1
|
Pasteurella bacteraemia: Impact of comorbidities on outcome, based on a case series and literature review. Int J Infect Dis 2020; 92:89-96. [PMID: 31926353 DOI: 10.1016/j.ijid.2020.01.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 12/19/2019] [Accepted: 01/02/2020] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Pasteurella bacteraemia is rare, but has been associated with a high mortality rate. The aim of this study was to estimate the impact of comorbidities on patients with Pasteurella bacteraemia. METHODS All cases of Pasteurella bacteraemia in adults treated in our centre between January 2008 and December 2017 were included retrospectively and compared with cases identified in a systematic review of the literature via MEDLINE covering the years 1951-2017. The epidemiological, bacteriological, and clinical data were collected, as well as the instances of death after 30 days. RESULTS Twenty cases of Pasteurella bacteraemia identified in our centre and 99 cases from the literature review were included. A major comorbidity was found in 80/119 (67.2%) patients. The death rate at 30 days was 31.1%. The most common comorbidities were cirrhosis, immunosuppressive therapy, and malignant diseases. Age was not associated with mortality. On multivariate analysis, the only factor associated with mortality was a major comorbidity (odds ratio 2.78, 95% confidence interval 1.01-7.70; p = 0.04). CONCLUSIONS This study confirms the high mortality rate and highlights the importance of the host background, independent of age, in Pasteurella bacteraemia. Clinicians should be aware of the comorbidities in cases of Pasteurella infection, due to the poor prognosis of bacteraemia.
Collapse
|
2
|
Ferrari-Light D, Zimmermann E, Sundaram V, Lee AM. Pseudoaneurysm formation after Pasteurella multocida lower extremity vascular bypass graft infection. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2019; 5:232-234. [PMID: 31297473 PMCID: PMC6598727 DOI: 10.1016/j.jvscit.2019.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 02/10/2019] [Indexed: 12/05/2022]
Abstract
Prosthetic vascular bypass graft infection is a rare complication requiring prompt identification and isolation of the organism. A 66-year-old woman developed left lower extremity pain and a pulsatile pseudoaneurysm 7 months after left common femoral to peroneal artery bypass with prosthetic polytetrafluoroethylene graft, requiring re-exploration and a jump graft. Pasteurella multocida was isolated from blood and tissue culture specimens, and the patient admitted to a new kitten that frequently bit her lower extremities. Treatment included intravenous administration of ertapenem for 6 weeks followed by lifelong oral antibiotic suppression, which may offer the best chance for limb salvage when total graft explantation would result in amputation.
Collapse
Affiliation(s)
| | - Eric Zimmermann
- Department of Surgery, New York Presbyterian-Queens, Flushing, NY
| | - Varuna Sundaram
- Department of Surgery, New York Presbyterian-Queens, Flushing, NY
| | - Andy M Lee
- Department of Surgery, New York Presbyterian-Queens, Flushing, NY
| |
Collapse
|
3
|
Multiorgan Failure and Refractory Lactic Acidosis due to Pasteurella multocida Septicemia in a Patient with No Animal Exposure. Case Rep Infect Dis 2018; 2018:2574184. [PMID: 29765783 PMCID: PMC5885493 DOI: 10.1155/2018/2574184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 01/21/2018] [Accepted: 01/29/2018] [Indexed: 11/23/2022] Open
Abstract
Introduction Pasteurella multocida is a gram-negative coccobacillus pathogenic to animals. It can cause infection in humans by a bite, scratch, or lick from a cat or dog. P. multocida can cause a variety of infections in humans, including cellulitis, osteomyelitis, endocarditis, peritonitis, and septic shock. Case Presentation A 56-year-old male presented to our hospital with a 2-day history of fever, abdominal pain, nausea, and vomiting. He denied exposure to cats, dogs or other pets. He had severe respiratory distress requiring ventilator support, profound septic shock requiring multiple vasopressors, severe lactic acidosis, and renal failure requiring emergent hemodialysis. Blood cultures confirmed the presence of P. multocida. The patient subsequently died of cardiopulmonary arrest due to multiorgan failure with refractory shock. Conclusion P. multocida septicemia can lead to septic shock. Early identification of this organism may decrease mortality. Although our patient had no known cat or dog exposure, physicians should enquire about a history of animal exposure when a patient presents with an infection with no obvious cause.
Collapse
|
4
|
Sepsis by Pasteurella multocida in an Elderly Immunocompetent Patient after a Cat Bite. Case Rep Infect Dis 2017; 2017:2527980. [PMID: 29318064 PMCID: PMC5727562 DOI: 10.1155/2017/2527980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 10/25/2017] [Accepted: 10/30/2017] [Indexed: 11/17/2022] Open
Abstract
Pasteurella multocida colonizes animal scratches and bites. This bacterium was described to cause sepsis or endocarditis mainly in immunocompromised patients. We report the case of a 92-year-old woman presenting at the Emergency Department with coma and fever a week after the bite of her cat. The cat bite was misdiagnosed at admission partly due to an underestimation of this event by the patient's relatives. An inflamed area localized at perimalleolar skin of the right leg was detected. Laboratory biomarkers of inflammation were elevated. The cerebral computed tomography (CT) scan with angiographic sequences showed a complete occlusion of right intracranial vertebral artery. Total body CT scan and abdominal echocardiography were negative for foci of infection. Three consecutive blood cultures were positive for Pasteurella multocida. A diagnosis of sepsis by Pasteurella multocida was made, and the patient recovered after a specific antimicrobial treatment. In order to confirm the animal transmission, the cat saliva was cultured and found positive for Pasteurella multocida with a similar antibiotic sensitivity to that isolated from the patient. In conclusion, the case of a patient with coma and fever after a cat bite was presented. The transmission of pathogens from pets has to be carefully considered as an important route of infection in immunocompetent patients.
Collapse
|
5
|
Narsana N, Farhat F. Septic shock due to Pasteurella multocida bacteremia: a case report. J Med Case Rep 2015; 9:159. [PMID: 26163266 PMCID: PMC4499199 DOI: 10.1186/s13256-015-0643-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 06/23/2015] [Indexed: 11/15/2022] Open
Abstract
Introduction Pasteurella is a Gram-negative coccobacillus that causes a wide spectrum of diseases in humans and is commonly transmitted from cat and dog bites. An increasing number of cats and dogs are kept as pets in American households which increases the risk of pet-related infections. Case presentation An 82-year-old African American woman with multiple comorbidities presented with fever, vomiting and diarrhea; she later developed septic shock requiring vasopressors and intubation. She was found to have Pasteurella multocida bacteremia. Her hospital course was complicated by a pulseless electrical activity arrest. She had exposure to her pet cat at home. We believe that a possible portal of entry was her skin; however, other possibilities such as respiratory tract could not be excluded. She was treated with imipenem-cilastatin and discharged after 25 days. Conclusions Studies have shown a mortality range from 7 to 31% in Pasteurella bacteremia. Due to an increasing number of pets and high mortality of this disease, it is important to have a high suspicion for this infection, especially in elderly and immunocompromised patients.
Collapse
Affiliation(s)
- Niyati Narsana
- Department of Medicine, Medstar Washington Hospital Center, 110 Irving street NW, Suite 2A-50, Washington, DC, 20010, USA.
| | - Faria Farhat
- Department of Medicine, Medstar Washington Hospital Center, 110 Irving street NW, Suite 2A-50, Washington, DC, 20010, USA.
| |
Collapse
|
6
|
López-Cuenca S, Tejerina E, Martín-Pozo M, de la Cal M, García-Hierro P. Shock séptico por Pasteurella multocida en un paciente previamente sano. Med Intensiva 2013; 37:56-7. [DOI: 10.1016/j.medin.2012.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 04/08/2012] [Indexed: 10/28/2022]
|
7
|
|
8
|
Tattevin P, Souala F, Gautier AL, Rauch M, Bouet J, Arvieux C, Michelet C. Diabetes in patients with pasteurellosis. ACTA ACUST UNITED AC 2009; 37:731-3. [PMID: 16191890 DOI: 10.1080/00365540510044111] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
From 1991 to 2003, 20 patients with pasteurellosis were admitted to our unit, of whom 2 died. They presented with cellulitis (n = 14), arthritis (n = 6), pneumonia (n = 3), subcutaneous abscess (n = 3), bursitis (n = 2), meningitis, otitis, sinusitis and uveitis. Underlying diseases included diabetes (n = 6) and malignancy (n = 5). Diabetes could be a predisposing condition for pasteurellosis.
Collapse
Affiliation(s)
- Pierre Tattevin
- Infectious Diseases and Intensive Care Unit and the Department of Bacteriology, Pontchaillou University Medical Centre, Rennes, France.
| | | | | | | | | | | | | |
Collapse
|
9
|
Gálvez Hernández G, Lucas Pérez-Romero J, Pastor Juan M, Rodríguez Martín M, Martínez Díaz V, García Mas P, Llabrés Díaz J, Martí Soler V, Fernández Fúnez A. Shock séptico por Pasteurella multocida. Rev Clin Esp 2009; 209:316-7. [DOI: 10.1016/s0014-2565(09)71482-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
10
|
|
11
|
Schoeffler M, Crozon J, Levrat A, Guillaume C, Floccard B, Allaouchiche B. Pasteurellose bactériémique : à propos d'un cas. ACTA ACUST UNITED AC 2006; 25:309-11. [PMID: 16360299 DOI: 10.1016/j.annfar.2005.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2005] [Accepted: 11/08/2005] [Indexed: 10/25/2022]
Abstract
Bacteremic pasteurellosis is an uncommon form of Pasteurella multocida infection, usually involved in local infections. This systemic infection often occurs in immuno-compromised patient such as cirrhotic or alcoholic patients, with a high mortality rate (up to 60%). Septic shock may occur and neurological disorders or coma are frequent. We report such a case. Treatment associated local care, antibiotics (beta-lactam antibiotics plus fluoroquinolone) during 14 days and resuscitation of septic shock. Owing these therapies, septic shock was successfully treated without complications.
Collapse
Affiliation(s)
- M Schoeffler
- Service de réanimation, pavillon G, département d'anesthésie-réanimation, hôpital Edouard-Herriot, Lyon, France.
| | | | | | | | | | | |
Collapse
|
12
|
Kimura R, Hayashi Y, Takeuchi T, Shimizu M, Iwata M, Tanahashi J, Ito M. Pasteurella multocida septicemia caused by close contact with a domestic cat: case report and literature review. J Infect Chemother 2004; 10:250-2. [PMID: 15365869 DOI: 10.1007/s10156-004-0331-5] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2004] [Accepted: 07/01/2004] [Indexed: 11/28/2022]
Abstract
We report here a case of Pasteurella multocida infection caused by cat exposure presenting with septic shock, sinusitis, and pneumonia. The patient was a febrile 20-year-old woman who had been experiencing disturbed consciousness progressively. She had close contact with a domestic cat and had received some scratches on both arms. A magnetic resonance imaging (MRI) scan of the head showed a high intensity in the paranasal cavity, and a computed tomographic (CT) scan of the chest showed bilateral lung consolidations. The pathogen was identified as P. multocida by the cultures from blood and nasal discharge. She was given intensive antibiotic therapy with ceftriaxone and piperacillin, continuous hemodiafiltration (CHDF) therapy, and anticoagulation therapy. Owing to these therapeutic regimens, the septic shock was successfully treated without complications. We also review the literature on P. multocida septicemia.
Collapse
Affiliation(s)
- Ryosuke Kimura
- Department of Internal Medicine, Kariya General Hospital, 5-15 Sumiyoshi-cho, Kariya, Aichi 448-8505, Japan.
| | | | | | | | | | | | | |
Collapse
|
13
|
Félix M, Tallón P, Salavert M, Navarro V, Bretón JR, Pérez-Bellés C, Gobernado M. Bacteriemia por Pasteurella spp.: una entidad infrecuente durante los últimos 8 años en nuestro centro. Enferm Infecc Microbiol Clin 2003; 21:334-9. [PMID: 14525688 DOI: 10.1016/s0213-005x(03)72959-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To review and update the epidemic and clinical knowledge concerning disseminated blood disease caused by Pasteurella species in our area. METHODS Retrospective study of Pasteurella species bacteremia (PSB) episodes occurring in patients attended from January 1994 to December 2001 in a single tertiary hospital. RESULTS Among the 31 clinical samples remitted to the Microbiology Laboratory in which a species of Pasteurella was identified, 5 (16%) corresponded to positive blood cultures in 5 patients. Pasteurella multocida was the predominant species, identified in 70% of all isolations and all but one positive blood culture. All the patients were adults over 50 years old and all had underlying illnesses causing comorbidity or some degree of immunocompromise, with cardiovascular and hypertensive conditions being the most frequent; only one patient had liver cirrhosis. In all cases, except one, contact or coexistence with dogs or cats was documented. The clinical presentation of PSB was non-specific and only two episodes were related with a possible focal, soft-tissue origin. There were no serious complications, such as septic shock, organ failure or invasive disease (meningitis or endocarditis). All patients cured with antimicrobial treatment, although surgical debridement of infected bite wounds was required in two cases. The betalactams and other families of antibiotics showed excellent in vitro activity against the five strains of Pasteurella isolated. CONCLUSIONS PSB occurred in adult patients having a wide range of underlying illnesses and comorbidity factors. Most of them had contact with pets, though traumatic lesions were not present in all cases. Clinical presentation did not differ from other types of severe sepsis. Susceptibility and outcome of primary treatment with penicillins and other betalactams shows that they are still appropriate therapy. More emphasis should be placed on preventive measures related to care and hygiene among individuals with pets.
Collapse
Affiliation(s)
- Miguel Félix
- Unidad de Enfermedades Infecciosas. Hospital Universitario La Fe. Valencia. España
| | | | | | | | | | | | | |
Collapse
|
14
|
Schuchard M, Clauson W. An Interesting and Heretofore Unreported Infection of a Spinal Cord Stimulator: Smitten by a Kitten Revisited. Neuromodulation 2001; 4:67-71. [DOI: 10.1046/j.1525-1403.2001.00067.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
15
|
Mortensen JE, Giger O, Rodgers GL. In vitro activity of oral antimicrobial agents against clinical isolates of Pasteurella multocida. Diagn Microbiol Infect Dis 1998; 30:99-102. [PMID: 9554176 DOI: 10.1016/s0732-8893(97)00209-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Pasteurella multocida causes a wide variety of infections and is the most common localized soft tissue infection after animal bite injuries. Penicillin or amoxicillin has been considered agent of choice for therapy. Reported beta-lactamase production by some isolates, the therapeutic dilemma of the penicillin allergic patient, and the polymicrobial nature of some infections led to this study of alternate antimicrobial agents. The in vitro activity of ampicillin, amoxicillin/clavulanate, cefprozil, cefuroxime, erythromycin, clarithromycin, trimethoprim/sulfamethoxazole, ciprofloxacin, and tetracycline were compared to penicillin against 73 geographically diverse isolates of P. multocida from human infections collected since 1991. MIC90 (microgram/mL) were as follows: penicillin < or = 0.06; ampicillin < or = 0.5; amoxicillin/clavulanate < or = 0.5; cefaclor 1.0; cefprozil 1.0; cefpodoxime 0.06; cephalothin 2.5; cefuroxime < or = 0.25; erythromycin 2.0; azithromycin 1.0; clarithromycin 4.0; trimethoprim/sulfamethoxazole < or = 0.5/9.5; ciprofloxacin < or 0.25; tetracycline < or = 2.0. No beta-lactamase producing isolates were found in this study. This in vitro study has identified alternate oral agents to penicillins that may be appropriate for therapy of P. multocida infections.
Collapse
Affiliation(s)
- J E Mortensen
- Department of Pediatrics, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | | | | |
Collapse
|