Cat induced Pasteurella multocida peritonitis in peritoneal dialysis: a case report and review of the literature

Molecular characterization of Pasteurella multocida from cats and antibiotic sensitivity of the isolates

BACKGROUND

Companion animals, including dogs and cats, are frequently identified as sources of Pasteurella multocida, a bacterium that can be transmitted to humans and cause infections.

OBJECTIVES

This survey defines the prevalence, antibiotic sensitivity, capsular types, lipopolysaccharide (LPS) types and virulence factors of P. multocida isolated from cats.

METHODS

A total of 100 specimens from various cat breeds were collected. P. multocida was characterized using both biochemical tests and PCR. Genotypes of isolates were determined using capsular and LPS typing methods. Additionally, virulotyping was performed by detecting the presence of 12 virulence-associated genes. Disk diffusion was used to determine the antibiotic sensitivity of the isolates.

RESULTS

The prevalence of P. multocida in cats was 29%. Among the isolates, the majority were capsular type A (96.5%) and type D (3.4%), with a predominant presence of type A. Twenty-six of the isolates (89.66%) belonged to LPS genotype L6, whereas three isolates (10.3%) belonged to genotype L3. Among the 12 virulence genes examined, sodC, oma87, ptfA, nanB and ompH showed remarkable prevalence (100%). The toxA gene was detected in four isolates (13.8%). Variations were observed in other virulence genes. The nanH gene was present in 93.1% of the isolates, whereas the pfhA gene was detected in 58.6% of the isolates. The exbD-tonB, hgbB, sodA and hgbA genes showed prevalence rates of 96.5%, 96.5%, 96.5% and 82.8%, respectively. Additionally, particular capsule and LPS types were associated with specific virulence genes. Specifically, the toxA and pfhA genes were found to be more prevalent in isolates with capsular type A and LPS genotype L6. Most isolates were resistant to ampicillin, clindamycin, lincomycin, streptomycin and penicillin.

CONCLUSIONS

According to this epidemiological and molecular data, P. multocida from cats possess several virulence-associated genes and are resistant to antimicrobial medicines commonly used in humans and animals. Thus, it is crucial to consider the public health concerns of P. multocida in humans.

Pasteurella multocida Bacteremia Secondary to Peritoneal Dialysis Associated Peritonitis: A Case Report and Literature Review

We report the fiftieth case in the literature of Pasteurella species peritoneal dialysis (PD)-related peritonitis and the third reported case of Pasteurella multocida bacteremia associated with PD-related peritonitis. Our review provides the most up-to-date collection of all fifty reported cases of PD-related peritonitis caused by Pasteurella species. A 77-year-old Caucasian male with a past medical history significant for new-onset left-ventricular systolic heart failure, severe mitral valve regurgitation, and end-stage renal disease on PD for six months presented to the emergency department with a one-week cloudy peritoneal effluent and intermittent abdominal pain. Pasteurella multocida was isolated from blood cultures and peritoneal fluid cultures. The patient was treated with intravenous piperacillin-tazobactam and intraperitoneal cefepime. The PD catheter was not removed or exchanged. A repeat blood culture on the third hospital day was negative. His hospital course was complicated by cardiogenic shock, atrial fibrillation, and gastrointestinal bleeding, and his goals of care changed to focus on comfort measures. This case report and literature review provide a resource for healthcare providers who may encounter this infection in the future. This case also serves as a reminder of the challenges of PD in patients at risk of acquired zoonotic infections from their pets. Based on the reviewed three cases of Pasteurella multocida bacteremia associated with PD-related peritonitis, blood cultures may be a prudent option for patients presenting with peritoneal dialysis associated peritonitis to ensure that concurrent bacteremia is not overlooked.

Pet-related Pasteurella multocida induced peritonitis in peritoneal dialysis: a case report and review of the literatures

Background

P. multocida (Pasteurella multocida) is animal-sourced gram-negative coccobacillus which can be transmitted to human through many animals including household pets. P. multocida induced peritoneal dialysis-related peritonitis has rarely been reported. In recent years, there has been an increase in the incidence of P. multocida induced peritoneal dialysis-related peritonitis, for the reason that patients with PD at home bred household pets. In this study, we present a case of a P. multocida induced peritoneal dialysis-related peritonitis, which is suspected to be caused through intimate contact with a household cat and we have reviewed 28 cases reported before and give suggestions for treatment and the way of prevention.

Case presentation

A 75-year-old man with end-stage renal disease (ESRD) for nearly 5 years on continuous ambulatory peritoneal dialysis (CAPD) was admitted to the nephrology department with a 1-week history of abdominal pain and a cloudy peritoneal dialysis effluent. Based on the history, physical examination and laboratory results with the findings in the peritoneal dialysis fluid, a diagnosis of peritoneal dialysis-related peritonitis was confirmed. The final culture of initial peritoneal effluent results indicated the organism was P. multocida. After a 12-day antibiotic treatment, the condition of patient was not improved. The patient was switched to ampicillin/sulbactam (3 g intravenously) twice every day and the condition was improved significantly. On further inquiring, the patient reported that he had had a cat at home and when the patient did CAPD, the cat was usually playing with the tubing or contacting the patient during CAPD.

Conclusion

In our case and reviewed cases, P. multocida induced peritoneal dialysis-related peritonitis could be cured by proper antibiotic treatment. If individuals keep the pet away from the PD process, the infection route may be severed. P. multocida induced peritoneal dialysis-related peritonitis does not need catheter removal and exchange with hemodialysis except long-time intractable peritonitis.

A Case Report on Pasteurella multocida Peritoneal Dialysis-Associated Peritonitis: When Cats Think Medical Equipment Are Toys

Pasteurella multocida is an aerobic gram-negative coccobacillus usually found in the oral cavities of most healthy cats and dogs as part of their natural oral flora. This zoonotic pathogen can cause a variety of infections in humans through bites, scratches, or licking. Infections range from less severe cases, such as infected animal bites and cellulitis, to more severe cases of pneumonia, septic arthritis, osteomyelitis, sepsis, and meningitis. However, the number of reported cases of peritoneal dialysis-associated peritonitis caused by P. multocida has been limited worldwide. Here, we report the case of a 59-year-old man undergoing continuous cycling peritoneal dialysis who developed P. multocida peritonitis, believed to be secondary to domestic cat exposure to dialysis equipment. Due to the increasing trend of pet ownership, patients maintained on peritoneal dialysis should be educated on the importance of strict hygiene and avoiding pet contact with the dialysis equipment, especially in bag exchange areas. Although the best means of preventing such infections is to avoid having pets at home, the positive psychological effects of pet ownership should also be considered. Thus, patients in such situations should be continuously educated and encouraged to be mindful of the importance of environmental hygiene.

Capnocytophaga canimorsus peritonitis diagnosed by mass spectrometry in a diabetic patient undergoing peritoneal dialysis: a case report

Background

Bacterial peritonitis is a serious complication of patients undergoing peritoneal dialysis (PD). Although the identification of causative organisms and use of appropriate antibiotics are essential for treatment, rare and fastidious bacteria are sometimes difficult to detect by conventional biochemical assays. Capnocytophaga canimorsus is a fastidious and slow-growing bacterium that forms a part of the normal oral flora of dogs and cats and is extremely rare as a peritonitis-causing organism. This report demonstrates the usefulness of a mass spectrometry-based technique in identifying such a rare organism in PD-related peritonitis and discusses the diagnosis and treatment of C. canimorsus peritonitis.

Case presentation

A 49-year-old woman with type 2 diabetes mellitus underwent PD for two years. Repeated exit-site infections led to subcutaneous pathway diversion two months ago. She was hospitalized with fever and abdominal pain as well as cloudy dialysis effluent. Laboratory data revealed increased serum C-reactive protein level and white blood cell (WBC) count in the effluent. Her exit site had no sign of infection, leading to the diagnosis of PD-related peritonitis. Initial therapy with intraperitoneal ceftazidime immediately ameliorated her symptoms, and the WBC count in the effluent normalized in five days. Culture test results of the dialysis effluent on admission were negative with no information regarding the infection route. However, mass spectrometry (MALDI Biotyper, Bruker Daltonics) successfully obtained the specific spectral pattern for C. canimorsus. She had four cats in her house and was advised not to allow the cats in the room where the bag exchange took place.

Conclusions

C. canimorsus is a rare cause of peritonitis in PD patients and is usually susceptible to intraperitoneal third-generation cephalosporins. This mass spectrometry-based bacterial identification method could provide more opportunities to identify uncommon causes and promote appropriate antibiotics therapy in PD-related peritonitis.

Peritonitis Secondary to Uncommon Gram-Negative Coccobacillus Transmitted From a Cat in a Patient on Peritoneal Dialysis

Peritonitis caused by gram-negative organisms is a significant complication encountered in patients undergoing peritoneal dialysis and is associated with high morbidity and mortality. There has been recognition of peritonitis caused by uncommon organisms because of improved microbiological detection techniques. In this article, we report a rare case of peritonitis caused by Pasteurella multocida. We present a 58-year-old male on peritoneal dialysis with fever and abdominal pain. The peritoneal fluid was cloudy, and the analysis was consistent with peritonitis. The peritoneal fluid culture grew Pasteurella multocida. The patient was treated with a 3-week course of intraperitoneal ceftazidime, which resulted in the resolution of infection with the salvation of the peritoneal dialysis catheter. Patient education plays a very critical role in the prevention of peritonitis from Pasteurella multocida, particularly if patients have pets at home. The domestic pets should be kept away from the dialysis equipment and should not be allowed into the room during dialysis treatment. Incorporating the education in handing pets during the training session is the key aspect.

A Rare Case of Glossitis due to Pasteurella multocida after a Cat Scratch

Pasteurella is one of the zoonotic pathogens that can cause variety of serious infections in animals and humans such as bacteremia, septic shock, endocarditis, meningitis, prosthetic and native valve infections, osteomyelitis, skin and soft tissue infections, abscesses, and even pneumonia with empyema. However, there have been few reports of upper respiratory involvements like tonsillitis and epiglottitis in humans. We present a case of recurrent Pasteurella glossitis after a cat scratch which has not been reported in humans.

Pasteurella multocida non-native joint infection after a dog lick: A case report describing a complicated two-stage revision and a comprehensive review of the literature

Pasteurella multocida is a Gram-negative coccobacillus that is part of the normal oral flora of animals, including domestic cats and dogs. Prosthetic joint infections due to P multocida typically occur following an animal lick or bite. The present review describes a two-stage revision arthroplasty associated with a P multocida joint infection caused by a dog lick. The authors also provide a comprehensive review of the literature surrounding P multocida prosthetic joint infections.

Prosthetic joint infections (PJIs) are commonly caused by pathogens such as Staphylococcus aureus and coagulase-negative staphylococci; however, other microbial etiologies and specific risk factors are increasingly recognized. Pasteurella multocida is a Gram-negative coccobacillus that is part of the normal oral flora in many animals, and is particularly common in dogs and cats. PJIs caused by P multocida have been reported only rarely in the literature and typically occur in the context of an animal bite or scratch. The present article describes a P multocida joint infection that occurred after a dog lick and complicated a two-stage revision arthroplasty. A comprehensive review of the literature regarding P multocida PJIs follows.

Difficult peritonitis cases in children undergoing chronic peritoneal dialysis: relapsing, repeat, recurrent and zoonotic episodes

Despite technological improvements in dialysis connectology and dialysis technique, peritonitis remains the most common and most significant complication of peritoneal dialysis (PD) in children. Most children undergoing chronic PD experience none or only one peritonitis episode, while others have multiple episodes or episodes secondary to unusual organisms. Knowledge of potential risk factors and likely patient outcome is imperative if treatment is to be optimized. In this review we will, in turn, describe episodes of peritonitis that are characterized as either relapsing, recurrent, repeat or zoonosis-related to highlight the clinical issues that are commonly encountered by clinicians treating these infections.

Clinical Features and Outcomes of Pasteurella multocida Infection

Pasteurella multocida, a zoonotic infectious organism, has most often been described in patients after an animal bite. Here, we characterize the clinical features and outcomes of P multocida infection in a large cohort of patients according to the presence or absence of an animal bite.We retrospectively searched MUSC's laboratory information system for all patients with positive P multocida cultures from 2000 to 2014. Extensive data were abstracted, including clinical and outcome data. The Charlson comorbidity index (CCI) was used to assess comorbidities among patients.We identified 44 patients with P multocida infections, including 25 with an animal bite. The average age was 64 years and the majority of patients were women (N = 30). There was no difference in age and sex distribution among those with and without a bite (P = 0.38 and 0.75, respectively). A CCI ≥1 was significantly associated with the absence of a bite (P = 0.006). Patients presenting without a bite were more frequently bacteremic (37% vs 4%, respectively, P = 0.001), and were hospitalized more often (84% vs 44%, respectively, P = 0.012). Of the 8 patients who required intensive care unit (ICU)-based care, 7 were non-bite-related. There were 4 deaths, all occurring in patients not bitten.P multocida infections not associated with an animal bite were often associated with bacteremia, severe comorbidity(ies), immune-incompetent states, the need for ICU management, and were associated with substantial mortality.

Rapidly evolving conjunctivitis due to Pasteurella multocida, occurring after direct inoculation with animal droplets in an immuno-compromised host

Background

The rare descriptions, in the literature, of ocular infections due to Pasteurella multocida include: endophtalmitis, keratitis and corneal ulcers, Parinaud’s oculoglandular syndrome, and conjunctivitis. Here, we report a rare case of rapidly evolving conjunctivitis due to Pasteurella multocida, occurring after direct inoculation with animal droplets in an immuno-compromised host.

Case presentation

A 69-year-old, Caucasian male was referred to our department with purulent conjunctivitis, occurring five days after chemotherapy for an angioimmunoblastic-T-cell-lymphoma, and thirty-three hours after being struck in his right eye by his sneezing Dachshund dog. Physical examination revealed purulent conjunctivitis of the right eye associated with inflammatory edema of both lids. Direct bacteriological examination of conjunctival secretions showed gram-negative bacilli and regular, grey non-hemolytic colonies appearing the next day on blood agar. The oxidase test was positive for these colonies. An antibiotherapy associating intravenous amoxicillin and amoxicillin/clavulanate was administered. The outcome was favorable in the next three days allowing discharge of the patient with amoxicillin (2 g tid per os).

Conclusion

This case report may be of interest for infectious diseases, ophthalmology or oncology specialists, especially nowadays with chemotherapy being administered in day care centres, where unusual home pathogens can be encountered in health related infections. In this case, previous animal contact and conjunctival samples showing Enterobacteriaceae like colonies with positive oxidase test were two important clues which could help clinicians to make the diagnosis of Pasteurella conjunctivitis in every day practice.

Antimicrobial resistance and virulence gene profiles in P. multocida strains isolated from cats

Cats are often described as carriers of Pasteurella multocida in their oral microbiota. This agent is thought to cause pneumonia, conjunctivitis, rhinitis, gingivostomatitis, abscess and osteonecrosis in cats. Human infection with P. multocida has been described in several cases affecting cat owners or after cat bites. In Brazil, the cat population is approximately 21 million animals and is increasing, but there are no studies of the presence of P. multocida in the feline population or of human cases of infection associated with cats. In this study, one hundred and ninety-one healthy cats from owners and shelters in São Paulo State, Brazil, were evaluated for the presence of P. multocida in their oral cavities. Twenty animals were positive for P. multocida , and forty-one strains were selected and characterized by means of biochemical tests and PCR. The P. multocida strains were tested for capsular type, virulence genes and resistance profile. A total of 75.6% (31/41) of isolates belonged to capsular type A, and 24.4% (10/41) of the isolates were untypeable. None of the strains harboured toxA, tbpA or pfhA genes. The frequencies of the other genes tested were variable, and the data generated were used to build a dendrogram showing the relatedness of strains, which were clustered according to origin. The most common resistance profile observed was against sulfizoxazole and trimethoprim-sulphamethoxazole.

Cat-induced Pasteurella multocida peritonitis in continuous ambulatory peritoneal dialysis

Pasteurella multocida is a zoonotic pathogen found in the oral cavities of both domestic and wild animals. Although P. multocida has been involved in a wide range of human diseases, only a limited number of studies on P. multocida peritonitis in patients undergoing peritoneal dialysis (PD) had been carried out. We herein present the case of P. multocida peritonitis in a patient undergoing continuous ambulatory PD, which is believed to have resulted from contact with cats. We suggest that patients undergoing PD and having domestic animals at home should be educated about the possible transmission of the infection from the animals; in addition, these patients should also maintain a high level of personal hygiene.

Pasteurella multocida infection in cats: ABCD guidelines on prevention and management

OVERVIEW

Pasteurella species are part of the normal oral flora of cats. They are also a common cause of infection in this species and an important zoonotic agent. INFECTION IN CATS: Pasteurella species are commonly isolated from subcutaneous abscesses and pyothorax in cats. They may also cause secondary lower respiratory tract infection and have been associated with spinal empyema and meningoencephalomyelitis. INFECTION IN HUMANS: Disease in humans mainly occurs after a cat bite or scratch, but may also be transmitted via respiratory secretions from cats in close contact with a person. Signs of local infection after a cat bite appear in a few hours (3-6 h). Severe disease and a fatal outcome mostly occur in immunocompromised people, but have also been reported in immunocompetent healthy individuals. Cat ownership by immunocompromised people may carry a risk.

Spontaneous bacterial peritonitis by Pasteurella multocida under treatment with rifaximin

Spontaneous bacterial peritonitis (SBP) is a life-threatening complication of liver cirrhosis. Recently, rifaximin, a non-absorbable antibiotic which is used to prevent recurrent hepatic encephalopathy, has been proposed as effective prophylaxis for SBP. Here, we present an unusual case of SBP under treatment with rifaximin. A 50-year-old woman with liver cirrhosis was admitted because of tense ascites and abdominal pain. She was under long-term oral prophylaxis with rifaximin due to hepatic encephalopathy. Paracentesis revealed SBP caused by Pasteurella multocida, which was sensitive to multiple antibiotics, including rifaximin. Treatment with ceftriaxone resulted in rapid resolution of the peritonitis and restoration of the patient. Since P. multocida is usually transmitted from pets, the patient's cat was tested and could be identified as the most likely source of infection. This case should elicit our awareness that uncommon pathogens and unusual routes of transmission may lead to SBP, despite antibacterial prophylaxis with non-absorbable antibiotics. Nevertheless, such infections may still remain sensitive to systemic therapy with conventional antibiotics.