bird droppings histoplasmosis - jan-2015

Brief Awareness on

Bird Droppings Cryptococcosis & Histoplasmosis

By

Mitul Desai (MCOH1)

Corporate Industrial Hygienist

Agenda

BIRD DROPPINGS

• Introduction

• Health Effects

• Diagnosis & Treatment

• Removal / Cleaning

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Bird DroppingsIntroduction

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Background

Bird droppings are noticeable in / around birds feeding, roosting (resting) &

shelter (nesting) spots. For example,

• building roof that allows birds ingress & / or nesting e.g. Maintenance Workshops

• roof area of abandon process equipment / machinery (e.g. gathering Station)

• in / around RO & STP plants or under large size tress

• balconies, ventilation systems

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Why are we discussing this topic?

Birds droppings introduce parasites & ticks into the

environment. This combined with the unpleasant

odours presents a risk to human health.

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Bird Droppings – Introduction

• Large populations of roosting / nesting birds may present the

risk of disease to people nearby.

• Serious health risks may arise from disease organisms that

can grow in the nutrient-rich accumulations of bird droppings,

feathers & debris under a roost — particularly if roosts have

been active for years.

• External parasites also may become a problem when

infested birds or bats leave roosts or nests. The parasites

then can invade buildings & bite people.

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Bird Droppings – Introduction

• Soil that contains large amounts of bird or bat droppings allow growing

of particular types of disease organisms (parasites - fungus, bacteria).

• The soil under a birds roost usually have to be enriched by droppings

for two years or more for the organisms to reach significant levels.

• Any activity that disturb the contaminated soil or bird droppings allows

these bacteria / fungus spores (microscopic size) to circulate in the air.

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• When people breathe in these spores, they

enter the lung. The person’s body temperature

allows the spores to transform into yeast.

• The yeast can then travel to lymph nodes & can

spread to other parts of the body through the

bloodstream.

Activities that may disturb soil with bird droppings

• Exploring caves with birds nesting;

• Cleaning / sweeping of area (having birds droppings);

• Cleaning, Painting or Demolition of roof, chimney, HVAC,

(abandoned) buildings & bridges with birds roosting / nesting;

• Farming / Gardening or Pest control;

• Microbiology laboratory work etc.

It is unlikely that healthy people will become infected even at

high levels of exposure. A major risk factor for infection is a

compromised immune system.

Bird Droppings – Exposure to Disease Organism

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Bird DroppingsHealth Effects

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Bird Droppings – Diseases

• Histoplasmosis is a disease caused by a fungus called

Histoplasma capsulatum, which grows in pigeon droppings. It

also grows in soils & can be found throughout the world.

• Cryptococcosis is a fungal disease caused by a fungus

called Cryptococcus, associated with droppings & also grows

in soils. It is very unlikely that healthy people will become

infected even at high levels of exposure.

• Psittacosis is an infection caused by Chlamydia psittaci, a

type of bacteria found in the droppings of birds such as

pigeons. When bird droppings dry & become airborne,

people may inhale them & get sick.

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Bird Droppings – Histoplasma

• The fungus histoplasma lives throughout the world - Most

common in North & Central America & lives in parts of

South America, Africa, Asia & Australia.

• Birds can get histoplasmosis & spread the fungus in their

droppings.

• Histoplasmosis can’t spread from the lungs between people

or between people & animals.

• However, in extremely rare cases, the infection can be

passed through an organ transplant with an infected organ.

Information for Supervisors11

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Biology of Histoplasmosis

Information for Supervisors

• Histoplasmosis symptoms appear about 10 days after initial

infection. Most cases of produce no symptoms or very mild ones.

• Other people may have flu-like symptoms that usually go away on

their own within a few weeks. Symptoms include: fever, cough,

extreme tiredness, chills, headache, chest pain & body aches

• However, if the infection becomes severe, the symptoms may last

longer than this. Severity of illness depends on immunity of the

person & the intensity of the exposure.

• The disease primarily affects the lungs. Occasionally, if other

organs are affected may cause death, if left untreated.

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Histoplasmosis – Symptoms

Histoplasmosis - Symptoms

• In rare cases, chronic lung infection or sudden flu-like infection

• Those with compromised immune systems (e.g. people living with

HIV / AIDS or cancer patients):

– are more at risk of developing histoplasmosis

– can develop into a long-term lung infection that can spread

from the lungs to other parts of the body (e.g. the brain & spinal

cord) called disseminated histoplasmosis

– mortality is high who develop histoplasmosis.

• The histoplasma fungus may cause a potentially blinding eye

condition known as ocular histoplasmosis syndrome (OHS).

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• When the disease spreads throughout the body, it affects

many organ systems & the person may then develop:

Anemia, Meningitis, Mouth ulcers, Infection of heart valves,

Pneumonia, Enlarged liver & spleen, Swollen lymph nodes

• Persons with a history of pulmonary disease can develop

chronic pulmonary histoplasmosis causing pericarditis(inflammation of fibrous sac surrounding the heart – causing chest pain),

broncholithiasis, pulmonary nodules, mediastinal fibrosis

(fibrosis on lymph nodes - blocking major vessels & airways).

• In persons who develop progressive, chronic or disseminated

disease, symptoms may persist for months or longer.

Histoplasmosis – Chronic Health Effects

Information for Supervisors15

Cryptococcosis – Symptoms

Cryptococcosis (or cryptococcal) is a fungal disease associated

with bird droppings & also grows in soils. It is caused by one of

three species of Cryptococcus – neoformans or gattii or grubii.

Symptoms

• Blurred vision or double vision

• Bone pain or tenderness of the breastbone

• Chest pain, Confusion, Dry cough, Fatigue, Fever,

Headache, Nausea, Skin rash - pinpoint red spots, Sweating

• Swollen glands, Unintentional weight loss, Weakness

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Psittacosis – Symptoms

Psittacosis is an infection caused by Chlamydia psittaci (a type of

bacteria) found in the droppings of birds e.g. pigeons. Symptoms usually

develop within 10 days after exposure / infection:

• Pneumonia with flu-like symptoms. Fever, chills & tiredness

• Mild or overwhelming whole-body inflammation & respiratory failure

• Respiratory – cough, sore throat, breathing shortness, chest pain

• Neurological (common) – photophobia, anxiety or extreme uneasiness

• Gastrointestinal (rarely) – vomiting, abdominal pain, diarrhoea &

jaundice

• Dermatological – facial rash (horder spots)

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Bird DroppingsDiagnosis & Treatment

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Information for Supervisors

Testing Environment for Histoplasma

Testing the environment for detecting Histoplasma is not useful because:

• The fungus is thought to be common in the environment in certain areas.

• A soil sample that tests positive for Histoplasma does not necessarily mean

that it is a source of infection & a sample that tests negative does not

necessarily mean that the fungus is not there.

• It is currently only done for scientific research; there is no standard test

commercially available.

If there are bird or bat droppings in / around your home or work area,

clean-up, if possible. If it is not possible to clean-up, try not to disturb it.

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Information for Supervisors

Histoplasmosis - Diagnosis

• Healthcares rely on the following to diagnose histoplasmosis:

– medical & travel history, symptoms,

– physical exams,

– imaging tests (chest x-rays or CT scans of lungs)

– sample collection & laboratory test tests (blood & urine sample, fluid from

respiratory tract, a tissue biopsy or culture).

• For some people, the symptoms of histoplasmosis will go away without

treatment. However, prescription antifungal medication (e.g.

itraconazole) is needed to treat severe histoplasmosis in the lungs,

chronic histoplasmosis & infections that have spread from the lungs to

other parts of the body (disseminated histoplasmosis).

• Depending on the severity of the infection & the person’s immune status,

the course of treatment can range from 3 months to 1 year.

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Information for

Supervisors

Histoplasmosis & Cryptococcosis – Treatment

• Mild cases may not need treatment.

• Some infections may not need treatment but may require

regular check-ups to make sure the infection has not spread.

• More serious cases, with symptoms that include high fever,

trouble breathing, loss of appetite (hunger) & malaise

(uneasiness), lung lesions or the disease spreading are

treated with anti-fungal medications.

• Anti-fungal drugs may need to be taken for a long time.

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Histoplasmosis & Cryptococcosis are diseases caused by fungus called Histoplasma

capsulatum & Cryptococcus fungal respectively.

It is unlikely that healthy people will become infected even at high levels of exposure.

Information for Supervisors

• Psittacosis is treated with Antibiotics.

• Patients normally show a response within 24-72 hours.

• Treatment is normally given for 2-3 weeks to lower the risk of

relapse (recurrence of a past medical condition).

• Patients who have severe disease are managed in intensive

care units & given intravenous fluids, using respiratory &

cardiovascular support.

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Psittacosis – Treatment

Psittacosis is an infection caused bacteria found in the droppings of birds e.g. pigeons.

Information for Supervisors

Bird DroppingsRemoval & Cleaning

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Bird Droppings – Removal / Cleaning

Safe removal / cleaning-up of bird droppings &

wastes is vital:

• to improve the aesthetic appearance of the

building or surface it is present on &

• to eliminate human health issues / hazards.

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• Ensure only authorized personnel are involved & present

during the removal of bird droppings.

• Ensure all the workers follow the necessary HSE

requirements to minimize risk from organisms in the

droppings.

• Remove small / negligible amount of droppings with soap

water or dispose in a dustbin.

• For removing large amounts of droppings, involve

professional hazardous waste operators.

• Remove large amounts of droppings by putting them into

sealed plastic garbage bags.

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Bird Droppings – Removing / Cleaning

• Rinse-off the outside of these bags before storing/sending

them for their safe disposal. While still wearing the respirator,

remove protective clothing & place it in a plastic bag.

• After complete removal of droppings, clean the area with hot

soapy water. Cleaning of large quantity of droppings may

involve sanitizing the area using adequate disinfectants to

kill any bacteria & organisms that may be present.

• Advise the workers to take shower.

• Take measures to prevent birds from reestablishing roost or

nest in the area of concern.

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Bird Droppings – Removing / Cleaning

Precautions - Prior to start Removal of bird droppings

• Confirm if there is intrusion & birds resting or nesting in roof /

roof cavities, they can be repelled by using ultrasonic repellant

equipment or repelling gels.

• Take care of eggs, baby or dependant birds - if there are baby

birds in nests present, wait until the birds have left the nest.

• Once birds are removed from roof cavities, permanently close

off all entry / ingress points in the area of concern.

• Clean-up any affected areas, after removing old nests, dead

birds, if any.

Bird Droppings – Removal / Cleaning

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Bird Droppings – Removal / Cleaning

Health & Safety Precautions - Prior to Removal of droppings

• Perform HSE Risk assessment for the cleaning task

• Ensure the removal work is done only by healthy individuals

• Ensure availability of necessary tools & PPE:

– water spray, hand brush or shovel (for large-scale

droppings)

– disposable suit, nitrile rubber gloves, safety goggles, shoe

covers,

– dust mask / half mask (that can filter 0.3 microns particles)

or full face mask if dealing with large quantity.

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Bird Droppings – Removal / Cleaning

Health & Safety Precautions - Prior to Removal of droppings

• Perform tool box talks to inform workers about the health

hazards & the method to be followed. Advise them to follow

good personal hygiene practices.

• Spray a fine jet of water over bird droppings to minimize

creation of dust & the spores to become airborne, when it is

disturbed.

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Bird Droppings – Ticks, Mites & other Parasites

• Bird roosts / nests harbor parasites (species that benefits at the expense

of the other species, the host) for example – bugs, ticks, lice, fly etc.

• Although, these parasites can bite & irritate, they are unlikely to transmit

diseases to humans.

• Droppings, feathers & dead birds in roosting/nesting area breed flies &

insects that may become problems in the immediate area. These pests

may fly through open windows or crawl through cracks to enter bldgs.

• Most parasites associated with bird roosts die quickly after the birds

leave, some may live for several weeks.

• Discourage birds from roosting around bldgs. Alternatively, treat the

affected area with appropriate insecticides for control of fleas, ticks,

mites & similar pests.

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If you understand the causes, then you can do

something about them,

otherwise you are left just to deal with the effects.

Thank You All

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