A case report of Pasteurella multocida meningitis in a patient with non-traumatic skull base defect

Pasteurella multocida infection induces blood-brain barrier disruption by decreasing tight junctions and adherens junctions between neighbored brain microvascular endothelial cells

Meningitis induced by Pasteurella multocida has been substantially described in clinical practice in both human and veterinary medicine, but the underlying mechanisms have not been previously reported. In this study, we investigated the influence of P. multocida infection on the permeability of the blood-brain barrier (BBB) using different models. Our in vivo tests in a mouse model and in vitro tests using human brain microvascular endothelial cell (hBMEC) model showed that P. multocida infection increased murine BBB permeability in mice and hBMEC monolayer permeability. Furthermore, we observed that P. multocida infection resulted in decreased expression of tight junctions (ZO1, claudin-5, occludin) and adherens junctions (E-cadherin) between neighboring hBMECs. Subsequent experiments revealed that P. multocida infection promoted the activation of hypoxia inducible factor-1α (HIF-1α)/vascular endothelial growth factor A (VEGFA) signaling and NF-κB signaling, and suppressed the HIF-1α/VEGFA significantly remitted the decrease in ZO1/E-cadherin induced by P. multocida infection (P < 0.001). NF-κB signaling was found to contribute to the production of chemokines such as TNF-1α, IL-β, and IL-6. Additionally, transmission electron microscopy revealed that paracellular migration might be the strategy employed by P. multocida to cross the BBB. This study provides the first evidence of the migration strategy used by P. multocida to traverse the mammalian BBB. The data presented herein will contribute to a better understanding of the pathogenesis of the zoonotic pathogen P. multocida.

Pasteurella multocida Infection Presented With Frequent Diarrhea in the Cirrhotic Patient

A 49-year-old woman with alcoholic cirrhosis who owned a pet cat was brought to the hospital with frequent diarrhea every 30 min for two days. She was treated intensively for septic shock; however, she died on the third day. Pasteurella multocida is known to cause soft tissue infections; however, in immunocompromised individuals, it can cause severe invasive infections. Physicians should consider P. multocida infection when a patient with liver cirrhosis presents in shock following symptoms of enteritis. Clinical decisions should be made considering that this infection is associated with a high mortality rate and rapid deterioration.