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BACKGROUND: Reptile-associated salmonellosis (RAS) occurs when Salmonella is transmitted from a reptile to a person. Our study objective was to describe the epidemiology of RAS in Minnesota during 1996-2011.
METHODS: Minnesotans with confirmed Salmonella infections are interviewed about illness characteristics and risk factors including reptile exposure. Willing cases can submit stool from the reptile for culture. Serotype and pulsed-field gel electrophoresis (PFGE) subtype of Salmonella isolates from reptiles and cases are compared. This was a descriptive study; univariate analyses were conducted and a Fisher’s exact test was used to compare categorical variables.
RESULTS: A total of 8,389 sporadic non-typhoidal salmonellosis cases were reported in Minnesota during 1996-2011; of these, 290 (3.5%) reported reptile exposure. A median of 17 cases of RAS were reported each year. The median age was 11 years, with 17% of cases occurring in infants and 47% in children less than 10 years of age. Fifty percent were female. Ninety-five percent of cases had non-invasive infections, the median illness duration was 8 days, and 23% required hospitalization. The most commonly reported reptile type was lizard (47%), followed by snake (20%), turtle (19%), and multiple types (15%). Eighty-four percent of isolates from cases reporting reptile exposure were Salmonella enterica subspecies I. The top three serotypes were Typhimurium (15%), Enteritidis (7%), and subspecies IV serotypes (7%). Of 70 reptiles tested, 60 (86%) were positive for Salmonella; 36 (60%) of these yielded the same Salmonella serotype as the human isolate. Twenty-six of 27 reptile isolates that were subtyped by PFGE were indistinguishable from the human isolate. Of these, 88% were subspecies I; the most common serotypes were Enteritidis (12%), Typhimurium (8%), and Bareilly (8%). Eighty-three (34%) cases reported using rodents as feed for the reptile. Feeding rodents to the reptile was associated with a 3-fold increase in the odds of the case testing positive for Enteritidis, and a 9-fold increase in the odds of the reptile testing positive for either Enteritidis or Typhimurium.
CONCLUSIONS: RAS accounts for up to 3.5% of salmonellosis cases in Minnesota. In this study, 17% of cases occurred in infants, suggesting that Salmonella can readily be transmitted without direct contact with a reptile. Salmonella Enteritidis and Typhimurium were the most common serotypes identified in cases and in associated reptiles, suggesting that reptiles are a source of human infection with serotypes not traditionally considered to be reptile-associated. Additionally, rodents could be an important source of subspecies I Salmonella colonization in reptiles.