The prevalence of Trichophyton mentagrophytes and Cheyletiella spp. in guinea pigs in Dutch petshops Fig.1: Trichophyton mentagrophytes after 3 weeks on Sabouraud dextrose agar Report Kim van Avermaete – 3154475 Research project: September 2011 – March 2012 Supervisors: Dr. Ing. P. van Overgaauw & Dr. N.J. Schoemaker Utrecht University Abstract Dermatophytes form a group of closely related fungi that can cause disease in animals and man by invading hairs, skin and nails. They use keratin for their growth. Dermatophytosis is an important zoonotic disease. The source of human infections usually originates from a lower animal source and in some research projects Trichophyton mentagrophytes was the most frequently isolated dermatophyte with the guinea pig as a main source. Most guinea pigs infected with T. mentagrophytes are asymptomatic carriers and do not show clinical signs. Skin lesions, which usually start on the head and then progress over the back, flanks and limbs, however, do occur. These skin lesions are pruritic in guinea pigs, just as they are in man, in which pruritus and the specific ‘ringworm’ lesion are the main symptoms. Little is known about the number of infected guinea pigs (carriers and clinical cases) in the Netherlands. Outside the Netherlands prevalence’s of 1.4% to 34.9% were found. The aim of this study was to determine the prevalence of T. mentagrophytes in guinea pigs in Dutch pet shops. 179 guinea pigs in 88 pet shops without skin lesions were examined. In 17.3% of the guinea pigs and in 27.3% of the total number of pet shops T. mentagrophytes was isolated. The A. benhamiae-complex was isolated in 29 of 31 positive guinea pigs and the A. vanbreuseghemii-complex of the T. mentagrophytes-complex was isolated in 2 of the 31 positive guinea pigs. T. mentagrophytes was predominantly found in the Northern and Western parts of the Netherlands. Furthermore, neither a significant sex, breed or age predisposition, nor a significant correlation of infection with T. mentagrophytes and hairtype, cage-occupation, turnover-rate, origin, exchange of bowls and coupling/combining of animals were found. Cheyletiella is an on the surface of the skin living mite, which is a common parasite in dogs, cats and rabbits. Since it does not have extreme host specificity, it can also infect guinea pigs and humans. Cheyletiella is an obligate parasite which completes its life cycle in approximately 35 days on the skin surface. The mite is transmitted by direct contact. In rabbits the severity of clinical signs ranges from asymptomatic to moderate. Since little is known about the prevalence of the zoonotic ectoparasite Cheyletiella parasitovorax in Dutch pet shops and this ectoparasite can enhance susceptibility for Trichophyton mentagrophytes infections, the guinea pigs examined for Trichophyton mentagrophytes were also examined for the presence of Cheyletiella, but no ectoparasites were found. This study shows that in a quarter of the Dutch pet shops guinea pigs are being sold which are a zoonotic risk of dermatophytosis in humans and that in Dutch petshops Cheyletiella is a very uncommon parasite in guinea pigs. Index 1. Introduction 1 2. Methods & Materials - §2.1 Sampling - §2.2 Culturing - §2.3 Differentiation - §2.4 Statistical evaluation 5 5 6 7 10 3. Results - §3.1 Trichophyton mentagrophytes §3.2 Cheyletiella parasitovorax 12 12 16 4. Discussion - §3.1 Trichophyton mentagrophytes - §3.2 Cheyletiella parasitovorax 17 17 19 5. Conclusion 20 6. Advice - 21 21 21 §6.1 General preventive measurements §6.2 Measurements in case of a dermatophyte 7. Acknowledgements 23 8. References 24 9. Appendices - Appendix 1 - Appendix 2 27 28 38 1. Introduction Trichophyton mentagrophytes is a fungus which belongs to the dermatophytes. The dermatophytes form a closely related group of pathogenic fungi, which occur worldwide and can cause disease in animals and man.15,48,66 There are a lot of different dermatophytes, which can be classified into three anamorphic (asexual) genera: Epidermophyton, Microsporum and Trichophyton, which together contain over 40 species.3,15,25,44,66 New molecular analytical methods revealed that several dermatophytes of the anamorph genera Trichophyton and Microsporum are also capable of reproducing sexually. These forms are classified in the teleomorphic genus Arthroderma.8,15,35,48,66 The confirmed teleomorphs of the zoophilic isolates of the T. mentagrophytes complex are Arthroderma benhamiae, Arthroderma simii and Arthroderma vanbreuseghemii.2,29,60,61 Most of the dermatophytes in guinea pigs and rabbits are associated with A. benhamiae.20 Dermatophytes can invade the hair, nails and the stratum corneum of the skin of the living host and use keratin for their growth.15,44,25 Infection occurs by direct contact with an infected animal and indirect through fomites and infected epithelial debris in the environment.1,12,34,44 Under favorable conditions fomites can remain infectious for months or even years.12,34,59 The infectious form of dermatophytes are arthrospores which are released by fragmentation of hyphae in keratinized structures and adhere to these superficial structures. This is followed by germination and the production of hyphae. The latter then invade the stratum corneum or hair follicles. Hydrolytic enzymes, such as keratinase, may aid in the invasion proces.15,25,34,44,64 Signs due to a dermatophyte infection may range from mild to severe as a consequence of the host’s reaction to the metabolic products of the dermatophyte, the virulence of the infecting species, the anatomic location of the infection and local environmental factors.48,64,66 The animals most at risk are the young, aged, debilitated and immune suppressed animals.44 The disease is often seen secondary to stressors40,48 and minor trauma. Inappropriate shampooing and ectoparasites can also facilitate infection, while high environmental temperature and humidity may contribute to a more severe infection.34,43,44 Animals and man poses various forms of defense mechanisms against an infection with a dermatophyte. In animals grooming of the skin and coat may remove arthrospores.15,34 The skin of humans and animals functions as a physical barrier, is exposed to UV light, and has a low moisture condition which is unfavorable for fungal growth. In addition, the skin possesses antifungal substances and a commensal microflora of saprophytic microorganisms competing with the dermatophyte, thereby preventing colonization of the skin by dermatophytes.51,65 Furthermore there is continuous keratinization and epidermal proliferation with continuous shedding of the stratum corneum with which the dermatophyte is be removed.65 It is assumed that keratinocytes not only play a role in the physical barrier of the skin but also initiate a cutaneous inflammatory reaction by releasing cytokines.4 -1- After passing the physical barriers the dermatophytes are encountered by phagocytes, including macrophages, which are soon reinforced by the recruitment of large numbers of neutrophils to the sites of infection.28 Macrophages and neutrophils mostly contribute to the antifungal innate immune response through phagocytosis and direct pathogen killing.52 These cells contain pattern recognition receptors (PRRs), including Toll-like receptors (TLRs) with which they recognize pathogen associated molecular patterns (PAMPs).27,50,51 Recognition by TLRs leads to the production of several important mediators of innate immunity, such as cytokines and chemokines.37,39,54,62 The Toll pathway also leads to the surface expression of co-stimulatory molecules that are essential for the induction of adaptive immune responses.9,28,50 The cell mediated immune response is the main mechanism of defense against fungal infections, but certain types of antibody responses may also play a role in the protection of the host.42 Th1 cells predominantly produce cytokines such as IFN-y and promote cell mediated immunity and phagocyte activation, thereby playing a role in the clearance of a fungal infection. Th2 cells mainly produce cytokines such as interleukins 3 and 4 and tend to promote antibody production. Th2 immunity usually results in susceptibility to infection or allergic responses.7,9,13,62 According to their habitats and host preferences dermatophytes can be classified as geophilic, zoophilic or antropophilic species. Geophilic species are saprophytes in soil and occasionally cause disease in man; antropophilic and zoophilic species are obligatory parasites of which the first normally infects animals but can also affect man and of which the latter only have man as a host.1,64 Antropophilic fungi in man results in dermatophytosis which is mostly confined to protected areas of the body. Dermatophytosis due to geophilic or zoophilic species, however, is commonly found on exposed areas of the body (head, arms, legs). The antropophilic species can cause insidious and chronic infections in humans, while the zoophilic species do not seem to be able to cause such infections and usually result in much more acute inflammatory infections.41,59,65 It has been suggested that there is a kind of inhibitor in the keratin of the preferred host that ‘turns off ‘ the production of the inflammatory agents by the colonizing fungus. When the fungus colonizes a different host, however, the inhibitor is lacking.48 Dermatophytosis is probably the most important zoonotic disease which is transmitted directly from the animal to the person.5,41 The skin of humans who are infected can show the development of one or more red circular lesions of limited size, which can coalesce. The lesions can be localized on any part of the body. The head seems the most frequently involved. In time, the lesions will become dry and scaly, whereby central healing is seen (the classical form). In many infections, however, the entire area shows greater or less scaling. Pruritus is a main symptom of dermatophytosis in man, while erythema, induration and swelling are also seen.12,59 Infections caused by dermatophytes (ringworm) are classified according to their localization on the body of the infected animal or human and by appending the Latin term designating the body site after the word tinea, for example tinea capitis for ringworm of the scalp and tinea corporis for ringworm of the body (trunk, shoulders or limbs).24,66 -2- Humans are usually infected by a lower animal source.41,55Alteras (1966) found that, in patients suffering from dermatophytosis, the zoophilic dermatophyte Trichophyton mentagrophytes is the dermatophyte most frequently isolated, with the guinea pig as its main source.5 A few years earlier, the same results were described by Koch and Rieth (1958).31Fumeaux (2004) found Arthroderma benhamiae of the T. mentagrophytes-complex in 9 isolates of 8 children and 1 adult suffering from inflammatory dermatophytosis. Eight of these individuals had had previous contact with rodents, mostly guinea pigs.18 In guinea pigs the dermatophyte most commonly isolated is Trichophyton mentagrophytes.15,32,43,47,53,63 To a lesser extent Microsporum canis may also be found.5,47 Most of the guinea pigs infected with T. mentagrophytes show no clinical signs and are asymptomatic carriers.15,63 Guinea pigs that do have symptoms, show skin lesions, which usually start on the head and gradually progress over the back, the flanks and the limbs. These lesions are often pruritic and can consist of focal circular areas of alopecia, scaling and erythema.12,40,46 The best way to take samples of symptomatically infected animals is to take hairs from the sides of the lesion. If crusts are present, a part of these should also be collected. Hairs must be pulled out instead of cut off.26 Sampling of asymptomatic animals is best performed with the Mackenzie’s toothbrush technique.53 With this technique, not only hairs but also keratin debris is collected. This is especially useful as the hyphae may only be present in the stratum corneum.26,57 The two media most frequently used to culture dermatophytes are the sabouraud dextrose agar and the dermatophyte test medium (DTM).57 The sabouraud dextrose agar is the most widely used medium in medical mycology for the isolation and routine subculture of most common fungal pathogens. It contains glucose, peptones and agar.38 Bacteria and saprophytic fungi which colonize the skin and/or its hair/nails could interfere with isolation of dermatophytes since dermatophytes grow more slowly. Therefore, media for isolation of dermatophytes are supplemented with antibiotics (chloramphenicol, gentamycin) and antimycotic cycloheximide, which prevents growing of saprophytic fungi.11 The DTM is a sabouraud dextrose agar, which contains cycloheximide, gentamicin and chlortetracyclin as antifungal and antibacterial agents and phenol red as a pH indicator. The medium contains protein and carbohydrates. The dermatophytes firstly use this protein as a nutrient source of which the alkaline metabolites turn the medium from yellow to red.57,66 When the medium does not contain protein anymore, the dermatophyte starts to use carbohydrates of which the acid metabolites turn the medium from red to yellow.57 White mycelia growth and a color change to red within 10 days after inoculation is conclusive for the presence of dermatophytes.15 There are some disadvantages of the dermatophyte test medium. The DTM must be evaluated daily,15,57 which is impractical for this study as a lot of pet shops had to be visited. The red -3- color change can also be due to nonpathogenic fungi and the DTM does not allow visualization of colony reverse pigmentation, which is often important in identification.57,66 Since desiccation and ultraviolet light hinder growth,57 the plates should be packed in plastic bags and incubated in the dark. Little is known about the number of infected guinea pigs (symptomatically and asymptomatically) in the Netherlands. The reported prevalence of T. mentagrophytes outside of the Netherlands ranges from 1.4% to 34.9%.6,17,32,53,63 Since dermatophytosis is a common zoonotic disease which can easily be transferred from guinea pigs to humans and the fact that T. mentagrophytes is one of the main etiologic agents which is often found in guinea pigs, it was found important to know the prevalence of this dermatophyte in guinea pigs in the Netherlands. Furthermore, guinea pigs are predominantly sold to children who are more susceptible to an infection with dermatophytes than adults.22,59 In addition, the young animals which are sold are those most susceptible to infection with dermatophytes.12,67 It would therefore be important to know what the prevalence of T. mentagrophytes would be in young guinea pigs sold in pet shops. The aim of this study was therefore to determine the prevalence of T. mentagrophytes in guinea pigs in Dutch pet shops. Cheyletiella Cheyletiella is an on the surface of the skin living mite, which is a common parasite in dogs (Cheyletiella yasguri),45 cats (Cheyletiella blakei),30 and in rabbits (Cheyletiella parasitovorax).21,58,67 The various species do not have extreme host specificity and may also infect guinea pigs and humans. In guinea pigs the mite is not seen very often.56,58,67 Cheyletiella is an obligate parasite which completes its life cycle in approximately 35 days on the skin surface. The mite is transmitted by direct contact. They usually survive not longer than 1-2 days away from the host.67 In rabbits the mite can cause crusts on the back, trunk and flanks. An increased scaling and alopecia is often seen. The severity of clinical signs ranges from asymptomatic to moderate.23,58 In man, Cheyletiella can give large numbers of intensely itchy papules with necrotic areas on the places were there has been contact with the animal. There is even a case report of cheyletiellosis with systemic manifestations.14 Since little is known about the prevalence of the zoonotic ectoparasite Cheyletiella parasitovorax in Dutch pet shops and this ectoparasite can enhance susceptibility for Trichophyton mentagrophytes infections,58 the guinea pigs examined for Trichophyton mentagrophytes were also examined for the presence of Cheyletiella. -4- 2. Materials & Methods 2.1 Sampling 2.1.1 Pet shop selection To determine the amount of pet shops which needed to be sampled throughout the Netherlands a power-analysis was performed. The following assumptions were made: Total amount of pet shops in the Netherlands (n= 1232). The expected prevalence of the diseases was assumed at 5%; a confidence interval of 95% was used and an error of 5% was accepted. Based on these assumptions a random sample of 69 pet shops was needed. To extend the reliability of this research project, 125 pet shops were selected. A total of 91 shops were cooperating, of which 3 did not sell Guinea pigs. Therefore, a total of 88 pet shops were included in this study. None of the pet shops were notified in advance of the visit to prevent extra measures taken by the shop, which could influence the outcome of the study. To get an overview of T. mentagrophytes in part of the Netherlands, the provinces were also divided in four groups of three provinces. The first consisted of Friesland, Groningen and Drenthe; the second contained Overijssel, Gelderland and Flevoland; the third consisted of Utrecht and Noord- and Zuid-Holland and the last group contained the provinces Zeeland, Noord-Brabant and Zuid-Limburg. 2.1.2 Animals In each pet shop a sample was taken from one guinea pig per cage that contained these animals. The age, gender and hair type of every sampled animal was recorded. In addition, it was recorded whether the animal was housed alone or with other guinea pigs and/or rabbits. The type of bedding in the cage, as well as the first impression of the hygiene was also recorded. A total of 179 guinea pigs were examined (Table 2.1). Their age ranged from 4 weeks up to 2 years with a median age of 12 weeks (Table 2.4). Of all these animals 61.5% (110/179) was male and 38.5% female (69/179) (Table 2.3). Of the guinea pigs 86.0% (154/179) was short haired, 11.7% (21/179) had long hairs and 2.2% (4/179) did have hairs of medium length (Table 2.5). Further more 36.9% (66/179) was housed solely, 34.6% (62/179) was housed with 1 or more guinea pigs and 28.5% (51/179) with or without guinea pigs but with rabbits (Table 2.6). In all of the pet shops and cages the first impression of the hygiene was good. 2.1.3 Questionnaire Each owner of the pet shop was asked to fill out a questionnaire. Topics in the questionnaire focused on the amount of guinea pigs sold on a yearly basis, the origin of the animals (wholesale business/private sector/etc.), the presence of a veterinary policy, a protocol at time of the arrival of the animals (preventive therapy) and their hygiene policy. The complete questionnaire can be found in Appendix 1. In the results the following factors and their influence on infection with T. mentagrophytes are being worked out separately: age, gender, hair-type, cage-occupation, turn-over rate, supplier, exchange of animals and exchange of bowls. -5- A possible correlation between percentages of infection and the different provinces will also be worked out. 2.1.4 Sample taking The Mackenzie’s toothbrush technique was used in all animals whereby the entire body of the guinea pig was brushed during one minute with a new toothbrush.26,57 The toothbrushes were then placed in a paper bag and closed with a staple. All bags were preserved in a large plastic bag. To determine if the animals were infected with Cheyletiella parasitovorax, the animals were brushed with a flee comb36 and the hairs and scales from this comb were examined in light with a magnifying glass (the mites are 270 – 540 µm36). When there was doubt about whether the ectoparasite was present or not, the comb was tapped on a white paper and examined with the magnifying glass again. 2.2 Culturing 2.2.1 Media For this study sabouraud B dextrose agar plates were used. These plates contained peptic digest of animal tissue 5.0g/l; pancreatic digest of casein 5.0g/l; dextrose 40.0g/l; agar 15.0g/l; Inositol 10.0g/l; Cycloheximide 0.2g/l; Vitamin B 1.0g/l and Depomycin 3.0g/L. 2.2.2. Culture Contents of each toothbrush was cultured within 1-7 days (Table 2.11) after sampling. The brushes were gently pressed onto the sabouraud dextrose agar. When the brush also contained hair and scales, these were taken by sterile tweezers and inoculated on the agar plate. The plates were incubated in the dark for 3 weeks at 25 °C. The plates were checked for growth of T. mentagrophytes on a weekly basis. When no fungal growth was seen within three weeks, the culture was considered negative. Plates containing colonies, which were suspected to be T. mentagrophytes, were examined at one week post inoculation to count the amount of colonies present. At a later stage colonies could coalesce, making it impossible to count them anymore. Suspected colonies were subcultured in the dark on a malt extract agar (MEA) plate for three weeks at 25 °C in a plastic bag. The MEA plate was used to cultivate, isolate and enumerate T. mentagrophytes. After one to three weeks when the MEA plate contained pure growth, a preparation of a small part of a colony was made and stained with blue lactic acid to visualize the macro- and microconidia of T. mentagrophytes. These preparations were examined under the microscope with a magnification of 853.3. After one or two weeks when the MEA plate showed a mixed culture instead of a pure culture, a new MEA plate was inoculated with part of the colony from the sabouraud plate or the MEA plate and incubated again for three weeks. -6- 2.3. Differentiation In this research project the differentiation of T. mentagrophytes happened by means of colonic growth morphology, specific microscopic findings and PCR. 2.3.1. Morphology24 The colonies of T. mentagrophytes on a Sabouraud dextrose agar plate are often star-shaped. They are powdery to floccose. The colonies have a cream to yellowish color. The down side often has an ochre to red-brown color, occasionally a yellow or dark brown color is observed. (For M. canis the colonies have a spreading and radiating shape. They are woolly. The colonies have a grayish- to tannish-white color. The down side is deep ochraceous-yellow). Fig.2: Trichophyton mentagrophytes after 1 week on Sabouraud dextrose agar -7- Fig.3: Trichophyton mentagrophytes after 3 weeks on Sabouraud dextrose agar Fig. 4: Trichophyton mentagrophytes after 3 weeks on Sabouraud dextrose agar (down side) -8- 2.3.2. Microscopy24 With microscopy of a preparation of T. mentagrophytes from a MEA plate, microconidia and macroconidia could be observed. The macroconidia are usually sparse. They are 3-8 celled and 20-50 x 6-8µm in size. They have smooth and thin walls, and are clavate to cigar-shaped. The microconidia are frequently present. They have a spherical shape and are arranged in dense, grape-like clusters or arranged alongside the hyphae. The hyphae are frequently present. They are spiral formed, and are 2 µm in diameter. (For M. canis the macroconidia are 6-12 celled and 35-110 x 12-25 µm in size. They have rough and thick walls with thinner septa. They are spindle-shaped, with a slightly bent, verrucose, rostrate apex. The microconidia have a clavate to pyriform form, and are arranged alongside undiffertiated hyphae.) Fig. 5: Microscopic preparation of T. mentagrophytes (sigar-shaped macroconidia) Fig.6: Microscopic preparation of T. mentagrophytes (grape-like structures with microconidia) 2.3.3 Molecular analyses The best way to confirm that the colony on a plate is actually T. mentagrophytes is the use of molecular analyses.20 Martin Meijer BSc of the CBS isolated the DNA of the agents growing on the plates of which was thought under the microscope that they may contain T. mentagrophytes. Because there was a maximum on the number of cultures of which we could -9- analyze DNA, we chose to do a PCR of one culture of every positive shop. There were two shops in which we had two different cultures, of these shops a PCR of both cultures was done. 2.3.3.1 DNA isolation 1. 300µl Microbead solution was added to a Microbead tube 2. 50µl MD1 was also added 3. The colony was scraped from the culture with an inoculation loop 4. The Microbead tubes were shortly put in the vortex 5. The Microbead tubes were vortexed with the MO Bio adapter for 10 minutes 6. The tubes were centrifuged at room temperature for 1 minute, RPM=9600 7. 100µl MD2 was added to 2ml tubes and the supernatant was added to these tubes 8. These tubes were vortexed for 5 seconds 9. These 2ml tubes were put on ice for a few minutes 10. The 2ml tubes were centrifuged for 1 minute, RPM=9600 11. The supernatant was added to new sterile 2ml tubes and to these tubes 900µl MD3 was added 12. The 2ml tubes were gently mixed with a pipette 13. 700µl of the 2ml tubes with supernatant was added on the spin filters, which than were centrifuged for 1 minute, RPM=9600 14. The filters were than gentle pulled out of the tubes, the supernatant was removed, after which the filters were put back into the tubes 15. The residual supernatant of step 13 was added on the spin filters 16. These were centrifuged for 1 minute, RPM=9600 17. The filters were gently pulled out of the tubes, the supernatant removed and the filters put back to the tubes 18. 300µl MD4 was added to the spin filters and this was centrifuged for 1 minute, RPM=9600 19. The filters were then again pulled out of the tubes, the supernatant removed and the filters put back in the tubes, which were centrifuged for 1 minute, RPM=9600 20. The spin filters were pulled out of the tubes and added to new 2ml tubes 21. 50µl MD5 was added in the middle of the spin filter in the new 2ml tubes 22. These new tubes were centrifuged for 1 minute, RPM=9600 23. The tubes were left for a few minutes at room temperature 24. The spin filters were thrown away and the tubes with DNA stored at -20°C 2.3.3.2 PCR Of every tube a PCR was done by Martin Meijer BSc of the Centraal bureau voor schimmelcultures. A specific set of primers of dermatophytes was added. 2.4 Statistical evaluation All the collected data were added in excel and SPSS. The computer program SPSS was used to do the statistics of this research project. An independent samples T-test was used to determine if the mean age of guinea pigs on which T. mentagrophytes was found significantly deviates from the mean age of guinea pigs free from T. mentagrophytes. - 10 - The Chi-Square test was used to test if there was a correlation between infection with T. mentagrophytes and the province where the animals came from, the age-groups, the gender and hair type of the animals, the cage-occupation, the turnover of the shop, the origin of the animals and whether exchange of bowls and coupling/combining of animals of different cages took place. When a significant correlation was found, a Cramer’s V value was determined. - 11 - 3. Results 3.1. Trichophyton mentagrophytes No clinical cases of dermatophytosis were seen in any of the pet shops visited. 3.1.1. Questionnaire Based on the questionnaire 12.8% (23/179) came from shops where there were less than 20 guinea pigs sold per year, 34.6% (62/179) came from shops where they sell 21-50 guinea pigs per year, 33.0% (59/179) came from shops where they sell 51-100 guinea pigs per year and 19.6% (35/179) of the animals lived in shops where they yearly sell more than 100 guinea pigs (Table 2.7). A total of 28.5% (51/179) of the animals lived in shops where the animals were always supplied by wholesaler’s, 6.7% (12/179) was examined in shops where wholesaler’s only sometimes were used as suppliers and the greatest part of the animals, 64.8% (116/179) was examined in shops that never used wholesaler’s as their suppliers (Table 2.8). A percentage of 73.2% (131/179) of the animals was housed in shops where there was no exchange of bowls between the cages and 26.8% (48/179) of the animals lived in shops where there was exchange of bowls (Table 2.10). At last 75.4% (135/179) of the animals was housed in shops where the staff sometimes coupled or combined animals (Table 2.9). 3.1.2. Samples 3.1.2.1. Morphology (Table 3.4) Of the 179 samples taken, 41 showed growth that could resemble T. mentagrophytes on the sabouraud agar and were transferred to the malt extract agar plates after 1-2 weeks. 32 of them were still suspected of being T. mentagrophytes on the base of morphology after two to three weeks of growth on sabouraud dextrose agar plates. These 32 cultures came from a total of 24 shops. 3.1.2.2. Microscopy After two or three weeks of growth on the malt extract agar plates, a preparation of these 32 malt extract agar plates with suspected cultures was made and were examined under the microscope. After de microscopy only one culture could be considered negative. 3.1.2.3 PCR After morphologic and microscopic examination only 31 cultures were left. A PCR confirmed that they contained T. mentagrophytes. In 22 of the 24 pet shops (91.7%) in which T. mentagrophytes was found the Arthroderma benhamiae complex of T. mentagrophytes was isolated and in 2 of these pet shops (8.3%) the Arthroderma vanbreuseghemii complex of T. mentagrophytes was isolated. Based on the similarity of the morphologic and microscopic appearance and the fact that some infected animals lived in the same shop, this corresponds to 29 (93.5%) with Arthroderma benhamiae infected guinea pigs and 2 with Arthroderma vanbreuseghemii infected guinea pigs (6.5%). - 12 - 3.1.3. Statistics 3.1.3.1 Prevalence’s T. mentagrophytes was found on 31 of the 179 examined guinea pigs, which corresponds to 17.3% of the animals (Table 3.5). T. mentagrophytes was isolated on Guinea pigs in 24 of the 88 pet shops examined, resulting in a prevalence of T. mentagrophytes in Dutch pet shops of 27.3%. 3.1.3.2 Statistics Provinces (Table 3.1-3.3, 3.6-3.12) Province Visited Positive shops shops Groningen Friesland Drenthe Overijssel Gelderland Noord-Brabant Zuid-Limburg Zeeland Zuid-Holland Noord-Holland Utrecht Flevoland 5 6 3 14 13 9 3 3 18 9 4 1 Percentage + in province on total shops visited in province (%) 80.0 16.7 0.0 21.4 7.7 11.1 33.3 100.0 16.7 55.6 50.0 0.0 4 1 0 3 1 1 1 3 3 5 2 0 Percentage + on total shops visited (%) Percentage + on total + shops (%) 4.6 1.1 0.0 3.4 1.1 1.1 1.1 3.4 3.4 5.7 2.3 0.0 16.7 4.2 0.0 12.5 4.2 4.2 4.2 12.5 12.5 20.8 8.3 0.0 Table 3.1: Percentages of positive shops per province (%) The percentages of positive shops per province differed from 0% to 100%, the percentages of positive shops per province on the total amount of shops visited, range from 0% to 5.7% and the percentages of positive shops per province on the total number of positive shops differ from 0% to 20.8% (Table 3.1). - 13 - Province Groningen Friesland Drenthe Overijssel Gelderland Noord-Brabant Zuid-Limburg Zeeland Zuid-Holland Noord-Holland Utrecht Flevoland Chi-Square: 35.13, significance 0.00 Percentage of positive guinea pigs (%) 22.6 9.7 0.0 16.1 3.2 3.2 3.2 9.7 9.7 16.1 6.5 0.0 Cramer V 0.44 Table 3.2: Percentage of positive guinea pigs per province There is a significant correlation, although it is not a strong one (Cramer V 0.44), between the percentage of positive guinea pigs and the provinces (Table 3.2). Most of the positive guinea pigs were found in Groningen followed by Noord-Holland and Overijssel. Province-group Percentage of positive guinea pigs (%) Friesland, Groningen, Drenthe Overijssel, Gelderland, Flevoland Utrecht, Noord- en Zuid-Holland Zeeland, Noord-Brabant, Zuid-Limburg Chi-Square: 10.55, significance 0.01 32.2 19.4 32.3 16.1 Cramer V 0.24 Table 3.3: Percentage of positive guinea pigs per province-group T. mentagrophytes was more often found in the Northern and Western parts of the Netherlands than it was found in the South and Eastern parts of the Netherlands (Table 3.3). As the Cramer V value was 0.24, this is not a strong significant correlation. Gender (Table 3.13-3.14) T. mentagrophytes was found on 15.5% of all male and on 20.3% of all female guinea pigs. 54.8% of the positive guinea pigs were male and 45.2% were female guinea pigs. There is not a significant correlation between the gender of the guinea pigs and infection with T. mentagrophytes. Age (Table 3.33-3.38) The mean age of the guinea pigs on which T. mentagrophytes was found was 14.1 weeks and the mean age of the negative guinea pigs 18.8 weeks. The significance level of the independent samples T-test was 0.18, so there is not a significant deviation between the mean age of the positive and the negative group of guinea pigs. - 14 - When the guinea pigs which had an age of 78 weeks or more were left out, the mean age of the guinea pigs on which T. mentagrophytes was found was 12 weeks and the mean age of the negative guinea pigs 14.8 weeks. The significance level of this independent samples T-test was 0.12, so also in this case there is not a significant deviation between the mean age of the positive and the negative group of guinea pigs. When the guinea pigs which had an age of 52 weeks or more were left out, the outcomes were a mean age of 12 weeks for positive guinea pigs, 13.9 weeks for negative guinea pigs with a significance level of 0.19 so no significant deviation between the mean age of the positive and the negative group of guinea pigs. Hair type (Table 3.15 & 3.16) T. mentagrophytes was found on 17.5% of the short haired guinea pigs, on 14.3% of the guinea pigs with long hairs and on 25% of the guinea pigs with medium hairs. 90.3% of the positive guinea pigs was short haired, 6.5% had long hairs and 3.2% had hairs of a medium length. There was no significant correlation between infection with T. mentagrophytes and hair type of the guinea pigs. Cage-occupation (Table 3.17 & 3.18) T. mentagrophytes was found in 19.7% of the guinea pigs that were housed solely, in 17.7% of the animals which were housed with other guinea pigs and in 13.7% of the guinea pigs which were housed with rabbits and with or without other guinea pigs. 41.9% of the positive guinea pigs were housed solely, 35.5% were housed with other guinea pigs and 22.6% were housed with rabbits and with or without other guinea pigs. There was no significant correlation between the cage-occupation and infection with T. mentagrophytes. Turnover (Table 3.19 & 3.20) T. mentagrophytes was found in 17.4% of the guinea pigs from shops with a turnover of less than 20 guinea pigs per year, in 16.1% of the guinea pigs from shops with a turnover of 21-50 guinea pigs per year, in 13.6% of the guinea pigs from shops with a turnover of 51-100 guinea pigs per year and in 25.7% of the guinea pigs from shops with a turnover of more than 100 guinea pigs per year. 87.1% of the positive guinea pigs came from shops with a turnover of more than 20 guinea pigs per year. There was no significant correlation between the turnover of the shops and infection with T. mentagrophytes. Origin (Table 3.21-3.22; 3.27-3.32) T. mentagrophytes was found in 19.6% of the guinea pigs that were supplied by wholesaler’s, in 17.2% of the guinea pigs that came from shops that never used wholesaler’s as suppliers and in 8.3% of the guinea pigs that came from shops that sometimes used wholesaler’s as suppliers. 64.5% of the positive guinea pigs came from shops that never used wholesalers as suppliers of their animals. - 15 - There was no significant correlation between occurrence of dermatomycosis and supplementation by wholesalers. To find out if there is a relation between the provinces with the highest percentage of infection (Groningen, Noord-Holland and Overijssel) and supplying by wholesalers in these provinces the Chi-Square test was used. 28.5% of all the guinea pigs came from shops that used wholesalers as their suppliers. It is remarkable that 94.1% (16/17) of the guinea pigs which were sampled in Noord-Holland came from shops that only used wholesalers as their supplier. 31.4% of the total number of shops which used wholesalers were located in Noord-Holland. A significant correlation between the provinces and the use of wholesalers as suppliers (Chi-Square of 136.36, significance level of 0.00, Cramer’s V of 0.62) was found. To find out if there is a relation between the province-groups with the highest percentage of infection (Northern and Western parts of the Netherlands) and supplying by wholesalers in these parts the Chi-Square test was used. One of the 27 guinea pigs (3.7%) sampled in the northern part of the Netherlands, 14 of the 65 guinea pigs (21.5%) sampled in the eastern part of the Netherlands, 27 of the 53 guinea pigs (50.9%) sampled in the western part of the Netherlands and 9 of the 34 guinea pigs sampled in the southern part of the Netherlands came of shops which used only wholesalers as their suppliers. 52.9% of the total guinea pigs which were supplied by wholesalers were sampled in the western part of the Netherlands (Noord- &Zuid- Holland and Utrecht). A significant correlation between the province-groups and the use of wholesalers as suppliers (Chi-square of 39.0, significance level of 0.00, Cramer’s V of 0.33) was found. Bowl-exchange (Table 3.23 & 3.24) T. mentagrophytes was found in 18.3% of the guinea pigs that came from shops where no bowl exchange took place and in 14.6% of the guinea pigs that came from shops were bowl exchange did take place. 77.4% of the positive guinea pigs came from shops where no exchange of bowls between the cages took place. There was no significant correlation between infection with T. mentagrophytes and bowlexchange. Coupling/Combining of guinea pigs (Table 3.25 & 3.26) T. mentagrophytes was found in 18.1% of the guinea pigs that came from shops where coupling or combining of animals took place and in 17.0% of the guinea pigs that came from shops where coupling or combining of animals did not take place. 74.2% of the positive guinea pigs came from shops that did not couple or combine animals. There was no significant correlation between coupling/combining of animals and infection with T. mentagrophytes. 3.2. Cheyletiella As shown in Table 2.1, the fur mite was detected on none of the examined guinea pigs. - 16 - 4. Discussion 4.1. Trichophyton mentagrophytes In this first study into the prevalence of T. mentagrophytes in Dutch pet shops, this fungus was detected on Guinea pigs in 27.3% of the visited pet shops. The prevalence in pet shops turned out to be higher than the estimated prevalence of 5% that was presumed for the power analysis performed prior to the study.17,58,63 All the positive guinea pigs were asymptomatic carriers. Because this dermatophyte has zoonotic potential it is good to know that T. mentagrophytes can be present without noticing it and that this might be the case more often than assumed. Shop owners should be aware of this fact so that they may send their customers to their doctor if symptoms of ringworm appear after buying a new pet. T. mentagrophytes was found in 17.3% of the guinea pigs. This is a higher percentage than was found in previous studies where the prevalence of T. mentagrophytes in asymptomatic guinea pigs ranged from 1.4 to 13% (amount of animals per study ranged from 63 to 222).6, 17,53,63 The fact that in this study T. mentagrophytes was found is not surprising because in guinea pigs this is the dermatophyte most commonly isolated.15,32,43,47,53,63 It is to be expected that laboratory animals have a lower prevalence of T. mentagrophytes compared to pet animals. The latter may explain why in some of the previous studies, which included laboratory guinea pigs, an overall lower prevalence was found. The higher prevalence found in this research project could also be due to a prevalence difference of dermatophytes between countries.67 Kraemer, however, retrospectively used 1132 specimens collected from guinea pigs in 395 (34.9%) of which T. mentagrophytes was found. These specimens were collected from three different laboratories. Except from all states in Germany, a small number of samples also originated from Austria, Italy, Luxembourg, the Netherlands and Switzerland. One laboratory received specimens of animals suspected of dermatophytoses. In this laboratory 251 of 584 (43%) of the specimens were positive for T. mentagrophytes. In the other two laboratories T. mentagrophytes was found in 27% (105/383) and 23.6% (39/165) of the cases.32 In the second part of this study healthy pet guinea pigs, guinea pigs with skin diseases and guinea pigs with diseases not affecting the skin were evaluated prospectively. This resulted in a prevalence of 8.5%, 7.7% and 8.0%, respectively. In 91.7% of the positive pet shops and in 93.5% of the guinea pigs on which T. mentagrophytes was found, the Arthroderma benhamiae complex of T. mentagrophytes was isolated. The Arthroderma vanbreuseghemii complex of T. mentagrophytes was isolated in 8.3% of the positive pet shops and in 6.5% of the positive guinea pigs. This is consistent with the findings of Gräser, who reported that both complexes can be found on guinea pigs and strains of the A. benhamiae complex are very likely to have rabbits and guinea pigs as a more restricted range of host species.20 No relationship was found between the two shops in which - 17 - A. vanbreuseghemii was cultured, as they were located many kilometers (235 km) apart and they did not share the same suppliers. In this study no gender predisposition was found, which is consistent with previous reports on T. mentagrophytes in guinea pigs and other wild rodents.19,32,33 Younger animals seem more susceptible to an infection, which can be due to a stronger immunity in older animals because they had more contacts with fungi12 or because they have an insufficiently developed immune system and smaller amounts of fungistatic fatty acids in their sebum.40,63,67 The mean age of the guinea pigs on which T. mentagrophytes was found was 14 weeks and the mean age of the guinea pigs with a negative culture was 19 weeks. Of the animals which were over 26 weeks of age 5.6% and of the animals which were younger than 26 weeks of age 18.6% were positive for T. mentagrophytes. A total of 96.8% of the positive guinea pigs in this study was younger than 26 weeks. This outcome is influenced by the fact that mainly younger animals were sampled, but similar findings were encountered by other researchers. They found that all the infected guinea pigs were less than six months of age63 and the affected animals were significantly younger than the animals with negative cultures.32 Furthermore, in one research project a higher mortality rate in young guinea pigs infected with Trichophyton mentagrophytes during an epizootic outbreak of T. mentagrophytes was found.43 We did not find a significant correlation between infection and hair type. Thus, in this study a breed predisposition for T. mentagrophytes is not found. This is consistent with other reports which commonly also do not mention a breed predisposition, except for the report of Van Geel, in which is stated that all of the four guinea pigs which were found positive for T. mentagrophytes were short haired.63 In this study no significant correlation was found between the cage occupation, the turnover of the shop, the origin of the animals, the bowl-exchange between the cages and coupling/combining of animals on the one side and infection with T. mentagrophytes on the other side (Table 3.28 – 3.37). Guinea pigs are social animals, which live in groups. Individual housing may therefore result in stress, which in turn could possibly influence the immune response and make individually housed guinea pigs more susceptible to an infection. This also counts for housing with too many animals in a small cage. In this study there was not a great difference in percentages of positive animals between solely housed animals and guinea pigs that were housed with congeners. This could be due to the fact that in most shops the animals in the same cage had the same origin and combining/coupling with animals of different origin was seldom done. This reduces the risk of cross infection. Further more overcrowding was barely seen. Some guinea pigs fight with each other or are left on their own when the other animals in their cage are sold, in these - 18 - cases, combining or coupling of the guinea pigs, if health and welfare are concerned, are good decisions. Infection between cages via fomites could of course also occur.1,12,34,44 This, however, is not very likely, because in 95.5% of the shops just one cage with guinea pigs was positive for Trichophyton mentagrophytes and most of the positive guinea pigs came from shops were the food and water bowls were not exchanged. In these shops cleaning and feeding of the cages was done one cage at a time, whereby all attributes of one cage were placed back into the same cage before starting with the next. The lowest infection was seen in guinea pigs that were also housed with rabbits. The fact that rabbits seem no greater source of infection is consistent with our own study (unpublished data) and other studies, in which was found that guinea pigs are more often carriers of T. mentagrophytes32 and that rabbits are more resistant to infections with dermatophytes.6,17,53 A shop which sells more guinea pigs per year has more supply and thus introduction of new young guinea pigs, which could be a source of infection, in the shop. Even so, if more animals need to be cleaned and handled, it could be the case that they get less attention and care and the risk of cross infection may be higher due to a bit more time-dependent carelessness. This research did not show a significant correlation between the turnover of the shop and infection with T. mentagrophytes, but the highest percentage of positive guinea pigs were found in shops with a turnover of more than 100 (25.8% against 17.4; 16.1 and 13.6%). It should be noticed that most of the owners gave an estimation of their turnover rates and that the turnover is seasonally influenced. Most of the animals are sold in the summer. The shops mostly have less guinea pigs and less supply of guinea pigs during winter, in which season this research project took place. For this reason it could be interesting to repeat this study during summer. The assumption that T. mentagrophytes would be isolated more on guinea pigs that were supplied by wholesalers, is not confirmed by this study. Over 60% of the positive guinea pigs came from shops that never used wholesalers as animal suppliers. 4.2. Cheyletiella No fur mite was detected on any of the guinea pigs that were examined. This is probably due to the fact that the mite does not infect guinea pigs very often56,58 and most of the animals were getting preventive therapy with ivermectine, which is also effective in combating Cheyletiella-infections before they were put into the cage.36,58 - 19 - 5. Conclusion Trichophyton mentagrophytes was found in 17.3% of the examined guinea pigs in Dutch pet shops. The present study showed that guinea pigs in Dutch pet shops could be carriers of T. mentagrophytes without showing lesions or clinical signs and that the dermatophyte is present in 27.3% of the Dutch pet shops. Because this dermatophyte has zoonotic potential and because it has guinea pigs, which are often bought as children’s pets, as its main carriers, further research is needed to reveal factors influencing the prevalence of T. mentagrophytes in pet shops so that in future preventive measurements can be taken to decrease this percentage. - 20 - 6. Advise We wrote an advice about how to deal with dermatophytes in a pet shop and we sent every cooperating pet shop a copy. 6.1. General preventive measurements Cleaning and disinfection of the cages must be done before arrival of new animals and by appearance of the disease. All the bedding must be removed and all surfaces and cageattributes must be cleaned. After these two steps disinfection can take place, with a solution of bleach/chloride in water23 or with a solution of halamid (sodium p-tolueensulfonchlooramid) in water. After the disinfection the cages should be rinsed well with water to prevent burning skin lesions in the animals. Newly arrived animals should be checked for (skin)lesions and should be washed with imaverol. It is wise to keep newly arrived animals apart for a while because they could bear diseases with them. In case of (skin)lesions all newly arrived animals should be kept apart of the animals that are already present. Since guinea pigs are frequent carriers of dermatophytes, they should be kept apart from rabbits to prevent infecting the latter animals. Stress should be avoided. Prevention of overcrowding and individual housing and giving them the comfort of good food and a possibility to hide prevents stress.47 General measures to prevent spreading of the disease in the shop are important. The cages should be kept apart, water and food bowels should stay with the same animals. Before switching of to another cage, the hands of the staff should be disinfected. Infected and ill animals should be touched and fed after the healthy animals are done. Customers should not be allowed to touch the animals. 6.2. Measurements in case of a dermatophyte infection In case of a dermatophyte-infection, the supplier should always be informed. Although the infected animal has already been sold, it is still possible that the dermatophyte is still present in the shop. Therefore all the cages should be cleaned and disinfected as mentioned at the general preventive measurements, followed by treatment of the cages with enilconazole (Imaverol concentrate). This should be diluted in water (10ml emulsion/L water). The cages should be left to dry on air or can be dried with a hairdryer. While treating the cage, gloves should be worn. The animals that are still present in the shop should be washed with imaverol. The animals that show skin lesions or the animals of which is confirmed that they are carriers of the dermatophyte should be kept apart. These animals should be sent back to the supplier. The infected animals that are already sold should be treated with itraconazol (rabbit 5-10 mg/kg,23 guinea pig 5mg/kg) every 24 hour for 4-6 weeks.10,49 From these animals a culture should be made every month to determine if they are still infected. The treatment should be continued until two successive cultures are negative. In practice treatment during 1 month seems enough to eliminate the dermatophyte. - 21 - We also informed the owners of the pet shops about the zoonotic character of the dermatophytes and that immune-compromised humans are more at risk. Hands and clothes should be washed thoroughly after touching the animals. - 22 - 7. Acknowledgements Many thanks to Dr. Nico Schoemaker, Utrecht University and Dr. Ing. Paul van Overgaauw, Institute for Risk Assessment Sciences for their support during this research project and to Angele Timan and Ali Eggenkamp for all their help and support with obtaining the Sabouraud B agar plates and usage of the incubator. I also would like to thank Martin Meijer BSc. and Prof. Dr. Dr. h. c. R A Samson of the CBSKNAW Fungal Biodiversity Centre for their time, support, leads and help in the differentiation and isolation of Trichophyton mentagrophytes. The Dibevo (Amersfoort, Netherlands) are acknowledged for sponsoring this research project and for providing the addresses of all pet selling shops in the Netherlands. Finally I would like to thank all the cooperating pet shops for the warm welcome, their time and interest and their cooperation. - 23 - 8. References 1. Ajello, L., 1962. Present day concepts in the dermatophytes. MycopatholMycolAppl 17:315-324 2. Ajello, L., Cheng, S.L., 1967. The perfect state of Trichophyton mentagrophytes. Sabouraudia 5:230-234 3. Ajello, L., 1968. A taxonomic review of the dermatophytes and related species. Medical Mycology, 6(2):147-159 4. Almeida, S.R., 2008. Immunology of Dermatophytosis. Mycopathologia 166:277-283 5. Alteras, I., 1966. Human dermatophyte infections from laboratory animals. Medical Mycology 4:143-145 6. Balsari, A., Bianchi, C., Cocilovo, A., Dragoni, I., Poli, G., Ponti, W., 1981. Dermatophytes in clinically healthy laboratory animals. Laboratory Animals 15:75-77 7. 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(eds): Pathology of Domestic Animals. San Diego, Academic Press, 1993, pp 661-664, 686 - 26 - 9. Appendices Appendix 1 (Chapter 2) - Table 2.1: Examined guinea pigs - Frequency tables 2.2 - 2.10 - Questionnaire - Table 2.11 : Dates of sampling and culturing 28 32 35 36 Appendix 2 (Chapter 3) - Table 3.4 : Amount of suspected colonies after 1 week - Table 3.5: Percentage of guinea pigs with T. mentagrophytes - Table 3.6: Percentages of positive shops per province (%) - Cross-Tables & Chi-Square Tests 3.7 – 3.32 - Independent samples T-test 3.33 – 3.38 38 39 39 40 49 - 27 - Appendix 1 Table 2.1 Examined guinea pigs Specimen 1C 2B 3B 3C 3E 4E 5B 5C 5D 5E 7F 7G 7H 8C 9A 10B 11B 12B 12C 12E 13B 13C 16A 16C 17B 17D 18C 19A 19D 19E 20A 20B 21A2 22A 23A 24B 24D 25C 25E 25F 26B 26C Gender ♂ ♀ ♂ ♂ ♀ ♀ ♂ ♂ ♂ ♀ ♀ ♀ ♀ ♀ ♂ ♀ ♂ ♀ ♂ ♂ ♀ ♀ ♀ ♂ ♀ ♀ ♂ ♀ ♂ ♂ ♀ ♂ ♂ ♀ ♀ ♀ ♂ ♂ ♂ ♀ ♂ ♂ Hair length Long Short Short Short Short Short Short Short Short Short Short Short Short Short Medium Short Short Short Long Short Short Short Short Short Short Short Short Short Short Short Short Short Short Short Short Short Short Long Short Short Short Short Age (wks) Cage occupation* 10 6 4 9 5 7 20 38 10 52 24 16 12 16 10 10 16 8 10 36 78 78 6 6 12 14 14 10 10 10 16 16 104 6 7 7 9 12 7 4 10 10 S MS SS SS SS SS S S SS S S S S S MS SS S SS MS MS S S MS MS SS SS S S SS S S S MS SS MS SS S MS MS SS MS S - 28 - Cheyletiella - Hygiene + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + 27E 27F 28D 29B 30C 30D 31B 31C 32A 33A 33B 33C 34A 35B 36A 36B 36D 36E 37A 37E 37F 38B 38C 39A 39B 39C 40C 40D 41D 41E 42AX 42B 43A 43B 43C 44B 44C 44D 44F 44G 45A 45B 46D 46E 46F 47B 47E 47F 48A 48C ♀ ♂ ♂ ♀ ♂ ♀ ♂ ♀ ♂ ♀ ♂ ♂ ♂ ♀ ♀ ♀ ♀ ♂ ♂ ♀ ♂ ♀ ♂ ♂ ♂ ♂ ♂ ♂ ♂ ♂ ♂ ♂ ♂ ♂ ♀ ♂ ♀ ♀ ♂ ♂ ♂ ♂ ♂ ♀ ♂ ♂ ♀ ♂ ♂ ♂ Short Short Short Short Short Short Short Short Short Short Short Short Short Long Short Short Long Short Short Short Short Short Short Short Short Short Short Long Short Short Short Short Long Long Long Short Long Short Short Medium Long Long Short Short Short Short Short Short Short Long 5 8 9 10 13 18 6 12 10 11 7 12 14 16 78 10 78 78 12 10 8 9 10 18 16 16 8 52 11 8 5 52 16 16 16 26 14 5 14 8 8 12 6 6 10 9 9 26 26 26 SS SS SS SS S S SS SS S MS MS MS SS S SS MS S SS SS SS S SS S S S S MS SS MS MS MS S S S S MS MS MS MS SS SS MS SS SS SS SS S S MS MS - 29 - - + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + 48D 49E 49F 50B 50D 50E 51C 52A 53A 53C 54A 55B 56A 56C 56D 57B 58B 59A 59C 60A 60C 60E 61A 61B 61D 61G 62D 63A 63B 63C 63G 64A 65D 66A 66D 67B 68A 68B 69B 69E 69F 70A 70B 71C 72A 73E 73F 74A 74B 75A ♂ ♂ ♂ ♂ ♀ ♂ ♂ ♂ ♂ ♂ ♀ ♀ ♀ ♂ ♀ ♂ ♂ ♀ ♂ ♀ ♂ ♂ ♂ ♂ ♀ ♂ ♂ ♀ ♂ ♂ ♂ ♂ ♂ ♂ ♀ ♂ ♂ ♀ ♂ ♀ ♂ ♂ ♂ ♂ ♂ ♂ ♀ ♂ ♀ ♀ Long Medium Short Short Short Short Short Short Short Long Short Short Short Short Short Long Short Short Short Short Short Short Short Short Short Short Short Short Short Medium Short Short Short Short Short Short Short Short Short Short Short Short Short Short Long Long Short Short Short Short 26 18 18 9 11 12 26 26 12 10 15 5 26 12 12 10 10 8 8 13 26 11 36 26 26 26 15 8 7 16 12 36 9 26 26 10 9 6 10 10 10 9 9 5 36 26 26 14 8 11 MS S S SS S SS SS S SS SS S SS SS S MS MS MS MS MS S MS SS S SS SS S SS MS SS S S S MS SS SS SS SS SS S SS S SS MS S SS S MS SS S SS - 30 - - + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + 11 20 20 20 11 11 8 8 10 12 14 14 8 8 12 12 78 78 78 8 8 78 26 10 10 16 26 26 26 20 16 5 15 10 16 20 6 *S=Solely, SS=Same Species, MS=Mixed Species 75E 76A 76B 76D 77A 77B 78B 79A 80A 80E 80F 80G 80H 81B 82D 82E 83A 83C 83F 83G 84A 85B 85D 86A 86C 87B 87C 87E 88A 88C 88D 89B 89C 90C 90D 90E 91A ♂ ♂ ♀ ♂ ♀ ♂ ♀ ♀ ♂ ♀ ♂ ♂ ♀ ♂ ♀ ♂ ♂ ♂ ♂ ♀ ♂ ♂ ♀ ♀ ♀ ♀ ♀ ♂ ♀ ♂ ♀ ♂ ♂ ♂ ♂ ♀ ♀ S MS S MS S SS MS MS S SS S S SS SS SS SS S S S SS S MS SS MS S MS MS MS MS MS MS MS MS S S S S Short Short Short Short Long Short Short Short Short Short Long Short Short Short Short Short Short Short Short Short Short Short Short Short Short Short Short Short Short Short Short Long Short Short Short Short Short - 31 - - + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + Frequency tables Table 2.2: Total number of guinea pigs Table 2.3: Male and female percentages of the random sample (%) Table 2.4: Age in weeks of the examined guinea pigs Table 2.5: Hair type of the examined guinea pigs - 32 - Table 2.6: Cage-occupation of the examined guinea pigs Table 2.7: Amount of guinea pigs sold per year Table 2.8: Origin of the guinea pigs Table 2.9: Coupling/Combining of the guinea pigs Table 2.10: Bowl-exchange between cages - 33 - - 34 - Questionnaire How many guinea pigs are sold in this pet shop per year? 50 100 150 200 250 300 Different, … What is the origin of the bought animals? Wholesale Private Different, … What’s the veterinary policy in the pet shop? Is there a vet who visually checks the animals on a certain moment?Yes/No Are the animals get a preventive therapy before they entering their cages? Yes/No How? With? How is the hygiene policy in the shop? How many times are the cages cleaned? With? Are the eat- and drink bowls of different cages exchanged or do they always stay in the same cage? Firm/Exchange Are animals being moved to other cages or mixed when they didn’t arrive together? Yes/No What is the size of the cages in m2? What is the knowledge of the employees? Which diplomas? Are the employees familiar with the term ‘Zoonosis’? Familiar/Not familiar Is the shop recognized by StichtingDierbaar? Yes/No - 35 - Table 2.11 Dates of sampling and culturing Shop 1 2 3 4 5 6* 7 8 9 10 11 12 13 14* 15* 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 Sampling 03-11-2011 03-11-2011 09-11-2011 10-11-2011 10-11-2011 15-11-2011 15-11-2011 15-11-2011 16-11-2011 16-11-2011 17-11-2011 22-11-2011 22-11-2011 22-11-2011 23-11-2011 23-11-2011 23-11-2011 29-11-2011 29-11-2011 30-11-2011 30-11-2011 30-11-2011 01-12-2011 01-12-2011 01-12-2011 06-12-2011 06-12-2011 06-12-2011 06-12-2011 07-12-2011 07-12-2011 07-12-2011 08-12-2011 08-12-2011 08-12-2011 08-12-2011 09-12-2011 13-12-2011 14-12-2011 14-12-2011 14-12-2011 15-12-2011 15-12-2011 15-12-2011 Culturing 09-11-2011 09-11-2011 10-11-2011 10-11-2011 10-11-2011 18-11-2011 18-11-2011 18-11-2011 18-11-2011 18-11-2011 18-11-2011 25-11-2011 25-11-2011 25-11-2011 25-11-2011 25-11-2011 25-11-2011 02-12-2011 02-12-2011 02-12-2011 02-12-2011 02-12-2011 02-12-2011 02-12-2011 02-12-2011 09-12-2011 09-12-2011 09-12-2011 09-12-2011 09-12-2011 09-12-2011 09-12-2011 09-12-2011 09-12-2011 09-12-2011 09-12-2011 09-12-2011 16-12-2011 16-12-2011 16-12-2011 16-12-2011 16-12-2011 16-12-2011 16-12-2011 - 36 - 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 15-12-2011 20-12-2011 20-12-2011 21-12-2011 21-12-2011 21-12-2011 21-12-2011 22-12-2011 22-12-2011 04-01-2012 05-01-2012 05-01-2012 10-01-2012 10-01-2012 10-01-2012 12-01-2012 12-01-2012 12-01-2012 12-01-2012 17-01-2012 17-01-2012 17-01-2012 17-01-2012 17-01-2012 18-01-2012 18-01-2012 18-01-2012 18-01-2012 18-01-2012 24-01-2012 24-01-2012 24-01-2012 24-01-2012 24-01-2012 24-01-2012 24-01-2012 25-01-2012 25-01-2012 25-01-2012 25-01-2012 25-01-2012 26-01-2012 26-01-2012 26-01-2012 02-02-2012 02-02-2012 02-02-2012 16-12-2011 23-12-2011 23-12-2011 23-12-2011 23-12-2011 23-12-2011 23-12-2011 23-12-2011 23-12-2011 06-01-2012 06-01-2012 06-01-2012 13-01-2012 13-01-2012 13-01-2012 13-01-2012 13-01-2012 13-01-2012 13-01-2012 20-01-2012 20-01-2012 20-01-2012 20-01-2012 20-01-2012 20-01-2012 20-01-2012 20-01-2012 20-01-2012 20-01-2012 27-01-2012 27-01-2012 27-01-2012 27-01-2012 27-01-2012 27-01-2012 27-01-2012 27-01-2012 27-01-2012 27-01-2012 27-01-2012 27-01-2012 27-01-2012 27-01-2012 27-01-2012 03-02-2012 03-02-2012 03-02-2012 *These shops didn’t have guinea pigs, just rabbits - 37 - Appendix 2 Table 3.4: Amount of suspected colonies after 1 week Specimen Amount of suspected colonies after 1 week 2B Countless 8C 20 11B 20 32A 20-30 36D 30-40 53A Countless 54A 5 55B 40 63A 15 63B 40-50 63C 7 68A Countless 68B 5 69B Countless 69E 43 69F 6 70A 1 70B 4 71C Countless 73E 3 76A 1 77A 2 77B 6 81B 16 83G 14 84A 3 85D Countless 86A 4 87B 3 88A 1 90C 8 90D* 2 *This sample turned out not to be T. mentagrophytes after microscopic examination - 38 - Percentages of shops & guinea pigs with T. mentagrophytes Table 3.5: Percentage of guinea pigs with T. mentagrophytes Table 3.6 Percentages of positive shops per province (%) Province Visited shops Positive shops Percentage + (%) in province Percentage + on total (%) Groningen Friesland Drenthe Overijssel Gelderland Noord-Brabant Zuid-Limburg Zeeland Zuid-Holland Noord-Holland Utrecht Flevoland 5 6 3 14 13 9 3 3 18 9 4 1 4 1 0 3 1 1 1 3 3 5 2 0 80,0 16,7 0,0 21,4 7,7 11,1 33,3 100,0 16,7 55,6 50,0 0,0 4,55 1,14 0,00 3,41 1,14 1,14 1,14 3,41 3,41 5,68 2,27 0,00 - 39 - Percentage + on total + shops (%) 16,67 4,17 0,00 12,50 4,17 4,17 4,17 12,50 12,50 20,83 8,33 0,00 Cross-Tables & Chi-Square tests Table 3.7 & 3.8: Cross-Table & Chi-Square of the Provinces - 40 - Table 3.9: Cramer’s V value of the Chi-Square of the Provinces and Infection Table 3.10 & 3.11: Cross-Table & Chi-Square of Province-groups Table 3.12: Cramer’s V value of the Chi-Square of the Province-groups & Infection - 41 - Table 3.13 & 3.14: Cross-Table & Chi-Square of Gender - 42 - Table 3.15 & 3.16: Cross-Table & Chi-Square of Hair-type Table 3.17 & 3.18: Cross-Table & Chi-Square of Cage-occupation - 43 - Table 3.19 & 3.20: Cross-Table & Chi-Square of Turnover Table 3.21 & 3.22: Cross-Table & Chi-Square of Origin - 44 - Table 3.23 & 3.24: Cross-Table & Chi-Square of Bowl-exchange - 45 - Table 3.25 & 3.26: Cross-Table & Chi-Square of Coupling/Combining of guinea pigs - 46 - Table 3.27 & 3.28: Cross-Table & Chi-Square of Provinces and Origin - 47 - Table 3.29: Cramer’s V value of the Chi-Square of provinces & origin Table 3.30 & 3.31: Cross-Table & Chi-Square of Province-groups and Origin Table 3.32: Cramer’s V value of the Chi-Square of the province-groups & origin - 48 - Independent samples T-test Table 3.33: Group statistics Table 3.34: Independent samples test Table 3.35: Group statistics (without guinea pigs older than 1.5 year) Group Statistics Infected N Mean Std. Deviation Std. Error Mean + 30 11,97 5,980 1,092 - 139 14,75 9,332 ,792 age in weeks Table 3.36: Independent samples test (without guinea pigs older than 1.5 year) - 49 - Table 3.37: Group statistics (without guinea pigs older than 1 year) Group Statistics Infected N Mean Std. Deviation Std. Error Mean + 30 11,97 5,980 1,092 - 136 13,93 7,583 ,650 age in weeks Table 3.38: Independent samples test (without guinea pigs older than 1 year) - 50 -