For sepsis cases, however, she recommended starting with vancomycin and a cephalosporin.
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.”
Pet Safety: 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 pediatricians 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.
Countering these risks, she 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. For example, 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. All dairy foods should be pasteurized, and any foods containing eggs, poultry, or meat should be well cooked.
Stem cell recipients should always wash their hands after handling an animal. Someone else should clean a cage, a litter box, or a fish tank while the patient is immunocompromised. Litter boxes should be cleaned daily and kept away from food preparation or eating areas.
At the first suspicion of a pet's illness, the animal should be taken to the vet, Dr. McFarland said.
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.
“Kissing frogs is not recommended,” she said; kissing dogs, cats, and other household pets also is discouraged.
For more information, including brochures to download, Dr. McFarland recommended referring parents to