1. Case Study Pathogenic Bacteriology 2009 Case #7, 34, 64 Evelyn Loi Hien Dang Jose Cervantes Jr.

2. Case Summary  8:00am 65-year-old woman bitten by her cat on dorsal aspect of the right middle finger.  4:00pm swelling and pain the finger and dorsum of the right hand. pain in the axilla, red streaking up the forearm, and chills. Body temperature: 38 o C  Lab Aspiration of abscess sent for culture  Operating room Incision and drainage of abscess

3. Key Information Pointing to Diagnosis  Age  Body temperature 38 o C  Arm Red streaking Pain in axilla  Hand Erythema Swelling Warmth Tenderness of finger  Elevated WBC 12,000 /microliter

4. Classification,Gram Stain Results, and Microscopic Appearance of Pathogen 1. Which organism was isolated on culture of the abscess?  Family: Pasteurellacaea  Genus: Pasteurella  Species: multocida Gram – Coccobacilli Bipolar staining Fermentative Non-motile Facultative anaerobe

5. Diagnosis/Isolation/Identification/ of Pathogen  Media No growth on Mac plate Growth on Chocolate and Blood Agar  Biochemical testing Oxidase + Indole + Catalase+ Nitrate + Urease -

6. Diseases and Pathogenesis of Disease Caused by P. multocida  Virulence Factor Endotoxin Capsule What is the reservoir of this organism? How do humans most commonly become infected by this organism?  Upper respiratory tract of pets and farm animals as NF  Bites or scratches inflicted by dogs and cats

7. Diseases caused by Pasteurella  Soft tissue inflammation Purulent wounds, cellulitis, abscesses  Deep soft-tissue inflammation Tenosynovitis Septic arthritis Osteomyelitis Which other clinical syndromes can be caused by this organism?  Systemic infection (rare) Endocarditis Meningitis  Eyes Conjunctivitis Corneal ulcer  Respiratory Pharangitis Pneumonia (patients with underlying pulmonary disease)

8. Therapy and Prognosis of Patient Infected with P. multocida  Cat bites are worse than dog bites because of their small, sharp and penetrative teeth.  Aggressive organism Symptoms appear within 24 hours Sensitive to antibiotics  Antibiotics Highly sensitive to Penicillin Chloramphenicol Tetracyclin Ciprofloxins

9. How can infection with this organism be prevented?  Young infants should avoid contact with the saliva of dogs and cats  Inform immunocompromised patients and children about Pasteurella infection and animal exposure  Don’t pet strange animals  Never bother an animal that is eating or sleeping  Be sure household pets are up to date on their vaccinations  Seek medical advice if there is redness, swelling, or pain if you suffer an animal bite.

10. Primary Research Article Contributing to the Understanding of the Disease caused by Pasteurella multocida  Freshwater, A. (2008). Why Your Housecat’s Trite Little Bite Could Cause You Quite a Fright: A Study of Domestic Felines on the Occurrence and Antibiotic Susceptibility of Pasteurella multocida. Zoonoses and Public Health. 55:507- 513.  Purpose Identify potential antibiotic resistance Examine carriage rate  Materials and Methods Specimen collection  409 veterinary clinics, humane shelters, private residence  Cats’s gingival margins Culture and ID of specimens  CBA, MacConkey Antibiotic susceptibility testing  Penicillin and Penicillin derivatives G-tests  Age, breed, food type, gingival scale, lifestyle and sex

11.  G test  No significant relationship between individual factors and the presence of P. multocida  Carriage rate is 90%  Susceptibility testing Penicillin (Penicillin derivatives) is still the suitable method to treat cat bite wounds  Canine bites far outnumber cat bites 20-80% of all cat bite wounds become infected 3-18% of dog bite wounds become infected Results & Discussion AntimicrobialsSusceptibility Benzylpenicillin100% Amoxicillin- clavulanate 100% Cefazolin98.37% Azithromycin94.02% Table 1 % Susceptibility in 409 isolates of Pasteurella multocida Biochemical testResult Catalase production+ Glucose acidification+ Nitrate reduction+ Indole production+ Mannitol fermentation+ MacConkey agar- Arginine dihydrolase production- B-Galactosidase production- Esculin production- Glucose fermentation- Protease production (gelatin hydrolysis)- Urease production- Table 2 Characterization of Pasteurella multocida

12. Take Home Message  Pasteurella multocida  Diseases usually involves domestic animals such as cats and dogs  Typical symptoms abscess and cellulitis at local wounds Fever Elevated white blood cells  Diagnostics Antimicrobial susceptibility testing  Pasteurella can be aggressive (symptoms within 24 hours) however it can be treated easily. Penicillin  Prevention Inform children and immunocompromised individuals about Pasteurella infection and animal exposure.  Transmission animal bite, scratches, licks, and inhalation

13. References  Freshwater, A. (2008). Why Your Housecat’s Trite Little Bite Could Cause You Quite a Fright: A Study of Domestic Felines on the Occurrence and Antibiotic Susceptibility of Pasteurella multocida. Zoonoses and Public Health. 55:507-513.  Bryant, Barbara J. et al. (2007). Pasteurella multocida bacteremia in asymptomatic plateletpheresis donors: a tale of two cats. Transfusion. 47: 1984-1989.  Green, Bryant T. et al. (2001). Pasteurella multocida Meningitis: Case Review of the last 11 Y. Scand J Infect Dis. 34:213-217  Loiez, Caroline et al. (2002). Pasteurella multocida and Intrauterine Device: A Woman and her Pets. Scand J Infect Dis. 34:473-474  Wade, T. et al. (1999). Pasteurella multocida meningitis in infancy- (a lick may be as bad as a bite). Eur J Pediatr 158: 875-878  Kimura, Ryosuke et al. (2004) Pasteurella multocida septicemia caused by close contact with a domestic cat: case report and literature review. J Infect Chemoter. 10: 250-252  McQueen, Nancy. Winter 2009. Pasteurellacaea.