Clinical Manual for Management of the HIV-Infected ... - myCME.com

contact with the patient. Patients should wash their
hands after handling pets (especially before eating)
and avoid contact with pet feces to reduce the risk of
cryptosporidiosis, salmonellosis, and campylobacteriosis.
Cats
Patients should consider the potential risks of cat
ownership such as the risk of toxoplasmosis, Bartonella
infection, and enteric infections. Those who elect to
obtain a cat should adopt or purchase an animal that is
more than 1 year of age and in good health to reduce
the risk of cryptosporidiosis, Bartonella infection,
salmonellosis, and campylobacteriosis.
Litter boxes should be cleaned daily, preferably by
an HIV-negative, nonpregnant person; if the HIVinfected
patient performs this task, he or she should
wash hands thoroughly afterward to reduce the risk of
toxoplasmosis. Also to reduce the risk of toxoplasmosis,
cats should be kept indoors, should not be allowed to
hunt, and should not be fed raw or undercooked meat.
Flea control will help reduce the risk of Bartonella
infection. Although declawing generally is not advised,
patients should avoid activities that may result in
cat scratches or bites to reduce the risk of Bartonella
infection. Patients should wash the sites of cat scratches
or bites promptly and should not allow cats to lick the
open cuts or wounds.
Testing of cats for toxoplasmosis or Bartonella infection
is not recommended.
Birds
Screening of healthy birds for C neoformans, M avium,
or Histoplasma capsulatum is not recommended. Areas
contaminated with bird droppings should be avoided
if possible, and soil beneath bird-roosting sites should
not be disturbed. Contact with chicks and ducklings has
been associated with salmonellosis.
Other
Contact with reptiles (such as snakes, lizards, iguanas,
and turtles) should be avoided to reduce the risk of
salmonellosis.
Gloves should be used while cleaning aquariums
to reduce the risk of infection with Mycobacterium
marinum.
Contact with exotic pets, such as nonhuman primates,
should be avoided.
Section 2—Health Maintenance and Disease Prevention | 2–31
Food- and Water-Related Exposures
Raw or undercooked eggs (including foods that
may contain raw eggs, such as some preparations
of hollandaise sauce, Caesar and certain other salad
dressings, homemade mayonnaises, eggnog, uncooked
cake batter, and cookie dough); raw or undercooked
poultry, meat, or seafood, especially raw shellfish;
unpasteurized dairy products; unpasteurized fruit
juice; and raw seed sprouts (alfalfa, mung bean sprouts)
may contain enteric pathogens such as Salmonella,
pathogenic strains of Escherichia coli, and parasites
including Cryptosporidium. Poultry and meat are safest
if the internal temperature is verified with a meat
thermometer to be at least 180°F (poultry) or 165°F
(red meat). If a thermometer is not available, meats
should be cooked until no traces of pink remain;
however, color changes do not always correlate with
internal temperature. Fruits and vegetables should be
washed thoroughly, or cooked, before being eaten.
Cross-contamination of foods should be avoided.
Uncooked meats should not be allowed to come into
contact with other foods. Hands, cutting boards,
counters, and knives and other utensils should be
washed thoroughly after contact with uncooked foods.
Although listeriosis is uncommon in the United States,
it is a serious disease that occurs more frequently among
immunocompromised persons, including those with
HIV disease. Persons at increased risk of listeriosis may
elect to do the following:
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Avoid soft cheeses (eg, feta, brie, camembert, blueveined,
and Mexican-style cheeses such as queso
fresco). Hard cheeses, processed cheeses, cream
cheese, cottage cheese, and yogurt generally are safe
from listeriosis.
Cook leftover foods or ready-to-eat foods, such as
hot dogs, until they are steaming hot before eating.
Avoid foods from delicatessen counters, such as
prepared meats, salads, and cheeses, or heat these
foods until steaming before eating. Canned or shelfstable
pate and meat spreads need not be avoided.
Avoid raw or unpasteurized milk or milk products,
including goat’s milk, or foods containing
unpasteurized milk or milk products.
Patients should not drink water directly from lakes
or rivers because of the risk of cryptosporidiosis and
giardiasis. Even accidental ingestion of lake, river, or
ocean water while swimming, rafting, boating, skiing, or
engaging in other types of recreational activity carries
this risk.