Without a spleen, patients also are at high risk for malaria and other insect-borne infections. Physicians should ask about mosquito and tick exposure and teach parents travel precautions.
Indeed, family education is a priority when caring for a child who has lost a spleen. “You need to give them something written, as you want them to understand the risk of infection,” she said. “And you want to do it more than once.”
Teach Parents About Zoonoses
Many physicians—Dr. McFarland among them—do not have the heart to banish all pets from the home of an immunocompromised child.
“The better you can take care of your animal … the less likely your pet will get sick,” is the message she urged physicians to give to parents of immunocompromised patients. Keeping the animal healthy will help the child stay well.
Dr. McFarland said the U.S. Public Health Service has identified five zoonoses of particular concern that immunocompromised children can pick up from animals: salmonellosis, campylobacteriosis, bacillary angiomatosis (Bartonella henselae, or cat scratch disease), cryptosporidiosis, and toxoplasmosis.
She also summarized the benefits of pet ownership, including decreased loneliness and increased feeling of intimacy and constancy.
The first principle of pet safety, she said, is to buy or adopt a healthy animal, preferably an adult. Young animals are more vulnerable to pathogens. No animal with diarrhea should be handled by the child.
Second, keep the animal healthy by preventing exposure to pathogens. Don't let cats or dogs roam. Fleas and ticks are a concern, as well as exposure to other animals and their feces, and anything else the pet might eat off the street.
Keep the animal inside, and keep the toilet seat down so the pet does not use the fixture as a fountain. Feed the animal well, and make sure it does not get into the garbage.
Third, avoid all contact with feces.
Dr. McFarland offered additional recommendations for patients, including children, who undergo hematopoietic stem cell transplants (MMWR 2000;49[RR10]:1–128). Parents should be advised of the risks, but children don't need to be forced to part with their pets.
Animals should be fed high-quality commercial pet food, according to Dr. McFarland, and at the first suspicion of a pet's illness, the animal should be taken to the vet.
Even with these precautions, some animals are prohibited as pets. She listed all reptiles (with a warning against reptile fomites), ducklings or chicks, and exotic pets, including nonhuman primates.
For more information, including brochures to download, Dr. McFarland recommended referring parents to