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Pasteurella Multocida Infection

Pasteurella multocida is a bacterial microorganism primarily found in cats and dogs. Human disease, most commonly in the form of localized skin and soft tissue infection, occurs after close contact with animal hosts. Respiratory tract infections and bacteremia, particularly in immunocompromised individuals, may also occur. The diagnosis mandates a thorough clinical workup and isolation of the organism from adequate patients samples through microbiological methods.


Presentation

Pasteurella multocida belongs to the normal microbial flora of the oral cavity of various animals, but is most abundant in cats and dogs, as studies estimate that up to 90% of cats and 50% of dogs harbor this pathogen in their mouths [1] [2]. Hence, this gram-negative anaerobic coccobacillus is principally encountered in general practice as a causative agent of cellulitis and soft-tissue infections developing as a result of close animal contact (a scratch or a bite) [1] [2] [3] [4]. Signs and symptoms - erythema, hyperemia, and discharge (often purulent) from the wound being typical findings, appear shortly after contact [4]. Proximal lymphadenitis is a frequent finding, while fever is reported in about 20% of cases [5] [6]. Main complications include the formation of abscesses and dissemination of the infection into the skeletal system (septic arthritis and osteomyelitis) [4] [6]. In addition to skin infections, Pasteurella multocida is also able to colonize the human respiratory tract, presumably after being in contact with carrier animals as well [4] [6]. Several reports have described the wide range of respiratory infections (from rhinosinusitis to pneumonia and abscess formation) that are seen in elderly patients suffering from chronic lung disorders or immunosuppression [3] [4] [6]. Furthermore, bacteremia and systemic infections may ensue as a complication of pneumonia and respiratory spread, particularly in patients with hepatic disease (cirrhosis), diabetes mellitus, chronic kidney disease and malignant diseases [3] [6]. Rare reports have documented endocarditis, central nervous system (CNS) infection, and intraabdominal infections by P. multocida [5].

Lymphadenopathy
  • Kikuchi disease is a rare condition characterized by fever and persistent lymphadenopathy. Its aetiology is unknown, but it has been associated with viral, bacterial, and protozoal agents.[ncbi.nlm.nih.gov]
  • The spectrum of disease produced ranges from localized, including abscess, cellulitis, lymphadenopathy, and osteomyelitis, to systemic, with septicemia, septic arthritis, respiratory, and central nervous system involvement.[ncbi.nlm.nih.gov]
  • B acteremia A ngiomatosis R etinitis T ransverse myelitis O culoglandular syndrome H epatis peliosis E ndocarditis N odes (Lymphadenopathy) S kin involvement Pasteurella multocida infection mnemonic: PCO P asteurella causes C ellulitis and O steomyelitis[medicowesome.com]
Hemoptysis
  • We report a case in which hemoptysis was the sole manifestation of Pasteurella infection. The patient was a middle-aged man with severe obstructive lung disease and exposure to cats.[ncbi.nlm.nih.gov]
Sputum
  • Depending on the site, appropriate patients samples (sputum, exudate from the skin, synovial fluid, or blood) should be obtained.[symptoma.com]
Blister
  • The swelling led to skin blistering and necrosis from which P. multocida was isolated. Those lesions progressed rapidly. The patient also had a history of chronic liver injury as described in previous reports.[ncbi.nlm.nih.gov]
  • The swelling led to skin blistering and necrosis from which P. multocida was isolated. Those lesions progressed rapidly. The patient also had a history of chronic liver injury as described in previous reports. 1995 S.[karger.com]
Chronic Abscess
  • Despite its apparent rarity, chronic abscess due to P. multocida should be considered in the differential diagnosis of solitary pulmonary masses.[ncbi.nlm.nih.gov]
Erythema
  • Signs and symptoms - erythema, hyperemia, and discharge (often purulent) from the wound being typical findings, appear shortly after contact. Proximal lymphadenitis is a frequent finding, while fever is reported in about 20% of cases.[symptoma.com]
Joint Stiffness
  • Despite a fairly wide antibiotic susceptibility pattern of this organism, the infection may have long-term consequences such as osteomyelitis, or small joint stiffness due to paraarticular infection.[ncbi.nlm.nih.gov]
Suggestibility
  • This case report suggests that P. multocida infection can be potentially caused from saliva of cows as well as dogs or cats.[ncbi.nlm.nih.gov]
  • Molecular genetic analysis of P. multocida isolates obtained from the human patient and his pet strongly suggests a zoonotic transmission of this bacterium.[ncbi.nlm.nih.gov]
  • Ampicillin-sulbactam (Unasyn) 1.5 – 3.0 grams IV q6h Piperacillin-tazobactam (Zosyn ) 3.375 grams IV q6h Imipenem 500mg IV every 6 hours [Range: 250-1000 mg q6-8h] Disclaimer The authors make no claims of the accuracy of the information contained herein; and these suggested[globalrph.com]
  • In vivo studies suggest that concentration in phagocytes may contribute to drug distribution to inflamed tissues. Treats mild-to-moderate microbial infections.[emedicine.medscape.com]
Renal Insufficiency
  • Despite postoperative duodenal perforation, abdominal Candida infections, wound dehiscence, and renal insufficiency, the patient is alive 1 year postoperatively.[ncbi.nlm.nih.gov]
Meningism
  • A case of neonatal sepsis and meningitis resulting from horizontal transmission of P. multocida is described.[ncbi.nlm.nih.gov]
  • An unusual case of meningitis and pericardial tamponade caused by Pasteurella multocida after a cat bite is reported.[ncbi.nlm.nih.gov]
  • However, P. multocida can also cause systemic infections (such as pneumonia, lung abscess, peritonitis, endocarditis, meningitis and sepsis)-especially in patients with other underlying medical conditions.[ncbi.nlm.nih.gov]
  • […] multocida A28.0 ICD-10-CM Codes Adjacent To A28.0 A26.7 Erysipelothrix sepsis A26.8 Other forms of erysipeloid A26.9 Erysipeloid, unspecified A27 Leptospirosis A27.0 Leptospirosis icterohemorrhagica A27.8 Other forms of leptospirosis A27.81 Aseptic meningitis[icd10data.com]

Workup

The diagnosis of P. multocida infection should be made early on, as this bacterial pathogen is highly susceptible to antimicrobial therapy, but also because more severe forms may be life-threatening [5] [6] [7]. One of the most important parts of the workup is a thoroughly obtained patient history that will confirm recent or previous close animal contact [7]. Additionally, physicians must inquire about the presence of underlying diseases and comorbidities that could serve as risk factors for respiratory and systemic infections by P. multocida, whereas a complete physical examination is also important in identifying the site of infection. Once a presumptive diagnosis of a bacterial etiology is made, microbiological studies are necessary to determine the exact pathogen. Depending on the site, appropriate patients samples (sputum, exudate from the skin, synovial fluid, or blood) should be obtained. Cultivation of P. multocida on standard media is a convenient method for its detection, but it is frequently masked by other structurally similar pathogens that could be present in nonsterile specimens (for example, haemophilus influenzae and francisella tularensis, the causative agents of whooping cough and tularemia, respectively) [2] [5] [6] [7]. Furthermore, skin and soft-tissue infections are often polymicrobial [6]. Still, the presence of large buttery colonies on blood agars consisting of gram-negative coccobacilli, developing after only one night of incubation, should be sufficient to make the diagnosis [6]. Molecular methods, such as polymerase chain reaction (PCR), can be used for more detailed analysis of P. multocida [2].

Treatment

  • Although the bacteria showed a decrease in antibiotic susceptibility, her symptoms and X-ray findings became stable, and severe exacerbations were not observed for the last few years after a low-dose erythromycin treatment was started.[ncbi.nlm.nih.gov]
  • A 64-year-old man was admitted with abdominal pain 6 weeks after treatment with intravenous flucloxacillin for cellulitis of his right leg.[ncbi.nlm.nih.gov]
  • The present case emphasizes the importance of appropriate initial treatment of skin wounds. Patients at risk should be aware of the possible consequences of being bitten, scratched or licked by their pet.[ncbi.nlm.nih.gov]
  • Treatment with a tetracycline and corticosteroids was successful. Pasteurella multocida infection, despite its habitual benign course, should be suspected among differential diagnoses of lymphogranulomatous affections with hepatic involvement.[ncbi.nlm.nih.gov]
  • Clinical features and treatment of the disease are discussed.[ncbi.nlm.nih.gov]

Prognosis

  • In this Grand Round, we review the clinical features, epidemiology, treatment, and prognosis of P multocida infections with a focus on these features in patients who are immunosuppressed.[ncbi.nlm.nih.gov]

Etiology

  • The etiology of Pasteurella multocida must be borne in mind in cases of sepsis in immunodeficient individuals, such as the cirrhotic patient, as well as exposure to domestic animals.[ncbi.nlm.nih.gov]
  • Once a presumptive diagnosis of a bacterial etiology is made, microbiological studies are necessary to determine the exact pathogen.[symptoma.com]

Epidemiology

  • P multocida is a rare cause of infections in immunocompromised hosts, epidemiologically linked to exposure to cats, dogs, and other animals.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Prevention

  • (October 26, 2015) Centers for Disease Control and Prevention. Tularemia. Available online at . Accessed February 2017. (January 18, 2017) Qureshi S. Clostridial Gas Gangrene. Medscape Reference. Available online at . Accessed February 2017.[labtestsonline.it]

References

Article

  1. Giordano A, Dincman T, Clyburn BE, Steed LL, Rockey DC. Clinical Features and Outcomes of Pasteurella multocida Infection. Barbara A, ed. Medicine (Baltimore). 2015;94(36):e1285.
  2. Wilson BA, Ho M. Pasteurella multocida: from Zoonosis to Cellular Microbiology. Clin Microbiol Rev. 2013;26(3):631-655.
  3. Orsini J, Perez R, Llosa A, Araguez N. Non-zoonotic Pasteurella multocida Infection as a Cause of Septic Shock in a Patient with Liver Cirrhosis: A Case Report and Review of the Literature. Journal of Global Infectious Diseases. 2013;5(4):176-178.
  4. Weber DJ, Wolfson JS, Swartz MN, Hooper DC. Pasteurella multocida infections. Report of 34 cases and review of the literature. Medicine (Baltimore) 1984;63:133–154
  5. Mandell GL, Bennett JE, Dolin R. Mandel, Douglas and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, Pennsylvania: Churchill Livingstone; 2015
  6. Murray PR, Rosenthal KS, Pfaller MA. Medical Microbiology. Seventh edition. Philadelphia: Elsevier/Saunders; 2013.
  7. Kofteridis DP, Christofaki M, Mantadakis E, et al. Bacteremic community-acquired pneumonia due to Pasteurella multocida. Int J Infect Dis. 2009;13(3):e81-83.

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Last updated: 2019-07-11 20:10