Bite-related and septic syndromes caused by cats and dogs

St Andrew's ambulatory care strategy for animal & human bite injuries & localised infections

BACKGROUND

Infected animal bites and localised infections are traditionally managed by inpatient admission, intravenous antibiotics, and localised washout +/- debridement. Our hand trauma protocol was modified to accommodate the challenges faced in delivering this pathway during the COVID-19 pandemic.

OBJECTIVE

To evaluate the outcomes of two management pathways, ambulatory (2020) vs inpatient (2019), at a single tertiary referral centre.

METHOD

Data were prospectively collected (March - July 2020), and compared to data held for the previous year (March - July 2019). Only referrals for animal or human bites and infections were included (adult and paediatric patients); particular focus was placed on patient antibiotic administration, subsequent management and clinical progress.

RESULTS

There were 254 patient referrals and 200 operations between March - July 2019 (2019 group, n = 166) and March - July 2020 (2020 group, n = 88). A higher proportion of patients had ambulatory care management in the 2020 versus 2019 group (76.1 %, 67/88 vs. 42.8 %, 71/166; p < 0.001). A lower proportion of patients received intravenous antibiotics in the 2020 versus 2019 group (25.0 %, 22/88 vs. 54.2 %, 90/166; p < 0.001). The proportion of operatively managed patients were similar in the 2019 and 2020 groups (76.5 %, 127/166 vs. 72.7 %, 64/88; p = 0.51). There was no significant difference in complications (9 %, 15/166, vs. 4.5 %, 4/88; p = 0.195), or re-admission rates (3.6 % %, 6/166 vs. 2.3 %, 2/88; p = 0.56) in the 2019 versus 2020 groups.

CONCLUSION

An ambulatory care treatment pathway for carefully selected patients with non-severely infected animal bites and localised infections, has comparable outcomes to routine admission for intravenous antibiotics and surgery.

LEVEL OF EVIDENCE

III.

Pasteurella Multocida Paravertebral Abscess Following Cat Scratch in Revision Spine Surgery: A Case Report

CASE

A 71-year-old man with a history of multiple revision lumbar spine surgeries following rod exchange with local and systemic infection symptoms including purulent drain output. Imaging demonstrated extensive submuscular fluid collection. Subsequent surgical debridement with deep cultures demonstrated Pasturella multocida; retrospectively, the patient recalled being scratched by his cat 1 week before presentation.

CONCLUSION

Pasturella multocida is a rare cause of paravertebral abscess following spinal surgery, but prevalent in cat flora. As domesticated animals are extremely common, clinicians and patients need to be aware of cat scratch as a potential source for postoperative infection through hematogenous seeding of the surgical site in the immediate postoperative period.

Surgical treatment of mammalian bites----experience in the management of facial wounds by dog and cat bite in China

Mammalian bites to the face challenges not only related to wound healing but also to aesthetic outcomes. This study aims to summarize 7 years of experience in treating mammalian bite wounds and propose a surgical approach for managing these wounds. From July 2016 to August 2023, 185 cases were treated and retrospectively evaluated. Variables collected included age, gender, anatomical location, wound features, and treatment management. The postoperative results were reviewed and analyzed. Of the 185 patients, 27.57% were under 18 years of age; with dog bites accounting for approximately 89.19% of cases. Notably, 59.46% of the injuries occurred in females. The most common injury sites were the forehead, chin, and cheek. Primary closure was utilized for 96.22% of the wounds. The fatty areas, such as the cheek, parotid gland, and mandibular region, were identified as high-risk areas for bite infections. In contrast, the forehead, periocular, nose, ear, and lip were classified as low-risk areas, while other regions were considered moderate-risk zones. The infection rates post-primary closure for high, moderate and low-risk areas are 9.09%, 6.67%, and 2.56%, respectively. Complex mammalian bite wounds should receive prompt plastic and reconstructive surgical treatment at a tertiary center. Most wounds can be effectively repaired with primary closure and other plastic techniques. Special attention should be given to high-risk bite wounds to prevent infection. This paper provides essential considerations and recommendations for the medical and surgical management of patients presenting with bite injuries.

The polymicrobial nature of the oral cavity and claws of cats diagnosed by mass spectrometry and next-generation sequencing

Close contact between cats and humans increases the risk of transmission of zoonotic pathogens, through bites and scratches due to the complexity of microorganisms in the oral and nail microbiotas of felines. This study investigated the presence of bacteria and fungi in the oral cavity and claws of 100 apparently healthy cats using conventional and selective microbiological culture media, and next-generation sequencing (NGS) and mass spectrometry (MALDI-TOF MS). Furthermore, antimicrobial susceptibility testing of bacteria isolates was performed by disc diffusion method. In total, 671 bacteria and 33 yeasts were identified by MALDI-TOF MS. Neisseria animaloris (10.8 %), Staphylococcus felis (8.5 %), and Pasteurella multocida (7 %) were the most prevalent bacteria in oral cavity samples (n = 343), while the most common yeast (n = 19) was Candida albicans (68.4 %). Staphylococcus pettenkoferi (13.4 %), Staphylococcus felis (6.4 %), and Staphylococcus simulans (5.8 %) were the prevalent bacteria identified in the claw samples (n = 328), while Rhodotorula mucilaginosa (57.2 %) was the most common yeast (n = 14). NGS predominantly identified the genera Moraxella, Neisseria, Pasteurella, and Fusobacterium in oral cavity samples, whereas enterobacteria and staphylococci were prevalent in nail bed samples. In addition, the genera Capnocytophaga and Bartonella were identified, which have been described in serious human infections secondary to feline aggressions. Levofloxacin, marbofloxacin, and amoxicillin/clavulanic acid were the most effective drugs against the main groups of bacteria identified. Multidrug resistance was observed in 17 % of the bacterial isolates. Furthermore, three staphylococci harboring the methicillin resistance gene mecA were identified. We highlight the complexity of microorganisms inhabiting the oral/claw microbiotas of cats, the high resistance rate of the isolates to conventional antimicrobial agents, and the zoonotic risk of aggressions caused by bites and scratches from domestic cats.

Cat bite injuries to the hand and forearm: the impact of antibiotic treatment on microbiological findings and clinical outcome

INTRODUCTION

Patients and physicians often underestimate cat bite injuries. The deep and narrow wound seals quickly and provides an environment for the inoculated saliva and bacteria. Interestingly, the literature reports no bacterial growth in the microbiological workup of wound swaps in up to 43%. The time between bite injury and the first clinical presentation, the start of antibiotic treatment and surgical debridement might affect these findings. Therefore, the current project examines if (1) these factors impact the outcome of microbiological results following cat bite injuries and (2) the detection of bacterial growth leads to higher complication rates, longer hospital stays, longer total treatment time, or higher total treatment costs.

MATERIALS AND METHODS

This single-center retrospective study analyzed data from 102 adult patients. All patients received antibiotic and surgical treatment following a cat bite injury. Microbiological samples were collected during surgery in all cases. The time from the bite incident to the first presentation, beginning of antibiotic administration, and surgical debridement was calculated. Demographic data, complication rate, length of hospital stay, total treatment time, and total treatment costs were recorded. (1) A generalized linear model was fitted using the microbiological outcome as the dependent variable. (2) Two groups (negative or positive microbiological results) were formed and statistically compared.

RESULTS

The median age was 50 (SD 16), and 72% were female. (1) The time from the bite incident to the first clinical presentation, antibiotic administration, or surgical treatment was not associated with the outcome of the microbiological result. (2) No significant differences were observed between the two groups.

CONCLUSIONS

Our data do not suggest that early antibiotic administration or delayed surgical treatment affects the outcome of the microbiological workup following cat bite injuries to the hand and forearm. The microbiological outcome did not affect the complication rate, treatment time, and total treatment costs.

Management Strategies for Common Animal Bites in Pediatrics: A Narrative Review on the Latest Progress

Animal bites are a common reason for children to visit primary care and emergency departments. Dog bites are the most prevalent, followed by cat bites at 20-30%. Other animals such as bats, monkeys, snakes, and rats collectively contribute less than 1% of cases. Hospitalization is necessary in only 4% of animal bite incidents. The main aim of this narrative review is to summarize the main protocols currently followed in pediatrics in cases involving the most common bites from different animal species. Analysis of the literature showed that the management of common animal bites in children presents a multifaceted challenge requiring a comprehensive understanding of the epidemiology, clinical presentation, and treatment modalities associated with each specific species. Effective wound management is paramount in reducing the risk of infection and promoting optimal healing outcomes. Additionally, tetanus vaccination status should be assessed and updated as necessary, and prophylactic antibiotics may be indicated in certain cases to prevent secondary infections. Furthermore, the role of rabies prophylaxis cannot be overstated, particularly in regions where rabies is endemic or following bites from high-risk animals. In addition to medical management, psychosocial support for both the child and their caregivers is integral to the overall care continuum. Future studies exploring the efficacy of novel treatment modalities, such as topical antimicrobial agents or advanced wound dressings, may offer new insights into optimizing wound healing and reducing the risk of complications.

Medico-legal implications of dog bite injuries: A systematic review

Dog bites pose a significant global public health issue and are the most common type of injury caused by animals. While most dog bites result in minor harm, they can also lead to severe or even fatal consequences. In cases involving serious injury or death, forensic pathologists investigate various aspects, including the crime scene, the injuries sustained by the victim, and the characteristics of the dog suspected to have caused the bite. The aim of this study is to provide a systematic review of the literature on the medical-legal implications of dog bites in forensic practice, in order to recognize the dog bite victim features, the injuries and their consequences related to, and to identify the offending dogs. The literature search was performed using PubMed, Scopus and Web of Science from January 1980 to March 2023. Eligible studies have investigated issues of interest to forensic medicine about dog bites to humans. A total of 116 studies met the inclusion criteria and were included in the review and they were organized and discussed by issue of interest (biting dog features, dog bite victim features, anatomical distribution of dog bites, injuries related to dog bites, cause of death, bite features, dog identification and post-mortem dog depredation). The findings of this systematic review highlight the importance of bite mark analysis in reconstructing the events leading to the attack and identifying the dog responsible. In medical forensic evaluations of dog bite cases, a multidisciplinary approach is crucial. This approach involves thorough analysis of the crime scene, identification of risk factors, examination of dog characteristics, and assessment of the victim's injuries. By combining expertise from both human and veterinary forensic fields, a comprehensive understanding can be achieved in dog bite cases.

Patterns of Common Dermatological Conditions among Children and Adolescents in Pakistan

Background and Objectives: Dermatological disorders are highly prevalent among children in Pakistan. The present cross-sectional study aims to identify the spectrum of dermatological conditions among children and adolescents in Pakistan. Materials and Methods: A total of 582 patients (50.9% males; 49.1% females) were included in the study based on their age (5.7 ± 4.1 years), dermatological condition, and epidemiology. The youngest patient was aged ten days, whereas the eldest was seventeen. Age criteria were further stratified into three categories: infants and toddlers (≤5 years), children (≥5 to <12 years), and adolescents (≥12 to <18 years). Amongst them, the majority was from Punjab (81.6%), while the other regions included were Azad Jammu and Kashmir (14.4%), Islamabad (3.3%), and Khyber Pakhtunkhwa (0.7%). Results: Scabies was the highest reported skin condition with 281 (45.55%) patients, followed by 114 (19.6%) with eczema, 60 (10.3%) with dermatitis, 33 (5.7%) with tinea capitis, 17 (2.9%) with tinea corporis, 16 (2.7%) with impetigo, and 15 (2.6%) with folliculitis. Other conditions include urticaria, burns, infections, pediculosis, tinea inguinalis, tinea faciei, nappy rashes, alopecia, warts, tinea incognito, tinea cruris, and acne vulgaris. The chi-squared test showed a high prevalence of tinea corporis and acne among adolescents (12-17 years), whereas eczema, dermatitis, and impetigo were more prevalent among infants and toddlers. Conclusions: Pets or livestock and poor hygiene were found to be highly reported risk factors for many dermatological conditions like scabies and fungal infections. Dermatological conditions are common in younger individuals, but unfortunately, many children do not receive the desired medical assistance.

PetBERT: automated ICD-11 syndromic disease coding for outbreak detection in first opinion veterinary electronic health records

Effective public health surveillance requires consistent monitoring of disease signals such that researchers and decision-makers can react dynamically to changes in disease occurrence. However, whilst surveillance initiatives exist in production animal veterinary medicine, comparable frameworks for companion animals are lacking. First-opinion veterinary electronic health records (EHRs) have the potential to reveal disease signals and often represent the initial reporting of clinical syndromes in animals presenting for medical attention, highlighting their possible significance in early disease detection. Yet despite their availability, there are limitations surrounding their free text-based nature, inhibiting the ability for national-level mortality and morbidity statistics to occur. This paper presents PetBERT, a large language model trained on over 500 million words from 5.1 million EHRs across the UK. PetBERT-ICD is the additional training of PetBERT as a multi-label classifier for the automated coding of veterinary clinical EHRs with the International Classification of Disease 11 framework, achieving F1 scores exceeding 83% across 20 disease codings with minimal annotations. PetBERT-ICD effectively identifies disease outbreaks, outperforming current clinician-assigned point-of-care labelling strategies up to 3 weeks earlier. The potential for PetBERT-ICD to enhance disease surveillance in veterinary medicine represents a promising avenue for advancing animal health and improving public health outcomes.

Microbial Complexity of Oral Cavity of Healthy Dogs Identified by Mass Spectrometry and Next-Generation Sequencing

The high complexity of the oral microbiota of healthy dogs and the close exposure of humans to companion animals represent a risk of the transmission of potential zoonotic microorganisms to humans, especially through dog bites, including multidrug-resistant ones. Nonetheless, a limited number of comprehensive studies have focused on the diversity of the microorganisms that inhabit the oral cavities of healthy dogs, particularly based on modern molecular techniques. We investigated bacterial and fungal organisms in the oral cavities of 100 healthy dogs based on a combination of conventional and selective microbiological culture, mass spectrometry (MALDI-TOF MS), and next-generation sequencing. In addition, in vitro antimicrobial susceptibility patterns of isolates and mecA resistance gene were assessed. A total of 213 bacteria and 20 fungi were isolated. Staphylococcus pseudintermedius (40/100 = 40%), α-hemolytic Streptococcus (37/100 = 37%), and Pasteurella stomatis (22/100 = 22%) were the most prevalent bacteria diagnosed by microbiological culture and MALDI-TOF MS, whereas Aspergillus (10/100 = 10%) was the most common fungi identified. Based on next-generation sequencing of selected 20 sampled dogs, Porphyromonas (32.5%), Moraxella (16.3%), Fusobacterium (12.8%), Conchiformibius (9.5%), Bergeyella (5%), Campylobacter (3.8%), and Capnocytophaga (3.4%) genera were prevalent. A high multidrug resistance rate was observed in Staphylococcus pseudintermedius isolates, particularly to azithromycin (19/19 = 100%), penicillin (15/19 = 78.9%), and sulfamethoxazole/trimethoprim (15/19 = 78.9%). In addition, the mecA resistance gene was detected in 6.1% (3/49) of coagulase-positive staphylococci. Here, we highlight the microbial complexity of the oral mucosa of healthy dogs, including potential zoonotic microorganisms and multidrug-resistant bacteria, contributing with the investigation of the microbiota and antimicrobial resistance patterns of the microorganisms that inhabit the oral cavity of healthy dogs.

In Silico Functional Characterization of a Hypothetical Protein From Pasteurella Multocida Reveals a Novel S-Adenosylmethionine-Dependent Methyltransferase Activity

Genomes may now be sequenced in a matter of weeks, leading to an influx of "hypothetical" proteins (HP) whose activities remain a mystery in GenBank. The information included inside these genes has quickly grown in prominence. Thus, we selected to look closely at the structure and function of an HP (AFF25514.1; 246 residues) from Pasteurella multocida (PM) subsp. multocida str. HN06. Possible insights into bacterial adaptation to new environments and metabolic changes might be gained by studying the functions of this protein. The PM HN06 2293 gene encodes an alkaline cytoplasmic protein with a molecular weight of 28352.60 Da, an isoelectric point (pI) of 9.18, and an overall average hydropathicity of around -0.565. One of its functional domains, tRNA (adenine (37)-N6)-methyltransferase TrmO, is a S-adenosylmethionine (SAM)-dependent methyltransferase (MTase), suggesting that it belongs to the Class VIII SAM-dependent MTase family. The tertiary structures represented by HHpred and I-TASSER models were found to be flawless. We predicted the model's active site using the Computed Atlas of Surface Topography of Proteins (CASTp) and FTSite servers, and then displayed it in 3 dimensional (3D) using PyMOL and BIOVIA Discovery Studio. Based on molecular docking (MD) results, we know that HP interacts with SAM and S-adenosylhomocysteine (SAH), 2 crucial metabolites in the tRNA methylation process, with binding affinities of 7.4 and 7.5 kcal/mol, respectively. Molecular dynamic simulations (MDS) of the docked complex, which included only modest structural adjustments, corroborated the strong binding affinity of SAM and SAH to the HP. Evidence for HP's possible role as an SAM-dependent MTase was therefore given by the findings of Multiple sequence alignment (MSA), MD, and molecular dynamic modeling. These in silico data suggest that the investigated HP might be used as a useful adjunct in the investigation of Pasteurella infections and the development of drugs to treat zoonotic pasteurellosis.

A Sublatissimus Dorsi Abscess Due to Pasteurella multocida Caused by a Cat Scratch

We encountered a 51-year-old male patient who was not immunocompromised. Thirteen days before his admission, his right forearm was scratched by his pet cat. Swelling, redness, and purulent discharge appeared at the site, but he did not seek medical attention. He developed a high fever and was hospitalized with a diagnosis of septic shock, respiratory failure, and cellulitis on plain computed tomography. After admission, the swelling on his forearm was relieved with empirical antibiotics, but the symptoms spread from his right axilla to his waist. We suspected necrotizing soft tissue infection and made a trial incision in the lateral chest up to the latissimus dorsi, but were unable to prove it. However, an abscess was later found under the muscle layer. Second incisions were made to allow the abscess to drain. The abscess was relatively serous, and no tissue necrosis was observed. The patient's symptoms improved rapidly. In retrospect, the patient probably already had the axillary abscess on admission. It may have been detected at this point if contrast-enhanced computed tomography had been performed, and early axillary drainage may have accelerated the patient's recovery, which could also have prevented the formation of the latissimus dorsi muscle abscess. In conclusion, the Pasteurella multocida infection on the patient's forearm induced a very unusual presentation and caused an abscess to form under the muscle, unlike necrotizing soft tissue infections. Early contrast-enhanced computed tomography may aid earlier and more appropriate diagnosis and treatment in such cases.

Waterhouse-Friderichsen syndrome following a dog bite in an asplenic patient: case report and review of the literature

The Waterhouse-Friderichsen syndrome represents a critical condition characterized by a septic shock associated with a disseminated intravascular coagulation causing the plugging of the microvascular network virtually all organs and systems, including the skin, the kidneys, the liver, and adrenal glands; the mortality rate is elevated, and survivors often must undergo multiple limb amputations. Here, we describe the uncommon case of an asplenic patient who developed this syndrome after a superficial wound caused by a dog bite causing an initial infection due to Capnocytophaga canimorsus that is part of the normal oral microbiome of pets. The clinical and pathological findings and the current and future therapeutic options are reviewed and discussed.

Renal abscess with Capnocytophaga canimorsus infection from a dog bite

We present a case of renal abscess caused by Capnocytophaga canimorsus infection in a previously healthy middle-aged man. He presented with sepsis and an acute kidney injury, and although not identified on his initial assessment, he had sustained a dog bite 5 days prior to hospital admission. The patient developed left loin pain and imaging investigation revealed a renal abscess. Gram stain showed a gram-negative bacillus and C. canimorsus was identified by 16S PCR from these samples along with aspirate from the abscess. The patient responded to treatment with carbapenems but required a prolonged course. His clinical condition was further complicated by a pleural effusion and the development of fatigue symptoms consistent with a post-infection chronic fatigue syndrome. We present this case which we believe to be the first documented case of C. canimorsus causing renal abscess. We discuss the challenges relating to investigation, management and the importance of detailed diagnostic exposure histories in sepsis of unknown origin.

The potential for the double risk of rabies and antimicrobial resistance in a high rabies endemic setting: detection of antibiotic resistance in bacterial isolates from infected dog bite wounds in Uganda

BACKGROUND

Post-exposure treatment for dog bites in humans aims at alleviating the risk of rabies and promoting wound healing. Wound healing may be complicated by bacteria. This study identified the different bacteria and their antibiotic susceptibilities in infected dog bite wounds (DBWs) in Uganda.

METHODS

A cross-sectional study was conducted among 376 dog bite patients. Wound swabs from patients with infected DBWs were collected and inoculated into recommended media. They were cultured for both aerobic and anaerobic bacteria. All isolated bacteria were identified based on colony characteristics, gram stain, and standard biochemical tests. Molecular identification was performed for strains that were resistant to three or more antibiotics. Antibiotic susceptibility testing was conducted using the disc diffusion method following the modified Kirby-Bauer method. The data were analysed using Stata version 15 software.

RESULTS

Approximately half of the patients (52.9%, 199/376) presented with infected wounds. Majority of the swabs (84.4%, 168/199) were culture positive, and yielded a total of 768 isolates where about half (52.9%, 406/768) were gram positive bacteria, and about two-thirds (64.6%, 496/768) were recovered from category II wounds. Among the gram positive bacteria, 339 (83.5%) were aerobes where Staphylococcus aureus (103, 30.4%), Coagulase-negative staphylococci (68, 20.1%), and Corynebacterium spp (33, 9.7%) had the highest prevalence. For the 362 Gram negative isolates, 217 (59.9%) were aerobes and the commonest isolates were P. maltocida (64, 29.5%), Capnocytophaga canimorsus (36, 16.6%) and P. canis (26, 12.0%). Gram-positive isolates were resistant to metronidazole (93.6%), oxacillin (68.5%), ceftriaxone (14.6%) and amoxicillin/clavulanic acid (14.0%). Gram negative isolates were resistant to metronidazole (100%), ampicillin (30.7%), oxacillin (29.3%), and doxycycline (22.9%). Multidrug resistance was in 105 (29.0%) and 121/406 (29.8%) of the gram-negative and gram-positive isolates, respectively. All gram-positive isolates were susceptible to vancomycin and ciprofloxacin.

CONCLUSIONS

Infection rates of DBWs in Uganda are high and the dominant bacterial isolates are Staphylococcus aureus, Pasteurella spps, and Capnocytophaga canimorsus. Multidrug resistance to commonly used antibiotics is high. The recommendation in the Uganda Clinical Guidelines to use metronidazole in the management of DBWs should be reviewed. DBWs should be enlisted for routine antimicrobial resistance surveillance and rational use of antimicrobial agents should be promoted.

Mycobacterium chelonae Infection After a Cat Bite: A Rare Case Report

We describe a 62-year-old woman with a 1-month-old unhealed cat bite wound caused by Mycobacterium chelonae presenting with persistent infection despite treatment with cefazolin and amoxicillin. This is the first reported case of M. chelonae infection caused by a cat bite. Cat bites are affected by the cat’s food microbiome, so clinicians should consider the cat’s diet if wounds are not responding as expected to first-line therapy.

Risk factors associated with infection in patients sustaining dog bites to the face

PURPOSE

The purpose of this study is to identify which patient-level factors, if any, influence the risk of infection following dog bite wounds to the face.

MATERIALS AND METHODS

This retrospective cohort study was conducted using the Kids' Inpatient Database (KID). The primary predictor variable was the type of facial injury. The primary outcome variable was the presence of facial infection. SPSS was used to perform statistical analyses and statistical significance was set at a P-value of < 0.05.

RESULTS

Our final sample comprised a total of 4,420 patients who suffered dog bites to the face, of which 1,237 (28.0%) resulted in infection. Open wound (n = 4,176, 94.5%) was the most common facial injury, followed by bone fractures (n = 105, 2.4%). Relative to children 16-20 years old, children who were 0-5 years old were three times more likely to develop an infection (P < 0.01). Finally, open wounds (P < 0.01) were over seven times more likely to get infected relative to fractures.

CONCLUSIONS

Young children, particularly those below the age of five, are vulnerable to dog bite wounds to the face. Open wounds posed the greatest risk of getting infected.

Zoonotic Bacterial Respiratory Infections Associated With Cats and Dogs: A Case Series and Literature Review

Cats and dogs make up an essential part of the household for families in the United States. Close contact with pets can carry a risk of potential infectious disease transmission. This case series outlines causes of zoonotic pneumonia associated with cats and dogs, with a particular focus on the three cases presented of respiratory infection with Bordetella (B.) bronchiseptica and Pasteurella (P.) multocida in patients with an underlying malignancy. B. bronchiseptica is a rare bacterial pathogen in humans that can cause disease in immunocompromised individuals. Interpreting the significance of B. bronchiseptica as a pathogenic agent can be challenging given that this microbe often accompanies other organisms in culture. P. multocida is another important pathogen known to cause severe respiratory infection in immunocompromised populations or those with certain underlying comorbidities. A broadened differential for other bacterial etiologies of zoonotic respiratory infection acquired from dogs or cats includes Francisella tularensis, Yersinia pestis, Coxiella burnetii, and Bartonella henselae. These pathogens should be considered in the correct clinical context. Pets also play a role as reservoirs for the transmission of resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA), methicillin-resistant Staphylococcus intermedius group (SIG), and extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae. Immunocompromised individuals must be educated on the potential for household transmission of zoonotic disease and how to limit certain types of close contact with pets. This report also highlights the importance of flea and tick control in pets for the prevention of zoonotic disease spread.

Candida parapsilosis osteomyelitis following dog bite: a case report and review of the literature

Candida osteomyelitis is uncommon, especially after dog bites. We describe a case of a 63-year-old man without significant comorbidities presenting progressing swelling of the distal interphalangeal joint (DIJ) of right index finger following a dog bite. Despite empiric antibiotic therapy and local medications, there were no clinical signs of improvement. Clinical examination revealed fistula with purulent drainage on the volar region. Even though laboratory data showed inflammatory markers on range, magnetic resonance imaging (MRI) demonstrated signs of osteomyelitis. The patient was taken to exploration and debridement of the bite wound. Culture of the bone biopsy showed growth of Candida parapsilosis. Therefore, the patient was diagnosed with isolated fungal osteomyelitis and was initiated on fluconazole therapy. The treatment was effective and all symptoms were resolved in 8 weeks after the surgery. There were no signs of recurrence after 20 months of follow-up. The patient had no cosmetic abnormalities or sequelae. Concurrently with the description of the case report a review of the literature was provided. According to the authors, there are three main etiopathogenesis for this infection. The first pathogenic mechanism is direct inoculation into the deep tissues through the dog bite. The second hypothesis is direct translocation of the pathogen from the skin to the deep tissue and to the bone. The last mode of transmission is hematogenous dissemination. Fungal osteomyelitis are really rare conditions, especially after dog bites, but nevertheless it should be considered as a possible diagnosis when there is no response to antibiotics.

Spatial, Temporal, and Demographic Patterns in the Prevalence of Hemorrhagic Septicemia in 41 Countries in 2005–2019: A Systematic Analysis with Special Focus on the Potential Development of a New-Generation Vaccine

Hemorrhagic septicemia (HS) caused by Pasteurella multocida B:2 and E:2 is among the fatal bacterial diseases in cattle and buffaloes that are economically valuable in Asian and African countries. The current work aims to study the prevalence of HS among buffaloes, cattle, sheep, and goats in 41 countries in 2005–2019. The data analysis revealed that 74.4% of the total infection rate in the world was distributed among cattle, followed by buffaloes (13.1%). The mortality of HS among cattle and buffaloes increased in 2017–2019 compared to the period between 2014 and 2016. The best measure to control the disease is through vaccination programs. Current commercial vaccines, including live-attenuated vaccines and inactivated vaccines, have some shortcomings and undesirable effects. Virus-like particles (VLPs) have more potential as a vaccine platform due to their unique properties to enhance immune response and the ability to use them as a platform for foreign antigens against infectious diseases. VLPs-based vaccines are among the new-generation subunit vaccine approaches that have been licensed for the human and veterinary fields. However, most studies are still in the late stages of vaccine evaluation.

WSES/GAIS/WSIS/SIS-E/AAST global clinical pathways for patients with skin and soft tissue infections

Skin and soft-tissue infections (SSTIs) encompass a variety of pathological conditions that involve the skin and underlying subcutaneous tissue, fascia, or muscle, ranging from simple superficial infections to severe necrotizing infections.Together, the World Society of Emergency Surgery, the Global Alliance for Infections in Surgery, the Surgical Infection Society-Europe, The World Surgical Infection Society, and the American Association for the Surgery of Trauma have jointly completed an international multi-society document to promote global standards of care in SSTIs guiding clinicians by describing reasonable approaches to the management of SSTIs.An extensive non-systematic review was conducted using the PubMed and MEDLINE databases, limited to the English language. The resulting evidence was shared by an international task force with different clinical backgrounds.

βLact-Pred: A Predictor Developed for Identification of Beta-Lactamases Using Statistical Moments and PseAAC via 5-Step Rule

Beta-lactamase (β-lactamase) produced by different bacteria confers resistance against β-lactam-containing drugs. The gene encoding β-lactamase is plasmid-borne and can easily be transferred from one bacterium to another during conjugation. By such transformations, the recipient also acquires resistance against the drugs of the β-lactam family. β-Lactam antibiotics play a vital significance in clinical treatment of disastrous diseases like soft tissue infections, gonorrhoea, skin infections, urinary tract infections, and bronchitis. Herein, we report a prediction classifier named as βLact-Pred for the identification of β-lactamase proteins. The computational model uses the primary amino acid sequence structure as its input. Various metrics are derived from the primary structure to form a feature vector. Experimentally determined data of positive and negative beta-lactamases are collected and transformed into feature vectors. An operating algorithm based on the artificial neural network is used by integrating the position relative features and sequence statistical moments in PseAAC for training the neural networks. The results for the proposed computational model were validated by employing numerous types of approach, i.e., self-consistency testing, jackknife testing, cross-validation, and independent testing. The overall accuracy of the predictor for self-consistency, jackknife testing, cross-validation, and independent testing presents 99.76%, 96.07%, 94.20%, and 91.65%, respectively, for the proposed model. Stupendous experimental results demonstrated that the proposed predictor “βLact-Pred” has surpassed results from the existing methods.

The wound severity of animal bite victims visiting rabies prevention clinics and the influencing factors in Central China: a cross-sectional investigation

Background

Animal bites are a major public health problem. The more serious the bite wound is, the higher the risk of developing rabies is. This study aimed to investigate the severity of wounds among animal bite victims and identify the influencing factors in Wuhan, China.

Methods

A cross-sectional study was conducted among 1015 animal bite victims visiting rabies prevention clinics. We performed a face-to-face interview to collect information on the exposure category of the bite wound, the type of the offending animal, exposure-to-risk situations, etc. Factors associated with exposure categories were identified by multivariate logistic regression analysis.

Results

Five hundred and sixty-four (55.57%) cases were category III exposures, 418 (41.18%) were category II exposures, and 33 (3.25%) were category I exposures. People who were hurt by their own domestic animals (odds ratio [OR] = 1.55, 95% confidence interval [CI]: 1.14–2.10), and those exposed to animals unvaccinated against rabies (OR = 1.45, 95% CI: 1.08–1.95) had a higher risk for category III exposures. Respondents who did not know the fatality of rabies were more likely to be injured seriously compared to those who knew that rabies is fatal, and the OR was 1.40 (95% CI, 1.05–1.86).

Conclusions

This study showed that factors associated with the severity of bite wounds mainly included types of the offending animal, vaccination status of the animal, and knowledge of rabies fatality. Educational programs and awareness-raising campaigns should be provided to decrease severe animal bites, especially targeting pet owners and those with limited rabies knowledge.

Gemella morbillorum- and Capnocytophaga sp.-Related Mycotic Thoracic Aortic Aneurysm and Mediastinal Abscess: An Unusual Case Report, a Treatment Challenge, and a Review of Literature

A thoracic mycotic aortic aneurysm is an uncommon entity that can complicate mediastinal abscesses. Gemella morbillorum and Capnocytophaga sp. are oral bacteria that are very rarely encountered in this setting, especially when occurring together and with other organisms, posing a difficult treatment challenge per the available guidelines and sensitivities. We present in detail this interesting case of a multi-organism mediastinal abscess and thoracic mycotic aortic aneurysm after a previous esophagogastroduodenoscopic procedure in a 51-year-old female with known achalasia who presented with upper abdominal pain, including a successful surgical and antibiotic treatment regimen and a literature review of the involved topics.

Treatment of moderate grade dog bite wounds using amoxicillin-clavulanic acid with and without enrofloxacin: a randomised non-inferiority trial

BACKGROUND

Dog-to-dog bite wounds are a common veterinary emergency presentation: despite this, there is insufficient information to guide veterinarians on appropriate empirical antimicrobial management.

OBJECTIVES

Investigate the effectiveness of amoxicillin-clavulanic acid with and without enrofloxacin in the treatment of moderate grade dog bite wounds (DBW). To describe common pathogens and their antimicrobial susceptibility patterns.

MATERIALS AND METHODS

In a single-centre parallel group pragmatic trial, 50 dogs presenting with moderate grade DBW were prospectively randomised to receive amoxicillin-clavulanic acid (group A) or amoxicillin-clavulanic acid and enrofloxacin (group B). Swabs were taken for culture and susceptibility testing at admission. Stabilisation, wound care and surgical debridement were performed at the discretion of admitting clinicians. The primary outcome was complication due to infection at 10 days, with Bayesian inference used to estimate the difference in proportions between treatment groups.

RESULTS

Of the 24 dogs in treatment group A, 1 required the addition of enrofloxacin at re-examination. None of the 26 dogs in group B required alteration of antimicrobial coverage. The difference in complication rate due to infection between treatment groups was 4.2%. Twenty-one different organisms were identified: Staphylococcus pseudintermedius, Neisseria spp., Pasteurella multocida and P. canis were the most common. Over 90% of gram-negative and gram-positive isolates were susceptible to amoxicillin-clavulanic acid. Ninety-six percent of gram-negative and 86% of gram-positive isolates were susceptible to enrofloxacin.

CONCLUSION AND CLINICAL SIGNIFICANCE

Amoxicillin-clavulanic acid is an appropriate empirical antimicrobial choice for moderate DBW in South East Queensland. Reduced empirical enrofloxacin use will promote antimicrobial stewardship and potentially antimicrobial resistance.

Rare case of Capnocytophaga canimorsus meningitis in a man without risk factors

Capnocytophaga canimorsus meningitis is an uncommon but potentially serious cause of meningitis, which is considered particularly rare in healthy and immunocompetent individuals. We present a case of C. canimorsus meningitis in a young, immunocompetent patient which was acquired following a dog bite. We review the literature and propose that underdiagnosis of this condition is likely. To avoid misdiagnosis, and thus improper management, clinicians should ensure that they identify animal exposure in all meningitic patients, and adopt a higher clinical suspicion in the absence of classical risk factors.

A Bite So Bad: Septic Shock Due to Capnocytophaga Canimorsus Following a Dog Bite

Infection by Capnocytophaga canimorsus (C. canimorsus), a Gram-negative rod found in the normal oral flora of canine and feline species and transmitted through bites or scratches, is a rare phenomenon. Infections most commonly occur in alcoholics and immunocompromised patients. In this report, we describe the case of a middle-aged male with a history of alcohol abuse who presented with septic shock and multisystem organ failure following a suspected dog bite. The patient was a 59-year-old Caucasian male with alcohol abuse disorder who initially presented with encephalopathy and lethargy. The patient had scratches and multiple healing wounds, with a mottled appearance on his extremities. According to his wife, the patient had been playing aggressively with his dog at home. On admission, he was febrile, tachycardic, and saturating in the 80s on ambient air. His extremities rapidly developed diffuse purpura and dry gangrene of all digits along with the tip of his nose and genitals. The patient developed septic shock and multisystem organ failure. Blood cultures initially grew Gram-positive cocci and Gram-negative rods for which broad-spectrum antibiotics were initiated. Follow-up blood cultures were positive for C. canimorsus and the antibiotic regimen was adjusted accordingly. His condition continued to deteriorate. His family opted for comfort measures only and he died soon after. Common sequelae of C. canimorsus infection include septic shock with multisystem organ failure, disseminated purpuric lesions, hypotension, encephalopathy, and acute renal failure. As seen in our patient, C. canimorsus infection should be considered in such patients, particularly if there is a recent history of an animal bite. Prompt initiation of appropriate treatment is essential to improve patient prognosis.

Diversity and characterization of temperate bacteriophages induced in Pasteurella multocida from different host species

Background

Bacteriophages play important roles in the evolution of bacteria and in the emergence of new pathogenic strains by mediating the horizontal transfer of virulence genes. Pasteurella multocida is responsible for different disease syndromes in a wide range of domesticated animal species. However, very little is known about the influence of bacteriophages on disease pathogenesis in this species.

Results

Temperate bacteriophage diversity was assessed in 47 P. multocida isolates of avian (9), bovine (8), ovine (10) and porcine (20) origin. Induction of phage particles with mitomycin C identified a diverse range of morphological types representing both Siphoviridae and Myoviridae family-types in 29 isolates. Phage of both morphological types were identified in three isolates indicating that a single bacterial host may harbour multiple prophages. DNA was isolated from bacteriophages recovered from 18 P. multocida isolates and its characterization by restriction endonuclease (RE) analysis identified 10 different RE types. Phage of identical RE types were identified in certain closely-related strains but phage having different RE types were present in other closely-related isolates suggesting possible recent acquisition. The host range of the induced phage particles was explored using plaque assay but only 11 (38%) phage lysates produced signs of infection in a panel of indicator strains comprising all 47 isolates. Notably, the majority (9/11) of phage lysates which caused infection originated from two groups of phylogenetically unrelated ovine and porcine strains that uniquely possessed the toxA gene.

Conclusions

Pasteurella multocida possesses a wide range of Siphoviridae- and Myoviridae-type bacteriophages which likely play key roles in the evolution and virulence of this pathogen.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12866-021-02155-9.

Diagnosis and Management of Common Hand Infections

While many hand infections are superficial, diligent evaluation, diagnosis, and treatment of these infections are central for preventing disability and morbidity. Maintaining a wide differential diagnosis is important as some hand infections may mimic others. In geographic areas with more than a 10% to 15% prevalence of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) hand infections, empiric antibiotics should adequately cover MRSA. Once culture results are available, antibiotic regimens should be narrowed to reduce the development of resistant pathogens.

Infectious Complications of Bite Injuries

Animal and human bite injuries are a public health burden. Dog bites outnumber cat bites, but cat bites pose the greatest risk for infection. Skin and soft tissue infections are the most frequent infectious manifestations resulting from bite injury, although invasive infection may occur through direct inoculation or dissemination through the bloodstream. Although contemporary, well-designed trials are needed to inform clinical practice, preemptive antibiotic therapy after a bite injury is warranted for injuries posing high risk for infection and for patients at risk of developing severe infection; antibiotics should target aerobic and anaerobic microbes that comprise the oral and skin flora.

Wound infection caused by Neisseria zoodegmatis, a zoonotic pathogen: a case report

The isolation of Neisseria zoodegmatis from a 63-year-old female presenting to the emergency department following a cat bite injury to her right hand is described in this report. N. zoodegmatis , also known as Centers for Disease Control (CDC) group EF-4b, is considered to be a zoonotic pathogen, and is usually associated with dog or cat bites. Despite the potential of this organism to cause serious soft tissue infections, it can be overlooked in routine clinical laboratories due to its slow growth characteristics and when the history of animal bite is not provided to the laboratory. This case highlights the importance of appropriate clinical history provision to the microbiology laboratory to help provide important information about potential pathogens and allow microbiologists to optimize culture and identification methods. The introduction of tools such as matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) into clinical laboratories allows identification and the interpretation of results to be performed within a few minutes of isolation on proper culture media, as opposed to traditional methods, whose slowness may be problematic, as shown in this case report.

Determination of phylogenetic relationships among methicillin-resistant Staphylococcus aureus recovered from infected humans and Companion Animals

Companion animals carry different microorganism of severely public health hazard for human; the kindness relation and contact between humans and companion animals may the route in the transmission of most zoonotic bacteria, including Methicillin-Resistant Staphylococcus aureus (MRSA). Therefore, the current study investigate the companion animals mainly dogs and cat as a reservoir for MRSA and the genetic similarity between the recovered strains of MRSA from such companion animals and their owners. One hundred swabs were collected under aseptic condition from companion animals and seventy swabs were collected from nasal and soft tissue of the infected owners in contact. All samples were examined with standard microbiological techniques, antimicrobial sensitivity, molecular typing and genetic finger printing using RAPD-PCR to determine the genetic finger printing of the recovered strains from humans and companion animals. The prevalence of the MRSA was higher in dog's swabs than human swabs. Dog swabs showed a rate of (44.4%), cat's revealed (27.3%), while the owner swabs could detect (42.8%). The antibiotics profiles were 69.2% and all MRSA strains were positive for mecA gene (100%), while only 25 strains (38.5%) were positive for Panton Valentine Leukocidin (PVL gene). Phylogenetic tree revealed 4 clusters with complete genetic relatedness and higher identity between the strains recovered from humans and companion animals. Our results revealed that there is great similarity between the recovered strains, indicating that pets play an important role in colonization and transmitting MRSA to humans, and vice versa.

Antimicrobial susceptibility monitoring of canine and feline skin and ear pathogens isolated from European veterinary clinics: results of the ComPath Surveillance programme

BACKGROUND

The ComPath project is a pan-European programme dedicated to the monitoring of antimicrobial susceptibility of canine and feline pathogens using standardized methods and centralized minimal inhibitory concentration (MIC) determination.

OBJECTIVES

To report antimicrobial susceptibilities of major pathogens isolated from nontreated animals with acute clinical signs of skin, wound or ear infections in 2013-2014.

METHODS AND MATERIALS

MICs were determined by agar dilution for commonly used drugs and interpreted using Clinical and Laboratory Standards Institute (CLSI) breakpoints, if available.

RESULTS

Of 1,676 isolates recovered, the main species isolated from dogs were Staphylococcus pseudintermedius, followed by Streptococcus spp., Pseudomonas aeruginosa and Escherichia coli. In cats, Pasteurella multocida, coagulase-negative staphylococci (CoNS) and Staphylococcus aureus were isolated most frequently. Resistance rates observed for S. pseudintermedius were <26.7% for penicillin, clindamycin and chloramphenicol, and ≤11.5% for ampicillin, amoxicillin/clavulanate, cefalexin, cefovecin, gentamicin and fluoroquinolones. For S. aureus, resistance rates ranged up to 90.9% for β-lactams, and were 19.7% for clindamycin, 27% for fluoroquinolones and 0.0-6.1% for other drugs. The mecA gene was confirmed by PCR in 10.6% of S. pseudintermedius, 11.6% of CoNS and 31.4% of S. aureus isolates. In streptococci/enterococci, resistance to penicillin, ampicillin and chloramphenicol ranged from 0.0% to 11.3%, whereas fluoroquinolone resistance ranged from 0.0% to 8.5%. For E. coli, resistance ranged from 13.8 to 15.9% for fluoroquinolones and from 86.2% to 100.0% for β-lactams. Low rates of resistance (0.0-6.3%) were observed in P. multocida, and for P. aeruginosa resistance to gentamicin was 10.3%.

CONCLUSION

Overall, antimicrobial resistance of cutaneous/otic pathogens isolated from dogs and cats was low (1-10%) to moderate (10-20%). For several pathogens, the paucity of CLSI recommended breakpoints for veterinary use is a bottleneck.

Rapidly Progressive Infection of Hand After a Cat Bite

Cat bites represent the second most common mammalian bites after dog bites and are responsible for three-quarters of bites that result in infection. We report a case of a 60-year-old retired woman who was admitted to the surgery daily clinic due to fever and pain with three necrotic bite wounds on her hand and lymphangitis, which developed one day after she had been bitten by her cat. Prompt debridement, irrigation and drainage combined with empiric oral amoxicillin/clavulanic acid, resulted in clinical improvement and reduction of elevated inflammatory parameters specifically C-reactive protein. While wound cultures remained sterile, serology results were positive for Bartonella henselae.

"Cat and dog bite injuries of the hand: early versus late treatment"

INTRODUCTION

Animal bites of the hand are common injuries in the emergency department. Serious complications may occur if those injuries are not treated adequately. The purpose of the study was to examine if there is a difference between the treatment of animal bite injuries at an early stage (first treatment within the first 24 h after injury, group I) versus a later stage (first treatment more than 24 h after injury, group II) retrospectively.

MATERIALS AND METHODS

Between January 2010 and March 2016, a total of 69 patients with cat and dog bite injuries were treated in our hospital emergency room (ER). 45 patients arrived at the ER within 24 h after the injury (group I). 24 patients were treated more than 24 h after injury for the first time (group II). A retrospective study with evaluation of the clinical data including wound aspect, tissue damage, treatment, and antibiotics was performed.

RESULTS

In group I, 27 were outpatients and 18 were in-house patients with an average hospitalization period of 3.3 days ± 1.12 days. 16 patients were treated conservatively. An operation was performed in 29 patients and in 3 patients a second look surgery was necessary. In group II, 5 patients were outpatients and 19 were inpatients with an average hospitalization period of 5.8 days ± 1.9 days. An operation was performed in 22 patients, and 2 were treated conservatively. In five patients, a second look surgery was necessary in group II.

CONCLUSION

The study demonstrates that an early treatment of cat and dog bite injuries leads to less second-look operations and a shorter hospitalization. Hence, animal bite injuries of the hands should be treated immediately to avoid further complications.

LEVEL OF EVIDENCE

Level 3, therapeutic.

Capnocytophagia canimorsus - Severe sepsis in a previously well individual with no evidence of a cat or dog bite. A case report

Capnocytophagia canimorsus (C. canimorsus) is a Gram-negative bacilli present in the gingival flora of canine and feline species. It is the second most common cause of infection following dog bites and contact with canine saliva, leading to severe sepsis in immunocompromised patients with no evidence of a breach to the skin. We present the case of a previously healthy 51-year-old male who presented with disseminated intravascular coagulopathy, acute renal failure with widespread haemorrhagic bullae and skin necrosis. He was treated empirically with broad-spectrum antibiotics for sepsis of unknown origin for several days before C. canimorsus infection was identified on blood cultures. Following this, a more detailed social history identified the vital historical detail that the patient owned 7 dogs. His purpura fulminans secondary to sepsis was managed conservatively with regular dressings by the Burns Department. Our experience demonstrates that C. canimorsus should be considered as a causative organism in patients presenting with sepsis of unknown origin after contact with domestic animals and treated with early antibiotic therapy.

•

Consider canimorsus infection as a cause of sepsis in healthy patients with no evidence of dog/cat bites or scratches.

•

Infection may be severe, causing DIC and multi-organ failure.

•

The pathogen is slow-growing and difficult to isolate.

•

Empirical treatment with broad-spectrum antibiotics is required alongside regular dressings to minimize transdermal fluid losses and maintain core body temperature.

Lessons learned from conventional animals: Encouragement to use specific-pathogen-free animals

Experimental rabbits provide evidence for translational research regarding the pathogenies or treatment of human diseases. We developed a novel method for regenerating the middle ear mucosa using autologous cultured nasal mucosal epithelial cell sheets, and evaluated the wound healing process in the middle ear mucosa of experimental rabbits. Nonetheless, vigilant microbiological monitoring of experimental animals is essential to effectively prevent a decline in their health conditions, which may affect the research results. We experimented with contamination of Pasteurella multocida in non-specific-pathogen-free (SPF) rabbits (without microbiological monitoring). Most non-SPF rabbits had otitis media, whereas SPF rabbits did not, which affected their results during the mucosal regeneration study. The contamination was resolved by changing the experimental design from using non-SPF rabbits to that using SPF rabbits. It is crucial to use the SPF animals for any surgical intervention studies.

•

Use of specific-pathogen-free experimental animals is crucial.

•

Pasteurella multocida, a resident of rabbits, easily causes infection by surgical intervention.

•

Conventional infection-free animals are not equivalent to specific-pathogen-free ones.

A Rare Case of Neisseria animaloris Hand Infection and Associated Nonhealing Wound

Neisseria animaloris is a rare pathogen in humans primarily associated with dog and cat bites. Fourteen cases have been documented in the literature related to the difficulty in identifying this bacterium in the laboratory. We present a patient case demonstrating a prolonged treatment course, which is often seen as the result of misdiagnosis, and subsequent nonhealing wound requiring multiple surgeries and eventual wide excision with staged graft coverage. We discuss the clinical course, laboratory identification techniques, surgical treatment, and patient outcome.

Pasteurella multocida Septic Shock: Case Report and Literature Review

Pasteurella multocida is a small, Gram-negative, facultatively anaerobic coccobacillus that inhabits the normal microbiota of the respiratory tract of several animals, especially cats and dogs. By infecting humans, a wide range of clinical pictures can evolve varying from mild local cellulitis to more severe systemic diseases (e.g., meningitis, pneumonia, endocarditis, and bacteremia). Septic shock is an uncommon complication of P. multocida infection, with less than 100 cases reported in the literature. It is frequently associated with cirrhotic and immunocompromised individuals and rarely immunocompetent ones. Here, we present a case of Pasteurella multocida septic shock in an elderly man secondary to leg cellulitis with a review of the relevant literature.

Pasteurella multocida vertebral osteomyelitis, myositis and epidural abscess in a diabetic cirrhotic patient

Pasteurella multocida is frequently associated with soft tissue infections related to animal bites or scratches. These infections are usually mild but can lead to serious complications especially in high-risk patients. We present a chronic Pasteurella. multocida vertebral osteomyelitis with extensive spondylodiscitis, myositis and epidural abscess in a patient with diabetes and liver cirrhosis. Pasteurella multocida should be suspected in bone and soft tissue infections even if the site of infection is distant to the site of the animal bite, scratch or lick, especially in high-risk patients.

Risk of human exposure to animal bites in China: a clinic-based cross-sectional study

Human exposure to animal bites is the most important public health concern in relation to rabies transmission. This study aims to determine the factors associated with human exposure to animal bites in China. A cross-sectional study of visitors to rabies prevention clinics who were seeking treatment because of exposure to animal bites or scratches was conducted in Wuhan, China. Humans exposed to animal bites (n = 1015) were interviewed, and 87% of the bites were attributed to domestic animals. The risk types for animal bites included unprovoked aggression (31.7%), excessive play (27.5%), insufficient preparedness (26.7%), and improper care of animals (14.1%). Children aged 1-15 years (OR = 9.069, 95% CI: 4.572-17.987, P < 0.001) were more likely to be injured because of excessive play. Nonvaccinated people (OR = 2.168, 95% CI: 1.034-4.545, P = 0.040) and people who discontinued the rabies vaccine regimen (OR = 2.600, 95% CI: 1.561-4.331, P < 0.001) were at risk of rabies exposure and were more likely to be injured because of improper care of animals. This study showed that domestic animals were responsible for most animal bites. The associated factors were age, educational attainment, and animal ownership. Community health education with a special attention to schoolchildren and animal owners should be provided.