When Dan Levitis, his wife, Iris, and their three young children trooped into a Madison, Wis., urgent care clinic about 8 a.m. on New Year’s Day 2018, the staff didn’t seem surprised to see them. The family had sought treatment several times in the previous months for recurrent strep throat infections.
The first case occurred in late October 2017. Levitis, an evolutionary biologist who at the time was an associate scientist at the University of Wisconsin, was in Massachusetts on a research trip when his wife called to tell him that she and all three of their kids — Tigerlily, then 6, Kestrel, who was 3, and 14-month-old Peregrine — had tested positive for strep and were taking antibiotics.
Levitis, who had been battling a sore throat since leaving Madison several days earlier, called his doctor and was given a prescription for an antibiotic. Because the rest of his family was infected, he, too, was presumed to have strep.
After a round of antibiotics, everyone seemed to recover.
But five weeks later, his daughters complained of sore throats. This time, the entire family was tested. Throat cultures revealed that all five had strep.
Within a few days, the infection seemed to have cleared. But success was short-lived; the New Year’s Day visit occurred three weeks later. This time, the doctor prescribed a different antibiotic.
Levitis said he and his wife were reminded of the need to finish the full course of antibiotics and of sanitation measures they had been following, including replacing the toothbrushes they had been using.
But two weeks later, on Jan. 16, Kestrel and Tigerlily had strep again. And at the end of January, all three kids tested positive.
“We were so done with this and painfully aware that something was wrong,” Levitis recalled. Nobody at school or day care was getting strep, he said, so he suspected that something in their house was the source.
Levitis called his mother, a retired pediatrician who had practiced in suburban Maryland, for advice. She told him about a family she had seen who kept getting strep until they got rid of their pet cat.
Four months before the first outbreak, the family had adopted Umberto, a 3-year-old gray cat, from a nearby family.
Levitis said his wife asked their doctors about the possibility that cats could be vectors of strep, while he queried his cousin, a veterinarian.
“They all pretty much said the same thing: ‘There’s no evidence that cats can transmit strep to humans, but if you want to be safe, get rid of the cat,’” Levitis recalled.
That seemed unthinkable; they all adored Umberto. “He’s so loving and patient with our kids and such a wonderful pet,” Levitis said. “And we didn’t know for sure that he was the culprit.”
Iris Levitis asked their vet whether she could test Umberto for strep in case he was a conduit. The vet refused: Umberto seemed healthy and there was no reason to swab the throat of a healthy cat, which would require hooking him up to oxygen and administering general anesthesia.
As a scientist, Levitis said he was frustrated that no one seemed willing to consider the possibility that in rare cases a cat might harbor strep that could be transmitted to humans. A few published reports had suggested such a scenario.
The Levitises called a few other veterinary practices to see whether they’d test Umberto; all said no.
In early March, 3-year-old Kestrel got strep throat along with respiratory syncytial virus, which led to pneumonia, resulting in a two-day hospitalization. After she got home, “Iris had the brilliant idea” of calling the university animal hospital and trying to talk to an expert there, Levitis recalled. Maybe, the couple thought, an academic center would be more receptive to the cat hypothesis than community vets had been.
She wound up talking to Caitlin Barry-Heffernan, a fourth-year veterinary internal medicine resident. Then she handed the phone to her husband for his pitch.
“I talked about it as a research case,” Levitis said, “not a guy who got strep throat from his cat.”
“We were all kind of skeptical,” recalled Barry-Heffernan, who now practices in Southfield, Mich., outside Detroit. It is uncommon, she said, for cats to carry strep A, because the bacteria “doesn’t like to live on animals.”
But she was intrigued by the possibility and persuaded by Levitis.
On April 4, while the entire family was taking antibiotics for the seventh bout of strep in as many months, Umberto was seen by Barry-Heffernan and a vet student. They whisked Umberto, who Barry-Heffernan said seemed “perfectly healthy,” into a nearby room and quickly swabbed his throat. Neither anesthesia nor oxygen was required.
“Umberto was a really nice cat,” she recalled, so the procedure wasn’t difficult.
To the surprise of the vet school faculty, group A strep was found in the cat’s throat; it appeared to match the strain of strep collected during Levitis’ most recent throat culture.
“Almost certainly Umberto was contributing to the family’s infections,” Barry-Heffernan said. She prescribed antibiotics for the cat and a disinfectant spray for his fur. And the Levitises were given another round of antibiotics.
Soon afterward, they left on a previously scheduled two-week trip to Costa Rica. In their absence, Umberto was given his medication, and the house was professionally cleaned for a second time.
Since then, Levitis said, no one has had strep.
“Once we identified Umberto as a carrier, it was really easy to address,” Barry-Heffernan said. It seems likely that the infection was being passed among the asymptomatic cat and various members of the family; it probably originated in a human. (Similarly, the small number of cats and dogs known to have tested positive for the coronavirus are believed to have been infected by people; there is no evidence that animals can transmit the virus to humans.)
Barry-Heffernan said she hopes that the Levitises’ unusual case doesn’t cause people to get rid of their pets. “It was very easily treated,” she noted.
Levitis, who now lives in Northern California with his family — and Umberto — said he is convinced that treating the cat eradicated the infection that had bedeviled his family.