Erythromycin failure with subsequent Pasteurella multocida meningitis and septic arthritis in a cat-bite victim

Pasteurella multocida: from zoonosis to cellular microbiology

In a world where most emerging and reemerging infectious diseases are zoonotic in nature and our contacts with both domestic and wild animals abound, there is growing awareness of the potential for human acquisition of animal diseases. Like other Pasteurellaceae, Pasteurella species are highly prevalent among animal populations, where they are often found as part of the normal microbiota of the oral, nasopharyngeal, and upper respiratory tracts. Many Pasteurella species are opportunistic pathogens that can cause endemic disease and are associated increasingly with epizootic outbreaks. Zoonotic transmission to humans usually occurs through animal bites or contact with nasal secretions, with P. multocida being the most prevalent isolate observed in human infections. Here we review recent comparative genomics and molecular pathogenesis studies that have advanced our understanding of the multiple virulence mechanisms employed by Pasteurella species to establish acute and chronic infections. We also summarize efforts being explored to enhance our ability to rapidly and accurately identify and distinguish among clinical isolates and to control pasteurellosis by improved development of new vaccines and treatment regimens.

Pasteurella multocida infection in a cirrhotic patient: case report, microbiological aspects and a review of literature

Pasteurellosis is a zoonosis often caused by cat or dog bites or scratches, or by direct exposure to their secretions. Pasteurella multocida is the main pathogen involved in infections through domestic animal bites; generally a local infection characterized by its particular virulence with consequent rapid onset. Serious infection has also been reported in persons affected by comorbidity without domestic animal bite injuries. Here we report the case of a woman with lower limb exudating vesicular skin ulcers affected by liver cirrhosis, bilateral knee arthritis, septicemia with positive blood culture and synovial fluid culture for Pasteurella multocida. The etiology of Pasteurella multocida must be borne in mind in cases of sepsis in immunodeficient individuals, such as the cirrhotic patient, as well as exposure to domestic animals.

Hospital management of animal and human bites

The management of bites severe enough to warrant hospital admission is complex. This review includes the epidemiology, clinical management, investigations, microbiology and role of antimicrobials for all types of animal and human bites likely to be encountered in UK hospitals.

Broth microdilution and disk diffusion tests for susceptibility testing of Pasteurella species isolated from human clinical specimens

Broth microdilution and disk diffusion susceptibility testing were performed on 73 strains of Pasteurella species isolated from human infections and on five American Type Culture Collection strains of Pasteurella species. Both methods appear reliable for testing susceptibilities of Pasteurella species.

Management of lacerations in the emergency department

The goals of wound management are simple: avoid infection and achieve a functional and aesthetically pleasing scar. This is achieved by reducing tissue contamination, debriding devitalized tissue, and restoring perfusion in poorly perfused wounds, in conjunction with a well-approximated skin closure.

Pasteurella multocida meningitis: case report and review of the last 11 y

Pasteurella multocida meningitis is a rare clinical occurrence. We report a new case and review the 28 other cases described in the English literature. A history of recent animal contact remains strongly associated with P. multocida meningitis (noted in 89% of all cases), with licking of mucus surfaces or injured skin being most common. Bacteremia was present in 63% of all patients. Spread from an adjacent site of infection continues to be an important factor, with otitis media being documented or strongly suspected in 24% of all cases. The presenting signs and symptoms were characteristic of bacterial meningitis, with fever, headache, nucal rigidity and an altered level of consciousness being present in most patients. Cerebrospinal fluid analysis was typical for bacterial meningitis. Penicillin G or ampicillin was the most common definitive treatment; however, third-generation cephalosporins have been successful. The mean duration of treatment was 14 d. Neurologic complications were present in 17% of patients overall and mortality remains substantial at 25%. Although not statistically significant, there is a trend toward decreased neurologic complications and mortality during the last 11 y.

Comparative in vitro activities of GAR-936 against aerobic and anaerobic animal and human bite wound pathogens

GAR-936 is a new semisynthetic glycylcycline with a broad antibacterial spectrum, including tetracycline-resistant strains. The in vitro activities of GAR-936, minocycline, doxycycline, tetracycline, moxifloxacin, penicillin G, and erythromycin were determined by agar dilution methods against 268 aerobic and 148 anaerobic strains of bacteria (including Pasteurella, Eikenella, Moraxella, Bergeyella, Neisseria, EF-4, Bacteroides, Prevotella, Porphyromonas, Fusobacterium, Staphylococcus, Streptococcus, Enterococcus, Corynebacterium, Propionibacterium, Peptostreptococcus, and Actinomyces) isolated from infected human and animal bite wounds in humans, including strains resistant to commonly used antimicrobials. GAR-936 was very active, with an MIC at which 90% of the strains are inhibited (MIC(90)) of < or =0.25 microg/ml, against all aerobic gram-positive and -negative strains, including tetracycline-resistant strains of Enterococcus, Streptococcus, and coagulase-negative staphylococci, except for Eikenella corrodens (MIC(90), < or =4 microg/ml). GAR-936 was also very active against all anaerobic species, including tetracycline-, doxycycline-, and minocycline-resistant strains of Prevotella spp., Porphyromonas spp., Bacteroides tectum, and Peptostreptococcus spp., with an MIC(90) of < or =0.25 microg/ml. Erythromycin- and moxifloxacin-resistant fusobacteria were susceptible to GAR-936, with an MIC(90) of 0.06 microg/ml.

Comparative in vitro activities of ABT-773 against aerobic and anaerobic pathogens isolated from skin and soft-tissue animal and human bite wound infections

We studied the comparative in vitro activities of ABT-773, a new ketolide, against 268 aerobic and 148 anaerobic recent isolates from clinical bites using an agar dilution method and inocula of 10(4) CFU/spot for aerobes and 10(5) CFU for anaerobes. The following are the MIC ranges and MICs at which 90% of isolates are inhibited (MIC(90)s) of ABT-773 for various isolates, respectively: Pasteurella multocida and Pasteurella septica, 0.125 to 2 and 1 microg/ml; other Pasteurella species, 0.125 to 1 and 0.5 microg/ml; Corynebacterium spp., 0.015 to 0.06 and 0.015 microg/ml; Staphylococcus aureus, 0.03 to 0.06 and 0.06 microg/ml; coagulase-negative staphylococci, 0.015 to >32 and 32 microg/ml; streptococci, 0.015 to 0.03 and 0.03 microg/ml; Eikenella corrodens, 0.25 to 1 and 1 microg/ml; and Bergeyella zoohelcum, 0.03 to 0.25 and 0.06 microg/ml. For anaerobes the MIC ranges and MIC(90)s of ABT-773 were as follows, respectively: Prevotella heparinolytica, 0. 06 to 0.125 and 0.125 microg/ml; Prevotella spp., 0.015 to 0.125 and 0.06 microg/ml; Porphyromonas spp., 0.015 to 0.03 and 0.015 microg/ml; Fusobacterium nucleatum, 0.5 to 8 and 8 microg/ml; other Fusobacterium spp., 0.015 to 8 and 0.5 microg/ml; Bacteroides tectum, 0.015 to 0.5 and 0.06 microg/ml; and Peptostreptococcus spp., 0.015 to 0.25 and 0.03 microg/ml. ABT-773 was more active than all macrolides tested against S. aureus, E. corrodens, and anaerobes, but all compounds were poorly active against F. nucleatum. The activity of ABT-773 was within 1 dilution of that of azithromycin against Pasteurella spp., and ABT-773 was four- to eightfold more active than clarithromycin against Pasteurella spp. ABT-773 may offer a therapeutic alternative for bite wound infections.

Treating mammalian bite wounds

The incidence of dog, cat and human bites has been increasing steadily and represents an important cause of morbidity and mortality in the United States. Approximately half of all Americans will suffer a bite wound during their lifetime, and the annual medical costs of managing these injuries has been estimated to be over $100 million. Possible complications may include disfigurement, dismemberment and infection. Effective management requires rapid medical evaluation and may necessitate surgical intervention and prophylactic antibiotic therapy. As bite wounds are microbiologically diverse and most often polymicrobial in nature, selection of an appropriate antibiotic regimen requires knowledge of common pathogens. Close clinical follow-up is recommended to minimize the risk of late complications.

Activity of gatifloxacin compared to those of five other quinolones versus aerobic and anaerobic isolates from skin and soft tissue samples of human and animal bite wound infections

The activity of gatifloxacin against 308 aerobes and 112 anaerobes isolated from bite wound infections was studied. Gatifloxacin was active at </=0.016 microg/ml against all 148 Pasteurella isolates (eight species and three subspecies) tested and all other aerobes tested, including Actinobacillus-Haemophilus spp., Eikenella corrodens, Neisseria weaveri, Weeksella zoohelcum, staphylococci, and streptococci. Fusobacteria were sometimes resistant. Gatifloxacin MICs at which 90% of the isolates were inhibited were 0. 125 microg/ml against Bacteroides tectum and Prevotella spp., 0.25 microg/ml against Porphyromonas spp., and 0.5 microg/ml against peptostreptococci.

Linezolid activity compared to those of selected macrolides and other agents against aerobic and anaerobic pathogens isolated from soft tissue bite infections in humans

Linezolid was tested against 420 aerobes and anaerobes, including 148 Pasteurella isolates, by an agar dilution method. Linezolid was active against all Pasteurella multocida subsp. multocida and P. multocida subsp. septica isolates and most Pasteurella canis, Pasteurella dagmatis, and Pasteurella stomatis isolates. The MIC was </=2 microg/ml for staphylococci, streptococci, EF-4b, Weeksella zoohelcum, Fusobacterium nucleatum, other fusobacteria, Porphyromonas spp., Prevotella spp., peptostreptococci, and almost all Bacteroides tectum isolates.

Pasteurella multocida meningitis and septic arthritis secondary to a cat bite

Animal bites are seen almost daily in the emergency department, and the majority heal without complication. Pasteurella multocida is frequently the causative organism of localized wound infections and cellulitis in this patient population. P. multocida infection is usually associated with close contact with pets, such as dogs and cats, that harbor this organism as normal oral flora. Meningitis and septic arthritis are very rare sequelae of P. multocida infection. This case report presents a patient with P. multocida bacteremia, meningitis, and septic arthritis developing together as a complication of a cat bite.

Activities of HMR 3004 (RU 64004) and HMR 3647 (RU 66647) compared to those of erythromycin, azithromycin, clarithromycin, roxithromycin, and eight other antimicrobial agents against unusual aerobic and anaerobic human and animal bite pathogens isolated from skin and soft tissue infections in humans

The activities of HMR 3004 and HMR 3647 and comparator agents, especially macrolides, were determined by the agar dilution method against 262 aerobic and 120 anaerobic strains isolated from skin and soft tissue infections associated with human and animal bite wounds. HMR 3004 and HMR 3647 were active against almost all aerobic and fastidious facultative isolates (MIC at which 90% of the isolates are inhibited [MIC90], < or = 0.5 and 1 microg/ml, respectively) and against all anaerobes [Bacteroides tectum, Porphyromonas macacae (salivosa), Prevotella heparinolytica, Porphyromonas sp., Prevotella sp., and peptostreptococci] at < or = 0.25 and < or = 0.5 microg/ml, respectively, except Fusobacterium nucleatum (HMR 3004, MIC90 = 16 microg/ml; HMR 3647, MIC90 = 8 microg/ml) and other Fusobacterium species (MIC90, 1 and 2 microg/ml, respectively). In general, HMR 3004 and HMR 3647 were more active than any of the macrolides tested. Azithromycin was more active than clarithromycin against all Pasteurella species, including Pasteurella multocida subsp. multocida, Eikenella corrodens, and Fusobacterium species, while clarithromycin was more active than azithromycin against Corynebacterium species, Weeksella zoohelcum, B. tectum, and P. heparinolytica.

Animal bites. Guidelines to current management

Several factors need to be considered when evaluating animal bites. These include type of animal involved, specific nature of the wound, circumstances of the attack, interval between injury and treatment, and location of the bite. Of concern are direct destruction of tissue and risk of infection. Use of antibiotic prophylaxis is controversial, but most authorities agree that it is needed for hand wounds, puncture wounds, or "dirty" wounds of any type in any location. The choice of antibiotic is also controversial, but initial empirical treatment generally relies on broad-spectrum coverage. Rabies prophylaxis is indicated for bites by carnivorous wild animals, bats, and unvaccinated domestic animals. Review of the patient's tetanus status is mandatory.