eMedicine Specialties > Infectious Diseases > Bacterial Infections

Pasteurella Multocida Infection

Author: Alexandre Lacasse, MD, MSc, Fellow in Infectious Diseases, University of Tennessee at Memphis
Coauthor(s): Michael Gelfand, MD, FACP, Chief, Professor, Department of Internal Medicine, Division of Infectious Diseases, Methodist Healthcare of Memphis, University of Tennessee; Thomas Lafeber, MD, Consulting Staff, Wellstar Infectious Disease LLC; J Robert Cantey, MD, Chief of Infectious Disease, Veterans Affairs Medical Center, Director, Professor, Department of Medicine, Division of Infectious Diseases, Medical University of South Carolina
Contributor Information and Disclosures

Updated: Jan 21, 2009

Introduction

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.

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.

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.

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.

Clinical

History

  • A history of animal exposure, whether occupational or recreational, should alert the physician to the possibility of a zoonosis.
  • A detailed pet history, including exposure to pets owned by friends or strangers, should reveal the possibility of Pasteurella infection. However, cases of Pasteurella infection occur in the total absence of an epidemiological link.

Physical

Physical findings of P multocida infection relate to the site of infection, as follows:

  • Local - Erythema, warmth, pain and tenderness, purulent discharge, lymphangitis, joint swelling, decreased range of motion
  • Respiratory - Sinus tenderness, hoarseness, pharyngeal erythema, rales and rhonchi upon chest auscultation, dullness to percussion, changes in vocal fremitus
  • CNS - Focal neurologic deficits, signs of meningeal irritation (eg, nuchal rigidity, Brudzinski sign, Kernig sign)
  • Abdominal - Abdominal tenderness, guarding and rebound, hepatosplenomegaly, costovertebral angle tenderness
  • Ocular - Corneal ulcer, conjunctival injection, decreased visual acuity
  • Cardiovascular - Hypotension, tachycardia, new cardiac murmur, embolic phenomenon
  • Lymph nodes - Regional adenopathy

Causes

Causes of P multocida infection include the following:

  • Dog bite or lick
  • Cat bite, lick, or scratch
  • Idiopathic (no history of pet exposure)
  • Immunosuppression

More on Pasteurella Multocida Infection

Overview: Pasteurella Multocida Infection
Differential Diagnoses & Workup: Pasteurella Multocida Infection
Treatment & Medication: Pasteurella Multocida Infection
Follow-up: Pasteurella Multocida Infection
Multimedia: Pasteurella Multocida Infection
References
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References

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Further Reading

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Keywords

Pasteurella multocida infection, P multocida infection, pasteurellosis, coccobacillus, coccobacilli, bacterial infection, dog bite, cat bite, cat scratch, bite wound, animal bite wound, cat lick, pet wound, pet bite, meningitis, tetanus, rabies

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Contributor Information and Disclosures

Author

Alexandre Lacasse, MD, MSc, Fellow in Infectious Diseases, University of Tennessee at Memphis
Alexandre Lacasse, MD, MSc is a member of the following medical societies: American College of Physicians, American Medical Association, and Infectious Diseases Society 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, Chief of Infectious Disease, Veterans Affairs Medical Center, Director, 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 College of Physicians, American Society for Clinical Investigation, American Society for MOHS Surgery, Infectious Diseases Society of America, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Aaron Glatt, MD, Professor of Clinical Medicine, New York Medical College; President and CEO, Former Chief Medical Officer, Departments of Medicine and Infectious Diseases, 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.

CME Editor

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.

 
 
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