E. Cuniculi Positive Bun – Concerns

[JMH11]

Hi all,

I was wondering if anyone has any knowledge regarding the transmission of e. cuniculi.

For some background, Thumper presented with head tilt and anorexia back in April 2021. The vet initially began treatment for an ear infection, but added in albendazole once his E. cuniculi titers came back positive. He quickly recovered over the course of the month, and has had no symptoms since. The infection coincided with the beginning of my pregnancy, and I was heavily involved in his care and cage cleaning prior to confirming the pregnancy. Naturally, I had some concerns about this.

So, I discussed with my OB, and he does not seem concerned. He believes that 1) It is unlikely that I would contract the e. cuniculi unless severely immunosuppressed and 2) I would have obvious symptoms if I were to contract it. He believes that my interactions with Thumper can carry on as usual. However, at his most recent follow-up, Thumper’s vet seemed very cautious about me interacting with or cleaning up after him. She recommended that I always wash my hands after touching him, etc. She also recommended that our child not interact with him until capable of washing hands thoroughly afterwards.

The vet’s recommendations have left me feeling very nervous to interact with Thumper, and I feel as though I need to keep him secluded from our family. This is not a good life for him, and rehoming him has become an option in my mind, as painful as it is.

Does anyone have any deeper knowledge into the transmissibility of this organism? How far do I need to go in limiting contact with him during pregnancy? Limiting contact for our child? I’d really appreciate any insight.

(Text formatted edited by Wick for readability)

[LBJ10]

Highly unlikely. There are documented cases of EC infections in people, but they were severely immunocompromised (e.g. HIV). I would listen to your doctor. There is little reason to be concerned.

I’m assuming Thumper is a single rabbit. This means he has had EC for some time, probably from his mother when he was born. Just because his titer is positive for EC does not mean he is shedding. In fact, shedding spores typically takes place during the first few weeks following initial infection. Then the spores are not shed in the urine anymore.

The strange thing about EC is that a majority of rabbits have it, but most never show any symptoms. If they do show symptoms, it can be years after the initial infection (i.e. it lies dormant in the body).

[DanaNM]

I agree with LBJ10 (and your OB), EC is not like toxoplasma in terms of parasite type and risk to humans (which you’ve likely heard about as a risk for pregnant women). I found one study that looked at infection with EC in pregnant women.  Infections were rare, and the women who tested positive for EC also had immunological disorders: https://pubmed.ncbi.nlm.nih.gov/22324244/

The guidance from the Rabbit Welfare Association says the same thing: https://rabbitwelfare.co.uk/rabbit-care-advice/ownership/pet-rabbits-health/

I’m not a vet or medical doctor, but I am a biologist with a specialization in parasitology. From a quick read skim of some literature it looks like there have never been any documented cases of EC transmission from rabbits to humans, and in people without severely compromised immune systems (HIV patients, people who’ve had organ transplants, etc) that test positive tend to have no symptoms.  Most people seem to pick up microsporidia (the type of parasite) infections from drinking contaminated water (source: https://www.infectiousdiseaseadvisor.com/home/decision-support-in-medicine/infectious-diseases/microsporidiosis-microbiology/):

“Microsporidian spores are commonly found in surface water, and human pathogenic species have been found in municipal water supplies, tertiary sewage effluent, and groundwater. Water contact has been found to be an independent risk factor for microsporidiosis in some studies, but not in others. Encephalitozoon cuniculi spores are viable for at least 6 days in water. Most microsporidian infections are transmitted by oral ingestion of spores, with the site of initial infection being the gastrointestinal tract. Microsporidia are probably zoonotic infections, given their widespread distribution in animals and birds. In addition, infective spores of Microsporidia are present in multiple human body fluids (e.g., stool, urine, and respiratory secretions) during infection, suggesting that person-to-person transmission via multiple routes (oral, respiratory and sexual) is possible. Although congenital transmission of Enc. cuniculi has been demonstrated in rabbits, mice, dogs, horses, foxes, and squirrel monkeys, it has not been demonstrated in humans.”

So I think that washing hands after dealing with litter box things is not a bad idea, but that’s just good hygiene anyway! And I don’t think you need to be worried about cuddling with your bunny or any of that, you can trust your doctor!

. . . The answers provided in this discussion are for general guideline purposes only. The information is not intended to diagnose or treat your pet. Seek the advice of your veterinarian or a qualified behaviorist.  

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