1
|
Davita TR, Giunto N, Husnain M, Wong K. A Case of Persistent Pasteurella multocida Cellulitis Complicated With Large Endocarditis Vegetation. Cureus 2024; 16:e68825. [PMID: 39371856 PMCID: PMC11456357 DOI: 10.7759/cureus.68825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2024] [Indexed: 10/08/2024] Open
Abstract
In the realm of infective endocarditis, a distinct and infrequent player emerges - Pasteurella multocida, an organism more commonly associated with zoonotic infections, now warranting careful consideration in this unique case report. P . multocida is a Gram-negative, facultative anaerobic cocco-bacillus and a common member of the oral bacterial flora of cats and dogs. In humans, it commonly causes skin and wound infections after bites and scratches. Disseminated P . multocida infection seeded into the heart valve is very rare and has only been reported in about one case per year worldwide with only 42 cases found in the literature and only five cases reported to have underlying liver cirrhosis as in our case. This is a case of a 73-year-old female with a past medical history of Child-Pugh B liver cirrhosis secondary to primary biliary cholangitis with portal hypertension, splenomegaly, pancytopenia, severe aortic stenosis, and paroxysmal atrial fibrillation presented to hospital with generalized weakness, fever, and new lower extremity rash 48 hours after last dose of antibiotic. She had recent hospitalization for left lower extremity cellulitis and P. multocida bacteremia and received 14 days of high-dose oral amoxicillin-clavulanate with negative blood culture prior to discharge. She occasionally helps her son to feed his cats and dog whenever he travels. She was readmitted and a repeat blood culture showed P. multocida. Transthoracic echocardiogram showed a 1.9 cm × 1 cm mobile mass attached to the anterior mitral valve leaflet, which was new compared to the prior study obtained during her first admission. She was not a suitable candidate for valve surgery due to her comorbidities. P. multocida was found to be susceptible to penicillin, ampicillin, levofloxacin with negative beta lactamase. Her cellulitis, fever, and bacteremia eventually resolved with intravenous antibiotics. She was ultimately discharged with a two-week course of intravenous ceftriaxone, continued with oral levofloxacin to complete six weeks of total treatment, and followed by long-term penicillin suppression. In this case report, we delve into a rare and intriguing clinical presentation of P . multocida endocarditis. Our patient is the second reported case which showed complication of native mitral valve endocarditis even in the setting of bacteremia resolution. This report sheds light on the challenging diagnosis and management of this uncommon yet clinically significant condition, highlighting the importance of vigilant and prompt intervention in cases of infective endocarditis with atypical causative agents.
Collapse
Affiliation(s)
| | - Nathan Giunto
- Internal Medicine, Northeast Ohio Medical University, Akron, USA
| | | | - Ken Wong
- Infectious Disease, Cleveland Clinic Akron General, Akron, USA
| |
Collapse
|
2
|
Asaeda T, Ueda T, Nozaki Y, Murakami Y, Morosawa M, Inaba H, Ogashiwa H, Doi M, Nakajima K, Shirakawa M, Nakamura A, Ikeda N, Sugiyama Y, Wada Y, Ito T, Takesue Y. Clinical features of pasteurellosis without an animal bite or scratch in comparison with bite/scratch pasteurellosis. J Infect Chemother 2024; 30:820-823. [PMID: 38373634 DOI: 10.1016/j.jiac.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/20/2023] [Accepted: 02/04/2024] [Indexed: 02/21/2024]
Abstract
Pasteurellosis is a common zoonotic infection that occurs after an animal bite or scratch (B/S). We compared the clinical features of six patients with non-B/S pasteurellosis with those of 14 patients with B/S infections. Pasteurella multocida was identified with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry in all six non-B/S infections, whereas 13 of the 14 B/S infections were identified with diagnostic kits. The non-B/S infections were pneumonia (n = 3), skin and soft tissue infections (n = 2), and bacteremia (n = 1). Pneumonia occurred in two patients with underlying pulmonary disease, whereas ventilator-associated pneumonia developed in one patient with cerebral infarction. Pasteurella multocida was isolated from a blood specimen and nasal swab from a patient with liver cirrhosis (Child-Pugh class C) and diabetes. Cellulitis developed in one patient with diabetes and normal-pressure hydrocephalus, who had an open wound following a fall, and in one patient with diabetes and a foot ulcer. Three patients with non-B/S infections had no pet and no episode of recent animal contact. The rate of moderate-to-severe comorbidities was significantly higher in patients with non-B/S infections than in those with B/S infections (100% and 14.3%, respectively, p < 0.001). In conclusion, non-B/S infections can develop in patients with chronic pulmonary disease, invasive mechanical ventilation, or open wounds, or who are immunocompromised, irrespective of obvious animal exposure. In contrast to B/S infections, non-B/S pasteurellosis should be considered opportunistic.
Collapse
Affiliation(s)
- Tsubasa Asaeda
- Department of Respiratory Medicine, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, Aichi, 479-8510, Japan.
| | - Takashi Ueda
- Department of Infection Control and Prevention, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Japan.
| | - Yasuhiro Nozaki
- Department of Respiratory Medicine, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, Aichi, 479-8510, Japan.
| | - Yasushi Murakami
- Department of Respiratory Medicine, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, Aichi, 479-8510, Japan.
| | - Mika Morosawa
- Department of Respiratory Medicine, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, Aichi, 479-8510, Japan.
| | - Hiroko Inaba
- Department of Dermatology, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, Aichi, 479-8510, Japan.
| | - Hitoshi Ogashiwa
- Department of Clinical Technology, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, Aichi, 479-8510, Japan.
| | - Miki Doi
- Department of Clinical Technology, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, Aichi, 479-8510, Japan.
| | - Kazuhiko Nakajima
- Department of Infection Control and Prevention, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Japan.
| | - Manabu Shirakawa
- Department of Neurosurgery, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Japan.
| | - Akifumi Nakamura
- Division of Thoracic Surgery, Department of Surgery, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Japan.
| | - Naoto Ikeda
- Division of Hepatobiliary and Pancreatic Diseases, Department of Gastroenterology, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Japan.
| | - Yuya Sugiyama
- Department of Plastic Surgery, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Japan.
| | - Yoshihiro Wada
- Department of Dermatology, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Japan.
| | - Takahiro Ito
- Department of Clinical Infectious Diseases, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, 479-8510, Japan.
| | - Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Japan; Department of Clinical Infectious Diseases, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, 479-8510, Japan.
| |
Collapse
|
3
|
Sia T, Yong E. Pasteurella multocida bacteraemia with liver abscess. BMJ Case Rep 2024; 17:e258386. [PMID: 38232998 PMCID: PMC10806919 DOI: 10.1136/bcr-2023-258386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
A previously healthy woman in her mid-70s presented with right upper quadrant abdominal pain, fever, intermittent chills and malaise for 1 week. She was clinically septic with raised inflammatory markers. Her blood culture revealed Pasteurella multocida, which was susceptible to penicillin and amoxicillin-clavulanic acid. CT of liver revealed an abscess of 8.0×7.9×8.5 cm at the left lobe of the liver. However, the abscess was not amenable for surgical or radiological drainage. She was a farmer and had close contact with her pet cats. She was occasionally scratched by her cats when caring for them. The liver abscess resolved completely without drainage after prolonged antimicrobial therapy of 109 days. She commenced on 63 days of intravenous antimicrobials and 46 days of oral amoxicillin-clavulanic acid. This case illustrated P. multocida bacteraemia with a large liver abscess in an immunocompetent adult after non-bite exposure.
Collapse
Affiliation(s)
- Tonnii Sia
- Imperial College London, London, UK
- Sarawak General Hospital, Kuching, Sarawak, Malaysia
| | - Eunice Yong
- Department of Medicine, Miri Hospital, Miri, Malaysia
| |
Collapse
|
4
|
McPherson DF, Menghani SV, Bhalodi RG, Roesch TA. Canine Conundrum: Non-Bite Transmission Leading to Pasteurella multocida Epicardial Abscess. Am J Med 2024; 137:e3-e5. [PMID: 37757962 DOI: 10.1016/j.amjmed.2023.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/11/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023]
Affiliation(s)
- David F McPherson
- St. Luke's University Hospital Network (SLUHN), Bethlehem, Pa; St. Luke's Family Medicine Residency - Anderson, St. Luke's University Hospital Network (SLUHN), Easton, Pa
| | - Sanjay V Menghani
- University of Arizona College of Medicine, Tucson; Medical Scientist Training MD-PhD Program, University of Arizona College of Medicine, Tucson.
| | - Rina G Bhalodi
- St. Luke's University Hospital Network (SLUHN), Bethlehem, Pa; St. Luke's Psychiatry Residency - Anderson, St. Luke's University Hospital Network (SLUHN), Bethlehem, Pa
| | - Torey A Roesch
- St. Luke's University Hospital Network (SLUHN), Bethlehem, Pa; St. Luke's Infectious Disease Associates, Bethlehem, Pa
| |
Collapse
|
5
|
Lu B, Feng X, Ye T, Shan K, Wang S, Shi Y, Pan X. Bloodstream infection, peritonitis, and pneumonia caused by Pasteurella multocida in a patient with liver cirrhosis despite no animal contact: case report and literature review. Front Cell Infect Microbiol 2023; 13:1267941. [PMID: 37822356 PMCID: PMC10562540 DOI: 10.3389/fcimb.2023.1267941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/05/2023] [Indexed: 10/13/2023] Open
Abstract
Pasteurella multocida is an opportunistic pathogen. Previously reported infections associated with P. multocida have often been linked to contact with cats, dogs, and other animals. Cases of systemic multiple-site infections following P. multocida infection are rare. This case study presents a 49-year-old middle-aged man with post-hepatitis B cirrhosis and no history of animal contact. The patient was admitted with symptoms of fever accompanied by diarrhea, abdominal distension, and cough. Blood tests showed elevated levels of CRP, PCT, and IL-6, and blood culture revealed the growth of P. multocida. CT scans revealed a large amount of abdominal effusion, a small amount of pleural effusion, and pulmonary infection foci. The patient's condition improved after successive administration of ceftriaxone and levofloxacin to fight the infection, and abdominal puncture and drainage. Multiple-site infections caused by P. multocida are rarely encountered in patients with liver cirrhosis but without animal contact, which could be regarded as serious conditions warranting careful attention in terms of clinical diagnosis and treatment.
Collapse
Affiliation(s)
- Bin Lu
- Department of Infectious Diseases, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, China
| | - Xuewen Feng
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Tinghua Ye
- Department of Clinical Laboratory, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, China
| | - Kangfei Shan
- Department of Radiology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, China
| | - Sipei Wang
- Department of Clinical Laboratory, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, China
| | - Yunzhen Shi
- Department of Infectious Diseases, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, China
| | - Xinling Pan
- Department of Biomedical Sciences Laboratory, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, China
| |
Collapse
|
6
|
Nomoto K, Hata Y, Ichimata S, Mizuno S, Nishida N. An autopsy case of infective aortic aneurysm with Pasteurella multocida infection: clinicopathological appearance and a review of literatures. Ann Clin Microbiol Antimicrob 2023; 22:58. [PMID: 37434170 DOI: 10.1186/s12941-023-00611-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 07/07/2023] [Indexed: 07/13/2023] Open
Abstract
Here, we showed our clinicopathological findings of infected aortic aneurysm (IAA) with Pasteurella multocida, which is a Gram-negative coccobacillus and is part of the normal oral flora of many animals. The patient was a 76-year-old male animal owner with a history of diabetes mellitus, alcoholic liver damage, and laryngeal cancer. He died 16 days after admission without undergoing operation because of poor general condition. Autopsy showed saccular outpouching with loss of the existing aortic wall and marked neutrophilic infiltration in the suprarenal abdominal aorta. Rupture was not evident. A polymerase chain reaction assay using DNA extracted from formalin-fixed paraffin-embedded specimen of the aneurysmal wall detected the Pasteurella multocida gene, therefore we conclude that the present case was IAA of native aorta with Pasteurella multocida infection. A review of the literature showed that IAA of native aorta with Pasteurella multocida infection is opportunistic and that liver disorder, alcohol addiction, diabetes mellitus, and animal bite may increase its risk. On the other hand, aortic endograft infection with Pasteurella multocida frequently occurred without an immunocompromised state. Pasteurella multocida may be a distinct causative microorganism in IAA, and/or sepsis when the participant is an animal owner.
Collapse
Affiliation(s)
- Kazuhiro Nomoto
- Department of Pathology, Koseiren Takaoka Hospital, 5-10 Eiraku-cho, Takaoka, Toyama, 933-8555, Japan
| | - Yukiko Hata
- Department of Legal Medicine, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan
| | - Shojiro Ichimata
- Department of Legal Medicine, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan
| | - Syu Mizuno
- Division of General Medicine and Infectious Diseases, Koseiren Takaoka Hospital, 5-10 Eiraku-cho, Takaoka, Toyama, 933-8555, Japan
| | - Naoki Nishida
- Department of Pathology, Koseiren Takaoka Hospital, 5-10 Eiraku-cho, Takaoka, Toyama, 933-8555, Japan.
- Department of Legal Medicine, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan.
| |
Collapse
|