An unusual case of Pasteurella multocida bacteremic meningitis

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 activates apoptosis via the FAK-AKT-FOXO1 axis to cause pulmonary integrity loss, bacteremia, and eventually a cytokine storm

Pasteurella multocida is an important zoonotic respiratory pathogen capable of infecting a diverse range of hosts, including humans, farm animals, and wild animals. However, the precise mechanisms by which P. multocida compromises the pulmonary integrity of mammals and subsequently induces systemic infection remain largely unexplored. In this study, based on mouse and rabbit models, we found that P. multocida causes not only lung damage but also bacteremia due to the loss of lung integrity. Furthermore, we demonstrated that bacteremia is an important aspect of P. multocida pathogenesis, as evidenced by the observed multiorgan damage and systemic inflammation, and ultimately found that this systemic infection leads to a cytokine storm that can be mitigated by IL-6-neutralizing antibodies. As a result, we divided the pathogenesis of P. multocida into two phases: the pulmonary infection phase and the systemic infection phase. Based on unbiased RNA-seq data, we discovered that P. multocida-induced apoptosis leads to the loss of pulmonary epithelial integrity. These findings have been validated in both TC-1 murine lung epithelial cells and the lungs of model mice. Conversely, the administration of Ac-DEVD-CHO, an apoptosis inhibitor, effectively restored pulmonary epithelial integrity, significantly mitigated lung damage, inhibited bacteremia, attenuated the cytokine storm, and reduced mortality in mouse models. At the molecular level, we demonstrated that the FAK-AKT-FOXO1 axis is involved in P. multocida-induced lung epithelial cell apoptosis in both cells and animals. Thus, our research provides crucial information with regard to the pathogenesis of P. multocida as well as potential treatment options for this and other respiratory bacterial diseases.

Pasteurella Multocida Infection in Humans

Pasteurella multocida (P. multocida) is an immobile, anaerobic, Gram-negative coccobacillus fermenting bacterium. This pathogen is commonly prevalent in the upper airways of healthy pets, such as cats and dogs, but was also confirmed in domestic cattle, rabbits, pigs, birds, and various wild animals. Infection in humans occurs as a result of biting, scratching, or licking by animals and contact with nasopharyngeal secretions. Inflammation at the site of infection develops within the first day from the injury. It is usually confined to the skin and subcutaneous tissue but, in particular situations, may spread to other organs and manifest as a severe systemic infection. Careful history-taking and microbiological confirmation of the infection enable diagnosis and appropriate treatment. Any wound resulting from an animal bite should be disinfected. The preferred and highly effective treatment against local P. multocida infection is penicillin or its derivatives. The prognosis for P. multocida infections depends on the infected site and the patient's comorbidities.

Bloodstream infection, peritonitis, and pneumonia caused by Pasteurella multocida in a patient with liver cirrhosis despite no animal contact: case report and literature review

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.

Lower Respiratory Infection in Humans Caused by Pasteurella Multocida

BACKGROUND

Pasteurella (P.) multocida commonly occurs in the upper respiratory tract of healthy domestic pets, especially cats and dogs. People become infected by biting, scratching or direct contact with the animal's saliva. Inflammation develops in the wound and limits itself to the skin and subcutaneous tissue. P. multocida may cause respiratory tract infections and severe life-threatening complications. The study aimed to identify the lower respiratory infection in humans caused by P. multocida, to determine the potential source of infection and the associated symptoms, comorbidities and applied treatment.

MATERIALS AND METHODS

Between January 2010 and September 2021, 14,258 patients underwent 16,255 routine flexible video bronchoscopy (FVB), and the same number of bronchoalveolar lavage fluid (BALF) samples for microbiological examination were taken.

RESULTS

Microbiological examinations of the BALF only allowed the identification of six patients with P. multocida infection. All persons reported multiple scratches or bites and licking or kissing by their pets in the past. Productive cough with expectoration of mucopurulent discharge was the predominant symptom.

CONCLUSIONS

A lower respiratory infection caused by P. multocida is not common in humans. It should be considered particularly in elderly patients with underlying diseases and exposure to cats and dogs.

Vascular Endothelial Growth Factor A Contributes to Increased Mammalian Respiratory Epithelial Permeability Induced by Pasteurella multocida Infection

Pasteurella multocida infection can cause significant zoonotic respiratory problems in both humans and animals, but little is known about the mechanisms used by P. multocida to invade and cross the mammalian respiratory barrier. In this study, we investigated the influence of P. multocida infection on the dysfunction of the respiratory epithelial barrier. In vivo tests in mouse infection models demonstrated that P. multocida infection significantly increased epithelial permeability and increased the expression of vascular endothelial growth factor A (VEGFA) and endothelial nitric oxide synthase (eNOS) in murine tracheae and lungs. In murine lung epithelial cell (MLE-12) models, P. multocida infection decreased the expression of tight junctions (ZO-1) and adherens junctions (β-catenin and E-cadherin) proteins but induced the activation of hypoxia-inducible factor 1α (HIF-1α) and VEGFA signaling. When the expression of HIF-1α is suppressed, the induction of VEGFA and ZO-1 expression by P. multocida infection is decreased. We also found that intervention of HIF-1α and VEGFA signaling affected infection outcomes caused by respiratory bacteria in mouse models. Most importantly, we demonstrate that P. multocida infection increases the permeability of human respiratory epithelial cells and that this process is associated with the activation of HIF-1α and VEGFA signaling and likely contributes to the pathogenesis of P. multocida infection in humans. IMPORTANCE The mammalian respiratory epithelium forms the first line of defense against infections with P. multocida, an important zoonotic respiratory pathogen. In this study, we found that P. multocida infection increased respiratory epithelial permeability and promoted the induction of the HIF-1α-VEGFA axis in both mouse and murine cell models. Similar findings were also demonstrated in human respiratory epithelial cells. The results from this study provide important knowledge about the pathogenesis of P. multocida causing infections in both animals and humans.

The microbiota in eosinophilic esophagitis: A systematic review

Eosinophilic esophagitis (EoE) is an atopic disease of the esophagus that has shown a significant increase in incidence and prevalence in the last 20 years. The etiology of EoE is unclear, and few studies explore the esophageal microbiota in EoE. The local microbiome has been implicated in the pathogenesis of several allergic and inflammatory diseases, such as asthma and eczema. In this study, we performed a systematic review to evaluate differences in the microbiota profile of patients with EoE compared with controls. MEDLINE, Embase, Cochrane Library, Scopus, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases were searched to identify studies investigating the microbiota composition in EoE. Three reviewers screened the articles for eligibility and quality. Seven articles underwent full-text review, and a narrative synthesis was undertaken. The microbiota of the mouth and esophagus are correlated. Patients with active EoE present increased esophageal microbial load and increased abundance in particular species, such as Haemophilus and Aggregatibacter. On the other hand, EoE patients present a decrease in Firmicutes. High microbial load and abundance of Haemophilus are observed in EoE patients, but little evidence exists to demonstrate their influence on inflammation and disease. Understanding microbial signatures in EoE might contribute to the development of novel therapeutic strategies.

Pasteurellosis Vaccine Commercialization: Physiochemical Factors for Optimum Production

Pasteurella spp. are Gram-negative facultative bacteria that cause severe economic and animal losses. Pasteurella-based vaccines are the most promising solution for controlling Pasteurella spp. outbreaks. Remarkably, insufficient biomass cultivation (low cell viability and productivity) and lack of knowledge about the cultivation process have impacted the bulk production of animal vaccines. Bioprocess optimization in the shake flask and bioreactor is required to improve process efficiency while lowering production costs. However, its state of the art is limited in providing insights on its biomass upscaling, preventing a cost-effective vaccine with mass-produced bacteria from being developed. In general, in the optimum cultivation of Pasteurella spp., production factors such as pH (6.0–8.2), agitation speed (90–500 rpm), and temperature (35–40 °C) are used to improve production yield. Hence, this review discusses the production strategy of Pasteurella and Mannheimia species that can potentially be used in the vaccines for controlling pasteurellosis. The physicochemical factors related to operational parameter process conditions from a bioprocess engineering perspective that maximize yields with minimized production cost are also covered, with the expectation of facilitating the commercialization process.

Disseminated Pasteurella multocida in a patient with liver cirrhosis and spontaneous bacterial peritonitis - The role of cirrhosis-associated immune dysfunction

Disseminated Pasteurella multocida infection is rare and usually occurs in patients who are immunocompromised. Patients with liver cirrhosis seem to be particularly vulnerable; potentially related to cirrhosis associated immune dysfunction syndrome, frequently present in this population. While many patients report pet cat or dog bites or scratches, some patients develop infection even without obvious exposure, just from being in contact with animals. We present a patient with cellulitis and spontaneous bacterial peritonitis by Pasteurella multocida in whom infection disseminated and the patient developed bacteremia that seeded in the right acromioclavicular joint. We hypothesize that the port of entry for infection in our patient was contact with a pet cat through a chronic open leg wound. The patient was treated with intravenous ceftriaxone 2 g daily for 6 weeks and attained complete recovery.

Cochlear implantation after deafness from Pasteurella multocida meningitis

A woman in her late 40s who works as a veterinary technician represented to the emergency department with increasing headache, confusion, neck stiffness, subjective fevers and distorted hearing 2 days after diagnosis of viral infection at an outside emergency department.Diagnosis of Pasteurella multocida was made from blood cultures and lumbar puncture. Intravenous ceftriaxone was administered for 21 days. By the time of resolution of acute meningitis, she had become completely deaf bilaterally. MRI revealed faint early ossification/possible labyrinthitis ossificans of the basal cochlea, which was confirmed on surgical exploration during the placement of cochlear implants bilaterally 42 days later. We discuss how the atypical features of this infection lead to diagnostic delay and high morbidity, the unique imaging/surgical findings resulting from the infection, and the clinical utility of early and bilateral cochlear implantation in this and similar cases.

Three novel immunogenic proteins determined through 2-Dimensional electrophoresis and mass spectrometry with immune serum confer protection against challenge with porcine Pasteurella multocida in mouse models

Pasteurella multocida is an important zoonotic pathogen that causes multiple diseases in both animals and humans. Test of good immunogenic proteins is beneficial for vaccine development and disease control. In the present study, we determined four novel immunogenic proteins of P. multocida by using 2-DE MALDI-TOF MS with immune serum. These four proteins included a trimethylamine-N-oxide reductase TorA, a translation elongation factor Ts, a phosphoglyceromutase PGAM, and a peroxiredoxin PrX. Among these proteins, TorA, Prx, and PGAM were successfully expressed by using E. coli. Western-blotting assays showed that recombinant TorA, Prx, and/or PGAM displayed good reactions with infectious sera of P. multocida serogroups A, B, D and F. Immunization of either rTorA, rPrx, and/or rPGAM induced significantly high levels of antibodies as well as IFN-γ, IL-4 and IL-10 in mice (P < 0.01). Protective efficacy tests revealed that vaccination of either rTorA, rPrx, and/or rPGAM protected 60% ~ 80% of the tested mice against the challenge with P. multocida field isolate. Our results obtained from the present study suggest that these three proteins could be tested as good vaccine candidates against P. multocida infections.

An Abrasion, a Prosthetic Shoulder, and a Cat with a Licking Tendency: Case Report and Literature Review of P. multocida Joint Seeding

Pasteurella multocida is a pathogen well known for its zoonotic transmission, most commonly by cats and dogs. When bacteremia ensures from an infection, patients with foreign objects present in their bodies, including prosthetic joints and mesh implants, become vulnerable to seeding. There have been multiple documented cases in which P. multocida bacteremia has resulted in infection of both native and prosthetic joints. Furthermore, cases have been documented in which patients with P. multocida bacteremia have developed meningitis and neurological complications. Here, we present a patient with multiple comorbidities including multifactorial immunocompromise, advanced age, and multiple prosthetic joints who developed prosthetic joint infection and spinal osteomyelitis after the development of Pasteurella bacteremia. Aggressive treatment was undertaken given her risk factors, and a combination of antibiotics and surgery was utilized, with the patient making a full recovery.

Intravenous pharmacokinetics of moxifloxacin following simultaneous administration with flunixin meglumine or diclofenac in sheep

In this study, the pharmacokinetics of moxifloxacin (5 mg/kg) was determined following a single intravenous administration of moxifloxacin alone and co-administration with diclofenac (2.5 mg/kg) or flunixin meglumine (2.2 mg/kg) in sheep. Six healthy Akkaraman sheep (2 ± 0.3 years and 53.5 ± 5 kg of body weight) were used. A longitudinal design with a 15-day washout period was used in three periods. In the first period, moxifloxacin was administered by an intravenous (IV) injection. In the second and third periods, moxifloxacin was co-administered with IV administration of diclofenac and flunixin meglumine, respectively. The plasma concentration of moxifloxacin was assayed by high-performance liquid chromatography. The pharmacokinetic parameters were calculated using a two-compartment open pharmacokinetic model. Following IV administration of moxifloxacin alone, the mean elimination half-life (t_1/2β ), total body clearance (Cl_T ), volume of distribution at steady state (V_dss ) and area under the curve (AUC) of moxifloxacin were 2.27 hr, 0.56 L h^-1  kg^-1 , 1.66 L/kg and 8.91 hr*µg/ml, respectively. While diclofenac and flunixin meglumine significantly increased the t_1/2β and AUC of moxifloxacin, they significantly reduced the Cl_T and V_dss . These results suggest that anti-inflammatory drugs could increase the therapeutic efficacy of moxifloxacin by altering its pharmacokinetics.

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

Background

Pasteurella multocida is a gram-negative coccobacillus that is primarily found in oropharynx of dogs, cats and other animals. It causes infections in human beings through contact with animal saliva in the form of licks, bites and scratches of animals colonized by the bacteria. Meningitis due to Pasteurella multocida is rare in immunocompetent individuals. We report a case of meningitis due to Pasteurella multocida in an immunocompetent patient.

Case report

A 30-year-old gentleman presented with 2-day history of fever and neck stiffness. 6 weeks earlier, he was treated as a case of bacterial meningitis. During that hospital stay, he was diagnosed to have bony defect in the sellar floor based on MRI head performed to evaluate for a prolonged history of CSF rhinorrhea. He was discharged and scheduled for an elective endoscopic endonasal/open repair of the skull base defect after resolution of meningitis. CSF findings during current admission also showed features of bacterial meningitis. CSF culture showed Pasteurella multocida sensitive to penicillin, ampicillin and ceftriaxone. Retrospective history revealed patient’s contact with stray cats as he used to feed them but there was no history of licks, bites. He was treated with intravenous ceftriaxone 2 g twice a day for 14 days with complete resolution of his symptoms.

Conclusion

Pasteurella multocida is an important cause of bacterial meningitis in patients with skull defect. Patients with traumatic or non-traumatic bony defect of skull should avoid contact with dogs and cats to prevent the spread of infection the central nervous system.

Pasteurella multocida: Genotypes and Genomics

Pasteurella multocida is a highly versatile pathogen capable of causing infections in a wide range of domestic and wild animals as well as in humans and nonhuman primates. Despite over 135 years of research, the molecular basis for the myriad manifestations of P. multocida pathogenesis and the determinants of P. multocida phylogeny remain poorly defined. The current availability of multiple P. multocida genome sequences now makes it possible to delve into the underlying genetic mechanisms of P. multocida fitness and virulence. Using whole-genome sequences, the genotypes, including the capsular genotypes, lipopolysaccharide (LPS) genotypes, and multilocus sequence types, as well as virulence factor-encoding genes of P. multocida isolates from different clinical presentations can be characterized rapidly and accurately. Putative genetic factors that contribute to virulence, fitness, host specificity, and disease predilection can also be identified through comparative genome analysis of different P. multocida isolates. However, although some knowledge about genotypes, fitness, and pathogenesis has been gained from the recent whole-genome sequencing and comparative analysis studies of P. multocida, there is still a long way to go before we fully understand the pathogenic mechanisms of this important zoonotic pathogen. The quality of several available genome sequences is low, as they are assemblies with relatively low coverage, and genomes of P. multocida isolates from some uncommon host species are still limited or lacking. Here, we review recent advances, as well as continuing knowledge gaps, in our understanding of determinants contributing to virulence, fitness, host specificity, disease predilection, and phylogeny of P. multocida.

Isolation of a T7-Like Lytic Pasteurella Bacteriophage vB_PmuP_PHB01 and Its Potential Use in Therapy against Pasteurella multocida Infections

A lytic bacteriophage PHB01 specific for Pasteurella multocida type D was isolated from the sewage water collected from a pig farm. This phage had the typical morphology of the family Podoviridae, order Caudovirales, presenting an isometric polyhedral head and a short noncontractile tail. PHB01 was able to infect most of the non-toxigenic P. multocida type D strains tested, but not toxigenic type D strains and those belonging to other capsular types. Phage PHB01, the first lytic phage specific for P. multocida type D sequenced thus far, presents a 37,287-bp double-stranded DNA genome with a 223-bp terminal redundancy. The PHB01 genome showed the highest homology with that of PHB02, a lytic phage specific for P. multocida type A. Phylogenetic analysis showed that PHB01 and PHB02 were composed of a genus that was close to the T7-virus genus. In vivo tests using mouse models showed that the administration of PHB01 was safe to the mice and had a good effect on treating the mice infected with different P. multocida type D strains including virulent strain HN05. These findings suggest that PHB01 has a potential use in therapy against infections caused by P. multocida type D.

Influence of amino acids and vitamins on the growth of gdhA derivative Pasteurella multocida B:2 for use as an animal vaccine

Pasteurella multocida serotype B:2 is the causative agent of haemorrhagic septicaemia, a fatal disease in cattle and buffaloes. For use as a vaccine in the treatment of HS disease, an efficient cultivation of attenuated gdhA derivative P. multocida B:2 (mutant) for mass production of viable cells is required. In this study, the role of amino acids and vitamins on the growth of this particular bacterium was investigated. Initially, three basal media (Brain-heart infusion, Terrific broth, and defined medium YDB) were assessed in terms of growth performance of P. multocida B:2. YDB medium was selected and redesigned to take into account the effects of amino acids (glutamic acid, cysteine, glycine, methionine, lysine, tyrosine, and histidine) and vitamins (vitamin B1, nicotinic acid, riboflavin, pyridoxine, pantothenic acid, and biotin). High viable cell number was largely affected by the availability of micronutrient components and macronutrients. Histidine was essential for the growth whereby a traceable amount (20 mM) was found to greatly enhance the growth of gdhA derivative P. multocida B:2 mutant (6.6 × 10⁹ cfu/mL) by about 19 times as compared to control culture (3.5 × 10⁸ cfu/mL). In addition, amongst the vitamins added, riboflavin exhibited the highest impact on the viability of gdhA derivative P. multocida B:2 mutant (5.3 × 10⁹ cfu/mL). Though the combined histidine and riboflavin in the culture eventually did not promote the stacking impact on cell growth and cell viability, nonetheless, they were still essential and important in either growth medium or production medium.