Septic Arthritis and Osteomyelitis Caused by Pasteurella multocida

This report presents a case of progressive septic arthritis and osteomyelitis caused by a rare pathogen, Pasteurella multocida, thought to be provoked by the use of systemic corticosteroids. Despite initial improvement after antibiotics and surgical procedure, the patient returned with new, associated symptoms 1 month later. This concurrent set of circumstances leading to a life-threatening condition has not been reported, to the best of our knowledge. Physicians aware of such a case will be better prepared to diagnose, treat, and educate their patients. Additionally, the diagnostic challenge presented by this case report emphasizes the need for vigilance and thoroughness in obtaining histories from patients presenting with seemingly benign complaints, especially in vulnerable populations, such as infants, pregnant women, and immunocompromised adults.

Psoas abscess due to Pasteurella multocida

Psoas abscess is a pus collection within the muscle compartment. It is a very uncommon entity. It can be primary as a result of haematogenous spread or secondary as a consequence of a direct extension of an infectious focus. Diagnosis is usually delayed because nonspecific clinical presentation. Staphylococcus aureus is the most common organism cultured in this type of abscess. We describe a secondary psoas abscess in an elderly female patient. The patient presented with fever, right groin pain and malaise. Following laboratory, radiological and microbiological analyses the patient was diagnosed as having a psoas abscess due to Pasteurella multocida, which is a Gram negative bacteria, part of the normal oral flora of many animals and can causes human infections after animal scratches or bites. More rarely is to find this organism causing psoas abscesses. Because of insidious clinical presentation, the diagnosis of psoas abscess is a challenge and a high index of suspicion is required. We emphasize the importance of bacteriological confirmation of microorganism involved to choose the correct antibiotics. Percutaneous drainage is the treatment of choice. Open surgical drainage should be reserved if percutaneous drainage fails.

Necrotizing fasciitis complicated by fatal multiple organ dysfunction due to Pasteurella multocida infection: a case report

Necrotizing fasciitis is rarely caused by Pasteurella multocida, a facultative anaerobic gram-negative coccobacillus found in the flora of the oro-gastrointestinal tract of many animals. We describe a rare case with overwhelming septicaemia resulting in multiple organ failure.

Pasteurella multocida infection of a total knee arthroplasty after a "dog lick"

The patient we report here underwent a total knee arthroplasty (TKA) which got infected with P. multocida after her dog had licked a small wound at the third toe of the same foot. Despite a correct treatment comprising synovectomy and cleansing, and an active antibiotic treatment for 3 months, the patient was readmitted for persistent infection of the same knee 2 weeks after the end of the antibiotic treatment. Sampling during surgery allowed for the growth of a P. multocida isolate proven by a molecular method to be identical to the previously isolated strain. This recurrent P. multocida infection was treated by a two-step change of the TKA comprising a 2-month period of antibiotic treatment between the two surgical interventions.

Pasteurella multocida bacteremia and tuboovarian abscess

BACKGROUND

Tuboovarian abscess is commonly associated with sexually transmitted pathogens. We report a tuboovarian abscess caused by a rare pathogen, Pasteurella multocida, which was managed conservatively.

CASE

A 50-year-old sexually inactive woman presented with suprapubic pain and fever. Cat scratches were seen on her hand. Ultrasonography showed a 7.9-cm complex cystic adnexal structure. Her fever persisted despite broad-spectrum parenteral antibiotics. After placement of a transvaginal drain, the patient defervesced, and her pain improved. Both blood cultures and cyst aspirates grew Pasteurella multocida.

CONCLUSION

Tuboovarian abscess secondary to rare pathogens must be considered in the differential diagnosis of acute febrile pelvic illness in a non-sexually active woman. Minimally invasive drainage procedures may avoid surgery in patients failing initial antibiotic therapy.

[Subacute bacterial endocarditis due to Pasteurella pneumotropica. Case Report]

Endocarditis due to Pasteurella pneumotropica are very rarely described. We report a new case of bacterial endocarditis in a 43 years-old patient with mitral stenosis. The patient was admitted to the hospital for lethargy, malaise and hemiparesis. On physical examination, a new systolic murmur was found. Transthoracic echocardiography revealed a vegetation on the mitral valve. Three blood culture sets were drawn and after 24 hours of incubation, the last two sets yielded Pasteurella pneumotropica and cell wall deficient forms (L-forms). The patient was successfully treated with gentamicin and ceftriaxone and underwent mitral valve replacement.

[Pasteurella multocida infections--10 years' experience]

Dog and cat bites are commonly seen at emergency rooms, but have been inadequately characterized. This study attempted to characterize the clinical features of 10 patients from whom P. multocida was cultured. During the past 10 years, 108 patients have been hospitalized for pet bites, at a rate of 3.4/10,000 hospitalizations. Five patients had a documented exposure to cats, 3 to dogs, and two had an unknown exposure. The mean age was 50.8 years (+/- 20.5) and 80% were men. An average delay of 5.7 days was noted from exposure to hospitalization, and additional 4.4 days until P. multocida was characterized. P. multocida was cultured from wounds in six patients, and three patients had bacteremia; another patient had septic arthritis. Six patients needed debridement and the average hospital stay was 11.7 days (3 times our hospital's average). Animal bites may take a complicated course. Our findings call for reassessment of the need for prophylaxis in animal bites.

Pasteurella multocida tenosynovitis of the hand: sonographic findings

Pasteurella multocida is a common cause of infection in humans subsequent to bites or scratches by dogs and, particularly, cats. This infection usually results in superficial skin and soft tissue infections. Sonography can be used for diagnosing inflammatory conditions affecting tendons, including acute and chronic tenosynovitis. P. multocida tenosynovitis is rare, and the diagnosis can be missed if adequate tests are not performed. We report 2 cases of P. multocida tenosynovitis of the hand and wrist in which sonography played a valuable role in assessing the affected tissues and guiding fine-needle aspiration of fluid accumulations in the involved tendon sheaths. The diagnosis was confirmed microbiologically in each case.

Pasteurella canis osteomyelitis and cutaneous abscess after a domestic dog bite

The genus Pasteurella is part of the normal oral flora of many animals, including domestic cats and dogs. In humans, Pasteurella may cause complications ranging from cellulitis to septicemia but rarely causes osteomyelitis or septic arthritis after bites and/or scratches by cats and dogs. Although Pasteurella multocida is a common cause of infection, other Pasteurella species have also been cultured from wounds in humans. We describe here, a case of a cutaneous abscess and acute osteomyelitis associated with P canis after a domestic dog bite. To our knowledge, no previous case of P canis has been reported as the cause of acute osteomyelitis in humans.

Pericardial tamponade caused by Pasteurella multocida infection after a cat bite

An unusual case of meningitis and pericardial tamponade caused by Pasteurella multocida after a cat bite is reported. The patient was successfully treated by antibiotics and pericardiocentesis and made an uneventful recovery from a life threatening condition. This case illustrates the potential dangers that can arise from a seemingly trivial and commonplace injury.

Reduction of mortality in specific-pathogen-free layer chickens by a caprine serum fraction after infection with Pasteurella multocida

Caprine serum was fractionated by size, and its proteinaceous material <8,000 Da [caprine serum fraction immunomodulator 2 (CSF-I2)] was evaluated for its ability to impart immunoresistance to specific-pathogen-free (SPF) layer chickens. The SPF layers were challenged with 18 to 30 cfu of Pasteurella multocida X-73 (serotype 1) at 5 wk of age. A high degree of mortality was apparent 24 and 48 h later (62+/-14% and 88+/-7%, respectively). Mortality observed after 48 h was minimal. Noting the rapid onset of mortality, we administered CSF-I2 (material that expressed no direct antimicrobial activity but was believed to be an immunostimulant) 1 d before challenge and coincident to time of challenge. The group of birds that received CSF-I2 (either 5 or 10 mg per administration) expressed significant reduction in mortality throughout the 1-wk study period. Reduction in mortality appeared to be dose dependent. Birds that received two administrations of 10 mg CSF-I2 had significantly fewer deaths than did the group of birds that received half that amount. No deaths were recorded through 24 h, whereas, at 48 h, the percentage mortality was 13 in CSF-I2-treated birds. This study demonstrates that one or more small molecular weight compounds isolated from caprine serum were able to reduce mortality in SPF layers infected with Pasteurella multocida.

Bacteriological warfare amongst cats: what have we learned about cat bite infections?

Cat bite infections are one of the most common infectious diseases presenting to veterinary practices and to emergency rooms at human hospitals. This review describes the disease in humans and cats, the origin of organisms involved in cat bite abscesses and the importance of selected organisms such as members of the genus Porphyromonas in the disease. It also discusses future directions, the importance of identifying significant organisms and why an understanding of antimicrobial susceptibility patterns is of consequence to the outcome of the disease in humans and cats.

Granulomatous hepatitis in pasteurella multocida infection

Numerous diseases can lead to multilocular lesions of the liver. The authors report a rare pediatric case of hepatic granulomas due to Pasteurella multocida: a 7-year-old girl with chronic fever was investigated by sonography and CT scan, demonstrating mesenteric lymph node enlargement and numerous small hepatic lesions. After surgical biopsy, histopathology of the liver specimens showed pyogenic granuloma, with serologic testing positive for Pasteurella multocida. Treatment with a tetracycline and corticosteroids was successful. Pasteurella multocida infection, despite its habitual benign course, should be suspected among differential diagnoses of lymphogranulomatous affections with hepatic involvement. No case of liver and lymph node foci in a child has been previously described.

Animal bites and Pasturella infections

Although bite wounds are common injuries in the pediatric population, most are minor. Dog bites are the most common animal bite wound. Children are more likely to have head and face injuries and share a disproportionate number of fatal wound injuries. Cat bites have a twofold higher risk of infection than dog wounds, with the most frequent and important pathogen being P multocida. Both cat and dog bite wounds are associated with a wide range of aerobic and anaerobic pathogens. Principles of wound management include copious irrigation, cautious debridement, appropriate antibiotics, elevation, and immobilization. The patient should have follow-up contact and usually a visit within 24 to 48 hours after the initiation of therapy.

Enhancement of respiratory immunity to Pasteurella multocida by cholera toxin in rabbits

Cholera toxin (CT) is a potent adjuvant for the mucosal immune system. The purpose of this study was to determine if coadministration of CT with a potassium thiocyanate extract of Pasteurella multocida (PTE) leads to enhanced anti-PTE antibody activity and increased protection of rabbits against infection with P. multocida and associated disease. Groups of rabbits were immunized intranasally on days 0, 7, and 14, with phosphate buffered saline (PBS), 200 micrograms of CT, 1.0 mg of PTE, or 1.0 mg PTE with 200 micrograms CT. Nasal lavage and serum samples were collected over 28 days after initial immunization and evaluated by ELISA for specific antibody directed against PTE. Marked increases in serum (IgG) and nasal lavage (IgA) anti-PTE antibody activity were found beginning after day 14 in rabbits immunized with PTE. Rabbits immunized with PTE and CT demonstrated further increases in this activity. Tracheobronchial lavage samples collected at the time of necropsy demonstrated a significant level of anti-PTE IgA activity in animals immunized with PTE, and coadministration with CT stimulated a further significant increase in this activity. Groups of similarly immunized rabbits were challenged 16 days after initial immunization with 5 x 10(7) CFUs of P. multocida. Nasal lavage samples were cultured for P. multocida over the next 10 days. Rabbits were euthanized within 10 days after challenge, tissues cultured for P. multocida, and histopathologic lesion severity graded using a numeric scale. Rabbits immunized with PTE survived longer, had less severe lesions of the lungs, pleura, and liver, and fewer P. multocida CFUs cultured from samples than PBS or CT controls. Coadministration of CT led to further reductions in lesion severity of those tissues and numbers of P. multocida CFUs cultured from samples. Increased nasal turbinate atrophy of rabbits immunized with PTE with or without CT was associated with increased mean survival time. In summary, coadministration of CT with PTE enhanced protective immunity to P. multocida disease and infection in rabbits.

Pasteurella aerogenes isolated from ulcers or wounds in humans with occupational exposure to pigs: a report of 7 Danish cases

Pasteurella aerogenes is rarely isolated from human specimens. The species is found in the digestive tract of pigs. From 1976 to 1994 7 strains were cultured in Denmark from wounds or ulcers. Five patients were bitten by pigs and 2 patients with ulcers were employed in pig farming. A mixture of bacterial species was often found. All 7 strains of P. aerogenes were susceptible to ampicillin, cephalosporins and ciprofloxacin. Ability to hydrolyse urea, to produce oxidase and catalase, to decarboxylate ornithine and to produce gas from glucose and inability to produce indole was characteristic for P. aerogenes. Most bite wounds were located on the lower lateral part of the thigh. Foul smelling pus and abscess formation was the rule. Incision, drainage and antibiotic treatment were usually necessary.

[Treatment of orbital abscesses and phlegmon in dogs and cats]

A diagnosis of orbital cellulitis or abscess was made in 13 dogs and four cats over the past five years. A foreign body was found in three of these cases. In five cases pasteurella spp. was isolated. In 15 of these cases the abscess was drained surgically. One dog was permanently blind due to inadequate surgical drainage of the abscess. In the remaining cases healing was uneventful. The surgical and medical therapy of orbital abscesses is illustrated by an exemplary case.

Pasteurella multocida isolation from a tuboovarian abscess. A case report

BACKGROUND

Human infection with Pasteurella multocida occurs most commonly following a nonhuman animal bite wound or cat scratch, with local skin and soft tissue infections the most frequent posttraumatic manifestations. Genitourinary tract pathology attributable to this organism occurs infrequently, with only one previous reported case of P multocida infection presenting in the form of a tuboovarian abscess.

CASE

A 44-year-old woman with an acute abdomen underwent exploratory laparotomy, revealing a right-sided tuboovarian abscess. Following a total abdominal hysterectomy and bilateral salpingo-oophorectomy with a seven-day postoperative course of intravenous metronidazole, ampicillin and gentamicin, the patient was sent home on a regimen of cephradine, only to return with sepsis three days later. A course of intravenous aqueous penicillin sodium, metronidazole and cefotaxime was administered for the treatment of P multocida sepsis since this organism was identified in the intraoperative pelvic fluid culture 24 hours after the patient's initial discharge. After 13 days of the above regimen, the patient achieved full defervescence and was discharged on hospital day 15.

CONCLUSION

In the setting of a tuboovarian abscess, the clinician should consider P multocida as a potential etiologic agent, especially in a patient with extensive exposure to nonhuman animals. In the treatment of an acute adnexal infection secondary to this organism, one should employ perioperative therapy with the appropriate antibiotics for a duration of at least 14 days.

Pasteurella multocida infection of a total hip arthroplasty. A case report

The authors report a case history of a diabetic woman requiring revision hip arthroplasty of a Charnley total hip prosthesis that was infected with Pasteurella multocida. The infection of the loose prosthesis followed a cat bite to the same leg. Advice is given on the management of patients with infection following animal inoculations, and the subject of increased risk with a loose prosthesis is discussed.

Pasteurella infection in a total knee arthroplasty

Hematogenous infection of a total joint arthroplasty is a serious complication that has well-known etiologies. One of the most unusual inciting events is a bite wound. Pasteurella multocida is an anaerobic organism found in the mouths of mammals that has rarely been found to infect total knee arthroplasties. Prompt recognition of such an infection and prophylactic treatment with a penicillinase-resistant penicillin should maximize the patient's opportunity to eradicate such an infection.

Pasteurella multocida empyema: successful treatment with open thoracostomy

Pasteurella multocida appears to be an uncommon pathogen in human thoracic empyema. The morbidity and mortality associated with these infections has been significant, presumably secondary to the elderly populations they affect, many with chronic lung disease and impaired pulmonary defenses. We report a case of pasteurella empyema treated with open thoracostomy and rib resection and advocate use of such a procedure early in the treatment of patients with this infection.

The effect of venous blood stream cooling on survival of bacterially infected rabbits

The effect of physical cooling on the mortality rate of rabbits infected with Pasteurella multocida was investigated. Rabbits were cooled for 48 hours after bacterial injection by passing cold fluid through small hollow metal cuffs which had been surgically implanted around the abdominal vena cavae of rabbits. The average body temperatures of the rabbits during the 24-hour period after the intravenous injection of live Pasteurella multocida was 40.92 +/- 0.20 degrees C in control rabbits and 38.98 +/- 0.71 degrees C in cooled rabbits. 90% of physically cooled rabbits survived compared with 46% of control rabbits 48 hours after bacterial injection, suggesting that thermoregulatory effector mechanisms involved in cold defense may enhance survival.

Use of recombinant bovine alpha 1 interferon in reducing respiratory disease induced by bovine herpesvirus type 1

Intranasal or intramuscular treatment of calves with recombinant bovine alpha 1 interferon before challenge with bovine herpesvirus type 1 and Pasteurella haemolytica reduced clinical signs, number of sick days, lung lesions, and weight loss. The effective dose was determined to be relatively broad within the range of 1 to 50 mg per animal. No adverse effects were observed even at high doses of interferon (50 mg per animal). Administration before virus infection was more effective than administration at the same time as virus infection. Although interferon administration had dramatic effects on the survival of animals, it did not have much effect on virus secretion in the upper respiratory tract. Therefore, the mechanism by which interferon reduces the susceptibility of animals to viral-bacterial synergy was postulated to be via its immunomodulatory effects.

Osteomyelitis of the heel with Pasteurella pneumotropica: a case report

A rare case of Pasteurella pneumotropica occurring in a polymicrobial anaerobic osteomyelitis of the heel is presented. The natural history, predisposing conditions, treatment, and postoperative care are presented. Surgical excision of the infected portion of the calcaneus, appropriate antibiotics, and lift with proper supporting heel cup all aided in returning the patient to her normal daily activities.

Pasteurella infections of the head and neck

Infections caused by Pasteurella occur most frequently after domestic animal bites or scratches and in individuals with agricultural or veterinary contact with animals. A serious Pasteurella infection developed in an agricultural worker following tumor extirpation of a head and neck neoplasm. Review of Pasteurella infections in humans disclosed that 31 of 446 reported infections involved head and neck structures. The most serious of these involved the adjacent central nervous system. Surgical drainage combined with parenteral penicillin remains the treatment of choice in these infections. Aminoglycosides are not effective in treating this organism.

Effect of bovine alpha 1 interferon on bovine herpesvirus type 1-induced respiratory disease

Treatment of calves with bovine recombinant alpha 1 interferon prior to challenge with bovine herpesvirus type 1 increased the animals' ability to withstand a subsequent Pasteurella haemolytica challenge. The reduction in viral-bacterial synergy observed following interferon treatment did not appear to be due to a direct effect of the interferon on virus replication in the upper respiratory tract. Thus, even though interferon-treated animals shed slightly less virus from their nasal passages than did untreated animals, this reduction was not statistically significant. Furthermore, there was no difference in the level of intranasal interferon secreted by control or interferon-treated animals. These results suggest that interferon treatment does not affect the production of endogenous interferon. In contrast, a significant difference was observed between the number of days that control animals were sick, the levels of serum fibrinogen and the functional activity of polymorphonuclear neutrophilic granulocytes obtained from infected calves. These results suggest that bovine recombinant alpha 1 interferon may have a greater immunomodulatory effect than a direct antiviral effect in this model. This is further supported by the observation that bovine herpesvirus type 1 is relatively resistant to the direct antiviral effect of bovine recombinant alpha 1 interferon in vitro.

Hematogenous Pasteurella multocida brain abscess

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Pasteurella multocida infections. Report of 34 cases and review of the literature

Pasteurella multocida, a small, gram-negative coccobacillus , is part of the normal oral flora of many animals, including the dog and cat. P. multocida is the etiologic agent in a variety of infectious disease syndromes. We have reported 34 cases of infection caused by P. multocida and have reviewed the English literature. P. multocida infections may be divided into three broad groups: 1. Infections resulting from animal bites and scratches : The most common infections caused by P. multocida are local wound infections following animal bites or scratches . Cats are the source of infection in 60 to 80% of cases and dogs in the great majority of the remainder. Local infections are characterized by the rapid appearance of erythema, warmth, tenderness, and frequently purulent drainage. The most common local complications are abscess formation and tenosynovitis. Serious local complications include septic arthritis proximal to bites or scratches , osteomyelitis resulting from direct inoculation or extension of cellulitis, and the combination of septic arthritis and osteomyelitis, most commonly involving a finger or hand after a cat bite. 2. Isolation of P. multocida from the respiratory tract: The isolation of P. multocida from the respiratory tract must be interpreted differently than its isolation from other systemic sites. Most commonly P. multocida found in the respiratory tract is a commensal organism in patients with underlying pulmonary disease, but serious respiratory tract infections including pneumonia, empyema, and lung abscesses may develop. Most patients with respiratory tract colonization or infection have a history of animal exposure. 3. Other systemic infections: P. multocida is recognized as a pathogen in a variety of systemic infections including bacteremia, meningitis, brain abscess, spontaneous bacterial peritonitis, and intra-abdominal abscess. P. multocida often acts as an opportunistic pathogen with a predilection for causing bacteremia in patients with liver dysfunction, septic arthritis in damaged joints, meningitis in the very young or elderly, and pulmonary colonization or invasion in patients with underlying respiratory tract abnormalities.(ABSTRACT TRUNCATED AT 400 WORDS)

A field trial, of preshipment vaccination, with intranasal infectious bovine rhinotracheitis-parainfluenza-3 vaccines

A total of 849 calves, 278 controls, 335 vaccinated intranasally with IBR-PI3/TS and 236 vaccinated intranasally with IBR-PI3/PTC were studied in a field trial of preimmunization. All calves were vaccinated in Saskatchewan at least three weeks prior to shipment to feedlots. Four hundred and twenty six calves were not sold within eight weeks of vaccination; however, seven of these died within four weeks of vaccination. Treatment rates varied from 1.0% to 5.2%. There was no significant effect of vaccination on treatment rates. Similarly, there was no significant effect of vaccination in the 74 calves sold to feedlots in Saskatchewan. Three hundred and forty nine calves were sold to feedlots in Ontario. Two of these died from fibrinous pneumonia. Treatment rates varied from 1.7% to 33.3% in different feedlots, but there was no significant effect of vaccination on treatment rates. Therefore, preimmunization is unlikely to significantly reduce the overall treatment rate in calves entering feedlots.

Pasteurella multocida osteomyelitis caused by cat bite

A previously healthy 15-year-old girl was bitten by a cat in her left thumb. Despite initial treatment with penicillin she developed osteomyelitis after a period of four months. Pasteurella multocida was cultured from the necrotic bone. The infection showed low activity and was successfully treated with surgery combined with penicillin.

Pasteurella multocida--the major cause of hand infections following domestic animal bites

Pasteurella multocida is a common cause of infection following bites or scratches caused by dogs and (especially) cats. It is rarely reported, however, and apparently often overlooked as a pathogen. The typical clinical manifestation is a rapidly developing cellulitis at the site of injury. The infection is potentially dangerous and can cause a chronic local infection of deep tissues and osteomyelitis. It responds well to several antimicrobials, with penicillin being drug of choice. Fifty-five patients are reported--72% with cat bites and/or scratches and 28% with dog bites. Ninety-two percent of the wounds went deeply through the skin. All patients presented for treatment 12 to 72 hours after receiving the animal wounds to their hands. Drainage from all wounds was serosanguineous or purulent, and cultures taken were positive for P. multocida. All of the wounds responded to surgical drainage and penicillin. One patient developed osteomyelitis. The acute onset of cellulitis, lymphangitis, and serosanguineous or purulent drainage from hand wounds 12 to 24 hours after cat or dog bites should suggest P. multocida as the predominant etiologic agent. Immediate surgical drainage and penicillin therapy is the treatment of choice.

Pasteurella multocida subdural empyema: a case report

The first case of Pasteurella Multocida subdural empyema is reported. This was secondary to hematogenous spread from the pharynx to a chronic subdural hematoma. Positive cultures were obtained from the primary source, the blood and the subdural space. The patient was discharged with no neurological deficit following surgical drainage and parenteral antibiotics. The incidence, predisposing factors, clinical features, bacteriology, diagnostic procedures, treatment and mortality of subdural empyema are briefly discussed.

Pasteurella multocida empyema: case report and review of the literature

A case report and review of 13 cases of Pasteurella multocida empyema in the English literature demonstrate the apparent increased pathogenicity of this organism in patients with chronic lung disease. The infections were marked by their indolence, minimal febrility, blood-tinged pleural fluid, and predilection for the elderly. The was no characteristic roentgenographic pattern. Animal exposure commonly preceded the illnesses. It is postulated that the disease occurs in patients with impaired pulmonary defenses who acquire the organism via the inhalation of infectious droplets aerosolized from the oropharynx of animals where P multocida is part of the normal flora. Although most isolates were penicillin sensitive, there was significant mortality.

Pasteurella multocida infection in the hand

We have discussed 13 patients with Pasteurella multocida infection of the hand, six of whom developed chronic hand impairment as a result of the infection. It is thus apparent that chronic morbidity following Pasteurella infection of the hand is nearly 50 percent. Despite a fairly wide antibiotic susceptibility pattern of this organism, the infection may have long-term consequences such as osteomyelitis, or small joint stiffness due to paraarticular infection. We wish to emphasize the rapid evolution of the clinical picture following inoculation and the need for vigorous antibiotic therapy supplemented by rest, elevation immobilization, and occasional surgical decompression or drainage. At this time, the preferred antibiotic for initial care would appear to be on of the cephalosporins changed to penicillin for the culture-proven infection.

Human pulmonary pasteurellosis

Pasteurella multocida causes hemorrhagic septicemia in many domestic and wild animals. The most common human infection with P multocida is a local cellulitis following animal-inflicted wounds, preponderantly cat bites and scractches. The typical clinical manifestations and complications have been well described previously. We present three cases of pulmonary pasteurellosis that were recently evaluated by the infectious diseases service at Barnes Hospital. In three additional cases, the technologists in the microbiology laboratory isolated P multocida from respiratory tract secretions.