Pasteurella multocida Bacteremia in a Patient With Ovarian Cancer and Chemotherapy-induced Neutropenia

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.

Pasteurella bacteraemia: Impact of comorbidities on outcome, based on a case series and literature review

OBJECTIVES

Pasteurella bacteraemia is rare, but has been associated with a high mortality rate. The aim of this study was to estimate the impact of comorbidities on patients with Pasteurella bacteraemia.

METHODS

All cases of Pasteurella bacteraemia in adults treated in our centre between January 2008 and December 2017 were included retrospectively and compared with cases identified in a systematic review of the literature via MEDLINE covering the years 1951-2017. The epidemiological, bacteriological, and clinical data were collected, as well as the instances of death after 30 days.

RESULTS

Twenty cases of Pasteurella bacteraemia identified in our centre and 99 cases from the literature review were included. A major comorbidity was found in 80/119 (67.2%) patients. The death rate at 30 days was 31.1%. The most common comorbidities were cirrhosis, immunosuppressive therapy, and malignant diseases. Age was not associated with mortality. On multivariate analysis, the only factor associated with mortality was a major comorbidity (odds ratio 2.78, 95% confidence interval 1.01-7.70; p = 0.04).

CONCLUSIONS

This study confirms the high mortality rate and highlights the importance of the host background, independent of age, in Pasteurella bacteraemia. Clinicians should be aware of the comorbidities in cases of Pasteurella infection, due to the poor prognosis of bacteraemia.

Pasteurella multocida infections in cancer patients

Background: Pasteurella multocida is a small, gram-negative coccobacillus, which most commonly causes soft tissue infections due to animal bites or scratches, mainly from cats and dogs. Immunocompromised hosts, such as cancer patients, are more likely to develop systemic complications as a result of P. multocida infections. Objective: Retrospectively analyze the medical records of four afflicted patients being managed at Moffitt Cancer Center, Tampa, USA between 1999 and 2009, and careful study for additional 32 cases of P. multocida infection among cancer patients with variegated histology found in the current medical literature. Methods: Of 36 subjects, 67% of the patients had been diagnosed with a solid organ cancer, whereas 33% had a hematologic malignancy. Clinical scenarios described fever as the most frequent initial presentation and bacteremia as the most prevalent mode of infection. Results: Forty-seven percent of the patients had experienced some sort of animal contact and 41% showed evidence of skin or soft tissue infection. The status of the white blood cell count, was available in 22 patients (of 36 patients), and 27% demonstrated neutropenia. The survival percentage of the patients with known clinical outcome was 77%. Conclusion: Medical management mostly involved antibiosis with beta-lactams. Atypical scenario of Pasteurella multocida infection may involve bites or scratches (specifically from cats or dogs) in a cancer patient presenting with sepsis and accompanied by skin or soft tissue or respiratory tract infection. A high level of suspicion for P. multocida as a possible pathogen in cancer patients would facilitate an amelioration in morbidity ameliorating, and timely initiation of specific antibiotics.

[A case of cat-scratch-induced Pasteurella multocida infection presenting with disseminated intravascular coagulation and acute renal failure]

Domestic animals are the main reservoirs of Pasteurella species for human zoonosis due to bites and scratches. Pasterurella multocida may cause serious soft-tissue infection and, less commonly, sepsis or septic shock, particularly in insufficient initial therapy and an immunocompromised host. We report a case of cat-scratch-induced P. multocida infection, presenting with disseminated intravascular coagulation and acute renal failure. A febrile 83-year-old woman with consciousness disturbance and a subcutaneous left-foot abscess due to a scratch from a pet cat. She was successfully treated with antibiotic piperacillin and clindamycin therapy and aggressive wound drainage.