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].

• 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]

• Purpura

  She developed purpura fulminans (PF) of bilateral upper and lower extremities along with gangrene on the tips of her fingers and toes. Blood cultures confirmed Pasteurella multocida as the causative organism. [ncbi.nlm.nih.gov]

• 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]

  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]

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].

• Candida

  Despite postoperative duodenal perforation, abdominal Candida infections, wound dehiscence, and renal insufficiency, the patient is alive 1 year postoperatively. [ncbi.nlm.nih.gov]

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]

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

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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.