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

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.

Case Report: Septic shock due to Pasteurella multocida in an immunocompetent elderly from a rural area of the Colombian Caribbean

Pasteurella multocida is a germ known to present opportunistic pathologies in most cases associated with contact with animals or their secretions. Systemic infections are rare and tend to occur in patients with risk factors or those who have contact with animals. A case of P. multocida bacteremia is presented in a 76-year-old male patient from a rural area of the Colombian Caribbean who was admitted due to a neurological condition with no personal history and no relevant epidemiological data. His deterioration was torpid, and he died possibly from P. multocida.

Spectrum of human Pasteurella species infections in tropical Australia

BACKGROUND

Acquired zoonotic infections with Pasteurella bacterial species have a wide clinical spectrum of disease from invasive infections to localised bite-wound infections.

METHODS

This study reviewed the spectrum of the demographic, clinical, temporal, and microbiological trends of laboratory confirmed Pasteurella species infections presenting to a single-centre tropical tertiary hospital over a twenty-year period.

RESULTS

195 episodes from 190 patients were included. 51.3% patients were female, and 20.5% Aboriginal or Torres Strait Islander peoples. Crude incidence of Pasteurella spp. infections increased from 1.5 per 100,000 population in 2000, to 11.4 per 100,000 population in 2021. There were 22 (11.3%) bloodstream infections, 22 (11.3%) invasive, 34 (17.4%) deep local, 98 (50.2%) superficial infections, and 19 (9.7%) other or unknown. Adults over 65 years of age accounted for the majority of bacteraemias (63.7%). More severe infections, including bacteraemia, invasive and deep local infections, were more common in lower limb infections and in those with underlying comorbidities. Animal contact with cats was more common in bloodstream infections (36.4%), but dog bites more common in invasive, deep local and superficial infections. 30-day all-cause mortality was low at 1.0%. Pasteurella multocida was most commonly identified (61.1%), but P. canis, P. dagmatis, and other Pasteurella infections were also noted. 67.7% of specimens were polymicrobial, with other significant organisms being Staphylococcus aureus, Streptococcus pyogenes, Group G Streptococcus and Pseudomonas aeruginosa.

CONCLUSION

Pasteurella species remain clinically important pathogens, with the ability to cause severe and invasive infections with associated morbidity. Presentations to hospital are becoming more common, and the polymicrobial nature of bites wounds has implications for empiric antibiotic guidelines.

Infective Endocarditis by Pasteurella Species: A Systematic Review

Pasteurella spp. are non-motile, facultative anaerobic, Gram-negative coccobacilli that are commonly found in the oral cavity and the gastrointestinal tract of some animals and are known to be the cause of infections. Usually, infections by Pasteurella spp. in humans is more common in the context of an animal bite leading to a skin and soft tissue infection (SSTI). Infective endocarditis (IE) is rarely caused by Pasteurella spp.; however, it can pose diagnostic and therapeutic dilemmas due to its rarity. The aim of the present study was to systematically review all cases of IE by Pasteurella spp. in the literature. A systematic review was performed of PubMed, Scopus and the Cochrane Library (through 20 December 2021) for studies providing data on epidemiology and clinical and microbiological characteristics as well as data on treatment and outcomes of IE by Pasteurella spp. A total of 28 studies containing data for 28 patients were included. Prosthetic valve was present in 21.4% of patients. The aorta was the most commonly involved intracardiac site. Fever, sepsis, septic shock and heart failure were the most common clinical presentations. Cephalosporins, aminopenicillins and penicillin were the antimicrobials used most commonly. Overall mortality was 17.9%.

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.

Longer than 2 hours to antibiotics is associated with doubling of mortality in a multinational community-acquired bacterial meningitis cohort

To optimally define the association between time to effective antibiotic therapy and clinical outcomes in adult community-acquired bacterial meningitis. A systematic review of the literature describing the association between time to antibiotics and death or neurological impairment due to adult community-acquired bacterial meningitis was performed. A retrospective cohort, multivariable and propensity-score based analyses were performed using individual patient clinical data from Australian, Danish and United Kingdom studies. Heterogeneity of published observational study designs precluded meta-analysis of aggregate data (I² = 90.1%, 95% CI 71.9–98.3%). Individual patient data on 659 subjects were made available for analysis. Multivariable analysis was performed on 180–362 propensity-score matched data. The risk of death (adjusted odds ratio, aOR) associated with treatment after two hours was 2.29 (95% CI 1.28–4.09) and increased substantially thereafter. Similarly, time to antibiotics of greater than three hours was associated with an increase in the occurrence of neurological impairment (aOR 1.79, 95% CI 1.03–3.14). Among patients with community-acquired bacterial meningitis, odds of mortality increase markedly when antibiotics are given later than two hours after presentation to the hospital.

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.

Pasteurella multocida vertebral osteomyelitis, myositis and epidural abscess in a diabetic cirrhotic patient

Pasteurella multocida is frequently associated with soft tissue infections related to animal bites or scratches. These infections are usually mild but can lead to serious complications especially in high-risk patients. We present a chronic Pasteurella. multocida vertebral osteomyelitis with extensive spondylodiscitis, myositis and epidural abscess in a patient with diabetes and liver cirrhosis. Pasteurella multocida should be suspected in bone and soft tissue infections even if the site of infection is distant to the site of the animal bite, scratch or lick, especially in high-risk patients.

Pasteurella Multocida meningoencephalomyelitis in a dog secondary to severe periodontal disease

Pasteurella multocida can cause meningoencephalomyelitis in canine patients with severe periodontal disease. Fever and neutrophilic pleocytosis in the cerebrospinal fluid are likely, and blood culture and/or empiric antibiotic therapy are indicated.

Pasteurella multocida meningoencephalitis in an immunocompetent adult with multiple cat scratches

We present the case of a 49-year-old woman admitted to our Acute Medical Unit with a 2-day history of fever, vomiting and confusion. The patient was alcohol dependent and had sustained several scratches from her pet cat, which her pet dog had licked. She deteriorated in the Emergency Department-developing high fever, worsening confusion and meningism. Blood cultures were taken and broad spectrum antibiotics commenced prior to CT scanning and diagnostic lumbar puncture. Blood cultures and CSF 16S ribosomal PCR confirmed a diagnosis of Pasteurella multocida bacteraemia and meningoencephalitis. The patient was successfully treated with 14 days of intravenous antibiotics. P multocida is a Gram-negative coccobacillus which frequently colonises the nasopharynx of animals; it is a recognised but very rare cause of meningoencephalitis in immunocompetent adults. This case highlights the need to consider P multocida infection in patients with prior animal contact, regardless of their immune status.

Zoonotic bacterial meningitis in human adults

OBJECTIVE

To describe the epidemiology, etiology, clinical characteristics, treatment, outcome, and prevention of zoonotic bacterial meningitis in human adults.

METHODS

We identified 16 zoonotic bacteria causing meningitis in adults.

RESULTS

Zoonotic bacterial meningitis is uncommon compared to bacterial meningitis caused by human pathogens, and the incidence has a strong regional distribution. Zoonotic bacterial meningitis is mainly associated with animal contact, consumption of animal products, and an immunocompromised state of the patient. In a high proportion of zoonotic bacterial meningitis cases, CSF analysis showed only a mildly elevated leukocyte count. The recommended antibiotic therapy differs per pathogen, and the overall mortality is low.

CONCLUSIONS

Zoonotic bacterial meningitis is uncommon but is associated with specific complications. The suspicion should be raised in patients with bacterial meningitis who have recreational or professional contact with animals and in patients living in regions endemic for specific zoonotic pathogens. An immunocompromised state is associated with a worse prognosis. Identification of risk factors and underlying disease is necessary to improve treatment.

An unusual case of meningitis

Pasteurella multocida is a Gram-negative anaerobe that is known to colonize household pets; in fact, it has been reported to be present in a majority of cats and dogs. P multocida can cause a variety of infections in humans, of which skin infections are the most common. This article describes a case involving a 56-year-old man who developed meningitis caused by P multocida following tympanomastoidectomy. The authors discuss the treatment course and most likely route of infection in this case, and summarize the cases of P multocida-associated meningitis presented in the literature.

Pasteurella multocida is a rare cause of bacterial meningitis. A 56-year-old man with several pets developed a profoundly decreased level of consciousness following left tympanomastoidectomy. Lumbar puncture produced cerebrospinal fluid with the typical findings of meningitis (low glucose, high protein, high leukocytes). Cultures from the cerebrospinal fluid and a swab of the left ear revealed Gram-negative coccobacillus identified as P multocida. The organism was sensitive to ceftriaxone, ampicillin and penicillin, and a 14-day course of intravenous penicillin was used as definitive treatment, resulting in full recovery. Although rare, P multocida should be considered as a potential cause of meningitis in patients with animal exposure, particularly in the setting of recent cranial surgery.

Prolonged incubation period in neonatal Pasteurella multocida meningitis and bacteremia

Pasteurella multocida, often found as part of the human oral flora and in finger/toenails, also exists in many animals, especially cats, dogs, and pigs. Although rare, pasteurella infection in neonates can cause serious systemic disease, such as meningitis. In this article, a 23-day-old girl presented with decreased appetite and irritability for >2 days. Eighteen days previously her pet cat had jumped onto the left side of her head while she was sleeping. On laboratory data C-reactive protein was high, and on cerebrospinal fluid (CSF) analysis leukocyte count was extremely high, with low glucose and high protein. P. multocida grew out of the blood and CSF cultures, and she was successfully treated with antibiotics for 3 weeks. Although pasteurellosis rarely occurs, it can sometimes lead to life-threatening situations, so parents should exercise caution when having pets around their children.

The actions of Pasteurella multocida toxin on neuronal cells

Pasteurella multocida toxin (PMT) activates the G-proteins Gα_i(1-3), Gα_q, Gα_11, Gα₁₂ and Gα₁₃ by deamidation of specific glutamine residues. A number of these alpha subunits have signalling roles in neurones. Hence we studied the action of this toxin on rat superior cervical ganglion (SCG) neurones and NG108-15 neuronal cells. Both Gα_q and Gα₁₁ could be identified in SCGs with immunocytochemistry. PMT had no direct action on Kv7 or Cav2 channels in SCGs. However PMT treatment enhanced muscarinic receptor mediated inhibition of M-current (Kv7.2 + 7. 3) as measured by a 19-fold leftward shift in the oxotremorine-M concentration–inhibition curve. Agonists of other receptors, such as bradykinin or angiotensin, that inhibit M-current did not produce this effect. However the amount of PIP₂ hydrolysis could be enhanced by PMT for all three agonists. In a transduction system in SCGs that is unlikely to be affected by PMT, Go mediated inhibition of calcium current, PMT was ineffective whereas the response was blocked by pertussis toxin as expected.

M1 muscarinic receptor evoked calcium mobilisation in transformed NG108-15 cells was enhanced by PMT. The calcium rises evoked by uridine triphosphate acting on endogenous P2Y₂ receptors in NG108-15 cells were enhanced by PMT. The time and concentration dependence of the PMT effect was different for the resting calcium compared to the calcium rise produced by activation of P2Y₂ receptors. PMT's action on these neuronal cells would suggest that if it got into the brain, symptoms of a hyperexcitable nature would be seen, such as seizures.

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Pasteurella multocida toxin (PMT) activates a range of G-protein alpha subunits.

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PMT increased muscarinic receptor mediated suppression of Kv7 potassium current in sympathetic neurones.

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PMT enhances both muscarinic and purinergic receptor mediated calcium mobilisation in NG108-15 cells.

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Both these events are mediated by the G-proteins Gq or G11.

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We would predict that the symptoms of central nervous system PMT toxicity would be hyperexcitable events such as seizures.

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.

Successful treatment of Pasteurella multocida meningitis with aztreonam

This is the first reported case of the successful treatment of Pasteurella multocida meningitis with aztreonam in a patient with multiple antibiotic allergies.

Diabetes in patients with pasteurellosis

From 1991 to 2003, 20 patients with pasteurellosis were admitted to our unit, of whom 2 died. They presented with cellulitis (n = 14), arthritis (n = 6), pneumonia (n = 3), subcutaneous abscess (n = 3), bursitis (n = 2), meningitis, otitis, sinusitis and uveitis. Underlying diseases included diabetes (n = 6) and malignancy (n = 5). Diabetes could be a predisposing condition for pasteurellosis.

Successful treatment of Pasteurella multocida meningitis with aztreonam

This is the first reported case of the successful treatment of Pasteurella multocida meningitis with aztreonam in a patient with multiple antibiotic allergies.

Meningitis and subgaleal, subdural, epidural empyema due to Pasteurella multocida

Pasteurella is a Gram-negative coccobacillus found in 70-90% of oral cavities of cats, and as well, is isolated from the digestive systems of dogs, rats, rabbits, monkeys, and other animals. Pasteurella multocida has been known to cause infections in humans, the most familiar being soft tissue infection after animal bites. However, this organism may affect a variety of systems, causing serious disease. Pasteurella multocida can cause septic arthritis, osteomyelitis, pneumonia, endocarditis, meningitis, and septicemia. We report a case of bacterial meningitis, subgaleal, subdural, and epidural empyema due to Pasteurella multocida by a rabbit licking that resulted in neurological complications and a prolonged recovery period.

[Pasteurella multocida meningitis following neurosurgery]

Pasteurella multocida is a rare cause of meningitis. We report a case of P. multocida meningitis following a recent neurosurgery procedure and review the 32 cases previously described.

Rapid and accurate identification of human isolates of Pasteurella and related species by sequencing the sodA gene

The identification of Pasteurella and related bacteria remains a challenge. Here, a 449- to 473-bp fragment (sodA(int)) internal to the sodA gene, encoding the manganese-dependent superoxide dismutase, was amplified and sequenced with a single pair of degenerate primers from the type strains of Pasteurella (18 strains), Gallibacterium (1 strain), and Mannheimia (5 strains) species. The sodA(int)-based phylogenetic tree was in general agreement with that inferred from the analysis of the corresponding 16S rRNA gene sequences, with members of the Pasteurella sensu stricto cluster (Pasteurella multocida, Pasteurella canis, Pasteurella dagmatis, and Pasteurella stomatis) forming a monophyletic group and Gallibacterium and Mannheimia being independent monophyletic genera. However, the sodA(int) sequences showed a markedly higher divergence than the corresponding 16S rRNA genes, confirming that sodA is a potent target to differentiate related species. Thirty-three independent human clinical isolates phenotypically assigned to 13 Pasteurella species by a reference laboratory were successfully identified by comparing their sodA(int) sequences to those of the type species. In the course of this work, we identified the first Gallibacterium anatis isolate ever reported from a human clinical specimen. The sodA(int) sequences of the clinical isolates displayed less than 2.5% divergence from those of the corresponding type strains, except for the Pasteurella pneumotropica isolates, which were closely related to each other (> 98% sodA(int) sequence identity) but shared only 92% sodA(int) identity with the type strain. The method described here provides a rapid and accurate tool for species identification of Pasteurella isolates when access to a sequencing facility is available.

[Pasteurella multocida meningo-encephalitis with aphasia in a young adult]

We report the first case of Pasteurella multocida meningo-encephalitis with aphasia in a 28 year-old-patient. The investigations confirmed the diagnosis of bacterial meningitis. But the delay in identification of the organism involved iterative changes of antibiotherapy. The evolution was finally favourable with appropriate antibiotic treatment. The epidemiologic investigation highlighted the responsibility of a patient's cat carrying the same bacterial strain. Finally we discuss the epidemiologic, clinical and therapeutic features of this unusual meningitis.

Pasteurella multocida meningitis: case report and review of the literature

Pasteurella multocida forms part of the normal flora in the nasopharynx of many domestic and wild animals. Most human P. multocida infections are soft tissue infections due to animal bites. P. multocida meningitis is a rare condition. We report a case of P. multocida meningitis with a complicated outcome and review the literature of this condition.

Sialic Acid metabolism and systemic pasteurellosis

Pasteurella multocida subsp. multocida is a commensal and opportunistic pathogen of food animals, wildlife, and pets and a zoonotic cause of human infection arising from contacts with these animals. Here, an investigation of multiple serotype A strains demonstrated the occurrence of membrane sialyltransferase. Although P. multocida lacks the genes for the two earliest steps in de novo sialic acid synthesis, adding sialic acid to the growth medium resulted in uptake, activation, and subsequent transfer of sialic acid to a membrane acceptor resembling lipooligosaccharide. Two candidate-activating enzymes with homology to Escherichia coli cytidine 5'-monophospho-N-acetylneuraminate synthetase were overproduced as histidine-tagged polypeptides. The synthetase encoded by pm0187 was at least 37 times more active than the pm1710 gene product, suggesting pm0187 encodes the primary sialic acid cytidylyltransferase in P. multocida. A sialate aldolase (pm1715) mutant unable to initiate dissimilation of internalized sialic acid was not attenuated in the CD-1 mouse model of systemic pasteurellosis, indicating that the nutritional function of sialate catabolism is not required for systemic disease. In contrast, the attenuation of a sialate uptake-deficient mutant supports the essential role in pathogenesis of a sialylation mechanism that is dependent on an environmental (host) supply of sialic acid. The combined results provide the first direct evidence of sialylation by a precursor scavenging mechanism in pasteurellae and of a potential tripartite ATP-independent periplasmic sialate transporter in any species.

Pasteurella multocida meningitis and cervical spine osteomyelitis in a neonate

A 20-day-old male infant presented with fever, decreased alertness and quadriparesis as a result of Pasteurella multocida meningitis and C1-2 vertebral osteomyelitis. Although his household contained 2 pet cats, there was no history of bites, scratches or licks. We speculate that colonization of the nasopharynx was followed by contiguous spread to the retropharyngeal soft tissue, cervical vertebrae and meninges.

Acute disseminated encephalomyelitis associated with Pasteurella multocida meningitis

OBJECTIVE

To describe a case of Pasteurella multocida meningitis associated with acute disseminated encephalomyelitis (ADEM).

CASE REPORT

A 33-year-old woman employed in a dog pound presented herself to hospital with fever and meningismus and was found to have culture positive Pasteurella multocida meningitis. Despite appropriate antibiotic treatment her clinical course was characterized by a persistent fever and worsening encephalopathy, which prompted further neurological investigation. Spinal fluid exam and serial MRI scans as well as her one-year clinical course were found to be compatible with ADEM.

CONCLUSION

Persistent fever and worsening encephalopathy in meningitis may indicate a para-infectious immune process such as ADEM, and may serve as indications for further neurological investigation.

Bacteriemia por Pasteurella spp.: una entidad infrecuente durante los últimos 8 años en nuestro centro

OBJECTIVES

To review and update the epidemic and clinical knowledge concerning disseminated blood disease caused by Pasteurella species in our area.

METHODS

Retrospective study of Pasteurella species bacteremia (PSB) episodes occurring in patients attended from January 1994 to December 2001 in a single tertiary hospital.

RESULTS

Among the 31 clinical samples remitted to the Microbiology Laboratory in which a species of Pasteurella was identified, 5 (16%) corresponded to positive blood cultures in 5 patients. Pasteurella multocida was the predominant species, identified in 70% of all isolations and all but one positive blood culture. All the patients were adults over 50 years old and all had underlying illnesses causing comorbidity or some degree of immunocompromise, with cardiovascular and hypertensive conditions being the most frequent; only one patient had liver cirrhosis. In all cases, except one, contact or coexistence with dogs or cats was documented. The clinical presentation of PSB was non-specific and only two episodes were related with a possible focal, soft-tissue origin. There were no serious complications, such as septic shock, organ failure or invasive disease (meningitis or endocarditis). All patients cured with antimicrobial treatment, although surgical debridement of infected bite wounds was required in two cases. The betalactams and other families of antibiotics showed excellent in vitro activity against the five strains of Pasteurella isolated.

CONCLUSIONS

PSB occurred in adult patients having a wide range of underlying illnesses and comorbidity factors. Most of them had contact with pets, though traumatic lesions were not present in all cases. Clinical presentation did not differ from other types of severe sepsis. Susceptibility and outcome of primary treatment with penicillins and other betalactams shows that they are still appropriate therapy. More emphasis should be placed on preventive measures related to care and hygiene among individuals with pets.