The Islamic University of Gaza Medical Technology Department Faculty Of Science Medical Technology Department Pasteurella By : duaa s.sabra No : 220045439 To: Dr. Abdelraouf Elmanama

+  65 year old woman Cat with infectious organisms Cat bite!!!

Symptoms bitten by cat on middle finger Pain and swelling on the right hand Pain on axilla (under the joint where the arm and shoulders connect) Red streaking of the forearm chills

Symptoms Temperature rose to 38 degrees Celsius and whole upper extremity had swelling, erythema, warmth and tenderness on dorsum of hand. On the puncture wound, erythema was noted over WBC count was high (12,000/microliter) with immature neutrophils in peripheral blood. – proves infection in the bone marrow Aspiration of abscess was sent to be cultured.

1. What organism was isolated? Pasteurella Genus: Pasteurella Species: Multocida Class: Gamma Pasteurellae Gram negative coccobacilli Pleomorphic arrangement Non-spore forming Bipolar staining Non-motile

History was first found in 1878 in fowl cholera-infected birds. However, Pasteurella it was not isolated until 1880, by - the man whom Louis Pasteur is named in honor of

P. Multocida picutre

Microbiology Zoonotic (related to animal sources) Short, encapsulated Aerobic, facultatively anaerobic Small, gray, shining colonies on blood agar Resistance associated with degree of encapsulation

Pasteurella Multocida Biochemistry: Columbian Blood Agar Gamma hemolysis Growth Chocolate agar Foul odor!!!

LABORATORY INDICATIONS: Oxidase + Non-motile Catalase + Non-hemolytic (some are beta-hemolytic) Indole + Ornithine decarboxylase +

Pasteurella Multocida Urea – Ferment = glucose, sucrose, mannitol, xylose and sorbitol Usually inactive to biochemical tests Trevisan 1887

Traditionally, diagnosis of Pasteurella was based on clinical findings, culture and/ or serological testing. Although culture identification methods are definitive, they are time consuming and costly. False-negative culture results are frequently observed due to the fact that P. multocida dies easily during transport to the laboratory or is overgrown by other bacteria (nasal flora and contaminants) in the culture. Serology can be used for cases when infection is suspected in organs for which cultures are not attainable, or when culturing has yielded no results. However, a seropositive titer to P. multocida merely indicates past exposure to the organism. Because many rabbits and other animals have been exposed to this organism, a diagnosis of pasteurellosis cannot be made based on serologic results alone. Molecular detection by PCR, however, offers a highly sensitive, accurate and timely method for detecting Pasteurella and confirming current infection

Pasteurella multocida Clinical symptoms: swelling erythema Warmth tenderness Red streaking Pus production

Pasteurella multocida 2. What is the reservoir of this organism? How do humans most commonly become infected by this organism?? House pets (especially cats) – humans can be infected through bites and scratches or infection through existing open wounds

Pasteurella multocida Cat bites are more infectious because of their sharp teeth which enables the organism to penetrate through the skin, joint and even bone These organisms inhabit the nasal, gingival, and tonsillar regions of many dogs and most cats, as well as those of many other animals.

Pasteurella multocida Diseases: Progressive Cellulitis: acute inflammation of the connective tissue of the skin Lymphangitis: inflammation of the lymphatic channels – causing red streaks Red streaks - occur when P. multocida enters the lymphatic system and infect the lymphatic vessels forming inflammation, which causes the red streaks on the surface of skin. Abscesses: collection of pus in a cavity Tenosynovitis: inflammation of the tendon and tendon sheath Osteomyelitis: acute or chronic inflammatory process of the bone Septic arthritis: direct invasion of joint space

Disease Patterns wound infections pneumonia “shipping fever”, septicemia, mastitis pneumonia, septicemia, mastitis respiratory disease pneumonia, atrophic rhinitis rales, oculonasal discharge, diarrhea “avian cholera” rhinosinusitis “snuffles”, genital infections

Laboratory Tests Bronchoscopy inflamed airways

Pasteurella multocida Treatment penicillin ampicillin amoxicillin-clavulanic acid ticarcillin Doxycycline fluoroquinolones

Pasteurella multocida 3. How can infection of this organism be prevented?? Never leave a young child alone with a pet. Do not try to separate fighting animals. Avoid sick animals and animals that you don't know. Leave animals alone while they're eating. Keep pets on a leash when in public. Select your family pet carefully, and be sure to keep your pet's vaccinations (shots) up-to-date.

Pasteurella multocida infection

Epidemiolgy Found worldwide Commensals in the upper respiratory tract of fowl and mammals Carrier rate 55% in dogs and 60-90% of cats Causes a variety of disease in animals Fowl cholera mastitis

Epidemiology (cont.) 0.6-1.8 cases of P. multocida infection per 100,000 per year Most commonly transmitted to humans through bites (cat, dog, other felines, horses, pigs, rats, rabbits, wolves) Isolated from 50% of dog and 75% of cat bites Infections not related to bites probably stem from contact with animal secretions

cellulitis

Septic arthritis Septic arthritis most commonly involves a single joint, usually the knee. Predilection for joints already damaged (RA, DJD, prostheses). Bite usually distal to involved joint without direct penetration. NOT preceded by a bite or scratch in 1/3 of cases (hematogenous spread) More than 50% of patients with septic arthritis are immunosuppressed.

Osteomyelitis Local extension of soft-tissue infection or direct innoculation Cat bites > dog bites

Respiratory infections Usually have underlying COPD (37%), bronchiectasis (21%), malignancy (15%), cirrhosis (8%) Pneumonia, pharyngitis, sinusitis, lung abscesses

Other infections Bacteremia Endocarditis: 15 case reports Most are immunocompromised (cirrhosis, malignancy/chemotherapy) Mortality approximately 30% Endocarditis: 15 case reports Meningitis: 50% of cases infants < 1 year, 30% adults > 60 years Peritonitis: usually associated with peritoneal dialysis (cat had punctured dialysis tubing in 65%) Endophthalmitis

Association with liver disease Cirrhosis of any etiology, hepatitis, infiltrating tumors Impairment of reticuloendothelial system makes patient prone to infection with encapsulated organisms

Pasteurellosis Pasteurella (snuffles) is a common cause of respiratory disease in rabbits. Most rabbits are exposed to it and harbor the organism that causes it. In can become a chronic problem that is difficult to control. This page contains graphic pictures of rabbits with severe infections- it might not be appropriate viewing for all ages. Cause The bacteria that causes this disease is called Pasteurella multocida. This bacteria has several strains that differ in their ability to cause problems. Most rabbits are exposed to this bacteria at some time in their lives. Some of them will show symptoms only when stressed. These carriers can spread the problem to other rabbits without any symptoms of their own. This can make control difficult. Pasteurella is spread by mating, through general contact (especially respiratory), or through wounds from fighting.

Treatment Most cases are treated with antibiotics Treatment Most cases are treated with antibiotics. They sometimes need to be given for weeks or months. The majority of cases brought for treatment are chronic in nature. In these situations the bacteria has had time to become well entrenched, and there is no guarantee that antibiotics will work. If they do work the problem can recur when the antibiotics are stopped. This emphasizes the need for routine exams in general (every 6-12 months), and a physical exam any time the above symptoms are noted. Other medications are used if your pet is showing central nervous system or ocular symptoms. Pets that are circling or are wry necked might respond to oral medication to make them more comfortable. Plugged tear ducts are flushed and conjunctivitis is treated with antibiotic drops

Abscesses are treated surgically Abscesses are treated surgically. Rabbits have a very thick and tenacious discharge when they form an abscess, and require more care than the abscesses of most other animals. Surgical removal can be difficult, especially in the chronic cases, because the abscessed area can become extensive in nature. Multiple surgeries might be needed, and wound care at home is necessary. This is a severe abscess on the back of a rabbit that has been anesthetized and is undergoing surgery to correct its problem. The wound has just been opened by the scalpel blade at the top left of the screen (arrow).

Prevention Most rabbits are exposed to this bacteria early in life. Determining which rabbits will develop symptoms of this problem is difficult. Minimizing stress (heat, overcrowding), proper diet (high in timothy and alfalfa hay, minimal pellets), a clean environment, fresh drinking water at all times, along with early neutering can help in minimizing the chance of this infection.

Lab Studies Gram stain of pus or other fluid specimens may show small, gram-negative, non–spore-forming pleomorphic coccobacilli that resemble Haemophilus species or N meningitidis. Wright, Giemsa, or Wayson stains enhance bipolar staining. Some strains exhibit a mucous capsule.

Species P. multocida P. aerogenes P. anatis P. avium P. bettyae P. caballi P. canis P. dagmatis P. gallicida P. gallinarum P. granulomatis P. langaaensis P. lymphangitidis P. mairii P. multocida P. pneumotropica P. skyensis P. stomatis P. testudinis P. trehalosi P. ureae P. volantium

Any questions??