Pasteurella Multocida Infection 

  • Author: Alexandre Lacasse, MD, MSc; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Jan 11, 2012
 

Background

Pasteurella multocida is a small, gram-negative, nonmotile, non–spore-forming coccobacillus with bipolar staining features. P multocida often exists as a commensal in the upper respiratory tracts of many livestock, poultry, and domestic pet species, especially cats and dogs. P multocida infection in humans is often associated with an animal bite, scratch, or lick, but infection without epidemiologic evidence of animal contact may occur. See the image below.

Pasteurella multocida infection. Pasteurella multocida infection.

Wound infections associated with animal bites usually have a polymicrobial etiology, mandating the empiric use of broad-spectrum antimicrobials targeted at both aerobic and anaerobic gram-negative bacteria. Nevertheless, Pasteurella species are commonly isolated pathogens in most animal bites, especially in dog- and cat-related injuries. These injuries can be aggressive, with skin manifestations typically appearing within 24 hours following a bite. These wounds can exhibit a rapidly progressive soft-tissue inflammation that may resemble group A β-hemolytic Streptococcus pyogenes infections.

Deeper soft tissue can also be affected, manifesting as tenosynovitis, septic arthritis, and osteomyelitis. More-severe disseminating infections may also develop, including endocarditis or meningitis, the latter mimicking Haemophilus influenzae or Neisseria meningitides infections in young children. Fortunately, Pasteurella species are fairly sensitive organisms and can be treated with a penicillin-based regimen.

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Pathophysiology

  • Local: P multocida infection usually presents as an infection that complicates an animal bite or injury. Complications include rapidly progressive cellulitis, abscesses, tenosynovitis, osteomyelitis, and septic arthritis. The latter two are particularly common following cat bites because of their small, sharp, penetrative teeth.
  • Respiratory: P multocida may cause upper respiratory tract infections, including sinusitis, otitis media, mastoiditis, epiglottitis, pharyngitis, and Ludwig angina.[1] In rare cases, P multocida may also cause lower respiratory tract infections, including pneumonia, tracheobronchitis, lung abscess,[2] and empyema,[3] usually in individuals with underlying pulmonary disease.
  • Cardiovascular: P multocida has been reported to cause native- and prosthetic-valve endocarditis,[4] pericarditis, mycotic aneurysms, vascular graft infections, central venous catheter infections, bacteremia, sepsis, and septic shock.
  • Central nervous system: P multocida is an uncommon cause of meningitis, subdural empyema, and brain abscess. P multocida meningitis has been associated with cat licks and bites occurring on the face in persons at the extremes of age.[5]
  • Gastrointestinal: P multocida rarely causes gastrointestinal problems but has been associated with appendicitis, hepatosplenic abscesses, and spontaneous bacterial peritonitis. P multocida has been isolated in patients with polymicrobial peritoneal dialysis catheter–associated peritonitis.
  • Ocular: P multocida periocular abscess, conjunctivitis, corneal ulcers, and endophthalmitis have been reported.
  • Genitourinary tract: P multocida pyelonephritis, renal abscess, epididymitis, and cervicitis have been reported in rare cases.
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Epidemiology

Frequency

United States

According to the American Pet Association, approximately 150 million dogs and cats live in the United States, cats currently outnumbering dogs by 13 million. Animal bites account for 1% of annual emergency department visits. The estimated cost in health care expenditures has been reported to be $30 million per year. Approximately 10% of animal bites require medical attention; 1-2% eventually require hospitalization.

The vast majority of animal bites involve dogs (85-90%), followed by cats (5-10%). Infectious complications occur in approximately 15-20% of dog-related bites and more than 50% of cat-related ones. Dog bites are associated with younger animals engaging in playful activities, mostly with children. German shepherd, pit bull, Staffordshire terrier, and mixed breeds are most commonly involved with human bites, while the golden retriever and Labrador retriever are least. Cat bites are usually provoked, typically by female felines, and occurring on the upper extremities or face. Sharp and long teeth of cats can easily penetrate human skin and create a deep puncture wound and even inoculate the periosteum component of bones. Indeed, cat-related wounds more commonly progress to more serious and deeper-tissue infections, including osteomyelitis and meningitis.

International

P multocida infections occur worldwide. Cats are involved in 60-80% of human P multocida infections. Moreover, P multocida is isolated in 50% of dog bites.

Mortality/Morbidity

It is estimated that 10-20 human deaths per year occur following an animal bite.

Infectious complications occur in approximately 15-20% of dog-related bites and more than 50% of cat-related ones. Following a bite, a rapidly progressive cellulitis may develop; deeper structures, including tendons, joints, and bones, can become affected, especially in cat-related injuries. Dissemination can occur.

Degenerative joint disease, rheumatoid arthritis, and prosthetic joints have been associated with the development of P multocida septic arthritis.

Chronic obstructive pulmonary disease is a risk factor for P multocida respiratory tract infection, which carries a mortality rate of approximately 30%. Diabetes mellitus and liver dysfunction are predisposing conditions associated with pasteurellosis and associated bacteremia.[6]

P multocida infections during pregnancy and in utero transmission have also been reported.[7, 8]

Localized P multocida infections carry an excellent prognosis. Significant morbidity has been associated with musculoskeletal P multocida infections, especially those involving the hand. Disseminated P multocida infections carry a 25-30% overall mortality risk.

Age

All age groups can be affected by P multocida infections. Young children seem to be frequently involved in nonfatal dog bites. P multocida meningitis typically occurs in persons at the extremes of age.

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Contributor Information and Disclosures
Author

Alexandre Lacasse, MD, MSc  Internal Medicine Faculty, Assistant Director, Medicine Clinic, Infectious Disease Consultant, St Mary's Health Center

Alexandre Lacasse, MD, MSc is a member of the following medical societies: American College of Physicians, American Medical Association, Association of Program Directors in Internal Medicine, Infectious Diseases Society of America, and Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Coauthor(s)

Michael Gelfand, MD, FACP  Chief, Professor, Department of Internal Medicine, Division of Infectious Diseases, Methodist Healthcare of Memphis, University of Tennessee

Michael Gelfand, MD, FACP is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, and Southern Medical Association

Disclosure: Nothing to disclose.

Thomas Lafeber, MD  Consulting Staff, Wellstar Infectious Disease LLC

Thomas Lafeber, MD is a member of the following medical societies: American Medical Association, American Society of Transplantation, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

J Robert Cantey, MD  Professor, Department of Medicine, Division of Infectious Diseases, Medical University of South Carolina

J Robert Cantey, MD is a member of the following medical societies: Alpha Omega Alpha, American Society for Clinical Investigation, American Society for Microbiology, Infectious Diseases Society of America, International Society of Travel Medicine, Musculoskeletal Infection Society, Phi Beta Kappa, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Specialty Editor Board

Larry I Lutwick, MD  Professor of Medicine, State University of New York Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus

Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Aaron Glatt, MD  Professor of Clinical Medicine, New York Medical College; President and CEO, Former Chief Medical Officer, Departments of Medicine and Infectious Diseases, St Joseph Hospital (formerly New Island Hospital)

Aaron Glatt, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Infectious Diseases Society of America, International AIDS Society, and Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

References

  1. Dryden MS, Dalgliesh D. Pasteurella multocida from a dog causing Ludwig's angina. Lancet. Jan 13 1996;347(8994):123. [Medline].

  2. Lion C, Lozniewski A, Rosner V, et al. Lung abscess due to beta-lactamase-producing Pasteurella multocida. Clin Infect Dis. Nov 1999;29(5):1345-6. [Medline].

  3. Fernandez-Esparrach G, Mascaro J, Rota R, et al. Septicemia, peritonitis, and empyema due to Pasteurella multocida in a cirrhotic patient. Clin Infect Dis. Mar 1994;18(3):486. [Medline].

  4. Nettles RE, Sexton DJ. Pasteurella multocida prosthetic valve endocarditis: case report and review. Clin Infect Dis. Oct 1997;25(4):920-1. [Medline].

  5. Wade T, Booy R, Teare EL, et al. Pasteurella multocida meningitis in infancy - (a lick may be as bad as a bite). Eur J Pediatr. Nov 1999;158(11):875-8. [Medline].

  6. Tattevin P, Souala F, Gautier AL, et al. Diabetes in patients with pasteurellosis. Scand J Infect Dis. 2005;37(10):731-3. [Medline].

  7. Rollof J, Johansson PJ, Holst E. Severe Pasteurella multocida infections in pregnant women. Scand J Infect Dis. 1992;24(4):453-6. [Medline].

  8. Waldor M, Roberts D, Kazanjian P. In utero infection due to Pasteurella multocida in the first trimester of pregnancy: case report and review. Clin Infect Dis. Feb 1992;14(2):497-500. [Medline].

  9. Baud D, Bizzini A, Jaton K, Achtari C, Prod'hom G, Greub G. Pasteurella multocida Zoonotic Ascending Infection: An Unusual Cause of Tubo-Ovarian Abscess. Vector Borne Zoonotic Dis. Sep 16 2011;[Medline].

  10. American Academy of Pediatrics. Bite Wounds. In: Red Book 2000 - Report of the Committee on Infectious Diseases. 25th ed. Oak Grove, Ill: American Academy of Pediatrics; 2000:156-9.

  11. Brivet F, Guibert M, Barthelemy P, et al. Pasteurella multocida sepsis after hemorrhagic shock in a cirrhotic patient: possible role of endoscopic procedures and gastrointestinal translocation. Clin Infect Dis. May 1994;18(5):842-3. [Medline].

  12. Champlin FR, Shryock TR, Patterson CE, et al. Prevalence of a novel capsule-associated lipoprotein among pasteurellaceae pathogenic in animals. Curr Microbiol. Apr 2002;44(4):297-301. [Medline].

  13. Chang K, Siu LK, Chen YH, et al. Fatal Pasteurella multocida septicemia and necrotizing fasciitis related with wound licked by a domestic dog. Scand J Infect Dis. 2007;39(2):167-70. [Medline].

  14. Citron DM, Warren YA, Fernandez HT, et al. Broth microdilution and disk diffusion tests for susceptibility testing of Pasteurella species isolated from human clinical specimens. J Clin Microbiol. May 2005;43(5):2485-8. [Medline].

  15. Clark RB, Joyce SE. Activity of meropenem and other antimicrobial agents against uncommon gram-negative organisms. J Antimicrob Chemother. Aug 1993;32(2):233-7. [Medline].

  16. Fajfar-Whetstone CJ, Coleman L, Biggs DR, Fox BC. Pasteurella multocida septicemia and subsequent Pasteurella dagmatis septicemia in a diabetic patient. J Clin Microbiol. Jan 1995;33(1):202-4. [Medline].

  17. Goldstein EJ, Citron DM. Comparative activities of cefuroxime, amoxicillin-clavulanic acid, ciprofloxacin, enoxacin, and ofloxacin against aerobic and anaerobic bacteria isolated from bite wounds. Antimicrob Agents Chemother. Aug 1988;32(8):1143-8. [Medline].

  18. Goldstein EJ, Citron DM, Merriam CV, et al. Activity of gatifloxacin compared to those of five other quinolones versus aerobic and anaerobic isolates from skin and soft tissue samples of human and animal bite wound infections. Antimicrob Agents Chemother. Jun 1999;43(6):1475-9. [Medline].

  19. Goldstein EJ, Citron DM, Merriam CV, et al. Comparative in vitro activities of GAR-936 against aerobic and anaerobic animal and human bite wound pathogens. Antimicrob Agents Chemother. Oct 2000;44(10):2747-51. [Medline].

  20. Goldstein EJ, Citron DM, Richwald GA. Lack of in vitro efficacy of oral forms of certain cephalosporins, erythromycin, and oxacillin against Pasteurella multocida. Antimicrob Agents Chemother. Feb 1988;32(2):213-5. [Medline].

  21. Green BT, Ramsey KM, Nolan PE. Pasteurella multocida meningitis: case report and review of the last 11 y. Scand J Infect Dis. 2002;34(3):213-7. [Medline].

  22. Griego RD, Rosen T, Orengo IF, et al. Dog, cat, and human bites: a review. J Am Acad Dermatol. Dec 1995;33(6):1019-29. [Medline].

  23. Kimura R, Hayashi Y, Takeuchi T, et al. Pasteurella multocida septicemia caused by close contact with a domestic cat: case report and literature review. J Infect Chemother. Aug 2004;10(4):250-2. [Medline].

  24. Koch CA, Mabee CL, Robyn JA, et al. Exposure to domestic cats: risk factor for Pasteurella multocida peritonitis in liver cirrhosis?. Am J Gastroenterol. Jul 1996;91(7):1447-9. [Medline].

  25. Kravetz JD, Federman DG. Cat-associated zoonoses. Arch Intern Med. Sep 23 2002;162(17):1945-52. [Medline].

  26. Layton CT. Pasteurella multocida meningitis and septic arthritis secondary to a cat bite. J Emerg Med. May-Jun 1999;17(3):445-8. [Medline].

  27. Lion C, Conroy MC, Carpentier AM, et al. Antimicrobial susceptibilities of Pasteurella strains isolated from humans. Int J Antimicrob Agents. Apr 2006;27(4):290-3. [Medline].

  28. Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 5th ed. Philadelphia, Pa: Churchill Livingstone; 2000:2404-7.

  29. Meha H, Mackle I. Prosthetic joint infection with Pasteurella multocida following cat scratch: a report of 2 cases. J Arthroplasty. Jun 2004;19(4):525-7.

  30. Murphy E. Microbiology of animal bites. Clinical Microbiology Newsletter. Apr 2008;30(7):47-50.

  31. Rosenau A, Labigne A, Escande F, et al. Plasmid-mediated ROB-1 beta-lactamase in Pasteurella multocida from a human specimen. Antimicrob Agents Chemother. Nov 1991;35(11):2419-22. [Medline].

  32. Ruiz-Irastorza G, Garea C, Alonso JJ, et al. Septic shock due to Pasteurella multocida subspecies multocida in a previously healthy woman. Clin Infect Dis. Jul 1995;21(1):232-4. [Medline].

  33. Spagnuolo PJ. Pasteurella multocida infectious arthritis. Am J Med Sci. May-Jun 1978;275(3):359-63. [Medline].

  34. Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft-tissue infections. Clin Infect Dis. Nov 15 2005;41(10):1373-406. [Medline].

  35. Weber DJ, Wolfson JS, Swartz MN, et al. Pasteurella multocida infections. Report of 34 cases and review of the literature. Medicine (Baltimore). May 1984;63(3):133-54. [Medline].

 
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