The virus can cause inflammation of the gingiva, leading to redness, swelling, and bleeding.
Pharyngitis: Herpes B virus can cause sore throat, difficulty swallowing, and inflammation of the pharynx.
Oral herpes: In some cases, Herpes B virus infection can lead to oral herpes, characterized by cold sores or blisters on the lips, inside the mouth, or on the tongue.
Herpes B virus infection can also cause the lymph nodes in the neck to become swollen and tender. A high fever is a common symptom of Herpes B virus infection, along with headache, muscle aches, and fatigue. It’s important to note that Herpes B virus infection can be extremely serious and potentially life-threatening, especially if left untreated [27].
3. Fungal zoonotic diseases with oral manifestations
Fungal zoonotic diseases are infections caused by fungi that can be transmitted between animals and humans. Although oral manifestations are relatively rare, some fungal zoonotic diseases can present with symptoms in the oral cavity [28]. The oral manifestations of fungal zoonotic diseases can often be mistaken for other conditions, making accurate diagnosis and appropriate treatment crucial. Treatment for these conditions typically involves antifungal medications, and in some cases, surgical intervention may be necessary [29].
3.1 Candidiasis
Candidiasis, commonly known as thrush, is caused by the Candida species, particularly
3.2 Histoplasmosis
Caused by the fungus
3.3 Blastomycosis
Caused by the fungus
3.4 Paracoccidioidomycosis (South American blastomycosis)
Paracoccidioidomycosis, caused by the fungi
3.5 Sporotrichosis
Caused by the fungus
3.6 Aspergillosis
Aspergillosis is caused by fungi from the
3.7 Cryptococcosis
Cryptococcosis, caused by the fungi
3.8 Zygomycosis (Mucormycosis)
Zygomycosis, also known as mucormycosis, is caused by fungi from the Mucorales order, which are found in soil, decaying organic matter, and certain foods. Although not directly transmitted from animals to humans, people can become infected through inhalation of fungal spores or direct contact with contaminated materials, particularly if they have a weakened immune system or existing health conditions [47]. It is a rare but potentially life-threatening infection that can affect various organs and tissues, including the oral cavity. Oral manifestations of zygomycosis may include necrotizing ulcers, black eschars, or destruction of oral tissues, such as the palate or gingiva [48]. These lesions can be extremely painful and may cause significant morbidity and mortality if not treated promptly (Figure 4).
To minimize the risk of contracting fungal zoonotic diseases, individuals should take precautions such as wearing gloves and protective clothing when handling soil or animals, avoiding areas with heavy accumulations of bird or bat droppings, maintaining good hygiene practices, and ensuring proper ventilation in indoor environments [50]. For individuals with weakened immune systems or underlying health conditions, additional preventive measures may be necessary, such as wearing masks in high-risk environments or taking antifungal medications as prophylaxis.
4. Bacterial zoonotic diseases with oral manifestations
4.1 Cat-scratch disease
Cat-scratch disease (CSD), also known as cat-scratch fever, is a bacterial zoonotic infection caused by
While the most common manifestations of cat-scratch disease involve lymph nodes and flu-like symptoms, the infection can also affect oral health in several ways. CSD may cause oral ulcers or sores in the oral cavity [53]. These ulcers can be painful and make eating or drinking difficult. Infected individuals may experience periodontitis or gingivitis, which can cause redness, swelling, and bleeding of the gingiva. In rare instances, CSD may cause erythema or redness of the oral mucosa, leading to discomfort and potential complications if left untreated [54]. Once these bacteria are introduced into the oral cavity, they can potentially cause secondary infections that may lead to more severe oral health issues, such as periodontitis or dental abscesses.
4.2 Plague
Plague, a severe and potentially fatal zoonotic infection, is caused by the bacterium
Infections caused by
5. Zoonotic disease prevention in dental practice settings
In dental care setups, practitioners may come into contact with zoonotic pathogens through direct contact with infected animals or indirectly through contaminated instruments, surfaces, or airborne transmission [57]. Therefore, it is crucial for dental care professionals to adopt preventive measures to minimize the risk of zoonotic diseases in their practice.
5.1 Education and training
Continuous education and training of dental professionals on zoonotic diseases are vital for effective prevention. Dental care professionals should be knowledgeable about the different types of zoonoses, their transmission modes, and the necessary precautions to take. This knowledge can be acquired through formal education, professional development courses, and regular workshops. Dental professionals should also be trained in identifying potential zoonotic disease symptoms and handling suspected cases.
5.2 Personal protective equipment (PPE)
The use of appropriate PPE, including gloves, masks, eye protection, and gowns, is essential in preventing the transmission of zoonotic pathogens. Dental professionals should adhere to strict protocols regarding the use, disposal, and replacement of PPE to minimize the risk of cross-contamination and infection [58].
The following PPE components should be considered:
Gloves: Disposable gloves should be worn during all procedures involving potential exposure to blood, body fluids, or contaminated surfaces. Gloves should be changed between patients and disposed of properly.
Masks: Dental professionals should wear surgical masks or respirators to protect against the inhalation of aerosols or droplets containing pathogens. Masks should be replaced regularly and disposed of properly.
Eye protection: Safety goggles or face shields should be worn to protect the eyes from splashes, sprays, or airborne particles.
Gowns: Disposable gowns should be used to protect clothing from contamination. Gowns should be changed between patients and disposed of properly.
5.3 Infection control and sterilization procedures
Dental care professionals should follow strict infection control protocols, including regular cleaning and sterilization of dental instruments, surfaces, and equipment. The use of disposable items, such as single-use dental needles and saliva ejectors, can help minimize the risk of cross-contamination. Proper disposal of contaminated waste, such as used gloves, masks, and sharps, should be practiced to prevent environmental contamination.
Instrument sterilization: All reusable dental instruments should be thoroughly cleaned and sterilized between patients using appropriate methods such as autoclaving or chemical sterilization.
Surface disinfection: Surfaces in the dental operatory, including countertops, dental chairs, and light handles, should be regularly cleaned and disinfected using EPA-registered disinfectants.
Equipment maintenance: Dental equipment, such as handpieces and ultrasonic scalers, should be maintained, cleaned, and sterilized according to the manufacturer’s recommendations.
Use of disposable items: Whenever possible, single-use items such as dental needles and saliva ejectors should be utilized to minimize the risk of cross-contamination.
Proper waste disposal: Contaminated waste, including used gloves, masks, and sharps, should be disposed of in designated biohazard containers.
5.4 Animal handling policies
In cases where dental care professionals encounter animals in their practice, such as service animals or therapy pets, strict animal handling policies should be in place. These policies should include guidelines on hand hygiene, avoiding direct contact with animals when possible, and immediately reporting any incidents of bites or scratches. Additionally, dental care setups should ensure that animals present in the clinic have been properly vaccinated and are free of any known zoonotic diseases.
Hand hygiene: Dental professionals should practice proper hand hygiene before and after handling animals, including washing hands with soap and water or using alcohol-based hand sanitizers.
Avoiding direct contact: Whenever possible, dental professionals should avoid direct contact with animals, especially if they have open wounds or broken skin.
Reporting incidents: Any incidents of bites or scratches should be immediately reported, and appropriate medical attention should be sought.
Animal vaccination and health checks: Dental care setups should ensure that animals present in the clinic have been properly vaccinated and are free of any known zoonotic diseases. Regular health check-ups should be conducted by a veterinarian to ensure the animals’ well-being and to minimize the risk of disease transmission.
5.5 Airborne transmission prevention
To minimize the risk of airborne transmission of zoonotic pathogens, dental care setups should invest in proper ventilation systems, air purifiers, and high-efficiency particulate air (HEPA) filters. Regular maintenance and cleaning of these systems are essential to ensure their efficiency in preventing the spread of airborne pathogens [59]. The following measures can be taken to prevent airborne transmission:
Ventilation systems: Dental care setups should have adequate ventilation systems in place to ensure proper air circulation and reduce the concentration of airborne pathogens.
Air purifiers: The use of air purifiers with HEPA filters can help remove airborne particles, including pathogens, from the air, reducing the risk of transmission.
Regular maintenance and cleaning: Ventilation systems and air purifiers should be regularly maintained and cleaned according to the manufacturer’s recommendations to ensure their efficiency in preventing the spread of airborne pathogens.
5.6 Surveillance and reporting
Dental care professionals should be vigilant in monitoring for signs and symptoms of zoonotic diseases in both patients and staff. Any suspected cases should be promptly reported to relevant public health authorities, and appropriate measures, such as isolation and contact tracing, should be implemented to prevent further transmission [60]. The following steps can be taken to enhance surveillance and reporting:
Monitoring for symptoms: Dental professionals should be trained to identify potential signs and symptoms of zoonotic diseases and to report any suspected cases to the appropriate public health authorities.
Reporting incidents: Any incidents of potential zoonotic disease transmission, such as animal bites or scratches, should be promptly reported to the relevant public health authorities.
Implementing control measures: In the event of a suspected case, dental care setups should implement appropriate measures, such as isolation, contact tracing, and enhanced infection control procedures, to prevent further transmission.
As zoonotic diseases continue to pose a significant threat to global health, it is crucial for dental care setups to prioritize preventive measures to minimize the risk of transmission. By adopting comprehensive policies and protocols, including education, the use of PPE, infection control, animal handling, airborne transmission prevention, and surveillance, dental care professionals can contribute to the global effort to combat zoonotic diseases and protect the health of their patients and auxiliary staff.
6. Conclusion
The connection between oral health and zoonotic diseases highlights the importance of maintaining good oral hygiene to reduce the risk of disease transmission. By adopting a comprehensive approach that includes oral health practices, public awareness, vaccination and disease control, and interdisciplinary collaboration, we can effectively address the challenges posed by zoonotic diseases and promote better health outcomes for both humans and animals. By implementing a One Health approach and addressing the root causes of zoonotic disease emergence and spread, we can work toward reducing the impact of these diseases on human, animal, and environmental health. Preventing and controlling zoonotic diseases require a collaborative, interdisciplinary approach known as One Health, which recognizes the interconnectedness of human, animal, and environmental health. This approach involves cooperation among various sectors, including public health, veterinary medicine, agriculture, and wildlife management, to monitor and respond to zoonotic disease threats effectively.
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